Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.1285
P. Alavi Nejad, M. Mokhtare, F. Farsi, M. Arshadzadeh, S. Shetty, O. Eslami, M. Arefi, M. H. Emara, E. Abdelsameea, J. Rezaei, S. M. A. Alavi, Q. T. Tran, R. Salma, A. Parsi, M. H. Ahmed, A. Monged, A. Quadri, A. Jawad, A. U. Rehman, S. H. Lee, N. S. Behl, E. Ghoneem
The aim of current study is to evaluate impact of COVID19 pandemic and vaccination against it on the course and symptoms of IBD. During a six months’ period, all of the IBD cases who attend in outpatient clinics of nine referral centers in 6 countries include and request to fill a questionnaire about their demographic characters and pattern of IBD, any history of involvement with COVID19 and their vaccination history. overall 812 cases from 16 countries included (52.4% male) with average age of 36.8 y (range 7 – 76). 68.5% of participants diagnosed as UC and 29.5% as CD. 80% of participants have vaccinated against COVID19 (average 2.3 times, range 1 – 5). Among those who vaccinated (group A) 31.6% experienced side effects and complication without any mortality. The most common complications of vaccination include fever (24%), fatigue (20.1%) and anorexia 8.6%. The most common reasons for vaccination refusal (group B) were fear of vaccine complication (55.5%), no believe in vaccine protection (29.6%) and fear of immunocompromised condition (17.9%). In group A overall 61% of participants involved with COVID 19 (36.2% after vaccination) in comparison with 48.1% in group B (P = 0.0052). Most of the involvements in both groups were not sever and just a minority of patients admitted to hospital (10% in group A and 6.4% in group B). Following COVID involvement, 45.1% of cases suffered with GI symptoms (mostly diarrhea (72.5%) and abdominal pain (64.5%)). In group A, 37.3% of involvements have happened before vaccination. Vaccination against COVID19 is safe and effective among IBD patients and following vaccination, most of complications are minor and negligible. In case of COVID involvement, it would not be serious and there is no need to hold the medications. Among IBD patients, the most common reason for vaccination refusal is fear of vaccine side effect.
{"title":"P1155 Impact of COVID19 pandemic and vaccination among IBD patients: a multinational cross sectional survey","authors":"P. Alavi Nejad, M. Mokhtare, F. Farsi, M. Arshadzadeh, S. Shetty, O. Eslami, M. Arefi, M. H. Emara, E. Abdelsameea, J. Rezaei, S. M. A. Alavi, Q. T. Tran, R. Salma, A. Parsi, M. H. Ahmed, A. Monged, A. Quadri, A. Jawad, A. U. Rehman, S. H. Lee, N. S. Behl, E. Ghoneem","doi":"10.1093/ecco-jcc/jjad212.1285","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1285","url":null,"abstract":"\u0000 \u0000 \u0000 The aim of current study is to evaluate impact of COVID19 pandemic and vaccination against it on the course and symptoms of IBD.\u0000 \u0000 \u0000 \u0000 During a six months’ period, all of the IBD cases who attend in outpatient clinics of nine referral centers in 6 countries include and request to fill a questionnaire about their demographic characters and pattern of IBD, any history of involvement with COVID19 and their vaccination history.\u0000 \u0000 \u0000 \u0000 overall 812 cases from 16 countries included (52.4% male) with average age of 36.8 y (range 7 – 76). 68.5% of participants diagnosed as UC and 29.5% as CD. 80% of participants have vaccinated against COVID19 (average 2.3 times, range 1 – 5). Among those who vaccinated (group A) 31.6% experienced side effects and complication without any mortality. The most common complications of vaccination include fever (24%), fatigue (20.1%) and anorexia 8.6%. The most common reasons for vaccination refusal (group B) were fear of vaccine complication (55.5%), no believe in vaccine protection (29.6%) and fear of immunocompromised condition (17.9%). In group A overall 61% of participants involved with COVID 19 (36.2% after vaccination) in comparison with 48.1% in group B (P = 0.0052). Most of the involvements in both groups were not sever and just a minority of patients admitted to hospital (10% in group A and 6.4% in group B). Following COVID involvement, 45.1% of cases suffered with GI symptoms (mostly diarrhea (72.5%) and abdominal pain (64.5%)). In group A, 37.3% of involvements have happened before vaccination.\u0000 \u0000 \u0000 \u0000 Vaccination against COVID19 is safe and effective among IBD patients and following vaccination, most of complications are minor and negligible. In case of COVID involvement, it would not be serious and there is no need to hold the medications. Among IBD patients, the most common reason for vaccination refusal is fear of vaccine side effect.\u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"17 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.1379
E. De Dycker, S. Vermeire, M. Ferrante, T. Lambrechts, A. Paps, P. Geens, E. Loddewijkx, J. Sabino, T. Hillary, B. Verstockt
Three Janus kinase (JAK) inhibitors, tofacitinib (TFC), filgotinib (FIL) and upadacitinib (UPA), have been approved for treatment of Crohn’s disease (CD) and/or ulcerative colitis (UC). During the IBD registrational trials, acne was reported as adverse event (AE) in 5-7% of UPA treated patients, but not in the FIL and TFC programs. Hence, we assessed the prevalence of JAK inhibitor associated acne in a real-life cohort. All patients initiating JAK inhibitors for active moderate-to-severe CD or UC at our center were included. Patients were prospectively monitored at prespecified timepoints, and specifically assessed for AEs including acne. Affected patients completed a visual analogue scale (VAS) to assess the impact of acne on their quality of life. All pictures of skin lesions were assessed by a dermatologist specialized in inflammatory skin diseases. In total, 46 patients initiated TFC, 40 FIL and 79 UPA. None of the TFC or FIL treated patients reported new onset of acne. Instead, 17 (21.5%) patients (9 CD, 8 UC; median [IQR] age 28.2 [25.2-45.0]; 47.1% female) spontaneously reported acne during UPA therapy. Most (89.5%) reported new onset of acne, while 2 (10.5%) mentioned a deterioration of existing acne during UPA induction. Previous acne during adolescence was reported by 46.2%. Lesions were present in the face (82.3%), back (23.5%), chest (23.5%) and scalp (11.8%). The acne phenotype included inflammatory papules in all patients, but also pustules (66.7%), nodules (33.3%), cysts (11.1%) and comedones (11.1%) were observed. A median VAS score of 5.5 [5.0-7.0] highlighted the impact on the patient’s quality of life, though no patient interrupted UPA due to acne. Six (35.2%) patients were referred to a dermatologist for acne. Most patients (82.4%) received topical skin therapy during UPA induction based on a standard operation procedure approved by the dermatologist and communicated via the IBD nurses. Three patients (17.6%) received antibiotics during UPA induction because of acne. During UPA maintenance, 5 patients (29.4%) reported resolution of skin problems with only 1 requiring continued skin therapy. Ten patients (58.7%) continued topical skin therapy during maintenance, with 4 of them requiring continued antibiotic treatment for at least 3 months. A single patient was deescalated from UPA 30mg to 15mg QD because of severe acne, with little improvement. In this real-world experience, JAK inhibitor associated acne was uniquely linked to UPA, occurring in one fifth of patients. This is more prevalent than observed in the registrational trials. Awareness and patient education are therefore important, as well as early referral to the dermatologist for appropriate treatment.
{"title":"N07 JAKne: JAK inhibitor associated acne, a real-life single-center experience","authors":"E. De Dycker, S. Vermeire, M. Ferrante, T. Lambrechts, A. Paps, P. Geens, E. Loddewijkx, J. Sabino, T. Hillary, B. Verstockt","doi":"10.1093/ecco-jcc/jjad212.1379","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1379","url":null,"abstract":"\u0000 \u0000 \u0000 Three Janus kinase (JAK) inhibitors, tofacitinib (TFC), filgotinib (FIL) and upadacitinib (UPA), have been approved for treatment of Crohn’s disease (CD) and/or ulcerative colitis (UC). During the IBD registrational trials, acne was reported as adverse event (AE) in 5-7% of UPA treated patients, but not in the FIL and TFC programs. Hence, we assessed the prevalence of JAK inhibitor associated acne in a real-life cohort.\u0000 \u0000 \u0000 \u0000 All patients initiating JAK inhibitors for active moderate-to-severe CD or UC at our center were included. Patients were prospectively monitored at prespecified timepoints, and specifically assessed for AEs including acne. Affected patients completed a visual analogue scale (VAS) to assess the impact of acne on their quality of life. All pictures of skin lesions were assessed by a dermatologist specialized in inflammatory skin diseases.\u0000 \u0000 \u0000 \u0000 In total, 46 patients initiated TFC, 40 FIL and 79 UPA. None of the TFC or FIL treated patients reported new onset of acne. Instead, 17 (21.5%) patients (9 CD, 8 UC; median [IQR] age 28.2 [25.2-45.0]; 47.1% female) spontaneously reported acne during UPA therapy. Most (89.5%) reported new onset of acne, while 2 (10.5%) mentioned a deterioration of existing acne during UPA induction. Previous acne during adolescence was reported by 46.2%. Lesions were present in the face (82.3%), back (23.5%), chest (23.5%) and scalp (11.8%). The acne phenotype included inflammatory papules in all patients, but also pustules (66.7%), nodules (33.3%), cysts (11.1%) and comedones (11.1%) were observed. A median VAS score of 5.5 [5.0-7.0] highlighted the impact on the patient’s quality of life, though no patient interrupted UPA due to acne. Six (35.2%) patients were referred to a dermatologist for acne. Most patients (82.4%) received topical skin therapy during UPA induction based on a standard operation procedure approved by the dermatologist and communicated via the IBD nurses. Three patients (17.6%) received antibiotics during UPA induction because of acne. During UPA maintenance, 5 patients (29.4%) reported resolution of skin problems with only 1 requiring continued skin therapy. Ten patients (58.7%) continued topical skin therapy during maintenance, with 4 of them requiring continued antibiotic treatment for at least 3 months. A single patient was deescalated from UPA 30mg to 15mg QD because of severe acne, with little improvement.\u0000 \u0000 \u0000 \u0000 In this real-world experience, JAK inhibitor associated acne was uniquely linked to UPA, occurring in one fifth of patients. This is more prevalent than observed in the registrational trials. Awareness and patient education are therefore important, as well as early referral to the dermatologist for appropriate treatment.\u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"15 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0596
G. Mulinacci, L. Pirola, D. Gandola, D. Ippolito, C. Viganò, A. Laffusa, C. Gallo, P. Invernizzi, S. Danese, S. Massironi
Sarcopenia is prevalent among patients with Inflammatory Bowel Disease (IBD) and impacts IBD patient’s surgical and therapeutic outcomes, thus necessitating effective diagnostic tools to assess muscle mass and function in this population. A total of 153 consecutive patients were enrolled, 100 in the "training cohort" and 53 in the "study cohort". Three superficial muscles (Rectus Femoris (RF), Rectus Abdominis (RA) and Biceps Brachii (BB)) were chosen for sarcopenia detection with muscle ultrasound (US). The "training cohort" served for feasibility and interobserver variability assessment of US measurement. In the "study cohort", muscle ultrasound (US), bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI) were employed to measure muscle parameters. BIA served as the reference standard for comparison. Accuracy of a self-reported questionnaire for sarcopenia screening was assessed. The prevalence of sarcopenia in IBD patients was 50%. Muscle US demonstrated good diagnostic accuracy in detecting sarcopenia compared to BIA, with Area Under the Receiver Operating Characteristic Curve (AUROC) values of 80% and 85% for RA and BB thickness, respectively. Moreover, an Ultrasound Muscle Index (USMI) was defined by the sum of RA, BB, and RF thickness measurements divided by the square of the patient's height, resulting in an AUROC of 81%. Several muscle cutoffs for sarcopenia were recognized, with those of RA and USMI being correlated with the highest positive (84.3%) and negative (99%) predictive values, respectively. Excellent inter-rater and intra-rater reliability (ICC > 0.95) were observed for US measurements. Additionally, the agreement between the US and magnetic resonance measurements of rectus abdominis was excellent (ICC 0.96). The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. The study provides cutoff values for US measurements, aiding clinicians in accurate diagnosis. Self-reported questionnaires showed limitations in identifying sarcopenia, underlining the importance of objective measures like US or BIA. Muscle loss in IBD patients appears to be associated with disease activity rather than systemic inflammatory markers. This research has significant implications for disease management in IBD patients and underscores the need for further investigations with larger cohorts and long-term follow-ups to validate these findings.
{"title":"P466 Ultrasound muscle assessment for sarcopenia screening in patients with Inflammatory Bowel Disease: A prospective study (SarcUS-IBD)","authors":"G. Mulinacci, L. Pirola, D. Gandola, D. Ippolito, C. Viganò, A. Laffusa, C. Gallo, P. Invernizzi, S. Danese, S. Massironi","doi":"10.1093/ecco-jcc/jjad212.0596","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0596","url":null,"abstract":"\u0000 \u0000 \u0000 Sarcopenia is prevalent among patients with Inflammatory Bowel Disease (IBD) and impacts IBD patient’s surgical and therapeutic outcomes, thus necessitating effective diagnostic tools to assess muscle mass and function in this population.\u0000 \u0000 \u0000 \u0000 A total of 153 consecutive patients were enrolled, 100 in the \"training cohort\" and 53 in the \"study cohort\". Three superficial muscles (Rectus Femoris (RF), Rectus Abdominis (RA) and Biceps Brachii (BB)) were chosen for sarcopenia detection with muscle ultrasound (US). The \"training cohort\" served for feasibility and interobserver variability assessment of US measurement. In the \"study cohort\", muscle ultrasound (US), bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI) were employed to measure muscle parameters. BIA served as the reference standard for comparison. Accuracy of a self-reported questionnaire for sarcopenia screening was assessed.\u0000 \u0000 \u0000 \u0000 The prevalence of sarcopenia in IBD patients was 50%. Muscle US demonstrated good diagnostic accuracy in detecting sarcopenia compared to BIA, with Area Under the Receiver Operating Characteristic Curve (AUROC) values of 80% and 85% for RA and BB thickness, respectively. Moreover, an Ultrasound Muscle Index (USMI) was defined by the sum of RA, BB, and RF thickness measurements divided by the square of the patient's height, resulting in an AUROC of 81%. Several muscle cutoffs for sarcopenia were recognized, with those of RA and USMI being correlated with the highest positive (84.3%) and negative (99%) predictive values, respectively. Excellent inter-rater and intra-rater reliability (ICC > 0.95) were observed for US measurements. Additionally, the agreement between the US and magnetic resonance measurements of rectus abdominis was excellent (ICC 0.96).\u0000 \u0000 \u0000 \u0000 The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. The study provides cutoff values for US measurements, aiding clinicians in accurate diagnosis. Self-reported questionnaires showed limitations in identifying sarcopenia, underlining the importance of objective measures like US or BIA. Muscle loss in IBD patients appears to be associated with disease activity rather than systemic inflammatory markers. This research has significant implications for disease management in IBD patients and underscores the need for further investigations with larger cohorts and long-term follow-ups to validate these findings.\u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"11 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0715
J. H. Bae, J. B. Park, J. Baek, S. W. Hong, S. Park, D. H. Yang, B. Ye, J. Byeon, S. Myung, S. K. Yang, S. Hwang
Studies on elective switching to the subcutaneous (SC) formulation of infliximab revealed comparable efficacy and safety and higher infliximab level than those exhibited by intravenous (IV) infliximab. However, no studies have reported on the effectiveness of SC switching in ulcerative colitis (UC) patients who experienced IV infliximab failure during maintenance treatment. This retrospective study included UC patients who had been switched to SC infliximab because of IV infliximab failure, between January 2021 and January 2023. Group A was defined as having clinically and biochemically active UC (secondary loss of response), and group B consisted of patients with stable symptoms but biochemically active UC. Twenty-three patients met the inclusion criteria: 15 in group A and 8 in group B. The serum infliximab levels significantly increased after SC switching in both groups. Electively switched group also exhibited increased infliximab levels after SC switching. Group A showed improved partial Mayo score with a significant decrease in faecal calprotectin (FC) and C-reactive protein after switching. In group B, the FC level significantly decreased without clinical relapse after switching. A high proportion of patients (≥ 80%) in both groups achieved clinical and/or biochemical response at last follow-up. During the follow-up period, only two patients in group A discontinued SC infliximab, and only one complained of severe injection site reaction. In UC patients who experience IV infliximab failure during maintenance treatment, switching to SC infliximab may be a promising option because of its efficacy and safety.
关于选择改用英夫利西单抗皮下注射制剂的研究显示，与静脉注射英夫利西单抗相比，皮下注射英夫利西单抗的疗效和安全性相当，英夫利西单抗水平也更高。然而，对于在维持治疗期间静脉注射英夫利西单抗失败的溃疡性结肠炎（UC）患者，还没有关于皮下注射英夫利西单抗的有效性的研究报告。 这项回顾性研究纳入了 2021 年 1 月至 2023 年 1 月期间因静脉注射英夫利西单抗失败而改用静脉注射英夫利西单抗的 UC 患者。A组定义为临床和生化活动性UC（继发性应答丧失），B组包括症状稳定但生化活动性UC患者。 23 名患者符合纳入标准：两组患者的血清英夫利西单抗水平在SC转换后均显著升高。选择性换药组在换药后也显示出英夫利西单抗水平的升高。A 组的部分梅奥评分有所改善，换药后粪便钙粘蛋白（FC）和 C 反应蛋白明显下降。在 B 组中，换药后 FC 水平明显下降，但无临床复发。在最后一次随访中，两组中均有很高比例的患者（≥ 80%）获得了临床和/或生化应答。在随访期间，A 组仅有两名患者停用了 SC 英夫利西单抗，仅有一名患者抱怨出现了严重的注射部位反应。 对于在维持治疗过程中静脉注射英夫利西单抗失败的 UC 患者，改用 SC 英夫利西单抗可能是一个很有前途的选择，因为它既有效又安全。
{"title":"P585 Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure","authors":"J. H. Bae, J. B. Park, J. Baek, S. W. Hong, S. Park, D. H. Yang, B. Ye, J. Byeon, S. Myung, S. K. Yang, S. Hwang","doi":"10.1093/ecco-jcc/jjad212.0715","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0715","url":null,"abstract":"\u0000 \u0000 \u0000 Studies on elective switching to the subcutaneous (SC) formulation of infliximab revealed comparable efficacy and safety and higher infliximab level than those exhibited by intravenous (IV) infliximab. However, no studies have reported on the effectiveness of SC switching in ulcerative colitis (UC) patients who experienced IV infliximab failure during maintenance treatment.\u0000 \u0000 \u0000 \u0000 This retrospective study included UC patients who had been switched to SC infliximab because of IV infliximab failure, between January 2021 and January 2023. Group A was defined as having clinically and biochemically active UC (secondary loss of response), and group B consisted of patients with stable symptoms but biochemically active UC.\u0000 \u0000 \u0000 \u0000 Twenty-three patients met the inclusion criteria: 15 in group A and 8 in group B. The serum infliximab levels significantly increased after SC switching in both groups. Electively switched group also exhibited increased infliximab levels after SC switching. Group A showed improved partial Mayo score with a significant decrease in faecal calprotectin (FC) and C-reactive protein after switching. In group B, the FC level significantly decreased without clinical relapse after switching. A high proportion of patients (≥ 80%) in both groups achieved clinical and/or biochemical response at last follow-up. During the follow-up period, only two patients in group A discontinued SC infliximab, and only one complained of severe injection site reaction.\u0000 \u0000 \u0000 \u0000 In UC patients who experience IV infliximab failure during maintenance treatment, switching to SC infliximab may be a promising option because of its efficacy and safety.\u0000 \u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"7 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.1427
M. Ghiboub, W. D. de Jonge, J. P. M. Derikx, Ernst van Heurn, Rene van den Wijngaard
More than 70% of CD patients experience visceral hypersensitivity (VH) despite reaching remission. VH treatment is difficult because the mechanism of its complication is unknown. Serotonin is mainly produced in the gut and regulates several physiological processes, such as intestinal immunity and pain. Disturbances in serotonin levels are associated with CD severity and VH. Intriguingly, we have recently observed that serotonin can covalently bind to glutamine at position 5 on histone H3 tail, leading to histone serotonylation (H3Q5ser) in peripheral blood mononuclear cells (PBMCs). Another study has demonstrated that H3Q5ser can also occur in cultured neuronal cells. Our objective is to investigate the role of this newly discovered epigenetic signature (H3Q5ser) in immune cells and enteric neurons in CD and its potential impact on the transcriptional programs of the inflammatory response and VH. To accomplish this goal, we will first determine the concentrations of serotonin in the mucosa and serum of active CD patients compared to healthy controls and establish how these levels relate to the enhancement of H3Q5ser in immune cells and enteric neurons. To study the functional role of H3Q5ser in cell activation, we will use site-directed or oligonucleotide- mediated mutagenesis to induce a point mutation in cultured enteric neuron cell lines and PBMCs to remove the binding site for serotonin on histone. Both wild-type and mutant cells will be incubated with or without serotonin and subjected to chromatin immunoprecipitation sequencing and RNA sequencing profiling to investigate the effect of H3Q5ser on the transcriptional programs associated with inflammation and VH. This project will provide a comprehensive understanding of the impact of the changes in serotonin concentrations on H3Q5ser-related gene expression in CD- associated VH and the inflammatory response. Our anticipated impact is subsequent studies that monitor H3Q5ser in VH in CD patients during treatment.
70% 以上的 CD 患者尽管病情得到缓解，但仍会出现内脏过敏（VH）。内脏过敏症的治疗十分困难，因为其并发机制尚不清楚。血清素主要产生于肠道，调节多种生理过程，如肠道免疫和疼痛。血清素水平的紊乱与 CD 的严重程度和 VH 有关。有趣的是，我们最近观察到血清素能与组蛋白 H3 尾部第 5 位的谷氨酰胺共价结合，导致外周血单核细胞（PBMCs）中的组蛋白血清素化（H3Q5ser）。另一项研究表明，H3Q5ser 也可发生在培养的神经元细胞中。我们的目的是研究这种新发现的表观遗传学特征（H3Q5ser）在 CD 免疫细胞和肠道神经元中的作用及其对炎症反应和 VH 转录程序的潜在影响。 为实现这一目标，我们将首先测定活动性 CD 患者粘膜和血清中的血清素浓度，并与健康对照组进行比较，确定这些浓度与免疫细胞和肠道神经元中 H3Q5ser 增强的关系。为了研究 H3Q5ser 在细胞活化中的功能作用，我们将使用定点诱变或寡核苷酸介导的诱变技术，在培养的肠道神经元细胞系和 PBMC 中诱导点突变，以去除组蛋白上的血清素结合位点。野生型和突变型细胞将与或不与血清素一起培养，并进行染色质免疫沉淀测序和 RNA 测序分析，以研究 H3Q5ser 对与炎症和 VH 相关的转录程序的影响。 该项目将使我们全面了解血清素浓度变化对 CD 相关 VH 和炎症反应中 H3Q5ser 相关基因表达的影响。我们预期的影响是在治疗过程中对 CD 患者 VH 中的 H3Q5ser 进行监测的后续研究。
{"title":"ECCO Grant Serotonin gets into your genes: the role of histone serotonylation in inflammatory response and visceral hypersensitivity in Crohn’s Disease","authors":"M. Ghiboub, W. D. de Jonge, J. P. M. Derikx, Ernst van Heurn, Rene van den Wijngaard","doi":"10.1093/ecco-jcc/jjad212.1427","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1427","url":null,"abstract":"\u0000 \u0000 \u0000 More than 70% of CD patients experience visceral hypersensitivity (VH) despite reaching remission. VH treatment is difficult because the mechanism of its complication is unknown. Serotonin is mainly produced in the gut and regulates several physiological processes, such as intestinal immunity and pain. Disturbances in serotonin levels are associated with CD severity and VH. Intriguingly, we have recently observed that serotonin can covalently bind to glutamine at position 5 on histone H3 tail, leading to histone serotonylation (H3Q5ser) in peripheral blood mononuclear cells (PBMCs). Another study has demonstrated that H3Q5ser can also occur in cultured neuronal cells. Our objective is to investigate the role of this newly discovered epigenetic signature (H3Q5ser) in immune cells and enteric neurons in CD and its potential impact on the transcriptional programs of the inflammatory response and VH.\u0000 \u0000 \u0000 \u0000 To accomplish this goal, we will first determine the concentrations of serotonin in the mucosa and serum of active CD patients compared to healthy controls and establish how these levels relate to the enhancement of H3Q5ser in immune cells and enteric neurons. To study the functional role of H3Q5ser in cell activation, we will use site-directed or oligonucleotide- mediated mutagenesis to induce a point mutation in cultured enteric neuron cell lines and PBMCs to remove the binding site for serotonin on histone. Both wild-type and mutant cells will be incubated with or without serotonin and subjected to chromatin immunoprecipitation sequencing and RNA sequencing profiling to investigate the effect of H3Q5ser on the transcriptional programs associated with inflammation and VH.\u0000 \u0000 \u0000 \u0000 This project will provide a comprehensive understanding of the impact of the changes in serotonin concentrations on H3Q5ser-related gene expression in CD- associated VH and the inflammatory response. Our anticipated impact is subsequent studies that monitor H3Q5ser in VH in CD patients during treatment.\u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"3 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0425
J. Miyoshi, Y. Kimura, H. Morikubo, H. Komatsu, H. Yonezawa, M. Matsuura, T. Hisamatsu
Today molecular-targeted medications (MTMs) are widely used for ulcerative colitis (UC). Predicting the efficacy of MTMs early after induction remains a crucial clinical challenge. Intestinal ultrasound (IUS) is now considered a non-invasive, promising monitoring tool for UC. It can assess the disease activity of UC in the whole colon safely and repeatedly. Here, we hypothesized that over time IUS assessment can predict the MTM efficacy early, contribute to early clinical decision-making on whether to continue or switch MTMs, and reduce the burden of colonoscopy (CS) recommended to be scheduled at around 6 months after the induction. We analyzed 44 patients who started an MTM for active UC, underwent IUS at baseline and 3 months, and took CS at 6 months after the induction. The clinical disease activity and endoscopic activity at 6 months were assessed with Lichtiger index (LI) and Mayo endoscopic subscore (MES), respectively. Clinical remission was defined as a LI ≤ 3. Endoscopic improvement (EI) was defined as a MES = 0 or 1. In addition to the assessment of sonographic findings, such as bowel wall thickness (BWT), bowel wall stratification including submucosa index (SMI), bowel wall flow with modified Limberg score (mLS), Milan Ultrasound Criteria (MUC), UC-IUS index (UII), Kyorin Ultrasound Criterion for UC (KUC-UC; BWT<3.8mm with SMI<50%) were evaluated. Patients who achieved steroid-free clinical remission (SFCR) showed better improvement in BWT, %BWT, and mLS in 3 months compared to those who did not achieve SFCR (p<0.01 for each). The improvement in MUC and UII was also observed in patients who achieved SFCR at 6 months (p<0.001 for both). In ROC analyses, the area under the curve for SFCR at 6 months was 0.80 with BWT, 0.80 with %BWT, 0.81 with mLS, 0.85 with MUC, and 0.85 with UII. Among the 44 patients, 7 patients achieved MUC≤ 6.2, estimating MES=0/1, at 3 months, and 6 out of 7 patients demonstrated EI at 6 months (positive predictive value [PPV]=87.5%). Meanwhile, 4 patients satisfied KUC-UC at 3 months and all of them achieved SFCR and EI at 6 months (PPV=100%). Our study suggests that patients who achieved sonographic improvement in 3 months can continue an ongoing MTM therapy and that patients who demonstrated sonographic findings estimating EI at 3 months can postpone CS at 6 months.
{"title":"P295 Early sonographic improvement predicts the middle-term efficacy of molecular-targeted medications for Ulcerative Colitis","authors":"J. Miyoshi, Y. Kimura, H. Morikubo, H. Komatsu, H. Yonezawa, M. Matsuura, T. Hisamatsu","doi":"10.1093/ecco-jcc/jjad212.0425","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0425","url":null,"abstract":"\u0000 \u0000 \u0000 Today molecular-targeted medications (MTMs) are widely used for ulcerative colitis (UC). Predicting the efficacy of MTMs early after induction remains a crucial clinical challenge. Intestinal ultrasound (IUS) is now considered a non-invasive, promising monitoring tool for UC. It can assess the disease activity of UC in the whole colon safely and repeatedly. Here, we hypothesized that over time IUS assessment can predict the MTM efficacy early, contribute to early clinical decision-making on whether to continue or switch MTMs, and reduce the burden of colonoscopy (CS) recommended to be scheduled at around 6 months after the induction.\u0000 \u0000 \u0000 \u0000 We analyzed 44 patients who started an MTM for active UC, underwent IUS at baseline and 3 months, and took CS at 6 months after the induction. The clinical disease activity and endoscopic activity at 6 months were assessed with Lichtiger index (LI) and Mayo endoscopic subscore (MES), respectively. Clinical remission was defined as a LI ≤ 3. Endoscopic improvement (EI) was defined as a MES = 0 or 1. In addition to the assessment of sonographic findings, such as bowel wall thickness (BWT), bowel wall stratification including submucosa index (SMI), bowel wall flow with modified Limberg score (mLS), Milan Ultrasound Criteria (MUC), UC-IUS index (UII), Kyorin Ultrasound Criterion for UC (KUC-UC; BWT<3.8mm with SMI<50%) were evaluated.\u0000 \u0000 \u0000 \u0000 Patients who achieved steroid-free clinical remission (SFCR) showed better improvement in BWT, %BWT, and mLS in 3 months compared to those who did not achieve SFCR (p<0.01 for each). The improvement in MUC and UII was also observed in patients who achieved SFCR at 6 months (p<0.001 for both). In ROC analyses, the area under the curve for SFCR at 6 months was 0.80 with BWT, 0.80 with %BWT, 0.81 with mLS, 0.85 with MUC, and 0.85 with UII. Among the 44 patients, 7 patients achieved MUC≤ 6.2, estimating MES=0/1, at 3 months, and 6 out of 7 patients demonstrated EI at 6 months (positive predictive value [PPV]=87.5%). Meanwhile, 4 patients satisfied KUC-UC at 3 months and all of them achieved SFCR and EI at 6 months (PPV=100%).\u0000 \u0000 \u0000 \u0000 Our study suggests that patients who achieved sonographic improvement in 3 months can continue an ongoing MTM therapy and that patients who demonstrated sonographic findings estimating EI at 3 months can postpone CS at 6 months.\u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"362 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0598
J. Kim, M. Walshe, K. Borowski, R. Milgrom, J. Stempak, S. Lee, K. Croitoru, M. Silverberg
The low serum concentration of anti-tumor necrosis factor-alpha (anti-TNFα) agents and the presence of anti-drug antibodies are related to poor therapeutic outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the prognosis of patients having both antidrug antibodies and supratherapeutic drug concentrations. IBD patients on maintenance infliximab (IFX) or adalimumab (ADA) therapy were prospectively recruited. Serum drug concentrations and antidrug antibodies were measured (Anser, Prometheus). The drug concentrations were classified as subtherapeutic (IFX: <3 µg/mL; ADA: <5 µg/mL), therapeutic (IFX: 3-8 µg/mL; ADA 5-10 µg/mL), and supratherapeutic (IFX > 8 µg/mL; ADA > 10 µg/mL) concentrations regardless of the timing of blood sample collection. We analysed the relationship between i) drug concentrations and ii) the presence and absence of anti-drug antibodies with use of systemic corticosteroids and anti-TNF discontinuation. Of 172 patients (122 CD [70.9%], 44 UC [25.6%], 3 IBD-U [1.7%], and 3 IBD-pouch [1.7%]), the median age was 32.3 years (range, 24.8-42.5), and the median duration of IBD was 9.7 years (range 5.3-15.6). IFX and ADA were used in 81 (47.1%) and 91 (52.9%) patients, respectively, and concurrent usage of immunomodulators and systemic corticosteroids was observed in 39 (22.7%) and 23 (13.4%) patients, respectively. Supratherapeutic, therapeutic, and subtherapeutic concentrations were observed in 74 (43.0%), 32 (18.6%), and 66 (38.4%), respectively. The patients with antidrug antibodies (n = 79, 45.9%) showed a higher frequency of having subtherapeutic drug concentrations (68.4% vs 12.9%, P < 0.001) compared to those without antibodies, and the presence of antibodies was an independent predictor of discontinuation of anti-TNFα agents (hazard ratio 3.50, 95% confidence interval 1.88-6.51, P < 0.001, Fig. 1A). In subgroup analysis, patients with antidrug antibodies and supratherapeutic drug concentration exhibited a tendency to have improved drug persistence compared to those with subtherapeutic drug concentration, albeit insignificantly (P = 0.099, Fig. 1B). However, the persistence in this group was still poorer than that observed in patients without antibodies (P = 0.003). Finally, neither anti-TNFα concentrations nor the presence of antidrug antibodies were associated with the need for additional systemic corticosteroid use within 6 months. The presence of antidrug antibodies can predict the discontinuation of anti-TNFα agents despite supratherapeutic drug levels. While supratherapeutic drug concentration may improve the treatment persistence of anti-TNFα agents in patients with anti-drug antibodies, it does not last as long as in those without antibodies.
{"title":"P468 Relevance of anti-drug antibodies in context of supra-therapeutic anti-TNF concentrations","authors":"J. Kim, M. Walshe, K. Borowski, R. Milgrom, J. Stempak, S. Lee, K. Croitoru, M. Silverberg","doi":"10.1093/ecco-jcc/jjad212.0598","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0598","url":null,"abstract":"\u0000 \u0000 \u0000 The low serum concentration of anti-tumor necrosis factor-alpha (anti-TNFα) agents and the presence of anti-drug antibodies are related to poor therapeutic outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the prognosis of patients having both antidrug antibodies and supratherapeutic drug concentrations.\u0000 \u0000 \u0000 \u0000 IBD patients on maintenance infliximab (IFX) or adalimumab (ADA) therapy were prospectively recruited. Serum drug concentrations and antidrug antibodies were measured (Anser, Prometheus). The drug concentrations were classified as subtherapeutic (IFX: <3 µg/mL; ADA: <5 µg/mL), therapeutic (IFX: 3-8 µg/mL; ADA 5-10 µg/mL), and supratherapeutic (IFX > 8 µg/mL; ADA > 10 µg/mL) concentrations regardless of the timing of blood sample collection. We analysed the relationship between i) drug concentrations and ii) the presence and absence of anti-drug antibodies with use of systemic corticosteroids and anti-TNF discontinuation.\u0000 \u0000 \u0000 \u0000 Of 172 patients (122 CD [70.9%], 44 UC [25.6%], 3 IBD-U [1.7%], and 3 IBD-pouch [1.7%]), the median age was 32.3 years (range, 24.8-42.5), and the median duration of IBD was 9.7 years (range 5.3-15.6). IFX and ADA were used in 81 (47.1%) and 91 (52.9%) patients, respectively, and concurrent usage of immunomodulators and systemic corticosteroids was observed in 39 (22.7%) and 23 (13.4%) patients, respectively. Supratherapeutic, therapeutic, and subtherapeutic concentrations were observed in 74 (43.0%), 32 (18.6%), and 66 (38.4%), respectively. The patients with antidrug antibodies (n = 79, 45.9%) showed a higher frequency of having subtherapeutic drug concentrations (68.4% vs 12.9%, P < 0.001) compared to those without antibodies, and the presence of antibodies was an independent predictor of discontinuation of anti-TNFα agents (hazard ratio 3.50, 95% confidence interval 1.88-6.51, P < 0.001, Fig. 1A). In subgroup analysis, patients with antidrug antibodies and supratherapeutic drug concentration exhibited a tendency to have improved drug persistence compared to those with subtherapeutic drug concentration, albeit insignificantly (P = 0.099, Fig. 1B). However, the persistence in this group was still poorer than that observed in patients without antibodies (P = 0.003). Finally, neither anti-TNFα concentrations nor the presence of antidrug antibodies were associated with the need for additional systemic corticosteroid use within 6 months.\u0000 \u0000 \u0000 \u0000 The presence of antidrug antibodies can predict the discontinuation of anti-TNFα agents despite supratherapeutic drug levels. While supratherapeutic drug concentration may improve the treatment persistence of anti-TNFα agents in patients with anti-drug antibodies, it does not last as long as in those without antibodies.\u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"355 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0537
N. Totton, E. Sheldon, N. Ezaydi, M. Bursnall, D. Hind, R. Wakeman, A. Lobo
Patient-Reported Experience Measures (PREMs) assess a patient’s healthcare experiences and are important to improve the quality of healthcare. A PREM specific to inflammatory bowel disease (IBD) was co-produced with service users. This study aimed to validate the PREM. The IBD PREM contains 38-items and comprises three domains: ‘the care team’, ‘what matters to me’, and ‘living with Crohn’s or Colitis’. Scores can be calculated for each domain and summated to give a total score. Validation was completed on data collected from participants who completed the PREM every 3 months alongside the IBD-Control measure of disease activity at a single UK tertiary IBD service. The PREM was assessed for acceptability; reliability (internal consistency and repeatability); known groups validity; criterion validity and responsiveness. Face and content validity were completed before finalisation using ‘Think Aloud’ interviews. The dataset used for validation was extracted in September 2023 and contained responses from 287 participants (63% female, 89% White British, median age: 52) comprising 1,699 PREM responses between November 2021 and August 2023. Acceptability was demonstrated with very low rates of missing data (four items with >5% missing) and median submission duration of 4.8 minutes (IQR: 3.6 – 6.6). High Cronbach’s alpha scores (0.85, 0.97, 0.88 and 0.97 for each of the domains and total PREM score respectively) show internal consistency of the measure. However, the particularly high value on one domain and the total score suggest some overlapping items may remain. An intraclass corelation coefficient of 0.88 (95% CI: 0.85 to 0.91) suggests good repeat reliability over a two-week timeframe. Good comprehension of the measure by service users satisfied face and content validity. Known groups validity was supported with lower score on ‘living with Crohn’s or Colitis’ domain the for those with an IBD Control score of less than 13 by 0.38 (95% CI: 0.23 to 0.54), p<0.001). A low to moderate correlation of 0.37 (95% CI: 0.32 to 0.42) was found between the total PREM score and the IBD Control score, as expected. Ceiling and floor effects had a maximum of 6% demonstrating potential responsiveness of the PREM. The change over a year detected by those that stated that had experienced a change was 0.53 (95% CI: 0.41 to 0.66, n=38) on a five-point scale.Conclusion The co-produced PREM is an acceptable, valid, reliable, and responsive tool to measure experience of IBD care for quality improvement. Further work should assess the potential for item reduction as well as correlation to other related measures.
{"title":"P407 Validation of a newly developed patient-reported experience measure for people with Inflammatory Bowel Disease","authors":"N. Totton, E. Sheldon, N. Ezaydi, M. Bursnall, D. Hind, R. Wakeman, A. Lobo","doi":"10.1093/ecco-jcc/jjad212.0537","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0537","url":null,"abstract":"\u0000 \u0000 \u0000 Patient-Reported Experience Measures (PREMs) assess a patient’s healthcare experiences and are important to improve the quality of healthcare. A PREM specific to inflammatory bowel disease (IBD) was co-produced with service users. This study aimed to validate the PREM.\u0000 \u0000 \u0000 \u0000 The IBD PREM contains 38-items and comprises three domains: ‘the care team’, ‘what matters to me’, and ‘living with Crohn’s or Colitis’. Scores can be calculated for each domain and summated to give a total score.\u0000 Validation was completed on data collected from participants who completed the PREM every 3 months alongside the IBD-Control measure of disease activity at a single UK tertiary IBD service. The PREM was assessed for acceptability; reliability (internal consistency and repeatability); known groups validity; criterion validity and responsiveness. Face and content validity were completed before finalisation using ‘Think Aloud’ interviews.\u0000 \u0000 \u0000 \u0000 The dataset used for validation was extracted in September 2023 and contained responses from 287 participants (63% female, 89% White British, median age: 52) comprising 1,699 PREM responses between November 2021 and August 2023.\u0000 Acceptability was demonstrated with very low rates of missing data (four items with >5% missing) and median submission duration of 4.8 minutes (IQR: 3.6 – 6.6). High Cronbach’s alpha scores (0.85, 0.97, 0.88 and 0.97 for each of the domains and total PREM score respectively) show internal consistency of the measure. However, the particularly high value on one domain and the total score suggest some overlapping items may remain. An intraclass corelation coefficient of 0.88 (95% CI: 0.85 to 0.91) suggests good repeat reliability over a two-week timeframe.\u0000 Good comprehension of the measure by service users satisfied face and content validity. Known groups validity was supported with lower score on ‘living with Crohn’s or Colitis’ domain the for those with an IBD Control score of less than 13 by 0.38 (95% CI: 0.23 to 0.54), p<0.001). A low to moderate correlation of 0.37 (95% CI: 0.32 to 0.42) was found between the total PREM score and the IBD Control score, as expected.\u0000 Ceiling and floor effects had a maximum of 6% demonstrating potential responsiveness of the PREM. The change over a year detected by those that stated that had experienced a change was 0.53 (95% CI: 0.41 to 0.66, n=38) on a five-point scale.Conclusion\u0000 The co-produced PREM is an acceptable, valid, reliable, and responsive tool to measure experience of IBD care for quality improvement. Further work should assess the potential for item reduction as well as correlation to other related measures.\u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"149 8‐10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.1265
M. Pascual, C. de Prado Tejerina, G. Gárate, M. Serrano, M. J. García, B. Castro, V. González-Quintanilla, J. Madera, J. Crespo, J. Pascual, M. Rivero Tirado
Data on a possible comorbidity between migraine and inflammatory bowel disease (IBD) are controversial. Our aim was to determine the prevalence of migraine in a cohort of IBD patients. We performed a cross-sectional study in a cohort of IBD patients at our IBD Unit. After informed consent, consecutive IBD patients aged 18-64 years were interviewed. Those who admitted a history of headache in the last year were asked to answer the three questions of the id-Migraine validated questionnaire. Those who answered "yes" to the three of them were classified as "definite" migraine and those who answered "yes" to two were classified as "probable" migraine. For all patients we collected demographic data, IBD subtype, disease duration, hospitalizations or surgeries and medical treatments. Migraine prevalence data of IBD patients were compared with reported local migraine prevalence data at 18-65 years of age (Cephalalgia 2011; 31: 463-70). Statistical analysis was done with SPSS®. We interviewed 283 consecutive IBD patients aged 20-65 years. Main characteristics of this population are described in table 1. Headache was present in 176 (62.2%) patients. Of those, 59 (20.8%; 95% CI 16.1-25.5%) met migraine criteria either definite (n= 33; 11.7%; 95% CI 8-15.4%) or probable (n=26; 9.2%; 95% CI 5.8-12.5). When divided by gender, 12 men (9.6%; 95% CI 4.4-14.) and 47 women (29.8%; 95% CI 22.7-36.9%) met migraine criteria. The prevalence of migraine was significantly increased in IBD patients (20.8%) versus that reported for our general population (12.6%; p= 0.0001). By sex, these differences remained significant in women (29.8% in IBD versus 17.2% in our general population; p=0.0001), but not in men (9.6% in IBD vs 8.0%; p=0.45) (Figure 1). By IBD subtypes, there were no significant differences between CD and UC in migraine prevalence (20.7% vs 19.6% respectively; p=0.58). Regarding IBD characteristics, men with total migraine had higher biologic treatment (66.7% vs 44% p=0.032), and immune mediated inflammatory diseases or extraintestinal manifestations of IBD (33.3% vs 9.6% p=0.0016), but the number of men with migraine was low (12). These associations were not significant for women, nor overall population (p>0.05). Additionally, we did not find any significant association in total migraine patients in the use of mesalazine, disease duration, immunomodulators, surgeries or hospitalizations, neither in total number of patients nor stratified by sex. Migraine prevalence is higher in patients with IBD than general population, which is a further example of the bidirectional gut-brain interaction. The fact that this association was stronger for women suggests an influence of sex-related factors. ISCIII PI20/01358 and FEDER.
关于偏头痛与炎症性肠病（IBD）之间可能存在合并症的数据尚存在争议。我们的目的是确定偏头痛在一组 IBD 患者中的发病率。 我们在IBD科对一组IBD患者进行了横断面研究。在获得知情同意后，我们对 18-64 岁的连续 IBD 患者进行了访谈。那些承认在过去一年中有过头痛病史的患者被要求回答 id-Migraine 验证问卷中的三个问题。对其中三个问题回答 "是 "的患者被归类为 "确定 "偏头痛，对其中两个问题回答 "是 "的患者被归类为 "可能 "偏头痛。我们收集了所有患者的人口统计学数据、IBD亚型、病程、住院或手术以及治疗情况。IBD患者的偏头痛患病率数据与当地报道的18-65岁偏头痛患病率数据进行了比较（Cephalalgia 2011; 31: 463-70）。统计分析采用 SPSS®。 我们连续采访了 283 名 20-65 岁的 IBD 患者。这些患者的主要特征见表 1。176名（62.2%）患者有头痛症状。其中，59人（20.8%；95% CI 16.1-25.5%）符合偏头痛标准，包括明确的（33人；11.7%；95% CI 8-15.4%）或可能的（26人；9.2%；95% CI 5.8-12.5%）。按性别划分，12 名男性（9.6%；95% CI 4.4-14.）和 47 名女性（29.8%；95% CI 22.7-36.9%）符合偏头痛标准。与普通人群（12.6%；P= 0.0001）相比，IBD 患者的偏头痛发病率（20.8%）显著增加。从性别上看，这些差异在女性（IBD 患者为 29.8%，而普通人群为 17.2%；P=0.0001）中仍然显著，但在男性（IBD 患者为 9.6%，而普通人群为 8.0%；P=0.45）中则不显著（图 1）。按IBD亚型划分，CD和UC的偏头痛发病率没有明显差异（分别为20.7% vs 19.6%；P=0.58）。关于 IBD 特征，总偏头痛的男性患者接受生物治疗的比例较高（66.7% vs 44% p=0.032），免疫介导的炎症性疾病或 IBD 肠外表现的比例也较高（33.3% vs 9.6% p=0.0016），但偏头痛的男性患者人数较少（12）。这些关联对女性和整个人群都不显著（P>0.05）。此外，在所有偏头痛患者中，我们没有发现美沙拉嗪的使用、病程、免疫调节剂、手术或住院治疗与患者总数或性别分层有任何显著关联。 偏头痛在 IBD 患者中的发病率高于普通人群，这是肠道与大脑双向作用的又一例证。这种关联在女性中更为明显，这表明与性别有关的因素也有影响。ISCIII PI20/01358 和 FEDER。
{"title":"P1135 Increased prevalence of migraine in women with inflammatory bowel disease: a cross-sectional study","authors":"M. Pascual, C. de Prado Tejerina, G. Gárate, M. Serrano, M. J. García, B. Castro, V. González-Quintanilla, J. Madera, J. Crespo, J. Pascual, M. Rivero Tirado","doi":"10.1093/ecco-jcc/jjad212.1265","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1265","url":null,"abstract":"\u0000 \u0000 \u0000 Data on a possible comorbidity between migraine and inflammatory bowel disease (IBD) are controversial. Our aim was to determine the prevalence of migraine in a cohort of IBD patients.\u0000 \u0000 \u0000 \u0000 We performed a cross-sectional study in a cohort of IBD patients at our IBD Unit. After informed consent, consecutive IBD patients aged 18-64 years were interviewed. Those who admitted a history of headache in the last year were asked to answer the three questions of the id-Migraine validated questionnaire. Those who answered \"yes\" to the three of them were classified as \"definite\" migraine and those who answered \"yes\" to two were classified as \"probable\" migraine. For all patients we collected demographic data, IBD subtype, disease duration, hospitalizations or surgeries and medical treatments. Migraine prevalence data of IBD patients were compared with reported local migraine prevalence data at 18-65 years of age (Cephalalgia 2011; 31: 463-70). Statistical analysis was done with SPSS®.\u0000 \u0000 \u0000 \u0000 We interviewed 283 consecutive IBD patients aged 20-65 years. Main characteristics of this population are described in table 1.\u0000 Headache was present in 176 (62.2%) patients. Of those, 59 (20.8%; 95% CI 16.1-25.5%) met migraine criteria either definite (n= 33; 11.7%; 95% CI 8-15.4%) or probable (n=26; 9.2%; 95% CI 5.8-12.5). When divided by gender, 12 men (9.6%; 95% CI 4.4-14.) and 47 women (29.8%; 95% CI 22.7-36.9%) met migraine criteria.\u0000 The prevalence of migraine was significantly increased in IBD patients (20.8%) versus that reported for our general population (12.6%; p= 0.0001). By sex, these differences remained significant in women (29.8% in IBD versus 17.2% in our general population; p=0.0001), but not in men (9.6% in IBD vs 8.0%; p=0.45) (Figure 1).\u0000 By IBD subtypes, there were no significant differences between CD and UC in migraine prevalence (20.7% vs 19.6% respectively; p=0.58). Regarding IBD characteristics, men with total migraine had higher biologic treatment (66.7% vs 44% p=0.032), and immune mediated inflammatory diseases or extraintestinal manifestations of IBD (33.3% vs 9.6% p=0.0016), but the number of men with migraine was low (12). These associations were not significant for women, nor overall population (p>0.05). Additionally, we did not find any significant association in total migraine patients in the use of mesalazine, disease duration, immunomodulators, surgeries or hospitalizations, neither in total number of patients nor stratified by sex.\u0000 \u0000 \u0000 \u0000 Migraine prevalence is higher in patients with IBD than general population, which is a further example of the bidirectional gut-brain interaction. The fact that this association was stronger for women suggests an influence of sex-related factors.\u0000 ISCIII PI20/01358 and FEDER.\u0000 \u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"138 1‐3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1093/ecco-jcc/jjad212.0849
R. Oliveira, B. Mendes, J. Cunha Neves, E. Amorim, J. Roseira, H. Tavares de Sousa
Exclusive enteral nutrition (EEN) is recommended for preoperative nutritional optimization (PNO) in adult Crohn's disease (CD) patients. However, during ambulatory oral EEN, a lack of routine monitoring for vitamins may occur, with a potential risk of hypervitaminosis-related toxicity, which remains unexplored. This study aims to assess the serum levels of vitamins and micronutrients in CD patients undergoing EEN and to examine its potential impact. Complicated phenotype CD patients followed at a University Tertiary Hospital who were started on oral EEN June 2021 - June 2023 were prospectively included. EEN composition was determined and modified by an IBD nutritionist according to patients’ nutritional status and needs and laboratory values. Compliance was monitored daily, both for in- and outpatients. Patients’ weight and serum values (albumin, C-reactive protein [CRP], iron, folic acid, and vitamins B1, B6, B12, A, D, E and K) were monitored weekly. Nine patients (median age 29 years, 55.6% female) received a median of 24 (IQR 14.5-25.0) days of EEN, for PNO of symptomatic stricturing (7, 77.8%) or abdominal penetrating disease (2, 22.2%). All patients were discharged while on EEN, which was maintained until elective surgery (4, 44.4%) or the planned start of advanced medical therapy (5, 55.6%), with EEN successfully avoiding emergent surgeries. Patients were started on a combination of hypercaloric-hyperproteic and hypercaloric-normoproteic ready-to-drink concentrated polymeric formulas, providing 30 kcal/kg/d and 1.2-1.5g/kg/d of protein. EEN daily volume ranged from 1000 to 1400mL. Compliance was 100%, requiring flavour adjustments for tolerance. Table 1 illustrates changes over time in patients' weight and serum levels of interest. Resolution of anaemia and hypoalbuminemia was achieved, while weight was maintained . Hypervitaminosis cases were remarkably detected: 5 (55.6%) for vitamin B1, 4 (44.4%) for A, 2 (22.2%) for E, and 3 (33.3%) for K, with increasing trends over time. However, no symptoms related to hypervitaminosis were reported. Our study on PNO EEN in CD uncovered a gap in routine monitoring for essential vitamins during EEN. While achieving significant clinical improvement, our findings revealed subtle and asymptomatic cases of hypervitaminosis in short-term EEN courses. These results underscore that vitamin monitoring is advisable during EEN, especially in prolonged EEN protocols due to possible hypervitaminosis-related toxicity.
成人克罗恩病（CD）患者术前营养优化（PNO）建议采用纯肠内营养（EEN）。然而，在非卧床口服 EEN 期间，可能会出现缺乏维生素常规监测的情况，从而有可能导致与维生素过量相关的毒性，而这一问题仍未得到探讨。本研究旨在评估接受 EEN 的 CD 患者的血清维生素和微量营养素水平，并探讨其潜在影响。 该研究前瞻性地纳入了 2021 年 6 月至 2023 年 6 月在一家大学附属三级医院接受随访、开始口服 EEN 的复杂表型 CD 患者。由一名 IBD 营养师根据患者的营养状况和需求以及实验室数值确定并调整 EEN 成分。每天对住院和门诊患者的依从性进行监测。每周监测患者的体重和血清值（白蛋白、C反应蛋白[CRP]、铁、叶酸、维生素B1、B6、B12、A、D、E和K）。 九名患者（中位年龄 29 岁，55.6% 为女性）接受了中位数为 24 天（IQR 14.5-25.0）的 EEN 治疗，用于无症状狭窄的 PNO（7 例，77.8%）或腹部穿透性疾病（2 例，22.2%）。所有患者在接受 EEN 治疗期间均已出院，EEN 治疗一直持续到择期手术（4 例，44.4%）或按计划开始高级药物治疗（5 例，55.6%），EEN 成功避免了急诊手术。患者开始服用高钙-高蛋白和高钙-正常蛋白即开即饮浓缩配方奶粉，提供 30 千卡/千克/天的热量和 1.2-1.5 克/千克/天的蛋白质。EEN 的日摄入量为 1000 至 1400 毫升。依从性为 100%，需要根据耐受性调整口味。表 1 说明了患者体重和血清相关水平随时间的变化情况。贫血和低白蛋白血症得到缓解，而体重保持不变。显著发现了维生素过多症病例：维生素 B1 高达 5 例（55.6%），维生素 A 高达 4 例（44.4%），维生素 E 高达 2 例（22.2%），维生素 K 高达 3 例（33.3%），并且随着时间的推移呈上升趋势。不过，没有报告出现与维生素过量相关的症状。 我们对 CD 患者进行的 PNO EEN 研究发现，在 EEN 期间对必需维生素进行常规监测是一项空白。在临床症状得到明显改善的同时，我们的研究结果还发现了在短期 EEN 疗程中出现的微妙且无症状的维生素缺乏症病例。这些结果表明，在 EEN 期间最好进行维生素监测，尤其是在长期 EEN 方案中，因为可能会出现与维生素过量相关的毒性。
{"title":"P719 Vitamin and micronutrient excess in patients with Crohn’s disease under oral ambulatory exclusive enteral nutrition","authors":"R. Oliveira, B. Mendes, J. Cunha Neves, E. Amorim, J. Roseira, H. Tavares de Sousa","doi":"10.1093/ecco-jcc/jjad212.0849","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0849","url":null,"abstract":"\u0000 \u0000 \u0000 Exclusive enteral nutrition (EEN) is recommended for preoperative nutritional optimization (PNO) in adult Crohn's disease (CD) patients. However, during ambulatory oral EEN, a lack of routine monitoring for vitamins may occur, with a potential risk of hypervitaminosis-related toxicity, which remains unexplored. This study aims to assess the serum levels of vitamins and micronutrients in CD patients undergoing EEN and to examine its potential impact.\u0000 \u0000 \u0000 \u0000 Complicated phenotype CD patients followed at a University Tertiary Hospital who were started on oral EEN June 2021 - June 2023 were prospectively included. EEN composition was determined and modified by an IBD nutritionist according to patients’ nutritional status and needs and laboratory values. Compliance was monitored daily, both for in- and outpatients. Patients’ weight and serum values (albumin, C-reactive protein [CRP], iron, folic acid, and vitamins B1, B6, B12, A, D, E and K) were monitored weekly.\u0000 \u0000 \u0000 \u0000 Nine patients (median age 29 years, 55.6% female) received a median of 24 (IQR 14.5-25.0) days of EEN, for PNO of symptomatic stricturing (7, 77.8%) or abdominal penetrating disease (2, 22.2%). All patients were discharged while on EEN, which was maintained until elective surgery (4, 44.4%) or the planned start of advanced medical therapy (5, 55.6%), with EEN successfully avoiding emergent surgeries. Patients were started on a combination of hypercaloric-hyperproteic and hypercaloric-normoproteic ready-to-drink concentrated polymeric formulas, providing 30 kcal/kg/d and 1.2-1.5g/kg/d of protein. EEN daily volume ranged from 1000 to 1400mL. Compliance was 100%, requiring flavour adjustments for tolerance. Table 1 illustrates changes over time in patients' weight and serum levels of interest. Resolution of anaemia and hypoalbuminemia was achieved, while weight was maintained . Hypervitaminosis cases were remarkably detected: 5 (55.6%) for vitamin B1, 4 (44.4%) for A, 2 (22.2%) for E, and 3 (33.3%) for K, with increasing trends over time. However, no symptoms related to hypervitaminosis were reported.\u0000 \u0000 \u0000 \u0000 Our study on PNO EEN in CD uncovered a gap in routine monitoring for essential vitamins during EEN. While achieving significant clinical improvement, our findings revealed subtle and asymptomatic cases of hypervitaminosis in short-term EEN courses. These results underscore that vitamin monitoring is advisable during EEN, especially in prolonged EEN protocols due to possible hypervitaminosis-related toxicity.\u0000 \u0000","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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