bluuebunny/crossref_metadata_2025_split huggingface dataset:
P224 Crohn’s disease experiences among a paediatric population: A qualitative study reviewing the agreement of symptoms discussed by children and adolescents
Authors: Coskun U , Kelly K , Hunter T , Newton L , Symonds T , Delbecque L 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) is a type of inflammatory bowel disease that can occur at any age. CD symptoms can have a significant impact on health-related quality of life (HRQL). Although key symptoms and impacts of CD in adults are well-known, they have not been well explored or documented in children and adolescents. The objective of this study was to explore the similarities and differences in CD symptoms and impacts across various age groups (children and adolescents) and develop a list of most common symptoms and impacts for these populations.

Methods
Children (ages 5–11 years) and adolescents (ages 12–17 years) with CD and parents/caregivers of children with CD (ages 2–11 years) were recruited from US medical practices. Qualitative semi-structured interview guides were developed, informed by published literature. Face-to-face and telephone concept elicitation interviews were conducted, audio-recorded, and transcribed. Transcripts were analysed using thematic methods facilitated by NVivo.

Results
A total of 49 individuals participated in this study (child n = 11, adolescents n = 20, parents/caregivers n = 18). Preliminary results showed that there was a high level of qualitative agreement between CD symptoms in children and adolescents. The ranking of the top 15 symptoms was nearly identical between the two cohorts. The most frequently discussed symptoms (discussed by ≥75% of the participants in each cohort) were feeling gassy, abdominal pain, diarrhoea, incomplete evacuation, tiredness, and urgency. The second most frequently discussed symptoms (discussed by ≥50% of the participants in each cohort) were cramping, constipation, blood in stool, and frequent bowel movement. While abdominal cramping and blood in stool were discussed by ≥75% of the adolescents, 63% and 50% of the children discussed them respectively. Similarly, while bloating and nausea were discussed by ≥50% of adolescents, 38% and 25% of children discussed them, respectively. Finally, while vomiting was discussed by 50% of the children, 33% of the adolescents discussed it. Impacts due to CD were also regularly discussed across both cohorts but less so by the children. School and low mood/sadness were discussed by ≥50% of the participants in each cohort. Exercise/sport, play/leisure activities, annoyance/frustration, and eating/drinking limitations were discussed by ≥50% of the adolescents but &lt;50% of the children.

Conclusion
The results from the CE interviews show the clear burden of CD and that this is mostly similar across children and adolescents allowing for a future unified disease model to be developed.
P231 Epidemiological profile and long-term outcomes from a large PSC-IBD cohort
Authors: Caon A E , Martins C , Cruz M , Leite Barros L , Azevedo M , Queiroz N , Carlos A , Milane L , Oba J , Braga M , Sipahi A , Damião A , Cançado E 
Published: January 2020

Abstract

Background
Primary sclerosing cholangitis (PSC) is a chronic and progressive cholestatic disease associated with inflammatory bowel diseases (IBD) in 70% of cases.1 When combined, they present as one distinct phenotypical disease referred to as PSC-IBD with milder clinical course, despite more extensive colonic involvement and an increased risk of malignancies. The aim of this study was to assess clinical features and long-term outcomes of PSC-IBD patients from a quaternary hospital in Brazil.

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

Results
In total, 92 patients with concurrent PSC and IBD were identified. Of 92 cases, 80 (87%) had ulcerative colitis (UC) and 12 (13%) were diagnosed with Crohn’s disease (CD). There was a slight predominance of male, 51 (55%). The mean age at both IBD and PSC diagnosis was 31 and 35 years, respectively. Most of them were diagnosed with IBD prior to PSC (53%). The mean IBD duration was 15 years and 10 years in PSC subjects. The prevalence of pancolitis in UC patients was 91%. All CD cases presented ileocolonic involvement. Present or past smoking history was reported in 6% of the cohort. Aminosalicylates were the most common treatment used for IBD in 59 patients (64%). 15 of them (16%) were on monotherapy with immunobiologics and 7 patients (8%) were on combotherapy. Only 3 subjects were on anti-integrin. In our cohort, 61 cases (66%) were treated with ursodeoxycholic acid. Colorectal neoplasia and cholangiocarcinoma were observed in 6 (7%) and 3 patients (3.3%), respectively. Colorectal dysplasia was found in 20 subjects (22%) on a routine colonoscopy. Overall, 17 patients (19%) required proctocolectomy and 11 cases (12%) have undergone orthotopic liver transplant. There were 12 deaths, mainly PSC and cancer-related.

Conclusion
Herein we present the largest cohort of concomitant PSC and IBD in Latin America. In our centre, we have found higher rates of extensive IBD, although few of them required colectomy. The present data on cancer and dysplasia are consistent with reports in the literature.

Reference
P234 Frequency detectiveness of some viral infections in patients with inflammatory bowel diseases
Authors: Babayeva-Sadigova G , Babayev Z , Asadova G , Mahmudov U , Quliyev F , Mirzazade O 
Published: January 2020

Abstract

Background
The prevalence of opportunistic infections in individuals with inflammatory bowel disease (IBD) remains relevant. Viral infections are a common cause of systemic inflammation of the digestive tract. Clinically expressed herpes and parvovirus infections are a serious problem, especially for people with prolonged immunosuppression. The aim of the study was

t
o assess the incidence of certain herpes and parvovirus infections in patients with IBD.

Methods
In total, 189 patients with IBD, 102 with ulcerative colitis and 87 with Crohn’s disease were examined. Of the number of patients: 98 women, 91man. The age of patients is from 16 to 63 years (mean age 41.4 ± 4.8). In addition to a standard examination, disease activity was assessed by indicators of highly sensitive C-reactive protein, homocysteine, vitamin D in blood serum, albumin in urine, calprotectin and lactoferrin in faeces. All patients underwent serological blood tests by ELISA for specific antibodies to herpes viruses and IgG/IgM antibodies to parvovirus B19, determination of DNA to herpes simplex viruses of types 1-2,6(HSV1-2?HSV6), Epstein–Barr (EBV}, cytomegalovirus (CMV), herpes zoster (HZV) by PCR in blood and mucosal biopsy, and also avidity.

Results
Among patients with IBD, active infections (herpes and parvoviruses) in the blood occurred in 81 patients (42.8%); of them, 39 patients (20.6%) were diagnosed with monoherpesvirus infections, in 16 patients parvovirus (8.4%), and in 26 (13.8%) cases, active mixed viral infections were detected. In 79 cases (41.7%) of PCR biopsy material was positive for isolated infection: 36 cases (19%) of CMV, 21 cases (11.1%) of EBV, 22 cases (11.6%) of HSV6. Tissue viral infection was found in 34 patients (17.9%). Clinical endoscopic and laboratory indicators of activity in IBD were significantly higher in patients with active viral infections (p ˂ 0.05), which indicates the negative effect of chronic active herpes and parvovirus infections on the course of inflammatory bowel diseases. However, significant differences between patients with ulcerative colitis and Crohn’s disease were not detected.

Conclusion
The frequency of occurrence of herpes and parvovirus lesions in patients with IBD in the blood is more than 42.8%, isolated infection in the tissue in 41.7%, and mixed infection in 17.9% of the number of patients. The clinical endoscopic picture, as well as laboratory data indicate a more severe course of diseases in the presence of these infections.
P237 Annual incidence and prevalence of ulcerative colitis and Crohn’s disease from 2010 to 2017 in four Nordic countries: Results from the TRINordic study
Authors: Lördal M , Burisch J , Langholz E , Knudsen T , Voutilainen M , Moum B , Saebo B , Paula H , Malmgren C , Coskun M , Melberg H O 
Published: January 2020

Abstract

Background
Incidence and prevalence of inflammatory bowel diseases (IBD) have been increasing for the past decades in the western world, however with an emerging trend of incidence stabilisation in recent years. There is an indication of higher IBD incidence and prevalence in northern Europe, especially in the Nordic region, compared with southern Europe.

Methods
This retrospective observational study collected data from the National Patient Registries and National Prescription Registries (Sweden [SWE], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate the annual incidence and prevalence of ulcerative colitis (UC) and Crohn’s disease (CD). Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later and no K51 or K50 codes prior to 2010 were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Incidence proportions highlight results through 2016, as 2017 patients had less than 1-year follow-up.

Results
In total, 69,876 patients were included (SWE n = 27,902, NOR n = 20,761, FIN n = 2,118, DEN n = 19,095), of which 44 367 patients were diagnosed with UC and 25,509 with CD. In 2016, the annual incidence of UC was 28 patients per 100,000 persons in NOR, 32 patients per 100,000 persons in DEN, 25 patients per 100,000 persons in SWE, and 44 patients per 100,000 in FIN. The corresponding results for the annual incidence of CD per 100,000 persons were 22 in NOR, 16 in DEN, 16 in SWE, and 21 in FIN. The prevalence per 100,000 persons of both UC and CD was the highest in DEN, followed by SWE and NOR, and lowest in FIN. Prevalence estimates increased in all four Nordic countries during 2010–2017: for UC, from 409 to 488 patients in SWE, from 256 to 428 in NOR, from 129 to 375 in FIN, and from 577 to 798 in DEN. For CD, it increased from 261 to 313 patients in SWE, from 164 to 258 in NOR, from 54 to 164 in FIN, and from 280 to 400 in DEN.

Conclusion
This retrospective observational study showed that during 2016, the annual incidence of UC ranged from 25–44 patients per 100,000 persons across the evaluated Nordic countries, whereas the annual incidence of CD was 16–22 patients per 100,000 persons. Prevalence of both UC and CD increased during 2010–2017 in all four countries. Estimates of UC and CD incidence and prevalence in this analysis are greater than reported in the published literature. Additional analyses are underway to further explore the impact of methodological decisions on the estimates of UC and CD annual incidence and prevalence.
P243 Changes in the therapeutic management of inflammatory bowel disease in the biological era – a nationwide retrospective cohort study in three Nordic countries: Results from the TRINordic study
Authors: Zhao M , Lördal M , Langholz E , Knudsen T , Voutilainen M , Høivik M L , Moum B , Saebo B , Haiko P , Malmgren C , Coskun M , Melberg H O , Burisch J 
Published: January 2020

Abstract

Background
The use of biologic therapy has increased significantly during the last decade. In 2015, one in three Crohn’s disease (CD) patients and one in five ulcerative colitis (UC) patients had received biologics within 2 years of diagnosis 1 in Denmark (DEN), Sweden (SWE) and Norway (NOR). Whether this change in treatment strategy has resulted in changes in the use of conventional drugs (5-aminosalicylates [5-ASA], immunomodulators [IM] or corticosteroids) remains unknown. An aim of this study was to investigate the use of these drugs in the biological era.1 Høivik ML et al. Time to first treatment with biologic agents for ulcerative colitis and Crohn’s disease across four Nordic countries: Results from the TRINordic study, Submitted to ECCO 2020.

Methods
A total of 67,758 incident IBD patients (42,894 UC, 24,864 CD) diagnosed between 2010 to 2017 were included in a nationwide cohort in DEN, NOR and SWE. Information on drug treatment was extracted from the National Patient Registries and the National Prescription Registries. Patients were required to have at least 1-year of follow-up post-diagnosis; results are limited to patients diagnosed between 2010 to 2016, inclusive.

Results
During 2010 to 2016, cumulative exposure to 5-ASA in CD patients at 2 years after diagnosis declined from 19.0%, 39.0% and 50.5% in 2011 to 16.3%, 31.1% and 39.6% in 2016 in DEN, NOR and SWE, respectively (p &lt; 0.001). The opposite trend was observed in UC where 87.3–91.1% received 5-ASA within 2 years in 2015 compared with 75.8–87.3% in 2011 (p &lt; 0.001) (Figure 1). In all countries, corticosteroid use remained stable in CD with more than half of patients receiving corticosteroids within 2 years of diagnosis. In UC, corticosteroid use within 2 years of diagnosis increased in NOR from 42.2% in 2011 to 51.6% in 2015 (p &lt; 0.001) but remained stable in DEN and SWE (Figure 2). The use of IM within 2 years increased in CD patients in NOR and SWE from 36.5% and 40.8% in 2010 to 51.3% and 52.1% in 2015 (p &lt; 0.001). IM were less frequently used in UC but increased similarly from 14.0% and 21.1% in 2010 to 22.5% and 26.4% in 2015 (p &lt; 0.001). In DEN, IM use remained stable over time (Figure 3).

Conclusion
The use of 5-ASA declined over time in patients diagnosed with CD but increased over time in patients diagnosed with UC. Corticosteroid use remained stable in CD but increased over time in UC patients in NOR. The increasing and earlier use of biologics was accompanied by increasing use of IM in all countries. While this could suggest a more aggressive treatment approach, differences in treatment practices across countries might contribute to these findings. The impact of changes in treatment strategies on disease outcomes remains to be shown.
P260 Adaptation of TECCU App based on patients’ perceptions for telemonitoring inflammatory bowel disease: A qualitative study using focus groups
Authors: Del Hoyo Francisco J , Nos P , Faubel R , Bastida G , Muñoz D , Valero E , Garrido A , Savini C , Bella P , Peña B , Aguas M 
Published: January 2020

Abstract

Background
Despite the continuous adaptation of eHealth systems for patients with inflammatory bowel disease (IBD), a significant disconnection persists between users and developers. Since non-adherence remains high, it is necessary to better understand the patients’ perspectives on telemonitoring for IBD. The aim of this study was to adapt the TECCU app to the preferences and needs of IBD patients.

Methods
A qualitative study was carried out using successive focus groups of IBD patients. Meetings were audio-recorded and a thematic analysis approach was employed until data saturation was achieved. The first group included patients who had used the TECCU app in a pilot clinical trial, and subsequent meetings included patients with Crohn’s disease and ulcerative colitis recruited from the Spanish Confederation of patient associations. The information collected at each meeting guided consecutive changes to the platform.

Results
Data saturation was reached after 3 focus groups, involving a total of 18 patients. Three main themes emerged: (1) platform usability; (2) the communication process; and (3) contents of the platform. All participants indicated that TECCU is easy to use, permitting continuous and personalised feedback. Nevertheless, the platform was adapted according to the patients′ perspectives to foster a flexible follow-up and shared decision-making, using open and safe communication networks. Many participants appreciated the educational elements and the app was connected to reliable and continuously updated webpages.

Conclusion
IBD patients valued the usability and personalised monitoring offered by the TECCU App. Improvements in the messaging system and continuous updates of the educational contents were performed to address patients′ needs and favour their engagement.
P263 Proximal disease extension in patients with ulcerative proctitis: Associated factors and experience of an IBD tertiary Brazilian centre
Authors: Ferreira S , Queiróz Marques de Mendonça R , Steltenpool Tonin Borges I , de Avelar Cardoso P H , Rose Otoboni Aprile L , Serafim Parra R , Ribeiro Feitosa M , Feres O , Ribeiro da Rocha J J , de Ameida Troncon L E 
Published: January 2020

Abstract

Background
Ulcerative proctitis (UP) accounts for a significant proportion of cases of ulcerative colitis (UC) and implies limited involvement of the rectum. Some patients presenting initially with UP may progress to more extensive colitis (inflammation found distally to the rectum-sigmoid junction). Although several predictive factors for this progression have been described, none has been established as definitive. We aimed at determining risk factors predictive of proximal disease extension in UP.

Methods
Retrospective analysis of data from 97 patients (67% female) with UP (Montreal Classification: E1) with at least 12 months of follow-up at the IBD tertiary centre from January 2001 up to December 2018. Proximal extension was evaluated endoscopically during follow-up and was defined as E1 progressing to E2/E3. Factors examined comprised age, gender, race, presence of extra-intestinal manifestations, Mayo endoscopic score, disease relapse, use of corticosteroids, immunosuppressive and biological agents and colectomy. We used univariate analysis (Chi-square test) to assess the association of individual factors to proximal disease extension.

Results
A total of 29 (29.9%) patients experienced proximal disease extension during a mean follow-up of 137.36 ± 86.63 months. The following factors were significantly associated with proximal disease extension: higher initial Mayo score (p = 0.035) and higher initial disease severity (p = 0.0024). Use of corticosteroids initially (86.2% vs. 41.2%, p &lt;0.0001), increased disease relapse rate (86.2% vs. 20.6%, p &lt; 0.0001)and the need for immunosuppressive agents (57.1% vs. 13.6%, p &lt;0.0001) or biological agents (42.9% vs. 10.3%, p &lt;0.0001) were all significantly higher among UP patients with disease proximal extension, when compared with non-extensors. Colectomy was also associated with proximal disease extension (p = 0.0002). No significant association was found between UP proximal extension and gender, race, age at diagnosis and extraintestinal manifestations.

Conclusion
UP is a dynamic disease that may progress over time. UP patients with increased clinical and endoscopic severity at the diagnosis are likely to evolve with proximal extension and should be more carefully followed up.

Reference
P268 Systematic review and meta-analysis: Inflammatory bowel disease (IBD) associated colonic dysplasia prognosis in the video-endoscopic era
Authors: Kabir M , Fofaria R , Basset P , Arebi N , Tozer P , Hart A , Wilson A 
Published: January 2020

Abstract

Background
Management of dysplasia in IBD patients is largely based on outcomes reported by a small number of observational studies, most of which include data from the pre-videoendoscopic era (before 1990). The impact of recent advances in dysplasia detection e.g. high definition chromoendoscopy (HDCE) and endoscopic resection techniques on colorectal cancer (CRC) risk needs to be better understood to inform management decision-making. We conducted an updated review of dysplasia prognosis in the videoendoscopic (VE) era according to lesion morphology, grading and endoscopic resectability.

Methods
The search strategy is described in Figure 1. The inclusion criteria were studies of (1) IBD colitis patients with dysplasia, (2) who had a colectomy or at least one colonoscopy on follow-up, and (3) reported on the incidence of CRC, according to the endoscopic visibility, morphology and grade of the index dysplasia. The primary outcomes were: (a) the ‘prevalent CRC rate’ (incidental CRC found on colectomy undertaken within 6 months of a dysplasia diagnosis and may represent missed cancers on colonoscopy) and (b) the incidence of metachronous CRC found on follow-up of more than 6 months after a dysplasia diagnosis. Meta-analyses were performed to obtain pooled estimates of the outcomes as appropriate. Quality of the evidence was assessed using GRADE criteria.

Results
Thirty studies met criteria for inclusion. The pooled estimated prevalent cancer rate for visible and invisible high-grade dysplasia (HGD) patients were 14% (95% CI 0–54; I2=92) and 11% (95% CI 5–20) respectively; for visible and invisible low-grade dysplasia (LGD) patients it was 3% in both groups (95% CI 0–8; I2=19–45); and for indefinite dysplasia it was 1% (95% CI 0–7). Risk of metachronous CRC, 2 years after endoscopic resection of polypoid or non-polypoid LGD were 0–5% and 0–22%, respectively. Risk of metachronous CRC, 2 years after a diagnosis of invisible LGD or indefinite dysplasia were 0–28% and 0–1%, respectively. The lowest rates for both primary outcomes were noted for dysplasia detected during HDCE surveillance and resected en bloc with clear histological resection margins.GRADE assessment of the quality of evidence was low or very low due to the inclusion of mainly case series or small cohort studies with heterogeneous populations and limited follow-up.

Conclusion
The results from this review suggest that the recent advances in endoscopic techniques are reducing the rates of prevalent and metachronous CRC. However, the evidence-base informing dysplasia prognosis from the VE era remains of low quality. More long-term data on the risk of metachronous CRC, particularly after the resection of non-polypoid dysplasia, is required to inform decision making.