bluuebunny/crossref_metadata_2025 huggingface dataset:
P838 Increased Risk of Avascular Necrosis in Patients With Inflammatory Bowel Disease: a nationwide population based cohort study
Authors: Moon J M , Kwon K E , Jung S Y , Choi C H , Lee J W , Shin S Y , Joo H J
Published: January 2023

Background

Avascular necrosis (AVN) is bone death due to disruption of blood supply causing disability and significant morbidity. Although considered multi-factorial, corticosteroid use is a well-known risk factor. Not only is AVN more prevalent in Inflammatory bowel disease (IBD), but IBD patients are often exposed to higher corticosteroids usage. Therefore, we aimed to investigate epidemiology and risk factors of avascular necrosis in Asian IBD patients.

Methods

We conducted a nationwide population-based cohort using Korean National Health Insurance Service (NHIS) database from January 2007 to December 2020. Newly diagnosed IBD patients were defined according to the International Classification of Diseases, 10th revision (ICD-10), and at least one prescription of IBD-specific medications. 1:3 sex-, age- matched subjects from the general population were selected. We investigated newly diagnosed AVN using the ICD-10 code and the incidence rates and risk of AVN were assessed with multivariate cox regression models.

Results

A total of 62,417 IBD population was identified, where ulcerative colitis (UC) comprised of 44,106. Age at diagnosis was younger in Crohn's disease (CD) than in UC (30±15 years and 43±16.3 years). UC population revealed greater number of comorbidities such as hypertension (16.7% and 7.1% for UC and CD, respectively), diabetes mellitus (12.4% and 9.5%), dyslipidemia (27.6% and 25.2%), and cerebrovascular diseases (4.5% and 2.5%). During the mean follow-up period of 6.75 years, 54,591 (87.5%) of the total IBD patients were exposed to systemic steroids (86.4% and 90.1% for UC and CD, respectively). Approximately 76.8% in the IBD group were prescribed with ≥10 mg/day of corticosteroids with mean duration of 16.3±35.1 days. A total of 100 (0.16%) newly diagnosed AVN cases were observed in the IBD population. Time from the index date to AVN diagnosis was 4.47±3.29 years. Compared to the non-IBD controls, the incidence of AVN was significantly increased in IBD subjects (adjusted hazard ratio [aHR] with 95% confidence interval [CI], 1.28 [1.01-1.63]). UC patients in particular were at an elevated risk for developing AVN (aHR with 95% CI, 1.39 [1.07-1.80]), whereas risk analysis for CD patients demonstrated results that were statistically not significant (aHR with 95% CI, 1.00 [0.63-1.57]).

Table 1 Incidence rates and risk ratios of AVN in patients with IBD

Conclusion

Risk of AVN was elevated in Korean IBD patients compared to non-IBD population, especially for UC. Physicians dealing with IBD patients should be aware of etiological factors of AVN along with corticosteroid use. Future study is needed to investigate on the mechanisms associated with AVN in IBD.
P844 Frequency of Extraintestinal Manifestations in vedolizumab versus anti-TNF Treated Patients with Inflammatory Bowel Diseases
Authors: Liava C , Sinakos E , Dimitroulas T , Navrozidou C , Akriviadis E
Published: January 2023

Background

Patients with moderate to severe inflammatory bowel diseases (IBD) treated with gut-selective vedolizumab (VDZ) may be more likely to develop de novo extraintestinal manifestations (EIMs) or exacerbate pre-existing EIMs, compared to those treated with systemic anti-tumor necrosis factors (anti-TNF), as has been demonstrated mainly in retrospective studies. We aimed to compare the frequency of EIMs in IBD patients treated with VDZ vs those receiving anti-TNF therapies, based on prospectively-retrospectively collected data from a cohort of IBD patients followed in daily clinical practice.

Methods

300 patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2022. Logistic regression analysis and chi-squared test were used to compare the frequency of EIMs between IBD patients treated with VDZ vs anti-TNF.

Results

Of the 300 patients with IBD, 111 received biologic therapy [82 with Crohn’s disease (CD), 28 with ulcerative colitis (UC), and 1 with indeterminate colitis (IC)]. The median age of these IBD patients was 39 years. The majority (80%) were treated with anti-TNF agents (88 received anti-TNF and 23VDZ). CD patients received more frequent anti-TNF therapy (69 of 88 patients treated with anti-TNF, OR 2.95; 95% CI: 1.11-7.81; P<.05); patients with UC received more frequently VDZ [10 of 23 patients treated with VDZ (44%) vs 18 of 88 patients treated with anti-TNF (21%), P<.05]. IBD patients diagnosed with perianal disease had an increased trend of receiving anti-TNF therapy than those without (OR 2.34; 95% CI: 0.87-6.31; P=.094). EIMs were observed in 55% of patients included in the cohort (52% were treated with anti-TNF vs 70% treated with VDZ, P=.144), as summarized in table 1. IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents (OR 3.03; 95% CI:1.12–8.21; P<.05).

Conclusion

In this cohort study, IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents. This result may be explained by the gut-selective anti-inflammatory effect of VDZ, which appears to limit its clinical effect on EIM prevention.
P859 Accuracy of self-reporting of immune-mediated inflammatory diseases by patients with inflammatory bowel disease. Results from a hospital-based cohort.
Authors: De Francisco Garcia R M , Pérez-Martínez I , Castaño-García A , Celada-Sendino M , Fernández-González E , García-Pérez C , Martínez-Gozález S , Rolle V , Queiro R , Alonso-Castro S , Santos-Juanes J , Gueimonde M , Riestra S
Published: January 2023

Background

The association of several immune-mediated inflammatory diseases (IMIDs) in the same patient is well known. IMID, especially joint and cutaneous diseases, are frequently diagnosed in patients with inflammatory bowel disease (IBD). However, the degree of knowledge that patients with IBD have about the coexistence of other IMIDs is little studied. Our aim was to evaluate the accuracy of self-reporting of IMID by patients with IBD.

Methods

Prospective, unicentric study that included patients attended in person at the IBD Unit of the Central University Hospital of Asturias (Spain) between August 2020 and December 2021. Patients were invited to participate in the study, and, after signing the informed consent, they answered a questionnaire about the presence or not of 50 IMIDs (self-reported diagnosis). The diagnosis of an IMID was confirmed in the medical records of each patient (reference diagnosis). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (proportion of subjects correctly classified) of self-reporting was calculated. Statistical analyses were performed with R software version 4.0.2.

Results

A total of 1,621 patients were included. Forty-four percent of patients had ulcerative colitis, 53% had Crohn’s disease and 3% had an IBD-unclassified, 50% were men, and the age at diagnosis of IBD was 38±15.2 years. Seven hundred and twelve patients were receiving mesalazine, 67 corticosteroids, 394 immunomodulators and 532 biologics. Six hundred and twenty-seven (39%) patients were diagnosed with at least one IMID, 177 (10.9%) with two, 49 (3%) with three, and 17 (1%) with more than three. Sixteen percent of patients had a joint IMID and 15% a cutaneous IMID. Self-reporting of IMID by IBD patients has a sensitivity, specificity, PPV, NPV and accuracy of 0.75 (95% CI 0.73-0,78), 0.89 (95% CI 0.86-0.91), 0.92 (95% CI 0.89-0.93), 0.69 (95% CI 0.66-0.73) and 0.81 (95% CI 0.79-0.83), respectively. Table 1 shows the results by IMID groups (joint, cutaneous, digestive, endocrinological, ocular, others), and Table 2 shows the results of the most frequent IMIDs.

Conclusion

Eighty-one percent of patients with IBD are able to correctly identify the coexistence or not of IMIDs. It was observed that in the case of joint IMIDs there is a significant percentage of patients who do not know whether or not they suffer from one of these diseases.
P861 Frequency and Influence of a Positive Family History on the Clinical Course of Inflammatory Bowel Diseases
Authors: Liava C , Sinakos E , Dimitroulas T , Navrozidou C , Akriviadis E
Published: January 2023

Background

Previous studies on the difference in phenotypes and disease course between familial and sporadic inflammatory bowel diseases (IBD) have resulted in heterogenous conclusions. However, a positive family history is considered the strongest recognizable risk factor for developing IBD and is present in 8-12% of cases. We aimed to compare the frequency of a positive family history between patients with Crohn’s disease (CD) and ulcerative colitis (UC) and additionally to evaluate possible clinical parameters that may influence the clinical course of familial IBD cases, based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice.

Methods

Patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 to March 2022. Logistic regression analysis was used to examine clinical parameters that may influence the clinical course of familial IBD cases and the chi-squared test to compare the frequency of a positive family history between patients with UC and CD.

Results

We collected 300 patients diagnosed with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis). About 10% of IBD patients had a first degree relative with IBD (13% in CD and 4% in UC group, P< .05), as summarized in table 1. Female IBD patients had a 4-fold increased risk to have a first degree relative with IBD (OR 3.79; 95% CI: 1.44-9.98; P< .01). Similarly, CD patients had a 3-fold increased risk (OR 3.31; 95% CI: 1.08-10.18); P< .05). IBD patients who had a first degree relative with IBD were at greater risk for hospitalization for IBD flare or other complications (OR 3.07; 95% CI: 1.12-8.38; P< .05), to undergo a surgical procedure, mainly colectomy (OR 5.20; 95% CI: 1.98-13.68; P< .01), to develop perianal disease (OR 3.42; 95% CI: 1.25-9.35; P< .05), to develop sacroiliitis (OR 3.72; 95% CI: 1.40-9.91; P< .01), and to being treated with anti-TNF agents (OR 3.21; 95% CI: 1.14-9.08; P< .05). Furthermore, in patients with a family history of IBD there was a trend for extraintestinal manifestations (OR 2.47; 95% CI: 0.91-6.74; P= .078), especially from the musculoskeletal system (OR 2.45; 95% CI: 0.94-6.34; P= .066), skin (OR 2.83; 95% CI: 0.94-8.45; P= .065) and ocular system (OR 4.92; 95% CI: 0.89-27.26; P= .068), as shown in table 2.

Conclusion

In this retrospective-prospective cohort study, family history of IBD in first degree relatives was present in 13% of patients with CD and 4% of patients with UC, and was associated with increased risk for hospitalization, surgical procedures, occurrence of perianal disease, treatment with anti-TNF agents, and a trend for developing EIMs.
P863 Exploring patients’ perceptions of clinical research in inflammatory bowel disease and barriers to participating in clinical trials
Authors: Chatten K , Kalra P , Bower P , Mclaughlin J , Ghosh S , Limdi J
Published: January 2023

Background

The rising incidence and prevalence of inflammatory bowel disease (IBD), its uncertain aetiology and multidimensional and negative effects on people’s lives have underscored the importance and need for research across disciplines. Despite this, participation in research in IBD remains relatively low, with virtually no data exploring patients’ perceptions and barriers to participation in research among people living with IBD. This is a preliminary report from an on-going study in the UK.

Methods

Consecutive outpatients attending IBD clinics at our centre were invited to complete a questionnaire survey. Information on patient demographics, disease duration and activity were recorded and patient perceptions and barriers to participating in research were explored.

Results

Of 401 patients approached to date, 332 (82.8%) consented to complete the questionnaire. Of 60 patients who declined, 70% were male. Among 332 participants, 176 (53.2%) were female, age between 18- 80. 164 participants had Crohn’s disease (CD,49.4%), 147 ulcerative colitis (UC) (44.3%), 8 (2.4%) had IBD-unspecified and 13 (3.9%) were unsure of their diagnosis. 209 (63%) patients were on biologics. The mean Harvey Bradshaw Index (HBI) was 4.4 (CD) and partial Mayo score 2.1 (UC).

303 (91.3%) participants said they would participate in research, but only 65.3% stated they would be interested in drug trials. Reasons cited for participation were to advance medical knowledge (277/303, 91.4%) followed by the possibility of “effective” treatment (231/303, 76.2%).

Of those that stated they were not interested in research at all, 17/29 (58.6%) were male. Their most important reasons for not wanting to participate were time constraints followed by concern for health. Although optional to answer if interested in research, a further 100/303 (33%) cited concern for own health (54/100, 54.0%) followed by time constraints (34/100, 34%) as barriers. Only 15 felt deterred by the possibility of receiving a placebo (15/100, 15%) or having more tests (12/100 12%).

Direct conversation with their doctor (201/332, 60.5%) was felt most motivational to participation in research.

Conclusion

Most patients express interest in participating in IBD research, with majority interested in participating drug trials. The placebo element did not deter sentiment about participation in trials and direct communication with clinicians is valued. More data will be available for analysis and reporting in the coming months.
P883 Parental and perinatal risk factors associated with onset of Inflammatory Bowel Disease: A systematic literature review and meta-analysis
Authors: Mallon K , Mcbride C , Doherty G , Burns R
Published: January 2023

Background

Several risk factors have been associated with the onset of Inflammatory Bowel Disease (IBD), including pre and early life exposures occurring during gestation and up to the end of an infant’s first year of life.

Perinatal factors linked to the subsequent development of IBD include parental and environmental exposures. It is postulated that exposure to such factors impacts immune system development leading to alterations in immune responses and increased susceptibility to disease.

Limited evidence evaluates this association systematically whilst focusing specifically on the perinatal period. The purpose of this review was to systematically determine whether parental and perinatal factors are associated with IBD onset.

Methods

We searched the following electronic databases: Ovid MEDLINE, Web of Science, and the Cochrane Library. Searches were conducted from 01/01/2002 until 26/01/2022. Keywords and search terms related to ‘perinatal’ and ‘inflammatory bowel disease’ were applied.

Case control studies, RCTs and cohort studies evaluating the association between parental and perinatal factors and IBD were included.

Study protocol details have been published on the International Prospective Register of Systematic Reviews (PROSPERO). Available from: http://https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290798Databases

Results

Our initial search identified 14,989 potentially relevant articles to include (see Figure 1). After title and abstract screening there were 119 articles that met the eligibility criteria. After full-text review and further assessment of these 119 articles, 18 articles were deemed suitable for study synthesis based on the eligibility criteria.

Across the 18 articles, a range of parental and perinatal factors were included: family history IBD (n=8), breastfeeding (n=7), disease during pregnancy (n=4), maternal age (n=4), birth delivery method (n=4), antibiotic exposure (n=3), pre-term birth (n=3), birth weight (n=2), environmental exposures in infancy (e.g. pet exposure, rural dwelling) (n=2), diet (n=1), vaccination (n=1) and maternal smoking (n=1).

Conclusion

This review provides a detailed summary of parental and perinatal factors associated with the onset of IBD. The evidence generated will influence the development of diagnostic risk assessment tools and detailed patient pathway paradigms to address current shortcomings within the delivery of IBD care, providing opportunities to improve efficiency and reduce healthcare costs. The findings will inform on key targets for primary prevention strategies at this early life stage and provide valuable insight on IBD onset to academics, clinicians, patients and policy makers.
P884 Association between psychosocial factors experienced in childhood or adolescence and occurrence of Inflammatory Bowel Disease (IBD) in adulthood: a case-control study in Quebec, Canada
Authors: Esmingeaud L , Jantchou P , Nicolau B , Madathil S , Rousseau M C
Published: January 2023

Background

The incidence of inflammatory bowel disease (IBD) has been steadily increasing worldwide and its etiology remains poorly understood. This study aims to estimate the associations between exposure to psychosocial factors in childhood or adolescence and the development of IBD in adulthood, separately for Crohn's disease and ulcerative colitis.

Methods

A case-control study nested in a population-based birth cohort was carried out. A total of 993 cases of Crohn's disease, 489 cases of ulcerative colitis and 914 controls born between 1970 and 1974 in Quebec, Canada, were analyzed. Sociodemographic and medical information were extracted from administrative databases. Participants filled out a questionnaire including a section on selected psychosocial factors experienced over their life course. Odds ratios (OR) and confidence intervals (95% CI) for the associations between psychosocial factors in childhood (0-9 years), adolescence (10-17 years) or over the full pediatric period (0-17 years), and IBD in adulthood were estimated by unconditional logistic regression models adjusted for potential confounding factors. For each association, a model including tailored covariates selected with a directed acyclic graph was estimated. The number of psychosocial factors experienced over the pediatric period was also analyzed in relation to the risk of IBD in adulthood.

Results

Some factors were associated with the risk of Crohn’s disease, such as sexual abuse in childhood (OR=1.58; 95% CI: 1.08-2.30) or over the full pediatric period (OR=1.39; 95% CI: 1.04-1.84). Likewise, the following factors occurring during adolescence were associated with increased odds of Crohn’s disease: parental neglect (OR=1.64; 95% CI: 1.01-2.66), the death of a loved one (OR=1.37; 95% CI: 1.02-1.85), and anxiety disorders (OR=1.66; 95% CI: 1.02-2.70). An association was identified between the experience of anxiety disorders from 0 to 17 years and ulcerative colitis in adulthood (OR=1.67; 95% CI: 1.05-2.67). Finally, exposure to three or more (vs. none) psychosocial factors from 0 to 17 years old was associated with the occurrence of Crohn's disease (OR=1.63; 95% CI: 1.13-2.36), but not ulcerative colitis (OR=0.98; 95% CI: 0.60-1.60) in adulthood.

Conclusion

In this study, the occurrence of sexual violence, parental neglect, the death of a loved one or anxiety disorders during childhood and/or adolescence was associated with the development of IBD in adulthood. Our results bring new light to the etiological puzzle of IBD by focusing on psychosocial factors and their accumulation during periods of vulnerability. Further studies taking into account resilience and assessing microbiota changes will be needed to confirm these results.
P885 Does long term corticosteroid use increase the risk of femur fracture in Inflammatory Bowel Disease patients? : A nationwide population-based cohort study
Authors: Kim B , Sung Hoon J , Jiyoung L
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) patients have been reported to have a higher frequency of femur fracture than healthy controls. Based on the data femur fractures in IBD patients, not many studies analyzing this correlation have been reported various risk factors, including corticosteroid therapy. Aim of this study was to demonstrate the prevalence of femur fracture in IBD patients with long-term corticosteroids.

Methods

The National Healthcare Insurance Service (NHIS) database of IBD patients between 2008-2018 was used for this cohort study. We collected the data of ICD-10 code, sex, age, comorbidities, corticosteroid use and IBD-related medications. The sex- and 10-year age matched non-IBD reference population was extracted during the same study period at a matching ratio of 1:3.

Results

From 2008 to 2018, 33,778 patients with IBD and 101,265 patients in the reference population were followed up for a median 5.0 years. The result showed that the use of corticosteroid more than 1year increased the risk of femur fracture of both Ulcerative Colitis and Crohn's Disease patient ((HR 2.83; 95% CI 1.37-5.84; P<0.01 and HR 2.62; 95% CI 1.00-6.86; p<0.05), respectively. Also, long term use of corticosteroid increased the severity of femur fracture (HR 0.62; 95% CI 0.43-0.90; p<0.05).

Conclusion

Femur fractures in patients with IBD patients are generally associated with results in hospitalization and related with significant morbidity and mortality. As use of corticosteroid and its duration contributed to femur fracture risk include its severity, prevention of fracture and careful corticosteroid therapy strategy should be considered.
P889 Serologic response with antimicrobial antibodies during the preclinical phase of inflammatory bowel disease
Authors: Rodríguez-Lago I , Cabriada J L , Barreiro-de Acosta M
Published: January 2023

Background

Previous data have shown that the inflammatory process underlying ulcerative colitis (UC) and Crohn’s disease (CD) can start years before the diagnosis. Serum proteomic and serologic markers have been identified during this period, providing the opportunity for early detection of the initial immune disturbances. Our aim was to determine if patients with an incidental diagnosis of UC or CD demonstrate a serologic response based on antimicrobial antibodies, therefore preceding the symptomatic onset of the disease.

Methods

We performed a prospective single-center study including all asymptomatic subjects with a diagnosis of UC or CD during the colorectal cancer screening program and available data on antimicrobial antibodies between 01/10/2013 – 29/02/2022. The diagnosis of IBD was established by a combination of clinical data, endoscopic findings suggestive of UC or CD, and after histologic confirmation. ASCA IgA, ASCA IgG (EliA ASCA IgA/IgG, ThermoFisher) and ANCA (EUROPattern, PerkinElmer; EliA IgG, ThermoFisher) antibodies were determined. Positive results were considered above 10 U/mL for ASCA, 3.5 for ANCA-MPO and 2.00 for ANCA-PR3. Descriptive statistics were used.

Results

A total of 26 incidentally-diagnosed patients were included, 19 with UC (21% left-sided, 32% extensive; 53% former smokers), and 7 with CD (57% ileal, 29% colonic; 14% active smokers), with a median age of 51 years (IQR, 51-57). Three patients showed at least one positive test (12%). One patient (5%) with extensive UC showed positive ANCA results, and he developed symptoms 2 months after diagnosis. Two patients (28%) with CD (L2B2 and L1B1, according to Montreal classification) showed positivity to ASCA IgA/IgG at diagnosis, and both have remained asymptomatic after a median of 23 months. After a median follow-up of the whole cohort of 54 months (IQR, 26-67), 12 patients (46%) developed symptomatic disease.

Conclusion

A low proportion of patients with an incidental diagnosis of IBD demonstrate a serological response based on antimicrobial antibodies, suggesting that this situation corresponds to the initial phases of IBD when systemic immune disturbances might not be detectable yet.
P893 Budget impact analysis of introducing infliximab subcutaneous for the treatment of Inflammatory Bowel Disease in Latvia
Authors: Yoo H K , Jang M Y , Kwon T S
Published: January 2023

Background

Since the marketing authorisation of infliximab (IFX) subcutaneous (SC) in 2021, most of the western European countries had adopted CT-P13 SC. However, a few central and eastern European (CEE) countries including Latvia failed to adopt the new version of IFX. Infliximab SC injection at home significantly reduces number of outpatient visits and intravenous (IV) administrations. This is a tremendous benefit for countries with modest healthcare budget like Latvia because it will contribute to the effective use of hospital resources, especially in a pandemic era. This study describes the economic impact of introducing CT-P13 SC to the Latvian market from the perspective of society.

Methods

A prevalence-based budget impact model was developed incorporating epidemiological data, administration cost data, and patient share data from Nacionālais Veselības Dienests (NVD). The analysis compared a “world with” CT-P13 SC scenario to a “world without” CT-P13 SC. The cost of IFX SC was assumed to be at parity to IFX IV which allows to capture the savings from the administration cost. This model compares annual cost of treatment including drug acquisition costs, administration cost and indirect cost of same molecule and further line of treatments (vedolizumab, ustekinumab, and tofacitinib).

Results

This model estimates the financial impact on 2,000 patients with Crohn’s disease (CD) and ulcerative colitis (UC). Savings yield from IV administration cost is approximately €135,000 over the five-year period. Compared to the “world without” scenario, the introduction of CT-P13 SC resulted in cost savings of €1.03 million for treating CD and UC in Latvia over a 5-year period. The savings will be able to treat additional 220 patients, which equates to 11% of current patients, in a 5-year period.

Conclusion

Despite poor access to biologics in Latvia compared to other European countries, utilisation of IFX is high in Latvia compared to other biologics. Adding a SC treatment option to the existing care will not only improve patient outcome but also may lead to cost savings for the Latvian society. Parity pricing of IFX SC to IV IFX will enable budget reduction and result in improved patient experience with infliximab.
P894 Diagnostic yield of routine stool pathogen tests during the relapse of Inflammatory Bowel Disease
Authors: Huang V , Albadrani A , Alshowair M
Published: January 2023

Background

To make the diagnosis of Inflammatory bowel disease (IBD) flare, it is traditionally necessary to exclude infectious colitis, including bacteria and parasites. Furthermore, Infectious colitis prevalence varies between geographic areas of the world.

It has been a routine clinical practice of sending broad stool testing and cultures to the laboratory before starting targeted therapy for IBD flare. The purpose of this study is to examine the yield of stool testing in adult patients with inflammatory bowel disease flare.

Methods

It is a retrospective study. We reviewed the medical records of the admitted patients with IBD flare at Mount Sinai Hospital, Toronto, Canada between October 2018, and August 2019. We used a computer-generated list of patients admitted with a diagnosis of IBD. We excluded patients with no confirmed diagnosis of IBD or admitted for reasons other than IBD flare. A number of variables were recorded, such as the patient's demographics, concurrent and previous IBD therapy, steroid use, presenting symptoms, vital signs, and the results of the initial laboratory investigation

Results

This study included 96 adult patients admitted with IBD flare. A total of ninety-four of our samples were tested for C. difficile at the time of admission. Only 9.4% were positive for C. difficile. Six of them had ulcerative colitis and three had Crohn’s disease.

The percentage of patients evaluated with stool cultures was 86%, while the percentage of patients evaluated for ova and parasites was 51% at the time of patient admission. Only 34% of the population had colonic biopsies stained for Cytomegalovirus (CMV) of which 74% had ulcerative colitis. None of the stool cultures nor CMV tests were positive in our population.

The risk of acquiring C difficile infection was not significantly correlated with the patient's disease phenotype, the biological therapy they were receiving, or their smoking history. In our sample, clinical tests and routine laboratory tests did not predict infectious colitis. The CRP level, as well as the neutrophil and eosinophil counts, were not associated with positive C. difficile infection.

Conclusion

In IBD flare, we did not routinely identify pathogens besides C difficile. Aside from areas where bacterial or parasitic infections are prevalent, routine stool testing with cultures and parasites has a low yield.
P906 Prevalence and CARD9 IBD risk variant rs4077515 in a Chilean IBD Cohort
Authors: Pérez T , Bustamante M L , Magne F , Alvares D , Álvarez-Lobos M , Hernandez-Rocha C , Aguliar N , Azocar L , Baez P , Zazueta A , Estela R , Escobar S , Silva V , De la Vega A , Arriagada E , Espino A , Miquel J F , Travisany D
Published: January 2023

Background

Genome-wide association studies (GWAS) have identified hundreds of polymorphisms associated with an increased risk of developing IBD. Among risk genes identified by GWAS, CARD9, a gene encoding an adapter molecule involved in the innate immune response to fungi and bacteria, has been related to IBD risk. CARD9 alleles in IBD patients may have either a protective function or a high genetic risk factor such as rs4077515. Interestingly, the CARD9S12N (rs4077515) variant has a higher frequency in the Latin South American population than the Caucasian population. The relevance of rs4077515 in the risk of IBD in the Latino population is unknown.

Aims

(1) To estimate allele and genotype frequencies for rs4077515 in IBD patients and Chilean controls and compare with Ensembl genome database (public data available). (2) To compare the allele and genotype distributions in IBD patients and controls, including association tests and estimation of ORs according to additive, dominant and recessive penetrance models.

Methods

260 IBD patients were genotyped using the TaqMan SNP genotyping technology based on qPCR. Aggregated genotype information for 3147 population-based Chilean controls was retrieved from a published study on gallstones in Chileans (Lorenzo et al., Hepatology 2021). We calculated the allele and genotype frequencies for rs4077515 and then compared these frequencies with controls. A Chi-square test of association was used under the null hypothesis of no association between genotypes and disease. Univariate and multiple logistic regression were performed (additive, dominant, and recessive penetrance models).

Results

Table 1 compares rs4077515 allele and genotype frequencies in Chileans and other populations (Ensembl data set). Table 2. exhibits the estimated odds ratio for IBD, CD, and UC in Chilean population. Table 3. reveals the association results for rs4077151 models in the Chilean population.

Conclusion

In this study, the A risk allele for rs4077515 is significantly more frequent in the Chilean population than reported in other populations such as European, but similar to Amerindian. In this Chilean cohort, the variant rs4077515 is not associated with higher IBD risk. However, this could be an effect of sample size, or patients carrying rs4077515 requires an additional factor to IBD development.
P911 The changes in the faecal microbiome and metabolome in Crohn’s disease after treatment with anti-TNFα antibodies are of secondary origin
Authors: Hurych J , Mascellani Bergo A , Lerchová T , Hlináková L , Kubát M , Malcová H , Cebecauerová D , Schwarz J , Karásková E , Hecht T , Vyhnánek R , Ťoukálková L , Dotlačil V , Kobrová K , Čížková A , Horváth R , Bronsky J , Havlík J , Hradský O , Cinek O
Published: January 2023

Background

Treatment by anti-TNFα antibodies (aTNFα) is known to change the dysbiotic faecal bacteriome in Crohn’s disease (CD). However, whether the change is caused by aTNFα itself or by improving the gut inflammation status is unknown. Therefore, we aimed to identify and compare bacterial taxa and faecal metabolite changes upon aTNFα between children with CD and juvenile idiopathic arthritis (JIA), a disease very rarely affecting the gut.

Methods

Faecal samples were analysed for bacteriome by massively parallel sequencing of the V4 region of the 16S rRNA and for faecal metabolome by 1H nuclear magnetic resonance. Gut inflammation status was assessed by faecal calprotectin levels.

Results

In total, 530 stool samples from 121 children (CD 54, JIA 18, healthy 49) from six different hospitals in Czechia were collected. In CD patients, 37 progressed to the need for aTNFα therapy, whereas 17 remained on other therapeutic modalities; in JIA, 14 received aTNFα, whereas four remained on other treatments. In JIA, calprotectin levels were not different from controls (P=0.16), and lower than in CD (~50 fold, P<10-16). Among CD, when aTNFα therapy was administered, their calprotectin levels decreased by a mean of 59% as compared to the period off-therapy (P=1.40 x 10-5). Regarding the microbiome and metabolome changes, five bacterial genera and four metabolites significantly changed their abundance/concentration upon aTNFα administration in CD but not in JIA. Within the bacteriome, Blautia, Ruminococcus, Intestinibacter and Erysipelatoclostridium (all phylum Firmicutes) increased, whereas Allistipes (phylum Bacteroidota) decreased. Among metabolites, glucose and glycerol increased, whereas isoleucine and uracil decreased. The analysis of bacteriome composition revealed dysbiosis in CD, with a shift away from Proteobacteria towards Firmicutes and Actinobacteria after aTNFα.

Conclusion

Our findings suggest that aTNFα therapy changes the dysbiotic microbiome in CD towards healthier composition. This is supported by relatively comprehensive longitudinal stool sampling in a multicentric study. Most importantly, the observed bacteriome changes upon treatment with TNFα blockers are of secondary origin, as they occur only in CD patients, whose gut inflammation status improves after the treatment, and no effects are observed in the control group of JIA.
P913 Interactions between Intestinal Microbiota and micro-RNAs in Inflammatory Bowel Disease
Authors: Eun C S , Oh E H , Lee A R , Park C H , Han D S
Published: January 2023

Background

Both gut microbiota and micro-RNAs (miRNAs) have been implicated in the pathogenesis of inflammatory bowel disease (IBD). We aimed to investigate the interactions between gut microbiota and miRNAs which are altered in murine colitis models and patients with IBD using multi-omics analysis.

Methods

Gut microbiota and miRNAs were analyzed in a mouse experiment (7 dextran sodium sulfate [DSS]-treated mice, 7 azoxymethane [AOM] and DSS-treated mice, and 6 controls) and a human experiment (10 patients with active Crohn’s disease, 10 patients with active ulcerative colitis [UC], and 8 healthy controls). DNA was extracted from mouse feces and human colonic tissues, and 16S rRNA gene sequencing was performed to evaluate changes in gut microbiota. miRNA expression levels were measured by microarray analysis from mouse and human colonic tissues. mRNA expression levels were examined by microarray analysis from colonic tissues of UC patients. Correlation and network analyses were performed to evaluate the interactions among gut microbiota, miRNAs and mRNAs.

Results

Principal coordinate analysis showed distinct gut microbiota composition and miRNA expressions among the groups in the mouse and human experiments. Also, comparative analysis showed many miRNAs differentially expressed and many bacterial amplicon sequence variants (ASVs) differentially identified among the groups. Spearman correlation rank test and network analysis revealed multiple correlations and interactions among specific miRNAs and bacterial ASVs. In UC patients, genes associated with functional categories in biological process, such as positive regulation of cytokine production, cytokine-mediated signaling pathway, cell adhesion, positive regulation of response to external stimulus, and leukocyte migration were upregulated than healthy controls. mRNAs in UC patients also showed multiple correlations and interactions with specific miRNAs and bacterial ASVs.

Conclusion

Gut microbiota composition and miRNA expressions were distinctly altered in patients with IBD and murine colitis models. Specific miRNAs were associated with specific bacterial ASVs and mRNAs, suggesting the interactions among miRNAs, gut microbiota and mRNAs in the pathogenesis of IBD. Our data imply that global complicated interactions between gut microbiota and miRNAs, rather than specific individual microbiota-miRNA interaction, might play more important role in IBD.
N07 A qualitative study on how patients with Inflammatory Bowel Disease feel supported in managing their disease using an app
Authors: Fallesen J P , Minet L R , Skjøth M M , knudsen T , Kjeldsen J
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) is incurable and, for most patients, lifelong treatment and regular follow-up is required. A close communication with healthcare professionals is crucial. Recent studies show that E- health technologies are promising tools for close monitoring and communication among patients with IBD. Especially mobile-health apps are becoming increasingly popular. Based on need assessment and user involvement, an IBD-app was developed to support patients’ communication with healthcare professionals. The aim of this study was to explore patients’ experiences on how they feel supported in managing their disease using this IBD-app.

Methods

A phenomenological hermeneutic approach based on qualitative methods was applied to obtain an understanding of the patients’ experiences on how they feel supported in managing their disease using an app. Individual telephone interviews with 12 outpatients were conducted. Participants were recruited from two outpatient clinics at the Departments of Medical Gastroenterology at Odense University Hospital and Hospital South West Jutland in Esbjerg. The analysis was based on condensation of meaning. The tool consists of five steps that allows the researcher to give, the opinions expressed by the informant, a shorter formulation. It summarizes long statements and record the main meaning in few words. Afterwards, the informants' statements are exposed to a critical commonsense and theoretical interpretation with the aim of a broader understanding.

Results

Twelve outpatients with IBD, including five men and seven women age range from 18-75, participated in individual telephone interviews. The analysis generated four themes on how they feel supported in managing their disease through an app. The patients feel supported when the app helps them to: (1) strength selfcare-management through empowerment (2) conserves autonomy through a flexible contact with healthcare professionals (3) obtain a care-relationship through access to healthcare professionals (4) obtain dialogue with healthcare professionals.

Conclusion

This study indicates that patients with IBD perceived an app developed to support patients’ communication with healthcare professionals as meaningful and supportive. The results suggest the usefulness of building in functionality to support empowerment, autonomy, care-relationships and dialogue. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed.
N12 Development and introduction of a pre-clinic screening, triage system and virtual consultations for patients with Inflammatory Bowel Disease: a nurse led quality improvement project (QIP)
Authors: Gleeson S , Buckley P M , McCarthy D J , Sugrue K , O'Grady D J , O'Sullivan C , O'Sullivan G , Naughton C
Published: January 2023

Background

•In the IBD centre, Mercy University Hospital( MUH), all patients (Approximately 4000 patients with IBD) attend the outpatient clinic for face-to-face consultations as per prescheduled appointments regardless of disease status.

• Mismatch between need and access to care. Patients in remission attend for elective appointments, while patients in need of urgent specialist review may have to wait or else attend clinics which are already at capacity as an urgent appointment. The increasing strain on the OPD system calls for new models of care to be explored.

• Aim :develop and implement a pre-clinic screening , triage system and virtual consultations for low-risk patients & evaluate the impact on patient reported and health service outcomes.

• Prioritise patients with more unstable IBD symptoms for face-to-face consultations, while for patient with stable IBD to increase consultation choice (virtual or face to face)

• Examine impact on patient experience

• Examine impact on OPD waiting lists

Methods

• QIP conducted over a 6 month period. 1980 patients included in the study. 1560 patients were scheduled to attend OPD in the 6month timeframe and 420 patients were on the IBD OPD waitlist for return/ first time consult.

• logic model planning and PDSA cycles to develop ,test, refine and implement; 1.A pre-clinic screening, assessment and triage pack to assess patients clinical status and education needs 2.Inclusion and exclusion criteria for virtual consultations 3.Clinic pathway algorithms 4.Weekly virtual IBD MDTs

Results

• 95% of patients completed the pre-clinic screening and triage pack, of these 37% were eligible for telephone consultation and 89% of those deemed eligible were happy to switch from face to face to telephone consultation.

• 30% of patients who attended for pre-clinic screening and triage assessment required fast tracking of OPD appointments due to unstable disease and received earlier interventions e.g. colonoscopies, MRI’s and medication optimisation.

• IBD waiting list of 420 patients was cleared with this initiative, all patients were offered a telephone or OPD consultation based on the result of the pre-clinic triage assessment and patient preference.

83% of patients would be happy to continue with the new model as it was perceived as more convenient , time efficient and less disruptive to everyday life.

Conclusion

• This study highlighted that virtual management of IBD is acceptable to patients, significantly decreased clinic visit utilisation and can reduce the growing burden of IBD on health care resources .This initiative had many positive organisational outcomes including the elimination of the IBD OPD waiting list, reduction in non-essential clinic attendances and potential cost savings.
N22 Inflammatory bowel disease nursing in Italy: the experience of the Academic Hospital of Udine
Authors: Povoli A , Simonetta G , D'Agaro P , Marangone S , Marino M , Berretti D
Published: January 2023

Background

Inflammatory bowel diseases (IBDs) are a group of conditions characterized by a chronic inflammation of the digestive tract. IBDs can lead to extraintestinal manifestations that concern articulations, skin, liver, kidneys and eyes. Given the complexity of the diseases, patient affected by IBD are monitored by a multi-disciplinary team whose IBD nurse becomes one of the main figure. In 2018, the University of Udine fostered the post-graduate IBD nurse education programme called “IBD nurse case manager”, with the aims to a) promote high standards of clinical practice and research initiatives; and b) educate active members of the multi-disciplinary professional network both at national and international level.

Methods

A retrospective observational study has been conducted in 2022. All patients who attended the IBD clinic for administration of biological therapy, gastroenterological visits, training for subcutaneous therapy administration, follow-up for clinical studies (also via calls and/or emails) were included. Descriptive statistic has been used to describe the activity of the IBD clinic from 2018 to 2021

Results

From the 1st of January 2018 to the 31st of December 2021, a total of 1,114 patients (47% females; average age of 45 years) were admitted to the IBD clinic. Outpatient visits were 701 in 2018 and 679 in 2019, while 639 during the COVID-19 pandemic in 2020 and 708 in 2021; from 2020 to 2021 there was an increase of 11% of activities. The number of drug administrations increased by 35% from 2018 (n=353) to 2019 (n=475); also, these endovenous therapies were not modified in 2020 (n=487, +3%) and in 2021 (n=476, -3%). The number of education sessions for subcutaneous therapy decreased by 15% from 2018 (n=30) to 2019 (n=26); then, the number increased by 34% from 2019 to 2020 (n=35) and by 135% from 2020 to 2021 (n=83). Follow-up appointments for clinical studies decreased by 60% from 2018 (n=26) to 2019 (n=11), then, the number increased by 100% from 2019 to 2020 (n=22) and decreased by 20% during 2021 (n=17). In 2020, virtual visits were implemented, with an increase of 458% of phone calls in 2021 (n=1,329) compared to 2020 (n=290).

Conclusion

Data show that qualified nurses may improve IBD pathways and increase the IBD clinic activities with high quality standards of care. In addition, motivation, satisfaction and willingness to continue education training were perceived among nurses. The collaboration between the University of Udine and the Hospital of Udine showed encouraging results that can be replicated in similar contexts.
Tuning the expression of the bacterial relBE toxin–antitoxin system inSaccharomyces cerevisiaeallows characterizing the subsequent growth inhibition
Authors: Duperray Maëlle , François Jean-Marie , Capp Jean-Pascal
Published: January 2023

The bacterial toxin–antitoxin systems are each composed of a toxin, which severely inhibits bacterial cells growth, and a specific neutralizing antitoxin. Some toxin–antitoxin systems are functional when expressed in the yeast Saccharomyces cerevisiae. For instance, the expression of the relE toxin gene leads to a strong growth defect in yeast, whereas the expression of the relB antitoxin gene restores growth. Nevertheless, there is no available data regarding the required expression levels of each component of the relBE system leading to these growth phenotypes, neither their effects on cell viability. Here we used a double inducible plasmid-based system to independently modulate the relative amounts of relB and relE, and performed growth and gene expression analyses. These results allow us to correlate growth phenotypes to the expression levels of the toxin and the antitoxin, and to determine the levels necessary to observe either a strong growth inhibition or a normal growth. We also showed that the relE expression produces cell cycle progression defect without affecting cell viability. These results provide a detailed characterization of the functioning of the relBE system in S. cerevisiae, and open applicative perspectives of yeast growth control by bacterial toxin–antitoxin systems.