bluuebunny/crossref_metadata_2025 huggingface dataset:
P1121 The risk of inflammatory bowel disease following serious infectious mononucleosis: A Danish nested case-control study
Authors: Harper S , Ebert A , Mitchell W , Elmahdi R
Published: January 2024

Background

Epstein-Barr virus (EBV) infects ~95% of adults globally and limited early life transmission opportunities can delay EBV exposure till adolescence/early adulthood, increasing the risk of severe EBV infection, which most commonly manifests as infectious mononucleosis (IM). This study sought to investigate a potential aetiological association between IM and inflammatory bowel disease (IBD).

Methods

In this longitudinal nested case-control study, Danish nationwide registries were used to identify 37,156 IBD patients and 222,936 sex- and age-matched healthy controls, between 2005-2021. Logistic regression was used to calculate the odds ratio (OR) for IM hospitalisation prior to IBD diagnosis stratified by sex, age at IM diagnosis, age at IBD diagnosis, and IBD subtype (Crohn’s disease [CD] or ulcerative colitis [UC]). Additionally, exposure-controlled time-to-event analyses were used to explore the association between IM hospitalization and poor IBD prognosis. This association was measured using the occurrence of IBD-related hospitalization, surgery, complication and/or anti-TNF therapy commencement up to 10 years post-IBD diagnosis.

Results

Previous IM hospitalisation was significantly associated with the development of both CD (OR: 1.44, 95% CI: 1.20-1.73) and UC (OR: 1.27, 95% CI: 1.09-1.47). Sex was not found to be a significant effect modifier of this association for either CD (p=0.4) or UC (p=0.9). Those hospitalised with IM at a younger age had a higher odd of developing CD than those hospitalised in early adulthood (0-14-years OR: 2.60 [95% CI: 1.41-4.59]; >20-years OR: 2.04 [95% CI: 1.23-3.25]). A similar pattern was observed for UC development (0-14-years OR: 2.62 [95% CI: 1.44-4.55]; >20-years OR: 1.50 [95% CI: 0.97-2.25]). Poor disease prognosis following hospitalisation with IM within 10 years post-IBD diagnosis was only seen in CD (CD IRR: 1.52 [95% CI: 1.20-1.92]; UC IRR: 0.87 [95% CI: 0.65-1.16]).

Conclusion

This study demonstrated an association between IBD development and prior hospitalisation with IM, indicating the possibility of EBV infection as a significant contributor to IBD development. Strengthening understanding of IBD development can contribute to the prevention of IBD and improve management.
P1125 Incidence and Neoplastic Risk Associated with Colonic Stricture in Pediatric-Onset Crohn's Disease: A Population-based Study
Authors: Richard N , Leroyer A , Dupont C , Turck D , Bertrand V , Wils P , Gower-Rousseau C , Guillon N , Savoye G , Ley D , Sarter H , Fumery M
Published: January 2024

Background

The identification of colonic stricture in patients with Crohn's disease (CD) often leads to surgery due to concerns about associated neoplasia. Nevertheless, information regarding the neoplastic risk associated to colonic stricture is still limited. The objective of this study was to assess both the incidence of colonic stricture in pediatric-onset CD and the associated neoplastic risk at the population-based level.

Methods

All patients diagnosed with CD before age 17 between 1988 and 2011, and included in a population-based registry, were followed until 2013. Colonic stricture was defined as a narrowing of the digestive lumen observed on endoscopic or radiological examination. Excluded were stricture in the ileocaecal valve, anal canal, or low rectum. Univariate risk factors for colonic stricture were explored using Cox proportional hazards models with time-dependent variables, and a multivariable Cox model analysis was performed.

Results

A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median age at diagnosis was 14.5 years [IQR: 12.0-16.1]. Throughout the follow-up period (median follow-up, 8.8 years [4.6-14.2]), patients were predominantly exposed to 5-aminosalicylates (88.1%), immunosuppressants (70.6%), and biologics (47.9%). Colonic stricture was diagnosed in 52 patients, including 11 at CD diagnosis. The cumulative incidence of colonic stricture in CD was 2.9% [1.8%-4.0%] at 5 years. The overall incidence rate of colonic stricture in CD was 5.4 cases/1000 person-years, 95% CI [4.1-7.1]. In multivariable analysis, an increased risk of colonic stricture was observed during periods of active disease (HR = 2.62, [1.40-4.89], p<0.01). Conversely, the absence of colonic involvement at diagnosis (HR = 0.18, [0.04, 0.80], p<0.05) or treatment with aminosalicylates (HR = 0.39, [0.19-0.79], p<0.05) was associated with a lower risk of colonic stricture. After a median follow-up of 6.4 [2.4-12.7] years, colonic stricture surgical resection was performed in 29 patients (55.8%). Colon adenocarcinoma was detected in one patient (1.9%) within 6 months after the diagnosis of colonic stricture.

Conclusion

In this population-based study of pediatric-onset Crohn's disease, 52 patients (5%) experienced colonic stricture, with a 2.9% incidence rate observed after 5 years of follow-up. Additionally, one patient (2%) presented with an associated adenocarcinoma.
P1157 Burden of herpes zoster in patients with inflammatory bowel disease treated with immunosuppressive agents
Authors: Chan P , Jorga A , Caldera F , Powell N , Yun H
Published: January 2024

Background

Patients with inflammatory bowel disease (IBD) are at increased risk of infections such as herpes zoster (HZ) due to immunosuppressive (IS) therapy. We conducted a targeted literature review to identify the burden of HZ in patients with IBD treated with IS agents.

Methods

We conducted a PubMed search to collate publications reporting on HZ in patients with IBD receiving IS treatment (from 01/01/2013 to 01/11/2023; excluding preclinical studies, narrative reviews and case reports). Findings were supplemented with a second PubMed search specific to paediatric patients with IBD (aged ≤18 years). Additional publications were included based on authors’ expertise as well as relevant abstracts presented at ECCO and DDW in 2022 and 2023.

Results

Overall, 178 publications were identified and 77 were included, along with ten recent congress abstracts. The most common IS treatments were Janus kinase inhibitors (JAKi), including tofacitinib and upadacitinib, followed by tumour necrosis factor inhibitors (TNFi). Additional treatments included anti-interleukin (IL)-23 agents (risankizumab, ustekinumab, mirikizumab) and sphingosine-1-phosphate (S1P) receptor modulators (etrasimod, ozanimod). HZ incidence rates are typically higher in patients with IBD compared with non-IBD populations (7.02–18.34 vs 3.22–11.29 per 1000 patient years, respectively). In paediatric patients, incidence rates are as high as 8.49/1000 patient years, with a standardised incidence ratio of 3.38 compared with the general population. Two studies reported a significant association between IBD and risk of hospitalisation for HZ in children and adolescents. Patients with IBD aged <50 years may have higher incidence of HZ compared with those aged >60 years without IBD. Risk factors for HZ in IBD patients include older age, lower weight, geographic region, prior TNFi failure and use, dose, and combination of IS medications. Increased incidence of HZ is associated with IS medication, particularly JAKis. Limited data exists on novel anti IL-23 agents and S1P receptor modulators, with some studies reporting a similar risk of HZ in treated patients compared with placebo, and others reporting an increased risk. HZ-related discontinuation is rare. Vaccination can reduce the risk of HZ in treated IBD populations, and studies have identified areas to improve vaccination adherence.

Conclusion

Patients with IBD of all ages, but specifically those aged <50 years, are at higher risk of HZ compared with non-IBD cohorts, and IS medications contribute to this risk. Vaccination against HZ prior to initiating IS treatment could benefit patients with IBD.
P1182 What has changed in Inflammatory Bowel Disease during last three decades?
Authors: Altın S , Kemeç G , Kayıkçı K , Deniz D , Çelik A O , İstemihan Z , Nuriyev K , Rüstamzade A , Genç S , Cavus B , Çifcibaşı Örmeci A , Akyüz F , Demir K , Beşışık F , Kaymakoğlu S
Published: January 2024

Background

With its increasing incidence, IBD varies epidemiologically both over the years and geographically. The increase in treatment alternatives over the years has led to differences in the management of patients. Revealing the impact of years on IBD from past to present and realizing the paths we have gone through will make us more conscious of future paths. Therefore, we aimed to reveal the epidemiological findings in our IBD patients over three decades.

Methods

IBD patients followed up at our university hospital, a tertiary center, were included in our study. The demographic, epidemiological and medical data of the patients were recorded retrospectively from the patient files. Descriptive statistics for continuous variables in the study; expressed as mean, standard deviation (SD), number (n) and percentage (%). "Independent T-test" and "One-Way Analysis of Variance (ANOVA)" were calculated to compare continuous measurements according to categorical groups. In the calculations, the statistical significance level was taken as p<0.05 and SPSS (IBM SPSS for Windows, ver.26) statistical package program was used for analyses.

Results

A total of 346 IBD patients, 198 of whom (57.2%) had Crohn's disease and were followed up from the gastroenterology outpatient clinic, were included in the study. The mean age of the patients was 49.07±13.82 years and the mean BMI was 23.02±4.58 kg/m2. 182 (52.6%) of the patients were male. The disease duration was 34.46±12.74 years. The patients were divided into three-decade groups according to their diagnosis dates as years: a total of 84 patients was diagnosed in 1985-2003, 192 patients in 2004-2013, and 70 patients in 2014-2023. The patients were compared within these date groups in terms of age at diagnosis, gender, first biological agent preference, and the time when the first biological agent was started (Fig.1). From the first decade to the third decade, the proportion of patients diagnosed with Crohn's disease was 50%, 57.3%, 65.7%, respectively, and the proportion of patients diagnosed with UC was 50%, 42.7% and 34.3%, respectively (p<0.05). The rates of requiring hospitalization at initial diagnosis were 48%, 42.2%, and 40%, respectively, from the first decade to the third decade (p<0.05). The need for bowel surgery at diagnosis (for Crohn's disease patients) was 33.3%, 26.36% and 13.04% within 3 decades, respectively (p<0.05).

Conclusion

While the rate of patients diagnosed with Crohn's disease has increased compared to 30 years ago, the rate of patients diagnosed with UC was decreased. While the need for hospitalization at diagnosis and the need for surgery in CD have decreased in the last decade compared, biological agents have been started earlier in IBD patients in the last decade.
P1187 Persistence of Advanced Therapies in Patients with Inflammatory Bowel Disease: Retrospective cohort study using large healthcare claims database in Japan
Authors: Matsuoka K , Kawamura S , Zhang Y , Chung H , Wahking B , Tan J Y , Qiu H , Nakajo K
Published: January 2024

Background

Inflammatory bowel disease (IBD) is a lifelong disease and strategically utilizing advanced therapies is essential. Few studies exist to inform the drug utilization of biologics or JAK inhibitors in Japan. The objective is to describe persistence of index and subsequently used biologics or JAK inhibitors in patients with Crohn’s disease (CD) or ulcerative colitis (UC) in Japan.

Methods

This retrospective cohort study used the Japan Medical Data Center database, which contains claims data from 14 million individuals in Japan. Patients who were diagnosed with CD or UC, and received advanced therapy, including biologics and JAK inhibitors, between January 1, 2010 and September 30, 2022 were included. Patients aged at least 15 years old were required to have no treatment with advanced therapies within 6-month prior to the initiation of index treatments of interest: adalimumab, infliximab, vedolizumab, golimumab, ustekinumab and tofacitinib for CD and UC in Japan. Persistence was defined as having continuous treatment with each therapy over a specified follow-up period (i.e., 6 months, 12 months, 18 months, or 24 months since the index date), without the presence of a pre-defined treatment gap, i.e., 1.5 times the number of days covered by the prior day’s supply.

Results

The numbers of eligible patients with CD and UC during the study period were 1,115 and 1,942, respectively. Among patients with CD, the distribution of index treatment for adalimumab, infliximab, ustekinumab and vedolizumab was 41.4%, 37.4%, 18.2%, and 3.0%, respectively. Among patients with UC, the distribution of index treatment for infliximab, adalimumab, vedolizumab, golimumab, tofacitinib and ustekinumab was 33.6%, 24.8%, 17.5%, 11.2%, 7.3% and 5.6%, respectively. For CD cohort, persistence of ustekinumab was numerically highest in all periods (94.7% at 6 months, 91.3% at 12 months, 88.2% at 18 months and 80.4% at 24 months), followed by infliximab (94.1%, 87.7%, 82.0% and 76.8%, respectively). For UC cohort, highest persistence was observed in ustekinumab through all periods (95.1% at 6 months, 84.0% at 12 months, 81.6% at 18 months and 75.0% at 24 months), followed by vedolizumab (82.0%, 69.7%, 64.2% and 59.4%, respectively). As subsequent treatments, persistence of ustekinumab and infliximab were comparable for CD while the highest persistence was observed for ustekinumab through all periods for UC.

Conclusion

Persistence of advanced IBD treatments available in Japan was investigated. As an index treatment, ustekinumab maintained high persistence through 2 years from the index date both in CD and UC. This data provides valuable information on the management of patients living in Japan with IBD under real-world setting.
P1188 Epidemiology and direct healthcare costs of patients with Inflammatory Bowel Disease (IBD) in an Asian cohort in the first year following diagnosis
Authors: Qiu T Y , Tan Y Y , Tan M T K , Wong R S M , Lee J H Y , Chan W P W
Published: January 2024

Background

Inflammatory Bowel Disease (IBD) is a chronic condition requiring multi-disciplinary care with significant investigation and treatment burden. Indeed, the global treatment market has exceeded US$ 20 billion and is expected to exceed 27 billion in 2030. We aim to study the epidemiology and direct healthcare costs of newly diagnosed IBD patients in their first year of diagnosis in Singapore General Hospital (SGH) and identify factors associated with high direct healthcare costs.

Methods

The study included patients identified from a prospectively maintained IBD registry of SGH. We enrolled patients newly diagnosed with IBD from 2015 to 2022. Patients who received prior treatment or investigation at other institutions were excluded. Data on clinical characteristics and direct costs (investigations, medications, clinic visits, hospitalisations and surgeries) were collected.

Results

A total of 199 patients were enrolled across 2015 - 2022. 96 patients had Ulcerative Colitis (UC) and 103 had Crohn’s disease (CD) (Table 1).

There were 26 (20-28) new cases of IBD diagnosed at SGH yearly. Direct healthcare costs of patients in their first year of diagnosis remained steady with an overall 7.1% change in total expenditure from 2015 through 2022. A drop in expenditure happened in 2020 and 2021 due to COVID outbreak and country lockdown. (Fig 1A)

The mean cost per patient-year (PPY) was US$12995 for CD US$104345 for UC. 10 (8-11) patients required admission within the first year of diagnosis, with a mean hospitalisation cost PPY of $269717 (± 73771). Overall, inpatient costs accounted for 39.3 % (IQR 34.8 - 44) of yearly expenditure (Fig 1B). A median of 16.7% (14.6-22.1) of patients were started on biologics within the first year of diagnosis.

Patients with CD had significantly greater mean expenditure than those with UC on imaging ($1036 vs $328, p = 0.001) and biologics ($1535 vs $603, p = 0.033).

Patients above the 75th percentile of mean cost PPY were defined as having high healthcare cost. This was $12265 and $15957 for UC and CD respectively. Factors associated with high costs were hospitalisation (p < 0.001), biologics (p = 0.001), surgery (p = 0.01) for both UC and CD. UC extent, CD behaviour, history of smoking and age> 40 were not predictive of high costs.

Conclusion

Patients with CD have greater expenditure compared to patients with UC in the first year following diagnosis. Biologics use, surgery and hospitalisation are significant drivers of costs. The proportion of newly diagnosed patients requiring admission and their corresponding costs have remained consistent during our period of study. These findings encourage early identification of at-risk patients with institution of treatment to minimise hospitalisation and surgical burden.
P1210 Gut microbiota profiling and disease course in patients with ulcerative colitis in clinical remission
Authors: Singh A , Sundharam S S , Midha V , Singh D , Mahajan R , Krishnamurthi S , Sood A
Published: January 2024

Background

The inflammatory bowel diseases, encompassing ulcerative colitis (UC) and Crohn’s disease (CD) are characterized by a relapsing-remitting disease course. Despite achieving remission, approximately one-third of the patients relapse annually and yet the microbiota associated with relapse remains elusive. We hypothesized that distinctions in gut microbial composition among patients in clinical remission could potentially influence the disease course. We aimed to discern a distinctive microbial signature in patients with UC in clinical remission, which could serve as a predictive marker for the sustained clinical remission.

Methods

This was a prospective observational cohort study conducted as a collaborative work between Dayanand Medical College and Hospital (DMCH), Ludhiana, and Institute of Microbial Technology (IMTECH), Chandigarh. Adult (≥18 years age) patients with an established diagnosis of mild UC (defined as no previous requirement of immune-modulators or biologics to induce or maintain remission) and in clinical remission, were included between January 2019 and December 2020 and followed for one year. The clinical remission was defined as partial Mayo score <2 for at least 6 months, with endoscopic Mayo score 0 and fecal calprotectin <100 µg/g within 4 weeks of enrolment. Utilizing using 16S rRNA metabarcoding based metagenome analysis, the bacterial composition of the collected stool samples were determined.

Results

During the study period, 34 patients (mean age 41.41±13.89 years, 20 [58.82%] males) meeting the eligibility criteria were included for analysis and followed up for one year. (Figure 1) The majority of the patients (21, 61.76%) had left sided colitis. On follow-up, 14 patients (41.17%) experienced a disease relapse (median time to relapse 6 [3-8.25] months). The phyla Firmicutes, Actinobacteria, Bacteroidetes and Proteobacteria were abundant in both the groups [sustained remission (n=20) and disease relapse (n=14)], but specific phyla were enriched in each cohort, Actinobacteria in remission and Proteobacteria in relapse groups. The genera Escherichia, Klebsiella, Enterobacter, Enterococcus, Streptococcus were enriched in relapse group. Interestingly the genus Clostridium was enriched in relapsed cohort whereas genera like Bifidobacterium, Prevotella, Bacteroides, Alistipes, Faecalibacterium were abundant in the remission cohorts.

Conclusion

There are inter-individual differences in the gut microbiota profile of patients with UC in clinical remission. These microbial differences can serve as determinants of the disease course.
P1222 Gut microbiome differences regarding lifestyle and the history of COVID-19 infection in ulcerative colitis patients
Authors: Straume Z , Krumina N , Elbere I , Rozenberga M , Rudzite D , Ozolina J , Pjalkovskis J , Megnis K , Skuja V , Krumina A
Published: January 2024

Background

The microbiome contributes to the pathogenesis of ulcerative colitis (UC) but the contribution of different lifestyle and environmental factors to the compositional variability of the gut microbiota is unclear. Also, it is known that microbiota plays an important role in infectious diseases like coronavirus disease 2019 (COVID-19).

Methods

In 6-month time (June 2021 to December 2021) 49 UC outpatients from Riga East Clinical University Hospital were included in a Cross-sectional study. All patients were divided into groups according to COVID-19 status (COVID-19posvs COVID-19neg) within 6 months. The effect of the lifestyle (smoking cigarettes, alcohol intake, sports activities, and high psychological stress level) and COVID-19 to the gut microbiota in patients with UC was investigated. For taxonomical classifying of the gut microbiome metagenome data, MetaPhlAn v.2.6.0 tool was used. In further analysis gut microbiome (mostly bacteria phyla) and related data was analysed with SPSS 20.0.

Results

Out of 49 patients, 31(63%) were male and 18(37%) were female, the mean age was Md=38 [IQR:34-51]. Fourteen patients (28.6%) have been COVID-19 pos and 35(71.4%) COVID-19 neg. There were no statistically significant differences between COVID-19 pos and COVID-19 neg patients and their microbiota, nor between COVID-19 pos symptomatic 12(24.5%) and asymptomatic 37(75.5%) patients and their gut microbiome. Out of 49, 24(49%) were doing sports, of those 18(51.4%) were COVD-19neg vs. 6 (42.9%) COVID-19pos, p=0.82. Evaluating differences in the gut microbiome regarding physical activities there was no statistical significance. Of 49 patients, 30(61.2%) have smoked before, while 19(38.8%) haven’t smoked. Medium smoking time was 8 years Md=8 [IQR:4.50-20.0]. Analysing gut microbiome in smokers/non-smokers, and the length of smoking, there were found no statistically significant differences. Thirty-five (71.4%) were using alcohol, and 14(28.6%) were not. Those who were using alcohol had statistically significantly more Firmicutes in their gut microbiome Md= 64.8[IQR:53.7-70.4] than no users Md=48[IQR:37.5-66.3], p=0.041. Regarding high stress levels, those who had less stress 18(36.7%), had more Actinobacteria in their gut microbiome Md=11.7[IQR:6.92-14.8] vs stressful patients 31(63.3%) Md=6.03[IQR:2.23-13.8], p=0.03.

Conclusion

There were no changes in gut microbiome in COVID-19 positive and COVID-19 negative patients, nor in smokers and no smokers. Alcohol users had more bacteria Firmicutes in their gut microbiome. There were no differences in gut microbiome in UC patients doing or lacking sports. UC patients with less stress had more Actinobacteria in their gut microbiome.
P1232 Alterations in microbial composition in patients with newly diagnosed Crohn's disease over a course of one year: data from a prospective longitudinal real-world study
Authors: Sharar Fischler T , Reshef L , Godny L , Freidenberg A , Pauker M , Rabinowitz K , Avni-Biron I , Gophna U , Dotan I , Yanai H
Published: January 2024

Background

Gut microbial composition in Crohn's disease (CD) is variable, changing with specific interventions. We aimed to explore the dynamics in microbial alterations in a cohort of patients with newly diagnosed Crohn's disease (ndCD) over one year.

Methods

This was a prospective longitudinal real-world study of patients with ndCD1 naïve to therapy who were treated at the physician's discretion. Clinical outcomes at one year were corticosteroid-free clinical remission (CSFR) and biochemical remission ([BR], CRP<1mg/dL and FC<150ug/g). We sequenced paired stool samples from diagnosis and after one year using 16S rRNA gene (V4) and analyzed changes in diversity and dysbiosis indices. A linear mixed-effect model was constructed to identify factors associated with microbial alterations and to identify specific genera that drove the alterations while controlling for confounders.

Results

Seventy-five patients completed one-year follow-up (49.3% female, median age 27 years [IQR 22-38.5], therapeutic interventions: 45 patients on biological therapies [43 anti-TNF], 26 antibiotics, 10 corticosteroids, 5 underwent surgery, and 59 various nutritional interventions). Rates of CSFR, BR, and conjoined CSFR-BR at one-year post-diagnosis were 64%, 56%, and 45.3%, respectively. We observed an overall significant increase in microbial Shannon diversity (H index), p<0.001, and decreased microbial dysbiosis index (MDI), p=0.007, from baseline to one year. On subgroup analysis, these alterations were significant among patients who achieved the clinical outcomes (all p<0.05) and even more prominent among patients who were on biological therapies (both indices p<0.001). Notably, in the biological therapy subgroup, the microbial composition at diagnosis was less diverse and more dysbiotic than in the non-biological subgroup. In the latter, microbial composition at diagnosis was less disrupted and remained relatively stable over time. Linear mixed model analysis corroborated a positive association between biological therapy and the positive dynamics in microbial indices (H-index, p=0.020 and MDI, p=0.040). Fifteen specific genera drove the microbial alterations over time (Table 1), while alterations in the relative abundance of some genera correlated with changes in clinical biomarkers and clinical indices (Figure 1).

Conclusion

The microbial composition of this real-world cohort of patients with ndCD improved over the course of one year, which was significant for patients who achieved clinical outcomes and was more prominent for patients requiring biological therapy. In this subgroup, the microbial signature was less diverse and more dysbiotic when diagnosed; this likely led the significant improvement over time.

1 Yanai H,et al. Crohns Colitis 360 2023;5:otad064
P1233 Serum insulin is associated with c-reactive protein and gut microbial diversity in inflammatory bowel disease
Authors: Wark G , Kaakoush N O , Samocha-Bonet D , Ghaly S , Danta M
Published: January 2024

Background

Obesity, impaired glucose tolerance and unfavorable lipid profile are established risk factors for cardiovascular disease. Patients with inflammatory bowel disease (IBD) may be at increased risk of cardiovascular disease, and new therapies such as JAK inhibitors may further add to this risk. C-reactive protein (CRP) is a marker of systemic inflammation that may increase with active IBD and is correlated with metabolic risk in non-IBD cohorts. Diet, in particular consumption of ultra-processed foods, has been linked to gut dysbiosis and the onset, course, and response to treatment of both IBD and metabolic disease. The aim of this study was to identify metabolic risk in a cohort of individuals with IBD through an analysis of diet, metabolic parameters and stool microbial diversity.

Methods

This two-week prospective case-control study enrolled non-diabetic individuals with IBD in clinical remission and healthy individuals (HC). Baseline body mass index (BMI), waist circumference (WC) and waist to hip ratio, detailed diet diary, serum metabolic and inflammatory parameters, stool bacterial microbiota and faecal calprotectin (FC) were examined.

Results

Eighty-one participants; 57 with IBD (26 ulcerative colitis (UC), 31 Crohn’s disease (CD)) and 24 HC participants were recruited. In the IBD group, there was a positive correlation between serum insulin, triglycerides, BMI and WC with CRP and a negative correlation between HDL and CRP (Table 1). There were no associations between measured metabolic risk factors and FC. Stool microbial alpha diversity of the IBD group was lower than that of the HC cohort, with lower species richness (IBD 21.4 v HC 26.8, p<0.01) and Shannon’s diversity index (SDI) (IBD 3.1 v HC 3.4, p=0.03) (Figure 1). In the IBD group, there was a negative association between serum insulin and CRP with stool species evenness (SE) and SDI (insulin: SE r=-0.41, adj-p=0.02, SDI r=-0.39, adj-p=0.02; CRP: SE r=-0.4, p=0.02, SDI r=-0.4, p=0.02) and a negative association between intake of processed meat and stool alpha diversity metrics (SE r=-0.39, adj-p=0.046 and SDI r=-0.42, adj-p=0.02 respectively). There were no significant associations between serum metabolic profile and dietary intake with stool alpha diversity in the HC group.

Conclusion

Unhealthy diet, higher body weight and suboptimal glucose control were positively associated with CRP in participants with IBD. Gut microbiota with reduced diversity may be a common link between adverse metabolic outcomes and IBD. Serum insulin should be explored as a common biomarker of metabolic and gut microbial health.
N02 Inflammatory bowel disease patients with impaired quality of life on biologic therapy benefit from the support of an IBD nurse specialist: Results of a randomized controlled trial in Germany (IBDBIO-ASSIST study) - The IBD nurses perspective
Authors: Hartmann P , Zemke J , Plachta-Danielzik S , Steiner I M , Pohlschneider D , Urzica E , Tappe U , Schreiber S , Steinkat N , Langbrandtner J , Hüppe A , Stargardt T , Bokemeyer B
Published: January 2024

Background

IBD nurses play an important role in the Multidisciplinary Team of managing patients with IBD. IBDBIO-ASSIST was a randomised controlled trial assessing the efficacy of care provided by an IBD nurse specialist in improving health-related quality of life (QoL) in IBD patients on biologic therapy in an outpatient setting in Germany.

Methods

In total, 1086 IBD patients on biologic therapy were randomly assigned to either a control group (CG) receiving usual IBD care or an intervention group (IG) receiving additional care from an IBD nurse. Two IBD nurses per site received an extra study specific IBD training before including patients. The primary outcome was disease-specific QoL (sIBDQ) assessed at months (M) 6, 12, and 18. In addition, IBD nurses provided a final assessment of various aspects of their work in the context of the study at M6 (T0) and M15 (T1), and patients were asked about their satisfaction level with the IBD nurses.

Results

The analysis of patients with impaired QoL at baseline (EQ-VAS < 75 [median]), showed an improvement in sIBDQ over 6 M that became significant at M12 and remained significant through M18 (baseline: IG 4.24; CG 4.31; M18: IG 5.02; CG 4.76; P= .017) (Table 1). Regarding the 5 aspects of fun, usefulness, successful discussions in consultations with patients, successful support of patients, and appreciation by patients, the nurses expressed positive assessments (“completely” and “rather”) at both measurement points, with values of more than 90% (Fig. 1). About 20% to 30% of the nurses reported being rather dissatisfied with two aspects of their jobs: time and space resources for discussions and recognition by physicians. 94% of patients in the IG felt that the additional care provided by the IBD nurses was highly beneficial.

Conclusion

IBD patients with impaired QoL derived a significant benefit from the additional care provided by an IBD nurse specialist, leading to meaningful improvements in sIBDQ over the long term. The survey results from the IBD nurses and patients in the IG revealed a very positive perception of the new form of care. It is noteworthy that an improvement in care provision was reported both by the nurses and the participating patients. Some physicians also experienced benefits from the intervention as they were relieved of certain time-consuming tasks by the IBD nurses. It should be noted that more than 20% of the IBD nurses did not feel sufficiently appreciated by physicians, and about 30% criticised the lack of time and space resources. When introducing the IBD nurse-led care concept into usual practice, these aspects should be considered.
N11 The effect of progressive relaxation techniques on disease activity, anxiety, sleep, and quality of life in individuals with Ulcerative Colitis
Authors: Artan Y , Yıldırım Y , Unal N G
Published: January 2024

Background

The aim of the study was to determine the effect of progressive relaxation techniques on disease activity, anxiety, sleep quality, and quality of life in individuals with ulcerative colitis.

Methods

This study was conducted as a randomized controlled three-arm experimental study. A total of 56 patients with ulcerative colitis were randomly divided into a progressive relaxation (n=19), placebo (n=19) and control (n=18) group. The data of the study were collected using the "Individual Identification Form", "Partial Mayo Score", "State-Trait Anxiety Inventory", "Pittsburgh Sleep Quality Index", and "Inflammatory Bowel Disease Quality of Life Questionnaire". Progressive relaxation techniques were applied to individuals in the progressive relaxation group by providing a video and educational brochure and practicing at least once a day for 25-minute sessions for 8 weeks; a special music selection for relaxation was played for individuals in the placebo group for at least one 25-minute session a day for 8 weeks. No application was made to individuals in the control group. Data collection forms were applied to all individuals before and 4th and 8th weeks after the application.

Results

The average age of the participants in the study was 38.75±11.47, and 51.8% of them were female. It was found that there was a decrease in disease activity scores at the 4th and 8th weeks in both the progressive relaxation and placebo groups, with a greater decrease observed in the progressive relaxation group.This difference was not statistically significant.

Anxiety levels of the individuals, it was found that there was a statistically significant decrease in both state and trait anxiety score averages at the 4th and 8th weeks in both the progressive relaxation and placebo groups, with a higher percentage of decrease observed in the progressive relaxation group (p<0.05).

Sleep quality score averages at the 4th and 8th weeks, it was found that there was no statistically significant change in the control group, while the score averages of both the progressive relaxation and placebo groups significantly decreased, with a higher percentage of decrease observed in the progressive relaxation group (p<0.05).

In the progressive relaxation and placebo groups, it was found that the life quality score averages significantly increased at the 4th and 8th weeks, with a higher percentage of increase observed in the progressive relaxation group (p<0.05).

Conclusion

Our study has shown that progressive relaxation techniques can reduce anxiety levels and improve sleep and quality of life in individuals with ulcerative colitis.
N15 Developing a Tool for educating newly diagnosed Patients with Inflammatory Bowel Disease based on a Quality Database Indicator
Authors: Kjaer-Mikkelsen E , Edelbo R , Riddersholm C , Blichfeldt B , Krogager Y , Andersen D V , Berg A
Published: January 2024

Background

There is evidence that education improves quality of life and empowers patients with chronic diseases including inflammatory bowel disease(IBD).

Education also indicates a better use of ressources enabling relevant treatment to be started earlier.

Education meets an increasing wish from patients to be involved.

ECCO recommend patient education and state that this is well handled by specialist nurses.

When establishing Danish Quality Database for Inflammatory Bowel Disease(DANIBD) the steering committee agreed that education for the newly diagnosed patients with IBD should be an indicator of quality.

This was a new task and a big challenge for many clinics and also it was unusual for nursing to stand out so clearly in a database.

The tool aims at 1.- supporting the clinics in implementing the new task into clinical practice 2.- securing uniformity in the education in relation to fulfilling the indicator and 3.- improving quality of patient education and nurse consultations to patients with IBD.

Methods

In the IBD group of the Danish Nursing Association(DSR) it was decided to develop a tool that would serve as an inspiration or could be used directly by the clinics.

The tool should ensure that the demands in the indicator was met but should also contain inspiration for other subjects regarding patient education and nurse consultations.

Based on literature and the experience of the group members a list of subjects were made and distributed among the group members for developing slides and notes.

At plenary meetings all this was put together, structured and edited.

In order to get a professional product a collaboration with an art director was established.

Financing was secured by donations from the pharmaceutical industry.

Results

There now are two powerpoint presentations - one for Crohn's disease and one for ulcerative colitis.

each presentation is split in two parts. Part one meets the database and part two is an inspiration for covering other subjects relevant for patient education and nurse consultations.

The presentations encourages the dialogue with the patient and can be customized by the individual clinics or the individual nurses.

The presentations contain additional notes and links to further information.

In order to help implement the tool two nurses from each clinic in Denmark were invited to one day of training in using the tool and in communication.

The presentations were put on the webpage of the IBD group from where it can be downloaded and used by everyone interested.

Conclusion

Developing a quality indicator within the database has started an engaging process focusing on the patient and on improving nursong for patients with IBD.

It is expected that the tool will help support and empower patients in their lives with IBD.
N27 Group meetings for adolescents with IBD: results of a survey on patients’ interests
Authors: Gigante S , Cerizza A , Pozzi K , Comoretto R I , Martinato M
Published: January 2024

Background

The increase in both the incidence and prevalence of IBD, especially in people under 21 years of age1,2,3 outlines new issues to be considered in caring for these patients, like the psychosocial effects on both adolescents and their families, school absences, and developmental delay2. The need for better support to improve their HRQoL4, the embarrassment related to the disease, the anxiety about a sudden appearance of gut symptoms, frequent hospital admissions, and diet restrictions, can lead to social isolation5,6. Group meetings designed to make adolescents and young adults with IBD meet each other and with healthcare professionals (HCP) who are experts in IBD can create a safe environment in which to discuss fears, everyday problems and possible solutions, and any doubt about their condition. This could also provide support, suggestions, and opportunities to peer-compare, further promoting social relationships. This study investigated their willingness to participate in this experience and what they consider important to discuss.

Methods

A focus group involving HCP from a paediatric gastroenterology clinic and interviews with a sample of patients provided the basis on which a clear and easy-to-understand survey was developed concerning interest in the project, willingness to participate, topics to be discussed, and needs of peer relationship. The survey was then performed collecting anonymous data to avoid any kind of potential bias.

Results

Twenty-two patients aged 14 to 19 years completed the survey, showing their poor occasions of discussion about the disease and its related issues with other patients (54.5% of them do not know people with IBD) even if they can talk with their family, HCP and peers outside the hospital or outpatient clinic settings (tab 1). The willingness to participate in a group meeting is higher in the oldest subjects, and they show the highest interest in a peer relationship with patients of the same age and expert HCP. The topics considered more significant are 'nutrition' and 'mood' (described by almost two-thirds of patients) followed by ‘symptoms’ and ‘social life’ (fig 1). The best meeting schedule from the patient's point of view is every 6-8 weeks, with both in-person and virtual participation.

Conclusion

This study provides useful information on the feasibility and willingness of young patients with IBD to participate in such interventions. After the experimental application of group meetings, it will be mandatory to let patients provide feedback on this activity and to assess their effects on patients’ psychosocial well-being.

References (DOI)

1 10.1016/j.crohns.2013.01.010

2 10.1053/j.gastro.2021.12.282

3 10.1016/j.gtc.2023.05.001

4 10.1093/ibd/izy041

5 10.1007/s10880-021-09778-0

6 10.1111/hsc.13755
N37 Fatigue in Japanese patients with Inflammatory Bowel Disease: a comparative study based on a systematic review
Authors: Takai M , Tanaka M , Sakagami K , Ito H
Published: January 2024

Background

Fatigue is a common symptom in patients with inflammatory bowel disease (IBD), often persisting even when the disease is in a state of remission. In addition, it is associated with a diminished quality of life (QOL). However, in Japan, only few studies have focused on fatigue in patients with IBD. The Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scale has shown reliability and validity in assessing fatigue in patients with IBD, and studies using this scale have been conducted worldwide. In this study, we aimed to examine the current state of fatigue among Japanese patients with IBD using the FACIT-F scale and compare these findings with data from the global studies through a systematic review.

Methods

Data from 488 patients with IBD treated at a specialized IBD clinic were analysed. Patient characteristics, such as sex, age, and disease duration, along with FACIT-F scores, height, and weight were included as survey items in the questionnaire administered to patients. Data on the disease names and activities, as determined by the Crohn's disease activity index and partial Mayo score, were obtained from medical records. For international comparison, information on age, sex, country, disease duration, body mass index, and disease activity was extracted from each article and listed alongside FACIT-F scores. We conducted a search on PubMed using the search terms ‘inflammatory bowel disease’ OR ‘Crohn's disease’ OR ‘ulcerative colitis’ AND ‘fatigue’ AND ‘FACIT-F’ OR ‘FACIT’ OR ‘FACIT-fatigue’. After applying our predetermined inclusion criteria, we selected eight studies that met our requirements.

Results

The articles of the systematic review included population sizes ranging from 100 to 1185 patients. Patients’ age varied between the late 30s and early 50s, and the proportion of male patients ranged from 39% to 66%. The duration of disease was approximately 10 years. The proportion of disease names and activities was diverse. The overall mean FACIT-F scores ranged from 38.9 ± 11.0 to 41.6 ± 8.6, while the medians [interquartile ranges] ranged from 30 [22-39] to 41 [35-47]. For each article that presented the FACIT-F scores as means ± standard deviations, the t-tests revealed no statistically significant differences. Overall, the FACIT-F scores were higher (indicating higher QOL) in the remission phase than in the active phase. Additionally, these scores were higher in male patients than in female patients and in patients with ulcerative colitis than in those with Crohn’s disease. These findings were consistent across all countries included in this study.

Conclusion

The FACIT-F scores of Japanese patients with IBD demonstrated a similar trend to those of other countries.
N38 Male patients with Crohn's Disease and perianal fistulae and their experience of sexuality and dialogue with healthcare professionals about their sexuality - a qualitative interview study
Authors: Winther Andersen K , Primdahl J
Published: January 2024

Background

The incidence and prevalence of inflammatory bowel disease (IBD) has increased significantly over the last 30 years. IBD most often debuts in young adulthood and can have an impact on the patient's body image, intimate relationships and sexual function. The aim of this study was to explore how male patients with Crohn's disease and perianal fistulae, experience how their disease affects their sexuality, and how they experience the dialogue with healthcare professionals about sexuality and their related challenges.

Methods

A qualitative study based on a phenomenological hermeneutic approach was applied. Six male participants with Crohn's disease and perianal fistulae were recruited from an outpatient clinic at a regional hospital, Lillebaelt hospital, Vejle and Kolding. Data were collected via semi-structured telephone interviews. The transcribed interviews were analyzed using qualitative content analysis as described by Graneheim and Lundman. The analysis encompassed both a manifest and a latent level.

Results

The analysis led to the development of five themes:

1) The disease and sexuality. Flare-ups in the participants Crohn's disease posed an obstacle to intimacy, negatively affecting their sexlife during flare-ups. The participants used problem-focused and emotional coping strategies to overcome these limitations in their relationships, regarding intimacy and sex.

2) The phases of life - importance for sexuality. Sexuality was affected at different stages in life, independent of the participants' Crohn's disease. The balance with family, relationships, small children and work life, also had an impact on the participants desire for sex and intimacy with their partner and vice versa.

3) The importance of fistulas for sexlife. Acitive fistuala negatively affected the participants' sexuality. Their masculinity was affected by erectile dysfunction, which was a common complication to surgery.

4) Sexuality - an omitted topic in healthcare dialogue. Sexuality was often an omitted topic in the healthcare dialogue, even though the topic was important to the participants.

5) Is sex taboo? Sexuality was a topic the participants considered to be impacted by taboo, which encompassed both the participants and the health care professionals.

Conclusion

In patients with Crohn's disease and fistulae, sexuality must be seen in a bio-psycho-social perspective. Gender roles and coping strategies are important topics to include in the health care professionals dialogue with these patients.