bluuebunny/crossref_metadata_2025_split huggingface dataset:
P401 Sarcopenia in children and young adults with primary sclerosing cholangitis and IBD
Authors: Shteyer E , Cytter-Kuint R , Winberg L 
Published: January 2020

Abstract

Background
Malnutrition is common in children with inflammatory bowel disease (IBD) and in liver diseases. The nutritional status can be assessed by evaluating for sarcopenia, which is described as the loss of muscle mass and/or strength that are reflected by decreased psoas muscle surface area (PMSA). Accumulating data shows association of PSMA with chronic diseases, however, literature regarding sarcopenia in children is still limited. The aim of this study is to assess sarcopenia in children and young adults with sclerosing cholangitis (PSC) with or without IBD.

Methods
Retrospective analysis of patients below 25 years of age diagnosed with PSC between the years 2010–2018 was done. Patients who performed magnetic resonance imaging (MRI) were included in the study. Detailed clinical, anthropometric, laboratory and imaging findings were recorded. The control group was comprised of children who underwent MRI due to suspected scoliosis or kidney structural anomalies and had normal study. PMSA was determined at intervertebral disc L3.

Results
Sixty-five patients were included in the study. Twenty with PSC with a mean age of 15.2 ± 5 years, 12 were female and 9 had IBD. The control group comprised of 45 healthy subjects with no significant difference in age, gender and BMI from the study group. There was no significant difference in PMSA between groups. However, PMSA significantly correlated with aspartate transaminase (AST) and Platelet Ratio Index (APRI) score (marker for hepatic fibrosis, r = −0.49, p = 0.02). Additionally, PMSA was significantly higher in patients who had both PSC and IBD (475.61 ± 136 vs. 789 ± 328, p = 0.01).

Conclusion
Children and young adults with concomitant PSC and IBD were in a better nutritional status in comparison to patients with PSC alone, as evidenced by a lesser degree of sarcopenia. Additionally, sarcopenia correlates to the degree of liver fibrosis assessed by APRI score. Further larger studies are warranted in order to corroborate the importance of sarcopenia in patients with PSC.
P410 Could the disease become ‘a friend’? The mediating role of illness acceptance on self-efficacy and quality of life of gastroenterological patients
Authors: Rudnik A , Piotrowicz G , Rydzewska G , Bidzan M , Ozgo E 
Published: January 2020

Abstract

Background
Irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD) are chronic conditions characterised by severe intestinal symptoms and other general symptoms, which impede daily functioning and affect the quality of life of patients. Understanding the significance of psychological factors in the disease development and therapy can improve the satisfaction with life of gastroenterological patients. The aim of the study was to analyse the impact of accepting the disease on the relation between an important personal resource, which is one’s self-efficacy and both satisfaction with life and components of the quality of life.

Methods
The study group consisted of 104 patients (N = 104), 58 women and 46 men suffering from IBS (35), UC (33) or CD (36). The average age equalled 32.56 years (SD = 11.04). The average duration of the disease was 8.5 years (SD = 6.9). The following research methods were used: the Generalised Self Efficacy Scale GSES (Schwarzer, Jerusalem, Juczynski), the Acceptance of Illness Scale AIS (Felton, Revenson, Hinrichsen, Polish adapt. by Juczynski), the Quality of Life SF-36v2 Questionnaire—the Polish version, the Satisfaction with Life Scale SWLS (Diener, Emmons, Larson, Griffin, Polish adapt. by Juczynski) and the author’s own questionnaire to collect the demographic data.

Results
The data were analysed using the independent sample t-test, chi-square test, Pearson correlation, regression analysis and mediation analysis. The study did not prove that the disease diagnosis (IBS, UC or CD) differed the level of satisfaction with life or the level of quality of life. Participants with IBS demonstrated a higher level of illness acceptance in comparison to IBD patients (p = 0.028). A strong positive correlation (p &lt; 0.01) was observed between generalised self-efficacy and satisfaction with life—SWL (r = 0.37) and components of quality of life: lower perceived bodily pain—BP (r = 0.20), social role functioning—SF (r = 0.29) and mental health—MH (r = 0.35). Results pointed out that acceptance of illness mediated the relationship between generalised self-efficacy and SWL, BP, SF, and MH (β = 0.38 95% CI: 0.16–0.59; β = 0.25 95% CI: 0.004–0.73; β = 1.23 95% CI: 0.20–2.25; β = 1.18 95% CI: 0.46–1.90).

Conclusion
Psychological factor as acceptance of illness can be considered to be a resource which helps to cope with challenges posed by gastrointestinal disorders. Therefore, it is so significant to increase its level by applying psychotherapeutic methods tailored to the age and the needs of a patient.
P471 What is the appropriate cut-off value of CRP to predict endoscopic remission in ulcerative colitis patients with clinical remission?
Authors: Shin J , Seong G , Song J H , Kong S M , Kim T J , Kim E R , Hong S N , Chang D K , Kim Y H 
Published: January 2020

Abstract

Background
A noninvasive and reliable markers for predicting endoscopic remission (ER) in ulcerative colitis (UC) patients with clinical remission (CR) provide important information in predicting disease progression and in determining treatment. Faecal calprotectin test is known to be the most accurate to predict ER, but patients are reluctant to handle faecal materials. C-reactive protein (CRP) is one of the surrogate markers for assessing disease activity, but it is known to have low sensitivity and specificity of normal CRP value (&lt;0.3 mg/dl). The sensitivity of the CRP test has been improved, and even fine values within the normal range can be measured. The aim of this study was to determine appropriate CRP cut-off values for the prediction of ER in UC patients with CR even though within normal CRP range.

Methods
A total of 132 UC patients who underwent endoscopic evaluation in CR were retrospectively reviewed. Serum biomarkers including haemoglobin, leukocytes, platelets, erythrocyte sedimentation rate, and CRP were evaluated within 1 week period from endoscopic evaluation. The clinical and endoscopic activity was measured by simple clinical colitis activity index and endoscopic Mayo subscore.

Results
In UC patient with CR, CRP level was significantly lower in ER (median 0.05, 0.03–2.57) vs. non-ER (median 0.11 0.03-2.81). (p &lt; 0.005) The proportion of males in non-ER was slightly higher than in ER (24, 72.7% vs. 52, 52.5 %; p = 0.042), and only gender and CRP showed statistical differences in baseline clinical characteristics. CRP had predictive value of ER [Area under the curve (AUC = 0.760)] and the sensitivity was 71.4%, specificity was 71.7 % at cut-off value of 0.09mg/dl. In contrast, the sensitivity and specificity of normal CRP (0.3mg/dl) were low. (sensitivity 27.3%, specificity 90.9%).

Conclusion
Norma CRP cut-off values are not sufficient to reflect ER. It may be helpful to change the CRP cut-off value that predicts ER in CR to value other than 0.3 mg/dl.
P517 A randomised, placebo-controlled pilot trial of faecal microbiota transplantation for paediatric Crohn’s disease
Authors: Hill L , Popov J , Hartung E , Moshkovich M , Figueiredo M , Pai N 
Published: January 2020

Abstract

Background
The role of faecal microbiota transplant (FMT) in Crohn’s disease (CD) remains unclear. Small, open-label case series have shown high rates of clinical remission but protocols have varied across studies, and no randomised controlled trials (RCT) have been performed. We present a protocol for the first pilot RCT of FMT in paediatric CD patients, using a novel colonoscopic + oral capsular intervention that uses fresh-frozen and prepared, lyophilised donor stool. We will measure improvements in clinical disease activity, inflammatory biomarkers, endoscopic markers of mucosal inflammation, as well as, assess key aspects of trial feasibility.

Methods
Patients 3–17 years with active CD, on stable medication doses for 4 weeks are eligible. Patients will have an initial colonoscopy during which they will receive an infusion into the terminal ileum of normal saline (placebo) or prepared healthy donor stool (RBX2660; Rebiotix, USA) (active). This will be followed by 6-weeks of bi-weekly oral capsular therapy, containing methylcellulose (placebo) or lyophilised healthy adult donor stool (RBX7455; Rebiotix, USA). Randomisation is 2:1 to active and placebo arms (n = 45). Patients will be followed over 24 weeks. (Figure 1)

Results
Study feasibility will be assessed by: rate of recruitment, completion of sample collections, and frequency and type of adverse events. Clinical outcomes will be measured serially using: Paediatric Crohn’s Disease Activity Index (PCDAI), faecal calprotectin, blood inflammatory markers, and Simple Endoscopic Score for Crohn’s Disease (SES-CD) at baseline and end-of-study. Stool 16s rRNA, metagenomics, and urine metabolomics profiles will be performed on collected stool and urine samples. Patients who complete the placebo arm will be eligible to enter an open-label extension study.
Results will be measured through ITT and PP analyses. Proportions and percentages will be reported on feasibility outcomes; odds ratios, mean differences and 95% confidence intervals will be reported on clinical outcomes as preliminary estimates of efficacy.

Conclusion
This is the first pilot RCT of FMT in the treatment of CD. Recruitment commenced April 2019 and 13 patients have met screening criteria, with 5 enrolled thus far. This study is novel for its focus on paediatric CD patients, and its use of a combined oral + colonoscopic FMT delivery method. The results of this trial will offer preliminary estimates of efficacy for FMT-based therapies in CD, and may support expansion to a future larger multicenter paediatric RCT using our validated study protocol.
P543 UC remission mucosa displays upregulated inflammatory mediators
Authors: Arkteg C , Goll R , Dixon Gundersen M , Anderssen E , Fenton C G , Florholmen J 
Published: January 2020

Abstract

Background
Ulcerative colitis (UC) is a chronic inflammatory bowel disease. In UC, a wide range of criteria is used for disease remission, with few studies investigating the differences between disease remission and normal control groups. This paper compares known inflammatory and healing mediators in the mucosa of UC in clinical remission and normal controls, in order to better describe the remission state and the fundamental pathology

Methods
Mucosal biopsies from 72 study participants (44 UC and 24 normal controls) were included from the Advanced Study of inflammatory bowel disease (ASIB Study), Arctic University of Norway, Norway. Clinical remission was defined as Mayo clinical score ≤ 2, with endoscopic subscores of ≤ 1. Targeted gene transcription analyses were performed by quantitative polymerase chain reaction (qPCR) and using hydrolysis probes and SYBR-green.

Results
Among the mucosal transcripts examined, 10 genes were regulated in remission vs. normal controls, 8 upregulated pro-inflammatory transcripts (IL1B, IL33, TNF, TRAF1, CLDN2, STAT1, STAT3 and IL13Ra2) and 2 downregulated (pro-inflammatory TBX21 and anti-inflammatory TGFB1). Between the active and normal group, 5 additional genes were differently regulated CASP8, ADAM17, DFB1 and TFF3 were up-regulated while CHUK was down-regulated. Several master transcription factors for T-cell development (TBX21, GATA3, FOXP3, RORC and SPI1) and important inflammatory mediators (IL33, IL6, TGFB, IL10 and TLR4) were upregulated in patients with Mayo endoscopic score of 1 in comparison to 0.

Conclusion
The mucosa of UC in clinical and endoscopic remission differs from normal mucosa, suggesting a remaining dysregulation of inflammatory and wound healing mechanisms. In addition, there is a significant expression difference between mayo endoscopic score of 1 and 0. This difference indicates that t-cell differentiation is still ongoing in the Mayo endoscopic subscore (MES) of 1. Interestingly, TNF did not differ between MES 0 and 1 suggesting an alternative inflammatory pathway in low-grade UC inflammation.
P642 Serum adalimumab levels measured between days 9 and 13 from drug injection can be interpreted clinically in a similar way to trough levels in patients with inflammatory bowel disease
Authors: Guardiola Capón J , Serra K , Rodríguez-Alonso L , Santacana E , Padullés N , Ruiz-Cerulla A , Arajol C , Camps B , Surís G , Sanchez E , Rodríguez-Moranta F 
Published: January 2020

Abstract

Background
AntiTNF therapeutic drug monitoring is currently performed at trough, immediately before drug administration. However, in clinical practice when subcutaneous medications are used, blood extractions often do not coincide with that moment. The aim of this study was to know if adalimumab levels measured between injections are sufficiently similar to trough levels to be used in clinical practice in a similar way.

Methods
295 adalimumab level determinations performed at different time points of 99 injection cycles in 55 patients with inflammatory bowel disease (IBD) were included in the study. 51 patients received 40mg every 2 weeks and 4 patients received 80mg every 2 weeks.

Results
Median adalimumab levels (IQR) at trough, between days 1–4, 5–8 and 9–13 were 10.6 (6–12), 12.3 (7–18), 13 (7–19) and 10.8 (8–12), respectively. The median differences between trough level and days 1–4, 5–8 and 9–13 were 1.7 (IC 95% 1–2.3) (p &lt; 0.001), 2.3 (IC 95% 1.5–3.1) (p &lt; 0.001), 0.6 (IC 95% –0.2–1.3) (p = 0.13), respectively.

Conclusion
Adalimumab levels between days 9 and 13 from drug injection are very similar to trough level and could be interpreted clinically at the same way. Adalimumab levels between days 1 and 8 are significantly higher, although, differences are small.
P692 Exploring relationships between microbiome, faecal calprotectin and healthy eating index in patients with ulcerative colitis: Interim analyses of a randomised controlled trial
Authors: Raman M , Taylor L , Schick A , Ohland C , McCoy K , Kaur S , Panaccione R , Reimer R 
Published: January 2020

Abstract

Background
This study explored relationships between gut microbiome, faecal calprotectin (FCP) and an adapted Canadian healthy eating index (CHEI) in ulcerative colitis (UC) patients enrolled in a randomised controlled dietary intervention trial.

Methods
Patients with both active and quiescent disease were recruited from the Foothills Medical Center in Calgary, Alberta, Canada and randomised to either an 8-week reduced sulfur anti-inflammatory diet intervention (INT; n = 14) or conventional management control group (CM; n = 10). Each INT patient met with a registered dietitian for diet teaching, in person at baseline, over the phone at 2 weeks, and in person at 4 weeks. Stool samples and 24-h dietary recalls were collected at baseline and 8 weeks. DNA from stool samples was extracted and the V4 region of the 16S gene was sequenced. FCP was extracted and analyzed using the EK-CAL ELISA. An adapted CHEI was generated from diet recalls using previously validated scoring guidelines. Relationships between variables were analyzed using analysis of variance and chi-squared.

Results
Mean age of the sample was 36.3 (SD=8.7) and 58% were male. Baseline medications included aminosalicylates (71%), steroids (50%), biologics (33%), immunosuppressants (25%) and 21% of patients had taken antibiotics within the last 3 months. Α-diversity, or within-community diversity, significantly increased in the CM group and remained stable in the INT group over time (p = 0.005). Β-diversity, or between-community diversity appeared to increase in the intervention group over time (p &lt; 0.01); however, this may have been influenced by antibiotic use in five patients. Significant differential features between the CM and INT groups (p &lt; 0.01) at the genus level were identified in the phyla Firmicutes and Proteobacteria, specifically Catenibacterium, Parvimonas, Coprococcus_2 and Desulfovibrio. FCP appeared to be different between the groups (p = 0.05) with a greater percentage of INT patients moving from high FCP (&gt;250 mg/g) to low FCP (&lt;250 mg/g); 50% of INT patients and 20% of CM patients normalised FCP levels. As CHEI increased in the whole sample, indicating higher diet quality, FCP decreased significantly (p = 0.04).

Conclusion
In an interim analysis, a dietary intervention shows efficacy in manipulating the microbiome. Higher diet scores representing a healthier diet were also related to lower faecal calprotectin levels.
P695 Vedolizumab induction and maintenance though levels and long-term clinical and biochemical status in inflammatory bowel disease
Authors: Gutiérrez Casbas A , Sempere Robles L , Muñoz Pérez R , Rodríguez Angulo A , Climent S , Cameo Lorenzo J I , Díaz M , Boada P , Más-Serrano P 
Published: January 2020

Abstract

Background
Therapeutic drug monitoring (TDM) postinduction of vedolizumab (VDZ) could have relationship with long-term outcome of inflammatory bowel disease (IBD) patients. However, clinical utility of TDM during maintenance VDZ therapy remains unclear. To examine the association of induction and maintenance vedolizumab though levels (VTL) with clinical and biochemical long-term outcome in IBD patients.

Methods
We performed a retrospective cohort study, including all consecutive IBD patients of our centre on VDZ treatment who had VTL and anti-vedolizumab antibodies (AVA) measured during induction and maintenance therapy. All patients had received a minimum of 6 weeks therapy following standard induction (0, 2, 6 ± 10 week dosing. Clinical response and remission were defined by Partial Mayo Score (PMS, UC) or Harvey Bradshaw Index (HBI, CD) and were assessed at week 52.Biochemical remission was defined as CRP &lt; 0.5 g/dl and faecal biomarker remission as faecal calprotectin (FC) &lt; 250 µg/g. Measurement of VTL and AVA was performed by ELISA assays(Vedolizumab-TheraDiag(R) with a detection limit for VTL of 2 μg/ml and measurement range of 2–60 μg/ml.

Results
In total, 34 patients were included (55.9% UC; 44.1% CD, 50% women). Median age was 52.76(17–83) and mean disease duration was 8 ± 7.2 years. Median baseline HBI was 6(0–12) and PMS was 5(3–7). FC and CRP measured before first dose of VDZ were 1425 ± 1189 μg/g and 2.1 ± 2.4 mg/dl. A total of 14 patients (41.2%) were naïve for biologic therapy. Only three patients (8.8%) were receiving a concomitant immunomodulator. Clinical response to induction phase was reported in 76%. Clinical remission, clinical response, biochemical remission and faecal biomarker remission were present in 30% (9/29), 41.4% (12/29), 40.9% (9/22) and 35% (7/20), respectively, at week 52. Thirteen patients (13/26, 50%) needed dose escalation at week 52. Twenty-six patients (78.8%) were persistent in VDZ therapy at the end of the study. The median level of VDZ at weeks 6 and 24 were 16.13 ± 7.06 μg/ml and 9.6 ± 6.7 μg/ml. Comparing patients with and without clinical response or remission to VDZ at week 52 no significant difference in VTL was found at Week 6 (16.27 vs. 15.46 μg/ml, p = 0.8) and week 24 (7.6 vs. 12.7 μg/ml, p = 0.1). No difference was observed in VTL in patients in biochemical remission (week 6: 23.6 vs. 15.7 μg/ml, p = 0.2; week 24: 10.3 vs. 10.2 μg/ml, p = 0.9) or with faecal biomarker remission (week 6: week 6: 25.5 vs. 16.2 μg/ml, p = 0.1; week 24: 10.7 vs. 8.2 μg/ml, p = 0.6) at week 52. No patient developed antibodies.

Conclusion
In this real-world study of IBD patients receiving VDZ, early induction or maintenance VTL are not associated with long-term outcome.
P733 The influence of concomitant familial Mediterranean fewer on Crohn’s disease course: Data from an FMF endemic area
Authors: Yuksel I , Kilincalp S , Coskun Y , Akinci H , Hamamci M 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) and Familial Mediterranean fever (FMF) are both inflammatory disorders characterised by recurrent abdominal pain and fever attacks. Mutations of Mediterranean (MEFV) gene appear to be associated with stricturing behaviour and extraintestinal manifestations of CD. Further clinical studies regarding progression of CD in coexistence with FMF is still required. The aim of this study was to evaluate the influence of concomitant FMF in CD patients on the course of the CD in FMF endemic area.

Methods
Total 210 adult patients who had diagnosed with CD with or without FMF between November 2006 and April 2019 were respectively examined. FMF diagnoses were based on Tel-Hashomer criteria. The Montreal classification was used to define location and behaviour of CD. CD patients were divided into two groups FMF positive and FMF negative. Severity of CD was assessed by the need for hospitalisation related to CD, whether biological therapy was received and/or whether surgery was undergone due to CD. All demographic features, MEFV mutations, location/behaviour of disease, and extraintestinal manifestations were analysed retrospectively.

Results
In the present study, 8 (3.8%) of the total 210 CD patients have concomitant FMF. Mean follow-up time in CD-FMF was 59.55 months and CD-non-FMF was 60.98 months. CD patients with or without FMF showed similar demographic features including age, sex, smoking behaviour, disease location, behaviour, and treatment regimen in maintenance of the remission. Regarding extraintestinal manifestations, only peripheral arthritis was found significantly higher in CD-FMF patients (n = 3, 37.5%) compared CD-non-FMF patients (n = 21, 10.4%). In the CD-FMF patients, a result of MEFV mutation gene analysis was found in medical records 6 patients. Of those, 2 had homozygote MEFV mutation, 2 had heterozygote MEFV mutation and 2 without any MEFV mutations. In CD-FMF group, percentage of patients on biological therapy (n = 4, 50%) was significantly higher than CD-non FMF group (n = 24, 11.9%) (p = 0.012). Steroid dependence and hospitalisation in CD-FMF (n = 3, 37.5% and n = 5, 62.5%) group were relatively higher than CD-non-FMF (n = 83, 41.1%) group, but not statistically significant. The percentage of CD-FMF patients who underwent intestinal surgery (n = 1, 12.5%) was similar to that of CD-non-FMF (n = 33, 16.3%).

Conclusion
In the current study, the prevalence of FMF in CD patients was detected 3.8% in FMF endemic area. The group of patients on biological therapy in CD-FMF patients was significantly higher than CD-non-FMF patients. Frequency of hospitalisation in CD-FMF patients was relatively higher than CD-non-FMF patients. Our findings indicate that concomitant FMF in CD patients may have a negative effect on the course of CD.