P178 - A pilot study of elemental diet for chronic pouchitis

Inflammatory Bowel Disease Clinical

Objectives:PERFUSE is a non-interventional study of 1233 patients [inflammatory rheumatic disease, n = 496; inflammatory bowel disease (IBD), n = 737] receiving infliximab (IFX) biosimilar SB2 therapy. This analysis describes response to treatment and persistence on SB2 for up to 12 months in pediatric IBD patients (n = 126).Methods:Pediatric IBD patients with Crohn disease (CD) or ulcerative colitis (UC), either naïve or switched from originator IFX, who started SB2 in routine practice after September 2017 were eligible. Data were captured for 12 months following SB2 initiation. Disease activity was measured using C-reactive protein (CRP) levels and the Harvey-Bradshaw Index or Pediatric Ulcerative Colitis Activity Index for CD and UC patients, respectively. Body mass index and height z scores were used to assess patient growth between initiation (M0) and month 12 (M12).Results:One hundred twenty-six pediatric IBD patients were included (102 CD patients, 51 naïve and 51 switched; 24 UC patients, 9 naïve and 15 switched). Naive patients’ disease scores decreased between M0 and M12. CRP measurements also decreased in naïve CD patients. Switched patients’ disease scores and CRP levels remained stable between M0 and M12. Height z scores improved significantly over the course of the treatment for all groups except for naïve UC patients.Conclusions:SB2 provides effective disease control for naïve and switched pediatric patients. Clinical remission rates improved in naïve patients and no loss of control was observed in switched patients after 1 year. Growth failure is not observed in IBD patients under SB2 treatment.

P-008: Fecal gas analysis by electronic nose: a novel, non-invasive technique for assessment of active and quiescent pediatric inflammatory bowel disease

The present study aimed to investigate faecal calprotectin as a diagnostic marker to differentiate between patients with inflammatory bowel disease (IBD) and those with irritable bowel syndrome (IBS). A total of 20healthy control subjects, 26patients with IBS and 58patients with IBD, including 22with ulcerative colitis (UC) and 36with Crohn's disease (CD), were recruited for the present study. Calprotectin was analysed in stool samples, and C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were assessed in blood samples. CRP and calprotectin levels, and the ESR were observed to be significantly higher in patients with CD and UC compared with those of the healthy control subjects (P<0.0001). Furthermore, in patients with IBD and IBS, significant increases in faecal calprotectin and CRP levels were observed (694.8±685.0µg/g in IBD vs. 85.8±136.1µg/g in IBS and 0.851±1.200mg/dl in IBD vs. 0.16±0.23mg/dl in IBS, respectively; P<0.0001). Area under the receiver operating characteristic curve analysis revealed that, in patients with IBD, the levels of faecal calprotectin [0.931±0.029; 95% confidence interval (CI), 0.874‑0.987] were significantly higher than that of CRP (0.865±0.041; 95%CI, 0.785‑0.946) and the ESR (0.869±0.042; 95% CI, 0.786‑0.952). These findings indicate that faecal calprotectin may represent a novel biomarker for diagnosing IBD and may be effective in distinguishing between IBD and IBS.

P-049: Reproducibility of serologic antibody activity at diagnosis and after treatment in pediatric ulcerative colitis and Crohn’s disease

Background Ileo-colonoscopy remains the gold standard for assessing Inflammatory Bowel Disease (IBD) activity, but its invasiveness and cost limit frequent use in clinical practice. Current biomarkers, including C-reactive protein (CRP) and fecal calprotectin (FC), show suboptimal sensitivity and specificity, and FC adherence is often poor. Lipopolysaccharide-binding protein (LBP), a circulating acute-phase reactant binding bacterial lipopolysaccharides, reflects microbial translocation and intestinal permeability. We aimed to evaluate LBP as a potential non-invasive biomarker of disease activity in IBD. Methods In this prospective observational study, adult patients (≥18 years) with confirmed Crohn’s disease (CD) or ulcerative colitis (UC) undergoing follow-up endoscopy were enrolled. Inclusion required endoscopic activity (SES-CD ≥4 for CD; Mayo ≥1 for UC). Exclusion criteria included chronic liver disease, pregnancy, proctocolectomy, or stoma. Study visits were scheduled at baseline, 8–16 weeks (V1), and 16–24 weeks (V2); only baseline and V1 data were considered for the present analysis. Clinical activity (PRO2) and biomarkers (CRP, FC) were collected. Serum LBP was measured by ELISA. Diagnostic accuracy and correlations with disease activity were assessed using nonparametric and correlation analyses. Results Eighty-nine IBD patients were included (45 CD, 44 UC). Cohort demographic data are summarized in Table 1. At baseline, LBP correlated strongly with CRP (ρ = 0.546, p &amp;lt; 0.001) and moderately with endoscopic activity (ρ = 0.31, p &amp;lt; 0.01), but not with FC. LBP also correlated positively with PRO2 scores (ρ = 0.293, p &amp;lt; 0.01), supporting its association with both objective and patient-reported disease activity. As shown in Figure 1A, the correlation between CRP and LBP at baseline strengthened after excluding corticosteroid-treated patients with normal CRP (ρ = 0.59, p &amp;lt; 0.001), indicating that LBP levels are not influenced by corticosteroid therapy. Between baseline and V1, changes in LBP (ΔLBP) positively correlated with changes in CRP (ΔCRP) (ρ = 0.455, p &amp;lt; 0.01) (Figure 1B), supporting its value for dynamic monitoring. Finally, PRO2-based response showed that clinical non-responders exhibited a significant increase in LBP from baseline to Visit 1 (p &amp;lt; 0.05), suggesting that LBP may act as an early marker of lack of response (Figure 1C). Conclusion In this prospective PROBIO cohort of active IBD, serum LBP correlated with objective inflammatory markers and patient-reported outcomes, while remaining unaffected by corticosteroids therapy. These findings support LBP as a potential non-invasive biomarker for disease activity and treatment monitoring in IBD. Conflict of interest: Mrs. Minsart, Charlotte: No conflict of interest Toris, Louison: No conflict of interest Husson, Cécile: No conflict of interest Cremer, Anneline: No conflict of interest Amininejad, Leila: No conflict of interest Franchimont, Denis: No conflict of interest Liefferinckx, Claire: Consultancy/speaker fees: Takeda, Janssen, Abbvie, Alfasigma, Celltrion

ObjectiveWe aimed to assess patients with axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) for disease activity and serum markers of endothelial dysfunction.MethodsWe studied 161 patients (123 males, 38 females) with axSpA: 153 with ankylosing spondylitis and 8 with non-radiographic axSpA, and 30 healthy controls (HC). We collected: age; sex; disease duration; extra-articular symptoms (IBD and acute anterior uveitis), comorbidities; human leukocyte antigen B27 status; and treatment. We measured serum interleukin (IL)-6, interleukin-18, IL-23, vascular endothelial growth factor (VEGF) epidermal growth factor (EGF), asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1), and fetuin-A levels.ResultsIBD was diagnosed in 19 (11.8%) patients with axSpA. Compared to patients with axSpA without IBD, those with IBD had higher serum C-reactive protein (CRP) level (p = 0.05), erythrocyte sedimentation rate (ESR) (p = 0.005), and serum ET-1 levels (p = 0.01). In patients with axSpA and IBD, ET-1 levels correlated positively with CRP level (p = 0.006) and ESR (p = 0.02), and ADMA levels with visual analog scale scores (p = 0.01). Patients with axSpA and IBD had higher serum levels of IL-6 (p = 0.01), IL-18 (p = 0.005), and ADMA (p = 0.01) and lower serum levels of fetuin-A (p = 0.01) than did controls.ConclusionsPatients with axSpA and IBD had higher levels of disease activity, as assessed by ESR and CRP and ET-1 levels, than did patients with axSpA without IBD. Compared to HC, patients with axSpA and IBD had increased IL-18, ADMA levels and decreased fetuin-A level.

Leucine-rich alpha-2 glycoprotein (LRG) is a novel serum biomarker for inflammation in inflammatory bowel disease (IBD). This prospective study aimed to compare the value of LRG with C-reactive protein (CRP) and fecal calprotectin for evaluating clinical and endoscopic disease activity in patients with IBD. At entry, clinical and endoscopic disease activity was assessed in 267 patients with IBD (ulcerative colitis [UC] 203; Crohn's disease [CD] 64), and the levels of LRG, CRP and fecal calprotectin were measured. The accuracy of the biomarkers for the detection of clinical and endoscopic disease activity was determined by the area under the receiver operating characteristic curve. Leucine-rich alpha-2 glycoprotein showed a significant relationship with the clinical and endoscopic severity in both UC and CD (both diseases, P < .0001). In the clinical assessment of UC, the accuracy of LRG was significantly higher than that of CRP (0.73 vs 0.63; P < .001). In the endoscopic assessment of UC, the accuracy of LRG was significantly higher than that of CRP (P = .01), but it was significantly lower than that of fecal calprotectin (P = .009; LRG, 0.80; CRP, 0.72; fecal calprotectin, 0.91). In the clinical and endoscopic assessment of CD, the accuracy was not significantly different between the biomarkers (clinical activity: LRG, 0.71; CRP, 0.64; fecal calprotectin, 0.66; in endoscopic activity: LRG, 0.79; CRP, 0.78; fecal calprotectin, 0.81). Leucine-rich alpha-2 glycoprotein is a reliable serum biomarker for the assessment of clinical and endoscopic disease activity in patients with IBD. It can be an alternative to CRP for the assessment of UC.

Purpose: The clinical differentiation of inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS) is a difficult process due to the overlapping variety of symptoms. A rapid diagnosis is essential for determining specific medical therapy and for optimizing patient care. Lactoferrin, a marker of activated neutrophils, is a validated indicator of intestinal inflammation, which offers a noninvasive aid for ruling out IBS and for monitoring disease activity in IBD. The aim of our study was to evaluate a rapid membrane test for detecting elevated fecal lactoferrin (IBD EZ VUE™) in the differentiation of active IBD from IBS and as an indicator of disease activity. Methods: Fecal specimens were collected from 116 patients (94 IBD/22 IBS) and from 27 healthy controls. The male: female ratio was 1:1.9 with 73 pediatric and 70 adult specimens. Uncoded samples were tested for elevated lactoferrin using the rapid membrane assay and results were confirmed by enzyme-linked immunosorbent assay (IBD-CHEK™). Disease diagnosis was based on clinical histories and disease activity was assessed using the Harvey Bradshaw Activity Index (HBAI). Results: Compared with disease diagnosis and activity, the rapid membrane assay differentiated active IBD from IBS and healthy controls with 100% sensitivity, specificity, and correlation for adult patients. Active IBD was separated from inactive IBD in adults with 100% sensitivity, specificity, and correlation. In the pediatric group (0–20 years old), active IBD was differentiated from IBS and healthy controls with 100% sensitivity, 91.7% specificity, and 98.1% correlation. The assay was 100% sensitive and 89.5% specific, with 96.7% correlation for discriminating active IBD from inactive IBD in pediatric patients. Lactoferrin levels in active IBD patients were significantly elevated compared to inactive IBD, IBS, and healthy controls (p < 0.002). Conclusions: The IBD EZ VUE™ rapid membrane assay was sensitive and specific for determining IBD activity in pediatric and adult patients. The test was comparable to the HBAI and lactoferrin ELISA, and rapidly detected elevated lactoferrin to help differentiate IBD from IBS. Periodic testing for lactoferrin in IBD patients can aid the determination of disease state and management of patient care.

Laboratory markers have been investigated in inflammatory bowel disease (IBD) for diagnostic and differential diagnostic purposes, for assessment of disease activity and risk of complications, for prediction of relapse, and...

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.

Introduction: Vitamin D deficiency is a known complication in inflammatory bowel disease (IBD), contributing to bone loss, growth impairment, and immune dysfunction. While adults with IBD are at increased risk of deficiency, there is limited comparative data on pediatric patients. Understanding differences in vitamin D status across age groups is critical for informing screening and management strategies. This study aims to compare the prevalence of vitamin D deficiency in pediatric versus adult IBD patients using a large national dataset. Methods: A retrospective cross-sectional analysis was performed using a national dataset of patients with IBD, stratified into pediatric (<18 years) and adult (≥18 years) groups. Each group was stratified based on the presence or absence of vitamin D deficiency, using International Classification of Diseases-10 codes. Adults and children without IBD served as the 2 comparison groups. Descriptive statistics, chi-square tests, and logistic regression analyses were used to estimate prevalence, calculate odds ratios (ORs), and adjust for potential confounders, including age, sex, race, obesity, smoking status, and Charlson comorbidity index. A P-value < 0.05 was considered statistically significant. Results: In adults, 5,171 of 185,918 IBD patients (2.78%) had vitamin D deficiency, compared to 1.58% of non-IBD adults (adjusted OR: 1.63; 95% CI: 1.53–1.74; P < 0.001). In pediatric IBD patients (n = 2,480), 87 (3.51%) had vitamin D deficiency, compared to 0.05% of non-IBD children (adjusted OR: 25.79; 95% CI: 16.02–41.50; P < 0.001). When comparing IBD patients directly, pediatric IBD patients were 1.27 times more likely to have vitamin D deficiency than adult IBD patients (OR: 1.27; P < 0.001). Conclusion: This large-scale analysis shows that pediatric IBD patients have a higher prevalence and relative risk of vitamin D deficiency than adults. The stronger association in children is particularly concerning, given vitamin D's role in immune regulation, gut barrier integrity, and microbiome balance—all critical in controlling intestinal inflammation. Deficiency in these areas may contribute to more severe disease and complications. These findings highlight the need for routine vitamin D screening and early supplementation in pediatric IBD to prevent growth impairment, bone fragility, and flares. Limitations include the retrospective design which may underestimate true deficiency rates. Future research should assess long-term outcomes of supplementation and optimal management strategies across the lifespan.

Intestinal Behçet's disease (BD) is a manifestation of BD involving the gastrointestinal tract. Although fecal calprotectin (FC) is a useful inflammatory marker, its role in intestinal BD is unclear. We retrospectively analyzed 78 patients with intestinal BD to evaluate correlations between FC levels and the Disease Activity Index for Intestinal Behçet's Disease (DAIBD), C-reactive protein (CRP), and erythrocyte sedimentation rate. FC and CRP levels were compared between patients in endoscopic remission and those with active disease. Receiver operating characteristic (ROC) curve analysis was used to evaluate FC's ability to predict endoscopic activity and ulcer size. FC levels significantly correlated with DAIBD scores (r= 0.253, P= 0.025) and CRP (r= 0.227, P= 0.046). Patients with endoscopically active disease had higher FC (1,124 ± 1,957 μg/g vs. 367 ± 1,208 μg/g; P< 0.001) and CRP levels (16.0 ± 23.7 mg/L vs. 14.4 ± 46.5 mg/L; P= 0.027) than those in remission. Patients with larger ulcers ( ≥ 30 mm) had higher FC levels than those with smaller ulcers (2,212 ± 2,609 μg/g vs. 962 ± 1,822 μg/g; P= 0.034). An FC cutoff level of 176 μg/g discriminated active endoscopic disease (sensitivity 59.3%, specificity 83.3%), with an area under the ROC curve (AUC) of 0.724 (95% confidence interval, 0.605-0.843; P= 0.002), outperforming CRP (AUC, 0.657). FC levels correlated with DAIBD scores and endoscopic inflammation in intestinal BD. FC outperformed CRP in detecting endoscopic activity, supporting its use in disease management.

Pediatric patients diagnosed with inflammatory bowel disease (IBD) are at risk of suboptimal peak bone mass attainment. This study aimed to understand rates of bone health screening adherence, describe factors associated with dual-energy X-ray absorptiometry (DXA) acquisition, and identify factors associated with abnormal DXA. We performed a retrospective cohort study of pediatric IBD patients over a 10-year time frame. We included IBD patients (2-20 years of age) enrolled in ImproveCareNow and excluded patients with primary metabolic bone disease. Time-to-event methods and multivariable logistic regression were employed to identify factors associated with DXA acquisition and abnormal DXA. In 676 patients, 464 (68.63%) pediatric patients with IBD had a risk factor for low bone mineral density (BMD); 137 (29.53%) underwent an initial DXA scan. Quiescent disease was significantly associated with a reduced likelihood of DXA (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97), while weight z-score <-2 was significantly associated with DXA performance (HR: 2.07; 95% CI: 1.08-3.98). Abnormal DXA results (BMD z-score ≤-1) occurred in 59 (35.54%) individuals. After adjusting for visit diagnosis, delayed puberty, severe disease course, 6 months or greater of steroid exposure, and history of fracture, BMI z-score <-1 (odds ratio: 5.45; 95% CI: 2.41-12.33) was associated with abnormal DXA. DXA screening occurred in less than one-third of eligible pediatric IBD patients. Compliance was more common in patients with a weight z-score <-2 and less common in those with quiescent disease. BMI strongly predicted abnormal DXA results when adjusting for risk factors for abnormal BMD.

Background Subcutaneous infliximab (SC-IFX) offers comparable efficacy and safety profiles to intravenous infliximab (IV-IFX) use in patients with inflammatory bowel disease (IBD), with relative pharmacokinetic stability demonstrated 1, 2. Minimal experience with SC-IFX use in paediatric IBD has been described3, 4. We aimed to assess the clinical tolerability of SC-IFX use in children with IBD requiring anti-tumour-necrosis factor (anti-TNF) treatment. Methods A prospectively identified cohort of children with IBD commenced 120mg fortnightly SC-IFX dosing between February to July 2024 in an Australian tertiary paediatric centre. Treatment followed switch from stable intravenous infliximab (IV-IFX) biosimilar maintenance dosing, or as part of induction treatment. Baseline and four-weekly biochemical and clinical disease activity assessments were undertaken over a 12 week period of follow-up. Results Thirty-one of thirty-three patients completed the 12-week period of treatment follow-up. Median age was 15 years (IQR 14-16.5 years) and 76% (25/33) were male. Twenty-seven patients (82%) had a Crohn’s disease diagnosis. SC-IFX was prescribed as part of induction dosing in 18% (6/33). Biochemical parameters are outlined in Table 1. Median infliximab level increased by 10mg/L to 17.6mg/L at week 12, with a statistically significant increase between baseline level and all other timepoints over the follow-up period (Figure 1). Sixteen patients (48%) had a serum infliximab level greater than 20mg/L at 12 week follow-up. There was no statistically significant change in clinical disease activity indices (Paediatric Crohn’s Disease Activity Index [PCDAI] or Paediatric Ulcerative Colitis Activity Index [PUCAI]) assessed across study timepoints. No correlation between patient characteristics, including demographics, immunomodulator use and previous (if any) IV-IFX regimen, and biochemical markers at baseline or week 12 was seen. High tolerability and treatment persistence were observed in our patient group without any safety concerns. Conclusion We describe the largest cohort of children with IBD prescribed SC-IFX with short-term follow-up. Serum infliximab level increased by 10mg/L over the study period, without significant change in faecal calprotectin and clinical disease activity indices. We observed high treatment persistence in our patient group. Our real-world experience suggests paediatric SC-IFX use may be a reasonable alternative to IV-IFX dosing in children in with IBD. Further large-cohort studies and long-term paediatric data is required. References 1)Schreiber S, Ben-Horin S, Leszczyszyn J et al. Randomized Controlled Trial: Subcutaneous vs Intravenous Infliximab CT-P13 Maintenance in Inflammatory Bowel Disease. Gastroenterology 2021; 160: 2340-53. 2)Buisson A, Nachury M, Bazoge M et al. Long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel disease treated with intensified doses: The REMSWITCH-LT study. Aliment Pharmacol Ther 2024; 59: 526-34. 3)Gianolio L, Armstrong K, Swann E et al. Effectiveness of Switching to Subcutaneous Infliximab in Pediatric Inflammatory Bowel Disease Patients on Intravenous Maintenance Therapy. J Pediatr Gastroenterol Nutr 2023; 77: 235-9. 4)Gianolio L, Armstrong K, Swann E et al. OC5 Effectiveness and safety of switching to subcutaneous infliximab in paediatric inflammatory bowel disease patients on established intravenous biosimilar infliximab maintenance therapy: real world data from a regional cohort. Frontline Gastroenterology 2024; 15: A4-A.