Introduction

Ulcerative colitis (UC) is often complicated by Cytomegalovirus (CMV) colitis. The importance of CMV infection for the outcome of UC is still ill-defined. Common practice consists of obtaining colonic biopsies to search for CMV in patients with UC flares and treat infections with ganciclovir.

Aims & Methods

The aim of the present study is to describe the characteristics and management of patients with UC and concomitant CMV infection. For this purpose, we conducted a retrospective data collection from 2 Greek hospitals for the years 2017-2023. The primary endpoint was defined as the need for colectomy in the first year after CMV infection diagnosis. The statistical program SPSS-23 was used for the analysis.

Results

In total, 47 cases of CMV infection in 37 patients with UC were reported as 7 patients experienced CMV recurrence. Most cases were observed in men (68%) with mean age of 47.5 years (SD 18.2), median UC duration 3 years (IQR 1-8) and Montreal classification E2 in 31.9% and E3 68.1% occasions. The diagnosis was established by PCR in colonic biopsies in 46.8% cases, by immunohistochemistry in another 46.8% and solely by detection of inclusion bodies in 6.4%. At the time of diagnosis of CMV infection 7 (14.9%) cases were receiving combination therapy with a biologic agent and an immunomodulator, 20 (42.6%) monotherapy with a biologic agent, and 1 (2.1%) monotherapy with an immunomodulator. Nine-teen patients (40.4%) were not on immunomodulatory therapy. Most patients (22, 46.8%) received ganciclovir and concomitant corticosteroids, while 4 (8.5%) received infliximab, corticosteroids and ganciclovir and 2 (4.3%) ustekinumab, corticosteroids and ganciclovir. One case required treatment with Foscarnet due to CMV resistance to ganciclovir, and 18 received monotherapy with ganciclovir. Regarding maintenance treatment in patients who did not require immediate colectomy, 18 (38.3%) received anti-TNF, 6 (12.7%) ustekinumab, 4 (8.5%) vedolizumab, 3 (6.4%) tofacitinib and 1 (2.1%) risankizumab. Colectomy rate in the first year after CMV infection was 21.3% with 4 patients undergoing surgery during initial hospitalization. In univariate logistic regression age >54 years (P=0.025), disease duration >6.5 years (P=0.035), serum albumin <3.8 mg/dl (P=0.026), UC PRO bowel movement >2 (P=0.016) and vedolizumab (P=0.035) as treatment at diagnosis were associated with a higher probability of colectomy in the first year. Accordingly, in multivariate logistic regression UC PRO bowel movement >2 (P=0.041) remained a statistically significant factor for colectomy while a tendency remained for albumin <3.8mg/dl (P=0.082).

Conclusion

CMV infection is more common in patients with ulcerative pancolitis under immunomodulatory treatment and should be diagnosed via a combination of immunohistochemistry and PCR in biopsies. Patients with prominent diarrhea [UC PRO bowel movement >2] may be particularly prone to colectomy.

Disclosure

GB: Advisor/lecturer for Janssen, Pfizer, Takeda, Abbvie, MSD, Mylan, Genesis Pharma, Adacyte Therapeutics, Amgen, Ferring, Cooper; Funding (Grants/Honoraria): Pfizer, Takeda, Abbvie, Aenorasis; Research/Clinical Trials: Abbvie, Takeda
EZ: Advisor/lecturer for Pfizer, Takeda, Abbvie, Amgen, Genesis Pharma, Aenorasis, Janssen
SM: Advisory/Lecturer for Pfizer, Takeda, Abbvie, Ferring, MSD, Janssen

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

Prompt initiation of advanced therapy (AT) medications, encompassing biologics and small molecule treatments, is crucial for the effective treatment of inflammatory bowel disease (IBD). The time taken from the decision to start the AT to it’s first administration, or time to advanced therapy (TAT), can vary significantly between individuals negatively impacting upon their disease course. However, our knowledge of the causes for the variation in TAT is poor.

Aims & Methods

We aimed to investigate the impact that different demographic and disease-related factors have on the TAT. A retrospective analysis of electronic patient records, conducted at a tertiary IBD referral centre in London in March 2024, analysed electronic patient records of all those over the age of 18 currently being treated for IBD with an AT and collected data on the TAT for their index AT, defined as the number of days from the documented decision to start an AT to the date of the first administration. Data was also collected on multiple variables which including disease type, type of AT, age, sex, ethnicity and socioeconomic status by analysing patients’ Index of Multiple Deprivation (IMD). A multiple negative binomial regression was performed entering all variables together to assess their relative effect on TAT.

Results

1298 patients were identified and 485 were excluded due to either their index AT being started elsewhere, incomplete data, a positive screening test or because they were enrolled in a clinical trial. The multiple binomial regression found that TAT was significantly longer for those of non-white ethnicity (p=0.039) (table 1). Analysis for patients of black ethnicity found an Incident Rate Ratio (IRR) of 1.46 (95% CI 1.09,1.95), for mixed ethnicity IRR=1.26 (95% CI 0.77,2.05) and for asian ethnicity IRR=1.17 (95% CI 0.96, 1.41) when compared to white patients. Treatment with adalimumab was also associated with a longer TAT (p=<0.001, IRR 1.37, 95% CI 0.95,1.96) but no other factors were statistically significant: IMD p=0.133; age p=0.155; sex p=0.702; disease type p=0.335.

Conclusion

Our study has identified that non-white ethnicity is associated with a longer TAT and this may be a contributing factor to worse outcomes in patients with IBD from an ethnic minority background. Further research into the causes for this are required to help address this health disparity.