bluuebunny/crossref_metadata_2025_split huggingface dataset:
P100 Higher yield of serrated and adenomatous dysplasia detected with chromoendoscopy when compared with high-definition in patients with Primary Sclerosing Cholangitis and Inflammatory colitis
Authors: Gupta V , Hartery K , Bassett P , Culver E , East J 
Published: May 2021

Abstract

Background
There is an increased risk of colorectal dysplasia/cancer in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD); cumulative risk of 14% at 5 years and 17% at 10 years. SCENIC (2015) consensus guidelines recommend surveillance with chromoendoscopy (CE) and use of a high definition (HD) scope with white light colonoscopy. We aimed to assess the value of CE and HD scope in detection of dysplasia in PSC-IBD.

Methods
We analysed all colonoscopic surveillance performed for PSC-IBD between 2010–2020 at Oxford University Hospitals (n=422 procedures). Continuous variables were assessed by Kruskal-Wallis (three groups) and categorical variables by Chi-square test. Repeat measurements were accounted for by multilevel regression models with individual colonoscopies nested within patients. Multilevel ordinal logistic regression was used for assessment of bowel prep. Outcomes were adjusted for confounding variables (adj).

Results
359 colonoscopies were analysed in 91 patients with PSC-IBD (69/422 were excluded as prior dysplasia detected). CE and HD scope use increased in frequency over the 10-year period (p=0.02). HD were rarely used in those with bowel preparation deemed inadequate (p&lt;0.001), but there was no association between CE and bowel prep quality. Dysplasia detection (adenomatous and serrated lesions) was higher with CE compared with white light examination; 14% vs 3% (p&lt;0.001), and after adjusting for confounders (p&lt;0.009) and use of HD scope (p&lt;0.01), OR 5.02 (CI 1.43–17.7). Dysplasia detection was higher with HD compared with standard definition (SD); 14% vs 6% (p&lt;0.04), but was non-significant after adjusting for confounders, OR 1.93 (CI 0.69–5.4). Dysplasia was more likely to be found on targeted than random colonic biopsies (p&lt;0.001).
CE increased detection of serrated lesions (9% vs 2% (p=0.06) OR 3.5 adj) and more so adenomatous dysplasia (6% vs 1% (p=0.03) OR 12 adj) compared to white light. HD increased detection of serrated lesions (9% vs 3.5% (p=0.04) OR 2 adj) but not adenomatous dysplasia (6% vs 2.5% (p=0.19) compared to SD. (Table 1)

Conclusion
CE is superior to HD and SD white light examination for dysplasia detection in PSC-IBD after accounting for confounders and performed better for adenomatous than serrated lesions.
P132 Uncovering blood biomarkers of Inflammatory Bowel Diseases by Raman spectroscopy and FAP dosage: toward a noninvasive triage of patients in first care diagnostic
Authors: Truffi M , Morasso C , Albasini S , Malovini A , Bellazzi R , Piccotti F , Caldarone A , Sorrentino L , Mazzucchelli S , Sampietro G , Colombo F , Ardizzone S , Corsi F 
Published: May 2021

Abstract

Background
Currently, a major point of concern in the management of Inflammatory Bowel Diseases (IBD) is the absence of accurate and specific circulating biomarkers able to drive diagnosis in a timely and noninvasive manner. Aim of the present study was to explore blood biomarkers of IBD by coupling the targeted detection of circulating fibroblast activation protein (FAP), a recognized valuable marker of bowel lesion in IBD, and Raman spectroscopy (RS), a quick and label-free metabolomic technique that provides a real-time biochemical characterization of plasma samples without any previously known target.

Methods
Blood samples were collected from over 140 patients with IBD and 170 control subjects matched for gender and age. Isolated plasma was analysed by enzyme-linked immunosorbent assay for quantitative detection of circulating form of FAP. RS was performed on dry droplets of plasma, with the aim to decipher specific fingerprint of IBD in peripheral blood. A predictive model was built on FAP and Raman data separately, to determine specificity, sensitivity and accuracy of the two approaches in patients classification. Supervised multivariate model was applied on a subset of 203 patients to discriminate IBD and control subjects based on combined datasets.

Results
FAP levels were reduced in patients with IBD as compared to controls (p&lt;0.0001). The sensitivity and specificity of FAP were 70% and 84% based on the optimal cutoff (57.6 ng mL-1, AUC=0.78). Raman spectra of IBD plasma revealed significant differences in peaks corresponding to carotenoids, proteins with β-sheet secondary structure, lipids and aromatic amino-acids. A machine learning model was applied on a subset of patients reaching an accuracy of 85% in classifying IBD and control subjects. No statistically significant differences were observed so far between the discriminative performance of the sole RS or the combination of RS and FAP.

Conclusion
RS and FAP dosage enable new discoveries in the biological fingerprint of IBD plasma and provide novel candidate biomarkers of IBD. Our preliminary results strongly suggest that novel blood-based approaches could represent a fast noninvasive way to triage patents with suspected IBD in first care diagnostic, to be applied prior to further specific evaluation.
P173 Subfertility in young women and men patients with Crohn′s disease
Authors: Rodríguez A , Herreros B , Muñoz R , Sempere L , Sirera P , González-Bueno V , Torregrosa M E , Alfayate R , Orts B , Zapater P , Tejedo D , Moreno-Pérez O , Gutiérrez A 
Published: May 2021

Abstract

Background
Crohn’s disease (CD) affects young adults on reproductive age. They are likely to desire pregnancy and are often concerned about the potential effects of inflammatory bowel disease on fertility. Aims to investigate the effect of CD in fertility, studying the ovarian reserve in women by serum anti-Müllerian hormone (AMH) and Sertoli cell function in men measured by serum Inhibine (IB).

Methods
Cross-sectional, prospective, case-control study, including CD patients, aged 18–40 yr, and healthy controls(HC) matched by gender and age(ratio 2:1). Morning IB was measured using ELISA. Serum AMH was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected. We defined impaired fertility potential as IB level &lt; 89 pg/mL and AMH &lt;1.66 ug/L 0–24 yr, &lt;1. 18 ug/L 25–29 yr, &lt;0.67 ug/L 30–34 yr, &lt;0.77 ug/L 35–39 yr, &lt;0.01 ug/L 40–44 yr. AMH &lt; 2 ug/L under 40 yr was considered low.

Results
A total of 122 subjects were included:73 men(48 CD, 25 HC) and 49 women(21 CD, 28 HC). No statistical difference was found between mean serum AMH levels in CD and HC women(2,23±1,8 vs 2,86±1,9 ug/L, p=0,5). The rate of abnormal serum AMH levels according to age did not differ between groups (19% CD vs 25% HC, p=0,4). When classified according to age(&lt;30 and &gt;30 yr), the serum AMH levels remained comparable in &lt;30 yr (3.3±2.06 CD vs 3,2±1.96 ug/L HC, P=0.9). However, a low AMH level(&lt;2 ug/L) was measured in 13 CD women(61%) and in 9 HC(32%)(P &lt; 0.03), especially in&gt;30 yr, 9 CD(90%)vs 4 in HC(40%)(p=0.02). Serum IB levels were significantly lower in CD men vs HC (175.4 ±62.3 vs 234.12±75.56 ug/L, p=0.002). We did not find abnormal IB(&lt;89 pg/mL) in HC vs 3(6%) among CD men.

Conclusion
Women with CD did not have severe ovarian reserve alterations compared to a control population. However higher proportion of CD women showed low AMH (&lt; 2 ug/L), especially those &gt; 30 years. These data could be helpful for female CD patients who want to have children. Inhibine levels, as biomarker of Sertoli cell function, were lower in CD men compared to healthy controls.
P174 Defining Crohn’s Disease Strictures Using Intestinal Ultrasound Compared to Histopathology
Authors: Cooper J , Danois K , Koro K , Wilson S , Medellin A , Ma C , Novak K , Seow C , Kaplan G , Panaccione R , Lu C 
Published: May 2021

Abstract

Background
Fibrostenotic Crohn’s Disease (CD) is a challenging phenotype often requiring surgical resection. MRE (magnetic resonance enterography) is commonly used to diagnose CD strictures, but is limited by access, cost, and long acquisition time. The CONSTRICT consensus criteria for defining CD strictures is based only on MRE or CT (computed tomography) and includes: increased bowel wall thickness (BWT), narrowed luminal apposition, and pre-stenotic dilation &gt; 3cm. This definition has not been studied using intestinal US (IUS). IUS is a cost-effective, easily repeatable, and well-tolerated tool with similar sensitivity and specificity to MRE in diagnosing and monitoring CD. In patients with a confirmed CD stricture on ileal resection (gold standard for diagnosis), we aim to assess the applicability of CONSTRICT criteria in diagnosing strictures with IUS.

Methods
In this pilot study, thirty CD patients who underwent small bowel resection from 2015–2019 with IUS (fasting, no oral contrast) within 6 months prior to surgery (excluding fistulizing disease) were randomly identified for chart review Stricture was confirmed on resected ileum as microscopic presence of fibrosis, muscle hypertrophy, inflammation, and macroscopic localized luminal narrowing with decreased circumference on pathology. Student’s t-tests, sensitivities and specificities were calculated for IUS in detecting strictures.

Results
20 out of 30 patients had fibrostenosis on pathology and IUS. Only 40% (8/20) met CONSTRICT criteria for stricture diagnosis on IUS, despite having a stricture on pathology. All patients had elevated BWT and luminal narrowing, but 60% (12/20) of patients did not have prestenotic dilation &gt; 3cm. Mean dilation was 2.9 cm (SD 1.38) and was significantly different from the mean stricture diameter of 1.3cm (SD 0.59 cm, p=0.0001, 95% CI: 0.9–2.2). Mean BWT was 8.7 mm (SD: 2.5, range 5–15), and mean luminal apposition was 2.3 mm (SD 1.2, range 0.2–5.8mm). IUS has a sensitivity of 95.2% (CI: 76.2 - 99.9%) and specificity of 66.7% (29.9 - 92.5%) in detecting strictures, when compared to the gold standard.

Conclusion
Diagnosis of fibrostenotic CD with CONSTRICT criteria using CT/MR may not be applicable to IUS. Only 40% of patients met criteria despite histologic-confirmed strictures. Unlike MR/CTE, IUS is not routinely performed with oral contrast, and as a result prestenotic dilation may be underestimated. Thus, perhaps additional criteria of stricture diameter &lt; 50% of prestenotic dilation size is more appropriate for IUS. This pilot study provides the initial data to further delineate the definition of strictures on IUS for future validation and will inform both clinical practice and trial design.
P205 Influencing factors of Sleep quality in patients with Crohn’s Disease
Authors: Sabbah M , Jlassi H , Bellil N , Trad D , Ouakaa A , Bibani N , Gargouri D 
Published: May 2021

Abstract

Background
Sleep is considered vital for the health and quality of life of individuals. Recently, studies have suggested that sleep disturbances are common in people with Crohn’s disease (CD) and in the majority of cases are related to disease activity.The aim of our study was to determine the prevalence of insomnia in patients with CD and to identify the influencing factors.

Methods
A prospective cross-sectional study including patients with CD followed in the department between July and August 2020 was carried out. Epidemiological and clinical data have been collected. Self-report questionnaires were given to patients. Insomnia was assessed using the Insomnia Severity Index (ISI) which provides a valid index of the overall severity of insomnia. A score between 0 and 7 indicates the absence of insomnia; between 8 and 14 a mild infra-clinical insomnia; between 15 and 21 moderate clinical insomnia, and between 22 and 28 severe insomnia. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) questionnaire which is a scale of 14 items rated from 0 to 3. Seven questions are related to anxiety and seven to depression. Fatigue was screened for using the Fatigue Severity Scale (FSS) which has 9 questions rated from one to seven. Significant fatigue was defined by a score greater than or equal to 5.5. Statistical analysis was performed by SPSS 21 software (p significant if less than 0.05).

Results
Thirty two patients with a mean age of 38.28 years [18–60 years] and a sex ratio equal to 1 were enrolled. Mean duration of the disease was 10.56 years [1–40 years]. At the time of inclusion, the average Harvey Bradshaw (HAB) score was 5.14 [1–14].
Mean insomnia score was 12.62 [0–26]. The insomnia severity index showed mild insomnia in 4 patients (12.5%), moderate insomnia in 7 patients (22%) and severe insomnia in 8 patients (25%).
The HADS score revealed obvious depression in 19% of patients, doubtful depression in 25% of patients. 56% of patients had no symptoms of depression. Likewise, anxiety was objectified in 22% of patients and doubtful anxiety in 37% of patients. 41% of patients had no symptoms of anxiety. The mean fatigue score was 3.75 ± 1.9 [range 1–9]. A fatigue score greater than or equal to 5.5 was observed in 3 cases (9%).
A significant positive correlation was found between the insomnia severity score and the depression score (r = 0.4, p = 0.035) as well as the fatigue severity score (r: 0.36, p = 0.04).

Conclusion
Our study shows that insomnia is very common in patients with CD. The factors associated with these sleep disturbances were depression and fatigue. Gastroenterologist and psychologist should join forces to evaluate emotional as well as sleep disturbances for a better global CD management.
P207 Clinical outcome of patients with Ulcerative colitis after anti-TNF discontinuation -\t10 years follow up
Authors: Johnsen K M , Mona D G , Florholmen J , Goll R 
Published: May 2021

Abstract

Background
Biological therapy for ulcerative colitis (UC) such as anti-TNF have shown high efficacy in achieving remission. There is a lack of information about the long-term outcomes after biologic withdrawal and validated clinical, immunologic, genetic or laboratory markers that can predict outcome after withdrawal accurately. The aims of this study were to describe the long-term outcomes after anti-TNF withdrawal and discover potential biomarkers to predict long-term remission as an approach to towards personalized medicine.

Methods
75 patients with moderate to severe UC treated to remission with anti-TNF were included in the study. These patients were categorized as either “Long term remission” (LTR) or “Relapse”. The “Relapse” group were divided in subgroups by the highest treatment level needed to obtain remission the last 3 years of observation: non-biological therapy, biological therapy or colectomy. LTR were divided in LTR + immunomodulating (imids) drugs and a new clinical phenotype “Near the Cure of disease” (NCD), defined as &gt; 3 years in remission with no medication or 5ASA only.

Results
The median (IQR) observation time of all patients included were 121(111–137) months. Of the 75 patients 46 (61%) did not receive biological therapy including 23 (31%) in LTR + imids. Of the 23 patients 16 were defined as NCD with an observation time of median (IQR) 95(77–113) months. Fourteen patients underwent colectomy and 15 patients received biological therapy the last 3 years of the follow-up. Mucosal TNF copies/µg mRNA &lt; 10 000 at anti-TNF discontinuation predicted long-term remission, biological free remission and lower risk of colectomy with a HR 0.36 (0.14–0.92) for long term remission, HR 0.17 (0.04–0.78) for biological free remission and HR 0.12 (0.01–0.91) for coelctomy.

Conclusion
This 10-year anti-TNF discontinuation follow up study of UC shows that 61% of patients experience an altered phenotype to a milder disease course without need of biological therapy. Normalized mucosal TNF transcript predict this mild disease course and lower risk of colectomy. Of special interest is that 21% of the patients defined as “Near the cure of disease” were in long-term remission without any medication or receiving 5ASA only.
P221 Crohn’s disease patients unable to complete preoperative mechanical bowel preparation have increased risk of anastomotic complications: results of a prospective observational study
Authors: Kunovsky L , Marek F , Kala Z , Ivanecka D , Iesalnieks I 
Published: May 2021

Abstract

Background
To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centers in Germany and the Czech Republic.

Methods
Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole/Paramomycin or Metronidazole/Neomycine. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was the occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intra-abdominal septic complications (IASC) which were defined as anastomotic leak, intra-abdominal abscess, fistula or peritonitis.

Results
Between 6/2016 and 3/2021, 157 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Forty (26%) developed complications from the MBP, mostly vomiting; twenty-nine patients (18.5%) were not able to complete the MBP. Female sex (HR 4.2, p=0.016) was associated with an increased probability of not being able to complete the MBP. Postoperative anastomotic leak occurred in 5 patients (3%). In a multivariate analysis, the risk of anastomotic leak was significantly higher in patients unable to complete the MBP (10.5%), as compared to patients with complete MBP (1.6%, p=0.01, HR 21.0). Postoperative IASC occurred in 7 patients (7%). Patients unable to complete preoperative MBP were at higher risk of developing IASC. However, the difference was not statistically significant (14% vs. 5%, p=0.12).

Conclusion
The anastomotic leak rate was low when preoperative MBP and oral antibiotics were used. However, patients not able to complete MBP might be at an increased risk.
P231 Work productivity loss in perianal crohn’s disease
Authors: Jlassi H , Sabbah M , Bellil N , Trad D , Ouakaa A , Bibani N , Gargouri D 
Published: May 2021

Abstract

Background
Few data exist on the socio-professional impact in patients with perianal Crohn’s disease, probably because the patient-doctor relationship is mainly focused on obtaining clinical, biological and endoscopic remission of the Crohn’s disease (CD).
Our study aimed to evaluate the impacts of perianal Crohn’s disease on work productivity.

Methods
A prospective cross-sectional study including patients with CD followed in the Gastroenterology department between July and August 2020 was performed. Professional impact was assessed using Work Productivity and Activity Impairment questionnaire (WPAI) which is composed of 6 questions evaluating during the last seven days preceding the interview with the patient, the absenteeism, the presenteeism, the total decrease in productivity and the decrease in daily activities for health reasons. The results are multiplied by 100, expressed as a percentage of time lost. A higher percentage indicates greater depreciation and less productivity. Professional impact was compared in patients with perianal Crohn’s disease and controls without perianal symptoms.

Results
Thirty two patients were included. The mean age was 38.28 years [18–60] and the sex ratio was 1. Perianal manifestations were observed in 15 patients (44% of cases). Thirteen patients (41%) were in paid employment at the time of inclusion. CD was responsible for an average absenteeism of 30% ± 10.4% [0–80%] of the working time during the last seven days. An average percentage of work impairment defining the presenteeism was noted to be 52% ± 28% [0–80%] of working time. The overall average decline in productivity was estimated at 56% ± 22% [0–97%]. CD was responsible for an average restriction of 45% ± 33% [0–100%] of usual daily activities.
By comparing the professional impact according to the presence or not of anoperineal lesions (APL), an association between the mean rate of activity restriction and the presence of APL (p = 0.04) was objectified. However, no significant association was noted in the other dimensions of the WPAI questionnaire.

Conclusion
According to our study, it appears that Crohn’s disease is a source of reduced work productivity especially in case of perianal manifestation. These results should be confirmed by larger studies.
P255 Efficacy and safety of a restrictive ferric carboxymaltose infusion strategy for iron deficiency anemia in inflammatory bowel disease patients
Authors: Crispino F , Grova M , Maida M , Renna S , Casà A , Rizzo G , Macaluso F S , Orlando A 
Published: May 2021

Abstract

Background
Iron deficiency anemia (IDA) is a common condition in patients with inflammatory bowel disease (IBD) and ferric carboxymaltose (FCM) has shown fast correction of hemoglobin (Hb) levels and good tolerability. We evaluated the response to FCM in IBD patients with IDA. The primary outcome was the assessment of the rate of response to single or multiple FCM infusions after 12 months from the first infusion. Secondary outcomes were the response to a single FCM infusion after 3 months and the assessment of FCM safety.

Methods
We retrospectively included 185 consecutive patients from IBD Unit of “Villa Sofia-V. Cervello” Hospital who received at least a dose of 500 mg FCM infusion between 2015 and 2018. Complete response (CR) was defined as Hb ≥13 g/dL (men) or ≥12 g/dL (women) or Hb increase ≥2 g/dL; partial response (PR) was defined as Hb increase ≥1 and &lt;2 g/dl, without anemia correction; response was considered either CR or PR. Failure was defined as Hb increase &lt;1 g/dl. A univariate analysis was performed among complete responders, partial responders and failures at 3 and 12 months.

Results
After 12 months the mean number of FCM infusions was 1.7 ± 1.1 and the rate of response was 139/185 (75.1%; CR: 48.6%; PR: 26.4%). Concerning our secondary endpoint, 169/185 patients received a single infusion of FCM within 3 months, and 134/169 patients (79.2%) achieved response (CR: 56.8%; PR: 22.4%). At univariate analysis low ferritin was the only variable associated with failure at 12 months (p &lt; 0.003). No adverse events were reported.

Conclusion
A restrictive FCM infusion strategy is effective in most IBD patients with IDA. Interestingly, no association was found with Hb and weight at baseline, so further studies are needed to assess their effective role in deciding dosage of FCM.