P046 Starch consumption is associated with serologic responses in patients with ulcerative colitis and an ileo-anal pouch

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Background: Serologic markers are associated with complicated Crohn's disease (CD). Ulcerative colitis (UC) patients after proctocolectomy with ileo-anal anastomosis (pouch surgery) often develop de-novo small intestinal inflammation (pouchitis). Serologic responses against sugar moieties (glycans) in pouch patients have similarities with those observed in CD. We hypothesized that serologic responses may reflect consumption of dietary sugars, specifically starch.

Our aim was to correlate anti-glycan serologic responses and dietary sugars and starch consumption in UC patients with a pouch, and its evolution over time.

Methods: UC pouch patients were recruited and serum was evaluated for the presence of the anti-glycan antibodies anti-chytobioside (ACCA), anti-laminaribioside (ALCA), anti-mannobioside (AMCA) antibodies, and anti-Saccharomyces cerevisiae (ASCA) using ELISA. Food-frequency questionnaires (FFQ) were filled. Correlation between dietary sugars and starch consumption and anti-glycan serologic responses was assessed.

Results: Seventy five pouch patients were recruited: 38 (50.7%) women, average age 45.2±14 and pouch age 9.8±6.7 years. The rate of seropositivity against any anti-glycan was 26 patients (34.7%) of which 11 (14.7%), 8 (10.7%), 13 (17.3%) and 2 (2.7%) patients were positive for ACCA, ALCA, AMCA and ASCA, respectively. In a multivariate analysis, higher starch consumption was associated with higher titers of AMCA and ACCA antibodies, with an increase of 4.08% {(0.8–7.4), p=0.014} and 4.8% {(0.7–9.1), p=0.007} for each 10 grams of dietary starch, respectively. In a subgroup analysis of 21 patients with longitudinal follow-up of 9.1±5 months, AMCA and ACCA increased in correlation with starch consumption, with an increase of 6% {(1.2–11.2), p=0.015} and 6.2% {(1.8–10.8), p=0.006} for each 10 grams increase of dietary starch. ASCA or ALCA levels did not correlate with starch consumption.

Conclusions: Starch consumption is associated with increased serologic responses against glycans, specifically ACCA and AMCA. This may suggest that an increased intake of dietary polysaccharides may trigger a specific immune response in patients with IBD. Further dietary modification is being evaluated.

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