bluuebunny/crossref_metadata_2025 huggingface dataset:
P136 Faecal calprotectin as therapeutic target in patients with Crohn’s disease treated with anti-TNF: a meta-analysis of individual data
Authors: Mami A , Nancey S , Pugliese D , Molander P , Boschetti G , Nogueira I , Pereira B , Buisson A
Published: January 2020

Background

Faecal calprotectin (Fcal) could be a non-invasive alternative to endoscopy to assess therapeutic efficacy in patients with Crohn’s disease (CD). We performed a systematic review and meta-analysis of individual data to assess the performances of FCal after anti-TNF induction therapy to predict mid-term steroids-free clinical remission (CFREM) in CD.

Methods

We included all the studies reporting patients with CD receiving anti-TNF agents with Fcal measurement before and after induction therapy (from 8 to 14 weeks) with follow-up > 6 months, no therapeutic intervention based on FCal during the follow-up and mid-term clinical evaluation between week 32 and week 54. CFREM was defined as CDAI < 150 and continuation of the same anti-TNF agent without steroids.

Results

We identified five articles including 165 patients with CD (mean age = 34.5 ± 12.8 years, median CD duration 5 years [2–12], female gender = 52.7%, active smokers = 33.3%, prior bowel resection = 25.6%, CD location (L1 = 32.1%, L2 = 15.8%, L3 = 52.1%), perianal lesions = 22.4%). The patients were treated with infliximab (50.9%), adalimumab (47.3%) or certolizumab (1.8%), and received concomitant immunosuppressants in 48.5% of the patients. Mid-term CFREM was achieved in 57.3% of the patients. Fcal level after anti-TNF induction therapy was lower in patients who achieved mid-term CFREM (100 µg/g [48–267] compared with those who did not (491 µg/g [165–856]; p < 0.001). The relative decrease of Fcal between before and after induction therapy was also associated with mid-term CFREM (p = 0.022). In multivariable analysis adjusted on CDAI, CRP and disease duration, FCal level (p = 0.014) and relative decrease of anti-TNF (p = 0.025) after induction were associated with mid-term CFREM. Cut-off values between 200 and 400 µg/g showed close performances to predict mid-term CFREM. FCal <250µg/g predicted mid-term CFREM with: Se = 73.3%[63.0%-82.1%], Spe = 67.7%[54.9%-78.8%], PPV = 75.9%[65.5%-84.4%] and NPV= 64.7%[52.2%-75.9%]. A relative decrease ≥ 50% between baseline and the end of induction was the best threshold to predict mid-term CFREM (Se = 59.6%[48.6–69.8%], Spe = 78.5%[66.5–87.7%], PPV = 79.1%[67.4–88.1%] and NPV = 58.6% [47.6–69.1%]). We found a significant study effect (ICC =0.36 ± 0.18) due to the variability according to FCal assay. The likelihood of being in CFREM at mid-term (PPV) according to the combination of CDAI, CRP and Fcal was presented in Figure 1.

Conclusion

The improvement of Fcal after anti-TNF induction therapy is predictive of mid-term CFREM in patients with IBD. The combination of clinical remission, CRP normalisation and FCal improvement should be a therapeutic target in patients with CD. Our work highlighted the need of international standardisation of Fcal measurement.
P145 Orofacial granulomatosis in Crohn’s disease: an ECCO CONFER multi-centre case series
Authors: Phillips F , Verstockt B , Sladek M , de Boer N , Katsanos K , Karmiris K , Albshesh A , Eriksson C , Bergemalm D , Molner T , Ellul P
Published: January 2020

Background

Orofacial granulomatosis (OFG) is a rare syndrome characterised by swelling of the orofacial area secondary to an underlying granulomatous inflammatory process. Concurrent intestinal Crohn’s disease (CD) has been described in 20–50% of adult patients with OFG.

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 OFG in CD, with clinical data recorded in a standardised collection form.

Results

This report includes 28 patients with OFG associated with CD: 14 males with mean age of 32 years ( ± 12.4 SD, range 14–60) and 14 females with mean age of 40.3 years ( ± 21.0 SD, range 11–79). Crohn’s distribution was ileal in six patients, colonic in six patients, ileocolonic in 15 patients and isolated upper gastrointestinal tract (UGI) disease in a single patient; six patients (21.4%) had UGI involvement and 11 patients (39%) had perianal disease. The diagnosis of OFG was made prior to CD diagnosis in 5 patients (mean of 0.9 years prior, range 1 month to 2 years), at the same time as CD in 4 cases, and after CD diagnosis in 19 cases (mean of 11.4 years after, range 6 months to 33 years). CD was undiagnosed in 5 patients, quiescent in 11 patients and active in 12 patients. The distribution of OFG involved the lips in 16 cases, buccal mucosa in 18 cases, tongue in eight cases and gums in five cases, with many patients having multiple areas involved. Angular cheilitis was present in 15 cases and aphthous or deep ulcers in 16 cases. Pyostomatitis vegetans and facial palsy were present in 1 case each. Pain was present in 25 cases, with impaired swallowing or speaking in 6 cases and psychological distress in 9 cases.

A number of different treatments led to remission, including topical therapies in 2 cases, steroid injections in 2 cases, exclusive enteral nutrition in 1 case, anti-TNFs in 11 cases, Vedolizumab in 1 case, Ustekinumab in 1 case and Thalidomide in 2 cases. A further 7 cases were resistant to therapy including anti-TNFs and a single case had spontaneous remission without therapy.

Conclusion

This case series of OFG in CD highlights multiple points. The diagnosis of OFG usually occurs after that of CD and can be many decades after, but may also occur prior to or at the time of diagnosis of intestinal disease. Perianal disease and UGI disease are common associations, and there is a significant symptom burden due to pain and impaired swallowing, leading to psychological distress in many. Remission can be obtained with a variety of treatments, including topical and intralesional agents, biologic agents, and thalidomide.
P152 Should professionals provide their patients with digital health training resources?
Authors: Echarri Piudo A , Molina Arriero G , Sierra Ausin M , Calvo Moya M , Pérez Calle J L , Fraga Iriso R , Morete Pérez M C , Botella Mateu B , Ollero Pena V , Enriquez Rodriguez M , Nos Mateu P , Castro Senosiain B , Martín Rodriguez D , Mancenido Marcos N
Published: January 2020

Background

One of the aims of the Spanish Working Group on inflammatory bowel disease IBD (GETECCU), is to improve the quality of life of their patients. Quality standards for IBD Units include educational and care support of IBD patients. A trained patient progress better and consumes fewer resources. Although the internet is the main source of information, it is not always accurate. G-EducaEII (GETECCU’s working group) aims to create resources supported by professionals, such as educainflamatoria.com, witch is currently recommended by 60 different Spanish IBD Units as a resourse for knowledge and self-control of the disease for the patients.

The objective of this study was to analise the sources and searches for information in patients with IBD, assessing the feeling of safety when using a reference website, wich is endorsed by IBD professionals. To value the quality, usefulness and understandability of the website, as well as situations where professionals advise to use it.

Methods

Observational study to assess the perspectives of patients and professionals when using a reference website endorsed by professionals and GETECCU. Patients evaluated the website, through anonymous questionnaires (10 questions each) (web link).

The professionals of G-EducaEII units and the patients they had seen over the last 3 months were invited to take part in the study.

Results

100 professionals and 380 patients participated in the study. The website was the principal source of information used by patients (92%). Its information, videos and ilustrations were clasificated as easy to understand (78%) and very useful for training (90%). Symptoms, diets and treatments for the disease, were the main searches carried out on the website.

Difference in age, sex, illness, years from diagnostic and treatment were analysed. All the professionals considered important to support their patients from the Units and most of them (98%) thought it was very suitable to have a proven and quality website, mainly for newly diagnosed and post-hospitalised patients. All the professional recommended the use of the website where it wasn’t available.

Conclusion

Professionals and patients support the availability of an endorsed website, mainly in newly diagnosed and post-hospitalised situations. Patients value and trust a website endorsed by their professionals and use it extensively in their training. The most frequently requested information is related to symptoms, diets and treatments. Patients suggest the organisation of topics for specific conditions. IBD professionals should be involved in educational support initiatives for the patients. The development of a national reference website is a guarantee of reliable training for the patient with IBD.
P154 Sinusitis Prompts Evaluation for Co-existing or Subsequent inflammatory bowel disease
Authors: Rai V , Traboulsi C , Gulotta G , Rubin D
Published: January 2020

Background

The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterised by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analyses from our group identified an increased prevalence of sinusitis among patients with IBD, predictive factors of developing sinusitis in IBD, and differences in stratifying patients with IBD and sinusitis (IBD+S) based on order in which these conditions were diagnosed. We now report on the factors associated with the development of IBD in patients with sinusitis.

Methods

This is a retrospective study at our tertiary IBD center. We utilised our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between 1/2000–5/2019 and age ≥18 years were included. Demographic and disease-related information were collected. Categorical variables were analysed using Fisher’s exact test and continuous variables were analysed using Wilcoxon rank-sum test.

Results

Of 14,366 patients with IBD, 386 (2.69%) patients have IBD+S. Of the 386 IBD+S patients, 118 patients (30.6%) were diagnosed with sinusitis before IBD. These 118 IBD+S patients were included in univariate and multivariate analysis with 14,753 non-IBD patients with sinusitis. The average age at IBD diagnosis among all IBD patients was 37.32 ± 18.79 years, and the average age at sinusitis diagnosis for sinusitis patients was 40.93 ± 21.42 years. On multivariate analysis, age of sinusitis diagnosis >40 years old (OR 1.52, 95% CI 1.04–2.28), black race (OR 2.82, 95% CI 1.29–7.43), white race (OR 4.33, 95% CI 2.02–11.23), and female sex (OR 1.52, 95% CI 1.03–2.28) were significant predictors of IBD in sinusitis patients (Table 1A). In comparison, multivariate analysis showed that black race (OR 8.09, 95% CI 4.91–14.26), white race (OR 3.35, 95% CI 2.08–5.80), female sex (OR 1.51, 95% CI 1.22–1.87), and bowel obstruction (OR 2.00, 95% CI 1.53–2.58) were significantly associated with sinusitis in IBD patients (Table 1B).

Conclusion

Sinusitis patients diagnosed older than 40 years old have 1.5 greater odds of subsequent IBD, suggesting that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent IBD risk. Female sex and race are shared factors in the risk of sinusitis in IBD patients and risk of IBD in sinusitis patients.
P157 Patient-reported disease activity in a large sample of ulcerative colitis patients using social media-delivered questionnaires
Authors: Abreu M T , Cataldi F , Van Horn K , Herbert L B , Fridman M , Setyawan J
Published: January 2020

Background

Medical therapy for inflammatory bowel disease (IBD) should have dual goals of improving symptoms and mucosal healing. Patient-reported outcomes (PROs) used for approval of ulcerative colitis (UC) treatments include number of bowel movements and bloody stools.[1] Recent research highlights the discordance between PROs and mucosal healing.[2] The aim of this analysis is to understand patient perspectives on UC symptoms and disease burden based on a cross-sectional survey of UC patients. We hypothesised that UC patients experience disease activity despite treatment and that current PROs fail to capture the full impact of disease activity on patients’ lives.

Methods

The IBD In America survey recruited patients via InflammatoryBowelDisease.net and associated social platforms in 2019. Patients self-reported an IBD diagnosis, were 18+, lived in U.S., and participated without monetary incentive. Survey questions addressed diagnosis, symptoms, QoL, treatment, demographics, etc. Survey terms were based on how patients discuss UC in the IBD online community. Remission was defined as ‘significant reduction of symptoms without an actual cure.’ Flare was defined as ‘temporary intensification of symptoms.’ Patients were categorised by disease activity based on number of flares and remission status during the past year.

Results

Of 487 patients diagnosed with UC, mean age was 45.6 (SD 16.0); 85% were female; 89% moderate to severe; 78% diagnosed in past 5 years; and 51% taking 5ASAs, 37% biologics/JAKs, and 23% immunomodulators. Despite treatment, 46% experienced 15+ symptom days in the past month. Fatigue/low energy was most frequent complaint (86%) followed by urgency to move bowels (80%), abdominal pain/cramps (76%), joint pain/inflammation (67%), and bloating (66%). Daily pain was experienced by 32%; even patients in remission with no flares experienced pain at least once a month (55%). Difficulty completing daily tasks was reported by 37%, and 27% felt their UC was not controlled despite efforts to manage it. Only 7% reported being in remission with no flares (past year) and no symptoms (past month).

Conclusion

Most UC patients experience frequent symptoms and flares while on treatment. The most common and bothersome symptoms are not taken into account in PROs nor addressed with current treatment. A more holistic approach to patient disease is needed.

Reference
P158 Semi-automated detection of qualitative features of Crohn’s disease activity found on CT-enterography using machine learning
Authors: Stidham R , Enchakalody B , Waljee A , Su G , Al-Hawary M , Wasnik A
Published: January 2020

Background

Imaging is essential in the assessment of Crohn’s disease (CD) severity, phenotype, and therapeutic response. However, qualitative findings can be limited by interobserver variation and ambiguous feature definitions. Our aim was to evaluate computational approaches for identifying qualitative disease features using CT-enterography (CTE).

Methods

CD subjects with ileal CD and CTE imaging between 2009 and 2017 were retrospective identified at a single tertiary care centre. CTE scans were reviewed by two fellowship-trained abdominal radiologists who labelled diseased and normal bowel transitions agreeing on definitions of qualitative findings prior to labelling. Computed intestinal features were used by machine learning methods (k-nearest neighbour, support vector machines, random forest) to model regions of diseased bowel and predict qualitative findings with 5-fold cross validation. Cohen’s kappa with quadratic weighting was used to assess agreement between radiologists and model predictions.

Results

In 206 unique patients, 548 small bowel segments underwent paired radiologist review for qualitative imaging findings. Automated localisation of diseased vs. normal bowel segments had excellent performance, with an AUC, PPV, and NPV of 0.922, 0.924, and 0.918, respectively (Figure 1). Radiologist-to-Radiologist and Radiologist-to-automated prediction agreement on qualitative findings are shown in Table 1. Agreement on the degree of mural enhancement between radiologists was very good (k = 0.75,95% CI 0.68–0.82), with nearly identical agreement (k = 0.75, 95% CI 0.72–0.79) between radiologists and automated grading models.

Conclusion

Computer vision methods have excellent performance for automatically distinguishing diseased from normal ileum and show potential for qualitative disease assessments of Crohn’s disease on CTEs.
P161 Intra-abdominal abscess in Crohn’s disease
Authors: SAIR A , Lagdali N , Ben El Barhdadi I , Berhili C , Borahma M , Ajana F Z
Published: January 2020

Background

Crohn’s disease (CD) is associated with the emergence of complications, including intra-abdominal abscess. Management is multidisciplinary based on close medical-surgical collaboration. The aim of the study was to evaluate the clinical characteristics, the efficacy of different therapeutic options of intra-abdominal abscess in CD patients and to identify predictive factors of a favorable response.

Methods

Medical records of 56 CD patients who had intra-abdominal abscess were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and therapeutic data were retrospectively assessed. Treatment progression was appreciated.IBM SPSS software 21.0 was used for statistical analysis of our data.

Results

In total, 897 patients were identified as having CD in the study period, 56 of them developed intra-abdominal abscess. Means that the prevalence of intra-abdominal abscess in CD patients was 6,2%.

Mean age was 35,24 ± 11,6 years old with a sex ratio M/F 0,64. 47,3% had penetrating CD. 50.9% of our patients were known to be carriers of Crohn’s disease, 45% of whom were on 5-ASA, while the remaining patients 49.1% (n = 26), the abscess was inaugural and revealing of the CD.The clinical signs were dominated by pain in 80%, the abscess was localised mainly at the right iliac fossa in 77.7% of cases. Median size of collection was 3,8 ± 2 cm. There were 47,3% patients who had fistula associated to abscess. The initial reactive C protein ranged from 14 to 320 (median 58.3) mg/L.

All patients had first-line treatment based on broad-spectrum bi-antibiotic therapy, alone in 25.5%, combined with surgical resection in 45.5%, surgical abscess drainage without resection in 23,6% or guided by imaging in 5.5%, the initial success was 71.7%. 28.3% of patients underwent surgery for initial treatment failure, which was dominated by ileocecal resection in 53.1%. Overall success was 92.3%, only one death was noted following postoperative release with peritonitis. Predictive factor of favorable response was: fistula associated with intra-abdominal abscess (p =0.03) and surgical resection seems to be the best therapeutic option (p < 0,001).

Conclusion

Intra-abdominal abscess is a complication of Crohn’s disease (CD) mainly penetrating, in almost half of the cases, it can reveal CD. Our study showed that the presence of fistula appears to be significantly associated with therapeutic success and the best results are obtained in the case of surgical resection.
P163 Changes in diagnostic delay in inflammatory bowel diseases over the years: a retrospective single-centre analysis
Authors: Di Ruscio M , Vernia F , Variola A , Lunardi G , Resimini S , Geccherle A
Published: January 2020

Background

Delayed diagnosis is common in inflammatory bowel diseases (IBD) and has been reported to be longer for patients with Crohn’s disease (CD) than for those with ulcerative colitis (UC). Aims of study were to assess the median time to diagnosis in IBD patients, to examine whether diagnostic delay (DD) has improved over the years and its impact on biological treatment and need for surgery.

Methods

A retrospective monocentric study including IBD patients living in the area of Verona (Italy), diagnosed up to 2019 and followed-up for at least 6 months at IRCCS Sacro Cuore—Don Calabria, Negrar, was carried out. DD was defined as the period (months) from symptoms onset to histological diagnosis of IBD and reported as <6 months, 6–12 months and >12 months.

Results

Six-hundred-six patients (255 CD; 351 UC; 308 males; 298 females) were enrolled. Median DD was 10 (IQR 2–12), 6 (IQR 1–12) and 2 (IQR 1–7) months <2000, between 2001–2010, and >2010, respectively. Median time to diagnosis was not significantly longer in CD than in UC patients (4 vs. 3 months; IQR 1- 12). No sex- or age-related differences in DD were observed. Using the Mann–Whitney test, DD was longer in patients diagnosed <2000 and between 2001–2010, than in those diagnosed >2010 (p = 0.0000 and p = 0.0004). Comparing DD <2000 and >2010, the statistical difference was reported for UC (p = 0.0000) but not for CD (p = 0.2756). Considering the use of biologics over the years, patients diagnosed between 2000–2010, and >2010 were compared (194 CD and 333 UC), reporting a significant increase in their use both for CD (30 vs. 60; p = 0.0008) and UC (28 vs. 43; p = 0.0000). DD did not influence the need for biological treatment in both diseases (p = 0.987 for CD; p = 0.433 for UC). Considering a DD <6, 6–12, and >12 percentages of patients needing biologics were respectively 53.4%, 63.6% and 56.5% for CD and 28.5%, 34.1% and 26.3% for UC. Seventy-two CD and 27 UC patients needed surgery. Analyzing the time to surgery, DD did not influence the rate of resections in CD (p = 0.6559), as well as in UC (p = 0.2792).

Conclusion

In our cohort, DD has significantly decreased over the last years, more for UC than CD patients. This is probably related to the increased awareness of patients on disease and of general practitioners in sending them to the specialist. Considering the published literature, UC and CD did not differ in DD; moreover age at diagnosis did not affect DD in our patients. DD did not influence the need for biological treatment or surgery rates in both diseases. These results are probably related to the difference in disease extension and severity among the patients enrolled. An analysis on targeted patients at higher risk for bowel damage is presently under way.
P165 The patient’s journey: the IBD terrain
Authors: Mahmood T , Mahmood T
Published: January 2020

Background

Patients with IBD have already travelled a long journey before they muster up courage to speak about their symptoms with their doctor or the family. During this period they may undergo enormous suffering. This educational film, part sponsored by Crohn’s and Colitis UK, highlights this issue for the first time. It recognises that doctors and nurses are not trained to address pre-consultation journey of IBD patients.

Methods

This 40 min long drama documentary film was made with the help of a filming crew. Script was written, directed, produced and co-edited by the two authors with the help of the filming experts. It was part sponsored by the Crohn’s and Colitis UK. The film tells three touching stories that aim to educate patients and medical professionals. It shows physical, emotional, social and relational effects of silent sufferers with IBD.

Results

It is highlighted that patient journeys before they muster up courage to speak to anybody about their symptoms have a massive bearing on their general outcomes. The doctors and nurses so frequently are naïve about this aspect of patient care, as we are neither taught about it nor trained to deal with it.

Conclusion

This film is first of its kind. There is need for the Medical education curriculum to incorporate training and awareness about suffering of IBD patients before having medical consultations, and prior to sharing their stories with relatives and friends. The film has educational elements for all; doctors and nurses as well as the patients.
P182 Bowel Preparation in inflammatory bowel diseases (IBD): preliminary results from a randomised trial evaluating efficacy, tolerability and safety of cleansing solutions in IBD patients
Authors: Rueda Garcia J L , Suárez Ferrer C , Martín-Arranz E , Poza J , Sánchez-Azofra M , García-Ramirez L , Poladura B , Verges T , Noci J , Martín-Arranz M D
Published: January 2020

Background

Colonoscopy is the first-line procedure for the diagnosis and management of inflammatory bowel disease (IBD). Data regarding bowel preparation in patients with IBD are scarce. Our aim was to evaluate efficacy, safety and tolerability of the main available colon cleansing formulations in IBD patients: sodium picosulfate with magnesium citrate (SM+MC), 2L polyethylene glycol-ascorbate (2L-PEG-a) and 1L polyethylene glycol-ascorbate (1L-PEG-a).

Methods

Study design: Phase 4, randomised, single-centre, prescriber and colonoscopist-blinded study. EudraCT Number 2018-001402-28. Patients: IBD patients aged over 18 requiring colonoscopy. Exclusion criteria: pregnant women, past history of bowel resection, severe acute IBD flare or low-quality cleansing score in a colonoscopy performed 12 months prior to enrolment. Patients were randomized 1:1:1 to receive 1L PEG-a, 2L PEG-a or SP+MC; all preparations were administered in a split-dose regimen. Colonoscopies are performed by trained IBD specialists. Endpoints: Primary endpoint: Bowel cleansing using Boston Bowel Preparation Score (BBPS). We considered high-quality cleansing (HQC) a BBPS ≥5. Secondary endpoints: tolerability and patient satisfaction, evaluated via questionnaires filled before and after undergoing colonoscopy. Questionnaires contained items to be ranged on a scale from 1 to 10. Safety was monitored via adverse event reporting, laboratory evaluation at colonoscopy and telephonic follow-up. Statistical analysis: We used Student’s T/ANOVA and χ² tests for comparison between quantitative and qualitative variables, respectively. Software was Stata for Mac OS. We considered statistical significance a p-value < 0.05.

Results

Seventy-seven patients have been enrolled and subsequently randomised: 31 SP+MC vs. 24 2L-PEG-a vs. 22 1L-PEG-a. Colon cleansing was similar between solutions (% of HQC: SP+MC 100% vs. 2L-PEG-a 91% vs. 1L-PEG-a 95’4%, p = 0.28). Tolerability among the different formulations was also comparable (p = 0.68). Looking at patient satisfaction, instructions for SM+MC were rated higher (p = 0.05). No serious adverse events were reported. Data can be seen in Table 1.

Conclusion

No differences were observed between bowel preparations in patients with IBD concerning cleansing and tolerability. Instructions for SP+MC were easier from patient’s point of view than the others. Recruiting is still active so definitive conclusions are yet to be reported.
P191 Lower values of skeletal muscle index measured by bioelectrical impedance in active IBD patients
Authors: Vranesic Bender D , Domislović V , Barišić A , Karas I , Ljubas Kelečić D , Brinar M , Turk N , Krznarić Ž
Published: January 2020

Background

Inflammatory bowel disease (IBD) is commonly associated with alteration in fat and lean mass. Body mass index (BMI) is not a prime index for assessing nutritional status, while a better way to evaluate it would be to bioimpedance analysis. In addition, correlation of body composition with disease severity has not been well studied. The aim of this study was to evaluate the association of body composition and muscle strength with disease activity in adult patients with Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

All patients underwent the analysis of body composition measured by bioelectrical impedance analysis (TANITA body composition analyser, BC-420MA). Lean mass (LM), fat-free mass index (FFMI) and skeletal muscle index (SMI) were calculated using standard formulae. Muscle strength was obtained from handgrip strength values (HS) measured with Jamar Hydraulic Hand Dynamometer. Medical history data were obtained from clinical and electronic medical records. Active disease was defined as Crohn’s disease Activity Index (CDAI) >150 for CD and Partial Mayo Score ≥3 for UC patients. Underweight patients were defined as BMI<18.5 kg/m2.

Results

In this study we have enrolled 120 patients (CD = 86, UC = 34; 65% male). Average age was 37.5 (35.3–39.6). Clinically active disease was present in 23 patients (19.1%), CD (n = 15), UC (n = 8). There were no statistically significant differences among patients with active and inactive disease in FFMI (kg/m2) 17(15–19.8) vs. 18.5 (15.7–20.3), p = 0.18, LM (kg) 56.5 (44.3–65.1) vs. 48.3 (43–67.2), p = 0.21, fat mass (%) 16 (11.5–23) vs. 11.8 (7.9–21), p = 0.14, and MS 33.3( ± 11.5) vs. 28.3 ( ± 9.9), p > 0.05. The SMI (kg/m2) was significantly lower in patients with active disease comparing to group with inactive disease 8.1(7.7–9.9) vs. 10(8.6–10.6), p = 0.032. Underweight patients were significantly more prevalent in active group comparing to inactive (30.4% vs. 6.4%, p = 0.0011).

Conclusion

IBD patients with active disease have lower skeletal muscle index, while there was no difference in other components of body composition. In addition, underweight patients have a significantly higher proportion of active disease. Body composition analysis by BIA could be a useful tool in the evaluation of patients with inflammatory bowel diseases; however, there is a need to define age-, gender- and disease-specific, percentile-based thresholds specifically for patients with IBD, which can simplify the screening procedures in clinical practice, and suggest nutritional intervention.
P196 High frequency of undiagnosed mental illness in inflammatory bowel diseases
Authors: MARAFINI I , Longo L , Salvatori S , Miri Lavasani D , Pianigiani F , Calabrese E , Rossi R , Siracusano A , Di Lorenzo G , Monteleone G
Published: January 2020

Background

Inflammatory bowel diseases (IBD) are associated with mental disorders, which can negatively influence the course of IBD. Nonetheless, psychiatric disorder comorbidities (PDCs) remain undiagnosed in many IBD patients. The aim of this study was to assess the frequency of undiagnosed psychiatric comorbidities in IBD patients.

Methods

Two-hundred-thirty-seven adult IBD [136 Crohn’s disease (CD) and 101 with ulcerative colitis (UC)] outpatients were consecutively recruited in a single university hospital centre between January 2018 and June 2019. After the visit for IBD clinical evaluation, participants completed self-report questionnaires and then underwent a clinical interview by a trained psychiatrist.

Results

One-hundred-fourteen (48%) IBD patients had at least one undiagnosed psychiatric disorder. Forty-three (18%) patients presented a single PDC, 40 (16.8%) had two PDCs, 11 (4.6%) had 3 PDCs, 12 (5%) had 4 PDCs, 7 (2.9%) had 5 PDCs and 1 (0.4%) had 6 PDCs. PDCs were equally distributed among CD (72/136, 53%) and UC (42/101, 42%) patients. Mood disorders (54/114, 47%) and anxiety (27/114, 24%) disorders were the most common PDC; moreover, 23 (20%) patients suffered from post-traumatic stress disorder (PTSD), 3 (3%) had an obsessive-compulsive disorder, and 7 (6%) a substance abuse/dependence disorder. Fifty-nine per cent of IBD patients diagnosed with a psychiatric disorder during the study did not have a positive psychiatric anamnesis. PDCs were not related to activity, phenotype or localisation of IBD.

Conclusion

Psychiatric disorders are common in IBD but not related to activity, phenotype or localisation of bowel disease. Overall, these findings suggest the necessity to include psychiatric evaluation in the management of IBD patients.
P199 Outcomes of Crohn’s rectovaginal fistulae in a specialist centre
Authors: Twum-Barima C , Iqbal N , Reza L , Vaizey C , Hart A , Tozer P
Published: January 2020

Background

Rectovaginal fistula (RVF) is a devastating complication of Crohn’s disease (CD). Despite advances in medical and surgical treatment, management of CD RVF remains challenging. Surgery is the principal treatment with adjunctive medical therapy. This study tracks patients from initial fistula presentation through their treatment pathways.

Methods

We reviewed our retrospective RVF database (2009–2019). Patients were captured through imaging and surgical coding. Outcomes included patient satisfaction, fistula closure and stoma reversal.

Results

We identified 66 patients with CD RVF from our database of 327 RVF patients, with a median age of 40 years and mean follow up of 6.3 years. Cross-sectional analysis of patients’ initial symptoms, management and outcomes identified three groups: 1-quiescent luminal disease, with minimal fistula symptoms; 2-quiescent luminal disease, but moderate fistula symptoms (suitable for RVF repair); 3-poorly controlled luminal disease and active fistula, requiring medical control and/or defunctioning before RVF repair.

Thirty-one patients were identified in group 1 (‘minimal symptoms’). The median age was 37 years and most were on Infliximab (32%) or combination therapy (45%). Patients reported a negative impact on the quality of life (QoL) (39%), such as sex avoidance and psychosocial impairment. Some patients later required defunctioning (22%) or proctectomy (13%). Fistula symptoms improved in 16% following medical treatment alone. One patient developed a mucinous adenocarcinoma.

Nine patients were identified in group 2 (‘immediately suitable for repair’). The median age was 44 years. A low QoL was reported in 44%. Reparative procedures included rectal advancement flap and omentoplasty. Two patients were defunctioned. Fistula closure was seen in 44% after medical and surgical treatment.

Twenty-six patients presented in group 3 (‘poorly controlled luminal disease and active fistula’) and 17 patients joined this group after symptom deterioration (15 from group 1 and 2 from group 2). The median age was 45 years. All patients were on biologics/combination therapy and defunctioned. Some 30% underwent proctectomy. Some patients declined stoma reversal (7%) and proctectomy (12%). Markedly poor QoL was reported in 35% of patients. Medical escalation resulted in fistula closure in 14% of patients.

Conclusion

Complex RVF with poorly controlled disease requires faecal diversion/proctectomy and optimal medical therapy. Well-timed reparative surgery in a selected group yields reasonable outcomes. Management is dependent on factors such as the extent of CD, fistula symptoms, response to medical treatment, suitability for local repair and patient choice.
P205 Assessing the impact of age at diagnosis on transition process in patients with inflammatory bowel diseases from paediatric to adult care
Authors: Yang X Y , Tchogna S A , Deslandres C , Jantchou P
Published: January 2020

Background

Twenty-five per cent of paediatric patients with inflammatory bowel disease (IBD) are diagnosed between the age of 16 and 18 years. They represent a unique challenge associated with the short follow-up time between diagnosis and transition to adult care.

Methods

The primary aim was to compare the current transitional process in adolescents diagnosed before 16 years (early-adolescence (EA)) or after 16 years (late-adolescence (LA)). The secondary aim was to investigate clinical factors associated with age at transfer. Patients diagnosed between 2013 and 2015, at the IBD clinic of CHU Sainte-Justine and followed up to the transfer to adult care were included in the study. The date of transfer to adult care was defined as the date of the last visit in the paediatric unit. The factors associated with the transition process and transfer included: disease type, disease severity at diagnosis and last paediatric visit, age at diagnosis, treatment group, disease burden (hospitalisations/relapses) and disease education.

Results

We included 144 patients (77 males; median (interquartile range (IQR) age at diagnosis 15.2 (14.3–16.2) years; CD (n = 98), UC (n = 31) and IBD-U (n = 15). The median (IQR) duration of paediatric follow-up was 3.6(2.7–4.1) years in the EA group when compared with 1.4 (1.0–1.8) years in the LA group; p < 0.01. While most of the patients completed the transition at a median (IQR) age of 18.0(17.9–18.3) years, 15 % of patients were transferred at an older age (18.5 to 20 years). Overall, 75.7% were in remission, 13.9% with mild disease activity and 10.4% with moderate activity at the last paediatric visit. Patients with moderate activity at last paediatric visit tend to be transferred at an older age as compared with patients in remission or mild activity. The median (IQR) age were, respectively, 18.4(18.2–19.1), 18.0(17.9–18.1), 18.0(17.9–18.3) years; p =0.024. There was a modest correlation between age at diagnosis and age at transfer (R = 0.22; p = 0.0068). Patients were transferred to adult gastroenterologists in academic hospitals (50.8%) or non-academic hospitals (43.1%). However, the disease activity at transfer was not associated with the adult care setting (academic vs. non-academic). The number of relapses and hospitalisations during paediatric care were associated with older age at transfer: (> 18.5 years vs. < 18.5 years): median(IQR) 0.8(0.4–1.4) vs. 0.3(0.−0.6) for relapses; p = 0.009 and 0.4(0.0–1.1) vs. 0.3(0.0–0.7) for hospitalisations; p = 0.009.

Conclusion

Paediatric IBD diagnosed at late adolescence tend to have more active disease and older age at transfer. Therefore, efforts to design a structured transitional care program are needed in order to improve transition outcomes for IBD patients with a special focus for subjects diagnosed in late adolescence.
P210 Clostridium difficile infection in pre-existing inflammatory bowel disease: Management and outcomes
Authors: CAMPBELL I , Brownson E , Robertson E
Published: January 2020

Background

Inflammatory bowel disease (IBD) is a recognised risk factor for clostridium difficile infection (CDI), and CDI in an IBD patient is associated with higher morbidity and mortality. It is thought that factors including alterations in the gut microbiome, mucosal disruption and immunosuppression provide a synergistic environment for CDI to complicate an IBD flare. Despite this, there is conflicting evidence available on management. Our aim was to examine a series of recent cases to assess our own practice and subsequent outcomes.

Methods

A retrospective analysis was carried out of hospitalised cases of CDI in IBD patients in Greater Glasgow and Clyde from 2017 to 2018. Patients were identified via the CDI database held by the microbiology department; those with co-existing IBD were extrapolated. Data collected included demographics, IBD subtype and presence of other CDI risk factors. Severity of symptoms was assessed using Truelove and Witts Criteria. Initial management and changes following the diagnosis of CDI were noted. Outcomes were measured by the length of stay, survival to discharge, and requirement for surgical intervention. One year outcomes were assessed by recording mortality, treatment escalation and re-admission to hospital.

Results

29 patients in total were identified (61% female, 39% male). Twenty-one had a diagnosis of ulcerative colitis, 7 Crohn’s disease, and 1 IBD unclassified. Twenty-four were on immunosuppressive therapy at the time of CDI, 11 were on dual or triple immunosuppression. This was continued during admission in all but three cases. Once the diagnosis of CDI was established, metronidazole was given in 16 cases and vancomycin in 13. Steroid treatment varied - 13 received oral steroids, 5 IV steroids and 11 no steroids. There was no clear correlation between steroid management and outcome. Assessment with the Travis criteria on day 3 indicated a high chance of colectomy in 12 patients, however only one required surgical intervention. No patients received a faecal transplant. The median length of stay was 15 days (range 3–169). One patient did not survive to discharge.

In those surviving to discharge, a further 6 had died at one year, bringing the one-year mortality to 24%. Three had CDI as a contributory factor listed on the death certificate. 31% of surviving patients had their IBD treatment escalated in the year following admission, 17% were treated for CDI relapse, and 28% had readmission to hospital.

Conclusion

Managing CDI in patients with co-existing IBD is challenging. This case series highlights the lack of consensus on how this should be approached, even within a single health board. Morbidity and mortality are high. This suggests that a wider body of work is required to establish guidelines and provide better outcomes.
P214 Low bone mineral density in inflammatory bowel disease patients
Authors: Eddy C , Stanton S , Subramaniam K
Published: January 2020

Background

Low bone mineral density (BMD) is an extra-intestinal manifestation and common complication of inflammatory bowel disease (IBD). There are many risk factors thought to contribute to this reduction in BMD but there is no clear consensus on screening for low BMD in IBD. This study was performed to determine the prevalence, screening strategy and risk factors for low BMD in the IBD population at a single tertiary centre.

Methods

Patients with IBD attending a single tertiary centre were included. Electronic medical records were reviewed and data on demographics, BMD assessments with dual-energy X-ray absorptiometry (DXA) scans as well as risk factors for low BMD were collected. BMD classification was in line with the World Health Organisation definitions. Multivariate analysis with logistic regression was used to compare variables.

Results

There were a total of 553 IBD patients; 281 (50.8%) were females and 364 (65.8%) had Crohn’s disease. Of the total cohort, 245 (44.3%) had a DXA scan performed. Of the 245 patients that had a DXA scan, 101 (41.2%) were defined as osteopenic, 16 (6.5%) were defined as osteoporotic and 128 (52.2%) had normal BMD. The average age of the DXA cohort at the time of scanning was 39 years old. There were 124 (50.6%) females and Crohn’s disease was present in 70.2% (n = 172) of the DXA cohort. The average BMI of the DXA cohort was 26.5 with a range of 16.5 to 59.1. The majority (n = 173; 70.6%) of the DXA cohort had reportedly never smoked with the rest being either current smokers (n = 35; 14.3%) or ex-smokers (n = 37; 15.1%) at the time of their scan. Follow up DXAs occurred in 34.6% of those 245 patients with an average time between scans of 4.6 years. In terms of the risk factors, gender was not found to be a significant risk factor (p = 0.085) along with the type of IBD (p = 0.174), steroid usage 20 mg/day in the 2 years prior to DXA scan (p = 0.886) and smoking history (p = 0.195). However, patients aged ≥50 years were more likely to have low BMD than patients aged <50 years (65.6% vs. 41.8%, p < 0.001). Similarly patients with a BMI <25.5 were more likely to have low BMD than patients with a BMI ≥25.5 25.5 (59.7% vs. 36.5%; p = 0.001).

Conclusion

We found a high prevalence of osteopenia (41%) but osteoporosis (6.5%) was uncommon in this IBD population from a single tertiary centre. Only age ≥50 years and BMI <25.5 were found to be significant risk factors for low BMD. Screening of this population was inconsistent with only 44% of the total cohort having an initial DXA scan and 35% of those who have an initial scan having a follow-up DXA scan. Local guidelines on screening for low bone mineral density are warranted.
P216 Anti-drug antibodies to infliximab: A comparison of free anti-drug antibody measurement
Authors: Hamilton R , Shields S , MacDonald J , Dunlop A , Perry M , McGucken A , Gribben E , Galloway P
Published: January 2020

Background

Infliximab (IFX) is a biologic drug that inhibits the action of TNFα, a pro-inflammatory cytokine implicated in the pathogenesis of inflammatory bowel disease (IBD). IFX has greatly improved the outcomes for patients with IBD, but response to the drug is not universal. Primary non-response to IFX treatment occurs in up to 30% of IBD patients while up to 46% of patients develop secondary loss of response.1,2 Anti-drug antibodies (ADAs) to IFX are considered a significant risk factor for the loss of response to treatment, hence the measurement of ADAs as part of therapeutic drug monitoring is an increasingly utilised tool. The detection of ADAs varies widely depending on the type of assays used. The aim of this study was to determine the qualitative concordance of three commercially available ELISA kits for measurement of free ADAs to IFX on the Grifols Triturus analyser.

Methods

150 patient samples with low IFX drug levels (≤0.6 µg/ml) were analysed for free ADAs using Promonitor, Lisa Tracker and IDKmonitor kits on the Grifols Triturus automated ELISA analyser.

Results

Kappa coefficient (κ) analysis indicated a moderate agreement between the Promonitor and IDKmonitor assays (κ = 0.484 (95% CI, 0.357 to 0.611)) and the IDKmonitor and Lisa Tracker assays (κ = 0.485 (95% CI, 0.348–0.621)) as well as substantial agreement between the Promonitor and Lisa Tracker assays (κ = 0.768 (95% CI, 0.667–0.870)). Figure 1 shows the distribution of samples identified as free ADA positive by each kit.

Conclusion

Although a broad qualitative agreement was found between the three kits, they should not be used interchangeably for patient management. All kits appear amenable for utilisation in a high-throughput laboratory though a true quantitative comparison between these kits was precluded by the absence of any certified reference material for free ADAs to IFX. Further research is required to estimate the impact of free ADAs on efficiency of IFX treatment and patient management.

References
P220 Predictors of prognosis after discontinuation of first-use biologics in IBD patients with at least 24 months follow-up
Authors: Shivaji U N , Bazarova A , Critchlow T , Smith S C , Nardone O M , Love M , Davis J , Ghosh S , Iacucci M
Published: January 2020

Background

In clinical practice, patients with IBD have their biologic therapies withdrawn due to variety of reasons. The aim of the study was to report on predictors of prognosis in IBD patients after biologics have been discontinued, with a minimum follow-up of 24 months.

Methods

All IBD patients who discontinued their first-use biologic were identified between January 2013 and Dec 2016 from EMR at a tertiary referral centre, to ensure at least 24 months follow-up. Reasons for discontinuation and pre-defined adverse outcomes (steroid and other rescue therapies, hospitalisations, surgery including perianal) were recorded. The data were analysed using multivariable and univariable logistic regressions within a machine learning technique in order to predict adverse outcomes, within the stated timeframe. We tested the significance of the identified predictors and performed Kaplan–Meier survival analysis to compare patients with elective vs. non-elective discontinuation of biologics.

Results

147 patients who discontinued biologics (M = 74, median age 39y; CD = 110) were identified. Follow-up ranged from 24 to 60 months (median 40 months). The reasons for non-elective discontinuation included side effects (n = 21, 14%), primary or secondary non-response (n = 33, 22%) and patient choice (n = 10, 7%), among others. 59 (40%) patients had elective discontinuation. In this cohort, elective discontinuation resulted in fewer IBD-related adverse outcomes (AO) compared with non-elective. Figure 1 shows a Kaplan–Meier curve comparing the two (p = 0.003).

Using data from all 147 patients, multivariable logistic regression analysis was done to identify significant predictors of prognosis. These are represented in Table 1.

Overall, a significant number of patients (n = 80, 54%) had AO within 6 months of discontinuation, and 96 (65%) patients needed biologics to be restarted by the end of the study follow-up period.

Conclusion

Among IBD patients who discontinued biologics, there were fewer AO when they were electively discontinued. However, majority of patients required restart of biologics to manage their disease during the follow-up period. Clinicians need to be cautious when considering biologic discontinuation given the high proportion of AO and re-escalation to biologics therapy.