bluuebunny/crossref_metadata_2025_split huggingface dataset:
P174 High frequency of fatigue and sleep alterations impact on the quality of life in Mexican patients with inflammatory bowel disease
Authors: Yamamoto-Furusho J K , Parra-Holguin N N , Fresán-Orellana A 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) refers to ulcerative colitis (UC) and Crohn’s disease (CD). All patients with chronic diseases can have serious effects on their sleep quality and high levels of fatigue, which directly affect the quality of life of patients with IBD. It has been reported that up to 44% of patients have alterations in sleep quality and up to 72% have symptoms of fatigue The aim of the present study is the validation of the Fatigue Scale in IBD (IBD-F) in Mexican patients and to evaluate the quality of sleep and fatigue in IBD patients according to their quality of life.

Methods
This is a cross-sectional study which included 98 patients aged 18 to 65 years with diagnosis of IBD, during the period from March to June 2019; three evaluation instruments will be applied to them: IBD-F, Pittsburgh Sleep Quality Index (PSQI) and Quality of life in patients with IBD (IBDQ-32). The clinical variables and demographics were collected through the review of clinical records. All analyses were performed with version 22.0 of the SPSS statistical program and the level of statistical significance was set at p &lt; 0.05.

Results
A total of 98 patients were included in the study, 58.2% were female with an average age of 44.9 years (S.D.= 12.1, range 19–64 years). The clinical remission of IBD was 79.6%, the predominant extension in UC was pancolitis in 74.4% followed by left colitis in 12.8% (n = 11) and proctosigmoiditis in 12.8% (n = 11). For CD, the most frequent location was ileocolonic in 75%, ileal in 16.7% and colonic in 8.3%. The stricturing phenotype occurred in 75%, inflammatory in 16.7% and fistulizing in 8.3%. The clinical activity of the disease presented in 21.4% (n = 21) patients and 78.6% (n = 77) patients were in remission. Severe fatigue occurred in 28.6% (n = 28) patients, mild-moderate fatigue in 60.2%(n = 59) and 11.2% (n = 11) with no fatigue. Sleep disturbances requiring medical attention and treatment were presented in 52.1% (n = 51) patients, alterations requiring medical attention in 18.4% (n = 18) patients and 29.6% (n = 29) patients with no sleep disturbances. Patients with severe fatigue showed greater alterations in the quality of life on three dimensions of digestive (p &lt; 0.001), systemic (p &lt; 0.05) and emotional symptoms (p &lt; 0.05). Patients with sleep quality alterations also affected globally the four dimensions of quality of life.

Conclusion
This study demonstrates a high frequency of fatigue and sleep quality alterations that impact in the decrease of the quality of life in IBD patients
P180 Association between serum and tissue protein profiles in patients with active inflammatory bowel disease: the ASCERTAIN study
Authors: Stevens T , Wildenberg M , Koželj M , Novak G , Gecse K , Duijvestein M , Löwenberg M , Drobne D , D’Haens G 
Published: January 2020

Abstract

Background
To facilitate personalised treatment of inflammatory bowel disease (IBD), biomarkers for disease entity and disease severity in easily accessible samples are required. Therefore, we aimed to (i) identify proteins that discriminate Crohn’s disease (CD) from ulcerative colitis (UC), (ii) assess the association of proteomic profiles with disease severity and (iii) assess the potential to use serum samples as a proxy for intestinal biopsies.

Methods
In this prospective cross-sectional study, IBD patients with active endoscopic disease (presence of ≥1 ulcer (CD) or Mayo score ≥1 (UC)) and age matched non IBD controls (normal endoscopy) were included. In IBD, biopsies were taken from inflamed tissue; in CD from the edge of an ulcer and in UC and controls between 20 and 25 cm from the anal verge. Disease severity was dichotomised in mild vs. severe defined as SES CD &lt;10 vs. ≥11 in CD and Mayo endoscopy score 1/2 vs. 3 in UC. Ninety-two inflammatory proteins were measured in biopsies and serum using a proximity extension assay (OLINK). The elastic net algorithm was used to select proteins associated with disease severity. Multiplicity adjustments were done using the Benjamini–Hochberg approach.

Results
Forty-one CD, 39 UC and 10 controls were included. Median SES-CD score [IQR] was 9 [7–16] in CD. In UC, 20 (51.3%), 15 (38.5%) and 4 (10.3%) patients had an endoscopic Mayo score of 3, 2 and 1, respectively. Three proteins differed significantly between UC and CD in tissue (IL-17A, IL13 and CCL4). However, this was not reflected in serum levels of these molecules. For prediction of disease severity in CD, elastic net regression identified a set of 11 serum proteins that discriminated mild from severe disease (accuracy 0.667). Top five proteins were IFNγ (OR 3.03), CCL23 (OR 1.28), Cystatin D (OR 0.61), TNF (OR 1.28) and HGF (OR 1.17) (Figure 1). In tissue, no discriminatory profile was identified. Conversely, in serum of UC, no proteins were selected, while a set of three tissue proteins was associated with disease severity (accuracy 0.725). These proteins were osteoprotegerin (OPG) (OR 1.66), IL8 (OR 1.09) and CCL25 (OR 0.97). The discrepancy between serum and tissue was further supported by correlation analyses. Of all 92 proteins, only three showed significant correlation between tissue and serum: IL17A (r = 0.44), TGF-α (r = 0.42) and IL6 (r = 0.39).

Conclusion
Proteomic profiles between tissue and serum in active IBD correlated poorly. Only in CD, serum markers differentiated mild from severe disease. In UC, no proteins in serum were selected whereas in tissue, expression of OPG, IL-8 and CCL25 was associated with disease severity. These data again emphasise the difference between CD and UC on a molecular level.
P183 The prevalence of incidental terminal ileitis in persons undergoing non-diagnostic colonoscopy: a meta-analysis
Authors: Agrawal M , Bento-Miranda M , Walsh S , Colombel J F , Ungaro R 
Published: January 2020

Abstract

Background
Incidentally diagnosed terminal ileitis has been reported among asymptomatic persons undergoing non-diagnostic colonoscopy. The purpose of our study was to determine the prevalence and long-term outcomes of asymptomatic terminal ileitis.

Methods
We developed and executed a systematic search strategy in three biomedical databases (Medline, Embase and Web of Science) and relevant scientific meeting abstracts, from inception to May 1, 2019, to identify observational studies that reported the prevalence of asymptomatic terminal ileitis in adults undergoing screening or polyp surveillance colonoscopy, and/or the long-term outcomes of such lesions. A random-effects meta-analysis was conducted to determine the pooled prevalence rate, confidence interval (CI), and report the heterogeneity score I2. Risk factors for progression to overt CD were abstracted.

Results
Of 2388 eligible studies, 1784 were screened after excluding duplicates, 84 were reviewed in full text and 14 studies were eligible for inclusion. Eight studies reported the prevalence of asymptomatic terminal ileitis in 46,460 persons undergoing non-diagnostic colonoscopy, and eight (two of eight reporting prevalence) studies reported follow-up data. The pooled rate of asymptomatic terminal ileitis was 1.5% (CI 1.0%, 16.3%), with I2 of 0 (Figure). The use of non-steroidal anti-inflammatory drugs varied between 0% and 37%. Of 147 persons with asymptomatic terminal ileitis with follow-up data (range 13–63.6 months in three studies), five had progression to CD, three were treated for CD with steroids, 5-amino salicylates, azathioprine and vedolizumab, and lesions resolved in four. Three studies reported the absence of symptoms as a predictor of lack of progression.

Conclusion
Asymptomatic terminal ileitis can be found incidentally in 1.5% of non-diagnostic colonoscopies. Based on limited data, the rate of its progression to overt CD seems low, and watchful waiting could likely be a reasonable strategy. More long-term follow-up studies are needed to inform the natural history of incidental terminal ileitis, factors that predict progression to CD and therapeutic implications.
P188 Evaluation of Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition in patients affected by inflammatory bowel disease (IBD) candidates for elective surgery
Authors: Fiorindi C , Cricchio M , Ficari F , Alpigiano G , Scaringi S , Giudici F 
Published: January 2020

Abstract

Background
In inflammatory bowel disease (IBD), malnutrition has been associated with increased postoperative complications incidence, longer hospital stay and higher costs. ESPEN guidelines recommend that all IBD patients must be screened for malnutrition. Recently, so-called GLIM criteria were developed to uniform malnutrition diagnosis. Our aim was to determine the prevalence of malnutrition comparing the different malnutrition criteria.

Methods
The nutritional status of all IBD patients’ candidates to surgery in our Centre during 2019 was assessed. According to the GLIM criteria, the diagnosis of malnutrition is based on the presence of almost one phenotypic criteria (non-volitional weight loss, low body mass index and reduced muscle mass) and almost one aetiologic criteria (reduced food intake or assimilation; biochemical inflammation). The results were compared with that found adopting ESPEN 2015 criteria for malnutrition to evaluate their concordance.

Results
Fifty-three consecutive IBD patients [38 Crohn’s disease (CD) and 15 ulcerative colitis (UC)] were evaluated. The average values of Body Mass Index, Free Fat Mass Index ad Phase Angle were 22.69 kg/m2, 17.6 kg/m2 and 5.8° respectively. According to the Nutritional Risk Screening (NRS) test 40% (21 patients) of patients were at high nutritional risk. Forty-five per cent (24 patients) were malnourished according to GLIM criteria (14 with severe malnutrition and 10 with moderate malnutrition), while according to the ESPEN criteria only 26% (14 patients) (Table 1). The correlation between GLIM and ESPEN, calculated with the Cohen’s kappa coefficient (k) was moderate/good (k 0,605).

Conclusion
GLIM criteria indicate higher prevalence of malnutrition than ESPEN criteria. Interestingly, the same 14 patients malnourished for ESPEN have severe malnutrition (Stage 2) according to GLIM. Furthermore, seven malnourished patients according to GLIM criteria are not considered at nutritional risk according to NRS, probably because it does not consider the muscle mass loss. Patients with CD have a higher prevalence of aetiological factors, while UC patients have a higher prevalence of phenotypic factors. Malnutrition prevalence was higher in UC probably due to the ileostomy present before second-stage surgery 4 months after subtotal colectomy in acute severe cases. The concordance between GLIM and ESPEN 2015 appears moderate/good.
P192 TELEDERMA: telemedicine system for dermatological lesions in patients with inflammatory bowel disease
Authors: Molina Arriero G , Pradera Cibreiro C , De las Heras Sotos C , Fraga Iriso R , Ollero Pena V , Morete Pérez M C , Echarri Piudo A 
Published: January 2020

Abstract

Background
Dermatological lesions are a common extra-intestinal manifestation (EIM) associated with inflammatory bowel disease (IBD) or its treatment. The severity of the lesions requires a preferential assessment by the dermatologist. The photography allows a telematic evaluation and non-face-to-face analysis. There are no published experiences of telemedicine in patients with IBD and dermatological EIMs. This study aimed to assess the results of a telematic system for the evaluation of dermatological lesions in patients with IBD (TELEDERMA) developed between the Dermatology Department and IBD Unit.

Methods
The retrospective study that evaluates this system from its implementation in June 2014 to December 2017 (3.5 years). TELEDERMA (TD) establishes the issuance of a telematic consultation with images through electronic clinical history. A therapy is advised by a dermatologist either through an electronic prescription or a personal appointment. The study evaluates the average time of the telematic consultation, type of lesion and attitude of patients towards the therapy, type and characteristics of the IBD, treatments applied, other EIMs, smoking and dermatological history. Patients were asked to describe and evaluate their level of satisfaction.

Results
A total number of 47 consultations from 39 patients (70% females) with an average age of 33.2 (8–75) have been made.41 of these consultations were made in patients with Crohn Disease (CD) and 6 in patients with ulcerative colitis (UC). Sixty-seven per cent of the patients with UC had pancolitis. CD Patients had ileal o ileocolonic location (82%) with inflammatory (39%) and stricturing (55%) behaviour. Eighteen per cent of the patients had an active flare-up. 1 out of every four patients had other EIMs. The most frequent reason for teleconsultation was paradoxical psoriasiform lesions (n = 13, 33.3%) of anti-TNF agents (70% of the patients) and suppurative hidradenitis (n = 4, 10.3%). The resolution was achieved in 87%, and only one patient had to interrupt the anti-TNF therapy. The average waiting time was 4.7 days (0–14), compared with the 60 and 28 days of the current waiting list with a routine or preferential request, respectively. All the patients evaluated this system positively, highlighting the advantages of rapidness in both the resolution of the consultations.

Conclusion
TD is a useful tool for the rapid assessment of dermatological lesions associated with IBD. It prevents the patients from going to the emergency department, improves the care quality and the degree of satisfaction of the patients. The most frequent teleconsultations were related to psoriasiform lesions associated with anti-TNF therapy. The interruption of treatment was exceptional.
P204 Re-established CRP cut-off in UC; it may be a better predictor of mucosal remission
Authors: Bakkaloglu O K , Eskazan T , Bozcan S , Yıldırım S , Kurt E A , Hatemi A İ , Erzin Y , Celik F 
Published: January 2020

Abstract

Background
Although faecal calprotectin can predict mucosal remission in ulcerative colitis, the CRP level in this context is insufficient and frequently stay under the current cut off level. While some patients with active mucosal disease have normal CRP levels most patients in mucosal remission have much lower CRP levels. The aim of this study is to define CRP cut off levels in the prediction of mucosal remission, considering both extensiveness and severity, in ulcerative colitis.

Methods
We retrospectively reviewed colonoscopy reports of ulcerative colitis patients (who are not on any steroid treatment at that time) which were performed between December 2016 and March 2019 and also their CRP levels which were obtained at the same week of the colonoscopy examination. We excluded the data of patients with any other possible cause of inflammation or infection at the time of laboratory assessment. Degree of mucosal disease at colonoscopy was evaluated according to endoscopic Mayo score. Mucosal remission was defined as endoscopic Mayo score 0 or 1. The extent of mucosal inflammation was classified according to Montreal classification. The CRP level with optimal sensitivity and specificity for mucosal remission prediction was assessed by ROC curve analysis and positive and negative predictive values were also calculated.

Results
A total of 331 colonoscopy reports of 260 patients (122 m, 138 f) were involved in this study. There were no significant differences between ages of patients when compared with ex, and Montreal classification and we did not find any correlation between age and CRP levels. Sensitivity, specificity, positive predictive value and negative predictive values for 5 mg/l, 3 mg /l and 2 mg/l are summarised in Table 1. CRP levels which predict Mayo 0 disease, mucosal remission (Mayo 0–1) and Mayo 3 disease are shown in Table 2. At the ROC curve analysis, we found that CRP level of approximately 2.9 mg/l can predict mucosal remission with a 77% sensitivity and % 80 specificity in all examinations without grouping into a separate segmental disease. For subgroups with Montreal E1, E2 and E3 ROC curve analysis suggested 1,8 mg/l (sn. 84%, sp. 90%), 2,7 mg/l (sn. 75%, sp. 75%) and 3 mg/l (sn. 80%, sp. 80%) CRP levels can be used for prediction of mucosal remission respectively (Table 3). It is important to emphasise that 30% of all patients with Mayo 3 colonoscopy and further 23% of patients with Montreal E3–Mayo 3 activity have CRP levels below the regular cut-off value of 5 mg/l.

Conclusion
CRP cut-off level of approximately 2.9 mg/l can predict mucosal remission in ulcerative colitis better than standard cut-off of 5 mg/l which has a low positive predictive value and specificity even at extended and active mucosal disease.
P230 Health-related quality of life in adolescents and young adults (AYA) with inflammatory bowel disease and its correlations with demographic, clinical, laboratory and therapeutic evaluations
Authors: Oba J , Deboni M , Toma R , Sobrado C , Azevedo M , Carlos A , Borba M , Damião A , Carrilho F , Silva C 
Published: January 2020

Abstract

Background
IBD, including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic recurrent inflammatory diseases of the gastrointestinal tract, most often diagnosed in adolescence and young adulthood. Extra-intestinal manifestation (EIM) may be present initially in up 50% or before IBD is diagnosed. IBD and its complications are associated with morbidity and has considerable impact upon patients’ health-related quality of life (HRQoL). HRQoL is an essential complement to the examination of clinical symptoms and functional limitations and has emerged as an important outcome measure to evaluate an individual’s adaptation to a chronic medical condition like IBD. It is known the neurocognitive maturation that support integration of executive and emotion systems are not fully mature until 25 years, making this period a time of socio-emotional vulnerability and adjustment. So, our objective was to evaluate the HRQoL in adolescents and young adults (AYA) patients with IBD and compare with a peer’s health control and investigate the variables which can be attributed to HRQoL in these patients.

Methods
59 AYA IBD patients (13–25 years) and 60 AYA healthy controls (13–25 years) completed the Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), Short Form Health Survey (SF-36) questionnaires and pain visual scale, according to age. After we compared HRQoL between Crohn’s disease (CD) vs. UC (ulcerative colitis) in AYA population. The demographic data, extra-intestinal manifestation, overlap syndromes, disease active status, treatment and outcomes were also evaluated.

Results
PedsQL4.0 domain ‘school/ work’ and SF-36 domain ‘general health perception’ was reduced in IBD AYA patients compared with healthy controls (p &lt; 0.05). However, no difference in all domains and pain scale was observed between CD and UC AYA patients. Disease activity, as well as extra-intestinal manifestations, overlap syndromes, treatments and outcomes, did not influence the HRQoL of the AYA patients. Autoimmune sclerosing cholangitis and the use of prednisone were significantly higher among UC patients, whereas previous gut surgery was higher between CD patients. However, these disease factors did not significantly influence the HRQoL between CD vs. UC.

Conclusion
HRQoL was significantly lower among IBD AYA patients when compared with healthy controls. Disease factors did not influence HRQoL between CD and UC AYA patients. These results highlight areas to focus clinical attention for assessment and future interventions among AYA with IBD.
P238 Natural history of perianal fistulizing Crohn’s disease in the Swiss IBD cohort
Authors: Aslan N , Rossel J B , Pittet V , Safroneeva E , Godat S , Vavricka S , Greuter T , Biedermann L , Straumann A , Scharl M , Schaad M , Hahnloser D , Rogler G , Schoepfer A 
Published: January 2020

Abstract

Background
Data of large cohort studies on the fate of perianal fistulizing Crohn’s disease (CD) is scarce. We aimed to evaluate the prevalence and natural history of perianal fistulas in adults with Crohn’s disease (CD).

Methods
Data from the Swiss IBD cohort study were analysed. The Swiss IBD Cohort study includes since 2006 IBD patients, follow-up questionnaires are completed once a year. Patients were recruited from university centres (80%), regional hospitals (19%), and private practices (1%).

Results
Among 2163 CD patients, 495 (22.9%) ever had perianal fistulas whereas 1668 (77.1%) did not. Patients with perianal fistulas were characterised by the following features when compared with patients without perianal fistulas: younger age at diagnosis (23.4 vs. 25.3 years, p = 0.001), longer disease duration at enrolment (9.6 vs. 4.9 years, p &lt; 0.001), longer disease duration at latest follow-up (17.4 vs. 11.2 years, p &lt; 0.001), less frequenty isolated ileal disease at diagnosis (15.8% vs. 28.6%, p &lt; 0.001), more frequently rectal disease at enrolment (32.5% vs. 14.8%, p &lt; 0.001) and latest follow-up (24.2% vs. 11.7%, p &lt; 0.001), more frequently acne inversa (1.4% vs. 0.1%, p &lt; 0.001), and more frequently intestinal resection (49.5% vs. 35.3%, p &lt; 0.001). The prevalence of extraintestinal manifestations was not different (59.0% vs. 54.4%, p = 0.073). Compared with patients without perianal fistulas, patients with perianal fistulas were more frequently treated with topical 5-ASA (14.8% vs. 8.0%, p &lt; 0.001), systemic steroids (78.2% vs. 70.1%, p &lt; 0.001), azathioprine (82.6% vs. 77%, p = 0.008), methotrexate (28.3% vs. 22.2%, p = 0.005), infliximab (71.9% vs. 50.8%, p &lt; 0.001), adalimumab (36% vs. 27.9%, p &lt; 0.001), certolizumab pegol (18.6% vs. 11.5%, p &lt; 0.001), and antibiotics (69.1% vs. 41.2%, p &lt; 0.001). Regarding fistula anatomy, 321 patients (64.8%) had a low perianal fistula, 82 (16.6%) a high perianal fistula, and 227 (45.9%) a perineal fistula. The following fistula therapies were ever applied: perianal abscess drainage (45.7%), fistulectomy/fistulotomy (39.6%), seton drainage (28.7%), mucosal sliding flap (2%), fistula plug (1.4%), and fibrin glue instillation (1%).

Conclusion
In our national cohort roughly one-quarter of CD patients was diagnosed with perianal fistulizing disease. Compared with patients without perianal fistulas, patients with perianal fistulizing disease were characterised by several stigmata of complicated disease course such as a higher frequency of intestinal resections and higher prevalence of treatment with biologic agents.