bluuebunny/crossref_metadata_2025_split huggingface dataset:
P201 Evaluation of the role of anti-TNF in stabilizing the progression of intestinal lesions in Crohn’s disease using the Lemann Index
Authors: Hassine A , Akkari I , Mrabet S , Ben Jazia E 
Published: May 2021

Abstract

Background
The Lemann Index (LI) was developed to assess cumulative digestive tract damage in patients with Crohn’s disease (CD), independently of clinical and biological activity. Recently, therapeutic goals in CD have focused on achieving mucosal healing and deep remission rather than simple symptom control, thus requiring prevention of progression of intestinal damage. The aim of this study was to assess the influence of different treatments on the progression of structural damage, using the LI.

Methods
we retrospectively included all patients with CD, followed in our center during the period between January 2016 and January 2020. The LI was calculated from the first (LI1) and the last (LI2) clinical consultations. The evolution of (LI1-LI2) or Delta LI (DLI) was recorded.

Results
112 patients with CD were collected, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. Regarding maintenance treatment, 51.8% of patients (n = 58) were on Azathioprine, 23.2% (n = 26) were on aminosalicylates, and 25% (n = 28) were on anti-TNF, including 42, 9% under combination therapy. The median follow-up was 36.82 ± 16.83 months, with no difference between the groups. During follow-up, the mean LI increased significantly from 3.34 [0.58–8.82] to 7.82 [0.62–32.6] in the azathioprine group (p = 0.0001), from 2.0 [0.58–6.52] to 3.91 [0.6–14.03] in the Aminosalicylates group (p = 0.001) and from 3.79 [1.05–8.42] to 10.01 [2.58–33.08] in the Anti-TNF group (p = 0.0001). The mean DLI was -4.48 for the Azathioprine group, -1.9 for the Salicylates group and -6.14 for the Anti-TNF group, with no statistically significant difference (p = 0.16).

Conclusion
In patients with CD, the LI tends to increase over time. In our series, the use of Anti-TNF α does not appear to be able to reduce the progression of intestinal lesions, compared to other therapies.
P225 Impact of Inflammatory Bowel Diseases on patients working life
Authors: Sahar N , Dahmani W , Nour E , Aya H , Wafa B A , Aida B S , Salem A , Ahlem B , Mehdi K , Hanene J , Ali J 
Published: May 2021

Abstract

Background
Inflammatory bowel diseases (IBD) are a group of chronic disabling gastrointestinal disorders, consisting mainly of Crohn’s disease (CD) and ulcerative (UC). A substantial part of the burden of illness in these conditions relates to the functional impairment, particularly affecting the ability to work.
The aims of this study were to determine the impact of IBD on the working life of patient and to identify factors associated with a decreased productivity at work in patients with IBD.

Methods
A cross-sectional study carried out at the Gastroenterology department of Sahloul University Hospital (CHU) over a period of 6 months. Patients with IBD (CD or UC) who present to the outpatient clinic or are hospitalized in the ward or day hospital were included. A questionnaire drawn up on the basis of qualitative studies on this subject is used to collect data on the professional career, the characteristics of the position held, difficulties encountered at work on a daily basis.The questionnaire will be accompanied by the “Work Productivity and Activity Impairment” (WPAI) work productivity score.

Results
Among the 82 patients included, 58 had Crohn disease (CD) and 24 had ulcerative colitis (UC). The sex ratio was 1.2 and the mean age of our patients was 33.5 ± 10.2 years. . The majority of UC patients had pancolic involvement (n = 18; 75%). Among the 58 patients followed for CD, 24 (41.4%) had anoperineallesions. Twenty-two patients (26.8%) had already undergone intestinal resection. Six patients (7.3%) were on prolonged sick leave. The majority of patients worked in the private sector (n = 68; 82.9%). Two patients (2.4%) had a fixed rate of work per night. No patient had a job requiring frequent travel. Sixty-two patients (75.6%) had a weekly hourly volume greater than 40 hours.In half of the cases, the discovery of the disease preceded the choice of a professional career; among the remaining patients, this choice was influenced by IBD in 4 cases (10, 5%). Sixteen patients (21.5%) had to skip work hours during the week preceding the interview. The average number of hours missed due to a specific IBD-related problem was 5 hours with extremes ranging from 3 to 10 hours per week. An overall decrease in productivity (BGP) greater than 50% was objectified in 16 patients (21%). The average rates of absenteeism, presenteeism and BGP were 10.49%, 71.25% and 74.14% respectively. The presence of anoperineallesions was the only variable associated with BGP (50% vs 13.3%; p = 0.044).

Conclusion
The impact of IBD on professional activity appears to be significant and requires special attention from both the gastroenterologists and the occupational physicians.
P244 Clinician preferences in treating steroid resistant ulcerative colitis: a discrete-choice experiment (DCE) survey
Authors: Wickramasekera N , Shackley P , Coates E , Barr A , Lee M , Blackwell S , Bedford H , Dames N , Probert C , Sebastian S , Lobo A 
Published: May 2021

Abstract

Background
The optimum treatment for steroid resistant ulcerative colitis (SRUC) is not clear and a range of options can be considered. The aim of this study was to quantify the relative importance of different treatment characteristics to clinicians and understand their preferences for benefit-risk trade-offs.

Methods
A discrete choice experiment (DCE) was conducted in the UK via online survey of clinicians with expertise in inflammatory bowel disease. This involved 12 tasks where respondents selected a preferred treatment option when presented with two competing, hypothetical treatment profiles for a SRUC scenario. Profiles described five treatment characteristics focusing on clinical outcomes and safety, identified from qualitative interviews with clinicians and evidence from systematic reviews. DCE responses were analysed using conditional logistic regressions. Regression coefficients were used to calculate benefit-risk trade-offs, to find the rate at which clinicians are willing to trade levels of risks in exchange for the preferred levels of clinical outcomes. Regression coefficients were also used to predict uptake rates for selected drugs currently prescribed to patients with SRUC.

Results
116 clinicians completed the survey (age 46y; female 42%; consultant 60%; nurse 26%; mean experience 11y). Figure 1 shows the treatment characteristics that make respondents more likely (positive coefficient) or less likely (negative coefficient) to choose a treatment. One unit increase in both lymphoma risk and serious infection risk were strongly considered when clinicians were choosing a treatment compared to one unit increase in the symptom improvement characteristics. Clinicians would accept a higher lymphoma risk of 5 per 10,000 patient years for a 10% improvement in remission rate compared to 4 and 2 cases per 10,000 patient years for 10% better rates of clinical response and mucosal healing respectively. Clinicians at secondary hospitals accepted a lymphoma risk of 4 cases per 10,000 patient years for a 10% improvement in remission vs 7 per 10,000 patient years at tertiary centres. Similar trade-off results were found for serious infection risks. Predicted uptake comparing preferred characteristics to existing treatments was infliximab (62%), tofacitinib (18%), vedolizumab (15%) and adalimumab (5%).

Conclusion
Clinicians are willing to make difficult trade-offs and tolerate elevated safety risks in exchange for therapeutic benefits. Risk tolerance was highest if the treatment improved long term remission rate, lowest for mucosal healing and higher in clinicians at tertiary centres. The results help to better understand treatment decisions and identify outcomes that might be considered in choosing agents to evaluate in clinical trials.
P245 Evaluation of quality of life in patients with perineal Crohn’s disease: a monocentric Tunisien study
Authors: Hamdi S , Ben Ameur W , Hammami A , Elleuch N , Dahmani W , Ben Slama A , Ksiaa M , Braham A , Ajmi S , Jaziri H , Jmaa A 
Published: May 2021

Abstract

Background
Perianal manifestations of Crohn’s disease considerably affects the life quality of patients. This study aims to assess the quality of life of patients with perineal Crohn’s disease by using the SIBDQ (Short Inflammatory Bowel Disease Questionnaire) and to evaluate its correlation with the Perineal Disease Activity Index (PDAI).

Methods
We retrospectively reviewed the medical records of patients with perineal Crohn’s disease between January 2018 and December 2020. Patients with active luminal disease were not included in this study (Crohn’s Disease Activity Index (CDAI) &gt; 150). All participants answered the SIBDQ. Active perineal disease was defined as a PDAI &gt; 7. We studied the correlation between SIBDQ and PDAI. Patients were divided into 2 groups according to the duration of the disease greater or less than 5 years. SIBDQ and PDAI were compared between the 2 groups.

Results
We included 52 patients with a mean age of 37 years (range: 17–62 years). There were 34 males (65.4%) and 18 females (34.6%). Crohn’s disease has been diagnosed for 7.6 years in average (range 2–19 years). The PDAI varied from 1 to 15 (average=7) and the SIBDQ ranged from 11 to 66 (average= 41). The SIBDQ was inversely correlated to the PDAI with a Pearson’s correlation coefficient equal to -0.885 (p=0.01). Indeed, the SIBDQ score for patients with an active perineal disease was significantly lower than those with inactive one (28.3 ± 11.6 vs. 50.1 ± 7.7; p&lt; 0.0001), which indicates a worse life quality. Comparing the 2 groups, there were no significant differences in terms of age, gender and PDAI. The SIBDQ was lower in patients who had the disease for more than 5 years compared to the other ones (38.3 ±15.6 vs.48.2 ± 7.5; p=0.003).

Conclusion
The quality of life for patients with perineal Crohn’s disease seems to be altered by both activeness and duration of the disease. The SIBDQ is a simple tool that helps physicians detect patients with poor life quality. Other studies are necessary to validate this questionnaire for the evaluation of the quality of life in patients with perineal Crohn’s disease.
P337 Early infliximab clearance predicts remission in children with Crohn’s Disease
Authors: Chung A , Carroll M , Almeida P , Petrova A , Mould D , Wine E , Huynh H 
Published: May 2021

Abstract

Background
Recent studies suggest pediatric Crohn’s Disease (CD) patients have higher infliximab clearance (IFX CL) for body weight and lower serum IFX when dosing by weight. Our aim was to determine if IFX CL calculated based on therapeutic drug monitoring (TDM) data predicts long term outcome.

Methods
Retrospective study of CD patients seen at the Stollery Children’s hospital from Jan 2013-Jul 2019. Anthropometric, lab, IFX TDM & disease data were collected for those having &gt;2 serum IFX levels. IFX CL was calculated using non linear mixed effects modelling. The data was fit to a 2-compartment model with linear elimination. Outcomes were defined at 4, 9 & 15 months. Remission is defined as wPCDAI&lt;12.5, CRP&lt;4 & steroid-free for 4 months. Subjects that underwent intestinal surgery or ceased IFX due to refractory CD are non-responders. Logistic regression was used to determine early predictors (at baseline or end of induction) associated with remission at 4, 9 & 15 months. The variables evaluated were: IFX CL, IFX trough level, sex, age, PARIS classification, CRP, ESR, Alb, Hgb, weight, BSA, BMI, previous anti-TNF & immunomodulator use.

Results
85 subjects were included, with a median follow up of 670 days (IQR: 304,1105). See table 1 for baseline characteristics. Regression analysis showed early IFX CL was the only significant early predictor of remission for every timepoint. Baseline IFX CL and end of induction IFX CL, measured in L/h, were associated with 15-month remission with an OR of 0.606 (95%CI: 0.394,0.931; p=0.022) and 0.373 (95%CI: 0.207,0.669; p=0.001) respectively. Similar results obtained at 4 & 9 months. ROC analysis of remission was done using only early IFX CL. A baseline IFX CL of 5.83 L/h predicted 15-month remission with a sensitivity & specificity of 0.649 & 0.667 (AUC=0.701). End of induction IFX CL of 6.06 L/h predicted 15-month remission with a sensitivity & specificity of 0.676 & 0.611 (AUC=0.709). Similar results obtained at 4 & 9 months.

Conclusion
In all timepoints, early IFX CL was a strong predictor of later remission compared to dose intensity, frequency, IFX levels and wPCDAI & CRP at end of induction. This suggests early IFX CL is a marker of early biological response to IFX. Early dose optimization is required in those with high IFX CL to ensure optimal response with adequate drug exposure. This will facilitate early change in treatment for those with inadequate response.
P350 SAFIIR: Study of Anemia Following Intravenous Iron Repletion
Authors: Rioux L C , Bernard E J , Bourgault M , Mondragon P , Rioux V 
Published: May 2021

Abstract

Background
The main objective of this study was to assess the prevalence of anemia and the secondary objectives aimed to evaluate the real-life impact of intravenous iron therapy on anemia correction in patients living with Inflammatory Bowel Disease (IBD).

Methods
We performed a retrospective cohort study of adult patients (18 to 80 years old) with a Crohn’s Disease or Ulcerative Colitis diagnosis who were followed at our clinic between January 2018 and March 2020. Clinical data were obtained from the patients’ electronic medical records. Iron-deficiency anemia was defined as hemoglobin (Hb) &lt; 12,0 g/dL and/or transferrin saturation (TSAT)&lt; 20 % and/or low serum iron (≤ 10 μmol/L). Intravenous (IV) iron treatment was defined as at least one infusion of iron isomaltoside, iron sucrose, or sodium ferric gluconate. The secondary analyses were performed in terms of IV iron treatments.

Results
Of the cohort of 556 IBD patients, 223 (40.1%) had an anemia diagnosis. Among the latter, 39 patients received an intravenous iron treatment and had laboratory results in the 8 weeks preceding and in the 8 weeks following the treatment. Table 1 shows the response to intravenous iron treatment in patients with baseline Hb &lt; 12,0 g/dL (n=28 patients, 47 IV iron infusions). Table 2 shows the changes in anemia-related laboratory values in the 8 weeks preceding and in the 8 weeks following intravenous iron treatment.

Conclusion
This was the first study to evaluate the prevalence of iron-deficiency anemia and the real-life impact of intravenous iron treatment among patients living with IBD in Quebec, Canada. The findings will serve as a baseline for subsequent interventions to improve the wellbeing and the quality of life of IBD patients with anemia.
P361 No increased postoperative risk of venous thromboembolism in patients with Ulcerative Colitis undergoing colectomy after tofacitinib exposure
Authors: De Greef I , Verstockt B , Bislenghi G , Terrasson I , Sabino J , Ferrante M , D’Hoore A , Vermeire S 
Published: May 2021

Abstract

Background
Colectomy for ulcerative colitis (UC) has been associated with postoperative morbidity and mortality, including venous thromboembolism (VTE). Patients with inflammatory bowel diseases (IBD) have a 2 to 4-fold increased risk for developing VTE, as compared to non-IBD patients. Due to recent concerns on increased VTE associated with tofacitinib exposure, we aimed to evaluate the 180-day postoperative VTE risk in UC patients undergoing colectomy after tofacitinib use in comparison to patients failing biologicals and undergoing the same surgery.

Methods
This retrospective cohort study included all UC patients who underwent colectomy between 2014 and 2020 in our tertiary IBD center. All medical charts were reviewed, and clinically relevant information extracted, including indication for colectomy, development of postoperative VTE (deep venous thrombosis, pulmonary or extra-pulmonary embolisms) within 180 days of surgery, low-molecular weight heparin (LMWH) prophylaxis and perioperative therapy exposure (steroids within 1 month prior to surgery, biologicals or tofacitinib within 3 months prior to surgery).

Results
One-hundred seven UC patients (49.5% women, median [IQR] age 38.0 [27.0 – 53.0] years) underwent colectomy due to refractory disease (n=93), dysplasia or carcinoma (n=12) or polyposis (n=2) (Table 1). Thirty-six (33.6%) patients were operated urgently. At the time of surgery, 44 (41.1%) were on steroids, 38 (35.5%) on anti-TNF agents, 27 (25.2%) on vedolizumab/etrolizumab, 6 (5.6%) on anti-IL12/23 agents and 12 (11.2%) on tofacitinib. All patients received antithrombotic prophylactic LMWH postoperatively. During the 180-day postoperative period, 3 (2.8%) patients developed an intra-abdominal thrombosis, none of them had a history of VTE. Two thromboses were found by coincidence on CT scans which were performed in light of postoperative fever and inflammatory blood tests, the other patient was symptomatic. All 3 patients had been exposed to vedolizumab: one had an underlying malignancy (colon adenocarcinoma), the 2 others also had been exposed to corticosteroids prior to colectomy. No VTE was seen in the patients who underwent colectomy while on tofacitinib.

Conclusion
The overall risk for UC patients to develop VTE after colectomy is low with adequate antithrombotic prophylactic therapy. In particular, we did not observe any VTE in our colectomy patients who were exposed to tofacitinib prior to surgery. The three patients who developed VTE despite LMWH had additional risk factors (concomitant steroid use, active cancer).
P382 High anti-tumor necrosis factor alpha treatment trough concentrations are not associated with higher rate of adverse events in pediatric patients with inflammatory bowel disease
Authors: Zvuloni M , Matar M , Levi R , Shamir R , Assa A 
Published: May 2021

Abstract

Background
Anti-tumor necrosis factor alpha (anti-TNFα) therapy is commonly used to treat refractory pediatric inflammatory bowel disease (IBD). Prolonged use of anti-TNFα therapy has been linked to a number of adverse events. We aimed to assess the relationship between serum trough concentrations (TC) of anti-TNFα and adverse events rate among patients with pediatric IBD.

Methods
The medical records of 135 pediatric patients with IBD who were treated with anti-TNFα agents from 2015 to 2020 and had sequential monitoring of TC were reviewed retrospectively for the presence of adverse events (infusion reactions, infections, acute cutaneous reactions, psoriatiform rashes, elevated transaminases and others). The association between demographic or disease related variables and adverse events were analyzed using multivariate analysis.

Results
Out of 135 patients, [59 (43.7%) female, mean age at diagnosis 12.9 (±3)years, 111 (82.2%) Crohn’s disease] who had 1645 measurements of TC [1037(63%) infliximab, range 0-46 µgr/ml] during a median follow-up period of 1.7 years (1.1-2.7), we recorded 120 adverse events in 42 patients (31%). When analyzing TC as continuous measure or as a categorical measure (&gt; or &lt;10 µgr/ml) there were not associated with a higher rate of adverse events (p=0.9).Patients who reported non-infusion related adverse events were younger at the time of diagnosis (mean age 11.4±3.9 vs.13.3±2.8years) than those without adverse effect (p=0.029). There was no statistically significant correlation between other variables (gender, disease type, Paris classification, extra-intestinal manifestation, perianal disease, and the pediatric disease activity index) and the occurrence of adverse events.

Conclusion
Based on our cohort, higher TCs were not associated with higher rate of anti-TNF related adverse events whereas younger age at diagnosis increased the risk for such events. The study protocol was approved by the local Internal Review Board at the Rabin/Schneider Medical Center (RMC0320-10).
P390 Diverting Loop Ileostomy in Medically Refractory Crohn’s Colitis
Authors: Patel P , Wu L 
Published: May 2021

Abstract

Background
Medically Refractory Crohn’s Colitis (MRCC) necessitates surgical treatment. Patients may be malnourished, hyper-inflammatory and unstable (tachycardia, elevated temperatures and hypotension). Acute Defunctioning Ileostomy Formation Alone (DIFA) may be a safer option than total/subtotal Acute Colectomy and Ileostomy Formation (ACIF) in the urgent/semi-urgent setting - allowing optimisation of patient condition for further medical therapy or elective surgery.

Methods
Multi-centre, retrospective outcomes analysis was performed. Local investigators identified all patients aged ≥16 with MRCC, that underwent urgent/semi-urgent surgery between 1/1/1999 and 31/12/2019. The primary outcome was 30-day all-cause morbidity. Multiple secondary outcomes were defined relating to 30-day, 1-year and 18-month follow up.

Results
82 patients from seven hospitals satisfied selection criteria - 12 DIFA and 70 ACIF. 30-day all-cause morbidity (8.3% vs 52.9%), median length of stay (8 vs 17 days), open surgical approach (25.0% vs 75.0%) and 1-year readmission rates (25.0% vs 37.1%) were all significantly lower for the DIFA group. 30-day all-cause mortality, critical care admission, 30-day return to theatre and 1-year morbidity were all lower for the DIFA group. The DIFA group had a 16.7% 1-year colectomy rate and 25% 18-month ileostomy rate.

Conclusion
DIFA is a safe alternative to ACIF for surgical treatment of urgent/semi-urgent MRCC. Larger scale prospective studies are warranted to confirm this.