NAFLD is more common and occurs at a younger age in IBD than in nonIBD subjects. However, further investigation is required to ascertain possible NAFLD pathogenic IBD-related factors other than conventional/metabolic ones. 10.1093/ibd/izy051_video1izy051.video15774874877001.

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), can be associated with several extra-intestinal manifestations requiring a multidisciplinary management both in terms of work-up and therapy. Oral lesions are common in patients with IBD, with a prevalence ranging from 5% to 50%. These can represent an oral location of IBD as well as a side-effect of drugs used to treat the intestinal disease. Oral manifestations, occurring in patients with IBD, can be divided in nonmalignant, specific, and non-specific ones, and malignant lesions. While there is undoubtedly a need to search for an IBD in patients with oral lesions associated with intestinal symptoms, the work-up of those with an exclusive oral lesion should be personalized. Fecal calprotectin is a non-invasive marker of intestinal inflammation and may be used to select which patients need to undergo endoscopic examination, thereby avoiding unnecessary investigations. The pharmacological armamentarium to treat oral lesions associated with IBD includes topical or systemic corticosteroids, immunosuppressive agents, and biologic drugs.

Adalimumab (ADA) is a human anti-tumor necrosis factor (TNF-α) monoclonal antibody used in inflammatory bowel diseases, such as Crohn’s disease (CD). Vitamin-D (VD) is important for biological functions, such as the modulation of expression of genes encoding enzymes and transporters involved in drug metabolism and transport. ADA trough levels were associated with VD concentrations in patients with IBD, but no data are present in the literature concerning VD pathway-related gene single-nucleotide polymorphisms (SNPs) in affecting clinical outcomes. For this reason, the aim of this study was to evaluate the ability of VD-related genetics to predict clinical remission at 3 and 12 months in patients affected by CD treated with ADA. Patients affected by CD were included in this study. SNPs in CYP27B1, CYP24A1, GC, and VDR genes were analyzed through real-time PCR. A total of 63 patients were enrolled. Calprotectin, hemoglobin, and C-reactive protein levels were influenced by SNPs in VDR, CYP27B1, and GC genes. After 3 months of therapy, clinical remission was predicted by smoke, systemic steroids, and VDR BsmI, whereas at 12 months by GC 1296AA/AC and VD supplementation. This study reports the association between VD pathway-related genetics and ADA treatment. Further studies are needed to confirm these promising data.

Colorectal cancer (CRC) is slightly increased in inflammatory bowel disease (IBD) patients, with roughly a 2.5-fold increase compared to the general population. Clinical features associated to CRC risks are extent and severity of colonic involvement, disease duration, concomitant primary sclerosing cholangitis (PSC) and/or familial history of CRC in first-degree relatives. Colonic Crohn’s disease (CD) and ulcerative colitis (UC) share similar risks when similar colonic extent is affected. Risk stratification affects outcomes and surveillance programs.Newer endoscopic techniques substantially ameliorated diagnostic performance of endoscopy, and nowadays the standard for CRC surveillance in IBD patients is high-definition endoscopy, with dye-spray or virtual colonoscopy, oriented at targeted (+ random) colonic biopsies.Visible dysplastic lesions should be considered for endoscopic resection, while invisible dysplasia is still a mandatory proctocolectomy indication.Newer endoscopic interventional techniques (endoscopic mucosa resection, EMR, and endoscopic submucosal dissection, ESD) are appropriate therapeutic techniques to be delivered, but long-term risks of cancer should be balanced towards proctocolectomy.

Background Inflammatory bowel disease (IBD) are complex chronic disabling disease with variable disease activity. Physicians’ and patients’ perception of disease burden may vary considerably. The use of eHealth tools is a useful technique to monitor disease burden, but physicians- and patients-reported disease measurement do not overlap completely. Aim of this study was to perspectively explore agreement for rating disease activity and impact between patients, senior (consultants) and junior (residents) physicians. Methods Using a tele-monitoring platform (IBD Tool), 508 consecutive IBD patients filled disease activity (Harvey Bradshaw Index, HBI, for Crohn’s and Patient Simple Clinical Colitis Activity Index, P-SCCAI, as appropriate) and disease impact (Pictorial Representation of Illness and Self-Measure, PRISM) validated questionnaires at the time of outpatient visits. At the same timepoint also senior and junior physicians filled the same activity (HBI and Clinician SCCA, C-SCCAI) and impact (PRISM) questionnaires. Agreement between patients’ and physicians’ scores was analysed with intraclass and concordance correlation coefficients and Spearman’s rank correlation coefficient. Results A total of, 629 filled questionnaires regarding, 508 patients was available for analysis. Crohn’s patients were, 52%, and females were, 50%, median age of patients was, 44 years, and their median age at diagnosis was, 28 years, while median disease duration was, 12 years; overall, 39% of patients underwent surgery before being enrolled. Agreement for different scores among patients, senior and junior physicians was always significant and details are reported in Table, 1. Table, 1. Agreement among patients, senior and junior physicians for HBI, SCCAI and PRISM. A closer inverse relationship between activity indices and PRISM was found in physicians’ scores, while it was looser in patients’ scores. Senior physicians’ agreement was -0.774 and -0.793 for HBI and C-SCCAI, respectively, to PRISM (p<0.0001); Junior physicians’ agreement was -0.745 and -0.753 for HBI and C-SCCAI, respectively, to PRISM (p<0.0001); patients’ agreement was -0.414 and -0.498 for HBI and C-SCCAI, respectively, to PRISM (p<0.0001). Conclusion Agreement of patients’ and physicians’ scoring of disease activity on a tele-monitoring platform is good and significant, and it is optimal between junior and senior doctors. According to published data, physicians’ and patients’ agreement regarding the perception of disease impact on patients’ lives (measured with PRIMS) is slightly worse, although still significant, while it is good comparing junior and senior physicians’ rates. When exploring relationships between PRISM and disease activity scores it is good for physicians, and only average for patients.

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