bluuebunny/crossref_metadata_2025_split huggingface dataset:
P315 Short-chain fatty acid profile in inflammatory bowel disease
Authors: Oliveira L , Yukie Sassaki L , Elisa Valencise Quagli A , Ribeiro de Barros J 
Published: January 2020

Abstract

Background
Short-chain fatty acids (SCFAs) are products of colonic bacterial degradation of dietary fibre. They are important in the colon, affecting the morphology and function of colonocytes. SCFAs consist of a molecule with one to six carbons, of which acetate, propionate and butyrate are the most abundant. In recent decades, it has become apparent that SCFAs can play a key role in the prevention and treatment of metabolic syndrome, intestinal disorders and certain cancers. Crohn’s disease (CD) and ulcerative colitis (UC) are characterised by recurrent chronic intestinal inflammation, probably due to an inadequate immune response coupled with intestinal microbiota imbalance. The aim of this study was to evaluate the profile of SCFA in patients with UC and CD, and compared with non-ill individuals.

Methods
The individuals were divided into three groups: RCU, CD and control, the faeces were donated by them, and the SCFAs were measured by chromatographic analysis using a Thermo Scientific GC-MS coupled to a Thermo ISQ 230ST mass detector. All results are expressed as mean ± SEM.

Results
It was possible to observe a different SCFAs profile between individuals with CD and UC and control where acetate and propionate levels in patients with UC and CD were higher than in non-sick individuals and butyrate with lower levels in individuals with CD and RCU (Graph 1). SCFAs have anti-inflammatory capabilities and also a preferred energy source for colon epithelial cells, as well as lowering the pH of the colon and inhibiting the growth of pathogenic organisms. Dysbiosis decreases butyrate concentrations, which may result in nutrient deficiency at the epithelial level, altering immune responses, as well as acting directly as an anti-inflammatory agent by disabling the NFκB pathway, with a consequent decrease in inflammatory cytokine synthesis.

Conclusion
Thus, the reported results have implications for various physiological and pathological conditions in inflammatory bowel diseases, especially with respect to butyrate and the production of inflammatory mediators, and partly explain the beneficial effects attributed to this fatty acid in the treatment of inflammatory and inflammatory diseases support the realisation of new studies aimed at the development of therapeutic alternatives to the use of conventional anti-inflammatory drugs.
P319 Clinical characteristics of patients with inflammatory bowel disease and metabolic syndrome
Authors: Gubonina I V , Grinevich V , Poluektov M , Kolodin T , Lapteva S , Gamzaeva A , Gubonina N 
Published: January 2020

Abstract

Background
Currently the incidence of patients with Metabolic Syndrome (MS) tends to increase among patients with inflammatory bowel disease (IBD). The purpose of the study is to investigate the course of IBD depending on the presence of MS.

Methods
This cross-sectional analysis was performed on the database of patients with IBD to estimate the frequency of MS presence and study the clinical course (extension of pathologic process, severity and phenotype) of Crohn’s disease (CD) and ulcerative colitis (UC).

Results
347 patients with IBD were included in the investigation: 259 patients with UC and 88 patients with CD. MS was revealed with the same frequency among patients with UC (26 patients, 10.04%) and CD (9 patients, 10.23%). Proctitis (48 patients, 20.6%) and left-sided colitis (121 patients, 51.93%) are usually found among patients with UC without MS while total colitis is significantly more frequent among patients with underlying MS (12, 46.15%, p &lt; 0,05). It was found that patients without MS more often suffered from mild UC (116 patients, 49.79%, p &lt; 0,01) while among patients with MS severe UC occurred more frequently (6 patients, 23.08%, p &lt; 0.05). Among patients with CD and MS, there was no significant correlation between underlying MS and localisation, severity and course of CD.

Conclusion
Patients with UC and MS suffer from a more severe course of UC (as to both the extension of pathologic process and severity) in comparison with the patients with UC without MS. Due to the small quantity of patient with CD and MS insufficient evidence for the influence of MS on the course of CD has been obtained.
P324 Deep enteroscopy after balloon dilatation for differential diagnosis of small bowel stricture
Authors: Lim C H , Kim J 
Published: January 2020

Abstract

Background
Use of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin may result in gastrointestinal complications including ulceration, bleeding, and stricture. Chronic fibrosis and chronic ulcerations form bowel stricture which is the most severe stage of NSAIDs induced enteropathy. Capsule endoscopy and balloon enteroscopy may provide detailed information of small bowel mucosal lesions such as longitudinal ulceration suggesting Crohn’s disease. However, more distal or proximal evaluation above stricture is impossible due to severe stricture. Nowadays, balloon dilatation through the enterosope is available and can dilate stricture site by expanding force. This technique allows enteroscope to pass of stricture site and provides accurate evaluation of more proximal or distal small bowel above the stricture. We report our experience of small bowel evaluation after balloon dilatation.

Methods
Nine patients with small bowel stricture and history of NSAIDs between 2012 February and 2019 October were analysed. All patients with small bowel stricture had symptoms including abdominal pain, abdominal fullness, or vomiting and enteroscope could not pass the stricture site. Balloon dilatations were performed with through the scope balloon from 8 mm to 15 mm diameter in these patients. After adequate dilation, enteroscope passage could pass the stricture site. Detailed mucosal evaluation of more proximal or distal small bowel above the stricture was performed.

Results
Successful and adequate balloon dilation of small bowel stricture was achieved in 9 of 9 patients. Additional deep and longitudinal ulceration suggesting Crohn’s disease was found after successful passage of enteroscope in 3 of 9 patients. In 6 of 9 patients, additional chronic shallow ulcerative lesions without deep and longitudinal ulceration was found after eneteroscope passage. Deep enteroscopy after balloon dilatation provided important diagnostic clue and treatment strategy in 3 of 9 patients.

Conclusion
Deep small bowel evaluation above the stricture after balloon dilatation may provide additional and detailed information for differential diagnosis of small bowel stricture.
P339 Assessment of DNA-thioguanine nucleotide identifies patients at risk of thiopurine-induced leukopoenia in inflammatory bowel disease
Authors: Zhu X , Chao K , Gao X , Huang M , Wang X D 
Published: January 2020

Abstract

Background
Thiopurine drugs plays an important role for immunosuppressive therapy in inflammatory bowel disease. The molecular mechanism of the thiopurine toxicity is primarily mediated by DNA-incorporated thioguanine nucleotides (DNA-TGN). The aim of this study was to assess the impact of DNA-TGN levels on thiopurine-induced toxicity.

Methods
Patients over 18 years who were diagnosed with IBD and prescribed on thiopurines from February 2019 to August 2019 were recruited. All of them were genotyped with NUDT15 R139C before the thiopurine therapy. A novel assay was established to measure levels of DNA-TGN in blood leucocytes. The DNA-TGN and 6TGN levels were correlated with clinical toxicity.

Results
185 patients with Crohn’s disease and 5 patients with ulcerative colitis were included in this study. DNA-TGN and 6TGN levels could be quantified in 229 patients’ blood samples. Thiopurine-induced leukopoenia (TIL) arose in 19 individuals with the median 6TGN level of 308.0 pmol/8×108 RBC which was not significantly different from the patients without TIL (p = 0.050). However, there was a significant association between DNA-TGN levels and TIL. Patients who developed TIL were identified with a higher DNA-TGN levels compared with those who did not (p = 0.00030, 456.9 (63.3–879.2) vs. 268.9 (45.6–916.8) fmol/μg DNA). The area under the ROC curves of the continuous DNA-TGN concentration to predict TIL was 0.75 (95% CI: 0.63~0.87) and almost 84% (16/19) of the TIL could be explained based on the DNA-TGN cut-off value of 343.9 fmol/μg DNA

Conclusion
This study shows that quantification of DNA-TGN levels can be applied to gauge thioprine therapy and avoid TIL after pre-genotyping NUDT15 R139C in inflammatory bowel disease patients.
P341 Induction of response and remission: a network meta-analysis of induction studies comparing ontamalimab with other treatments for moderate-to-severe ulcerative colitis
Authors: Vickers A , Nag A , Devine B , Sands B E , Panaccione R , Peyrin-Biroulet L , Danese S , Vermeire S , Gorelick K J , Goetsch M , Hartley L 
Published: January 2020

Abstract

Background
Decisions regarding the treatment of ulcerative colitis (UC) should be based on appropriate, high-quality evidence. In the absence of head-to-head trials, network meta-analysis (NMA) can be used to compare the efficacy and safety of several treatments. We conducted an NMA to compare the efficacy of ontamalimab (anti-MAdCAM-1) using its phase 2 data, with all other biologics and novel small molecules for which induction study data on response and remission in patients with UC were available.

Methods
A systematic literature review was conducted in November 2017 to identify published randomised controlled trials of induction treatment in patients with moderate-to-severe UC. An NMA of the identified studies was performed using random-effects models and methods based on NICE guidance. Odds ratios and 95% credible intervals were calculated to describe the relative differences between all treatments and placebo in terms of efficacy in inducing response and remission. Results were generated for anti-TNF-naïve and -experienced populations.

Results
A total of 14 phase 2 and phase 3 induction studies of the following agents were included: adalimumab (160/80 mg), etrolizumab (100 mg and 300 mg), golimumab (200/100 mg), infliximab (5 mg), ontamalimab (22.5 mg and 75 mg), ozanimod (0.5 mg and 1 mg), tofacitinib (10 mg) and vedolizumab (300 mg). The definitions of response and remission used across trials were consistent. Between-study homogeneity was good and enabled pooling of results. Figure 1 shows odds ratios for induction of response and remission with treatments relative to placebo in anti-TNF-naïve and -experienced patients. All treatments, including ontamalimab, significantly differentiated from placebo in anti-TNF-naïve patients, with the exception of etrolizumab and ozanimod for response and remission, respectively. Tofacitinib (p = 0.0043) and infliximab (p = 0.0013) were superior to adalimumab in inducing response; whereas etrolizumab 100 mg (p = 0.0377), as well as tofacitinib (p = 0.0287) and infliximab (p = 0.0163), was superior to adalimumab in inducing remission.

Conclusion
This study suggests ontamalimab and most other treatments induce response and remission better than placebo. Although conducted before any large-scale head-to-head trials of these drugs, the study suggests a few treatments could be superior to adalimumab in terms of efficacy. However, varying endpoint timings, the combination of phase 2 and 3 data, and lack of control for placebo response could underscore large variances in the data and preclude firm conclusions being drawn.
P350 Perceptions of faecal microbiota transplantation in patients with ulcerative colitis
Authors: Chauhan U K , Popov J , Kalantar M , Wolfe M , Moayyedi P , Marshall J K , Halder S , Kaasalainen S 
Published: January 2020

Abstract

Background
Faecal microbiota transplantation (FMT) is widely being studied for its therapeutic efficacy for a variety of ailments. Despite its gaining popularity, there is a limited understanding of firsthand patient experiences. We explored perceptions of patients who chose to pursue FMT and patients who declined FMT in favour of conventional medications for the treatment of their ulcerative colitis (UC).

Methods
Using qualitative descriptive design, eligible patients were invited to participate in face-to-face semi-structured interviews before and after FMT treatment. Interviews were audiotaped, transcribed, and analysed using a thematic analysis.

Results
Main baseline themes across the FMT (n = 9) and non-FMT (n = 8) groups included: (i) knowledge of FMT, (ii) attitudes around FMT, and (iii) factors contributing to the decision to pursue FMT. Post-FMT themes included: (i) experiences with FMT, and (ii) perceived response to treatment. We found a poor general understanding of FMT across both cohorts, suggesting a need for improving patient education. Non-FMT patients were less likely to have heard or researched FMT in the past due to feelings of ‘it just sounds weird’. Similar concerns were found across both groups, including fear of transmissible infections, cost of experimental therapy, and aversion to stool. Expectations varied between the two groups, with feelings of hope and a sense of ‘last resort’ driving patients to pursue FMT. In contrast, the non-FMT cohort felt a need to further research FMT, explore other treatment options before committing to FMT, and were more likely to describe their disease activity as ‘not at the severe end’. This demonstrates that FMT may be perceived as a ‘last-ditch effort’. Despite initial aversion, the non-FMT group demonstrated an interest in learning more about FMT and felt more open to the possibility of pursuing FMT in the future. The FMT group was more likely to harbour a positive view of natural medicine and classify FMT as natural, while the non-FMT cohort expressed ‘I’m not really into the weird stuff’. Post-FMT, some patients expressed delight in the perceived changes in their symptoms, including improved quality of life, decreased urgency, and less concerns with accidents.

Conclusion
Our results suggest that important motivating factors for pursuing FMT are a perception of naturality and a sense of last resort. With improved education, FMT may pose an acceptable and tolerable treatment option for patients with UC.
P351 Spontaneous intra-abdominal abscesses in Crohn’s disease: The experience of a tertiary centre
Authors: Pereira Guedes T , Sequeira P , Freire L , Castro-Poças F , Rocha A , Santos M , Pedroto I , Lago P 
Published: January 2020

Abstract

Background
Crohn’s Disease (CD) is a transmural inflammatory disease with the possibility of pan-gastrointestinal involvement that could lead in 10–30% of the cases to spontaneous intra-abdominal abscesses (SIAP). Their management is multidisciplinary and personalised. Our goal was to describe the acute management of SIAP in our centre, as well the recurrence rate of abscess and the need of elective surgery.

Methods
We retrospectively reviewed medical records of CD patients who have been admitted for intra-abdominal abscess between April 2009 and August 2017. Patients with secondary or perianal abscesses were excluded.

Results
24 patients were included in this study with a mean time of hospital stay of 22.13 days. Seventy-nine per cent were male, the mean age was 39 years and 50% were smokers. According to Montreal’s Classification: 62,5% were A2, 58,5% L1 and 75% B3 (+p in 8,3%). 9 were under immunosuppressants (IS), 5 under corticosteroid and 4 under anti-TNF(2 combo therapy). All patients were admitted at the emergency room, more frequently with abdominal pain. 20,8% had SIAP as the first manifestation of CD. The most frequent location was inner loops(mean size was 5.54 cm (0.5–13 cm)). All the patients were prescribed with antibiotics; 10 had only antibiotic; 10 also performed percutaneous drainage(PD); 3 underwent surgical drainage, and 1 suffer from spontaneous drainage by an enterocutaneous fistula. Treatment failure was seen in 1 patient of antibiotic and PD groups. 83,3% underwent exclusive enteral nutrition during the hospital stay. 36,4% started corticotherapy. During follow-up, 33,3% added anti-TNF and 15 patients underwent elective surgery ±11.1 month after the discharge. Only 1 relapse of the SIAP was identified after 8 months of discharge. No deaths due CD were observed.

Conclusion
Our population consisted of predominately in young males, with younger age at the diagnose of CD, with ileal involvement and under IS. 5 patients had SIAD as the first manifestation of CD. The majority of the SIAP was controlled in acute context with only 1 patient showing a recurrence of SIAP. 15 patients needed elective surgery in the follow-up period, and 33,3% escalated medical therapy. Our results regarding the need for elective surgery aren’t far from published. More studies with larger cohorts are needed highlighting the individual management of each patient.
P358 Predictors of response to faecal microbiota transplantation in patients with active ulcerative colitis
Authors: Singh A , Sood A , Midha V , Mahajan R , Bansal N , Kaur K , Singh D 
Published: January 2020

Abstract

Background
Faecal microbiota transplantation (FMT) has been shown to be effective for induction of remission in nearly 50% patients with active UC. At present, factors impacting the response to FMT in UC remain unclear.

Methods
Patients with active UC treated with FMT via colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22 between September 2015 and March 2019 were analysed. Response to FMT was defined as achievement of clinical remission (Mayo score ≤2, with each sub-score ≤ 1 and endoscopic subscore of 0) at week 22. Patient and disease characteristics and FMT-related factors, considered to affect response to FMT were evaluated in a multivariable logistic regression analysis to determine the predictors of response to FMT. A statistical model was subsequently developed for predicting the success of FMT.

Results
Out of 140 patients with active UC and treated with FMT [mean age 34.29 ± 11.51 years, 65.71% males (n = 92), mean total Mayo score 7.8 ± 2.26], 57 (40.71%) achieved clinical remission. Of the various factors analysed, disease extent E2 (OR 2.34, 95% CI 1.17–4.68, p = 0.016), endoscopic Mayo score 1 (OR 15.375, 95% CI 1.89–125.11, p = 0.011) or 2 (OR 2.12, 95% CI 1.06–4.25, p = 0.035) and number of FMT sessions ≥ 4 (OR 16.74, 95% CI 4.85–57.85, p &lt; 0.001) were found to be associated with response to FMT. An estimated response score was developed and score ≥4 predicted response to FMT with an accuracy of 74.3% [sensitivity 64.79% (95% CI 52.54% to 75.76%); specificity 84.06% (95% CI 73.26% to 91.76%, AUROC 0.834)].

Conclusion
Disease Extent E2, endoscopic mayo score 1 or 2, and number of FMT sessions ≥4 predict response to FMT in active UC. The prediction model has good discriminative power at identifying individuals likely to respond to FMT.
P363 Moderate endurance and muscle training are safe to perform for patients with quiescent or mild active Crohn’s disease and increases their strength
Authors: Seeger W A , Thieringer J , Esters P , Allmendinger B , Schulze H , Dignass A 
Published: January 2020

Abstract

Background
The aim of this study was to examine the practicability and potential influence of moderate endurance and muscle training in patients with quiescent or mildly active Crohn’s disease (CD).

Methods
In this randomised controlled pilot trial 45 CD Patients with a CDAI below 220 were randomised to a control, an endurance or a muscle training group. Participants had to exercise individually for 3 months three times per week. Outcome parameters included disease activity (CDAI), inflammatory parameters and calprotectin, anthropometric data, general well-being (sIBDQ), physical activity (IPAQ), cardiorespiratory fitness as well as strength in the upper and lower extremities.

Results
Forty-five patients were randomised into an endurance (17), muscle (15) and control (13) group, respectively. In the endurance group, the dropout rate was 47% (8) vs. 13% (2) in the muscle group and 0 in the control group. Only one patient discontinued the study due to CD specific symptoms. One patient had to stop the study due to another concomitant disease. One patient in each intervention group was lost to follow-up. The most frequent reason for termination was lack of time and motivation: 37.5% (3) in the endurance group vs. 50% (1) in the muscle group. In both groups, the maximal and average force in the upper and lower extremity increased significantly (all p &lt; 0.04). A statistically significant improvement of the quality of life could only be seen in the endurance group in the subclass ‘mood’ of the sIBDQ (p = 0.03). CDAI decreased in the muscle group in contrast to both other groups, statistical significance, however, was not reached.

Conclusion
This study shows that both endurance and muscle training can be safely performed in patients with mild-to-moderate CD. Muscle training seems to be more feasible for this patient group. Both forms of exercise have beneficial effects on strength and presumably on comorbidities, e.g. bone mineral density and thromboembolic complications. Further research in a larger population and also patients with higher disease activity is needed to examine the effects of moderate exercise on disease activity and immunological changes in CD patients.