BACKGROUND AND AIMS:The impact of Physical activity (PA) on the activity of inflammatory bowel disease (IBD) remains unclear. PATIENTS AND METHODS:A descriptive cross-sectional study included consecutive patients with Crohn's disease (CD), ulcerative colitis (UC). PA was assessed using the short International Physical Activity Questionnaire. PA was classified as low, medium or high PA. PA was also assessed according to WHO recommendations. IBD activity was evaluated using PRO-2, while IBD-related disability was assessed with the IBD-disk questionnaire. RESULTS:Among a total of 2514 patients (1715 CD), only 28.8% met the WHO recommendations on PA (49.8% had low PA, 35.2% had medium PA, and 15.0% had high PA). Medium and high PA levels were associated with a higher rate of patient-reported clinical remission in patients with CD (OR 1.30 [1.08-1.57] for medium PA, and 1.33 [1.03-1.72] for high PA vs. low PA; p-trend=0.02) but not in those with UC. Higher PA levels were associated with less IBD-related disability in both CD, and UC. CONCLUSION:In a large cohort of IBD patients, moderate and high PA was associated with higher rates of clinical remission in patients with CD and lower IBD-related disability in both CD and UC patients.

BACKGROUND AND AIMS:Bowel urgency is one of the most distressing symptoms experienced by patients with inflammatory bowel disease (IBD). The relationship between bowel urgency and multidimensional IBD-related disability has not been well characterised. PATIENTS AND METHODS:We conducted a multicentre cross‑sectional study including adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Patients completed self-administered questionnaires evaluating bowel urgency and IBD-related disability using the IBD-Disk questionnaire. Severe bowel urgency was defined as an IBD-disk bowel urgency subscore ≥6. RESULTS:A total of 2,514 patients (1,715 with CD) were included. Severe bowel urgency was observed in 17.1% of patients with UC and in 20.4% of patients with CD, compared to 3.6% and 7.6%, respectively, in those in clinical remission according to PRO-2 criteria. In multivariate analysis in patients with UC, factors associated with severe bowel urgency were general well-being subscore ≥2 and abdominal pain subscore ≥2 while treatment with advanced therapy, clinical remission according to PRO-2, fatigue subscore <5, work productivity subscore <3 and sexual life subscore <2 were negatively associated. In patients with CD, factors were rectal bleeding subscore ≥2, abdominal pain subscore ≥2 and history of intestinal resection while clinical remission, fatigue subscore <5, work productivity subscore <3 and sexual life subscore <2 were negatively associated. CONCLUSION:Severe bowel urgency is frequent in both patients with CD and UC beyond IBD activity and is strongly associated with various dimensions of IBD-related disability. These findings emphasise the importance of systematically assessing urgency in routine clinical practice.

INTRODUCTION:Intravenous infliximab (IFX) is the cornerstone for treating patients with perianal Crohn's disease (pCD). Data on the recently launched subcutaneous (SC) IFX for pCD are limited. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. METHODS:We conducted a multicenter retrospective cohort study from the GETAID, including patients with either active (group 1) or inactive (group 2) pCD when they started SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months before initiation of SC IFX; for group 2: inactive pCD for >6 months at the time of IV to SC switch. The primary end points were clinical remission at 6 months in group 1 and pCD relapse in group 2. RESULTS:Of the 183 patients included in 24 centers, 66 were in group 1 and 117 in group 2. The median follow-up was 50.4 (27.0-64.6) and 53.4 (40.6-67) weeks, respectively. In group 1 at 6 months, clinical remission was observed in 44.6% of patients and clinical response in 87.7%. Clinical remission including seton removal occurred in 35.5% of patients. In multivariable analysis, high body mass index was the only independent predictor of remission (odds ratio 0.88, 95% confidence interval 0.77-0.99). In group 2, rates of relapse-free survival were 94.3% and 87.9% at 6 and 12 months, respectively. Sixteen cases (8.3%) of adverse events related to SC injection were observed. DISCUSSION:SC IFX was effective and safe for the treatment of active pCD and for maintaining remission after switching in this large multicenter cohort, thus supporting its use in routine practice in this indication.

BACKGROUND:Diet and risk of developing inflammatory bowel disease (IBD) has been extensively studied. AIMS:To investigate the association between diet and IBD activity. METHODS:Consecutive outpatients in 40 French and Belgian centers completed diet and IBD activity questionnaire between April and May 2023 in a cross-sectional study. Associations between diet and clinical remission were adjusted for gender, age, body mass index, education, smoking, and past CD-surgery. RESULTS:Among 2514 patients included, 1715 had Crohn's disease (CD) and 799 had ulcerative colitis (UC). Overall, the mean age was 42.4 years, 52.3 % were women, and 56.4 % were in clinical remission. Among CD patients, clinical remission was associated with a higher intake of fruits (aOR 1.60 [1.20-2.14]) and coffee (aOR 1.57 [1.17-2.11]). Among UC patients, clinical remission was associated with a higher intake of fruits (aOR 1.72 [1.15-2.56]) and salad (aOR 1.73 [1.12-2.66]). A higher adherence to a Mediterranean diet was associated with CD (aOR 1.39 [1.06-1.84]) but not UC remission. A higher adherence to a healthy diet was not associated with either CD nor UC remission. CONCLUSIONS:CD remission was associated with higher intakes of fruits, coffee and a Mediterranean diet, while UC remission was associated with higher intakes of fruits and salad. As this was a cross-sectional study, the main limitation was the possibility of reverse causality.

We report the first case of collagenous colitis attributed to perindopril use, in a 90-year-old woman. The patient developed diarrhea with hypokalemia, 3 weeks after perindopril was introduced in her medications for uncontrolled hypertension. Significant thickening of the basal epithelial membrane (up to 80μm) was found on random colon biopsies. Diarrhea resolved within 3 days after perindopril withdrawal. Four months later, left colon biopsies revealed a normalization of the basal membrane thickness. The intrinsic imputability of perindopril as the causative agent of microscopic colitis is considered to be reasonable by the French accountability technique. There was no rechallenge test conducted.

Background Acute gastrointestinal bleeding (AGIB) is common in older patients but the use of iron in this context remains understudied.Aims This study aimed to evaluate prospectively the efficacy of ferric carboxymaltose to treat anaemia in older patients after AGIB.Methods This randomised double-blinded placebo-controlled clinical trial was conducted in 10 French centres. Eligible patients were 65 years or more, had controlled upper or lower gastrointestinal bleeding and a haemoglobin level of 9-11 g/dl. Patients were randomly assigned, in a 1:1 ratio, to receive either one intravenous iron injection of ferric carboxymaltose or one injection of saline solution. The primary endpoint was the difference in haemoglobin level between day 0 and day 42. Secondary endpoints were treatment-emergent adverse events, serious adverse events, rehospitalisation and improvement of quality of life (QOL) at day 180.Results From January 2013 to January 2017, 59 patients were included. The median age of patients was 81.9 [75.8, 87.3] years. At day 42, a significant difference in haemoglobin level increase was observed (2.49 g/dl in the ferric carboxymaltose group vs. 1.56 g/dl in the placebo group, P = 0.02). At day 180, QOL, measured on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, improved by 10.5 points in the ferric carboxymaltose group and by 8.2 points in the placebo group (P = 0.56). Rates of adverse events and rehospitalisation were similar in the two groups.Conclusions Intravenous iron seems safe and effective to treat anaemia in older patients after AGIB and should be considered as a standard-of-care treatment. ClinicalTrials.gov (NCT01690585).

Background: Switching from a reference product (RP) to a biosimilar (BS) aims to generate savings. Patient adherence after a switch is linked to overall experience that can be impacted by patient or treatment characteristics. Objectives: This study aimed to analyse patient-experience and satisfaction after the switch from an adalimumab (ADA) RP or BS to CT-P17[1] (ADA BS high concentration (HC), citrate-free). Methods: YU-MATTER (NCT05427942), a multicentric prospective observational study included patients with chronic inflammatory rheumatic disease (CIR) or inflammatory bowel disease (IBD) treated with ADA: either the RP (HC: 100mg/ml) or a BS with low concentration (LC: 50 mg/ml). Patients were switched to CT-P17 and followed-up for 3 months (M). Clinical characteristics were collected at M0, including patient-experience via 5 self-questionnaires developed in collaboration with patient associations to explore satisfaction regarding the injection (Likert 7), discomfort (pain [NRS 0-10], redness [Likert 4], itching [NRS 0-10], and haematoma [Likert 3]). Satisfaction and overall injection tolerance (pain < 4 AND absence of redness AND itching < 4 AND absence of haematoma) were assessed between M0 (just before switch) and M3 (3 months after switch). Factors associated with satisfaction improvement (Likert) were explored through multivariable logistic regression. Results: Of the 232 patients analysed, the rheumatology population counted 65 patients with CIR (RA=17, AS=35, nr-axSpA=7, PsA=6,). mean age was 54±9 years; median disease duration was 9 years ([Q1; Q3]: [5; 18]) and 49.2% were men. Over the analysed population, 119 (51.2 %) patients were switched from a BS (45 with citrate) and 113 (48.7%) from the RP. At 3 months, 175 patients (75.4%) were satisfied with the injection and 145 (62.5%) had a stable or improved satisfaction versus the previous ADA. Among patients receiving a BS, the presence of citrate was significantly associated with an improvement of satisfaction after switching to CT-P17 (58.3% vs. 30.0%, p=0.006). Overall injection tolerance significantly improved after switching from 28.9 % at M0 to 57.7 % at M3 (p<0.0001). A significant decrease of pain related injection was observed after the first injection of CT-P17 (median -2 [-4;-1]) for patients switched from a BS and remained stable for patients switched from the RP (median 0 [-1;1]). In multivariable analysis, the switch from a LC ADA was an independent factor of satisfaction improvement (vs from the RP, odds ratio=3.03; p=0.003; Table 1). Conclusion: The global experience of switching to CT-P17 was positive with an overall improvement in injection tolerance. Injection volume was an independent factor associated with a successful experience. REFERENCES: [1] Furst DE, and al. Efficacy and safety of switching from reference adalimumab to CT-P17 (100 mg/ml): 52-week randomized, double-blind study in rheumatoid arthritis. Rheumatology (Oxford). 2022.[2] Horne R, and al. The Beliefs about Medicines Questionnaire: The Development and Evaluation of a New Method for Assessing the Cognitive Representation of Medication. Psychology & Health 1999. Acknowledgements: We thank all patients for their active participation in the study by answering questionnaires, patient associations (AFA, ANDAR, AFS) for their contribution to the study design and e-Health Services Sanoïa for the follow-up during the study and their input to results interpretation. Disclosure of Interests: Hubert Marotte AbbVie, Amgen, Bristol Myers Squibb, Celltrion HealthCare, Galapagos, Lilly France, MerckSharp & Dohme, Novartis, Nordic Pharma, Pfizer, and Sanofi Aventis, AbbVie, Amgen, Bristol Myers Squibb, Celltrion HealthCare, Galapagos, Lilly France, MerckSharp & Dohme, Novartis, Nordic Pharma, Pfizer, and Sanofi Aventis, Bristol Myers Squibb, Celltrion HealthCare, Galapagos, Lilly France, Novartis, Nordic Pharma, Pfizer, andSanofi Aventis, Laure Gossec AbbVie, Amgen, BMS, Celltrion Healthcare, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, AbbVie, Amgen, BMS, Celltrion Healthcare, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Lilly, Pfizer, Sandoz, UCB, AbbVie, Amgen, BMS, Celltrion Healthcare, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Lilly, Pfizer, Sandoz, UCB, Vered Abitbol Pfizer, Takeda, Amgen, Mylan Viatris, Sandoz, Janssen, Fresenius, Gilead, Tillotts, Celltrion, Pfizer, Takeda, Amgen, Mylan Viatris, Sandoz, Janssen, Fresenius, Gilead, Tillotts, Celltrion, Eric Senbel Lilly, Nordic, Roche, Chugai, Novartis, Sandoz, Biogen, Fresenius Kabi, Abbvie, Amgen, Biogen, Celltrion HealthcareNordic, Roche, Chugai, AbbVie, Amgen, Pfizer, Sanofi, MSD, Biogen, Janssen, Fresenius KabiNordic, Roche, Chugai, Fresenius Kabi, Celltrion HealthcareGuillaume Bonnaud Abbvie, Amgen, Biogen, Celltrion, Cvasthera, Ferring, Fresenius, Galapagos, Gilead, Mayoli Spindler, MSD, Janssen, Pfizer, Roche, Takeda, Tillots, Sandoz, ViatrisXavier Roblin Celltrion, MSD, Pfizer, Abbvie, Amgen, Biogen, Takeda, Janssen, BMS, Ferring, Tillots, ViforYoram Bouhnik Abbvie, Amgen, Biogaran, Biogen, Boehringer Ingelheim, Celltrion Healthcare, Ferring, Fresenius Kabi, Galapagos, Gilead, Hospira, Iterative Scopes, Janssen, Lilly, Mayoli Spindler, Merck, MSD, Norgine, Pfizer, Roche, Sandoz, Sanofi, Shire, Takeda, Tillotts, UCB, ViatrisStephane Nancey Takeda, Pfizer, MSD, Abbvie, Janssen, Tillots, HAC Pharma, Novartis, Amgen, Sanofi, Hospira, Biogen, Roche, Sandoz, Celltrion, Boerhinger Ingelheim, Nicolas Mathieu Atawao Healthcare, Celltrion, CTMA, Gilead, Janssen, Abbvie, Amgen, Biogen, Ferring, Gilead, MSD, Janssen, Pfizer, Sandoz, TakedaCelltrion, Mylan, Sandoz, Abbvie, Amgen, Janssen, Pfizer, TakedaJérôme Filippi Abbvie, Amgen, Biogen, Celltrion, Galapagos, HAC pharma, Janssen, MSD, Pfizer, Sandoz, Takeda, TillottsLucine Vuitton: None declared, Stéphane Nahon Celltrion Healthcare, Abbvie, Fresenius, Amgen, Celltrion Healthcare, Abbvie, Fresenius, Amgen, Azeddine Dellal Celltrion Healthcare France, Fresenius Kabi, Alice DENIS Celltrion Healthcare France, Caroline HABAUZIT Celltrion Healthcare France, Salim Benkhalifa Celltrion Healthcare France, Guillaume BOUGUEN AbbVie, Takeda, MSD, Janssen, Celltrion, AbbVie, Takeda, Mylan, Pfizer, Sandoz, Amgen, Ferring, Janssen, Celltrion, AbbVie, Takeda, Fresenius, Janssen, Vifor, Sandoz.Table 1Multivariable analysis of factors associated in improvement of satisfaction at 3 months with CT-P17 for 189 patients.OR [95% CI] (p-value)Adalimumab biosimilar LC vs. Adalimumab RP HC3.03 [1.46- 6.29] (0.003)CT-P17 pen vs CT-P17 syringe4.97 [1.38- 17.87] (0.014)Pain at injection site at M0 (for 1 point)1.17 [1.01- 1.35] (0.032)

Appropriate prescription of Proton pump inhibitors (PPIs) remains an important concern amid the rising overuse. A gap exists in the literature regarding the benefit of PPI prophylaxis and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB). This study aims to describe the characteristics of hemorrhage in relation to PPI use in patients experiencing UGIB, with a focus on high-risk individuals requiring gastroprotection. Data from a French multicentric cohort of patients experiencing UGIB were analyzed. Patients using PPI were compared to those without PPI considering bleeding etiologies and outcomes of peptic ulcer disease (PUD)-related hemorrhage. The rate of PPI use and its effect on bleeding characteristics in high-risk populations, defined based on international guidelines, were also assessed. Among 2497 included patients, 31.1

Background: Several adalimumab preparations are now available for patients with inflammatory bowel disease (IBD). Comparative satisfaction and tolerability are unknown. Objectives: This study investigated IBD patient satisfaction with approved adalimumab biosimilars and their originator. Design: In this cross-sectional study, we included 941 consecutive adalimumab-treated patients with IBD across 45 centres affiliated with the Groupe d’Etude Therapeutique des Affections Inflammatoires du tube Digestif who completed a satisfaction questionnaire comprising four items each rated by a 10-point scale. Methods: The differences in responses were performed using a one-way analysis of variance followed by Tukey’s honest significant difference test. Results: The most commonly used drugs at inclusion were Humira ® (436/941, 46.3%), Amgevita ® (177/941, 18.8%) and Hulio ® (105/941, 11.2%). The mean overall satisfaction rate with adalimumab was 8.5 (standard deviation 1.8). Overall satisfaction was significantly higher in patients treated with Humira (8.6 (1.5)), Hulio (8.6 (1.8)) or Amgevita (8.5 (1.4)) ( p < 0.05). Satisfaction with the subcutaneous injection form was higher for patients treated with Yuflyma ® (9.0 (1.4)), Humira (8.9 (1.3)) and Hulio (8.9 (1.7)) ( p < 0.05). A total of 299 patients (31.8%) described injection site reactions. In all, 223 patients (23.7%) reported being previously treated with another adalimumab of which (32/223, 14.3%) discontinued treatment due to side effects. Conclusion: In this real-world setting, patients with IBD had a high level of satisfaction with adalimumab treatment, with some differences in terms of overall satisfaction and satisfaction with the injection device.

Biosimilars are cost-effective alternatives to reference products for patients with inflammatory bowel diseases (IBD) and chronic inflammatory rheumatic diseases (CIRD), but patient beliefs can affect adherence to the transition. This study aimed to explore patient experience and satisfaction after switching to CT-P17, a high-concentration (100 mg/mL), citrate-free adalimumab biosimilar. This observational, multicenter, prospective French study included adult patients with IBD or CIRD who switched to CT-P17 from reference adalimumab (R-ADA; 100 mg/mL) or a low-concentration adalimumab biosimilar (ADA-BioS; 50 mg/mL). Patients completed online questionnaires to assess treatment perceptions, satisfaction, and tolerance at study inclusion (under previous treatment) and over 3 months of CT-P17 treatment. The primary criterion was overall patient satisfaction, which was assessed with the question, “What is your global satisfaction with the CT-P17 injection?”, using a 7-point Likert scale. Multivariate logistic regression analysis was performed to identify factors associated with increased treatment satisfaction after switching to CT-P17. The total analysis population included 232 patients (IBD 72.0

Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract where early diagnosis and timely, appropriate management are essential to prevent severe complications and reduce the need for surgery. This review sought to investigate factors contributing to diagnostic delays in CD, which typically ranged from 5 to 16 months. Delays were often due to nonspecific symptoms that could be mistaken for irritable bowel syndrome (IBS) and were influenced by various factors including age, education level, smoking, NSAID use, and disease characteristics like isolated ileal involvement. Healthcare system disparities also played a significant role, with delays varying by access to care. The review highlighted that delayed diagnosis was linked to worse disease outcomes, such as increased severity and complications, and underscored the importance of early intervention combined with timely management. Strategies to mitigate delays included implementing red flag tools, using inflammatory biomarkers like fecal calprotectin, and enhancing public and healthcare provider awareness. Addressing these factors and improving referral pathways and healthcare system efficiencies were crucial for enhancing early diagnosis and patient outcomes.

Abstract Background Infliximab (IFX) demonstrated its effectiveness in perianal CD (pCD) and represents the first-line medical treatment. A subcutaneous (SC) formulation has recently been developed, however so far it has not been specifically investigated in pCD. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. Methods We conducted a multicentre retrospective cohort study in the French GETAID, in patients with either active (group 1) or inactive (group 2) pCD who received SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months prior to initiation of SC IFX; and for group 2: inactive pCD for > 6 months at the time of IV to SC switch, but with a history of seton drainage. The primary endpoint in group 1 was clinical remission at 6 months (absence of anal ulcers, and absence of draining fistula). Univariate and multivariable logistic regression analyses were performed to identify predictors of clinical remission. In group 2, the primary endpoint was perianal clinical recurrence during follow-up. Results A total of 192 patients were included in 24 centres. Mean age was 38.9 years, 43.2% were women, 25.1% were smokers. 66 patients were included in group 1, 117 in group 2. In 9 patients, pCD had a > 6 months persistent activity on IV IFX when switched to SC. In group 1, median follow-up was 46 (26.6-64.6) weeks, 51/66(77.3%) patients received combination therapy, surgical drainage was performed in 40(60.6%) patients. One(1.5%), 1(1.5%), 32(48.5%), 20(30.3%) and 12(18.2%) patients received 0, 1, 2, 3 and ≥ 4 IV perfusions respectively before SC switch. At M6, 27/61(44.3%) patients were in clinical remission and 53/61(86.9%) in clinical response. MRI remission or response was achieved in 19/28(68%) patients. In univariate analysis, factors inversely associated with remission were BMI, previous pCD surgery, initial seton drainage, and SC dose optimization. In multivariable analysis, prior exposure to ≥1 biologic (OR 0.248;CI95% [0.071-0.861]p= 0.0243) was predictive of clinical remission. In group 2, median follow-up was 53.6(36.7-67) weeks. The pCD recurrence rate at 6 months was 3.1%. The recurrence-free survival curve is shown in Figure1. Overall, SC IFX was discontinued in 20(10.4%) patients, 8 switched back to IV. Two cases of immunization were observed. Median IFX serum concentration was > 20(17.1- > 20) µg/l. There were 16(8.3%) cases of adverse events related to pain/injection-site reaction: 4 switched back to IV, 1 stopped IFX. There were 5 cases of infection, no case of cancer. Conclusion Our results are in line with those reported in the literature on the effectiveness of IV IFX in pCD. The SC formulation appears to be effective and safe for active pCD, and for maintaining remission in inactive pCD

Background Anti-TNF are usually maintained during pregnancy in patients with inflammatory bowel disease (IBD) but safety is still a concern for them. Aims To provide data on management of anti-TNF agents during pregnancy, safety of live vaccines (BCG-MMR-rotavirus) and breastfeeding in newborns and dedicated information delivered to IBD women. Methods We performed an observational study in 25 centers from 2016 to 2018. We administered questionnaires to women with IBD receiving anti-TNF during pregnancy with newborn follow-up ≥ one year. Results Of 153 patients, 52 % maintained anti-TNF during the third trimester. Anti-TNF was shortly resumed in 79 % (58/73) after delivery. The rate of breastfeeding was 44 % (68/153) without any complication; 38 % of the mothers denied to breastfeed based on physician's advice. 26 % (34/129) of the newborns received live vaccines before 6 months-old (BCG:30 %; MMR:63 %; Rotavirus:8 %) and only 3 complications occurred (local BCGitis=1, fever=2). Information concerning anti-TNF during pregnancy/post-partum was delivered to 92 % of the patients, mainly by a gastroenterologist (97 %) who discussed with the obstetrician or the paediatrician in only 48 % and 25 %. Conclusion In IBD patients, maintaining anti-TNF during pregnancy and breastfeeding is safe. Accidental live vaccines before 6 months did not lead to significant adverse events. The communication about these questions remains to improve.

BACKGROUND:The impact of inflammatory bowel disease (IBD) on caregivers has rarely been investigated. Our work aims to explore the burden of IBD on the different aspects of caregivers' lives. METHODS:We conducted an online survey via the social network of the French IBD patient organization addressed to patients' caregivers who were asked to fill in a questionnaire covering the impact of the disease on different aspects of their lives. Impacts were measured by a visual analog scale (VAS). A VAS score ≥5 of 10 was considered significantly high. We then performed uni- and multivariate analyses of predictors of higher impact on parents and partners, separately. RESULTS:A total of 853 caregivers participated, predominantly women (77%). The mean age was 48.5 years. Their relationship with the patient was mainly parents in 57.1% and partners in 30.6%. The type of IBD was Crohn's disease in 63% and ulcerative colitis in 35%. The psychological burden was the highest among parents and was mainly correlated with a lack of knowledge about IBD and professional compromise (P < .05). The impact on leisure was the highest among partners and was affected by psychological, sexual, and professional burdens (P < .05). About 50% of partners experienced an absent sexual relationship for weeks/months and decreased libido regardless of IBD type. Professional impact was greater in parents compared with partners, and 36% of caregivers needed work arrangements. CONCLUSIONS:IBD has a high impact on different aspects of life of patients' caregivers. Therefore, interventions to reduce the disease burden in this population are needed.

Background and Aims There are concerns regarding the potential impact of the COVID-19 outbreak on patients with inflammatory bowel disease [IBD]. We report on the impact of the COVID-19 outbreak in a European prospective cohort study of patients with IBD Patients and Methods We prospectively collected data from 5457 patients with IBD nested in the ongoing I-CARE project and still followed up in April 2020, with monthly online monitoring of clinical activity, treatment, imaging and endoscopy. Investigators were also contacted to report incidental cases. Results In total, 233 [4.3%] reported COVID-19 and 12 [0.2%] severe COVID-19, with no COVID-19 deaths. The risk of COVID-19 in patients with IBD was not increased compared to the general population (standardized incidence ratio [SIR]: 1.18, 95% confidence interval [CI] [1.03-1.34], p = 0.009), as well as the risk of severe COVID-19 (SIR: 0.69, 95% CI [0.35-1.20], p = 0.93). We did not observe any negative impact of the different IBD-related medication on the risk of either COVID-19 or severe COVID-19. In 2020, the COVID-19 outbreak resulted in a drastic decrease in endoscopic and imaging procedures from March to May 2020 compared to 2018 and 2019. No impacts on clinical IBD disease activity as well as ongoing treatment were noted. Conclusion No increases in either COVID-19 or severe COVID-19 incidences were observed in patients with IBD. There was no impact of COVID-19 on IBD-related medication and clinical activity. Access to endoscopy and imaging was restricted during the first months of the first COVID-19 outbreak.

BACKGROUND:Medical treatment of inflammatory bowel disease (IBD) has evolved significantly, and treatment with immunomodulators is recommended. These medications may alter the patient's immune response and increase the risk of opportunistic infections. Our aim was to evaluate the prevalence and the incidence of acute or chronic HEV infection in IBD patients under immunomodulatory treatment.PATIENTS AND METHODS:We conducted a retrospective, multicenter, observational study between 2017 and 2018. IBD outpatients hospitalized for the infusion of immunomodulators were included in 16 French centers. During their daily hospitalization, blood samples were drawn for HEV serology (IgM and IgG) and HEV RNA detection.RESULTS:A total of 488 patients were included, of which 327 (67%) patients had Crohn's disease and 161 (33%) ulcerative colitis. HEV IgM was detected in 3 patients, but HEV RNA was undetectable in all patients. The HEV IgG seroprevalence rate was 14.2%. IgG-positive patients were older at sampling (p = 0.01) and IBD diagnosis (p = 0.03), had higher seafood consumption (p = 0.01) and higher doses of azathioprine (p = 0.03). Ileal and upper digestive tract involvement was more frequent in IgG-positive patients (p = 0.009), and ileocolic involvement was more frequent in IgG-negative patients (p = 0.01). Under multivariate analysis, age > 50 years [OR: 2.21 (1.26, to 3.85), p = 0.004] was associated with previous HEV infection.CONCLUSION:Systematic screening for HEV infection is not needed among IBD patients on immunomodulatory medications. However, in the event of abnormal liver test findings, HEV should be part of the classic diagnostic assessment.