P2568 - Systematic Review: Exploring the Potential of Metformin in Inflammatory Bowel Diseases

Harshal Prakash Chorya, MBBS¹, Sanjana Devaragudi, MBBS², Aishwar Dixit, MBBS³, Kalyani Chowdary, MBBS⁴, Sweta Sahu, MBBS^5
1Baroda Medical College, Vadodara, Gujarat, India; ²Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India; ³Baba Raghav Das Medical College, Lucknow, Uttar Pradesh, India; ⁴Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India; ⁵JJM Medical College, Devanagere, Karnataka, India

Introduction: This systematic review illuminates the multifaceted potential of metformin as a therapeutic intervention for Inflammatory Bowel Disease. Metformin’s anti-inflammatory effects are manifested through a variety of mechanisms, encompassing the inhibition of NF-κB activation, modulation of the AMPK pathway, adjustment of Th17/Treg balance, and suppression of pro-inflammatory cytokines. These multifaceted actions collectively contribute to its capacity to alleviate disease activity.

Methods: Four databases, Medline, PubMed, PMC, and Google Scholar, were used to conduct a schematic literature search for studies from inception up to March 19, 2023. We scrutinized these databases and identified 17 studies. We employed SYRCLE and ROBINS-I risk of bias tools. The outcomes examined included the impact of Metformin on disease activity, colon length, body weight, histological features and inflammatory markers.

Results: The Disease Activity Index (DAI) serves as a methodological tool for quantifying symptoms in individuals diagnosed with IBD. This composite measure includes scores for weight loss, stool consistency, and hematochezia. Remarkably, all the 10 studies that reported DAI scores showed a reduction in these scores following metformin administration (100%). In 12 studies in which mean colon length was assessed, prevention of shortening of colon length was observed following metformin administration in 6 out of 9 studies (66.7%). 2 studies observed increased colon length (22.2%) by metformin administration and 3 studies in which the colon weight / length ratio was observed, 100% showed a reduced ratio following the intervention. Body weight was assessed in 9 studies, in which 7 showed improvement in body weight reduction (77.8%). The histological features of IBD include immune cell infiltration, epithelial changes, submucosal changes, crypt abscesses, Paneth cell changes, and basement membrane changes that aid in the disease diagnosis. Out of the 15 studies that provided histological evaluation, 9 (60%) had lower histology scores compared to the control group. Pro-inflammatory cytokines were reported in 14 studies. Data suggested that TNF α was reduced in 100% studies it was reported in. Similarly, IL-6 (100%) , TGF-β 1 (33.3%) , MDA (100%), MPO (80%) , NF-Kβ(100%) , Caspase-3 (100%) , IL-17 (100%), IL-1 β (100%), IL-18 (100%) and Caspase-1 (100%).

Discussion: The evidence underscores Metformin’s anti-inflammatory properties through the various pathways and mechanisms in Table 1.0.



Disclosures:


Harshal Prakash Chorya, MBBS¹, Sanjana Devaragudi, MBBS², Aishwar Dixit, MBBS³, Kalyani Chowdary, MBBS⁴, Sweta Sahu, MBBS⁵. P2568 - Systematic Review: Exploring the Potential of Metformin in Inflammatory Bowel Diseases, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.