Inflammatory bowel disease (IBD) pathogenesis is thought to be induced by a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Severe acute respiratory syndrome coronavirus 2 (SARS-nCoV2) may have increased capacity to generate autoimmune disease as evidenced by known spikes in diseases such as type 1 diabetes mellitus. Public health interventions like masking and closures additionally created remarkable drops in typical viral infections, with remarkable shifts in influenza-like illness reporting in 2020. This study aims to evaluate the impact of SARS-nCoV2 and associated interventions on pediatric IBD presentation in New York City using records of new diagnoses at a consortium of 4 institutions between 2016 and June 2022. We fit time series model (autoregressive integrated moving average model) to monthly and quarterly number of cases of each disease for January 2016–March 2020 and forecast the period between April 2020 and June 2022. We note no decrease in ulcerative colitis (UC) or Crohn disease (CD) in the aftermath of historic low levels of overall viral illness, and statistically significant increases in CD diagnoses and elevation in UC diagnoses creating a trend suggesting overall increase in IBD diagnoses exceeding the baseline rate of increase. These data suggest a possible linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation.

SARS-nCoV2 may have increased capacity to generate autoimmune disease; multiple reports suggest increased risk of Type 1 Diabetes, and case reports suggest other autoimmune linkages. Inflammatory Bowel Disease (IBD) pathogenesis appears to be a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Given the perceived role of infection in pathogenesis, decreased incidence of all infections during the pandemic secondary to non-pharmaceutical interventions should decrease IBD incidence rates. The aim of this study was to evaluate the association between the Covid-19 pandemic and IBD presentation in NYC using data from new diagnoses at a consortium of institutions. Using EMR systems all diagnoses at 4 collaborating institutions were retrieved from 2015-2021. We fit time series model (ARIMA) to the quarterly number of cases of each disease for January 2016-March 2020 and forecast the subsequent 21 months. We not only did not observe a decline in pediatric IBD secondary to absent viral illness, but noted a statistically significant increase in Crohn's Disease approximately 6 months after the initial 2020 COVID wave in NYC, and trends suggesting increases overall in IBD diagnoses above the existing trend towards increased disease presentation that pre-dated the pandemic. This data suggests that there may be a linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation, warranting further evaluation in the aftermath of the Omicron wave.

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IntroductionIrritable bowel syndrome (IBS) is characterized by abdominal pain and changes in bowel habits. FODMAPs are poorly absorbed short-chain carbohydrates that may drive commensal microbial gas production, promoting abdominal pain in IBS. Low-FODMAP diet can result in symptomatic improvement in 50-80% of IBS patients. However, this diet is not meant to be sustained long term, with concern for downstream nutrition and microbial issues. In this study, we evaluate the function of a targeted FODMAP enzymatic digestion food supplement FODZYME® containing an inulinase enzyme in a simulated gastrointestinal environment.MethodsUsing SHIME®, a multi-compartment simulator of the human gut, FODZYME® dose finding assay in modeled gastrointestinal conditions assessed enzymatic ability to hydrolyze 3 g of inulin. Full intestinal modeling assessing digestion of inulin, absorption of fructose, gas production and other measures of commensal microbial behavior was completed using 1.125 g of FODZYME®.ResultsAfter 30 minutes, 90% of the inulin was converted to fructose by 1.125 g of FODZYME®. Doubling dosage showed no significant improvement in conversion, whereas a half dose decreased performance to 77.2%. 70% of released fructose was absorbed during simulated small intestinal transit, with a corresponding decrease in microbial gas production, and a small decrease in butyrate and short chain fatty acid (SCFA) production.DiscussionFODZYME® specifically breaks down inulin in representative gastrointestinal conditions, resulting in decreased gas production while substantially preserving SCFA and butyrate production in the model colon. Our results suggest dietary supplementation with FODZYME® would decrease intestinal FODMAP burden and gas production.Study HighlightsWhat is KnownIBS and related gastrointestinal diseases impact over 10% of the populationThe low-FODMAP diet has a high efficacy in managing symptoms in patients with IBS.Long term use of the low-FODMAP diet may have health consequences and is challenging to maintainWhat is NewThe targeted inulinase in food supplement FODZYME® effectively digests fructans (inulin) in a high-fidelity simulated gastrointestinal environmentAddition of FODZYME® decreased gas production with only a small impact on short chain fatty acid production in the simulated colon.