bluuebunny/crossref_metadata_2025_split huggingface dataset:
P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?
Authors: ZEMEL M , Solo E , Klausner J , Tulchinsky H 
Published: January 2020

Abstract

Background
Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence.

Methods
We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins.

Results
202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar.
We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance.

Conclusion
The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.
P173 Very–Early-Onset inflammatory bowel disease: Russian single centre experience
Authors: Shchigoleva A , Shumilov P 
Published: January 2020

Abstract

Background
The incidence of very early-onset inflammatory bowel disease (VEOIBD) is on the rise in Russia but the clinical data is lacking. We aim to study the disease phenotype, clinical course and the presence of primary immunodeficiency (PID) patients in this group.

Methods
Clinical records of VEOIBD patients treated in Russian State Pediatric Hospital between 2000 and 2018 were revised. In 60 patients admitted between 2016 and 2018 targeted sequencing (PID panel) was performed. 10 patients received genetic testing previously.

Results
135 VEOIBD patients were identified: 95 (70%)with ulcerative colitis (UC), 31 (23%) with Crohn’s disease, 9 (7%) with PID. In 14 (11%) IBD patients the diagnosis was changed from UC to CD and vice versa. Median time of diagnosis was 7 months in UC, 24 months in CD and 44 months in PID. The most common clinical symptoms were loose stools (UC—98%, CD—84%), bloody stools (UC—93, CD—65%), stomach ache (UC—53%, CD—52%), fever (UC—35%, CD—42%). Common laboratory features included anemia (UC—56%, CD—39%), low serum ferrum level (UC—75%, CD—61%), thrombocytosis (UC—53%, CD—45%). From 103 patients tested for ANCA 26% had positive results (24—UC, 3—CD). Mean calprotectin level (76 patients) was 750 ± 54.4 μg/g. Pancolitis was seen in UC (84%), as well as in CD (61%). Epithelioid granulomas in CD were present in 7 patients, in 5 of them they were detected years after initial diagnosis. Sixty-nine% of UC and 90% of CD patients received steroids as induction therapy, steroid-dependency was common (42% in UC and 55% in CD). Forty-nine% of patients with UC and 23% od CD patients received azathioprine, anti-TNF agents were used in 26% UC patients and 77% CD patients. In 35% of patients receiving anti-TNF biologic therapy was started before the age of 6 years. 23,8% of VEOIBD patients failed to achieve clinical remission. Total colectomy was performed in 11 patients, in 3 of them the diagnosis was subsequently changed to CD. Segmental resection was performed in 9 CD patients, in 3 of them while on therapy. The most common form of PID was XIAP deficiency (3 patients), 2 of them achieved endoscopic remission after allogenic stem cell transplantation.

Conclusion
In the VEOIBD group CD resembles UC clinically and endoscopically. A substantial number of patients requires immunosuppressive and biologic therapy before the age of 6 years. Colectomy rates are still high regardless the use of biologics. Boys with refractory VEOIBD should be screened for XIAP deficiency.
P175 Fatty liver disease as a complication of immune-mediated inflammatory diseases: prevalence and risk factors in inflammatory bowel disease
Authors: Arias Loste M T , García García M J , Rodriguez-Duque J C , Iruzubieta P , Rivas C , Pascual M , Castro B , García A , Lopez-Montejo L , Rasines L , Garcia-Nieto E , Cagigal M L , Rivero M , Crespo J 
Published: January 2020

Abstract

Background
Previous publications made by our group showed an increased prevalence of fatty liver disease (NAFLD) in immune-mediated inflammatory diseases (IMIDs). However, the existing data on inflammatory bowel disease (IBD) are contradictory.
Hypothesis: the prevalence of NAFLD is increased in IBD independently of the presence of metabolic factors.

Methods
Cross-sectional case–control study. Cases: prospective cohort single-center IBD patients. Controls: random sample from general population (Ethon cohort) paired 1: 2 by age, sex, BMI and T2D diagnosis. The diagnosis of NAFLD has been established by transition elastography (TE) CAP and confirmed by liver biopsy.

Results
The study scheme is presented in the figure. The prevalence of NAFLD is higher in IBD vs. general population (p = 0.04) and is associated with age, BMI, sex and metabolic syndrome. More frequently, IBD patients with NAFLD presented with severe complications of IBD and to a lesser extent receive TNF therapy. There is a mean serum elevation of CRP, ESR and ferritin compared with IBD subjects without NAFLD. In multivariant analysis, IBD is an independent predictor of NAFLD (adjusted OR 1.31; p = 0.007). The NAFLD associated with IBD is less frequently associated with T2D than NAFLD in the general population, and has a higher proportion of subjects with advanced fibrosis (TE &gt; 8.7 kPa: 45/350 [12.9%] vs. 23/669 [3.4%]; p &lt; 0.0001) and mean value of TE is significantly higher (6.09 vs. 5.11 kPa; p &lt; 0.0001). Non-invasive fibrosis scores have a high NPV in the diagnosis of advanced fibrosis in IBD (FIB4: 88%; APRI: 87%; NFS: 88%; HepametFS: 87 %)

Conclusion
The prevalence of NAFLD is higher in IBD patients, with IBD being an independent predictor of NAFLD. Patients with IBD and NAFLD have a higher systemic inflammatory burden and this results in an increased risk of advanced fibrosis associated with IBD comparatively with the control NAFLD population.
P176 Expert consensus on acquisition and reporting of intestinal ultrasonography activity in Crohn’s disease. A prospective inter-rater agreement study
Authors: Wilkens R T , Nylund K , Petersen F , De Voogd F , Maaser C , Kucharzik T , Maconi G , Allocca M , Lu C , Palmela C , Vaughan R , Christensen B , Novak K L 
Published: January 2020

Abstract

Background
Intestinal ultrasonography (IUS) is a promising cross-sectional imaging modality used to assess transmural disease and complications in Crohn’s disease (CD). Although recently positioned as a first-line modality for evaluation as per ECCO guidelines, standard measurements, reproducibility and nomenclature have not yet been clearly established. The aim of this study was to evaluate the inter-rater agreement for parameters identified as important by experts through Delphi consensus.

Methods
IUS parameters demonstrating inflammatory activity were systematically reviewed in the literature and presented to IUS experts. Individual parameters were selected by a blinded Delphi consensus panel to establish relative contribution to inflammatory activity in CD. Weighted grading of each parameter was further established by expert consensus. Image acquisition for optimal measurement was established by consensus. Two phases for evaluating inter-rater variability were undertaken. Phase 1: blind review by 8 readers of 20 de-identified CD cases. Cases with poor agreement were reviewed to clarify discrepancy and improve agreement. Phase 2: an additional 30 de-identified CD cases blindly were reviewed by 12 independent expert readers. Inter-rater agreement was evaluated for all 4 key parameters. Statistics were performed using Stata 16. Bowel wall thickness (BWT) was assessed using intraclass correlation coefficient (ICC) and the ordinal parameters using weighted Cohens Kappa.

Results
The Delphi process reduced 12 activity parameters to 4 key contributors including BWT, color Doppler signal (CDI), inflammatory fat and bowel wall echostratification (Figure 1).
BWT was regarded as pathologic if the average of 4 measurements were &gt; 3 mm for the small and large bowel, and grades of the additional parameters established (Table 1).
Bowel wall thickness was comprised of 2 measurements in cross section and 2 in longitudinal orientation (Figure 2). Interobserver agreement was almost perfect for BWT: ICC=0.91 (95% CI 0.83 to 0.96) p = 0.001, while there was moderate agreement for CDI κ=0.60 (95% CI 0.48–0.72) p = 0.001. Agreement for inflammatory fat detection was also moderate with κ= 0.50 (95% CI 0.33–0.66) p = 0.001, while stratification was fair κ= 0.39 (95% CI 0.26–0.53) p = 0.001.

Conclusion
This expert consensus-based IUS activity score clearly establishes the reproducibility of this standardised approach to measure inflammatory activity in patients with CD. Using our method, BWT which is known as the most important parameter, is highly reproducible with CDI and inflammatory fat demonstrating moderate reproducibility. This score may provide the foundation for the future incorporation of IUS in research studies and clinical trials.
P178 Variation in assessment of outcomes for inflammatory bowel disease in routine clinical practice: a mixed-methods study
Authors: Razanskaite V , Williamson P , Young B , Bodger K 
Published: January 2020

Abstract

Background
A number of global initiatives have sought to standardise the assessment of outcomes for inflammatory bowel disease (IBD), both for clinical trials (Core Outcome Sets1) and routine practice (ICHOM2). Our aim was to explore variability in the assessment and recording of clinical IBD outcomes during routine practice in England, evaluating the range of individual outcomes elicited and the extent of objective quantification of symptoms.

Methods
We performed ethnographic observations of 102 IBD clinic consultations conducted by 24 IBD clinicians (10 consultants, 10 IBD nurses and 4 trainees) in six acute hospitals in the North West region of England. We analysed 909 retrospective clinic records from outpatient IBD clinic visits recorded for observed patients in routine electronic patient records (EPRs). Audio-recordings of observed consultations and clinic records were analysed for pre-defined IBD outcomes, including those items required for Crohn’s Disease Activity Index (CDAI), Harvey–Bradshaw Index (HBI), Mayo Clinic Score (MCS) and Simple Clinical Colitis Activity Index (SCCAI). In addition, we performed 24 semi-structured interviews with IBD clinicians to explore the barriers and facilitators to capturing structured IBD outcomes in EPRs.

Results
The most commonly elicited and recorded outcomes were general well-being (95% consultations [C] and 61% clinic records [R]), stool frequency [SF] (87% C, 68% R), abdominal pain [AP] (79% C, 46% R), blood in stool [BS] (71% C, 57% R) and loose stool (64% C, 51% R). Clinical disease activity indices (HBI and SCCAI) were collected in only 15 (14.7%) observed consultations and recorded in 51 (5.6%) clinic letters. There was marked variation in the quantification of individual symptom items of MCS, SCCAI, CDAI and HBI in analysed consultations and records. Both PRO2 Crohn’s disease outcomes [AP and SF] were collected in 29/50 (58%) observed consultations and recorded in 169/484 (35%) records. Both PRO2 ulcerative colitis outcomes [SF and BS] were collected in 42/52 (81%) consultations and 253/425 (60%) records. Selected outcomes were recorded significantly more frequently by IBD nurses compared with doctors. Clinicians reported a range of IT barriers and issues with psychometric properties of currently available clinical disease activity indices in practice.

Conclusion
There is significant variability in the breadth, depth and quantification of IBD clinical outcomes during routine clinical assessments. Although most domains of clinical disease activity indices were elicited in consultations, formal scoring and assessment over fixed time periods was rare. There is an urgent need for practical alternatives to clinician reported disease activity indices in routine care.
P184 Temporary defunctioning ileostomy in therapy refractory Crohn’s colitis: A viable alternative to immediate colorectal resection?
Authors: van der Holst A M , Otten T , van Renterghem A R P K M , Dijkstra G , van Loo E S , van Praag E M , Buskens C J , Stassen L P S 
Published: January 2020

Abstract

Background
The faecal stream is one of many factors influencing the pathogenesis of Crohn’s disease. Previous research demonstrated some Crohn’s patients benefit from temporary faecal diversion. This study aims to determine the role of temporary faecal diversion by means of a defunctioning ileostomy in treating patients with therapy refractory Crohn’s colitis.

Methods
Data were retrieved by retrospectively assessing patient records. All patients receiving a temporary ileostomy for therapy refractory Crohn’s colitis from three Dutch hospitals between 2010 and 2018 were included. Patients with previous colorectal resection or malignancy were excluded. Stoma reversal, permanent stoma and extension of colorectal resection at follow-up were determined as primary outcomes.

Results
Thirty-six patients received a temporary defunctioning ileostomy for therapy refractory Crohn’s colitis. Stoma reversal was attempted in 20 (56%) patients after a mean period of 1 year of which nine underwent additional resection during stoma reversal. After a mean follow-up of 4.2 years, resection was performed in 29 (81%) patients of which 14 (39%) had reduced resection in comparison with the necessary resection at the time of faecal diversion. Among the 14 (39%) patients with restored continuity, three patients remained with full preservation of the colon. Moreover, the presence of proctitis was associated with low stoma reversal rates (p = .007).

Conclusion
Temporary faecal diversion is associated with reduced resection and reduced risk of permanent ileostomy; therefore, it may be a decent alternative for immediate colorectal resection for patients with isolated Crohn’s colitis. Unfortunately, temporary defunctioning ileostomy is not a viable alternative for resection in Crohn’s patients suffering from proctitis.
P186 Prevalence and management of anaemia in Greek patients with inflammatory bowel disease: a multicentre real-life cohort study
Authors: Karmiris K , Fotinogiannopoulou K , Velegraki M , Koureta E , Axiaris G , Kateri C , Kokkotis G , Kapizioni C , Markopoulos P , Katsoula A , Gklavas A , Papaconstantinou I , Giouleme O , Tsironi E , Michalopoulos G , Bamias G , Papadopoulos V , Kapsoritakis A , Zampeli E , Michopoulos S , Karatzas P , Papatheodoridis G , Theodoropoulou A , Koutroubakis I E 
Published: January 2020

Abstract

Background
Anaemia is a common extra intestinal manifestation of inflammatory bowel disease (IBD) that plays an important role in patients’ quality of life. The aim of our study was to evaluate the prevalence of anaemia and its current management in referral IBD centres in Greece.

Methods
We performed a retrospective analysis of demographic, clinical, laboratory and IBD-related treatment data as well as data concerning the type of anaemia and its treatment in IBD patients registered in 10 Greek tertiary referral centres. Consecutive patients (the last seen) having at least two follow-up visits with available to retrieve relevant laboratory results were included. Anaemia was defined by the World Health Organization criteria. Patients with co-morbidities related to anaemia were excluded.

Results
A total of 751 IBD patients have been registered so far and their demographic and clinical characteristics are presented in Table 1. The point prevalence of anaemia at inclusion was 26.8 % (201 patients), whereas the overall prevalence of history of anaemia was 38.7% (291 patients). The prevalence of anaemia was numerically higher in CD (41.1 %, n = 186) than in ulcerative colitis (35.2 %, n = 105) but the difference was not statistically significant (p = 0.13). Persistent anaemia (anaemia in all measurements) was found in 40 (13.7%) and recurrent anemia in 102 (35.1%) patients, whereas 54 (18.5 %) had a history of anaemia before IBD diagnosis. IBD patients with anaemia at entry had higher activity (HBI, SCCAI and CRP) and lower quality of life (SIBDQ) scores than patients without anaemia (for all comparisons p &lt; 0.05). Among the 291 patients with anaemia iron supplementation was administered in 239 (82.3%); oral iron in 52 (17.9%) and iv iron in 205 (70.4%). Vitamin B12 and folate were administered in 54 and 107 patients, respectively.

Conclusion
The point prevalence of anaemia in Greek IBD patients is 26.8%. Almost half of the patients with anaemia present recurrent or persistent anaemia. The presence of anaemia is associated with active disease and lower quality of life. The vast majority of patients received iron supplementation mainly in the form of iv iron.
P190 Systematic review: Gastrointestinal ultrasound scoring indices for inflammatory bowel disease
Authors: Goodsall T , Nguyen T , Ma C , Jairath V , Bryant R 
Published: January 2020

Abstract

Background
The management of inflammatory bowel disease (IBD) requires frequent monitoring and assessment of disease activity. Endoscopic assessment with biopsy remains the gold standard for disease activity. Gastrointestinal ultrasound (GIUS) is a non-invasive, accessible and affordable test used to assess and monitor IBD and has been shown to be similar to MRI for detecting disease. The aim of this study was to systematically review the literature to identify scoring indices used for GIUS measurement of disease activity in IBD and to appraise their operating characteristics.

Methods
A systematic search of Embase, Medline, Pubmed, Cochrane Central and Clinical Trials.gov from inception to July 2019 was conducted according to PRISMA guidelines. Included were all study types reporting GIUS indices used for grading activity of severity of IBD in comparison to an objective reference standard. Studies using an exclusive clinical reference standard were excluded. All study types and abstracts were considered. Study quality was assessed using the QUADAS tool.

Results
27 eligible studies were identified investigating 1647 patients. Disease phenotype was Crohn’s disease (CD) (n = 13), ulcerative colitis (UC) (n = 10) and IBD (n = 4). The most common reference standard was colonoscopy (n = 23), histology (n = 2), and imaging (n = 2). Bowel wall thickness was an index parameter in 26 studies. The most frequent cut off was 3mm (n = 10), 4mm (n = 9), 5mm (n = 1), and not specified (n = 6). There was no noticeable difference in magnitude of cut off when stratified by disease phenotype. Colour Doppler was an index parameter in 16 studies and was based on the Limburg score (n = 7), binary (n = 7) or categorical (n = 2). Bowel wall stratification was an index parameter in 15 studies and was more frequently used in UC (70%) and IBD (75%) indices than in CD indices (38%). Other index parameters included bowel wall compressibility, presence of complications such as abscess or fistula, bowel wall echogenicity, mesenteric inflammatory, lymphadenopathy, contrast enhancement, ulceration, peristalsis, strictures, absence of haustra coli, and tissue sonoelastography. Twenty-three studies were identified as at risk of bias. Overall concordance was substantial to excellent and accuracy was good to excellent. Two studies demonstrated substantial inter-observer agreement. No studies reported intra-observer agreement.

Conclusion
The identified GIUS scoring indices demonstrate applicability to both CD and UC with good accuracy and concordance. Current evidence does not adequately address concerns about the intra- and inter-observer variability of GIUS. There is a need for robust validation of an evidence-based GIUS index before more widespread use in IBD as a surrogate for colonoscopy and in clinical trials.