scholarly journals P689 Aeromonas infection and Inflammatory Bowel Disease: a single tertiary center analysis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S607-S607
Author(s):  
J Alves Da Silva ◽  
T Pereira Guedes ◽  
D Falcão ◽  
S Neves ◽  
P Costa ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severe Infection ◽  
Data Retrieval ◽  
Colonic Involvement ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
Resistant Strains ◽  
Stool Cultures ◽  
University Setting

Abstract Background Aeromonas genus consists of gram-negative rods known to cause a spectrum of diseases in humans. Inflammatory bowel disease (IBD) is an idiopathic complex condition where multiple factors contribute to its development and progression. The association of Aeromonas infection with IBD manifestation have been proposed by other authors and is still largely unknown. We aim to look for the significance of Aeromonas infection and for significant differences between IBD and non-IBD patients. Methods A retrospective observational data retrieval and analysis was performed of all patients positive for Aeromonas in stool cultures, during a 10-year period, from a Portuguese tertiary and university setting hospital. Results Fifty patients, 56% of male sex and with a mean age of 42.1 years-old were included. Thirty-eight (76%) were non-IBD and 12 (24%) were IBD patients. IBD patients were more frequently under immunosuppressors. Two patients were asymptomatic and 44% develop mild, 44% moderate and 16.7% severe infection. The main Aeromonas strains isolated were Aeromonas hydrophila/caviae. Co-isolation with other bacteria was found in 4 non-IBD patients and histological findings compatible with Cytomegalovirus were found in 2 IBD patients. Non-IBD patients presented more frequently with fever and IBD patients with bloody diarrhea and abdominal pain. There was higher tendency for severe infection rate in IBD patients with higher antimicrobial therapy use. Steroids were exclusively used in IBD group. No significant differences were observed for isolation of Aeromonas resistant strains. From the IBD, 4 patients had the diagnosis of Ulcerative Colitis and 9 of Crohn’s Disease with colonic involvement. Of them 5 patients received the diagnosis after the acute episode of Aeromonas infection. Conclusion Clinical presentation of Aeromonas infection differ between IBD and non-IBD patients. Non-IBD patients had milder severity of infection with less use of antibiotics. Aeromonas infection seem to play an important role on the contribution of IBD manifestation.

A Population- and Family-Based Study of Canadian Families Reveals Association of HLA DRB1*0103 With Colonic Involvement in Inflammatory Bowel Disease

2003 ◽  
Vol 9 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Mark S. Silverberg ◽  
Lucia Mirea ◽  
Shelley B. Bull ◽  
Janet E. Murphy ◽  
A. Hillary Steinhart ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Colonic Involvement ◽  
Inflammatory Bowel ◽  
Family Based

Serum IgG4 Subclass Deficiency Defines a Distinct, Commonly Encountered, Severe Inflammatory Bowel Disease Subtype

2020 ◽  
Author(s):  
Filippos Koutroumpakis ◽  
Anna Evans Phillips ◽  
Dhiraj Yadav ◽  
Jorge D Machicado ◽  
Maaz Ahsan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Severity ◽  
Bowel Disease ◽  
Disease Process ◽  
Serum Igg4 ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
Subclass Deficiency ◽  
Igg4 Deficiency

Abstract Background Immunoglobulin G subclass 4 (IgG4) is hypothesized to play an immunomodulatory role, downregulating humoral immune responses. The role of this anti-inflammatory molecule in inflammatory bowel disease (IBD) has not been fully characterized. We sought to define alterations in serum IgG4 in patients with IBD and their association with multiyear disease severity. Methods We analyzed metadata derived from curated electronic health records from consented patients with IBD prospectively followed at a tertiary center over a 10-year time period. Patients with IBD with IgG4 serum levels available formed the study population. Demographics and multiyear clinical data were collected and analyzed. We stratified patients with IBD with low, normal, or high serum IgG4 levels. Results We found IgG4 characterized in 1193 patients with IBD and low IgG4 levels in 233 patients (20%) and elevated IgG4 levels in 61 patients (5%). An IgG4 deficiency did not significantly correlate with other antibody deficiencies. In a multiple Poisson regression analysis, low IgG4 was associated with more years on biologic agents (P = 0.002) and steroids (P = 0.049) and more hospital admissions (P < 0.001), clinic visits (P = 0.010), outpatient antibiotic prescriptions (P < 0.001), and CD-related surgeries (P = 0.011) during the study period after controlling for certain confounders. Elevated IgG4 was only associated with primary sclerosing cholangitis (P = 0.011). A cohort of patients with IgG4-deficient severe IBD received intravenous Ig replacement therapy, which benefited and was continued in 10 out of 11 individuals. Conclusions An IgG4 subclass deficiency, distinct from other antibody deficiencies, occurred commonly in a referral IBD population and was associated with multiple markers of disease severity. This is the first association of IgG4 subclass deficiency with an inflammatory disease process. Further work is needed to define the mechanistic role of IgG4 deficiency in this severe IBD subgroup.

scholarly journals Risk of Colorectal Cancer in Inflammatory Bowel Disease: Prevention and Monitoring Strategies According With Risk Factors

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Enrica Giuffrida ◽  
Michela Mangia ◽  
Alessandro Lavagna ◽  
Enrico Morello ◽  
Maurizio Cosimato ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Virtual Colonoscopy ◽  
Fold Increase ◽  
High Definition ◽  
Endoscopic Techniques ◽  
Colonic Involvement ◽  
Monitoring Strategies ◽  
Inflammatory Bowel

Colorectal cancer (CRC) is slightly increased in inflammatory bowel disease (IBD) patients, with roughly a 2.5-fold increase compared to the general population. Clinical features associated to CRC risks are extent and severity of colonic involvement, disease duration, concomitant primary sclerosing cholangitis (PSC) and/or familial history of CRC in first-degree relatives. Colonic Crohn’s disease (CD) and ulcerative colitis (UC) share similar risks when similar colonic extent is affected. Risk stratification affects outcomes and surveillance programs.Newer endoscopic techniques substantially ameliorated diagnostic performance of endoscopy, and nowadays the standard for CRC surveillance in IBD patients is high-definition endoscopy, with dye-spray or virtual colonoscopy, oriented at targeted (+ random) colonic biopsies.Visible dysplastic lesions should be considered for endoscopic resection, while invisible dysplasia is still a mandatory proctocolectomy indication.Newer endoscopic interventional techniques (endoscopic mucosa resection, EMR, and endoscopic submucosal dissection, ESD) are appropriate therapeutic techniques to be delivered, but long-term risks of cancer should be balanced towards proctocolectomy.

scholarly journals Impact of diagnostic delay to the clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmiina Sulkanen ◽  
Marleena Repo ◽  
Heini Huhtala ◽  
Pauliina Hiltunen ◽  
Kalle Kurppa
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Bowel Disease ◽  
Clinical Presentation ◽  
Diagnostic Delay ◽  
Good Prognosis ◽  
Pediatric Inflammatory Bowel Disease ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
Bloody Stools

Abstract Background Undelayed diagnosis is thought to be a major determinant for good prognosis in pediatric inflammatory bowel disease (PIBD). However, factors predicting diagnostic delay and the consequences of this remain poorly defined. We investigated these issues in a well-defined cohort of PIBD patients. Methods Comprehensive electronic data were collected from 136 PIBD patients retrospectively. Diagnostic delay was further classified into < 6 and ≥ 6 months, and < 12 and ≥ 12 months. Logistic regression was used to calculate whether the delay was associated with clinical features and/or risk of complications and co-morbidities at diagnosis. Results The median age of patients was 12.4 years and 43.4% were females. Altogether 35.5% had Crohn´s disease (CD), 59.1% ulcerative colitis (UC) and 6.6% IBD undefined (IBD-U). The median delay before diagnosis was 5.0 months in all, 6.6 months in CD, 4.1 months in UC, and 9.8 months in IBD-U (UC vs. CD, p = 0.010). In all but IBD-U most of the delay occurred before tertiary center referral. Abdominal pain predicted a delay > 6 months in all PIBD (OR 2.07, 95% CI 1.00–4.31) and in UC patients (3.15, 1.14–8.7), while bloody stools predicted a shorter delay in all PIBD (0.28, 0.14–0.59) patients and in CD (0.10, 0.03–0.41) patients. A delay > 6 months was associated with a higher frequency of complications (2.28, 1.01–5.19). Conclusions Delay occurred mostly before specialist consultation, was longer in children presenting with abdominal pain and in CD and was associated with risk of complications. These findings emphasize the roles of active case-finding and prompt diagnostic evaluations.

scholarly journals P631 Food triggers in inflammatory bowel disease from the patients’ and doctors’ perspective

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S568-S568
Author(s):  
M Cappello ◽  
L Guida ◽  
F M Di Giorgio ◽  
A Busacca ◽  
L Carrozza ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Dairy Products ◽  
Healthcare Professionals ◽  
Medical Advice ◽  
Processed Meat ◽  
Tertiary Center ◽  
Fried Foods ◽  
Inflammatory Bowel ◽  
Carbonated Drinks

Abstract Background Diet is receiving growing attention as a key environmental factor involved in the pathogenesis of Inflammatory Bowel Disease (IBD). Dietary components have a relevant role in triggering symptoms from the patients’perspective, but there is a gap between patients’ and doctors’ beliefs. Every patient has collected his or her own list of prohibited foods and reports a clinical benefit from avoiding such foods. Elimination of nutrients can lead to nutritional deficiencies and impact on style and quality of life. The aim of this study is to identify frequently avoided foods in a Mediterranean cohort of patients with IBD. Methods Consecutive patients with IBD attending our tertiary center for infusion of biologics or for follow-up visits were enrolled. Demographics and disease characteristics UC or CD) were recorded in a dedicated database. A questionnaire investigated food avoided and reasons for dietary changes, if self-driven or advised by doctors or other healthcare professionals. Results 167 patients agreed to participate in the study. Eighty-one patients (48.8%) had UC, 86 (51.5%) had CD. Mean age was 48.6 ± 16 (range 18–77 years), 57.5% were males. Patients were in clinical remission or with mild activity. Most patients, about 80%, and especially patients with CD avoided certain foods considered as triggers, and this avoidance was usually practiced in both exacerbations of the disease and remission periods. This occurred upon medical advice in a minority of patients, especially for vegetable avoidance (13.2%). Foods more frequently avoided were spicy foods, seasoned foods, fried foods, milk and dairy products, carbonated drinks, spirits, vegetables, legumes, and whole grain bread. Processed meat was avoided in about 6.6% (only in 1.8% upon medical advice) and coffee in 12.6%. A lactose-free diet was advised by the treating physicians only in 14.3% of patients. 4 patients were on a glutenfree diet because of a self-reported gluten sensitivity. The role of other healthcare professionals (dietitician, nurses) was marginal in their food choices. Conclusion Most of the patients set diet on self-experience and give up many foods. Our results are comparable with those of previous studies. Spicy foods, seasoned and fried foods, carbonated drinks, and dairy products are on top of the list. Legumes and vegetables, the cornerstones of the Mediterranean diet, are also avoided even though the evidence that dietary fibers can induce relapse is lacking. The benefit reported could be related to the effect on IBS-related symptoms frequent in IBD in remission. Further studies and a greater involvement of doctors in providing dietary recommendations are warranted.

scholarly journals Anemia in Crohn’s Disease—The Unseen Face of Inflammatory Bowel Disease

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1046
Author(s):  
Mihaela Dranga ◽  
Lucian Vasile Boiculese ◽  
Iolanda Popa ◽  
Mariana Floria ◽  
Oana Gavril ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Clinical Manifestations ◽  
World Health ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
The Impact

Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn’s disease. Material and Methods. We made a prospective study on 134 patients with Crohn’s disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization’s definition, the activity of the disease was assessed by Crohn’s disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL.

scholarly journals P829 Methylation patterns in dysplasia in inflammatory bowel disease patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S643-S643
Author(s):  
I A da Luz Rosa ◽  
P Silva ◽  
S Mata ◽  
F Magro ◽  
F Carneiro ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Promoter Methylation ◽  
Bowel Disease ◽  
Cpg Islands ◽  
Cross Sectional Study ◽  
Promoter Regions ◽  
Cross Sectional ◽  
Colonic Involvement ◽  
Inflammatory Bowel ◽  
Methylation Patterns

Abstract Background Inflammatory Bowel Disease (IBD) with colonic involvement increases colorectal cancer risk. However, the distinction between IBD related and sporadic dysplasia in IBD patients is difficult. Some data favours the importance of abnormal DNA methylation in IBD-related carcinogenesis. Our study aimed to define methylation patterns in patients with a colonic cancer or dysplasia diagnosis following an IBD diagnosis. Methods Multicentric cross-sectional study- 91 samples from colonic mucosa with/without dysplasia from 9 patients with IBD-related dysplasia/cancer and 26 patients with IBD and sporadic dysplasia/cancer were included. Methylation patterns of CpG islands in the promoter regions of 67 genes were studied by Methylation-specific Multiplex Ligation-dependent Probe Amplification. Results Mean age at IBD diagnosis: 42±16 years; at dysplasia diagnosis: 56± ± 14 years. Twenty-nine patients had ulcerative colitis. Twenty-five patients had at least 1 lesion endoscopically described as adenoma-like, 4 at least 1 non-adenoma like, 3 had cancer and 3 had dysplasia in flat mucosa. No patient had both adenoma-like and non-adenoma-like lesions. Patients with an IBD-related lesion were significantly younger at IBD diagnosis (p = 0.003) and at dysplasia/cancer diagnosis (p = 0.039). Promoter methylation of IGF2, RARB, ESR1, CHFR, CDH13, WT1, GATA5, WIF1 genes was significantly associated to dysplasia/cancer; methylation of MSH6, TIMP3 was significantly associated to IBD-related dysplasia/cancer. Promoter methylation of MSH6, MSH3, RUNX3, CRABP1, TP73, RARB, CDH13, PAX5, WT1, THBS1, TP53, SFRP1, WIF1, APAF1, BCL2 genes was significantly associated to active IBD. Conclusion Methylation analysis, namely of MSH6, may contribute to the classification of dysplastic lesions in IBD– to be further tested in prospective studies.

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