P164 Celiac Disease among a large cohort of inflammatory bowel disease patients: epidemiology and outcome implications

Abstract Background Inflammatory bowel disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC) and undetermined IBD (IBD-U), are autoimmune chronic remittent diseases affecting the gut. On the other hand celiac disease (CeD) is a gluten related disorder leading to duodenal villous atrophy. Lately, the link between CeD and IBD has become of growing interest. Indeed, CeD prevalence among IBD population has been widely investigated, as well as IBD prevalence in CeD population. Particularly, IBD seems to have a significantly higher prevalence among CeD population than in general population and CeD seems to be more prevalent in IBD population. However, there is still lack of data on whether CeD can influence IBD outcome. So, primary outcome of our study is to measure prevalence of CeD among IBD population and secondary outcome is to evaluate possible influence of CeD on IBD outcome. Methods Data were collected from march 2020 to September 2020 from IBD internal registry in San Giovanni Antica Sede Hospital in Turin. To detect CeD patients, all patients were screened and the ones with a reported duodenal lesion were selected. From those, the ones with defined diagnosis of CeD (presence of serum IgA antitransglutaminase and or IgA anti endomisial antibodies) were finally selected. Prevalence of CeD among IBD was compared to that of general population basing on literature. Then 76 patients were randomly selected as control group, in roder to investigate secondary outcome. To define IBD as complicated Siegel’s score was used (1 out of five item needed to define complicated disease). Results Among 5732 IBD patients we detected 80 patients with duodenal lesions, of whom 27 were diagnosed with CeD. So, prevalence of CeD among our population is about 0,49% whiich is similar to that of general population (0,48%, P=0.98). No differences were found in CeD prevalence among CD, UC and IBD-U subgroups. As regards secondary outcome, in case group complicated IBD was 44,4% while among control group 26,3% (p=0.08). In a mean follow up time of 133,93 months, mean time from diagnosis to complication of IBD was 58,2 months in case group and 102,7 months in control group. As shown in figure 1, Kaplan-Maier curve for event free survival comparing the two groups shows a significant difference between CeD + IBD patients and IBD only patients (p=0,002). Conclusion Even though the retrospective nature of the study could lead to underestimate CeD diagnosis, among our cohort of IBD patients CeD prevalence seems not to be significantly higher than among general population. Despite of that, when associated to CeD, IBD seems to have earlier complications, so these patients may deserve a top down therapeutical approach and/ or a more strict follow up.

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Risk of Anxiety and Depression in Patients with Inflammatory Bowel Disease: A Nationwide, Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm8050654 ◽

2019 ◽

Vol 8 (5) ◽

pp. 654 ◽

Cited By ~ 17

Author(s):

Kookhwan Choi ◽

Jaeyoung Chun ◽

Kyungdo Han ◽

Seona Park ◽

Hosim Soh ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Bowel Disease ◽

Population Based ◽

Anxiety And Depression ◽

Healthcare Insurance ◽

Inflammatory Bowel ◽

One Year ◽

Constant Slope

Background and Aims: Inflammatory bowel disease (IBD) may be associated with anxiety and depression. The aim of this study was to evaluate the incidence of anxiety and depression in patients with IBD compared to the general population. Methods: A nationwide population-based cohort study was conducted using claims data from the National Healthcare Insurance service in Korea. We compared the incidence of anxiety and depression between 15,569 IBD patients and 46,707 non-IBD controls, age and sex matched at a ratio of 1:3. Results: During a mean follow-up of six years, IBD patients experienced significantly more anxiety (12.2% vs. 8.7%; p < 0.001) and depression (8.0% vs. 4.7%; p < 0.001) compared to controls. The curves showing cumulative incidences of anxiety and depression showed a steep rise within one year following a diagnosis of IBD, leading to lines with a constant slope. The hazard ratio (HR) for new onset anxiety following a diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) was 1.63 and 1.60, respectively, compared to controls (p < 0.001). Compared to controls, the HR for developing depression after a diagnosis of CD and UC was 2.09 and 2.00, respectively (p < 0.001). The risks of anxiety and depression in patients with IBD were higher compared to controls, except in those with diabetes mellitus, hypertension, and dyslipidemia, or who required immunomodulators and biologics within one year of the IBD diagnosis. Conclusions: The risk of anxiety and depression increased after a diagnosis of IBD compared to the general population.

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P280 Anti glycoprotein-2 antibody in pediatric inflammatory bowel disease and celiac disease: prevalence, diagnostic value and variation at follow-up

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(14)60401-3 ◽

2014 ◽

Vol 8 ◽

pp. S179-S180

Author(s):

M. Vallorani ◽

S. Gatti ◽

V. Romagnoli ◽

L. Marinelli ◽

G. Ciarrocchi ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Celiac Disease ◽

Bowel Disease ◽

Diagnostic Value ◽

Disease Prevalence ◽

Pediatric Inflammatory Bowel Disease ◽

Inflammatory Bowel

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Immunosuppression following liver transplantation and the course of inflammatory bowel disease – a case control study

Zeitschrift für Gastroenterologie ◽

10.1055/s-0043-117183 ◽

2017 ◽

Vol 56 (02) ◽

pp. 117-127 ◽

Cited By ~ 2

Author(s):

Martina Mogl ◽

Daniel Baumgart ◽

Andreas Fischer ◽

Johann Pratschke ◽

Andreas Pascher

Keyword(s):

Inflammatory Bowel Disease ◽

Liver Transplantation ◽

Mycophenolate Mofetil ◽

Bowel Disease ◽

Control Group ◽

Sustained Remission ◽

Short Term ◽

Surgical Interventions ◽

Inflammatory Bowel

Abstract Aim The aim of this study was to investigate the influence of immunosuppression following orthotopic liver transplantation (OLT) on course of inflammatory bowel disease (IBD) including disease activity and complications. Methods Out of 1168 patients undergoing liver transplantation between 1988 and 2000 at our center, we identified those with IBD (n = 67). In a comparative cohort study, IBD patients after OLT were compared to controls without OLT. All drugs including immunosuppressive and anti-inflammatory medication and complications during follow-up were recorded in 6-month intervals. Also, surgical interventions before and after OLT as well as endoscopic interventions with macroscopic and microscopic findings were collected and analyzed. Additionally, development of malignant neoplasias was recorded. Results Of the 67 individuals with IBD and OLT, 41 were available for analyses and compared with 42 controls. The mean follow-up was 7.4 (range: 3 – 15) years. Short-term therapy with calcineurin inhibitors or mycophenolate mofetil led to short-term remission, yet sustained remission could only be achieved in patients receiving mycophenolate mofetil. At 14.5 years, clinical remission was reached by significantly more patients in the transplant group (54 %) than in the control group (33 %, p = 0.0295). Patients in the control group required nearly 2 times as many surgical interventions related to IBD than patients in the transplant group. Neoplasias were more common in the OLT (n = 8) compared with 4 solid organ cancers in the control group, respectively. Conclusions Our data demonstrate an overall positive impact of immunosuppression following OLT on the course of IBD, especially with mycophenolate mofetil, but an increased rate of malignancies.

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Common Etiologies and Clinical Significance of Gastric Intraepithelial Lymphocytosis

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz113.060 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S61-S62

Author(s):

Sunjida Ahmed ◽

Ruliang Xu

Keyword(s):

Inflammatory Bowel Disease ◽

Morbid Obesity ◽

Celiac Disease ◽

Bowel Disease ◽

Intraepithelial Lymphocytes ◽

Gi Tract ◽

Inflammatory Bowel ◽

H Pylori ◽

Intraepithelial Lymphocytosis

Abstract Background Increased intraepithelial lymphocytes or intraepithelial lymphocytosis (IEL) in the upper gastrointestinal (GI) tract is a response to various mucosal injury. However, the frequency of gastric IEL in GI tract biopsy is not well documented, and the etiologies of gastric IEL are yet to be defined. Methods Cases with a diagnosis of “intraepithelial lymphocytosis” and “intraepithelial lymphocytes” were retrieved from 25,074 GI biopsies and 8,921 partial gastrectomies in our departmental database (Powerpath) for a 1-year period. The diagnosis of IEL was confirmed by the report and/or slide review. Possible etiology or causes of gastric IEL were investigated by correlation with clinical information from LIS (EPIC). Results A total of 694 cases with IEL were identified from 33,995 GI tract specimens (biopsy and resection). Among 694 cases, 34 (4.89%) were gastric biopsy and resection cases with IEL, whereas 561 (80.8%), 37 (5.3%), and 62 (8.9%) were duodenal, esophageal, and colonic specimens, respectively. Thirty-four gastric cases with IEL were closely associated with morbid obesity (8, 23.5%), H pylori infection (8, 23.5%), celiac disease (5, 14.7%), lymphocytic gastritis (5, 14.7%), nonspecific gastritis (4, 11.4%), inflammatory bowel disease (3, 8.8%), and gastroesophageal reflux disease (1, 1.9%). Seventeen of 34 (50%) cases had IEL in both gastric and duodenal mucosa. Those 17 cases with gastroduodenal IEL had morbid obesity (n = 5), celiac disease (n = 5), lymphocytic colitis (n = 2), inflammatory bowel disease (n = 2), H pylori gastritis (n = 2), and nonspecific gastritis (n = 1). Five patients with a diagnosis of lymphocytic gastritis were treated with a protein pump inhibitor after pathologic diagnosis. Among them, 4 had a followed-up endoscopy in 12 months, and 3 of them showed persistent IEL in a follow-up biopsy. Conclusion Gastric IEL is less common than duodenal IEL. It is associated with a broad differential diagnosis. Follow-up biopsy may be necessary for some types of gastric IEL. Persistent IEL in follow-up biopsy may be suggestive of a different etiology or requires different treatment strategy.

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Safety of Immunizations for the Adult Patient With Inflammatory Bowel Disease—A Systematic Review and Meta-analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab266 ◽

2021 ◽

Author(s):

Athanasios Desalermos ◽

Michael Pimienta ◽

Markos Kalligeros ◽

Fadi Shehadeh ◽

Leonidas Diamantopoulos ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Primary Outcome ◽

Meta Analysis ◽

Analysis Data ◽

Secondary Outcome ◽

Vaccine Preventable Diseases ◽

Vaccination Rates ◽

Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have low vaccination rates for vaccine-preventable diseases. Fear of adverse reactions (AEs) appear to negatively affect vaccination efforts. We aimed to systemically review the risks for AEs following immunization for patients with IBD. Methods We searched PubMed and Embase until April 15, 2020, for studies evaluating the safety of vaccinations among patients with IBD. The primary outcome was the incidence of systemic and local AEs among vaccinated patients. Secondary outcome was the rate of IBD flare following immunization. We utilized a random effects meta-analysis of proportions using the DerSimonian-Laird approach to estimate the safety of immunizations. Results A total of 13 studies with 2116 patients was included in our analysis after fulfilling our inclusion criteria. Seven studies examined the influenza vaccine, 4 the pneumococcal vaccine, 1 the recombinant zoster vaccine, and 1 the hepatitis B vaccine. Follow-up of patients was up to 6 months. The majority of AEs were local, with a pooled incidence of 24% (95% CI, 9%-42%) for all vaccines. Systemic AEs were mostly mild, without resulting in hospitalizations or deaths, with a pooled incidence of 16% (95% CI, 6%-29%) for all vaccines. Flare of inflammatory bowel disease after vaccination found with a pooled incidence of 2% (95% CI, 1%-4%) and we include in the analysis data from all immunizations examined. Discussion Our study demonstrated that AEs after vaccination are mainly local or mildly systemic and do not differ significantly from the expected AE after recommended immunizations for the general population. Thus, gastroenterologists should reinforce that vaccines are safe in patients with IBD.

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P621 Lactose intolerance assessed by analysis of genetic polymorphism, breath test and symptoms in patients with inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.741 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S561-S562

Author(s):

O M Nardone ◽

F Manfellotto ◽

C D’Onofrio ◽

A Rocco ◽

G Annona ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Bowel Disease ◽

Clinical Remission ◽

Breath Test ◽

Lactose Intolerance ◽

Control Group ◽

Wild Type ◽

Significant Difference ◽

Inflammatory Bowel

Abstract Background Many patients with inflammatory bowel disease (IBD) make restriction of dairy products to control their symptoms. We aimed to investigate the prevalence of lactose intolerance assessed with hydrogen breath test (H-BT) in IBD patients in clinical remission with symptoms suggestive for lactose intolerance, compared to a sex- age- and BMI-matched control population. We further detected the prevalence of three single nucleotide polymorphisms of the lactase (LCT) gene: the lactase non persistence LCT-13910CC (genetic wildtype) and the intermediate phenotype LCT-22018AG, LCT-13910CT and we assess the correlation between genotype and H-BT Methods We performed a prospective study enrolling IBD patients in clinical remission: Crohn disease (CD) activity index CDAI<150 for CD and pMayo score≤1 for ulcerative colitis (UC) and controls. All of them underwent clinical evaluation, H-BT and genetic test analysing lactase gene polymorphisms located on chromosome 2. Statistical analysis was performed using chi-square, Student’s t-test and ANOVA. Results A total of 54 IBD patients and 69 matched controls were enrolled. H-BT was positive in 35(64.8%) IBD patients and 43 (62.3%) controls (p=0.3). No significant difference in lactose intolerance rate, assessed by H-BT and symptoms,was found between CD and UC patients (p =0.8). The wild-type genotype was found in 46 (85.2%) IBD patients , CT22018, AG13910 and CT22018/AG13910 polymorphisms were found in 9.3%, 1.8% and 3.7% respectively. While in the control group, the wild-type genotype, CT22018, AG13910 and CT22018/AG13910 polymorphisms were found in 87%, 5.8%, 5.8% and 1.4% of cases, respectively. The wild type and polymorphisms’ prevalence did not differ between IBD population and control group (85.2%vs 87%, p=0.1) (14.8% vs 13%, p=0.7) [Fig.1] and between CD and UC (p>0.05) [Fig.2]. The correlation between positive H-BT and genetic analysis showed that the wild-type genotype was associated with higher rate of lactose intolerance in the total population (OR 5.31, 95%CI 1.73–16.29, p=0.003) and in the IBD population (OR 7.61, 95%CI 1.36–42.7, p=0.02), even thought not in the control group (OR 4, 95%CI 0.90–17.68, p=0.07) Fig.1 Fig.2 Conclusion The prevalence of lactose intolerance in IBD is high but not dissimilar from that of the general population. The prevalence of the wild-type genotype in patients with IBD does not differ from the general population and it correlates with higher rate of lactose intolerance assessed with H-BT. Despite suggestive symptoms, about 1/3 of IBD patients is not lactose intolerant, not needing elimination diet. These can lead to promote a rationale and balanced dietary management in IBD and thereby preventing the occurrence of calcium phosphate metabolism disorders.

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Risk Factors of Urothelial Cancer in Inflammatory Bowel Disease

Journal of Clinical Medicine ◽

10.3390/jcm10153257 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3257

Author(s):

Gian Paolo Caviglia ◽

Giorgio Martini ◽

Angelo Armandi ◽

Chiara Rosso ◽

Marta Vernero ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

General Population ◽

Bowel Disease ◽

Urothelial Cancer ◽

Increased Risk ◽

History Of ◽

Inflammatory Bowel ◽

Number Of Publications

Extraintestinal cancers are important complications in patients with inflammatory bowel disease (IBD). A limited number of publications are available regarding the association between IBD and urothelial cancer. The primary outcome of our study was the comparison of the prevalence of urothelial cancer in patients with IBD with respect to the prevalence in the general population. Secondary outcomes were the assessment of risk factors for the onset of urothelial cancer in IBD. In a retrospective study we examined the medical records of all patients with a confirmed diagnosis of IBD followed in our clinic between 1978 and 2021. For each of the patients with identified urothelial cancer, more than ten patients without cancer were analyzed. Furthermore, 5739 patients with IBD were analyzed and 24 patients diagnosed with urothelial cancer were identified. The incidence of urothelial cancer, compared with the incidence in the general population, was not significantly different (0.42% vs. 0.42%; p = 0.98). Twenty-three cases were then compared (1 case was discarded due to lack of follow-up data) against 250 controls. During the multivariate analysis, smoking (odds ratio, OR = 8.15; 95% confidence interval, CI = 1.76–37.63; p = 0.007) and male sex (OR = 4.04; 95% CI = 1.29–12.66; p = 0.016) were found as risk factors. In conclusion, patients with IBD have a similar risk of developing urothelial cancer compared to the general population, but males with a history of smoking are at increased risk.

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