bluuebunny/crossref_metadata_2025 huggingface dataset:
P565 COVID-19 vaccination satisfaction and hesitancy in patients with inflammatory bowel disease: “inside referral center” survey
Authors: Todeschini A , Contaldo A , Ierardi E , Di Leo A , Principi M
Published: January 2022

Background

Covid-19 infection is an exceptional pandemic that has involved millions of people worldwide with dramatic humane, social and economic concerns. Since December 2020, two mRNA and one inactivated vaccines were approved for people administration. The vaccinal access calendar was scheduled according with risk degree of infection and complications. In some regional setting patients with inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) were considered fragile and therefore had a priority approach to vaccine administration compared to the general population. The purpose of this work was to measure the satisfaction and the concerns of a cohort of IBD patients who were administered the anti-Sars CoV-2 vaccine “inside reference center” by their dedicated nursing staff.

Methods

Anti-SARS-CoV-2 vaccine (PfitzerÆ) in two shots were administrated to 346 IBD patients. Afterwards completed vaccination, all patients were given a questionnaire consisting of 4 items focused on the level of satisfaction and the impact of the pandemic on their illness.

Results

346 patients, 168 CD and 178 UC, 147 female and 199 male, 249 in biologicals and 97 in immunomodulatory therapy, regularly followed up in an IBD unit, were enrolled. All patients received two shots of SARS-CoV-2 vaccine by their IBD nursing staff. Upon close of the vaccination course, a questionnaire was dispensed. The pandemic did not affect IBD at all in 37.5% and a lot in 9.2% of participants. The majority (95%) of patients welcomed the possibility of getting vaccinated; only 7% feared the vaccine’s influence on the course of the IBD. The main concerns were the possibility of adverse effects (33%) and the failure to achieve immunity (17%), few for the type of vaccine (3%) and the need for a further booster (6%). Almost all patients (99%) felt safer to have vaccinated at their IBD reference center.

Conclusion

In this cohort of IBD patients, SARS-CoV-2 vaccination “inside reference center” has shown broad compliance and a high degree of confidence. Most did not report that the pandemic affected regular IBD management.
P570 Prevalence and risk factors for intestinal resection in patients with Crohn’s disease in a Greek referral center
Authors: Orfanoudaki E , Foteinogiannopoulou K , Theodoraki E , Drygiannakis I , Romanos I , Koutroubakis I E
Published: January 2022

Background

Nearly half of patients with Crohn’s disease (CD) require any kind of surgical resection within 10 years after diagnosis and about one third of them need an additional second intervention within the next decade. We aimed to investigate the prevalence and risk factors for intestinal resection in Greek patients with CD.

Methods

Consecutive CD patients with complete follow up data, recorded prospectively in a registry of a tertiary university hospital from 2011–2021, were studied retrospectively. All patients with a history of at least one bowel resection for luminal disease were enrolled. Surgeries for perianal disease, fistulae or other complications were excluded. At the same time, the role of potential risk factors for surgical intervention was analyzed.

Results

Out of a total of 372 CD patients recorded in the database, 85 patients (23%) with a history of 96 surgical resections were identified. Sixty one percent were male, with a mean (±SD) age of 48.5 (±15.3) years, median (IQR) age at disease diagnosis 25.5 (21–37) years, 39% smokers, L1 49%, L2 11%, L3 40%, B2 57% and B3 37%.

Median (IQR) time from diagnosis to first surgical resection was 58 (8.3–120.8) months, while in 17% the diagnosis was made with the surgery. Half of the patients (52%) were operated due to no response to treatment, presenting with ileus or stricture formation, whereas other causes for operation were perforation ± abscess (24%) and dysplasia (4%) [20% cause not specified in files]. Fifty three percent were naïve to biologic treatment prior to surgery and needed resection sooner that those experienced to biologics [median (IQR) time from diagnosis to surgery 12 (0–72) vs 88 (46–172) months, p<0.0001]. A second surgery became necessary in 11 patients (13%) due to disease recurrence after a mean (±SD) time of 152 (±117) months after the first, whereas only one needed a third one.

In the univariate analysis bowel resection was associated with younger age at diagnosis (p<0.0001), shorted disease duration (p<0.0001), structural and fistulizing phenotype (p<0.001) and smoking (p=0.0017). All associations remained significant also in the multivariate analysis (Table 1).

Conclusion

One out of four patients in our cohort needed bowel resection for their luminal CD with younger age at diagnosis, shorter disease duration, structuring/fistulizing phenotype and smoking being identified as possible risk factors.
P571 The Nordic diet as a tool to improve the activity of disease and psycho-emotional wellbeing in patients with mild and moderate Ulcerative Colitis – the pilot study
Authors: Birka I , Girgensone G , Anspuka L , Šantare D
Published: January 2022

Background

The Nordic diet (ND) has been associated with reduced inflammatory markers and improved anxiety and stress symptoms. Our aim was to evaluate the effect of the ND on the activity of ulcerative colitis (UC), symptoms of anxiety, depression, and fatigue.

Methods

Patients (N=12) with mild and moderate UC were included (excluding severe UC, UC proctitis, infections). The activity of UC was evaluated with partial Mayo score (pMS) and fecal calprotectin (FC), psycho-emotional wellbeing – using hospital anxiety and depression scale (HADS) and inflammatory bowel disease – fatigue (IBD-F) questionnaire. The patients were evaluated at 3 consecutive visits at week 0, 6 and 10. During the first visit, the patients were consulted by a nutritionist to adjust their diets, received written recommendations and were able to contact the nutritionist later. At every visit HADS, IBD-F scores, and BMI, pMS and FC were registered. The ND score was calculated as described by Bjørnarå et al., 2015. Patients were considered compliant if the ND score increased by at least 2 points and unhealthy snacks were absent or almost excluded. Related samples Wilcoxon signed rank test and independent samples Kruskal-Wallis test were used to assess statistical significance. The ND score was described as low (0–3), medium (4–5) or high (6–10).

Results

The characteristics of all patients are summarised in Table 1. One patient had mild exacerbation of UC during the study managed with increased dose of mesalamine. Changes of the ND score (Fig.1) differed significantly in visit 2 (p=0.01).

After exclusion of non-compliant patients, the data of 8 patients was analysed. The pMS, FC, HADS, IBD-F (level and impact) did not show significant changes at visit 2. BMI was significantly reduced at visit 2 (p=0.018), median at visit 1 was 28.55 (IQR: 24.16 – 32), visit 2 - 27.65 (23.2 – 30.16) kg/m2.

We also found lower FC levels in patients with high ND score, but the difference was not statistically significant (Fig. 2). No significant differences were found regarding the psycho-emotional wellbeing but the impact of fatigue on everyday life was higher in low ND score group (Fig. 3).

Conclusion

We were not able to show improved FC nor psycho-emotional symptoms after 6 weeks of the ND. The adherence decreased after visit 2, therefore another consultation with the nutritionist could be beneficial to improve the understanding and motivation of the patients. Compliance with the ND reduced BMI and high adherence might be associated with lower FC levels. Further studies with larger patient groups would improve reliability of the results. This pilot study is part of the project financed by BIOCODEX MICROBIOTA FOUNDATION 2020.
P573 The safety profile of upadacitinib maintenance therapy in ulcerative colitis in the Phase 3 U-ACHIEVE study is consistent with that in approved indications
Authors: Colombel J F , Panaccione R , Nakase H , Burmester G , Cohen S B , Mease P , Guttman-Yassky E , Liu J , Zhou W , Ilo D , Higgins P
Published: January 2022

Background

The oral, small-molecule, selective and reversible Janus kinase inhibitor upadacitinib (UPA) is approved for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), moderate-to-severe atopic dermatitis (AD) and ankylosing spondylitis, and is under investigation in ulcerative colitis (UC). This assessment reviewed adverse event (AE) data for UPA maintenance therapy in UC in the context of the known long-term safety profile of UPA in its approved indications.

Methods

Safety data were collated from patients with UC who responded to 8 weeks’ induction treatment with UPA 45 mg once daily (QD) and were enrolled in U-ACHIEVE to receive maintenance treatment (UPA 15 mg, 30 mg QD or placebo) for ≤52 weeks. Treatment-emergent AEs (TEAEs) were defined as AEs with an onset on or after the first dose, and ≤30 days after the last dose, of study drug. Safety data were also collected from two AD (15 and 30 mg doses), six RA (15 mg dose in all, 30 mg dose in four) and two PsA (15 and 30 mg doses) Phase 3 trials. Exposure-adjusted event rates were calculated for TEAEs and AEs of special interest (AESIs).

Results

Data were available for 746 patients with UC who received 8 weeks’ induction with UPA 45 mg and were randomised to maintenance treatment as follows: placebo, n=245; UPA 15 mg, n=250; UPA 30 mg, n=251. Rates of any AEs, serious AEs, severe AEs and AEs leading to treatment discontinuation were lower with both UPA doses versus placebo (Table 1). No deaths occurred. Rates of the above AE categories in patients with UC who received maintenance treatment with UPA 15 or 30 mg were within the ranges previously reported in AD, RA and PsA, apart from neutropenia (Table 1). AESI rates in UC were generally similar with UPA and placebo, except for higher rates of herpes zoster, creatine phosphokinase elevation, hepatic disorder, and venous thromboembolism (VTE), but lower rates of anaemia, with UPA (Table 2). Non-melanoma skin cancer was reported only with UPA 30 mg. One adjudicated major cardiovascular event was reported in each of the placebo and UPA 30 mg arms. VTE only occurred with UPA treatment (two events per arm). Based on the limited number of patients exposed, and apart from a higher VTE rate, AESI rates in the UC maintenance study were generally similar to those reported in patients receiving long-term treatment with UPA 15 or 30 mg QD in AD, RA or PsA.

Conclusion

The safety profile of UPA maintenance treatment in UC is consistent with that in its approved indications. Although VTE rates were higher in UC, background VTE risk is known to be increased in UC versus AD, RA and PsA. This review identified no new important safety risks.
P609 Significant variations in practice in managing mild-Crohn’s disease: results from the 2021 Y-ECCO-ClinCom survey
Authors: Dart R , Irving P
Published: January 2022

Background

Epidemiological data suggests Crohn’s disease (CD) runs a mild course in a third of patients. Furthermore, the AZTEC study demonstrated that 30% of patients with uncomplicated CD responding to initial therapy remain in clinical remission at one year when maintained by placebo (Gastroenterology 2013;145:766). There are no proven maintenance strategies other than immunosuppression in CD. ECCO does not recommend maintenance therapy in those newly diagnosed with uncomplicated disease achieving remission with steroids, however in the absence of prognostic biomarkers treatment decisions can be difficult, risking over treatment for some. This questionnaire aimed to explore clinicians’ prescribing strategies and attitudes toward patients with mild CD.

Methods

A questionnaire was devised in conjunction with the Y-ECCO and ClinCom committees and distributed to attendees to the 2021 virtual ECCO conference.

Results

124 complete responses were obtained from gastroenterologists 54%, gastroenterology trainees 29% with surgeons/nurses comprising most of the remainder. 61% respondents were from university hospitals, 33% general hospitals and 6% private clinics, 79% of whom practise in Europe.

Approaches to induction and maintenance of remission were investigated in ileocolonic and isolated colonic CD (table and figure). Budesonide and or systemic steroids are often used for induction of remission in both CD subtypes, however a range of therapeutics are also used, with only one respondent taking a wait and see approach in colonic but not ileocolonic CD. In both CD subtypes >50% of patients who achieve steroid-induced remission would be maintained using immunosuppression with either an immunomodulator or biologic, whereas 28% and 6% (ileocolonic) and 20% and 19% (colonic) would watch and wait/treat with 5-ASA respectively, representing significant variation in practise. 80% respondents felt development of complicated disease was unlikely in these patients, despite this, 60% would treat with maintenance therapy. 55% respondents felt that mild CD was easy to manage, however 45% felt neutral or negative towards managing mild CD; the management approach undertaken by either group of respondents was equally varied.

Conclusion

Current practise does not reflect ECCO guidance, likely due to uncertainties over the natural history of disease and the difficulty in predicting complications. Perception of the difficulty of managing mild CD did not appear to influence treatment decisions. Patients with mild CD comprise a significant proportion of our patients, yet management may be less clear cut than for aggressive disease and further work on risk stratification and management algorithms may avoid over-treatment of patients who may never develop complications.
P620 Differences in illness perceptions of Inflammatory Bowel Disease (IBD) between Healthcare Practitioners (HCPs) and patients in a UK tertiary IBD centre
Authors: Duff A , Dawson P , Pavilidis P
Published: January 2022

Background

The common sense model of illness (Leventhal et al 1997) suggests that illness perceptions influence coping strategies and outcomes. Negative perceptions of IBD are associated with poorer psychological and physical health, quality of life (Polak et al, 2019) and adherence (van der Have et al, 2016). There are differences among healthcare professionals in how they view IBD (Dickman et al, 2011) however, it is unknown how perceptions of illness vary between patients and HCPs

Methods

All patients with IBD who were referred to IBD psychology clinic were asked to complete Brief Illness Perception Questionnaire (BIPQ, Broadbent et al, 2006) as part of their assessment.

HCPs as part of the same team were asked to complete 5 items adapted from the BIPQ (How long do you think your patients will have IBD, how much control do think is possible with IBD, how much do you think treatment can help, how much do you feel that you understand IBD and how much do you feel IBD affects patients emotionally) and asked for 3 causes of IBD.

Descriptive statistics and Mann-Whitney tests were performed as well as a thematic analysis (Braun & Clarke, 2006) of the causes.

Results

Data was available for 148 patients and 24 HCPs (11 doctors and 13 other HCPs).

There were no significant differences between HCPs and patients in their views of illness duration or their understanding of IBD. However, patients felt that disease control was less likely and treatment effectiveness was less helpful than HCPs. HCPs felt that patients were more emotionally impacted by IBD than patients themselves.

There was a difference in how each group ranked the themes. All HCPs identified genetics, whereas many fewer patients did. Patients were more likely to identify psychological, environmental and lifestyle as being important, were more likely to say that the cause was unknown or to not respond to the question.

Conclusion

Our findings suggest a disconnect between the views held by patients and HCPs as to the underlying cause of their IBD as well as our ability to achieve disease control with effective medical therapy. This highlights the importance of open communication with and education of patients from their first encounter with HCPs and throughout their disease course. It is worth noting that all patients included had been referred to the IBD psychology service and are more likely to have had a difficult disease course or persistent symptoms which may explain the difference in views on treatment and remission.
P645 Ileocecal resection in paediatric Crohn’s disease based on the Hungarian Paediatric IBD Registry
Authors: Müller K , Bajzat D , László S S
Published: January 2022

Background

Despite optimized treatment, almost one-third of the patients with IBD develop

complications such as fistulae, strictures, and abscesses, thus need surgical treatment within 5 years of diagnosis. In paediatric Crohn’s disease surgery may be considered when a patient has active disease despite optimized medical treatment.

The aim of our study was to evaluate the practice of surgical interventions in paediatric Crohn’s disease regarding indications, postoperative therapy and follow-up endoscopy in Hungary.

Methods

We performed a retrospective analysis based on the database of the Hungarian Paediatric IBD Registry (HUPIR). The HUPIR is a prospective, nationwide registry launched in 2007. Data of patients who underwent ileocecal resections between January 2010 and December 2019 were included in the analysis. We applied descriptive statistical methods to characterise the cumulative incidence of surgical resections, the urgency of the interventions, postoperative complications and follow-up endoscopies.

Results

Altogether 943 newly diagnosed CD patients were reported between 2010 and 2019, among them 55 (6%) had ileocecal resection of 99 children with CD who underwent (10%) surgical interventions within 2.15 years mean follow-up period. Surgical data of ileocecal resections were available in 47 (85%) cases (mean age: 14.5 years, male:20). Disease localization at diagnosis was ileocecal in 38% and ileocolonic in 40.2%. The mean time between diagnosis and surgical intervention was 21.2 months (0–62). The ileocecal resection was elective in 37 (78.7%), and laparoscopic resection was performed in 17 cases (36%). Frequency of early postoperative complication was 8.5% (4/47), which was not associated with the urgency of the intervention, the technique, preoperative corticosteroid or anti-TNF treatment. Only the third of the patients (17/47, 36%) had colonoscopy within 6 months after resection.

Conclusion

Based on the HUPIR the number of surgical ICR is lower than in earlier reports reflecting a different approach. The early complication rate was low despite the low number of interventions. In a middle-income country, it is a question why surgical intervention are lower compared to international. Paediatric gastroenterologists seem to prefer conservative therapy probably due to the lack of experienced paediatric IBD surgeons.
P666 Trend of Lower gastrointestinal Endoscopy in Patients with Inflammatory Bowel Diseases: A Nationwide Population-Based Study in South Korea
Authors: Kim S , Lee S , Han K , Soh H , Koh S J , Lee H J , Im J P , Kim J S
Published: January 2022

Background

Endoscopy plays an essential role in the diagnosis and management of inflammatory bowel disease (IBD). Although the interval of endoscopy is important to assess the disease status of IBD, there are limited research date on the real-world use of endoscopy in patients with IBD. Therefore we aimed to evaluate the current status of lower gastrointestinal (GI) endoscopy in IBD patients.

Methods

We conducted a nationwide, retrospective, observational cohort study using the Korean national health insurance claims data. The endoscopy cohort with IBD was defined as an IBD population who underwent at least one colonoscopy or sigmoidoscopy between 2010 and 2019. We evaluated the annual number of lower GI endoscopy use, including colonoscopy and sigmoidoscopy in the IBD prevalent patients. In addition, we analyzed the trend of endoscopy use stratified by year after diagnosis in the patients with newly diagnosed IBD between 2010 and 2017 and the logistic regression modeling was used to estimate odds ratios and 95% confidence intervals for endoscopy, compared with never having had endoscopy, by demographic factor and therapeutic medications used for IBD.

Results

The analysis included 54,634 IBD patients (34,633 male and 20,001 female), among whom 24,577 (44.94%) underwent lower GI endoscopy. During a mean follow-up of 4 years, endoscopy was performed the most in the first year after diagnosis, and it showed a decreasing trend after that. Multivariate analysis showed that IBD patients with biologics and small molecules received more endoscopy than patients without the medication (hazard ratio [HR] 27.671, 95% confidence interval [CI] 11.296–67.783). In Crohn’s disease, increased number of biologics and small molecules correlated with increased number of endoscopy (HR 1.049, 95% CI 0.981–1.122 for single biologic; HR 2.343, 95% CI 1.726–3.182 for two or more biologics). In ulcerative colitis, however, only the use of biologics and small molecules, not the number of medication, correlated with increased number of endoscopy (HR 23.26, 95% CI 9.489–57.02). IBD patients with steroid (HR 1.562, 95% CI 1.509–1.61) and 5-aminosalicylic acid (HR 1.622, 95% CI 1.537–1.711) were received more endoscopy than patients without the medication.

Conclusion

Endoscopy was performed more frequently in the first one year after diagnosis with IBD. Also, this study demonstrated significant association between the use of endoscopy and the biologics/small molecules administered for IBD.
P670 Familial Inflammatory Bowel Disease is associated with a more adverse disease compared to sporadic cases
Authors: Boaz E , Ariella B G S , Menachem S , Eran G , Petachia R , Shlomo Y , Koslowsky B
Published: January 2022

Background

A family history increases the risk for inflammatory bowel diseases (IBD). However, data on differences in phenotypic characteristics and severity among patients with a strong family history of IBD are both scarce and controversial. The aim of the present study was to compare the phenotypic features of IBD patients with 4 or more affected first-degree relatives with sporadic cases of IBD.

Methods

Patients with familial and sporadic IBD were identified from the institutional IBD database. IBD Patients with at least 4 first-degree affected relatives were selected for analysis and were compared to non-matched sporadic cases with IBD chosen randomly from our local database. The sporadic cases had a first and second degree negative family history of IBD. Comparison for type of IBD [Crohn’s disease (CD) vs. ulcerative colitis (UC)], age at onset as well as for disease extent, behavior, perianal disease, extraintestinal manifestations (EIM), and indicators of severe disease (i.e., need for biological agents and surgery) were analyzed.

Results

Thirty six patients with familial IBD (29 Crohn’s disease (CD), 7 ulcerative colitis (UC)) were compared to 88 sporadic IBD patients (61 CD, 24 UC, 3 IBD-unclassified). Disease duration was 10.1 ± 8.3 in the familial and 8.1 ± 7.3 years in the sporadic cases, p=0.18. The familial cases were younger at diagnosis (19.1± 8.6 vs. 25.7 ± 11.8, P < 0.003). Patients with familial compared to sporadic IBD were significantly more likely to require steroid treatment (84.8% vs. 54.5%, P < 0.002) biological treatment (91.6%, vs. 63.6%, P < 0.002) or surgery (25%, vs. 11.4%, P = 0.056), respectively.

Conclusion

IBD with a very strong positive family history is associated with younger age at onset and a more adverse IBD phenotype compared to sporadic IBD.
P673 Trends in inflammatory bowel disease infections and vaccinations in the past four decades - a high-level text mining analysis of PubMed publications
Authors: Lahat A , Klang E
Published: January 2022

Background

Many therapeutic options for inflammatory bowel disease emerged during the last decades, along with the rise in disease prevalence and incidence. These new treatments exposed patients to various potential infections and promoted pre-treatment screening and vaccination. We aimed at assessing the published literature on different prophylactic screening and vaccination options in that period.

Special attention was attributed to latest data assessing covid-19 vaccinations.

Methods

We have queried PubMed for all available IBD-related entries published during 2000–2020. The following data were extracted for each entry: PubMed unique article ID (PMID), title, publishing journal, abstract text, keywords (if any), and authors’ affiliations.

Two gastrointestinal specialists decided in consensus on a list of terms to classify entries. The terms belonged to four groups: Opportunistic Infections, prophylactic screening, prophylactic vaccinations/treatment, regular vaccines. Annual trends of publications for the years 1980–2020 were plotted for different screening, vaccinations, and infections types. The slopes of publication trends were calculated by fitting regression lines to the annual number of publications.

Results

Overall, 98,339 IBD entries were published between 1980 and 2020. Of those, 10,128 entries belonged to one of the four investigated groups. Entries concerning opportunistic infections showed the sharpest rise, with 22 entries and 1980 to 623 entries in 2020 (slope 3.6, p<0.001). Entries concerning prophylactic screening rose from 10 entries in 1980 to 204 entries in 2020 (slope 1.4, p<0.001). Both entries concerning prophylactic vaccinations/treatments and regular vaccines did not show a significant rise (slope 0.08, and slope 0.22, respectively). Publications’ trend is shown in figure 1.

Figure 1- publication trends of vaccines and opportunistic infections in IBD patients during the past four decades

During COVID 19 pandemic a total of 44 publications were identified. Of them. 37 were relevant to vaccines and immune reaction. 19 publications (51%) were guidelines/recommendations, 14 (38%) assessed immune reaction to vaccination, most of them (11, 61%) to mRNA vaccines.

Results are shown in figure 2.

Figure2- publication trends of COVID 19 vaccines during the pandemic

Conclusion

According to publications trend analysis, during the past two decades, publications regarding opportunistic infections and prophylactic screening increased stteply compared to the two decades during pre- biologic area.

During COVID -19 pandemic most publications included vaccinations’ recommendations and guidelines, and only 38% included real-world data assessing reaction to vaccinations. More research is needed.
P694 COVID-19 vaccination rate and willingness of an additional dose among inflammatory bowel disease patients receiving biologic therapy
Authors: Ramos Lopez L , Carrillo-Palau M , Alonso-Abreu I , Reygosa C , Hernández-Buylla N , Amaral C , Hernández A , Benítez-Zafra F , Pérez-González F , Quintana-Díaz H , Hernández-Guerra M
Published: January 2022

Background

Vaccination against COVID19 prevents its severe forms and associated mortality and offers a promising action to control this pandemic. In Spain, by October 2021, 87.9% of the target population, including IBD patients had received the complete vaccination regimen. In September 2021, an additional dose of vaccine was approved in patients with immunosuppression including IBD patients on biologic agents. We evaluated the vaccination rate and additional dose willingness in this group of-at risk patients.

Methods

A single-center, cross-sectional study was performed among IBD patients on biologic agents and elegibles for an additional dose of COVID19 vaccine between 19th October and 12th November 2021. Patients were identified by the list provided by the Pharmacy service. IBD clinical characteristics and type of vaccine and date of administration were checked in medical records. Acceptance and adverse effects of vaccination were evaluated after telephone or face-to-face survey in these IBD patients.

Results

Out of a total of 344 patients, 269 patients (46.1% male; mean age 47±16 years; crohn′s disease n=198/ ulcerative colitis n=66/ indeterminate colitis n=5) received at least one vaccine dose and were included. The patients were on Infliximab (40.9%), Ustekinumab (29.7%), Adalimumab (20%), and Vedolizumab (8.9%). Co-treatment with immunosuppressors was used in 73.2% of patients. Only 15 (5.6%) patients refused the COVID19 vaccine: 26.7% for fear of vaccine`s adverse effects, 33.3% for doubts about a “new-design” vaccine and 40% for conviction (COVID19 pandemic denial). 46.7% of the cases would not change their opinion, but 33.3% would re-consider after discussing with their doctor and/or receiving information on the adverse effects of the vaccine. Previous to the additional dose, COVID19 vaccination was present in 94.4% of patients (n=254) (complete regimen using Pfizer 63%,Astra-Zeneca 15.4%, Moderna 12.2% and Janssen in 9.4% of patients, respectively). 42.7% of patients personally requested the appointment for initial dose of vaccination and 59.1% contacted the IBD Unit to discuss the decision to be vaccinated. Adverse effects occurred in 53.9% of the cases after the standard vaccination regimen, mainly pain in the arm (40%). Up to 94.1% of the patients agreed for an additional dose and 57.2% had already received the additional dose at the time of the assessment.

Conclusion

IBD patients on biological agents and at high-risk for COVID19 accept the vaccine as well as an additional dose if recommended. Physicians in charge of IBD units should provide information and confidence in the use of the vaccine in these IBD patients. Remains to be studied the impact of the additional dose of vaccine in these patients.
P713 Gut microbiota alterations after bowel preparation amongst inflammatory bowel disease patients
Authors: Rutka M , Szántó K , Bacsur P , Resál T , Jójárt B , Bálint A , Ari E , Kintses B , Fehér T , Asbóth A , Pigniczki D , Bor R , Fábián A , Farkas K , Maléth J , Szepes Z , Molnár T
Published: January 2022

Background

Bowel preparation prior to colonoscopy is a routine procedure and supposed to be safe. However, the exacerbation of the complaints could be observed in numerous cases after colonoscopy in patients with inflammatory bowel disease (IBD, Crohn’s disease CD, ulcerative colitis UC). Therefore, our study aimed to investigate the short- and long-term changes of the fecal microbiota composition influenced by the bowel preparation with sodium-picosulphate and magnesium-oxide.

Methods

IBD patients (inactive or mild) preparing for colonoscopy with bowel preparation were enrolled in the study. Control group (HC) consisted of non-IBD patients who were recommended to undergo colonoscopy due to abdominal complaints. Clinical data, blood and stool samples were collected before colonoscopy (point A), 3 days later (point B) and 4 weeks later (point C) to assess disease activity and the changes of the gut microbiome. Fecal microbiota structure was determined by sequencing V4 region of the 16S rRNA gene. Microbiome structure was determined at family level. Statistical analysis included differential abundance analysis and Mann-Whitney test, values of p<0.05 were considered significant.

Results

41 patients (9 CD, 13 UC, 19 HC) were enrolled in our study. After the bowel preparation, alpha diversity in the CD group was lower compared to UC(p=0.01) and control(p=0.02) patients at point B. Alpha diversity of UC patients was significantly higher than CD (p‹0.01) and control (p=0.03) groups at point C. Alpha diversity of UC patients increased from point A to C (p=0.04). However, a decreasing tendency in alpha diversity was observed in patients with CD at A to C period (p=0.26). These changes couldn’t be observed in the control group. Beta diversity showed slight differences between the IBD groups and the control group. After bowel preparation, beta diversity of CD patients immediately (from A to B) changed p=0.03), while beta diversity of UC patients seems to continually change from point A to C(p=0.03). Based on the differential abundance analysis, Clostridiales and Pseudomonadaceae families increased, while Bifidobacteriaceae, Carnobacteriaceae, Veillonellaceae and Pasteurellaceae families decreased in CD patients compared to the HC at point B. The most growing families in HC group were Brucellaceae, Moraxellaceae and Alcaligenaceae at A to B period.

Conclusion

Our findings may suggest that bowel preparation can result in a significant change in faecal microbial composition in IBD. Microbial alterations recovering earlier in UC patients due to changed mucosa. Reduced alpha diversity and altered abundance in CD may have potential role in disease exacerbation. Further examinations are needed to clarify our pilot results.
N02 The importance of the multidisciplinary team (MDT) and its impact on quality of life and medication adherence in patients with Inflammatory Bowel Disease
Authors: Herrerias G , Barros J R , Lopes M A , Saad-Hossne R , Baima J P , Sassaki L Y
Published: January 2022

Background

IBD is a chronic immune-mediated disease that requires continuous patient care. The frequent contact and the good relationship with the multidisciplinary team (MDT) are essential for improving quality of life (QoL) and medication adherence aiming at treatment success. The aim of the study was to assess the importance of MDT in the view of patients with IBD and its impact on QoL and in medication adherence.

Methods

A cross-sectional study was carried out, including 114 patients from an IBD reference center in Brazil. The relevance of MDT was assessed through a questionnaire that included the importance of physicians, nurses, nutritionists and psychologists in the patient care. QoL was assessed by IBDQ. Treatment adherence and knowledge about the disease were assessed using the Morisky and CCKNOW questionnaires, respectively.

Results

In total, 69 (60.53%) patients with CD and 45 (39.47%) patients with UC were included. The mean age was 39.16 (±13.50) years and 58.77% were female. The disease duration was 9.88 (±7.35) years. Presence of comorbidities was observed in 52.63% patients. About 57 (82.61%) patients with CD use biological therapy, with a statistical difference (p <0.0001) when compared to patients with UC (37.78%). The gastroenterologist was considered very important by 91.23% of patients, coloproctologist by 62.07% of patients, nurse by 65.05% of patients, nutritionist by 50% of patients and psychologist by 47.25% of patients. In the analysis of QoL, 24 (21.05%) patients had excellent QoL, 52 (45.61%) had good QoL, 29 (25.44%) had regular QoL and 9 (7.89%) had poor QoL, with no difference between patients who followed with nurses or other MDT professionals (Table 1). Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among patients with CD (p = 0.01). Patients identify the doctor as the main provider of care for their health, but about 10% leave with doubts from their appointments. 10% of patients think that more care with the nurse is necessary and less than 10% of patients are clarified by the nurse about QoL, ostomies, fecal incontinence, disease activity, biological therapy and sexuality.

Conclusion

Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals, mainly do the Covid pandemic in 2020 and 2021. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL.
N20 Safety of extended blood monitoring for adult Inflammatory Bowel Disease (IBD) patients on oral azathioprine during the COVID-19 pandemic: a single-centre audit
Authors: Al-Hasani A , Younge L , Chana A
Published: January 2022

Background

Azathioprine (AZA) is a recognised treatment option for maintaining remission in IBD patients. Myelotoxicity and abnormal liver function tests may present at any stage of therapy, therefore ECCO advises practitioners to check full blood count, liver and kidney function tests at 3-monthly intervals for patients established on therapy. During the COVID-19 pandemic, UK guidance suggested reducing blood test monitoring to a minimum safe frequency to facilitate ‘shielding’ of vulnerable patient groups.

Patients established on treatment at St Mark’s Hospital for more than 12 months, on stable doses were deemed eligible for extended blood monitoring intervals of 6-monthly. The aim of this audit was to assess the impact of this extension on patient safety, by measuring outcomes against locally agreed standards.

Methods

All patients on AZA were identified using the pharmacy dispensing system and patient information software for blood test results, clinic letters and notes. Outcomes for patients who had extended blood monitoring were collected retrospectively including monitoring calls to the IBD advice line and any hospital admissions associated with therapy. Subsequent blood test results were also captured.

Results

A total of 92 patient records were identified and analysed. Table 1 shows the achieved compliance (%) to the audit standards compared to the target compliance (%). 54% of patients (n=50) received medication that lasted beyond the standard 12-week validity of a blood test, i.e. had extended blood monitoring. Of those 50 patients, 43 were eligible for extended blood monitoring (86%). From 50 patients with extended blood monitoring, one patient had elevated alanine aminotransferase levels which improved after a one-week treatment break. Another patient called the IBD advice line reporting nausea and abdominal cramps due to treatment and was advised to split the dose and monitor for side effects. No patients were admitted to emergency care or hospital due to deranged blood test results or adverse effects from their medication.

Conclusion

Overall the findings suggest that the temporary relaxation of blood monitoring did not adversely affect patient safety. For more comprehensive results, it would be prudent to repeat the audit using a larger sample size; however the audit has established a baseline at a time of unprecedented changes in the workplace, which will be useful in guiding future practice.
The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia
Authors: Everett Brandon P , Nakonezny Paul A , Mulligan Edward P , Chhabra Avneesh , Wells Joel
Published: January 2022

The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.
Rates of readmission and reoperation following pelvic osteotomy in adolescent patients: a database study evaluating the pediatric health information system
Authors: Faust Millis , Allahabadi Sachin , Swarup Ishaan
Published: January 2022

Rates and reasons for readmission and reoperation following adolescent pelvic osteotomy are not well-defined. This study aimed to (1) determine 30-day and 90-day readmission rates and the 2-year reoperation rate after pelvic osteotomy in adolescents and (2) identify reasons for readmission and reoperation. The Pediatric Health Information System database was queried between 10 January 2015 and 1 January 2020 for patients meeting selected International Classification of Diseases (ICD-10) procedure and diagnosis codes relating to pelvic osteotomies. Readmission rates were calculated within 30 and 90 days from index osteotomy. The ipsilateral reoperation rate was calculated within 2 years from index osteotomy. Reasons for these outcomes were identified. Univariate and multivariate analyses were utilized to identify readmission risks. Of 1475 patients, 5.4% and 9.2% were readmitted within 30 and 90 days, respectively. Reasons for readmission were consistent across both time points and included infection, hip-related orthopedic conditions and neurologic conditions. Younger age (OR 0.83, 95% CI: 0.76, 0.89; P < 0.0001) and male sex (OR 1.77, 95% CI: 1.23–2.54; P = 0.002) were predictive of readmission within 90 days. The 2-year reoperation rate was 32.1%, of which 79.8% underwent reoperation for hardware removal, 17.7% for revision and 1.3% for hip replacement. 30-day readmission, 90-day readmission and 2-year reoperation rates after adolescent pelvic osteotomy were 5.4%, 9.2% and 32.1%, respectively. Younger age and male sex were predictive of 90-day readmission. Most ipsilateral reoperations were for hardware removal. Understanding readmission and reoperation risks following pelvic osteotomy can benefit patient counseling and improve expectations of post-surgical outcomes.

Level of Evidence:

IV, case series.
Evaluation of Diaphragmatic Function after Interscalene Block with Liposomal Bupivacaine: A Randomized Controlled Trial
Authors: Berg Aaron A. , Flaherty James M. , Habeck Jason M. , Harrison Alicia K. , Braman Jonathan P. , Kaizer Alexander M. , Hutchins Jacob L.
Published: January 2022

Background

Interscalene blocks provide analgesia for shoulder surgery but also cause phrenic nerve paralysis. Liposomal bupivacaine is approved for use in interscalene blocks with the potential to provide longer pain control. However, the impact of liposomal bupivacaine on the phrenic nerve has not been evaluated. It was hypothesized that patients who received an interscalene block with both bupivacaine and liposomal bupivacaine would have a decreased diaphragmatic excursion when compared to bupivacaine alone at 24 h.

Methods

This was a double-blinded study of adult patients who were randomized to receive an interscalene block with either 20 ml 0.5% bupivacaine (bupivacaine group) or 10 ml 0.5% bupivacaine plus 10 ml liposomal bupivacaine (liposomal bupivacaine group). Twenty-six patients were randomized with 22 included in the analysis. Diaphragmatic excursion (via ultrasound) and spirometry were assessed before the block, in the postanesthesia care unit, and at 24 h postblock. The primary outcome was diaphragm excursion with sigh. No adverse events were observed.

Results

At 24 h, the liposomal bupivacaine group median [25th, 75th], had a greater percent change in diaphragmatic excursion during sigh breath compared to the bupivacaine group, –24% [–30, –9] versus 9% [–8, 26], difference in location, 32 (95% CI, 12 to 52), P = 0.007. Five patients in the liposomal bupivacaine group had a greater than 25% reduction in diaphragmatic excursion at 24 h versus zero in the bupivacaine group. They also had a significantly greater percent reduction in forced expiratory volume in 1 s and forced vital capacity compared with the bupivacaine group at 24 h (median decrease of 22% vs. 2%, P = 0.006, and median decrease of 19% vs. 1%, P = 0.049, respectively).

Conclusions

The addition of liposomal bupivacaine to bupivacaine in an interscalene block results in statistically significant reductions in diaphragm excursion and pulmonary function testing 24 h after block placement when compared to bupivacaine alone. This reduction, however, falls within the range of normal diaphragmatic function.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Effect of Percutaneous Posterior Pelvic Ring Reduction and Fixation on Patient-Reported Outcomes
Authors: Obey Mitchel R. , Buesser Katherine E. , Hofer Erin L. , Miller Anna N.
Published: January 2022

Objectives:

The purpose of this study was to assess patient outcomes using Patient-Reported Outcomes Measurements Information System (PROMIS) scores after closed reduction and percutaneous fixation (CRPF) of the posterior pelvic ring and determine whether quality of reduction affects the outcomes.

Design:

This is a retrospective cohort study.

Setting:

The study involved a Level I trauma center.

Patients:

The study included 46 adult patients with operatively treated pelvic ring injuries (63% OTA/AO 61-B) who underwent CRPF between 2014 and 2018 at a single institution.

Intervention:

The intervention involved closed reduction and percutaneous posterior pelvic ring fixation.

Main Outcome Measurements:

The main outcome measurements were postoperative patient PROMIS scores, including physical function, pain interference, anxiety, and depression, and radiographic measurements of postoperative displacement and pelvic deformity.

Results:

After CRPF, PROMIS scores of physical function, pain interference, and anxiety were significantly improved at the time of final follow-up when compared with the first postoperative visit. The amount of malreduction or pelvic deformity did not significantly affect outcome scores; however, results were limited by small sample size.

Conclusions:

CRPF of posterior pelvic ring injuries results in good functional and radiographic outcomes. Degree of malreduction may not affect outcomes as much as previously believed.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.