bluuebunny/crossref_metadata_2025_split huggingface dataset:
P612 Dietary practices and beliefs of British South Asians with inflammatory bowel disease: A prospective UK study
Authors: Crooks B , McLaughlin J , Limdi J K 
Published: January 2020

Abstract

Background
The increasing incidence of inflammatory bowel disease (IBD) in newly industrialised countries and immigrant populations appears to outpace that which genetic influences alone could instigate. Environmental factors, in particular, the western diet, are therefore implicated in its aetiopathogenesis. Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian IBD patients and information resources utilised to guide these beliefs.

Methods
A prospective, cross-sectional, questionnaire-based study is being conducted across hospitals in the UK. Two-hundred South Asian patients with IBD are being recruited to complete a questionnaire regarding demographics and dietary practices.

Results
Data from 118 patients are available to date. Mean patient age is 43 years (51% female). Sixty-five per cent have ulcerative colitis (UC) and 33% Crohn’s disease (CD). Fifty-one per cent are of Indian ethnicity, 37% Pakistani and 10% Bangladeshi. Forty-nine per cent of patients were born in the UK to parents who were born outside of the UK and 51% of patients were born outside the UK. Mean disease duration is 10.5 years. Forty-six per cent considered diet to be an initiating factor in their IBD, based on their own experience (85%) as well as information from internet resources (31%) and other patients with IBD (19%). Fifty-nine per cent of patients felt that diet had triggered a relapse of their disease. Most commonly reported foods were spicy (69%) and fatty foods (47%), milk products (44%) and red meat (37%). Eighty-six per cent of patients avoided certain foods in an attempt to prevent an IBD ‘flare’. Most frequently avoided foods were spicy foods (76%), fatty foods (69%), red meat (60%), coffee (55%), carbonated drinks (54%) and milk products (53%). One in four patients had tried a specific exclusionary diet, with 13% having tried a gluten-free diet in the absence of coeliac disease, to manage their symptoms. Just over a half of patients reported being able to find specific dietary advice for IBD, most commonly via the internet. Over half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD. 1 in 3 consumed certain foodstuffs or nutritional supplements to prevent a relapse of IBD, most commonly turmeric in 25% of these patients.

Conclusion
Dietary restriction may be highly prevalent amongst the British South Asian IBD community with a high proportion reporting diet as an initiating factor and trigger for disease flares. Studies on immigrant populations may hold valuable clues regarding the influence of migration, environmental influences and drift from traditional cultural practices on IBD aetiopathogenesis and related symptoms. A larger dataset will be presented at conference proceedings.
P618 Post-operative Crohn’s disease patients undergoing colonoscopy require significantly more analgesia and sedation compared with a non-IBD population
Authors: Rowan C , Janjua M , Foley C , Burke J , Boland K , O’Toole A 
Published: January 2020

Abstract

Background
Rates of surgical intervention in Crohn’s disease have declined. However, a significant proportion of patients still require surgical resection and have been shown to have higher post-op pain scores and analgesia requirements. The aim of this study was to assess sedation requirements and comfort scores of post-operative Crohn’s disease patients at endoscopy.

Methods
Patients with a previous intestinal resection undergoing colonoscopy in 2017 were identified using an electronic reporting system. Data regarding patient demographics, disease characteristics, sedation requirements, comfort scores and endoscopy reports were collected. Patients with Crohn’s disease were compared with a non-IBD post-op population.

Results
n = 153 patients were included. n = 56 Crohn’s disease, n = 2 UC and n = 95 non-IBD patients underwent colonoscopy. Patient characteristics in Table 1.
13.6% of patients had a documented history of chronic pain or other relevant conditions that may affect comfort scores. 68.3% of patients with Crohn’s disease were on therapy at the time of endoscopy. The median dose of midazolam administered was 3 mg (IQR 2–4 mg); median fentanyl dose was 50 μg. (IQR 50–75 μg). The median dose of Midazolam was significantly higher in patients with Crohn’s disease (3 mg IQR 3–4 mg vs. 3 mg IQR 2–3; p = 0.006). The median dose of fentanyl required was also significantly higher in post-operative Crohn’s patients (50 μg IQR 50–100 μg vs. 50 μg; p = 0.001). The median comfort score in Crohn’s disease patients was higher (indicating more discomfort) when compared with the non-IBD cohort. (median score 2 and 1 respectively) There was no significant difference in the proportion of patients with chronic pain or multiple intestinal resections (p = 0.84 and p = 0.142).
There was a statistically significant difference in comfort scores;n = 19 Crohn’s disease patients (39.6%) had comfort score 1, compared with n = 70 non-IBD patients (71.4%) (p = 0.04). There was no significant difference in the median doses of midazolam or fentanyl when comparing Crohn’s disease patients with and without active endoscopic disease. (p = 0.07 and p = 0.10 respectively).

Conclusion
Patients with Crohn’s disease undergoing colonoscopy in the post-operative setting have significantly higher analgesia requirements. Comfort scores are significantly worse when compared with non-IBD patients who have had similar intestinal resections. Endoscopists should use techniques, e.g. CO2 insufflation in addition to medication to ensure comfort amongst patients with Crohn’s disease.
P621 Physician preferences for biologics (originator vs. biosimilar) for the treatment of ulcerative colitis in France, Germany and the UK
Authors: Huynh L , Hass S , Sands B E , Duh M S , Sipsma H , Cheng M , Lax A , NAG A 
Published: January 2020

Abstract

Background
Although originator biologics are effective therapies for patients with ulcerative colitis (UC), they can be costly and may not be widely available. Therefore, less expensive biosimilars have been developed and approved to treat and manage symptoms. In this new treatment landscape, UC-treatment preferences are unknown. Thus, this interim analysis aimed to characterise physician preferences for biologics for the treatment of UC in France, Germany and the UK.

Methods
As part of a broader chart review study, treatment preferences were also collected from participating gastroenterologists and general practitioners (GPs) in France, Germany and the UK who had treated patients (≥ 18 years) with moderate-to-severe UC who had received ≥ 1 UC-related biologic any time from 2014 to 25 October 2019. Descriptive statistics were used to describe the sample overall, and by physician speciality and treatment preference.

Results
Physicians (161 gastroenterologists; 57 GPs) were from different clinical settings in France (39.9%), Germany (28.4%) and the UK (31.7%). Overall, infliximab (33.0%) and adalimumab (32.1%) were selected more often as first treatment options than their biosimilars (17.0% and 9.6%, respectively). Gastroenterologists preferred biosimilars more frequently than GPs did (35.4% vs. 1.8%). More physicians who preferred biosimilars were from France (48.3%) than Germany (17.2%) or the UK (34.5%). In France and the UK, 93.8% of physicians who selected biosimilars worked in hospital settings; in Germany, 50.0% worked in clinics and 50.0% worked in practice settings with statutory and private patients. Physicians who preferred biosimilars treated more patients with UC in the preceding 12 months than those who preferred originators did (mean ± SD: 110.3 ± 113.9 vs. 94.0 ± 93.2). Although most physicians reported efficacy as a reason for biologic preference (93.6%), physicians who preferred originators were more likely to report good tolerability (73.8%) and patient preference (20.6%) and less likely to report affordability or availability (11.9%) than physicians who preferred biosimilars (63.8%, 10.3% and 44.8%, respectively). In patients who failed anti-TNF therapy, vedolizumab was the preferred treatment (78.9%), although this preference differed by speciality (gastroenterologists: 83.2%; GPs: 66.7%).

Conclusion
Originator biologics for treating patients with moderate-to-severe UC dominate the treatment landscape in Europe, driven primarily by efficacy, tolerability and patient preference. However, variations and differences in preferences by speciality and clinical setting may suggest a need to explore additional treatment options to manage disease symptoms among patients with UC.
P626 Patients with IBD seek extra supportive care: insights from Israeli social media networks
Authors: SHARVIT G , Goren I , Godny L , Yadgar K , Elial Fatal S , Barkan R , Turner D , Dotan I , Yanai H 
Published: January 2020

Abstract

Background
Social Media (SM) networks are a major communication tool for patients with inflammatory bowel diseases (IBD) and healthcare professionals (HCPs). In Israel there are several SM platforms, some guided by HCPs while others are patients closed members groups. The largest HCP- patients network is called ‘Camoni’ (‘like me’). We aimed to assess topics of patients’ interest by exploration through SM.

Methods
This study had two phases: I –a qualitative study to assess topics of patients’ interest- screening. Posts of patients with IBD on ‘Camoni’ were evaluated by thematic analysis: identifying patterned meaning, coding based on topic, and categorising major groups. II - an anonymized survey was distributed online through SM networks. The survey was based on the identified topics in the screening, asking the participants to elect and delve only on the five most relevant topics. Satisfaction was assessed by visual analogue scales (VAS) of 0–100 points.

Results
Screening included 2,123 posts published on Camoni between 2014–2019. The analysis revealed 18 different topics (Figure 1). The online survey was launched on November 2019 and had 329 responders: male 47.9%, age 38 years (IQR 29–51), disease duration 10 years (IQR 4–20), active disease 43%, using medications 80.9%: steroids 8.9%, anti-TNFs 31.6%, anti-integrins 9.1%, ustekinumab 4.6%, tofacitinib 2.1%. Crohn’s disease 63.4%, perianal disease 40.8%, extraintestinal manifestations 27%, history of surgery 36.4%, care in hospital outpatient clinics 67.8%. The distribution of satisfaction VAS scores was asymmetric with skewness to the right (Figure 3). Median (IQR) for general satisfaction of the treating physician - 87.5 (73–99), accessibility to HCPs - 77.5 (48.5–92), HCP professionalism 90 (75–99), degree of understanding patients’ concerns 81 (51–96), effectiveness of communication with HCPs 81 (59.7–96). The first five elected-topics of interest were: diet, lifestyle, complementary and alternative medicine, interpretation of medical results, and referral of patients to specialists and reviews (Figure 2). Most responders (85.1%) prefer to be active on an SM network that is guided by HCPs; however,, only 22% of online survey responders were active on Camoni.

Conclusion
Patients with IBD with a significant disease burden are highly satisfied from conventional care. However, patients are still in need for further support and information, perceived as not being addressed in the conventional setting. An operative multidisciplinary setting in routine care, incorporating dietitians, IBD-nurses and HCP’s focusing on alternative and complementary medicine is advised.
P641 An increased baseline mucosal TNF burden linked to adalimumab non-response: opportunities for therapeutic drug monitoring
Authors: Verstockt B , Stylli J , Rahimian P , Rajulapati A , Ehring K , Thomas D , Sabino J , Ferrante M , Singh S , Vermeire S 
Published: January 2020

Abstract

Background
Various studies report robust associations between serum adalimumab (ADM) exposure and therapeutic outcome, which has led to the implementation of reactive therapeutic drug monitoring. As very little is known how serum levels relate to tissue and faecal ADM levels and to tumour necrosis factor (TNF) levels, we measured serum, tissue and faecal drug and TNF, and questioned how all this is linked to the therapeutic efficacy of ADM.

Methods
We prospectively recruited paired serum, mucosal biopsies and stools from 15 patients with ulcerative colitis (UC, n = 8) and Crohn’s disease (CD, n = 7) initiating ADM. All received ADM standard dosage. Samples were collected at baseline and week 8 (UC) or month 6 (CD). Endoscopic remission was defined as a Mayo endoscopic sub-score 0 (UC) or complete absence of ulcerations (CD). ADM levels were measured using a homogeneous immunoassay in which the ADM-TNFα complex is formed and captured. TNFα and IL-6 were quantified using an in-house developed immunoassay. Total tissue protein content was quantified in order to normalise the data.

Results
Pre-treatment tissue TNF and IL6 levels correlated significantly (r = 0.8, p &lt; 0.001) and were lower in ADM remitters (n = 8) in contrast to non-remitters (4.5 vs. 8.6 pg/mg, p = 0.03; 7.1 vs. 122.5 pg/mg, p = 0.05). Pre-treatment faecal TNF was numerically lower in remitters (0.4 vs. 1.0 pg/mg, p = 0.30), but did not correlate with tissue/serum TNF (p = 0.84, p = 0.58). Although ADM did not significantly impact post-exposure serum or faecal TNF and IL6, it did reduce tissue TNF and IL6 (p = 0.02, p = 0.003), both in remitters (median −38.3%, p = 0.04; median −86.0%, p = 0.04) and non-remitters (median −59.5%, p = 0.16; median −84.5%, p = 0.03). Although TNF and IL6 changes did not correlate with ADM exposure or change in calprotectin, the decrease in faecal calprotectin significantly correlated with tissue, but not serum, ADM levels (r = 0.74, p = 0.01). ADM exposure was significantly higher in remitters as compared with non-remitters, both in serum (14.6 vs. 5.9 mg/ml, p = 0.009) and in tissue (53.1 vs. 24.1 ng/mg, p = 0.04). However, serum and tissue ADM levels correlated only moderately (r = 0.5, p = 0.1). Finally, tissue TNF/tissue ADM ratios were significantly higher in non-remitters, both considering pre (p = 0.007) and post TNF (p = 0.03). Faecal loss of ADM could be documented in a single patient only.

Conclusion
Both in tissue and serum ADM exposure was significantly higher in remitters, though tissue and serum ADM exposure did not perfectly correlate. A higher baseline tissue TNF burden was associated with non-response to ADM, and may help in the differentiation to select the appropriate biological in a given patient: no anti-TNF or intensified dosing in patients with a high baseline tissue TNF burden.
P652 Underweight patients with Crohn’s disease and without vitamin D supplementation are at high risk of vitamin D deficiency
Authors: Vranesic Bender D , Domislović V , Brinar M , Ljubas Kelečić D , Karas I , Novosel M , Matašin M , Krznarić Ž 
Published: January 2020

Abstract

Background
Vitamin D deficiency is frequently present in inflammatory bowel disease (IBD) with a higher incidence in Crohn’s disease (CD) than in ulcerative colitis (UC). Given the involvement of the alimentary tract, many factors can contribute to vitamin D deficiency. The aim of the study was to investigate the association of vitamin D deficiency according to body mass index (BMI) in adult patients with IBD.

Methods
A cross-sectional study was conducted on a cohort of 152 IBD patients, 68.1% (n = 104) CD and 31.9% (n = 48) UC. The mean age of the total study population was 37.3±11.8 years and 57.3% (n = 87) were male. All patients were adult, Caucasian and without vitamin D supplementation. Patients were recruited during one year period.

Results
Out of all IBD patients, 60.5% (n = 92) had vitamin D deficiency, 32.2%, (n = 49) insufficiency and 7.2% (n = 11) sufficiency. According to BMI categories there were 12.5% (n = 19) obese patients, 27.6% (n = 42) overweight, 51.3% (n = 78) with normal body weight, and 8.6% (n = 13) underweight. There was a significant difference in vitamin D levels according to different BMI categories in terms of underweight patients having the lowest vitamin D levels; underweight 29.84±11.94 mmol/l, normal 46 ± 20.7 mmol/l, overweight 48±20.1 mmol/l, obese 51±15.3 mmol/l. In addition, there was a significant correlation of vitamin D levels and BMI values (Rho = 0.212, 95% CI 0.069–0.345, p = 0.004), which was more clearly observed in the lower range of BMI values (Figure 1). Male underweight patients had lower levels of vitamin D compared with female patients (26.6 ± 9 vs. 34.7 ± 5.6, p &lt; 0.05). Both patients with CD and UC had significant positive correlation of vitamin D levels and BMI values (UC Rho=0.40, 95% CI 0.16–0.59, p = 0.001, UC Rho = 0.27, 95% CI 0.01–0.05, p = 0.044). However, when comparing vitamin D levels according to phenotype, a significant difference in vitamin D levels was observed in underweight CD (28.4 ± 11.1) comparing to underweight UC patients (40.6 ± 10.6), p &lt; 0.05. In logistic regression analysis, CD phenotype was risk factor for vitamin D deficiency (OR 2.18 95% CI 1.01–4.72, β = 1.22, p = 0.04).

Conclusion
Our results on untreated IBD patients show a high proportion of vitamin D deficiency both in CD and UC, and significant correlation of vitamin D levels and BMI values, especially in the lower range of BMI values. Moreover, underweight CD patients have lower vitamin D levels comparing to UC. This suggests the need for regular vitamin D monitoring and supplementation especially in IBD patients at risk.
P656 Clinical implications of endoscopic submucosal dissection in management of patients with ulcerative colitis-associated dysplasia
Authors: Sakurai T , Nezu R , Okada A , Komeda Y , Nagai T , Masaki S , Yamada M , Takashima K , Kashida H , Kudo M 
Published: January 2020

Abstract

Background
Colectomy has been recommended for patients presenting ulcerative colitis (UC)-associated dysplasia because of the risk of metachronous recurrence. However, it has been recently proposed that endoscopic submucosal dissection (ESD) of dysplasia, combined with subsequent surveillance, may contribute to avoiding colectomy. This study assessed clinical implications of ESD in UC-associated dysplasia.

Methods
We investigated 30 lesions (27 patients) of UC-associated dysplasia/cancer treated with ESD and surgery (15 ESD and 16 surgery) including a patient who underwent surgery following ESD. Among them, paraffin-embedded tissues of 15 lesions (6 cancers, 7 high-grade dysplasia: HGDs, 2 low-grade dysplasia: LGDs) and 11 surrounding mucosae were available and gene mutation analysis was performed. Indications for ESD were determined according to the criteria applied for sporadic colorectal neoplasms that are based on magnifying endoscopy.

Results
The median follow-up duration was 40 months. Three out of 27 patients (11%) developed metastasis. Although no serious complications, local recurrence, or metastasis occurred in 13 patients undergoing ESD, one out of them (7.7%) had metachronous colorectal cancer 3 years after ESD in the rectum, where TP53 mutation and diffuse p53 staining was found at non-dysplastic mucosae. Based on magnifying endoscopy, we underestimated the invasion depth in two cases: in a case of deeply submucosal invasive mucinous cancer, endoscopic ultrasonography exhibited thickening of the submucosal layer exclusively at the lesion.

Conclusion
The proposed indication for ESD in UC-associated dysplasia is that a lesion is well-demarcated and surrounding mucosa is not actively inflamed and does not exhibit diffuse p53 staining. ESD would contribute to advances in the management of UC-associated dysplasia.
P665 Which second-line biologic after anti-TNF failure during Crohn’s disease: Ustekinumab or vedolizumab, a multicentre retrospective study
Authors: Rayer C , Roblin X , Laharie D , Caron B , Flamant M , Dewitte M , Fumery M , Viennot S , Bourreille A , Pariente B , Siproudhis L , Peyrin-Biroulet L , Bouguen G 
Published: January 2020

Abstract

Background
Anti-TNF antibodies treatments are the only first-line reimbursed biologics for Crohn’s disease (CD) in several countries. Recently, Vedolizumab (VDZ) and Ustekinumab (UST) were added to the therapeutic armamentarium for CD refractory to a first anti-TNF antibody. However, studies comparing these two compounds remain unavailable. Our aim was to compare their efficacy in second-line treatment in CD after failure of one TNF antagonist.

Methods
All patients with CD refractory (primary or secondary non-responders) to first anti-TNF treatment and receiving UST or VDZ as a second biologic were included retrospectively in 10 French tertiary centres. The remission and clinical response were assessed at week 14. On the long-term, the cumulative probabilities of being in remission were estimated using the Kaplan–Meier method and the associated factors using a Cox proportional risk model. The drug survival to assess efficacy as well as side effects was assessed by actuarial analysis.

Results
88 patients were included, 50 (57%) females (mean age: 41 ± 15 years), 61 (69%) being treated with UST and 27 (31%) with VDZ. The first anti-TNF was discontinued for primary or secondary non-response in 66 (75%) patients and for side effects in 22 (25%) patients, without any difference between the anti-TNF antibody previously used. Among the 55 patients with endoscopic data at baseline, 55 (98%) had ulceration, a CRP above 5mg/l for 33/71 (46%) patients and a faecal calprotectin &gt; 250 µg/g for the 12 patients tested. At week 14, no difference was observed for clinical response and clinical remission according to the type of treatment: the rate of clinical response and remission were 74% (UST)/58% (VDZ) (p = 0.20) and 33% (UST)/26% (VDZ) (p = 0.56), respectively. The only factor associated with short-term remission was the lack of optimisation prior to anti-TNF discontinuation (p = 0.038) regardless of the type of second-line therapy (UST, p = 0.02; VDZ, p = 0.03). After a mean follow-up of 67 weeks, the cumulative probabilities of being in remission at 6 and 12 months were 16% and 34% for UST and 25% and 44% for VDZ, respectively (p = 0.24 for UST vs. VDZ). The drug survival was higher in the UST group as compared with the VDZ group (HR (UST vs. VDZ) = 2.36 [1.02–5.5], p = 0.04).

Conclusion
Our preliminary results suggest that VDZ and UST have similar efficacy in the short- and long-term response when used as a second-line biologic therapy in CD refractory to a first anti-TNF antibody. These results will be complemented for the congress by the inclusion of additional patients recruited into this registry.