Introduction

The role of faecal immunochemical testing (FIT) as a biomarker to stratify patients with lower gastrointestinal (GI) symptoms is well established. However, its use in patients with iron deficiency anaemia (IDA) is controversial. The aim of this study was to investigate the role of FIT in predicting small bowel (SB) pathology in patients with IDA.

Aims & Methods

Patients with IDA and a FIT test who had negative bidirectional endoscopy and underwent a Small Bowel Capsule Endoscopy (SBCE) were included. Patients were split into two groups. Group-1: Positive FIT (> 4 ug Hb/g) and IDA; Group-2: Negative FIT and IDA. Patients demographics, past medical history, medication history, haemoglobin and ferritin results, FIT levels and capsule endoscopy findings were recorded.

Results

58 Group-1 patients (median age 71.5years (IRQ 58.7-76); 46.5% male) had a median haemoglobin of 104 g/L (IQR 97.7- 120.3) ferritin12 (IQR 8- 18) and median FIT 31(IQR 16.7- 158). 28 Group-2 patients (median age 61.5 years (IQR 49-69); males- 60.7%) had a median haemoglobin of 107 g/L (IQR 94- 123) and ferritin 11.5 (IQR 7- 20). There was a significant difference in median age between the two groups (p=0.008). In 26 (44.8%) patients from Group-1 there was significant pathology identified on SBCE (angioectasia- 18, visible blood- 3, polyp-1, NSAID enteropathy-3, Duodenal ulcer-1 and SB Crohns-1). In 11 (39.2%) patients from Group 2 there was significant pathology identified on SBCE (angioectasia- 6, visible blood- 2, NSAID enteropathy-2, SB Crohns-1 and coeliac-1). Some patients had more than one lesion on SBCE. The sensitivity and specificity of a positive FIT predicting SB pathology was 70.27% and 34.6 9% respectively. 10 patient in Group-1 and 2 patients in Group-2 admitted to using NSAIDs post-procedure although they had not revealed this during their pre-procedure medication documentation.

Conclusion

In patients with IDA and no clear cause seen at conventional upper and lower endoscopy, small bowel pathology was present in over a third of cases although this was not predicted by the FIT result. Capsule endoscopy should be considered in these cases. Regular NSAID use can cause significant SB pathology. It is important to screen for NSAID use prior to SBCE. Studies with larger numbers are needed to assess correlation between FIT and SB pathology in patients with IDA.

Introduction

High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET) and magnetic resonance defecography (MR-defecography) are important tools in studying constipation.

Aims & Methods

Evaluate the prevalence of functional defecation disorders and structural anorectal alterations in patients with constipation and compare the findings of HD-ARM and BET with MR-defecography.
Retrospective cohort study including patients with functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) submitted to HD-ARM, BET and MR-defecography. Patients were divided into three groups: 1) normal anorectal evacuation pattern in HD-ARM and BET; 2) abnormal anorectal evacuation pattern and BET; 3) normal anorectal evacuation pattern and abnormal BET, or abnormal anorectal evacuation pattern and normal BET.

Results

A total of 64 patients were included, 49 with FC (76.6%) and 15 with IBS-C (23.4%). There were 20 patients in group 1 (31.3%), 11 in group 2 (17.2%) and 33 in group 3 (51.5%). In MR-defecography, 47 patients had relevant structural anorectal alterations (73.4%) and 15 had an abnormal contraction of the puborectalis during the defecatory maneuver (23.4%).
Nineteen patients were diagnosed with dyssynergic defecation (29.7%). These patients had significantly higher residual anal pressure and lower percentage of anal relaxation during defecation (109.6±43.2 vs 85.8±29.7 mmHg, p=0.038 and 9% vs 24%, p=0.018, respectively), as well as a lower differential of rectoanal pressure (-32.2±31.4 vs 3.0±29.6 mmHg, p<0.001).
Patients with structural anorectal alterations had a significantly higher body mass index (BMI) (27.4±4.5 vs 23.5±3.3, p=0.002), and all obese patients had structural alterations.
Comparing the findings of HD-ARM and BET with MR-defecography: in group 1, 15 patients had structural alterations (75.0%); in group 2, 8 patients had structural alterations (72.7%); in group 3, 22 patients only had structural alterations (66.7%), 6 only had dyssynergic defecation (18.2%), 2 patients had both (6.0%) and 3 did not have any findings (9.1%). In 24.2% of patients with inconclusive findings in HD-ARM and BET, MR-defecography allowed the diagnosis of dyssynergic defecation.

Conclusion

Patients with structural anorectal alterations had a significantly higher BMI. Almost three quarters of patients with FC and IBS-C had relevant structural anorectal alterations and one third had dyssynergic defecation. Therefore, it is important to combine MR-defecography with HD-ARM and BET in the study of constipation.

Introduction

Nutritional deficiencies are common in IBD patients and have been widely reported in Crohn's disease (CD) patients in particular. Nonetheless micronutrient screening is not routine in all centres in the UK. Body Mass Index (BMI) is widely used for detecting malnutrition in clinical practice but it is not sensitive marker of muscle mass. Hand grip strength (HGS) is quick to perform and may be an effective parameter to predict muscle function and health in IBD patients in busy outpatient settings. Different cut points are used in clinical practice to determine muscle weakness and may yield different results.

Aims & Methods

The aims of this study were (1) To examine micronutrient status (2) To establish the incidence of over- and under-weight and (3) To measure hand grip strength to determine the frequency of dynapenia in stable patients with IBD referred to specialist dietitian clinic for advice.
A baseline micronutrient screen including 9 vitamin and minerals (Vitamins A,D, E, folate, B12, ferritin, selenium, copper and zinc as well as haemoglobin) was performed on all consenting patients at initial dietitian appointment. Inflammatory marker, C reactive protein, was also checked. Patients with raised CRP, were excluded from the micronutrient analysis. All patients were weighed, height measured and BMI calculated. Hand grip strength was measured using Marsden hand grip dynamometer. The maximum result of 6 trials was recorded and its corresponding percentile (1). Dynapenia was defined as HGS<16kg for females and <27kg for males (2) . Results of Ulcerative colitis (UC) and Crohn’s disease (CD) patients were compared.

Results

A total of 292 consecutive patients, (108m, 184 f) referred for dietitian input from April 2023 to March 2025 were included. Mean age was 45 years (SD18). 201 patients with CD and 91 with UC were included. Results are presented in Table 1. No difference in micronutrient status was found between CD and UC patients apart from vitamin D where a higher incidence of deficiency was found in UC compared with CD patients (p=0.045). Contrary to widespread belief incidence of underweight was low in both CD and UC with a higher incidence of obesity in both groups than underweight. Over a quarter of the IBD population had muscle weakness defined by both Dodds et al (2014) and Cruz-Jentofft et al (2019) which is concerning (1,2).

Conclusion

Vitamin D status in particular should be monitored in all stable patients with IBD. A high proportion of both UC and CD patients were found to have weak muscle strength. HGS is a readily obtainable measure quick to perform and could be easily incorporated into routine clinical practice. Further research is needed to establish its clinical significance for stable IBD patients.

References

1. Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Sayer AA. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014 Dec 4;9(12):e113637. doi: 10.1371/journal.pone.0113637. PMID: 25474696; PMCID: PMC4256164.
2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. Erratum in: Age Ageing. 2019 Jul 1;48(4):601. doi: 10.1093/ageing/afz046. PMID: 30312372; PMCID: PMC6322506.

Disclosure

No conflict of interest to disclose

Introduction

Metastatic Crohn’s disease (MCD), also known as cutaneous Crohn’s disease is one of the rarest cutaneous lesions in IBD. It is defined by granulomatous lesions infiltrating the skin that are discontinuous from the affected GI tract. In most occasions, MCD occurs parallel to the course of a well-establish GI disease, but occasionally it can precede the GI manifestations from months to years. Studies addressing the therapeutic approach to MCD are limited. Ustekinumab is licenced for Crohn`s disease and also for skin disorders including psoriasis. We report our experience in managing MCD in a tertiary IBD centre.

Aims & Methods

This is a single centre retrospective review of biopsy proven cutaneous Crohn’s disease. Patient details obtained from patient records included demographic data, previous failure to biologics and/or IMS, response and time to response to Ustekinumab and therapeutic drug monitoring.

Results

A retrospective review of patients with cutaneous Crohn’s disease was performed. All patients had undergone a skin biopsy for histologically confirmation. Ten patients were included (Males: Females 5:5). Median age was 53 years (IQR 24-67). The most common location was the perianal area often preceded by a surgical wound from a proctectomy and 2 patients had peristomal skin affected. Ninety- percent of patients had failed antiTNF therapy and 6 out of 10 had failed to both Infliximab and Adalimumab, one of them had also lost response to Vedolizumab. All patients received ustekinumab with median follow up since initiation of 45 months (IQR 27-60). All patients noticed improvement since initiation of Ustekinumab with a median time to response of 10 weeks (IQR 4-28). Four out of 10 patients achieved a complete healing of the skin lesions while rest of patients reported a partial response. Most patients had therapeutic or supratherapeutic Ustekinumab level ranging from 2 to 6 mg/L. Dose escalation was done in 8 patients.

Conclusion

Metastatic Crohn’s disease is a rather uncommon entity with different clinical manifestations. Our series report satisfactory response to ustekinumab in MCD. Larger studies are required to confirm these findings.

Introduction

Corpus Atrophic Gastritis (CAG) is a precancerous inflammatory condition of the oxyntic mucosa. Up today, two types of CAG are distinguished: 1) autoimmune (corpus-restricted), defined for CAG sparing the antrum 2) Helicobacter pylori (Hp)-related (multifocal), which involves antrum too.
Antrum involvement/sparing is crucial for both CAG definition as autoimmune and gastric cancer risk level, which is increased in case of pan-atrophy/pan-metaplasia, according to OLGA and OLGIM scores. CAG natural history is still poorly known, especially regarding antrum evolution. In cases with previous antral involvement, possible antrum healing after cure of Hp infection was formerly described. So, given the importance of the criterium antrum-sparing, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.

Aims & Methods

Given the importance of the criterium antrum-spared, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.
We performed a retrospective study on 130 patients with CAG and antrum involvement according to updated Sydney System. Mean time of FU gastroscopy was 40.6(range 4-192) months. In 13 patients corpus atrophy was not confirmed at FU, so were excluded. At baseline, among the remaining 117 patients [mean age 63 (range 20-87) years; F 67.5%], 47 (40.2%) had antral non-atrophic and 70 (59.8%) had antral atrophic gastritis, metaplastic in 84.3%. Histologically diagnosed Hp infection was present in 27.3% of patients, all receiving eradication therapy, anti-parietal cells antibodies (APCA) were positive in 53.8%.

Results

At FU 29/117(24.8%) of patients with tout-court involved antrum showed a complete restitutio ad integrum of antral mucosa. In particular, on 70 cases with antral atrophy at baseline, atrophy regressed in 15 (21.4%). Hp infection at baseline was present in 38% of patients who reported complete antral healing at FU, cured in all but one. Both antral healing and atrophy regression were found to be similar in Hp-cured and not-cured/negatives (p>0.05). In 8 patients (6.8%) a worsening of antral histology at FU was reported: 5 developed antral atrophy, not present at baseline, and 3 antral atrophic patients developed intestinal metaplasia.

Conclusion

Nearly 25% of CAG patients with antral involvement showed complete antrum healing, with regression of baseline antral atrophy in 21.4%. Antral healing occurred also in patients without history of Hp infection and/or eradication. These data suggest that in CAG natural history, concomitant antral involvement may regress irrespective of Hp cure, implying cancer risk reduction and raising queries about histology as sole criteria diagnostic for autoimmune gastritis.

References

1. Lahner et al. Dig LIver Dis 2019
2. Sipponen P et al. Gastroenterology clinics of North America 2000
3. Annibale B Helicobacter 1997

Introduction

The efficacy and safety of upadacitinib (UPA), an oral reversible Janus kinase inhibitor, were demonstrated for patients with Crohn’s disease (CD) in three phase 3 randomized, controlled, double-blind clinical trials: U-EXCEL (NCT03345849), U-EXCEED (NCT03345836), and U-ENDURE (NCT03345823).^1–3 UPA is approved for the treatment of moderately to severely active CD.^4,5 The STRIDE-II CD treat-to-target guidelines recommend using composite clinical and endoscopic treatment targets to improve patient outcomes.⁶ We assess the efficacy of UPA in patients with moderately to severely active CD using stringent, composite efficacy endpoints.

Aims & Methods

In two phase 3 induction studies, U‑EXCEL and U-EXCEED, patients were randomized 2:1 to receive once-daily UPA 45 mg or placebo (PBO) for 12 weeks. Those who achieved a clinical response (≥30% decrease in average daily very soft or liquid stool frequency [SF] and/or ≥30% decrease in average daily abdominal pain score [APS] and both not worse than baseline) to UPA were re-randomized 1:1:1 to receive UPA 15 mg, UPA 30 mg, or PBO in the 52-week U-ENDURE maintenance study. Five composite clinical and endoscopic endpoints were assessed at weeks 12 of induction and 52 of maintenance therapy: (1) enhanced clinical response (per very soft/liquid SF and APS) and endoscopic response; (2) clinical response (CR-100) and endoscopic response; (3) clinical remission per CD Activity Index (CDAI) and endoscopic response; (4) SF/APS clinical remission and endoscopic remission; and (5) CDAI clinical remission and endoscopic remission. Treatment group differences were compared using the Cochran-Mantel-Haenszel test, adjusted for stratification factors. Analyses used nonresponder imputation while incorporating multiple imputation to handle missing data due to COVID-19.

Results

A greater proportion of patients receiving UPA 45 mg vs PBO achieved stringent clinical and endoscopic endpoints at week 12: enhanced clinical response and endoscopic response (33.7 vs 6.1%); CR-100 and endoscopic response (27.8 vs 5.2%); CDAI clinical remission and endoscopic response (24.7 vs 5.2%); SF/APS clinical remission and endoscopic remission (15.7 vs 3.5%); and CDAI clinical remission and endoscopic remission (15.0 vs 3.7%; for all comparisons, nominal P values ≤ .001; Table). At week 52, a greater proportion of patients who received UPA 15 mg or UPA 30 mg achieved stringent clinical and endoscopic endpoints vs patients in the PBO group (Table). Composite endpoint achievement rates were numerically greater with UPA 30 mg than with UPA 15 mg (Table). The safety of UPA in CD was previously reported.^1–3
​

Conclusion

In both induction and maintenance studies, patients receiving UPA had greater achievement of stringent efficacy endpoints vs patients who received PBO. UPA 30 mg demonstrated numerically greater clinical and endoscopic efficacy vs UPA 15 mg. The largest differences between UPA and PBO treatment groups occurred for the enhanced clinical response and endoscopic response endpoint.

References

1. Colombel JF, et al. Gastroenterology. 2022;162(Suppl):1394.
2. Loftus EV Jr. United European Gastroenterol J. 2022;10(Suppl 8):103–104.
3. Panés J, et al. Am J Gastroenterol. 2022;117(Suppl):10.
4. RINVOQ. Summary of Product Characteristics. AbbVie Deutschland GmbH & Co. KG; 2023. Accessed 24 April 2023. https://www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf.
5. RINVOQ. Summary of Product Characteristics. AbbVie Inc.; 2023. Accessed March 27, 2023. https://www.medicines.org.uk/emc/product/12830/smpc.
6. Turner D, et al. Gastroenterology. 2021;160(5):1570–1583.

Disclosure

SD has served as a speaker, consultant, and advisory board member for AbbVie, Actelion, Alfa Wasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson & Johnson, Millennium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, Schering-Plough, UCB Pharma, and Vifor.
BGF has consulted for AbbVie, AbolerIS, AgomAB Therapeutics, Allianthera, Amgen, AnaptysBio, Applied Molecular Transport Inc, Arena Pharma, Avoro Capital Advisors, Atomwise,, BioJamp, Biora Therapeutics, Boehringer-Ingelheim, Boxer, Celsius Therapeutics,Celgene/BMS, Connect BioPharma, Cytoki, Disc Medicine, Duality, EcoR1, Eli Lilly, Equillium, Ermium,, First Wave, First Word Group, Galapagos, Galen Atlantica, Genentech/Roche, Gilead, Gossamer Pharma, GSK, Hinge Bio, Hot Spot Therapeutics, Index Pharma, Imhotex, Immunic Therapeutics, JAKAcademy, Janssen, Japan Tobacco Inc., Kaleido Biosciences, Landos Biopharma, Leadiant, L.E.K. Consulting, Lenczner Slaght, LifeSci Capital, Lument AB, Millennium, MiroBio, Morgan Lewis, Morphic Therapeutics, Mylan, OM Pharma, Origo BioPharma, Orphagen, Pandion Therapeutics, Pendopharm, Pfizer, Prometheus Therapeutics and Diagnostics, Play to Know AG, Progenity, Protagonist, PTM Therapeutics, Q32 Bio, Rebiotix, REDX, Roche, Sandoz, Sanofi, Seres Therapeutics, Silverback Therapeutics, Surrozen Inc., Takeda, Teva, Thelium, Tigenix, Tillotts, Ventyx Biosciences, VHSquared Ltd., Viatris, Ysios, Ysopia, and Zealand Pharma; a speaker for AbbVie, Janssen, and Takeda; an advisor for AbbVie, Amgen, AMT, AnaptysBio, Axio Research, Boehringer-Ingelheim, Celgene/BMS, Ecor1Capital, Eli Lilly, Genentech/Roche, GSK, Index, Janssen, MiroBio, Morphic, Origo BioPharma, Pfizer, Progenity, Prometheus, REDX Pharma, Sanofi, Takeda, Teva, and Tillotts Pharma; a senior scientific director for Alimentiv Inc.; an employee of Western University; and holds stocks in Gossamer Pharma.
FM has served as a speaker and received honoraria from AbbVie, Biogen, Falk Pharma, Ferring, Hospira, Laboratorios Vitoria, Merck Sharp & Dohme, and Vifor.
PLL has been a speaker and/or advisory board member for AbbVie, Arena, Falk Pharma, Ferring, Genentech, Janssen, Kyowa Hakko Kirin Pharma, Mitsubishi Tanabe Pharma, MSD, Pfizer, Roche, Shire, Takeda, and Tillots; and has received unrestricted research grants from AbbVie, MSD, and Pfizer.
JOL has received grants for investigator led research from Takeda, Hospira / Pfizer, Abbvie, Gilead and has been a speaker and / or advisory board member for Allergan, Abbvie, Bristol Myers Squib, Celgene, Celltrion, Cornerstones US, Galapagos, Gilead, GSK, Lily, MSD UK, Shire, Ferring, Takeda, Pfizer, Janssen, Bristol Myers Squib,
TH has received research grants from AbbVie, Alfresa Pharma, Daiichi Sankyo, EA Pharma, JIMRO, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Pfizer, and Takeda. He has received lecture fees from AbbVie, EA Pharma, Janssen, Mitsubishi Tanabe Pharma, Pfizer, and Takeda.
BS has served as consultant for AbbVie, Boehringer, BMS, Celgene, Falk Pharma, Galapagos, Gilead, Janssen, Landos, Lilly, Pfizer, Prometheus, and Takeda, and received speaker’s fees from AbbVie, CED Service GmbH, BMS, Falk Pharma, Ferring, Galapagos, Janssen, Novartis, Pfizer, and Takeda.
ED, APL, AG, and CD, are employees of AbbVie, and may own AbbVie stock and/or stock options.
JDL has received personal fees, grants, and/or other support from AbbVie, Amgen, Arena Pharmaceuticals, Bridge Biotherapeutics, Bristol-Myers Squibb, Celgene, Galapagos, Gilead, Janssen Pharmaceuticals, Johnson & Johnson Consumer Inc., Lilly, Merck, Nestle Health Science, Pfizer, Protagonist Therapeutics, Samsung Bioepis, Sanofi, Takeda, and UCB.
Funding: AbbVie Inc. funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the abstract. All authors had access to relevant data and participated in the drafting, review, and approval of this abstract. No honoraria or payments were made for authorship. AbbVie and authors thank all the trial investigators and the patients who participated in this clinical trial. Medical writing support was provided by Morgan A Gingerich, PhD, of JB Ashtin, and funded by AbbVie.