Introduction

Bile acids malabsorption (BAM) is considered as a one of the possible mechanisms of the irritable bowel syndrome with diarrhea (IBS-D) development. Limitations of BAM first-line treatment – bile acid sequestrants – require investigation of new therapeutic approaches. Probiotic bacteria capable to produce bile salt hydrolase (BSH) are promising in the treatment of IBS-D and assumed BAM

Aims & Methods

The aim of the trial was to compare the effectiveness of combined treatment (a probiotic based on strains of Lactobacillus, Streptococcus, Bifidobacterium, Saccharomyces boulardii and cholestyramine) with cholestyramine monotherapy in the treatment of IBS-D.
Materials and methods: a 12-week randomized trial included 108 patients with IBS-D that were divided into 2 groups: a control group (n=51) receiving only cholestyramine (monotherapy) and an experimental group (n=57) receiving a combination of cholestyramine and the study probiotic (based on strains of Lactobacillus, Streptococcus, Bifidobacterium, Saccharomyces boulardii). Before the start of the treatment, the relative activity (RA) of the BSH of the investigated probiotic was determined using the ultraperformance liquid chromatography with mass spectrometry (UPLC-MS). During the stages of the study, patients were evaluated using clinical scales, including symptoms questionnaires with visual analog scale (VAS).

Results

The BSH RA of the studied probiotic was 2.07±0.06 U/ml compared to 1.0±0.04 U/ml of capsules with L. plantarum and 0.03±0.01 U/ml – with L. plantarum without BSH-genes. In the experimental group, the severity of bloating and visceral sensitivity index values were lower after 8 and 12 weeks, and the value of the type of stool according to the Bristol scale and its daily frequency – after 12 weeks compared to the control group, p<0.05 in all. According to the scale of IBS-adequate relief, the percentage of achieving a clinical effect was higher in the experimental group compared to the control group after 12 weeks, OR = 1.31 (95% CI; 1.03-1.68), p=0.038.

Conclusion

Additional prescribing of a probiotic with BSH producing bacterial strains was more effective in relieving the clinical manifestations of IBS-D and achieving a therapeutic effect compared to cholestyramine monotherapy.

Introduction

IBD is a global health problem. It is necessary to understand the evolution and treatment exposure in a cohort of newly diagnosed IBD patients in the biologic era in the South of Europe

Aims & Methods

Aims: 1) To describe the main epidemiological and clinical characteristics of patients at IBD diagnosis and the long-term outcomes; 2) to analyse the use of drugs for IBD, and the need of hospitalisations and surgeries; 3) to compare IBD management based on the type of disease and the resources of the hospitals.
Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD —Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified— during 2017 in the 17 Spanish regions were included. Patients who consented were followed-up for 5 years (yr) after diagnosis. Treatment was grouped into 5 categories: mesalamine (oral or topical), steroids (intravenous, oral, or topical), immunomodulators (thiopurines, methotrexate or cyclosporine), biologics (anti-TNF, vedolizumab, ustekinumab) or JAK inhibitors (JAKi), and surgery. Hospitals were classified into high resources and low resources ones. Cumulative incidence of exposure to each of the studied treatments was estimated by Kaplan-Meier curves; curves were compared with log-rank test.

Results

A total of 3,301 incident cases of IBD diagnosed during 2017 in 108 hospitals, covering over 22 million inhabitants in Spain (about 50% of the population), were enrolled into the follow-up study. Main characteristics of the cohort are summarised in table 1A and 1B. Median diagnosis delayed was 3.5 months (5.6 in CD and 2.7 in UC, p<0.001). During the 5-yr follow-up, 25% of UC patients progressed to more extensive involvement, while 8% of CD patients with inflammatory behaviour progressed to either stricturing or fistulising behaviour. Most of the patients who received mesalamine, corticosteroids, or immunomodulators initiated treatment within the first 2 years after diagnosis (figure 1). However, the cumulative incidence of biologics/JAKi usage steadily increased over time, reaching 49% by the 5-yr timepoint in CD. In terms of surgeries, a progressive increase in cumulative incidence was observed in CD; however, the incidence of colectomy remained stable in UC from the 2^nd year post-diagnosis. The management and progression of IBD unclassified were similar to that of UC. Regarding the type of hospital, a higher cumulative incidence of biologics/JAKi usage, hospitalisations, and surgeries was observed in CD at high resources hospitals. No differences were observed in the use of other therapeutic resources or the management of UC.

Conclusion

In the EpidemIBD large-scale epidemiological study, we have observed that the delay in diagnosing IBD is shorter than previously described. Approximately 50% of patients with CD and 20% of patients with UC end up receiving biologics/JAKi in the first 5 yrs following diagnosis. The percentage of patients undergoing surgery was lower than previously reported; in the case of UC, the majority of colectomies occurred within the first 2 yrs after diagnosis.

Disclosure

MDMA has received consulting and/or speaker fees from AbbVie, Pfizer, Takeda, Janssen, Tillotts Pharma and Galapagos; and has received research funding from Abbvie, Janssen and Pfizer.
RF-I has served as a speaker, advisory member or has received research funding from Takeda, MSD, Abbvie, Janssen, Pfizer, Palex, Shire Pharmaceuticals, TillottsPharma, Faes, Adacyte, Ferring and Casenrecordati.
R. Lorente has served as a speaker, or has received research or education funding from Abbvie, Pfizer, Takeda, Janssen and Galapagos.
IV has served as a Speaker, consultant and advisory member for and has received funding for: MSD, Abbvie, Pfizer, Ferring, Shire Pharmaceuticals, Takeda, Tillots, Jannsen y Galápagos.
EF-S Tillotts Pharma (speaker and travel grants), Ferring (speaker and travel grants) ), Faes (travel grants), MSD (speaker and travel grants), Abbvie (speaker and travel grants), Falk (travel grants), Shire (speaker and travel grants), Takeda (speaker and travel grants).
LAG has served as speaker or has received research or education funding from MSD; Abbvie; Kern Pharma; Ferring; Faes Farma; Shire Pharmaceuticals; Pfizer; Takeda; Janssen; Tillots Pharma and OtsuKa Pharmaceutical

Introduction

Patients with Hypermobile Ehlers Danlos Syndrome (hEDS) have a high prevalence of Disorders of Gut-Brain Interaction (DGBI) and pose complex nutritional challenges in gastroenterology clinic. Despite this, little is known regarding nutrient intake and adequacy in hEDS.

Aims & Methods

Our aim was to assess nutrient intake and adequacy of patients with hEDS, as well as to determine which factors, including co-existent DGBI, are associated with poor intake. We conducted a cross sectional survey of patients with hEDS from two tertiary neurogastroenterology clinics as well as the Ehlers-Danlos Support UK. Inclusion criteria were adults with hEDS, exclusion criteria were those currently or previously using artificial nutrition. Patients completed the validated semi-quantitative Scottish Collaboration Group Food Frequency Questionnaire (FFQ) alongside questionnaires characterising: demographics, DGBIs (Rome IV), gastrointestinal, mood, somatic and autonomic symptoms, past history of eating disorders and screen for Avoidant Restrictive Food Intake Disorder (ARFID) using the Nine Item Avoidant-Restrictive Scale (NIAS). Nutrient intake was calculated from the FFQ and nutrient adequacy was calculated by comparison with UK daily reference values (DRVs) for age and sex. Unpaired t-tests were performed to compare nutrient intakes among patients with and without comorbidities, including the most common DGBIs.

Results

425 participants were included in the final analysis (mean: 41 years, 96% female). Only 48.5% reported BMI in the normal range, whereas 5.2% were underweight (BMI <18.5 kg/m²)and46.4% were overweight/obese (BMI >25 kg/m²). Only one third met their estimated average requirements (EAR) for energy (kcal/d). The majority met their reference nutrient intake (RNI) for protein (87.3%) and fat (72.5%), in contrast to only 21.2% for carbohydrate. Fibre intakes were very low (AOAC mean 23.7g/day (SD: 12.7) with only 24.7% meeting the RNI of 30 g/d. More than 58% of participants met/exceeded their DRV for micronutrients (zinc, magnesium, copper, manganese and selenium) and >95% for vitamins. Patients with functional nausea (n=157) were less likely to meet their protein requirements compared to those without (82.2% vs. 90.3%, p=0.015) and also had lower intakes for sodium (p=0.02), magnesium (p=0.02), calcium (p=0.01), zinc (p=0.002), selenium (p=0.03), folic acid (p=0.02) and vitamin C (p=0.05). Patients with previous eating disorders were less likely to meet nutrient requirements for thiamine (p=0.01) and vitamin B12 (p=0.04). Patients with ARFID (n=110) were less likely to meet requirements for all nutrients (except fat, calcium, vitamin D, vitamin B12) compared to patients without.

Conclusion

Patients with hEDS are rarely underweight and tend to consume high protein, high fat diets that are low in fibre. Functional nausea is the single most important DGBI impacting nutrient intake, as well as previous eating disorders and disordered eating (ARFID). These factors should be considered by clinicians and dietitians when assessing nutrient intake in this complex patient group.

Disclosure

RT, AF and QA have received a grant from EDS-UK to conduct this study. AF undergoes consulting work for Abbvie.
KW has received research funding from Almond Board of California, Danone, International Nut & Dried Fruit Council, and has a patent for volatile organic compounds in the detection and management of IBS.
QA undergoes consulting work for Takeda Pharmacueticals, and Classado Biosciences Ltd.

Introduction

The severity of bleeding and the time-to-endoscopy are generally recognised as risk factors for mortality in patients with GI bleeding. However, how to grade the bleeding severity (BS) is not clearly defined and it is not clear its relationship with the time-to-endoscopy. We found that the bleeding severity correlates with 5 clinical items: altered mental status, systolic blood pressure ≤100 mmHg, blood ureic nitrogen ≥130 mg/dl, haemoglobin ≤8 gr/dl and clinical presentation with hematemesis.

Aims & Methods

The aim of the study is to evaluate if the interaction between bleeding severity and timing-to-endoscopy could impact on the death risk. A prospective multicentre cohort study, including all consecutive patients with upper gastrointestinal bleeding admitted to 50 Italian hospitals was conducted. Charlson's comorbidity index and ASA scores were used to define the patients’ performance status. According to the previously cited clinical items, we defined bleeding severity (BS) and graded it in low, intermediate, and high-risk classes depending on the presence and the number of items at the time of admission. Timing to endoscopy was defined according to ESGE* guidelines and was divided into 4 time-frames (<6h; 6/12h; 12/24h; >24h).

Results

2,525 patients were included (mean age 68 [±15.8], male 67.3%); the bleeding was non-variceal in 82.3%. Overall, 176 patients died (6.9%); 28 (1.9%) in the low BS group (1,463 patients), 28 (8.6%) in the intermediate BS group (606 pts) and 96 (21%) in the high BS group (p<0.000). In our population, the 4-time frames do not impact on the mortality in the low and intermediate classes of risk. In the high BS class, there is an interaction between the time to endoscopy and the mortality, with the lower mortality observed in the 6/12 hrs frame.

Conclusion

In our population, the death risk gradually rises as the bleeding severity increases. Bleeding severity identifies 3 different classes of death risk and the time to endoscopy seems unrelated to mortality in low and intermediate BS classes. In the high BS patients, the lower mortality was observed in the timing to endoscopy 6-12 hrs.

References

* Ian M. Gralnek et al. Endoscopy 2021; 53: 300–332

Disclosure

nothing to disclose