Introduction

Malnutrition is a common condition of patients with inflammatory bowel disease (IBD) and could be associated with sarcopenia i.e. a reduced muscle mass and strength. Recent data suggest that the prevalence of sarcopenia is, respectively, 52% and 37% in Crohn's disease (CD) and ulcerative colitis (UC). It is well demonstrated that sarcopenic IBD patients have two to three times higher risk of lost of response to biotechnology drugs than non-sarcopenic patients.

Aims & Methods

Consecutive IBD patients accessing the IBD outpatient service were enrolled. Detailed data regarding the characteristics of MC and CU populations, current therapy and disease activity are reported. Each patient was interviewed about the frequency (none, low, high) and the kind (aerobic or anaerobic) of the physical activity they were practicing.
At the enrolment, nutritional assessments were performed by body mass index (BMI) evaluation according with the World Health Organization recommendations, global subjective assessment by the MUST (Malnutrition Universal Screening Tool) index according with the European Society for Clinical Nutrition and Metabolism and the Global Leadership Initiative on Malnutrition [GLIM]. Moreover, the SARC-F questionnaire, recommended by the scientific consensus EWGSOP 2 to identify individuals at risk for sarcopenia was administrated. A SARC-F value ≥ 4 was significant of sarcopenia. Finally, the quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Univariate and multivariate analysis was conducted between BMI, MUST, SARC-F and IBDQ values and patient characteristics (age, current therapy, disease activity and physical activity).

Results

A total of 321 IBD patients (158 CD and 163 UC), 56.07% male, with a mean age of 44.78 years were enrolled. Sixty-seven patients (20.87%) reported a current smoking habit. A mean BMI of 70.37 kg, was calculated. Regarding malnutrition, 199 patients (61.99%) were considered at low risk (MUST=0), 75 subjects (23.36%) at medium risk (MUST=1), 47 (14.64%) at high risk (MUST ≥2). A SARC-F value ≥4 was evaluated in 50 patients (15.58%). A reduction in quality of life, understood as IBDQ < 209, was found in 45 (14.02%) patients. Females and males presented a significantly different prevalence of sarcopenia (chi2: 9.69; p-value: 0.002).
Univariate analysis shows a significant protective role of male sex (OR vs. female sex: 0.33; p-value: 0.018) in the risk of sarcopenia; older subjects had a slightly higher sarcopenic risk (OR: 1.04; p-value <0.001). The risk was associated with corticosteroid therapy (OR 1,03, p-value <0.001), with increasing MUST (OR 1,65, p-value <0.001) and with the IBDQ decreases (OR 2,1; p-value<0.001).
Multivariate analysis confirmed an higher incidence of sarcopenia in female subjects of advanced age with active-stage disease (R²: 0.88, p-value<0.0001), furthermore female patients with active-stage disease who did not engage in physical activity had a greater impairment in quality of life, regardless of age (R²: 0.75, p-value<0.0001). Aerobic and anaerobic physical activity played a protective role in the onset of sarcopenia regardless of sex and age (R²: 0.82, p-value<0.0001).

Conclusion

In our cohort of patients, sarcopenia was present in only 18.94%. Male sex was found to be a protective factor for sarcopenia. Disease status is firmly linked to the risk of sarcopenia. Regular physical activity has been shown to have a protective role for good quality of life and it was related with a lower risk of sarcopenia. This study will continue to expand the cohort taken into account.

Introduction

Sarcopenia is prevalent in patients with inflammatory bowel disease (IBD) and impacts surgical and therapeutic outcomes; thus, effective diagnostic tools are needed to assess muscle mass and function in IBD population. The ileo-psoas muscle (IP) muscle has already been used in the literature for the assessment of sarcopenia, however, as it is a deep muscle and it needs experienced operators for a proper measurement. Therefore, diaphragm muscle (DM) more superficial and easily assessed, was examined to check its correlation with IP.

Aims & Methods

The aim of this work was to evaluated the correlation of positivity SARC-F score with ultrasound (US) measure of the IP and DM.
A total of 50 IBD patients with significant suspected sarcopenia with SARC-F score positive ≥4, were enrolled. IP and DM US were detected in the enrolled patients. The transverse diameter of the right IP was evaluated. We defined "reliable" the measurements of the IP that fulfilled all of the following criteria: all anatomical boundaries could be clearly identified (superior margin of the iliac crest and lumbar vertebrae); the maximum diameter of the psoas between each of the three measurements did not deviate from the other two by more than 5 mm. Moreover, we calculated the US psoas/height ratio as the average of the psoas diameter divided by the patient's height (mm/m). For DM, an extended space between the axillary line and the hemi clavicular line was used, in the diaphragmatic thickness between the hyperechogenic limiting. Diameters during expiration and during inspiration were assessed, then diaphragmatic expansion was evaluated. We calculated the diaphragm/height ratio (mm/m) as well. The correlation between IP and DM ratio was researched by using the Pearson correlation test. Age and sex were taken into consideration as confounders in a linear regression model, using the psoas/height ratio and these confounders as independent variables and the diaphragm index as dependent variable.

Results

The mean of the three US IP measured diameters was 30.37 mm, the psoas/height ratio was 17.92 mm/m. The mean maximum inspiration DM diameter was 20.4 mm (± 5 mm), the mean minimum expiration DM diameter was 10.7 mm (± 35 mm). The mean difference between the two diameters was 9.7 mm (± 3,4 mm). The diaphragm/height ratio was 0.59 mm/m (±0.21 mm/m). A significant correlation was identified between IP and DM ratio, with a Pearson coefficient r = 0.3568 (p-value <0.05). A consistent association was found between the two indices, with diaphragm/height ratio increasing linearly with the psoas/height ratio (OR: 0.018; p-value: 0.008). Multivariate analysis showed that age and sex were not significantly associated with the diaphragm/height ratio (p-value >0.05).

Conclusion

The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. IP US is confirmed to correlate with sarcopenia. DM can be used more easily and correlates with IP. This research could take a significant implications for disease management in IBD patients and underscores the importance of further investigations to validate these findings in larger cohorts. This study will continue to expand the cohort under evaluation.

Introduction

Disease-specific knowledge plays a central role in chronic disease management. In patients with inflammatory bowel disease (IBD), limited knowledge is linked to poorer perceived health and increased discomfort (1).

Aims & Methods

This study assessed disease-specific knowledge among adult patients with IBD at a tertiary center and defined existing knowledge gaps. Factors associated with higher or lower levels of knowledge were explored.
The retrospective cohort study included 392 IBD patients who completed a comprehensive questionnaire between March 2020 and April 2021 (2). Questionnaire responses were analyzed alongside clinical records to quantify disease-specific knowledge. A scoring system was developed to quantify disease-specific knowledge (0–8 points), based on correct diagnosis, Montreal classification, complications, and current therapies. Scores were categorized as low (0–5) or high (6–8) knowledge levels. Associations between knowledge levels and disease-related, sociodemographic, and psychosocial factors were analyzed using logistic regression analysis.

Results

While most patients correctly identified their diagnosis (kappa: 0.863, CI: 0.816–0.905, p < 0.001) and advanced treatment (e.g. infliximab: kappa: 0.959, CI: 0.925–0.983, p < 0.001), knowledge gaps were observed regarding disease location (e.g. isolated proctitis in ulcerative colitis: kappa: 0.101, CI: –0.051–0.341, p = 0.128), complications, comorbidities, and certain other medications. In the univariate analysis a higher knowledge level was found in patients with Crohn’s disease, younger age at diagnosis, in patients with no disease activity, and treatment with biologics, in those receiving disability pension and in patients with a high Perceived Stress Questionnaire (PSQ) score for worries (table). A younger age at diagnosis (p = 0.028) and having Crohn’s disease (p < 0.001) were independently associated with higher knowledge levels whereas active disease was associated with lower disease-specific knowledge.
Table:
Univariate logistic regression analysis for items significantly associated with higher knowledge levels

Conclusion

Significant disease-specific knowledge gaps were identified, particularly concerning disease location, complications, and comorbidities. Targeted patient education should focus on addressing these specific deficits in susceptible groups.

References

1. Tormey LK, Reich J, Chen YS, Singh A, Lipkin-Moore Z, Yu A, et al. Limited Health Literacy Is Associated With Worse Patient-Reported Outcomes in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25:204–12.
2. Koletzko L, Klucker E, Le Thi TG, Breiteneicher S, Rubio-Acero R, Neuhaus L, et al. Following Pediatric and Adult IBD Patients through the COVID-19 Pandemic: Changes in Psychosocial Burden and Perception of Infection Risk and Harm over Time. J Clin Med. 2021;10:4124.

Introduction

A significant proportion of patients with inflammatory bowel disease (IBD) have concomitant rheumatological manifestations. On the other hand, patients with spondyloarthritis (SpA) often report gastrointestinal symptoms, some of them being associated to IBD. However, the exact prevalence of this disorder is still controversial, and the optimal approach to its diagnosis remains unknown.

Aims & Methods

Our main was to determine the prevalence of undiagnosed IBD in patients with axial SpA (radiographic and non-radiographic) and psoriatic arthritis (PA). EISER is a multicenter, nationwide, observational, and cross-sectional study where 13 Spanish hospitals participated. Patients ≥18 years-old diagnosed with PA or SpA according to the CASPAR or ASAS criteria, respectively, were selected. Patients receiving biologics or systemic steroids at baseline or within the previous 30 days were not included. Regarding patients older than 50 years, only those without valid colonoscopy in the previous 3 years were included. Rheumatologist performed a baseline visit and collected demographic, clinical, and treatment data. Fecal calprotectin (FC) was determined by the Quantum Blue rapid test and this was followed by a gastroenterologist consultation. A complete colonoscopy was indicated on all patients with symptoms, FC≥80 µg/g without NSAIDs, or 160 µg/g if they were on NSAIDs. Capsule endoscopy or magnetic resonance enterography were performed in those with no findings on colonoscopy.

Results

A total of 559 patients were included (51% men; mean 52.2 years; mean disease duration of SpA/PA was 12.3 years). The most frequent rheumatological disease was radiographic SpA (37%), followed by peripheral APs (36%). Abnormal FC was observed in 47% and 53% of patients with PA and EspAx (80% radiographic-SpA vs 20% non-radiographic-SpA), respectively. Mean FC levels were higher among radiographic-SpA (395 µg/g) compared to the rest of the groups (306 µg/g for non-radiographic-SpA and 306 µg/g in PA). Overall, 11,5% had gastrointestinal symptoms, with the most common being abdominal pain (16%) and chronic diarrhea (11%). In total, 189 colonoscopies were performed, 40% demonstrating at least one abnormal finding, mostly aphthous ulcers (66%), superficial ulcers (21%) and erythema (14%), and they were mainly located in the terminal ileum (41%). Finally, 23 patients were diagnosed with IBD (4.4%), mostly with radiographic-SpA (83%), followed by peripheral PA (8.7%) and non-radiographic-SpA and axial PA (4.3% each). All patients but two were diagnosed with CD (91.3%), with 1 case of unclassified IBD (4.3%) and 1 with nonspecific ileitis (4.3%).

Conclusion

FC levels in patients with SpA and PA, followed by an appropriate endoscopic and/or radiological diagnostic algorithm, allows the identification of a relevant subgroup of patients with previously undiagnosed IBD

Introduction

Inflammatory bowel disease(IBD) that includes Ulcerative colitis (UC) and Crohn’s disease (CD) may be associated with considerable changes in body composition, which include alterations in muscle and adipose tissue mass as well as osteopenia and osteoporosis which can have considerable impact on disease course and outcome.

Aims & Methods

Body composition and presence of sarcopenia were assessed in patients with UC and CD and their relationship with disease duration, location and severity was studied. This was a Single-Centre cross-sectional study conducted from January 2022 to June 2023. Body composition analysis was performed using bioelectrical impedance (BIA) method and sarcopenia assessment was done with hand grip strength (HGS) using digital hand dynamometer and skeletal muscle index (SMI) at 3^rd lumbar vertebral(L3) level using computed tomography (CT).

Results

A total of 132 patients (92 UC and 40 CD) were included. Mean age and sex in UC (37.33 ± 12.91 years, 46.7% males) and in CD (39.05 ± 15.05 years, 52.5% males). Mean duration of disease in UC and CD were 5.9 ± 5.28 years and 6.13 ± 4.33 years respectively. In UC group 41.3% patients had pancolitis and 37% had left sided colitis, among CD patients ileal(L1) and colonic disease(L3) was 37.5% each and 55% patients had inflammatory disease behavior. In UC patients 33.7% had active disease and in CD 40 % had active disease. In UC group, mean total body fat percentage was significantly lower with disease duration of 1-5 years compared to those with disease duration > 5 years (23.67 ± 8.52% vs 29.39 ± 7.14%, p=0.003) and mean visceral fat level was lower in those with active disease than in remission (3.26±3.09 vs 6.49±6.77, p=0.013). CD patients did not show any significant change in BMI, total body fat percentage, whole body skeletal muscle percentage with respect to disease duration, location, behavior and severity. In UC group mean dominant HGS and L3-SMI were lower in active disease than remission (22.27 ± 8.72 kg vs 28.57 ± 9.1 kg, p=0.002 and 36.5 ±13 cm²/m² vs 42.74±13.92 cm²/m², p=0.02). Among CD patients no significant change in HGS and L3-SMI were observed. As per European consensus definition, prevalence of probable sarcopenia and sarcopenia in UC and CD were (26% and 9.4%) and (32.5% and 15%) respectively. On comparison between UC and CD, SMI was significantly lower in CD patients(Table1). When BIA method was used to measure low muscle mass, the prevalence of sarcopenia in UC and CD were13.4% and 17.5%. Difference observed with the two methods of measurement of sarcopenia prevalence was not significant.

Table 1- Body composition and sarcopenia variables in UC and CD

Conclusion

Point prevalence of probable sarcopenia and sarcopenia was found to be 26% & 9.4% among UC and 32.5% and 15% patients with CD. CD patients had lower muscle mass as compared to UC patients. BIA showed good diagnostic accuracy compared to CT in assessing muscle mass. Both these methods can be considered complementary diagnostic tools in assessment of sarcopenia among patients with UC or CD.

Introduction

There is evidence linking inflammatory bowel disease (IBD) and cardiovascular diseases. However, the roles of histologic and clinical activity of IBD in the development of arrhythmias remain unknown.

Aims & Methods

In this nationwide cohort study in Sweden, we included IBD patients with histologic data (n = 61,383; diagnosed 1969–2017; classified as histologic inflammation vs. remission based on the Swedish version of the Systematized Nomenclature of Medicine codes) and clinical activity data (n = 96,154; diagnosed 1969–2020; classified as clinically active vs. quiescent IBD based on IBD-related hospitalization, surgery, and treatment escalation) and followed them through December 31, 2021. The primary outcome was incident arrhythmias (including atrial fibrillation/flutter, bradyarrhythmias, other supraventricular arrhythmias, and ventricular arrhythmias/cardiac arrest) within 2 years after documented histologic inflammation (vs. remission) or clinically active IBD (vs. quiescent IBD). Poisson regression models estimated incidence rates (IRs) of arrhythmias, while Cox proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). We adjusted for age at IBD diagnosis, sex, calendar year at index date, county of residence, educational attainment, country of birth, number of health care visits, and history of CVD-related comorbidities in the model.

Results

Histologic inflammation was associated with an increased risk of developing any arrhythmias compared to histologic remission (IR: 62.0 vs. 47.2 per 10,000 person-years; aHR = 1.35, 95%CI: 1.18–1.54), corresponding to one additional event of arrhythmia per 338 IBD patients over 2 years after histologic inflammation. We found an excess risk for atrial fibrillation/flutter (aHR = 1.38, 95%CI: 1.18–1.62) and ventricular arrhythmias/cardiac arrest (aHR = 1.73, 95%CI: 1.22–2.44), but not for bradyarrhythmias or other supraventricular arrhythmias. Compared to clinically quiescent IBD, active IBD was also related to a higher risk of arrhythmias (IR: 67.4 vs. 108.4; aHR = 1.77, 95%CI: 1.66–1.88), affecting all subtypes except bradyarrhythmias. In patients with clinically quiescent IBD, histologic inflammation was also associated with an increased risk of arrhythmias (aHR = 1.16, 95%CI: 1.00–1.36, P=0.054).

Conclusion

Histologic and clinical activity were associated with a slightly increased risk of arrhythmias in patients with IBD.

Disclosure

All authors have completed the ICMJE uniform disclosure form and declare:
OO has been PI on projects at Karolinska Institutet financed by grants from Janssen, Pfizer, AbbVie, Takeda, Galapagos/Alfasigma, Ferring, and Bristol Myer Squibb. JH served as speaker or advisory board member for AbbVie, BMS, Celltrion, Eli Lilly, Ferring, Galapagos, Gilead, Index Pharma, Janssen, Medtronic, Merck, MSD, Novartis, Pfizer, Sandoz, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma, and Vifor Pharma and received grant support from Takeda, Janssen, and MSD. FE has served as an advisory board member for Boehringer Ingelheim. JFL has coordinated a study for the Swedish IBD Quality Register (SWIBREG), which received funding from Janssen Corporation. JFL has also received financial support from MSD to develop a paper reviewing national healthcare registers in China. JFL has a research collaboration on celiac disease with Takeda and has a research collaboration on fibrosis in IBD with MSD. The other authors report no disclosures relevant to the manuscript.