Introduction

Irritable bowel syndrome (IBS) is a common functional disorder caused by an imbalance in the brain-gut axis. Visceral hypersensitivity (VHS) plays a leading role in the pathogenesis of IBS, leading to pain syndrome. To assess pain syndrome in IBS, researchers usually rely on subjective patient reports using a visual analogue scale (VAS), which does not reflect VHS and does not allow for an objective evaluation of clinical manifestations of the disease or the effectiveness of therapy.

Aims & Methods

Aim: To study the value of the balloon-dilation test (BDT) in determining the threshold of visceral sensitivity and its potential for evaluating therapy effectiveness in patients with IBS with diarrhea (IBS-D).
Materials and methods: 46 patients with severe IBS-D (Drossman DA, 1999) were examined, including 24 women with a median age of 31 (25;39) years and 22 men with a median age of 28.5 (23;35) years. The diagnosis corresponded to Rome IV criteria. Pain syndrome in IBS-D was evaluated using a 10-point VAS. BDT was performed to determine the threshold of visceral sensitivity. Patients were consulted by a psychiatrist to identify mental status disorders and prescribe antidepressants. Therapy effectiveness was evaluated after 8 weeks. Statistical analysis was performed using Statistica 12 software (StatSoft Inc., USA). The level of significance was set at p <0.05.

Results

In all patients with IBS-D, the severity of pain (VAS) reached 8 (7;10) points. BDT revealed a violation of all visceral sensitivity parameters (VSP) (see Table 1). Mental status disorders were detected in all patients: 56.4% had anxiety, 26.12% had anxiety-depression, and 17.48% had depressive disorders. After 8 weeks of therapy, a significant decrease in the level of pain syndrome from 8 (7;10) to 1 (0;3) points on VAS was noted (p <0.05).

Table 1. Dynamics of visceral sensitivity parameters according to BDT

Indicator (ml)	Before treatment	After treatment	Wilcoxon, p-value
	Me (25%; 75%)
First urge	32(21;43)	78 (72;86)	p <0,05
Intense urge	40(30;54)	98(86;113)	p <0,05
Maximally tolerated volume	59 (50;71)	134(116;198)	p <0,05

According to BDT, the threshold of VHS significantly improved in all patients: the maximal tolerable volume of air in the balloon increased, and the first urge to defecate occurred later (see Table 1). After antidepressant therapy, the mental status of patients improved: anxiety disorders were alleviated, anxiety-depressive disorders persisted in 8.7%, and depressive disorders in 10.9% with minimal severity.

Conclusion

BDT allows for an objective characterization of VHS and provides a quantitative assessment of pain syndrome in IBS, unlike the subjective VAS scale. In the examined group of patients with IBS-D, an increase in the threshold of VHS was noted after antidepressant therapy, leading to pain syndrome remission. Manifestations of mental disorders decreased, leading to IBS-D remission.

Introduction

Ulcerative colitis (UC) is a chronic inflammatory disorder characterized by periods of relapse and remission. Current treatment options aim to achieve mucosal healing and sustain long-term remission, yet many patients experience treatment failure. Filgotinib (FIL), a selective JAK1 inhibitor, has emerged as a promising therapeutic agent in UC management with favorable outcomes in clinical trials. This study aimed to evaluate the real-world efficacy and safety of FIL in patients with moderate-to-severe UC.

Aims & Methods

We conducted a multicenter, observational, retrospective study involving adult patients with moderate-to-severe UC who were treated with FIL within the ENEIDA registry, a nationwide prospectively-maintained database. Data were collected from 32 Spanish IBD units between 12/2021 and 10/2024. Patients were eligible if they had an established diagnosis of UC, had been initiated on FIL and without previous colectomy. The primary outcome was clinical remission (defined as partial Mayo ≤2 with no subscore >1 and no rectal bleeding) at week 12 and 52, along with its safety profile.

Results

A total of 100 patients were included (mean age of 38.1 years (SD 18), 58% male, and a median disease duration of 98 months [IQR, 37-166], 61% non-smokers, 18% extraintestinal manifestations). Most of them had extensive (51%) or left-sided colitis (40%). Prior exposure to anti-TNF was present in 81%, vedolizumab in 42%, and ustekinumab in 34%, with 18% also exposed to JAK inhibitors; including 27% exposed to >2 mechanisms. The majority of patients had Mayo 2 or 3 endoscopic score at baseline (88%). All but 2 patients started FIL 200 mg bid (98%) and 30% received concomitant steroids or immunosuppressants (4%).
Steroid-free clinical remission was 43% and 32% after 12 and 52 weeks, respectively. FIL persistence was 62% with median treatment duration of 7 months (IQR, 4-11). Among those previously exposed to JAK inhibitors, persistence was 83% and 39% after 12 and 52 weeks, respectively. This subgroup showed steroid-free clinical remission rates of 33% and 14%, respectively. Overall, hospital admission was indicated in 6% and colectomy in 1%.
FIL was generally well-tolerated, with 17% of patients reporting at least one adverse event, 18% of them considered as serious, including herpes zoster infection in 2% (both vaccinated, 1 severe infection requiring FIL withdrawal), with no cardiovascular or thromboembolic events reported.

Conclusion

In this real-world, multicenter observational study, FIL demonstrated its efficacy in the induction and maintenance of clinical remission in patients with active UC. The real-world safety profile was consistent with previous data, with no unexpected adverse events. These findings support FIL as a valuable therapeutic option in the management of UC.

Disclosure

IRL has received financial support for traveling and educational activities from or has served as an advisory board member for Abbvie, Adacyte, Alfasigma, Biogen, Chiesi, Faes Farma, Ferring, Fresenius Kabi, Galapagos, Johnson & Johnson, Eli Lilly, Mirum Pharmaceuticals, Merck, Pfizer, Roche, Takeda, and Tillotts Pharma. Research support from AbbVie. IRL is supported by a research grant from Gobierno Vasco-Eusko Jaurlaritza [Grant No 2020111061 and 2023222006].

Introduction

Microplastic particles (MPs) have previously been confirmed to be found in the human body and are suspected to lead to systemic health effects (1). One biological matrix in which MPs have been detected is human faeces (2). While there is growing evidence suggesting potential impacts on the gut microbiome from animal (3) and in-vitro/ex-vivo studies (4), studies investigating this relationship in the human are still lacking.

Aims & Methods

This pilot study aimed to investigate the impact of short-term plastic reduction on the gastrointestinal tract of healthy participants, focussing on MP presence and gut microbial composition.
Sixty healthy volunteers participated by providing two stool samples: one prior to and one after a seven-day intervention during which they actively minimized plastic exposure. To facilitate the reduction, participants were provided with plastic-free alternatives (e.g., glass water bottles, wooden kitchen utensils, plastic-free dental care products, tin lunch boxes), together with instructions on how to avoid plastic-packaged goods and find alternatives. Dietary habits and plastic contact were recorded using detailed questionnaires to assess behavioural changes and identify potential sources of exposure. Stool samples were analysed using 16S rRNA gene sequencing for changes in microbial diversity and potential differential taxa. Additionally the samples were frozen at –80°C for future MP quantification, where method development is ongoing.

Results

Fifty-five participants completed the study, with an average self-reported success rate of 76% in adhering to the intervention. Forty percent of participants fully avoided plastic packaging, while 56% achieved partial avoidance. Participants noted challenges, particularly in avoiding plastic in meat and dairy products and during restaurant visits. Despite these obstacles, 92.7% expressed a lasting commitment to reducing plastic use post-intervention, with many reporting intentions to continue purchasing fresh products, reduce fast food intake, and adopt sustainable household practices, especially replacing plastic utensils. Initial microbiome analysis revealed no significant changes in alpha or beta diversity following reduced plastic exposure; however, differential abundance analysis identified potential specific taxa shifts. One species each within the genera Clostridium, Ruminococcus, and Blautia showed reduced abundance post-intervention, while species from the genera Bacteroides and Anaerostipes were associated with increased abundance after plastic fasting.

Conclusion

A short-term reduction in plastic exposure is feasible and can effectively raise awareness and promote long-term behavioural change in plastic consumption habits. However, no significant changes in gut microbial diversity were observed within the study period, with only shifts in a limited number of species visible. Due to the stability of the gut microbial composition, longer changes in plastic exposure might be necessary to trigger stronger effects.

References

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(2) Schwabl, P., Köppel, S., Königshofer, P., Bucsics, T., Trauner, M., Reiberger, T., & Liebmann, B. (2019). Detection of Various Microplastics in Human Stool: A Prospective Case Series. Annals of internal medicine, 171(7), 453–457. https://doi.org/10.7326/M19-0618
(3) Hirt, N., & Body-Malapel, M. (2020). Immunotoxicity and intestinal effects of nano- and microplastics: a review of the literature. Particle and fibre toxicology, 17(1), 57. https://doi.org/10.1186/s12989-020-00387-7
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