bluuebunny/crossref_metadata_2025 huggingface dataset:
P224 Crohn’s disease experiences among a paediatric population: A qualitative study reviewing the agreement of symptoms discussed by children and adolescents
Authors: Coskun U , Kelly K , Hunter T , Newton L , Symonds T , Delbecque L
Published: January 2020

Background

Crohn’s disease (CD) is a type of inflammatory bowel disease that can occur at any age. CD symptoms can have a significant impact on health-related quality of life (HRQL). Although key symptoms and impacts of CD in adults are well-known, they have not been well explored or documented in children and adolescents. The objective of this study was to explore the similarities and differences in CD symptoms and impacts across various age groups (children and adolescents) and develop a list of most common symptoms and impacts for these populations.

Methods

Children (ages 5–11 years) and adolescents (ages 12–17 years) with CD and parents/caregivers of children with CD (ages 2–11 years) were recruited from US medical practices. Qualitative semi-structured interview guides were developed, informed by published literature. Face-to-face and telephone concept elicitation interviews were conducted, audio-recorded, and transcribed. Transcripts were analysed using thematic methods facilitated by NVivo.

Results

A total of 49 individuals participated in this study (child n = 11, adolescents n = 20, parents/caregivers n = 18). Preliminary results showed that there was a high level of qualitative agreement between CD symptoms in children and adolescents. The ranking of the top 15 symptoms was nearly identical between the two cohorts. The most frequently discussed symptoms (discussed by ≥75% of the participants in each cohort) were feeling gassy, abdominal pain, diarrhoea, incomplete evacuation, tiredness, and urgency. The second most frequently discussed symptoms (discussed by ≥50% of the participants in each cohort) were cramping, constipation, blood in stool, and frequent bowel movement. While abdominal cramping and blood in stool were discussed by ≥75% of the adolescents, 63% and 50% of the children discussed them respectively. Similarly, while bloating and nausea were discussed by ≥50% of adolescents, 38% and 25% of children discussed them, respectively. Finally, while vomiting was discussed by 50% of the children, 33% of the adolescents discussed it. Impacts due to CD were also regularly discussed across both cohorts but less so by the children. School and low mood/sadness were discussed by ≥50% of the participants in each cohort. Exercise/sport, play/leisure activities, annoyance/frustration, and eating/drinking limitations were discussed by ≥50% of the adolescents but <50% of the children.

Conclusion

The results from the CE interviews show the clear burden of CD and that this is mostly similar across children and adolescents allowing for a future unified disease model to be developed.
P231 Epidemiological profile and long-term outcomes from a large PSC-IBD cohort
Authors: Caon A E , Martins C , Cruz M , Leite Barros L , Azevedo M , Queiroz N , Carlos A , Milane L , Oba J , Braga M , Sipahi A , Damião A , Cançado E
Published: January 2020

Background

Primary sclerosing cholangitis (PSC) is a chronic and progressive cholestatic disease associated with inflammatory bowel diseases (IBD) in 70% of cases.1 When combined, they present as one distinct phenotypical disease referred to as PSC-IBD with milder clinical course, despite more extensive colonic involvement and an increased risk of malignancies. The aim of this study was to assess clinical features and long-term outcomes of PSC-IBD patients from a quaternary hospital in Brazil.

Methods

We retrospectively reviewed all PSC-IBD patients registered and followed-up in our outpatient clinic between January 2000 and July 2019. Conventional colonoscopic and histological criteria were used to diagnose IBD, whereas radiographic or histological criteria for PSC. Medical records were abstracted for the following data: demographic characteristics; duration, extent, and treatment of IBD; duration, extent, and treatment of PSC; colorectal neoplasia (dysplasia and cancer); surgical treatment for IBD; liver transplantation and death.

Results

In total, 92 patients with concurrent PSC and IBD were identified. Of 92 cases, 80 (87%) had ulcerative colitis (UC) and 12 (13%) were diagnosed with Crohn’s disease (CD). There was a slight predominance of male, 51 (55%). The mean age at both IBD and PSC diagnosis was 31 and 35 years, respectively. Most of them were diagnosed with IBD prior to PSC (53%). The mean IBD duration was 15 years and 10 years in PSC subjects. The prevalence of pancolitis in UC patients was 91%. All CD cases presented ileocolonic involvement. Present or past smoking history was reported in 6% of the cohort. Aminosalicylates were the most common treatment used for IBD in 59 patients (64%). 15 of them (16%) were on monotherapy with immunobiologics and 7 patients (8%) were on combotherapy. Only 3 subjects were on anti-integrin. In our cohort, 61 cases (66%) were treated with ursodeoxycholic acid. Colorectal neoplasia and cholangiocarcinoma were observed in 6 (7%) and 3 patients (3.3%), respectively. Colorectal dysplasia was found in 20 subjects (22%) on a routine colonoscopy. Overall, 17 patients (19%) required proctocolectomy and 11 cases (12%) have undergone orthotopic liver transplant. There were 12 deaths, mainly PSC and cancer-related.

Conclusion

Herein we present the largest cohort of concomitant PSC and IBD in Latin America. In our centre, we have found higher rates of extensive IBD, although few of them required colectomy. The present data on cancer and dysplasia are consistent with reports in the literature.

Reference
P234 Frequency detectiveness of some viral infections in patients with inflammatory bowel diseases
Authors: Babayeva-Sadigova G , Babayev Z , Asadova G , Mahmudov U , Quliyev F , Mirzazade O
Published: January 2020

Background

The prevalence of opportunistic infections in individuals with inflammatory bowel disease (IBD) remains relevant. Viral infections are a common cause of systemic inflammation of the digestive tract. Clinically expressed herpes and parvovirus infections are a serious problem, especially for people with prolonged immunosuppression. The aim of the study was

t

o assess the incidence of certain herpes and parvovirus infections in patients with IBD.

Methods

In total, 189 patients with IBD, 102 with ulcerative colitis and 87 with Crohn’s disease were examined. Of the number of patients: 98 women, 91man. The age of patients is from 16 to 63 years (mean age 41.4 ± 4.8). In addition to a standard examination, disease activity was assessed by indicators of highly sensitive C-reactive protein, homocysteine, vitamin D in blood serum, albumin in urine, calprotectin and lactoferrin in faeces. All patients underwent serological blood tests by ELISA for specific antibodies to herpes viruses and IgG/IgM antibodies to parvovirus B19, determination of DNA to herpes simplex viruses of types 1-2,6(HSV1-2?HSV6), Epstein–Barr (EBV}, cytomegalovirus (CMV), herpes zoster (HZV) by PCR in blood and mucosal biopsy, and also avidity.

Results

Among patients with IBD, active infections (herpes and parvoviruses) in the blood occurred in 81 patients (42.8%); of them, 39 patients (20.6%) were diagnosed with monoherpesvirus infections, in 16 patients parvovirus (8.4%), and in 26 (13.8%) cases, active mixed viral infections were detected. In 79 cases (41.7%) of PCR biopsy material was positive for isolated infection: 36 cases (19%) of CMV, 21 cases (11.1%) of EBV, 22 cases (11.6%) of HSV6. Tissue viral infection was found in 34 patients (17.9%). Clinical endoscopic and laboratory indicators of activity in IBD were significantly higher in patients with active viral infections (p ˂ 0.05), which indicates the negative effect of chronic active herpes and parvovirus infections on the course of inflammatory bowel diseases. However, significant differences between patients with ulcerative colitis and Crohn’s disease were not detected.

Conclusion

The frequency of occurrence of herpes and parvovirus lesions in patients with IBD in the blood is more than 42.8%, isolated infection in the tissue in 41.7%, and mixed infection in 17.9% of the number of patients. The clinical endoscopic picture, as well as laboratory data indicate a more severe course of diseases in the presence of these infections.
P237 Annual incidence and prevalence of ulcerative colitis and Crohn’s disease from 2010 to 2017 in four Nordic countries: Results from the TRINordic study
Authors: Lördal M , Burisch J , Langholz E , Knudsen T , Voutilainen M , Moum B , Saebo B , Paula H , Malmgren C , Coskun M , Melberg H O
Published: January 2020

Background

Incidence and prevalence of inflammatory bowel diseases (IBD) have been increasing for the past decades in the western world, however with an emerging trend of incidence stabilisation in recent years. There is an indication of higher IBD incidence and prevalence in northern Europe, especially in the Nordic region, compared with southern Europe.

Methods

This retrospective observational study collected data from the National Patient Registries and National Prescription Registries (Sweden [SWE], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate the annual incidence and prevalence of ulcerative colitis (UC) and Crohn’s disease (CD). Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later and no K51 or K50 codes prior to 2010 were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Incidence proportions highlight results through 2016, as 2017 patients had less than 1-year follow-up.

Results

In total, 69,876 patients were included (SWE n = 27,902, NOR n = 20,761, FIN n = 2,118, DEN n = 19,095), of which 44 367 patients were diagnosed with UC and 25,509 with CD. In 2016, the annual incidence of UC was 28 patients per 100,000 persons in NOR, 32 patients per 100,000 persons in DEN, 25 patients per 100,000 persons in SWE, and 44 patients per 100,000 in FIN. The corresponding results for the annual incidence of CD per 100,000 persons were 22 in NOR, 16 in DEN, 16 in SWE, and 21 in FIN. The prevalence per 100,000 persons of both UC and CD was the highest in DEN, followed by SWE and NOR, and lowest in FIN. Prevalence estimates increased in all four Nordic countries during 2010–2017: for UC, from 409 to 488 patients in SWE, from 256 to 428 in NOR, from 129 to 375 in FIN, and from 577 to 798 in DEN. For CD, it increased from 261 to 313 patients in SWE, from 164 to 258 in NOR, from 54 to 164 in FIN, and from 280 to 400 in DEN.

Conclusion

This retrospective observational study showed that during 2016, the annual incidence of UC ranged from 25–44 patients per 100,000 persons across the evaluated Nordic countries, whereas the annual incidence of CD was 16–22 patients per 100,000 persons. Prevalence of both UC and CD increased during 2010–2017 in all four countries. Estimates of UC and CD incidence and prevalence in this analysis are greater than reported in the published literature. Additional analyses are underway to further explore the impact of methodological decisions on the estimates of UC and CD annual incidence and prevalence.
P243 Changes in the therapeutic management of inflammatory bowel disease in the biological era – a nationwide retrospective cohort study in three Nordic countries: Results from the TRINordic study
Authors: Zhao M , Lördal M , Langholz E , Knudsen T , Voutilainen M , Høivik M L , Moum B , Saebo B , Haiko P , Malmgren C , Coskun M , Melberg H O , Burisch J
Published: January 2020

Background

The use of biologic therapy has increased significantly during the last decade. In 2015, one in three Crohn’s disease (CD) patients and one in five ulcerative colitis (UC) patients had received biologics within 2 years of diagnosis 1 in Denmark (DEN), Sweden (SWE) and Norway (NOR). Whether this change in treatment strategy has resulted in changes in the use of conventional drugs (5-aminosalicylates [5-ASA], immunomodulators [IM] or corticosteroids) remains unknown. An aim of this study was to investigate the use of these drugs in the biological era.1 Høivik ML et al. Time to first treatment with biologic agents for ulcerative colitis and Crohn’s disease across four Nordic countries: Results from the TRINordic study, Submitted to ECCO 2020.

Methods

A total of 67,758 incident IBD patients (42,894 UC, 24,864 CD) diagnosed between 2010 to 2017 were included in a nationwide cohort in DEN, NOR and SWE. Information on drug treatment was extracted from the National Patient Registries and the National Prescription Registries. Patients were required to have at least 1-year of follow-up post-diagnosis; results are limited to patients diagnosed between 2010 to 2016, inclusive.

Results

During 2010 to 2016, cumulative exposure to 5-ASA in CD patients at 2 years after diagnosis declined from 19.0%, 39.0% and 50.5% in 2011 to 16.3%, 31.1% and 39.6% in 2016 in DEN, NOR and SWE, respectively (p < 0.001). The opposite trend was observed in UC where 87.3–91.1% received 5-ASA within 2 years in 2015 compared with 75.8–87.3% in 2011 (p < 0.001) (Figure 1). In all countries, corticosteroid use remained stable in CD with more than half of patients receiving corticosteroids within 2 years of diagnosis. In UC, corticosteroid use within 2 years of diagnosis increased in NOR from 42.2% in 2011 to 51.6% in 2015 (p < 0.001) but remained stable in DEN and SWE (Figure 2). The use of IM within 2 years increased in CD patients in NOR and SWE from 36.5% and 40.8% in 2010 to 51.3% and 52.1% in 2015 (p < 0.001). IM were less frequently used in UC but increased similarly from 14.0% and 21.1% in 2010 to 22.5% and 26.4% in 2015 (p < 0.001). In DEN, IM use remained stable over time (Figure 3).

Conclusion

The use of 5-ASA declined over time in patients diagnosed with CD but increased over time in patients diagnosed with UC. Corticosteroid use remained stable in CD but increased over time in UC patients in NOR. The increasing and earlier use of biologics was accompanied by increasing use of IM in all countries. While this could suggest a more aggressive treatment approach, differences in treatment practices across countries might contribute to these findings. The impact of changes in treatment strategies on disease outcomes remains to be shown.
P260 Adaptation of TECCU App based on patients’ perceptions for telemonitoring inflammatory bowel disease: A qualitative study using focus groups
Authors: Del Hoyo Francisco J , Nos P , Faubel R , Bastida G , Muñoz D , Valero E , Garrido A , Savini C , Bella P , Peña B , Aguas M
Published: January 2020

Background

Despite the continuous adaptation of eHealth systems for patients with inflammatory bowel disease (IBD), a significant disconnection persists between users and developers. Since non-adherence remains high, it is necessary to better understand the patients’ perspectives on telemonitoring for IBD. The aim of this study was to adapt the TECCU app to the preferences and needs of IBD patients.

Methods

A qualitative study was carried out using successive focus groups of IBD patients. Meetings were audio-recorded and a thematic analysis approach was employed until data saturation was achieved. The first group included patients who had used the TECCU app in a pilot clinical trial, and subsequent meetings included patients with Crohn’s disease and ulcerative colitis recruited from the Spanish Confederation of patient associations. The information collected at each meeting guided consecutive changes to the platform.

Results

Data saturation was reached after 3 focus groups, involving a total of 18 patients. Three main themes emerged: (1) platform usability; (2) the communication process; and (3) contents of the platform. All participants indicated that TECCU is easy to use, permitting continuous and personalised feedback. Nevertheless, the platform was adapted according to the patients′ perspectives to foster a flexible follow-up and shared decision-making, using open and safe communication networks. Many participants appreciated the educational elements and the app was connected to reliable and continuously updated webpages.

Conclusion

IBD patients valued the usability and personalised monitoring offered by the TECCU App. Improvements in the messaging system and continuous updates of the educational contents were performed to address patients′ needs and favour their engagement.
P263 Proximal disease extension in patients with ulcerative proctitis: Associated factors and experience of an IBD tertiary Brazilian centre
Authors: Ferreira S , Queiróz Marques de Mendonça R , Steltenpool Tonin Borges I , de Avelar Cardoso P H , Rose Otoboni Aprile L , Serafim Parra R , Ribeiro Feitosa M , Feres O , Ribeiro da Rocha J J , de Ameida Troncon L E
Published: January 2020

Background

Ulcerative proctitis (UP) accounts for a significant proportion of cases of ulcerative colitis (UC) and implies limited involvement of the rectum. Some patients presenting initially with UP may progress to more extensive colitis (inflammation found distally to the rectum-sigmoid junction). Although several predictive factors for this progression have been described, none has been established as definitive. We aimed at determining risk factors predictive of proximal disease extension in UP.

Methods

Retrospective analysis of data from 97 patients (67% female) with UP (Montreal Classification: E1) with at least 12 months of follow-up at the IBD tertiary centre from January 2001 up to December 2018. Proximal extension was evaluated endoscopically during follow-up and was defined as E1 progressing to E2/E3. Factors examined comprised age, gender, race, presence of extra-intestinal manifestations, Mayo endoscopic score, disease relapse, use of corticosteroids, immunosuppressive and biological agents and colectomy. We used univariate analysis (Chi-square test) to assess the association of individual factors to proximal disease extension.

Results

A total of 29 (29.9%) patients experienced proximal disease extension during a mean follow-up of 137.36 ± 86.63 months. The following factors were significantly associated with proximal disease extension: higher initial Mayo score (p = 0.035) and higher initial disease severity (p = 0.0024). Use of corticosteroids initially (86.2% vs. 41.2%, p <0.0001), increased disease relapse rate (86.2% vs. 20.6%, p < 0.0001)and the need for immunosuppressive agents (57.1% vs. 13.6%, p <0.0001) or biological agents (42.9% vs. 10.3%, p <0.0001) were all significantly higher among UP patients with disease proximal extension, when compared with non-extensors. Colectomy was also associated with proximal disease extension (p = 0.0002). No significant association was found between UP proximal extension and gender, race, age at diagnosis and extraintestinal manifestations.

Conclusion

UP is a dynamic disease that may progress over time. UP patients with increased clinical and endoscopic severity at the diagnosis are likely to evolve with proximal extension and should be more carefully followed up.

Reference
P268 Systematic review and meta-analysis: Inflammatory bowel disease (IBD) associated colonic dysplasia prognosis in the video-endoscopic era
Authors: Kabir M , Fofaria R , Basset P , Arebi N , Tozer P , Hart A , Wilson A
Published: January 2020

Background

Management of dysplasia in IBD patients is largely based on outcomes reported by a small number of observational studies, most of which include data from the pre-videoendoscopic era (before 1990). The impact of recent advances in dysplasia detection e.g. high definition chromoendoscopy (HDCE) and endoscopic resection techniques on colorectal cancer (CRC) risk needs to be better understood to inform management decision-making. We conducted an updated review of dysplasia prognosis in the videoendoscopic (VE) era according to lesion morphology, grading and endoscopic resectability.

Methods

The search strategy is described in Figure 1. The inclusion criteria were studies of (1) IBD colitis patients with dysplasia, (2) who had a colectomy or at least one colonoscopy on follow-up, and (3) reported on the incidence of CRC, according to the endoscopic visibility, morphology and grade of the index dysplasia. The primary outcomes were: (a) the ‘prevalent CRC rate’ (incidental CRC found on colectomy undertaken within 6 months of a dysplasia diagnosis and may represent missed cancers on colonoscopy) and (b) the incidence of metachronous CRC found on follow-up of more than 6 months after a dysplasia diagnosis. Meta-analyses were performed to obtain pooled estimates of the outcomes as appropriate. Quality of the evidence was assessed using GRADE criteria.

Results

Thirty studies met criteria for inclusion. The pooled estimated prevalent cancer rate for visible and invisible high-grade dysplasia (HGD) patients were 14% (95% CI 0–54; I2=92) and 11% (95% CI 5–20) respectively; for visible and invisible low-grade dysplasia (LGD) patients it was 3% in both groups (95% CI 0–8; I2=19–45); and for indefinite dysplasia it was 1% (95% CI 0–7). Risk of metachronous CRC, 2 years after endoscopic resection of polypoid or non-polypoid LGD were 0–5% and 0–22%, respectively. Risk of metachronous CRC, 2 years after a diagnosis of invisible LGD or indefinite dysplasia were 0–28% and 0–1%, respectively. The lowest rates for both primary outcomes were noted for dysplasia detected during HDCE surveillance and resected en bloc with clear histological resection margins.GRADE assessment of the quality of evidence was low or very low due to the inclusion of mainly case series or small cohort studies with heterogeneous populations and limited follow-up.

Conclusion

The results from this review suggest that the recent advances in endoscopic techniques are reducing the rates of prevalent and metachronous CRC. However, the evidence-base informing dysplasia prognosis from the VE era remains of low quality. More long-term data on the risk of metachronous CRC, particularly after the resection of non-polypoid dysplasia, is required to inform decision making.
P270 Ulcerative colitis disease extent and inflammatory burden assessment: DUBLIN and modified Nancy score
Authors: Rocha Silva J C , Rodrigues J , Rodrigues A , Silva A , Fernades C , Sousa A , Sousa M , Gomes A C , Afeto E , Carvalho J
Published: January 2020

Background

Current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent of mucosal inflammation. The DUBLIN score (Degree of Ulcerative Colitis Burden of Luminal Inflammation) is a simple bedside clinical score that estimates inflammatory burden using both disease severity and extent, which correlates with objective inflammatory markers and is associated with clinical outcomes. The validated Nancy score is used to evaluate histological activity; nonetheless, it does not take in consideration disease extension. We aimed to evaluate the relation of both Mayo and Dublin scores with disease activity and as predictive factors of clinical relapse. Also, we developed a modified Nancy score in order to assess histologic activity considering disease extension.

Methods

A retrospective cohort study, which consecutively included all UC patients submitted to colonoscopy with biopsies between 2016 and 2019 in our unit. Mayo and DUBLIN scores were calculated. Modified Nancy score was calculated as a product of Nancy Score and disease extent (E1-E3). Correlation of both endoscopic and histologic scores with biomarkers, relapse (in a 6months) and relapse-free time as performed.

Results

107 patients were selected, 52.3% (n = 56) male, mean age = 48.4 ± 13.9 years. Mean Dublin score was 2.65 ± 2.75. Mayo and DUBLIN scores presented good correlation (r = 0.880, p < 0.001). Also Dublin score correlated with modified Nancy score (p < 0.001). Both Dublin score (p = 0.009) and modified Nancy score (p = 0.026) correlated with C-reactive protein levels. Nancy score correlated with faecal calprotectin (p = 0,025).

Relapse occurred in 26.2% (n = 28) of patients with a mean time for the event of 13 ± 7 weeks. Mayo Score (p < 0.001), Dublin score (p < 0.001), Nancy score (p < 0.001) and modified Nancy score (p < 0.001) presented a significant association with relapse. Areas under the ROC curve were 0.786 for Dublin score, 0.751 for Mayo score, 0.84 for Nancy score and 0.79 for modified Nancy score.

Conclusion

DUBLIN and modified Nancy scores correlate with each other and with biomarkers and are independent predictors of relapse. Dublin score was superior to Mayo score in the prediction of relapse.
P273 Point-of-care bowel ultrasound for detecting ileocolonic inflammation in Crohn’s disease
Authors: Allocca M , Fiorino G , Furfaro F , Zilli A , Gilardi D , Radice S , Peyrin-Biroulet L , Danese S
Published: January 2020

Background

A ‘treat-to-target’ strategy with close monitoring of intestinal inflammation is recommended in Crohn’s disease (CD). Bowel ultrasound (US) is a non-invasive, point-of-care tool to assess CD activity and severity. However, no clear US-based parameters of activity have been identified by using magnetic resonance imaging (MRI) and colonoscopy together as a reference standard. We aimed to investigate whether US parameters could be able to measure CD activity and severity, comparing with the MaRIA and the SES-CD scores.

Methods

Ileal and/or colonic CD consecutive patients were prospectively assessed by CS, MRE and bowel US. Bowel wall thickening (mm), bowel wall-flow at colour Doppler (BWF: 0 absent; 1 present), bowel wall pattern (BWP: 0 normal; 1 hypoechogenic; 2 hyperchogenic; 3 lost), presence of mesenteric lymph nodes (0 absent; 1 present) and mesenteric hypertrophy (0 absent; 1 present), evaluated at bowel US were compared with CS+MRE findings as a reference standard. Activity was defined by an SES-CD score>2 and/or a MaRIA score>7).

Results

Sixty CD patients were prospectively enrolled (37% with ileal localisation, 15% with colonic localisation and 48% with ileocolonic localisation). Thirty patients had endoscopically active CD, 34 had radiologically active disease, 37 (62%) had active disease assessed at CS or MRE (SES-CD > 2 or MaRIA score >7 in at least one segment). BWT, presence of BWF, hypoechogenic or lost BWP significantly correlated with endoscopic and radiological activity (OR 4.51, 33.75, and 2.74 respectively, all p < 0.001). The multivariable analysis identified only BWT (per 1-mm increase, OR: 6.56, 95% CI 1.25–34.44, p = 0.026) as an independent predictor for disease activity. The cut-off value of 4.4 mm BWT was identified to distinguish active vs. non-active disease (AUROC 0.905, Sensitivity 81%, Specificity 96%). A significant correlation was found between BWT and MaRIA and SES-CD score (r = 0.768, 95% CI 0.662–0.868, p < 0.0001; r = 0.602, 95% CI 0.409–0.743; p < 0.0001; respectively).

Conclusion

Bowel US is able to assess and measure disease activity in ileocolonic CD in real-time. BWT correlated very well with the MaRIA score and the SES-CD score. Further studies are needed to confirm these findings and to demonstrate the role of point-of-care US in CD management.
P291 Diagnostic utility of the neutrophil-platelet rate (NeuPla) as a marker of activity in patients with ulcerative colitis
Authors: Yamamoto-Furusho J K , Mendieta-Escalante E A
Published: January 2020

Background

Ulcerative colitis (UC) is a chronic disease characterised by periods of activity and remission. There are biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and faecal calprotectin that are elevated in patients with active UC. The platelet, one of the main activators of neutrophils, contains IL-8, a potent neutrophil chemo-attractant and P-selectin that induces excretion of superoxide in the neutrophils, forming platelet-neutrophil aggregates that are increased in individuals with UC activity. No previous studies have evaluated the neutrophil-platelet (NeuPla) rate as a tool for evaluating disease activity. The aim of this study was to evaluate the clinical utility of NeuPla rate in patients with UC.

Methods

A total of 158 patients with a definitive diagnosis of UC were included and NeuPla index was calculated on the ratio between neutrophil differential count and platelets from complete blood count (CBC) at least 1 day after the colonoscopy and colon biopsies. The activity was classified according to Mayo endoscopic sub-score, Riley score, Truelove-Witts, Montreal, full Mayo, and Yamamoto-Furusho indexes.

Results

The correlation of the NeuPla index with all activity indexes was statistical significant (p <0.001) as well as faecal calprotectin (rho: 0.532, p = .0001). The ROC curve was used to determine the cut off level of NeuPla according to moderate activity (optimal cut off 14.63 with a sensibility of a 79.5% and specificity of 51.3% with an Area Under the Curve (AUC) of .635 and severe activity (optimal cut off 18.7 with a sensibility of 80% and specificity of 81.8% AUC of .749) considering as a gold standard the endoscopy findings as shown in Figure 1.

Conclusion

The NeuPla index has a good diagnostic utility in order to distinguish patients with clinical and endoscopic activity without the need to perform invasive studies such as colonoscopy. This index is a cheap and easy access monitoring tool and a better diagnostic performance in comparison with other serum biomarkers CPR, ESR and serum albumin.
P294 Clinic features and the prognosis of colonic Crohn’s disease
Authors: Ozgur D , Hatemi A I , Erzin Y , Çelik A
Published: January 2020

Background

In this study, we aimed to investigate the prognosis of colonic Crohn’s disease (CD) and to compare colonic CD with ileocolonic CD.

Methods

This study included 63 patients with colonic CD who were followed at least 1 year. The same number of patients with ileocolonic CD whose age of diagnosis and sex were similar to colonic CD patients were included in the study. Data about demographics, serological, clinic characteristics, medical treatment, surgical treatment requirements and complications during follow-up were obtained retrospectively from patient files.

Results

The files of 1289 CD patients who were followed up at a clinic of inflammatory bowel disease of Cerrahpaşa School of Medicine were scanned. There were 63 patients with colonic CD. Control group was formed as it was noted in the Methods section. The rate of patients who smoked was lower in colonic CD (47.6% vs. 65%, p = 0.048). ASCA positivity was higher in patients with ileocolonic CD (80% vs. 33.4%, p = 0.027). At the time of diagnosis, 87.3% of colonic CD patients and 65% of ileocolonic CD patients had inflammatory phenotype (p = 0.003). During follow-up, stenosis and penetrating disease development were more common in patients with ileocolonic disease (46% vs. 15.8%, p = 0.001). The rate of abdominal surgery was lower in colonic CD (11% vs. 38%, p = 0.001). Hospitalisation rate was less in colonic CD than ileocolonic CD (36.5% vs. 57%, p = 0.02). In colonic CD, use of azatioprine was less than ileocolonic CD and the number of patients treated with oral mesalazine monotheraphy is higher than ileocolonic CD. Endoscopic remission was higher in colonic CD (%61 vs. %28, p = 0.001).

Conclusion

The results of our study showed that colonic CD has different phenotype characteristics, treatment response and laboratory features than ileocolonic Crohn’s disease. Colonic CD has a lower penetrating and/or stenosing phenotype rate than ileocolonic CD. Surgery and hospitalisation were less common in patients with colonic Crohn’s disease. In addition, patients with colonic CD have a higher endoscopic remission rate. For these reasons, we conclude that colonic Crohn’s disease has a better prognosis than ileocolonic Crohn’s disease.
P304 Extranodal primary intestinal lymphoma in inflammatory bowel disease: An ECCO CONFER multi-centre case series
Authors: Phillips F , Verstockt B , Ribaldone D , Guerra I , Teich N , Katsanos K , Filip R , Molner T , Karmiris K
Published: January 2020

Background

There is a small but measurable increased risk of lymphoma in inflammatory bowel disease (IBD). Evidence coming from case reports and small case series of primary intestinal lymphoma in IBD suggest an association with inflamed tissue and immunosuppressant use, mainly thiopurines.

Methods

This was a multicentre case series supported by the European Crohn’s and Colitis Organisation (ECCO) and performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. A call was made to report on cases of intestinal lymphoma in IBD and clinical data were recorded in a standardised case report form.

Results

Fifteen patients with intestinal lymphoma from 8 centres were included [12 males and 3 females, mean age 47.8 ( ± 16.4 SD, range 26–76) years at lymphoma diagnosis]. Eleven patients had Crohn’s disease: 7 had diffuse large B-cell lymphoma (DLBCL), 2 had Hodgkin’s disease and 2 had MALT lymphoma. Four patients had ulcerative colitis: DLBCL, MALT, indolent T-cell and immunoblastic lymphoma with plasma cell differentiation were diagnosed as a single case in each. Nine patients presented with symptoms of bowel obstruction, two presented with a non-obstructing mass, and there were single cases of isolated weight loss, symptoms resembling disease flare, indolent jaundice (from a duodenal lymphoma) and an incidental finding. The location of lymphoma was rectum in 3 cases, colon in 3 cases, small intestine in 4 cases, ileocolonic anastomosis in one case, stomach in one case and in multiple upper and lower GI sites in 3 cases. Lymphoma was located within the area affected from IBD in 10 patients, with four of these having active intestinal inflammation at the time of diagnosis. At lymphoma diagnosis, 7 patients were on azathioprine (one of whom also had adalimumab for 3 months), one was on infliximab for 1 month, one was on low dose steroids, one was on an aminosalicylate and 5 had not received IBD-related medications. Lymphoma was diagnosed at a mean time of 10.4 ( ± 7.07 SD, 1–24) years after IBD diagnosis in 11 patients, prior to IBD in one and concurrently with IBD in 3. Remission was achieved in 11 patients after treatment, 2 died from their lymphoma despite treatment and 2 are being monitored without therapy.

Conclusion

This case series of primary intestinal lymphomas in IBD illustrates a strong male predilection and a wide histological type range, with the majority being DLBCL. More than half of the cases cannot be attributed to IBD-related treatment whilst in a third of patients, lymphoma developed at a distant site from the area affected from IBD, thereby questioning the role of active inflammation or medication use in its development. The majority of cases successfully recovered after appropriate treatment.
P316 Hepatobiliary manifestations measured by vibration-controlled transient elastography in inflammatory bowel disease: A prospective hospital-based cohort study
Authors: Moon W , Seo K I
Published: January 2020

Background

Intestinal mucosal injury is supposed to cause liver disease and inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) is a typical chronic injury of intestinal mucosa. Therefore, we investigated the hepatobiliary manifestation with liver ultrasonography (LUS) and vibration-controlled transient elastography (VCTE) in IBD.

Methods

IBD patients newly diagnosed in Kosin University Gospel Hospital were enrolled consecutively. Gross hepatobiliary abnormality was evaluated with LUS and simultaneous liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed to evaluate hepatic injury and steatosis with VCTE. Laboratory tests including hepatic biochemistries, anti-nuclear antibody (ANA), and faecal calprotectin level (FC) were taken.

Results

Eighty-two (37 patients of CD and 45 UC) patients were enrolled. Gallbladder abnormality was noted in 39 patients (47.5%) including stone in 7, sludge in 11, polyp in 10, wall thickening in 9 and collapsed in 2. CAP >233 dB/m was in 33 patients (40.2%) and LSM >5.5 kPa in 10 (12.2%). Nineteen patients (23.2%) were diagnosed fatty liver. FC was 382 ± 785 (mean ± SD). CAP >233 dB/m was significantly associated with lower FC (209.6 vs. 352.1, p = 0.038). The correlation coefficient was −0.316 between CAP and FC (p = 0.006). LSM >5.5 kPa tended to be lower FC but was not statistically significant (199.8 vs. 306.2, p = 0.283). ANA was positive in 14 patients (17.1%). In ANA positive patients, FC was significantly higher than ANA negative patients (609.5 vs. 319.4, p = 0.015).

Conclusion

In this prospective analysis, the major hepatobiliary manifestations in IBD patients were gallbladder abnormality and fatty liver and there could be an association between low hepatic fat amount and intestinal disease activity.
P330 Inflammatory Bowel Disease (IBD) patients frequently report adverse drug reactions during biologic therapy: A multicentre, prospective, patient-reported pharmacovigilance monitoring system
Authors: THOMAS P , West R , Russel M , Jansen J , van Lint J , Jessurun N , Römkens T , Hoentjen F
Published: January 2020

Background

The use of biologicals has improved the treatment of IBD but the understanding of adverse drug reactions (ADRs) and the knowledge of patients’ perception on ADRs is poor. Patient-reporting may provide more insight in the extent and burden of ADRs in daily practice which in turn can lead to treatment optimisation. This study aimed to assess systematic patient-reported ADRs during biological therapy in IBD patients.

Methods

This multicentre, prospective, event monitoring study enrolled adult Crohn’s disease (CD) and ulcerative colitis (UC) patients treated with a biological between 1 January 2017 and 31 December 2018. Patients completed bimonthly comprehensive web-based questionnaires regarding indication and use of, description of biological induced ADRs, follow-up of previous ADRs, experienced burden of the ADR using a 5-point Likert scale, contact with a healthcare provider and therapeutic consequences due to the ADR. Patient-reported ADRs were MedDRA coded by trained pharmacovigilance assessors. MedDRA is a multi-hierarchical dictionary used to code reported ADRs into specific unambiguous terms (preferred terms). Preferred terms are subsequently grouped into high-level terms, high-level group terms and system organ classes. In total there are 26 system organ classes.

Results

In total, 182 patients in 4 centres (female 51%, mean (standard deviation) age 42.2 (14.2) years, CD 77%) were included and completed 750 questionnaires. At baseline, 49% used an immunomodulator (43% thiopurines, 6% methotrexate), while biologicals were documented as follows: 59% infliximab, 30% adalimumab, 9% vedolizumab, 1% ustekinumab. At least one ADR was reported by 50% of the participants, and 233 ADRs were reported in total with a median reported ADRs per participant of 2 (interquartile range, 1–3). Fatigue (n = 26), headache (n = 20), injection site reactions (n = 16) and arthralgia (n = 12) were most commonly reported, with a mean burden of 3.31, 1.63, 2.55 and 3.33, and a correlation in time with the administration of the biologic was described in 58%, 85%, 81% and 8% in these ADRs, respectively. Participants contacted a healthcare provider in 62% of all ADRs. In two out of 90 patients who reported an ADR, the biological was discontinued.

Conclusion

We established a patient-reported pharmacovigilance monitoring system and participants in this study frequently reported ADRs due to biologicals. Fatigue and arthralgia resulted in the highest burden. This reporting system may provide more understanding of patient-experienced ADRs which may ultimately lead to increased adherence of therapy and improved quality of life.
P335 Treatment strategies after mucosal healing (MH) in ulcerative colitis
Authors: Sitibondo A , Viola A , Costantino G , Centritto A , Belvedere A , Pisana V , Abbruzzese A , Alibrandi A , Fries W
Published: January 2020

Background

MH and deep remission are the major therapeutic goals in the treatment of ulcerative colitis (UC), but the best therapeutic strategy after reaching MH in terms of maintenance or de-escalation is still poorly defined. This retrospective study aimed to evaluate the maintenance of remission in patients who maintained therapy vs. patients de-escalating treatment.

Methods

Data of patients with UC who reached mucosal healing were retrospectively investigated. Demographic data/gender, age), disease-related data (extension, duration, age at onset), together with data on smoking behaviour and on therapy after reaching MH were collected. MH was defined as an endoscopic Mayo score of 0. The primary endpoint was clinical relapse regardless of therapeutic regimen. The outcome of patients maintained on therapy was compared with patients who de-escalated therapy and to patients with mild disease maintained on mesalazine.

Results

One hundred thirty-five patients with MH were followed for a mean time of 94 months (SD 57.2) and divided into 3 groups: group 1 (de-escalation; 45 patients), in which MH was reached with IMM or biologics and therapy was continued with only mesalazine, group 2 (no de-escalation; 40 patients) in which MH was reached with IMM or biologics, group 3 (only treatment with 5-ASA; 50 patients). In the 3 groups, disease relapse occurred in 62%, 30% and 38% respectively in a mean time of 22, 25 and 36 months. Patients who de-escalated therapy were more likely to relapse than patients who maintained initial treatment (p = 0.003, log-rank test)(Figure 1). A subgroup analysis showed as only for MH reached with anti-TNFs de-escalation strategy was related to an increasing risk of relapse (p = 0.003). No risk factors for relapse were identified on multivariate analysis.

Conclusion

Maintaining treatment after MH is reached represents the best strategy to maintain remission. Patients on anti-TNFs were more likely to relapse after de-escalation. An evaluation on pharmacoeconomics seems to be advised in order to identify a more sustainable strategy.
P336 Minimally invasive surgery is safe and feasible for luminal Crohn’s disease
Authors: Nnaji M , Chin Y F , Pujji O , Wilkinson B , Mohan S , Yassin N A
Published: January 2020

Background

Crohn’s disease (CD) is an inflammatory bowel condition that still requires surgical intervention in about 70% of cases with laparoscopic surgery increasingly becoming the preferred approach. We present our experience in laparoscopic and open surgery for luminal CD in a DGH setting.

Methods

This was a retrospective analysis of data collected prospectively between 2008 and 2018. All patients with the diagnosis of CD who underwent a surgical intervention for luminal CD were selected and their demographic, clinical and surgical outcomes data analysed.

Results

183 patients were identified. 162 (87%) underwent open and 21 (13%) laparoscopic surgery (p < 0.0001). The median age was 48 years (16–82 years) in the open group and 42 years (16–64 years) in the laparoscopic group(p = 0.05). Male:female ratio was 1:1.2 in the open and 1:1 in the laparoscopic groups. Anastomotic leak rates were lower in the laparoscopic group (0% vs. 2.5%, p = 0.3520). Statistically significant lower readmission rates (9.5% in the laparoscopic, 18% in the open groups, p = 0.0255) and reoperation rates (14% in the laparoscopic and 18% in the open groups, p = 0.0108) were noted in the laparoscopic group.

Conclusion

Laparoscopic surgery is safe in patients requiring surgical intervention for Crohn’s disease with a notable trend towards improved clinical outcomes.
P343 Efficacy of adalimumab in mild-to-moderate inflammatory bowel disease: Real-life data from single-centre experience in the long-term period
Authors: Akyüz F , Ormeci A , Namazova N , Guzel M , Abbasgoulizadeh A , Tahincioğlu L , Alaskarlı S , Gürel E , Bilgin E , Atasoy A , Cavus B , Demir K , Besısık F , Kaymakoğlu S
Published: January 2020

Background

Adalimumab (ADA) is one of the most preferred anti-TNF agents because of its ease of use in real life. We aimed to evaluate the efficacy of ADA in the long-term period of inflammatory bowel disease (IBD) patients.

Methods

Patients treated with adalimumab (ADA) as the first- and second-line biological treatment for mild to moderate active IBD between January 2009 and March 2019 were included. The clinical and endoscopic response rate of ADA were evaluated, retrospectively. Remission was defined in ulcerative colitis patients (UC), if stool frequency ≤ 3/day with no bleeding and no mucosal lesions at the colonoscopy. Remission was defined in Crohn’s disease patients (CD) if CDAI < 150 and mucosal healing at the colonoscopy.

Results

Fifty-eight patients (81% Crohn’s disease, 58.6% biologic naive) were included in this study. Mean age was 41.4 ± 12.3 years old (19–67 years) and 46.6% of them were female. Median follow-up time was 57 months in UC and 65 months in Crohn’s disease (CD). Infliximab experience rate before ADA in UC and CD was 36.4%, 42.6%, respectively. CD’s related surgery rate was 43.5%; surgery rate 87.5% before ADA therapy and 12.5% after ADA treatment. Clinical and endoscopic remission rates were 81.8% / 63.6% and 89.4%/ 63.4 in UC and CD, respectively at the end of follow-up period. Loss of response rate was 20% in UC and 28.3% in CD (table). Mean months for loss of response were 42 ± 25.4 months and 29.7 ± 12 months in UC and CD, respectively. Clinical remission was obtained by dose escalation in 66% of CD patients who had response loss. Loss of response rate was not significantly different between IFX naive and IFX experienced patients (p > 0.05). There was no significant adverse event during the follow-up period.

Conclusion

In real life, the efficacy of ADA treatment is high in mild-to-moderate active IBD. Endoscopic remission was also acceptable for this group of patients.