bluuebunny/crossref_metadata_2025_split huggingface dataset:
P765 Fatigue as one of the most important symptoms in adult patients with inflammatory bowel disease: Croatian tertiary centre pilot study
Authors: Ćaćić P , Tomašić V , Kralj D , Bišćanin A , Dorosulić Z , Lerotić I , Ogresta D , Forgač J , Hrabar D 
Published: January 2020

Abstract

Background
Although there have been revolutionary improvements in care of IBD patients, considering the effect of lifelong disease with numerous relapses, one of our goals is to recognise burden of chronic symptoms such as fatigue which can significantly interfere with performance of everyday activities, and negatively impact on quality of life (QoL).

Methods
Randomly selected IBD patients were invited to anonymously fulfil multiple mixed-methods (quantitave/qualitative) Quality of Life questionnaires (SF-36, IMPACT, SIDBQ, IBD disk) in order to evaluate prevalence of fatigue as well as the variables associated with an increased risk of fatigue (using the Fisher’s exact test).

Results
The study population included 70 patients (50.7% male, mean age 38.1 years, 55.7% Crohn’s disease). The prevalence of fatigue was 48.6% and variables associated with an increased risk of fatigue were: anxiety/depression (p = 0.002), lower perception of general well-being (p = 0.03), sleep disturbance (p = 0.02), inadequate interpersonal interactions (p = 0.03) and unsatisfactory performance in educational and professional daily activities (p = 0.01). The presence of joint pain as a common extraintestinal manifestation of IBD was not associated with fatigue (p = 0.06).

Conclusion
Chronic fatigue is a debilitating symptom among adult patients with IBD. Anxiety/depression, lower perception of general well-being, sleep disturbance, inadequate interpersonal interactions and unsatisfactory performance in educational and professional daily activities were associated with fatigue in this Croatian cohort of IBD patients.
P766 ABO blood groups and ulcerative colitis: A hospital-based study in central Taiwan
Authors: Lai H C , Chou J W , Cheng K S , Wu Y H , Tsai Y Y , Chen T W 
Published: January 2020

Abstract

Background
The variations in ABO blood groups are reported to be associated with multiple disorders. Ulcerative colitis (UC) is a chronic and relapsing disease of the gastrointestinal tract with unclear etiology. The incidence and prevalence of UC are low but increasing in Taiwan The aim of our current study was to investigate the distribution of ABO blood groups in patients with UC and to explore its impact on disease severity.

Methods
From January 2000 to November 2019, we retrospectively collected patients diagnosed as UC in our hospital, a tertiary referral center in central Taiwan. Clinical characteristics of patients with UC including gender, age at diagnosis, ABO blood groups, disease phenotype and behaviour, operation rate and baseline laboratory data were collected.

Results
A total of 129 patients with UC were enrolled into our current study (Table 1). We found out male predominance as 62.8% of all patients. The mean diagnostic age of all UC patients was 39.0 years. Of 129 UC patients, 43 (33.3%) were blood type O, 41 (31.8%) were blood type A, 38 (29.5%) were blood type B, and the remainders 7 (5.4%) were blood type AB. However, there was no significant association between the ABO blood groups and UC patients compared with the general population of Taiwanese1 (p = 0.1906) (Table 2). In the subgroup analysis of each blood type, there were no significant difference of disease location and operation rate between groups. Furthermore, blood type A UC patients had higher hemoglobin level compared with blood type O patients (13.31 g/dl vs. 12.30 g/dl, p = 0.0347). Blood type A UC patients had lower erythrocyte sedimentation rate (ESR) level compared with blood type O patients (12.46 mm/h vs. 21.5 mm/h, p = 0.0288). Blood type O UC patients had the highest ESR level compared with non-O groups (p = 0.0228) (Table 3). We analysed the characteristics of UC patients between the diagnostic age older or younger than 40 years. However, there were no significant difference between two age groups (Table 4).

Conclusion
ABO blood groups were not associated with the prevalence of UC, although UC patients with blood type A had the higher prevalence in our current study compared with the general populations with blood type A. UC patients with blood type O had higher baseline ESR level. UC patients with blood type A had higher baseline hemoglobin level.
P771 Increasing prevalence and direct health care cost of inflammatory bowel disease: A population-based evidence from a western Canadian province
Authors: Osei J A , Peña-Sánchez J N , Fowler S A , Muhajarine N , Kaplan G , Lix L M 
Published: January 2020

Abstract

Background
More than 0.3% of the populations in Europe, North America, and Oceania live with inflammatory bowel disease (IBD). Canada has increasing prevalence trends of IBD with 1% of Canadians estimated to have IBD by 2030. Evidence about IBD prevalence and health care costs over time can contribute to health resources allocation and health care planning. Our study aimed to 1) estimate the prevalence and direct health care costs of IBD in the province of Saskatchewan (SK), Canada, and 2) test if trends in the prevalence and direct health care costs of IBD increased over two decades.

Methods
We conducted a retrospective population-based cohort study using administrative health data of SK between 1999/00 and 2016/17 fiscal years. A validated case definition was used to identify prevalent IBD cases. The costing method adopted by the Canadian Institute for Health Information was used to estimate direct health care costs in 2013/14 Canadian dollars among IBD cases. Generalised linear models (GLMs) with generalised estimating equations were used to test the trends. Negative binomial and gamma distributions were used to, respectively, model prevalence and health care cost trends. Sex and age group were covariates in all models; the Charlson comorbidity index was also included in the cost model. Annual prevalence rates and direct health care cost estimates with their 95% confidence intervals (95%CI) were reported.

Results
In 2016, there were 6468 (Crohn’s disease: 3663 [56.63%], ulcerative colitis: 2805 [43.37%]) IBD cases ascertained in SK. The number of prevalent cases increased over the analysis period by 56%. The total direct health care costs increased from $7.8 million in 1999 to $50.8 million in 2016. The average annual IBD prevalence increased from 341/100,000 (95%CI 340–341) in 1999 to 664/100,000 (95%CI 663–665) in 2016, a 3.3% (95%CI 2.4–4.3) average annual increase. The total average annual direct health care costs of IBD increased from $1.8 (95%CI $1.6–2.0) thousand per patient in 1999 to $7.1 (95%CI $6.7–7.5) thousand per patient in 2016, an average annual increase of 9.2% (95% CI 8.5–9.8), Figure 1.

Conclusion
In the Canadian province of SK, prevalence and direct health care costs, respectively, tripled and quadrupled over two decades. Our results provide relevant information and analysis on the burden of IBD in SK. These findings are in agreement with previous studies from other provinces. The evidence of constant increasing prevalence and health care cost trends of IBD needs to be recognised by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.
P773 Patient reported outcomes, partial MAYO score and SCCAI are equally accurate in predicting mucosal healing in UC: Preliminary results from a prospective study
Authors: Golovics P , Gonczi L , Reinglass J , Verdon C , Afif W , Wild G , Bitton A , Seidman E , Bessissow T , Lakatos PhD P L 
Published: January 2020

Abstract

Background
Optimal management of patients with ulcerative colitis (UC) requires the accurate assessment of disease activity. Endoscopic evaluation is considered the gold standard approach, but it is invasive. We aimed to determine how strong patient reported outcomes, clinical scores and symptoms correlate with endoscopy for assessment of disease activity in UC patients.

Methods
One hundred and thirty-six patients were included prospectively (age: 48 (IQR: 38–61) years, duration 12 (4–19) years, 63 females, 53.7% extensive disease, 40.4% on biologicals) at the time of the colonoscopy. The 2 item patient reported outcome (PRO), partial MAYO, Simple Clinical Colitis Activity Index (SCCAI), Mayo endoscopic subscore (MES), Baron and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores were calculated. C reactive Protein (CRP) and fecal calprotectin (FCAL) was available in 58.1 and 33.8% of patients. 20.7% had clinical flare, treatment was escalated in 17.8% of patients. Sensitivity, specificity, PPV and NPV values were calculated, ROC analysis and K-statistics were performed.

Results
Rectal bleeding(RBS), stool frequency(SF) subscore of 0, or total PRO2 remission(RBS0 and SF≤1), partial MAYO(≤2) and SCCAI(≤2.5) remission were similarly associated to mucosal healing defined by MES(0 or ≤1) or Baron (0 or ≤1) scores (Table 1). PRO2 remission (AUCMES0/Baron0:0.747/0.715, AUCMES0-1/Baron0-1:0.867/0.863), SF AUCMES0/Baron0:0.731/0.703, AUCMES0-1/Baron0-1:0851/0.839), RBS(AUCMES0/Baron0:0.708/0.685, AUCMES0-1/Baron0-1:0.828/0.835) partial Mayo (AUCMES0/Baron0:0.792/0.755, AUCMES0-1/Baron0-1:0.917/0.903) and SCCAI (AUCMES0/Baron0:0.738/0.724, AUCMES0-1/Baron0-1:0.908/0.880) were similarly associated with mucosal healing in a ROC analysis. There was a string association between MES and Baron (k=0.798), while moderate agreement between UCEIS and MES (K=0.451) or Baron (K=0.499) scores. Agreement between CRP and clinical remission or endoscopic healing (MES/Baron) was poor (K~0.2), while agreement between FCAL (&gt;100 or &gt;250) and RBS-PRO2 remission (K&gt;250:0.56–0.61) or MES/Baron 0 was moderate to good(K&gt;100:0.54-0.53 and K&gt;250:0.50–0.54)

Conclusion
We found no difference across accuracy of RBS, SF, PRO2, partial Mayo and SCCAI in predicting endoscopic healing. A strong association was found with high PPV for MES/Baron ≤1 and high NPV for MES/Baron 0. FCAL, but not CRP was associated to clinical and endoscopic remission.
P784 A new questionnaire to investigate patients’ knowledge of relevant aspects of inflammatory bowel disease clinical course and outcomes: preliminary results
Authors: Zerboni G , Barello S , Festa S , Aratari A , Graffigna G , Papi C 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) patient’s knowledge is a key factor for shared treatment decision making. Some studies have already investigated IBD knowledge but never focused on patient’s awareness about the major disease outcomes nor clinical course nor therapeutic aspects. The aim of the present study is to assess disease knowledge in IBD patients using a novel 11 items questionnaire.

Methods
An 11 items questionnaire was developed. The questionnaire explored different aspects of IBD course and prognosis: pattern of symptoms, disease complications, need for surgery, risk and prevention of colon-rectal cancer (CRC), extra-intestinal manifestations (EIMs), predictors of poor prognosis, benefit/risk of immunosuppressive and biological therapy and IBD in pregnancy. The questionnaire was handed out to consecutive Crohn’s disease (CD) and ulcerative colitis (UC) patients in regular follow-up at a referral centre. Clinical and socio-demographic characteristics were collected in a dedicate database. Descriptive analysis of quantitative variables was presented as mean or median. Fisher test and Student’s t-test were used for categorical and continuous variables. A p &lt; 0.05 was considered statistically significant.

Results
Three hundred and four patients were enrolled and 290 completed the questionnaire (95%). Of these 53% UC and 47% CD. The mean age was 51 years (range 18–83); 56% were male. Most of the patients were in clinical remission (85%). The mean number of appropriate answer was 4 upon 11. Overall only 26% answered successfully more than half of the items. Looking at the single items, two third of patients were aware of current strategies of CRC prevention, chance of EIMs and woman capability to become pregnant. The questions about immunosuppression and biologic therapy were more correctly answered by those patients who had experienced them (p = 0.000001), whereas those about the risk of surgery were not influenced by the patient’s previous clinical history (UC p = 1; CD p = 0.067). Only about one third of women were aware of the most relevant risk factor of worst pregnancy outcome. Age &lt;40 years old (p = 0.00003), high level of education (high school and degree, p = 0.0015) and current or previous biologic therapy (p = 0.0007) were associated with a higher level of IBD knowledge.

Conclusion
These results suggest that the overall disease knowledge in IBD patients is low and should be improved. Young age, education and biologic exposure are associated with an adequate awareness of disease course. This questionnaire should be validated and correlated to other patient-related measures such as health engagement and health literacy in prospective studies.
P791 Difference between paediatric Crohn’s disease and ulcerative colitis at diagnosis in Korea: results from a multicentre, registry-based, retrospective cohort study
Authors: Choe B H , Kang B , Suh H R , Kim E S , Park J H , Kim M J , Choe Y H , Kim S , Koh H , Lee Y J , Park J H , Ryoo E 
Published: January 2020

Abstract

Background
Despite its increasing incidence, large-scale data regarding the demographics and characteristics of paediatric inflammatory bowel disease (IBD) at diagnosis in Korea is scarce. We aimed to compare the differences of paediatric Crohn’s disease (CD) and ulcerative colitis (UC) at diagnosis in Korea.

Methods
This analysis was conducted using data from a multicentre, registry-based, retrospective cohort study conducted at five centres in Korea between 2013 and 2018. Baseline demographics, clinical characteristics, results from laboratory, endoscopic, radiologic examinations were compared between paediatric CD and UC patients who were &lt;19 years at diagnosis.

Results
A total 307 patients were included in this analysis. Among them 227 patients were diagnosed with CD (73.9%), and 80 patients (26.1%) with UC. The male to female ratio was 2.49:1 for CD, and 1.29:1 for UC (p = 0.019). Median age at diagnosis was 14.4 years (IQR 12.4–16.2) for CD, and 14.4 (11.7–16.5) for UC (p = 0.962). Symptoms at presentation that were dominant in CD patients compared with UC patients were abdominal pain (76.2% vs. 51.2%, p &lt; 0.001), weight loss (51.5% vs. 22.5%, p &lt; 0.001), perianal fistulas (18.9% vs. 0%, p &lt; 0.001), perianal skin tags (15.9% vs. 1.2%, p &lt; 0.001), fever (20.3% vs. 6.2%, p = 0.007), and oral ulcers (13.7% vs. 3.8%, p = 0.026), while hematochezia was the only dominant symptom in UC patients compared with CD patients (86.2% vs. 30.8%, p &lt; 0.001). White blood cell counts, platelet counts, ESR, CRP were significantly higher, and serum albumin level was significantly lower in CD patients. ASCA was positive in 44.5% and 16.2% of CD and UC patients, respectively (p &lt; 0.001), and ANCA was positive in 15.0% and 58.8% of CD and UC patients, respectively (p &lt; 0.001). Terminal ileal involvement on endoscopy was prominent in CD (62.1% vs. 16.2%, p &lt; 0.001), while rectal involvement was more prominent in UC (52.4% vs. 83.8%, p &lt; 0.001). Small bowel involvement and perianal perforating diseases on radiologic exams were also more prominent in CD.

Conclusion
Clinical symptoms, laboratory test results, radiologic findings, endoscopic findings were significantly different between paediatric Crohn’s disease and ulcerative colitis at diagnosis in Korea. A large-scale study on a nationwide basis is expected to better clarify this difference in the future.
P792 Breastfeeding in our patients with inflammatory bowel disease
Authors: Charro Calvillo M , Charro-Calvillo M , Peña-Gonzalez E , Ber-Nieto Y , Botella Esteban M T , Alcalá Escriche M J , Lacarta García P , Fernandez Bonilla E , Mir Subías A , Arroyo-Villarino M T , Lafambra Cabrejas E , Nerin De la puerta J , Vicente Lidón R , García López S , Corsino Roche P 
Published: January 2020

Abstract

Background
Breastfeeding is one of the most important environmental factors in early childhood for later development of an Inflammatory Bowel Disease. The duration of lactation is essential for it to have a protective effect. In addition to IBD patients, breastfeeding can have a beneficial effect for preventing disease relapse. For these reasons, we plan to know how lactation develops in our group of patients with Inflammatory Bowel Disease (IBD).

Methods
A retrospective analysis of patients followed by gastroenterology consultations, with established diagnosis of IBD and with at least one gestation, in a period from January 2011 to January 2016. The data were collected a posteriori through two simple questionnaires, one completed by the patient, collecting the type of childbirth and breastfeeding she experienced and factors that influenced it. Another form is filled out by the gastroenterologist recording the characteristics of his inflammatory bowel disease. The data is collected in a structured database in Microsoft Excel and analysed with the SPSS statistic package for Windows.

Results
Data from 78 patients diagnosed with IBD are analysed from eight public hospitals in our autonomous community. 61.1% of patients have ulcerative colitis and 38.9% Crohn’s disease. The deliveries were mainly vaginal (82%), compared with 18% of caesarean-sections, four of them directly motivated by digestive disease. More than half of patients (57.7%) started breastfeeding after childbirth, 10.25% breastfeeding and 32.05% mixed breastfeeding But only 34.6% reach six months of breastfeeding, reaching 39.7% if we include mixed breastfeeding. In 17 patients (21.8%) their base-based inflammatory bowel disease directly influenced the development of lactation. Pharmacological treatment is the main cause for breastfeeding, followed by disease outbreaks, hospitalisations and surgery. Only 47.4% of the patients stated that in the IBD consultation they were given some information about breastfeeding, although almost all replied that they would have liked to receive it.

Conclusion
The majority of patients with inflammatory bowel disease in our consultations, do not reach six months of breastfeeding currently recommended by the World Health Organisation, so we have a great opportunity for improvement in this field and as gastroenterologists, we can contribute by providing more information to our patients about breastfeeding and its relationship with IBD.
P793 Patients’ concerns are strongly associated with distress and quality of life among family caregivers of adult inflammatory bowel disease patients in remission
Authors: Argyriou K , Karantanos P , Vasilakis N , Kapsoritakis A , Lalla E , Varytimiadis K , Mpetsios G , Tsakiridou E , Potamianos S 
Published: January 2020

Abstract

Background
Patients’ concerns were negatively associated with adaptation and outcomes in inflammatory bowel diseases (IBD), even when the disease is in remission. Concurrently, relatives overestimate patients’ worries with unknown implications on their quality of life (QoL).Our aim was to investigate the association among disease-related concerns, distress and QoL among family caregivers of adult IBD patients in remission.

Methods
One hundred and ninety-three consecutive IBD patient-caregiver dyads from the outpatient clinic of two referral centres were screened for eligibility. Dyads with psychiatric and other co morbidities were excluded. 66 patients were in remission and recruited. Patients’ concerns and caregivers’ distress were assessed by using the Rating Form of IBD patient Concerns (RFIPC) and the caregiver self-assessment questionnaire ‘How Are You?’ of the American Medical Association, respectively, whereas caregiver’s QoL was measured with the SF-36 questionnaire. Data are presented as median and range. The influence of population characteristics and patients’ concerns on caregivers’ distress and QoL were evaluated with linear regression.

Results
Sixty-six IBD patients (40[47] years, 51.5 % females, 37.9% full-time employment) and caregivers (47[33] years, 60% females, 60% 1st degree relative, 60% full-time employed) included in the analysis. Among patients, the median RFIPC score was 36.8 [43.52], whereas worries about the unknown nature of the disease, feeling out of control, having access to quality medical care, the fear of side effects and the energy level prevailed. Among caregivers, a median of 7 [14] hours were spent on care giving per week with 48.4 % of the caregivers developing distress and achieving low scores on sf-36. Among all examined variables, the increased level of concerns was the sole factor that was independently associated with increased distress (beta=0.947, p = 0.000) and low QoL (beta=–0.567–0.345, p = 0.000) in the caregivers’ population.

Conclusion
In remission, increased patients’ concerns was the only factor that was found to be strongly associated with increased level of distress and low QoL in family caregivers. Potential interventions might seek to provide support to those who care for IBD patients.

References
P797 The inexorable increase of biological exposure in paediatric inflammatory bowel disease: a Scottish population-based, longitudinal study 2015–2019
Authors: Burgess C , Jackson R , Chalmers I , Russell R K , Hansen R , Henderson P , Wilson D C 
Published: January 2020

Abstract

Background
The use of biologics in paediatric inflammatory bowel disease (PIBD) is rapidly changing with the introduction of new mode of action medications, cheaper biosimilar alternatives, improved convenience with home care options and an increasing focus on early intensified management. No nationwide paediatric data is available to objectively capture this shifting landscape and its effect on healthcare resources. We aimed to identify the incidence and prevalence of biologic use within Scottish PIBD services.

Methods
In Scotland, specialist paediatric gastroenterology, hepatology and nutrition (PGHAN) services are coordinated through three tertiary academic centres (Glasgow, Edinburgh and Aberdeen) which act as regional referral hubs covering all district general hospitals. A nationwide cohort of prospectively identified PIBD cases less than 18 years of age with paediatric-onset IBD (A1 phenotype; diagnosed &lt;17 years of age) were captured within paediatric services over a 4.5-year period (01.01.2015–30.06.2019). All patients who received infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ) or ustekinumab (UST) during the study period (prevalent cases) or received their first dose of these biologics (incident cases not including biosimilar switches) were retrospectively audited. Point prevalence was calculated on 30 June each year and period prevalence as 6 month epochs.

Results
In total 495 incident new start biological therapies were commenced on 403 PIBD patients over the study period; 295 IFX (60%), 161 ADA (32%), 24 VDZ (5%), 15 UST (3%). The proportion of new start biologics changed over time with IFX initiation rates decreasing (87–54%) while ADA (13–31%), VDZ (0–10%) and UST (0–6%) all increased. Biosimilar penetration of new start anti-tumour necrosis factor (anti-TNF) biologics increased from 3% to 91% by 30.06.2019. The overall number of prevalent PIBD patients increased from 554 to 644 over the study period. Point prevalent rates of current biologic therapy usage increased from 20.2% on 30.06.15 to 43.5% on 30.06.19; an average annual percentage increase of 29%.

Conclusion
Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing PIBD treatment landscape with a significant increase in biologic therapy (from 20% to 43% in just 4 years), a near-complete shift to biosimilar anti-TNF and use of biologics with new modes of action which are as yet unlicensed for PIBD.