bluuebunny/crossref_metadata_2025_split huggingface dataset:
P010 Case Study of a Patient With Crohn's Disease and Surgical Wound Dehiscence
Authors: Jaqueline Barros , Madhoor Ramdeen , Giedre Herrerias , Adilson Cardoso , Everton Silva , Bruna Velozo , Julio Baima , Rubia Alencar , Rogerio Saad-Hossne , Ligia Sassaki 
Published: December 2019

CASE:
Background: Specialized nursing care makes all the difference in the management of patients with inflammatory bowel disease (IBD). The aim of the study is to report the experience of an IBD nurse in Brazil, caring for a patient with Crohn's Disease (CD), with emphasis on nurse empowerment as a member of the multidisciplinary team. Methods: Case study with a description of the nurses' behavior regarding an outpatient CD patient from São Paulo State/Brazil. Data were collected through outpatient follow-up and home visits from December 2017 to April 2018. Consultations were performed by an IBD nurse, a general nurse and a stomatherapist. To obtain the data, we used the clinical anamnesis, physical examination and visualization of the records in the patient's medical record. Results: Male patient, 20 years-old, presenting stenosing and fistulizing ileocolonic CD since 2009. Refractory to Adalimumab, using Infliximab 10mg/kg every 8 weeks and Azathioprine 50 mg/day. In December 2017, he underwent Hartmann rectosigmoidectomy for intestinal sub-occlusion, requiring provisional ileostomy. The surgery was succesful and the patient remained at postoperative rest in the hospital for five days. Two days after hospital discharge, the patient sought emergency room due to several abdominal pain, especially in the surgical incision; edema and seropurulent exudate, which required removal of the stitches, resulting in surgical wound dehiscence. The patient's first evaluation after surgery at the IBD nursing outpatient clinic occurred four days after hospital discharge. The patient reported having a good recovery, did not perform any kind of physical activity, kept the diet as directed by the nutritionist, maintained good hygiene of the incision and that his mother was changing the stoma bag as directed by the nurse. The open surgical wound had full-length fibrin tissue, exudate, greenish discharge, characteristic odor, presence of biofilm, measuring 15 cm in height and 5 cm in width. After discussion with the multidisciplinary team, we opted for second intention healing. For cleaning the wound bed we used the 10-minute gauze-soaked Polyhexanide Solution, the primary dressing was performed with the adaptive polyester mesh impregnated with fatty substances, hydrocolloids and silver particles and then the secondary dressing with gauze and microporous tape. Primary dressing was done once a week by nurses and secondary dressing daily by the patient's mother after training. Complete wound healing took 4 months and after that, the patient resumed daily activities more safely. Conclusion: In this context, it was clear that the nurses' knowledge about the disease, the correct management of postoperative complications enabled the more agile and effective progress of wound treatment, favoring better quality of life for the patient and allowing reflection on the subject exposed.
P011 Clinical Outcomes of Primary Sclerosing Cholangitis in IBD Patients: A Single Center Experience
Authors: Martins Camilla , Elisa Caon Ana , Cruz Marilia , Barros Luísa , Azevedo Matheus , Carlos Alexandre , Queiroz Natália , Milani Luciane , Oba Jane , Rocha Beatriz , Leite André , Sipahi Aytan , Cançado Eduardo , Damião Adérson 
Published: December 2019

BACKGROUND:
Primary sclerosing cholangitis (PSC) is a chronic and progressive cholestatic disease associated with Inflammatory Bowel Diseases (IBD) in 70% of cases. When combined, they present as one distinct phenotypical disease referred as PSC-IBD with milder clinical course, despite of more extensive colonic involvement and an increased risk of malignancies. The aim of this study was to assess the prevalence, characteristic features and long-term complications of PSC-IBD patients from a quaternary hospital in Brazil.

METHODS:
We retrospectively reviewed all PSC-IBD patients registered and followed-up in our center between January 2000 and July 2019. Conventional colonoscopic and histological criteria were used to diagnose IBD, whereas radiographic or histological criteria for PSC. Medical records were abstracted for the following data: demographic characteristics; duration, extent, and treatment of IBD; duration, extent, and treatment of PSC; colorectal neoplasia (dysplasia and cancer); surgical treatment for IBD; liver transplantation and death.

RESULTS:
In total, 84 patients with concurrent PSC and IBD were identified. Of 84 cases, 74 (87%) had Ulcerative Colitis (UC) and 11 (13%) were diagnosed with Crohn’s disease (CD). There was a slight predominance of male, 46 (54%). The mean age at both IBD and PSC diagnosis was 31 and 36 years, respectively. Most of them were diagnosed with IBD prior to PSC. The mean IBD duration was 15 years and 10 years in PSC subjects. The prevalence of pancolitis in UC patients was 80%. All CD cases presented ileocolonic involvement. Present or past smoking history was observed in 4 patients (4.7%). Aminosalicylates were the most common treatment used for IBD in 54 patients (64.3%). 15 of them (18%) were on monotherapy with immunobiologics and 7 patients (8.3%) were on combotherapy. Only 1 subject was on anti-integrin. In our cohort, 55 cases (66.7%) were treated with deoxycholic acid. Colorectal neoplasia and cholangiocarcinoma was observed in 6 (7%) and 2 patients (2.3%), respectively. Colorectal dysplasia was found in 12 subjects (22%) on a routine colonoscopy. Overall, 18 patients (21.4%) required proctocolectomy and 9 cases (10.7%) have undergone orthotopic liver transplant. There were 12 deaths, mainly PSC and cancer-related.

CONCLUSION(S):
This is the largest cohort of concomitant PSC and IBD patients in Latin America. In our center, we have found higher rates of extensive IBD although few of them were on biologics. The present data on cancer and dysplasia are consistent with reports in the literature.
P016 Microscopic Colitis With Quiescent Crohn’s Disease: A Case Report
Authors: Bommena Shoma , Alishahi Yasmin 
Published: December 2019

CASE:
Microscopic Colitis (MC) coexistent in patients with inflammatory bowel disease (IBD) is rare. It is not clear if this is merely a chance association or results from a common genetic predisposition or pathophysiological pathway. It has also been hypothesized that MC is a part of spectrum of IBD. We report a case of Crohn’s disease whose clinical course was complicated by collagenous colitis while on adalimumab. This is a case of a 62-year-old veteran with past medical history of tobacco dependence, GERD and Crohn's disease. Crohn’s colitis was diagnosed in 2000 and patient was treated with adalimumab with mucosal healing and histological remission. She was diagnosed with microscopic colitis in August 2017 that was treated with budesonide. Each time the budesonide was titrated off, her microscopic colitis would flare and during one of the titrations, she required hospitalization. Colonoscopy during this time showed no endoscopic evidence of active colitis. The mucosa appeared normal and biopsies throughout the colon revealed quiescent disease. Biopsies, however, did show irregularly thickened collagen table entrapping small capillaries and inflammatory cells consistent with collagenous colitis. There was no evidence of acute inflammation, granuloma, dysplasia or malignancy. She was placed back on budesonide 9 mg daily which resolved her symptoms of diarrhea. Microscopic Colitis (MC) and inflammatory bowel disease (IBD) differ in their epidemiology, clinical symptoms, endoscopic findings and histopathology. Colonic mucosa appears normal on endoscopy and crypt architecture is not distorted typically in microscopic colitis. A retrospective observational study of 31 patients with both IBD and MC showed a common feature of having long standing Ulcerative Colitis (UC) at a younger age with onset of CC (collagenous colitis) at an older age. Findings of specific negative associations with Crohn’s disease were detected for a number of taxa within the family of ruminococcaceae, in a study of microbiome in new onset Crohn’s disease. Several species of this family are important for the maintenance of gut homeostasis. A recent study on gut microbiota in collagenous colitis demonstrated that the patients with CC displayed a shift in some taxa, like the ruminococcaceae family, which resembles the above-described IBD associated dysbiosis. This could indicate that the pathogenesis of the diseases might have mechanisms related to the gut microbiome in common. The association between collagenous colitis and IBD is still unclear. In patients with Ulcerative Colitis or Crohn’s disease, the onset of new symptoms of non-bloody diarrhea with no signs of IBD relapse on endoscopy, mucosal biopsies should be obtained to rule out MC.
P020 Serum Ustekinumab and Anti-Ustekinumab Antibody: Analysis of Over 2000 Patient Results Using Lab Developed Electrochemiluminescent Immunoassays (ECLIA)
Authors: Yang Jane , Chun Kelly 
Published: December 2019

BACKGROUND:
Ustekinumab (UST) is a monoclonal interleukin-12 and -23 antagonist. To optimize efficacy, clinicians need to establish target concentrations based on studies elucidating UST pharmacokinetics and the relationship between serum UST and desired clinical and endoscopic outcomes. IM-UNITI data (n = 397) suggest a target UST trough concentration (TC) of >1 ug/mL at steady state (week 24) (1). Other smaller studies suggest week 8 and maintenance TC cutoffs of 2 and 4.5 ug/mL, respectively (2,3). In March 2018, therapeutic drug monitoring (TDM) to measure UST drug and anti-drug antibodies (ADAb) was launched. Here, 2098 ustekinumab patient results were analyzed.

METHODS:
Measurements of UST drug (free, ADAb-unbound) and anti-ustekinumab antibody (total including IgM and IgG subtypes) were performed by lab-developed ECLIA [2]. All ADAb positive samples are confirmed by a signal suppression test. Lower limits of quantitation are 0.1 ug/mL for UST and 40 ng/mL for ADAb. These ECLIAs were tested by Janssen R&D (Spring House, PA) for specificity, sensitivity, drug tolerance, accuracy, and precision and found to strongly agree with Janssen’s own R&D assays used in clinical trials (4). Clinical histories and blood collection timing are unknown.

RESULTS:
Of 2098 measured samples, 95.9% (2012) were ADAb-free and only 4.1% (86) had measurable anti-ustekinumab antibodies. In the absence of ADAb, UST concentrations ranged 0.1 to >32 ug/mL. Due to a highly sensitive lower limit of quantitation (0.1 ug/mL), only 38 (1.9%) had undetectable drug (<0.1). Of all ADAb-free samples, 9.2% were <1.0 and 24.6% were <2.0. Interestingly, half (50.4%) had UST less than 4.0. High UST (>10) occurred in 8.9% while 38.8% were 4.0–10. A small subset of patient samples (2.1%) had very high UST >20. Anti-ustekinumab antibodies ranged 42 to 9634 ng/mL. Only 3 of 2098 samples had ADAb > 1000; mean concomitant UST was undetectable. Most ADAb titers were 40–99 with a mean free UST of 4.5 ug/mL.

CONCLUSION(S):
Most samples received for UST monitoring were negative for anti-ustekinumab antibody and had UST <10 ug/mL. The therapeutic range for UST has yet to be firmly established. If a therapeutic cutoff of 1.0 ug/mL is used, then clinicians must be aware of the need for an adequately sensitive UST assay. Here, we found that 9.2% were <1 ug/mL. Using a cutoff of 2 ug/mL, 24.6% were below target. And if the threshold is 4.0 ug/mL, then the majority (50.4%) would be considered sub-therapeutic. Gastroenterologists are currently using TDM to try to optimize UST; therefore, better-established target concentrations for UST would be beneficial.
P031 A Rare Case of Crohn’s Disease and Hemophilia Presenting With Acute Massive Gastrointestinal Bleeding
Authors: Ahmed Hamed , Hamed Amira , Lambert Karissa , Ali Eslam 
Published: December 2019

INTRODUCTION:
Coexistence of Inflammatory bowel disease (IBD) and Hemophilia is rare. IBD is a chronic inflammatory condition that is known to be associated with a hypercoagulable state, while hemophilia is due to a deficiency of blood coagulation factors leading to prolonged bleeding. Acute massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). This case reports an unusual initial presentation of Crohn’s disease with massive (GIB) in a patient with hemophilia.

CASE PRESENTATION:
A 19 year old Caucasian male with history of mild Hemophilia A presented with a 1 week history of painless hematochezia. He denied any abdominal pain, rectal pain, nausea, vomiting, and diarrhea. He denied tobacco, alcohol, and recent NSAID use. On physical examination, patient was tachycardic, had mild abdominal tenderness, and hematochezia on rectal exam. Laboratory finding was significant for an acute drop in hemoglobin from 10.7 g/dL to 6.7 g/dL. Given history of hemophilia, factor VIII level was checked and low at 44 % [normal range of 55%–145%]. Patient was resuscitated with fluids and blood products and given factor VIII replacement. Esophagogastroduodenoscopy was unremarkable. Given his young age and painless hematochezia, meckel’s scan was performed and was unremarkable. Subsequently, patient underwent a colonoscopy which surprisingly revealed an inflamed, erythematous, and ulcerated ileocecal valve. The endoscopic findings along with the pathological findings were consistent with CD. Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein were elevated. Patient was started on prednisone and was scheduled a close hospital follow-up with gastroenterology clinic.

CONCLUSION:
IBD is rarely associated with inherited bleeding disorders like hemophilia. In this subset of patients, CD may present with an acute painless GIB. IBD is associated with a hypercoagulable state. However, it can still occur in patients with a bleeding disorder.
P037 Patterns of Care Among Patients Treated With Ustekinumab for Crohn’s Disease: Results From a Chart Review
Authors: Ruetsch Charles , Davis Tigwa , Clerie Jennifer , Obando Camilo , Izanec James , Muser Erik 
Published: December 2019

BACKGROUND:
Crohn’s Disease (CD) is a chronic, progressive disease that causes severe and debilitating symptoms often leading to hospitalizations and surgeries. Biologic therapy can treat the underlying pathology, but treatment non-response is common. In 2016, the FDA approved ustekinumab for the treatment of adult patients with moderately to severely active CD who have failed or were intolerant to conventional therapy or failed or were intolerant to treatment with one or more TNF blockers. The study objective was to use chart data to characterize CD patients starting ustekinumab.

METHODS:
Of the medical charts for 109 adult CD patients who initiated ustekinumab therapy (index), 100 charts (92%) for patients who remained on UST therapy at six months were analyzed. Variables extracted from charts included patient demographics, CD-related complications, CD medication use, disease duration, and lab values. The 3 measurement periods were: 1) historical (up to 3 years prior to index); 2) pre-index period (6 months prior to index) and 3) post-index period (6 months following index dose).

RESULTS:
The study sample was mostly female (65%) and Caucasian (58%) with a mean age of 42.2 ± 14.9 yrs and a disease duration of 9.6 ± 10.5 yrs. Of the 100 patients, 82% were bio-experienced, including 45 who had already failed at least two biologics prior to starting ustekinumab. Adalimumab was the most recent biologic used in 49% of patients, followed by vedolizumab (21%), infliximab (17.5%), and certolizumab (12.3%). The most common reasons for switching to ustekinumab were secondary loss of response (48%), followed by primary non-response (15%), and side effects (13%). During the pre-index period, 18 (17%) reported a CD-related complication (e.g., fistula, obstruction, anemia, etc.) and these complications resolved in 16 of 18 patients (89%) during the treatment period. In the post-index period, only 50% of patients had at least one lab test in the chart and only 2% underwent a colonoscopy. Over the treatment period, steroid used decreased by 61% from 23% of the study population pre-index to 9% post-index (P < 0.01).

CONCLUSION(S):
Three-fourths of patients who started ustekinumab had previously failed other biologic therapies, and over 90% remained on ustekinumab for at least the six months after initiating treatment. During this time, most patients had resolution of their CD-related complications and most patients on steroids were able to discontinue them.
P048 Mesenchymal Stromal Cells of Bone Marrow Reduce the Risk of Postoperative Recurrence of Crohn's Disease
Authors: Knyazev Oleg , Kagramanova Anna , Konoplyannikov Anatoliy , Kulakov Dmitriy , Korneeva Irina , Zvyaglova Mariya , Babayan Anait , Parfenov Asfold 
Published: December 2019

BACKGROUND:
Crohn's disease (CD) in the form of terminal ileitis occurs in approximately 1/3 of CD patients and is often complicated by the formation of ileum stricture or ileocecal valve. The operation of choice is resection of ileocecal Department with the formation of ileo of ascendants. Depending on the combination of risk factors, as well as on the effectiveness of previous anti-relapse therapy, patients after surgery should be stratified into groups with different risks of postoperative recurrence.

OBJECTIVE:
To evaluate the effectiveness of mesenchymal stem/stromal cells (MS/SC) as anti-relapse therapy in patients with low-risk CD after ileocecal resection.

METHODS:
36 patients with CD in the form of terminal ileitis with a stricture of the terminal ileum with signs of intestinal obstruction after the ineffectiveness of the course of conservative therapy (application of GCS) underwent resection of the ileocecal Department with the formation of ileo-ascendoanastomosis. All patients had a low risk of postoperative recurrence of Crohn's disease. However, the first group of patients aged 19 to 58 years (Me-29) (n = 18) received MS/SC. The second group of patients aged 20 to 68 years (Me-36) (n = 18) received mesalazines 4 gr/day. The follow-up period was 60 months. The monitoring was carried out by endoscopic picture and/or CT-enterography, C-RP level, fecal calprotectin (FCP). Average baseline CRP in the 1st group was 29.5 ± 3.2 mg/l, in the 2-nd – to 27.75 ± 3, 0 (P = 0,73), the level of the FCP in the 1-st group 1019,4 ± 97,2 mkg/g, in the 2nd – 998,8 ± 127, 3 mkg/g (P = 0,9).

RESULTS:
After 24 months in the 1st group of patients the average level of C-RP was 9.5 ± 1.9 mg/l, in the 2nd group −17.8 ± 3.3 mg/l (p = 0.027). The level of the FCP in the 1st group −98,0 ± 12,1 mkg /g, in the 2nd – 121,7 ± 14,2 mkg /g (P = 0,27). After 24 months of follow-up, 1 (5.5%) patient from the first group (n = 18) had a relapse that required the appointment of GCS. In the second group, relapse occurred in 4 (22.2%) patients out of 18 (RR 0.25; 95% CI 0.031–2.025; P = 0.15). After 60 months in the 1st group of patients the average level of C-RP was 10.76 ± 2.1 mg/l, in the 2nd group -19.2 ± 3.5 mg/l (P = 0.039). The level of the FCP in the 1st group of 100.4 ± 13.7 per mkg /g, in the 2nd – 191, 7 ± 24, 9 mkg /g (P = 0.002). After 60 months of follow-up, 1 (5.5%) patient from the first group had a relapse. In the second group, relapse occurred in 8 (22.2%) patients out of 18 (RR 0.125; 95% CI 0.017–0.9; P = 0.008).

CONCLUSION(S):
The use of mesenchymal stem/stromal cells (MS/SC) as anti-relapse therapy in patients with low-risk CD after ileocecal resection significantly reduces the risk of postoperative recurrence of CD.
P060 Reproductive and Sexual Function in Men With IBD in Brazil
Authors: Machado Marta , Lima Fernanda 
Published: December 2019

BACKGROUND:
There are studies focusing on fertility, pregnancy and sexual issues for women with inflammatory bowel disease. On the other hand, relatively little attention has been focused on reproductive and mainly sexual function issues faced by men with IBD. Sexual function may be adversely affected by some medications used to treat IBD, the depression that may accompany active IBD, and proctocolectomy. The present study aims to evaluate the reproductive and sexual function of patients with IBD in Brazil.

METHODS:
This prospective study was conducted by a self-completed cross-sectional online questionnaire answered by 225 male IBD patients over 18 years of age throughout Brazil in 2019 for 10 weeks.

RESULTS:
A total of 225 patients answered the questionnaire, 78.2% were between 18 and 38 years old, 69.67% were diagnosed with Crohn's disease, 27.96% ulcerative colitis and 2.37% indeterminate colitis. 50.24% had children, 42.48% were using contraception, 33.02% did not plan pregnancy, 28.78% of patients reported that the disease disrupted family planning, 70.37% did not consider having more children. , were taking the following medications when their wives became pregnant 20, 31 5-ASA, 12.5% Corticosteroids, 11,71 Immunosuppressants, 14.84% Biological, 0.003% Antibiotic, 47.65% without any treatment. Of the patients studied, 30.14% have an erection problem, 20.45% sought the help of a urologist, 32.55% of the patients underwent surgery for the treatment of IBD, 87.56% reported that their doctors never addressed the issue. family planning during treatment and 13.81 of the patients proactively approached the issue with their doctors.

CONCLUSION(S):
The data presented show that family planning is little explored by both doctors and male patients. Inflammatory bowel diseases may influence family planning with regard to not having children or considering having more children. Sexual dysfunction can occur in a considerable number of patients, but few seek expert help.