bluuebunny/crossref_metadata_2025_split huggingface dataset:
P103 FULMINANT CLOSTRIDIUM DIFFICILE ENTERITIS IN A PATIENT WITH ULCERATIVE COLITIS FOLLOWING TOTAL COLECTOMY RELIEVED BY ILEAL DECOMPRESSION
Authors: Rolfsen Matthew , Forster Erin , George Virgilio , Curry Scott 
Published: January 2020

Abstract
A 20 year old female with a history of Ulcerative colitis status post total colectomy and end ileostomy was admitted to the intensive care unit with septic shock. She had initially been diagnosed with fulminant ulcerative pancolitis three months prior, and after failing to respond to dual therapy with high dose infliximab and azathioprine, she underwent total colectomy and end ileostomy as the first part of a staged ileal pouch-anal anastomosis procedure.
Upon presentation to the emergency department, she endorsed fevers, chills, abdominal pain, and decreased stomal output. Diagnostic workup was notable for polymerase chain reaction (PCR) positive for Clostridium difficile toxin A and toxin B. She began treatment with oral vancomycin and IV flagyl, but remained critically ill with persistent fevers, vasopressor requirement and imaging showing 4.1 cm dilation of her distal ileum. As such the decision was made to attempt decompression via placement of a rectal tube into her ileostomy, after which her ostomy output improved from &lt;20cc/day to 7L in the ensuing 48 hours. During this time she defervesced, was taken off of vasopressors, and was able to be discharged from the hospital one week later.
Infectious agents are the most common cause of diarrhea worldwide. Amongst implicated culprits, C. difficile is both the most common nosocomial infection and the most common cause of death due to gastrointestinal infections. Mechanisms of infectious diarrhea include formation of various toxins as well as cellular adherence and invasion (1). In the case of C. difficile, the gram positive anaerobe produces both an enterotoxin (toxin A) and a cytotoxin (toxin B).
In patients found to have C. difficile infections (CDI), the vast majority are affected by colitis. There is a small prevalence of extracolonic CDI, including extraintestinal in a small subgroup (0.17%)(2). According to literature, extracolonic CDI carries a 20% mortality rate. Out of those cases of extracolonic CDI, the majority (4/7 in a small case series), had a history of a previous colonic surgery (3). It has been postulated that the reason for increased prevalence amongst patients with previous colonic surgery is the adaptation of ileal flora to resemble fecal flora following ileostomy (3).
Although not considered to be standard of care, colonic decompression has been described for patients with toxic megacolon refractory to medical therapy. In a seven patient series which looked at decompressive colonoscopy with intracolonic perfusion of vancomycin in patients with toxic megacolon, 57% had complete resolution (5). In a patient who has undergone ileostomy and who had a significant amount of dilation on her imaging, we felt that her clinical scenario was analogous to megacolon, and that an escalation in therapy was warranted.

Image 1. CT Abdomen showing diffuse ileal dilation
P104 PEDIATRIC CROHN’S DISEASE PRESENTINAG AS GENITAL EDEMA
Authors: Ebach Dawn , Storm Douglas , Gosse Matthew 
Published: January 2020

Abstract
Two 12 year old boys presented to pediatric urology with chief complaints of genital swelling who were eventually diagnosed with Crohn’s disease.
Patient 1 presented with swelling, erythema and discomfort of his penis. He did not respond to topical hydrocortisone or oral antibiotics. With history of short stature he was referred to pediatric GI. He had oral ulcerations and perianal skin tag, but denied abdominal pain or diarrhea. Weight was at the 3rd percentile height was at the 2nd percentile. He had Hgb of 12.2, and iron saturation of 8 with normal ESR and CRP. ASCA IgA was normal but IgG was elevated at 66 (normal &lt;20). Endoscopy revealed erythema with linear ulcerations in the stomach and aphthous ulcerations of the colon with erythema and edema of the ileocecal valve with inability to intubate it. Pathology demonstrated mild chronic active gastritis and mild chronic active colitis with granulomas. Magnetic resonance enterography (MRE) showed mild enhancement at the ileocecal area. Budesonide improved the penile erythema but did not change the edema. He was then started on methotrexate and infliximab with no improvement of the edema. Topical tacrolimus did not resolve edema. At age 15 he had surgical resection of the indurated subcuticular penile tissues with pathology revealing fibrotic stroma with lymphoplasmacytic inflammation and rare granulomas. He has recovered well from his penile procedure with a dramatic improvement in the cosmetic appearance, with no recurrence of the penile edema.
Patient 2 had scrotal edema, erythema, and discomfort. A scrotal ultrasound demonstrated moderate to severe scrotal edema without epididymitis, orchitis, or abscess. He was prescribed a dose of prednisone and diphenhydramine. Swelling improved but he presented a month later with recurrent scrotal edema and pain and was prescribed doxycycline for a presumed diagnosis of cellulitis along with recommendations for ice, compression and elevation. He returned to the ER the next day due to serous seepage from the scrotum. Upon follow up in urology, a pediatric gastroenterology referral was performed as a family history of Crohn’s disease in the mother, maternal aunt, and maternal grandmother was noted. Labs revealed a slightly elevated ESR of 17, elevated CRP of 7.3 (normal &lt;0.5), negative ASCA, and mildly elevated fecal calprotectin of 193. Endoscopy revealed aphthous ulcerations in the duodenal bulb and patchy erythema of the terminal ileum. Pathology revealed mild reflux esophagitis, mild reactive changes in the stomach, mild chronic duodenitis, and mild active ileitis. MRE was normal. He was treated with budesonide and mesalamine with subsequent improvement in the scrotal edema.
Patients presenting as genital edema as their initial Crohn’s presentation is rare and it is important for providers to be aware of this rare manifestation.
Epitheliod granuloma in the bowel.
Epitheliod granuloma in penile tissue.
P108 TEDUGLUTIDE USE IN CROHN’S DISEASE: A CASE SERIES
Authors: Chiplunker Adeeti , Ha Christina , Paski Shirley 
Published: January 2020

Abstract

Background
Teduglutide is a glucagon-like peptide-2 (GLP-2) analogue with trophic effects on the intestinal mucosa to increase the absorptive surface area and enhance nutrient and fluid absorption of the small bowel (SB).1 It has been shown to reduce parenteral nutrition (PN) and intravenous fluid (IVF) requirements and is an important adjunct in the medical management of short bowel syndrome (SBS).1–2 Crohn’s disease (CD) is an important etiology of SBS but use of teduglutide in this population can be challenging.

Aim
The aim of this case series was to describe the use of teduglutide in CD patients.

Methods
A retrospective case series of all CD patients with SBS who used teduglutide at the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center. Age, duration of SBS, length of remaining SB and colonic continuity status were recorded. BMI, average daily PN kilocalories (kcal), and IVF requirements were recorded at the time of teduglutide initiation. The duration of teduglutide use was calculated. Teduglutide dose, dose adjustment history, reason for dose adjustment, and therapy complications were noted.

Results
9 patients were included (5 male/4 female). Median age was 57 years (IQR 32). Median length of remaining small bowel was 60cm (IQR 27.5) and median duration of SBS was 8 years (IQR 9.83). Median BMI at teduglutide initiation was 18.66 (IQR 4.29) with a median duration of PN of 4.5 years (IQR 9.42) and median PN kcal/day of 971.43 (IQR 518). The median duration of teduglutide was 1.1 years (IQR 3.4).
4 patients (44%) had a teduglutide dose change. 2 patients had dose interval extended from daily to every other day to reduce injection burden. 1 patient developed obstructive symptoms on daily dosing, which resolved when the dose interval was extended to every other day. 1 patient had to stop therapy due to a small bowel obstruction requiring hospitalization. 8 patients (88%) were able to wean or stop PN/IVF with addition of teduglutide. 1 patient had to restart PN despite teduglutide therapy. Table 1.

Discussion
Teduglutide is effective in Crohn’s disease patients and facilitates weaning of PN and IVF requirements. Most patients tolerate the recommended dose with daily injections, but the dose interval can be extended to every other day to reduce obstructive symptoms or reduce the injection burden without affecting ability to wean PN/IVF.

References
P124 COMPARISONS OF HOLISTIC PATIENT-REPORTED OUTCOMES BY BIOLOGIC DRUG CLASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A REAL-WORLD STUDY IN IBD PARTNERS
Authors: Long Millie , Zhang Xian , Chen Wenli , Lissoos Trevor 
Published: January 2020

Abstract

Background
Increasing numbers of biologic agents are now available for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC). Limited data are available on clinical characteristics of populations initiating these therapies and relevant holistic patient-reported outcomes (PROs) in the real-world.

Methods
We used data from IBD Partners from May 2014-May 2019. Individuals initiating an anti-tumor necrosis factor (anti-TNF) agent or vedolizumab (VDZ) were included. A subgroup with at least 6 months of follow-up who had baseline data within 90 days of therapy initiation were included in longitudinal analyses. We aimed to: 1) compare clinical characteristics of patients initiating each biologic therapy and 2) compare PROs at follow-up by drug class. Outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) T scores for anxiety, depression, fatigue, pain interference, and social satisfaction. We used logistic regression models controlling for prior biologic exposure, age, sex, prior hospitalization, disease duration, surgery (for CD), and baseline values of each PRO to compare PROs at follow-up by drug class. Levels of each PRO within a half standard deviation of the general population T score represented wellness.

Results
A total of 878 patients initiating anti-TNF (625 CD, 253 UC) and 651 initiating VDZ (415 CD, 236 UC) were included. Patients with CD initiating VDZ were more likely to be older, had longer disease duration, increased IBD-related hospitalization, more prior surgeries, and were more likely to be biologic exposed (P&lt;0.05 for all). Patients with UC initiating VDZ were more likely to be male and biologic exposed (P&lt;0.05 for both) (Table 1). In longitudinal analyses, a total of 198 patients on anti-TNF and 168 on VDZ were included for CD; a total of 85 on anti-TNF and 96 on VDZ were included for UC. Individuals with CD initiating VDZ had significantly greater fatigue, pain interference, and reduced social satisfaction at baseline compared with the anti-TNF population. For UC, PROs at baseline were similar across drug groups. In both CD and UC, there were no significant differences in adjusted odds of wellness for each PRO at follow-up by drug class (Table 2).

Conclusions
CD patients initiating VDZ in this real-world cohort had multiple factors consistent with more severe disease compared with those initiating anti-TNF. In longitudinal analyses after at least 6 months of treatment with VDZ or anti-TNF, there were no differences in wellness of PROs, such as anxiety, depression, fatigue, pain interference, or social satisfaction by drug class for CD or UC.
P129 INPATIENT OUTCOMES OF SEPSIS IN INFLAMMATORY BOWEL DISEASE PATIENTS: A 2016 NATIONWIDE INPATIENT SAMPLE ANALYSIS
Authors: Vohra Ishaan , Attar Bashar , Sharma Sachit , Katiyar Vatsala , Jaiswal Manthan 
Published: January 2020

Abstract

Introduction
Patients with inflammatory bowel disease are at increased risk of infections due to the immunosuppressive drugs used for its treatment and by the virtue of the disease itself. The risk of infection is further exacerbated by decreased host response to vaccines.

Objective
The objective of this study is to determine the outcomes of sepsis in patients with Inflammatory bowel disease (IBD).

Methods
The 2016 National Inpatient Sample database was used to identify patients admitted with primary diagnosis of sepsis using ICD 10 code. The subgroup analysis was done to identify patients with IBD. IBD patients were further subdivided into Ulcerative colitis and Crohn’s disease. We analyzed inpatient demographics using chi-square. Predictors of inpatient mortality were calculated using univariate and multivariable regression models.

Results
1,899,169 patients were admitted for sepsis in 2016. 10,485 UC and 13,879 CD patients with sepsis were identified. UC patients admitted with sepsis had a higher mortality (47.9%) compared to CD patients (37.8%). After adjusting for potential confounders, CD was associated lower odds of mortality as compared to UC (aOR 0.77, 95% CI 0.60–0.97, P=0.031). Independent predictors of mortality were Age (aOR 1.02, 95% CI 0.60–0.97, P=0.031) and increased Charlson comorbidity index (aOR 1.76, 95%CI 1.27–2.44 P=0.001). Acute renal failure patients requiring inpatient hemodialysis (aOR 2.8, 95% CI 1.9–4.1,P=0.000) and patients with septic shock requiring pressor support(aOR 1.6 95% CI 1.01–2.51, P=0.044) were also associated with higher odds of mortality. Severe malnourishment (aOR 0.005, 95% CI 1.18–2.62, P=0.005) and patients who developed obstruction (aOR 1.9, 95% CI 1.3–2.7, P=0.001) were also associated independent predictors of mortality on multivariate logistic regression.

Conclusions
Sepsis admissions in CD patients had better outcomes compared with UC patients. Age, Charlson comorbidity index, renal function and nutritional status of patient were useful tools to predict mortality. Further, research is needed to identify other predictors and to determine the mechanisms of underlying clinical differences.
P134 PREVALENCE OF LACTOSE INTOLERANCE IN INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES BETWEEN 2014 AND 2019: A POPULATION-BASED STUDY
Authors: Mansoor Emad , Abou-Saleh Mohannad , Sarmini Muhammad Talal , Chouhan Vijit , Regueiro Miguel , Katz Jeffry , Cooper Gregory 
Published: January 2020

Abstract

Background
The role of dairy foods in the continued symptomatology of patients with IBD is unclear. This is in part due to limited data on epidemiology of lactose intolerance (LI) in IBD. We sought to utilize a large population based database to evaluate the prevalence of LI in IBD.

Methods
We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with a diagnosis of “Crohn’s disease” (CD) and “Ulcerative Colitis” (UC) between June 2014 and 2019, based on Systematized Nomenclature Of Medicine – Clinical Terms. We calculated the prevalence LI in IBD overall, and among different age, race and gender based sub-groups and identified risk factors for LI in IBD.

Results
Of the 35,521,930 individuals in the database from October 2014–2019, we identified 165,750 and 140,640 individuals with a diagnosis of CD and UC with overall prevalence rates of 0.47% and 0.4% respectively. The prevalence of LI in individuals without IBD was 0.2%. Compared to individuals without IBD, the prevalence of LI in CD was increased at 0.9% [OR: 4.56, 95% CI: 4.33–4.81, p&lt;0.0001] and prevalence of LI in UC was increased at 0.8% [OR: 4.03, 95% CI: 3.80–4.28, p&lt;0.0001] (Figure 1).
The prevalence of LI in CD was increased in: females at 0.98% vs males at 0.77% [OR: 1.27, 95% CI: 1.14–1.41, p&lt;0.0001]; African-Americans at 1.52% vs Caucasians at 0.87% [OR: 1.73, 95% CI: 1.50–2.00, p&lt;0.0001] and children (&lt;18yo) at 2.39% vs adults (≥18yo) at 0.88% [OR: 2.77, 95% CI: 2.13–3.60, p&lt;0.0001].
The prevalence of LI in UC was increased in: females at 0.91% vs males at 0.64% [OR: 1.41, 95% CI: 1.25–1.60, p&lt;0.0001]; African-Americans at 1.45% vs Caucasians at 0.78% [OR: 1.84, 95% CI: 1.55–2.19, p&lt;0.0001] and children (&lt;18yo) at 1.8% vs adults (≥18yo) at 0.79% [OR: 2.28, 95% CI: 1.46–3.57, p=0.0003].

Conclusions
This is one of the first large studies to date that has described the prevalence of LI in IBD in the United States. We found that the prevalence of LI to be increased nearly 4-fold in IBD. We recommend screening for LI in IBD patients with active symptoms to delineate active disease from symptomatology due to LI.
13 ASTROVIRUS ALTERS THE GUT MUCUS BARRIER AND REDUCES COLONIZATION TO ENTEROPATHOGENIC E. COLI
Authors: Cortez Valerie , Sharp Bridgett , Livingston Brandi , Rowe Hannah , Alsallaq Ramzi , Rosch Jason , Margolis Elisa , Schultz-Cherry Stacey 
Published: January 2020

Abstract
Goblet cells, specialized epithelial cells that produce mucus, are essential for gut health. Dysfunctional goblet cell secretion can weaken the mucus barrier, bringing commensal microbes and other lumenal contents in contact with the epithelial barrier, triggering inflammation. We recently discovered that murine astroviruses infect goblet cells in the small intestine, making it the first enteric virus in which this tropism has been recognized in vivo. To first determine whether astrovirus infection alters mucus production in goblet cells, we used periodic acid-Schiff staining of small intestinal tissues and found a thicker mucus layer in infected compared to mock-infected animals (1.85 to 2.51-fold, p&lt;0.001). Because changes to the mucus barrier can alter the microbial environment in the gut, we used 16S metagenomic to characterize the microbiome after infection. We found that the relative frequency of well-characterized mucus-degrading bacteria significantly increased after infection (p&lt;0.001). Using phylogenetic edge principal components analysis, we also identified distinct microbiome shifts between 0 and 14 days post-infection, corresponding to peak infection. Finally, to determine the extent to which these changes in the mucus barrier could have a functional consequence to host disease susceptibility, we developed a neonatal model for astrovirus and tested whether animals inoculated with enteropathogenic E. coli (EPEC), an adherent bacterial pathogen, would be protected from colonization. In comparison to animals inoculated with EPEC alone, co-infected animals had significantly reduced EPEC colonization (p&lt;0.01). Together, these studies reveal a new avenue of enteric virus regulation of gut homeostasis and immunity via goblet cells and highlight astroviruses as a novel model to study the mucus barrier. Future studies are needed to determine whether astrovirus-induced increases in the mucus barrier protect from other gastrointestinal diseases and how these data translate to human astroviruses, which predominately infect children &lt;1-year-old and coincides with the development of gut immunity.
P142 TARGETED COLON DELIVERY OF NIPEP-IM-0127 PEPTIDE FOR INFLAMMATORY BOWEL DISEASE (IBD) TREATMENT
Authors: Kim Deogil , Lee Dong Woo , Jo Beom Soo , Park Yoon Shin , Lee Jue Yeon , Park Yoon Jeong , Chung Chong Pyung 
Published: January 2020

Abstract
Under Inflammatory bowel disease (IBD), autoantibody-type VII collagen complex can induce autoimmune reaction and continue with the inflammation. Here, we introduced synthetic 19 amino acid sequenced peptide termed as NIPEP-IM-0127 that inhibits autoantibody-type VII collagen complex formation. The NIPEP-IM-0127 was further formulated for oral administration. Primary function of NIPEP-IM-0127 selectively localizes to wound gut barrier and masks exposed type VII collagen, which is the starting of autoimmune reaction. Disrupted type VII collagen by the disease was bound to the applied peptide, which interfere autoimmune complex formation by competitive binding inhibition between antibody and peptide. NIPEP-IM-0127 thus recovered inflammatory cytokine level by the inhibition of immune complex creation. The orally applied NIPEP-IM-0127 peptide was primarily detected at the surface of colon tissue after 9 hours of administration, while no distributions were shown in other organs. Most importantly, significant mucosal regeneration and healing has been achieved by NIPEP-IM-0127. The following GLP toxicity studies, including safety pharmacology, genotoxicity, single and repeated dose toxicity, demonstrated that NIPEP-IM-0127 showed no significant toxic effect in in mouse and monkey. Taken together, the NIPEP-IM-0127 is suggested to be a novel therapeutic candidate for IBD treatment by the dual effects combining immune modulation and intestine barrier healing.
P078 DONOR SELECTION INFLUENCES THERAPEUTIC EFFECTS OF FECAL MICROBIOTA TRANSPLANTATION FOR ULCERATIVE COLITIS
Authors: Haga Keiichi , Ishikawa Dai , Okahara Koki , Nomura Kei , Ito Shoko , Takahashi Masahito , Shibuya Tomoyoshi , Nagahara Akihito 
Published: January 2020

Abstract

Background
We have recently reported the efficacy of combination of triple-antibiotic therapy and fecal microbiota transplantation (A-FMT) for patients with ulcerative colitis (UC). It has been reported that FMT with frozen donor faeces (frozen-FMT) is as effective as fresh-FMT for Clostridium difficile infection. However, it is still unclear which donor and condition is suitable for FMT on UC. The aim of this study was to evaluate the effectiveness of frozen-FMT compared to fresh-FMT, and verify effective conditions. Moreover, we explore the concept of best donor for A-FMT success.

Methods
This prospective and randomized controlled study was conducted from July 2017 to September 2019 at Juntendo University Hospital. Eligible patients were at least 20 years of age, with a diagnosis of active UC which were required a Lichtiger’s clinical activity index (CAI) of 5 or more, or with an endoscopic Mayo score of 1 or more. Patients were randomly allocated fresh or frozen faecesfrom 2 healthy donors. Triple-antibiotic therapy (Amoxicillin, Fosfomycin, Metronidazole; AFM) was administered to patients with UC for 2 weeks, and up to 2 days before FMT. Clinical outcomes were assessed at8 weeks and 1 year after treatment. Clinical response was defined as a decrease of CAI of 3 points or more, and remission was defined as 3 points or less. Maintenance of efficacy was defined as no exacerbation of CAI and no intensification of treatments.

Results
29 patients completed protocol (fresh-FMT; n = 15, frozen-FMT; n = 14). At 8 weeks after treatment, clinical response and remission were observed in fresh-FMT (46.7%, 33.3%), and in frozen-AFM (64.3%, 42.9%) respectively.There were no significant differencesin therapeutic effectsbetween frozen-FMT and fresh-FMT.On the other hand, in cases which age difference between donor and patient was more than 16 years, maintenance rate was significantly lower than 0–15 age difference (0–15 vs ≧16, n = 14, 15 p&lt;0.05). Interestingly,in cases that age difference between patient and donor was 0–15 years, high therapeutic effect was observed in patients treated withfresh- FMT.

Conclusion
This study showed that A-FMT with frozen faeces is as effective as cases treated with fresh faeces. In addition, findings from this study indicate that donor selection influences treatment effects, and age difference between patient and donor might be an important factor for A-FMT success.