bluuebunny/crossref_metadata_2025_split huggingface dataset:
P168 Isolated terminal ileitis: when capsule endoscopy is key for Crohn’s disease diagnosis
Authors: FREITAS M , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Rosa B , Moreira M J , Cotter J 
Published: January 2020

Abstract

Background
Terminal ileitis (TI) is a common condition in clinical practice and may be associated with a wide variety of diseases, mostly Crohn’s disease (CD). Data regarding predictors of CD diagnosis in isolated TI are lacking, particularly concerning small bowel capsule endoscopy (SBCE) findings.

Aim
To evaluate predictive factors for CD diagnosis in patients with isolated TI detected during ileocolonoscopy, submitted to SBCE.

Methods
Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected. The diagnosis of CD was based on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations.

Results
One hundred and two patients with isolated ileitis on ileocolonoscopy were included. After performing SBCE, 34.3% of the patients had a diagnosis of CD. All CD diagnosed patients had positive SBCE findings. Extraintestinal manifestations (p = 0.003), weight loss (p = 0.01), abnormal imaging (p = 0.04) and positive SBCE findings (p = 0.005) were independently associated with CD diagnosis. Regarding SBCE, presence of proximal small-bowel disease (p = 0.02), diffuse findings (p = 0.002) and presence of moderate to severe inflammatory activity (Lewis Score≥790) (p &lt; 0.001) were independently associated with CD diagnosis.

Conclusion
SBCE is a valuable tool that should be systematically used in patients presenting with isolated TI, since it enabled CD diagnosis in approximately one-third of patients. A diagnosis of CD should be considered when a patient with TI shows extraintestinal manifestations, weight loss, abnormal imaging and positive SBCE findings, especially proximal involvement, diffuse findings and the presence of moderate to severe inflammatory activity.
P187 The significance of netrin-1 level in the clinical activity of ulcerative colitis, its association between TNF-α and IL-6
Authors: Korkmaz H , Fidan K 
Published: January 2020

Abstract

Background
In this study, we investigated the importance of netrin-1 levels in ulcerative colitis (UC) in clinical activity of the disease, and its association with other proinflammatory cytokines IL-6 and TNF-α.

Methods
This study is a type of case–control study. Sixty-seven patients with UC (36 of them activation, 31 of remission) and 50 healthy controls were included in the study. UC patients; ‘Truelove Witts clinical activity index by remission (n = 31), mild activation (n = 21), moderate activation (n = 6) and severe activation (n = 9) were divided into groups. Netrin, IL-6 and TNF-α measurements in plasma samples were performed using enzyme-linked immunosorbent assay kit.

Results
Between the patient group and the control group; there was a statistically significant difference between netrin-1, IL-6, TNF-α, neutrophil, platelet (p &lt; 0.05 for all). The plasma netrin-1 mean of UC with severe activation group (139.21 ± 48.09 pg/ml) was statistically significantly higher than that of the mild activation (p = 0,037), remission group (p = 0,001) and control group(p = 0,011). The plasma netrin-1 mean of UC with moderate activation group was statistically significantly higher than that of the mild activation(p = 0,045) and remission group(p = 0,004).

Conclusion
Our results reveal that plasma netrin-1 levels have been shown to be associated with UC activation, similar to proinflammatory cytokines such as TNF-α and IL-6, in UC.
P193 Validation of the two-item UC patient-reported outcome (PRO2) against the simple clinical colitis activity index (SCCAI), measures of biochemical disease activity and quality of life
Authors: Samaan M , Cunningham G , Tamilarasan G , Ray S , Mawdsley J , Anderson S , Sanderson J , Arkir Z , Irving P 
Published: January 2020

Abstract

Background
Patient-reported outcomes (PRO) have an increasingly important role in IBD. This is true of monitoring of disease activity in clinical practice and as well as the evaluation of new therapies, when used as clinical trial endpoints. An interim two-item PRO (PRO2) has been developed for UC that ranges from 0–6 and consist of the patient-derived items from the Mayo score (rectal bleeding and stool frequency). PRO2 was internally validated against endoscopic outcomes. We aimed to add external validation across a range of clinical, biochemical and quality of life outcomes.

Methods
Data were collected as part of the GO-LEVEL study, an open-label, phase IV, investigator-initiated study (NCT03124121) which included a prospective cohort of UC patients commencing golimumab induction therapy, as well as a cross-sectional cohort receiving maintenance treatment. Patients commencing induction therapy all had disease activity objectively confirmed and were evaluated at weeks 6, 10 and 14. Patients receiving maintenance therapy were recruited either at the point of flare or during stable remission. Clinical disease activity was evaluated using PRO2 and SCCAI, quality of life using IBD-Control as well as a 100mm visual analogue scale (IBD-Control-VAS), and biochemical activity using FC and CRP. Clinical remission was defined as a score of &lt;3 using SCCAI, or 0 using PRO2. Correlations were calculated using Spearman’s correlation coefficient (rs) and contingency table analyses using Chi-square.

Results
GO-LEVEL included a total of 112 patients across the two study cohorts. A total of 217 PRO2 assessments were made with concurrent SCCAI and IBD-Control scores available at all timepoints. CRP measurements were available at 214 of these and FC at 207. Strong correlations were observed between PRO2 and SCCAI (rs = 0.94, p &lt; 0.0001), as well as with IBD-Control (rs=−0.82, p &lt; 0.0001) and IBD-Control-VAS (rs = −0.78, p &lt; 0.0001). Significant correlations were also seen between PRO2 and FC (rs = 0.38, p &lt; 0.0001) as well as PRO2 and CRP (rs=0.31, p &lt; 0.0001).
Of the 217 assessments, 109 were in SCCAI defined remission, 95 were in PRO2 defined remission and the two were highly contingent (p &lt; 0.0001). The sensitivity and specificity of disease activity assessments made with PRO2 vs. SCCAI were 0.85 and 0.98, respectively. The positive and negative predictive values were 0.98 and 0.87, respectively.

Conclusion
The PRO2 performs well when validated against an established clinical disease activity index (SCCAI), quality-of-life assessments and biochemical markers of disease activity. PRO2 assessments have the benefit of being more rapid to administer (comprising of only two items) than SCCAI (6 items), whilst providing similar and accurate evaluations of remission status.
P198 Colorectal cancer diagnosis in patients with inflammatory bowel disease in Spain: A room for improvement
Authors: Saldana R , Savini C , Bella Castillo P , Vera Mendoza I , Nos Mateu P 
Published: January 2020

Abstract

Background
Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD), characterised by chronic inflammation of the digestive tract. IBD patients have an increased risk of developing colorectal cancer (CRC) compared with the general population. A proper screening in this population is essential to guarantee an early CRC diagnosis and maximise the success of the treatment. The aim of the study was to analyse the usual clinical practice in the diagnosis of CRC in IBD patients in Spain, and possible areas of improvement.

Methods
This preliminary qualitative study was carried out through the creation of four round tables with gastroenterologists and oncologists from different cities of Spain. The opening and closing tables were composed by 1 representative of the Confederation of Associations of Patients with CD and UC of Spain, an expert patient, a nurse from an IBD Unit, a representative of the Spanish Working Group on CD and UC, a gastroenterologist, an oncologist. The first one was necessary to point out the issues that were considered as the most important ones to be discussed in the round tables. In the closing table, all the debates were analysed in order to formulate conclusions.

Results
According to health professionals, the average delay time from the suspicion of an IBD flare, until the diagnosis of a CRC, is 3 months. The difficulty and delay in the diagnosis of CRC is generally attributed to the fact that the symptoms of the two pathologies usually overlap. Medical specialists currently suggest performing chromoendoscopy, in order to increase the rate of early detection of CRC. However, even if patients’ management and CRC prevention are described by the ECCO guidelines, we identify a lack of standardisation of the techniques for the diagnosis of CRC, which cannot guarantee an equal follow-up of IBD patients at the national level. Also, it can vary not only depending on the geographical area, but also in the centre. The reasons why the follow-up cannot be done – or is not done properly, are the lack of time, human resources, diagnostic tools and patient collaboration.

Conclusion
From a quantitative point of view, specialists perceive the early CRC underdiagnosis in IBD patients as a minor problem, since they agree that there may be little escaping to the screenings that are routinely performed to these patients. On the other hand, at a qualitative level they recognise it is a major problem, since a delay in diagnosis or misdiagnosis can lead to patient’s death. Thus, hospital administrations should provide resources that allow an adequate follow-up of all IBD patients. Also, the creation of multidisciplinary units would guarantee better management of these patients.
P202 Crohn’s disease extent and small bowel inflammatory activity: Results of a small bowel capsule endoscopy study
Authors: Mitselos I , Lamouri C , Theopistos V , Kavvadias A , Moutzoukis M , Beka E , Katsanos K , Christodoulou D 
Published: January 2020

Abstract

Background
Small bowel capsule endoscopy (SBCE) enables the direct visualisation of the entire small bowel (SB) mucosa and the application of the Lewis score allows the reliable assessment of the SB mucosal inflammatory activity in Crohn’s disease (CD) patients. The study aim was to investigate the association of disease location, extent and inflammatory activity in CD patients with the use of SBCE

Methods
Retrospective study of 80 consecutive patients with an established CD that underwent SBCE in the Gastroenterology Department of the University Hospital of Ioannina between January 2007 and October 2019, for the evaluation of disease extent and disease activity.

Results
Fifty-one patients had evidence of endoscopic disease activity. In 30 of these patients (58.8%), the disease was located in the ileum and proximal SB, whereas in 20 patients (39.2%) the disease was located solely in the terminal ileum. In one patient (2%) treated with adalimumab, the disease was located solely in the jejunum. Eight patients (15.7%) had evidence of disease activity in the upper GI. All patients with upper GI disease activity demonstrated proximal SB disease involvement. The median Lewis score in patients with proximal CD was 1350 (mean 1666.3; Std 1343) median) against 458 (mean 1548,6; Std 1751) in patients with disease located in the ileum (p = 0.10).

Conclusion
In our study, proximal small bowel disease involvement was present in &gt;50% of CD patients. Upper GI involvement was associated with extensive SB disease. Patients with proximal SB CD demonstrated a higher median Lewis score compared with those with CD located solely in the terminal ileum.
P213 Can artificial intelligence help differentiate inflammatory intestinal diseases in China? Models applying random forest and convolutional neuron network
Authors: Li Y , Tong Y , Lu K , Yu S , Qian J 
Published: January 2020

Abstract

Background
Differentiating between ulcerative colitis (UC), Crohn’s disease (CD) and intestinal tuberculosis (ITB) is challenging under endoscopy. We aimed to realise automatic differential diagnosis among these diseases through machine learning algorithms.

Methods
A total of 6399 consecutive patients (5128 UC, 875 CD and 396 ITB) who had taken colonoscopy examinations in Peking Union Medical College Hospital from January 2008 to November 2018 was enrolled. The input was the description of the endoscopic image in the form of free-text. Word segmentation and key word infiltration were conducted as data pre-processing. Random forest (RF) and convolutional neural network (CNN) were applied to different disease entities. Three two-class classifiers (UC and CD, UC and ITB, CD and ITB) and a three-class classifier (UC, CD and ITB) were built. Sensitivity/specificity and precision/recall were applied to evaluate the performance of two-class classifiers and the three-class classifier, respectively.

Results
The classifiers built in this research were well-performed and the CNN had a better performance in general. The RF sensitivities/specificities of UC-CD, UC-ITB and CD-ITB were 0.89/0.84, 0.83/0.82 and 0.72/0.77, while the CNN of CD-ITB was 0.90/0.77. The precision/recall of UC-CD-ITB was 0.97/0.97, 0.65/0.53 and 0.68/0.76 by RF, respectively, and 0.99/0.97,0.87/0.83 and 0.52/0.81 by CNN, respectively.

Conclusion
Classifiers built by RF and CNN had an excellent performance when classifying UC with CD or ITB. For the differentiation of CD and ITB, high specificity and sensitivity were reached as well. Artificial intelligence through machine learning is very promising in helping unexperienced endoscopists differentiate inflammatory intestinal diseases.
P247 Sex-related differences in clinical diagnosis of inflammatory bowel disease
Authors: Sempere Robles L , Purificación B , Cameo J , Gutiérrez A , Laveda R , García M , Aguas M , Medina L , Martinez A , Jimenez N , Nos P , Jover R , van-der Hofstadt C , Ruiz M T 
Published: January 2020

Abstract

Background
There is a lack of knowledge of the differences between women and men in clinical behaviour at the onset of inflammatory bowel disease (IBD). We hypothesise a potential diagnostic delay in women in IBD. The aims of this study were: (1) to evaluate the differences in diagnostic effort between women and men with IBD and (2) to assess the sex differences in IBD diagnosis and its impact on the gender roles, the quality of life and the emotional sphere.

Methods
We performed a prospective multicentre observational study in adults with a new diagnosis of IBD. The diagnostic process of IBD was reconstructed with semistructured interviews and electronic clinical records. Time to diagnostic resolution after the onset of symptoms and misdiagnosis of IBD in the different levels of the healthcare system were analysed. Patient delay was defined as the period from symptom recognition to first medical consultation. An additional interview was conducted to assess differences between women and men in the influence of IBD in gender roles (directed questions), quality of life (IBDQ-32), anxiety and depression (Hospital Anxiety and Depression Scale) and stress (Disease-Related Stress Appreciation Scale).

Results
121 patients were included (44.6% CD, 53.7% UC, 1.7% IBD-U), (43.8% women 56.2% men) (median age 43 years, 29.5–55). Time to diagnostic resolution was higher in women compared with men, 214 days (93–452) vs. 90 days (40–183) p = 0.001. These differences were more evident in CD 326 days (94–627) / 67 days (28–182) p = 0.007, than in CU 174 days (92–350) / 92 days (47–184) p = 0.078. There were no significant sex differences in patient delay. Misdiagnosis of IBD was found to be 71.7% for women and 48.5% for men (p = 0.010). Data from Table 1 and Table 2 show the sex differences in the ‘influence’ of IBD in a sample of gender roles evaluated, the quality of life and the emotional sphere.

Conclusion
Our results demonstrate that women with IBD show a higher diagnostic delay and misdiagnosis compared with men. This delay is more evident in CD. Moreover, there is a higher impact of IBD diagnosis in women on the gender roles, the quality of life and the emotional sphere.
P251 Small bowel capsule endoscopy is a valuable diagnostic tool in isolated terminal ileitis
Authors: FREITAS M , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Rosa B , Moreira M J , Cotter J 
Published: January 2020

Abstract

Background
Terminal ileitis (TI), is a common condition in clinical practice and may be associated with a wide variety of diseases. Small bowel capsule endoscopy (SBCE) is a valuable diagnostic tool for small bowel diseases; however, data regarding its diagnostic impact on isolated TI are sparse. The aim of the study was to evaluate the diagnostic value of SBCE for isolated TI detected during ileocolonoscopy.

Methods
Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected.

Results
One hundred and two patients with isolated ileitis on ileocolonoscopy were included. Positive findings on SBCE were found in 84 (82.4%) patients, being ulcers the most common finding (76.5%). Endoscopic abnormalities proximal to terminal ileum were found in 36.3% of patients. After SBCE, 63.7% of patients had a final diagnosis, Crohn’s disease (CD) was the most common (34.3%), followed by NSAIDs enteropathy (12.7%). Elevated faecal calprotectin (p = 0.001) was independently associated with positive SBCE findings. There was a tendency for high levels of erythrocyte sedimentation rate be associated with positive findings (p = 0.07). However, the presence of symptoms, imaging abnormalities and other laboratory findings such as leukocytosis, anaemia, and elevated C-reactive protein were not predictors of positive SBCE findings. At multivariate analysis, only elevated faecal calprotectin (OR 6.0, IC 95% 1.9–18.7; p = 0.002) was a significant predictive factor for positive SBCE findings.

Conclusion
SBCE revealed a high diagnostic yield in patients with isolated ileitis on ileocolonoscopy enabling a definite diagnosis in almost two-thirds of patients. Approximately one-third of patients had findings proximal to terminal ileum and a similar percentage was diagnosed with CD. In patients with isolated ileitis on ileocolonoscopy, SBCE should be considered to evaluate small bowel lesions, particularly when there is an elevated faecal calprotectin, even when other clinical, imagiological or laboratorial abnormalities are absent.
P253 The prevalence of type 6 herpes with polyps in patients with inflammatory bowel disease
Authors: Babayeva-Sadigova G , Babayev Z , Mahmudov U , Asadova G , 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 infections are a serious problem, especially for individuals with prolonged immunosuppression. The aim of this study was

t
o assess the frequency of detection of herpes-6 type with polyps in patients with IBD.

Methods
189 patients with IBD, 102 with ulcerative colitis and 87 with Crohn’s disease were examined. Of the number of patients: 98women, 91man. The age of the patients is from 16 to 63 years (mean age 41.4 ± 4.8), out of 189 patients intestinal polyps were identified in 61 patients with a colonoscopy. In addition to standard clinical and endoscopic examinations, disease activity was assessed by indicators of highly sensitive C-reactive protein, homocysteine, vitamin D in blood serum, albumin in urine, calprotectin, lactoferrin and pyruvate kinase in faeces. All patients underwent a serological blood test by ELISA for specific antibodies to herpesvirus type 1–6 IgG/IgM antibodies, as well as avidity, determination of DNA to herpes viruses of types 1–6 species by PCR in blood and mucosal biopsy.

Results
Among patients with IBD (n = 189), active herpes viruses in the blood were found in 65 patients (34.4%); of them, 39 patients (20.6% (n = 189) and 60%(n = 65),respectively) were diagnosed with monoherpesvirus infections, and 26 (13.7%(n = 189) and 40%(n = 65), respectively) of myxedvirus infections. PCR of the biopsy material was positive in isolation for type 6 herpes virus in 22 cases (11.6% (n = 189) and 33.8% (n = 65)) and in 34 cases (17.9% (n = 189) and 52.3% (n = 65)) a myxedvirus lesion was detected in the tissue (HV6 + EPB, HV6 + CMV), these indicators were detected in patients with intestinal polyps. Although clinical and endoscopic and laboratory indicators of disease activity were significantly higher in patients with mixed tissue lesions (p˂0.05), the level of faecal pyruvate kinase was higher in patients with polyps, indicating a negative effect of herpes type 6 on the course of inflammatory bowel diseases. At the same time, no significant differences were found between patients with ulcerative colitis and Crohn’s disease.

Conclusion
The frequency of occurrence of herpes type 6 on PCR biopsy in patients with polyps with IBD is more than 91.8% (36.5% in isolation and 55.7% of mixed lesions) and is accompanied by higher rates of faecal pyruvate kinase, which is already an indicator of emerging malignancy. The authors propose the determination of polyps in patients with IBD HV6 by PCR biopsy of intestinal tissue.
P257 Prognostic value of bowel ultrasonography for the management of Crohn’s disease
Authors: Suarez Ferrer C J , Poza Cordon J , Crivillen Anguita O , Martin Arranz E , Rueda Garcia J L , Sanchez Azofra M , Garcia Ramirez L , Noci Belda J , Martin Arranz M D 
Published: January 2020

Abstract

Background
The ‘treat to target’ strategy for managing patients with Crohn’s disease (CD) requires simple, reliable and non-invasive monitoring tools. Bowel ultrasound is an emerging technology that could be useful in this field. The aim of our study is to determine whether bowel ultrasound is a useful tool to assess activity in CD and if its results correlate with long-term evolution of the disease.

Methods
Patients who had a bowel ultrasound for clinical practice between February 2013 and October 2018 in our centre were retrospectively included. Evolution of patients was assessed at follow-up based on the presence of echographic signs of activity and therapeutic changes solely based on echographic features.

Results
277 CD patients were included, of which 51% (142 patients) are women with a mean age at diagnosis of CD 35.3 years old (18.7 SD). The median follow-up time was 24 months (range 5–73 months). Among patients included, echographic signs of inflammatory activity were identified in 166 patients (60%). Out of these, 116 patients (70%) received treatment step-up based on the results of ultrasound. It was observed that out of the 161 patients (58%) in which of the attending physician did not modify treatment after performing ultrasound, only 43 had activity on ultrasound (26.7%). Also among patients whose treatment was scaled, 100% had echographic activity. These differences reached statistical significance (p &lt; 0.0001). Among patients with echographic activity, disease evolution was worse than in those without activity, presenting less time to the next disease flare. Thus median disease-free survival (without flares) after performing ultrasound was 18 months when ultrasonographic activity identified (although in most patients (70%) treatment was scaled) vs. 47 months in patients without ultrasound activity, with statistically significant differences (p &lt; 0.0001).

Conclusion
Intestinal ultrasound is a technique capable of detecting inflammatory activity in patients with Crohn’s disease and the presence of ultrasound activity is a risk factor for a subsequent activity flare and/or clinical relapse.