bluuebunny/crossref_metadata_2025_split huggingface dataset:
P245 Inter-rater reliability of gastrointestinal ultrasound in the assessment of disease activity in patients with inflammatory bowel disease prior to commencing medical therapy
Authors: Smith R , Taylor K , Friedman A , Su H , Con D , Gibson P 
Published: January 2020

Abstract

Background
Gastrointestinal ultrasound (GIUS) is an emerging modality in Australia for the assessment of disease activity in patients with inflammatory bowel disease (IBD). Its utility relies upon reproducibility of key indices, particularly when performed by different operators.

Methods
The aim of this article was to address the inter-rater reliability among GIUS-credentialed gastroenterologists in Australia, in their assessment of GIUS indices reflecting disease activity in patients with IBD.

Methods
Patients with IBD were prospectively recruited for paired, consecutive, blinded GIUS assessment at the commencement of a new medical therapy. GIUS was performed by two of four gastroenterologists accredited in GIUS at our centre. GIUS assessment was completed of the known disease distribution. Bowel wall thickness (BWT) was determined from a mean of four measurements for each segment of bowel examined. Colonic and small bowel BWT was defined as normal &lt;3 mm, mild disease 3.1–6 mm, moderate disease 6.1–9 mm and severe disease &gt;9.1 mm. Anastomotic BWT measures were considered as normal &lt;5 mm or abnormal &gt;5.1 mm. Colour Doppler assessment of the bowel wall was based on the Limberg scale1: no colour Doppler signal, mild, moderate and severe. The presence or absence of mesenteric hyperechogenicity surrounding each bowel segment and the presence or absence of reactive lymphadenopathy was assessed. The inter-rater reliability was tested with the Fleiss kappa.

Results
26 patients were assessed. Sixty-nine per cent had a diagnosis of Crohn’s disease, 19% with ulcerative colitis and 12% with IBD unclassified. A total of 80 bowel segments were assessed. In the assessment of BWT, the observed agreement was 77.5% and the inter-rater reliability was in the substantial range with a Fleiss’ kappa of 0.63 (95% CI 0.48–0.78, p &lt; 0.001). Of note, the percentage of BWT measures that differed by &lt;1 mm, between each operator, was 79%. When assessing the degree of Doppler activity, the observed agreement was 82.5% and again inter-rater reliability in the substantial range with a Fleiss’ kappa of 0.68 (95% CI 0.54–0.83, p &lt; 0.001). The assessment of mesenteric hyperechogenicity showed an observed agreement of 96.3%, with a near-perfect inter-rater agreement with a Fleiss’ kappa of 0.89 (95% CI 0.76–0.99, p &lt; 0.001). For the presence or absence of lymphadenopathy, the observed agreement between users was 84.6% with a substantial inter-rater agreement reflected by a Fleiss’ kappa of 0.64 (95% CI 0.29–0.98, p &lt; 0.001).

Conclusion
Among Gastroenterologists experienced and credentialed in GIUS, the inter-rater reliability of markers of intestinal inflammation was substantial, providing confidence in the reproducibility of findings between different operators.
P266 Atopic diseases are associated with the development of inflammatory bowel diseases: A nationwide population-based study
Authors: Hong S W , Soh H , Lee H J , Han K , Park S , Moon J M , Kang E A , Chun J , Im J P , Kim J S 
Published: January 2020

Abstract

Background
The association between atopic diseases and inflammatory bowel diseases (IBD) still remains unclear. We conducted a nationwide population-based study to investigate the effect of atopic diseases on the development of IBD.

Methods
A total of 9,950,548 subjects who received medical check-up between 2009 and 2012 were included and followed up until 2017. The presence of any atopic disease including atopic dermatitis (AD), allergic rhinitis (AR), and asthma were evaluated. Patients who developed IBD including Crohn’s disease (CD) and ulcerative colitis (UC) were identified using the claims data from National Health Insurance.

Results
During a mean follow up of 7.3 years, 1,426 (0.014%) subjects developed CD and 5,916 (0.059%) subjects developed UC. The incidences of CD (per 100,000 person-years) were 4.088, 2.255, and 2.344 in patients with AD, AR, and asthma,, respectively. The incidences of UC were 11.926, 9.857, and 9.377 in patients with AD, AR, and asthma, respectively. Multivariable analysis revealed that the adjusted hazard ratios (aHR) for incident CD in patients with AD, AR, and asthma were 2.21, 1.33, and 1.59 (95% confidence interval (CI) 1.251–3.896, 1.152–1.532, and 1.186–2.123, respectively) compared with controls. The risk for incident UC in patients in AD, AR, and asthma were 1.51, 1.32, and 1.28 (95% CI 1.081–2.101, 1.235–1.416, and 1.110–1.484, respectively) compared with controls. Moreover, increase in the number of atopic diseases gradually increased the risk for CD and UC; CD showed aHR of 1.36 and 1.65 (95% CI 1.180–1.571 and 1.143–2.370), and UC showed aHR of 1.30 and 1.49 (95% CI 1.216–1.398 and 1.247-1.170) in one, and two or more atopic diseases, respectively.

Conclusion
Patients with any atopic diseases showed an increased risk for IBD, while an increase in the number of atopic diseases gradually increased the risk for IBD.
P274 The clinical significance of anastomotic ulcers after ileocolic resection to predict postoperative recurrence of Crohn’s disease
Authors: Kim J Y , Park S H , Kim Y J , Park J C , Noh S , Lee J S , Kim J , Ham N S , Oh E H , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K 
Published: January 2020

Abstract

Background
The Rutgeerts score (RS) is used to predict postoperative recurrence in Crohn’s disease (CD) patients after ileocolic resection primarily based on endoscopic finding at the neoterminal ileum. However, assessing anastomotic ulcers (AUs) is still a matter of debate. Our aim was to investigate the clinical significance of AUs on endoscopic recurrence in postoperative CD patients.

Methods
This was a single-centre retrospective study analysing postoperative CD patients with the RS of i0 to i1 at the first ileocolonoscopy within 1 year after ileocolic resection between 2000 and 2016 and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs predicting endoscopic recurrence (RS ≥ i2b).

Results
Among 116 patients who were in endoscopic remission at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the 30.0 months (interquartile ranges, 21.3–53.3) of median follow-up periods after the index ileocolonoscopy, 56.1% (55/98) showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs defined as ulcer occupying ≥ 1/4 of the circumference or ≥ 3 ulcers confined to anastomotic ring, or any ulcers extended to ileocolic mucosa showed endoscopic recurrence. On multivariable analysis, the presence of AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; p &lt; 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–6.79; p &lt; 0.001) were associated with endoscopic recurrence, respectively.

Conclusion
AUs are associated with a significantly higher risk of endoscopic recurrence in postoperative CD patient who are in endoscopic remission.
P275 Biological therapies for patients with Crohn’s disease: More options mean less surgical interventions
Authors: Chin Y F , PUJJI O , Wilkinson B , Mohan S , Nnaji M , Yassin N 
Published: January 2020

Abstract

Background
The advent of biologic therapy and their acceptance into mainstream use for the medical management of patients with inflammatory bowel disease (IBD) has transformed the landscape of treatment for this condition. It has particularly become a mainstay in the treatment of fistulating or perianal Crohn’s Disease (CD). Data have shown that overall, 70% of patients will require surgical resections for CD. Consequently, questions have endured regarding the effect of biologic medications on the overall treatment course of CD patients. Our aim is to identify the efficacy of biologics by measuring surgical free survival. We subcategorised the period into 3 categories, including periods less than a year 1–5 years and &gt;5 years and comparing these with the number of biologics they required to be switched either due to side effects or loss of medical response.

Methods
A retrospective analysis of prospectively collected data was correlated with the clinical coding department, inflammatory bowel disease and surgical databases. Patients receiving biological therapies were identified (Infliximab, Adalimumab, Vedolizumab, Ustekinumab, Certolizumab). Demographics, clinical and surgical data were analysed.

Results
Sixty-six patients were included in our analysis. Male to female ratio is 1 to 1.07, age range was 18–77, median age 41 (SD:17.46) years old. Twenty-five patients had ileocaecal resection, 17 had hemi and segmental colectomy, 7 had small bowel resection, 10 had subtotal colectomy and 7 had panproctocolectomy. Refractory to one biologic does not indicate biological failure; number of biologics switched and surgical free survival were compared. We have utilised the Spearman correlation coefficient for nominal analysis which gave us a coefficient of +0.725, p = 0.00. This indicates that both factors have a strong positive correlation between numbers of biologics patients used against period required for surgical management.

Conclusion
In the current era of biological therapies, with a breadth of choice of therapeutic agents, our data has a positive correlation between the number of biological agents used and surgery-free survival for patients with Crohn’s disease. A multidisciplinary approach to the management of these patients should be personalised, and suitability to each biological agent should be considered in addition to close surgical observation.
P279 Early detection of mucinous adenocarcinoma within fistulating peri-anal Crohn’s disease
Authors: Corr A , Reza L , Lung P , Jenkins I , Antoniou A , Latchford A , Wilson A , Arebi N , Burling D , Warusavitarne J , Faiz O , Thomas-Gibson S , Hart A , Tozer P 
Published: January 2020

Abstract

Background
The development of peri-anal fistula mucinous adenocarcinoma (MA) is a presumed rare but recognised event in patients with fistulating peri-anal Crohn’s disease. The true incidence is unknown, with a lack of robust registry data. Fistula mucinous cancers may evade early diagnosis, presenting with locally advanced intra-pelvic disease, necessitating debilitating and morbid exenterative surgery. Given the limitations of endoluminal assessment of this region in the context of an often extra-luminal disease process, MRI studies were reviewed in conjunction with EUA and endoscopic findings.

Methods
We performed a retrospective analysis of 8 cases of biopsy-proven mucinous adenocarcinoma (MA) that had developed within known Crohn’s related anal fistula. Serial MRI studies pre-dating the diagnosis of malignancy were reviewed in order to establish whether there are early predictive features of MA development within a fistula tract. Demographic, disease and surgical history were collected including the time of fistula diagnosis and histological confirmation of mucinous adenocarcinoma.

Results
The median time to histological diagnosis of MA from the time of diagnosis of Crohn’s disease was 426 (96–480) months and from diagnosis of fistulating disease 66 (24–156) months. On review of sequential MRI fistula protocol studies, a characteristic ‘budding’ appearance within the T2 high signal ‘sepsis’/fistula tract is noted in all of our MA fistula cancer cases (Fig1 and 2). This finding pre-dates the histological diagnosis of MA by a median of 42(12–156) months. Weight loss was a presenting symptom in 4 of the 8 (50%) patients and all 8 patients reported a new significant peri-anal pain and high volume discharge which prompted reassessment and referral. Metastatic disease was not detected in any of the 8 cases. Potentially curative pelvic exenteration was possible in 7 patients.

Conclusion
Mucinous adenocarcinoma within this cohort often culminates in exenterative surgery by the time a diagnosis is made. There is an opportunity for early detection on MRI of the development of MA in an anal fistula by recognition of ‘budding’ within the tract. An earlier diagnosis may lessen the magnitude and morbidity of subsequent radical surgery following prolonged growth of these lesions. Long-standing Crohn’s anal fistula should be surveyed with MRI and any finding of ‘budding’ within the tract on T2 sequences should prompt urgent examination under anaesthetic and biopsy.
P280 Sodium picosulfate low-volume and split-dosed bowel preparation facilitates endoscopic monitoring of patients with inflammatory bowel disease
Authors: Fasoulas K , Katsimpeli A , Kevrekidou P , Kafalis N , Stergiou E , Bouzoukas S , Lazaraki G , Tzilves D , Soufleris K 
Published: January 2020

Abstract

Background
The concept of Treat to Target and Tight Control relies heavily on bowel mucosa assessment. This implies that multiple endoscopies should be performed for any patient with moderate to severe inflammatory bowel disease (IBD). Improving patient tolerance of bowel preparation is important as we stride for frequent endoscopic monitoring. We aimed to compare low-volume (2 litres) Sodium Picosulfate (Pico) and high-volume (4 litres) Polyethylene Glycol (PEG) bowel preparation regimens, as well as split dosing, in terms of tolerance, efficacy and safety.

Methods
We included all adult IBD patients of our IBD clinic who underwent colonoscopy in the last 2 years for the sole purpose of mucosal healing assessment. We excluded patients with an indication of cancer surveillance, acute severe colitis, bowel strictures with obstructive symptoms, and patients with renal or liver failure. We used a Visual Analog Scale (VAS) assessed by patients to evaluate tolerance, and Boston Bowel Preparation Scale (BBPS) assessed by physicians to evaluate efficacy.

Results
A total of 139 patients were included in the study: 70 (50,4%) male patients, 86 (61,8%) with Crohn’s disease and 53 (38,2%) with ulcerative colitis, with a mean age of 46,14 years (range 17–74) and mean disease duration of 10.12 years. We included 21 patients (15.1%) with a previous ileocecal resection. Low-volume Pico preparation was received by 48 (34,5%) patients. High-volume PEG preparation was received by 91 (65,5%) patients. Split dosed preparation was received by 49 (35.2%) patients. Low-volume Pico preparation was significantly better tolerated than high-volume PEG preparation (VAS 81,75 vs. 65,69, p &lt; 0,001) without a negative impact on bowel preparation quality (BBPS 7,65 vs. 7,32, p = 0.237). Split dosing did not improve tolerance (VAS 74,96 vs. 67,75, p = 0.221) but it improved the quality of the preparation (BBPS 7,94 vs. 7.13, p = 0,002). No meaningful differences were observed in terms of isolated aphthous ulcers (0% vs. 4%, p = 0,325). Complete intake of preparation was significantly higher in the low-volume Pico group (94,7% vs. 74,7%, p = 0,002). Complete colonoscopy was achieved in all patients. No serious adverse events related to the bowel preparation were reported. Patients in the low-volume Pico group were slightly younger (42,54 vs. 48,03 years, p = 0,034) and more likely to have had surgery (25% vs. 9,9%, p = 0,018).

Conclusion
Although this was a single-centre non-randomised study with a relatively small number of patients, it clearly demonstrated that low-volume PICO split dosed bowel preparation is superior for IBD patients scoped to check for endoscopic remission, as it improves tolerance and quality without compromising efficacy. Further evidence from randomised studies is needed.
P284 Disentangling fibromyalgia from spondyloarthopathy in the patient with inflammatory bowel disease
Authors: Variola A , Bertolini E , Di Ruscio M , Vernia F , Geccherle A , Beltrami M , Tinazzi I , Macchioni P 
Published: January 2020

Abstract

Background
Joint pain is common in subjects affected by Inflammatory bowel disease (IBD) and is linked to several factors including spondyloarthritis (SpA), drug therapy, concomitant osteoarthritis and fibromyalgia (FM). The primary aim of this study was to estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of IBD patients. The secondary aim was to assess the impact of FM on clinimetric scores and ultrasonographic features.

Methods
Consecutive cases with IBD attending two IBD Units were assessed by a rheumatologist for ASAS criteria for SpA or the 2010 ACR criteria for FM. The rheumatological assessment included a 66 swollen joint count (SJC) and 68 tender joint count (TJC), Maastricht Ankylosing Spondylitis Score (MASES), Leeds Enthesitis Index (LEI) and the FM tender points examination, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). One hundred and fifty-eight patients seen at Reggio Emilia centre underwent US entheseal examination. MRI and HLA-B27 determination were requested if needed for diagnostic confirmation.

Results
301 patients were enrolled with 148 completing the clinical and imaging/laboratory assessment if requested for diagnostic purpose. A total of 37 IBD patients (12%) met the ACR criteria for FM: 27 patients (9%) presented the criteria for primary FM and 10 patients (3.3%) presented FM and SpA. Patients who met FM criteria were mostly female (81%, p &lt; 0.001), slightly older, with longer duration of disease; no correlation with smoking, sedentary job, body mass index (BMI) or psoriasis. Of note FM patients presented higher LEI, BASDAI and BASFI scores than SpA patients. At US examination patients who satisfied ASAS criteria for SpA had significantly higher mean enthesis/patient PD positive as compared with IBD and FM group (p &lt; 0.001 for the two comparison) and had more patients with at least one PD positive enthesis (p &lt; 0.001 and p = 0.028 respectively). Acute entheseal lesions had a higher prevalence in the ASAS+ group as compared with the other two groups (p = 0.002 vs. IBD group and p = 0.009 vs. FM group). Chronic entheseal lesions had the same prevalence in the three groups of patients.

Conclusion
FM is common among IBD patients and more prevalent in females and patients aged ≥ 45 years old. In this subgroup of patients SpA disease activity indices performed poorly for distinguishing patients with disease activity from those with functional impairment. On the contrary, US examination showed a promising discriminating capacity in SpA patients.
P287 Patient sex does not affect endoscopic outcomes of biologicals in patients with inflammatory bowel disease, but is possibly associated with adverse events: A systematic review
Authors: Lie M R K L , Paulides E , van der Woude C J 
Published: January 2020

Abstract

Background
There are several known factors influencing the efficacy and tolerability of biological therapies. Whether patient sex affects this is currently unclear, yet this knowledge would be helpful for risk and benefit stratification. This study assesses the role of patient sex on the efficacy and tolerability of biological therapies used for the treatment of IBD.

Methods
A systematic literature search was performed on 08 April 2019 using Embase (including Medline), Medline OvidSP, Cochrane Central Register of Controlled Trials, Web of Science and Pubmed. The primary outcome was the influence of patient sex on endoscopic outcomes in IBD patients treated with biologicals. The secondary outcome was the influence of patient sex on adverse events during biological therapy. Studies examining either of the outcomes were included in the assessment, regardless of study type or setting.

Results
The search yielded 19461 citations. After review 55 studies were included in the study, involving 28465 patients treated with adalimumab, certolizumab pegol, infliximab or vedolizumab. Of the 41 studies that objectively examined patient sex and efficacy of biological therapy, none found a significant association. Of the 14 studies examining patient sex and adverse events, 7 found that adverse events such as infections or skin lesions occur more frequently in female than in male patients. No meta-analysis of the primary or secondary outcome could be performed due to lack of exact reporting of summary measures.

Conclusion
There is no evidence for a sex difference in endoscopically measured response to biological therapies in IBD patients. However, there is a possible influence of sex on the occurrence of adverse events with a higher incidence in females.
P297 Novel serum soluble markers of histological healing in ulcerative colitis
Authors: Nardone O M , Jeffery L , Bazarova A , Acharjee A , Gkoutos G , Zardo D , Shivaji U N , Smith S C , Ghosh S , Iacucci M 
Published: January 2020

Abstract

Background
The recent introduction of a commercial panel of soluble biomarkers, that can predict endoscopic healing, may support the monitoring and management of Crohn’s disease reducing the need of repeated endoscopy.1 Achieving histological remission (HR) is currently considered to be an important target in ulcerative colitis (UC).2 The aim of this study was to identify serological markers of HR in patients with UC and determine their diagnostic accuracy individually and in combination to predict HR.

Methods
We enrolled 40 UC patients referred to a tertiary academic centre for colonoscopy as part of standard of care. Demographic data and histologic data (RHI, Nancy) were collected. Concentrations of these biomarkers were compared with the histology at the time that the patients underwent colonoscopy with advanced enhancement technologies and targeted biopsies. Histological healing was defined as Nancy ≤1 and RHI ≤3. A total of 55 soluble analytes, relevant to inflammation or shown to be altered in IBD, were measured in serum using Procartaplex luminex assays (ThermoFisher). Finally, 24 analytes that were detected in more than 40% of patients were selected in downstream modelling and used to train a logistic regression model.

Results
We identified Brain-Derived Neurotrophic Factor (BDNF) and Macrophage Inflammatory Proteins (MIP-1 α) that, when combined together, showed the highest predictive power for predicting RHI≤3 and Nancy ≤ 1 with an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% CI: 0.69–0.97). When we investigated analytes separately for predicting the same outcome, univariate logistic regression was significant for two other markers: Leukemia Inhibitory Factor (LIF) and Vascular Cell Adhesion Molecule 1 (sVCAM1) showing higher values associated with the lack of healing. The AUROC was 0.74 for LIF (95% CI: 0.591–0.89) and 0.72 for sVCAM1 (95% CI: 0.53–0.90).

Conclusion
BDNF, MIP-1α, LIF and sVCAM may be promising markers to assess histological healing in UC patients. Replication in larger cohorts of patients is now required.
*OMN and LJ contributed equally.

References