Introduction

Partial enteral nutrition (PEN) is a consolidated treatment in children with Crohn’s disease (CD). However, the benefit of PEN is not well-established for adults with CD. Hence, we aimed to assess the effectiveness of PEN in combination with biological therapy on transmural response/remission and clinical outcomes in adults with CD who lost response to biologics.

Aims & Methods

We performed a single-centre retrospective observational study by including patients who received PEN due to loss of response to biologics. The primary endpoint was the transmural response/remission rate at six months. We defined transmural remission as bowel wall thickness ≤3 mm, while transmural response as a decrease in BWT≥25%. Secondary endpoints included clinical remission, defined as Harvey Bradshaw Index<5, and selected clinical outcomes such as surgery, hospitalisations, and therapy change at six months. Patients were considered adherent when they completed PEN for 6-8 weeks as required for induction of remission, whereas they were not adherent when they stopped or did not tolerate it.

Results

Forty-two patients,25 males (59,5%) with a mean age of 36,1 ±15,6yo and a mean disease duration of 138,0 ±113,1 months, were enrolled.14 patients completed PEN at eight weeks, with a rate of adherence of 33,3%. While 16(38.1%) patients stopped the treatment for intolerance and maintained only biological therapy, 12(28.6%) underwent surgery before six months follow-up. At six months, patients treated with PEN+biologic had a transmural response of 64,9% compared to 25% treated only with biologics (p=0.03). In both groups, no patients achieved transmural remission. Nevertheless, clinical remission was obtained in 9 (64,3%) patients treated with PEN+biologic compared to 4 (25%) with biologic (p=0.03). Three patients (18.7%) underwent surgery, all intolerant to PEN. Patients who interrupted PEN and maintained biologics had a higher rate of 56,2% of dose escalation/interval and 68,7% changed therapy at six months compared to 7,1% and 14,2% respectively treated with PEN+biologic(p<0.05) [Table 1].

Conclusion

For patients who lost response to biological therapy, the addition of PEN was associated with transmural response and clinical remission. Multiple failures to biologics were associated with adherence to PEN. Therefore, it should be considered in difficult-to-treat patients.

Disclosure

None to declare

Introduction

The IBD-Disk is a widely used, self-administered visual analogue tool for measuring disability in patients with inflammatory bowel disease (IBD). However, it does not capture key aspects of daily life, particularly diet and nutrition, which are critical for IBD patients and may significantly influence disability.

Aims & Methods

This cross-sectional study explored the prevalence of moderate to severe disability in young adults with IBD and evaluated the use of a modified IBD-Disk (mIBD-Disk) to screen for eating disorders and food avoidance. Patients previously diagnosed with IBD during childhood and adolescence (<18 years old), and currently followed at two adult IBD academic centers, were consecutively enrolled. All participants were assessed for disability and screened for eating disorders (ED) and avoidant restrictive food intake disorder (ARFID). Restrictive eating behaviours were evaluated using the Nine Item ARFID Screen (NIAS), which assesses three domains: picky eating, low appetite, and food-related fear with a score >23 suggesting probable ARFID. The Eating Attitudes Test (EAT-26) was used to screen for ED, with a score ≥20 indicating a positive result. Disability was measured using the IBD-Disk with a score >40 indicating moderate to severe disability) and the modified IBD-Disk (mIBD-Disk)¹, which consisted of the original 10 items plus an additional question on dietary habits, for a total of 11 items

Results

A total of 144 patients (50.7% with Crohn’s disease) were included, with a median age of 24 years (range: 21–28), and 54.2% were female. One-third (34.7%) had clinically active disease, and the median BMI was 21.8 (range: 20.1–24.2). Moderate to severe disability, as assessed by the IBD-Disk, was observed in 38.9% (56/144) of the cohort, and the median mIBD-Disk score was 33 (IQR: 16–61). ARFID risk was identified in 24 participants (16.7%), with food-related fear being the most frequent domain (13.2%). The median EAT-26 score was 5 (range: 3–12), with ED present in 17 patients (11.8%). In both univariate and multivariate analyses, moderate to severe disability (OR: 4.03; 95% CI: 1.23–13.17; p = 0.02) and a score greater than 4 on question 11 of the mIBD-Disk related to dietary habits (OR: 3.49; 95% CI: 1.06–11.47; p = 0.04) were independently associated with ARFID risk. ROC curve analysis showed that the mIBD-Disk Q11 had an 82% diagnostic accuracy (95% CI: 0.73-0.91) for predicting ARFID.

Conclusion

Patients diagnosed with IBD in childhood and adolescence have an increased prevalence of moderate to severe disability. Integrating the mIBD-Disk into clinical practice could provide an effective tool to identify patients at risk for eating behaviours and food avoidance, supporting timely referrals for nutritional and psychological interventions

References

Nardone OM, et al. Dig Liver Dis. 2025 Mar;57(3):753-761. doi: 10.1016/j.dld.2024.11.004. . PMID: 39617658.

Introduction

Crohn’s disease (CD) is a complex immune-mediated disease of the gastrointestinal (GI) tract where the gut microbiota plays an important role. Current biological treatment options in CD include the anti-TNFα agents adalimumab and infliximab (anti-TNF), vedolizumab (VEDO), and ustekinumab (USTE). Finding biomarkers to predict therapy response is still a clinically unmet need, for the majority of CD patients fail to reach endoscopic remission within one year of treatment. While most studies focus on fecal samples, mucosa-adherent microbial biopsies could bring forth more stable biomarkers.

Aims & Methods

In this study, we sought to identify microbial signatures in mucosal colon and ileum biopsies aimed at differentiating responders (R) from non-responders (NR), prior to the start of biological treatment. Ileal and colonic biopsies from CD patients were prospectively collected at the start of treatment with biological agents. Three distinct cohorts of patients were recruited: anti-TNF, VEDO and USTE. Patients were classified as either R or NR based on endoscopic response (≥50% reduction in SES-CD score) in combination with steroid-free clinical response (≥3 point drop in HBI or HBI ≤4, no systemic steroids) and/or biochemical response (≥50% reduction in CRP and fecal calprotectin or a basal CRP ≤5 g/mL and calprotectin ≤250 µg/g). Mucosal-associated microbiome composition was determined using 16S rRNA gene sequencing. Multivariate statistical analysis was performed in R statistical environment using the packages phyloseq, vegan and DESeq2.

Results

At baseline, colonic biopsies were collected from 117 CD patients. In anti-TNF cohort, alpha diversity, described by Shannon index, and species richness were significantly higher in R than NR. Accordingly, the relative abundance of 13 genera was higher in R, while only four genera had lower abundance in R than NR. In VEDO and USTE, differences in alpha and beta diversity were not significant, however, discriminatory analysis at genus level revealed 10 and 15 genera with significantly different relative abundance in R and NR of the VEDO and USTE, respectively. Overall analysis of the colon-derived signal (n=117) was performed combining the above discriminatory genera’s relative abundance, leading to
1) establishment of “treatment-specific” genera, discriminatory for only one biological;
2) “treatment-aspecific” response supporters, discriminatory in at least two biologicals sharing direction, and
3) “treatment-drivers”, discriminatory in at least two cohorts with contradicting direction.
Respective analysis was followed for the ileal biopsies (n=107). Intra-cohort approach showed that, at baseline, alpha and beta diversity did not differ between R and NR. However, analysis at genus level revealed 14, 25 and 13 discriminatory genera in the anti-TNF, VEDO and USTE cohorts, respectively, falling in the “treatment-specific”, “treatment-aspecific” and “treatment-drivers” categories, as well.

Conclusion

We established three group of microbial signatures that discriminate response to biological therapy:
(a) biological agent “treatment-specific” genera,
(b) “treatment-aspecific”, and
(c) “treatment-drivers”, distinct per GI location, namely ileum and colon.
We suggest microbial evaluation of these taxa at the treatment decision process, to support most suitable agent. Acknowledging that analysis at genus level may allow for species-level differences within a genus, sophisticated modelling at amplicon sequence variant level is currently undertaken.

Disclosure

ECCO Pioneer Grant

Clinical Case Summary

The management of Crohn’s Disease (CD) during pregnancy presents significant challenges. Active CD can be treated with corticosteroids (CS) or tumour necrosis factor-alpha (TNF-α) inhibitors (1). While these treatments are generally considered safe during pregnancy, they are not without potential side effects, leading to patient hesitancy in initiating therapy despite guidance from Inflammatory Bowel Disease (IBD) specialists (2).
We present the case of a 34-year-old woman, recently diagnosed with CD who opted not to use medication during her pregnancy. For the initial 26 to 28 weeks, she received conservative treatment. Following a deterioration in her symptoms and an increase in calprotectin levels, she commenced the Crohn’s Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN). This resulted in significant symptomatic improvement and a decrease in faecal calprotectin levels. At 40 weeks of gestation, she delivered a healthy baby.
This case underscores the potential efficacy of CDED and PEN as dietary management strategies for CD during pregnancy, although further research is warranted to compare these approaches with conventional treatments. Additionally, it emphasises the critical role of preconception counselling regarding medication safety and effective disease management during pregnancy.

References

No references of illustrative material (endoscopic, radiological and pathological images, innovative physiological or other research data)

Introduction

Dietary changes are common in individuals with inflammatory bowel disease (IBD) to manage symptoms and avoid perceived triggers. However, such adaptations may predispose patients, especially adolescents and young adults, to eating disorders (ED) and avoidant/restrictive food intake disorders (ARFID).

Aims & Methods

This cross-sectional study aimed to assess the prevalence of ED and ARFID in young adults with paediatric-onset IBD, identify associated risk factors, and examine the relationship between ED, ARFID and the risk of malnutrition. Patients previously diagnosed with IBD at <18 years of age and currently followed at two adult IBD academic centers were consecutively enrolled. Screening for ED, ARFID and malnutrition was performed. ARFID risk was assessed using the Nine Item ARFID Screen (NIAS), which evaluates picky eating, low appetite, and food-related fear, with scores >23 were indicating probable ARFID. ED risk was evaluated using the Eating Attitudes Test (EAT-26), with scores ≥20 considered positive. Malnutrition risk was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), with scores >=6 indicating malnutrition¹​

Results

A total of 144 patients were included (median age 24 years [range: 21–28]; 54.2% female), with 50.7% diagnosed with Crohn’s disease (CD). History of enteral nutrition during childhood was reported in 40.3% of patients, predominantly among those with CD (64.4%). At the time of evaluation, one-third (34.7%) of the cohort had active disease, and the median BMI was 21.8 (IQR 20.1–24.2).
ARFID risk was observed in 16.7% of patients, with food-related fear being the most prevalent domain (13.2%) with no significant association with the disease activity (37.5% vs 34.2%; p=0.46). Based on EAT-26 scores, 11.8% screened positive for ED. The PG-SGA scores correlated significantly with the NIAS scores (rho=0.56, p<0.001) but not with EAT-26 (p=0.26). Malnutrition (PG-SGA ≥6) was observed in 15.3% of the cohort and it was significantly associated with ARFID risk (p<0.001). Prior exposure to enteral nutrition was not associated with increased ARFID risk (p=0.54), but was significantly associated with a reduced risk of ED (p=0.008).

Conclusion

Young adults with pediatric-onset IBD are at risk of ARFID, especially driven by food-related fears, and, to a lesser extent, of ED. Prior exposure to enteral nutrition was not associated with increased ARFID risk, but it was associated with a reduced risk of ED, supporting its safe use in pediatric IBD management. Routine assessment for eating disorders and malnutrition risk should be standard practice in IBD care for young adults

References

1. Gabrielson DK, Scaffidi D, Leung E, et al. Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer. 2013;65(2):234-239. doi:10.1080/01635581.2013.755554

Introduction

Comparative effectiveness of biologics in preventing penetrating disease (PD) complications in Crohn’s disease (CD) is unknown. We compared the risk of developing luminal and perianal PD (LPD and PPD) between biologics used as first-line therapies.

Aims & Methods

We performed a propensity-score adjusted comparative effectiveness study. Adults (≥18 years) with CD (≥3 administrative claims for CD [K50.*]) who initiated their first biologic (anti-tumor necrosis factor [anti-TNF], ustekinumab ([UST]) or vedolizumab [VDZ]) were identified from Merative™ commercial database between 2006 and 2020. LPD was determined by ICD claims and PPD by a validated case definition consisting of ICD claims and procedural codes. We excluded pre-existing PD and prior biologic exposure using a minimum look-back period of one year. Patients were followed until a PD event and censored if a new biologic class was initiated, loss of medical coverage or a study end. Cohorts were balanced by inverse probability of treatment weighting (IPTW) based on age, sex, comorbidities, prior CD surgery, and CD severity. Pairwise comparisons were performed by cox-proportional hazard models, adjusted for immunomodulator exposure, and with biologic exposure treated as a time dependent variable based on a medication possession ratio of 0.8.

Results

Our analysis included 40,693 patients: (93%) anti-TNF, (3%) UST and (4%) VDZ. Our cohort had a median age of 39 years (IQR, 28-50) and 54% were female. Penetrating complications were identified during follow-up in 8567 (21%) patients overall: 2,204 (5%) LPD and 7,474 (18%) PPD. After IPTW all comparisons were well balanced (standardized difference <0.1 for each pairwise comparisons). PPD was more common than LPD overall (Log-rank p<0.0001). Anti-TNF was protective against LPD (HR, 0.66; 95% CI, 0.55–0.78; p<0.0001) and PPD (HR, 0.88; 95% CI, 0.80–0.96; p=0.0045;) compared with VDZ and LPD (HR, 0.37; 95% CI, 0.30–0.46; p<0.0001;) compared with UST (Table 1). There were no significant differences in the risk of LPD and PPD between VDZ and UST. The protective association between anti-TNF therapy and PD was more pronounced when our study period was limited to after 2016 when all three treatments were commercially available.

Conclusion

Anti-TNF therapy was associated with a lower risk of LPD and PPD compared with VDZ and LPD compared with UST. Further studies are needed to validate these findings and to determine potential reasons for these differences.

Disclosure

JM: Consultancy fees and/or Honoraria: Janssen, Abbvie, Takeda, Pfizer. Research funding: BMS, Pfizer and Leo Pharma, Honoraria: Bayer, Pfizer, Sanofi, BMS and Leo Pharma.
PD: has received research support under a sponsored research agreement unrelated to the data in the paper and/or consulting from AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Pfizer, Prometheus Biosciences, Takeda Pharmaceuticals, Roche Genentech, Scipher Medicine, Fresenius Kabi, Teva Pharmaceuticals, Landos Pharmaceuticals, Iterative scopes and CorEvitas, LLC.
The other authors have no conflicts