bluuebunny/crossref_metadata_2025 huggingface dataset:
P767 Intestinal ultrasonography predicts short term clinical remission in patients with moderate-to-severe ulcerative colitis
Authors: Zorzi F , De Cristofaro E , Abreu M T , Montesano L , Cuccagna E , Essofi S , Biancone L , Monteleone G , Calabrese E
Published: January 2023

Background

Intestinal ultrasonography (IUS) is a non-invasive, easily accessible and low-cost procedure to visualize the colon and determine disease activity, extent and treatment response in IBD. Our aim was to investigate whether ultrasonographic parameters predict short-term clinical remission in ulcerative colitis (UC).

Methods

Consecutive patients (pts) with moderate-to-severe UC (total Mayo score>6) starting biological therapies or small molecules were included. Patients were evaluated at baseline by clinical, biochemical, endoscopic (endoscopic Mayo score), and IUS assessments. IUS, doppler and elastographic parameters assessed at baseline before starting therapy were: bowel wall thickening (BWT), echopattern, blood flow (adapted Limberg’ score), Milan Ultrasound criteria (MUC) and shear wave elastography values. The most affected colonic segment was used for all imaging assessments. Clinical remission at 3 months was defined as partial Mayo Score=0-1. Predictive factors of clinical remission at 3 months were analyzed by logistic regression. ROC curve analysis was used to identify the best cut-off of BWT in predicting clinical remission.

Results

Thirty-one UC pts were enrolled (12 males [39%]; median age: 45 years, range 18-72; median disease duration: 108 months, range 3-312). Sixteen per cent of pts had left colitis and 84% had extensive UC according to the Montreal criteria. Forty-eight per cent of pts were treated with Anti-TNFs, 39% with vedolizumab, 10% with ustekinumab and 3% with tofacitinib. At baseline, 84% of patients had moderate disease and 16% severe disease according to the total Mayo score. A lower total Mayo score and partial mayo score at baseline were predictive of clinical remission at 3 months after starting biological therapy or small molecules than endoscopic Mayo score (OR 0.58, 95% CI 0.33-0.99, p=0.03; OR 0.55, 95% CI 0.29-0.99, p=0.037; OR 0.57, 95% CI 0.16-1.93, p=0.36, respectively; Figure 1, panels A-C). A lower BWT, Limberg’ score and MUC at baseline were predictive of clinical remission at 3 months (OR 0.19, 95% CI 0.05-0.72, p=0.0023; OR 0.22, 95% CI 0.06-0.77, p=0.004; OR 0.48, 95% CI 0.21-0.83, p=0.001, respectively; Figure 1, panels D-F). The most accurate cut-off value of BWT for predicting clinical remission was <6 mm with sensitivity and specificity of 70% and 82%, respectively (Figure 1, panel G).

Conclusion

IUS easily predicts early clinical remission in patients with moderate-to-severe UC after therapy.
P786 Induction of endoscopic response, remission and ulcer-free endoscopy with upadacitinib is associated with improved clinical outcomes in patients with Crohn’s disease
Authors: Panés J , Louis E , Bossuyt P , Joshi N , Lee W J , Lacerda A , Remple V , Xuan S , Loftus Jr. E V
Published: January 2023

Background

STRIDE-II guidelines recommend endoscopic healing as an important treatment goal in Crohn’s disease (CD). This study evaluated the association of achieving endoscopic outcomes at week 12 and clinical outcomes at week 52 of maintenance treatment in patients with CD treated with upadacitinib (UPA).

Methods

This post-hoc analysis evaluated data from two Phase 3 UPA induction (U-EXCEED and U-EXCEL) trials and the maintenance (U-ENDURE) trial in patients with moderate to severe CD. Patients who responded to 12-week induction therapy with UPA (45 mg per day [QD]) in U-EXCEED or U-EXCEL and received maintenance therapy with UPA (15 or 30 mg QD) up to 52 weeks in U-ENDURE were included. Clinical outcomes (CD activity index [CDAI] remission, CDAI response, steroid-free CDAI remission, high sensitivity C-reactive protein [hs-CRP] level ≤5 mg/L, and fecal calprotectin level [F-cal] ≤250 mcg/g), were evaluated at week 52 and compared between patients who achieved endoscopic response, endoscopic remission and ulcer-free endoscopy (absence of ulceration) at week 12 and those who did not using Chi-square test.

Results

Of 337 clinical responders included in the analyses, 152 (45.1%), 87 (25.8%), and 75 (22.3%) patients achieved endoscopic response, endoscopic remission, and ulcer-free endoscopy, respectively, at the end of induction. Significantly more patients who achieved an endoscopic response at end of induction (vs those who did not) attained clinical outcomes at week 52 (CDAI remission, 52.0% vs 34.6%; CDAI response, 54.6% vs 39.5%; hsCRP ≤5 mg/L, 52.0% vs 30.8%; and F-cal ≤250 mcg/g, 42.1% vs 21.6%; P≤0.01, Table 1). Patients who achieved an endoscopic response vs those who did not at end of induction were also more likely to attain steroid-free CDAI remission (50.0% vs 30.9%) at week 52, (P≤0.05, Table 1). Similar findings were observed in patients who achieved endoscopic remission vs those who did not at end of induction (P≤0.01, Table 1). Significantly more patients attained CDAI remission (58.7% vs 37.7%), CDAI response (58.7% vs 42.7%), hsCRP ≤5 mg/L (58.7% vs 35.0%) and F-cal ≤250 mcg/g (50.7% vs 25.0%) at week 52, among patients who achieved ulcer-free endoscopy vs those who did not at end of induction (P≤0.05, Table 1).

Conclusion

Achieving endoscopic outcomes at end of induction is associated with meaningful improvement in symptoms and inflammatory biomarkers at 52 weeks for patients with CD receiving UPA therapy. Endoscopic remission and ulcer-free endoscopy are associated with very similar long-term benefits.
P789 Inflammatory Bowel Disease subgroups identified by longitudinal faecal calprotectin profiles: A 10-year retrospective analysis of the Lothian IBD Registry
Authors: Constantine-Cooke N , Monterrubio-Gómez K , Plevris N , Derikx L A A P , Lyons M , Jenkinson P W , Gros B , Jones G R , Vallejos C A , Lees C W
Published: January 2023

Background

Faecal calprotectin (FCAL) is routinely used to monitor mucosal inflammation, and high FCAL values are associated with poor outcomes in IBD.

Having previously found clusters characterised by distinct FCAL profiles in a Crohn’s disease (CD) cohort of 356 subjects, we aimed to extend this approach to all IBD patients treated by the Edinburgh IBD Unit.

Methods

Subjects were required to have a diagnosis of IBD, three FCAL measurements within ten years of diagnosis between January 2005 and September 2019, and be treated by the Edinburgh IBD Unit. All FCAL was measured on the same ELISA essay as part of routine clinical care.

Latent class mixed models, an extension of linear mixed effects models with cluster specific fixed effects, were used to model and cluster FCAL trajectories. Fixed and random effects were modelled using natural cubic splines, which allows flexible models with relatively low computational cost when compared to high degree polynomials. Akaike information criterion, Bayesian information criterion and alluvial plots were used to decide on the appropriate number of clusters.

CD subjects were modelled independently of UC and IBDU subjects, with similar clusters across disease subtypes given the same numbering for ease of comparison. Hereafter, we will describe the UC and IBDU patients collectively.

Results

1,214 CD and 1,194 UC/IBDU subjects met the inclusion criteria. Across follow-up, 10,503 (median 7 per subject) FCAL measurements were available for patients with CD and 7,495 (median 5 per subject) for those with UC/IBDU.

Figure 1. Log-transformed ten-year faecal calprotectin profiles for Crohn’s disease subjects. Red curves demonstrate overall profile for each cluster. The blue dotted lines indicate an FCAL of log (250 μg/g), the commonly accepted threshold for biochemical remission.

For CD, six clusters were found to be appropriate, whereas five clusters were found to be the most appropriate for UC/ IBDU.

The overall cluster prmofiles were remarkably similar between CD and UC/IBDU. Both CD cluster 2 and UC cluster 2, the largest clusters, were characterised by consistently high FCAL across follow-up: remaining above the 250 μg/g threshold commonly used for biochemical remission (blue dotted lines in the figures).

Figure 2. Log-transformed ten-year faecal calprotectin profiles for ulcerative colitis subjects

Conclusion

After grouping CD and UC/IBDU subjects in a large cohort by their 10-year FCAL trajectories, we found remarkably similar trajectories across the two groups. In both cases, we found a large cluster of subjects with consistently elevated FCAL, which warrants further investigation.
P794 Effectiveness of administering zinc acetate hydrate to patients with inflammatory bowel disease and zinc deficiency: a retrospective observational two-center study
Authors: Sakurai K , Katsurada T , Aoyama K , Fukushima S , Onishi R , Yagisawa K , Nishimura H , Ito T , Furukawa S , Maemoto A , Sakamoto N
Published: January 2023

Background

Inflammatory bowel disease (IBD) patients frequently have zinc deficiency and that IBD patients with zinc deficiency are at higher risk for IBD-related complications and surgery. We reported the efficacy of zinc replacement therapy for IBD patients with zinc deficiency at ECCO2020, and now we report the results of our analysis with an extended observation period and an additional number of patients.

Methods

IBD patients with zinc deficiency who received zinc acetate hydrate (ZAH) from March 2017 to November 2021 were registered in this 2-center（Hokkaido University Hospital and Sapporo Higashi Tokushukai Hospital）, retrospective, observational study.

Results

One hundred twenty patients with Crohn’s disease (CD, n=82) or ulcerative colitis (UC, n=38) were registered.

Median serum zinc level and CDAI in CD patients significantly improved (59.0-92.3 μg/dL, P<0.001; 118-86, P<0.001, respectively) 4 weeks after ZAH administration. Similarly, median serum zinc levels and CDAI significantly improved (58.5-82.0 μg/dL, P<0.001; 96-78, P<0.001, respectively) 20 weeks after ZAH administration. In the 18 patients who underwent endoscopy both within 4 weeks before and within 60 weeks after ZAH administration, median SES-CD improved from 11.5 to 5.5 (P<0.001). Logistic regression analysis identified “serum zinc level ≥52 μg/dl before ZAH administration” as a factor contributing to normalization of serum zinc concentration and “CDAI ≥96 before ZAH administration” as a factor contributing to improvement of disease activity.

Median serum zinc level and partial Mayo scores (PMS) in UC patients significantly improved (63.0-94.0μg/dL, P<0.001; 2-0, P=0.002, respectively) 4 weeks after ZAH administration. Median serum zinc levels significantly improved (62.0-100.0μg/dL, P<0.001) 20 weeks after ZAH administration, but no significant changes in PMS were observed. In the 12 patients who underwent endoscopy both within 4 weeks before and within 60 weeks after ZAH administration, median UCEIS improved from 5 to 3 (P=0.004).

Logistic regression analysis identified “dose of ZAH ≥75 mg/day” as a factor contributing to normalization of serum zinc concentration and “serum zinc level ≥65 μg/dl before ZAH administration” as a factor contributing to improvement of disease activity.

In both CD and UC, there was a significant correlation between serum zinc level and CDAI, CRP, and serum albumin level before ZAH administration.

Conclusion

ZAH administration to IBD patients with zinc deficiency is effective in improving zinc deficiency and may contribute to improving disease activity in IBD.
P796 Effectiveness and safety of ustekinumab for patients with ulcerative colitis: A single-centre retrospective study
Authors: Kimura M , Shimizu M , Shirai M , Sakaguchi Y , Kobayashi K , Iruya R , Seki S , Naitou D , Nishimiya T , Oouchi Y , Shibamoto M , Iwashita H , Miyamura M , Kikuchi H , Yamada A , Nakamura K , Matsuoka K
Published: January 2023

Background

Ustekinumab, a monoclonal antibody directed against the interleukin 12/23 p40 subunit, was approved worldwide in 2020 for the treatment of ulcerative colitis. The efficacy of ustekinumab in inducing and maintaining remission in moderate to severe ulcerative colitis was demonstrated in the phase 3 clinical study, the UNIFI trial; however, real-world data on the effectiveness and safety of ustekinumab for patients with ulcerative colitis is still scarce. We aimed to investigate the real-world effectiveness and safety of ustekinumab in patients with ulcerative colitis.

Methods

This was a single-centre retrospective study enrolling patients with ulcerative colitis who were aged 16 years or more and administered ustekinumab between March 2022 and March 2022 at Toho University Sakura Medical Center, a tertiary center. Data were extracted by chart review. Ustekinumab was administered as a single intravenous infusion (approximately 6 mg/kg) followed by 90mg subcutaneous injection at week 8 and then by 90mg subcutaneous injection every 8-12 weeks. The endpoints were 1) the proportion of patients achieving symptomatic remission, defined as a rectal bleeding score of 0 and a stool frequency score of 0 or 1 in patient-reported outcome-2 (PRO-2), at week 8, 2) time to discontinuation, and 3) safety during the observation periods.

Results

We enrolled 53 patients in this study, with a median age of 45 years (interquadrant range: 27-57). Thirty patients (56.6%) were male and 23 (43.4%) were female. The majority of patients (n=39; 73.6%) had extensive colitis. Notably, 21 (38.9%) patients were naïve to advanced therapies. Thiopurines had been administered to 24 (45.3%) patients. Twenty-one (39.6%) patients achieved symptomatic remission at week 8 after a single intravenous infusion. The proportion of patients with symptomatic remission was numerically higher in advanced therapy-naïve patients compared with advanced therapy-experienced patients (47.6% versus 34.4%) (Figure 1). Univariate analysis failed to identify clinical predictors for symptomatic remission at week 8. The time to discontinuation were significantly longer in advanced-therapy naïve patients compared with advanced therapy experienced patients, with a median observation period of 296 days (Figure 2). As for safety, one patient discontinued ustekinumab due to skin disorder. One death due to pneumonia was observed, which was unrelated to ustekinumab.

Conclusion

Ustekinumab was effective and safe in the real-world setting. Advanced-therapy naïve patients were more likely to continue ustekinumab compared with advanced therapy experienced patients.
P806 Perianal Crohn’s Disease (pCD): The outcome of 2nd line and 3rd line biologics in perianal Crohn’s disease
Authors: Shani U , Ben Shabat N , Klang E , Ungar B , Ben-Horin S , Kopylov U
Published: January 2023

Background

Treating perianal Crohn’s disease (pCD) is challenging with at least 60% of the patients not responding or relapsing after a year of 1st line biological therapy. Effectiveness data on 2nd and 3rd line in pCD is still quite limited. The aim of this study was to describe the effectiveness of 2nd and 3rd line biological therapy in pCD.

Methods

A retrospective cohort study of patients with pCD from a large tertiary center registry. We included all patients with pCD that were treated with >1 biologic while anti-TNF was the first one used. Primary outcome was defined as clinical failure of 2nd or 3rd line treatment (as defined by the clinician) or radiological evidence for disease progression by MRI or transrectal ultrasonography (TRUS). Secondary outcomes were relapse of perianal fistula or abscess.

Results

Registry included 893 patients with pCD who are being followed up routinely in a dedicated IBD clinic; 643 patients received 1 biological were excluded. Final cohort included 245 patients treated with ≥2 biologics.

In 2nd line, 40/245 patients (16%) treated with infliximab (IFX), 128/245 (52%) with adalimumab (ADA), 48/245 (20%) with vedolizumab (VDZ) and 32/245 (13%) with ustekinumab (UST). 7/32 patients (22%) treated with UST failed the treatment, compared to 32/40 (80%), 101/128 (79%) , 37/48 (77%) patients treated with IFX, ADA and VDZ, respectively [Hazard Ratio(HR) 0.27 (0.1-0.69)]. Median time of 2nd line treatment with UST, anti-TNFs and VDZb was 2.5 (IQR=1-3[uk1] ), 3 (IQR=1-5) and 3 (IQR=1-4) years, respectively. Higher response rate in 2nd line therapy was associated with longer response duration to 1st line [OR (1.11-1.55), p<0.001)].

99/245 patients (40%) required 3rd line treatment (VDZ - 52/99 , UST - 47/99 (48%)) patients). 8/47 patients (17%) under UST therapy experienced clinical failure, compared to 41/52 (78.8%) patients treated with VDZ [HR 0.32 (0.12-0.68)]. Median duration (years) of third line treatment with both UST and VDZ was 3 years (IQR=3-1).

Figure A shows Kaplan-Meier survival analysis to 2nd line and 3rd line failure.

Conclusion

2nd and 3rd line biological therapies may be efficacious in pCD patients. Ustekinumab appears to be effective as a 2nd or 3rd line treatment. Longer duration of treatment is associated with a higher likelihood of response to 2nd line treatment.
P815 Diet, nutrition, and the multidisciplinary approach in adults with Inflammatory Bowel Disease
Authors: Playford C , Asghar Z , Armstrong S , Ngomba R , Rochford A
Published: January 2023

Background

Patients with Inflammatory Bowel Disease (IBD) may associate dietary triggers with symptoms and even relapse of the disease, yet this is rarely acknowledged and included in treatment plans. Patients often self-impose dietary restrictions and manipulate their diet which can have significant health complications including nutrient deficiencies and malnutrition1. This often leads to a worse disease state, poorer clinical outcomes, and a reduced quality of life for these patients2.

Methods

A self-administered survey was digitally created with Crohn’s and Colitis UK (CCUK) and advertised through the CCUK website and their social media accounts. Patients with IBD aged ≥18 years were identified through convenience sampling. Those who were three months peri-operative or had a stoma were excluded from the study as their nutritional needs and experiences were likely to be more complex. Statistical Package for Social Sciences (version 27) was used for statistical analysis. A P-value of <0.05 was considered statistically significant.

Results

267 participants completed the survey, 77.5% were female, 30% of participants were aged 36-45 years and 53.9% had Crohn’s disease. 44.9% of participants had been diagnosed with IBD for >10 years. 90% of participants believed that food impacted on their disease at least some of the time. 77% reported that dietary therapy may be useful in managing their disease (P-value < 0.001). Table 1 highlights where patients with IBD source dietary information. 93% of patients report a ‘trial and error’ approach to dietary manipulation to reduce their symptoms. Access to formal dietetic advice is extremely limited and reported by only 13% of participants. The majority of participants (78.7%) reported that a multidisciplinary approach was ‘very important’ in IBD care despite 68.2% reporting no access to a multidisciplinary team (P-value = 0.006).

Table 1. Sources of IBD dietary information

Conclusion

Diet plays an important role in the disease course for patients with IBD; however, our respondents reported poor dietary support from healthcare professionals. This may lead to unsupervised dietary restrictions based on poor sources of information that can cause or worsen nutrient deficiencies and lead to adverse health outcomes. Patients with IBD should have access to high quality dietary advice to help manage the disease.

References:

1. Nazarenkov N, Seegar K, Beekan L, et al. Implementing dietary modifications and assessing nutritional adequacy of diets for Inflammatory Bowel Disease. Gastroenterology & Hepatology. 2019; 15: 133-144.

2. Balestrieri P, Ribolsi M, Guarino M, et al. Nutritional aspects in Inflammatory Bowel Disease. Nutrients. 2020; 12: 1-11.
P817 Symptoms of COVID-19 in Patients with Immune Mediated Inflammatory Diseases
Authors: Schlosser T , Krasselt M , Elsing L , Hecker M , Holler B , Hoffmeister A
Published: January 2023

Background

Pandemic situation of the novel coronavirus disease (COVID-19) represents a challenging condition with a plethora of aspects. Symptoms of patients with immune mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) and different rheumatic diseases are not well described.

Methods

We conducted a prospective questionnaire-based study (04/2022 – 10/2022) at our university medical center. Outward patients over the age of 18 years were screened. Participating patients reported about their individual COVID-19 history during pandemic′s course.

Results

In the end, 156 patients were willing to participate. Vast majority of the cohort had an established diagnosis of inflammatory bowel disease (117 [75%] vs. 39 [25%] patients with rheumatic disease). Eightyone patients (51%) self-reported about their COVID-19 infection. Diagnosis had usually been established by positive PCR. In general, courses of infection were mild: Only two patients (2% of patients with reported COVID-19) were hospitalized due to COVID-19 with one of the two needing intensive care. Asymptomatic COVID-19 had been described by 7 persons (9% of patients with reported COVID-19). Acute COVID-19 was accompanied by fatigue/tiredness in 58 persons (72% of patients with COVID-19) as most frequent symptom. Other complaints were common cold (55 patients = 68%), cough (51 patients = 63%), headache (44 patients = 54%) and fever (35 patients = 43%). Joint respectively muscle pain was a symptom of eight respectively nine patients with rheumatic IMID (=33%/38% of 24 self-reported COVID-19). Five rheumatic patients (21%) presented diarrhea as complaint due to COVID-19. In the IBD subgroup 15 patients (27% of 57 self-reported COVID-19) had this complaint. Painful joints were mentioned in 23 IBD patients (41%). Aching muscles occurred in 19 IBD patients (34%).

Conclusion

Discrimination between symptoms of COVID-19 in contrast to chronic IMID condition can be difficult as complaints might be overlapping.
P822 The negative impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study
Authors: Cooney R , Barrett K , Russell R K
Published: January 2023

Background

Whilst the high burden of mental health comorbidity in people with inflammatory bowel disease (IBD) is now being recognised, less is known about the additional impacts of having concurrent IBD and a mental health condition, especially in children and young adults.

Methods

We conducted a retrospective, observational study using a large UK primary care dataset (Optimum Patient Care Research Database). Children and young adults (aged 5-25 years) diagnosed with IBD prior to 2015 were identified and grouped into those with and without prevalent mental health conditions (any of depression, anxiety, eating disorders, body image disorder, attention-deficit disorder, behavioural disorders, adjustment disorder, acute stress disorder, schizophrenia, bipolar disorder or post-traumatic stress disorder). The following outcomes were compared over 5 years in the two groups; quality-of-life indicators (bowel symptoms [abdominal pain, discomfort or bloating, diarrhoea], systemic symptoms [fatigue, sleep problems, weight-loss, underweight, growth retardation], emotional function [low mood, substance abuse, deliberate self-harm, suicidal attempt or parasuicide] and social function [absence from school, absence from work, unemployment]), IBD-specific therapy interventions (diet [nutritional supplements], medications [oral and rectal 5-aminosalicylic acid and steroids, antimetabolites and tumour necrosis factor inhibitors] and surgery [abdominal and stoma formation]), and healthcare utilisation (primary care interactions and hospital admissions). Adjustment for confounders was performed using Cox regression for non-recurring outcomes (e.g. stoma formation), and negative binomial or Poisson regression for outcomes with recurring events (e.g. primary care interactions).

Results

1,943 individuals with IBD were identified. 295 of these had a prevalent mental health condition. Mental health comorbidity was associated with increased bowel symptoms (adjusted Incident Rate Ratio [aIRR] 1.82; 95% Confidence Interval [CI] 1.33, 2.52), sleep disturbance (adjusted Hazard Ratio [aHR] 1.63; 95% CI 1.02, 2.62), substance abuse (aHR 3.63; 95% CI 1.69, 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12, 1.58) and hospital admissions (aIRR 1.87; 95% CI 1.29, 2.75) (Figure 1). In those >18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21, 1.99) (Figure 1).

Conclusion

Mental health comorbidity in children and young adults with IBD is associated with increased IBD symptoms, healthcare utilisation and time off work. Given the impact of mental health comorbidity, it is crucial those affected are monitored and receive appropriate mental health support as part of their multidisciplinary care.
P827 SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with Inflammatory Bowel Disease: A systematic review and meta-analysis
Authors: Van De Pol N , Pan Q , Derikx L A A P , Bakker L , van der Woude C J , de Vries A C
Published: January 2023

Background

Patients with inflammatory bowel disease (IBD) have reduced seroconversion rates to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of (severe) COVID-19. We evaluated SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients.

Methods

A systematic literature search was performed for studies which reported SARS-CoV-2 breakthrough infection rates and/or the disease course of COVID-19 in patients with IBD after COVID-19 vaccination. Primary outcome was the rates of breakthrough infection per time period. In meta-analyses, the pooled relative risk was calculated with a random effects model for vaccinated patients compared to vaccinated controls, to partially vaccinated and unvaccinated patients with IBD.

Results

A total of 16 studies were included in analysis. The study period ranged from January 2020 to October 2021, and a follow-up time ranges from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in IBD patients within the study follow-up time. Strikingly, only studies with vaccination prior to December 2021 showed a breakthrough infection rate above 2%. (Figure 1). The disease course of a breakthrough infection is generally mild, with mild constitutional and respiratory symptoms in 85% of infected IBD patients. Hospitalization and mortality rates are low (0-8.7% and 0-4.3% respectively). Meta-analyses showed a significantly lower pooled relative risk of breakthrough infection for vaccinated as compared to unvaccinated IBD patients (RR 0.07, 95% CI 0.03; 0.18). No difference was observed in risk of breakthrough infections between IBD patients and non-IBD controls (RR 1.01, 95% CI 0.92; 1.10), and no difference between vaccinated and partially vaccinated IBD patients (RR 0.67, 95% CI 0.38; 1.18). The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. One study reported higher breakthrough infection rates for patients treated with infliximab in comparison to vedolizumab (P<.05). Other studies showed no impact on the breakthrough infection rates for immunosuppressive treatment vs no treatment, anti-TNF-α/corticosteroids vs without anti-TNF-α/corticosteroids and other biologics vs anti-TNF-α.

Conclusion

Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time. Data on the impact of IBD medication on the rate of breakthrough infections and disease course require further elucidation.
P828 Incidence and predictors of arterial and venous thromboembolic events in hospitalized patients with inflammatory bowel disease compared to patients with acute infective gastroenteritis and colitis: a propensity score-matched study
Authors: Papa A , Lopetuso L R , Mignini I , Settanni C R , Scaldaferri F , Pugliese D , Laterza L , Covino M , Franceschi F , Gasbarrini A
Published: January 2023

Background

Arterial and venous thromboembolic events (ATEs and VTEs) represent a common complication of inflammatory bowel disease (IBD) with significant morbidity and mortality. Risk factors for thromboembolic complications may differ in IBD patients from those in the general population. This study aimed to assess the incidence and risk factors for ATEs and VTEs in a cohort of hospitalized patients with IBD compared to patients with acute infective gastroenteritis or colitis (AIGEC).

Methods

The clinical records of patients with IBD and AIGEC admitted to our Academic Hospital over six years were reviewed. We compared the incidence and risk factors of ATEs and VTEs between the two cohorts (1203 patients with IBD and 2652 with AIGEC) and propensity score-matched (PSM) subpopulations, including 831 patients for each group. In addition, we assessed the effect of IBD itself on the occurrence of ATEs and VTEs.

Results

In the PSM cohort, the ATEs rate was significantly higher in patients with IBD than in controls (10.1% vs. 5.5%, p=0.001), as well as the incidence of ischemic heart disease (IHD) (7.9% vs. 3.6%, p<0.001). On the contrary, the incidence of VTEs was similar between the two study groups. IBD diagnosis, male sex, hypertension, diabetes, and the Charlson Index were independently associated with ATEs. In patients diagnosed with IBD, the adjusted odds ratio (OR) for an ATE occurrence was 2.21 [1.47 – 3.31] compared to controls. Age emerged as the only factor significantly associated with VTEs.

Conclusion

Compared to patients with AIGEC, IBD patients showed an increased risk of ATEs but not VTEs, probably for implementing venous thrombosis prophylaxis. IBD itself represents an independent risk factor for ATEs, particularly for IHD. These findings confirm that chronic inflammation is a consistent trigger for the cardiovascular atherothrombotic disease. Consequently, tight control of inflammation must be considered an essential target to reduce cardiovascular risk.
P834 Physical activity in people with Inflammatory Bowel Disease – towards precision prevention
Authors: Villumsen M , Poulsen A , Thomsen T , Jess T , Aadahl M , Allin K
Published: January 2023

Background

Existing evidence suggests that physical activity, in addition to medical treatment, can counteract physical symptoms and improve the quality of life in patients with inflammatory bowel disease (IBD). We aimed to understand patients' patterns of physical activity to guide the development of an evidence-based personalised intervention for the promotion of physical activity and reduction of sedentary behaviour in patients with IBD.

Methods

We included a population of 207,959 participants who responded to The Danish Capital Region Health Surveys during the period 2007 to 2021. The population included 1777 individuals with prevalent IBD [705 with Crohn’s disease and 1072 with ulcerative colitis]. Information on sedentary behaviour and physical activity was obtained from self-reported questionnaires, the Physical Activity Scale version 2.1., and sociodemographic information from central nationwide registers. Self-rated physical and mental health was measured with SF-12. Data were weighted for survey design and were analysed by multiple regression analyses.

Results

The proportion that adopted the recommended physical activity level of at least 4 hours of low, moderate, or high intensity was lower among patients with IBD compared to the background population, also when adjusting for sociodemographic variables and population weights (OR=0.86; 95% CI 0.84-0.88). Among patients with IBD, more women than men were physically active. Crohn’s disease, living alone, having non-western ethnicity, having a BMI< 18.5 or BMI >30, having an unhealthy diet, being outside the labour market, and having small children were all associated with lower levels of physical activity. Moderate to high level of physical activity among patients with IBD was associated with higher self-rated physical health than low levels of physical activity (p<0.001). The highest mental quality of life score was among IBD patients with moderate physical activity compared to high or low physical activity (p<0.001).

Conclusion

Patients with IBD, especially those with Crohn’s disease, have lower levels of physical activity and more sedentary behaviour compared to non-IBD individuals. Moderate physical activity is associated with a higher physical and mental quality of life score in individuals with IBD compared to high or low levels of physical activity. These results can guide clinicians when IBD patients ask for advice on physical activity. Furthermore, we will use the results to guide the development of an evidence-based personalised intervention for the promotion of physical activity and reduction of sedentary behaviour in patients with IBD.
P835 Visceral adiposity independently predicts time to flare in inflammatory bowel disease, but BMI does not
Authors: Sehgal P , Su S , Zech J , Nobel Y , Luk L , Economou I , Shen B , Kiran P , Freedberg D
Published: January 2023

Background

Obesity is rising globally and has been associated with increased IBD disease severity, prolonged hospital stay and increased development of extra-intestinal manifestations. Measuring “visceral adiposity” by CT scan may be a more meaningful way of classifying obesity compared to traditional measures such as BMI. This study compared visceral adiposity measured by CT scan versus BMI as a predictor of time to IBD flare among patients with CD and UC.

Methods

This was a retrospective cohort study. Consecutive adults with IBD were included if they had a colonoscopy to evaluate IBD flare and a CT scan within a 30-day window of the colonoscopy from 2010 to 2022. Charts were reviewed until 100 patients with Crohn’s and 100 with UC had been identified. Patients were followed for up to 6 months after the index CT scan for IBD flare, which was characterized by hospitalization/ER visit related to IBD, initiation of steroids, dose escalation, change in IBD medication, or IBD surgery. The primary exposure was the visceral adipose tissue to subcutaneous adipose tissue ratio (VAT:SAT) which was obtained from the index CT scan using TomoVision slicOmatic software. BMI was calculated based on height and weight at the time of the index CT scan. Cox proportional hazard modeling was used to test VAT:SAT and BMI as predictors of time to IBD flare, after adjusting for other factors.

Results

100 CD and 100 UC patients were included. The median age was 43 (IQR 31-58), 41% of the population was female, and most were White (55%) or Hispanic (26%). Overall, 20% of the cohort flared with a median time to flare of 88 days (IQR 42.5 – 118.5) among those who flared. For all patients, VAT:SAT was significantly associated with time to flare as seen in Figure 1 (HR 4.8, 95% CI 1.67 to 13.7 for VAT:SAT≥1.0 vs VAT:SAT<1.0), but BMI was not (HR 0.88 95% CI 0.35 to 2.18 for BMI ≥25 vs BMI <25). After stratifying the cohort into CD and UC cohorts, a significant association between VAT:SAT ≥1.0 and time to flare remained for CD (HR 7.68, 95% CI 0.93 – 63.2) but not for UC (HR 0.26, 95% CI 0.018 – 3.70). BMI was not associated with time to flare in either CD or in UC patients (Figure 2).

Conclusion

Visceral adiposity (VAT:SAT ratio on CT scan) was associated with decreased time to IBD flare, but BMI was not. This relationship may be stronger among Crohn’s compared to Ulcerative colitis patients. Future studies should investigate the mechanisms by which visceral adiposity may contribute to IBD disease activity.
P836 Trends in the prevalence of Inflammatory Bowel Disease in Lithuania during 2001-2020
Authors: Karpavičiūtė V , Kiudelis G , Kupčinskas J , Kupčinskas L
Published: January 2023

Background

The prevalence of inflammatory bowel disease (IBD) is increasing worldwide, affecting millions of individuals. The highest incidence and prevalence are found in Northern Europe and Northern America. There is a lack of new epidemiological studies in the Eastern European region. The objective of this study was to assess changes in the prevalence of IBD in Lithuania during two last decades.

Methods

Data on the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) (ICD-10 code K50, K51) in Lithuania during 2001-2020 were obtained from the Institute of Hygiene, where the data were systematized from the Mandatory Health Insurance Information System. Changes in the prevalence trends in men and women, children and adults during 2001-2020 were assessed using Joinpoint regression analysis.

Results

In 2020, the overall prevalence of CD was 33/100,000 and the prevalence of UC was 117/100,000. Gender differences in the prevalence of IBD were not significant. The prevalence of CD among adults in Lithuania has increased 3-fold over 20 years, while the prevalence of UC has increased 4-fold. During 2001-2020, the average annual increase in UC prevalence (8.0%/year, p<0.001) was higher than in CD (6.3%/year, p<0.001). Also, it shows increased UC/CD ratio: in 2001, the ratio was 2.5:1, while in 2020, was observed a higher UC/CD ratio 3.5:1. When comparing changes in the prevalence of IBD, some differences were observed between adults and children. During 2001-2020, the average annual growth rate of CD in children increased not significantly (2.1%/year, p>0.05), while for adults, a significant increase was observed (6.8%/year, p<0,001). Similar trends were noticed in the assessment of the prevalence changes of UC: during 2001-2020, the prevalence of UC in children increased slightly (3.1%/year, p>0.05), while significant growth was observed for adults (7.8%/year, p<0.001). When comparing the children prevalence ratio of CD and UC, it remained almost the same over 20 years, and it was found that CD is more commonly diagnosed in children than UC (CD/UC ratio in 2001 was 1.8:1, while in 2020, it was 1.7:1). In adults, CD/UC ratio was opposite of children, and has changed during 2001-2020: CD/UC ratio in 2001 was 1:2.9, while in 2020, it was 1:3.7.

Conclusion

The results show that the prevalence of IBD in adults is steadily increasing, while the number of cases in children has not changed significantly over 20 years. Also, it was observed, that Crohn's disease is diagnosed at younger age than ulcerative colitis, which is more commonly diagnosed in older age.
P853 Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in the Faroe Islands compared to inflammatory bowel disease patients in Eastern and Western Europe – An Epi-IBD study
Authors: Nielsen K R , Midjord J , Hammer T , Vang A , Berbisá M Á F , Johannesen H , Burisch J
Published: January 2023

Background

The incidence of inflammatory bowel disease (IBD) in the Faroe Islands is the highest in the world and has increased dramatically over the past sixty years - possibly due to changes in environmental factors towards a more “westernised” standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in the Faroe Islands, and to compare the results to Eastern and Western European IBD patients.

Methods

The Faroese Epi-IBD study group is a nationwide, prospective inception cohort of 388 unselected IBD patients from the Faroe Islands covering a background population of 53,000 inhabitants. Patients were diagnosed between 2010 and 2021. At the time of diagnosis patients were asked to complete the 87-item IOIBD questionnaire concerning environmental factors. Findings were compared to Eastern and Western European IBD patients from the Epi-IBD cohort.

Results

A total of 311 patients (80.2 %) answered the questionnaire, 46 (14.8 %) had Crohn’s disease (CD), 217 (69.8 %) had ulcerative colitis (UC), and 48 (15.4 %) had IBD unclassified (IBDU). The number of former smokers, breastfeeding, coffeine intake, and oral contraceptive was higher than both Eastern and Western Europe. Vaccination against tuberculosis, measles, and rubella was similar to Western Europe; while vaccination against pertussis, diphtheria, tetanus, and polio was similar to Eastern Europe. Childhood diseases of measles, pertussis, rubella, mumps were higher than both Eastern and Western Europe.

Fruit and vegetable intake was lower than both Eastern and Western Europe. High sugar intake, and fast-food intake was similar to Eastern Europe.

Conclusion

Faroese IBD patients differ in terms of exposure to environmental factors prior to the diagnosis to both Eastern and Western Europe patients. Analysis of the impact of environmental factors on difference in disease course and incidence between the Faroese Epi-IBD study group and the Eastern Europe and Western Europe Epi-IBD cohort are currently in progress.
P880 High incidence of inflammatory bowel disease in Northern Australia: a prospective community population-based Australian incidence study in the Mackay-Isaac-Whitsunday region
Authors: Flanagan A , O'Connor S , Allsop S , Tobin J , Pretorius C , Brown I , Bell S , Daveson A J
Published: January 2023

Background

The Mackay-Isaac-Whitsunday region encompasses 173,892 people within a 400 km (250mile) radius in Queensland, Australia. We aimed to determine the incidence of Inflammatory Bowel Disease (IBD) in this region in northern Australia (-21.14°S) and to allow a comparison with southern Australian and New Zealand data (Geelong, Australia -38.14°S; Tasmania -41.43°S and -42.88°S [Launceston and Hobart] and Canterbury, New Zealand -43.46 °S).

Methods

A prospective observational community population-based IBD study was conducted between 1 June 2017 and 31 May 2018. Primary outcome measures include the crude annual incidence rate of IBD, Crohn's disease (CD), Ulcerative colitis (UC) and infammatory bowel disease unspecified (IBDU), while secondary outcomes includes disease phenotype and behaviour. All new cases were identified through primary health care referrals and public and private hospital referrals into the clinic. All new cases of IBD were prospectively defined using rigorously recognised and accepted criteria and categorised using the Montreal Classification.

Results

Fifty-six new cases of IBD were identified. Twenty-three were CD, 30 were UC and 3 were IBDU. The crude annual incidence rate per 100 000 for IBD, CD, UC and IBDU was 32.2 (95% confidence interval (CI): 24.78–41.84), 13.23 (95% CI: 8.79– 19.90), 17.25 (95% CI: 12.06–24.67) and 1.73 (95% CI: 0.56–5.35). When directly age-standardised to the World Health Organisation Standard Population Distribution, the overall CD, UC and IBDU incidence were 13.19, 17.34 and 1.85 per 100 000, with an overall age-standardised IBD incidence of 32.38.

Conclusion

This is the first study to define the incidence of IBD in a Northern Australian cohort and to allow a comparison between North and Southern Australia. The IBD crude is the highest reported in Australia. Like others, we found a high and low incidence of upper gastrointestinal Crohn's disease and complicated disease at diagnosis respectively, likely reflective of the increased availability and early uptake of endoscopic procedures.
P887 Epidemiology of perianal fistulising Crohn’s disease: a systematic literature review
Authors: McKay C , Pacis S , Bolzani A , Geransar P , Panés J
Published: January 2023

Background

Complex Crohn’s perianal fistulas (CPF) are a debilitating complication of Crohn’s disease (CD). Data about the epidemiology of complex CPF are limited. This systematic literature review (SLR) aimed to understand the epidemiology of CPF in adult and paediatric CD populations globally.

Methods

Electronic databases (MEDLINE, Embase, EBM Reviews, EconLit) were searched. PICOS-T (population, interventions, comparators, outcomes, study design, time) selection criteria were used to identify relevant studies, and two reviewers independently screened and extracted data. Articles included observational studies with >50 patients published in English from 1 Jan 2015 to 17 Feb 2022. The study was still included if complex CPF was not defined. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias/quality of studies (good, fair or poor). Outcomes of interest were the prevalence and incidence of CPF. Studies reporting epidemiology as an objective were considered primary epidemiology studies. Data were summarized using descriptive statistics.

Results

In total, 140 studies were included, of which most were of good (n=14) or fair (n=98) quality regarding risk of bias. Few studies (n=24) defined complex CPF; hence, outcomes included all types of CPF. An epidemiology outcome was reported in 86 studies (covering all major geographic regions and age groups; Table 1), including 36 population-based studies and 20 primary epidemiology studies. CPF prevalence, reported in 84 studies, varied widely (Table 2). For adult studies (including those not reporting an age range; n=44) and paediatric-only studies (n=15), CPF prevalence (interquartile range) was in the range 1.5–81.0% (10.5–30.1%) and 5.5–47.3% (13.1–19.9%), respectively. Complex CPF prevalence (range) was reported in 18 studies and varied widely (3.4–54.6%); of these, four were primary epidemiology studies (3.4–29.3%). CPF incidence was reported in 15 studies: two studies reported incidence in person-years (PY) as 133.83 per 100 000 PY and 1100 per 100 000 PY. Of studies reporting cumulative CPF incidence at specific timepoints, incidence at 1 year after CD diagnosis was most frequently reported (n=8, range 3.5–50.1%; Table 3).

Conclusion

This SLR highlights a wide range in prevalences and incidences of CPF, potentially due to a lack of standardized definitions for CPF alongside a range of reported timepoints. Prevalences were up to 81.0% for CPF and 54.6% for complex CPF, and CPF incidences reached 1100 per 100 000 PY. This SLR demonstrates that understanding the burden of CPF in CD populations globally is challenging and consistent definitions are required to permit cross-study comparisons.

Funding: Takeda Pharmaceuticals USA, Inc.