Introduction

The role of nutritional status, as indicated by the body mass index (BMI), ininflammatory bowel diseases inflammatory bowel diseases (IBD) is encountered at various levels: etiopathogenic, therapeutic, and prognostic.

Aims & Methods

The aim of this study was to assess the impact of the BMI on the disease course of IBD patients.
Methods: This was an 8-year study period [January 2016-December 2023] of patient records followed for IBD. We collected clinical, biological, radiological, endoscopic, therapeutic, and follow-up data. Patients were divided into three groups based on body mass index (BMI) at diagnosis: group 1: overweight or obese patients (BMI ≥ 25 kg/m²), group 2: patients with normal BMI (18.5 ≤ BMI < 25 kg/m²), and group 3: patients with malnutrition (BMI < 18.5 kg/m²). A comparison of the three groups was performed through univariate logistic regression.

Results

We enrolled 126 patients, with a mean age of 37.3 years [14-75] and a gender ratio (M/F) of 1.5. The median BMI at inclusion was 20.98 kg/m² [13-33]. Malnourishment was observed in 24.6% of patients at the disease first diagnosed. Obesity or overweight were noted in 18.25% of patients, while 57.14% had normal BMI. Patients with malnutrition mostly had Crohn's disease (96.77%) with ileal, colonic, and ileocolonic localization in 3, 13, and 14 cases respectively. Comparison of these groups showed no significant differences in terms of age (p = 0.09), sex ratio (p = 0.06), smoking history (p = 0.54), disease duration (p = 0.25), disease phenotype (p = 0.64), perianal (p = 0.67) or upper digestive tract involvements (p = 0.4). However, a significant association was observed between normal BMI and clinical and biological remission compared to other BMIs (p = 0.013). After a mean follow-up of 56 months [6 - 90], there was no significant difference between the three groups regarding the occurrence of CD complications (p = 0.78), the use of immunosuppressive therapies (p = 0.49), biotherapies (p = 0.24), or surgical intervention (p = 0.12).

Conclusion

According to our study, a normal BMI seems to be associated with better control of IBD, highlighting the importance of nutritional status in these patients. This findings need to be confirmed by large-scale studies.

Disclosure

no conflict of interest

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

Inflammatory bowel disease (IBD) is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with IBD are at increased risk of depression and anxiety disorders.
The IBD Disk is a validated 10-question, self-administered visual questionnaire that includes characterisation of psychosocial disease burden. Whether scores in these domains correlate with traditional measures, such as the Hospital Anxiety and Depression Scale (HADS), is not known.

Aims & Methods

The aim of this study was to assess the prevalence of anxiety and depression in IBD patients, and the correlation between IBD-Disk and traditional measures.
We conducted a cross-sectional study over 3 months between April and June 2023. IBD patients responded to the IBD-Disk and HADS questionnaires.
HADS Scores are out of 21; with 0–7 normal, 8–10 mild, 11–15 moderate and 16–21 severe.

Results

We enrolled 57 patients (50.9% men) with a median age of 38 years [31-48].
Thirty-eight patients (66.7%) had Crohn's disease (CD). It was ileal in 14 patients (36.8%), ileocolic in 15 (39.5%), and colonic in 9 (23.7%). Ano-perineal involvement was present in 36.8% of cases. Nineteen patients (33.3%) had ulcerative colitis. Pancolic involvement was noted in 13 patients (68.4%).
Thirteen patients were depressed (22.8%) and 16 patients were anxious (28.1%).
In univariate analysis, depression was significantly associated with clinical disease activity (p=0.002), hospitalization at the time of interview (p<0.001), anemia (p=0.01), elevated CRP (p=0.015), hypoalbuminemia (p=0.016) and corticoresistance profile (p=0.01).
Anxiety was significantly associated with clinical activity (p=0.043), hypoalbuminemia (p=0.023) and high CRP (p=0.043). In multivariate analysis, only hospitalization at the time of interview and corticoresistance were independent risk factors for depression (OR=15.169, p<0.001; OR=5.577, p=0.042 respectively). The only independent risk factor for anxiety was clinical disease activity (OR=3.437, p=0.049).
A significant correlation was noted between the IBD-Disk global score, the anxiety score and the depression score (respectively r=0.511 and r=0,524, p<0.001).

Conclusion

IBD patients tend to have a higher prevalence of depression and anxiety disorders than the general population. The IBD disk is an easy tool that correlates well with HADS scores. Its utilisation in clinic allows holistic assessment, particularly in patients with active disease.

Introduction

The most common among surgical antireflux methods for the treatment of hiatal hernias (HH) are Nissen, Toupet, or Dor surgery. Among the disadvantages of these interventions, the greatest importance is the destruction of the physiological cardia, which is accompanied by the recurrence of HH, dysphagia, gas-bloat syndrome and heartburn recovery. Despite the advances in HH surgery, the performance of antireflux operations remains debatable.

Aims & Methods

To improve methods of diagnosis and treatment of complications of insufficiency of the physiological cardia in HH.In 2017-2022, 78 patients with HH were diagnosed and treated surgically in the digestive surgery department of the institute.
The type and degree of HH were determined during X-ray examination. An endoscopic examination was performed to determine the condition of the mucous membrane of the esophagus and the degree of violations of the physiological cardia. Endoscopic balloon manometry was used to study pressure in the lower esophageal sphincter (LES) and monitor the effectiveness of antireflux surgery.

Results

Axial HH (I type) was diagnosed during X-ray examination – in 60 (77.0%); paraesophageal (II type) – in 9 (11.5%); mixed (III type) – in 9 (11.5%) patients. Depending on the amount of penetration of organs into the chest cavity, HH of the 1st degree was established – in 42 (53.8%), 2nd degree – in 27 (34.6%) and 3rd degree – in 9 (11.5%) patients.
Changes in the mucous membrane of the esophagus – in 40 (51.3%) patients with type I and III HH: non-erosive reflux esophagitis – in 9 (11.5%), erosive reflux esophagitis – in 16 (20.5%), esophageal ulcer – in 6 (7.7%), peptic stricture of the esophagus on the background of esophagitis – in 3 (3.8%), Barrett's esophagus - in 6 (7.7%) patients.
During endoscopic balloon manometry, the pressure in the LES is reduced: axial HH – (11.39±2.44) mmHg, paraesophageal – (13.54±3.32) mmHg, mixed – (8.06±3, 64) mm Hg (the norm is 14-21 mm Hg). The first stage of treatment for patients with reflux esophagitis was conservative therapy, for peptic stricture of the esophagus – endoscopic balloon hydrodilatation, for Barrett's esophagus – argon plasma ablation. As a second stage, 78 patients underwent standard laparoscopic antireflux operations according to Nissen – in 32 (41.1%), Toupet – in 7 (8.9%), Dor – in 5 (6.4%), and in 34 (43.6%) patients, according to the proposed method, which preserves the connections of the diaphragm, esophagus, and stomach, and performing cardiocrurorrhaphy, fundocruroesophagorraphy, cardiogastroplication with gastrodiaphragmopexy restores the antireflux function of the physiological cardia.In the long term, from 6 months to 4 years, significantly more complications were diagnosed after standard antireflux operations compared to the proposed method - gas bloat-syndrome (X²=4.65, p=0.031) pylorospasm (X²=4.03, p=0.045), dysphagia (X²=4.30, p=0.038) and recurrence of HH – 11 (25.0%) vs 3 (8.8%) cases (p<0.05).

Conclusion

The proposed two-stage method of surgical treatment of patients with HH is highly effective. The application of the proposed method ensures the elimination of pathological changes in the mucous membrane of the esophagus, the restoration of the physiological cardia, the preservation of the anatomical relationships of the diaphragm and the zone of the esophageal-gastric transition. In the postoperative period, the proposed method reduces the frequency of recurrence of HH, occurrence of gas bloat-syndrome, pylorospasm, and dysphagia.