bluuebunny/crossref_metadata_2025_split huggingface dataset:
P125 Could gut microbiota metagenomic analysis improve diagnosis in paediatric Inflammatory Bowel Disease population?
Authors: Pujol Muncunill G , Monleon-Getino A , Méndez-Viera J , Álvarez-Carnero L , Martin de Carpi J 
Published: May 2021

Abstract

Background
Gut microbiota plays an important role in maintaining intestinal homeostasis. Recent studies postulate that dysbiosis may be involved in the pathogenesis of Inflammatory Bowel Disease (IBD). The aim of the study was to characterize the metagenomic biodiversity of the gut microbiota in Paediatric Inflammatory Bowel Disease patients (PIBD) and whether microbiome data could be used as diagnostic tool.

Methods
A prospective, longitudinal observational pilot clinical trial with consecutive inclusion of PIBD patients matched with healthy controls by age and sex was performed. A total of 36 children were planned to be included: 12 Crohn’s Disease (CD), 12 Ulcerative Colitis (UC) and 12 healthy controls (HC). Demographic, clinical and analytical data were recorded and stool and saliva samples were collected at onset, 3 and 6 months for DNA sequencing and bioinformatics analysis.

Results
Twenty-three patients (12CD, 11UC) and 9 HC were included (at the time of data analysis). Fifty-six percent were male; mean age: 11.7 years (IQR: 8–15). CD patients at onset had a mean Paediatric Crohn’s Disease Activity Index (PCDAI) of 22.5 (IQR: 10–55), a mean Faecal Calprotectin (FC) of 2384 mg/kg (IQR: 159–6000) and 83% of them had inflammatory markers elevation (Erythrocyte Sedimentation Rate (ESR) and/or C-reactive protein (CRP)). Patients with UC presented a mean Paediatric Ulcerative Colitis Activity Index (PUCAI) of 43.6 (IQR: 10–80) at onset, mean CF of 3381 mg/kg and 18% presented an increase of inflammatory markers (ESR and/or CRP). To date, Next Generation Sequencing (NGS) metagenomic study (saliva and stools) has been performed from 15 subjects (9 CD, 2 UC and 4 HC) at onset and 9 subjects (7 CD and 2 UC) at 3 months. A differential microbiota pattern was observed in both, saliva and stools, for CD at onset and at 3 months. In the stools, three differential taxa were found at onset of the disease and at 3 months and in saliva, another three differential taxa were observed compared to HC. In UC, 6 differential taxa (&gt; 3 % diff. HC-UC, p-value=0) were selected in stools and 7 in saliva at onset compared to HC. Globally, a higher microbial biodiversity was observed for HC compared to CD at onset, but it was not statistically significant.

Conclusion
Provisional results showed a possible differential signature in both saliva and stools of patients with paediatric CD. These results must be validated with all the samples in process, and probably using larger paediatric cohorts before the development of these techniques as a diagnostic tool in the clinical practice.
P137 Preliminary validation of a multi-stage machine learning algorithm to assess histological inflammation in inflammatory bowel disease
Authors: Hagendorn E , Karsen S , Pai R , Jairath V , Knight H , Schwartz A , Laroux S , Butler J , Dunstan R 
Published: May 2021

Abstract

Background
The histologic assessment of inflammatory bowel disease (IBD) relies on qualitative grading methods. Although widely accepted, these instruments are time consuming, require specialized training, and suffer from inter-rater disagreement. For these reasons there is a need for more consistent and less biased methods to assess IBD histology.

Methods
The algorithm was initially developed using hematoxylin and eosin (H&E) stained whole slide images of colon biopsies (238 ulcerative colitis [UC], 30 Crohn’s Disease [CD], and 28 endoscopically normal adjacent [ENA]). The first two stages implement convolutional neural networks (CNN) which segment 11 key anatomical features (Figure 1). The third stage extracts the features and models them for prediction.

Results
The first stage of the algorithm was validated on an independent test dataset by calculating the intersection-over-union (IoU) for the ground truth and prediction masks, resulting in a value of 0.97. A preliminary validation for stage 2 was performed by randomly selecting 30 unique biopsy sections from the test dataset and applying a 150um x 150um counting frame. An expert gastrointestinal pathologist confirmed correct cell identification by the algorithm for three of the primary inflammatory cell types: plasma cells, eosinophils, and neutrophils which resulted in a sensitivity/specificity of 0.76/0.99, 0.78/1.00, and 1.00/0.98 respectively. The final stage predicts RHI grades which could be directly compared to pathologist reads (Figure 2, 3, and 4).

Conclusion
This is the first study to demonstrate the value of machine learning to assess histologic activity in IBD. These methods lay the foundations for future work, and we believe stages 1 and 2 can be explored independently to statistically characterize the histologic changes of IBD, enabling the improvement of preexisting grading systems.
P164 Celiac Disease among a large cohort of inflammatory bowel disease patients: epidemiology and outcome implications
Authors: Vernero M , Ribaldone D G , Giudici G , Stalla F M , Dutto C , Bugianesi E , Saracco G M , Caviglia G P , Astegiano M 
Published: May 2021

Abstract

Background
Inflammatory bowel disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC) and undetermined IBD (IBD-U), are autoimmune chronic remittent diseases affecting the gut. On the other hand celiac disease (CeD) is a gluten related disorder leading to duodenal villous atrophy. Lately, the link between CeD and IBD has become of growing interest. Indeed, CeD prevalence among IBD population has been widely investigated, as well as IBD prevalence in CeD population. Particularly, IBD seems to have a significantly higher prevalence among CeD population than in general population and CeD seems to be more prevalent in IBD population. However, there is still lack of data on whether CeD can influence IBD outcome. So, primary outcome of our study is to measure prevalence of CeD among IBD population and secondary outcome is to evaluate possible influence of CeD on IBD outcome.

Methods
Data were collected from march 2020 to September 2020 from IBD internal registry in San Giovanni Antica Sede Hospital in Turin. To detect CeD patients, all patients were screened and the ones with a reported duodenal lesion were selected. From those, the ones with defined diagnosis of CeD (presence of serum IgA antitransglutaminase and or IgA anti endomisial antibodies) were finally selected. Prevalence of CeD among IBD was compared to that of general population basing on literature. Then 76 patients were randomly selected as control group, in roder to investigate secondary outcome. To define IBD as complicated Siegel’s score was used (1 out of five item needed to define complicated disease).

Results
Among 5732 IBD patients we detected 80 patients with duodenal lesions, of whom 27 were diagnosed with CeD. So, prevalence of CeD among our population is about 0,49% whiich is similar to that of general population (0,48%, P=0.98). No differences were found in CeD prevalence among CD, UC and IBD-U subgroups. As regards secondary outcome, in case group complicated IBD was 44,4% while among control group 26,3% (p=0.08). In a mean follow up time of 133,93 months, mean time from diagnosis to complication of IBD was 58,2 months in case group and 102,7 months in control group. As shown in figure 1, Kaplan-Maier curve for event free survival comparing the two groups shows a significant difference between CeD + IBD patients and IBD only patients (p=0,002).

Conclusion
Even though the retrospective nature of the study could lead to underestimate CeD diagnosis, among our cohort of IBD patients CeD prevalence seems not to be significantly higher than among general population. Despite of that, when associated to CeD, IBD seems to have earlier complications, so these patients may deserve a top down therapeutical approach and/ or a more strict follow up.
P179 Treatment decisions and biologic adoption rates in newly diagnosed Crohn’s disease in Japan
Authors: Hisamatsu T , Yoon A 
Published: May 2021

Abstract

Background
Biologic therapy in Crohn’s disease (CD) has significantly improved treatment outcomes. Still, providing an optimal care for individual patient in real-world is complex. We report the real-world treatment decisions between biologics and systemic corticosteroids (SCS) and associated factors in newly diagnosed CD in Japan.

Methods
Patients with CD diagnosis (Index) and at least one CD therapeutic agent prescribed between 2006 and 2019 were screened from the JMDC database. JMDC is a health claims database where various sized (small to very large) companies’ employees and their dependents are enrolled. Subjects with a minimum 12-month CD-diagnosis-free enrolment period up to the Index, and a minimum 12-month observational period after the Index were included in the analysis. Subjects were categorised into 2 groups (A: without biologics, B: with biologics) based on their first-year treatment, and then further into 4 groups: SCS without biologics (A1), No SCS nor biologics (A2), Biologics with no prior SCS (B1), Biologics with prior SCS (B2).

Results
859 subjects were included. 38.4% (B: n=330/859) initiated biologics within a year since diagnosis (Table 1). Among them, 73.3% (B2: n=242/330) initiated biologics without prior SCS, so-called a top-down approach. Among the rest who were not treated with biologics within the first year, 27.2% (A1: n=114/529) received SCS. B were 7.5 years younger on average and had a higher rate of perianal symptoms (43.0%) compared to A (22.9%). Trend analyses showed that the rates of biologic adoption in the first year have been relatively stable over a decade since 2008 to 2019 (Table 2).

Conclusion
Real-world treatment decisions in newly diagnosed CD were investigated, and perianal symptoms were strongly associated with biologic therapy. Biologic adoption rates in CD seemed higher and faster in Japan compared to Europe. According to a Danish study reported by Alulis et al. (2020), 28.5% of CD patients received biologics at some point during the whole study period, of which 46.2% received within a year. These figures suggest that 13.2% of newly diagnosed CD were treated with biologics within the first year in the Danish study compared to 38.4% in our study.
P180 Endoscopic scoring systems for Crohn’s Disease and Ulcerative Colitis and their correlation with histological and clinical outcomes
Authors: Gibbons E , Hayes T , Shahzad C K , Hussain A , Hall B , Smyth C , Farrell R , Kelly O 
Published: May 2021

Abstract

Background
Endoscopy and histopathology are vital for evaluating disease activity and treatment response in inflammatory bowel disease. Correlation between endoscopic and histological indices has not been fully examined. The primary aim of this study was to examine the correlation of endoscopic scores with histological assessment and association with flare/hospitalisation in the ensuing 12 months.

Methods
We selected 100 random colonoscopies performed for IBD surveillance/assessment in 2019. Adult patients with a complete colonoscopy were included. All reports were blindly scored by 2 expert endoscopists using SES CD or Mayo score as appropriate. Histology was retrieved from HistoLab database and classified as normal, mild, moderate and severe. Clinical demographics, CRP, fecal calprotectin levels, flare episodes and hospitalisations were recorded. Correlation between endoscopic and histologic activity was tested. Comparisons were made between patients in histologic and endoscopic remission v those with endoscopic and histologic activity regarding association with flare/hospitalisation.

Results
100 IBD patients (median age 49 IQR 22; 54% female; 50% Crohn’s disease) were included. A wide range of SES-CD scores were noted (median score 2 and IQR 6). 48% were in remission (0–2), 34% mild with score 3–6, 18% moderate with score 7–15 and 4% severe disease activity scoring &gt; 16. Of those in endoscopic remission, 87.5% had normal histology. Of the 9 with moderate endoscopic disease all ranges of histological status were described. All levels of the Mayo scale (median score 1) were represented. Similar to the Crohn’s group, 87.5% of those in endoscopic remission also had normal histology. In total 42 patients were in both endoscopic and histological remission, and only 7% experienced a flare of disease activity in the following 12 months, with no hospitalisations. In total 40 patients had both endoscopically and histologically active disease, and 45% of these had a flare in the ensuing 12 months with two hospitalisations.The ROC curve for SES-CD score and histological remission is 0.73 +/- 0.07 95%CI 0.59 -0.87 and for the Mayo score and histological remission 0.87 +/- 0.05 95%CI 0.78- 0.97.

Conclusion
Accurate assessment of disease activity guides therapy choices and helps assess response to treatment in our IBD cohort. In this study the SES-CD and Mayo endoscopic scores showed good correlation with histological assessment. Those with active endoscopic and histologic disease experienced more flares and had higher rates of hospitalisation than those in remission. Further investigation with higher study numbers and incorporation of a standardised histological grading system are required.
P191 Non-specific terminal ileitis: prevalence, clinical course and association with later diagnosis of Crohn’s disease
Authors: Koureta E , Tampaki M , Voulgaris T , Laoudi E , Karatzas P , Papatheodoridis G 
Published: May 2021

Abstract

Background
The existing literature does not provide adequate guidance on the diagnosis and management of patients with non-specific terminal ileitis, while the data regarding the percentage of patients that finally develop Crohn’s disease are scarce.

Methods
The aim of this study was to evaluate the prevalence and natural course of non-specific terminal ileitis in patients who underwent colonoscopy in our department during the last decade. All patients with endoscopic findings of terminal ileitis and non-specific histological findings between 2008 and 2018 were included in the study. Patient characteristics, initial symptoms, biopsy findings, and the patients’ clinical and endoscopic course were recorded. Patients with a history of Crohn’s disease or histological findings related to specific diseases were excluded.

Results
Out of 5.353 colonoscopies in total, 92 patients (mean age: 50 years, men: 56.5%, asymptomatic: 72.5%) with non-specific terminal ileitis were identified (prevalence: 1.7%). Among 92 patients, 56 (61%) had available follow-up information for at least 6 months after initial endoscopy. In these patients, the reasons for performing endoscopy were chronic diarrhea (21/56, 37.5%), screening (16/56, 28.6%), abdominal pain (12/56, 21.4%), iron deficiency (5/56, 9%) and visible blood in stool (2/56, 3.5%). Endoscopic findings included erosions/ulcerations (62.5%), mucosal edema (23.2%), mucosal erythema (10.7%) and ileal valve stenosis (3.6%). Among 56 patients, 16 (28.6%) received medical treatment that included aminosalicylates (25%), budesonide (62.5%) and antibiotics (12.5%). Recession of symptoms was recorded in 20 out of 40 symptomatic patients (50%). Interestingly, symptomatic relief was more frequent in patients who did not receive any treatment (75%) comparing to those who received medications (26.3%), (p=0.02). In total, 23/56 (41%) patients underwent 2nd endoscopy with persisting endoscopic findings in 15/23 (65.2%). Eleven out of 56 (19.6%) patients were eventually diagnosed with Crohn’s disease. The probability of Crohn’s disease diagnosis was significantly higher in symptomatic patients (27.5%) comparing to asymptomatic (0%) (p=0.019). The majority of patients with Crohn’s disease (9/11, 81.8%) remained symptomatic after initial endoscopy (p= 0.002), while 90% of them had persisting endoscopic findings in follow-up endoscopy (p=0.019).

Conclusion
Non-specific terminal ileitis has a generally benign clinical course regardless of the administered treatment. However, patients with persisting symptoms and endoscopic findings should be followed closely to monitor later development of Crohn’s disease.
P195 Predictors of colectomy in patients with acute severe ulcerative colitis: single-center retrospective analysis
Authors: Mingazov A , Achkasov S , Vardanyan A , Baranova T 
Published: May 2021

Abstract

Background
Acute severe ulcerative colitis is observed in 25% of patients1. Near 40% of this severe patients might undergo surgery2 and the mortality rate in this group of patients reaches 6.3%3. Untimely surgery leads to severe metabolic disorders, infectious postoperative complications, and increases the risk of death4,5. Eventually, the purpose of this study is identify predictors of colectomy in patients with acute severe ulcerative colitis.

Methods
A retrospective study included 74 patients with acute severe ulcerative colitis, who were treated at the clinic in 2017(Fig. 1). The patients were divided into the groups: group of colectomy - 54/74 (73%) and group of conservative treatment 20/74 (27%) (Fig 1). The predictors, like serum albumin, C-reactive protein, hemoglobin, endoscopic picture of «extensive ulcers», and clinical data were analyzed. The statistical analysis was performed using the software«Statistica 13.3» and «RStatistica».

Results
There were no difference by gender, age and duration of the disease in the groups. Mean of albumin and hemoglobin levels were significantly lower in the colectomy group. The endoscopy «extensive ulcers» was significantly more common in the operated patients (Tab 1). Also univariate, multivariate and ROC analyses were performed (Tab 2), (Fig 2).
The risk of colectomy when endoscopy «extensive ulcers» combined with an albumin level&lt;31 g/l and hemoglobin&lt;107 g/l, was 100%. A nomogram for predicting the probability of colectomy was constructed (Fig 3). This logistic model has a statistically significantly high predictive value (AUC=0.93, p=0.006).

Conclusion
The endoscopic picture of «extensive ulcers» in combination with an albumin level of less than 31 g/l and hemoglobin less than 107 g/l are predictors of colectomy with high predictive value.
P213 Having Inflammatory Bowel Disease Negatively Impacts Household and Family Life
Authors: Paulides E , Cornelissen D , van der Woude C J 
Published: May 2021

Abstract

Background
Inflammatory bowel disease (IBD) can have a major impact on different aspects of life. This study aimed to provide insight into the impact of IBD on household and/or family life, and to determine whether this differed between sex.

Methods
Between September and December 2020, adult IBD patients from the outpatient clinic of the Erasmus Medical Center (Rotterdam, the Netherlands) were invited to fill out a survey. A questionnaire was developed to measure the impact of IBD on functioning in the household and on family planning. Generic disability and work disability were measured with the IBD Disability Index (IBD-DI) and the Work Productivity and Activity Impairment Questionnaire (WPAI-IBD). Data were analysed using descriptive statistics and tests for independent groups.

Results
Of the 229 patients who participated (response rate 74%), 68% had Crohn’s disease, 69% was female and the median age was 38.0 years. Many patients experienced difficulties with domestic activities (55.0%), leisure (53.9%), parenting (50.6%), sexual activities (48.4%) and interpersonal relationships (39.1%) because of IBD in the past week. Furthermore, 32.7% of patients felt that IBD interfered with their desire to have children. Female sex was associated with more severe limitations in various aspects of household life, more interference in family planning and higher generic disability scores.

Conclusion
IBD had a markedly negative impact on household and/or family life in many patients. In order to optimize patient care, physicians need to be aware of household and family related difficulties and strive for a holistic treatment approach.
P227 Timing of acute severe colitis in the course of an inflammatory bowel disease: is it a prognostic factor?
Authors: Sahar N , Dahmani W , Nour E , Aya H , Wafa B A , Aida B S , Ahlem B , Mehdi K , Hanene J , Ali J 
Published: May 2021

Abstract

Background
In this study, we aimed to compare outcomes of patients with a severe acute colitis (SAC) inaugurating their inflammatory bowel disease (IBD) with SAC occurring in those with Known diagnosis of IBD.

Methods
We conducted a retrospective chart review of patients who were admitted to our unit for severe acute colitis over 7 years. Demographics, characteristics of the disease, clinical presentation, laboratory, morphologic investigations, treatments and outcomes were reviewed from medical records. Patients were divided in two groups: SAC inaugurating IBD (A) and SAC occurring during the course of Known IBD (B) and compared in terms of clinical presentation, response to medical treatment and colectomy rate. Statistical analysis was performed with SPSS software version 19.

Results
A total of 62 patients were colliged (23 males and 39 females). Mean age at the onset of SAC was 36 years (14–78 years). There were 34 patients of group (A) and 28 patients of group (B). Overall, there were 28 patients with Crohn’s disease, 31 patients with UC and 3 others with indetermined colitis. There were no differences between both of the groups with regard to sex, age at the onset of SAC, smoking status, family history of IBD, body mass index and laboratory findings including full blood count and C reactive protein. Mean Truelove–Witts score was higher in group A vs group B (4 Vs 3, p&lt;0.0001). Erythrocyte sedimentation rate was slightly higher in group A than group B (68 Vs 53, p=0.07). Overall, endoscopic signs of severity were significantly more common in patients from group A vs group B: deep colonic ulcerations (p=0.05) and diffuse mucosal abrasions (p=0.04). Patients from group B seem to respond better to steroid therapy than patients from group A (68% Vs 58%, p=0.5). There was no difference between both of the groups with regard to use of cyclosporine, colectomy, and recurrence of SAC.

Conclusion
Patients with severe acute colitis inaugurating their IBD seemed to have more severe clinical presentation than in those followed for IBD and complicated by SAC. However, response to therapy and need for colectomy are similar in both groups.