bluuebunny/crossref_metadata_2025 huggingface dataset:
P219 Disease-specific avoidance is a predictor for fatigue in inflammatory bowel disease patients
Authors: Fierens L , Van de Pavert I , Walentynowicz M , Coenen S , Geens P , Weyts E , Van Oudenhove L , Vlaeyen J , von Leupoldt A , Van Assche G , Vermeire S , Ferrante M , Van Diest I
Published: January 2020

Background

A substantial group of patients with inflammatory bowel disease (IBD) experience fatigue, even while in clinical remission. At present, disease-specific behaviours that maintain or worsen symptom burden including fatigue have not been explored. We developed a questionnaire evaluating IBD-specific avoidance behaviour and investigated how this relates to self-reported fatigue.

Methods

This study was a close collaboration between the psychology and gastroenterology department of our tertiary referral centre. A 72-item IBD-specific avoidance behaviour questionnaire (IBD-B) was generated based on literature review and input from clinicians and a patient focus group (n = 10). Between July 2018 and March 2019, 500 consecutive IBD patients were included at our infusion unit (wave 1) (participation rate 79%, 48% male, 66% Crohn’s disease (CD), median age 40). Patients completed the 72-item IBD-B, a demographic questionnaire, patient-reported outcome assessing disease activity (PRO2) and a Visual Analogue Scale (VAS) for fatigue. Test–retest reliability was assessed in 89 patients (54% male, 70% CD, median age of 40) who completed the IBD-B, PRO2 and VAS fatigue scale a second time after 4–12 weeks (wave 2). Clinical remission was defined as an abdominal pain score ≤1 and a liquid to very soft stool frequency ≤1.5 in CD patients and as no rectal bleeding and a stool frequency ≤1 in patients with ulcerative colitis (UC). A principal component analysis (PCA) was then used to reduce the number of items and investigate the underlying factor structure of the IBD-B. The predictive value of IBD-specific behaviours for fatigue was finally investigated both cross-sectionally and prospectively.

Results

At wave 1, 46% and 69% of CD and UC patients, respectively, were in clinical remission. PCA suggested a reduction of the 72-item to a final 25-item IBD-B and a seven-factor solution for use in clinical practice (loading factors >0.5, Table 1). The final 25-item IBD-B showed good psychometric properties. The median (IQR) total IBD-B and fatigue scores were, respectively, 29 (40-20) and 52 (77-25) for patients in clinical remission compared with 38 (48-28) and 74 (87-50) for patients not in clinical remission (both p < 0.01). Both cross-sectional and prospective significant correlations between IBD-B factors and fatigue were demonstrated (Table 2).

Conclusion

The IBD-B is a valuable tool to accurately measure IBD-specific avoidance behaviour in IBD patients. IBD patients without clinical remission report higher IBD-B values and show a higher correlation between avoidance behaviour and fatigue. Further research should now focus on identifying predictors for fatigue in IBD patients in clinical remission.
P221 Thromboembolic events in hospitalised patients with inflammatory bowel disease – a large tertiary hospital experience
Authors: Levartovsky A , Barash Y , Ben-Horin S , Ungar B , Klang E , Soffer S , Kopylov U
Published: January 2020

Background

Patients with inflammatory bowel disease (IBD) have a greater risk of venous thromboembolism (VTE) events compared with the general population especially during flares, in both hospitalised and ambulatory patients. Although VTE prophylaxis (thromboprophylaxis) is recommended in hospitalised IBD patients, the implementation is not universal, especially for non-IBD-related hospitalisations. In this study, we aimed to present the rates of VTEs and thromboprophylaxis among hospitalised IBD patients.

Methods

We created an electronic data repository of all IBD patients who visited the emergency department (ED) of our tertiary medical centre between 2012 and 2018. Data included tabular demographic and clinical variables (reason for referral, VTEs, clinical characteristics, hospitalisation, lab results, treatment and outcome) as well as free-text physician records. For this study, we searched the data repository for VTE cases, using ICD10 coding.

Results

Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) Crohn's disease and 849 (35.3%) Ulcerative colitis patients. Thromboprophylaxis was administered in 463 hospitalisations (12.4% of IBD-related and 10.9% of non-IBD-related hospitalisations). 1.5% of patients (36/2405) who visited the ED had a new VTE. Thirty patients were diagnosed with a deep vein thrombosis (DVT), two patients with a pulmonary embolism (PE) and six additional patients were diagnosed with both a DVT and PE in the same hospitalisation. Eleven patients had a VTE during a non-IBD-related hospitalisation and six patients during an IBD-related hospitalisation (0.6% vs. 0.3%, respectively, pv = 0.12). Five patients (29.4%) developed VTEs after receiving thromboprophylaxis during hospitalisation. The majority (72.7%) of VTEs diagnosed during a non-IBD-related hospitalisation did not have additional thrombosis-related risk factors. One patient died during hospitalisation and two more patients died in the upcoming 30 days (unrelated to VTEs).

Conclusion

The rate of thromboprophylaxis in hospitalised IBD patients is low, despite posing life-threatening implications. Thromboprophylaxis should be implemented in IBD patients hospitalised for all indications.
P223 Oesophagal involvement is a predictor of anti-TNF treatment failure in patients with Crohn’s disease
Authors: Sakata Y , Tsuruoka N , Esaki M
Published: January 2020

Background

Oesophageal Crohn’s disease (CD) is rare and not well known. We aimed to determine the clinical features of CD patients with oesophagal lesions seen at our institution.

Methods

Upper gastrointestinal (GI) endoscopy was performed as a routine procedure for the diagnosis of upper GI involvements in CD patients from 2012 to 2018 at Saga University Hospital. CD patients with oesophagal lesions were evaluated for demographics, CD characteristics, endoscopic findings, and treatments.

Results

A total of 68 CD patients underwent upper gastrointestinal endoscopy and 8 patients with oesophagal involvement were identified. The detecting rate of CD specific lesion in the oesophagus by endoscopy was 11.8%. 7 out of 8 patients were male and average age is 27 years (range, 18–61 years). Extraesophageal lesions included three types of CD (3 patients with ileitis, 3 patients with colitis, and 2 patients with ileocolitis) were found. 6 patients (75%) had oral ulcers at the time of oesophageal CD symptom onset. Four patients (50%) complained of retrosternal pain as an oesophageal-specific symptom and other patients complained of loss of appetite. Endoscopic findings showed small, round, superficial ulcerations in 4, and deep longitudinal ulcerations in 4. Superficial ulcerations were found throughout the entire oesophagus. No patients were found to have oesophageal strictures and fistulizing disease. 5 out of 8 patients (62.5%) developed loss of response (LOR) to anti-TNF treatment. Incidence of LOR in CD patients with oesophageal involvement was significantly higher compared with patients without oesophageal involvement (odds ratio 6.67, 95% CI 1.23–36.06, p = 0.031).

Conclusion

Although oesophageal lesions of CD have been regarded as uncommon in adults, it has become increasingly recognised. The oesophageal CD should be considered in all CD patients complaining of upper gastrointestinal symptoms. Oesophageal involvement in CD patients predicted LOR to anti-TNF treatment.
P228 Cytomegalovirus Infection: is it a cause of flare-up in inflammatory bowel diseases?
Authors: Busacca A , Mascaretti R , Carrozza L , Guida L , De Grazia S , Peralta S , Calvaruso V , Cappello M
Published: January 2020

Background

The presence of CMV in blood is quite common in patients with severe flares of ulcerative colitis (UC) and Crohn’s disease (CD) and seems to predict an adverse outcome. The impact of antiviral treatment on CMV in this setting (indications and drug options) is an unresolved issue. Our aim was to reassess the CMV role in patients with IBD hospitalised for severe exacerbations, analysing the relationship between CMV positivity, clinical characteristics, antiviral therapy and disease outcomes.

Methods

We evaluated a homogeneous cohort of 97 consecutive patients with IBD hospitalised from 2012 to 2018. Data regarding age, gender, smoke, familial predisposition, type of IBD, extent, according to Montreal classification, disease activity (clinical and endoscopic), therapy at the time of relapse were registered in a dedicated database. CMV was tested by PCR in whole blood. The relationship between antiviral therapy and disease outcomes (rate of colectomy, mortality) was analysed.

Results

Among the 97 patients, 51 were females. In the UC group (67 patients, 69.1%), mean age was 48,8, SD ± 17,7 whereas in the CD group (30 patients, 31%), mean age was 39,9 years (SD ± 15,2). Fifteen per cent of patients had a family predisposition for IBD. There were no differences at baseline between UC and CD, except disease duration (longer in UC) and therapy at the time of relapse (high dose steroids more common in UC). Thirty-one patients (32 %) tested positive for CMV on PCR. Smoking habit, shorter disease duration, therapy on admission (high dose steroid and/or immunomodulators) and endoscopic activity assessed by Mayo endoscopic sub-score were the variables significantly related to CMV positivity. Antiviral therapy was adopted in 22% of patients and the decision to treat was based on clinical judgement and viral load. Treated patients had higher endoscopic activity than untreated (Mayo sub-score 3 vs. 2,6, p < 0,004). The mean hospital duration was longer in treated patients 22.3 ( ± 11.1) days, vs. 14,8(+/−8,6) days. 3 patients underwent surgery within 90 days, 2 patients died; all of them were positive for CMV DNA. No significant differences were observed on either colectomy or mortality rate in relation to the use of antiviral therapy.

Conclusion

This single-centre study confirms that the CMV reactivation during disease flares of IBD is common and related to disease duration, severe endoscopic lesions, and immunosuppression (high dose steroids and/or immunomodulators).Antiviral drugs do not seem to modify surgical outcomes or mortality but increase the hospitalisation length. However, the retrospective design and the limited sample size of the study do not allow to draw definitive conclusions: the real impact on outcome and the role of antiviral therapy will require adequately powered prospective studies.
P232 In suspected small bowel Crohn’s disease: Clinical impact of using capsule endoscopy to make decisions
Authors: Gonzalez R A , Gómez E J , Pereyra L , Mella J M , Panigadi G N , Fischer C , Roel M , Cimmino D , Pedreira S , Boerr L A
Published: January 2020

Background

Capsule endoscopy (CE) can detect small bowel (SB) lesions compatible of Crohn’s disease (CD) in patients with suggestive symptoms but with inconclusive results for the diagnostic workup. However, the clinical impact of CE in helping physicians to make decisions about patients with suspected CD is not currently well established. The aim of the study was to investigate the clinical impact of CE to confirm diagnosis of CD and also to evaluate whether the results of CE modify therapeutic decisions.

Methods

We conducted a single-centre retrospective cohort study. All consecutive adult’s patients submitted to CE for clinical suspected of CD, on period November 2012 to November 2018, were included. Data on demography, previous research, medications for IBD, CE procedures and follow-up were analysed. Multivariate logistic regression analysis was carried out to identify predictors of CD.

Results

A total of 329 CE protocols in adult’s patients were performed over the study period. Ninety were in IBD patients and were included in the analysis 63 CEs submitted for suspected of CD: Clinical suspected CD 54(86%) and colitis unclassified 9 (14%). The mean age was 41 years (range 17–77 years) and 54% were males. The CE reached the caecum in 58 cases (92%) and retention was observed in 5 (8%) with only one patient (1.6%) requiring surgical removal. Overall, 28 of 63 patients (44%) had CE findings consistent with the diagnosis of CD. The lesions identified by CE included ulcers 24 (86%), erythema and villous oedema 17(61%), aphthas and mucosal erosions 5 (18%), stenosis 2 (7%) and were distributed mainly in the distal part of the SB (third tertile) in 23 (82%), but in 14 (50%) cases the proximal SB (first and second tertiles) was also affected. The mean Lewis Score (LS) was 903 (112–4356). Significant inflammatory activity (LS ≥ 135) was detected in 17 (27%) and was moderate or severe (LS > 790) in 7 (11%). CE visualise normal SB mucosa in 34 (54%) of patient’s, which rules out CD. Therapeutic started in 23 (36%) of patients, initiating a new IBD medication in most cases in the 3 months after the CE. On logistic regression analysis, male (p = 0.02) and findings in ileocolonoscopy (p = 0.004) were independents predictors of CD.

Conclusion

In our cohort, CE in suspected CD confirm diagnosis in 44% of cases. Male gender and findings in ileocolonoscopy appear to be independents predictors of CD. CE is a useful tool in suspected CD, since it adds relevant information for diagnosis and had a great impact on therapeutic decisions.
P233 Evaluating the association between faecal calprotectin and endoscopic outcomes in ulcerative colitis using the HICKORY open-label induction cohort
Authors: Reinisch W , El Azzouzi B , Li R , Lacey S , Daperno M , Mishkin D , Park K T , Hassanali A , Hussain F , Oh Y
Published: January 2020

Background

In clinical practice, faecal calprotectin (FC) is used to monitor disease activity in ulcerative colitis (UC); however, there is no consensus on optimal cut-off values of FC for predicting endoscopic outcomes. FC performance has not been extensively assessed in the context of clinical trials using central endoscopy. This study aimed to evaluate the association between FC and endoscopic disease activity and to propose a meaningful cut-off FC value to predict endoscopic outcomes using data from the open-label induction (OLI) cohort of HICKORY (NCT02100696).

Methods

HICKORY is a Phase 3 study evaluating etrolizumab in anti-tumour necrosis factor α-experienced patients with moderate-to-severe UC. The study included patients who received ≥1 dose of etrolizumab 105 mg subcutaneously every 4 weeks during a 14-week induction period. Percentage change in FC was calculated at week 14. The endoscopic activity was measured by Mayo Clinic score (MCS) endoscopic subscore (ES) using a robust central-reading model. Endoscopic improvement was defined as ES=0/1; clinical remission as MCS ≤2 and no individual subscore >1. FC analysis was performed by Covance® (Bühlman FC ELISA assay). Receiver operator characteristic (ROC) curve analyses were used to calculate cut-off FC values.

Results

A total of 97 patients (mean age [standard deviation], 41.2 ± 13.4 years) were included in the analysis. Median (interquartile range [IQR]) baseline duration of disease was 6.3 (3.2–12.3) years with a median (IQR) MCS of 9 (8–10). Median (IQR) baseline FC and ES were 254 (156–455) µg/g and 3 (3-3). At week 14, median (IQR) FC percentage change was −13 (−57 to 112). A numerical association between changes in FC level and ES was observed (Table). A cut-off FC value of 159 µg/g was observed to predict endoscopic improvement with >70% sensitivity and specificity; ROC area under the curve was 0.78 (Figure). Similar results were observed for clinical remission.

Conclusion

In this exploratory analysis using HICKORY OLI cohort data, changes in FC appear to associate with changes in ES. A cut-off FC value of 159 µg/g predicted endoscopic improvement. In UC, FC may be a useful non-invasive biomarker for ascertaining endoscopic disease activity in clinical trials; however, further clinical studies validating FC cut-offs against centrally read endoscopy are needed.
P235 Serological biomarkers of interstitial matrix and basement membrane remodelling correlate the Modified Mayo Endoscopic Score (mMES) for ulcerative colitis
Authors: Mortensen J , Godskesen L E , Lindholm M , Krag A , Karsdal M A , Manon-Jensen T , Kjeldsen J
Published: January 2020

Background

Endoscopy is a mainstay in ulcerative colitis (UC) for disease activity monitoring. The modified Mayo Endoscopic Score (mMES) for UC takes into account disease extent and hereby additional objectivity can be achieved for endoscopic assessment. However, endoscopic evaluation of the intestinal mucosa is time-consuming and inconvenient for the patients. Therefore, surrogate biomarkers for endoscopic examinations are warranted. The aim of this study was to evaluate serological neo-epitope biomarkers of type IV collagen degradation (C4M) and formation (PRO-C4), type III collagen degradation (C3M), type V collagen formation (PRO-C5) and macrophage activity (VICM) and their association with the mMES for UC.

Methods

Endoscopic disease activity was scored using mMES for UC patients (n = 63). Patients were stratified according to the disease activity severity based on mMES (remission = 0–1, mild = 2–4, moderate = 5–6, severe >6). ELISA was applied for biomarker measurements (C4M, PRO-C4, C3M, PRO-C5 and VICM) in serum. Pearson correlations and one-way-ANOVA with FDR correction were applied for statistical analysis. A multivariate regression model was developed in order to combine the ECM biomarkers as a composite index. This model was correlated with the mMES and compared with FC and C-reactive protein (CRP) levels.

Results

All the biomarkers correlated to mMES (VICM: r = 0.35, p = 0.0063; PRO-C5: r = 0.33, p = 0.009; C3M: r = 0.32, p = 0.011; C4M: r = 0.28, p = 0.0255; PRO-C4: r = 0.25, p = 0.044). Stratification of the patients revealed that VICM, C3M, and C4M serum levels were significantly elevated in UC patients with severe mMES compared with patients in remission (VICM: p = 0.0158, C3M: p = 0.04), mild disease activity (VICM: p = 0.0002, C3M: p = 0.0049, C4M: p = 0.0084) and moderate disease activity (VICM: p = 0.0166). Biomarkers that correlated significantly with the mMES were included in the multivariate regression model as a composite biomarker index. The biomarker model correlated significantly with mMES (r = 0.45, p = 0.0002) (Figure 1A) and the model was also able to discriminate between the different stages of disease activity (p = 0.0007) (Figure 1D). FC correlated with mMES (r = 0.48, p = 0.0001) (Figure 1B and E), however CRP did not correlate with mMES (Figure 1C and F).

Conclusion

The combined tissue-remodelling biomarkers correlated significantly with mMES for UC. The ECM serological biomarkers performed better than CRP, and equally good as FC. Thus, serological biomarkers of ECM remodelling, especially basement membrane degradation, interstitial matrix degradation and macrophage activity biomarkers may be used as surrogate markers for endoscopic disease activity assessment for UC.
P240 CDEIS score of 2 is optimal cut-off associated with lower risk of disease progression in early Crohn’s disease: Data from the CALM study
Authors: Ungaro R , Jordan R , Yzet C , Bossuyt P , Baert F , Vanasek T , D’Haens G R , Wilhelmus Joustra V , Panaccione R , Novacek G , Reinisch W , Armuzzi A , Golovchenko O , Prymak O , Goldis A , Travis S , Hébuterne X , Ferrante M , Rogler G , Fumery M , Danese S , Rydzewska G , Pariente B , Hertervig E , Stanciu C , Serrero M , Diculescu M , Peyrin-Biroulet L , Laharie D , Wright J P , Gomollón F , Irina G , Schreiber S , Motoya S , Hellström P M , Halfvarson J , Colombel J F
Published: January 2020

Background

The optimal endoscopic target in early Crohn’s disease (CD) that limits long-term disease complications is unknown.

Methods

We analysed medical records from patients who had follow-up data since the end of CALM. Patients with Crohn’s disease endoscopic index of severity (CDEIS) scores at the end of CALM were included. The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since the end of CALM. We compared median CDEIS and per cent improvement from baseline CDEIS. Youden index analysis was used to identify optimal CDEIS cut-off score associated with CD progression. Kaplan–Meier and Cox regression methods were used to compare rates of progression by different CDEIS targets. Multivariable models were adjusted for age, prior surgery, and stricturing behaviour.

Results

110 patients with median age 28 (IQR 22–38) years, disease duration 0.2 (0.1–0.5) years, and median follow up of 3.1 (1.9–4.4) years were included. Eleven per cent had a history of stricture, 5.5% history of surgery, and 52% were originally in the tight control arm of the CALM study. Median CDEIS score at end of CALM was 3 (0–5.4) and 32 (29%) patients had disease progression. Baseline median CDEIS score was similar between those with and without progression [10.9 (7.5–15.5) vs. 11.9 (8–17.5)]. Median CDEIS score at the end of CALM was higher among those with progression [1.3 (0–5.1) vs. 4.9 (3–9.1), p < 0.001)]. Patients within higher quartiles of CDEIS score had higher rates of progression over time (Figure 1). Patients without disease progression had a greater median decrease in CDEIS score from baseline to end of CALM [90% (60–100%) vs. 50% (30–80%), p < 0.001]. The optimal CDEIS score cut-off was 2 with sensitivity 84%, specificity 60% and NPV 90% for progression. Patients with CDEIS ≤ 2 had less progression over time compared with patients with > 50% improvement from baseline CDEIS (not reaching CDEIS ≤ 2) and those not meeting either endpoint (Figure 2). On adjusted analysis, CDEIS score ≤ 2 was associated with a decreased risk of progression (aHR 0.23, 95% CI 0.09–0.56).

Conclusion

In early CD, a CDEIS score ≤ 2 is optimal cut-off associated with a lower risk of disease progression.
P242 Prior pregnancy outcome is an important determinant of subsequent pregnancy outcome in women with inflammatory bowel diseases
Authors: Rottenstreich A , Fridman Lev S , Rotem R , Mishael T , Koslowsky B , Goldin E , Grisaru-Granovsky S , Bar-Gil Shitrit A
Published: January 2020

Background

Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Disease flare throughout gestation are not uncommon and can substantially affect pregnancy outcomes. We aimed at the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD.

Methods

Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011–2018.

Results

Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout the follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn’s disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11–32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 215.52), p < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), p < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalisation during pregnancy (14.7% vs. 0, p = 0.02) and preterm delivery (32.4% vs. 5.7%, p = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 grams, p = 0.03), in those with disease flare as compared with those with maintained remission.

Conclusion

History of disease relapse at previous gestation and periconception disease activity were found as an important predictor of disease flare among IBD women. These data would facilitate adequate counselling and informed management decisions among reproductive-aged IBD women and their treating physicians.
P245 Inter-rater reliability of gastrointestinal ultrasound in the assessment of disease activity in patients with inflammatory bowel disease prior to commencing medical therapy
Authors: Smith R , Taylor K , Friedman A , Su H , Con D , Gibson P
Published: January 2020

Background

Gastrointestinal ultrasound (GIUS) is an emerging modality in Australia for the assessment of disease activity in patients with inflammatory bowel disease (IBD). Its utility relies upon reproducibility of key indices, particularly when performed by different operators.

Methods

The aim of this article was to address the inter-rater reliability among GIUS-credentialed gastroenterologists in Australia, in their assessment of GIUS indices reflecting disease activity in patients with IBD.

Methods

Patients with IBD were prospectively recruited for paired, consecutive, blinded GIUS assessment at the commencement of a new medical therapy. GIUS was performed by two of four gastroenterologists accredited in GIUS at our centre. GIUS assessment was completed of the known disease distribution. Bowel wall thickness (BWT) was determined from a mean of four measurements for each segment of bowel examined. Colonic and small bowel BWT was defined as normal <3 mm, mild disease 3.1–6 mm, moderate disease 6.1–9 mm and severe disease >9.1 mm. Anastomotic BWT measures were considered as normal <5 mm or abnormal >5.1 mm. Colour Doppler assessment of the bowel wall was based on the Limberg scale1: no colour Doppler signal, mild, moderate and severe. The presence or absence of mesenteric hyperechogenicity surrounding each bowel segment and the presence or absence of reactive lymphadenopathy was assessed. The inter-rater reliability was tested with the Fleiss kappa.

Results

26 patients were assessed. Sixty-nine per cent had a diagnosis of Crohn’s disease, 19% with ulcerative colitis and 12% with IBD unclassified. A total of 80 bowel segments were assessed. In the assessment of BWT, the observed agreement was 77.5% and the inter-rater reliability was in the substantial range with a Fleiss’ kappa of 0.63 (95% CI 0.48–0.78, p < 0.001). Of note, the percentage of BWT measures that differed by <1 mm, between each operator, was 79%. When assessing the degree of Doppler activity, the observed agreement was 82.5% and again inter-rater reliability in the substantial range with a Fleiss’ kappa of 0.68 (95% CI 0.54–0.83, p < 0.001). The assessment of mesenteric hyperechogenicity showed an observed agreement of 96.3%, with a near-perfect inter-rater agreement with a Fleiss’ kappa of 0.89 (95% CI 0.76–0.99, p < 0.001). For the presence or absence of lymphadenopathy, the observed agreement between users was 84.6% with a substantial inter-rater agreement reflected by a Fleiss’ kappa of 0.64 (95% CI 0.29–0.98, p < 0.001).

Conclusion

Among Gastroenterologists experienced and credentialed in GIUS, the inter-rater reliability of markers of intestinal inflammation was substantial, providing confidence in the reproducibility of findings between different operators.
P266 Atopic diseases are associated with the development of inflammatory bowel diseases: A nationwide population-based study
Authors: Hong S W , Soh H , Lee H J , Han K , Park S , Moon J M , Kang E A , Chun J , Im J P , Kim J S
Published: January 2020

Background

The association between atopic diseases and inflammatory bowel diseases (IBD) still remains unclear. We conducted a nationwide population-based study to investigate the effect of atopic diseases on the development of IBD.

Methods

A total of 9,950,548 subjects who received medical check-up between 2009 and 2012 were included and followed up until 2017. The presence of any atopic disease including atopic dermatitis (AD), allergic rhinitis (AR), and asthma were evaluated. Patients who developed IBD including Crohn’s disease (CD) and ulcerative colitis (UC) were identified using the claims data from National Health Insurance.

Results

During a mean follow up of 7.3 years, 1,426 (0.014%) subjects developed CD and 5,916 (0.059%) subjects developed UC. The incidences of CD (per 100,000 person-years) were 4.088, 2.255, and 2.344 in patients with AD, AR, and asthma,, respectively. The incidences of UC were 11.926, 9.857, and 9.377 in patients with AD, AR, and asthma, respectively. Multivariable analysis revealed that the adjusted hazard ratios (aHR) for incident CD in patients with AD, AR, and asthma were 2.21, 1.33, and 1.59 (95% confidence interval (CI) 1.251–3.896, 1.152–1.532, and 1.186–2.123, respectively) compared with controls. The risk for incident UC in patients in AD, AR, and asthma were 1.51, 1.32, and 1.28 (95% CI 1.081–2.101, 1.235–1.416, and 1.110–1.484, respectively) compared with controls. Moreover, increase in the number of atopic diseases gradually increased the risk for CD and UC; CD showed aHR of 1.36 and 1.65 (95% CI 1.180–1.571 and 1.143–2.370), and UC showed aHR of 1.30 and 1.49 (95% CI 1.216–1.398 and 1.247-1.170) in one, and two or more atopic diseases, respectively.

Conclusion

Patients with any atopic diseases showed an increased risk for IBD, while an increase in the number of atopic diseases gradually increased the risk for IBD.
P274 The clinical significance of anastomotic ulcers after ileocolic resection to predict postoperative recurrence of Crohn’s disease
Authors: Kim J Y , Park S H , Kim Y J , Park J C , Noh S , Lee J S , Kim J , Ham N S , Oh E H , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K
Published: January 2020

Background

The Rutgeerts score (RS) is used to predict postoperative recurrence in Crohn’s disease (CD) patients after ileocolic resection primarily based on endoscopic finding at the neoterminal ileum. However, assessing anastomotic ulcers (AUs) is still a matter of debate. Our aim was to investigate the clinical significance of AUs on endoscopic recurrence in postoperative CD patients.

Methods

This was a single-centre retrospective study analysing postoperative CD patients with the RS of i0 to i1 at the first ileocolonoscopy within 1 year after ileocolic resection between 2000 and 2016 and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs predicting endoscopic recurrence (RS ≥ i2b).

Results

Among 116 patients who were in endoscopic remission at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the 30.0 months (interquartile ranges, 21.3–53.3) of median follow-up periods after the index ileocolonoscopy, 56.1% (55/98) showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs defined as ulcer occupying ≥ 1/4 of the circumference or ≥ 3 ulcers confined to anastomotic ring, or any ulcers extended to ileocolic mucosa showed endoscopic recurrence. On multivariable analysis, the presence of AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; p < 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–6.79; p < 0.001) were associated with endoscopic recurrence, respectively.

Conclusion

AUs are associated with a significantly higher risk of endoscopic recurrence in postoperative CD patient who are in endoscopic remission.
P275 Biological therapies for patients with Crohn’s disease: More options mean less surgical interventions
Authors: Chin Y F , PUJJI O , Wilkinson B , Mohan S , Nnaji M , Yassin N
Published: January 2020

Background

The advent of biologic therapy and their acceptance into mainstream use for the medical management of patients with inflammatory bowel disease (IBD) has transformed the landscape of treatment for this condition. It has particularly become a mainstay in the treatment of fistulating or perianal Crohn’s Disease (CD). Data have shown that overall, 70% of patients will require surgical resections for CD. Consequently, questions have endured regarding the effect of biologic medications on the overall treatment course of CD patients. Our aim is to identify the efficacy of biologics by measuring surgical free survival. We subcategorised the period into 3 categories, including periods less than a year 1–5 years and >5 years and comparing these with the number of biologics they required to be switched either due to side effects or loss of medical response.

Methods

A retrospective analysis of prospectively collected data was correlated with the clinical coding department, inflammatory bowel disease and surgical databases. Patients receiving biological therapies were identified (Infliximab, Adalimumab, Vedolizumab, Ustekinumab, Certolizumab). Demographics, clinical and surgical data were analysed.

Results

Sixty-six patients were included in our analysis. Male to female ratio is 1 to 1.07, age range was 18–77, median age 41 (SD:17.46) years old. Twenty-five patients had ileocaecal resection, 17 had hemi and segmental colectomy, 7 had small bowel resection, 10 had subtotal colectomy and 7 had panproctocolectomy. Refractory to one biologic does not indicate biological failure; number of biologics switched and surgical free survival were compared. We have utilised the Spearman correlation coefficient for nominal analysis which gave us a coefficient of +0.725, p = 0.00. This indicates that both factors have a strong positive correlation between numbers of biologics patients used against period required for surgical management.

Conclusion

In the current era of biological therapies, with a breadth of choice of therapeutic agents, our data has a positive correlation between the number of biological agents used and surgery-free survival for patients with Crohn’s disease. A multidisciplinary approach to the management of these patients should be personalised, and suitability to each biological agent should be considered in addition to close surgical observation.
P279 Early detection of mucinous adenocarcinoma within fistulating peri-anal Crohn’s disease
Authors: Corr A , Reza L , Lung P , Jenkins I , Antoniou A , Latchford A , Wilson A , Arebi N , Burling D , Warusavitarne J , Faiz O , Thomas-Gibson S , Hart A , Tozer P
Published: January 2020

Background

The development of peri-anal fistula mucinous adenocarcinoma (MA) is a presumed rare but recognised event in patients with fistulating peri-anal Crohn’s disease. The true incidence is unknown, with a lack of robust registry data. Fistula mucinous cancers may evade early diagnosis, presenting with locally advanced intra-pelvic disease, necessitating debilitating and morbid exenterative surgery. Given the limitations of endoluminal assessment of this region in the context of an often extra-luminal disease process, MRI studies were reviewed in conjunction with EUA and endoscopic findings.

Methods

We performed a retrospective analysis of 8 cases of biopsy-proven mucinous adenocarcinoma (MA) that had developed within known Crohn’s related anal fistula. Serial MRI studies pre-dating the diagnosis of malignancy were reviewed in order to establish whether there are early predictive features of MA development within a fistula tract. Demographic, disease and surgical history were collected including the time of fistula diagnosis and histological confirmation of mucinous adenocarcinoma.

Results

The median time to histological diagnosis of MA from the time of diagnosis of Crohn’s disease was 426 (96–480) months and from diagnosis of fistulating disease 66 (24–156) months. On review of sequential MRI fistula protocol studies, a characteristic ‘budding’ appearance within the T2 high signal ‘sepsis’/fistula tract is noted in all of our MA fistula cancer cases (Fig1 and 2). This finding pre-dates the histological diagnosis of MA by a median of 42(12–156) months. Weight loss was a presenting symptom in 4 of the 8 (50%) patients and all 8 patients reported a new significant peri-anal pain and high volume discharge which prompted reassessment and referral. Metastatic disease was not detected in any of the 8 cases. Potentially curative pelvic exenteration was possible in 7 patients.

Conclusion

Mucinous adenocarcinoma within this cohort often culminates in exenterative surgery by the time a diagnosis is made. There is an opportunity for early detection on MRI of the development of MA in an anal fistula by recognition of ‘budding’ within the tract. An earlier diagnosis may lessen the magnitude and morbidity of subsequent radical surgery following prolonged growth of these lesions. Long-standing Crohn’s anal fistula should be surveyed with MRI and any finding of ‘budding’ within the tract on T2 sequences should prompt urgent examination under anaesthetic and biopsy.
P280 Sodium picosulfate low-volume and split-dosed bowel preparation facilitates endoscopic monitoring of patients with inflammatory bowel disease
Authors: Fasoulas K , Katsimpeli A , Kevrekidou P , Kafalis N , Stergiou E , Bouzoukas S , Lazaraki G , Tzilves D , Soufleris K
Published: January 2020

Background

The concept of Treat to Target and Tight Control relies heavily on bowel mucosa assessment. This implies that multiple endoscopies should be performed for any patient with moderate to severe inflammatory bowel disease (IBD). Improving patient tolerance of bowel preparation is important as we stride for frequent endoscopic monitoring. We aimed to compare low-volume (2 litres) Sodium Picosulfate (Pico) and high-volume (4 litres) Polyethylene Glycol (PEG) bowel preparation regimens, as well as split dosing, in terms of tolerance, efficacy and safety.

Methods

We included all adult IBD patients of our IBD clinic who underwent colonoscopy in the last 2 years for the sole purpose of mucosal healing assessment. We excluded patients with an indication of cancer surveillance, acute severe colitis, bowel strictures with obstructive symptoms, and patients with renal or liver failure. We used a Visual Analog Scale (VAS) assessed by patients to evaluate tolerance, and Boston Bowel Preparation Scale (BBPS) assessed by physicians to evaluate efficacy.

Results

A total of 139 patients were included in the study: 70 (50,4%) male patients, 86 (61,8%) with Crohn’s disease and 53 (38,2%) with ulcerative colitis, with a mean age of 46,14 years (range 17–74) and mean disease duration of 10.12 years. We included 21 patients (15.1%) with a previous ileocecal resection. Low-volume Pico preparation was received by 48 (34,5%) patients. High-volume PEG preparation was received by 91 (65,5%) patients. Split dosed preparation was received by 49 (35.2%) patients. Low-volume Pico preparation was significantly better tolerated than high-volume PEG preparation (VAS 81,75 vs. 65,69, p < 0,001) without a negative impact on bowel preparation quality (BBPS 7,65 vs. 7,32, p = 0.237). Split dosing did not improve tolerance (VAS 74,96 vs. 67,75, p = 0.221) but it improved the quality of the preparation (BBPS 7,94 vs. 7.13, p = 0,002). No meaningful differences were observed in terms of isolated aphthous ulcers (0% vs. 4%, p = 0,325). Complete intake of preparation was significantly higher in the low-volume Pico group (94,7% vs. 74,7%, p = 0,002). Complete colonoscopy was achieved in all patients. No serious adverse events related to the bowel preparation were reported. Patients in the low-volume Pico group were slightly younger (42,54 vs. 48,03 years, p = 0,034) and more likely to have had surgery (25% vs. 9,9%, p = 0,018).

Conclusion

Although this was a single-centre non-randomised study with a relatively small number of patients, it clearly demonstrated that low-volume PICO split dosed bowel preparation is superior for IBD patients scoped to check for endoscopic remission, as it improves tolerance and quality without compromising efficacy. Further evidence from randomised studies is needed.
P284 Disentangling fibromyalgia from spondyloarthopathy in the patient with inflammatory bowel disease
Authors: Variola A , Bertolini E , Di Ruscio M , Vernia F , Geccherle A , Beltrami M , Tinazzi I , Macchioni P
Published: January 2020

Background

Joint pain is common in subjects affected by Inflammatory bowel disease (IBD) and is linked to several factors including spondyloarthritis (SpA), drug therapy, concomitant osteoarthritis and fibromyalgia (FM). The primary aim of this study was to estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of IBD patients. The secondary aim was to assess the impact of FM on clinimetric scores and ultrasonographic features.

Methods

Consecutive cases with IBD attending two IBD Units were assessed by a rheumatologist for ASAS criteria for SpA or the 2010 ACR criteria for FM. The rheumatological assessment included a 66 swollen joint count (SJC) and 68 tender joint count (TJC), Maastricht Ankylosing Spondylitis Score (MASES), Leeds Enthesitis Index (LEI) and the FM tender points examination, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). One hundred and fifty-eight patients seen at Reggio Emilia centre underwent US entheseal examination. MRI and HLA-B27 determination were requested if needed for diagnostic confirmation.

Results

301 patients were enrolled with 148 completing the clinical and imaging/laboratory assessment if requested for diagnostic purpose. A total of 37 IBD patients (12%) met the ACR criteria for FM: 27 patients (9%) presented the criteria for primary FM and 10 patients (3.3%) presented FM and SpA. Patients who met FM criteria were mostly female (81%, p < 0.001), slightly older, with longer duration of disease; no correlation with smoking, sedentary job, body mass index (BMI) or psoriasis. Of note FM patients presented higher LEI, BASDAI and BASFI scores than SpA patients. At US examination patients who satisfied ASAS criteria for SpA had significantly higher mean enthesis/patient PD positive as compared with IBD and FM group (p < 0.001 for the two comparison) and had more patients with at least one PD positive enthesis (p < 0.001 and p = 0.028 respectively). Acute entheseal lesions had a higher prevalence in the ASAS+ group as compared with the other two groups (p = 0.002 vs. IBD group and p = 0.009 vs. FM group). Chronic entheseal lesions had the same prevalence in the three groups of patients.

Conclusion

FM is common among IBD patients and more prevalent in females and patients aged ≥ 45 years old. In this subgroup of patients SpA disease activity indices performed poorly for distinguishing patients with disease activity from those with functional impairment. On the contrary, US examination showed a promising discriminating capacity in SpA patients.
P287 Patient sex does not affect endoscopic outcomes of biologicals in patients with inflammatory bowel disease, but is possibly associated with adverse events: A systematic review
Authors: Lie M R K L , Paulides E , van der Woude C J
Published: January 2020

Background

There are several known factors influencing the efficacy and tolerability of biological therapies. Whether patient sex affects this is currently unclear, yet this knowledge would be helpful for risk and benefit stratification. This study assesses the role of patient sex on the efficacy and tolerability of biological therapies used for the treatment of IBD.

Methods

A systematic literature search was performed on 08 April 2019 using Embase (including Medline), Medline OvidSP, Cochrane Central Register of Controlled Trials, Web of Science and Pubmed. The primary outcome was the influence of patient sex on endoscopic outcomes in IBD patients treated with biologicals. The secondary outcome was the influence of patient sex on adverse events during biological therapy. Studies examining either of the outcomes were included in the assessment, regardless of study type or setting.

Results

The search yielded 19461 citations. After review 55 studies were included in the study, involving 28465 patients treated with adalimumab, certolizumab pegol, infliximab or vedolizumab. Of the 41 studies that objectively examined patient sex and efficacy of biological therapy, none found a significant association. Of the 14 studies examining patient sex and adverse events, 7 found that adverse events such as infections or skin lesions occur more frequently in female than in male patients. No meta-analysis of the primary or secondary outcome could be performed due to lack of exact reporting of summary measures.

Conclusion

There is no evidence for a sex difference in endoscopically measured response to biological therapies in IBD patients. However, there is a possible influence of sex on the occurrence of adverse events with a higher incidence in females.
P297 Novel serum soluble markers of histological healing in ulcerative colitis
Authors: Nardone O M , Jeffery L , Bazarova A , Acharjee A , Gkoutos G , Zardo D , Shivaji U N , Smith S C , Ghosh S , Iacucci M
Published: January 2020

Background

The recent introduction of a commercial panel of soluble biomarkers, that can predict endoscopic healing, may support the monitoring and management of Crohn’s disease reducing the need of repeated endoscopy.1 Achieving histological remission (HR) is currently considered to be an important target in ulcerative colitis (UC).2 The aim of this study was to identify serological markers of HR in patients with UC and determine their diagnostic accuracy individually and in combination to predict HR.

Methods

We enrolled 40 UC patients referred to a tertiary academic centre for colonoscopy as part of standard of care. Demographic data and histologic data (RHI, Nancy) were collected. Concentrations of these biomarkers were compared with the histology at the time that the patients underwent colonoscopy with advanced enhancement technologies and targeted biopsies. Histological healing was defined as Nancy ≤1 and RHI ≤3. A total of 55 soluble analytes, relevant to inflammation or shown to be altered in IBD, were measured in serum using Procartaplex luminex assays (ThermoFisher). Finally, 24 analytes that were detected in more than 40% of patients were selected in downstream modelling and used to train a logistic regression model.

Results

We identified Brain-Derived Neurotrophic Factor (BDNF) and Macrophage Inflammatory Proteins (MIP-1 α) that, when combined together, showed the highest predictive power for predicting RHI≤3 and Nancy ≤ 1 with an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% CI: 0.69–0.97). When we investigated analytes separately for predicting the same outcome, univariate logistic regression was significant for two other markers: Leukemia Inhibitory Factor (LIF) and Vascular Cell Adhesion Molecule 1 (sVCAM1) showing higher values associated with the lack of healing. The AUROC was 0.74 for LIF (95% CI: 0.591–0.89) and 0.72 for sVCAM1 (95% CI: 0.53–0.90).

Conclusion

BDNF, MIP-1α, LIF and sVCAM may be promising markers to assess histological healing in UC patients. Replication in larger cohorts of patients is now required.

*OMN and LJ contributed equally.

References