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DOP69 Long-term outcome of infantile and very early onset IBD: A multi-
center study from the IBD Porto group of ESPGHAN

Article in Journal of Crohn s and Colitis · January 2022

DOI: 10.1093/ecco-jcc/jjab232.108

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i112
DOP68
CD-TREAT diet induces remission and improves
quality of life in an open label trial in children and
adults with active Crohn’s Disease
V. Svolos*1, R. Hansen1, R. Russell1, D.R. Gaya1, S. John Paul1,
J. Macdonald1, B. Nichols1, R. Papadopoulou1, M. Logan1,
S. Mckirdy1, R. Gervais1, U. Ijaz1, S. Milling1, S. Shields1, D. Wilson1,
P. Henderson1, S. Din1, G.T. Ho1, K. Gerasimidis1
1
Glasgow Royal Infirmary New Lister Building, Department of Human
Nutrition- School of Medicine- College of Medical- Veterinary and Life
Sciences, Glasgow, United Kingdom
Background: Exclusive enteral nutrition (EEN) is an established induc-
tion treatment for active Crohn’s disease (CD) with a proposed mech-
anism of action involving the gut microbiome. We have previously
shown that CD-TREAT diet, a food-based diet with similar dietary
profile to EEN, improves rat ileitis and replicates the effect of EEN on
the gut microbiome of healthy volunteers and animal models. Here,
we test the efficacy of CD-TREAT diet to induce clinical remission in
active CD.
Methods: This is an open-label study in children (wPCDAI≥12.5) and
adults (HBI≥5) with active CD. Primary outcome was clinical response
(wPCDAI fall≥17.5; HBI fall≥3) or clinical remission (wPCDAI< 12.5;
HBI<5) after 8 week treatment with CD-TREAT. Secondary outcomes
included improvement of quality of life (QoL) and reduction in faecal
calprotectin (FC) levels. Since CD-TREAT diet is gluten-free, adherence
to treatment was assessed by the detection of the gluten immunogenic
peptide (GIP) in faeces. Data are presented with median (IQR).
Results: 25 children, [age, 14.4 (12.5,15.7) years] and 32 adults, [age,
32.6 (24.2,43.9) years] were treated. 7 (12%) failed treatment and
n=10 (18%) dropped out during the first 2 weeks of treatment due to
palatability issues. In patients who completed 8 weeks of CD-TREAT
course (n=40), 85% and 78% achieved clinical response and remission,
respectively. CD-TREAT diet improved QoL in children [IMPACT-III
score, baseline: 136 (122,143) vs 8weeks: 148 (133,153), p<0.01] and
in adults [sIBDq score, baseline: 30 (26,45) vs 8weeks: 60 (48, 64),
p<0.001]. Faecal GIP decreased during treatment [ng/g stool, base-
line: 1250 (589, 1250), 4weeks: 0 (0,269), 8weeks: 0 (0,329), mg/
mg, p<0.001 for both] showing adherence with the CD-TREAT diet.
However, 33% and 40% of the patients had detectable faecal GIP at 4
and 8 weeks, respectively, revealing at least partial non-adherence. 30%
Digital oral presentations
of patients who completed CD-TREAT (n=12/40) experienced >50%
FC reduction. Median FC levels decreased significantly? in the group of
patients (n=22) who had undetectable GIP at 4 or 8 weeks [mg/kg FC,
baseline: 1190 (361,1129); 8weeks: 534 (92,1230), p<0.01].
Conclusion: CD-TREAT diet improved disease activity indices and QoL
in the majority of patients who completed treatment and decreased FC
in those who were most likely to be compliant. Future RCT should aim
to compare CD-TREAT with other induction treatments and improve
meal variety and palatability to improve compliance and reduce drop-
out rates.
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DOP69
Long-term outcome of infantile and very early
onset IBD: A multi-center study from the IBD Porto
group of ESPGHAN
A. Guz Mark*1,2, M. Aloi3, L. Scarallo4, M. Bramuzzo5, J.C. Escher6,
P. Alvisi7, P. Henderson8, I. Hojsak9, R. Lev-Tzion10, W. El-Matary11,
T. Schwerd12, B. Weiss13, M. Sladek14, C. Strisciuglio15, K. Müller16,
C. Olbjørn17, C. Tzivinikos18, A. Yerushalmy-Feler19, A. Christiaens20,
L. Norsa21, I. Viola22, L. de Ridder6, D. Shouval23, S. Lega5,
P. Lionetti24, G. Catassi25, A. Assa26
1
Schneider Children’s Medical Center of Israel, Institute of
Gastroenterology- Nutrition and Liver Diseases, Petach Tikva, Israel, 2Tel-
Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel, 3Umberto
I Hospital, Pediatric and Gastroenterology Unit- Sapienza University of
Rome, Rome, Italy, 4Meyer children’s Hospital, Gastroenterology and
Nutrition Unit, Florence, Italy, 5Institute for Maternal and Child Health
- IRCCS “Burlo Garofolo”, Gastroenterology- Digestive Endoscopy
and Nutrition Unit, Trieste, Italy, 6Erasmus MC-Sophia Children’s
Hospital, Department of Pediatric Gastroenterology, Rotterdam,
The Netherlands, 7Maggiore hospital, Pediatric Gastroenterology
unit, Bologna, Italy, 8Royal Hospital for Children and Young People,
Department of Paediatric Gastroenterology and Nutrition, Edinburgh,
United Kingdom, 9Children’s Hospital Zagreb, University of Zagreb
Medical School, Zagreb, Croatia, 10Shaare Zedek Medical Center,
Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and
Nutrition, Jerusalem, Israel, 11Pediatric Gastroenterology, University of
Manitoba, Winnipeg, Canada, 12Dr von Hauner Children’s Hospital-
LMU Munich, Department of Pediatrics, Munich, Germany, 13Edmond
& Lily Safra Children’s Hospital- Sheba Medical Center and Sackler
Faculty of Medicine- Tel Aviv University, Pediatric Gastroenterology
Unit, Tel Aviv, Israel, 14Jagiellonian University Medical College,
Department of Pediatrics- Gastroenterology and Nutrition, Krakow,
Poland, 15Department of Woman- Child and General and Specialistic
Surgery, University of Campania Vanvitelli, Naples, Italy, 16Heim Pal
National Institute for Pediatrics, Institute for Translational Medicine-
Faculty of Medicine- University of Pécs, Budapest, Hungary, 17Akershus
university hospital, Department of Pediatric and Adolescent Medicine,
Lørenskog, Norway, 18Al Jalila Children ‘s Hospital - Mohammed Bin
Rashid University, Paediatric Gastroenterology Department, Dubai,
United Arab Emirates, 19”Dana-Dwek” Children’s Hospital- Tel
Aviv Sourasky Medical Center and the Sackler Faculty of Medicine-
Tel Aviv University, Pediatric Gastroenterology Institute, Tel Aviv,
Israel, 20University Hospital Brussels, Pediatric Gastroenterology and
Nutrition, Brussels, Belgium, 21ASST Papa Giovanni XXIII, Pediatric
Hepatology- Gastroenterology and Transplantation, Bergamo, Italy,
22
University of Messina, Pediatric Gastroenterology and Cystic Fibrosis
Unit- Department of Human Pathology in Adulthood and Childhood
“G. Barresi, Messina, Italy, 23Schneider Children’s Medical Center of
Abstracts of the 17th Congress of ECCO - European Crohn’s and Colitis Organisation
Israel- Sackler Faculty of Medicine- Tel-Aviv University, Institute of
Gastroenterology- Nutrition and Liver Diseases-- Israel, Petach Tikva,
Israel, 24Meyer Children’s Hospital- University of Florence, Department
NEUROFARBA- Gastroenterology and Nutrition Unit, Florence, Italy,
25
Sapienza University of Rome - Umberto I Hospital, Pediatric and
Gastroenterology Unit, Rome, Italy, 26Shaare Zedek Medical Center-
The Hebrew University of Jerusalem, Juliet Keidan Institute of Pediatric
Gastroenterology Hepatology and Nutrition, Jerusalem, Israel
Background: Very early-onset inflammatory bowel disease (VEOIBD)
is diagnosed before the age of 6 years while infantile IBD occurs be-
fore the age of 2 years. We aimed to assess disease characteristics and
long-term outcomes in these populations.
Methods: We conducted a retrospective longitudinal cohort study in 21
pediatric centers worldwide. Patients diagnosed with VEOIBD between
the years 2008–2018 with at least 2 years of follow-up were included.
Results: The cohort included 243 patients (52% males), with median
follow-up of 5.8 (IQR 3.2–8.4) years. Median age at diagnosis was 3.3
(IQR 1.8–4.5) years, with 69 (28%) diagnosed before the age of 2 years.
Disease was classified as Crohn’s disease (CD), ulcerative colitis (UC)
and IBD-unclassified (IBDU) in 30%, 59% and 11%, respectively. In
patients with UC or IBDU, 75% presented with pancolitis. In patients
with CD, 62% presented with isolated colonic disease and 32% with
ileo-colonic disease, while 19% had perianal involvement. Genetic test-
ing was performed in 96 (40%) patients [40 (58%) <2 years, 56 (32%)
2–6 years, p=0.001], with monogenic diagnosis identified in 23% (33%
and 16%, respectively, p=0.08). The most common findings were muta-
tions in IL10-receptor (5 cases, 23%). Stricturing or penetrating disease
was observed in 9 cases (4%).
First induction therapies were corticosteroids, 5-aminosalicylic acid
(5ASA) and nutritional therapy in 53%, 30% and 11%, respect-
ively. Corticosteroids were more common as first induction in in-
fantile vs. non-infantile IBD (64% vs. 49% respectively, p=0.003).
Maintenance therapies included deep immune-suppression (mainly
biologics and corticosteroids) in 51%, immunomodulators in 27%,
and non-immunosuppressive agents (5-ASA, nutritional therapy and
antibiotics) in 22% of patients, with no significant differences be-
tween age groups.
Compared to patients diagnosed after 2 years of age, patients with in-
fantile IBD presented with higher rates of IBDU, lower levels of hemo-
globin and albumin and higher levels of CRP, lower weight (but not
height) z-scores, had lower rates of response to first induction therapy
and shorter time to hospitalization during follow-up (p<0.05 for all).
Colectomy was performed in 11% and diversion surgery in 4% of
the cohort, with no significant differences between age groups. No
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malignancies and nor deaths were observed. At end of follow-up, 85%
of patients were in corticosteroid free clinical remission.
Conclusion: Patients with VEOIBD, including infantile IBD, have fair
long-term outcome with low rates of complications and surgical inter-
ventions. Nevertheless, patients with infantile IBD demonstrated more
severe clinical features at presentation and a lower response to induc-
tion therapy.
DOP70
Anti-TNF withdrawal according to a risk-stratified
protocol does not reduce the risk of relapse in
patients with Inflammatory Bowel Disease in
endoscopic remission: A prospective study
R. Mahmoud1, E. Savelkoul*2, W. Mares3, R. Goetgebuer4,5,
B. Witteman3, D. de Koning6, I. Minderhoud7, S. van Tuyl8,
P. van Boeckel9, N. Mahmmod9, M. Lutgens10, C. Horjus11,
T. Römkens12, D. Akol-Simsek13, J. Jansen14, F. Hoentjen2,15,
B. Jharap16, B. Oldenburg1; AWARE study group Dutch Initiative on
Crohn’s and Colitis
1
University Medical Centre Utrecht, Department of Gastroenterology
and Hepatology, Utrecht, The Netherlands, 2Radboud University
Medical Centre, Department of Gastroenterology and Hepatology,
Nijmegen, The Netherlands, 3Gelderse Vallei Hospital, Department of
Gastroenterology and Hepatology, Ede, The Netherlands, 4Erasmus
Medical Centre, Department of Gastroenterology and Hepatology,
Rotterdam, The Netherlands, 5Amsterdam University Medical Centre,
Department of Gastroenterology and Hepatology, Amsterdam, The
Netherlands, 6Gelre Hospital, Department of Gastroenterology and
Hepatology, Apeldoorn, The Netherlands, 7Tergooi Medical Centre,
Department of Gastroenterology and Hepatology, Hilversum, The
Netherlands, 8Diakonessenhuis, Department of Gastroenterology
and Hepatology, Utrecht, The Netherlands, 9St. Antonius Hospital,
Department of Gastroenterology and Hepatology, Nieuwegein,
The Netherlands, 10Elisabeth-TweeSteden Hospital, Department of
Gastroenterology and Hepatology, Tilburg, The Netherlands, 11Rijnstate
Hospital, Department of Gastroenterology and Hepatology, Arnhem, The
Netherlands, 12Jeroen Bosch Hospital, Department of Gastroenterology
and Hepatology, ‘s-Hertogenbosch, The Netherlands, 13Medical Centre
de Veluwe, Department of Gastroenterology and Hepatology, Apeldoorn,
The Netherlands, 14Onze Lieve Vrouwe Gasthuis OLVG, Department
of Gastroenterology and Hepatology, Amsterdam, The Netherlands,
15
University of Alberta, Division of Gastroenterology- Department of