bluuebunny/crossref_metadata_2025 huggingface dataset:
P1111 Prevalence and risk factors for active tuberculosis in Tunisian IBD patients
Authors: Ben Safta N , Hlila T , Ben Mustpha N , Laabidi S , Gouiaa D , Serghini M , Fekih M , Labidi A , Boubaker J
Published: January 2024

Background

IBD patients are at risk of active tuberculosis,given the use of immunosuppressive treatments.Our country is an endemic region for tuberculosis,which may increase this risk.

The aim of our study was to estimate the prevalence of active tuberculosis in IBD patients with prior screening and to investigate associated risk factors.

Methods

This was a retrospective and descriptive study,including all IBD patients admitted in the department,who had a screening for latent tuberculosis,over a 10-year period[2012-2022].Patients with less than 12 months' follow-up were excluded.

Results

We included 100 patients, 52 men and 48 women.Crohn's disease(CD)was present in 86% of cases,and ulcerative colitis in 14%.CD was predominantly ileocolic (47%).The phenotype of luminal CD was inflammatory, stenosing and fistulizing in 36.6%,28% and 35.4% of cases respectively.Anoperineal involvement was present in 41.9% of CD patients.At the time of screening, patients were on salicylates, steroids and thiopurines in 13%,27% and 22% of cases respectively.Body mass index median was 22.7kg/m².Two-thirds of patients(65%)were in a flare-up at the time of screening,with 50.8% in moderate severity, and 3.1% in severe acute colitis.Ninety patients had a negative TST.The quantiFERON test was positive in 9 patients and indeterminate in one,in four of them, the TST was also positive. There were no abnormalities on chest X-rays in all patients.Fifteen patients received chemoprophylaxis, mainly because of suspected latent tuberculosis, but also because of severe undernutrition despite a negative workup in 3 patients.Chemoprophylaxis was isoniazid monotherapy for 9 months,except for 3 patients who received isoniazid and rifampicin dual therapy for 3 months.The prevalence of active tuberculosis in our patients was 11%.The median time from onset of tuberculosis to screening was 12 months.Almost all patients were on anti-TNFα monotherapy(n=4) or combotherapy(n=6).One patient was on azathioprine only. Chest CT scans showed signs suggestive of tuberculosis in only 2 patients.Among patients who developed active tuberculosis, 2 had previously received chemoprophylaxis for a positive TST. In a univariate study,we analyzed all variables for risk factors associated with the occurrence of tuberculosis in our patients.Apart from the use of anti-TNF drugs(p=0.03),no statistically significant associations were found:severity of relapse during screening(p=0.3),undernutrition as evidenced by a low BMI(p=0.92),albuminemia(p=0.77),C reactive protein(p=0.8).

Conclusion

The median delay to onset of active tuberculosis suggests post-screening transmission.This is further evidence of the need to shorten the time required for systematic updating of the tuberculosis work-up in endemic countries.
P1139 Lymphocytic Colitis: A large case series in the United Kingdom
Authors: Gilmour N , Giaslakiotis K , Hoque S
Published: January 2024

Background

Lymphocytic colitis, a type of microscopic colitis, was previously thought to be a rare condition. It is a histological diagnosis characterised by chronic loose stools and normal findings on endoscopy. It is now thought that it could be implicated in up to 10% of people with chronic diarrhoea, and has traditionally been associated with certain medications. We conducted a retrospective case analysis of patients diagnosed with the condition on histology between January 2018 till December 2022.

Methods

A list of patients who had undergone colonoscopy and biopsy for chronic diarrhoea, with no evidence of inflammatory bowel Disease (IBD), was generated. The patient’s electronic health records were then manually analysed, and data was collected using certain parameters including presence of autoimmune disease, faecal calprotectin levels/QFIT, smoking status, medication use (NSAIDS, PPI, Statins or SSRIs), colonoscopy findings, treatment choice and treatment outcomes. 121 patients were eligible based on histopathology consistent with a diagnosis of lymphocytic colitis.

Results

The median age was 63, with a 3:2 split of female to male patients. 63% reported painless, chronic diarrhoea lasting more than 6 weeks. 10.7% had painless and bloody diarrhoea, 23% had diarrhoea with abdominal pain. 25.4% had evidence of autoimmune disease. 43% were taking a PPI, 6.6% and NSAID, 41% a statin and 25.6% an SSRI. 27% were active smokers at the time of presentation. 62.8% of patients had a normal colonoscopy report, with the rest having ‘’abnormal reports” due to polyps. Faecal calprotectin levels ranged from 20-954. QFIT was positive in 35% of patients. 34% of patients were treated under a gastroenterologist. Of those who received budesonide only: 46% recovered with no relapse, 20% had relapsed in under 6 months, 16% relapsed after 6 months, 16% did not present again. Of the patients who received loperamide only, 66% reported resolution of symptoms. All histology demonstrated lymphocytosis in the lamina propria, 16% had expansion of the subepithelial collagen band, often termed ‘incomplete Microscopic colitis’.

Conclusion

Use of PPIs, statins and SSRIs are highly represented in the data, compared with general population usage. Treatment with either budesonide or loperamide generally lead to better symptom control, indicating patients should be referred to gastroenterology upon diagnosis. Clinicians should judiciously prescribe the above medications with clear indication and avoid prescribing indefinitely.
P1143 Per- and poly-fluoroalkyl substances (PFAS) exposure is associated with later occurrence of inflammatory bowel disease
Authors: Agrawal M , Midya V , Maroli A , Valvi D , Magee J , Ungaro R , Porter C , Petrick L , Colombel J F
Published: January 2024

Background

Environmental chemical exposures are increasingly acknowledged as risk factors for inflammatory bowel disease (IBD). Per- and poly-fluoroalkyl substances (PFAS), a large class of persistent fluorinated organic chemicals, widely used in the modern environment, may be implicated in IBD etiology, but data are conflicting.

Methods

We investigated the association of PFAS mixture concentrations in pre-diagnostic serum with adult-onset IBD in a pilot study within the pre-clinical Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects (PREDICTS) study. This is a nested case-control study of military personnel with Crohn’s disease (CD), ulcerative colitis (UC), and age-, sex-, and race-matched healthy controls with serum samples obtained at four-time points 1-10 years prior to IBD diagnosis. Using untargeted liquid-chromatography high-resolution mass spectrometry analytical approach, we conducted an untargeted metabolomic analysis and semiquantitative measurement of fluorinated compounds, including legacy PFAS and emerging PFAS chemicals. We used weighted quantile sum regression models adjusted for confounders to study the association of PFAS as a mixture with the odds of CD and UC at each time point.

Results

Our study sample included individuals with CD, UC, and matched healthy controls (n=25, each group, 4 samples per individual). Baseline characteristics were similar across cases and controls. We identified nine well known PFAS compounds and 27 other known fluorinated compounds. The chemical mixture of fluorinated compounds, including the known PFAS, in the serum samples within one year of diagnosis was associated with higher odds of CD and UC [odds ratio (OR) 2.13, 95% CI 1.33, 3.41, and 1.76, 95% CI 1.15, 2.68, respectively] per one unit increase in decile. These associations remained consistent for the PFAS mixture measured in serum at all four time points up to 10 years prior to diagnosis for both CD and UC (Figure). Major contributors to the overall mixture indices included legacy PFAS, as well as emerging PFAS chemicals.

Conclusion

We observed a substantial increase in the odds of CD and UC among individuals with higher serum PFAS mixture levels up to 10 years prior to diagnosis. Studies to understand underlying mechanisms are ongoing.
P1149 Risk of Clostridioides difficile infection in patients with inflammatory bowel disease
Authors: Martinez Lozano H , Saralegui Gonzalez P , Fueyo Peláez P R , García García A , Miranda-Bautista J , Reigadas Ramírez E , Alcalá Hernández L , Muñoz García P , Marín-Jiménez I , Menchén L
Published: January 2024

Background

Patients with inflammatory bowel disease (IBD) are at increased risk of Clostridioides difficile infection (CDI). CDI in IBD patients has been associated with poor clinical outcomes including higher morbidity and mortality. Immunosuppressant therapy has been proposed as a risk factor for CDI. However, the particular relationship between biologic therapy and CDI is controversial. We aimed to assess whether biologic therapy increased the risk of developing CDI in three cohorts of patients with immune-mediated inflammatory diseases (IBD and rheumatic diseases).

Methods

We conducted a retrospective study including three cohorts: IBD patients receiving biologic therapies (IBD-Bio), IBD patients treated with non-biologic therapies (IBD-Bio-naïve), and patients with rheumatic diseases receiving biologics (RHEUMA-Bio). Different biologic agents were considered for IBD-Bio cohort: infliximab, adalimumab, golimumab, certolizumab, ustekinumab, and vedolizumab. For RHEUMA-Bio, the biologics included were infliximab, adalimumab, golimumab, certolizumab, ustekinumab, secukinumab, etanercept, abatacept, tocilizumab, rituximab, guselkumab and ixekizumab. We estimated the incidence rate (IR) of CDI episodes between 2015 and 2021 among the three cohorts. Risk factors of CDI were assessed using logistic regression model. Furthermore, we performed subgroup analysis to identify risk factors of CDI in the IBD cohorts (IBD-Bio and IBD-Bio-naïve) and within the IBD-Bio cohort. We used R software for data analysis.

Results

Overall, we included 1868 patients, 603 in IBD-Bio, 440 in IBD-Bio-naïve, and 825 in the RHEUMA-Bio cohort. The number of CDI episodes was 3, 42, and 25 for the RHEUMA-Bio, IBD-Bio, and IBD-Bio-naïve cohorts, respectively. The IR for CDI was 1.27 100 person-years (95% confidence interval [95% CI], 0.91-1.71) for IBD-Bio, followed by 0.95 100 person-years (95% CI 0.61-1.40) for IBD-Bio-naïve and declined to 0.07 100 person-years (95% CI 0.01-0.20) for RHEUMA-Bio cohort. We identified having IBD (odds ratio [OR]:18.98, CI 95% 5.82- 61.92, p<0.001) as the major risk factor for developing CDI after adjusting for age, sex, need for biologics, and comorbidities in the three cohorts. Among IBD patients, there were no differences in CDI between biologic and naive cohorts. Within the IBD-Bio cohort, the number of biologics received (OR: 1.56, CI 95% 1.22- 2.01, P<0.001) and short disease duration (1.08, CI 95% 1.04- 1.13, P<0.001) were associated with a higher risk of CDI.

Conclusion

The major risk factor associated with CDI development was the diagnosis of IBD. Biologic therapy was not associated with a higher risk of CDI. In IBD patients on biologic therapy, the number of biologics received increased the risk of CDI.
P1163 Incidence and risk of hip replacement rate in patients with inflammatory bowel disease in Taiwan
Authors: Lai H C , Wu Y H , Wang C P , Huang P J , Cheng K S , Chou J W
Published: January 2024

Background

The incidence and prevalence of inflammatory bowel disease (IBD) are low but increasing in Taiwan. Management of comorbidities such as osteoporosis is becoming increasingly important in treating patients with IBD. Hip fracture is the most serious consequence of low bone mineral quality and is associated with excess risk of mortality. The present study aimed to investigate the total/partial hip replacement in IBD patients in Taiwan.

Methods

In a matched nationwide cohort study, we evaluated the risk of total/partial hip replacement in IBD patients. We conducted univariable and multivariable Cox models to estimate the hazard ratios (HRs) and 95% conﬁdence intervals (CIs). The Kaplan-Meier curves were plotted to describe the cumulative incidence of hip replacement among the two cohorts.

Results

a total of 51,301 patients with IBD and 153,903 patients without IBD were included in this study. In Table 1, distribution of gender, age, comorbidities, and medications were similar between two cohorts (SMD<0.1), except stroke, renal insufficiency, steroid, 5-ASA and anti-osteoporotic agents. The mean (standard deviation) age was 51.00 (17.76) and 49.89 (16.85) years and the sex ratio between female and male was approximately 50% and 50% in two cohorts, respectively. As shown in Table 2, patients with IBD had a significantly higher risk of hip replacement than the control group (adjusted HR=1.11, 95% CI=1.03-1.19). For the sake of a visual picture of cumulative incidence of hip replacement, consider the graphic representation in Figure 1 (Kaplan-Meier plot). Compared to female individuals, male individuals had significantly lower risks of hip replacement (adjusted HR=0.73, 95%CI=0.68-0.78). Older patients had more risk of hip replacement. Individuals aged 40-59, aged 60-79, aged >79 had significantly higher risks of hip replacement (adjusted HR >1, p-value<0.05) compared to individuals aged 20-39. Table 3 showed that IBD patients who are females, aged 40-59, or steroid users tended to have a higher risk of hip replacement compared to individuals without IBD (adjusted HR > 1, p-value < 0.05). We further stratified different dose of steroid use in IBD and non-IBD cohorts in Table 4. IBD patients receiving different steroid doses did not show influence on the risk of hip replacement. We demonstrated no difference in the hospital days, mortalities and morbidities among patients with hip replacement in non-IBD and IBD cohorts in Table 5. Higher rate of GI bleeding in IBD group had a significant difference than non-IBD group.;

Conclusion

Our present results indicate that patients with IBD had an overall higher total/partial hip replacement in Taiwan.
P1164 Early monitoring of ustekinumab concentration after induction is related to clinical remission in ulcerative colitis & Crohn`s disease - STOCUSTE study
Authors: Sabhan H , Johansson F , Bello F , Wennerström C , Forsberg O , Borin A , Almer S , Höög C , Söderman C , Lördal M
Published: January 2024

Background

Ustekinumab (UST), an anti-interleukin-12/23 antibody, is used to treat moderate to severe inflammatory bowel disease (IBD). The STOCUSTE study includes IBD patients treated with UST at four teaching hospitals in Stockholm to provide long-term follow-up data. We investigated in a real-world setting the utility of therapeutic drug monitoring (TDM) to optimize treatment and correlated the serum concentrationof UST to clinical outcomes.

Methods

This retrospective study includes patients diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC) treated with UST and followed until withdrawal of treatment for any reason, or until end of study,July 31, 2021. Concentration data and dosing interval were collected at each follow-up (3, 6, 9, 12, 24,36, 48, 60 months) in relation to presence of remission defined as Physician Global Assessment (PGA)= 0.

Results

In total, 418 patients were included, 322 (48% females) with CD and 96 (46% females) with UC. In 229 patients the UST concentration was analyzed at least once and never in the remaining 188 patients. In general, the UST serum concentrations were above 1 μg/ml. At 3 months follow-up, patients in remission had a significant higher concentration of UST compared to non-remitting patients. (Table 1) in the total cohort, as well as when analyzed separately in UC ad CD. There was no significant difference in UST concentrations at 6 months or later between patients in remission versus non-remission for either IBD diagnosis. Further, TDM was related to higher rates of remission at 3 months of follow-up.

Conclusion

In this study, early measurement of serum UST (≤3 months) correlated to the clinical response. Serum concentrations at later time points were similar in patients in remission and in patients with active disease. These results from a real-world setting might partly be explained by that serum concentrations were not taken in a systematic manner.
P1178 Detection of occult liver disease in patients with Inflammatory Bowel Disease
Authors: Ladrón Abia P , Sicilia Aladren B , Hernández Bernad J , Quiñones Castro R , Martín Izquierdo A , Villar Lucas C , Ibañez García M , Hernández Villalba L , Burgueño Gómez B , Antona Herranz M , Cimavilla Román M , Aguilar Argeñal L F , Gómez Camarero J
Published: January 2024

Background

Investigation of liver disease is recommended in the ECCO Guidelines for Extraintestinal Manifestations in Inflammatory Bowel Disease (IBD). The aim of this study was to analyse the prevalence of liver disease in IBD patients, to examine the frequency of different aetiologies, and to investigate a possible correlation between the severity of liver disease and IBD.

Methods

Cross-sectional descriptive study including all patients with inflammatory bowel disease (IBD) of nine hospitals in Spain. The study of liver disease was carried out in two phases: patients with FIB-4 greater than 1.3 (greater than 2 in those aged 65 years or more), as well as those with APRI greater than 0.5 and/or elevated transaminases were selected as those at risk of liver disease. In the second phase, these patients underwent a medical history, comprehensive blood tests, abdominal ultrasound with SWE elastography and Fibroscan® (including transitional elastography (TE) and Controlled Attenuation Parameter (CAP)).

Results

In total, 5302 patients were enrolled and 1640 (31%) were identified as at risk for liver disease. The University Hospital of Burgos has completed the second phase of the study in patients diagnosed with IBD between 2010 and 2021 (n=151). Of these patients, 72.2% were male and the median age was 61 years. Ulcerative colitis (57%) was the most common type of IBD and 62% of the patients were overweight or obese, while 12% of the patients had high-risk alcohol consumption. Metabolic hepatic steatosis was the most frequent cause of liver disease (35%).

Moderate/severe steatosis was detected in 44.3% of patients by CAP and 24% by ultrasound. The prevalence of advanced fibrosis was 10.6% and 12% when assessed by ET and SWE, respectively. Notably, 12.6% displayed ultrasound signs of chronic liver disease.

A positive correlation was found between the ET and the SWE for liver fibrosis, with a correlation coefficient of ĸ = 0.663.

On univariate analysis, an increased risk of significant fibrosis (p=0.011) and moderate/severe steatosis (p=0.00) was found only in those who were overweight or obese. However, no association with severity of liver disease was found for perianal disease, use of immunosuppressants or history of previous surgery.

Conclusion

The incidence of unrecognised liver disease in IBD patients is substantial, with metabolic hepatic steatosis being the most common cause. The severity of liver disease in these patients cannot be ignored, with one in ten patients having advanced fibrosis. In the univariate study, only obesity was found to correlate with the severity of steatosis and fibrosis, while IBD severity showed no significant association with liver disease severity.
P1184 Two simple tools for assessing depression and anxiety in patients with Inflammatory Bowel Diseases
Authors: Fracas E , Costantino A , Buoli M , Zignani N , Conforti F , Piazza N , Vecchi M , Caprioli F
Published: January 2024

Background

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can trigger the onset of depressive and anxiety symptoms. The evaluation of mental well-being in patients with a chronic medical condition is considered a good clinical practice and it is strongly recommended by the World Health Organization. Nevertheless, mental health is not routinely investigated in this context for several reasons, including lack of training by healthcare professionals, stigma associated to mental health and gender-relatedstereotypes. The objectives of our study were to assess the presence of depressive and anxiety symptoms inpatients affected by IBD using two simple validated questionnaires and to identify potential related factors, particularly gender differences.

Methods

We conducted a single center observational study evaluating anxiety and depressive symptoms in patients with IBD treated with biological therapy at the IBD Unit of Ospedale Policlinico of Milan during October 2022. We assessed depressive and anxiety symptoms using respectively the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) that are easy self-administered rating scales. Univariate analyses and regression models were applied for the purpose of the study.

Results

Among a total of 174 consecutive patients, 158 completed the questionnaires. The prevalence of moderate tosevere depression (PHQ-9 score > 9) in the total sample was 18.4%, and it was higher in CD than in UC (21% vs 9.7%). The prevalence of clinically significant anxiety symptoms (GAD-7 score > 9) was 24% (25.7% in CD and 19.3% in UC). Focusing on gender differences, similar prevalence of significant anxiety anddepression was observed between males (M) and females (F); respectively 18.6% M vs 17.6% F for depression (PHQ-9 > 9) and 22.2% M vs 25.4% F for anxiety (GAD-7 > 9). Of note, a relevant association was observed between younger age and higher GAD-7 (β =-0.639; p=0.021) and PHQ-9 (β =-0.604, p=0.055) scores.

Conclusion

Both males and females (especially younger) IBD patients in biological therapy are largely affected bysignificant depressive and anxiety symptoms. The administration of simple questionnaires like PHQ-9 andGAD-7 in routine clinical practice can facilitate early identification of patients requiring mental health support, this is crucial as psychiatric conditions can complicate the course of the disease and adherence to treatments.
P1194 Single-cell analysis reveals clonal expansions of pro-inflammatory tissue-resident memory Th17 cells in Crohn's disease
Authors: Lee Y , Baek J , Park S , Kim Y , Lee J L , Hwang S W , Park S H , Yang S K , Han B , Kweon M N , Song K , Yoon Y S , Ye B D , Lee H S
Published: January 2024

Background

Crohn's disease (CD) is a chronic inflammatory disorder affecting the bowel wall. Tissue-resident memory T (Trm) cells are implicated in CD, yet their characteristics remain unclear. We aimed to investigate the transcriptional profiles and functional characteristics of Trm cells in the small bowel of CD and their interactions with immune cells.

Methods

Seven patients with CD and four with ulcerative colitis as controls were included. Single-cell RNA sequencing and paired T cell receptor sequencing assessed T cell subsets and transcriptional signatures in lamina propria (LP) and submucosa/muscularis propria-enriched fractions (SM/MP) from small bowel tissue samples.

Results

We identified 58,123 T cells grouped into 16 populations, including the Th17 Trm, CD4+ Trm, and CD8+ Trm clusters. In patients with CD, we identified Trm cells with a Th17 signature (termed Th17 Trm) in the bowel, demonstrating significantly increased proportions of the Th17 Trm cluster in both the LP and SM/MP areas. The Th17 Trm cluster demonstrated heightened expression of canonical tissue-residency marker genes (ITGAE, ITGA1, and CXCR6) along with elevated levels of IL17A, IL22, CCR6, and CCL20. The clonal expansion of Th17 Trm cells in CD was accompanied by enhanced transmural dynamic potential, as indicated by significantly higher migration scores. CD-prominent Th17 Trm cells displayed an increased interferon gamma (IFNγ)-related signature linked with STAT1 activation, inducing chemokines (i.e., CXCL10, CXCL8, and CXCL9) in myeloid cells.

Conclusion

Our findings underscored the elevated Th17 Trm cells throughout the small bowel in CD, contributing to disease pathogenesis through IFNγ induction and subsequent chemokine production in myeloid cells.
P1195 Identification of immune cell infiltration and potential candidate biomarker in anti-IL 12/23 treated Crohn’s disease patients by integrated bioinformatics analysis and machine learning
Authors: Li Q , Tang J , Chao K , Gao X
Published: January 2024

Background

Variations existed in patients' responses to ustekinumab (UST) treatment in Crohn's disease (CD), but the underlying cause remains unknown1. Our objective was to investigate the involvement of immune cells and identify potential biomarkers that linked to the response to IL 12/23 inhibitors in patients with CD.

Methods

The analysis utilized the GSE207022 dataset, which consisted of 54 non-responders and 9 responders to UST in CD cohort (Table 1). Initially, differentially expressed genes (DEGs) were identified. Subsequently, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were peformed. LASSO regression was used to further screen the most powerful hub genes2. ROC curve analysis was employed to evaluate the predictive performances of these genes. CIBERSORT was used to estimate the proportion of immune cell types. These significantly altered genes were further subjected to clustering analysis into immune cell-related infiltration. To validate the reliability of the candidates, patients prescribed with UST as the first line biologics in our center were included as an independent dataset.

Results

A total of 99 DEGs were obtained from the integrated dataset. Analyses of GO and KEGG revealed a significant enrichment of immune response pathways in CD patients. We identified nine hub genes (SOCS3, CD55, KDM5D, IGFBP5, LCN2, SLC15A1, XPNPEP2, HLA-DQA2, and HMGCS2) that were primarily associated with the response versus non-response patients. These nine genes accurately predicted treatment response with an area under the curve (AUC) of 0.96. Non-response individuals exhibited a relatively high Th1 cell polarization. Both LCN2 and KDM5D genes showed positive correlations with Th1 cells and the Th1/Th2 ratio. Furthermore, we validated LCN2 and KDM5D genes as effective predictive markers using independent validation datasets (Figure 1).

Conclusion

Th1 cell polarization was an important cause of non-response to IL-12/23 agents in CD patients, and LCN2 and KDM5D could be used as predictive markers to identify non-response patients effectively.

1. Newman AM, Liu CL, Green MR, et al. Robust enumeration of cell subsets from tissue expression profiles. Nat Methods. 2015;12(5):453-457. doi:10.1038/nmeth.3337.

2. Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med. 2016;375(20):1946-1960. doi:10.1056/NEJMoa1602773.
N04 Impact of phase angle on nutritional assessment and disease activity in patients with Ulcerative Colitis
Authors: Bueno Hernández N , Viridiana Montsserrat M M , Javier Ivanovychs C R , Francisca M S , Jorge D L R
Published: January 2024

Background

An increase in the prevalence of Ulcerative Colitis (UC) has been reported, especially in Latin America, malnutrition occurs in up to 70% of patients with active disease. The complete assessment of nutritional status is the best method to make an adequate diagnosis since it considers 4 parameters, anthropometry, biochemistry, clinical, and dietary, however, it is very extensive and there are other methods such as bioelectrical impedance (BIA), which is a non-invasive way to estimate the percentage and amount of fat, muscle, water and phase angle (PhA). Moreover, PhA has been proposed as a marker of cell integrity which may be a substitute for complete nutritional assessment. Therefore, the study aimed to evaluate the effectiveness of PhA in the nutritional diagnosis of patients with UC.

Methods

A cross-sectional study was carried out in patients with UC and healthy controls. Body composition was measured in both groups to obtain the PhA. U Mann-Whitney test was used to compare the data. Patients were classified according to their PhA, considering a normal value of >6.1° and a low value of >6.1°.

Results

The study included 60 UC and 120 controls, 65% were women, and 35% men, the PhA was lower in UC compared to the controls, in addition to the fact that patients with active disease had a lower PhA compared to patients with remission (5.6±0.9 vs 6.06±0.8, p<0.05). In our study, patients with a low PhA had a lower amount of weight (Active: 60.5±13.6 vs 70.3±.8, p=0.018, Remission: 57.1±11.4 vs 69.4±8.7, p=0.006), dry lean mass (Active: 13.8±3.6 vs 18.2±.6, p=0.009; Remission: 13.1±2 vs 19.7±5.3, p<0.001), total body water (Active: 27.4±6.2 vs 32.9±4.6, p=0.028; Remission: 25.3±3.8 vs 34.4±9.2, p=0.003), and intracellular water (Active: 51.9±3.2 vs 55.1±3.3, p=0.042; Remission: 49.3±10.7 vs 55.8±3.6, p=0.025 ) regardless of disease activity. In this population, we can observe that the inflammation markers (ESR, CRP) were increased in accordance with the activity of the disease associated with PhA, which is consistent with what has been reported in the literature.

Conclusion

The PhA is modified in patients with UC compared to healthy patients, even more so when they have active disease. Women with active UC are those at risk of malnutrition and cardiovascular risk measured by PhA and CCI. PhA is effective in diagnosing malnutrition in patients with UC regardless of conventional parameters for evaluating nutritional status (Figure 1).
N26 Disease outcomes and patient’s perspectives after switching biologics from intravenous to subcutaneous administration. A real-world experience in a tertiary IBD-unit
Authors: Dewitte G , Akhayad S , Truyens M , Geldof J , Lobaton T
Published: January 2024

Background

Since 2022, subcutaneous (SC) formulations of infliximab (IFX) and vedolizumab (VDZ) became available. This study aims to assess patients’ perspectives on potential switch to SC administration.

Methods

A prospective observational, nurse-led study was performed at the Ghent University Hospital. Patients treated with IV IFX or VDZ, deemed suitable by the treating physician based on the DIAMOND multi-stakeholder position statement of the Belgian IBD Research and Development group (BIRD), were offered switch to SC administration between 01/01/2022-30/06/2023. Participants were asked to fill out questionnaires regarding personal perspective on a potential switch to SC administration. Data was collected using REDCap®. Descriptive and univariate analyses were performed with Excel ®. The study was approved by the Ethical committee of UZ Ghent (ONZ-2022-0296).

Results

In total 404 patients receiving IV IFX or VDZ were identified within the inclusion period. Of those, 196 received 8-weekly treatment. After screening by the treating physician, 157 patients met the inclusion criteria of whom 84 agreed to participate (Figure 1).

Questionnaires were filled out completely by 70 of the included patients. Fourty patients were treated with VDZ (57.1%) and 42.9% with IFX. Fourty-three patients (61.40%) had Crohn’s disease, 26 (37.1 %) had ulcerative colitis and 1 (1.4 %) indeterminate colitis. Fifteen patients (21.4%) had previous experience with SC self-injections. Thirty-four participants (48.6%) chose to switch to SC administration of their current treatment, 36 refused (51.4%).

In general, patients were aware of the possibility to switch to SC administration before entering the study as 71% knew this formulation was available. Main information channels were: treating physician (56%) and/or IBD nurse (58%).

Univariate analyses comparing switchers versus non-switchers are shown in Table 1. Patients who refused switch were more concerned about potential adverse events (agree: 61.1% vs 23.5%), loss of response (agree: 41.4% vs 11.4%) or incompliance (agree: 47.2% vs 14.7%) with SC formulations. Furthermore, the associated physician visit at the IV-administration unit was deemed more important to non-switchers (agree: 88.9% vs 55.9%).

Patients who switched were less concerned about potential differences in healthcare costs (disagree: 70.6 vs 36.1%) and felt that regular visits to the IV-administration unit had big impact on QoL (agree: 64.7% vs 11.2%).

Conclusion

Patient’s perspectives differed significantly between those who chose to switch to SC IFX/VDZ and those who remained under the IV formulation. This should be considered when discussing treatment options with the patients and confirms the importance of patient engagement in managing IBD.
N28 Stress and Inflammatory Bowel Disease – are there any differences during flare and remission?
Authors: Jäghult S , Svedberg M , Soto Villagran S , Kumlin M
Published: January 2024

Background

Patients with Inflammatory Bowel Disease (IBD) often experience that stress has a negative effect on the disease. Studies have also shown a possible connection between stress and active IBD. This study aims to investigate the patients´ level of stress (both subjective and objective) in relapse and in remission. With this information we may determine if the levels of stress are higher in active disease compared to remission.

Methods

Inclusion criteria were having diagnosis with ulcerative colitis or Crohn`s disease, being over 18 years old, and having a flare in IBD. Measurements were made in cortisol in saliva and filling in the questionnaires Short Health Scale (SHS) and Perceived Stress Scale (PSS). All measurements were done at the beginning of the flare and then a second time when the patient was classified as being in remission. Flare and remission were determined by endoscopic examination and fecal calprotectin.

Results

A total of 20 patients completed the study. Median age was 45 years. A number of 17 (85%) had ulcerative colitis, and 12 (60%) were women. The levels of cortisol showed normal values both in active disease and in remission. Neither the results in PSS showed any differences between active and non-active disease. However, the results showed medium high values of stress in both measurements (table 1). SHS showed improvements in all four questions, but mostly in question 1 concerning symptoms.

Conclusion

No significant differences could be found in levels of stress when measuring cortisol and experienced stress in flare and in remission. However, the PSS showed that the participants had medium high levels of stress at both measurements. This could indicate a more constant stress in patients with IBD. A weakness in this study is the difficulty in measuring cortisol at the same time in each patient. Another weakness is the small population. There is still a need to examine the connection between stress and IBD. Concerning this study there is a wish to more closely investigate possible differences within each patient.
N32 Implementation of chromoendoscopy in colorectal cancer screening in patients with Inflammatory Bowel Disease
Authors: Lavín Expósito C , Bouhmidi Assakali A , Jurado Monroy R M , Rodríguez Romero V , Vozmediano Sánchez P , Velasco del Burgo M , Alañon Barba M , Moraleda Cebrian F , Hidalgo Juárez M L , Pinilla Sánchez J , Bonillo Merino C , Cabanillas Navarro M L , Laguna Laguna M T , Salueña Salueña I , Sánchez Pardo A M , Barreto Suárez E , Sánchez Alonso M
Published: January 2024

Background

Patients with inflammatory bowel disease (IBD) have a higher risk of colorectal cancer (CRC), so we must implement the best available endoscopic technique to detect it early, decreasing the risk of CRC and death.

There is low adherence to CRC screening by chromoendoscopy with dye in patients with IBD, despite the fact that national and international clinical practice guidelines consider this technique of choice based on the available evidence.

Description Of The Initiative

The standardization of a screening procedure, based on the evidence of endoscopy, allows any member of the team, doctor or nurse, to detect the need for the indication, improving screening in terms of follow-up interval and technique.

Likewise, the inflammatory nurse will have to know the technique to be able to inform the patient and improve their adherence, preparation and resolve doubts.

The main aim is early detection of dysplasia and CRC.

The side aims are:

▪ To improve the implementation of chromoendoscopy as a technique for CRC screening.

▪ Improve patient adherence to colonoscopy.

Methods

The development of an endoscopic follow-up procedure according to risk factors in patients with ulcerative colitis and colonic Crohn's disease, in which chromoendoscopy is the technique of choice. The technique in our center is with 0.4% carmine indigo diffusion with catheter-diffuser, but it is possible to adapt other alternatives according to availability.

The procedure establishes the follow-up interval at 1, 3 or 5 years depending on the low, medium or high risk, respectively, depending on the activity, extent and duration of the disease, presence of stenosis and pseudopolyps, primary sclerosing cholangitis and/or family history of CRC.

Results

In our center, 100% of screenings are performed by chromoendoscopy with dye, by a single expert endoscopist, scheduled with a longer examination time than a conventional colonoscopy and with optimization of bowel preparation.

Conclusion

CRC screening of patients with IBD should preferably be performed with chromoendoscopy with dye, establishing follow-up intervals depending on known risk factors, both clinical, endoscopic and histological, and this indication should be standardized in a procedure that is known to all members of the team.
N46 Stress after an Ulcerative Colitis diagnosis: examining the role of psychological factors in Ulcerative Colitis using Interpretative Phenomenological Analysis
Authors: Black J , Norton C , Sweeney L , Czuber-Dochan W
Published: January 2024

Background

People with ulcerative colitis (UC) report higher levels of stress, anxiety, and depression than the general population. 89% of people with IBD in the UK surveyed in 2019 said they found coping hard. However, most relevant research relies on generic stress questionnaires which ignore confounders typical in UC, such as fatigue. This study aims to provide rich, detailed accounts of how individuals encounter stress after a UC diagnosis.

Methods

An hour-long, semi-structured interview was conducted in January 2022 with a 76-year-old man, reporting high levels of perceived stress and diagnosed with UC three months previously. He was asked about stressors, coping and support during UC diagnosis and beyond. Interpretative Phenomenological Analysis (IPA) examines the detailed, unique interpretation of a significant experience to an individual. IPA methodology follows four stages: exploratory notes; formulating Experiential Statements (ESs) summarising the meaning of the experience to the interviewee; connecting similar ESs and developing Personal Experiential Themes (PETs), the three to five most important elements of the participant’s experience.

Results

Four PETs were formulated:

My UC needs a positive, practical mental approach, not an emotional one

Mixed experience with healthcare services affected my anxiety and disease management

My UC symptoms and overall health affected my emotional well-being and coping

I believe there is an absence of evidence on UC’s causes, cure, or helpful lifestyle changes

The interviewee didn’t "dwell on these things" although he felt "it’s another thing and I’m going to have to deal with this long term". He "could email the nurse there if I had any problems and I did at one stage and got an instant reply" but at other times he felt "abandoned here because nobody is taking me seriously. I keep phoning these people up, they keep passing me to other people". He had developed "strategies to cope with being diagnosed" but was surprised "nobody seems to know why [UC onset] happens. There isn’t a cure for it. They don’t seem to know what causes these flare-ups etc. etc. and all we know is that it’s going to carry on."

Conclusion

Our interviewee described his symptoms and existing health and healthcare services as stressors, his family and clinicians’ support, his practical, unemotional approach to coping and the need to keep positive. IPA comprehensively captured the interviewee’s interpreted experiences after an UC diagnosis, charting nuanced relationships between stressors, support, and coping. Our study will analyse a further nine individuals’ experiences of stress in the year after an UC diagnosis to inform development of an intervention enhancing resilience to stress.
ECCO Grant Serotonin gets into your genes: the role of histone serotonylation in inflammatory response and visceral hypersensitivity in Crohn’s Disease
Authors: Ghiboub Mohammed , de Jonge Wouter J , Derikx Joep P M , van Heurn Ernst , van den Wijngaard Rene
Published: January 2024

Background and Aims

More than 70% of CD patients experience visceral hypersensitivity (VH) despite reaching remission. VH treatment is difficult because the mechanism of its complication is unknown. Serotonin is mainly produced in the gut and regulates several physiological processes, such as intestinal immunity and pain. Disturbances in serotonin levels are associated with CD severity and VH. Intriguingly, we have recently observed that serotonin can covalently bind to glutamine at position 5 on histone H3 tail, leading to histone serotonylation (H3Q5ser) in peripheral blood mononuclear cells (PBMCs). Another study has demonstrated that H3Q5ser can also occur in cultured neuronal cells. Our objective is to investigate the role of this newly discovered epigenetic signature (H3Q5ser) in immune cells and enteric neurons in CD and its potential impact on the transcriptional programs of the inflammatory response and VH.

Methods

To accomplish this goal, we will first determine the concentrations of serotonin in the mucosa and serum of active CD patients compared to healthy controls and establish how these levels relate to the enhancement of H3Q5ser in immune cells and enteric neurons. To study the functional role of H3Q5ser in cell activation, we will use site-directed or oligonucleotide- mediated mutagenesis to induce a point mutation in cultured enteric neuron cell lines and PBMCs to remove the binding site for serotonin on histone. Both wild-type and mutant cells will be incubated with or without serotonin and subjected to chromatin immunoprecipitation sequencing and RNA sequencing profiling to investigate the effect of H3Q5ser on the transcriptional programs associated with inflammation and VH.

Anticipated Impact

This project will provide a comprehensive understanding of the impact of the changes in serotonin concentrations on H3Q5ser-related gene expression in CD- associated VH and the inflammatory response. Our anticipated impact is subsequent studies that monitor H3Q5ser in VH in CD patients during treatment.
ECCO Grant Investigating regenerative pathways in salivary glands to mitigate oral manifestations of inflammatory bowel diseases
Authors: Monasterio G , Villablanca E
Published: January 2024

Background and Aims

Inflammatory bowel diseases (IBD) impact 4-16% of patients with extraintestinal manifestations in the upper gastrointestinal (GI) tract, including stomach and esophageal ulcers, dry mouth, taste alterations, halitosis, ulcers, and periodontitis. The underlying mechanisms remain unclear. This study hypothesizes that intestinal inflammation disrupts upper GI tract homeostasis by impairing salivary gland functions and aims to:

Aim 1: Elucidate cellular and molecular mechanisms of intestinal inflammation on upper GI tract mucosa and salivary glands.

Aim 2: Evaluate therapeutic potential of liver X receptor (LXR) activation in restoring salivary gland function in colitis-induced oral pathology.

Methods

I will use a novel mounting method for spatial proteogenomic analysis of upper GI tract mucosa to identify colitis-induced perturbations. Salivary glands will be studied separately, employing bulk and single-cell transcriptomic profiling to identify mechanisms driving colitis-induced atrophy, dysfunction, and candidate regenerative pathways. Additionally, salivary gland organoids will be used to study regeneration mechanisms in vitro, such as LXR activation, and the therapeutic potential of successful candidate pathways will be tested in vivo using pre-clinical models of colitis and salivary gland damage/repair (irradiation).

Anticipated Impact

This research will provide insights into mechanisms by which intestinal inflammation disrupts upper GI tract homeostasis through salivary gland impairment and assess the role of candidate pathways in salivary gland regeneration. In the short to medium term, findings may contribute to developing novel therapeutic strategies for managing colitis-induced oral pathology, benefiting the IBD community by improving patients' quality of life.
Impact of chronic obstructive pulmonary disease in patients with atrial fibrillation: an analysis from the GLORIA-AF registry
Authors: Romiti Giulio Francesco , Corica Bernadette , Mei Davide Antonio , Frost Frederick , Bisson Arnaud , Boriani Giuseppe , Bucci Tommaso , Olshansky Brian , Chao Tze-Fan , Huisman Menno V , Proietti Marco , Lip Gregory Y H
Published: January 2024

Aims

Chronic obstructive pulmonary disease (COPD) may influence management and prognosis of atrial fibrillation (AF), but this relationship has been scarcely explored in contemporary global cohorts. We aimed to investigate the association between AF and COPD, in relation to treatment patterns and major outcomes.

Methods and results

From the prospective, global GLORIA-AF registry, we analysed factors associated with COPD diagnosis, as well as treatment patterns and risk of major outcomes in relation to COPD. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). A total of 36 263 patients (mean age 70.1 ± 10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. The prevalence of COPD was lower in Asia and higher in North America. Age, female sex, smoking, body mass index, and cardiovascular comorbidities were associated with the presence of COPD. Chronic obstructive pulmonary disease was associated with higher use of oral anticoagulant (OAC) [adjusted odds ratio (aOR) and 95% confidence interval (CI): 1.29 (1.13–1.47)] and higher OAC discontinuation [adjusted hazard ratio (aHR) and 95% CI: 1.12 (1.01–1.25)]. Chronic obstructive pulmonary disease was associated with less use of beta-blocker [aOR (95% CI): 0.79 (0.72–0.87)], amiodarone and propafenone, and higher use of digoxin and verapamil/diltiazem. Patients with COPD had a higher hazard of primary composite outcome [aHR (95% CI): 1.78 (1.58–2.00)]; no interaction was observed regarding beta-blocker use. Chronic obstructive pulmonary disease was also associated with all-cause death [aHR (95% CI): 2.01 (1.77–2.28)], MACEs [aHR (95% CI): 1.41 (1.18–1.68)], and major bleeding [aHR (95% CI): 1.48 (1.16–1.88)].

Conclusion

In AF patients, COPD was associated with differences in OAC treatment and use of other drugs; Patients with AF and COPD had worse outcomes, including higher mortality, MACE, and major bleeding.