Exabis Library

1. To review the goals achieved in Imaging of IBD during the past few years and the new challenges for the next future
2. 1. To understand the future directions of imaging for IBD
3. To have an overview of the current and future role of AI in Imaging of IBD

Educational objectives:

1. Recognize the importance of diet in IBD and the interaction with microbes
2. Diet: not just feeding ourselves
3. ‘Functional foods’: diet as a microbe-altering treatment
4. Discuss what microbe-targeted diet therapy in IBD might look like in the future

Summary:

Both microbes and diet are likely to be involved in the pathogenesis of IBD and some studies suggest that it is the interaction between diet and microbes that offers opportunities for understanding why IBD develops and possibly even offer therapeutic options. Key to this is the recognition that elements in our diet specifically target and influence the microbes and that altering the diet could impact IBD, through effects on microbes.

This talk will focus on how this knowledge and area of research is likely to evolve in the future, highlighting the importance of specific food compounds (such as fibre), the use of complex research tools (including metabolomics), the development of personalized diets, and how this all might impact patient care, and perhaps even disease prevention. While this field is still in very early stages of development, there is much promise that diet will have a major impact on IBD care in the future, through defining impacts on microbes. It is important for both dietitians and those involved in diet research in IBD to be aware of this evolving field.

1) To review the clinical key predictors of poor outcome in IBD
2. To understand the progress made in predicting the future for a given IBD patient
3. To learn how to communicate risk to the patient

IBD is a chronic immune-mediated disease that requires continuous patient care. The frequent contact and the good relationship with the multidisciplinary team (MDT) are essential for improving quality of life (QoL) and medication adherence aiming at treatment success. The aim of the study was to assess the importance of MDT in the view of patients with IBD and its impact on QoL and in medication adherence.

A cross-sectional study was carried out, including 114 patients from an IBD reference center in Brazil. The relevance of MDT was assessed through a questionnaire that included the importance of physicians, nurses, nutritionists and psychologists in the patient care. QoL was assessed by IBDQ. Treatment adherence and knowledge about the disease were assessed using the Morisky and CCKNOW questionnaires, respectively.

:In total, 69 (60.53%) patients with CD and 45 (39.47%) patients with UC were included. The mean age was 39.16 (±13.50) years and 58.77% were female. The disease duration was 9.88 (±7.35) years. Presence of comorbidities was observed in 52.63% patients. About 57 (82.61%) patients with CD use biological therapy, with a statistical difference (p <0.0001) when compared to patients with UC (37.78%). The gastroenterologist was considered very important by 91.23% of patients, coloproctologist by 62.07% of patients, nurse by 65.05% of patients, nutritionist by 50% of patients and psychologist by 47.25% of patients. In the analysis of QoL, 24 (21.05%) patients had excellent QoL, 52 (45.61%) had good QoL, 29 (25.44%) had regular QoL and 9 (7.89%) had poor QoL, with no difference between patients who followed with nurses or other MDT professionals (Table 1). Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among patients with CD (p = 0.01). Patients identify the doctor as the main provider of care for their health, but about 10% leave with doubts from their appointments. 10% of patients think that more care with the nurse is necessary and less than 10% of patients are clarified by the nurse about QoL, ostomies, fecal incontinence, disease activity, biological therapy and sexuality.

Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals, mainly do the Covid pandemic in 2020 and 2021. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL.

Data regarding the influence of prednisolone tapering on clinical outcomes among patients with ulcerative colitis (UC) are limited. We aimed to investigate the influence of different prednisolone tapering algorithms on the effectiveness of infliximab (IFX) among patients with UC.

This Danish retrospective single-center study included all patients with UC who were treated with IFX between 2009 and 2019 at Herlev University Hospital. The patients were grouped according to the prednisolone tapering: standard (≤5 mg/week), fast (>5 mg/week), or direct discontinuation after an initial course of less than one week. Finally, we included a control group of patients treated with IFX monotherapy. The primary outcome was corticosteroid-free clinical remission at weeks 14 and 52 defined as a partial Mayo score ≤1. Variables with a p-value ≤0.20 in univariable regression analysis were included in multivariable analysis. A subgroup analysis containing patients with acute severe ulcerative colitis (ASUC) treated with at least 40 mg of prednisolone at initiation of IFX was performed.

The study included 148 patients with UC of whom 81 (54.7%) were treated with prednisolone at the initiation of IFX. No association between prednisolone tapering and corticosteroid-free clinical remission with IFX at weeks 14 or 52 was observed (Figure 1 and Table 2). However, a higher proportion of patients in the standard tapering group achieved a C-reactive protein (CRP) level less than 5 mg/L at week 14 as compared with the fast-tapering group (23/23 (100%) vs. 14/18 (77.8%); p=0.03) and directly discontinuation group (6/10 (60%); p=0.03). This difference was not explained by prednisolone usage. In addition, none of the patients within the standard tapering regime (0/24; 0%) had severe activity at week 14 whereas this was seen in 4/19 (21.1%) in the fast tapering regime (p=0.03). In the subgroup analysis of 33 patients with ASUC, the standard tapering algorithm was associated with higher clinical remission as compared with the fast tapering regime at week 14 (9/14 (64.3%) vs. 5/19 (27.8%); p=0.02) and clinical response or remission at week 52 (12/14 (85.7%) vs. 7/19 (36.8%); p=0.01, Figure 2).

This study demonstrated no overall impact of prednisolone tapering algorithms on short and long-term effectiveness of IFX in patients with UC. However, standard tapering resulted in lower CRP levels and fewer cases of severe disease activity in the overall cohort and higher rate of short and long-term clinical response among ASUC patients, as compared with fast tapering regimes. Taken together, the data indicate that longer corticosteroid exposure in patients with high disease burden might improve IFX responses.

Educational objectives

1-    To understand that IBD are associated with worse quality of life and high rates of depression, beyond symptoms alone.

2-    To consider the role of psychological components on postoperative outcomes

3-    To understand the rationale and results of our study

4-    To understand the rationale for preoperative psychological support in IBD patients

Summary

Background: Inflammatory bowel diseases lead to increased rates of depression and reduced quality of life (QoL), beyond intestinal symptoms alone. QoL seems to improve at 1 year after surgery, but not in the short term. No studies have explored the potential role of psychological components (mindfulness in particular) on postoperative outcomes. 

Aim: the aim of this pilot-study was to explore the correlation between a set of psychological predictors, QoL and surgical outcomes.

Methods: psychological questionnaires were administered before surgery. QoL questionnaires were administered both preoperatively and at 30- 90 days and 6 months after surgery. Length of stay (LOS), postoperative pain and complications were also evaluated. 

Results: 30 patients were enrolled(56% Crohn’s - CD, 44% ulcerative colitis - UC). 67% were males. Mean age was 43,5, mean BMI 22,6. Most patients were ASA 2(70%). Smoke habit was reported in 17%. Charlson Comorbidity Index was 0 in 54% of patients, 1 in 23%, 2 in 17%, 3 in 3% and > 5 in 3%. Index procedure was ileocecal resection in 47% of cases, total colectomy in 13% and restorative proctectomy in 40%. Mean operative time was 186 minutes. In 53% of patients a temporary stoma was performed. No differences in baseline psychological characteristics were found between CD and UC patients. Higher levels of stress(PSS) (P=0.0008), anxiety(HADS-A)(P=0.028) and depression (HADS-D)(P=0.028)were correlated with worse preoperative QoL. No correlation was found between preoperative psychological predictors and LOS, postoperative pain and functional recovery (time to 1° bowel movement). However, the logistic regression model found a correlation between postoperative complications and Anxiety(HADS-A). Patients experienced a significant increase in QoL after surgery(30 days, P=0.008; 90 days, P=0.005). Patients with higher QoL and Cognitive Flexibility Scale scores at baseline had more probabilities to experience a significant improvement 30 and 90 days after surgery(P<0.0001; P=0.04).

Conclusions: stress, anxiety and depression impacted on preoperative QoL. Anxiety correlated with postoperative adverse outcomes. Cognitive flexibility had a positive effect on QoL improvement at 30 and 90 days after surgery. Patients with higher baseline QoL were more susceptible to improve their QoL over time after surgery.