bluuebunny/crossref_metadata_2025 huggingface dataset:
P143 Changes in the Clinical Phenotype and Behavior of Pediatric Luminal Crohn’s Disease at Diagnosis in the Last Decade
Authors: Sassine S , Savoie-Robichaud M , Lin Y F , Djani L , Christine C A , Qaddouri M , Fadela Zekhnine S , Grzywacz K , Groleau V , Dirks M , Drouin É , Halac U , Marchand V , Girard C , Courbette O , Patey N , Dal Soglio D , Deslandres C , Jantchou P
Published: January 2022

Background

Crohn’s disease (CD) triggers are incompletely understood and the incidence of the disease has been increasing. The aims of this study were to describe the trends in the clinical, endoscopic, histological, and laboratory characteristics of pediatric CD during the last decade and to describe the seasonal variation of disease presentation at diagnosis.

Methods

Patients under 18 years old and diagnosed between 2009 and 2019 were included. Patients clinical, endoscopic, histological, and laboratory data were collected from the medical records. Data were analyzed for the cohort as a whole and according to diagnostic periods (2009–2014 and 2015–2019) and seasons.

Results

654 patients were included in the study. The total number of incident CD cases significantly increased yearly. Patients diagnosed between 2015 and 2019 were younger at diagnosis (OR: 2.30, p<0.0001), had more perianal diseases (OR= 2.30, p<0.001) and more intestinal biopsy granulomas (OR= 1.61, p=0.003) as compared to the 2009–2014 cohort. Also, there was a strong association between intestinal biopsy granulomas, young age at diagnosis and perianal fistulas or abscesses; the presence of granulomas was associated with greater perianal involvements (OR= 2.25, p<0.001) and younger age at diagnosis (OR = 0.90, p=0.0002). PCDAI and SES-CD scores at diagnosis, disease location and behavior and laboratory markers did not change over time.

There were fewer CD diagnosis during winter. The highest vitamin D levels in patients occurred in summer and fall, but the majority of patients had, regardless of the season of diagnosis, severe vitamin D deficiency (the median vitamin D level was 60.0 nmol/L in summer and fall compared to 47.0 nmol/L in winter-spring, p=0.003). Vitamin D levels at diagnosis are inversely correlated with PCDAI (Pearson correlation coefficient = -0.19, p=0.03) and SES-CD (-0.20, p=0.04). Patients diagnosed in fall had lower PCDAI and SES-CD scores, less failure to thrive, less digestive symptoms and less extensive digestive involvement. Colonic disease was significantly more frequent during summer and fall (27.3% of patients diagnosed in summer and fall versus 18.2% of cases in winter and spring, p=0.01).

Figure 1:PCDAI at diagnosis according to the season.

Figure 2:Proportion of patients with L1-L2-L3 disease locations by the Paris classification according to the season of diagnosis.

Conclusion

The disease phenotype has changed over the years and there are important seasonal trends in the frequency and severety of the disease suggesting possible disease triggers. Our findings provide interesting avenues for future research, such as identifying the clinical significance of granulomas, vitamin D deficiency and microbiota on pediatric CD activity.
P162 Prevalence and incidence of nonalcoholic fatty liver disease in Inflammatory Bowel Disease patients: risk factors for progression
Authors: Crispino F , Brinch D , Scrivo B , Celsa C , Di Grado G , Sapia A , Petta S , Cappello M
Published: January 2022

Background

Cross-sectional studies have assessed the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD). However, longitudinal studies are more suitable to capture dynamic changes. Our aim was to investigate the prevalence and progression of NAFLD in a cohort of IBD patients using validated non-invasive tools. The role of metabolic, disease-related and genetic factors as predictors of NAFLD was also assessed.

Methods

IBD patients without known chronic liver disease were enrolled between 2019 and 2021. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36 or controlled attenuation parameter (CAP) ≥288 dB/m. Demographic data, traditional risk factors for NAFLD, biochemical tests and disease features were retrospectively collected in a dedicated database at the time of IBD diagnosis (defined as baseline) and at the last follow-up visit. PNPLA3 rs738409 C>G and TM6F2 E167K C>T polymorphisms were also investigated. Univariate and multivariate logistic regression analysis were performed to identify risk factors for NAFLD at baseline and at the end of follow-up.

Results

227 consecutive patients (mean age 46.1 ± 13.4 years, 48.7% males, 57% Crohn’s disease, mean disease duration 9.4 ±7.5 years) were enrolled. Laboratory data at the time of diagnosis were available for 64 patients. The mean HSI was 30.9 ± 4.9 and 8/64 eligible patients (12.5%) had NAFLD at baseline. Male sex (odds ratio [OR]: 5.6; 95% confidence interval [CI] 3.1–8.9; P = 0.02) and body mass index (BMI) (OR: 1.4, 95% CI 1.1–2.9; P = 0.0008) were significantly associated with NAFLD at baseline. 11/64 (17.1%) patients developed NAFLD, accounting for an incidence rate of 4.0/100 PY; this was predicted only by changes in BMI over time (OR: 13.6, 95% CI 4.8–19.5; P = 0.001). At the last follow-up visit, NAFLD was diagnosed in 31.2% (71/227) according to HSI and in 21.1% (48/227) according to CAP. Among 8 patients with NAFLD at baseline, HSI worsened in 6 patients (41.0 ± 3.3 vs 44.0 ± 5.2), while two patients had steatosis regression. At the end of follow-up, age (P = 0.01), BMI (P = 0.002) and previous surgery (P = 0.01) were independently associated with NAFLD.

Conclusion

Our study confirms that NAFLD is common in patients with IBD. Variables related to IBD were not associated with incident NAFLD. Age, BMI and previous surgery were independently associated with NAFLD progression, suggesting a pathogenetic role of gut microbiota and impairment in bile acids metabolism. Our results suggest the need for active surveillance for NAFLD in patients with IBD.
P167 Functional outcomes of transanal versus transabdominal proctectomy with ileal pouch-anal anastomosis in Ulcerative Colitis. A comparative study
Authors: Bislenghi G , Denolf M , Wolthuis A , D’Hoore A
Published: January 2022

Background

This study aimed at comparing functional outcomes and quality of life (QoL) after transanal and transabdominal approach for ileal-pouch surgery in ulcerative colitis (UC)Ileal-pouch surgery ensures satisfactory intestinal function and QoL. The transanal ileal pouch-anal anastomisis (Ta-IPAA) has recently been developed in the effort to address the technical shortfalls of the traditional transabdominal approach (Tabd-IPAA). According to previous studies, Ta-IPAA is safe. However, functional outcomes after ta-IPAA are scarcely described.

Methods

This is a retrospective study of consecutive UC patients who underwent IPAA from 2011 to 2017. Only patients operated according to a modified-2 or 3 stage approach were included in the analysis. Close rectal dissection was systematically performed in Ta-IPAA as opposed to total mesorectal excision in Tabd-IPAA. Groups were compared after propensity score weighting. Functional outcomes were assessed using two functional scoring systems: the Pouch Functional Score (PFS) and the Öresland score (OS). The global quality of life scale (GQOL) was used for patients’ overall perspective on QoL. Follow-up was scheduled at 1, 3, 6, and 12 months postoperatively.

Results

One hundred and nine patients were included. Of them, 38 patients underwent Ta-IPAA. At 12 months follow-up, mean OS and PFS were 4.6 (CI 3.2–6.0) vs 6.2 (CI 5.0–7.3), p=0.02 and 6.1 (CI 3.5–8.8) vs 7.4 (CI 5.4–9.5), p=0.32, for Ta and Tabd-IPAA, respectively. Mean GQOL score for Ta-IPAA was 82.7 (CI 75.1–90.2) vs 75.5 (69.4–81.6) for Tabd-IPAA (p=0.038).

Conclusion

Transanal IPAA provides better functional results and QoL scores than Tabd-IPAA in UC patients.
P173 Endoscopic findings in the upper gastrointestinal tract in Crohn’s Disease – highly specific and closely related to Helicobacter pylori negative gastritis
Authors: Graca-Pakulska K , Błogowski W , Zawada I , Urasińska E , Deskur A , Bielicki D , Dąbkowski K , Starzynska MD- PhD T
Published: January 2022

Background

Scientific data indicates that in the course of Crohn’s disease (CD), certain endoscopic abnormalities in the upper gastrointestinal tract (UGIT), such as bamboo joint-like appearance (BJA) in the stomach, may be frequently present. However, there are not many clinical analyses available, in which prevalence of various endoscopic UGIT lesions would be comprehensively evaluated.

The purpose of the study was to investigate the characteristic of UGIT involvement in CD, with a particular focus on the Helicobacter pylori (Hp) status, BJA lesions and presence of microscopic changes in the stomach.

Methods

A total of 565 consecutive patients were prospectively recruited into the study (98 with CD and 467 controls). All individuals underwent upper esophagogastroduodenoscopy (EGD) with biopsy using a high definition endoscope with narrow band image. Chi-square and t-student tests were used for statistical analysis.

Results

The majority of CD patients (n=77; 79%) were found to have different abnormalities in EGD. Most commonly these were found in the stomach (n = 73; 74%), followed by duodenum (n= 39; 40%) and oesophagus (n=6; 6%). Mucosal redness/edema, BJA in the proximal part of the body and/or fundus, as well as antral erosions were the most prevalent gastric lesions. BJA was present in 44 (45%) of CD patients, and in one individual from the control group (0.002%), p<0.00001. BJA presence among CD patients was irrespective of sex, age, location, duration, intensity or course of the disease, as well as medications taken. Ulcerations and erosions were most commonly found lesions in the duodenum. Most of the CD patients were Hp negative (n = 94; 95.9%), while in the control group the majority of individuals were infected with Hp (57,1%), p<0.0001. Comparison between Hp negative patients with CD and controls revealed that gastric BJA lesions, duodenal ulcers and erosions were present exclusively in CD. These lesions were accompanied by chronic microscopic gastritis in all cases. Finally, the prevalence of microscopic HP negative gastritis was significantly higher in patients with CD than in controls (95.7% vs 15%, p<0.0002).

Conclusion

Our results demonstrated that chronic Hp negative gastritis is present in nearly all CD patients, and is strongly associated with presence of gastric BJA lesions, as well as ulcerations and erosions of the duodenum. Furthermore, the results of our study support previously reported observations that BJA is a specific lesion for CD and may be used as an endoscopic diagnostic marker.

This work was financed by the Program of the Minister of Science and Higher Education - “Regional Initiative of Excellence” in 2019–2022, no. 002/RID/2018/19.
P189 Perceptions of Cannabis use in women with Inflammatory Bowel Disease of reproductive age: A cross-sectional study
Authors: Tandon P , O’Connor K , Steinhart H , Desphande A , Maxwell C , Huang V
Published: January 2022

Background

Cannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers. We aimed to determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age.

Methods

Women with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test.

Results

Sixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p<0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy.

Conclusion

Many women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.
P191 Development and validation of a 13-item short version of the IBD self-efficacy scale
Authors: Tanaka M , Kawakami A , Sakagami K , Terai T , Fernandez J , Keefer L , Ito H
Published: January 2022

Background

The IBD-Self-Efficacy Scale (IBD-SES) is an outcome measurement scale used in various countries, with psychometric properties that predicted psychological distress and showed moderate correlation with QOL. Although the 29-item IBD-SES is useful, a shorter instrument would increase the likelihood of usage. In this study, we aimed to develop a substantially shorter, but still as valid version of IBD-SES.

Methods

A total of 919 patients, 482 from a specialized IBD clinic (UC: 184, CD: 298) and 437 online (UC: 255, CD: 182), were used for psychometric assessment. The original 29-item IBD-SES was reduced using three major analytic steps (assessed ceiling or floor effect, correlation between items, test-retest reliability). The shorter version was evaluated on construct validity by confirmatory factor analysis, criterion validity by Pearson’s correlation coefficients with original version, and internal consistency by Cronbach’s alpha coefficient.

Results

In the item reduction process, the following items were removed: 2 items due to a ceiling effect, 12 additional items due to high correlation, 2 more items due to a low intraclass correlation coefficient (ICC). The short version was confirmed to consist of the same 4 subscales as the original version, [Managing Stress and Emotions], [Managing Medical Care], [Managing Symptoms and Disease] and [Maintaining Remission] and was validated by confirmatory factor analysis. The fit indices were as follows: Normed χ2 = 7.18 (p < 0.001), comparative fit index (CFI) = 0.94, goodness-of-fit index (GFI) = 0.93, adjusted goodness-of-fit index (AGFI) =0.89, parsimony goodness-of-fit index (PGFI) = 0.60, and the root mean square error of approximation (RMSEA) = 0.084. Correlation with the original IBD-SES in each subscale was high (0.97–0.98). Cronbach’s alpha for each subscale ranged from 0.68 to 0.86.

Conclusion

The study showed that the revised scale has improved psychometric properties and demonstrated the reliability and validity of the IBD-SES13. The revised scale could provide clinical usefulness with the possibility of higher response rates.
P198 An inflammatory serum metabolomic signature predicts response to vedolizumab treatment in people with Crohn’s Disease
Authors: Radford-Smith D , Yates A , Hageman I , Joustra V , Li Yim A , Davids M , Henneman P , Hakvoort T , D’Haens G , de Jong W , Anthony D , Satsangi J , Probert F
Published: January 2022

Background

While Vedolizumab (VDZ) is an established treatment for Crohn’s disease (CD), primary non-response is well-recognised – there is an urgent clinical need for biomarkers that predict response, before initiation of treatment. Metabolomic profiling is a rapidly growing field in biomarker discovery and can distinguish between active and quiescent inflammatory bowel diseases. Here, we sought to identify a metabolic signature able to predict response to VDZ.

Methods

Prospective serum samples from 62 CD patients before (baseline) and post-treatment follow-up (FU) (median 30 weeks, IQR 27–35) were analyzed. Patients were stratified into n=35 responders (R) and n=27 non-responders (NR) using endoscopic (≥50% reduction in SES-CD score), clinical (≥3 point drop in HBI or HBI ≤4, no systemic steroids), and/or biochemical assessments (≥50% reduction in C-reactive protein (CRP) and fecal calprotectin (fCal) or a basal CRP ≤5 g/mL and fecal calprotectin ≤250 µg/g). Untargeted metabolomic profiling was carried out using high-resolution nuclear magnetic resonance (NMR) spectroscopy. Significant differences in metabolite signatures were identified by orthogonal partial least squares discriminant analysis (OPLS-DA). Model accuracy (acc.) was assessed by external 10-fold cross-validation (CV), permutation testing, and validated on an independent test set.

Results

We first demonstrate that bowel preparation required for endoscopy had a significant impact on the serum metabolite profile (CV acc. 77±4%, acc. n=10 independent test set 80%, KS test p-value < 0.001) and samples taken from patients at colonoscopy were excluded from further analysis. This reduced the cohort size; 19 baseline (12R/7NR) and 25 FU (16R/9NR). No significant difference in baseline fCal or CRP was observed between R and NR (t-test p-value >0.05). The metabolite profiles at baseline and FU were indistinguishable (KS test p-value > 0.05) suggesting the metabolome was stable. However, high (>300 µg/g) fCal values were associated with elevated N-acetyl-glycoprotein (GlycA), a known inflammatory marker, elevated serum glucose along with decreased lipoprotein and lactate levels (CV acc. 74±3%, acc. n=10 independent test set 100%, KS test p-value < 0.001). This same metabolite signature predicts response (CV acc. 61±5%, acc. n=6 independent test set 83%, KS test p-value < 0.001) with responders exhibiting increased metabolic inflammation at baseline.

Conclusion

Here, we identify an inflammatory metabolic signature which predicts response to VDZ. Work to confirm these findings in a larger cohort and extend this method to investigate infliximab, adalimumab and ustekinumab treated patients, as part of the EPIC Pioneer study, is ongoing.
P200 The diagnostic yield of pan-enteric capsule endoscopy in inflammatory bowel disease: A systematic review and meta-analysis
Authors: Tamilarasan A G , Tran Y , Paramsothy S , Leong R
Published: January 2022

Background

Capsule endoscopy (CE) is a non-invasive diagnostic modality enabling real time video imaging of the gastrointestinal (GI) mucosa with an ingestible recording device. Major technological advancements now allow pan-enteric capsule endoscopy (PCE) to thoroughly assess the entire GI tract. CE is increasingly utilised in the inflammatory bowel disease (IBD) diagnostic algorithm. Our aim was to evaluate the diagnostic accuracy of PCEs in IBD.

Methods

We comprehensively searched electronic databases (MEDLINE, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials) for studies comparing the diagnostic accuracy of PCE with colonoscopy or magnetic resonance enterography (MRE). Prospective studies with ≥ 10 IBD patients were included in our final analysis. Diagnostic accuracy and yield were calculated for the detection of active IBD. Meta-analysis of proportions was performed to assess for an incremental benefit between modalities. The risk of bias was determined by the Quality Assessment of Diagnostic Accuracy in Systematic Reviews (QUADAS-2). Data was analysed by calculating forest plots and the use of the I2 statistic for heterogeneity.

Results

Fourteen studies, including 797 patients, were identified comparing PCE diagnostic yield with colonoscopy or MRE. Seven studies evaluated PCE diagnostic yield in CD and 7 studies in UC. There was a low risk of bias for the majority of included studies; only 1 study was found to have a high risk of bias. In CD, there was a trend to superiority of PCE over MRE and colonoscopy (individually and for pooled outcomes) with a pooled odds ratio (OR) of 1.25 (95% CI 0.85–1.86) (Fig 1) for the detection of CD. This translates to an incremental benefit in diagnostic yield of 5% and 7% for PCE compared with MRE and colonoscopy respectively. PCE performed comparably with colonoscopy in the terminal ileum and colon with ORs of 1.19 (95% CI 0.78–1.79) (Fig 2), and 1.14 (95% CI 0.76–1.71) (Fig 3) respectively. PCEs had a diagnostic sensitivity for the detection of UC of 93.8% (95% CI 87.6%-97.0%) (Fig 4) and a specificity of 69.8% (95% CI, 38.2%-89.6%). This equates to a diagnostic OR of 24.0 (95% CI 10.4–55.3). Subgroup analysis suggested that newer PCEs had greater diagnostic yield than the earlier devices (for UC and CD).

Conclusion

PCEs have a comparable diagnostic yield to colonoscopy and MRE in Crohn’s disease. This was true for the small and large bowel, giving PCE an advantage over standard CE as a single pan-enteric assessment tool for CD. Limitations include the standardisation of PCE scoring systems and the lack of transmural assessment. In UC, PCE has an excellent diagnostic sensitivity and positive predictive value, but is limited by the lack of histologic assessment and poor specificity.
P206 Comparison of dye-spraying chromoendoscopy and virtual chromoendoscopy for colonic dysplasia detection in longstanding Inflammatory Bowel Disease
Authors: Correia J , Ponte A , Proença L , Rodrigues A , Pinho R , Leite S , Fernandes C , Rodrigues J , Silva J C , Gomes C , Afecto E , Estevinho M M , Freitas T
Published: January 2022

Background

Dye-spraying chromoendoscopy (DCE) is the technique of choice for colonic surveillance in patients with long-standing extensive Inflammatory Bowel Disease (IBD). Conversely, the use of virtual chromoendoscopy (VCE) is still controversial. This study aimed to compare lesion and dysplasia detection and accuracy of margins delineation between VCE and DCE.

Methods

Eleven gastroenterologists were given a survey with 20 pairs of pictures of IBD surveillance colonoscopies (10 with nondysplastic lesions, 5 with dysplastic lesions and 5 with no lesions). Each pair contained the same image captured during colonoscopy using VCE and DCE. The 40 pictures were randomly ordered to avoid any classification bias. For each picture, the gastroenterologist assessed the presence/absence of lesion and, when a lesion was identified, assessed the presence/absence of dysplasia and delineated its margins. To compare lesion and dysplasia detections between techniques, the sensitivity, specificity and inter-observer agreement (using fleiss’ kappa (K) test) were calculated. The chi-square test was used to assess the accuracy of margins delineation.

Results

When assessing lesion detection using VCE, sensitivity (S) and specificity (E) were 0.93 and 0.49 and in, DCE, 0.97 and 0.38, respectively. When assessing dysplasia detection using VCE, S and E were 0.74 and 0.60 and, in DCE, 0.67 and 0.62, respectively. Interobserver agreement analysis revealed that VCE and DCE had a moderate agreement in lesion detection - 0.57 and 0.58, respectively; however, for dysplasia detection, VCE had a fair agreement (k=0.30) and DCE a slight agreement (k=0.11). The rate of accurately defined margins was similar for both techniques (p=0.22).

Conclusion

Similar lesion and dysplasia detection and margins delineation were achieved with both techniques. However, concerning dysplasia detection, interobserver agreement was slightly better using VCE. Therefore, VCE may constitute a valid alternative to DCE for dysplasia screening in IBD. Further studies are needed to validate these findings.
P215 Correlation between small bowel capsule endoscopy and biomarkers in postoperative recurrence in Crohn’s Disease
Authors: Elosua Gonzalez A , Rullan M , Rubio S , Oquiñena S , Macías E , Elizalde I , Vicuña M , Aznárez M R , Juanmartiñena J F , Borda A , Rodriguez C , Fernández-Urién I , Nantes Ó
Published: January 2022

Background

Endoscopic postoperative recurrence (POR) measured by the Rutgeert′s score is a strong predictor of clinical recurrence. Ileocolonoscopy is the gold standard in the diagnosis of POR by recent guidelines and is recommended within the first 6 to 12 months after surgery. After the initial ileocolonoscopy the monitoring is usually based on non-invasive test such as fecal calprotectin (FCP), imaging studies or small bowel capsule endoscopy (SBCE) since symptoms are not reliable of mucosal lesions. Our aim was to evaluate the accuracy of FCP and C-reactive protein (CRP) for detection of endoscopic recurrence measured by SBCE.

Methods

We included all patients with known CD with previous ileocolonic resection followed in the Inflammatory Bowel Disease Unit of Hospital Universitario de Navarra from 01/01/2008 to 31/12/2019 in which a SBCE was performed. CRP was considered elevated if >5g/L. To avoid bias from disease activity in colon undetectable by SBCE, only L1 patients were included in this specific analysis. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and diagnostic Odds Ratio (DOR) were calculated. Receiver operating characteristic curve (ROC) and its area under the curve (AUC) were calculated with FCP and CRP.

Results

A total of 113 SBCE procedures were performed for evaluation of POR but only 89 were L1 patients. CRP was available for all patients (16.9% elevated) and FCP for 66.3% within 3 months previous to SBCE. Patients with significant POR had a higher mean CRP (4.8 ± 6.6 vs 2.5 ± 5.2, p= 0.017) and FCP (176.3 ± 178 vs 86.3 ± 132, p= 0.04). Diagnostic performance for detecting ≥i2 in neoterminal ileum for CRP was: sensitivity 24.4 %, specificity 89.6%, PPV 66.7%, NPV 58.1%, DOR 2.8. Diagnostic accuracy was obtained for FCP levels of 50 µg/g, 100 µg/g, 150 µg/g and 200µg/g and shown on the table.CRP and FCP had an AUC of 0.7 (95% CI 0.56–0.84) and 0.7 (95% CI 0.56–0.84) respectively.

Conclusion

FCP is an accurate surrogate marker of postoperative endoscopic recurrence.

The FCP cut-off 100 µg/g appears to have the best overall accuracy.
P230 Ultrasonography-based and Magnetic Resonance-based Lémann Index: two sides of the same coin
Authors: Allocca M , Dell’Avalle C , Radice S , Bonifacio C , Furfaro F , Zilli A , D’Amico F , Peyrin-Biroulet L , Danese S , Fiorino G
Published: January 2022

Background

Lémann Index (LI) is a well-established validated index to assess cumulative bowel damage in Crohn’s disease (CD). Magnetic resonance imaging and colonoscopy are usually used to measure LI. We assessed the accuracy of bowel ultrasound in assessing LI and its sensitivity to change in a longitudinal cohort of CD patients, in comparison with magnetic resonance imaging.

Methods

We performed a prospective observational study of 60 patients with active CD. All patients underwent bowel ultrasound, magnetic resonance imaging, and colonoscopy at baseline and at reassessment, within 1 year from treatment with biologics (30 patients were treated with adalimumab, 22 with ustekinumab, four patients with infliximab, and four with vedolizumab). The primary analysis was to determine the correlation between magnetic resonance-based LI and ultrasonography-based LI, both at baseline and at reassessment. Additional analyses established the magnitude of change in LI over time, measured by magnetic resonance imaging and colonoscopy, and its correlation with those in LI measured by bowel ultrasound and colonoscopy.

Results

The mean values of magnetic resonance-based LI and ultrasonography-based LI at baseline were 6.3 (± 4.8) and 6.4 (± 4.9) respectively, p= 0.39; at reassessment, 5.3 (± 4.6) and 5.5 (± 4.9) respectively, p= 0.30. No differences were observed according to different treatments (Table1). There were significant differences between LI assessed at baseline and LI at reassessment, independently by the imaging tool used for measuring it (p < 0.05). Very high correlations were observed between the magnetic resonance-based LI and ultrasonography-based LI (at baseline, r= 0.964, p < 0.0001; at reassessment, r= 0.970, p < 0.0001) (Figure 1). The magnitude of change in magnetic resonance-based LI correlated with those in ultrasonography-based LI (r= 0.871; p < 0.0001) (Figure 1).

Conclusion

LI can be measured by bowel ultrasound alternatively to magnetic resonance imaging, without no meaningful change in its value.
P249 Serum calprotectin is useful to confirm Inflammatory Bowel Disease activity but is not effective to predict relapse
Authors: Veyrard P , Roblin X , Mao R , Nancey S , Waeckel L , Berger A E , Williet N , Bastide L , Barrau M , Tournier Q , Paul S
Published: January 2022

Background

Serum calprotectin (SC), a novel biomarker of inflammatory bowel diseases (IBD), has been recently investigated with conflicting results. The purpose of this study was to assess the ability of SC for predicting disease relapse in patients with IBD treated by biologic therapies, and to evaluate the correlation between SC and clinical and endoscopic relapse and with other biomarkers including fecal calprotectin (FC) and C-reactive protein (CRP).

Methods

All consecutive IBD patients in deep remission (clinical and endoscopic or imaging remission) were recruited in this prospective study and followed 12 months. Blood and stool samples were collected for SC, serum CRP and FC measurement. SC was measured the day of inclusion (baseline, D0), 3 months (M3) and 6 months (M6) later and in case of relapse during the study period. Relapse was defined as clinical, biomarkers, or endoscopic/imaging activity. So, firstly, we looked at evolution of SC before relapse to analyze a predicting value of loss of response (LOR). We also compared SC for patients with active IBD and those with symptoms without inflammation.

Results

Among the 119 patients included, 54 (46.4%) patients experienced a disease relapse during follow-up. When we looked at the kinetic of SC during follow-up, median SC levels did not increase in patients who relapsed: 3.15 µg/l at baseline, 3.38 µg/l at M3, 3.33 µg/l at M6 and 3.99 µg/l in case of relapse (p=0.63).

We compared SC during relapse with patients in endoscopic remission but clinical symptoms which defined secondary Irritable Bowel Syndrome, we found that SC levels were higher in active IBD and similar between the groups of patients with IBS or deep remission (3.05µg/l IBS vs 2.99µg/l remission vs 5.1µg/l for relapsers, p=0.04). In patients with clinical symptoms, SC presents a good predictive value for relapse. (AUROC 0.764, IC95: 0.68–0.88), giving a sensitivity of 72% with a specificity of 77%, using a cut-off value of 4.45mg/ml. A weak, but significant correlation was found between SC and FC levels (r=0.35, P= 0.001). A combined score with CRP, FC and SC didn’t improve its diagnostic accuracy.

Conclusion

SC was significantly higher in patients with relapse compared to those in endoscopic remission with or without clinical symptoms. It seemed that it permit to oppose patients with active IBD and those with symptoms of IBS. However, it failed to predict relapse.
P258 Impact of inflammatory bowel diseases on the phenotype and severity of primary sclerosing cholangitis - a systematic review with meta-analysis
Authors: Attauabi M , Wewer M D , Bendtsen F , Seidelin J B , Burisch J
Published: January 2022

Background

Data regarding the impact of co-occurring inflammatory bowel diseases (IBD) on the phenotype and severity of primary sclerosing cholangitis (PSC) are emerging. The purpose of our study was to characterize the phenotype and disease course of PSC in relation to co-occurring IBD.

Methods

The purpose of our study was to characterize the phenotype and disease course of PSC in relation to co-occurring IBD. The systematic review and meta-analysis were conducted according to Cochrane’s recommendations. PubMed and EMBASE were searched from database inception till January 2020 for studies reporting disease phenotype and severity of PSC in association with co-occurrence of IBD. Meta-analyses were performed using a random-effects model. The quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS).

Results

The electronic search yielded 12,220 studies which were narrowed down to 132 after screening based on study titles and abstracts. Of these, a full-text review identified 42 eligible studies, including a total of 8,081 and 5,728 patients with PSC and with or without co-occurring IBD, respectively (Figure 1). The mean NOS score was 6.4 ad included 23 (54.8%) and 18 (42.9%) studies of moderate and high methodological quality, respectively.

The meta-analysis demonstrated that co-occurrence of IBD was associated with significantly less frequent involvement of the extra-hepatic ducts (risk ratio (RR)=0.50 (95% CI 0.33–0.75), p<0.01, I2=0%) as compared with patients without co-occurring IBD. However, IBD-PSC and PSC without IBD had similar rate of small-duct PSC, histologic stages of PSC, risk of developing cirrhosis, and features of decompensation. Furthermore, in comparison to patients with isolated PSC, co-occurring IBD was associated with an increased overall risk of malignancies (RR=1.53 (95% CI 1.01–2.32), p=0.04, I2=46%), which was ascribed to colorectal cancers (RR=4.77 (95% CI 2.50–9.09), p<0.01, I2=0%) and not cholangiocarcinomas (RR=0.88 (95% CI 0.59–1.31), p=0.54, I2=31%), gallbladder cancers (RR=2.28 (95% CI 0.39–13.21), p=0.36, I2=0%), or hepatocellular carcinomas (RR=4.49 (95% CI 0.57–35.46), p=0.15, I2=0%). Regarding long-term PSC outcomes, having IBD was not associated with the need of liver transplantation (RR=0.84 (95% CI 0.50–1.41), p=0.52, I2=60%) or mortality (RR=0.74 (95% CI 0.37–1.50), p=0.40, I2=37%), but was associated with a longer liver transplantation-free survival (hazard ratio = 0.70 (95% CI 0.60–0.82), p<0.01, I2=5%).

Conclusion

This systematic review with meta-analysis suggests that IBD is associated with a distinct phenotype and course of PSC, thus emphasizing the importance of a multidisciplinary approach to patients with co-occurring PSC and IBD.
P273 Inflammatory Bowel Disease and COVID-19 vaccine
Authors: Zahra Bianco E , Tabone T , Cassar P , Agius D , Zammit D , Vella Baldacchino A , Scicluna C , Gatt K , Ciantar M , Montebello B , Ellul P , Sciberras M
Published: January 2022

Background

Owing to the COVID-19 pandemic, inflammatory bowel disease (IBD) patients are strongly encouraged to vaccinate against SARS-COVID-19. In fact, the uptake of this vaccine in IBD cohorts has been greater than the general population. The adverse events of this vaccine are predicted to be low. The aim of this study was to assess the percentage of IBD patients who took the COVID-19 vaccine- including booster- and any significant adverse events. Any possible correlation with lifestyle habits, treatment and disease activity was also established.

Methods

Data was collected prospectively. 200 patients with a histological diagnosis of IBD were randomly recruited through our local database. Data was gathered using electronic case summaries and direct patient contact. Data collected included; diagnosis, type and number of COVID-19 vaccines taken, demographics, lifestyle habits, treatment and any adverse events to the vaccine. Patients were also asked about any concerns regarding this vaccine.

Results

187 patients (57.8% male) were recruited. 73.8% of which had Crohn’s disease (CD), 25.7% had Ulcerative colitis (UC) and 0.5% were unclassified. Mean age was 41.96 (SD ±16.56). 37.8% were on Azathioprine/6- Mercaptopurine, 93.5% were on biologicals and 33.2% were on both. 61% had quiescent IBD while 2.1% had severe IBD. 19.7% were current smokers while 15.8% were ex-smokers. 98.9% received at least one COVID-19 vaccine.

Table 1 illustrates the type of vaccine administered to IBD patients.

17% of patients were concerned regarding the effectiveness of the vaccine due to IBD treatment. 19.8% of IBD patients believed that the vaccine may trigger a flareup of their disease. 11.8% of patients felt that not enough information was available to make an informed choice. 7.1% of IBD patients had treatment altered in response to the COVID-19 vaccine.

Graph 1 shows the percentage of both local and systemic adverse events to 1st, 2nd and 3rd Covid-19 vaccine in IBD patients.

Conclusion

This study demonstrates that the uptake of COVID-19 vaccine in IBD patients was high. The most commonly report adverse events were pain at the injection site and fever. Increased in temperature at the injection site occurred more frequently with the 3rd dose. A number of patients had a change in their medication in response to at least one the vaccines. Larger studies are needed to decipher whether data can be extrapolated on a larger scale.
P276 Prevalence, clinicopathological, and biological characteristics of serrated polyps in patients with ulcerative colitis
Authors: Nishio M , Kunisaki R , Shibata W , Ajioka Y , Hirasawa K , Takase A , Chiba S , Inayama Y , Ueda W , Okawa K , Tsunoda S , Azuma D , Yaguchi K , Fujii K , Nakamori Y , Madarame A , Nishida D , Fuse M , Araki K , Saigusa Y , Kimura H , Kato J , Maeda S
Published: January 2022

Background

Serrated polyps are recognized as precursors of colorectal cancer in general population and have recently been reported in patients with ulcerative colitis (UC). However, their prevalence and detailed characteristics remain unclear.

Methods

The prevalence and clinicopathological and biological characteristics of serrated polyps in patients with UC were retrospectively examined in a single tertiary inflammatory bowel disease centre in Japan from 2000 to 2020.

Results

In total, 252 neoplasms, including 36 serrated polyps (26 in colitis-affected segments, 10 in colitis-unaffected segments), were identified in 187 patients with UC. The proportion of serrated polyps was significantly higher from 2010 to 2020 (35/213, 17%) than from 2000 to 2009 (1/39, 3%; p = 0.023). Serrated polyps in colitis-affected segments were common in patients with extensive colitis (88%), a history of persistent active colitis (58%), and a long duration of UC (12.1 years). Serrated polyps in colitis-affected segments were more common in men (88%). Of 26 serrated polyps in colitis-affected segments, 15, 6, and 5 were categorized as sessile serrated lesion (SSL)-like dysplasia, traditional serrated adenoma (TSA)-like dysplasia, and serrated dysplasia not otherwise specified (SD NOS), respectively. SSL-like dysplasia was common in the proximal colon (67%) and with BRAF mutation (62%), whereas TSA-like dysplasia and SD NOS were common in the distal colon (100% and 80%) and with KRAS mutations (100% and 75%). CpG island hypermethylation phenotype-positive status was observed in 60% cases of TSA-like dysplasia but in only 25% cases of SSL-like dysplasia and SD NOS.

Conclusion

Serrated polyps have recently been increasing in patients with UC. Serrated polyps in colitis-affected segments were common in men with extensive and longstanding colitis, suggesting that chronic inflammation is involved in the development of serrated polyps in patients with UC.
P279 Prevalence of iron deficiency in inflammatory bowel disease
Authors: Resál T , Bacsur P , Lupas D , Szántó K , Rutka M , Fábián A , Bor R , Szepes Z , Farkas K , Varga M , Molnár T
Published: January 2022

Background

Iron deficiency (ID) is one of the most common extraintestinal manifestation of inflammatory bowel disease, which often remains untreated, despite the fact, that ID significantly impairs patients’ quality of life. Since anaemia develops through several pathomechanisms (e.g., occult bleeding, chronic inflammation, medicines), treating anaemia requires to manage the underlying pathological changes as well.

Methods

In our prospective, two-centers study, we assessed the frequency of ID among our IBD patients. The diagnosis of iron deficiency (iron deficiency anaemia [IDA], anaemia of chronic inflammation [CDA], anaemia of mixed origin [AMO]) was based on the ECCO’s anaemia guideline. According to the guideline, haemoglobin, CRP, ferritin, transferrin saturation, serum iron values, total iron binding capacity, hematocrit, and platelet counts were collected from our patients on a one-off basis. We aimed to compare the frequency of ID in a biologic centre, and in a non-biologic centre hospital as well. In addition, we assessed the frequency of the need for oral and intravenous iron replacement, respectively, based on the guideline as well.

Results

720 patients were included in our study (CD 58.8%, UC 41.2 %). Average age was 43.3 years. We found, that 26.6% of our patients had anemia. There was no significant difference in the prevalence of ID (p=0.65) between CD and UC patients. Based on the ECCO criteria, 61.8% of them have ID (33.0% IDA, 23.0% AMO, 5.8% CDA), and in the rest of the cases (38.2%) it was classified to be anaemia of other origin (AOO), however, in 68.5% of these cases ID can be suspected at some degree, as ferritin was < 100 mg/l and/or transferrin saturation ≤ 20%. In total, 133 patients (69.6%) had anaemia in remission, and 58 patients (30.4%) in case of activity (CRP ≥10 mg/l). In addition, we found an association between elevated CRP levels and the prevalence/severity of anemia (p<0.001) as mean CRP was 5.9 mg/l in the non-anaemic, 9.9 mg/l in the anaemic, and 16.0 mg/l in the severe anaemic group. Anemia (p<0.001) and iron deficiency anemia (p<0.001) were significantly more common in patients treated in a clinical/biological centre, compared to a non-biological hospital. Patients with active disease received iv. ferric-carboximaltose, which turned to be efficient (Hgb>120–130 g/l) already after 2 months in 76.5% of the cases.

Conclusion

Based on our results, anemia and iron deficiency are common complications of IBD and correlate well with disease activity. Consequently, we suggest, that iron deficiency should be a part of the treat to target approach, and in case of ID, iv. ferric-carboximaltose is efficient in activity as well.
P281 TELEIBD: A telematic fast-track pathway for patients with high suspicion of Inflammatory Bowel Disease in primary care
Authors: Pradera Cibreiro C , Ramos Alonso M , Fernández López M , Molina Arriero G , Fraga Iriso R , González Furelos T , Ollero Pena V , Echarri Piudo A
Published: January 2022

Background

The incidence and prevalence of Inflammatory bowel disease (IBD) are increasing in the last years.

In primary care (PC) patients often present with confusing and non-specific symptoms which can often be a delay in referring and diagnosing suspected IBD. The average time from symptom onset to diagnosis of IBD is longer than five years in up to 18% of cases and 64% of patients presenting to emergency care with symptoms of IBD prior to the diagnosis.

Shared care protocols and closer working with integrated care teams can bridge the gap between primary and specialized care, improving their assistance

Methods

This is a retrospective study that evaluates the results of TELEIBD (telematic circuit care) in patients with high diagnostic suspicion of IBD between PC and IBD Unit of our health area since its implementation in August 2019 to October 2020.

The number of telematic consultations, average resolution time, adaptation to referral criteria, complementary tests requested and diagnostic confirmation were evaluated.

TELEIBD establishes the issuance of a telematic consultation through the electronic clinical history when a patient meets previously established criteria.

Specialized IBD physician who evaluates the case, can advise a diagnostic or therapeutic attitude either by electronic means or face-to-face with the patient.

Results

A total number of 77 care consultations from 77 patients (58,4% females) have been made. The average age was 49,2 years and the average reponse time were 7,5 days.

After teleconsultation, 46 patients (59.7%) were not requested medical test. Lower gastrointestinal endoscopy (LGE) was performed in 25 patients, blood and faecal calprotectin testing in 7 patients, magnetic resonance (MR) or computer tomographic (CT) enterography in 6 patients.

Taking into account the criteria for referral to a specialist, a total of 15 patients (19,5%) fully met the criteria, 13 patients (16,9%) partially met the criteria and 49 patients (63,6%) did not meet it. The main reason fot not meeting the criteria were the inadequated use of TELEIBD (53,1%).

Of the 25 LGE requested, 3 were suggestive of Ulcerative Colitis (UC) and 1 of Crohn’s Disease (CD). Diagnosis of CD was confirmed in 2 patients, using MR or CT enterography.

Diagnoses were reached in 4 patients, 3 of the group that met referral criteria (20%) and 1 of the group that partially met it (7.7%). The diagnosis was not achieved in any patient who did not partially and/or fully meet the referral criteria.

Conclusion

TELEIBD can be a useful tool for the quick assessment of patients who meet the criteria for high suspicion of IBD. Training primary care physicians in the referral criteria of the pathway is essential to improve the functioning of the circuit.