bluuebunny/crossref_metadata_2025_split huggingface dataset:
P780 Proteinuria is associated with the development of Crohn’s disease: a nationwide population-based study
Authors: Kim J S , Park S , Lee H J , Soh H , Moon J M , Hong S W , Kang E A , Im J P 
Published: January 2020

Abstract

Background
Proteinuria has been identified as a sign of systemic endothelial dysfunction and chronic inflammation, and associated with the development of several systemic inflammatory diseases. However, the impact of proteinuria and its severity on the incidence of inflammatory bowel disease (IBD) has not been studied yet. The aim of this study was to determine the association between proteinuria measured by urine dipstick test and the development of IBD.

Methods
We conducted a nationwide population-based cohort study using claims data from the National Health Insurance (NHI) database, a mandatory health insurance programme covering about 97% of the Korean population. A total of 9,917,400 people aged 20 years or older who had undergone a national health examination conducted by NHI in 2009 were followed until 2017. The study population was classified into four groups, negative, trace, 1+, and ≥2+, depending on the degree of proteinuria measured by urine dipstick test. The primary endpoint was the newly diagnosed IBD, Crohn’s disease (CD) or ulcerative colitis (UC) during the follow-up period, which was detected by both ICD-10 (K50 and K51) and the rare intractable disease registration programme codes which provide co-payment reduction of up to 90% in South Korea.

Results
The incidence of CD significantly increased according to the degree of proteinuria (adjusted hazard ratio [aHR] with 95% confidence interval [CI], 1.01(0.703–1.451), 1.515(1.058–2.162), and 2.053(1.301–3.24) in trace, 1+, and ≥2+ dipstick groups, respectively) as compared with the dipstick-negative group. However, there was no significant difference in the incidence of UC among the degrees of proteinuria (aHR with 95% CI, 1.12(0.949–1.323), 0.947(0.764–1.174), 1.009(0.741–1.373 in trace, 1+, and ≥2+ dipstick groups, respectively). In subgroup analysis, dipstick-positive proteinuria independently increased the incidence of CD regardless of subgroups. However, in the development of UC, dipstick-positive proteinuria increased the risk of UC in those with diabetes mellitus (DM), but not in those without DM (aHR, 1.527 vs. 0.846; interaction p-value 0.004).

Conclusion
Proteinuria, measured by dipstick test, may be associated with the development of CD.
P803 The risk of spine and hip fracture in patients with inflammatory bowel diseases: a nationwide population-based study
Authors: Kim Y J , Ahn H J , Noh S , Park J C , Kim J Y , Kim J , Ham N S , Oh E H , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K , Park S H 
Published: January 2020

Abstract

Background
This nationwide population-based study sought to investigate the risk of spine and hip fracture in patients with inflammatory bowel diseases (IBD).

Methods
Using the 2007–2016 data from the Korean national health insurance claims database, we calculated incidence rate and incidence rate ratios (IRR) of spine and hip fracture in patients with IBD (n = 18,228; 64.1% male, 65.9% ulcerative colitis [UC]) compared with age- and sex- frequency matched subjects in 1:10 ratio (n = 186,871). A Cox regression model was used to evaluate risk of spine and hip fracture.

Results
The incidence rate and IRR of spine and hip fracture in IBD were 2.88/1000 person-years and 1.21 (95% confidence interval [CI], 1.11–1.31) during the median follow-up of 4.5 years. The risk for spine and hip fracture was significantly higher in UC (IRR 1.39, 95% CI, 1.25- 1.54), whereas it was not significantly higher in Crohn’s disease (IRR 0.85, 95% CI, 0.67- 1.06) than matched controls. In UC, the IRR of spine fracture was 1.41 (95% CI, 1.24–1.58) and the IRR of hip fracture was 1.40 (95% CI, 1.11–1.71). In multivariable analysis using the Cox regression model, the risk of spine and hip fracture increased with age (p trend &lt; 0.001), in female patients (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.50–2.51) and in patients with comorbidities including osteoporosis (aHR 2.86; 95% CI, 2.10–3.89), stroke (aHR 2.74; 95% CI, 1.78–4.21) hypertension (aHR 1.82; 95% CI, 1.38–2.41), diabetes mellitus (aHR 1.67; 95% CI, 1.25–2.24) and dyslipidaemia (aHR 1.36; 95% CI, 1.05–1.78).

Conclusion
In a population-based study from Korea, we found that the risk for spine and hip fracture increased in patients with IBD, especially in UC patients. Also, this risk increased in patients who are older, female, or have comorbidities.
P804 Temporal trends and the influence of regional and socioeconomic status on the incidence of inflammatory bowel disease: Using National Health Insurance Service Database in Korea, 2005–2017
Authors: Kim S , Lee J , Kwak G , Park Y , Oh S , - S , Yang K , Yoon H , Kim K 
Published: January 2020

Abstract

Background
Well analysed data from the health insurance registry allows us detailed and various analyses of a nation-wide population study. In this study, we validate the diagnostic criteria of occurrence of new cases of Inflammatory Bowel Disease (IBD) using health insurance database and investigate the epidemiological features of IBD in Korea.

Methods
A population-based clinical data of patients with IBD in the Songpa-Kangdong district of Seoul was used as reference cases and the database of National Health Insurance Service from 2005 to 2015 was retrospectively reviewed to compare the diagnostic criteria. The most accurate criterion was applied to the entire database (2002–2017) with 3-year washout period for further assessment. Non-parametric statistics and p for trend analysis were used.

Results
The most accurate criteria of new cases of IBD was the combination of the experience of colonoscopy, IBD-specific medications at least 3 months and the International Classification of Disease 10th codes for Crohn’s disease (CD) and Ulcerative colitis (UC). With this criterion, new incident cases of IBD were 40,807 (14,183 CD, 26,624 UC) during the study period. The male to female ratio of age-adjusted incidence rate was 2.5:1 for CD and 1.4:1 for UC. Age- and sex-adjusted incidence per 100,000 population of CD and UC had increased from 1.4 and 3.6 (in 2005) to 2.2 and 4.2 (in 2017). Over 13 year period, the peak incidence of CD in both male and female was between 15 and 24 years of age without significant change while the peak incidence of UC was shifted from 55–64 years (in 2005–2008) to 25–34 years of age (in 2014–2017). There was a positive correlation between the socioeconomic status and incidence of IBD (p &lt; 0.01). The standardised incidence rates of CD and UC in metropolitan areas were 2.4 and 4.3 per 100,000 population, while that in non-metropolitan areas were 2.0 and 3.8 per 100,000 population. The incidence rate of CD in metropolitan area was still significantly higher than in non-metropolitan area after the adjustment of socioeconomic status (p = 0.03).

Conclusion
The incidence of IBD in Korea has increased over the recent decade with the shift to younger age groups. The higher incidence in higher socioeconomic status and metropolitan areas gives a clue to the aetiology of this disease.
P832 Gastrointestinal infections are associated with unique gut microbiome signatures in patients with inflammatory bowel disease
Authors: Axelrad J , Hine A , Devlin J , Loke P , Cadwell K 
Published: January 2020

Abstract

Background
Stool PCR pathogen panel assays have implicated enteric infection in nearly 30% of inflammatory bowel disease (IBD) flares, most commonly with Clostridioides difficile, Escherichia coli, and norovirus. Many questions remain about the interpretation of a positive stool PCR result, and the similar presentations of infection and flare present a clinical challenge. We aimed to characterise the gut microbiome during an infection with C. difficile, E. coli, or norovirus in patients with and without IBD to microbially differentiate patients with an enteric infection, flare of IBD, and flare of IBD complicated by a pathogen.

Methods
We performed a cross-sectional study of patients with a stool PCR panel positive for C. difficile, E. coli subtypes, norovirus, or negative for all pathogens during an episode of gastrointestinal symptoms from September 2018 to February 2019. Clinical data and remnant stool specimens were collected. Our primary outcome was microbiome signature using 16s bacterial rRNA gene sequencing derived from linear discriminant analysis effect size (LEfSe) to identify microbes associated with each pathogen and clinical scenario stratified by IBD.

Results
We identified 119 patients, 19 (16%) with IBD, with C. difficile (n = 30), an E. coli subtype (n = 30), norovirus (n = 29), or negative for all pathogens (n = 30; Table). Hematochezia on presentation and recent antibiotic or hospitalisation exposure was more common in pathogen negative patients compared with pathogen positive patients (p = 0.045, p = 0.007, respectively). Patients with IBD without a pathogen or with C. difficile tended to have higher serum biomarkers of inflammation (median CRP 24 and 28, respectively) compared with patients with an E. coli subtype (CRP 5) or norovirus (CRP 11). On LEfSe, patients with C. difficile were enriched in Enterobacteriaceae and Clostridioides, E. coli subtypes in Faecalibacterium, norovirus in Roseburia, and negative for a pathogen in Bacteroides. Stratifying by IBD and pathogen, there were several differentially abundant microbes denoting a specific gut microbial signature associated with each pathogen and IBD (Figure).

Conclusion
In this study of patients with C. difficile, E. coli, norovirus, or negative for pathogens during an episode of gastrointestinal symptoms, there were major differences in presentation and gut microbiota between patients with and without an enteric pathogen and IBD. These data demonstrate that gut microbiomes distinguish and differentially respond to pathogens. In patients with IBD, coupled with a unique microbiota, serum biomarkers of inflammation were lower in patients with E. coli or norovirus, suggesting a milder subset of IBD flare.
P838 Characteristics of mucosal microbial composition of patients with inflammatory bowel disease susceptibility HLA genotype
Authors: Hirano A , Umeno J , Torisu T 
Published: January 2020

Abstract

Background
Although inflammatory bowel diseases (IBD) is presumed to develop as the result of dysregulated immune response to the intestinal microbiota in genetically susceptible hosts, the association between microbiota and genotypes in IBD patients remains unclear. The human leukocyte antigen (HLA)-Cw*1202-B*5201-DRB1*1502 haplotype has been reported to increase the susceptibility to ulcerative colitis (UC), and the HLA-DRB1#37Ser reduce the risk of Crohn’s disease (CD) in East Asian population. We investigated the association between IBD susceptibility HLA genotype and mucosal microbial composition to elucidate the pathogenesis of IBD.

Methods
Mucosal bioptic sampling was performed from the rectum under colonoscopy for the analysis of mucosal microbial composition among 54 IBD patients (27 patients with CD and 27 patients with UC). The mucosal microbial community structure was investigated using 16S rRNA gene sequences, and the structures were analysed using Qiime and LEfSe software. All patients were genotyped using the Affymetrix Japonica Array, and their HLA genotypes were determined by imputation based on the Japanese-specific references.

Results
Twelve CD patients had the HLA-DRB1#37Ser allele and 15 UC patients had the HLA-Cw*1202-B*5201-DRB1*1502 allele. Microbes of family Barnesiellaceae and genus Anaerofilum were more abundant in HLA-DRB1#37Ser allele carriers when compared with non-carriers among CD patients. Among UC patients, decreased abundance of the genus Acidaminococcus and increased abundance of genera Veillonella, SMB53, Lachnospira and Haemophilus was evident in HLA-Cw*1202-B*5201-DRB1*1502 allele carriers when compared with non-carriers.

Conclusion
IBD susceptibility HLA genotype might affect mucosal microbiota composition in both CD and UC.
P841 Evaluation of gut microbiota composition in NAFLD with UC pancolitis in clinical remission: a pilot study
Authors: Cocciolillo S , De Palma G , Chen T , Ghali M P , Deschenes M , Wong P , Wild G , Afif W , Lakatos P L , Bitton A , Sebastiani G , Bercik P , Bessissow T 
Published: January 2020

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver disease in Western countries and is a frequently reported comorbidity in inflammatory bowel disease (IBD). A complex interaction among polygenic predisposition, IBD-specific risk factors, microbiome, multiple environmental and patients’ factors could explain the development of NAFLD in IBD. Gut dysbiosis is increasingly recognised as an important player in NAFLD, as well as in IBD pathogenesis. So far, no study has examined the gut microbiota composition in IBD patients with NAFLD. We aimed to characterise faecal microbiota according to NAFLD status in a pilot cohort of ulcerative colitis (UC) pancolitis in clinical remission.

Methods
This was a cross-sectional pilot study using transient elastography (TE) with controlled attenuation parameter (CAP) to diagnose NAFLD in UC pancolitis patients in clinical remission, defined as partial Mayo score ≤1. NAFLD was diagnosed non-invasively as CAP ≥248 dB/m. Exclusion criteria included: use of corticosteroids in the last year and antibiotics or probiotics/prebiotics in the last 2 months prior to inclusion; significant alcohol intake (AUDIT-C &lt;5); hepatitis B or C infection. Stool samples were collected within 12 h from TE with CAP evaluation. Gut microbiota composition was analysed by 16S rRNA gene sequencing with Illumina technique. Statistical analysis by NAFLD status was performed using Fisher’s exact or Mann–Whitney’s test as appropriate.

Results
A total of 11 UC pancolitis patients in clinical remission were included (mean age 53 years, 36.4% male, time since IBD diagnosis 16 years). NAFLD was diagnosed in 7 cases (63.6%, mean CAP 291 dB/m). Patients with pancolitis and NAFLD had higher BMI (mean 31 vs. 22 kg/m2, p = 0.006) as well as waist circumference (mean 100 vs. 81 cm, p = 0.006) compared with those without NAFLD, but no other differences in demographic, clinical or pharmacological parameters were found between pancolitis with or without NAFLD. Patients with pancolitis and NAFLD clustered separately from those without NAFLD, when computing Bray Curtis dissimilarities (tested with Adonis, p = 0.006). In addition, patients with pancolitis and NAFLD presented with decreased bacterial richness (p = 0.017) but not diversity. This was accompanied by a significant increase of Bacteroides spp. relative abundance in faecal samples of patients with pancolitis and NAFLD (q = 0.017).

Conclusion
This pilot study demonstrates, for the first time, that, in UC pancolitis patients, NAFLD associates with altered gut microbiota composition. Further studies are needed to understand the exact role of gut microbiota in UC pancolitis with NAFLD and to evaluate the use of microbiota-directed approaches for the treatment of NAFLD in these patients.
P851 Effects of conservation time on the diversity and relative abundance of intestinal microbiome in samples of faecal matters
Authors: León F M , Nieto C A , Corredor Z , Flórez-Sarmiento C , Parra-Izquierdo V , Romero-Sanchez C 
Published: January 2020

Abstract

Background
Given the complexity and diversity of the intestinal microbiome, there is a technical challenge of finding the best way to study the factors that affect the quality of the sample to obtain results in a precise an complete way.

Objective
To establish the effect of storage time under constant cryopreservation conditions (−20°C) in stool samples for the study of the gastrointestinal microbiome

Methods
A sample of stool was distributed in 3 fractions (1, 2 and 3). Time 0 without cryopreservation and immediate DNA extraction (1). The samples of 15 (2) and 30 (3) days were cryopreserved at −20°C before the extraction of the genetic material. After ultracentrifugation at 4 degrees Celsius, the precipitate was subjected to enzymatic and mechanical lysis to obtain the total DNA. The DNA quality was evaluated techniques to ensure the quality and concentration of genetic material. Once the DNA of the three samples was obtained, they were subjected to the latest generation of a variable region of the 16S gene, using MiSeq technology (Illuminates). Data in relative abundances and frequencies were recorded. Project supported by the Administrative Department of Science, Technology and Innovation-Colciencias Health Call 2017, Code 130877757442

Results
About 140 thousand readings were obtained for samples 1 (day 0) and 2 (day 15) and 160 thousand for sample 3 (day 30), with a reading quality Q20% between 97 and 98 and Q30% around 94, indicating a high-reliability value for each of the samples. Regarding the classification from the Operating Taxonomic Unit (OTU), 119, 99 and 106 were reported for samples 1, 2 and 3, respectively. The data obtained revealed changes over time at the level of the main edges reported for normal microbiome (Bacteroidetes, Firmicutes, Actinobacteria) between 1 and 2 vs. sample 3. For Firmicutes and Actinobacteria, decreases in abundance of 34% were observed (samples 1 and 2) at 20% for Firmicutes in sample 3 and from 4% (samples 1 and 2) to 0.8% (sample 3) for Actinobacteria. On the contrary, Bacteroidetes presented an increase in its abundance from 58% (Samples 1 and 2) to 76% (sample 3). The Proteobacterium edge did not show significant changes in its abundance

Conclusion
It was possible to demonstrate that the cryopreservation time before DNA extraction is an important variable that influences the percentage and integrity of the microbiota from faecal matter. Confirming that the maximum reliable shelf life at −20° in stool samples is up to 15 days, suggesting that for longer storage the temperature decrease up to −80° should be taken into account to maintain stability in the results of relative abundance and bacterial diversity
N06 Help-seeking behaviours for fatigue in inflammatory bowel disease
Authors: NI DHALAIGH D , Anna Marie G , Farrell D 
Published: January 2020

Abstract

Background
Fatigue is a common and burdensome symptom of inflammatory bowel disease (IBD). Although many symptoms of IBD can be debilitating, fatigue is reported by people with IBD as the most difficult symptom to live with. It is experienced by up to 86% of people in active disease and 41–48% of people with IBD in remission, and impacts greatly on all aspects of people’s lives. Fatigue is a complex and invisible symptom and therefore can often be overlooked by those caring for people with IBD. Since it is invisible, it can only be made known to healthcare professionals if patients seek help for it. The experience of people who seek help for IBD fatigue is unknown, as are the reasons some choose to seek help and others do not. This study aims to explore the determinants of help-seeking behaviour for fatigue in IBD and examine why some people with IBD fatigue are more likely to seek help than others.

Methods
An exploratory qualitative method was employed, underpinned by the Theory of Planned Behaviour. A voluntary sample of 12 people with a diagnosis of IBD was recruited from the Irish Society of Crohn’s and Colitis. The sample included people who had and who had not sought help for IBD fatigue in the past. Semi-structured interviews were conducted using an interview guide. Themes were uncovered using content analysis.

Results
Themes uncovered included symptom perception, impact of IBD fatigue and knowledge of and access to sources of help. Most commonly, people did not seek help if they could continue life with relative normalcy in spite of IBD fatigue. Access and availability of help was perceived as good. Barriers, such as time and cost, were identified as making help-seeking more difficult at times, however these did not prevent seeking help. Poor knowledge of the sources of help, IBD fatigue being regarded as an inferior symptom to other symptoms and the perceived lack of interventions to manage the complex symptom emerged as important factors influencing help-seeking behaviour.

Conclusion
The Theory of Planned Behaviour was found to be a useful framework to predict help-seeking behaviour for IBD fatigue. Symptom perception, impact of IBD fatigue and knowledge of and access to sources of help are the most influential aspects of help-seeking behaviour. IBD fatigue appears to lack the legitimacy of other IBD symptoms. Therefore, there is a need for healthcare professionals to fully acknowledge and routinely assess fatigue as part of the clinical management of IBD. Further research aimed at specifically managing fatigue as a major IBD burden is warranted, in particular multidimensional, holistic interventions to help people cope with the impact of IBD fatigue.
42 Comparison of different imaging modalities for the quantification of tricuspid valve geometry and regurgitation
Authors: Ozturk C , Schueler R , Weber M , Nickenig G , Hammerstingl C 
Published: January 2020

Abstract

Objectives
Tricuspid regurgitation (TR) is a frequent valvular heart disease with relevant adverse impact on patients´ prognosis. Imaging of tricuspid valve and tricuspid Regurgitation is through anatomical circumstances is challenging. In this study, we aimed to compare the ability of different imaging modalities to visualize and quantify tricuspid valve (TV) function and annular dimensions.

Methods and Results
We prospectively included 40 consecutive patients (Age: 77.5 ± 7.1 years) with high surgical risk (EuroSCORE II: 8.8 ± 12.1%) and significant TR, who underwent transesophageal echocardiography (TEE) and multislice computed tomography (MSCT) to evaluate TR, TV function, and dimensions. In general, 2D-TEE showed lower diameters than MSCT with a significant but weak correlation between both imaging modalities for AP diameters (41.4 ± 7.8 mm, 47.2 ± 8.9 mm, r = 0.68, p = 0.05correlation, p = 0.03difference) and for SL diameters (41.6 ± 5.3 mm, 46.6 ± 4.6 mm, r = 0.71correlation, p = 0.05difference, p = 0.03). We found no significant correlation, however significant difference agreement, between MSCT and 2D-TEE on measures for annulus perimeter (117.6 ± 18.9 mm, 130.3 ± 21.5 mm, r = 0.3, p = 0.4correlation, p = 0.03difference) and annulus area (10.1 ± 3.3 cm2, 13.4 ± 4.1 cm2, r = 0.5, p = 0.4correlation, p = 0.04difference).
When comparing 3D-TEE with MSCT, we found a strong correlation between both imaging modalities concerning TV annulus areas (12.9 ± 2.6 cm2, 13.4 ± 4.1 cm2, r = 0.94, p = 0.0017correlation, p &lt; 0.001difference), and perimeter (130.1 ± 12.4 mm, 130.3 ± 21.5 mm, r = 0.9, p = 0.002correlation, p = 0.005difference), as well as for AP (43.8 ± 3.2 mm, 47.2 ± 8.9 mm, r = 0.73, p = 0.03correlation, p = 0.008difference) and SL diameters (44.5 ± 3.6 mm, 46.6 ± 4.6 mm, r = 0.86, p = 0.02correlation, p = 0.1difference). MSCT was not useful for TR grading and determination of TV function. In addition to conventional 2D echocardiography, only 3D-TEE allowed for direct measurement of effective regurgitant orifice area (EROA), which differed significantly from calculated EROA (p &lt; 0.05).

Conclusion
3D-TEE is highly comparable to MSCT and superior to 2D imaging for the determination of TV geometry and diameters. In contrast to MSCT, 3D-TEE allows sufficient grading and functional assessment of TR.