bluuebunny/crossref_metadata_2025 huggingface dataset:
P793 Infliximab and prevention of colectomy in acute severe ulcerative colitis: an individual patient data meta-analysis
Authors: Wang Z , Afif W , Hanžel J , Kobayashi T , Papamichail K , Roblin X , Peyrin-Biroulet L , Vermeire S , Dreesen E
Published: January 2023

Background

Infliximab (IFX) is used to treat patients with acute severe ulcerative colitis (ASUC) who fail to respond to intravenous corticosteroid therapy. Yet, a significant proportion of patients does not respond adequately and requires colectomy. Our aim was to explore baseline predictors of colectomy-free survival during IFX rescue therapy in patients with steroid-refractory ASUC.

Methods

We performed an individual patient data meta-analysis (IPDMA) with data retrospectively collected from hospitalised, corticosteroid-refractory patients diagnosed with ASUC (based on Truelove and Witts’ criteria) who received IFX rescue therapy. Baseline characteristics including sex, smoking status, disease extent, disease duration, Mayo endoscopic subscore, serum albumin, C-reactive protein, haemoglobin, and white blood count were evaluated as predictors of colectomy-free survival at three and twelve months after start of IFX therapy. Data were analysed using R software (v4.2.0).

Results

Data were collected from six centres contributing a total of 140 patients (Table 1). Fifteen patients (10.7%) required colectomy within three months and another eight patients underwent colectomy by one year (total colectomy rate after one year 16.4%) (Figure 1). No baseline predictors of colectomy-free survival were identified (log-rank P>0.05). Patients who received intensified IFX induction therapy (n=64, >5 mg/kg), in contrast to patients on regular induction doses of 5 mg/kg at weeks 0-2-6 (n=49), did not have lower rates of colectomy.

A total of 53 IFX serum trough concentrations (TC) were measured in 31 patients. The median IFX TC during weeks (w)1-2 of therapy was 13.5 mg/L (interquartile range [IQR] 9.3-16.3 mg/L), and 7.0 (IQR 1.9-12.0) mg/L during w3-6. Target attainment rates were 8.3% (1/12 patients) and 18.2% (2/11 patients), respectively, towards the previously reported IFX TC targets of 28.3 mg/L at w2 and 15.0 mg/L at w6 for achieving endoscopic remission at w12.1 IFX TCs during induction were not significantly different between patients who received standard and intensified induction therapy.

Conclusion

Colectomy rates remain a significant burden of ASUC even for patients receiving IFX. In our interim IPDMA, we did not identify baseline predictors of colectomy-free survival. Poor target attainments of the previously established concentration targets demand dose optimisation. Pharmacometrics modelling of the IFX dose-exposure-biomarker/measure-response relationship within the spECTRUM consortium (DEFINE study) will facilitate dose-finding simulations to demonstrate the value of model-informed therapeutic drug monitoring.

References:

1. Papamichael et al. Clin Gastroenterol Hepatol. 2016.
P800 Upadacitinib is effective and safe for Crohn’s Disease: prospective real-world experience
Authors: Friedberg S , Choi D , Hunold T , Choi N K , Garcia N M , Picker E A , Cohen N A , Cohen R D , Dalal S R , Pekow J , Sakuraba A , Cleveland N K , Rubin D T
Published: January 2023

Background

Upadacitinib (upa) is a novel selective JAK-1 inhibitor that has demonstrated efficacy in the treatment of moderate to severe ulcerative colitis (UC) and Crohn’s disease (CD) and has received regulatory approval for UC. We report our prospective real-world experience with upadacitinib in patients with CD.

Methods

We performed a prospective analysis of clinical outcomes during upa therapy in patients with CD using pre-determined follow-up intervals at weeks 0, 2, 4, and 8 as part of a formalized treatment evaluation protocol at our institution. We used the Harvey Bradshaw Index (HBI), C-reactive protein (CRP) and fecal calprotectin (FCP). Clinically active disease was defined as HBI ≥5. Clinical response was defined as a decrease of ≥ 3 points from baseline HBI. Clinical remission was defined as HBI <5. Corticosteroid free clinical remission (CSFR) was defined as those in clinical remission, not taking any form of systemic corticosteroid at the specific time point. CRP normalization was defined as baseline elevated and then within the normal range for the lab used (Quest Diagnostics (Secaucus, NewJersey) ≤8 mg/L or University of Chicago Medicine ≤5 mg/L). FCP response and remission was assessed at three different cutoffs: less than 250 μg/g, 150 μg/g, and 50μg/g. Adverse events were recorded as treatment-related adverse events (AE) and serious adverse events (SAE).

Results

47 patients with CD received ≥4 weeks of upa (Table 1). 100% had previously received anti-TNF therapy and 93.6% had received ≥2 advanced therapies (biologic, small molecule, calcineurin-inhibitor). At weeks 4 and 8, 16/21 (76.2%) and 12/16 (75.0%) achieved clinical response and 14/21 (66.7%) and 11/16 (68.8%) achieved clinical remission by 8 weeks, respectively (Table 2). Of those who were on steroids at baseline, 100% (5/5) achieved CSFR. Results were seen as early as week 2 with clinical remission rates of 52.6%. Mean HBI decreased from 6.7 (SD 4.6) at week 0 to 3.5 (3.7) at week 8 (Figure 1). Mean FCP decreased by 707.0 (SD 1026.0) μg/g at week 0 to 74.6 (SD 56.2) μg/g at week 8. Of those with FCP >150 μg/g at baseline, 100% (4/4) achieved FCP <150 μg/g by week 8 (Table 2). Mean CRP decreased by 12.8 (SD 19.1) mg/L to 4.9 (SD 8.0) mg/L at week 8. Of those with CRP >5 mg/L at week 0, 80% (4/5) achieved CRP <5 mg/L by week 8 (Table 2). 23.4% of patients had an AE after starting upa (Table 3). The most common of these was acne (14.9%). Two AEs led to discontinuation and there was a single possible SAE (anemia which was also multifactorial from severely active Crohn’s ileitis and vitamin B12 deficiency).

Conclusion

In this large, prospective real-world experience in medically-resistant patients with CD, we describe that upadacitinib is rapidly effective and safe.
P807 Pregnancy and maternal outcomes in a cohort of patients with Inflammatory bowel disease: Encouraging data from a multi-disciplinary clinic in a tertiary center
Authors: Avni Biron I , Hayat L , Ollech J E , Banai-Eran H , Narkis B , Houri O , Pauker M H , Shay V , Dotan I , Hadar E , Yanai H
Published: January 2023

Background

Pregnant women with inflammatory bowel diseases (IBD) are prone to adverse pregnancy outcomes. This study aimed to assess pregnancy outcomes and disease management for pregnant patients with IBD treated at a multi-disciplinary IBD- maternal-fetal medicine (MFM) clinic.

Methods

This retrospective cohort study included consecutive pregnant patients with IBD having a singleton gestation who attended the IBD-MFM clinic at the Rabin Medical Center between 2012 and 2019. We assessed disease activity and flare management at conception and through pregnancy for the IBD cohort. Pregnancy outcomes of interest included: adverse neonatal and obstetrical outcome and mode of delivery. We also assessed three integrative outcomes: a favorable and a poor pregnancy outcome and an unfavorable maternal outcome. The IBD pregnant cohort was compared with a cohort of non-IBD pregnant women who gave birth at the same shift (1:5-10 control). Multivariable logistic regression was used for risk assessment.

Results

141 IBD pregnant patients and 1119 non-IBD pregnant women were included. Mean maternal age 32[±4] years. IBD patients had a higher rate of nulliparity (70% [50/141] vs. 30% [340/1119], p<0.001) and had a lower BMI (21.42 kg/m2 [19.18-23.44] vs. 22.48 [20.31-25.59], p=0.002). All other baseline characteristics were comparable. Among the IBD patients, 60% (85/141) were diagnosed with Crohn’s disease (CD), and the rest with ulcerative colitis (UC). At conception, 88% (124/141) were in clinical remission, 83% (117/141) were on maintenance therapy, and 30.5% (43/141) were on biologics. Through pregnancy, 36.2% (51/141) flared, 14% (20/141) received systemic steroids, and 3% (2/141) initiated a new biologic. Flares were significantly more frequent among patients with UC vs. CD (48.2%, [27/56] vs. 28.2%, [24/85], p=0.015). The majority of neonatal and obstetrical outcomes and all three composite outcomes were comparable between the IBD pregnant and the non-IBD cohorts, table 1. Cesarean delivery was more frequent among the IBD pregnant patients compared with the non-IBD pregnant women (34.8%, [49/141] vs. 24.1%, [270/141], p=0.021). Risk analysis revealed that a diagnosis of IBD was not associated with either a favorable or a poor pregnancy outcome, nor an unfavorable maternal outcome, see table 2.

Conclusion

In this IBD-pregnant cohort followed at a multi-disciplinary IBD- MFM clinic, outcomes were encouraging and comparable with the non-IBD cohort. A diagnosis of IBD was not associated with pregnancy or maternal outcomes.
P813 A scoping review on the assessment and improvement of health-related physical fitness in patients with Inflammatory Bowel Disease
Authors: Demers K , Bak M T J , Bongers B C , de Vries A C , Jonkers D M A E , Pierik M J , Stassen L P S
Published: January 2023

Background

Reaching the STRIDE-II therapeutic targets for inflammatory bowel disease (IBD) requires an interdisciplinary approach. Lifestyle interventions focusing on enhancing and preserving health-related physical fitness (HRPF) may aid in improving subjective health, decreasing disability, or even controlling inflammation. However, ambiguity remains about the status and impact of HRPF (body composition, cardiorespiratory fitness [CRF], muscular strength [MS], muscular endurance [ME], and flexibility) in IBD patients, hindering the development of physical activity and exercise guidelines. The aim of this scoping review was to provide an overview of the literature assessing HRPF components of interest (i.e., CRF, MS, ME, and flexibility) in IBD patients, as well as how HRPF is affected by physical activity and physical exercise training interventions.

Methods

A systematic search was performed in multiple databases up to 5 Nov 2022. Eligible studies included IBD patients and assessed HRPF components of interest or evaluated physical activity or physical exercise training interventions.

Results

The search yielded 7323 articles, of which 68 were included (Figure 1), with a median sample size of 42 (IQR 24–77). Of these studies, 53 were conducted in adults and 15 in children or adolescents. Most studies (n=32) focused on patients with Crohn's disease (CD), followed by studies that included both CD and ulcerative colitis (UC) patients (n=30) and studies that included only UC patients (n=6). A total of 56 studies assessed HRPF components, including CRF, MS, and ME (n=2); CRF and MS (n=5); MS and ME (n=7); CRF (n=13); MS (n=28); and ME (n=1) (Figure 2). Great heterogeneity existed in assessment methods, with frequent use of non-validated field tests (Table 1). According to limited studies that used gold-standard tests, CRF appears to be reduced in IBD patients, but controversial findings emerged regarding MS and ME. Physical activity or physical exercise training interventions in patients with IBD were evaluated in 22 studies, with only ten reporting effects on HRPF, overall indicating a favorable impact. However, most studies included only patients in remission or with mild disease activity, lacked proper patient selection based on HRPF, and the type and intensity of interventions varied across studies.

Conclusion

This review highlights a lack of literature on the accurate assessment of HRPF in patients with IBD, leading to a scarcity of evidence on the effect of physical activity and physical exercise training interventions. Future research should focus on validating practical field tests, elucidating the association between HRPF and patient-reported and clinical outcomes, and determining the optimal physical training paradigm for IBD patients.
P816 The efficacy of an over the counter multivitamin and mineral supplement to prevent opportunistic infections in patients with inflammatory bowel disease in remission
Authors: Laheij R , van Knippenberg Y , Heil A , Mannaerts B , Bruin K , Lutgens M , Sikkema M , de Wit U , Laheij R
Published: January 2023

Background

Patients with inflammatory bowel disease (IBD) treated with immunomodulators or biological therapy are at increased risk of infections. Malnutrition and vitamin or mineral deficiencies are common among patients with IBD. The results of various studies have indicate that vitamin deficiencies might increase the risk of infections.

Methods

Single-centre, randomized, double-blinded, placebo-controlled clinical trial to compare a multivitamin and mineral supplement (vitamin group) versus identical in appearance placebo (placebo group). Patients with Crohn’s disease or ulcerative colitis using immunomodulators and/or biological therapy without vitamin deficiency were considered for participation in our study.

Participants were asked to take a daily multivitamin and mineral supplement or placebo and report the occurrence of infections during a 24 weeks period of follow up. The primary endpoint of this study was the difference in incidence of infection between the two groups measured by a validated questionnaire, the revised version of the ID screen to assess infection13.

Randomization was conducted by using computer generated random numbers with an allocation ratio of 1:1 to vitamin supplement or placebo in blocks of 8 and stratified according to type of IBD.Results

Between July 2020 and February 2021, 320 patients were randomized. Treatment arms consisted out of 162 and 158 for vitamin and placebo, respectively. Both groups showed similarity in patient characteristics. All patients were included in the intention-to -Treat (ITT), 265 patients in the per protocol (PP) (compliance >80%) analyses. For both groups, 107 patients reported an infection during the 24 weeks follow up period (Unadjusted Odds Ratio: 0.93 (95% confidence interval: 0.56-1.48). In the vitamin group, 32 patients received antibiotics for an infection compared with 21 patients in the placebo group (Unadjusted Odds Ratio: 1.61 (95% confidence interval: 0.88-2.93). 166 patients in the PP analysis reported an infection (Unadjusted Odds Ratio: 0.91 (95% confidence interval: 0.55-1.50), 23 reported a serious infection (Unadjusted Odds Ratio: 2.57 (95% confidence interval: 1.02 -6.46). None of the patients was hospitalized due to serious infection.

Conclusion

An over the counter multivitamin and mineral supplement did not reduce the risk of infection for patients with IBD in remission with immunomodulators and/or biological therapy.
P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis
Authors: Brunet E , Melcarne L , Llovet L P , Garcia-Sague B , Vela E , Cleries M , Pontes C , García-Iglesias P , Puy A , Villoria A , Calvet X
Published: January 2023

Background

Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia.

Methods

Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD.

Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC).

Results

Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals.

The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient.

Conclusion

Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.
P837 Incidence, evolution of disease phenotype, time to biological therapy and medium-, long-term surgery rates in IBD-U patients in Western Hungary – a population-based study between 1977–2020, data from the Veszprem county cohort
Authors: Gonczi L , Lakatos L , Golovics P A , Pandur T , David G , Erdelyi Z , Szita I , Lakatos P L
Published: January 2023

Background

The number of epidemiological population-based studies on unclassified inflammatory bowel disease (IBD-U) patients are very limited. The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course of IBD-U since 1977. Our aim was to evaluate incidence, prevalence, disease course, time to biological therapy and surgery rates in a prospective population-based database of incident IBD-U patients diagnosed between 1977 and 2018, with follow-up until 2020.

Methods

Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, time to first biological therapy, disease progression, and colectomy was registered.

Results

Data of 119 incident IBD-U patients were analyzed (male/female: 55/64; median age at diagnosis: 34 years(y) (IQR: 24-47)). Adjusted mean incidence rate was 0.76 (CI95%: 0.63-0.9) /105 person-years in the total study period, and 0.96 (CI95%: 0.79-1.16) /105 person-years between 1990-2018. Disease extent at diagnosis was proctitis in 7.6%, one-sided colitis (left-sided colitis, or isolated right-sided colitis) in 36.1%, and extensive (pancolitis) in 56.3%. The probability of progression in colonic disease extent was 6.7% (SE:2.3) at 3 years, 10.3% (SE:2.8) at 5 years and 15.3% (SE:3.4) at 10 years. Figure 1. The probability of developing terminal ileitis, thus disease classification change – Crohn’s disease was 2.6% (SE:1.5) at 5 years and 3.5% (SE:1.7) at 10 years. Figure 2. Perianal disease developed in 5% (n=6) of all patients during the total follow-up. The probability of receiving biological therapy in patients diagnosed after the year 2000 (n=62), was 15.5% (SE:4.8) at 5 years, and 19.4% (SE:5.3) at 10 years. Figure 3. The overall resective surgery rate was 16.8% at the end of follow-up. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal- or total colectomy. The cumulative probability of resective surgery was 7.6% (SE:2.4) at 1 year, 9.3% (SE:2.7) at 5 years, 13.5% (SE:3.3) at 10 years, and 18.5% (SE:3.9) at 20 years. Figure 4.

Conclusion

Initial disease phenotype was severe in most cases of IBD-U and colonic progression is substantial over time. Disease classification change to Crohn’s disease with development of terminal ileitis or perianal disease was low. High rates of biological therapy and surgery are suggestive of a severe disease course of IBD-U.
P839 Clinical activity in inflammatory bowel diseases is associated with consumption of processed foods
Authors: Sarbagili Shabat C , Zelber-Sagi S , Fliss Isakov N , Hirsch A , Ron Y , Thurm T , Maharshak N
Published: January 2023

Background

Western diet and its food components have been suggested to influence inflammatory bowel diseases (IBD) clinical course. However, the association of dietary processing factors and disease activity is uncertain. We aimed to evaluate whether intake of foods with varying processing levels is associated with disease activity in IBD patients.

Methods

A cross-sectional study of adult patients with IBD was performed at a tertiary center between August 2019 to June 2022, by collecting clinical and dietary data from consecutive patients who signed an informed consent form. Clinical activity was defined using HBI (Crohn's disease) and SCCAI (ulcerative colitis). Dietary intake was assessed using a dedicated validated processed food questionnaire (PFQ) that categorizes dietary intake into three groups of processed food levels: unprocessed or minimally processed, processed, and ultra-processed. Adjusted odds ratios for disease activity were determined using a multivariate logistic regression.

Results

A total of 242 IBD patients (62.8% Crohn’s disease patients) were enrolled, of whom 73.1% were in clinical remission. Comparing the higher tertile to the lowest tertile of foods consumption - unprocessed foods (OR 0.29, 95% CI 0.13-0.65) and processed foods (OR 0.40, 95% CI 0.19-0.82) were negatively associated with disease activity, while high consumption of ultra-processed foods was positively associated with active disease (OR 2.24, 95% CI 1.05-4.77). All ultra-processed food subgroups were positively associated with higher odds of active disease.

Conclusion

Higher intake of unprocessed or minimally processed foods was associated with lower odds of clinically active IBD, while higher ultra-processed foods intake was associated with higher odds of active disease. Further studies are needed to evaluate the impact of different levels of food processing on disease activity.
P840 Longitudinal bidirectional association of physical activity and disease activity in children with Inflammatory Bowel Disease: a cohort study
Authors: Dehbidi Assadzadeh L , Youn E Y J , Huang F , Djani L , Belmesk L , Madagh S , Kanters C , Yang X , Chennou F , Geng S Y , Bouthot J , Colette D , Jantchou P
Published: January 2023

Background

Studies have shown that regular physical activity (PA) can contribute to lower inflammatory markers over time in pediatric patients with an inflammatory bowel disease (IBD). However, patients with active disease may be less prone to engage in PA and therefore, develop sedentary habits. No study so far, have investigated if clinical disease activity (CDA) can affect PA longitudinally and if PA may impact disease outcomes. The aim of this study was to investigate the bidirectional association between PA and CDA in a cohort of children and adolescents with IBD.

Methods

IBD patients of CHU Sainte-Justine pediatric hospital were prospectively surveyed using the Canadian Health Measures Survey Children’s Physical Activity Questionnaire during outpatient visits every three months for one year. PA levels were classified according to Canadian moderate-to-vigorous PA (MVPA) recommendations. Clinical data was collected retrospectively through patients’ files. CDA was determined at baseline and at each follow-up visit.

Results

A total of 247 IBD patients (median age [IQR], 15 years [13-17]; 55% male) were included. Among them, 167 (68%) were diagnosed with Crohn’s disease and 80 (32%) with ulcerative or indeterminate colitis. At the initial visit, 65% of patients were considered in clinical remission, 28% of patients were considered “sedentary”, 21% “moderately active”, 31% “extremely active” and 25% “vigorously active”. Patients classified as “extremely active” (34-74 minutes of daily MVPA) at initial visit were less likely to have active CDA at follow-up (odds ratio (OR) [95% CI]: 0.30 [0.09-0.96]). Inversely, CDA at baseline did not correlate with PA levels at follow-up. BMI, sex and age did not significantly affect PA level or CDA between follow-ups.

Conclusion

This study demonstrates a possible protective association between higher PA level and CDA over time in pediatric IBD. These findings stress the importance to engage children with IBD in regular physical activity.
P841 Implication of Clostridioides difficile in the diagnosis and evolution of patients with pediatric inflammatory bowel disease
Authors: Palomino Pérez L M , Delgado Fernández-Valdés M , Velasco Rodríguez-Belvís M , Cañedo Villarroya E , De la Mano Hernández A , Dominguez Ortega G , Martínez Pérez J , Martinez Navarro G , Martín Fernández C , Di Campli Zaghlul M , García Hernández P , Sánchez Llorente P , Muñoz Codoceo R A
Published: January 2023

Background

In the recent decades, the incidence of Clostridioides difficile (Cd) infection in children with inflammatory bowel disease (IBD) has increased, possibly due to underlying dysbiosis. The main objective of this study is to compare the prevalence of this infection in patients with IBD and without it, as well as secondarily to describe risk factors for Cd and its impact on the evolution of IBD.

Methods

Unicentric, observational and retrospective study of paediatric patients (<18 years old) undergoing Cd screening at the Hospital Infantil Universitario Niño Jesús in the last 5 years. Patients with IBD were those who met the Porto criteria. Statistical analysis was performed using SPSS.

Results

3,360 paediatric patients were included. Of the 150 patients whose screening was requested by the Digestive Section, 87 had IBD. There were no statistically significant differences in the prevalence of infection in patients with IBD compared to other patients (p=0,061).

According to the Paris Classification, no differences were found in relation to the prevalence of Cd infection, except for patients with growth impairment (G1), with a higher prevalence of infection compared to those without (G0) (33.3% vs. 13.9%) p<0.05. Regarding treatment, a higher prevalence of Cd infection was observed in patients receiving aminosalicylates monotherapy (42.9% vs. 13.4%) p<0.05 and in patients receiving NEE in monotherapy (60% vs. 15.8%) p<0.05. In contrast, a lower prevalence of Cd was observed in patients treated with azathioprine (with or without other therapies) compared to those not receiving azathioprine (10.3% vs. 26.2%) p<0.05. A lower prevalence of positives was also observed among those treated with biologics (with or without other therapies) (8% vs. 23.2%) p<0.05.

Patients with IBD in whom the test was positive required more frequent changes in their baseline treatment than those who had negative screening (72.2% vs. 14.9%, p<0.05).

Conclusion

Although it has not been demonstrated that Cd is more prevalent in patients with IBD, it does seem to condition the course of the disease, being patients in whom more treatment changes have been made. Given the complexity of the data related to infection rates in relation to the different treatments, further studies in pediatric patients with concomitant IBD and Cd are considered necessary to confirm such differences and explain the possible pathophysiology.
P845 Increased incidence of herpes zoster in patients with Inflammatory Bowel Diseases in Europe
Authors: Marijam A , Vroom N , Bhavsar A , Posiuniene I , Lecrenier N , Vroling H
Published: January 2023

Background

Immunocompromised (IC) patients, including those with autoimmune Inflammatory Bowel Diseases (IBD), are at increased risk for herpes zoster (HZ). HZ affects one in three adults aged ≥50 years, with complications of post-herpetic neuralgia (PHN) in around one in ten affected adults. PHN impacts patients’ health-related quality of life and is difficult to treat. Both HZ and PHN place a financial burden on healthcare systems. The objective was to systematically review the incidence of HZ in IC populations.

Methods

A systematic literature review was performed to identify observational studies reporting on the HZ incidence in a broad range of IC populations in the European Union/European Economic Area, Switzerland and United Kingdom (2002-2022). The results for IBD patients are reported here.

Results

Overall, 26 studies reported HZ incidence rates, with three reporting on IBD patients.

In Valencia, Spain, using hospital and primary care data in adult patients (≥18 years), HZ incidence rates were higher in IBD patients versus non-IC patients, and increased with age (Table 1). In this study, IBD versus non-IC patients had significantly higher rates of HZ complications (7.67 [3.51-14.57] vs. 2.64 [2.42-2.86] per 100,000 person-years [PY]) and of HZ recurrence (2.48 [2.06-2.96] vs. 1.56 [1.53-1.59] per 100 PY), driven by high rates in patients ≥60 years.1

In England, data from the Clinical Practice Research Datalink matched IBD patients (≥18 years) to non-IC patients. HZ incidence was higher in IBD versus non-IC patients and increased with age (Table 1).2

From German claims data (2012) in over ten million adults (≥18 years), HZ incidence in patients with ulcerative colitis and Crohn’s disease were higher than in the non-IC population (Table 1).3

Table 1. HZ incidence rate (per 1,000 person-years) in IBD versus non-IC patients

Conclusion

Three large real-world studies confirmed significantly higher HZ incidence rates in IBD versus non-IC patients, with higher rates in older age groups. These findings support healthcare providers and guideline committees in reinforcing HZ prevention strategies for IBD patients. An adjuvanted recombinant HZ vaccine is the first approved for use in IC populations, and may help reduce the healthcare system and patient burden.

References:

1Muñoz-Quiles et al. BMC Infect Dis 2020; 20(1): 905;

2Yanni et al. BMJ Open 2018; 8(6): e020528;

3Schröder et al. J Infect 2017; 75(3): 207-15.

Funding: GlaxoSmithKline Biologicals S.A. funded this study and all costs related to publications development.
P848 Risk of Orthorexia Nervosa in Patients with Inflammatory Bowel Disease: A Link with Eating Disorders?
Authors: Di Giorgio F M , Modica S P , Ciminnisi S , Saladino M , Muscarella S , Melatti P , Brinch D , Petta S , Cappello M
Published: January 2023

Background

Self-imposed food restrictions are common in patients with inflammatory bowel disease (IBD) because oftheir erroneous belief of the role of food in disease worsening and, recently, eating disorders have alsobeen described. Orthorexia nervosa is characterized by the obsession of eating healthy and natural foods.Only a few studies have assessed orthorexia in patients with digestive disease and there are no studies inIBD. The aim of this study is to assess the risk of orthorexia in patients with IBD.

Methods

158 consecutive subjects were prospectively recruited from February to October 2022 in a tertiary referralcenter: 113 patients with IBD and 45 healthy controls. The cohort of IBD patients consisted of 74 patientson biologic drugs, 28 patients on conventional therapy, and 12 patients admitted to the ward for diseaseflares. Demographic and clinical data were collected, and the ORTO-15 questionnaire, validated by Doniniet al., was used to assess the risk of orthorexia.

Results

Patients with IBD had a prevalence of orthorexia of 77%, significantly higher than the 47% observed in thecontrol group (p <0.001). No statistically significant differences between patients with and without risk oforthorexia in relation to age (p=0.66), gender (p=0.37), marital status (p=0.78), educational status (p=0.88),and occupation (p=0.64) were found, although a nonsignificant trend could be observed for a lower BMI inpatients with risk of orthorexia compared with those without orthorexia (mean BMI 26.7 VS 25 kg/m2,p=0.12). The prevalence of orthorexia did not differ in relation to the diagnosis of UC or CD (p=0.98), nor tothe duration (p=0.75), the type of biological or conventional therapy (p=0.42), disease activity as measuredby Mayo score/HBI (p=0.47), and the presence of ostomy (p=0.33). The only statistically significantdifference observed concerned the history of previous surgery for IBD in patients with orthorexia (19.5percent), versus 3.8 percent in patients without orthorexia (p=0.05).

Conclusion

Our study showed that most patients with IBD has a risk of orthorexia and that this is associated with alower BMI and a history of previous surgery for IBD. Further research is warranted to evaluate the clinicalimpact of orthorexia in patients with IBD and its relationship with the avoidant restrictive food intakedisorder (ARFID) or other eating disorder. Evidence based counselling by a qualified dietician is stronglywarranted in IBD clinics.
P851 Impact of an integrated model of care for inflammatory bowel disease on direct healthcare costs: A population-based matched cohort study from Saskatchewan, Canada
Authors: Maldonado F , Penz E , Jones J , Pena-Sanchez J N
Published: January 2023

Background

Integrated models of care (IMC) for IBD lead to reduced hospitalizations, surgeries, comorbidities, and overall improved outcomes. There are limited studies assessing the impact of IMC on direct healthcare costs. We aimed to estimate the impact of exposure to an IMC on direct healthcare costs among individuals diagnosed with IBD.

Methods

We conducted a quasi-experimental difference-in-difference (DID) cost analysis using administrative health data from Saskatchewan, Canada. We included individuals ≥18 years old meeting a validated administrative IBD case definition between January 2009 and March 2015. IBD cases were classified as exposed or non-exposed to the Saskatchewan IMC and required to have three years of healthcare coverage after baseline (i.e., first visit with an IMC [exposed] or a non-IMC [non-exposed] gastroenterologist). The direct healthcare costs were derived from the administrative databases, adjusted to 2014/15 Canadian dollars, and categorized into hospitalizations, physician visits, and medication claim costs (i.e., immunomodulators [IMM], biologics [BIOL], aminosalicylates[5-ASA]). Propensity scores (PS) were calculated based on healthcare utilization and comorbidities in the 12 months before baseline. Cases (exposed) were matched 1:5 controls (non-exposed) based on PS and disease duration. DID estimators were determined for each cost category using mixed linear regression models including age, sex, disease type, and area of residence as covariables.

Results

In total, 2905 IBD cases were included in the study, 597 exposed and 2308 non-exposed individuals (Figure); the majority were females (52%), lived in urban areas (74%), and had Crohn’s Disease (61%). The mean age was 44.6 years (SD=15.5) and the average disease duration at baseline was 5.7 years (SD=5). In comparison to the non-exposed group, the costs of physician visits (IBD-related [DID= $-139, 95%CI -209 to -68], IBD-specific [DID=$-155, 95%CI -212 to -97], and specialty visits [DID=$-135, 95%CI -201 to -69]); and IMM dispensations (DID=$-18, 95%CI -35 to -2) were lower in the exposed group. Conversely, we identified higher total healthcare costs (DID=$1707, 95%CI 369 to 3044); IBD-related medication (DID=$2341, 95%CI 1484 to 3197) and BIOL (DID= $2467, 95%CI 1605 to 3328) dispensations costs in the exposed group. There were no other statistically significant differences between the groups.

Conclusion

We identified lower physician visit and IMM costs in the exposed group than in the non-exposed one. Total healthcare costs were higher among the exposed group, largely driven by higher BIOL costs. These results highlight the potential cost impact of IMC for IBD and the need for cost-effectiveness studies of IMC to further assess value of this care model.
P855 The impact of the severe financial crisis on drug persistence and disease course in IBD patients in Lebanon
Authors: Sharara A , Ibrahim M A , Allam J , Haidar-Ahmad D , Chalhoub C , Francis R
Published: January 2023

Background

Lebanon is currently going through an unprecedented financial crisis (considered as one of the worst in the world in modern times) that has affected all aspects of everyday life. In particular, the economical crash has significantly crippled the Lebanese healthcare sector, resulting in severe shortages of basic drugs and medications, most of which cannot be produced locally. Patients with chronic diseases including those with Inflammatory Bowel Disease (IBD) have been impacted most given their need for costly and chronic treatment including biologics.

Methods

We collected data using a 12-question web survey disseminated through social media platforms of the patient organization, I Battle Disease. The questions aimed to explore the patients’ ability to acquire the necessary medications, whether they had to alter or completely stop their treatment, and any resulting complications (forced corticosteroid use, hospitalization, or surgery) it had on the course of their disease.

Results

102 patients completed the survey. The patients were nearly evenly split between Crohn’s disease (53%) and ulcerative colitis (47%). Adalimumab was the most commonly used medication before the economic crisis (30%), followed by infliximab (18%), vedolizumab (10%), ustekinumab (8%), and tofacitinib (8%). Azathioprine and 5-ASA monotherapy were used by 8% and 19% of patients respectively. All biologics and small molecules used to be covered fully by third party payors including the National Social Security Fund (38%), the Ministry of Public Health (22%), and private insurance (18%). As a result of the crisis, the majority of patients (69%) declared stopping or interrupting their treatment in the past 3 years, with most (46%) having interrupted treatment for >12 months. 22% of patients reported switching to azathioprine due to issue in access to biologics. Additionally, 69% of patients reported worsening of their condition after stopping treatment, resulting in forced steroid use (36%), switching to another medication (36%), or unscheduled hospital admission (15%). Further, 66% of participants confirmed that they had to purchase their medications from abroad or through a local private vendor using out-of-pocket foreign currencies. Finally, 12% of patients reported that they had to immigrate or seek employment abroad due to difficulty with drug access.

Conclusion

The recent financial and economic events in Lebanon have imposed significant challenges on patients with IBD, affecting their adherence to therapy and consequently the control of their disease. There is an urgent need for action within the public health context to improve IBD medication availability and accessibility for the Lebanese population.
P856 Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDs with Inflammatory Bowel Disease: results from the Prospective Urban Rural Epidemiology (PURE) study
Authors: Narula N , Wong E C L , Pray C , Marshall J K , Rangarajan S , Islam S , Bahonar A , Alhabib K F , Kontsevaya A , Ariffin F , Co H U , Al Sharief W , Szuba A , Wielgosz A , Diaz M L , Yusuf R , Kruger L , Soman B , Li Y , Wang C , Yin L , Mirrakhimov E , Lanas F , Davletov K , Rosengren A , Lopez-Jaramillo P , Khatib R , Oguz A , Iqbal R , Yeates K , Avezum Á , Reinisch W , Moayyedi P , Yusuf S
Published: January 2023

Background

Several medications have been considered to contribute to the aetiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.

Methods

This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results

During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p<0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.

Conclusion

Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.
P864 Frailty is associated with fatigue in older patients with Inflammatory Bowel Disease
Authors: Fons A , Asscher V , van der Meulen-de Jong A , Stuyt R , Baven-Pronk M , van der Marel S , Jacobs R , Mooijaart S , Kalisvaart K , Maljaars J
Published: January 2023

Background

Fatigue is a common and debilitating symptom experienced by patients with inflammatory bowel disease (IBD). Studies focusing on fatigue in IBD were conducted in a relatively young population. However, little is known about the prevalence and factors associated with fatigue in the older population with IBD and how it relates to frailty.

Methods

The aim of this study was to determine the prevalence of fatigue and to identify factors associated with fatigue in older patients with IBD. Data were used from a prospective, multicenter cohort study, that included both older patients with IBD (aged > 65 years) and younger patients with IBD (aged < 65 years). Patients aged < 65 years served as a control group to compare the fatigue prevalence found in older patients. A geriatric assessment (including the Geriatric 8 (G8) questionnaire) was performed to measure frailty at baseline in older subjects. Fatigue was evaluated using one item from the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Univariable and multivariable regression analysis were performed to assess factors associated with fatigue in older patients with IBD. Active disease was defined as the presence of clinical or biochemical disease activity.

Results

Fatigue prevalence in 405 older patients with IBD varied between 45.8% (71/155) in patients with active disease to 23.6% (59/250) in patients with disease in remission. In younger patients, fatigue prevalence varied between 59.5% (47/79) in active disease to 55.3% (42/76) in disease in remission. Multivariable analysis showed a significant association between fatigue and depression (Odds ratio (OR) 2.98, 95% confidence interval (CI) 1.23-7.17), sleeping disturbances (OR 4.25, 95% CI 2.40-7.54), use of immunomodulators (OR 2.24, 95% CI 1.15-4.38), and an abnormal frailty screening (G8) (OR 2.02, 95% CI 1.14-3.57). Frailty measured by geriatric assessment (OR 2.47, 95% CI 1.49-4.12) was also independently associated with fatigue. No association was found between fatigue and disease activity in multivariate analysis.

Conclusion

Fatigue has a lower prevalence in older patients with IBD compared to younger patients with IBD, but the prevalence increased sharply when active disease is present. Fatigue in older patients is associated with depression, sleeping disturbances and use of immunomodulators. Moreover, both risk of frailty in frailty screening and frailty measured in a geriatric assessment associate with fatigue in older patients with IBD.
P866 Skin lesions among consecutive Inflammatory bowel disease patients in outpatient setting
Authors: Jonaityte I R , Kiudelis G , Valiukeviciene S , Kupcinskas J , Jonaitis Prof. L
Published: January 2023

Background

It is well known that skin lesions may be frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). During literature analysis we found out that there is an obvious lack of epidemiological data regarding this issue. Therefore, the aim of our study was to establish the prevalence of skin lesions among consecutive IBD patients in outpatient department.

Methods

Prospective study included out-patients with IBD who were managed in the hospital of Lithuanian University of Health Sciences from January to October of 2022. Patients completed the questionnaires including the demographic and the IBD data and history or present state of cutaneous lesions. We considered skin lesions related to IBD or its treatment if they were diagnosed following the diagnosis of IBD. Skin lesions which were reported before the diagnosis of IBD were considered as not related to IBD.

Results

152 patients were included, mean age (MA) – 42.0±13.9 years. There were 88 (57.9%) males and 64 (42.1%) females. Ulcerative colitis (UC) was diagnosed in 110 (72.4%) patients, Crohn’s disease (CD) – in 42 (27.6%) patients. MA of UC patients was 42.3±13.6, CD – 41.1±14.9, p>0.05. In total, skin lesions were indicated by 65 (42.8%) subjects. According to our criteria, in 46 (30.3%; 95% CI: 23-38%) cases, skin lesions were considered as obviously related to IBD or its treatment. We further analyzed latter cases.

Among UC patients, 32 (29.1%; 95% CI: 20-38%) had skin lesions related to IBD, among CD patients – 14 (33.3%; 95% CI: 18-48%), p>0.05.

Erythema nodosum was diagnosed in 6 (3.9%) patients, pyoderma gangrenosum – 5 (3.3%), acne – 1 (0.7%), psoriasis – 9 (5.9%), vitiligo – 2 (1.3%), epidermolysis bullosa acquisita – 1 (0.7%), hemorrhagic vasculitis – 1 (0.7%), eczema – 9 (5.9%), allergic rash – 4 (2.6%).

The comparison of different skin lesions among UC and CD patients is presented in table 1.

Among the patients with UC proctitis, skin lesions were reported in 2 of 15 (13.3%) patients; among left-sided colitis – in 8 of 27 (29.6%); among pancolitis – in 22 of 67 (32.8%), p=0.03 between the groups of proctitis and pancolitis.

Comparing the different forms of CD, skin lesions were reported in 3 of 15 (20.0%) patients with ileitis, 4 of 10 (40.0%) patients with colitis and 7 of 17 (41.2%) patients with ileocolitis; p>0.05 between different groups.

Conclusion

In our series the prevalence of skin lesions obviously related to IBD or its treatment is 30.3%. There were no differences in the prevalence of skin lesions between the UC and CD patients. The most common skin lesions in UC were psoriasis and skin eczema, in CD – erythema nodosum and skin eczema. Cutaneous lesions were significantly more prevalent in extensive UC compared to distal disease.