bluuebunny/crossref_metadata_2025_split huggingface dataset:
P677 It’s time to grow up: what is it like to transition from the paediatric to adult inflammatory bowel disease service?
Authors: Keightley P , Prematunga R , Hoffmann P , Subramaniam K 
Published: January 2020

Abstract

Background
inflammatory bowel disease (IBD) is a chronic disease with an increasing incidence in the paediatric population. We explored the experiences of two groups of patients, those who transitioned directly from the paediatric to the adult service before the transitional IBD clinic was established, referred to as ‘adult’ and those who engaged in the new transitional clinic, referred to as ‘transitional’.

Methods
Sixteen (8 in each group as described above) out of 20 suitable patients participated. Patients were administered the IBD Questionnaire (IBDQ), Kessler Psychological Distress Scale (K10), Patient- Doctor Relationship Questionnaire (PDRQ-9) and Stressful Life Events Questionnaire. A semi-structured interview was administered to patients and carers about their experiences of diagnosis, paediatric care, transition to adult services and adult care.

Results
The average age of participants in both groups was 17. The transitional clinic had a higher proportion of Crohn’s disease. In the adult group, there were more males and the reverse in the transitional group. The adult clinic patients had more active disease, use of steroids, and emergency department presentations. The mean CRP of 36 mg/l at first visit to the adult clinic improved to 12 mg/l, at last, follow-up whereas mean CRP at first and last visit to the transitional clinic remained at 2 mg/l. Both clinics had similar rates of compliance and attendance. In the transitional and adult clinics respectively the mean IBDQ was 193 (SD=31) and 174 (SD = 22) with higher scores reflecting better health-related quality of life, the K10 mean score was 16 (SD = 7.5) and 17.5 (SD = 4.3) indicating a moderate level of distress, the PDRQ-9 mean scores were 4.3/5 (SD = 0.75) and 4.8/5 (SD = 0.4) indicating good therapeutic relationships. Both groups reported a similar number of stressful life events. Key themes were identified in both patient and carer interviews: (1) Diagnosis and illness: Diagnostic uncertainty, frustration at the diagnostic process, and the importance of finding a doctor you trust. (2) Maturity: growing up fast for some and seeking independence, growing up slowly for others while non-ill peers matured faster. (3) Carer adjustment: The central role of mothers and fathers as carers. Some adolescents feel highly responsible for their parents’ and families’ well-being.

Conclusion
Patients with IBD and their carers face particular difficulties during the period of transition from a paediatric to adult service. These are factors specific to the illness and factors related to maturation and development. There should be flexibility around maturity which is not rigidly age-based but instead based on the specific developmental needs of different families and adolescents.
P696 The usefulness to treatment enhancement for the patients of ulcerative colitis with clinical remission diagnosed as Mayo endoscopic subscore 1
Authors: Kubota Kajiwara M , Uchiyama K , Azuma Y , Yasuda R , Takayama S , Takagi T , Naitoh Y 
Published: January 2020

Abstract

Background
In many clinical trials of ulcerative colitis (UC), Mayo endoscopic subscore (MES) has been used to diagnose mucosal healing to evaluate the effectiveness of various treatment. Although both MES 0 and MES 1 were defined as the endoscopic mucosal healing, several studies reported that the risk of clinical relapse was significantly higher in the patients diagnosed as MES 1 compared with MES 0. However, it has not been established the beneficial effect to escalate the treatment for the patients diagnosed as MES 1 to avoid clinical relapse. In the present study, we retrospectively investigated the effectiveness about the escalation of treatment for UC patients with clinical remission diagnosed as MES 1.

Methods
A total of 68 patients with UC diagnosed as clinical remission (4 and under of Lichtiger CAI score) between April 2014 to October 2019 were enrolled in this study. All patients were endoscopically diagnosed as MES 1 and observation period was 12 months from the time of endoscopy. Relapse of UC was defined as the need for more aggressive treatment for UC due to aggravation of clinical symptoms or endoscopic findings. The relapse ratio was compared between the patients who continued the same treatment and the patients who had enhanced treatment. Enhanced treatment was defined as additional oral medicine or local preparations including enemas, suppositories, and foams within 3 months from endoscopic examination.

Results
In 68 patients, 12 patients were received enhanced treatment and 56 patients were continued the same treatments. There were no significant differences in clinical background between the two groups such as mean age (enhanced treatment group vs. same treatment group: 47.9 years vs. 42.9 years), disease type, disease duration (110.3 months vs. 94.8 months), and disease activity (Lichtiger CAI score: 2.5 vs. 2.8). The group of the enhanced treatment included 8 patients with oral 5-aminosalicylates escalation and 4 patients with additional local preparations. The relapse ratio was higher in patients with same treatment group (0%) compared with enhanced treatment group (14.3%).

Conclusion
Our results indicate that the enhancement of the treatment for UC patients with clinical remission diagnosed as MES 1 is effective to avoid relapse.
P713 Effects of vedolizumab on health-related quality of life, work productivity and patient concerns in patients with ulcerative colitis and Crohn’s disease in the UK and Ireland: OCTAVO cohort 2
Authors: Parkes G , Akbar A , Beales I , Buckley M , Creed T , Din S , Fraser A , Plevris N , Meadowcroft S , Owen G , Heggs N 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel disease (IBD) experience substantial impairment in health-related quality of life (HRQoL), therefore HRQoL endpoints are considered important measures of treatment outcome. OCTAVO evaluated the effects of vedolizumab on HRQoL, work productivity and patient concerns in IBD patients in the UK and Ireland.

Methods
OCTAVO is an ongoing multicentre, observational study to evaluate the impact of vedolizumab on two cohorts. Cohort 1 examined the impact of vedolizumab on concomitant medications compared with anti-TNFs in biologic naïve patients with ulcerative colitis (UC). Cohort 2 was non-comparative and observed changes in patient reported outcomes (PROs) in patients with UC and Crohn’s disease (CD) prescribed vedolizumab at any point in the treatment pathway. PROs are assessed by Short Inflammatory Bowel Disease Questionnaire (SIBDQ), IBD-Control-8 (IBD-C-8), Work Productivity and Activity Impairment (WAPI) and Rating Form of IBD Patient Concerns (RFIPC). PROs are collected prospectively at baseline, Week 14, 6 months and 12 months post-initiation via online questionnaires. The results of an interim analysis of Week 14 PROs for patients aged ≥18 years newly initiated on vedolizumab enrolled across 7 hospital sites in Cohort 2 are reported here.

Results
Sixty-one patients (21 CD, 40 UC; 51% male) were recruited, with a median age of 39.0 (IQR 32.0–55.0); and median disease duration of 9.6 years (IQR 1.7–17.2) for CD and 5.6 years (IQR 1.3–17.4) for UC. Mean total SIBDQ scores at Week 14 were: 45.2 for CD; 50.0 for UC. Scores increased by 8.5 points in CD patients and 10.2 points in UC patients in the first 14 weeks of the study. Similarly, improvements in IBD-C-8, WPAI-UC/CD sub-scores and RFIPC were observed in both CD and UC (Table 1).

Conclusion
Vedolizumab treatment was associated with meaningful improvements in PROs at Week 14. Improvements were seen across all measures (SIBDQ, IBD-C-8, WPAI-CD/UC and RFIPC) and were similar between CD and UC. Further investigation of vedolizumab on PROs in the real world is required to assess impact in the longer-term, the full analysis of OCTAVO at months 6 and 12 will help to provide this.
P715 The prevalence of chronic musculoskeletal pain in patients with ulcerative colitis in comparison to control subjects: A cross-sectional study
Authors: Pettersson N , Kragsbjerg F , Hamrin A , Forsblad-D′elia H , Karling P 
Published: January 2020

Abstract

Background
Musculoskeletal symptoms are common in patients with ulcerative colitis (UC) but there is no data on the prevalence of chronic regional pain (CRP) and chronic widespread pain (CWP) in patients with UC compared with control subjects.

Methods
From a national IBD Register (SWIBREG), all living patients with a confirmed UC diagnosis, aged 20–74 years, who were residents of two counties in Northern Sweden (n = 1164) were posted a validated questionnaire. Subjects (n = 3867) from a previous study using the same questionnaires was used as Controls (Bergman et al). The questionnaire comprises demography, history of pain and body localisation of pain. The disease activity of UC was measured by Patient- Simple Clinical Colitis Activity Index (P-SCCAI). CRP and CWP was defined as having pain for at least three months the last year. CWP was defined as having pain on both left and right side of the body and both above and below the waist, and in the axial skeleton.

Results
The response rate for the patients with UC was 43.6% and for the control subjects 62.7%. The patients were older than the control subjects (mean age 53.1 vs. 46.5 years; p &lt; 0.001) but there was no difference in gender (men 50.7% vs. 46.7%; p = 0.108). The reported prevalence of any chronic pain, CRP and CWP was higher in patients with UC vs. controls (53.9% vs. 39.5%; p &lt; 0.001; 33.5% vs. 24.2%; p &lt; 0.001 and 19.7% vs. 12.5%; p &lt; 0.001). The differences for reported chronic pain (any pain) was seen in all age groups. The patients with UC reported significant more pain in the regions ‘lower back’, ‘hip/upper leg’ and ‘lower leg/foot compared with controls (Table). The patients with P-SSCAI &gt;5 (n = 110) reported more CWP than patients with P-SSCAI &lt;5 (n = 411) (48.2% vs. 12.1%; p &lt; 0.001) and controls (48.2% vs. 12.5%; p &lt; 0.001) with significant differences for all body regions but there was no difference in CWP between patients with P-SSCAI &lt;5 and controls (12.1% vs. 12.5%; p = 0.852). There was a slightly higher prevalence of reported ‘any chronic pain’ between patients with P-SSCAI &lt;5 and controls (46.8% vs. 39.5%; p = 0.007).

Conclusion
Patients with UC reported more chronic pain than control subjects, especially from the lower back and hip region. Disease activity was associated with more pain included all body regions.
P747 Adherence to ECCO guidelines for cancer surveillance is associated to the detection of early cancer: A retrospective, single-centre, cohort study
Authors: PARIGI T L , Roda PhD G , Allocca M , Furfaro F , Loy L , Zilli A , Bonovas S , Danese S , Fiorino G 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD) are at increased risk of developing gastrointestinal (GI) malignancies. The aim of this study is to assess the risk of malignancies in IBD patients and the impact of cancer screening according to the ECCO guidelines in a tertiary referral centre.

Methods
We retrospectively analysed the electronic database of all IBD patients followed by the IBD Centre of Humanitas Research Hospital, Milan, from January 2010 to October 2019, and collected all new diagnoses of solid and haematological tumours since 2010. The annual standardised incidence rate (SIR), rate of mortality and early cancer diagnosis were calculated and a descriptive analysis of drug exposure, disease duration, family history of any cancer, smoking habits was made.

Results
We included 5239 patients, with a total 19820 patient-years follow-up. Eighty-four malignancies in 81 patients were retrieved, 71 were included in the final analysis (38 CD, 32 UC, 31 females). Average age at tumour diagnosis was 52.9 years (range 19–78). 64% of patients were former or active smokers, 31% had a family history of cancer or IBD. Sixty-two per cent of patients were previously exposed or had 5-ASA at the time of cancer, 40% azathioprine, 43% anti-TNF or vedolizumab. The annual SIR for all kinds of malignancy was 0.358%. GI malignancies were the most frequent (n = 17, 23.9%, 47% UC, 53% in CD). Six over 8 GI tract malignancies in UC patients were found in the colon or rectum (mean disease duration 22.5 years), whereas in CD patients 5/9 were in the small-bowel (mean disease duration 7.0 years). Melanoma and breast cancer (n = 8 each) were the most common non-GI cancers, followed by prostate (n = 7) and bladder (n = 6). No significant difference in incidence was found between CD or UC. Non-Hodgkin lymphomas and leukaemia (3 and 1, respectively) only occurred in CD patients. Other tumours included thyroid (n = 5), lungs (n = 4), testicle (n = 3), ovary (n = 2), kidney (n = 2), head-nose-throat (n = 2), pancreas (n = 1), brain (n = 1), and non-melanoma skin cancer (n = 1). Death occurred in 11% of patients, 8 of them for late stage cancer. Only 2 were related to the concomitant IBD (1 colo-rectal and 1 anal cancer). In patients regularly screened according to the ECCO Guidelines (GI cancer, haematological and skin cancer), there was a significantly higher number of detection of early cancer (28 vs. 1, p = 0.003), although no differences in mortality rates were reported in the two groups (2 vs. 2, p = 0.10).

Conclusion
The overall incidence of cancer in our cohort was not different from the current literature available. Adherence to the ECCO Guidelines for cancer surveillance improves the detection of early cancer in IBD patients.
P749 Epidemiological and clinical characterisation of inflammatory bowel disease (IBD) in Latin America and the Caribbean: The EPI-LATAM IBD study from the Pan American Crohn’s colitis organisation
Authors: Yamamoto-Furusho J K , Parra-Holguín N N , Grupo-Colombiano E , Bosques-Padilla F , Veitia-Velásquez G , Torres E , Piñol-Jiménez F , Bautista S , Frías-Santana A , Villa-Ovalles K , Otoya-Moreno G , Iadé-Vergara B 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) is currently recognised as a global health problem, since its incidence and prevalence have increased significantly worldwide in recent years. Studies in Latin America are only limited to reporting incidence and prevalence, so our main objective is to report the clinical and epidemiological characteristics of IBD in Latin American and Caribbean countries.

Methods
This is a multicentre cohort study in which 8 Latin American and Caribbean countries were included: Colombia, Cuba, Mexico, Peru, Puerto Rico, Dominican Republic, Uruguay and Venezuela during the period from August 2017 to October 2019. Two study groups were conducted by geographic region due to their ethnicity, Group 1) Caribbean: Cuba, Puerto Rico and Dominican Republic, Group 2) Latin America: Colombia, Mexico, Venezuela and Peru. Statistical analysis was performed with the statistical programme SPSS v.24. A value of p &lt;0.05 was taken as significant.

Results
This study included a total of 4216 IBD patients from 8 countries. The CD was more frequent than UC in the following countries: Puerto Rico with 68.5%, Dominican Republic 56.3% and Peru with 53.1%, while in the rest of the countries the frequency of UC predominated, in Colombia by 79.2%, Venezuela in 78.4%, Cuba in 69.9% and Mexico in 75.8%. The Caribbean countries had a significantly higher frequency in the fistulising phenotype in CD with 65.1% (p = 0.0001), steroid dependence in 11.51% (pp = 0.002), steroid resistance in 28.5% (pp = 0.0001), thiopurine intolerance in 1.40% (p = 0.0002), extraintestinal manifestations in 55.91% (p = 0.0001), IBD surgeries in 32.10% (p = 0.0001) and family history of IBD reported a frequency of 15.60% (p = 0.0001). For Latin America, the frequency of pancolitis was more frequent in 48.21% (p = 0001) in patients with UC. The factors associated with the use of biological therapy were: fistulising phenotype in CD, steroid resistance, thiopurine intolerance, presence of extraintestinal manifestations and IBD-related surgeries. There is an increased frequency in the diagnosis of IBD in the last two decades (2000–2019), being 7.5 times for UC and 12.5 times for CD as show in Figure 1.

Conclusion
This is the first large and multicentre study in Latin America and the Caribbean which showed significant increase in the diagnosis of IBD in the last two decades as well as the differences in clinical and epidemiological characteristics between both regions.
P750 Prevalence and characteristics of incidentally diagnosed inflammatory bowel disease during screening colonoscopy
Authors: Han Y M , Lee J , Im J P , Kim J S 
Published: January 2020

Abstract

Background
Colonoscopy is the most powerful tool for colon cancer screening. As the performance rate of screening colonoscopy was rapidly increased, there was also a great increase in the incidental detection of inflammatory lesions during screening colonoscopy. The significance and clinical course of these lesions were never been investigated. The aim of this study is to evaluate the prevalence and clinical significance of incidentally detected inflammatory lesions during screening colonoscopy and investigate the characteristics of newly diagnosed inflammatory bowel disease among them.

Methods
Health check-up patients who underwent screening colonoscopy at Seoul National University Hospital Healthcare System Gangnam Center in 2018 were enrolled. Among them, patients who showed endoscopic inflammatory lesions such as ulcer, erosion, erythema, spontaneous bleeding, friability or exudate were selected. We reviewed the pathologic reports of those patients. We investigated if there were suggestive pathologic findings of inflammatory bowel disease, which were defined as presence of one of these findings: cryptitis, crypt abscess, crypt distortion, crypt atrophy or noncaseating granuloma. We classified them as possible inflammatory bowel disease patients and closely monitored clinical course of these patients. We investigated prevalence of incidentally diagnosed inflammatory bowel disease among health check-up patients.

Results
A total of 10366 patients underwent screening colonoscopy at Seoul National University Hospital Healthcare System Gangnam Center. Among them, 237 patients showed inflammatory lesions on colonoscopy. Nine patients were already diagnosed with inflammatory bowel disease; 1 with Bechet’s disease and 8 with ulcerative colitis. The others had no previous medical history of colonic disease. Biopsy specimens were obtained in 200 patients. Eighteen patients showed one of suggestive pathologic findings of inflammatory bowel disease. Among them, 12 patients did not undergo further diagnostic examination because they did have no associated symptom. Two patients immediately diagnosed as ulcerative colitis and other 4 patients underwent short-term follow-up colonoscopy. Three of them showed resolution of previously noted inflammatory lesions and the remaining one finally diagnosed with ulcerative colitis. Briefly, 3 patients were diagnosed with inflammatory bowel disease, 3 with eosinophilic colitis, 1 with tuberculosis, and 1 with amoebic colitis.

Conclusion
Incidental detection of inflammatory lesions during screening colonoscopy was relatively high; however, prevalence of inflammatory bowel disease is low. Careful examination of associated symptom and sustained close long-term follow-up are needed.
P756 Cervical smear screening results amongst women with inflammatory bowel disease at an Irish hospital
Authors: Pillay L , Piggott R S , Ganter N , McCormack G 
Published: January 2020

Abstract

Background
Human papillomavirus (HPV) is strongly linked to the pathogenesis of cervical dysplasia; women with IBD may be at greater risk of developing cervical pathology, especially those on immunosuppressive therapies. In Ireland a national screening programme begins at age 25 and continues until age 60. This was a preliminary study looking at the number of women seen at our IBD clinic with a prior abnormal smear test, and the correlation to their medication history.

Methods
All women attending our IBD service, over an 8 week duration, were asked to complete a questionnaire regarding previous smear testing and results. We also looked at their diagnosis, years since diagnosis and medication history. Any patient who was referred on for a colposcopy was considered as having an abnormal smear.

Results
A total of 80 women with an average age of 51.5 years (SD ±±33.5) and with an average 20.8 years (SD ±±20.2) since diagnosis had been screened. 10 were under the age of 25 and thus excluded, of these 7 were vaccinated against HPV. Seven women who were eligible, had never had a smear and therefore excluded. A total of 63 women previously had a smear test in their lifetime.

Conclusion
Conclusion Our study shows that women in our IBD cohort have a significantly higher risk of having an abnormal smear vs. the average Irish women (23.8% vs. national average of 9.8%, p = 0.006). Furthermore, the majority (80%, p &lt; 0.001) of these patients were on immunosuppressive therapy at the time of the abnormal smear test. While the conclusion we can draw from this study are limited, we believe it emphasises the need for stringent adherence by IBD patients to screening guidelines for early detection of cervical dysplasia.
P776 Hospital re-admission in patients with inflammatory bowel disease: what are the risk factors?
Authors: Fromson R , Johnson E , Routledge E , Jameie-Oskooei S , Blad W , Patel R , Wong V 
Published: January 2020

Abstract

Background
Early re-admission after hospitalisation for an inflammatory bowel disease (IBD) flare is a negative quality indicator and causes unnecessary healthcare expense. Scoring systems to predict IBD readmissions have been shown to be ineffective. We aimed to describe the IBD re-admission rate at our hospital and investigate the risk factors.

Methods
Retrospective study of patients admitted to a London-based district general hospital under the gastroenterology team with a flare of inflammatory bowel disease between 2015 and 2018. Characteristic including but not limited to demographics, disease type, length of stay (LOS) during index admission, biochemistry and biologic use were recorded. Hospital software (Sunquest Integrated Clinical Environment, Medway) was used to identify patients re-admitted at 30 and 90 days after discharge. Multivariate logistic regression was performed.

Results
One hundred and thirty-eight patients were admitted with an IBD flare during the study period (74 (53.6%) Crohn’s disease (CD), 56 (40.6%) ulcerative colitis (UC), 8 (5.8%) IBD-U). Median age 33.5 (IQR 26–52), 71 (51.4%) female. Median LOS was 4.5 days (IQR 1.8–8). 36 (26%) patients were taking a biologic. Re-admissions occurred within 30 days in 19 patients (13.7%) and within 90 days in 30 patients (21.7%). Multivariate logistic regression showed that a raised CRP on discharge was associated with re-admission. For every increased unit of CRP by one there was an increased risk of readmission by 1.1 times (p = 0.05). Patients aged 22–39 were significantly less likely to be readmitted (OR: 0.38, p = 0.015). Male patients were significantly more likely to be readmitted (OR: 2.52, p = 0.05).

Conclusion
The 30 days and 90 days re-admission rate for our IBD population is just over 10% and 20%, respectively. CRP at discharge is significantly associated with both 30 and 90 days re-admission. After adjusting for confounders; CRP, age older than 40 and male gender were associated with re-admission to hospital. We advise caution in discharging IBD patients with raised inflammatory markers. Close follow-up within a few days of discharge would be appropriate in this high-risk sub-group.