Introduction

Malnutrition and weight loss are well-recognized complications of Crohn disease (CD), however nutritional routine assessment is not commonly performed, resulting in under-detection of both malnutrition and nutrient deficiencies. In fact, a number of nutrition screening tools are available including the Nutritional Risk Index (NRI).
The aim of this study was to assess the nutritional status using the NRI and to investigate the associated factors to malnutrition during CD.

Aims & Methods

We conducted a retrospective single-center study, including patients followed for CD over a 7-year period [2014 - 2021]. Malnutrition risk was estimated based on the NRI calculated at first presentation with the following formula: NRI = (1.519 × serum albumin (g/L) + 41.7× (present weight/usual weight).
Nutrition status of patients was categorized into four groups: NRI>100: no risk group, NRI= 97.5–100: mild risk, NRI= 83.5–97.5: moderate risk, and NRI< 83.5: severe risk group of malnurition. Radiologic sarcopenia was assessed by calculating the total psoas area index.

Results

In total, 50 patients were enrolled with a mean age of 44.3 years, a median disease duration of 106 months and a sex ratio M/F of 3.16.
Based on NRI, 11/50 (22%) patients had normal nutritional status, 27/50 (54%) mild-moderate risk of malnutriton and 12/50 (24%) had severe malnutrition.
In the univariate study, severe malnutrition risk was associated with the presence of anemia (p=0.002), thrombocytosis (p=0.05), hypocholesterolemia (p=0.024), the presence of radiologic sarcopenia (p=0.05), extensive ileal involvement of more than 50 cm (p=0.014), the occurrence of complications such as intra-abdominal collection (p=0.001) and thromboembolic complications (p=0.05). Regarding, patients who underwent surgical treatment, the occurrence of postoperative complications and extensive small bowl resection were factors associated with severe malnutrition with a p-value of 0.02 and 0.025 respectively.
On multivariate regression analysis, severe malnutrition risk was a predictive factor of developing intra-abdominal abscess (OR 10.5 95% CI 2.22-49.51), p=0.003).

Conclusion

Patients with Crohn’s disease have a high incidence of nutritional risk and malnutrition witch was associated with severe course of CD. Nutritional Risk Index is a simple, validated and reproducible tool to identify patients at increased risk of malnutrition allowing adapted nutritional support.

Clinical Case Summary

Cryptosporidiosis is a gastrointestinal infection caused by the protozoan Cryptosporidium spp. It is typically self-limited in immunocompetent patients. However, in immunocompromised individuals, it can lead to moderate to severe diarrhea and significant morbidity and mortality.¹
We present the case of a 31-year-old woman with a history of Crohn’s disease in remission, who presented with a one-week history of diarrhea (up to 10 bowel movements daily), abdominal pain, and fever (38°C). Laboratory tests revealed an elevated C-reactive protein (CRP), and intestinal ultrasound showed bowel wall thickening, hyperemia and wall disruption, suggestive of an active flare. However, routine stool culture isolated Cryptosporidium, and based on her clinical background, oral paromomycin and azithromycin were initiated, resulting in complete clinical remission.
Cryptosporidiosis is a common parasitic cause of diarrhea, particularly affecting immunocompromised patients, such as those with HIV, cancer or solid organ transplants.²
Although few cases have been described in inflammatory bowel disease (IBD), the immunosuppressive state of these patients may increase the risk of infection. Diagnosing cryptosporidiosis in this population can be challenging, as stool tests detect only about 30% of cases, and the clinical presentation often mimics an IBD flare.³
Treatment is generally supportive and reserved for severe or refractory cases. Nitazoxanide is the drug of choice, and in non-responders, it can be combined with fluoroquinolones or azithromycin. In IBD patients, the decision to initiate specific antiparasitic treatment depends on the degree of immunosuppression and the clinical scenario.⁴
A clear association between IBD and cryptosporidiosis has not been established, but it is crucial to rule out opportunistic gastrointestinal infections in suspected flare-ups before starting specific therapies.
image "Bowel wall thickening, hyperemia, and disruption of the normal layer pattern."

References

(1) Janssen B, Snowden J. Cryptosporidiosis. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28846353.
(2) Liu B, Schnider A, DeArmond M, Banach DB, Haubrich BA. Cryptosporidiosis in individuals with inflammatory bowel disease: a scoping review protocol. BMJ Open. 2024 Oct 15;14(10):e086529. doi: 10.1136/bmjopen-2024-086529. PMID: 39414295; PMCID: PMC11481120.
(3) Ferreira J, Baden R, Magge S, Cheifetz A. Cryptosporidiosis masquerading as a Crohn's flare. Inflamm Bowel Dis. 2011 Oct;17(10):E133-4. doi: 10.1002/ibd.21811. Epub 2011 Jul 7. PMID: 21739536.
(4) Manthey MW, Ross AB, Soergel KH. Cryptosporidiosis and inflammatory bowel disease. Dig Dis Sci 1997;42:1580–6.

Introduction

Endoscopic scores are crucial for assessing Crohn's disease (CD) severity, guiding therapy, and monitoring progression. The Simplified Endoscopic Score for Crohn's Disease (SES-CD) is widely used for this purpose [1]. Accurate scoring is vital for patient care. Recently, artificial intelligence has demonstrated potential in medical image interpretation [2]. This study aims to evaluate ChatGPT's effectiveness in rating the SES-CD.

Aims & Methods

This retrospective study evaluated ChatGPT's accuracy in assessing CD endoscopic activity using the SES-CD. One representative still image was selected for each bowel segment, and stricture degrees were provided separately if present. ChatGPT scored the SES-CD based on these images. The IBD expert's ratings were validated by calculating the intra-class correlation coefficient (ICC) with clinical trial central readers. The ICC between the IBD expert and ChatGPT scores was calculated to determine ChatGPT's reliability in SES-CD scoring.

Results

Nine (mean age 32.0 ± 11.8 years, 77.8% male) were included, with 45 bowel segments. Three (33.4%), 5 (55.6%), and 1 (11.1%) had nonstricturing nonpenetrating, structuring, and penetrating disease, respectively. Four (44.4%) had ileal disease and 5 (55.6%) had ileocolonic disease. Five (55.6%) had previous IBD surgery.
The SES-CD scores of the participants, rated by IBD expert in the hospital, revealed the following mean and standard deviation for each segment of the bowel: 6.9 ± 2.3 in the ileum, 1.3 ± 2.6 in the right colon, 1.6 ± 2.4 in the transverse colon, 1.3 ± 2.6 in the left colon, and 1.3 ± 2.6 in the rectum. The total SES-CD score was 12.4 ± 10.9. The score reliability of the institute IBD expert was tested compared to the clinical trial central reader and an intraclass correlation coefficient was calculated and found to be 0.96 (95% CI, 0.84-0.99) which is considered extremely correlated.
The mean and standard deviation of ChatGPT score in each segment were: 6.4 ± 2.4 in the ileum, 2.4 ± 3.8 in the right colon, 0.9 ± 2.7 in the transverse colon, 0.3 ± 1.0 in the left colon, 0.6 ± 1.3 in the rectum, with total SES-CD score of 10.6 ± 6.8. The calculated ICC between the expert and ChatGPT obtained SES-CD scores was 0.80 (95% IC, 0.64- 0.89) which is considered highly correlated.

Conclusion

Despite being based on only one photo per segment, ChatGPT demonstrated satisfactory performance in estimating endoscopic activity in CD. The differences between the IBD expert obtained scores and ChatGPT scores were acceptable, suggesting that artificial intelligence has the potential to be a useful tool in clinical and research settings, providing an accurate estimation of disease severity based on limited visual data.

References

1- Daperno M, D'Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004;60(4):505-512.
2- Levartovsky A, Albshesh A, Grinman A, et al. Enhancing diagnostics: ChatGPT-4 performance in ulcerative colitis endoscopic assessment. Endosc Int Open. 2025;13:a25420943. Published 2025 Mar 14.

Introduction

Current treatments for Crohn’s disease (CD) and ulcerative colitis (UC) are associated with loss of treatment response. However, studies assessing the real-world burden of non-response in Canada are scarce and the clinical and humanistic burden remains unknown. We aimed to describe the burden of active disease on symptom prevalence and work impairment by describing patients with CD and UC according to remission status.

Aims & Methods

Data were drawn from the Adelphi Real World Inflammatory Bowel Disease Specific Programme™, a real-world, cross-sectional survey of gastroenterologists (GEs) and their consulting patients with CD and UC in Canada from June 2023 to January 2024. Data included physician-reported patient demographics and clinical characteristics. Descriptive analyses were conducted.

Results

19 physicians reported data for 144 patients (73 with CD and 71 with UC). Physicians reported 20% of patients not to be in clinical or endoscopic remission (non-remitters), 31% to be in clinical remission only and 49% in both clinical and endoscopic remission. Mean (standard deviation) age was 44.5 (20.5) years among non-remitting patients, 33.5 (13.3) years among those in clinical remission only and 40.4 (17.4) years among patients in those with clinical and endoscopic remission. Among non-remitting patients, 38% were an ex-smoker, versus 14% of clinical remission and 18% of clinical and endoscopic remission patients. The most reported comorbid conditions included anxiety (24% non-remitters, 14% clinical remitters, 18% clinical and endoscopic remitters), depression (14% non-remitters, 0% in clinical remitters, and 14% in clinical and endoscopic remitters) and hypertension (14% non-remitters, 9% clinical remitters, and 14% clinical and endoscopic remitters). Top three current symptoms included fatigue (52% non-remitters, 32% clinical remitters, 15% clinical and endoscopic remitters), abdominal pain (69% non-remitters, 14% clinical remitters, 7% clinical and endoscopic remitters), and non-bloody diarrhea (48% non-remitters, 7% clinical remitters, 6% clinical and endoscopic remitters). Regarding employment, 38% of non-remitters were working full-time versus 48% of clinical remitters, and 58% of clinical and endoscopic remitters.

Conclusion

Patients with CD/UC that had not achieved or maintained remission experienced more symptom burden, comorbid conditions, and were often not in full-time employment than those in disease remission. Notably, non-remitters experienced a high symptom burden, including fatigue, abdominal pain, and diarrhea, which impacted daily living. Patients with both clinical and endoscopic remission experienced fewer symptoms and full-time employment. This highlights the importance of, and significant unmet need for, effective treatment in IBD to manage disease symptoms and decrease inflammation.

Disclosure

Janssen Global Services funded the research and I am an employee of Janssen

Introduction

Patients with Crohn’s disease (CD) are at risk of progressing from inflammatory to stricturing and penetrating phenotypes. The influence of the type of remission on phenotype progression has not been adequately evaluated.

Aims & Methods

Retrospective cohort study including surgically naïve CD patients with inflammatory or stricturing phenotype evaluated concomitantly by magnetic resonance enterography and colonoscopy. The degree of remission was correlated with the risk of progressing to stricturing and penetrating phenotypes.

Results

381 CD patients were included, 21.8% with transmural remission, 21.3% with isolated endoscopic remission, 10.5% with isolated radiologic remission, and 46.5% without remission. Patients with transmural remission presented the lowest rates of phenotype progression (1.2%), with a significant difference compared to isolated endoscopic remission (18.3%, P≤ 0.001), isolated radiologic remission (17.5%, P=0.002), and no remission (36.9%, P≤0.001). In multivariate regression analysis, transmural remission (OR 0.023 95%CI 0.003-0.171, P<0.001), isolated radiologic remission (OR 0.342 95%CI 0.141-0.826, P=0.017), and isolated endoscopic remission (OR 0.441 95%CI 0.220-0.881, P=0.020) resulted in lower rates of phenotype progression compared to no remission.
Figure 1 presents the Kaplan-Meier estimates of remaining free of penetrating complication (upper curve) and free of stricturing and/or penetrating complication (lower curve) after the baseline assessment in patients with no remission (A), isolated endoscopic remission (B), isolated radiologic remission (C), and transmural remission (D).

Conclusion

The degree of intestinal remission correlates with the risk of phenotype progression. Patients with transmural remission are at the lowest risk of progressing to stricturing and penetrating phenotypes.

Introduction

We conducted a retrospective analysis of administrative claims data comparing the risk of serious infections in patients with Crohn’s disease (CD) on advanced biological therapies.

Aims & Methods

Using a real world cohort from Optum Labs® warehourse, we identified CD patients who were new users of the advanced therapy with either tumor necrosis factor-α (TNF) antagonists (infliximab, adalimumab, and certolizumab pegol), IL-12/23 antagonists (ustekinumab), IL-23 antagonists (risankizumab), anti-integrin agents (vedolizumab), or Janus kinase (JAK) inhibitors (tofacitinib and upadacitinib) between 2016 and 2023. All patients had continuous insurance coverage for at least one year before and after treatment initiation. We estimated incidence rates (IRs) and compared risks of serious infections (requiring hospitalization) using multinomial propensity score based stabilized inverse probability of treatment weighting accounting for confounding agents at baseline. Hazard ratios were derived from Cox proportional hazard model to assess risk of serious infections in a cohort balanced for known confounders.

Results

We included 12,245 patients with CD (mean age: 44.5 ± 17.5 years; 54.2% female; 30.9% using concomitant steroids), followed for a mean duration of 2.2 ± 0.2 years. The incidence rates (IRs) per 100 person-years for serious infections in the incident users were: TNF antagonists (n=5,274; IR: 8.81 [4.95-13.22]), vedolizumab (n=2,716, IR: 6.02 [5.30-6.76]), ustekinumab (n=3,544; IR: 4.92 [4.36-5.50]), risankizumab (n=559; IR: 8.79 [6.15-11.65]), and JAK inhibitors (n=152; IR: 8.81 [4.95-13.22]). Patients receiving JAK inhibitors were more likely to be females (67.1% vs. 54.2% overall), higher comorbidity burden (mean Charlson Comorbidity index of 1.72 vs. 1.03 overall), diabetic (18.4% vs. 10.5% overall) and more likely to be using concomitant steroids at baseline (42.1% vs. 30.9% overall). No difference was observed for hazard ratios comparing the risk of events across therapies (table 1).

Table 1: Hazard ratios for risk of serious infections in patients with Crohn’s disease receiving advanced biological therapies and small molecules

Conclusion

In this large real-world cohort of patients with CD, no significant differences were observed in the risk of serious infections across the advanced therapies.

Disclosure

CM: Consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Forte Biosciences, Fresenius Kabi, Gilead, Janssen, McKesson, Mirador Therapeutics, Mylan, Pendopharm, Pfizer, Prometheus Biosciences Inc., Roche, Sanofi, Takeda, Tillotts Pharma; speaker's fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Merck, Organon, Pendopharm, Pfizer, Sanofi, Takeda, Tillotts Pharma; royalties from Springer Publishing; research support from AbbVie, Eli Lilly, Ferring, Pfizer.
VJ: Consulting/advisory board fees from AbbVie, Alimentiv Inc, Arena pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus, Reistone Biopharma, Roche, Sandoz, Second Genome,Takeda, Teva, Topivert, Ventyx, Vividion; speaker’s fees from, Abbvie, Ferring, Galapagos, Janssen Pfizer Shire, Takeda, Fresenius Kabi
SS: Research grants from Pfizer

Clinical Case Summary

Background: Protein-energy malnutrition (PEM) is a common complication in patients with Crohn’s disease (CD), affecting 30% to 82.8% of individuals. Contributing factors include diarrhea, inflammatory activity, dietary restrictions, and nutrient malabsorption. This case report aims to describe a newly diagnosed CD patient with severe malnutrition and myopenia, highlighting the impact of inflammatory activity on nutritional status and the importance of early multidisciplinary management for optimizing treatment and improving quality of life.
Case report: A 27-year-old female patient presented with abdominal pain, anorexia, and progressive weight loss of 10 kg over five months (22% of body weight), consistent with severe malnutrition. She was admitted to diagnostic evaluation, and complementary exams confirmed a diagnosis of CD with ileal involvement, stenosing type (Montreal A2L1B2). Treatment was initiated with combined infliximab and azathioprine therapy. Nutritional assessment revealed a weight of 31 kg, BMI of 12.3 kg/m² (severe underweight), phase angle of 4.4°, lean mass of 26.1 kg, and fat mass of 4.9 kg, with an abnormal intra/extracellular mass ratio (0.75). The patient was classified as severely malnourished based on arm muscle circumference (AMC), with both lean and fat mass below expected levels. Computed tomography (CT) showed a muscle area of 82.02 cm², visceral fat of 1.80 cm², and subcutaneous fat of 1.49 cm², with a Skeletal Muscle Index (SMI) of 32.44 cm²/m² (reference range: 38.5 cm²/m²), indicating myopenia.
Conclusion: Myopenia is a common condition in CD patients and is associated with worsened quality of life, increased risk of disease relapse, and therapeutic failure. The inflammatory process exacerbates malnutrition through anorexigenic mediators, while muscle mass reduction underscores the need for studies focusing on nutrition and physical exercise as complementary strategies in the management of inflammatory bowel diseases.

References

• Balestrieri, P., Ribolsi, M., Guarino, M. P. L., Emerenziani, S., Altomare, A., & Cicala, M. (2020). Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients, 12(2), 372. https://doi.org/10.3390/nu12020372
• Wei, H., Yuan, Z., Ren, K., Jin, Y., Ren, L., Cao, B., Zhou, Y., & Chen, L. (2023). Body Composition in Inflammatory Bowel Disease. Archives of Iranian medicine, 26(3), 172–175. https://doi.org/10.34172/aim.2023.26
• Massironi, S., Viganò, C., Palermo, A., Pirola, L., Mulinacci, G., Allocca, M., Peyrin-Biroulet, L., & Danese, S. (2023). Inflammation and malnutrition in inflammatory bowel disease. The lancet. Gastroenterology & hepatology, 8(6), 579–590. https://doi.org/10.1016/S2468-1253(23)00011-0
• Ando, K., Uehara, K., Sugiyama, Y., Kobayashi, Y., Murakami, Y., Sato, H., Kunogi, T., Sasaki, T., Takahashi, K., Ueno, N., Kashima, S., Moriichi, K., Tanabe, H., Okumura, T., & Fujiya, M. (2022). Correlation Among Body Composition Parameters and Long-Term Outcomes in Crohn's Disease After Anti-TNF Therapy. Frontiers in nutrition, 9, 765209. https://doi.org/10.3389/fnut.2022.765209
• Nardone, O. M., de Sire, R., Petito, V., Testa, A., Villani, G., Scaldaferri, F., & Castiglione, F. (2021). Inflammatory Bowel Diseases and Sarcopenia: The Role of Inflammation and Gut Microbiota in the Development of Muscle Failure. Frontiers in immunology, 12, 694217. https://doi.org/10.3389/fimmu.2021.694217