bluuebunny/crossref_metadata_2025 huggingface dataset:
P830 Significant racial and ethnic disparities exist in health-care utilization in inflammatory bowel disease: a systematic review and meta-analysis
Authors: Chhibba T , Tandon P , Natt N , Brar G , Gurpreet M , Geoffrey N
Published: January 2023

Background

The incidence of inflammatory bowel disease (IBD) is rising worldwide though it remains unknown how race and ethnicity mediate health-care utilization. We aimed to better define this relationship in this systematic review and meta-analysis.

Methods

We explored the impact of race or ethnicity on the likelihood of needing an IBD-related surgery, hospitalization, and emergency department (ED) visit. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated with I2 values reporting heterogeneity. Differences in IBD phenotype and treatment between racial and ethnic groups of IBD were reported.

Results

Fifty-eight studies were included. Compared to White patients, Black patients were less likely to undergo a Crohn’s disease (CD) (OR 0.69, 95% CI, 0.50-0.95, I2=68.0%) or ulcerative colitis (OR 0.58, 95% CI, 0.40-0.83, I2=85.0%) surgery, more likely to have an IBD-hospitalization (OR 1.54, 95% CI, 1.06-2.24, I2=77.0%), and more likely to visit the ED (OR 1.74, 95% CI, 1.32-2.30, I2=0%). There were no significant differences in disease behavior or biologic exposure between Black and White patients and between Hispanic and White patients (Table 1). Hispanic patients were less likely to undergo a CD surgery (OR 0.57, 95% CI, 0.48-0.68, I2=0%) but more likely to be hospitalized (OR 1.38, 95% CI, 1.01-1.88, I2=37.0%) compared to White patients. There were no differences in health-care utilization between White and Asian or South Asian patients with IBD.

Conclusion

There remain significant differences in health-care utilization amongst races and ethnicities in IBD. Future research is required to determine factors behind these differences to achieve equitable care for all persons living with IBD.
P832 Cannabis Use in IBD Patients: A Population-Based Study
Authors: Dasu N , John J , Blair B , Khalid Y , Walters R , Chhoun C , Suga H
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) leads to a chronic inflammatory state in the body with significant long-term impact on patient morbidity and mortality. This study investigates the inpatient hospitalization outcomes in patients with IBD with the concurrent utilization of cannabis compared to IBD patients without a concurrent diagnosis to indicate cannabis usage.

Methods

The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD with concurrent cannabis use were identified. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

Results

We identified 1,198,839 patients with IBD of which 29,445 were matched to those with cannabis use. The average age was 38.67 years. There was a significant decrease in inpatient mortality (OR 0.28, CI 0.19-0.41, p<0.0001), hospital length of (-0.17 days CI -0.35 -0.01, p<0.041), and total cost of hospitalization (-$11,054.70, CI -13,681.15 - -8427.24, p<0.0001) between patients with IBD with cannabis use when compared to IBD patients without cannabis use.

Conclusion

This study demonstrates a significant decrease in mortality rate, cost of hospitalization, and length of stay in IBD patients with concurrent diagnoses to indicate cannabis usage. This study shows that there are substantial therapeutic effects of cannabis in the management of patients with IBD. Further studies are warranted to investigate the factors that may be driving these differences. Future arms of investigation would be warranted to investigate the effect of cannabis on remission rates, rates of hospitalization, and patient Mayo Endoscopic Scores and Simple Endoscopic Scores for Crohn’s disease.
P833 Cervical cancer risk in newly diagnosed ulcerative colitis: a nationwide population-based study
Authors: Kim H S , Kim H , Kim K
Published: January 2023

Background

The association between ulcerative colitis (UC) and increased risk of cervical cancer in women remains controversial. We investigated cervical cancer risk in South Korean UC patients using the Korean National Health Insurance (NHI) claims data.

Methods

UC definitions included both ICD-10 codes and UC-specific prescriptions. We analyzed incident cases diagnosed between 2006 and 2015. Age-matched women without UC (control group) were randomly selected from the general population (1:3 ratio). Hazard ratios (HRs), adjusted for different covariates, were calculated using multivariate Cox proportional hazard regression. In total, 12,632 and 36,797 women with and without UC, respectively, were enrolled.

Results

Cervical cancer developed in 0.21% (68 person-years) and 0.14% (172 person-years) of UC patients and controls, respectively. The HR (95% CI) of cervical cancer in the UC group, with reference to the control group, was 1.56 (0.97-2.50). HR, stratified by age, was significantly high in elderly UC patients (≥60 years) at 3.65 (1.54–8.66). In UC patients, old age (≥40 years) and low socioeconomic status were associated with increased cervical cancer risk.

Conclusion

Elderly UC patients had a higher incidence of cervical cancer than age-matched controls in Korea, suggesting that elderly patients with newly diagnosed UC should be screened for cervical cancer.
P842 SARS-CoV-2 antibody titers analysis in immune mediated inflammatory disease patients after COVID-19 vaccination: a monocentric retrospective study
Authors: Delaleeuwe I , Aoun J , Hoyois A , Brasseur C , Di Romana S , Muls V
Published: January 2023

Background

Immune-mediated inflammatory diseases (IMID) including inflammatory bowel diseases (IBD) and inflammatory arthritides are commonly treated with biological therapies, in particular anti-TNF. Patients on anti-TNF have impaired protective immunity following pneumococcal, influenza and viral hepatitis. However, the serological response to COVID-19 vaccination is still under-studied. Recent studies demonstrated that serologic response is attenuated in IMID patients on immunosuppressive therapy. In this study, the primary outcome is to describe the antibody response in IMID patients according to baseline patient characteristics, type of inflammatory disease, treatment and disease activity. Secondary outcome is to compare antibody response in patients treated with anti-TNF, versus other biologic therapies.

Methods

This study is a monocentric retrospective study, including 265 IMID patients followed at CHU Saint Pierre, Belgium, between 2021 and 2022. Respective baseline patient characteristics, vaccination status, treatment type, disease activity and SARS-CoV-2 antibody titers (IgG) after first, second and third vaccination were collected and analyzed.

Results

A total of 265 patients were enrolled (mean age 47 years old, 35% males, 67% IBD patients). Of these, 217 patients (82%) completed the 2 doses of vaccination and 130 patients (49%) the 3 doses, while 40 patients (15%) remained unvaccinated. Antibody titers after 2 doses of vaccination were available for 50 patients. In this group, the median antibody titer was 93 AU/mL [26-421] after first vaccination, raised up to 640 AU/mL [271-800] after the second vaccination (Δ85%, p<0.0001). Similarly, a statistically significant increase was noted in the subgroup of patients with available serologic data after 3 vaccination doses (N=18). The median antibody titer after the first vaccination in anti-TNF subgroup (N=15) was lower than that in other biotherapies subgroup (N=23); 34 AU/mL [6-145] versus 131 AU/mL [34-704] respectively. However, after the second vaccination, higher antibody titers were found in the anti-TNF subgroup, 686 AU/mL [321-800] versus 400 AU/mL [250-800] (p<0.388).

Conclusion

In our cohort of IMID patients, followed at CHU Saint Pierre, Belgium, there was a statistically significant raise in antibody titers after the second and third dose of COVID-19 vaccination, regardless of the type of inflammatory disease, disease activity, type of treatment and vaccine type. The antibody titers in this particular immunocompromised population were comparable to that found in the literature for the general population. More prospective observational studies are needed with a larger sample size to determine the characteristics of patients with sub-optimal serological response.
P843 Mucinous and signet-ring colonic adenocarcinoma in Inflammatory Bowel Disease
Authors: Neri B , Pizzi F , Savino L , Salvatori S , Mossa M , Lolli E , Calabrese E , Sica G , Petruzziello C , Monteleone G , Biancone L
Published: January 2023

Background

Colorectal cancer (CRC) risk is increased in patients (pts) with long-standing colitis related to Inflammatory Bowel Disease (IBD). A higher frequency mucinous and signet-ring colonic adenocarcinoma has been suggested in IBD, but data regarding risk factors for these aggressive CRC are currently lacking. Primary aim was to assess the frequency of mucinous and signet-ring adenocarcinoma in IBD pts with CRC. Secondary aim was to assess risk factors for these histotypes of CRC.

Methods

From January 2002 to July 2022, all IBD pts with concomitant CRC were retrospectively enrolled. Inclusion criteria: 1) age ≥18; 2) well-defined diagnosis of IBD and CRC; 3) available histological and surgical report. Exclusion criteria: Missing data. Characteristics of IBD were reported according to standard criteria. Data were expressed as median [range]. Student-t Test and χ2 test were used for comparisons. Univariate logistic regression model was applied for assessing risk factors for mucinous and signet-ring adenocarcinoma (OR [95%CI]).

Results

The study population included 40 IBD pts with concomitant CRC: 24 (60%) with Ulcerative Colitis (UC) and 16 (40%) with Crohn’s Disease (CD). CRC included standard adenocarcinoma in 23 (57.5%) and mucinous or signet-ring in 17 (42.5%) pts. CD was more frequently stricturing in pts with standard adenocarcinoma (7 [77.8%] vs 1 [14.4%], p=0.04). CRC most frequently involved the rectum in pts with mucinous or signet-ring adenocarcinoma vs standard adenocarcinoma (4 [17.4%] vs 8 [47.1%]; p=0.04). Other IBD characteristics did not differ between standard and mucinous or signet-ring adenocarcinoma, including: age at CRC diagnosis (61 [30-80] vs 53 [29.80]; p=0.61), gender (F): 8 [34.8%] vs 5 [29.4%]; p=0.98), IBD duration at CRC diagnosis (14 [1-45] vs 17 [1-36]; p=0.74), smoking status (p=0.78), IBD type (UC: 14 [60.9%] vs 9 [56.3%]; p=0.84), UC extent and CD localization, frequency of perianal disease (p=0.37), thiopurine (p=0.55) or biologic (p=0.55) use. The proportion of pts surgically treated for CRC (20 [86.9%] vs 17 [100%], p=0.34) and the frequency of CRC-related death (3 [13.1%] vs 5 [29.4%]; p=0.37) were also comparable between groups. At diagnosis, CRC stage was comparable between pts with standard vs mucinous or signet-ring adenocarcinoma (stage I: 6 [26.1%] vs 1 [5.9%]; p=0.21; II: 9 [39.1%] vs 4 [23.5%]; p=0.48; III: 5 [21.7%] vs 7 [41.2%]; p=0.34); IV: 3 [13.1%] vs 2 [11.8%]; p=0.71). At univariate analysis, no specific risk factors for mucinous and signet-ring colonic adenocarcinoma were detected.

Conclusion

In the tested cohort of IBD patients with CRC, mucinous and signet-ring adenocarcinomas were observed in almost half of cases, although no specific risk factors were identified.
P847 Insomnia is common in IBD and associated with increased disability and abdominal pain
Authors: Barnes A , Andrews J , Bryant R V , Mountifield R
Published: January 2023

Background

Insomnia is common in those with chronic medical conditions. Insomnia is associated with decreased quality of life and is readily treatable through cognitive behavioural therapy for insomnia (CBTi). This study aimed to describe the associations with insomnia in an IBD population and its relationship with IBD related disability.

Methods

An online questionnaire was administered through three tertiary IBD centres, social media and through a patient advocacy group (Crohn’s Colitis Australia). The questionnaire included the insomnia index severity (ISI), a validated assessment of insomnia and its severity, with a score over 14 considered clinically significant insomnia. Validated measures of anxiety (GAD-7), depression (PHQ-9), physical activity (sIPAQ), and disability (IBD-DI-SR) were also utilised. IBD activity was assessed clinical IBD activity scores (HBI or SCCAI).

Results

There were 670 responses included in the analysis. Median age was 41 years (32-70), with the majority being female (78%), and 57% having Crohn’s disease. The mean disease duration was 11.9 years (10.4), 30% had undergone surgery for IBD and around half were on biologics (50.5%).

The mean ISI score was 12.7 (6.09). Over a third of the cohort had at least moderate insomnia (ISI>15). A one-way ANOVA revealed differences in disability scores (IBD-DI-SR) (see table 1) between insomnia severity groups (F(3,619) = 20.99, p < 0.001), with disability scores worsening with increasing severity of insomnia.

Multivariable logistic regression analysis (see table 2) revealed that clinically significant insomnia was significantly associated with clinically active IBD, abdominal pain, clinically significant anxiety, and clinically significant depression.

Conclusion

Insomnia is common in people with IBD with at least one third reporting moderate insomnia. Given that insomnia was associated with increased disability, consideration should be given for routine screening for insomnia in IBD patients. Mental health conditions and ongoing pain should be addressed with consideration given to referral for CBTi.
P850 Co-medication before and after onset of inflammatory bowel disease in adults or elderly
Authors: Lund K , Zegers F D , Nielsen J , Brodersen J B , Knudsen T , Kjeldsen J , Larsen M D , Nørgård B M
Published: January 2023

Background

The incidence of Inflammatory Bowel Disease (IBD) is increasing. Co-medication is clinically important in addition to the treatment of IBD. However, real-world data on co-medication is sparse. Thus, we aimed to describe whether a diagnosis of IBD affects the prescription pattern of co-medication used to treat other diseases in adult-onset and elderly-onset IBD.

Methods

This nationwide cohort study utilized data from Danish Health Registers. We included patients with adult-onset of IBD (18-59 years of age) and elderly-onset of IBD (+60 years of age) from 1998-2018 with three years of follow-up after the diagnosis for all patients. We identified patients who had at least two diagnoses of IBD in The National Patient Register. We described redeemed prescriptions of 11 common groups for medication used to treat conditions other than IBD using data from The Danish National Prescription Registry.

Results

We identified 36,165 incident patients. We created two cohorts; 27,386 (75%) had adult-onset IBD, and 8,779 (25%) patients had elderly-onset IBD, Table 1. The proportion of patients with redeemed prescriptions in both cohorts was statistically significantly increased one and three years after onset of IBD for antidepressants, antipsychotics, sedatives/hypnotics, opioids, non-opioid analgesics, antidiabetics, and proton pump inhibitors, compared to one and three years before diagnosis, Figure 1 & Figure 2.

Conclusion

The proportion of patients with redeemed prescriptions for antidepressants, antipsychotics, sedatives/hypnotics, opioids, non-opioid analgesics, antidiabetics, and proton pump inhibitors was significantly increased one and three years after a diagnosis of IBD compared to one and three years before diagnosis.
P852 predictors of complicated disease course in UC in an administrative database: a nationwide study from the epi-IIRN
Authors: Lujan R , Atia O , Focht G , Greenfeld S , Kariv R , Loewenberg Weisband Y , Lederman N , Matz E , Dotan I , Turner D
Published: January 2023

Background

There is uncertainty about the ability to predict disease course in UC, often since prediction studies are small and include selected population. We aimed to use a large nationwide cohort to explore predictors of disease course in UC.

Methods

Data of patients diagnosed with UC in the epi-IIRN cohort 2005-2020 were retrieved from the four Israeli Health-Maintenance-Organizations covering 98% of the population. The following potential predictors were explored: demographic data, laboratory results, induction medications, and extra-intestinal manifestations. The primary outcome was complicated disease course defined as colectomy, steroid-dependency, or need for more than one biologic class. Hierarchical clustering categorized disease severity at diagnosis based on available laboratory results into four groups of disease severity (mild, moderate, severe, and extreme).

Results

A total of 15,111 UC patients with 114,208 person-years of follow-up were included, of whom 2,213 (14%) had complicated disease course. The latter was predicted in a Cox multivariable regression model by induction therapy with biologics (HR 3.84 [2.4-6.12]) and severity of laboratory tests prior to diagnosis (HR 1.41 [1.03-1.92]). The use of topical treatment (5-ASA or steroids enema/suppository) as monotherapy was protective with a decreased risk of complicated disease course (compared with untreated, HR 0.5 [0.38-0.63). Younger age of diagnosis (HR of pediatric-onset compared to adult-onset 1.79 [1.48-2.15]) and recent year of diagnosis (HR 1.03 [1-1.04]) were also associated with complicated outcome. Jews had 23% reduced risk of complicated disease course compared with Arabs (HR 0.77 [0.60-0.97]) (Figure 1). Specifically in the laboratory tests, there was a gradual increase in complicated disease amongst the disease severity clusters (p<0.001; Figure 2).

Conclusion

In this nationwide cohort, complicated disease course was apparent in 14% of patients and predicted by serum laboratory tests and induction therapy with biologics. Jewish ethnicity and topic therapy (reflecting proctitis) were associated with better outcomes.
P854 Race and ethnicity in ulcerative colitis clinical trial enrolment: a post hoc analysis of patient demographics and clinical characteristics from GEMINI 1, VARSITY, and VISIBLE 1
Authors: Khan R M Q , Ananthakrishnan A N , Loftus Jr E V , Iroku U , Mukherjee R , Uddin S , Odufalu F D , Liu J
Published: January 2023

Background

The incidence of inflammatory bowel disease (IBD) has risen among Black individuals and Hispanic or Latino individuals in the USA in recent decades; however, these patients are underrepresented in clinical trials of IBD therapies. We aimed to perform a post hoc analysis of the baseline demographics and clinical characteristics in three phase 3 clinical trials of vedolizumab for ulcerative colitis (UC) to identify differences between racial and ethnic groups.

Methods

The baseline demographics and clinical characteristics of patients with UC who were enrolled in GEMINI 1, VARSITY, and VISIBLE 1 were pooled and stratified by race and ethnicity, which were self-reported. The inclusion criteria for these trials included adult patients with moderately to severely active UC who had a prior inadequate treatment response, loss of response, or intolerance to conventional therapies or anti-tumour necrosis factor α treatment. Data were analysed using descriptive statistics, with mean or median values calculated for continuous variables, and the number and proportion of patients reported for categorical variables. T-tests and exact tests were used to compare continuous and categorical variables, respectively, between Black and White patients and between Hispanic or Latino patients and those who were not Hispanic or Latino.

Results

We included 1,358 patients, of whom 1,171 (86.2%) were White, 148 (10.9%) were Asian, 14 (1.0%) were Black, and 25 (1.8%) were of multiple or unspecified racial groups (Table 1). Black patients had significantly higher mean weight (87.9 kg vs 74.8 kg, p < 0.01) and body mass index (30.5 kg/m2 vs 25.2 kg/m2, p < 0.01), but lower albumin (38.5 g/L vs 41.2 g/L, p < 0.05) and haemoglobin levels (115.5 g/L vs 126.1 g/L, p < 0.05) than White patients (Table 1). Ethnicity data were recorded for 465 patients (34.2%). Hispanic or Latino patients were shorter in height (166.6 cm vs 171.0 cm, p < 0.01) and had shorter mean disease duration (4.6 years vs 7.6 years, p < 0.01) than those who were not Hispanic or Latino (Table 2). A non-significant, but numerically greater proportion of Hispanic or Latino patients had pancolitis than those who were not Hispanic or Latino (50.0% vs 35.8%).

Conclusion

In this post hoc analysis of vedolizumab clinical trials, Black patients and Hispanic or Latino patients with UC had differences in certain demographic and disease characteristics versus White patients and patients who were not Hispanic or Latino, respectively. These differences may have implications for therapy. Thus, inclusion of a more diverse patient population that reflects the demographics of the general population is warranted to adequately ascertain drug efficacy across racial and ethnic groups.
P871 Consideration of smoking and familial aggregation of appendectomy together may change our previous belief about the influence of appendectomy in Inflammatory Bowel Disease (Ulcerative Colitis vs Crohn's Disease)
Authors: Bakkaloglu O K , Eskazan T , Onal U , Candan S , Balamir M , Kurt E A , Hatemi I , Erzin Y , Celik A F
Published: January 2023

Background

While appendectomy is known to be associated with Crohn's Disease (CD), it is claimed to be protective against Ulcerative Colitis (UC). However, it is not clear whether this is a cause-effect relationship or is due to different inflammatory and genetic characteristics of the two different diseases. The discrete effects of smoking on the course of CD and UC are well known. Yet, the familial aspect of appendectomy in IBD patients and its relationship with smoking have not been discussed before.

Methods

The frequency of appendectomy, smoking status of the patients (never / ever smoker) and their relations with each other were evaluated in 227 CD, 180 UC patients and their families (including biological parents and children).

Results

58% of the patients were male and the median age in the whole group was 42 years (Table-1). Age was found to be higher in UC patients compared to CD (44-40 p:0.002). The frequency of appendectomy in the whole group was 16.5%; It was 6.7% in UC and 24.8% in CD (p:0.001) (Reference prevalence of appendectomy in normal population is reported as %7). Age was higher in patients with appendectomy compared to IBD patients without appendectomy (45-41 p:0.08). Smoking was detected more frequently in both CD patients, and IBD patients with appendectomy (both p<0.001). The risk of appendectomy in IBD patients was associated with a family history of appendectomy (31%-15% p:0.005). Similar to the increased incidence of appendectomy in CD patients, family history of appendectomy in IBD patients was associated with a family history of CD, but this relationship could not be demonstrated for UC. The frequency of appendectomy in families of CD patients was higher than in families of UC patients (22%-15% p:0.07). In the regression analysis, CD, smoking and increasing age were found to be independently associated with appendectomy in IBD patients (Table 2).

Conclusion

The co-occurrence of CD and appendectomy, compared to UC, and the relationship between appendectomy and family history suggest that similar genetic factors and ultimately inflammatory pathways may be effective in both diseases. The association of smoking with increased CD and appendectomy frequencies, together with its paradoxical effect on UC, suggests that smoking may be a triggering factor on inflammatory pathways in some individuals with this genetic background. These results may also jeopardize the recently claimed protective role of appendectomy on UC.
P872 Underrepresentation of Palestinian Citizens of Israel in Israeli Inflammatory Bowel Disease Trials
Authors: Hassan M , Ghersin I
Published: January 2023

Background

Recent studies have described a significant racial disparity, with a very low proportion of racial minorities, in clinical trials of therapies for inflammatory bowel diseases (IBD), along with limited reporting of ethnicity data.

Palestinian citizens of Israel (commonly referred to as Israeli Arabs) are Israel’s largest ethnic minority, comprising 21% of the Israeli population. This minority group suffers from substantial health inequalities, as evidenced by increased rates of obesity, smoking and diabetes and a lower life expectancy compared to Israeli Jews. It is worth noting that the incidence of IBD among Palestinian citizens of Israel is on the rise.

We sought to describe ethnic representation in Israeli IBD clinical trials.

Methods

We systematically reviewed Israeli IBD trials from the past 20 years.

Each publication was examined for ethnicity data.

The proportion of trials reporting ethnicity were calculated among all reported.

Results

The search yielded 99 publications.

The year of publication ranged from 2002 to 2022.

Only 7 of 99 trials (7.1%) included ethnicity demographics, with 92/99 (92.9%) not reporting ethnicity at all.

There was no mention of ethnicity or limitations surrounding ethnicity inclusion in the discussion section of any of the other included publications.

Of the 7 trials reporting ethnicity, 6 studies included Palestinian patients (6/99 trials, 6.1%). The other study reported data regarding IBD among Ethiopian Jews migrating to Israel.

Data regarding the religious affiliation of Palestinian patients was available in 3 out of 6 studies (50%).

Conclusion

The reporting of ethnicity and the inclusion of Palestinian citizens of Israel in Israeli IBD trials have been poor.

Greater effort should be made at multiple levels for the appropriate participation of all ethnic groups in Israeli IBD trials.

We believe this will enhance our understanding of disease processes and response to treatment in different patient populations, and ultimately improve the quality of life of our patients.
P874 Comparison and Propensity Score of Seroconversion After Two Doses Of SARS-CoV-2 Vaccine in IBD Patients And Liver Transplant Recipients
Authors: Indellicati G , Rendina M , Todeschini A , Lillo C , Castellaneta A , D'Uggento A M , Di Leo A , Principi M
Published: January 2023

Background

Suboptimal anti-Sars-Cov2 vaccine response has been demonstrated during immunosuppressive treatments. Liver Transplant Recipients (LTRs) and Inflammatory Bowel Disease (IBD) patients are different setting of populations who are both undergoing immunosuppressive treatments.

In this work, we pooled and compared, retrospectively, these two populations to evaluate anti-SARS-CoV2 seroconversion after the second dose of vaccination. Different comorbidities and therapies outcomes have been explored as well.

Methods

The antibody titres standardized of the two cohorts have been analysed. Matched patients of both populations for comorbidities and therapies with application of propensity score have been investigated.

Results

240 LTRs and 424 IBD patients were analysed. Most have received an mRNA based vaccine (BNT162b2 or mRNA-1273: 99.1%). The seroconversion rate of 84% for LTRs and 93% for IBD patients was recorded. To multivariate analysis, hypertension (OR 2.8618, 95% CI 1.0012 to 8.1802), the mycophenolate administration (OR 2.9733, 95% CI 1.1820 to 7.4794) and the steroid use (OR 5.4531, 95% CI 1.0706 to 27.7761) were significantly associated with reduced seroconversion in LTRs cohort; meanwhile, the older age (OR 1.0369, 95% CI 1.0076 to 1.0670) and the thiopurine consumption (OR 2.9484, 95% CI 1.0089 to 8.6166) with that in IBD population. After Propensity Score Matching application, the seroconversion rates, not statistically different, of 86% for LTRs and 92% for IBD patients were found. Hypertension (OR 2.73, 95%CI 1.1258 to 6.6138), diabetes (OR 3.16, 95% CI 1.1888 to 8.4217), age > 65y (OR 2.93, 95% CI 1.1712 to 7.3153) and the female sex (OR 2.54, 95% CI 1.0963 to 5.9104) were correlated with reduced seroconversion in both populations.

Conclusion

After Propensity Score Matching, the seroconversion rates of IBD and LTR patients were not statistically different. Hypertension, diabetes and age > 65y revealed a significant influence on seroconversion and the female showed a reduced seroconversion in comparison to male.
P876 Disease course of Inflammatory Bowel Disease Unclassified in adult patients : a population-based study (1988-2014)
Authors: Jougon J , Leroyer A , Wils P , Guillon N , Sarter H , Gower-Rousseau C , Savoye G , Turck D , Fumery M , Ley D
Published: January 2023

Background

Inflammatory bowel disease unclassified (IBDU) represents 1 to 20 % of inflammatory bowel disease (IBD). There are few data on the natural history of IBDU. The aim of this study was to evaluate the disease course of IBDU in a population-based cohort.

Methods

All patients diagnosed with IBDU between 1988 and 2014, aged > 17 years at diagnosis, and prospectively enrolled in a population-based registry, were followed until diagnostic reclassification as Crohn’s disease (CD) or ulcerative colitis (UC), or date of loss of follow-up. Clinical presentations at diagnosis of IBDU, CD or UC were compared. The probability of diagnostic reclassification of IBDU during follow-up was studied by the Kaplan-Meier method, and its variation factors by Cox models.

Results

A total of 480 patients with an initial diagnosis of IBDU were included, representing 3.6% of incident IBD cases in the registry. The probability of IBDU diagnosis within IBD significantly decrease over the study period (6.2% from 1988 to 1996, 3.3% from 1997 to 2005 and 2.1% from 2006 to 2014, p<0.0001). Small bowel exploration and gastroscopy rates at diagnosis were significantly lower in IBDU than in UC and CD. Of these 480 patients, 388 were followed up, with a median duration of 2.4 years (IQR: 0.5-9.5). The cumulative probability of reclassification of IBDU was 17% at 1 year, 41% at 5 years, and 54% at 10 years (median time since initial diagnosis: 8.0 years (IQR: 6.3-12.0)); the probability of reclassification to UC was 10% at 1 year, 22% at 5 years, and 30% at 10 years, and to CD was 5%, 13%, and 18%, respectively. The median time to diagnostic reclassification decreased over the study period (14.3 years (IQR: 9.0-17.2) in 1988-1996, 5.1 years (3.1-9.4) in 1997-2005, and 5.6 years (3.4-8.3) in 2006-2014, p<0.0001), in parallel with an increased rate of reclassification during the most recent periods of diagnosis (HR: 1.76 in 1997-2005 and 1.67 in 2006-2014). Presence of rectal bleeding at diagnosis and 1st degree family history of IBD were respectively associated with risk of reclassification to UC (HR: 1.65, p=0.044) and CD (HR: 2.72, p=0.0134). Exposure to anti-TNF increased significantly after diagnostic reclassification (HR: 4.05, p<0.0001). During follow-up, 13.4 % of patients with IBDU required surgery.

Conclusion

In this population-based study, almost half of the patients with an initial diagnosis of IBDU were reclassified during follow-up, after a median time from diagnosis of 8 years. The rate of IBDU and the delay to diagnostic reclassification decreased over the study period, presumably due to an improvement in primary diagnostic evaluation.
P878 Country is the main determinant of differences in nutritional therapy practices across Europe: Results of the Y-ECCO ClinCom Survey 2022
Authors: Selin K A , Andersson S , Bilén K , Strid H , Björk J , Bresso F , Hedin C
Published: January 2023

Background

Diet is known to affect inflammatory bowel disease (IBD), but the optimal nutritional therapy during a severe flare is uncertain. The goal of this study was to describe variation in nutritional practices across Europe, between professions, types of hospitals and healthcare systems, as well as between ulcerative colitis (UC) and Crohn’s disease (CD).

Methods

A novel questionnaire comprising 17 questions, of which 5 concerning demographic data, was distributed digitally in the ECCO Congress 2022 and via the ECCO country representatives. In the comparisons of categories (e.g., countries), only categories with at least 25 responses were considered, and Chi-squared test was used.

Results

The survey was completed by 313 participants. Table 1 summarises their main characteristics.

Physicians and dietitians were most commonly responsible for determining nutritional therapy for IBD inpatients (Table 2). The commonest form of nutritional therapy was oral nutritional supplements (ONS) on top of easy to digest food. Total parenteral nutrition (TPN) was used by 10% of respondents for UC patients and 7% for CD. Almost a quarter of respondents reported less than 25% of patients being assessed by a dietitian in the first 3 days of a flare. Energy intake, stool frequency and inflammatory biomarkers were the commonest factors to determine when to change nutritional therapy. No specific nutritional screening tool was used by 45% of respondents.

There was significant variation between different European countries and healthcare professions for all the outcomes measured (p<0.050). However, in 7 of total 12 questions the variation between professions was only caused by variation in selecting the “I don’t know” alternative. When countries were grouped by healthcare index (HI), countries with high HI showed higher proportion using ONS on top of easy to digest food in CD (p=0.008), being more likely to use a specific nutritional screening tool for assessment (p<0.001) and using more approximate nutritional monitoring in UC instead of reporting all intake (p=0.002). Moreover, nutritional therapy management did not vary according to hospital type (university versus general), apart from criteria of changing nutritional therapy in CD (p=0.021) and monitoring intake in UC (p=0.046).

During the first three days of a severe flare, a diet consisting exclusively of ONS was significantly more frequently used for CD than UC (p=0.018, Figure 1). Otherwise, similar nutritional therapy strategies were reported for CD and UC including using TPN to a similar extent.

Conclusion

Country is the main determinant of differences in nutritional practice across Europe. Diet consisting exclusively of ONS is more common during a flare of CD than UC.
P891 Estimating diet’s quality in patients with Crohn’s disease during remission
Authors: Karachaliou A , Yannakoulia M , Bletsa M , Mantzaris G J , Tzouvala M , Bamias G , Kontogianni M D
Published: January 2023

Background

Patients with Crohn’s disease (CD) experience inadequate energy and nutrients’ intake and food restrictions especially during active disease, but in remission it is recommended to follow guidelines for the general population. However, sparce data support patients’ reluctance to abandon restrictions they usually follow during disease flare-ups. The aim of the study was to evaluate dietary intake in terms of macronutrients, food groups and adherence to healthy dietary patterns in a sample of patients with CD in remission.

Methods

Disease activity was assessed endoscopically and using the Harvey-Bradshaw Index (HBI<5 indicates remission). Nutrients’ intake was assessed through two non-consecutive 24-hour dietary recalls and food groups consumption through a validated food frequency questionnaire. Dietary intake was compared to relevant recommendations (ESPEN’s guidelines for protein intake, EFSA’s recommendations for healthy adults for other macronutrients’ intake and national dietary guidelines for adult Greek population for food groups’ consumption). Adherence to the Mediterranean diet was estimated using MedDietScore (values 0-55, higher values indicate higher adherence) and to the European dietary guidelines for cardiovascular disease prevention with CVD-score (values 0-11, higher values indicate higher adherence).

Results

148 patients (50.7% males, 40.8±13.7 years) were evaluated. 14% reported lower protein intake than recommended. Carbohydrate intake was lower (42.3±8.3 %), sugars intake was higher than the recommended threshold of 10% [13.1 (9.3, 16.4) %] and total fat (39.3±7.5%) and saturated fat [12.7 (10.5, 14.6) %] intakes were higher than recommended. Also, fibers intake was lower than the recommended values of 25-30g/day [15.7 (11.5, 21.2) g/day] and remained low even when excluding those with structuring disease (n=71) [median intake 15.2 (11.1, 21.5) g/day]. Regarding food groups’ consumption, patients reported lower dairy [1.60 (0.96, 2.28) portions/day], non-refined cereals [0.21 (0.02, 0.70) portions/day], fruits [1.06 (0.42, 1.92) portions/day], vegetables [1.11 (0.64, 1.84) portions/day] and legumes [1.26 (0.00, 3.71) portions/week] consumption and higher total red meat [4.23 (2.94, 6.22) portions/week] and sweets [4.97 (1.96, 8.96) portions/week] consumption than the recommended. Mean MedDietScore was 28.7±5.5 and mean CVD-score was 5.42±1.39, both reflecting a low-to-moderate diet’s quality.

Conclusion

Contrary to European dietary guidelines encouraging patients with CD to follow a healthy, without restrictions, dietary pattern during remission, patients fail to adhere to these recommendations and follow a diet of low-to moderate quality.
P895 Differences in ulcerative colitis patients regarding COVID-19 status
Authors: Straume Z , Krūmiņa N , Ozoliņa J , Krūmiņa A , Skuja V
Published: January 2023

Background

Severe acute respiratory syndrome coronavirus 2 is the novel coronavirus that caused the coronavirus disease 2019 (COVID-19) outbreak. Studies have increasingly reported the involvement of other organs, including the gastrointestinal system, in addition to the respiratory system. Ulcerative colitis is an inflammatory bowel disease with an unknown cause. Emerging data suggest that the gastrointestinal system may be influenced by COVID-19 via the expression of angiotensin-converting enzyme-2, but data on the association between COVID-19 and ulcerative colitis, are lacking.

Methods

In 6-month time (June to December 2021) 49 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital were included in a cross-sectional study. All patients were divided into groups according to medically proven COVID-19 status (COVID-19+ vs COVID-19-) in the last 6 months. Information about diet, IBD medications, food supplements, vitamins, sports activities, marital status, education level, and income level was collected. Data were analyzed with SPSS 20.0.

Results

Out of 49 patients, 33(63.3%) were males and 13(36.7%) were females, median age was 38.0 [IQR=17] years. Fourteen patients (28.6%: 7(50%) in each gender) were Covid-19+ within last 6 months. Median time patients suffered from COVID-19 was 7 [IQR=15.3] days. The most common symptoms were: 11(19.6%) fever, 6(10.7%) rhinitis and 5(8.9%) weakness. The most common diet among all patients was IBD diet 33(67.3%) from those 12(21.4%) were COVID-19- and 4(78.6%) were COVID-19+, p=0.00. Out of 49 patients, 25(44.6%) were using food supplements (fish oil, curcumin, collagen, zinc, calcium) of those 17(30.4%) patients were COVID-19-, 8(14.3%) COVID-19+, p=0.00. Most commonly used vitamins were vitamin D 18(64,3%), from those 15(42.9%) were COVID-19-, 3(21.4%) COVID-19+, p>0.5; vitamin C – 7(32,8%), from those 4(11.4%) were COVID-19-, 3(21.4%) COVID-19+, p>0.5. Twenty-four (49%) were doing sports, of those 18(51.4%) were COVID-19-, 6 (42.9%) COVID+; p>0.5. Most common sports activities were cycling 8(16.3%), running 8(16.3%) and fitness 6(12.2%). Most commonly used IBD medications were mesalazine 35(71.4%), azathioprine 7(14.3%) and biologics 4(8.16%), there were no statistically significant differences between COVID-19+ and COVID-19-. There were no statistically significant differences between marital status, education level, and income regarding COVID-19 status.

Conclusion

COVID-19 was less common among patients who were using food supplements and followed IBD diet.
P898 Uncovering of tissue-associated risk factors that lead to different genetic risk profiles across Inflammatory Bowel Disease patients
Authors: Gaite A , Sánchez-Mayor M , Bujanda L , Marigorta U M
Published: January 2023

Background

Polygenic risk scores (PRSs) are emerging as a tool of choice to summarize the risk of disease in each individual. The calculation of PRSs is based on genetic variants and effect sizes obtained from large studies using many different cohorts of patients. In inflammatory bowel disease (IBD), GWAS meta-analysis based on over 75.000 IBD patients from different multi-ethnic cohorts has discovered around 300 independent associated variants. This information can be used to estimate genetic risk and detect individuals with several higher odds of developing the disease during their lifetime. However, PRSs usually do not incorporate functional information about causal variants, and the potential for heterogeneity in effect sizes among subgroups of individuals is disregarded entirely. Hence, PRSs might be ill-suited to capture subcomponents of genetic risk that may account for key differences among specific etiological profiles of patients. Fine mapping of GWAS causal variants show an enrichment in variants associated with changes in gene expression in specific tissues, suggesting that risk of complex diseases is led by an accumulation of variants that change the transcriptome towards a pathogenic profile. To explore the biological nature of IBD risk we propose a tissue transcriptional risk (t-TRS) score

Methods

We perform Transcription Wide Association studies (TWAS) based on gene expression prediction models in nine IBD relevant tissues and a meta-analysis of European IBD GWAS. We next estimated the t-TRS of people from UK biobank and compared its prediction performance against PRS measuring the area under the curve (AUC)

Results

We performed nine TWAS studies and obtained 636 genes that are genome wide significant in at least one tissue. Although eQTL weights are shared across tissues, we observe a high number of tissue specific signals, specifically in terminal ileum and lymphocytes. Pathway enrichment analysis on the 600-gene set showed enrichment of immune functions like “Signaling by interleukins” and “Antigen presentation”. We also show the predicting value of t-TRS is better than the PRS in all tissues. In addition, clustering of individuals according with t-TRS yield 3 subgroups of patients

Conclusion

Functionally informed genetic predictors allow not only to better stratify patients, but also to discover which are the biological pathways that accumulate risk variants in subgroups of IBD patients
P903 Lactase non-persistence and Inflammatory Bowel Disease in a Basque cohort
Authors: Garcia-Etxebarria K , Merino O , Ezcurra A , Segues N , Arzallus T , Marigorta U M , Vignau R , Bujanda L
Published: January 2023

Background

Patients with inflammatory bowel disease (IBD) experience symptoms (e. g. abdominal pain, bloating, or diarrhoea) that could be partially due to food intolerances or malabsorption. Thus, those patients could restrict some foods in their diet to avoid the symptoms. Among others, they could restrict their intake of dairy products, since lactose intolerance is one of the most prevalent intolerances. Although the role of lactose intolerance in IBD has been studied, the results are not entirely conclusive.

Recently, we analysed the genetic basis of IBD in a Basque cohort and we have taken advantage of the data we had available to study the role of the lactase non-persistence in IBD.

Methods

The genotype of the single nucleotide polymorphism (SNP) rs4988235 was retrieved from 1427 individuals (492 IBD cases and 935 controls from the general population) studied previously in a Basque cohort. The G allele of that SNP is associated with the non-persistence of lactase and the individuals were classified as carriers and non-carriers of that allele.

The effect of the carriership of that allele in the risk of IBD was analysed through generalized linear models, adjusting by the first four principal components of the genetic distance between individuals. In addition, IBD subtypes and behaviour and location of Crohn’s Disease (CD) were analysed.

Results

On the whole, 1089 individuals (76.31%) were carriers of the non-persistent lactase allele. This high prevalence is due to the effect of the mixture of modern European (where the 68.08% was carrier) and ancient European (87.45%) ancestries of the actual Basque population.

Although there is a trend, the carriers of the non-persistent lactase allele did not show a significantly higher risk of developing IBD (OR=1.5, 95%CI: 0.9-2.5, P=0.0749). When subtypes were analysed, there was no higher risk of developing Ulcerative Colitis (P=0.4261), while the risk of developing CD approached formal significance (OR=1.4, 95%CI: 0.99-1.9, P= 0.0584).

Considering this result, we further analysed the effect of the non-persistent lactase allele regarding the behaviour or location of CD. The carriers of the non-persistent lactase allele had a higher risk of penetrating CD (OR=2.7, 95%CI: 1.1-7.9, P=0.0437) and of colonic CD (OR=4.7, 95%CI: 1.4-29.4, P=0.0375).

Conclusion

Although the sample size was limited, the carriers of the non-persistent lactase allele were higher in penetrating CD and colonic CD than in the general population. Thus, lactose consumption could affect those cases of CD and, therefore, follow-up analyses are needed to validate these results.
P909 Microbiome dynamics leading up to and during pregnancy in a matched IBD-control cohort
Authors: Binyamin D , Turjeman S , Koren O , Ben Ya'acov A , Gold G , Goldenberg R , Bar-Gil Shitrit A
Published: January 2023

Background

A common feature of inflammatory bowel diseases (IBD) is dysbiosis of gut microbiota. IBD usually affects women during their childbearing years, but successful pregnancy outcomes have become a reality for many women with IBD. Pregnancy in general and pregnancy in IBD in particular, has been reported to dramatically affect gut microbial composition and function. In the present study, we have characterized the changes in the gut microbiota that occur from preconception to the first trimester of pregnancy in healthy women and in women with IBD.

Methods

Fecal samples were collected from 39 pregnant IBD patients and 38 pregnant healthy controls at two time-points: preconception and during the first trimester. Bacterial DNA was extracted, amplified, cleaned and sequenced (16S rRNA gene). Then, microbiome analysis was performed using QIIME2 to compare profiles between the groups and across the time points.

Results

The microbiomes of IBD patients were significantly different than those of healthy controls, and bacterial richness was significantly lower than controls both in preconception and first trimester samples. Even though no significant differences were observed between sampling time points, the shift in the bacterial population from preconception to the first trimester in the IBD groups was significantly larger compared to the shift in the control group. We also found that the genus Sutterella was significantly more abundant in healthy controls in samples collected during the first trimester compared to IBD patients. When specifically focusing on this genus in preconception samples, we found the same pattern of increased abundance in the control group.

Conclusion

While there were no differences in the microbiota across time points, the increased delta between IBD versus controls may suggest that disease phenotype permits increased microbiome plasticity than the control group. Furthermore, the results may be related to modulation of immune response that may be associated to inflammatory state and medical treatments; however, further studies are warranted.