bluuebunny/crossref_metadata_2025 huggingface dataset:
P1193 Cross-Disease Analysis Unveils CXCL6 as a Shared Immune Mediator in Ulcerative Colitis and Periodontitis: Novel Insights from Bioinformatics
Authors: Gao X
Published: January 2025

Background

Emerging evidence underscores a pathological bidirectional relationship between ulcerative colitis (UC) and periodontitis (PD) through the oral-gut axis, highlighting a complex interplay with significant implications for patient health. However, the shared molecular features underlying this interaction have yet to be explored.

Methods

In this study, we initially established a potential link between periodontitis and ulcerative colitis based on Mendelian randomization. Following this, we analyzed gene expression profiles from the Gene Expression Omnibus (GEO) for both UC and PD, identifying overlapping genes between UC-differentially expressed genes (DEGs) and PD-DEGs.

Results

Functional enrichment analysis revealed associations with various immune pathways, underscoring the immunological relevance of these genes. Intersection with immune-related genes (IRGs) yielded 25 candidate genes, among which CXCL6 emerged as a central hub gene identified through three machine learning methods: LASSO, RF, and SVM-RFE. Subgroup analysis based on CXCL6 expression demonstrated that the CXCL6-high group exhibited increased immune cell infiltration and enhanced immune function. Moreover, our investigation of CXCL6 in relation to biological therapies in UC patients indicated a reduction in CXCL6 levels following treatment, suggesting potential benefits of biological therapies. Finally, we validated the expression of CXCL6 in a rat model of dual diseases.

Conclusion

In summary, CXCL6 is identified as a diagnostic biomarker and potential therapeutic target for UC combined with PD, warranting further investigation into its clinical significance and associated mechanisms.
P1198 Statin Use for Primary Prevention of Cardiovascular Disease and its Association with Risk of Incident Inflammatory Bowel Disease: A Population-Based Cohort Study
Authors: Faye A , Allin K , Juul Poulsen G , Jess T
Published: January 2025

Background

Environmental factors, which play a critical role in the rising incidence of inflammatory bowel disease (IBD), may hold the key for prevention. Statins, known for their cardiovascular benefits, possess anti-inflammatory properties and have been hypothesized to reduce the risk of developing IBD, though prior data have been limited. Thus, to advance what is known, we prospectively assessed the association between statin use and the risk of IBD among individuals eligible for statin therapy.

Methods

Using a prospective new user design within the Danish National Registries, we identified a population-based cohort of individuals ≥ 40 years-old from 2008-2022 who were eligible for statin therapy for the primary prevention of cardiovascular disease. Statin users were matched 1:1 to non-statin users on age, sex, year, and underlying cardiovascular risk factors, with this process repeated one hundred times to ensure an accurate risk estimate. Cox proportional hazards models were then used to obtain adjusted hazard ratios (aHRs) for the development of incident IBD.

Results

In total, 163,563 statin users were matched to 163,563 non-statin users during each iteration. The overall cohort was predominantly male (56.2%), aged between 50-69 years old (63.5%), and primarily met criteria for statin consideration due to the presence of hypertension in the setting of an elevated low-density lipoprotein (51.9%). Overall, statin users did not have a lower risk of developing IBD compared to non-users (aHR 0.88, 95% CI 0.74-1.04), with subgroup analysis demonstrating that this effect held true for both UC (aHR 0.86, 95% CI 0.70-1.05) and CD (aHR 0.95, 95% CI 0.70-1.28; Table 1; Figure 1). Sensitivity analysis where statin users were censored at the time of treatment discontinuation suggested a possible benefit for the development of UC (aHR 0.78, 95%CI 0.61-1.00), though this was not statistically significant.

Conclusion

In the largest and first nationwide new-user designed cohort study, statin use—prescribed in individuals ≥40 years for the primary prevention of cardiovascular disease—was not associated with a reduced risk of developing UC or CD. This contrasts with findings from smaller, previous case-control studies, however our data suggest that ongoing use may possibly be protective for the later development of UC.
P1199 Early life exposures predict childhood-onset IBD in a population-based cohort
Authors: Agrawal M , Hansen A V , Colombel J F , Allin K H , Jess T
Published: January 2025

Background

While many early life exposures have been associated with IBD, prediction of risk based on these variables is not yet available. Therefore, we developed and validated a prediction model for IBD based on early life exposures.

Methods

We conducted a nationwide population-based cohort study leveraging cross-linked Danish registers consisting of all liveborn singleton offspring in the Danish National Birth Cohort with available data on early life exposures based on the first four DNBC interviews (weeks 12 and 30 of pregnancy, 6 months, and 18 months of offspring age), who were alive and residents of Denmark until at least 18 months of age. Follow up was until IBD diagnoses (based on primary and secondary diagnoses codes in the National Patient Register), emigration, death or end of the study period, September 1, 2022. We used elastic net with underlying Cox regression model to predict IBD diagnosis at ≤14 and >14 years of age.

Results

A total of 50,592 offspring were included in the study for a median (IQR) of 21.8 (20.4, 22.9) years. Of these, 310 (0.6%) persons were diagnosed with IBD during follow-up. Early life risk factors were predictive of IBD risk at ≤14 years of age but not later in life [Harrell’s C statistic (SE) 0.72 (0.018) and 0.52 (0.004), respectively]. All of the 74 variable terms considered for inclusion were included in the final model, with the five most important being parental IBD, number of infection episodes age 6-18 months, household mammal pets (protective), number of infection episodes age 0-6 months, and antibiotics exposure age 6-18 months. The cumulative incidence of IBD at age 14 years of age was 0.66% (95% CI 0.49-0.84) among those in the highest 5% for predicted risk, and 0.09 % (95% CI 0.075-0.01) for those in the lowest 95% (Figure).

Conclusion

In a nationwide cohort with long-term follow up data, early life exposures were predictive of childhood-onset IBD, but not later in life. This model warrants validation and could potentially be used to determine IBD risk in children towards prevention strategies.
P1207 Therapy goals and Quality of Life among older patients with Inflammatory Bowel Disease: results of an international EFCCA survey
Authors: Fons A , Girardi P , Savini C , Maljaars J , Haaf I , Avedano L , Asscher V
Published: January 2025

Background

The number of older patients with Inflammatory Bowel Disease (IBD) is rapidly growing, however they are underrepresented in research. To enhance more personalized and patient-centered care, it is important to study the disease burden and therapy goals of this population. Therefore, the aim of this study was to explore prioritized therapy goals, clusters of therapy goals and determinants of quality of life (QoL) in older patients with IBD.

Methods

This was an international, anonymous, online survey in older patients (age ≥ 60 years) with IBD, proposed and conducted by the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA), between May 2023 and November 2023. Patients were asked to select three out of twelve pre-specified therapy goals. A cluster analysis was performed to identify patterns or combinations of therapy goals that were reported together, using a binary distance and an agglomerative clustering algorithm. QoL was assessed by one question about general well-being (five-point Likert scale). We assessed the influence of the therapy goal clusters on QoL by an ordinal regression model adjusting for common confounders.

Results

Of 1997 included respondents from 34 countries, with a median age of 66 years (IQR 63-71), 297 (14.8%) reported poor-terrible QoL. Older patients with IBD most often prioritized therapy goals related to decreasing fatigue (56%), preserving/restoring a good mood (43%) and decrease diarrhea/incontinence (32%). Six clusters of therapy goals were identified and labelled: 1 - Inflammation control, 2 - IBD-symptom control, 3 - Mobility capacity, 4 - Bodily perception, 5 - Mood and energy, 6 - Activity engagement. The proportion of patients with very well QoL was highest in cluster 6 (60%) and the lowest in cluster 2 (17%). Low QoL was independently associated with therapy goal clusters related to Inflammation control (adjusted Odds Ratio (aOR) 1.86 95% confidence interval (95%CI): 1.24-2.77), IBD-symptom control (aOR: 3.19, 95%CI: 2.13-4.79), Mobility capacity (aOR: 2.14, 95%CI: 1.41-3.24) and Mood and energy (aOR: 1.82, 95%CI: 1.19-2.78), compared to the Activity engagement cluster.

Conclusion

Older patients with IBD prioritize therapy goals focused on reducing fatigue, improving mood and decreasing diarrhea/incontinence. Low QoL was significantly associated with therapy goal clusters emphasizing inflammation control, IBD symptoms, mobility, and mood/energy. These results are indicative for the need to evaluate the QoL in older patients with IBD in the context of their therapy goals.
P1212 Effectiveness of Vedolizumab to Reduce Bowel Urgency in a Canadian Real-World Ulcerative Colitis Cohort
Authors: Battat R , Leung Y , Tandon P , Ward R , Wadhwa A , Power S , Weiss J , Moulson R , Pettengell C , Feagan B G
Published: January 2025

Background

Vedolizumab is a gut-selective anti-lymphocyte trafficking drug indicated for the treatment of moderately to severely active ulcerative colitis (UC). Bowel urgency, the immediate or sudden need to have a bowel movement, is a common symptom in UC, that reduces quality of life. We are assessing this emerging and important patient-reported outcome among patients treated with vedolizumab in a real-world cohort.

Methods

This is a retrospective, non-interventional study using data collected as part of the Canadian Takeda Patient Support Program (PSP). Included patients were aged ≥18 years at vedolizumab initiation, consented to secondary use of data and had moderately to severely active UC with an Urgency Numeric Rating Scale (UNRS) score available at baseline. We report the point and percentage reduction from baseline in UNRS 6 weeks following vedolizumab initiation and the association between bowel urgency clinically meaningful improvement (CMI) and clinical remission and response at Week 6, among UC patients with UNRS ≥3 at baseline. Bowel urgency CMI was defined as change from baseline UNRS ≥3 in patients with UNRS ≥3 at treatment baseline. Clinical response was defined as partial Mayo score (pMayo) decrease of ≥2 points and ≥25% from baseline, remission was defined as a score <3. Association between bowel urgency and clinical outcomes was assessed using Fisher’s exact and chi-squared tests with significance specified by a two-sided p-value of <0.05.

Results

87 patients with UC (84% bio-naïve) were eligible. Median age was 44 years (Q1, Q3: 32, 60) and 54% of patients were female. Median baseline UNRS was 7 (Q1, Q3: 3, 8), median pMayo was 7 (Q1, Q3: 6, 8). Disease duration prior to vedolizumab was 5 years (Q1, Q3: 1, 14). Overall, patients with baseline UNRS ≥3 (83% of patients) experienced a median reduction of 3 points from baseline to Week 6 (IQR: 2–8), equating to 60% reduction from baseline (IQR: 20, 100) (Table 1). At 2 and 6 weeks, 39% and 61% of patients experienced bowel urgency CMI, respectively. Notably, there was a significant association between bowel urgency CMI at Week 6 and clinical outcomes (Table 2): patients in bowel urgency CMI were more likely to be in remission when compared to those not in bowel urgency CMI (68% vs. 35%, p=0.009), and more likely to be in response (95% vs. 73%, p=0.023).

Conclusion

Following 6 weeks of vedolizumab induction treatment, bowel urgency decreased from baseline by 60% in patients with moderate to severe UC. Furthermore, bowel urgency CMI was significantly associated with improved clinical outcomes. This study demonstrated the effectiveness of vedolizumab in early reduction of bowel urgency among a real-world cohort of Canadian patients.
P1217 Epidemiology and Temporal Trends of IBD in Central Taiwan
Authors: Chen Y Y , Huang C W , Chou J W , Yen H H
Published: January 2025

Background

Inflammatory Bowel Disease (IBD), as a chronic inflammatory disease of the gastrointestinal tract, encompasses Crohn's disease (CD) and ulcerative colitis (UC). With industrialization and advancements in healthcare, the prevalence of IBD in Taiwan is on the rise.

Methods

This study collected data from 593 IBD patients treated at Changhua Christian Hospital and China Medical University Hospital, analyzing the epidemiology of IBD in central Taiwan.

Results

The cohort included 200 CD and 393 UC patients, with an average age of 40.62 ± 15.08. CD exhibited a higher male proportion than UC (72.50% vs. 62.09%, p = .012). CD patients also had higher rates of appendectomy, bowel resection, and perianal disease surgery before IBD diagnosis, along with increased use of steroids, immunosuppressants, and biologics compared to UC. Over time, Taiwan's UC to CD ratio decreased (≦2005: 2.50; 2006-2015:2.06; 2016-2023:1.76), and CD's L2 location and B3 behavior proportions also declined. The proportion of the UC patients with location E1 was increased.

Conclusion

Taiwan's IBD population mimics patterns observed in high-income countries, with a declining UC to CD ratio. The reduced L2 location and B3 behavior in CD and suggest improved diagnostic awareness and more comprehensive colonoscopy examinations in Taiwan.

References

1.Sairenji T, Collins KL, Evans DV. An Update on Inflammatory Bowel Disease. Prim Care. Dec 2017;44(4):673-692. doi:10.1016/j.pop.2017.07.010

2.The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. Jan 2020;5(1):17-30. doi:10.1016/s2468-1253(19)30333-4

3.Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open. Mar 28 2023;13(3):e065186. doi:10.1136/bmjopen-2022-065186

4.Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. Dec 23 2017;390(10114):2769-2778. doi:10.1016/s0140-6736(17)32448-0
P1219 Late onset inflammatory bowel disease (IBD): Experience from two tertiary centers in Greece
Authors: Ioannou A , Theocharis G , Geramoutsos G , Sotiropoulos C , Koumentakis C , Leonidakis G , Pardalis P , Pantelakis E , Thomopoulos K , Michopoulos S , Zampeli E
Published: January 2025

Background

The incidence of IBD in the elderly has increased in recent years1. Aim of the study was the reporting of disease and patient characteristics when IBD diagnosis was set after 60 years.

Methods

Data were retrieved retrospectively from patients’ medical records and included demographics, disease phenotype, types of treatment and mortality.

Results

Of 1017 registered patients, 133 were diagnosed ≥60 years (13.08%). 87 (65.4%) men, mean age at diagnosis 67.7 years (range 61-83). 74 with Crohn's disease (CD) (55.6%): 34 (45.9%) ileal disease (L1), 22 (29.7%) ileocolic (L3), 18 (24.3%) colonic disease (L2). 68 (91.9%) patients had inflammatory phenotype and 6 (8.1%) perianal disease. Of 59 patients with ulcerative colitis (UC), 30 (50.8%) had extensive disease (E3), 24 (40.7%) left sided colitis (E2) and 5 (8.5%) proctitis (E1). 57 (42.9%) patients were treated with mesalamine. 76 patients (57.1%) required biologic therapy: 25 (32.9%) anti-TNFs, 30 (39.5%) vedolizumab and 21(27.6%) ustekinumab. 27 (20.3%) patients underwent surgery for the disease. Co-morbidities: 74 patients (55.6%) suffered with arterial hypertension, 42 (31.5%) dyslipidemia, 33 (24.8%) diabetes mellitus and 19 (14.2%) coronary heart disease. Between the years 2014 - 2024 12 patients were deceased [8M/4F, median age 75.8 years (R65-85)]. 7 with ulcerative colitis (UC) and 5 with CD. The mortality rate in this population was 1.17%. The registered causes of death were: 5/12 (41.7%) malignancy, 4/12 (33.4%) cardiac events, 1/12 (8.3%) infection, 1/12 (8.3%) gastrointestinal cancer and 1/12 (8.3%) other causes.

Conclusion

1) Less than 15% of patients were diagnosed with IBD after 60 years in a population from two tertiary centers 2) The majority required biologic therapy. 3) Mesalamine and vedolizumab were the most frequently administered drugs. 4) One fifth required surgery for their disease. 5) Co-morbidities were recorded in almost all cases. 6)Mortality rate was relatively low and the two leading causes of death were malignancies and cardiovascular events.

References

1.Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther. 2016 Feb 6;7(1):51-65. doi: 10.4292/wjgpt.v7.i1.51. PMID: 26855812; PMCID: PMC4734955.
P1220 Circulating Metabolite Signatures Linking Physical Activity to Inflammatory Bowel Disease Risk and Interactions with Genetic Susceptibility
Authors: He Z , Sun Y , Huang H , Fu T , Yuan S , Larsson S C , Ludvigsson J F , Wang X , Magro F , Bai Y , Chen J
Published: January 2025

Background

Recent studies have demonstrated the protective effect of physical activity on incident IBD, but the underlying mechanism remain unclear. Here, large-scale circulating metabolomics data was used to identify a metabolic signature reflecting moderate-to-vigorous physical activity (MVPA). We then investigated whether this signature mediated the association between MVPA and inflammatory bowel diseases (IBD) risk and how genetic susceptibility to IBD played roles in the association.

Methods

The present study was conducted in two prospective cohorts: the UK Biobank (n=194,292 for prospective analysis, n=12,766 for identification of the metabolic signature) and the Whitehall II study (n=5,925 for validation of the metabolic signature). MVPA in minutes per day was assessed by questionnaires and the circulating metabolome was profiled using a high-throughput nuclear magnetic resonance (NMR)-based platform. Associations between MVPA and individual metabolites were assessed using multivariable linear models and the MVPA-related metabolic signature was identified using elastic net regression. The primary analyses evaluated the prospective associations between MVPA/metabolic signature and incident IBD using multivariable Cox proportional hazards regression, and further examined the mediation role of the metabolic signature and the interaction with genetic susceptibility to IBD.

Results

We identified 100 metabolites significantly associated with MVPA, with a combination of 25 metabolites selected comprising the metabolic signature. During a mean follow-up of 13.3 years, 1,259 incident IBD cases were documented. Both MVPA and metabolic signature were associated with reduced incident IBD, with hazard ratio [HR] of 0.77 (95%CI, 0.66-0.90) and 0.60 (95%CI, 0.51- 0.71) for highest quartile vs. lowest quartile, respectively. The MVPA-related metabolic signature mediated 15.2% of the inverse association between MVPA and IBD risk. Participants with low MVPA/ metabolic signature and high genetic risk showed the highest IBD incidence, with both additive and multiplicative interactions observed.

Conclusion

The identified metabolic signature reflecting MVPA was found to mediate the inverse association between MPVA and incident IBD. Measuring a specific set of metabolites representative of MVPA, together with genetic susceptibility, may identify individuals with higher risk of IBD.
P1221 Microscopic colitis and risk of venous thromboembolism: A nationwide matched cohort study
Authors: Forss MD PhD A , Bröms G , Bergman D , Thuresson M , Sun J , Eriksson C , Olén O , Zöller B , Ludvigsson J F
Published: January 2025

Background

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, have been associated with an increased risk of venous thromboembolism (VTE). However, data on VTE is lacking in large population-based cohorts of microscopic colitis (MC). We aimed to investigate the association between MC and VTE.

Methods

We included all Swedish adults (≥18 years) with MC without previous VTE (1990-2017, n=12,489, follow-up until 2021). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded colorectal histopathology reports from all 28 pathology departments in Sweden. MC patients were matched for age, sex, calendar year and county of residence with up to five reference individuals (n=55,809) without MC or previous VTE from the general population. Sensitivity analyses included full sibling comparisons and stricter definition of VTE requiring a primary diagnosis of VTE. Incidence rates and multivariable-adjusted hazard ratios (aHRs) with 95% confidence interval (CI) were calculated using Cox proportional hazards modelling.

Results

Over a median of 10.0 years of follow-up, 755 (6.0%; 11.3/1000 person-years [95%CI 10.5-12.1]) VTE events occurred in individuals with MC and 2674 (4.8%; 8.6/1000 person-years [8.3-8.9]) in reference individuals. Individuals with MC had a higher overall relative risk of any VTE event compared with reference individuals (aHR 1.21 [1.11-1.32]), including higher risk of pulmonary embolism (aHR 1.23 [1.08-1.40]), deep vein thrombosis of the legs (aHR 1.16 [1.03-1.32), and other VTE events (aHR 1.31 [1.08-1.58]). Compared to full siblings, individuals with MC showed numerically, but statistically non-significant, higher relative risk of VTE (aHR 1.15 [0.98-1.35]). Restricting the outcome definition to VTE diagnoses recorded as the primary diagnosis, the estimate of any VTE event was similar for MC overall (aHR 1.26 [1.15-1.39]). In the stratified analyses of VTE there were no major differences in sex, age group, follow-up time, year of MC diagnosis, country of birth, and presence/absence of celiac disease diagnosis at the index date.

Conclusion

In this population-based study, individuals with MC had a 21% higher risk of VTE compared with reference individuals from the general population, equal to one extra VTE event for every 37 MC individuals followed for ten years.
P1223 Maternal dietary patterns during pregnancy and offspring’s risk of paediatric Inflammatory Bowel Disease - a cohort study
Authors: Anneberg MSc O M R , Halldórsson Þ I , Olsen S F , Bjerregaard A A , Hansen A V , Jess T , De Freitas M B
Published: January 2025

Background

The association between maternal dietary patterns during pregnancy and offspring’s risk of paediatric-onset inflammatory bowel disease (pIBD) is largely unknown. Therefore, we explored this link in mother-child dyads from the Danish National Birth Cohort (DNBC).

Methods

The DNBC is a nationwide cohort of pregnant mothers from Denmark enrolled between 1996 and 2002. In gestational week 25, a food frequency questionnaire assessed maternal intakes of >360 foods during the previous four weeks. The foods were divided into 37 groups, and intakes of the food groups (g/day) were z-score normalised to make them comparable. K-means cluster analysis determined maternal dietary patterns by grouping mother-child dyads into mutually exclusive clusters based on maternal intakes of the 37 food groups. The children were followed from birth to their 18-year birthday through national patient registries using their personal identification number. Medical information from the registries was used to identify the children who developed pIBD, defined as ≤18 years of age when they received their first IBD diagnosis (n=182). Cox proportional hazards model analysed associations of maternal dietary patterns with offspring’s hazard ratios (HR) for pIBD, using the most common pattern as the reference. Analyses were adjusted for parental IBD diagnosis and maternal educational level, gestational weight gain, smoking, energy intake, nutritional supplement use, and antibiotics use.

Results

The study included 63,877 singleton mother-child dyads from the DNBC. K-means cluster analysis identified five dietary patterns among the mothers: a diverse dietary pattern (n=16,386), a Western-like dietary pattern (n=22,901), a plant-rich dietary pattern (n=17,541), an animal-based dietary pattern (n=4,473), and a non-recommended dietary pattern (n=2,576). Mothers with a diverse dietary pattern had high intakes of most food groups, especially meat, fish, vegetables, fruits, potatoes, desserts, and legumes. This dietary pattern reduced offspring’s risk of pIBD by 44% compared to the Western-like dietary pattern (HR 0.56; 95% CI: 0.35-0.91), which was attributed to a decreased risk of Crohn’s disease (HR 0.41; 95% CI: 0.22-0.76) but not ulcerative colitis (HR 0.73; 95% CI: 0.38-1.39). No associations with pIBD were found for the plant-rich, animal-based, and non-recommended dietary patterns compared to the Western-like dietary pattern (p > 0.05).

Conclusion

In this prospective cohort study, we found that adhering to a diverse diet during pregnancy, characterised by high intakes of various food groups, protects the offspring against pIBD. Future studies should explore whether specific food groups or nutrients drive this association.
P1224 Bidirectional association between sleep pattern and inflammatory bowel disease: a large population-based prospective cohort study
Authors: Le K , Liu Y , Bai R , Sheng J , Zhu J , Xie S , Ma D , Liu Z
Published: January 2025

Background

Disturbances in sleep have been associated with systemic inflammation and increased susceptibility to various chronic diseases. However, the specific mechanisms by which sleep influences plasma protein expression and contributes to the increased risk of inflammatory bowel disease (IBD) have not been fully elucidated.

Methods

We analysed data from 381,228 participants in the UK Biobank. Sleep was scored with chronotype, sleep duration, insomnia, and daytime sleepiness. Adjusted odds ratios (ORs) for prevalent IBD in unhealthy sleep patterns were estimated, as well as adjusted hazard ratios (HRs) for incident IBD by sleep patterns. A subset cohort of 40,392 participants was used for proteomic profiling, with differential expression analysis and weighted gene co-expression network analysis (WGCNA) conducted. A proteomic prognostic risk model was also established using the least absolute shrinkage and selection operator (LASSO)-Cox regression.

Results

Among the 381,228 participants in the clinical cohort, 100,622 (26.4%) had unhealthy sleep (sleep score 0-2) at baseline. Prevalent IBD was associated with increased odds of unhealthy sleep (OR = 1.250, 95% CI: 1.165-1.340, p < 0.001, Figure 1). Participants with unhealthy sleep had a higher risk of incident IBD (HR = 1.237, 95% CI: 1.136-1.348, p < 0.001). In the proteomic cohort, unhealthy sleep and IBD displayed 182 common differentially expressed proteins. Enrichment analysis revealed significant inflammatory pathways, including positive regulation of cytokine production and immune cell activation. WGCNA identified seven module eigengenes, with unhealthy sleep impacting IBD through cell activation and chemotaxis pathway and amino acid and organic acid metabolism. Incorporating protein biomarkers enhanced the performance of predicted models that achieved an AUC of 0.81 for predicting 2-year IBD onset. Unhealthy sleep participants with high protein scores were at high risk of incident IBD (HR=3.370, 95% CI: 2.300-4.938, p < 0.001), highlighting the importance of monitoring systemic inflammation.

Conclusion

Unhealthy sleep and IBD are bidirectionally linked, with inflammatory and metabolic proteins mediating the effect of poor sleep on IBD risk. Patients with sleep disturbances should be screened for inflammatory biomarkers to evaluate their IBD risk. Enhancing sleep quality may serve as an effective strategy for preventing and managing IBD.

References

Sleep disorders and inflammatory disease activity: chicken or the egg? Am J Gastroenterol. 2015 Apr;110(4):484-8.
P1234 Inflammatory Bowel Disease Trends and Advanced Therapy Utilization: Insights from the UAE
Authors: Ahmed H A , Swaid T K , Alzaabi M N , Khan S W , Ali A B A A , Tenaiji K S A A , Alahmad M A , Omar N M , Ahmed E F , Hosani I I A , Kumar K K C , Malik T A , Quraishi M N ,   SSMC
Published: January 2025

Background

The Middle East is experiencing a rapid increase in inflammatory bowel disease (IBD) likely due to urbanization, dietary changes and environmental factors. The region lacks sufficient data, making it challenging to comprehend the full extent of IBD's impact on healthcare systems. This research aims to investigate IBD trends, disease behaviour, evolution and persistence of advanced therapy (AT) within a predominantly Arab patient population in UAE.

Methods

This observational study at a tertiary IBD centre in the UAE utilized the local IBD registry (prospective data collection from 2022). Data included disease characteristics, and AT usage. Descriptive statistics, regression models and Kaplan-Meier analysis were employed.

Results

Of the 859 IBD patients treated from 2012 to 2024, comprehensive data were available for 321 patients under active follow-up of which 64.2% comprised of Crohn’s disease (CD) and 35.8% with ulcerative colitis (UC). A ten-fold rise over a 22-year period in new diagnoses of IBD, particularly CD was observed. Median age at diagnosis was 25 years (IQR 25-42), with CD patients younger (24 years) than UC patients (28 years). Within CD, 20% had stricturing, 17% penetrating and 36% with perianal disease. 85% of CD and 61% of UC patients were exposed to at least one AT; 25% of CD and 18% of UC patients >2 ATs, and 16% of CD and 11% of UC >3 ATs. Infliximab and adalimumab were the main first-line ATs, while ustekinumab and risankizumab used in later AT lines. Ustekinumab and risankizumab, showed higher AT persistence compared to anti-TNFs. In CD, stricturing disease (p<0.05), penetrating disease (p<0.01), longer disease duration (p<0.05), and younger age at diagnosis (p<0.05) were linked to higher exposure to AT lines. In UC, younger age at diagnosis (p=0.001) was associated with increased number of AT exposures. Use of AT significantly changed between 2017–2020 and 2021–2024 (p<0.001). Infliximab, adalimumab and vedolizumab were initially the most prevalent, with ustekinumab, risankizumab, and upadacitinib usage rising substantially by 2022. The time to initiate AT for CD and UC following diagnosis decreased significantly since 2017 by 6.82 and 6.91 months per year, respectively (p<0.001), with a combined median time of 2.46 months (IQR 4.8) for CD for 2023-2024.

Conclusion

This is the first comprehensive evaluation of IBD in the UAE, highlighting a significant rise in new diagnoses, particularly CD with aggressive phenotypes, reflecting broader regional trends. AT utilization has evolved, with ustekinumab and risankizumab demonstrating better persistence and increasing adoption. These insights into disease patterns will help inform future regional healthcare policies.
P1235 COlombian PrevaLence of Extraintestinal Manifestations in Inflammatory bowel disease in an adult and pediatric cohort after evaluation by a multidisciplinary group COLEMI – study
Authors: Parra Izquierdo V , Frías-Ordoñez J , Puentes-Manosalva F , Sarmiento F , Garcia-Duperly R , Vargas M , Reyes G , Florez-Sarmiento C , Lobaton T
Published: January 2025

Background

Inflammatory Bowel Disease (IBD) is increasingly recognized as a systemic disorder, given its high prevalence of extra-intestinal manifestations (EIM) affecting various organs. The frequency of these manifestations varies depending on factors such as geographical region, IBD subtype, disease location, disease duration, and the timeliness of diagnosis, yet data on this topic remain limited in Latin America. This study aimed to assess the prevalence of the primary EIMs in IBD patients in Colombia, as well as to examine differences between Crohn's disease (CD) and ulcerative colitis (UC).

Methods

Prospective observational descriptive multicenter study in adult and pediatric patients with IBD of the Colombian IBD Foundation, with suspicious of EIM and after confirmed with by a multidisciplinary group in Colombia.

Results

A total of 266 out of 482 (55.1%) patients with inflammatory bowel disease (IBD) were suspected of having extra-intestinal manifestations (EIM) by their gastroenterologists, of which 197 (74.1%) were confirmed upon evaluation by a multidisciplinary team, resulting in an EIM prevalence of 40.9%, with a predominance of female patients (67.5%). Of the cohort, 95% were adults and 5% were pediatric patients, with 134/197 (68%) diagnosed with ulcerative colitis (UC) and 63/197 (32%) with Crohn's disease (CD), 49.2% of whom required biologic therapy. In UC patients, extensive colitis (E3) was the most common disease extension, while ileo-colonic (L3) involvement predominated in CD. The most frequent types of EIM were articular (36%), followed by cutaneous (34.5%) and ocular (24.9%) manifestations. The hospitalization rate due to IBD was 72.5%, with EIM present in 37.5% of UC patients and 52.5% of CD patients (Figure 1). Hepatobiliary manifestations (odds ratio [OR] = 1.931; 95% confidence interval [CI] 0.4311-13.66, p=0.44) were more common in UC compared to CD, whereas articular (OR=2.277; 95% CI 1.228-4.22), cutaneous (OR=1.027; 95% CI 0.5474-1.925), oral (OR=2.017; 95% CI 0.8727-4.661), and ocular (OR=2.683; 95% CI 1.374-5.23) manifestations were more frequent in CD (Figure 1). In terms of the number of EIMs, 71.5% of UC patients had one, 16% had two, and 12.5% had three or more, while in CD, 50.7% had one, 27% had two, and 22.2% had three or more. A higher prevalence of EIM was observed in the central region of the country (Figure 2).

Conclusion

The prevalence of EIM in this Colombian cohort was high (40,9%), predominating the CD, female, extensive disease and higher requirement for biologicals.
P1240 Overweight in patients with inflammatory bowel disease and the associated risk of malnutrition
Authors: Suarez Ferrer C J , Cubillo Garcia C , Garcia-Rojas Pleite C , Rueda Garcia J L , Martin Arraz E , Sanchez Azofra M , Poza Cordon J , Garcia Ramirez L , Noci Belda J , Martin-Arranz M D
Published: January 2025

Background

Although inflammatory bowel disease(IBD) has traditionally been associated with malnutrition,the prevalence of overweight(0W)and obesity is currently increasing.Moreover, both overweight and chronic inflammation can elevate the risk of essential micronutrient deficiencies.The objective of this study is to investigate the prevalence of OW in a cohort of IBD patients and the associated risk of nutritional deficiencies

Methods

This is a cross-sectional study that consecutively included patients attending the day hospital for intravenous biologic that didn’t fulfill exclusion criteria (e.g. short bowel syndrome or oral nutritional supplements).All patients underwent weight and height measurements,assessment of IBD clinical activity (Harvey-Bradshaw Index[HBI] for Crohn's disease and Walmsley Index[WI] for ulcerative colitis and completion of the MUST(Malnutrition Universal Screening Tool) questionnaire. A blood test was also performed to obtain a comprehensive nutritional profile, and fecal calprotectin(FC)levels were measured

Results

A total of 93 patients were included. Baseline characteristics are summarized in TABLE 1.Regarding body mass index(BMI), 2 patients(2.5%) had a BMI below 18.5, 45 (57%) were classified as normal weight(BMI 18.5-25), and 32 (40.5%) were OW(BMI over 25). No differences were found in clinical activity ( HBI or WI) between OW and normal-weight patients(p=0.75 and p=0.57, respectively).However, a lower mean FC level was observed in overweight patients(166.2 µg/g vs. 445.1 µg/g),though this difference did not reach statistical significance(p=0.18).Similarly, no significant differences in C-reactive protein levels were observed between the two groups(5.13 mg/L vs. 2.6 mg/L; p=0.09).There were also no differences in the type of IBD, disease location or the line of biologic treatment among patients with or without OW. OW IBD patients showed a statistically significant association with higher levels of prealbumin, hemoglobin, triglycerides, and ferritin.No greater micronutrient deficiencies were identified in overweight patients compared to those with normal weight. The laboratory profiles of both groups are summarized in TABLE 2.Regarding the risk of malnutrition, using the self-completed portion of the MUST questionnaire to minimize potential BMI bias, it was identified that only 20% of patients with intermediate/high risk of malnutrition were OW(p=0.04) ( vs normal-weight patients; p=0.04)

Conclusion

OW is common in IBD patients,even among those with active inflammation and refractory response to advanced treatments. In our experience,OW IBD patients do not exhibit greater micronutrient deficiencies compared to normal-weight patients,though they do present characteristic laboratory alterations associated with OW
P1241 Identification and characterization of patients with Crohn's disease and complex perianal fistulas using Natural Language Processing and machine learning: INTUITION-CPF Study.
Authors: García-Olmo D , Chaparro M , Marquez Mosquera L , González Argenté- F J , Perez Calle J L , Tomé Pizarro M , Aparicio J , Montoto C , Sánchez Guillén L , P Gisbert J
Published: January 2025

Background

Crohn’s disease (CD) is an inflammatory condition that can cause perianal fistulas (mostly complex), affecting 26-35% of CD patients. There is no gold-standard treatment for perianal disease, leading to significant unmet needs. This study uses Artificial Intelligence (AI) to analyze electronic medical records (EMRs) to identify and characterize CD patients with complex perianal fistulas (CPF). It offers an overview of patient characteristics, treatment patterns, and CPF incidence in CD patients attending inflammatory bowel disease units in Spain.

Methods

INTUITION-CPF is a national, multicenter, retrospective study. EMRs of patients with CD, diagnosed or not with CPF (overall CD population) from January 2015-December 2021, were reviewed and processed using an AI analysis based on machine learning and Natural Language Processing (NLP). There were two phases in the study. Phase 1: NLP-identified patients with CD+CPF were manually validated to assess sensitivity and specificity; and Phase 2: characteristics, treatments and visits to departments were analysed in eligible patients with CD+/-CPF. Here, we present results from the phase 2.

Results

A total of 2,182 patients with CD were identified. Median age (range) was 51 years (21-105). 263 patients (12%) suffered from CPF, of which 70% experienced pain, 48% active (suppurative) disease, and 28% perianal abscesses. The estimated annual incidence of CPF among CD patients was 1.6%.

Patients with CD+CPF had more medical treatments (91%) compared to overall CD patients (74%). Proportion of patients receiving biologics was near double for CD+CPF compared to overall CD patients (41% vs 21%) with infliximab the most frequently used (26%) (Table 1). 13% of the overall CD population had ≥1 surgery, compared with 36% of patients with CD+CPF. The main surgeries in patients with CD+CPF included seton placement (14%), advancement flap surgery (FLAP) (16%) and ostomy (13%) (Table 1).

Hospitalisation (≥24h) was required for 49% of overall CD patients vs 64% of those with CPF. Gastroenterology (73%) was the most frequently visited department, followed by surgery (31%) and emergency departments (27%) (Figure 1).

Conclusion

This study demonstrates that CD patients with CPF require more complex and multidisciplinary management, including more biological treatments and surgeries, and exhibit higher hospitalization and emergency visit rates compared to overall CD patients.Inconsistencies with the existing literature highlight the opportunity to further enhance NLP techniques to achieve more accurate outcomes.
P1243 Extraintestinal Manifestations in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study in Taiwan
Authors: Kuo T H , Tsai M J , Chou J W , Lai H C , Wu Y H , Huang P J , Cheng K S
Published: January 2025

Background

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), is rare in Taiwan. There are also few reports on the the prevalence rate of extraintestinal manifestations (EIMs) in IBD. This study aimed to assess the risk of EIMs in patients with IBD and examine the relationship between the timing of IBD diagnosis and EIM onset.

Methods

We conducted a retrospective cohort study using administrative data from the Taiwan National Health Insurance Research Database and Registry for Catastrophic Illness Patients Database from 2013 to 2021. The index date for the cohort was defined as the date of the first recorded IBD diagnosis. EIM diagnoses were identified in the health registry using the appropriate International Classification of Diseases 9 and 10 codes. The selection of EIMs refers to 2024 European Crohn's and Colitis Organisation (ECCO) guidelines, of which include uveitis, scleritis, episcleritis, Oral manifestations, PSC, AIH, spondyloarthropathy with axial/non-axial, pyoderma, gangrenosum, erythema nodosum, and Sweet syndrome1. We calculated the mean and median time of EIM onset relative to IBD and categorizing EIMs as occurring either before or after IBD onset.

Results

The study included 1,774 IBD patients. The incidence rate (IR) of EIMs in IBD patients was 1.167 per 100 persons/years from 2013 to 2021. The highest IR was 2.105 in 2013, and the lowest was 0.357 in 2021. The rate of EIMs development among IBD patients during the follow-up period from 2013 to 2019. Pyoderma had the highest IR at 0.846 per 100 persons/year, followed by primary sclerosing cholangitis at 0.733 per 100 persons/years, oral mucosa lesion at 0.733 per 100 people and ankylosing spondylitis at 0.564 per 100 persons/years (table1). Our analysis showed that EIMs appeared an average of 2.08 years after IBD diagnosis (median 1.48 years) and 5.50 years before IBD diagnosis (median 5.46 years).

Conclusion

We firstly reported the EIM risk by 1.167 per 100 persons/years in a relative low prevalence country. However, some classical EIMs mentioned in the 2024 ECCO guidelines do not occur as frequently among IBD patients in Taiwan as expected. We still need further investigation in this issue. We can extend the follow-up period to collect more data, which will allow us to reach a more solid and reliable conclusion.

References

1.Gordon H, Burisch J, Ellul P, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024;18:1-37. doi:10.1093/ecco-jcc/jjad108.
P1244 Differential impact of appendectomy with appendiceal inflammation versus no inflammation on inflammatory bowel disease risk in a population-based cohort
Authors: Agrawal M , Hansen A V , Harpaz N , Colombel J F , Jess T , Allin K H
Published: January 2025

Background

The appendix is implicated in inflammatory bowel disease (IBD) risk. However, the relationship of appendectomy for appendicitis versus other indications, when the appendix is not inflamed, with IBD onset is ambiguous. We conducted a population-based cohort study to explore the risk of ulcerative colitis (UC) and Crohn’s disease (CD) following appendectomy of the inflamed appendix and removal of the uninflamed appendix for other indications.

Methods

We conducted a matched cohort study where all individuals with appendectomy in the Danish National Patient Register between January 1997 and August 2022 were matched 1:10 by sex, year of birth and municipality of residence at the time of appendectomy to individuals without appendectomy. Study participants were excluded if they were not residents of Denmark for at least two years prior to the index date. Based on cross-linked data from the Danish Pathology Register, we categorized appendectomy cases into those with and without appendiceal inflammation. Follow up started 180 days after appendectomy until IBD diagnosis, based on primary and secondary diagnoses codes in the National Patient Register, emigration, death or end of the study period, whichever came first. We used Cox proportional hazards regression to calculate the hazard ratios and 95% confidence interval for outcomes UC and CD, in appendectomy cases with and without appendiceal inflammation, compared to individuals without appendectomy after adjusting for age at appendectomy (index date), sex, calendar year, urbanization, and municipal-level socioeconomic index.

Results

A total of 145,147 individuals who underwent appendectomy and 1,451,470 individuals without appendectomy were followed for a median of 12 (IQR 6,19) years. Of all individuals with appendiceal inflammation, no appendiceal inflammation, and individuals without appendectomy, 308, 149 and 6,052 were diagnosed with UC, and 336, 191 and 3,166 with CD, respectively, during follow up. Kaplan Meier curves are demonstrated in the Figure. The adjusted hazard ratio (95% CI) for UC among those with and without appendiceal inflammation, compared to individuals without appendectomy, was 0.65 (0.58 - 0.73) and 1.26 (1.06 - 1.50), respectively. Corresponding estimates for CD were 1.33 (1.19 - 1.50) and 3.13 (2.65 - 3.69), respectively.

Conclusion

In a nationwide cohort with long-term follow up data, appendectomy following appendiceal inflammation was protective against UC while appendectomy following no inflammation was associated with increase in UC risk. Appendectomy, irrespective of appendiceal inflammation, was associated with CD risk.