Fistulizing Crohn’s disease (CD) is a severe phenotype associated with morbidity and impaired health-related quality of life (HRQoL). However, it remains unclear whether HRQoL impairment is driven by fistula presence or ongoing inflammatory activity. This study aimed to evaluate the association of fistulizing disease, disease activity, and treatment exposure with HRQoL. This cross-sectional study included consecutive adult patients with CD attending a tertiary inflammatory bowel disease clinic. Patients were classified as having fistulizing or non-fistulizing disease. The primary outcome was HRQoL, assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ) and its four subdomains. Luminal and perianal disease activities were evaluated using the Crohn’s Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). Associations were analyzed using t-test or Mann–Whitney U test, Chi-square or Fisher’s exact test, and Spearman’s rank correlation, as appropriate. A total of 209 patients were included (mean age 38.6 ± 13.1 years; 36.8

Background: Phoenixin-14 (PNX-14), a hypothalamic peptid, has anti-inflammatory, antioxidant and anxiolytic effect in rodents. Considering brain-gut interaction in the pathogenesis of inflammatory bowel disease (IBD) we aimed to investigate serum PNX-14 levels in patients with the disorder. Methods: Consented patients with ulcerative colitis (UC, n = 26), with Crohn’s Disease (CD n = 19), sex and age matched healthy volunteers (HC n = 38) were enrolled in a pilot cross-sectional study. All subjects filled out the QoL Short Form and the Hospital Anxiety and Depression Scale (HAD) questionnaires. Serum PNX-14 levels were assayed with ELISA. Data was expressed as median (quartiles) and compared by nonparametric ANOVA or t test. p < 0.05 was accepted as significant. Results: PNX-14 levels were similar in all study groups. However, patients on azathioprine and/or any biological agent (n = 24) had lower PNX-14 levels as compared with those who were only on mesalamine (n = 18). PNX-14 levels negatively correlated with HAD-A scores. HAD-D score was high and QoL sub-scores were low in IBD patients as compared with HCs. PNX-14 was significantly lower in UC patients with depression as comparedwith the rest of UC group. Conclusion: Serum PNX-14 levels do not discriminate IBD patients from HC. However, statistically significant low serum PNX levels in patients on azathioprine and /or any biological agent may reflect the heterogeneity of pathogenesis of IBD and particularly of patients with UC. Moreover, serum PNX-14 levels in IBD patients negatively correlated with HAD-A scores reflecting brain-gut interaction. Studies that will be conducted in treatment naïve patients may clarify role of PNX in the disease.

Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, frequently complicated by stricture, fistula, and abscess. Strictures affect nearly 50

Abstract Background Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are common causes of AZA discontinuation in IBD patients1,2. This study compares HLA alleles linked to AZA-AP3,4, along with demographic and clinical data, between AP and GI-INT patients. Methods Data from five IBD centers were used to form three groups: Control (n=88), AZA-AP (n=44), and GI-INT (n=44). Patients diagnosed with AP during AZA treatment per the Atlanta criteria (radiology, elevated amylase/lipase, and typical pain) were placed in the AZA-AP group. The GI-INT group included cases with pancreatitis-like symptoms lacking objective evidence, appearing within hours of AZA use and resolving very rapidly after stopping the medication. The impact of patients’ demographic data, disease characteristics, and HLA-DQA1/HLA-DRB1 allele status on AZA-AP and GI-INT were analyzed. Factors associated with AP (p<0.1) were further evaluated using regression analysis. Results A total of 176 patients were evaluated, and their socio-demographic characteristics are summarized in Table 1. Crohn’s disease was the most common diagnosis. Female gender was more prevalent in the AZA-AP and GI-INT groups compared to controls (p=0.018 and p<0.001, respectively). The AZA-AP group had a higher age at diagnosis than controls (p=0.016), but no difference was noted for the GI-INT group (p=0.15). Alcohol use and smoking were more common in the AZA-AP group. In the AZA-AP group, AP developed at a median of 4 weeks, with 91% of cases occurring within the first 3 months (AP onset occurred in one patient after 8 years and in another after 5 years). GI-INT developed at a median of 1 day, with a maximum onset time of 3 days. HLA-DQA1/DRB1 positivity was comparable between the GI-INT and control groups (9.2% vs. 14.8%; p=0.42) but was higher in the AZA-AP group (27.3% vs. 14.8%; p=0.08) (Table 1). Regression analysis indicated that female gender, older age at diagnosis, active smoking, alcohol use, and HLA-DQA1/DRB1 positivity were independently associated with an increased AP risk (OR: 2.7, 95% CI: 1.008–7.221; p=0.048) (Table 2). To prevent one case of pancreatitis, avoiding AZA in all individuals with the risk allele would mean that testing around 6 patients (NNTest) is necessary. Conclusion In IBD patients, azathioprine-associated pancreatitis most commonly occurs within the first 3 months of treatment and is independently associated with active smoking, alcohol use, female gender, and HLA-DQA1/DRB1 positivity. In contrast, GI intolerance typically begins within hours of the first dose, up to a maximum of 3 days, shows no significant demographic differences from the AZA-AP group, and is not associated with HLA-DQA1/DRB1 positivity. References 1.Teich N, Mohl W, Bokemeyer B, et al. Azathioprine-induced Acute Pancreatitis in Patients with Inflammatory Bowel Diseases--A Prospective Study on Incidence and Severity. J Crohns Colitis. 2016;10(1):61-68. doi:10.1093/ecco-jcc/jjv188 2.Eskazan T, Bozcan S, Atay K, et al. Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease: Results From a Tertiary Referral Center. Pancreas. 2021;50(9):1274-1280. doi:10.1097/MPA.0000000000001914 3.Wilson A, Wang Q, Choi YH, et al. Pretreatment HLADQA1-HLADRB1 Testing for the Prevention of Azathioprine-Induced Pancreatitis in Inflammatory Bowel Disease: A Prospective Cohort Study. Clin Transl Gastroenterol. 2021;12(4):e00332. Published 2021 Apr 5. doi:10.14309/ctg.0000000000000332 4.Heap GA, Weedon MN, Bewshea CM, et al. HLA-DQA1-HLA-DRB1 variants confer susceptibility to pancreatitis induced by thiopurine immunosuppressants. Nat Genet. 2014;46(10):1131-1134. doi:10.1038/ng.3093

Objective/Aim:Differentiating the gastrointestinal (GI) involvement of Behçet's disease (BD) and inflammatory bowel diseases (IBD) can be a diagnostic challenge. We previously reported that the wall thickness of the common femoral vein (CFV) is higher in BD patients compared to Crohn's disease (CD) with a limited number of IBD patients with only CD. This study aimed to evaluate the CFV thickness measurement in BD patients and in a larger group of IBD patients including both ulcerative colitis (UC) and CD. Methods:The study included patients with BD (n=117), IBD (n=87, [53 CD, 34 UC]), and healthy gender-matched controls (HC) (n=85). CFV wall thicknesses were measured with Doppler ultrasonography. Results:Among BD patients, 70 (59.8%) had major organ (48[41.0%] vascular, 21[30.0%] ocular, 11[15.7%] gastrointestinal, and 8[11.4%] neurological) involvement. The mean right CFV thickness was 0.75±0.21 mm, 0.32±0.08 mm, and 0.28±0.13 mm for BD, IBD, and HC, respectively (p<0.001). BD patients had significantly higher CFV wall thicknesses compared to IBD patients and HC (adj. p<0.001 for both), and CFV thicknesses in IBD were comparable to HC (adj.p>0.05). Among BD patients, CFV thicknesses did not differ in patients with and without GI involvement. CFV thicknesses were also similar in patients with CD and UC. Conclusion:CFV thickness was significantly higher in BD compared to CD and UC patients. These results suggest that the CFV wall thickness measurement may be used in daily practice to differentiate GIBD from IBD.

Abstract Background Crohn's disease (CD) is a chronic, remitting disease with sometimes inadequate response to the treatment and these factors may impact the quality of life of patients. Our study aims to evaluate the impact of fistulizing disease, different treatment options and disease activity on the quality of life of in CD. Methods Patients who applied to the inflammatory bowel disease outpatient clinic between August 2021 and September 2023 were invited to the study respectively. Patients who agreed to participate were included in the study. The quality of life of the patients was assessed with the Inflammatory Bowel Disease Questionnaire (IBDQ), and disease activity was assessed with the Crohn's Disease Activity Index (CDAI). In addition, the Perianal Disease Activity Index (PDAI) was used in those with perianal disease. The quality of life scores of the patients were compared in terms of clinical and demographic parameters. Results A total of 209 patients enrolled in our study; 103 (49.3%) were non-fistulizing and 106 (50.7%) were fistulizing. 78 of the fistulizing patients had perianal fistula. A moderately strong and statistically significant negative correlation was found between CDAI and total IBDQ (r=-.538, p<0.001). A statistically significant negative correlation was found between PDAI and total IBDQ (r=-.372, p=0.001). Although the mean total IBDQ value of nonfistulizing patients (148.97 ±36.41) was higher than fistulizing patients (144.61±37.46), fistulizing status did not significantly affect the total IBDQ score (p=0.395). Being a woman significantly affects all sub-scores of IBDQ score and total IBDQ score. Although the mean total IBDQ score of patients under biological treatment was higher than who were not using them; the difference was not significant (p=0.771). In addition, the quality of life score was significantly lower in those with a diagnosis of spondyloarthropathy (p=0.012). Conclusion In the current literature, the presence of perianal fistula has been shown to have a negative effect on quality of life in several studies (1,2,3). Our study revealed a negative relationship between PDAI and CDAI values and total IBDQ score. In addition, our study showed that gender had a significant effect on total IBDQ, while fistulizing condition, use of biological agents, and surgical history did not affect the total IBDQ score. It is possible that this partial difference with the current literature is due to the difference of quality of life assesments. References 1-Spinelli A, Yanai H, Girardi P, Milicevic S, Carvello M, Maroli A, Avedano L. The Impact of Crohn's Perianal Fistula on Quality of Life: Results of an International Patient Survey. Crohns Colitis 360. 2023 Jul 25;5(3):otad036. doi: 10.1093/crocol/otad036. PMID: 37529012; PMCID: PMC10390083. 2-Kato M, Yoneyama-Hirozane M, Iwasaki K, Matsubayashi M, Igarashi A. Health-related quality of life in health states corresponding to different stages of perianal fistula associated with Crohn's disease: a quantitative evaluation of patients and non-patients in Japan. J Mark Access Health Policy. 2023 Jan 15;11(1):2166374. doi: 10.1080/20016689.2023.2166374. PMID: 36684854; PMCID: PMC9848226. 3-Karki C, Athavale A, Abilash V, Hantsbarger G, Geransar P, Lee K, Milicevic S, Perovic M, Raven L, Sajak-Szczerba M, Silber A, Yoon A, Tozer P. Multi-national observational study to assess quality of life and treatment preferences in patients with Crohn's perianal fistulas. World J Gastrointest Surg. 2023 Nov 27;15(11):2537-2552. doi: 10.4240/wjgs.v15.i11.2537. PMID: 38111766; PMCID: PMC10725550.

Background: Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are major causes of drug discontinuation in inflammatory bowel disease (IBD). This study compared HLA alleles, demographics, and clinical variables between AZA-AP and AZA-GI-INT. Methods: Data from five IBD centers included control (n = 88), AZA-AP (n = 44), and GI-INT (n = 44) groups. AP was defined by the Atlanta criteria, and GI-INT as acute dyspeptic symptoms related to AZA that resolved after withdrawal. Demographics, disease features, and HLA-DQA1/DRB1 alleles were assessed for associations. Results: Among 176 patients, female sex was more frequent in AZA-AP and GI-INT than controls (p = 0.018, p < 0.001). AZA-AP patients were older at diagnosis vs. controls (p = 0.016) but not vs. GI-INT (p = 0.15). Smoking and alcohol were more common in AZA-AP. The median onset of AP was four weeks, with 91% occurring within three months. GI-INT occurred rapidly, with a median of one day and a maximum of three days after the first dose. HLA-DQA1/DRB1 positivity was comparable in GI-INT and controls (9.2% vs. 14.8%, p = 0.42) but higher in AZA-AP (27.3% vs. 14.8%, p = 0.08). Regression identified female sex, smoking, alcohol, budesonide, and HLA-DQA1/DRB1 positivity (OR 3.01, 95% CI 1.004-9.058; p = 0.049) as independent risk factors for AZA-AP. Conclusions: AZA-AP, but not GI-INT, appears genetically influenced, with HLA-DQA1/DRB1 association extending across populations. In IBD, AZA-AP usually emerges within three months and is linked to female sex, smoking, alcohol, and budesonide. GI-INT typically develops within hours to three days of initiation. These findings support AZA-AP and GI-INT as distinct idiosyncratic entities shaped by genetic, metabolic, and sensitivity factors.

The incidence of inflammatory bowel disease (IBD) is rising in newly industrialized nations, yet nationally representative data from Türkiye are limited. We characterized recent epidemiologic trends, clinical features, and geographic distribution of newly diagnosed IBD across Türkiye. This retrospective multicenter cohort included adults (≥18 y) with newly diagnosed IBD at 24 gastroenterology centers spanning all 7 Turkish regions (2010-2022). Demographics, disease behavior/extent, smoking status, family history, and province of residence were collected. Temporal and regional patterns were analyzed using χ 2 tests and segmented regression. Among 3463 patients, 51.1% had UC, 44.0% CD, and 0.7% IC. Males comprised 57.7%; median age at diagnosis was 30 years for CD and 32 years for UC. Annual IBD diagnoses more than doubled from 2010 to 2021. The UC-to-CD ratio increased from 0.94:1 (2010-2016) to 1.29:1 (2016-2022, P < 0.001). CD most often showed inflammatory behavior (55.5%) and ileocolonic involvement (37.1%); UC frequently presented as pancolitis (39.3%). Smoking (24.2% vs 10.9%) and family history (6.8% vs 4.5%) were more common in CD than UC (both P <0.01). Choropleth mapping revealed a west-to-east gradient, with Marmara and Aegean regions bearing the highest burden. Multivariable analysis showed UC diagnosis was independently associated with state-hospital care, residence in Central Anatolia or the Black Sea, and age ≥60 years. Incident IBD in Türkiye has risen steadily, with UC now exceeding CD. Patients predominantly present in early adulthood. Regional and hospital-level differences highlight the need for a national registry and targeted resource allocation.

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease with remissions and flares. Approximately 20% of UC Patients develop acute severe ulcerative colitis (ASUC), a serious condition that is refractory to standard therapies and leads to morbidity and mortality. Rescue therapy (salvage therapy) with steroids, cyclosporine, and/or infliximab is recommended by guidelines.1 The colectomy rate in ASUC remains at around 36% even in the biological millennium.2 Upadacitinib (UPA) is a JAK1 selective inhibitor used effectively to treat UC. The role of UPA as a rescue therapy in ASUC is not clear. This study aims to evaluate the outcomes of UPA as a rescue therapy in ASUC patients. Methods A total of 31 steroid- and infliximab-refractory ASUC patients from 10 IBD centers from all over Türkiye were included between April 2023 and October 2024 in our study. Demographics of the patients and disease characteristics were recorded. Stool frequency (per day), rectal bleeding scores, and C reactive protein (CRP) were assessed from the electronic database at baseline (week 0), week 1, 4, 8, and 16 retrospectively. Complete clinical response was defined as stool frequency ≤3 per day and rectal bleeding score 0-1. Results Mean age was 36±13years; 16(51.6%) were female, mean disease duration was 6.9±5.4 years, 30(96.8%) had immunomodulator experience (Table1). A total of 10 patients had ≥ 3 biologics failures. Complete clinical response at weeks, 4, 8, and 16 were in 13 (42%), 16 (64%), 12 (67%), and 10 (77%) patients respectively. Rescue therapy responses were not statistically significant between ≥3 and <3 biologics failure groups (p=0.580) at week1. CRP normalization (<3 mg/L) at week 4 was found in 9(36%) patients. By the end of the week, 6 (33%) patients had undergone colectomy. Clinical responses and surgery rates of UPA at week1,4,8, and 16 were detailed in Figure 1. Conclusion UPA provided a complete clinical response as a rescue therapy within the first week in 42% of cases in anti-TNF and steroid non-responders even with multiple biologics experience. Over half of the patients showed clinical remission by weeks 4 and 8. References 1.Raine T, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2022;16(1):2-17. doi:10.1093/ecco-jcc/jjab1782. 2.Moore AC, Bressler B. Acute Severe Ulcerative Colitis: The Oxford Criteria No Longer Predict In-Hospital Colectomy Rates. Dig Dis Sci. Feb 2020;65(2):576-80.

Abstract Background Patient-reported outcome measures (PROMs) are used to assess the effectiveness of treatments received by patients in terms of clinical response in inflammatory bowel disease (IBD). We aimed to evaluate the perceived clinical response from the patient’s perspective using PRO2, IBD Control Questionnaire (ICQ) and Visual Analogue Scale (VAS) at the end of induction therapy in patients treated with upadacitinib. We also aimed to evaluate the correlation of PROMs with biochemical response. Methods We included IBD patients who underwent upadacitinib induction therapy from 01/07/2024 to 01/10/2024 in ten centers. ICQ and VAS assessments (Higher scores are better) were used in conjunction with CRP levels and PRO2 assessments (Lower scores are better) performed at baseline and at the end of induction treatment. Results A total of 75 patients who completed the induction phase were included, 52% were female and 50.7% were treated for Crohn’s disease (CD). Treatment was switched in 54.7% of patients due to uncontrolled chronic disease, in 42.7% for loss of response and in 2.7% for drug side effects. PRO2 mean scores were changed from 4.86 ± 3.06 to 1.67 ± 1.28 (p<0.05) and 18.61 + 10.42 to 7.36 + 5.10 (p<0.05) for ulcerative colitis (UC) and CD respectively. At the end of induction treatment, 47.2% of UC group and 66.7% in the CD group were classified as in clinical remission according to PRO2 scores. The rate of patients reporting side effects was 30.7%. Acne and skin rashes were reported more frequently (13.2 %). According to the visual analog scale, 80% of the patients reported improvement in their condition (p<0.05), and the mean VAS score and IBD control score were 71.9 and 13.7 (p<0.05) for patients in remission in the UC group and 70 and 14.7 (p<0.05) in the CD group compared to active patients. ICQ scores and VAS were negatively correlated with PRO2 scores and CRP levels (p<0.05 for both pairs). On the other hand both scores were not correlated with CDAI and mayo scores (p>0.05). Conclusion In this real-life cohort of patients treated with upadacitinib, 80% report a significant improvement in their condition. ICQ and VAS can be used to understand patients’ perspective on treatment efficacy. Conventional activity scores probably not helpful for early assessment of clinical activity compared to PROMs.

Abstract Background Strictures can be developed in approximately half of the Crohn’s disease (CD) patients during the course of the disease. Stricturing CD can be treated by medical, endoscopic and surgical options. In this study, we investigated the risk factors of CD related surgery and postoperative complications in stricturing CD. Methods We included the patients with stricturing Crohn’s disease who were followed up in our inflammatory bowel disease specific outpatient clinic between 1989 and 2024. Demographic and clinical data were collected retrospectively from the hospital electronic system and patient files. We divided our cohort into two groups as with and without CD-related surgery, and compared these two groups in terms of factors affecting the need for surgery. We examined the CD-related surgery groupin terms of the development of complications within 90 days following surgery. Results A total of 129 patients were included in the study. The mean age was 40.26 ± 14.13 years, and 59 (45.7%) of the patients were female. Sixty-two (48.1%) patients had tobacco exposure or were currently smoking. Nine (7.0%) patients had multiple strictures. Intestinal fistula was present in 35 (68.6%) patients in the surgical group, and it was found to be significantly higher compared to the non-surgical group (p=0.02). While 63 (63.6%) patients in the surgical group had a history of biological use, 36 (36.4%) patients in the non-surgical group had biological exposure, and this difference was statistically significant (p=0.003). Complications developed in 23 (31.5%) of the operated patients in the first 90 days after the operation (19 infectious, 8 non-infectious). Intestinal fistula, multiple stenoses and biological exposure (p = 0.02, p = 0.02, p = < 0.0001, respectively) were observed at a higher rate in the group with complications. In multivariate analysis, biological exposure was found to be a risk factor for surgery (p = 0.01; RR: 3.45), and the presence of abscess was found to be a risk factor for the development of complications following surgery (p = 0.01, RR: 8.09). Conclusion In our study, the presence of intestinal fistula and exposure to biological agents were found to be higher in the surgical group. In line with the current literature, the use of biological agents was found to be a factor affecting the need for surgery, and the presence of abscess was found to be a factor affecting postoperative complications (1, 2). References 1.Bossuyt P, Debeuckelaere C, Ferrante M, de Buck van Overstraeten A, Vanbeckevoort D, Billiet T, Wolthuis A, Cleynen I, Van Assche G, D’Hoore A, Vermeire S. Risk Stratification for Surgery in Stricturing Ileal Crohn’s Disease: The BACARDI Risk Model. J Crohns Colitis. 2018 Jan 5;12(1):32-38. 2.Celentano V, Giglio MC, Pellino G, Rottoli M, Sampietro G, Spinelli A, Selvaggi F; Italian Society of Colorectal Surgery SICCR. High complication rate in Crohn’s disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study. Int J Colorectal Dis. 2022 Jun;37(6):1421-1428.

BACKGROUND:The incidence of inflammatory bowel disease (IBD) is rising in newly industrialized nations, yet nationally representative data from Türkiye are limited. We characterized recent epidemiologic trends, clinical features, and geographic distribution of newly diagnosed IBD across Türkiye. METHODS:This retrospective multicenter cohort included adults (≥18 y) with newly diagnosed IBD at 24 gastroenterology centers spanning all 7 Turkish regions (2010-2022). Demographics, disease behavior/extent, smoking status, family history, and province of residence were collected. Temporal and regional patterns were analyzed using χ2 tests and segmented regression. RESULTS:Among 3463 patients, 51.1% had UC, 44.0% CD, and 0.7% IC. Males comprised 57.7%; median age at diagnosis was 30 years for CD and 32 years for UC. Annual IBD diagnoses more than doubled from 2010 to 2021. The UC-to-CD ratio increased from 0.94:1 (2010-2016) to 1.29:1 (2016-2022, P < 0.001). CD most often showed inflammatory behavior (55.5%) and ileocolonic involvement (37.1%); UC frequently presented as pancolitis (39.3%). Smoking (24.2% vs 10.9%) and family history (6.8% vs 4.5%) were more common in CD than UC (both P <0.01). Choropleth mapping revealed a west-to-east gradient, with Marmara and Aegean regions bearing the highest burden. Multivariable analysis showed UC diagnosis was independently associated with state-hospital care, residence in Central Anatolia or the Black Sea, and age ≥60 years. CONCLUSION:Incident IBD in Türkiye has risen steadily, with UC now exceeding CD. Patients predominantly present in early adulthood. Regional and hospital-level differences highlight the need for a national registry and targeted resource allocation.

Background: This study aimed to determine the prevalence of probable sarcopenia and sarcopenia in patients with inflammatory bowel disease (IBD) by using the European Working Group on Sarcopenia in Older People (EWGSOP2) diagnostic criteria. Methods: Sarcopenia was assessed by using the sequential four-step algorithm. (1) Find: Sarcopenia risk by simple clinical symptom index (strength, assistance walking, rise from a chair, climb stairs, and falls [SARC-F questionnaire]). (2) Assess: Probable sarcopenia by low muscle strength on handgrip. (3) Confirm: Confirmed sarcopenia by low appendicular skeletal muscle mass on bioimpedance analysis. (4) Severity: Severe sarcopenia by low 4-m gait speed test. Results: A total of 129 adult patients with IBD younger than 65 years and 50 age- and sex-matched healthy control (HC) participants were included to the study. Handgrip strength, gait speed, and SARC-F scores were significantly lower in patients with IBD than in the HCs (P = 0.032, <0.0001, and <0.0001, respectively). Based on the EWGSOP2 definition, 17.8% of patients with IBD had probable sarcopenia, and six patients had confirmed sarcopenia. According to the ethnicity-based population thresholds, 34.9% of patients with IBD had probable sarcopenia, and two patients had confirmed sarcopenia. Corticosteroid use within the past year was identified as an independent risk factor for low muscle strength (P = 0.012; odds ratio, 4.133), along with advanced age and disease activity. Conclusion: One-third of the patients younger than 65 years with IBD had probable sarcopenia, defined as low muscle strength, whereas the incidence of confirmed sarcopenia remained relatively low.

Abstract Background This study aims to assess the past decade's epidemiology of inflammatory bowel disease (IBD) patients in Türkiye and identify year-to-year variations. Methods A total of 3463 patients diagnosed between 2010 and 2022 were included. The patients' demographic and phenotypic characteristics, smoking habits, and family histories were assessed. Differences between geographic regions and age groups were analyzed. Results Among patients, 1523 (44%) had Crohn's disease (CD), 1768 (51.1%) had ulcerative colitis (UC), and 23 (0.7%) had indeterminate colitis (Table). Male proportions were higher in both CD and UC patients, with the most common age range for diagnosis being 21-30 years (Figure). Over time, newly diagnosed cases and rates per population increased according to Turkish Statistical Institute data (Figure). Patients were divided into two groups based on diagnosis years (2010-2016 and 2016-2022), CD initially dominated, but UC prevalence grew in the last 6 years (p<=0.001). Recently diagnosed CD patients showed higher inflammatory involvement (78.0% vs. 63.4%; p<=0.001), and the inflammatory phenotype rose post-2016 (75.2% vs. 60.4%; p<=0.001). CD patients had more smokers (24.2% vs. 10.9%; p<=0.001) and family history of IBD (6.8% vs. 4.5%; p=0.004) than UC patients. Patients over 60 years old had a higher male gender ratio (64.4% vs. 55.9%; p<=0.001) and UC frequency (62.2% vs. 52%; p<=0.001) compared to those under 60 years old. The inflammatory phenotype in CD patients was lower in those under 60 years old compared to those over 60 years old (70.4% vs. 85.4%; p<=0.001). The frequency of pancolitis in UC patients was lower in those over 60 years old (31.3% vs. 41.4%; p<=0.001). Conclusion In Türkiye, IBD is more prevalent in males and is frequently diagnosed between ages 20 to 30. In CD, inflammatory and ileocolonic involvement is most common, while in UC, pancolitis is observed. The earlier diagnosis peak and increased pancolitis in UC patients might relate to tertiary centers' inclusion with transition clinics and focus on severe cases. Recently, newly diagnosed UC cases have notably surpassed CD cases.

Background: The risk of hepatitis B reactivation in hepatitis B surface antigen-negative phase of hepatitis B virus-infected patients exposed to biologic agents is not clear. We aimed to investigate the reactivation rate in hepatitis B surface antigen-negative phase of hepatitis B virus-infected patients after biologic therapy. Methods: Patients followed at gastroenterology, rheumatology, and dermatology clinics with a diagnosis of immune-mediated inflammatory diseases were screened. Immune-mediated inflammatory diseases patients exposed to biologic agents with a negative hepatitis B surface antigen and positive hepatitis B core immunoglobulin G antibody were included in the study. Results: We screened 8266 immune-mediated inflammatory disease patients, and 2484 patients were identified as exposed to biologic agents. Two hundred twenty-one patients were included in the study. The mean age was 54.08 ± 11.69 years, and 115 (52.0%) patients were female. The median number of different biologic subtype use was 1 (range: 1-6). The mean biologic agent exposure time was 55 (range: 2-179) months. One hundred and fifty-two (68.8%) patients used a concomitant immunomodulatory agent, and 84 (38.0%) patients were exposed to corticosteroids during biologic use. No hepatitis B reactivation with a reverse seroconversion of hepatitis B surface antigen positivity was seen. Antiviral prophylaxis for hepatitis B was applied to 48 (21.7%) patients. Hepatitis B virus-DNA was screened in 56 (25.3%) patients prior to the biologic exposure. Two patients without antiviral prophylaxis had hepatitis B virus-DNA reactivation with a negative hepatitis B surface antigen during exposure to the biologic agent. Conclusion: We found 2 reactivations and no hepatitis B surface antigen seroconversion in our cohort. Antiviral prophylaxis for patients exposed to biologic agents may need to be discussed in more detail.

anti-HBc IgG)-positive patients under biologic treatment

BACKGROUND:Assessment of endoscopic activity in ulcerative colitis (UC) is important for treatment decisions and monitoring disease progress. However, substantial inter- and intraobserver variability in grading impairs the assessment. Our aim was to develop a computer-aided diagnosis system using deep learning to reduce subjectivity and improve the reliability of the assessment.METHODS:The cohort comprises 11 276 images from 564 patients who underwent colonoscopy for UC. We propose a regression-based deep learning approach for the endoscopic evaluation of UC according to the Mayo endoscopic score (MES). Five state-of-the-art convolutional neural network (CNN) architectures were used for the performance measurements and comparisons. Ten-fold cross-validation was used to train the models and objectively benchmark them. Model performances were assessed using quadratic weighted kappa and macro F1 scores for full Mayo score classification and kappa statistics and F1 score for remission classification.RESULTS:Five classification-based CNNs used in the study were in excellent agreement with the expert annotations for all Mayo subscores and remission classification according to the kappa statistics. When the proposed regression-based approach was used, (1) the performance of most of the models statistically significantly increased and (2) the same model trained on different cross-validation folds produced more robust results on the test set in terms of deviation between different folds.CONCLUSIONS:Comprehensive experimental evaluations show that commonly used classification-based CNN architectures have successful performance in evaluating endoscopic disease activity of UC. Integration of domain knowledge into these architectures further increases performance and robustness, accelerating their translation into clinical use.