bluuebunny/crossref_metadata_2025_split huggingface dataset:
P197 A snap-shot survey of IBD patients’ at a tertiary centre: a focus on knowledge and willingness to self-manage
Authors: DYALL L , Kamperidis N , Fofaria R , Fenech V , Tyrrell T , Barber S , Shah J , Randall S , Okpeh C , Arebi N 
Published: January 2020

Abstract

Background
Good quality Care in inflammatory bowel disease (IBD) includes the provision of patient-relevant information.1 Data on the level of patient understanding is lacking. We studied patients’ understanding of their IBD condition.

Methods
The IBD team and patient representatives devised a 16-item questionnaire that collected data on baseline demographics and disease-specific characteristics. Answers denoting understanding were scored positively. A sum (Q-sum) of the individual question scores was expressed as median (range).

Results
150 patients were surveyed (49% male). Thirty-nine per cent had ulcerative colitis, 51% Crohn’s Disease and 10% IBD-unclassified. There were: 39 aged &lt;30, 94 aged 30–60, and 15≥60.
The median (range) Qsum was 9 (1–16). Twelve per cent of patients had a Qsum of ³13. The Qsum of patients &lt; 60 years old was 10 (2–16) compared with 7 (1–13) of the ≥60 age group (p = 0.02). Sixty-two per cent of the younger and 60% of the older group perceived themselves as well informed (p = 0.9). The Qsum scores were 12 (2–14), 10 (2–16) and 8.5 (3–14) for patients with disease duration of ≤1 year, 2–15 and ≥15 years respectively (p &lt; 0.05). There was no difference in scores according to disease and medication type.
96% of patients in the &lt;60 age group were willing to access online information compared with 60% in the ≥60 age group (p &lt; 0.01). Younger patients were more confident in recognising symptoms of a flare [86%] compared with those aged ≥60 [60%] (p = 0.01), and were also more likely to understand how their condition may progress compared with older patients (66% vs. 40%, p &lt; 0.05).
Among patients &lt;60 years only 14% of males and 26% of females (p = 0.08) reported having enough information on fertility. Sixty-six per cent of patients on biologic drugs and 53% on non-biologic drugs considered themselves well informed (p = 0.12). Forty-six per cent of the non-biologics cohort also reported low levels of knowledge on self-management of mild flares. Seventy-six per cent of the biologics group and 87% of the non-biologics group expressed willingness for information on self-management (p = 0.1).

Conclusion
Older patients are less well informed, less confident in recognising symptoms of a flare, and less likely to access on-line resources. The level of knowledge inversely correlated with disease duration. This may reflect the heightened recent awareness on the inclusion of patient education in clinical care and availability of resources. There is an interest in receiving information on self-management of mild flares. Education sessions should be personalised according to patient characteristics and objective measures such as PAM score (Insignia Health), implemented to show benefits.

Reference
P225 Using a standardised reporting proforma is associated with improved endoscopic assessment in UC
Authors: KADER R , Middleton P , Ahmad O , Dart R , McGuire J , Sebepos-Rogers G , Segal J , Shakweh E , Samaan M 
Published: January 2020

Abstract

Background
Repeated endoscopic assessments are an essential part of ulcerative colitis (UC) disease management and current guidelines recommend the use of an endoscopic activity score, either the endoscopic Mayo score or Ulcerative Colitis Endoscopic Index of Severity (UCEIS) as treatment targets. These indices have prognostic value, with endoscopic healing associated with favourable short- and long-term outcomes. This multi-centre study aimed to assess the frequency of using endoscopic disease activity scores in UC patients undergoing lower GI endoscopy.

Methods
Lower GI endoscopy reports from patients with UC were retrospectively reviewed from 7 sites in London between April and October 2018. Endoscopy reports were assessed based on the BRIDGe endoscopic reporting criteria including the use of Mayo or UCEIS score. The comparison was made between site factors (specialist IBD centres/non-specialist centres, use of reporting proforma), endoscopist speciality (gastroenterology, surgery or nurse endoscopist), level of training (consultant, registrar or nurse endoscopist) and interest in IBD. Chi-squared was used to compare groups.

Results
899 lower GI endoscopy reports were reviewed. Mayo or UCEIS was used in 51% of cases (453/899). The use of endoscopic scores were significantly higher in gastroenterologists than in surgeons and nurse endoscopists respectively (401/762 (53%) vs. 22/54 (41%) vs. 30/83 (36%)), and higher in registrar trainees than consultants and nurse endoscopists (175/251 (70%) vs. 248/565 (44%) vs. 30/83 (36%)) and in those with a specialist interest in IBD compared with those without (237/409 (58%) vs. 216/490 (44%), p &lt; 0.0001). The use of endoscopic scores was more frequent in specialist IBD centres than in non-specialist centres (417/728 (58%) vs. 36/172 (21%), p &lt; 0.001). One centre used a reporting proforma which was associated with a significantly higher frequency of score use compared with centres without a proforma (202/260 (78%) vs. 251/639 (39%), p &lt; 0.0001).

Conclusion
Reporting of endoscopic disease activity using a standardised scoring system occurs in only half of cases from this large multi-centre cohort. Frequency of use is higher in specialist IBD centres and when performed by gastroenterology specialists. Endoscopy reports from a site that used a standardised reporting proforma were significantly more likely to include an endoscopic index as well as a range of other reporting items. This suggests, at least in part, that endoscopy reporting may be optimised by the introduction of a proforma. Integration of a standardised proforma into reporting software would target all endoscopists performing UC endoscopies regardless of speciality, site or IBD interest.
P249 Use of a point-of-care screening tool to identify depression and anxiety in patients with inflammatory bowel disease
Authors: Karpin J , Rodriguez T , Traboulsi C , Rai V , Rubin D 
Published: January 2020

Abstract

Background
Depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Recent guidelines from the ACG recommend screening for depression and anxiety in IBD patients, but the most effective and efficient way to do this is not established. We used a novel computerised adaptive testing technology to screen IBD patients for depression and anxiety and compared the screening results to disease activity.

Methods
Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH™ survey from Adaptive Testing Technologies (Chicago, IL). This tool is provided as a text or email link and takes 3–5 min to complete. We reviewed disease and patient characteristics. Categorical variables were assessed using Fisher’s exact test. Clinical remission status was determined by the senior author, blinded to the CAT-MH™ results.

Results
134 patients (75 women, 112 Caucasian, 84 Crohn’s disease) participated in the study, 85 of whom had no prior history of psychiatric disorders. We identified 51 patients with depression (46 mild, 3 moderate, 2 severe); 32/51 (62.7%) were previously undiagnosed. Thirty-six subjects tested positive for anxiety (24 mild, 10 moderate, 2 severe); 20/36 (55.6%) were previously undiagnosed. 2/134 patients were positive for suicidal ideation in the past month. Sex, race, type of IBD, surgical history, and number of discontinued medications were not significant (Table 1). Patients with active disease had a significantly greater relative risk for having depression (RR 2.26, 95% CI 1.50–3.39) and anxiety (RR 1.88, 95% CI 1.09–3.24) (Figure 1).

Conclusion
We demonstrate the utility of a novel screening tool for depression and anxiety in IBD patients. Furthermore, we illustrate the positive association between clinically active disease status and the presence of depression and anxiety. Physicians should consider patients with clinically active IBD at risk for depression and anxiety and treat or refer them accordingly.
P296 Quality of reporting of lesions detected at surveillance colonoscopy for IBD
Authors: SHARMA N , Virk A , Nardone O , Smith S , Rimmer P , Shivaji U , Ghosh S , Iacucci M 
Published: January 2020

Abstract

Background
International guidelines of ESGE and ASGE have laid out best practice for documentation of lesions at colonoscopy but few performance indicators have been proposed for surveillance colonoscopy in IBD. A recent publication has highlighted the key performance indicators for surveillance colonoscopy.1 We conducted an audit of current quality of colonoscopy reports documenting lesions detected during surveillance colonoscopy.

Methods
A retrospective analysis of patients who underwent colonoscopy for IBD surveillance over a five year period (2014–2019) at the Queen Elizabeth Hospital, Birmingham, UK was performed. The reports were analysed by independent academic doctors in the gastroenterology division trained in quality of endoscopic report analysis. Optimum criteria for documentation comprised lesion nature (Paris classification), size, documentation of Kudo classification and pit pattern, borders and ulceration.

Results
A total of 1028 colonoscopies were performed for IBD surveillance and the procedures were standardised with routine dye spraying since 2016. The mean patient age was 47.9 years (SD 16.8). Visual evidence of colonoscopic lesions was recorded in 273 cases. Key performance indicators documented for each endoscopic criterion and lesion nature is noted in the Table. Low-grade dysplasia was detected in 61 patients, and carcinoma in 4 patients; no patient had high-grade dysplasia. Benign lesions such as pseudopolyps were detected in the rest. 7 patients had sessile serrated lesions.

Conclusion
At IBD surveillance colonoscopy, documentation of lesions is better for the domains of size, Paris classification and Kudo pit pattern, though not perfect. We also highlight that our colonoscopic documentation of borders and presence of ulcerations is done poorly. It is important that comprehensive training is undertaken to improve documentation as it is essential for the proper choice of management of these lesions.

Reference
P301 Agreement in histologic diagnosis of preneoplastic lesions in inflammatory bowel disease: Results from a national survey in Italy
Authors: Canavese G , Saragoni L , Salviato T , Reggiani Bonetti L , Leoncini G , Baron L , Facchetti M , Vignale C , Villanacci V 
Published: January 2020

Abstract

Background
Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of gastrointestinal tract: the inflammatory damage increases the risk of developing preneoplastic and neoplastic conditions. Therefore, a good agreement between pathologists in the detection of preneoplastic lesion is essential in the management of IBD patients, in order to decrease the risk of progression towards neoplastic lesions. An agreement study on 4 pathologists and 38 cases of dysplasia demonstrated a fair agreement (k=0.4).1 A similar study demonstrated that the lowest level of agreement in the category indefinite for dysplasia (κ = 0.251).

Methods
The study consisted of a survey about diagnostic agreement in a series of preneoplastic lesions of IBD-affected patients, based on digital images. The occurrence of the disease and the occurrence of dysplasia were considered in the study. The study enclosed biopsy specimens from 30 colonoscopies and 1 surgical specimen, related to 20 patients with a clinical pattern of IBD from 4 reference centres in Italy. Digital slides were uploaded in an open-source learning platform. For each endoscopy, sampling sites with similar morphology were aggregated in 54 ‘blocks’, and a series of close-ended questions about (A) the occurrence of IBD (active, in remission, absent, not evaluable) and (B) the evidence of dysplasia (LG, HG, absent, undefined) have been submitted for every block. For each case, a final comprehensive evaluation about (1) the occurrence of IBD (present, absent, unsuitable for assessment), (2) the disease classification (ulcerative colitis, Crohn’s disease, unfit for differential diagnosis, not possible for lack of clinical data), (3) the occurrence of IBD-related dysplasia (IBD with dysplasia, dysplasia not IBD-related, dysplasia untestable, absent) and (4) the classification of dysplasia (sporadic adenoma, ALM, DALM, unclassifiable) were provided. Twenty gastrointestinal pathologists from as many centres in Italy were enrolled.

Results
325 of the 400 tests were successfully concluded.
Agreement values

Conclusion
A preliminary data analysis demonstrated a good agreement about the occurrence of IBD, and a lower agreement about the occurrence of dysplasia and its classification in IBD. Analysis of the correlation between agreement and clinical-histologic parameters could provide interesting spotlights on diagnostic algorithms in this field.
P302 Diagnostic accuracy of a serum-based biomarker panel for endoscopic activity in ulcerative colitis
Authors: HOLMER A , Boland B , Singh S , Le H , Neill J , Miralles A , Collins A , Sandborn W , Dulai P 
Published: January 2020

Abstract

Background
The endoscopic healing index (EHI, Monitr, Prometheus Biosciences, San Diego, CA) is a serum-based biomarker panel available for identifying mucosal inflammation in Crohn’s disease.[1] We aimed to study its performance for identifying mucosal inflammation in ulcerative colitis.

Methods
EHI was analysed on serum samples paired with endoscopies from adult patients (≥18 years) participating in a prospective biobank (June 2014 to December 2017). Area under receiver operating characteristic curves (AUROC) were used to assess the accuracy of EHI for endoscopic improvement (EI; Mayo endoscopic sub-score [MES] 0–1) and endoscopic remission (ER; MES 0). Sensitivity for EHI was calculated using a cut-off previously identified for Crohn’s disease which optimised performance for ruling out endoscopic activity (20 points). Alternative cut-offs were explored.

Results
A total of 114 patients were included, with an overall prevalence of 56% and 44% for EI and ER. The AUROC was 0.79 (95% CI 0.70–0.87) for EI and 0.70 (95% CI 0.61–0.80) for ER. A cut-off of 20 points had a sensitivity of 94% (95% CI 83–99%) for ruling out moderate to severe (MES 2–3) endoscopic activity, and a sensitivity of 84% (95% CI 72–92%) for ruling out mild to severe (MES 1–3) endoscopic activity. A cut off of 40 points or higher had &gt; 90% specificity for ruling in moderate to severe (MES 2–3) or mild to severe (MES 1–3) endoscopic activity. (Table 1)

Conclusion
EHI has favourable accuracy in identifying the presence of mucosal inflammation in patients with ulcerative colitis. Although it was not developed and validated for ulcerative colitis, further validation is warranted.

Reference
P320 Thrombocytosis in acute inflammatory bowel disease: a useful biomarker?
Authors: Gazelakis K , Chu I , Martin C , Ward M , Sparrow M 
Published: January 2020

Abstract

Background
Differentiating between infectious gastroenteritis and a flare of inflammatory bowel disease (IBD) can be difficult. Small studies have shown that thrombocytosis may not occur in infectious gastroenteritis. We aimed to determine whether thrombocytosis is a reliable biomarker in distinguishing between these two diagnoses in patients presenting with diarrhoea.

Methods
A retrospective cohort study was conducted at a tertiary referral IBD centre. From January 2000 and December 2018, patients admitted with acute diarrhoea were included. Inclusion criteria were infective gastroenteritis, IBD flare or both. IBD diagnosis was confirmed by standard clinical, radiological and histopathological criteria. Clinical and biochemical parameters were collected.

Results
There were 351 infectious and 506 IBD flare cases. Among these 216 (42.8%) had Crohn’s disease, 276 (54.7%) ulcerative colitis, and 13(2.6%) had IBD-unclassified. Table 1 summarises the main results. Those with acute IBD flare had a longer duration of diarrhoea, bloody diarrhoea, lower albumin and anaemia (p &lt; 0.05 for all comparisons). Patients with infectious diarrhoea were more likely to be older, female, have vomiting and fever and leucocytosis (p &lt; 0.05 for all comparisons). Median platelet count was higher in patients with IBD flares, 334 vs. 220 (p &lt; 0.001) and persisted on multivariate analysis (p &lt; 0.001, OR1.45). On multivariate analysis, other significant associations for IBD flare were age (OR.85, p &lt; 0.001) female sex (OR.23, p &lt; 0.110), blood in faeces (OR 5.98, p &lt; 0.001) vomiting (OR .17, p &lt; 0.001) and albumin (OR.83, p = 0.02). A sub-analysis compared patients with known IBD and infectious gastroenteritis with an identified pathogen (n = 47), with those with an IBD flare alone showed no significant difference in platelet count between groups (419 vs. 465, respectively, p = 0.17).

Conclusion
Our study shows significant differences between clinical and biological markers in patients with acute IBD flares compared with those with infectious gastroenteritis. In particular, thrombocytosis occurs in IBD flares but not in infectious gastroenteritis. This biomarker can be used to differentiate between these diagnoses and guide management.
P326 Reasons for and effectiveness of switching back to originator infliximab after a prior switch to CT-P13 biosimilar
Authors: Mahmmod S , Schultheiss J P D , Tan A C I T L , Lutgens M W M D , Gilissen L P L , Mahmmod N , van der Meulen - de Jong A E , Dijkstra G , van Bodegraven A A , Oldenburg B , Fidder H H 
Published: January 2020

Abstract

Background
In current clinical practice, patients with inflammatory bowel disease (IBD) treated with originator infliximab (IFX) have been or are being switched to biosimilar infliximab (CT-P13) because of lower costs and seemingly similar effectiveness of biosimilars. Over a one-year follow-up, 7%-26% of the patients discontinue CT-P13 treatment. Common reasons for CT-P13 discontinuation are (subjective) loss of response or adverse events. As a result of these newly experienced symptoms, patients are occasionally switched back to treatment with originator IFX. However, not much is currently known regarding reverse switching to originator IFX. We aimed to assess the prevalence of and the specific reasons for reverse switching to originator infliximab within 52-weeks after an initial conversion from originator infliximab to CT-P13 in patients with IBD. Additionally, we evaluated whether reinitiating originator infliximab led to the desired favourable effect and sustained infliximab use.

Methods
In this retrospective, multicentre cohort study, data of IBD patients from eight hospitals in the Netherlands were collected. Adult patients with IBD were eligible for inclusion if they were switched from infliximab originator to CT-P13 and had a follow-up time of at least 52 weeks after initial conversion. Reasons for re-switching were categorised into adverse events or loss of response on the biosimilar. Drug survival was analysed with a time-varying Cox proportional hazards model.

Results
A total of 684 patients with IBD were switched (516 Crohn’s disease, 168 ulcerative colitis). Reverse switching was seen in 74 (10.8%) patients after a median of 140 days (IQR 86–231). Reverse switchers were more often females (70.3% vs. 49.7%, p &lt; 0.001) and had shorter originator treatment (4.0 [IQR 2.6–6.5] vs. 5.2 [IQR 3.0–7.5] years, p = 0.037) than those who stayed on CT-P13. A total of 105 symptoms for switching were reported. IBD-like symptoms (25.7%) and dermatological symptoms (21.9%) were the most common. Four patients had objectified loss of response. All regained response after switching back. IBD-like symptoms and dermatological symptoms were reversible in 74.1% and 87%, respectively. Overall reversibility of symptoms was 73.3%. Cox proportional hazards model with CT-P13/originator infliximab as time-varying covariate, yielded no difference in survival risk (hazard ratio 1.23, 95% CI 0.65–2.33).

Conclusion
Switching back to originator infliximab seems effective in patients with IBD, who experience adverse effects or loss of response after switching from originator to CT-P13. Switching patients back to originator infliximab might, therefore, be justified in case patients experience new side effects or loss of response after switching to CT-P13.
P327 Effectiveness of anti-TNF vs. vedolizumab as a second biologic in IBD: results from national Swedish registers
Authors: Rundquist S , Sachs M , Eriksson C , Olén O , Montgomery S , Halfvarson J 
Published: January 2020

Abstract

Background
We aimed to evaluate the effectiveness of tumour necrosis factor antagonist (anti-TNF) compared with vedolizumab (VDZ) as a second-line biological treatment in IBD.

Methods
A propensity score-matched cohort was created using data from the Swedish National Patient Register, the Swedish Quality Register for IBD (SWIBREG) and the Swedish Prescribed Drug Register. Patients with Crohn’s disease (CD) or ulcerative colitis (UC) exposed to anti-TNF as a first-line biologic, who initiated a second biologic agent 1 May 2014 – 31 December 2016 were included (n = 1363). We compared patients exposed to anti-TNF vs. patients exposed to VDZ as a second-line biologic treatment. The primary outcome was drug continuation rate at 12 months. Secondarily, we assessed survival without hospitalisation (because of IBD, complications of IBD or IBD-related surgery) and survival without IBD-related surgery. Risk of infections was investigated as survival without a) prescription of antibiotics and b) hospitalisation because of infection. Additionally, the proportion of patients on corticosteroids at 12 months was assessed.

Results
After 1:1 propensity score matching, the cohort was restricted to 400 patients (CD, n = 198; UC, n = 202). For CD, estimated drug continuation rate at 12 months was 72.7% in the VDZ-treated patients, compared with 73.7% in the anti-TNF treated patients (Figure 1A). Survival without IBD-related hospitalisation (81.8% vs. 87.9%, p = 0.25), IBD-related surgery (81.8% vs. 88.9%, p = 0.17), prescription of antibiotics (64.6% vs. 70.7%, p = 0.33) and hospitalisation due to infection (94.9 % vs. 87.9%, p = 0.08) did not significantly differ between the groups. Likewise, there was no statistically significant difference in proportions of patients on corticosteroids at 12 months (21.2% vs. 22.2%, p = 0.86). For UC, estimated drug continuation rate at 12 months was 69.3% in the VDZ-treated patients, compared with 62.4% in the anti-TNF treated patients (Figure 1B). VDZ treated patients had lower survival without IBD-related hospitalisation (82.2% vs. 93.1%, p = 0.02) and IBD-related surgery (82.2% vs. 94.1%, p = 0.01). Survival without antibiotics (81.2% vs. 70.3%, p = 0.08) and hospitalisation due to infection (92.1% vs. 92.1%, p = 0.97) as well as corticosteroid treatment at 12 months (17.8% vs. 23.8%, p = 0.30) did not differ significantly between the groups.

Conclusion
In this propensity score-matched cohort, the effectiveness and safety of anti-TNF and vedolizumab appear comparable when used as a second-line biologic in CD. In patients with UC, risk of hospitalisation and surgery was lower in patients treated with anti-TNF. Randomised controlled trials are needed to confirm these findings.
Support provided by Takeda.