bluuebunny/crossref_metadata_2025_split huggingface dataset:
P120 Developing “My quality of life” programme based on ICHOM Standard Set for IBD: 1-year results
Authors: Roa I , Merino O , Gómez Irwin L , Arosa M , García González J M , Ituarte R , Méndez T Á , Cortón L , Castelo S , Suárez M J 
Published: May 2021

Abstract

Background
Inflammatory bowel diseases (IBD) are chronic relapsing diseases of unknown etiology, usually beginning at a young age. Although life expectancy of IBD patients is near to the mean of healthy population, IBD has a significantly negative impact on patients’ quality of life. Recent research has evidenced that a poorer quality of life can contribute to relapse or worsening of IBD symptoms, reduce treatment adherence and lead to poorer outcomes.
The Ezkerraldea-Enkarterri-Cruces Healthcare Organization in Spain has made a firm commitment to adopt the Value-Based Health Care (VBHC) model, which advocates for the incorporation of patient-perceived quality of life variables to the items we normally assess. The IBD Unit, in pursuit of adhering to the VBHC corporate programme, has launched on a process to analyze our health care delivery system and improve the effectiveness of our Performance Improvement Plan based on patients’ experience.
Objectives:
- To identify and systemize the incorporation of perceived quality of life variables
- To reorient medical care towards what really matters to patients

Methods
We have built a multi-disciplinary team comprised of healthcare professionals involved in IBD management (Figure 1). Patients form the core of the team’s meetings, helping in the development of User Experience (Figure 2) and Empathy Maps (Figure 3) by using Design Thinking strategies. After the detection of the obstacles faced by patients, we outlined a Process Map (Figure 4), where we critically analyzed the route followed by patients in our health-care system before reaching the IBD Unit. Subsequently, a specific route was outlined considering the set proposed for the disease by the ICHOM consortium as a reference framework. Questionnaires and surveys were designed using patient information across different areas of care, in order to guarantee the correct functioning of the route.

Results
We obtained a list of 14 improvement proposals which are currently at different levels of evaluation. In our first year, we have been able to implement important modifications which include:
- A specific remote consultation for IBD patients
- Fast track pathways
- Nutritional guidelines to assure compliance
- Shortening waiting lists
- Reduction in patient bureaucracy and paperwork
- Virtual monitorization of patients with asymptomatic disease

Conclusion
- VHBC implementation implies a transformation of the organization
- User Experience tools add a different perspective to the route design, focusing on what really matters to patients and improving their quality of life
- This change of perspective is important, especially in chronic diseases, so that patients feel less lonely with their disease and better outcomes can be obtained
P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics
Authors: Viola A , Giambò F , Chiappetta M F , Costantino G , Pallio S , Navarra G , Alibrandi A , Fries W 
Published: May 2021

Abstract

Background
The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC).

Methods
IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019.

Results
A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p&lt;0.001) both. Treatment delays or transitory stops were more frequent in EV (p&lt;0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p &lt; 0.001).

Conclusion
Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.
P165 Non-invasive biomarkers of type III collagen cross-linking reflects fibrolysis in patient with luminal CROHN’S DISEASE
Authors: Pehrsson M , Godskesen L E , Bay-Jensen A C , Asser Karsdal M , Krag A , Kjeldsen J , Høg Mortensen J 
Published: May 2021

Abstract

Background
Type III collagen of the interstitial matrix is highly expressed in fibrotic tissue of Crohn’s disease (CD) and suggested to undergo remodelling during the characteristic deep tissue inflammation. Periods of inflammatory flares and remission could thus be reflected by varying degrees of type III collagen degradation and formation in relation to fibrogenesis and resolution of fibrosis. The aim was to investigate the association between type III collagen remodelling and CD disease phenotypes based on the Montreal classification

Methods
40 CD patients were endoscopically assessed according to the Montreal B classification (luminal or stricturing phenotype) and Harvey Bradshaw Index for clinical disease activity (&lt;4 = inactive; &gt;4 = active). Patients were stratified based on both the Montreal B classification and HBI scores. Biomarkers were assessed by ELISA: 1) CTX-III (cross-linked protease degraded fragments of type III collagen), PC3X (cross-linked type III collagen formation), 3) PRO-C3 (type III collagen formation), and 4) C3M (MMP-9 degradation fragments)

Results
Biomarker levels of CTX-III was significantly elevated in CD patients with luminal- and clinically inactive- disease compared to patients with stricturing- and clinically inactive- disease and luminal- and clinically active- disease (p&lt;0.01 and p&lt;0.05, fig 1A). The levels of net fibrolysis of cross-linked type III collagen (CTX-III/PC3X) was significantly higher in patients with luminal- and clinically inactive- disease compared to patients with stricturing- and clinically inactive- disease (p&lt;0.001), luminal- and clinically active- disease (p&lt;0.001), and patients with stricturing- and clinically active- disease (p&lt;0.05, fig 1C). Significantly elevated levels of net type III collagen degradation (C3M/PRO-C3) were observed in patients with a luminal- and clinically active- disease compared to luminal- and clinically inactive- as well as stricturing- and clinically inactive- disease (p&lt;0.05). Furthermore, net type III collagen degradation was elevated compared to patients with stricturing- and clinically active- disease (p&lt;0.05, fig 1F). Biomarker levels of PC3X, C3M, and PRO-C3 were unable to differentiate between patient groupings (fig 1B, D, and E)

Conclusion
Proteolytic degradation of cross-linked type III collagen (CTX-III) reflecting resolution of fibrosis in CD patients with luminal disease, may be associated with a protective effect against fibrogenesis and progression to fibrostenosis. These data indicate differences in cross-linked and non-cross-linked type III collagen remodelling in CD patients, and their potential use for differentiating patient phenotypes and disease activity
P171 Immune-mediated diseases (IMID) and COVID-19: results from an observational retrospective multicenter study
Authors: Calviño Suárez C , Dos-Santos R , Baston-Rey I , Montero F J , Ferreiro-Iglesias R , Marin-Jimenez I , Gonzalez C M , Perez-Pampin E , Barreiro-de Acosta M 
Published: May 2021

Abstract

Background
The novel coronavirus emerged in 2019 in Wuhan has caused a global pandemic of coronavirus disease (COVID-19). Immune-mediated diseases (IMID), as inflammatory arthritis or inflammatory bowel disease (IBD), have some special implications due to their pathogenesis and treatments. Some treatments employed in IMID are now being used in the treatment of severe COVID-19. There still exists controversy about IMID behavior and its complications. Our aim was to assess COVID-19 severity in IMID patients and its prognosis predictors.

Methods
An observational retrospective multicenter study was performed in two Spanish Hospitals (University Clinical Hospital in Santiago de Compostela and Gregorio Marañón Hospital). Patients were selected if they were diagnosed of an IMID (rheumatoid arthritis, psoriatic arthritis, espondyloarthritis, ulcerative colitis and Crohn’s disease) and had COVID-19 infection between February and April 2020. Demographic, clinical, analytical and treatment data were collected. Stata 15.1 was used to perform statistical analysis.

Results
91 patients were included. 55 suffered from a rheumatic disease and 36 suffered IBD. Univariable analysis reached age, comorbidity, female gender, flu vaccine, arthropathy, basal csDMARD, pneumonia and basal CRP as potential predictors of non-severe (absence of death, respiratory insufficiency, intensive care unit admission or sepsis) COVID-19 disease (p &lt; 0.2). After multivariable analysis, only female gender (OR 4.60 [CI95% 1.00, 21.2] p=0.050), lower age (OR 0.94 [CI95% 0.88, 1.00] p=0.042) and lower basal levels of CRP (OR 0.87 [CI95% 0.77, 0.97] p=0.010) were predictors for non-severe disease (p &lt; 0.005). Mean time of healing (symptoms solved in outpatient and hospital discharge in admitted) from COVID-19 was 13.8 days (SD 16.3). Univariable analysis showed arthropathy, COVID-19 symptomatic and basal GC dose as potential predictors of higher time-to-healing from COVID-19 disease (p &lt; 0.2). After multivariable analysis, only lower GC basal dose predicts higher time-to-healing (OR -1.83 [CI95% -2.81, -0.84] p=0.001).11 patients deceased because of SARS-CoV-2 infection. Univariable analysis reached age, basal csDMARD, pneumonia and basal CRP as potential predictors of COVID-19 mortality (p &lt; 0.2). After multivariable analysis, only higher age was a predictor for mortality (OR 1.14 [CI95% 1.04,1.25] p=0.006).

Conclusion
IMID patients showed similar predictors of mortality than general population involving COVID-19. Immune-modulating agents did not seem to overshadow the prognosis of COVID-19 infection. Female gender, lower age and lower basal CRP is associated with mild COVID-19 disease as well higher age points out the worst prognosis. Even that, each case should be individualized.
P208 Differentiating intestinal tuberculosis from Crohn’s Disease: External validation of a new nomogram
Authors: Dahmani W , Sahar N , Ay H , Nour E , Wafa B A , Aida B S , Ahlem B , Mehdi K , Hanene J , Ali J 
Published: May 2021

Abstract

Background
Intestinal tuberculosis (IT) poses a real problem of differential diagnosis with Crohn’Disease (CD). Indeed, the distinction between these two pathologies represents a real challenge for clinicians because of their multiple similarities. Based on simple biological, endoscopic and radiological criteria, A new nomogram was developed by Yao He et al. who would differentiate between the two diseases.

Objective
To validate externally this new nomogram in a series of patients with IT and CD.

Methods
We have collected retrospectively patients diagnosed with CD and IT in our center for a period 11 years old. Patients whose medical file included the data used in the nomogram have been included. The discrimination performance of the nomogram was evaluated by calculating the area under the ROC curve.

Results
Of the 76 included patients, 16 had one IT and 60 had one CD. The average age of patients with IT was 44.76 ± 19 years old. The most frequent revealing symptoms were subocclusive syndromes (n = 10) followed by abdominal pain (n = 8). Endoscopic lesions were located in the majority of cases in the ileocecal region (n = 12) and were dominated by the retracted aspect of the cecum (n = 5), transverse colonic ulcerations (n = 4) and valvular stenosis (n = 2). A tumor appearance was noted in two patients.The radiological images of the lungs suggestive of pulmonary tuberculosis were found only in two patients. Intradermal reaction (IDR) to tuberculin was positive in all cases where it was practiced. (n = 14). In ten cases, the diagnosis of ITwas made following bowel resection whose indications were diagnostic uncertainty (n = 4), acute bowel obstruction (n = 4) and suspected CD ileocecal refractory to medical treatment (n = 2). The discrimination of the nomogram analyzed by the ROC curve was 0.956 (95% CI [0.875; 1]). A threshold of 0.5 was associated with a sensitivity of 98.3%; a specificity of 92.8% and a positive and negative predictive value for the diagnosis CD of 98.3 and 92.8 respectively.

Conclusion
Although Tunisia is a country of strong endemicity for tuberculosis, intestinal localization seems infrequent and misdiagnosed. The nomogram applied seems to have excellent performance diagnose what could prevent resections intestinal for diagnostic purposes. However, studies multicenter prospective studies remain necessary for a large-scale validation.
P212 Assessment of Crohn’s disease activity using global MaRIA score in patients with ileal and ileocolonic disease
Authors: Hrabric Sonje K , Domislović V , Brinar M , Cukovic-Cavka S , Turk N , Grgic D , Sjekavica I , Krznaric Z 
Published: May 2021

Abstract

Background
Magnetic resonance index of activity (MaRIA) is composed of features independently associated with endoscopic disease activity and is surrogate marker of disease activity. The aim of this study was to evaluate correlation of global MaRIA (gMaRIA) with clinical and biochemical disease activity indices and diagnostic accuracy for active disease in patients with terminal ileum disease and ileocolonic disease.

Methods
This is a cross-sectional study which included 251 patients with diagnosed CD. Global MaRIA (gMaRIA) index was calculated on 6 bowel segments (the distal ileum, ascending, transverse, descending, sigmoid colon and rectum) using following parameters: bowel wall thickness, ulcers, edema and relative contrast enhancement. Disease activity was defined as combination of clinical and biochemical disease activity (CRP&gt;5 or HBI≥5). Disease extension was classified using Montreal classification (L1 ileum, L2 colon, L3 ileum and colon).

Results
This study included 251 CD patients [age 35 (25–47), 55.3% males, BMI 21.8 (18–25) kg/m2, median disease duration 7 (2–15) years]. Ileal disease (L1) was present in 84 (33.5%) and ileocolonic disease (L3) in 151 (60.1%) patients. Correlation of gMARIA with biochemical indices of disease activity (CRP) was r=0.48, p&lt;0.001 and with HBI r=0.33, p&lt;0.001. Diagnostic accuracy of gMARIA in defining active disease in patients with L1 disease was considerably high [AUC 0.83 (95%CI 0.72–0.91)]. On the other hand, diagnostic accuracy in defining active disease in patients with L3 disease was good [AUC 0.71 (95%CI 0.62–0.79)], which is lower compared to L1 disease. In surgically naïve patients diagnostic accuracy of L1 disease was [AUC 0.88 (95%CI 0.72–0.96)], and for L3 disease [AUC 0.78 (95%CI 0.64–0.89)].

Conclusion
Global MaRIA index showed higher diagnostic accuracy in detecting clinically and biochemically active disease in terminal ileum compared to ileocolic disease. These results emphasize the important role of magnetic resonance enterography in monitoring disease activity in patients with isolated ileal disease. Global MaRIA score correlates better with biochemical disease activity compared to clinical disease activity, which points out to the significance of biochemical remission.
P215 Blood-based prognostic biomarkers in Crohn’s patients treated with biologics: a new promising tool to predict endoscopic outcomes
Authors: Grova M , Crispino F , Maida M , Renna S , Mocciaro F , Casà A , Rizzuto G , Scimeca D , Di Mitri R , Macaluso F S , Orlando A 
Published: May 2021

Abstract

Background
There is a growing need for biomarkers of inflammation to monitor and predict therapeutic outcome in Crohn’s disease (CD) patients. We aimed to evaluate whether the level of circulating blood cells, expressed as ratios (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; ELR, eosinophil-to-lymphocyte ratio and ENLR, eosinophil*neutrophil-to-lymphocyte ratio), could be used as early prognostic biomarker of endoscopic response (ER) in patients starting biological therapy with infliximab, adalimumab, vedolizumab and ustekinumab. Association with steroid-free clinical remission at week 54 and endoscopic disease activity at baseline, as well as other variables related with ER were also evaluated as secondary outcomes.

Methods
Consecutive patients with CD who started biological therapy between June 2016 and July 2019 in two Italian tertiary centers were enrolled. We used multivariate analysis to evaluate whether NLR, PLR, ELR and ENLR at baseline and after 12 weeks of treatment could predict ER (SES-CD ≤ 2 or SES-CD ≤ 2 and Rutgeerts score i0-i1) after 54 weeks of treatment. Receiver operating characteristic (ROC) curves were generated to identify the area under the curve (AUC) and find the best cut-off values of NLR, PLR, ELR and ENLR for the prediction of ER. To enhance the diagnostic performance, these ratios were combined with baseline Harvey Bradshaw Index (HBI) in a prognostic model.

Results
107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013) and ENLR (p = 0.021) compared with those without ER; similar results were confirmed after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.026). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR, respectively. The best cut-offs values were included in the HBI-based prognostic model: 81.8% of patients with HBI ≥ 5 and higher ratios did not achieve ER, while all patients with HBI &lt; 5 and lower ratios reached ER. Interestingly, ENLR was found to be linearly associated with SES-CD at baseline (p = 0.035).

Conclusion
To the best of our knowledge, this is the first study assessing NLR, ELR and ENLR as predictive markers of therapeutic response in CD patients. Low levels of these ratios can predict endoscopic response and could be used in clinical practice for a better management of CD patients needing biological therapy. Further prospective studies are needed to confirm these results in larger cohorts.
P217 Clostridium Difficile Infection as a cause of severe outcomes in patients with Inflammatory Bowel Disease
Authors: Fadeeva N , Knyazev O , Parfenov A , Kagramanova A , Lishinskaya A , Babayan A , Danilov M , Dolgopyatov I 
Published: May 2021

Abstract

Background
The prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is higher than in general population. CDI may produce a negative effect on the clinical course of IBD. The aim of the study was to define the frequency of CDI in patients with IBD and to study risk factors that predict severe outcomes associated with CDI in IBD patients.

Methods
1278 medical records were analyzed in a retrospective study of patients with IBD, of which 808 patients met the inclusion criteria. Patients were divided into 2 groups based on the presence of a preliminary diagnosis of CDI. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Statistical analysis was carried out using Pearson Chi-square and two-sample t-test.

Results
The frequency of CDI in patients with IBD was 17.6%. The mean age of occurrence of CDI in patients with IBD was 37.8±12.9. The first group included 143 patients CDI+IBD, and the second group - 665 patients IBD without CDI. In the first group C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin levels were significantly higher and albumin level was lower than in the second group (р&lt;0.05). The average albumin level in the first group was 20.8±1.83 mg/l, in the second group – 38.7±2.36 mg/l (р&lt;0.05). Only 25.3% of all patients with CDI had a history of antibiotic use, and 30.4% had previously used steroids. Long-term immunosuppressive therapy in patients with IBD has an impact on the development of CDI: among patients with CDI 48.7% long-term received azathioprine/6-mercaptopurine, in patients without IBD – 18.3% (p&lt;0.001). Only 19% of patients with CDI had control of the disease with salicylate therapy, while 62% of patients without CDI achieved remission by taking salicylates (p&lt;0.05). Of these, 7 patients (4.9%) met our primary outcome (1 death, 6 colectomy) at a median of 21 days. On multivariate analysis, serum albumin&lt;22 mg/L (HR 7.93, 95% CI 1.006–62.57), was independent predictors of our primary outcome.

Conclusion
The frequency of CDI in patients with IBD was 17.6%. The study shows that patients with IBD are more sensitive to the development of CDI at a young age, while not having such traditional risk factors as recent hospitalization or antibiotic use. Patients with IBD with CDI in history often noted the ineffectiveness of therapy with salicylates; often require the assignment of biological therapy. IBD patients with CDI have a lower average albumin, and a higher activity of the inflammatory process (p&lt;0.05). Serum albumin&lt;22 mg/L was independent predictors of severe outcomes in hospitalized IBD patients with CDI.