Severe Disease Activity Based on the Paris Classification Is Associated with the Development of Extraintestinal Manifestations in Korean Children and Adolescents with Ulcerative Colitis

Abstract Background Inflammatory bowel disease (IBD) and its major forms, i.e. Crohn’s disease (CD) and ulcerative colitis (UC), have systemic implications, which, as suggested by Vavricka et al., can be divided into extraintestinal manifestations (EIM) directly related to immune mechanisms and non-immune extraintestinal complications resulting from malabsorption. Extraintestinal manifestations may develop prior to or after IBD diagnosis. The aim of the study was to determine the prevalence and types of extraintestinal manifestations (EIMs) in paediatric-onset inflammatory bowel diseases (IBD), i.e., Crohn’s disease (CD) and ulcerative colitis (UC), depending on disease activity and location, and to determine whether the presence of EIM is associated with a distinctive clinical course of IBD. Methods The medical records of 336 children with IBD with or without EIMs were retrospectively analysed, especially regarding the following characteristics: age at diagnosis, clinical symptoms, nutritional status, the Paris Classification, and IBD activity. The diagnosis was made based on the revised Porto criteria. The medical histories of patients and data obtained in physical examinations were analysed, especially the following: (a) anthropometric measurements for nutritional status assessment based on percentile charts of the OLAF study, (b) disease activity using the PCDAI and the PUCAI, disease location and type according to the Paris classification. Results The study population of 336 children comprised 175 patients with UC and 161 patients with CD. EIMs were diagnosed in 65 patients (19%). The most frequent immune-related EIM in UC patients was primary sclerosing cholangitis (PSC); the collective proportion of PSC and PSC/autoimmune hepatitis (AIH) was 13,7% of UC patients. Arthropathy was the most prevalent EIM in the subpopulation of CD participants (8,6%). Pancolitis was a risk factor for EIMs in the UC and especially for PSC and AIH/PSC. We also analysed the population for correlation in presented symptoms pattern in patients EIM(+) vs. EIM(-) as well as differences in age and sex distribution and IBD activity, location and behaviour. Conclusion EIMs are a significant issue in the population of children with IBD; they developed in 19% of our patients. Determination of the prevalence of these manifestations and related risk factors might raise awareness of the problem and facilitate diagnosis and therapy.

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P121 REAL WORLD PREVALENCE OF BOWEL MOVEMENT URGENCY – A SNAPSHOT OF SYMPTOM EXPERIENCE REPORTED BY PATIENTS WITH ULCERATIVE COLITIS PARTICIPATING IN SPARC IBD

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.116 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S44-S45

Author(s):

April Naegeli ◽

Yan Dong ◽

Xian Zhou ◽

Nathan Morris ◽

Vipin Arora ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Real World ◽

Ad Hoc ◽

Bowel Movement ◽

Severe Disease ◽

Symptom Experience ◽

Biologic Treatment ◽

Patient Reported ◽

Bowel Movements

Abstract Background Urgency, also referred to as bowel movement urgency or bowel urgency, is the sudden need for a bowel movement. Bowel urgency is one of the most bothersome and important symptoms experienced by patients with ulcerative colitis (UC), contributing to decrements in quality of life. Bowel urgency is distinct from the common symptoms associated with UC, namely stool frequency and rectal bleeding, however patients often experience all symptoms, urgent, frequent bowel movements with bleeding, concurrently. Bowel movement urgency is a key symptom for triggering clinical consideration of UC diagnosis and for defining more severe disease activity in clinical practice. Methods The results published here are based on data obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. To better understand the prevalence of bowel movement urgency in patients with UC, an ad hoc analysis was performed using data from a Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study of adult patients with IBD that collects and links clinical data, patient-reported outcome (PRO) data, and serial bio-samples throughout the course of the patients’ disease. The enrollment visit was defined as 7 days from the patients’ date of enrollment in SPARC IBD. At study enrollment, patients were asked to answer questions based on their symptom experiences. Patients reported how much urgency they experienced before bowel movements on average during the past 3 days (none, mild, moderate, moderately severe, severe, not applicable). Descriptive analyses for patient demographic and disease characteristics were conducted. Additionally, contingency table analyses were conducted exploring the association of urgency with other UC symptoms and other measures of UC disease severity. Results Of 1,833 patients included in the SPARC IBD data cutoff of May 13, 2019 (Enrolled from 08 November 2016 to 15 May 2019), 582 were patients with UC, of which 514 had urgency data available. Overall, 51.8% of patients were male, and the mean age is 42.4 years (Table 1). At enrollment, 59.7% of patients reported some level (mild, moderate, moderately severe/severe) of urgency. Forty-six percent of UC patients with urgency data were receiving biologic treatment with 31% still reporting mild urgency, and 32% reporting moderate to severe urgency (Table 1). The severity of urgency was associated with patient reported severity of other UC symptoms and disease activity (Table 2). Conclusion Results from ad hoc analyses using a real-world sample of patients with UC suggest that bowel movement urgency is a prevalent symptom of UC which varies with disease activity.

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Association of serum retinol and circulating inflammatory cells with disease activity in ulcerative colitis patients

Nutrition & Food Science ◽

10.1108/nfs-05-2018-0131 ◽

2019 ◽

Vol 49 (2) ◽

pp. 203-212

Author(s):

Nasim Abedimanesh ◽

Alireza Ostadrahimi ◽

Saeed Abedimanesh ◽

Behrooz Motlagh ◽

Mohammad Hossein Somi

Keyword(s):

Ulcerative Colitis ◽

T Cells ◽

Vitamin A ◽

Disease Activity ◽

Cd8 T Cells ◽

Severe Disease ◽

Inflammatory Cells ◽

Serum Retinol ◽

Content Type ◽

Lymphocyte Ratio

Purpose The purpose of this study is to explore the association of serum retinol and number of circulating inflammatory cells and disease activity in patients with ulcerative colitis. Design/methodology/approach A total of 60 patients with ulcerative colitis were enrolled in a cross-sectional pilot study. Patients were recruited from specialized clinic of Tabriz University of Medical Sciences, Iran between April and August 2015. Mayo clinic index was used to assess clinical disease activity score. Blood samples were collected. Serum retinol was assessed using HPLC to determine vitamin A status. Complete blood count and lymphocyte phenotyping were performed by automated hematology analyzer and flow-cytometric analysis, respectively. Findings According to Mayo scoring, 68.33 per cent of patients had mild and 31.66 per cent had moderate or severe disease activity. About 43.33 per cent of patients were vitamin A deficient, with 23.33 per cent having moderate to severe deficiency (serum retinol < 20 µg/dl). Lower levels of serum retinol and higher count and percentages of CD3+, CD8+ T cells and neutrophil to lymphocyte ratio were statistically associated with disease activity according to univariate analysis (p = 0.002, 0.037, <0.001, 0.031, 0.002 and 0.039); however, in binary logistic regression, only lower levels of serum retinol were independently associated with disease activity with a OR of 0.564 (p = 0.021; 95 per cent CI 0.35-0.92). Originality/value Vitamin A deficiency was detected in this study population. Patients with moderate to severe disease activity demonstrated lower serum retinol, higher CD8+ T cells and neutrophil to lymphocyte ratio compared to patients with mild disease activity.

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Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis

BMC Gastroenterology ◽

10.1186/s12876-021-01903-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuki Aoyama ◽

Tomoki Inaba ◽

Sakuma Takahashi ◽

Hisae Yasuhara ◽

Sakiko Hiraoka ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Steroid Therapy ◽

Induction Therapy ◽

Clinical Remission ◽

Severe Disease ◽

Active Phase ◽

Antineutrophil Cytoplasmic Antibody ◽

Proteinase 3 ◽

Aminosalicylic Acid

Abstract Background Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate whether PR3-ANCA levels could also predict the success of induction therapy and to compare its performance against other markers, including serum CRP and fecal hemoglobin. Methods This was a multicenter retrospective study. In total, 159 patients with active-phase UC underwent colonoscopy. Disease activity was measured using the Mayo endoscopic subscore (MES). PR3-ANCA positivity and the response to induction therapy, either 5-aminosalicylic acid or steroid, were assessed. PR3-ANCA, CRP, and fecal hemoglobin were measured during the active phase, and during clinical remission. Results Eighty-five (53.5%) of 159 patients with active UC were positive for PR3-ANCA. PR3-ANCA titers were significantly higher in the group of patients with MES 3 compared to patients with MES 1 (P = 0.002) or MES 2 (P = 0.035). Steroid therapy was administered to 56 patients with a median partial Mayo score of 7 (5–9), which is equivalent to moderate-to-severe disease activity. PR3-ANCA positivity of non-responders to steroid therapy was significantly higher than that of responders (71.9% vs, 41.7%, P = 0.030), whereas CRP and fecal hemoglobin were not predictive of steroid response. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with non-response to steroid therapy (odds ratio 5.19; 95% confidence interval, 1.54–17.5; P = 0.008). Of the 37 patients treated to clinical remission who were also positive for PR3-ANCA during the active phase, 27 had an MES of ≥ 1, and 10 patients had an MES of 0. In clinical remission, the proportion of patients with MES 0 in 17 patients whose PR3-ANCA became negative was significantly higher than that in 20 patients whose PR3-ANCA remained positive (47.1% vs. 10.0%, P = 0.023). Conclusions PR3-ANCA not only serves as a marker of disease activity, but also predicts the failure of steroid therapy in moderate-to-severe UC. Trial registration: This study was retrospectively registered in the UMIN Clinical Trials Registry System (000039174) on January 16, 2020.

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