Flare-up Of Ulcerative Colitis Research Articles

S1315 Prevalence and Pattern of Infection in Ulcerative Colitis Flare-Ups

S1315 Prevalence and Pattern of Infection in Ulcerative Colitis Flare-Ups

Mimicking Ulcerative Colitis Flare-Ups Induced by Azathioprine Causes AKI

Mimicking Ulcerative Colitis Flare-Ups Induced by Azathioprine Causes AKI

S3221 An Atypical Case of Yersinia enterocolitica Infection in a Patient Suspected With Ulcerative Colitis Flare-Up

S3221 An Atypical Case of Yersinia enterocolitica Infection in a Patient Suspected With Ulcerative Colitis Flare-Up

Vedolizumab as Rescue Therapy in Carboplatin-Gemcitabine-Induced Triggered Acute Severe Ulcerative Colitis Flare-Up

Approximately 20% of patients with ulcerative colitis (UC) develop acute severe UC (ASUC), for which intravenous systemic steroid therapy and possibly infliximab-based rescue therapy are generally imposed. However, there are no significant guideline recommendations on ASUC regarding vedolizumab as an alternative in this setting. A case report was presented where a patient with steroid-dependent UC developed ASUC induced by second-line chemotherapy. Treatment with intravenous methylprednisolone was imposed, but there was no reduction in bowel movements in the days following admission. Rescue therapy with infliximab was contraindicated because of the oncologic history. Surgical consultation, contraindicated colectomy, and administration of vedolizumab 300 mg were initiated. After infusion with vedolizumab, there was a significant reduction in bowel movements starting the day after infusion until normalisation of bowel movements within three days and the concomitant normalisation of inflammatory indices. The patient is currently in clinical remission, on therapy with vedolizumab 108 mg subcutaneously every two weeks, and is in oncologic follow-up for pulmonary neoplasm. This case highlights the novel potential of vedolizumab as a possible rescue therapy in ASUC, especially in special populations, where it may offer a better safety profile. Although cyclosporine and infliximab still represent the mainstays of salvage therapy for steroid-refractory ASUC, new therapeutic agents may also be effective, such as vedolizumab, ustekinumab, and anti-Janus kinase agents.

Modern Metaproteomics: A Unique Tool to Characterize the Active Microbiome in Health and Diseases, and Pave the Road towards New Biomarkers-Example of Crohn's Disease and Ulcerative Colitis Flare-Ups.

Thanks to the latest developments in mass spectrometry, software and standards, metaproteomics is emerging as the vital complement of metagenomics, to make headway in understanding the actual functioning of living and active microbial communities. Modern metaproteomics offers new possibilities in the area of clinical diagnosis. This is illustrated here, for the still highly challenging diagnosis of intestinal bowel diseases (IBDs). Using bottom-up proteomics, we analyzed the gut metaproteomes of the same twenty faecal specimens processed either fresh or after a two-month freezing period. We focused on metaproteomes of microbial cell envelopes since it is an outstanding way of capturing host and host–microbe interaction signals. The protein profiles of pairs of fresh and frozen-thawed samples were closely related, making feasible deferred analysis in a distant diagnosis centre. The taxonomic and functional landscape of microbes in diverse IBD phenotypes—active ulcerative colitis, or active Crohn’s disease either with ileo-colonic or exclusive colonic localization—differed from each other and from the controls. Based on their specific peptides, we could identify proteins that were either strictly overrepresented or underrepresented in all samples of one clinical group compared to all samples of another group, paving the road for promising additional diagnostic tool for IBDs.

Development of Aortic Regurgitation After LVAD Implantation with Descending Thoracic Aorta Anastomosis Technique

<h3>Introduction</h3> Aortic regurgitation (AR) is a complication of LVAD support. Prevalence raises 30%. Left thoracotomy (LT) access and descending thoracic aorta anastomosis technique (DTAAT) avoid conventional sternotomy complications, especially with patients with previous coronary artery bypass grafts (CABG), those with previous sternotomies or porcelain aorta. We describe two cases of severe AR after LVAD implantation with DTAAT. <h3>Case Report</h3> First case is a 70 y-o-male with advanced heart failure (HF) due to dilated ischaemic cardiomyopathy (ICM) with previous CABG. LVEF was 25%. In June 2019, he had a HM3 (HeartMate III, St. Jude Medical) implantation by LT. The initial plan was to anastomose the outflow graft to the ascending aorta but due to calcified plaques, DTAA was done. Postoperative course included hemothorax. On discharge, there was pulsatility and patient reached high dose of vasodilators. His LVAD parameters: 5100 rpm, 3.1 Lpm, PI 6-7. After 803 days on support, in August 2021, he was admitted due to an ulcerative colitis flare-up. Natriuretic peptides were high and a transoesophageal echocardiogram (TOE) revealed a significant aortic regurgitation which is pending of a TAVR procedure. Second case is a 73 y-o-male with advanced HF due to dilated ICM with previous CABG. LVEF was 15%. In December 2019, he had a HM3 implantation by LT. Due to CABG (internal mammary artery to the descending coronary artery) near the sternum, a DTAAT was performed. Postoperative course included left hemothorax and politrasfusion. Early after, the aortic valve was closed with 5200 rpm, 4.1Lpm, PI 4-5 and echocontrast was noticed in the aortic root. Later on a thrombus was evidenced above the non coronary cusp. After 354 days on support, in December 2020, he went into pulmonary oedema. A TOE revealed a torrential AR with was successfully treated with an urgent TAVR. <h3>Summary</h3> We report two cases of AR after DTAAT in which the aetiology could be related to a minor wash out of the aortic root. DTAAT is particularly applicable for patients with a history of previous cardiac surgery and usually done in destination therapy cases because the anastomosis to the descending aorta can be hard to reach during transplantation. DTAAT should be applicable to patients with increased ventricle dimensions and if aortic valve is closed, a surveillance of thrombus formation and AR development should be advised.

Sudden-Onset Polyposis in Pediatric Patients With Ulcerative Colitis.

To the Editors: Inflammatory polyps may develop in 10% to 20% patients with inflammatory bowel disease (IBD).1 However, such patients are mostly adults, and polyps rarely develop in children. Filiform polyps are extremely rare in children with ulcerative colitis (UC).2 Herein, we present a case of sudden-onset filiform polyposis during UC treatment in an 11-year-old girl. Low-grade dysplasia was histopathologically confirmed in another single polyp; therefore, this case underlines the importance of evaluating the heterogeneity of inflammatory polyps in pediatric patients with UC and follow-up of such patients. A 9-year-old girl presented with severe anemia and hematochezia. Her blood test findings were as follows: white blood cell count, 12 620/μL (eosinophils, 10.3%); hemoglobin, 6.4 g/dL. Her QuantiFERON-TB test result was negative; furthermore, she tested negative for cytomegalovirus, herpes simplex virus, fluorescent antinuclear antibody, Clostridium difficile, and antineutrophil cytoplasmic antibodies. Her immunoglobulin E level was 260.5 IU/mL (reference range, <158 IU/mL). Moreover, her fecal calprotectin concentration was over 6000 mg/kg. Colonoscopy showed a severe UC flare-up throughout the colon. She was initially treated with corticosteroids, azathioprine, and 5-aminosalicylic acid; however, there was no symptom improvement. After 4 months, infliximab (5 mg/kg) was administered; however, diarrhea and hematochezia persisted. Her fecal calprotectin concentration was 2000 to 5000 mg/kg. Infliximab trough level and anti-infliximab antibody were 0.1 μg/mL and 25.3 ng/mL, respectively. Therefore, infliximab was discontinued, and intermittent steroid treatment was continued with cyclosporine as the main drug. Although there was no acute exacerbation of UC, complete remission could not be achieved. Colonoscopy performed 15 months later yielded findings similar to those obtained in the previous one. After 18 months, polyps that had not been seen before suddenly appeared in the form of filiform polyposis in the transverse colon (Figure 1A). Biopsy findings revealed inflammatory polyposis (Figure 1B). A single polyp (sized approximately 3 cm) was observed in the sigmoid colon (Figure 1C); histopathological examination showed low-grade dysplasia (Figure 1D). The patient underwent diagnostic exome sequencing; APC gene mutation or other IBD- or immune deficiency–related mutations were not detected. Tumor marker levels and positron emission tomography computed tomography findings indicated no evidence of malignancy in other organs.

An Unexpected Guest in a Patient With Ulcerative Colitis

Question: A 16-year-old girl with a 2-year history of ulcerative colitis was referred to our university hospital because of fever, vomiting, and epigastric pain for 10 days; bloody diarrhea during the last month; and a rapid involuntary weight loss (5 kg). Sixth months earlier, during remission with oral mesalamine (60 mg/kg), she suffered a mild-to-moderate ulcerative colitis flare-up requiring oral prednisolone (1 mg/kg for 2 weeks and then tapered). At admission, physical examination showed pallor, mild signs of dehydration, and diffuse abdominal pain without signs of peritoneal irritation. Written consent for publication was obtained from the patient and her parents. Laboratory investigations revealed anemia, mild eosinophilia, hypoalbuminemia, an increased erythrocyte sedimentation rate, and fecal calprotectin. Specific serologic tests and blood and stool cultures for bacteria and viruses were negative. Colonoscopy showed pancolitis with continuous diffuse granular and friable mucosa (Mayo Score of 2) and upper endoscopy showed antral gastritis and diffuse duodenitis with nonbleeding erosions. The patient was started on steroids (1 mg/kg) followed by the amelioration of diarrhea, but persistence of mild grade fever and vomiting. Histologic examination showed crypt distortions and abscesses associated with goblet cell depletion. An upper endoscopy showed a normal esophageal and gastric mucosa. Duodenal histology (periodic acid–Schiff staining method) is presented in Figure A. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Aspergillus fumigatus was identified in duodenal biopsy specimens. Serum galactomannan antigen test (Bio-rad Platelia Aspergillus Ag kit) and specific IgM (DRG IgM ELISA) assays were positive (index 4.1 and 6.5 UI/mL, respectively); chest and brain computed tomography scans were normal.1Donnelly J.P. Chen S.C. Kauffman C.A. et al.Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium.Clin Infect Dis. 2020; 71: 1367-1376Crossref PubMed Scopus (898) Google Scholar Antifungal treatment with voriconazole (loading dose: 6 mg/kg/12 h on the first day, then 4 mg/kg/12 h) was started and steroids were tapered.2Patterson T.F. Thompson 3rd, G.R. Denning D.W. et al.Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America.Clin Infect Dis. 2016; 63: e1-e60Crossref PubMed Scopus (1405) Google Scholar A comprehensive immune assessment was performed after discontinuing steroid therapy. After 1 week of treatment, the clinical condition and inflammatory markers improved. Aspergillus fumigatus is a ubiquitous saprophytic fungus with low pathogenicity in healthy individuals, but may be the major cause of life-threatening infection in immunocompromised individuals. Enteric aspergillosis is an uncommon presentation of invasive aspergillosis, which can disseminate hematogenously to other organs. Clinical features of invasive aspergillosis include abdominal pain, fever, and hematochezia or peritonitis subsequent to bowel ischemia or perforation; typical endoscopic findings include ulcerations or islands of necrotic tissue. Glucocorticosteroids are critical in the management of inflammatory bowel disease (IBD), but are associated with increased risk of opportunistic infections due to immune suppression. It should also be emphasized that IBD itself predisposes to infective complications3Kucharzik T. Ellul P. Greuter T. et al.ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease.J Crohns Colitis. 2021; 15: 879-913Crossref PubMed Scopus (70) Google Scholar and that gastrointestinal infections can be potential triggers for IBD relapse.

Effects of tissue cytomegalovirus quantitative polymerase chain reaction in the management of ulcerative colitis flare-ups: Should we wave aside?

Background and Study AimsThe role of cytomegalovirus (CMV) infection for disease reactivation in ulcerative colitis (UC) patients remains controversial and diagnostic tests are yet to be standardized. We aimed to define the clinical relevance of CMV detection by mucosal polymerase chain reaction (PCR) in UC patients by comparing the clinical course of UC in CMV-treated and CMV-untreated groups in tissue CMV-PCR positive cases. Patients and MethodsIn this retrospective study, 141 patients diagnosed with moderate-to-severe UC admitted to our clinic with disease flare, colonic tissue CMV PCR was assessed. ResultsThe median age of the study population was 39 years, and 99 (70.2%) patients were male. Eighty-eight (62.4%) patients were CMV-PCR (+) and 53 (37.6%) were CMV PCR (-). The CMV-PCR (+) and CMV PCR (-) groups showed no significant difference concerning age, sex, disease duration, site of involvement and disease activity and administered treatments. The median tissue CMV-PCR was 41,098 IU/mL (IQR:2,344.25–136,192). Thirty-four of 88 CMV-PCR (+) patients received antiviral therapy. The tissue CMV-PCR level of patients who received antiviral therapy was 124,381 IU/mL (IQR: 19,309–412,335), and it was 6,292 IU/mL (IQR: 997–71,154) in patients who did not receive antiviral therapy; (p < 0.001). Sixteen (47.1%) of 34 patients who received antiviral therapy achieved remission. Two of the non-responders underwent colectomy (one because of dysplasia and one who did not respond subsequent biologic agent either). Remaing 16 achieved remission by escalating the immunsuppresive/biologic agent therapy. ConclusionCMV infection is responsible for only a minority of cases of UC flares and all are steroid-resistant cases. Most of the patients non-responsive to antiviral treatment respond to increased anti-inflammatory treatment. Hesitancy in the decision of escalating immunsuppresive treatment rather than CMV disease may be responsible for worsening disease course and increased colectomy rate in a significant number of the patients who are tissue CMV-PCR (+).

Factors Affecting Ulcerative Colitis Flare-Ups: Associations With Smoking Habits and Other Patient Characteristics.

Background and study aimsCurrently, there are no studies conducted in the Kingdom of Saudi Arabia (KSA) that have assessed the relationship between ulcerative colitis (UC) flare-ups and smoking. The present study aims to assess the risk of UC flare-ups and evaluate the relationship between UC flare-ups and smoking in adult patients following up at King Abdulaziz University Hospital in Jeddah, KSA.Patients and methodsThis was a retrospective study involving patients with confirmed UC between January 2015 and December 2020. Various information was examined, including demographic, clinical, endoscopic, radiologic, and laboratory data. Descriptive statistics were used for summarizing findings and a logistic regression analysis was applied to test for possible associations.ResultsEighty-nine patients with UC were included in the study. Almost half (48.3%) had recurrent UC flare-ups during follow-up. A non-significant relationship was found between recurrent UC flares and all types of smoking habits (cigarette smoking, P = 0.15; shisha smoking, P = 0.88; and vape smoking, P = 0.09). Participants who were underweight (P = 0.041), had family history of UC (P = 0.013), depression (P = 0.033), fecal incontinence (P = 0.003), iron deficiency anemia (P = 0.009), or a malignancy (P = 0.039) had a significantly higher probability of experiencing recurrent flares. Binary logistic regressions revealed that family history of UC (OR = 5.3, P = 0.007) and fecal incontinence (OR = 4.7, P = 0.006) were associated significantly with recurrent flares.ConclusionThere was no clear association between smoking and recurrent UC flares identified in this cohort. Of the variables considered, UC patients with fecal incontinence or family history of UC were at the highest risk of developing recurrent flares.

S2431 Ulcerative Colitis Flare-Ups Following mRNA COVID-19 Vaccination

Introduction: Ulcerative colitis (UC) is an autoimmune disease commonly managed with immunosuppressants. However, its put UC patients at a higher risk for infections. Therefore, vaccination is an important part of management. Messenger RNA (mRNA) vaccine is a new type of vaccine only widely used against COVID-19. The effect of mRNA vaccines on UC patients on immunomodulatory treatement is relatively unknown. Here, we present the first case of UC flare-up after receiving the SARS-CoV-2 mRNA vaccine. Case description/methods: A 36-year-old female with past medical history of ulcerative colitis, autoimmune pancreatitis presented with intermittent lower abdominal pain and diarrhea for 2 weeks with fever for 1 day. Her last flare-up was 3 years ago before she was put on Tofacitinib. She never required hospitalization. Her symptoms started the second day after she received the second dose of Pfizer COVID-19 vaccine. She had daily 5-10 times of non-bloody diarrhea and abdominal cramps. Her symptoms subsided after 7 days of initial onset. On day 11, she started to have daily up to 15 times bloody bowel movements, along with nausea, vomiting, unable to maintain oral intake. Day 17 after vaccination, patient went to ED after fever of 100.5F. On presentation, she is afebrile, WBC 11.9, CRP 61.8, calprotectin 1840, Clostridioides difficile negative, GI Panel negative. CT showed severe colitis involving the left colon from splenic flexure to rectum. Colonoscopy showed erythematous, granular, hemorrhagic, and ulcerated mucosa in the entire examined colon. Terminal ileum, cecum, ascending, transverse, descending, sigmoid and rectum biopsies were negative for CMV, showed chronic active colitis. Patient received intravenous Methylprednisolone, then transited to oral Prednisone taper and resumed her Tofacitinib. Her symptoms gradually improved. Discussion: To our best knowledge, no report has shown the association of mRNA vaccine and UC flare-up. In general, non-live vaccines are safe for UC patients regardless of immunosuppressants usage. Live vaccines are also contraindicated Tofacitinib users like our patient. In the Pfizer COVID-19 vaccine trial, patients on immunosuppressive therapy were excluded. Given the temporal relationship between the vaccine and her flare-up in the setting of long-term remission history, we are concerned that the stress induced by the mRNA vaccine may increase the risk of flare-up. More studies need to be done to evaluate the safety profile of mRNA vaccine for UC patients on immunosuppressants.Figure 1.: A: Nodular mucosa in second portion of duodenum. B: Multiple ulcers in terminal ileum. C and D: 1.7 cm segment of terminal ileum circumferential bowel wall thickening with mucosal hyperenhancement and submucosal edema.

Effect of cytomegalovirus infection on moderate and severe ulcerative colitis

AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.

Effect of cytomegalovirus infection on moderate and severe ulcerative colitis

AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.

Efficacy of tofacitinib as a «rescue therapy» in patients with severe ulcerative colitis

AIM: to evaluate the effectiveness of tofacitinib as a second line treatment.PATIENTS AND METHODS: the study included 12 patients, 4 (33.34%) males and 8 (66.66%) females. The median age was 41 ± 5 years. All patients admitted to the hospital with a severe flare-up of ulcerative colitis, which was the inclusion criterion in this study. Clinical manifestations, laboratory parameters, and colonoscopy were done at the time of administration of tofacitinib, on days 3 and 7, and after 12 weeks.RESULTS: a fast clinical response on 3 day of treatment, reduction in stool frequency, decrease blood in stool was noted in 10 (83.3%) patients. After 7 days from the start of TFCS therapy, all patients showed a decrease from severe activity to mild activity, as well as a decrease in inflammatory blood markers and hemoglobin levels. During the follow-up for 12 weeks, 100% of patients showed positive clinical and laboratory changes. In 10 (83.4%) patients, remission or maintenance of negligible minimal activity was noted.CONCLUSION: the results obtained show that the use of TFTB in hormone-resistant patients can be effective as a second line of “rescue therapy”.

Efficacy of tofacitinib as a «rescue therapy» in patients with severe ulcerative colitis

AIM: to evaluate the effectiveness of tofacitinib as a second line treatment.PATIENTS AND METHODS: the study included 12 patients, 4 (33.34%) males and 8 (66.66%) females. The median age was 41 ± 5 years. All patients admitted to the hospital with a severe flare-up of ulcerative colitis, which was the inclusion criterion in this study. Clinical manifestations, laboratory parameters, and colonoscopy were done at the time of administration of tofacitinib, on days 3 and 7, and after 12 weeks.RESULTS: a fast clinical response on 3 day of treatment, reduction in stool frequency, decrease blood in stool was noted in 10 (83.3%) patients. After 7 days from the start of TFCS therapy, all patients showed a decrease from severe activity to mild activity, as well as a decrease in inflammatory blood markers and hemoglobin levels. During the follow-up for 12 weeks, 100% of patients showed positive clinical and laboratory changes. In 10 (83.4%) patients, remission or maintenance of negligible minimal activity was noted.CONCLUSION: the results obtained show that the use of TFTB in hormone-resistant patients can be effective as a second line of “rescue therapy”.

Therapeutic Potential of Escherichia coli Nissle 1917 in Clinically Remission-attained Ulcerative Colitis Patients: A Hospital-based Cohort Study.

Escherichia coli Nissle 1917 (EcN) alone therapy is as effective as mesalamine in inducing and maintaining remission in ulcerative colitis (UC). The efficacy and safety of EcN in combination with standard therapies have not been studied. This study examined the changes in the inflammation markers and symptoms following the additional administration of EcN to patients showing the clinical remission of UC. UC patients who received EcN after being in clinical remission for more than 3 months at Kosin University Gospel Hospital between 2013 and 2018 were evaluated through the retrospective medical-record-based review. The partial Mayo score, fecal calprotectin (FC), BMI, hemoglobin, serum cholesterol, serum albumin levels, and the safety profiles were examined at 3rd and 6th months after initiating EcN. Ninety-four patients were included. After 3 months of treatment, there was no significant change in FC (156.3 μg/g to 141.1 μg/g) (p=0.653). On the other hand, partial Mayo score decreased significantly from 0.085 to 0.014 (p=0.025), and the bodyweight (p=0.001), BMI (p<0.001), hemoglobin (p=0.009), and cholesterol level increased (p=0.148). One patient (1.1%) experienced a serious adverse event with UC flare-up, and 14 patients (14.9%) discontinued EcN due to adverse events; all developed within 3 months. Additional administration of EcN to clinically remission-attained UC patients may improve the UC symptoms without changing the FC levels. EcN-associated adverse events develop within the early few weeks.

S2293 Do You Have Chest Pain? Worth to Ask in Ulcerative Colitis Flare-Up

S2293 Do You Have Chest Pain? Worth to Ask in Ulcerative Colitis Flare-Up

Remission of ulcerative colitis flare-up induced by nivolumab

BackgroundImmune checkpoint inhibitors (ICIs) have been used to treat many cancers, but ICIs are rarely administered for malignant tumours coexisting with inflammatory bowel disease.Methods and resultsWe report a 77-year-old man experiencing an ulcerative colitis (UC) flare-up after receiving nivolumab as third-line therapy for multiple metastases of renal cell carcinoma. Mild UC (proctitis form) had been diagnosed at age 59 years and remission was maintained for 17 years with only a low dose of 5-ASA. After nivolumab treatment, the patient developed diarrhoea, bloody stools and was hospitalised. Computed tomography revealed inflammation involving the entire colon and endoscopy revealed severe UC exacerbation. Histological analysis showed UC findings and also increased crypt apoptosis which is unusual for inflammatory bowel diseases, while being typical of ICI-induced colitis. As with ICI-induced colitis, this exacerbation was strongly suggested to have been caused by nivolumab, although remission was achieved by increasing the 5-ASA dose to 4000 mg without prednisolone.ConclusionThe administration of ICI for UC is not as yet sufficiently safe and further research is required.

Management of acute severe ulcerative colitis in Spain: A nationwide clinical practice survey

Abstract Introduction Ulcerative colitis (UC) is a chronic disease of the digestive tract and up to 20–30% of UC patients may suffer a severe flare-up during the course of the disease. Although there are national and international recommendations about its clinical management, there is not enough information about the treatment of acute severe UC in clinical practice. Methods An electronic and anonymous survey with 51 multiple-choice questions was performed among all the members of the Spanish Crohn's Disease and Ulcerative Colitis Working Group (GETECCU). Results Out of the 164 responders (20%), most were gastroenterologists (95%), with 59% from tertiary hospitals treating a median of 5 patients per year (IQR: 3–8) with a severe flare-up of ulcerative colitis. An endoscopic examination was routinely performed in 86% of patients (62% at admission). The most commonly used corticosteroid was methylprednisolone, usually at a dose of 60 mg/day, and its response was assessed after a median of 3 days (IQR: 3–5). Both in thiopurine-naive and thiopurine-refractory patients, infliximab was the drug most frequently prescribed as rescue therapy. Half of responders (55%) had ever prescribed a first dose of infliximab higher than 5 mg/kg, and a higher proportion (73%) had ever prescribed an earlier dose of infliximab in the second or third infusion. Conclusions Acute severe UC is generally managed according to current treatment guidelines in our setting. The rescue therapy most commonly prescribed is infliximab, and the use of intensified or accelerated regimens with this biological drug is not unusual.

P295 Impact of superimposed cytomegalovirus infection on the outcomes of ulcerative colitis flare-up

P295 Impact of superimposed cytomegalovirus infection on the outcomes of ulcerative colitis flare-up