Introduction

Dietary therapies have revolutionised treatment for irritable bowel syndrome (IBS). However, response rates to the diet with the highest evidence of efficacy (the low FODMAP diet) remain at 50-75%, suggesting other potential drivers of symptom onset. A low food chemical elimination-rechallenge diet targeting bioactive food chemicals (including salicylates, amines, glutamate and other additives), is commonly applied in Australia in patients exhibiting both gastrointestinal and extra-intestinal symptoms. However, data supporting the low chemical diet is scant, and safety concerns exist due to its restrictive nature potentially causing nutritional deficiencies and disordered eating.

Aims & Methods

This cross-sectional survey in patients with IBS and healthy controls aimed to evaluate the frequency of co-existing extra-intestinal symptoms, as well as explore patient perceptions and use of the low chemical diet. Participants with IBS (IBS-Severity Scoring System¹ (IBS-SSS) >75), and healthy controls (not meeting Rome IV and ≤75 on IBS-SSS) were recruited via online advertisement. Validated questionnaires were used to assess gastrointestinal symptoms (IBS-SSS¹), extraintestinal symptoms (extended PHQ-12²), and food additive intake (IBD-Food additive questionnaire³). Additional questionnaires assessed use of dietary therapies with specific focus on food chemicals. Data was analysed using independent samples t-test and chi-square test.

Results

204 IBS and 22 healthy controls completed the study. Total IBS-SSS for the IBS participants was 277±79, compared to 36±28 in the healthy control group (p<0.01). IBS participants were more likely to report extra-intestinal symptoms including headaches (p<0.01), migraines (p=0.03), fatigue (p<0.01), difficulty sleeping (p=0.03), rhinitis (p=0.02), urticaria (p=0.04) and mood disturbance (p<0.01). Twenty-one (10%) of IBS participants were following a low chemical diet compared to none in the control group. Of these 21 participants, dietary advice was provided by a dietitian (n=13), general practitioner (n=6), gastroenterologist (n=6), naturopath (n=3), family/friend (n=4) and/or the diet was self-initiated (n=7). IBS participants were more likely to report at least one food chemical as a trigger for gastrointestinal (38% vs 13%, p=0.03) and/or extra-intestinal (30% vs 9%, p=0.04) symptoms (Table 1). There was no significant difference in consumption (g/day or g/kg/day) of ultra-processed, additive containing foods.

Table 1. Suspected dietary triggers (food chemical specific) for gastrointestinal and extra-intestinal symptoms

Conclusion

Patients with IBS are more likely to report experiencing extra-intestinal symptoms compared to healthy controls. Despite limited evidence, a low food chemical diet is utilised by patients with IBS to manage both gastrointestinal and extra-intestinal symptoms. Further data is needed to understand the efficacy and safety of the low chemical diet in IBS.

References

1. Francis., et al (1997). Aliment Pharmacol Ther., 95(4), 999-1007
2. Spiller., et al. (2010). Aliment Pharmacol Ther., 32(6), 811-820
3. Trakman., et al. (2020). Nutrients, 12(3). 812.

Disclosure

No conflicts to declare

Introduction

Due to the daily rhythm of insulin level, an increase of the morning fasting blood sugar value was known in prediabetes statements. ECG heart rate variability (HRV) parameters like low-frequency (LF) and high-frequency (HF) also have a circadian pattern. The ratio of LF/HF can show the activity of the autonomic nervous system.
The evaluation of the epidemiological and metabolic aspects of lifestyle (effects of missing meals, high carbohydrate intake, night shift etc.) could help find a more accurate pathophysiological knowledge to improve overweight in therapy-resistant patients and clearing the risk of it.

Aims & Methods

Our aim was to compare the results of the mother-child group described in our reference abstract and the group performing physical work during night shift. Searching long-term effects of regular night shift physical work and staying awake, such as anaerobic exercise. Could more objective effects on weight loss or on cardiovascular risk be identified than mentioned in other night shift studies?
17 mothers (M) and 24 children (Ch) consecutively, and 24 night shift employees (NS) were examined in the morning after their night shift. The epidemiological parameters were evaluated, then the oral loading test with orally intake of 75 g of glucose was performed. We checked the venous blood gas parameters to follow mitochondrial function indirectly. The function of the autonomic nervous system was determined by a 2-minute resting HRV and LF/HF values.

Results

Our groups (mean+SD): age were M=48.8 +/- 5.1 vs. Ch=23.5+/-5.4, vs. NS=45.7+/-10.0. The averages of BMI were M=28.59 vs. Ch=31.65 vs. NS=31.56.
The 0-minute insulin: M=5.4 +/- 3.43 vs. Ch=9.0+/-4.13, vs. NS=10.17+/-5.06 which is significant according to Student's t-test, p(M-Ch)=0.003. p(M-NS)= 0.001. The lifestyle differences were irregularity and skipping of the breakfast in the NS group.
The venous lactate was after 120 minutes of the glucose intake (mean +/- SD) M=1.37 +/-0.52 vs. Ch=1.56 +/-0.43, vs. NS=1.51 +/-0.19. Lactate reference value (Siemens Epoc Reader) <0.75 mmol/l, p (M-Ch)=0.005, vs. p(M-NS)=0.003. The 0-minute lactate values were M=1.03+/-0.44 vs. Ch = 1.02 +/- 0.31, vs. NS = 1.17 +/- 0.48. p>0.05. HRV LF/HF values (mean+/- SD) were M= 1.2+/-0.54, vs. Ch=1.05 +/-0.59 vs. NS=0.74+/-0.23, p(M-NS) =0.025, p(M-Ch)>0.05. The venosus partial pressure of oxygen (average +/- SD) were M=28.2 +/- 7.22 vs. Ch=29.8+/-7.26, vs. NS=26.8+/-6.55. p(M-NS)>0,05.

Conclusion

The higher basal insulin and lactate level and lower venosus partial pressure of oxygen in the NS group could be explained by a relative tissue hypoxia which a factor of anaerobic metabolism and could increase the consumption of glucose in the muscles by GLUT4 transporters and elevating the level of circulating glucose.
The vagus tone helped in the dynamic autonomic regulation and it was responsible for cardiovascular health. Its decreasing correlates with the lower LF/HF ratio, which could be a marker for physical overload of the NS group.
Unsuccessful weight loss could be explained with the proportionally higher insulin level in NS group, which causes a feeling of hunger and helps the fat storage. On the other hand, the lower effectiveness of calorie-restricted diets should be improved with regular meals during night shift.
We presented a possible clinically measurable sign of the pathophysiological features of the adipose tissue hypoxygenisation as in hypoxia inducible factor 1-alpha studies presented.
We were planning a long-term health risk study to demonstrate the effectiveness of these parameters.

References

UEG 2023 Abstract 642 and 1400

Introduction

Inflammatory bowel disease (IBD) is a complex multi-factorial disease characterized by chronic inflammation of the gastrointestinal tract. Despite significant efforts to understand the pathogenetic mechanisms of IBD, the elucidation of its etiopathology and progression is far from fully understood. The direct analysis of the intestinal tissue from the endoscopy which lead to IBD diagnosis (before starting any treatment) would the ideal samples to elucidate IBD pathogenesis.

Aims & Methods

High-throughput mass-spectrometry-based quantitative proteomic analysis was performed using formalin-fixed paraffin-embedded human intestinal samples from newly diagnosed patients to elucidate the potential mechanisms responsible for gut inflammation in Crohn´s disease (CD) and ulcerative colitis (UC). For this purpose, 193 formalin-fixed paraffin-embedded samples from 40 active UC patients, 67 active CD patients and 46 normal biopsies from healthy controls (HC) were analyzed. Proteins with p-value < 0.05 were considered as significantly dysregulated. Moreover, we used Ingenuity Pathway Analysis (IPA) to analyze the pathways and functions in different locations of the gut (ileum or left colon) that could be related to IBD pathogenesis.

Results

A total of 2,903 proteins were identified, of which 1,010 were differentially expressed between left colon from CD patients and HC. 1,242 proteins were differentially expressed between left colon from UC patients and HC, and 952 differential proteins discriminated between left colon from CD and UC patients. In the comparative study of ileum biopsies from Crohn's disease patients and healthy controls, 956 proteins were differentially expressed. IPA revealed multiple canonical pathways, including EIF2 signaling, regulation of eIF4 and P7056K signaling, mitochondrial dysfunction, and oxidative phosphorylation altered in ileum biopsies from CD patients compared to HC. Regarding the proteomic study in left colon samples, the main canonical pathways enrichment in the comparison of UC and CD with HC were the following: neutrophil extracellular trap signaling pathways, fatty acid oxidation, sitruin signaling pathway, tRNA charging, and mitochondrial dysfunction.

Conclusion

The proteomic results revealed dysregulated proteins and pathways in ileum and left colon biopsies from patients with active CD and UC compared to HC that may unravel key mechanisms contributing to the pathogenesis of these diseases. The results of the study serve as a starting point for hypotheses to understand the pathogenesis and search for therapeutic targets.

Introduction

Crohn's disease (CD) is associated with a high risk of complications, stenosis and fistula frequently requiring surgery.
The aim of our work is to study the epidemiological profile of patients operated on for CD, to compare operated and non-operated patient and to determine the predictive factors for recourse to surgery.

Aims & Methods

This is a retrospective descriptive, comparative and analytical monocentric study over 40 years from January 1983 to april 2023 in a gastroenterology department including all patients followed for CD and operated on. Data was collected from patient registers.
We compared the operated and non-operated group, then we studied the factors associated with surgery in univariate and then multivariate analysis.

Results

Of 1103 patients followed for CD, 31.82%(351) were operated, including 86%(302) operated once, 12%(43) operated twice and 1.4%(5) operated 3 times. The median age of diagnosis was 31[22.5-40]years and the sex-ratio F/M=1.1.
A history of appendectomy was found in 17.2%(60) of patients. Smoking is found in 26.9%(94) of patients.
Patients operated on have an ileocolic location in 68.5%(237), colonic in 14.7%(52), ileal in 12.7%(44) of cases, and upper location in 3.8%(13).
The stenosing phenotype is observed in 38.4%(131) of patients, fistulizing in 35.2%(120) and inflammatory in 26.4%(90). Anoperineal manifestations were associated in 38.8%(122).
Recourse to corticosteroid is observed in 44.2%(155) of operated patients, 40.5%(142) who received immunosuppressive treatment and 26.6%(93) who had benefited from biotherapy.
19.9% (70%) were operated on following a complication of their disease, including 11.4%(8) of those operated on for severe acute colitis, 51.4%(36) for an occlusion, 22.8%(16) for an intestinal perforation, 17.1% (12) for a deep abscess and 4.2% (3) following degeneration.
By comparing the group of operated and non-operated patients, the diagnosis age <40 years was found at a higher rate in the operated p <0.001. In these patients, there is a higher frequency of ileocolic localization, fistulizing and stenosing forms and associated MAP (p<0.001/0.009). We noted a higher rate of patients who were under immunosuppressant p<0.001 and under biotherapy p=0.03 in operated patients.
In multivariate analysis, a history of appendectomy is associated with a high risk of surgery (OR=1.8, 95%CI:0.06-1.2, p=0.02) as well as the fistulizing phenotype (OR=6.5, 95%CI:1.4-2.3 , P<0.001) and the stenosing phenotype (OR=5.3, 95% CI:1.2-2, P<0.001). The occurrence of a complication (OR=9, IC95%=1.5-2.8, p<0.001) as well as the use of immunosuppressants (OR=1.6, IC95%: 0.1-0.8, p=0.001) are associated with a risk surgery high.
The use of corticosteroid therapy is associated with a lower risk of surgery (OR=0.6, 95%CI: -0.8;-0.1, p=0.006).
Other factors such as sex, smoking, location, anoperineal manifestations and biotherapy are not factors associated with surgery.

Conclusion

Despite the revolution in medical treatment, surgery remains a fundamental treatment in the management of CD. In our series, the history of appendectomy, the fistulizing and stenosing character of the disease, the treatment with immunosuppressant and the occurrence of complications are associated with an increased risk of recourse to surgery.
Corticosteroid therapy is associated with a low risk of surgery.
Sex, smoking, location and anoperineal manifestations are not associated with the risk of surgery.