Introduction

Information and communications technology (ICTs) include computer applications for dialogical, informative, or social use. ICTs are resources in the management of chronic diseases such as inflammatory bowel disease (IBD).

Aims & Methods

To understand their use by IBD patients in Latin America (LatAm), we aimed to assess the barriers and preferences (B&P) of ICTs in this population. From May to June 2022, 17 centers from 9 Spanish-speaking countries in LaTam were invited to participate in a survey-based-study to assess patients with IBD. A 351 cases sample was calculated. Included patients were >15-year-old, with IBD confirmed by histopathology. Patients diagnosed <6 months, hospitalized, without IBD-specific treatment, with psychiatric or oncological disease, health care providers, and unable to answer the survey were excluded. An ad-hoc, anonymous, and online survey was designed. The use of ICTs was estimated using a Likert scale. Surveys with >25% blank data were excluded; in those with <25%, blank questions were counted as such. A sample of 205 was calculated.

Results

341 cases from 11/17 centers of 6/9 countries were included: Argentina 216, Uruguay 58, Ecuador 33, Chile 16, Peru 12, Paraguay 6. Median age was 37 /28-51) years; 200 (58.7%) females; 240 (70.4%) ulcerative colitis (UC), 90 (26.4%) Crohn’s Disease (CD), and 11 (3.2%) indeterminate colitis (IBDU); 14 (4.1%) rurality; 158 (46.3%) complete secondary education, and 111 (32.6%) higher education. 306 (89.7%) owned a smartphone. WhatsApp (WA) was the most frequently used ICT by 325 (95.3%), followed by Instagram (Ig) 199 (58.4%), email 195 (57.2%), Facebook (Fb) 192 (56.3%), and YouTube (YT) 175 (51.3%). For IBD-specific purposes, the most used were WA 130 (38.1%), Fb 93 (27.3%), email 83 (24.3%), YT 73 (21.4%), and Ig 72 (21.1%). 48% used at least one ICT daily. 61.3% stated that they totally/strongly agreed to use ICTs to seek information on self-care measures, 57% diets, and 54% symptoms. Only 15.8% stated that this information was easily accessible, 45.7% easy to understand, 34.9% of good quality, and 25% were concerned about data privacy. 91.5% stated that they would use an IBD-specific application to obtain updated information on IBD and 88.6% stated a preference for mobile-availability (Figure 1).

Conclusion

IBD patients in LatAm use different ICTs for IBD-specific purposes. ICTs are means to transmit information and maintain communications with and among patients with IBD. However, it is necessary to improve access, accuracy, and understanding of such resources while ensuring patient data privacy. To our knowledge, this is the first study to describe B&P with ICTs use in LatAm IBD patients. NCT04893928.

Disclosure

Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, EndoSound, and mdconsgroup. The other authors declare no conflicts 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.

Introduction

The use of mobile Health applications (mHealth apps) is increasingly frequent as telehealth provides clinical support for patients with chronic pathologies, including health education, symptom surveillance, follow-up, and promotes therapeutic adherence and compliance. There are mHealth apps directed to patients with inflammatory bowel disease (IBD) that have shown to significantly improve IBD disease knowledge level, therapeutic adherence, and even quality of life. Nevertheless, the vast majority is not available in Spanish, thus have limited access and use, no documented validation or user-patient acceptance test (UAT), little multifunctionality and/or difficulty handling.

Aims & Methods

We developed a multifunctional and intuitive free access mHealth app directed to Spanish speakers with IBD and we aimed to validate it with a UAT. The Development and Assessment of a Mobile Application for Sanitary Support in Spanish speakers with Crohn’s and ulcerative Colitis (DAMASCO) is an independent and multicenter project in Latin America. It is an observational, analytic, and prospective study. During this phase, a prototype mHealth app was designed in Adobe XD and a UAT was used in ambulatory IBD patients, with a ≥6 months diagnosis, cared for in a 3rd level hospital during July/2022. The UAT was performed on-line using the Mobile Application Rating Score (MARS), a tool of 30 questions scaled with Likert. It was taken as a reference a Likert (L) 4-5 (very good-excellent). MARS was translated from English to Spanish using the Sperber method. This study was approved by the institutional ethics committee (633 LMiP0Se/22).

Results

The prototype has the following purposes: symptom registry, medication reminder, pending studies, and food diary. Of the 40 people invited for the UAT, 38 accepted and 33 showed ≥75% of the MARS. The sample had a median age of 35 (29-45), 20/33 (60.6%) women, 22/33 (66.7%) ulcerative colitis, and 11/33 (33.3%) Crohn's disease. There was a higher score between questions related to functionality (L4-5 96%), followed by adherence to mHealth app (L4-5 80.3%), content (L4-5 76.5%), and design (L4-5 68.7%). mHealth app specific IBD evaluation had a very good-excellent score in 93.1% of the input. The mHealth app was rated with four and five stars by 20/33 (60.1%) and 5/33 (15.2%), respectively. There was a 1.4% input loss (Figure 1).

Conclusion

The recently developed mHealth app constitutes an intuitive, easy-to-use multifunctional free access tool highly accepted among Spanish speaking patients with IBD.

Disclosure

Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, and mdconsgroup. The other authors declare no conflicts of interest.

Introduction

Significant advances have been made in identifying biomarkers to predict IBD onset. With the use of predictive testing to identify individuals at risk of developing the disease, it would be possible to intervene and try to mitigate that risk. However, the feasibility of such strategy would depend on whether individuals at risk of developing IBD would be willing to undergo predictive testing and preventive interventions.

Aims & Methods

An anonymized electronic survey was created in eight different languages and disseminated by clinicians and patient’s associations; patients with IBD, patients with an at-risk first-degree relative (offspring), and their first-degree relatives were invited to provide their feedback. The survey had four main sections – participants’ characterization, knowledge of disease, predictive tests and preventive interventions. Univariate and multivariate logistic regression were used to assess factors associated to acceptance of predictive testing and preventive interventions.

Results

Overall, 2034 participants (73% women, mean age of 43±13 years old) from 66 different countries (80% from Europe), participated. Most participants (52%) were parents with IBD with healthy at-risk children. 51% of individuals with IBD had Crohn’s disease, 56% were undergoing treatment with biologics, 28% had a history of surgery, and 61% reported a significant impact on their quality of life caused by disease. 73% recognized IBD as a disease with no defined genetic transmission, but with an increased risk among FDR of affected patients. Most participants (82%) would be willing to undergo, predictive testing, or to have their children undergo them, mainly with minimally-invasive blood (91%), stool (90%) or saliva tests (78%), or intestinal ultrasound (68%); 46% would accept a colonoscopy. The main benefits recognized with predictive testing were the possibility of starting preventive interventions to minimize the risk of developing IBD (69%) and to obtain an earlier diagnosis (58%). The main disadvantage was anxiety generated from a positive result (57%). Overall, 97% of participants were willing to accept preventive interventions. The most accepted were dietary modification (82%), physical exercise (79%) and probiotics (71%). Overall, 40% and 34% would accept oral or intravenous/subcutaneous immunosuppressive treatment, respectively; provided that the risk of minor adverse events was negligible to acceptable (23%), while 44% considered that the risk of major adverse events should be <1% to be acceptable. In multivariate analysis, factors associated with less acceptance of predictive testing were older age (p<0.001) and treatment with thiopurine (p<0.001). Factors only associated with less acceptance of preventive interventions were having ulcerative colitis (p=0.004) or undetermined colitis (p<0.001) and being treated with mesalazine (p<0.001). Having a disease with low impact in their/their family members’ quality of life were associated with less acceptance of both predictive testing and preventive interventions (p<0.001).

Conclusion

The vast majority of parents with children at-risk for IBD, or first-degree relatives at risk for IBD development would accept minimally-invasive predictive testing for IBD. The vast majority expressed acceptance of non-pharmacological interventions, however, more than one-third would be willing to accept immunosuppressive medications, particularly if associated with a low risk of minor and major adverse events. This data provides useful and important information for the development of prediction and prevention strategies.

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.

Clinical Case Summary

A 77-year-old man underwent liver transplantation in 2008 due to alcoholic cirrhosis associated with hemochromatosis, and was taking tacrolimus and mycophenolate mofetil since that.
He was admitted in the Emergency Department in February 2023 with right upper quadrant abdominal pain and diarrhea for one week. Abdominal computed tomography(CT) showed ileal thickening. Laboratory tests revealed leukocytosis(19,000 leukocytes/mm3) and elevated C-reactive protein(16 mg/dL). Acute gastroenteritis was assumed and he was discharged on metronidazole with clinical improvement. One month later, he returned to the Emergency Department with abdominal pain for two days. CT revealed concentric wall thickening of the last ileal loop and a probable enteromesenteric fistula. He was admitted for further evaluation. Colonoscopy revealed deep mucosal ulceration of the terminal ileum. After colonoscopy, his abdominal pain worsened, so he repeated the abdominal CT, which showed a new organized collection in the right flank measuring 63 mm and small gas bubbles of pneumoperitoneum in the right upper quadrant. He underwent ileocecal resection with terminal ileostomy, and the histopathological evaluation revealed a neoplasm composed of atypical lymphoid proliferation, with positive immunohistochemistry for CD45, CD20, CD79a, BCL2, and BCL6, compatible with diffuse large B-cell lymphoma. After staging and exclusion of distant disease, the patient was proposed for chemotherapy following reduction of immunosuppression.
The clinical presentation of Inflammatory Bowel Disease can be quite heterogeneous and several pathologies can mimic its clinical, endoscopic, and/or histological findings. This case illustrates the importance of considering the diagnosis of small bowel lymphoma as a differential diagnosis of Crohn's disease, especially in elderly patients with risk factors, such as chronic immunosuppression.

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.