bluuebunny/crossref_metadata_2025_split huggingface dataset:
P014 IBD AND VTE RISK: LET’S TALK ABOUT IT
Authors: Dave Jenny , Chawla Karan , Carro-Cruz Francis , Rao Vinay , Gibilisco Jessica , Baumgartner Scott , Negreira Katherine , Borum Marie 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel disease (IBD) have a 1.5–3 fold increase in the risk of venous thromboembolism (VTE). Additionally, VTE in patients with IBD is associated with a 2.1 fold increase in mortality compared to the general population. The risk of VTE is increased with active inflammation. It is speculated that individuals with IBD are inconsistently advised about VTE risk. This study evaluated the frequency of counseling about VTE in IBD patients.

Methods
A retrospective medical record review of all IBD patients seen at a university gastroenterology practice during a 5 year period was performed. Patients’ age, gender, disease type and documented counselling about VTE risk were obtained. A database was created maintaining patient confidentiality. Analysis was conducted using Fisher’s Exact Test with significance set at p&lt; 0.05. The study was approved by the university IRB.

Results
Records of 381 patients were reviewed. There were 209 females and 172 males with a mean age of 44 years (range 20–82). 279 had ulcerative colitis, 96 had Crohn’s disease and 6 had indeterminate colitis. Self-reported ethnicity included 195 White, 97 Black/African-American (AA), 11 Asian, 1 Hawaiian, 34 other and 43 did not report their ethnicity. 13 (3.4%) patients (7 females, 6 males) were counselled about VTE risk. The 7 women who were counselled were &lt;50, with no significant difference in counselling of women &lt;50 compared to women &gt;50 (p=0.11). The 6 men who were counseled were &lt;50, with no significant difference in counseling of men &lt;50 compared to men &gt;50 (p=0.09). There was no difference in the rate of counselling based upon gender (p=1.000), ethnicity (Whites vs. non-Whites, p=0.77; Whites vs. AA, p=1.00) or disease type (p=0.31).

Discussion
Venous thromboembolism is a known risk of inflammatory bowel disease. While VTEs infrequently occur in IBD patients, it is important that there is awareness about the potential risk. This study revealed that VTE risk is rarely discussed with IBD patients. While this study is limited by single institutional design, size and reliance on documentation, it suggests that increased efforts can be made to educate IBD patients about VTEs. Recognition of VTE risks can improve IBD management and optimize clinical outcomes.
P002 IBD PARTNERSHIPS: UNDERSTANDING PATIENTS VS. CLINICIANS PERSPECTIVES OF IBD TREATMENT OPTIONS TO IMPROVE SHARED DECISION-MAKING
Authors: Zelinsky Sandra , Finlayson Catherine 
Published: January 2020

Abstract

Background
The patient is the only constant in the care journey, the person who experiences both processes and the outcomes of care. There is an international shift towards including patients as equal partners in research. Co-producing research with Inflammatory Bowel Disease (IBD) patients to understand their values, needs and priorities when making treatment decisions will potentially improve shared decision-making between IBD patients and their Healthcare Providers (HCPs). To facilitate this process patients and HCPs must have a common understanding of expected medication benefits, risks and the potential impact on quality of life. The information available to facilitate this conversation must be aligned and reflect the priorities that IBD Patients and Healthcare Providers consider when making treatment decisions. Both parties can then share information and work towards an agreement to what treatment plan should be implemented.

Aims
To understand what matters most to IBD patients when making treatment decisions by conducting a qualitative patient-led peer to peer study which will inform the development of an IBD patient and HCP survey.

Methods
IBD patients (≥ 18 years of age) were recruited through the IBD clinic at the University of Calgary and via social media. Focus groups were held in three separate provinces (British Columbia, Alberta and Ontario) in both rural and urban locations. The focus groups were facilitated by a Patient Engagement Researcher to alleviate any potential power dynamics and to create a safe space for IBD patients to share their perspectives. A participatory action research approach was used to encourage co-production with participants throughout the focus groups. The focus groups were audio recorded. Flip charts and sticky notes were used for brainstorming and prioritization exercises. All audio and written data were transcribed. Thematic analysis was used to identify emerging themes and patient priorities.

Results
A total of 21 participants attended the focus groups from both rural and urban locations. Participant diversity ranged in ethnicity and age. Most of the participants were female (18 females and 3 males) of which 4 were biologic naïve and 17 were biologic exposed. The Top 5 IBD Patient Priorities when making treatment decisions are 1) Risks(more serious/long term) 2) Education(Support/Evidence Based Information/Resources) 3) Side Effects(short term/less serious) 4) Efficacy 5) Impact(Quality of Life/ Lifestyle/Logistics).

Conclusions
Co-producing research ‘with’ and ‘by’ IBD patients helped to generate priorities that matter most to patients when making treatment decisions. The patient priorities will help in the development of an IBD Patient and HCP survey. The results from the two surveys will be compared to understand patient vs. HCP perspectives.
P018 INTERNET DIETS: ONLINE INFORMATION REGARDING NUTRITIONAL TREATMENTS FOR IBD
Authors: Baumgartner Scott , Rao Vinay , Khan Ali , Borum Marie 
Published: January 2020

Abstract

Background
Nutrition is a vital component in the management of IBD and can be an effective primary therapy for many patients. Certain types of diets, including the Western diet, have been speculated to be associated with increased IBD risk or exacerbations. There are currently no specific dietary recommendations for IBD risk reduction. However, online resources may offer nutritional guidance to patients seeking information. This study evaluated specific nutritional and dietary treatment information for IBD on the Internet.

Methods
Google search engine was used to query “nutrition and inflammatory bowel disease” to obtain the first 100 websites. Websites that were non-accessible, duplicates, videos without transcripts, or evaluated animal models were excluded. Websites were categorized as informational or academic/professional. Websites were reviewed for discussion of specific nutritional treatments, acknowledgement of areas of uncertainty and references. Statistical analysis was performed using a two-tailed Fisher’s Exact Test with a significance value set at p &lt;0.05.

Results
89 (50 informational, 39 academic) met the inclusion criteria. No websites were commercial or personal. 49 (55%) websites discussed nutrition as a treatment modality. Enteral nutrition was discussed in 38 (77.6%), probiotics in 22 (44.9%), parenteral nutrition in 21 (42.9%), elimination diet in 19 (38.8%), and low FODMAP diet in 15 (30.6%). Academic resources discussed specific nutritional therapy more often than informational resources (82.1% and 45.0%, respectively; p=0.003) (Figure 1). Academic resources acknowledged areas of uncertainty more frequently than informational resources (64.1% and 30.0%, respectively; p=0.024). Academic resources cited references significantly more often than informational resources (80.9% and 10.6%, respectively; p&lt;0.0001).

Discussion
This study shows that the most commonly discussed nutritional therapy was enteral feedings (77.6%), followed by probiotics (44.9%), parenteral feeding (42.9%), elimination diet (38.8%), and the low FODMAP diet (30.6%). Academic websites discussed dietary options significantly more than informational websites. These results suggest that there is a paucity in consumer-oriented literature regarding nutrition in IBD. Academic websites are the primary online resources for information about nutrition in IBD, discuss areas of uncertainty, and offer references. As patients with IBD are increasingly utilizing the Internet for recommendations regarding disease management, it is important that both academic and informational online IBD resources provide comprehensive nutritional information to enhance patient education.

Reference
P020 PRACTICE PATTERNS OF PRIMARY CARE AND GASTROENTEROLOGY PHYSICIANS IN THE MANAGEMENT OF IRON DEFICIENCY ANEMIA IN INFLAMMATORY BOWEL DISEASE
Authors: Wade Francis , Odufalu Florence-Damilola , Grosch Gretchen , Chambers Melissa , Schroeder Katie 
Published: January 2020

Abstract

Introduction
Iron deficiency Anemia (IDA) is a common complication of inflammatory bowel disease (IBD). High prevalence of IDA in IBD suggests suboptimal surveillance and treatment. Oral iron is poorly tolerated, associated with worsened disease activity, and often insufficient to reverse anemia in IBD patients. Intravenous (IV) iron is favored for treatment of IDA in IBD in most clinical scenarios and many guidelines recommend IV iron as first line for IBD patients. Regardless, oral iron is prescribed commonly for IDA in IBD. The objective of this study is to determine practice patterns of primary care physicians (PCP) and gastroenterologists (GI) in the management of IDA in IBD.

Methods
We anonymously surveyed GI and PCP attendings and trainees at Saint Louis University School of Medicine in St. Louis, Missouri, using paper self-administered instruments. We asked about practice patterns in the management of IDA in IBD patients and knowledge of IV iron. The study questionnaire was developed based on United States expert opinion consensus statements and European guideline recommendations published in the Journal of Crohn’s and Colitis and Inflammatory Bowel Diseases.

Results
Of GI responders, 92.3% were fellows, 7.7% were attendings; of PCP responders, 81.8% were residents, 18.2% were attendings. 15.4% GIs, 12.7% PCPs were very comfortable managing IBD patients with IDA; 76.9% GIs, 58.2% PCPs were somewhat comfortable; 7.7% GIs, 29.1% PCPs were not comfortable (p=0.275). 61.5% GIs, 25.5% PCPs always check iron studies when evaluating anemic IBD patients; 30.1% GIs, 21.8% PCPs check most of the time; 7.7% GIs, 34.5% PCPs sometimes check; 0% GIs, 12.7% PCPs rarely check; 0% GIs, 5.4% PCPs never check (p =0.05). In mild Crohn’s disease with severe anemia, 15.4% GIs, 41.8% PCPs would prescribe oral iron daily; 15.4% GIs, 12.7% PCPs would prescribe oral iron every other day; 69.2% GIs, 45.5% PCPs would prescribe IV iron (p=0.58). 0% GIs reported good knowledge of IV iron, 53.8% reported acceptable knowledge, and 46.1% reported poor knowledge. 7.7% GIs, 10.9% PCPs reported good knowledge of how to order IV iron; 53.8% GIs, 7.3% PCPs reported acceptable knowledge; 38.5% GIs, 81.8% PCPs reported poor knowledge (p=0.000215). 23.1% GIs, 61.8% PCPs thought PCPs were responsible for screening for IDA in IBD patients; 76.9% GIs, 36.4% PCPs thought GIs were responsible (p= 0.0131).

Discussion
Both PCPs and GIs perceived responsibility to manage IDA in IBD patients. PCPs were less likely than GIs to screen for IDA in anemic IBD patients or to report adequate knowledge of clinic processes to order IV iron. Future efforts to reinforce gastroenterologists’ role in the management of IDA in IBD and to bolster familiarity with IV iron and its indications might improve outcomes and quality of life for IBD patients.
P023 THE ASSOCIATION BETWEEN BIOLOGIC USE AND SPECIMEN LENGTH IN CROHN’S DISEASE
Authors: Wood Trevor , Zaghiyan Karen , Fleshner Phil 
Published: January 2020

Abstract

Introduction
Despite advances in medical management, including the use of biologic agents, up to 80% of Crohn’s patients (CD) ultimately require operative intervention. Additionally, these patients are at risk for additional operative intervention within their lifetime. Given the risk of short bowel syndrome secondary to multiple bowel resections, conservation of bowel length is of paramount importance. A common yet unproven belief in the gastroenterology community is that intensive preoperative medical therapy might reduce the length of bowel removed at surgery. In this study, we compared specimen length in CD patients treated or not treated with biologic agents before surgery.

Objective
To determine if there is an association between biologic use and reduced specimen length after bowel resection.

Methods
Prospectively generated clinical profiles on consecutive CD patients undergoing their first ileocolic or small bowel resection between November 1999 to July 2019 were reviewed. Patients were classified into 2 groups: Group A patients were treated with biologic agents at any time before surgery while Group B patients had never received a biologic agent. Specimen length was determined by review of pathology reports. In patients with multi-segment resections, the sum of the specimens was recorded. The means of the two groups were compared using Students t test.

Results
The study cohort of 392 patients had a mean age of 36.2 (SD 15.9) years and included 53% males. Group A included 247 (63%) patients and Group B included 145 (37%) patients. Groups were comparable in terms of background demographics with the exception of age, use of preoperative immunomodulator therapy, and medical intractability as an indication for surgery (p value 0.01, &lt;0.01, 0.02 respectively) The mean specimen length in Group A was 29.1cm compared to 29.9cm in the Group B (p=0.68). A subgroup analysis of ileocolic resections and small bowel resections was completed. Within the ileocolic group, there was no significant difference in length between groups with respect to the total specimen length (p=0.92), colonic portion (p=0.15), and small bowel portion (p=0.67). Analysis of small bowel resection specimens also found no difference in length between the groups (p=0.63).

Conclusions
The use of biologics in CD was not associated with reduced specimen length in ileocolic resections and in small bowel resections
P029 VTE RISK WITH IBD PLUS ORAL CONTRACEPTIVES: ARE PATIENTS AWARE?
Authors: Dave Jenny , Chawla Karan , Carro-Cruz Francis , Rao Vinay , Gibilisco Jessica , Baumgartner Scott , Negreira Katherine , Borum Marie 
Published: January 2020

Abstract

Background
The risk of venous thromboembolism (VTE) is 1.5–3 fold higher in individuals with IBD compared to the general population. In addition, combination hormonal oral contraceptives (OCPs) are associated with a 3–5 fold increase in VTE. However, there is limited data regarding VTE risk in women with IBD who are on OCPs. It is speculated that women with IBD who may be at increased risk for VTE occurrence are not consistently counselled about VTE risks. This study evaluated the rate of VTE counselling in reproductive aged women and those on oral contraceptives.

Methods
A retrospective medical record review of all IBD women seen at a university gastroenterology practice during a 5 year period was performed. Patients’ age, disease type, OCP use and VTE risk counseling were obtained. A database was created maintaining patient confidentiality. Analysis was conducted using Fisher’s Exact Test with significance set at p&lt; 0.05. The study was approved by the university IRB.

Results
There were 209 female IBD patients with a mean age of 44 years (range 23–82). 153 had ulcerative colitis, 53 had Crohn’s disease and 3 had indeterminate IBD. Self-reported ethnicity included 93 White, 67 Black/African-American, 7 Asian, 1 Hawaiian, 19 other and 22 declined reporting their ethnicity. There were 146 women of reproductive age (&lt;50 years) and 63 women &gt;50 years. 7 women, all age &lt;50, were counselled about potential VTE risk. There was no significant difference (p=0.105) in the rate of VTE counselling in women based upon age. In the 24 women of reproductive age who were on OCPs, one patient was counselled about increased VTE risk. There was no significant difference (p=1.00) in the rate at which women of reproductive age on OCPs (1 in 24, 4.2%) were counselled compared to women of reproductive age who were not on OCPs (6 in 122; 4.9%).

Discussion
Venous thromboembolism can result in significant morbidity and mortality. Individuals with IBD are at increased risk for VTEs. Women with IBD on oral contraceptives may be at greater risk for VTEs than other IBD patients. This study revealed that IBD women infrequently receive education about VTE risk. There was no significant difference in the rate of counselling in women based upon age. There was also no significant difference in the VTE counselling in women of reproductive age who were on OCPs compared to those who were not on OCPs. Whle this study is limited based upon single institutional design, retrospective evaluation and small sample size, it offers important information for further study and educational initiatives. Enhanced efforts to educate individuals about the risk for VTEs can improve IBD management and outcomes.
P034 A QUALITATIVE STUDY EXPLORING THE BURDEN OF CROHN’S DISEASE AMONG CHILDREN AND ADOLESCENTS
Authors: Coskun Ufuk , Kelly Kim , Hunter Theresa , Newton Louise , Symonds Tara , Delbecque Laure 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) is a type of inflammatory bowel disease that can occur at any age, though is most common between ages 15–35 years. CD symptoms can have a significant impact on health-related quality of life (HRQL). Although key symptoms and impacts of CD in adults are well-known, exploration of these in children and the level of agreement between child reported symptoms and impacts and those observed by parents/caregiver have not been well documented.

Objectives
Understand patients’ experiences of CD, including CD symptoms and the burden of living with CD, from the perspective of CD child and adolescent participants and parents/caregivers of children with CD.

Methods
Children (ages 5–11 years) and adolescents (ages 12–17 years) with CD and parents/caregivers of children with CD (ages 2–11 years) were recruited from US clinical sites. Qualitative semi-structured interview guides were developed, informed by published literature. Face-to-face and telephone concept elicitation interviews were conducted, audio-recorded and transcribed. Transcripts were analyzed using thematic methods facilitated by Nvivo.

Results
A total of 43 participants participated in this study. Preliminary results showed that pain, frequent bowel movements, diarrhea, and tiredness were spontaneously discussed by ≥60% of the participants, while blood in stool, cramping in abdomen, urgent bowel movement, nausea, and low appetite were spontaneously discussed by ≥30% of the participants. More than 15 other symptoms such as joint issues, abscess/fissures, and hives/rashes were each mentioned by at least one participant. In addition, ≥50% of the participants discussed impacts related to CD including school attendance, exercise/sports, eating and drinking limitations, and play and leisure.

Conclusions
The results from CE interviews demonstrate the clear burden of CD on children and adolescents.
P035 ADJUNCT PHARMACOTHERAPY USE FOR POUCH-RELATED SYMPTOMS IN PATIENTS WITH ILEAL POUCH-ANAL ANASTOMOSIS
Authors: Nyabanga Custon , Axelrad Jordan , Zhang Xian , Barnes Edward , Sandler Robert , Chang Shannon 
Published: January 2020

Abstract

Background
For patients with recalcitrant ulcerative colitis or indeterminate colitis, surgical intervention with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the standard of therapy. The most common complication after IPAA is pouchitis, which may manifest with pouch related symptoms (PRS) such as increased bowel frequency, abdominal pain, pelvic pain, urgency, or incontinence, necessitating use of adjunctive pharmacotherapies for symptom control. We evaluated the prevalence of opioid-, NSAID-, and probiotic-use among IPAA patients with and without PRS.

Methods
Utilizing patient questionnaires from the IBD Partners database cohort of patients with IPAA, we examined baseline characteristics, antibiotic and biologic use, adjunct pharmacotherapy use, and patient reported outcomes (PROs) including bowel frequency, urgency of defecation, and general well-being. We used specific Patient-Reported Outcome Measurement Information System (PROMIS) measures (measured in T-scores) to assess abdominal pain and depression. Bivariate analysis of baseline demographics and medication use patterns was performed to compare IPAA patients with PRS and without PRS. Among patients with PRS, PROs were compared among opioid, NSAID, and probiotic users.

Results
We identified 363 patients with IPAA patients in the IBD Partners database, and 266 (73%) reported PRS within 6 months of completing their last survey. In comparison to those without PRS, patients with significant PRS had a shorter time since diagnosis of IBD (P = 0.015), higher prevalence of antibiotic use (P &lt; 0.05), higher rectal steroid use (P = 0.003), and more prevalent adalimumab use (P = 0.041). Among patients with PRS, there were no significant differences in PROs based on NSAID or probiotic usage. However, opiate users with PRS noted increased bowel frequency, urgency of defecation, poor general well-being, abdominal pain, and depression (P &lt; 0.05 for all variables).

Conclusion
Among IBD patients with IPAA with PRS, the use of NSAIDS and probiotics was not associated with differences in PROs. Opioid use was associated with higher burden of PRS, but further studies will be required to elucidate association or causality.