bluuebunny/crossref_metadata_2025 huggingface dataset:
P789 Bacteriological profile of material collected from perianal lesions from patients with Crohn’s disease in the tertiary IBD centre in southern Poland
Authors: Filip R , Gruszecka J
Published: January 2020

Background

Both anal abscesses and fistulas are potential complications in the course of Crohn’s disease. Chronic immunosuppression, loose stools and poor wound healing in this population pose a challenge to the treatment of perianal diseases. The purpose of our hospital research was to determine the dominant bacterial species found in perianal abscesses and fistula discharge, resulting in anal abscess and/or fistula outflow in patients with Crohn’s disease hospitalised in a tertiary IBD centre in Poland.

Methods

The results of tests of patients admitted and subsequently conservatively treated or treated for anal fistula or abscess in the period from January 1, 2017 to June 30, 2019 were evaluated. Information obtained from medical records included clinical information, results of laboratory tests and results of swab cultures of perianal lesions for culturing and antibiotic sensitivity of microorganisms isolated. Material was collected from patients in accordance with applicable procedures.

Results

In the analysed period, a total of 306 swabs from perianal lesions from 44 patients with the diagnosis of Crohn’s Disease were collected, of which microbial growth was observed in 38 patients. Escherichia coli (45.5%, p < 0.001) was the most frequently isolated pathogen, Staphylococcus aureus was the second most common pathogen (15.9%, p < 0.001). In vitro sensitivity tests showed that Escherichia coli (ESBL-extended-spectrum-beta-lactamase producing strain with a broader substrate spectrum) was found in 4 samples, Staphylococcus aureus (MRSA- strain resistant to all beta-lactam antibiotics: penicillins with inhibitors, cephalosporins, monobactams, carbapenems except for ceftaroline). The analysis of the results obtained did not show seasonal variability in the number of positive microbiological tests found on cultures of perianal lesions.

Conclusion

A retrospective analysis of microbiological results of anal abscesses and fistula outflow was performed in patients with Crohn’s Disease with perianal changesi. Escherichia coli was the predominant pathogen isolated. The second most common organism was Staphylococcus, isolated from 9 patients. Staphylococci were not found in samples from other patients with IBD. The evaluation of the obtained results shows that positive results of cultures of swabs from lesions in the anal area were found more often in samples taken from men (25 samples–65.8%) than from women (13 samples–34.2%).
P802 Probability of vedolizumab response as defined by clinical decision support tool is associated with lower healthcare utilisation in patients with Crohn’s disease
Authors: Dulai P , Wan Y , Huang Z , Luo M
Published: January 2020

Background

A clinical decision support tool (CDST) has been developed and validated for predicting treatment effectiveness of vedolizumab (VDZ) in Crohn’s disease (CD). We evaluated this tool’s ability to predict healthcare resource utilisation using real-world data.

Methods

CD patients treated with VDZ were identified using real-world data from the Optum (n = 358) and Truven MarketScan (n = 1445) databases. The full CDST with 3 clinical variables (prior bowel surgery, prior fistulising disease, prior TNF-antagonist exposure) and 2 lab values (albumin and CRP) was applied to the Optum dataset with available lab data, and patients were stratified into low (n = 27), intermediate (n = 152), or high (n = 179) probability of response groups. A modified weighting of the 3 clinical variables was created for application in Truven MarketScan due to the lack of availability of lab data. To assess the coherence with the full 5-variable CDST, the modified 3-variable CDST was used to stratify Optum patients into low (n = 137) or high (n = 221) probability of response, and then subsequently validated in the Truven MarketScan dataset (low, n = 510; high n = 935; response probability groups). Rates of hospitalisation, surgery, emergency department (ED) visits and annualised per patient costs were compared across response probability groups.

Results

Using the full 5-variable CDST, we observed a linear trend of significantly lower rates of ED visits, hospitalisation, surgery, and healthcare-related costs with increasing probability of response (Table). These results were consistent when using the modified 3 variable CDST in the Optum patient dataset where we observed a 3-fold higher rate of per patient healthcare costs in the low probability of response group compared with the high probability of response group ($6535 vs. $1900, p = 0.016). In the Truven patient dataset, the modified 3 variable CDST was also associated with a significantly lower rate of hospitalisation, surgery, and healthcare costs in the high probability of response group (Table). The majority of cost differences between high and low response groups was driven by costs related to hospitalisation and surgery.

Conclusion

A simple CDST can identify CD patients treated with VDZ who present a higher risk for healthcare resource utilisation, especially for hospitalisation and surgery. This tool could be integrated into population health monitoring algorithms using real-world data and offer flexibility on requirements of lab data.
P805 Patients with Crohn’s disease treated with ustekinumab vs. vedolizumab in real-world settings
Authors: Chiorean M , Jiang J , Candela N , Chen G , Romdhani H , Latremouille-Viau D , Shi S , Bungay R , Fan T
Published: January 2020

Background

Ustekinumab (UST) and vedolizumab (VDZ) are approved biologic therapies for moderate to severe Crohn’s disease (CD). Comparative data on real-world patient characteristics and healthcare costs for these drugs are scarce.

Methods

We examined healthcare costs associated with UST (healthcare common procedure coding system [HCPCS]: J3357, J3358, C9261, C9487, Q9989) and VDZ (HCPCS: C9026, J3380) in a retrospective cohort study of Truven commercial claims data (2009–2018) for adults with CD (international classification of diseases-9/10 codes: 555/K50). Eligible patients (18–89 years old) initiated UST or VDZ (index drug) on/after Sept 26, 2016, had CD as the latest relevant autoimmune disease on or before index drug initiation (index) date, ≥6 months of data available both before and after the index date, completed induction, and initiated maintenance therapy. Entropy balancing was used to address confounding factors (baseline characteristics). Primary outcome was healthcare costs assessed from a US payer perspective from index date to treatment discontinuation or end of follow-up (time on treatment). Cost were reported in 2018 US$ per patient per month and compared between treatment groups overall, and for biologic-naïve and -experienced (≥1 pre-index biologic therapy for CD) subgroups, using mean cost differences (MCD) obtained from weighted two-part models.

Results

The 599 (117 biologic-naive) UST- and 589 (172 biologic-naive) VDZ-treated patients who met eligibility criteria were similar in sex (54% and 57% female), mean age (41 ± 14 and 44 ± 14 years), time since diagnosis (42 ± 33 and 46 ± 35 months) and Charlson comorbidity index (0.4 ± 1.0 and 0.6 ± 1.1). Disease location, follow-up duration, and prior therapies and surgeries were also comparable. Characteristics were similar in biologic-naïve and -experienced patients. Mean weighted time on treatment was 11.4 and 12.1 months in UST- and VDZ-treated patients. Mean weighted total healthcare costs per patient per month was higher with UST vs. VDZ (MCD=$5051) driven by total index drug costs (MCD=$4946; Table). Cost differences were consistent in biologic-naïve and -experienced patients (total cost MCD=$4466 and $4836, both p < 0.01).

Conclusion

Characteristics of UST- and VDZ-treated patients in real-world settings were comparable. In this population of patients receiving maintenance treatment for CD, index drug costs make UST treatment substantially more costly than VDZ. Further comparison of healthcare outcomes in patients treated with UST vs. VDZ is warranted.
P809 Increase of tuberculosis due to combination therapy in inflammatory bowel disease: a nationwide population-based study in Korea
Authors: Choi S J , Kim E S , Lee J M , Choi H S , Keum B , Jeen Y T , Chun H J
Published: January 2020

Background

Recent researches reported that inflammatory bowel disease (IBD) in Asia has become more prevalent. Since IBD is chronic inflammation disorder and its relapse is frequent, obtaining and maintaining remission is important. As our knowledge on the pathogenesis of IBD deepened, many immunosuppressants and biological agents were introduced and confirmed to be both safe and effective. However, biologics known as anti-tumour necrosis factor (anti-TNF) agents was reported to lose response over time in 23–46% of patients. Therefore, combination therapy adding immunomodulator drug such as azathioprine was introduced and showed better outcome by optimising biologic pharmacokinetics and minimising immunogenicity. Adversely, rates of tuberculosis are increased, but there is no large population data estimating and comparing these risk in combination therapy.

Methods

We used 2008–2016 data of the South Korean Health Insurance and Review Agency (HIRA), and odd ratio (OR) for tuberculosis in IBD patients who underwent anti-tumour necrosis factor (TNF) agent, azathioprine, or combination therapy.

Results

Between 2008 and 2016, 47,760 patients were newly diagnosed as IBD, 29,440 as UC and 15,320 as CD. We compared the risk of tuberculosis according to the medication divided into 5 groups; infliximab only, azathioprine only, combination of azathioprine and infliximab, azathioprine monotherapy and infliximab monotherapy, and azathioprine and infliximab whether simultaneously or separately. We also compared the risk between male and female. Hazard ratio of tuberculosis in infliximab monotherapy, azathioprine, and combination therapy in IBD patients were 1.132, 1.256, and 2.118, respectively.

Conclusion

Our study shows that Korean IBD patients are at risk for tuberculosis, and this results may highlight the importance of screening for tuberculosis in IBD patients.
P821 HLADQA1-HLADRB1 pre-emptive screening for azathioprine-induced pancreatitis in inflammatory bowel disease: a preliminary report
Authors: Wilson A , Wang Q , Gregor J , Chande N , Beaton M , Ponich T , Sey M , Yan B , Kim R
Published: January 2020

Background

Genetic variation in the HLADQA1-HLADRB1*07:01 haplotype is strongly associated with azathioprine (AZA)-induced pancreatitis in inflammatory bowel disease (IBD). We aimed to evaluate the utility of pre-emptive HLA DQA1-HLADRB1*07:01 screening to reduce the risk of AZA-induced pancreatitis in an IBD population.

Methods

A prospective cohort study is ongoing in IBD patients being considered for AZA therapy who are assigned to pre-treatment HLA DQA1-HLADRB1*07:01 (rs2647087) screening (n = 372 currently recruited) and compared with historical controls who have received AZA standard of care (n = 373). Participants in the pre-emptively screened group found to be variant carriers (AC or CC) are excluded from AZA treatment while wild type carriers (AA) received standard dosing. The incidence of clinically diagnosed pancreatitis (lipase >3 times the upper limit of normal and one of abdominal pain or imaging findings suggestive of pancreatitis) occurring within 3 months in all participants with AZA exposure is being compared between the prospective and historic populations.

Results

The minor allele frequency of HLADQA1-HLADRB1*07:01 is 29%. To date, 194 participants (AA genotype) in the pre-emptively-screened cohort have received AZA therapy and completed the 3-month follow-up period. An additional 136 individuals with AA genotype are needed to obtain the target sample size (n = 330). Thus far, fewer cases of AZA-induced pancreatitis are seen in the pre-emptively screened population (pre-emptive cohort, 1/194 vs. historical controls, 13/373; odds ratio = 7.01, 95%CI = 0.91–53.98, p = 0.04).

Conclusion

Pre-emptive HLA DQA1-HLADRB1*07:01 screening may reduce the risk of pancreatitis during AZA treatment in patients with IBD. Completion of this study will help define whether HLA DQA1-HLADRB1*07:01 screening is a clinically-actionable and relevant tool for the safe use of AZA therapy in IBD.
P826 A predictive molecular classification developed in UC patients with active disease is observed consistently in a heterogeneous group of IBD patients
Authors: Kulmala K , Diaz O E , Huber S , Hedin C , Villablanca E J
Published: January 2020

Background

We have previously identified an unsupervised molecular classification of ulcerative colitis (UC) into two groups, UC1 and UC2, predictive of response to biologic therapy1. In that study, gene expression data in inflamed colonic biopsies from several published UC cohorts were used. UC1 is characterised by, for example, high expression of Cytochrome P450 26B1 (CYP26B1), calprotectin (S100A8) and interleukin 11 (IL11) and poor response to infliximab, which is also predicted by high expression of oncostatin M (OSM)2. In the current study the consistency of this classification was investigated in a heterogeneous group of inflammatory bowel disease (IBD) patients. Also, we sought to validate a quantitative polymerase chain reaction (qPCR) primer set as an alternative, more convenient methodology instead of microarray.

Methods

PCR primers for 7 differentially expressed genes that distinguished UC1 from UC2 in our microarray study were validated. OSM was also included. Separate gut biopsy samples (n = 44) from 15 patients, (8 Crohn’s disease, 7 UC), from different locations and at different time points, were analysed with qPCR.

Results

A heatmap of Pearson correlation coefficients (r) between gene expression levels and clinical factors for the pooled data was generated, Figure 1. Strong correlations, defined as 0.7 ≤ r ≤ 1.0, were found between OSM, CYP26B1, S100A8 and IL-11 (pairwise correlations were statistically significant, p < 0.00001). Similar inter-gene correlations were also observed within individual samples, (data not shown). Gene expression levels were not associated with inflammation, Figure 1.

Conclusion

These data demonstrate that the group genes we have previously identified as predictive of response to biologic therapy in UC, (CYP26B1, S100A8 and IL-11) plus OSM are also concordantly up-regulated in biopsy material from heterogeneous patients. Thus not only patients with active UC, but also other forms of IBD may be sub-grouped according to this gene expression pattern. The capacity of this gene expression profile to predict therapeutic response should therefore be tested in a broader range of IBD patients. The fact that the concordance of the up-regulation of these genes was independent of inflammation per se, supports the clinical significance of this molecular clustering. Establishment of qPCR-based characterisation into UC1 and UC2 presents a more convenient methodology for clinical stratification.

References
P831 The role of adherent-invasive E. coli in pediatric Crohn’s disease: cause or effect?
Authors: Faqerah N , Logan Michael , Russell Richard , Gerasimidis Konstantinos , Walker Daniel
Published: January 2020

Background

The ability of adherent-invasive E. coli (AIEC), to adhere and invade intestinal epithelial cells and survive autophagy implicates them in the pathogenesis of Crohn’s disease (CD). Previous studies focused mostly on differences in the abundance of E. coli between patients with CD and healthy controls. Here, we studied changes in E. coli levels, E. coli strains and their ability to utilise carbon sources during treatment with exclusive enteral nutrition (EEN), at food reintroduction, and compared with healthy controls.

Methods

E. coli strains were isolated from culturing stool samples of twelve children with CD before and during induction treatment with EEN and following that, at food reintroduction. 10 healthy children acted as controls. 69 samples (CD, n = 59; healthy children, n = 10) were investigated in total. Absolute concentration of E. coli was measured with qPCR, changes in E. coli strains using colicin sensitivity spot tests and their ability to utilise carbon sources with Biolog phenotype microarrays.

Results

There was no significant change in the absolute levels of E. coli in patients with CD before or during EEN, and after food reintroduction. In comparison to healthy children, patients with CD had significantly higher levels of E. coli (p-value= 0.001). There were changes in E. coli at a strain-level in nine out of twelve CD patients as tested using colicin sensitivity tests before, during EEN, and after food reintroduction. Biolog microarrays showed a significant difference in E. coli community utilisation of 17 carbon sources in CD patients at different time points. Utilisation of polysaccharides, D-cellobiose, sucrose, and D-raffinose was increased during EEN compared with treatment initiation and after treatment cessation, at food reintroduction. In contrast, there was a significant reduction in utilisation for L-fucose and L-Rhamnose monosaccharides, sugar alcohols like D-glucose 6-PO4, and fatty acids such as propionic acid and acetoacetic acid by the end of EEN compared with treatment initiation and at reintroduction of habitual diet. In comparison to healthy controls, E. coli utilisation of different carbon sources in patients with CD was significantly different compared with CD patients during EEN only.

Conclusion

Children with CD experience changes in E. coli strains and in their ability to utilise certain carbon sources during treatment with EEN and compared with healthy controls. Analysis of strain-level metagenomic data will provide a comprehensive depiction of changes in E. coli population during EEN and compared with the healthy status.
P834 Effects of short-chain fatty acids supplementation on gut inflammation in DSS-induced murine colitis model
Authors: Eun C S , Han D S , Lee J G , Park C H
Published: January 2020

Background

Short-chain fatty acids (SCFAs) play an important role in maintaining gut homeostasis. However, inconclusive results exist whether administration of SCFAs ameliorates gut inflammation in patients with inflammatory bowel disease. We aimed to evaluate the effects of butyrate or mixture of SCFAs on gut inflammation in the dextran sulphate sodium (DSS)-induced murine colitis model.

Methods

Following oral treatment with 150 mM sodium butyrate or mixture of SCFAs (67.5 mM acetate, 40 mM butyrate, 25.9 mM propionate) for 2 weeks, acute colitis was induced in the C57BL/6 mice by adding 2% DSS to the drinking water for 7 days. Clinical activities including weight change and histologic findings of colonic segments were examined. Flow cytometry analysis was performed for analyzing regulatory T cells in the colonic lamina propria. To characterise the change of intestinal microbiota, high throughput Illumina MiSeq sequencing for sequential faces were performed.

Results

There were no significant differences in weight change, colonic length, and histological inflammation score between the DSS group, butyrate group, and SCFA mixture group. However, fluorescence activated cell sorter (FACS) analysis revealed that the expression of CD4+Foxp3+ regulatory T cells were increased in the butyrate and SCFA mixture groups than in the DSS group. Metagenomic sequencing analysis demonstrated that gut microbial profiles of the butyrate and SCFA mixture groups were significantly different from those of the control and DSS groups in PCoA. The relative abundances of the phyla Verrucomicrobia and Proteobacteria, species Akkermansia muciniphila and Escherichia fergusonii were increased in the butyrate and SCFA mixture groups than control and DSS groups.

Conclusion

Oral administration of butyrate or mixture of SCFAs resulted in changes in the gut microbial profiles and increased regulatory T cell expressions. However, gut inflammation was not alleviated by butyrate or SCFA supplementation in the DSS-induced murine colitis model.
P835 Correlation between microbial markers and faecal calprotectin in IBD patients
Authors: Amoedo Cibeira J , Ramió-Pujol S , Serra-Pagès M , Bahí A , Puig-Amiel C , Oliver L , Gilabert P , Clos A , Mañosa M , Cañete F , Miquel-Cusachs J O , Torrealba L , Busquets D , Sàbat M , Domènech E , Guardiola J , Garcia-Gil J , Aldeguer X
Published: January 2020

Background

Crohn disease (CD) and Ulcerative colitis (UC) are characterised by episodes of exacerbations and remissions. Monitoring disease activity based on intestinal lesion is mandatory prior to any change in the therapeutic strategy. Colonoscopy is the gold standard technique to monitor the disease activity in IBD patients, but it is usually discarded because of costs and risk issues. The concentration of Faecal Calprotectin (FC) is widely used as a non-invasive marker of inflammation of the intestinal mucosa, allowing the assessment of the disease activity. Recently, different studies have demonstrated that certain microbial species, part of intestinal microbiota which can be detected in stool samples, are capable of correlating with disease activity in CD and UC patients. The purpose of this study was to analyse the correlation between these microbial indicators and the FC to monitor the disease activity in CD and UC patients.

Methods

FC levels were used to define inflammatory disease activity, the predetermined cut-off of 250 μg/g of faeces was used, higher values indicated an active inflammation and lower values indicated disease in remission. Two cohorts consisting of 61 patients of CD (25 with active inflammation and 36 with remission) and 90 of UC (42 with active inflammation and 48 with remission) were recruited by the Gastroenterology department of 4 Catalan hospitals. A sample of faeces was collected from each patient. FC and the following markers were quantified by qPCR: Faecalibacterium prausnitzii (Fpra), Escherichia coli (Eco), Akkermansia muciniphila (Akk), Ruminococcus sp. (Rum), Bacteroidetes (Bac) and Methanobrevibacter smithii (Msm) for each sample.

Results

The bacterial markers presented different behaviour depending on the disease analysed. The abundances of Eco and Bac were higher in CD with active inflammation compared with CD with remission. In contrast, no significant differences were found for Fpra, Akk, Rum, and Msm. Besides, a significant positive correlation between Eco abundance and FC levels (0.280, p = 0.029) and a significant negative correlation between Msm and FC levels (−0.299, p = 0.021) were observed.

According UC patients, while the abundance of Eco was higher in patients with active inflammation, the abundance of Rum was significantly less abundant. No significant differences were found for Fpra, Akk, Bac, and Msm. Moreover, we also observed a significant negative correlation between Rum and FC levels (−0.308, p = 0.003, respectively).

Conclusion

The abundance of Eco and Msm in CD patients and the abundance of Rum in UC patients correlate to FC in order to determine inflammatory disease activity. So, these markers can also be an accurate discriminator of active disease in CD and UC patients.
P837 Changes in the intestinal microbiota of patients with inflammatory bowel disease during an 8-week infliximab infusion cycle
Authors: Seong G , Song J H , Shin J , Kong S M , Kim E R , Chang D K , Hong S N , Kim Y H
Published: January 2020

Background

This study investigated changes in the intestinal microbiota during 8-week infliximab maintenance therapy in inflammatory bowel disease (IBD) patients with clinical remission. Microbial compositional differences were analysed according to the trough level of infliximab (TLI) and mucosal healing (MH) status.

Methods

16S rRNA gene-based microbiome profiling was performed on 10 and 74 faecal samples from 10 healthy volunteers and 40 adult IBD patients, respectively. All enrolled IBD patients were in clinical remission during infliximab maintenance therapy. To identify changes in the intestinal microbiota, faecal sampling occurred at 1–2 weeks (1W) and 7–8 weeks (7W) after infliximab infusion. TLI was measured by ELISA at 8 weeks immediately before the subsequent infusion; MH was evaluated by endoscopy within 3 months.

Results

No significant differences were found in microbial composition, species richness, and diversity indices between 1W and 7W samples or in microbial composition and diversity between healthy volunteer and 1W or 7W samples. However, 7W faecal samples from the patients with TLI≥5 μg/ml showed increased species richness compared with TLI<5 μg/ml, and patients with MH showed increased species diversity compared with non-MH. Beta-diversity analysis showed clustering between samples in the MH and non-MH groups. LefSe analysis identified differential expression of Faecalibacterium prausnitzii group between TLI < 5 μg/ml and TLI ≥ 5 μg/ml and MH and non-MH groups.

Conclusion

There were no significant changes in the intestinal microbiota during an 8-week infliximab infusion cycle in IBD patients with clinical remission; however, microbial composition, species richness, and diversity were associated with TLI and MH status.
P840 Immunomodulatory effects of two different postbiotics on primary human cell culture
Authors: Mayorgas A
Published: January 2020

Background

Inflammatory bowel disease (IBD) is characterised by chronic, relapsing intestinal inflammation with extensive damage of the colonic mucosa and a remarkable dysbiosis. Since the current treatments show limitations in the response of some patients and many of them are associated with important side effects, new and safer strategies are needed. Postbiotics are any soluble factor resulting from the metabolic activity of a live probiotic bacteria or any released molecule capable of providing health benefits through a direct or indirect mechanism. Nevertheless, the effects of certain postbiotics in the context of intestinal inflammation have not been extensively addressed. Our aim is to study the immunomodulatory properties of two different postbiotics on primary human cell culture and their protective effects on human intestinal ex vivo 2D culture.

Methods

Postbiotics from Streptococcus salivarius subsp. thermophilus and Lactobacillus paracasei Lpc-37 were obtained after the microbial culture of each bacterial strain. Supernatants were collected at OD600 = 0.6, filtered and frozen. Immunostimulatory, immunosuppressor or immunomodulatory effects of each postbiotic were tested in peripheral blood mononuclear cells (PBMCs) isolated from healthy donors (n = 4). PBMCs are a heterogenous cell population that includes myeloid as well as lymphoid immune cells. Postbiotics were used to assess whether bacterial metabolites could modulate the cytokine release in particular IL-12p40 and IL-10 by LPS-stimulated PBMC, mimicking innate immune activation. Dendritic cells (DCs) differentiated from isolated human monocytes were also stimulated with all postbiotics (n = 2) to study the innate-adaptive immune crosstalk by analyzing IL-10 and IL-12p70 secretion. Postbiotics stimulation was also performed in differentiated human intestinal epithelial monolayers derived from EpOCs (Epithelial Intestinal Organoids Cells) to analyse the outcome in an ex vivo organ culture.

Results

Postbiotics derived from S.thermophilus and Lpc-37 were able to increase the secretion of IL10 in both PBMCs and monocyte-derived DCs, while no change was shown in IL-12p40/IL-12p70 production. Interestingly, S. thermophilus also showed a ‘per se’ anti-inflammatory effect due to an increase of IL-10 in non-stimulated PBMCs. On the other hand, postbiotics were able to up-regulate MUC2 expression in the 2D organ culture while down-regulating LGR5.

Conclusion

Overall we conclude that the tested postbiotics show an immunomodulatory effect as well as important properties on intestinal epithelial-cells stemness and differentiation, being S. thermophilus the best candidate due to its remarkable anti-inflammatory effect in both stimulated and non-stimulated cells.
P845 Impact of Clostridium difficile infection in patients admitted with ulcerative colitis
Authors: Gros Alcalde B , Soto Escribano P , Iglesias-Flores E , Marín Pedrosa S , García-Sánchez V , Benítez J M
Published: January 2020

Background

Clostridium diffile (CD) infection it is becoming increasingly more prevalent in general population and especially in patients with inflammatory bowel diseases (IBD). Patients with ulcerative colitis (UC) with CD infection during a flare can present greater morbidity and mortality. The objectives of the study were (a) to evaluate the proportion of CD infection in patients admitted with UC; (b) to compare the rates of colectomy in UC admitted with and without CD infection; (c) to analyse the association between the infection and worse results according to readmissions, need of treatment intensification and hospital stay; and (d) to describe predictive factors associated with worse evolution in patients with CD infections.

Methods

Cases and controls retrospective study. We included patients admitted due to a flare of UC in our hospital from 2000 to 2018. Variables related to hospital stay, adverse events, need of colectomy in the first year and mortality were collected. We analysed the data with SPSS using chi-square test, Kruskal–Wallis and multivariant analysis to identify factors of bad evolution.

Results

We analysed 235 admitted patients with UC flare. 62.1% male, mean age 43.6 years old (SD 12). Seventy-two per cent presented extensive colitis and 22% left coliits. 7.7% had perianal disease and 8.7% extraintestinal manifestations. Endoscopic activity was 75.8% Mayo Index 3 and 23% Mayo Index 2. 15.9% of the patients had complications during their hospitalisation related to their disease: 37.8% had toxic megacolon, 11% perforation and 11.2% of the total needed surgery during the hospitalisation. Twenty-eight patients (12.2%) had CD infection, among them 23.5% suffered recurrence infection of CD. This infection was statistically significant related to a higher rate of readmission (48.1% vs. 23%, p = 0.007) and higher rates of colectomy during the first year from the admission (13% vs. 2.9%, p = 0.05). We did not find differences among both groups of patients in terms of complications of their IBD, neither need of treatment intensification, nor mortality. Predictive factors of bad evolution were not identify with multivariant analysis.

Conclusion

CD infection is prevalent in UC admitted patients, with high rates of recurrence, this infection is related with higher rates of readmission and bigger need of colectomy during the first year.
P850 Comparison of sampling methods in assessing the microbiome from patients with ulcerative colitis
Authors: Lee H S , Kim T O , Jung S H , Baek D H
Published: January 2020

Background

Most of studies have reported a dysbiosis of ulcerative colitis (UC) using readily accessible stool samples. However, the faecal samples might not fully represent mucosa-associated microbiome. We hypothesised that luminal contents including loosely adherent luminal bacteria after bowel preparation may be suitable for diagnosing the dysbiosis of UC.

Methods

Sixteen patients with UC (9 men and 7 women, mean age: 52.13 ± 14.09 years) and 15 sex- and age-matched healthy individuals (8 men and 7 women, mean age: 50.93 ± 14.11 years) participated in the study. The subjects donated faecal samples before colonoscopy and received luminal contents aspiration and endoscopic biopsy during the colonoscopy. The composition of each microbiome samples was analysed by 16S rRNA-based nest-generation sequencing.

Results

Microbiome of stool, luminal contents and biopsy was significantly different from each other in alpha diversity and beta diversity. However, another analysis showed a correlation between the stool and luminal contents in Procrustes test (p = 0.001) and Mantel test (p = 0.0001). Stool microbiome in patients with UC was different from stool microbiome in healthy control. Microbiome of luminal contents microbiome and biopsy samples in patients with UC were not different from that of healthy control. Stool and lavage predicted UC in accuracy of AUC 0.85 and 0.81, respectively

Conclusion

Microbiome of stool, luminal contents and biopsy were significantly different from each other. Further studies would be needed to know optimal sampling of intestinal dysbiosis.
N09 Pain management in inflammatory bowel disease: feasibility of an online therapist-supported CBT-self-management intervention
Authors: Sweeney L , Moss-Morris R , Czuber-Dochan W , Norton C
Published: January 2020

Background

Chronic pain is a poorly managed symptom of inflammatory bowel disease (IBD). Cognitive behavioural therapy (CBT) has an evidence-base in functional gastrointestinal conditions and chronic pain. We aimed to test the feasibility and acceptability of a 9-week online facilitator-supported CBT intervention, tailored for people with chronic IBD-related pain.

Methods

A single arm pre-post design with nested qualitative interviews was used with 20 individuals with IBD and chronic pain. Participants were recruited online through an IBD charity and had consented to research in a previous survey or responded to an online charity advert. Individuals who met the inclusion criteria e.g. reported a pain-interference score of ≥4/10 (Brief Pain Inventory) and had no indicators of acute causes of pain, were invited to take part. Faecal calprotectin was collected. Outcomes included recruitment and retention rates, pain interference and severity (Brief Pain Inventory), quality of life, psychosocial measures and self-reported disease activity (IBD-Control). Follow-up face to face or telephone interviews were conducted following the intervention to obtain feedback on sessions and tasks, facilitator support and areas for improvement.

Results

Of 145 survey respondents contacted, 55 (37.9%) responded. Two additional individuals were recruited from the study advertisement. 20/57 (35.1%) met screening and eligibility criteria. Twenty consented to the study and 60% of those returning a stool sample were in clinical remission (<250ug/g). One individual withdrew after Session 1, 17 (85%) engaged with intervention sessions and 11 (55%) completed at least 5/9 sessions. 16 (80%) of recruited participants completed the post-intervention questionnaire at week 9. Mean score for overall acceptability was 43.4 (0–70). No changes were observed for pain outcomes, but quality of life and pain self-efficacy increased following the intervention. Self-reported disease activity, depression, anxiety, pain catastrophising and avoidance resting behaviour decreased. Qualitative feedback demonstrated the value of particular elements of the intervention, such as thought monitoring and facilitator support. Some participants felt content was oversimplified and that further information was needed on practical management strategies, including diet.

Conclusion

Online CBT for chronic IBD-related pain appears feasible and acceptable. The results demonstrate positive effects for improving quality of life and reducing psychological distress, however online and face to face recruitment methods are recommended. To establish efficacy for reducing pain and improving quality of life, larger randomised controlled trials are required.
N12 An evaluation of the impact of IBDoc in clinical practice 5 years after introduction
Authors: Sugrue K , Gleeson S , McCarthy J , Buckley M
Published: January 2020

Background

Faecal Calprotectin is a well-established biomarker to measure the level of inflammation in the gut. Assessment of calprotectin is important to measure disease activity, effectiveness of treatments as well as predicting relapses in inflammatory bowel disease (IBD). IBDoc® allows reliable testing of faecal calprotectin using a smartphone at home. IBDoc® was introduced at Mercy University Hospital in 2014 and now has 733 users. It has proved hugely popular with patients, has increased medication compliance and promoted self management. The objective of this study was to evaluate the impact of IBDoc® in clinical practice.

Methods

IBDoc® results were monitored over a 6 month period. A total of 240 tests were performed by patients with IBD (age 18–52 years). The results were evaluated to determine suitable clinical interventions, fast track clinic appointments, urgent colonoscopies, change of medical therapy and suitability for Virtual Clinics (VC’s).

Results

Of the 240 tests performed 40% had a normal result, 40% were moderate and 20% were high. All of the normal results avoided clinic appointments which freed up clinic time for patients with active disease and resulted in cost savings for the hospital. 70% of these patients were deemed suitable for future Virtual Clinics which resulted in further cost savings and freed up Consultant time. The majority of patients 60% had moderate or high results. The 20% of results that were high were all booked for urgent colonoscopy. All of the moderate results were fast tracked to clinic and 20% of these had a change of medical therapy.

Conclusion

This study shows the benefits of using IBDoc® in clinical practice. It is central to facilitating a fast track system for patients which results in better outcomes for patients.
89 Simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy
Authors: Rodrigo D , Estandia U , Perez P , Perez C , Cortes A , Panera E
Published: January 2020

We report a 62-year-old man with a past medical history of dyslipidemia, paranoid schizophrenia and permanent atrial fibrillation. A ATTE performed at his district hospital revealed rheumatic mitral valve disease with double lesion: severe regurgitation and mild stenosis, plus moderate tricuspid regurgitation and a mean PAP of 32mm Hg. Cardiac catheterization showed no abnormalities of the coronary arteries.

He was transferred to our hospital and scheduled for mitral valve replacement and tricuspid ring valvuloplasty. Preoperative transesophageal echocardiography showed an abnormal subvalvular mitral apparatus, with false tendons and multiple papillary muscles, resembling a hammock mitral valve. Most cordae tendinae arose from a single dominant papillary muscle at a posterior medial region, which provoke severe mitral regurgitation due to coaptation defect and mild subvalvular mitral stenosis. It could also be appreciated hypertrabeculation in the lateral medial, basal and apical segments. This suggested no-compaction cardiomyopathy associated with hammock mitral valve. Left ventricular systolic function was preserved. No evidence of rheumatic mitral valve disease was found in transesophageal echocardiographic study performed at our hospital.

On the 30th April 2019 he underwent mechanic mitral valve replacement (Bicarbon 29mm) and tricuspid ring valvuloplasty (Edwards Physio 32mm) surgery. Once the patient was weaned from cardiopulmonary bypass, severe left ventricle systolic dysfunction ensued, predominantly localized in the anterior, inferior septal, inferior lateral basal and medial segments. Apical segments had preserved mobility An adrenalin infusion prior weaning from CBP was initiated. Preserved mobility of the mitral prosthesis discs was observed. The patient developed cardiogenic shock in spite of high doses of dobutamin and adrenaline infused. IACB was implanted with 1:1 assistance. The patient was transfered to the hemodynamic room in order to rule out coronary complications. Cardiac catheterization showed no significant angiographic lesions.

During the first postoperative hours, the patient was stabilized allowing progressive lowering of the drugs (adrenaline, dobutamine). TTE showed normally functioning prosthetic mitral valve and preserved left ventricle systolic function. An MRI was performed demostrating no-compaction cardiomyopathy

Conclusion

This case report describes a rare presentation of simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy.

Perioperative left ventricle dysfunction in no-compaction cardiomyopathy is related to subendocardial ischemia caused during extracorporeal circulation in the multiple prominent ventricular trabeculations with deep intertrabecular recesses corresponding to non-compacted myocardium .This must be taken account in those patients with no-compaction cardiomyopathy scheduled for cardiac surgery in order to take preventive measures.

Abstract 89 Figure. non - compacted myocardium
90 Transient severe mitral regurgitation caused by an exclusively dopamine secreting paraganglioma
Authors: Stassen J , Verwerft J , Stroobants D , Herbots L
Published: January 2020

INTRODUCTION

A 93 year old woman presented to the hospital because of severe dyspnea with a sudden onset. Her medical history was positive for a sick sinus syndrome for which she received a DDD pacemaker in 2014. Furthermore an intra-abdominal paraganglioma (PGL) was discovered a year earlier which was treated conservatively because of her age and lack of symptoms.

On physical examination, a sinus rhythm of 88 bpm (pacemaker rhythm) and oxygen saturation of 80% was noted. Blood pressure was 66/38 mmHg. An urgent blood gas analysis showed an elevated blood lactate concentration of 5.5 mmol/l. Her signs and symptoms were compatible with a cardiogenic shock.

Transthoracic echocardiography (TTE) revealed a notable hyperdynamic left ventricular (LV) function and a severe mitral regurgitation (MR) (ERO 0,7 cm2), based on restriction and tenting of both the anterior and posterior mitral leaflet with a systolic pulmonary artery pressure (PAPs) of 70mmHg + CVP.

Because of her age and a written declaration of will, only a supportive therapy with oxygen and morphine was given. After 45minutes however, the patient suddenly and completely recuperated. Her vital signs stabilized with a blood pressure of 110/60 mmHg and oxygen saturation of 95%. A second TTE showed only a mild MR without any restriction of the mitral leaflets and a normalized PAPs of 30mmHg +CVP. The patient was hospitalized for further investigation.

COURSE DURING HOSPITALIZATION

During the next 48 hours, four similar episodes with acute dyspnea and signs and symptoms of cardiogenic shock were documented. Each time, TTE revealed a hyperdynamic LV function with a severe MR, based on tenting of both mitral valve leaflets. These episodes always terminated spontaneously with only a mild residual MR afterwards. An angiography was performed and showed no coronary lesions.

DIFFERENTIAL DIAGNOSIS

Because of the paroxysmal episodes, documentation of a hyperdynamic LV function with severe hypotension and the known PGL, a 24h urine collection was performed. The results demonstrated a markedly elevated urine dopamine concentration (5300 µg/l) with normal concentrations of adrenaline (3.5 µg/l) and noradrenaline (64.3 µg/l). 3-Methoxytyramine, the metabolite of dopamine, was also highly elevated (4700 µg/l). As such, the diagnosis of a dopamine producing PGL was made. The patient refused any treatment and she went home in a palliative setting.

CONCLUSION

Dopamine-secreting PGL is a very rare entity without a classic clinical presentation. This is the first case report showing a severe MR with cardiogenic shock, leading to the diagnosis of a dopamine secreting PGL. The mechanism of the MR is still unclear, but strain measurements did show an exacerbation of the RV pacing induced dyssynchrony during the episodes of shock, hypothesizing that dopamine release exacerbated the pacing induced asynchrony of the papillary muscles, leading to a functional MR.
93 A hemodynamic challenge in assessment of echocardiographic mitral regurgitation severity
Authors: Ferreira J , Morais J , Ferreira H , Roque D , Beringuilho M , Faria D , Freitas A , Morais C
Published: January 2020

Mitral regurgitation severity is, in accordance to current recommendations, typically evaluated by echocardiography. Several hemodynamic factors may influence this evaluation, especially systemic arterial blood pressure at the time of echocardiographic evaluation.

A 71-year-old woman was admitted in our Cardiology ward with acute decompensated heart failure. She had been previously admitted about 3 months earlier by acute decompensated heart failure, and at that time, admission transthoracic echocardiography (TTE) demonstrated mitral regurgitation, which was evaluated as severe. Systolic systemic arterial blood pressure at the time of that TTE was registered as 135mmHg. For further evaluation of mitral regurgitation mechanism, the patient underwent transoesophageal echocardiography (TEE), and in that exam mitral regurgitation was assessed as only moderate. For that exam, patient was sedated with 5mg of intravenous Midazolam, a drug with known secondary hypotensive effect. Although systemic arterial blood pressure was not described in the TEE report, retrospective analysis of nursery blood pressure records showed that patient was hypotensive during exam with systolic arterial blood pressure of 80-90mmHg. Patients was discharged, and in actual admission, concern was raised that mitral regurgitation could have been underestimated in previous TEE due to reduced afterload caused by the hypotensive effect of sedation. It was then decided to repeat TEE, and, in order to counterpose the hypotensive effect of Midazolam, TEE was performed under intravenous continuous infusion of Phenylephrine, a selective α-1 receptor antagonist with a significant vasopressor effect and minimal effect on cardiac contractility. Systolic systemic arterial blood pressure during this exam was recorded as 135-140mmHg. In this exam mitral regurgitation was confirmed as severe and patient was patient was oriented for mitral valve surgery.

DIscussion

This case illustrates the importance of assessment of hemodynamic status of the patient during echocardiographic evaluation of mitral regurgitation severity, and presents a pharmacological strategy to compensate hypotensive effects of sedative agents used during TEE.