Introduction

The nutritional status of patients affected by inflammatory bowel disease (IBD) is often impaired. Although a link between inflammation-related pathophysiologic mechanisms and malnutrition in IBD has been proposed, the role of dietary regimen and adherence to Mediterranean diet, known to have anti-inflammatory properties, is under investigated. The aim of this study was to assess quality of diet and adherence to Mediterranean diet in a cohort of Sardinian IBD patients.

Aims & Methods

We conducted a case-control study in which IBD patients, both Crohn’s disease (CD) and ulcerative colitis (UC), were compared with healthy controls matched for age, sex and BMI at a 1:2 ratio. Diet Quality Index (DQI) and Medi-Lite questionnaires were collected from IBD patients and controls to assess individual diet quality and adherence to Mediterranean diet, respectively. Subgroup analysis by disease phenotypic characteristics and use of biologic or small molecules as proxy of disease severity was also performed. Differences between groups were analyzed by descriptive statistics and non-parametric tests were used to assess statistical significance of the observed differences.

Results

Fifty CD and an equal number of UC were matched each with 100 healthy control subjects. Both DQI and Medi-Lite scored significantly lower in IBD patients as compared to controls (DQI: CD 34.5 [IQR 33-37] vs CTRL 40 [IQR 38.5-43] p<0.0001; UC 34.5 [IQR 33-37] vs CTRL 42 [IQR 40-44] p<0.0001; Medi-Lite CD 7.5 [IQR 7-9] vs CTRL 9 [IQR 7-10] p=0.0379; UC 8 [IQR7-10] vs CTRL 9 [IQR 8-10.5] p=0.0046). In CD, DQI was consistently lower than controls independently of disease localization and behavior. However, Medi-Lite score was significantly lower in patients with stricturing phenotype and ileo-colonic localization. In UC patients, DQI was consistently lower as compared to controls independently of disease extent. Among these patients, Medi-Lite score was significantly lower only in those with extensive colitis. Finally, DQI was lower in both CD and UC independently of the use of concomitant biologic or small molecules, while Medi-Lite resulted significantly lower in UC but not CD patients undergoing major therapies.

Conclusion

IBD was associated with an overall low quality of diet independently of disease type and phenotype. However, Medi-Lite score detected a lower adherence to Mediterranean diet in patients affected by ileo-colonic stenosing disease and in UC patients with extensive colitis suggesting that the potential benefit of Mediterranean diet may be deemed by low acceptance in specific IBD patient subgroups.

Introduction

Intestinal ultrasound (IUS) has proven to be a valuable tool for accurately detecting intestinal damage and characterizing disease behavior in Crohn’s disease (CD). IUS scoring systems for CD activity have been developed, however all the studies had methodological flaws. Therefore, studies comparing and validating the existing IUS scores in CD patients are required.

Aims & Methods

In this study, we aimed to compare two main existing scores, Bowel Ultrasound Score (BUSS) and International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in patients with ileal CD using the simplified endoscopic activity score for CD (SES-CD).
An observational cross-sectional study was performed to evaluate the disease activity in adult CD patients with ileal involvement between November 2019 and February 2024. All patients had undergone ileocolonoscopy and IUS, the time interval between the two procedures was lower than 10 days. Receiver operating characteristic (ROC) curve analyses was performed for BUSS and IBUS-SAS to predict SES-CD ≤2 for CD.

Results

Total 56 adult patients with ileal CD were included in the study, 38 patients (67.9%) were male, the median age was 40.5 (IQR 26-46.75) years and the median duration of the disease was 8.4 (IQR, 4.93-10.29) years. In the endoscopically remission (SES-CD ≤2) group; the median BUSS was 2.63 (IQR 2.12-3.45) and the median IBUS-SAS was 14 (IQR, 11.3-18.4), while in the endoscopically active (SES-CD >2) group; the median BUSS was 5.67 (IQR, 3.47-7.76) and the median IBUS-SAS was 49.7 (IQR, 23.3-72.65). The median BUSS and median IBUS-SAS in the endoscopically remission group were significantly lower than those of the endoscopically active group (p< 0.001, for both). The cut-off value for BUSS to determine endoscopic remission (SES-CD ≤2) was 3.9 (AUC: 0.839, 95% CI: 0.737-0.941, sensitivity: 92%, specificity: 73%, p < 0.001), while the cut-off value for IBUS-SAS to establish endoscopic remission (SES-CD ≤2) was 24.4 (AUC: 0.871, 95% CI: 0.780-0.962, sensitivity: 100%, specificity: 73%, p < 0.001).
There was a very high positive correlation between BUSS and IBUS-SAS (r=0.914, p<0.001), a high positive correlation between BUSS and SES-CD (r=0.659, p<0.001), a moderate positive correlation between BUSS and CRP (r=0.577, p<0.001). There was a high positive correlation between IBUS-SAS and SES-CD as well as IBUS-SAS and CRP (r=0.728, p<0.001 and r=0.657, p<0.001 respectively).

Conclusion

In this study, we found that the most accurate cut-off value for BUSS was 3.9 and the most accurate cut-off value for IBUS-SAS was 24.4 in CD patients with endoscopic remission (SES-CD ≤2) group. Also, we have confirmed that both BUSS and IBUS-SAS significantly correlate with endoscopic activity in a real-world cohort.

Introduction

The BELCOMID study recruited immune mediated inflammatory disease (IMID) patients during the COVID19 pandemic. Patients were evaluated before vaccination, after onset of the vaccination campaign and after onset of booster vaccinations. Clinical data, Nucleocapsid(N-)antibodies and Spike(S-)antibodies were assessed.

Aims & Methods

Current subgroup analysis aimed to firstly, explore factors associated with N-/S-antibody response in IMID patients with different COVID19 vaccination status. Five patient groups were identified. G1: no vaccination before the vaccination campaign, G2: complete baseline vaccination, G3: 1 booster, G4: 2 boosters, G5: patients refusing every vaccine even after the booster campaign. We report on influence of IMID treatment and smoking status.
Secondly, we explored influence of SARS-CoV2 infection and vaccination on IMID flare-up.

Results

Demographics of 2165 recruited IMID patients are shown in Table.
After baseline vaccination (G2) odds of N-seroconversion were higher in patients treated with combined IMM/TIMT (OR2.52, p=0.023). No other association with N-seroconversion was found.
Mean S-antibody titre increased progressively from G2 to G4. After completed baseline vaccination (G2), odds of S-antibody seroconversion were lower in those treated with TIMT (OR0.28, p=0.0079) particularly rituximab (OR0.0354, p<0.001), IMM (OR0.276, p<0.001), combined IMM/TIMT (OR0.156, p<0.001) and systemic steroids (OR0.183, p<0.001). IMID flare prior to vaccination was associated with lower risk of S-seroconversion (RR0.94, p<0.001). By contrast, mean S-titre was higher for those treated with antiIL23 (mean ratio 2.17, p=0.011) and vedolizumab (mean ratio 1.84, p<0.001) in G2.
After 1 booster (G3), lower odds of S-seroconversion remained with rituximab (OR0.0368, p<0.001), IMM (OR0.222, p=0.0014), combined IMM/TIMT (OR0.15, p<0.001) or systemic steroids (OR0.0637, p<0.001). Vedolizumab was associated with lower odds of being in the lowest S-titer quartile (OR0.206, p<0.001). Odds for S-antibody seroconversion with anti-TNF were higher compared to rituximab both for patients in G2 (OR26.3, p<0.001) and G3 (OR27.5, p<0.001).
Patients who received 2 boosters (G4) all had S-seroconversion and no IMID treatment modality was associated with higher odds of being in the lowest quartile.
After baseline vaccination (G2) smokers had higher risk of being in the lowest S-antibody titer quartile (RR1.45, p=0.0098). This observation persisted after 1 booster (G3)(RR1.42, p=0.0122) but was no longer noticed after 2 boosters (G4).
After start of booster vaccinations, 25.17% of patients had experienced IMID flare-up in the previous months. No significant association between IMID flare-up rate and previous SARS-CoV2 infection was found. There was no increased risk of IMID flare-up with additional booster vaccination. However, patients who received 2 booster vaccines showed a lower RR for IMID flare-up compared to those who only received 1 booster (RR0.70, p=0.0067).

	G1 (N: 2144)	G2 (N: 1532)	G3 (N: 1283)	Group 4 (N: 147)	Group 5 (N: 40)
Mean age (SD)	44.6 (35.5)	46.9 (30.8)	46.6 (32.7)	51.0 (15.7)	39.4 (14.4)
Male/female	1088 (51.0%)/1047 (49.0%)	794 (51.9%)/737 (48.1%)	661 (51.6%)/621 (48.4%)	80 (54.4%)/67 (45.6%)	24 (60.0%)/16 (40%)
Active smoker	369 (17.2%)	261 (17.0%)	201 (15.7%)	24 (16.3%)	12 (30.0%)
TIMT (targeted treatment)	1580 (73.7%)	1232 (80.4%)	1073 (83.6%)	119 (81.0%)	38 (95.0%)
IMM (immunomodulator)	456 (21.3%)	311 (20.3%)	225 (17.5%)	39 (26.5%)	8 (20.0%)
IMM+TIMT combined	263 (12.3%)	197 (12.9%)	152 (11.8%)	24 (16.3%)	8 (20.0%)
Recent systemic steroids	229 (10.7%)	91 (5.94%)	59 (4.60%)	6 (4.08%)	4 (10.0%)

Conclusion

Certain immune-modulating treatment modalities and smoking may blunt serologic COVID19 vaccination responses. However, this is overcome by repeated booster vaccination without increased risk of IMID flare-up.

Disclosure

The BELCOMID study group received research grants from following pharmaceutical companies: Almirall, Roche, Janssen, Pfizer, Eli Lilly, Amgen, Biogen, Mylan, LEO Pharma. These companies had no role in study design, conduct nor reporting of results.

Introduction

Accurate assessment of disease activity and prediction of treatment response and prognosis are challenges in the management of chronic inflammatory bowel disease (IBD). Due to the invasiveness of colonoscopy, non-invasive methods are of high clinical relevance. Bowel ultrasonography (B-US) is establishing itself as a non-invasive, cost-effective method in daily clinical practice.

Aims & Methods

The aim of this study is to evaluate the correlation between B-US and endoscopy in relation to inflammatory activity and severity of IBD. Patients were retrospectively selected for comparison between B-US and endoscopy. A total of 473 patients were included, of whom (n=274) had Crohn's disease (CD) and (n=199) had ulcerative colitis (UC). The examination results were divided into four sections (terminal ileum, proximal colon, distal colon and rectum) and systematically analyzed. Inflammatory activity was classified according to intestinal wall thickness in mm: none (0): 0-2.9, mild (1): 3.0-4.9, moderate (2): 5.0-7.9, severe (3): >8.0. Endoscopic evaluation was performed according to simplified Mayo and SES-CD criteria.

Results

Based on endoscopy, patients were divided into groups with inflammatory activity (274 CD, 175 UC) and remission (34 CD, 24 UC). Comparison of B-US and endoscopy showed a significant correlation regarding inflammatory activity (r=0.44, p<0.001). The correlation was more significant in UC (r=0.5548, p<0.001) than in CD (r=0.3665), except in the ileum in UC (r=-0.1050, p<0.4822). The best correlation in MC was found in the ileum (r=0.4783, p<0.001) and in the distal colonic segments (r=0.5217, p<0.001), while in UC the best correlation was found in the proximal (r=0.5586, p<0.001) and in the distal colonic segments (r=0.6250, p<0.001). Localization of rectal inflammation was associated with lower diagnostic accuracy. Compared to endoscopy, B-US showed a sensitivity of 82.2%, a specificity of 51.7% and a positive predictive value of 92.4%.

Conclusion

B-US shows reliable diagnostic accuracy compared to endoscopy in assessing inflammatory activity in IBD patients and can be considered as a complementary non-invasive diagnostic tool.

Disclosure

AL recieved research funding from the European Regional Development Fund (Project ID: ZS/2018/11/95324) and the German Federal Ministry of Education and Research (BMBF) (FKZ 01GM2204A). AL has received speaker fees from Janssen, Ferring and Luvos.

Introduction

Perianal fistulising Crohn’s disease (PFCD) affects up to 20% of patients with Crohn’s Disease (CD). PFCD can cause pain, purulent discharge and faecal incontinence, leading to significant morbidity and reduction in quality of life. The use of biologic therapy, antibiotics and surgical intervention remain the mainstay of management of perianal fistulas.

Aims & Methods

This study aims to review current practices in the management of PFCD across two large tertiary IBD centres. This retrospective cohort study assessed adult patients with PFCD between two tertiary Australian hospitals between 2006 to 2024. Patients with PFCD were identified using prescribing data. CD phenotype, therapy and fistula-related data were extracted. Biologic choice and therapeutic drug monitoring, antibiotic choice and duration, surgical intervention, and length of stay in hospital were monitored. Cross-sectional disease activity of perianal fistulizing disease was assessed at the time of data collection using clinical fistula symptom grade and radiological assessment were available. Clinical remission was defined as fistula symptom grade of 1 or less. Radiological remission was defined by healing fistula tracts or no active inflammation seen on MRI. The study was approved by the Central Adelaide Local Health Network Human Research Ethics Committee (HREC19145).

Results

Gender Male, n Female, n Age, y, median (IQR)	n = 57 30 27 40 (31-54)
Active Smoker, n (%)	14 (24.5)
Median length of clinical follow up, months, n (IQR)	46.5 (23.8-72.3)
Antibiotics Prescribed Metronidazole, n treated (%) Amoxicillin / Clavulanic acid, n treated (%) Others, n treated (%)	47 (68.1) 13 (27.7) 9 (4.2)
Duration of Antibiotics Metronidazole, median duration, days (IQR) Amoxicillin / Clavulanic acid, median duration, days (IQR) Others, median duration, days (IQR)	5 (5-7) 5 (5-10) 14 (7-14)
Biologic therapy Total patients on biologic therapy, n (%) Infliximab, n (%) Adalulimab, n (%) Ustekinumab, n (%)	56 (98.2) 43 (75.4) 11 (19.3) 2 (3.5)
Therapeutic Drug Monitoring (Infliximab) Infliximab level performed, n (%) Subtherapeutic (Infliximab level <10), n (%) Active disease and subtherapeutic (Infliximab level <10), n (%)	37 (86%) 30 (81.1%) 12 (40%)
Remission status Clinical Remission, n (%) - Defined as Fistula symptom grade of 1 or less Radiological Remission, n (%) - Defined as healing fistula tracts or no active inflammation seen on MRI	48 (84.2) 33 (57.8)
Subtherapeutic Therapeutic Drug Monitoring (All biologic agents) In Remission, n (%) Active Disease, n (%)	18 (56.2) 14 (43.8)

Table 1. Baseline characteristics

57 patients (median age, 40 years (31-54); 52.6% male) with PFCD were included in the study and followed over a median duration of 46.5 months (23.8-72.3). There were a total of 157 individual surgical procedures over the period, 2.75 per patient, most of which (94.2%) were examination under anaesthesia. Antibiotic therapy was dispensed for either perianal sepsis or an actively draining fistula in 26 patients, 2.65 number of courses per patient. The most common antibiotic prescribed was Metronidazole (68.1%), followed by Amoxicillin / Clavulanic acid (27.7%). The median duration of antibiotic therapy was 5 days (5-7) for Metronidazole and 5 days (5-10) for Amoxicillin / Clavulanic acid. There were 56 (98.2%) patients on biologic therapy. The most common biologic agent was Infliximab (75.4%), followed by Adalimumab (19.3%) and Ustekinumab (3.5%). At the time of analysis, 48 patients (84.2%) were in clinical remission and 33 patients (57.8%) were in radiographical remission. In patients treated with infliximab, 37/43 (86%) had therapeutic drug monitoring performed. Amongst these, 30 (81.1%) had subtherapeutic levels (defined as Infliximab level < 10), with 12/30 (40%) of patients having active PFCD.

Conclusion

Across two tertiary IBD centres, management of PFCD is variable and not in keeping with current guidelines. Short courses of antibiotic therapy were used, and the majority of patients had subtherapeutic drug levels when tested. Optimising outcomes for patients with PFCD requires awareness of best practice and a multidisciplinary team approach.

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).

Time point	Endoscopic response (n=5)	Endoscopic non-response (n=8)	p-value
Median BWT (IQR) at baseline	4.5 mm (3.2-6.2)	5.1 mm (3.6-6.5)	p=0.61
Median BWT (IQR) at W4	1.9 mm (1.8-3.8)	4.7 mm (3.3-5.9)	p=0.019
Median BWT (IQR) at W8-23	2.2 mm (1.8-3.7)	5.3 mm (4.3-6.7)	p=0.008
Median decrease in BWT (IQR) W4	-42% (-53% to -38%)	-3% (-16% to +9%)	p=0.003
Median decrease in BWT (IQR) W8-23	-45% (-51% to -35%)	-10% (-1% to +24%)	p=0.003

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.