bluuebunny/crossref_metadata_2025_split huggingface dataset:
P737 Ustekinumab induction effectiveness in Crohn’s disease in a real-life cohort
Authors: Sánchez Rodríguez E , Mesonero Gismero F , López sanroman A 
Published: January 2020

Abstract

Background
Evaluation of Ustekinumab induction therapy is generally performed at week 16. Our aim was to evaluate if a delayed response may be expected beyond that time.

Methods
Retrospective study including patients with CD who received Ustekinumab since 1 June 2017 to 1 May 2019. Iv induction dose was based on weight while maintenance was conducted with 90 mg subcutaneous every 8 weeks.

Results
Twenty-five patients (52% male) were enrolled, of whom 28% (7/25) had ileal, 28(7/25) colonic, 44% (11/25) ileocolonic and 8% (2/25) upper tract involvement. Sixty-eight per cent (17/25) presented an inflammatory, 16% (4/25) a stricturing and 16% (4/25) a penetrating behaviour. Perianal disease was diagnosed in 20% of patients (5/25). All patients 100% (25/25) had previously taken immunosuppressants and 96% (24/25) biological therapy (mean 1.8 ± 0.87 (0–3) per patient): 36% (9/25) one, 36% (9/25) two and 24% (6/25) three agents. Ustekinumab was prescribed for achieving remission in 92% (23/25) of the patients, fistulising disease in 4% (1/25) and for maintenance of remission in the same percentage. Follow-up was 373.16 ± 182.53(59–683) days. Discontinuation rate was 24% (6/25), due to primary failure in 100% (6/6). For those who stopped the drug, average treatment time was 137.17 ± 95.11(61–1320) days whereas that of those who continued was 346.84 ± 192.10(32–669) days. Clinical response was evaluated at week 8, week 14–16, week 22–24 and during long-term maintenance (Table 1). All comparisons were statistically significant (p &lt; 0.05). We recorded Harvey-Bradshaw index(H-B), CRP and faecal calprotectin (FC) before induction with ustekinumab, at weeks 14–16, at weeks 22–24 and during maintenance. Results are presented in Table 2.

Conclusion
Evaluation of induction effectiveness at week 22–24 may allow to rescue those patients who present a delayed response to UST. During a 373.16 days follow-up, loss of response to Ustekinumab is low.
P738 Real world outcomes on the efficacy and safety of combination of biologic and immunosuppressive therapy in liver transplant recipients with inflammatory bowel disease
Authors: Chatzinikolaou M L , O’Shea N , Erian G , Koutsoumpas A , Ryan J , Hamilton M , Murray C 
Published: January 2020

Abstract

Background
Following liver transplantation (LT), more than a third of patients with inflammatory bowel disease (IBD) will have an aggressive disease course, requiring treatment with biologics. Data on efficacy and safety of biologics in this setting are limited. We report our experience in IBD patients on biologics following LT.

Methods
Data were collected retrospectively from medical files of patients who underwent LT from 1989 to 2019 in a tertiary referral centre and required IBD treatment with biologics post-LT. Clinical and endoscopic responses, and concomitant corticosteroid requirement were used as a measure of efficacy. Adverse events and infections were recorded.

Results
We identified 10 patients who received treatment with biologics post-LT. The majority were males (n = 7), had a diagnosis of ulcerative colitis (UC) prior to LT (n = 9) and the primary liver disease leading to LT was primary sclerosing cholangitis (PSC). Median time from LT to biologic initiation was 6 years (range 2–17). All patients received tacrolimus as part of anti-rejection therapy, 8 patients were on azathioprine and 2 on mycophenolate mofetil. Two patients had a proctocolectomy prior to LT. The majority (n = 9) were biologic naïve. As a 1st line treatment 7 patients received infliximab (IFX), 1 adalimumab (ADA) and 2 vedolizumab (VDZ). Following allergic reaction to IFX, 2 patients were switched to VDZ. One patient with chronic pouchitis received ADA following IFX failure. Mean duration on IFX in patients on maintenance therapy was 23 months (range 8–33), for ADA 34 months (range 17–50) and for VDZ 12 months (range 6–24). Three patients on IFX (1 with chronic pouchitis) responded to treatment, with one achieving endoscopic remission and another improvement of pouchitis. One patient, despite initial response, treatment escalation and rescue corticosteroids, required colectomy, and so did another after failing both IFX and VDZ. The 2 patients on maintenance ADA showed clinical and endoscopic improvement. Responses to VDZ were mixed; 2 patients improved, but 3 did not respond to VDZ therapy. The infections recorded for patients on IFX (n = 4/7) were cholangitis, Clostridium difficile, TB-related erythema induratum, EBV and CMV colitis, liver and perianal abscesses and Bell’s palsy secondary to CMV/EBV. One patient (n = 1/2) on ADA had a bacterial upper respiratory tract infection, while another on VDZ (n = 1/5) developed pericarditis, corneal ulceration and viral eye infection. No cancers have been detected to date (median follow-up 107 months, range 26–253).

Conclusion
Anti-TNF and VDZ therapy may be effective in the post-LT IBD setting. Caution is warranted regarding infections, particularly for patients on concomitant anti-rejection therapy and IFX.
P743 Time trends of Crohn’s disease in Catalonia from 2011 to 2017. Increasing use of biologics correlates with a reduced need for surgery. A population-based study in Catalonia
Authors: Brunet E , Melcarne L , Vela E , Clèries M , Pontes C , García-Iglesias P , Gallach M , Hernández L , Soria A , Jordi V , Pedregal P , Grau G , Garcia-Sagué B , Frisancho L E , Villòria A , Vergara M , Calvet X 
Published: January 2020

Abstract

Background
Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalisation. However, data on the trends in biological drug use and outcomes in CD patients are scarce. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes such as surgery and hospitalisation in Catalonia.

Methods
All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Time trends for surgery and hospitalisation were described and tested for correlation with treatment using the statistical package R, version 3.4.3.

Results
Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively. Biological treatment use rose from 15.0% to 18.7%. Adalimumab was the most frequently prescribed biologic (1604 patients; 52% of all biologics in 2017). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017, and surgical resection rates from 24.1 to 18.0. The rate of CD-related hospitalisations per 1000 patients/year also fell, from 92.7 to 72.2.

Conclusion
Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During the same period, we observed an improvement in the outcomes of CD patients.
P751 Prevalence and risk factors of non-alcoholic fatty liver disease in inflammatory bowel diseases
Authors: Hoffmann P , Jung V , Behnisch R , Gauss A 
Published: January 2020

Abstract

Background
Non-alcohol fatty liver disease (NAFLD) is a widespread disease in Europe with a prevalence of 20–30% in the German population. Some studies have revealed even higher prevalence in patients with inflammatory bowel diseases (IBD). The majority of prior studies on this subject are cross-sectional analyses. Longitudinal data for the identification of prognostic parameters are missing.

Methods
This is a monocentric retrospective study encompassing both a cross-sectional and a longitudinal part. The study included 440 patients with Crohn’s disease (CD) and 254 patients with ulcerative colitis (UC). Inclusion criteria were diagnosis of IBD, age &gt;17 years, and having received at least one abdominal ultrasound of the liver at the IBD outpatient clinic of the Heidelberg University Hospital. Exclusion criteria were presence of any infectious liver disease, alcoholic fatty liver disease, or documented abuse of alcohol. NAFLD was defined by echogenicity via ultrasoud and assigned in degrees of severity (no, mild, moderate or severe steatosis). As potential risk factors for the development of NAFLD, demographic characteristics, IBD activity (clinical scores, laboratory results, endoscopic or ultrasound findings), and IBD medications were investigated.

Results
The prevalence of NAFLD was 48% in CD patients and 44% in UC patients. Higher age and body mass index (BMI) were significantly associated with the occurrence of NAFLD. NAFLD was associated with higher Harvey Bradshaw Index in CD patients, while laboratory results, endoscopic or ultrasound findings proving inflammation were not associated with NAFLD. In UC patients, there was no association between disease activity and NAFLD.
The use of steroids, immunomodulators or biologics was not associated with NAFLD, while the use of sulfasalazine was associated with NAFLD only in CD patients.
In the longitudinal part of this study, 2467 hepatic ultrasound results were included. Age and BMI in CD patients and BMI in UC patients were significant risk factors in the mixed logistic regression model. Also, in CD patients, higher HBI, former bowel resections, endoscopic disease activity and use of azathioprine–not of steroids–were risk factors of NAFLD. In UC patients, endoscopic disease activity was significantly associated with NAFLD in the mixed logistic regression model.

Conclusion
There is a high prevalence of NAFLD in German IBD patients. The risk to develop NAFLD increases in older patients and patients with higher BMI. Disease activity and azathioprine use in CD may increase the prevalence of NAFLD. Our study provides a rationale for regular ultrasound screening of the liver in IBD patients.
P754 Inflammatory bowel disease-like disease in patients with primary immunodeficiencies with chronic digestive symptoms: Diagnostic yield of colonoscopy
Authors: SANCHEZ M B , Cepeda J , Etchevers M J , Sobrero M J , Gonzalez Sueyro R , Arguero M J , De Paula J A , Marcolongo M M 
Published: January 2020

Abstract

Background
Primary immunodeficiencies (PIDs) are a heterogeneous group of diseases characterised by genetic defects in the immune system. The respiratory and gastrointestinal tracts are the most affected. Digestive involvement may be due to infections, immune-mediation or malignancy. Immune-mediated involvement is expressed clinically and endoscopically like an inflammatory bowel disease (IBD-like disease). The objective of this study was to describe the endoscopic and histological findings in patients with PID and chronic digestive symptoms studied by colonoscopy with a final diagnosis of IBD-like disease.

Methods
Between 2004 and 2017 we included 30 patients with PID, chronic digestive manifestations and at least one colonoscopy with negative stool microbiological studies.

Results
Of the patients included, 19 (63%) were women. The median age was 62 years (IQR 49–74). Seven (23%) presented selective IgA deficiency, 11 (37%) common variable immunodeficiency (CVID) and 12 (40%) hypogammaglobulinemia. The digestive symptoms reported were chronic diarrhea (73%), abdominal pain (73%) and weight loss (36%). Ten patients (33.3%) had IBD associated, 5 had a pattern of ulcerative colitis (UC), 3 of Crohn’s disease (CD) and 2 of non-classifiable IBD (NCIBD). Diarrhoea was the most common manifestation in those with IBD-like disease (100%). The most frequent-related PID was CVID (54%). Of the 5 UC-like patients, 4 were extensive and 1 proctitis; the 3 CD-like patients presented ileocolic location. Of the 10 patients with IBD-like disease colonoscopy showed: oedema (40%), loss of vascular pattern (40%), erosions (30%), ulcers (40%), pseudopolyps (10%) and 50% did not present endoscopic findings at the time of the study. Histological features were chronic inflammation (100%), cryptitis-pericryptitis-microabscesses (60%) and granulomas (10%). Additionally, we found the presence of apoptotic cells (40%) and absence of plasmocytes in the lamina propria (40%). Upper endoscopy was performed concomitantly in 24 patients, in 17% we found at duodenum nodularity and scalloping. Duodenal biopsies were taken in 15 patients and the histological features were: increased intraepithelial lymphocytes (40%), crypt hyperplasia (20%), atrophic mucosa (6.6%).

Conclusion
One third of patients with PID and chronic digestive symptoms who performed a colonoscopy presented IBD-like disease. CVID was the most associated PID with IBD-like disease. Half of the patients had no colonoscopic findings, so taking random biopsies is suggested. Histological findings were typical of IBD, being the presence of apoptotic bodies and the absence of plasma cells distinctive of the associated PID.
P757 Focusing on the future: Reducing barriers and improving access to inflammatory bowel disease specialty care across Canada
Authors: Heisler C G , Mirza R , Kits O , Zelinsky S , Veldhuyzen van Zanten S , Nguyen G , McCurdy J , MacMillan M , Lakatos P L , Targownik L , Fowler S , Rioux K , Jones J 
Published: January 2020

Abstract

Background
Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence and limited resources, timely access to IBD care continues to be a widespread issue for patients and healthcare providers. Despite this pervasive issue, there has been no published research to date elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. The aim of the study was to elicit a qualitative stream of data to better understand phenomena related to access to IBD care from a patient-centered perspective.

Methods
Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from both urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member involved in their care to the focus groups. Co-facilitated by a researcher and patient-research partner, all focus groups were audio recorded, transcribed verbatim, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences in relation to IBD care access.

Results
Sixty-three participants were recruited in 14 focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Thematic analyses identified four main barrier themes, each with multiple sub-themes: (1) structure/system issues (i.e. system stagnation), (2) processes (i.e. information management), (3) experiences (i.e. psychosocial support), and (4) patient as partner (i.e. autonomy, power dynamics). In response, four solution themes were proposed: (1) integration of holistic care into the clinical practice, (2) readily accessible psychosocial and nutritional support, (3) increased patient advocacy, and (4) continuity and liaison through provision of a healthcare navigator resource.

Conclusion
The complexity of IBD specialty care access cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in can be better understood and improved on both a national and international scale.
P761 Illness cognition of Saudi patients with Crohn’s disease
Authors: Mosli M H A , Saeedi A , ALNEFAIE M , Bawahab N , Abdu L , Shobai S 
Published: January 2020

Abstract

Background
The prevalence of Crohn’s disease (CD) has markedly increased in Saudi Arabia over the past 3 decades.Patients’ awareness of the chronic recurrent course and potential risk of disease complications can lead to a wide range of psychological and interpersonal concerns. Patients’ cognition about the disease and treatment are important mediators as they explain the occurrence of individual differences in the individuals’ adjustment to chronic diseases. The aim of this study is to assess illness cognition of Saudi patients diagnosed with CD and to identify clinical predictors.

Methods
Consecutive patients with confirmed CD seen in the adult outpatient gastroenterology clinic at King Abdulaziz university hospital were recruited between January and December of 2019. Data was collected from interviews conducted with the patients and from the hospitals’ electronic medical records.The primary endpoint of the study was patients’ illness cognition according to the illness cognition questionnaire (ICQ), which can be used to assess three cognitive functions that patients attribute to disease: helplessness (6 items), acceptance (6 items), and perceived benefits (6 items). Each item is scored from 1 to 4, with 1 corresponding to ‘Not’, and 4 corresponding to ‘Totally. Descriptive statistics were used to summarise patient characteristics and linear regression analysis was used to identify predictors of the ICQ score.

Results
A total of 88 patients were surveyed, of which 55.8% were females, 18% were smokers and 11.5% had undergone CD-related surgery. The mean age was 26.9 ± 7.7 years and the mean duration of disease was 54.7 ± 60.5 months. Perianal disease was reported by 16.1% of the cohort. Twenty eight percent of patients reported that they ‘completely’ missed things that they like to do the most because of their illness and 35% responded by ‘not at all’ when asked if they had learned to live with their disease. Forty one percent of patients reported that the illness ‘completely’ controls their life and 30% responded by ‘not at all’ when asked if they can accept their illness. Mean ICQ score was 44.3 ( ± 6.6). On linear regression analysis, duration of the disease in months (coef = −0.04, p = 0.008) and fatigue (coef = −1.40, p = 0.04) were predictive of the ICQ score.

Conclusion
A considerable proportion of Saudi patients diagnosed with CD report negative perception of their disease. Duration of illness and presence of fatigue appear to be predictive of the ICQ score.
P764 Phenotypic analysis of patients with inflammatory bowel disease: 23 year data of a centre in a South American country
Authors: Páez Cancelado C C , García Duperly R , Park J , López Panqueva R , Londoño Schimmer E E , Rey Rubiano A M , Padrón Mercado J E , Mejía Arango M , Gómez Aldana A , Vallejo Madroñero R J , Mendoza De Molano B 
Published: January 2020

Abstract

Background
Inflammatory Bowel Disease (IBD) includes Ulcerative Colitis (UC) and Crohn Disease (CD). In the last decade, there have been introduced therapeutic changes that have revolutionised the pharmacologic and surgical management of patients with IBD. The incidence of UC and CD has been increasing in Latin America but the exact prevalence is unknown. Our objective is to describe the demographic characteristics, clinical and therapeutic aspects of the IBD in patients that have presented in the University Hospital Fundación Santa Fe de Bogotá (UH-FSFB), Colombia.

Methods
Retrospective Descriptive Cohort Study. Clinical histories, pathology reports, and endoscopic results from data base HI-ISIS of the UH-FSFB and medical data between January 1996 and February 2019 were recollected, stored in Excel and analysed using IBM SPSS Statistics Visor. Patients with diagnosis of IBD were included. Patients with incomplete clinical histories were excluded.

Results
From 398 patients included in this study, 72.1% had UC, 25.6% CD and 2.3% Indeterminate Colitis. The average age of diagnosis was 43.54 years (range: 12–91). In both patients with UC and CD there were smaller proportions of men than women (0.9:1 for UC and 0.7:1 for CD).
Of the patients with UC, 46.3% had been hospitalised. 37.2% presented with proctitis, 23.8% left colitis and 39% with pancolitis. 13.5% had an asymptomatic clinical disease, 22.4% mild, 15.3% moderate, and 48.8% severe. 12.9% received biological therapy (BT). 24.3% of patients received a second line BT. Fifteen per cent required surgical interventions (SI), of which there were no mortalities. 27% who were receiving BT required SI.
Of the patients with CD, 82.4% required hospitalisation. 43.1% had an ileal, 9.8% colonic, 39.2% ileal- colonic, 0% isolated upper digestive and 21.6% perianal compromise. 34.3% had non-stenosing behaviour, 49% stenosing and 16.7% penetrating. 44.1% of patients with CD received BT of which 40% required a second line BT. 55.9% required SI, of which 1 mortality was reported. 71.1% who were receiving BT required a SI.

Conclusion
Our study contributes to the epidemiology and integral management required by patients with IBD in our environment. More studies are recommended that replicate our methodology in the population with IBD in both Colombia and Latin America.