bluuebunny/crossref_metadata_2025 huggingface dataset:
P1191 Early Clinical, Biological, and Sonographic Response in Ileal Crohn’s Disease Patients Treated with Upadacitinib: A Single-Centre Real-World Experience
Authors: Maria A , Laura C , David R D L C , cristina O , Carmen G , Berta D L H , Francisco L , Ángeles M , carmen Y , Begoña C , Yago G L
Published: January 2025

Background

Upadacitinib (UPA), a selective JAK1 inhibitor, has shown efficacy in moderate-to-severe Crohn’s disease (CD), even in patients refractory to advanced therapies. This study aimed to evaluate the effectiveness, safety, and durability of UPA in refractory CD in real-world settings, with a focus on early objective assessment using biological markers and intestinal ultrasound (IUS).

Methods

A retrospective analysis was conducted on 41 CD patients (61% male, median age 40 years [SD: 33–53], mean disease duration 11 years [SD: 6–17]). Disease characteristics and prior treatments, including anti-TNF (100%), ustekinumab (70.7%), vedolizumab (19.5%), and risankizumab (9.8%), were recorded. Clinical (Harvey-Bradshaw Index [HBI]), biological (C-reactive protein [CRP], fecal calprotectin [FCP]), and IUS parameters (wall thickness, affected segment length, Limberg score) were assessed at 1, 2, 3, 6, and 12 months. Median follow-up was 8.2 months (SD: 4.8–12.3). Treatment patterns included standard induction (46.3%), extended induction (29.3%), and sustained high-dose (24.4%).

Results

Clinical response (≥2-point HBI reduction) was significant from week 4 and sustained throughout follow-up. Baseline CRP was 0.60 mg/dL (SD: 0.28–1.30), decreasing to 0.30 (SD: 0.05–0.80) at 1 month, 0.14 (SD: 0.04–0.64) at 3 months, and 0.10 (SD: 0.04–0.42) at 12 months, showing a non-significant downward trend. FCP dropped from 860 µg/g (SD: 270–1700) to 506 (SD: 186–2343) at 1 month, 260 (SD: 121–1200) at 3 months, and 205 (SD: 120–382) at 12 months, with a similar non-significant trend.

Of 31 patients with baseline IUS, 55.6% showed radiological improvement in at least two IUS parameters at 12 months, though not statistically significant.

Nine patients (22%) discontinued UPA due to adverse events (7.3%) or lack of response (17%). Non-severe adverse effects were reported in 53.7%, predominantly dermatological, without requiring dose adjustments or discontinuation. No severe infections, thromboembolic events, or cardiovascular complications were observed.

Conclusion

UPA demonstrated rapid, effective, and safe treatment for refractory CD in clinical practice. Trends toward early clinical, biological, and sonographic improvements were observed, highlighting its potential in real-world management of refractory CD.
P1194 Evaluating the Cost-Utility of Intestinal Resection Before Anti-Tumor Necrosis Factor Therapy for Strictures in Crohn's Disease in China
Authors: Tang X , Bai X , Yang H , Han W
Published: January 2025

Background

Crohn's disease is a chronic, relapsing immune-mediated disorder. Stricturing Crohn's disease is severe and frequent complication. The therapeutic landscape has been revolutionized with the advent of biologic agents.

Methods

A hybrid model was used. The model consisted of a decision tree model component and a Markov model component with 10-year follow-up for assessing the different therapies. Quality-adjusted life-years and costs were discounted at an annual rate of 5%. A sensitivity analysis was performed to evaluate the resilience of the results in the face of parameter uncertainty.

Results

According to our base-case analysis results, maintenance treatment with adalimumab after enterectomy is the most cost-effective (more quality-adjusted life-years gained and less cost incurred), followed by adalimumab ($47,709.37/QALY vs. $45,986.53/QALY vs. $66,526.40/QALY vs. $46,186.51/QALY). The results of one-way sensitivity analysis and probabilistic sensitivity analysis demonstrated the robustness of the model and base-case analysis accounting for the uncertainty of parameters.

Conclusion

In patients treated surgically after an initial diagnosis of intestinal stricture, adalimumab is a biologic agent that should be recommended for later maintenance therapy. In contrast, surgery may be recommended later in patients who were not treated surgically at the outset.

References

Knowles, S., et al., Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part II. Inflammatory bowel diseases, 2018. 24(5): p. 966-976.

Rieder, F., C. Fiocchi, and G. Rogler, Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases. Elsevier, 2017(2).

Mak, J.W.Y. and S.C. Ng, Epidemiology of fibrostenosing inflammatory bowel disease. Journal of digestive diseases, 2020. 21(6): p. 332-335.

Lin SN, M.R., Qian C, Bettenworth D, Wang J, Li J, Bruining DH, Jairath V, Feagan BG, Chen MH, Stenosis Therapy and Antifibrotic Research (STAR) Consortium; Rieder F. Development of antifibrotic therapy for stricturing Crohn's disease: lessons from randomized trials in other fibrotic diseases. Physiol Rev, 2022.
P1201 Pre- and postnatal metal exposures impact Crohn’s Disease risk and intestinal inflammation in an analysis of deciduous teeth
Authors: Tinoco da Silva Torres J , Midya V , Picker M , Martinez M , Moreira-Barbosa C , Kim T , H Allin K , Jess T , Saraiva S , Gouveia C , Talamini R , Brand E , Oldenburg B , Amil Dias J , Amorim R , Trindade E , Colombel J F , Peter I , Arora M , Agrawal M
Published: January 2025

Background

Early-life exposures influence long-term health, including the risk of IBD, however measuring these exposures is challenging. A prior pilot study showed that deciduous teeth could quantify environmental exposures. Here we analyzed essential and toxic metals in baby teeth to explore their impact on Crohn’s Disease (CD) risk during pre- and early postnatal periods.

Methods

We obtained deciduous teeth from 2 cohorts:1) individuals with CD and controls who had their baby teeth stored (IBD Tooth Fairy Study), and 2) offspring of women with and without IBD, followed since birth (MECONIUM Study). Essential [magnesium, calcium, chromium, manganese, cobalt, nickel, copper, zinc, molybdenum] and non-essential [lithium, aluminum, arsenic, strontium, cadmium, tin, lead, bismuth] metals were measured using laser ablation-inductively coupled plasma mass spectrometry. Teeth neonatal line was used as a reference to differentiate pre- and postnatal exposures. Data were analyzed using metal-to-calcium ratios to evaluate metal content variations over time. Weighted quantile regression analyses determined the relationship between metal mixtures (essential and non-essential) pre- and postnatally with incident CD (IBD Tooth Fairy Study) and with fecal calprotectin (Fcal) level at 2 years of age (MECONIUM Study).

Results

Sixty teeth were analyzed from the IBD Tooth Fairy cohort (27 CD, mean age at diagnosis 17y (range 5-32); 33 controls; mean age at recruitment 21.6y (range 7-48). Pre- and postnatal mixture of essential metals was associated with lower adjusted odds ratio (aOR) of CD, with manganese as the primary contributor (aOR [95%CI]: 0.51 [0.28, 0.91] and 0.69 [0.43, 1.12], respectively). Conversely, a mixture of non-essential metals was linked to increased odds of CD, with cadmium as the main contributor (aOR [95%CI]: 3.23 [1.11, 9.41] and 2.46 [1.24, 4.88], respectively) (Figure 1A).

From the MECONIUM Study, 29 teeth were analyzed (6, 6, and 17 from offspring of women with CD, UC, and controls, respectively). Median Fcal (mcg/gm) at age 2 years was 243.5 in offspring of women with IBD and 111 in offspring of women without IBD. A mixture of essential metals (pre- and postnatal) was associated with lower Fcal levels at age 2 years, with manganese being the highest contributor in both periods (Figure 1B).

Conclusion

Pre- and postnatal exposures to essential and non-essential metals, measured in baby teeth, were associated with the risk of developing CD and higher Fcal levels in babies at risk for IBD, with manganese being the top contributor in both cohorts. Future research should expand these findings and explore the mechanistic pathways through which these exposures affect IBD risk.
P1343 Impact of Biologic Therapy on Gut Microbiome in Crohn's Disease: An Indian Patient Cohort Study
Authors: Raghunathan N , Gunala N , Thakur M , Mekala D , Patel R , Bharath P , Kumari V , Gavate R , Banerjee R
Published: January 2025

Background

The advent of biologic therapy has revolutionized the treatment paradigm in IBD. In developing countries including India, where affordability and accessibility drive the treatment choice, it is important to understand the mechanisms behind biologic therapy and pave way to the future to predict response rates. This prospective study examines the impact of biologic therapy on the gut microbiome in moderate-to severe CD patients in India.

Methods

Fecal samples were collected from healthy controls(n=36) and 39 CD patients at baseline and after completing induction doze [Infliximab (n=16), Vedolizumab (n=6), and Ustekinumab (n=17)]. Individuals on recent antibiotics(<8weeks)/probiotics/NSAIDs were excluded. Clinical response was assessed at 6-weeks, with follow-up at 6 months to classify responders (CDAI<150) and non-responders(CDAI>150). DNA was isolated from 114 fecal samples and subjected to whole-genome shotgun metagenomics to generate a minimum of 6GB data per sample. After removal of human DNA read contamination, taxonomy and functional annotation was assigned using Kraken2, Bracken, and Human3 tools and statistical significance by using Wilcoxon Test (R-Studio).

Results

The gut microbiome in CD at baseline exhibited reduced diversity, lower SCFA-producing bacteria and increased pro-inflammatory bacteria like Collinsella and Escherichia compared to healthy cohort. The human DNA content in fecal samples was significantly higher in CD compared to healthy cohort with mean of 19.2% and 0.06% respectively. Post biologic therapy, there was significant restoration of the gut microbiome with increase in bacterial diversity, increased abundance of SCFA-producing Firmicutes and Phascolaractobacterium , probiotic Bifidobacterium species and reduction in pathogenic bacteria Enterococcus gallinarium. The average human DNA content also decreased to 9.6%. On sub-analysis, between responders (n=31) and non-responders; pathogenic Klebsiella pneumonia, Fusobacterium and Corynebacterium were found to be higher in non-responders compared to responders (Fig2A). Further, 19 metabolic pathways significantly differed between responders and non-responders, which included those pathways responsible for degradation of carbohydrates and generation of precursor metabolites and energy higher in the former (Fig2B).

Conclusion

There is increased gut dysbiosis in CD relative to healthy cohort which appears to get restored upon biologic therapy. The findings suggest the biologic therapy may play a role in restoring the compromised intestinal barrier in CD. A microbiome-based signature to predict response rates on biologic therapy can be seen in future.
P1348 Unique gut microbiome profile can distinguish Intestinal Tuberculosis and Crohn`s Disease: An Indian patient cohort study
Authors: Raghunathan N , Thakur M , Gunala N , Mekala D , Patel R , Bharath P , Banerjee R
Published: January 2025

Background

The rising IBD in the Tuberculosis(TB) endemic zones of Asia poses diagnostic challenges. TB and Crohn`s Disease (CD) have overlapping clinical symptoms, radiologic and histopathology features. Here, we aimed to study the gut dysbiosis in CD and ITB and use a machine-learning(ML)-based algorithm to identify a microbiome-based signature to distinguish the two conditions.

Methods

We recruited 26 confirmed ITB, 28 CD and 26 healthy controls. Fecal samples were collected from treatment-naive patients. Individuals on recent antibiotics(<8weeks)/probiotics/NSAIDs were excluded. Fecal DNA was extracted for 16SrRNA-V4 sequencing. Taxonomy(LEfSe) and functional pathway predictions (PICRUSt) were generated and analysed. Microbial taxa were classified based on Amplicon Sequence Variant Approach. Statistical analyses were performed using Wilcoxon Test (R-Studio). Seven ML-models were tested for performance to differentiate CD-ITB and identify a microbial signature using Gini index.

Results

Bacterial alpha diversity; both Shannon and Simpson indices were significantly lower in CD compared to ITB (Fig1A). The CD cohort showed reduced Firmicutes, but higher abundance of Bacteroidota and Desulfobacterota relative to ITB. The median Firmcutes: Bacteroidota ratio (F:B) was the least in CD (2.15), followed by ITB (4.4) and healthy (6.4) (Fig1B&C). Accuracies of KNN and XGBoost algorithms for differentiation between CD-ITB were 88% and 85%, respectively(Fig2A). Butyrate-producers Faecalibacterium, Lachnoclostridium, and Eubacterium hallii were lower in CD (Fig2B) with reduced abundance of 3 butyrate-production pathways (HEXITOLDEGSUPER-PWY,PWY-6628,PWY-5677). ML-based unique microbial signature of 6 taxa, including Escherichia coli, Romboutsia Streptococcus and Bifidobacterium was identified (Fig2C).

Conclusion

CD and ITB demonstrate significant differences in bacterial diversity and F:B ratio suggesting severe dysbiosis in CD relative to ITB. Reduced butyrate producers in CD and increased pathogens were key features. These findings highlight microbiome analysis as a promising non-invasive diagnostic tool for differentiating CD-ITB.
P1350 The Role of oral Porphyromonas gingivalis and Its Outer Membrane Vesicles in Inflammatory Bowel Disease
Authors: Yang C , Zhao Y , Chen J , Chen N
Published: January 2025

Background

The etiology of Inflammatory bowel disease (IBD) remains elusive, but emerging evidence suggests a potential link between oral microbiota and IBD. Porphyromonas gingivalis(Pg.), a major pathogen in periodontal disease, and its outer membrane vesicles(OMVs) may play significant roles in the development and progression of IBD.

Methods

Animal models of IBD were established to observe the impact of Pg. and its OMVs on intestinal inflammation. In vitro cell culture was conducted to explore the interaction between Pg.-OMVs and intestinal epithelial cells and immune cells.

Results

Through the analysis of salivary microbiota in IBD patients and healthy individuals, we observed a significant increase in the abundance of Pg. in the saliva of IBD patients. OMVs may serve as a novel medium for oral bacteria to communicate with the gut. Our findings indicate that Pg.-OMVs can promote the development of IBD through various mechanisms. Firstly, they can disrupt intestinal barrier function by promoting inflammation in intestinal epithelial cells and degrading tight junction proteins. Additionally, Pg.-OMVs carry pathogenic factors and pro-inflammatory molecules, which activate intestinal macrophages to polarize towards the M1 phenotype, inducing inflammatory responses. Beyond systemic effects, we discovered that the key virulence factor LPS of Pg. can stimulate oral epithelial cells to secrete exosomes. These exosomes exhibit pro-inflammatory properties, including the disruption of the intestinal mucosal barrier and the promotion of macrophage polarization towards the M1 phenotype, with subsequent secretion of inflammatory factors.

Conclusion

Porphyromonas gingivalis and its outer membrane vesicles play important roles in the pathogenesis of IBD. Understanding these mechanisms provides new insights into the relationship between oral health and IBD and may lead to the development of novel diagnostic and therapeutic strategies for IBD.
P1356 Comparison of different diagnostic test for detection of CMV colitis in hospitalized patients with ulcerative colitis: an interim analysis
Authors: Melotti L , Rinaldi M , Gabrielli L , Rosini F , Salice M , Scaioli E , Calabrese C , Dussias N , Vanigli N , Gionchetti P , Rizzello F
Published: January 2025

Background

Cytomegalovirus (CMV) colitis is a serious concern worsening the prognosis of patients with ulcerative colitis (UC) as an independent risk factor for hospitalization and surgery. European guidelines indicate that immunohistochemistry [IHC], tissue polymerase chain reaction [PCR], or possibly both, are essential for confirming active CMV colitis in IBD and should be considered as standard tests. The aim of our study is to evaluate the diagnostic performance of different tests used for diagnosis of CMV infection in comparison with the gold standard in hospitalized patients for UC flare.

Methods

We prospectively included consecutive UC patients hospitalized for a UC flare since March 2024. UC activity was assessed according to the Truelove&Witts score together with CMV-DNA PCR on blood, stool, tissue and IHC on colonic biopsies were all performed within 5 days from admission. Demographic data, history of medications, lab test at admission were collected for every patient. Patients were treated for UC according to guidelines; in case of CMV positivity on IHC or tissue CMV PCR > 250 cp/mg (qPCR) they received either ganciclovir or vanganciclovir if useful according to investigators. We registered clinical remission and need of surgery within 30-days from hospitalization.

Results

In this interim analysis we collected data on 51 patients. Of these, 70.6% were admitted with severe UC according to the Truelove&Witts score, with a median endoscopic Mayo score of 3, and 49% of the patients were steroid-refractory at hospital admission. 63% of patients achieved clinical remission 30 days after admission, whereas 37% did not show signs of response, including 4 patients who needed surgery within this time frame. In our cohort 16/51patients (31.4%) were diagnosed with CMV colitis according to IHC or qPCR > 250 cp/mg, while only 3/51 patients (5.8%) confirmed the diagnosis according to IHC criteria. Only 8 patients received antiviral treatment; in the remaining 8 cases antiviral treatment was not indicated due to lack of presumed clinical benefit. Blood positive CMV-DNA was found in 8 patients; among them 5 were confirmed with CMV colitis. Only 3 patients tested positive for stool CMV-DNA, however all of them received a subsequent confirmation of CMV colitis.

Conclusion

Concordance between diagnostic criteria (qPCR vs IHC criteria) was low confirming the unreliability of currently accepted diagnostic test. Preliminary data about alternative sources of CMV DNA testing looks promising and more reliable. Further data are needed to attain definite conclusions.
N28 The UK Inflammatory Bowel Disease Reasearch Network ; Preliminary results from advanced therapies in Inflammatory Bowel Disease a multi-centre evaluation of current practice
Authors: Cairnes V , Devine D , Wen S , Owen H , Mason I , KIrkham B , Harrision W , Diaz R , Robinson K , Chan M , Campbell R , Tyrrell T , Gray L , Clarke M , Hawkins S , LLoyd-Ford G , Avery P ,   The UK Inflammatory Bowel Disease Nurse Research Network
Published: January 2025

Background

In early 2024, 25 research-ready nurses specialising in IBD joined the United Kingdom IBD Nurse Research Network (UK IBD NRN). This network is dedicated to collaborating on national service evaluation and research initiatives, aiming to enhance service delivery and improve patient experiences within IBD care. Each year, the network will undertake one project, with a ballot for ideas held towards the end of the project. The first initiative focuses on monitoring advanced therapies (AT-IBD) used in the UK for treating IBD.

Current recommendations for monitoring advanced therapies in IBD remain ambiguous, and the efficacy of proactive therapeutic drug monitoring (TDM) is still uncertain. To address this, we sought to explore the variations in monitoring practices across IBD services in the UK, focusing on key areas such as access to medication, adherence to monitoring protocols, and the effectiveness of therapeutic drug monitoring.

Methods

Data collection instruments using REDCap were created and launched in November 2024. Data includes site demographics, a minimum of ten and a maximum of 25 reactively and proactively monitored cases. The case data is collected from retrospective monitoring events and anonymised. Descriptive statistics are used to report results.

Results

Seventeen unique users are entering data from 15 sites. The survey is open to all four nations of the UK. Responses have been received in England and Wales. Of the 17 users (15;82.4%) reported having had training to interpret blood results. IBD patient population was reported by seven out of eleven sites, with a total of 39,843 reported. Two sites shared the entire local population, and three were reported as unknown. The seven sites that reported the IBD patient population used an electronic health record. There is variance in the pre-screening undertaken (Figure 1);

access to advanced therapies appears different, with some sites not having access to newer small-molecule medications (Figure 2).

There is wide variation in routine and TDM frequency across all therapies.

Conclusion

The AT-IBD project is ongoing, with full results anticipated to provide insights into current practices for monitoring advanced therapies in the UK. The collected data may offer valuable insights regarding adherence and the effectiveness of advanced therapy monitoring, particularly concerning patient safety and outcomes. The UK IBD NRN remains committed to providing opportunities for training, collaboration, and research for IBD nurses across the UK.
N46 Exploring the impact of initiating a Patient Reported Outcome Measure (PROM) by utilising an Inflammatory Bowel Disease (IBD) pre clinic questionnaire prior to patients attending an IBD outpatients clinic
Authors: Scott G
Published: January 2025

Background

Initiating a Patient Reported Outcome Measure (PROM) through an Inflammatory Bowel Disease (IBD) pre-clinic questionnaire can have a significant impact on the management and outcomes of patients attending an IBD outpatient clinic. This includes improved patient-centred care by enhanced understanding of the patient experience and targeted consultations, improved clinical outcomes, enhanced communication and shared decision making and increased efficiency and resource utilisation.

Methods

The PROM pre-clinic questionnaire was designed by the Consultant Nurse and was sent to a sample group of patients with IBD for their thoughts. The Consultant Nurse was keen to hear the views of the patients on the suitability of the questions, length of the questionnaire, any topics not covered in the questionnaire, and why we are requesting this to be completed prior to clinics. This exercise proved very popular with the patients as they felt that we really wanted to know what they thought and that they were involved from the start.

Results

Initiating a Patient Reported Outcome Measure (PROM) through an IBD Pre-Clinic Questionnaire has led to a number of significant improvements within the clinic for both patients and service alike, This includes early identification and interventions for patients, individualised treatment plans, better understanding of patient concerns, increased patient engagement, efficient use of clinic time, and quality improvement initiatives. The main improvement is that the patients loves it as it gives them the vehicle to highlight their concerns. The PROM pre-clinic questionnaire was started on one clinic and is now used on all of my clinics. Now we know that the system works we will be sending this questionnaire to our patients virtually prior to each clinic and will be rolling this out to all nurse led clinics.

Conclusion

Initiating a Patient Reported Outcome Measure (PROM) using an IBD pre-clinic questionnaire has the potential to significantly enhance the management of IBD in outpatient settings. It improves patient-centred care, clinical outcomes, communication, efficiency, and overall patient engagement and satisfaction. While there are challenges to implementation, the benefits for both patients and healthcare providers make a compelling case for the adoption of PROMs in IBD management.
N47 Implementation of a Nurse Led Vaccination clinic for Inflammatory Bowel Disease patients
Authors: O Sullivan C , Keogh A , Sugrue K , Gleeson S , McCarthy J , Buckley M , Moran C , Sheehan D , McDonald C , O Brien L , Twomey R
Published: January 2025

Background

Patients over the age of 50 years and those who are on immunosuppressive therapy are at increased risk of contracting Herpes Zoster (Shingles). Most recent international (ECCO) guidelines have recommended that all patients commencing on JAK inhibitors be vaccinated to ensure optimum protection against the Shingles Virus. Shingrix (non-live) vaccine is available in Ireland but is not reimbursed by the HSE, therefore patients are required to pay privately. Unfortunately, due to the significant cost of receiving this vaccine in the community the uptake among IBD patients is minimal.

The aim of this clinic was:

•To provide optimum protection against the Shingles virus to all IBD patients commencing on a JAK inhibitor

•To eliminate the burden of shingles for immunocompromised patients with IBD

•To ensure evidence-based practice is adhered to in line with national and international guidelines

•To provide a nurse led vaccination clinic for patients with IBD

•To ensure that all patients with IBD have equal access to Shingrix

Methods

We negotiated with the pharmacy department to ensure all patients on JAK inhibitors have access to Shingrix vaccination at no cost to the patient. A business case was submitted to the Mercy University Hospital Drugs and therapeutics board. Vaccination protocol was designed with key stakeholders, which was then communicated to all team members. A weekly nurse led vaccination clinic was established in October 2023. Vaccination administration given in two consecutive doses as per guidelines.

Results

Since the launch of the weekly nurse led vaccination clinic, 196 vaccinations have been administered to date, with 98 patients fully vaccinated with Shingrix (non-live vaccination). JAK inhibitor treatment can now be commenced without delay, resulting in increased patient satisfaction with the IBD service. Of the vaccinated patients, to date, none have developed Shingles.

Conclusion

This nurse led project has ensured that patients with IBD who require treatment with a JAK inhibitor can now avail of vaccination in line with national and international guidelines resulting in increased patient service satisfaction and reassurance following vaccination with nil adverse effects experienced from patients.

References

T Kucharzik, P Ellul, T Greuter, J F Rahier, B Verstockt, C Abreu, A Albuquerque, M Allocca, M Esteve, F A Farraye, H Gordon, K Karmiris, U Kopylov, J Kirchgesner, E MacMahon, F Magro, C Maaser, L de Ridder, C Taxonera, M Toruner, L Tremblay, M Scharl, N Viget, Y Zabana, S Vavricka, on behalf of the European Crohn’s and Colitis Organisation [ECCO], ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease, Journal of Crohn's and Colitis, Volume 15, Issue 6, June 2021, Pages 879–913, https://doi.org/10.1093/ecco-jcc/jjab052
N48 Fatigue in Inflammatory Bowel Diseases: A Bibliometric and Content Analysis
Authors: Terzi A , Artan Y , Yıldırım Y , Deveci Kocakoç İ
Published: January 2025

Background

Fatigue in inflammatory bowel diseases is a symptom that can significantly affect quality of life and comfort, which can bring symptoms such as sleep disorders and pain. In this study, a bibliometric analysis of studies on fatigue in inflammatory bowel diseases was conducted.

Methods

The analysis of the study was conducted with the biblioshiny program, which is the application of the bibliometrix package. Studies conducted between 1987 and 2024 were included in the search. The search was performed using the keywords "IBD", "Inflammatory Bowel Disease", "ulcerative colitis", "Crohn's disease" and "fatigue". A total of 520 studies were reached, 288 articles remained when book chapters and proceeding papers were excluded, these studies were also reviewed by three experts, and when irrelevant publications were excluded, a total of 238 articles were analyzed.

Results

According to the results of the analysis, the years with the highest number of studies were 2023, 2022 and 2021, respectively. The top three journals with the most publications were Journal of Chrons & Colitis, Inflammatory Bowel Diseases, Alimentary Pharmacology and Therapeutics (Figure 1). The country with the highest number of publications on the subject is the Netherlands. Most relevant words quality of life, crohns disease and depression (Figure 2).

Conclusion

The study results show that there has been an increase in studies on IBD and fatigue in recent years. The pandemic period may be one of the factors in this increase. The prominence of words such as quality of life and depression indicates that fatigue is closely related to psychological problems and quality of life. Therefore, it is recommended that future studies on IBD should address the multidimensional aspects of fatigue and investigate the effects of these conditions on treatment and care.

References

Nocerino, A., Nguyen, A., Agrawal, M., Mone, A., Lakhani, K., & Swaminath, A. (2020). Fatigue in inflammatory bowel diseases: etiologies and management. Advances in therapy, 37, 97-112. Van Langenberg, D. R., & Gibson, P. R. (2010). Systematic review: fatigue in inflammatory bowel disease. Alimentary pharmacology & therapeutics, 32(2), 131-143.

Van Langenberg, D. R., & Gibson, P. R. (2010). Systematic review: fatigue in inflammatory bowel disease. Alimentary pharmacology & therapeutics, 32(2), 131-143.
N51 How to guide, for selecting and managing High Cost Drugs in Inflammatory Bowel Disease (IBD)
Authors: Scott G , Abreu B
Published: January 2025

Background

We developed this guide as our gastroenterology consultants requested a tool which summarise biologics/small molecules guidelines to help with decision making in regards to starting, escalating or switching treatment, without requiring extensive research. This would allow junior doctors to be familiar with these IBD drugs. This guide is being used by consultants, in teaching sessions with junior doctors and distributed on the wards. To assess the benefits, we aim to use a questionnaire so we can improve.

Methods

This started in March 2024 and a first copy was distributed with doctors in April 2024. The document was developed to be concise and made in 2-pages. As requested, includes drug class, brand, administration route, induction, maintenance, option to escalate dose, pre-screening and routine bloods, contraindications, common side effects and age range. Most doctors are aware of the drug but not on administration route or monitoring which can influence the choice. We noted during IBD clinics that sometimes the biologic suggested does not fit patients’ lifestyle, which requires re-discussion with consultant for a more suitable option, which delays treatment. To evaluate this project, we are taking verbal feedback and aim to use a questionnaire among experienced consultants and junior doctor.

Results

The guide is being used during teaching session given by IBD lead to junior doctors and they say this is a resourceful tool for their knowledge development and consolidation. We do not have results from questionnaires but we aim to collect and analyse. One gastroenterology consultant emailed “Great initiative and very practical guide!” Doctors discuss with patients the options accurately and when attending IBD clinic they are aware of the options allowing an informed decision for a drug which suits their lives, and start as soon as possible. On the wards, teams are aware of some IBD treatments, this allows them to arrange the necessary pre-screening while waiting IBD review.

Conclusion

For this to continue to be updated, we will follow the latest studies. Some individuals have concerns because of the lack of experience. If they have the main guideline available, this will bring more confidence and allows space for treatments to be compared. Administration route, blood monitoring and socioeconomic factors can affect the medication that we chose for patients, it is essential that when counselling, doctors are also aware of this. Most recently, patients are referred to IBD team with a clearer plan and more aware of the implications. Following positive feedback, we are planning other guides for mesalazine and corticosteroids. This can be shared with other departments with IBD patients, such as endoscopy and surgical wards.
Perianal Crohn’s disease across borders – understanding unmet needs to aid future global solutions
Authors: Hart A
Published: January 2025

Background and aims

Perianal Crohn’s disease (pCD) represents a challenging manifestation of CD, with a high symptomatic and psychological burden for patients. Epidemiologic differences in this CD phenotype have been reported across the world. At ECCO 2020, a Consortium was established to address pCD. An initial project was the development of a new classification of perianal fistulising Crohn’s disease (PFCD) (Geldof et al. LGH 2022). It has now developed “standard operating procedures” (SOPs) for clinical, radiologic and biosample collection, to facilitate consistent and collaborative research. Aims: Now, the Consortium’s goals are to expand and support low- and middle-income countries (LMICs), to 1) build data collection platforms to explore phenotypic similarities and differences across continents in PFCD regarding demographics, diagnosis (including issues around delayed diagnosis), treatments, outcomes and molecular architecture (using transcriptomic techniques); and 2) enable infrastructural developments at collaborating sites to support future IBD research and education, using PFCD as the template.

Methods

Collaborations have been established with Asia, South America and Africa. Data collection templates developed by the Consortium (with a data dictionary) will be used to interrogate a cohort of patients with PFCD (demographics, disease distribution, diagnosis pathways, treatment outcomes – both medical and surgical). Additionally, data will be collected from an inception cohort of patients with new PFCD. Biosample collection and banking will be conducted, prioritising new diagnosis/treatment-naïve patients and will focus on transcriptomic research (where pilot data points to differences).

Anticipated impact

This proposal will address each item of ECCO’s 5-year REACH strategy. It will assess time to diagnosis, equitable access and sustainable healthcare, probe pathogenic drivers of this CD-phenotype and address the holistic impact of PFCD in different parts of the world. Importantly, it will drive learning, understanding and education to improve care for pCD patients globally and establish networks and infrastructure for wider IBD research.
Prevalence, clinical and anorectal function characterization of faecal incontinence and rectal urgency in ulcerative colitis patients (HOPE Study)
Authors: Casanova M J , Gisbert J P , Santander C , Alcaide M J , Barbeito E e , Barreiro de Acosta M , Bermejo E , Carrión S , Cuevas del Campo L , de Benito M , Rubín de Célix C , García Alonso J , Fe García-Sepulcre M , Hernández Camba A , Huguet J M , Matallana V , Rodríguez D M , Opio V , Muñiz M P , Ramos L , Riestra S , Sanahuja A , Sequeiros M D , Sierra Moros E , Torra S
Published: January 2025

Background and aims

Faecal incontinence (FI) and rectal urgency (RU) are underestimated and underdiagnosed in ulcerative colitis (UC) patients. Our primary aim is to evaluate the prevalence and severity of FI and/or RU in UC patients. Secondary aims include investigating the causes of FI and/or RU, identifying factors associated with FI and/or RU, and describing anorectal function in UC patients in remission who report these symptoms.

Methods

This is a prospective, multicentre study with two parts. The first part is an epidemiological analysis involving 667 UC patients, in whom the prevalence of FI and/or RU will be assessed. The second part focuses on characterizing anorectal function in patients who report FI and/or RU while in remission. As per clinical practice, an endoscopic study will rule out disease activity as a cause of symptoms in all patients reporting FI and/or RU in the first part. Those confirmed to be in remission will proceed to the second part, where anorectal function will be evaluated using high-resolution anorectal manometry. Therapeutic strategies for FI and RU will be proposed following clinical practice guidelines, and we will record responses to these treatments and their impact on symptom severity. Additionally, we will assess the impact of these therapeutic strategies on patients' quality of life.

Anticipated impact

To provide effective therapy for FI and/or RU in UC patients, it is essential to understand their prevalence during both active disease and remission, as well as the underlying mechanisms in remission. Our study aims to reveal the true prevalence of FI and RU in UC patients, expand knowledge of anorectal function in those in remission, and help identify therapeutic targets to alleviate these burdensome symptoms, ultimately improving quality of life for affected individuals.
Divergence in genetic (co)variances and the alignment of gmax with phenotypic divergence
Authors: Jarvis Will M C , Careau Vincent , Rundle Howard D
Published: January 2025

To better understand the sources of biological diversity in nature, we need information on the mechanisms underlying population divergence. Biological systems with patterns of naturally occurring adaptive variation among populations can provide insight into the genetic architecture of diverging traits and the influence of genetic constraints on responses to selection. Using a system of reproductive character displacement in the North American mushroom-feeding fly Drosophila subquinaria, we assessed patterns of genetic (co)variance among a suite of chemical signaling traits and divergence in this pattern among populations. D. subquinaria exhibits stronger reproductive isolation against the closely related Drosophila recens in sympatry, where both female mating preferences and male chemical signaling traits have diverged from the ancestral allopatric populations. We collected 3 wild populations from each region and, in the lab, characterized the phenotypic divergence in these traits, as well as the additive genetic (co)variance structure (G-matrix), via replicate breeding designs. We found divergence between allopatric and sympatric D. subquinaria in the shape and size of the G-matrix, and that the leading axis of genetic variance (gmax) had changed in sympatry to come into alignment with the primary axis of phenotypic divergence between the sympatric and allopatric regions.
The Afterlives of Transitional Justice
Authors: Zvobgo Kelebogile , Parente Francesca
Published: January 2025

ABSTRACT∞

Rising authoritarianism, far-right parties and violent political movements in the 21st century prompt scholars and practitioners to revisit two foundational assumptions in the transitional justice field, which was established in the 20th century amid the third wave of democratization. The first is that transitional justice is a consequence and a cause of democratic transition and consolidation. The second is that transitional justice has been a successful global project. Current political developments challenge us to take stock of the field and consider the implications for current and future scholarship and practice. In this introduction to the ‘Afterlives of Transitional Justice’ special issue of the International Journal of Transitional Justice (IJTJ), we first reflect on the many forms (‘lives’) that transitional justice has taken over the decades. The contributions address transitional justice’s life in three ways: as the transition to democracy, as the tools and processes themselves and as an academic and practice field. We then consider evolution and change in transitional justice (‘afterlives’). In increasingly perilous times for human rights, we hope that the insights gathered in these pages will help affected communities, activists, practitioners, policymakers and scholars look back in order to move forward and uphold the promise ‘Never again!’
Evaluating dimensionality reduction of comorbidities for predictive modeling in individuals with neurofibromatosis type 1
Authors: Gupta Aditi , Hillis Ethan , Oh Inez Y , Morris Stephanie M , Abrams Zach , Foraker Randi E , Gutmann David H , Payne Philip R O
Published: January 2025

Objective

Dimensionality reduction techniques aim to enhance the performance of machine learning (ML) models by reducing noise and mitigating overfitting. We sought to compare the effect of different dimensionality reduction methods for comorbidity features extracted from electronic health records (EHRs) on the performance of ML models for predicting the development of various sub-phenotypes in children with Neurofibromatosis type 1 (NF1).

Materials and Methods

EHR-derived data from pediatric subjects with a confirmed clinical diagnosis of NF1 were used to create 10 unique comorbidities code-derived feature sets by incorporating dimensionality reduction techniques using raw International Classification of Diseases codes, Clinical Classifications Software Refined, and Phecode mapping schemes. We compared the performance of logistic regression, XGBoost, and random forest models utilizing each feature set.

Results

XGBoost-based predictive models were most successful at predicting NF1 sub-phenotypes. Overall, features based on domain knowledge-informed mapping schema performed better than unsupervised feature reduction methods. High-level features exhibited the worst performance across models and outcomes, suggesting excessive information loss with over-aggregation of features.

Discussion

Model performance is significantly impacted by dimensionality reduction techniques and varies by specific ML algorithm and outcome being predicted. Automated methods using existing knowledge and ontology databases can effectively aggregate features extracted from EHRs.

Conclusion

Dimensionality reduction through feature aggregation can enhance the performance of ML models, particularly in high-dimensional datasets with small sample sizes, commonly found in EHRs health applications. However, if not carefully optimized, it can lead to information loss and data oversimplification, potentially adversely affecting model performance.
Supplemental Screening With MRI in Women With Dense Breasts: The European Perspective
Authors: Kilburn-Toppin Fleur , Allajbeu Iris , Healy Nuala , Gilbert Fiona J
Published: January 2025

Breast cancer is the most prevalent cancer in women in Europe, and while all European countries have some form of screening for breast cancer, disparities in organization and implementation exist. Breast density is a well-established risk factor for breast cancer; however, most countries in Europe do not have recommendations in place for notification of breast density or additional supplementary imaging for women with dense breasts. Various supplemental screening modalities have been investigated in Europe, and when comparing modalities, MRI has been shown to be superior in cancer detection rate and in detecting small invasive disease that may impact long-term survival, as demonstrated in the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial in the Netherlands. Based on convincing evidence, the European Society of Breast Imaging issued recommendations that women with category D density undergo breast MRI from ages 50 to 70 years at least every 4 years and preferably every 2 to 3 years. However, currently no countries in Europe routinely offer women with BI-RADS category D density breasts MRI as supplemental imaging. The reasons for lack of implementation of MRI screening are multifactorial. Concerns regarding increased recalls have been cited, as have cost and lack of resources. However, studies have demonstrated breast MRI in women with BI-RADS category D density breasts to be cost-effective compared with the current breast cancer screening standard of biannual mammography. Furthermore, abbreviated MRI protocols could facilitate more widespread use of affordable MRI screening. Women’s perception on breast density notification and supplemental imaging is key to successful implementation.
Noisy nocebo harms: a two-part problem for active drug surveillance
Authors: Due Austin
Published: January 2025

Objectives

To illustrate both the bioethical and data-quality or ‘epistemic’ issues that are constitutive of the ‘nocebo effect’ in active pharmaceutical surveillance. This is intended to both motivate careful risk communication with patients and to assist researchers in developing the growing practice of active pharmacovigilance.

Methods

An examination and consideration of the definition of nocebo effect and an investigation into an imagined case of how nocebo effects arise in the process of active surveillance with the purposes of illustrating the two-part problem.

Key Findings

Nocebo effects as negative expectation or conditioning effects are bioethical issues in the course of active pharmacovigilance insofar as they are genuine harms patients can experience. However, this is only one ‘side’ of the problem that nocebo effects entail. When nocebo effects are reported as suspected adverse drug reactions to databases aimed at discovering the actual pharmacological properties of drugs, this is ‘noise’ in those databases.

Conclusion

Due to the two-part problem that nocebo effects entail in active surveillance, i.e. that they are genuine patient harms and they are ‘noise’ in pharmacovigilance databases aimed at discovering the pharmacological properties of drugs, we ought to be careful to mitigate these in practice and in research methods. This more robust account of the issues that nocebo effects are constitutive of more comprehensively motivates careful risk communication.
The role of alternative oxidase in the maintenance of cellular redox balance under hypoxia via participation in nitric oxide turnover
Authors: Igamberdiev Abir U , Bykova Natalia V
Published: January 2025

Alternative oxidase (AOX) regulates the level of reactive oxygen species and nitric oxide (NO) in plants. While it alleviates NO formation under normoxic conditions, there are several indications that in conditions of low oxygen, such as during seed germination before radicle protrusion, in meristematic stem cells, and in flooded roots, AOX can be involved in the production of NO from nitrite. Whereas the first reports considered this role as indirect, more evidence has since accumulated that AOX can act as a nitrite:NO reductase. Such activity of the structurally similar di-iron proteins in bacteria has been demonstrated. We review the literature on this topic and show that AOX can be induced under hypoxic conditions and participate in NO turnover via the phytoglobin–NO cycle. This results in the facilitation of glycolytic reactions by reoxidation of the glycolytically formed NADH and diverting the glycolytic carbon toward the formation of alanine and other amino acids. Pyruvate formed in glycolysis can activate AOX and facilitate its operation under these conditions. It is concluded that AOX is an important player in the hypoxic response in plants that regulates the redox level by participating in NO turnover as a nitrite:NO reductase in cooperation with nitrate reductase and phytoglobin.