bluuebunny/crossref_metadata_2025_split huggingface dataset:
P739 Patients with Crohn’s disease with intestinal failure have less active disease than patients with Crohn’s disease without intestinal failure
Authors: Bouri S , Willsmore J , Geldof J , Gabe S , Donnelly S , Hart A 
Published: January 2020

Abstract

Background
Intestinal failure (IF) is an uncommon complication of severe Crohn’s disease (CD) due to extensive or recurrent resections or complications. It is observed that disease activity might remit once IF develops. This is unexpected given the previous disease course. The aim of this study is to compare the number of patients in deep remission with CD–intestinal failure (CD-IF) to CD without IF.

Methods
A single tertiary centre retrospective analysis was performed on CD-IF patients on parenteral nutrition due to short bowel vs. patients with small bowel CD. CD patients were selected from consecutive hospital clinics if they lived in the local catchment area. Deep remission was defined by the lack of objective indicators of inflammation during the year prior to their latest clinic; including imaging, endoscopy and faecal calprotectin.

Results
94 CD-IF and 94 CD patients were included. The proportion of female patients was 56.4% (CD-IF) and 46.8% (CD); mean age was 51.2 (CD-IF) and 41.5 years (CD); mean duration of disease 24 (CD-IF) and 16 years (CD); proportion with a stoma 73.4% (CD-IF) and 7.4% (CD). In the CD-IF group, 80.9% were in deep remission compared with 37.2% in the CD group (p &lt; 0.0001) (Table 1). Medication requirements were higher in the CD group. 45/94 (47.9%) (CD-IF) vs. 27/94 (28.7%) (CD) (p = 0.005) were not on medications Biologics were required by 23/94 (24.5%) (CD-IF) vs. 48/94 (51.1%) (CD) (p = 0.0003). Combination therapy (immunomodulator and a biologic) was required by 6/94 (6.4%) (CD-IF) vs. 26/94 (27.7%) (CD) (p = 0.0003) (Table 2). 17 of the 27 CD patients not on medications were in remission and 10 had active disease (of whom 2 refused treatment, 1 was pregnant and 7 had stable mild disease with no major symptoms). 38 of the 45 CD-IF patients off medications were in remission and 7 had active disease (of whom 2 had surgery, 2 are due to start biologics, 1 died and 2 had stable mild disease).

Conclusion
CD-IF patients were more often in remission than those with CD; they required less medications and less biologics. Plausible reasons for this observation could include that there is less bowel which can inflame; perhaps parenteral nutrition or an altered diet has a protective effect via modulation of the microbiota.
P745 Perianal disease in Crohn’s disease is associated with higher rate of hospitalisation and mortality despite a higher utilisation of biologics: Report from the epiIIRN cohort
Authors: ATIA O , Asayag N , Focht G , Cahan A , Dotan I , Balicer R , Gavish M , Feldman B , Brufman I , Haklai Z , Turner D 
Published: January 2020

Abstract

Background
Perianal disease is a disabling complication of Crohn’s disease (CD). In this study, we aimed to explore the incidence of fistulising perianal CD (PCD) and its association with treatment pattern and disease outcomes, within the validated epiIIRN cohort which includes all IBD patients in Israel (n = 45,074). We also aimed to differentiate simple from complicated PCD.

Methods
The current analysis was performed on data from the two largest Health Maintenance Organisations (HMOs), covering 75% of the Israeli population. First, we developed and validated algorithms to identify fistulising PCD patients and differentiate simple from complex disease, by establishing two reference cohorts of true positive PCD patients (TP, patients with perianal abscess/fistula) classified into simple or complicated PCD, and true negatives (TN) of CD patients without perianal disease (validated by chart reviews). We then applied the algorithms on the complete epiIIRN IBD cohort. Random charts were reviewed to validate again PCD diagnosis.

Results
The chosen algorithm included patients with at least one perianal-related diagnosis, procedure or surgery (sensitivity/specificity 75%/96% for identifying PCD, and 70%/79% for differentiating complicated vs. simple PCD). Of the total 26,440 CD patients, 4237 (16%) had fistulising PCD, of whom 1004 (4% of the total) had complicated PCD. Those with complicated PCD were diagnosed with IBD at a younger age than simple PCD and non-PCD (29.2 ± 13.6 vs. 32.2 ± 16 and 32.8 ± 16.7 years, respectively) (p &lt; 0.001). PCD patients were treated more often with biologics (32% in non-PCD compared with 47% in simple PCD and 70% in complicated PCD, p = 0.01), steroids (74%, 78% and 83%, respectively; p &lt; 0.001) and immunomodulators (56%, 64% and 67%, respectively; p &lt; 0.001). Despite this, PCD patients had more hospitalisations (median 0 (IQR 0–2), 5 (2–11) and 13 (7–22) in non PCD, simple PCD and complicated PCD, respectively, p &lt; 0.001), more colon surgery (5%, 18% and 52% in non PCD, respectively, p &lt; 0.001) and higher mortality compared with CD patients without perianal disease (p &lt; 0.001).

Conclusion
Conclusion: Despite the higher utilisation of immunomodulators and biologics, patients with PCD are at higher risk of hospitalisation and surgical resection, higher need for steroids and higher mortality. PCD is a strong predictor of disease course and thus should prompt early intensified treatment and close monitoring.
This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.
P763 Epstein–Barr virus serological status in paediatric patients with inflammatory bowel disease
Authors: Feo-Ortega S , Pujol Muncunill G , Minguez-Rodríguez B , Álvarez-Carnero L , Guevara-Caviedes L N , Coronel-Arismendi M B , Vila-Miravet V , Martin De Carpi F J 
Published: January 2020

Abstract

Background
The impact of Epstein–Barr virus (EBV) infection on the clinical outcomes of children and adolescents with inflammatory bowel disease (IBD) is not well known. The aim of the study is to evaluate the seroprevalence, seroconversion rate and complications associated with EBV infection in a cohort of paediatric IBD (PIBD) patients at a tertiary care hospital.

Methods
A descriptive study was performed collecting demographic, clinical and treatment data from medical records as well as EBV serological status of paediatric IBD patients from 2012 to 2018. In seronegative patients, seroconversion rate was evaluated. Complications associated with primary EBV infection were described. Since September 2016, EBV serology was included into the initial work-up for PIBD patients. For those patients who did not have EBV study at IBD onset, it was performed during follow-up.

Results
A total of 307 patients with PIBD were diagnosed between 2012 and 2018. EBV status was available for 131 patients (43%). Of those, 57% had Crohn’s Disease, 41% Ulcerative Colitis, and 2% IBD unclassified (66% males; median age at IBD diagnosis: 13.2 years (IQR: 0.8–17.8)). In 102 patients serological EBV status was determined at IBD onset; while in 17 patients it was performed during the follow-up. Overall, EBV seroprevalence was 67%, and no differences were observed regarding age (over or under 10 years-old). EBV seroprevalence was higher in females than in males (80% vs. 60.5%, p = 0.02). Regarding IBD treatment, 84% had received immunosuppressive treatment [thiopurines (32%), anti-TNF (9%) and combined treatment (59%)], without differences in the seroprevalence rate according to the treatment modality. Forty-three patients were seronegative, and 12 of them had a second determination during follow-up. Overall, 5 patients showed seroconversion (42%) after a mean follow-up of 24 months (IQR: 22–26). All these patients had received treatment with thiopurines: 2 patients presented symptomatic mononucleosis with neutropenia, requiring hospital admission and withdrawal of immunosuppressive treatment and 3 patients had asymptomatic primary infection.

Conclusion
EBV seroprevalence in our paediatric IBD cohort is similar as previously described in the literature. EBV status study in patients with IBD, especially prior to initiation of thiopurines, may be useful to plan subsequent follow-up since a non-negligible percentage of them could present with complicactions of primary EBV infection under immunosuppressive treatment.
P767 Prevalence and incidence rates of inflammatory bowel disease among First Nations: Population-based evidence from Saskatchewan, Canada
Authors: Peña-Sánchez J N , Jennings D , Osei J A , Andkhoie M , Brass C , Bukassa Kazadi G , Fowler S , Johnson-Jennings M , Lu X , Marques Santos J D , Porter L , Porter R , Quintin C L , Sanderson R , Teucher U 
Published: January 2020

Abstract

Background
Worldwide, the epidemiology of inflammatory bowel disease (IBD) has been widely studied in the general population; however, there is limited-to-no evidence about IBD among Indigenous peoples, specifically among First Nations (FNs). Saskatchewan (SK) is a province in western Canada with a population of 1.1 million, 11% of whom are FNs. We aimed to estimate the prevalence, incidence, and trends of IBD among FNs in SK since 1999.

Methods
As part of a patient-oriented research project, we conducted a retrospective population-based study between 1999 and 2016 fiscal years using administrative data for the province of SK. A previously validated algorithm that required multiple health care contacts was applied to identify IBD cases (Crohn’s disease [CD] and ulcerative colitis [UC]). The ‘self-declared FN status’ variable in the Person Health Registration System was used to determine FNs meeting the IBD case definition and the population at risk. Generalised linear models (GLMs) with generalised estimated equations and a negative binomial distribution were used to estimate the annual prevalence of IBD, CD, and UC. Incidence rates and their corresponding 95% confidence intervals (95%CI) were estimated using GLMs with a negative binomial distribution. The GLMs were used to test trends overtime.

Results
The annual prevalence of IBD among FNs in SK increased from 64 (95%CI 62–66) per 100,000 people in 1999 to 142 (95%CI 140–144) per 100,000 population in 2016. Also, the prevalence of CD and UC increased during the study period, with 53/100,000 (95%CI 52–55) for CD and 87/100,000 (95%CI 86–89) for UC in 2016. The average increase in the prevalence of IBD was 4.2% (95%CI 3.2–5.2) per year, with similar trends observed in CD (4.1% [95%CI 3.3–4.9]) and UC (3.4% [95%CI 2.3–4.6]). The incidence rates of IBD among FNs were 11 (95%CI 5–25) per 100,000 people in 1999 and 3 (95%CI 1–11) per 100,000 population in 2016. No statistically significant changes were observed in the incidence rates over time (p = 0.09).

Conclusion
This study is the first epidemiological work providing detailed evidence of IBD among FNs. We identified that FNs have increasing trends in the prevalence of IBD, which has also been described in the Canadian general population. In contrast to the general population of Canada and other developed countries that have shown decreasing trends, the incidence rates of IBD among FNs appear to be stable over time. Also, among FNs, UC appears to be more prevalent than CD; this pattern has been observed in the general populations of developing countries. These results illuminate the need to advocate for better health care and wellness for FNs living with IBD.
P782 Immune status to viral infectious diseases and associated factors in Korean patients with inflammatory bowel diseases
Authors: Hong H S , Jung J , Park S H , Noh S M , Oh E H , Kim J Y , Kim J , Hwang S W , Yang D H , Byeon J S , Myung S J , Yang S K , Ye B D 
Published: January 2020

Abstract

Background
Data on the protective immune status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV) and Epstein–Barr virus (EBV) infection among inflammatory bowel disease (IBD) patients is still lacking. Therefore, we investigated seropositivity to viral infectious diseases and associated factors in Korean IBD patients.

Methods
In this retrospective cohort study, serum immunoglobulin G (IgG) antibody positivity against measles virus, mumps virus, rubella virus, VZV, HAV and EBV viral capsid antigen (VCA) were measured in consecutive patients with Crohn’s disease (CD) or ulcerative colitis (UC) who first visited the IBD clinic of Asan Medical Centre, Seoul, Korea. Seropositivities and their associated factors were analysed.

Results
Of 263 study subjects, one hundred sixty seven (67.3%) were males. Median age at diagnosis of IBD and median age at serologic tests were 28 years (interquartile range [IQR], 20–41) and 30 years (IQR, 22–46), respectively. UC patients were 50.9% (n = 134) and median disease duration at serologic tests were 6 months (IQR, 0–59). One hundred eighty two patients (69.2%) were not under any immunosuppressive therapy. Seropositivity rates were 84.0% for measles, 85.2% for mumps and 66.5% for rubella. IgG anti-VZV positivity rates were 87.4%, but only half (50.0%) were positive for IgG anti-HAV. IgG against EBV VCA was positive in 93.6%. Younger age at IBD diagnosis (&lt;40 years) was independently associated with non-protection status against measles (odds ratio [OR], 8.76; 95% confidence interval [CI], 2.06–37.30). Younger age (&lt;40 years) at serologic test was independently associated with non-protection status against rubella (OR, 2.08; 95% CI, 1.16–3.73) and HAV (OR, 9.07; 95% CI, 4.51–18.24). Among 182 patients who were not under any immunosuppressive therapy, seropositivity rates were 83.0% for measles, 85.2% for mumps, 67.6% for rubella, 88.9% for VZV, 52.5% for HAV and 92.0% for EBV VCA, respectively. Younger age at IBD diagnosis (&lt;40 years) was independently associated with non-protection status against measles (OR, 14.41; 95% CI, 1.91–108.78) and HAV (OR, 14.52; 95% CI, 4.85–43.49). IBD type, UC was independently associated with seroprotection status against HAV (OR, 2.55; 95% CI, 1.28–5.09) among patients who were not under immunosuppressive therapy.

Conclusion
Seroprotection rates for common vaccine-preventable diseases and EBV among Korean IBD patients with or without immunosuppressive therapy were similar to those of the general Korean population. In the young age group under 40 years old, immunity to measles, rubella and HAV is needed to be checked together with proper vaccination as needed.
N16 Inflammatory bowel disease (IBD) Nurses’ role and level of practice in Ireland: a National online survey
Authors: Keogh A M , Farrell D 
Published: January 2020

Abstract

Background
The role of the IBD nurse is evolving in Ireland. While Ireland has a sound base of expertise and infrastructure for providing IBD services, the lack of a dedicated specialist nurse was found to be the most significant barrier to delivering best care (ISG, 2016). There is currently no data on the role and level of practice of IBD nurse nationally.

Methods
A cross-sectional, descriptive online survey was undertaken. The 72-item survey was adapted from the tool used in the National UK IBD standards survey (Mason et al 2012) and underpinned by the Standards and Requirements for Clinical Nurse Specialists (NMBI, 2008). The survey was distributed to all members (n = 50) of the inflammatory bowel disease Nurses Association of Ireland (IBDNAI) and members were also invited to share the survey with colleagues not on the database.

Results
A total of 35 nurses working in IBD services across 22 hospitals nationally completed the survey, including IBD Clinical Nurse Specialists (CNS) (24%), IBD Clinical Nurse Managers II (CNM) (18%), IBD Nurses (12%), IBD Research Nurses (12%), Staff Nurses (9%); Infusion Nurses (6%), and IBD Advanced Nurse Practitioners (6%). The majority of respondents worked in adult IBD services (94%), with most working in their IBD role between 3 to 6 years and within gastroenterology up to 10 years. Only 44% of respondents work exclusively in IBD. The highest level of education reported was masters (40%), degree (40%); however, 75% of respondents have not completed a postgraduate diploma in gastroenterology. Services provided by nurses included patient education (94%), telephone advice line (81%), coordinating biologic service (69%), screening patients prior to administrating biologics (66%), email service for patients (59%), development of initiative for the IBD service (56%), coordinating care of inpatients (53%), follow-up (53%) and rapid access clinics (53%). Over half of respondents (61%) reported working unpaid overtime (typically 1–2 hours per week), with service suspended in their absence (45%). 36% of participants conducted original research and 48% conduct audits on their service.

Conclusion
IBD nurse’s role and level of practice varies greatly in Ireland. Many nurses are working in diverse roles with a wide variety of titles providing an extensive service to patients, often at a higher level than is recognised within their role title. IBD nurses are highly educated and well experienced; however the lack of specialist education has resulted in nearly as many IBD CNM’s as CNS’s which is causing variation in the title of the IBD nurse. There is a need for the development of a postgraduate programme in gastroenterology to include IBD and more IBD nurse specialists to deliver a quality, evidence-based service.
40 Long-term clinical outcome of functional tricuspid regurgitation
Authors: Mutlak D , Lessick J , Agmon Y , Aronson D 
Published: January 2020

Abstract

Background
Significant functional tricuspid regurgitation (TR) has been associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and to clinical outcome.

Methods
We studied 5886 patients who were followed for a period of 10-years after the index echocardiographic examination. The relationship between TR severity and the composite endpoint of admission for heart failure or cardiovascular mortality was analyzed using a Cox model. An additional analysis included a propensity-score-matching. To simplify the modeling of the severity of LHD, we calculated an additive score summing the number of LHD components as follows: reduced LVEF, LA enlargement ≥moderate, aortic or mitral valve disease (regurgitation or stenosis ≥moderate) and PASP≥50 mmHg.

Results
Higher TR grade was associated with markers of LHD including left ventricular systolic dysfunction, valvular heart disease ≥moderate, left atrial enlargement and pulmonary hypertension (All P &lt; 0.001). There was a significant interaction between TR and the presence of LHD with regard to the endpoint of heart failure in the model for admission for heart failure (P = 0.01) and the combined endpoint of heart failure and cardiovascular mortality (P = 0.02). In both models, moderate/severe TR was associated with higher risk for heart failure (hazard ratio [HR] 3.13; 95% CI 2.49–3.93, P &lt; 0.0001) and the combined endpoint of heart failure or cardiovascular mortality (HR 2.61; 95% CI 1.33–5.13, P = 0.005) only in patients without LHD. The interaction plot (Figure) demonstrates that when LHD is present, TR is not a predictor of clinical outcome.
Propensity score matching yielded 350 patient pairs, of which 88% had LHD. The HR for heart failure or cardiovascular mortality at 10-years was 0.78 (95% CI 0.56–1.08, P = 0.14) in the moderate/severe TR as compared with the trivial/mild TR.

Conclusions
Moderate or severe functional TR portends an increased risk for heart failure and cardiovascular mortality only when isolated, without concomitant LHD.
Abstract 40 Figure. Interaction plot
100 Association of age-related left atrial remodeling with ischemic stroke in patients with normal sinus rhythm
Authors: Bianco F , De Caterina R , Chandra A , Goncalves A , Aquila I , Solomon S D , Chen L Y 
Published: January 2020

Abstract

OnBehalf
The ARIC Study

Background
Age-related left atrial (LA) structural/functional abnormalities in elderly patients with normal sinus rhythm and preserved ejection fraction may precede the development of overt atrial fibrillation, and also may be related to stroke.

Purpose
To evaluate the association of 3-dimensional echocardiographic (3DE) atrial contractility parameters with subclinical cerebral infarcts (SCIs), as assessed by brain MRI, and clinically diagnosed stroke

Methods
We studied 407 participants (mean age 76 ± 5 years, 40.5% male) from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) without AF and who underwent a brain MRI and a 3DE examination in 2011-13. We defined 3 groups: those with no cerebral infarcts on brain MRI (NCIs, N = 315); those with MRI-diagnosed SCIs (N = 58); and those with clinically diagnosed stroke (N = 34).

Results
While still within the normal range, LA indexed volume significantly increased across the 3 groups (P-trend = 0.01).This was accompanied by an increase in the LA global longitudinal strain (GLS), an echocardiographic index of LA reservoir function (P-trend = 0.004). E/e’ divided by LA GLS—index of atrial stiffness—worsened across groups (P-trend = 0.005) and was independently associated with SCIs and Stroke, pooled together, [OR per 1 %-1, 1.97; 95% CI (1.24, 3.11), P = 0.004], and Stroke [OR per 1 %-1, 2.30; 95% CI (1.23, 4.30), P = 0.009]. LA GLS was marginally associated with an increased odd of SCIs [OR per 1 %, 1.07; 95% CI (1.01, 1.13), P = 0.014].

Conclusions
Among elderly participants with normal sinus rhythm and preserved ejection fraction in a large cohort study, markers of LA function and stiffness are associated with increased odds of subclinical infarcts and stroke. These data suggest that even subtle LA dysfunction, which may contribute to LA stasis, may predispose to subclinical cerebral infarcts and stroke.