bluuebunny/crossref_metadata_2025 huggingface dataset:
P159 Patients with Inflammatory Bowel Disease Present with Lower Trabecular Bone Scores
Authors: Yarur A , Alexandra B , Beniwal-Patel P , Stein D , Nunez L , Berens B , Shaina S , Parakkal D , Shaker J , Jenna S
Published: May 2021

Background

Patients with inflammatory bowel diseases (IBD) have lower bone mineral density (BMD). However, BMD does not reflect bone micro-structure/geometry, nor indicates the intrinsic properties of bone tissue. The trabecular bone score (TBS) delivers an indirect measurement of bone microarchitecture and predicts fracture risk independent of bone density. The aim of this study was to assess if patients with IBD present with lower TBS vs a healthy control (HC) population and to identify variables associated with lower TBS.

Methods

This prospective cohort study included patients with active Crohn’s disease (CD) or ulcerative colitis (UC) and a matched HC group. Patients with ostomies, short gut or known endocrine co-morbidities associated with low BMD, patients with osteoporosis on pharmacologic therapy were excluded. L1-L4 TBS and BMD parameters were determined by dual-energy X-ray absorptiometry (DXA) using a GE Lunar iDXA scan and TBS iNsight™ and GE enCORE™. Other collected variables included demographics, disease phenotype, laboratories (25-OH vitamin D [25OHD] and parathyroid hormone levels [PTH]), disease activity (c-reactive protein [CRP], simple endoscopic score [SES-CD] in CD, and endoscopic Mayo score [EMS] in UC). IBD severity was stratified based on endoscopy: mild (EMS=1 in UC or SES-CD=3–6), moderate (EMS=2 or SES-CD=7–15) and severe (EMS=3 or SES-CD>15). The primary outcome was the L1-L4 TBS. Secondary outcomes were left total and neck femoral BMD and the L1-L4 region BMD.

Results

A total of 141 patients were included (115 IBD and 26 HC). Patients with IBD had significantly lower TBS, femoral and L1-L4 BMD and Z-Scores when compared to controls (Figure 1). Endoscopic disease activity was not associated with TBS (Figure 2) or total/neck femur and L1-L4 BMD and Z-scores (p>0.05 for all). When stratifying levels by 25OHD quartiles, patients with 25OHD ≥28 ng/mL (the highest 50th percentile of the study population) had significantly higher TBS Z-scores when compared to those with 25OHD ≤28 ng/mL (0.3 [-0.2 – 1.1] vs -0.1 [-1.1 – 0.5], p=0.002). No associations were seen between TBS Z-scores and use of steroids, gender, type of IBD (UC vs CD), smoking status or when comparing females 50 years or older vs the rest of the group (p>0.05 for all). Moreover, there were no differences in TBS between patients who did or did not engage in resistance exercises (p=0.22) and/or regular aerobic exercises (RAPA ≥6) (p=0.84).

Conclusion

Patients with IBD present with lower TBS Z-scores when compared to HC and there is no correlation with disease activity. The only variable associated with lower TBS was a 25OHD <28 ng/mL. Further studies looking at the implications of these findings are warranted.

FIGURE 1

FIGURE 2
P194 Alexithymia traits are associated with symptom severity and disease activity in IBD patients
Authors: Vinni E , Karaivazoglou K , Lourida T , Kalogeropoulou M , Tourkochristou E , Tsounis E , Lampropoulou E , Theocharis G , Thomopoulos K , Gourzis P , Triantos C
Published: May 2021

Background

Alexithymic traits are quite prevalent in patients with inflammatory bowel diseases (IBD) and have been linked with a heightened psychological burden including anxiety, depression, somatization and obsessive-compulsive symptoms. However, there are limited data regarding the association of alexithymia with gastrointestinal symptom severity and disease activity.

Methods

The current study was conducted at the Division of Gastroenterology of the University Hospital of Patras, in Greece with the collaboration of the Department of Psychiatry. Adult IBD outpatients and healthy controls were enrolled to the study. Alexithymic traits were assessed with the Toronto Alexithymia Scale (TAS-20). Disease activity was assessed with the calculation of the Truelove-Witts Index for ulcerative colitis (UC) patients and the Harvey-Bradsaw Index for Crohn’s disease (CD) patients.

Results

57 IBD patients and 50 healthy controls entered the study. 26 (45.6%) IBD patients reported clinically significant alexithymia traits. In addition, IBD patients faced increased difficulties in emotional expression (p=0.024) and reported increased overall alexithymic traits (p=0.033) compared to healthy controls. Moreover, we detected a borderline tendency of IBD patients to exhibit more disturbances in emotional recognition (p=0.067) compared to the control group. Difficulties in emotional recognition were significantly correlated with the presence of nausea (p=0.031), belly pain (p=0.015) and bloating (p=0.018), while overall alexithymic traits were strongly associated with the presence of nausea (p=0.008). Finally, increased disease activity was significantly associated with a higher total alexithymia score in Crohn’s disease (p=0.037) and ulcerative colitis (p=0.047) patients.

Conclusion

IBD patients report increased alexithymic traits which are associated with more severe gastrointestinal symptomatology and increased disease activity.
P201 Evaluation of the role of anti-TNF in stabilizing the progression of intestinal lesions in Crohn’s disease using the Lemann Index
Authors: Hassine A , Akkari I , Mrabet S , Ben Jazia E
Published: May 2021

Background

The Lemann Index (LI) was developed to assess cumulative digestive tract damage in patients with Crohn’s disease (CD), independently of clinical and biological activity. Recently, therapeutic goals in CD have focused on achieving mucosal healing and deep remission rather than simple symptom control, thus requiring prevention of progression of intestinal damage. The aim of this study was to assess the influence of different treatments on the progression of structural damage, using the LI.

Methods

we retrospectively included all patients with CD, followed in our center during the period between January 2016 and January 2020. The LI was calculated from the first (LI1) and the last (LI2) clinical consultations. The evolution of (LI1-LI2) or Delta LI (DLI) was recorded.

Results

112 patients with CD were collected, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. Regarding maintenance treatment, 51.8% of patients (n = 58) were on Azathioprine, 23.2% (n = 26) were on aminosalicylates, and 25% (n = 28) were on anti-TNF, including 42, 9% under combination therapy. The median follow-up was 36.82 ± 16.83 months, with no difference between the groups. During follow-up, the mean LI increased significantly from 3.34 [0.58–8.82] to 7.82 [0.62–32.6] in the azathioprine group (p = 0.0001), from 2.0 [0.58–6.52] to 3.91 [0.6–14.03] in the Aminosalicylates group (p = 0.001) and from 3.79 [1.05–8.42] to 10.01 [2.58–33.08] in the Anti-TNF group (p = 0.0001). The mean DLI was -4.48 for the Azathioprine group, -1.9 for the Salicylates group and -6.14 for the Anti-TNF group, with no statistically significant difference (p = 0.16).

Conclusion

In patients with CD, the LI tends to increase over time. In our series, the use of Anti-TNF α does not appear to be able to reduce the progression of intestinal lesions, compared to other therapies.
P225 Impact of Inflammatory Bowel Diseases on patients working life
Authors: Sahar N , Dahmani W , Nour E , Aya H , Wafa B A , Aida B S , Salem A , Ahlem B , Mehdi K , Hanene J , Ali J
Published: May 2021

Background

Inflammatory bowel diseases (IBD) are a group of chronic disabling gastrointestinal disorders, consisting mainly of Crohn’s disease (CD) and ulcerative (UC). A substantial part of the burden of illness in these conditions relates to the functional impairment, particularly affecting the ability to work.

The aims of this study were to determine the impact of IBD on the working life of patient and to identify factors associated with a decreased productivity at work in patients with IBD.

Methods

A cross-sectional study carried out at the Gastroenterology department of Sahloul University Hospital (CHU) over a period of 6 months. Patients with IBD (CD or UC) who present to the outpatient clinic or are hospitalized in the ward or day hospital were included. A questionnaire drawn up on the basis of qualitative studies on this subject is used to collect data on the professional career, the characteristics of the position held, difficulties encountered at work on a daily basis.The questionnaire will be accompanied by the “Work Productivity and Activity Impairment” (WPAI) work productivity score.

Results

Among the 82 patients included, 58 had Crohn disease (CD) and 24 had ulcerative colitis (UC). The sex ratio was 1.2 and the mean age of our patients was 33.5 ± 10.2 years. . The majority of UC patients had pancolic involvement (n = 18; 75%). Among the 58 patients followed for CD, 24 (41.4%) had anoperineallesions. Twenty-two patients (26.8%) had already undergone intestinal resection. Six patients (7.3%) were on prolonged sick leave. The majority of patients worked in the private sector (n = 68; 82.9%). Two patients (2.4%) had a fixed rate of work per night. No patient had a job requiring frequent travel. Sixty-two patients (75.6%) had a weekly hourly volume greater than 40 hours.In half of the cases, the discovery of the disease preceded the choice of a professional career; among the remaining patients, this choice was influenced by IBD in 4 cases (10, 5%). Sixteen patients (21.5%) had to skip work hours during the week preceding the interview. The average number of hours missed due to a specific IBD-related problem was 5 hours with extremes ranging from 3 to 10 hours per week. An overall decrease in productivity (BGP) greater than 50% was objectified in 16 patients (21%). The average rates of absenteeism, presenteeism and BGP were 10.49%, 71.25% and 74.14% respectively. The presence of anoperineallesions was the only variable associated with BGP (50% vs 13.3%; p = 0.044).

Conclusion

The impact of IBD on professional activity appears to be significant and requires special attention from both the gastroenterologists and the occupational physicians.
P244 Clinician preferences in treating steroid resistant ulcerative colitis: a discrete-choice experiment (DCE) survey
Authors: Wickramasekera N , Shackley P , Coates E , Barr A , Lee M , Blackwell S , Bedford H , Dames N , Probert C , Sebastian S , Lobo A
Published: May 2021

Background

The optimum treatment for steroid resistant ulcerative colitis (SRUC) is not clear and a range of options can be considered. The aim of this study was to quantify the relative importance of different treatment characteristics to clinicians and understand their preferences for benefit-risk trade-offs.

Methods

A discrete choice experiment (DCE) was conducted in the UK via online survey of clinicians with expertise in inflammatory bowel disease. This involved 12 tasks where respondents selected a preferred treatment option when presented with two competing, hypothetical treatment profiles for a SRUC scenario. Profiles described five treatment characteristics focusing on clinical outcomes and safety, identified from qualitative interviews with clinicians and evidence from systematic reviews. DCE responses were analysed using conditional logistic regressions. Regression coefficients were used to calculate benefit-risk trade-offs, to find the rate at which clinicians are willing to trade levels of risks in exchange for the preferred levels of clinical outcomes. Regression coefficients were also used to predict uptake rates for selected drugs currently prescribed to patients with SRUC.

Results

116 clinicians completed the survey (age 46y; female 42%; consultant 60%; nurse 26%; mean experience 11y). Figure 1 shows the treatment characteristics that make respondents more likely (positive coefficient) or less likely (negative coefficient) to choose a treatment. One unit increase in both lymphoma risk and serious infection risk were strongly considered when clinicians were choosing a treatment compared to one unit increase in the symptom improvement characteristics. Clinicians would accept a higher lymphoma risk of 5 per 10,000 patient years for a 10% improvement in remission rate compared to 4 and 2 cases per 10,000 patient years for 10% better rates of clinical response and mucosal healing respectively. Clinicians at secondary hospitals accepted a lymphoma risk of 4 cases per 10,000 patient years for a 10% improvement in remission vs 7 per 10,000 patient years at tertiary centres. Similar trade-off results were found for serious infection risks. Predicted uptake comparing preferred characteristics to existing treatments was infliximab (62%), tofacitinib (18%), vedolizumab (15%) and adalimumab (5%).

Conclusion

Clinicians are willing to make difficult trade-offs and tolerate elevated safety risks in exchange for therapeutic benefits. Risk tolerance was highest if the treatment improved long term remission rate, lowest for mucosal healing and higher in clinicians at tertiary centres. The results help to better understand treatment decisions and identify outcomes that might be considered in choosing agents to evaluate in clinical trials.
P245 Evaluation of quality of life in patients with perineal Crohn’s disease: a monocentric Tunisien study
Authors: Hamdi S , Ben Ameur W , Hammami A , Elleuch N , Dahmani W , Ben Slama A , Ksiaa M , Braham A , Ajmi S , Jaziri H , Jmaa A
Published: May 2021

Background

Perianal manifestations of Crohn’s disease considerably affects the life quality of patients. This study aims to assess the quality of life of patients with perineal Crohn’s disease by using the SIBDQ (Short Inflammatory Bowel Disease Questionnaire) and to evaluate its correlation with the Perineal Disease Activity Index (PDAI).

Methods

We retrospectively reviewed the medical records of patients with perineal Crohn’s disease between January 2018 and December 2020. Patients with active luminal disease were not included in this study (Crohn’s Disease Activity Index (CDAI) > 150). All participants answered the SIBDQ. Active perineal disease was defined as a PDAI > 7. We studied the correlation between SIBDQ and PDAI. Patients were divided into 2 groups according to the duration of the disease greater or less than 5 years. SIBDQ and PDAI were compared between the 2 groups.

Results

We included 52 patients with a mean age of 37 years (range: 17–62 years). There were 34 males (65.4%) and 18 females (34.6%). Crohn’s disease has been diagnosed for 7.6 years in average (range 2–19 years). The PDAI varied from 1 to 15 (average=7) and the SIBDQ ranged from 11 to 66 (average= 41). The SIBDQ was inversely correlated to the PDAI with a Pearson’s correlation coefficient equal to -0.885 (p=0.01). Indeed, the SIBDQ score for patients with an active perineal disease was significantly lower than those with inactive one (28.3 ± 11.6 vs. 50.1 ± 7.7; p< 0.0001), which indicates a worse life quality. Comparing the 2 groups, there were no significant differences in terms of age, gender and PDAI. The SIBDQ was lower in patients who had the disease for more than 5 years compared to the other ones (38.3 ±15.6 vs.48.2 ± 7.5; p=0.003).

Conclusion

The quality of life for patients with perineal Crohn’s disease seems to be altered by both activeness and duration of the disease. The SIBDQ is a simple tool that helps physicians detect patients with poor life quality. Other studies are necessary to validate this questionnaire for the evaluation of the quality of life in patients with perineal Crohn’s disease.
P337 Early infliximab clearance predicts remission in children with Crohn’s Disease
Authors: Chung A , Carroll M , Almeida P , Petrova A , Mould D , Wine E , Huynh H
Published: May 2021

Background

Recent studies suggest pediatric Crohn’s Disease (CD) patients have higher infliximab clearance (IFX CL) for body weight and lower serum IFX when dosing by weight. Our aim was to determine if IFX CL calculated based on therapeutic drug monitoring (TDM) data predicts long term outcome.

Methods

Retrospective study of CD patients seen at the Stollery Children’s hospital from Jan 2013-Jul 2019. Anthropometric, lab, IFX TDM & disease data were collected for those having >2 serum IFX levels. IFX CL was calculated using non linear mixed effects modelling. The data was fit to a 2-compartment model with linear elimination. Outcomes were defined at 4, 9 & 15 months. Remission is defined as wPCDAI<12.5, CRP<4 & steroid-free for 4 months. Subjects that underwent intestinal surgery or ceased IFX due to refractory CD are non-responders. Logistic regression was used to determine early predictors (at baseline or end of induction) associated with remission at 4, 9 & 15 months. The variables evaluated were: IFX CL, IFX trough level, sex, age, PARIS classification, CRP, ESR, Alb, Hgb, weight, BSA, BMI, previous anti-TNF & immunomodulator use.

Results

85 subjects were included, with a median follow up of 670 days (IQR: 304,1105). See table 1 for baseline characteristics. Regression analysis showed early IFX CL was the only significant early predictor of remission for every timepoint. Baseline IFX CL and end of induction IFX CL, measured in L/h, were associated with 15-month remission with an OR of 0.606 (95%CI: 0.394,0.931; p=0.022) and 0.373 (95%CI: 0.207,0.669; p=0.001) respectively. Similar results obtained at 4 & 9 months. ROC analysis of remission was done using only early IFX CL. A baseline IFX CL of 5.83 L/h predicted 15-month remission with a sensitivity & specificity of 0.649 & 0.667 (AUC=0.701). End of induction IFX CL of 6.06 L/h predicted 15-month remission with a sensitivity & specificity of 0.676 & 0.611 (AUC=0.709). Similar results obtained at 4 & 9 months.

Conclusion

In all timepoints, early IFX CL was a strong predictor of later remission compared to dose intensity, frequency, IFX levels and wPCDAI & CRP at end of induction. This suggests early IFX CL is a marker of early biological response to IFX. Early dose optimization is required in those with high IFX CL to ensure optimal response with adequate drug exposure. This will facilitate early change in treatment for those with inadequate response.
P350 SAFIIR: Study of Anemia Following Intravenous Iron Repletion
Authors: Rioux L C , Bernard E J , Bourgault M , Mondragon P , Rioux V
Published: May 2021

Background

The main objective of this study was to assess the prevalence of anemia and the secondary objectives aimed to evaluate the real-life impact of intravenous iron therapy on anemia correction in patients living with Inflammatory Bowel Disease (IBD).

Methods

We performed a retrospective cohort study of adult patients (18 to 80 years old) with a Crohn’s Disease or Ulcerative Colitis diagnosis who were followed at our clinic between January 2018 and March 2020. Clinical data were obtained from the patients’ electronic medical records. Iron-deficiency anemia was defined as hemoglobin (Hb) < 12,0 g/dL and/or transferrin saturation (TSAT)< 20 % and/or low serum iron (≤ 10 μmol/L). Intravenous (IV) iron treatment was defined as at least one infusion of iron isomaltoside, iron sucrose, or sodium ferric gluconate. The secondary analyses were performed in terms of IV iron treatments.

Results

Of the cohort of 556 IBD patients, 223 (40.1%) had an anemia diagnosis. Among the latter, 39 patients received an intravenous iron treatment and had laboratory results in the 8 weeks preceding and in the 8 weeks following the treatment. Table 1 shows the response to intravenous iron treatment in patients with baseline Hb < 12,0 g/dL (n=28 patients, 47 IV iron infusions). Table 2 shows the changes in anemia-related laboratory values in the 8 weeks preceding and in the 8 weeks following intravenous iron treatment.

Conclusion

This was the first study to evaluate the prevalence of iron-deficiency anemia and the real-life impact of intravenous iron treatment among patients living with IBD in Quebec, Canada. The findings will serve as a baseline for subsequent interventions to improve the wellbeing and the quality of life of IBD patients with anemia.
P361 No increased postoperative risk of venous thromboembolism in patients with Ulcerative Colitis undergoing colectomy after tofacitinib exposure
Authors: De Greef I , Verstockt B , Bislenghi G , Terrasson I , Sabino J , Ferrante M , D’Hoore A , Vermeire S
Published: May 2021

Background

Colectomy for ulcerative colitis (UC) has been associated with postoperative morbidity and mortality, including venous thromboembolism (VTE). Patients with inflammatory bowel diseases (IBD) have a 2 to 4-fold increased risk for developing VTE, as compared to non-IBD patients. Due to recent concerns on increased VTE associated with tofacitinib exposure, we aimed to evaluate the 180-day postoperative VTE risk in UC patients undergoing colectomy after tofacitinib use in comparison to patients failing biologicals and undergoing the same surgery.

Methods

This retrospective cohort study included all UC patients who underwent colectomy between 2014 and 2020 in our tertiary IBD center. All medical charts were reviewed, and clinically relevant information extracted, including indication for colectomy, development of postoperative VTE (deep venous thrombosis, pulmonary or extra-pulmonary embolisms) within 180 days of surgery, low-molecular weight heparin (LMWH) prophylaxis and perioperative therapy exposure (steroids within 1 month prior to surgery, biologicals or tofacitinib within 3 months prior to surgery).

Results

One-hundred seven UC patients (49.5% women, median [IQR] age 38.0 [27.0 – 53.0] years) underwent colectomy due to refractory disease (n=93), dysplasia or carcinoma (n=12) or polyposis (n=2) (Table 1). Thirty-six (33.6%) patients were operated urgently. At the time of surgery, 44 (41.1%) were on steroids, 38 (35.5%) on anti-TNF agents, 27 (25.2%) on vedolizumab/etrolizumab, 6 (5.6%) on anti-IL12/23 agents and 12 (11.2%) on tofacitinib. All patients received antithrombotic prophylactic LMWH postoperatively. During the 180-day postoperative period, 3 (2.8%) patients developed an intra-abdominal thrombosis, none of them had a history of VTE. Two thromboses were found by coincidence on CT scans which were performed in light of postoperative fever and inflammatory blood tests, the other patient was symptomatic. All 3 patients had been exposed to vedolizumab: one had an underlying malignancy (colon adenocarcinoma), the 2 others also had been exposed to corticosteroids prior to colectomy. No VTE was seen in the patients who underwent colectomy while on tofacitinib.

Conclusion

The overall risk for UC patients to develop VTE after colectomy is low with adequate antithrombotic prophylactic therapy. In particular, we did not observe any VTE in our colectomy patients who were exposed to tofacitinib prior to surgery. The three patients who developed VTE despite LMWH had additional risk factors (concomitant steroid use, active cancer).
P382 High anti-tumor necrosis factor alpha treatment trough concentrations are not associated with higher rate of adverse events in pediatric patients with inflammatory bowel disease
Authors: Zvuloni M , Matar M , Levi R , Shamir R , Assa A
Published: May 2021

Background

Anti-tumor necrosis factor alpha (anti-TNFα) therapy is commonly used to treat refractory pediatric inflammatory bowel disease (IBD). Prolonged use of anti-TNFα therapy has been linked to a number of adverse events. We aimed to assess the relationship between serum trough concentrations (TC) of anti-TNFα and adverse events rate among patients with pediatric IBD.

Methods

The medical records of 135 pediatric patients with IBD who were treated with anti-TNFα agents from 2015 to 2020 and had sequential monitoring of TC were reviewed retrospectively for the presence of adverse events (infusion reactions, infections, acute cutaneous reactions, psoriatiform rashes, elevated transaminases and others). The association between demographic or disease related variables and adverse events were analyzed using multivariate analysis.

Results

Out of 135 patients, [59 (43.7%) female, mean age at diagnosis 12.9 (±3)years, 111 (82.2%) Crohn’s disease] who had 1645 measurements of TC [1037(63%) infliximab, range 0-46 µgr/ml] during a median follow-up period of 1.7 years (1.1-2.7), we recorded 120 adverse events in 42 patients (31%). When analyzing TC as continuous measure or as a categorical measure (> or <10 µgr/ml) there were not associated with a higher rate of adverse events (p=0.9).Patients who reported non-infusion related adverse events were younger at the time of diagnosis (mean age 11.4±3.9 vs.13.3±2.8years) than those without adverse effect (p=0.029). There was no statistically significant correlation between other variables (gender, disease type, Paris classification, extra-intestinal manifestation, perianal disease, and the pediatric disease activity index) and the occurrence of adverse events.

Conclusion

Based on our cohort, higher TCs were not associated with higher rate of anti-TNF related adverse events whereas younger age at diagnosis increased the risk for such events. The study protocol was approved by the local Internal Review Board at the Rabin/Schneider Medical Center (RMC0320-10).
P390 Diverting Loop Ileostomy in Medically Refractory Crohn’s Colitis
Authors: Patel P , Wu L
Published: May 2021

Background

Medically Refractory Crohn’s Colitis (MRCC) necessitates surgical treatment. Patients may be malnourished, hyper-inflammatory and unstable (tachycardia, elevated temperatures and hypotension). Acute Defunctioning Ileostomy Formation Alone (DIFA) may be a safer option than total/subtotal Acute Colectomy and Ileostomy Formation (ACIF) in the urgent/semi-urgent setting - allowing optimisation of patient condition for further medical therapy or elective surgery.

Methods

Multi-centre, retrospective outcomes analysis was performed. Local investigators identified all patients aged ≥16 with MRCC, that underwent urgent/semi-urgent surgery between 1/1/1999 and 31/12/2019. The primary outcome was 30-day all-cause morbidity. Multiple secondary outcomes were defined relating to 30-day, 1-year and 18-month follow up.

Results

82 patients from seven hospitals satisfied selection criteria - 12 DIFA and 70 ACIF. 30-day all-cause morbidity (8.3% vs 52.9%), median length of stay (8 vs 17 days), open surgical approach (25.0% vs 75.0%) and 1-year readmission rates (25.0% vs 37.1%) were all significantly lower for the DIFA group. 30-day all-cause mortality, critical care admission, 30-day return to theatre and 1-year morbidity were all lower for the DIFA group. The DIFA group had a 16.7% 1-year colectomy rate and 25% 18-month ileostomy rate.

Conclusion

DIFA is a safe alternative to ACIF for surgical treatment of urgent/semi-urgent MRCC. Larger scale prospective studies are warranted to confirm this.
P402 Is co-trimoxazole prophylaxis necessary for Inflammatory Bowel Disease patients receiving triple immunosuppression?
Authors: Phillips G , Moore-Gillan C , Mohamed Z , Mikin P , Peake S , Hicks L
Published: May 2021

Background

ECCO Guidelines (1) advocate Co-trimoxazole (TMP/SMX) prophylaxis against Pneumocystis jirovecii for patients with inflammatory bowel disease (IBD) on triple immunosuppression, although the evidence level is low and based on non-IBD patient data (2). We assessed adherence to this guidance and frequency of infection events among IBD patients at Imperial College Healthcare NHS Trust, London, UK.

Methods

Eligible patients were defined as those on a combination of 2 immunosuppressants (with one of those being a biologic) between December 2017 to December 2020, who received a course of high dose steroids (≥20mg prednisolone). Patient demographics, IBD treatment, TMP/SMX prophylaxis and infections (including hospitalisation) developed within 30-days of starting high dose steroids were recorded retrospectively using the hospital electronic patient records.

Results

In the cohort of 247 patients on concomitant biologic and immunosuppression dual therapy 176/247 (71%) were ≤ 49 years old and 136/247 (55%) were male. Over the three year observation period, 333 individual thiopurine-biologic combinations were prescribed; Of the biologics 157/333 (47%) were infliximab, 91/333 (27%) adalimumab, 50/333 (15%) vedolizumab, 27/333 (8%) ustekinumab and 8/333 tofacitinib (3%). All received azathioprine or 6MP concurrently.

Steroids were prescribed on 75 occasions for 50 (20%) patients. Of 28/75 (37%) prescriptions where TMP/SMX was co-prescribed 4/28 (14%) developed infections with 1/28 (4%) requiring hospitalisation. There were no respiratory infections in this group. Of the 47/75 (63%) where TMP/SMX was not prescribed 7/47 (15%) developed infections (4/47 respiratory, 2/47 skin or bone, 2/47 [MZ1] gastrointestinal infections). One patient had 2 infections. The hospitalisation rate was 2/47 (4%). There were no confirmed cases of Pneumocystis jirovecii in either group.

Conclusion

Existing evidence for TMP/SMX prophylaxis in this setting is limited and is reflected in the varied clinical practice observed. However, no difference in clinically significant infection rates among individuals with and without TMP/SMX prophylaxis was observed in our setting. Further data are required to validate the utility of antibiotic prophylaxis in severely immunosuppressed IBD cohorts to better guide its use.

References
P430 Prognostic significance of neuropeptide expression in ileal neural plexuses in Crohn’s disease. A retrospective study
Authors: Gklavas A , Tiniakos D , Karandrea D , Karamanolis G , Bamias G , Papaconstantinou I
Published: May 2021

Background

Intestinal resection in Crohn’s disease (CD) is not curative and the risk for postoperative recurrence (POR) remains high. Highlighting risk factors for POR is crucial for the postoperative management of CD patients. Myenteric plexitis is a well-established risk factors for POR. The primary purpose of this study was to evaluate the correlation of neuropeptide P (NPY)-, vasoactive intestinal peptide (VIP)- and substance P (SP)-ergic nerve density with the presence and severity of plexitis in myenteric and submucosal plexuses in the proximal resection margin. Secondary aims were to assess the value of abovementioned neuropeptides’ expression in predicting POR and to recognize additional risk factors.

Methods

We conducted a retrospective, single-center study on CD patients who underwent ileocolonic resection (ICR) between January 2010 and December 2016. Exclusion criteria were age <16 years, patients with missing or invalid data precluding analysis, the presence of a diverting ileostomy on enrollment and specimens inappropriate for the evaluation of histologic features of interest in the proximal resection margin. Demographic and clinical data were retrieved, and the incidence or endoscopic, clinical and surgical POR was recorded. The presence and severity of plexitis was evaluated by hematoxylin and eosin staining. Giemsa staining was used for the recognition of mast cells. Immunohistochemistry was used was used for the detection of T-lymphocytes and NPY-, VIP- and SP-ergic neurons. The expression of the above peptides was quantified using image analysis.

Results

Seventy-nine patients (44 males) with a median age of 35 years were included. The median follow-up was 71 months. Myenteric and submucosal plexitis were present in 83.5% and 73.4% of patients, respectively. No association was detected between the density of NPY, VIP and SP expression and the presence or severity of plexitis. Similarly, the number of the involved T-lymphocytes or mast cells was not correlated with the expression of these peptides. Univariate and multivariate Cox proportional regression analysis was performed for the detection of risk factors for POR. Smoking and moderate/severe myenteric plexitis were independent risk factors for endoscopic and clinical POR, whereas an involved ileal margin was recognized as a risk factor for clinical POR.

Conclusion

This study did not document a correlation between plexitis in proximal resection margin and the expression of specific neuropeptides. According to our findings, smoking, myenteric plexitis, and involved ileal margin are independent risk factors for POR.
P498 Diagnosing and differentiating iron deficiency in inflammatory disorders: still an unsolved mystery?
Authors: Aksan A , Aksan S , Farrag K , Schröder O , Stein J M
Published: May 2021

Background

It is well established that inflammation can mimic some aspects of iron deficiency (ID) by impairing the utilisation of existing iron stores for red cell production and inducing an iron-sequestration syndrome and hypoferraemia. Diagnosis of ID is therefore complex and there is currently no standard clinical test capable of clearly distinguishing ID when inflammation is present. Often, a combination of parameters is necessary. The aim of this study was to investigate which sole parameter or combination of parameters can best predict ID in patients with IBD.

Methods

A cross-sectional study was conducted using routine blood samples from patients with IBD. Blood samples were analysed for standard blood count, iron status (serum ferritin; SF, transferrin saturation; TSAT), inflammation parameters (high sensitivity C-reactive protein; hsCRP) and soluble transferrin receptor (sTfR) using standard methodology. A multiparameter index test (MCV, TSAT, SF) was performed to define patients with iron restricted erythropoiesis (IRE) (IRE group) when at least 2 of the 3 parameters indicated IRE. Cut-off values for TSAT (<20%) and SF (<30/μL) were defined according to ECCO guidelines and for MCV (80 fL) according to the literature. Criteria taken to indicate absolute ID (AID) were hsCRP <5 mg/L, SF 30 μg/L and TSAT < 20%, while functional ID (FID) was denoted by hsCRP ≥ 5 mg/L, SF < 100 μg/L and TSAT < 20%.

Results

168 IBD patients (88f; 85CD/83UC;43.4±14.9y) were enrolled. Of these, 107/168 had inflammation. 100/168 patients had IRE, of whom 70/100 had FID and 30/100 had AID. ROC analysis was performed to compare different parameters as detectors of IRE and to summarise the performance of each respective parameter (Table 1). When inflammation was absent, the best combination was SF and TSAT, whereas in the presence of inflammation, the best combination was found to be TSAT and sTfR. The addition of MCV, which showed high specificity regardless of inflammation, was found to add additional value to the diagnosis in the context of inflammation (p <0.001).

Conclusion

Of those parameters studied, none was suitable to diagnose IRE when taken alone. In the absence of inflammation, ID in IBD can be adequately determined by combining SF and TSAT. When inflammation is present, however, the combination of TSAT with sTfR measurement was found to be more accurate, while the additional inclusion of MCV added additional value to the diagnosis.
P513 Assessment of quality indicators in The Swedish Inflammatory Bowel Disease Registry (SWIBREG) for Crohn’s Disease treated with biological therapies
Authors: Xu C , Byman V , Hossain J , Storlåhls A , Hedin C
Published: May 2021

Background

The development and clinical application of quality indicators (QI) for IBD are objectives of The Swedish inflammatory bowel disease registry (SWIBREG)(1). These include objective and subjective parameters aiming to standardise IBD care in Sweden(2).We aimed to evaluate QI target attainment at Karolinska University Hospital, and to identify specific patient or disease parameters associated with failure to reach QI targets.

Methods

QI targets as defined by SWIBREG were analysed in patients with Crohn′s disease undergoing treatment with biologics. A retrospective register-based study included 292 patients who received biological treatment between 2018-08-01 and 2020-01-31. Pediatric Crohn’s patients and patients with a treatment duration <6 months were excluded.

Results

Faecal Calprotectin (FC) and Haemoglobin (Hb) values were registered for 80% and 86%, respectively. Anaemia prevalence was 30%. Significantly lower monitoring frequencies were observed in patients undergoing treatment with Adalimumab and patients with biological treatment duration >1 year. FC was <250 μg/g in 77% of patients. The QI target for the frequency of Short Health Scale (SHS) registration was met whereas that of Physician Global Assessment (PGA) was not. The QI target for the most recent value of both SHS and PGA were met. Only 70% of smokers, 72% of patients with biological treatment duration >1 year and 52% of adalimumab patients had a registered SHS evaluation.

Conclusion

Adalimumab treatment, treatment duration and smoking are associated with decreased frequency of registration of QIs. Efforts are needed to ensure quality of care for these groups. A lower rate of PGA monitoring may reflect a lack of capacity for physician assessments and could be complemented with “professional global assessments” by specialist IBD nurses.

References

1. Ludvigsson JF, Andersson M, Bengtsson J, Eberhardson M, Fagerberg UL, Grip O, et al. Swedish Inflammatory Bowel Disease Register (SWIBREG) - a nationwide quality register. Scand J Gastroenterol. 2019;54(9):1089–101.

2. Berry SK, Melmed GY. Quality indicators in inflammatory bowel disease. Intest Res. 2018;16(1):43–7.
P518 Compliance with Faecal calprotectin home testing as standard during COVID-19 pandemic compared to laboratory based testing pre-COVID
Authors: Edwards D , Ibrahim M , Cooney R , Boulton R
Published: May 2021

Background

Faecal calprotectin (FC) testing has become a standard non-invasive tool to monitor disease control in Inflammatory Bowel Disease (IBD)(1). Reported patient compliance with submitting samples for hospital testing has been as low as 35% (2). We aimed to evaluate patient compliance with rapid home faecal calprotectin testing kits compared to hospital based testing in our university teaching hospital.

Methods

100 patients with a diagnosis of IBD for at least 1 year and attended IBD clinic between January 2019 and August 2020 were selected. Our laboratory ceased performing FC testing in late March and we introduced home testing (BÜHLMANN IBD doc). 50 patients who were, pre-pandemic, requested to bring a stool sample to the laboratory for hospital-based ELISA testing were randomly selected. We compared these to 50 random patients who had a home-based FC testing. Patients who were supplied with home testing kits received training from IBD nurses as well as on-line training materials. Data was collated retrospectively. Compliance was recorded if result was documented within 6 weeks of request.

Results

Prior to the introduction of home testing, only 52% of the patients’ sampled complied with hospital-based testing. This compared to a 70% compliance rate, when home testing was requested (Figure 1).

Figure 1. Comparison of percentage of compliance between hospital and home faecal calprotectin test request.

Conclusion

The improvement in FC testing compliance with rapid home testing kit compared to laboratory based testing illustrates the benefit of adapting home testing as the standard in future. The considerable increase in compliance by home testing may be due less disruption to patient’s personal life i.e., ability to undergo testing at home, symptoms such as faecal incontinence preventing patients delivering samples to hospital and COVID pandemic compelling patients to stay at home. Adopting rapid FC home testing as standard provides patients with increased locus of control regarding their care, providing health care professionals with rapid results, thus, will improve management of IBD. The ability for patients to perform home test has obvious advantages during the COVID pandemic.

References
P546 The safety and efficacy of the new-generation budesonide-MMX in the aspect of the cytochrome P-450 enzyme genotype
Authors: Resál T , Farkas K , Molnár T
Published: May 2021

Background

Unlike previous forms of budesonide absorbing from the ileal and ascending colon region, the new-generation budesonide-MMX contains a formula, that allows absorption throughout the whole colon. Budesonide is degraded in the liver by cytochrome P450 3A enzyme, but so far, there is no study examining the relationship between the budesonide’s effect and the enzyme activity. CYP3A5 is absent in 90% of the European/caucasian population due to a functional loss mutation (CYP3A5*3), whereas patients with the wild-type CYP3A5*1 allele may be expected to have increased metabolism. The most common genetic polymorphisms in CYP3A4 (CYP3A4*1B and CYP3A4*22) result in increased and decreased expression, respectively.

Methods

We enrolled 33 patients with UC in this prospective study until January of 2021. Patients received 9 mg oral budesonide-MMX once daily until 8 weeks. Laboratory parameters (cholesterol, triglyceride, CRP) and serum hormone levels (parathormone, dehydroepiandrosterone and cortisol) were monitored before and after the 8-week therapy to follow metabolic and hormonal changes. During these visits, body composition analysis was also performed with InBody 770 machine to observe the adverse effects of budesonide-MMX in respect of body fat mass, body mass index, protein content of the body and bone mineral content. We examined the CYP450 3A (CYP3A5 and CYP3A4) enzyme genotype of the patients, to see, whether the different alleles of this drug-degrading enzyme affect the efficacy and safety.

Results

33 patients had received the 2-month therapy. By the end of follow-up, based on partial Mayo score, 26 (78.8%) patients experienced remission and 6 patients (18.2%) were primary non-responders. Mean pMayo score decreased from 4.18 to 1.63 (p<0.001). No significant changes were observable regarding body composition. Serum cholesterol level showed significant increase (p<0.001), while triglyceride and CRP did not show significant changes. Serum cortisol levels were decreased (p<0.001), while PTH and DHEA showed no significant decrease. Only two patients experienced side effects: one of them hypertonia, headache and acnes, while the other mild diarrhoea. 3 patients have CYP3A5*1/*3 genotype, and 16 have CYP3A5*3/*3. There was no significant difference between the two groups, regarding safety and efficacy. Only 1 patient have CYP3A4*1B genotype, while the rest have CYP3A4*1, hence, no statistics could be performed.

Conclusion

In our study, budesonide-MMX proved to be safe and effective in the therapy of UC, however, cholesterol was elevated in the serum. Based on our cohort, different genotypes of CYP3A don’t have an impact on the effect of the drug, however, CYP3A allele variants are rare, therefore, further examinations should be performed.
P557 Long-term outcomes following laparoscopic ileocecal resection without any residual lesion for Crohn’s disease: a single-center observational study
Authors: Ge X , Zhou W
Published: May 2021

Background

To describe the characteristic of Crohn’s disease (CD) patients undergoing ileocecal resection, and to analyze the long-term outcomes following surgery.

Methods

A retrospective study on patients undergoing ileocecal resection without any from residual disease in the remnant intestine from July 2011 to March 2020 was conducted. The clinical data and the following outcomes were evaluated.

Results

Among 86 CD patients, the mean disease duration was 33.4 months, 40 patients had perianal fistula. 53 patients underwent surgery due to stricture, 26 was perforation, and 7 was failure of medical therapy. 27 (31.4%) patients suffered postoperative complications. Mean follow-up was 44.4 months, 47 (54.7%) patients had an endoscopic recurrence with 9 were non-anastomotic recurrence, 20 were anastomotic recurrence, and 18 were both anastomotic and non-anastomotic recurrence, and 4 patients had a surgical recurrence. Furthermore, 41 (47.7%) had postoperative prophylaxis with 22 (25.6%) azathioprine and 17 (19.8%) infliximab. 45 (52.3%) patients were without postoperative prophylaxis, 19 (42.2%) had an endoscopic recurrence, and 26 (57.8%) had none endoscopic recurrence. The penetrating disease and lower skeletal muscle index were independent risk factors for endoscopic recurrence.

Conclusion

CD patients with penetrating disease or lower skeletal muscle index were suggested to have earlier postoperative prophylaxis after ileocecal resection without any from residual disease in the remnant intestine.
P574 Exploring treatment of Crohn’s disease and ulcerative colitis in the Middle East and Northern Africa: An analysis of the HARIR observational cohort study
Authors: Hamed W , Salem O E , Alharbi O , Sharaf M , Taylor C , Sherief A , Besar A
Published: May 2021

Background

This analysis of the HARIR study explored disease characteristics, treatment and outcomes of patients (pts) with diseases including Crohn’s disease (CD) or ulcerative colitis (UC) treated with biologics in clinical practice where data are limited: North Africa, the Middle East and Western Asia.

Methods

HARIR was a prospective, observational, multicentre, cohort, phase 4 study (NCT03006198). This analysis included adult pts with CD or UC who were starting infliximab, golimumab or ustekinumab (study period: March 2016–December 2018; terminated early). Pts needed to be previously untreated with study drugs or received ≤2 biologics prior to enrolment. Treatment was at physician’s discretion. Pts were followed for 1 year or until study withdrawal (amended from 2 years); pts who stopped the study due to study termination were considered to have completed the study. For CD, the main efficacy outcomes were Crohn’s Disease Activity Index (CDAI) treatment response, remission and change from baseline of inflammatory Bowel Disease Questionnaire (IBDQ). Adverse events (AEs) and serious AEs (SAEs) were recorded.

Results

A total of 86 pts with CD or UD from Algeria, Egypt, Kuwait, Qatar and Saudi Arabia were enrolled; 56 pts completed the study. Target enrolment was achieved for CD but was 1 pt short for UC. Mean (SD) age was 32.7 (11.5) years for CD and 29.6 (9.4) years for UC. Most pts with CD and UC had not previously received biologics (CD: 95.2%, 59/62; UC: 66.7%, 16/24). All pts with CD and UC received infliximab. Investigators noted lack of access to study drug and concomitant treatments as limiting factors for enrolment. Immunosuppressant use was low; methotrexate was used by 1 pt with UC prior to study treatment and azathioprine or mycophenolate mofetil were used by 19.4% (12/62) of pts with CD and 24.0% (6/25) of pts with UC during the study. At Month 3, 29.2% (14/48) of pts with CD had a positive treatment response (CDAI score ≥70 to ≥25% versus baseline; Figure). The percentage of pts with CD in clinical remission was 53.8% (28/52) at baseline and 70.8% (34/48) at Month 3 (Figure). Mean (SD) IBDQ score increased by 11.3 (39.6%) points from baseline to Month 3 (Figure). Overall, pt numbers were too low to analyse outcomes for CD after Month 3 and over the study duration for UC. In CD and UC, respectively, AEs were reported by 25.8% (16/62) and 37.5% (9/24) of pts and SAEs were reported by 12.9% (8/62) and 16.7% (4/24) of pts.

Conclusion

Infliximab treatment was well tolerated, and a moderate clinical response was observed for this Middle Eastern and Northern African population. Limited accessibility to biologics and concomitant treatments in these countries restricted conduct of the study.