bluuebunny/crossref_metadata_2025_split huggingface dataset:
P282 Early disease acceleration in patients with newly diagnosed Crohn’s disease in India and Israel: Insights from an East-West inception cohort
Authors: Goren I , Yanai H , Pal P , Adigopula B , Pendyala S , Ganesh G , Yadgar K , Banerjee R , Dotan I 
Published: January 2020

Abstract

Background
Environmental and genetic factors might affect Crohn’s disease (CD) course. These are significantly different in developing countries such as India compared with the West, and may affect triggers of disease development and its early course. We aimed to assess early CD course in patients in India compared with Israeli patients (‘TiiiGER’ project).

Methods

Adults (&gt;18 years) diagnosed with CD using accepted clinical, endoscopic and histologic criteria were prospectively recruited. Disease acceleration was defined by the first CD-related surgery, CD-related hospitalisation or recommendation to start steroids, immunomodulatory or biologic therapy.
Results: Overall 104- Indian and 156-Israeli patients were recruited. Indian patients had male predominance (65.4% vs. 50.6%, p = 0.019), were diagnosed at a significantly older age (37.8 ± 12.8 vs. 31.8 ± 12.8 years, p &lt; 0.0001), had significantly more colonic disease location (35.6% vs. 19.2%, p = 0.003), and more stenotic behaviour (36.6% vs. 6.5%, p &lt; 0.0001), compared with Israelis. During a mean follow-up of 14.5 ± 2.7 months, disease acceleration occurred in 50% of Indian and 66.7% of Israeli patients, within a median of 7.6 (interquartile range [IQR] 1.9–25.6) and 3.4 (IQR 1.3–23) months, p = 0.05. A lower ratio of Indian patients was treated with steroids, immunomodulatory or biologic therapy (hazard ratio 0.563; 95% CI, 0.373–0.851, p = 0.006).

Conclusion
In this Indo-Israeli inception cohort, more than half of the patients with newly diagnosed CD experienced early disease acceleration. Distinct features, different rates of disease acceleration and treatment policies, highlight the global need for research into key factors in IBD evolution across ethnically and geographically diverse populations.
*The final two authors contributed equally.
P285 Is faecal immunochemical test a suitable alternative to faecal calprotectin in children?
Authors: SANDHU K , Ayling R , Naik S 
Published: January 2020

Abstract

Background
Faecal calprotectin (FCP) has widely been used as a non-invasive marker for intestinal inflammation in children. Faecal immunochemical test (FIT) is well established in bowel cancer screening programmes in adults. FIT is cost-effective and easier to handle in comparison to FCP. We aimed to evaluate the performance of FIT in the paediatric population and compare it with FCP.

Methods
Clinicians in paediatric gastroenterology clinic who requested FCP for further investigation. These patients provided a sample of FIT from the same stool. These samples were collected over a 10-month period from November 2018 to September 2019. FIT samples were taken into a proprietary tube (Eiken Chemical, Tokyo, Japan) and stored at 4°C until analysis. FCP was measured using Liason Calprotectin (Diasorin, Italy).

Results
131 samples were returned; 131 FIT and 102 FCP of which 7 calprotectin samples were insufficient for analysis. In 95 patients we had paired samples for FIT and FCP. The normal range for FCP was 0–200 µg/g and for FIT was 0–4 µg/g. Twenty-three of 95 patients were non-IBD (24.2%). In the IBD group; 42 had Crohn’s, 27 ulcerative colitis and 3 indeterminate colitis. 15 were new diagnosis of IBD. In the 95 patients; FIT was normal (&lt;4 µg/g) in 50 patients and abnormal (&gt;4 µg/g) in 45 patients. FCP was normal (&lt;200 µg/g) in 45 patients and abnormal (&gt;200 µg/g) in 50 patients. FIT positively correlated with calprotectin, Spearman’s rank coefficient 0.653, p &lt; 0.001. There were 32 patients with FIT &gt;20µg/g and in 29 of these patients, FCP was &gt;200 µg/g. In 60 patients with FIT and in 35 patients with FCP underwent colonoscopies. Table 1 shows the diagnostic value of FIT in comparison to histological inflammation.
The correlation of FIT with histological findings are shown in Figure 1. All patients with normal histology had a FIT &lt;4 µg/g. In 91.4% of patients with moderate to severe histological inflammation had a FIT &gt;5 µg/g.

Conclusion
Our study is the first to compare FIT and FCP in the paediatric population. Our results suggest that FIT correlates well with FCP and can be used to differentiate between functional bowel disease and inflammation in children. A FIT of &gt; 20 µg/g was consistent with the finding of severe inflammation.
P288 Gut barrier failure biomarkers in IBD: Is there anything new beyond „The Wall’?
Authors: Sipeki N , Kovats P , Balogh B , Shums Z , Norman G L , Antal-Szalmas P , Papp M 
Published: January 2020

Abstract

Background
Several defects in the many specialised components of mucosal barrier have been reported in inflammatory bowel disease (IBD). These alterations may represent a primary dysfunction in Crohn’s disease(CD), but they may also perpetuate chronic mucosal inflammation in ulcerative colitis(UC). Changes in intestinal permeability can predict IBD course.

Methods
We aim to determine the predictive potential of a panel of serological markers that reflect either mechanical or immunological gut barrier dysfunction regarding determination of disease phenotype, therapeutic strategy and long-term disease course in a prospective referral adult IBD patient cohort.
Sera of 266 CD (m/f:112/154, median age:25 years, B1:80.1%, P1:18.0%) and 187 UC (m/f:86/101, median age:33 years, extensive colitis:28.3%) patients were assayed for intestinal fatty acid-binding protein(I-FABP) and various immunoglobulin A (IgA) molecules, anti-F-actin[AAA IgA/IgG] and anti-gliadin[AGA IgA/IgG]) by enzyme-linked immunosorbent assay (ELISA) along with 155 healthy controls (HCONT). Clinical data were available on unfavourable disease outcome as well as disease activity and medical treatment during the prospective follow-up (median: 143 and 135 mths for CD and UC respectively).

Results
In UC, median I-FABP level was significantly lower than in HCONT(177.2 vs. 244.3 pg/ml; p &lt; 0.05). sIgA level was higher in both CD and UC compared with HCONT(51.2 and 46.0 vs. 29.2 μg/ml; p &lt; 0.0001). AAA positivity with IgA type predominance was significantly higher in CD(40.2vs UC:15.7; HCONT:6.2%). AGA was also more prevalent in CD(16.5vs UC:6.7; HCONT:7.2%). There was an association between the presence of IgA type AAA or AGA and antimicrobial antibodies. ACA IgA was also more prevalent in case of AAA IgA positivity(52.9 vs. 32.7%, p = 0.009). PS/PT IgA positivity was higher in AGA IgA positive patients (33.3 vs. 7.6%, p = 0.001). Complicated disease behaviour at sample procurement was associated with the presence of AAA and AGA IgA positivity. In Kaplan–Meier analysis concomitant presence of IgA and IgG type AAA was associated with a shorter time to resective surgery (HR[95% CI]: 2.03[1.06–3.90]) along with a higher risk of a second surgery needed (HR[95% CI]: 2.82[1.14–6.98]). Sensitivity analysis showed that the later remained significant in B1 patients (p = 0.002) and also remained independent predictor in multivariate Cox-regression analysis comprising relevant clinical factors(HR[95% CI]: 2.88[1.07–7.78], p = 0.037).

Conclusion
The presence of AAA and AGA reflects the ongoing mucosal damage in IBD rather than has a value in predicting the disease course.
P290 Long-term disease outcome of ulcerative colitis (UC) in South Ostrobothnia, Finland with a follow-up time of 25 years
Authors: Kontola K , Oksanen P , Huhtala H , Tunturi-Hihnala H , Jussila A 
Published: January 2020

Abstract

Background
Finland has one of the highest prevalence of inflammatory bowel disease (IBD), especially UC. There is scarce data about long-term disease outcome in UC in population-based cohorts. The aim was to evaluate the long-term clinical outcome of patients with UC in the region of South Ostrobothnia, a district in rural central western Finland with a population of about 190 000.

Methods
All patients treated with diagnosis of UC or IBDU (inflammatory bowel disease Unclassified) during years 1981–2000 were included in this study. Data were collected retrospectively from the patient registry of the Central Hospital of South Ostrobothnia until 1 August 2019.

Results
There were 589 patients with a median follow-up time of 25 years. Median age at the diagnosis was 34 years. 59% of patients were male, 93% had UC and 7% IBDU. According to Montreal classification 80% had extensive disease, 15% left-sided disease and 5% proctitis. Medical treatment used at any point during the disease is shown in Table 1.
Twenty-two per cent of patients had colectomy. Of operated patients, (pan)proctocolectomy with ileostomy was performed to 50%, IPAA (ileal pouch anal anastomosis) to 40% and IRA (ileorectal anastomosis) to 3%. Median time from the diagnosis to surgery was 11 years; the risk of surgery is shown in Table 2.
Twenty-six per cent of the operations were emergency surgeries. The mean age at the time of surgery was 49 years. The indications for colectomy are specified in Table 3.
Cumulative risk of colorectal cancer (CRC) and biliary tract cancer was 3.2% and 1.7%, respectively. Twenty-eight per cent of patients died during follow-up, at the mean age of 72 years. The cause of death was recorded for 91/167 and the most common causes were cardiovascular disease and malignancy.

Conclusion
In this population-based cohort with surveillance of 25 years 22% patients with UC or IBDU were operated. Even after becoming available, biological medication is rarely used for UC patients diagnosed in the prebiologic era.
P292 Inflammatory bowel disease and their implications in Roma ethnicity: A preliminary study
Authors: Castro B , García García M J , Pascual M , Fernández-Forcelledo J L , Crespo J , Rivero M 
Published: January 2020

Abstract

Background
The pathogenesis of inflammatory bowel disease (IBD) is multifactorial and many factors have been involved such as genetic or environmental elements. The characteristics of IBD in different ethnic groups have been investigated to clarify the North-South gradient. We considered that Roma patients seem to have a more aggressive disease than Caucasian patients but no data to support this feeling is published. For this reason, the aim of our study is to analyse clinical characteristics of our cohort of IBD patients comparing Roma and Caucasian ethnicity

Methods
A retrospective cohort study was realised in both IBD Units to compare Roma and Caucasian groups. IBD patients were identified in the outpatient clinic. Demographical, clinical characteristics, pharmaceutical requirements and surgeries were collected. This group was matched by age, gender, disease and location of IBD with Caucasian patients.

Results
24 Roma patients were identified in our cohort. The prevalence of Gypsy ethnic group in our cohort was 1.66%. A percentage of 41.67% were men (n = 10) meanwhile 58.33% (n = 14) were women. The average age of the patients of our cohort was 43.77 years (SD 12.82). Crohn’s disease (CD) was observed in 62.5% (n = 15), ulcerative colitis (UC) in 29.19% (n = 7) and Unclassified IBD in 8.33% (n = 2). A statistic significant difference in family history was observed in the group of Roma patients (50%, n = 12 vs. 8.34%, n = 2) (p =0.001). Regarding to therapy, the Roma group required biological treatment in 58,32% (n = 14) compare to a percentage of 25% (n = 6) (p = 0.019) in the Caucasian group. We also found more hospital admissions (5.18 (SD 4,33) vs. 2,5 (SD 1,93) (p = 0,04)) and surgical procedures (41.66%, n = 10 vs. 12.5%, n = 3) (p = 0,023).

Conclusion
In our cohort, the Roma IBD patients showed more familial aggregation than the Caucasian group. An aggressive disease was also found in Roma patients and the subsequent increase in biological therapy, hospital admissions and surgical procedures to control the disease. Future studies should be performing to investigate genetic or environmental factors associated with this ethnic group.
P293 Loss of response after first-line biologic therapy in patients with inflammatory bowel disease: practical approach and management
Authors: Busacca A , Scrivo B , Giuffrida E , Guida L , Carrozza L , Calvaruso V , Cappello M 
Published: January 2020

Abstract

Background
Anti-tumour necrosis factors (anti-TNFs) have greatly improved therapeutic strategies for the treatment of inflammatory bowel diseases (IBDs). However, a significant number of patients do not respond or lose response over time (LOR). The aim of this retrospective prospective study was to evaluate patients (patients) treated with anti-TNFs as first-line treatment, with subsequent LOR, defined as recurrence of disease activity during maintenance therapy. We determine the prevalence of LOR and its management.

Methods
Three-hundred forty patients with IBDs were included: 65% had Crohn’s disease and 35% ulcerative colitis. Mean age at diagnosis was 31,5 years and medium time between diagnosis and start of biologic treatment was 72 months. Among 300 patients treated with anti-TNFs, LOR occurred in 33%, 38% was in treatment with Infliximab, 55% with Adalimumab, and 7% with Golimumab and it was statistically related with smoke (p = 0.028), type of drug (p = 0.001) and with the duration of treatment (p = 0.019).

Results
Among patients with LOR, 88% had a persistent clinical activity, evaluated by clinical scores (HBI and pMayo score) and 56% had a persistent endoscopic activity, evaluated by endoscopic scores (SES-CD and Mayo). After the LOR, 56% of patients optimised treatment for medium time of 7,8 month, 31% switched to another Anti-TNF, 7% swapped to a different class of biologics (Vedolizumab or Ustekinumab) and 4% had surgery as a treatment strategy. During treatment with anti-TNF as second-line treatment, LOR occurred in 17 patients. Anti-TNFs was the third line therapy in 3 patients, while Vedolizumab in 13. Only 2 patients in treatment with Vedolizumab had a second LOR and started Ustekinumab.

Conclusion
Loss of response occurred frequently in patients treated with biologics. Optimisation of treatment was not efficacious during a long period and the use of another biologic (anti-TNF or another class) is the more suitable strategy in our centre, with success in 35% of patients who lose response.
P306 Frequency and structure of extra-intestinal manifestations in IBD
Authors: Skalinskaya M , Skazyvaeva E , Bakulin I , Rasmagina I , Komarova D , Ivanova K 
Published: January 2020

Abstract

Background
IBD are immunomediated diseases that usually manifest at an early age, require lifelong pathogenetic therapy and significantly reduce the quality of life of a patient.

Methods
Since February 2017, the ‘North-West register of IBD patients’ has installed data of 1130 patients with an introduced diagnosis of UC or CD: 41.3% of them are patients with a diagnosis of CD and 58.7%—with a diagnosis of UC.

Results
Among patients with IBD the majority had mild (33.4%) and moderate activity (34%), a quarter was in remission and 7.65%—expressed activity. A population researches study using the University of Manitoba’s IBD epidemiology database (UMIBDED) reported that 6.2% of IBD patients had at least one extraintestinal manifestation, and 0.3% had several. The extraintestinal manifestations were observed in 43.4% of patients; meanwhile, 25% of them revealed mostly than one extraintestinal manifestation. System manifestations were more often registered in CD than in UC. The most frequent extraintestinal manifestations were signs of involvement of skeletal and muscular system. On the first place, it is peripheral arthropathy (73.6%), sacroiliitis (8.8%), ankylosing spondyloarthritis (8.8%), entezitis (10.3%) rheumatoid arthritis (1.5%), dactylitis (1.5%) were less frequent. Generally, articulate manifestations were noted by 17.5% of all included patients. In CD and UC, extra-intestinal manifestations were more often common in patients with a moderate attack (in 75.6 % and 51.6% of cases). In CD, extra-intestinal manifestations were more often frequent in patients with moderate attack −50.8%, in patients in remission there numbered to 32.8%, in severe attack-14.8%, in mild-1.6%. In UC, extra-intestinal manifestations were observed in severe attack in 2.6%, in moderate attack 35.9%, in mild attack 41%, in patients in remission 20.5%.

Conclusion
Among patients with IBD, extraintestinal manifestations, among which joint lesions prevail, are detected in 43.4% of the examined persons. The trend is noted to reduce the number of patients with severe attacks of the disease and extraintestinal manifestations, that can be related with improving the quality of diagnosis, reduction of terms of diagnosing and developing new methods of treatment for IBD. Peripheral arthropathy predominate among the extra-intestinal manifestations. We found no correlation between the severity of IBD and the presence of extra-intestinal manifestations. The spectrum of extra-intestinal manifestations includes more than 20 manifestations (diseases), which requires skills and experience in their diagnosis, as well as joint management of such patients by specialists of various profiles.
P307 Colorectal neoplasia risk in patients with inflammatory bowel disease and serrated lesions
Authors: De Jong M , Vos S , Nagtegaal I , van Herwaarden Y , Derikx L , Hoentjen F 
Published: January 2020

Abstract

Background
The presence of serrated lesions (SLs) is an established risk factor for colorectal neoplasia development in the general population. However, the impact of SLs on the colorectal neoplasia risk in inflammatory bowel disease (IBD) patients is unknown. In addition, SLs might have been misclassified in IBD patients in the past, in part due to revisions of classification systems. Presently, SLs are categorised as hyperplastic lesions, sessile SLs, and traditional serrated adenomas. We aimed (1) to compare the colorectal neoplasia risk in IBD patients with SLs vs. IBD patients without SLs, and 2) to study the subclassification of SLs in IBD patients before and after histopathological review by two expert gastrointestinal pathologists.

Methods
We identified all IBD patients with colonic SLs from 1996 to 2019 in a tertiary referral centre using the local histopathology database. Patients with neoplasia prior to SL diagnosis were excluded. Clinical data from patients’ charts were retrieved until June 2019. A subgroup of 135 SLs was reviewed by two pathologists. The log-rank analysis was used to compare the cumulative (advanced) neoplasia incidence in IBD patients with SL vs. IBD patients without SL undergoing surveillance in the same time period. Patients were censored at the end of surveillance or at colectomy.

Results
We identified 376 SLs in 204 IBD patients (61.9% ulcerative colitis (UC)). In the original reports, 91.9% was classified as a hyperplastic lesion. After histopathological review, 120/136 (88%) of the SLs were confirmed (16 were no SL). Of the 120 confirmed SLs, 62.2% was classified as a sessile SL, 37.8% as a hyperplastic lesion, and 0.8% as a traditional serrated adenoma. The mean time from IBD diagnosis to the first serrated lesion was 14.3 ( ± 12.3) years. A total of 41/204 (20.0%) of patients developed neoplasia (3 CRC, 3 HGD, and 35 LGD; including 2 HGD and 17 LGD at the moment of serrated lesion detection). In the 304 patients without SL (52.6% UC), 63 developed neoplasia (20.7%; 8 CRC, 5 HGD and 50 LGD). Patients who received follow-up colonoscopies after SL (n = 127) had an increased cumulative risk of neoplasia (p &lt; 0.01), but no increased risk of advanced neoplasia (p = 0.50) compared with the group of IBD patients without SL (Figure 1).

Conclusion
The presence of SLs in IBD patients was associated with a relatively high risk of synchronous colorectal neoplasia as well as an increased risk of subsequent neoplasia, although not with an increased risk of advanced neoplasia. Histopathological review confirmed the SL diagnosis in the majority of lesions, although a large proportion of the hyperplastic lesions was reclassified as a sessile SL.
P309 Ferritin or transferrin saturation vs. soluble transferrin receptor for iron deficiency diagnosis in inflammatory bowel disease
Authors: DAUDE S , Remen T , Chateau T , Danese S , Gastin I , Baumann C , Gueant J L , Peyrin-Biroulet L 
Published: January 2020

Abstract

Background
Iron deficiency is common in inflammatory bowel disease (IBD) and can negatively affect the quality of life even in the absence of anaemia. Diagnosis of iron deficiency is based on ferritin and transferrin saturation (TfS) in routine practice, yet guideline thresholds are not evidence-based. Serum levels of soluble transferrin receptor (sTfR) are the best non-invasive test as it is not influenced by inflammation, but the test is costly with low availability. Thus, the aim of this study was to evaluate for the first time the accuracy of ferritin and/or TfS for diagnosing iron deficiency in IBD and identify the optimal thresholds of these parameters using sTfR as the gold standard.

Methods
Serum samples were collected from IBD patients (n = 2,072) receiving a biologic in routine practice. Diagnostic accuracy was assessed using receiver operating characteristic curves for ferritin and TfS levels separately or combined.

Results
No ferritin or TfS threshold had good diagnostic performance in CD patients. In UC patients with CRP &lt;10 mg/l, optimal iron deficiency diagnostic performances were observed with ferritin and TfS thresholds of 65 µg/l and 16%, respectively. For UC patients with CRP &gt;10 mg/l, the thresholds with the best diagnostic performance were 80 µg/l for ferritin and 11% for TfS. There was no added value for combined ferritin and TfS.

Conclusion
In conclusion, we found that ferritin and TfS are reliable parameters for iron deficiency diagnosis only in UC patients, at thresholds different from current guidelines. In CD patients, sTfR should be used given the poor diagnostic performance of ferritin and TfS.