bluuebunny/crossref_metadata_2025_split huggingface dataset:
P082 Spicy food is a vital trigger for relapse in patient with inflammatory bowel disease
Authors: Chen Y , Ma C , Dang Y , Chen K , Shen S , Jiang M , Zeng Z , Zhang H 
Published: January 2020

Abstract

Background
The dietary is one of the environmental triggers for inflammatory bowel disease (IBD). We investigated which types of food can induce the relapse and worsen the symptoms in IBD patients through the epidemiologic study, and then explored the underlying mechanisms in an animal study.

Methods
A questionnaire assessing demographics, dietary habits and relapse-associated risk factors in patients has been administered to consecutive IBD patients who suffered one or more relapses at West China Hospital from September 2016 to November 2018. The mice with dextran sulphate sodium (DSS)-induced chronic colitis were orally administrated with top one type of risk food. The severity of mice colitis after administration was evaluated by disease activity index (DAI), histology, activity of myeloperoxidase (MPO) and the level of inflammatory cytokines. The infiltration of immune cells in lamia propria (LP) of mice was analysed by flow cytometry (FCM).

Results
A total of 306 patients participated in the survey, including 188 ulcerative colitis (UC) patients and 118 Crohn’s disease (CD) patients. Spicy food ranked first for the relapse in patients with IBD. In particular, 54.3% (n = 102) UC patients and 53.4% (n = 63) CD patients reported that the intake of spicy food could cause a relapse. Fifty per cent UC (n = 94) patients and 40.7% (n = 48) CD patients reported that the intake of spicy food could worsen their symptoms. In the animal study, the oral administration of capsaicin aggravated the chronic colitis in mice, along with the increased activity of MPO and the upregulated level of inflammatory cytokines. The pro-inflammatory effect of capsaicin was dose independent but time dependent. The antagonist for transient receptor potential vanilloid 1 (TRPV1), the receptor of capsaicin, could significantly suppress the capsaicin-induced deterioration of colitis. FCM revealed that capsaicin-administration led to the recruitment of multiple types of immune cells in mice LP and the recruitment of neutrophils was the most prominent.

Conclusion
The intake of spicy food can contribute to the relapse and deterioration of symptoms in IBD patients with UC and CD. In mice, the oral administration of capsaicin exacerbated DSS-induced colitis which was characterised by the recruitment of neutrophils, indicating the association between neutrophils and the relapse-triggering effect of capsaicin in colitis.
P101 Biomarkers of elastin degradation are associated with clinical and biochemically active disease in Crohn’s disease
Authors: Pehrsson M , Domislović V , Karsdal M A , Brinar M , Barisic A , Krznaric Z , Manon-Jensen T , Mortensen J H 
Published: January 2020

Abstract

Background
In Crohn’s disease (CD), the extensive and potentially transmural inflammation results in increased activity of both matrix metalloproteases (MMPs) and serine proteases, causing a higher degree of intestinal tissue remodelling. This increased proteolytic activity could potentially cause degradation and loss of function of mechanical and functional matrix proteins, such as elastin. Therefore, we sought to investigate the association between biomarkers of elastin degradation and the disease activity in CD patients.

Methods
Seventy-two CD patients and 29 healthy donors (HD) were included in the study. Disease activity was determined according to the Crohn’s disease activity index score (CDAI &gt;150) and/or a faecal calprotectin (fCALP &gt;250). Additionally, CD patients were endoscopically assessed according to the simple endoscopic score (SES) for CD. Different protease derived biomarkers of elastin degradation: protease-3 (ELP-3), MMP-7 (ELM-7) and cathepsin-G (EL-CG) was measured in serum by ELISA. One-way ANOVA (Kruskal–Wallis) was applied for the statistical analysis.

Results
The levels of ELP-3 was significantly elevated in active CD when compared with the HD (p &lt; 0.001), and inactive CD (p &lt; 0.01). Levels of EL-G were significantly elevated when comparing active CD and HD (p &lt; 0.05), with the same result observed for the levels of EL-CG when comparing active CD and the HD (p &lt; 0.05). Endoscopically, ELP-3 was shown significantly elevated in moderate–to-severe CD patients when compared with the HD (p &lt; 0.01).

Conclusion
In this study, measurements of the elastin degradation markers were capable of differentiating between CD patients with either a clinically active or biochemically active disease, with the biomarker levels being significantly highest in the patients with an active disease. This was also the case when assessing endoscopic disease activity, where the protease-3-derived biomarker levels were highest in patients of moderate-to-severe disease activity. As such, the data provide indications of the beneficial use of these serum biomarkers as additional disease activity assessment tools for CD patients.
P112 Body composition and resting energy expenditure in IBD patients receiving biological therapy
Authors: Vranesic Bender D , Cengic L , Ljubas Kelecic D , Karas I , Grbin Hodžić A , Domislović V , Brinar M , Juričić M , Krznarić Ž 
Published: January 2020

Abstract

Background
As a feature of changing phenotype of IBD in the last decade, we observe increased rates of obesity and increased BMI values as well as changes in body composition. Special interest is the impact of biological therapy on body composition and prevalence of obesity in IBD patients, since the data on this topic are limited. The aim of this study was to determine body composition and resting energy expenditure of patients treated with biological therapy.

Methods
The study included 74 patients (39 male and 35 female) at the Clinical Hospital Center Zagreb (52 patients with Crohn’s disease and 22 with ulcerative colitis) treated with infliximab/adalimumab/ustekinumab/vedolizumab. Resting energy expenditure was measured by the indirect calorimetry (Cosmed Quark CPET) and compared with the predicted resting energy expenditure calculated using Harris-Benedict equation. Detailed medical and nutritional anamnesis was taken and we measured the following body composition parameters using TANITA body composition analyser, BC-420MA: body mass index (BMI), fat mass (FM), visceral fat rating (VFR), muscle mass (MM) and skeletal muscle mass index (SMI) was calculated.

Results
Increased BMI was observed in 32% of the patients, while 41% of the whole sample had an increased FM. The mean value of skeletal muscle index (SMI) was 9,061,15 kg m−2 and it revealed the presence of moderate sarcopenia in 32 patients (43%), of which 30 were men. Indirect calorimetry (IC) obtained the value of resting energy expenditure (REE), with the measured REE (1569,81240,95 kcal) on average significantly lower than predicted (1640,36255,28 kcal), t(73)=−3.023, p &lt; 0.05. The results of this study revealed a significant prevalence of moderate sarcopenia in men, increased body mass and fat mass, and slightly lowered resting energy expenditure. There was no significant difference between body composition parameters and REE between different types of biological therapy.

Conclusion
The incidence of classical forms of malnutrition in this group of patients is significantly lower in comparison with standard therapy and previous experience. Most of the patients were well nourished and we observed trends toward overweight and sarcopenic obesity in some patients. A slight decrease in REE in the whole sample could be a reflection of impact of biological therapy on fat tissue and profound modulation of lipid metabolism as well as decreased muscle mass and physical activity level of the patients.
P115 Real-world experience of peri-operative treatments on surgical complications after Ileo-caecal resection in Crohn’s disease
Authors: Di Stefano S , Liefferinckx C , Cremer A , Amininejad L , Van Gossum A , Devière J , Van de Stadt J , Franchimont D , Buggenhout A 
Published: January 2020

Abstract

Background
The current recommendations remain vague as to whether biologics are safe or deleterious when surgery is contemplated in patients with Crohn’s disease (CD). Conflicting data do not enable to adopt a definitive position on the time to surgery. The aims of this study were to evaluate the impact of perioperative treatments on the rate of surgical complications and to report surgical recurrence rate of CD after ileo-caecal (IC) resection.

Methods
This was a retrospective monocentric cohort study of consecutive CD patients who underwent IC resection between 1996 and 2018. An ethical committee has been approved (P2019/376). The overall rate of surgical complications was evaluated within 30 days after surgery. The effect of pre- and postoperative treatments was assessed on overall morbidity, general and infectious complications, anastomotic leakage and risk factors. Statistical analyses were performed using SPSS.

Results
Demographic data of the 165 CD patients who underwent a primary IC resection are presented in Table 1.

The median age at time of the first IC resection was 35 years (IQR 24–44) while the median follow-up was 6.1 years (IQR 1–11). The overall rate of complications was 18% including 8.7% and 3.3% patients with infectious complications and anastomotic leakage, respectively. No risk factors have been found to be associated with surgical complications. In particular, immunosuppressants and biologics did not increase the risk of surgical complications. Twenty-four per cent of patients (n = 39/160) needed a second IC resection due to stenosis at the anastomosis site in 69.2% of cases (n = 27/39). Surgical recurrence was found to increase linearly over time with a second surgery after a median follow-up of 8 years (IQR 2–12). Anti-TNF used as post-operative treatment had a protective role on surgical recurrence in multivariable regression with odd ration (OR) of 0.15, p = 0.001 (Table 2).

Conclusion
Prevalence of complications after an IC resection in CD patients was of 18% in this retrospective monocentric cohort. No risk factors were found to be associated with surgical complications. Anti-TNF seems to have a protective role on surgical recurrence.
P127 Lemann Index for Assessment of Crohn’s disease association with the quality of life, endoscopic disease activity and magnetic resonance indices of activity
Authors: Straksyte V , Kiudelis G , Kupcinskas L , Zaboriene I 
Published: January 2020

Abstract

Background
Crohn’s disease (CD) is one of the subtypes of idiopathic inflammatory bowel disease and is characterised by continuing inflammation and progressive gut damage. Despite many scoring indices of CD, there is a lack of more global assessment tools for the evaluation of the total disease impact on the gut.

Methods
One hundred adult patients with proven CD underwent magnetic resonance enterocolonography (MR-EC), colonoscopy and clinical activity assessment. Patients’ quality of life was assessed by IBDQ. MR-EC was used to evaluate the Magnetic Resonance Index of Activity (MaRIA- global (G)), modified (m)MaRIA-G, Clermont-G and the Lemann Index (LI). The CD Endoscopic Index of Severity (CDEIS) was used to score the endoscopic activity of the disease.

Results
LI and IBDQ (r = −0.813, p &lt; 0.01) showed a strong negative correlation. IBDQ also demonstrated a strong negative correlation with other MR-EC indices: MaRIA-G, mMaRIA-G and Clermont-G (r = −0.731, r = −0.749, r = −0.726, p = 0.01) respectively. Moreover, there was a moderate correlation between MaRIA-G and CDEIS, also MaRIA-G and LI, respectively (r = 0.698 and r = 0.658, p = 0.01). As well as MaRIA-G and LI, other MR-EC indices mMaRIA-G and Clermont-G showed good correlation with CDEIS (r = 0.580 and r = 0.585, p = 0.01).

Conclusion
A strong negative correlation between LI and the quality-of-life measured by IBDQ was determined. This correlation was less pronounced when using the MaRIA-G index; therefore, the LI could be more helpful in assessing more global characteristics of the disease, besides the inflammatory activity of the gut.
P128 Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real life experience
Authors: Rubín De Célix Vargas C , Chaparro M , Moreno J A , Santander C , Gisbert J P 
Published: January 2020

Abstract

Background
Patients with inflammatory bowel disease (IBD) are at increased risk for developing colorectal cancer (CRC). Recent practice guidelines suggest the use of chromoendoscopy with targeted biopsies to identify dysplastic lesions. The aim of this study was to know the dysplasia detection rate with chromoendoscopy in a real life cohort and to describe endoscopic characteristics of the lesions detected and their management.

Methods
Single-centre retrospective and observational study of all chromoendoscopies done between January 2016 and May 2019 in adult patients with left-sided/extensive ulcerative colitis or Crohn’s disease involving more than one-third of the colon. All polyp characteristics were collected (localisation, size, Paris and Kudo classifications) and their treatments received (endoscopic resection or surgery).

Results
One hundred and eighty-six chromoendoscopies on 160 patients were included. Of all chromoendoscopies, the dysplasia detection rate was 24% (23% of patients had dysplasia in any chromoendoscopy done during the period of the study). Ninety-two patients (57%) were men. Eighty-six (54%) had ulcerative colitis, 72 (45%) Crohn’s disease and 2 (1%) non-classifiable IBD. Twenty-five (15%) had family history of CRC. 118 (74%) received treatment with aminosalicylates, 67 (42%) with thiopurines and 42 (26%) with biologics. A total of 212 lesions were detected, 94% were located in areas of mucosa close to the segment affected by IBD. Most of them were located in the rectum (36%) and left colon (30%). More than half of the lesions were flat polyps (31% Paris 0-IIa, 25% Paris 0-IIb). The most frequent Kudo pit pattern was Kudo II (43%) and Kudo IIIs (33%). A total of 123 (58 %) lesions were non-neoplastic and 74 (35%) were neoplastic. Among these, 69 (93%) were low-grade dysplasia and five were high-grade dysplasia: 5/5 located in rectum, and one of them could not be suitable for endoscopic resection. Twelve lesions could not be retrieved. Only five patients (3%) required surgical treatment. In the univariate analysis, the presence of dysplasia was not related with age, sex, smoking, or type of IBD. Dysplastic lesions were more frequently localised distal to the splenic flexure (OR, 0.543; 95% CI, 0.30–0.99; p &lt; 0.05) compared with non-dysplastic lesions; they were non-polypoid lesions: Paris 0-IIa, 0-IIb, 0-IIc (OR, 0.11; 95% CI, 0.02–0.59; p &lt; 0.001). The polyp size was not a predictor of dysplasia.

Conclusion
This study reports a high dysplasia detection rate (24%) via targeted chromoendoscopic biopsies in a real life cohort. Endoscopic resection removed the lesions in most of the cases; only 3% of patients need surgery (partial colectomy). Our results underlines the importance of colorectal cancer surveillance in IBD patients.
P132 Performance of a severity score in risk stratification of patients with ulcerative colitis
Authors: Morão B , Frias Gomes C , Gouveia C , Costa Santos M P , Torres J 
Published: January 2020

Abstract

Background
Patient stratification according to the risk of developing complications is an essential step to define the best treatment approach in patients with ulcerative colitis (UC). Recently, Siegel et al (Gut 2017) published a score that aims to access the disease severity, considering disease activity (both clinical and endoscopic factors) and complications during the disease course, ranging from 0 to 100 values (higher values indicating worse disease severity). Our goal was to evaluate the capacity of this score calculated at the time of diagnosis (dx) to predict disease course during follow-up (FU): steroid use, therapy escalation to immunomodulators or biologics, hospitalisation and/or abdominal surgery.

Methods
Retrospective cohort study including incident cases of UC in our centre between December 2012 and December 2018. We calculated the score at the time of dx and at the end of FU and collected data about disease course.

Results
Eighty-five patients (57% men with a mean age of 43 ± 17 years) with newly diagnosed UC were included. Disease extension according to Montreal was E1 in 30/85 patients, E2 in 37/85 patients and E3 in 18/85 patients. Median FU time was 40 months. Median risk score at the time of dx was 30 (IQR 3–91) and it was higher in patients with younger age (36 vs. 26, p = 0.08) and extensive colitis (64 vs. 26, p &lt; 0.001). During FU, 19/85 and 17/85 patients needed steroid use and therapy escalation, respectively. Proximal disease extension occurred in one patient. Hospital admission for acute exacerbation and/or colectomy was required in 6/85. The score at dx was higher in patients who underwent hospital admission or colectomy (score: 70 vs. 26, p = 0.002), or that needed steroid (score: 57 vs. 26, p &lt; 0.001) or therapy escalation (score: 57 vs. 26, p &lt; 0.001) during FU. In a survival analysis, the time for steroid use (plogrank &lt; 0.001) or therapy escalation (plogrank &lt; 0.001) was lower in patients with a higher score at dx (61 vs. 88 months and 56 vs. 86 months, respectively). The median score at the end of FU was 3 (IQR 0–66); a second colonoscopy was not available in three patients, who were not included in this analysis. There was a score reduction in 77/82 patients (39/82 had a score of 0). Only one patient had a similar score and 4/85 patients had a higher score. Patients with a significant score reduction during FU (below the median) were more frequently patients with no need for steroid use (p &lt; 0.001) or therapy escalation (p = 0.002).

Conclusion
This severity score seems to be a promising tool for risk stratification and prognosis determination in patients with UC, and its utility should be validated in prospective studies.
P135 Disease-related worries and concerns in UK patients with ulcerative colitis: 2-year data from ICONIC
Authors: Bhala N , Hart A , Watts D , Lewis S , Ghosh S , van Haaren S , Hansell C , Ahmad T 
Published: January 2020

Abstract

Background
ICONIC is the largest ongoing, prospective, multi-country observational study assessing cumulative disease-associated burden in adults with ulcerative colitis (UC) under routine care. This local subanalysis evaluated patient worries and concerns up to 2 years in UK patients using the Rating Form of inflammatory bowel disease (IBD) Patient Concerns (RFIPC) questionnaire.

Methods
Adults with early UC (diagnosed ≤36 months) were enrolled irrespective of treatment regimen or disease severity. Patients completed RFIPC, a 25-item questionnaire comprising frequently reported worries/concerns of IBD patients, at each visit (6-month intervals). Responses are scored on a 10-cm visual analogue scale for each individual question from 0 (no concerns) to 10 (a great deal). The mean of all 25 items represents the total score (lower scores indicate less worries/concerns). In this analysis, data are reported for UK patients as observed using descriptive statistics at baseline (BL, visit 1 [V1]), 1 year (V3), and 2 years (V5). Patients were stratified by physician-assessed disease severity (mild, moderate, severe, in remission) at baseline.

Results
Sixty-three UK patients were included (37 [59%] female; mean ± SD age 43.4 ± 15.7 years; median [interquartile range] time since UC diagnosis 126 (59 to 260) days; physician-assessed UC severity: mild 18 [29%], moderate 18 [29%], severe 11 [17%], in remission 16 [25%]). Mean ± SD total RFIPC scores for all patients were 2.9 ± 2.3 (n = 63) at V1, 2.7 ± 2.5 (n = 40) at V3, and 2.2 ± 2.0 (n = 35) at V5. At BL, mean ± SD RFIPC total scores by physician-assessed disease severity at BL were: mild 3.2 (1.9); moderate 2.6 (2.6); severe 4.8 (2.4); in remission 1.8 (1.7). The changes from BL to 2 years, stratified by physician-assessed disease severity at BL, were: mild −1.2 (1.4); moderate −0.7 (1.7); severe −2.2 (2.7); in remission −0.2 (1.0). The disease-related-specific concerns with the highest mean total RFIPC scores (i.e. scores &gt;4.0) for all patients at BL were ‘energy level’, ‘having an ostomy bag’ and ‘effects of medication’. Mean total RFIPC scores for these specific concerns decreased between V1 and V5 for all patients. Of 5 UK sites, all had established multi-disciplinary teams (MDTs) and four had a psychologist in situ.

Conclusion
Despite all UK centres having MDTs and most having a psychologist in situ, this subanalysis from ICONIC demonstrated a high burden of worries and concerns in early UC patients with more severe disease. These concerns were most notable at BL, and appeared to decrease over time. The greatest concerns were with the treatment and complications of the disease; this included concerns about energy levels, highlighting that fatigue remains an unmet need for UC patients.
P136 Faecal calprotectin as therapeutic target in patients with Crohn’s disease treated with anti-TNF: a meta-analysis of individual data
Authors: Mami A , Nancey S , Pugliese D , Molander P , Boschetti G , Nogueira I , Pereira B , Buisson A 
Published: January 2020

Abstract

Background
Faecal calprotectin (Fcal) could be a non-invasive alternative to endoscopy to assess therapeutic efficacy in patients with Crohn’s disease (CD). We performed a systematic review and meta-analysis of individual data to assess the performances of FCal after anti-TNF induction therapy to predict mid-term steroids-free clinical remission (CFREM) in CD.

Methods
We included all the studies reporting patients with CD receiving anti-TNF agents with Fcal measurement before and after induction therapy (from 8 to 14 weeks) with follow-up &gt; 6 months, no therapeutic intervention based on FCal during the follow-up and mid-term clinical evaluation between week 32 and week 54. CFREM was defined as CDAI &lt; 150 and continuation of the same anti-TNF agent without steroids.

Results
We identified five articles including 165 patients with CD (mean age = 34.5 ± 12.8 years, median CD duration 5 years [2–12], female gender = 52.7%, active smokers = 33.3%, prior bowel resection = 25.6%, CD location (L1 = 32.1%, L2 = 15.8%, L3 = 52.1%), perianal lesions = 22.4%). The patients were treated with infliximab (50.9%), adalimumab (47.3%) or certolizumab (1.8%), and received concomitant immunosuppressants in 48.5% of the patients. Mid-term CFREM was achieved in 57.3% of the patients. Fcal level after anti-TNF induction therapy was lower in patients who achieved mid-term CFREM (100 µg/g [48–267] compared with those who did not (491 µg/g [165–856]; p &lt; 0.001). The relative decrease of Fcal between before and after induction therapy was also associated with mid-term CFREM (p = 0.022). In multivariable analysis adjusted on CDAI, CRP and disease duration, FCal level (p = 0.014) and relative decrease of anti-TNF (p = 0.025) after induction were associated with mid-term CFREM. Cut-off values between 200 and 400 µg/g showed close performances to predict mid-term CFREM. FCal &lt;250µg/g predicted mid-term CFREM with: Se = 73.3%[63.0%-82.1%], Spe = 67.7%[54.9%-78.8%], PPV = 75.9%[65.5%-84.4%] and NPV= 64.7%[52.2%-75.9%]. A relative decrease ≥ 50% between baseline and the end of induction was the best threshold to predict mid-term CFREM (Se = 59.6%[48.6–69.8%], Spe = 78.5%[66.5–87.7%], PPV = 79.1%[67.4–88.1%] and NPV = 58.6% [47.6–69.1%]). We found a significant study effect (ICC =0.36 ± 0.18) due to the variability according to FCal assay. The likelihood of being in CFREM at mid-term (PPV) according to the combination of CDAI, CRP and Fcal was presented in Figure 1.

Conclusion
The improvement of Fcal after anti-TNF induction therapy is predictive of mid-term CFREM in patients with IBD. The combination of clinical remission, CRP normalisation and FCal improvement should be a therapeutic target in patients with CD. Our work highlighted the need of international standardisation of Fcal measurement.