INTRODUCTION: In Hungary, population-based colorectal cancer (CRC) screening was introduced shortly before the onset of COVID-19 pandemic. We aimed to assess the combined impact of these 2 factors on the incidence and characteristics of CRC. METHODS: The retrospective cohort study included all patients with newly diagnosed CRC between 2014 and 2023 and divided into prepandemic with screening (2015-2016, 2019), prepandemic without screening (2014, 2017-2018), pandemic (2020-2021), and postpandemic (2022-2023) subgroups. CRC incidence, diagnostic patterns, and tumor stage were compared across subgroups. RESULTS: Crude CRC incidence in institution's care area was lower during pandemic (102.51 per 100,000) compared with the prepandemic with screening (117.92 per 100,000; P = 0.060) and postpandemic (120.60 per 100,000; P = 0.044) subgroups. Age-standardized incidence differed significantly only between the prepandemic with screening and pandemic subgroups (125.30 vs 105.88 per 100,000; P < 0.001). During pandemic, the proportion of early-stage (on the American Joint Committee on Cancer 0-I) cancers was significantly reduced compared with the prepandemic with screening subgroup (18.74% vs 25.08%; P = 0.048) and the proportion of T1 cancers was also lower compared with the postpandemic subgroup (6.90 vs 12.2%; P = 0.026). During pandemic, both the annual number of colonoscopies (2,706.00) and the mean number of colonoscopies required to detect 1 CRC (15.56) were markedly lower compared with the prepandemic with screening (4,590.67 and 13.97), prepandemic without screening (3,824.33 and 10.67), and postpandemic (4,573.50 and 15.50) subgroups. DISCUSSION: The COVID-19 pandemic was associated with unfavorable changes in CRC epidemiology. Organized screening may have mitigated the negative impact during the pandemic and postpandemic periods.

Az akut epehólyag-gyulladás gold standard terápiája a cholecystectomia, azonban az irányelvek középsúlyos és súlyos gyulladás esetén a műtétre nem alkalmas betegnél is az epehólyag tehermentesítését javasolják a konzervatív terápia mellett. A perkután transhepaticus epehólyagdrenázs mellett az endoszkópos megoldások (például a transpapillaris és az endoszkópos ultrahang által vezérelt epehólyagdrenázs) is régóta elérhetőek, azonban a klinikai gyakorlatban még kevésbé terjedtek el. A transpapillaris epehólyagdrenázs technikai és klinikai sikeressége összevethető a perkután transhepaticus epehólyagdrenázséval, míg szövődményrátája alacsonyabb, valamint kisebb eséllyel alakul ki ismételten gyulladás a műtétig eltelt időben.

BACKGROUND Patient satisfaction plays a pivotal role in ensuring sustained adherence to colonoscopy-based colorectal cancer screening programs. AIM To evaluate patient satisfaction following endoscopic procedures in the Hungarian population-based colorectal cancer screening program. METHODS Data were obtained from an anonymous, standardized self-administered questionnaire completed between January 2021 and November 2023. Most items were closed-ended, and satisfaction was measured on a 5-point scale. RESULTS A total of 4010 questionnaires were analyzed, with a patient-level response rate of 40.6%. Overall satisfaction with the procedure was 4.89 ± 0.42 on a 5-point scale, with 95% of respondents rating each individual assessed aspect as good (score of 4) or very good (score of 5). However, 9.96% of participants reported severe pain (scores of 1 or 2), and 24.80% reported moderate pain (a score of 3) during the examination. The sedation rate was 61.42%. Procedure-related discomfort was significantly negatively associated with male gender, age > 61 years, the use of sedation, the quality of preprocedural information provided by the endoscopist, and the perceived experience of the endoscopist and staff. Procedure-related pain, the quality of the recovery area, post-procedural information, communication skills, and the perceived competence of the endoscopy unit staff were significant determinants of overall patient satisfaction. CONCLUSION Positive patient feedback indicates high-quality care. Further improvements in overall satisfaction may be achieved by optimizing pain management, sedation practices, post-procedural recovery conditions, and communication between healthcare professionals and patients.

BACKGROUND:Familial adenomatous polyposis (FAP) is a disorder of autosomal dominant inheritance that is responsible for around 1% of colorectal cancer (CRC) cases. AIM:To determine the mutation profile of FAP-specific to the Hungarian population. METHODS:This prospective single-center study enrolled patients with clinically suspected FAP or attenuated FAP (aFAP). Whole-exome next-generation sequencing was performed to detect variants of 50 FAP priority genes and 173 CRC predisposing genes or other CRC disease-associated genes. To identify larger deletions and insertions, a multiplex amplifiable probe hybridization technique was used. The identified genes were then classified according to the American College of Medical Genetics and Genomics guidelines. RESULTS:A total of 26 index patients with clinically suspected FAP (n = 21) and aFAP (n = 5) were enrolled. APC gene alterations were confirmed in 92.31% of the cases (region 1B deletion, n = 2; whole-gene deletion, n = 4; frameshift mutation, n = 2; nonsense mutation, n = 5, and splice mutation, n = 1), with the remaining two cases having CHEK2 and MSH3 gene alterations. According to pathogenicity, 21 cases had pathogenic mutations, 6 cases had likely pathogenic mutations, and 16 cases had variants of unknown significance (VUS). The most frequent of the latter were the POLE (n = 5) and PIEZO1 (n = 4) gene variants. CONCLUSION:Germline mutations in the APC gene were confirmed in more than 90% of Hungarian patients with clinically suspected FAP. Although the role of VUS genes is unclear, they are highly likely to play a role in the development of CRC.

BACKGROUND:Iron deficiency anaemia (IDA) is a common comorbidity in inflammatory bowel diseases (IBD). It is hypothesized that IDA result in poorer outcomes also in patients with remission. METHODS:This multicenter retrospective real-life cohort study assessed the predictive value of IDA in inactive IBD patients. IDA was defined as ferritin <30 μg/mL and transferrin saturation <20% with the presence of anaemia. Primary outcome was the need of hospitalization/abdominal surgery. Secondary outcome was minor complications, defined as new treatment admission and/or dose escalation during the follow-up period. RESULTS:In total, 708 patients (median age:43.1 years [IQR: 32.3-49.6]; male/female ratio:332/379; CD:397, UC:311; IDA/non-IDA 85/623) were enrolled. The presence of IDA increased the risk of minor complications (OR:1.9) and hospitalization/abdominal surgery (OR:2.8). CONCLUSION:IDA predicts the risk of relapse in patients with clinical and biochemical remission in the outpatient setting. IDA may help to identify underlying disease activity in patients with clinical and biochemical remission in time, therefore, in these cases we suggest further workups and to consider treatment modification.

Purpose:Data regarding treatment switch from the originator infliximab (IFX) to GP-1111 in inflammatory bowel disease (IBD) are limited. Only a few studies have examined the financial aspects of biosimilar use, none of them regarding GP-1111. The study aimed to evaluate the long-term efficacy and safety of the IFX biosimilar GP-1111 in patients with IBD who underwent a nonmedical switch from the original IFX in real-life settings. Further, it investigated the switch from a health economics perspective. Patients and Methods:A prospective cohort study was conducted on patients with IBD who were on maintenance IFX treatment and who switched to the IFX biosimilar GP-1111 due to financial constraints, with a 1-year follow-up period. Clinical and laboratory parameters were measured at baseline and at weeks 8, 16, and 52 and serum IFX levels were measured at baseline and at week 24. Statistical analyses were performed using the paired t-test, Pearson's chi-square test, Kaplan-Meier survival curves, Cox proportional hazard regression models, and univariate linear model. Results:This study included 142 patients (95 with Crohn's disease and 47 with ulcerative colitis). The average serum IFX level remained within the therapeutic range from baseline (3.2 ± 2.3 μg/mL) to week 24 (3.7 ± 2.7 μg/mL, p = 0.106). The corticosteroid-free remission (S-SFR) rates were stable (baseline: 69.7%, follow-up: 72.9%, p = 0.58). The 1-year treatment persistence rate was 83.1%. The adverse events included allergic reactions (IR: 6.3 per 100 patient-years) and paradoxical reactions (IR: 2.4 per 100 patient-years). Based on the estimated cost analysis, biosimilar use could lead to significant savings, with a total of 201.9 million HUF (514,000 €). Conclusion:The IFX biosimilar GP-1111 was safe and effective against IBD in real-world settings. The average serum IFX levels and S-SFR rates remained stable, while no identifiable factors leading to treatment discontinuation were observed. Biosimilar use has a cost advantage with a reassuring safety profile.

Abstract Background Bowel urgency is one of the most bothersome symptoms of ulcerative colitis (UC). The Urgency Numerical Rating Scale (U-NRS) measures the degree of faecal urgency experienced over the past 24 hours by patients with UC on a scale of 0-10. We assumed that the scale has a large variance, as patients evaluate their own symptoms differently. The urge may be different quality for two patients with the same score. The score on the U-NRS may be influenced by the individual’s specific perception of symptoms (degree of pain, speed of urge). The objective of our study was to investigate the possible components of urgency using the U-NRS. Methods Patients with UC older than 18 years treated at our departments for at least 3 months and having complaints were enrolled in our study. The patients filled out our non-validated questionnaire with questions about fecal urgency (U-NRS), pain level, speed of urge, incontinence and lifestyle characteristics associated with incontinence. Statistical analysis was performed using SPSS program. Results 205 patients were enrolled, median age was 40 years, the mean of disease duration was 11.8±9.4 years. The mean U-NRS score was 3.2±3.2, 64 patients (31%) had 0 score and 8 (4%) had 10 score. 12% of the patients (n=24) felt most difficult to hold mucus, 38% (n=77) stool and 31% (n=63) other secretions. 9% (n=19) had urge with every stool in the last 24 hours, 35% (n=71) had less than half of defecations. Patient reported outcome (PRO2) had a significant but weak correlation with U-NRS (ͳb=0.348 p=0.000)(Figure 1). The speed of urge defined more the level of urgency than the pain level (R2=0.798, F(1, 203)=803.86 p<0.001, β=0.894 vs R2=0.805, F(2, 202)=417.98, p<0.001, β=0.117). The duration of faeces holding in the last 7 days had significant connection to U-NRS (R2=0.211, F(1, 203)=54.432, p<0.001, β=-0.46). Patients using public restroom at least once during the last week had significantly higher score on U-NRS than other patients (4.6±3.1 vs 2.4±3 p<0.0001). The usage of diapers was also significantly more often in patients with higher U-RNS score (5.2±3.2 vs 2.9±3.1,p<0.0001). Faecal leakage both during the day and night was significiantly higher with higher U-NRS score (p<0.0001 for both) Conclusion Urgency is more defined by the speed of urge than the pain. Using public restroom, usage of diapers and faecal leakage are associated with higher U-NRS. Bowel urgency greatly affects the daily life of UC patients, therefore, it has to be taken into count in therapy managing. Figure 1

Background/Objectives: Data on the real-world effectiveness and safety of selective JAK inhibitors (JAKis) in ulcerative colitis (UC) and Crohn’s disease (CD) are limited. Methods: We conducted a multicentre, retrospective study to assess clinical, biochemical, and endoscopic outcomes of selective JAKis in bio-experienced UC and CD. Results: A total of 246 patients (mean age: 40.5 ± 14.5 years; 131 UC and 115 CD) were included with a median follow-up of 7.5 months. Among the CD patients receiving upadacitinib (n = 115), 76.2% achieved clinical remission (CR) at week 12. Furthermore, 59.5% of the upadacitinib-treated UC patients (n = 100) experienced CR at week 8. Corticosteroid-free CR (CSFCR) was achieved by 76.9% of the CD patients and 80.6% of the UC patients at week 24, while 50.0% and 36.1% experienced endoscopic remission. At week 52, 66.7% of the CD and 86.2% of the UC patients achieved CSFCR, whereas 54.5% and 52.9% had endoscopic remission. In UC, the effectiveness of upadacitinib was not compromised by prior tofacitinib failure, while the upadacitinib-treated CD patients with stricturing and penetrating disease were less likely to achieve CR by the end of the induction phase (p = 0.04). C-reactive protein (p[CD] < 0.0001; p[UC] < 0.0001) and faecal calprotectin (p[CD] < 0.0001; p[UC] = 0.02) decreased significantly in both patient groups as early as week 2. Among the filgotinib-treated UC patients (n = 31), 28.6% were in CR at week 12. At week 24 and 52, 59.1% and 60% achieved CSFCR, while 0.0% and 20.0% had endoscopic remission. Both C-reactive protein (p = 0.04) and faecal calprotectin (p = 0.04) decreased significantly by week 12. Hyperlipidaemia (9.7–9.8%) was the most common adverse event. Conclusions: Selective JAKis are rapidly effective and safe for treating refractory, moderate-to-severe CD and UC.

Background: Many patients with severe ulcerative colitis (UC) fail to respond to first-line corticosteroids and require second-line rescue therapy with cyclosporin (CsA) to avoid colectomy. Objectives: To assess the short- and long-term effectiveness and safety of CsA therapy. Design: A single-center, retrospective study was conducted, including patients who received IV CsA therapy for severe, steroid-refractory UC. Methods: Data on therapeutic response and adverse events (AEs) were reported. The Kaplan-Meier method was used to estimate colectomy-free survival rates. The incidence of inflammatory bowel disease flare-ups and the use of advanced therapies after CsA discontinuation were also assessed. Regression analyses were performed to identify predictors for therapeutic response, colectomy, and AEs with CsA. Results: A total of 92 UC patients (54.4% male, mean age: 40.0 ± 14.0 years) were included with the median follow-up time of 14 years (IQR: 7–18). Clinical response was achieved in 88.0%, and clinical remission was observed in 23.9% of patients after the median 6-day (IQR: 7–5) IV phase. A total of 40.7% of responders experienced clinical remission, whereas 13.6% had endoscopic remission at the time of CsA withdrawal (median after 5 months of therapy). Patients receiving concomitant immunomodulators were more likely to achieve clinical remission with CsA ( p = 0.002; OR: 6.4). After CsA discontinuation, 23.5% of patients relapsed within 6 months, while 59.3% of patients were started on biologics. The probability of colectomy-free survival was 74.7%, 62.6%, 57.1%, and 45.6% at 1, 3, 5, and 14 years after CsA initiation. AEs were reported in 53.3% of patients, mainly hyperlipidaemia, hypertension, and infections. Hypoalbuminaemia (<35 g/L) at treatment initiation increased the risk of AEs ( p = 0.03; OR: 0.4), whereas the occurrence of AEs was not associated with concomitant immunomodulator use ( p = 0.9). Conclusion: CsA may be a potent therapeutic option to induce remission in steroid-refractory, severely active UC, and its effectiveness may be enhanced by the concomitant use of immunomodulators, without compromising safety.

Bevezetés: A perianális, fisztulázó Crohn-betegség (PFCD) rendkívül nagy terhet jelent a betegek életében. A mesenchymalis őssejtkezelés hatékonysága és biztonságossága ellentmondásos, és hiányoznak a valós életből származó evidenciák. Vizsgálatunk célja a darvadstrocel terápia alkalmazhatóságának vizsgálata volt a PFCD kezelésében. Módszerek: Retrospektív, multicentrikus vizsgálatunkba perianális fisztulával rendelkező, Crohn-betegségben szenvedő résztvevőket vontunk be; az utánkövetés minimum 6 és maximum 12 hónap volt. Elsődleges kimenetelként elemeztük a perianális klinikai remisszió (az összes kezelt fisztula záródása) arányát a 26. és az 52. héten, míg a másodlagos kimenetel a klinikai válasz aránya (≥1 záródott, kezelt fisztula), a perianális aktivitás (PDAI), a betegelégedettség és a nemkívánatos események megjelenése volt. Az adatokat bevonáskor, valamint a 26. és az 52. héten gyűjtöttük. A hatékonyságot jellemző kimenetelek predikciójához logisztikus regressziós analízist végeztünk. Eredmények: Összesen 223 beteg adatai alapján (férfi/nő arány 0,48) a perianális klinikai remisszió aránya 78,2% és 62,3% volt a 26. és az 52. héten, míg a kiindulási PDAI pontszám (OR: 0,75), a fisztulák száma (OR: 0,28) és a műtétek között eltelt idő (OR: 0,98) a kezelés sikertelenségével volt összefüggésben. A klinikai válasz aránya 84,4% és 79,8% volt a 26. és az 52. héten. Továbbá a betegek 77,8%-a és 78,4%-a tapasztalta a szubjektív perianális tünetek javulását a 26. és az 52. héten mért adatok alapján. Nemkívánatos események a betegek 13,5%-ánál jelentkeztek: leggyakrabban perianális tályogot és proctalgiát rögzítettek. Következtetés: A hatékonysági adatok vizsgálatunkban magasabbak, mint a klinikai vizsgálatok adatai. A biztonsági profil megnyugtató és a betegek elégedettsége magas. A megfelelő betegkiválasztás és a sebészi tapasztalat segíthet a sikeres kezelés elérésében.

Abstract Background Data suggest that patients’ knowledge about their chronic disease is associated with treatment adherence, and education may help improve disease outcomes. The effectiveness of educational activities depends on the source of the information. Our study aimed to compare the effectiveness of targeted educational activities in written and podcast formats for patients with inflammatory bowel disease (IBD). Methods In this nationwide randomized controlled trial, IBD patients were enrolled between December 2023 and May 2024. At baseline, enrolled patients completed an online questionnaire assessing general knowledge of their disease (Inflammatory Bowel Disease Knowledge [IBD-KNOW]) and health-related quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and Patient Health Questionnaire-9 [PHQ-9]). Patients were randomized (1:1) into a control and an intervention group and the latter received targeted telemedical educational material, either in podcast format or as a written version, covering topics on anatomy, medical and surgical therapy, quality of life, epidemiology, diet/lifestyle, reproduction, and vaccination. This content was developed by IBD experts. Two months after the educational material was distributed, intervention group was re-tested, and satisfaction was measured. Descriptive statistics, Welch’s test, and Fisher’s exact test were used, with p-values <0.05 considered significant. Results A total of 221 patients were recruited, among whom 129 (58%) had Crohn’s disease (median age was 42 years [IQR 34-49], and median disease duration was 10 years [IQR 4-19], Table 1). Higher baseline IBD-KNOW scores were associated with longer disease duration (95% CI for B: 0.08-0.22, p < 0.001) and lower PHQ-9 scores (95% CI for B: 0.23-0.001, p = 0.052). Of the 221 patients, 95 were randomized into the intervention group to receive educational content, with 46/95 receiving the written version and 49/95 the podcast. Baseline characteristics and overall IBD-KNOW scores did not differ significantly between groups, except for a clinically irrelevant age discrepancy. After the educational intervention, the intervention group had higher overall IBD-KNOW scores compared to the control group (26.7 vs. 23.7, p < 0.001), while the format of the educational activity or quality of life had no significant impact on scores (Figure 1). Patient satisfaction was high (mean score of 8 ± 1.98) and was not influenced by the format of the educational content. Conclusion Telemedical education may enhance disease knowledge among IBD patients, with both forms of educational materials proving equally effective. Although no clear predictors of educational efficacy were identified, disease duration was associated with higher baseline knowledge.

Abstract Background Data are scarce on the deep remission of tofacitinib (TOFA) in moderate-to severe ulcerative colitis (UC), however, it can fundamentally change disease course and behaviour. Methods This was a prospective cohort study, assessing the short-term effectiveness of TOFA in UC patients. Baseline was the day of induction of TOFA. Clinical, biochemical, endoscopic and histological activities were assessed at baseline and at week 8 and 12, and we collected one-year treatment persistence. Primary outcome was week 12 histological remission (HR), defined as Nancy score<1 and endoscopic Mayo score (eMayo)≤1. Secondary outcomes were week 12 corticosteroid-free remission (CSFR), defined as clinical remission (CR; partial Mayo score [pMayo]<2 with a rectal bleeding subscore of 0) and C-reactive protein (CRP) ≤5 mg/L and endoscopic remission (eMayo score ≤1), furthermore, one-year treatment persistence were assessed. Data was handled by intention to treat analysis. We performed multivariable logistic, Cox-regression and linear regression models to control potential confounders and to reduce bias. The most reliable models were selected based on ROC analyzes with highest area under the curve (AUC). Results A total of 75 moderate-to severe UC patients (mean age 38.4 ± 12.1; male/female ratio 32/44) were involved in our prospective cohort study. In total, 7 patients (9.2%) achieved histological remission, while 20 patients (26.7%) achieved endoscopic remission. We found, that one-year treatment persistence was strongly influenced by week 12 endoscopic remission (β=3.79 [95% CI: 1.21 – 6.37]), but not by HR (β=1.58 [95% CI: -0.74 – 3.89]). In total, 34 patients (44.7%) were in CSFR at week 12, and higher baseline pMayo score decreased (OR=0.64 [95% CI: 0.43 – 0.94]), while albumin increased (OR=1.33 [95% CI: 1.01 – 1.76]) the chance of achieving the outcome (AUC = 0.93). Conclusion Based on our prospective cohort study, short-term HR is still a hard-to-reach endpoint in moderate-to-severe UC on TOFA. We found, that one-year treatment persistence is influenced by endoscopic mucosal healing, but not by HR, however, it should be enhanced, that as only a few patients achieved HR, the necessary statistical power was lacking.

Abstract Background High-quality endoscopy in IBD is associated with better clinical outcomes, while quality measurement supports effective quality control. The European Society of Gastrointestinal Endoscopy recommends using nine performance measures, depending on the indication for endoscopic examination in IBD. Our study aimed to compare colonoscopy quality between tertiary and secondary referral centers for IBD patients, based on endoscopic reports. Methods In this cross-sectional study, colonoscopy reports of IBD patients were analyzed. At our tertiary center, we consecutively enrolled patients over 18 years old with established IBD between July and October 2024, using their available colonoscopy reports. The secondary care group included patients referred to our tertiary center, with the last existing report from secondary care used for analysis, while the tertiary care group consisted of our patients whose most recent report was similarly used. Nine key performance measures (indication, bowel preparation, photo documentation, ileal intubation, biopsy, endoscopic activity score, high-definition and chromoendoscopy use, and neoplasia detection) were evaluated based on colonoscopy reports. Patients were stratified by procedure indication (diagnostic, activity assessment, or surveillance) as well. Descriptive statistics, Welch’s, and Fisher’s exact tests were used to compare groups, with p-values <0.05 considered significant. Results Overall, 207 colonoscopy reports were assessed, of which 68/207 were performed at secondary care level. A total of 78/207 patients were diagnosed with Crohn’s disease, while unclassified diagnoses were noted only at secondary centers. Activity control (88% vs. 38%, p<0.001) and surveillance (8% vs. 0%, p=0.02) examinations were more common at the tertiary level. Bowel preparation was better at tertiary centers (Boston Bowel Preparation Scale [BBPS] 8.3±2.3 vs. 7.2±1.2; p=0.003), and use of BBPS was more frequent at higher levels of care (p<0.001). Disease activity scores were more commonly used at the tertiary level during activity control examinations (51.2% vs. 19.2%, p=0.004), while ileal intubation was also more frequent at the tertiary level (53% vs. 28%; p<0.001). Procedure and withdrawal times did not differ between levels in diagnostic or activity control examinations. Neoplasia detection was low, and biopsy rates were similar. Conclusion Quality indicator targets were met in neither secondary nor tertiary centers; however, wider investigation is needed to verify these results. Broad education can help to improve the quality of colonoscopy in IBD care.

Abstract Background Crohn’s disease (CD) complicated with intra-abdominal abscess often requires surgical intervention. Image guided percutaneous drainage (PD) can help to avoid surgical interventions, however there is limited evidence on the optimal management after PD. Our study aimed to analyze the long-term outcomes of CD complicated with intra-abdominal abscess after intervention. Methods In this multicenter, multinational retrospective trial penetrating CD patients with simplex intra-abdominal abscess were enrolled and followed. Baseline was defined as the day of the first detection of simplex abdominal abscess, while follow-up period of 12-24 months was set. Patients with urgent resection were excluded. Patients were grouped based on elective surgical need during follow-up after a successful PD, while a control group of patients after resection without PD is created. Primary outcome was the abscess recurrence, while stoma rate, post procedural complications rate (<30 days), and postoperative luminal recurrence were analyzed as secondary outcomes. Logistic regression and Cox-regression models were created, while descriptive statistics, Welch’s test, and Fisher’s exact test were used to compare groups, with p-values <0.05 considered significant. Results A total of 131 CD patients from 7 countries were recruited (Table 1., 58% were male, the median age at inclusion was 31.4 [IQR25-40] years) and 74/131 patients had PD due to simplex abdominal abscess during a median follow-up of 104 (74-104) weeks. Abscess recurrence rates did not differ between groups (p=0.155, Figure 1.); however baseline SES-CD score was coupled with increased risk of recurrence (HR=1,17, 95% CI 0.993-1.389). Need for re-drainage was more common amongst PD patients (OR=0.092, 95% CI=0.012-0.732), while new stoma was created more frequently in patients without prior PD (OR=2.50, 95% CI=1.034-6.034). Postoperative luminal recurrence was similar between groups based on PD. Surgical complications were coupled with increased odds in patients without prior PD (OR=8.609, 95% CI=1.825-40.616), septic complications, perforation and new fistula formation were reported the most, while PD associated complication did not occur. Conclusion However, abscess recurrence did not differ between groups, PD prior to surgery strongly correlated with less stoma creature. Furthermore, surgical treatment of intra-abdominal abscess alone may be coupled with post procedural complications.

Abstract Background Perianal fistulas of Crohn’s disease (CD) create a significant burden on patient lives. However, the efficacy and safety of adipose-derived mesenchymal stem cell treatment are contradicting, and real-world evidence is lacking. We aimed to examine the usability of darvadstrocel therapy in managing perianal CD. Methods In this retrospective multicenter study CD patients with perianal fistulas were enrolled and followed. The primary outcome was perianal clinical remission (all treated fistulas have closed) at weeks 26 and 52, while the secondary outcomes were clinical response rates (≥ 1 fistulas have closed), perianal activity (PDAI), patient satisfaction, and adverse events. The data was recorded at the baseline and weeks 12, 26, and 52. Prediction of primary outcomes was performed by logistic regression. Results Overall, based on the data of 223 patients (Table 1., male/female ratio: 0.48), perianal clinical remission was achieved in 78.2% and 62.3% until week 26 and 52 (Figure 1.), whereas baseline PDAI score (OR 0.75), number of fistulas (OR 0.28), and the number of weeks after preparation for surgery (OR 0.98) were associated with treatment failure. The clinical response rates were 84.8% and 79.8% at week 26 and 52. Moreover, the improvement of subjective perianal symptoms was achieved in 77.8% and 78.4% of the patients, respectively. Adverse events occurred in 13.5% of the patients, with perianal abscesses and proctalgia reported the most. Conclusion Effectiveness data are higher than the clinical trials. The safety profile is reassuring, and patients’ satisfaction is high. Appropriate patient selection, fistula preparation and expertise may help to achieve treatment success.

Background: Different endoscopic scoring systems for assessing ulcerative colitis (UC) severity are available. However, most of them are not correlated with disease extent. Objectives: Our study aimed to compare the predictive value of the PanMay score versus the endoscopic Mayo (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Dublin score in predicting long-term outcomes of UC. Design: This retrospective study enrolled consecutive UC patients who underwent colonoscopy before at least a 3-year follow-up. Methods: The PanMayo, MES, UCEIS, and Dublin scores and the baseline clinical and demographic characteristics of the participants were assessed. Endpoints were disease flare that required novel biological therapy, colectomy, and hospitalization. Patients were stratified using baseline clinical activity. Results: Approximately 62.8% of the 250 enrolled patients were in clinical remission. In these patients, the PanMayo, MES, and Dublin scores were positively associated with the risk of clinical flare. The MES score increased with clinical flare. The PanMayo score (>12 points), but not the MES score, was associated with the need for novel biological initiation and biological escalation. Furthermore, the Dublin and UCEIS scores of patients in remission who need novel biological treatment had a similar trend. Colectomy risk was associated with PanMayo and Dublin scores. Conclusion: The combined endoscopic assessment of disease extent and severity can be more accurate in predicting outcomes among patients with UC. PanMayo score can be utilized in addition to the existing scoring systems, thereby leading to a more accurate examination. Summary: UC endoscopic scores do not assess extension. Our study aimed to analyze the predictive value of the PanMayo score. Based on 250 patients, results showed that the long-term disease outcomes of UC could be predicted with the PanMayo score more accurately.

Alterations to intestinal microbiota are assumed to occur in the pathogenesis of inflammatory bowel disease (IBD). This study aims to analyze the association of fecal microbiota composition, body composition, and lipid characteristics in patients with Crohn’s disease (CD). In our cross-sectional study, patients with CD were enrolled and blood and fecal samples were collected. Clinical and endoscopic disease activity and body composition were assessed and laboratory tests were made. Fecal bacterial composition was analyzed using the shotgun method. Microbiota alterations based on obesity, lipid parameters, and disease characteristics were analyzed. In this study, 27 patients with CD were analyzed, of which 37.0% were obese based on visceral fat area (VFA). Beta diversities were higher in non-obese patients (p < 0.001), but relative abundances did not differ. C. innocuum had a higher abundance at a high cholesterol level than Bacillota (p = 0.001, p = 0.0034). Adlercreutzia, B. longum, and Blautia alterations were correlated with triglyceride levels. Higher Clostridia (p = 0.009) and B. schinkii (p = 0.032) and lower Lactobacillus (p = 0.035) were connected to high VFA. Disease activity was coupled with dysbiotic elements. Microbiota alterations in obesity highlight the importance of gut microbiota in diseases with a similar inflammatory background and project therapeutic options.