The relationships between depression, inflammation and self-reported disease activity in IBD and their impact on healthcare usage

BACKGROUND

Depression is common in people living with Inflammatory Bowel Disease (IBD). Depression rates increase with active disease and are linked to poorer clinical outcomes. Previous studies investigating the relationship between contemporaneous IBD disease activity and depression are often poorly controlled, use small samples and/or rely on self-reported measures of disease activity. Depression and self-reported disease activity (SRDA) are linked to increased healthcare usage, however, objective inflammation is rarely statistically controlled. The primary aim was to understand how self-reported disease activity and inflammation are related to depression. Secondary aims included assessing the relative influence of self-reported disease activity, inflammation and depression on healthcare usage.

METHODS

This was a cross-sectional analysis of baseline data collected as part of a randomised controlled trial (trial registration no: ISRCTN71618461) of a digital treatment for symptom self-management in IBD (n = 599). Bivariate associations of demographic and clinical variables with depression were conducted to identify relevant covariates. Multiple linear regressions assessed (i) the relationships between depression (Patient Health Questionnaire-9 (PHQ-9)), SRDA (IBD-Control) and intestinal inflammation (faecal calprotectin (FCP)) and (ii) whether these variables explained variance in healthcare usage and economic indicators.

RESULTS

Depression was significantly predicted by SRDA (β = -0.82, p < 0.001) but not FCP, with the model explaining 37% of the variance in depression (F(2,596) = 175.1, p < 0.001). FCP was only weakly associated with SRDA (r = -0.16, p < 0.001). Depression was independently associated with visits to primary care (β = 0.19, p < 0.001), IBD secondary care (β = 0.13, p < 0.001), IBD-related A&E attendance (β = 0.10 p < 0.05) and the impact of IBD on productivity (β = 0.24 p < 0.001) in the last 3 months.

CONCLUSIONS

Depression was related to SRDA but not FCP. Depression was also associated with healthcare usage even when SRDA and inflammation were statistically controlled. Routinely assessing and treating depression in IBD alongside managing inflammation may improve symptoms for patients and reduce healthcare costs.

Bibliometric analysis of Crohn's disease in children, 2014-2024

Background

In recent years, the incidence of Crohn's disease has risen significantly in the pediatric population, and its prolongation has had a major impact on children's physical and mental health as well as on the quality of life of their families, and has therefore received extensive attention from scholars around the world. A large number of articles have been published on Crohn's disease in children; however, there is still a lack of studies that use visualization methods for bibliometric analysis of relevant literature. The purpose of this paper is to statistically analyze the published literature in the field of Crohn's disease in children in order to help in the future diagnosis and treatment of Crohn's disease in children.

Methods

Literature meeting the inclusion criteria was screened from the Web of Science Core Collection database. Literature was visualized and analyzed by author, country, institution, journal, reference, and keyword using Citespace (6.2.R4) and VOSviewer (1.6.18).

Results

A total of 3,177 eligible publications were included. There is an overall increasing trend in the number of annual publications.Turner, Dan published the most number of articles with 78 and has a high impact in the field of CD. The most cited author was Levine, A. Among countries and institutions, the United States and Tel Aviv University had the highest number of publications. The journal with the most publications is Journal Of Pediatric Gastroenterology And Nutrition. The most co-cited journal was Inflammatory Bowel Diseases. The most cited document was ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents, and the most cited document with the highest outbreak intensity was The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update.The most frequent keyword was "inflammatory bowel disease".

Conclusion

This study provides a visual summary of information for the field of pediatric Crohn's disease and contributes to international collaboration to promote research in the field of pediatric Crohn's disease.

The Intestinal Mucin Isoform Landscape Reveals Region-Specific Biomarker Panels for Inflammatory Bowel Disease Patient Stratification

BACKGROUND AND AIMS

Mucosal healing is considered a key therapeutic endpoint in inflammatory bowel diseases (IBD) and comprises endoscopic improvement of inflammation without taking barrier healing into account. Mucins are critical components of the mucosal barrier function that give rise to structurally diverse isoforms. Unraveling disease-associated mucin isoforms that could act as an indication for barrier function would greatly enhance IBD management.

METHODS

We present the intestinal mucin RNA isoform landscape in IBD and control patients using a targeted mucin isoform sequencing approach on a discovery cohort (n = 106). Random Forest modeling (n = 1683 samples) with external validation (n = 130 samples) identified unique mucin RNA isoform panels that accurately stratified IBD patients in multiple subpopulations based on inflammation, IBD subtype (Crohn's disease [CD], ulcerative colitis [UC]), and anatomical location of the intestinal tract (i.e. ileum, proximal colon, distal colon, and rectum).

RESULTS

Particularly, the mucin RNA isoform panels obtained from the inflamed UC and CD distal colon showed high performance in distinguishing inflamed biopsies from their control counterparts (AUC of 93.3% and 91.1% in the training, 95.0% and 96.0% in the test, and 89.5% and 78.3% in the external validation datasets, respectively). Furthermore, the differentially expressed MUC4 (PB.1238.363), MUC5AC (PB.2811.15), MUC16 (ENST00000397910.8), and MUC1 (ENST00000462317.5 and ENST00000620103.4) RNA isoforms frequently occurred throughout the different panels highlighting their role in IBD pathogenesis.

CONCLUSIONS

We unveiled region-specific mucin RNA isoform panels capturing the heterogeneity of the IBD patient population and showing great potential to indicate barrier function in IBD patients.

Protein epigenetic scores and overall mortality in the longitudinal Swedish Adoption/Twin Study of Aging (SATSA)

INTRODUCTION

DNA methylation (DNAm) has a functional role in gene regulation, and it has been used to estimate various human characteristics. Variation in DNAm is associated with aging and variability of the proteome. Therefore, understanding the relationship between blood circulating proteins, aging, and mortality is critical to identify disease-causing pathways. We aimed to estimate the association between protein epigenetic scores (EpiScores) and overall mortality in the Swedish Adoption/Twin Study of Aging (SATSA).

METHODS

We included information from 374 individuals collected between 1992 and 2014. Our exposures were 109 protein EpiScores generated using DNAm data and prediction models by the MethylDetectR shiny app. All-cause mortality was the outcome of interest. To estimate the protein EpiScores associations with all-cause mortality, we fitted Cox proportional hazard models adjusted for age, sex, education, smoking status, body mass index, and occupation. We also conducted co-twin control analyses to control for shared familial factors.

RESULTS

The mean age of participants at the first assessment was 68.6 years. In total, nine protein EpiScores (e.g., Stanniocalcin 1) were associated with a higher risk for all-cause mortality. In contrast, five protein EpiScores (e.g., Prolyl endopeptidase) were associated with a lower risk for all-cause mortality.

CONCLUSION

The protein EpiScores associated with an increased mortality risk represent proteins involved in metabolic functions, immune response, and inflammation. Conversely, those associated with a lower risk represent proteins involved in neurogenesis and cellular functions. Overall, it is possible to predict protein levels from DNAm data that could have clinical relevance.

Exploring the Impact of Chemotherapy on the Emergence of Antibiotic Resistance in the Gut Microbiota of Colorectal Cancer Patients

With nearly half of colorectal cancer (CRC) patients diagnosed at advanced stages where surgery alone is insufficient, chemotherapy remains a cornerstone for this cancer treatment. To prevent infections and improve outcomes, antibiotics are often co-administered. However, chemotherapeutic interactions with the gut microbiota cause significant non-selective toxicity, affecting not only tumor and normal epithelial cells but also the gut microbiota. This toxicity triggers the bacterial SOS response and loss of microbial diversity, leading to bacterial mutations and dysbiosis. Consequently, pathogenic overgrowth and systemic infections increase, necessitating broad-spectrum antibiotics intervention. This review underscores how prolonged antibiotic use during chemotherapy, combined with chemotherapy-induced bacterial mutations, creates selective pressures that drive de novo antimicrobial resistance (AMR), allowing resistant bacteria to dominate the gut. This compromises the treatment efficacy and elevates the mortality risk. Restoring gut microbial diversity may mitigate chemotherapy-induced toxicity and improve therapeutic outcomes, and emerging strategies, such as fecal microbiota transplantation (FMT), probiotics, and prebiotics, show considerable promise. Given the global threat posed by antibiotic resistance to cancer treatment, prioritizing antimicrobial stewardship is essential for optimizing antibiotic use and preventing resistance in CRC patients undergoing chemotherapy. Future research should aim to minimize chemotherapy's impact on the gut microbiota and develop targeted interventions to restore microbial diversity affected during chemotherapy.

Fecal Myeloperoxidase Levels Reflect Disease Activity in Children With Crohn's Disease

BACKGROUND

Crohn's disease (CD) is a major form of inflammatory bowel disease (IBD) which has relapsing and remitting symptoms. Better ways to detect and monitor active disease are required for early diagnosis and optimal outcomes. We assessed fecal myeloperoxidase (fMPO), a neutrophil-derived enzyme that produces hypochlorous acid, as a marker of disease activity in children with CD.

METHODS

This observational study assessed myeloperoxidase (MPO) levels in fecal samples from children aged <17 years with CD (51 with active or 42 inactive disease) measured by enzyme-linked immunosorbent assay (ELISA) and compared to controls (35 healthy siblings and 15 unrelated well children). Results were correlated with fecal calprotectin, serum C-reactive protein, urinary glutathione sulfonamide (a biomarker of hypochlorous acid), and disease activity scores. Differences between groups were assessed by analysis of variance. Receiver-operating-characteristic curves were used to assess how biomarkers predicted disease and disease activity.

RESULTS

Fecal myeloperoxidase activity and fMPO protein correlated with fecal calprotectin (r = 0.78, P < .0001, and r = 0.81, P < .0001, respectively). Fecal myeloperoxidase activity and protein levels were significantly higher (P ≤ .0001) in individuals with active disease compared to healthy sibling controls, unrelated well children, and those with inactive disease. A 9.7 µg/g fMPO protein cutoff distinguished inactive from active disease (sensitivity = 75%, specificity = 76%). Urinary GSA was elevated in children with active disease (P < .0001) and correlated with fMPO protein (r = 0.43, P = .0002) in a subset of 72 children with IBD and controls.

CONCLUSIONS

Fecal myeloperoxidase may be superior to fCal at reflecting disease severity in children with CD and produces the damaging oxidant hypochlorous acid during active inflammation.

Why Symptoms Linger in Quiescent Crohn's Disease: Investigating the Impact of Sulfidogenic Microbes and Sulfur Metabolic Pathways

INTRODUCTION

Even in the absence of inflammation, persistent symptoms in patients with Crohn's disease (CD) are prevalent and worsen quality of life. We previously demonstrated enrichment in sulfidogenic microbes in quiescent Crohn's disease patients with (qCD + S) vs without persistent GI symptoms (qCD-S). Thus, we hypothesized that sulfur metabolic pathways would be enriched in stool while differentially abundant microbes would be associated with important sulfur metabolic pathways in qCD + S.

METHODS

We performed a multicenter observational study nested within SPARC IBD. Quiescent inflammation was defined by fecal calprotectin level < 150 mcg/g. Persistent symptoms were defined by CD-PRO2. Active CD (aCD) and non-IBD diarrhea-predominant irritable bowel syndrome (IBS-D) were included as controls.

RESULTS

Thirty-nine patients with qCD + S, 274 qCD-S, 21 aCD, and 40 IBS-D underwent paired shotgun metagenomic sequencing and untargeted metabolomic profiling. The fecal metabolome in qCD + S was significantly different relative to qCD-S and IBS-D but not aCD. Patients with qCD + S were enriched in sulfur-containing amino acid pathways, including cysteine and methionine, as well as serine, glycine, and threonine. Glutathione and nicotinate/nicotinamide pathways were also enriched in qCD + S relative to qCD-S, suggestive of mitochondrial dysfunction, a downstream target of H2S signaling. Multi-omic integration demonstrated that enriched microbes in qCD + S were associated with important sulfur metabolic pathways. Bacterial sulfur metabolic genes, including CTH, isfD, sarD, and asrC, were dysregulated in qCD + S. Finally, sulfur metabolites with and without sulfidogenic microbes showed good accuracy in predicting the presence of qCD + S.

DISCUSSION

Microbial-derived sulfur pathways and downstream mitochondrial function are perturbed in qCD + S, which implicate H2S signaling in the pathogenesis of this condition. Future studies will determine whether targeting H2S pathways results in improved quality of life in qCD + S.

Risk factors for difficult endoscopic bowel dilation of predominantly shorter and noninflammatory strictures among patients with inflammatory bowel disease: findings from inflammatory bowel disease tertiary centers in Poland and Czech Republic

BACKGROUND AND AIMS

Intestinal strictures are a common and serious adverse event of inflammatory bowel disease (IBD). Endoscopic balloon dilation (EBD) is the first step in treatment to avoid surgery. The aim of this study was to assess the prevalence, risk factors, and clinical sequelae of difficult EBD.

METHODS

This retrospective, multicenter study included 861 patients with IBD treated with EBD due to strictures. Risk factors for difficult EBD, defined as ≥3 per year, were evaluated.

RESULTS

During a median (IQR) of 23.00 (14.00-42.00) months of follow-up, there were 392 (45.5%) easier EBDs performed, while difficult EBDs were performed in 489 (54.5%) cases. Long-term efficacy of EBD, defined as >12 months without surgery, was achieved in 392 (100%) easier EBDs versus 457 (97.4%) difficult EBDs (Cramer's V = .11; P = .004). However, 149 (17.3%) patients underwent surgery for unsuccessful EBD. The most important risk factors for difficult EBD, classified as modifiable, were smoking and treatment with adalimumab (especially if trough levels were normal) and ustekinumab. Vedolizumab and immunosuppressive therapy were identified as protective factors. Multivariable logistic regression analysis indicated good fit of the model to the data, pointing to a protective role for total parental nutrition and worsening of smoking (both, P < .001).

CONCLUSIONS

Reduction of difficult EBDs should be considered primarily in the context of their modifiable risk factors. Prospective studies with simultaneous evaluation of transmural healing are needed to truly assess whether vedolizumab treatment, immunosuppressive therapy, and total parenteral nutrition reduce the risk of EBD.

Long-term outcome of pediatric acute severe colitis: A prospective 5-year follow-up of the PRASCO trial

OBJECTIVES

The PRASCO trial reported the short-term superiority of an antibiotic cocktail plus intravenous corticosteroids (IVCS) over IVCS alone in children with acute severe colitis (ASC). Here, we report the extension of the PRASCO trial and the long-term outcomes of the antibiotic cocktail in ASC.

METHODS

This prospective follow-up of the PRASCO trial documented disease outcomes and treatments annually through 5 years. The primary outcome was colectomy, and the secondary outcome was escalation to biologics, analyzed descriptively.

RESULTS

A total of 26 children were included (12 receiving IVCS and 14 receiving IVCS + antibiotics), 19% of whom underwent colectomy during the follow-up period. The estimated probability of colectomy at 3, 6, and 12 months from admission were 7.1%, 7.1%, and 21% with IVCS + antibiotics and 0%, 8.3%, and 17% with IVCS. No children required colectomy after the first year of follow-up. The estimated probability of escalating to biologics were 66%, 77%, and 77% after 1, 2, and 3 years with IVCS + antibiotics and 42%, 51%, and 76% with IVCS. Clinical remission was higher in the IVCS + antibiotics group at each timepoint (e.g., 30% vs. 11% at 5-years). Delta of Pediatric Ulcerative Colitis Activity Index (PUCAI) score from baseline to day three of admission predicted future escalation to biologics (area under curves (AUC) 0.84 [95%CI 0.59-1.0]).

CONCLUSION

While adding antibiotics to IVCS may provide better short-term outcomes, the long-term benefits were comparable to IVCS alone. At 5 years, about one-fifth of children had undergone colectomy, and almost four-fifths had escalated to biologics, particularly during the first year after admission.

Faecal calprotectin-based strategy for long-term monitoring of patients with Crohn's disease without or with mild endoscopic postoperative recurrence

BACKGROUND

Endoscopic evaluation 6-12 months after ileocolonic resection (ICR) in Crohn's disease (CD) is advised to assess the development of postoperative recurrence (POR) but no further recommendations are available for long-term monitoring if no POR is noticed.

METHODS

Prospective, open-label, study including asymptomatic patients with CD and ICR in whom no POR was observed at the last endoscopic evaluation. Patients were followed-up for two years and ileocolonoscopy was performed by means of a faecal calprotectin (FC)-based strategy.

RESULTS

Fifty-five patients were included. Six patients presented FC levels >250 µg/g in two consecutive measurements and severe endoscopic POR (RES i3-i4) was observed in four of them, whereas one had intermediate POR (RES i2) and one was diagnosed with colonic adenocarcinoma. Regarding the remaining patients, intermediate endoscopic POR was observed in 12 but none with severe endoscopic POR. The rate of severe endoscopic POR was 67 % among patients with two consecutive FC levels >250 µg/g. The area under the receiving operating curve for the prediction of severe endoscopic POR was 0.98 (p = 0.002).

CONCLUSIONS

Serial measurement of FC is a suitable tool for the long-term monitoring of CD patients who do not develop early endoscopic POR and provides a suitable screening strategy for ileocolonoscopy.

Meta-Analysis: Exclusive Enteral Nutrition in Adults With Ulcerative Colitis

BACKGROUND

Exclusive enteral nutrition (EEN) is an established dietary therapy for Crohn's disease but its role in ulcerative colitis remains unclear.

AIMS

To investigate the efficacy of EEN in adults with active ulcerative colitis and compare variations in treatment protocols, safety, tolerability and adherence.

METHODS

We conducted a systematic search of MEDLINE, Embase, Cochrane CENTRAL, Emcare, CINAHL, Web of Science and trial registries for articles published from inception until July 21, 2024. We included all experimental and observational studies that described the use of EEN in adults with active ulcerative colitis. This review was registered on PROSPERO (CRD42022319584).

RESULTS

Of 3273 articles screened, we included 10 studies (334 adults). Overall, there was no difference between EEN and comparator for ulcerative colitis remission induction (median follow-up 14 days, risk ratio (RR) 1.15, 95% confidence interval (CI) 0.71-1.85; 2 studies). In acute severe ulcerative colitis, there was no difference between EEN and comparator for corticosteroid failure (RR 0.76, 95% CI 0.48-1.20; 2 studies) or risk of colectomy (RR 0.88, 95% CI 0.51-1.51, n = 2 studies) during index admission. The pooled discontinuation rate was 3% (95% CI 0-10; 9 studies). There was heterogeneity in trial design, methodology and assessment of outcomes.

CONCLUSION

EEN was well tolerated with low therapy discontinuation in adults with active ulcerative colitis. However, there is insufficient evidence to support the use of EEN as an adjunctive therapy to standard of care. Further, well-designed studies with reproducible methodology and endpoints are necessary to evaluate its effectiveness.

REGISTRY NUMBER FOR SYSTEMATIC REVIEW

PROSPERO 2022 CRD42022319584.

Prediction of Native Liver Survival in Patients With Biliary Atresia 20 Years After the Kasai Procedure

OBJECTIVE

To establish risk models for long-term native liver survival (NLS) in patients with biliary atresia.

METHODS

In this retrospective study, we analyzed data from 1792 patients registered in the Japanese Biliary Atresia Registry. Using multivariate logistic regression, we created predictive models for NLS at 1, 5, 10, 15, and 20 years postoperatively. Variables at the first year of age and those at 1 and 5 years postoperatively were used. The variables used in this model were selected using a forward-backward stepwise selection method. The models were further assessed using C-statistics of internal validation with 1000 bootstrapping resamples.

RESULTS

The models using only variables at the first year of age showed insufficient predictive ability. The variables used in the model for NLS at 20 years postoperatively included the age at Kasai procedure, high levels of gamma-glutamyltranspeptidase at 1 year postoperatively, and low levels of cholinesterase at 5 years postoperatively. The models with internally validated C-statistics greater than 0.8 were as follows: NLS at 5 years postoperatively based on the variables at 1 year postoperatively (internally validated C-statistics: 0.88), at 10 years postoperatively based on the variables at 1 year postoperatively (0.86), and at 20 years postoperatively based on the variables at 1 year (0.81) and 5 years (0.83) postoperatively.

CONCLUSION

Overall, we developed satisfactory risk models for NLS up to 20 years postoperatively using variables up to 5 years postoperatively.

Comparison of the techniques for isolating immunoassay-suitable proteins from heterogeneous fecal samples

Immunoassays could provide valuable insights into disease biomarkers and gut health by measuring fecal proteins. However, reliably isolating intact proteins from feces is challenging due to its heterogeneous and variable composition. This paper aims to review and compare different methods for extracting proteins from fecal samples to make them suitable for immunoassay analysis. Mechanical homogenization helps release proteins by disrupting solids, while protease inhibitors preserve protein integrity. Detergents like SDS solubilize proteins by disrupting hydrophobic interactions. Organic solvents such as acetone precipitate proteins and remove contaminants. Thermal treatment denatures proteases. Immunocapture uses antibodies to purify target proteins away from interference selectively. Commercial kits contain optimized buffers but may be cost-prohibitive. Combining mechanical, chemical, and immunological techniques synergistically integrates their advantages, improving the recovery of native proteins with reduced matrix effects. While all methods have merits, tailored protocols integrating multiple mechanisms appear most promising for extracting immunoassay-suitable fecal proteins. Further optimization and standardization of such combination approaches matched to proteins and assays of interest helps expand noninvasive fecal proteome analysis.

Longitudinal Changes in Fecal Microbiota During Hospitalization in Horses With Different Types of Colic

BACKGROUND

Research on fecal microbiota changes during hospitalization of horses with colic is emerging.

OBJECTIVES

Describe changes of the fecal microbiota during hospitalization of horses with colic caused by inflammatory (INFL), simple (SIMPLE), and strangulated (STR) obstructions, and investigate associations with survival.

ANIMALS

Twenty-three horses with colic: 9 in INFL, 5 in STR, and 9 in SIMPLE groups. Seventeen horses survived, and 6 were euthanized.

METHODS

Prospective observational study. Fecal samples were collected on admission (D1), on days 3 (D3) and 5 (D5). Bacterial taxonomy profiling was obtained by V1V3 16S amplicon sequencing. Data were compared using a 2-way permutational analysis of variance (PERMANOVA). Linear discriminant analysis Effect Size (LEfSE) analysis identified significant bacterial population differences, with significance set at p < 0.05 and a linear discriminant analysis (LDA) cut-off > 3.0.

RESULTS

Alpha diversity indices remained stable during hospitalization within each colic group. However, at D5, the INFL group had significantly higher richness (p < 0.01) and diversity (Shannon, p < 0.001 and Simpson, p < 0.05) than other colic types. Beta diversity (Jaccard membership and Bray-Curtis indices) was significantly different in the INFL compared to SIMPLE and STR groups (both p < 0.001) but not between SIMPLE and STR. Beta diversity membership analysis by analysis of molecular variance (AMOVA) indicated a significant difference between survivors and non-survivors within the INFL group (p < 0.01). Increased relative abundances of Bacilliculturomica and Saccharofermentans were associated with survival.

CONCLUSIONS

Microbiota showed no significant variation over 5 days of hospitalization. Colic type influenced fecal microbiota more than hospitalization duration. Specific bacterial populations may differ between survival and non-survival groups.

Serum bile acids early after portoenterostomy are predictive for native liver survival and portal hypertension in biliary atresia

OBJECTIVES

To compare the predictive value of serum bile acids on native liver survival (NLS) and portal hypertension (PH) at various time points early after portoenterostomy (PE) in biliary atresia (BA).

METHODS

This was a retrospective observational study. Serum bilirubin and bile acid concentrations were defined by enzymatic spectrophotometry 1, 3, and 6 months after PE. After defining optimal bilirubin and bile acids cutoffs by area under the receiver operating characteristic (AUROC) curves, cutoffs were compared with other predictors of NLS and PH in Cox regression.

RESULTS

Out of 56 patients, 42 (75%) achieved clearance of jaundice (COJ, bilirubin <20 µmol/L at 6 months). Both bilirubin and bile acids at 3 and 6 months were accurate predictors of NLS among all patients (AUROC 0.82-0.91, p < 0.001). In COJ patients, bile acids (AUROC 0.82, p = 0.003), but not bilirubin, at 1 month also predicted NLS. Among all patients, the strongest predictors of NLS were bilirubin >18.5 µmol/L and bile acids >150 µmol/L at 3 months, increasing the risk of transplantation/death seven- and eightfold, respectively (p < 0.001 for both). In COJ patients, the strongest predictor of NLS was bile acids >119 µmol/L at 3 months, increasing the risk of transplantation/death 12-fold (p = 0.014). Bile acids and bilirubin at 3 and 6 months predicted PH development in COJ patients with moderate accuracy (AUROC 0.72-0.78, p = 0.004-0.019). Bilirubin >8.5 µmol/L and bile acids >78 µmol/L at 6 months increased PH risk 13-fold (p < 0.001) and 4-fold (p = 0.006).

CONCLUSIONS

Serum bile acids offer a simple and useful additional tool to predict PE outcomes in BA, particularly after COJ.

Study protocol, menu design, and rationale for a study testing the effects of a whole fruit-rich diet on glycemic control, liver fat, pancreatic fat, and cardiovascular health in adults with type 2 diabetes

Dietary interventions such as very-low-calorie diets and low-carbohydrate diets can improve glycemic control and even induce type 2 diabetes (T2D) remission. However, less is known about the effects of carbohydrate-rich whole foods, such as whole fruit, in people with T2D. Therefore, the aim of this pilot study is to investigate the effects of a whole fruit-rich diet on glycemic control, ectopic fat, and cardiovascular risk factors in adults with T2D. In this pilot study, sixteen adults aged 20 to 70 years with insulin-independent T2D for ≤6 years will complete a 12-week controlled-feeding intervention while maintaining their weight. During the ramp-up phase (weeks 1-4), participants progressively consume more whole fruit. During weeks 5 to 12, participants eat a fruit-rich Mediterranean diet providing 50% of calories as whole fruit (∼16.4 servings/day). All outcomes are measured at weeks 0, 4, and 12. The primary outcome is glycemic control, assessed hierarchically by whether participants achieve nondiabetic glucose concentrations without antihyperglycemic medications; the total dose of antihyperglycemic medications; mean glucose during a three-hour oral glucose tolerance test; and mean 24-hour glucose from continuous glucose monitoring. Secondary outcomes include intrahepatic lipid, pancreatic fat, blood pressure, heart rate, and serum lipids. We hypothesize that a fruit-rich diet will improve glycemic control, reduce the need for antihyperglycemic medications, decrease ectopic fat, and improve cardiovascular risk factors. This novel study will help determine the effects of a whole fruit-rich diet on glycemic control and liver fat and whether diabetes remission may be possible without losing weight. This study was registered at ClinicalTrials.gov (NCT03758742).

Utility of endoscopy in paediatric gastroenterology and hepatology-Review and updates

Paediatric endoscopy has been an integral part of the diagnostic evaluation and management of gastroenterology and hepatology diseases in children. This area of clinical medicine has made meteoric advancements since it was first introduced conserving it's traditional roles of gastroscopy and colonoscopy but broadening significantly it's clinical utility and diagnostic accuracy with new and emerging technology. This article aims to explore and review the current utility and emerging applications of diagnostic and therapeutic endoscopy for the practicing paediatric gastroenterologist and hepatologist.

Approach to anaemia in gastrointestinal disease: A position paper by the ESPGHAN Gastroenterology Committee

Anaemia is a frequent consequence of many gastrointestinal (GI) diseases in children and it can even be the initial presenting symptom of underlying chronic GI disease. The definition of anaemia is age and gender-dependent and it can be classified based on pathophysiology, red cell morphology, and clinical presentation. Although nutritional deficiencies, including GI malabsorption of nutrients and GI bleeding, play a major role, other pathophysiologic mechanisms seen in chronic GI diseases, whether inflammatory (e.g., inflammatory bowel disease) or not (e.g., coeliac disease and dysmotility), are causing anaemia. Drugs, such as proton pump inhibitors, mesalamine, methotrexate and sulfasalazine, are also a potential cause of anaemia. Not uncommonly, due to a combination of factors, such as iron deficiency and a chronic inflammatory state, the underlying pathophysiology may be difficult to decipher and a broad diagnostic work-up is required. The goal of treatment is correction of anaemia by supplementation of iron and vitamins. The first therapeutic step is to treat the underlying cause of anaemia including bleeding control, restoration of intestinal integrity and reduction of inflammatory burden. The route of iron and vitamin supplementation is guided by the severity of anaemia.

Vitamin D and its analogs in immune system regulation

Vitamin D was discovered as the cure for nutritional rickets, a disease of bone growth arising from inadequate intestinal calcium absorption, and for much of the 20th century, it was studied for its critical role in calcium homeostasis. However, we now recognize that the vitamin D receptor and vitamin D metabolic enzymes are expressed in numerous tissues unrelated to calcium homeostasis. Notably, vitamin D signaling can induce cellular differentiation and cell cycle arrest. Moreover, the vitamin D receptor and the enzyme CYP27B1, which produces the hormonal form of vitamin D, 1,25-dihydroxyvitamin D (1,25D), are expressed throughout the immune system. In addition, CYP27B1 expression in immune cells is regulated by physiological inputs independent of those controlling its expression in calcium homeostatic tissues. These observations have driven the development of 1,25D-like secosteroidal analogs and nonsecosteroidal analogs to separate the effects of vitamin D on cell differentiation and function from its calcemic activities. Notably, some of these analogs have had considerable success in the clinic in the treatment of inflammatory and immune-related disorders. In this review, we described in detail the mechanisms of vitamin D signaling and the physiological signals controlling 1,25D synthesis and catabolism, with a focus on the immune system. We also surveyed the effects of 1,25D and its analogs on the regulation of immune system function and their implications for human immune-related disorders. Finally, we described the potential of vitamin D analogs as anticancer therapeutics, in particular, their use as adjuncts to cancer immunotherapy. SIGNIFICANCE STATEMENT: Vitamin D signaling is active in both the innate and adaptive arms of the immune system. Numerous vitamin D analogs, developed primarily to minimize the dose-limiting hypercalcemia of the active form of vitamin D, have been used widely in preclinical and clinical studies of immune system regulation. This review presents a description of the mechanisms of action of vitamin D signaling, an overview of analog development, and an in-depth discussion of the immunoregulatory roles of vitamin D analogs.

The gut microbiome across the lifespan: how diet modulates our microbial ecosystem from infancy to the elderly

This comprehensive review examines the impact of dietary patterns on gut microbiome composition and diversity from infancy to old age, linking these changes to age-related health outcomes. It investigates how the gut microbiome develops and changes across life stages, focusing on the influence of dietary factors. The review explores how early-life feeding practices, including breastfeeding and formula feeding, shape the infant gut microbiota and have lasting effects. In elderly individuals, alterations in the gut microbiome are associated with increased susceptibility to infections, chronic inflammation, metabolic disorders and cognitive decline. The critical role of diet in modulating the gut microbiome throughout life is emphasised, particularly the potential benefits of probiotics and fortified foods in promoting healthy ageing. By elucidating the mechanisms connecting food systems to gut health, this review provides insights into interventions that could enhance gut microbiome resilience and improve health outcomes across the lifespan.

Italian validation of the IBD-disk tool for the assessment of disability in inflammatory bowel diseases: A cross-sectional multicenter study

INTRODUCTION

IBD-Disk is a simple, easy-to-use, and self-administered analogue visual tool for assessing disability in patients with Inflammatory Bowel Disease (IBD). However, it has not yet been validated in Italian. This study aims to validate IBD-Disk in an Italian cross-sectional multicentre study.

METHODS

This study was conducted in eight IBD centres from February 2023 to October 2023. After forward-backwards translation of IBD-Disk into Italian, patients consecutively completed IBD-Disk (at baseline and after 7 days), IBD-Disability Index (IBD-DI) and IBDQ-32 for quality of life.

RESULTS

We enrolled 767 patients (377, 49,2% CD; 390, 50,8% UC) who completed the IBD-Disk [median score of 30 (IQR=11-52)]. Internal consistency was excellent, with Cronbach's α of 0.92 (95%CI=0.92-0.92). To evaluate the validity, the IBD-Disk was compared with the IBD-DI and IBDQ-32, revealing a significant positive correlation of 0.70 (95% CI=0.66-0.73; p<0.001) and 0.83 (r=0.83, 95% CI=0.80-0.85; p<0.001), respectively. The intraclass correlation coefficient (ICC) was 0.84 (95% CI=0.82-0.86) for test-retest. Female gender, clinically active IBD and the presence of extraintestinal manifestations led to higher IBD-Disk scores.

CONCLUSION

This study validated the IBD-Disk in a large cohort of Italian IBD patients, demonstrating that it is a valid, reliable and responsive tool for quantifying IBD-related disability. This validation facilitates its integration into the daily clinical management of IBD patients.

Diabetes remission in newly diagnosed type 2 diabetes mellitus through short-term continuous subcutaneous insulin infusion intensive therapy combined with low-carbohydrate diet treatment

AIM/INTRODUCTION

To evaluate the therapeutic efficacy short-term continuous subcutaneous insulin infusion (CSII) intensive therapy combined with a low-carbohydrate diet (LCD) for diabetes remission in patients with newly diagnosed type 2 diabetes mellitus.

MATERIALS AND METHODS

This study included patients newly diagnosed with type 2 diabetes mellitus, who were randomly divided into two groups: conventional (conventional CSII + traditional lifestyle guidance); and intensive (intensive CSII + LCD lifestyle guidance). CSII was used for blood glucose control, with continuous glucose monitoring (CGM) used to monitor blood glucose levels. The primary outcome measure was hemoglobin A1c (HbA1c) level; secondary outcomes included body weight, body mass index (BMI), waist circumference, glycemic control, and biochemical indices.

RESULTS

The time in range (TIR) in the intensive treatment group was greater than that in the conventional treatment group (P < 0.05). There was no significant difference in the incidence of hypoglycemia between the two groups (P > 0.05). Compared with the conventional treatment group, diabetes remission rates were significantly greater in the intensive treatment group (P < 0.05). In the intensive treatment group, fasting plasma glucose (FPG), HbA1c, Homeostasis Model assessment of Insulin Resistance (HOMA-IR), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and changes in body weight, BMI, visceral fat area (VFA), and subcutaneous fat area (SFA) decreased significantly (P < 0.05). FPG, HOMA-IR, TG, LDL-c, and changes in body weight, BMI, waist circumference, and VFA were significantly correlated with HbA1c levels (P < 0.05).

CONCLUSIONS

The combination of intensive CSII and LCD lifestyle guidance had been improved the remission rate in patients with newly diagnosed type 2 diabetes mellitus.

Fecal and Serum Calprotectin Concentrations in Cats With Chronic Enteropathies Before and During Treatment

Background

Chronic enteropathies (CE) are common in cats. Reliable biomarkers that can distinguish different causes and predict or monitor responses to treatment are currently lacking.

Hypothesis/Objectives

Evaluate calprotectin concentrations in serum and feces as potential biomarkers in cats with CE.

Animals

Forty‐three cats with either chronic inflammatory enteropathy (CIE; n = 25) or small cell gastrointestinal lymphoma (SCGL; n = 18) and 36 healthy cats were prospectively enrolled.

Methods

Fecal and serum calprotectin concentrations were determined before and during treatment. Cats with CIE were treated with diet, prednisolone, or diet and prednisolone, and cats with SCGL were treated with prednisolone plus chlorambucil with or without diet.

Results

Compared to controls, fecal calprotectin concentration was significantly higher in cats with CE (median, ≤ 161 ng/g; range, ≤ 161–2827 vs. median, ≤ 161 ng/g; range, ≤ 161–790; p = 0.01). No significant differences were found in fecal (median ≤ 161 ng/g; range, ≤ 161–1920 vs. median, 189 ng/g; range, ≤ 161–2827; p = 0.3) or serum calprotectin (median, ≤ 1291 mg/L; range, ≤ 1291–15 358 vs. median, ≤ 1291 mg/L; range, ≤ 1291–6422; p = 0.99) between cats with CIE and cats with SCGL. Fecal calprotectin was significantly decreased after treatment in cats with CE (median, ≤ 161 ng/g; range, ≤ 161–1897 vs. median, ≤ 161 ng/g; range, ≤ 161–656; p = 0.02).

Conclusions

Fecal calprotectin concentration might be a good biomarker for diagnosis and treatment monitoring for a subset of cats with CE. Serum calprotectin concentrations do not seem to be useful for diagnosis or treatment monitoring in cats with CE. Neither fecal nor serum calprotectin concentrations could differentiate cats with CIE from cats with SCGL.

Factors influencing food-related quality of life in patients with inflammatory bowel disease: A systematic review

BACKGROUND

People diagnosed with Inflammatory bowel disease (IBD) often have severe dietary restrictions and avoidance due to the uncertainty of intestinal symptoms. Inadequate dietary intake may increase the risk of malnutrition and result in impaired food-related quality of life (FRQoL). Few studies investigated factors influencing FRQoL in patients with IBD. This study aimed to synthesize the existing evidence regarding FRQoL among patients with IBD, including the current situation, measurement instruments, and related influencing factors.

METHOD

The comprehensive literature search was conducted in databases including PubMed, Embase, CINAHL, PsycInfo, Cochrane Library, as well as the most commonly used Chinese databases (CNKI, Wanfang and CBM). Studies published between January 2015 and December 2023 on FRQoL in patients with IBD were included. The Joanna Briggs Institute (JBI) critical appraisal checklist was utilized to evaluate the methodological quality of the selected studies.

RESULTS

Finally, only five studies met the inclusion criteria were reviewed, including three cross-sectional studies and two case-control studies. The Food-related quality of life-29 Scale (FR-QoL-29) with a total core of 145 was the most used instrument measuring FRQoL in patients with IBD. The mean scores of FRQoL ranged from 69.9 to 102.3 in adult patients with IBD and 94.3 in children. A diverse range of factors were associated with FRQoL, including socio-demographic, clinical, psychological, diet-related, and nutrient intake factors.

CONCLUSIONS

The main influencing factors of FRQoL among patients with IBD included disease activity status, severe symptoms, history of IBD surgery, negative emotion reaction, and restrictive eating behaviour. Clinicians should work in concert with dietitians, keeping an eye on the disease status, nutrition intake, and restrictive eating habits, assessing FRQoL and providing personalized dietary recommendation for the patients with IBD.

[Position paper of the Society for Paediatric Gastroenterology and Nutrition (GPGE) on the off-label use of biologics and signal inhibitors in children and adolescents with IBD that have already been approved for adults]

Therapy for children and adolescents with chronic inflammatory bowel disease (IBD) is basically no different from that for adult patients. However, of the steadily increasing number of biologics and signalling inhibitors for adults, only two TNFα antibodies are currently approved in Germany for the treatment of IBD from the age of 6. This means that a large proportion of the drugs authorised for adults with IBD are not available for children and adolescents with moderate to severe disease. The small number of approved drugs also makes it difficult to achieve the prognostically important goal of achieving a sustained remission of IBD soon after diagnosis, which is characterised by the patient being free of symptoms and also the objectifiable goal of mucosa healing. This position paper is intended to present the current study situation on the drug treatment of children and adolescents with IBD outside the age limit and to serve as a basis for information and decision-making for the Medical Service in the assessment of individual case applications as well as for the treating physicians, the cost bearers, health policy and social court decision-makers.

Antibiotic Use In Utero and Early Life and Risk of Chronic Childhood Conditions in New Zealand: Protocol for a Data Linkage Retrospective Cohort Study

BACKGROUND

The incidence of many common chronic childhood conditions has increased globally in the past few decades, which has been suggested to be potentially attributed to antibiotic overuse leading to dysbiosis in the gut microbiome.

OBJECTIVE

This linkage study will assess the role of antibiotic use in utero and in early life in the development of type 1 diabetes (T1D), attention-deficit/hyperactive disorder (ADHD), and inflammatory bowel disease.

METHODS

The study design involves several retrospective cohort studies using linked administrative health and social data from Statistics New Zealand's Integrated Data Infrastructure. It uses data from all children who were born in New Zealand between October 2005 and December 2010 (N=334,204) and their mothers. Children's antibiotic use is identified for 4 time periods (at pregnancy, at ≤1 year, at ≤2 years, and at ≤5 years), and the development of T1D, ADHD, and inflammatory bowel disease is measured from the end of the antibiotic use periods until death, emigration, or the end of the follow-up period (2021), whichever came first. Children who emigrated or died before the end of the antibiotic use period are excluded. Cox proportional hazards regression models are used while adjusting for a range of potential confounders.

RESULTS

As of September 2024, data linkage has been completed, involving the integration of antibiotic exposure and outcome variables for 315,789 children. Preliminary analyses show that both prenatal and early life antibiotic consumption is associated with T1D. Full analyses for all 3 outcomes will be completed by the end of 2025.

CONCLUSIONS

This series of linked cohort studies using detailed, complete, and systematically collected antibiotic prescription data will provide critical new knowledge regarding the role of antibiotics in the development of common chronic childhood conditions. Thus, this study has the potential to contribute to the development of primary prevention strategies through, for example, targeted changes in antibiotic use.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66184.

Bone Health in Paediatric Inflammatory Bowel Disease

Paediatric inflammatory bowel disease (IBD) is often complicated by bone loss resulting in an increased risk of fractures and impaired quality of life. Underlying inflammation, nutritional deficiencies and glucocorticoid therapy are some of the factors contributing to secondary osteoporosis in IBD. Optimising nutrition, dietary supplementation and timely screening are essential in preventing bone loss. Bisphosphonate therapy remains the cornerstone of medical management of osteoporosis. This review explores the various mechanisms contributing towards poor bone health in IBD and the recent advances in diagnostic and preventive approaches along with updates in management strategies.

Lactobacillus acidophilus TW01 Mitigates PM2.5-Induced Lung Injury and Improves Gut Health in Mice

Background/Objectives: Exposure to fine particulate matter (PM2.5) causes significant respiratory and gastrointestinal health problems. In our prior research, we identified Lactobacillus acidophilus TW01 as a promising strain for mitigating oxidative damage, enhancing wound healing in intestinal epithelial cells, and protecting bronchial cells from cigarette smoke extract. Building upon these findings, this study examines the protective effects of this strain on lung damage induced by particulate matter (PM) through the gut-lung axis in mouse models. Methods: This study evaluated the protective effects of L. acidophilus TW01 against PM2.5-induced lung injury using two in vivo mouse models (OVA sensitization combined with PM2.5 exposure and DSS-induced colitis). Results: L. acidophilus TW01 exhibited significant protective effects in two in-vivo models, reducing pro-inflammatory cytokines (TNF-α, IL-6, and IL-5), modulating the immune response (IgG subtypes), and improving gut barrier integrity. Importantly, L. acidophilus TW01 increased the abundance of beneficial gut bacteria (Bifidobacterium and Lactobacillus). Conclusions: These findings highlight the significant protective/therapeutic potential of L. acidophilus TW01 in mitigating the adverse health effects of PM2.5 exposure, emphasizing the interplay between the gut and lung microbiomes in overall health. The multi-faceted protective effects of this probiotic suggest a novel, multi-pronged therapeutic strategy for addressing the widespread health consequences of air pollution.

Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis

OBJECTIVES

Assess the efficacy and safety profiles of different sodium-glucose cotransporter-2 inhibitors (SGLT2is) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients.

DESIGN

Bayesian network meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were searched before 18 December 2024.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) evaluating T2DM patients taking one of 12 SGLT2is as add-on therapy to metformin. Efficacy outcomes focused on glycated haemoglobin (HbA1c) reduction, fasting plasma glucose (FPG) reduction and weight loss (WL). Safety outcomes included adverse events (AEs), serious AEs (SAEs), hypoglycaemia, urinary tract infections (UTI) and genital infections (GI).

DATA EXTRACTION AND SYNTHESIS

Two investigators independently extracted data. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool (V.2.0) for RCTs.

RESULTS

23 RCTs involving 9144 patients and 11 SGLT2is were included. Compared with placebo, most SGLT2is reduced HbA1c (mean difference (MD), -0.45~-0.80%), FPG (MD, -0.78~-2.02 mmol/L) and body weight (MD, -0.88~-2.67 kg). Only 10 mg of henagliflozin increased the incidence of AEs, and none of the included interventions increased the risks of SAEs or UTIs. 50 mg of empagliflozin exhibited higher risks of hypoglycaemia. Only 10 mg of empagliflozin increased the risk of GI. According to the surface under the cumulative ranking values, SGLT2is with optimal efficacy and safety were 15 mg of ertugliflozin in HbA1c reduction, 300 mg of canagliflozin in FPG reduction, WL and hypoglycaemia, 400 mg of sotagliflozin in total AEs, 10 mg of ertugliflozin and 150 mg of ipragliflozin in SAEs, 12.5 mg of ipragliflozin in UTI and 1 mg of ertugliflozin in GI.

CONCLUSIONS

As add-on therapy, SGLT2is demonstrated favourable antidiabetic efficacy and acceptable safety. 300 mg of canagliflozin was the best option among the included interventions considering favourable glucose control and WL. Some novel SGLT2is (eg, henagliflozin) exhibited promising efficacy and safety profiles, but more research is needed to validate the findings.

Predictive Value of Serum N-Terminal Pro-Brain Natriuretic Peptide, D-Dimer, Albumin Combined with T-Cell Subsets in Detecting Coronary Artery Damage in Children with Kawasaki Disease

Aims/Background Kawasaki disease (KD) is the common acute, self-limiting vasculitis in children, often affecting coronary arteries, which may lead to coronary artery dilation, stenosis, or in severe cases, myocardial infarction. This study aimed to identify new approaches for reducing or preventing coronary artery lesions (CAL) in KD patients by analyzing specific serological markers across various paediatric groups. Methods Clinical data were collected from 100 children diagnosed with Kawasaki disease (KD) admitted at First Affiliated Hospital of Hebei North University between May 2023 and June 2024. These children were divided into two groups based on coronary artery injury status: Occurrence group (n = 31) and Non-occurrence group (n = 69). Additionally, data from 100 children with acute upper respiratory tract infections (URTI) and 100 healthy children who underwent routine physical examination during the same period (Healthy group) were included for comparison. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), D-dimer (D-D), albumin (ALB), and T-cell subsets were measured and compared across groups to evaluate their clinical utility in diagnosing coronary artery damage in KD. Results NT-proBNP and D-D levels were highest in KD children with coronary artery injury and lowest in the healthy group, while ALB levels were lowest in KD children with coronary artery injury and highest in the healthy group, with statistically significant differences (p < 0.001). Analysis of T-cell subsets revealed that cluster of differentiation (CD)3+, CD4+, and CD4+/CD8+ levels were highest in the Healthy group, while CD8+ levels were highest in the Occurrence group, with statistically significant differences (p < 0.001). The combined diagnostic model demonstrated an area under the curve (AUC) value of 0.885 (95% CI: 0.829-0.941), showing higher specificity and AUC value compared to each marker individually. Conclusion The combination of serum NT-proBNP, D-D, ALB, and T-cell subsets offers valuable predictive insights for coronary artery damage in KD children and may serve as an auxiliary diagnostic tool.

Combining mechanistic modeling with machine learning as a strategy to predict inflammatory bowel disease clinical scores

Disease activity scores are efficacy endpoints in clinical trials of inflammatory bowel disease (IBD) therapies. Crohn's disease activity index (CDAI), Mayo endoscopic score (MES) and Mayo score are frequently used in clinical trials. They rely on either the physician's observation of the inflammatory state of the patient's gastrointestinal tissue alone or combined with the patient's subjective evaluation of general wellbeing. Given the importance of these scores in evaluating the efficacy of drug treatment and disease severity, there has been interest in developing a computational approach to reliably predict these scores. A promising approach is using mechanistic models such as quantitative systems pharmacology (QSP) which simulate the mechanisms of the disease and its modulation by the drug pharmacology. However, extending QSP model simulations to clinical score predictions has been challenging due to the limited availability of gut biopsy measurements and the subjective nature of some of the evaluation criteria for these scores that cannot be described using mechanistic relationships. In this perspective, we examine details of IBD disease activity scores and current progress in building predictive models for these scores (such as biomarkers for disease activity). Then, we propose a method to leverage simulated markers of inflammation from a QSP model to predict IBD clinical scores using a machine learning algorithm. We will demonstrate how this combined approach can be used to (1) explore mechanistic insights underlying clinical observations; and (2) simulate novel therapeutic strategies that could potentially improve clinical outcomes.

Are Vitamin D Levels Related to Sarcopenia in Children with Inflammatory Bowel Disease?

Background: Data on the impacts of vitamin D deficiency on sarcopenia in pediatric patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are lacking. We aimed to investigate the relationships between vitamin D levels and sarcopenia in patients with newly diagnosed IBD. Methods: A cross-sectional, retrospective study was conducted in a tertiary care children's hospital. Pediatric IBD patients who underwent magnetic resonance (MR) enteroclysis at the time of initial diagnosis were included. Total psoas muscle area (tPMA) at the L4/L5 intervertebral level was demonstrated on MR by scanning the right and left psoas muscle areas. Sarcopenia was defined as a measurement under the 10th percentile according to MR-derived reference values of tPMA percentile charts for healthy children aged 1-18 years. Vitamin D insufficiency was defined as a serum 25-OH-D level below 30 ng/mL and deficiency as that below 20 ng/mL. Collected data from demographic evaluation, clinic, and laboratory tests were statistically assessed. Results: According to the MR-derived reference values of tPMA, 85% (n = 33) of UC and 81% (n = 21) of CD patients had sarcopenia. The severe vitamin D deficiency ratio was 35.9% (n = 14) in UC and 38.5% (n = 10) in CD. We found that vitamin D levels were similar in patients with UC and CD, while they were significantly lower in the group below the 3rd percentile of tPMA (n = 41, median 9.8) than in the group between the 3rd and 10th percentiles (n = 13, median 16.9; p = 0.038). Conclusions: Formulating strategies to recognize and prevent sarcopenia, including the prevention and-if necessary-the treatment of vitamin D deficiency, could bring multi-faceted benefits.

The Role of Calprotectin in the Diagnosis and Treatment of Inflammatory Bowel Disease

The management of inflammatory bowel disease (IBD), which is characterized by immunodeficiency, has attracted increasing attention, highlighting the necessity for more precise and streamlined diagnostic approaches in clinics. Calprotectin, an immune cell-derived protein with inherent anti-inflammatory and antimicrobial properties, plays a pivotal role in immune regulation and intestinal homeostasis. Its expression levels are intricately linked to IBD activity, enabling differentiation between inflammatory and non-inflammatory states while predicting recurrence risks. As a non-invasive biomarker, fecal calprotectin (FC) and serum calprotectin (SC) analysis offers high reproducibility and clinical utility, facilitating both IBD diagnosis and real-time disease monitoring. Beyond its diagnostic specificity in distinguishing IBD from other gastrointestinal disorders, calprotectin also emerges as a promising therapeutic target, due to its dual role in modulating inflammatory pathways and interacting with the gut microbiota. With collaborative advancements in standardized detection protocols and innovative research methodologies, it is anticipated that calprotectin-based strategies will be integrated into mainstream clinical practice for IBD.

Breastfeeding patterns and total volume of human milk consumed influence the development of the infant oral microbiome

Background

The oral microbiome of breastfed infants is distinct from that of formula-fed infants. However, breastfeeding characteristics, such as time spent breastfeeding (min/24 h), breastfeeding frequency (number of breastfeeds per day), and human milk intake (ml/day) vary significantly between breastfeeding dyads.

Objectives

Given that human milk and breastfeeding exposures likely influence early colonisation of the infant oral microbiome, this study aimed to elucidate the impact of breastfeeding characteristics on the development of the infant oral microbiome.

Materials and methods

Oral swabs (n = 55) were collected from infants at three months of age, alongside breastfeeding data collected over a 24-hour period. Bacterial DNA profiles were analysed using full-length 16S rRNA gene sequencing.

Results

Variations in breastfeeding characteristics contributed to differences in microbial community structure. Total breastfeeding duration (min/24 h) was positively associated with Bifidobacterium longum and Lactobacillus gasseri, while breastfeeding frequency was negatively associated with Veillonella sp. Additionally, human milk intake (ml/24 h) was negatively associated with Streptococcus parasanguinis.

Conclusion

These findings underscore the significant influence of early life feeding practices on oral microbial communities and emphasise the importance role of breastfeeding in shaping the oral microbiome during early life.

Tryptophan metabolites profile predict remission with dietary therapy in pediatric Crohn's disease

Background

Crohn's disease (CD) exclusion diet combined with partial enteral nutrition (CDED + PEN) or exclusive enteral nutrition (EEN) is effective in inducing remission in mild-to-moderate pediatric CD. Although CDED + PEN is better tolerated and has higher compliance compared to EEN, a subset of patients does not achieve remission. Diet-induced remission is shown to be positively associated with specific changes in tryptophan-metabolites.

Objectives

To investigate whether the abundance of baseline fecal tryptophan-metabolites predicts dietary therapy outcomes in pediatric CD.

Design

Diagnostic accuracy study and secondary analysis of previously conducted Randomized Controlled Trial (RCT).

Methods

Twenty-six patients from previously performed RCT of mild-to-moderate pediatric CD were included. The patients were classified as having clinical remission (R) (n = 19 in total; CDED + PEN = 10 and to EEN = 9) or No-Remission (NR) (n = 7 in total; CDED + PEN = 3 and EEN = 4) following 6 weeks of therapy, based on the Pediatric Crohn's Disease Activity Index score (⩽10 = remission). We performed a targeted quantitative analysis of 21 tryptophan-metabolites in baseline (t = 0) fecal samples from both groups, utilizing liquid chromatography coupled with quadrupole mass spectrometry. Receiver operator characteristic curve (ROC) and random forest analysis (RFA) were used to assess the predictive power of fecal tryptophan-metabolites for dietary outcomes at baseline. Ratios of tryptophan-metabolites were compared to investigate different downstream tryptophan pathways.

Results

Baseline fecal kynurenine level was significantly higher in NR compared to R for CDED + PEN (p = 0.02) and EEN (p = 0.04). ROC analysis highlighted the robust predictive power of kynurenine for CDED + PEN (area under the curve (AUC = 0.97)) and EEN (AUC = 0.88)-induced remission. RFA corroborated these observations. The ratio serotonin/kynurenine was the strongest predictor of CDED + PEN-induced remission (AUC = 1). The ratio 5-hydroxytryptophan/kynurenine (AUC = 0.88) predicted EEN-induced remission. By combining data from CDED + PEN and EEN, kynurenine (AUC = 0.91) and ratios of quinolinic acid/kynurenine (AUC = 0.93) and kynurenine/indole-3-acetic acid (AUC = 0.88) demonstrated strong predictive performance for dietary therapy-induced remission.

Conclusion

Baseline tryptophan metabolites have the potential to serve as a biomarker for dietary remission in pediatric CD. Some tryptophan metabolite ratios showed the most promising predictive capabilities. If confirmed in validation studies, baseline fecal tryptophan markers may be able to provide much-needed guidance to personalize dietary intervention within the management of pediatric CD.

Trial registration

NCT01728870.

Modified Pulsatilla decoction alleviates 5-fluorouracil-induced intestinal mucositis by modulating the TLR4/MyD88/NF-κB pathway and gut microbiota

BACKGROUND

Modified Pulsatilla decoction (PD), a PD with licorice and ejiao, is a classic Traditional Chinese Medicine formula with significant efficacy in treating intestinal mucositis (IM) induced by tumor therapy. However, its specific molecular and biological mechanisms remain unclear.

AIM

To investigate the therapeutic effect and mechanism of modified PD in IM.

METHODS

This study used an IM mouse model established using 5-fluorouracil injections to investigate the effects of the modified PD (3, 6, and 12 g/kg) in IM. The primary chemical components of the modified PD were identified using liquid chromatography-mass spectrometry. Body weight loss, diarrhea scores, intestinal length, histopathological scores, and inflammatory cytokine levels were measured to evaluate the effects of the modified PD in IM. Effects on the TLR4/MyD88/NF-κB pathway were evaluated using western blot analysis. The intestinal microbiota was characterized using Illumina NovaSeq sequencing.

RESULTS

The results showed that modified PD significantly improved weight loss and diarrhea and shortened the intestines in IM mice. Mechanistically, modified PD suppressed the TLR4/MyD88/NF-κB pathway and downregulated the expression of reactive oxygen species, lipopolysaccharides, and pro-inflammatory cytokines (IL-1β, TNF-α, IFN-γ, IL-6, IL-8, and IL-17), while increasing the expression of the anti-inflammatory cytokine IL-10. Furthermore, modified PD protected the intestinal mucosal barrier by increasing the expression of tight junction proteins (occludin-1, claudin-1, and ZO-1) and mucin-2. Finally, 16S rDNA sequencing revealed that modified PD improved intestinal dysbiosis.

CONCLUSION

Our research offers new insights into the potential mechanism of modified PD in alleviating IM and provides experimental evidence supporting its pharmaceutical application in clinical IM treatment.

Fecal calprotectin from ileostomy output in patients with Crohn's disease

BACKGROUND

Fecal calprotectin (FC) is a reliable biomarker widely used for assessing disease activity and postoperative monitoring in patients with Crohn's disease (CD); however, its efficacy in patients with an ileostomy is poorly understood. Our study evaluated whether FC from the ileostomy output can be used to predict postoperative small bowel inflammation in patients with CD.

METHODS

Data from patients with CD and an ileostomy who had undergone FC measurement between January 1, 2015, and December 30, 2022, were analyzed retrospectively. Patients were enrolled in the study if they had undergone FC tests with concurrent imaging and/or endoscopic studies, facilitating comparison between FC tests and imaging and/or endoscopic examinations. FC measured with the point-of care (POC) test was denoted as FC-POCT, and that measured using the enzyme-linked immunosorbent assay (ELISA) was denoted as FC-ELISA.

RESULTS

This study analyzed 101 patients and 224 FC test results. FC concentration differed significantly in patients with signs of small bowel inflammation on imaging and/or ileoscopy compared with those in remission (FC-POCT: median 191.0 µg/g; interquartile range [IQR], 94.6-499.0 µg/g vs. 29.9 µg/g; IQR, 29.9-50.0 µg/g; P < 0.001; FC-ELISA: median 252.5 µg/g; IQR, 118.5-911.0 µg/g vs. 16.8 µg/g, IQR, 8.2-33.0 µg/g; P < 0.001). The optimal cutoff value for FC-POCT and FC-ELISA to distinguish between small bowel inflammation and remission was 63.3 µg/g (area under the curve [AUC], 0.90; 95% confidence interval [CI], 0.88-0.97) and 40.1 µg/g (AUC, 0.89; 95% CI, 0.79-0.99), respectively. We also compared the diagnostic accuracy between the POC and ELISA testing methods and found no statistically significant difference (P = 0.692).

CONCLUSIONS

FC from the ileostomy output is a valuable biomarker with high sensitivity and specificity for monitoring small bowel inflammation in postoperative patients with CD and an ileostomy.

Pediatric Inflammatory Bowel Disease Type Unclassified: A Nationwide Cohort Study in Scotland With up to 20 Years Follow-up Shows Reclassification in the Majority and Mild Course in Those Whose Diagnosis Is Unchanged

BACKGROUND

Given the paucity of long-term longitudinal data for inflammatory bowel disease type unclassified (IBDU), we aimed to clarify IBDU disease course and reclassification rate by presenting nationwide data with up to 20 years of follow-up.

METHODS

We analyzed a prospectively identified 11-year cohort of pediatric patients diagnosed with IBDU between January 1, 2003 and December 31, 2013 at all Scottish pediatric IBD centers and followed up into adult services until December 31, 2022. Data were obtained from electronic medical records at fixed timepoints (5 and 10 years post-diagnosis) and at the final follow-up.

RESULTS

Overall, 102 patients were included in the analysis (57/102 [56%] male, median [interquartile range {IQR}] age at diagnosis: 11.5 [9.1-13.2] years) with a median (IQR) follow-up length of 10.5 (8.6-14.0) years. A change of diagnosis was made in 61 of 102 patients (60%); of these, 30 patients (29%) were reclassified to Crohn's disease (CD) and 31 patients (30%) to ulcerative colitis (UC). Patients who remained with IBDU had higher 1- to 5-year remission rates (IBDU 30/39 [77%] vs reclassified 16/57 [28%], P < .05), with lower rates of moderate-to-severe disease (IBDU 3/39 [8%] vs reclassified 31/57 [54%], P < .05) and less need for biologics across all timepoints (IBDU vs reclassified: first timepoint 1/39 [3%] vs 17/57 [30%], second timepoint 1/33 [3%] vs 26/56 [46%], third timepoint 0/18 [0%] vs 16/33 [49%]; all P < .05). Higher rates of surgical resections were observed in reclassified patients (reclassified 11/61 [18%] vs IBDU 1/41 [2%], P = .02).

CONCLUSIONS

In our nationwide pediatric IBDU cohort, 60% of patients were reclassified to either UC or CD over 10.5 years of median follow-up; those who remained with IBDU had a milder disease course.

The Effect of Colesevelam on the Microbiome in Postoperative Crohn's Disease

BACKGROUND

While surgery plays a pivotal role in the management of ileal Crohn's disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn's disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn's disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence.

METHODS

Patients with Crohn's disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT ≤ 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert's score, with disease remission defined as Rutgeert's score

RESULTS

A total of 14 patients who completed the study, 10 of whom had a 75SeHCAT positive diagnosis of bile acid diarrhea and were started on treatment with colesevelam. Four patients did not require treatment as 3 were asymptomatic and 1 had a negative 75SeHCAT scan. Three of the fourteen patients had disease recurrence at their 6-12 month postoperative colonoscopy assessment, of which 1 patient was taking colesevelam and 2 patients were not taking colesevelam. A total of 44 fecal samples and 44 mucosal biopsies underwent 16S ribosomal RNA gene analysis to assess α/β-diversity and microbial composition. In the colesevelam treated patients there was no significant difference in α/β-diversity pre- and posttreatment. Pretreatment, the 3 most abundant bacterial classes in all patients were Bacteroidia, Clostridia, and Gammaproteobacteria. Following 6-12 months of treatment, out of the 9 patients on colesevelam, 5/9 (55.6%) had a reduction in Bacteroidia, 9/9 (100%) had an increase in Clostridia, and 7/9 (77.8%) had a reduction in Gammaproteobacteria. Of the 2 patients not given colesevelam, one showed a reduction in Bacteroidia, increase in Clostridia and a reduction in Gammaproteobacteria.

CONCLUSIONS

This small pilot study demonstrated that patients who were given colesevelam, were more likely to be in disease remission at their 6-12 months colonoscopy review compared with those not treated. Furthermore, treatment with colesevelam may have a role in altering the microbiome to help maintain remission states in postoperative Crohn's disease. Larger mechanistic studies are now needed to confirm these findings and demonstrate statistical significance as well as investigate whether this benefit may be present even in those patients with 75SeHCAT negative disease.

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Key Words

• Crohn’s disease
• bile acid diarrhoea
• bile acid sequestrants
• colesevelam
• microbiome
• terminal ileal resection

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MESH Headings

• Humans
• Crohn Disease/surgery
• Crohn Disease/microbiology
• Crohn Disease/drug therapy
• Female
• Male
• Adult
• Pilot Projects
• Gastrointestinal Microbiome/drug effects
• Colesevelam Hydrochloride/therapeutic use
• Middle Aged
• Diarrhea/drug therapy
• Diarrhea/etiology
• Diarrhea/microbiology
• Bile Acids and Salts/metabolism
• Postoperative Complications/drug therapy
• Postoperative Complications/microbiology
• Feces/microbiology
• Colonoscopy
• Ileum/surgery
• Follow-Up Studies
• Recurrence
• Young Adult
• RNA, Ribosomal, 16S/genetics

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Grants

• Bowel and Cancer Research

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Affiliation(s)

Aditi Kumar Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
Mohammed Nabil Quraishi University of Birmingham Microbiome Treatment Centre, Birmingham, UK Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Hafid O Al-Hassi Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, UK
Mohammed Elasrag Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
Jonathan P Segal Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia
Manushri Jain Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
Helen Steed Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton, UK
Jeffrey Butterworth Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
Adam Farmer Division of Gastroenterology & Hepatology, St Louis University Hospital, St Louis, MO, USA
John Mclaughlin Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Department of Gastroenterology, Salford Royal Foundation Trust, Stott Lane, UK
Andrew D Beggs University of Birmingham Microbiome Treatment Centre, Birmingham, UK Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
Matthew J Brookes Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton, UK

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Collaborators Collapse

Increased Risk of Inflammatory Bowel Disease Among Patients With Nontyphoidal Salmonella Infections: A Population-Based Cohort Study

BACKGROUND

Despite the known association between microorganisms and development of inflammatory bowel disease (IBD), the role of nontyphoidal Salmonella (NTS) in IBD is not adequately addressed. We aimed at elucidating the relationship between NTS infection and the risk of IBD.

METHODS

Based on the National Health Insurance Research Database in Taiwan, this retrospective cohort study enrolled patients with NTS infection (exposure group; n = 4651) and those without NTS infection (comparator group; n = 4651) who were propensity score matched (1:1) by demographic data, medications, comorbidities, and index date. All patients were followed until IBD onset, individual mortality, or December 31, 2018. Cox proportional hazards regression analysis was performed to determine the hazard ratios and 95% confidence intervals (CIs). Sensitivity analyses were used for cross-validation.

RESULTS

The NTS group demonstrated an increased risk of IBD compared with the non-NTS groups (adjusted hazard ratio [aHR], 2.12; 95% CI, 1.62-2.78) with a higher risk of developing ulcerative colitis in the former (aHR, 2.27; 95% CI, 1.69-3.04). Nevertheless, the small sample size may contribute to lack of significant difference in Crohn's disease. Consistent findings were noted after excluding IBD diagnosed within 6 months of NTS infection (aHR, 2.28; 95% CI, 1.71-3.03), excluding those with enteritis/colitis before index date (aHR, 1.85; 95% CI, 1.28-2.68), excluding those using antibiotics for 1 month in the year before IBD onset (aHR, 1.81; 95% CI, 1.34-2.45), inverse probability of treatment weighting (aHR, 1.64; 95% CI, 1.31-2.04), and inclusion of individuals regardless of age (n = 10 431; aHR, 1.83; 95% CI, 1.53-2.19).

CONCLUSIONS

Patients with NTS were associated with an increased risk of developing IBD, especially ulcerative colitis.

Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand

BACKGROUND

The incidence of pediatric inflammatory bowel disease (IBD) is rising, and there is an increasing need to support adolescents when they transition to adult care. Evidence supports the use of a structured transition process but there is great variation across Australasia. The study aim was to develop evidence and expert opinion-based consensus statements to guide transitional care services in IBD.

METHODS

A modified UCLA-RAND methodology was employed to develop consensus statements. An IBD expert steering committee was formed and a systematic literature review was conducted to guide the drafting of consensus statements. A multidisciplinary group was formed comprising 16 participants (clinicians, nurses, surgeons, psychologists), who anonymously voted on the appropriateness and necessity of the consensus statements using Likert scales (1 = lowest, 9 = highest) with a median ≥7 required for inclusion. Patient support groups, including direct input from young people with IBD, informed the final recommendations.

RESULTS

Fourteen consensus statements were devised with key recommendations including use of a structured transition program and transition coordinator, mental health and transition readiness assessment, key adolescent discussion topics, allied health involvement, age for transition, and recommendations for clinical communication and handover, with individualized patient considerations. Each statement reached median ≥8 for appropriateness, and ≥7 for necessity, in the first voting round, and the results were discussed in an online meeting to refine statements.

CONCLUSIONS

A multidisciplinary group devised consensus statements to optimize pediatric to adult transitional care for adolescents with IBD. These guidelines should support improved and standardized delivery of IBD transitional care within Australasia.

Global Epidemiology and Geographic Variations of Pediatric-Onset Inflammatory Bowel Disease: A Comprehensive Analysis of the Global Burden of Disease Study 1990 to 2019

BACKGROUND

An increasing incidence of pediatric-onset inflammatory bowel disease (PIBD) has been reported in many countries. However, the global burden and distribution of this disease remain less understood. We aimed to examine the global epidemiology and trends of PIBD from 1990 to 2019.

METHODS

Data from the 2019 Global Burden of Disease Study, covering 204 countries, were analyzed. We assessed key measures like incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using linear regression to calculate annual percentage changes and assess trends.

RESULTS

Between 1990 and 2019, the PIBD incidence rate increased and the DALY rate and mortality rate declined. The incidence rate was notably elevated in the high Socio-demographic Index (SDI) quintile, reaching 6.3 per 100 000 person-years, corresponding to 13 914 new cases in 2019. Incidence and prevalence of PIBD positively correlated with the SDI, while higher death and DALY burdens were observed in lower-SDI countries. In 2019, the top 5 countries with the highest PIBD incidence rates were Canada (19.9 per 100 000 population), Denmark (12.4 per 100 000 population), Hungary (8.5 per 100 000 population), Austria (8.1 per 100 000 population), and the United States (7.4 per 100 000 population). Several countries experienced significant increases in incidence rates from 1990 to 2019, led by Taiwan (annual percent change 4.2%), followed by China (2.8%), Japan (2.1%), Australia (1.8%), and Hungary (1.6%).

DISCUSSION

PIBD incidence has significantly increased since 1990. High-SDI countries face higher incidence, while lower-SDI countries experience higher mortality and DALY burdens. The study underscores the need for ongoing monitoring and research to address this emerging public health issue.

Overcoming dietary complexity in type 2 diabetes: influencing factors and coping strategies

BACKGROUND

Adherence to dietary guidelines is a fundamental aspect of diabetes management; however, it poses a significant challenge for patients with diabetes. Our research aims to assess the level of dietary compliance among individuals with type 2 diabetes (T2DM) and to identify the factors that influence their adherence to dietary advice.

METHODS

This study was a cross-sectional survey. The patients with T2DM undergoing treatment at our hospital from March, 2023, to June, 2024 were included. Compliance with dietary recommendations was assessed using the validated dietary compliance scale for type 2 diabetes mellitus patients (DCS-T2DM). Spearman correlation and logistic regression analyses were conducted to evaluate the factors influencing dietary compliance in patients with T2DM.

RESULTS

A total of 308 T2DM patients were included in our study. The results revealed that 46.10% of the participants had suboptimal dietary compliance. There were significant correlations between dietary compliance and several demographic and clinical factors, including age (r = 0.501), gender (r = 0.447), education level (r = 0.610), average monthly household per capita income (r = 0.627), and the duration, since T2DM diagnosis (r = 0.552), all of which were statistically significant (p < 0.05). Logistic regression identified age (OR = 1.705, 95%CI 1.262 ~ 1.987), gender (OR = 2.401, 95%CI 1.909 ~ 3.134), education level (OR = 3.083, 95%CI 2.434 ~ 3.957), average monthly household per capita income (OR = 3.721, 95%CI 2.553 ~ 4.405), and the time since T2DM diagnosis (OR = 2.470, 95%CI 1.755 ~ 3.262) as significant predictors of dietary compliance.

CONCLUSIONS

46.10% of patients with T2DM exhibited suboptimal dietary adherence, with age, gender, education, income, and diabetes duration significantly predicting compliance. It is imperative for healthcare providers to devise individualized intervention strategies that incorporate these pivotal factors to enhance dietary adherence in patients with T2DM.

Diagnostic interval of inflammatory bowel disease in Chinese children and its relationship with growth parameters: a retrospective study

Background

Delayed diagnosis of inflammatory bowel disease (IBD) is common in Europe and North America, with limited research in Asia. We aimed to investigate factors influencing delayed diagnosis of IBD in Chinese children and the impact of delayed diagnosis on growth.

Methods

This was a retrospective study. Clinical data on children with IBD were collected through electronic medical records. The diagnostic interval includes the time from symptom onset to hospital admission and admission to diagnosis. Diagnostic delay was defined as the upper quartile of the time interval from the first symptom to the diagnosis of IBD. For the effect on growth indicators, the length of follow-up was at least 3 months from diagnosis.

Results

This study included 222 children with IBD, predominantly with Crohn's disease (86.0%). Approximately one-quarter of children require more than 366 days to be diagnosed with IBD, primarily due to the extended interval between the onset of initial symptoms and hospital admission. Multivariate logistic regression models showed that fever was associated with a prolonged time interval from first symptom onset to admission and the odds ratio (OR) was 0.45 [95% confidence interval (CI) 0.22-0.94]. Age and bloody stools were associated with prolonged intervals from admission to diagnosis, with ORs of 0.84 (95% CI 0.77-0.92) and 0.36 (95% CI 0.14-0.94), respectively. Delayed diagnosis was associated with height at first admission and follow-up. Children with a delayed diagnosis had a 5.87-fold higher chance of growth retardation upon initial admission compared to children without a delayed diagnosis (95% CI 1.59-24.05). After 15.7 months of follow-up, this elevated risk remained (OR 3.28, 95% CI 1.00-10.50).

Conclusion

Delayed diagnosis is common in Chinese children with IBD and is associated with persistent height impairment.

The association between perceived social support and self-management behaviors in adolescents and young adults with inflammatory bowel disease: the chain mediating role of basic psychological needs and anxiety/depression

Introduction

The incidence of inflammatory bowel disease (IBD) has been increasing, with adolescents and young adults being the peak age of onset. Self-management behaviors were demonstrated to enhance remission and quality of life, yet the mechanisms influencing self-management behaviors remained under-explored. Perceived social support is crucial to self-management behaviors, alongside the roles of basic psychological needs, anxiety, and depression.

Methods

We conducted a two-center cross-sectional survey in China from July to August 2024 via convenience and snowball sampling to investigate how these variables influence self-management behaviors. Data were collected utilizing the structured self-report questionnaires. Mediating effects were analyzed using the bootstrap method.

Results

A total of 183 adolescents and young adults with IBD (male: 71.58%), aged 13 to 24 years old (M = 20.33, SD = 3.03), were included in the analysis. The research findings include the following points: (1) perceived social support positively predicted self-management behaviors (β = 0.767, P < 0.001); (2) perceived social support affected self-management behaviors through chain mediation involving basic psychological needs and anxiety/depression.

Conclusion

Clinical practitioners should enhance social support for adolescents and young adults with IBD and improve their perceptions of such support, fulfill basic psychological needs, and alleviate anxiety and depression to promote effective self-management behaviors.

Body mass index does not influence loss of response to tumor necrosis factor inhibitors in Crohn's disease

OBJECTIVES

Moderate to severe Crohn's disease (CD) treatment was revolutionized by introducing anti-tumor necrosis factor (TNF) agents, which is still a cornerstone of the treatment. It is speculated that adipose tissue may influence treatment response, especially for non-weight-adjusted agents.

PATIENTS AND METHODS

Research comparing the effectiveness of anti-TNFs between eutrophic and overweight patients may impact clinical management. We performed a retrospective analysis of a CD patient database. The primary endpoint was loss of response (LOR) after 54 weeks with infliximab (IFX) and adalimumab (ADA) in patients with body mass index (BMI) <25 and ≥25. Secondary endpoints were steroid-free remission and endoscopic remission rate.

RESULTS

One hundred seventy-nine CD patients were evaluated; 48.9% had LOR after 54 weeks of anti-TNF therapy. Fifty-four patients had a BMI ≥25, with 51 receiving IFX and 28 receiving ADA. The univariate analysis identified LOR in 56.5% of the patients with IFX and 34.9% in the ADA group (p=0.009). In the 54-week multivariate analysis, loss of response in the IFX group with BMI ≥25 had a relative risk of 1.04 [CI 0.60-1.80 (p=0.891)] compared to patients with BMI <25. Being overweight or obese led to a risk of 1.50 for LOR for ADA at 54-week time point [CI 0.60-3.74 (p=0.0387)]. Clinical remission at 54 weeks was similar between BMI groups.

CONCLUSIONS

Being overweight did not influence the LOR to treatment when IFX and ADA were compared, nor did it affect clinical and endoscopic remission after 54 weeks.

Prevalence of Sexual Dysfunction in Inflammatory Bowel Disease: Systematic Review and Meta-analysis

BACKGROUND AND AIMS

Patients with inflammatory bowel disease (IBD) may experience symptoms of sexual dysfunction (SD). However, the magnitude of this problem remains uncertain. Therefore, we performed a systematic review and meta-analysis to assess the prevalence of SD in adult patients with IBD.

METHODS

MEDLINE, EMBASE, and EMBASE Classic (from inception to April 9, 2024) were searched to identify observational studies reporting the prevalence of SD in adult patients with IBD based on validated screening instruments. Data were extracted, and pooled prevalence (PP), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated.

RESULTS

Of 1017 citations evaluated, 18 articles fulfilled the eligibility criteria, containing 2694 patients with IBD recruited from 13 different countries. The PP of SD in IBD patients was 50.6% (95% CI, 40.8%-60.5%; I2 = 96.3%) with an OR = 2.94 (95% CI, 1.99%-4.35%, I2 = 73.4) compared to healthy controls. When we considered ulcerative colitis (UC) or Crohn's disease (CD) separately, the PP of SD was 64.8% (95% CI, 45.1%-82.1%; I2 = 88.8%) in patients with UC and 58.3% (95% CI, 36.0%-79.0%; I2 = 95.3%) in patients with CD. In the subgroup analysis based on sex, the PP of SD was higher in females with IBD than in males (62.7% vs 34.0%; OR = 3.99, 95% CI, 2.80%-5.68%; I2 = 61.7%). Furthermore, the PP of SD was higher in patients with active disease than in patients with inactive disease (75.1% vs 34.2%; OR = 9.65, 95% CI, 1.02%-91.33%, I2 = 95.5%).

CONCLUSIONS

We demonstrated high prevalence of SD in IBD patients, especially in women. Encouraging gastroenterologists to screen for, and treat, these disorders with a holistic approach might improve quality of life of patients with IBD.