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A SINGLE CENTRE AUDIT REVIEWING THE PRACTICE OF ACUTE SEVERE ULCERATIVE COLITIS (ASUC) MANAGEMENT USING CALCINEURIN INHIBITOR AND BIOLOGICAL THERAPY. ARE THEY SHOWING GOOD OUTCOME AND SUCCESS IN AVOIDING COLECTOMY AT 30 DAYS AND 1 YEAR MARK?

Rachel Hill 1, Muhammad Hafiz Kamarul Bahrin 1, Mohammad Ali Raza Qizalbash 1, Mirza Faisal Anwar Baig 1

Affiliations

1 Nottingham University Hospital, Nottingham, United Kingdom

Summary

AI Generated

A retrospective audit of 74 patients with acute severe ulcerative colitis treated with infliximab or ciclosporin between 2021-2022 found high colon retention rates with infliximab and universal colectomy requirement with ciclosporin.

Among 32 patients receiving inpatient infliximab, 84.4% achieved complete colon retention at one year, with 78.1% avoiding further flare-ups.
All six patients treated with ciclosporin failed therapy and required rescue colectomy; five had received ciclosporin as second-line treatment after infliximab failure.
Among inpatient infliximab recipients, all 14 patients co-prescribed purine analogues avoided colectomy at one year, compared with 14 of 18 not receiving purine analogues.
Mortality included one chest sepsis death in the inpatient infliximab group and one death in the outpatient infliximab group within one year, plus one ciclosporin patient death.
The authors conclude their data support biological therapy to avoid colectomy in acute severe ulcerative colitis, with purine analogue co-prescription appearing protective.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Up to 30% of patients inflicted with acute severe ulcerative colitis (ASUC) requires an urgent colectomy during their inpatient stay¹, despite use of corticosteroid therapy. In younger population cohort, of which Ulcerative Colitis (UC) is fairly prevalent, the idea of having a colectomy with stoma formation does not constitute an ideal physical image, hence many prefer to be managed conservatively through medical therapy. The two options licensed for this purpose are infliximab and ciclosporin².

Aims & Methods

Our audit aims to look at the use of infliximab and ciclosporin to manage an ASUC and whether they result in long term remission and significant colon retention rate at 30 days and 1 year mark.
We carried out a retrospective audit on 74 patients who received said therapies between 2021 to 2022 for ASUC. Subsequently we calculated the number of patients who required re-admission with flare-ups, the colon retention rate at 30 days and 1 year post therapy initiation, as well as the 30 days and 1 year mortality rate as a direct or indirect result of said therapies (we defined this as evidence of clinically immunosuppressive state leading to severe sepsis).

Results

There are only 6 patients in total (8.69%) who were given ciclosporin to treat an ASUC episode as compared to infliximab, which forms the majority of the population (68 patients). All of them were commenced in an inpatient setting . On top of that, they failed to improve despite this and subsequently required a form of rescue colectomy. Of these, 5 required ciclosporin as the second line treatment following failed primary therapy with infliximab, going by the recommendation by the BSG Guideline.
Among those who were prescribed infliximab, 32 (47.1%) requires initiation as inpatient (IP) as compared to 36 (52.9%) who commenced in an outpatient (OP) setting. Among those who requires IP initiation, we saw there is 84.4% complete colon retention rate at 1 year mark and 6.25% colon retention rate lasting less than 30 days and more than 30 days but less than 1 year respectively. 1 patient died within 1 year of receiving the scheduled infliximab therapy as a result of overwhelming chest sepsis, which may or may not be related to this. Most patients successfully avoided further flare up at 1 year mark post infliximab initiation (78.1%).
Further focusing onto infliximab therapy initiation as IP, 14 patients were co-prescribed purine analogues as compared to 18 who were not. All these 14 patients successfully avoided colectomy at 1 year mark as compared to 14 out 18 patients from the other group.
Accelerated infliximab therapy was trialled in 2 IP cases and they both demonstrated complete colon retention at 1 year mark, though we acknowledge that our data is too small to make any conclusive statement for or against this regime.

Rescue therapy	Total number of patients included	Further episode of flare up			Colectomy			Death
Rescue therapy	Total number of patients included	None	within 30 days	within 1 year	None	within 30 days	within 1 year	None	within 30 days	within 1 year
Ciclosporin	6	6	0	0	0	6	0	5	0	1
Infliximab IP	32	25	4	5	27	2	2	32	0	0
infliximab OP	36	36	0	0	36	0	0	35	0	1

Conclusion

In summary, our data on colon retention rate, the survival rate and the need for re-admission demonstrated a strong case to advocate for biological therapy as a mean to avoid colectomy and re-admission in those with ASUC. The rate of colectomy in the calcineurin inhibitor group is high but we must note that their ASUC severity is higher as they failed to respond to the 1st line treatment to begin with. No difference in outcome was seen in the accelerated regime group, but co-prescription of purine analogues appears to be protective.

References

1. Berinstein JA, Sheehan JL, Dias M, Berinstein EM, Steiner CA, Johnson LA, Regal RE, Allen JI, Cushing KC, Stidham RW, Bishu S, Kinnucan JAR, Cohen-Mekelburg SA, Waljee AK, Higgins PDR. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol. 2021 Oct;19(10):2112-2120.e1. doi: 10.1016/j.cgh.2021.05.038. Epub 2021 May 25. PMID: 34048936; PMCID: PMC8760630.
2. Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011 May;60(5):571-607. doi: 10.1136/gut.2010.224154. PMID: 21464096.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Francis Phillip

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CONSUMPTION OF ULTRA-PROCESSED FOOD PROMOTE INFLAMMATORY POTENTIAL OF FECAL MICROBIOME THROUGH ALTERING THE BALANCE OF TH17 AND RORYT TREG

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CONSUMPTION OF ULTRA-PROCESSED FOOD PROMOTE INFLAMMATORY POTENTIAL OF FECAL MICROBIOME THROUGH ALTERING THE BALANCE OF TH17 AND RORYT TREG

Jeongseok Kim 1, Cong Phi Dang 2, Cathy McShane 1, Alyssa Waslyk 1, Qilong Li 1, Benoît Chassaing 3, Sun-Ho Lee 1,2, Ken Croitoru 1,2, Williams Turpin 1,2

Affiliations

1 Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada

2 Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

3 Institut Pasteur, Université Paris Cité, INSERM U1306, Paris, France

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Abstract

Introduction

Crohn’s disease (CD) is a chronic disorder of unknown etiology. Diet, particularly the consumption of ultra-processed foods (UPFs), has been implicated in CD development. Despite this, there is limited research examining how UPFs influence the mucosal immune response. Our study aims to (i) determine whether long-term UPF consumption alters the inflammatory potential of the gut microbiome and (ii) assess whether transfer of the microbiome from individuals consuming high amounts of UPFs affects intestinal T-cell populations in germ-free mice (GFMs).

Aims & Methods

Serum and stool samples collected prior to the onset of CD were obtained from the GEM project, a cohort of prospectively followed healthy first-degree relatives of CD patients. The microbiome was characterized by 16S rRNA sequencing of stool DNA, and serum protein profiles were measured using the Olink Proximity Extension Assay. For mouse experiments, human feces from high- or low-UPF consumers, defined as individuals with more than 40% of daily caloric intake derived from NOVA4 food items according to the NOVA classification, were transplanted into wild-type germ-free recipient mice fed either a standard chow diet or a Western diet. After four weeks of microbial colonization, lamina propria T-cell populations in the intestine, including RORγt⁺ Treg (CD4⁺RORγt⁺FoxP3⁺) and Th17 (CD4⁺RORγt⁺FoxP3⁻) cells, were analyzed using flow cytometry.

Results

Our study included 2,336 participants, including 1,977 from Canada and 359 from the United States. The mean proportion of total energy consumption from UPFs was 36.6 ±12.7%. Participants with higher UPF consumption showed significant difference in 36 serum proteins (q<0.007) compared with those with lower UPF consumers. Notably, immune-related proteins, including IL2RA, TNFRS9, TNFRSF11A, and CD4, were enriched in individuals with high UPF consumption. Microbiome analysis revealed that several taxa, predominantly from the Lachnospiraceae and Ruminococcaceae families, were associated with UPF consumption. In addition, the presence of Marvinbryantia was associated with an increased risk of CD among individuals with high UPF consumption. Mice receiving feces from high-UPF consumers exhibited reduced proportion of protective RORyt⁺ Treg cells in both the ileum and colon (p<0.001). Moreover, mice fed a Western diet (high in fat and simple sugars) and colonized with feces from high-UPF consumer showed a significantly higher proportion of Th17 cells in the colon than mice receiving feces from low-UPF consumers (p=0.023).

Conclusion

Our findings suggest that UPF consumption alters the inflammatory potential of the gut microbiome. Using gnotobiotic mice, we further demonstrated that UPF-associated microbial communities may induce an imbalance between RORγt⁺ regulatory T cells and Th17 cells. Together, these results suggest that the gut microbiome associated with high UPF consumption may contribute to CD onset through immune dysregulation and support the notion that dietary modulation of the microbiome could represent a potential strategy for CD prevention.

Disclosure

On half of the CCC-GEM Project Research Consortium
Funding agencies: CCC, CIHR, and Helmsley Charitable trust

Event

UEG Week Barcelona 2026

Topics

IBD Mechanisms & Personalised Medicine Immunology Gut Microbiota Small Intestine & Nutrition

Submission format

Abstract

Session

On bugs and food: New lessons in microbiomics and dietomics in IBD

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Francis Phillip

UEG Presentation

New

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HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

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HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Alejandra Angela Carriles Linares 1,2, Michele Salerno 1,2, Stefano De Zanet 1,2, Faris Hrvat 1, Laura Loy 2, Roberto Gabbiadini 2, Patrizia Gnagnarella 3, Giuseppe Privitera 1,2, Arianna Dal Buono 2, Cristina Bezzio 1,2, Daniele Piovani 1,2, Stefanos Bonovas 1,2, Gisella Figlioli 1,2, Giulia Rizzo 2, Giada Mori 2, Gianluca Tognon 4, Samuel Elias Pineda Chavez 2,1, Massimo Claudio Fantini 5,6, Sara Onali 5,6, Michele Carvello 1,2, Antonino Spinelli 1,2, Alessandro Armuzzi 1,2, Stefania Vetrano 2,1

Affiliations

1 Humanitas University, Pieve Emanuele, Milan, Italy

2 IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

3 IEO European Institute of Oncology IRCCS, Milan, Italy

4 University of Skövde, Skövde, Sweden

5 Azienda Ospedaliero-Universitaria di Cagliari, Monserrato, Cagliari, Italy

6 University of Cagliari, Monserrato, Cagliari, Italy

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Abstract

Introduction

Fibrostenotic Crohn’s disease (CD) leads to intestinal obstruction and surgery, yet determinants of fibrogenesis remain poorly defined. While dietary patterns influence inflammation, their role in fibrotic progression remains unclear. We investigated whether Mediterranean diet adherence influences disease progression.

Aims & Methods

We conducted a retrospective cohort study including 1,092 patients with Crohn’s disease from two tertiary referral centers (mean age at diagnosis 33.6 years, SD 15.3; 54% male), with B1 disease in 67%, B2 in 27%, and B3 in 6%. Mediterranean diet adherence was quantified using a validated food frequency questionnaire and a 0–9-point score.
The primary outcome was intestinal surgery for fibrostenotic CD, and the secondary outcome was de novo intestinal stenosis. Time-to-event analyses were performed using Kaplan–Meier estimates and multivariable Cox regression, with time zero defined as first clinical assessment. Patients were censored at last clinical follow-up for surgery and at last colonoscopy for stenosis, reflecting routine clinical practice with variable follow-up intervals.
Mechanistic studies were performed in SAMP1/YitFc mice fed a Mediterranean or control diet for 12 weeks. Disease severity, fibrosis, and ileal remodeling were assessed. Spatial transcriptomics was performed in murine tissue, while bulk RNA sequencing was conducted on fibroblasts from 10 CD patients stratified by diet adherence.

Results

Over a median follow-up of 2.54 years (3,772 person-years), 313 patients (28.7%) underwent surgery, corresponding to an incidence rate of 8.3 per 100 person-years. The 5-year cumulative incidence of surgery decreased progressively across Mediterranean diet adherence levels (39.2% low, 31.8% moderate, 25.0% high; p < 0.001).
For de novo stenosis, the 5-year cumulative incidence was 49.6% (95% CI 45.6–53.2%), with a graded reduction across adherence levels (56.4%, 51.2%, 35.8%). Multivariable models confirmed an independent protective association between higher Mediterranean diet adherence and both outcomes.
In mice, the Mediterranean diet attenuated intestinal inflammation and collagen deposition compared with the control diet (p < 0.001).
Spatial transcriptomics revealed diet-dependent remodeling of the intestinal microenvironment, characterized by expansion of goblet cells and RGS5+ structural myofibroblasts, with reduced SPP1+ pro-fibrotic and CD74+ inflammatory fibroblasts. In contrast, the control diet promoted inflammatory and metabolically dysregulated stromal states. Similarly, in human samples, high Mediterranean diet adherence was associated with enrichment of RGS5+ structural myofibroblasts in the intestinal mucosa.

Conclusion

Higher adherence to the Mediterranean diet is associated with reduced risk of intestinal surgery and de novo stenosis in CD. Integrated human and experimental data suggest that the Mediterranean diet may modulate fibrostenotic progression by directly reshaping epithelial and stromal cellular states, beyond anti-inflammatory effects, providing a potential strategy to influence intestinal tissue remodeling.

Event

UEG Week Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition IBD Gut Microbiota

Submission format

Abstract

Session

Beyond prescriptions: Improving IBD outcomes with non-pharmaceutical approaches

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

CONSUMPTION OF ULTRA-PROCESSED FOOD PROMOTE INFLAMMATORY POTENTIAL OF FECAL MICROBIOME THROUGH ALTERING THE BALANCE OF TH17 AND RORYT TREG

Williams Turpin

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Stefania Vetrano

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Karl Mårild

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Brecht Hens

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Konrad Aden

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Francis Phillip

UEG Presentation

New

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DIET QUALITY AND DIVERSITY IN CHILDHOOD AND ADOLESCENCE AND LATER RISK OF INFLAMMATORY BOWEL DISEASE: A TRI-NATIONAL BIRTH COHORT STUDY

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DIET QUALITY AND DIVERSITY IN CHILDHOOD AND ADOLESCENCE AND LATER RISK OF INFLAMMATORY BOWEL DISEASE: A TRI-NATIONAL BIRTH COHORT STUDY

Annie Guo 1, Ida Sigvardsson 1, Sabine Jansson 2,3, Henrik Imberg 4,5, Anne Lise Brantsæter 6, Anne Vibeke Wewer 7,2,3, Johnny Ludvigsson 8,9, Ketil Størdal 10,11, Mikkel Malham 3,2, Karl Mårild 12,1

Affiliations

1 University of Gothenburg, Gothenburg, Sweden

2 Hvidovre Hospital, Hvidovre, Denmark

3 Copenhagen University Hospital, Hvidovre, Denmark

4 Statistiska Konsultgruppen Sweden AB, Gothenburg, Sweden

5 University of Gothenburg, Gothenburgsw, Sweden

6 Norwegian Institute of Public Health, Oslo, Norway

7 Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark

8 Crown Princess Victoria Children’s Hospital, Linköping, Sweden

9 Linköping University, Linköping, Sweden

10 Oslo University Hospital, Oslo, Norway

11 University of Oslo, Oslo, Norway

12 Queen Silvia Children’s Hospital, Gothenburg, Sweden

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Abstract

Introduction

Diet influences the gut microbiome composition and immune system development across the lifespan.^{1, 2} While a high diet quality in the first year of life has been associated with a reduced risk of later IBD,³ the impact of diet in school age and adolescence on IBD risk remains largely unexplored.

Aims & Methods

The aim was to investigate the associations between diet quality and diversity in childhood and adolescence and later risk of inflammatory bowel disease (IBD). We followed individuals born in 1996–2009 from three population-based birth cohorts (The Norwegian Mother, Father and Child Cohort Study, the Danish National Birth Cohort, and All Babies in Southeast Sweden). The primary outcome was IBD, and the time of event was defined as the first of at least two diagnostic codes for IBD in linked national patient registers by 2022. Dietary exposures were measured using repeated questionnaires: diet quality at ages 7–8 and 11–14 years was measured using a modified Healthy Eating Index, and diet diversity at age 11–14 years was assessed using a Diet Diversity Score. Each dietary exposure was modeled into low, medium, and high based on tertiles. Cohort-specific adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for developing IBD, Crohn’s disease (CD), and ulcerative colitis (UC) were estimated using Cox proportional hazards regression adjusted for sex, IBD heredity, and socioeconomic status, pooled across cohorts using a random-effects model. Joint modeling was conducted to account for the repeated diet quality measurements and their association with time to IBD development.

Results

We followed 137,179 individuals for 1,894,582 person-years. During this time, 811 developed IBD. The pooled aHR for IBD comparing high vs low diet quality was 0.83 (95% CI 0.62–1.10) at ages 7–8, and 0.69 (0.51–0.93) at ages 11–14 (Table 1). Similar associations were observed for CD (ages 7–8: aHR=0.74 [0.45–1.21]; ages 11–14: aHR=0.66 [0.44–0.99]), but not for UC (ages 7–8, aHR=0.98 [0.73–1.31]; ages 11–14, aHR=0.71 [0.48–1.07]). For high vs low diet diversity at ages 11–14, the pooled aHRs were 0.76 (0.58–1.00) for overall IBD, 0.79 (0.49–1.26) for CD, and 0.74 (0.49–1.11) for UC. Joint modelling also showed that a higher overall longitudinal diet quality exposure was associated with a reduced risk of IBD (0.87 [0.78–0.97] and CD (0.87 [0.78–0.94], with largely similar estimates in the adjusted model.

	Inflammatory bowel disease		Crohn's disease
Exposure	HR (95% CI)	aHR (95% CI)	HR (95% CI)	aHR (95% CI)
Diet quality 7-8 years
Low	Reference	Reference	Reference	Reference
Medium	0.80 (0.67–0.95)	0.79 (0.66–0.94)	0.78 (0.60–1.01)	0.76 (0.58–0.99)
High	0.83 (0.64–1.08)	0.83 (0.62–1.10)	0.76 (0.47–1.22)	0.74 (0.45–1.21)
Diet quality 11-14 years
Low	Reference	Reference	Reference	Reference
Medium	0.83 (0.66–1.04)	0.83 (0.66–1.04)	0.84 (0.61–1.16)	0.83 (0.60–1.16)
High	0.69 (0.51–0.92)	0.69 (0.51–0.93)	0.66 (0.44–0.99)	0.66 (0.44–0.99)

Multiple imputation was applied to handle missing data. CI, confidence interval; HR, hazard ratio.

Conclusion

In this tri-national birth cohort study, higher diet quality in childhood and adolescence, particularly at 11–14 years of age, was associated with a lower risk of CD.

References

1. Lynch SV, Pedersen O. The Human Intestinal Microbiome in Health and Disease. N Engl J Med 2016;375:2369-2379.
2. Dong TS, Gupta A. Influence of Early Life, Diet, and the Environment on the Microbiome. Clinical Gastroenterology and Hepatology 2019;17:231-242.
3. Guo A, Ludvigsson J, Brantsæter AL, et al. Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts. Gut 2024;73:590-600.

Event

UEG Week Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition IBD Gut Microbiota

Submission format

Abstract

Session

Beyond prescriptions: Improving IBD outcomes with non-pharmaceutical approaches

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Francis Phillip

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Why are you using conventional therapies, doc? A case-based perspective and state-of-the-art overview

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Why are you using conventional therapies, doc? A case-based perspective and state-of-the-art overview

Peter Bossuyt 1, Brecht Hens 2

Affiliations

1 Imelda General Hospital, Bonheiden, Belgium

2 UZ Brussel, Brussels, Belgium

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Session

Dilemmas in ulcerative colitis: Back to the basics or fast forward

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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CONSUMPTION OF ULTRA-PROCESSED FOOD PROMOTE INFLAMMATORY POTENTIAL OF FECAL MICROBIOME THROUGH ALTERING THE BALANCE OF TH17 AND RORYT TREG

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Francis Phillip

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Epithelial metabolism controlling inflammation in IBD

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Epithelial metabolism controlling inflammation in IBD

Konrad Aden 1

Affiliations

1 IKMB + First Medical Department, Kiel, Germany

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Abstract

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Mechanisms & Personalised Medicine Immunology IBD

Session

Metabolic aspects of immunomodulatory IBD therapy

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Williams Turpin

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

DIET QUALITY AND DIVERSITY IN CHILDHOOD AND ADOLESCENCE AND LATER RISK OF INFLAMMATORY BOWEL DISEASE: A TRI-NATIONAL BIRTH COHORT STUDY

Karl Mårild

Why are you using conventional therapies, doc? A case-based perspective and state-of-the-art overview

Brecht Hens

Epithelial metabolism controlling inflammation in IBD

Konrad Aden

D-LACTIC ACIDOSIS COMPLICATION OF A SHORT BOWEL SYNDROME MIMICKING A NEUROLOGICAL DISORDER - AN UNDER-RECOGNIZED, HIGHLY TREATABLE ENTITY THAT MIGHT BE MORE COMMON THAN WE THINK

Francis Phillip

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D-LACTIC ACIDOSIS COMPLICATION OF A SHORT BOWEL SYNDROME MIMICKING A NEUROLOGICAL DISORDER - AN UNDER-RECOGNIZED, HIGHLY TREATABLE ENTITY THAT MIGHT BE MORE COMMON THAN WE THINK

Muhammad Hafiz Kamarul Bahrin 1, Mirza Faisal Anwar Baig 1, Francis Phillip 1

Affiliations

1 Nottingham University Hospital, Nottingham, United Kingdom

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Abstract

Clinical Case Summary

Our case study presents a 51-year-old female with a history of Short Bowel Syndrome (SBS) secondary to previous extensive bowel resection as a result of bowel ischemia. She presented as an emergency following a fall, sustaining a right-sided femoral fracture. She also exhibited altered mental status and slurred speech, which was initially thought to be a stroke. Physical examination, however, was unremarkable. Computed tomography (CT) of the head was normal. Laboratory testing revealed a high anion gap metabolic acidosis with normal lactate level and kidney function (lab results table will be inserted).

Initial treatment was commenced with intravenous 0.9% saline solution and her fractured femur was promptly operated on. Subsequently, she admitted to having consumed a high carbohydrate diet and regular alcohol intake for the past few weeks. On this basis, D-lactic acid assay was checked and was found to be markedly elevated. Diagnosis of D-lactic acidosis (D-LA) was made and she was treated with parenteral nutrition and hydration, correction of electrolyte imbalances, and oral Rifaximin. Specialist dietitian input was sought and she was subsequently commenced on low carbs diet and was warned against alcohol consumption. Remarkable improvement in her mental and physical status was achieved within 1 week.D-LA is a rare metabolic complication and should be considered in the differential diagnosis of patients with a history of SBS and altered mental status¹. It often mimics a neurological disorder hence diagnosing it in an acute setting can be challenging. This relates largely to colonic flora-driven anaerobic carbohydrates fermentation, releasing D-lactic acid (which is an enantiomer of L-lactic acid, a common compound of human metabolism) into the bloodstream². D-lactic acid is shown to accumulate in and damages the cerebellum³ in many case studies. Prompt recognition and early specialist dietitian input are key to avoid complications and improve outcomes.

References

1. Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215. doi: 10.1155/2015/476215. Epub 2015 Apr 22. PMID: 25977687; PMCID: PMC4421027.
2. Sheedy, J. R., Wettenhall, R. E., Scanlon, D., Gooley, P. R., Lewis, D. P., Mcgregor, N., Stapleton, D. I., Butt, H. L., & Meirleir, K. L. D. (2009, July 1). Increased D-lactic acid intestinal bacteria in patients with chronic fatigue syndrome. In Vivo. Retrieved April 16, 2023, from https://iv.iiarjournals.org/content/23/4/621#ref-6.
3. N. Gurukripa Kowlgi, Lovely Chhabra, "D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome", Gastroenterology Research and Practice, vol. 2015, Article ID 476215, 8 pages, 2015. https://doi.org/10.1155/2015/476215.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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