bluuebunny/crossref_metadata_2025 huggingface dataset:
P1203 Spatial mapping and geographic variation of inflammatory bowel disease in Canada: A population-based study using Statistics Canada data
Authors: Goodwin S , Haan M , Yuan Y , Wilk P , Jairath V
Published: January 2025

Background

Crohn’s Disease (CD) and Ulcerative Colitis (UC) pose significant challenges to patients and healthcare systems, with a rising incidence and prevalence globally1,2. To address the challenges of health resource allocation and understand the geographic distribution of these conditions in Canada, we conducted the spatial mapping of IBD across Canada using national population survey data available from Statistics Canada.

Methods

We utilized data from the 2009-2018 Canadian Community Health Survey (CCHS) to identify individuals with CD or UC. Prevalence rates, both crude and adjusted for age and sex, were calculated for each health region in Canada. Spatial dependencies between health regions were estimated using global Moran’s I and local indicators of spatial association (LISA) were used to identify clusters of health region (hot-spots) where the prevalence was significantly higher than in other areas. We further applied spatial simultaneous autoregressive lag models to explore the influence of region-level sociodemographic factors on identified spatial dependencies.

Results

A total of 492,560 individuals from 2010-2018 CCHS were included, representing 29,846,350 Canadians across 109 health regions. Survey data revealed that 0.38% of Canadians self-reported having CD and 0.47% reported having UC. The majority of respondents reported being urban-residing, middle-aged, and white. Across Canadian provinces, the age and sex-standardized prevalence of IBD ranged from 742 per 100,000 in Quebec to 1267 per 100,000 in Nova Scotia (Figure 1). Spatial analysis identified significant dependencies among health regions, but these spatial associations were explained by the differing distributions of sociodemographic characteristics in each health region (Table 1). Increased health region-level prevalence of CD and UC was associated with a larger proportion of individuals 30+ years, identifying as a female, immigrants, or as white (p<0.05 for each).

Conclusion

Data from this large, population-based Canadian national survey demonstrated significant geographic variation in the prevalence of CD and UC. However, after adjusting for patient demographic characteristics, the spatial dependency became non-significant. Key characteristics related to urbanization including the age distribution and proportion of immigrants in a health region were associated with increased prevalence rates. These results suggest that differences in CD and UC prevalence between geographic areas are primarily driven by individual demographics rather than differences in characteristics of local healthcare delivery systems and further support the notion that characteristics of urbanization increase the prevalence of IBD in an area1.

References

1.Ng et al., 2017. Doi: 10.1016/s0140-6736(17)32448-0

2.Coward et al., 2023. Doi: 10.1093/jcag/gwad004
P1204 Childhood EBV infection is protective against IBD, while adulthood EBV infection is not: a population-based cohort study
Authors: Agrawal M , Allin K H , Hansen A V , Colombel J F , Jess T
Published: January 2025

Background

Emerging data indicate a role of Epstein Barr Virus (EBV) infection in immune-mediated diseases risk. However, its role in inflammatory bowel disease (IBD) risk remains to be elucidated.

Methods

We conducted a nationwide population-based cohort study leveraging cross-linked Danish registers consisting of individuals with a record of being tested for EBV between January 1, 2008 and August 31, 2020. We determined the impact of previous EBV infection, active IBV infection, and no EBV infection on IBD risk, based on EBV serological tests, using adjusted Cox proportional hazards regression analyses after adjusting for sex, type of test, year of test, and age at test. We also determined the impact of age at infection, categorized as early or late childhood or adulthood (0-12, 13-20, and ≥21 years, respectively).

Results

Of 20,386 individuals included in the study who were followed from the first EBV test for a median (IQR) of 3.93 (2.18-5.95) years, 250 developed IBD. In the overall analysis, there were null associations between prior or current EBV infection and IBD risk. In analyses stratified by age, EBV infection in early and late childhood were associated with a protective effect against IBD, although not statistically significant in the former group (aHR 0.81, 95% CI 0.40, 1.66 and 0.50, 95% CI 0.26, 0.95, respectively). This association was driven by an increase in the risk of Crohn’s disease (CD), but not ulcerative colitis (aHR 0.36, 95% CI 0.15, 0.87 and aHR 0.82, 95% CI 0.32, 2.11, respectively). Among adults, while EBV infection was not associated with IBD risk (aHR 2.17, 95% CI 0.71, 6.62), the effect estimate was in the opposite direction relative to that in childhood, suggesting a potentially increased risk.

Conclusion

In a nationwide cohort, childhood EBV infection was protective against CD. Adulthood EBV infection was not protective, and possibly associated with increased IBD risk, although this was not statistically significant. Validation studies will help elucidate further.
P1206 The Incidence and Disease Course of Perianal Disease in Paediatric-Onset Crohn's Disease: A Danish Nationwide Cohort Study Covering 1980-2022
Authors: Ström A , Jansson S , Wewer M D , Burisch J , Malham M , Wewer V ,   The Copenhagen IBD Center
Published: January 2025

Background

Perianal Crohn's disease (CD) is characterised by fistulae and/or abscesses in the anal region and leads to significant morbidity. We aimed to estimate the incidence and describe the disease course of perianal disease in paediatric-onset CD patients (<18 years at CD diagnosis).

Methods

In a nationwide registry-based cohort study, we identified all incident patients with paediatric-onset CD in Denmark from 1980 to 2018. We followed the patients until emigration, death, or December 31, 2022, and recorded the cumulative incidence of perianal disease based on data from the National Patient Registry. Using perianal disease as an exposure, we further assessed the risks of major abdominal surgeries, colorectal and anal cancer, and mortality. We used multivariate Cox regression analysis with biological age as the timescale to estimate hazard ratios adjusted (aHR) for sex, family income, and calendar year of CD diagnosis.

Results

We identified 2,356 paediatric-onset CD patients, of whom 769 (32.6%) were diagnosed with perianal CD. Total follow-up time was 38,584 person-years. The cohort is described in detail in Table 1.

The cumulative incidence of perianal CD was 14.0%, 21.1%, and 28.1% after 1, 5, and 10 years after CD diagnosis, respectively. The incidence density during the study period was 29 (95% confidence interval [CI]: 26.8–30.9) per 1,000 person-years, corresponding to 45.2% after 30 years of follow-up. Among the 769 patients with perianal CD, 460 (59.8%) had perianal abscesses, 399 (51.9%) perianal fistula, and 627 (81.5%) patients underwent perianal surgery. Of CD patients with perianal disease, 308 (40.1%) required a stoma compared to 147 (9.3%) of patients without, corresponding to an aHR of 2.8 (95% CI: 2.3-3.4). When comparing CD patients with perianal disease to those without, the aHRs for major abdominal surgery, cancer, and mortality were 1.5 (95%CI: 1.3–1.8), 0.8 (95% CI: 0.2–2.7), and 1.5 (95%CI: 0.9–2.7), respectively. Of the 68 patients that died, 35 (2.2/1,000 person-years) had perianal disease, whereas 33 (1.4/1,000 person-years) had not. Further risk analysis is presented in Figure 1.

Conclusion

In this nationwide cohort of patients with paediatric-onset CD (<18 years at CD diagnosis), 29 patients per 1,000 person-years developed perianal disease between 1980-2022. Patients with perianal CD were more likely to require major abdominal surgery, including stoma surgery, and had a higher risk of mortality compared to patients without perianal CD. Our study underlines the severity of perianal disease in paediatric-onset CD.
P1218 Pancreatic Involvement in Patients with Inflammatory Bowel Disease: A Cohort Study of 474 IBD Patients
Authors: Darkaoui D , Koulali H , Zazour A , Ouiam E , Ismaili Z , Kharrasse G
Published: January 2025

Background

Inflammatory bowel disease (IBD) is a systemic condition that extends beyond the gastrointestinal tract, affecting multiple organ systems, including the skin, musculoskeletal system, and eyes... . The pancreas is one such organ that can be affected, exhibiting diverse manifestations through various pathophysiological mechanisms. These manifestations range from asymptomatic elevations of pancreatic enzymes to severe conditions such as acute pancreatitis (AP), autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic cancer. This study evaluates the prevalence and characteristics of pancreatic involvement in patients with IBD.

Methods

This retrospective, descriptive, analytical study spanned nine years (January 2016–December 2023) and included regular follow-up of patients with a confirmed diagnosis of IBD. We specifically investigated different pancreatic involvements in IBD patients, excluding asymptomatic elevations of pancreatic enzymes.

Results

A total of 474 IBD patients were analyzed: 291 with Crohn's disease (CD), 178 with ulcerative colitis (UC), and 5 with indeterminate colitis. Pancreatic involvement was observed in 6 patients (4 women and 2 men), comprising 3 with Crohn's disease and 3 with ulcerative colitis, resulting in an overall prevalence of 1.26%. The mean age of presentation for pancreatic manifestations was 42.5 years (range 23–59 years), with a male-to-female ratio of 0.5. The prevalence among CD patients was 1.03%, compared to 1.68% in UC patients.

Five cases of acute pancreatitis were documented:Medication-related AP: Two patients developed acute pancreatitis related to 6-mercaptopurine and azathioprine.

Biliary and medication-related AP: One patient treated with 5-ASA presented with a bile duct stone, suggesting a biliary or drug-related cause.

Morphological anomaly

Another case was linked to mesalazine or pancreas divisum.

Autoimmune pancreatitis (type 2): One case was identified, associated with exocrine pancreatic insufficiency.

Diffuse abdominal pain with elevated lipase: One patient exhibited elevated lipase levels and acute renal failure without imaging abnormalities.

Conclusion

Pancreatic abnormalities in patients with IBD encompass diverse clinical manifestations and etiologies. Our findings indicate that acute pancreatitis is the most common presentation, primarily linked to medications such as azathioprine, 6-mercaptopurine, and mesalazine, as well as biliary causes and autoimmune disorders. The identification of type 2 autoimmune pancreatitis underscores the importance of further research into the pathophysiology of pancreatic involvement in IBD.
P1225 A cross-sectional study of Inflammatory Bowel Disease in older people across Australasia, a Crohn’s Colitis Cure data insights program
Authors: Seng C , Su W K , Wilson W , Connor S J , Andrews J M , Walker G
Published: January 2025

Background

There is an increasing population of older people with inflammatory bowel disease (IBD) owing to both increasing incidence over 70 years of age and an overall ageing IBD population. The management of older people with IBD can be challenging especially considering higher rates of comorbidity, polypharmacy, frailty, infection risk and malignancy. Furthermore, this cohort is mostly excluded from registry clinical trials for novel therapies, limiting the applicability of trial findings. Here, we aimed to establish the characteristics of IBD and its management with a focus on older people across Australasia.

Methods

Crohn’s Colitis Care (CCCare) is a cloud-based electronic medical record used in Australasia since 2018. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September of 2024. People with IBD under active care (encounter within 14 months) were included. The cohort was divided into three age groups: < 40 years, 40 – 69 years and ≥ 70 years.

Results

Of 7506 eligible people, the median age was 42 years (IQR 31 – 56). Those ≥70 years comprised 8.1%. Analysis of the most common comorbidities found cardiovascular related diseases to be the most common amongst those ≥70 years (Table 1). Hypertension was the most commonly reported (24.7%), followed by hyperlipidaemia (14.0%), gastro-oesophageal reflux disease (11.7%) and ischaemic heart disease (10.7%). This contrasts with those aged < 40 where anxiety (4.9%), asthma (4.6%), iron deficiency (4.2%) and depression with anxiety (3.7%) were the most common comorbidities. Medical management characteristics are summarised in Table 2. There was lower use of immunomodulators (IMS), steroids and advanced therapies in older people compared with both younger cohorts. In those receiving an advanced therapy in the older cohort, vedolizumab (12.4%) was the most often prescribed followed by infliximab (8.7%) and ustekinumab (8.6%). There was no significant difference in the rates of endoscopic or radiological remission across the three cohorts.

Conclusion

These data are important for demonstrating real worse disease and management characteristics across the age spectrum in IBD, in a large binational cohort under routine care. Despite lower rates of steroid, immunomodulatory and advanced therapy in the older cohort, there were no significant differences in rates of achieving radiological or endoscopic remission across the three cohorts. This may be in part due to a difference in phenotype for those diagnosed with IBD in later life. This overview demonstrates the potential of a database such as CCCare in informing ongoing management practices in this growing population.
P1226 Inflammatory Bowel Diseases and Prior Malignant Diagnoses - A Danish Nationwide Cohort Study 1996-2022
Authors: Plovgaard J , Damsgaard Wewer M , Bendtsen F , Burisch J
Published: January 2025

Background

Due to the increasing prevalence of inflammatory bowel diseases (IBD), an ageing population and the increased risk of cancer associated with IBD, the number of patients diagnosed before or while having their IBD is increasing. We aimed to describe the treatment of IBD patients with a prior malignant diagnosis relative to IBD patients without.

Methods

Danish national registers were used to identify all incident Crohn’s disease (CD) and Ulcerative Colitis (UC) patients in Denmark, their exposure to drugs and surgeries, and cancer status, between 1996-2022.

Cox regressions compared the risk of exposure to medications and the risk of surgery for patients with malignant comorbidity.

Results

58,402 incident IBD patients (18,383 CD (31.5%), 40,019 UC (68.5%)) were included and followed for a median of 10 years (IQR: 5, 17 yrs). 2,370 (4.1%) had cancer prior to IBD. Of the remaining 56,032 IBD patients, 4,445 (7.9%) had their first cancer diagnosis after their IBD diagnosis. Anti-TNF therapy was used in 16% (n = 92) of CD patients with cancer prior to IBD and in 41% (n = 6,857) of CD patients without cancer. Anti-TNF was used in 9.0% (n = 161) of UC patients with cancer prior to IBD and in 20% (n = 7,159) of UC patients without cancer. Immunomodulators were used in 27% (n = 159) of CD patients with cancer prior to IBD and in 52% (n = 8,594) of CD patients without cancer. Immunomodulators were used in 12% (n = 220) of UC patients with cancer prior to IBD and in 27% (n = 9,555) UC patients without cancer.

Exposure to medical therapy was visualised in Figure 1

Being diagnosed with cancer prior to CD diagnosis was negatively associated with exposure to immunomodulators (p = 0.005), while it increased the risk of receiving no medical treatment compared to CD patients without prior cancer (p < 0.001). The need for surgery was not associated with having cancer prior to CD diagnosis (p = 0.705). In UC patients, a negative association was found for both immunomodulators (p = 0.001) and for receiving no treatment (p < 0.001), while a positive association was found for both anti-TNF (p = 0.027) and anti-integrin therapy (p < 0.001) for UC patients with prior cancer. Prior cancer increased the risk of requiring surgery for UC patients (p < 0.001)

Conclusion

Patients with cancer prior to IBD were treated differently than patients without prior cancer as they received less immunomodulator therapy and more often received no medical therapy at all. UC patients more often required surgery, while this was not the case for CD patients. This supports the need for an individualised approach to immunosuppressive treatment for IBD patients with cancer.
P1229 Updated Epidemiology of Osteoporosis in the Inflammatory Bowel Disease Population and Associated Risk Factors: Insights from a Retrospective Cohort Analysis
Authors: Khataniar H , Desai A , Kochhar G
Published: January 2025

Background

Osteoporosis is a prominent extra-intestinal complication in patients with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of osteopenia and osteoporosis among patients with IBD varies widely, ranging from 22%-77% and 17%-41%, respectively, depending on population characteristics, geographic location, and study design [1]. Despite these variations, the burden of osteoporosis in IBD is unequivocal, impacting quality of life and increasing the risk of fractures.

Methods

We conducted a retrospective cohort study using the TriNetX database to assess the incidence of osteoporosis in patients with IBD between 2013 and 2023. Data were stratified by age, sex, and race. A comparative analysis of osteoporosis risk in IBD versus non-IBD populations was performed, along with an exploration of risk factors specific to UC and CD cohorts. Propensity score matching was employed to adjust for confounders, including age, sex, race, BMI, smoking, primary sclerosing cholangitis (PSC), steroid use, autoimmune diseases, IBD medications, and surgical history. Risk was quantified as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results

A total of 120,396 patients with IBD (mean age 43.8 ± 19.4, female sex 53.073%, White race 79.01%) were analyzed. The five-year incidence of osteoporosis was significantly higher in the IBD cohort (aOR: 1.43, 95% CI: 1.38-1.48) compared to the non-IBD cohort. Among IBD subtypes, CD patients exhibited a higher risk (aOR: 1.53, 95% CI: 1.46-1.60) compared to UC patients (aOR: 1.38, 95% CI: 1.32-1.44) [Figure 1].

Osteoporosis incidence was notably higher in females (IBD: 9.78%, UC: 10.48%, CD: 9.38%) than in males (IBD: 3.55%, UC: 3.67%, CD: 3.87%) and increased significantly with age, reaching 21.67% in patients over 80 years old. Racial disparities were evident, with the highest incidence observed among White patients (7.35%). Significant risk factors for osteoporosis in IBD included long-term corticosteroid use (aOR: 2.29, 95% CI: 2.25-2.32), malnutrition (aOR: 1.56, 95% CI: 1.53-1.59), use of TNF-alpha inhibitors (aOR: 1.40, 95% CI: 1.36-1.43), PSC (aOR: 2.30, 95% CI: 2.08-2.54), intestinal surgery (aOR: 1.21, 95% CI: 1.18-1.23), hemoglobin levels of <10 g/dL (aOR: 1.20, 95% CI: 1.19-1.21), albumin levels of <2.5 g/dL (aOR: 1.07, 95% CI: 1.05-1.08), and mood disorders (aOR: 1.16, 95% CI: 1.15-1.17) [Figure 2].

Conclusion

Osteoporosis is a significant concern for patients with IBD, with females, older adults, and CD patients being most at risk. Early and targeted interventions are crucial to reducing bone loss and improving long-term outcomes in this vulnerable population.

References

1.Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009 Jul;122(7):599-604. doi: 10.1016/j.amjmed.2009.01.022. PMID: 19559158; PMCID: PMC2894700.
P1231 Cross-sectional assessment of body composition and muscle function in Crohn's disease patients, stratified by presence and extent of intestinal resection
Authors: Becherucci G , Parisio L , Profeta F , Foscarini E , Covello C , Del Gaudio A , Di Vincenzo F , Iaccarino J , Pizzoferrato M , Petito V , Masi L , Troisi S , Pane C , Calvez V , Laterza L , De Biasio F , Marmo C , Mignini I , Turchini L , Amatucci V , Giordano L N , Ribaudi E , Biamonte F , Cammarota G , Pugliese D , Lopetuso L , Gasbarrini A , Papa A , Scaldaferri F
Published: January 2025

Background

Crohn's disease (CD) is a leading cause of short bowel syndrome (SBS) in adults, which can result in intestinal failure (IF) when intravenous nutritional or electrolyte supplementation is required. SBS is frequently associated with sarcopenia, characterized by loss of muscle mass and function, which adversely impacts quality of life and increases the risk of complications. This study aimed to evaluate differences in body composition and muscle strength among CD patients at varying risk levels for SBS.

Methods

We conducted a cross-sectional study involving consecutive CD outpatients. The participants were divided into two groups. Group A consisted of CD patients diagnosed with SBS and patients who had undergone two or more bowel resections, or a resection of more than 50 cm. Group B included patients who had never undergone surgery or those who had undergone a resection of less than 50 cm. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured via hand grip testing with a dynamometer, recording the best result of three attempts with the dominant hand. We administered food frequency questionnaire (FFQ) to assess eating habits. Statistical analyses, including t-tests or Mann-Whitney tests, were used as appropriate, with a significance threshold of p < 0.05.

Results

The study cohort included 150 patients (mean age 53 years [±19,2]; 24% female). Group A showed an average BMI of 23,7±4 kg/m2, whereas group B showed an average BMI of 24.6±5 kg/m2. Muscle strength measured between groups was reduced in group A showing significant differences in hand grip test compared to group B (p-value<0.001). However, no significant differences were observed in BIA parameters, including muscle mass, or in eating habits across the groups.

Conclusion

Our study revealed that SBS patients and CD patients resected two or more times or with a resection greater than 50 cm had reduced muscle strength without a corresponding reduction in muscle mass, indicating impaired muscle function. Further research is needed to better understand the relationship between Crohn's disease-related resections and their impact on both muscle quality and quantity.

Funded by:2.1 "Rafforzamento e potenziamento della ricerca biomedica del SSN",finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project "Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets"code:PNRR-MAD-2022-12376791
P1232 A Novel Inflammatory Bowel Disease Registry Powered by Artificial Intelligence and Natural Language Processing
Authors: Liu J , Massaro C , Cruz E , Kalisky I , Lunken G , Leung Y , Bressler B , Rosenfeld G
Published: January 2025

Background

Accurate data registries may assist clinicians and researchers to gain insights into inflammatory bowel disease(IBD) and provide opportunities to improve overall patient care. However, most data registries are limited by the amount of time needed to collect and record patient-level data. Machine learning and natural language processing(NLP) can facilitate data collection, storage, and retrieval, reducing or even eliminating the need for human data entry. The aim of this study was to describe and validate a novel IBD repository(IBD Data Lake), leveraging machine learning and NLP techniques, as useful tools to curate and retrieve pertinent, real time clinical data in the IBD patient population.

Methods

The IBD Data Lake was created by medical professionals, translational researchers, and data strategists at the IBD Centre of British Columbia. Structured and unstructured data were extracted from patients’ electronic medical record and were transferred to a secure cloud infrastructure and curated into a searchable database. A customized user interface was created to search the IBD Data Lake. An advanced NLP service(Comprehend MedicalTM) was employed to extract clinical information from the unstructured text and data from medical documents in PDF format. Manual chart review was used as the gold standard to validate all information from the IBD Data Lake.

Results

A list of 208 patients(104 IBD patients matched to 104 non-IBD patients) from the IBD Data Lake was generated between July 1, 2018 and July 31, 2023. After a thorough chart review, the IBD cohort comprised 101 IBD patients and the non-IBD cohort included 102 non-IBD patients. The IBD Data Lake’s performance metrics for identifying IBD patients were as follows: sensitivity 98.1%, specificity 97.1%, positive predictive value 97.1%, and negative predictive value 98.1%.The machine learning and NLP components of the IBD Data Lake demonstrated high performance in analyzing key IBD unstructured clinical characteristics: for distinction of ulcerative colitis or Crohn’s disease, sensitivity was 100% and specificity 98.2%; for smoking status, sensitivity was 100% and specificity 96.9%; and for extraintestinal manifestations, sensitivity was 92% and specificity 100%.

Conclusion

A novel IBD Data Lake that integrates machine learning and NLP techniques has been validated. IBD patients have been identified with great accuracy and the machine learning/NLP components of the IBD Data Lake allow for a comprehensive and timely extraction and organization of unstructured data. This will ultimately lay the groundwork for recruitment of specific IBD cohorts of interest to address the gaps that remain in our knowledge. It has the potential to drive innovation in the field of IBD and gastroenterology.
P1237 Musculoskeletal involvement is frequent in bio-naïve patients with IBD initiating biological treatment– a prospective cohort study
Authors: Vladimirova N , Zhao M , Ørnbjerg L M , Møller J M , Attauabi M , Nielsen Y J W , Saboori S , Burisch J , Østergaard M
Published: January 2025

Background

Musculoskeletal (MSK) involvement in IBD patients contributes to poorer outcomes and reduced quality of life (QoL). Recognising MSK involvement is important before initiating biologics, as their effects can differ between the gut, peripheral joints and spine. We aimed to describe the prevalence and distribution of peripheral and axial MSK symptoms and clinical findings in IBD patients starting biological treatment.

Methods

Bio-naïve IBD patients were consecutively recruited. Musculoskeletal symptoms were assessed using questionnaires and a structured interview. A rheumatologist conducted a clinical evaluation of peripheral joints, entheses, and spine mobility and considered various differential diagnoses.

Results

Of 82 patients (ulcerative colitis (UC): 33, Crohn’s disease (CD): 49), 51(62%) had musculoskeletal symptoms and 51(62%) had clinical findings (Table 1). Peripheral joint pain was reported by 39(48%) patients, usually affecting the hands, followed by the knees and ankles. Entheseal pain was present in 15(18%) patients, most often affecting the lateral hips, followed by the Achilles and patella tendons. Back pain was reported by 33(40%) patients. In 16 of these patients, the assessing rheumatologist could attribute the symptoms to competing differential diagnoses, such as degenerative spine disease (n=15), osteoarthritis (n=3) and overuse injury (n=2). Patients with CD suffered from significantly more MSK symptoms, particularly joint pain, compared to UC patients (67% vs. 40%, and 65% vs. 30%, respectively, p-values=0.01).

Clinical evaluation revealed arthritis in 24(29%) patients and enthesitis in 50(61%). The small peripheral joints were predominantly involved in an oligo- and polyarticular pattern. Achilles tendon insertions were the most frequently affected entheses; enthesitis was asymptomatic in 72% of the cases. The Assessment of Spondyloarthritis international Society (ASAS) classification criteria for peripheral spondyloarthritis were met in 44% of patients; and for fibromyalgia in 8.5% of patients, all with clinically active IBD. Being female was associated with more frequent musculoskeletal symptoms and clinical findings. No other differences in clinical findings were observed between UC and CD, nor between those with active and inactive IBD. Patients with MSK involvement had significantly lower EQ-5D scores than those without.

Conclusion

Two-thirds of IBD patients scheduled for their first biological treatment exhibited musculoskeletal involvement, sometimes asymptomatically. Axial and peripheral symptoms were equally common. A multidisciplinary approach is crucial for early detection and integrated treatment aiming for remission in all disease domains to improve patients’ QoL.
P1239 Microplastics are associated with biomarker of intestinal inflammation in a pilot analysis of the PLANET Study
Authors: Lykkemark J , Picker M , Kim T , Nguyen I , Weinstein K , Chen R , Simon-Sánchez L , Lordachescu L , Torres J , Stone J , Bianco A , Shaw L , Tavella N , Jess T , Allin K , Peter I , Colombel J F , Vianello A , Vollertsen J , Agrawal M
Published: January 2025

Background

Micro- and nanoplastics are pollutants of growing concern, given the ongoing rise in their production and accumulation in the environment. Emerging data implicate microplastics (MP) in adverse health outcomes. However, their role in intestinal inflammation and inflammatory bowel disease (IBD) is not well studied.

Methods

We established the Exploring the Role of Plastics and Toxins in Intestinal Inflammation (PLANET) Study to understand the impact of MP on intestinal inflammation and Crohn’s disease (CD) in women with and without CD and their offspring. We prospectively recruited pregnant women with and without CD in the third trimester, obtained clinical and survey data, and collected stool samples without the use of plastic materials, taking strict precautions to avoid ambient MP contamination in processing. Using a well-established protocol for MP analyses, consisting of multi-step enzymatic and oxidative treatment and state-of-the-art µFourier Transform Infrared Spectroscopy (µFTIR) imaging, we measured the number, estimated mass, and types of MP larger than 10 µm in stool samples. Then, using an ELISA assay, we measured fecal calprotectin. We conducted Spearman’s partial correlation analyses while controlling for IBD status.

Results

Of the 11 study participants in this pilot analysis, four individuals had IBD. The median (IQR) age at enrollment was 38 years (IQR 34, 29). MPs were detected in all third trimester stool samples, with a count ranging from 34-410 particles/g dry weight of stool. The distribution of types of MP is reported in Figure(a). The median fecal calprotectin level for those with and without IBD was 48.1 µg/g and 13.2 µg/g, respectively. The counts and total mass of MP in stool samples were positively rank correlated with fecal calprotectin concentration on controlling for IBD status (Spearman’s r = 0.65, p = 0.04 and 0.48, p = 0.16, respectively; Figure(b)).

Conclusion

MP were detected in all stool samples in our pilot analysis of pregnant women with and without CD, and higher MP count was correlated with fecal calprotectin, indicative of intestinal inflammation. Further exploration of MP in intestinal inflammation and IBD, including transgenerational impact, is ongoing.

Figure: (A) Distribution of microplastics and their subtypes across stool samples from study participants (B) Correlation between microplastic count and fecal calprotectin concentration.
P1247 An argument for screening? Disordered eating patterns are highly prevalent in Inflammatory Bowel Disease (IBD)
Authors: Grande E , Barnes A , Mountifield R
Published: January 2025

Background

The complex relationship between body image perception, disordered eating behaviours, and quality of life (QoL) has been poorly examined in patients with IBD. Although individuals with chronic gastrointestinal conditions are at an increased risk for disordered eating behaviours, the prevalence and risk factors associated with these attitudes remain underexplored in IBD. Therefore, this study aimed to investigate the relationship between IBD activity, body image perception, and disordered eating behaviours to determine clinical features that impact patient QoL.

Methods

An online questionnaire was administered through a tertiary centre IBD clinic in South Australia. Disordered eating behaviours were assessed via the validated Eating Disorder Examination-Questionnaire (EDE-Q7). Clinically significant eating disorder attitude is defined as EDE-Q7 score >3.5. Univariate and multivariate logistic regression analyses were performed to correlate clinically significant disordered eating behaviours with patient sex, disease activity, and the presence of clinical depression or anxiety.

Results

In a cohort of 210 respondents, clinically significant disordered eating behaviours were observed in 33.2% of respondents. Higher global EDE-Q7 scores were significantly associated with female sex (P<0.0001), active IBD (P=0.0169), and clinical depression (P<0.0001) and anxiety (P<0.0001). High global dietary restraint, shape/weight overevaluation, and body dissatisfaction subscores were significantly associated with female sex (P=0.0063; P=0.0001; P<0.0001), patients with clinical depression (P=0.0142; P<0.0001; P<0.0001), and patients with clinical anxiety (P=0.0003; P<0.0001; P<0.0001). IBD activity and Crohn’s disease were significantly associated with high global shape/weight overevaluation subscores (P=0.0216; P=0.0175) and body dissatisfaction subscores (P=0.0063;P=0.0117). Furthermore, clinically significant disordered eating behaviours were significantly associated with IBD activity (OR, 2.2; 95% CI, 1.3-4.0; P=0.007), clinical anxiety (OR, 7.7; 95% CI, 4.0-14.7; P<0.0001) and clinical depression (OR, 4.6; 95% CI, 2.4-8.7; P<0.0001). Multivariate regression analysis showed that the odds of high global EDE-Q7 scores are significantly increased by clinical anxiety (OR, 8.9; 95% CI, 4.3-18.4; P<0.0001).

Conclusion

This study demonstrates that disordered eating behaviours are highly prevalent in patients with IBD. Collectively, these findings provide important insight into the eating and body image behaviours that impact the QoL of patients with IBD.
P1249 Higher dietary glycemic index, but not glycemic load, is associated with increased risk of ulcerative colitis: a prospective cohort study
Authors: Ye S , Fu T , Tu Y , Wellens J , Chen X , Larsson S C , Sun J , Dan L , Wan X , Chen J , Magro F
Published: January 2025

Background

Previous epidemiological studies observed inconsistent effects of carbohydrate intake on incident inflammatory bowel disease (IBD). We aimed to evaluate the effects of glycemic index and glycemic load, the two main indicators to measure the quality and quantity of carbohydrates, on the risk of two main subtypes of IBD, Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

This analysis included 121,148 participants who were free of IBD at baseline in the UK Biobank. We collected dietary information from a validated web-based 24-hour dietary recalls questionnaire and estimated dietary glycemic index and glycemic load based on carbohydrate foods. The primary outcome was the incident CD and UC. Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Substitution analyses were conducted to test associations with risk for CD and UC after replacing medium or high glycemic index foods with low glycemic index foods.

Results

In the current analysis, participants with lowest quartile of glycemic index were more likely to be females, and with lower BMI, and those with highest quartile of glycemic load were more likely to be none to moderate alcohol consumers and non-smokers. During a median follow-up of 10.6 years, 133 incident CD and 335 incident UC cases were identified. In the fully multivariable-adjusted model, a 13% (95% CI 1%-27%) higher risk of UC was associated with each 1-SD increment of dietary glycemic index. Comparing the lowest glycemic index, we found that highest dietary quartile of glycemic index was associated with increased risk of UC (HR 1.46, 95%CI 1.07-1.99, P = 0.016; P for trend = 0.005), but not with CD. We did not find significant associations between dietary glycemic load with risk of CD and UC. Additionally, replacing medium or medium and high glycemic index foods with low glycemic index foods was associated with a lower risk of UC, respectively.

Conclusion

Conclusion: Our findings provide evidence that a higher dietary glycemic index, but not glycemic load, was associated with an increased risk of UC, further demonstrated by the substitution analyses, suggesting the importance of dietary glycemic index in dietary recommendations for UC prevention. Therefore, the large interventional trial should be considered to evaluate the role of low glycemic index diets in preventing UC and expected to be applied in dietary recommendations for UC prevention.
P1251 A Care Pathway for Inflammatory Bowel Disease can Reduce Healthcare Costs and is Cost-Effective
Authors: Visser E , Oude Voshaar A M , van Linschoten R , Bodelier A , Fitzpatrick C , de Jonge V , Vermeulen H , Verweij E , van der Wiel S , van der Horst D , van der Woude C J , West R L , van Noord D ,   Southwest Netherlands IBD Study Group
Published: January 2025

Background

Hospitals in the southwest of the Netherlands collaborate to improve inflammatory bowel disease (IBD) care. As part of this initiative, a standardised care pathway (CP) for the treatment of IBD with biologics and small new molecules has been developed. The CP addresses initiation, switching, and discontinuation of therapy, as well as diagnostic testing and treatment follow-up. The CP has been implemented in six of the eight hospitals to improve patient outcomes, standardise care and reduce healthcare costs. This natural experiment provides an opportunity to evaluate the cost-effectiveness of the CP using a quasi-experimental design. We aimed to estimate the causal effect of CP implementation on costs and health outcomes.

Methods

A cost-utility analysis with a societal perspective was conducted. Adult patients with an IBD diagnosis for at least 3 months and treated with biologics and small new molecules were eligible for inclusion. Costs were assessed for both standard care (December 2020 - December 2021) and the CP over a one-year period (March 2022 – March 2023), without discounting costs and effects and standardizing costs to 2022. Missing data were handled using single imputation nested within a bootstrap procedure. The analysis employed a difference-in-differences (DiD) approach to estimate causal effects of the CP implementation, controlling for pre-existing differences between hospitals and general time trends that would have occurred without the intervention. For the cost-effectiveness analysis, we utilized the cumulative incremental costs and mean incremental quality adjusted life years (QALYs) from the post-intervention DiD effects. The DiD-derived incremental costs and QALYs were used to calculate the incremental cost-effectiveness ratio (ICER) and construct cost-effectiveness acceptability curves using normal approximation.

Results

Approximately 25% of the eligible population was included. At baseline, patients in intervention (n=842) and control hospitals (n=331) had comparable characteristics in terms of age, sex, diagnosis and comorbidities. The DiD-analysis showed cost savings primarily driven by reduced hospital costs (-€1,107; 95%CI: -€2,130 to -€109) while maintaining quality of life (QALY difference: 0.01; 95%CI: -0.02 to 0.04). The ICER was located in the southeast corner of the cost-effectiveness plane, indicating that the treatment with the CP is a dominant strategy compared to standard care (Figure 1).

Conclusion

A CP for the treatment of IBD with biologics and small new molecules was developed to improve IBD care and reduce healthcare costs. Our results showed that standardising IBD care is effective for reducing healthcare costs, while maintaining quality of life.
P1254 The impact of vitamin D supplementation on clinical outcomes in Inflammatory Bowel Disease: a regression discontinuity analysis
Authors: Sninsky J , Sansgiry S , Taylor T , Perrin M , Kanwal F , Hou J
Published: January 2025

Background

Vitamin D deficiency is prevalent among patients with Inflammatory Bowel Disease (IBD) and is associated with adverse clinical outcomes. While vitamin D's immunomodulatory and anti-inflammatory properties suggest potential therapeutic benefits, its effect on IBD management remains uncertain. This study evaluates the impact of vitamin D supplementation on corticosteroid use, emergency department (ED) visits, and hospitalisations using a quasi-experimental regression discontinuity design (RDD).

Methods

A retrospective cohort of IBD patients within the United States Veterans Health Administration was analysed from 2000–2024. Patients prescribed vitamin D within three months after a serum 25-hydroxyvitamin D assay were included, excluding those with prior supplementation or subtherapeutic dosing (<1,000 IU/day). Outcomes were assessed 3–15 months post-assay. Using the 30 ng/mL vitamin D threshold, RDD was employed to estimate causal effects, adjusting for covariates (age, gender, and IBD type). Statistical analysis was performed with the RDrobust statistical package.

Results

Among 5,021 IBD patients (median age 63 years; 89% male; 58% Ulcerative Colitis, 39% Crohn’s Disease, 3% Indeterminate Colitis), the median vitamin D level was 23 ng/mL. Approximately 41% of patients were prescribed vitamin D. Patients with vitamin D levels just below the 30 ng/mL threshold were significantly more likely to receive supplementation compared to those above the threshold (35% vs 24%, p = 0.02)(Fig 1A). Vitamin D supplementation demonstrated a 36% absolute risk reduction (ARR) in corticosteroid use at the 30 ng/mL threshold (95% CI: [-0.72, 0.00], p = 0.05)(Fig 1B). Trends towards reduced ED visits (ARR 17%) and hospitalisations (ARR 3%) were observed, though these findings did not achieve statistical significance.

Conclusion

Vitamin D supplementation at levels near the 30 ng/mL threshold significantly reduces corticosteroid use in IBD patients. While trends towards reduced ED visits and hospitalisations were not statistically significant, the directionality supports potential broader benefits. This study highlights the utility of vitamin D as a low-cost, accessible adjunct therapy in IBD management, particularly for those with deficiency. Further prospective studies are warranted to confirm these findings, optimise dosing strategies, and establish the ideal therapeutic targets for vitamin D in this population.
P1256 Prevalence and Predictive Factors of Cutaneous Manifestations in IBD Patients: A Cohort Study
Authors: Darkaoui D , Benmoussa M , Koulali H , Zazour A , Elmqaddem O , Ismaili Z , Kharrasse G
Published: January 2025

Background

Inflammatory bowel disease (IBD) is a systemic disorder affecting multiple organ systems, including the skin, musculoskeletal, and ocular systems. the clinical manifestations range from mild and transient to severe, with significant impacts on morbidity, quality of life, and healthcare costs. This study aims to evaluate the prevalence and predictive factors of cutaneous manifestations in IBD patients.

Methods

This retrospective study, conducted over eight years from January 2016 to December 2023, included IBD patients. Dermatological lesions (excluding anoperineal lesions) were diagnosed by dermatologists through clinical examinations, cultures, and biopsies as needed. Data were extracted from medical records and analyzed using SPSS version 21.0.

Results

A total of 273 IBD patients were included, with a median age of 41 years (range 15–72, SD ±13). Among them, 141 (51.6%) were female, resulting in a female-to-male ratio of 1.06. Crohn's disease (CD) was diagnosed in 175 patients (64%) and ulcerative colitis (UC) in 98 (36%). Cutaneous manifestations occurred in 89 patients (32.6%), with a median age of 39 years (range 15–70, SD ±13).

Gender and Contraception

Of the 89 patients with dermatological symptoms, 45 (50%) were female, with no significant gender association (p = 0.8). However, 40% of the females with cutaneous manifestations were using contraception (p = 0.05).

IBD Subtypes

Cutaneous manifestations were more common in CD patients (35%) than in UC patients (27.6%), but this difference was not significant (p = 0.18).

Medication and Lifestyle Factors

NSAID use was significantly associated with cutaneous manifestations (44%, p = 0.03), while smoking (35%, p = 0.61) and alcohol use (24%, p = 0.34) showed no significant associations.

Inflammatory Markers and Perianal Disease

Elevated CRP levels were linked to dermatological symptoms (39.5%, p = 0.04). Among CD patients with perianal manifestations, 26 out of 51 developed cutaneous symptoms (p = 0.008).

Other Factors

Family history of IBD (10%, p = 0.69), history of abdominal surgery (36.9%, p = 0.2), corticosteroid use (34.1%, p = 0.66), and vitamin D deficiency (33.6%, p = 0.64) were not significantly associated with cutaneous manifestations.

Conclusion

Cutaneous manifestations were observed in 32.6% of IBD patients, more often in CD than UC. Significant predictors of dermatological symptoms included contraceptive use, NSAID use, and elevated CRP levels. In CD patients, perianal manifestations were strongly linked to cutaneous symptoms (p = 0.008). These findings emphasize the need for gender and management of IBD-related skin issues, along with further research to explore underlying mechanisms and develop targeted therapies.