bluuebunny/crossref_metadata_2025_split huggingface dataset:
P434 Factors associated with medical and psycosocioeconomic changes in IBD during the COVID-19 pandemic and post-pandemic period
Authors: Hu S , Wang X , Shen B , Yu Q , Zheng J J , Chen Y 
Published: May 2021

Abstract

Background
The pandemic of COVID-19 had posed challenges in every aspect of the people’s life. COVID-19 had affected all age groups in both previously healthy individuals and those with chronic disease including IBD. This study aimed to investigate the occurrence and factors associated with psychosocioeconomical and medical changes in patients with IBD during the COVID-19 pandemic and post-pandemicperiod in China.

Methods
The survey questionnaires were sent to the patients with IBD in China including epicentres and outside. Bivariate analyses and logistic regression models were used to analysis associations between IBD and various demographic, disease factors, and patient-reported outcomes including working conditions, income, anxiety, stress, and sadness.

Results
Of the 2277 respondents, 144 (6.3%) respondents were from Hubei province which was the epicenter of COVID-19 in China. Multivariable regression demonstrated that patients had part-time work (odds ratio [OR]: 4.28; 95% confidence interval [CI]: 2.48-7.36; P&lt;0.001) or those had middle education level (high school graduate and bachelor’s degree) (OR:7.28; 95%CI: 3.58-14.81; P&lt;0.001) were more likely to have reduced income compared with those had full-time work or less than high school education level. In addition, female (OR: 1.41; 95%CI: 1.16-1.71; P= 0.01) patients were at higher risk of having an anxiety, stress and sadness disorder. While un-married patients (OR: 0.76; 95% CI: 0.63-0.91; P=0.003) patients were less likely to have mood changes. Moreover, IBD patients with active disease (OR: 4.79; 95% CI: 3.87-5.91; P&lt;0.001) were at higher risk of IBD medication changes.

Conclusion
The results from this large survey demonstrated that the COVID-19 pandemic affected the patients with IBD financially, psychosocially, and medically. Our findings highlighted the importance of screening for psychosocioeconomic and medical changes in patients with IBD, with particular attention to those of female sex, have part-time work, and active disease. Our IBD community needs to develop effective and feasible strategies to deal with current and future challenges such as a viral pandemic.
P446 Plasma rich in growing factors as treatment for perianal fistulas in Crohn’s disease: unicentre experience
Authors: Soto Sánchez A , Hernandez Camba A , Hernández M , Hernández G , Pérez Sánchez E , Barrera Gómez M 
Published: May 2021

Abstract

Background
Perianal Crohn’s disease (PCD) adds a significant morbidity and reduced quality of life. Complex fistulas occur in up to 20% of patients. The available treatment of PCD includes immunosuppressive drugs, antibiotics, different surgeries but are associated with high recurrence rates. A new alternative using plasma rich in growth factors (PRGF) for the treatment of complex fistulas has emerged from to achieve better healing with the minimum possible complications without affecting anal continence. This study aims to assess the feasibility, safety and efficacy of local injection of PRGF in patients with PCD.

Methods
Retrospective observational and descriptive study analyzing 6 Crohn′s Disease (CD) patients undergoing complex anal fistula sealing with PRGF from March 2019 to December 2020. All patients underwent endoanal ultrasound and 60% a pelvic magnetic resonance also. The technique consisted of locating the tract without the use of hydrogen peroxide, active curettage of the tract and closure the internal fistulous orifice (IFO) with single stitches Vicryl® 3/0. Subsequently, 50% of the PRGF-rich fraction was injected in the submucosa of the closed internal fistula orifice. The other 50% is injected in the fistulous tract. With PRGF-poor fraction a three-dimensional fibrin matrix is created and filled the previously curetted fistulous tract. We describe the results in terms of demographic variables, outcomes, surgical procedure and complications. Endpoint was fistula closure by physical examination and endoanal ultrasound.

Results
Sixty seven percent of the patients were female, mean age was 43 (26y SD). The clinical characteristics of the patients are described in table 1. All of the patients had previous abscess drainage surgery. The most frequent fistula was mid-transsphincteric type. 66.7% had seton at the time of surgery and only one patient had no medical treatment at that time. The median follow-up was 30 months. The recurrence rate was 66.7% with no differences with in age, sex, comorbidity, type of fistula, fistula location, medical treatment and whether they had a seton implanted at the time of surgery. No patient presented complications. The median follow-up was 16 months.

Conclusion
PRGF sealing appears to be feasible, safe and a promising option in the treatment of PCD. Further studies should be carried out to determine the real use of PRGF in PCD.
P450 Vaccination strategies in Inflammatory Bowel Disease patients: perspective of physicians and patients
Authors: Ferreiro Iglesias R , Hernández Camba A , Saldaña R , Rodríguez-Lago I , Zabana Y , Barreiro-de Acosta M 
Published: May 2021

Abstract

Background
Despite the existence of specific recommendations, patients with Inflammatory Bowel Disease (IBD) have shown low immunization rates. The aim of this study was to evaluate the management of vaccines in clinical practice in IBD from the perspective of physicians and patients.

Methods
An online anonymous survey was sent to 8000 patients from a national patient association (ACCU-Spain) and 1000 members of the Spanish IBD Working Group (GETECCU). Three invitations were sent between October-December 2020. Forty questions were jointly designed by ACCU and GETECCU in two different surveys for physicians and patients. Descriptive analyses were performed, comparing physician’s and patient’s responses by standard statistical analyses

Results
144 physicians and 1302 patients responded to the surveys (overall mean age of 43 years (SD 9.5). 65% of physicians managed more than 200 patients and 80% had &gt;5 years of experience. Most physicians (99%) were concerned about vaccines in IBD patients in their clinical practice, and 63% of them considered vaccines very important. Only 3.5% of physicians recommended live vaccines for their IBD patients with immunosuppressive treatments. One third of physicians did not recommend HPV vaccine. In spite of 69% of physicians recommending influenza vaccine during pregnancy, only 7.2% of pregnant patients indicated that they had received advice on influenza vaccination on their pregnancy (p&lt;0.001). Only 16.6% of physicians recommended live vaccines during the first year of life in children born to mothers exposed to biologics, and 4.4% did not recommend inactive vaccines. Moreover, patients treated with biologics considered that physicians were well trained in vaccines, compared to those treated with other drugs. Table 1 summarizes the perspective of physicians and patients.

Conclusion
Deficiencies in knowledge regarding vaccination of IBD patients can be frequent. The perspective of physicians and patients is different, with physicians perceiving more recommendations related to vaccines than patients were recommended.
P512 Safety of reduced clinical monitoring in patients with stable Inflammatory Bowel Disease on maintenance thiopurine therapy
Authors: Jansen F M , Smits L S , Thomas P W A , den Broeder N , de Jong D J , van Dop W A , Hoentjen F 
Published: May 2021

Abstract

Background
Thiopurine-treated inflammatory bowel disease (IBD) patients are monitored every 3 to 4 months with outpatient visits and laboratory assessments to evaluate disease activity and safety of therapy. However, the risk of thiopurine-related adverse events decreases after the initiation phase. The aim of this study was to assess the safety of reduced clinical monitoring in steroid-free quiescent IBD patients on stable maintenance thiopurine monotherapy.

Methods
This single-centre prospective cohort study evaluated a reduced monitoring strategy that involved 6-monthly laboratory assessment combined with alternating outpatient and phone appointments, during 104 weeks. We enrolled IBD patients who were in steroid-free remission &gt; 6 months on thiopurine monotherapy including azathioprine, 6-mercaptopurine or tioguanine. The primary outcome was thiopurine-related adverse events (AE) requiring change or discontinuation of thiopurine therapy after 104 weeks of follow-up. Secondary outcomes were assessed at week 52 and included other thiopurine-related AEs and laboratory abnormalities.

Results
We included 85 patients (42 years median age, 61.2% Crohn’s disease, 62% female) with a median disease duration of 12.5 years. At baseline, 47 patients were treated with azathioprine (55.3%), 25 with 6-mercaptopurine (29.4%) and 13 with tioguanine (15.3%) for a median duration of 6.7 years. During 104 weeks of follow-up, thiopurine therapy was ceased in two patients because of multiple infections (n=1) and gastrointestinal complaints (n=1). Other reasons for thiopurine cessation (n=37) were stable remission (n=26), patient preferences (n=9) and high 6-TGN levels (n=2). In total, 20 patients underwent thiopurine dose adjustments due to high metabolite levels (n=9), remission (n=3), disease flare (n=3), patient preferences (n=3), and low metabolite levels (n=2). At 52 weeks, 27 laboratory abnormalities were observed, yet none required therapy adjustments. In 13 patients (15.3%) myelotoxicity was detected, including mild leukopenia (n=11), mild and moderate thrombopenia (n=2). In 16.5%, hepatoxicity was observed (n=14) including mild (n=9) and moderate (n=1) elevated aspartate aminotransferase and mild elevated alkaline phosphatase (n=4).

Conclusion
A reduced monitoring strategy appeared relatively safe in a strictly selected cohort of stable thiopurine-treated IBD patients. Overall, two patients had to cease thiopurine therapy due to thiopurine-related AEs independent of monitoring frequency. No laboratory abnormalities required therapy adjustments and 57.1% of patients continued therapy throughout 104 weeks of follow-up. This strategy may contribute to safe reduction of time and health care costs for both IBD patients and physicians in daily IBD practice.
P514 Influence of the frequency of glucocorticosteroid therapy courses on the hormonal resistance in patients with ulcerative colitis
Authors: Knyazev O , Tishaeva I , Kagramanova A , Shkurko T , Veselov A 
Published: May 2021

Abstract

Background
One of the most effective anti-inflammatory agents in ulcerative colitis (UC) are glucocorticosteroids (GCS), which block the release of arachidonic acid, prevent the formation of inflammatory mediators, have an immunomodulatory effect, affect tissue fibrinolysis, which leads to a decrease in inflammation and bleeding of the mucous membrane. However, in 9–16% of patients UC, hormone resistance develops.

Objective
to establish the dependence of hormonal resistance on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS.

Methods
96 patients with moderate to severe UC (Truelove-Witts) who received several courses of GCS. Males 51 (53.1%), females 45 (46.9%). The median age was 34±4.2 years. The duration of the anamnesis was from 3 to 7 years (Me 4 years). Patients were divided into three groups depending on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS. Group 1-st (n=30) received ≤1 course of GCS for 12 months for UC exacerbation, group 2-nd (n=34)-1–2 courses of GCS, group 3-rd (n=32)-3 ≥ courses of GCS. The frequency of hormone resistance (HR) was compared in groups of patients.

Results
Among 96 patients with UC, HR was established in 12 (12.5%) patients. In group 1 of UC patients who received less than 1 course of GCS for 12 months for UC exacerbation, patients with HR were 1 (3.3%), in group 2-2 (5.9%) patients with HR, in group 3–9 (28.1%) patients with HR.
When comparing groups 1-st and 2-nd, it was found that the incidence of HR in both patients who received 1–2 courses of GCS for 12 months did not differ (OR-1.813; 95% CI 0.156 - 21.057; p&gt;0.05).
When comparing the 1-st and 3-rd groups showed that the incidence of HR in patients who received 3 or more courses of corticosteroids within 12 months is significantly higher than in patients who received ≤1 course of corticosteroids within 12 months (OR-0.088; 95% CI, 0.010–0.747; p&lt;0.05).
When comparing the 2-nd and 3-rd groups showed that the incidence of HR in patients who received more than 3 courses of corticosteroids within 12 months also has a tendency to a higher risk of development of HR than the patients receiving 2 or fewer courses of corticosteroids within 12 months (OR-0.160; 95% CI, 0.032–0.810; p&lt;0.05).

Conclusion
The frequency of courses of glucocorticosteroid therapy for exacerbation of the disease for 12 months affects the risk of developing hormone resistance in patients with ulcerative colitis.
P519 Impact of skin examination prior to initiation of biological treatment in patients with Inflammatory Bowel Disease: preliminary data
Authors: Hartl C , Novacek G , Reinisch S , Saciri A , Reinisch W , Primas C , Maier H 
Published: May 2021

Abstract

Background
Dermatological affections are common in patients with inflammatory bowel disease (IBD). We aimed to assess if skin examination prior to initiation of biologics in IBD patients would detect relevant skin diseases, such as skin malignancies, which could influence treatment as well as management.

Methods
In this ongoing cohort study we included IBD patients of the Dept. of Gastroenterology and Hepatology of the Medical University of Vienna with indication for biological treatment. Consultants of Dermatology performed a complete dermatological screening prior to initiation of therapy. We recorded all pathological findings, although the focus of this study is on certain dermatoses of high impact (melanoma, non-melanoma skin cancer, hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum and warts). Furthermore, we used a detailed questionnaire comprised of family history, medication and personal history of IBD. In cases of diagnostic uncertainties we confirmed our differential diagnosis by histopathological and further diagnostic investigations. The descriptive results are given as absolute numbers and percentages.

Results
431 patients were included, 322 patients (74.7%) with Crohn’s disease, 103 (23.9%) with ulcerative colitis and 6 (1.4%) with inflammatory bowel disease unclassified. Melanoma was diagnosed in 3 out of 431 patients (0.7%). Non-melanoma skin cancer was detected in 22 patients (5.2%). Pyoderma gangrenosum, hidradenitis suppurativa and erythema nodosum were present in 5 (1.2%), 12 (2.8%), and 3 (0.7%) patients, respectively. We found viral warts in 73 patients (16.9%). 88 patients (20.4%) received further diagnostic investigations and 302 patients (70.1%) dermatological treatment for the detected skin diseases.

Conclusion
Dermatological screening prior to initiation of treatment with biologics can identify IBD patients with skin malignancies and other high-impact skin diseases. This may influence further IBD treatment as well as management decisions. We conclude that prior dermatological screening is of high importance for safe management of IBD patients with biological therapy.
P547 Safety and efficacy of vedolizumab in the treatment of patients with moderate to severe Ulcerative Colitis: a systematic review and meta-analysis
Authors: Khorshid Fasge M , Alboraie M , Abbas W , Sayed Z E , El-Nady M 
Published: May 2021

Abstract

Background
To perform a systematic review and meta-analysis discussing the efficacy and safety of vedolizumab (VDZ) treatment in patients with active moderate to severe ulcerative colitis (UC).

Methods
Using relevant keywords, we searched PubMed, Web of Science, Scopus, and Cochrane Central databases, until June 2020. We included interventional and observational cohort studies which assessed the safety and effectiveness of VDZ 300 mg intravenous infusion, in patients with active moderate to severe UC. We used the Cochrane risk of bias assessment tool and the Newcastle-Ottawa scale to assess the quality of included interventional and cohort studies, respectively. Dichotomous outcomes were pooled as proportion, 95% Confidence interval (CI), and p-value under the random-effects model in the open meta-analyst software.

Results
We found 10 interventional studies and 35 cohort studies, including 4,794 patients eligible for our review. Most of the included citations were single-arm studies. Our meta-analysis showed that VDZ therapy could induce a significant clinical response in UC patients up to 54 weeks (proportion 0.516, 95% CI [0.453, 0.578], p &lt; 0.001). VDZ was associated with clinically significantly clinical remission and steroid-free clinical remission after 54 weeks (p &lt; 0.0001). Durable clinical remission, histological remission, and endoscopic response rates were maintained in UC patients taking VDZ at the 52nd week. There was no significant difference between VDZ and placebo regarding the incidence of drug-related serious adverse events (p = 0.113) and death rates (p = 0.085).

Conclusion
Our systematic review and meta-analysis showed that the use of VDZ in patients with active moderate to severe UC was associated with high percentages of clinical response and remission rates in induction and maintenance treatment stages. VDZ seems to be well tolerated in UC patients, apart from some infections and inflammations. Future RCTs should compare VDZ to active treatments for longer follow-up periods with larger sample size.
P572 The influence of beliefs about medication in therapeutic adherence among patients with inflammatory bowel disease
Authors: De Castro Parga M L , Alvarez-Smith C , Sanroman L , Figueira M , Hernández V , Pineda J , Martinez-Cadilla J , Pereira S , Rodriguez-Prada I 
Published: May 2021

Abstract

Background
Medication nonadherence in inflammatory bowel disease (IBD) is common and has a negative impact on disease outcome. It is currently not clear whether in patients with IBD, the opinions, beliefs and attitudes towards medicines determine an adequate therapeutic adherence. Our aim was to assess what the real influence of medication opinions is on IBD patients adherence.

Methods
Patients attending a tertiary hospital IBD outpatient clinic were enrolled. They filled the BMQ (Beliefs about Medication Questionnaire): a 18-item standardized scale assessing specific opinions about medication that a person is taking and beliefs about the potential for harm and overuse of medication in general. Pharmacy refill data were checked for the previous 3 months and their medication possession ratios (MPR) were calculated. Nonadherence was defined as MPR&lt;0.8.Ethical approval was obtained.

Results
We analyzed 193 IBD patients: 96 women and 97 men with average age 46.1 years. Ulcerative colitis 109 (56.6%) and 84 Crohn′s disease (43.5%). Oral mesalazine was used for IBD control in 48%, immunosuppressnat in 43.5% and targeted therapies, 28.5%. MPR detected non-adherence in 57 patients (29.5%). Patients with CD had a higher adherence than those with UC (78.6 vs 64.2% p=0.03). Non-adherence was higher in patients with mesalazine 41.3% (p=0.001) and lower with targeted therapies 15% (p=0.007). BMQ classified our IBD patients in 60% “ambivalent”, 36% “accepting”, 7% “indifferent” with no “sceptical”: Females had a higher puntuation in BMQ harm about medication scale (p= 0.006). Surgical patients scored higher about the necessity of their IBD medication (0.005) and patients with a low educational level showed many concerns about IBD medication (0.002). Nevertheless there were neither significant differences in BMQ general (abuse/harm) or specific (need/concern) scores nor in attitude profiles between patients with adequate adherence and non-adherent patients.

Conclusion
Non-adherence behaviour in IBD patients was not associated with beliefs about medication. Ulcerative colitis and oral mesalazine were related to lower adherence, meanwhile patients on directed therapies showed high adherence,
P579 Online Education Significantly Improved Gastroenterologists’ Knowledge of Treatment Options and Therapeutic Goals in Ulcerative Colitis
Authors: Bell E , Calle M , Vermeire S 
Published: May 2021

Abstract

Background
With the rapid evolution in treatment strategies and the increasing range of available therapeutics for ulcerative colitis (UC), keeping pace with advances can be a challenge for busy physicians.
We assessed whether online CME can improve gastroenterologists’ knowledge of therapeutic goals and treatment options in UC.

Methods
Gastroenterologists participated in an online CME activity entitled ‘Management of UC: Expert Insights on Current and Emerging Therapies’. This was a 30-minute video roundtable discussion with accompanying slides. Educational effect was assessed using a repeated-pair design, pre-/post-assessment. A Chi-square test of independence determined if a statistically significant improvement (5% significance level, P&lt;.05) existed in the number of correct responses between the pre-test and post-test scores. Cramer’s V estimated the effect size of the education (&lt;.06, modest impact; .06-.15, noticeable impact; .16-.26, considerable impact; &gt;.26, extensive impact). The activity launched on 21 November 2019 with data collection through 4 February 2020.

Results
• Significant improvement in average percentage of correct responses, rising from 67% at baseline to 77% post-activity (P&lt;.001) and noticeable educational impact (Cramer’s V=0.113)
• The percentage of gastroenterologists (n=232) answering all 3 questions correctly rose from 32% at baseline to 55% post-activity
• Significant improvements in knowledge of the minimum therapeutic goal for a patient with moderate-to-severe UC (P&lt;.01) and the VTE risk associated with treatments for UC (P&lt;.01)
• Numerical improvement in knowledge of clinical data from the UNIFI trial for ustekinumab in moderate-to-severe UC
• Almost half (44%) of gastroenterologists indicated improved confidence in their ability to describe clinical data for emerging biologic agents in UC

Conclusion
Online education, delivered as a 30-minute video roundtable discussion among experts, significantly improved gastroenterologists’ knowledge of therapeutic goals and treatment options in UC, which should equip them with the knowledge to make more informed choices for their patients. The success of this online activity, particularly with regard to the impressive improvement in confidence, suggests that gastroenterologists would benefit from further education to reinforce not just their knowledge of clinical data for novel agents but also their confidence in using these new agents to manage patients with UC.