bluuebunny/crossref_metadata_2025_split huggingface dataset:
P815 Are hospitalised patients with inflammatory bowel disease at increased risk of invasive bacterial infections? Results from POLIBD 2-year cohort study
Authors: Filip R , Gruszecka J 
Published: January 2020

Abstract

Background
The disease itself as well as immunomodulatory and biological therapy are risk factors for invasive bacterial infections in patients with inflammatory bowel disease (IBD). However, there are limited data on risk factors for bacteraemia in the general population of hospitalised patients with inflammatory bowel disease.
The aim of the study was to assess the rate of bacteraemia in hospitalised patients with Inflammatory Bowel Disease and risk factors.

Methods
An observational cohort of hospitalised patients with Inflammatory Bowel Disease, aged 23–65 years, from 2017 to 2019 in a large tertiary hospital localised in Rzeszow (south-eastern Poland). Patients with one or more positive blood culture were reviewed. Those with Carlson comorbidity index of 2 or greater were excluded. Basic descriptive statistic and logistic regression to evaluate risk factors for bacteraemia were used.

Results
Of 727 admitted patients, only 1.24% had bacteraemia (9/727) (8, Crohn’s Disease; 1, Ulcerative Colitis). The most common pathogens were Staphylococcus epidermidis (MRCNS - methicillin-resistant coagulase-negative Staphylococcus - strain resistant to all beta-lactam antibiotics: penicillins, penicillins with a B-lactamase inhibitor, cephalosporin and carbapenem) (4/9 patients) and Escherichia coli (3/9 patients). The mortality rate at 30 days of patients with bacteraemia was 0% (no deaths in IBD patients with bacteraemia observed). Longer hospitalisation (mean length of stay for patients with CD was 42 ± 33 vs. 7.95 ± 17.3, p &lt;0.001; mean length of stay for a patient with UC 15 ± 23 vs. 6.25 ± 15.4, p = 0.004) was associated with an increased risk of bacteraemia. Older age was not associated with an increased risk of bacteraemia (P&gt;0.05). In multivariate analysis, treatment with either anti-tumour necrosis factor α, purine analogues, steroids or amino salicylates was not associated with an increased risk of bacteraemia.

Conclusion
Prolonged hospitalisation, but not Inflammatory Bowel Disease-related treatment, is associated with an increased risk of bacteraemia in hospitalised patients with Inflammatory Bowel Disease.
P818 Venous thromboembolism is rare among hospitalised patients with an inflammatory bowel disease flare: a multicentre retrospective cross-sectional study
Authors: Khoury T , Shafrir A , Kalisky I , Safadi M , Mari A , Mahamid M , H Katz L , Kadah A , Sbeit W 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) patients have twice the risk of venous thromboembolism (VTE) compared with healthy controls. VTE can occur at both hospitalisation and after discharge. We aimed to assess the prevalence of VTE among IBD patients who were hospitalised with disease flare at three Israeli Hospitals.

Methods
A retrospective cross-sectional analysis including all IBD patients who were admitted with disease flare at Galilee Medical Center, EMMS Nazareth Hospital and Hadassah Medical Center. Exclusion criteria were patients with confirmed diagnosis of hypercoagulable state or patients on drugs with pro-coagulable potential.

Results
Eighty-one patients with overall 114 admissions were included in the study. The average age was 42.2 ± 18.5 years. Sixty-six patients (57.9%) were males. Forty-five admissions (39.5%) were due to ulcerative colitis (UC) flare and 69 admissions (60.5%) were secondary to Crohn’s disease (CD) flare. Twenty-eight patients (24.6%) were smokers. Twenty-five patients (21.9%) and 39 patients (34.2%) were on recent biological and steroid treatment (within 3 months). The mean C-reactive protein and albumin levels at the day of discharge were 4.2 ± 4.6 mg/dl (normal range 0–0.5) and 3.5 ± 0.7 g/dl (normal values above 3.2), respectively. During hospitalisation, 57 (50%), 55 (48.2%), 29 (25.4%), 19 (16.7%) and 8 (7%) patients were treated with intravenous steroids, antibiotics, amino-salicylates, surgery and immunomodulators, respectively. Only four patients (3.5 %) were on prophylactic subcutaneous anticoagulation (enoxaparin) throughout their hospital stay and only 1 patient (0.9%) who have not been on anticoagulation developed in-hospital symptomatic VTE episode. Notably, this patient suffering from CD with ileo-colonic involvement developed subclavian vein thrombosis two day after PICC line insertion for total parenteral nutrition to optimise his nutritional state before performing surgery. The mean hospitalisation length was 6.5 ± 6.6 days.

Conclusion
In-hospital VTE was rare among our IBD patients admitted with disease flare. In fact, the only one VTE event reported in our cohort is probably related to the PICC line insertion and not related to IBD flare. Notably undergoing surgery in our cohort was not correlated with VTE episodes. Further studies are warranted to characterise IBD patients at risk for VTE, to assess the risk factors for in-hospital VTE development and to address further the role of prophylactic anticoagulation among hospitalised IBD patients, mainly those with bloody diarrhoea.
P819 Seroprevalence of Borrelia burgdorferi antibodies in patients with ulcerative colitis
Authors: Dulger A C 
Published: January 2020

Abstract

Background
Lyme disease is a significant zoonotic tick-borne disease with an increasing prevalence in northern hemisphere. The infected tick of the genus Ixodes is responsible for spreading of the disease. Erythema migrans lesions, cranial-nerve (particularlyfacial-nerve) palsy and meningitis, carditis and arthritis are the main manifestations of the disease. Diagnosis of Lyme disease mainly depends on medical history, compatible clinical signs in connection with laboratory findings including more than two IgM bands or more than 5 IgG bands on immunoblot. Ulcerative colitis (UC) is a immun-mediated large bowel disease that is characterised by abdominal pain, bloody diarrhoea and tenesmus due to lymphoplasmocyter infiltration of the mucosal crypts. There have been many studies describing a wide range of genetic, immunologic and environmental risk factors in patients with UC. However, there is no report whether Borrelia burgdorferi antibodies are protective in patients with UC.

Methods
This was a single centre retrospective observational study of patients with UC vs. age and -matched healthy controls. The medical records of gastroenterology clinic patients with UC between July 2018 and May 2019 were reviewed. At total, 51 (15 female; the mean age 46 years; 35 of them were using anti-TNF agents) UC patients have tested for Borrelia antibodies. On the other hand, 66 age-matched otherwise healthy control subjects (36 female; mean age was 54 years) were selected as comparator group.

Results
While, only 2 patients (3%) were tested positive for Borrelia bugdorferi (BB) Ig G antibody, 15 subjects (22.7%) had a positive result for BB Ig G antibody in control group. There was a significant difference between groups in terms of BB Ig G seropositivity (p &lt; 0.001). found significantly low rates of BB Ig g seroprevalance in patients with UC. The reason of this phenomenon is unclear.

Conclusion
The low rate of BB Ig G in patients with UC may have been related to presence of aberrant NK T cells in colonic mucosa. Evidence suggests a inverse link between Lyme arthritis and elevated levels of NK T cells, therefore we hypothesise that UC-related T cells regulates Borrelia trafficking. On the other hand, it has been a well known fact that UC is also related to improvement in sociodemographic development in developing world. Lyme disease is mostly driven by tick exposure in rural areas and mostly seen in forestal areas of the world rather than city centres. This phenomenon may also compatible with real life prevalence models of the inflammatory bowel diseases. In conclusion, these data indicate, for the first time, the inverse association between UC and seropositivity of BB antibodies could lead to design new diagnostic and prognostic tools.
P827 The clinical phenotype of collagenous colitis is associated with T-cell-related genetic variants
Authors: Roda G , Piovani D , Prantesh J , Gordon I , Asselta R , Duga S , Vetrano S , Bonovas S , Harpaz N , Danese S , Peter I , Colombel J F , Rieder F 
Published: January 2020

Abstract

Background
Collagenous colitis (CC) is a common cause of chronic diarrhoea and highly associated with immune-mediated diseases. The aetiology of CC may involve a dysregulated immune response in genetically predisposed individuals. Our preliminary data identified ancestral HLA haplotype 8.1 and non-HLA CC risk loci being associated with CC. We here carried out the first genotype/clinical phenotype association study in a large cohort of CC patients.

Methods
This study combined Immunochip data from 300 patients with centrally read histologically confirmed CC with retrospectively collected clinical data in a quarternary care centre. We tested 21 SNPs previously associated with CC (Roda et al. submitted) for their genetic association with selected phenotypic variables (histology, autoimmune diseases, relapse rate, concomitant medications, number of bowel movements at diagnosis, sex and response to therapy). We performed univariable linear, logistic and Poisson regression analyses for associations with the outcome variables.

Results
300 CC patients [median age 63 (IQR: 54–63); 80% female] were included after quality control. The genetic variants associated with clinical phenotypes can be found in Table 1. We identified a link of several genes involved in T cell function with CC phenotypes. IL2A was associated with risk of additional autoimmune disorders reinforcing the possible role of T cells in both diseases. RUNX3 involved in Th17 cells and TGF-beta pathways was a risk factor for IEL infiltrates. Notably, we identified two protective factors: one near C5orf30, previously implicated in rheumatoid arthritis and collagen-induced arthritis, was linked with a reduced rate of flares; ZNF365, involved in uric acid excretion and associated with ileal Crohn’s disease, was found protective in relation to collagen band thickness. When assessing non-genetic variables, number of bowel movements correlated with collagen band thickness (p &lt; 0.01); concomitant use of sertraline was protective for relapse rates (p = 0.021), and current smoking (p = 0.022) was linked with relapse rates.

Conclusion
We found a significant association of T-cell-related genes and CC clinical phenotypes. Additionally, our study identified current smoking and increased collagen band thickness as risk factors for disease severity.
P829 Methylation patterns in dysplasia in inflammatory bowel disease patients
Authors: da Luz Rosa I A , Silva P , Mata S , Magro F , Carneiro F , Peixoto A , Silva M , Sousa H , Roseira J , Parra J , Barosa R , Vieira A , Brito M J , Lago P , Coelho A , Moleiro J , Silva J , Fonseca R , Albuquerque C , Pereira A D 
Published: January 2020

Abstract

Background
Inflammatory Bowel Disease (IBD) with colonic involvement increases colorectal cancer risk. However, the distinction between IBD related and sporadic dysplasia in IBD patients is difficult. Some data favours the importance of abnormal DNA methylation in IBD-related carcinogenesis. Our study aimed to define methylation patterns in patients with a colonic cancer or dysplasia diagnosis following an IBD diagnosis.

Methods
Multicentric cross-sectional study- 91 samples from colonic mucosa with/without dysplasia from 9 patients with IBD-related dysplasia/cancer and 26 patients with IBD and sporadic dysplasia/cancer were included. Methylation patterns of CpG islands in the promoter regions of 67 genes were studied by Methylation-specific Multiplex Ligation-dependent Probe Amplification.

Results
Mean age at IBD diagnosis: 42±16 years; at dysplasia diagnosis: 56± ± 14 years. Twenty-nine patients had ulcerative colitis. Twenty-five patients had at least 1 lesion endoscopically described as adenoma-like, 4 at least 1 non-adenoma like, 3 had cancer and 3 had dysplasia in flat mucosa. No patient had both adenoma-like and non-adenoma-like lesions. Patients with an IBD-related lesion were significantly younger at IBD diagnosis (p = 0.003) and at dysplasia/cancer diagnosis (p = 0.039). Promoter methylation of IGF2, RARB, ESR1, CHFR, CDH13, WT1, GATA5, WIF1 genes was significantly associated to dysplasia/cancer; methylation of MSH6, TIMP3 was significantly associated to IBD-related dysplasia/cancer. Promoter methylation of MSH6, MSH3, RUNX3, CRABP1, TP73, RARB, CDH13, PAX5, WT1, THBS1, TP53, SFRP1, WIF1, APAF1, BCL2 genes was significantly associated to active IBD.

Conclusion
Methylation analysis, namely of MSH6, may contribute to the classification of dysplastic lesions in IBD– to be further tested in prospective studies.
P836 Biomarkers response to anti-TNF treatment in Crohn’s disease through the intestinal microbiota
Authors: Sanchis L , Manresa S , Martínez J F , Valls M , Iborra M , Paredes J M , Boscá M , Huguet J M , Gil R , Maroto N , Rodriguez J , Cortés X 
Published: January 2020

Abstract

Background
The alteration of the intestinal microbiota is a necessary requirement for the development of Crohn’s disease (CD). The anti-TNF alfa (TNF) treatment has radically changed the prognosis of the disease, modifying the therapeutic objective which is the induction and subsequent maintenance of mucosal healing. It is unknown, if this cure/improvement correlates with changes in the microbiota. The objectives of the study were: evaluate the changes in the microbiota in CD pre and after six months with TNF, determine the changes in the microbiota based on the clinical-biological response to TNF and calculate the F. prausnitzii/E. coli (F/E) ratio as an indicator of therapeutic response.

Methods
This was a prospective observational multicentre study that included 27 patients with CD who started treatment with TNF. 16 healthy individuals were included to establish the local healthy microbiota. The existence of disease activity was determined using the Harvey-Bradshaw index (HBI), analytical parameters such as C-reactive protein and faecal calprotectin measured at the beginning of the study, 3 and 6 months; classifying patients as responders (R) and non-responders (NR). The composition of the microbiota (the alpha and beta diversity), as well as the F/E ratio as indicators of dysbiosis, were evaluated by massive genomic sequencing, at the date of inclusion and 6 months after starting TNF through faecal samples.

Results
Prior to TNF, the loss of Clostridia class genera, producers of short chain fatty acids, as well as the significant increase (p &lt;0.01) of Proteobacteria, highlighting the Escherichia/Shigella genus with respect to healthy controls. The microbiota varied according to response to the TNF: the Proteobacteria phylum affected in NR with respect to healthy and R group (p &lt;0.005). Although, R group (13/27) significantly increase Clostridia class bacteria (such as Faecalibacterium) as well as alpha diversity with respect to NR group (p &lt;0.01), with a tendency towards a microbiota similar to controls. There is a significant association (p &lt;0.001) in the F/E relationship between the R group and NR group The F/E ratio was the most accurate (area under a curve of 0.87), when, we compare this value with HBI and CF as biomarkers of response to TNF.

Conclusion
The anti-TNF treatment allows partial restoration of the intestinal microbiota in responders with a tendency towards eubiosis, with respect to non-responders. The determination of F. prausnitzii/E. coli ratio can provide a reliable indicator of response to anti-TNF treatment in Crohn’s disease.
P843 Intestinal microbiota changes according to disease activity in patients with ulcerative colitis
Authors: Barberio B , Bertazzo E , Marinelli C , Massimi D , Ghisa M , Gubbiotti A , Casadei C , Lorenzon G , Zingone F , D’Incà R , Savarino E V 
Published: January 2020

Abstract

Background
Intestinal dysbiosis has been consistently described in patients with inflammatory bowel disease (IBD), particularly about changes in gut microbiota’s composition and reduction of biodiversity. The identification of a characteristic microbiota could bring to a better understanding of ulcerative colitis (UC) pathogenesis and to find possible microbial markers of disease activity in UC. The primary purpose of our study has been to evaluate the different compositions of gut microbiota between subjects with UC and healthy controls and between patients in remission and patients with severe colitis.

Methods
A total of 64 subjects were enrolled: 18 with severe colitis (sUC), 22 UC patients in remission (rUC) and 24 healthy controls (HC). Faecal samples were analysed using the Illumina technique (16S NGS). Statistical analyses were performed with Kruskal–Wallis test. Shannon index and equipartition index were calculated to evaluate α-diversity between the samples and then were compared trough Student’s t-test.

Results
Significant statistical differences in relative frequencies of phyla exist between UC patients and HC: frequencies of the phyla Firmicutes (with a median of 48.10% in UC and of 34.31% in HC, p &lt; 0.001) and Actinobacteria (0.67% in UC and 0.17% in HC, p = 0.006) were higher in UC, while frequencies of the phyla Bacteroidetes (48.82% in UC and 54.97% in HC, p = 0.005), Cyanobacteria (0% in UC and 1.28 in HC, p &lt; 0.001) and Verrucomicrobia (0% in UC and 2.58% in HC, p &lt; 0.001) were lower in UC. Significant statistical differences in relative frequencies of phyla were found between patients with rUC and sUC: Fusobacteria (median 0.005% for sUC, 0% for rU, p = 0.05) and Proteobacteria (7.88% in sUC, 3.22% for rUC, p = 0.015) were higher in patients with sUC. There was no difference between the relative frequencies of the other phyla (Firmicutes, Bacteroidetes, Actinobacteria, Cyanobacteria and Verruccomicrobia). The gut microbiota biodiversity has been evaluated through Shannon index and equipartition index. Biodiversity was increased in UC patients respect to HC, while it was similar between rUC and sUC patients.

Conclusion
The difference between the gut microbiota of rUC and sUC patients is mainly the relative frequency of the phylum Proteobacteria, increased in sUC patients. The α-diversity is similar in these two groups, suggesting a limited role in the influence of the course of the disease.
P844 Higher proportions of genera and species in the Firmicutes phylum are associated with a healthy pouch compared with patients with chronic pouchitis
Authors: Segal J , Mullish B , Clark S , Marchesi J , Hart A 
Published: January 2020

Abstract

Background
Studies highlighting changes in bacterial composition in the ileoanal pouch are limited by heterogeneity in analysis techniques and sampling strategies Therefore, caution must be used when interpreting microbiota data. Similar to findings in IBD, a decrease in bacterial diversity and ‘dysbiosis’ are associated with acute and chronic inflammation in the pouch. Changes in Clostridium spp. and E. coli are associated with inflamed pouches and treatment response. This study aimed to compare the bacterial microbiota composition in patients with chronic pouchitis who responded to antibiotics vs. those who did not.

Methods
Patients with confirmed chronic pouchitis defined by a pouch disease activity score ≥ 7 were treated with antibiotics. If patients were already on antibiotics, they were offered the opportunity to stop. Follow up was at 4 weeks to check clinical status. Patients who came off antibiotics who flared were given the opportunity to restart the antibiotics to prevent deterioration. Patients were analysed as either on antibiotics if they received antibiotics 2 weeks prior to the clinic or off antibiotics if they had stopped all antibiotics 2 weeks prior to follow-up. Stool was collected from patients on follow-up and DNA was extracted from this stool. Sequencing was performed on an Illumina platform. Statistical analysis was performed using STAMP 2.1.3 software with Welch’s two-sided t-test for comparing two groups with false discovery rate correction.

Results
There were 28 patients in the cohort; 23 patients with chronic pouchitis and 5 healthy controls who had never had pouchitis. Ten patients were female. The median age of the cohort was 47 years (range 26–74 years). A total of 12 samples on antibiotics and 11 off antibiotics. There were 10 responders and 13 non-responders. There were no differences between responders and non-responders and no differences in those taking antibiotics vs. those not taking antibiotics with chronic pouchitis. Healthy controls had significantly higher proportions of clostridium genera (p = 0.01) when compared with patients who fail to respond to antibiotics. Healthy controls had significantly higher proportions of lachnospiraceae species (p = 0.03) when compared with those that responded to antibiotic treatment for chronic pouchitis.

Conclusion
In a small cohort with chronic pouchitis we were unable to detect any bacterial differences between those that responded to antibiotics vs. those that did not. Despite this a healthy pouch had significantly higher proportions of Firmicutes species and genera which has been supported in other literature.