Tumor necrosis factor-alpha (TNF-α) inhibitors, including infliximab, have redefined the treatment of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC). Despite their efficacy, these agents are associated with rare but serious adverse events, including drug-induced interstitial lung disease (D-ILD). We report a case of infliximab-induced ILD in a 63-year-old male undergoing treatment for UC. The patient presented with fever, dyspnea, and a miliary hypersensitivity pattern on imaging. Infectious causes were excluded, and drug-induced pulmonary toxicity was diagnosed. Discontinuation of infliximab and appropriate management led to gradual clinical improvement. This case highlights the importance of early recognition and management of pulmonary complications associated with TNF-α inhibitors. Given that UC itself and other autoimmune diseases can predispose patients to ILD, we also explore the role of disease activity and additional risk factors, including prior exposure to 5-aminosalicylic acid-based medications. Endoscopic disease activity, fecal calprotectin levels, autoimmune markers (ANA, ENA, ANCA), and bronchoalveolar lavage results are provided to further elucidate the diagnostic process.

Infliximab, a monoclonal antibody targeting tumor necrosis factor-alpha (TNF-α), is widely used in treating inflammatory bowel diseases (IBD), including ulcerative colitis (UC). While generally well-tolerated, infliximab is associated with rare but significant adverse effects, including autoimmune hemolytic anemia (AIHA). This report describes the case of a 54-year-old male diagnosed with UC, who developed hemolytic anemia secondary to infliximab therapy after 1 year of treatment. During the infusion preceding the onset of anemia, the patient experienced a severe infusion reaction characterized by urticaria, bronchospasm, chills, fever, and pulsating headache. Laboratory findings confirmed hemolytic anemia with a positive direct and negative indirect Coombs tests. The patient responded well to corticosteroid therapy (prednisone at 1 mg/kg/day for 30 days) and stopping anti-TNF-α, with hemoglobin levels improving from 7.2 g/dL at presentation to 14.6 g/dL after 1 month. AIHA should be considered an uncommon but serious complication of infliximab therapy, necessitating careful monitoring, especially in patients treated for gastrointestinal indications. This case underscores the importance of recognizing and managing infusion-related complications of biologic therapies.

ObjectivesAn adequate bowel preparation is essential for a quality colonoscopy. Patients with inflammatory bowel disease (IBD) show low compliance with bowel preparation due to the large volume of lavage solution to be ingested, especially if active symptoms are present, and the frequency of having a colonoscopy. We evaluated the efficacy and tolerability of a very low-volume (VLV) polyethylene glycol (PEG)-based solution in patients with IBD.MethodsA cohort of 103 consecutive patients, 56 with Crohn's disease and 47 with ulcerative colitis, received a 1-L PEG-based bowel preparation divided into two 500-mL doses taken the evening before and the morning of the colonoscopy, each dose followed by at least another 500-mL of clear fluids. Colon cleansing was scored according to the Boston Bowel Preparation Scale (BBPS) and evaluated in relation to influencing variables.ResultsBowel cleansing was adequate (BBPS >= 6) in 88 patients (85.4%). The time interval between the end of bowel preparation and the beginning of colonoscopy and the disease activity significantly affected colon cleansing. Most patients declared a complete intake of lavage solution (99%), the willingness to repeat the same bowel preparation in a future colonoscopy (86.4%), and a good taste assessment.ConclusionThe VLV PEG-based bowel preparation is effective and well accepted by IBD patients. As minimizing the volume of lavage solution required, the VLV-bowel preparation here tested could be of choice in subjects who perform periodically colonoscopy or in those who do not tolerate a larger amount of liquids.

Radiation-induced hemorrhagic gastritis (RIHG) is a rare but potentially fatal event following radiotherapy for locally advanced gastric cancer; the treatment of this condition is not standardized. Only few cases of RIHG have been reported, treated with different therapeutic approaches. Here we report the case of a 79-year-old patient who underwent subtotal gastrectomy for gastric cancer, followed by adjuvant chemo-radiotherapy. Approximately 3 months after the end of the treatment, she developed recurrent diffuse bleeding originating from the entire mucosa of the gastric pouch and from a marginal ulcer. As the bleeding was refractory to several endoscopic treatments and surgery was not indicated, the patient underwent two sessions of transcatheter selective arterial embolization, with resolution of bleeding. Arterial embolization has already been reported for the treatment of hemorrhagic cystitis, developing after irradiation of the pelvis for prostate, bladder, rectum, and cervix cancer. However, to our knowledge, it has never been reported as a treatment for hemorrhagic gastritis. Based on this case, we suggest arterial embolization as an option in the management of RIHG, when standard endoscopic treatment fails.

Ulcerative colitis (UC) and colonic diverticulosis can co-exist in some patients. However, the natural history of UC associated with colonic diverticulosis is not well known. We here compared the disease characteristics and outcome of UC patients with and without concomitant colonic diverticulosis. Medical records of 347 UC patients were included in an observational, retrospective, nested-matched case-control study. Cases were 92 patients with UC and concomitant colonic diverticulosis, while controls were 255 UC patients without concomitant colonic diverticulosis. A propensity score matching (PSM) was used to homogenate cases (n = 92) and controls (n = 153) for age. UC patients with concomitant colonic diverticulosis were less likely to have an extensive disease (25/92, 27.1%) and to experience steroid dependence (8/92, 8.6%) compared to patients without concomitant colonic diverticulosis (70/153, 45.7% and 48/153, 31.3%, respectively; p < 0.001). The use of immunosuppressants (9/92, 9.7% vs. 37/153, 24.1%; p = 0.007) or biologics (3/92, 3.2% vs. 26/153, 16.9%, p < 0.001) was significantly lower in UC patients with concomitant diverticulosis compared to the control group. On multivariate analysis, steroid dependence and extensive colitis were significantly less frequent in UC patients with concomitant colonic diverticulosis compared to UC patients without diverticula. UC patients with coexisting colonic diverticulosis are less likely to have an extensive disease and to be steroid-dependent.

Cross-talk between cancer cells and the immune cells occurring in the tumor microenvironment is crucial in promoting signals that foster tumor growth and metastasis. Both cancer cells and immune cells secrete various interleukins (IL), which, either directly or indirectly, stimulate cancer-cell proliferation, survival, and diffusion, as well as contribute to sculpt the immune microenvironment, thereby amplifying tumorigenic stimuli. IL-34, a cytokine produced by a wide range of cells, has been initially involved in the control of differentiation, proliferation, and survival of myeloid cells. More recent studies documented the overexpression of IL-34 in several cancers, such as hepatocarcinoma, osteosarcoma, multiple myeloma, colon cancer, and lung cancer, and showed that tumor cells can produce and functionally respond to this cytokine. In this review, we summarize the multiple roles of IL-34 in various cancers, with the aim to better understand the relationship between the expression of this cytokine and cancer behavior and to provide new insights for exploring a new potential therapeutic target.

PURPOSE:Patients with stricturing Crohn's disease (CD) may experience episodes of intestinal sub-occlusions, which in many cases lead to surgery. The aim of this study was to examine whether adding a liquid diet to medical therapy could improve the management of patients with stricturing CD.METHODS:Medical records of CD outpatients with a small bowel stricture, either receiving (group 1) or not (group 2) a 24-h liquid diet every 10-14 days, were retrospectively analyzed. Number of sub-occlusive episodes, frequency, and timing of intestinal resections for strictures were analyzed.RESULTS:During the 12-month follow-up, there was no significant difference in the occurrence of new sub-occlusive episodes between the 2 groups (10/37 patients (27%) in group 1 vs 9/45 patients (20%) in group 2). Similarly, the number of patients undergoing bowel resections for sub-occlusive episodes non-responsive to medical therapy did not statistically differ between the two groups (9 patients (24.3%) in group 1 vs 7 patients (15.5%) in group 2). In group 1, surgeries were equally distributed along the 12-months of follow-up, while 85.7% of patients in group 2 underwent intestinal resection within the first 3 months of follow-up.CONCLUSION:Adding a liquid diet to medical therapy does not help management of patients with stricturing CD.

Background and Aims The topically applied Toll-like receptor 9 [TLR9] agonist cobitolimod is a first-in-class DNA-based oligonucleotide with demonstrated therapeutic efficacy in clinical trials with ulcerative colitis [UC] patients. We here characterized its anti-inflammatory mechanism in UC. Methods Luminal cobitolimod administration was evaluated in an experimental dextran sodium sulfate [DSS]-induced colitis model. Cultured blood and mucosal cells from UC patients were treated with cobitolimod and analysed via microarray, quantitative real-time PCR, ELISA and flow cytometry. Intestinal slides of cobitolimod-treated UC patients were analysed by immunohistochemistry. Results Cobitolimod administration markedly suppressed experimental colitis activity, and microarray analyses demonstrated mucosal IL10 upregulation and suppression of IL17 signalling pathways. Cobitolimod treatment was associated with significant induction of mucosal IL10+Tr1 and Treg cells and suppression of Th17 cells. TLR9 knockout mice indicated that cobitolimod requires TLR9 signalling for IL10 induction. In UC patients, mucosal TLR9 levels correlated with severity of inflammation. Cobitolimod inhibited IL17A and IL17F, but increased IL10 and FoxP3 expression in cultured intestinal UC T cells. Cobitolimod-mediated suppression of intestinal IL17+T cells was abrogated by IL10 blockade. Furthermore, cobitolimod led to heightened IL10 production by wound healing macrophages. Immunohistochemistry in intestinal biopsies of cobitolimod-treated UC patients indicated increased presence of IL10+mononuclear and regulatory T cells, as well as reduction of IL17+cells. Conclusion Activation of TLR9 via cobitolimod might represent a novel therapeutic approach in UC, as it suppresses Th17 cells and induces anti-inflammatory IL10+macrophages and regulatory T cells, thereby modifying the dysregulated intestinal cytokine balance. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast

Randomized controlled clinical trials and real-life observations indicate that less than 50% of patients with Crohn’s disease (CD) or ulcerative colitis (UC) respond to vedolizumab, a humanized monoclonal antibody that blocks the α4β7 integrin. Since α4β7-expressing lymphocytes mainly infiltrate the left colon, we assessed whether localization of CD and UC influences vedolizumab-induced remission. One hundred and eighty-one patients (74 CD and 107 UC) receiving vedolizumab in 3 referral centers were retrospectively evaluated for clinical remission at week 14. Demographic and clinical characteristics were compared between remitters and non-responders, and multivariable multinomial analysis was performed to identify predictors of remission. Remission was achieved in 17 CD (23%) and 34 UC (32%) patients, respectively. In CD, localization of the lesions did not influence clinical remission. In UC, the remitters had more frequently a distal/left-sided colitis (21/34, 62%) as compared to the non-responders (9/47, 19%), and extensive colitis was more frequent in the non-responders (38/47, 81%) than in the remitters (13/34, 38%). The multivariable multinomial analysis showed that distal/left-sided colitis was associated with a higher probability of clinical remission while extensive colitis was inversely associated with induction of remission. Data indicate that UC patients with distal or left-sided colitis are more likely to achieve remission than patients with extensive colitis following vedolizumab treatment.

After its first description in December 2019, Covid-19, an infectious respiratory disease caused by the novel coronavirus SARS-CoV-2 ([1]Zhu N. Zhang D. Wang W. Li X. Yang B. Song J. Zhao X. Huang B. Shi W. Lu R. Niu P. Zhan F. Ma X. Wang D. Xu W. Wu G. Gao G.F. Tan W. China novel coronavirus investigating and research team. a novel Coronavirus from patients with Pneumonia in China, 2019.N Engl J Med. 2020; 382: 727-733Crossref PubMed Scopus (18371) Google Scholar), has spread throughout the world and on March 11, 2020 the World Health Organization declared it a pandemic. The SARS‐CoV‐2 infection is more frequent in elderly and in subjects with co-existing pathologies and weakened immune system. The risk of infection or death due to Covid-19 in patients with inflammatory bowel diseases (IBD) is unknown at this stage. However, it has been presumed that IBD patients who are on steroids, immunosuppressive drugs or biologics could be more susceptible to SARS-CoV-2 infection, as these therapies are associated with increased risk of viral infections ([2]Dulai P.S. Thompson K.D. Blunt H.B. Dubinsky M.C. Siegel C.A Risks of serious infection or lymphoma with anti-tumor necrosis factor therapy for pediatric inflammatory bowel disease: a systematic review.Clin Gastroenterol Hepatol. 2014; 12: 1443-1451Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar). To gain entry into the cells SARS‐CoV‐2 uses angiotensin-converting enzyme 2, a protein that is highly expressed in the human gut ([3]Hoffmann M. Kleine-Weber H. Schroeder S. Krüger N. Herrler T. Erichsen S. Schiergens T.S. Herrler G. Wu N.H. Nitsche A. Müller M.A. Drosten C. Pöhlmann S SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.Cell. 2020; (Mar 4. pii: S0092-8674(20)30229-4)https://doi.org/10.1016/j.cell.2020.02.052Abstract Full Text Full Text PDF PubMed Scopus (13243) Google Scholar,[4]Harmer D. Gilbert M. Borman R Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme.FEBS Lett. 2002; 532: 107-110Crossref PubMed Scopus (651) Google Scholar). An analysis of patients with SARS-CoV-2 infection showed that some patients experienced gastrointestinal symptoms/signs and the virus was identified in stool samples of infected patients. Viral RNA was present in the stool of over 50% of patients and, even after testing negative for SARS-CoV-2 in respiratory samples, nearly one fifth of the patients remained positive for the virus in stool samples ([5]Wang W. Xu Y. Gao R. Lu R. Han K. Wu G. Tan W Detection of SARS-CoV-2 in Different Types of Clinical Specimens.JAMA. 2020; (Mar 11)https://doi.org/10.1001/jama.2020.3786Crossref Scopus (3745) Google Scholar,[6]Xiao F. Tang M. Zheng X. Liu Y. Li X. Shan H Evidence for gastrointestinal infection of SARS-CoV-2.Gastroenterology. 2020; (Mar 3. pii: S0016-5085(20)30282-1. doi. 1053/j.gastro.2020.02.055)Abstract Full Text Full Text PDF Scopus (1990) Google Scholar). These findings suggest that the course of SARS-CoV-2 infection may involve cells of the gastrointestinal tract, a finding of importance for patients with IBD. We here examined the frequency of symptoms/signs suggestive of Covid-19 in IBD patients and assessed the risk of SARS-CoV-2 infection in IBD. This was an observational study including IBD patients regularly followed in our tertiary referral center at the "Tor Vergata University Hospital", Rome, Italy. Like many countries worldwide, Italy has been placed under lockdown as Covid-19 cases surge in our country since February 2020. Consequently, the scheduled follow-up visits in the IBD centres were canceled or postponed and the patients have had the possibility to communicate with the IBD team through a dedicated phone number. During the calls, we recorded any symptom/sign suggestive of Covid-19 as well as information about direct contacts with subjects known to be affected by SARS-CoV-2 and data relative to the admission of the patients to the hospital for undergoing a nasopharyngeal swab to identify carriers of SARS-CoV-2. Clinical activity and management of the IBD patients were also monitored. All patients had provided their informed consent for the use of personal and clinical data for scientific purposes, and no patient refused to participate. The study variables were summarized descriptively using numbers and percentages for discrete variables, while median and range were used for continuous variables. Cumulative incidence of SARS-CoV-2 infection in IBD was calculated dividing the positive cases by the overall population of IBD patients enrolled for the study. Cumulative incidence of laboratory-confirmed SARS-CoV-2 infection in the Italian population was extracted from data of the Italian Health Minister (www.salute.gov). Incidence rate of SARS-CoV-2 in the IBD population was obtained with the direct method using the general Italian population as standard. Results were presented as odds ratios (OR) and their 95% confidence intervals (CI). From March 24 to April 30, 2020, we collected information regarding 672 IBD patients who were scheduled to receive a visit at the Tor Vergata Hospital in the same period. Baseline demographic and clinical characteristics, as well as concomitant treatments for IBD are shown in the table. The median age of the patients was 46 years (range: 16–83), 46% of the patients were female, and 59% had a diagnosis of CD. No patient refused to provide information regarding his/her symptoms/signs. Most patients remain on stable therapy with conventional drugs or biologics, and 20 patients (3%) discontinued treatment during the Covid-19 outbreak (table 1). A flare-up occurred in 90 (13%) patients; adjustment of therapy led to disappearance of the symptoms in all the patients.Table 1Demographic and clinical characteristics of IBD patients.Number of patients672Gender female n (%)311 (46)Median Age (range) years46 (16–83)Patients working during quarantine n (%)125 (20)Median co-habiting persons (range)3 (1–8)IBD diagnosis n (%)Crohn's disease397 (59)ulcerative colitis269 (40)IBD unclassified6 (1)Patients experiencing IBD flare n (%)90 (13)Current treatments n (%)No therapy56 (9)Mesalamine367 (54)Steroids29 (4)Immune suppressant43 (6)Anti-TNFa183 (27)Vedolizumab27 (4)Ustekinumab31 (5)Antibiotics38 (6)Experimental drug6 (1)Therapy discontinuation n (%)20 (3)Causes for therapy discontinuation n (%)Fear for covid-194 (0.6)Adverse events6 (0.9)Physician's indication1 (0.1)Others9 (1.3) Open table in a new tab Ten out of 672 patients (1.5%) underwent rhino-pharyngeal swab: 3 patients because experienced respiratory symptoms, which were highly suggestive of Covid-19, and 7 patients because had a direct contact with SARS-CoV-2-infected individuals. Three out of these 10 patients resulted positive and two of them were hospitalized: one patient had a lung cancer and eventually died. Of the 672 patients, 38 (5.6%) had been travelling to high risk geographical areas and 64 (9.5%) had direct contacts with individuals living in high risk areas. All these patients experienced no suggestive symptoms of Covid-19. On April 30, 2020 205,463 subjects were positive among an overall Italian population of 6031,7000. Cumulative incidence of laboratory-confirmed SARS-CoV-2 in Italy was 3.41 cases per 1000 habitants. In our IBD population, the crude incidence rate of SARS-CoV-2 infection was 4.46 cases per 1000 patients. Patients with IBD had a numerically, but non statistically higher standardized risk of SARS-CoV-2 infection compared with the general population (OR 1.31; 95% CI 0.26–3.85; p 0.50). Up to April 30, 2020, more than 205,463 cases of SARS-CoV-2 infection have been diagnosed in Italy, accounting for 0,3% of the total population. Although, we need more robust epidemiological data to draw a conclusion regarding the incidence rate of Covid-19 in IBD, our findings suggest that IBD patients are not at increased risk of Covid-19 as compared with the general population. Indeed, after more than 2 months from the first Covid-19 patient diagnosed in Italy, only 3 out of our 672 patients (0,44%) were infected by SARS-CoV-2. Approximately one sixth of our patients, who had direct contacts with either infected patients or individuals living in high risk geographical areas or were themselves travelling to such regions, were negative for SARS-CoV-2 and/or remain asymptomatic. We are aware that the present study has some limitations. It is likely that the incidence of SARS-CoV-2 infection in our IBD population is underestimated as the majority of the patients did not underwent rhino-pharyngeal swab. However, in this context, it is noteworthy that such a diagnostic test was not provided to the general Italian population unless there were reasons to suspect SARS-CoV-2 infection. Thus, it is unlikely this limitation have had a major impact on the comparison of incidences. We restricted our analysis to the IBD patients scheduled to receive a visit during the study period and, therefore, this cohort could be not representative of our IBD population, which comprises more than 3000 patients. However, our data are in line with those published recently by Norsa and colleagues, who reported no case of SARS-CoV-2 infection in a cohort of IBD patients living in a high-risk area of Northern Italy ([7]Norsa L. Indriolo A. Sansotta N. Cosimo P. Greco S. D'Antiga L Uneventful course in IBD patients during SARS-CoV-2 outbreak in northern Italy.Gastroenterology. 2020; (Apr 2pii: S0016-5085(20)30445-5)https://doi.org/10.1053/j.gastro.2020.03.062Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar). We did not attempt to assess risk factors for SARS-CoV-2 infection in IBD, as the only 3 cases documented in our study prevented the use of logistic regression models. Notably, more than one third of our patients were receiving biologics and all of them experienced no Covid-19-related symptoms thus supporting the hypothesis that such drugs do not increase the risk of Covid-19 ([8]Monteleone G. Ardizzone S. Are patients with inflammatory bowel disease at increased risk for Covid-19 infection?.J Crohns Colitis. 2020; (Mar 26:jjaa061)https://doi.org/10.1093/ecco-jcc/jjaa061Crossref Scopus (155) Google Scholar,[9]Monteleone G. Sarzi-Puttini P.C. Ardizzone S Preventing COVID-19-induced pneumonia with anticytokine therapy.Lancet Rheumatol. 2020; 2 (May): e255-e256https://doi.org/10.1016/S2665-9913(20)30092-8Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar). Based upon these data, we feel IBD patients should be encouraged to continue their treatment even during Covid-19 outbreak in order to prevent disease flares and IBD-associated complications. At the same time, IBD patients, particularly those with co-existing comorbidities (e.g. hypertension, diabetes, cardiovascular diseases) should strictly adhere to healthcare infection prevention and control measures. Giovanni Monteleone served as an advisory board member for AbbVie. Emma Calabrese has received fees from ABBVIE, TAKEDA and JANSSEN. The other authors have no conflict of interest. No specific funding has been received for this work.

Background: Anemia of Chronic Disease (ACD) can negatively influence the clinical course of Inflammatory Bowel Disease (IBD) patients. The aim of this study was to evaluate the effect of Vedolizumab on ACD in IBD. Methods: Clinical data of 75 IBD patients (25 Crohn’s disease (CD) and 50 Ulcerative Colitis (UC)) receiving Vedolizumab in a tertiary referral IBD center were retrospectively evaluated and the effect of the drug on ACD was ascertained at weeks 14 and 24. Results: ACD was diagnosed in 35 (11 CD and 24 UC) out of 75 (47%) IBD patients. At both week 14 and week 24, improvements and resolutions of ACD were achieved by 13/35 (37%) and 11/35 (31%) patients, respectively. Baseline demographic/clinical characteristics did not differ between patients with ACD improvements/resolutions and those with persistent ACD. Clinical response occurred more frequently in patients who achieved ACD resolution (10/11, 91%) than in those without ACD improvement (5/11, 45%, p = 0.022). When analysis was restricted to anemic patients, ACD resolution was documented in 10/22 patients (45%) achieving clinical response and 1/13 of non-responders (8%; p = 0.02). Conclusions: ACD occurs in half of the IBD patients and, in nearly two thirds of them, Vedolizumab treatment associates with ACD resolution/improvement.

Inflammatory Bowel Diseases (IBD), whose denomination comprehends Crohn's Disease (CD) and Ulcerative Colitis (UC), are intestinal chronic diseases that often require lifelong medical therapy. In the last two decades monoclonal antibodies against the cytokine TNF have become integral parts in the treatment of IBD patients, however there are unwanted side-effects and one third of patients show primary non-response while another subgroup loses response over time. Finding novel drugs which could act as therapies against precise pro-inflammatory molecular targets to avoid unwanted systemic side effects and additionally the process of immunization, represents an important aim for subsequent therapeutic approaches. Oligonucleotide based therapies represent a promising novel concept for the treatment of IBD. The molecular action of oligonucleotides ranges from inhibition of the translational process of mRNA transcripts of pro-inflammatory molecules, to mimicking bacterial DNA which can activate cellular targets for immunomodulation. Alicaforsen, selectively targets ICAM-1 mRNA. ICAM-1 is an adhesion molecule which is upregulated on endothelial cells during IBD, thereby mediating the adhesion and migration of leucocytes from blood to sites of active inflammation. In CD parenteral application of alicaforsen did not show therapeutic efficacy in phase II trials, but it demonstrated an improved efficacy as a topical enema in distal UC. Topical application of alicaforsen might represent a therapeutic perspective for refractory pouchitis as well. SMAD7 is a protein that inhibits the signaling of TGFβ, which is the mainstay of a regulatory counterpart in cellular immune responses. An antisense oligonucleotide against SMAD7 mRNA (mongersen) demonstrated pre-clinical and phase II efficacy in CD, but a phase III clinical trial was stopped due to lack of efficacy. Cobitolimod is a single strand oligonucleotide, which mimics bacterial DNA as its CpG dinucleotide sequences can be recognized by the Toll-like receptor 9 on different immune cells thereby causing induction of different cytokines, for example IL10 and IFNα. Topical application of cobitolimod was studied in UC patients. We will also discuss two other novel oligonucleotides which act on the GATA3 transcription factor (SB012) and on carbohydrate sulfotransferase 15 (STNM01), which could both represent novel promising therapeutic options for the treatment of UC.

Background: 5-aminosalicylates (5-ASA) are commonly prescribed for inflammatory bowel disease (IBD).Whilst they are effective in mild-moderate ulcerative colitis (UC), evidence for their benefit in Crohn's Disease (CD) is controversial.Few data are available on the evolution of 5-ASA prescriptions over time, from a population level.Methods: 5-ASA prescription trends in prevalent IBD patients in The Health Improvement Network (THIN) UK primary care database were evaluated retrospectively across five 4-year periods (era 1-5) between 1996-2015.The proportion of patients prescribed 5-ASA at any time of their disease, and within 1 year of IBD diagnosis was stratified by IBD type, 5-ASA type and age group ($12-<18, $18-<65, $65 years).Prolonged use was defined as continuous use for $12 months.Chi-squared test for trend was used to evaluate differences in prescription

BACKGROUND AND AIMSWhether inflammatory bowel disease [IBD] is associated with specific psoriasis phenotypes is undefined. In a case-control prospective study, we aimed to assess the severity and phenotype of psoriasis in IBD vs matched non-IBD controls with psoriasis [non-IBD].METHODSFrom 2011 to 2013, dermatological assessment was performed in all IBD patients showing lesions requiring characterisation. In patients with psoriasis, assessment included: presence, characteristics, and severity. Each IBD patient with psoriasis was matched [gender, ethnicity, age ± 5 years] with one non-IBD patient with psoriasis.STATISTICAL ANALYSISdata were expressed as median [range], chi-square, Student's t test.RESULTSDermatological assessment was performed in 251 IBD patients [115 females, age 47 [16-85]; IBD duration 9 years [1-46]]: 158 Crohn's disease [CD] [63%], 93 ulcerative colitis [UC] [37%]. Psoriasis was detected in 62 [25%] IBD patients: 36 [58%] CD, 26 UC [42%; p = 0.44]. Clinical characteristics were comparable between IBD patients with or without psoriasis: age 50 [23-72] vs 47 [16-85]; IBD duration 9.5 [1-46] vs 9 [1-41]; p = non-significant]. The non-IBD group included 62 patients with psoriasis: 35 male; age 47 [18-75]. Mild psoriasis was more frequent in IBD vs non-IBD [87% vs 53%; p < 0.0001], whereas moderate and severe psoriasis were more frequent in non-IBD vs IBD [37% vs 13%, p = 0.004; 10% vs 0%; p = 0.036]. Plaque-type psoriasis was the most common phenotype in both IBD and non-IBD [p < 0.0001 vs others phenotypes].The frequency of plaque-type, nail psoriasis and psoriatic arthritis was lower in IBD vs non-IBD [p = 0.008; p < 0.0001; p = 0.006]. Psoriasis occurred after anti-tumour necrosis factor [TNF]α treatment in six CD patients [7%].CONCLUSIONSSeverity and phenotypes of psoriasis may differ between patients with IBD and their matched non-IBD controls.