bluuebunny/crossref_metadata_2025 huggingface dataset:
P110 Identification of the tryptophan metabolite 3-hydroxyanthranilic acid as a novel tool for the differentiation of Crohn’s disease phenotypes
Authors: Huhn M , Herrero San Juan M , Melcher B , Dreis C , Schmidt K , Pfeilschifter J M , Vieth M , Stein J , Radeke H H
Published: January 2020

Background

The widely varying therapeutic response of patients with inflammatory bowel disease (IBD) continues to raise question regarding the unclarified heterogeneity of disease pathomechanisms. While biomarkers for the differentiation of Crohn’s disease (CD) vs. ulcerative colitis (UC) have been suggested, specific markers for a subclassification of CD phenotypes are still rare. Since an altered signature of the tryptophan metabolism is associated with chronic inflammatory disease, we sought to characterise potential biomarkers focusing on the downstream metabolites of kynurenine metabolism. The widely varying therapeutic response of patients with inflammatory bowel disease (IBD) continues to raise question regarding the unclarified heterogeneity of disease pathomechanisms. While biomarkers for the differentiation of Crohn’s disease (CD) vs. ulcerative colitis (UC) have been suggested, specific markers for a subclassification of CD phenotypes are still rare. Since an altered signature of the tryptophan metabolism is associated with chronic inflammatory disease, we sought to characterise potential biomarkers focusing on the downstream metabolites of kynurenine metabolism.

Methods

Using immunohistochemical staining, we analysed and compared the mucosal tryptophan immune metabolism in biotic samples from patients with UC (n = 11), CD (n = 11) and healthy control (n = 12). Localisation-specific quantification of immune cell infiltration, tryptophan-metabolizing enzyme expression and mucosal tryptophan downstream metabolite levels was performed.

Results

As expected, we found generally increased immune cell infiltrates in the tissue of all patients with IBD. However, in patients with CD, significant differences were found between regulatory T-cell markers in the ileum compared with the colon. In line with this finding, we identified kynureninase as a modulator of immunosuppressive kynurenine levels specifically in the ileum of patients with CD. Correspondingly, significantly elevated levels of the kynurenine metabolite 3-hydroxyanthranilic acid were detected in CD ileum samples.

Conclusion

Highlighting the heterogeneity of the different phenotypes of CD, we identified 3-hydroxyanthranilic acid as a potential mucosal biomarker allowing the localisation-specific differentiation of ileum or colon inflammation in patients with CD. Moreover, we characterised the kynurenine-degrading enzyme kynureninase as a modulator of immunosuppression and chronic inflammation with potential therapeutic relevance.
P122 High correlation between faecal calprotectin and a Novel Integral Index for evaluating disease activity in ulcerative colitis patients
Authors: Yamamoto-Furusho J K , Mendieta-Escalante E A
Published: January 2020

Background

Ulcerative colitis (UC) is a chronic and incurable disease characterised by periods of activity and remission. There are several indexes that evaluate the UC activity from clinical, biochemical and endoscopic parameters. The faecal calprotectin is a non-invasive marker for detecting intestinal inflammation in UC patients. A new novel integral disease index (Yamamoto-Furusho index) includes clinical, biochemical, endoscopic and histological findings that evaluate the full spectrum of activity in UC patients. The aim is to correlate the Novel Index Activity index (Yamamoto-Furusho Index) with faecal calprotectin levels in UC patients and compare with other indexes.

Methods

A total of 158 patients with confirmed diagnosis of UC from the IBD Clinic were recruited in the period between July 2017 and June 2019. All demographic and clinical characteristics were collected from clinical charts. The faecal calprotectin was measured at least 1 week before the colonoscopy and biopsies. The Spearman’s Rho was used for the correlation. A p-value of <0.05 was considered as significant.

Results

We analysed 185 patients with UC, 85 patients (51.8%) were women and 73 (44.5%) men, with an average current age of 43.53 years (+14.35), an age at diagnosis of 36.6 + 15.1 years and disease duration of 11.27 ± 8.1 years. The extension was distributed on proctitis (E1) in 13.3%, left colitis (E2) in 19.6% and pancolitis (E3) in 31.6%. The treatment was based on mesalazine in 93.9%, steroids in 26.2% and azathioprine in 15.9%. The correlation between faecal calprotectin and the Yamamoto–Furusho index was high (rho = 0.730, p < 0.0001) compared with other indexes such as endoscopic Mayo sub-score (rho = 0.705, p = <0.001); Truelove–Witts (rho = 0.644, p = <0.001), Full Mayo score (rho = 0.708, p = <0.001) and Montreal (rho = 0.551, p = <0.001).

Conclusion

The novel integral index showed a high correlation with faecal calprotectin compared with other UC indexes for evaluating disease activity in UC patients.
P123 Sarcopenia is a predictor for severe disease course in paediatric inflammatory bowel disease
Authors: Atlan L , Pratt L T , Cohen S , Shiran S , Yerushalmy-feler A
Published: January 2020

Background

Inflammatory bowel disease (IBD) is a chronic immune-mediated disease with high impact on nutritional status. Sarcopenia was related to higher risk of intestinal resection and rescue therapy in adult IBD patients; however, data in paediatric population is missing. The aim of this study was to evaluate muscle mass as a predictor of disease outcome in paediatric IBD.

Methods

All paediatric IBD patients that underwent a magnetic resonance enterography (MRE) study for disease assessment at the Tel Aviv Sourasky Medical Center in 2008–2019 were retrospectively included. Muscle mass was assessed by measuring the area of the psoas muscle at the upper level of L3 on MRE by a freehand region of interest (ROI). Psoas index was defined as the average psoas area divided by body surface area, and then was divided into quartiles. Disease location and radiological signs of IBD were documented. Clinical data including disease activity and course, medications, exacerbations and laboratory results were documented.

Results

We included 101 patients, 69 (68.3%) Crohn’s disease patients and 32 (31.7%) ulcerative colitis patients. The mean age was 13.05 ± 3.48 years at diagnosis and 15.03 ± 3.27 years at MRE. The psoas index was significantly lower in patients with presence of fatty proliferation (p = 0.021), comb sign (p = 0.001) and extensive disease in MRE (p = 0.012) and in radiologic evidence of disease complications such as abscess or fistula (p = 0.027). In a univariate analysis, patients with psoas index in the lower quartile had significantly higher risk of need for biologic therapy during follow-up (HR = 35.1, p < 0.001; Figure 1) and higher risk of disease exacerbation (HR = 25.1, p < 0.001; Figure 2) compared with patients with psoas index in the upper quartile. In a multivariate analysis adjusted for age, gender, disease type, haemoglobin, C-reactive protein, albumin, disease activity and interval from diagnosis to MRE, patients with psoas index in the lower quartile had significantly higher risk of need for biologic therapy (HR = 12.1, p = 0.046) and of disease exacerbation (HR = 9, p = 0.047) compared with patients with psoas index in the upper quartile.

Conclusion

Sarcopenia correlates with the radiological severity of IBD and was found to be an independent predictor for severe clinical disease course. Muscle mass in MRE studies may be used as a possible marker for disease outcome in paediatric IBD.
P129 Value of diffusion-weighted magnetic resonance enterocolonography for assessing Crohn’s disease activity
Authors: Straksyte V , Kiudelis G , Kupcinskas L , Zaboriene I
Published: January 2020

Background

We aimed to determine diffusion-weighted imaging (DWI) value to predict active Crohn’s disease (CD) and compare apparent diffusion coefficients (ADC) with endoscopic and conventional magnetic resonance imaging (MRI) CD activity indices.

Methods

Overall, 229 patients with suspected CD prospectively underwent magnetic resonance enterocolonography (MR-EC) with DWI sequence and ileocolonoscopy. Magnetic resonance activity index (MaRIA), Clermont index, and CD endoscopic index of severity (CDEIS) were calculated.

Results

Out of 229 investigated patients, the clinical diagnosis of CD was confirmed in 100 persons. Using receiver operating characteristic curve, we showed that DWI score ≥2 had 96.9% sensitivity and 82.3% specificity for diagnosing CD. A threshold of ADC value of 1.30×10–3mm2/s can distinguish between normal and inflamed bowel segments with a sensitivity of 73.8% and a specificity of 98% using Copenhagen diagnostic criteria as the reference standard. While using MaRIA, the threshold of ADC value was established of 1.32 × 10–3 mm2/s with sensitivity and specificity (97.9%, 97.8%). ADC correlated with MaRIA-G (global) (r = -0.69, p = 0.001), Clermont-G (r = -0.722, p = 0.001) and CDEIS (r = -0.69, p = 0.001).

Conclusion

DWI is a valuable tool which is able to identify inflamed bowel segments as accurate as conventional MARIA score and to discriminate between mild and moderate and severe CD activity.
P133 Pregnancy in inflammatory bowel disease: experience of a Chilean cohort
Authors: Núñez P , Sepúlveda E , Simian D , Figueroa C , Flores L , Ibáñez P , Kronberg U , Lubascher J , Pizarro G , Quera R
Published: January 2020

Background

In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during their reproductive age. IBD in remission is the ideal scenario when planning a pregnancy. Here, we describe the demographic, clinical and pregnancy/childbirth characteristics in patients with IBD treated at a tertiary centre in Chile between 2017 and 2019.

Methods

Observational, analytic study. We retrospectively reviewed women diagnosed with IBD who were pregnant or delivered during the study period. Demographic, clinical, obstetric and delivery data were obtained from the IBD registry, approved by the local IRB. Descriptive statistics and association tests performed (χ2, p < 0.05).

Results

Forty-six women with IBD were included (Tables 1). At the beginning of pregnancy, 19 (41%) had active disease and 27 (59%) were in remission. Of those with active disease, 8 (79%) remained active and six had spontaneous abortions. In those who were in remission, 20 (74%) remained in this condition. Six patients (13%) discontinued treatment (four based on external medical advice, two on her own). Preconception counselling was performed in 16/40, group with a higher percentage of remission during pregnancy (69% vs. 25%, p = 0.006). Pregnancy outcomes by disease activity are presented in Figure 1. Patients who had a flare during pregnancy had newborn with lower weight compare with the group that always remained in remission (2,945 vs. 3,323 g; p = 0.007).

Conclusion

In this cohort, we observed that pregnancy during remission presents better outcomes and that preconception counselling would allow a better IBD control during pregnancy.
P134 Patient empowerment in inflammatory bowel disease (IBD): early education at a new diagnosis IBD clinic (NDC)
Authors: Fenech V A , Kamperidis N , Tyrrell T , Dyall L , Fofaria R , Misra R , Barber S , Randall S , Shah J , Arebi N
Published: January 2020

Background

IBD is a chronic condition that affects young and older people. Co-existing diseases are common. Patient-centred care includes education and support to empower patients and is a recognised dimension of high-quality care. Patient empowerment with knowledge, skills and confidence (‘patient activation’) is associated with better outcomes in many chronic diseases. We aimed to measure patient activation in recently diagnosed IBD patients and to identify factors associated with levels of activation.

Methods

A NDC was set up at St Mark’s Hospital to offer patients education, information resources and signposts to verified information sources. Patient activation was measured using the Patient Activation Measure (PAM®) tool (Insignia Health) before and after the first consultation. PAM® is a validated questionnaire with 13 questions to generate an activation score ranging from 1 to 4. Non-activation was defined as PAM levels 1 and 2. Demographic (age in years (SD)), disease specific characteristics and anxiety (Generalised Anxiety Disorder Scale, GAD-2) and depression [Patient Health Questionnaire (PHQ-2)] data were collated at the first visit. The National Statistics Socio-economic classification (NS-SEC) was used to classify socio-economic status (SES). Categorical variables were analysed with chi-square test and numerical variables with Student’s t-test.

Results

Twenty-nine patients (51.7% male) attended NDC (ulcerative colitis = 15, Crohn’s disease = 10, unclassified IBD = 4). 28 completed PAM questionnaires. Mean age was 43.2 ( ± 16.4). 5/28 had a family history of IBD, 6/28 were smokers, 11/28 had another chronic condition, and 16/28 were of non-White ethnic background. Sixty-nine% had active disease. SES and psychological scores were available for 14/28 and 16/28 patients, respectively. Fifty per cent (14/28) of patients were non-activated before NDC; 57.1% (8/14) showed an improvement in activation after NDC. Mean age for activated and non-activated patients was 40.6 ( ± 19.0) and 46.6 ( ± 13.9), respectively (p = 0.35). There was no association between gender, family history, smoking, co-morbidity, ethnic background and SES with activation. None of the four patients (4/16) who scored for anxiety or depression were activated compared with 50% (6/12) of non-anxious/depressed patients (p = 0.07). No patients (0/7) in intermediate or higher SES were activated compared with 43% (3/7) of lower SES (p = 0.05).

Conclusion

Most non-activated patients had improved activation after attending NDC. Anxiety and depression may contribute to non-activation. Early assessment of patient activation may guide healthcare providers to offer individualised support. Further studies to evaluate the sustainability of patient activation and its effect on clinical outcomes are ongoing.
P140 Factors associated with development of NAFLD in patients with inflammatory bowel disease: a 5-year retrospective study on 225 patients
Authors: Domislović V , Knežević-Štromar I , Premužić M , Brinar M , Vranešić Bender D , Milinković A , Matašin M , Mikolašević I , Krznarić Ž
Published: January 2020

Background

Patients with IBD are at higher risk for non-alcoholic fatty liver disease (NAFLD) comparing to general population. Complex pathogenesis of NAFLD in IBD may be related to disease-specific risk factors such as chronic inflammation, steroid exposure, drug induced hepatotoxicity, malnutrition and alteration of gut microbiota, which is emerging as a major factor in the pathogenesis of NAFLD. The goal of the study was to investigate factors associated with NADLF and advanced liver fibrosis (ALF) in patients with CD and UC.

Methods

This is a retrospective study on IBD patients without extraintestinal manifestations and known liver disease. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36, and ALF was defined as FIB-4 ≥ 2.67. Predictors of NAFLD development were analysed using Kaplan–Meier and Cox regression analyses.

Results

In this retrospective study, we have included 225 IBD patients; 72.4% (n = 163) patients with CD and 27.6% (n = 62) patients with UC (median age 41.2 yr, 53.7% males) which were observed for a median of 4.6 years. There were 63.1% (n = 142) patients with normal BMI, 27.6% (n = 62) overweight and 9.3% (n = 21) obese patients. Obese patients had the highest HIS score 43.9 ± 5.9, following with overweight 37.8 ± 5.7 and normal BMI 30 ± 4.3 kg/m2, p < 0.001. During the follow-up obese and overweight patients had higher risk of developing NAFLD comparing to patients with normal BMI (obese HR = 11.1 95% CI 4.3–28.3 and overweight HR = 5.55 95% CI 3.4–9.1, Logrank test p < 0.001) (Figure 1). Regarding FIB-4 score there, was no difference among different BMI categories (p = 0.192), and there was no difference in ALF development in the follow-up period (Logrank test p = 0.91). In Cox proportional-hazards regression significant predictors for NAFLD development were dyslipidaemia HR=2.11, 95% CI 1.2–3.7, overweight HR=6 95% CI 3.6–10, and obesity HR=13.4, 95% CI 7–35.

Conclusion

NAFLD is frequent comorbidity in patients with CD and UC, which can lead to development of advanced liver fibrosis. Our results show that patients with IBD have a high risk of NAFLD development, whereas the increased risk for ALF was not observed. Overweight and obese patients and those with dyslipidemia should be closer monitored due to significantly higher risk of NAFLD. This study points out the complexity disease-specific risk factors and importance of better stratifying IBD patients at risk of NAFLD and advanced liver fibrosis.
P148 Reproducibility of PICaSSO score by using narrow banding images (NBI) to assess mucosal and histological healing in ulcerative colitis (UC) patients
Authors: Cannatelli R , Nardone O , Shivaji U , Smith S C L , Bazarova A , Zardo D , Ghosh S , Iacucci M
Published: January 2020

Background

The endoscopic and histological healing are key therapeutic targets in ulcerative colitis(UC) patients. PICaSSO (Paddington International virtual ChromoendoScopy ScOre)1,2 is a new Virtual Chromoendoscopy Endoscopic (VCE) score to better define mucosal healing by mucosal and vascular features. Originally validated using iSCAN platform, the aim of this study was to evaluate the reproducibility of PICaSSO with NBI near focus platform and to assess if this could predict histological healing.

Methods

We prospectively studied 78 UC patients (mean age 43.4 years, 52.6% male) who underwent colonoscopy for colitis assessment or surveillance using NBI near focus (Olympus, Japan). Endoscopic activity was assessed by using ulcerative colitis Endoscopic Index of Severity (UCEIS) and PICaSSO; whilst histological activity was scored by the Robarts Histology Index (RHI). ROC curves were performed to evaluate sensitivity, specificity and accuracy of endoscopy scores to predict histological healing.

Results

Out of 78 patients, 47 (60.3%) were in clinical remission according to the partial Mayo score. 28(35.9%) and 32(41.0%) were in endoscopic remission according to UCEIS≤1 and PICaSSO≤3, respectively. The best cut-off of UCEIS to predict histological healing was less or equal to 1. Sensitivity, specificity and accuracy were 84.6% (95% CI 63.5, 96.4), 88.5% (95% CI 70.1, 97.8) and 87.2% (95% CI 75.6, 93.6), respectively. The Area Under the ROC curve (AUROC) was 93.3% (95% CI 88.2, 98.3). The best threshold of PICaSSO in the prediction of histological healing was less or equal to 3. PICaSSO ≤ 3 have sensitivity of 96.2% (95% CI 76.9, 100), specificity of 86.5% (95% CI 67.3, 96.2) and accuracy of 89.7% (95% CI 77.6, 96.2) to predict histological healing, estimated as RHI ≤ 3. The AUROC was 95.3% (95% CI 91.1, 99.5).

Conclusion

PICaSSO VCE score can be easily and accurately reproduced with NBI near focus platform and it has better operating characteristics than UCEIS to predict histological healing defined by RHI.

Reference
P155 Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases
Authors: Amihai R , Mishael T , Grisaru-Granovski S , Koslowsky B , Abitbol G , Goldin E , Bar-Gil Shitrit A
Published: January 2020

Background

Inflammatory bowel diseases (IBDs) are commonly diagnosed in reproductive-aged women and can substantially affect pregnancy outcomes. Non-invasive monitoring of IBD during the prenatal course is particularly challenging as traditional laboratory biomarkers are often affected by pregnancy-related physiologic changes. We aimed to evaluate the role of fecal calprotectin (FC) in monitoring disease activity and predicting relapse among IBD women throughout gestation.

Methods

Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2014–2018. FC levels were determined with an enzyme-linked immunoassay.

Results

A total of 265 FC (preconception, n = 41; first trimester, n = 48; second trimester, n = 84; third trimester, n = 76; postpartum, n = 16) measurements were obtained in 157 pregnancies. Higher FC concentrations were found in all time points in those with active disease than those in remission as assessed by either physician global assessment or disease clinical scores. FC levels were significantly correlated with physician global assessment and disease activity indices in all 5 periods of investigation. Excluding those with disease flare at the time of conception, disease relapse was encountered during the prenatal course in 40 (31.5%) of the remaining 127 pregnancies. FC levels were significantly higher in those who experienced a disease flare later in the course of gestation as compared with those who maintained clinical remission (median 341 vs. 224 μg/g, p = 0.04).

Conclusion

FC appears to be a reliable marker of ongoing disease activity throughout the prenatal course as well as a predictor of imminent disease flare among IBD pregnant patients.
P159 Histopathological findings of preclinical inflammatory bowel disease
Authors: Rodríguez-Lago I , Merino O , Azagra I , Maiz A , Zapata E , Higuera R , Montalvo I , Fernández-Calderón M , Arreba P , Carrascosa J , Iriarte A , Muñoz-Navas M , Cabriada J L , Barreiro-de Acosta M
Published: January 2020

Background

The diagnosis of inflammatory bowel disease (IBD) is usually established after the development of symptoms, but preclinical disease may be present years before the final diagnosis. Recently, histology has become one of the main outcomes of IBD treatment. The primary aim of our study was to define the main histological findings of preclinical IBD and its association with the natural history of the disease.

Methods

This multicentric, retrospective study included all patients who participated in the colorectal cancer screening programme in 11 centres between 2009–2014. All patients were firstly assessed by a faecal immunochemical test (OC-Sensor, Eiken Chemical Co., Tokyo, Japan) and, if this test was positive (cut-off 20 μg Hgb/g), a colonoscopy was performed. All patients had an incidental diagnosis of IBD confirmed by histology, according to current ECCO criteria, during a screening colonoscopy. Three histologic findings were evaluated at diagnosis: presence of granuloma, crypt abscesses and/or eosinophilic infiltrate. The main outcomes were the development of symptoms and the risk of proximal disease extension. The frequency of each finding was described separately by IBD subtype and the chi-square test was used to describe possible association with the main outcomes.

Results

During this period we performed 31,005 colonoscopies after 498,227 FIT. Finally, 110 patients were included with an incidental diagnosis of ulcerative colitis (UC, 79 cases), Crohn’s disease (CD, 24 cases) or IBD-Unclassified (IBD-U, 7 cases). Crypt abscesses were present in 56%, 33% and 57% of UC, CD and IBD-U patients, respectively (Figure 1). An eosinophilic infiltrate was observed in 27%, 25% and 57% of patients, respectively. Granuloma were only observed in 4% of CD patients. There were no statistically significant differences in these findings according to IBD subtype (p = 0.14, 0.22 and 0.17 for crypt abscesses, eosinophilic infiltrate and granuloma, respectively). After a median follow-up of 25 months (IQR, 11–42), 36% of patients developed symptomatic disease. Neither of the histological findings were associated with a higher risk of developing symptomatic disease (p = 0.29, 0.78 and 0.3, respectively). No patient showed proximal extension of UC.

Conclusion

Preclinical IBD is frequently associated with the presence of crypt abscesses, especially in UC. Granuloma is probably a late finding in CD. Around one third of patients show a eosinophilic infiltrate in the early phases of the disease.
P162 Prevalence of nafld (non alcoholic fatty liver disease) and fibrosis in inflammatory bowel disease: the impact of traditional risk factors, intestinal inflammation and genetic phenotype
Authors: Scrivo B , Celsa C , Busacca A , Giuffrida E , Pipitone R M , Grimaudo S , Calogero C , Petta S , Cappello M
Published: January 2020

Background

Prevalence of NAFLD has recently been reported increased in inflammatory bowel disease (IBD) with conflicting results due to heterogeneity of published studies, especially in the diagnostic definition of NAFLD. The increased risk of NAFLD might be related to traditional risk factors but also to IBD-related factors. The role of genetic markers has been addressed only in one study. The aim of our study has been to assess the prevalence of NAFLD and fibrosis in a homogeneous cohort of patients with IBD, assessing the role of metabolic, disease-related and genetic factors.

Methods

the diagnosis of NAFLD was based on transient fibroelastometry findings (CAP ≥288 dB/m) and HSI (Hepatic Steatosis Index). Demographic data, traditional risk factors for NAFLD (BMI, lipid profile), comorbities, laboratory tests, disease features (type of IBD, duration, extent, extraintestinal manifestations, relapses/year, disease activity, previous surgery, therapy) were registered in a dedicated database. PNPLA3 rs738409 C>G single nucleotide polymorphism, encoding for I148M protein variant, was investigated by Taqman assay.

Results

208 consecutive patients were enrolled: 120 males, 121 Crohn’s disease, 87 ulcerative colitis, mean age 46,4 ± 15,2 years. 26 patients (12,5%) were on steroids, 121 on biologics. The prevalence of NAFLD was 20,7% with mean HSI being 38,3 ± 4,7.On univariate analysis, patients with NAFLD were older (54,6 ± 11,1 years), had higher BMI (28,1 ± 3,9 vs. 24,1 ± 3,8), had more frequently hypertension and high level of LDL and tryglicerides. No significant difference was found as far as concerns gender, number of relapses, extraintestinal manifestations, disease activity and duration and ongoing therapy. Medium stiffness value was higher in patients with NAFLD (6,4 ± 2,4 vs. 4,8 ± 2,2 KPa). CG phenotype of PNAPL3 was more frequent among NAFLD patients, though the result was not significant. On multivariate analysis age, BMI, previous surgery and level of stiffness > 6,9 kPa were independently related to NAFLD.

Conclusion

This single center cross-sectional study shows that, by using transient elastography, the prevalence of NAFLD in IBD is 20,7% with a significantly increase of liver stiffness and development of fibrosis. NAFLD was related to traditional risk factors (age, BMI, lipid profile) and to previous ileal resection, the last probably due to changes of gut microbiota. Neither intestinal inflammation and drugs nor genetic testing for PNAPL3 seem to be related to the development of NAFLD. Longitudinal studies are warranted to assess the progression of fibrosis and the role of therapeutic interventions.
P164 HLA G expression is differentially expressed in infiltrating cells in inflammatory bowel disease and in healthy specimens
Authors: Ferreira S , Abiodoun Sadissou I , Serafim Parra R , Ribeiro Feitosa M , Sanches Lizarte Neto F , Pretti da Cunha Tirapelli D , Naiara zambelli Ramalho L , Feres O , Ribeiro da Rocha J J , Donadi E A , de Almeida Troncon L E
Published: January 2020

Background

Since HLA-G is an immune checkpoint molecule and since Crohn’s disease (CD) and ulcerative colitis (UC) exhibit immune-mediated mechanism deregulation, we aimed to evaluate HLA-G intestinal expression and soluble (sHLA-G) levels in CD/UC patients, stratified according to CD phenotype/localisation and UC extension.

Methods

HLA-G tissue expression was assessed by immunohistochemistry in biopsies collected from 151 patients (90 CD, 61 UC) and 24 healthy controls, and in surgical resections (28 CD, 12 UC). Plasma sHLA-G levels (97 CD, 81 UC and 120 controls) were evaluated using ELISA

Results

HLA-G expression was observed in intestinal epithelial cells of controls and CD/UC specimens, exhibiting closely similar profiles, and in lamina propria infiltrating cells, exhibiting differential patterns. In biopsies, CD/UC lamina propria plasma cells/lymphocytes presented: i) increased HLA-G expression compared with controls (p < 0.0001), ii) irrespective of the extent, UC cell staining was greater compared with CD cells (p = 0.0011), and iii) the inflammatory CD phenotype presented increased number of infiltrating cells compared with stenosing and fistulizing phenotypes (p = 0.0407). In surgical resections, CD/UC patients exhibited increased infiltrating cell HLA-G expression in lesion areas compared with margins. sHLA-G levels were increased in UC/CD patients (p < 0.0001) when compared with controls, but no difference was observed between patients.

Conclusion

Increased infiltrating cell HLA-G expression associated with increased sHLA-G levels in CD/UC patients may reflect host on-going strategies to suppress chronic inflammation.

References
P166 Inflammatory bowel disease: risk factors to disease activity during pregnancy and postpartum
Authors: Vicente Costa R , Currais P , Simões C , Pinto L , Correia L
Published: January 2020

Background

The literature suggests that inflammatory bowel disease (IBD) activity during the periconceptional period is a risk factor for active disease during pregnancy. This study aims to evaluate if there is influence of IBD characteristics (type, classification, duration, activity in the periconceptional period, severity and treatment of disease) on the frequency of active disease during pregnancy and postpartum.

Methods

Retrospective study that included pregnant women followed in Maternal-Fetal Medicine department at Hospital de Santa Maria diagnosed with IBD, with information on ≥2 of the referred variables and delivery between March 2012 and July 2018 (n = 37; 24 Crohn’s disease, CD and 13 ulcerative colitis, UC). The statistical tests used were chi-square and Fisher’s exact test.

Results

There was no statistically significant difference between CD and CU in the activity of IBD during pregnancy and postpartum.

Diagnosis >5 years and >10 years ago was associated with lower frequency of active disease during pregnancy (15% vs. 78.6%, p < 0.005 and 8.3% vs. 59.1%, p = 0.009, respectively), but did not influence postpartum activity. Age at diagnosis (≤16 years or 17–40 years) did not appear to influence IBD activity.

IBD activity during the periconceptional period and pregnancy had a statistically significant association (72.7% with active disease during the periconceptional period and pregnancy and 26.1% with quiescent IBD at the time of conception but active during pregnancy, p = 0.023). There were 3 cases of IBD remission during pregnancy (2 CD and 1 UC). Of the 15 cases of active disease during pregnancy, 6 of them (40%; 4 with CD and 2 with UC) were reactivations. 3 women had active IBD during the postpartum period and all of them already had active disease during pregnancy. Regarding severity, all cases of active IBD were classified as mild disease.

The type of therapy (biological, corticosteroids, thiopurines, salicylates, antibiotics or lack of therapy) was not related to disease activity during pregnancy or postpartum. Prior bowel surgery related to IBD (n = 7, all with CD) was associated with a lower frequency of active disease during pregnancy (0% vs. 51.7%, p = 0.027).

Conclusion

The diagnosis of IBD for more than 5 or 10 years and previous bowel surgery were associated with a lower frequency of active disease during pregnancy. There was a relationship between IBD activity in the periconceptional period and pregnancy, which reinforces the importance of pregnancy planning and prior disease control.
P169 Balloon enteroscopy in small bowel Crohn’s disease (CD) with suspected bleeding
Authors: LAW N M
Published: January 2020

Background

Deep enteroscopy with Single Balloon Enteroscopy (SBE) has been used in the evaluation of small bowel diseases and could be performed by a single operator. The role and safety of SBE in suspected small bowel CD with bleeding remained uncertain. Our primary aim was to evaluate the role of SBE in the management of suspected small bowel Crohn’s Disease (CD) with bleeding. The secondary aim was to find out whether SBE could provide definitive diagnosis and therapeutic intervention.

Methods

Hospitalised patients with iron deficiency anaemia (IDA) and/or overt GI bleeding were studied. All had prior negative oesophagogastro-duodenoscopy (OGD) and colonoscopy followed by single operator SBE. The indications were IDA in 28 patients, overt GI bleeding in 18 patients and IDA with abdominal pain and/or weight loss in 6 patients. Twenty and six patients had CT scan and capsule endoscopy done respectively with normal or unconfirmed small bowel lesions.

Results

Fifty-two patients with suspected small bowel bleeding were studied with mean age of 51 (range 20 -84) years. Small bowel Crohn’s disease were diagnosed in 7 patients with jejunal and ileal involvement in 2 and 5 patients respectively. All patients had subsequent histopathology confirmation from biopsies taken during the procedures. In addition, SBE allowed the retrieval of a stuck capsule scope in a patient with proximal ileal stricture. Repeated balloon dilatation through SBE was done successfully in one patient with distal ileal stricture without complication.

Conclusion

Small bowel Crohn’s disease was found in 21% of our patients with suspected small bowel bleeding. SBE is the preferred method of small bowel evaluation after negative upper and lower GI evaluation in this selected patients. Definitive diagnosis and targeted biopsies confirmed the diagnosis of CD as compared with radiological imaging and capsule endoscopy. SBE also provided safe therapeutic intervention in those patients with small bowel stricture from CD through endoscopic dilatation.
P170 Clinical characteristics of inflammatory bowel disease associated to hydradenitis suppurativa
Authors: Gutiérrez Casbas A , Muñoz R , Rodríguez A , Sempere L , Cameo J I
Published: January 2020

Background

Hydradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicle characterised by recurrent, painful nodules, abscesses, and sinus tracts. A clinical association between HS and inflammatory bowel disease (IBD), especially Crohn’s disease (CD), has been described in several previous observational studies.The etiology of both diseases is complex and largely unknown, but it appears that the mechanisms behind these diseases are multifactorial, caused by an interaction of genetic and environmental factors, and characterised by a dysregulated local immune response.

Methods

Aims: We performed a retrospective study to further characterise IBD patients diagnosed with HS in a single center.

Methods: A total of 23 patients with well established HS and IBD were identified in our center. Clinical and demographic relevant characteristics were obtained through extensive review of the health records. Each case of HS was confirmed by a dermatologist and was characterised by its location and Hurley’s classification.

Results

We included 23 patients diagnosed with HS and IBD (56,5% women, mean age 27,09 ± 11,17 years and 69,6% were diagnosed with CD). Montreal classification of CD patients was: L1: 31,3% and L2 -L3 62,6%; B1 87,5%, B2 12,5% and B3 12,5%. A total of 11 patients had been operated related to IBD: 7 (63,6%) for perianal disease and 4(36,6%) underwent bowel resection. The most common localisations affected by HS were axillary 11 (47,8%), inguinal 6 (26%), perianal 1 (4,3%), inguinal plus perianal 1 (4,3%), axillary plus inguinal 1 (4,3%), axillar plus perianal plus submammary 1 (4,3%) and scrotum 1 (4,3%). Patients were divided by Hurley’s classification into three categories: 10 (43,5%) as Hurley I, 11(47,8%) Hurley II and 2(8,7%) Hurley III. A total of 14 patients (60,9%) underwent surgery related to HS. Eleven patients (47,8%) were current smokers, 3(13%) former smokers and 9 (39,1%) non-smokers. Thirty percent of the patients had overweight. Seven patients (30%) were treated with antiTNF and 3(13%) with ustekinumab.

Conclusion

Overweight and smoking, risks factors shared by patients with HS and IBD, are presented in 30–50% of our series of patients. HS is more frequent in CD patients with colonic and perianal involvement. This association should be taken into account in IBD patients with these clinical characteristics due to its implication in differential diagnosis of perianal CD and in choosing effective therapy for both conditions.
P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?
Authors: ZEMEL M , Solo E , Klausner J , Tulchinsky H
Published: January 2020

Background

Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence.

Methods

We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins.

Results

202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar.

We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance.

Conclusion

The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.
P173 Very–Early-Onset inflammatory bowel disease: Russian single centre experience
Authors: Shchigoleva A , Shumilov P
Published: January 2020

Background

The incidence of very early-onset inflammatory bowel disease (VEOIBD) is on the rise in Russia but the clinical data is lacking. We aim to study the disease phenotype, clinical course and the presence of primary immunodeficiency (PID) patients in this group.

Methods

Clinical records of VEOIBD patients treated in Russian State Pediatric Hospital between 2000 and 2018 were revised. In 60 patients admitted between 2016 and 2018 targeted sequencing (PID panel) was performed. 10 patients received genetic testing previously.

Results

135 VEOIBD patients were identified: 95 (70%)with ulcerative colitis (UC), 31 (23%) with Crohn’s disease, 9 (7%) with PID. In 14 (11%) IBD patients the diagnosis was changed from UC to CD and vice versa. Median time of diagnosis was 7 months in UC, 24 months in CD and 44 months in PID. The most common clinical symptoms were loose stools (UC—98%, CD—84%), bloody stools (UC—93, CD—65%), stomach ache (UC—53%, CD—52%), fever (UC—35%, CD—42%). Common laboratory features included anemia (UC—56%, CD—39%), low serum ferrum level (UC—75%, CD—61%), thrombocytosis (UC—53%, CD—45%). From 103 patients tested for ANCA 26% had positive results (24—UC, 3—CD). Mean calprotectin level (76 patients) was 750 ± 54.4 μg/g. Pancolitis was seen in UC (84%), as well as in CD (61%). Epithelioid granulomas in CD were present in 7 patients, in 5 of them they were detected years after initial diagnosis. Sixty-nine% of UC and 90% of CD patients received steroids as induction therapy, steroid-dependency was common (42% in UC and 55% in CD). Forty-nine% of patients with UC and 23% od CD patients received azathioprine, anti-TNF agents were used in 26% UC patients and 77% CD patients. In 35% of patients receiving anti-TNF biologic therapy was started before the age of 6 years. 23,8% of VEOIBD patients failed to achieve clinical remission. Total colectomy was performed in 11 patients, in 3 of them the diagnosis was subsequently changed to CD. Segmental resection was performed in 9 CD patients, in 3 of them while on therapy. The most common form of PID was XIAP deficiency (3 patients), 2 of them achieved endoscopic remission after allogenic stem cell transplantation.

Conclusion

In the VEOIBD group CD resembles UC clinically and endoscopically. A substantial number of patients requires immunosuppressive and biologic therapy before the age of 6 years. Colectomy rates are still high regardless the use of biologics. Boys with refractory VEOIBD should be screened for XIAP deficiency.
P175 Fatty liver disease as a complication of immune-mediated inflammatory diseases: prevalence and risk factors in inflammatory bowel disease
Authors: Arias Loste M T , García García M J , Rodriguez-Duque J C , Iruzubieta P , Rivas C , Pascual M , Castro B , García A , Lopez-Montejo L , Rasines L , Garcia-Nieto E , Cagigal M L , Rivero M , Crespo J
Published: January 2020

Background

Previous publications made by our group showed an increased prevalence of fatty liver disease (NAFLD) in immune-mediated inflammatory diseases (IMIDs). However, the existing data on inflammatory bowel disease (IBD) are contradictory.

Hypothesis: the prevalence of NAFLD is increased in IBD independently of the presence of metabolic factors.

Methods

Cross-sectional case–control study. Cases: prospective cohort single-center IBD patients. Controls: random sample from general population (Ethon cohort) paired 1: 2 by age, sex, BMI and T2D diagnosis. The diagnosis of NAFLD has been established by transition elastography (TE) CAP and confirmed by liver biopsy.

Results

The study scheme is presented in the figure. The prevalence of NAFLD is higher in IBD vs. general population (p = 0.04) and is associated with age, BMI, sex and metabolic syndrome. More frequently, IBD patients with NAFLD presented with severe complications of IBD and to a lesser extent receive TNF therapy. There is a mean serum elevation of CRP, ESR and ferritin compared with IBD subjects without NAFLD. In multivariant analysis, IBD is an independent predictor of NAFLD (adjusted OR 1.31; p = 0.007). The NAFLD associated with IBD is less frequently associated with T2D than NAFLD in the general population, and has a higher proportion of subjects with advanced fibrosis (TE > 8.7 kPa: 45/350 [12.9%] vs. 23/669 [3.4%]; p < 0.0001) and mean value of TE is significantly higher (6.09 vs. 5.11 kPa; p < 0.0001). Non-invasive fibrosis scores have a high NPV in the diagnosis of advanced fibrosis in IBD (FIB4: 88%; APRI: 87%; NFS: 88%; HepametFS: 87 %)

Conclusion

The prevalence of NAFLD is higher in IBD patients, with IBD being an independent predictor of NAFLD. Patients with IBD and NAFLD have a higher systemic inflammatory burden and this results in an increased risk of advanced fibrosis associated with IBD comparatively with the control NAFLD population.
P176 Expert consensus on acquisition and reporting of intestinal ultrasonography activity in Crohn’s disease. A prospective inter-rater agreement study
Authors: Wilkens R T , Nylund K , Petersen F , De Voogd F , Maaser C , Kucharzik T , Maconi G , Allocca M , Lu C , Palmela C , Vaughan R , Christensen B , Novak K L
Published: January 2020

Background

Intestinal ultrasonography (IUS) is a promising cross-sectional imaging modality used to assess transmural disease and complications in Crohn’s disease (CD). Although recently positioned as a first-line modality for evaluation as per ECCO guidelines, standard measurements, reproducibility and nomenclature have not yet been clearly established. The aim of this study was to evaluate the inter-rater agreement for parameters identified as important by experts through Delphi consensus.

Methods

IUS parameters demonstrating inflammatory activity were systematically reviewed in the literature and presented to IUS experts. Individual parameters were selected by a blinded Delphi consensus panel to establish relative contribution to inflammatory activity in CD. Weighted grading of each parameter was further established by expert consensus. Image acquisition for optimal measurement was established by consensus. Two phases for evaluating inter-rater variability were undertaken. Phase 1: blind review by 8 readers of 20 de-identified CD cases. Cases with poor agreement were reviewed to clarify discrepancy and improve agreement. Phase 2: an additional 30 de-identified CD cases blindly were reviewed by 12 independent expert readers. Inter-rater agreement was evaluated for all 4 key parameters. Statistics were performed using Stata 16. Bowel wall thickness (BWT) was assessed using intraclass correlation coefficient (ICC) and the ordinal parameters using weighted Cohens Kappa.

Results

The Delphi process reduced 12 activity parameters to 4 key contributors including BWT, color Doppler signal (CDI), inflammatory fat and bowel wall echostratification (Figure 1).

BWT was regarded as pathologic if the average of 4 measurements were > 3 mm for the small and large bowel, and grades of the additional parameters established (Table 1).

Bowel wall thickness was comprised of 2 measurements in cross section and 2 in longitudinal orientation (Figure 2). Interobserver agreement was almost perfect for BWT: ICC=0.91 (95% CI 0.83 to 0.96) p = 0.001, while there was moderate agreement for CDI κ=0.60 (95% CI 0.48–0.72) p = 0.001. Agreement for inflammatory fat detection was also moderate with κ= 0.50 (95% CI 0.33–0.66) p = 0.001, while stratification was fair κ= 0.39 (95% CI 0.26–0.53) p = 0.001.

Conclusion

This expert consensus-based IUS activity score clearly establishes the reproducibility of this standardised approach to measure inflammatory activity in patients with CD. Using our method, BWT which is known as the most important parameter, is highly reproducible with CDI and inflammatory fat demonstrating moderate reproducibility. This score may provide the foundation for the future incorporation of IUS in research studies and clinical trials.