bluuebunny/crossref_metadata_2025 huggingface dataset:
P742 Morbidity and mortality outcomes of paediatric-onset inflammatory bowel disease in early adult life: A Scottish population-based, nested case–control study
Authors: Burgess C , Schnier C , Chalmers I , Russell R K , Hansen R , Henderson P , Wood R , Wilson D C
Published: January 2020

Background

The risk of morbidity and mortality related to paediatric-onset inflammatory bowel disease (PIBD) and its treatment is a major concern to both patients and clinicians, especially when this may affect early adult life. We aimed to determine whether PIBD patients are at increased risk of ischaemic heart disease (IHD), stroke, cancer and death in a nationwide population-based study using administrative health data research methodology.

Methods

All children diagnosed with PIBD in Scotland 1981–2017 were identified within the Scottish Morbidity Record inpatient and day-case dataset (SMR01). PIBD cases were defined as any inpatient International Classification of Diseases (ICD) coding for Crohn’s disease (CD; 555/K50) or ulcerative colitis (UC; 556/K51) until age 16; 10% of cases were individually validated. A nested case-control study (1:3 ratio) matched for sex, age, postcode sector and deprivation quintile within the Scottish population was performed. Data-linkage was applied to SMR01, SMR06 (Scottish Cancer Registry) and NRS deaths datasets to identify any diagnosis of IHD, acute stroke, cancer or mortality. Cancer diagnoses were classified into potential disease related (small bowel, colonic, rectal, anal, hepatobiliary) or treatment related (lymphoma, leukaemia, myeloma, PTLD) cancers. Hazard ratios (HR) were calculated for each outcome using mixed effects Cox regression and the potential effect of sex, year of diagnosis and age at diagnosis were explored.

Results

The study population comprised 2484 children with PIBD and 7451 matched controls. Median age of PIBD diagnosis was 12 years (IQR 10–14) and age at end of follow-up 24 years (IQR 17–33) with 141,605 total person-years follow-up. Validation identified 242/261 true positive cases (positive predictive value 93%). 2 cases (0.08%) and 7 controls (0.09%) had an admission for IHD during follow-up (p = 0.845); 6 cases (0.24%) and 5 controls (0.07%) were admitted for stroke (p = 0.024). PIBD cases had a significantly higher risk of any cancer diagnosis (62 cases: 97 controls) HR 1.97 (p < 0.001), including a 31.9 times higher risk of disease-related cancers (p < 0.001) and a 6 times higher risk of treatment-related cancers (p = 0.011). The effect of PIBD on cancer risk was higher in males, but not related to year or age. PIBD cases had a greater risk of mortality (60 cases: 51 controls) HR 3.61 (p < 0.001). The specific mortality risk from infection was 21.4 times higher in PIBD cases (p = 0.004); the risk of suicide was 2.4 times higher but not statistically significant (p = 0.085). The effect of PIBD on mortality risk was not modified by sex, year or age.

Conclusion

Cancer and mortality are meaningful, serious early adult life adverse sequelae of PIBD however IHD and stroke occur infrequently.
P760 Differences in persistence of oral mesalazine preparations as monotherapy in patients with ulcerative colitis
Authors: Fossmark R , Olaisen M , Martinsen T C , Melberg H O
Published: January 2020

Background

Oral mesalazine is the mainstay treatment of ulcerative colitis (UC). Mesalazine exerts its anti-inflammatory effect locally in the colonic mucosa. The mucosal mesalazine concentration is inversely correlated with the degree of inflammation and previous studies have found that mucosal drug concentrations differ between various oral mesalazine preparations. In the current study we have examined the drug persistence of oral mesalazine preparations in a national cohort of UC patients.

Methods

Patients with newly diagnosed UC from 2010 to 2014 using oral mesalazine as anti-inflammatory monotherapy 3 months after the time of diagnosis were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The patients were retrospectively followed through 2017, median follow-up time was 1029 days. Treatment failure was defined as start of topical mesalazine or glucocorticoid preparations, systemic glucocorticoids, immunomodulators and biologic treatment or a change to another oral mesalazine preparation. Drug persistence was defined as duration of oral mesalazine preparation in monotherapy. Disease was categorised as more severe in patients who had dispensed systemic glucocorticoids the first three months after diagnosis. Drug persistence at national and regional level was stratified by mesalazine preparation (Mezavant (MEZ), Asacol (ASA), Pentasa (PEN), Salofalk (SAL)) and disease severity. Consumption was estimated based on defined daily doses (DDD = 1.5 g) of mesalazine dispensed from pharmacies.

Results

A total of 3421 patients were identified. Overall median mesalazine drug persistence was 311 days. The persistence differed between the preparations in descending order: MEZ (398 days), SAL (374 days), PEN (273 days), ASA (266 days), and the order was similar in the four regions. Patients with more severe disease at diagnosis had shorter drug persistence (193 vs. 407 days). Systemic glucocorticoids were given to similar proportion of patients for ASA (0.60) and PEN (0.61), while this proportion of MEZ users was lower (0.52) and even lower for SAL users (0.43). The number of prescribed DDD the first year after diagnosis was slightly higher in MEZ users (MEZ 1.75, ASA 1.36, PEN 1.42, SAL 1.40).

Conclusion

There were significant differences in drug persistence between oral preparations that were not explained by differences in prescription at regional level, but could partially be related to differences in disease severity. These differences could have clinical implications and bear further investigations.
P768 Long-term prognosis of Crohn’s disease and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea
Authors: Ye B D , Park H , Kim S H , Hong S N , Yoon H , Kim Y J , Seo S I , Rhee K H , Kim Y H , Kim K H , Cha J M , Park S Y , Jeong S K , Kim J S , Im J P , Jang J , Kim J H , Suh S O , Kim Y K , Park S H , Yang S K
Published: January 2020

Background

No previous population-based study has evaluated the natural course of Crohn’s disease (CD) over three decades in non-Caucasians. We previously reported a 30-year trend in the epidemiology of inflammatory bowel disease (IBD) in the Songpa-Kangdong (SK) District of Seoul, Korea between 1986 and 2015 (1). In this study, we aimed to analyse the long-term natural course of Korean patients with CD in the SK-IBD population-based cohort.

Methods

All patients newly diagnosed with CD between 1986 and 2015 were enrolled in this study. To assess the temporal trends in treatment paradigms and in the prognosis of CD, patients were divided into two cohorts according to the year of CD diagnosis: cohort 1, 1986–2003 and cohort 2, 2004–2015 (the anti-tumour necrosis factor [anti-TNF] era). Disease characteristics at diagnosis, outcomes and their predictors were evaluated.

Results

A total of 418 patients were enrolled. There were 318 males (76.1%) and median age at CD diagnosis was 22 years (interquartile range [IQR], 18–29). Disease location at CD diagnosis was ileal in 104 patients (24.9%), colonic in 39 (9.3%), and ileocolonic in 275 (65.8%). Disease behaviour at CD diagnosis was inflammatory in 339 patients (81.1%), stricturing in 34 (8.1%), and penetrating in 45 (10.8%). Perianal fistula/abscess was present in 43.3% (n = 181) before or at CD diagnosis. During the median follow-up of 108.1 months, the overall use of systemic corticosteroids, thiopurines, and anti-TNF agents was 57.4%, 80.9%, and 34.2%, respectively. Compared with the cohort 1, the cumulative probability of commencing corticosteroids decreased (p = 0.001), whereas that of commencing thiopurines and anti-TNF agents increased (both p < 0.001) in the cohort 2. A total of 113 patients (27.0%) underwent intestinal resection, demonstrating cumulative risks of intestinal resection at 1, 5, 10, 20, and 25 years after diagnosis of 12.5%, 16.5%, 25.6%, 49.7%, and 55.5%, respectively. Multivariate Cox regression analysis revealed that stricturing behaviour at diagnosis (hazard ratio [HR] 2.393, 95% confidence interval [CI] 1.234–4.641), penetrating behaviour at diagnosis (HR 4.514, 95% CI 1.752–11.629), and the cohort 2 (HR 0.530, 95% CI 0.297–0.945) were independent predictors of intestinal resection. The standardised mortality ratio was 1.867 (95% confidence interval, 0.502–4.780).

Conclusion

Korean patients showed a similar clinical course and intestinal resection rate compared with Western patients. The risk of intestinal resection has decreased in the anti-TNF era.

Reference
P778 Longitudinal trajectory of fatigue in inflammatory bowel disease patients: a prospective study
Authors: Borren N , Long M , van der Woude J , Sandler R , Ananthakrishnan A
Published: January 2020

Background

Fatigue is a commonly reported and sometimes disabling symptom in patients with inflammatory bowel disease (IBD). Its prevalence, mechanism, and impact remain poorly understood. Using a large cohort of patients with IBD, we aimed to prospectively determine the trajectory of fatigue and to identify determinants and impact of incident and prevalent fatigue on patients with IBD.

Methods

This prospective study was nested within the IBD partners cohort, a validated internet-based cohort of patients with IBD. Participants were invited to prospectively complete questionnaires assessing fatigue status at baseline and subsequently after 6 and 12 months. Fatigue was assessed using the validated Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score. A FACIT-F score of < 43 was defined as significant fatigue. We examined the trajectory and predictors of different courses of fatigue including incident fatigue (not fatigued as baseline but fatigued at 6 months) and resolved fatigue (fatigue at baseline but resolved on follow-up).

Results

A total of 2429 patients (1605 CD, 824 UC) completed baseline assessment among whom 1057 completed a second assessment at 6 months. First, we identified three distinct patterns of fatigue. Episodic fatigue defined as fatigue at any one (but not both) time point was the most common, affecting 1182 patients (57.0%). Persistent fatigue (at both baseline and follow-up) affected 33.5% (n = 695) while only 196 patients (9.5%) reported no fatigue at any time point (n = 196) (Figure). Patients that reported persistent or intermittent fatigue were more likely to have active disease (p < 0.001), be younger, (p < 0.001), report anaemia (p = 0.002) and low vitamin B12 levels (p < 0.001) and to have a prior diagnosis of depression, anxiety or sleep disorder (p < 0.001). Among patients who were not fatigued at baseline, 26% developed new fatigue at 6 months defined as incident fatigue). The strongest predictor of this being presence of sleep disturbance at baseline (OR 2.45, 95% CI 0.24–1.55) (Table). In contrast, only 12.3% of those with fatigue at baseline had symptom resolution by month 6. Resolution of fatigue was more common in those with UC (p = 0.03), quiescent disease at baseline (p = 0.006), not receiving biologic therapy at baseline (p = 0.016) and no sleep disturbance (p < 0.001), anxiety (p = 0.002) and depressive (p = 0.005) symptoms at baseline.

Conclusion

Our findings indicate three distinct trajectories of fatigue in patients with IBD with their distinct predictors. Importantly, 26% of patients developed new onset fatigue at 6 months demonstrating the substantial impact of this on patients with IBD.
P788 Gender differences in consumption of processed and ultra-processed foods in Crohn’s disease patients
Authors: Sarbagili Shabat C , Zelber-Sagi S , Fliss Isakov N , Ron Y , Hirsch A , Maharshak N
Published: January 2020

Background

Consumption of processed foods is thought to be associated with Crohn’s disease (CD) pathogenesis. In Israel, CD demonstrates higher prevalence rate among men. Our aim was to examine gender differences among CD patients in the consumption of processed foods.

Methods

A post hoc analysis of a prospective validation study of a novel processed food questionnaire (PFQ) was performed in adult CD patients followed at a tertiary center in Israel. The PFQ categorises food items according to the level of processing as unprocessed or minimally processed, processed and ultra-processed foods. Demographic and clinical data were collected. Linear regression, ANOVA, t-test were performed looking at the association between disease characteristics, age, education, gender and consumption of processed foods.

Results

Sixty patients (33 men, 27 women) were included in the analysis. Mean age of participants was 29.4 ± 8.6 for men and 31.7 ± 10.2 for women. Men consumed on average more portions of processed foods per day than women (3.09 ± 2.31 vs. 1.98 ± 1.32, p = 0.023, respectively). Similar association was found for ultra-processed foods consumption, where men consumed 1.63 ± 0.75 more portions per day than women (5.77 ± 2.90 vs. 4.14 ± 2.87, p = 0.034, respectively). Disease characteristics (duration, behaviour, and activity), age and education levels were not associated with consumption of processed foods.

Conclusion

Men with CD consumed significantly more processed and ultra-processed foods compared with women, emphasising a need for dietary intervention in men if these findings are consistent in larger studies.
P796 Annual prevalence and clinical outcomes of ulcerative colitis with primary sclerosing cholangitis in Korea over the last 10 years
Authors: Jung S H , Kim T O , Baek D H , Kim D B , Song G A , Kang H S , Goong H J , Bae J H , Hye Kyung S , Lee H S
Published: January 2020

Background

The prevalence of ulcerative colitis (UC) in Korea has recently increased significantly, but there is few data for the prevalence and clinical outcomes of primary sclerosing cholangitis (PSC) associated UC. Thus, we assessed the prevalence of primary sclerosing cholangitis (PSC)and analysed clinical outcomes in Korean UC patients.

Methods

National Health Insurance System (NHIS) claim data from 2008 to 2017 were used in this population-based study. UC patients and PSC patients were identified by codes for ulcerative colitis (UC: K51) and (PSC: K830) in the NHIS registration system. Clinical events were defined as emergency department visit, hospitalisation, colectomy and liver transplantation.

Results

The overall number of UC with PSC & without PSC patients has increased steadily (Table 1). The prevalence of PSC in UC patients has increased since 2008 and was 0.33%in 2017.Clinical events were more frequent in UC with PSC, but the incidence of clinical events has decreased since 2008 in both groups (Figure 1).In 2017, the number of UC with PSC was 189 (male;118 vs. female;71) and the mean age of UC with PSC was 50.82 years(vs. UC without PSC;49.74). The incidence was low in teenagers and there was no difference in prevalence by age group.

Conclusion

This study confirmed that the prevalence of PSC is increasing in Korea. Additionally, UC with PSC patients have poor clinical outcomes. Therefore, the prevalence of PSC in UC patients suggests the need for greater attention and effort in clinical practice.
P808 Prevalence and factors associated with sleep disturbances in inflammatory bowel disease patients compared with normal controls
Authors: Caloz E , Vullièmoz M , Haba Rubio J , Pittet V , Mamadou Barry P , Michetti P , Heinzer R , Maillard M H
Published: January 2020

Background

Environmental factors, including sleep disturbances, have been associated with the risk of flare in inflammatory bowel disease (IBD). Symptoms, treatment side effects and pro-inflammatory status have been shown to have an effect on sleep quality and duration. Previous studies showed that around 44% of IBD patients suffer from sleep disorders. We aimed at determining the prevalence of sleep disturbances in IBD patients, as compared with normal controls, and factors associated with disturbances.

Methods

We conducted a cross-sectional study on adult patients included in the Swiss IBD cohort study. We excluded pregnant women and night workers. We used the HypnoLaus cohort as a control population. Demographics, clinical, treatments, SF-36 and IBDQ (bowel, emotional, social and systemic sub-scores) quality of life data were extracted from the SIBDCS. We sent patients a questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), Epworth score (ESS), and Restless Leg Syndrome (RLS) Score. We assessed differences regarding those scores between IBD and controls. We performed logistic regression analyses to evaluate factors associated with sleep disturbances in the IBD population.

Results

A total of 1139 patients answered to the questionnaire: 613 CD, 526 UC, 47% males, mean (SD) age: 50(15) years, median (IQR) disease duration: 15 (15) years. One out of five patients had extraintestinal manifestations (EIM). Forty-one percent were receiving biologic treatment (UC: 27.6%, CD: 53.0%). We found 906 age-sex-BMI matched controls who answered the PSQI, ESS and RLS. A significantly higher proportion of IBD patients had impaired sleep quality (PSQI) as compared with the control population (61.3% vs. 33.9%; p < .001). The proportion of IBD patients with ESS sleep deficiency (incl. daytime sleepness) was significantly higher as compared with controls (32.5% vs. 23.4%; p < .001). We also found a higher prevalence of RLS in IBD than in controls (27.8% vs. 13.0%; p < .001). Factors associated with impaired sleep quality were female gender (OR=1.37; p = .048), IBDQ bowel (OR=1.03; p = .033) and IBDQ systemic (OR=0.83; p < .001). ESS sleep deficiency was associated with IBDQ emotional (OR=1.02, p = .050) and social (OR=0.95; p = .046). RLS was associated with increased age (OR=1.02, p < .001), being a smoker (OR=1.54; p = 0.035), prior steroid use (OR=2.17, p = .001) and IBDQ emotional (OR=0.95, p = .005).

Conclusion

Sleep disturbances are highly prevalent in IBD patients compared with the control population. In IBD, sleep disturbances were associated with IBD-specific quality of life, but not with disease activity and EIM. Future studies should address whether early detection and active management of sleep disorders might influence disease control and long-term outcomes.
P817 Influence of inflammatory bowel diseases on depression and suicidal risk: a questionnaire-based survey
Authors: Molnár T , Miheller P , Sarlós P , Sánta A , Juhász A , Hamvas E , Nyári T , Szántó K J , Bor R , Fábián A , Bálint A , Milassin Á , Rutka M , Szepes Z , Farkas K
Published: January 2020

Background

Inflammatory bowel diseases (IBD) patients are at increased risk for mental health problems. Managing IBD patients requires cooperation between gastroenterologists and psychologists and psychiatrists. We would like to assess the frequency of depression and suicidal thoughts among Hungarian IBD patients.

Methods

Multicentre, questionnaire-based survey among inflammatory bowel diseases patients. Demographic data and patient’s medical history was obtained with self-filling questionnaires. Patients’ psychic status was measured with Patient’s Health Questionnaire (PHQ-9), Beck Hopelessness Scale (short version). The survey was conducted in 3 IBD centres in Hungary, First Department of Medicine, University of Szeged, First Department of Surgery, University of Semmelweis and First Department of Medicine, University of Pécs.

Results

Three hundred IBD patients filled the questionnaires from the 3 IBD centres. Female-male ratio was 57% - 47%. Mean age at the time of the study was 38.8 years (SD 12.5) and mean disease duration was 11.5 years (SD 8.2). Sixty-two point three% was diagnosed with Crohn’s disease, 37.7% with ulcerative colitis, one patients reported IBD unclassified and three patients did not know the type of IBD. Sixty-nine point three% of the patients self-reported the remission state of IBD, while 30.7% self-reported to have active IBD. Proportion of patients on each category of PHQ-9 scale were the followings: severe 2%, moderate to severe 5.3%, moderate 21.3%, mild 33.6% and 37.6% had normal score. Nine point three% of the patients had elevated suicidal risk. More severe PHQ-9 category was associated with elevated risk for suicide. Significant difference was shown in the Hopelessness Scale’s results among the two genders, female patients had higher risks for suicidal thoughts. Those IBD patients in remission have lower probability for moderate or severe depression.

Conclusion

We have to be aware of that every IBD patient has increased risk for depression and suicide. Among our patients the rate of moderate to severe and severe depression was relatively low. Every tenth of our patients had elevated risk of suicide.
P842 Analysis of fungal microbiota dysbiosis in inflammatory bowel disease
Authors: Zeng L , Wang Y , Zhuo M
Published: January 2020

Background

Inflammatory bowel disease（IBD）is chronic relapsing and remitting disease of the gastrointestinal tract. Although the precise aetiology and pathogenesis of IBD remains elusive, epidemiological data conclusively point to be attributed to an aberrant immune response against environmental factors such as the gut microbiota in a genetically susceptible host. The bacterial microbiota plays a major role in human physiology and pathogenesis of IBD. The Fungi are often ignored in studies. Although the role of fungi has been suggested in pathogenesis of IBD, the available data are scarce. The aim of our study was to analyse and compare the faecal fungal microbiota in patients with IBD and healthy subjects (HS).

Methods

Our study evaluated fungal composition of the faecal microbiota of 66 patients with CD and 38 patients with UC diagnosed in West China Hospital and 39 HS by ITS2 sequencing. The Qiime pipeline was used to assess composition and diversity. Using LEfSe observed differential fungal composition between subjects.

Results

The faecal fungal microbiota was dominated by two phyla, basidiomycetes and ascomycetes in both IBD and HS. We observed that fungal microbiota was skewed in IBD, with an decreased basidiomycota/ascomycota ratio, a decreased proportion of Aspergillus and Saccharomyces and an increased proportion of Exophiala. Polythrincium, clonostachys, Candida compared with HS. Using LEfSe, we observed several differential fungal composition in different subject. Exophial a (p = 0.02), Agaricales (p = 0.02)species were overrepresented in UC, whereas Bulleribasidiaceae (p = 0.01), Ustilaginaceae (p = 0.007), Ustilaginales (p = 0. 007),Ustilaginomycetes (p = 0.007)species were overrepresented in HS. We then directly compared the fungal composition between subgroup of CD and UC, we observed Eurotiales（p = 0.007）, Aspergillus（p = 0.025), Thermoascus（p = 0.04）species were overrepresented in UC-remission. Ascomycota (p = 0.008) and Didymellaceae (p = 0.02)species were associated with CD-remission, whereas Saccharomyces (p = 0.03) and Xylariaceae (p = 0.006) species were associated with CD-flare. There was no significant difference in fungal Alpha diversity between IBD and HS. Beta diversity analysis showed that one subgroup of IBD samples segregated from HS whereas another subgroup overlapped with HS.

Conclusion

There was no significant change in fungal diversity in IBD. However, we observed fungal composition was skewed with decreased basidiomycota/ascomycota ratio on phyla level, particularly in IBD-flare group. The fungal composition was dominated by Aspergillus and Saccharomyces in HS, while the proportion of Exophiala, Polythrincium, Clonostachys, Candida was increased in IBD on genus level.
P849 Analysis of rectal swabs for microbiome sampling in a cohort of IBD patients during disease exacerbation. POLIBD survey results
Authors: Filip R , Gruszecka J
Published: January 2020

Background

There are only a few studies that have investigated the role of intestinal infections other than Clostridium difficile in Inflammatory Bowel Disease (IBD). Objectives: Our goal was to investigate the frequency of intestinal infections detected by rectal swabs in IBD patients during admission due to exacerbation of the disease.

Methods

We conducted a cross-sectional analysis of 299 patients who underwent microbiome sampling with the use of rectal swabs from January 1, 2017 to June 30, 2019, treated at a tertiary IBD centre in Poland. Our main goal was to assess the presence of any infection that could mimic or coexist with IBD exacerbation.

Results

A total of 299 patients were subjected to microbiological examination, including 61 patients with Crohn’s Disease (CD), 143 patients with Ulcerative Colitis (UC) and 95 patients with diarrhoea not related to IBD. Positive results of rectal swab culture were found in a total of 22 samples - in 17 patients with IBD and 5 patients without IBD. Among the IBD patients, positive rectal swab cultures were obtained in cases of UC - 13 samples, 76.5%, p <0.001, CD - 4 samples, 23.5% positive results, p = 0.001. In patients with IBD compared with patients without IBD, a higher incidence of intestinal infections was found (in patients with IBD 8.3%, p <0.001, in patients without IBD 5.2%, p < 0.001). Analysis of the results obtained showed seasonal variability in the number of positive microbiological tests found for cultures of rectal swabs in IBD patients. Positive results of rectal swabs from patients with IBD were significantly more frequent in the summer months - 12, 70.6%, p < 0.001 than in the winter months, when 5 positive test results were found (29.4%, p <0.001).

Conclusion

A retrospective analysis of rectal swabs for microbiome sampling collected from IBD patients during disease exacerbation treated in a tertiary IBD centre in Poland was performed. Intestinal infections, other than Clostridium difficile, were found in 17 patients with IBD symptoms. Positive results from rectal swabs of patients without symptoms of IBD were found in 5 cases. The evaluation of the obtained results shows that positive results of rectal swabs were found more often in samples taken from women (12 samples - 68.7%) than from men (5 samples - 29.3%).
N04 Knowledge, attitude and perception of inflammatory bowel disease patients towards colorectal cancer risk, its management and the role of healthcare providers: a cross-sectional study in the UK
Authors: Khan F , Czuber-Dochan W , Norton C
Published: January 2020

Background

Inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC) and requires specialised cancer risk management. Although literature exists on general disease-related knowledge in IBD patients, limited studies have assessed IBD patients’ knowledge of CRC risk and its management. Consequently, patient perception of the role of a healthcare provider (HCP) in patient education of CRC risk and their attitude towards recommended risk management has not been assessed in UK IBD patients.

Methods

We conducted a cross-sectional online survey with IBD patients recruited via charity sources from April-July 2019. Adult patients (>18 years) with a confirmed diagnosis of IBD for 2 years and adequate command of English language were included. A self-designed and piloted questionnaire with open and closed-ended questions was used. Closed-ended data were analysed using descriptive statistics and open-ended responses were analysed using content analysis. Fischer’s exact test and bivariate logistic regression were used to test for association between knowledge and patient demographics.

Results

92 participants, including 52.5% CD and 67.5% females, responded. 88% knew that IBD increases CRC risk. The mean fear of CRC risk (0–10 visual analogue scale) was 6.37 (SD ± 2.8). One-fifth were aware of colonoscopy as the best screening tool; 88% were unaware of screening initiation time. 90% would agree to their doctor’s recommendation of colonoscopy to ensure early cancer diagnosis and treatment. For dysplasia with 10% risk of CRC, 46.7% would not agree to colectomy mainly due to 10% risk of CRC not being high enough to undergo surgery. Forty-eight per cent of participants said that they never had a discussion about increased CRC risk in IBD with their doctor. Almost two-thirds were not informed about the role of screening/surveillance in cancer. Two-thirds were satisfied with the information provided by their HCP. Overall, patients desired more information about their individualised cancer risk and services available for managing the increased risk.

Conclusion

IBD patients are well informed about IBD-associated CRC risk, feared this risk greatly but were poorly aware of screening initiation time. HCP’s role in cancer knowledge dissemination was sub-optimal and patients desired more knowledge. We need deeper understanding of patients’ educational needs related to CRC.
N10 Effectiveness of self-management workshop in inflammatory bowel diseases according to psychosocial profiles. Clinical trial
Authors: Rivera Sequeiros A , Torres Dominguez Y , Á M , Macías Izquierdo , Ruiz Romero M V
Published: January 2020

Background

The main objective in the management of chronic diseases is to maintain and improve the quality of life. In this sense, the involvement of the patient in their self-care should be a priority for nursing, but we know that the results are not always the desired ones. Self-care education and training should focus on social and emotional aspects, identified as predictors of the deterioration of the quality of life. Studies have identified psychosocial profiles (Controlled, Reinforced, Weak, Fragile) of patients with inflammatory bowel diseases (IBD) based on their level of social support and emotional coping. These profiles could predict the effectiveness of these educational workshops. This study aims to compare the effectiveness of a self-management workshop in different patient profiles to identify what type of patient might benefit and which don’t.

Methods

Non-randomised clinical trial. 61 outpatients were included. Inclusion criteria: Have IBD, be over 18 years old and sign the informed consent. They were included in a self-management training programme to learn about the disease and coping. There were 4 sessions in a month. They completed a questionnaire before the workshop, at the end of the workshop, at 3 months and at 6 months. The variables were sociodemographic, clinical, quality of life, coping, perceived stress, social support and anxiety-depression.

Results

The characteristics of the sample are shown in Table 1. The four psychosocial profiles described in the literature were identified and the effectiveness of the workshop in each one was analysed. The intrasubject linear analysis showed a linear type increase in the quality of life of patients with Reinforced and Weakening profile, between baseline and third month (−3.81, p = 0.036, CI: (− 7.45; −0.17) and − 6.21, p = 0.004, CI: (− 11.08; −1.35) respectively). The observed power was 91.5% and 93.8% for each case. However, no significant differences were found in patients with Controlled profile and Fragiles. The results found were not associated with other variables of the study.

Conclusion

Identifying psychosocial profiles allows us to succeed with the type of education we offer to patients. We must customise the information and resources. In the case of patients with a great lack of family support, one would first have to intervene with the family and then offer emotional education and not vice versa.
113 Echocardiographic assessment of right ventricular outflow tract obstruction in hypertrophic cardiomyopathy - efficacy of dual chamber pacing in reducing of gradient
Authors: Wojtkowska A , Zarczuk R , Brzozowski W , Lukasik S , Tomaszewski M , Czekajska-Chehab E , Wysokinski A , Tomaszewski A
Published: January 2020

Hypertrophy of the right ventricle (RV) in the course of hypertrophic cardiomyopathy (HCM) is found in 30-60% of cases, with the possibility of a right ventricular outflow tract obstruction (RVOTO), obstruction in the apex or the middle part of the right ventricle.

A patient, aged 41, admitted due to limitation of exercise tolerance, effort dyspnea, presyncope. In an echocardiogram, interventricular septum (IVS) hypertrophy was observed up to 2.0 cm; normal size of the heart cavities; normal left ventricular systolic function (EF-70%). A color doppler mapping detected the zone of flow acceleraction and turbulent flow in right ventricular outflow tract (RVOT), next a spectral doppler examination showed the RVOT obstruction with a maximal gradient of 64 mmHg. Because of the suboptimal echocardiographic imaging, a heart CT scan was performed, revealing the features of left ventricular hypertrophy, most severe at the base and the medium part of IVS (up to 25 mm). Asymmetric hypertrophy of the middle portion of the right ventricle and right ventricular outflow tract obstruction was also observed. A hemodynamic study confirmed the presence of gradient in RVOT, up to 40 mmHg. Holter electrocardiogram recorded an episode of non-sustained ventricular tachycardia. Taking into account the clinical picture, the family history of the disease, and calculated HCM Risk SCD (7.55%), the decision was made to implant a dual chamber cardioverter defibrillator. The defibrillator electrode was fixed at the apex of the right ventricle. A short AV delay was programmed for prevalent right ventricular stimulation (AV delay 100 ms), resulting in 99.6% ventricular stimulation. The control echocardiogram showed a reduction in the maximum gradient in RVOT to 24 mmHg. In addition, the patient was treated with a beta-blocker.

To sum up, in the case of HCM we should always examine the RV with color and spectral doppler to exclude potential narrowing in RV.

Constant AV sequential stimulation with a short AV delay is a recognized method that can be considered in symptomatic adult HCM patients with a left ventricular outflow tract obstruction. In the case described here, the above mentioned method proved effective in the significant reduction of the gradient in the right ventricular outflow tract.

Abstract 113 Figure. gradient in RVOT
157 Reduced non-invasive myocardial work predicts significant coronary artery disease
Authors: Sabatino J , Leo I , De Rosa D , Polimeni A , Sorrentino S , Spaccarotella C , Mongiardo A , Aquila I , Di Salvo G , Indolfi C
Published: January 2020

Funding Acknowledgements

ESC Training Grant 2019

Background

Non-invasive prediction of critical coronary artery stenosis (CCS) is challenging. CCS may cause persistent impaired longitudinal function at rest, which could be detected by two-dimensional speckle tracking echocardiography (2D-STE). However, strain parameters are load dependent, hence they might not reflect systolic function accurately. A novel non-invasive method to calculate MW recently showed a strong correlation with invasive work measurements.

Objectives

To investigate the ability of non-invasive Myocardial Work (MW) indices: 1) to identify the ischaemic risk area during acute coronary occlusion (ACO); 2) to predict the ischaemic risk area underlying a CCS before coronary angiography.

Methods

The study population comprises 80 individuals: fifty consecutive patients (pts) referred for coronary angiography in a single tertiary coronary care centre and thirty controls (CTRL). Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before coronary angiography, during ACO, and immediately after revascularization to measure longitudinal strain along with myocardial work indices: Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE).

Results

Compared to baseline, we found a significant reduction of global longitudinal strain (GLS) (p = 0.005), MWI, MCW and MWE (p < 0.001) during ACO. After the procedure, we observed a significant improvement in GLS, MWI, MCW and MWE (p < 0.001) compared to the findings obtained during CO.

Interestingly, baseline global MWI, MCW and MWE were significantly reduced in pts with CCS at angiography compared to controls (p < 0.05). Moreover, regional MWE, but not longitudinal strain, measured within the myocardial segments underlying the CCS, was significantly reduced compared to non-target segments (p < 0.001).

Conclusions

Our results demonstrate that non-invasive estimation of regional and global MW parameters are able to identify myocardial ischemia upon ACO. Moreover, myocardial work indices measured at rest were able to predict the presence of CCS before invasive angiography, whereas MWE was more sensitive than myocardial strain to document regional impairment of myocardial function.

Abstract 157 Figure.
160 Echocardiographic assessment of CRT candidates. Does additional scar evaluation by MRI improve prediction of response?
Authors: Duchenne J , Cvijic M , Larsen C K , Galli E , Aalen J M , Voros G , Beela A S , Unlu S , Penicka M , Hopp E , Bogaert J , Smiseth O A , Donal E , Voigt J U
Published: January 2020

Background

Myocardial scar presence and extent, has a considerable influence on response to cardiac resynchronization therapy (CRT). Apical rocking (ApRock) and septal flash (SF) are associated with favourable outcome after CRT. Little is known however to which extent visual assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. We therefore investigated, if additional scar assessment by cardiac magnetic resonance imaging (MRI) adds to the predictive value of the visual evaluation of echocardiographic images in CRT candidates.

Methods

A total of 201 unselected patients referred for CRT, who fulfil the contemporary guidelines for CRT implantation, were enrolled in this prospective multicentre study. Two experienced observers visually assessed echocardiographic images before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments of the left ventricle (LV), resulting in a CRT response prediction (i.e. Integrative Prediction). A third observer provided a consensus reading in case of disagreement. All observers were blinded to all patient information other than the ischaemic aetiology of heart failure. Independent from that, segmental myocardial scar burden was objectified by late gadolinium enhancement (LGE) cardiac MRI (LGE > 50%). CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, one year after device implantation.

Results

Overall, 69 (34%) patients had an ischaemic aetiology of heart failure. Before CRT, ApRock and SF were present in 129 (64%) and 136 (68%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.85 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.77-0.91) (Figure A), while the echocardiographic Integrative Prediction had an AUC of 0.90 (95% CI: 0.84-0.95), with a sensitivity of 93% and a specificity of 87% for the prediction of CRT response (Figure B) (p < 0.05 vs. ApRock and SF alone). When combining information on ApRock, SF and the number of scarred segments on MRI in a statistical model, the AUC was comparable to the echocardiographic Integrative Prediction [0.90 (95% CI: 0.84-0.96)] as was sensitivity and specificity (91% and 83%, respectively, p = N.S. vs. Integrative Prediction) (Figure C).

Conclusions

An integrative visual assessment of LV function has an excellent predictive value for CRT response. Our data show, that the echocardiographic estimation of scar burden is sufficiently accurate and cannot be further improved by an additional MRI scar assessment.

Abstract 160 Figure.
P223 Cat bite with unexpected consequences
Authors: Moser M , Koenig A , Dannenberg V , Speidl W , Riesenhuber M , Bergler-Klein J , Binder T , Gabriel H , Schneider M
Published: January 2020

A 25 y/o female patient with corrected tetralogy of Fallot (1995), pulmonary valve bio-prosthesis (1999) with consequent stenosis, and finally implantation of a pulmonary valve Hancock-conduit (2005), presented to our department with night sweats, shortness of breath, and fever for the past three weeks. Leukocytes and CRP were elevated, transthoracic echocardiography revealed a large vegetation on the pulmonary valve prosthesis with relevant stenosis (peak gradient 70 mmHg). The patient reported to have an 18-year-old cat as a pet, which had bit her shortly before onset of symptoms.

Blood cultures remained negative, bacterial broad spectrum PCR revealed Bartonella species. PET-CT was ordered and confirmed pulmonary valve endocarditis.

The patient was treated with antibiotics and eventually transferred to cardiac surgery due to persistently high gradients over the valve in combination with exertional dyspnea.

Bartonella is a well-known cause of blood culture negative infective endocarditis, which must be tested for specifically. This case underlines the importance of taking complete patient history, including presence of pets and especially recent bites. Comprehensive imaging must be performed timely in every patient with known valve disease and unexplained symptoms.

Abstract P223 figure 1
P225 Carcinoid heart disease: report of a case in a patients with trombocytopenia absent radius
Authors: Quezada M , Ayala R , Ramos M , Villa Benayas Z , Calderon-Dominguez M , Toro R
Published: January 2020

Background

The carcinoid syndrome is characterized by extensive and several clinical manifestations. The diarrhea, the cutaneous flushing are the most frequents symptoms while cardiac manifestations (carcinoid heart disease) (CHD) occurs in a mean of 40%. Nowadays, the number of cases of CHD is lower than 20%, as a consequence of the widespread use of somatostatin analogues. At present, there is a mean delay in diagnosis of CHD of 1.5 years from the time of carcinoid syndrome detection. Hence, CHD is associated with a poor prognosis for clinical management.

Case report

We present a case of 45-years-old active woman, with Thrombocytopenia absent radius (TAR). This is characterized by a bilateral absence of the radio with the presence of both thumbs and thrombocytopenia. Our patient was attended for dyspnea of medium efforts, history of diarrhea, cutaneous flushing with tachycardia and elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) (89,6 mg/24 (2,0-9,0)). The Transthoracic echocardiography showed morphologic changes that affected the tricuspid valve: diminished curvature of the leaflets, altered dynamic motion of the leaflets during diastole, fused and shortened chordae retraction and reduced excursion of the valve. A moderate to severe tricuspid regurgitation and tricuspid stenosis with gradient media de 5 mmHg was observed. In addition, the right ventricle was dilated, a severe pulmonary hypertension, a right pleural effusion and a minor pericardial effusion circumference were detected. All these findings were consistent with CHD.

Conclusions

This report describes an unusual case of CHD in TAR patient. In fact, the interest of this case is the role played by the echocardiogram in the differential diagnosis for tricuspid valve diseases. Tricuspid stenosis is an infrequent condition and it is usually related with rheumatic disease associated with mitral valve disease. Although the carcinoid syndrome is infrequent, any changes in the anatomical structure of the tricuspid valve (thickening, fibrosis and rigidity associated with stenosis and tricuspid regurgitation) should alert us to the suspicion of CHD

Abstract P225 Figure.
P226 Caseous calcification of the mitral annulus: a silent cause of intracardiac mass
Authors: Campos I , Galvao Braga C , Costeira-Pereira A , Salome N , Vieira C , Pereira V H , Costa-Oliveira C , Marques Pires C , Medeiros P , Flores R , Mane F , Marques J
Published: January 2020

INTRODUCTION

Caseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification with a central liquefaction necrosis, being an uncommon echocardiographic finding (0.5 to 1%) which may be mistaken for an intracardiac tumor, thrombus or vegetation. This chronic degenerative process can occurs at advanced ages, particularly in women, and patients with hypertension, chronic renal failure or calcium metabolism abnormalities. Since patients often remain asymptomatic, conservative treatment for this lesion is generally sufficient.

CASE REPORT

DESCRIPTION

We report a case of an 86-year-old female with a known history of hypertension and diabetes, who was referred to our department in order to investigate the diagnosis of an intracardiac mass visualized through a routine transthoracic echocardiography. She reported effort dyspnea, but refused to have other cardiovascular symptoms.

In order to study this intracardiac mass, the patient was submitted to a transthoracic echocardiogram that showed a rounded mass of 16 × 22 mm in the anterior mitral annulus, mainly in P1 scallop, not causing valve stenosis and with a mild mitral regurgitation. This prompted the need for transesophageal echocardiography which revealed a spheroid mass of heterogeneous content with calcification points, regular edges and with faint central echo-lucent area without acoustic shadowing, attached to the anterior mitral valve leaflet. No communication with any cardiac chamber could be detected. The mass did not determine any restriction to the opening of mitral valve cusps. A cardiac MRI was requested to complete the diagnostic evaluation revealing that the lesion was located at the base of the anterior leaflet. In the T1 and T2 sequences the mass was hypointense, whereas in the perfusion sequence, no contrast penetration was detected in the mass and in the late enhancement. These findings, as well as the presence of a calcified envelope in the cardiac computed tomography scan, confirmed the suspicion of caseous calcification of the mitral annulus.

DISCUSSION

AND CONCLUSIONS

We present an unusual case of caseous calcification of the mitral annulus in which the multi-modal approach was crucial to confirme the diagnosis. Although transthoracic echocardiography can be sensitive in the diagnosis of this entity, the diagnosis may sometimes still be inconclusive. Thus, multi-modality with transesophageal echocardiography, cardiac MRI or CT can lead to a definitive diagnosis, avoiding an mistaken diagnosis with the need of a surgical approach. Since this pathology is most frequently detected in asymptomatic patients, the patients should be treated medically and monitored clinically and echocardiographically for an early recognition of possible complications.

Abstract P226 Figure. Caseous calcification of mitral annulus