Introduction

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD) with an important impact on patients' quality of life. The prevalence is uncertain (6% to 74% depending on the definition and on the subgroup of patients examined). In Italy a prevalence of anemia at the diagnosis of 13.6% among the adult IBD outpatients is reported.

Aims & Methods

We aimed to determine the prevalence of anemia and its characteristics at the diagnosis in children with IBD and to investigate its trend during follow-up.
This was an observational, multicenter cohort study including data of IBD children with anemia at the diagnosis prospectively enrolled in the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) IBD registry. Data were collected at the diagnosis and anemia trend was evaluated at 1-year follow-up. Anemia was diagnosed based on the WHO criteria and classified as mild, moderate, and severe accordingly. Based on serum ferritin and CRP level and/or transferrin saturation (TNSat), anemia was defined as iron deficiency anemia (IDA), anemia of chronic disease (ACD) or inflammatory IDA (InflIDA).

Results

Five hundred eighty-nine [295 CD (50%) and 294 UC/IBDU (50%)] out of 1634 children with IBD presented with anemia, resulting in a prevalence of 36%. Anemia rate was higher in CD than in UC (39% vs 33%, p = 0.009) and most patients had moderate anemia (55%). Iron deficiency anemia and InflIDA were diagnosed equally in 42% of children, while only 15.4% presented with ACD. Children with CD showed higher rates of mild anemia (38% vs 33%,p<0.0001) and a higher frequency of ACD compared to UC patients (26.5% vs. 4.5%, p < 0.0001). A severe form of anemia was more common in UC (13% vs 6%, p= 0.001) as well as the IDA (53% vs 31%,p<0.0001). Younger age and lower albumin levels significantly correlated with the severity of the anemia in CD. In UC, females were more likely to experience severe anemia (69% vs 47%, p=0.02) and an extensive disease was prevalent in children with moderate and severe anemia than in those with mild anemia (p=0.01 and p=0.03, respectively). At 1 year, 99 children (17%) were still anemic. At the multivariable logistic regression analysis, baseline wPCDAI and SES-CD significantly correlated with the risk of the persistence of anemia at 1 year in CD. No variables correlated with the persistence of anemia in UC.

Conclusion

More than one-third of pediatric patients presents with anemia at the diagnosis of IBD, most commonly moderate. A severe anemia is most common in UC compared to CD. IDA (alone or in its form of ACD) is the most common cause of anemia in children with IBD. One out of five is still anemic after 1 year from the diagnosis.

Introduction

Celiac disease is a chronic, autoimmune disease that affects the small bowel in genetically predisposed persons precipitated by the ingestion of gluten. Celiac disease (CeD) and inflammatory bowel disease (IBD), principally Crohn’s disease (CD) and ulcerative colitis (UC) are among the most common immune-mediated gastrointestinal diseases.
Some studies have described the coexistence of the 2 diseases in the same patient.

Aims & Methods

The aims of the present study were to determine the prevalence of inflammatory bowel disease (IBD) and to elucidate the clinical features in patients with CeD with concomitant IBD.
We conducted a cross-sectional and single-center study. A total of 205 adults with CeD were included, and following up at the Gastroenterology unit of the Constantine University Hospital between 2015 and 2021. The diagnosis of CeD was made with the positive serology and histology of endoscopic duodenal biopsies and we identified those who were also diagnosed with IBD. The diagnosis of IBD associated to CeD was established based on clinical, endoscopic, histopathological, and radiological findings. Clinical, demographic, laboratory and morphological characteristics were analysed in these conditions. Osteodensitometry was performed on every patient with CeD and IBD.

Results

Among 205 patients with CeD, 14 had co-existent IBD (6,8%; n = 11 CD, n = 3 UC), their mean age at diagnosis of CeD was 29.7 ± 15.7 years. Females constituted 64,3%. The average delay of diagnosis between IBD and CeD was 6.4±3.8 years. The diagnosis of CeD preceded that of IBD in 35,7% (n=5) and 28,5% (n=4) of patients was concurrently diagnosed with IBD and CeD. Patients with CeD and concomitant IBD had a higher frequency of atypical symptoms of CeD (63,6%). Various extra-intestinal manifestations have been reported in 71,4% (aphthous stomatitis: 35,7%; depression: 42,8%). Osteoporosis was detected in 1 case with CD. Celiac disease serology was positive in all cases. The distribution of duodenal histology results according to Marsh-Oberhuber classification were 4/14 Marsh 3a, 6/14 Marsh 3b, 4/14 Marsh 3c. Other autoimmune disorders, including autoimmune thyroiditis (n=2) and type-1 diabetes (n=1). Of the patients diagnosed with CeD and CD, 7 had Ileocolonic involvement and only 2 had perianal disease. The dominant behaviour of CD was of the Stricturing type in 7 cases. Two patients with UC had extensive colitis. All patients were put on a gluten-free diet (GFD). IBD was treated with 5-aminosalicylic acid (n=1), immunomodulators (n=7) and biological therapy (n=6).

Conclusion

In our study of patients with CeD the prevalence of IBD was 6,8% (IC 95% 3,8%-11,2%). It’s higher than previously reported in a number of studies. CD was more common than UC. Patients with UC and CeD were more likely to have pancolitis.

Introduction

A significant proportion of patients with inflammatory bowel disease (IBD) have concomitant rheumatological manifestations. On the other hand, patients with spondyloarthritis (SpA) often report gastrointestinal symptoms, some of them being associated to IBD. However, the exact prevalence of this disorder is still controversial, and the optimal approach to its diagnosis remains unknown.

Aims & Methods

Our main was to determine the prevalence of undiagnosed IBD in patients with axial SpA (radiographic and non-radiographic) and psoriatic arthritis (PA). EISER is a multicenter, nationwide, observational, and cross-sectional study where 13 Spanish hospitals participated. Patients ≥18 years-old diagnosed with PA or SpA according to the CASPAR or ASAS criteria, respectively, were selected. Patients receiving biologics or systemic steroids at baseline or within the previous 30 days were not included. Regarding patients older than 50 years, only those without valid colonoscopy in the previous 3 years were included. Rheumatologist performed a baseline visit and collected demographic, clinical, and treatment data. Fecal calprotectin (FC) was determined by the Quantum Blue rapid test and this was followed by a gastroenterologist consultation. A complete colonoscopy was indicated on all patients with symptoms, FC≥80 µg/g without NSAIDs, or 160 µg/g if they were on NSAIDs. Capsule endoscopy or magnetic resonance enterography were performed in those with no findings on colonoscopy.

Results

A total of 559 patients were included (51% men; mean 52.2 years; mean disease duration of SpA/PA was 12.3 years). The most frequent rheumatological disease was radiographic SpA (37%), followed by peripheral APs (36%). Abnormal FC was observed in 47% and 53% of patients with PA and EspAx (80% radiographic-SpA vs 20% non-radiographic-SpA), respectively. Mean FC levels were higher among radiographic-SpA (395 µg/g) compared to the rest of the groups (306 µg/g for non-radiographic-SpA and 306 µg/g in PA). Overall, 11,5% had gastrointestinal symptoms, with the most common being abdominal pain (16%) and chronic diarrhea (11%). In total, 189 colonoscopies were performed, 40% demonstrating at least one abnormal finding, mostly aphthous ulcers (66%), superficial ulcers (21%) and erythema (14%), and they were mainly located in the terminal ileum (41%). Finally, 23 patients were diagnosed with IBD (4.4%), mostly with radiographic-SpA (83%), followed by peripheral PA (8.7%) and non-radiographic-SpA and axial PA (4.3% each). All patients but two were diagnosed with CD (91.3%), with 1 case of unclassified IBD (4.3%) and 1 with nonspecific ileitis (4.3%).

Conclusion

FC levels in patients with SpA and PA, followed by an appropriate endoscopic and/or radiological diagnostic algorithm, allows the identification of a relevant subgroup of patients with previously undiagnosed IBD

Introduction

Malnutrition is a common condition of patients with inflammatory bowel disease (IBD) and could be associated with sarcopenia i.e. a reduced muscle mass and strength. Recent data suggest that the prevalence of sarcopenia is, respectively, 52% and 37% in Crohn's disease (CD) and ulcerative colitis (UC). It is well demonstrated that sarcopenic IBD patients have two to three times higher risk of lost of response to biotechnology drugs than non-sarcopenic patients.

Aims & Methods

Consecutive IBD patients accessing the IBD outpatient service were enrolled. Detailed data regarding the characteristics of MC and CU populations, current therapy and disease activity are reported. Each patient was interviewed about the frequency (none, low, high) and the kind (aerobic or anaerobic) of the physical activity they were practicing.
At the enrolment, nutritional assessments were performed by body mass index (BMI) evaluation according with the World Health Organization recommendations, global subjective assessment by the MUST (Malnutrition Universal Screening Tool) index according with the European Society for Clinical Nutrition and Metabolism and the Global Leadership Initiative on Malnutrition [GLIM]. Moreover, the SARC-F questionnaire, recommended by the scientific consensus EWGSOP 2 to identify individuals at risk for sarcopenia was administrated. A SARC-F value ≥ 4 was significant of sarcopenia. Finally, the quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Univariate and multivariate analysis was conducted between BMI, MUST, SARC-F and IBDQ values and patient characteristics (age, current therapy, disease activity and physical activity).

Results

A total of 321 IBD patients (158 CD and 163 UC), 56.07% male, with a mean age of 44.78 years were enrolled. Sixty-seven patients (20.87%) reported a current smoking habit. A mean BMI of 70.37 kg, was calculated. Regarding malnutrition, 199 patients (61.99%) were considered at low risk (MUST=0), 75 subjects (23.36%) at medium risk (MUST=1), 47 (14.64%) at high risk (MUST ≥2). A SARC-F value ≥4 was evaluated in 50 patients (15.58%). A reduction in quality of life, understood as IBDQ < 209, was found in 45 (14.02%) patients. Females and males presented a significantly different prevalence of sarcopenia (chi2: 9.69; p-value: 0.002).
Univariate analysis shows a significant protective role of male sex (OR vs. female sex: 0.33; p-value: 0.018) in the risk of sarcopenia; older subjects had a slightly higher sarcopenic risk (OR: 1.04; p-value <0.001). The risk was associated with corticosteroid therapy (OR 1,03, p-value <0.001), with increasing MUST (OR 1,65, p-value <0.001) and with the IBDQ decreases (OR 2,1; p-value<0.001).
Multivariate analysis confirmed an higher incidence of sarcopenia in female subjects of advanced age with active-stage disease (R²: 0.88, p-value<0.0001), furthermore female patients with active-stage disease who did not engage in physical activity had a greater impairment in quality of life, regardless of age (R²: 0.75, p-value<0.0001). Aerobic and anaerobic physical activity played a protective role in the onset of sarcopenia regardless of sex and age (R²: 0.82, p-value<0.0001).

Conclusion

In our cohort of patients, sarcopenia was present in only 18.94%. Male sex was found to be a protective factor for sarcopenia. Disease status is firmly linked to the risk of sarcopenia. Regular physical activity has been shown to have a protective role for good quality of life and it was related with a lower risk of sarcopenia. This study will continue to expand the cohort taken into account.

Introduction

Early-onset inflammatory bowel disease (EO-IBD), defined as disease onset before the age of 6 years, represents a distinct subgroup of pediatric IBD. It is associated with extensive colonic involvement, resistance to standard therapy, and a higher risk of complications, including extraintestinal manifestations (EIMs).

Aims & Methods

The purpose of our study was to analyze the clinical features of EO-IBD in children of a large gastroenterological center in the Russian Federation. This retrospective single-center cohort study included 37 children diagnosed with EO-IBD between 2019 and 2024. Clinical and demographic data were collected from outpatient records. Intestinal symptoms (abdominal pain, stool frequency and consistency, pathological impurities) and EIMs were assessed. Special attention was given to the timing of EIM onset relative to intestinal symptoms.

Results

The study included 37 patients — 17 with Crohn’s disease (CD) and 20 with ulcerative colitis (UC) — all of whom were diagnosed before or at the age of 6. The median (Me) age at diagnosis was 5 years for both UC (IQR 3 – 6) and CD (IQR 4 – 6). The groups were comparable in terms of sex (p = 0.56) and age (p = 0.81). The median time from symptom onset to diagnosis was 10 months for UC (IQR 6.25 – 18) and 8.5 months for CD (IQR 5.5 – 15.8), with no significant difference between the groups (p = 0.74). Growth retardation (SDS < –2) was observed in four boys with CD at age 6. The most common symptoms in CD were abdominal pain (64.7% vs 60% in UC; OR 0.82; CI 0.22 – 3.12; p = 0.77) and weight loss (29.4% vs 7.1%; p = 0.019). Fever occurred exclusively in the CD group (35.3%). In contrast, UC was more frequently associated with diarrhea (90% vs 70.6% in CD; OR 3.75; CI 0.62 – 22.6; p = 0.13) and blood in stool (85% vs 64.7%; OR 0.32; CI 0.067 – 1.57; p = 0.15). EIMs were observed in 7 of 20 (35%) UC patients and 7 of 17 (41.2%) CD patients. The most frequent EIM in both groups was peripheral arthritis – found in 3 UC patients (10%) and 5 CD patients (29.4%) (p = 0.29). Peripheral arthritis was significantly more likely to occur after the onset of intestinal symptoms (p < 0.001). In two patients of each group, an EIM was the first manifestation of disease. In 43.2% of patients, an accurate diagnosis was not possible at disease onset, and they were initially classified as having IBD-unclassified (IBD-U). During follow-up, the time to establish a definitive diagnosis was measured. The median time to UC diagnosis was 24 weeks (IQR 20 – 48), and for CD it was 40 weeks (IQR 30–45.5) (p = 0.56).

Conclusion

EO-IBD in young children presents with specific phenotypic traits and a high rate of EIMs. Delayed diagnosis is common, particularly in cases initially classified as IBD-U. Our findings emphasize the need for early recognition and accurate differentiation of IBD subtypes in this challenging age group.

Disclosure

No financial support has been provided for this work. The authors declare that there is no conflict of interest.