bluuebunny/crossref_metadata_2025_split huggingface dataset:
P250 Root cause analysis to identify missed opportunities for the diagnosis of colorectal cancer in inflammatory bowel disease
Authors: Gordon C , Chee D , Hamilton B , Chanchlani N , Heerasing N M , Hendy P , Lin S , Wesley E , Daniels I , Goodhand J R , Kennedy N A , Ahmad T 
Published: January 2020

Abstract

Background
Colonoscopic surveillance in inflammatory bowel disease (IBD) patients leads to earlier detection of colorectal cancer (CRC) and reduces CRC-associated deaths. However, adherence to international surveillance guidelines in practice is poor. Consequently, we hypothesised that patients with IBD-associated CRC had suboptimal endoscopic surveillance and conducted a root cause analysis of IBD-associated CRC diagnoses to identify the scale of missed surveillance opportunities.

Methods
We calculated the incidence of CRC in our IBD population between 1998 and 2019 by cross-referencing the hospital’s CRC and IBD databases. All cases were adjudicated by IBD specialists to determine eligibility for surveillance using guidelines contemporaneous to the time of CRC diagnosis. For all eligible patients, a root cause analysis was conducted to determine whether there were missed opportunities to detect CRC.

Results
Our search identified 94 patients with IBD and CRC. We excluded 16 patients diagnosed with IBD after the diagnosis of CRC. The overall incidence of IBD-associated CRC in East Devon from 1998 to 2019 was 0.17% per year (95% CI 0.14 %–0.18%) with no statistically significant change seen over time (R2= 0.15, p = 0.11). Fifty-one patients (65%) were male, the median age at diagnosis of CRC was 69 years (range 21–88) and the median duration of IBD prior to CRC diagnosis was 21 years (range 0–57). After adjudication, 42 (54%) patients were eligible for surveillance at the time of CRC diagnosis. Correctly timed surveillance colonoscopy identified 5/42 (12%) CRC cases, but failed to identify CRC in 6 (14%) patients with so-called interval cancers. Overdue surveillance colonoscopy identified a further 4/42 (10%) cases. Overall, 27/42 (64%) IBD-associated CRC cases were classified as having had missed opportunities for surveillance. Root cause analyses found that 10 (37%) patients had not been offered surveillance despite on-going secondary care follow-up. Four (15%) patients had a delayed diagnosis of CRC because of a failure to account for the adequacy of previous colonoscopic and histological findings. Thirteen patients were managed exclusively in primary care including 7 (26%) patients who had been discharged back to primary care without a plan for surveillance and 6 (22%) patients who were never known to secondary care.

Conclusion
Two-thirds of patients who were eligible for surveillance had a missed opportunity to diagnose CRC. In most cases, the patient was known to the secondary care IBD service but no recommendation for surveillance was made. There is a need to implement processes to facilitate identification and recall of patients eligible for surveillance across primary and secondary care.
P252 The cardiovascular risk profile in patients with inflammatory bowel disease: A cross-sectional single-centre study (the CARE-IBD study)
Authors: Sleutjes J A M , Roeters van Lennep J E , Verploegh P J , van der Woude C J , de Vries A C 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular diseases (CVD). The European Society of Cardiology guidelines recommend to use a 1.5 factor CVD risk multiplier in rheumatoid arthritis, but state a gap in evidence for other inflammatory diseases. The aim of this study was to assess the prevalence of CVD and traditional cardiovascular risk factors in IBD.

Methods
This is a single-centre cross-sectional study at the IBD outpatient clinic in September and October 2019. Patients ≥18 years underwent body measurements (systolic, diastolic blood pressure (SBP, DBP), length, weight, waist, hip circumference), biochemical analysis (plasma glucose, total cholesterol (TC), triglycerides, HDL, LDL) and completed an extensive cardiovascular questionnaire (history of CVD, thromboembolic events, medication use). To identify groups at risk of hypertension (SBP&gt;140 or DBP&gt;90 mmHg), overweight (&gt;25 kg/m2), hyperlipidaemia (TC&gt;5 mmol/l) and cardiovascular events, comparisons were made between gender, IBD subtype (Crohn’s disease (CD), ulcerative colitis (UC)) and disease activity (Harvey Bradshaw Index or Simple Clinical Colitis Activity Index&gt;5).

Results
A total of 235 IBD patients were included (112 males (48%), median age 45 years (IQR 33–55): 143 CD (61%), 92 UC (39%)). Median SBP and DBP were 135 (IQR 122–145) and 84 mmHg (IQR 66–93); hypertension was present in 43% of patients. Median BMI was 24.5 kg/m2 (IQR 21.9–27.4); 41% of patients were overweight. Hyperlipidaemia was present in 19% of patients. The self-reported prevalence of hypertension was 13%, hyperlipidaemia 8%, diabetes 4%, cardiovascular disease (heart failure, myocardial infarction, transient ischaemic attack, cerebrovascular accident) 10% and thromboembolic events (deep venous thrombosis, pulmonary embolism) 8%. Male patients showed a higher prevalence of hypertension (61%), greater waist–hip ratio (0.93, all p &lt; .001), higher triglyceride (1.6 mmol/l, p = .003) and lower HDL levels (1.2 mmol/l, p = .000) as compared with females. CD patients were more frequently smokers (16%) with disease activity (51%)(p &lt; .001), but showed lower levels of triglycerides (1.6 mmol/l, p = .013), TC (4.0 mmol/l) and LDL (2.3 mmol/l) (p &lt; .001) as compared with UC. During active disease lower levels of LDL were observed as compared with remission (2.4 vs. 2.7 mmol/l, p = .040).

Conclusion
CVD are considerably prevalent in IBD patients. Well-known CVD risk factors hypertension, obesity and hyperlipidaemia are highly prevalent and remain undiagnosed in a substantial proportion of patients. Although no significant association is observed between CVD and gender or IBD subtype, CVD risk profile is different. Screening and early treatment of CVD risk factors might be recommended in IBD.
P254 Virtual chromoendoscopy with Narrow Band Imaging (NBI) for the classification of polypoid and non-polypoid lesions in ulcerative colitis: A prospective study using different endoscopic classifications
Authors: Cassinotti A , Fociani P , Beretta E , Duca P , Nebuloni M , Ardizzone S 
Published: January 2020

Abstract

Background
In ulcerative colitis (UC), the diagnostic accuracy of virtual chromoendoscopy with non-magnified Narrow Band Imaging (NBI) was disappointing in the detection and differential diagnosis of neoplastic lesions in most trials performed according to unclear diagnostic criteria. The Kudo and NICE criteria are validated in the general population, but controversial in UC. Recently, a modified Kudo classification specific for the inflammatory setting of UC has been developed using virtual chromoendoscopy with Fuji Intelligence Color Enhancement (FICE). The performance of NBI according to these three classifications for optical diagnosis of neoplastic and non-neoplastic lesions in UC has never been analysed.

Methods
All visible, polypoid and non-polypoid, lesions found during consecutive surveillance colonoscopies with non-magnified NBI (Exera II CV180) for long-standing UC (&gt;8 years from disease onset) were included in a prospective, single-centre study, and classified as suspected or not suspected for neoplasia according to the NICE, Kudo and Kudo-modified criteria. The primary endpoint was to compare the sensitivity (SE), specificity (SP), negative (-LR) and positive (+LR) likelihood ratios of the three classifications, using histology as the reference standard.

Results
394 lesions (mean size 6 mm, range 2–40 mm; type 0-Is 83%) from 84 patients (males 62%; mean age 57 y, range 30–79 y; mean disease duration 20 y) were found: 21 (5%) were neoplastic, 49 (12%) hyperplastic and 324 (82%) inflammatory lesions. The diagnostic accuracy of the NICE, Kudo and modified-Kudo classifications were, respectively: SE 76% vs. 71% vs. 86% (p = not significant); SP 55% vs. 69% vs. 79% (p &lt; 0.05 Kudo-mod vs. both Kudo and NICE); +LR 1.69 vs. 2.34 vs. 4.15 (p &lt; 0.05 Kudo-mod vs. both Kudo and NICE); -LR 0.43 vs. 0.41 vs. 0.18 (p = not significant).

Conclusion
The diagnostic accuracy of NBI for the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with the conventional classifications validated in the general population, but it is significantly better with the modified Kudo classification specific for UC. The role of NBI in UC surveillance for neoplasia should be re-evaluated according to more accurate diagnostic criteria.
P255 Predictors of postoperative morbidity in patients with inflammatory bowel disease
Authors: Imperatore N , Pellegrini L , Bucci L , Rispo A , Guarino A D , Testa A , Peltrini R , Amendola A , Patturelli M , Castiglione F 
Published: January 2020

Abstract

Background
More than half of patients suffering from inflammatory bowel disease (IBD) requires surgery in their lifetime. However, predictors of post-operative morbidity and mortality are poorly investigated. Our aim was to assess the predictors of post-operative mortality and morbidity in IBD.

Methods
retrospective cohort study enrolling all IBD subjects followed-up and operated at our tertiary IBD Centre from 2015 to 2018. For each patient, we evaluated patient-dependent (comorbidities, smoking, drugs, nutritional status), disease-dependent (disease duration, location, behaviour, extension), surgery-dependent variables (duration, emergency/election, laparoscopy/laparotomy, bowel/colic resection, length of intestinal resection).

Results
158 subjects were operated during the period study (males 53.8%, Crohn’s disease 75.3%, mean age 41.9 + 16.2, disease duration 109.5 + 98.3 months); the majority (83%) underwent an elective surgery. No patient died. About morbidity, 40 (25.3%) developed post-operative complications: wound infection (8.9%), respiratory complications (6.9%), prolonged ileum (5.1%), anastomotic leak (3.2%), urinary infections (3.2%), abdominal abscess (3.2%), anastomotic bleeding (3.2%), other infections (2.5%), abdominal bleeding (1.9%), obstruction (1.3%). Two subjects (1.3%) required re-operation within 30 days. A surgery-duration &lt;142 min was predictive for a better post-operative outcome (sensitivity 80%, specificity 42%, PPV 32%, NPV 85.9%). At binary logistic regression, stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6–6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4–9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.4–0.8, p = 0.01), surgery duration &lt;142 min (OR 0.2, 95% CI 0.08–0.7, p = 0.03), were the only predictors for post-operative morbidities. A pre-operative BMI&lt;24 was also predictive for anastomotic leak (OR 4.3, 95% CI 1.8–8.6, p = 0.02); pre-operative hypoalbuminemia was predictive for urinary infections (OR 2.5, 95% CI 1.8–7.9, p = 0.04); pre-operative infliximab was predictive for pneumonia (OR 3.8, 95% CI 2.2–6.3, p = 0.01); diabetes (OR 5.7, 95% CI 2.3–9.8, p &lt; 0.01) and pre-operative steroids (OR 6.1, 95% CI 1.8–11.4, p &lt; 0.01) were predictors of wound infection; need for TPN predicted prolonged ileum (OR 6.1, 95% CI 2.3–15.3, p = 0.03).

Conclusion
about a quarter of IBD patients undergoing surgery develops a post-operative complication, especially infective. Several patient-related, disease-related and surgery-related factors are predictive for post-operative morbidity. The recognition of these factors, as well the multidisciplinary approach (gastroenterologists, surgeons and nutritionists), and intensive preoperative management could be able to minimise these complications.
P256 Anti-glycan antibody seropositivity at diagnosis does not predict future disease course in patients with Crohn’s disease
Authors: Lyons P , Noor N , Lee J C , McKinney E F , Parkes M , Smith K G C 
Published: January 2020

Abstract

Background
Biomarkers predictive of a patient’s future disease course are critical for personalised medicine. There are two Crohn’s disease (CD) assays with validated associations to a clinical outcome; seropositivity for anti-glycan antibodies (AGAs, Glycominds) and a transcriptional signature of T-cell exhaustion (PredictSURE-IBD™, PS-IBD). The optimal time to use these tests would be at diagnosis before bowel damage occurs. As AGAs have primarily been measured in patients after therapy it’s unclear if they provide prognostic information at diagnosis. To address this we performed a head-to-head comparison of both tests in newly diagnosed CD patients.

Methods
We recruited 74 CD patients with active disease; all patients gave written informed consent and were managed using an accelerated step-up strategy in accordance with international guidelines. Active disease was confirmed by one or more objective marker (raised CRP/calprotectin or endoscopic review) and active symptoms. AGA seropositivity was measured at Addenbrooke’s with the IBDX panel (Glycominds) according to manufacturer’s instructions. Patient stratification was also performed using the PS-IBDtest (PredictImmune Ltd) according to manufacturer’s instructions.

Results
Most (80%–59/74) patients were newly diagnosed; 58% (43/74) were seropositive for at least 1 AGA, 19% (14/74) were positive for ≥2 AGAs. Newly diagnosed patients had fewer AGAs (51%, 30/59) than previously diagnosed (87%, 13/15) patients (p = 0.018). We stratified patients into two groups based on seropositivity for 2 or more AGAs—associated with an increased risk of more severe disease but found no significant difference in time to, or frequency of, treatment escalation between the groups. Stratification of patients into IBDhi and IBDlo groups with PS-IBDrevealed a significant difference in the subsequent disease course with IBDhi patients experiencing more aggressive disease, characterised by a shorter time to treatment escalation compared with IBDlo patients (p = 0.001).

Conclusion
AGA seropositivity at diagnosis (as assessed using the IBDX antibody panel) did not predict the need to escalate treatment due to frequently-relapsing or chronically-active disease. Lower AGA seropositivity in newly diagnosed patients compared with those with previous diagnoses suggested that the extent of antibody positivity is a function of disease duration. Previously reported associations between AGA positivity and disease outcome may, therefore, reflect retrospective aggressive disease course and are unlikely to be useful for informing treatment decisions in newly diagnosed patients. The PS-IBD test result correlated with subsequent disease course indicating suitability for early prediction of clinical outcome.
P265 IBD′s features depending on the age group of patients and the timing of diagnosis of the disease
Authors: Skalinskaya M , Skazyvaeva E , Zhuravleva M , Bakulin I , Komarova D , Rasmagina I , Ivanova K 
Published: January 2020

Abstract

Background
Untimely diagnosis increases the number of severe forms of IBD, which enlarges the possibility of life-threatening complications, extraintestinal presentations, and the patient’s need for surgical treatment.

Methods
We analysed the data of 1130 patients with an established diagnosis of UC or CD. The dynamics of the timing of diagnosis of IBD, the nature of the disease, the frequency of occurrence of intestinal complications, extraintestinal presentations were evaluated.

Results
The maximum frequency of start of both UC and CD falls on the young age of patients - from 19 to 38 years. The duration of symptoms before diagnosis is established is 2.3 years (27.4 months) for CD, 1.1 years (12.1 months) for UC. 81.8% of patients with UC are diagnosed no more than 4 years, but in 10.9% of patients this interval was 4–9 years; in 3.6%, 9–13 years; in 1.9%, 13–18 years, and in another 1.8%, more than 20 years. In CD 59.5% of patients fall into the diagnosis interval up to 4 years, in 27.4% this period takes from 4 to 9 years, in 7%—10–15 years, and in 6% more than 6 years. At the age of 18–25 years severe course of IBD is observed in 12% of patients, at the age of 26–30 years—in 18%, 31–40 years—in 9%. Older people are more likely to experience mild IBD, and the percentage of severe and moderate forms is 4% and 29%, respectively, after 60, and less than 0.5% and 19.5%, respectively, after 70 years. Extraintestinal presentations were observed in 43.4% of patients, with 25% of them having more than one of them. In patients with CD, the development of complications in the first 4 years of the disease was noted in 62%, in UC—in 58.9%. In patients with intestinal complications, the diagnosis period was 2.9 years, without them—2.4 years. However, in patients with a history of surgical treatment of IBD, the diagnosis period was less than 1 year. 69, 3% of revealed patients with a history of needing one or more hospitalisations associated with IBD, and 15.8% underwent surgery for IBD.

Conclusion
Based on the data obtained, it can be concluded that the main part of complications occurs in the first few years after the onset of the disease. With late diagnosis, the probability of developing not only intestinal complications, but also extra-intestinal presentations significantly increase, which reflects a more severe form of the disease. The shorter time of diagnosis of IBD in patients who need surgical treatment is explained by more pronounced symptoms that require urgent medical care. However, the proportion of IBD with severe and moderate form is greater in young age groups, and as the ‘growing up’ groups - the number of patients with mild IBD begins to prevail.
P267 Validation of the short inflammatory bowel disease questionnaire as an outcome measure in Crohn’s disease patients
Authors: Reggev S , Goran G , Sarid O , Schwartz D , Sergienko R , Slonim-Nevo V , Friger M , Nemirovsky A , Vinogradov E , Monsonego A , Greenberg D , Odes S 
Published: January 2020

Abstract

Background
Health-related quality-of-life by the self-report, disease-specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is increasingly used as an outcome measure in Crohn`s disease (CD) patients in clinical trials. Higher SIBDQ scores indicate better quality-of-life; the range is 10 to 70. However, the construct validity of SIBDQ and its responsiveness to change of disease status require validation.

Methods
Adult (≥18 years) CD patients (n = 108) with Harvey–Bradshaw Index (HBI) &gt;4 and &lt;16 prospectively filled in the SIBDQ at two time-points (T1, T2) 3 months apart. Medical data at T1 and T2 were collected, and recorded by their physicians in the HBI. Biomarkers of disease activity included Calprotectin and C-reaction protein (CRP), measured at T1 and T2. The construct validity of SIBDQ in relation to biomarkers and HBI was determined by Pearson correlations and group comparisons using Student`s t-test. Statistical significance was taken as p &lt; 0.05. Patients’ medications were prescribed without regard to the study protocol.

Results
Demographic and medical characteristics (median, %) of the cohort were: age 30 years; females 65%, married/partner 48%; higher education 83%; BMI 22; non-smokers/past-smokers 92%; disease duration 5 years; past Crohn’s disease-related surgery 17%; Montreal classification A2 89%, L2+L3 89%, B1+B2 89%, perianal disease 18%; medications: corticosteroids 4%, 5-ASA 5%, immunomodulators 21%, biologicals 43%. HBI and SIBDQ median scores at T1 and T2 were: HBI: 9 and 4 (p &lt; 0.001); SIBDQ: 43 and 49 (p &lt; 0.001). SIBDQ scores correlated inversely with Calprotectin (r = −0.395, p = .002), CRP (r = −0.208, p = .046), and HBI (r = −0.345, p &lt; 0.001). Baseline HBI scores were used to divide the cohort into two groups for comparison: mild disease (5–7) vs. moderate disease (8–16). Mild disease patients reported higher SIBDQ scores than those with moderate disease (42.7 vs. 39.7, t = 1.96, p = 0.05). Regarding sensitivity of SIBDQ to clinical changes between T1 and T2, we found that change in SIBDQ correlated significantly with change in CRP across these two administrations (r = −0.232, p = 0.042). Finally, defining clinical response in CD as a decrease from baseline HBI score by ≥3 points, SIBDQ change scores were significantly larger in treatment responders (n = 51, M = 6.25) than non-responders (n = 30, M = 1.13, t = −3.042, p = 0.003).

Conclusion
The SIBDQ measure is a valid assessment of quality-of-life in CD, correlating with biomarkers and sensitive to change of disease activity, with potential for use as a patient-reported outcome in both clinical practice and as a primary end-point in clinical trials.
P271 Trends in faecal calprotectin levels during pregnancy and post-partum in healthy women
Authors: Doherty J , Moore R , Kivlehan C , Twomey P , McAuliffe F , Cullen G 
Published: January 2020

Abstract

Background
Faecal calprotectin (FCP) is one of the most widely used non-invasive tools for diagnosis and assessment of inflammatory bowel disease (IBD). Numerous factors can influence FCP levels including weight, smoking status and medications. In clinical practise FCP is commonly used to identify flares during pregnancy. For a test that is widely used minimal data exists on the determinants of normal levels and variations in concentrations during pregnancy in healthy individuals. Our aim is to determine normal FCP levels during pregnancy and post-partum and whether levels change during pregnancy and post-partum in healthy individuals.

Methods
We performed a prospective study analysing FCP levels from pregnant women at 16- and 34-weeks’ gestation and 4- and 12-weeks post-partum. Basic demographics were collected including age, parity, medical history, BMI and smoking status. Patients with a history of gastrointestinal disorders were excluded. FCP concentrations were measured with a quantitative ELISA assay.

Results
98 patients were included in our study. 172 stool samples were collected for analysis. Sixty-two stool samples were collected at 16 weeks gestation, 48 samples from 34 weeks gestation, 38 samples from 4weeks post-partum and 24 samples from 12 weeks post-partum. The median age was 33 years (21–44). Forty-one patients had a BMI &gt; 25 (42%). Sixteen patients were ex-smokers (16%) and one patient was actively smoking (1%). The median FCP levels from 16 weeks gestation was 29.5 (10–476), median level from 34 weeks gestation was 25.6 (10–259), from 4 weeks post-partum was 23.4 (10–318) and 12 weeks post-partum was 29.4 (10–216) (Table 1). There was no significant change in median FCP levels over the course of pregnancy and post-partum (p = 0.294). Interestingly median FCP levels were normal at all time points however we saw a slight numerical increase in FCP levels during pregnancy in patients whose BMI was &gt; 25 and this reached statistical significance at 4weeks post-partum (p = 0.01) (Table 1, Graph 1). There was also a significant increase in FCP at 4 weeks post-partum in patients who were ex-smokers (p = 0.004). (Table 1, Graph 1).

Conclusion
FCP levels are not affected by physiological changes in pregnancy or post-partum in normal healthy individuals without IBD. This confirms FCP is an effective tool for identifying flares of colitis during pregnancy. However, when using this tool, one should be aware that levels can be slightly altered by a patients’ smoking history and their weight and a detailed clinical history is essential when interpreting results.