Introduction

Janus Kinase (JAK) inhibitors are licensed for the treatment of ulcerative colitis with the benefits of a fast onset of action and a short half-life.[i] This makes them a potential treatment option for patients hospitalised with UC, including those previously treated with, or unsuitable for, infliximab or cyclosporine. There is currently limited published evidence in this setting, drawn from small case series.

Aims & Methods

We performed a retrospective analysis of data collected at 14 sites in the United Kingdom, including both tertiary IBD centres (n=10) and general hospitals (n=4) between January 2019 to January 2024. We included patients who were hospitalised due to active UC and commenced a JAK inhibitor for that indication during the same admission. Baseline data included disease duration and extent, prior exposure to advanced therapies, clinical and endoscopic assessments of disease activity and laboratory parameters. We reviewed treatments administered during the same admission, including corticosteroids and advanced therapies.
Coprimary endpoints were colectomy rate at 30 days and 12 months. 12 week, 6 month and 12month persistence data was collected. Adverse outcomes and treatment persistence at the same time points were also recorded.

Results

80 patients (filgotinib (n=15), tofacitinib (n=25) and Upadacitinib (n=40) were included, with a minimum of 12 weeks follow-up. 43/80 (54%) were male, mean age was 37±14, mean admission albumin 35 and CRP 52. Extent of disease was E1 1/80 (1%), E2 31/80 (39%) and E3 48/80 (60%).
63/80 (79%) of patients had prior anti-TNF exposure (infliximab 47/80 (59%), including 13/80 (16%) of whom had received it as a previous rescue therapy). 31/80 (39%) were on prednisolone at admission.
50/80 (63%) had a baseline endoscopic assessment within 72 hours of admission, of which 34/50 (68%) had severe (Mayo 3) endoscopic activity.
During admission, prior to JAK inhibitor administration, treatments given included IV hydrocortisone (93%), methylprednisolone (5%), infliximab (4%) and cyclosporine (1%).
Colectomy rates were 8% and 14% at day 30 and week 12 respectively. In patients for whom 12-month follow-up data were available, 5/34 (15%) had undergone a colectomy at that timepoint.
There was one recorded herpes zoster infection and no recorded thromboses or major adverse cardiovascular events.

Table 1. JAK Inhibitor & Treatment Persistence

Conclusion

JAK inhibitors appear to offer a valuable treatment option for patients hospitalised with active UC. This appears to be the case even in patients with prior anti-TNF exposure. 86% of patients avoided colectomy at 12 weeks, with a similar proportion colectomy-free at 12-months. The risk of adverse events was small. Our study is, to our knowledge, the largest dataset examining the initiation of JAK inhibitors for those hospitalised with UC.

References

[i] Agrawal M, Kim ES, Colombel J-F. JAK inhibitors safety in ulcerative colitis: practical implications. Journal of Crohn's and Colitis. 2020;14(Supplement_2):S755-S60.

Introduction

Patients with eosinophilic oesophagitis often experience diagnostic delays. Untreated eosinophilic oesophagitis may result in fibrosis and stricture formation, leading to morbidity and impaired quality of life. Early diagnosis and treatment can potentially prevent these outcomes and reduce emergency admissions with food bolus obstruction. The reasons for these delays have not been examined in primary care previously. This study quantifies the time to eosinophilic oesophagitis diagnosis and examines factors associated with diagnostic delays.

Aims & Methods

A retrospective cohort study of incident eosinophilic oesophagitis patients between 1st Jan 2006 and 31st Dec 2022 was undertaken using Clinical Practice Research Datalink (CPRD AURUM) linked to hospital admission data in Hospital Episode Statistics. Patients were followed from first proton pump inhibitor (PPI) prescription or presentation with eosinophilic oesophagitis related symptoms (food bolus obstruction or dysphagia) identified from SNOMED CT codes for primary care and ICD-10 codes for secondary care to diagnosis. The association between patient level factors and time to eosinophilic oesophagitis diagnosis was examined using a Robust Poisson regression model.

Results

2300 eosinophilic oesophagitis patients were studied (67.7% male; age 38 (IQR 30-49)). Median time to diagnosis was 3.6 years (IQR 0.5-8.7). 80.7% patients had a PPI prescription record in primary care prior to eosinophilic oesophagitis diagnosis with a time to eosinophilic oesophagitis diagnosis of 4.9 years (IQR 1.5- 9.7). Factors associated with more than 3 years to diagnosis included: female sex (adjusted risk ratio 1.18, 95% CI 1.10-1.27); smoking (1.11, 1.01-1.23); compared with baseline of elective endoscopy, urgent endoscopy for dysphagia (1.35, 1.18-1.54), urgent endoscopy for food bolus obstruction (1.26, 1.13-1.41), dysphagia presentation in primary care (1.16, 1.08-1.25), food bolus obstruction presentation in primary care (1.11,1.00-1.23) and PPI prescription in primary care (3.08, 2.58-3.67). 77% of patients had PPI treatment prescribed after eosinophilic oesophagitis diagnosis. 21% patients with no history of asthma or chronic obstructive pulmonary disease were prescribed a steroid inhaler (presumably swallowed) after eosinophilic oesophagitis diagnosis.

Conclusion

Longer time to eosinophilic oesophagitis diagnosis was associated with being female, smoking, food bolus obstruction and dysphagia presentations in primary or secondary care and particularly PPI prescriptions in primary care.

Introduction

Eosinophilic oesophagitis is a condition characterised by symptoms of dysphagia and/or food impaction in adults, with oesophageal histology showing a peak eosinophil count of >15 eosinophils/high power field (or >15 eosinophils/0.3mm2 or >60 eosinophils / mm2), and the absence of other causes¹. Recent BSG guidelines for the management of Eosinophilic oesophagitis (EOE) in adults recommend repeat endoscopy to ensure histological remission on treatment. This can require multiple procedures that are unpleasant for patients and are resource intensive. Capsule sponge is a minimally invasive oesophageal cell sampling technology that has been used in >15000 patients with Reflux symptoms and Barrett’s oesophagus. To date it has not been used in adults with EOE in clinical practice. The COSIE study is a pragmatic prospective ongoing study of adults with non-stenotic EOE to evaluate capsule sponge in routine clinical practice.

Aims & Methods

All adult patients attending a monthly dedicated EOE clinic May 2023 to April 2024 in a non-specialist hospital, were screened by a single consultant, Patients were offered capsule sponge and same day gastroscopy at least 8 weeks after starting or changing therapy or after three weeks from first diagnostic gastroscopy to monitor disease response and activity. The Endosign device was used in all patients. The Dysphagia Symptom Questionnaire, cytological and histological eosinophil count and Endoscopic reference score (EREFS) were measured as part of the ongoing study. Qualitative outcomes including success rate of swallowing, satisfactory cell sample (sufficient squamous cells), evidence of sponge reaching the stomach (columnar cells seen), complications and patient feedback and test preference were collected patient satisfaction questionnaire was collected after the procedure on the same day . All sponge cytology were processed by CYTED laboratories and endoscopic histology as part of normal clinical practice.

Results

138 patients with EOE attended the clinic between May 2023 and April 2024. 77 patients identified as suitable, 41/53 (75%) agreed to take part. 12/53 (25%) declined to take part in the study when our research nurse contacted them and 24 are awaiting testing. 31/41 (75.6%) were male and 10 (24.4%) females. Median age observed was 50 years, standard deviation 14.58, minimum was 19 years old and maximum age recorded was 72 years. Of the 41 patients who attempted to swallow capsule sponge 5 (12%) failed to swallow after 2 attempts. There have been no complications and no sponge detachments. 36 /41 (87.8%) agreed to same day gastroscopy. On same day gastroscopy examination, 20/ 36(55.5%) had minor grade I or II visible abrasions. No mucosal tears were evident. There was evidence of the capsule sponge reaching the stomach in 29/32 (90.6%). Adequate squamous cytological specimen were produced in 32/32 (100%). 36 (87.8%) patients found test acceptable of which 28/37 (75.6%) of those who expressed a preference preferred capsule sponge to gastroscopy.

Conclusion

The preliminary results show that capsule sponge is feasible to use in routine clinical practice and can be used safely to sample the oesophagus in non-stenotic EOE, providing sufficient samples. It is well tolerated and patients preferred capsule sponge to gastroscopy. Ongoing work will assess clinical effectiveness and management outcomes, comparative eosinophil counts and will contribute to a multicentre QUBIE (QUantitative Biomarker Identification for Eosinophilic oesophagitis) study to evaluate potential biomarkers in EOE.

References

Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut 2022;71:1459-1487.

Introduction

Intestinal point-of-care ultrasound, as standardized by the International Bowel Ultrasound Group (IBUS), has emerged as a valuable tool for diagnosing, monitoring, and managing patients with Inflammatory Bowel Disease (IBD). While IBUS emphasizes a structured intestinal assessment, some European centers adopt a more comprehensive approach, combining intestinal ultrasound with a complete abdominal examination.
The Karolinska Centre for Digestive Health, a tertiary referral institution providing specialized care to approximately 4,500 patients with IBD, established a dedicated Gastrointestinal Ultrasound Unit in October 2023. This unit offers advanced diagnostic services to both hospitalized patients and those treated on an outpatient basis.

Aims & Methods

This retrospective study aimed to assess the prevalence of secondary extraintestinal findings in IBD patients undergoing comprehensive abdominal ultrasound between October 4, 2023, and March 4, 2025. All patients underwent ultrasound assessments that included both intestinal and abdominal imaging. Patients referred for indications unrelated to intestinal ultrasound (IUS), as well as those undergoing repeat examinations, were excluded from the analysis to ensure data consistency.
All examinations were performed by a single gastroenterologist with 25 years of ultrasound experience. In cases where secondary extraintestinal findings were identified, patients’ electronic medical records were reviewed to determine whether these findings represented new diagnoses or previously known conditions.

Results

The study included 348 patients with IBD, 201 (58%) females and 147 (42%) males, with a mean age of 42.4 years. Among these, 260 (75%) were referred internally by our IBD Outpatient Clinic, 47 (13%) by the Gastroenterology Ward, 33 (10%) by private outpatient clinics, and the remainder from other healthcare sites. IUS revealed evidence of intestinal inflammation in 144 patients (42%), while findings were normal in 204 patients (58%).
Furthermore, 150 patients presented with a total of 195 secondary extraintestinal findings, of which 113 (58%) represented newly identified pathologies. Among all secondary findings, the majority, 104 (53%), were related to the hepatobiliary system, including 33 newly diagnosed cases of hepatic steatosis and 17 new cases of cholecystolithiasis. One patient demonstrated ultrasound features suggestive of primary sclerosing cholangitis (PSC) and is currently undergoing further evaluation. Additional findings involved the reproductive system (29/15%), urinary system (15/7%), spleen (32/16%), and pancreas (5/2%). Various other intra-abdominal findings were also identified (37/18%). Notably, one patient presented with a suspicious mass in the right iliac fossa, and another demonstrated ultrasound findings suggestive of a prostatic tumor; both cases were referred for further oncologic evaluation. Additionally, three patients were newly diagnosed with intraductal papillary mucinous neoplasm (IPMN), which was subsequently confirmed via magnetic resonance imaging, and all were enrolled in the national IPMN surveillance protocol.

Conclusion

A considerable proportion of patients with IBD were found to have previously unknown extraintestinal abdominal pathologies, underscoring the essential role of comprehensive ultrasound examination that combines both intestinal and abdominal assessment. Fortunately, only a minority of these findings resulted in changes to patient management.

Disclosure

Francesca Bresso has acted as national and/or local principal investigator for clinical trials for Janssen, Ferring, and AbbVie. Charlotte Hedin served as a speaker and/or advisory board member for AstraZeneca, AbbVie, Dr. Falk Pharma and the Falk Foundation, Galapagos, Janssen, Pfizer, Ferring, Takeda, and Tillotts Pharma and received grant support from Tillotts Pharma and Takeda. Stephan L. Haas has served as a speaker for Takeda, Santax Medico, Tillotts Pharma, Johnson & Johnson, and Mediahuset. The rest of the authors have nothing to declare.

Introduction

Hepatocellular carcinoma (HCC) is an end stage liver disease with increasing morbidity and mortality worldwide. Development of the disease is dependent on various genetic, dietary and environmental factors. While alcohol-related liver disease (ALD/MetALD) remains a major contributor, metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming increasingly relevant in clinical practice. There is increasing evidence for the role of bacteria, for instance, such as Bifidobacterium and Blautia, which were considered protective, while Streptococcus has been associated with disease progression. However, little is known about the alteration of microRNAs (miRNAs) in liver diseases and its interrelationship with microbial environment in view of etiological factors.

Aims & Methods

This study aimed to elucidate gastrointestinal miRNA alterations and explore their relationship with microbiome composition in patients with different stages of liver disease in terms of disease etiology. Multi-omics analyses were performed in a subset of well characterized patients (n=59) with liver disease and healthy controls. Systematic characterization included clinical, laboratory, demographic and imaging characterization and dietary preferences. Patients subclassification included fibrosis stage (no fibrosis, fibrosis, liver cirrhosis(LC)) and etiology (MetALD/ALD vs. MASLD). Fecal miRNAs were extracted using the Qiagen miRNeasy Kit and profiled via Agilent miRNA microarray. Microbiome analyses were performed amplifying the V1-V2 region of the 16S rRNA gene following Illumina sequencing.

Results

For miRNA analysis stringent criteria were applied to identify high quality miRNA targets. From approximately 4,000 candidates filtering resulted in selection of 202 high-quality miRNAs with reliably measurable concentrations. 28 of these miRNAs showed significantly positive alterations in concentration in patients with liver disease and 7 miRNAs significant negative alterations. Specifically, miR-642a-3p, miR-5006, miR-6781, and miR-6849 were elevated in feces in patients with LC. In contrast, miR-6869, miR-4467, and miR-5001 were present in lower concentration in LC patients. Notably, miR-4467 also showed strong negative associations with liver-specific laboratory markers, including gamma-glutamyl transferase (GGT) (r=-0.34; p=0.026) and M65, a marker of apoptosis (r=-0.42; p=0.005). Cross-sectional comparison of miRNA and microbiome data revealed miRNA alterations associated with specific microbial signatures. MiR-6795-5p, which was associated with liver stiffness (r = 0.39, p = 0.01), also correlated positively with the abundance of Streptococcus, a genus linked to disease progression (r=0.29; p=0.047). Conversely, miR-6869, miR-4467, and miR-5001 showed positive correlations with the potentially protective genera Blautia and Bifidobacterium (miR-6869: r_{Bifidobacterium}=0.35; p_{Bifidobacterium}=0.012; r_Blautia=0.37; p_Blautia=0.008; miR-4467: r_Blautia=0.41; p_Blautia=0.002; miR-5001: r_Blautia=0.38; p_Blautia=0.006).

Conclusion

Multi-omics analysis reveals distinct alterations in fecal miRNAs and gut microbiota across different stages of liver disease. Changes in microbial composition were associated with shifts in miRNA profiles, suggesting a functional link in maintaining intestinal homeostasis. These findings highlight the potential of integrated microbiome–miRNA signatures as novel diagnostic and therapeutic targets. Further studies are warranted to validate these associations and explore their clinical applications.

Introduction

Azathioprine and mercaptopurine are commonly used to treat Inflammatory Bowel Disease (IBD), with around 6 in 10 patients being prescribed them at some point. Adherence to treatment is important to maintain disease control, prevent flare ups, reduce the need for steroids and improve wellbeing. A good response to treatment may delay or negate the need to escalate treatment to Biologic medications or surgery. Despite this, treatment non-adherence is a common problem among patients with chronic diseases, averaging at around 50%. In IBD specifically, the data varies widely, but non-adherence to oral therapy has been reported to be as high as 72%.

Aims & Methods

The aim of this study was to determine the adherence to azathioprine and mercaptopurine in IBD patients across the Bristol, North Somerset, South Gloucestershire Integrated Care Board (BNSSG ICB). Primary care records were searched to identify all patients with IBD prescribed azathioprine or mercaptopurine. Demographic data as well as data on disease type, length of treatment and co-prescription with a Biologic treatment was collected. Medication adherence was determined by GP records of pharmacy refill data.

Results

A total of 1313 patients were identified as having IBD and a current prescription for azathioprine or mercaptopurine, from 78 GP surgeries (98% of surgeries within the BNSSG ICB). 154 patients were excluded as they had been on azathioprine for less than 1 year. 59% of the 1159 included patients had Crohn’s disease. 360 patients (31%) were on combination therapy with a Biologic medication. 324 patients (28%) were found to be non-adherent with their medication based on prescription refill data suggesting that they do not have an adequate supply of medication.

Conclusion

Our data suggests that adherence to the immunosuppressant medications azathioprine and mercaptopurine in patients with IBD is comparable or slightly better than in other chronic diseases. However, pharmacy refill data is an indirect measure of medication adherence so adherence may have been overestimated. There remains a substantial proportion of patients who are not adhering to treatment, which is likely to be associated with poorer outcomes.

References

Chan W, Chen A, Tiao D, et al. Medication adherence in inflammatory bowel disease. Intest Res. 2017 Oct;15(4):434-445

Disclosure

No conflicts of interest to declare.