bluuebunny/crossref_metadata_2025_split huggingface dataset:
P731 Biologics use in elderly patients with IBD: Experience in a UK secondary care setting
Authors: Alexakis C , Robinson J , Yeates R , Ho-Yen N , Mathew S , Gallagher M , Banks C , Alexandropoulou K 
Published: January 2020

Abstract

Background
The combination of an ageing population coupled with a rising incidence in inflammatory bowel disease (IBD) will undoubtedly result in increased use of biologic agents in older patients with IBD, yet long-term data on the use of these drugs in this population remains scarce. We describe our experience of biologic treatment in IBD patients aged 60 years or greater at a UK district general hospital.

Methods
This was a retrospective descriptive study performed at Royal Surrey NHS Foundation Trust which serves a population of 300,000 people. IBD patients on biologic therapy are all registered on a prospectively collated database. Patients were included in this study if their biologic start date was on or after their 60th birthday. Each patient had their clinical records assessed and the following baseline data were recorded: sex, IBD subtype, concurrent medication use, relevant medical history and co-morbid status (using the Charleston Morbidity Index (CMI)), age at biologic start date and biologic subtype. Patients were followed up from biologic start date to biologic end date, death or end of study period (01.07.2019). Kaplan Meier analysis was used to generate biologic survival or ‘persistence’. During follow-up, we recorded the incidence of both infective and non-infective complications, and the incidents of both IBD surgery and malignancy.

Results
Of 220 patients on biologic therapy, 19 (8.7%) were aged ≥60 years at initiation, of whom 18 had data included in the analysis including 431 patient-months of follow-up. 78% were male. Half of patients had Crohn’s disease. Median CMI was 4. Only 1 patient had a history of malignancy prior to biologic initiation. Mean age at biologic initiation was 69 years. 72% of patients were on concurrent immune suppression medication. Most patients (72%) were commenced on Infliximab (Adalimumab 17%, Vedolizumab 11%). Median biologic treatment time was 17 months. The 6, 12 and 24 month biologic persistence rates were 78%, 67% and 28% respectively. 22% of patients were subsequently treated with a second biologic. 17% required surgery despite biologic use. Over half (56%) of patients suffered a complication post first biologic initiation, the most frequent being infection which affected 44% of patients during follow-up. Where recorded or available, 41% of patients developed antibodies to biologic, with a mean time of 11.4 months treatment. There were no recorded malignancies in any patient following biologic initiation.

Conclusion
Just under one in 10 of our biologic cohort is above the age of 60 on commencement of therapy. Despite a heavy burden of infective complications, there is reasonable biologic persistence in this group, and importantly a negligible malignancy risk following treatment initiation.
P735 Comparative assessment of probiotics and standard therapies for mild to moderate ulcerative colitis: A systematic review and network meta-analysis
Authors: Paschos P , Katsoula A , Malandris K , Sarigianni M , Athanasiadou E , Koukoufiki A , Giouleme O , Tsapas A 
Published: January 2020

Abstract

Background
We performed a systematic review and network meta-analysis to compare probiotics to current therapies in the induction and maintenance of remission in ulcerative colitis (UC).

Methods
We systematically searched Medline, Embase, CENTRAL up to November 2018. We included randomised controlled trials (RCTs) in patients with mild to moderate UC that compared probiotics, sulfasalazine, mesalamine (low dose &lt;2 g/day, standard dose ≥ 2 g/day), olsalazine, balsalazide, budesonide, budesonide MMX and beclomethasone either alone or in combination with topical therapy, to each other or placebo. We excluded trials where &lt;50% of the population had extensive or left-sided colitis. Outcomes were remission (induction studies), relapse (maintenance studies) and discontinuation due to adverse events (tolerability). We conducted random-effects network meta-analysis and ranked treatments based on the surface under the cumulative ranking (SUCRA) probabilities.

Results
Forty-eight trials (probiotics 6 trials) of induction therapy and 30 trials (probiotics 6 trials) of maintenance therapy were included in the analysis. In studies with probiotics concomitant treatment, mainly mesalamine, were allowed. At induction, probiotics were not superior to placebo (OR 1.43; 95%CI 0.84–2.42) and they were inferior to combined oral and topical mesalamine therapy (OR 0.28; 95%CI 0.12–0.66) and combined mesalamine and beclomethasone therapy (OR 0.27; 95%CI 0.09–0.83). On SUCRA analysis, combination therapies (SUCRA 0.92 and 0.93) were ranked the highest followed by balsalazide (SUCRA 0.71), budesonide ΜΜΧ (SUCRA 0.68), standard dose mesalamine (SUCRA 0.52), beclomethasone (SUCRA 0.50), olsalazine (SUCRA 0.41), probiotics (SUCRA 0.29), low dose mesalamine (SUCRA 0.26) and sulfasalazine (SUCRA 0.23) in terms of inducing remission. Probiotics were well tolerated. At maintenance, probiotics (OR 0.35; 95%CI 0.19–0.62) and their combination with mesalamine (OR 0.38; 95%CI 0.15–0.99) had lower rate of relapse compared with placebo, but there were no differences when compared with other treatments. On SUCRA analysis, probiotics either alone or combined with mesalamine had comparable SUCRA values to standard dose mesalamine (SUCRA 0.59) and sulfasalazine (SUCRA 0.68). The combination of oral and rectal mesalamine was superior to placebo (OR 0.10; 95%CI 0.04–0.26) and all other treatments and it was ranked highest (SUCRA 0.99). Probiotics were ranked the best tolerated option in terms of discontinuation due to adverse events (SUCRA 0.80).

Conclusion
Probiotics are well tolerated but they are not effective in inducing remission in active UC. They may be effective when added to mesalamine therapy in preventing relapse of quiescent UC, but large, well-designed RCTs are needed.
P748 Characteristics of inflammatory bowel diseases in different stage of adolescence
Authors: Szántó K J , Bálint A , Bor R , Fábián A , Milassin Á , Rutka M , Szepes Z , Vass N , Molnár T , Farkas K 
Published: January 2020

Abstract

Background
There is a lack of data regarding clinical and therapeutic characteristics in middle and late adolescent inflammatory bowel diseases (IBD) patients in real life. Our aim was to retrospectively evaluate patient’s characteristics and therapeutic features among the Hungarian adolescent inflammatory bowel diseases population. Also our aim was to assess whether these patients before the transition have more serious disease phenotype than those after transition.

Methods
Retrospective, epidemiological study using the National Health Insurance Fund social security databases. Adolescent Hungarian IBD patients who were observable in the database between 2008 and 2017 were enrolled. Patients were analysed according to two groups: patients between ages of 14–17 years were defined middle adolescent patients, and patients between 18–21 years were defined late adolescent patients.

Results
The incidence of IBD was 24.82/100 000 in the middle and 38.17/100 000 in the late adolescent patients. Prevalence rates showed an increasing tendency in both groups. Incidence and prevalence rates were higher in the late adolescent patients. Mesalazine was used in high proportion of patients (66.6% vs. 69.3% of the middle and late adolescent patients, respectively), also in UC and CD patients. While, the use of sulphasalazine (13.1% vs. 19.6%, respectively) and azathioprine (20.3% vs. 11%, respectively) was relatively low. The need of biologics was higher in the middle adolescence group (p &lt; 0.001). Use of anti-TNF agents increased during the observational period in both groups (p &lt; 0.001). Corticosteroid use was similar in both groups; a decreasing tendency was observed. Rate of hospital admissions to gastroenterology department was higher than to surgery department in both groups. The number of hospital admissions to gastroenterology (p &lt; 0.001, p = 0.001) and surgery departments (p &lt; 0.001 and p = 0.031) decreased significantly in both groups throughout the observational period.

Conclusion
We have analysed the data of huge number of adolescent patients diagnosed with IBD to get better overview on the clinical and treatment characteristics of patients in these sensitive age groups. Overall, the increasing use of anti-TNF therapy and decreasing tendency of corticosteroid use reflects significant changes and improvement in treatment paradigm not only in adult but paediatric care. The higher need of anti-TNF agents reflects that these adolescent patients before the transition have more severe disease phenotype.
P753 Elevation of liver enzymes in a large cohort of patients with inflammatory bowel disease
Authors: ATIA O , Turner D , Mendelovici A , Assa A , Mozer-Glassberg Y , Cahan A , Lederman N , Matz E , Dotan I , Shteyer E 
Published: January 2020

Abstract

Background
Elevation in liver enzymes (ELE) is often seen in patients with inflammatory bowel disease (IBD). The aim of this study is to assess the incidence, character, chronicity, degree, and etiology of ELE in within the validated epiIIRN cohort which includes all IBD patients in Israel (n = 45,074).

Methods
We current analysis was performed on data from three of four Health Maintenance Organisations (HMOs), covering 48% of the Israeli population. The identification of Crohn’s disease (CD) and ulcerative colitis (UC) utilised previously validated algorithms. Retrieved data included demographics, anthropometric measures, liver enzymes, medications and other diagnoses codes. Mild ELE was defined from upper normal limit (UNL) to X2 UNL, moderate X3 UNL and severe elevation ≥X4 UNL). The pattern of elevation was defined as hepatocellular (isolated elevation of ALT and/or AST), cholestatic (elevated GGT and/or ALK and bilirubin) and mixed pattern. Chronicity of ELE was defined as brief (&lt;30 days) to chronic (&gt;180 days).

Results
The total incidence (ever) of ELE in CD patients was 33% (3098/9421) and 28% in UC (2001/7040); p &lt; 0.001. The mean age at ELE was 29.9 years (IQR 17.2–47.5) in CD and 37.9 years (23.2–53.8) in UC (p &lt; 0.001). Hepatocellular pattern had more commonly in UC (54% vs. 47%, p &lt; 0.001) as mixed pattern (22% vs. 20%, p = 0.01), while cholestatic pattern had more commonly in CD (31% vs. 26%, p &lt; 0.001). The ELE was transient in 609 (9%) patients, while 4054 (62%) had chronic ELE. Mild ELE was recorded in 860 (22%) CD patients and 460 (19%) UC, and severe in 328 (8%) CD and 253 (10%) UC. ELE was recorded during the first three months after initiation of thiopurines in 604 (15%) CD and 201 (8%) UC patients (p &lt; 0.001), after biologics in 346 (9%) CD and 62 (3%) UC (p &lt; 0.001), after steroids in 538 (14%) and 272 (11%), respectively (p = 0.01) and after methotrexate in 76 (2%) and 15 (0.6%), respectively (p = 0.001). The incidence of fatty liver was most common in UC (5% vs. 3%, p = 0.006).

Conclusion
ELE is common complication in IBD patients, more so in UC. When enzymes do increase in CD they tend to reach higher levels. Drug induced liver injury was more common in CD.
This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.
P758 Ileorectal anastomosis vs. ileal pouch-anal anastomosis for the surgical treatment of ulcerative colitis: A Markov decision analysis
Authors: De Buck Van Overstraeten A , Brar M , Khorasani S , Dossa F , Myrelid P 
Published: January 2020

Abstract

Background
Ileorectal anastomosis (IRA) in patients with ulcerative colitis (UC) results in decreased postoperative morbidity and better functional outcome but leads to increased risk for rectal cancer compared with ileal pouch-anal anastomosis (IPAA). This study aims to compare IRA with IPAA in UC, using decision analysis.

Methods
A Markov simulation model was designed to simulate clinical events of IRA and IPAA over a time horizon of 40 years with time cycles of 1 year (Figure 1). The base case was a 35-year-old patient with ulcerative colitis and relatively preserved rectum. Probabilities and utilities, required to populate the model, were derived from observational studies, identified after a systematic literature search using MEDLINE. Primary outcomes were life years (LY) and quality-adjusted life years (QALY). Deterministic sensitivity analyses were performed to assess the impact of changing variables on the preferred treatment. Monte Carlo probabilistic sensitivity analysis, using 10 000 samples, was performed to account for uncertainty of variables. Prevalence of rectal cancer, IPAA and IRA failure and the stoma rate were calculated at the end of the time horizon, using markov cohort analysis.

Results
The model resulted in lower LY (36.22 vs. 37.02) and higher QALYs (33.42 vs. 31.57) for IRA. The results of the Monte Carlo probabilistic sensitivity analysis demonstrated that IRA was the preferred treatment option in 63% of the samples, accounting for a clinical significant margin of 0.25 QALY (Figure 2). The model was also sensitive to the utility of IRA, IPAA and end-ileostomy. A higher proportion of IRA patients will develop rectal cancer (7.6% vs. 3.2%) and 43.5% of all IRA patients will end with an ileostomy as opposed to 23.0% of all IPAA patients. The study was limited by characteristics inherent to modeling studies, including assumptions necessary to build the model, data input based on best available but often limited evidence and unavoidable extra- and interpolation of data.

Conclusion
IRA was the preferred treatment option when quality-adjusted life years was the outcome, with higher life years for IPAA. This model highlights that both surgical strategies are useful in ulcerative colitis patients with relatively spared rectum.
P777
Clostridioides difficile infection in children with inflammatory bowel disease: A Canadian population-based study
Authors: El-Matary W , Chandrakumar A , Zohni H 
Published: January 2020

Abstract

Background
Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhoea and gastroenteritis associated mortality, especially in children with inflammatory bowel disease (IBD). The aim of this work was to investigate the incidence and risk factors associated with Clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba, Canada.

Methods
Our longitudinal population-based cohort comprised of all children and young adults &lt;17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients.

Results
Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p = 0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR) = 4.30; 95% CI: 1.44–12.87) and anti-tumour necrosis factor (TNF) biologics (HR = 3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our paediatric IBD population was 25%.

Conclusion
Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy.
P781 Prevalence of antinuclear antibodies in inflammatory bowel disease and seroconversion after biological therapy
Authors: García García M J , Rodriguez-Duque J C , Arias Loste M T , Castro Senosiain B , Crespo J , Rivero M 
Published: January 2020

Abstract

Background
Higher levels of antinuclear antibodies (ANA) are detected in healthy populations with a prevalence of 6%. In autoimmune disorders it reaches 50–80%. In patients under TNF, the prevalence of positive ANA observed was 40% and occasionally may induce lupus like syndrome (LLS). However, there is a lack of evidence about the global prevalence in inflammatory bowel disease (IBD) and insufficient data about seroconversion of ANA after the beginning of biological therapy.

Methods
A unicentric transversal study of 879 IBD patients was designed. ANA determination was performed by immunofluorescence assay. IBD patients were classified according to the biological therapy. Presence and of ANA and titres were collected previously to the beginning of anti-TNF therapy. LLS symptoms were collected in a retrospective way.

Results
A valid result of ANA was obtained in 862 patients. Patients with any autoimmune disease which involve positive ANA were excluded. Positive ANA was reported in 13.62% of IBD patients. The prevalence of ANA was 28.67% in those patients under biological therapy (p &lt; 0.001), especially if the biological treatment was anti-TNF. No significative difference was observed in those patients receiving ustekinumab or vedolizumab therapy. Positive ANA was observed in 4.67% for combined treatment with immunomodulator and biological therapy. In contrast, if the patient received only biological therapy, positive ANA was collected in 24 % (p &lt; 0.001). A reduction in albumin levels and higher levels of IgG and IgM were related to positive ANA. It is important to highlight that a percentage of 53.45% positive ANA had never received biological therapy in the previous 5 years; that means, a 7.28% prevalence in the global cohort. A 48.15% of the patients had ANAs previous to the beginning of biological therapy. ANAs seroconversion was observed in 73.08% of the patients after the treatment.

Conclusion
IBD patients have a 13.62% prevalence of positive ANA; higher than prevalence in healthy population. The presence of ANA is frequently associated in patients under anti-TNF treatment and decreases with immunomodulator therapy associated to anti-TNF. It is unknown if positive ANA in IBD patients could be conditioned to the future development of other autoimmune disorders. Prospective studies are necessary to clarify these aspects.
P786 Non-alcoholic fatty liver disease among patients with inflammatory bowel disease in Qatar: Prevalence and risk factors
Authors: Almohannadi M , Chandra P , Varughese B , Darweesh A , Hamid A , Badi A , Kaabi S A , Yakoob R , Al-Ejji K , Sultan K , Abunahia N , Ameer Hamza Shah M , Derbala M 
Published: January 2020

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) has been progressively identified in patients with inflammatory bowel disease (IBD) in Qatar. We aim to characterise NAFLD in IBD patients in Qatar and to determine predictors for its severity.

Methods
A retrospective observational study was conducted on 913 IBD patients in Hamad hospital between January 2008 and December 2017. The prevalence of NAFLD among IBD cases was estimated and associations between two or more qualitative variables were assessed using χ2-test. Quantitative data between two independent groups were analysed using unpaired t-test. Univariate and multivariate logistic regression analysis were applied to determine the predictive values of each predictor for NAFLD among IBD patients.

Results
Among 913 IBD patients with a mean age of 36.9 ± 13.2 years and BMI 26.9 ± 6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs. 11.9%; p = 0.949). Patients who developed NAFLD were older at baseline, higher BMI and had a higher prevalence of diabetes and hypertension. Age &gt;50 years (OR 3.34; 95% CI 1.82, 6.14; p = 0.001), BMI &gt;30kg/m2 (OR 2.87; 95% CI 1.71, 4.84; p = 0.001), the presence of hypertension (OR 1.98; 95% CI 1.16, 3.38; p = 0.01) and diabetes mellitus (OR 3.05; 95% CI 1.87, 4.95; p = 0.001), were all positive and significantly associated with an increased risk whereas gender female associated with significantly decreased risk for NAFLD (OR 0.63; 95% CI 0.41, 0.98; p = 0.04). Multivariate analysis showed age &gt;40 to 50 years (adjusted OR 2.98; 95% CI 1.62, 5.48; p = 0.001), age &gt;50 years (adjusted OR 2.03; 95% CI 1.03, 4.0; p = 0.04), BMI&gt;30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; p = 0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; p = 0.02) significantly associated with an increased risk of NAFLD whereas gender female showed protective effect and have decreased risk (adjusted OR 0.58; 95% CI 0.36, 0.93; p=0.02). The treatment with biologic does not increase the risk of steatosis and the predicted cut-off NAFLD score of ≥ -1.67 had good predictive ability for significant steatosis.

Conclusion
The prevalence of NAFLD in IBD patients was 11.8% in Qatar. We did not find an association between the medications used and the progression to NAFLD in IBD patients. Older age, high BMI and diabetes mellitus increase its risk. Non-invasive screening using NAFLD Score could help early diagnosis and initiation of interventions in such patients.
P789 Bacteriological profile of material collected from perianal lesions from patients with Crohn’s disease in the tertiary IBD centre in southern Poland
Authors: Filip R , Gruszecka J 
Published: January 2020

Abstract

Background
Both anal abscesses and fistulas are potential complications in the course of Crohn’s disease. Chronic immunosuppression, loose stools and poor wound healing in this population pose a challenge to the treatment of perianal diseases. The purpose of our hospital research was to determine the dominant bacterial species found in perianal abscesses and fistula discharge, resulting in anal abscess and/or fistula outflow in patients with Crohn’s disease hospitalised in a tertiary IBD centre in Poland.

Methods
The results of tests of patients admitted and subsequently conservatively treated or treated for anal fistula or abscess in the period from January 1, 2017 to June 30, 2019 were evaluated. Information obtained from medical records included clinical information, results of laboratory tests and results of swab cultures of perianal lesions for culturing and antibiotic sensitivity of microorganisms isolated. Material was collected from patients in accordance with applicable procedures.

Results
In the analysed period, a total of 306 swabs from perianal lesions from 44 patients with the diagnosis of Crohn’s Disease were collected, of which microbial growth was observed in 38 patients. Escherichia coli (45.5%, p &lt; 0.001) was the most frequently isolated pathogen, Staphylococcus aureus was the second most common pathogen (15.9%, p &lt; 0.001). In vitro sensitivity tests showed that Escherichia coli (ESBL-extended-spectrum-beta-lactamase producing strain with a broader substrate spectrum) was found in 4 samples, Staphylococcus aureus (MRSA- strain resistant to all beta-lactam antibiotics: penicillins with inhibitors, cephalosporins, monobactams, carbapenems except for ceftaroline). The analysis of the results obtained did not show seasonal variability in the number of positive microbiological tests found on cultures of perianal lesions.

Conclusion
A retrospective analysis of microbiological results of anal abscesses and fistula outflow was performed in patients with Crohn’s Disease with perianal changesi. Escherichia coli was the predominant pathogen isolated. The second most common organism was Staphylococcus, isolated from 9 patients. Staphylococci were not found in samples from other patients with IBD. The evaluation of the obtained results shows that positive results of cultures of swabs from lesions in the anal area were found more often in samples taken from men (25 samples–65.8%) than from women (13 samples–34.2%).