Introduction

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), and endometriosis are two nosological frameworks affecting young women. They share a spectrum of abdominal symptoms and partially common pathophysiological mechanisms involving immune system dysregulation. It is described that women with endometriosis have a higher risk of developing IBD. However, the impact of endometriosis on IBD is poorly understood. The aim of our study was to evaluate the impact of the coexistence of both diseases on the phenotype and evolution of IBD.

Aims & Methods

We conducted a retrospective cohort study in 18 GETAID (Groupe d’Étude Thérapeutique des Affections Inflammatoires du tube Digestif) centers between June 2022 and March 2023. Any patient with both endometriosis and IBD was eligible for inclusion. They were then randomly matched to 1 or 2 patients with IBD without endometriosis, according to the following criteria: type of IBD (CD or UC), year of birth (± 5 years), year of IBD diagnosis (± 4 years), and date of the last consultation (± 2 years). Data from non-exposed patients (IBD alone) were collected from a single center (CHU de Lille). The evolution of IBD was assessed using a composite severity criterion including intestinal damage (stenosis, fistula, or intra-abdominal abscess) or the need for intestinal resection surgery. The use of immunosuppressants and biologics was also recorded.

Results

In total, 207 patients with both endometriosis and IBD (149 CD and 58 UC) were included and matched to 409 patients with IBD alone. The median age of patients at the diagnosis of IBD was 23 years [IQR 18; 29]. The median follow-up duration for IBD was 10 years [5.75; 17]. For patients with CD, there was no difference between the two groups regarding disease location, disease phenotype, and anoperineal involvement. For patients with UC, there was a difference in disease extent with more rectal involvement in the endometriosis group (29.3% vs 12.6%; p=0.03). Patients exposed to endometriosis had significantly less use of immunosuppressive treatments (UC p < 0.01; CD p < 0.001) and biologics (UC p < 0.01; CD p < 0.001), both anti-TNF (UC p=0.01; CD p < 0.001) and non-anti-TNF (UC p=0.04; CD p=0.001). In the actuarial analysis according to the composite severity criterion, patients exposed to endometriosis had a more favorable evolution of their CD than non-exposed patients (HR=0.68; 95% CI [0.50; 0.92]; p=0.011). In the subgroup of patients with CD who underwent surgery for their endometriosis during follow-up (n=72), a less severe progression was also observed (HR=0.65; 95% CI [9.42; 1]; p=0.05). The luminal surgery rate for CD in these patients was lower (32.2% vs 43.9%; p=0.01) in the "exposed" group. No difference was observed for anoperineal manifestations (p=0.16) and the use of anoperineal surgery (p=0.82). For the UC group, those with endometriosis seemed to have a less favorable disease course, according to the composite severity criterion (HR=1.73; 95% CI [0.74; 4.00]; p=0.20). However, the rate of colectomy was not significantly higher for exposed patients (19.0% vs 11.5%; p=0.20).

Conclusion

Although patients with endometriosis are at a higher risk of developing IBD, it does not negatively influence the course of IBD. On the contrary, patients with CD appear to have a less severe progression, with significantly less exposure to immunosuppressants and biologics. However, both conditions have a major impact on patients, requiring multidisciplinary follow-up to ensure symptom control and improve their quality of life.

Introduction

Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of thisstudy was to prospectively evaluate sarcopenia by combining morphological and functional criteria inan outpatient IBD population.

Aims & Methods

In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of ourdepartment between March 1st and 31st, 2023. Patients with short bowel syndrome were notincluded. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter,and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement < 16 to 26, and myopenia was defined by anappendicular muscle mass index (AMMI) < 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) < 15 to 17 inwomen or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patientswere followed-up at 6 months to measure a composite criterion of disease activity combining one ofthe factors: FC > 250μg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-relatedsurgery

Results

In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) orUC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic(48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%)involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologicsadministered were infliximab (61%),vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopeniawas 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years,p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%,p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significantdifference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tendedto be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs.21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to thecomposite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline).Myopenia indices were strongly correlated with handgrip values(r=0.7, p<0.001)

Conclusion

In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in11% and myopenia in 20% of cases, and associated with an increase in morbidity

Disclosure

No conflict of interest

Introduction

A sedentary lifestyle, poor fiber intake and other unhealthy dietary habits have been associated with diverticular disease (DD). On the contrary, the Mediterranean Diet (MD), which involves factors such as consuming locally grown food products, family meals, conviviality, involvement in the preparation of meals, as well as high intake of vegetables, legumes, fruit and cereals, medium intake of fish, low intake of meat and saturated fat, high intake of unsaturated fat (particularly olive oil), a medium-low intake of dairy products (yogurt and cheese), and a moderate intake of wine, seems to protect against DD. Moreover, populations that follow the MD pattern show a 50% lower rate of cardiovascular mortality due to cardiovascular disease and show highest longevity. (1)

Aims & Methods

Aim: to compare adherence to MD as a whole and its different components in subjects with and without diverticular disease.

Materials and methods: all patients undergoing colonoscopy at our Endoscopy Unit of a Tertiary Hospital in Northeastern Italy from January to June 2022 were invited to participate in the study, completing three questionnaires including personal/medical history and medications, symptoms, physical activity questionnaire, and Medi-Lite (ML) questionnaire for the assessment of adherence to MD. Subjects were then divided in two groups based on the endoscopic diagnosis of diverticular disease (DD).

Results

A total of 3757 patients underwent colonoscopy at our center during the 6-month study period, 1112 of whom completed the questionnaires and therefore constituted the study population. Overweight (BMI>25 kg/cm²) was observed in 61% of males and 40.2% of females, and correlated inversely (OR<1) with higher education attainment, daily physical activity of at least 30 minutes, and, in females, the performance of a structured physical activity/sport for at least 60 minutes a week. Moreover, being married or widowed and consuming meals preferably at home, as opposed to consuming meals at restaurants or cafeterias, were significantly associated with overweight (OR>1), especially in female patients. In the overall population, normal weight was more frequently associated with consumption of meat, while in females, it is associated with greater consumption of raw vegetables. Overweight was more frequently associated with consumption of salami and cheese, especially in the female population, and it correlated with the presence of cardiovascular diseases (especially hypertension). DD was present in 400/1112 (35.9%) of subjects and this condition was significantly associated with (OR>1) male sex, older age (61-75 years), overweight (BMI>25 kg/cm²), cardiovascular disease, polypharmacy, cigarette smoking, alcohol use, cheese consumption, abdominal pain as the chief complaint, and lower education attainment. No correlation was found between DD and the MD score or its components. In patients with DD, abdominal pain was inversely and significantly associated with an elevated ML score (OR=0.085) and consumption of meat (OR=0,096) and legumes (OR=0,079) (p<0.05).

Conclusion

Subjects undergoing colonoscopy share similar dietary and lifestyle habits, while in the presence of DD, ingestion of certain products seems to have an impact on symptoms.

References

1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344.

Introduction

Common variable immunodeficiency (CVID) is the most prevalent primary immune deficiency. Two-thirds of CVID patients present concomitant autoimmune disorders, including gastrointestinal autoimmune disease, other than being at risk for gastric cancer.

Aims & Methods

We aimed to assess the prevalence of autoimmune gastrointestinal manifestation in patients with CVID and to evaluate the diagnostic yield of EGDS for the screening of gastric pre-neoplastic lesions in a prospective cohort of patients with CVID. From June 2020 to June 2022, we prospectively enrolled patients with CVID diagnoses from a tertiary referral center. At enrollment, patients underwent a gastroenterological screening consisting of clinical evaluation and laboratory tests for the screening of autoimmune gastrointestinal disease. Moreover, all patients were proposed to undergo an esophagogastroduodenoscopy (EGD) regardless of the presence of GI symptoms to rule out pre-neoplastic gastric lesions and upper gastrointestinal disease in the presence of clinical suspicion. Patients with lower GI symptoms were proposed for colonoscopy.

Results

We included 94 patients with CVID, of whom 58 (61.7%) were females, with a mean age of 44.3 years old [standard deviation (SD) 16.3]. Overall, 12 patients (12.8%) were diagnosed with one or more gastrointestinal autoimmune diseases. Eight patients (8.5%) had ongoing therapy with intravenous immunoglobulin, while 24 (25.5%) with subcutaneous immunoglobulin. Four patients (4.3%) had a previous celiac disease diagnosis, with a negative serology at screening, and only 1 (1.1%) patient had evidence of villous atrophy and duodenal inflammation at the time of EGD. Three (3.2%) patients were diagnosed with autoimmune atrophic gastritis with negative serology and evidence at biopsies taken during EGD of atrophic gastritis. One patient (1.1%) was diagnosed with ulcerative colitis, one patient (1.1%) with Crohn’s disease, and 5 patients (5.3%) with autoimmune hepatitis. Sixteen (16, 17%) patients reported inhalant allergy, 5 (5.3%) reported food allergy, and 26 (27.7%) reported drug-related allergy. Eleven (11.7) patients reported previous Helicobacter pylori (HP) infection, while only 1 (1.1%) patient was diagnosed with an ongoing HP infection. Fifty-eight patients underwent EGD, with endoscopic evidence of esophagitis in 8 patients (13.8%), gastritis in 45 (77.6%), and duodenal atrophy/inflammation in 23 (39.7%), of whom 41.4% had histological evidence of duodenal lymphocytosis. No patient was diagnosed with gastric cancer. Twenty-three patients underwent colonoscopy according to clinical indication, which showed at biopsy sampling ileal nodular follicular hyperplasia in 2 patients (8.7%), microscopic (lymphocytic) colitis in 2 patients (8.7%), ulcerative colitis in 1 (4.3%) and Crohn's disease in 1 (4.3%).

Conclusion

Celiac disease, atrophic gastritis, and autoimmune hepatitis were the most common gastrointestinal autoimmune overlaps of patients with CVID. Autoimmune gastrointestinal diseases in patients with CVID may pose a particular diagnostic challenge since autoantibodies are often absent. Five percent of CVID patients screened with EGD was found with a gastric pre-neoplastic lesion. Further data are needed to define the optimal timing of endoscopic follow-up of these patients for the screening of pre-neoplastic and neoplastic lesions.

Disclosure

Served as an advisory board member for EG Pharma
Received lecture grants from AlfaSigma, Bromatech, Echosens, Ferring, Mayoly Spindler and Schwabe Pharma.

Introduction

Gastroesophageal reflux is responsible for various extresophageal symptoms that are commonly labelled as laryngopharyngeal reflux (LPR). These mostly include cough, throat clearing, globus sensation and hoarseness. The pathophysiological link between reflux and symptoms likely includes direct effect of the refluxate on the upper airways epithelium and reflex that is initiated by stimulation of the afferent nociceptive fibres in the distal esophagus by acidic gastroesophageal reflux. Arguably, the relationship between reflux and laryngopharyngeal symptoms might involve other, yet not well explored mechanisms. In our previous research we found that LPR patients have impaired mucociliary clearance of the respiratory epithelium of the upper airways. This could contribute to the inflammation persistence and the presence of symptoms. We therefore aimed to determine whether any parameter of the reflux burden as detected by 24-hour pH/impedance correlates with ciliary beat frequency (CBF), the major quantifiable aspect of mucociliary clearance.

Aims & Methods

Consecutive patients with LPR confirmed by off PPI 24-hour pH/impedance had a sample of the ciliated epithelium obtained from the nose using a cytology brush. Nasal CBF was analysed using a digital high‐speed video microscope and the dedicated software application Ciliary Analysis (NI LabVIEW). Healthy volunteers without either esophageal or extraesophageal reflux symptoms served as a control group. Both patients’ and healthy volunteers’ group were without any airway inflammation at least 3 months prior to the evaluation and were at least 10 days of PPI therapy. Maximal, minimal, and the median value of the CBF (Hz) was obtained. We performed correlation analyses between the acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI) in all impedance segments (Z1-Z6) and CBF values.

Results

32 patients with LPR confirmed by 24-hour pH/impedance that had positive reflux symptom index (RSI>13) were included in the final analysis. Of them, 12 patients had confirmed by positive acid exposure time (AET>6%) and/or abnormal number of reflux episodes (>80). Firstly, we confirmed our previous observations that LPR patients had lower CB frequency (median value) compared to the healthy individuals (6,37±2,17 vs. 10,9±1,9; p<0.0001). Separate analysis of patients with proven GERD showed no CBF difference from the remaining (pH negative patients) (6,26±2,53 vs. 6,43±1,94; p=0,42). Secondly, we performed correlation analysis between AET/number of reflux episodes and CBF. We found no significant correlation between reflux burden and median value of CBF (N=32, R=-0.18, p=NS and R=0.05, p=NS for AET and number of refluxes, resp.). Thirdly, we performed correlation analyses between CBF and MNBI values of all impedance segments. Indeed, correlation analysis between median CBF and MNBI Z1-Z6 showed no significant correlations (N=32, R=-0.16, 0.09, 0.28, 0.01, 0.14 for Z1, Z2, Z3, Z4, Z5, Z6, resp., resulting in p=NS in all segments).

Conclusion

pH positive LPR patients had no difference in CBF values from the remaining (pH negative) patients. Reflux burden in the esophagus as determined by pH recording does not seem to be related to ciliary beat frequency. We observed no significant correlation between the MNBI values in any impedance segment and the median CBF value. Further research should be performed to determine the putative mechanism between the impairment of CBF and reflux.
Supported by: VEGA 1/0060/23