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Background: In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. However, only a few studies have focused on the impact of overweight and obesity on IBD-related disability., Aims: To identify the factors associated with obese and overweight patients with IBD, including IBD-related disability., Patients and Methods: In this cross-sectional study, we included 1704 consecutive patients with IBD in 42 centres affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID) using a 4-page questionnaire. Factors associated with obesity and overweight were assessed using univariate and multivariate analyses (odds ratios (ORs) are provided with 95% confidence intervals)., Results: The prevalence rates of overweight and obesity were 24.1% and 12.2%, respectively. Multivariable analyses were stratified by age, sex, type of IBD, clinical remission and age at diagnosis of IBD. Overweight was significantly associated with male sex (OR = 0.52, 95% CI [0.39-0.68], p < 0.001), age (OR = 1.02, 95% CI [1.01-1.03], p < 0.001) and body image subscore (OR = 1.15, 95% CI [1.10-1.20], p < 0.001) (Table 2). Obesity was significantly associated with age (OR = 1.03, 95% CI [1.02-1.04], p < 0.001), joint pain subscore (OR = 1.08, 95% CI [1.02-1.14], p < 0.001) and body image subscore (OR = 1.25, 95% CI [1.19-1.32], p < 0.001) (Table 3)., Conclusion: The increasing prevalence of overweight and obesity in patients with IBD is associated with age and poorer body image. A holistic approach to IBD patient care should be encouraged to improve IBD-related disability and to prevent rheumatological and cardiovascular complications., Competing Interests: Declaration of Competing Interest Yoram Bouhnik received lecture and consulting fees from Abbvie, Biogaran, Boehringer-Ingelheim, CTMA, Ferring, Gilead, Hospira, ICON, Inception IBD, Janssen, Lilly, Mayoli Spindler, Merck, MSD, Norgine, Pfizer, Robarts Clinical Trials, Roche, Sanofi, Shire, Takeda, UCB and Vifor Pharma. This author has also stock ownership of Inception IBD, San Diego, CA, USA. Melanie Serrero has received lecture or consulting fees from Abbvie, Ferring, Amgen, Celltrion, Janssen, Ferring, Takeda and Tillotts. Jerome Filippi has received lecture and consulting fees from Abbvie, Amgen, Biogen, Ferring, HAC Pharma, Janssen, MSD, Pfizer, Sandoz and Takeda. Xavier Roblin reported a relationship with MSD, Abbvie, Amgen, Sandoz, Pfizer, Takeda and Janssen. Guillaume Bouguen received lecture fees from Abbvie, Ferring, MSD, Takeda and Pfizer and consultant fees from Takeda, Janssen. Denis Franchimont is research director of FNRS; he has received educational grants from Abbvie, Takeda, MSD, and has received honoraria fees for lectures or consultancy from Ferring, Falk, Chiesi, Abbvie, MSD, Centocor, Pfizer, Amgen, Janssen, Mundipharma, Takeda and Hospira. Guillaume Savoye has received lecture fees from Vifor Pharma, Takeda, Pfizer, HAC Pharma, Abbvie, MSD, and Ferring France. This author has also received travel accommodations from Ferring, Abbvie, and MSD France as well as a research grant from Ferring. Anthony Buisson has received research funding from Pfizer, lecture fees from Abbvie, Ferring, Hospira, MSD, Janssen, Sanofi-Aventis, Takeda and Vifor Pharma and consulting fees from Abbvie, Biogen, Janssen, Pfizer and Takeda. Edouard Louis has received fees for: Research Grant: Takeda, Pfizer; Educational Grant: Abbvie, Takeda, Janssen; Speaker Fees: Abbvie, Ferring, MSD, Falk, Takeda, Hospira, Janssen, Pfizer, Celgene; Advisory Board: Abbvie, Ferring, MSD, Takeda, Celgene, Hospira, Janssen; Consultant: Abbvie Stephane Nancey has received consulting fees from Merck, Abbvie, Takeda, Ferring, Norgine, Vifor Pharma, Novartis, Janssen Cilag, Hospira, Takeda and HAC Pharma Vered Abitbol has received lecture fees from Amgen, Biogen, Mylan, Sandoz, Pfizer, Takeda, Janssen, Tillots, Gilead, Ferring Jean-Marie Reimund has received consulting fees from Hospira and Pfizer. This author has also received lectures fees from Abbvie, Biocodex, Ferring, Janssen Cilag, Pfizer and Takeda, as well as travel accommodations from Ferring, Abbvie, MSD, Janssen Cilag, Pfizer, Hospira and Takeda Olivier DeWit declares counseling, boards, transport or personal fees from Abbvie, BMS, Celltrion, Ferring, Galapagos, Janssen, Mylan, Pfizer, and Takeda Lucine Vuitton has received lecture fees from Abbvie, MSD, Takeda, Ferring, Janssen and Pfizer, and research grants from MSD, Takeda and Pfizer. Nicolas Mathieu has received consulting fees from Celltrion, Mylan, MSD, Gilead, Sandoz and lecture fees from Abbvie, Amgen, Biogen, Janssen, MSD, Pfizer, Takeda Laurent Peyrin-Biroulet has received consulting fees from Merck, Abbvie, Janssen, Genentech, Ferring, Norgine, Tillots, Vifor, Shire, Therakos, Pharmacosmos, Pilège, BMS, UCB-Pharma, Hospira, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, and HAC-Pharma. This author has also received lecture fees from Merck, Abbvie, Takeda, Janssen Cilag, Ferring, Norgine, Tillots, Vifor, Therakos, HAC-Pharma, and Mitsubishi. Cyrielle Gilletta received lecture fees from Abbvie, Takeda, Pfizer and Janssen and consulting fees from Abbvie, Janssen and Takeda. Matthieu Allez has received honoraria from Novo Nordisk, MSD, Abbvie, Ferring, Genentech, Janssen, Pfizer, GSK, Hospira, UCB, Novartis, Takeda, Mayolo-Spindler. Stephanie Viennot has received consulting fees from Abbvie, MSD, Takeda, Vifor Pharma and Ferring. Catherine Le Berre has served as a consultant for Abbvie, Janssen and Gilead; reports receiving payment for lectures from AbbVie, Celltrion, Ferring, Fresenius Kabi, Galapagos, Janssen, MSD, Pfizer and Takeda. Medina Boualit has received travel accommodation from Abbvie, Janssen Takeda and Pfizer. Lucile Boivineau has received consulting fees from Abbvie and Tillotts. Mathurin Fumery has received lecture and consulting fees from Abbvie, MSD, Boehringer, Pfizer, Takeda, Janssen and Ferring. Ludovic Caillo received board and lecture fees from Abbvie, Janssen, Pfizer, Takeda, Amgen David Laharie has received counseling, boards, transports and/or fees from Abbvie, Biogaran, Biogen, Ferring, HAC-pharma, Janssen, MSD, Novartis, Pfizer, Prometheus, Roche, Takeda, Theradiag, Tillots. Maria Nachury has received lecture and consulting fees from Abbvie, Adacyte, Amgen, Arena, Biogen, CTMA, Ferring, Gilead, Janssen, Mayoli Spindler, MSD, Pfizer, Takeda, Viatris Aurelien Amiot has received consulting fees from Abbvie, Hospira, Takeda, Gilead and Biocodex as well as lecture fees and travel accommodations from Abbvie, Janssen, Biocodex, Hospira, Ferring, Takeda and MSD. This author has also received advisory board fees from Gilead, Takeda and Abbvie. No conflicts of interest are claimed by the remaining authors., (Copyright © 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Recent data regarding the impact of biologics and new surgical techniques on the indications and outcomes of colectomy for ulcerative colitis (UC) are limited., Aims: The present study aimed at determining the trend of colectomy in UC by comparing colectomy indications and outcomes between 2000 and 2010 and 2011-2020., Methods: This observational retrospective study was conducted in two tertiary hospitals, including consecutive patients who underwent colectomy between 2000 and 2020. All data concerning UC history, treatment and surgeries were collected., Results: Among the 286 patients included, 87 underwent colectomy in 2001-2010 and 199 in 2011-2020. Patients' characteristics were similar between groups, except for prior biologic exposure (50.6 % vs. 74.9%; p<0.001). The indications of colectomy significantly decreased for refractory UC (50.6 % vs. 37.7%; p = 0.042), but were similar for acute severe UC (36.8 % vs. 42.2%; p = 0.390) and (pre)neoplastic lesions (12.6 % vs. 20.1%; p = 0.130). A widespread use of laparoscopy (47.7 % vs. 81.4%; p<0.001) was associated with fewer early complications (12.6 % vs. 5.5%; p = 0.038)., Conclusion: Over the last two decades, the proportion of surgery for refractory UC significantly decreased compared to other surgical indications while surgical outcomes improved despite larger exposure to biologics., (Copyright © 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Patients' experience with healthcare professionals could influence their clinical outcomes., Aims: To assess inflammatory bowel disease (IBD) patients' experience with their disease, their treatment and their relationship with their physician., Methods: A one-week cross-sectional study was conducted in 42 IBD centres. 2011 consecutive outpatients with IBD completed an anonymous self-report questionnaire assessing their experience with and knowledge of IBD., Results: A quantitative assessment of the doctor-patient relationship revealed that patients' knowledge of IBD and IBD treatment ranged from 7.4 to 8.3 out of 10. In addition to IBD physicians, other sources of information about IBD and current treatment mainly included the internet (80% and 63%, respectively) and general practitioners (61% and 54%). Knowledge about education programmes (28%) was poor, resulting in a lack of willingness to further use these resources (25%). Concerns about IBD treatment were raised in 76% of patients, mostly related to the fear of adverse events (47%) and a lack of efficacy (33%). The need of alternative healthcare professionals was reported by 89% of the sample., Conclusion: In a large cohort of patients, we highlighted gaps in the management of patients with IBD regarding the need for higher-quality information and the implementation of alternative healthcare professionals., (Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: The interleukin-23 pathway is implicated genetically and biologically in the pathogenesis of Crohn's disease. We aimed to assess the efficacy and safety of risankizumab (BI 655066, Boehringer Ingelheim, Ingelheim, Germany), a humanised monoclonal antibody targeting the p19 subunit of interleukin-23, in patients with moderately-to-severely active Crohn's disease., Methods: In this randomised, double-blind, placebo-controlled phase 2 study, we enrolled patients at 36 referral sites in North America, Europe, and southeast Asia. Eligible patients were aged 18-75 years, with a diagnosis of Crohn's disease for at least 3 months, assessed as moderate-to-severe Crohn's disease at screening, defined as a Crohn's Disease Activity Index (CDAI) of 220-450, with mucosal ulcers in the ileum or colon, or both, and a Crohn's Disease Endoscopic Index of Severity (CDEIS) of at least 7 (≥4 for patients with isolated ileitis) on ileocolonoscopy scored by a masked central reader. Patients were randomised 1:1:1 using an interactive response system to a double-blind investigational product, and stratified by previous exposure to TNF antagonists (yes vs no). Patients received intravenous 200 mg risankizumab, 600 mg risankizumab, or placebo, at weeks 0, 4, and 8. The primary outcome was clinical remission (CDAI <150) at week 12 (intention-to-treat population). Safety was assessed in patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT02031276., Findings: Between March, 2014, and September, 2015, 213 patients were screened, and 121 patients randomised. At baseline, 113 patients (93%) had been previously treated with at least one tumour necrosis factor (TNF) antagonist (which had failed in 96 [79%]). At week 12, 25 (31%) of 82 risankizumab patients (pooled 41 patients in 200 mg and 41 patients in 600 mg arms) had clinical remission versus six (15%) of 39 placebo patients (difference vs placebo 15·0%, 95% CI 0·1 to 30·1; p=0·0489). Ten (24%) of 41 patients who received 200 mg risankizumab had clinical remission (9·0%, -8·3 to 26·2; p=0·31) and 15 (37%) of 41 who received the 600 mg dose (20·9%, 2·6 to 39·2; p=0·0252). 95 (79%) patients had adverse events (32 in the placebo group, 32 randomised to 200 mg risankizumab, 31 randomised to 600 mg risankizumab); 18 had severe adverse events (nine, six, three); 12 discontinued (six, five, one); 24 had serious adverse events (12, nine, three). The most common adverse event was nausea and most common serious adverse event was worsening of underlying Crohn's disease. No deaths occurred., Interpretation: In this short-term study, risankizumab was more effective than placebo for inducing clinical remission in patients with active Crohn's disease. Therefore, selective blockade of interleukin-23 via inhibition of p19 might be a viable therapeutic approach in Crohn's disease., Funding: Boehringer Ingelheim., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Ciclosporin and infliximab are potential rescue treatments to avoid colectomy in patients with acute severe ulcerative colitis refractory to intravenous corticosteroids. We compared the efficacy and safety of these drugs for this indication., Methods: In this parallel, open-label, randomised controlled trial, patients were aged at least 18 years, had an acute severe flare of ulcerative colitis defined by a Lichtiger score greater than 10 points, and had been given an unsuccessful course of high-dose intravenous steroids. None of the patients had previously received ciclosporin or infliximab. Between June 1, 2007, and Aug 31, 2010, patients at 27 European centres were randomly assigned (via computer-derived permutation tables; 1:1) to receive either intravenous ciclosporin (2 mg/kg per day for 1 week, followed by oral drug until day 98) or infliximab (5 mg/kg on days 0, 14, and 42). In both groups, azathioprine was started at day 7 in patients with a clinical response. Neither patients nor investigators were masked to study treatment. The primary efficacy outcome was treatment failure defined by absence of a clinical response at day 7, a relapse between day 7 and day 98, absence of steroid-free remission at day 98, a severe adverse event leading to treatment interruption, colectomy, or death. Analysis was by intention to treat. This trial is registered with EudraCT (2006-005299-42) and ClinicalTrials.gov (NCT00542152)., Findings: 115 patients were randomly assigned; 58 patients were allocated to receive ciclosporin and 57 to receive infliximab. Treatment failure occurred in 35 (60%) patients given ciclosporin and 31 (54%) given infliximab (absolute risk difference 6%; 95% CI -7 to 19; p=0·52). Nine (16%) patients in the ciclosporin group and 14 (25%) in the infliximab group had severe adverse events., Interpretation: Ciclosporin was not more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. In clinical practice, treatment choice should be guided by physician and centre experience., Funding: Association François Aupetit, Société Nationale Française de Gastroentérologie, and the International Organization for the study of Inflammatory Bowel Disease., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: This study aimed to examine whether circulating concentrations of a range of vitamins and trace elements in patients receiving long-term cyclic enteral tube feeding vary during the day, and whether standardised time points for blood sampling are required for assessment of nutrient status., Methods: Circulating concentrations or activities of water-soluble vitamins (thiamine, riboflavin, and vitamins B6, B12, folate and C), fat-soluble vitamins (A, D, E) and trace elements (iron, zinc, copper and selenium (assessed by glutathione peroxidase activity), were measured at 0,3,6 and 9-12h after cessation of nocturnal feeding (fasting), in eight clinically stable patients receiving cyclic nocturnal enteral nutrition., Results: The circulating concentrations of the nutrients did not change between the fed and fasted state (repeated-measures-ANOVA) except the following: plasma folate increased progressively from 10.9 (SD 4.6)nmol/l in the fed state to 14.0 (SD 4.4)nmol/l at 9-12 h after cessation of feeding (P<0.05); plasma zinc increased progressively throughout the fasting period by 33.5% (8.57, SD 0.68 vs. 11.44, SD 1.85 micromol/l, in fed state vs. 9-12h fast respectively, P<0.05); and total tocopherol/cholesterol ratio decreased by 9.6% during the study period (P<0.02), while gamma-tocopherol increased by 59.2% (P<0.05). For all analytes, the concentrations in blood samples taken at 3 and 6h after cessation of feeding were not significantly different from those at 9-12h., Conclusions: Although cessation of nocturnal tube feeding had no significant effect on the circulating concentrations of most micronutrients, it increased plasma folate and zinc concentrations, and decreased the tocopherol/cholesterol ratio. The timing for blood sampling should be standardised when the status of these nutrients is assessed in patients receiving cyclic tube feeding.

This chapter is an overview of the literature on serological markers of inflammatory bowel diseases (IBD), focusing on anti-neutrophil cytoplasm autoantibodies (ANCA) and anti- Saccharomyces cerevisiae mannan antibodies (ASCA). The methodology for ANCA and ASCA testing is first introduced. The value of these markers as diagnostic tools is then discussed. Other chapters are devoted to the potential role of ANCA and ASCA in disease monitoring, disease stratification and as subclinical markers in families. Finally reviewed are other antibodies recently tested in clinical trials such as pancreatic antibodies and antibodies directed against bacterial antigens. The role of these antibodies in the pathophysiology of IBD still needs to be assessed. We also need to identify the ASCA immunogen(s) eliciting the antibody response.

Background: Body composition in children is generally measured by 2-component (2C) models, which are subject to error arising from variation in fat-free mass (FFM) composition. The 4-component (4C) model, which divides body weight into fat, water, mineral, and protein, can overcome these limitations., Objective: The aims of our study were to 1) describe 4C model data for children aged 8-12 y; 2) evaluate interindividual variability in the hydration, bone mineral content, and density of FFM; 3) evaluate the success with which 2C models and bedside techniques measure body composition in this age group with use of the 4C model as a reference., Design: Dual-energy X-ray absorptiometry, underwater weighing, deuterium dilution, bioelectrical impedance analysis, and anthropometry were used to determine body composition in 30 children. The contribution of methodologic error to the observed variability in the hydration and density of FFM was evaluated by using propagation of error., Results: Mean (+/-SD) FFM density and hydration were 1.0864+/-0.0074 kg/L and 75.3+/-2.2%, respectively, and were significantly different from adult values (P < 0.02). Relative to the 4C model, deuterium dilution and dual-energy X-ray absorptiometry showed no mean bias for fatness, whereas underwater weighing underestimated fatness (P < 0.025). Fatness determined by using skinfold-thickness and bioelectrical impedance analysis measurements along with published equations showed poor agreement with 4C model data., Conclusions: Biological variability and methodologic error contribute equally to the variability of FFM composition. Our findings have major implications for bedside prediction methods used for children, traditionally developed in relation to underwater weighing.

This report describes the use of multiple frequency bioimpedance analysis (MFBIA) to monitor fluid changes in a patient who developed severe dehydration and recovered. Initially, the patient weighed 53.2 kg, his total body water (TBW; D(2)0 dilution) was 33.5 L, his extracellular water (ECW; Br dilution) was 19.5 L, and hydration of the fat-free mass (FFM; dual-energy X-ray absorptiometry) was normal (73%). The resistances at infinite and 0 frequency were R(inf) = 454 and R(0) = 580 ohm respectively, which predicted TBW = 33.1 L and ECW = 16.6 L. On day 7, when the weight loss was 7.2 kg, FFM had decreased by 7.4 kg, and R(inf) and R(0) had increased to 662 and 902 ohm respectively, predicting decreases of 5.8 L in TBW and 3.7 L in ECW. On recovery (day 14), all parameters had returned to baseline values. This study encourages the use of MFBIA as a bed-side technique for the serial assessment of body water compartments in patients with disturbances in fluid balance.

Ten lactose malabsorbers were intubated and given fresh or heated yogurt to which polyethylene-glycol (PEG) and spores of Bacillus stearothermophilus (SBS) had been added as internal standards. In duodenal samples taken after fresh yogurt ingestion, viable starter culture was detected for 60 min in 6 of 7 subjects and the ratio of microbial beta-galactosidase activity to SBS remained similar during this period to its value in the preingested yogurt. In the two groups ingesting fresh and heated yogurt respectively, ratios of lactose to PEG remained similar to preingested values for 90 min and duodenal pH remained less than 5.1. In vitro, at pH 5.0, beta-galactosidase activity in yogurt dropped by 80%. These data clearly show that after fresh yogurt ingestion, viable starter culture reaches the duodenum and contains beta-galactosidase activity. However, the buffering capacity of the yogurt that protects bacteria from acidic gastric secretion also prevents microbial beta-galactosidase from hydrolyzing lactose in the duodenum.