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Crohn Disease (CD) prevalence is rising worldwide. As altered genetics are improbable, this phenomenon likely relates to environmental-dietary changes linked with gut microbiome. We aimed to define host and microbial factors at CD diagnosis.

Multiomics analyses ofSOURCE cohort including clinical, biomarkers (CRP, fecal calprotectin), food frequency questionnaire (FFQ), serum metabolomics, mucosal terminal ileum (TI) transcriptomics, and fecal and mucosal biopsy samples for 16S microbial amplicon sequencing.

25 newly-diagnosed CD and 33 controls (median age 28 years, 50% males). Gender, age, and BMI did not differ between groups, but CRP (p=0.001) and calprotectin (p=E-10) were significantly higher in CD. FFQ results showed that compared to controls, pre-diagnosis CD patients consumed significantly more added sugar (g/day), starch (g/day) nitrite (mg/day), and significantly less vitamin K, D, vegetables, and olive oil (Fig 1). Microbial analyses highlighted significant differences (FDR<0.1) in amplicon sequence variants (ASVs) abundance between stool and biopsies samples (73 ASVs) and between CD and Controls samples (82 ASVs). Biopsy vs. stool samples were enriched for Veillonella, Fusobacterium, Neisseria, and Ruminococcus gnavus. CD showed higher abundance of Enterobacteriaceae and Ruminococcus gnavus with reduction of several Ruminococcaceae and Lachnospiraceae taxa (Fig. 1). Ileal transcriptomics differential expression (FC>1.5, FDR<0.05) replicated previous results with significant induction in CD of DUOX2, CXCL9, and DEFB4A and pathways linked to innate and adaptive immunity, and to extracellular matrix. CD down regulated genes included GUCA2B, SLC10A2, and GSTA1, and pathways linked with epithelial transporters. Serum metabolomics highlighted significant variations (FDR<0.25) in  Linoleic acid, aKG, Tryptophan, nicotinamide, Docosahexaenoic acid, oxalate, and GABA between CD and controls. We next tested for significant association (FDR<0.25) between diet and multi-OMICs (Fig. 2). Associations between gut microbiome and TI transcriptomics, and serum metabolomics showed that Erysipelotrichacea taxa positivity correlated with serum oxalate, and TI expression of CEACAM6 and DUOX2. Associations between diet and TI transcriptomics and serum metabolomics indicated that B12, tryptophan and riboflavin consumptions were negatively associated with the bile acid transporter SLC10A2 in the TI, and vegetables consumption was positively associated with oxalate degrading Oxalobacter.

Conclusions: FFQ identifies difference in diet at the onset of CD that may contribute to pathogenesis. Integration between dietary and OMICs layers disclosed novel correlations warranting further exploration.

Objectives:
1. To understand the role of the IBD dietitian in the MDT 
2. To review the current dietary approaches for IBD management
3. To discuss whether diet can be used as a prevention strategy

Understand whether upper GI pathology is found in UC, and byanswering the following questions:

1.      Do patients with ulcerative colitis have lesions in the upper GI tract?
2.     Are there lesions in the upper GI tract that are unique to ulcerative colitis? 
3.    If upper GI UC exist, are there any predisposing factors?
4.    Is it possible to use upper GI biopsies in patients with colitis, to distinguish UC from Crohn’s disease (CD)?

Inflammatory bowel disease specimens have specific features which, in general, differ between Ulcerative Colitis and Crohn's disease.
The typical characteristics of UC are diffuse mucosal alteration and a regular bowel wall, whereas CD specimens usually show thickening of the bowel wall, visceral adhesions and mucosal skip lesion. 
It is important to identify and recognise these features in order to section the surgical organs correctly. For this reason, there are recommendations for the cut up of IBD specimens. 

Educational objectives:
- To learn how to approach an IBD specimen
- To understand the macroscopic differences between UC and CD specimens
- To learn how to dissect an IBD specimen and why
- To understand the importance of cut up in IBD pathology

Artificial Intelligence and Digital Pathology are rapidly growing disciplines that have the potential to revolutionise the field of inflammatory bowel disease. ML and DL approaches offer the ability to synthesise and incorporate large amounts of data to improve diagnostic accuracy, uncover new disease associations, identify at risk individuals, and guide therapeutic decision making. While challenges to the routine use of DP and AI in IBD remain, continued exploration of possible applications are expected to accelerate the drive toward precision medicine.
-To understand basic principles of Digital Pathology and Artificial Intelligence.
-To review pros and cons of DP and AI.
-To have an overview of DP and AI in IBD pathology.

1. To define the appropriate timing between medical and surgical management of IBD
2. To review medical and surgical treatment indications of the complications of IBD  
3. To learn how to decide in multidisciplinary team between the two modalities of treatment 

Discussion of presented topics as a chair of the complete session

Discussion of Tailored medical therapy in UC and the surgical approach.

1. To understand the similarity between both types of IBD regarding structural and functional damage
2. To review the risk of intestinal cancer in both types of IBD
3. To review the prevalence of extra-intestinal manifestations (EIMs) in both Crohn's disease and ulcerative colitis
4. To emphasise the impact that both UC and CD can have on patient's life (quality of life, disability, fatigue, anxiety/depression, work productivity)
5. To have an overview of the economic burden of IBD in 2021

Ulcerative proctitis (UP), defined as a colonic location limited to the rectum, is a poorly investigated condition in children, usually considered as a minor form of Ulcerative Colitis (UC). The aim of the present study was to compare the disease course of paediatric patients affected by UP at diagnosis with the other UC locations.

This multicentre retrospective observational study has been carried out starting from the data prospectively registered in the IBD Registry of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Seventeen IBD referral centres adhering to the registry were included in the study. Patients age 0 to 18 years, who were diagnosed with UC according to the Porto criteria starting from January 1, 2009, to May 1st, 2021 were identified. Only children with a minimum follow-up of 12 months were included in the study. Once enrolled, children were subsequently divided in two groups based on Paris classification: group 1 (E1) and group 2 (E2, E3 and E4).

Eight-hundred-eighty-five children were finally included in the study (median age at diagnosis: 11.2 years, range: 0-18 years; M/F: 434/451), of whom 176 (19.8%) belonging to group 1 and 709 (80.1%) to group 2. The median age at diagnosis was significantly higher in group 1 when compared to group 2 [11.9 (0-18) versus 11 (0-18) years, respectively; (p<0.001)]. At diagnosis, the induction therapy was significantly different with 68 (39.5%) patients of group 1 undergoing steroid therapy versus 505 (71.2%) of group 2 (p<0.001) and 79 (41.9%) of group 1 practising only mesalamine respect to 186 (26.2%) of group 2 (p<0.001).  A higher number of children from group 2 started immunosuppressive or biologic therapy as maintenance therapy at diagnosis [Group 1: 11 (6.2%) versus 173 (24.4%), respectively; (p<0.001)]. The median follow-up of our cohort was 4.5 years (range 1-13 years). At the last follow-up, 67/176 (38%) children with UP showed an extension of their disease location without significant difference when compared to group 2 [265 (37.5%); p=0.9], while 81 (45%) children from Group 1 were under immunosuppressive or biologic therapy versus 566 (79.8%) from group 2 (p<0.001). Five children (3%) of Group 1 underwent colectomy during the follow up versus 45 (6.9%) of Group 2 (p=0.06).

UP is a frequent location of paediatric onset UC and the risk of endoscopic extension of proctitis is similar to the more extensive forms. A considerable number of patients with UP required immunosuppressive or biologic therapy during the follow-up and no significant difference was observed in terms of surgery. Overall, UP cannot be considered as a minor form of UC.