bluuebunny/crossref_metadata_2025_split huggingface dataset:
P059 SIGNIFICANTLY INCREASED MUCOSAL EOSINOPHILS IN PATIENTS WITH POST-IBD IBS-D SYNDROME MAY HAVE A NEW AVENUE
Authors: Tozlu Mukaddes , Beketaev Ilimbek , Younes Mamoun , Dar Wasim , Ju Changqing , Ertan Atilla 
Published: January 2020

Abstract

Introduction
Inflammatory bowel disease (IBD) patients in remission who present with irritable bowel syndrome with diarrhea (IBS-D) like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS-D. This syndrome was first reported by Isgar et al. who documented IBS-type symptoms in 33% of their patients with chronic ulcerative colitis (CUC) in remission in 1983. In their meta-analysis of 13 studies incorporating 1,703 patients, Halpin and Ford in 2012 calculated a pooled prevalence of 35% for IBS symptoms among IBD subjects in remission. The post-IBD IBS-D syndrome represents a source of considerable stress, incurs morbidity and impairs quality of life of these patients. The etiology of this syndrome is unknown and may be multifactorial such as environmental, psychological, GI motility disarray, genetic components and possibly by gut microbiome.

Methods
We conducted a retrospective, single-center study of patients with history of IBD and IBS-D like symptoms. The demographic characteristics, type of IBD, colonoscopy, biopsy findings and empirical medical management outcome were analyzed.

Results
We have found significantly increased mucosal eosinophils (&gt;50 HPF in both side of the colon examined) in our patients with post-IBD IBS-D syndrome. In this study, 15 CUC patients and 20 Crohn’s disease patients with this syndrome were investigated and showed no clinical, serological, mucosal or microscopic IBD activity. These patients had non-bloody diarrhea (5–20 x daily), lower abdominal cramps (%90), mild weight loss (4–6 lbs) and fecal incontinence (%25) who were placed on the GI-hypoallergenic diet and budesonide therapy. Sixty seven percent of these 35 patients with post-IBD IBS-D responded well clinically to this management. Increased mucosal eosinophils in these patients with post-IBD IBS-D may have eosinophilic colopathy that may be related to intestinal permeability disarray. The epithelium in these IBD patients who are in remission may have the production of pro-inflammatory cytokines by the eosinophils, especially IL-23 and IL-33. This interesting area investigation is in progress by our research faculty.

Conclusion
In summary, this is an exciting new finding that significantly increased mucosal eosinophils in our patients with post-IBD IBS-D syndrome may have a new avenue, eosinophilic colopathy. Interestingly, these patients have responded to the GI-hypoallergenic diet and budesonide therapy. Obviously, we need more patients in the near future with longer follow-up and we hope that the other investigators may confirm our findings.
P102 ANEMIA IN IBD PATIENTS ASSOCIATED WITH INCREASED HEALTHCARE UTILIZATION
Authors: Blaney Hanna , Mathew Antony , Snellings Robin , Duong Camille , England Julie , Vu Peter , Keum Yo Sup , Hammonds Kendall , Johnson Christopher 
Published: January 2020

Abstract

Introduction
Anemia is a common systemic complication of inflammatory bowel disease (IBD), with reported prevalence up to 74%. Anemia is associated with worse disease outcome and quality of life. The Crohn’s and Colitis Foundation recently published an initiative quantifying the healthcare cost of IBD patients. They found that the presence of anemia was associated with high resource utilization, particularly hospitalization. The purpose of this study was to determine how anemia severity impacts healthcare utilization and if treatment of anemia reduces healthcare utilization.

Methods
An IRB-approved retrospective chart review including patients 18 years of age and older at a tertiary referral center with IBD (Crohn’s Disease (CD) or Ulcerative Colitis (UC)) who had a CBC and an encounter with gastroenterology (GI) from 2014–2018. Demographic, laboratory, treatment, and visit data were extracted from electronic records and records were manually reviewed for verification. Anemia and anemia severity were defined by the World Health Organization classification of anemia.

Results
930 patients with IBD were included in the analysis, with 516 (56%) patients with CD, 409 (44%) with UC, and 5 (0.5%) with unspecified IBD. Of these patients, 502 (54%) had anemia based on lab values, with 194 (39%) having mild anemia, 244 (49%) with moderate anemia, and 64 (13%) with severe anemia. 321 unique patients had at least one admission during this time period. Patients with anemia had more hospitalizations (p=0.0019) and longer hospital stays, averaging 1.9 days longer (p&lt;0.0001), compared to patients with IBD without anemia. Patients with anemia also had statistically more visits to the ED (p=0.0037), GI clinic visits (p&lt;0.0001), and primary care visits (p=0.0036) as compared to patients with IBD without anemia. Furthermore, patients with severe anemia had an increase in number of hospitalizations (p=0.0169), increased length of stay (p=0.0344) and more GI visits (p=0.043) when compared to patients with less severe anemia. Treatment of anemia did not result in a statistically significant reduction in utilization of care as measured through number of hospitalizations, length of stay, or outpatient visits when compared to patients with anemia who were not treated.

Discussion
Our results demonstrate that the presence of anemia is correlated with increased health care utilization in patients with IBD, with increasing anemia severity associated with a higher utilization of care. Our results also suggest that treating anemia does not reduce health care utilization. Anemia has been associated with increased disease activity and could represent a marker of more severe disease, possibly explaining these associations. Future research is needed to determine if treatment of anemia in IBD results in reduced health care visits and costs.
23 EFFECTS OF VEDOLIZUMAB ON EXTRAINTESTINAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASE
Authors: Dimopoulos Christina , Hung Kenneth , Proctor Deborah , Ruggiero Eilzabeth , Al-Bawardy Badr 
Published: January 2020

Abstract

Background
Vedolizumab (VDZ) is an α4β7 integrin monoclonal antibody that is effective for both Crohn’s disease (CD) and ulcerative colitis (UC). There is limited data on how vedolizumab’s gut selective mechanism impacts extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD).

Methods
A retrospective study of all IBD patients at our institution who received at least 1 dose of VDZ between 1/1/2014 and 8/1/2019 were included. Primary outcome was rate of new or worsening EIMs after initiation of VDZ. Secondary outcomes were factors associated with new or worsening EIMs after VDZ. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a chi-square test or Fisher’s exact test. A multivariable logistic regression model was built to identify factors associated with EIMs. The final model was obtained by sequentially subtracting variables and retaining variables that were independently associated with EIMs while controlling for other factors. We also identified factors associated with new or worsening of EIMs after VDZ therapy using Fisher’s exact testing and univariable logistic regression.

Results
A total of 142 patients were included (53.5% with CD, 41.6% with UC, and 4.9% with indeterminate colitis). The median age was 39 years (range 15–78), and 49.3% were women (Table 1). EIMs were noted in 53.5% (n=76) and included: peripheral arthritis (39.4%), sacroileitis (15.5%), erythema nodosum/pyoderma gangrenosum (9.2%), uveitis (4.9%), and episcleritis (0.7%). Twenty patients had more than one EIM. Significant factors associated with having EIMs included female sex (63.2% with EIM vs 33.3% without, p-value &lt; 0.01), tobacco use (23.7% with EIM vs 6.1% without, p &lt; 0.01), CD (60.5% with EIM vs 45.5% without, p=0.02), and prior biologic agent use (94.7% with EIM vs 74.2% without, p &lt; 0.01). On multivariable analysis, female sex (OR 3.19, 95% CI 1.52–6.72), tobacco use (OR 4.84, 95% CI 1.45–16.23), and prior biologic agent use (OR 4.30, 95% CI 1.30–14.20) were the only significant factors.
Of the 76 patients with EIMs, 71.1% (n=54) had stable or improved EIMs after starting VDZ and 28.9% (n=22) had worsening or new EIMs after VDZ. Patients who were on steroids at the time of VDZ induction were more likely to have stable or improved EIMs compared to who did not receive concomitant steroid therapy (OR for worsened EIMs 0.20, 95% CI 0.06–0.63) (Table 2). Prior biologic use and current combination therapy did not significantly predict worsening or new EIMs.

Conclusion
Female sex, tobacco use, and prior biologic agent use are significantly associated with EIMs of IBD. Post-VDZ, the majority of patients had stable to improved EIMs. Patients on concomitant steroid therapy at the time of VDZ induction were more likely to have improved or stable EIMs compared to patients not on steroids.
P105 PREDICTIVE FACTORS FOR DEVELOPING SMALL BOWEL OBSTRUCTIONS AFTER ILEAL RESECTION IN PATIENTS WITH CROHN’S DISEASE
Authors: Mulgund Aditi , Patel Nedhi , Schwartz Michael , Beniwal-Patel Poonam , Amir Patel , Stein Daniel , Otterson Mary , Yarur Andres 
Published: January 2020

Abstract

Background and Aims
Patients with Crohn’s disease (CD) may require small bowel resections. Unfortunately, some of these patients may develop post-operative small bowel obstructions (SBO). Many clinicians perceive ileal resections dramatically increase the risk of developing SBO in the future, but the incidence and risk factors to developing SBO are poorly described. The primary aim of this study is to document the incidence and factors associated with the development of SBO not related to recurrence of disease in CD patients that undergo ileal resection. We also sought to assess long-term outcomes of this complication.

Methods
We performed a retrospective cohort study including patients aged 18 years or older with CD, who have had ileocecal resection with ileocolonic anastomosis or segmental small bowel resection. Data abstracted included demographics, phenotype and therapies of CD, disease recurrence post-ileal resection and multiple surgical variables. The primary outcome was the development of SBO within 5 years post-surgery not including obstructions secondary to recurrence of CD.

Results
92 total patients were included in the analysis. All had a colonoscopy within a year of the surgery. The mean Rutgeerts score was 0 (interquartile range [IQR] 0 to 2) and the mean short endoscopic score was 0 (IQR 0 to 4). The remainder of baseline characteristics are shown in Table 1. At 6 months, 1 year, and 5 years, the rate of SBO was 4/92 (4%), 6/92 (6.5%), and 15/92 (16%), respectively. Throughout follow-up, only 5 patients had an SBO attributed to intra-abdominal adhesions and only 2 patients required surgical lysis of adhesions. Patients that were found to have histologic inflammation in the margins of the resected bowel specimen had a significantly higher chance of developing an SBO within 5 years of the initial surgery (OR: 4.5 [95%CI: 1.3–15.3], p=0.02 - Table 2). Conversely, patients with either active endoscopic and/or radiologic inflammation on post surgical surveillance colonoscopy did not have a higher risk of developing an SBO within 5 years of the initial surgery (p=0.37). Finally the length of bowel resected at the index surgery was not associated with the development of an SBO (AUC: 0.62, p=0.18).

Conclusions
The incidence of SBO after ileal resection in CD is low and resolves with medical management on most cases. Inflammation in the margins of the resected bowel and previous bowel resections were associated with new SBO within 5 years. These results must take into account the study population were monitored and cannot be extrapolated to those patients that lost follow-up.
P127 FACTORS ASSOCIATED WITH FECAL URGENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS: A CROSS-SECTIONAL STUDY FROM SPARC IBD
Authors: Jajeh Hamzeh , Dawwas Ghadeer , Lewis James 
Published: January 2020

Abstract

Background
Fecal urgency among patients with inflammatory bowel disease (IBD) can lead to psychological, functional, and social distress. Factors associated with urgency remain poorly understood.

Objective
To examine the association between urgency and fecal calprotectin concentration, rectal bleeding, stool frequency, perianal disease, rectal involvement, and disease duration.

Methods
The results are based on data obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. This cross-sectional study used data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study. We included patients with an urgency score at their first study visit. Urgency was rated on a 5-point Likert scale from no to severe urgency. The Kruskal-Wallis test was used to compare fecal calprotectin levels across fecal urgency scores. Logistic regression models were used to evaluate the association of fecal urgency with the amount of rectal bleeding, stool frequency, perianal disease (for Crohn’s disease (CD)), disease involving the rectum (for CD), disease duration, while adjusting for age and gender in each model.

Results
2289 patients were included (54% female, 67% CD, mean age 43). The fecal calprotectin concentration was significantly associated with fecal urgency scores (P-value= 0.01). In adjusted models of the overall population, CD vs UC was not associated with urgency (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.70–1.13). Fecal urgency was associated with stool frequency (&gt; 4 stools more than normal, OR 2.49; 95% CI 1.46–4.25) but not amount of bleeding. Among patients with CD, perianal disease (OR, 3.40; 95% CI, 1.18–9.79) was associated with fecal urgency.

Conclusion
In this study of patients in SPARC IBD, factors associated with fecal urgency were fecal calprotectin levels, stool frequency, and perianal disease.
P128 INCIDENCE AND OUTCOMES OF HOME PARENTERAL NUTRITION IN PATIENTS WITH CROHN’S DISEASE IN OMLSTED COUNTY, MINNESOTA, USA
Authors: Bakhshi Zeinab , Yadav Siddhant , Harmsen William , Tremaine William , Salonen Bradley , Bonnes Sara , Loftus Edward 
Published: January 2020

Abstract

Introduction
Patients (pts) with Crohn’s disease (CD) undergoing multiple surgeries are at risk of extensive bowel resections, short bowel syndrome (SBS) and malnutrition and may need home parenteral nutrition (HPN). The aim of our study was to estimate the incidence of HPN use in pts with CD in a population-based cohort, and to assess clinical outcomes and complications associated with nutritional intervention.

Methods
This study was a retrospective population-based cohort using Rochester Epidemiology Project to identify pts who were diagnosed with CD between 1970 and 2011 in Olmsted County, MN. To identify the individuals who required HPN, these Pts were crossed against the list of those who enrolled in the local HPN program. Descriptive statistics were used to evaluate incidence and clinical outcomes.

Results
Four hundred twenty nine pts with CD were diagnosed in Olmsted County between 1970 and 2011. Of these, 14 received HPN between 1992 and 2018. The pts were followed for a median of 16.85 years after diagnosis of CD (interquartile (IQR), 12.25–24.70) and required HPN a median of 7.67 years after diagnosis (IQR,1.6–15.89). Among the 14 receiving HPN, 85.71% were females. Eleven (78.57%) had moderate to severe CD and 12 (85.71%) pts involved with fistulizing disease. Crohn’s disease involved the ileum in 92.86%, colon in 71.43%, and proximal GI in 14.29% of the pts. Thirteen (92.86%) pts underwent surgery primarily due to obstruction (84.62%). Other indication included: failure of medical therapy (46.15%), fistulizing disease (46.15%), severe pain (30.77%), abdominal abscess (23.08%), bleeding (15.38%), and necrosis (15.38%). Median number of bowel resections was 4 (range, 0–7). Twelve pts (85.71%) had a stoma placed.
The median duration of HPN was 2.48 years (range, 0.11–16.36). Indications for HPN included SBS in 64.28%, malnutrition in 28.57% and bowel rest in 21.43%. The mean number of hospitalizations after the start of HPN was 5 (range, 0–20). Catheter-related bloodstream infections occurred in 10 (71.43%) pts, and 3 (21.43%) had a thrombosis. Four pts had osteoporosis and 2 had osteopenia. Parenteral nutrition-associated liver disease occurred in 2 (14.29%) of pts. The pts’ body weight increased a median of 2.5 kilograms (kg) 6 months after the start of HPN but decreased a median of 1 kg at 12 months. Four (30.77%) pts were on HPN at time of last follow-up. Five (35.71%) pts deceased mainly due to CD.

Conclusion
Less than 4% of pts with CD need HPN. Most pts on HPN have moderate to severe disease who have undergone extensive bowel resection with resultant SBS and malnutrition. Approximately 70% were able to discontinue HPN. Interestingly, after 6 months, pts lost most of the weight they gained during the first 6 months of HPN. It was possible that this was due to noncompliance, or increased metabolic needs because of active disease.
P130 LEADING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE: A NATIONWIDE ANALYSIS
Authors: Weber Andrew , Sauk Jenny , Limketkai Berkeley 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel diseases (IBD) often ask whether their condition would affect their life span. However, available data are sparse. The aims of this study were to compare the ages of death between patients with and without IBD and to determine the leading causes of death amongst inpatients with IBD in a large nationwide database.

Methods
The Nationwide Readmissions Database (NRD) provides a nationally representative sampling of patient-linked hospitalizations throughout the United States. For years 2010 through 2016, we identified individuals with Crohn’s disease (CD) or ulcerative colitis (UC) based on International Classification of Diseases-Clinical Modification codes, ninth and tenth revisions (ICD-9, ICD-10). The mean age of death was compared between IBD and non-IBD inpatients. Cluster analyses were used to evaluate the leading causes of death among IBD patients based on the associated codes in the first three diagnosis positions.

Results
Between 2010 and 2016, there were 934,331 CD and 623,596 UC patients admitted. There were more deaths associated with UC than CD (3.11% vs. 1.72%; P &lt;0.01) (Figure 1). Amongst CD patients, the average age of death was 68.2 years, compared to 70.5 years for non-IBD patients (P &lt;0.01). For UC patients, the average age of death was 71.9 years, compared to 70.5 years for non-IBD patients (P &lt;0.01). The most frequent diagnoses for CD patients who died while hospitalized were sepsis (31.1%), respiratory failure (13.0%), and fluid electrolyte and acid-base disorders (12.5%) (Table 1). Interestingly, motor vehicle accidents were associated with a significant number of deaths among CD patients (7.0%). Pre-defined diagnoses of interest associated with death included myocardial infarction (3.3%), deep vein thrombosis/pulmonary embolism (2.0%), and malignancy (6.7%). Diagnoses most frequently noted in UC patient who died while inpatient included sepsis (43.4%), fluid electrolyte and acid-base disorders (13.6%), and respiratory failure (10.9%). Similarly to CD, motor vehicle accidents were again associated with a significant number of UC deaths (5.5%). Pre-defined diagnoses associated with death in UC included myocardial infarction (3.5%), deep vein thrombosis/pulmonary embolism (2.0%), and malignancy (5.8%).

Conclusions
In a large nationally representative database of hospitalized patients, although those with CD and UC were found to have statistically significant differences in age at death when compared with the general population, the absolute differences were small. Diagnoses most frequently associated with inpatient mortality were sepsis, respiratory failure, and fluid electrolyte and acid-base disorders. There was also a large number of motor vehicle-related deaths among IBD patients.
P144
IN SILICO IDENTIFICATION OF PUTATITVE CLAUDIN CHANNEL BLOCKERS
Authors: Wu Emma , Samanta Priyanka , Li Ye , Shen Le , Khalili Fatemeh , Weber Christopher 
Published: January 2020

Abstract
Compromised epithelial barrier function is known to be associated with inflammatory bowel disease (IBD) and may contribute to disease development. One mechanism of barrier dysfunction is increased expression of paracellular tight junction ion and water channels formed by claudins. Claudin-2 and -15 are two such channels. We hypothesize that blocking these channels could be a viable therapeutic approach to treat diarrhea in IBD. In an effort to develop blockers of these channels, we turn to our previously developed and validated in silico models of claudin-15 (Samanta et al. 2018). We reasoned that molecules that can bind with the interior of claudin pores can limit paracellular water and ion flux. Thus, we used docking algorithms to search for putative drugs that bind in the claudin-15 pore. AutoDock Vina (Scripps Research Institute) was initially used to assess rigid docking using small molecule ligand databases. The ligands were analyzed based on binding affinity to the pore and visualized using VMD (University of Illinois at Urbana-Champaign) for their potential blockage of the channel. Overall, a total of eight candidate ligands from the databases were identified: three from the UICentre database of 10000 ligands, one chemically similar structure identified in another online database (Chemspider), and four which are modifications on the chemical structure generated using ChemDraw. The analysis revealed that the eight ligands were docked in two predominant positions. In the first position, the ligands with more rings docked in an almost linear fashion and interacted with both D55 and D64 pore residues. In the second position of binding, the ligands were more flexible and could hence fold to interact only with D55 residues, thus biding predominantly in the center of the pores. To further evaluate these ligands, we will now turn to 1) flexible claudin-15 docking studies, 2) molecular dynamic simulations and, 3) in vitro measurements using monolayers induced to express claudin -15 and claudin-15 mutants. We also developed a claudin-2 homology model on which we will perform docking studies and in vitro measurements, which we expect will result in similar candidate ligands for blocking claudin-2. Finally, other databases will be analyzed for potential ligand blockers of claudin-2 and -15.