BACKGROUND Perianal fistulae strongly impact on quality of life of affected patients. AIM To challenge and novel minimally invasive treatment options are needed. METHODS Patients with Crohn’s disease (CD) in remission and patients without inflammatory bowel disease (non-IBD patients) were treated with fistulodesis, a method including curettage of fistula tract, flushing with acetylcysteine and doxycycline, Z-suture of the inner fistula opening, fibrin glue instillation, and Z-suture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks. Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included. The primary end point was fistula healing, defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk. RESULTS Fistulodesis was performed in 17 non-IBD and 3 CD patients, with a total of 22 fistulae. After 24 wk, all fistulae were healed in 4 non-IBD and 2 CD patients (overall 30%) and fistula remained closed until the end of follow-up at 10-25 mo. In a secondary per-fistula analysis, 7 out of 22 fistulae (32%) were closed. Perianal disease activity index (PDAI) improved in patients with fistula healing. Low PDAI was associated with favorable outcome (P = 0.0013). No serious adverse events were observed. CONCLUSION Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low PDAI needs to be confirmed.

Background: Inflammatory bowel disease (IBD) needs early interventions and an individual specialist–patient relationship. Distance from a tertiary IBD center might affect patient’s disease course and outcome. We investigated whether the patient-to-specialist distance has an impact on the disease course using the well-defined patient collective of the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Methods: Patient’s home address at diagnosis (postal zip code) was extracted from the SIBDCS database. Distance between each zip code and the nearest located IBD specialist center was calculated and classified into the following three sections based on proximity: <10 km (group 1); 10–35 km (group 2); >35 km (group 3). Results: Our study included in total 408 IBD patients [234 Crohn’s disease (CD), 154 ulcerative colitis (UC), 20 IBD unclassified (IBDU)]. Median age was lowest in group 2 at diagnosis (G1: 28 years; G2: 21 years, G3: 26 years, p < 0.01). The diagnostic delay did not differ between groups. CD patients in group 1 were treated more often with anti-tumor necrosis factor (TNF) agents (72% versus 56%, p = 0.04) and 5-aminosalicylates (44% versus 28%, p = 0.04) than in group 3. UC/IBDU patients in group 1 were treated more often with corticosteroids than patients in group 3 (83% versus 58%, p < 0.01). The occurrence of IBD-related surgeries did not differ between groups. Conclusions: Patient-to-specialist distance might affect drug treatment. However, disease course and the need for IBD-related surgery does not seem to be associated with a longer distance to specialist care in Switzerland.

BACKGROUND:Young patients with Crohn's disease (CD) show a high prevalence of human papillomavirus (HPV) which is the main cause of high-grade squamous intraepithelial lesions (HSIL). A major complication for patients undergoing immunocompromising therapy is the development of genital dysplasia. METHODS:We report the case of a 32-year-old patient with recurrent genital dysplasia under long-term therapy for CD with a focus on different drug-related, immunosuppressive mechanisms. RESULTS:Gynecological examination and biopsy revealed high-grade vulvar intraepithelial neoplasia (VIN) positive for HPV 16 treated with laser vaporization. Due to the combination of HPV positivity, intraoperative multilocularity, and CD, follow-up examinations were performed every 6 months. One year later, the patient showed a VIN at a new location and additionally, a cervical intraepithelial neoplasia (CIN), which were surgically treated. Catch-up HPV vaccination was applied accessorily. After the switch from a TNF-α blocker to vedolizumab, which acts as a gut-selective anti-integrin, the subsequent PAP smear, vulvoscopy, and colposcopy showed no more evidence of dysplasia. CONCLUSIONS:This case report highlights that gut-selective immunosuppression with vedolizumab might be favorable in young HPV-positive patients due to a good side effect profile. Regular screening and HPV vaccination are a mainstay of dysplasia prevention and control. The risk for HPV-associated dysplasia in immunosuppressed patients is highly dependent on the choice of immunosuppressive therapy.

Background/Aims Extraintestinal manifestations (EIM) involving joints, skin, eyes and liver represent an important problem in the treatment of IBD patients. The aim of this study was to identify factors that are associated with the occurrence of joint EIM and therefore allow an early diagnosis and guide medical treatment. Methods We studied clinical and epidemiological data from 3298 patients included in the Swiss IBD Cohort Study (SIBDCS), 1860 suffered from Crohn’s disease (CD) and 1438 from ulcerative colitis or IBD unclassified (UC/IBDU). Results We found female gender as well as a longer disease duration and activity (specified as CDAI or MTWAI, respectively) to be related to the appearance of arthritis/arthralgia, but also sacroiliitis/ankylosing spondylitis in IBD patients. IBD patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis were more often treated with anti-TNF and patients with arthritis/arthralgia underwent more often IBD-related surgeries. We revealed that eye or skin EIM were more frequent in patients with arthritis/arthralgia or sacroiliitis/ankylosing spondylitis. In multivariate analysis, we confirmed female gender, longer disease duration, IBD-related surgery, presence of other EIM and treatment with anti-TNF to be independent risk factors for the onset of arthritis/arthralgia in CD and UC/IBDU patients. Conclusion In this study, we demonstrated that markers for a more severe disease course were associated with the onset of joint EIM in IBD patients. Our data suggest that in particular females under anti-TNF treatment and patients suffering from non-joint and/or IBD-related surgery should be close and carefully monitored for presence of arthritis or sacroiliitis/ankylosing spondylitis.

Background Many inflammatory bowel disease (IBD) patients follow a restrictive diet due to perceived positive effects on their symptoms. We assessed the prevalence of vegetarian (VD) and gluten-free diets (GFDs) in IBD patients, the reasons for following such a diet, and whether nutrition has an impact on disease activity and microbiota composition. Methods We included 1254 patients from the Swiss Inflammatory Bowel Disease Cohort Study with prospective acquisition of clinical data and psychosocial, disease-related and lifestyle factors between 2006 and 2015. Dietary habits were assessed through a self-report questionnaire. In 92 patients, we analysed intestinal mucosa-associated microbial composition using high-throughput sequencing. Results Overall, 4.1% (n = 52) of the patients reported following a VD and 4.7% (n = 54) a GFD. No differences regarding disease activity, fistula, hospitalization or surgery rates were observed. Patients on a VD or GFD had significantly higher levels of post-traumatic stress symptoms. Furthermore, GFD patients had significantly higher anxiety and depression symptom levels. The gut microbiota composition in IBD patients following a VD or GFD was significantly different compared to that of omnivores. Conclusions Although we did not identify a relevant impact of a specific diet on the course of the disease, there was a significant association with lower psychological well-being in VD and GFD patients.

Fatigue is a common symptom of patients with chronic inflammatory diseases in general - and specifically in inflammatory bowel disease (IBD) - which results in huge impairment on quality of life of individuals. In spite of its frequency only few studies systematically investigated symptom burden and risk factors for fatigue in IBD. We aim to identify the prevalence of fatigue in a large IBD cohort and address physical risk factors, as well as psychological markers associated with fatigue. We evaluated 1208 IBD patients from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Significant fatigue was defined as a visual analogue scale (VAS-F, range 0–10) ≥4 and severe fatigue as a VAS ≥8. Impact of fatigue on daily activities was assessed by the Fatigue Severity Scale with a score > 3 defining relevant impairment. IBD-related factors were assessed through patient and physician questionnaires. Overall, 672 IBD patients (55.6%) reported fatigue (VAS-F ≥4), whereas only 133 (11%) reported severe fatigue. Fatigue was associated with female gender (women 65.8% vs. men 43.9%, p < 0.001) and initial IBD diagnosis (Crohn’s disease 59.1% vs. ulcerative colitis 51.5%, p = 0.008). Furthermore, patients with fatigue were of younger age (47.7 years vs. 51.4 years, p < 0.001), had a younger age at diagnosis (26.9 vs. 30.4 years, p = 0.001), lower educational level, higher disease activity indices and higher rates of complications, extraintestinal manifestation and intestinal surgery. Furthermore, patients suffering from fatigue had significantly higher indices for anxiety and depression in the Hospital Anxiety and Depression Scale and lower values in quality of life (IBD questionnaire). An impact of fatigue on daily activities was found in 49.5% of patients. Fatigue is highly frequent in this large IBD cohort and impacts on daily activities. Patients at risk should be asked during outpatient visits about symptoms of fatigue and therapeutic strategies will need to be developed in the future.

Colorectal cancer (CRC) is one of the leading causes of cancer‐related deaths worldwide and the need for novel biomarkers and therapeutic strategies to improve diagnosis and surveillance is obvious. This study aims to identify β 6 ‐integrin (ITGB6) as a novel serum tumor marker for diagnosis, prognosis, and surveillance of CRC. ITGB6 serum levels were validated in retro‐ and prospective CRC patient cohorts. ITGB6 serum levels were analyzed by ELISA. Using an initial cohort of 60 CRC patients, we found that ITGB6 is present in the serum of CRC, but not in non‐CRC control patients. A cut‐off of ≥2 ng/mL ITGB6 reveals 100% specificity for the presence of metastatic CRC. In an enlarged study cohort of 269 CRC patients, ITGB6 predicted the onset of metastatic disease and was associated with poor prognosis. Those data were confirmed in an independent, prospective cohort consisting of 40 CRC patients. To investigate whether ITGB6 can also be used for tumor surveillance, serum ITGB6‐levels were assessed in 26 CRC patients, pre‐ and post‐surgery, as well as during follow‐up visits. After complete tumor resection, ITGB6 serum levels declined completely. During follow‐up, a new rise in ITGB6 serum levels indicated tumor recurrence or the onset of new metastasis as confirmed by CT scan. ITGB6 was more accurate for prognosis of advanced CRC and for tumor surveillance as the established marker carcinoembryonic antigen (CEA). Our findings identify ITGB6 as a novel serum marker for diagnosis, prognosis, and surveillance of advanced CRC. This might essentially contribute to an optimized patient care.

BACKGROUND:Extraintestinal manifestations (EIM) contribute significantly to the burden of disease in inflammatory bowel disease (IBD). Pain is a leading symptom in IBD and could be seen as an EIM itself. Treatment of IBD associated pain is challenging and insufficiently studied. A better knowledge on the association of pain and IBD specific treatment is warranted to improve the management of IBD patients.METHODS:All patients of the Swiss IBD Cohort Study (SIBDCS) (n = 2152) received a questionnaire regarding pain localization, pain character, and the use of IBD specific medication.RESULTS:1263 completed questionnaires were received. Twenty-one out of 184 patients (10%) receiving anti-TNF treatment compared to 142 out of 678 patients (21%) not receiving anti-TNF medication reported elbow pain (p = 0.002) while 28 out of 198 patients (14%) receiving steroid treatment significantly more often reported elbow pain compared to 59 from 696 patients (8%) not receiving steroids (p = 0.021). Furthermore, we found significantly more female patients under anti-TNF treatment to report knee/ lower leg pain and ankle/ foot pain compared to their male counterparts (36% vs. 20% and 22% vs. 10%, respectively, p = 0.015 for both comparisons). The frequency of knee, lower leg, ankle and foot pain was especially low in male patients under anti-TNF treatment, indicating a high benefit of male patients from anti-TNF therapy regarding EIM.CONCLUSIONS:The frequency of elbow pain was lower in IBD patients treated with anti-TNF but higher in patients treated with steroids.

Background and aims: Moxibustion treatment can repair mucosal tissue damage and regulate immune function in patients with ulcerative colitis (UC) associated with gut microbiome changes, but the impact of moxibustion on the gut microbiome remains unclear.Methods: An UC rat model was established by administering 4% dextran sulphate sodium (DSS).A total of 25 male rats were randomly divided into the following five groups: normal(A), UC model(B), UC model plus moxibustion(C), UC model plus mesalazine(D), and normal plus moxibustion(E).Following treatment gut microbiome profiling was conducted by metagenomic sequencing and the mRNA expression of inflammatory cytokines in colonic tissues were determined by semi-quantitative RT-PCR and ELISA.Results: The major phyla were Bacteroidetes, Firmicutes, Proteobacteria followed by the Actinobacteria in all groups.The major genus were Bacteroides, Bacteroides_bacterium_M7, Bacteroides_bacterium_H3 followed by the Prevotella in all groups.At genus level UC rats had a higher abundance of Bacteroides, Bacteroides_bacterium_M7 and Prevotella and a lower abundance of Bacteroides_bacterium_ H3 compared with normal rats.After treated with moxibustion, the abundance of Bacteroides_ bacterium_M7 and Prevotella were decreased, and Bacteroides_bacterium_H3 was increased (Figure 1).A total of 5984 species were identified, of which 2069 core species were present in all groups.The highest average number of species was detected in UC rats (4926), whereas the lowest (2896) was found in normal rats.At species level UC model rats had a significant higher abundance of Acinetobacter baumannii and a significant lower abundance of Acidithiobacillus ferrivorans, Acinetobacter johnsonii, Acinetobacter lwoffii, Acinetobacter rudis, Acinetobacter soli and Acinetobacter sp.BMW17 compared with normal rats (Figure 2).Additionally, Genes involved in certain metabolic pathways, such as Carbohydrate and Amino acid transport and metabolism, were under-represented in UC model rats compared with normal rats.These changes in microbiome profiles and metabolic pathways could be reversed by moxibustion treatment.The levels of pro-inflammatory cytokines interleukin (IL)-6, -12, -17, -23, interferon (IFN)-g and tumor necrosis factor (TNF)-a and its receptors 1 (TNFR1) and 2 (TNFR1) were all increased ( P < 0.01 or P < 0.05), whereas anti-inflammatory IL-2, -10 and transforming growth factor (TGF)-b were decreased in colonic tissues of UC rats (P < 0.01 or P < 0.05), all these changes could be reversed by moxibustion.Conclusion

we identified women with IBD using validated algorithms applied to health administrative data (Ontario Crohn's and Colitis Cohort).The primary outcome was any psychiatric disorder during pregnancy or in the first postpartum year (outpatient, emergency or hospitalization).Cox proportionate hazard regression compared risk of psychiatric disorders in those with/ without IBD, adjusting for maternal age, year of delivery, income, rurality, prenatal care, and C-section, reported as adjusted hazard ratios (aHR).In women with IBD only, logistic regression determined predictors of new-onset psychiatric disorder overall, and postpartum.Results were stratified by IBD type: Crohn's disease (CD) or ulcerative colitis (UC).Results: Risk of new psychiatric disorder in 3721 women with IBD was 22.7% vs 20.4% in 798,908 without IBD (aHR 1.12, 95% CI 1.05-1.20).Most healthcare contacts were for non-psychotic disorders (anxiety or depression) or substance-related disorders in the outpatient primary care settings.Risk was elevated for CD (aHR 1.12, 95% CI 1.02-1.23),but not UC (aHR 1.09, 95% CI 0.98-1.21),and post-partum (aHR 1.20, 95% CI 1.09-1.31),but not during pregnancy (aHR 1.04, 95% CI 0.94-1.15).At first health system contact for a mental health disorder, CD patients were at increased risk for non-psychotic disorders (aHR 1.14, 95% CI 1.04-1.26)and substance-related disorders (aHR 2.73, 95% CI 1.42-5.26),but not psychotic disorders.UC patients were not at increased risk for psychotic, non-psychotic, or substance-related disorders.Predictors of diagnosis of psychiatric disorders are noted in Table .Conclusion: Women with IBD have increased risk for new-onset psychiatric disorders, especially non-psychotic disorders (depression and anxiety) and substance-related disorders, in the peripartum period.Providers should be aware of this elevated risk to increase opportunities for prevention, early identification, and treatment.Predictors of risk of psychiatric diagnosis in pregnant women with IBD.Abbreviations: ADG:

Several systematic screening studies in the general population indicate a high number of unrecognised cases of Celiac disease (CeD). According to clinical experience and shared risk gene loci CeD and inflammatory bowel disease (IBD) may be associated conditions. However, the exact prevalence of asymptomatic and unrecognised CeD in IBD has not been systematically investigated on the large scale. We performed a large screening-study of the CeD seroprevalence in unselected IBD patients from the Swiss IBD Cohort study (SIBDCS). Anti-tissue transglutaminase (a-TTG) antibody IgA, anti-deamidated gliadin peptide IgG (g-DGP) and total serum immunoglobulin A were measured. In total serum samples of 2019 IBD patients (median disease duration 12 years, median age at enrolment into the SIBDCS 38 years, median BMI 24 kg/m2)were analysed, among them 1150 (57.3%) with Crohn’s disease (CD), 812 (40.5%) with ulcerative colitis UC and 45 (2.2%) with IBD unclassified (IBDu). In 8 (4 per mille) of the 2019 randomly selected SIBDCS patients a diagnosis of CeD had been established previously. Amongst the remaining 2011 IBD patients without CeD we found a seroprevalence of 1.5 per mille (0.149%) for a-TTG—the classical screening test in the absence of IgA deficiency—and 1 per mille (0.099%) for g-DGP. IgA deficiency (defined as <0.07 g/l) was detected in 4 per mille (0.398%). Importantly, the prevalence of a-TTG and g-DGP was not different in patients with vs. without immunosuppressive treatment. The overall prevalence of potential undiagnosed CeD in our SIBDCS collective according to presence of either g-DGP or aTTG (excluding known CeD cases) was 2 per mille (0.199%), whereas the overall CeD prevalence (composite of either the former or established CeD) was 4.5 per mille (0.446%). This is, to the best of our knowledge, the largest study on CeD seroprevalence in IBD to date, showing that the fraction of undiagnosed positive CeD-serology in IBD patients is very low. In contrast to several previous mostly single-centre reports on a potential higher occurrence of CeD (and in concordance with other such investigations not having found a higher CeD prevalence), the fraction of undiagnosed CeD cases in IBD patients appears to be exceedingly lower than those found in systematic screening studies on CeD prevalence in the general population. Our results do not warrant a widespread CeD screening in IBD patients.

BackgroundThe frequency of upper gastrointestinal [GI] tract involvement in Crohn`s disease [CD] has been reported with a large variation. Risk factors and disease course of patients with upper GI tract involvement remain largely elusive.MethodsData on CD patients in the Swiss Inflammatory Bowel Disease Cohort were analysed. Patients with upper GI tract involvement were compared with controls. Logistic regression models for prediction of upper GI tract involvement and Cox proportional hazard models for occurrence of complications were computed.ResultsWe included 1638 CD patients, of whom 107 [6.5%] presented with upper GI tract involvement at the time of diagnosis and 214 [13.1%] at any time. Prevalence of such involvement at diagnosis increased over time [5.1% for 1955-95 versus 11.3% for 2009-16]. In a multivariate logistic regression model, male sex and diagnosis between 2009 and 2016 [versus before 1995] were independent predictors for presence of upper GI tract involvement at CD diagnosis (odds ratio [OR] 1.600, p = 0.021 and OR 2.686, p < 0.001, respectively), whereas adult age was a negative predictor [OR 0.388, p = 0.001]. Patients with upper GI tract involvement showed a disease course similar to control patients (hazard ratio [HR] for any complications 0.887, (95% confidence interval [CI] 0.409-1.920), and a trend towards occurrence of fewer intestinal fistulas [log-rank test p = 0.054].ConclusionsPrevalence of upper GI tract involvement has been increasing over the past decades. Male sex and young age at diagnosis were identified as the main predictive factors for such involvement at CD diagnosis. Involvement of upper GI tract did not result in a worse outcome.

Several studies demonstrate a lower diversity in the gut microbiota of patients with inflammatory bowel disease (IBD). Microbial alterations induced by dietary changes are amongst the key suspected responsible environmental factors to promote an increase in the incidence of IBD, and may adversely impact the course of established disease. Subsequent to our already presented results of lower psychosocial wellbeing in vegetarian diet (VD) and gluten-free diet (GFD) IBD patients (Poster 711, ECCO 2017) we investigated comparative microbial composition of IBD patients according to diet. Dietary pattern was analysed in a total of 1656 IBD patients from the Swiss Inflammatory Bowel Disease Cohort Study between 2006 and 2015. Microbiota composition was analysed in 149 patients, including 12 vegetarian patients and 14 patients following a GFD by means of high-throughput sequencing. Within the majority of meat-eating patients, we further compared the microbiota of the low vs. high-meat-intake patients (i.e. ≤ 4 vs. >4 days per week). In the alpha diversity analysis (Shannon) we observed a significant difference between GFD and meat-eating Crohn's disease (CD) patients with lower species richness in meat-eating patients (p = 0.026). In the ulcerative colitis (UC) group no significant difference in the alpha diversity was seen. Both CD and UC revealed significantly different β diversity in meat-eating patients compared with their VD and GFD counterparts. Bacterial taxa did not differ according to diet types in CD, whereas within meat-eating CD patients the following significant differences in taxa were found: Faecalibacterium, Bilophila and Butyricimonas taxa were found to be less abundant in the high-meat-intake CD group. On the other hand, there was a higher relative abundance of Eubacterium (family Erysipelotrichaceae), Enterococcum, Lactobacillus, Lactococcus, Fusobacterium, and Tepidimonas in the high-meat-intake CD group. In UC meat-eating patients there was a significantly higher relative abundance of Ruminococcus compared with GFD and VD patients. The high-meat-intake UC patients had a higher relative abundance of Lachnospira, Ruminococcus, and Parabacteroides. The gut microbiota composition in meat-eating IBD patients is significantly different compared with those following a VD or GFD. The potentially anti-inflammatory taxa Faecalibacterium and Butyricimonas were reduced and the inflammatory taxa Erysipelotrichaceae and Enterococcus were increased in the high-meat-intake CD patients. Our results demonstrate several bacterial changes in regularly meat-eating IBD patients compared with VD or GFD, specifically lower species richness with a dose–response effect in meat-eating CD patients.

Background: Many IBD patients report restricting their diet due to perceived positive effects on their symptoms despite a current lack of evidence-based nutritional recommendations in this specific population. To date little is known about dietary habits of IBD patients, especially on the prevalence of vegetarian diet (VD) and gluten-free diet (GFD), while to the best of our knowledge no studies have yet investigated the impact of VD on course of disease in IBD patients. Methods: We included 1254 patients from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) with prospective acquisition of clinical data, psychosocial, disease-related and lifestyle factors between 2006 and 2015. Dietary habits (not part of routine enrollment and follow-up questionnaires) were subsequently inquired through a self-report questionnaire. Results: Overall 4.1% of the IBD patients reported to follow a VD (reported underlying reasons: respect for animals, 42.3%; expected benefit for general health, 17.3%; or IBD in specific, 17,3%) and 4.7% a GFD (majority of patients referred to a perceived beneficial effect on course of their IBD as underlying reason for gluten withdrawal). We did not find any differences in essential baseline disease characteristics, such as age at diagnosis of IBD, disease duration, type of IBD and disease localization in omnivores vs. patients with a VD or GFD. However, in IBD patients following a VD there were significantly more women (p=0.002) and patients with a lower body weight (median 63 vs. 71 kg in VD vs. normal diet patients; p<0.001). No differences regarding disease activity, overall complications, fistula, hospitalization or surgery rates were observed between patients following VD or GFD vs. their counterparts with regular diet. Nevertheless, we found evidence for higher psychological impairment and lower quality of life measures with a significantly higher Post Traumatic Stress Diagnostic Scale and lower mental component levels of the Short Form 36 Health Survey (SF-36) in patients on VD or GFD as well as significantly higher indexes for anxiety and depression in the Hospital Anxiety and Depression Scale (HADS) in GFD patients. Conclusions: In contrast to a significant fraction of patients perceiving (or potentially relying on, respectively) beneficial effects, no impact of VD or GFD on course of disease or complication rates was identified as compared to a regular diet. There was however a significant association to higher anxiety and depression as well as lower overall health score levels in VD or GFD patients. The latter may indicate, that psychosocial factors and expectations might be of higher importance in the decision to initiate and maintain a specific diet than an as a matter of fact occurring effect on course of IBD

Background Gallstones and kidney stones are known complications of inflammatory bowel diseases (IBD). Risk factors have been insufficiently studied and explanatory studies date back up to 30 years. It remains unclear, whether improved treatment options also influenced risk factors for these complications. Objectives Identifying risk factors for gallstones and kidney stones in IBD patients. Methods Using data from the Swiss Inflammatory Bowel Disease Cohort Study we assessed associations of diseases characteristics with gallstones and kidney stones in univariate and multivariate logistic regression analyses. Results Out of 2323 IBD patients, 104 (7.8%) Crohn’s disease (CD) and 38 (3.8%) ulcerative colitis (UC) patients were diagnosed with gallstones. Significant risk factors for gallstones were diagnosis of CD, age at diagnosis, disease activity and duration, NSAID intake, extra-intestinal manifestations and intestinal surgery. Kidney stones were described in 61 (4.6%) CD and 30 (3.0%) UC patients. Male gender, disease activity, intestinal surgery, NSAID usage and reduced physical activity were significant risk factors. Hospitalization was associated with gallstones and kidney stones. The presence of gallstones increased the risk for kidney stones (OR 4.87, p<0.001). Conclusion The diagnosis of CD, intestinal surgery, prolonged NSAID use, disease activity and duration and bowel stenosis were significantly associated with cholecystonephrolithiasis in IBD.

at two institutions.The efficacy of infliximab maintenance treatment was evaluated by the rate of sustained clinical benefit, which was estimated using the Kaplan-Meier method.Sustained clinical benefit was defined as the lack of treatment failure.Treatment failure was defined as the discontinuation of infliximab, dose escalation, or surgery for Crohn's disease.Combination therapy with infliximab and IM was defined as the initiation of IM within 6 weeks from the first administration of infliximab and continuation until 14 weeks.Combination therapy was divided into IM naïve and IM exposed group.IM naïve and IM exposed group were defined as receiving IM treatment for less and more than 3 months prior to infliximab administration, respectively.Sustained clinical benefits of infliximab according to the type of IM treatment were investigated using the log-rank test.Results: A total of 341 patients were included in this study (median age, 29.7 years), 90 were female.Of these, 243 patients received combination therapy.Of the 243 patients, 211 and 32 patients were administered azathioprine (AZA) and 6-mercaptopurine (6-MP), respectively.Of these, 83 and 126 patients were treated with 25 and 50 mg of AZA once a day, respectively.In addition, 23 patients were treated with 30 mg of 6-MP once a day.There were 190 patients in the IM naïve group and 53 patients in the IM exposed group.The 5 and 10year cumulative sustained clinical benefit rates in all patients were 49% and 39%, respectively.Sustained clinical benefit rates were significantly higher in patients receiving a combination of infliximab and AZA than in those receiving infliximab monotherapy.Whereas, there was no significant difference in sustained clinical benefit rates between patients receiving a combination of infliximab and 6-MP and infliximab monotherapy.Patients receiving a combination of infliximab and AZA in IM naïve, but not IM exposed group achieved a significantly higher clinical benefit than those receiving infliximab monotherapy.Sustained clinical benefit in patients receiving a combination of infliximab and either 25 or 50 mg of AZA was significantly higher than that in patients treated with infliximab monotherapy (Figure 1).Conclusions: Our data suggested that the combination of infliximab and low dose AZA (25 or 50 mg) as early as possible resulted in the better clinical outcome in Japanese patients with Crohn's disease.

Background: Long-term data of certolizumab pegol (CZP) in Crohn's disease (CD) from pivotal registry trials are limited. We therefore aimed to evaluate the long-term efficacy of CZP in clinical practice in Switzerland. Methods: In the First Approved Certolizumab Therapeutic Experience in Switzerland-III phase IV multicenter cohort, patients receiving CZP were prospectively included all over Switzerland in (non-) academic hospitals and private practice. Results: We included 104 CD patients (52 male; only 22.1% anti-tumor necrosis factor (TNF) naïve, CZP as third anti-TNF agent in 46.2%) with follow-up time between 6 weeks up to 5 years. During treatment with CZP, we observed a significant decrease of the Harvey Bradshaw Index from a median of 7 at baseline (interquartile range 4-11) to 4, 5, 4, 3, 3, and 2 at weeks 6, 26, 52, 78, 104, and 156, respectively. While anti-TNF naïve patients showed a significantly better response at the end of induction, during CZP maintenance therapy response was similar as compared to anti-TNF experienced patients as well as between patients with a short (0-5 years) vs. long duration of disease (>5 years). Conclusions: CZP is an effective long-term treatment option, including CD patients with long disease duration and prior treatment with 1 or 2 anti-TNF agents.