bluuebunny/crossref_metadata_2025 huggingface dataset:
P246 Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea
Authors: Cha J M , Park S H , Rhee K H , Hong S N , Kim Y H , Seo S I , Kim K H , Jeong S K , Lee J H , Park S Y , Park H , Kim J S , Im J P , Yoon H , Kim S H , Jang J , Kim J H , Suh S O , Kim Y K , Kim Y J , Ye B D , Yang S K
Published: January 2020

Background

No population-based study has evaluated the natural course of ulcerative colitis (UC) over three decades in non-Caucasians. We aimed to assess the long-term natural course of Korean patients with UC in a population-based cohort.

Methods

This Korean population-based SK-IBD cohort included all patients (N = 1013) newly diagnosed with UC during 1986–2015. Disease outcomes and their predictors were evaluated.

Results

During the median follow-up of 105 months, the overall use of systemic corticosteroids, thiopurines, and anti-tumour necrosis factor (TNF) agents was 40.8%, 13.9%, and 6.5%, respectively. Over time, the cumulative risk of commencing corticosteroids decreased, whereas that of commencing thiopurines and anti-TNF agents increased. During follow-up, 28.7% of 778 patients with proctitis or left-sided colitis at diagnosis experienced proximal disease extension. A total of 28 patients (2.8%) underwent colectomy, demonstrating cumulative risks of colectomy at 1, 5, 10, 20, and 30 years after diagnosis of 1.0%, 1.9%, 2.2%, 5.1%, and 6.4%, respectively. Multivariate Cox regression analysis revealed that extensive colitis at diagnosis (hazard ratio [HR] 8.249, 95% confidence interval [CI] 2.394–28.430), ever use of corticosteroids (HR 6.437, 95% CI 1.440–28.773), and diagnosis in the anti-TNF era (HR 0.224, 95% CI 0.057–0.886) were independent predictors of colectomy. The standardised mortality ratio in UC patients was 0.725 (95% CI 0.508–1.004).

Conclusion

Korean UC patients may have a better clinical course than Western patients, as indicated by a lower colectomy rate. The overall colectomy rate has continued to decrease over the past three decades.
P258 Managing an ever-increasing inflammatory bowel disease helpline service
Authors: Scott G , Gower L , Roads N , Lewis W
Published: January 2020

Background

Inflammatory bowel disease helplines have been initiated by Trusts throughout the country over many years. However many of them are not adequately job planned and have also seen a dramatic rise in calls over the years. Our Trust operates a helpline over 3 acute hospital sites. Previously calls were not accounted for financially and calls not documented in patient notes.

Methods

The nurses on each site utilise a standard form that notes the issues that patients contact the helpline for and the outcome of the call. The consultation is then dictated via a speech recognition system and a letter is generated and sent to the general practitioner. All calls are then added to a central spreadsheet which then categorises the calls into flare advice, medicines advice, investigation issues, appointment issues, etc.. The time that the call takes is also noted, to enable better job planning.

Results

The monitoring of these helpline calls have enabled the team to employ 2 further IBD nurses as the income generated has paid for them. It has also enabled better job planning and it has highlighted the increased number of calls that are taken by the nursing team and that they have been safely managed and accounted for. it has also enabled the team to trend the calls that are taken and the reasons why patients phone our helplines.

Conclusion

This project has shown a dramatic increase in activity for the IBD nurses. It has also highlighted the financial activity of the service and the contribution this provides to the gastroenterology department. This audit has since been utilised by the South East IBD Network.
P259 Systematic review of prognostic factors affecting the acquisition of transition readiness skills in patients with inflammatory bowel disease
Authors: JOHNSON L , Lee M , Jones G , Lobo A
Published: January 2020

Background

Around 25% of patients with inflammatory bowel disease (IBD) are diagnosed before the age of 20, meaning transition from paediatric to adult healthcare is inevitable for some. Good transition is important to maintain quality of care, and poor transition can result in adverse outcomes such as clinic and medication non-adherence. Certain skills are required in order for someone to be ready to transition, and the aim of this study was to identify modifiable and non-modifiable factors affecting the development of these skills in young people with IBD.

Methods

This review was registered on the PROSERO database (CRD42019152272) and conducted in line with PRISMA guidelines. Studies were included if they (1) explored factors affecting the acquisition of transition readiness skills in IBD patients 2) were written in English (3) were published since 1999. The databases MEDLINE, CINAHL and PsychINFO were searched from September - October 2019. Bias was assessed using the Quality in Prognostic Studies tool.

Results

Searches identified 822 papers and 27 full texts were retrieved. Sixteen papers were included in the final review, reporting on 1770 patients ranging from 10–29 years of age. Fourteen studies were cross-sectional and two longitudinal. Six assessed transition readiness, five self-management, two disease knowledge, one medication knowledge, one health literacy, and one both disease knowledge and self-management. Modifiable factors found were increased provider-communication about transition, transition duration, and health care satisfaction. Participant self-efficacy was found to be significant for three studies, and increased parent autonomy granting was related to higher disease knowledge in one study. Non-modifiable factors identified were age, sex, socioeconomic score, participant educational level and ethnicity. Nine studies showed increased age as a positive prognostic factor, and two additional papers found an effect for certain domains assessed. Four studies showed higher scores for females, and one study demonstrated higher self-rated self-efficacy scores for males. Disease-related non-modifiable factors identified were IBD family history, age at diagnosis, and absence from school.

Conclusion

This study identified five potentially modifiable factors. Strategies or interventions to address these in the IBD population transitioning to adult care might lead to improved experience and outcomes. This review also identified eight non-modifiable factors. This may allow healthcare and allied professionals to identify those at an increased risk of not developing the necessary competencies for transition and adapting the way in which they approach transition for each individual.
P262 Trends in the prevalence and severity of anaemia in paediatric patients with inflammatory bowel disease in the last decade
Authors: Geng S Y , Ridha Z , Pham B L , Tran E , Peixoto A , Tchogna S A , Deslandres C , Jantchou P
Published: January 2020

Background

Anaemia is one of the most common extraintestinal manifestations in patients with inflammatory bowel disease(IBD) at diagnosis. Studies have shown that anaemia was associated with low levels of quality of life, which improves with the correction of anaemia in adults. Recent data have shown an increase in the incidence and severity of paediatric IBD. We aim to investigate the trends in the prevalence of anaemia in children at diagnosis of IBD in the last decade. The secondary aim was to investigate the associations between haemoglobin (Hb) levels and disease characteristics.

Methods

Eligible patients (age ≤18 years, diagnosed with IBD from 2009 to 2018) were retrospectively identified through a prospective IBD database maintained at CHU Sainte-Justine, Montreal, Canada. Disease localisation and phenotype were defined according to the Paris Classification of IBD. Anaemia was defined by Hb levels according to WHO targets. The annual prevalence of anaemia was calculated according to subtype (inflammatory vs. iron deficiency). The Pediatric Crohn’s Disease Activity Index(PCDAI) and the Pediatric ulcerative colitis Activity(PUCAI) Index were used to assess the disease severity at diagnosis.

Results

We included 887 patients (439 females), mean(SD) age of 13.1 (3.4) years. Of these, 519 (58.5%) were identified with anaemia within 30 days of diagnosis. The median (IQR) Hb level at diagnosis was 108 (98 −114) g/dl. Severe anaemia(< 70 g/dl) was present in 1.8 % of patients. The prevalence of anaemia at diagnosis remained relatively stable ranging from 60.2% in 2009 to 60.4% in 2018. The annual proportion of inflammatory vs. iron-deficiency anaemia is displayed in Figure 1. Anaemia was more prevalent in CD (62.2%) than UC (57.9%) or IBD-U(39.6%). The median(IQR) PCDAI and PUCAI were respectively 37.5 (27.5–47.5) and 55.0 (40.0–65.0) in the anaemic group as compared with 27.5 (20.0–37.50) and 35.0 (25.0–55.0) in the non-anaemic group; p < 0.0001. Patients with anaemia had a lower BMI z-score [median(IQR) −0.84(−1.84–0.08)] than the non-anaemic patients[median(IQR) −0.38(−1.21–0.43)]; p < 0.001. The prevalence of anaemia correlated significantly with disease location: upper intestinal involvement [L4a(67.7%) L4b(63.6%) L4aL4b(60.7%) none (52.8%)] p = 0.024 for CD; for UC[E1(21.1%) E2(44.4%) E3(75.0%) E4 (71.1%)] p < 0.0001. A moderate correlation was found between Hb levels and C-reactive protein (r = −0.312, 95% CI: −0.378 to −0.243, p < 0.0001).

Conclusion

Anaemia remains a prevalent symptom in paediatric patients with IBD, and it is correlated with the extent of intestinal involvement and disease severity. The impact of anaemia at diagnosis and during follow-up on the levels of quality of life and physical activity is currently under investigation.
P282 Early disease acceleration in patients with newly diagnosed Crohn’s disease in India and Israel: Insights from an East-West inception cohort
Authors: Goren I , Yanai H , Pal P , Adigopula B , Pendyala S , Ganesh G , Yadgar K , Banerjee R , Dotan I
Published: January 2020

Background

Environmental and genetic factors might affect Crohn’s disease (CD) course. These are significantly different in developing countries such as India compared with the West, and may affect triggers of disease development and its early course. We aimed to assess early CD course in patients in India compared with Israeli patients (‘TiiiGER’ project).

Methods

Adults (>18 years) diagnosed with CD using accepted clinical, endoscopic and histologic criteria were prospectively recruited. Disease acceleration was defined by the first CD-related surgery, CD-related hospitalisation or recommendation to start steroids, immunomodulatory or biologic therapy.

Results: Overall 104- Indian and 156-Israeli patients were recruited. Indian patients had male predominance (65.4% vs. 50.6%, p = 0.019), were diagnosed at a significantly older age (37.8 ± 12.8 vs. 31.8 ± 12.8 years, p < 0.0001), had significantly more colonic disease location (35.6% vs. 19.2%, p = 0.003), and more stenotic behaviour (36.6% vs. 6.5%, p < 0.0001), compared with Israelis. During a mean follow-up of 14.5 ± 2.7 months, disease acceleration occurred in 50% of Indian and 66.7% of Israeli patients, within a median of 7.6 (interquartile range [IQR] 1.9–25.6) and 3.4 (IQR 1.3–23) months, p = 0.05. A lower ratio of Indian patients was treated with steroids, immunomodulatory or biologic therapy (hazard ratio 0.563; 95% CI, 0.373–0.851, p = 0.006).

Conclusion

In this Indo-Israeli inception cohort, more than half of the patients with newly diagnosed CD experienced early disease acceleration. Distinct features, different rates of disease acceleration and treatment policies, highlight the global need for research into key factors in IBD evolution across ethnically and geographically diverse populations.

*The final two authors contributed equally.
P285 Is faecal immunochemical test a suitable alternative to faecal calprotectin in children?
Authors: SANDHU K , Ayling R , Naik S
Published: January 2020

Background

Faecal calprotectin (FCP) has widely been used as a non-invasive marker for intestinal inflammation in children. Faecal immunochemical test (FIT) is well established in bowel cancer screening programmes in adults. FIT is cost-effective and easier to handle in comparison to FCP. We aimed to evaluate the performance of FIT in the paediatric population and compare it with FCP.

Methods

Clinicians in paediatric gastroenterology clinic who requested FCP for further investigation. These patients provided a sample of FIT from the same stool. These samples were collected over a 10-month period from November 2018 to September 2019. FIT samples were taken into a proprietary tube (Eiken Chemical, Tokyo, Japan) and stored at 4°C until analysis. FCP was measured using Liason Calprotectin (Diasorin, Italy).

Results

131 samples were returned; 131 FIT and 102 FCP of which 7 calprotectin samples were insufficient for analysis. In 95 patients we had paired samples for FIT and FCP. The normal range for FCP was 0–200 µg/g and for FIT was 0–4 µg/g. Twenty-three of 95 patients were non-IBD (24.2%). In the IBD group; 42 had Crohn’s, 27 ulcerative colitis and 3 indeterminate colitis. 15 were new diagnosis of IBD. In the 95 patients; FIT was normal (<4 µg/g) in 50 patients and abnormal (>4 µg/g) in 45 patients. FCP was normal (<200 µg/g) in 45 patients and abnormal (>200 µg/g) in 50 patients. FIT positively correlated with calprotectin, Spearman’s rank coefficient 0.653, p < 0.001. There were 32 patients with FIT >20µg/g and in 29 of these patients, FCP was >200 µg/g. In 60 patients with FIT and in 35 patients with FCP underwent colonoscopies. Table 1 shows the diagnostic value of FIT in comparison to histological inflammation.

The correlation of FIT with histological findings are shown in Figure 1. All patients with normal histology had a FIT <4 µg/g. In 91.4% of patients with moderate to severe histological inflammation had a FIT >5 µg/g.

Conclusion

Our study is the first to compare FIT and FCP in the paediatric population. Our results suggest that FIT correlates well with FCP and can be used to differentiate between functional bowel disease and inflammation in children. A FIT of > 20 µg/g was consistent with the finding of severe inflammation.
P288 Gut barrier failure biomarkers in IBD: Is there anything new beyond „The Wall’?
Authors: Sipeki N , Kovats P , Balogh B , Shums Z , Norman G L , Antal-Szalmas P , Papp M
Published: January 2020

Background

Several defects in the many specialised components of mucosal barrier have been reported in inflammatory bowel disease (IBD). These alterations may represent a primary dysfunction in Crohn’s disease(CD), but they may also perpetuate chronic mucosal inflammation in ulcerative colitis(UC). Changes in intestinal permeability can predict IBD course.

Methods

We aim to determine the predictive potential of a panel of serological markers that reflect either mechanical or immunological gut barrier dysfunction regarding determination of disease phenotype, therapeutic strategy and long-term disease course in a prospective referral adult IBD patient cohort.

Sera of 266 CD (m/f:112/154, median age:25 years, B1:80.1%, P1:18.0%) and 187 UC (m/f:86/101, median age:33 years, extensive colitis:28.3%) patients were assayed for intestinal fatty acid-binding protein(I-FABP) and various immunoglobulin A (IgA) molecules, anti-F-actin[AAA IgA/IgG] and anti-gliadin[AGA IgA/IgG]) by enzyme-linked immunosorbent assay (ELISA) along with 155 healthy controls (HCONT). Clinical data were available on unfavourable disease outcome as well as disease activity and medical treatment during the prospective follow-up (median: 143 and 135 mths for CD and UC respectively).

Results

In UC, median I-FABP level was significantly lower than in HCONT(177.2 vs. 244.3 pg/ml; p < 0.05). sIgA level was higher in both CD and UC compared with HCONT(51.2 and 46.0 vs. 29.2 μg/ml; p < 0.0001). AAA positivity with IgA type predominance was significantly higher in CD(40.2vs UC:15.7; HCONT:6.2%). AGA was also more prevalent in CD(16.5vs UC:6.7; HCONT:7.2%). There was an association between the presence of IgA type AAA or AGA and antimicrobial antibodies. ACA IgA was also more prevalent in case of AAA IgA positivity(52.9 vs. 32.7%, p = 0.009). PS/PT IgA positivity was higher in AGA IgA positive patients (33.3 vs. 7.6%, p = 0.001). Complicated disease behaviour at sample procurement was associated with the presence of AAA and AGA IgA positivity. In Kaplan–Meier analysis concomitant presence of IgA and IgG type AAA was associated with a shorter time to resective surgery (HR[95% CI]: 2.03[1.06–3.90]) along with a higher risk of a second surgery needed (HR[95% CI]: 2.82[1.14–6.98]). Sensitivity analysis showed that the later remained significant in B1 patients (p = 0.002) and also remained independent predictor in multivariate Cox-regression analysis comprising relevant clinical factors(HR[95% CI]: 2.88[1.07–7.78], p = 0.037).

Conclusion

The presence of AAA and AGA reflects the ongoing mucosal damage in IBD rather than has a value in predicting the disease course.
P290 Long-term disease outcome of ulcerative colitis (UC) in South Ostrobothnia, Finland with a follow-up time of 25 years
Authors: Kontola K , Oksanen P , Huhtala H , Tunturi-Hihnala H , Jussila A
Published: January 2020

Background

Finland has one of the highest prevalence of inflammatory bowel disease (IBD), especially UC. There is scarce data about long-term disease outcome in UC in population-based cohorts. The aim was to evaluate the long-term clinical outcome of patients with UC in the region of South Ostrobothnia, a district in rural central western Finland with a population of about 190 000.

Methods

All patients treated with diagnosis of UC or IBDU (inflammatory bowel disease Unclassified) during years 1981–2000 were included in this study. Data were collected retrospectively from the patient registry of the Central Hospital of South Ostrobothnia until 1 August 2019.

Results

There were 589 patients with a median follow-up time of 25 years. Median age at the diagnosis was 34 years. 59% of patients were male, 93% had UC and 7% IBDU. According to Montreal classification 80% had extensive disease, 15% left-sided disease and 5% proctitis. Medical treatment used at any point during the disease is shown in Table 1.

Twenty-two per cent of patients had colectomy. Of operated patients, (pan)proctocolectomy with ileostomy was performed to 50%, IPAA (ileal pouch anal anastomosis) to 40% and IRA (ileorectal anastomosis) to 3%. Median time from the diagnosis to surgery was 11 years; the risk of surgery is shown in Table 2.

Twenty-six per cent of the operations were emergency surgeries. The mean age at the time of surgery was 49 years. The indications for colectomy are specified in Table 3.

Cumulative risk of colorectal cancer (CRC) and biliary tract cancer was 3.2% and 1.7%, respectively. Twenty-eight per cent of patients died during follow-up, at the mean age of 72 years. The cause of death was recorded for 91/167 and the most common causes were cardiovascular disease and malignancy.

Conclusion

In this population-based cohort with surveillance of 25 years 22% patients with UC or IBDU were operated. Even after becoming available, biological medication is rarely used for UC patients diagnosed in the prebiologic era.
P292 Inflammatory bowel disease and their implications in Roma ethnicity: A preliminary study
Authors: Castro B , García García M J , Pascual M , Fernández-Forcelledo J L , Crespo J , Rivero M
Published: January 2020

Background

The pathogenesis of inflammatory bowel disease (IBD) is multifactorial and many factors have been involved such as genetic or environmental elements. The characteristics of IBD in different ethnic groups have been investigated to clarify the North-South gradient. We considered that Roma patients seem to have a more aggressive disease than Caucasian patients but no data to support this feeling is published. For this reason, the aim of our study is to analyse clinical characteristics of our cohort of IBD patients comparing Roma and Caucasian ethnicity

Methods

A retrospective cohort study was realised in both IBD Units to compare Roma and Caucasian groups. IBD patients were identified in the outpatient clinic. Demographical, clinical characteristics, pharmaceutical requirements and surgeries were collected. This group was matched by age, gender, disease and location of IBD with Caucasian patients.

Results

24 Roma patients were identified in our cohort. The prevalence of Gypsy ethnic group in our cohort was 1.66%. A percentage of 41.67% were men (n = 10) meanwhile 58.33% (n = 14) were women. The average age of the patients of our cohort was 43.77 years (SD 12.82). Crohn’s disease (CD) was observed in 62.5% (n = 15), ulcerative colitis (UC) in 29.19% (n = 7) and Unclassified IBD in 8.33% (n = 2). A statistic significant difference in family history was observed in the group of Roma patients (50%, n = 12 vs. 8.34%, n = 2) (p =0.001). Regarding to therapy, the Roma group required biological treatment in 58,32% (n = 14) compare to a percentage of 25% (n = 6) (p = 0.019) in the Caucasian group. We also found more hospital admissions (5.18 (SD 4,33) vs. 2,5 (SD 1,93) (p = 0,04)) and surgical procedures (41.66%, n = 10 vs. 12.5%, n = 3) (p = 0,023).

Conclusion

In our cohort, the Roma IBD patients showed more familial aggregation than the Caucasian group. An aggressive disease was also found in Roma patients and the subsequent increase in biological therapy, hospital admissions and surgical procedures to control the disease. Future studies should be performing to investigate genetic or environmental factors associated with this ethnic group.
P293 Loss of response after first-line biologic therapy in patients with inflammatory bowel disease: practical approach and management
Authors: Busacca A , Scrivo B , Giuffrida E , Guida L , Carrozza L , Calvaruso V , Cappello M
Published: January 2020

Background

Anti-tumour necrosis factors (anti-TNFs) have greatly improved therapeutic strategies for the treatment of inflammatory bowel diseases (IBDs). However, a significant number of patients do not respond or lose response over time (LOR). The aim of this retrospective prospective study was to evaluate patients (patients) treated with anti-TNFs as first-line treatment, with subsequent LOR, defined as recurrence of disease activity during maintenance therapy. We determine the prevalence of LOR and its management.

Methods

Three-hundred forty patients with IBDs were included: 65% had Crohn’s disease and 35% ulcerative colitis. Mean age at diagnosis was 31,5 years and medium time between diagnosis and start of biologic treatment was 72 months. Among 300 patients treated with anti-TNFs, LOR occurred in 33%, 38% was in treatment with Infliximab, 55% with Adalimumab, and 7% with Golimumab and it was statistically related with smoke (p = 0.028), type of drug (p = 0.001) and with the duration of treatment (p = 0.019).

Results

Among patients with LOR, 88% had a persistent clinical activity, evaluated by clinical scores (HBI and pMayo score) and 56% had a persistent endoscopic activity, evaluated by endoscopic scores (SES-CD and Mayo). After the LOR, 56% of patients optimised treatment for medium time of 7,8 month, 31% switched to another Anti-TNF, 7% swapped to a different class of biologics (Vedolizumab or Ustekinumab) and 4% had surgery as a treatment strategy. During treatment with anti-TNF as second-line treatment, LOR occurred in 17 patients. Anti-TNFs was the third line therapy in 3 patients, while Vedolizumab in 13. Only 2 patients in treatment with Vedolizumab had a second LOR and started Ustekinumab.

Conclusion

Loss of response occurred frequently in patients treated with biologics. Optimisation of treatment was not efficacious during a long period and the use of another biologic (anti-TNF or another class) is the more suitable strategy in our centre, with success in 35% of patients who lose response.
P306 Frequency and structure of extra-intestinal manifestations in IBD
Authors: Skalinskaya M , Skazyvaeva E , Bakulin I , Rasmagina I , Komarova D , Ivanova K
Published: January 2020

Background

IBD are immunomediated diseases that usually manifest at an early age, require lifelong pathogenetic therapy and significantly reduce the quality of life of a patient.

Methods

Since February 2017, the ‘North-West register of IBD patients’ has installed data of 1130 patients with an introduced diagnosis of UC or CD: 41.3% of them are patients with a diagnosis of CD and 58.7%—with a diagnosis of UC.

Results

Among patients with IBD the majority had mild (33.4%) and moderate activity (34%), a quarter was in remission and 7.65%—expressed activity. A population researches study using the University of Manitoba’s IBD epidemiology database (UMIBDED) reported that 6.2% of IBD patients had at least one extraintestinal manifestation, and 0.3% had several. The extraintestinal manifestations were observed in 43.4% of patients; meanwhile, 25% of them revealed mostly than one extraintestinal manifestation. System manifestations were more often registered in CD than in UC. The most frequent extraintestinal manifestations were signs of involvement of skeletal and muscular system. On the first place, it is peripheral arthropathy (73.6%), sacroiliitis (8.8%), ankylosing spondyloarthritis (8.8%), entezitis (10.3%) rheumatoid arthritis (1.5%), dactylitis (1.5%) were less frequent. Generally, articulate manifestations were noted by 17.5% of all included patients. In CD and UC, extra-intestinal manifestations were more often common in patients with a moderate attack (in 75.6 % and 51.6% of cases). In CD, extra-intestinal manifestations were more often frequent in patients with moderate attack −50.8%, in patients in remission there numbered to 32.8%, in severe attack-14.8%, in mild-1.6%. In UC, extra-intestinal manifestations were observed in severe attack in 2.6%, in moderate attack 35.9%, in mild attack 41%, in patients in remission 20.5%.

Conclusion

Among patients with IBD, extraintestinal manifestations, among which joint lesions prevail, are detected in 43.4% of the examined persons. The trend is noted to reduce the number of patients with severe attacks of the disease and extraintestinal manifestations, that can be related with improving the quality of diagnosis, reduction of terms of diagnosing and developing new methods of treatment for IBD. Peripheral arthropathy predominate among the extra-intestinal manifestations. We found no correlation between the severity of IBD and the presence of extra-intestinal manifestations. The spectrum of extra-intestinal manifestations includes more than 20 manifestations (diseases), which requires skills and experience in their diagnosis, as well as joint management of such patients by specialists of various profiles.
P307 Colorectal neoplasia risk in patients with inflammatory bowel disease and serrated lesions
Authors: De Jong M , Vos S , Nagtegaal I , van Herwaarden Y , Derikx L , Hoentjen F
Published: January 2020

Background

The presence of serrated lesions (SLs) is an established risk factor for colorectal neoplasia development in the general population. However, the impact of SLs on the colorectal neoplasia risk in inflammatory bowel disease (IBD) patients is unknown. In addition, SLs might have been misclassified in IBD patients in the past, in part due to revisions of classification systems. Presently, SLs are categorised as hyperplastic lesions, sessile SLs, and traditional serrated adenomas. We aimed (1) to compare the colorectal neoplasia risk in IBD patients with SLs vs. IBD patients without SLs, and 2) to study the subclassification of SLs in IBD patients before and after histopathological review by two expert gastrointestinal pathologists.

Methods

We identified all IBD patients with colonic SLs from 1996 to 2019 in a tertiary referral centre using the local histopathology database. Patients with neoplasia prior to SL diagnosis were excluded. Clinical data from patients’ charts were retrieved until June 2019. A subgroup of 135 SLs was reviewed by two pathologists. The log-rank analysis was used to compare the cumulative (advanced) neoplasia incidence in IBD patients with SL vs. IBD patients without SL undergoing surveillance in the same time period. Patients were censored at the end of surveillance or at colectomy.

Results

We identified 376 SLs in 204 IBD patients (61.9% ulcerative colitis (UC)). In the original reports, 91.9% was classified as a hyperplastic lesion. After histopathological review, 120/136 (88%) of the SLs were confirmed (16 were no SL). Of the 120 confirmed SLs, 62.2% was classified as a sessile SL, 37.8% as a hyperplastic lesion, and 0.8% as a traditional serrated adenoma. The mean time from IBD diagnosis to the first serrated lesion was 14.3 ( ± 12.3) years. A total of 41/204 (20.0%) of patients developed neoplasia (3 CRC, 3 HGD, and 35 LGD; including 2 HGD and 17 LGD at the moment of serrated lesion detection). In the 304 patients without SL (52.6% UC), 63 developed neoplasia (20.7%; 8 CRC, 5 HGD and 50 LGD). Patients who received follow-up colonoscopies after SL (n = 127) had an increased cumulative risk of neoplasia (p < 0.01), but no increased risk of advanced neoplasia (p = 0.50) compared with the group of IBD patients without SL (Figure 1).

Conclusion

The presence of SLs in IBD patients was associated with a relatively high risk of synchronous colorectal neoplasia as well as an increased risk of subsequent neoplasia, although not with an increased risk of advanced neoplasia. Histopathological review confirmed the SL diagnosis in the majority of lesions, although a large proportion of the hyperplastic lesions was reclassified as a sessile SL.
P309 Ferritin or transferrin saturation vs. soluble transferrin receptor for iron deficiency diagnosis in inflammatory bowel disease
Authors: DAUDE S , Remen T , Chateau T , Danese S , Gastin I , Baumann C , Gueant J L , Peyrin-Biroulet L
Published: January 2020

Background

Iron deficiency is common in inflammatory bowel disease (IBD) and can negatively affect the quality of life even in the absence of anaemia. Diagnosis of iron deficiency is based on ferritin and transferrin saturation (TfS) in routine practice, yet guideline thresholds are not evidence-based. Serum levels of soluble transferrin receptor (sTfR) are the best non-invasive test as it is not influenced by inflammation, but the test is costly with low availability. Thus, the aim of this study was to evaluate for the first time the accuracy of ferritin and/or TfS for diagnosing iron deficiency in IBD and identify the optimal thresholds of these parameters using sTfR as the gold standard.

Methods

Serum samples were collected from IBD patients (n = 2,072) receiving a biologic in routine practice. Diagnostic accuracy was assessed using receiver operating characteristic curves for ferritin and TfS levels separately or combined.

Results

No ferritin or TfS threshold had good diagnostic performance in CD patients. In UC patients with CRP <10 mg/l, optimal iron deficiency diagnostic performances were observed with ferritin and TfS thresholds of 65 µg/l and 16%, respectively. For UC patients with CRP >10 mg/l, the thresholds with the best diagnostic performance were 80 µg/l for ferritin and 11% for TfS. There was no added value for combined ferritin and TfS.

Conclusion

In conclusion, we found that ferritin and TfS are reliable parameters for iron deficiency diagnosis only in UC patients, at thresholds different from current guidelines. In CD patients, sTfR should be used given the poor diagnostic performance of ferritin and TfS.
P310 The efficacy of linked colour imaging, a novel endoscopic enhancement system, for diagnosing mucosal redness in ulcerative colitis patients in clinical remission
Authors: Takagi T , Uchiyama K , Kajiwara M , Azuma Y , Takayama S , Yasuda R , Inoue K , Ryohei H , Dohi O , Yoshida N , Kamada K , Ishikawa T , Yagi N , Naito Y , Itoh Y
Published: January 2020

Background

Endoscopic mucosal healing is considered as an important therapeutic goal in ulcerative colitis (UC) patients, and several endoscopic evaluations for colonic mucosa such as Mayo endoscopic subscore (MES) and Colitis Endoscopic Index of Severity (UCEIS) are used in clinical practice. Though the strict mucosal healing is defined as MES 0, the relapse of UC has been shown in the patients diagnosed as MES 0. In the present study, we aimed to investigate the efficacy of Linked Color Imaging (LCI), a novel endoscopic enhancement system, to predict long-term prognosis in UC patients diagnosed with MES 0.

Methods

Twenty-six patients with UC in clinical remission and diagnosed with MES 0 were enrolled. Endoscopic colonic images were assessed by LCI and UCEIS, using a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan). Endoscopic LCI images were classified into three subgroups by LCI classification as previously reported. Briefly, LCI patterns were classified as A, no redness; B, redness with visible vessels; and C, redness without visible vessels. Forty months was defined as the time interval between endoscopic diagnosis and relapse of UC. Histological activity was scored according to the Geboes’ score (GS) and the active mucosa was defined by GS>2B.1.

Results

LCI classification can further subdivide the colonic mucosa diagnosed as MES 0. The patients with LCI-A showed no relapse and the non-relapse rates compared with the patients with LCI-B showed significantly higher (p = 0.033), while the relapse rates of the patients with UCEIS 0 showed no difference compared with UCEIS 1 (p = 0.148). There was no statistical difference in the composition of LCI-A and relapse rate between active and inactive mucosa diagnosed by GS score.

Conclusion

Endoscopic LCI classification can further subdivide samples diagnosed MES 0. LCI can be a novel and surpassing approach to evaluate mucosal healing and predict the outcome in UC patients.
P313 Time to second pouchitis episode in a Dutch academic cohort
Authors: de Jong D C , Wasmann K , Buskens C , Bemelman W , Löwenberg M , Gecse K , Ponsioen C , D’Haens G , Hompes R , Duijvestein M
Published: January 2020

Background

Pouchitis is the most frequent long-term complication after proctocolectomy and ileal-pouch anal anastomosis (IPAA) in patients with ulcerative colitis (UC), with a long-term cumulative incidence of 24–59%.1,2 Pouchitis creates an important burden of disease with symptoms including urgency, increased stool frequency, mucinous and/or bloody stools and abdominal cramps. The majority of patients (65%) with an episode of acute pouchitis will experience at least one recurrence.3,4 However, these studies do not specifically address how soon these relapses will occur. The aim of this study is to determine the time until the second episode of pouchitis occurs.

Methods

In total, 353 consecutive UC patients who underwent RPC and IPAA from March 1999 until January 2018 were retrospectively reviewed. Information on the timing of pouchitis was retrieved from the electronic patient database. Baseline was defined as the date when the pouch was put in functional use. Pouchitis had to be objectified by endoscopic assessment at least once at one of the episodes. Patients with isolated ileitis of the afferent limb or cuffitis without pouchitis were excluded.

Results

91 (26%) patients received at least one endoscopic assessment of the pouch that showed pouchitis. Twenty-seven patients (30%) experienced only one episode of pouchitis, 42 patients (46%) had more than one episode and 22 patients (24%) went on to develop a chronic phenotype of pouchitis. The median time until the first episode of pouchitis was 388 days [IQR: 189–1049]. After excluding patients with only a single pouchitis episode and 9 chronic pouchitis patients who were treatment refractory or dependent after the first episode, 55 (60%) patients were assessed for the date of the second episode. Median time from the first episode until the second episode was 433 days [IQR: 272 – 1203] (Figure 1).

Conclusion

In this cohort of UC-IPAA patients, 70% of all pouchitis patients developed more than one episode of pouchitis or progressed into a chronic phenotype. The majority of second episodes of pouchitis occur within approximately 3 years of the first episode.
P317 Key features of bowel ultrasonography in managing inflammatory bowel disease patients
Authors: Les A , Iacob R , Costache R , Gheorghe L , Gheorghe C
Published: January 2020

Background

Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution.

Methods

Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS.

Results

Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p < 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness > 5 mm and for Doppler signal presence in the bowel wall (p < 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up.

Conclusion

The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.
P323 Successful validation of the quantum blue quantitative rapid test to monitor C-reactive protein in capillary blood of patients suffering from chronic inflammatory diseases
Authors: Takacs M , Hellige A , Schuster T , Schleifenbaum S , Föll D , Weber J M
Published: January 2020

Background

Only few biomarkers are useful for the therapy monitoring of patients suffering from inflammatory diseases, like inflammatory bowel disease (IBD) or rheumatoid arthritis (RA). Next to calprotectin C-Reactive Protein (CRP) is the best described and usually measured in the central laboratory. However, most patients are regularly checked at GP’s offices or small ambulatories. These sites need fast results with simple technology to react immediately. Our quantitative CRP rapid test based on lateral flow technology combined with a cost-effective reader fulfils all these criteria. It can be used with serum and whole blood. Here, we report the validation of the Quantum Blue® hsCRP in capillary blood and show first clinical applications of this new test.

Methods

The sandwich-type lateral flow test employing anti-CRP antibody-coated gold nanoparticles was calibrated with the ERM-DA474 CRP reference material. Fingerprick blood was collected and diluted 1:10 with a dedicated capillary blood preparation set and then applied onto the test cassette. After a 15-min incubation, the readout was performed with the Quantum Blue® Reader resulting in a quantitative measuring range of 1 to 20 mg/l. 122 capillary blood/serum pairs were collected to compare this rapid hsCRP test with the fully automated serum CRPL3 (PETIA) test on Roche cobas® c501. Clinical performance data together with concomitant CRP measurements were collated from 20 IBD and 69 RA patients. The resulting capillary blood CRP values including those from 28 healthy subjects were used to establish preliminary clinical cut-off values.

Results

56 capillary blood/serum sample pairs with values within the measuring range of both the hsCRP and the CRPL3 PETIA could be elected for a quantitative comparison. The capillary blood values were corrected against a mean haematocrit of 42%. A strong correlation (R = 0.941) with a minor bias of 6.1% by Bland-Altman plot was observed. Non-parametric analyses of capillary blood CRP levels from 20 IBD and 69 RA patients vs. their disease activity scores (CDAI, Mayo, DAS28, active joints) resulted in an upper reference limit of 5.8 mg/l and a 95%ile reference range from 1.0 to 19.7 mg/l. Patients with moderate (IBD) to severe (IBD, RA) disease activity could be significantly discriminated by capillary blood CRP from those with low activity or remission.

Conclusion

The BÜHLMANN Quantum Blue® hsCRP rapid test allows fast and easy detection of CRP in human capillary blood within 15 min in ambulatory settings. The assay shows an excellent absolute correlation to a fully automated serum CRP reference method. A preliminary clinical cut-off of 5.8 mg/l was established in two cohorts of IBD and RA patients to discriminate high from low disease activity.
P338 The effectiveness of a standardised biologic care pathway in the management and treatment of inflammatory bowel disease
Authors: Willett N , Heisler C G , Nazer N , Currie B , Phalen-Kelly K , Stewart M , Jones J
Published: January 2020

Background

inflammatory bowel disease (IBD) is a class of chronic immune-mediated diseases. Biologics have revolutionised the treatment of IBD. Existing literature suggests significant variation exists in the use of biologic treatment among physicians, from provider-specific prescribing to completion of the pre-biologic workup. These differences may influence the effectiveness of achieving and maintaining long-term remission. Clinical care pathways can standardise the use of biologics, improve patient outcomes, and increase consistency of care. The aim of the project was to determine whether the use of biologics to treat IBD managed within a standardised biologic care pathway (BCP) is safer and more effective compared with the current standard of care.

Methods

This was a retrospective, real-world cohort study of a prospectively implemented evidence-based BCP at the Nova Scotia Collaborative IBD (NSCIBD) program between 2015 and 2019. Patient inclusion criteria consisted of an adult with a diagnosis of IBD (including Crohn’s disease, ulcerative colitis, IBD-Unclassified) aged 18 years or older who was managed within the NSCIBD program. Preliminary descriptive analyses of the data are presented. Data collection is ongoing and multivariate analyses will be presented in full at ECCO.

Results

In total 249 patients were included in the cohort study (111 BCP patients, 138 non-BCP patients). The mean age was 49 years (range of 17–86 years). Sixty-nine per cent (171/249) of patients were diagnosed with CD, 28% (70/249) with UC, and 3% (8/249) with IBD-U. The mean duration of disease was 13 years (range of 0–36 years). Use of combination therapy was similar between the cohorts with 64% of BCP patients (n = 102) and 63% of non-BCP patients (n = 123) on combination therapy. Thirty-eight per cent of the BCP cohort required dosing interval changes vs. 29% in the non-BCP cohort (0.24 fold higher in BCP cohort). Seventy-one per cent of the BCP patients were exposed to TDM vs. 41% of the non-BCP cohort (0.40-fold more TDM in pathway cohort). Although 34% of BCP patients and 38% of non-BCP cohort patients reached clinical remission (n = 103 and 125, respectively), 38% of BCP patients and 21% of non-BCP patients achieved endoscopic remission (0.5-fold lower in the non-BCP cohort), (n = 29 and 53, respectively).

Conclusion

Preliminary analyses suggest patients managed within a BCP have their biologic management guided more often by the results of TDM and objective biomarkers than those not managed within a BCP. Although clinical remission was observed to be similar between the cohorts, attainment of endoscopic remission was more likely amongst patients managed within the BCP. Additional multivariate analyses will be presented at ECCO with a larger cohort size.
P340 Comorbidity is associated with safety outcomes in vedolizumab- and ustekinumab-treated inflammatory bowel disease patients
Authors: Asscher V , Biemans V , Pierik M , Dijkstra G , Van der Meulen-de Jong A , Löwenberg M , van der Marel S , de Boer N , Bodelier A , Jansen J , West R , Haans J , van Dop W , Weersma R , Hoentjen F , Maljaars J
Published: January 2020

Background

The effect of comorbidity on treatment outcomes of vedolizumab and ustekinumab in inflammatory bowel disease (IBD) patients is currently unknown. We aimed to assess the impact of comorbidity on safety and effectiveness of therapy in vedolizumab and ustekinumab treated IBD patients.

Methods

In this multi-centre prospective ICC Registry study, IBD patients from 10 IBD centres in the Netherlands starting vedolizumab or ustekinumab in regular care were enrolled. Prior to therapy initiation, comorbidity prevalence was assessed using the Charlson Comorbidity Index (CCI), a weighted index accounting for 16 comorbid diseases among which cardiovascular and pulmonary disease. The effect of an increased CCI was determined on safety outcomes (infection, all-cause hospitalisation and adverse events) during treatment and effectiveness outcomes (clinical response: reduction of ≥3 points in HBI/SCCAI, clinical remission (HBI ≤ 4/SCCAI ≤2), corticosteroid-free remission and biochemical ((CRP ≤5 mg/l and FCP ≤200 μg/g) combined with clinical remission) at 52 weeks of follow-up. Confounders were accounted for using multiple logistic regression.

Results

We included 203 vedolizumab and 207 ustekinumab treated patients: mean age 42.2 (SD 16.0) and 41.6 (SD 14.4) years, median HBI 7.0 (IQR 5.0–10.0) or SSCAI 5.0 (IQR 3.0–8.0) and median HBI 7.0 (5.0–11.8). Median treatment duration 54.0 (IQR 19.9–104.0) and 48.4 (IQR 24.4–55.1) weeks, median follow-up time 104.0 (IQR 103.1–104.0) and 52.0 weeks (IQR 49.3–100.4), respectively. More cardiovascular disease (congestive heart failure, myocardial infarction, peripheral vascular disease and cerebrovascular accidents/transient ischaemic attacks) and more pulmonary disease were present in vedolizumab patients at baseline (Table 1). CCI associated independently with safety outcomes in vedolizumab and ustekinumab. In vedolizumab, CCI associated with infection (OR 1.387, 95% CI 1.022–1.883, p = .036) and hospitalisation (OR 1.586, 95% CI 1.127–2.231, p = .008). In ustekinumab, CCI associated with hospitalisation (OR 1.621, 95% CI 1.034–2.541, p = .035). CCI did not associate with time to treatment cessation or effectiveness.

Conclusion

Comorbidity associated with all-cause hospitalisation in vedolizumab and ustekinumab treated IBD patients. A significant impact on infections was found only in vedolizumab treated patients. This study underlines the importance of comorbidity assessment in these IBD patients.