bluuebunny/crossref_metadata_2025 huggingface dataset:
P912 Increased Primary Bile Acids with Ileocolonic Resection Impact Ileal Inflammation and Gut Microbiota in Inflammatory Bowel Disease
Authors: Battat R , Scherl E , Lukin D , Charilaou P , Mahtani P , Gerber J , Gandara J , Dündar F , Zumbo P , Betel D , Guo C J , Longman R ,   Jill Roberts Institute Live Cell Bank
Published: January 2023

Background

A majority of Crohn’s disease (CD) patients require surgery. Ileitis recurs after most ileocolectomies and is a critical determinant for outcomes. The impact of ileocolectomy-induced bile acid (BA) perturbations on intestinal microbiota and inflammation are unknown. We characterized relationships between ileocolectomy, stool BA, microbiota, and intestinal inflammation in inflammatory bowel disease (IBD).

Methods

Validated IBD clinical and endoscopic assessments were prospectively collected. Matched primary and secondary BA concentrations measured in stool using Agilent Quadrupole Time of Flight Liquid chromatography-mass spectrometry were compared based on ileocolectomy and ileitis status. Primary BA thresholds for ileitis were evaluated using area under the receiver operating characteristic curve analyses. In CD, endoscopic remission was defined as SES-CD <3 or Rutgeerts 1. In UC, ER was defined as UC-ESS ≤ 1. Metagenomic sequencing profiled microbial composition and function. Relationships between ileocolectomy, BA and microbiota were assessed.

Results

In 166 patients, elevated primary and secondary BA existed with ileocolectomy. With ileitis, only primary BA (795 nMol/g vs 398 nMol/g, p=0.009) were higher compared to without ileitis. The optimal primary BA threshold (≥228nMol/g) identified ileitis on multivariable analysis (OR=2.3, p=0.04). Similar primary (471 nMol/g vs. 606 nMol/g, p=0.8) and secondary (382 nMol/g vs. 242 nMol/g, p=0.2) BA concentrations existed with and without colonic inflammation. Microbial diversity (Shannon index, p=0.0006), Faecalibacterium prausnitzii and O-acetylhomoserine aminocarboxypropyltransferase (MetY, p=0.0002) were decreased with elevated primary BA.

Amongst ileocolectomy patients, only those with elevated primary BA had diversity (p=0.01), F.prausnitzii and MetY (p=0.04) reductions.

Those with both ileocolectomy and intermediate (p=0.002) or high (≥228nMol/g, p=9.1e-11) ) primary BA had reduced F.prausnitzii compared to without ileocolectomy (Figure 1). Those with ileocolectomy and low (<29.2nMol/g) primary BA had similar F.prausnitzii as those without ileocolectomy (P=0.13). MetY was reduced with ileitis (p=0.02).

Conclusion

Elevated primary bile acids were associated with ileitis, and reduced microbial diversity, F.prausnitzii abundance, and enzymatic expression of MetY (acetate and L-methionine producing enzyme expressed by F.prausnitzii) and were the only factor associated with these findings after ileocolectomy.
P914 An adult zebrafish model for adherent-invasive Escherichia coli indicates protection from infection by treatment with probiotic E. coli Nissle
Authors: Nag D , Raychaudhuri S , Withey J
Published: January 2023

Background

Adherent-invasive Escherichia coli (AIEC) is an opportunistic pathogen associated with major inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC). AIEC is a human commensal but during unfavorable gastric conditions it exhibits pathogenic properties and induces inflammation in the gut, sometimes progressing to inflammation-induced colon cancer. The exact mechanisms for AIEC pathogenesis are still being discovered. As a human opportunistic pathogen, AIEC has few animal models. In recent years, zebrafish have emerged as a useful model for studies of various human pathogens. Here, a zebrafish model to study AIEC infection was developed.

Methods

Colonization of AIEC from overnight culture was determined with different infectious doses (103, 104, 105 and 106 CFU/ml of infection water) in zebrafish, incubating fish with AIEC in water for 6 h and then in fresh water for 18 h at 28o C. The invasive property of AIEC in zebrafish gut was determine by gentamycin protection assay. Persistent colonization of AIEC in zebrafish gut was also assessed for 10 days. Induction of pro-inflammatory markers such as IL-1β, TNFα, IFNγ and S100A-10b (akin to human calprotectin) in zebrafish intestinal cells in response to AIEC infection was determined by qRT PCR and ELISA. A probiotic strain, E. coli Nissle 1917 (EcN) was used as a therapeutic and prophylactic against AIEC infection. Propionic acid was used to augment the AIEC infection and the efficacy of ECN was tested against the hyper-infectious condition of AIEC in zebrafish.

Results

Bath inoculation with AIEC resulted in colonization, invasion and tissue disruption in the zebrafish intestine. The AIEC infection induced neutrophil recruitment and showed significant pro-inflammatory responses in zebrafish gut. S100A-10b protein of zebrafish, equivalent of a human IBD marker, calprotectin, was significantly increased in the zebrafish gut during AIEC infection. The probiotic E. coli Nissle 1917 (EcN) reduced AIEC colonization, tissue damage and pro-inflammatory responses in zebrafish in both prophylactic and therapeutic ways. Furthermore, EcN diminished the propionic acid-augmented hyper infection of AIEC in the zebrafish model.

Conclusion

In this study a new zebrafish model was developed to study the infection and inflammation induced by AIEC. Probiotic strain, EcN was used successfully against AIEC to reduce the inflammation in AIEC-zebrafish model.
P917 Intestinal complement interacts with commensal microbiota and provides pattern recognition in Inflammatory Bowel Disease
Authors: Reider S , Posch W , Koch R , Orth-Höller D , Würzner R , Wilflingseder D , Tilg H , Moschen A
Published: January 2023

Background

The complement system is a central humoral part of innate immunity and provides essential pattern recognition capabilities as well as effector functions such as opsonisation and target cell lysis. Its prominent role in infection and immunity is undisputed but its involvement in the pathogenesis of inflammatory bowel diseases remains less clear. Published data point to a role of complement within the intestinal lumen supporting clearance of pathogens1.

Methods

Expression of complement proteins within the intestinal epithelium was quantified by real-time qPCR on lesional and non-lesional biopsy samples from patients with IBD and healthy controls. The concentration of complement proteins was measured in fecal supernatants using ELISA. Flow cytometry of fecal bacterial single cell suspensions was used to assess complement (C3) and antibody (IgA) opsonisation status. Finally, cytometrically distinct populations were isolated by fluorescence-assisted cell sorting (FACS) and microbial community composition was investigated using 16S rDNA sequencing. Prediction of functional profiles from amplicon data was performed using Tax4Fun2.

Results

Complement expression in intestinal tissue was increased during active inflammation but certain targets were significantly less expressed in lesional mucosal sites (e.g. C6, C7). Free complement proteins in fecal supernatants were mostly undetectable by ELISA. In contrast, complement opsonisation was verified on fecal bacteria using flow cytometry. The degree of complement deposited on bacterial surfaces was significantly correlated with fecal calprotectin (p < 0.01). The percentage of complement-opsonized bacteria ranged from 0 to 5.3 % and did not correlate with intestinal inflammation while percentages of IgA opsonisation were generally higher (0.4 - 90.1%) and increased with fecal calprotectin (p < 0.01).

FACS followed by 16S amplicon sequencing detected differences in bacterial taxa abundance between complement-opsonized, IgA-opsonized and non-opsonized fractions. Functional in-silico profiling revealed associations of complement-opsonization with bacterial virulence factors.

Conclusion

Luminal and mucosal complement expression and activity is evident in patients with IBD. Complement opsonisation profiles are distinct from IgA opsonisation and show features of specificity regarding recognition of microbial features.

References:

1 K.P. Aßhauer, B. Wemheuer, R. Daniel, P. Meinicke (2015) Tax4Fun: predicting functional profiles from metagenomic 16S rRNA dataBioinformatics (2015) 31 (17): 2882-2884.

2 Sorbara, M. T., et al. (2018). Complement C3 Drives Autophagy-Dependent Restriction of Cyto-invasive Bacteria. Cell Host Microbe 23(5): 644-652 e645.
P918 Clostridium butyricum inhibits epithelial-mesenchymal transition of intestinal carcinogenesis through downregulating METTL3
Authors: Zhang K , Dong Y , Li M , Zhang W , Ding Y , Wang X , Chen D , Liu T , Wang B , Zhong W , Cao H
Published: January 2023

Background

Colorectal cancer (CRC) is related to gut microbiota dysbiosis, especially butyrate-producing bacteria reduction. Our previous study suggested administration of Clostridium butyricum (C. butyricum), a butyrate-producing bacterium, exerts a crucial effect against CRC. Methyltransferase-like 3 (METTL3) contributes to tumorigenic epigenetic regulation. We aimed to investigate the effects of C. butyricum on METTL3 in the prevention of CRC.

Methods

TCGA and CancerSEA databases were used to investigate METTL3 co-expressed genes, and the GO and KEGG enrichment analysis was conducted on METTL3. Tissue specimens of human normal colonic tissue, adenoma and carcinoma were obtained and examined the expression of METTL3, EMT-associated markers, and VM formation. We overexpressed METTL3 in CRC cells to assess cell migration and tube formation. Meanwhile, the effects of C. butyricum on METTL3, epithelial-mesenchymal transition (EMT), and vasculogenic mimicry (VM) formation in CRC cells were evaluated. Furthermore, a murine xenograft model was established to provide further evidence of the inhibition of C. butyricum on tumor growth.

Results

Database analysis suggested that METTL3 showed a positive correlation with proliferation, EMT, DNA repair, metastasis, and invasion. The expression of METTL3 gradually increased from human normal colon tissue, adenoma to carcinoma, and was positively correlated with VM formation and EMT. METTL3 overexpression promoted the proliferation, migration, and invasion of CRC cells and induced VM formation. C. butyricum could downregulate METTL3 expression in CRC cells and decrease the expression of vimentin and vascular endothelial growth factor receptor 2 to reduce EMT and VM formation. Moreover, C. butyricum alleviated the pro-oncogenic effect of METTL3 overexpressing plasmid in CRC cells. Accordingly, C. butyricum downregulated the expression of METTL3 in tumors and prevented EMT in nude mice.

Conclusion

C. butyricum could inhibit EMT and VM of intestinal carcinogenesis through downregulating METTL3. These findings broaden our understanding of probiotics supplement in the prevention and treatment of CRC.
P919 Gut microbial signature and phenotype-specific Indicators in fecal microbiota of Korean patients with Inflammatory Bowel Disease
Authors: Lee C K , Oh S J , Kim H J , Kim B H , Kim B K , Park Y K , Yang B G
Published: January 2023

Background

The incidence and prevalence of inflammatory bowel disease (IBD) in Asian countries have been increasing rapidly over the last few decades. This study was aimed to reveal gut metagenomic characteristics and identify a robust fecal microbial marker in Korean patients with IBD through a large-scale comparative study.

Methods

Gut metagenomic study using 640 fecal samples collected from patients with 523 IBD (223 Crohn’s disease [CD], 300 ulcerative colitis [UC]) and 117 healthy controls was conducted by 16S rRNA sequencing. Unsupervised cluster analysis based on the predicted functional genes was conducted. Microbiome Multivariable Association with Linear Models was used to determine relationship between metagenomic data and clinical metadata after adjusting for multiple covariates.

Results

Patients with IBD, particularly CD, had a significantly lower alpha diversity than the controls (p <0.05). An increase in stool consistency was positively associated with community diversity in controls and UC (p = 5.3e-11, Kruskal-Wallis test), but not in patients with CD. Differential abundance analysis revealed an expansion of the phylum Proteobacteria and its constituent taxa in CD, and Ruminococcaceae and Bacteroidaceae families in UC, LDA score [log10] >2.0, p <0.05. Patients with CD had a strong association with Escherichia-Shigella in their fecal microbiome compared to the controls in a multivariable model (FDR <0.01). Microbial functional prediction revealed the strong upregulation of bacterial invasion of epithelial cells and Shigellosis pathways in CD (FDR <0.01, absolute coefficient >2.0). Strong enhancement of the siderophores biosynthesis pathways, the aerobactin and enterobactin biosynthesis pathways (FDR <0.01, absolute coefficient of 2.947 and 1.971, respectively), with abundant contribution from the genus Escherichia-Shigella, is in line with the results obtained from taxonomic profiles. Clustering analysis identified two distinct function-based clusters showing a contrast in the diseae behavior of IBD. Cluster II enriched in patients with stricturing/penetrating Crohn's and extensive UC displayed a significant increase of the genus Escherichia-Shigella (Fig. 1a) and a simultaneous depletion of the genus Faecalibacterium (Fig. 1b), all FDR <10-50.

Conclusion

The present study adds to the growing evidence that the pathogenesis of CD is underpinned by the genus Escherichia-Shigella. Escherichia-Shigella may be a universal pathobiont in IBD, irrespective of ethnic and life-style backgrounds. Abundance shifting of Escherichia-Shigella and Faecalibacterium in fecal microbiomes is strongly linked with advanced behavior of IBD, which will have significant implications for future research on the diagnosis and treatment of the disease.
P922 Gut microbiome and mycobiome in inflammatory bowel disease patients with Clostridium difficile infection
Authors: Yu S , Ge X , Tan B , Tian B , Shi Y , Dai Y , Hu S , Li Y , Qian J
Published: January 2023

Background

Clostridium difficile infection (CDI) is common in patients with inflammatory bowel disease (IBD) and has been reported as a risk factor for poor outcome. However, gut microbiome and mycobiome of IBD patients with CDI have been barely investigated. This study aimed to assess the gut microbiome and mycobiome in IBD patients with CDI.

Methods

We collected fecal samples from patients with IBD and concomitant CDI (IBD-CDI group, n=38), patients with IBD and no CDI (IBD-only group, n=91), and healthy subjects (HC, n=40). Patients characteristics including demographic data, disease severity, and medication history were collected. 16S rRNA sequencing, metagenomic sequencing, and untargeted metabolomic analysis were carried out in the samples.

Results

We found that the bacterial alpha diversity of the IBD-CDI group was lower than the IBD-only group and HC. And the bacterial and fungal beta diversity variations between IBD patients and HC were significant, regardless of CDI status. But the IBD-CDI group did not significantly cluster separately from the IBD-only group. Several bacterial taxa, including Ruminococcus gnavus, Clostridium innocuum, and Veillonella were overrepresented in the IBD-CDI group compared with IBD-only group and HC. Furthermore, IBD patients with CDI were distinguished from the IBD-only group and HC by several fungal taxa, including underrepresentation of Candida albicans, and overrepresentation of Saccharomyces cerevisiae, Eremothecium sinecaudum, Torulaspora delbrueckii, Grosmannia clavigera, and Eremothecium gossypii. The fungal-bacterial transkingdom network was altered in the IBD patients with CDI with a decreased network density. Notably, the relative abundance of Grosmannia clavigera was markedly higher in severe ulcerative colitis patients (defined by Truelove and Witts criteria and Mayo score). Besides, prior antibiotic exposure was associated with decreased biodiversity and increased dysbiosis. Functional differences in IBD patients with CDI include enrichment of branched-chain fatty acid biosynthesis, succinate fermentation to butanoate, peptidoglycan biosynthesis, and tetrahydrofolate biosynthesis. The metabolomic data indicated that the differential metabolites were predominantly involved in amino sugar and nucleotide sugar metabolism, fatty acid metabolism, porphyrin and chlorophyll metabolism, and neomycin, kanamycin and gentamicin biosynthesis.

Conclusion

IBD patients with CDI had pronounced microbial dysbiosis. Gut micro-ecological changes and interkingdom crosstalk in IBD patients with CDI might provide insight into the pathological process and potential strategies for diagnosis and treatment in this subset of patients.
P926 Blautia Obeum Aggravates Colitis in a Murine Model
Authors: Lee C , Koh S J , Hong H T , Park H , Im J P , Kim J S
Published: January 2023

Background

Blautia is a genus of anaerobic bacteria known as having probiotic properties in several studies. The aim of this study was to investigate the role of Blautia obeum in inflammatory bowel disease which has not yet been elucidated.

Methods

To assess the role of B. obeum, 7 weeks-old C57BL/6 mice were treated with 3% dextran sulfate sodium (DSS) for 5 days with or without oral administration of B. obeum simultaneously in the first experiment. Comparing with negative (only phosphate buffered saline) and positive (without intake of microbiome) controls, prior daily administration of B. obeum (day 0 to 7) and subsequent administration of DSS (day 7 to 15) were done in the second experiment. Body weight was evaluated daily in those acute colitis models. Macroscopic analysis and histological evaluation for inflammatory activity were evaluated after sacrifice. Moreover, inflammatory cytokines such as interleukin (IL), tumor necrosis factor alpha (TNF-α), and interferon gamma (IFN-γ) in the colonic lamina propria mononuclear cells were measured by quantitative real-time polymerase chain reaction. Fecal samples were collected from all subjects during experiments, and the influences on gut microbiota were analyzed by 16S rRNA gene-pyrosequencing.

Results

B. obeum aggravated colitis assessed by body weight loss. Histologic severity was higher in mice treated with B. obeum than in controls. IL-17, IFN-γ, and TNF-α were increased in mice treated with B. obeum, compared with controls. A significantly lower richness (P<0.05) and difference in community composition (P=0.009) of metagenomic species was seen in mice treated by B. obeum, compared with controls. To confirm the direct role of B. obeum in a murine colitis, we treated antibiotics for 7 days before the administration of B. obeum. In this experiment. B. obeum aggravated colitis assessed by body weight reduction and colon shortening as well as histologic severity.

Conclusion

B. obeum aggravates colitis in mice. B. obeum can be an organism that is associated with the pathogenesis in inflammatory bowel disease.
P928 Identification of mucosal microbiome-host gene interactions in ulcerative colitis patients
Authors: Namjoo K , Beom Jae Pro L , Dr. f , Jeong-An G , Seung Han K , Moon Kyung J , Jong-Jae P
Published: January 2023

Background

With the development of NGS analysis, many studies have been performed on the role of gut microbiota in the pathogenesis of inflammatory bowel disease and the possibility of gut bacteria as a diagnosis and treatment modality for IBD. However, the role of gut microbiota in clinical applications such as markers for diagnosis, prognosis prediction and the therapeutic agents is still unclear, and further studies on host-microbe interactions are still needed. In this study, we tried to detect mucosal bacterial species which can discriminate between ulcerative colitis and normal control and the correlations between the microbiome and gene expression through integrated analysis of metagenomic sequencing and RNA-sequencing in the colonic mucosa of UC patients and normal controls.

Methods

Colonic tissues obtained from UC patients (n = 7) and normal control (n = 13) were subjected to 16S rRNA sequencing of the microbiome and next-generation sequencing (NGS) RNA-seq. The differentially expressed genes (DEGs) and DEGs-based enrichment terms were obtained. Gene set enrichment analysis (GSEA) and PathfindR were also used to reveal significant differences of meaningful gene sets. The datasets were analyzed individually and integrated including sociomedical factors for combined analysis using bioinformatics approaches. Correlation analyses were performed between microbiome and gene expression and network analysis were presented.

Results

From DEG results, 28 and 18 genes were higher expressed in the UC and normal groups, respectively. GSEA provided total 1,857 gene sets enriched in the UC group. We identified that patients with UC show decreased species such as Bacteroides coprocola, Bacteroides phlebeius, Parabacteroides merdae and increased abundance of other species, such as Eubacterium._eligens, Clostridium_clostridioforme, Faecalibacterium_prausnitzii. An integrative analysis identified immunomodulatory genes including HLA-G, PSMA4 for which gene expression is negatively correlated with Bacteroides species.

Conclusion

In addition to identifying mucosal microbiome and host-genes expression patterns in the UC patients, we showed the potential role of host-microbe interactions in the development of UC. These findings provided the integrated analysis of microbe- host gene can be served as a biomarker for diagnosis and treatment target in patients with UC.
N02 Our life is a roller-coaster! A qualitative phenomenological study exploring the impact of IBD on family members
Authors: Thapwong P , Norton C , Rowland E , Czuber-dochan W
Published: January 2023

Background

IBD significantly impacts individuals’ and their family members’ physical, psychosocial and emotional wellbeing. These then reduce quality of life. Whilst there are studies exploring the impact of IBD on children and their families, little is known about the impact of IBD on family members of adults with IBD. This study explored the impact of IBD on family members of adults diagnosed with IBD, what coping strategies they use and what support they need to manage the psychosocial and emotional burdens associated with supporting patients in managing their IBD.

Methods

An interpretive phenomenological study conducted, using an individual in-depth, semi-structured online interviews via MS Team, Zoom, or telephone. The interviews were audio recorded and transcribed verbatim. An inductive and deductive reflexive thematic analysis followed the Braun and Clark technique.

Results

Forty-three participants, including 17 people with IBD and 26 family members (parents, children, siblings, partners), were purposively selected. Three main themes and accompanying subthemes were created: (1) “Life is a roller coaster” (2) “There have been a lot of bridges to cross along the way” and (3) “My life would be better if...” Participants revealed that the impact of IBD on family members has better and worse aspects in terms of emotional wellbeing, relationship, pressure around roles and responsibilities, day-to-day burden, and siblings’ suffering. Positive coping strategies such as creating meaningful social networks, learning through living with the condition, and open communication were used by some. However, many used negative coping strategies such as avoidance, denial, and “battling on” without asking for help. To mitigate the negative impact of IBD, many family members expressed the need for support. This included proactive and effective communication from healthcare professionals, referral to meaningful sources of information and support, and support groups.

Conclusion

IBD impacts the emotional and psychosocial wellbeing of family members in both positive and negative ways. Some family members were able to use positive coping strategies, however many developed negative coping which affected their daily life. Interventions that support families to communicate better about the impacts of the condition on their wellbeing and/or provide psychosocial support will help family members of people with IBD better cope with disease and have a more fulfilling life. Health professionals need to understand the impact of IBD on family members and support them to cope with the psychosocial and emotional demands of the condition as well as the physical implications.
N03 Introducing video consultations as part of an IBD tight monitoring care pathway: interim results of the INTERACTION project
Authors: Hoefkens E , Lembrechts N , Bossuyt P , Pouillon L
Published: January 2023

Background

IBD requires tight monitoring of disease activity. E-health applications are associated with improved clinical outcomes and have a positive impact on healthcare costs. INTERACTION (telemedIciNe as parT of an intEgRAted IBD Care paThway @Imelda bONheiden) is a pilot project exploring the feasibility of implementation of teleconsultation in an existing tight monitoring care pathway and potential (dis)advantages for patients, health-care workers and quality-of-care.

Methods

INTERACTION is an ongoing, single-centre feasibility project including patients with moderate-to-severe IBD (UC/CD) treated with immunomodulators, subcutaneous biotherapy or oral small molecules since February 2022. Eligibility criteria include (i) stable treatment and remission, based on physician global assessment, patient-reported outcomes (UC: SCCAI<3; CD: PRO-2 ≤11), and faecal calprotectin (<250 µg/g) or endoscopy (UC: MES ≤1; CD: SES-CD ≤5), and (ii) digital access.. Participants agreed to embark in an adapted care pathway implementing video consultations with the treating physician alternating with in-person consultations. PRO’s and biomarkers were collected on dedicated time points (Figure 1). Patients’ expectations were questioned at the start of the pathway. Outcomes included patients’ experiences (assessed with the adapted Telehealth Usability Questionnaire), socio-economic impact, and clinical evolution (IBD-related flares or hospitalizations).

Results

At the moment of interim analysis (Oct 24th 2022), 37/44 (84%) invited patients wanted to participate. The majority expected that teleconsultations could be equal to in-person consultations (86%) and lead to an increased access to healthcare (92%) and time gain (97%). Seven patients refused participation for various reasons (Table 1). Four patients were screen failures due to lack of remission. Ultimately, 33 patients (baseline characteristics: Table 2) underwent a total of 67 consultations. The majority (92%) experienced the video consultations as (strongly) satisfactory (Figure 2). Patients’ time savings with video consultation compared to an in-person consultation varied between 0-30’ (16%); 30-60’ (36%), 60-120’ (36%) and more than 120’ (12%). The majority (92%) avoided a round trip to the hospital of at least 10 km. Forty percent averted absenteeism. One patient experienced an IBD flare without the need for hospitalisation during the median follow-up of 3 (IQR 3-5.5) months .

Conclusion

Implementing video consultations in the IBD care pathway of the ongoing INTERACTION project seems feasible, well-received and safe in patients with IBD in stable remission. In a second phase, video consultations led by an advanced IBD-nurse warrant further exploration.
N05 Highlighting the critical contributions of Inflammatory Bowel Disease nurses in Canada: Perspectives from nurses, gastroenterologists, individuals living with IBD, and caregivers.
Authors: Rohatinsky N , Zelinsky S , Chauhan U , Currie B , Frost K , Kroeker K , Ma C , Murray K
Published: January 2023

Background

Multidisciplinary teams are essential in managing Inflammatory Bowel Disease (IBD). IBD nurses play a critical role in improving patient outcomes and providing cost-effective quality of care. In Canada, access to IBD nurses remain inconsistent. There are more than 270,000 people living with IBD in Canada and fewer than 90 IBD nurses to care for them. This study was conducted to capture the value of IBD nurses, to identify gaps in resources, and to generate strategies for building IBD nurse capacity and enhancing the contributions of IBD nurses in Canada.

Methods

A convergent mixed-methods design was utilized to gather input from 4 stakeholder groups: IBD nurses, gastroenterologists, individuals living with IBD, and caregivers. Data collection was done through completing a review of the literature, stakeholder surveys, and one-on-one online semi-structured interviews with all stakeholders. Descriptive statistics were used for the quantitative analysis. Semi-structured interviews were audio recorded and transcribed verbatim then thematically analyzed.

Results

The IBD nurse’s role in clinical care was recognized as a value-add across all stakeholder groups. Having access to a specialized IBD nurse was recognized as a service that elevates the quality and continuity of patient care. As the interface between patients and other healthcare providers, there was recognition amongst stakeholders that IBD nurses are ideally positioned to educate patients about IBD management, general health promotion in the context of chronic disease and may support other aspects of care such as psychosocial, nutrition, and other extraintestinal manifestations or to help guide patients toward appropriate care channels. Many IBD nurses view advocacy as a logical extension of their official responsibilities, helping IBD patients to make treatment decisions and assisting them with disease challenges that affect their quality of life.

Conclusion

IBD nurses represent an underused resource in Canadian IBD care. Canada currently falls short of the recommended 2.5 full-time IBD nurse equivalents per 250,000 population. Achieving this objective will require a commitment to train IBD nurses and additional funding for their education and employment. The government can work with nursing institutions to set benchmarks, establish training programs, and create opportunities for IBD nurses in Canada. Introducing more IBD nurses into the system and using them to their full capacity makes sense from both a clinical and economic standpoint. It lifts the burden on gastroenterologists and primary care physicians, reduces costs to health systems while improving the overall quality of care for IBD patients.
N08 The emerging role of the IBD Care Manager: preliminary results from a survey by Italian IBD nurses
Authors: Napolitano D , Schiavoni E , Laterza L , Mora V , Sofo L , Pugliese D , Gasbarrini A , Scaldaferri F
Published: January 2023

Background

A multidisciplinary team (MT) approach has increasingly taken a prominent role in the management of IBD patients, providing a complete level of assistance. A key figure is represented by the IBD care Managers (ICM), who is usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation and the provision of practical information, health education and emotional support to patients. The ICM coordinate also each figure of the MT and help patients to accede to community resources and social services. The aim of the study is to investigate what are the skills required for ICMs, according to the nurses’ judgement.

Methods

A questionnaire was created by a team of experienced nurses on the basis of the Second N-Ecco declaration of consent and administered to nurses who have worked in an IBD unit for a period of at least three years. A definition of the ICM was provided to any participant. The questionnaire consisted of 3 sections: behavioural, knowledge and managerial skills than an ICM (score with Likert scale 0-4). The questions of the created sections were studied in relation to the benefits for the patient, the organizational advantages, the clinical advantages and the Italian state of the art.

Results

55 nurses partecipated to the study from 16 Italian centers. In the evaluation of behavioural skills (Fig. 1) of the ICM, "Management and support of the pregnant patient" (0.7), is the lowest scored item, while "patient privacy" obtained higher scores (3.2). In the evaluation of knowledge (Fig. 2) of the ICM, the "Knowledge of intimacy and sexuality" obtained the lowest score (0.7), while knowledge of pshyco-phisical and social impact of the disease obtained an higher score (1.8). In managerial skills (Fig. 3) the "Management of the pain" (0,8) obtained a lowest score compared to "Management of biological therapies" (2.6).

Conclusion

This is the first national survey exploring the role and the required skills of ICMs The awareness of ICM, their role and the measure of their performances, is the first step to foster the development of this figure in the health system. Further studies are mandatory to assess clinical and organizational outcomes.
N10 Facilitators and inhibitors to first adult care visits in the transition from paediatric to adult orientated Inflammatory Bowel Disease healthcare
Authors: Rea J , Greaney A M , Farrell D
Published: January 2023

Background

Inflammatory bowel disease (IBD) can be a very debilitating disease and it is found to be more extensive in children with rapid early progression. The successful transition of patients from paediatric to adult-oriented services is essential to prevent disruption in care and negative effects on long-term health outcomes. In particular, the attendance at the first adult care visits are a pivotal phase of a successful transition process to ensure continuity and retention in care. The aim of this study is to explore the inhibitors and facilitators to first adult care visits in the transition process from paediatric to adult oriented IBD healthcare.

Methods

An exploratory, descriptive, qualitative approach was employed, underpinned by a transition theory (Meleis, 2010). A purposive sample of seven participants (over 16 years of age) diagnosed with IBD, who transitioned in the last four years, were recruited, through two clinical sites in Ireland, and an IBD support organisation. Online semi-structured interviews were conducted via Microsoft Teams and data were analysed using content analysis.

Results

Three main themes were identified including the ‘perception of transition’, ‘knowledge and preparation’ and ‘being an adolescent with IBD’. The themes illuminate various inhibitors and facilitators to the first adult care visits. The theme perception of transition revealed that joint care visits and adult healthcare teams that actively engage with adolescents during the first adult care visits were facilitators, whereas difficulties contacting the adult services, lack of effective follow up and the change in language were inhibitors. More than one joint visit with the adult and paediatric healthcare teams and active promotion of independence facilitated knowledge and preparation for the first adult care visits. In contrast, a limited focus on disease management education and significant parental involvement inhibited the development of knowledge and preparation for the first adult care visits. Addressing adolescent specific topics, such as sexual health, and the availability of IBD supports, such as an IBD psychologist, social media platforms and meeting peers with IBD, supported being an adolescent with IBD and facilitated the first adult care visits.

Conclusion

Multiple, organised joint care visits with an active focus on promoting independence and providing education on disease management and adolescent specific topics, using age appropriate language, facilitates first adult care visits. Identifying the inhibitors and facilitators provide insights for healthcare professionals in supporting a successful transition process and highlights the need for transition policies and structured transition programmes.
N19 Fear of not being accepted: a synthesis of qualitative experiences of children and adolescents living with IBD
Authors: Craddock S , Fourie S
Published: January 2023

Background

There is an increasing number of paediatric and adolescent patients being diagnosed with Inflammatory Bowel Disease (IBD) 1. Being diagnosed at an early age can have a detrimental effect on a child’s development, so the need for support is vital. Adult experiences of living with IBD are known 2 , but very little is known about paediatric experiences. This literature review aimed to identify the paediatric and adolescent experiences of living with IBD and explore how IBD impacts their life.

Methods

A search was performed on following databases: Medline, CINAHL, and British Nursing Index. The inclusion criteria were: IBD, age under 18 years old, English language, primary qualitative research, and a publication date between 2016-2021. Out of the 43 papers identified, only three were selected as they met the inclusion/exclusion criteria. A qualitative synthesis of evidence was conducted, and the data was reinterpreted 3.

Results

Among the three papers, there was a dominant theme about the ‘Fear of not being accepted'. This overarching theme revolved around peer acceptance, and included two main themes: ‘Fear of disclosure' and 'How do I fit in?', as patients did not want to disclose their condition and expressed their desire to be viewed as normal. Throughout their experiences, children and adolescents expressed embarrassment as the primary feeling since living with IBD. Having IBD as a child or adolescent could adversely affect their psycho-social development, especially during their sexual development, affecting their romantic relationships and interactions with other people. The fear of not being accepted led participants to feel unattractive and apprehensive when forming new relationships.

Conclusion

It is imperative for children and adolescents to feel accepted, to feel comfortable disclosing their illness, and to feel equal to their peers. Children and adolescents face a variety of psycho- socio- emotional challenges living with IBD. Due to the limited number of studies that have explored the challenges that paediatrics and adolescents encounter, the need for more evidence is crucial. More evidence on children experiences of living with IBD would help healthcare professionals understand the impact of illness, and develop strategies to support children and adolescents living with IBD to minimise the fear of social stigma and rejection.

1. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12(12).

2. Fourie S, Jackson D, Aveyard H. Living with Inflammatory Bowel Disease: A review of qualitative research studies. Int J Nurs Stud. 2018;87:149-156.

3. Thomas J ;Harden A. Methods for the Thematic Synthesis of Qualitativeresearch in Sistematic Reviews.; 2007.
N20 The added shame of IBD: experiences of people from various ethnic backgrounds discussing sexual wellbeing in clinical settings
Authors: Fourie S , Czuber-Dochan W , Norton C
Published: January 2023

Background

Inflammatory bowel disease (IBD) causes significant difficulties in peoples’ lives, and negatively affects their sexual wellbeing (SWB). Evidence from diverse population is paramount when we seek equality, diversity and inclusion in healthcare.1 The evidence on patient SWB experience in the context of IBD comes from predominantly white participants.2 This study explored experiences from people with a diverse ethnic background, and cultural and religious influences on discussing SWB in a clinical setting.

Methods

Qualitative study. Data were collected via interviews and anonymous surveys and analysed using thematic analysis.3

Results

A total of 26 participants from across the world responded (M/F=10/16). Demographic data revealed that 42.3% were South Asian, 23% mixed race and 34.7 % had other backgrounds. Of the 26 participants, 61.5% were single, 35% had no religious beliefs, 30% were Hindu and 30% Muslim. Concerns related to sexual wellbeing were reported by 96% of participants, and all wanted the topic to be included in their routine care. The overarching theme was identified as The added shame, which referred to the stigma of ill health in their own culture. Two sub themes were Choosing to be single, as many avoided relationships due to cultural beliefs related to favouring those in good health and Feeling less alone. The second theme represented the 34% who reported discussing the topic with their clinical team and being the ones who initiated the conversation. They would have felt less alone if they had more information and understanding from their community and care providers. Some felt afraid of being judged due to the close-knit community which many of their clinicians were also part of, as they perceived being seen as promiscuous if they raised their concerns. Religion was not found to be a major barrier to discussions about SWB. A few mentioned that being single may be a reason why their clinicians did not initiate the conversation about SWB, as sex outside marriage is considered culturally and religiously unacceptable.

Conclusion

: Experiences of SWB of participants from various ethnic backgrounds did not differ greatly from those of the general IBD population,2 although added pressures were found rooted in cultural upbringing. A heightened sense of privacy and secrecy prevailed, possibly explaining the percentage of participants that reported to be single. Encouraging patient advocates from various ethnic backgrounds to raise awareness of the condition in their communities could help make improved communication possible.
N25 Diagnostic delay and economic burden in ibd: a multicenter italian experience in patients treated with biologics
Authors: Mocci G , Onidi F M , Magri' S , Bodini G , Lorenzetti R , Binaghi L , Dore M F , Martello S , Usai Satta P , Elisei W , Tursi A
Published: January 2023

Background

Inflammatory bowel diseases (IBDs), Crohn's disease (CD) and ulcerative colitis (UC), are chronic and immune-mediated diseases with a relapsing-remitting trend. The overall incidence of these diseases is increasing. However, it is estimated that more than one third of patients experienced symptoms for more than one year before diagnosis. Delay in IBD diagnosis has several clinical, therapeutic and economic implications. Early diagnosis and proper treatment are the cornerstones for improving the standard of care for these patients. This study aims to evaluate the diagnostic delay (DD) in patients with IBD and to analyze the clinical burden of the delay in IBD diagnosis in patients treated with biological drugs.

Methods

An observational and retrospective study was performed in IBD patients, regularly followed in four IBD Units. Data regarding delay in IBD diagnosis were assessed through a questionnaire evaluating the disease course. Moreover, data about biologics dispensation were obtained from the medical records in the period 2020-2022

Results

135 IBD patients were enrolled (UC 72, CD 63, M 80, F 55). Median age at diagnosis was 32 years (IQR 22-45); 7% of patients were ≤ 16 years old at diagnosis. Median age on erollement was 47 ( IQR 4-59) Median DD was 12 months (IQR: 6-24). No significant difference was found in median DD between UC [12 months (IQR: 4.5-12.0)] and CD patients [12 months (IQR: 12-48)]. However, the proportion of patients with a DD >24 months was significantly (p=0.007) higher in CD (21/63 = 33%) than in UC patients (10/72=13%). After a median disease duration of 10 years (IQR: 4-17), overall, 67 patients (49.7%) were exposed to one biologic agent, 43 patients (31.8%) were exposed to two biologic agents, 25 (18.5%) to three or more biologic agents. 23% of patients (31/135) underwent surgery. The statistical analysis showed that DD >24 months was not statistically significant associated with history of ≥ 2 biological drugs (p=0.51). Conversely, there was association with surgical treatment (p=0.004).

Conclusion

The diagnostic delay in IBD represents a challenge with clinical and, therapeutic impact. It’s crucial to cooperate with general practitioner and gastroenterologists not dedicated to IBD in order to reduce the diagnostic delay and guarantee an effective, appropriate and early treatment that will improve the patients’ quality of life and meanwhile reduce the health care system costs.
N26 Help-seeking experiences of patients with Inflammatory Bowel Disease from healthcare professionals: A qualitative descriptive study
Authors: Byron C , Lehane E , Burton A , Cornally N
Published: January 2023

Background

Due to the chronic, relapsing and remitting disease course associated with Inflammatory Bowel Disease (IBD), self-management tools inclusive of conceptualising the problem, acknowledging the need for external help and knowing where to seek help from are essential for the management of IBD. Those living with IBD are challenged by physical symptoms and psychological and social issues that they are unable to self-solve. Help-seeking behaviour (HSB) is a relatively new concept to health services research (Cornally & McCarthy, 2011) and has been infrequently applied to the area of IBD. When IBD-related challenges are beyond self-resolution, patients require help and support from healthcare professionals (HCPs). This engagement must be facilitated at the point of issue recognition, as opposed to at crisis point. Given the dearth of research in this area, this study explored the help-seeking experiences of patients living with IBD for the challenges associated with IBD from HCPs, to enable us through understanding their experiences, how best to support help-seeking pathways and/or early interventions to assist those living with IBD to resolve issues that challenge their day-to-day lives.

Methods

A qualitative descriptive design (Sandelowski 2000; Neegaard et al., 2009; Sandelowski 2010) was employed as little is known regarding the help-seeking experiences of those living with IBD, their sources of help and preferred methods of seeking help. Participants were recruited purposefully from two public university hospitals in the Republic of Ireland that provide dedicated in- and out-patient care to those living with IBD. Data were collected via semi-structured one-to-one phone interviews (n=8).

Results

An overarching theme of ‘coming to terms with managing my IBD’ and four themes of ‘help-seeking trigger’, ‘help-seeking hesitancy’, ‘help-seeking decision pathway’ and ‘need for support’ emerged from the data by way of latent pattern content analysis.

Conclusion

Typically, help is sought for IBD related challenges by contacting their designated IBD nurse directly via text, the preferred method, or via phone. The majority of participants spoke of negative experiences of seeking help prior to the introduction of an IBD nurse. These may be categorised either by lack of service provision or by symptoms being dismissed or not understood by HCPs who lack expertise in the area of IBD. Triggers for seeking help are in line with the challenges identified in our earlier meta-synthesis of patients’ experiences of IBD (Byron et al. 2020) and tend to mainly be related to the physical symptoms associated with IBD as well as the medical treatments being delivered. The need for both formal and informal psychological support was identified by participants.