Charlotte Goess

Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease

Body composition is poorly studied in inflammatory bowel disease (IBD). Sarcopenia describes a loss of muscle mass and strength.

Obesity in Inflammatory Bowel Disease: Gains in Adiposity despite High Prevalence of Myopenia and Osteopenia

Background: Rising rates of obesity have been reported in patients with inflammatory bowel disease (IBD); however, prospective data is lacking. The aim of this study is to prospectively evaluate body composition in adults with IBD over 24 months. Methods: Whole body dual energy X-ray absorptiometry (DXA) data was performed at 0 months, 12 months, and 24 months. Bone mineral density (BMD), fat mass index (FMI (kg)/height (m2)), appendicular skeletal muscle index (ASMI (kg)/height (m2)), visceral adipose tissue and the visceral adipose height index (VHI, VAT area (cm3)/height (m2)), and clinical and anthropometric assessments were performed at each time point. Multivariable linear mixed effects regression analyses were performed. Results: Initially, 154 participants were assessed at baseline (70% Crohn’s disease, 55% male, median age 31 years), of whom 129 underwent repeated DXA at 12 months, and 110 underwent repeated DXA at 24 months. Amongst those undergoing repeated DXA, their body mass index (BMI) significantly increased over time, such that by 24 months, 62% of patients were overweight or obese (annual change BMI β = 0.43, 95%CI = [0.18, 0.67], p = 0.0006). Gains in BMI related to increases in both FMI and VHI (β = 0.33, 95%CI = [0.14, 0.53], p = 0.0007; β = 0.08, 95%CI = [0.02, 0.13], p = 0.001; respectively), whereas ASMI decreased (β = −0.07, 95%CI = [−0.12, −0.01], p = 0.01) with a concordant rise in rates of myopenia (OR = 3.1 95%CI = [1.2, 7.7]; p = 0.01). Rates of osteopenia and osteoporosis were high (37%), but remained unchanged over time (p = 0.23). Conclusion: Increasing rates of obesity in patients with IBD coincide with decreases in lean muscle mass over time, while high rates of osteopenia remain stable. These previously undocumented issues warrant attention in routine care to prevent avoidable morbidity.

Visceral Adipose Tissue Is Associated With Stricturing Crohn’s Disease Behavior, Fecal Calprotectin, and Quality of Life

BACKGROUND Visceral adipose tissue (VAT) has been proposed to play a pathogenic role in Crohns disease (CD); however, prospective clinical data are lacking. The aim was to evaluate whether VAT, beyond body mass index (BMI), is associated with CD behavior, disease activity, quality of life (QoL), or outcomes. METHODS Body composition data and clinical, anthropometric, disease activity (fecal calprotectin [FC]), and QoL scores were gathered prospectively on adults with CD at 0, 12, and 24 months. BMI and, VAT metrics (visceral adipose tissue volume [cm3]/height [m2] index and VAT:subcutaneous adipose tissue [SAT] ratio) were calculated. Inflammatory bowel disease-related surgery and hospitalization were recorded over extended follow-up (median, 51 months). Multivariable linear mixed effects and logistic regression analyses were performed. RESULTS Ninety-seven participants were assessed at baseline (55% male; median age, 31 years), 84 at 12 months, and 72 at 24 months. VAT:SAT was positively associated with stricturing disease behavior (log odds ratio [OR], 1.7; 95% confidence interval [CI], 0.32 to 3; P = 0.01) and elevated FC in patients with ileocolonic disease (β, 1.3; 95% CI, 0.32 to 2.3; P = 0.01). VAT:SAT was associated with lower QoL, particularly in those with ileal disease (β, -12; 95% CI, -19 to -4.5; P = 0.05). However, no prospective associations were observed between serial VAT measurements and time to surgery or hospitalization. No correlations were found between BMI and disease behavior, activity, or QoL. CONCLUSIONS VAT:SAT, rather than BMI, is associated with stricturing CD behavior, elevated FC, and reduced QoL in a disease distribution-dependent manner. Further studies are required to substantiate the role of VAT as a useful biomarker in CD.

P190 Low muscle mass in inflammatory bowel disease (IBD): common and predictive of functional sarcopenia and osteopenia

polymorphous angiocentric and angiodestructive infiltrate. LYG affects the lungs predominantly. The digestive tract is rarely involved. Patients with a primary or secondary immunodeficiency are at increased risk for LYG. We report a case of LYG in a patient with Crohn’s disease (CD). This description also identifies an EBV-driven B-cell lymphoma in a patient following methotrexate (MTX) immunosuppression for inflammatory bowel disease (IBD). We have proceeded to an extensive review of the literature and to the best of our knowledge no other cases of Lung-free LYG have been described in patient CD. Methods: 40 years old female. Diagnosed with Crohn disease when she was 20 years old, she was an estenotic colonic she needed right hemicolectomy and then she also needed transverse colectomy because of a new stenosis. Since then, she followed MTX treatment. She came for consult in July 2012 with malaise, weight loss, severe malnutrition, abdominal pain, inflammation in midline abdomen. A CT scan was performed: a subcutaneous collection was seen, and ileosigmoidy stenosis and bowel stenosis. Surgery was performed, ileosigmoid resection and protective ileostomy. There were no immediate complications after the procedure. She was admitted to the hospital again because of malaise, evening fever, pain in left hypochondrium, and dehydration. Pathology examination results were obtained, with the diagnosis of lymphomatoid granulomatosis. The Hematology Department was consulted and Rituximab treatment was initiated (4 cycles). A new colon biopsy was obtained by colonoscopy and refractoriness was shown. Treatment with R-CHOPx6 was prescribed, obtaining parcial remission. Salvage therapy (R-ESHAPx2) was administrated, following autologous bone marrow transplantation. Results: Management of the disease was extremely challenging because of the overlapping of symptoms between Crohn’s disease and Lymphomatoid Granulomatosis. Because it is a very rare condition, we needed to consult a renowned center in pathology. No lung affection has been shown during the development of the disease. Conclusions: Immunosuppression produced by Crohn’s disease treatment creates risks that must be assumed by patients and doctors that treat them. Complex clinical characteristics and with no response to conventional treatments must make us think about associated entities. Biologic treatments and more specific drugs could reduce the incidence of these serious diseases.

P409 More targeted evaluation of nutrition in inflammatory bowel disease (IBD) reveals opportunities to optimise care: body mass index, body composition and iron deficiency

(42%), and 5 indeterminate colitis (11%); 67% of pts (30/45) were previously evaluated by a gastroenterologist while the remaining 33% (15/45) only by their general practitioner (GP). At final analysis only 60% of pts (27/45) reported a good overall satisfaction from their previous medical experiences. A complete dissatisfaction was observed in 11/30 pts (37%) previously evaluated by a gastroenterologist and in 7/15 pts (47%) evaluated only by their GP. Overall satisfaction rate before MI was significantly lower in pts affected by indeterminate colitis (p = 0.004) and in pts <40 years old (p = 0.02). Physicians’ communication skills were reported quite satisfactory by female (p = 0.01) while poorly satisfactory in pts with family history of IBD (p < 0.001), in pts <40 years old (p < 0.001), and in pts affected by indeterminate colitis (p = 0.05). Concerning physician empathy perceived by pts it was strongly in female pts (p < 0.001) and lack in those with family history of IBD (p < 0.001). At multivariable analysis only good physician empathy perceived by female resulted significant (p = 0.002). After MI counselling all pts (100%) reported a good overall satisfaction without lack of empathy (71% marked “excellent empathy”) due to the fact that they felt they had complete answers to their questions. All pts appreciated the use of explanatory pictures. The mean duration of the visit was 41.5±8.7 minutes. Conclusions: MI is very well appreciated by IBD pts. It is a quite time-consuming technique but considerably useful at the first visit and in younger pts. Explanatory pictures help pts to better understand their clinical condition. MI can help physicians, especially gastroenterologists, to move from “cure” to “care” with their IBD patients.

Tu1844 Symptom Stability and Economic Burden in Patients With Functional Dyspepsia: Observational 12 Month Follow-Up After a Short-Term Clinical Trial

Background: Serotonin (5-HT) signaling in the small intestine is involved in motor, sensory and secretory pathways. Studies of neuroendocrine cell mapping in functional dyspepsia (FD), characterized by upper gastrointestinal motor and sensory disturbances, are scarce although it has been previously noted that there is no significant difference in numbers of 5HT cells in duodenum in post infectious FD vs. controls1. In patients with irritable bowel syndrome, another functional bowel disorder, a low density of duodenal neuroendocrine cells is also described2.Aim: To examine the content of neuroendocrine cells in the duodenum of subjects with FD, specifically the relative content of serotonin (5-HT) containing cells and to investigate a possible relationship between neuroendocrine cell numbers and FD subtypes. Methods: A random sample of an adult Swedish population (n = 1000) (the Kalixanda study) underwent upper endoscopy and biopsies taken from the duodenal bulb (D1) and the second part of duodenum (D2). From this study 23 subjects with FD were identified, 13 with postprandial distress syndrome (PDS), 10 with epigastric pain syndrome (EPS) and 12 healthy controls. Immunocytochemistry was performed for Chromogranin A (CGA) and 5-HT. Positive cells were quantified per mm2. Results: Cases and controls showed similar demographics. The number of CGA stained cells was significantly lower in FD patients both in D1 (p = 0.01) and D2 (p = 0.04) whereas there was no significant difference in 5-HT content. See figure. When EPS and PDS were studied separately, the number of CGA stained cells was significantly decreased in D1 in patients with EPS (p = 0.03). Conclusions: The number of duodenal neuroendocrine cells is decreased in FD compared with control subjects, but this is not due to a reduction in the number of 5-HT containing cells. It is possible that this reduction reflects reduced cellular densities of other hormones (e.g. somatostatin) which could result in a high secretion of gastric acid, with a change in motility or visceral sensitivity leading to dyspeptic symptoms in these cases. 1. Futagami S et al. Am J Gastroenterol. 2010 ;105:1835-42. 2. El-Salhy M et al. Scand J Gastroenterol. 2010 ;45:1435-9.

Su1633 Placebo Effects in Functional Dyspepsia: A Preliminary Analysis on Symptoms in an Ongoing Randomized Placebo Controlled Trial

Background: Functional dyspepsia (FD) is a common disorder; however no currently available therapy is highly effective and most treatments provide only minimal gain over placebo. Due to the spontaneous fluctuation of disease activity, a considerable proportion of patients experience sufficient relief of symptoms even if treated with medications that are effective in a small subgroup of patients. We examined the efficacy of the herbal preparation STW5 (Iberogast®), esomeprazole and placebo in patients with FD. Methods: In a double-blind, double dummy, randomized study, FD patients (Rome III criteria) received either; esomeprazole (Nexium® 20mg/daily) + placebo; STW5 (20 drops/TID) + placebo; dual therapy or double placebo (“active treatment”) for 4 weeks. Thereafter, clinical responders all received placebo (“placebo treatment”) for 2 weeks. Ongoing responders were reassessed after 2 weeks of “no treatment”. Symptoms and severity (Nepean Dyspepsia Index [NDI-S], Gastrointestinal Symptom Score [GIS] and Leeds Dyspepsia Questionnaire [LDQ]), quality of life (Nepean Dyspepsia Index [NDI-QoL]) and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed. Visceral hypersensitivity was assessed with a nutrient challenge test before and after the 4 weeks of “active treatment”. Blinded data was divided into “nonresponder” and “responder” groups. Results: 70 FD patients (44 females; 48±2 years) have completed the study. 51 (73%) were responders to “active treatment”. Of 51 responders, 18 relapsed during “placebo treatment” (35% treatment withdrawal relapsers) and 20 relapsed on visible treatment cessation (39% placebo withdrawal relapsers); 13 continued with sufficient control of symptoms (26% sustained responders) after 2 weeks of “no treatment”. There were no baseline differences between non-responders and responders in regards to their initial symptom occurrence and severity, quality of life or anxiety or depression. In addition, there were no baseline differences between those that responded or relapsed after “treatment withdrawal” and/or “placebo-withdrawal”. After “active treatment” symptoms and severity decreased in responders, when compared with non-responders and this was matched by an improved quality of life (see table). Anxiety, depression and volume consumed during the nutrient challenge test were not different after “active treatment” between the nonresponders and responders. Conclusions: Thus far, 73% of FD patients respond symptomatically to “active treatment” and report an improved quality of life. However, the treatment(35%) and placebo-withdrawal relapse (39%) rates are also high. Baseline patient characteristics thus far have not been shown to predict response.

S1318 STW5 Leads to Changes in Immunologic Response, as Assessed by Cytokine Secretion, in Healthy Controls, but Not Subjects With Irritable Bowel Syndrome (IBS)

STW5 Leads to Changes in Immunologic Response, as Assessed by Cytokine Secretion, in Healthy Controls, but Not Subjects With Irritable Bowel Syndrome (IBS) Jenny Persson, Gerald Holtmann, Amelia N. Pilichiewicz, Montri Gururatsakul, MingXian Yan, Edmund C. Khoo, Judith Gapasin, Charlotte Goess, Nora B. Zschau, Lee-Anne Faraguna, Birgit Adam, Tobias Liebregts, Richard H. Holloway, Jane M. Andrews