bluuebunny/crossref_metadata_2025_split huggingface dataset:
P191 Lower values of skeletal muscle index measured by bioelectrical impedance in active IBD patients
Authors: Vranesic Bender D , Domislović V , Barišić A , Karas I , Ljubas Kelečić D , Brinar M , Turk N , Krznarić Ž 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) is commonly associated with alteration in fat and lean mass. Body mass index (BMI) is not a prime index for assessing nutritional status, while a better way to evaluate it would be to bioimpedance analysis. In addition, correlation of body composition with disease severity has not been well studied. The aim of this study was to evaluate the association of body composition and muscle strength with disease activity in adult patients with Crohn’s disease (CD) and ulcerative colitis (UC).

Methods
All patients underwent the analysis of body composition measured by bioelectrical impedance analysis (TANITA body composition analyser, BC-420MA). Lean mass (LM), fat-free mass index (FFMI) and skeletal muscle index (SMI) were calculated using standard formulae. Muscle strength was obtained from handgrip strength values (HS) measured with Jamar Hydraulic Hand Dynamometer. Medical history data were obtained from clinical and electronic medical records. Active disease was defined as Crohn’s disease Activity Index (CDAI) &gt;150 for CD and Partial Mayo Score ≥3 for UC patients. Underweight patients were defined as BMI&lt;18.5 kg/m2.

Results
In this study we have enrolled 120 patients (CD = 86, UC = 34; 65% male). Average age was 37.5 (35.3–39.6). Clinically active disease was present in 23 patients (19.1%), CD (n = 15), UC (n = 8). There were no statistically significant differences among patients with active and inactive disease in FFMI (kg/m2) 17(15–19.8) vs. 18.5 (15.7–20.3), p = 0.18, LM (kg) 56.5 (44.3–65.1) vs. 48.3 (43–67.2), p = 0.21, fat mass (%) 16 (11.5–23) vs. 11.8 (7.9–21), p = 0.14, and MS 33.3( ± 11.5) vs. 28.3 ( ± 9.9), p &gt; 0.05. The SMI (kg/m2) was significantly lower in patients with active disease comparing to group with inactive disease 8.1(7.7–9.9) vs. 10(8.6–10.6), p = 0.032. Underweight patients were significantly more prevalent in active group comparing to inactive (30.4% vs. 6.4%, p = 0.0011).

Conclusion
IBD patients with active disease have lower skeletal muscle index, while there was no difference in other components of body composition. In addition, underweight patients have a significantly higher proportion of active disease. Body composition analysis by BIA could be a useful tool in the evaluation of patients with inflammatory bowel diseases; however, there is a need to define age-, gender- and disease-specific, percentile-based thresholds specifically for patients with IBD, which can simplify the screening procedures in clinical practice, and suggest nutritional intervention.
P196 High frequency of undiagnosed mental illness in inflammatory bowel diseases
Authors: MARAFINI I , Longo L , Salvatori S , Miri Lavasani D , Pianigiani F , Calabrese E , Rossi R , Siracusano A , Di Lorenzo G , Monteleone G 
Published: January 2020

Abstract

Background
Inflammatory bowel diseases (IBD) are associated with mental disorders, which can negatively influence the course of IBD. Nonetheless, psychiatric disorder comorbidities (PDCs) remain undiagnosed in many IBD patients. The aim of this study was to assess the frequency of undiagnosed psychiatric comorbidities in IBD patients.

Methods
Two-hundred-thirty-seven adult IBD [136 Crohn’s disease (CD) and 101 with ulcerative colitis (UC)] outpatients were consecutively recruited in a single university hospital centre between January 2018 and June 2019. After the visit for IBD clinical evaluation, participants completed self-report questionnaires and then underwent a clinical interview by a trained psychiatrist.

Results
One-hundred-fourteen (48%) IBD patients had at least one undiagnosed psychiatric disorder. Forty-three (18%) patients presented a single PDC, 40 (16.8%) had two PDCs, 11 (4.6%) had 3 PDCs, 12 (5%) had 4 PDCs, 7 (2.9%) had 5 PDCs and 1 (0.4%) had 6 PDCs. PDCs were equally distributed among CD (72/136, 53%) and UC (42/101, 42%) patients. Mood disorders (54/114, 47%) and anxiety (27/114, 24%) disorders were the most common PDC; moreover, 23 (20%) patients suffered from post-traumatic stress disorder (PTSD), 3 (3%) had an obsessive-compulsive disorder, and 7 (6%) a substance abuse/dependence disorder. Fifty-nine per cent of IBD patients diagnosed with a psychiatric disorder during the study did not have a positive psychiatric anamnesis. PDCs were not related to activity, phenotype or localisation of IBD.

Conclusion
Psychiatric disorders are common in IBD but not related to activity, phenotype or localisation of bowel disease. Overall, these findings suggest the necessity to include psychiatric evaluation in the management of IBD patients.
P199 Outcomes of Crohn’s rectovaginal fistulae in a specialist centre
Authors: Twum-Barima C , Iqbal N , Reza L , Vaizey C , Hart A , Tozer P 
Published: January 2020

Abstract

Background
Rectovaginal fistula (RVF) is a devastating complication of Crohn’s disease (CD). Despite advances in medical and surgical treatment, management of CD RVF remains challenging. Surgery is the principal treatment with adjunctive medical therapy. This study tracks patients from initial fistula presentation through their treatment pathways.

Methods
We reviewed our retrospective RVF database (2009–2019). Patients were captured through imaging and surgical coding. Outcomes included patient satisfaction, fistula closure and stoma reversal.

Results
We identified 66 patients with CD RVF from our database of 327 RVF patients, with a median age of 40 years and mean follow up of 6.3 years. Cross-sectional analysis of patients’ initial symptoms, management and outcomes identified three groups: 1-quiescent luminal disease, with minimal fistula symptoms; 2-quiescent luminal disease, but moderate fistula symptoms (suitable for RVF repair); 3-poorly controlled luminal disease and active fistula, requiring medical control and/or defunctioning before RVF repair.
Thirty-one patients were identified in group 1 (‘minimal symptoms’). The median age was 37 years and most were on Infliximab (32%) or combination therapy (45%). Patients reported a negative impact on the quality of life (QoL) (39%), such as sex avoidance and psychosocial impairment. Some patients later required defunctioning (22%) or proctectomy (13%). Fistula symptoms improved in 16% following medical treatment alone. One patient developed a mucinous adenocarcinoma.
Nine patients were identified in group 2 (‘immediately suitable for repair’). The median age was 44 years. A low QoL was reported in 44%. Reparative procedures included rectal advancement flap and omentoplasty. Two patients were defunctioned. Fistula closure was seen in 44% after medical and surgical treatment.
Twenty-six patients presented in group 3 (‘poorly controlled luminal disease and active fistula’) and 17 patients joined this group after symptom deterioration (15 from group 1 and 2 from group 2). The median age was 45 years. All patients were on biologics/combination therapy and defunctioned. Some 30% underwent proctectomy. Some patients declined stoma reversal (7%) and proctectomy (12%). Markedly poor QoL was reported in 35% of patients. Medical escalation resulted in fistula closure in 14% of patients.

Conclusion
Complex RVF with poorly controlled disease requires faecal diversion/proctectomy and optimal medical therapy. Well-timed reparative surgery in a selected group yields reasonable outcomes. Management is dependent on factors such as the extent of CD, fistula symptoms, response to medical treatment, suitability for local repair and patient choice.
P205 Assessing the impact of age at diagnosis on transition process in patients with inflammatory bowel diseases from paediatric to adult care
Authors: Yang X Y , Tchogna S A , Deslandres C , Jantchou P 
Published: January 2020

Abstract

Background
Twenty-five per cent of paediatric patients with inflammatory bowel disease (IBD) are diagnosed between the age of 16 and 18 years. They represent a unique challenge associated with the short follow-up time between diagnosis and transition to adult care.

Methods
The primary aim was to compare the current transitional process in adolescents diagnosed before 16 years (early-adolescence (EA)) or after 16 years (late-adolescence (LA)). The secondary aim was to investigate clinical factors associated with age at transfer. Patients diagnosed between 2013 and 2015, at the IBD clinic of CHU Sainte-Justine and followed up to the transfer to adult care were included in the study. The date of transfer to adult care was defined as the date of the last visit in the paediatric unit. The factors associated with the transition process and transfer included: disease type, disease severity at diagnosis and last paediatric visit, age at diagnosis, treatment group, disease burden (hospitalisations/relapses) and disease education.

Results
We included 144 patients (77 males; median (interquartile range (IQR) age at diagnosis 15.2 (14.3–16.2) years; CD (n = 98), UC (n = 31) and IBD-U (n = 15). The median (IQR) duration of paediatric follow-up was 3.6(2.7–4.1) years in the EA group when compared with 1.4 (1.0–1.8) years in the LA group; p &lt; 0.01. While most of the patients completed the transition at a median (IQR) age of 18.0(17.9–18.3) years, 15 % of patients were transferred at an older age (18.5 to 20 years). Overall, 75.7% were in remission, 13.9% with mild disease activity and 10.4% with moderate activity at the last paediatric visit. Patients with moderate activity at last paediatric visit tend to be transferred at an older age as compared with patients in remission or mild activity. The median (IQR) age were, respectively, 18.4(18.2–19.1), 18.0(17.9–18.1), 18.0(17.9–18.3) years; p =0.024. There was a modest correlation between age at diagnosis and age at transfer (R = 0.22; p = 0.0068). Patients were transferred to adult gastroenterologists in academic hospitals (50.8%) or non-academic hospitals (43.1%). However, the disease activity at transfer was not associated with the adult care setting (academic vs. non-academic). The number of relapses and hospitalisations during paediatric care were associated with older age at transfer: (&gt; 18.5 years vs. &lt; 18.5 years): median(IQR) 0.8(0.4–1.4) vs. 0.3(0.−0.6) for relapses; p = 0.009 and 0.4(0.0–1.1) vs. 0.3(0.0–0.7) for hospitalisations; p = 0.009.

Conclusion
Paediatric IBD diagnosed at late adolescence tend to have more active disease and older age at transfer. Therefore, efforts to design a structured transitional care program are needed in order to improve transition outcomes for IBD patients with a special focus for subjects diagnosed in late adolescence.
P210 Clostridium difficile infection in pre-existing inflammatory bowel disease: Management and outcomes
Authors: CAMPBELL I , Brownson E , Robertson E 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) is a recognised risk factor for clostridium difficile infection (CDI), and CDI in an IBD patient is associated with higher morbidity and mortality. It is thought that factors including alterations in the gut microbiome, mucosal disruption and immunosuppression provide a synergistic environment for CDI to complicate an IBD flare. Despite this, there is conflicting evidence available on management. Our aim was to examine a series of recent cases to assess our own practice and subsequent outcomes.

Methods
A retrospective analysis was carried out of hospitalised cases of CDI in IBD patients in Greater Glasgow and Clyde from 2017 to 2018. Patients were identified via the CDI database held by the microbiology department; those with co-existing IBD were extrapolated. Data collected included demographics, IBD subtype and presence of other CDI risk factors. Severity of symptoms was assessed using Truelove and Witts Criteria. Initial management and changes following the diagnosis of CDI were noted. Outcomes were measured by the length of stay, survival to discharge, and requirement for surgical intervention. One year outcomes were assessed by recording mortality, treatment escalation and re-admission to hospital.

Results
29 patients in total were identified (61% female, 39% male). Twenty-one had a diagnosis of ulcerative colitis, 7 Crohn’s disease, and 1 IBD unclassified. Twenty-four were on immunosuppressive therapy at the time of CDI, 11 were on dual or triple immunosuppression. This was continued during admission in all but three cases. Once the diagnosis of CDI was established, metronidazole was given in 16 cases and vancomycin in 13. Steroid treatment varied - 13 received oral steroids, 5 IV steroids and 11 no steroids. There was no clear correlation between steroid management and outcome. Assessment with the Travis criteria on day 3 indicated a high chance of colectomy in 12 patients, however only one required surgical intervention. No patients received a faecal transplant. The median length of stay was 15 days (range 3–169). One patient did not survive to discharge.
In those surviving to discharge, a further 6 had died at one year, bringing the one-year mortality to 24%. Three had CDI as a contributory factor listed on the death certificate. 31% of surviving patients had their IBD treatment escalated in the year following admission, 17% were treated for CDI relapse, and 28% had readmission to hospital.

Conclusion
Managing CDI in patients with co-existing IBD is challenging. This case series highlights the lack of consensus on how this should be approached, even within a single health board. Morbidity and mortality are high. This suggests that a wider body of work is required to establish guidelines and provide better outcomes.
P214 Low bone mineral density in inflammatory bowel disease patients
Authors: Eddy C , Stanton S , Subramaniam K 
Published: January 2020

Abstract

Background
Low bone mineral density (BMD) is an extra-intestinal manifestation and common complication of inflammatory bowel disease (IBD). There are many risk factors thought to contribute to this reduction in BMD but there is no clear consensus on screening for low BMD in IBD. This study was performed to determine the prevalence, screening strategy and risk factors for low BMD in the IBD population at a single tertiary centre.

Methods
Patients with IBD attending a single tertiary centre were included. Electronic medical records were reviewed and data on demographics, BMD assessments with dual-energy X-ray absorptiometry (DXA) scans as well as risk factors for low BMD were collected. BMD classification was in line with the World Health Organisation definitions. Multivariate analysis with logistic regression was used to compare variables.

Results
There were a total of 553 IBD patients; 281 (50.8%) were females and 364 (65.8%) had Crohn’s disease. Of the total cohort, 245 (44.3%) had a DXA scan performed. Of the 245 patients that had a DXA scan, 101 (41.2%) were defined as osteopenic, 16 (6.5%) were defined as osteoporotic and 128 (52.2%) had normal BMD. The average age of the DXA cohort at the time of scanning was 39 years old. There were 124 (50.6%) females and Crohn’s disease was present in 70.2% (n = 172) of the DXA cohort. The average BMI of the DXA cohort was 26.5 with a range of 16.5 to 59.1. The majority (n = 173; 70.6%) of the DXA cohort had reportedly never smoked with the rest being either current smokers (n = 35; 14.3%) or ex-smokers (n = 37; 15.1%) at the time of their scan. Follow up DXAs occurred in 34.6% of those 245 patients with an average time between scans of 4.6 years. In terms of the risk factors, gender was not found to be a significant risk factor (p = 0.085) along with the type of IBD (p = 0.174), steroid usage 20 mg/day in the 2 years prior to DXA scan (p = 0.886) and smoking history (p = 0.195). However, patients aged ≥50 years were more likely to have low BMD than patients aged &lt;50 years (65.6% vs. 41.8%, p &lt; 0.001). Similarly patients with a BMI &lt;25.5 were more likely to have low BMD than patients with a BMI ≥25.5 25.5 (59.7% vs. 36.5%; p = 0.001).

Conclusion
We found a high prevalence of osteopenia (41%) but osteoporosis (6.5%) was uncommon in this IBD population from a single tertiary centre. Only age ≥50 years and BMI &lt;25.5 were found to be significant risk factors for low BMD. Screening of this population was inconsistent with only 44% of the total cohort having an initial DXA scan and 35% of those who have an initial scan having a follow-up DXA scan. Local guidelines on screening for low bone mineral density are warranted.
P216 Anti-drug antibodies to infliximab: A comparison of free anti-drug antibody measurement
Authors: Hamilton R , Shields S , MacDonald J , Dunlop A , Perry M , McGucken A , Gribben E , Galloway P 
Published: January 2020

Abstract

Background
Infliximab (IFX) is a biologic drug that inhibits the action of TNFα, a pro-inflammatory cytokine implicated in the pathogenesis of inflammatory bowel disease (IBD). IFX has greatly improved the outcomes for patients with IBD, but response to the drug is not universal. Primary non-response to IFX treatment occurs in up to 30% of IBD patients while up to 46% of patients develop secondary loss of response.1,2 Anti-drug antibodies (ADAs) to IFX are considered a significant risk factor for the loss of response to treatment, hence the measurement of ADAs as part of therapeutic drug monitoring is an increasingly utilised tool. The detection of ADAs varies widely depending on the type of assays used. The aim of this study was to determine the qualitative concordance of three commercially available ELISA kits for measurement of free ADAs to IFX on the Grifols Triturus analyser.

Methods
150 patient samples with low IFX drug levels (≤0.6 µg/ml) were analysed for free ADAs using Promonitor, Lisa Tracker and IDKmonitor kits on the Grifols Triturus automated ELISA analyser.

Results
Kappa coefficient (κ) analysis indicated a moderate agreement between the Promonitor and IDKmonitor assays (κ = 0.484 (95% CI, 0.357 to 0.611)) and the IDKmonitor and Lisa Tracker assays (κ = 0.485 (95% CI, 0.348–0.621)) as well as substantial agreement between the Promonitor and Lisa Tracker assays (κ = 0.768 (95% CI, 0.667–0.870)). Figure 1 shows the distribution of samples identified as free ADA positive by each kit.

Conclusion
Although a broad qualitative agreement was found between the three kits, they should not be used interchangeably for patient management. All kits appear amenable for utilisation in a high-throughput laboratory though a true quantitative comparison between these kits was precluded by the absence of any certified reference material for free ADAs to IFX. Further research is required to estimate the impact of free ADAs on efficiency of IFX treatment and patient management.

References
P220 Predictors of prognosis after discontinuation of first-use biologics in IBD patients with at least 24 months follow-up
Authors: Shivaji U N , Bazarova A , Critchlow T , Smith S C , Nardone O M , Love M , Davis J , Ghosh S , Iacucci M 
Published: January 2020

Abstract

Background
In clinical practice, patients with IBD have their biologic therapies withdrawn due to variety of reasons. The aim of the study was to report on predictors of prognosis in IBD patients after biologics have been discontinued, with a minimum follow-up of 24 months.

Methods
All IBD patients who discontinued their first-use biologic were identified between January 2013 and Dec 2016 from EMR at a tertiary referral centre, to ensure at least 24 months follow-up. Reasons for discontinuation and pre-defined adverse outcomes (steroid and other rescue therapies, hospitalisations, surgery including perianal) were recorded. The data were analysed using multivariable and univariable logistic regressions within a machine learning technique in order to predict adverse outcomes, within the stated timeframe. We tested the significance of the identified predictors and performed Kaplan–Meier survival analysis to compare patients with elective vs. non-elective discontinuation of biologics.

Results
147 patients who discontinued biologics (M = 74, median age 39y; CD = 110) were identified. Follow-up ranged from 24 to 60 months (median 40 months). The reasons for non-elective discontinuation included side effects (n = 21, 14%), primary or secondary non-response (n = 33, 22%) and patient choice (n = 10, 7%), among others. 59 (40%) patients had elective discontinuation. In this cohort, elective discontinuation resulted in fewer IBD-related adverse outcomes (AO) compared with non-elective. Figure 1 shows a Kaplan–Meier curve comparing the two (p = 0.003).

Using data from all 147 patients, multivariable logistic regression analysis was done to identify significant predictors of prognosis. These are represented in Table 1.
Overall, a significant number of patients (n = 80, 54%) had AO within 6 months of discontinuation, and 96 (65%) patients needed biologics to be restarted by the end of the study follow-up period.

Conclusion
Among IBD patients who discontinued biologics, there were fewer AO when they were electively discontinued. However, majority of patients required restart of biologics to manage their disease during the follow-up period. Clinicians need to be cautious when considering biologic discontinuation given the high proportion of AO and re-escalation to biologics therapy.