bluuebunny/crossref_metadata_2025_split huggingface dataset:
P270 Ulcerative colitis disease extent and inflammatory burden assessment: DUBLIN and modified Nancy score
Authors: Rocha Silva J C , Rodrigues J , Rodrigues A , Silva A , Fernades C , Sousa A , Sousa M , Gomes A C , Afeto E , Carvalho J 
Published: January 2020

Abstract

Background
Current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent of mucosal inflammation. The DUBLIN score (Degree of Ulcerative Colitis Burden of Luminal Inflammation) is a simple bedside clinical score that estimates inflammatory burden using both disease severity and extent, which correlates with objective inflammatory markers and is associated with clinical outcomes. The validated Nancy score is used to evaluate histological activity; nonetheless, it does not take in consideration disease extension. We aimed to evaluate the relation of both Mayo and Dublin scores with disease activity and as predictive factors of clinical relapse. Also, we developed a modified Nancy score in order to assess histologic activity considering disease extension.

Methods
A retrospective cohort study, which consecutively included all UC patients submitted to colonoscopy with biopsies between 2016 and 2019 in our unit. Mayo and DUBLIN scores were calculated. Modified Nancy score was calculated as a product of Nancy Score and disease extent (E1-E3). Correlation of both endoscopic and histologic scores with biomarkers, relapse (in a 6months) and relapse-free time as performed.

Results
107 patients were selected, 52.3% (n = 56) male, mean age = 48.4 ± 13.9 years. Mean Dublin score was 2.65 ± 2.75. Mayo and DUBLIN scores presented good correlation (r = 0.880, p &lt; 0.001). Also Dublin score correlated with modified Nancy score (p &lt; 0.001). Both Dublin score (p = 0.009) and modified Nancy score (p = 0.026) correlated with C-reactive protein levels. Nancy score correlated with faecal calprotectin (p = 0,025).
Relapse occurred in 26.2% (n = 28) of patients with a mean time for the event of 13 ± 7 weeks. Mayo Score (p &lt; 0.001), Dublin score (p &lt; 0.001), Nancy score (p &lt; 0.001) and modified Nancy score (p &lt; 0.001) presented a significant association with relapse. Areas under the ROC curve were 0.786 for Dublin score, 0.751 for Mayo score, 0.84 for Nancy score and 0.79 for modified Nancy score.

Conclusion
DUBLIN and modified Nancy scores correlate with each other and with biomarkers and are independent predictors of relapse. Dublin score was superior to Mayo score in the prediction of relapse.
P273 Point-of-care bowel ultrasound for detecting ileocolonic inflammation in Crohn’s disease
Authors: Allocca M , Fiorino G , Furfaro F , Zilli A , Gilardi D , Radice S , Peyrin-Biroulet L , Danese S 
Published: January 2020

Abstract

Background
A ‘treat-to-target’ strategy with close monitoring of intestinal inflammation is recommended in Crohn’s disease (CD). Bowel ultrasound (US) is a non-invasive, point-of-care tool to assess CD activity and severity. However, no clear US-based parameters of activity have been identified by using magnetic resonance imaging (MRI) and colonoscopy together as a reference standard. We aimed to investigate whether US parameters could be able to measure CD activity and severity, comparing with the MaRIA and the SES-CD scores.

Methods
Ileal and/or colonic CD consecutive patients were prospectively assessed by CS, MRE and bowel US. Bowel wall thickening (mm), bowel wall-flow at colour Doppler (BWF: 0 absent; 1 present), bowel wall pattern (BWP: 0 normal; 1 hypoechogenic; 2 hyperchogenic; 3 lost), presence of mesenteric lymph nodes (0 absent; 1 present) and mesenteric hypertrophy (0 absent; 1 present), evaluated at bowel US were compared with CS+MRE findings as a reference standard. Activity was defined by an SES-CD score&gt;2 and/or a MaRIA score&gt;7).

Results
Sixty CD patients were prospectively enrolled (37% with ileal localisation, 15% with colonic localisation and 48% with ileocolonic localisation). Thirty patients had endoscopically active CD, 34 had radiologically active disease, 37 (62%) had active disease assessed at CS or MRE (SES-CD &gt; 2 or MaRIA score &gt;7 in at least one segment). BWT, presence of BWF, hypoechogenic or lost BWP significantly correlated with endoscopic and radiological activity (OR 4.51, 33.75, and 2.74 respectively, all p &lt; 0.001). The multivariable analysis identified only BWT (per 1-mm increase, OR: 6.56, 95% CI 1.25–34.44, p = 0.026) as an independent predictor for disease activity. The cut-off value of 4.4 mm BWT was identified to distinguish active vs. non-active disease (AUROC 0.905, Sensitivity 81%, Specificity 96%). A significant correlation was found between BWT and MaRIA and SES-CD score (r = 0.768, 95% CI 0.662–0.868, p &lt; 0.0001; r = 0.602, 95% CI 0.409–0.743; p &lt; 0.0001; respectively).

Conclusion
Bowel US is able to assess and measure disease activity in ileocolonic CD in real-time. BWT correlated very well with the MaRIA score and the SES-CD score. Further studies are needed to confirm these findings and to demonstrate the role of point-of-care US in CD management.
P291 Diagnostic utility of the neutrophil-platelet rate (NeuPla) as a marker of activity in patients with ulcerative colitis
Authors: Yamamoto-Furusho J K , Mendieta-Escalante E A 
Published: January 2020

Abstract

Background
Ulcerative colitis (UC) is a chronic disease characterised by periods of activity and remission. There are biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and faecal calprotectin that are elevated in patients with active UC. The platelet, one of the main activators of neutrophils, contains IL-8, a potent neutrophil chemo-attractant and P-selectin that induces excretion of superoxide in the neutrophils, forming platelet-neutrophil aggregates that are increased in individuals with UC activity. No previous studies have evaluated the neutrophil-platelet (NeuPla) rate as a tool for evaluating disease activity. The aim of this study was to evaluate the clinical utility of NeuPla rate in patients with UC.

Methods
A total of 158 patients with a definitive diagnosis of UC were included and NeuPla index was calculated on the ratio between neutrophil differential count and platelets from complete blood count (CBC) at least 1 day after the colonoscopy and colon biopsies. The activity was classified according to Mayo endoscopic sub-score, Riley score, Truelove-Witts, Montreal, full Mayo, and Yamamoto-Furusho indexes.

Results
The correlation of the NeuPla index with all activity indexes was statistical significant (p &lt;0.001) as well as faecal calprotectin (rho: 0.532, p = .0001). The ROC curve was used to determine the cut off level of NeuPla according to moderate activity (optimal cut off 14.63 with a sensibility of a 79.5% and specificity of 51.3% with an Area Under the Curve (AUC) of .635 and severe activity (optimal cut off 18.7 with a sensibility of 80% and specificity of 81.8% AUC of .749) considering as a gold standard the endoscopy findings as shown in Figure 1.

Conclusion
The NeuPla index has a good diagnostic utility in order to distinguish patients with clinical and endoscopic activity without the need to perform invasive studies such as colonoscopy. This index is a cheap and easy access monitoring tool and a better diagnostic performance in comparison with other serum biomarkers CPR, ESR and serum albumin.
P294 Clinic features and the prognosis of colonic Crohn’s disease
Authors: Ozgur D , Hatemi A I , Erzin Y , Çelik A 
Published: January 2020

Abstract

Background
In this study, we aimed to investigate the prognosis of colonic Crohn’s disease (CD) and to compare colonic CD with ileocolonic CD.

Methods
This study included 63 patients with colonic CD who were followed at least 1 year. The same number of patients with ileocolonic CD whose age of diagnosis and sex were similar to colonic CD patients were included in the study. Data about demographics, serological, clinic characteristics, medical treatment, surgical treatment requirements and complications during follow-up were obtained retrospectively from patient files.

Results
The files of 1289 CD patients who were followed up at a clinic of inflammatory bowel disease of Cerrahpaşa School of Medicine were scanned. There were 63 patients with colonic CD. Control group was formed as it was noted in the Methods section. The rate of patients who smoked was lower in colonic CD (47.6% vs. 65%, p = 0.048). ASCA positivity was higher in patients with ileocolonic CD (80% vs. 33.4%, p = 0.027). At the time of diagnosis, 87.3% of colonic CD patients and 65% of ileocolonic CD patients had inflammatory phenotype (p = 0.003). During follow-up, stenosis and penetrating disease development were more common in patients with ileocolonic disease (46% vs. 15.8%, p = 0.001). The rate of abdominal surgery was lower in colonic CD (11% vs. 38%, p = 0.001). Hospitalisation rate was less in colonic CD than ileocolonic CD (36.5% vs. 57%, p = 0.02). In colonic CD, use of azatioprine was less than ileocolonic CD and the number of patients treated with oral mesalazine monotheraphy is higher than ileocolonic CD. Endoscopic remission was higher in colonic CD (%61 vs. %28, p = 0.001).

Conclusion
The results of our study showed that colonic CD has different phenotype characteristics, treatment response and laboratory features than ileocolonic Crohn’s disease. Colonic CD has a lower penetrating and/or stenosing phenotype rate than ileocolonic CD. Surgery and hospitalisation were less common in patients with colonic Crohn’s disease. In addition, patients with colonic CD have a higher endoscopic remission rate. For these reasons, we conclude that colonic Crohn’s disease has a better prognosis than ileocolonic Crohn’s disease.
P304 Extranodal primary intestinal lymphoma in inflammatory bowel disease: An ECCO CONFER multi-centre case series
Authors: Phillips F , Verstockt B , Ribaldone D , Guerra I , Teich N , Katsanos K , Filip R , Molner T , Karmiris K 
Published: January 2020

Abstract

Background
There is a small but measurable increased risk of lymphoma in inflammatory bowel disease (IBD). Evidence coming from case reports and small case series of primary intestinal lymphoma in IBD suggest an association with inflamed tissue and immunosuppressant use, mainly thiopurines.

Methods
This was a multicentre case series supported by the European Crohn’s and Colitis Organisation (ECCO) and performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. A call was made to report on cases of intestinal lymphoma in IBD and clinical data were recorded in a standardised case report form.

Results
Fifteen patients with intestinal lymphoma from 8 centres were included [12 males and 3 females, mean age 47.8 ( ± 16.4 SD, range 26–76) years at lymphoma diagnosis]. Eleven patients had Crohn’s disease: 7 had diffuse large B-cell lymphoma (DLBCL), 2 had Hodgkin’s disease and 2 had MALT lymphoma. Four patients had ulcerative colitis: DLBCL, MALT, indolent T-cell and immunoblastic lymphoma with plasma cell differentiation were diagnosed as a single case in each. Nine patients presented with symptoms of bowel obstruction, two presented with a non-obstructing mass, and there were single cases of isolated weight loss, symptoms resembling disease flare, indolent jaundice (from a duodenal lymphoma) and an incidental finding. The location of lymphoma was rectum in 3 cases, colon in 3 cases, small intestine in 4 cases, ileocolonic anastomosis in one case, stomach in one case and in multiple upper and lower GI sites in 3 cases. Lymphoma was located within the area affected from IBD in 10 patients, with four of these having active intestinal inflammation at the time of diagnosis. At lymphoma diagnosis, 7 patients were on azathioprine (one of whom also had adalimumab for 3 months), one was on infliximab for 1 month, one was on low dose steroids, one was on an aminosalicylate and 5 had not received IBD-related medications. Lymphoma was diagnosed at a mean time of 10.4 ( ± 7.07 SD, 1–24) years after IBD diagnosis in 11 patients, prior to IBD in one and concurrently with IBD in 3. Remission was achieved in 11 patients after treatment, 2 died from their lymphoma despite treatment and 2 are being monitored without therapy.

Conclusion
This case series of primary intestinal lymphomas in IBD illustrates a strong male predilection and a wide histological type range, with the majority being DLBCL. More than half of the cases cannot be attributed to IBD-related treatment whilst in a third of patients, lymphoma developed at a distant site from the area affected from IBD, thereby questioning the role of active inflammation or medication use in its development. The majority of cases successfully recovered after appropriate treatment.
P316 Hepatobiliary manifestations measured by vibration-controlled transient elastography in inflammatory bowel disease: A prospective hospital-based cohort study
Authors: Moon W , Seo K I 
Published: January 2020

Abstract

Background
Intestinal mucosal injury is supposed to cause liver disease and inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) is a typical chronic injury of intestinal mucosa. Therefore, we investigated the hepatobiliary manifestation with liver ultrasonography (LUS) and vibration-controlled transient elastography (VCTE) in IBD.

Methods
IBD patients newly diagnosed in Kosin University Gospel Hospital were enrolled consecutively. Gross hepatobiliary abnormality was evaluated with LUS and simultaneous liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed to evaluate hepatic injury and steatosis with VCTE. Laboratory tests including hepatic biochemistries, anti-nuclear antibody (ANA), and faecal calprotectin level (FC) were taken.

Results
Eighty-two (37 patients of CD and 45 UC) patients were enrolled. Gallbladder abnormality was noted in 39 patients (47.5%) including stone in 7, sludge in 11, polyp in 10, wall thickening in 9 and collapsed in 2. CAP &gt;233 dB/m was in 33 patients (40.2%) and LSM &gt;5.5 kPa in 10 (12.2%). Nineteen patients (23.2%) were diagnosed fatty liver. FC was 382 ± 785 (mean ± SD). CAP &gt;233 dB/m was significantly associated with lower FC (209.6 vs. 352.1, p = 0.038). The correlation coefficient was −0.316 between CAP and FC (p = 0.006). LSM &gt;5.5 kPa tended to be lower FC but was not statistically significant (199.8 vs. 306.2, p = 0.283). ANA was positive in 14 patients (17.1%). In ANA positive patients, FC was significantly higher than ANA negative patients (609.5 vs. 319.4, p = 0.015).

Conclusion
In this prospective analysis, the major hepatobiliary manifestations in IBD patients were gallbladder abnormality and fatty liver and there could be an association between low hepatic fat amount and intestinal disease activity.
P330 Inflammatory Bowel Disease (IBD) patients frequently report adverse drug reactions during biologic therapy: A multicentre, prospective, patient-reported pharmacovigilance monitoring system
Authors: THOMAS P , West R , Russel M , Jansen J , van Lint J , Jessurun N , Römkens T , Hoentjen F 
Published: January 2020

Abstract

Background
The use of biologicals has improved the treatment of IBD but the understanding of adverse drug reactions (ADRs) and the knowledge of patients’ perception on ADRs is poor. Patient-reporting may provide more insight in the extent and burden of ADRs in daily practice which in turn can lead to treatment optimisation. This study aimed to assess systematic patient-reported ADRs during biological therapy in IBD patients.

Methods
This multicentre, prospective, event monitoring study enrolled adult Crohn’s disease (CD) and ulcerative colitis (UC) patients treated with a biological between 1 January 2017 and 31 December 2018. Patients completed bimonthly comprehensive web-based questionnaires regarding indication and use of, description of biological induced ADRs, follow-up of previous ADRs, experienced burden of the ADR using a 5-point Likert scale, contact with a healthcare provider and therapeutic consequences due to the ADR. Patient-reported ADRs were MedDRA coded by trained pharmacovigilance assessors. MedDRA is a multi-hierarchical dictionary used to code reported ADRs into specific unambiguous terms (preferred terms). Preferred terms are subsequently grouped into high-level terms, high-level group terms and system organ classes. In total there are 26 system organ classes.

Results
In total, 182 patients in 4 centres (female 51%, mean (standard deviation) age 42.2 (14.2) years, CD 77%) were included and completed 750 questionnaires. At baseline, 49% used an immunomodulator (43% thiopurines, 6% methotrexate), while biologicals were documented as follows: 59% infliximab, 30% adalimumab, 9% vedolizumab, 1% ustekinumab. At least one ADR was reported by 50% of the participants, and 233 ADRs were reported in total with a median reported ADRs per participant of 2 (interquartile range, 1–3). Fatigue (n = 26), headache (n = 20), injection site reactions (n = 16) and arthralgia (n = 12) were most commonly reported, with a mean burden of 3.31, 1.63, 2.55 and 3.33, and a correlation in time with the administration of the biologic was described in 58%, 85%, 81% and 8% in these ADRs, respectively. Participants contacted a healthcare provider in 62% of all ADRs. In two out of 90 patients who reported an ADR, the biological was discontinued.

Conclusion
We established a patient-reported pharmacovigilance monitoring system and participants in this study frequently reported ADRs due to biologicals. Fatigue and arthralgia resulted in the highest burden. This reporting system may provide more understanding of patient-experienced ADRs which may ultimately lead to increased adherence of therapy and improved quality of life.
P335 Treatment strategies after mucosal healing (MH) in ulcerative colitis
Authors: Sitibondo A , Viola A , Costantino G , Centritto A , Belvedere A , Pisana V , Abbruzzese A , Alibrandi A , Fries W 
Published: January 2020

Abstract

Background
MH and deep remission are the major therapeutic goals in the treatment of ulcerative colitis (UC), but the best therapeutic strategy after reaching MH in terms of maintenance or de-escalation is still poorly defined. This retrospective study aimed to evaluate the maintenance of remission in patients who maintained therapy vs. patients de-escalating treatment.

Methods
Data of patients with UC who reached mucosal healing were retrospectively investigated. Demographic data/gender, age), disease-related data (extension, duration, age at onset), together with data on smoking behaviour and on therapy after reaching MH were collected. MH was defined as an endoscopic Mayo score of 0. The primary endpoint was clinical relapse regardless of therapeutic regimen. The outcome of patients maintained on therapy was compared with patients who de-escalated therapy and to patients with mild disease maintained on mesalazine.

Results
One hundred thirty-five patients with MH were followed for a mean time of 94 months (SD 57.2) and divided into 3 groups: group 1 (de-escalation; 45 patients), in which MH was reached with IMM or biologics and therapy was continued with only mesalazine, group 2 (no de-escalation; 40 patients) in which MH was reached with IMM or biologics, group 3 (only treatment with 5-ASA; 50 patients). In the 3 groups, disease relapse occurred in 62%, 30% and 38% respectively in a mean time of 22, 25 and 36 months. Patients who de-escalated therapy were more likely to relapse than patients who maintained initial treatment (p = 0.003, log-rank test)(Figure 1). A subgroup analysis showed as only for MH reached with anti-TNFs de-escalation strategy was related to an increasing risk of relapse (p = 0.003). No risk factors for relapse were identified on multivariate analysis.

Conclusion
Maintaining treatment after MH is reached represents the best strategy to maintain remission. Patients on anti-TNFs were more likely to relapse after de-escalation. An evaluation on pharmacoeconomics seems to be advised in order to identify a more sustainable strategy.
P336 Minimally invasive surgery is safe and feasible for luminal Crohn’s disease
Authors: Nnaji M , Chin Y F , Pujji O , Wilkinson B , Mohan S , Yassin N A 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) is an inflammatory bowel condition that still requires surgical intervention in about 70% of cases with laparoscopic surgery increasingly becoming the preferred approach. We present our experience in laparoscopic and open surgery for luminal CD in a DGH setting.

Methods
This was a retrospective analysis of data collected prospectively between 2008 and 2018. All patients with the diagnosis of CD who underwent a surgical intervention for luminal CD were selected and their demographic, clinical and surgical outcomes data analysed.

Results
183 patients were identified. 162 (87%) underwent open and 21 (13%) laparoscopic surgery (p &lt; 0.0001). The median age was 48 years (16–82 years) in the open group and 42 years (16–64 years) in the laparoscopic group(p = 0.05). Male:female ratio was 1:1.2 in the open and 1:1 in the laparoscopic groups. Anastomotic leak rates were lower in the laparoscopic group (0% vs. 2.5%, p = 0.3520). Statistically significant lower readmission rates (9.5% in the laparoscopic, 18% in the open groups, p = 0.0255) and reoperation rates (14% in the laparoscopic and 18% in the open groups, p = 0.0108) were noted in the laparoscopic group.

Conclusion
Laparoscopic surgery is safe in patients requiring surgical intervention for Crohn’s disease with a notable trend towards improved clinical outcomes.
P343 Efficacy of adalimumab in mild-to-moderate inflammatory bowel disease: Real-life data from single-centre experience in the long-term period
Authors: Akyüz F , Ormeci A , Namazova N , Guzel M , Abbasgoulizadeh A , Tahincioğlu L , Alaskarlı S , Gürel E , Bilgin E , Atasoy A , Cavus B , Demir K , Besısık F , Kaymakoğlu S 
Published: January 2020

Abstract

Background
Adalimumab (ADA) is one of the most preferred anti-TNF agents because of its ease of use in real life. We aimed to evaluate the efficacy of ADA in the long-term period of inflammatory bowel disease (IBD) patients.

Methods
Patients treated with adalimumab (ADA) as the first- and second-line biological treatment for mild to moderate active IBD between January 2009 and March 2019 were included. The clinical and endoscopic response rate of ADA were evaluated, retrospectively. Remission was defined in ulcerative colitis patients (UC), if stool frequency ≤ 3/day with no bleeding and no mucosal lesions at the colonoscopy. Remission was defined in Crohn’s disease patients (CD) if CDAI &lt; 150 and mucosal healing at the colonoscopy.

Results
Fifty-eight patients (81% Crohn’s disease, 58.6% biologic naive) were included in this study. Mean age was 41.4 ± 12.3 years old (19–67 years) and 46.6% of them were female. Median follow-up time was 57 months in UC and 65 months in Crohn’s disease (CD). Infliximab experience rate before ADA in UC and CD was 36.4%, 42.6%, respectively. CD’s related surgery rate was 43.5%; surgery rate 87.5% before ADA therapy and 12.5% after ADA treatment. Clinical and endoscopic remission rates were 81.8% / 63.6% and 89.4%/ 63.4 in UC and CD, respectively at the end of follow-up period. Loss of response rate was 20% in UC and 28.3% in CD (table). Mean months for loss of response were 42 ± 25.4 months and 29.7 ± 12 months in UC and CD, respectively. Clinical remission was obtained by dose escalation in 66% of CD patients who had response loss. Loss of response rate was not significantly different between IFX naive and IFX experienced patients (p &gt; 0.05). There was no significant adverse event during the follow-up period.

Conclusion
In real life, the efficacy of ADA treatment is high in mild-to-moderate active IBD. Endoscopic remission was also acceptable for this group of patients.