bluuebunny/crossref_metadata_2025 huggingface dataset:
P153 Fertility rate in women with IBD is decreased compared with general population: first multicentre survey in the Czech Republic
Authors: Duricova D , Bortlik M , Kratka Z , Slaba L , Kovarova T , Lukas M , Pfeiferova M
Published: January 2020

Background

Several previous studies reported negative impact of inflammatory bowel disease (IBD) on reproductive plans and fertility rate. The aim of our study was to investigate for the first time reproductive plans and fertility rate among Czech women with IBD.

Methods

Between March and August 2019 consecutive women with IBD (age 18–55 years) from 22 centres across the whole Czech Republic were anonymously surveyed during their visit of gastroenterology centre using predefined questionnaire. The questionnaire was created by physicians of participating centres and commented by members of Patient organisation. The questionnaire was divided into 5 domains focused on patient’s demographics, details on IBD and treatment, gynaecologic history, reproductive issue and patients’ knowledge on this topic. The fertility rate was calculated as mean number of children per woman with known number of children and compared with data from the general Czech population.

Results

The questionnaire was filled-in by 501 women (median age 33 years; 67% with Crohn’s disease) of whom 287 (57%) already had ≥ 1 child (median 2 children; 40% born before IBD diagnosis). Up to 56% women (281) confessed having ever fear of infertility due to IBD and 27% (137) reported that the disease influenced (mainly negatively) their earlier reproductive plans with regard to decision not to have children, to have fewer children, or another timing of the pregnancy then previously wished. The total fertility rate in our study group was lower compared with the general population with 0.99 live births/IBD women vs. 1.69 live births/woman in Czech population. The pattern of decreased fertility among IBD females was observed in all age-specific categories (Table 1). No significant difference in fertility rate between women with Crohn’s disease and ulcerative colitis was found (0.97 vs. 1.08, p = 0.51). Of the childless women, 67% planned to have offsprings in future, 16% were yet to decide and 16% did not want any children. Of those not planning infants, 58% reported IBD to be the primary cause, with the most frequent reason being fear of IBD heritability (29%) and worsening of IBD during pregnancy (26%).

Conclusion

Fertility rate in women with IBD in our survey was decreased compared with the general population of women in the Czech Republic. The negative impact of IBD seemed to contribute most to this finding.
P168 Isolated terminal ileitis: when capsule endoscopy is key for Crohn’s disease diagnosis
Authors: FREITAS M , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Rosa B , Moreira M J , Cotter J
Published: January 2020

Background

Terminal ileitis (TI) is a common condition in clinical practice and may be associated with a wide variety of diseases, mostly Crohn’s disease (CD). Data regarding predictors of CD diagnosis in isolated TI are lacking, particularly concerning small bowel capsule endoscopy (SBCE) findings.

Aim

To evaluate predictive factors for CD diagnosis in patients with isolated TI detected during ileocolonoscopy, submitted to SBCE.

Methods

Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected. The diagnosis of CD was based on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations.

Results

One hundred and two patients with isolated ileitis on ileocolonoscopy were included. After performing SBCE, 34.3% of the patients had a diagnosis of CD. All CD diagnosed patients had positive SBCE findings. Extraintestinal manifestations (p = 0.003), weight loss (p = 0.01), abnormal imaging (p = 0.04) and positive SBCE findings (p = 0.005) were independently associated with CD diagnosis. Regarding SBCE, presence of proximal small-bowel disease (p = 0.02), diffuse findings (p = 0.002) and presence of moderate to severe inflammatory activity (Lewis Score≥790) (p < 0.001) were independently associated with CD diagnosis.

Conclusion

SBCE is a valuable tool that should be systematically used in patients presenting with isolated TI, since it enabled CD diagnosis in approximately one-third of patients. A diagnosis of CD should be considered when a patient with TI shows extraintestinal manifestations, weight loss, abnormal imaging and positive SBCE findings, especially proximal involvement, diffuse findings and the presence of moderate to severe inflammatory activity.
P187 The significance of netrin-1 level in the clinical activity of ulcerative colitis, its association between TNF-α and IL-6
Authors: Korkmaz H , Fidan K
Published: January 2020

Background

In this study, we investigated the importance of netrin-1 levels in ulcerative colitis (UC) in clinical activity of the disease, and its association with other proinflammatory cytokines IL-6 and TNF-α.

Methods

This study is a type of case–control study. Sixty-seven patients with UC (36 of them activation, 31 of remission) and 50 healthy controls were included in the study. UC patients; ‘Truelove Witts clinical activity index by remission (n = 31), mild activation (n = 21), moderate activation (n = 6) and severe activation (n = 9) were divided into groups. Netrin, IL-6 and TNF-α measurements in plasma samples were performed using enzyme-linked immunosorbent assay kit.

Results

Between the patient group and the control group; there was a statistically significant difference between netrin-1, IL-6, TNF-α, neutrophil, platelet (p < 0.05 for all). The plasma netrin-1 mean of UC with severe activation group (139.21 ± 48.09 pg/ml) was statistically significantly higher than that of the mild activation (p = 0,037), remission group (p = 0,001) and control group(p = 0,011). The plasma netrin-1 mean of UC with moderate activation group was statistically significantly higher than that of the mild activation(p = 0,045) and remission group(p = 0,004).

Conclusion

Our results reveal that plasma netrin-1 levels have been shown to be associated with UC activation, similar to proinflammatory cytokines such as TNF-α and IL-6, in UC.
P193 Validation of the two-item UC patient-reported outcome (PRO2) against the simple clinical colitis activity index (SCCAI), measures of biochemical disease activity and quality of life
Authors: Samaan M , Cunningham G , Tamilarasan G , Ray S , Mawdsley J , Anderson S , Sanderson J , Arkir Z , Irving P
Published: January 2020

Background

Patient-reported outcomes (PRO) have an increasingly important role in IBD. This is true of monitoring of disease activity in clinical practice and as well as the evaluation of new therapies, when used as clinical trial endpoints. An interim two-item PRO (PRO2) has been developed for UC that ranges from 0–6 and consist of the patient-derived items from the Mayo score (rectal bleeding and stool frequency). PRO2 was internally validated against endoscopic outcomes. We aimed to add external validation across a range of clinical, biochemical and quality of life outcomes.

Methods

Data were collected as part of the GO-LEVEL study, an open-label, phase IV, investigator-initiated study (NCT03124121) which included a prospective cohort of UC patients commencing golimumab induction therapy, as well as a cross-sectional cohort receiving maintenance treatment. Patients commencing induction therapy all had disease activity objectively confirmed and were evaluated at weeks 6, 10 and 14. Patients receiving maintenance therapy were recruited either at the point of flare or during stable remission. Clinical disease activity was evaluated using PRO2 and SCCAI, quality of life using IBD-Control as well as a 100mm visual analogue scale (IBD-Control-VAS), and biochemical activity using FC and CRP. Clinical remission was defined as a score of <3 using SCCAI, or 0 using PRO2. Correlations were calculated using Spearman’s correlation coefficient (rs) and contingency table analyses using Chi-square.

Results

GO-LEVEL included a total of 112 patients across the two study cohorts. A total of 217 PRO2 assessments were made with concurrent SCCAI and IBD-Control scores available at all timepoints. CRP measurements were available at 214 of these and FC at 207. Strong correlations were observed between PRO2 and SCCAI (rs = 0.94, p < 0.0001), as well as with IBD-Control (rs=−0.82, p < 0.0001) and IBD-Control-VAS (rs = −0.78, p < 0.0001). Significant correlations were also seen between PRO2 and FC (rs = 0.38, p < 0.0001) as well as PRO2 and CRP (rs=0.31, p < 0.0001).

Of the 217 assessments, 109 were in SCCAI defined remission, 95 were in PRO2 defined remission and the two were highly contingent (p < 0.0001). The sensitivity and specificity of disease activity assessments made with PRO2 vs. SCCAI were 0.85 and 0.98, respectively. The positive and negative predictive values were 0.98 and 0.87, respectively.

Conclusion

The PRO2 performs well when validated against an established clinical disease activity index (SCCAI), quality-of-life assessments and biochemical markers of disease activity. PRO2 assessments have the benefit of being more rapid to administer (comprising of only two items) than SCCAI (6 items), whilst providing similar and accurate evaluations of remission status.
P198 Colorectal cancer diagnosis in patients with inflammatory bowel disease in Spain: A room for improvement
Authors: Saldana R , Savini C , Bella Castillo P , Vera Mendoza I , Nos Mateu P
Published: January 2020

Background

Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD), characterised by chronic inflammation of the digestive tract. IBD patients have an increased risk of developing colorectal cancer (CRC) compared with the general population. A proper screening in this population is essential to guarantee an early CRC diagnosis and maximise the success of the treatment. The aim of the study was to analyse the usual clinical practice in the diagnosis of CRC in IBD patients in Spain, and possible areas of improvement.

Methods

This preliminary qualitative study was carried out through the creation of four round tables with gastroenterologists and oncologists from different cities of Spain. The opening and closing tables were composed by 1 representative of the Confederation of Associations of Patients with CD and UC of Spain, an expert patient, a nurse from an IBD Unit, a representative of the Spanish Working Group on CD and UC, a gastroenterologist, an oncologist. The first one was necessary to point out the issues that were considered as the most important ones to be discussed in the round tables. In the closing table, all the debates were analysed in order to formulate conclusions.

Results

According to health professionals, the average delay time from the suspicion of an IBD flare, until the diagnosis of a CRC, is 3 months. The difficulty and delay in the diagnosis of CRC is generally attributed to the fact that the symptoms of the two pathologies usually overlap. Medical specialists currently suggest performing chromoendoscopy, in order to increase the rate of early detection of CRC. However, even if patients’ management and CRC prevention are described by the ECCO guidelines, we identify a lack of standardisation of the techniques for the diagnosis of CRC, which cannot guarantee an equal follow-up of IBD patients at the national level. Also, it can vary not only depending on the geographical area, but also in the centre. The reasons why the follow-up cannot be done – or is not done properly, are the lack of time, human resources, diagnostic tools and patient collaboration.

Conclusion

From a quantitative point of view, specialists perceive the early CRC underdiagnosis in IBD patients as a minor problem, since they agree that there may be little escaping to the screenings that are routinely performed to these patients. On the other hand, at a qualitative level they recognise it is a major problem, since a delay in diagnosis or misdiagnosis can lead to patient’s death. Thus, hospital administrations should provide resources that allow an adequate follow-up of all IBD patients. Also, the creation of multidisciplinary units would guarantee better management of these patients.
P202 Crohn’s disease extent and small bowel inflammatory activity: Results of a small bowel capsule endoscopy study
Authors: Mitselos I , Lamouri C , Theopistos V , Kavvadias A , Moutzoukis M , Beka E , Katsanos K , Christodoulou D
Published: January 2020

Background

Small bowel capsule endoscopy (SBCE) enables the direct visualisation of the entire small bowel (SB) mucosa and the application of the Lewis score allows the reliable assessment of the SB mucosal inflammatory activity in Crohn’s disease (CD) patients. The study aim was to investigate the association of disease location, extent and inflammatory activity in CD patients with the use of SBCE

Methods

Retrospective study of 80 consecutive patients with an established CD that underwent SBCE in the Gastroenterology Department of the University Hospital of Ioannina between January 2007 and October 2019, for the evaluation of disease extent and disease activity.

Results

Fifty-one patients had evidence of endoscopic disease activity. In 30 of these patients (58.8%), the disease was located in the ileum and proximal SB, whereas in 20 patients (39.2%) the disease was located solely in the terminal ileum. In one patient (2%) treated with adalimumab, the disease was located solely in the jejunum. Eight patients (15.7%) had evidence of disease activity in the upper GI. All patients with upper GI disease activity demonstrated proximal SB disease involvement. The median Lewis score in patients with proximal CD was 1350 (mean 1666.3; Std 1343) median) against 458 (mean 1548,6; Std 1751) in patients with disease located in the ileum (p = 0.10).

Conclusion

In our study, proximal small bowel disease involvement was present in >50% of CD patients. Upper GI involvement was associated with extensive SB disease. Patients with proximal SB CD demonstrated a higher median Lewis score compared with those with CD located solely in the terminal ileum.
P213 Can artificial intelligence help differentiate inflammatory intestinal diseases in China? Models applying random forest and convolutional neuron network
Authors: Li Y , Tong Y , Lu K , Yu S , Qian J
Published: January 2020

Background

Differentiating between ulcerative colitis (UC), Crohn’s disease (CD) and intestinal tuberculosis (ITB) is challenging under endoscopy. We aimed to realise automatic differential diagnosis among these diseases through machine learning algorithms.

Methods

A total of 6399 consecutive patients (5128 UC, 875 CD and 396 ITB) who had taken colonoscopy examinations in Peking Union Medical College Hospital from January 2008 to November 2018 was enrolled. The input was the description of the endoscopic image in the form of free-text. Word segmentation and key word infiltration were conducted as data pre-processing. Random forest (RF) and convolutional neural network (CNN) were applied to different disease entities. Three two-class classifiers (UC and CD, UC and ITB, CD and ITB) and a three-class classifier (UC, CD and ITB) were built. Sensitivity/specificity and precision/recall were applied to evaluate the performance of two-class classifiers and the three-class classifier, respectively.

Results

The classifiers built in this research were well-performed and the CNN had a better performance in general. The RF sensitivities/specificities of UC-CD, UC-ITB and CD-ITB were 0.89/0.84, 0.83/0.82 and 0.72/0.77, while the CNN of CD-ITB was 0.90/0.77. The precision/recall of UC-CD-ITB was 0.97/0.97, 0.65/0.53 and 0.68/0.76 by RF, respectively, and 0.99/0.97,0.87/0.83 and 0.52/0.81 by CNN, respectively.

Conclusion

Classifiers built by RF and CNN had an excellent performance when classifying UC with CD or ITB. For the differentiation of CD and ITB, high specificity and sensitivity were reached as well. Artificial intelligence through machine learning is very promising in helping unexperienced endoscopists differentiate inflammatory intestinal diseases.
P247 Sex-related differences in clinical diagnosis of inflammatory bowel disease
Authors: Sempere Robles L , Purificación B , Cameo J , Gutiérrez A , Laveda R , García M , Aguas M , Medina L , Martinez A , Jimenez N , Nos P , Jover R , van-der Hofstadt C , Ruiz M T
Published: January 2020

Background

There is a lack of knowledge of the differences between women and men in clinical behaviour at the onset of inflammatory bowel disease (IBD). We hypothesise a potential diagnostic delay in women in IBD. The aims of this study were: (1) to evaluate the differences in diagnostic effort between women and men with IBD and (2) to assess the sex differences in IBD diagnosis and its impact on the gender roles, the quality of life and the emotional sphere.

Methods

We performed a prospective multicentre observational study in adults with a new diagnosis of IBD. The diagnostic process of IBD was reconstructed with semistructured interviews and electronic clinical records. Time to diagnostic resolution after the onset of symptoms and misdiagnosis of IBD in the different levels of the healthcare system were analysed. Patient delay was defined as the period from symptom recognition to first medical consultation. An additional interview was conducted to assess differences between women and men in the influence of IBD in gender roles (directed questions), quality of life (IBDQ-32), anxiety and depression (Hospital Anxiety and Depression Scale) and stress (Disease-Related Stress Appreciation Scale).

Results

121 patients were included (44.6% CD, 53.7% UC, 1.7% IBD-U), (43.8% women 56.2% men) (median age 43 years, 29.5–55). Time to diagnostic resolution was higher in women compared with men, 214 days (93–452) vs. 90 days (40–183) p = 0.001. These differences were more evident in CD 326 days (94–627) / 67 days (28–182) p = 0.007, than in CU 174 days (92–350) / 92 days (47–184) p = 0.078. There were no significant sex differences in patient delay. Misdiagnosis of IBD was found to be 71.7% for women and 48.5% for men (p = 0.010). Data from Table 1 and Table 2 show the sex differences in the ‘influence’ of IBD in a sample of gender roles evaluated, the quality of life and the emotional sphere.

Conclusion

Our results demonstrate that women with IBD show a higher diagnostic delay and misdiagnosis compared with men. This delay is more evident in CD. Moreover, there is a higher impact of IBD diagnosis in women on the gender roles, the quality of life and the emotional sphere.
P251 Small bowel capsule endoscopy is a valuable diagnostic tool in isolated terminal ileitis
Authors: FREITAS M , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Rosa B , Moreira M J , Cotter J
Published: January 2020

Background

Terminal ileitis (TI), is a common condition in clinical practice and may be associated with a wide variety of diseases. Small bowel capsule endoscopy (SBCE) is a valuable diagnostic tool for small bowel diseases; however, data regarding its diagnostic impact on isolated TI are sparse. The aim of the study was to evaluate the diagnostic value of SBCE for isolated TI detected during ileocolonoscopy.

Methods

Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected.

Results

One hundred and two patients with isolated ileitis on ileocolonoscopy were included. Positive findings on SBCE were found in 84 (82.4%) patients, being ulcers the most common finding (76.5%). Endoscopic abnormalities proximal to terminal ileum were found in 36.3% of patients. After SBCE, 63.7% of patients had a final diagnosis, Crohn’s disease (CD) was the most common (34.3%), followed by NSAIDs enteropathy (12.7%). Elevated faecal calprotectin (p = 0.001) was independently associated with positive SBCE findings. There was a tendency for high levels of erythrocyte sedimentation rate be associated with positive findings (p = 0.07). However, the presence of symptoms, imaging abnormalities and other laboratory findings such as leukocytosis, anaemia, and elevated C-reactive protein were not predictors of positive SBCE findings. At multivariate analysis, only elevated faecal calprotectin (OR 6.0, IC 95% 1.9–18.7; p = 0.002) was a significant predictive factor for positive SBCE findings.

Conclusion

SBCE revealed a high diagnostic yield in patients with isolated ileitis on ileocolonoscopy enabling a definite diagnosis in almost two-thirds of patients. Approximately one-third of patients had findings proximal to terminal ileum and a similar percentage was diagnosed with CD. In patients with isolated ileitis on ileocolonoscopy, SBCE should be considered to evaluate small bowel lesions, particularly when there is an elevated faecal calprotectin, even when other clinical, imagiological or laboratorial abnormalities are absent.
P253 The prevalence of type 6 herpes with polyps in patients with inflammatory bowel disease
Authors: Babayeva-Sadigova G , Babayev Z , Mahmudov U , Asadova G , Quliyev F , Mirzazade O
Published: January 2020

Background

The prevalence of opportunistic infections in individuals with inflammatory bowel disease (IBD) remains relevant. Viral infections are a common cause of systemic inflammation of the digestive tract. Clinically expressed herpes infections are a serious problem, especially for individuals with prolonged immunosuppression. The aim of this study was

t

o assess the frequency of detection of herpes-6 type with polyps in patients with IBD.

Methods

189 patients with IBD, 102 with ulcerative colitis and 87 with Crohn’s disease were examined. Of the number of patients: 98women, 91man. The age of the patients is from 16 to 63 years (mean age 41.4 ± 4.8), out of 189 patients intestinal polyps were identified in 61 patients with a colonoscopy. In addition to standard clinical and endoscopic examinations, disease activity was assessed by indicators of highly sensitive C-reactive protein, homocysteine, vitamin D in blood serum, albumin in urine, calprotectin, lactoferrin and pyruvate kinase in faeces. All patients underwent a serological blood test by ELISA for specific antibodies to herpesvirus type 1–6 IgG/IgM antibodies, as well as avidity, determination of DNA to herpes viruses of types 1–6 species by PCR in blood and mucosal biopsy.

Results

Among patients with IBD (n = 189), active herpes viruses in the blood were found in 65 patients (34.4%); of them, 39 patients (20.6% (n = 189) and 60%(n = 65),respectively) were diagnosed with monoherpesvirus infections, and 26 (13.7%(n = 189) and 40%(n = 65), respectively) of myxedvirus infections. PCR of the biopsy material was positive in isolation for type 6 herpes virus in 22 cases (11.6% (n = 189) and 33.8% (n = 65)) and in 34 cases (17.9% (n = 189) and 52.3% (n = 65)) a myxedvirus lesion was detected in the tissue (HV6 + EPB, HV6 + CMV), these indicators were detected in patients with intestinal polyps. Although clinical and endoscopic and laboratory indicators of disease activity were significantly higher in patients with mixed tissue lesions (p˂0.05), the level of faecal pyruvate kinase was higher in patients with polyps, indicating a negative effect of herpes type 6 on the course of inflammatory bowel diseases. At the same time, no significant differences were found between patients with ulcerative colitis and Crohn’s disease.

Conclusion

The frequency of occurrence of herpes type 6 on PCR biopsy in patients with polyps with IBD is more than 91.8% (36.5% in isolation and 55.7% of mixed lesions) and is accompanied by higher rates of faecal pyruvate kinase, which is already an indicator of emerging malignancy. The authors propose the determination of polyps in patients with IBD HV6 by PCR biopsy of intestinal tissue.
P257 Prognostic value of bowel ultrasonography for the management of Crohn’s disease
Authors: Suarez Ferrer C J , Poza Cordon J , Crivillen Anguita O , Martin Arranz E , Rueda Garcia J L , Sanchez Azofra M , Garcia Ramirez L , Noci Belda J , Martin Arranz M D
Published: January 2020

Background

The ‘treat to target’ strategy for managing patients with Crohn’s disease (CD) requires simple, reliable and non-invasive monitoring tools. Bowel ultrasound is an emerging technology that could be useful in this field. The aim of our study is to determine whether bowel ultrasound is a useful tool to assess activity in CD and if its results correlate with long-term evolution of the disease.

Methods

Patients who had a bowel ultrasound for clinical practice between February 2013 and October 2018 in our centre were retrospectively included. Evolution of patients was assessed at follow-up based on the presence of echographic signs of activity and therapeutic changes solely based on echographic features.

Results

277 CD patients were included, of which 51% (142 patients) are women with a mean age at diagnosis of CD 35.3 years old (18.7 SD). The median follow-up time was 24 months (range 5–73 months). Among patients included, echographic signs of inflammatory activity were identified in 166 patients (60%). Out of these, 116 patients (70%) received treatment step-up based on the results of ultrasound. It was observed that out of the 161 patients (58%) in which of the attending physician did not modify treatment after performing ultrasound, only 43 had activity on ultrasound (26.7%). Also among patients whose treatment was scaled, 100% had echographic activity. These differences reached statistical significance (p < 0.0001). Among patients with echographic activity, disease evolution was worse than in those without activity, presenting less time to the next disease flare. Thus median disease-free survival (without flares) after performing ultrasound was 18 months when ultrasonographic activity identified (although in most patients (70%) treatment was scaled) vs. 47 months in patients without ultrasound activity, with statistically significant differences (p < 0.0001).

Conclusion

Intestinal ultrasound is a technique capable of detecting inflammatory activity in patients with Crohn’s disease and the presence of ultrasound activity is a risk factor for a subsequent activity flare and/or clinical relapse.
P261 Systematic review with meta-analysis: The impact of concomitant immune-mediated diseases on the disease course of inflammatory bowel disease
Authors: Attauabi M , Zhao M , Bendtsen F , Burisch J
Published: January 2020

Background

Several studies have shown an association between inflammatory bowel diseases [IBD] and immune-mediated diseases [IMIDs], but data on the impact of co-occurring IMIDs on IBD course are inconsistent. The aim of this study was to investigate the impact of co-occurring IMIDs on IBD phenotype and disease course.

Methods

PubMed and EMBASE were searched from database inception through December 2018 and updated in October 2019 for studies reporting prevalences or odds, risks or hazard ratios of IBD-related disease outcomes in patients with and without co-existing IMIDs. Meta-analyses were performed to estimate summary prevalences and risks of the outcomes which included disease extension, IBD-related surgery and hospitalisation, malignancy, mortality and need of medication (biologic therapy, steroids and immunomodulators). IMIDs were stratified into primary sclerosing cholangitis [PSC] and ‘IMIDs other than PSC’.

Results

A total of 93 studies comprising 14,307 IBD patients with IMIDs and 3,409,914 IBD patients without IMIDs were included in the study. Summary risks and prevalences with 95% confidence intervals for each outcome are presented in figures 1 and 2, respectively. The following results are all significant (p < 0.05). Compared with patients without co-occurring IMIDs, patients with ulcerative colitis [UC] and co-occurring IMIDs other than PSC more frequently received immunomodulators and steroids, and patients with Crohn’s disease [CD] and concomitant IMIDs other than PSC more often received biologic therapy. UC patients with co-existing IMIDs other than PSC more often underwent IBD-related surgery, while patients with CD and PSC received fewer surgeries. In addition, UC patients with co-occurring PSC were at increased risk for having extensive colitis, pancolitis, and malignancies. Patients with UC and PSC had a higher mortality rate, but no difference was found among patients with IMIDs other than PSC. PSC did not influence hospitalisation rates among IBD patients.

Conclusion

This meta-analysis found that IBD patients with co-existing IMIDs have a different disease course than patients without concomitant IMIDs. This study emphasises the importance of multidisciplinary care of IBD and that physicians caring for IBD patients need to be aware of IMIDs as a prognostic factor.
P264 Analysis of nutritional status and nutrient intake in patients with inflammatory bowel disease: a prospective, case–control study
Authors: YOON Y E , Kim H M , Kim J H , Youn Y H , Park H J , Park J J
Published: January 2020

Background

Anthropometric data and dietary intake pattern are poorly known in Asian inflammatory bowel disease (IBD) patients. The aim of this study was to investigate the nutritional status and nutrient intake of IBD patients compared with control population.

Methods

From February to June 2018, a total of 65 outpatients, including 33 ulcerative colitis (UC) and 32 Crohn’s disease (CD) were prospectively enrolled in Gangnam Severance Hospital. As a control group, age- and gender-matched 260 subjects were included among the Korean National Health and Nutrition Examination Survey (KNHANES) data. Anthropometry and body composition data were collected by bioelectrical impedance analysis(BIA); meanwhile, nutrient intake was measured based on diet diary.

Results

Based on Asia Pacific criteria, more than half of both UC and control group were obese or overweight, on the other hands, CD was relatively low, about 1/3. Compared with the UC group, body fat index including both fat mass index (FMI) and body fat percentage (BFP) were significantly lower in the CD group. Following nutrients intake including intake of energy, carbohydrate, niacin, sodium and potassium were significantly lower in UC than the control group. Meanwhile, intake of carbohydrate, thiamine, niacin, sodium, potassium and iron was significantly lower in CD than the control group. In addition, the ratio of energy intake through protein and fat was significantly higher in the IBD than the control group.

Conclusion

Similar to the control group, more than half of UC patients were overweight or obesity, meanwhile, the proportion of obese patients in CD was lower than in the control group. The ratio of energy intake through protein and fat was significantly higher in IBD than in the control group. Our results may have clinical implications for risk of IBD development in terms of dietary pattern and further direction of nutritional intervention.
P269 Mucosal capillary pattern recognition based on real-time computer-aided image analysis adequately detects histological remission in ulcerative colitis
Authors: Bossuyt P , De Hertogh G , Eelbode T , Vermeire S , Bisschops R
Published: January 2020

Background

Objective treatment targets are required in a treat-to-target approach for ulcerative colitis (UC). An automated endoscopic system that correlates with histology can be an objective predictor for sustained remission in UC. The infiltration of neutrophils is associated with irregularities of the pericryptal capillaries. For this, we aimed to develop an objective automated endoscopic tool to assess histological remission based on the evaluation of the morphology of the pericryptal capillaries during endoscopy.

Methods

We used a prototype endoscopic system with short-wave-length monochromatic light from a LED system. This enables to evaluate in real-time the superficial (<200µm) mucosal architecture (crypts, pericryptal capillaries) and mucosal bleeding, Figure 1. An image analysis algorithm was applied to provide a score that quantifies the specific morphology of the mucosal capillaries. The algorithm included two steps. First, bleeding (mucosal/luminal) was assessed by pattern recognition. Samples with bleedings were automatically classified as non-remission. In case of non-bleeding, the degree of congestion of the capillaries was measured (maximal localised density estimation after morphological hessian based vessel recognition) to assess an ideal cut off value that identifies histological remission (Geboes score (GBS) <2B.1; no neutrophils in the lamina propria). Consecutive patients with UC were evaluated with the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity (UCEIS) and the automated image analysis algorithm. To test the reliability of the algorithm and scores, the results were correlated with the GBS. Biopsies were taken in the matching area of the endoscopic evaluation.

Results

Fifty-eight patients with UC (53% male, median (IQR) age 41y (38–56), disease duration 7.1y (2.4–16.4)) with 113 evaluable segments (89% rectum or sigmoid) were included. The correlation between GBS and MES, UCEIS was good (r = 0.76, 0.75 respectively). The automated image analysis algorithm (Figure 2) detected histological remission with a higher performance (sens 0.79, spec 0.90) compared with UCEIS (sens 0.95, spec 0.69) and MES (sens 0.98, spec 0.61), resulting in a positive predictive value of 0.83, 0.65 and 0.59 for the automated image analysis algorithm, UCEIS and MES, respectively. The algorithm detected histological remission with high accuracy (86%).

Conclusion

Mucosal capillary pattern recognition based on an automated image analysis with short-wave-length monochromatic light detects histological remission with high accuracy in UC. This technique provides an objective and quantitative tool to assess histological remission in UC, and excludes inter-reader variability.
P278 Comparison of prostaglandin E–major urinary metabolite (PGE-MUM) with faecal calprotectin and faecal immunochemical tests for determining endoscopic remission in patients with ulcerative colitis
Authors: Sakurai T , Yoshihiro A , Haruna M , Ryosuke M , Yuki M , Mariko S , Tomoko S , Takushi Y , Masayuki S
Published: January 2020

Background

Faecal calprotectin (FC) and faecal immunochemical tests (FIT) have the disadvantage of requiring faecal samples. It has been reported that prostaglandin E–major urinary metabolite (PGE-MUM) values correlate with Mayo endoscopic scores (MESs) for ulcerative colitis (UC). However, there has been no report that PGE-MUM can determine endoscopic remission under remission phase UC, nor comparative study of PGE-MUM with FC and FIT. Thus, we aimed to examine the association between PGE-MUM values and the colonoscopy (CS) results of patients in the remission phase of UC, and to compare the accuracy of using PGE-MUM vs. that of using FC or FIT values for determining endoscopic remission.

Methods

Patients diagnosed with UC who were under clinical remission and had planned to undergo CS from August 2017 to March 2019 were enrolled. FC levels were measured and FITs were performed on the day of CS; PGE-MUM was measured either the day before or after CS. Three physicians independently scored the CS findings (MES, Modified Mayo Endoscopic Score [MMES], and UC endoscopic index of severity [UCEIS]) while blinded from clinical information. We analysed the differences in PGE-MUM values between two groups, which were divided between those that did achieve and those that did not achieve the following scores: (1) MES 0 point, (2) MES 1 point, (3) modified MES 0 point, (4) modified MES ≤1 point, (5) UCEIS 0 point, (6) UCEIS ≤2 points. In addition, the accuracy of PGE-MUM, FC, and FIT with respect to determining the achievement of (1) through (6) were compared by using areas under the receiver operating characteristics curves. Patients with altered UC activity between the day of PGE-MUM measurement and CS, and those who received NSAIDs on the day of PGE-MUM measurement, were excluded from the analysis.

Results

Of the 125 enrolled subjects, 30 patients were excluded (urine specimens not submitted, 11; poor stool specimens, 6; NSAIDs users, 10; clearly altered UC activity, 3). The remaining 95 patients (average age 48.2 years, 57 males, and 54 patients with total colitis type), were eligible for analysis. The median PGE-MUM values (in µg/g·Cr) for groups that did or did not achieve (1) through (6) were as follows: (1) 14.6/17.2, p = 0.106; (2) 14.9/20.5, p = 0.039; (3) 14.5/17.4, p = 0.059; (4) 14.1/21.8, p < 0.001; 5) 14.5/17.4, p = 0.059; (6) 14.7/22.2, p = 0.003. The areas under the receiver operating characteristics curves for PGE-MUM/FC/FIT used for determining the achievement of 1) through 6) were as follows: (1) 0.597/0.664/0.682, (2) 0.692/0.74/0.825, (3) 0.613/0.686/0.692, (4) 0.794/0.82/0.786, (5) 0.613/0.686/0.692 and (6) 0.778/0.824/0.825.

Conclusion

PGE-MUM is equally as effective as FC and FIT for determining the achievement of endoscopic remission.
P281 A serum biomarker panel can accurately identify the presence of mucosal ulcers in patients with Crohn’s disease
Authors: HOLMER A , Boland B , Singh S , Neill J , Le H , Miralles A , Collins A , Sandborn W , Dulai P
Published: January 2020

Background

Ulcer healing is the primary endoscopic treatment target in Crohn’s disease (CD) in routine practice. A novel serum-based biomarker panel named endoscopic healing index (EHI, Monitr, Prometheus Biosciences, San Diego, CA) was developed and validated for identifying mucosal inflammation as assessed by the simple endoscopic score for CD (SES-CD).1 We aimed to define the operating characteristics of EHI in routine practice for mucosal ulcers specifically.

Methods

EHI was analysed on serum samples paired with endoscopies from adult patients (≥18 years) participating in a prospective biobank (June 2014 to December 2018). Patients with an ileal pouch-anal anastomosis or an ileostomy were excluded. The performance of EHI for endoscopic disease activity was evaluated for subcomponents of SES-CD scores (0–60) including ulcer presence and size, extent of ulcerated surface, extent of affected surface, and presence of strictures. Diagnostic performance was assessed using previously identified cut-offs for optimal EHI performance in CD for ruling out endoscopic activity (20 points) and ruling in endoscopic activity (50 points). Logistic regression was performed to identify confounders of EHI (patient factors, disease characteristics) and for the strength of association between EHI and ulcers (presence, size).

Results

A total of 205 CD patients were included in the analysis (50% male, median age 37 years). EHI values were significantly higher with increasing ulcer size (p < 0.001). An EHI cut-off of 20 points exhibited modest sensitivity for ruling out any ulcers (85%, 95% CI 77–91), and large (0.5–20 mm) or very large (>20 mm) ulcers specifically (92%, 95% CI 84–97). An EHI cut-off of 50 points had modest specificity for ruling in the presence of any ulcers (85%, 95% CI 76–92), and large or very large ulcers specifically (87%, 95% CI 79–92). After accounting for the total extent of inflamed mucosa, extent of strictured mucosa, and disease location, each 20-point increase in EHI was independently associated with an incremental 1.7-fold increased probability for the presence of a large or very large ulcer (aOR 1.7, 95% CI 1.1–2.6).

Conclusion

EHI values were associated with ulcer size independent of inflammatory or stricture burden, and accurately identified the presence of ulcers and large or very large ulcers specifically. A cut-off of 50 points can reliably rule in the presence of ulcers and allow for treatment adjustment without endoscopy. A cut-off of 20 points can reliably rule out the presence of ulcers and signal completion of treatment adjustment algorithms.

Reference
P298 Patient-reported outcomes: the ICHOM standard set for IBD in real-life practice helps quantify deficits in current care
Authors: Wong D , Kantschuster R , Matini L , Simadibrata D , Lepetyukh M , Wilson J , Brain O , Palmer R , Ambrose T , Satsangi J , Travis S , Walsh A J
Published: January 2020

Background

Ulcerative colitis (UC) or Crohn’s disease (CD) are associated with symptoms that lead to reduced quality of life and increased healthcare utilisation. The patient reported outcome (PRO) tools are key to documenting outcomes that matter most to patients and are increasingly important to commissioners of health care seeking value. We report the first series of the ICHOM Standard Set for inflammatory bowel disease (IBD).

Methods

Patients treated for UC or CD in our tertiary referral centre are offered enrolment into the TrueColours IBD web-based PRO collection programme. This functions through email prompts, directly linked to validated questionnaires. Prompts for symptoms (daily SCCAI for UC and HBI for CD); quality of life (fortnightly IBD-Control); and other outcomes (baseline and 3 monthly ICHOM Standard Set), including data on steroid use, hospital admission and other measures through internationally agreed criteria.

Results

The first 500 consecutive patients enrolled (401 UC, 99 CD) were studied. 274 (55%) were female, mean age 40 years (sd 15), and mean BMI 26 (sd 6). 22/500 (5%) were current smokers. Baseline medications at the time of registration were no therapy 6%, topical therapies 21%, 5ASA 49%, thiopurines 24%, methotrexate 6%, budesonide 3%, prednisolone 10%, advanced therapies 37%. (adalimumab 13%, golimumab <1%, infliximab 9%, tofacitinib 1%, ustekinumab 1%, vedolizumab 16%). In the previous 12 months, prednisolone use was reported by 148 (37%) patients with UC vs. 25 (25%) patients with CD, p = 0.02: 107 (21%) for <3 months and 66 (13%) for >3 months. 61 (12%) patients reported requiring an IBD-related intervention (11% UC vs. 17% CD) and 25 (5%) reported an unplanned hospital admission (4% UC vs. 8% CD). Eighty-one (16%) participants had required at least one hospital admission in the preceding year, exceeded by 101 (20%) requiring at least one emergency department presentation in the same period. There were high rates of fatigue (53%) and mood disturbance (26%). Eighty-two (16%) felt they needed a treatment change, and 136 (27%) felt their current treatment was not useful for their IBD.

Conclusion

Outcomes reported by patients illustrate the scale of the therapeutic deficit in current care. The ICHOM Standard Set acts as a benchmark for comparing outcomes between institutions.
P303 Role of parietal healing by ultrasound in the evolution of patients with Crohn’s disease
Authors: Mayor Delgado P , Suarez Ferrer C J , Poza Cordon J , Martin Arranz E , Rueda Garcia J L , Sanchez Azofra M , Cuadros Martinez M , Ruiz Ramirez M A , Martin Arranz M D
Published: January 2020

Background

The objective of this study is to assess the degree of parietal involvement with ultrasound and see how they influence the prognosis according to the findings.

Methods

It was defined as ‘parietal healing’ the normalisation of ultrasound findings in a previously affected segment (parietal thickness less than 3 mm and absence of parietal hyperaemia). Therefore, patients with absence of ultrasound activity but without reaching parietal healing were considered to be those without significant inflammatory signs (parietal thickness <4.5 mm and absence of hyperaemia or other inflammatory data) but who had not ‘normalised’ the previously affected segment.

Results

A total of 111 patients without ultrasound inflammatory activity were included. It was studied whether normalisation of parameters in a previously affected segment, i.e. parietal healing gave a better prognosis during follow-up. It was detected that 74 patients achieved ‘parietal healing’ and this subgroup of patients generally had a flare in 12% of cases (9/74 patients) compared with 27% of cases (10/37) among patients without parietal healing, these differences were statistically significant (p = 0.05). Similar, it was identified that among patients without ultrasound activity who had a subsequent outbreak during follow-up, the median survival was lower (1,09 years) in patients without parietal healing vs. those with parietal healing (1.4 years), the differences reaching statistical significance (p = 0.03). Likewise, during the follow-up, it was objectived, by means of survival analysis, that the evolution of patients without ultrasound activity was more favourable in those with ‘parietal healing’ with remission 95% vs. 90% at first year, 89% vs. 81% at 2 years and 85% vs. 66% at 3 years of follow-up. The results are outlined in Figure 1.

Conclusion

To conclude, detecting parietal healing by ultrasound improves prognosis by decreasing the number of outbreaks and increasing the median survival until outbreaks occur.
P305 A location-based prediction model in Crohn’s disease regarding a novel serological marker, anti-Chitinase 3-like 1 autoantibodies
Authors: Sipeki N , Kovats P , Deutschmann C , Schierack P , Roggenbuck D , Maria P
Published: January 2020

Background

A defective neutrophil regulation in IBD is thought to play an important role in the onset or manifestation of IBD, since it could lead to damage of the intestinal mucosal barrier by infiltration of neutrophils in the inflamed mucosa and the accumulation of pathogens. Like neutrophils in the context of innate immune responses, immunoglobulin A (IgA) as an acquired immune response partakes in the defence of the intestinal epithelium. Under normal conditions, IgA would contribute to the elimination of microbes, but in connection with the loss of tolerance to CHI3L1 in IBD, IgA could participate in the CHI3L1-mediated improved adhesion and invasion of potentially pathogenic microorganisms. The tolerance brake to CHI3L1 and the occurrence of IgA auto-Abs to this particular target, the exact role and underlying mechanisms of CHI3L1 in the pathogenesis of IBD are still unclear.

Methods

We aim to determine the predictive potential of immunoglobulin subtypes of a novel serological marker, anti-chitinase 3-like 1 autoantibodies (aCHI3L1) regarding determination of disease phenotype, therapeutic strategy and long-term disease course in a prospective referral adult IBD patient cohort. Immunoblotting of antineutrophil-cytoplasmic antibody-positive sera of IBD patients on neutrophil proteins and MALDI-TOF mass spectrometry were used to identify autoantigenic targets in IBD. Sera of 257 CD and 180 UC patients were assayed for IgG, IgA, and secretory IgA (sIgA) type aCHI3L1 by enzyme-linked immunosorbent assay using recombinant CHI3L1 along with 86 healthy controls (HCONT).

Results

IgA type was more prevalent in CD than UC (29.2 vs. 11.1%) or HCONT (2.83%; p < 0.0001 for both). However, sIgA subtype aCHI3L1 positivity was higher in both CD and UC compared with HCONT (39.3 and 32.8 vs. 4.65%, respectively; p < 0.0001). The presence of both IgA and sIgA aCHI3L1 antibodies was associated with colonic involvement (p < 0.0001 and p = 0.038, respectively) in CD. Complicated disease behaviour at sample procurement was associated with the presence of aCHI3L1 sIgA positivity (57.1% vs. 36.0%, p = 0.009). Whilst, IgA type aCH3L1 was more prevalent in patients with frequent relapse during the disease course in CD (46.9% vs. 25.7%, p = 0.005). In a group of patients with concomitant presence of pure inflammatory luminal disease and colon involvement at the time of the diagnosis, positivity for IgA or sIgA type aCH3L1 predicted a faster progression towards complicated disease course in time-dependent models. This association disappeared after merging subgroups of different disease locations.

Conclusion

CHI3L1 is a novel neutrophil autoantigenic target in IBD. Consideration of antibody classes along with location-based prediction can revolutionise the future of serology in IBD.