bluuebunny/crossref_metadata_2025 huggingface dataset:
P160 A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease
Authors: Eliakim R , Yablecovitch D , Lahat A , Ungar B , Shachar E , Carter D , Selinger L , Neuman S , Ben-Horin S , Kopylov U
Published: January 2020

Background

Capsule endoscopy (CE) is an important modality for monitoring of Crohn’s disease (CD). We recently established that small bowel (SB) inflammation on CE quantified by a Lewis score >350 accurately predicts risk of relapse within 2 years in CD patients in clinical remission. Recently, a novel pan-enteric capsule (PillCam Crohn’s (PCCE), Medtronic, USA) was approved for use. However, no quantitative index for pan-enteric PCCE is currently available. The current study was undertaken as a sub-study of a prospective randomised controlled CURE-CD trial aiming to optimise treatment of CD patients in remission using a PCCE- based treat-to-target approach; the aim of this ancillary study was to compare the correlation and reliability of the novel PCCE inflamatory score (Eliakim score) with the Lewis score as performed by 2 independent experienced CE readers.

Methods

The study cohort includes CD patients in clinical remission (CDAI<150). The patients were prospectively enrolled and underwent patency capsule evaluation; if excreted within 30 h, PCCE was performed following bowel preparation. PCCE was repeated every 6 months; if no colonic disease was detected on first PCCE, subsequent examinations were performed without colonic preparation. Each PCCE was independently reviewed by 2 experienced readers (RE (reader 1);UK (reader 2)). All studies were scored using the Lewis score and Eliakim score (comprised of a sum of scores for most common and most severe lesions multiplied by percentage of involvement per bowel segment (3 for small bowel and 2 for colon) with an additional stricture score). Pearson’s and Spearman’ correlation, Cohen’s kappa and inter-rater reliability coefficient (IRC) between the scores and the readers were calculated as appropriate.

Results

Forty PCCE exams were included. The median LS was 225 for both readers (interquartile range (IQR)—157–815 for reader 1, 33- 1125 for reader 2). Both readers identified significant SB inflammation (LS>350) in 17/40 (42.5%) of the patients with strong agreement between the readers (Spearman’s r = 0.87, p < 0.0001). The median PCCE score was 6 (4–14.75) and 4 (2–14.75) for reader 1 and 2, respectively. There was a high IRC between the two readers for LS (0.88, p < 0.0001 for absolute agreement) and PCCE score (0.91, p < 0.0001). For the small bowel, the correlation between LS and PCCE was moderate for reader 1 (Pearson’s r = 0.72, p < 0.0001 and strong for reader 2 Pearson’s r = 0.84, p < 0.0001).

Conclusion

There is a need for a quantitative pan-enteric score for the novel Pillcam Crohns capsule. The presently proposed score, while mandating further clinical validation, has strong inter-reader reliability and moderate-to-strong correlation with the validated small bowel capsule score (LS)
P172 Immunisation and vaccination status at diagnosis in Pediatric inflammatory bowel disease
Authors: Velasco Rodríguez-Belvís M , Palomino Pérez L M , Sánchez Fernández-Bravo C , Jose Luis L F , Sanchiz Perea A , Cañedo Villarroya E , Domínguez Ortega G , Pedrón Giner C C , Rodríguez Manchón S , Martínez Pérez J , Muñoz González A , Muñoz Codoceo R A
Published: January 2020

Background

Pediatric inflammatory bowel disease (PIBD) patients are especially prone to vaccine-preventable diseases and opportunistic infections. The aim was to evaluate the immunisation and vaccination status in PIBD.

Methods

Descriptive and retrospective study that analyses the immunisation and/or vaccination for measles, mumps and rubella (MMR), hepatitis B virus (HBV), chickenpox, cytomegalovirus (CMV) and Epstein–Barr virus (EBV) of PIBD patients in a tertiary paediatric hospital (January 2015- Oct 2019) in the first 6 months after diagnosis.

Results

Amongst 57 patients, 17 (30%) had ulcerative colitis (UC), 35 (61%) Crohn’s disease (CD) and 5 (9%) unclassified IBD (uIBD). Up to 35 (61%) were male and the mean age at diagnosis was 10.2 ± 4.1 years. A total of 18 (32%) were currently on biological treatment and 45 (79%) on immunosuppressants. The disease location in CD patients was L3 (Paris classification) in 22 (63%) and L4a in 13 (37%). Only 2 (6%) showed perianal involvement. From the UC patients, 11 (65%) were E4. A delayed growth was observed in 6 (10%), all CD patients.

At diagnosis, 37 (65%) were HBV-vaccinated, 13 of them (35%) had a serological response and 22 (59%) had no response. Amongst the latter, 18 were re-vaccinated and 9 (50%) had a documented serological response. Up to 34 patients (60%) were MMR-vaccinated and 13 (38%) showed a complete response. Only 6 patients could be re-vaccinated. Up to 30 (52%) showed chickenpox immunisation. Only 4 of the non-immunised patients could be vaccinated and all of them responded to a single dose. Regarding CMV and EBV, 17 and 16 patients (46 and 43%) were IgG positive respectively, all of them were IgM negative.

Patients with CD were more likely to need HBV re-vaccination than other IBDs (p < 0.05). Regarding chickenpox, CD patients without growth delay (G0) needed less re-vaccination than those whose growth was affected (G1) (p < 0.05). However, UC patients with extensive disease (E4) needed less re-vaccination than those with limited disease (p < 0.05). Male patients seemed to be less likely to need re-vaccination, with no significant differences.

Conclusion

The serological assessment of vaccine-preventable diseases immunisation yielded poor results. Remarkably, a high percentage of HBV and MMR vaccinated patients showed no response. CD patients tended to more likely need revaccination, especially in the most severe cases (G1). Surprisingly, severity was not related with vaccination response in UC. Our results suggest that less than half of the patients had been previously infected by CMV or EBV. Based on this, it seems reasonable to serologically check the immunisation status in PIBD patients in order to, when appropriate, re-vaccinate before starting immunosuppressive therapies.
P174 High frequency of fatigue and sleep alterations impact on the quality of life in Mexican patients with inflammatory bowel disease
Authors: Yamamoto-Furusho J K , Parra-Holguin N N , Fresán-Orellana A
Published: January 2020

Background

Inflammatory bowel disease (IBD) refers to ulcerative colitis (UC) and Crohn’s disease (CD). All patients with chronic diseases can have serious effects on their sleep quality and high levels of fatigue, which directly affect the quality of life of patients with IBD. It has been reported that up to 44% of patients have alterations in sleep quality and up to 72% have symptoms of fatigue The aim of the present study is the validation of the Fatigue Scale in IBD (IBD-F) in Mexican patients and to evaluate the quality of sleep and fatigue in IBD patients according to their quality of life.

Methods

This is a cross-sectional study which included 98 patients aged 18 to 65 years with diagnosis of IBD, during the period from March to June 2019; three evaluation instruments will be applied to them: IBD-F, Pittsburgh Sleep Quality Index (PSQI) and Quality of life in patients with IBD (IBDQ-32). The clinical variables and demographics were collected through the review of clinical records. All analyses were performed with version 22.0 of the SPSS statistical program and the level of statistical significance was set at p < 0.05.

Results

A total of 98 patients were included in the study, 58.2% were female with an average age of 44.9 years (S.D.= 12.1, range 19–64 years). The clinical remission of IBD was 79.6%, the predominant extension in UC was pancolitis in 74.4% followed by left colitis in 12.8% (n = 11) and proctosigmoiditis in 12.8% (n = 11). For CD, the most frequent location was ileocolonic in 75%, ileal in 16.7% and colonic in 8.3%. The stricturing phenotype occurred in 75%, inflammatory in 16.7% and fistulizing in 8.3%. The clinical activity of the disease presented in 21.4% (n = 21) patients and 78.6% (n = 77) patients were in remission. Severe fatigue occurred in 28.6% (n = 28) patients, mild-moderate fatigue in 60.2%(n = 59) and 11.2% (n = 11) with no fatigue. Sleep disturbances requiring medical attention and treatment were presented in 52.1% (n = 51) patients, alterations requiring medical attention in 18.4% (n = 18) patients and 29.6% (n = 29) patients with no sleep disturbances. Patients with severe fatigue showed greater alterations in the quality of life on three dimensions of digestive (p < 0.001), systemic (p < 0.05) and emotional symptoms (p < 0.05). Patients with sleep quality alterations also affected globally the four dimensions of quality of life.

Conclusion

This study demonstrates a high frequency of fatigue and sleep quality alterations that impact in the decrease of the quality of life in IBD patients
P180 Association between serum and tissue protein profiles in patients with active inflammatory bowel disease: the ASCERTAIN study
Authors: Stevens T , Wildenberg M , Koželj M , Novak G , Gecse K , Duijvestein M , Löwenberg M , Drobne D , D’Haens G
Published: January 2020

Background

To facilitate personalised treatment of inflammatory bowel disease (IBD), biomarkers for disease entity and disease severity in easily accessible samples are required. Therefore, we aimed to (i) identify proteins that discriminate Crohn’s disease (CD) from ulcerative colitis (UC), (ii) assess the association of proteomic profiles with disease severity and (iii) assess the potential to use serum samples as a proxy for intestinal biopsies.

Methods

In this prospective cross-sectional study, IBD patients with active endoscopic disease (presence of ≥1 ulcer (CD) or Mayo score ≥1 (UC)) and age matched non IBD controls (normal endoscopy) were included. In IBD, biopsies were taken from inflamed tissue; in CD from the edge of an ulcer and in UC and controls between 20 and 25 cm from the anal verge. Disease severity was dichotomised in mild vs. severe defined as SES CD <10 vs. ≥11 in CD and Mayo endoscopy score 1/2 vs. 3 in UC. Ninety-two inflammatory proteins were measured in biopsies and serum using a proximity extension assay (OLINK). The elastic net algorithm was used to select proteins associated with disease severity. Multiplicity adjustments were done using the Benjamini–Hochberg approach.

Results

Forty-one CD, 39 UC and 10 controls were included. Median SES-CD score [IQR] was 9 [7–16] in CD. In UC, 20 (51.3%), 15 (38.5%) and 4 (10.3%) patients had an endoscopic Mayo score of 3, 2 and 1, respectively. Three proteins differed significantly between UC and CD in tissue (IL-17A, IL13 and CCL4). However, this was not reflected in serum levels of these molecules. For prediction of disease severity in CD, elastic net regression identified a set of 11 serum proteins that discriminated mild from severe disease (accuracy 0.667). Top five proteins were IFNγ (OR 3.03), CCL23 (OR 1.28), Cystatin D (OR 0.61), TNF (OR 1.28) and HGF (OR 1.17) (Figure 1). In tissue, no discriminatory profile was identified. Conversely, in serum of UC, no proteins were selected, while a set of three tissue proteins was associated with disease severity (accuracy 0.725). These proteins were osteoprotegerin (OPG) (OR 1.66), IL8 (OR 1.09) and CCL25 (OR 0.97). The discrepancy between serum and tissue was further supported by correlation analyses. Of all 92 proteins, only three showed significant correlation between tissue and serum: IL17A (r = 0.44), TGF-α (r = 0.42) and IL6 (r = 0.39).

Conclusion

Proteomic profiles between tissue and serum in active IBD correlated poorly. Only in CD, serum markers differentiated mild from severe disease. In UC, no proteins in serum were selected whereas in tissue, expression of OPG, IL-8 and CCL25 was associated with disease severity. These data again emphasise the difference between CD and UC on a molecular level.
P183 The prevalence of incidental terminal ileitis in persons undergoing non-diagnostic colonoscopy: a meta-analysis
Authors: Agrawal M , Bento-Miranda M , Walsh S , Colombel J F , Ungaro R
Published: January 2020

Background

Incidentally diagnosed terminal ileitis has been reported among asymptomatic persons undergoing non-diagnostic colonoscopy. The purpose of our study was to determine the prevalence and long-term outcomes of asymptomatic terminal ileitis.

Methods

We developed and executed a systematic search strategy in three biomedical databases (Medline, Embase and Web of Science) and relevant scientific meeting abstracts, from inception to May 1, 2019, to identify observational studies that reported the prevalence of asymptomatic terminal ileitis in adults undergoing screening or polyp surveillance colonoscopy, and/or the long-term outcomes of such lesions. A random-effects meta-analysis was conducted to determine the pooled prevalence rate, confidence interval (CI), and report the heterogeneity score I2. Risk factors for progression to overt CD were abstracted.

Results

Of 2388 eligible studies, 1784 were screened after excluding duplicates, 84 were reviewed in full text and 14 studies were eligible for inclusion. Eight studies reported the prevalence of asymptomatic terminal ileitis in 46,460 persons undergoing non-diagnostic colonoscopy, and eight (two of eight reporting prevalence) studies reported follow-up data. The pooled rate of asymptomatic terminal ileitis was 1.5% (CI 1.0%, 16.3%), with I2 of 0 (Figure). The use of non-steroidal anti-inflammatory drugs varied between 0% and 37%. Of 147 persons with asymptomatic terminal ileitis with follow-up data (range 13–63.6 months in three studies), five had progression to CD, three were treated for CD with steroids, 5-amino salicylates, azathioprine and vedolizumab, and lesions resolved in four. Three studies reported the absence of symptoms as a predictor of lack of progression.

Conclusion

Asymptomatic terminal ileitis can be found incidentally in 1.5% of non-diagnostic colonoscopies. Based on limited data, the rate of its progression to overt CD seems low, and watchful waiting could likely be a reasonable strategy. More long-term follow-up studies are needed to inform the natural history of incidental terminal ileitis, factors that predict progression to CD and therapeutic implications.
P188 Evaluation of Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition in patients affected by inflammatory bowel disease (IBD) candidates for elective surgery
Authors: Fiorindi C , Cricchio M , Ficari F , Alpigiano G , Scaringi S , Giudici F
Published: January 2020

Background

In inflammatory bowel disease (IBD), malnutrition has been associated with increased postoperative complications incidence, longer hospital stay and higher costs. ESPEN guidelines recommend that all IBD patients must be screened for malnutrition. Recently, so-called GLIM criteria were developed to uniform malnutrition diagnosis. Our aim was to determine the prevalence of malnutrition comparing the different malnutrition criteria.

Methods

The nutritional status of all IBD patients’ candidates to surgery in our Centre during 2019 was assessed. According to the GLIM criteria, the diagnosis of malnutrition is based on the presence of almost one phenotypic criteria (non-volitional weight loss, low body mass index and reduced muscle mass) and almost one aetiologic criteria (reduced food intake or assimilation; biochemical inflammation). The results were compared with that found adopting ESPEN 2015 criteria for malnutrition to evaluate their concordance.

Results

Fifty-three consecutive IBD patients [38 Crohn’s disease (CD) and 15 ulcerative colitis (UC)] were evaluated. The average values of Body Mass Index, Free Fat Mass Index ad Phase Angle were 22.69 kg/m2, 17.6 kg/m2 and 5.8° respectively. According to the Nutritional Risk Screening (NRS) test 40% (21 patients) of patients were at high nutritional risk. Forty-five per cent (24 patients) were malnourished according to GLIM criteria (14 with severe malnutrition and 10 with moderate malnutrition), while according to the ESPEN criteria only 26% (14 patients) (Table 1). The correlation between GLIM and ESPEN, calculated with the Cohen’s kappa coefficient (k) was moderate/good (k 0,605).

Conclusion

GLIM criteria indicate higher prevalence of malnutrition than ESPEN criteria. Interestingly, the same 14 patients malnourished for ESPEN have severe malnutrition (Stage 2) according to GLIM. Furthermore, seven malnourished patients according to GLIM criteria are not considered at nutritional risk according to NRS, probably because it does not consider the muscle mass loss. Patients with CD have a higher prevalence of aetiological factors, while UC patients have a higher prevalence of phenotypic factors. Malnutrition prevalence was higher in UC probably due to the ileostomy present before second-stage surgery 4 months after subtotal colectomy in acute severe cases. The concordance between GLIM and ESPEN 2015 appears moderate/good.
P192 TELEDERMA: telemedicine system for dermatological lesions in patients with inflammatory bowel disease
Authors: Molina Arriero G , Pradera Cibreiro C , De las Heras Sotos C , Fraga Iriso R , Ollero Pena V , Morete Pérez M C , Echarri Piudo A
Published: January 2020

Background

Dermatological lesions are a common extra-intestinal manifestation (EIM) associated with inflammatory bowel disease (IBD) or its treatment. The severity of the lesions requires a preferential assessment by the dermatologist. The photography allows a telematic evaluation and non-face-to-face analysis. There are no published experiences of telemedicine in patients with IBD and dermatological EIMs. This study aimed to assess the results of a telematic system for the evaluation of dermatological lesions in patients with IBD (TELEDERMA) developed between the Dermatology Department and IBD Unit.

Methods

The retrospective study that evaluates this system from its implementation in June 2014 to December 2017 (3.5 years). TELEDERMA (TD) establishes the issuance of a telematic consultation with images through electronic clinical history. A therapy is advised by a dermatologist either through an electronic prescription or a personal appointment. The study evaluates the average time of the telematic consultation, type of lesion and attitude of patients towards the therapy, type and characteristics of the IBD, treatments applied, other EIMs, smoking and dermatological history. Patients were asked to describe and evaluate their level of satisfaction.

Results

A total number of 47 consultations from 39 patients (70% females) with an average age of 33.2 (8–75) have been made.41 of these consultations were made in patients with Crohn Disease (CD) and 6 in patients with ulcerative colitis (UC). Sixty-seven per cent of the patients with UC had pancolitis. CD Patients had ileal o ileocolonic location (82%) with inflammatory (39%) and stricturing (55%) behaviour. Eighteen per cent of the patients had an active flare-up. 1 out of every four patients had other EIMs. The most frequent reason for teleconsultation was paradoxical psoriasiform lesions (n = 13, 33.3%) of anti-TNF agents (70% of the patients) and suppurative hidradenitis (n = 4, 10.3%). The resolution was achieved in 87%, and only one patient had to interrupt the anti-TNF therapy. The average waiting time was 4.7 days (0–14), compared with the 60 and 28 days of the current waiting list with a routine or preferential request, respectively. All the patients evaluated this system positively, highlighting the advantages of rapidness in both the resolution of the consultations.

Conclusion

TD is a useful tool for the rapid assessment of dermatological lesions associated with IBD. It prevents the patients from going to the emergency department, improves the care quality and the degree of satisfaction of the patients. The most frequent teleconsultations were related to psoriasiform lesions associated with anti-TNF therapy. The interruption of treatment was exceptional.
P204 Re-established CRP cut-off in UC; it may be a better predictor of mucosal remission
Authors: Bakkaloglu O K , Eskazan T , Bozcan S , Yıldırım S , Kurt E A , Hatemi A İ , Erzin Y , Celik F
Published: January 2020

Background

Although faecal calprotectin can predict mucosal remission in ulcerative colitis, the CRP level in this context is insufficient and frequently stay under the current cut off level. While some patients with active mucosal disease have normal CRP levels most patients in mucosal remission have much lower CRP levels. The aim of this study is to define CRP cut off levels in the prediction of mucosal remission, considering both extensiveness and severity, in ulcerative colitis.

Methods

We retrospectively reviewed colonoscopy reports of ulcerative colitis patients (who are not on any steroid treatment at that time) which were performed between December 2016 and March 2019 and also their CRP levels which were obtained at the same week of the colonoscopy examination. We excluded the data of patients with any other possible cause of inflammation or infection at the time of laboratory assessment. Degree of mucosal disease at colonoscopy was evaluated according to endoscopic Mayo score. Mucosal remission was defined as endoscopic Mayo score 0 or 1. The extent of mucosal inflammation was classified according to Montreal classification. The CRP level with optimal sensitivity and specificity for mucosal remission prediction was assessed by ROC curve analysis and positive and negative predictive values were also calculated.

Results

A total of 331 colonoscopy reports of 260 patients (122 m, 138 f) were involved in this study. There were no significant differences between ages of patients when compared with ex, and Montreal classification and we did not find any correlation between age and CRP levels. Sensitivity, specificity, positive predictive value and negative predictive values for 5 mg/l, 3 mg /l and 2 mg/l are summarised in Table 1. CRP levels which predict Mayo 0 disease, mucosal remission (Mayo 0–1) and Mayo 3 disease are shown in Table 2. At the ROC curve analysis, we found that CRP level of approximately 2.9 mg/l can predict mucosal remission with a 77% sensitivity and % 80 specificity in all examinations without grouping into a separate segmental disease. For subgroups with Montreal E1, E2 and E3 ROC curve analysis suggested 1,8 mg/l (sn. 84%, sp. 90%), 2,7 mg/l (sn. 75%, sp. 75%) and 3 mg/l (sn. 80%, sp. 80%) CRP levels can be used for prediction of mucosal remission respectively (Table 3). It is important to emphasise that 30% of all patients with Mayo 3 colonoscopy and further 23% of patients with Montreal E3–Mayo 3 activity have CRP levels below the regular cut-off value of 5 mg/l.

Conclusion

CRP cut-off level of approximately 2.9 mg/l can predict mucosal remission in ulcerative colitis better than standard cut-off of 5 mg/l which has a low positive predictive value and specificity even at extended and active mucosal disease.
P230 Health-related quality of life in adolescents and young adults (AYA) with inflammatory bowel disease and its correlations with demographic, clinical, laboratory and therapeutic evaluations
Authors: Oba J , Deboni M , Toma R , Sobrado C , Azevedo M , Carlos A , Borba M , Damião A , Carrilho F , Silva C
Published: January 2020

Background

IBD, including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic recurrent inflammatory diseases of the gastrointestinal tract, most often diagnosed in adolescence and young adulthood. Extra-intestinal manifestation (EIM) may be present initially in up 50% or before IBD is diagnosed. IBD and its complications are associated with morbidity and has considerable impact upon patients’ health-related quality of life (HRQoL). HRQoL is an essential complement to the examination of clinical symptoms and functional limitations and has emerged as an important outcome measure to evaluate an individual’s adaptation to a chronic medical condition like IBD. It is known the neurocognitive maturation that support integration of executive and emotion systems are not fully mature until 25 years, making this period a time of socio-emotional vulnerability and adjustment. So, our objective was to evaluate the HRQoL in adolescents and young adults (AYA) patients with IBD and compare with a peer’s health control and investigate the variables which can be attributed to HRQoL in these patients.

Methods

59 AYA IBD patients (13–25 years) and 60 AYA healthy controls (13–25 years) completed the Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), Short Form Health Survey (SF-36) questionnaires and pain visual scale, according to age. After we compared HRQoL between Crohn’s disease (CD) vs. UC (ulcerative colitis) in AYA population. The demographic data, extra-intestinal manifestation, overlap syndromes, disease active status, treatment and outcomes were also evaluated.

Results

PedsQL4.0 domain ‘school/ work’ and SF-36 domain ‘general health perception’ was reduced in IBD AYA patients compared with healthy controls (p < 0.05). However, no difference in all domains and pain scale was observed between CD and UC AYA patients. Disease activity, as well as extra-intestinal manifestations, overlap syndromes, treatments and outcomes, did not influence the HRQoL of the AYA patients. Autoimmune sclerosing cholangitis and the use of prednisone were significantly higher among UC patients, whereas previous gut surgery was higher between CD patients. However, these disease factors did not significantly influence the HRQoL between CD vs. UC.

Conclusion

HRQoL was significantly lower among IBD AYA patients when compared with healthy controls. Disease factors did not influence HRQoL between CD and UC AYA patients. These results highlight areas to focus clinical attention for assessment and future interventions among AYA with IBD.
P238 Natural history of perianal fistulizing Crohn’s disease in the Swiss IBD cohort
Authors: Aslan N , Rossel J B , Pittet V , Safroneeva E , Godat S , Vavricka S , Greuter T , Biedermann L , Straumann A , Scharl M , Schaad M , Hahnloser D , Rogler G , Schoepfer A
Published: January 2020

Background

Data of large cohort studies on the fate of perianal fistulizing Crohn’s disease (CD) is scarce. We aimed to evaluate the prevalence and natural history of perianal fistulas in adults with Crohn’s disease (CD).

Methods

Data from the Swiss IBD cohort study were analysed. The Swiss IBD Cohort study includes since 2006 IBD patients, follow-up questionnaires are completed once a year. Patients were recruited from university centres (80%), regional hospitals (19%), and private practices (1%).

Results

Among 2163 CD patients, 495 (22.9%) ever had perianal fistulas whereas 1668 (77.1%) did not. Patients with perianal fistulas were characterised by the following features when compared with patients without perianal fistulas: younger age at diagnosis (23.4 vs. 25.3 years, p = 0.001), longer disease duration at enrolment (9.6 vs. 4.9 years, p < 0.001), longer disease duration at latest follow-up (17.4 vs. 11.2 years, p < 0.001), less frequenty isolated ileal disease at diagnosis (15.8% vs. 28.6%, p < 0.001), more frequently rectal disease at enrolment (32.5% vs. 14.8%, p < 0.001) and latest follow-up (24.2% vs. 11.7%, p < 0.001), more frequently acne inversa (1.4% vs. 0.1%, p < 0.001), and more frequently intestinal resection (49.5% vs. 35.3%, p < 0.001). The prevalence of extraintestinal manifestations was not different (59.0% vs. 54.4%, p = 0.073). Compared with patients without perianal fistulas, patients with perianal fistulas were more frequently treated with topical 5-ASA (14.8% vs. 8.0%, p < 0.001), systemic steroids (78.2% vs. 70.1%, p < 0.001), azathioprine (82.6% vs. 77%, p = 0.008), methotrexate (28.3% vs. 22.2%, p = 0.005), infliximab (71.9% vs. 50.8%, p < 0.001), adalimumab (36% vs. 27.9%, p < 0.001), certolizumab pegol (18.6% vs. 11.5%, p < 0.001), and antibiotics (69.1% vs. 41.2%, p < 0.001). Regarding fistula anatomy, 321 patients (64.8%) had a low perianal fistula, 82 (16.6%) a high perianal fistula, and 227 (45.9%) a perineal fistula. The following fistula therapies were ever applied: perianal abscess drainage (45.7%), fistulectomy/fistulotomy (39.6%), seton drainage (28.7%), mucosal sliding flap (2%), fistula plug (1.4%), and fibrin glue instillation (1%).

Conclusion

In our national cohort roughly one-quarter of CD patients was diagnosed with perianal fistulizing disease. Compared with patients without perianal fistulas, patients with perianal fistulizing disease were characterised by several stigmata of complicated disease course such as a higher frequency of intestinal resections and higher prevalence of treatment with biologic agents.
P250 Root cause analysis to identify missed opportunities for the diagnosis of colorectal cancer in inflammatory bowel disease
Authors: Gordon C , Chee D , Hamilton B , Chanchlani N , Heerasing N M , Hendy P , Lin S , Wesley E , Daniels I , Goodhand J R , Kennedy N A , Ahmad T
Published: January 2020

Background

Colonoscopic surveillance in inflammatory bowel disease (IBD) patients leads to earlier detection of colorectal cancer (CRC) and reduces CRC-associated deaths. However, adherence to international surveillance guidelines in practice is poor. Consequently, we hypothesised that patients with IBD-associated CRC had suboptimal endoscopic surveillance and conducted a root cause analysis of IBD-associated CRC diagnoses to identify the scale of missed surveillance opportunities.

Methods

We calculated the incidence of CRC in our IBD population between 1998 and 2019 by cross-referencing the hospital’s CRC and IBD databases. All cases were adjudicated by IBD specialists to determine eligibility for surveillance using guidelines contemporaneous to the time of CRC diagnosis. For all eligible patients, a root cause analysis was conducted to determine whether there were missed opportunities to detect CRC.

Results

Our search identified 94 patients with IBD and CRC. We excluded 16 patients diagnosed with IBD after the diagnosis of CRC. The overall incidence of IBD-associated CRC in East Devon from 1998 to 2019 was 0.17% per year (95% CI 0.14 %–0.18%) with no statistically significant change seen over time (R2= 0.15, p = 0.11). Fifty-one patients (65%) were male, the median age at diagnosis of CRC was 69 years (range 21–88) and the median duration of IBD prior to CRC diagnosis was 21 years (range 0–57). After adjudication, 42 (54%) patients were eligible for surveillance at the time of CRC diagnosis. Correctly timed surveillance colonoscopy identified 5/42 (12%) CRC cases, but failed to identify CRC in 6 (14%) patients with so-called interval cancers. Overdue surveillance colonoscopy identified a further 4/42 (10%) cases. Overall, 27/42 (64%) IBD-associated CRC cases were classified as having had missed opportunities for surveillance. Root cause analyses found that 10 (37%) patients had not been offered surveillance despite on-going secondary care follow-up. Four (15%) patients had a delayed diagnosis of CRC because of a failure to account for the adequacy of previous colonoscopic and histological findings. Thirteen patients were managed exclusively in primary care including 7 (26%) patients who had been discharged back to primary care without a plan for surveillance and 6 (22%) patients who were never known to secondary care.

Conclusion

Two-thirds of patients who were eligible for surveillance had a missed opportunity to diagnose CRC. In most cases, the patient was known to the secondary care IBD service but no recommendation for surveillance was made. There is a need to implement processes to facilitate identification and recall of patients eligible for surveillance across primary and secondary care.
P252 The cardiovascular risk profile in patients with inflammatory bowel disease: A cross-sectional single-centre study (the CARE-IBD study)
Authors: Sleutjes J A M , Roeters van Lennep J E , Verploegh P J , van der Woude C J , de Vries A C
Published: January 2020

Background

Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular diseases (CVD). The European Society of Cardiology guidelines recommend to use a 1.5 factor CVD risk multiplier in rheumatoid arthritis, but state a gap in evidence for other inflammatory diseases. The aim of this study was to assess the prevalence of CVD and traditional cardiovascular risk factors in IBD.

Methods

This is a single-centre cross-sectional study at the IBD outpatient clinic in September and October 2019. Patients ≥18 years underwent body measurements (systolic, diastolic blood pressure (SBP, DBP), length, weight, waist, hip circumference), biochemical analysis (plasma glucose, total cholesterol (TC), triglycerides, HDL, LDL) and completed an extensive cardiovascular questionnaire (history of CVD, thromboembolic events, medication use). To identify groups at risk of hypertension (SBP>140 or DBP>90 mmHg), overweight (>25 kg/m2), hyperlipidaemia (TC>5 mmol/l) and cardiovascular events, comparisons were made between gender, IBD subtype (Crohn’s disease (CD), ulcerative colitis (UC)) and disease activity (Harvey Bradshaw Index or Simple Clinical Colitis Activity Index>5).

Results

A total of 235 IBD patients were included (112 males (48%), median age 45 years (IQR 33–55): 143 CD (61%), 92 UC (39%)). Median SBP and DBP were 135 (IQR 122–145) and 84 mmHg (IQR 66–93); hypertension was present in 43% of patients. Median BMI was 24.5 kg/m2 (IQR 21.9–27.4); 41% of patients were overweight. Hyperlipidaemia was present in 19% of patients. The self-reported prevalence of hypertension was 13%, hyperlipidaemia 8%, diabetes 4%, cardiovascular disease (heart failure, myocardial infarction, transient ischaemic attack, cerebrovascular accident) 10% and thromboembolic events (deep venous thrombosis, pulmonary embolism) 8%. Male patients showed a higher prevalence of hypertension (61%), greater waist–hip ratio (0.93, all p < .001), higher triglyceride (1.6 mmol/l, p = .003) and lower HDL levels (1.2 mmol/l, p = .000) as compared with females. CD patients were more frequently smokers (16%) with disease activity (51%)(p < .001), but showed lower levels of triglycerides (1.6 mmol/l, p = .013), TC (4.0 mmol/l) and LDL (2.3 mmol/l) (p < .001) as compared with UC. During active disease lower levels of LDL were observed as compared with remission (2.4 vs. 2.7 mmol/l, p = .040).

Conclusion

CVD are considerably prevalent in IBD patients. Well-known CVD risk factors hypertension, obesity and hyperlipidaemia are highly prevalent and remain undiagnosed in a substantial proportion of patients. Although no significant association is observed between CVD and gender or IBD subtype, CVD risk profile is different. Screening and early treatment of CVD risk factors might be recommended in IBD.
P254 Virtual chromoendoscopy with Narrow Band Imaging (NBI) for the classification of polypoid and non-polypoid lesions in ulcerative colitis: A prospective study using different endoscopic classifications
Authors: Cassinotti A , Fociani P , Beretta E , Duca P , Nebuloni M , Ardizzone S
Published: January 2020

Background

In ulcerative colitis (UC), the diagnostic accuracy of virtual chromoendoscopy with non-magnified Narrow Band Imaging (NBI) was disappointing in the detection and differential diagnosis of neoplastic lesions in most trials performed according to unclear diagnostic criteria. The Kudo and NICE criteria are validated in the general population, but controversial in UC. Recently, a modified Kudo classification specific for the inflammatory setting of UC has been developed using virtual chromoendoscopy with Fuji Intelligence Color Enhancement (FICE). The performance of NBI according to these three classifications for optical diagnosis of neoplastic and non-neoplastic lesions in UC has never been analysed.

Methods

All visible, polypoid and non-polypoid, lesions found during consecutive surveillance colonoscopies with non-magnified NBI (Exera II CV180) for long-standing UC (>8 years from disease onset) were included in a prospective, single-centre study, and classified as suspected or not suspected for neoplasia according to the NICE, Kudo and Kudo-modified criteria. The primary endpoint was to compare the sensitivity (SE), specificity (SP), negative (-LR) and positive (+LR) likelihood ratios of the three classifications, using histology as the reference standard.

Results

394 lesions (mean size 6 mm, range 2–40 mm; type 0-Is 83%) from 84 patients (males 62%; mean age 57 y, range 30–79 y; mean disease duration 20 y) were found: 21 (5%) were neoplastic, 49 (12%) hyperplastic and 324 (82%) inflammatory lesions. The diagnostic accuracy of the NICE, Kudo and modified-Kudo classifications were, respectively: SE 76% vs. 71% vs. 86% (p = not significant); SP 55% vs. 69% vs. 79% (p < 0.05 Kudo-mod vs. both Kudo and NICE); +LR 1.69 vs. 2.34 vs. 4.15 (p < 0.05 Kudo-mod vs. both Kudo and NICE); -LR 0.43 vs. 0.41 vs. 0.18 (p = not significant).

Conclusion

The diagnostic accuracy of NBI for the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with the conventional classifications validated in the general population, but it is significantly better with the modified Kudo classification specific for UC. The role of NBI in UC surveillance for neoplasia should be re-evaluated according to more accurate diagnostic criteria.
P255 Predictors of postoperative morbidity in patients with inflammatory bowel disease
Authors: Imperatore N , Pellegrini L , Bucci L , Rispo A , Guarino A D , Testa A , Peltrini R , Amendola A , Patturelli M , Castiglione F
Published: January 2020

Background

More than half of patients suffering from inflammatory bowel disease (IBD) requires surgery in their lifetime. However, predictors of post-operative morbidity and mortality are poorly investigated. Our aim was to assess the predictors of post-operative mortality and morbidity in IBD.

Methods

retrospective cohort study enrolling all IBD subjects followed-up and operated at our tertiary IBD Centre from 2015 to 2018. For each patient, we evaluated patient-dependent (comorbidities, smoking, drugs, nutritional status), disease-dependent (disease duration, location, behaviour, extension), surgery-dependent variables (duration, emergency/election, laparoscopy/laparotomy, bowel/colic resection, length of intestinal resection).

Results

158 subjects were operated during the period study (males 53.8%, Crohn’s disease 75.3%, mean age 41.9 + 16.2, disease duration 109.5 + 98.3 months); the majority (83%) underwent an elective surgery. No patient died. About morbidity, 40 (25.3%) developed post-operative complications: wound infection (8.9%), respiratory complications (6.9%), prolonged ileum (5.1%), anastomotic leak (3.2%), urinary infections (3.2%), abdominal abscess (3.2%), anastomotic bleeding (3.2%), other infections (2.5%), abdominal bleeding (1.9%), obstruction (1.3%). Two subjects (1.3%) required re-operation within 30 days. A surgery-duration <142 min was predictive for a better post-operative outcome (sensitivity 80%, specificity 42%, PPV 32%, NPV 85.9%). At binary logistic regression, stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6–6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4–9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.4–0.8, p = 0.01), surgery duration <142 min (OR 0.2, 95% CI 0.08–0.7, p = 0.03), were the only predictors for post-operative morbidities. A pre-operative BMI<24 was also predictive for anastomotic leak (OR 4.3, 95% CI 1.8–8.6, p = 0.02); pre-operative hypoalbuminemia was predictive for urinary infections (OR 2.5, 95% CI 1.8–7.9, p = 0.04); pre-operative infliximab was predictive for pneumonia (OR 3.8, 95% CI 2.2–6.3, p = 0.01); diabetes (OR 5.7, 95% CI 2.3–9.8, p < 0.01) and pre-operative steroids (OR 6.1, 95% CI 1.8–11.4, p < 0.01) were predictors of wound infection; need for TPN predicted prolonged ileum (OR 6.1, 95% CI 2.3–15.3, p = 0.03).

Conclusion

about a quarter of IBD patients undergoing surgery develops a post-operative complication, especially infective. Several patient-related, disease-related and surgery-related factors are predictive for post-operative morbidity. The recognition of these factors, as well the multidisciplinary approach (gastroenterologists, surgeons and nutritionists), and intensive preoperative management could be able to minimise these complications.
P256 Anti-glycan antibody seropositivity at diagnosis does not predict future disease course in patients with Crohn’s disease
Authors: Lyons P , Noor N , Lee J C , McKinney E F , Parkes M , Smith K G C
Published: January 2020

Background

Biomarkers predictive of a patient’s future disease course are critical for personalised medicine. There are two Crohn’s disease (CD) assays with validated associations to a clinical outcome; seropositivity for anti-glycan antibodies (AGAs, Glycominds) and a transcriptional signature of T-cell exhaustion (PredictSURE-IBD™, PS-IBD). The optimal time to use these tests would be at diagnosis before bowel damage occurs. As AGAs have primarily been measured in patients after therapy it’s unclear if they provide prognostic information at diagnosis. To address this we performed a head-to-head comparison of both tests in newly diagnosed CD patients.

Methods

We recruited 74 CD patients with active disease; all patients gave written informed consent and were managed using an accelerated step-up strategy in accordance with international guidelines. Active disease was confirmed by one or more objective marker (raised CRP/calprotectin or endoscopic review) and active symptoms. AGA seropositivity was measured at Addenbrooke’s with the IBDX panel (Glycominds) according to manufacturer’s instructions. Patient stratification was also performed using the PS-IBDtest (PredictImmune Ltd) according to manufacturer’s instructions.

Results

Most (80%–59/74) patients were newly diagnosed; 58% (43/74) were seropositive for at least 1 AGA, 19% (14/74) were positive for ≥2 AGAs. Newly diagnosed patients had fewer AGAs (51%, 30/59) than previously diagnosed (87%, 13/15) patients (p = 0.018). We stratified patients into two groups based on seropositivity for 2 or more AGAs—associated with an increased risk of more severe disease but found no significant difference in time to, or frequency of, treatment escalation between the groups. Stratification of patients into IBDhi and IBDlo groups with PS-IBDrevealed a significant difference in the subsequent disease course with IBDhi patients experiencing more aggressive disease, characterised by a shorter time to treatment escalation compared with IBDlo patients (p = 0.001).

Conclusion

AGA seropositivity at diagnosis (as assessed using the IBDX antibody panel) did not predict the need to escalate treatment due to frequently-relapsing or chronically-active disease. Lower AGA seropositivity in newly diagnosed patients compared with those with previous diagnoses suggested that the extent of antibody positivity is a function of disease duration. Previously reported associations between AGA positivity and disease outcome may, therefore, reflect retrospective aggressive disease course and are unlikely to be useful for informing treatment decisions in newly diagnosed patients. The PS-IBD test result correlated with subsequent disease course indicating suitability for early prediction of clinical outcome.
P265 IBD′s features depending on the age group of patients and the timing of diagnosis of the disease
Authors: Skalinskaya M , Skazyvaeva E , Zhuravleva M , Bakulin I , Komarova D , Rasmagina I , Ivanova K
Published: January 2020

Background

Untimely diagnosis increases the number of severe forms of IBD, which enlarges the possibility of life-threatening complications, extraintestinal presentations, and the patient’s need for surgical treatment.

Methods

We analysed the data of 1130 patients with an established diagnosis of UC or CD. The dynamics of the timing of diagnosis of IBD, the nature of the disease, the frequency of occurrence of intestinal complications, extraintestinal presentations were evaluated.

Results

The maximum frequency of start of both UC and CD falls on the young age of patients - from 19 to 38 years. The duration of symptoms before diagnosis is established is 2.3 years (27.4 months) for CD, 1.1 years (12.1 months) for UC. 81.8% of patients with UC are diagnosed no more than 4 years, but in 10.9% of patients this interval was 4–9 years; in 3.6%, 9–13 years; in 1.9%, 13–18 years, and in another 1.8%, more than 20 years. In CD 59.5% of patients fall into the diagnosis interval up to 4 years, in 27.4% this period takes from 4 to 9 years, in 7%—10–15 years, and in 6% more than 6 years. At the age of 18–25 years severe course of IBD is observed in 12% of patients, at the age of 26–30 years—in 18%, 31–40 years—in 9%. Older people are more likely to experience mild IBD, and the percentage of severe and moderate forms is 4% and 29%, respectively, after 60, and less than 0.5% and 19.5%, respectively, after 70 years. Extraintestinal presentations were observed in 43.4% of patients, with 25% of them having more than one of them. In patients with CD, the development of complications in the first 4 years of the disease was noted in 62%, in UC—in 58.9%. In patients with intestinal complications, the diagnosis period was 2.9 years, without them—2.4 years. However, in patients with a history of surgical treatment of IBD, the diagnosis period was less than 1 year. 69, 3% of revealed patients with a history of needing one or more hospitalisations associated with IBD, and 15.8% underwent surgery for IBD.

Conclusion

Based on the data obtained, it can be concluded that the main part of complications occurs in the first few years after the onset of the disease. With late diagnosis, the probability of developing not only intestinal complications, but also extra-intestinal presentations significantly increase, which reflects a more severe form of the disease. The shorter time of diagnosis of IBD in patients who need surgical treatment is explained by more pronounced symptoms that require urgent medical care. However, the proportion of IBD with severe and moderate form is greater in young age groups, and as the ‘growing up’ groups - the number of patients with mild IBD begins to prevail.