bluuebunny/crossref_metadata_2025 huggingface dataset:
P713 Effects of vedolizumab on health-related quality of life, work productivity and patient concerns in patients with ulcerative colitis and Crohn’s disease in the UK and Ireland: OCTAVO cohort 2
Authors: Parkes G , Akbar A , Beales I , Buckley M , Creed T , Din S , Fraser A , Plevris N , Meadowcroft S , Owen G , Heggs N
Published: January 2020

Background

Patients with inflammatory bowel disease (IBD) experience substantial impairment in health-related quality of life (HRQoL), therefore HRQoL endpoints are considered important measures of treatment outcome. OCTAVO evaluated the effects of vedolizumab on HRQoL, work productivity and patient concerns in IBD patients in the UK and Ireland.

Methods

OCTAVO is an ongoing multicentre, observational study to evaluate the impact of vedolizumab on two cohorts. Cohort 1 examined the impact of vedolizumab on concomitant medications compared with anti-TNFs in biologic naïve patients with ulcerative colitis (UC). Cohort 2 was non-comparative and observed changes in patient reported outcomes (PROs) in patients with UC and Crohn’s disease (CD) prescribed vedolizumab at any point in the treatment pathway. PROs are assessed by Short Inflammatory Bowel Disease Questionnaire (SIBDQ), IBD-Control-8 (IBD-C-8), Work Productivity and Activity Impairment (WAPI) and Rating Form of IBD Patient Concerns (RFIPC). PROs are collected prospectively at baseline, Week 14, 6 months and 12 months post-initiation via online questionnaires. The results of an interim analysis of Week 14 PROs for patients aged ≥18 years newly initiated on vedolizumab enrolled across 7 hospital sites in Cohort 2 are reported here.

Results

Sixty-one patients (21 CD, 40 UC; 51% male) were recruited, with a median age of 39.0 (IQR 32.0–55.0); and median disease duration of 9.6 years (IQR 1.7–17.2) for CD and 5.6 years (IQR 1.3–17.4) for UC. Mean total SIBDQ scores at Week 14 were: 45.2 for CD; 50.0 for UC. Scores increased by 8.5 points in CD patients and 10.2 points in UC patients in the first 14 weeks of the study. Similarly, improvements in IBD-C-8, WPAI-UC/CD sub-scores and RFIPC were observed in both CD and UC (Table 1).

Conclusion

Vedolizumab treatment was associated with meaningful improvements in PROs at Week 14. Improvements were seen across all measures (SIBDQ, IBD-C-8, WPAI-CD/UC and RFIPC) and were similar between CD and UC. Further investigation of vedolizumab on PROs in the real world is required to assess impact in the longer-term, the full analysis of OCTAVO at months 6 and 12 will help to provide this.
P715 The prevalence of chronic musculoskeletal pain in patients with ulcerative colitis in comparison to control subjects: A cross-sectional study
Authors: Pettersson N , Kragsbjerg F , Hamrin A , Forsblad-D′elia H , Karling P
Published: January 2020

Background

Musculoskeletal symptoms are common in patients with ulcerative colitis (UC) but there is no data on the prevalence of chronic regional pain (CRP) and chronic widespread pain (CWP) in patients with UC compared with control subjects.

Methods

From a national IBD Register (SWIBREG), all living patients with a confirmed UC diagnosis, aged 20–74 years, who were residents of two counties in Northern Sweden (n = 1164) were posted a validated questionnaire. Subjects (n = 3867) from a previous study using the same questionnaires was used as Controls (Bergman et al). The questionnaire comprises demography, history of pain and body localisation of pain. The disease activity of UC was measured by Patient- Simple Clinical Colitis Activity Index (P-SCCAI). CRP and CWP was defined as having pain for at least three months the last year. CWP was defined as having pain on both left and right side of the body and both above and below the waist, and in the axial skeleton.

Results

The response rate for the patients with UC was 43.6% and for the control subjects 62.7%. The patients were older than the control subjects (mean age 53.1 vs. 46.5 years; p < 0.001) but there was no difference in gender (men 50.7% vs. 46.7%; p = 0.108). The reported prevalence of any chronic pain, CRP and CWP was higher in patients with UC vs. controls (53.9% vs. 39.5%; p < 0.001; 33.5% vs. 24.2%; p < 0.001 and 19.7% vs. 12.5%; p < 0.001). The differences for reported chronic pain (any pain) was seen in all age groups. The patients with UC reported significant more pain in the regions ‘lower back’, ‘hip/upper leg’ and ‘lower leg/foot compared with controls (Table). The patients with P-SSCAI >5 (n = 110) reported more CWP than patients with P-SSCAI <5 (n = 411) (48.2% vs. 12.1%; p < 0.001) and controls (48.2% vs. 12.5%; p < 0.001) with significant differences for all body regions but there was no difference in CWP between patients with P-SSCAI <5 and controls (12.1% vs. 12.5%; p = 0.852). There was a slightly higher prevalence of reported ‘any chronic pain’ between patients with P-SSCAI <5 and controls (46.8% vs. 39.5%; p = 0.007).

Conclusion

Patients with UC reported more chronic pain than control subjects, especially from the lower back and hip region. Disease activity was associated with more pain included all body regions.
P747 Adherence to ECCO guidelines for cancer surveillance is associated to the detection of early cancer: A retrospective, single-centre, cohort study
Authors: PARIGI T L , Roda PhD G , Allocca M , Furfaro F , Loy L , Zilli A , Bonovas S , Danese S , Fiorino G
Published: January 2020

Background

Patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD) are at increased risk of developing gastrointestinal (GI) malignancies. The aim of this study is to assess the risk of malignancies in IBD patients and the impact of cancer screening according to the ECCO guidelines in a tertiary referral centre.

Methods

We retrospectively analysed the electronic database of all IBD patients followed by the IBD Centre of Humanitas Research Hospital, Milan, from January 2010 to October 2019, and collected all new diagnoses of solid and haematological tumours since 2010. The annual standardised incidence rate (SIR), rate of mortality and early cancer diagnosis were calculated and a descriptive analysis of drug exposure, disease duration, family history of any cancer, smoking habits was made.

Results

We included 5239 patients, with a total 19820 patient-years follow-up. Eighty-four malignancies in 81 patients were retrieved, 71 were included in the final analysis (38 CD, 32 UC, 31 females). Average age at tumour diagnosis was 52.9 years (range 19–78). 64% of patients were former or active smokers, 31% had a family history of cancer or IBD. Sixty-two per cent of patients were previously exposed or had 5-ASA at the time of cancer, 40% azathioprine, 43% anti-TNF or vedolizumab. The annual SIR for all kinds of malignancy was 0.358%. GI malignancies were the most frequent (n = 17, 23.9%, 47% UC, 53% in CD). Six over 8 GI tract malignancies in UC patients were found in the colon or rectum (mean disease duration 22.5 years), whereas in CD patients 5/9 were in the small-bowel (mean disease duration 7.0 years). Melanoma and breast cancer (n = 8 each) were the most common non-GI cancers, followed by prostate (n = 7) and bladder (n = 6). No significant difference in incidence was found between CD or UC. Non-Hodgkin lymphomas and leukaemia (3 and 1, respectively) only occurred in CD patients. Other tumours included thyroid (n = 5), lungs (n = 4), testicle (n = 3), ovary (n = 2), kidney (n = 2), head-nose-throat (n = 2), pancreas (n = 1), brain (n = 1), and non-melanoma skin cancer (n = 1). Death occurred in 11% of patients, 8 of them for late stage cancer. Only 2 were related to the concomitant IBD (1 colo-rectal and 1 anal cancer). In patients regularly screened according to the ECCO Guidelines (GI cancer, haematological and skin cancer), there was a significantly higher number of detection of early cancer (28 vs. 1, p = 0.003), although no differences in mortality rates were reported in the two groups (2 vs. 2, p = 0.10).

Conclusion

The overall incidence of cancer in our cohort was not different from the current literature available. Adherence to the ECCO Guidelines for cancer surveillance improves the detection of early cancer in IBD patients.
P749 Epidemiological and clinical characterisation of inflammatory bowel disease (IBD) in Latin America and the Caribbean: The EPI-LATAM IBD study from the Pan American Crohn’s colitis organisation
Authors: Yamamoto-Furusho J K , Parra-Holguín N N , Grupo-Colombiano E , Bosques-Padilla F , Veitia-Velásquez G , Torres E , Piñol-Jiménez F , Bautista S , Frías-Santana A , Villa-Ovalles K , Otoya-Moreno G , Iadé-Vergara B
Published: January 2020

Background

Inflammatory bowel disease (IBD) is currently recognised as a global health problem, since its incidence and prevalence have increased significantly worldwide in recent years. Studies in Latin America are only limited to reporting incidence and prevalence, so our main objective is to report the clinical and epidemiological characteristics of IBD in Latin American and Caribbean countries.

Methods

This is a multicentre cohort study in which 8 Latin American and Caribbean countries were included: Colombia, Cuba, Mexico, Peru, Puerto Rico, Dominican Republic, Uruguay and Venezuela during the period from August 2017 to October 2019. Two study groups were conducted by geographic region due to their ethnicity, Group 1) Caribbean: Cuba, Puerto Rico and Dominican Republic, Group 2) Latin America: Colombia, Mexico, Venezuela and Peru. Statistical analysis was performed with the statistical programme SPSS v.24. A value of p <0.05 was taken as significant.

Results

This study included a total of 4216 IBD patients from 8 countries. The CD was more frequent than UC in the following countries: Puerto Rico with 68.5%, Dominican Republic 56.3% and Peru with 53.1%, while in the rest of the countries the frequency of UC predominated, in Colombia by 79.2%, Venezuela in 78.4%, Cuba in 69.9% and Mexico in 75.8%. The Caribbean countries had a significantly higher frequency in the fistulising phenotype in CD with 65.1% (p = 0.0001), steroid dependence in 11.51% (pp = 0.002), steroid resistance in 28.5% (pp = 0.0001), thiopurine intolerance in 1.40% (p = 0.0002), extraintestinal manifestations in 55.91% (p = 0.0001), IBD surgeries in 32.10% (p = 0.0001) and family history of IBD reported a frequency of 15.60% (p = 0.0001). For Latin America, the frequency of pancolitis was more frequent in 48.21% (p = 0001) in patients with UC. The factors associated with the use of biological therapy were: fistulising phenotype in CD, steroid resistance, thiopurine intolerance, presence of extraintestinal manifestations and IBD-related surgeries. There is an increased frequency in the diagnosis of IBD in the last two decades (2000–2019), being 7.5 times for UC and 12.5 times for CD as show in Figure 1.

Conclusion

This is the first large and multicentre study in Latin America and the Caribbean which showed significant increase in the diagnosis of IBD in the last two decades as well as the differences in clinical and epidemiological characteristics between both regions.
P750 Prevalence and characteristics of incidentally diagnosed inflammatory bowel disease during screening colonoscopy
Authors: Han Y M , Lee J , Im J P , Kim J S
Published: January 2020

Background

Colonoscopy is the most powerful tool for colon cancer screening. As the performance rate of screening colonoscopy was rapidly increased, there was also a great increase in the incidental detection of inflammatory lesions during screening colonoscopy. The significance and clinical course of these lesions were never been investigated. The aim of this study is to evaluate the prevalence and clinical significance of incidentally detected inflammatory lesions during screening colonoscopy and investigate the characteristics of newly diagnosed inflammatory bowel disease among them.

Methods

Health check-up patients who underwent screening colonoscopy at Seoul National University Hospital Healthcare System Gangnam Center in 2018 were enrolled. Among them, patients who showed endoscopic inflammatory lesions such as ulcer, erosion, erythema, spontaneous bleeding, friability or exudate were selected. We reviewed the pathologic reports of those patients. We investigated if there were suggestive pathologic findings of inflammatory bowel disease, which were defined as presence of one of these findings: cryptitis, crypt abscess, crypt distortion, crypt atrophy or noncaseating granuloma. We classified them as possible inflammatory bowel disease patients and closely monitored clinical course of these patients. We investigated prevalence of incidentally diagnosed inflammatory bowel disease among health check-up patients.

Results

A total of 10366 patients underwent screening colonoscopy at Seoul National University Hospital Healthcare System Gangnam Center. Among them, 237 patients showed inflammatory lesions on colonoscopy. Nine patients were already diagnosed with inflammatory bowel disease; 1 with Bechet’s disease and 8 with ulcerative colitis. The others had no previous medical history of colonic disease. Biopsy specimens were obtained in 200 patients. Eighteen patients showed one of suggestive pathologic findings of inflammatory bowel disease. Among them, 12 patients did not undergo further diagnostic examination because they did have no associated symptom. Two patients immediately diagnosed as ulcerative colitis and other 4 patients underwent short-term follow-up colonoscopy. Three of them showed resolution of previously noted inflammatory lesions and the remaining one finally diagnosed with ulcerative colitis. Briefly, 3 patients were diagnosed with inflammatory bowel disease, 3 with eosinophilic colitis, 1 with tuberculosis, and 1 with amoebic colitis.

Conclusion

Incidental detection of inflammatory lesions during screening colonoscopy was relatively high; however, prevalence of inflammatory bowel disease is low. Careful examination of associated symptom and sustained close long-term follow-up are needed.
P756 Cervical smear screening results amongst women with inflammatory bowel disease at an Irish hospital
Authors: Pillay L , Piggott R S , Ganter N , McCormack G
Published: January 2020

Background

Human papillomavirus (HPV) is strongly linked to the pathogenesis of cervical dysplasia; women with IBD may be at greater risk of developing cervical pathology, especially those on immunosuppressive therapies. In Ireland a national screening programme begins at age 25 and continues until age 60. This was a preliminary study looking at the number of women seen at our IBD clinic with a prior abnormal smear test, and the correlation to their medication history.

Methods

All women attending our IBD service, over an 8 week duration, were asked to complete a questionnaire regarding previous smear testing and results. We also looked at their diagnosis, years since diagnosis and medication history. Any patient who was referred on for a colposcopy was considered as having an abnormal smear.

Results

A total of 80 women with an average age of 51.5 years (SD ±±33.5) and with an average 20.8 years (SD ±±20.2) since diagnosis had been screened. 10 were under the age of 25 and thus excluded, of these 7 were vaccinated against HPV. Seven women who were eligible, had never had a smear and therefore excluded. A total of 63 women previously had a smear test in their lifetime.

Conclusion

Conclusion Our study shows that women in our IBD cohort have a significantly higher risk of having an abnormal smear vs. the average Irish women (23.8% vs. national average of 9.8%, p = 0.006). Furthermore, the majority (80%, p < 0.001) of these patients were on immunosuppressive therapy at the time of the abnormal smear test. While the conclusion we can draw from this study are limited, we believe it emphasises the need for stringent adherence by IBD patients to screening guidelines for early detection of cervical dysplasia.
P776 Hospital re-admission in patients with inflammatory bowel disease: what are the risk factors?
Authors: Fromson R , Johnson E , Routledge E , Jameie-Oskooei S , Blad W , Patel R , Wong V
Published: January 2020

Background

Early re-admission after hospitalisation for an inflammatory bowel disease (IBD) flare is a negative quality indicator and causes unnecessary healthcare expense. Scoring systems to predict IBD readmissions have been shown to be ineffective. We aimed to describe the IBD re-admission rate at our hospital and investigate the risk factors.

Methods

Retrospective study of patients admitted to a London-based district general hospital under the gastroenterology team with a flare of inflammatory bowel disease between 2015 and 2018. Characteristic including but not limited to demographics, disease type, length of stay (LOS) during index admission, biochemistry and biologic use were recorded. Hospital software (Sunquest Integrated Clinical Environment, Medway) was used to identify patients re-admitted at 30 and 90 days after discharge. Multivariate logistic regression was performed.

Results

One hundred and thirty-eight patients were admitted with an IBD flare during the study period (74 (53.6%) Crohn’s disease (CD), 56 (40.6%) ulcerative colitis (UC), 8 (5.8%) IBD-U). Median age 33.5 (IQR 26–52), 71 (51.4%) female. Median LOS was 4.5 days (IQR 1.8–8). 36 (26%) patients were taking a biologic. Re-admissions occurred within 30 days in 19 patients (13.7%) and within 90 days in 30 patients (21.7%). Multivariate logistic regression showed that a raised CRP on discharge was associated with re-admission. For every increased unit of CRP by one there was an increased risk of readmission by 1.1 times (p = 0.05). Patients aged 22–39 were significantly less likely to be readmitted (OR: 0.38, p = 0.015). Male patients were significantly more likely to be readmitted (OR: 2.52, p = 0.05).

Conclusion

The 30 days and 90 days re-admission rate for our IBD population is just over 10% and 20%, respectively. CRP at discharge is significantly associated with both 30 and 90 days re-admission. After adjusting for confounders; CRP, age older than 40 and male gender were associated with re-admission to hospital. We advise caution in discharging IBD patients with raised inflammatory markers. Close follow-up within a few days of discharge would be appropriate in this high-risk sub-group.
P780 Proteinuria is associated with the development of Crohn’s disease: a nationwide population-based study
Authors: Kim J S , Park S , Lee H J , Soh H , Moon J M , Hong S W , Kang E A , Im J P
Published: January 2020

Background

Proteinuria has been identified as a sign of systemic endothelial dysfunction and chronic inflammation, and associated with the development of several systemic inflammatory diseases. However, the impact of proteinuria and its severity on the incidence of inflammatory bowel disease (IBD) has not been studied yet. The aim of this study was to determine the association between proteinuria measured by urine dipstick test and the development of IBD.

Methods

We conducted a nationwide population-based cohort study using claims data from the National Health Insurance (NHI) database, a mandatory health insurance programme covering about 97% of the Korean population. A total of 9,917,400 people aged 20 years or older who had undergone a national health examination conducted by NHI in 2009 were followed until 2017. The study population was classified into four groups, negative, trace, 1+, and ≥2+, depending on the degree of proteinuria measured by urine dipstick test. The primary endpoint was the newly diagnosed IBD, Crohn’s disease (CD) or ulcerative colitis (UC) during the follow-up period, which was detected by both ICD-10 (K50 and K51) and the rare intractable disease registration programme codes which provide co-payment reduction of up to 90% in South Korea.

Results

The incidence of CD significantly increased according to the degree of proteinuria (adjusted hazard ratio [aHR] with 95% confidence interval [CI], 1.01(0.703–1.451), 1.515(1.058–2.162), and 2.053(1.301–3.24) in trace, 1+, and ≥2+ dipstick groups, respectively) as compared with the dipstick-negative group. However, there was no significant difference in the incidence of UC among the degrees of proteinuria (aHR with 95% CI, 1.12(0.949–1.323), 0.947(0.764–1.174), 1.009(0.741–1.373 in trace, 1+, and ≥2+ dipstick groups, respectively). In subgroup analysis, dipstick-positive proteinuria independently increased the incidence of CD regardless of subgroups. However, in the development of UC, dipstick-positive proteinuria increased the risk of UC in those with diabetes mellitus (DM), but not in those without DM (aHR, 1.527 vs. 0.846; interaction p-value 0.004).

Conclusion

Proteinuria, measured by dipstick test, may be associated with the development of CD.
P803 The risk of spine and hip fracture in patients with inflammatory bowel diseases: a nationwide population-based study
Authors: Kim Y J , Ahn H J , Noh S , Park J C , Kim J Y , Kim J , Ham N S , Oh E H , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K , Park S H
Published: January 2020

Background

This nationwide population-based study sought to investigate the risk of spine and hip fracture in patients with inflammatory bowel diseases (IBD).

Methods

Using the 2007–2016 data from the Korean national health insurance claims database, we calculated incidence rate and incidence rate ratios (IRR) of spine and hip fracture in patients with IBD (n = 18,228; 64.1% male, 65.9% ulcerative colitis [UC]) compared with age- and sex- frequency matched subjects in 1:10 ratio (n = 186,871). A Cox regression model was used to evaluate risk of spine and hip fracture.

Results

The incidence rate and IRR of spine and hip fracture in IBD were 2.88/1000 person-years and 1.21 (95% confidence interval [CI], 1.11–1.31) during the median follow-up of 4.5 years. The risk for spine and hip fracture was significantly higher in UC (IRR 1.39, 95% CI, 1.25- 1.54), whereas it was not significantly higher in Crohn’s disease (IRR 0.85, 95% CI, 0.67- 1.06) than matched controls. In UC, the IRR of spine fracture was 1.41 (95% CI, 1.24–1.58) and the IRR of hip fracture was 1.40 (95% CI, 1.11–1.71). In multivariable analysis using the Cox regression model, the risk of spine and hip fracture increased with age (p trend < 0.001), in female patients (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.50–2.51) and in patients with comorbidities including osteoporosis (aHR 2.86; 95% CI, 2.10–3.89), stroke (aHR 2.74; 95% CI, 1.78–4.21) hypertension (aHR 1.82; 95% CI, 1.38–2.41), diabetes mellitus (aHR 1.67; 95% CI, 1.25–2.24) and dyslipidaemia (aHR 1.36; 95% CI, 1.05–1.78).

Conclusion

In a population-based study from Korea, we found that the risk for spine and hip fracture increased in patients with IBD, especially in UC patients. Also, this risk increased in patients who are older, female, or have comorbidities.
P804 Temporal trends and the influence of regional and socioeconomic status on the incidence of inflammatory bowel disease: Using National Health Insurance Service Database in Korea, 2005–2017
Authors: Kim S , Lee J , Kwak G , Park Y , Oh S , - S , Yang K , Yoon H , Kim K
Published: January 2020

Background

Well analysed data from the health insurance registry allows us detailed and various analyses of a nation-wide population study. In this study, we validate the diagnostic criteria of occurrence of new cases of Inflammatory Bowel Disease (IBD) using health insurance database and investigate the epidemiological features of IBD in Korea.

Methods

A population-based clinical data of patients with IBD in the Songpa-Kangdong district of Seoul was used as reference cases and the database of National Health Insurance Service from 2005 to 2015 was retrospectively reviewed to compare the diagnostic criteria. The most accurate criterion was applied to the entire database (2002–2017) with 3-year washout period for further assessment. Non-parametric statistics and p for trend analysis were used.

Results

The most accurate criteria of new cases of IBD was the combination of the experience of colonoscopy, IBD-specific medications at least 3 months and the International Classification of Disease 10th codes for Crohn’s disease (CD) and Ulcerative colitis (UC). With this criterion, new incident cases of IBD were 40,807 (14,183 CD, 26,624 UC) during the study period. The male to female ratio of age-adjusted incidence rate was 2.5:1 for CD and 1.4:1 for UC. Age- and sex-adjusted incidence per 100,000 population of CD and UC had increased from 1.4 and 3.6 (in 2005) to 2.2 and 4.2 (in 2017). Over 13 year period, the peak incidence of CD in both male and female was between 15 and 24 years of age without significant change while the peak incidence of UC was shifted from 55–64 years (in 2005–2008) to 25–34 years of age (in 2014–2017). There was a positive correlation between the socioeconomic status and incidence of IBD (p < 0.01). The standardised incidence rates of CD and UC in metropolitan areas were 2.4 and 4.3 per 100,000 population, while that in non-metropolitan areas were 2.0 and 3.8 per 100,000 population. The incidence rate of CD in metropolitan area was still significantly higher than in non-metropolitan area after the adjustment of socioeconomic status (p = 0.03).

Conclusion

The incidence of IBD in Korea has increased over the recent decade with the shift to younger age groups. The higher incidence in higher socioeconomic status and metropolitan areas gives a clue to the aetiology of this disease.
P832 Gastrointestinal infections are associated with unique gut microbiome signatures in patients with inflammatory bowel disease
Authors: Axelrad J , Hine A , Devlin J , Loke P , Cadwell K
Published: January 2020

Background

Stool PCR pathogen panel assays have implicated enteric infection in nearly 30% of inflammatory bowel disease (IBD) flares, most commonly with Clostridioides difficile, Escherichia coli, and norovirus. Many questions remain about the interpretation of a positive stool PCR result, and the similar presentations of infection and flare present a clinical challenge. We aimed to characterise the gut microbiome during an infection with C. difficile, E. coli, or norovirus in patients with and without IBD to microbially differentiate patients with an enteric infection, flare of IBD, and flare of IBD complicated by a pathogen.

Methods

We performed a cross-sectional study of patients with a stool PCR panel positive for C. difficile, E. coli subtypes, norovirus, or negative for all pathogens during an episode of gastrointestinal symptoms from September 2018 to February 2019. Clinical data and remnant stool specimens were collected. Our primary outcome was microbiome signature using 16s bacterial rRNA gene sequencing derived from linear discriminant analysis effect size (LEfSe) to identify microbes associated with each pathogen and clinical scenario stratified by IBD.

Results

We identified 119 patients, 19 (16%) with IBD, with C. difficile (n = 30), an E. coli subtype (n = 30), norovirus (n = 29), or negative for all pathogens (n = 30; Table). Hematochezia on presentation and recent antibiotic or hospitalisation exposure was more common in pathogen negative patients compared with pathogen positive patients (p = 0.045, p = 0.007, respectively). Patients with IBD without a pathogen or with C. difficile tended to have higher serum biomarkers of inflammation (median CRP 24 and 28, respectively) compared with patients with an E. coli subtype (CRP 5) or norovirus (CRP 11). On LEfSe, patients with C. difficile were enriched in Enterobacteriaceae and Clostridioides, E. coli subtypes in Faecalibacterium, norovirus in Roseburia, and negative for a pathogen in Bacteroides. Stratifying by IBD and pathogen, there were several differentially abundant microbes denoting a specific gut microbial signature associated with each pathogen and IBD (Figure).

Conclusion

In this study of patients with C. difficile, E. coli, norovirus, or negative for pathogens during an episode of gastrointestinal symptoms, there were major differences in presentation and gut microbiota between patients with and without an enteric pathogen and IBD. These data demonstrate that gut microbiomes distinguish and differentially respond to pathogens. In patients with IBD, coupled with a unique microbiota, serum biomarkers of inflammation were lower in patients with E. coli or norovirus, suggesting a milder subset of IBD flare.
P838 Characteristics of mucosal microbial composition of patients with inflammatory bowel disease susceptibility HLA genotype
Authors: Hirano A , Umeno J , Torisu T
Published: January 2020

Background

Although inflammatory bowel diseases (IBD) is presumed to develop as the result of dysregulated immune response to the intestinal microbiota in genetically susceptible hosts, the association between microbiota and genotypes in IBD patients remains unclear. The human leukocyte antigen (HLA)-Cw*1202-B*5201-DRB1*1502 haplotype has been reported to increase the susceptibility to ulcerative colitis (UC), and the HLA-DRB1#37Ser reduce the risk of Crohn’s disease (CD) in East Asian population. We investigated the association between IBD susceptibility HLA genotype and mucosal microbial composition to elucidate the pathogenesis of IBD.

Methods

Mucosal bioptic sampling was performed from the rectum under colonoscopy for the analysis of mucosal microbial composition among 54 IBD patients (27 patients with CD and 27 patients with UC). The mucosal microbial community structure was investigated using 16S rRNA gene sequences, and the structures were analysed using Qiime and LEfSe software. All patients were genotyped using the Affymetrix Japonica Array, and their HLA genotypes were determined by imputation based on the Japanese-specific references.

Results

Twelve CD patients had the HLA-DRB1#37Ser allele and 15 UC patients had the HLA-Cw*1202-B*5201-DRB1*1502 allele. Microbes of family Barnesiellaceae and genus Anaerofilum were more abundant in HLA-DRB1#37Ser allele carriers when compared with non-carriers among CD patients. Among UC patients, decreased abundance of the genus Acidaminococcus and increased abundance of genera Veillonella, SMB53, Lachnospira and Haemophilus was evident in HLA-Cw*1202-B*5201-DRB1*1502 allele carriers when compared with non-carriers.

Conclusion

IBD susceptibility HLA genotype might affect mucosal microbiota composition in both CD and UC.
P841 Evaluation of gut microbiota composition in NAFLD with UC pancolitis in clinical remission: a pilot study
Authors: Cocciolillo S , De Palma G , Chen T , Ghali M P , Deschenes M , Wong P , Wild G , Afif W , Lakatos P L , Bitton A , Sebastiani G , Bercik P , Bessissow T
Published: January 2020

Background

Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver disease in Western countries and is a frequently reported comorbidity in inflammatory bowel disease (IBD). A complex interaction among polygenic predisposition, IBD-specific risk factors, microbiome, multiple environmental and patients’ factors could explain the development of NAFLD in IBD. Gut dysbiosis is increasingly recognised as an important player in NAFLD, as well as in IBD pathogenesis. So far, no study has examined the gut microbiota composition in IBD patients with NAFLD. We aimed to characterise faecal microbiota according to NAFLD status in a pilot cohort of ulcerative colitis (UC) pancolitis in clinical remission.

Methods

This was a cross-sectional pilot study using transient elastography (TE) with controlled attenuation parameter (CAP) to diagnose NAFLD in UC pancolitis patients in clinical remission, defined as partial Mayo score ≤1. NAFLD was diagnosed non-invasively as CAP ≥248 dB/m. Exclusion criteria included: use of corticosteroids in the last year and antibiotics or probiotics/prebiotics in the last 2 months prior to inclusion; significant alcohol intake (AUDIT-C <5); hepatitis B or C infection. Stool samples were collected within 12 h from TE with CAP evaluation. Gut microbiota composition was analysed by 16S rRNA gene sequencing with Illumina technique. Statistical analysis by NAFLD status was performed using Fisher’s exact or Mann–Whitney’s test as appropriate.

Results

A total of 11 UC pancolitis patients in clinical remission were included (mean age 53 years, 36.4% male, time since IBD diagnosis 16 years). NAFLD was diagnosed in 7 cases (63.6%, mean CAP 291 dB/m). Patients with pancolitis and NAFLD had higher BMI (mean 31 vs. 22 kg/m2, p = 0.006) as well as waist circumference (mean 100 vs. 81 cm, p = 0.006) compared with those without NAFLD, but no other differences in demographic, clinical or pharmacological parameters were found between pancolitis with or without NAFLD. Patients with pancolitis and NAFLD clustered separately from those without NAFLD, when computing Bray Curtis dissimilarities (tested with Adonis, p = 0.006). In addition, patients with pancolitis and NAFLD presented with decreased bacterial richness (p = 0.017) but not diversity. This was accompanied by a significant increase of Bacteroides spp. relative abundance in faecal samples of patients with pancolitis and NAFLD (q = 0.017).

Conclusion

This pilot study demonstrates, for the first time, that, in UC pancolitis patients, NAFLD associates with altered gut microbiota composition. Further studies are needed to understand the exact role of gut microbiota in UC pancolitis with NAFLD and to evaluate the use of microbiota-directed approaches for the treatment of NAFLD in these patients.
P851 Effects of conservation time on the diversity and relative abundance of intestinal microbiome in samples of faecal matters
Authors: León F M , Nieto C A , Corredor Z , Flórez-Sarmiento C , Parra-Izquierdo V , Romero-Sanchez C
Published: January 2020

Background

Given the complexity and diversity of the intestinal microbiome, there is a technical challenge of finding the best way to study the factors that affect the quality of the sample to obtain results in a precise an complete way.

Objective

To establish the effect of storage time under constant cryopreservation conditions (−20°C) in stool samples for the study of the gastrointestinal microbiome

Methods

A sample of stool was distributed in 3 fractions (1, 2 and 3). Time 0 without cryopreservation and immediate DNA extraction (1). The samples of 15 (2) and 30 (3) days were cryopreserved at −20°C before the extraction of the genetic material. After ultracentrifugation at 4 degrees Celsius, the precipitate was subjected to enzymatic and mechanical lysis to obtain the total DNA. The DNA quality was evaluated techniques to ensure the quality and concentration of genetic material. Once the DNA of the three samples was obtained, they were subjected to the latest generation of a variable region of the 16S gene, using MiSeq technology (Illuminates). Data in relative abundances and frequencies were recorded. Project supported by the Administrative Department of Science, Technology and Innovation-Colciencias Health Call 2017, Code 130877757442

Results

About 140 thousand readings were obtained for samples 1 (day 0) and 2 (day 15) and 160 thousand for sample 3 (day 30), with a reading quality Q20% between 97 and 98 and Q30% around 94, indicating a high-reliability value for each of the samples. Regarding the classification from the Operating Taxonomic Unit (OTU), 119, 99 and 106 were reported for samples 1, 2 and 3, respectively. The data obtained revealed changes over time at the level of the main edges reported for normal microbiome (Bacteroidetes, Firmicutes, Actinobacteria) between 1 and 2 vs. sample 3. For Firmicutes and Actinobacteria, decreases in abundance of 34% were observed (samples 1 and 2) at 20% for Firmicutes in sample 3 and from 4% (samples 1 and 2) to 0.8% (sample 3) for Actinobacteria. On the contrary, Bacteroidetes presented an increase in its abundance from 58% (Samples 1 and 2) to 76% (sample 3). The Proteobacterium edge did not show significant changes in its abundance

Conclusion

It was possible to demonstrate that the cryopreservation time before DNA extraction is an important variable that influences the percentage and integrity of the microbiota from faecal matter. Confirming that the maximum reliable shelf life at −20° in stool samples is up to 15 days, suggesting that for longer storage the temperature decrease up to −80° should be taken into account to maintain stability in the results of relative abundance and bacterial diversity
N06 Help-seeking behaviours for fatigue in inflammatory bowel disease
Authors: NI DHALAIGH D , Anna Marie G , Farrell D
Published: January 2020

Background

Fatigue is a common and burdensome symptom of inflammatory bowel disease (IBD). Although many symptoms of IBD can be debilitating, fatigue is reported by people with IBD as the most difficult symptom to live with. It is experienced by up to 86% of people in active disease and 41–48% of people with IBD in remission, and impacts greatly on all aspects of people’s lives. Fatigue is a complex and invisible symptom and therefore can often be overlooked by those caring for people with IBD. Since it is invisible, it can only be made known to healthcare professionals if patients seek help for it. The experience of people who seek help for IBD fatigue is unknown, as are the reasons some choose to seek help and others do not. This study aims to explore the determinants of help-seeking behaviour for fatigue in IBD and examine why some people with IBD fatigue are more likely to seek help than others.

Methods

An exploratory qualitative method was employed, underpinned by the Theory of Planned Behaviour. A voluntary sample of 12 people with a diagnosis of IBD was recruited from the Irish Society of Crohn’s and Colitis. The sample included people who had and who had not sought help for IBD fatigue in the past. Semi-structured interviews were conducted using an interview guide. Themes were uncovered using content analysis.

Results

Themes uncovered included symptom perception, impact of IBD fatigue and knowledge of and access to sources of help. Most commonly, people did not seek help if they could continue life with relative normalcy in spite of IBD fatigue. Access and availability of help was perceived as good. Barriers, such as time and cost, were identified as making help-seeking more difficult at times, however these did not prevent seeking help. Poor knowledge of the sources of help, IBD fatigue being regarded as an inferior symptom to other symptoms and the perceived lack of interventions to manage the complex symptom emerged as important factors influencing help-seeking behaviour.

Conclusion

The Theory of Planned Behaviour was found to be a useful framework to predict help-seeking behaviour for IBD fatigue. Symptom perception, impact of IBD fatigue and knowledge of and access to sources of help are the most influential aspects of help-seeking behaviour. IBD fatigue appears to lack the legitimacy of other IBD symptoms. Therefore, there is a need for healthcare professionals to fully acknowledge and routinely assess fatigue as part of the clinical management of IBD. Further research aimed at specifically managing fatigue as a major IBD burden is warranted, in particular multidimensional, holistic interventions to help people cope with the impact of IBD fatigue.
42 Comparison of different imaging modalities for the quantification of tricuspid valve geometry and regurgitation
Authors: Ozturk C , Schueler R , Weber M , Nickenig G , Hammerstingl C
Published: January 2020

Objectives

Tricuspid regurgitation (TR) is a frequent valvular heart disease with relevant adverse impact on patients´ prognosis. Imaging of tricuspid valve and tricuspid Regurgitation is through anatomical circumstances is challenging. In this study, we aimed to compare the ability of different imaging modalities to visualize and quantify tricuspid valve (TV) function and annular dimensions.

Methods and Results

We prospectively included 40 consecutive patients (Age: 77.5 ± 7.1 years) with high surgical risk (EuroSCORE II: 8.8 ± 12.1%) and significant TR, who underwent transesophageal echocardiography (TEE) and multislice computed tomography (MSCT) to evaluate TR, TV function, and dimensions. In general, 2D-TEE showed lower diameters than MSCT with a significant but weak correlation between both imaging modalities for AP diameters (41.4 ± 7.8 mm, 47.2 ± 8.9 mm, r = 0.68, p = 0.05correlation, p = 0.03difference) and for SL diameters (41.6 ± 5.3 mm, 46.6 ± 4.6 mm, r = 0.71correlation, p = 0.05difference, p = 0.03). We found no significant correlation, however significant difference agreement, between MSCT and 2D-TEE on measures for annulus perimeter (117.6 ± 18.9 mm, 130.3 ± 21.5 mm, r = 0.3, p = 0.4correlation, p = 0.03difference) and annulus area (10.1 ± 3.3 cm2, 13.4 ± 4.1 cm2, r = 0.5, p = 0.4correlation, p = 0.04difference).

When comparing 3D-TEE with MSCT, we found a strong correlation between both imaging modalities concerning TV annulus areas (12.9 ± 2.6 cm2, 13.4 ± 4.1 cm2, r = 0.94, p = 0.0017correlation, p < 0.001difference), and perimeter (130.1 ± 12.4 mm, 130.3 ± 21.5 mm, r = 0.9, p = 0.002correlation, p = 0.005difference), as well as for AP (43.8 ± 3.2 mm, 47.2 ± 8.9 mm, r = 0.73, p = 0.03correlation, p = 0.008difference) and SL diameters (44.5 ± 3.6 mm, 46.6 ± 4.6 mm, r = 0.86, p = 0.02correlation, p = 0.1difference). MSCT was not useful for TR grading and determination of TV function. In addition to conventional 2D echocardiography, only 3D-TEE allowed for direct measurement of effective regurgitant orifice area (EROA), which differed significantly from calculated EROA (p < 0.05).

Conclusion

3D-TEE is highly comparable to MSCT and superior to 2D imaging for the determination of TV geometry and diameters. In contrast to MSCT, 3D-TEE allows sufficient grading and functional assessment of TR.
88 Severe tricuspid regurgitation due to papillary muscle rupture: A rare complication of anterior myocardial infarction and ventricular septal perforation
Authors: Nagumo M , Wada S , Saitou T , Li H , Sakai T , Iwanaga S
Published: January 2020

INTRODUCTION

Papillary muscle rupture (PMR) of the mitral valve is a fatal complication of acute myocardial infarction (MI). As a complication of anterior MI, PMR of the tricuspid valve is extremely rare. We experienced a case of acute anterior MI complicated with tricuspid PMR and ventricular septal perforation (VSP).

REPORT

An 85-year-old woman was admitted with general fatigue and appetite loss. Her consciousness was alert, but she was pale, and had cold extremities. Her blood pressure was 74/62 mmHg, and pulse was 99/min. There was no leg edema. Pan systolic regurgitant murmur (Levine III/VI) was audible at the lower left sternal border. Her oxygen saturation was 86% under room air. Electrocardiogram revealed ST segment elevation and QS pattern in V1 to V3. Transthoracic echocardiography revealed dyskinesis of the apical anterior septum, VSP with bidirectional shunt, and severe pulmonary hypertension. Left ventricular ejection fraction was preserved (58%). The anterior tricuspid leaflet was flail due to PMR, resulting in severe tricuspid regurgitation and right ventricular dilatation. Coronary angiography revealed a single vessel disease of the left anterior descending artery (LAD). We recommended surgical treatment, and transferred her to another hospital.

DISCUSSION

Common causes of tricuspid PMR are infective endocarditis and chest trauma. Right ventricular infarction, usually caused by right coronary artery (RCA) occlusion, may cause tricuspid PMR. In our case, however, tricuspid PMR was complicated with anterior MI. The tricuspid anterior, posterior, and septal leaflets are attached to anterolateral RV wall, inferior septum, and infundibular septum, respectively, via papillary muscles. Right ventricular branches and septal branches of the RCA usually supply these papillary muscles. Anterior leaflet PMR in this case was possibly due to anomalous blood supply of anterolateral RV wall by the right ventricular branches of the LAD. Right ventricular overload due to large VSP shunt elevated RV diastolic pressure and right atrial pressure, and might worsen ischemia of the RV wall.

Abstract 88 Figure. severe TR & shunt flow through VSP
101 Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction
Authors: Hubert A , Le Rolle V , Galli E , Hernandez A , Donal E
Published: January 2020

AIM

This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE).

METHOD

17 patients with proved cardiac amyloidosis and 18 patients with heart failure with preserved ejection fraction (HFpEF) were compared to 19 controls, from a local database. All TTE were performed using Vivid E95 ultrasound system (General Electrics Healthcare, Horten, Norway). The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel A)

RESULTS (Table 1): LVEF was similar between all groups whereas global longitudinal strain was significantly lower in amyloidosis group than controls (-14.4 vs -20.5%; p < 0.001). HFpEF and amyloidosis groups had a worse diastolic function than controls with a greater left atrial volume index , a faster tricuspid regurgitation, a greater E/e’ ratio with a p < 0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in HFpEF and amyloidosis group than controls (72 vs 36 vs 120.0 %.mL, respectively, p < 0.0001) with an intermediate profile of HFpEF(Figure 1, panel B, HFpEF in green). This area was better correlated with mean e’ (r = 0.650, p < 0.001) than all other indices.

CONCLUSION

LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function.

Main echocardiographic results Controls n = 19 HFpEF n = 18 Amyloidosis n = 17 p-value LVEDV (mL) 105 ± 15 103 ± 30 95 ± 93 0.476 LVEF (%) 65 ± 5 62 ± 7 62 ± 7 0.196 GLS (%) -20.5 ± 1.8 -18.4 ± 4.3 -14.4 ± 3.8 <0.0001 LAVi (ml.m-2) 22 ± 5 51 ± 14 51 ± 22 <0.0001 E/A ratio 2.1 ± 0.4 1.2 ± 0.7 1.7 ± 1.0 0.005 Mitral E/Ea average 5.9 ± 1.4 13.7 ± 5.8 17.3 ± 5.4 <0.0001 Vmax TR (m/s) 2.0 ± 0.3 3.1 ± 0.4 2.7 ± 0.5 <0.0001 V-S loop area (ml.%) 120 ± 54 72 ± 45 37 ± 21 <0.0001

Abstract 101 Figure 1