Introduction

Nearly 25% of patients are diagnosed with Inflammatory Bowel Disease (IBD) under 18 years old of age. To date, there are no transition models established and recommended in IBD setting, so each center tends to develop a transition model based on its own needs and experience.

Aims & Methods

To compare the effectiveness on transition readiness and quality of life of two different modes of transition, one based on sending the subject to a first gastroenterological visit in the clinic with the support of a clinical report prepared by the pediatrician (letter-based transition) and the other one characterized by combined visits in the presence of both the pediatrician and adult gastroenterologist (combined-visit- based transition).
From 2018 to 2021, patients diagnosed with IBD, aged between 16 and 19 years, and followed at the Paediatric Gastroenterology and Hepatology Unit of the Azienda Ospedale Università Padova, were randomized to the letter-based transition or the combined- visits-based transition. The transition readiness was verified using the Transition Readiness Assessment Questionnaire (TRAQ), whilst the quality of life was analysed using the Pediatric Quality of Life Inventory TM at the start of the study, at six months and after one year.

Results

The final sample analyzed consisted of 40 patients, 22 assigned to the letter-based group (10 males, mean age 18.6 ± 0.4) and 18 to the combined-visits groups (10 males, mean age 18.6 ± 0.5) with similar age and sex distribution. Twenty-one and 18 reached T2, respectively, and 17 in both groups reached T3. The clinical activity and calprotectin value did not change along the study in both groups (p >0.05). Three azathioprine and 4 anti-TNF therapy were stopped after transition. The TRAQ questionnaire improved significantly during the study both in the letter-based group (from 72.1 ± 12.46 to 82.35 ± 5.88, p 0.002) and in the combined-visits group (from 66.52 ± 15.06 to 76.0 ± 12.83, p 0.008). No significant change was observed in patients' perceived quality of life along the study in the letter-based group (from 83.9±8 to 86.2 ± 9.54, p = 0.17) while it improved in the combined-visits group (from 82.5 ± 8.23 to 89.1 ± 7.63, p <0.05).

Conclusion

Our data suggest that both transition models are able to obtain a marked improvement in transition readiness, while the quality of life improves only in the combined-visits transition. Therefore, despite the letter-based transition approach is a good option interms of costs and time sparing, the combined-visits process should be preferable when possible to improve both transition readiness and quality of life.

Introduction

Intestinal ultrasound (IUS), in particular bowel wall thickness (BWT), is accurate in determining endoscopic disease activity in ulcerative colitis (UC). Reduction of BWT six weeks into advanced anti-inflammatory treatment predicted endoscopic response and clinical remission. Filgotinib is a preferential JAK1-inhibitor effective in UC. Currently, there is no data on IUS-kinetics or early prediction of treatment response with filgotinib.

Aims & Methods

In this study, we aimed to identify early IUS predictors of treatment response to filgotinib in patients with moderate to severe UC. This prospective observational study included UC patients with active endoscopic disease (i.e. endoscopic MAYO score (EMS) ≥2) starting with filgotinib. Clinical scores (UCEIS, Lichtiger), biochemical parameters and IUS parameters of the sigmoid were assessed at baseline, after 4 weeks (W4) and at the time of the second endoscopy (between W8 and W23). Endoscopic remission (i.e. EMS=0), endoscopic response (i.e. decrease in EMS ≥1 compared to baseline) and clinical remission (SCCAI ≤2 or Lichtiger score ≤3) were assessed. IUS response (i.e. defined as a reduction in BWT of >25% or >2.0 mm, or >1.0 mm and one colour Doppler signal) was assessed at week 4. All normally distributed data were reported in mean ± standard deviation [SD] and non-normally distributed in median and interquartile range [IQR]. Mann–Whitney U tests were used to compare continuous non-parametric variables, chi square tests for dichotomous variables.

Results

A total of 20 patients were included. 13 patients underwent second endoscopy, 2 refused a follow-up endoscopy and 5 patients were still in follow-up. At baseline, 9 patients (9/20, 45%) had received ≥2 biologicals, 16 patients (16/20, 80%) had previous anti-TNF exposure, and no patients were exposed to other JAK-inhibitors. 8 patients (8/20, 40%) had severe endoscopic disease at baseline (i.e. EMS=3). 5 patients (5/13, 38%) were endoscopic responders at W8-23, and no patient reached endoscopic remission. BWT was significantly lower in the sigmoid colon from W4 onwards for patients reaching endoscopic response (Table 1). Decrease in BWT compared to baseline was statistically greater in endoscopic responders from W4 onwards (Table 1). IUS response was seen at W4 in 6 patients, of which 5 were endoscopic responders (83%, p=0.002). Decrease in BWT from W4 onwards was statistically greater in patients reaching clinical remission at W8-23 (-45% (-55% to -36.6%) vs -9% (-25% to +8%), p=0.014).

Conclusion

On IUS, UC patients treated with filgotinib have significantly lower BWT from week 4 onwards compared to baseline, which could predict endoscopic response.

Disclosure

MP received speakers fees from Janssen and Tillotts
CT received speakers fees from Tillotts
FV received speaker or honoraria fees from AbbVie, Janssen and Tillotts
ML received consultancy/lecturefees from Abbvie, Bristol Myers Squibb , Eli Lilly, Galapagos, Janssen-Cilag, Johnson & Johnson, Medtronic, Pfizer, Takeda and Tillotts.
RG Received speakers fee from Janssen and Tillotts
GD has served as a consultant and/or received speaker’s fees from AbbVie, Alimentiv, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion Healthcare, Cytoki Pharma, Eli Lilly, Ferring, Galapagos, Glaxo SmithKline, Gossamer Bio, Immunic, InDex Pharmaceuticals, Janssen, Johnson & Johnson, Kaleido, Pfizer, Progenity, Prometheus Biosciences, Prometheus Laboratories, Protagonist Therapeutics, Takeda, Tillotts, Ventyx Biosciences.
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 Abbvie, Celltrion, Ferring, Janssen Pharmaceuticals, Novartis, Pfizer Inc, Samsung Bioepis, Takeda and Tillotts.

Introduction

Many individuals rapidly regain excess weight once they stop dieting. This phenomenon, which is commonly called yoyo-dieting, is a pattern of losing weight and then regaining it, placing individuals at greater risk for metabolic complications and obesity. There is some evidence that yoyo-dieting-induced obesity causes long-term alterations in the gut microbiome composition. There is also increasing evidence suggesting that diets high in resistant starch (RS) may positively improve gut health and metabolism.

Aims & Methods

This study aimed to investigate how yoyo-dieting affects gut health and whether supplementation with resistant starch could be a promising and effective weight management strategy.
Male and female C57BL/6 mice (n=48/sex, n=8/group) were allocated to six different diets for 20 weeks [control, high-fat (HFD), yoyo-diet (HFD interspaced with control every 5 weeks), control with RS, HFD with RS, and yoyo-diet with RS]. Metabolic measurements were performed, including body weight, glucose and insulin tolerance tests, adipose tissue, and organ weight. Liver and intestines were collected for structural changes assessed by histology. Epithelial barrier integrity was assessed in Ussing chambers. Faecal samples were collected for microbial profiling using 16S ribosomal RNA sequencing.

Results

Male mice fed a HFD with RS had significantly lower weight gain, liver mass, adipose tissue, and insulin tolerance compared to mice fed a HFD alone, while no significant differences were observed in females. No significant differences in glucose tolerance and intestinal permeability were observed across all diets and between sexes. Male mice had significantly higher alpha diversity and a different microbiota profile compared to female mice. Mice fed diets supplemented with RS had significantly lower alpha diversity and a different microbiota profile compared to mice fed without RS. Male and female mice have different microbiota profiles. Mice fed a HFD with RS have a similar microbiota profile to mice fed the control diet with RS. After changing diets (switching from diets high in fat to the control diet – yoyo groups), no change in microbiome profile was observed in female mice previously fed HFD with RS, while male mice previously fed a HFD supplemented with RS had a similar microbiome profile to control mice.

Conclusion

Different microbiome signatures and metabolic measurements were observed in male and female mice. In male mice consuming a HFD, RS lowered weight gain and shifted the microbiota profile to one similar to mice fed a control diet with RS. In males consuming a HFD diet interspaced with the control diet (yoyo-diet), RS shifted the microbiota profile of mice to a similar signature seen in control animals. No significant differences were observed in females.

Disclosure

No conflict of interest