bluuebunny/crossref_metadata_2025_split huggingface dataset:
P772 Trends and risk factors of elderly-onset Crohn’s disease: A nationwide cohort study in South Korea
Authors: Moon J M , Kang E A , Han K , Hong S W , Soh H , Park S , Lee J , Lee H J , Im J P , Kim J S 
Published: January 2020

Abstract

Background
The incidence of inflammatory bowel disease (IBD) is increasing in Asia. Numerous risk factors associated with IBD development have been investigated. This study aimed to demonstrate the risk factors of Crohn’s disease (CD) diagnosed in persons aged &gt;40 years in South Korea and to specify any differences between age groups by using the National Health Insurance Service (NHIS) database.

Methods
Using the National Health Insurance Service (NHIS) database, a total of 14,060,821 persons aged &gt;40 years who underwent national health screening in 2009 were followed up until December 2017. Patients with newly diagnosed CD were enrolled and compared with non-CD cohort. CD was identified according to the International Classification of Diseases 10th revision and the rare/intractable disease registration programme codes from the NHIS database. The mean follow-up periods were 7.39 years. Age and sex were adjusted for in the multivariate analysis model.

Results
During the follow-up, 1337 (1.33/100,000) patients developed CD. Men in the middle-aged group (40–64 years) had a higher risk than women (adjusted HR [aHR] 1.46, 95% CI 1.29–1.66); however, this difference tended to disappear as the age of onset increases. In the middle-aged group, patients with a history of smoking (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 1.06–1.58) and anemia (aHR 1.99, 95% CI 1.67–2.36) had a significantly higher CD risk. In the elderly group (age, ³65 years), ex-smoking and anemia also increased the CD risk (aHR 1.58 [95% CI 1.16–2.18] and 1.91 [95% CI 1.53–2.38], respectively). Especially in the middle-aged group, those with chronic kidney disease (CKD) had a statistically elevated CD risk (aHR 1.38, 95% CI 1.06–1.79). Alcohol consumption and higher body mass index showed negative association trend with CD incidence in both of the age groups. (Middle-aged: aHR 0.76 [95%CI 0.65–0.87] and aHR 0.38 [95%CI 0.27–0.53], respectively) (elderly-group: aHR 0.57 [95%CI 0.42–0.77] and aHR 0.52 [95%CI 0.32-.83], respectively) For regular physical activity and dyslipidemia, negative correlation between CD incidences was proved only in the middle-aged group (aHR 0.85 [95%CI 0.74–0.96] and aHR 0. [95%CI 0.75 [95% CI 0.63–0.89], respectively).

Conclusion
This study demonstrated four risk factors (ex-smoking, anemia, CKD, and lower BMI) and three possible protective factors (alcohol consumption, physical activity, and dyslipidemia) for CD in Asians age &gt;40 years. Individuals with potential risk factors need more cautious monitoring for CD.
P775 Evolution of inflammatory bowel disease research from a bird’s eye perspective: A text-mining analysis of publication trends and topics
Authors: Barash Y , Klan E , Tau N , Ben-Horin S , Levartovsky A , Arebi N , Soffer S , Kopylov U 
Published: January 2020

Abstract

Background
There is an extensive and growing research effort in the field of inflammatory bowel diseases (IBD), with varying topics over the years. A comprehensive analysis of the trends in research and publications in IBD may help us grasp the gaps in knowledge and map out potential future areas of interest. Text-mining is the extraction of information from free text using computational methods. It can be applied to identify trends in a research field. The aim of our study was to create a map of IBD research of the last 25 years using text-mining techniques

Methods
We retrieved all available MEDLINE/PubMed annual datasets from 1992 to the end of 2017. We selected a set of relevant keywords from MeSH to include all papers relating to inflammatory bowel disease, Crohn’s disease and Ulcerative colitis. For each article we extracted the following data: article ID, title, journal, date of publication, abstract text, article type, keywords, citation frequency, and first author name and affiliation (from which we extracted the country of origin). We categorised the articles screening topics by using word combination and title match technique. We also scanned the topics in list of 100 papers (grouped by 5-year periods starting with 1992–1997) with the highest citation factor, i.e., the articles with the most citations from publish up to 2018.

Results
Between the years 1992 and 2017, 20,014 IBD-related publications appeared on PubMed. The annual number of publications increased almost 4-fold (from 354 in 1992 to 1361 in 2017). The USA had the highest number of papers (n = 3427/20,014, 17%) while Denmark and Israel had the highest rate of publications per population (for 2012–2017, 12 publications per 1 million in Israel and 17 in Denmark). The countries that achieved the most significant growth in publication rates were China, Egypt, Romania with growth rates of 0.0069, 0.0068 and 0.0062 respectively defined as the increase in articles per year normalised by the total amount of articles from that country. Out of 20014 papers, 5590 were successfully classified into 14 major topics. The topics that attracted the most publications over the years were medical therapeutics 1808/20014 (9% of articles from 1992 to 2017), followed by surgical treatment 1111/20014 (5.5%), endoscopy 637/20014 (3.2%) and genetics 552/20014 (2.7%), remaining stable through the study period.

Conclusion
There is a steady growth in the number of IBD-related publications. Although US is a world leader in the number of IBD publications overall, Denmark and Israel publish the most in relation to population size, while China, Romania and Egypt display the highest growth rate in the number of publications. Medical therapeutics is the most popular and best-cited topic.
P779 Intestinal cancer associated with Crohn’s disease: difference between those with short duration and those with long duration
Authors: Shinozaki M , Takahashi R 
Published: January 2020

Abstract

Background
Patients with Crohn’s disease (CD) have increased risk of developing intestinal cancer (IC). In patients with ulcerative colitis, cancer risk is thought to increase around 10 years after the onset of colitis. However, in patients with CD, significant proportion of those was with shorter CD duration, and little has been known about the clinical management. The aim of this study was to clarify the clinicopathological characteristics of IC associated with Crohn’s disease with short duration.

Methods
We searched for IC cases associated with CD from a Japanese medical database (Ichushi). We picked up 272 cases, where we selected the two groups: those with short duration (5 years or less; S-group; n = 51) and those with long duration (15 years or more; L-group; n = 135). The median durations of the two groups were 0 year and 20 years, respectively.

Results
The age at cancer diagnosis was 51 years (interquartile (40–62)) and 45 (39–56) in S-group and L-group, respectively (p = 0.028). Patients in S-group were significantly older at the time of cancer diagnosis (p &lt; 0.0001). The age at CD diagnosis was older in S-group than that in L-group (51 (38.5–62) years vs. 22 (9–68) years) with statistically significance (p &lt; 0.0001). Relating to disease location of CD according to the Montreal classification, the proportion of L1 and L2 were significantly more in S-group than L-group (31% vs. 18%, and 49% vs. 10%, respectively; p &lt; 0.0001). Penetrating type were significantly less in S group than that in L-group (28% vs. 59%; p = 0.003) in terms of disease behaviour according to the Montreal classification. In Japan, we found that majority of the colorectal cancer associated with CD is located at anorectum. However, in S-group, the proportion of anorectal cancer was only 26%, whereas that in L-group was 69%, and the difference reached statistical significance (p &lt; 0.0001). Well to moderately differentiated adenocarcinoma accounts for 81% in S-group, while the ratio was 44% in L-group, and the difference was significant (p &lt; 0.0001). Mucinous carcinoma was predominant in L-group (39%), and the proportion was significantly lower in S-group (12%; p = 0.0022). Clinical stage was similar in both groups, and the median was stage 2 (interquartile 1–3; p = 0.071). Median survivals were 21 and 26 months, and overall survival was also similar between the two groups (p = 0.51).

Conclusion
Some features were different between S-group and L-group, while the prognosis was not satisfactory in both groups despite relatively early clinical cancer stage. Older patients with short CD duration should be included as candidates of surveillance for neoplasia.
P785 Predictors of mortality in IBD patients treated for pneumonia
Authors: Ukashi O , Barash Y , Segel M J , Ungar B , Soffer S , Ben-Horin S , Klang E , Kopylov U 
Published: January 2020

Abstract

Background
Community-acquired pneumonia is among the most common infections affecting ulcerative colitis (UC) and Crohn’s disease (CD) patients. Data regarding epidemiology and outcomes of pneumonia in inflammatory bowel disease (IBD) patients is lacking. We aimed to investigate the epidemiology, natural history and predictors of adverse outcomes in IBD patients treated for pneumonia.

Methods
This was a retrospective cohort study that included consecutive adult patients that were admitted to Sheba Medical Center for pneumonia from an electronic repository of all emergency department admissions between 2012 and 2018. Data included tabular demographic and clinical variables and free-text physician records. Pneumonia cases were extracted using ICD10 coding. We compared the characteristics and outcomes of IBD and non-IBD patients, and CD and UC patients. We also examined the association of clinical and laboratory variables with thirty-day mortality.

Results
Of 16,732 admissions with pneumonia, 97 were IBD patients (45-CD; 52-UC). IBD patients were younger than non-IBD patients (66.8 years vs. 70.2 years, p-value = 0.077). Comorbidities such as diabetes (16.5% vs. 22.8%, p = 0.142), hypertension (30.9% vs. 41.4%, p = 0.037) and congestive heart failure (15.5% vs. 19.2%, p = 0.35) were more prevalent among non-IBD patients. Use of immunosuppressant and biological medications was more common among IBD patients (corticosteroids [19.6% vs. 9.7%, p = 0.001], azathioprine [5.2% vs. 0.4%, p &lt; 0.001], vedolizumab [2.1% vs. 0%, p &lt; 0.001], tumour necrosis factor-α inhibitors [6.2% vs. 0%, p &lt; 0.001]). Thirty-day mortality rate was similar among IBD patients and non-IBD patients (12.1% vs. 11.3%, p = 0.824). We found increased hospitalisation rate among IBD patients (92.8% vs. 85.6%, p = 0.045), but similar length of stay in hospital (6.2 days vs. 6.2 days, p = 0.989). Thirty-day mortality rate (11.1% vs. 11.5%, p = 0.947) and hospitalisation rate (93.3% vs. 92.3%, p = 0.846) were similar in CD and UC patients. On the other hand, CD patients were younger (57.6 years vs. 74.8 years, p &lt; 0.01) and had a shorter length of stay in hospital (4.8 days vs. 7.5 days, p = 0.046) compared with UC patients. Using regression analysis model, bronchiectasis (Adjusted odds ratio [AOR] 109.6, p = 0.008, opioid use (AOR 13.0, p = 0.03) and PPIs use (AOR 5.9, p = 0.05) were independently associated with the risk of 30-day mortality in IBD patients.

Conclusion
This is the first study to identify predictors of mortality in IBD patients with pneumonia. The rate of mortality and duration of stay were similar between IBD and non-IBD patients. Use of PPIs, opioids and presence of bronchiectasis were associated with a higher risk of mortality in IBD patients with pneumonia.
P795 Risk of incident paradoxical immune-mediated inflammatory diseases in patients with inflammatory bowel diseases treated with anti-TNF therapies: a nationwide Danish cohort study
Authors: WARD D , Gørtz S , Nyboe Andersen N , Kirchgesner J , Jess T 
Published: January 2020

Abstract

Background
Tumour necrosis factor (TNF) has a central role in the pathophysiology of immune-mediated inflammatory diseases (IMIDs) including rheumatoid arthritis, psoriasis, hidradenitis suppurativa, and inflammatory bowel diseases (IBD). However, there have been case reports of patients receiving an anti-TNF therapy for one IMID subsequently developing a second IMID. We conducted a nationwide cohort study investigating the risk of incident IMID following anti-TNF exposure in patients with IBD in Denmark.

Methods
We followed patients with IBD from 1 January 2005 or date of IBD diagnosis (whichever occurred last) to an outcome event including incident diagnosis of hidradenitis suppurativa, arthropathic psoriasis, other forms of psoriasis, or rheumatoid arthritis; or emigration, death or 31 December 2018 (whichever occurred first). Patients were defined as exposed after a 3-month lag period from first anti-TNF infusion throughout follow-up, analogous to an intention-to-treat design. The lag period was censored from analyses to avoid including incipient IMIDs, unlikely to be caused by newly initiated anti-TNF treatment. We excluded patients initiating anti-TNF or with an outcome diagnosis before either 1 January 2005 or IBD diagnosis. We used Cox regression models with age as the underlying timescale, and sex, type of IBD (Crohn’s disease or ulcerative colitis), and calendar period of IBD diagnosis (in 5 year groups) as strata to estimate hazard ratios for each outcome, comparing anti-TNF users and non-users.

Results
Incidence rates (and 95% confidence intervals [CI]) as events per 100 000 person-years among anti-TNF users and non-users were, respectively, 138 (109–173) and 25.6 (22.0–29.7) for hidradenitis suppurativa, 26.3 (15.6–44.4) and 7.81 (5.95–10.2) for arthropathic psoriasis, 1177 (1085–1277) and 204 (121–189) for other forms of psoriasis, and 152 (121–189) and 95.6 (88.5–103) for rheumatoid arthritis. Hazard ratios (and 95% C.I.) were increased for hidradenitis suppurativa 2.91 (2.15–3.94), arthropathic psoriasis 2.62 (1.40–4.93), other forms of psoriasis 4.76 (4.27–5.31), and rheumatoid arthritis 2.35 (1.83–3.01).

Conclusion
The results indicate that patients with IBD receiving anti-TNF have an increased risk of IMIDs. An almost 5-fold increase in the risk of psoriasis is consistent with previous reports of psoriasiform skin lesions related to anti-TNF use. However, as more severe IBD is likely to be associated with both initiating anti-TNF and the incidence of other inflammatory diseases, the results are subject to confounding by indication. Thus, these results should be considered preliminary, and we plan to further address confounding by using propensity score methods.
P800 Treatment patterns for biologics in ulcerative colitis and Crohn’s disease: A Danish Nationwide Register Study from 2003 to 2015
Authors: Alulis S , Vadstrup K , Borsi A , Nielsen A , Rikke Jørgensen T , Qvist N , Munkholm P 
Published: January 2020

Abstract

Background
The choice of biological treatment for Crohn’s disease (CD) and Ulcerative Colitis (UC) depends on disease severity and possible other factors. Patients with moderate to severe disease should be prescribed biologic response modifiers (biologics), according to guidelines. This study aims to explore the treatment patterns of patients diagnosed with CD and UC.

Methods
This national register study included patients diagnosed between 2003 and 2015, identified in the Danish National Patient Registry (NPR). Biologic therapies available during the study period were infliximab, adalimumab, vedolizumab and golimumab. The share of patients initiating and receiving biologic treatment in each year was calculated. Additionally, the time from IBD diagnosis to first biologic treatment and time between treatments were calculated.

Results
Among 10,302 CD patients and 22,144 UC patients, 28.5% of CD patients and 11.3% of UC patients received treatment with biologics during the study period, with an increasing number of patients initiating treatment with biologics for each successive year. 46% of CD and 45% of UC patients in the study population received their first biologic treatment within the first year after IBD diagnosis. 57–68% of CD and UC patients started treatment with their second line biologic within two months of the last treatment with their first line.

Conclusion
The number of patients initiating biologic treatments after diagnosis increased throughout the study period. Approximately half of patients diagnosed with CD and UC are receiving biologic treatments within the first year after diagnosis.
P810 Geriatric impairments in older inflammatory bowel disease patients are associated with higher disease burden: results of a multicentre cohort study
Authors: Asscher V , Waars S , van der Meulen-de Jong A , Stuyt R , Brouwer S , van der Marel S , Haans J , van Deudekom F , Mooijaart S , Maljaars J 
Published: January 2020

Abstract

Background
The population of older patients with Inflammatory Bowel Diseases (IBD) is expanding. Knowledge on the prevalence and impact of geriatric impairments is scarce in this heterogenous group. In other fields of medicine, it has been established that geriatric impairments associate with adverse outcomes. Therefore, the aims of our study were to assess the prevalence of geriatric impairments in older IBD patients and to evaluate the association between geriatric impairments and disease burden of IBD through the short Inflammatory Bowel Disease Questionnaire (sIBDQ).

Methods
Consecutive IBD patients aged ≥65 years were included at outpatient departments and infusion centres of four hospitals in The Netherlands. Comorbidity, polypharmacy and malnutrition (somatic domain), cognitive impairment and depressive symptoms (mental domain), handgrip strength and gait speed (physical domain) and impairments in (instrumental) activities of daily living ((I)ADL) (functional domain) were assessed. Disease activity was assessed through Harvey Bradshaw Index (HBI) or partial Mayo Score (pMS) (remission: HBI&lt;5 or pMS&lt;2); The sIBDQ was used to assess IBD disease burden. Association between geriatric impairments and sIBDQ was assessed using multiple linear regression, including confounders age, sex, IBD type, disease duration and disease activity.

Results
In total, 336 patients were included: median age 70.0 (IQR 67.0–73.0); 161 CD (47.9%); 71 active disease (21.1%); mean sIBDQ 59.7 (SD 8.1). Prevalence of geriatric impairments is tabulated (Table 1). Both active disease and the presence of two or more impaired domains were statistically significantly and independently associated with a higher disease burden (lower sIBDQ) (Table 2).

Conclusion
In an older IBD patient population, geriatric impairments are frequently encountered and associate with a higher disease burden. These results are a call for more research on the relationship between geriatric impairments and IBD disease burden to improve patient care in older IBD patients.
P811 A watchful approach for newly diagnosed Crohn’s disease patients with an inflammatory phenotype
Authors: Yassin S , Fliss-Isakov N , Ron Y , Hirsch A , Cohen N A , Maharshak N 
Published: January 2020

Abstract

Background
Early treat-to-target approach in Crohn’s disease (CD) patients is recommended to avoid complications. However, CD may not progress in all patients, despite lack of treatment or 5-ASA medications use, exposing this group of patients to unnecessary side effects if treated according to guidelines. We aimed to examine whether newly diagnosed CD patients with an inflammatory phenotype can benefit from a watchful approach.

Methods
This was a retrospective cohort study following CD patients at a tertiary centre, who were diagnosed between 2010 and 2015 and were followed for at least 1 year. Only patients with an inflammatory phenotype (Montreal classification B1) were included. Epidemiologic, clinical and endoscopic data was retrieved from medical records. A watchful approach was defined as maintenance therapy with 5-ASA medication only or no treatment at all during first year of diagnosis or further. Disease complications were defined as surgery or change in disease phenotype.

Results
Thirty-seven patients, (35.1% males at a mean age of 41.4 ± 19.6 years) were included in the study. During the follow-up period of 54.9 ± 28.7 months, 31 patients (86.0%) did not develop disease complications. The patients were characterised by females predominance (83.3% vs. 25.8%, p = 0.007), less smokers (25.8% vs. 83.3%, p = 0.006), earlier diagnosis from symptom onset (9.6 ± 15.6 months vs. 49.8 ± 57.0 months, p = 0.001) and prednisone therapy at diagnosis (87.1% vs. 50.0%, p = 0.032), compared with the patients that developed complications. There was no difference in clinical disease severity (HBI score 2.9 ± 1.5 vs. 3.1 ± 0.9, p = 0.721) or endoscopic activity (SES-CD score 6.3 ± 4.8 vs. 5.0 ± 4.8, p = 0.528) at diagnosis. Only 22.6% (7/31) of the patients were eventually treated with thiopurines or biologics for disease exacerbation.

Conclusion
A watchful approach of newly diagnosed CD patients with an inflammatory phenotype can be considered, especially in non-smoking women. This sub-group should be further characterised.
P812 Inflammatory bowel disease and hepatopathies: Beyond primary sclerosing cholangitis
Authors: Sanchez M B , Etchevers M J , De Paula J A , Gonzalez Sueyro R , Daffra P , Ramirez Medinacelli J , Sobrero M J , Marcolongo M M 
Published: January 2020

Abstract

Background
Inflammatory bowel diseases (IBD) and primary sclerosing cholangitis (PSC) are closely related. IBD-PSC has clinical characteristics that distinguish it from IBD without autoimmune liver disease (ALD). The association between autoimmune hepatitis (AH), overlapping syndrome (OS), primary biliary cirrhosis (PBC) and IBD is less known.

Methods
Clinical records of patients with IBD and PSC, AH, OS and PBC in a reference centre were reviewed retrospectively. Primary objective: to estimate the prevalence of ALD in patients with IBD. Secondary objectives: to establish the temporal gap between diagnosis of IBD and hepatopathy, severity of IBD, transplant requirement, displasia/colorectal carcinoma (CRC), and correlation between symptoms and endoscopic findings. All variables were compared according to liver disease.

Results
Of 1895 patients with IBD, 108 (5.7% [CI95% 4.7–6.8%]) had concomitant ALD, 78 PSC, 27 AH, 3 OS; no patient had PBC. 96.3% were associated with ulcerative colitis (UC). The prevalence of ALD in patients with UC was 7.6% (CI95% 6.3–9.2) and 1% (CI95% 0.3–2.5%) in patients with Crohn’s Disease. In patients with PSC, 56.4% were men, IBD diagnosis was previous than hepatopathy in 54.3% (median time 8.0 years), subsequent in 10% (7.9 years) and simultaneous, less than 1 year, in 35.7%. Conversely, in patients with AH, 55.6% were women, IBD was first diagnosed in 16% (median time 6.5 years), subsequent in 40% (5.3 years) and simultaneous in 44.0%. The median age at diagnosis was 32.5 (IQR 19.5–50.1) years for PSC and 13.1 (IQR 5.6–16.0) years for AH. Of 77 patients with available data, 97% had extensive colitis, without difference between PSC and AH. Patients with AH had more severe phenotype than PSC (Graphic 1).

High grade dysplasia/CRC was detected in 5 patients (9.6%) all with PSC. Liver transplantation was required in 38.5% of PSC-UC patients and in 20% of AH-UC patients. Regarding endoscopic-clinical concordance, 52% of patients with moderate-severe endoscopic score were asymptomatic with similar behaviour in both hepatopathies.

Conclusion
PSC and AH were the most frequent ALD associated with IBD, mostly extensive UC. In contrast to PSC, AH tended to be diagnosed before intestinal disease and at an earlier age with higher biological and hospital admissions requirement. More than a half of our cohort had an important clinical-endoscopic dissociation, so we emphasise the relevance of the objective measurement of inflammation with colonoscopy in this particular group of patients