bluuebunny/crossref_metadata_2025_split huggingface dataset:
P131 The simplified MARIA score is strongly correlated with the MARIA and Clermont scores to analyse the luminal activity of Crohn’s disease (CD) in magnetic resonance and is easier to calculate
Authors: Roblin X , Jardin S , cuilleron M , veyrard P , boschetti G , berger A E , flourie B , nancey S , paul S 
Published: January 2020

Abstract

Background
Two scores have shown their interest in evaluating the luminal activity of CD in magnetic resonance (MR), the MARIA and Clermont scores, but their calculation can be complicated in clinical practice. Recently, the Spanish authors validated a new simplified MARIA score (MARIAs) and retrospectively showed a very good correlation with the initial MARIA score (1). The purpose of this study was to validate this correlation in an independent cohort and to compare its feasibility with other scores.

Methods
This was a retrospective analysis of all MR performed in our department to evaluate the luminal activity of CD. Two independent radiologists each calculated the MARIA, Clermont and MARIAs scores (wall thickness &gt; 3mm, oedema, comb sign, ulcerations), each blind to the other and blind to clinical activity. In case of disagreement between the two radiologists, a third reader analyzed MR activity. Correlations were calculated between these three tests for the entire cohort. In addition, concordance tests were performed for predetermined thresholds of 7 to 11 for the MARIA score, 8.5 to 12.5 for the Clermont score and 1 to 2 for the MARIAs score. The duration of the analysis was reported for each reading. Isolated colonic CD were excluded from the study.

Results
One hundred and twenty-one CD were included (65 in clinical and biological activity, 33% ileal phenotype, mean age: 38.5 years, sex ratio M/F = 54.5%). The agreement between the MARIA score between 7 and 11, the Clermont score between 8.5 and 12.5 and the MARIAs score between 1 and 2 was 0.92 (Fleiss kappa test). The correlation between the MARIA score and its simplified score was very strong (r = 0.93; 95% CI: 0.9–0.95) as well as between the Clermont score and the MARIAs score (r = 0.92 95% CI: 0.89–0.95). Inter-observer agreement was significantly higher in the calculation of the MARIAs score (96%) compared with 80% for the MARIA and Clermont scores (p = 0.04). Reading time was significantly faster for the MARIAs score (3.45 ± 0.4 min) compared with the MARIA (10.05 ± 1.2 min) and Clermont (13.5 ± −3.5 min) scores (p &lt; 0.01). Positive predictive values for deep remission (clinical remission and calprotectin &lt; 250 µg/g stool) were 95% at thresholds &lt;1, &lt;7 and &lt;8.5 for the MARIAs, MARIA and Clermont scores, respectively.

Conclusion
In this independent cohort, we confirm the very strong correlation between the simplified MARIA score and the two reference scores (MARIA and Clermont) in the analysis of MC luminal activity as well as its rapid calculation and strong inter-observer agreement.
P138 Basal plasma cells in normal large bowel: what is normal?
Authors: Castelli P , Abuquteish D , Di Ruscio M , Lunardi G , Zamboni G , Riddell R 
Published: January 2020

Abstract

Background
Basal plasma cells (BPC) are a diagnostic criterion for inflammatory bowel disease (IBD) and their persistence following therapy also indicates an increased risk of relapse. However neither the definition of basal plasma cells nor what is normal has been well established. We examined these parameters and determined whether there is reginal variability throughout the large bowel.

Methods
We looked at two patient populations. Group A) Biopsies from 6 standardised sites around the colon (cecum to rectum) from 37 patients who had normal colonoscopy at IRCCS Sacro Cuore Hospital, Negrar, Verona, Italy for symptoms suggesting irritable bowel syndrome, who were free of all medical therapy. Group B) a validation cohort from Mt Sinai Hospital Toronto using sections from the same 6 sites from 16 subtotal and total colectomy specimens performed for non-obstructing colonic carcinoma, primarily Lynch syndrome. Basal plasma cells were counted between two crypts in both the basal 5%, and the basal 20% of the mucosa. A partitioned visual analogue scale (PVAS) was also developed to see if this could replace counting, especially as the distance between crypts in IBD is variable

Results
In group A, in the lowest 5% part of the lamina propria, basal plasma cells were found throughout the large bowel and were highest in the proximal colon and lowest in the rectosigmoid. The maximum number of plasma cells between crypts was seven for the cecum and two for the rectum, with a gentle gradation between these two. The PVAS (range 1–5) varied from a maximum of 2 proximally to 1 distally. When the basal 20% was counted, the scores ranged from 35 in the cecum to 12 in the rectum, again with a gradation between, but the PVAS increased from a maximum of 3 proximally to 2 in the rectum. In group B the results were virtually to Group A and the PVAS scores were also virtually identical, The main difference was that at least one plasma cell was seen in all sections, likely because tissue sections encompass a much larger area. These results were all statistically significant.

Conclusion
The normal large bowel has a gradation of plasma cells that is highest proximally and lowest distally, however assessed, and needs to be taken into account when assessing the presence of basal plasma cells as an indicator of increased likelihood of relapse of IBD. The PVAS developed can replace the chore of counting, and is likely more meaningful when architectural distortion is present.
P139 Prevalence of infections in patients affected by inflammatory bowel disease treated with anti-TNF-α agents: a single-centre experience
Authors: Imperatore N , Foggia M , Rispo A , Patturelli M , Calabrese G , Testa A , Nardone O , Pellegrini L , Guarino A D , Ricciolino S , Tosone G , Castiglione F 
Published: January 2020

Abstract

Background
Although the efficacy of anti-TNF α agents has dramatically changed the current management of inflammatory bowel disease (IBD), their safety represents an important issue in prescribing anti-TNF. In particular, anti-TNF α treatment has been associated with higher risk of developing infective disease, such as tuberculosis (TBC) and cytomegalovirus (CMV) reactivation and other viral/bacterial diseases. The aim of the present study was to evaluate the incidence and prevalence of CMV, TBC, hepatitis B (HBV) and C (HCV) infection/reactivation and other infections in IBD subjects treated with anti-TNF α.

Methods
retrospective analysis of prospective maintained database including all IBD subjects treated with anti-TNF α (infliximab, adalimumab and golimumab) for at least 1 year in the period 2013–2018, whose infective serological status (Quantiferon TB test, Mantoux, CMV IgM/IgG, HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, anti-HCV, anti-HIV, HSV IgM/IgG, VZV IgM/IgG, EBV IgM/IgG) was known before starting the treatment and during the follow-up. Incidence (number of infections per 100 patient-years) and prevalence of each infection was reported.

Results
Among 689 who started an anti-TNF α agent, 288 subjects (males 52.8%, mean age 28.5 + 12.2 years, Crohn’s disease 82.3%), met inclusion criteria and were enrolled. Total years/patient were 378.08 for infliximab, 627.58 for adalimumab and 8.25 for golimumab. Before starting treatment, CMV IgG antibodies were detectable in the majority (78.8%) of patients, but no case of IgM or CMV-DNA positivity was recorded; three subjects (1%) had latent TBC infection (LTBI) and were treated with isoniazide before starting anti-TNF; one case of HBV and one case of HCV infection were registered. During the anti-TNF α treatment, a total of 58 infective events (20.1%) were recorded: 63.8% during adalimumab and 36.2% during infliximab treatment. The most common infections were: urinary (34.5%), cutaneous (13.8%), HSV (13.8%), HPV (8.6%), upper respiratory infections (8.6%), gastroenteritis (6.9%), pneumonia (5.2%), bacteraemia (3.4%), VZV (3.4%) and de novo CMV (1.7%). Among them, 13 (22.4%) were considered severe, 11 (19%) needed hospitalisation and 9 (15.5%) led to anti-TNF withdrawal. No case of CMV or TBC reactivation was registered during the follow-up. The infection incidence rate was therefore 6.05/100 patient-years for adalimumab and 5.55/100 patient-years for infliximab (p = NS) (Table 1).

Conclusion
IBD patients are at high risk of developing infective disease during anti-TNF α therapy. The recognition of pre-exposure serological status, as well patients’ strict monitoring during maintenance treatment, dramatically reduces the risk of severe reactivation (in particular TBC and CMV reactivation).
P142 Systematic review: patient perceptions of monitoring tools in inflammatory bowel disease
Authors: Goodsall T , Noy R , Nguyen T , Costello S , Jairath V , Bryant R 
Published: January 2020

Abstract

Background
Management of inflammatory bowel disease (IBD) is directed toward both clinical symptoms as well as objective disease activity as a part of a ‘treat to target’ strategy. Despite the increasing burden of disease activity assessment in IBD, patient preferences for monitoring tools have scarcely been considered. This study aimed to describe the available evidence for patient preference, satisfaction, tolerance and/or acceptability of the available monitoring tools in adults with IBD.

Methods
A systematic search of Embase, Medline, Pubmed, Cochrane Central and Clinical Trials.gov from January 1980 to April 2019 was conducted using PRISMA best practice guidelines. Included were all study types reporting on the perspectives of adults with confirmed IBD on monitoring tools, where two or more such tools were compared. Outcome measures with summary and descriptive data were presented.

Results
10 studies evaluating 1846 participants were included. Study size ranged from 18 to 916 participants. Monitoring tools included venepuncture, stool collection and faecal calprotectin (FC), gastrointestinal ultrasound (GIUS), computed tomography (CT), magnetic resonance imaging (MRI), wireless capsule endoscopy (WCE), barium follow-through, and endoscopy. The measurement tools used were visual analogue scales (VAS), Likert scales or binary preference questions. Outcome domains were patient satisfaction, acceptability of monitoring tool, and patient preference. Meta-analysis was not possible due to heterogeneity of data. Overall, patient preference was for non-invasive tools of disease monitoring and these were associated with a higher level of acceptability. Across all included studies, GIUS was identified by patients as the preferred tool for disease activity assessment. Both FC and other forms of imaging (MRE and CTE) were generally considered preferable to endoscopy, however less so than GIUS. Patient preference for blood testing varied, but in one study was lower than endoscopy. Two studies compared VAS acceptability of multiple IBD monitoring tools. Among 1037 patients, GIUS was considered the most acceptable IBD monitoring tool (mean VAS 9.29), as compared with venepuncture (9.28), WCE (8.5), MRE (8.08), stool collection (7.87), colonoscopy (7.07) and sigmoidoscopy (5.27).

Conclusion
This is the first systematic review to evaluate patient perceptions of monitoring tools used in IBD. Patients showed a preference for GIUS and more generally for faecal sampling and non-invasive imaging over endoscopy. Further research should address whether clinician selection of more acceptable monitoring tools in IBD engenders greater patient satisfaction, adherence, and a consequent improvement in disease-related outcomes.
P147 Systematic review: diverting loop ileostomy as treatment option in severe inflammatory bowel disease
Authors: STEENHUIS M , van Son K 
Published: January 2020

Abstract

Background
Severe colitis in the setting of inflammatory bowel disease (IBD), refractory to medical treatment, has traditionally been treated with an emergent colectomy, typically consisting of a two-step approach with a loop diversion in a setting of acute colitis, followed by a colectomy when inflammation has decreased as to minimise the risk of post-operative complications. More recently, several studies have questioned the need for secondary colectomy or have considered stoma reversal a viable option after diversion. We conducted a literature search primarily looking at the incidence of successful reversal or acute colectomy during follow-up. Secondary outcomes were post-surgical complications and clinical improvement after diversion.

Methods
We identified articles using a literature search using six medical databases. Articles were selected on the following criteria; severe colitis (either Crohn’s disease (CD) or ulcerative colitis (UC)), refractory to medical treatment, treated using a temporary loop ileostoma instead of an acute setting colectomy and scoring of clinical improvement parameters, such as decreased medication use and improvement of nutritional state.

Results
Seven studies, of which one was an extension and one was paediatric, were included. All were small studies with 13 to 33 participants, resulting in a total of 145 patients. A range of 16–60% underwent stoma reversal of the diversion based on mucosa and clinical remission with a follow-up rate varying from 4 to 33 months. In six studies, 15–29% of patients undergoing stoma reversal were symptom free during follow-up. Two studies showed partial remission in 55.2% and 69% of participants. Total colectomy in the diverted group, described in 5 studies, was seen in 9–53%. Complication rates ranged from 12–29%. Overall clinical improvement was seen in &gt;80% % of diverted patients. Only 2 studies made subgroup analyses of CD and UC, which showed a better result in CD patients regarding clinical improvement (&gt;90% improvement vs. &gt;80% improvement in UC patients) and rates of successful diversion, which was seen in 3/14 (21%) CD patients and 3/19 (16%) UC patients.

Conclusion
Diverting loop ileostomy in severe IBD is an effective treatment to avoid acute setting colectomy, with improvement in clinical status in &gt;80% of patients and a chance of 15–29% of successful stoma reversal without symptoms of IBD.
P151 Can two different faecal calprotectin assays be used interchangeably in inflammatory bowel disease treatment?
Authors: Van Wassenaer E , Diederen K , Kindermann A , van Leeuwen E M M , D’Haens G R , Benninga M A , Koot B G P 
Published: January 2020

Abstract

Background
Faecal calprotectin (FC) is a broadly used sensitive biomarker for intestinal inflammation in inflammatory bowel disease (IBD) patients. However, in practice, interpretation of results can be complicated due to the use of different assays to determine FC. There is a lack of data comparing different FC assays. This study aimed to assess the agreement between two different assays for determining FC in patients with IBD.

Methods
Between January and April 2017, faecal samples of known IBD patients were tested with two assays: (1) EliA 2 Calprotectin, (Thermo Fisher Scientific Phadia, Sweden) and (2) ELISA tests (EK-Cal, Bühlmann Laboratories, Switzerland). FC measurements &gt;1800 mg/kg were displayed as 1800, as the EK-Cal test could not measure higher values. Samples were not homogenised before testing, and they were tested on the same day. Inter-assay variability was first displayed in a Bland-Altman plot, and then difference in the categorisation of the FC result(1: 0–250 mg/kg, 2: 250–500 mg/kg, 3: &gt;500 mg/kg) was assessed with the linear weighted Kappa (κ). Values for agreement were judged as follows: κ &lt;.0: poor, .0-.20: slight, .21-.40: fair, .41-.60: moderate, .61-.80: substantial, &gt;.80: almost perfect.

Results
A total of 171 patients (mean age 33 years (range: 7–81), 92 (54%) female, 117 (68%) Crohn’s disease, 53 (31%) ulcerative colitis, 1 (1%) IBD-U) were included in this study. Median FC levels were 242 mg/kg (range: 4−1800), and the mean difference between the two assays was 89 mg/kg (range: -1341 – 1140). The mean difference was largest in the high FC category, (3: 200 mg/kg, n = 60), and smallest in the low FC category (1: 5 mg/kg, n = 82)). There was no systematic difference between the two assays (Figure 1). In five out of 171 (3%) patients there was a difference of two categories between the two assays and in 25 out of 171 (15%), there was a difference of one category. There was substantial agreement between the two assays (κ=.78).

Conclusion
There is no systematic difference in FC measurements between the Phadia and EK-Cal assay in this cohort of IBD patients, and agreement between the two is substantial. This suggests that these two assays can be used interchangeably for monitoring IBD patients in clinical practice.
P160 A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease
Authors: Eliakim R , Yablecovitch D , Lahat A , Ungar B , Shachar E , Carter D , Selinger L , Neuman S , Ben-Horin S , Kopylov U 
Published: January 2020

Abstract

Background
Capsule endoscopy (CE) is an important modality for monitoring of Crohn’s disease (CD). We recently established that small bowel (SB) inflammation on CE quantified by a Lewis score &gt;350 accurately predicts risk of relapse within 2 years in CD patients in clinical remission. Recently, a novel pan-enteric capsule (PillCam Crohn’s (PCCE), Medtronic, USA) was approved for use. However, no quantitative index for pan-enteric PCCE is currently available. The current study was undertaken as a sub-study of a prospective randomised controlled CURE-CD trial aiming to optimise treatment of CD patients in remission using a PCCE- based treat-to-target approach; the aim of this ancillary study was to compare the correlation and reliability of the novel PCCE inflamatory score (Eliakim score) with the Lewis score as performed by 2 independent experienced CE readers.

Methods
The study cohort includes CD patients in clinical remission (CDAI&lt;150). The patients were prospectively enrolled and underwent patency capsule evaluation; if excreted within 30 h, PCCE was performed following bowel preparation. PCCE was repeated every 6 months; if no colonic disease was detected on first PCCE, subsequent examinations were performed without colonic preparation. Each PCCE was independently reviewed by 2 experienced readers (RE (reader 1);UK (reader 2)). All studies were scored using the Lewis score and Eliakim score (comprised of a sum of scores for most common and most severe lesions multiplied by percentage of involvement per bowel segment (3 for small bowel and 2 for colon) with an additional stricture score). Pearson’s and Spearman’ correlation, Cohen’s kappa and inter-rater reliability coefficient (IRC) between the scores and the readers were calculated as appropriate.

Results
Forty PCCE exams were included. The median LS was 225 for both readers (interquartile range (IQR)—157–815 for reader 1, 33- 1125 for reader 2). Both readers identified significant SB inflammation (LS&gt;350) in 17/40 (42.5%) of the patients with strong agreement between the readers (Spearman’s r = 0.87, p &lt; 0.0001). The median PCCE score was 6 (4–14.75) and 4 (2–14.75) for reader 1 and 2, respectively. There was a high IRC between the two readers for LS (0.88, p &lt; 0.0001 for absolute agreement) and PCCE score (0.91, p &lt; 0.0001). For the small bowel, the correlation between LS and PCCE was moderate for reader 1 (Pearson’s r = 0.72, p &lt; 0.0001 and strong for reader 2 Pearson’s r = 0.84, p &lt; 0.0001).

Conclusion
There is a need for a quantitative pan-enteric score for the novel Pillcam Crohns capsule. The presently proposed score, while mandating further clinical validation, has strong inter-reader reliability and moderate-to-strong correlation with the validated small bowel capsule score (LS)
P172 Immunisation and vaccination status at diagnosis in Pediatric inflammatory bowel disease
Authors: Velasco Rodríguez-Belvís M , Palomino Pérez L M , Sánchez Fernández-Bravo C , Jose Luis L F , Sanchiz Perea A , Cañedo Villarroya E , Domínguez Ortega G , Pedrón Giner C C , Rodríguez Manchón S , Martínez Pérez J , Muñoz González A , Muñoz Codoceo R A 
Published: January 2020

Abstract

Background
Pediatric inflammatory bowel disease (PIBD) patients are especially prone to vaccine-preventable diseases and opportunistic infections. The aim was to evaluate the immunisation and vaccination status in PIBD.

Methods
Descriptive and retrospective study that analyses the immunisation and/or vaccination for measles, mumps and rubella (MMR), hepatitis B virus (HBV), chickenpox, cytomegalovirus (CMV) and Epstein–Barr virus (EBV) of PIBD patients in a tertiary paediatric hospital (January 2015- Oct 2019) in the first 6 months after diagnosis.

Results
Amongst 57 patients, 17 (30%) had ulcerative colitis (UC), 35 (61%) Crohn’s disease (CD) and 5 (9%) unclassified IBD (uIBD). Up to 35 (61%) were male and the mean age at diagnosis was 10.2 ± 4.1 years. A total of 18 (32%) were currently on biological treatment and 45 (79%) on immunosuppressants. The disease location in CD patients was L3 (Paris classification) in 22 (63%) and L4a in 13 (37%). Only 2 (6%) showed perianal involvement. From the UC patients, 11 (65%) were E4. A delayed growth was observed in 6 (10%), all CD patients.
At diagnosis, 37 (65%) were HBV-vaccinated, 13 of them (35%) had a serological response and 22 (59%) had no response. Amongst the latter, 18 were re-vaccinated and 9 (50%) had a documented serological response. Up to 34 patients (60%) were MMR-vaccinated and 13 (38%) showed a complete response. Only 6 patients could be re-vaccinated. Up to 30 (52%) showed chickenpox immunisation. Only 4 of the non-immunised patients could be vaccinated and all of them responded to a single dose. Regarding CMV and EBV, 17 and 16 patients (46 and 43%) were IgG positive respectively, all of them were IgM negative.
Patients with CD were more likely to need HBV re-vaccination than other IBDs (p &lt; 0.05). Regarding chickenpox, CD patients without growth delay (G0) needed less re-vaccination than those whose growth was affected (G1) (p &lt; 0.05). However, UC patients with extensive disease (E4) needed less re-vaccination than those with limited disease (p &lt; 0.05). Male patients seemed to be less likely to need re-vaccination, with no significant differences.

Conclusion
The serological assessment of vaccine-preventable diseases immunisation yielded poor results. Remarkably, a high percentage of HBV and MMR vaccinated patients showed no response. CD patients tended to more likely need revaccination, especially in the most severe cases (G1). Surprisingly, severity was not related with vaccination response in UC. Our results suggest that less than half of the patients had been previously infected by CMV or EBV. Based on this, it seems reasonable to serologically check the immunisation status in PIBD patients in order to, when appropriate, re-vaccinate before starting immunosuppressive therapies.