bluuebunny/crossref_metadata_2025_split huggingface dataset:
P133 Clinical and ultrasonographic enthesitis in inflammatory bowel disease patients with and without psoriasis
Authors: Soriano A , Bertolini E , Bertani A , Beltrami M , Macchioni P 
Published: May 2021

Abstract

Background
Previous studies have reported the association between psoriasis (PsO) and inflammatory bowel disease (IBD). Coexistence of IBD and PsO has been associated with significant higher prevalence of enthesitis and dactylitis.
The aim of the study was to compare the prevalence of clinical and ultrasonographic peripheral enthesis abnormalities in a consecutive series of patients with IBD and psoriasis (PsO) as compared to a group of IBD patients without psoriasis (IBD).

Methods
174 IBD consecutive patients [36 PsO and 138 IBD, M/F 91/83, mean age 42.6±14.7 years, mean disease duration 110 ±12.3 months] were recruited. A complete clinical examination, MASES and LEI scores, BASDAI, and dactylitis count, was performed at study entry. Laboratory markers (namely ESR, CPR, Hb, fecal calprotectin) were collected. Axial or peripheral spondyloarthritis (SpA) diagnosis was made using ASAS criteria. US examination was performed by a rheumatologist blind to clinical data. Lateral epicondyle of the humerus, distal quadriceps femoris insertion into the patella, inferior pole of the patella, tibial distal insertion of the patellar tendon, calcaneal insertion of the Achilles tendon, and plantar aponeurosis insertion were examined bilaterally. Knee and ankle joints were evaluated for synovial hypertrophy, PD signal and fluid effusion. Enthesitis was defined according to OMERACT and scored as 0–36 for GUESS and 0–136 for MASEI.

Results
146 patients (83.4%) showed structural damage at &gt; 1 enthesis, 44 patients (25%) had at least 1 active enthesitis, with no significant difference between the two groups. PsO group showcased a significantly increased prevalence of patients having &gt; 1 thickened enthesis (86.1% vs 63.9%, p=0.009) and of PD signal at knee examination (11.1% vs 2.2%, p= 0.034). Enthesis thickness was significantly increased in PsO, in every examined site. Enthesophyte length was significantly increased in PsO group at quadriceps tendon, patellar distal insertion and Achilles tendon.

Conclusion
Presence of PsO and/or familiar history of PsO in IBD patients might represent a predisposing factor for the development of subclinical enthesytis as an extra-intestinal manifestation of IBD, during the disease course.
P141 IBUS-SAS for Crohn’s disease ultrasound activity: initial validation and research of the optimal cut-off score
Authors: Dragoni G , Innocenti T , Lynch E N , Fiorini C , Parisio L , Roselli J , Bagnoli S , Macrì G , Rogai F , Milani S , Galli A , Milla M 
Published: May 2021

Abstract

Background
Intestinal ultrasound (IUS) is being widely accepted as a reliable tool to objectively monitor Crohn’s disease (CD) activity. Recently, an international panel of experts developed an IUS score, called IBUS-SAS (International Bowel Ultrasound Segmental Activity Score). Our aim was to validate this index in a real-life cohort and find a cut-off score that correlates with common lab results of intestinal inflammation.

Methods
All CD patients referred to our unit for IUS examination between November 2020 and February 2021 were scored with the IBUS-SAS. Clinical activity at the time of presentation using Harvey-Bradshaw Index (HBI) was recorded, with remission defined as HBI&lt;5. Faecal calprotectin (FC) and C-reactive protein (CRP) within 8 weeks from IUS were also included. Upper limits of normal for CRP and FC were set at 0.5 mg/dL and 150 µg/g, respectively. Combined biomarkers remission (CBR) was defined as both negative CRP and FC. Pearson’s correlation (rho = ρ) was performed between IBUS-SAS and the other parameters. ROC analyses were carried out to find a predictive cut-off value of IBUS-SAS for CBR.

Results
In total, 40 CD patients were included. The characteristics of the cohort are reported in Table 1. In patients in clinical remission, IBUS-SAS was 27.52±17.42 (mean ±SD); in patients with clinical activity, it was 59.23±22.36. In individuals with negative FC, IBUS-SAS mean value was 26.59±16.85; in case of FC &gt;150 µg/g, it was 50.13±22.16. IBUS-SAS score directly correlated with all parameters considered: clinical activity (ρ=0.38, P=0.01), CRP (ρ=0.33, P=0.04) and FC (ρ=0.42, P=0.007). ROC analysis of IBUS-SAS for CBR revealed an area under the curve of 0.92 (95% CI 0.86–0.97), with a sensitivity of 83.3% and a specificity of 91.3% for a cut-off value of 42.9.

Conclusion
This pilot analysis of IBUS-SAS confirmed its potential to precisely define CD activity, correlating both with clinical scores and biomarkers. An IBUS-SAS cut-off value of 42.9 has demonstrated the highest sensitivity and specificity in predicting normal values of both CRP and FC. A comparison of IBUS-SAS with endoscopic activity and a larger cohort are needed to confirm these findings.
P142 Role of e-health in the management of Inflammatory Bowel Disease: A systematic review and meta-analysis
Authors: Kuriakose Kuzhiyanjal A J , Nigam G B , Antoniou G A , Cross R K , Farraye F A , Limdi J K 
Published: May 2021

Abstract

Background
The increasing incidence and prevalence of inflammatory bowel disease (IBD), has fuelled the need for innovative models of care.
We aimed to compare effectiveness of e-health interventions (virtual clinics, telephone consultation, remote monitoring or any web-based health platform) with standard care in management of IBD. Our primary outcomes were to assess the difference in disease activity and percentage of patients in clinical remission at the end of follow up. Our secondary outcomes were to investigate differences in quality of life (QoL), IBD-knowledge & rate ratios (RR) for endoscopic procedures, total healthcare encounters, corticosteroid use, and IBD related hospitalisation or surgery.

Methods
We searched Medline, Embase, PubMed, CINAHL, PsychInfo, Clinical trials registry and Cochrane databases for randomised controlled trials (RCT) published in the English language until November 2020, comparing e-health interventions to standard care for patients with IBD. Pooled estimates of dichotomous outcomes were calculated using the odds ratio (OR) and 95% confidence interval (CI) using the Mantel-Haenszel statistical method. For continuous data, the standardised mean difference (SMD) and 95% CI were calculated using the inverse variance statistical method. Event data were analysed and expressed as RR with 95% CI using the inverse variance statistical method. Random effects model was used.

Results
Nine studies involving 1841 participants (991 e-health group and 850 controls) were identified. There was no statistically significant difference between the mean disease activity scores for UC (SMD 0.22, 95% CI: -0.04–0.48) and CD (SMD 0.02, 95% CI: -0.18–0.22) in the e-health and standard care groups and no statistically significant difference in the percentage of patients in clinical remission at the end of follow up between both groups (OR -1.05, 95% CI: 0.76–1.45). Higher QoL (SMD 0.19, 95% CI: 0.05–0.34) and IBD knowledge (SMD 0.25, 95% CI: 0.12–0.37) scores were noted in the e-health group compared to standard care. There were no statistically significant differences noted in the RR for endoscopic procedures (RR 1.01, 95% CI: 0.81–1.26), total healthcare encounters (RR 1.03, 95% CI: 0.93–1.15;), IBD related, corticosteroid use (RR 0.99, 95% CI: 0.51–1.92), and IBD related hospitalisation (RR 0.81, 95% CI: 0.53–1.25) or surgery (RR 0.87, 95% CI: 0.49–1.55) between both groups.

Conclusion
E-health interventions are comparable with standard care for impact on disease activity, remission, endoscopy utilisation, total healthcare encounters, corticosteroid use, and IBD related hospitalisation or surgery. QoL and IBD related knowledge were higher in the e-health compared to the standard care group.
P150 Histologic features predicting prognosis and their relationship with endoscopic findings in Ulcerative Colitis patients with mucosal healing
Authors: Shin S , Choi C W , Moon J M , Kim H S , Choi C H 
Published: May 2021

Abstract

Background
Mucosal healing (MH) is one of the treatment targets in patients with ulcerative colitis (UC). However, it has been suggested that even in patients with MH, disease prognosis depends on histologic activity. This study aimed to evaluate histologic features predicting disease prognosis and their relationship with endoscopic findings in UC patients with MH.

Methods
We retrospectively reviewed the data of patients with UC who underwent colonoscopy or sigmoidoscopy with biopsy and evaluated eight histological features, including chronic inflammatory infiltrate, neutrophils in epithelium, ulceration, acute inflammatory cell infiltrate, basal plasmacytosis and serrated architectural abnormalities, as well as Nancy index (NI). Histologic variables predicting disease progression defined as starting corticosteroid, biologics, or small molecule agent, or undergoing clinical relapse or surgical operation were evaluated, and correlated with endoscopic findings.

Results
A total 194 biopsy specimens of 103 patients were evaluated. The highest grades of each histologic item were analyzed when biopsies were performed at multiple sites in one patient. 30.6% showed NI ≤ 1 (no acute inflammatory infiltrate) in 49 patients with endoscopic remission. Among 68 patients with MH, only 24.8% achieved NI ≤ 1. Mucosal friability in endoscopic findings was significantly associated with moderate-to-severe active histologic status (NI ≥3) (46.2% vs 80.0%, P=0.013), and patients with NI ≥3 showed significantly higher rates of disease progression during 13.7-month follow-up period (5.1% vs 19.0%, P=0.21). Ulceration and serrated architectural abnormalities were significantly associated with disease progression, and serrated architectural abnormalities was an independent risk factor in multivariate analysis (odds ratio 2.691 (95% confidence interval: 1.047–6.915), P=0.04).

Conclusion
Mucosal friability in endoscopic findings reflects moderate-to-severe active histologic status, and presence of serrated architectural abnormalities predicts disease progression in UC patients with MH. These findings may help identify patients need closer monitoring.
P153 IBD patients’ treatment preferences are heterogeneous, but largely affected by the avoidance of abdominal pain and side effects (P-POWER IBD study)
Authors: Louis E , Siegel C A , James B , Heidenreich S , Krucien N , Ghosh S 
Published: May 2021

Abstract

Background
Multiple treatments are approved for inflammatory bowel disease (IBD), each offering unique attribute profiles. Therapeutic targets historically included clinical and endoscopic outcomes, but updated guidelines1 also include absence of disability and restoration of quality of life (QoL). Optimising QoL requires understanding patient priorities and considering their preferences in treatment selection. This patient preference study (P-POWER IBD) quantified the tradeoffs patients would make between treatment attributes.

Methods
Adults with self-confirmed Crohn’s disease (CD) or ulcerative colitis (UC) who were receiving IBD treatment took part in an online cross-sectional survey. In a discrete choice experiment (DCE), patients were asked to choose between hypothetical treatments described by six attributes: administration, risk of mild or moderate side effects, risk of serious infections, and impact on abdominal pain, bowel urgency and fatigue. Attributes were selected based on foundational qualitative research and literature review.2 Qualitative and quantitative pilots were used to pre-test the DCE. Relative Attribute Importance (RAI) scores and maximum acceptable risk (MAR) of mild-to-moderate side effects were estimated from a mixed multinomial logit model.

Results
A total of 400 patients (CD: 54%; UC: 46%; female: 38%; mean age: 41 years [range: 18–78]) were recruited. All attributes significantly affected treatment preferences with preference heterogeneity observed (Figure 1). While all attributes were important, their relative importance differed (Figure 2). Avoiding abdominal pain was most important (RAI 33%) followed by the risk of mild or moderate side effects (RAI 27%), risk of serious infections (RAI 16%), treatment administration (RAI 10%), fatigue (RAI 9%), and bowel urgency (RAI 6%). CD patients placed greater importance on abdominal pain (p&lt;0.05) than UC patients and UC patients greater importance on bowel urgency than CD patients (p&lt;0.05). MAR indicated the increased risks of side effects patients would accept to improve other attributes (Figure 3). Notably, to reduce abdominal pain from severe to moderate, patients would accept an additional 19% risk of mild or moderate side effects and 31% if the pain was reduced to mild.

Conclusion
Patients with IBD had strong preferences that varied greatly and were willing and able to make tradeoffs between various important treatment attributes, in particular abdominal pain. Individual preferences should be considered in clinical practice as they may impact long-term targets and QoL.

References
P204 Elevated Fecal Calprotectin Levels Predict Flare-up in Patients with Inflammatory Bowel Disease During International Air Travel
Authors: Park J , Hyuk Y 
Published: May 2021

Abstract

Background
Inflammatory bowel disease (IBD) patients often experience disease flare-ups during international air travel. We aimed to evaluate the proportion of patients that experiences IBD flares during international air travel and identify risk factors associated with enhanced disease activity.

Methods
Patients with scheduled international air travel were enrolled in the study from the Seoul National University Bundang Hospital IBD clinic. Flight information and clinical data were collected via questionnaires and personal interviews, and risk factors associated with IBD flares were determined.

Results
Between May 2018 and February 2020, 94 patients were enrolled in the study (mean age, 33.0 years; males, 53.2%; mean disease duration, 56.7 months), including 56 (59.6%) with ulcerative colitis and 38 (40.4%) with Crohn’s disease. Of the 94 patients enrolled, 15 (16.0%) experienced an IBD flare-up and 79 (84.0%) remained in remission throughout travel. Logistic regression analysis revealed that high fecal calprotectin levels before travel (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000–1.001, p = 0.016), the presence of a comorbidity (OR: 6.334, 95% CI: 1.129–35.526, p = 0.036), and a prior emergency room visit (OR: 5.283, 95% CI: 1.085–25.724, p = 0.039) were positively associated with disease flare-up. The previous and current use of immunomodulators and biologics, time of flight, altitude, number countries visited, travel duration, objective of visit, and previous medical consultations were not associated with disease flare-up.

Conclusion
Factors including fecal calprotectin levels, prior visit(s) to the ER, and the presence of a comorbidity predicted IBD flare-up during international travel.
P216 Comparative Assessment C-reactive Protein Between a Point-of-Care Testing and Current Standard of Care (Immunonephelometric testing)
Authors: Lorenzon G , Marsilio I , Maniero D , Rigo A , Barberio B , Zingone F , Bahur B , Bray K R , Savarino E V 
Published: May 2021

Abstract

Background
C-reactive protein (CRP) is widely used as a biomarker of inflammatory disease activity in hospitalized and non-hospitalized patients. In particular, CRP is commonly used in patients suspected to have an inflammatory bowel disease (IBD) or with a confirmed diagnosis of IBD diagnosis in order to drive the diagnostic approach, to monitor disease activity and to guide therapeutic adjustments. However, standard laboratory CRP testing (Immunonephelometric assays) present some drawbacks, including a turnaround time of 1–2 hours, and the need of specialized equipment, offices and laboratory personnel. Because of that, point-of care testing (POCT) was recently developed in order to provide results within 2 minutes from blood collection, enabling a rapid response to clinical condition.

Aim
To determine the degree of analytical correlation between a recently developed POCT (ProciseDx) using capillary whole blood and the comparative Immunonephelometric assay using serum samples.

Methods
From October to November 2020, consecutive patients hospitalized at Gastroenterology Unit, Padua University Hospital, aged &gt; 18 years and with clinical evidence of active inflammatory disease or infection, who underwent to a standard of care CRP test (Dimension Vista – Siemens Healthineers) were included in the study (range 2.9–340 g/L). Within 1 hour from blood collection, in each patient, CRP quantitation from capillary whole blood collected by finger stick was performed using the ProciseDx CRP assay, with reportable range between 3.6–100 g/L. A Deming regression test was used to identify the correlation between the two methods.

Results
Eighty-three patients were enrolled (62.5% males with mean age ± SD: 60±18). The most common indications for hospitalisation were liver disease (34.9%), pancreatic disturbance (27.7%) and suspicious or recurrence of IBD (16.7%). ProciseDx POCT with finger prick samples required a turnaround time of 2±0.2 minutes, whereas serum samples analyzed in clinical laboratory with the reference method required a turnaround time of about 180±15 minutes (p&lt;0.001). Overall, the correlation between the two tests was high (R squared of 0.899 (95% CI 0.916–0.968)). In particular, the correlation between the methods was even higher with CRP values between 0–100 g/L with R squared of 0.961 (95% CI 0.958–0.986).

Conclusion
The ProciseDx POCT allows a more rapid and comparable accuracy of CRP assessment in hospitalized patients as compared to the standard laboratory measurement. Moreover, the ProciseDx POCT does not require specialised personnel to be performed. The use of ProciseDx POCT may improve and accelerate the decision-making approach, further reducing the resources required for CRP assessment.
P238 Enteropathy associated T-cell lymphoma as a diagnostic challenge in young patient with Crohn’s disease
Authors: Biscanin A , Tomasic V , Dorosulic Z , Kralj D , Lerotic I , Cacic P , Ogresta D , Hrabar D 
Published: May 2021

Abstract

Background
The diagnosis of Crohn’s disease (CD) can sometimes be challenging. Enteropathy associated T cell lymphoma (EATL) is a rare aggressive lymphoma highly associated with celiac disease1. It usually affects small bowel, with signs and symptoms which may mimic CD.

Methods
We present a case of a 37-year-old male patient with coeliac disease, CD and (mis)diagnosed EATL in proximal jejunum.

Results
Patient was referred to our clinic with a constant epigastric pain, weight loss (BMI 17.5), intermittent temperatures, joint pain and diarrhoea. Laboratory tests were normal. Serology for coeliac disease was highly positive. Abdominal ultrasound showed small amount of ascites. EGD showed small shallow stomach ulcers and aphthous mucosal changes of postbulbar part of duodenum. Histology suggested coexisting CD and celiac disease. CT scan detected thickened duodenal wall and suspected duodenal stenosis and enteroscopy was performed. Approximately 80 cm from pyloric ring multiple jejunal ulcers were found. Unfortunately, biopsy was not performed. Colonoscopy showed small ulcers of terminal ileum and histology was nonspecific. Diagnosis of coexisting CD and coeliac disease was established. Therapy with PPI, systemic glucocorticoids and azatioprine was introduced. Three months later patient was in a good clinical condition, but EGD showed multiple gastric and duodenal small ulcers. Dose of azathioprine was optimized because patient refused biologics. After six months of asymptomatic period EGD showed mucosal healing. Azatioprine was continued. One year after the diagnosis of CD he was admitted again to our hospital because of intermittent fevers, severe periumbilical pain, weight loss and dehydration. Laboratory tests showed anemia (Hb 111 g/L), leucocytosis (L12.6/L) an elevated CRP (168 mg/L). CT scan detected jejunal perforation with multiple liver and spleen abscesses. He went under surgery with jejunal resection and histological findings from resected jejunum suggested EATL. In two postoperative days, the patient had progressive liver injury and suppression of bone marrow activity, and despite all supportive treatments he died.

Conclusion
EATL is a serious complication of coeliac disease, it rarely develops in young people and presents diagnostic challenge especially in CD patients. The aim of this report was to raise awareness of the importance of endoscopy with tissue sampling and cross sectional imaging especially in refractory coeliac disease and CD patients.
P297 HLA-DQA1*05 allele and its association with the secondary loss of response to infliximab in patients with Inflammatory Bowel Disease
Authors: Angulo Mcgrath I , Bracho González M , Ocaña Ledesma A , Olmedo Martín R V 
Published: May 2021

Abstract

Background
It is estimated that around 40-50% of patients with Inflamatory Bowel Disease (IBD) will experience a secondary loss of response (SLR) to infliximab, being the immunogenicity a fundamental mechanism. The HLA class II allele, DQA1*05, that codifies the adaptative immune response, is present in approximately 40% of patients treated with anti-TNF, and has been recently associated with a higher probability of immunogenicity, secondary loss of response and discontinuation of anti-TNF therapy.
The aim of this study was to evaluate if the presence of one o more copies of this allele is associated with a higher chance of SLR in patients with IBD treated with infliximab in our project study area.

Methods
Retrospective observational cohort study. We conducted a review of our unit’s database, including in the study patients with IDB treated with infliximab that responded to the induction, in which the presence of HLA-DQA1*05 had been tested. SLR was defined as the recurrence or worsening of symptoms that entailed a treatment change or intensification, hospitalization or surgery. The predictive factors for SLR were identified through a uni and multivariate Cox regression analysis.

Results
88 patients with IDB were included (63 with Crohn’s Disease and 25 with Ulcerative Colitis), followed up to the SLR (52,3%) or a median of 35 months (IQR=58). 42% of these patients were carriers of the HLA-DQA1*05 allele. Patients’ clinical features are gathered in table 1. In the univariate analysis the disease duration in years (HR=0,9, IC 95% 0,85-0,97, p=0,008) and the presence of HLA-DQA1*05 (HR=2,27, IC 95% 1,07-4.83, P=0,03) were associated with the SLR. In the multivariate analysis, adjusted for smoking, previous restrictive surgery, years of evolution of the disease and the presence of combined immunosuppressive therapy, only the presence of HLA-DQA1*05 remained associated to the SLR (HR=2,32, IC 95% 1,07-5,02, p=0,03). Figure 1.

Conclusion
The presence of the HLA-DQA1*05 allele is frequent in patients with IBD, and it is associated with a secondary loss of response to infliximab. If confirmed with prospectively designed studies, the determination of this allele could guide physicians on the therapeutic decision making, advancing towards a more accurate medicine.