bluuebunny/crossref_metadata_2025_split huggingface dataset:
P140 Factors associated with development of NAFLD in patients with inflammatory bowel disease: a 5-year retrospective study on 225 patients
Authors: Domislović V , Knežević-Štromar I , Premužić M , Brinar M , Vranešić Bender D , Milinković A , Matašin M , Mikolašević I , Krznarić Ž 
Published: January 2020

Abstract

Background
Patients with IBD are at higher risk for non-alcoholic fatty liver disease (NAFLD) comparing to general population. Complex pathogenesis of NAFLD in IBD may be related to disease-specific risk factors such as chronic inflammation, steroid exposure, drug induced hepatotoxicity, malnutrition and alteration of gut microbiota, which is emerging as a major factor in the pathogenesis of NAFLD. The goal of the study was to investigate factors associated with NADLF and advanced liver fibrosis (ALF) in patients with CD and UC.

Methods
This is a retrospective study on IBD patients without extraintestinal manifestations and known liver disease. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36, and ALF was defined as FIB-4 ≥ 2.67. Predictors of NAFLD development were analysed using Kaplan–Meier and Cox regression analyses.

Results
In this retrospective study, we have included 225 IBD patients; 72.4% (n = 163) patients with CD and 27.6% (n = 62) patients with UC (median age 41.2 yr, 53.7% males) which were observed for a median of 4.6 years. There were 63.1% (n = 142) patients with normal BMI, 27.6% (n = 62) overweight and 9.3% (n = 21) obese patients. Obese patients had the highest HIS score 43.9 ± 5.9, following with overweight 37.8 ± 5.7 and normal BMI 30 ± 4.3 kg/m2, p &lt; 0.001. During the follow-up obese and overweight patients had higher risk of developing NAFLD comparing to patients with normal BMI (obese HR = 11.1 95% CI 4.3–28.3 and overweight HR = 5.55 95% CI 3.4–9.1, Logrank test p &lt; 0.001) (Figure 1). Regarding FIB-4 score there, was no difference among different BMI categories (p = 0.192), and there was no difference in ALF development in the follow-up period (Logrank test p = 0.91). In Cox proportional-hazards regression significant predictors for NAFLD development were dyslipidaemia HR=2.11, 95% CI 1.2–3.7, overweight HR=6 95% CI 3.6–10, and obesity HR=13.4, 95% CI 7–35.

Conclusion
NAFLD is frequent comorbidity in patients with CD and UC, which can lead to development of advanced liver fibrosis. Our results show that patients with IBD have a high risk of NAFLD development, whereas the increased risk for ALF was not observed. Overweight and obese patients and those with dyslipidemia should be closer monitored due to significantly higher risk of NAFLD. This study points out the complexity disease-specific risk factors and importance of better stratifying IBD patients at risk of NAFLD and advanced liver fibrosis.
P148 Reproducibility of PICaSSO score by using narrow banding images (NBI) to assess mucosal and histological healing in ulcerative colitis (UC) patients
Authors: Cannatelli R , Nardone O , Shivaji U , Smith S C L , Bazarova A , Zardo D , Ghosh S , Iacucci M 
Published: January 2020

Abstract

Background
The endoscopic and histological healing are key therapeutic targets in ulcerative colitis(UC) patients. PICaSSO (Paddington International virtual ChromoendoScopy ScOre)1,2 is a new Virtual Chromoendoscopy Endoscopic (VCE) score to better define mucosal healing by mucosal and vascular features. Originally validated using iSCAN platform, the aim of this study was to evaluate the reproducibility of PICaSSO with NBI near focus platform and to assess if this could predict histological healing.

Methods
We prospectively studied 78 UC patients (mean age 43.4 years, 52.6% male) who underwent colonoscopy for colitis assessment or surveillance using NBI near focus (Olympus, Japan). Endoscopic activity was assessed by using ulcerative colitis Endoscopic Index of Severity (UCEIS) and PICaSSO; whilst histological activity was scored by the Robarts Histology Index (RHI). ROC curves were performed to evaluate sensitivity, specificity and accuracy of endoscopy scores to predict histological healing.

Results
Out of 78 patients, 47 (60.3%) were in clinical remission according to the partial Mayo score. 28(35.9%) and 32(41.0%) were in endoscopic remission according to UCEIS≤1 and PICaSSO≤3, respectively. The best cut-off of UCEIS to predict histological healing was less or equal to 1. Sensitivity, specificity and accuracy were 84.6% (95% CI 63.5, 96.4), 88.5% (95% CI 70.1, 97.8) and 87.2% (95% CI 75.6, 93.6), respectively. The Area Under the ROC curve (AUROC) was 93.3% (95% CI 88.2, 98.3). The best threshold of PICaSSO in the prediction of histological healing was less or equal to 3. PICaSSO ≤ 3 have sensitivity of 96.2% (95% CI 76.9, 100), specificity of 86.5% (95% CI 67.3, 96.2) and accuracy of 89.7% (95% CI 77.6, 96.2) to predict histological healing, estimated as RHI ≤ 3. The AUROC was 95.3% (95% CI 91.1, 99.5).

Conclusion
PICaSSO VCE score can be easily and accurately reproduced with NBI near focus platform and it has better operating characteristics than UCEIS to predict histological healing defined by RHI.

Reference
P155 Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases
Authors: Amihai R , Mishael T , Grisaru-Granovski S , Koslowsky B , Abitbol G , Goldin E , Bar-Gil Shitrit A 
Published: January 2020

Abstract

Background
Inflammatory bowel diseases (IBDs) are commonly diagnosed in reproductive-aged women and can substantially affect pregnancy outcomes. Non-invasive monitoring of IBD during the prenatal course is particularly challenging as traditional laboratory biomarkers are often affected by pregnancy-related physiologic changes. We aimed to evaluate the role of fecal calprotectin (FC) in monitoring disease activity and predicting relapse among IBD women throughout gestation.

Methods
Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2014–2018. FC levels were determined with an enzyme-linked immunoassay.

Results
A total of 265 FC (preconception, n = 41; first trimester, n = 48; second trimester, n = 84; third trimester, n = 76; postpartum, n = 16) measurements were obtained in 157 pregnancies. Higher FC concentrations were found in all time points in those with active disease than those in remission as assessed by either physician global assessment or disease clinical scores. FC levels were significantly correlated with physician global assessment and disease activity indices in all 5 periods of investigation. Excluding those with disease flare at the time of conception, disease relapse was encountered during the prenatal course in 40 (31.5%) of the remaining 127 pregnancies. FC levels were significantly higher in those who experienced a disease flare later in the course of gestation as compared with those who maintained clinical remission (median 341 vs. 224 μg/g, p = 0.04).

Conclusion
FC appears to be a reliable marker of ongoing disease activity throughout the prenatal course as well as a predictor of imminent disease flare among IBD pregnant patients.
P159 Histopathological findings of preclinical inflammatory bowel disease
Authors: Rodríguez-Lago I , Merino O , Azagra I , Maiz A , Zapata E , Higuera R , Montalvo I , Fernández-Calderón M , Arreba P , Carrascosa J , Iriarte A , Muñoz-Navas M , Cabriada J L , Barreiro-de Acosta M 
Published: January 2020

Abstract

Background
The diagnosis of inflammatory bowel disease (IBD) is usually established after the development of symptoms, but preclinical disease may be present years before the final diagnosis. Recently, histology has become one of the main outcomes of IBD treatment. The primary aim of our study was to define the main histological findings of preclinical IBD and its association with the natural history of the disease.

Methods
This multicentric, retrospective study included all patients who participated in the colorectal cancer screening programme in 11 centres between 2009–2014. All patients were firstly assessed by a faecal immunochemical test (OC-Sensor, Eiken Chemical Co., Tokyo, Japan) and, if this test was positive (cut-off 20 μg Hgb/g), a colonoscopy was performed. All patients had an incidental diagnosis of IBD confirmed by histology, according to current ECCO criteria, during a screening colonoscopy. Three histologic findings were evaluated at diagnosis: presence of granuloma, crypt abscesses and/or eosinophilic infiltrate. The main outcomes were the development of symptoms and the risk of proximal disease extension. The frequency of each finding was described separately by IBD subtype and the chi-square test was used to describe possible association with the main outcomes.

Results
During this period we performed 31,005 colonoscopies after 498,227 FIT. Finally, 110 patients were included with an incidental diagnosis of ulcerative colitis (UC, 79 cases), Crohn’s disease (CD, 24 cases) or IBD-Unclassified (IBD-U, 7 cases). Crypt abscesses were present in 56%, 33% and 57% of UC, CD and IBD-U patients, respectively (Figure 1). An eosinophilic infiltrate was observed in 27%, 25% and 57% of patients, respectively. Granuloma were only observed in 4% of CD patients. There were no statistically significant differences in these findings according to IBD subtype (p = 0.14, 0.22 and 0.17 for crypt abscesses, eosinophilic infiltrate and granuloma, respectively). After a median follow-up of 25 months (IQR, 11–42), 36% of patients developed symptomatic disease. Neither of the histological findings were associated with a higher risk of developing symptomatic disease (p = 0.29, 0.78 and 0.3, respectively). No patient showed proximal extension of UC.

Conclusion
Preclinical IBD is frequently associated with the presence of crypt abscesses, especially in UC. Granuloma is probably a late finding in CD. Around one third of patients show a eosinophilic infiltrate in the early phases of the disease.
P162 Prevalence of nafld (non alcoholic fatty liver disease) and fibrosis in inflammatory bowel disease: the impact of traditional risk factors, intestinal inflammation and genetic phenotype
Authors: Scrivo B , Celsa C , Busacca A , Giuffrida E , Pipitone R M , Grimaudo S , Calogero C , Petta S , Cappello M 
Published: January 2020

Abstract

Background
Prevalence of NAFLD has recently been reported increased in inflammatory bowel disease (IBD) with conflicting results due to heterogeneity of published studies, especially in the diagnostic definition of NAFLD. The increased risk of NAFLD might be related to traditional risk factors but also to IBD-related factors. The role of genetic markers has been addressed only in one study. The aim of our study has been to assess the prevalence of NAFLD and fibrosis in a homogeneous cohort of patients with IBD, assessing the role of metabolic, disease-related and genetic factors.

Methods
the diagnosis of NAFLD was based on transient fibroelastometry findings (CAP ≥288 dB/m) and HSI (Hepatic Steatosis Index). Demographic data, traditional risk factors for NAFLD (BMI, lipid profile), comorbities, laboratory tests, disease features (type of IBD, duration, extent, extraintestinal manifestations, relapses/year, disease activity, previous surgery, therapy) were registered in a dedicated database. PNPLA3 rs738409 C&gt;G single nucleotide polymorphism, encoding for I148M protein variant, was investigated by Taqman assay.

Results
208 consecutive patients were enrolled: 120 males, 121 Crohn’s disease, 87 ulcerative colitis, mean age 46,4 ± 15,2 years. 26 patients (12,5%) were on steroids, 121 on biologics. The prevalence of NAFLD was 20,7% with mean HSI being 38,3 ± 4,7.On univariate analysis, patients with NAFLD were older (54,6 ± 11,1 years), had higher BMI (28,1 ± 3,9 vs. 24,1 ± 3,8), had more frequently hypertension and high level of LDL and tryglicerides. No significant difference was found as far as concerns gender, number of relapses, extraintestinal manifestations, disease activity and duration and ongoing therapy. Medium stiffness value was higher in patients with NAFLD (6,4 ± 2,4 vs. 4,8 ± 2,2 KPa). CG phenotype of PNAPL3 was more frequent among NAFLD patients, though the result was not significant. On multivariate analysis age, BMI, previous surgery and level of stiffness &gt; 6,9 kPa were independently related to NAFLD.

Conclusion
This single center cross-sectional study shows that, by using transient elastography, the prevalence of NAFLD in IBD is 20,7% with a significantly increase of liver stiffness and development of fibrosis. NAFLD was related to traditional risk factors (age, BMI, lipid profile) and to previous ileal resection, the last probably due to changes of gut microbiota. Neither intestinal inflammation and drugs nor genetic testing for PNAPL3 seem to be related to the development of NAFLD. Longitudinal studies are warranted to assess the progression of fibrosis and the role of therapeutic interventions.
P164 HLA G expression is differentially expressed in infiltrating cells in inflammatory bowel disease and in healthy specimens
Authors: Ferreira S , Abiodoun Sadissou I , Serafim Parra R , Ribeiro Feitosa M , Sanches Lizarte Neto F , Pretti da Cunha Tirapelli D , Naiara zambelli Ramalho L , Feres O , Ribeiro da Rocha J J , Donadi E A , de Almeida Troncon L E 
Published: January 2020

Abstract

Background
Since HLA-G is an immune checkpoint molecule and since Crohn’s disease (CD) and ulcerative colitis (UC) exhibit immune-mediated mechanism deregulation, we aimed to evaluate HLA-G intestinal expression and soluble (sHLA-G) levels in CD/UC patients, stratified according to CD phenotype/localisation and UC extension.

Methods
HLA-G tissue expression was assessed by immunohistochemistry in biopsies collected from 151 patients (90 CD, 61 UC) and 24 healthy controls, and in surgical resections (28 CD, 12 UC). Plasma sHLA-G levels (97 CD, 81 UC and 120 controls) were evaluated using ELISA

Results
HLA-G expression was observed in intestinal epithelial cells of controls and CD/UC specimens, exhibiting closely similar profiles, and in lamina propria infiltrating cells, exhibiting differential patterns. In biopsies, CD/UC lamina propria plasma cells/lymphocytes presented: i) increased HLA-G expression compared with controls (p &lt; 0.0001), ii) irrespective of the extent, UC cell staining was greater compared with CD cells (p = 0.0011), and iii) the inflammatory CD phenotype presented increased number of infiltrating cells compared with stenosing and fistulizing phenotypes (p = 0.0407). In surgical resections, CD/UC patients exhibited increased infiltrating cell HLA-G expression in lesion areas compared with margins. sHLA-G levels were increased in UC/CD patients (p &lt; 0.0001) when compared with controls, but no difference was observed between patients.

Conclusion
Increased infiltrating cell HLA-G expression associated with increased sHLA-G levels in CD/UC patients may reflect host on-going strategies to suppress chronic inflammation.

References
P166 Inflammatory bowel disease: risk factors to disease activity during pregnancy and postpartum
Authors: Vicente Costa R , Currais P , Simões C , Pinto L , Correia L 
Published: January 2020

Abstract

Background
The literature suggests that inflammatory bowel disease (IBD) activity during the periconceptional period is a risk factor for active disease during pregnancy. This study aims to evaluate if there is influence of IBD characteristics (type, classification, duration, activity in the periconceptional period, severity and treatment of disease) on the frequency of active disease during pregnancy and postpartum.

Methods
Retrospective study that included pregnant women followed in Maternal-Fetal Medicine department at Hospital de Santa Maria diagnosed with IBD, with information on ≥2 of the referred variables and delivery between March 2012 and July 2018 (n = 37; 24 Crohn’s disease, CD and 13 ulcerative colitis, UC). The statistical tests used were chi-square and Fisher’s exact test.

Results
There was no statistically significant difference between CD and CU in the activity of IBD during pregnancy and postpartum.
Diagnosis &gt;5 years and &gt;10 years ago was associated with lower frequency of active disease during pregnancy (15% vs. 78.6%, p &lt; 0.005 and 8.3% vs. 59.1%, p = 0.009, respectively), but did not influence postpartum activity. Age at diagnosis (≤16 years or 17–40 years) did not appear to influence IBD activity.
IBD activity during the periconceptional period and pregnancy had a statistically significant association (72.7% with active disease during the periconceptional period and pregnancy and 26.1% with quiescent IBD at the time of conception but active during pregnancy, p = 0.023). There were 3 cases of IBD remission during pregnancy (2 CD and 1 UC). Of the 15 cases of active disease during pregnancy, 6 of them (40%; 4 with CD and 2 with UC) were reactivations. 3 women had active IBD during the postpartum period and all of them already had active disease during pregnancy. Regarding severity, all cases of active IBD were classified as mild disease.
The type of therapy (biological, corticosteroids, thiopurines, salicylates, antibiotics or lack of therapy) was not related to disease activity during pregnancy or postpartum. Prior bowel surgery related to IBD (n = 7, all with CD) was associated with a lower frequency of active disease during pregnancy (0% vs. 51.7%, p = 0.027).

Conclusion
The diagnosis of IBD for more than 5 or 10 years and previous bowel surgery were associated with a lower frequency of active disease during pregnancy. There was a relationship between IBD activity in the periconceptional period and pregnancy, which reinforces the importance of pregnancy planning and prior disease control.
P169 Balloon enteroscopy in small bowel Crohn’s disease (CD) with suspected bleeding
Authors: LAW N M 
Published: January 2020

Abstract

Background
Deep enteroscopy with Single Balloon Enteroscopy (SBE) has been used in the evaluation of small bowel diseases and could be performed by a single operator. The role and safety of SBE in suspected small bowel CD with bleeding remained uncertain. Our primary aim was to evaluate the role of SBE in the management of suspected small bowel Crohn’s Disease (CD) with bleeding. The secondary aim was to find out whether SBE could provide definitive diagnosis and therapeutic intervention.

Methods
Hospitalised patients with iron deficiency anaemia (IDA) and/or overt GI bleeding were studied. All had prior negative oesophagogastro-duodenoscopy (OGD) and colonoscopy followed by single operator SBE. The indications were IDA in 28 patients, overt GI bleeding in 18 patients and IDA with abdominal pain and/or weight loss in 6 patients. Twenty and six patients had CT scan and capsule endoscopy done respectively with normal or unconfirmed small bowel lesions.

Results
Fifty-two patients with suspected small bowel bleeding were studied with mean age of 51 (range 20 -84) years. Small bowel Crohn’s disease were diagnosed in 7 patients with jejunal and ileal involvement in 2 and 5 patients respectively. All patients had subsequent histopathology confirmation from biopsies taken during the procedures. In addition, SBE allowed the retrieval of a stuck capsule scope in a patient with proximal ileal stricture. Repeated balloon dilatation through SBE was done successfully in one patient with distal ileal stricture without complication.

Conclusion
Small bowel Crohn’s disease was found in 21% of our patients with suspected small bowel bleeding. SBE is the preferred method of small bowel evaluation after negative upper and lower GI evaluation in this selected patients. Definitive diagnosis and targeted biopsies confirmed the diagnosis of CD as compared with radiological imaging and capsule endoscopy. SBE also provided safe therapeutic intervention in those patients with small bowel stricture from CD through endoscopic dilatation.
P170 Clinical characteristics of inflammatory bowel disease associated to hydradenitis suppurativa
Authors: Gutiérrez Casbas A , Muñoz R , Rodríguez A , Sempere L , Cameo J I 
Published: January 2020

Abstract

Background
Hydradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicle characterised by recurrent, painful nodules, abscesses, and sinus tracts. A clinical association between HS and inflammatory bowel disease (IBD), especially Crohn’s disease (CD), has been described in several previous observational studies.The etiology of both diseases is complex and largely unknown, but it appears that the mechanisms behind these diseases are multifactorial, caused by an interaction of genetic and environmental factors, and characterised by a dysregulated local immune response.

Methods
Aims: We performed a retrospective study to further characterise IBD patients diagnosed with HS in a single center.
Methods: A total of 23 patients with well established HS and IBD were identified in our center. Clinical and demographic relevant characteristics were obtained through extensive review of the health records. Each case of HS was confirmed by a dermatologist and was characterised by its location and Hurley’s classification.

Results
We included 23 patients diagnosed with HS and IBD (56,5% women, mean age 27,09 ± 11,17 years and 69,6% were diagnosed with CD). Montreal classification of CD patients was: L1: 31,3% and L2 -L3 62,6%; B1 87,5%, B2 12,5% and B3 12,5%. A total of 11 patients had been operated related to IBD: 7 (63,6%) for perianal disease and 4(36,6%) underwent bowel resection. The most common localisations affected by HS were axillary 11 (47,8%), inguinal 6 (26%), perianal 1 (4,3%), inguinal plus perianal 1 (4,3%), axillary plus inguinal 1 (4,3%), axillar plus perianal plus submammary 1 (4,3%) and scrotum 1 (4,3%). Patients were divided by Hurley’s classification into three categories: 10 (43,5%) as Hurley I, 11(47,8%) Hurley II and 2(8,7%) Hurley III. A total of 14 patients (60,9%) underwent surgery related to HS. Eleven patients (47,8%) were current smokers, 3(13%) former smokers and 9 (39,1%) non-smokers. Thirty percent of the patients had overweight. Seven patients (30%) were treated with antiTNF and 3(13%) with ustekinumab.

Conclusion
Overweight and smoking, risks factors shared by patients with HS and IBD, are presented in 30–50% of our series of patients. HS is more frequent in CD patients with colonic and perianal involvement. This association should be taken into account in IBD patients with these clinical characteristics due to its implication in differential diagnosis of perianal CD and in choosing effective therapy for both conditions.