Introduction

Shared decision-making is defended as an ideal model in the management of patients with chronic pathology, namely inflammatory bowel disease (IBD). The objective of this study was to identify knowledge gaps in IBD population, as well as correlate with patient demographic and sociocultural factors, to implement strategies aimed at improving care provision and patient empowerment.

Aims & Methods

Application of a survey to patients with IBD under biological therapy in a Day Hospital, from March 4^th to 22^nd 2024, and subsequent descriptive analysis.

Results

Out of the 102 patients with IBD (65% Crohn's Disease, 31% Ulcerative Colitis), 53% were men and 47% women, the majority of whom are Portuguese up to 50 years of age, with at least secondary education. The majority obtains information through health professionals and the Internet. The self-assessment of knowledge was higher than the demonstrated knowledge (90% consider themselves to be informed). The majority prefers to obtain oral information from health professionals or information leaflets (although only 50% had received information leaflets prior to starting biologics). The population over 50 years old, with a lower level of education and diagnosed more than 2 years ago, tends to have important knowledge gaps. 46% are unaware what medication can worsen the disease and 24% are unaware of the impact of tobacco. 56% of patients believe that a restrictive diet should be preferred, with 59% never being evaluated by a nutritionist, although 63% have already discussed this topic with their doctor. 85% of women are unaware of the implications of IBD on fertility, pregnancy and breastfeeding, particularly the population under 30 years of age and with a lower level of education.

Conclusion

The application of a survey across IBD population under biological therapy allowed to detect important gaps in the transmission of information adapted to each patient and identify key points to be optimized during the medical appointment or in dedicated Nursing and Nutrition appointments.

References

1. Xu D, Zhang H, Chen Y. Patients' views of shared decision making in inflammatory bowel disease: a survey in China. BMC Med Inform Decis Mak. 2021 Dec 6;21(1):340. doi: 10.1186/s12911-021-01702-8. PMID: 34872536; PMCID: PMC8650369.
2. Al Khoury, A., Balram, B., Bessissow, T. et al. Patient Perspectives and Expectations in Inflammatory Bowel Disease: A Systematic Review. Dig Dis Sci, 1956–1974 (2022). https://doi.org/10.1007/s10620-021-07025-y
3. A.F.A. Neto, P.M.N. Figueiredo, C. Correia. Patient Empowerment in Inflammatory Bowel Disease– Regarding Shared Decision-Making in the Treatment of IBD. Revista Portuguesa de Coloproctologia. Maio/Agosto 2022.
4. Song K, Wu D. Shared decision-making in the management of patients with inflammatory bowel disease. World J Gastroenterol. 2022 Jul 14;28(26):3092-3100. doi: 10.3748/wjg.v28.i26.3092. PMID: 36051346; PMCID: PMC9331519.

Introduction

Inflammatory bowel diseases (IBD) often affect women of childbearing age, complicating pregnancy management. These patients face medical and psychological challenges.

Aims & Methods

The aim of our study was to investigate the perception and the experience of pregnancy in IBD patients. A cross-sectional study was conducted between August and September 2024. A structured questionnaire was distributed through the national Tunisian association of IBD patients. It aimed to assess the impact of pregnancy in Tunisian women with IBD, focusing on complications, treatment adjustments and psychological effects.

Results

In total, 63 patients with IBD (Crohn Disease: 47.6 %, ulcerative colitis: 52.4%) responded to the questionnaire. Demographically, 1.6% were aged 18-25, 49.2% were 26-35, 31.7% were 36-45 and 17.5% were over 45 years old. In terms of educational level, 71.4% had completed university studies. Disease duration was over 10 years for 49.2% of the patients, 5-10 years for 27%, and less than 5 years for 23.8%. Pregnancy was planned in 68.3% of the cases. A significant proportion of patients 76.2% were afraid that IBD may lead to a complicated pregnancy and 60.3% worried about pregnancy’s impact on disease. To address these concerns, 74.6% sought information through internet and social media. Complications occurred in 55.6% of patients, mainly disease flares (34.9%), nutritional deficiencies (15.9%) and prematurity (14.3%). Colonoscopies were required in 20.6% of the pregnant patients. Regarding treatment, 46% were on aminosalicylates, 17.5% on azathioprine, 7.9% on anti-TNF, 3.2% on corticosteroids and 25.4% received no treatment during pregnancy. Therapeutic adjustment was made in 39.7% of the patients and a good compliance was reported in 54%. Concerns about treatment side effects affected 69.8% of the participants and 73% sought more information on treatment risks. Patients evaluated pregnancy’s impact on quality of life as low in 47.6% of cases, moderate in 33.3% and high in 19%. Disease perception improved in 30.2% of the participants, remained unchanged in 49.2% and worsened in 20.6%. In terms of mental health, 49.2% of the patients had anxiety, 11.1% had depression, and 28.6% reported general well-being. Patients with history of surgical treatment were more likely to have planned pregnancy (p=0.013). Individual research over the disease was significantly associated with long disease course (p=0.011) and high educational level (p=0.014). Low adherence to treatment was significantly higher in patients with high concerns about side effects (p=0.013). Regarding expectations, 63.5% of the patients expressed a desire for better collaborative care between obstetricians and gastroenterologists and 52.4 % would like to have psychological support.

Conclusion

This study highlights the need for holistic care to improve the management and quality of life for pregnant women with IBD.

Introduction

Aims & Methods

Results

Conclusion

References

Introduction

Inflammatory bowel disease (IBD) is strongly associated with joint inflammation, as is highlighted by the high prevalence of spondyloarthritis (SpA) in patients with IBD (up to 13%) compared to the general population (0.2-1.6%) [1, 2]. IBD and SpA have many overlapping features, including genetic risk factors, changes in the gut microbiota, and therapies targeting TNF-α , IL-23, or JAK [3]. However, current therapies for both diseases are unable to break the cycle of chronic inflammation, and still a significant proportion of patients fail to respond. Disease heterogeneity likely plays a role in this [4, 5], underscoring the necessity to improve management and refine classification.

Aims & Methods

In this study, 92 inflammation-related proteins were quantified in serum of patients from one IBD and one SpA cohort using the novel Olink proteomics proximity extension assay. Fold changes (FC) in expression with |log₂FC| > 0.5 were considered meaningful, and false discovery rates (FDR) <0.05 were considered significant. The IBD cohort existed of 255 IBD patients with (n=155) and without (n=100) self-reported joint complaints [8]. From the patients with joint complaints, 58 fulfilled any of the SpA criteria. The SpA cohort, or SPACE cohort, consisted of 169 patients with chronic back pain (≥3 months, ≤2 years) of unknown origin [9]. After 2 years of follow-up, 85 patients had proven axSpA. Serum samples were taken at baseline, and 167/169 samples from the SPACE cohort and 241/255 samples from the IBD cohort passed quality control and were included in the analysis.

Results

Thirty-four proteins were differentially expressed between 95 IBD patients without joint complaints and 85 proven axial SpA (axSpA) patients from the SPACE cohort, of which 14 were higher in IBD patients (including 4E‑BP1, IFN‑γ, TNF, FGF‑21, CD8A, and CCL9), and 20 were higher in axSpA patients (including CASP‑8, SIRT2, STAMBP, FGF‑19, ST1A1, and EN‑RAGE). In addition, the immune profile of IBD patients with joint complaints differed from IBD patients without joint complaints: 4E‑BP1, CASP-8, STAMBP, SIRT2, AXIN1, and TNFSF14, were significantly upregulated in patients with joint complaints. Of note, if IBD patients without joint complaints were compared to the subgroup of 58 patients with joint complaints who met criteria for SpA, the same proteins showed significant upregulation, suggesting minimal difference between IBD patients with joint complaints who meet or who do not meet SpA criteria. Direct comparison of patients who met and who did not meet SpA criteria within the group of IBD patients with joint complaints indeed showed no noteworthy difference in serum immune profile. Within the SPACE cohort, comparison of patients with chronic back pain with and without axSpA diagnosis also showed no significant difference in serum protein expression.

Conclusion

This study shows that patients with axSpA versus patients with IBD without joint complaints have differing serum immune profiles. Within IBD patients with self-reported joint complaints and within patients with self-reported chronic back pain (from the SPACE cohort), no distinct difference in immune profile is observed, regardless of SpA diagnosis. The inflammation signatures of patients with chronic inflammatory diseases should be further investigated to provide insights for enhancing disease management in the future.

References

1. Karreman, M.C., et al., The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis, 2017. 11(5): p. 631-642.
2. Stolwijk, C., et al., Global Prevalence of Spondyloarthritis: A Systematic Review and Meta-Regression Analysis. Arthritis Care Res (Hoboken), 2016. 68(9): p. 1320-31.
3. Gracey, E., et al., Revisiting the gut-joint axis: links between gut inflammation and spondyloarthritis. Nat Rev Rheumatol, 2020. 16(8): p. 415-433.
4. van Unen, V., et al., Mass Cytometry of the Human Mucosal Immune System Identifies Tissue- and Disease-Associated Immune Subsets. Immunity, 2016. 44(5): p. 1227-39.
5. Gulino, G.R., M. Van Mechelen, and R. Lories, Cellular and molecular diversity in spondyloarthritis. Semin Immunol, 2021. 58: p. 101521.
6. van Erp, S.J., et al., Classifying Back Pain and Peripheral Joint Complaints in Inflammatory Bowel Disease Patients: A Prospective Longitudinal Follow-up Study. J Crohns Colitis, 2016. 10(2): p. 166-75.
7. Marques, M.L., et al., Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort. Ann Rheum Dis, 2024. 83(5): p. 589-598.

Disclosure

FAG: grants from Stichting vrienden van Sole Mio and Stichting ASAS, grants and/or consulting fees from Abbvie, ASAS, BMS, Galapagos, Janssen, Lilly, Novartis, Pfizer, and UCB.
AEM: grants from Nestle, Norgine, Cablon, Galapagos, and ZonMW, ad boards/speaker fees from Tramedico, Janssen, Takeda, Galapagos, Vedanta, Ferring, AbbVie, and Dear Health.
PV: speaker fees from Takeda and Galapagos, advisory board: Takeda, Galapagos, Lilly, BMS, Janssen, and Abbvie

Introduction

Inflammatory bowel disease (IBD) and atopic diseases, namely asthma, atopic dermatitis (AD), and atopic rhinoconjunctivitis (AR) show a rising prevalence worldwide and share some genetic and epidemiological risk factors. Consequently, observational studies have explored the potential association between IBD and atopic diseases, with some conflicting data.

Aims & Methods

The objective of this study was to systematically review and summarize the current evidence on the co-occurrence of IBD and these atopic diseases.
We searched Medline, Embase, Web of Science and CENTRAL (from inception to August 14, 2022) to identify observational studies on the incidence or prevalence of IBD in atopic diseases (asthma, AD; AR) and vice versa.

Results

We included 23 observational studies (17 cohort, 4 case-control, 2 cross-sectional) on the association between IBD and asthma, comprising approximately 2 million patients; 17 of them showed a positive association and only one study showed a negative association. Nineteen studies (12 cohort, case-controls, 4 cross-sectional) on the association between IBD and AD were included, with approximately 2,6 million patients; 16 showed a positive association and 3 showed no association. We included 4 cohort studies on the association between IBD and AR, covering approximately 2,2 million patients which all showed a positive statistically significant association.

Conclusion

Published literature supports that IBD is associated with asthma, AD and AR, and vice versa. These results may increase gastroenterologists’ awareness for these diagnoses so that timely management can be initiated. Additional research is needed to determine if one disease influences the risk of developing the other or if the frequent co-occurrence of these diseases results from shared genetic, environmental and microbial factors. As far as the author’s know, this is the first systematic review that reports the association between IBD and the three main atopic diseases.

Introduction

Infection by Leishmania spp. in patients diagnosed with inflammatory bowel disease (IBD) is an uncommon infectious complication. The use of anti-TNF-α is well known risk factor for Leishmania infection (LI), particularly in some endemic areas, but only a few case series have been reported in the literature, mainly in the Mediterranean basin.

Aims & Methods

Aim: To evaluate the main demographic, IBD-disease features and risk factors as well as LI disease characteristic and required treatment among IBD patients who develop LI.
Methods: This is a retrospective, observational, multicenter study conducted in twenty-five Spanish hospitals, promoted by the Young Group of GETECCU, including patients diagnosed with IBD and subsequent diagnosis of LI.

Results

We collected a total of 73 patients, 48 of them were men (65.8%) with a mean age of 48 ± 15.06 years. 92% of patients resided in the Mediterranean basin, an endemic area of Leishmania. Only 1 patient was born outside of Spain. Nineteen percent of patients were smokers and 16.4% had some comorbidities.
Fifty patients had Crohn's disease (CD) (68.5%) with ileocolonic involvement (30.1%) and inflammatory behaviour (45.2%) and 42.9% had perianal disease. 94% of CD patients were on clinical remission at the time of LI diagnosis. In addition, 23 patients had ulcerative colitis (UC) (31.5%), being extensive colitis the most frequent extent (78.3%), and all of them were on clinical remission or had mild disease activity. 69 patients (94.5%) were under immunosuppressive and/or biologic treatment during the 6 months prior to the LI. 6.8% were on immunosuppressants monotherapy, 42.5% in combotherapy and 38.4% under biologic monotherapy. Regarding biological treatment, 97% of patients were under AntiTNF and only 2 patients were under treatment with Ustekinumab.
Regarding the characteristics of LI, 62 patients presented cutaneous involvement (85%), 9 visceral (12%) and the rest presented mucocutaneous involvement.
Symptoms associated to LI were fever (9.6%), abdominal pain (4.1%) and constitutional syndrome (8.2%), moreover 24.7% required hospital admission. Regarding the location of the skin lesions, the most frequent were the upper limbs (35.6%) followed by lower limbs (30.1%).
The treatment used for LI was systemic amphotericin in 60.3% of patients and pentavalent antimonials in 35.4%; the remaining patients were treated with other treatments, including miltefosine. LI solved at one month in 33 patients (45.2%) and at one year in 95.3% of patients, and only 11% of patients had recurrent LI.
Treatment was stopped temporarily in 38.4% of patients and definitively in 27.4%, starting Ustekinumab (36.8%), Vedolizumab (15.8%) and antiTNF (10.6%) and the rest of the patients remained without biological treatment after the LI.

Conclusion

The usage of antiTNF is associated to LI in IBD patients, but LI could also happen under inmunossupresants or ustekinumab therapy. Although cutaneous involvement is the most frequent manifestation, 12% of patients have visceral involvement or LI recurrences. This infectious complication should be considered in IBD patients in endemic areas.

Disclosure

No Conflict of Interest.

Introduction

Disease-specific knowledge plays a central role in chronic disease management. In patients with inflammatory bowel disease (IBD), limited knowledge is linked to poorer perceived health and increased discomfort (1).

Aims & Methods

This study assessed disease-specific knowledge among adult patients with IBD at a tertiary center and defined existing knowledge gaps. Factors associated with higher or lower levels of knowledge were explored.
The retrospective cohort study included 392 IBD patients who completed a comprehensive questionnaire between March 2020 and April 2021 (2). Questionnaire responses were analyzed alongside clinical records to quantify disease-specific knowledge. A scoring system was developed to quantify disease-specific knowledge (0–8 points), based on correct diagnosis, Montreal classification, complications, and current therapies. Scores were categorized as low (0–5) or high (6–8) knowledge levels. Associations between knowledge levels and disease-related, sociodemographic, and psychosocial factors were analyzed using logistic regression analysis.

Results

While most patients correctly identified their diagnosis (kappa: 0.863, CI: 0.816–0.905, p < 0.001) and advanced treatment (e.g. infliximab: kappa: 0.959, CI: 0.925–0.983, p < 0.001), knowledge gaps were observed regarding disease location (e.g. isolated proctitis in ulcerative colitis: kappa: 0.101, CI: –0.051–0.341, p = 0.128), complications, comorbidities, and certain other medications. In the univariate analysis a higher knowledge level was found in patients with Crohn’s disease, younger age at diagnosis, in patients with no disease activity, and treatment with biologics, in those receiving disability pension and in patients with a high Perceived Stress Questionnaire (PSQ) score for worries (table). A younger age at diagnosis (p = 0.028) and having Crohn’s disease (p < 0.001) were independently associated with higher knowledge levels whereas active disease was associated with lower disease-specific knowledge.
Table:
Univariate logistic regression analysis for items significantly associated with higher knowledge levels

Conclusion

Significant disease-specific knowledge gaps were identified, particularly concerning disease location, complications, and comorbidities. Targeted patient education should focus on addressing these specific deficits in susceptible groups.

References

1. Tormey LK, Reich J, Chen YS, Singh A, Lipkin-Moore Z, Yu A, et al. Limited Health Literacy Is Associated With Worse Patient-Reported Outcomes in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25:204–12.
2. Koletzko L, Klucker E, Le Thi TG, Breiteneicher S, Rubio-Acero R, Neuhaus L, et al. Following Pediatric and Adult IBD Patients through the COVID-19 Pandemic: Changes in Psychosocial Burden and Perception of Infection Risk and Harm over Time. J Clin Med. 2021;10:4124.