bluuebunny/crossref_metadata_2025 huggingface dataset:
P212 The Impact of Crohn’s Disease in Patients with Colorectal Cancer: A Danish Nationwide Cohort Study, 2009-2019
Authors: Johansen M P ,   Martha Pollen Johansen Mads Damsgaard Wewer Peter-Martin Krarup Johan Burisch and Andreas Nordholm-Carstensen
Published: January 2023

Background

Previous nationwide cohort studies have substantiated that patients with Crohn’s disease (CD) have an increased risk of colorectal cancer (CRC) compared with non-CD patients with CRC. In addition, when comparing mortality in patients with CD and CRC and patients without CD and CRC, the hazard ratio was significantly higher for CD patients with CRC.

Methods

Patient- and CRC characteriscs were extracted from the Danish Colorectal Cancer Group registry and merged with a nationwide cohort of patients with inflammatory bowel disease (IBD). Patients diagnosed with CRC from January 1st 2009 to December 31st 2019, were included. All individuals with IBD were identified, using registrations of diagnostic codes, pathology codes and specific surgeries or medications for IBD.

Results

In this nationwide cohort study, 38 154 patients were eligible for inclusion. In the CD cohort and CRC cohort, 160 (52%) and 17343 (46%) were female (p=0.024) (table1). Patients with CD had a statistical significant lower age at cancer diagnosis, 69 years (60-76), compared with sporadic CRC 71 years (64-78)(p=<0.001). In the age group analysis, 81 (26%) of the patients in the CD cohort were diagnosed before the age of 60. In comparison, 6531 (17%) of the patients in the sporadic CRC cohort were diagnosed before the age of 60, (p<0.001). Colon cancer was more frequent in the CD and CRC cohort (234 (76%) vs. 26753 (71%), p=0.027). A higher percentage of CD patients presented with a UICC stage III (88 (29%), 9529 (25%)) (p=0.014), whereas more patients in the sporadic CRC cohort presented with UICC IV (10 704, 28%, 61, 20%). CD patients had a statistically significant higher frequency of deficient Mismatch repair (dMMR) expression compared with non-CD CRC, 63 (23%) vs. 4370 (14%), p<0.001. Poor differentiated adenocarcinoma was more common in the CD -CRC, than in the non-CD CRC, 35 (13%) vs. 2113 (6.7%), p<0.001. CRC located in the right hemicolon, was more common in the CD-CRC patients. Rectal cancer was more common in non-CD CRC patients, p=0.027.

In a Cox regression analysis, higher age at cancer diagnosis was significantly associated with increased mortality when including all patients with CRC, hazard ratio (HR): 1.04, 95% CI: [1.04-1.04], P=<0.001. Female sex was associated with reduced mortality HR: 0.89 [0.86-0.91], p=<0.001. Presence of CD was not associated with increased mortality. CD diagnosed before the age of 60 was not associated with higher risk of mortality by CRC among CD patients.

Conclusion

No statistically significant difference was found in the mortality in CD associated CRC and sporadic CRC. A higher percentage of CD patients had a UICC III stage tumor, suggesting a more progressive disease.
P213 High prevalence and risk factors for nonalcoholic fatty liver disease in patients with Crohn's disease
Authors: Flores C , Souza R K , De Bona L R , Deconto M D , Arrojo R S , Gazzoni F F , Oliveira T F
Published: January 2023

Background

Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with Inflammatory Bowel Disease (IBD), particularly Crohn's Disease (CD). Despite this, the mechanisms and risk factors of NAFLD in IBD are still poorly understood and controversial. The aim of this study was to assess the prevalence and risk factors for NAFLD in patients with CD.

Methods

Prospective study conducted among consecutive patients with CD and treated at the Inflammatory Bowel Diseases outpatient clinic at University Hospital between July 2021 and May 2022. Demographic, anthropometric and CD characteristics, food intake, previous and current medications, pre-existing diseases, laboratory tests, plasma levels of trimethylamine oxide (TMAO) data were collected. All participants underwent ultrasound (US) of the upper abdomen for evaluation and classification of NAFLD.

Results

One hudndred and three patients with a mean age of 45.2 ± 15.0 years, 35.9% (n=37) were male. The prevalence of NAFLD was 40.8% (n=42) and overweight (BMI>25kg/m²) was present in 62.1%. Other associated diseases were present among NAFLD patients: systemic arterial hypertension (SAH) 4.9% (p<0,001), dyslipidemia 11.9% (p=0,040) and diabetes (DM) 19% (p=0,009). There were no statistically significant differences between CD characteristics or activity, previous or current CD treatment and food consumption with NAFLD. The presence of comorbidities such as SAH, DM and dyslipidemia, anthropometric markers such as Body Mass Index (BMI), waist circumference (AC), sagittal abdominal diameter (SAD), laboratory tests such as C-reactive protein (CRP), triglycerides (TG) and Liver enzymes were positively associated with the diagnosis of NAFLD. Plasma levels of TMAO showed no significant association with the presence of NAFLD and with CD activity but correlated with SAD (p 0,047). After adjusting for the multivariate model, only the variables SAH (p 0,046), DM (p 0,017), active CD (p 0,023), overweight (p 0,025) and obesity (p<0,001) remained associated to the presence of NAFLD.

Conclusion

The prevalence of NAFLD in patients with CD was 40.8%, higher than the global prevalence. The main risk factors for NAFLD in this population were like those in the general population such as systemic arterial hypertension, diabetes, dyslipidemia, visceral fat by sagittal abdominal diameter, overweight and obesity. The characteristics of CD, nutrient intake, and plasma levels of TMAO showed no relation with the presence of NAFLD. Crohn's disease activity by IHB and PCR showed a positive correlation with NAFLD. The high prevalence of NAFLD among CD patients should raise this concern for patient care.
P214 Cine MRI assessment of colonic motility in patients with ulcerative colitis associated constipation.
Authors: Miller C , Taylor S , Emmanuel A , Zarate-Lopez N , Pakpoor J , Fitzke H , Menys A , Holmes J , Atkinson D , Markus J , Blad W , Bloom S
Published: January 2023

Background

Constipation may be a feature of ulcerative colitis (uc) especially in left sided or distal disease. UC associated constipation (UCAC) can cause significant morbidity; treatment is typically with dietary fibre changes and laxatives. Diagnosis may be challenging but adequate treatment may improve clinical outcomes. The cause is incompletely understood with few studies of motility and transit. Study populations often having heterogenous groups, with limited assessment of right sided colonic motility. Cine MRI is a novel technique that can assess pan-colonic motility. Using this technique, We aim to investigate regional colonic motility in patients with active disease and UCAC symptoms.

Methods

The study was performed prospectively with 30 participants at a single-centre. Disease extent was confirmed to be distal to the splenic flexure. Active disease was defined as a faecal calprotectin >250, partial Mayo score ≥ 4 (rectal bleeding score ≥ 1) or an endoscopic mayo score >1. The 3 groups comprised 10 healthy controls with no symptoms of IBS/ constipation, 11 patients with active uc with symptoms of UCAC, and 9 patients with active uc without symptoms of UCAC. UCAC subjects met American Gastroenterology Association constipation criteria. Exclusion criteria comprised the use of drugs affecting motility, concomitant GI conditions, and recent laxative use. Subjects underwent two constipation questionnaires. Subjects were fasted > 8 hours and subjects consumed 1.4 litres of 2% mannitol over 90 minutes prior to a morning MRI scan. Post drink cine MRI was not acquired until the mannitol had reached the ascending colon (AC). Images were acquired over the entire abdomen for 10 minutes and using GI Quant software®(Motilent) regional colonic motility was assessed (Figure A), generating a motility index (MI) score (range 0-1000). Kruskal-Wallis and Mann-Whitney U (with Holm-Bonferroni correction) statistics were used.

Results

Baseline characteristics and questionnaire scores are outlined in Figure B and MI scores in Figure C.

There was no clear trend for differences in motility in the caecum or AC. In the transverse colon (TC) there was a trend to reduced MI in patients with UCAC compared to controls which was nearly significant (p=0.06).

Conclusion

We present a new technique for assessing regional colonic motility in patients with uc with a 10-minute scan, and offers a method to study the dysmotility that underpins UCAC. Motility appears to be reduced in the TC in patients with left sided uc and symptoms of UCAC compared to controls. Although not statistically significant this suggests hypomotility may be a contributing factor to UCAC. It suggests that stimulants/prokinetic may be more effective than change to dietary fibre in its treatment.
P218 It is time to grow up: readiness is associated with better outcomes in a prospective study of pediatric transition patients with Inflammatory Bowel Disease
Authors: Nardone O M , Martinelli M , De sire R , Calabrese G , Caiazzo A , Fioretti M T , Testa A , Limansky L , Rispo A , Di Luna I , Miele E , Staiano A , Castiglione F
Published: January 2023

Background

Approximately 25% of patients with inflammatory bowel disease (IBD) are diagnosed before age 20, making the transition from paediatric to adult healthcare challenging due to the high burden of these diseases at a critical time, such as adolescence. We aimed to assess patients’ readiness to transition from paediatric to adult IBD services and the impact on clinical outcomes. We further investigated adherence and quality of life at 12 months post- structured transition clinic

Methods

An observational, prospective study was conducted in a tertiary adult and paediatric IBD centre including adolescent aged≥17yo with a confirmed diagnosis of IBD before 16yo and in clinical remission who underwent “structured transition”. We collected demographics and clinical data 12 months before and after the transition visit. At the time of recruitment patients filled out the Transition Readiness Assessment Questionnaire (TRAQ) and they were defined ready based on a mean TRAQ value ≥ 3.0. The Morisky Medication Adherence Scale (MMAS) and the Short Form Health Survey (SF36) Questionnaire were completed baseline and 12 months after transition clinic. Receiving operating characteristics (ROC) curve was used to determine cut-off values of TRAQ for predicting medication adherence.We further investigated which demographic and clinical parameters could predict medication adherence.

Results

We enrolled 60 patients in clinical remission based on Crohn’s Disease Activity Index (CDAI) score of 115±124 for CD and pMayo 2,85±1,3 for UC, who had transitioned throughout transition clinic to adult care and completed 12 months follow-up [Table1].

Overall 42 patients (70%) were considered ready for transition, with a mean TRAQ score=3,2±0,5. The number of outpatient visits(1,86±0,75vs2,28±1,2;p<0,02) as well as the number of clinical relapses (0,38±0,4vs1,06±0,9;p<0,02) and hospitalizations (0,05±0,1vs0,33±0,33;p<0,05) at 12 months were significantly lower in ready than in not-ready patients. The quality of life did not differ pre-and 12 months post-transition clinic(p=0,09) and between ready and not-ready patients (p=0,71)[Table2].

Based on ROC curve a TRAQ cut-off≥3,46 could predict medication adherence with a sensibility of 55%,specificity 86% and an AUC=0,71(0,57-0,85;p=0,008)[Fig1].

At multivariate analysis, a high mean TRAQ value was associated with medication adherence at 12 months (OR:7,042CI:1,68-29,54,p=0.008)

Conclusion

Patients ready for transition were more likely to have fewer outpatient visits,disease flares and hospitalizations compared to not-ready patients. The quality of life did not differ pre- and post transition and between ready and not-ready patients.TRAQ score could be a reliable tool with high specificity to predict medication adherence
P220 Patient’s disease perception and health-related quality of life with IBD: Results from a Spanish cohort with 15 years of follow up
Authors: Elosua Gonzalez A , Rubio S , Irisarri R , Campillo A , Nantes Ó , Vicuña M , Angós R , Zozaya J M , Rodríguez C
Published: January 2023

Background

Crohn’s Disease (CD), ulcerative colitis (UC) and IBD unclassified (IBD-U) may affect the health-related quality of life (HRQoL). We evaluated HRQoL and patient’s disease course perception in the Navarra Incident Cohort (includes all new diagnosis from 2001-2003 in Navarra, Spain)

Methods

All patients were invited to complete two HRQoL questionnaires: the generic EuroQoL-5 dimensions (EQ-5D-3L) and the Inflammatory Bowel Disease Questionnaire (IBDQ-36). Patients’ disease course perception was evaluated using the four disease curves from the IBSEN cohort

Results

From 285 patients initially diagnosed, we obtained 158 questionnaires (72% response rate after excluding deaths and lost to follow-up); 103 UC, 50 CD and 5 IBD-U, 40% women and median age 52 (22-84). Most patients were in remission (99% UC/ 88% CD/ 100% IBD-U).

In EQ-5D-3L, 55% answered not having, 41% having some and 4% having significant impairment in at least one dimension. “Pain/discomfort” and “anxiety/depression” were the most affected dimensions with no differences by diagnosis. However, 91% of UC and 85% of CD patients considered their health status to be the same or better compared to the previous year.

Median IBDQ-36 score in UC was significantly higher than CD (227 vs 212, p=0.04). No differences were found in partial median scores in bowel symptoms and social impairment with significantly higher median scores in UC compared to CD in systemic symptoms, emotional function and functional impairment. Similar results between UC and IBD-U were obtained (table1).

Regarding disease course, 67% of UC and 54% of CD patients chose to have a progressive decrease in the intensity of symptoms since onset (p=0.2). Significantly more CD that UC patients considered a disease with recurrent flares of activity (40% vs 23%, p=0.015). The increase in symptoms throughout the evolution was the pattern chosen by 8% of UC and 4% of CD patients, while only 2% in each disease defined its situation as persistent chronic activity throughout the follow-up.

Conclusion

- Patients have a significant impact in their HRQoL despite being in remission

- Systemic symptoms, emotional function and functional impairment were more affected in CD patients.

- Most patients considered their disease as a progressive decrease in the intensity of symptoms with significantly more CD patients considered having recurrent flares of activity.
P222 Chronic pain is common in Paediatric Inflammatory Bowel Disease and impacts quality of life
Authors: Mardare R , Eskell L , Machta J , Fell J M E , Thangarajah D
Published: January 2023

Background

Prevalence of chronic pain (CP) is reported as 38% in adult inflammatory bowel disease (IBD), with a significant impact on quality of life, functional and social outcomes 1,2,3. Prevalence and attributes of chronic pain are unknown in paediatric IBD.

Aim

evaluate the prevalence, disease related factors, and impact on quality of life (QOL) of CP.

Methods

Prospective, cross-sectional single centre study included 41 children, (8 -18 years), of a predominantly CD cohort 29/41, (70%). Patients and their parents completed validated age-appropriate pain questionnaires4 and IMPACT III QOL questionnaire for IBD5. CP was defined mild and moderate to severe, as per von Korff scale6. Disease specific parameters were recorded. CP and NP medians were compared using Mann-Whitney tests and proportions using Chi squared test (p<0.05).

Results

CP was prevalent in 33/41 (80%) patients. Abdominal CP was common in 30/33 (90%), joint pain was present in 2/33, (6%) and headache in 1/33, (3%). CP subjects were adolescents with extensive and established disease, predominantly on biologics 26/33 (79%). Analgesia use was low 15/33 (45%), and there was no opiate use. There was no difference in Disease activity CP vs NP, defined by PCDAI, PUCAI, CRP and Faecal calprotectin. QOL life score was significantly lower in CP, there was no difference in body image QOL domain score in CP vs NP. Comorbidity was common 16/33 (48%) in the CP cohort, 5/16 (31%) had diagnoses that maybe associated with comorbid pain.

We have shown that anaemia and sleep disturbance may be a signal associated with CP (Fig 1).

Conclusion

CP is common in paediatric IBD, more common than previous adult studies. Unlike historic adult IBD cohorts, it is not associated with disease activity or related biomarkers. It is unknown whether functional pain co-exists in our cohort. CP significantly impacts emotional, wellbeing and social functioning in children with IBD. This is the first study to report on CP in children with IBD, strategies should target psychosocial intervention. Further studies are needed to evaluate potential effects of socioeconomic status, physical activity, anaemia and prevalence of functional pain in children with IBD. We recommend screening for CP in children with IBD as it is common.
P225 The accuracy of different intestinal ultrasound parameters in detecting endoscopic activity in patients with inflammatory bowel disease
Authors: Katsaros M , Palmela C , Kalogirou M , Frias Gomes C , Katsoula A , Torres J , Giouleme O
Published: January 2023

Background

Intestinal ultrasound (IUS) is considered an accurate tool for assessment of disease activity in inflammatory bowel disease (IBD) patients. We investigated the accuracy of IUS to detect active disease as compared to ileocolonoscopy.

Methods

We performed a two-center international cross-sectional study that included formally diagnosed IBD patients who underwent IUS and ileocolonoscopy, within a 4 weeks interval. Active disease on IUS was defined as bowel wall thickness (BWT) >3 mm in the most affected bowel segment. Additional IUS parameters evaluated included increase in Doppler color flow in the bowel wall (modified Limberg score > 0), presence of inflammatory fat (FW) and loss of bowel wall stratification (BWS). Active disease at endoscopy was defined as Simple Endoscopic Score for Crohn’s Disease (SES-CD) >2 and Mayo endoscopic score >0. The accuracy of IUS compared to ileocolonoscopy was estimated using sensitivity, specificity, and Cohen’s kappa coefficient analyses.

Results

We included 85 patients (table 1) performing IUS for disease monitoring (69.4%) and symptoms suggestive of IBD flare (30.6%). Disease was active in IUS in 38/42 (90.5%) of clinically active [Harvey Bradshaw index (HBI) ≥5, Simple Clinical Colitis activity index (SCCAI) >2] and 22/43 (51.2%) of clinically inactive patients (kappa coefficient 0.391, p<0.001). C-reactive protein (CRP) level was 6.95 mg/dl [IQR 2.19-17.75] vs 1.8 mg/dl [IQR 0.85-3.75] in active vs inactive disease on IUS respectively (p<0.001). All patients underwent both endoscopy and IUS, with 63/85 (74.1%) exhibited endoscopic activity. IUS demonstrated 92.1% sensitivity, 90.9% specificity, 96.7% PPV, 80% NPV and kappa coefficient 0.79 in detecting endoscopically active disease (p<0.001). IUS detected 58/63 (92.1%) of endoscopically active cases, and identified the most affected bowel segment in 50/63 (79%) of them. Inability of IUS to identify the most affected bowel segment at endoscopy included rectal involvement (53.8%), complex surgical history (15.38%), stenosis of ileocecal valve (7.69%) and limitations due to obesity (23.07%). Mean BWT of the most affected segment was 4.49 (±1.16) vs 2.33 mm (± 0.63) in endoscopically active vs inactive patients respectively (p<0.001). We furthermore evaluated the accuracy of additional IUS parameters (increased color Doppler flow, FW and loss of BWS) in predicting endoscopic activity (table 2).

Conclusion

IUS represents a non-invasive tool that can accurately identify disease activity both in Crohn’s disease and ulcerative colitis, when compared to ileocolonoscopy. The most sensitive parameter to detect endoscopic activity was an increased BWT.
P227 Patient experiences in ulcerative colitis: conceptual model and review of patient-reported outcome measures
Authors: Kim C , Brown F L , Burk C , Anatchkova M , Sargalo N , Kaushik A
Published: January 2023

Background

Symptoms of ulcerative colitis (UC) negatively affect patients’ health-related quality of life (HRQoL). The aim of this study was to identify symptoms and impacts experienced by patients with UC, develop a conceptual model (CM) and evaluate available patient-reported outcome (PRO) measures for appropriateness for inclusion in UC clinical studies.

Methods

We conducted a landscape assessment that included: targeted literature reviews (TLRs) to identify concepts of interest and frequently used PRO measures among patients with UC; label claims searches for US and European regulatory and health technology assessment (HTA) submissions; and US and European clinical trial database searches to identify PRO measures used as primary and secondary endpoints in ongoing clinical trials. Results from the TLR informed a CM of UC. Concepts from the CM were mapped to selected PRO measures. Appropriateness of selected PRO measures for UC populations was evaluated via a gap analysis.

Results

Fifty-two symptoms and 72 impacts of UC were identified from the TLR. The most frequently reported symptoms were diarrhoea, incontinence/leaking/lack of bowel control, urgency, rectal bleeding, frequent bowel movements and fatigue. The most frequently reported impacts were anxiety, depression, inability to conduct daily activities, embarrassment and affected relationships with others. The CM grouped the 52 symptom concepts into eight dimensions, the 29 impacts proximal to UC into two dimensions and the 43 impacts distal to UC into five dimensions (Figure 1). Of the 69 PRO measures identified, eight were selected for conceptual analysis based on being disease-specific and having evidence of use in regulatory label claims, HTA submissions, as UC clinical trial endpoints and/or having US Food and Drug Administration (FDA) qualification status. The five PRO measures that covered the most concepts when mapped against the CM and included in the gap analysis were: the Inflammatory Bowel Disease Questionnaire (IBDQ); Symptoms and Impacts Questionnaire for UC (SIQ-UC); UC-PRO symptoms modules (UC-PRO-Signs and Symptoms [UC-PRO/SS] and UC-PRO-Systemic Symptoms); UC-PRO impact modules (UC-PRO-Daily Coping [UC-PRO-DC], UC-PRO-Daily Life Impact [UC-PRO-DLI] and UC-PRO-Emotional Impact [UC-PRO-EI]); and Crohn’s and Ulcerative Colitis Questionnaire (CUCQ) (Table 1). All five PRO measures had good or excellent support for content validity; the UC-PRO/SS fully met FDA PRO guidance for content validity and most psychometric properties.

Conclusion

Based on the CM and PRO measures review, the IBDQ plus UC-PRO/SS are recommended to capture UC symptoms and IBDQ plus UC-PRO impact modules to capture proximal impacts. All PRO measures reviewed require further psychometric evaluation.
P230 Adalimumab in Crohn’s disease is protective against periodontitis based on a validated oral health questionnaire
Authors: Saravanapavan H , Rath S , Inniss S , Ong M , Sabalić M , D’Aiuto F , Rahman F , Smith A M
Published: January 2023

Background

Crohn’s disease (CD) is associated with a 3-4 fold increased risk of periodontitis compared to the general population1 though periodonitis is poorly recognised and diagnosed. Evidence from mouse models highlight an important link between oral and gut health. Periodontitis has been shown to lead to ectopic colonization of oral pathogens and oral Th17-T cells that activate lamina propria macrophages and exacerbate gut inflammation2. Very little is known about the patient demographics of those at risk of periodontitis. This study aimed to assess the risk factors for periodontitis in CD patients.

Methods

We conducted a cross-sectional study recruiting CD patients at UCLH through myCare, an online platform for patients linked to their clinical records. Patient data were obtained using EpicCare, a web-based electronic patient record database. Patient risk of periodontitis was determined using a previously validated oral health questionnaire3. Statistical tests were conducted using IBM SPSS Statistics 27.

Results

This single centre study included 89 CD patients; 54% female and median age of 40 (IQR 19-82). Patients predominantly identified as White British (56%). The majority had ileocolonic CD (51%) with non-stricturing/non-penetrating behaviour (70%) and were on biologic therapy (52%) (Tab 1). The oral health questionnaire identified 37% of CD patients at risk of periodontitis. There was no statistically significant association between periodontitis risk and age, gender, age at CD diagnosis, disease duration, CD phenotype, family history, body mass index (BMI) or smoking status. Current steroid, immunomodulator use and number of prior biologics also showed no association. Current use of adalimumab and ustekinumab were both independently correlated with risk of periodontitis (χ2 p=0.004 & χ2 p=0.044, respectively). 90% of patients receiving adalimumab were not at risk of periodontitis (Fig 1). In contrast, 60% of patients on ustekinumab were at risk of periodontitis. Logistic regression analysis showed that patients receiving adalimumab were 86% less likely to be at risk of periodontitis compared to patients not receiving adalimumab (OR 0.14 (CI 0.029 - 0.633, p=0.011)). 75% of the adalimumab group was anti-TNF naïve, but no association was seen between prior biologic use and periodontitis risk (p=0.91).

Conclusion

The questionnaire has identified a third of patients who are at risk of periodontitis in the CD cohort. Adalimumab shows benefit in mitigating this risk and may be a drug of choice in patients with oral disease. The questionnaire is a helpful tool to identify and refer at-risk patients.
P232 Serum neutrophil gelatinase associated lipocalin (NGAL) as a marker of activity of Inflammatory Bowel Disease
Authors: Ali K , Bahgat M , Borg A , Maher M , Abozeid F
Published: January 2023

Background

Inﬂammatory bowel disease (IBD) is a disease of activity and remission. Lipocalin 2 (LCN2), the coding gene for NGAL is one of the most over-expressed genes in the colonic mucosa in ulcerative colitis (UC) and crohn’s disease (CD). In our research we investigated the utility of serum level of Lipocalin 2 in assessing the activity of IBD

Methods

This was a single center case control study.It was conducted on 60 IBD patients, 50% (30 patients) were in remission and 50% were active.There were about 28 healthy control. Patients with IBD either UC or CD were enrolled from IBD clinic Mansoura specialized medical Hospital, Egypt.

All patients and control group were subjected to investigations including complete blood count (CBC) ,Erythrocyte Sedimentation Rate (ESR) ,C-reactive protein (CRP),Fecal calprotectin and serum neutrophil gelatinase associated lipocalin (NGAL) by ELISA.Patients only were subjected to sigmoidoscopy or ileo-colonoscopy.The activity of IBD was assessed for UC by MAYO score and CD by CDAI.

Results

NGAL showed significant increase among active IBD patients by mean± SD ng/ml (37.04 ± 9.63) than patients in remission (20.65± 4.35).It showed highly significant correlation with clinical and endoscopic activity of IBD r= 0.80, P<0.0001. Serum NGAL can easily discriminate patients with active IBD from healthy controls with AUC 95% C.I =1.00 (0.94-1.0), at the cutoff 18.52 , P< 0.0001, with sensitivity 100% and specificity 100%. While AUC of NGAL which can discriminate patients with active IBD and those in remission at the cutoff 26.95 was 0.97, P< 0.0001, with sensitivity 93.3% and specificity 93.3%.

In relation to fecal calprotectin, there was highly significant correlation between fecal calprotectin and serum NGAL (r=0.69 , P< 0.0001).Both CRP and ESR were positively correlated to NGAL by r=0.38 and r=0.29 (P<0.05) respectively.

Figure (1): NGAL ROC curve among active IBD cases versus healthy controls.

Conclusion

Serum NGAL can easily discriminate patients with active IBD from healthy controls as well as among patients in active or remission of IBD. NGAL in comparison to other markers as fecal calprotectin or CRP or ESR shows better statistical performance for activity of IBD. This clarifies its ability to be a highly significant predictor of activity of IBD besides its lower cost.
P236 Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn’s Disease: The Challenges of Accurate Endoscopic Scoring
Authors: Van Der Does De Willebois E , Duijvestein M , Wasmann K , D'Haens G , van der Bilt J , Mundt M , Hompes R , van der Vlugt M , Buskens C , Bemelman W ,   DETECT study group
Published: January 2023

Background

Adequate endoscopic scoring in Crohn’s disease (CD) is crucial, as it dictates the need for initiating postoperative medical therapy and is utilised as outcome parameter in clinical trials. We aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses.

Methods

Two prospective patient cohorts were included: ileocolic resection (ICR) for CD, and right-sided colon resection for colorectal cancer (CRC). Videos taken during colonoscopy six months postoperatively were evaluated. The SES-CD and modified Rutgeerts score were determined. Primary outcome was the presence of ulcerations in CD patients on both the inverted and everted stapled lines, fig1. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line.

Results

Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 (76·8%) at the inverted- versus 1/71 (1·4%) at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 (67·7%) at the inverted versus 0/6 (0%) at the everted stapled line. 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line.

Conclusion

Inverted stapled lines heal with ulcerations, whereas the everted stapled line heal without any ulcerations, both in CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients’ quality of life and on health-care costs if postoperative treatment is initiated incorrectly.
P244 Prognostic Value of post-biological induction fecal calprotectin concentration on the long-term outcomes of Crohn’s disease
Authors: Gagnaire M , Bendavid C , Dewitte M , Brunet T , Desfourneaux V , Bordet M , Siproudhis L , Bouguen G
Published: January 2023

Background

Endoscopy remains the gold standard in Crohn’s disease (CD) to assess mucosal healing but remains invasive and costly. Mucosal healing is the target to reach in current therapeutic strategies because of its association with improve CD outcomes. Fecal calprotectin is still only a surrogate marker due to the lack of data on its ability to predict disease progression. The main objective of this study is to assess whether the value of fecal calprotectin after introduction of biologic is predictive of long-term outcomes of Crohn’s disease.

Methods

From a prospective database, all patients followed for Crohn’s disease in a tertiary referral center were assessed. We included those in whom fecal calprotectin was measured 3 to 6 months after the introduction of a biologic. Patients were separated into two groups according to the value of fecal calprotectin (more or less than 250 µg/g). Disease outcome was assessed by a composite criterion including: the need for abdominal surgery, progression to complicated phenotype (B2, B3) and a change in therapy due to non-response.

Results

A total of 198 fecal calprotectin were measured within 3 to 6 months after introduction of biotherapy. Our study population was 61% female (n=120) with a mean age of 39 years. The average duration of the disease was 10 years, 41% (n=82) had never received biotherapy. The treatment initiated was an anti-TNF in 59% of cases (n=117), ustekinumab (n=64; 32%) or vedolizumab (n=17; 9%). A total of 127 (64%) fecal calprotectin were below 250 µg/g. We identified a strong association between postinduction fecal calprotectin value and the long-term outcome in Crohn’s disease patients. Fecal calprotectin was significantly associated with clinical remission without steroids at 1 year from initiation of treatment (p=0,014). In our population, 20 (10%) patients required surgery, 45 (23%) required a change in treatment, 13 (7%) had a change in phenotype and 61 (31%) had at least one of the three events described above. A fecal calprotectin level above 250 µg/g was associated with more abdominal surgery, phenotype and treatment change (HR 2.47 [1.4; 4,36] p:0,0018) (figure 3). In the subgroup of 82 (41%) patients with an available and elevated fecal calprotectine concentration before treatment initiation, the prognostic value of post-induction fecal calprotectin was even better (HR 4,83 [2,02; 11,6] p<0,001) (figure 1). Fecal calprotectin was the only factor significantly associated in uni and multivariate with long-term disease outcome.

Conclusion

Post induction fecal calprotectin seems to be a good prognostic marker of long-term evolution of Crohn’s disease. These data could lead to limit the use of colonoscopy currently recommended to 6 to 9 months after the start of treatment.
P245 The Relationship Between the Endoscopic Healing Index and Magnetic Resonance Enterography In Crohn’s Disease Patients
Authors: Smith E , Chen J , Pan Y , Mahtani P , Lukin D , Ahmed W , Longman R , Burakoff R , Scherl E , Battat R
Published: January 2023

Background

The endoscopic healing index (EHI) is a serum biomarker panel that identifies endoscopic Crohn’s Disease (CD) activity. Endoscopy and biomarkers are limited in assessing small bowel disease compared to magnetic resonance enterography (MRE). The Simplified Magnetic Resonance Index of Activity (MaRIAs) is validated to detect CD activity. Data are lacking on the relationship between EHI with other endpoints. This study performed the first assessment of EHI to diagnose CD-related intestinal inflammation on MRE using the MaRIAs score.

Methods

Data were extracted on CD patients with EHI within 90 days of MRE. We assessed the diagnostic accuracy of EHI for any (MaRIAs≥1) or severe (MaRIAs≥2) MR inflammation identified on MRE using area under the receiver operator characteristic (AUROC) curve analyses. Proportions with inflammation on MRE were compared between groups above and below the identified EHI and FCAL threshold. Analyses were repeated between EHI and active endoscopy (SES-CD≥5), fecal calprotectin (FCAL>50, >250), and clinical symptoms (CD PRO-2≥8).

Results

241 MREs uniquely paired to either EHI or FCAL from 155 patients, mean age was 42 years, 50.3% were female, 83.2% of patients had small bowel involvement, and 29.7% had penetrating disease. The mean time between EHI to MRE was 28 days, and the mean time between FCAL and MRE was 24 days. Both EHI and FCAL had similar accuracy to diagnose inflammation (AUROC: EHI:0.635-0.651, FCAL:0.680-0.708). Optimal EHI values were 42 and 26 for inflammation on MRE and endoscopy, respectively. Patients with EHI≥42 (100% vs. 63%, p=0.002), FCAL>50µg/g (87% vs. 64%, p<0.001) and FCAL>250µg/g (90% vs. 75%, p=0.02) had higher rates of MaRIAs≥1 compared to lower values. EHI differentiated ileitis more than FCAL (delta: 24-25% vs. 11-21%). Patients with low FCAL had high rates (59-69%) of active endoscopic disease, whereas those with low EHI rarely (6%) with endoscopic activity. Patients with FCAL≥50µg/g had higher rates of severe inflammation compared to FCAL<50µg/g (75% vs. 47%, p<0.001) whereas smaller differentiation existed for EHI. In patients with CD PRO-2 scores, clinical remission was not associated with disease activity corresponding to active EHI, endoscopy, or MRE.

Conclusion

In CD patients predominantly with ileal involvement, EHI>42 and FCAL>50 were both specific to confirm inflammation on MRE. Lower EHI values (<42), but not low FCAL (<50), were associated with lower rates of severe radiologic inflammation. MRE inflammation was frequently present in the presence of low EHI and FCAL with similar proportions of false negative MRE results. However, the absence of endoscopic inflammation was only associated with low EHI, but not low FCAL values.
P246 2D Shear Wave Elastography as novel tool for the assessment of disease severity in patients with IBD
Authors: Demir E , Cindoruk M , Karataş A , Karakan T , Kılıç G , Ergin M , Cerit M N , Ozbas C , Oktar S O , Ucar M , Gulbahar O , Demir B
Published: January 2023

Background

Intestinal Ultrasound (IUS) is a non-invasive modality capable of assessing disease activity in IBD. IUS is reliable, patient-friendly, and allows frequent monitoring of disease activity. Elastography is a measure of tissue stiffness, that is usually studied for the evaluation of intestinal fibrosis in previous studies. However, the addition of elastography to standard IUS for assessing disease severity is still limited. Here we present novel data on the diagnostic value of 2D shear-wave elastography (SWE) in the evaluation of disease severity in patients with IBD.

Methods

In this prospective descriptive study performed in a single center, consecutive 38 patients with UC and 22 CD were included. Disease activities of UC patients were evaluated by Mayo score and Endoscopic Activity Index (EAI) while Crohn’s Disease Activity Index (CDAI) and Harvey-Bradshaw Index (HBI) evaluated disease activation of CD patients. The bowel wall thickness (BWT) and Limberg score were also measured. The intestinal segment held by an experienced single operator with the 2D-SWE technique was estimated, and its value in kilopascal (kPa) was recorded.

Results

A statistically significant correlation was found between the stiffness values obtained with SWE, BWT and disease activity scores. Tissue stiffness (kPa) was correlated with HBI (r=0.772, p<0.01), CDAI (r=0.817, p<0.01), C-reactive protein (r=0.503, p=0.02) in CD. In UC, tissue stiffness was correlated with Mayo score (r=0.491, p=0.002), EAI (r=0.481, p=0.003) and C-reactive protein (r=0.423, p=0.009). The correlation of BWT and tissue stiffness was (r=0.797, p<0.05 and 0.698, p<0.05 in CD and UC, respectively). Limberg score was correlated with tissue stiffness values (r=0.743, p<0.05 and r=801, p<0.01 in CD and UC, respectively). The duration of illness was correlated with tissue stiffness values in patients with UC (r=0.665, p<0.05), however it was not correlated in CD patients.

Conclusion

2D-SWE is a promising tool in assessing disease activity in patients with CD and UC. Further studies are needed to understand the additive value of elastography in the clinical assessment of patients with IBD.
P255 Diagnostic delay and economic burden in Inflammatory Bowel Disease: a single-centre experience in patients treated with biologics
Authors: Todeschini A , Angelini C , Tessari R , Ossato A , Lunardi G , Geccherle A , Zuppini T , Variola A
Published: January 2023

Background

Inflammatory Bowel Disease (IBD), Crohn's Disease (CD) and Ulcerative Colitis (UC), are chronic and immune-mediated diseases with a relapsing-remitting trend. The overall incidence of these diseases is increasing. However, it is estimated that more than one third of patients experienced symptoms for more than one year before diagnosis. Delay in IBD diagnosis has several clinical, therapeutic and economic implications. Early diagnosis and proper treatment are the cornerstones for improving the standard of care for these patients.This study aims to evaluate the diagnostic delay in patients with IBD and to analyze the clinical and economic burden of the delay in IBD diagnosis in patients treated with biological drugs.

Methods

An observational and retrospective study was performed in IBD patients, regularly followed in our IBD Unit. Data regarding delay in IBD diagnosis were assessed through a questionnaire evaluating the disease course. Moreover, data about biologics dispensation were obtained from the medical records in the period 2014-2020.

Results

606 IBD patients were enrolled. The median delay in IBD diagnosis was 5.0 months (IQR:1.0 11.0); it was statistically lower in UC patients (4 months (IQR: 1.0 12.0)) compared to CD (6 months (IQR: 2.0 12.0)) ( p =0.041). Of these 606, 229 patients were treated with biological therapy; in this subgroup 58.9% showed a diagnostic delay. The statistical analysis showed that the diagnostic delay was statistically significant associated with biological drugs (p=0.041). Conversely, there was no association with surgical treatment. Moreover, it has appeared that the diagnostic delay is associated, with a trend of statistical significance, with need to switch or swap to other biologics (p=0.058). Regarding economic burden, patients with delayed diagnosis have significantly higher median annual cost of biological therapy than patients without diagnostic delay (€7179.26 vs € 5131.51 p= 0.009).

Conclusion

The diagnostic delay in IBD represents a challenge with clinical, therapeutic and economic impact. It’s crucial to cooperate with general practitioner and gastroenterologists not dedicated to IBD in order to reduce the diagnostic delay and guarantee an effective, appropriate and early treatment that will improve the patients’ quality of life and meanwhile reduce the health care system costs.
P256 Urinary lithogenic profile and gut and urinary microbiota in patients with inflammatory bowel diseases
Authors: Mignini I , Masucci L , De Maio F , Laterza L , Scaldaferri F , Settanni C R , Napolitano D , Baroni S , Garcovich M , Riccardi L , Gasbarrini A , Ferraro P M , Papa A
Published: January 2023

Background

Nephrolithiasis (NL) is a common extra-intestinal complication of inflammatory bowel disease (IBD) with recognizable morbidity and mortality. However, its pathogenesis and risk factors are not completely elucidated yet. Because of intestinal malabsorption, enteric hyperoxaluria is a crucial pathogenic mechanism responsible for developing urinary stones in IBD patients. In recent decades, growing evidence has highlighted the association between gut microbiota and NL, with a particular emphasis on the role of some oxalate-degrading bacteria, such as Oxalobacter formigenes, representing the mainstay of the so-called “gut-kidney axis.” More recent studies also hypothesize the involvement of urinary microbiota, but no data on IBD patients are available. Thus, we conducted a pilot study to analyse the urinary lithogenic profile in IBD patients and its relationship with gut and urinary microbiota.

Methods

Consecutive patients with IBD were prospectively enrolled. The presence of ileoanal pouch, ileostomy, colostomy, or short-bowel syndrome were exclusion criteria. Demographic and clinical data, including previous episodes of NL, were collected. Disease activity was evaluated using Harvey-Bradshaw and Mayo scores for Crohn’s disease (CD) and ulcerative colitis (UC). All patients underwent abdominal ultrasound for NL detection, and blood tests of kidney function (creatinine, blood urea nitrogen, creatinine clearance, electrolytes) were also measured, together with 24h-urine collection for lithogenic profile analysis, including calcium oxalate relative saturation ratio (RSRCaOx). In a subgroup of patients, urinary and faecal microbiota were also analysed through 16S rRNA sequencing.

Results

36 patients (20 CD and 16 UC) were enrolled. NL was more frequent in CD than in UC (25% vs. 6.25%). 24-h oxaluria was significantly increased in patients with previous or present NL (p=0.02), and RSRCaOx was significantly higher in CD than in UC (p=0.02) (Figure 1). Gut microbiota analysis revealed a higher relative abundance of Bacteroidetes and a lower abundance of Firmicutes in patients with an elevated RSRCaOx, defined for values more than the median (Figure 2). No statistically significant differences were observed in urinary microbiota composition in relation to high or low levels of RSRCaOx.

Conclusion

NL is more common in IBD patients with higher oxaluria levels, confirming oxalate excretion's crucial role in NL pathogenesis. Furthermore, our study reports an association between urinary stone development and Firmicutes/Bacteroidetes imbalance in the gut microbiota, suggesting possible further studies to identify patients at higher risk of NL.
P258 The association between dietary quality and disease severity in Korean young adult patients with Crohn’s disease: A pilot study
Authors: Jeong E S , Lee Y J , Song E M , Byeon J R , Lee A , Choe A R , Hong J T , Park Y H , Tae C H , Moon C M , Jeong H K , Shim K N , Jung S A , Kim Y , Kim S E
Published: January 2023

Background

Although associations between various single nutrients and exacerbation of inflammatory bowel disease (IBD) have been reported, more recent attention has focused on overall dietary patterns and quality rather than a single nutrient. This study was to investigate the association of dietary inflammatory potential and dietary quality with disease severity in young adult Crohn’s disease (CD) patients.

Methods

Non-consecutive 3-day food records were investigated in 25 patients with CD aged 19-40 years. Patients with moderate or severe active disease were excluded to investigate their usual dietary habits. A survey on dietary behavior was conducted and clinical data including the disease progress were collected. To investigate potential pro-inflammatory dietary habits in a patient's usual diet, food-based index of dietary inflammatory potential score (FBDI), glycemic index (GI), and glycemic load (GL) were calculated. Diet quality was evaluated using a tool called Diet Quality Index-international (DQI).

Results

Although most patients showed adequate caloric intake, 72% of the enrolled patients had a potential pro-inflammatory pattern identified as FBDI. The FBDI was significantly associated with intake of mixed coffee and sweeten drinks, beef, and pork (P < 0.05). Patients who had a serious clinical course such as history of surgery or the use of biologics, tended to have a higher FBDI (6.45 vs 2.44, P = 0.08), and showed a higher proportion with a low DQI (53% vs 20%, P = 0.06). Only 30% of the high FBDI group showed deep remission after 12 to 18 months of follow-up endoscopic or image study, whereas 72.7% of the low FBDI group showed deep remission (P =0.05). A significantly positive correlation was derived between FBDI and GL (r =0.452, P = 0.02).

Conclusion

For the care of patients with CD, it is necessary to evaluate the dietary quality as well as the total nutrient intake, and we need to educate the patients that dietary habits can affect the disease prognosis.