bluuebunny/crossref_metadata_2025 huggingface dataset:
P1245 Maternal intake of fish, dietary n-3 polyunsaturated fatty acids, and fish oil supplements during pregnancy and risk of early childhood Inflammatory Bowel Disease in the offspring
Authors: Brusco De Freitas M , Anneberg O M , Frodi Olsen S , Vinkel Hansen A , Ahrendt Bjerregaard A , Ingi Halldórsson Þ , Jess T
Published: January 2025

Background

A key question remains unanswered: whether maternal consumption of fish and fish oil supplements during pregnancy is associated with the risk of early childhood inflammatory bowel disease (IBD) in offspring. This association was examined in the present study.

Methods

Data from the Danish National Birth Cohort (1996–2002) were used, which collected maternal dietary data in early pregnancy using a food frequency questionnaire (FFQ), and data from the National Patient Registry to identify IBD cases. The study included mother-child dyads in which the mother had a singleton pregnancy, responded to the FFQ and demonstrated plausible energy intake and children under the age of 18 were considered. The exposure variables were assessed as tertiles of maternal intake of total fish (g/day), oily fish (g/day), lean fish (g/day), n-3 polyunsaturated fatty acids (PUFA) (g/day) from diet, and fish oil supplements (yes/no). Cox regression was used to calculate the hazard ratio (HR) with 95% confidence intervals (CIs) with the first tertile [T (lower intakes)] as the reference. Analyses were adjusted for maternal educational level, gestational weight gain, alcohol intake, smoking, antibiotics, parental IBD, diet quality (Healthy Eating Index), and offspring antibiotic consumption.

Results

The study included data on 67,770 mother-child dyads, and, among the offspring, 192 cases of IBD [Crohn disease (CD), n= 106; ulcerative colitis (UC), n= 86] were identified. The mean intake (standard deviation [SD]) in g/d was 27.2 (±6.10) of fish, 14.7 (±3.79) of oily fish and 12.5 (±3.34) of lean fish. The mean (SD) intake of n-3 PUFA was 0.509 g/d (±0.40), and 5.9% of women consumed fish oil during pregnancy. High maternal intake (T3) of n-3 PUFA was associated with a 38% reduction in IBD risk (HR: 0.62, 95% CI: 0.38-0.98) in offspring, whereas average intake of oily fish reduced the risk of UC in offspring (p= 0.047). Average (T2) and high intakes of lean fish also reduced the risk of IBD, by 49% (HR: 0.51, 95% CI: 0.33-0.77) and 35% (HR: 0.65, 95% CI: 0.43-0.98), respectively. More specifically, an average intake of lean fish reduced offspring CD risk by 58% (HR: 0.42, 95% CI: 0.23-0.77). No association was found in relation to the other variables.

Conclusion

The type of fish consumed during pregnancy appeared to influence the risk of developing CD and UC differently. Our large-scale population study suggests that maternal consumption of oily fish is protective against the development of UC in offspring, while maternal consumption of lean fish is protective against development of CD in offspring. Overall, these results favor fish consumption in pregnancy.
P1248 Higher Life’s Essential 8 score is associated with reduced risk of IBD-related surgery and all-cause mortality among 3,232 individuals with inflammatory bowel disease in a prospective cohort study
Authors: Jing F , Cao Y , Gong Q , Dan L , Zhu Y , Magro F , Fu T , Wang X , Chen J
Published: January 2025

Background

Previous studies indicated lifestyles that benefit cardiovascular health, are associated with the risk of prognosis in inflammatory bowel disease (IBD), while evidence lacked regarding the impact of cardiovascular health as a whole. We aimed to explore the potential longitudinal association between the overall cardiovascular health indicator, Life’s Essential 8 (LE8), and the adverse outcomes of IBD.

Methods

Using data from the UK Biobank, we included 3,232 individuals with IBD recruited in 2006–2010. The components of LE8, including diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure, were measured and given a score of 0–100. The LE8 score for each individual was the mean score of all components and was divided into three levels: low (0–49), moderate (50–79), and high (80–100). The adverse outcomes studies in our study included IBD-related surgery and all-cause mortality, ascertained via primary care, hospital inpatient data, and death registry. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the magnitude of the associations.

Results

Among the 3,232 individuals with IBD, 1,579 were female (49%) and 2,227 were with UC (69%). Over a mean (standard deviation) follow-up of 12.60 (2.74) years and 13.17 (1.89) years, 282 IBD-related surgery and 259 death events were documented. Among participants with UC, compared to participants with low LE8 score, the HRs (95% CIs) of those with high score for IBD-related surgery and all-cause mortality were 0.47 (0.26, 0.87) and 0.47 (0.25, 0.87). Similar inverse associations were demonstrated from the competing risk model between LE8 score and IBD-related surgery among individuals with UC. In addition, we did not observe any significant associations of LE8 score with the risk of IBD-related surgery and all-cause mortality among CD. The above associations were robust in sensitivity analyses when further adjusted for aminosalicylate use, corticosteroid use, immunomodulator use, CRP concentration, or baseline IBD duration separately.

Conclusion

Conclusion: Participants with higher LE8 score showed decreased risk of IBD-related surgery and all-cause mortality among individuals with UC, but not CD, highlighting the important role of adopting LE8 in improving the prognosis of UC. Future randomized control studies are needed to confirm the effect of enhancing LE8 score to reduce the risk of IBD-related surgery and all-cause mortality and better manage the disease course of IBD.
P1250 Spondyloarthritis before and after inflammatory bowel disease diagnosis and risk factors: a temporal trends analysis in a population-based cohort
Authors: Agrawal M , Sorensen C , Poulsen G , Moghaddam B , Gulko P S , Colombel J F , Jess T
Published: January 2025

Background

Axial and peripheral spondyloarthritides (SpA) and inflammatory bowel disease (IBD) are immune-mediated diseases with overlap in clinical and immunological features. However, temporal correlation of SpA and IBD in individual patients is not well characterized.

Methods

We conducted a nationwide population-based study between January 1, 1998 and July 31, 2022 to determine SpA prevalence before, and incidence after IBD diagnosis. Using ICD-10 codes in cross-linked Danish registers, we identified all residents with IBD diagnosis between January 1, 2006 and July 31, 2014 as well as controls matched 1:5 on age, sex, calendar year, and municipality of residency. We determined the odds ratios of SpA in the IBD group in the preceding years. Using adjusted Cox regression analysis, we determined the hazard ratios of new-onset SpA following IBD diagnosis in the proceeding years.

Results

Of 111,696 individuals included in the study, 18,616 (16.7%) were diagnosed with IBD. The prevalence of SpA was higher in IBD cases relative to matched controls (Figure). The aOR of SpA among those who later developed IBD, UC, or CD, compared to matched controls, was 1.98 (95% CI 1.81, 2.17), 1.67 (95% CI 1.49, 1.87) and 2.76 (95% CI 2.37, 3.21), respectively, in the 8-year period preceding IBD diagnosis. The odds of SpA were highest in the 2 years preceding IBD diagnosis. Among those with IBD, UC, and CD, compared to those without IBD, the aHR of new-onset SpA was 2.47 (95% CI 2.30, 2.65), 2.18 (2.00, 2.37), and 3.20 (95% CI 2.84, 3.60), respectively. When stratifying the IBD effect of SpA on sex and age, both females and the age group 8-45 years had higher risks for SpA following IBD diagnosis, when compared to male and older age groups, respectively.

Conclusion

In a population-based cohort, we demonstrate that the odds of SpA diagnosis are increased at least up to 8 years preceding IBD diagnosis and are highest 2 years preceding IBD diagnosis. SpA risk is increased among those with IBD, particularly among women and young adults. These clinical associations can improve early diagnosis and treatment of both IBD and SpA.
P1252 Prevalence, Incidence and Mortality of Pediatric Inflammatory Bowel Disease in Catalonia
Authors: Brunet E , Loverdos I , Vela E , Comalrena de Sobregrau C , Garcia-Tirado D , Melcarne L , Pontes C , Llovet L P , Garcia-Sague B , Frisancho L E , Lario S , Puy A , Ramirez-Lazaro M J , Villoria A , Calvet X
Published: January 2025

Background: Introduction

The epidemiologic status of pediatric inflammatory bowel disease (PIBD) has not been widely studied in Western Europe. The prevalence and incidence trends of the disease are largely unknown. The aim of this study is to determine the prevalence and incidence of PIBD and its mortality rate in Catalonia in the period 2011-2023.

Methods: Material and methods

A longitudinal study was performed using population-based data from the Catalan Health Surveillance System (CHSS). Data on prevalence, incidence and mortality of IBD in patients under the age of 18 years were obtained. Trends in age- and sex-adjusted rates were estimated. Crohn's disease (CD) and ulcerative colitis (UC) were also analysed separately.

Results

The number of PIBD patients rose from 307 in 2011 to 725 in 2023, with increases of 173% in UC and 113% in CD. The age- and sex-adjusted prevalence of PIBD rose from 23 (95%CI 20.5-25.7) to 48.1 (95%CI 44.7-51.7) per 1,000,000 inhabitants, while the annual incidence doubled, from 81 to 168. Although the peak incidence was recorded in 2022, the data suggest a flattening of the incidence curve in recent years. Seven patients died during follow-up, although the mortality rates were too low for further analysis.

Conclusion

Conclusion: The prevalence of PIBD is increasing rapidly in Catalonia. We observed also a trend towards a plateauing in the incidence that may suggest that prevalence might stabilize in the coming years.

References

N/A
P1255 Impact of depression on health related quality of life in Ulcerative Colitis patients-are we doing enough? A single tertiary center experience
Authors: Jaksic D , Vuksanovic S , Toplicanin A , Spiric--Milovancevic J , Maric G , Sokic-Milutinovic A
Published: January 2025

Background

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that significantly impacts patient’s health-related quality of life (HRQOL). Psychological factors such as anxiety, depression, and alexithymia may exacerbate these effects. This study aims to evaluate: HRQOL and possible factors affecting it, prevalence of anxiety, depression and alexytimia in patients with UC.

Methods

A cross-sectional study included 248 UC patients (117 males, mean age 44,7±14,6, 21 with proctitis, 63 with left sided and 164 with extensive colitis) Data were collected using standardized self-administered questionnaires (socio-demographic, GAD-7, PHQ-9, TAS-20 and SIBDQ-10). Clinical data on remission status, extraintestinal manifestations (EIM), comorbidities and use of advanced therapies were also collected. Hierarchical regression analysis of variables predicting SIBDQ-10 score in UC was done.

Results

In our patients average disease duration was 9.3 ± 7.4 years (range 0-49). 198 patients (79.8%) were treated with advanced therapies. Clinical and laboratory remission was present in 237 (95.6%) patients. Prevalence of depression, anxiety and alexithymia were 44.7%, 34.3% and 30.2% respectively. There were no differences in PHQ-9, GAD-7 and TAS-20 scores in relation to remission status (p>0.05). Average SIBDQ score was 56.5 ± 10.9. Patients in remission reported better SIBDQ-10 compared to those experiencing active symptoms (p=0.002). Results of hierarchical regresion analysis showed that remission of disease and higher depression score are the main factors influencing HRQOL in UC patients.

Conclusion

Prevalence of depression, anxiety and alexithymia in UC patients is high, even if disease is in remission. Remission of disease and high depression score are the main factors related to HRQOL. Depression adversely affects HRQOL in UC patients, highlighting the need for psychological screening and integrated mental health support in all UC patients. Strategies aimed at enhancing emotional well-being may improve overall quality of life and disease management in UC.
P1261 Reproductive Health Outcomes in Colombian Women with Inflammatory Bowel Disease: A Multicenter Cohort Study on Pregnancy, Fertility, and Disease Impact (REINFORCE Study)
Authors: Parra Izquierdo V , Osorio-Castrillon L , Juliao-Baños F , Frías-Ordoñez J
Published: January 2025

Background

The impact of Inflammatory Bowel Disease (IBD) on women's health, particularly in relation to reproductive health, remains an underexplored area in Latin American populations. This study aims to assess the effects of IBD on women's reproductive health, including pregnancy outcomes, fertility, and related complications, within a cohort of Colombian women.

Methods

Observational, multicenter and descriptive study involving adult and pediatric patients from two IBD Centers in different cities in Colombia. The study focused on evaluating aspects of sexual and reproductive health in women with IBD, with detailed data collection on pregnancy, fertility, childbirth, and cancer screening.

Results

Out of a total of 121 women with IBD, 63.6% (77/121 patients) were in reproductive age (15–44 years according to World Health Organization) (Table 1), the mean age was 33.2 years (range: 17.2–44.8 years, SD: 8), with a mean age at diagnosis of 28 years (range: 9.3–45.1 years, SD: 8.8) and a disease duration of 5.2 years (range: 0.3–21.9 years, SD: 4.7). UC was more prevalent in this group (71.4%). Most women had low rates of smoking, hospitalization, and surgical interventions for IBD, and pregnancy-related complications were generally rare. The majority of births were vaginal deliveries, and breastfeeding beyond 6 months was common, suggesting protective effects against IBD risk in offspring. Notably, while HPV vaccination rates were low, the prevalence of cervical cancer was also low. Family planning was reported by 48% of participants, and 1% required assisted reproductive technologies. Statistical analysis showed no significant association between age and pregnancy complications across age groups. However, UC was significantly associated with a higher risk of pregnancy complications (OR 5.5; 95% CI: 1.9–14.9; p=0.0001), and Crohn's disease (CD) also showed a trend toward increased risk (OR 4.6; 95% CI : 0.2–20.4; p=0.00002). Previous history of hospitalization due to disease activity, surgery, and the use of biological therapy was associated with an increased risk of pregnancy complications when it occurred (OR 1.97; 95% CI: 1.6–2.5; p= 0.07 for hospitalization, OR 12.12; 95% CI: 4.2–27.8; p=0.03 for surgery, OR 5.2; 95% CI: 1.64-13.1 ;p=0.00001).

Conclusion

This study underscores the significant impact of IBD on reproductive health in Colombian women, similar to trends in other populations. It emphasizes the importance of effective disease management before conception, given that the use of biological therapies that usually are associated with more severe disease, ongoing disease activity, and prior surgical interventions are risk factors for increased pregnancy complications.
P1262 Factors associated with bowel urgency in patients with inflammatory bowel disease – interims analysis of the Health Outcome Observatory (H2O) project
Authors: Schreiner P O , Fierens L , Ferrante M , Primas C , Dabsch S , Schilling V , Frick A , Reinisch W , Dejaco C , Schweiger K , Ritschl V , Mosor E , Long P , Winkler E , Mooslechner T , Wisniowski K , Kazemi-Shirazi L , Bäuerle M , Novacek G , Stamm T
Published: January 2025

Background

Bowel urgency is one of the most bothersome symptoms in patients with Ulcerative colitis (UC) and Crohn´s disease (CD). However, only recently attention has been focused on this symptom and data on associated factors, especially in patients with CD, is scarce. The Health Outcome Observatory (H2O) project aims to standardize and facilitate the collection of patients reported outcomes (PROs) and clinical outcomes by developing multi-stakeholder agreed Core Outcome Sets (COS) including one for patients with inflammatory bowel disease (IBD). The present study describes preliminary data on bowel urgency.

Methods

We analyzed prospectively collected data from the Health Outcome Observatory (H2O) project at the Medical University of Vienna, Austria. Bowel urgency was one of the collected variables and was defined by the validated Urgency Numeric Rating Scale (NRS) ≥ 3 (on a 0-10 scale). We used linear regression with bowel urgency as the outcome and age, gender, diagnosis (CD/IBDU/UC) and quality of life (PROMIS_Global_10_02; scale from 1-5) as predictors.

Results

Out of a total of 480 included patients who took part in the H2O project, we analyzed 388 patients who answered the question regarding bowel urgency. The mean urgency NRS in CD patients was 2.71 (SD +/- 2.92) and 2.24 in UC (SD +/- 2.68). Numerically more patients with CD (40.9%) than with UC (33.8%) complained about bowel urgency. Quality of life (coef 1.30, coef (95% CI) 1.01-1.59, p<0.01) was associated with bowel urgency. Age, gender, diagnosis (CD vs UC vs IBDU) was not associated with bowel urgency (see Table 1).

Conclusion

Bowel urgency is a common symptom in patients with inflammatory bowel disease and is associated with a lower quality of life. Caregivers should acknowledge the importance of this debilitating symptom.

References

Fierens L, Carney N, Novacek G, van der Woude CJ, Siegmund B, CasellasF, Borruel N, Huberts AS, Sonnenberg E, Gerold N, Primas C, Hedin CRH,Stamm T, Julsgaard M, Fiorino G, Radice S, Zini MLL, Gross E, Sander C,Arijs I, Vakouftsi VR, Koltai T, Health Outcomes Observatory H O PatientAdvisory Board For Inflammatory Bowel Diseases, Health OutcomesObservatory H2O Steering Committee, Charlafti I, Ferrante M. A CoreOutcome Set for Inflammatory Bowel Diseases: Development andRecommendations for Implementation in Clinical Practice Through anInternational Multi-stakeholder Consensus Process. J Crohns Colitis.2024 Oct 15;18(10):1583-1595. doi: 10.1093/ecco-jcc/jjad195. PMID:38019894.
P1263 Real-World Evidence Needs for Treatment Sequence Disease Modelling in Refractory Inflammatory Bowel Disease
Authors: Kodjamanova P , Sanon M , Dimova M , Wu E , Atanasov P
Published: January 2025

Background

Sequential use of biologics in Inflammatory Bowel Disease (IBD) is often required in clinical practice to restore or maintain long-term remission. Health technology agencies are requiring treatment sequencing models which are more reflective of clinical practice. The accurate modelling of treatment sequences would help better understand expected patient benefit and make more informed decisions. The aim of our targeted literature review (TLR) was to identify real-world evidence (RWE) on the effectiveness of second-line or later treatments for Crohn’s disease (CD) or ulcerative colitis (UC) refractory to initial therapy and assess its suitability for treatment sequence modelling.

Methods

We identified observational studies from Europe, the United States (US), and Canada via EMBASE, MEDLINE, and MEDLINE-In-Process (searched from 01/01/2018 to 11/12/2023). Study selection was conducted by a senior researcher and quality was checked by a second one. Evidence was analysed to assess the availability of clinical remission and response, and steroid-free remission data by line of therapy and across various time points. We then conducted a gap analysis against the evidence needs of a treatment sequence model

Results

After screening a total of 145 publications were included for data extraction in the review: 61 in ulcerative colitis (UC), 50 in Crohn’s disease (CD), and 34 in combined IBD. Studies were predominantly conducted in Europe (n=95), followed by the US (n=26), and Canada (n=3). A total of 12 studies reported clinical remission for first line, four for second line, and two each for third and fourth lines of treatments of refractory patients with UC. Additionally, eight studies reported data for first line, seven for second line, eight for third line, three for fourth line, and two for fifth line treatments of refractory patients with CD. The remaining studies combined results for multiple lines of treatment. Clinical remission during maintenance for patients with CD ranged between 47% - 79%, 38% - 87%, 28% - 68%, and 16% - 63%, for first, second, third, and fourth line, respectively and 40%-67%, 35% - 77%, 41% - 47%, and 16% - 21% for patients with UC. Studies lacked granularity in the assessment of clinical remission and response specific to individual treatments, stratified by specific treatment failure history

Conclusion

Studies identified in our evidence review did not report sufficiently granular data on clinical response or remission to reliably inform a treatment sequence model. Addressing these data gaps is essential for enabling more reliable decision-making in clinical practice, supporting better resource allocation, and ultimately improving long-term outcomes for refractory patients with IBD.
P1264 Metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with Inflammatory Bowel Disease (IBD). A prospective single-center study
Authors: Pastras P , Papantoniou K , Tsounis E , Kanaloupitis S , Aggeletopoulou I , Geramoutsos G , Sotiropoulos C , Zisimopoulos K , Thomopoulos K , Theocharis G , Triantos C
Published: January 2025

Background

Inflammatory bowel disease (IBD) has been linked to an increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This study assesses MASLD prevalence in IBD patients and its associations with demographic, clinical, and laboratory features.

Methods

This prospective study included 113 adult IBD outpatients [Crohn’s disease (CD): 63, ulcerative colitis (UC): 49, unclassified colitis: 1; male/female: 68/45; mean age: 47.8 years (SD: 15.06); mean age at IBD diagnosis: 35.84 years (SD: 15.57)] derived from the Gastroenterology Division, University Hospital of Patras, Greece. Of these, 95 patients underwent ultrasound, clinical evaluation, and laboratory testing to diagnose MASLD.

Results

Among the 95 patients evaluated, 22 (23.2%) were diagnosed with MASLD, 8 (9.4%) with alcoholic liver disease (ALD), and 65 (68.4%) had no steatotic liver disease (No-SLD). MASLD patients were predominantly male (n = 11), with a CD to UC ratio of 16:6, a mean age of 46.4 years (SD:10.80), and a mean IBD diagnosis age 34.82 years (SD:14.20). Patients with MASLD had significantly increased rates of central obesity (p = 0.001, OR = 5.90, CI: 2.10-16.58), overall obesity (p = 0.001, OR = 4.2, CI:1.15-15.22), higher body mass index (BMI) (p = 0.001, OR-1.25, CI:1.10-1.42), elevated SGOT (p=0.019, OR=1.06, CI=1.01-1.117), SGPT (p=0,027, OR=1.03, CI=1.003-1.059), and greater waist circumference (p=0.04, OR=1.05, CI:1.01-1.09) compared to non-MASLD patients. No significant differences were observed between groups regarding age (p = 0.787), age at IBD diagnosis (p = 0.723), sex distribution (p = 0.277), disease type (p = 0.312), smoking status (p = 0.335), γ-GT (p = 0.896) and ALP (p = 0.440). Lastly, no significant differences were found regarding IBD clinical activity markers (CDAI, p = 0.698; Trulove-Witts, p = 0.764), CRP (p=0.798), IBD-related surgery(p=0.734), or extraintestinal manifestations(p=0.059).

Conclusion

MASLD is prevalent among IBD patients and is significantly associated with central and overall obesity, increased BMI, liver enzymes, and waist circumference. These findings suggest MASLD could be an early indicator of metabolic syndrome in IBD patients, preceding other cardiometabolic disorders. Further research is needed to clarify the relationship between MASLD and IBD and guide early intervention strategies.
P1266 Gender Influence on Cutaneous Manifestations in IBD: A Focus on Contraceptive Use
Authors: Darkaoui D , benmoussa M , Koulali H , Zazour A , Ouiam E , Ismaili Z , Kharrasse G
Published: January 2025

Background

Inflammatory bowel disease (IBD) encompasses disorders characterized by chronic relapsing intestinal inflammation, often accompanied by extraintestinal manifestations, including skin involvement. The relationship between gender and cutaneous manifestations in IBD remains debated. This study aims to analyze the association between gender, contraceptive use, and the occurrence 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 with a median age of 41 years (range 15–72, SD ±13). Females accounted for 51.6% (n = 141). Cutaneous manifestations were observed in 89 patients (32.6%), with a median age of 39 years (range 15–70, SD ±13) and a female-to-male ratio of 1.02.

Among these 89 patients, 45 (31.9%) were female, with no significant gender association (P = 0.8). Of the 141 female patients, 18 (24.7%) were using contraception and exhibited cutaneous manifestations, showing a significant association (P = 0.05). Regarding disease type, 62 patients (35.4%) had Crohn's disease, while 27 (27%) had ulcerative colitis, with no significant difference in cutaneous manifestations between the groups (P = 0.18).

Different subtypes of cutaneous manifestations included:

•Reactive lesions: 32 patients (11.7%), with 19 (13.5%) female (P = 0.6).

•IBD-associated lesions: 36 patients (13.2%), with 20 (14.2%) female (P = 0.61).

•Treatment-related mucocutaneous lesions: 48 patients (17.6%), with 26 (18.4%) female.

•Nutritional malabsorption-related lesions: 28 patients (10.3%), with no significant gender association (P = 0.32).

Notably, erythema nodosum was found exclusively in females (n = 5, 1.8%), showing a significant gender association (P = 0.02). Psoriasis occurred in 12 patients (4.4%), with 4 (3%) female, which was not significant (P = 0.19). Aphthous stomatitis affected 23 patients (8.4%), with 14 (9.9%) female (P = 0.35). Pyoderma gangrenosum and vitiligo were rare, with no notable gender disparities.

Conclusion

This study highlights the complex relationship between gender and skin manifestations in IBD, showing a significant association between erythema nodosum and females, as well as a link between contraceptive use and skin issues. These findings suggest the need for further research into the hormonal and immunological factors involved. Adopting gender-specific strategies in managing IBD-related skin manifestations could improve patient outcomes and inform clinical practice.
P1270 Drugs associated with Microscopic Colitis: a comprehensive pharmacovigilance analysis
Authors: Cohen Y , Ben-Horin S , Goldman A
Published: January 2025

Background

Microscopic colitis (MC), a chronic inflammatory disease of the colon, has a strong association with drug exposure. The evolving landscape of drug prescriptions highlights the need for ongoing monitoring of medications that may contribute to MC development. This study aimed to comprehensively analyze contemporary global pharmacovigilance data to identify drugs associated with increased reporting of MC in real-world settings.

Methods

We conducted a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) from September 2014 to June 2024. The reporting odds ratio (ROR) was used to identify drugs associated with increased reporting of MC, adjusted for age, sex, and concomitant medications already linked to MC through a multivariable logistic regression model.

Results

Of 12,510,699 individual case safety reports in the entire database, 2,661 cases of MC were identified, with 103 drugs reported in at least five cases. The mean age in MC reports was 64.4 (±15.3), with a female predominance (73%). While several known drug-MC associations were corroborated (PPI: ROR= 13.20 [95% CI: 11.70-14.95], SSRI: ROR= 15.40 [13.36-17.63]), angiotensin 2 receptor blockers (ARBs), Angiotensin-Converting Enzyme inhibitors (ACEis) and statins also emerged as major contributors to MC reporting (ROR = 9.23 [7.8–10.84], ROR = 2.02 [1.28-3], ROR= 2.72 [2.11–3.44], respectively). Additionally, a strong association was identified with tocilizumab (ROR = 6.10 [4.63–7.87]), anti-interleukin 17 antibodies (ROR = 2.85 [2.01 - 3.91]), and immune checkpoint inhibitors (ROR = 2.09 [1.61–2.67]). Concomitant treatment of one or more drugs that increase MC risk was reported in 50% of the cases and was significantly associated with MC reporting in the multivariable model, suggesting cumulative drug exposure as a potential MC risk factor.

Conclusion

In this global contemporary pharmacovigilance study, MC was associated with increased reporting of ARBs, statins, tocilizumab, anti-interleukin 17 antibodies, and immune checkpoint inhibitors. The link between ARBs and MC, along with their known association with autoimmune-like enteropathy, suggests shared underlying etiological pathways. Prescribing physicians should be aware of this potential toxicity when gastrointestinal symptoms develop, particularly in patients with relevant concomitant medications.

Table 1 highlights significant differences between individuals with and without MC in age, gender, time to onset, concomitant medications, and hospitalization rates.

Figure 1 presents reporting odds ratios (ROR) with 95% confidence intervals, highlighting drug associations with microscopic colitis (MC) across age- and sex-adjusted and fully adjusted models.
P1271 The Astur-Frailty-IBD Study: Prevalence and factors associated with Frailty in elderly patients with Inflammatory Bowel Disease.
Authors: Carballo-Folgoso L , Duque Alcorta J M , Varela P , De Francisco García R , Armesto González E , Mancebo Mata A , Pérez-Martínez I , Rodríguez López P , De Jorge Turrión M Á , Castaño-García A , García-Pérez C , Martínez Martín G , Fernández-González E , Chiminazzo V , Díaz-Simal A , Suarez A , Riestra S
Published: January 2025

Background

Frailty is a dynamic concept that provide a more comprehensive assessment of biological reserve and functional status rather than chronological age alone. The aim of this study is to evaluate the prevalence of frailty and to analyse the factors associated with this condition in elderly inflammatory bowel disease (IBD) patients.

Methods

As part of the Astur-Frailty-IBD study (a multicentre prospective study of elderly IBD patients attended at three hospitals in Asturias, Spain), we present the baseline data of the cohort. We recruited all consecutive IBD patients ≥ 60 years during outpatient visits between March 1 and June 30, 2024. Demographic data and clinical characteristics of IBD were collected from the medical records and disease activity was assessed using clinical scores and biomarkers. All the patients were surveyed by face-to-face questionaries. Frailty was assessed using the Fried Frailty Phenotype which defines non-frail (0 criteria), prefrail (1-2), and frail phenotype (≥ 3 criteria). Comorbidity was assessed using Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale-Geriatric (CIRS-G). Univariable and multivariable ordinal logistic regression model was performed.

Results

A total of 612 IBD patients (median age 68.8 years, 50.2% females, 56.4% Crohn’s disease, median duration of the disease 15 years) were included in our study. One hundred and three (16.8%) patients were considered frail, 302 (49.3%) prefrail and 207 (33.8%) non-frail. Association of demographic, social and clinical factors according to different frailty levels are shown in Table 1. Univariate analysis showed the factors that are independently associated with increased risk of frailty were higher age, female gender, higher BMI, osteoarticular disease, polypharmacy, clinical activity, faecal calprotectin ≥ 250 μg/g, currently use of steroids, immunomodulator, or biologics, CCI ≥4, and CIRS-G ≥ 3. In contrast, ulcerative colitis, IBD-Unclassified and having good family support were associated with a lower risk of frailty (p=0.02). On multivariate analysis, higher age, female gender, family support, osteoarticular disease, both axial and peripheral, polypharmacy, clinical activity, currently use of steroids, and CIRS-G ≥ 3 were independent predictors of increased risk of frailty. The strongest predictor of risk of frailty was the clinical activity. These results are presented in table 2.

Conclusion

In our cohort, higher age, female gender, poor family support, osteoarticular disease, polypharmacy, clinical activity, current use of steroids, and CIRS-G ≥ 3 are independent predictors of increased risk of frailty.
P1272 Spatio-temporal distribution of IBD incidence at a territorial level in northern France using the EPIMAD registry (2000-2017): analysis of environmental determinants suggests influence of agricultural practices.
Authors: Paumelle M , Occelli F , Sarter H , Fumery M , Savoye G , Ley D , Lanier C , Wakim L M , Deram A , Genin M
Published: January 2025

Background

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBDs) with complex and multifactorial etiologies. Genetic factors have been identified but cannot fully account for disease incidence. Spatial heterogeneity in IBD incidence has been reported across various countries and scales, suggesting a significant influence of environmental factors. Leveraging the population-based EPIMAD registry in northern France (6 million inhabitants), this study aimed to analyze the spatial distribution of CD and UC incidence and identify potential environmental risk factors at a territorial level.

Methods

This ecological study was conducted at the municipal level across 3,041 municipalities within the EPIMAD registry's area for the period 2000-2017. Incident cases included 9,019 CD and 5,789 UC patients. Spatio-temporal age- and sex-standardized incidence ratios were modeled using Bayesian hierarchical models. An inventory of open-access environmental data sources identified 128 datasets, 19 of which were selected to generate 112 indicators at the municipal level. These indicators included contamination levels (air, water, soil), proximity to emission sources (e.g., industrial sites), land use, agricultural practices, natural features, and climate. Ecological regressions were used to explore associations between environmental indicators and incidence.

Results

Significant spatial disparities in CD and UC incidence were observed, remaining stable over time (Figure 1). For both CD and UC, associations were found with certain types of crops (e.g., sugar beets, barley, wheat, flax, and potatoes) and several metals in soil (e.g., molybdenum, nickel). Associations were more pronounced for CD, including strong links with pesticide use indicators (growth regulators, herbicides, fungicides) and soil contamination by other metals such as arsenic, cadmium, and thallium. For UC, a unique association was observed with soil contamination by polycyclic aromatic hydrocarbons (PAHs), while no significant association with pesticide use was found.

Conclusion

These findings highlight a relationship between IBD incidence and agricultural practices, providing new insights to the existing literature. Multivariate approaches should be employed to better describe environmental exposure profiles. Additionally, individual-level epidemiological studies are needed to confirm and expand upon these results.
P1273 High Crohn's Disease incidence associated with multiple heavy metal contamination in agricultural soils: findings from the CROPS project in Northern France
Authors: Wakim L M , Occelli F , Sarter H , Fumery M , Savoye G , Lanier C , Ley D , Paumelle M , Genin M , Deram A
Published: January 2025

Background

Crohn's Disease (CD) is a chronic intestinal disease with an unclear etiology and suspected environmental risk factors. The CROPS (CROhn’s disease and Pollution of Soils) project was initiated in Northern France to investigate links between the high incidence of CD and environmental pollutants. In this context, we combined data of a population-based registry of Inflammatory Bowel Disease (IBD) with environmental sampling data to identify the environmental profile of multi-contamination associated with high incidence.

Methods

This ecological study was conducted at the municipal level within the coverage area of the registry in Northern France. All patients diagnosed between 2000 and 2017 were included (n=9,019). Spatial clusters of significantly high (n=4) and low (n=4) CD incidence, adjusted for age and sex, were identified based on patients' residence addresses at diagnosis. Within these clusters, environmental sampling was performed across 240 sites using a hexagonal grid to ensure 30 samples per cluster. A total of 490 parameters were analyzed: 306 in soil (including emerging pollutants such as hormones and antibiotics, polycyclic aromatic hydrocarbons [PAHs], heavy metals, and pesticides), 152 in tap water (examining heavy metals and PAHs), and 30 in lichens (assessing heavy metals as indicators of air quality). Multi-contamination indices, such as the Mean Impregnation Ratio (MIR) and Pollution Index, were applied. Data analysis included Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), and Analysis of Variance (ANOVA) tests.

Results

High-incidence clusters, predominantly agricultural, had elevated heavy metal concentrations in soil (notably chromium, arsenic, zinc, and nickel), sulfadiazine in soils, high nitrate levels in water, and heavy metals in lichens. Low-incidence clusters, with greater urbanization, showed elevated PAHs in soil, heavy metals in water, and BPA in soils. Pollution profiles aligned with different land covers, with significant findings for agricultural lands (p<0.0001). A positive correlation between the relative risk and soil’s MIR for heavy metals in agricultural zones was noted (r=0.557, p=0.005).

Conclusion

These findings suggest a possible link between high CD incidence and heavy metal exposure in agricultural lands. Profiles of pollution were created for each cluster. Future studies should expand on pesticide and agricultural pollutant analysis to strengthen this hypothesis, and consider individual-level epidemiological approaches to further elucidate these potential environmental risk factors.
P1275 Understanding the burden of severe ulcerative colitis: outcomes and treatment use in a large U.S. cohort
Authors: Raine T , Lewis J , Chen Y , Parkes G , Huisingh C , Wegrzyn L
Published: January 2025

Background

Severe ulcerative colitis (UC) hospitalizations, including those with acute severe UC, result in colectomy and substantial life changes for up to 20% of patients. As the treatment landscape evolves, more knowledge on patient characteristics, treatment patterns, and outcomes in real-world settings is needed to understand the burden of severe UC hospitalizations.

Methods

This large retrospective cohort study utilized electronic health record (EHR) data from integrated delivery networks in the U.S. with linked insurance claims. As a proxy for ASUC, patients hospitalized for UC (primary position) and requiring intravenous (IV) steroid use (N=9,716) from Jan 1, 2014 – Dec 31, 2022 were included. Eligible patients were ≥18 years and had >180 days of prior EHR activity. A nested cohort (n=4,383) of patients discharged from the hospital without undergoing colectomy who had >1 year of post-hospitalization EHR activity and >1 health care encounter during the 1 year after the hospitalization were used to describe treatments and procedures during follow-up. Results were stratified by patient subgroups: 1) no prior IBD diagnosis, 2) prior IBD diagnosis, no prior advanced therapy, and 3) prior IBD diagnosis with prior advanced therapy.

Results

Of the 9,716 patients, the mean age was 46.3 years and 52.7% being female. Most had a previous IBD diagnosis (83.3%), and 23.8% had prior advanced therapy use. During the hospitalization, 13.5% received advanced therapy, primarily TNFi (11.3%), in addition to IV steroids, and in 8.2%, 13.2%, and 18.0% in subgroups 1, 2, and 3, respectively (p<0.0001). Colectomy was performed in 12.2% overall and in 12.6%, 9.2%, and 19.6% in subgroups 1, 2, and 3, respectively (p<0.0001). Among those discharged without colectomy, 33.3% received advanced therapy within 90 days, with subgroup 3 (55.5%) having higher use of these treatments compared to subgroup 2 (27.8%) and subgroup 1 (21.5%) (p<0.0001). Within 1-year post-index, 38.4% experienced a UC-related hospitalization. Cumulative risk of colectomy within 1 year post-index was 20.4% overall and 18.5%, 16.1%, and 32.7% in subgroups 1, 2, and 3, respectively (p<0.0001).

Conclusion

This study provides better understanding of the burden and outcomes for a contemporary cohort of patients with severe UC hospitalizations, especially those who received advanced therapy before hospitalization. These findings highlight the need for effective therapies and strategies for severe UC patients during and after hospitalization.
P1276 Persistent Insomnia Ignites the Flames of Crohn's Disease by Elevating Systemic Inflammation
Authors: Cao X , Zhao J , Zhang M , Lou S , Cao Q
Published: January 2025

Background

The association between insomnia and the risk of inflammatory bowel disease (IBD) remains inconclusive. We aim to investigate the association between insomnia and the risk of IBD, Crohn's disease (CD) and ulcerative colitis (UC), while further considering genetic vulnerability and inflammatory mediation.

Methods

This cohort study included 480,252 participants without IBD at baseline in the UK Biobank. The mean age of the population was 56.53 years old and 54.3% were female. Cox regression models examined the associations between insomnia and the incident of IBD, CD and UC. Polygenic risk score (PRS) for IBD, UC and CD was calculated. Subgroup and mediation analyses were conducted.

Results

A total of 480,252 participants were included. The mean age of the population was 56.53 years old and 54.3% were female. During a mean follow-up of 13.20 years, 3,219 incident IBD (1,005 CD and 2,207 UC) cases were documented. Compared to non-insomniacs, there was a significant increasing trend in the frequency of insomnia and the risk of incident IBD (P for trend=0.040) and CD (P for trend=0.003). Among individuals who usually have insomnia, the risk of CD incidence increased by 31% compared to those free of insomnia (hazard ratio [HR] 1.31; 95% confidence interval [CI]: 1.09-1.57; P=0.004), but no significant association was found between usually having insomnia and the risk of IBD (HR 1.10; 95% CI: 1.00-1.22; P=0.051) and UC (HR 1.03; 95% CI 0.91-1.16; P=0.678). Consistent results were observed in subgroup and sensitivity analyses. The connection between insomnia and CD was especially significant for participants with intermediate genetic susceptibility. High genetic risk individuals with usual insomnia were associated with a 2.51-fold increased risk of CD. The association between usually having insomnia and the risk of CD was partially mediated low-grade inflammation (INFLA) score by 6.36% (natural indirect effect [NIE] 1.018; 95% CI 1.013-1.023).

Conclusion

Insomnia exposure was associated with increased risk of CD but not UC. Further study is warranted to determine if modifying insomnia could mitigate CD risk.
P1281 Active perianal fistulising Crohn’s Disease is associated with a higher burden of psychological distress, depression, anxiety, stress and opioid use
Authors: Gu B , Su W K , Nano D , Wilson W , Iliescu S , Lynch K , Andrews J M , Connor S J , Ghaly S
Published: January 2025

Background

Perianal fistulising Crohn’s disease (PFCD) is an aggressive phenotype of Crohn’s disease (CD) which can cause pain, sepsis and faecal incontinence with relevant impairment in quality of life (QOL). We aimed to describe the effect of PFCD on QOL as measured by mental health indicators, opioid use and days out of role (DooR) due to inflammatory bowel disease (IBD) symptoms.

Methods

Crohn’s Colitis Care (CCCare) is a cloud-based clinical management system which has been used in routine clinical care in Australia and New Zealand since 2018. The CCCare Clinical Registry was interrogated in September 2024. Adults with CD across 25 IBD centres with an outpatient encounter between September 2023 and September 2024 were included. Mental health was assessed using the Kessler Psychological Distress Scale (K10) and the Depression Anxiety and Stress Scale (DASS-21).

Results

A total of 8317 people were identified with CD, of whom 2.7% (n = 222) had active PFCD, defined as a fistula on the most recent physical examination, imaging or endoscopy. Another 4.6% (n = 379) had previously documented PFCD and 92.8% (n = 7716) never had documented PFCD. The median age of the cohort was 42.0 years (IQR 30.0 – 57.0) with an even gender distribution (50.1% female). Most of the cohort resided in Australia (63.1%, n = 5249) and the remaining 36.9% in New Zealand (n = 3068).

People with active PFCD were more likely to be currently using opioid analgesia for their IBD (2.7% vs 0.5% vs 0.2%; p < 0.01) and to have at least one DooR since their last clinical assessment (12.7 vs 6.9 vs 6.0%; p < 0.01) compared to those with previous or never PFCD. People with active or previous PFCD were more likely to actively smoke than those without PFCD ever (14.4 vs 14.2 vs 7.3%; p < 0.01).

303 people had a completed DASS-21 and 141 a K10 within the study period. People with active PFCD had numerically higher median scores across all mental health indices but there was no statistically significant difference. A numerically higher percentage of people with active PFCD were experiencing psychological distress or reported at least mild anxiety, depression or stress compared to those with previous or have never had PFCD (table 1).

Conclusion

People with active PFCD have higher rates of opioid use, more time out of role, and higher scores in K10 and DASS-21 compared to those with previous PFCD or never had PFCD. This highlights the psychosocial burden on PFCD, and therefore the need to optimise management of PFCD as well as address psychiatric comorbidities. People with active PFCD were more likely to be active smokers, emphasising the importance of addressing smoking cessation in the multidisciplinary management approach.