Introduction

Inflammatory bowel diseases (IBD) have a peak incidence between the second and fourth decade of life, affecting women with IBD during their reproductive years, with fear, uncertainty, and poor knowledge of how the disease can impact their life. Our study aimed to assess the impact of IBD on the reproductive life of female patients with this condition.

Aims & Methods

Women aged 18-65 years with IBD followed at the IBD Unit of the Academic Hospital of Padua were enrolled. They were asked to complete a dedicated questionnaire while sitting in the waiting room for their routine follow-up visit. During the same period, healthy women of the same age were recruited among staff, familiars, and friends. Demographic and clinical data, information on fertility, hormonal therapy, endometriosis, pregnancy, and breastfeeding were collected. Logistic regression was used to analyze the risk of having specific outcomes in IBD compared to controls, expressing as odds ratio (OR) and 95% Confidential Intervals (CI). The statistical significance was set at 0.05.

Results

We enrolled 457 women, out of whom 228 had IBD, and 229 were age-matched healthy controls. The use of oral contraceptives was similar between patients and healthy controls. However, 52.5% of women with IBD took contraceptives for menstrual cycle disorders, whereas 60.5% of the healthy controls for the contraceptive purpose (p=0.003). The risk of infertility (OR 1.76, 95% CI 0.78-3.94) and endometriosis (OR 1.39, 95% CI 0.63-3.10) were similar between patients and healthy controls. The percentage of spontaneous and voluntary abortions was significantly higher in IBD patients than healthy controls (OR 2 and 3.62, respectively). The risk of pregnancy-related complications in the IBD population was more than 6 times higher in patients who experienced disease reactivation during pregnancy than in those with persistent remission (OR 6.9, 95% 1.51-31.28). Finally, we found that the chances of breastfeeding were 66% lower in patients with IBD than in controls (OR 0.44, CI 95% 0.22-0.91).

Conclusion

Our study underlines the negative impact of IBD on women's reproductive life and the importance of adequate counseling from the moment of conception choice to pregnancy and lactation. This will allow better management of the disease and reduce the impact of IBD on the daily life of IBD women.

References

Torres J., Chaparro M., Julsgaard M., et al. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis. 2023; 17:1-27

Introduction

Despite debilitating symptoms, no standardized disease severity index exists for microscopic colitis (MC). This gap hinders alignment with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) standards, which emphasize the importance of patient-reported outcome measures (PROMs) in new therapy approval.

Aims & Methods

This study aimed to validate the Microscopic Colitis Symptom Questionnaire (MCSQ) and develop the Microscopic Colitis Score (MCS), a novel disease severity index.
This prospective, multicenter study included 131 patients with biopsy-confirmed MC (67 remission, 64 active disease). Patients completed MCSQ and HRQoL assessments (IBDQ-32, SHS) at baseline and follow-up. Clustering analysis systematically identified distinct disease severity groups. MCS was developed as a composite score derived from MCSQ.

Results

Factor analysis revealed a three-factor MCSQ model with good internal consistency (Cronbach’s alpha = 0.88). Test-retest reliability (ICC=0.88) and responsiveness to treatment (p<0.01) of all MCSQ items were high. MCS, ranging from 0 (asymptomatic) to 15 (maximum symptoms), correlated strongly with HRQoL measures such as IBDQ-32 total score (r_p=-0.78), IBDQ-32 bowel symptoms (r_p=-0.80) and SHS bowel symptoms (r_s=0.69). Receiver-operating characteristic curves indicated that MCS could accurately identify patients in remission (as per Hjortswang criteria; AUC=0.85), as well as mild (AUC=0.97), moderate (AUC=0.93), or severe disease (AUC=0.96).

Conclusion

MCSQ and MCS are valid, reliable, and responsive tools that meet FDA and EMA standards. Both accurately reflect the diverse symptoms of MC. Compared to the binary Hjortswang criteria, MCS provides a nuanced evaluation of disease activity and holds promise for assessing therapeutic efficacy in future trials.

Disclosure

This work was supported with research grants from Mag-tarmfonden (grant 1–23 and 5-24) and Region Östergötland.
KPL has received speaker fees from Eli Lilly and Takeda; research support from Takeda and Ferring. YZ has received support for conference attendance, speaker fees, research support and consulting fees from: AbbVie, Adacyte, Alfa-Sigma, Almirall, Amgen, Boehringer Ingelheim, Dr Falk Pharma, FAES Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen, J&J, Kern, Eli Lilly, MSD, Otsuka, Pfizer, Sanofi, Shire, Takeda, Tillots. AMü has received speaker fees from Tillotts, Ferring, Eli Lilly, Falk Foundation, Jansson, Vifor; research support from Ferring.

Introduction

Microscopic colitis is a chronic inflammatory condition defined by a clinical triad: chronic diarrhea, endoscopy without significant abnormalities, and distinct histopathological features characterized by a largely normal appearance of the mucosa but increased numbers of lymphocytes in the epithelium and lamina propria on microscopy.

Aims & Methods

This study aims to explore the relationship between clinical presentation and histopathological features in microscopic colitis, with a focus on identifying prognostic factors linked to therapeutic response and symptom resolution.
This is a retrospective, descriptive study conducted over a 10-year period (September 2015 to May 2025), involving 54 patients diagnosed with microscopic colitis based on histological examination of colonic biopsies. Among them, 19 cases were identified as collagenous colitis and 35 as lymphocytic colitis. Data collected included epidemiological, clinical, endoscopic, histopathological, therapeutic, and follow-up information.
The histological parameters assessed were: characteristics of the lamina propria, intraepithelial lymphocytosis, presence and thickness of the subepithelial collagen band, and surface epithelial damage.

Results

A total of 54 cases of microscopic colitis were included in the study, among which 51 patients (94.4%) presented with chronic diarrhea, with a median of 7 diarrheic stools [IQR: 4.5–10.5]. One patient with lymphocytic colitis had concomitant celiac disease. Concerning medication use, 2 patients (3.7%) were taking proton pump inhibitors, and 3 (5.6%) were on venotonic agents.
Our analysis revealed several statistically significant correlations:

• A very strong positive correlation between the number of intraepithelial lymphocytes (IELs) and the frequency of diarrheal stools (r = 0.873; p < 0.001).

• A strong positive correlation between the number of diarrheal stools and the rate of clinical improvement (r = 0.633; p < 0.001).

• A strong association between subepithelial collagen band thickness and clinical improvement (r = 0.509; p < 0.001).

In addition, patients with an IEL count <30% experienced a significantly faster clinical response compared to those with ≥30%, with a median time to symptom resolution of 2 weeks versus 4 weeks, respectively (p < 0.001). Similarly, patients with subepithelial collagen band thickness <20 µm showed more rapid improvement than those with ≥20 µm (median time to improvement: 2 weeks vs. 6 weeks; p < 0.002).
Regarding treatment, 49 patients (90.7%) received budesonide, while 5 (9.3%) were managed with loperamide. A follow-up histological assessment performed 12 months after treatment initiation showed complete normalization of the colonic mucosa in all patients.

Conclusion

Microscopic colitis is a common cause of chronic diarrhea and represents a treatable condition. Accurate diagnosis relies on the recognition of characteristic histopathological features, highlighting the importance of a thorough histological assessment. The integration of clinical context with microscopic findings enables the pathologist to establish a confident diagnosis in most cases and to provide the gastroenterologist with precise and clinically relevant information.

Introduction

Crohn’s Disease patients (CD) with early complicated behaviour (stenosis or fistula) are thought to have a more severe long-term disease course. To address this question, we focused on ileal CD that requires early intestinal resection after diagnosis. We aimed to assess the impact of the time to surgery from diagnosis on the risk of severe disease course in patients with ileal CD undergoing a primary ileocecal resection (ICR) or ileal resection (IR).

Aims & Methods

All CD patients who underwent ICR or IR between January 2001 and December 2015, followed in two Inflammatory Bowel Disease (IBD) tertiary centres in France were included. Data were retrieved using dedicated IBD database and patients’ medical records. Early resection was defined as a surgery performed within 6 months after diagnosis. Two control groups with patients who underwent the first surgery between 6 months and 2 years and between 2 and 5 years after diagnosis were enrolled. The primary outcome was second intestinal resection. Secondary outcomes included the need for biologic treatment after initial intestinal surgery. Patients were followed from the date of first surgery until September 2022. Kaplan Meier survival analysis and log-rank test were used to estimate the survival without second intestinal resection and biologic initiation according to the time of first intestinal resection to diagnosis.

Results

Among 396 patients who underwent ICR or IR within 5 years after diagnosis, 130 (32.2%) patients had undergone surgery within 6 months after diagnosis (Group A), 130 (32.2%) patients between 6 months and 2 years (Group B) and 136 (33.7%) patients between 2 and 5 years (Group C). Clinical data are shown in Table 1. The cumulative risk of a second ICR or IR ten years after the first surgery was 25.2% (95% CI 12.5 - 40.2) in group A, 16.2% (10.0 - 25.8) in group B and 22.8% (9.8 – 39.1) in group C, without statistically significant difference (p = 0.22). The risk of biological exposure after the first surgery was significantly different in the three groups (p = 0.006). The cumulative risk to start a biologic therapy at ten years was 47.4% (37.9 – 57.9) in group A, 56.4% (46.5 – 66.7) in group B and 63.6% (53.6 – 73.6) in group C.

Conclusion

In a bicentric cohort with long-term follow-up, intestinal resection within 6 months of CD diagnosis was not associated with an increased risk of second surgery as compared to patients with primary ICR/IR later after diagnosis. Furthermore, patients with early intestinal resection did not need more biological therapies after the first surgery. On the contrary, patients with early resection had less need for biologic after first surgery. These data suggest that early intestinal resection in CD is not a predictor of poor long-term prognosis.