(1) Background: Sarcopenia has a high incidence in Crohn’s disease (CD) with considerable heterogeneity among ethnicities and variable impact on clinical outcomes. Aim: to assess the impact of sarcopenia on clinical outcomes in a cohort of Caucasian patients with active CD undergoing CT-enterography (CTE) for clinical assessment. We further investigated the prevalence of sarcopenia and its predictors. (2) Methods: Caucasian CD patients with moderate–severe clinical activity, who underwent CTE in an emergency setting, were retrospectively recruited. The skeletal muscle index (SMI) at the third lumbar vertebra was used to detect sarcopenia in the early stages. Clinical malnutrition was defined according to global clinical nutrition criteria. Clinical outcomes included the rate of surgery and infections within one year. (3) Results: A total of 63 CD patients (34 M; aged 44 ± 17 years) were recruited, and 48 patients (68.3%) were sarcopenic. Malnutrition occurred in 28 patients (44.4%) with a significant correlation between body mass index (BMI) and sarcopenia (r = 0.5, p < 0.001). The overall rate of surgery was 33%, without a significant difference between sarcopenic and non-sarcopenic (p = 0.41). The rate of infection in patients with sarcopenia was significantly higher than in non-sarcopenic (42%vs15%, p = 0.03). BMI (OR 0.73,95%, CI 0.57–0.93) and extraintestinal manifestations (EIM) (OR 19.2 95%, CI 1.05–349.1) were predictive of sarcopenia (p < 0.05). (4) Conclusions: Sarcopenia was associated with an increased rate of infections, and it was observed in 68.3% of the Caucasian cohort with active CD.

Inflammatory bowel disease (IBD) can extend beyond the gastrointestinal tract, affecting extraintestinal organs and significantly increasing morbidity and mortality. Despite early studies revealing kidney involvement in nearly a quarter of patients with IBD, renal manifestations have been notably overlooked. Among these manifestations, nephrolithiasis, obstructive uropathy, and fistula formation between the bowel and urinary tract are the most reported occurrences. Additionally, renal parenchymal involvement in IBD, including glomerulonephritis (GN), tubulointerstitial nephritis, and amyloidosis, has been documented. GN is particularly noteworthy, as a significant proportion of patients progress to end-stage kidney disease (ESKD). Although GN has long been recognized as a potential extraintestinal manifestation (EIM) of IBD, it has often been dismissed as an anecdotal association. Recently, several studies highlighted the clinical correlation between GN and IBD, suggesting a pathogenic interplay involving gut inflammation, dysbiosis, and intrinsic glomerular processes. Thus, our objective is to elucidate the basis of IBD-related nephropathies, with a specific focus on IgA nephropathy (IgAN) and the gut–kidney axis.

Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis, and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation, and maturation of the progenitor cells, and reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies that affect the gastrointestinal tract. The onset of both diseases may be at a young age (even during childhood or adolescence), and clinical manifestations may lead to misdiagnosis, due to similar characteristics such as recurrent infections, oral ulcers, perianal abscesses, and infertility. Moreover, the two pathologies are rarely associated, with different management and therapeutic options. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, due to persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia, and G-CSF therapy was started with benefits, underlining the crucial importance of proper differential diagnosis.

Introduction: Sarcopenia is a common and clinically relevant complication of Crohn’s disease (CD), reflecting the cross-link among chronic inflammation, malnutrition, and metabolic dysregulation. Adiponectin, an anti-inflammatory adipokine, and phase angle, a marker of cellular integrity, have emerged as potential indicators of muscle health. This study aimed to evaluate the role of anthropometric and inflammation parameters in 150 CD patients. Methods: Anthropometric and bioimpedance parameters including handgrip strength and PhA were collected to define sarcopenia according to EWGSOP2. Additionally, the levels of adiponectin and inflammatory cytokines (IL-6, IL-1β, TNF- α , CRP) were tested by ELISA. Adiponectin oligomeric status was assessed by Western Blotting. Results: Sarcopenia was identified in 8% and pre-sarcopenia in 71% of patients. Interestingly, sarcopenic and pre-sarcopenic patients were significantly younger and had lower BMI, fat-free mass, and skeletal mass compared to non-sarcopenic individuals ( p < 0.05). Phase angle values were also statistically lower in sarcopenic subjects (5.06 ± 0.67°). Adiponectin levels were significantly reduced in sarcopenic (14.0 ± 5.2 μg/mL) compared to pre-sarcopenic and non-sarcopenic patients (20.1 ± 4.5, 20.2 ± 3.6 μg/mL, respectively p < 0.05). The ROC analysis identified both adiponectin and PhA as accurate predictors of sarcopenia risk in CD. Analysis of adiponectin oligomers evidenced a significant down regulation of HMW and MMW isoforms in sarcopenic vs. pre-sarcopenic and non-sarcopenic patients. Discussion: Our findings support the pivotal role of metabolic and nutritional disorders in muscle loss in CD patients and indicate adiponectin and phase angle as complementary biomarkers of sarcopenia. Furthermore, our results, highlight the interplay among inflammation, adipose tissue dysfunction, and muscle wasting in Crohn’s disease.

Background and aims: An increased risk of acute pancreatitis (AP) has been reported in patients with inflammatory bowel disease (IBD), but data on its prevalence, etiology, and outcomes are limited. Materials and Methods: A two-step retrospective analysis spanning 10 years (2011–2020) was conducted across 34 European centers. The first step surveyed the prevalence of AP in patients with IBD, while the second gathered data on disease characteristics, etiology, and outcomes. Results: The survey found an expected AP prevalence of 1.13% (780/68,989), though only 0.58% (n = 398) met the inclusion criteria. The mean age was 33.6 ± 14.3; 52% were female, and 56.5% had Crohn’s disease (CD). AP was clinically mild in most cases (86.9%). Among 347 patients with available imaging, no alterations were observed in 81 (23.3%), whereas edematous AP was observed in 218 (62.8%). Drugs (mainly azathioprine) were the leading cause (55.3%), followed by biliary (14.8%) and autoimmune (7.8%) causes. In 13.5% of patients, AP was considered idiopathic. During a median follow-up of 67 months [IQR 34–96] from the index episode, recurrence was observed in 13% of patients, and 1.5% developed chronic pancreatitis. CD patients exhibited distinct risk profiles, including ileal involvement and smoking, whereas ulcerative colitis (UC) patients showed more frequent autoimmune and idiopathic etiologies. Conclusions: The PANDORA study established a 0.58% prevalence of AP in IBD patients, which was lower than expected. AP is usually mild both clinically and radiologically. An ileal location in CD and extensive colitis in UC are usually reported, and azathioprine seems to be the most common cause of AP in this setting, especially a few weeks after its introduction.

Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation and maturation of the progenitor cells, reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies with involvement of the gastrointestinal tract. Symptoms include diarrhea, abdominal pain, fever, weight loss and extraintestinal manifestations (EIMs). In recent years, the focus of IBD therapy, including conventional therapies and biological therapies, has moved from treatment of symptoms to "deep remission" of the disease. The association between cyclic neutropenia and CD is rarely reported in the literature. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, because of persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia and therapy with G-CSF was started with benefits, underlining the crucial importance of proper differential diagnosis.