Introduction

The Inflammatory Bowel Disease (IBD) Disk represents a self-administered questionnaire that can facilitate, in real time, assessment of IBD related disability, and IBD-related daily life burden^1,2. Surrogate markers of IBD activity tend to associate with increased disability. Intestinal ultrasound (IUS) is a non-invasive tool that can objectively and accurately define disease activity and complications in IBD patients.

Aims & Methods

The aim of our study was to investigate the correlation between IBD-Disk and IUS in IBD patients. We performed a cross-sectional study that included formally diagnosed IBD patients who underwent IUS and subsequently completed the IBD-Disk questionnaire. Active disease on IUS was defined as bowel wall thickness (BWT) >3 mm at the most affected bowel segment. The overall IBD-Disk score was calculated as the sum of its 10 components, ranging from 0 to 100 (best score: 0, worst score: 100). We explored the correlation between IBD-Disk and its components with IUS. We additionally investigated the correlation of IBD-related daily life burden with IUS. (IBD-Disk total score > 40: high IBD related daily life burden vs IBD-Disk total score ≤ 40: low IBD related daily life burden²).

Results

We included 69 patients (Table 1), who underwent IUS for disease monitoring (56.5%) and symptoms suggestive of disease flare (43.5%). Median IBD-Disk total score in our cohort was 48 (IQR 19-56.5). Median IBD-Disk total score was 52 (IQR 47-58.5) in IUS active vs 16 (IQR 6-23) in IUS inactive patients (p<0.001). The area under the ROC curve of IBD-Disk total score in predicting IUS activity was 0.909 (95% C.I: 0.819-0.99, p<0.001). IBD-Disk score >33 predicted disease activity in IUS with 93.5% sensitivity and 91.3% specificity. We observed a moderate correlation between IBD-Disk score and BWT (ρ=0.554, p<0.001) as well as between IBD-Disk score and C-reactive protein (ρ=0.686, p<0.001). Among the components of the IBD-Disk, 7/10 (abdominal pain, regulating defecation, education/work, sleep, energy, sexual function and interpersonal interactions) manifested a moderate correlation with BWT. IBD-Disk score > 40 was found in 40/46 (87%) of IUS active and 2/23 (8.7%) of IUS inactive patients, while IBD-Disk score ≤ 40 was found in 6/46 (13%) of IUS active and 21/23 (91.3%) of IUS inactive patients respectively (p<0.001). Median BWT was 2.1 mm (IQR 1.6-2.9) in patients with IBD-Disk score ≤ 40 and 6 mm (IQR 4.8-6.8) in patients with IBD-Disk score > 40 (p<0.001).

Conclusion

IBD-Disk displayed a significant correlation with IUS evidence of disease activity in IBD patients. Active disease in IUS was significantly correlated with a high IBD-related daily life burden as expressed by IBD-Disk total score > 40. IBD-Disk could be used in clinical practice to evaluate disease activity and severity in IBD patients.

References

1) S. Ghosh et al. Inflamm Bowel Dis. 2017, 333-340
2) S. Tadbiri et al. Journal Crohns Colitis, 2021, 766–773

Clinical Case Summary

Diseases damaging the enteric mucosa cause malabsorption that may trigger neurologic symptoms, both by immune-related processes and impaired absorption of essential vitamins.
Celiac disease (CD) is found in patients presented with nonhereditary ataxia. In these patients, abnormalities referred to as “gluten ataxia”, are probably the result of immunologic damage to the CNS and peripheral nerves.
B1 is an essential vitamin which its deficiency has broad clinical spectrum; thus, its diagnosis is challenging, and a sensitized clinician is needed to prompt identification. The encephalopathic form of adult thiamine deficiency is called Wernicke-Korsakoff syndrome.
A 40-y/o/w, G4P2, suffered from severe hyperemesis gravidarum resistant to antiemetics during trimester 1.
On 13^th week of pregnancy, she went to the ER, d/t confusion & extensive weakness. Her lab tests showed severe electrolytes deficiencies with transaminitis and elevated CPK levels. She was diagnosed with rhabdomyolysis secondary to her continuous vomiting. On her neurological examination psychomotor slowness and ataxia were found. Thus, Wernicke encephalopathy was suspected and her B1 level was tested and found low: 12 ug/L. She was hospitalized in the ICU to get electrolytes replacement and intravenous thiamine. To confirm the diagnosis, brain MRI was performed and demonstrated a classic picture of Wernicke encephalopathy (1).
6m later she gave birth, but her neurological deficits got worse. TTG level was tested and found positive. Gastroscopy showed duodenal scalloping (2) and Marsh 3C on biopsy (3). She started GFD and neurological rehabilitation. On repeated anamnesis she had abdominal pain before the pregnancy, but her investigation was negative.
This case illustrates a rare herald of CD and increases the awareness of possible manifestation of B1 def.
Points to discuss:

1. Two-hit theory of B1 def. (hyperemesis gravidarum and CD)
2. Neurologic manifestation of CD & B1 def.
3. Vitamins’ malabsorption in CD

References

1. Brain MRI with classic picture of Wernicke encephalopathy
2. Endoscopic picture of duodenal scalloping
3. H&E staining that demonstrates Marsh 3C in duodenal biopsy

Clinical Case Summary

Background: AL (amyloid light chain) amyloidosis is a rare systemic disorder affecting the heart, kidneys, nervous system, and gastrointestinal (GI) tract. GI involvement typically presents with malabsorption or dysmotility from mucosal amyloid deposition. We describe an unusual case presenting as small bowel obstruction (SBO), initially attributed to adhesions.
Case presentation: An 84-year-old man with a history of radical cystoprostatectomy and ileal conduit for urothelial carcinoma presented with recurrent SBO over three months. The initial suspicion was that of adhesive obstruction due to the surgical history. He underwent laparotomy with adhesiolysis and small bowel resection, but the symptoms persisted with high nasogastric output and ongoing obstruction. Histology from the first resected segment did not reveal any specific pathology.
A contrast follow-through study showed dilated small bowel loops with a transition point. Computed Tomography (CT) of the abdomen and pelvis revealed proximal jejunal dilation and segmental circumferential wall thickening.
Antegrade double-balloon enteroscopy (DBE) was performed and it revealed a tumor-like nodular stricture in the jejunum, 68 cm from the incisors. Biopsies showed Congo red-positive amyloid with birefringence and lambda-restricted plasma cells. Repeat surgical resection confirmed amyloid at both margins.
Bone marrow aspirate showed a lambda-restricted plasma cell population (0.5%). Mass spectrometry confirmed AL amyloidosis (lambda type).Positron Emission Tomography-CT (PET-CT) revealed Fluorodeoxyglucose uptake in the right paracolic peritoneum. Cardiac MRI ruled out cardiac involvement.
The patient received 8 cycles of bortezomib-cyclophosphamide-dexamethasone (VCD). Interval PET-CTs showed resolution and he remained well on maintenance bortezomib 16 months post-treatment initiation.
Conclusion: This case illustrates an unusual AL amyloidosis presentation, with a focal tumor-like jejunal stricture, causing SBO.

References

We plan to include endoscopic, radiological, and pathological visuals in the final poster. This includes:

1. Double-balloon enteroscopy (DBE) image showing a jejunal nodular lesion;
2. Congo red-stained histology demonstrating apple-green birefringence under polarized light;
3. Computed tomography (CT) showing proximal jejunal dilation and segmental mural thickening;
4. Initial and follow-up PET-CT scans showing fluorodeoxyglucose (FDG) uptake and treatment response;
5. Bone marrow aspirate results with flow cytometry and immunofixation confirming a lambda-restricted plasma cell population.

• Kwon JH et al. An Unusual Cause of Acute Intestinal Pseudo-Obstruction. Case Rep Gastroenterol. 2019;13(3):507–512. [PMC6873005]
• González-Suárez B et al. A Rare Cause of Diarrhea Detected by Balloon-Assisted Enteroscopy. Case Rep Gastroenterol. 2022;16(3):577–582. [PMC9638858]
• Siddiqui A et al. A Rare Cause of Intestinal Pseudo-obstruction: Gastrointestinal Amyloidosis. Cureus. 2020;12(4):e7583. [PMC7199901]