bluuebunny/crossref_metadata_2025_split huggingface dataset:
P145 Orofacial granulomatosis in Crohn’s disease: an ECCO CONFER multi-centre case series
Authors: Phillips F , Verstockt B , Sladek M , de Boer N , Katsanos K , Karmiris K , Albshesh A , Eriksson C , Bergemalm D , Molner T , Ellul P 
Published: January 2020

Abstract

Background
Orofacial granulomatosis (OFG) is a rare syndrome characterised by swelling of the orofacial area secondary to an underlying granulomatous inflammatory process. Concurrent intestinal Crohn’s disease (CD) has been described in 20–50% of adult patients with OFG.

Methods
This was a multicentre case series supported by the European Crohn’s and Colitis Organisation (ECCO) and performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. A call was made to report on cases of OFG in CD, with clinical data recorded in a standardised collection form.

Results
This report includes 28 patients with OFG associated with CD: 14 males with mean age of 32 years ( ± 12.4 SD, range 14–60) and 14 females with mean age of 40.3 years ( ± 21.0 SD, range 11–79). Crohn’s distribution was ileal in six patients, colonic in six patients, ileocolonic in 15 patients and isolated upper gastrointestinal tract (UGI) disease in a single patient; six patients (21.4%) had UGI involvement and 11 patients (39%) had perianal disease. The diagnosis of OFG was made prior to CD diagnosis in 5 patients (mean of 0.9 years prior, range 1 month to 2 years), at the same time as CD in 4 cases, and after CD diagnosis in 19 cases (mean of 11.4 years after, range 6 months to 33 years). CD was undiagnosed in 5 patients, quiescent in 11 patients and active in 12 patients. The distribution of OFG involved the lips in 16 cases, buccal mucosa in 18 cases, tongue in eight cases and gums in five cases, with many patients having multiple areas involved. Angular cheilitis was present in 15 cases and aphthous or deep ulcers in 16 cases. Pyostomatitis vegetans and facial palsy were present in 1 case each. Pain was present in 25 cases, with impaired swallowing or speaking in 6 cases and psychological distress in 9 cases.
A number of different treatments led to remission, including topical therapies in 2 cases, steroid injections in 2 cases, exclusive enteral nutrition in 1 case, anti-TNFs in 11 cases, Vedolizumab in 1 case, Ustekinumab in 1 case and Thalidomide in 2 cases. A further 7 cases were resistant to therapy including anti-TNFs and a single case had spontaneous remission without therapy.

Conclusion
This case series of OFG in CD highlights multiple points. The diagnosis of OFG usually occurs after that of CD and can be many decades after, but may also occur prior to or at the time of diagnosis of intestinal disease. Perianal disease and UGI disease are common associations, and there is a significant symptom burden due to pain and impaired swallowing, leading to psychological distress in many. Remission can be obtained with a variety of treatments, including topical and intralesional agents, biologic agents, and thalidomide.
P152 Should professionals provide their patients with digital health training resources?
Authors: Echarri Piudo A , Molina Arriero G , Sierra Ausin M , Calvo Moya M , Pérez Calle J L , Fraga Iriso R , Morete Pérez M C , Botella Mateu B , Ollero Pena V , Enriquez Rodriguez M , Nos Mateu P , Castro Senosiain B , Martín Rodriguez D , Mancenido Marcos N 
Published: January 2020

Abstract

Background
One of the aims of the Spanish Working Group on inflammatory bowel disease IBD (GETECCU), is to improve the quality of life of their patients. Quality standards for IBD Units include educational and care support of IBD patients. A trained patient progress better and consumes fewer resources. Although the internet is the main source of information, it is not always accurate. G-EducaEII (GETECCU’s working group) aims to create resources supported by professionals, such as educainflamatoria.com, witch is currently recommended by 60 different Spanish IBD Units as a resourse for knowledge and self-control of the disease for the patients.
The objective of this study was to analise the sources and searches for information in patients with IBD, assessing the feeling of safety when using a reference website, wich is endorsed by IBD professionals. To value the quality, usefulness and understandability of the website, as well as situations where professionals advise to use it.

Methods
Observational study to assess the perspectives of patients and professionals when using a reference website endorsed by professionals and GETECCU. Patients evaluated the website, through anonymous questionnaires (10 questions each) (web link).
The professionals of G-EducaEII units and the patients they had seen over the last 3 months were invited to take part in the study.

Results
100 professionals and 380 patients participated in the study. The website was the principal source of information used by patients (92%). Its information, videos and ilustrations were clasificated as easy to understand (78%) and very useful for training (90%). Symptoms, diets and treatments for the disease, were the main searches carried out on the website.
Difference in age, sex, illness, years from diagnostic and treatment were analysed. All the professionals considered important to support their patients from the Units and most of them (98%) thought it was very suitable to have a proven and quality website, mainly for newly diagnosed and post-hospitalised patients. All the professional recommended the use of the website where it wasn’t available.

Conclusion
Professionals and patients support the availability of an endorsed website, mainly in newly diagnosed and post-hospitalised situations. Patients value and trust a website endorsed by their professionals and use it extensively in their training. The most frequently requested information is related to symptoms, diets and treatments. Patients suggest the organisation of topics for specific conditions. IBD professionals should be involved in educational support initiatives for the patients. The development of a national reference website is a guarantee of reliable training for the patient with IBD.
P154 Sinusitis Prompts Evaluation for Co-existing or Subsequent inflammatory bowel disease
Authors: Rai V , Traboulsi C , Gulotta G , Rubin D 
Published: January 2020

Abstract

Background
The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterised by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analyses from our group identified an increased prevalence of sinusitis among patients with IBD, predictive factors of developing sinusitis in IBD, and differences in stratifying patients with IBD and sinusitis (IBD+S) based on order in which these conditions were diagnosed. We now report on the factors associated with the development of IBD in patients with sinusitis.

Methods
This is a retrospective study at our tertiary IBD center. We utilised our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between 1/2000–5/2019 and age ≥18 years were included. Demographic and disease-related information were collected. Categorical variables were analysed using Fisher’s exact test and continuous variables were analysed using Wilcoxon rank-sum test.

Results
Of 14,366 patients with IBD, 386 (2.69%) patients have IBD+S. Of the 386 IBD+S patients, 118 patients (30.6%) were diagnosed with sinusitis before IBD. These 118 IBD+S patients were included in univariate and multivariate analysis with 14,753 non-IBD patients with sinusitis. The average age at IBD diagnosis among all IBD patients was 37.32 ± 18.79 years, and the average age at sinusitis diagnosis for sinusitis patients was 40.93 ± 21.42 years. On multivariate analysis, age of sinusitis diagnosis &gt;40 years old (OR 1.52, 95% CI 1.04–2.28), black race (OR 2.82, 95% CI 1.29–7.43), white race (OR 4.33, 95% CI 2.02–11.23), and female sex (OR 1.52, 95% CI 1.03–2.28) were significant predictors of IBD in sinusitis patients (Table 1A). In comparison, multivariate analysis showed that black race (OR 8.09, 95% CI 4.91–14.26), white race (OR 3.35, 95% CI 2.08–5.80), female sex (OR 1.51, 95% CI 1.22–1.87), and bowel obstruction (OR 2.00, 95% CI 1.53–2.58) were significantly associated with sinusitis in IBD patients (Table 1B).

Conclusion
Sinusitis patients diagnosed older than 40 years old have 1.5 greater odds of subsequent IBD, suggesting that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent IBD risk. Female sex and race are shared factors in the risk of sinusitis in IBD patients and risk of IBD in sinusitis patients.
P157 Patient-reported disease activity in a large sample of ulcerative colitis patients using social media-delivered questionnaires
Authors: Abreu M T , Cataldi F , Van Horn K , Herbert L B , Fridman M , Setyawan J 
Published: January 2020

Abstract

Background
Medical therapy for inflammatory bowel disease (IBD) should have dual goals of improving symptoms and mucosal healing. Patient-reported outcomes (PROs) used for approval of ulcerative colitis (UC) treatments include number of bowel movements and bloody stools.[1] Recent research highlights the discordance between PROs and mucosal healing.[2] The aim of this analysis is to understand patient perspectives on UC symptoms and disease burden based on a cross-sectional survey of UC patients. We hypothesised that UC patients experience disease activity despite treatment and that current PROs fail to capture the full impact of disease activity on patients’ lives.

Methods
The IBD In America survey recruited patients via InflammatoryBowelDisease.net and associated social platforms in 2019. Patients self-reported an IBD diagnosis, were 18+, lived in U.S., and participated without monetary incentive. Survey questions addressed diagnosis, symptoms, QoL, treatment, demographics, etc. Survey terms were based on how patients discuss UC in the IBD online community. Remission was defined as ‘significant reduction of symptoms without an actual cure.’ Flare was defined as ‘temporary intensification of symptoms.’ Patients were categorised by disease activity based on number of flares and remission status during the past year.

Results
Of 487 patients diagnosed with UC, mean age was 45.6 (SD 16.0); 85% were female; 89% moderate to severe; 78% diagnosed in past 5 years; and 51% taking 5ASAs, 37% biologics/JAKs, and 23% immunomodulators. Despite treatment, 46% experienced 15+ symptom days in the past month. Fatigue/low energy was most frequent complaint (86%) followed by urgency to move bowels (80%), abdominal pain/cramps (76%), joint pain/inflammation (67%), and bloating (66%). Daily pain was experienced by 32%; even patients in remission with no flares experienced pain at least once a month (55%). Difficulty completing daily tasks was reported by 37%, and 27% felt their UC was not controlled despite efforts to manage it. Only 7% reported being in remission with no flares (past year) and no symptoms (past month).

Conclusion
Most UC patients experience frequent symptoms and flares while on treatment. The most common and bothersome symptoms are not taken into account in PROs nor addressed with current treatment. A more holistic approach to patient disease is needed.

Reference
P158 Semi-automated detection of qualitative features of Crohn’s disease activity found on CT-enterography using machine learning
Authors: Stidham R , Enchakalody B , Waljee A , Su G , Al-Hawary M , Wasnik A 
Published: January 2020

Abstract

Background
Imaging is essential in the assessment of Crohn’s disease (CD) severity, phenotype, and therapeutic response. However, qualitative findings can be limited by interobserver variation and ambiguous feature definitions. Our aim was to evaluate computational approaches for identifying qualitative disease features using CT-enterography (CTE).

Methods
CD subjects with ileal CD and CTE imaging between 2009 and 2017 were retrospective identified at a single tertiary care centre. CTE scans were reviewed by two fellowship-trained abdominal radiologists who labelled diseased and normal bowel transitions agreeing on definitions of qualitative findings prior to labelling. Computed intestinal features were used by machine learning methods (k-nearest neighbour, support vector machines, random forest) to model regions of diseased bowel and predict qualitative findings with 5-fold cross validation. Cohen’s kappa with quadratic weighting was used to assess agreement between radiologists and model predictions.

Results
In 206 unique patients, 548 small bowel segments underwent paired radiologist review for qualitative imaging findings. Automated localisation of diseased vs. normal bowel segments had excellent performance, with an AUC, PPV, and NPV of 0.922, 0.924, and 0.918, respectively (Figure 1). Radiologist-to-Radiologist and Radiologist-to-automated prediction agreement on qualitative findings are shown in Table 1. Agreement on the degree of mural enhancement between radiologists was very good (k = 0.75,95% CI 0.68–0.82), with nearly identical agreement (k = 0.75, 95% CI 0.72–0.79) between radiologists and automated grading models.

Conclusion
Computer vision methods have excellent performance for automatically distinguishing diseased from normal ileum and show potential for qualitative disease assessments of Crohn’s disease on CTEs.
P161 Intra-abdominal abscess in Crohn’s disease
Authors: SAIR A , Lagdali N , Ben El Barhdadi I , Berhili C , Borahma M , Ajana F Z 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) is associated with the emergence of complications, including intra-abdominal abscess. Management is multidisciplinary based on close medical-surgical collaboration. The aim of the study was to evaluate the clinical characteristics, the efficacy of different therapeutic options of intra-abdominal abscess in CD patients and to identify predictive factors of a favorable response.

Methods
Medical records of 56 CD patients who had intra-abdominal abscess were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and therapeutic data were retrospectively assessed. Treatment progression was appreciated.IBM SPSS software 21.0 was used for statistical analysis of our data.

Results
In total, 897 patients were identified as having CD in the study period, 56 of them developed intra-abdominal abscess. Means that the prevalence of intra-abdominal abscess in CD patients was 6,2%.
Mean age was 35,24 ± 11,6 years old with a sex ratio M/F 0,64. 47,3% had penetrating CD. 50.9% of our patients were known to be carriers of Crohn’s disease, 45% of whom were on 5-ASA, while the remaining patients 49.1% (n = 26), the abscess was inaugural and revealing of the CD.The clinical signs were dominated by pain in 80%, the abscess was localised mainly at the right iliac fossa in 77.7% of cases. Median size of collection was 3,8 ± 2 cm. There were 47,3% patients who had fistula associated to abscess. The initial reactive C protein ranged from 14 to 320 (median 58.3) mg/L.
All patients had first-line treatment based on broad-spectrum bi-antibiotic therapy, alone in 25.5%, combined with surgical resection in 45.5%, surgical abscess drainage without resection in 23,6% or guided by imaging in 5.5%, the initial success was 71.7%. 28.3% of patients underwent surgery for initial treatment failure, which was dominated by ileocecal resection in 53.1%. Overall success was 92.3%, only one death was noted following postoperative release with peritonitis. Predictive factor of favorable response was: fistula associated with intra-abdominal abscess (p =0.03) and surgical resection seems to be the best therapeutic option (p &lt; 0,001).

Conclusion
Intra-abdominal abscess is a complication of Crohn’s disease (CD) mainly penetrating, in almost half of the cases, it can reveal CD. Our study showed that the presence of fistula appears to be significantly associated with therapeutic success and the best results are obtained in the case of surgical resection.
P163 Changes in diagnostic delay in inflammatory bowel diseases over the years: a retrospective single-centre analysis
Authors: Di Ruscio M , Vernia F , Variola A , Lunardi G , Resimini S , Geccherle A 
Published: January 2020

Abstract

Background
Delayed diagnosis is common in inflammatory bowel diseases (IBD) and has been reported to be longer for patients with Crohn’s disease (CD) than for those with ulcerative colitis (UC). Aims of study were to assess the median time to diagnosis in IBD patients, to examine whether diagnostic delay (DD) has improved over the years and its impact on biological treatment and need for surgery.

Methods
A retrospective monocentric study including IBD patients living in the area of Verona (Italy), diagnosed up to 2019 and followed-up for at least 6 months at IRCCS Sacro Cuore—Don Calabria, Negrar, was carried out. DD was defined as the period (months) from symptoms onset to histological diagnosis of IBD and reported as &lt;6 months, 6–12 months and &gt;12 months.

Results
Six-hundred-six patients (255 CD; 351 UC; 308 males; 298 females) were enrolled. Median DD was 10 (IQR 2–12), 6 (IQR 1–12) and 2 (IQR 1–7) months &lt;2000, between 2001–2010, and &gt;2010, respectively. Median time to diagnosis was not significantly longer in CD than in UC patients (4 vs. 3 months; IQR 1- 12). No sex- or age-related differences in DD were observed. Using the Mann–Whitney test, DD was longer in patients diagnosed &lt;2000 and between 2001–2010, than in those diagnosed &gt;2010 (p = 0.0000 and p = 0.0004). Comparing DD &lt;2000 and &gt;2010, the statistical difference was reported for UC (p = 0.0000) but not for CD (p = 0.2756). Considering the use of biologics over the years, patients diagnosed between 2000–2010, and &gt;2010 were compared (194 CD and 333 UC), reporting a significant increase in their use both for CD (30 vs. 60; p = 0.0008) and UC (28 vs. 43; p = 0.0000). DD did not influence the need for biological treatment in both diseases (p = 0.987 for CD; p = 0.433 for UC). Considering a DD &lt;6, 6–12, and &gt;12 percentages of patients needing biologics were respectively 53.4%, 63.6% and 56.5% for CD and 28.5%, 34.1% and 26.3% for UC. Seventy-two CD and 27 UC patients needed surgery. Analyzing the time to surgery, DD did not influence the rate of resections in CD (p = 0.6559), as well as in UC (p = 0.2792).

Conclusion
In our cohort, DD has significantly decreased over the last years, more for UC than CD patients. This is probably related to the increased awareness of patients on disease and of general practitioners in sending them to the specialist. Considering the published literature, UC and CD did not differ in DD; moreover age at diagnosis did not affect DD in our patients. DD did not influence the need for biological treatment or surgery rates in both diseases. These results are probably related to the difference in disease extension and severity among the patients enrolled. An analysis on targeted patients at higher risk for bowel damage is presently under way.
P165 The patient’s journey: the IBD terrain
Authors: Mahmood T , Mahmood T 
Published: January 2020

Abstract

Background
Patients with IBD have already travelled a long journey before they muster up courage to speak about their symptoms with their doctor or the family. During this period they may undergo enormous suffering. This educational film, part sponsored by Crohn’s and Colitis UK, highlights this issue for the first time. It recognises that doctors and nurses are not trained to address pre-consultation journey of IBD patients.

Methods
This 40 min long drama documentary film was made with the help of a filming crew. Script was written, directed, produced and co-edited by the two authors with the help of the filming experts. It was part sponsored by the Crohn’s and Colitis UK. The film tells three touching stories that aim to educate patients and medical professionals. It shows physical, emotional, social and relational effects of silent sufferers with IBD.

Results
It is highlighted that patient journeys before they muster up courage to speak to anybody about their symptoms have a massive bearing on their general outcomes. The doctors and nurses so frequently are naïve about this aspect of patient care, as we are neither taught about it nor trained to deal with it.

Conclusion
This film is first of its kind. There is need for the Medical education curriculum to incorporate training and awareness about suffering of IBD patients before having medical consultations, and prior to sharing their stories with relatives and friends. The film has educational elements for all; doctors and nurses as well as the patients.
P182 Bowel Preparation in inflammatory bowel diseases (IBD): preliminary results from a randomised trial evaluating efficacy, tolerability and safety of cleansing solutions in IBD patients
Authors: Rueda Garcia J L , Suárez Ferrer C , Martín-Arranz E , Poza J , Sánchez-Azofra M , García-Ramirez L , Poladura B , Verges T , Noci J , Martín-Arranz M D 
Published: January 2020

Abstract

Background
Colonoscopy is the first-line procedure for the diagnosis and management of inflammatory bowel disease (IBD). Data regarding bowel preparation in patients with IBD are scarce. Our aim was to evaluate efficacy, safety and tolerability of the main available colon cleansing formulations in IBD patients: sodium picosulfate with magnesium citrate (SM+MC), 2L polyethylene glycol-ascorbate (2L-PEG-a) and 1L polyethylene glycol-ascorbate (1L-PEG-a).

Methods
Study design: Phase 4, randomised, single-centre, prescriber and colonoscopist-blinded study. EudraCT Number 2018-001402-28. Patients: IBD patients aged over 18 requiring colonoscopy. Exclusion criteria: pregnant women, past history of bowel resection, severe acute IBD flare or low-quality cleansing score in a colonoscopy performed 12 months prior to enrolment. Patients were randomized 1:1:1 to receive 1L PEG-a, 2L PEG-a or SP+MC; all preparations were administered in a split-dose regimen. Colonoscopies are performed by trained IBD specialists. Endpoints: Primary endpoint: Bowel cleansing using Boston Bowel Preparation Score (BBPS). We considered high-quality cleansing (HQC) a BBPS ≥5. Secondary endpoints: tolerability and patient satisfaction, evaluated via questionnaires filled before and after undergoing colonoscopy. Questionnaires contained items to be ranged on a scale from 1 to 10. Safety was monitored via adverse event reporting, laboratory evaluation at colonoscopy and telephonic follow-up. Statistical analysis: We used Student’s T/ANOVA and χ² tests for comparison between quantitative and qualitative variables, respectively. Software was Stata for Mac OS. We considered statistical significance a p-value &lt; 0.05.

Results
Seventy-seven patients have been enrolled and subsequently randomised: 31 SP+MC vs. 24 2L-PEG-a vs. 22 1L-PEG-a. Colon cleansing was similar between solutions (% of HQC: SP+MC 100% vs. 2L-PEG-a 91% vs. 1L-PEG-a 95’4%, p = 0.28). Tolerability among the different formulations was also comparable (p = 0.68). Looking at patient satisfaction, instructions for SM+MC were rated higher (p = 0.05). No serious adverse events were reported. Data can be seen in Table 1.

Conclusion
No differences were observed between bowel preparations in patients with IBD concerning cleansing and tolerability. Instructions for SP+MC were easier from patient’s point of view than the others. Recruiting is still active so definitive conclusions are yet to be reported.