Introduction

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a disease that complements Nonalcoholic Fatty Liver Disease (NAFLD) and is newly defined in 2020. It is defined based on metabolic abnormalities, regardless of the presence of liver disease caused by other causes such as alcohol consumption. Regarding the newly defined MAFLD, there has not been many studies related to the prevalence and risk factors in Korea, and no studies were found targeting soldiers, especially pilots.

Aims & Methods

The purpose of this study is to identify prevalence and risk factors for MAFLD in Korean air force army inclusive of pilots. The subjects are 1044 soldiers who underwent health checkups in Korean Air Force Aerospace medical center from January 2020 to December 2022. The data was retrospectively collected including age, height, weight, body mass index, waist circumference, blood pressure, smoking, drinking, exercise intensity, various blood test results, presence of fatty liver, and degree of fatty liver. Risk factors were analyzed using logistic regression.

Results

There were 667 pilots (64%) in our study, of whom 477 (72%) were high-performing pilots. The prevalence of MAFLD was 316 (30%) in all soldier. There was difference in the prevalence of MAFLD between pilot and non-pilot group (pilot group: 185 (28%), non-pilot group: 131 (35%) p-value=0.018). According to the multivariate analysis, body mass index (BMI), diabetes, systolic blood pressure, triglycerides (TG), uric acid (UA), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), alanine aminotransferase (ALT) were a risk factor associated with MAFLD among the entire soldiers. When categorized into pilot and non-pilot group, risk factors were associated with BMI, diabetes, alcohol consumption, and ALT in the non-pilot group. In the pilot group, they were statistically associated with age, BMI, dyslipidemia, TG, UA, HDL and ALT. Among them, UA showed the largest difference between the non-pilot group and the test group (non-pilot group: 1.14 (95% CI: 0.80-1.62), pilot group: 1.80 (95% CI: 1.38-2.36)).

Conclusion

There was a difference in the prevalence of MAFLD between pilot and non-pilot group. In particular, UA could be used to predict MAFLD as a specific risk factor in pilots comparing with non-pilots.

Introduction

Perianal fistulas occur in up to 30% of patients with Crohn’s disease (pfCD) and frequently require a combined medical and surgical treatment approach. Hyperbaric Oxygen Therapy (HBOT) has previously shown benefit in treatment-refractory pfCD.

Aims & Methods

In this pilot study, we aim to assess the feasibility of surgical fistula closure 4 weeks after HBOT, and efficacy of combining surgical closure and 8 weeks HBOT.
Patients with complex pfCD refractory to at least 6 months of anti-TNF therapy were included in this study. All patients received a seton prior to starting treatment with 40 sessions (8 weeks) of HBOT (each lasting 110 minutes, with 5-minute air breaks) with 100% oxygen at 2.4 atmosphere. At week 4 the seton was removed, and surgical closure of the internal fistula opening was attempted. All patients continued stable dose of medical treatment during the study. Response was assessed by the fistula drainage assessment (FDA) and the perianal disease activity index (PDAI) at week 9, 26 and 52, and by pelvic MRI at week 9 and 26. MRI response was defined as a decrease of 2 points in MAGNIFI-CD score, MRI remission as a MAGNIFI-CD ≤6. (Serious) Adverse Events (AE) were reported for 52 weeks. Univariate logistical regression was used to explore potential variates associated with PDAI response (≤4) at week 26.

Results

Ten patients completed treatment and were analyzed (Table 1). All patients completed HBOT and underwent a technically successful surgical procedure at week 4. No proctitis was encountered at week 4 during examination under anesthesia. PDAI response was achieved by 30%, 60%, 58% at week 9, 26 and 52, respectively. FDA response/remission was achieved in 50%/20%, 80%/40% and 80%/50% of patients at week 9, 26 and 52, respectively. MRI response/remission was achieved in 60%/10% and 60%/20% of patients at week 9 and 26, respectively. No significant parameters were associated with PDAI response at week 26 in univariate logistical regression. (S)AEs included one patient with a potential oxygen toxicity seizure without long term effects, and one patient reported claustrophobia, no new AEs were reported.

Table 1 Patient and fistula characteristics (n=10)

Conclusion

HBOT is feasible in combination with surgical therapy in patients with complex pfCD refractory to anti-TNF therapy. Patients had long-lasting benefit of the combined treatment approach. Further translational data are currently analyzed to clarify mechanisms of action and to explore potential biomarkers for therapy response.

Disclosure

LM, KB, JT and RvH have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this abstract. JS is President-elect of the European Society of Gastrointestinal and Abdominal Radiology. GD has served as consultant for AbbVie, Astrazeneca, Alimentiv, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Cosmo, Eli Lilly, Galapagos, GSK, Johnson and Johnson, Takeda, Pfizer Inc, Polpharma, Prometheus Biosciences, Tillotts and Ventyx; received speaker fees from AbbVie, Boehringer Ingelheim, Celltrion, Eli Lilly, Johnson and Johnson, Takeda, Pfizer Inc and Tillotts. CB has received grants from Boehringer Ingelheim and Roche; speakers honoraria from AbbVie, Janssen, Galapagos, Takeda, and Tillotts. KG has received grants from Pfizer Inc, Celltrion and Galapagos; consultancy fees from AbbVie, Arena Pharmaceuticals, Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Novartis, Pfizer Inc., Samsung Bioepis and Takeda and speaker’s honoraria from Celltrion, Ferring, Janssen Pharmaceuticals, Novartis, Pfizer Inc, Samsung Bioepis, Takeda and Tillotts.

Introduction

Optimal timing of endoscopy in patients with acute variceal bleeding (AVB) remains unclear. Studies in patients with peptic ulcer bleeding (PUB) have indicated that urgent endoscopy <6 hours from presentation may be associated with worsened patient outcome. We aimed to analyse the association between timing of endoscopy and mortality in AVB.

Aims & Methods

Prospective multicenter cohort study based on data from the 2022UK Audit on Acute upper gastrointestinal bleeding. The association between timing of endoscopy and in-hospital mortality was evaluated using logistic regression analyses with adjustment for differences in patients’ characteristics and severity of bleeding.

Results

We included 401 AVB patients. Mean age was 58 years, 65% were males, 75% had known cirrhosis at time of presentation, mean Child-Pugh score was 8.2, 31% had other comorbidities, 13% had ongoing bleeding at time of endoscopy, 78% were treated with terlipressin, 75% were treated with antibiotics, and 12.6% died during hospital admission. Mortality rates were 22%, 17%, 11%, and 11% for patients undergoing endoscopy in the periods <6, <12, 6-24 and >24 hours from presentation. Patients undergoing endoscopy < 6 hours had lower blood pressure, higher heart rate, lower haemoglobin, and higher peak-lactate levels than patients undergoing later endoscopy (see table). However, even haemodynamically stable patients with systolic blood pressure above 100mmHg had high mortality rates (16%) when performing urgent endoscopy < 6 hours. When adjusting for differences in patients’ characteristics, and severity of bleeding, we did not find any association between timing of endoscopy and mortality (Odds ratio (95% confidence interval): 1.01 (0.99-1.03); p=0.17).

Table: Patient characteristics in relation to time of endoscopy (n=401)

Conclusion

AVB is associated with significant mortality, in particular in patients undergoing urgent endoscopy <6 hours from presentation, which may be explained by more severe bleeding. When taking differences in patients characteristics and severity of bleeding into consideration, endoscopy within 6-12 hours appears to be associated with similar outcomes to endoscopy undertaken 6-24 hours from presentation, despite less time to patient optimization before endoscopy. Thus, the association between timing of endoscopy and outcome may differ between patients with AVB and patients with PUB.

Disclosure

No conflicts of interest.

Introduction

Inflammatory bowel disease (IBD) represents a group of chronic inflammatory disorders of the gastrointestinal tract. While the hallmark features of IBD involve inflammation and damage to the digestive system, the impact of the disease often extends beyond the gut, manifesting as a spectrum of extraintestinal manifestations (EIM), affecting various organs and contributing to the complexity and heterogeneity of IBD.

Aims & Methods

The aim of this study was to assess the impact of EIM in IBD on disease course. We conducted a retrospective, descriptive and comparative study including patients hospitalized for IBD over a 9-year period [January 2011-January 2020]. Patients with less than 2 years of follow-up were excluded. Clinico-biological data, disease severity, and long-term outcomes (surgery and disease course) were collected. Data were entered and analyzed via SPSS 26 software.

Results

We included 225 men and 227 women. We enrolled 341 patients diagnosed with Crohn's disease (CD) and 111 patients with ulcerative colitis (UC). The mean age at diagnosis was 36.15 ± 12.74 years. One-hundred and sixty-five patients (36.4%) had EIM with respectively: rheumatological manifestations (n=144), dermatological manifestations (n=26), ocular manifestations (n=17) and hepatic manifestations (n=8). We noticed a significant association of EIM with male gender (56.3% vs 45.9%; p=0.03). Rheumatological EIM were associated with a significant older age at disease onset (36.7 years vs 32.8 years; p=0.003). No significant association was noted between EIM with neither family history of IBD nor the type of IBD (p=0.33 and p=0.3 respectively). In case of CD, we noted a higher frequency of ileal involvement in patients with EIM, without a significant difference (61.4% vs 51.4%; p=0.07). No association was noted between EIM with neither fistulising behaviour nor with extended ileal disease nor with upper gastrointestinal tract involvement (p=0.1; p=0.5 and p=0.5 respectively). In case of UC, no association was noted between EIM and an extensive disease (p=0.7). As for treatment, EIM had no impact on corticosteroids’ use or immunosuppressive treatment (p=0.36 and p= 0.08), but was associated with a significant higher use of anti-TNF therapy (83.4% vs 27.2%; p=0.01). Response to corticosteroids and anti-TNF therapy was similar whether with or without EIM (p= 0.36 and p=0.24 respectively). In the sub-group of ocular EIM, we noted a higher failure of immunosuppressive treatment (70% vs 36.6%; p=0.04). We noted that EIM was associated with a rarer urge to surgical treatment (35.7% vs 44.9%;p=0.05) with a significant longer timeframe to surgery (47.7 months vs 27,2 months; p=0.03). The mean number of years of active disease was significantly higher in patients with EIM (3.3 vs 2.5; p=0.002) with a higher number of flare-ups (p=0.009) and hospitalizations (p<0.001), reflecting a better disease course in patients without EIM.

Conclusion

In our study, EIM were associated with an overall more severe disease course in IBD, thus, emphasizing the importance of comprehensive assessment and management strategies tailored to address both intestinal and extra-intestinal manifestations in the holistic care of IBD patients.