Objectives To evaluate the real-world technical performance, diagnostic yield and downstream endoscopy rates of colon capsule endoscopy (CCE) in Ireland and identify clinical factors associated with these outcomes. Methods This multicentre observational study analysed prospective data from the Irish Capsule Registry. Procedures from six centres between October 2023 and February 2026 were included. Outcomes included capsule transit, bowel cleansing adequacy, complete examination (complete transit with adequate cleansing), diagnostic yield and referral for lower gastrointestinal endoscopy. Multivariable logistic regression identified predictors of key outcomes. Results 920 CCE examinations were analysed (mean age 54.9±15.4 years; 61.4% female). Complete capsule transit was achieved in 81.1%, adequate bowel cleansing in 82.6% and complete examination in 70.1%. Clinically significant findings were detected in 38.7% of examinations, most commonly significant colonic polyps (≥3 polyps or any ≥6 mm). Lower gastrointestinal endoscopy was recommended in 38.0% of cases. Increasing age was independently associated with higher diagnostic yield (OR 1.01 per year, p=0.007), without affecting technical outcomes or endoscopy rates. Clinical indication influenced downstream endoscopy rates, highest in surveillance populations (50.4%) and lowest in inflammatory bowel disease assessment (22.2%). Incomplete examinations had substantially higher downstream endoscopy rates (56.2% vs 30.3%). Conclusions CCE demonstrated good technical performance and diagnostic yield in routine Irish practice, with downstream endoscopy rates consistent with a clinician-selected population. Outcomes varied by clinical indication, and older age was associated with higher diagnostic yield without adverse effects on performance. These findings emphasise patient selection, favouring lower-risk populations, while supporting use across age groups.

Abstract Background Ustekinumab (UST) is an anti-IL12/23 monoclonal antibody approved for use in psoriasis and inflammatory bowel disease (IBD). HLA-C*06 allele carriage has been associated with higher rates of response to UST in psoriasis patient populations.1 The association between HLA-C*06 carriage and UST response in IBD has not been previously evaluated. We aimed to further explore HLA-C*06 carriage as a pharmacogenetic marker as a response to UST therapy in IBD patients. Methods A multi-centre retrospective study of IBD patients treated with UST in Ireland was performed. Baseline demographics of the cohort were collected. HLA-C*06 genotypes were generated by imputation from whole genome sequence using HIBAG. UST therapy persistence, was considered a proxy for treatment response, and was expressed as time to discontinuation of UST therapy. The primary endpoint was UST therapy persistence segregated by HLA-C*06 allele genotype. Statistical analysis was performed using survival analysis and multivariate cox logistic regression with effect of covariates on outcome expressed as odds ratios (OR). Results 143 IBD patients were identified and included in the study population. In this population, 32 patients (22%) carried at least one HLA-C*06 allele. There was no significant difference in median time to UST therapy discontinuation comparing HLA-C*06 carriers to non-carriers at 700-days follow-up, p=0.32 [Figure 1]. In a multivariate regression neither HLA-C*06 allele carriage (OR 1.2, p=0.5), male gender (OR 1.2, p=0.6), CD phenotype (OR 1.6, p=0.44), nor concomitant immunomodulator use (OR 1.1, p=0.8) were independently associated with time to UST therapy discontinuation. Conclusion HLA-C*06 allele carriage is not associated with increased UST therapy persistence in IBD. Larger studies of UST therapy outcome in IBD patients with characterised HLA-C*06 genotype are required to confirm this finding. References 1.Talamonti M, Galluzzo M, Chimenti S, Costanzo A. HLA-C*06 and response to ustekinumab in Caucasian patients with psoriasis: Outcome and long-term follow-up. J Am Acad Dermatol. 2016;74(2):374-5.

Background and study aims Telemedicine has progressed significantly in recent years, with newer, more integrated information technology systems improving healthcare delivery. The development of the world's first cloud-based capsule platform could allow safe and timely virtual analysis of videos from a network of linked hospital centers. We aimed to assess the efficacy of Medtronic's PillCam Remote Reader System. Methods PillCam remote reader technical data were collected from the capsule endoscopy (CE) database over 8 months. User-reported performance was collect using an online survey. Outcomes included overall procedure success, video-upload/report-download rates and speeds, encryption/decryption rates, and user/reader satisfaction. Results Data from 377 studies encompassing seven different readers was collected (318 small bowel capsules, 59 colon capsules). Overall procedure success was 100% (all videos reported). Two upload delays occurred (< 24 hours). There were no encryption/decryption errors. Seven of seven respondents felt it easy to access and use vs one of seve for the old system. Six of seven respondents felt department efficiency increased. Benefits included off-site reading and multisite-conferences. Issues included offsite difficulty accessing other hospital systems. Conclusions PillCam remote reader is a reliable, secure, and effective capsule analysis platform and should be incorporated into any CE service development plan.

Aims The use of Colon Capsule Endoscopy (CCE) has increased widely in recent years. Successful visualisation and identification of pathology during CCE is contingent on good quality bowel preparation, while poor prep may result in repeat procedures and delayed or missed diagnoses. Traditionally people undergoing CCE are given similar bowel preparation to those undergoing colonoscopy (commonly 2L Poly-Ethylene Glycol (PEG)) split into 2x 1L doses, one consumed the day before the procedure, one consumed the morning of the procedure, both administered with a further 1L wter, referred to as Split Prep (SP). Patient reported satisfaction with morning doses of PEG have been variable, with travel inconvenience, early morning waking, and discomfort all having been reported as problematic. Complete bowel prep (2L PEG) on the day prior to colonoscopy has been shown to be equivalent to split prep for early morning procedures, however evidence of efficacy in CCE is lacking.

Abstract Background Carriage of HLA-DQA1*05 allele is associated with development of antidrug antibodies (ADA) in patients with Crohn’s Disease (CD) receiving anti-TNF therapy. The presence of ADA is not uniformly associated with anti-TNF therapy failure as patients with adequate trough drug concentrations, even where ADA are present, can maintain therapy response. We aimed to determine the impact of carriage of HLA-DQA1*05 allele on outcome of anti-TNF therapy evaluated by drug persistence in routine clinical practice. Methods A multi-centre retrospective study of IBD patients treated with anti-TNF therapy was performed. HLA-DQA1*05 genotypes were generated for each included patient by imputation from whole genome sequence using HIBAG. Only outcome of first anti-TNF therapy received by patients was evaluated in this study. Study primary endpoint was anti-TNF therapy persistence, expressed as time to discontinuation of anti-TNF therapy, segregated by HLA-DQA1*05 allele genotype. Patients discontinuing anti-TNF therapy due to primary or secondary loss of response or due to side-effects were considered therapy failures. Statistical analysis was performed using survival analysis and multivariate cox logistic regression with effect of covariates on outcome expressed as odds ratios (OR). Results 921 IBD patients were identified with 877 included in the study population. Baseline demographics for the entire cohort and segregated by HLA-DQA1*05 allele status are summarised in Figure 1. In the study population, 543 (62%) had no copy, 281 (32%) one copy and 53 (6%) two copies of HLA-DQA1*05 allele. Median time to anti-TNF therapy discontinuation in patients with 2 copies of HLA-DQA1*05 allele was significantly shorter compared to patients with 1 or no copy at 700-days follow-up: 418 versus 513 versus 541 days respectively, p=0.007 (Figure 2) with similar results observed at 2000-days follow-up (p=0.04). In a multivariate regression, factors independently associated with time to anti-TNF therapy discontinuation included: carriage of HLA-DQA1*05 allele OR 1.2, p=0.02; male gender OR 1.6, p=4.2 x 10-5; CD phenotype OR 0.7, p=0.009; and anti-TNF therapy type (infliximab) OR 1.5, p=0.002. Concomitant immunomodulator use was not associated with time to anti-TNF therapy discontinuation in this model, OR 0.97, p=0.84. Conclusion Carriage of two HLA-DQA1*05 alleles is associated with a less favorable outcome of anti-TNF therapy with shorter time to therapy discontinuation. Carriage of one HLA-DQA1*05 allele is not associated with outcome of anti-TNF therapy. Assessing HLA-DQA1*05 genotype has value in routine clinical practice as HLA-DQA1*05 homozygotes are at increased risk of anti-TNF failure which should be a consideration in IBD therapy selection.

Introduction Carriage of the HLA-DQA1*05 allele is associated with development of antidrug antibodies (ADAs) to antitumor necrosis factor (anti-TNF) therapy in patients with Crohn's disease. However, ADA is not uniformly associated with treatment failure. We aimed to determine the impact of carriage of HLA-DQA1*05 allele on outcome of biologic therapy evaluated by drug persistence. Methods A multicenter, retrospective study of 877 patients with inflammatory bowel disease (IBD) treated with anti-TNF therapy with HLA-DQA1*05 genotypes were generated by imputation from whole genome sequence using the HIBAG package, in R. Primary end point was anti-TNF therapy persistence, (time to therapy failure), segregated by HLA-DQA1*05 allele genotype and development of a risk score to predict anti-TNF therapy failure, incorporating HLA-DQA1*05 allele genotype status (LORisk score). Results In all, 877 patients receiving anti-TNF therapy were included in our study; 543 (62%) had no copy, 281 (32%) one copy, and 53 (6%) 2 copies of HLA-DQA1*05 allele. Mean time to anti-TNF therapy failure in patients with 2 copies of HLA-DQA1*05 allele was significantly shorter compared with patients with 0 or 1 copy at 700 days' follow-up: 418 vs 541 vs 513 days, respectively (P = .012). Factors independently associated with time to anti-TNF therapy failure included carriage of HLA-DQA1*05 allele (hazard ratio [HR], 1.2, P = .02; female gender HR, 1.6, P < .001; UC phenotype HR, 1.4, P = .009; and anti-TNF therapy type [infliximab], HR, 1.5, P = .002). The LORisk score was significantly associated with shorter time to anti-TNF therapy failure (P < .001). Conclusions Carriage of 2 HLA-DQA1*05 alleles is associated with less favorable outcomes for patients receiving anti-TNF therapy with shorter time to therapy failure. HLA-DQA1*05 genotype status in conjunction with clinical factors may aid in therapy selection in patients with IBD.

Abstract Background This study aimed to examine the current management and outcomes in pregnancy in our cohort of inflammatory bowel disease (IBD) patients. Methods Following ethical approval patients with at least one pregnancy with known Crohn’s Disease (CD) or Ulcerative Colitis (UC) were identified. Using a self-assessment questionnaire basic demographic, clinical data and pregnancy outcomes were recorded. Results Eighty-five patients were recruited between January and October 2019; 38 CD, 26 UC and 1 Indeterminate (ID). The mean age was 28.6 years (range 14–46 years) at diagnosis. In total there were 199 pregnancies: 168 live births, 2 stillbirths (1%); lower than the national rate of 3.0 per 1000 and 29 miscarriages (14.5%) compared with national rates of 1 in 5. The majority attended routine combined GP and maternity services, only 17 (20%) attended a specific high-risk maternity clinic. Biologic usage was similar pre and during pregnancy; 16 (22%), 11 (16%) with a slight increase post pregnancy 19 (30%). Overall 26% continued to smoke and 7% drank alcohol during their pregnancy. The total of reported flares were less frequent during pregnancy 45% (n = 35) vs. pre-partum 61% (n = 47) and post-partum 79% (n = 61), p = 0.021. In all there were 138 vaginal deliveries and 32 (19%) caesarean sections (CS). CS rates did not differ by disease type, UC 9/26 & CD 26/58, p = 0.4 There were 12 (7%) preterm deliveries 3 of which had low birth weights. 2 congenital abnormalities 1 % (cleft palate and spina bifida) lower that the national rate of 2–3% of live births and 14–24% of stillbirths, were recorded. Breast feeding rates were reported at 34% (n = 28), significantly lower than the national average rate of 46.3%. 81% of patients reported having had a recent smear test and 18% reported an abnormal smear. Seventy per cent of patients who reported having an abnormal smear were on immunosuppressant therapy. Conclusion The results from our ongoing study have found less disease activity during pregnancy possibly associated with continued use of biological therapy. However, there were higher rate of flares reported post-partum possibly related loss to immune tolerance developed during pregnancy, or lifestyle and environmental factors. Despite not attending a specific IBD pregnancy service outcomes in our cohort were good with lower than National average rates of miscarriage, stillbirths and congenital abnormalities. Worryingly rates of over a quarter of patients continued to smoke during pregnancy and only a third of patients breastfed; factors which could be targets for future education. High rate of abnormal smear tests, low rate of HPV vaccination warrants further research.

Background Serum vitamin D level is commonly low in patients with inflammatory bowel disease (IBD). Although there is a growing body of evidence that links low vitamin D level to certain aspects of IBD such as disease activity and quality of life, data on its prevalence and how it varies across disease phenotype, smoking status and treatment groups are still missing. Materials and methods Patients diagnosed with IBD between 2010 and 2011 were recruited. Demographic data and serum vitamin D levels were collected. Variance of vitamin D level was then assessed across different treatment groups, disease phenotype, disease activity and quality of life scores. Results A total of 238 (55.9% male) patients were included. Overall, 79% of the patients had either insufficient or deficient levels of vitamin D at diagnosis. Patients needing corticosteroid treatment at 1 year had significantly lower vitamin D levels at diagnosis (median 36.0 nmol/l) ( P =0.035). Harvey–Bradshaw Index ( P =0.0001) and Simple Clinical Colitis Activity Index scores ( P =0.0001) were significantly lower in patients with higher vitamin D level. Serum vitamin D level correlated significantly with SIBQ score ( P =0.0001) and with multiple components of SF12. Smokers at diagnosis had the lowest vitamin D levels (vitamin D: 34 nmol/l; P =0.053). Conclusion This study demonstrates the high prevalence of low vitamin D levels in treatment-naive European IBD populations. Furthermore, it demonstrates the presence of low vitamin D levels in patients with IBD who smoke.

Background Anti-TNF therapy (ATT) has been shown to have beneficial effects on bone metabolism in the short term, but there is a dearth of long term prospective data. Aim To evaluate the long term effects of ATT on bone metabolism. Method Retrospective observational cohort study of ATT naive IBD patients first evaluated in 2007 by DXA scan and by metabolic bone markers prior to, and one year post commencement of ATT. Patients were invited to undergo repeat DXA scan and serum bone marker measurement. Results To date, 73% (n=38/52) patients from the original study have been recruited for 10 year follow up. There were 3 deaths, 4 refusals, 7 uncontactable. DXA scans and serum samples have been collected on 24/38 patients. 50% were female, mean age of 44.5 years (range 27-80). 67% (n=16) Crohn’s, 33% (n=8) UC. 6 patients continued with immunomodulator (IMM), 11 with ATT (Adalimumab (n=5), Infliximab (n=6)), 2 with combination therapy (ATT/IMM), 1 with 5-ASA, 4 no treatment. Mean T score prior to ATT in 2007 was −1.46 (SD +/-1.24), and 0.81 (SD +/-1.04) at 10 years. The baseline and 10 year mean T-scores were −1.53 (SD +/-1.26) and −0.70 (SD +/-1.13) for patients remaining on ATT and −0.97 (SD +/-1.27) and −0.66 (SD +/-1.01) for those off ATT. Serum analyses are in process. Conclusions In this ongoing 10 year follow up study, results suggest that long term (>10 years) treatment with anti-TNF therapy has a beneficial effect on bone metabolism.

Frequency of anaemia and anaemia subtypes in east-west European inception cohort : an ECCO-EpiCom cohort study

BACKGROUND:No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe. METHODS:The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register. RESULTS:One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)]). Mean crude expenditure per patient in Western Europe (Eastern Europe) with Crohn's disease: investigations €1803 (€2160) (P = 0.44), surgery €11,489 (€13,973) (P = 0.14), standard treatment €1027 (€824) (P = 0.51), and biologicals €7376 (€8307) (P = 0.31). Mean crude expenditure per patient in Western Europe (Eastern Europe) with ulcerative colitis: investigations €1189 ( €1518) (P < 0.01), surgery €18,414 ( €12,395) (P = 0.18), standard treatment €896 ( €798) (P < 0.05), and biologicals €5681 ( €72) (P = 0.51). CONCLUSIONS:In this population-based unselected cohort, costs during the first year of disease were mainly incurred by investigative procedures and surgeries. However, biologicals accounted for >15% of costs. Long-term follow-up of the cohort is needed to assess the cost-effectiveness of biological agents.

Background:The EpiCom cohort is a prospective, population-based, inception cohort of inflammatory bowel disease (IBD) patients from 31 European centers covering a background population of 10.1 million. The aim of this study was to assess the 1-year outcome in the EpiCom cohort. Methods:Patients were followed-up every third month during the first 12 (±3) months, and clinical data, demographics, disease activity, medical therapy, surgery, cancers, and deaths were collected and entered in a Web-based database (www.epicom-ecco.eu). Results:In total, 1367 patients were included in the 1-year follow-up. In western Europe, 65 Crohn’s disease (CD) (16%), 20 ulcerative colitis (UC) (4%), and 4 IBD unclassified (4%) patients underwent surgery, and in eastern Europe, 12 CD (12%) and 2 UC (1%) patients underwent surgery. Eighty-one CD (20%), 80 UC (14%), and 13 (9%) IBD unclassified patients were hospitalized in western Europe compared with 17 CD (16%) and 12 UC (8%) patients in eastern Europe. The cumulative probability of receiving immunomodulators was 57% for CD in western (median time to treatment 2 months) and 44% (1 month) in eastern Europe, and 21% (5 months) and 5% (6 months) for biological therapy, respectively. For UC patients, the cumulative probability was 22% (4 months) and 15% (3 months) for immunomodulators and 6% (3 months) and 1% (12 months) for biological therapy, respectively in the western and eastern Europe. Discussion:In this cohort, immunological therapy was initiated within the first months of disease. Surgery and hospitalization rates did not differ between patients from eastern and western Europe, although more western European patients received biological agents and were comparable to previous population-based inception cohorts.

The cost of investigations and medical treatment including biological therapy in a European inception cohort from the biological era : An ECCO-EpiCom study

distal and proximal ileum in 15, 44, 11 and 11 of non-operated patients and 0, 24, 7 and 6 in operated patients (ns).Length of strictures was 5.6±3.4cm at surgery, 5.7±4.1 cm at SICUS (n.s).Pre-stenotic dilatation was present in 49/81(60%) and 15/37(40.5%)strictures in non-operated and operated patients, respectively (n.s).The length and lumen diameter of strictures were 5±5 cm and 6±1 mm in non-operated and 6.6±5 cm and 5.2±1.8mm in operated patients (n.s), respectively.There was no significant difference in the stricture site and location of CD at diagnosis, between operated and non-operated patients .Conclusions.Site, length, and degree of luminal narrowing of stricture do not differ between CD patients requiring and not requiring surgery.Severity of stricture does not appear to be the only factor of obstructive symptoms requiring surgery.It is likely that other factors contribute with stricture to indicate surgery.

Background and AimsThe EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD).MethodsA quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers.ResultsOf 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, p<0.05), the main source was the Internet (92% vs. 88% p=0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p<0.05), while in Eastern Europe, gastroenterologists were easier to contact (80% vs. 68%, p<0.05).ConclusionHealth care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.