bluuebunny/crossref_metadata_2025_split huggingface dataset:
P310 The efficacy of linked colour imaging, a novel endoscopic enhancement system, for diagnosing mucosal redness in ulcerative colitis patients in clinical remission
Authors: Takagi T , Uchiyama K , Kajiwara M , Azuma Y , Takayama S , Yasuda R , Inoue K , Ryohei H , Dohi O , Yoshida N , Kamada K , Ishikawa T , Yagi N , Naito Y , Itoh Y 
Published: January 2020

Abstract

Background
Endoscopic mucosal healing is considered as an important therapeutic goal in ulcerative colitis (UC) patients, and several endoscopic evaluations for colonic mucosa such as Mayo endoscopic subscore (MES) and Colitis Endoscopic Index of Severity (UCEIS) are used in clinical practice. Though the strict mucosal healing is defined as MES 0, the relapse of UC has been shown in the patients diagnosed as MES 0. In the present study, we aimed to investigate the efficacy of Linked Color Imaging (LCI), a novel endoscopic enhancement system, to predict long-term prognosis in UC patients diagnosed with MES 0.

Methods
Twenty-six patients with UC in clinical remission and diagnosed with MES 0 were enrolled. Endoscopic colonic images were assessed by LCI and UCEIS, using a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan). Endoscopic LCI images were classified into three subgroups by LCI classification as previously reported. Briefly, LCI patterns were classified as A, no redness; B, redness with visible vessels; and C, redness without visible vessels. Forty months was defined as the time interval between endoscopic diagnosis and relapse of UC. Histological activity was scored according to the Geboes’ score (GS) and the active mucosa was defined by GS&gt;2B.1.

Results
LCI classification can further subdivide the colonic mucosa diagnosed as MES 0. The patients with LCI-A showed no relapse and the non-relapse rates compared with the patients with LCI-B showed significantly higher (p = 0.033), while the relapse rates of the patients with UCEIS 0 showed no difference compared with UCEIS 1 (p = 0.148). There was no statistical difference in the composition of LCI-A and relapse rate between active and inactive mucosa diagnosed by GS score.

Conclusion
Endoscopic LCI classification can further subdivide samples diagnosed MES 0. LCI can be a novel and surpassing approach to evaluate mucosal healing and predict the outcome in UC patients.
P313 Time to second pouchitis episode in a Dutch academic cohort
Authors: de Jong D C , Wasmann K , Buskens C , Bemelman W , Löwenberg M , Gecse K , Ponsioen C , D’Haens G , Hompes R , Duijvestein M 
Published: January 2020

Abstract

Background
Pouchitis is the most frequent long-term complication after proctocolectomy and ileal-pouch anal anastomosis (IPAA) in patients with ulcerative colitis (UC), with a long-term cumulative incidence of 24–59%.1,2 Pouchitis creates an important burden of disease with symptoms including urgency, increased stool frequency, mucinous and/or bloody stools and abdominal cramps. The majority of patients (65%) with an episode of acute pouchitis will experience at least one recurrence.3,4 However, these studies do not specifically address how soon these relapses will occur. The aim of this study is to determine the time until the second episode of pouchitis occurs.

Methods
In total, 353 consecutive UC patients who underwent RPC and IPAA from March 1999 until January 2018 were retrospectively reviewed. Information on the timing of pouchitis was retrieved from the electronic patient database. Baseline was defined as the date when the pouch was put in functional use. Pouchitis had to be objectified by endoscopic assessment at least once at one of the episodes. Patients with isolated ileitis of the afferent limb or cuffitis without pouchitis were excluded.

Results
91 (26%) patients received at least one endoscopic assessment of the pouch that showed pouchitis. Twenty-seven patients (30%) experienced only one episode of pouchitis, 42 patients (46%) had more than one episode and 22 patients (24%) went on to develop a chronic phenotype of pouchitis. The median time until the first episode of pouchitis was 388 days [IQR: 189–1049]. After excluding patients with only a single pouchitis episode and 9 chronic pouchitis patients who were treatment refractory or dependent after the first episode, 55 (60%) patients were assessed for the date of the second episode. Median time from the first episode until the second episode was 433 days [IQR: 272 – 1203] (Figure 1).

Conclusion
In this cohort of UC-IPAA patients, 70% of all pouchitis patients developed more than one episode of pouchitis or progressed into a chronic phenotype. The majority of second episodes of pouchitis occur within approximately 3 years of the first episode.
P317 Key features of bowel ultrasonography in managing inflammatory bowel disease patients
Authors: Les A , Iacob R , Costache R , Gheorghe L , Gheorghe C 
Published: January 2020

Abstract

Background
Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution.

Methods
Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS.

Results
Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p &lt; 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness &gt; 5 mm and for Doppler signal presence in the bowel wall (p &lt; 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up.

Conclusion
The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.
P323 Successful validation of the quantum blue quantitative rapid test to monitor C-reactive protein in capillary blood of patients suffering from chronic inflammatory diseases
Authors: Takacs M , Hellige A , Schuster T , Schleifenbaum S , Föll D , Weber J M 
Published: January 2020

Abstract

Background
Only few biomarkers are useful for the therapy monitoring of patients suffering from inflammatory diseases, like inflammatory bowel disease (IBD) or rheumatoid arthritis (RA). Next to calprotectin C-Reactive Protein (CRP) is the best described and usually measured in the central laboratory. However, most patients are regularly checked at GP’s offices or small ambulatories. These sites need fast results with simple technology to react immediately. Our quantitative CRP rapid test based on lateral flow technology combined with a cost-effective reader fulfils all these criteria. It can be used with serum and whole blood. Here, we report the validation of the Quantum Blue® hsCRP in capillary blood and show first clinical applications of this new test.

Methods
The sandwich-type lateral flow test employing anti-CRP antibody-coated gold nanoparticles was calibrated with the ERM-DA474 CRP reference material. Fingerprick blood was collected and diluted 1:10 with a dedicated capillary blood preparation set and then applied onto the test cassette. After a 15-min incubation, the readout was performed with the Quantum Blue® Reader resulting in a quantitative measuring range of 1 to 20 mg/l. 122 capillary blood/serum pairs were collected to compare this rapid hsCRP test with the fully automated serum CRPL3 (PETIA) test on Roche cobas® c501. Clinical performance data together with concomitant CRP measurements were collated from 20 IBD and 69 RA patients. The resulting capillary blood CRP values including those from 28 healthy subjects were used to establish preliminary clinical cut-off values.

Results
56 capillary blood/serum sample pairs with values within the measuring range of both the hsCRP and the CRPL3 PETIA could be elected for a quantitative comparison. The capillary blood values were corrected against a mean haematocrit of 42%. A strong correlation (R = 0.941) with a minor bias of 6.1% by Bland-Altman plot was observed. Non-parametric analyses of capillary blood CRP levels from 20 IBD and 69 RA patients vs. their disease activity scores (CDAI, Mayo, DAS28, active joints) resulted in an upper reference limit of 5.8 mg/l and a 95%ile reference range from 1.0 to 19.7 mg/l. Patients with moderate (IBD) to severe (IBD, RA) disease activity could be significantly discriminated by capillary blood CRP from those with low activity or remission.

Conclusion
The BÜHLMANN Quantum Blue® hsCRP rapid test allows fast and easy detection of CRP in human capillary blood within 15 min in ambulatory settings. The assay shows an excellent absolute correlation to a fully automated serum CRP reference method. A preliminary clinical cut-off of 5.8 mg/l was established in two cohorts of IBD and RA patients to discriminate high from low disease activity.
P338 The effectiveness of a standardised biologic care pathway in the management and treatment of inflammatory bowel disease
Authors: Willett N , Heisler C G , Nazer N , Currie B , Phalen-Kelly K , Stewart M , Jones J 
Published: January 2020

Abstract

Background
inflammatory bowel disease (IBD) is a class of chronic immune-mediated diseases. Biologics have revolutionised the treatment of IBD. Existing literature suggests significant variation exists in the use of biologic treatment among physicians, from provider-specific prescribing to completion of the pre-biologic workup. These differences may influence the effectiveness of achieving and maintaining long-term remission. Clinical care pathways can standardise the use of biologics, improve patient outcomes, and increase consistency of care. The aim of the project was to determine whether the use of biologics to treat IBD managed within a standardised biologic care pathway (BCP) is safer and more effective compared with the current standard of care.

Methods
This was a retrospective, real-world cohort study of a prospectively implemented evidence-based BCP at the Nova Scotia Collaborative IBD (NSCIBD) program between 2015 and 2019. Patient inclusion criteria consisted of an adult with a diagnosis of IBD (including Crohn’s disease, ulcerative colitis, IBD-Unclassified) aged 18 years or older who was managed within the NSCIBD program. Preliminary descriptive analyses of the data are presented. Data collection is ongoing and multivariate analyses will be presented in full at ECCO.

Results
In total 249 patients were included in the cohort study (111 BCP patients, 138 non-BCP patients). The mean age was 49 years (range of 17–86 years). Sixty-nine per cent (171/249) of patients were diagnosed with CD, 28% (70/249) with UC, and 3% (8/249) with IBD-U. The mean duration of disease was 13 years (range of 0–36 years). Use of combination therapy was similar between the cohorts with 64% of BCP patients (n = 102) and 63% of non-BCP patients (n = 123) on combination therapy. Thirty-eight per cent of the BCP cohort required dosing interval changes vs. 29% in the non-BCP cohort (0.24 fold higher in BCP cohort). Seventy-one per cent of the BCP patients were exposed to TDM vs. 41% of the non-BCP cohort (0.40-fold more TDM in pathway cohort). Although 34% of BCP patients and 38% of non-BCP cohort patients reached clinical remission (n = 103 and 125, respectively), 38% of BCP patients and 21% of non-BCP patients achieved endoscopic remission (0.5-fold lower in the non-BCP cohort), (n = 29 and 53, respectively).

Conclusion
Preliminary analyses suggest patients managed within a BCP have their biologic management guided more often by the results of TDM and objective biomarkers than those not managed within a BCP. Although clinical remission was observed to be similar between the cohorts, attainment of endoscopic remission was more likely amongst patients managed within the BCP. Additional multivariate analyses will be presented at ECCO with a larger cohort size.
P340 Comorbidity is associated with safety outcomes in vedolizumab- and ustekinumab-treated inflammatory bowel disease patients
Authors: Asscher V , Biemans V , Pierik M , Dijkstra G , Van der Meulen-de Jong A , Löwenberg M , van der Marel S , de Boer N , Bodelier A , Jansen J , West R , Haans J , van Dop W , Weersma R , Hoentjen F , Maljaars J 
Published: January 2020

Abstract

Background
The effect of comorbidity on treatment outcomes of vedolizumab and ustekinumab in inflammatory bowel disease (IBD) patients is currently unknown. We aimed to assess the impact of comorbidity on safety and effectiveness of therapy in vedolizumab and ustekinumab treated IBD patients.

Methods
In this multi-centre prospective ICC Registry study, IBD patients from 10 IBD centres in the Netherlands starting vedolizumab or ustekinumab in regular care were enrolled. Prior to therapy initiation, comorbidity prevalence was assessed using the Charlson Comorbidity Index (CCI), a weighted index accounting for 16 comorbid diseases among which cardiovascular and pulmonary disease. The effect of an increased CCI was determined on safety outcomes (infection, all-cause hospitalisation and adverse events) during treatment and effectiveness outcomes (clinical response: reduction of ≥3 points in HBI/SCCAI, clinical remission (HBI ≤ 4/SCCAI ≤2), corticosteroid-free remission and biochemical ((CRP ≤5 mg/l and FCP ≤200 μg/g) combined with clinical remission) at 52 weeks of follow-up. Confounders were accounted for using multiple logistic regression.

Results
We included 203 vedolizumab and 207 ustekinumab treated patients: mean age 42.2 (SD 16.0) and 41.6 (SD 14.4) years, median HBI 7.0 (IQR 5.0–10.0) or SSCAI 5.0 (IQR 3.0–8.0) and median HBI 7.0 (5.0–11.8). Median treatment duration 54.0 (IQR 19.9–104.0) and 48.4 (IQR 24.4–55.1) weeks, median follow-up time 104.0 (IQR 103.1–104.0) and 52.0 weeks (IQR 49.3–100.4), respectively. More cardiovascular disease (congestive heart failure, myocardial infarction, peripheral vascular disease and cerebrovascular accidents/transient ischaemic attacks) and more pulmonary disease were present in vedolizumab patients at baseline (Table 1). CCI associated independently with safety outcomes in vedolizumab and ustekinumab. In vedolizumab, CCI associated with infection (OR 1.387, 95% CI 1.022–1.883, p = .036) and hospitalisation (OR 1.586, 95% CI 1.127–2.231, p = .008). In ustekinumab, CCI associated with hospitalisation (OR 1.621, 95% CI 1.034–2.541, p = .035). CCI did not associate with time to treatment cessation or effectiveness.

Conclusion
Comorbidity associated with all-cause hospitalisation in vedolizumab and ustekinumab treated IBD patients. A significant impact on infections was found only in vedolizumab treated patients. This study underlines the importance of comorbidity assessment in these IBD patients.
P345 Lack of anti-TNF drugs levels in fistula tissue: A reason for non-response in Crohn’s perianal fistula?
Authors: Adegbola S , Sarafian M , Sahnan K , Pechlivanis A , Phillips R , Knowles C , Haddow J , Warusavitarne J , Faiz O , Tozer P , Holmes E , Hart A 
Published: January 2020

Abstract

Background
Anti-TNF therapy is recommended as a treatment for patients with Crohn ́s perianal fistulas. However, a significant proportion of patients have a sub-optimal response to anti-TNF therapy. Higher serum levels of anti-TNF agents have been associated with improved outcomes in perianal Crohn’s disease. Currently, it is unknown whether anti-TNF agent levels can be detected in tissue from fistula tracts themselves and whether this is associated with response.

Methods
We undertook a pilot study to develop a method to measure fistula tissue levels of anti-TNF medication (infliximab and adalimumab) using a targeted proteomic technique that employs ‘signature peptide detection’ following trypsin digestion called ultraperformance liquid chromatography–mass spectrometry (UPLC-MS), to quantify a protein. The targeted UPLC- MS/MS detection and quantification method implemented were previously validated. Biopsies were obtained from patients with Crohn’s disease who underwent an examination under anaesthesia for worsening fistula symptoms despite maintenance anti-TNF therapy. Idiopathic (cryptoglandular) tissues from purposively sampled matched (age/gender) patients were analysed as negative controls and these samples were spiked with anti-TNF drugs as positive controls.

Results
Tissue was sampled from the fistula tracts of seven patients with Crohn’s perianal disease (5 patients were on adalimumab and 2 patients were on infliximab). The limit of detection (LOD) and linearity range of the method was assessed for each drug in the spiked idiopathic fistula samples. Infliximab and adalimumab had a LOD of 0.004 and 2 μg/ml respectively with linearity demonstrated for both drugs. The anti-TNF drugs, infliximab and adalimumab, were not detected in fistula samples from any of the Crohn’s patients despite detection in ‘spiked’ positive control samples. In addition, to validate the result, samples were concentrated (x10) and still there was no detection of the drugs in the test samples.

Conclusion
The anti-TNF drugs adalimumab and infliximab were not detected in fistula biopsy samples from patients with Crohn ́s perianal fistulas with refractory symptoms despite maintenance therapy. This raises the question on the role of tissue penetrance of anti-TNF drugs in response to therapy. Further work is required in a larger number of patients to validate the findings observed and investigate whether any correlation exists between tissue and serum levels of anti-TNF and clinical outcome.
P349 Infliximab in inflammatory bowel disease: Is premedication necessary?
Authors: Núñez P , Figueroa C , Flores L , Ibáñez P , Kronberg U , Lubascher J , Pizarro G , Quera R , Simian D 
Published: January 2020

Abstract

Background
The use of infliximab (IFX) in inflammatory bowel disease (IBD) has been associated with a 1–6% risk of infusion reactions. The usefulness of premedication with corticosteroids, paracetamol and/or antihistamines is controversial. The aim of this study is to assess, in IBD patients on IFX, whether there are differences in secondary reactions to the infusion between those who use premedication or not.

Methods
A retrospective cohort study was performed identifying patients with a diagnosis of IBD who received IFX at a tertiary centre in Santiago-Chile, since 2009. Acute reactions were defined as those that occurred in the first 24 h post-infusion and late reactions for more than 24 h. Infusion reactions were classified as mild, moderate and severe. Descriptive and association statistics were used (χ 2; p &lt; 0.05).

Results
Sixty-four patients were included with 1,263 infusions in total, 52% men (characteristics in Table 1). Median infusions per patient were 22 (2–66). All induction infusions were administered with premedication and in maintenance, 57% of them. Premedication was given with hydrocortisone, chlorphenamine and paracetamol. Flow chart according to premedication use or not is shown in Figure 1. In the maintenance group, there were 10/718 (1.4%) infusion reactions with premedication and 3/358 (0.8%) without it, non-significant differences (p = 0.432). In the induction group, there were 8/187 (4%) infusion reactions, significantly higher when compared with both maintenance groups (Figure 2).

Conclusion
In this cohort, premedication use in maintenance phase was not effective at reducing the rate of infusion reactions due to IFX. These results suggest that premedication would not be necessary during maintenance.
P353 Assessing compliance to screening for infectious diseases and vaccination in patients newly diagnosed with inflammatory bowel disease
Authors: Pringle R , Assadsangabi A 
Published: January 2020

Abstract

Background
Patients are frequently counselled on vaccinations and screened for infectious diseases prior to starting immune-modulating therapy; however, the most up-to-date ECCO guideline on the subject (1) recommends vaccination screening and completion at diagnosis. We assessed adherence to the ECCO guidelines in patients diagnosed with inflammatory bowel disease (IBD).

Methods
Medical records from 100 IBD patients up to 6 months of their diagnosis were analysed retrospectively at a tertiary IBD centre in the UK. Data were collected for infectious diseases screening, documentation of vaccination history and education/advice on vaccination. Vaccination rates for diphtheria, tetanus, pertussis, polio, hepatitis B, human papillomavirus (HPV), influenza, pneumococcal and varicella-zoster were documented if they were recorded in the medical notes.

Results
A total of 84% of patients were not screened for infectious diseases at diagnosis or within 6 months. Overall, 97% had no vaccination history documented and 97% were not advised to attend their GPs for vaccinations.

Conclusion
Despite the existence of international guidelines, poor compliance to vaccination in patients with IBD has been shown in line with previous reports (2). This suboptimal vaccination compliance could be partly due to poor documentation and the retrospective method of data collection. However, there is clearly an urgent need for education and execution of vaccination guidelines in IBD. This implementation of work is now ongoing at our unit through automatic formal standard vaccination notification on every IBD clinic visit, which will be further re-audited in 6 months’ time.