bluuebunny/crossref_metadata_2025_split huggingface dataset:
P261 Systematic review with meta-analysis: The impact of concomitant immune-mediated diseases on the disease course of inflammatory bowel disease
Authors: Attauabi M , Zhao M , Bendtsen F , Burisch J 
Published: January 2020

Abstract

Background
Several studies have shown an association between inflammatory bowel diseases [IBD] and immune-mediated diseases [IMIDs], but data on the impact of co-occurring IMIDs on IBD course are inconsistent. The aim of this study was to investigate the impact of co-occurring IMIDs on IBD phenotype and disease course.

Methods
PubMed and EMBASE were searched from database inception through December 2018 and updated in October 2019 for studies reporting prevalences or odds, risks or hazard ratios of IBD-related disease outcomes in patients with and without co-existing IMIDs. Meta-analyses were performed to estimate summary prevalences and risks of the outcomes which included disease extension, IBD-related surgery and hospitalisation, malignancy, mortality and need of medication (biologic therapy, steroids and immunomodulators). IMIDs were stratified into primary sclerosing cholangitis [PSC] and ‘IMIDs other than PSC’.

Results
A total of 93 studies comprising 14,307 IBD patients with IMIDs and 3,409,914 IBD patients without IMIDs were included in the study. Summary risks and prevalences with 95% confidence intervals for each outcome are presented in figures 1 and 2, respectively. The following results are all significant (p &lt; 0.05). Compared with patients without co-occurring IMIDs, patients with ulcerative colitis [UC] and co-occurring IMIDs other than PSC more frequently received immunomodulators and steroids, and patients with Crohn’s disease [CD] and concomitant IMIDs other than PSC more often received biologic therapy. UC patients with co-existing IMIDs other than PSC more often underwent IBD-related surgery, while patients with CD and PSC received fewer surgeries. In addition, UC patients with co-occurring PSC were at increased risk for having extensive colitis, pancolitis, and malignancies. Patients with UC and PSC had a higher mortality rate, but no difference was found among patients with IMIDs other than PSC. PSC did not influence hospitalisation rates among IBD patients.

Conclusion
This meta-analysis found that IBD patients with co-existing IMIDs have a different disease course than patients without concomitant IMIDs. This study emphasises the importance of multidisciplinary care of IBD and that physicians caring for IBD patients need to be aware of IMIDs as a prognostic factor.
P264 Analysis of nutritional status and nutrient intake in patients with inflammatory bowel disease: a prospective, case–control study
Authors: YOON Y E , Kim H M , Kim J H , Youn Y H , Park H J , Park J J 
Published: January 2020

Abstract

Background
Anthropometric data and dietary intake pattern are poorly known in Asian inflammatory bowel disease (IBD) patients. The aim of this study was to investigate the nutritional status and nutrient intake of IBD patients compared with control population.

Methods
From February to June 2018, a total of 65 outpatients, including 33 ulcerative colitis (UC) and 32 Crohn’s disease (CD) were prospectively enrolled in Gangnam Severance Hospital. As a control group, age- and gender-matched 260 subjects were included among the Korean National Health and Nutrition Examination Survey (KNHANES) data. Anthropometry and body composition data were collected by bioelectrical impedance analysis(BIA); meanwhile, nutrient intake was measured based on diet diary.

Results
Based on Asia Pacific criteria, more than half of both UC and control group were obese or overweight, on the other hands, CD was relatively low, about 1/3. Compared with the UC group, body fat index including both fat mass index (FMI) and body fat percentage (BFP) were significantly lower in the CD group. Following nutrients intake including intake of energy, carbohydrate, niacin, sodium and potassium were significantly lower in UC than the control group. Meanwhile, intake of carbohydrate, thiamine, niacin, sodium, potassium and iron was significantly lower in CD than the control group. In addition, the ratio of energy intake through protein and fat was significantly higher in the IBD than the control group.

Conclusion
Similar to the control group, more than half of UC patients were overweight or obesity, meanwhile, the proportion of obese patients in CD was lower than in the control group. The ratio of energy intake through protein and fat was significantly higher in IBD than in the control group. Our results may have clinical implications for risk of IBD development in terms of dietary pattern and further direction of nutritional intervention.
P269 Mucosal capillary pattern recognition based on real-time computer-aided image analysis adequately detects histological remission in ulcerative colitis
Authors: Bossuyt P , De Hertogh G , Eelbode T , Vermeire S , Bisschops R 
Published: January 2020

Abstract

Background
Objective treatment targets are required in a treat-to-target approach for ulcerative colitis (UC). An automated endoscopic system that correlates with histology can be an objective predictor for sustained remission in UC. The infiltration of neutrophils is associated with irregularities of the pericryptal capillaries. For this, we aimed to develop an objective automated endoscopic tool to assess histological remission based on the evaluation of the morphology of the pericryptal capillaries during endoscopy.

Methods
We used a prototype endoscopic system with short-wave-length monochromatic light from a LED system. This enables to evaluate in real-time the superficial (&lt;200µm) mucosal architecture (crypts, pericryptal capillaries) and mucosal bleeding, Figure 1. An image analysis algorithm was applied to provide a score that quantifies the specific morphology of the mucosal capillaries. The algorithm included two steps. First, bleeding (mucosal/luminal) was assessed by pattern recognition. Samples with bleedings were automatically classified as non-remission. In case of non-bleeding, the degree of congestion of the capillaries was measured (maximal localised density estimation after morphological hessian based vessel recognition) to assess an ideal cut off value that identifies histological remission (Geboes score (GBS) &lt;2B.1; no neutrophils in the lamina propria). Consecutive patients with UC were evaluated with the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity (UCEIS) and the automated image analysis algorithm. To test the reliability of the algorithm and scores, the results were correlated with the GBS. Biopsies were taken in the matching area of the endoscopic evaluation.

Results
Fifty-eight patients with UC (53% male, median (IQR) age 41y (38–56), disease duration 7.1y (2.4–16.4)) with 113 evaluable segments (89% rectum or sigmoid) were included. The correlation between GBS and MES, UCEIS was good (r = 0.76, 0.75 respectively). The automated image analysis algorithm (Figure 2) detected histological remission with a higher performance (sens 0.79, spec 0.90) compared with UCEIS (sens 0.95, spec 0.69) and MES (sens 0.98, spec 0.61), resulting in a positive predictive value of 0.83, 0.65 and 0.59 for the automated image analysis algorithm, UCEIS and MES, respectively. The algorithm detected histological remission with high accuracy (86%).

Conclusion
Mucosal capillary pattern recognition based on an automated image analysis with short-wave-length monochromatic light detects histological remission with high accuracy in UC. This technique provides an objective and quantitative tool to assess histological remission in UC, and excludes inter-reader variability.
P278 Comparison of prostaglandin E–major urinary metabolite (PGE-MUM) with faecal calprotectin and faecal immunochemical tests for determining endoscopic remission in patients with ulcerative colitis
Authors: Sakurai T , Yoshihiro A , Haruna M , Ryosuke M , Yuki M , Mariko S , Tomoko S , Takushi Y , Masayuki S 
Published: January 2020

Abstract

Background
Faecal calprotectin (FC) and faecal immunochemical tests (FIT) have the disadvantage of requiring faecal samples. It has been reported that prostaglandin E–major urinary metabolite (PGE-MUM) values correlate with Mayo endoscopic scores (MESs) for ulcerative colitis (UC). However, there has been no report that PGE-MUM can determine endoscopic remission under remission phase UC, nor comparative study of PGE-MUM with FC and FIT. Thus, we aimed to examine the association between PGE-MUM values and the colonoscopy (CS) results of patients in the remission phase of UC, and to compare the accuracy of using PGE-MUM vs. that of using FC or FIT values for determining endoscopic remission.

Methods
Patients diagnosed with UC who were under clinical remission and had planned to undergo CS from August 2017 to March 2019 were enrolled. FC levels were measured and FITs were performed on the day of CS; PGE-MUM was measured either the day before or after CS. Three physicians independently scored the CS findings (MES, Modified Mayo Endoscopic Score [MMES], and UC endoscopic index of severity [UCEIS]) while blinded from clinical information. We analysed the differences in PGE-MUM values between two groups, which were divided between those that did achieve and those that did not achieve the following scores: (1) MES 0 point, (2) MES 1 point, (3) modified MES 0 point, (4) modified MES ≤1 point, (5) UCEIS 0 point, (6) UCEIS ≤2 points. In addition, the accuracy of PGE-MUM, FC, and FIT with respect to determining the achievement of (1) through (6) were compared by using areas under the receiver operating characteristics curves. Patients with altered UC activity between the day of PGE-MUM measurement and CS, and those who received NSAIDs on the day of PGE-MUM measurement, were excluded from the analysis.

Results
Of the 125 enrolled subjects, 30 patients were excluded (urine specimens not submitted, 11; poor stool specimens, 6; NSAIDs users, 10; clearly altered UC activity, 3). The remaining 95 patients (average age 48.2 years, 57 males, and 54 patients with total colitis type), were eligible for analysis. The median PGE-MUM values (in µg/g·Cr) for groups that did or did not achieve (1) through (6) were as follows: (1) 14.6/17.2, p = 0.106; (2) 14.9/20.5, p = 0.039; (3) 14.5/17.4, p = 0.059; (4) 14.1/21.8, p &lt; 0.001; 5) 14.5/17.4, p = 0.059; (6) 14.7/22.2, p = 0.003. The areas under the receiver operating characteristics curves for PGE-MUM/FC/FIT used for determining the achievement of 1) through 6) were as follows: (1) 0.597/0.664/0.682, (2) 0.692/0.74/0.825, (3) 0.613/0.686/0.692, (4) 0.794/0.82/0.786, (5) 0.613/0.686/0.692 and (6) 0.778/0.824/0.825.

Conclusion
PGE-MUM is equally as effective as FC and FIT for determining the achievement of endoscopic remission.
P281 A serum biomarker panel can accurately identify the presence of mucosal ulcers in patients with Crohn’s disease
Authors: HOLMER A , Boland B , Singh S , Neill J , Le H , Miralles A , Collins A , Sandborn W , Dulai P 
Published: January 2020

Abstract

Background
Ulcer healing is the primary endoscopic treatment target in Crohn’s disease (CD) in routine practice. A novel serum-based biomarker panel named endoscopic healing index (EHI, Monitr, Prometheus Biosciences, San Diego, CA) was developed and validated for identifying mucosal inflammation as assessed by the simple endoscopic score for CD (SES-CD).1 We aimed to define the operating characteristics of EHI in routine practice for mucosal ulcers specifically.

Methods
EHI was analysed on serum samples paired with endoscopies from adult patients (≥18 years) participating in a prospective biobank (June 2014 to December 2018). Patients with an ileal pouch-anal anastomosis or an ileostomy were excluded. The performance of EHI for endoscopic disease activity was evaluated for subcomponents of SES-CD scores (0–60) including ulcer presence and size, extent of ulcerated surface, extent of affected surface, and presence of strictures. Diagnostic performance was assessed using previously identified cut-offs for optimal EHI performance in CD for ruling out endoscopic activity (20 points) and ruling in endoscopic activity (50 points). Logistic regression was performed to identify confounders of EHI (patient factors, disease characteristics) and for the strength of association between EHI and ulcers (presence, size).

Results
A total of 205 CD patients were included in the analysis (50% male, median age 37 years). EHI values were significantly higher with increasing ulcer size (p &lt; 0.001). An EHI cut-off of 20 points exhibited modest sensitivity for ruling out any ulcers (85%, 95% CI 77–91), and large (0.5–20 mm) or very large (&gt;20 mm) ulcers specifically (92%, 95% CI 84–97). An EHI cut-off of 50 points had modest specificity for ruling in the presence of any ulcers (85%, 95% CI 76–92), and large or very large ulcers specifically (87%, 95% CI 79–92). After accounting for the total extent of inflamed mucosa, extent of strictured mucosa, and disease location, each 20-point increase in EHI was independently associated with an incremental 1.7-fold increased probability for the presence of a large or very large ulcer (aOR 1.7, 95% CI 1.1–2.6).

Conclusion
EHI values were associated with ulcer size independent of inflammatory or stricture burden, and accurately identified the presence of ulcers and large or very large ulcers specifically. A cut-off of 50 points can reliably rule in the presence of ulcers and allow for treatment adjustment without endoscopy. A cut-off of 20 points can reliably rule out the presence of ulcers and signal completion of treatment adjustment algorithms.

Reference
P298 Patient-reported outcomes: the ICHOM standard set for IBD in real-life practice helps quantify deficits in current care
Authors: Wong D , Kantschuster R , Matini L , Simadibrata D , Lepetyukh M , Wilson J , Brain O , Palmer R , Ambrose T , Satsangi J , Travis S , Walsh A J 
Published: January 2020

Abstract

Background
Ulcerative colitis (UC) or Crohn’s disease (CD) are associated with symptoms that lead to reduced quality of life and increased healthcare utilisation. The patient reported outcome (PRO) tools are key to documenting outcomes that matter most to patients and are increasingly important to commissioners of health care seeking value. We report the first series of the ICHOM Standard Set for inflammatory bowel disease (IBD).

Methods
Patients treated for UC or CD in our tertiary referral centre are offered enrolment into the TrueColours IBD web-based PRO collection programme. This functions through email prompts, directly linked to validated questionnaires. Prompts for symptoms (daily SCCAI for UC and HBI for CD); quality of life (fortnightly IBD-Control); and other outcomes (baseline and 3 monthly ICHOM Standard Set), including data on steroid use, hospital admission and other measures through internationally agreed criteria.

Results
The first 500 consecutive patients enrolled (401 UC, 99 CD) were studied. 274 (55%) were female, mean age 40 years (sd 15), and mean BMI 26 (sd 6). 22/500 (5%) were current smokers. Baseline medications at the time of registration were no therapy 6%, topical therapies 21%, 5ASA 49%, thiopurines 24%, methotrexate 6%, budesonide 3%, prednisolone 10%, advanced therapies 37%. (adalimumab 13%, golimumab &lt;1%, infliximab 9%, tofacitinib 1%, ustekinumab 1%, vedolizumab 16%). In the previous 12 months, prednisolone use was reported by 148 (37%) patients with UC vs. 25 (25%) patients with CD, p = 0.02: 107 (21%) for &lt;3 months and 66 (13%) for &gt;3 months. 61 (12%) patients reported requiring an IBD-related intervention (11% UC vs. 17% CD) and 25 (5%) reported an unplanned hospital admission (4% UC vs. 8% CD). Eighty-one (16%) participants had required at least one hospital admission in the preceding year, exceeded by 101 (20%) requiring at least one emergency department presentation in the same period. There were high rates of fatigue (53%) and mood disturbance (26%). Eighty-two (16%) felt they needed a treatment change, and 136 (27%) felt their current treatment was not useful for their IBD.

Conclusion
Outcomes reported by patients illustrate the scale of the therapeutic deficit in current care. The ICHOM Standard Set acts as a benchmark for comparing outcomes between institutions.
P303 Role of parietal healing by ultrasound in the evolution of patients with Crohn’s disease
Authors: Mayor Delgado P , Suarez Ferrer C J , Poza Cordon J , Martin Arranz E , Rueda Garcia J L , Sanchez Azofra M , Cuadros Martinez M , Ruiz Ramirez M A , Martin Arranz M D 
Published: January 2020

Abstract

Background
The objective of this study is to assess the degree of parietal involvement with ultrasound and see how they influence the prognosis according to the findings.

Methods
It was defined as ‘parietal healing’ the normalisation of ultrasound findings in a previously affected segment (parietal thickness less than 3 mm and absence of parietal hyperaemia). Therefore, patients with absence of ultrasound activity but without reaching parietal healing were considered to be those without significant inflammatory signs (parietal thickness &lt;4.5 mm and absence of hyperaemia or other inflammatory data) but who had not ‘normalised’ the previously affected segment.

Results
A total of 111 patients without ultrasound inflammatory activity were included. It was studied whether normalisation of parameters in a previously affected segment, i.e. parietal healing gave a better prognosis during follow-up. It was detected that 74 patients achieved ‘parietal healing’ and this subgroup of patients generally had a flare in 12% of cases (9/74 patients) compared with 27% of cases (10/37) among patients without parietal healing, these differences were statistically significant (p = 0.05). Similar, it was identified that among patients without ultrasound activity who had a subsequent outbreak during follow-up, the median survival was lower (1,09 years) in patients without parietal healing vs. those with parietal healing (1.4 years), the differences reaching statistical significance (p = 0.03). Likewise, during the follow-up, it was objectived, by means of survival analysis, that the evolution of patients without ultrasound activity was more favourable in those with ‘parietal healing’ with remission 95% vs. 90% at first year, 89% vs. 81% at 2 years and 85% vs. 66% at 3 years of follow-up. The results are outlined in Figure 1.

Conclusion
To conclude, detecting parietal healing by ultrasound improves prognosis by decreasing the number of outbreaks and increasing the median survival until outbreaks occur.
P305 A location-based prediction model in Crohn’s disease regarding a novel serological marker, anti-Chitinase 3-like 1 autoantibodies
Authors: Sipeki N , Kovats P , Deutschmann C , Schierack P , Roggenbuck D , Maria P 
Published: January 2020

Abstract

Background
A defective neutrophil regulation in IBD is thought to play an important role in the onset or manifestation of IBD, since it could lead to damage of the intestinal mucosal barrier by infiltration of neutrophils in the inflamed mucosa and the accumulation of pathogens. Like neutrophils in the context of innate immune responses, immunoglobulin A (IgA) as an acquired immune response partakes in the defence of the intestinal epithelium. Under normal conditions, IgA would contribute to the elimination of microbes, but in connection with the loss of tolerance to CHI3L1 in IBD, IgA could participate in the CHI3L1-mediated improved adhesion and invasion of potentially pathogenic microorganisms. The tolerance brake to CHI3L1 and the occurrence of IgA auto-Abs to this particular target, the exact role and underlying mechanisms of CHI3L1 in the pathogenesis of IBD are still unclear.

Methods
We aim to determine the predictive potential of immunoglobulin subtypes of a novel serological marker, anti-chitinase 3-like 1 autoantibodies (aCHI3L1) regarding determination of disease phenotype, therapeutic strategy and long-term disease course in a prospective referral adult IBD patient cohort. Immunoblotting of antineutrophil-cytoplasmic antibody-positive sera of IBD patients on neutrophil proteins and MALDI-TOF mass spectrometry were used to identify autoantigenic targets in IBD. Sera of 257 CD and 180 UC patients were assayed for IgG, IgA, and secretory IgA (sIgA) type aCHI3L1 by enzyme-linked immunosorbent assay using recombinant CHI3L1 along with 86 healthy controls (HCONT).

Results
IgA type was more prevalent in CD than UC (29.2 vs. 11.1%) or HCONT (2.83%; p &lt; 0.0001 for both). However, sIgA subtype aCHI3L1 positivity was higher in both CD and UC compared with HCONT (39.3 and 32.8 vs. 4.65%, respectively; p &lt; 0.0001). The presence of both IgA and sIgA aCHI3L1 antibodies was associated with colonic involvement (p &lt; 0.0001 and p = 0.038, respectively) in CD. Complicated disease behaviour at sample procurement was associated with the presence of aCHI3L1 sIgA positivity (57.1% vs. 36.0%, p = 0.009). Whilst, IgA type aCH3L1 was more prevalent in patients with frequent relapse during the disease course in CD (46.9% vs. 25.7%, p = 0.005). In a group of patients with concomitant presence of pure inflammatory luminal disease and colon involvement at the time of the diagnosis, positivity for IgA or sIgA type aCH3L1 predicted a faster progression towards complicated disease course in time-dependent models. This association disappeared after merging subgroups of different disease locations.

Conclusion
CHI3L1 is a novel neutrophil autoantigenic target in IBD. Consideration of antibody classes along with location-based prediction can revolutionise the future of serology in IBD.
P314 C-Reactive protein is associated with depression and anxiety in patients with inflammatory bowel disease
Authors: Rodriguez T , Karpin J , Traboulsi C , Rai V , Rubin D 
Published: January 2020

Abstract

Background
Depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Though previous studies have proposed a relationship between anxiety, depression and IBD, causality and directionality are unknown. We used a novel computerised adaptive testing technology to screen IBD patients for depression and anxiety and compared the screening results to recent measures of C-reactive protein (CRP).

Methods
Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH™ survey from Adaptive Testing Technologies (Chicago, IL); we then reviewed disease and patient characteristics. CRP measures from within 6 months of survey administration were used and levels ≥5 mg/l were considered positive. Patients who are CRP non-reactive were excluded. Pearson Chi-Square test was used to assess correlation.

Results
134 patients (75 women, 112 Caucasian, 84 Crohn’s disease) participated in the study, 85 of whom had no prior history of psychiatric disorders. We identified 51 patients with depression (46 mild, 3 moderate, 2 severe) and 36 subjects with anxiety (24 mild, 10 moderate, 2 severe). Of the 134 patients recruited for this study, 57 had CRP reported. Median time between CRP measurement and CAT-MH™ administration was 2 days (IQR = 70). Categorical analysis stratified patients with positive and negative CRP who are also positive for depression and/or anxiety. Compared with patients with negative CRP values, patients with positive CRP were more likely to also test positive for depression and anxiety. These results were statistically significant for depression (p = 0.008) and nearly significant for anxiety (p = 0.058) (Figure 1). Quartile analysis of the 21 patients with elevated CRP levels revealed an increasing trend of average depression and anxiety severity scores. However, this correlation was lost when CRP &gt;21 mg/l (Figure 2).

Conclusion
We illustrate the significant association between CRP and depression and anxiety severity scores on the CAT-MH™ survey. These findings suggest a positive relationship between inflammation and depression and anxiety in IBD patients. Physicians should consider patients with elevated CRP levels at risk for these mental health conditions.