Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases

Abstract Background Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Disease flare throughout gestation are not uncommon and can substantially affect pregnancy outcomes. We aimed at the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD. Methods Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011–2018. Results Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout the follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn’s disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11–32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 215.52), p < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), p < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalisation during pregnancy (14.7% vs. 0, p = 0.02) and preterm delivery (32.4% vs. 5.7%, p = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 grams, p = 0.03), in those with disease flare as compared with those with maintained remission. Conclusion History of disease relapse at previous gestation and periconception disease activity were found as an important predictor of disease flare among IBD women. These data would facilitate adequate counselling and informed management decisions among reproductive-aged IBD women and their treating physicians.

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P155 Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.284 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S215-S216

Author(s):

R Amihai ◽

T Mishael ◽

S Grisaru-Granovski ◽

B Koslowsky ◽

G Abitbol ◽

...

Keyword(s):

Disease Activity ◽

Inflammatory Bowel Diseases ◽

Global Assessment ◽

First Trimester ◽

Fecal Calprotectin ◽

Physician Global Assessment ◽

Disease Flare ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Laboratory Biomarkers

Abstract Background Inflammatory bowel diseases (IBDs) are commonly diagnosed in reproductive-aged women and can substantially affect pregnancy outcomes. Non-invasive monitoring of IBD during the prenatal course is particularly challenging as traditional laboratory biomarkers are often affected by pregnancy-related physiologic changes. We aimed to evaluate the role of fecal calprotectin (FC) in monitoring disease activity and predicting relapse among IBD women throughout gestation. Methods Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2014–2018. FC levels were determined with an enzyme-linked immunoassay. Results A total of 265 FC (preconception, n = 41; first trimester, n = 48; second trimester, n = 84; third trimester, n = 76; postpartum, n = 16) measurements were obtained in 157 pregnancies. Higher FC concentrations were found in all time points in those with active disease than those in remission as assessed by either physician global assessment or disease clinical scores. FC levels were significantly correlated with physician global assessment and disease activity indices in all 5 periods of investigation. Excluding those with disease flare at the time of conception, disease relapse was encountered during the prenatal course in 40 (31.5%) of the remaining 127 pregnancies. FC levels were significantly higher in those who experienced a disease flare later in the course of gestation as compared with those who maintained clinical remission (median 341 vs. 224 μg/g, p = 0.04). Conclusion FC appears to be a reliable marker of ongoing disease activity throughout the prenatal course as well as a predictor of imminent disease flare among IBD pregnant patients.

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Implications of Dietary Impact on Hepatic Steatosis and IBD

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa098 ◽

2020 ◽

Vol 27 (1) ◽

pp. 10-11

Author(s):

Yejoo Jeon ◽

Berkeley N Limketkai

Keyword(s):

Disease Activity ◽

Hepatic Steatosis ◽

Mediterranean Diet ◽

Inflammatory Bowel Diseases ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Mediterranean

The Mediterranean diet was recently shown to benefit hepatic steatosis and disease activity in inflammatory bowel diseases. These findings advance our knowledge on dietary approaches for IBD and motivate inquiry on the role of obesity in IBD pathogenesis.

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IRF5 Acts as a Potential Therapeutic Marker in Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa200 ◽

2020 ◽

Author(s):

Yonghong Yang ◽

Cui Zhang ◽

Dehuai Jing ◽

Heng He ◽

Xiaoyu Li ◽

...

Keyword(s):

T Cells ◽

Disease Activity ◽

Inflammatory Bowel Diseases ◽

Peripheral Blood ◽

Cd4 T Cells ◽

Mononuclear Cells ◽

Orphan Receptor ◽

Peripheral Blood Mononuclear ◽

Bowel Diseases ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic inflammatory disorders. As is well known, interferon regulatory factor (IRF) 5 is closely associated with the pathogenesis of various inflammatory diseases. But the exact role of IRF5 in IBD remains unclear. Methods In this study, we detected IRF5 expression in peripheral blood mononuclear cells (PBMCs) and inflamed mucosa from IBD patients by immunohistochemistry, western blot, and quantitative real-time polymerase chain reaction. Peripheral blood CD4+ T cells were stimulated with inflammatory cytokines and transfected by lentivirus. Results In active IBD patients, the expression of IRF5 in PBMCs and inflamed colonic tissues was obviously increased and significantly associated with disease activity. Ectopic overexpression of IRF5 could promote the differentiation of IBD CD4+ T cells into Th1 and Th17 cells by regulating T-bet and RAR related orphan receptor C, whereas knockdown of IRF5 had the opposite effects. Tumor necrosis factor (TNF)-α upregulated expression of IRF5 in CD4+ T cells, but anti-TNF treatment with infliximab could markedly reduce IRF5 expression in CD4+ T cells and intestinal mucosa of CD patients. Conclusion Our study reveals a novel mechanism that IRF5 levels are correlated with disease activity in IBD and might function as a possible marker for the management of IBD via regulating Th1 and Th17 immune responses and cytokine production.

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