bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOP17 In high-risk Crohn’s Disease patients, anastomosis configuration types have similar rates of endoscopic recurrence
Authors: Bachour S , Shah R , Lyu R , Rieder F , Cohen B , Qazi T , Lashner B , Lipman J , Regueiro M , Lightner A , Holubar S , Click B 
Published: May 2021

Abstract

Background
There is conflicting data on the influence of surgical anastomosis configuration on endoscopic postoperative recurrence (POR) of Crohn’s disease (CD) following ileocolonic resection (ICR). Furthermore, whether this relationship differs by preoperative risk factors for POR has not been studied. We aimed to assess the role of ileocolonic anastomosis type on the rate and time to POR by preoperative POR risk.

Methods
Retrospective cohort study of adult CD patients who underwent ICR between 2009–2020 at a quaternary IBD referral center. Patients with a primary or secondary anastomosis and ≥1 postoperative colonoscopy were included. Endoscopic activity was assessed by modified Rutgeerts’ scoring. POR was defined as Rutgeerts’ ≥ i2b. Patients were categorized by anastomosis type: end-to-end (ETE), end-to-side (ETS), or side-to-side (STS). High-risk CD patients were defined by ≥1: age ≤ 30 years, active smoker, or ≥2 ICR for penetrating disease.

Results
548 CD patients (52.6% female, age 35 y, 15.5% &gt; 1 prior ICR, 19.7% on biologic prophylaxis, 74.8% high-risk for POR) were included in the study (Figure 1). The majority received a STS (52.0%, N=285), 27.2% ETS, and 20.8% ETE. Patients with an ETE were diagnosed with CD at a younger age (p=0.04), had more penetrating disease (p=0.01), hand-sewn anastomoses (p &lt;0.001), and diverting loop ileostomies (p=0.02). There were no differences in prior ICR, smoking, biologic prophylaxis, or in median time from ICR to first post-operative colonoscopy (388.5 days, p=0.41) or POR detection (905 days, p=0.8) by anastomosis type. ETS patients had a shorter median follow-up time (3.9 y, p=0.02). The majority (55.7%) of all patients experienced POR (57% ETS; 55.4% STS; 54.4% ETE). Overall, there was no significant association between anastomosis type and POR rate (p=0.91) or time to POR (p=0.32). However, in high-risk CD patients, ETS was significantly associated with more rapid time to POR on log-rank (p=0.03) and multivariable Cox modeling (HR=1.51; p=0.04). Postoperative prophylactic biologic therapy initiated within 3 months of ICR significantly delayed POR in the overall cohort (HR=0.64; p=0.012) and the high-risk CD subgroup (HR=0.67; p=0.047). High-risk CD patients on prophylactic biologics had no difference in time to POR by anastomosis type (p=0.66).

Conclusion
In post-operative CD patients, there is no difference in rates of endoscopic recurrence by anastomosis configuration regardless of risk stratification. In high-risk patients, ETS was associated with more rapid endoscopic recurrence compared to other configurations, however prophylactic postoperative biologics may protect against this effect.

Figure 2: KM Survival analysis of time (days) to POR
DOP20 Genetic of vitamin D as predictor of response to adalimumab in Crohn’s Disease
Authors: Cusato J , Ribaldone D G , Bertani L , Antonucci M , Tomasello C , Caviglia G P , Dibetto S , Mangia M , Astegiano M , D’Avolio A 
Published: May 2021

Abstract

Background
Personalised medicine is the direction towards are converging many efforts of experts in inflammatory bowel diseases (IBDs). The advent of biological drugs, with anti-TNF as first category, have revolutionized the managements of these patients. Unfortunately, several unmet needs are present, like an efficacy in about two third of the patients, onset of side effects like infections, paradoxical IMIDs. Being able to treat with these drugs only patients who will respond would avoid losing time without disease improvement and possible side effects.
Vitamin D is important for several biological functions, such as regulation of the immune response and modulation of expression of genes encoding enzymes and transporters involved in drug metabolism and transport. Vitamin D is activated by cytochrome (CYP) 27B1, inactivated by CYP24A1, transported in kidney by Vitamin D binding protein (VDBP, encoded by GC gene) and carries out its activities through its receptor (VDR).
No data are available concerning vitamin D genetics and response to anti-TNF drug adalimumab.
The aim of this study was to describe the relationship between vitamin D pathway-related gene single nucleotide polymorphisms (SNPs) and adalimumab clinical outcome in a cohort of patients affected by Crohn’s disease.

Methods
We performed a multi-centre prospective study including patients affected by Crohn’s disease who started adalimumab therapy. SNPs in CYP27B1, CYP24A1, GC and VDR genes were analysed. Clinical outcome was considered as clinical response and remission at 3 months of therapy.

Results
We enrolled 69 patients. Median age was 40 (IQR 31–56) years, males were 40 (58%). Median basal calprotectin was 396 (IQR 188–851) mg/Kg, and 36 (53.7%) had a positive PCR value.
We documented the following associations: CYP27B1 + 2838 CT/TT with perianal disease (p= 0.002), basal calprotectin (p= 0.018) and T3 calprotectin (p= 0.035), figure 1; CYP27B1-1260 GT/TT with perianal disease (p= 0.006), basal calprotectin (p= 0.036) and T3 calprotectin (p= 0.024); VDR ApaI CA/AA with basal calprotectin (p= 0.014) and T3 calprotectin (p= 0.036); VDR BsmI GA/AA with perianal disease (p= 0.036), and GC 1296 TG/GG with basal calprotectin (p= 0.014), figure 2.
GC 1296 TG/GG genotype polymorphism (p= 0.044, figure 3) predicted clinical remission at multivariate analysis.
Finally, median concentrations adalimumab trough levels at 3 months were 7.4 (IQR 5.5; 11.7) ug/mL. CYP24A1 3999 (p=0.025) and VDR TaqI (p=0.016) SNPs affected these levels.

Conclusion
This is the first study reporting the association between vitamin D pathway-related genetics and adalimumab treatment in a cohort of patients affected by IBD. Further studies in different and larger cohorts are needed to clarify these aspects.
DOP41 Temporal Trends in the epidemiology of Inflammatory Bowel Diseases in the public healthcare system in Brazil: A large population-based study
Authors: Quaresma A B , Damiao A O M C , Coy C S R , Magro D O , Valverde D A , Panaccione R , Coward S B , Ng S C , Kaplan G G , Kotze P G 
Published: May 2021

Abstract

Background
Background: Population-based data on incidence and prevalence of Inflammatory Bowel Diseases (IBD) in newly industrialized countries such as Brazil are scarce. This study aims to define temporal trends of estimated incidence and prevalence rates of Crohn’s disease (CD) and ulcerative colitis (UC) in Brazil using unique public healthcare datasets.

Methods
Methods: All IBD patients (UC and CD) from the unique public healthcare national system (DATASUS) were included from January 2012 to December 2020 and identified according to ICD codes, medication use or IBD-relates procedures. Data extraction was performed with the platform “TT Disease Explorer” (Techtrials Healthcare Data Science, Brazil) and checked by 2 independent reviewers. The platform collects publicly available data from the ministry of health via electronic algorithms (ETLs and Webcrawlers) with automatic updates. The population of Brazil was calculated according to the national Brazilian Geographics and Statistics Institute (IBGE). Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using poisson (or negative binomial) regression for incidence and log binomial regression for prevalence.

Results
Results: A total of 212,026 IBD patients (UC: n=140,705; CD: n=92,326) were included, There was a higher proportion of females as opposed to males, and age at health system entry was similar to developed countries (figure 1). Estimated incidence rates of IBD were 9.41 per 100,000 in 2012 and 9.57 per 100,000 in 2020 (AAPC=0.80%; CI -0.37–1.99; p=0.18); for UC, incidence increased from 5.69 per 100,000 to 6.89 per 100,000 (AAPC=3.04; CI 1.51–4.58; p&lt;0.001) and for CD incidence dropped from 3.71 per 100,000 to 2.68 per 100,000 (AAPC=-3.24%; CI -4.45- -2.02; p&lt;0.001) in the same time period (figure 2). Estimated prevalence rates of IBD increased significantly from 30.01 per 100,000 in 2012 to 100.13 per 100,000 in 2020 (AAPC=14.87%; CI 14.78–14.95; p&lt;0.001); For UC, from 17.4 per 100,000 to 66.45 per 100,000 (AAPC=16.51%; CI 16.41–16.62; p&lt;0.001) and for CD from 14.24 per 100,000 to 43.6 per 100,000 (AAPC=13.49%; CI13.37-13.61; p&lt;0.001) in the same time period (figure 3).

Conclusion
Conclusions: Estimated incidence rates of IBD have remained stable from 2012–2020. Incidence of CD is significantly decreasing whereas of UC is significantly increasing. There was a significant increase in estimated prevalence rates of CD and UC. This massive rise in prevalence can support planning for future strategies for public healthcare providers in our country towards better IBD care. This is the largest IBD epidemiological study from newly industrialized countries to date.
DOP66 The effect of exclusive enteral nutrition on circulating inflammatory protein levels in paediatric patients with Crohn’s Disease
Authors: Pidoux M , Logan M , Milling S , Ijaz U Z , Hansen R , Russell R K , Gerasimidis K 
Published: May 2021

Abstract

Background
Exclusive enteral nutrition (EEN) is the recommended first line treatment for active paediatric Crohn’s disease (CD). The mechanism of action and immunological effects of EEN remain unclear. This study compared circulating inflammatory proteins of patients with CD and ulcerative colitis (UC) with non-inflammatory bowel disease (non-IBD) controls and explored the effect of EEN in children with active CD.

Methods
Patients with CD were treated with EEN for 8 weeks, with plasma samples collected prior to EEN start and upon EEN completion. Levels of 92 inflammatory proteins were quantified using Olink Inflammation panel. Paired faecal samples were collected to measure faecal calprotectin (FC) levels by ELISA. Patients in which FC decreased &gt;50% during EEN were classed as FC responders; whereas patients who had a &lt;50% decrease in FC were classed as FC non-responders.

Results
84 patients were recruited (CD:54, UC:11, non-IBD:19). Paired plasma samples were collected from 18 patients with CD receiving EEN. Of these 18 patients, 72% achieved clinical remission by the end of EEN (wPCDAI &lt;12.5 points).
Prior to EEN start, 29 proteins were significantly different between patients with CD compared to non-IBD; and 25 proteins were significantly different between UC and non-IBD, Fig 1. EEN lead to the significant alteration of 23 proteins. This included 5 proteins, CCL23, CXCL10, IL6, IL24, and MMP-1 which were higher in patients with CD prior to EEN start compared to non-IBD, Fig 2.
In patients who achieved clinical remission during EEN, 22 proteins significantly changed from their EEN start levels by the end of EEN, Fig 3. FC responders had a similar pattern of protein changes, in which 22 proteins changed significantly during EEN, Fig 4. 16/22 (72%) of the proteins that changed significantly in the FC responder group during EEN, also changed during EEN in patients who entered clinical remission including significant reductions in several innate immune proteins such as IL-6 and IL-18.
Patients who did not achieve clinical remission did not have significant reductions in these proteins. Despite being higher in patients with CD prior to treatment compared to non-IBD, the level of 17 proteins, including IL17a and oncostatin M, did not change in FC responders during EEN.

Conclusion
EEN leads to alteration of multiple inflammatory proteins, in keeping with a reduction in innate immune pro-inflammatory activity and improvement in clinical response, although some inflammatory proteins remain elevated.

Figure 1: Venn diagram of proteins significantly different

Figure 2: Effect of EEN on protein levels

Figure 3: Effect of EEN on protein levels, stratified based on clinical response during EEN

Figure 4: Effect of EEN on protein levels, stratified based on FC response
DOP67 Comparison of the pharmacokinetics of CT-P13 between Crohn’s Disease and Ulcerative Colitis in biologic-naïve patients; a prospective multi-center observational study of the KASID
Authors: Kim E S , Park D I , Kim H J , Lee Y J , Koo J S , Kim E S , Yoon H , Lee J H , Kim J W , Shin S J , Kim H W , Kim H S , Park Y S , Kim Y S , Kim T O , Lee J , Choi C H , Han D S , Chun J , Kim H S 
Published: May 2021

Abstract

Background
We aimed to compare trough infliximab levels and the development of anti-drug antibody (ADA) for 1 year between Crohn’s disease (CD) and ulcerative colitis (UC) patients who were biologic-naïve and to evaluate their impact on clinical outcomes.

Methods
This was a prospective, multi-center, observational study. Biologic-naïve patients with moderate to severe CD and UC who started CT-P13 therapy were eligible for the study. The trough drug and ADA levels were measured serially for 1-year after CT-P13 initiation. Clinical outcomes were assessed with intention-to-treat purpose.

Results
267 patients who received CT-P13 treatment were enrolled in the study (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, p&lt;0.001) and clinical response (75.6% vs. 47.5%, p&lt;0.001) at 54-week were significantly higher in CD than in UC. The median trough drug level (μg/mL) was significantly higher in CD than in UC up to 14-week (2-week, 19 vs. 15, p&lt;0.001; 6-week, 13 vs. 9, p&lt;0.001; 14-week, 3 vs. 2, p=0.001, Fig 1). The median ADA level (AU/mL) was significantly lower in CD than in UC at 2-week (6 vs. 7, p=0.046), 30-week (8 vs. 12, p=0.007) and 54-week (9 vs. 12, p=0.032, Fig 1). The difference in drug and ADA levels between CD and UC remained significant after adjustment for confounders in repeated measures analysis. Cox proportional hazard analysis showed that CD over UC (adjusted hazard ratio (aHR) 0.78, 95% confidence interval (CI) 0.62–0.95, p=0.016, Fig 2) and no immunomodulator (aHR 1.55, 95% CI 1.07–2.25, p=0.02) were independent risk factors for the development of ADA. The development of ADA at 2-week (adjusted odds ratio (aOR) 0.12, 95% CI 0.03–0.6, p=0.009) and CD over UC (aOR 1.85, 95% CI 1.33–2.56, p=0.0002) were independent predictors of clinical remission at 54-week.

Conclusion
CD shows favorable pharmacokinetics of infliximab including high trough drug and low ADA level compared with UC which might be related with better clinical outcomes for 1-year of infliximab.
DOP81 Quality improvement by semi-automated benchmarking of a core outcome quality indicator set in Inflammatory Bowel Disease: A multicentric feasibility study
Authors: Bossuyt P , Baert D , Baert F , Hoefkens E , Huys I , Lembrechts N , De Jonckere E , Dewint P , Pouillon L 
Published: May 2021

Abstract

Background
Quality of care in inflammatory bowel disease (IBD) depends on multiple factors and is assessed through structure, process and outcome indicators. Structure and process indicators are more static and can easily be measured by an audit. Patient-oriented outcome indicators that impact on the quality of life are more difficult to assess.
The aim of the project was to build a platform that automatically captures key outcome quality indicators and provide benchmarking output to improve quality of care in IBD centres.

Methods
Literature was reviewed for relevant quality indicators in IBD. After two non-anonymized Delphi like review and consensus meetings, twelve quality indicators were selected for implementation. The definitions of the outcomes were aligned in consensus with the available International Consortium for Health Outcomes Measurement (ICHOM). A web-based interface was built in three large volume IBD centres in Belgium to collect data on multiple ways: (i) Patients complete patient-reported outcome questionnaires and disease specific questions when attending the outpatient clinic and/or day clinic; (ii) The software automatically extracts data from the electronic medical files including biochemical and endoscopic reports; (iii) The medical baseline characteristics and outcome indicators for each patient are completed by the healthcare professional at inclusion and after this on a yearly basis.

Results
In total 265 patients were included in the participating IBD centres. Three indicators could be directly extracted from the patient-reported outcome questionnaires (clinical remission, fatigue, work productivity). Two items could be retrieved by use of the bot that automatically extracts biochemical and endoscopic reports from the medical files (anaemia, deep remission). The other items were collected throughout yearly confirmation by a health care professional (colorectal cancer, steroid use [systemic/topical], severe infections, hospital admission, IBD surgery [perianal/abdominal]). All items are benchmarked in an anonymous way on a benchmarking dashboard. Each centre can only see his own position in the benchmarking diagram. Additionally, the case mix per centre (type IBD, severity, demographic data) was added to the benchmarking output to provide a balanced evaluation of the outcome indicators.

Conclusion
This is the first partially automated benchmarking initiative for quality of care in IBD. The data collection is feasible and provides an objective assessment and comparison of the IBD related quality of care in different centres. Further prospective evaluation needs to confirm that implementation of benchmarking improves the performance and quality of IBD management.
P187 Change in Urgency Status Among Ulcerative Colitis Patients: Understanding the Impact of Treatment Changes from the Corrona Inflammatory Bowel Disease Registry
Authors: Wolf D C , Naegeli A N , Moore P C , Janak J C , Crabtree M M , Shan M , Hunter T M , Sontag A , Cross R K 
Published: May 2021

Abstract

Background
Stooling urgency (also known as urgency to defecate) is one of the most common symptoms among Ulcerative Colitis (UC) patients (pts). Understanding factors associated with changes in urgency status, such as the association between timing of treatment changes and subsequent onset or resolution of urgency symptoms, are essential in addressing unmet pts needs. Our aim was to explore treatment frequency and persistence among UC pts stratified by a change in urgency status from enrollment to the 6-month follow-up (6M) visit.

Methods
Participants included UC pts in the Corrona Inflammatory Bowel Disease Registry between 5/3/17–9/1/20. Stooling urgency was defined as no urgency or urgency using the categories, none and hurry/immediate, from the Simple Clinical Colitis Activity Index (SCCAI). Urgency status groups were formed by urgency at enrollment and the 6M visit: no persistent urgency (NPU), i.e., no urgency at both visits; change from urgency to no urgency (UN); change from no urgency to urgency (NU); and persistent urgency at both visits (PU). Chi-square tests were conducted to compare treatment use and change between urgency status groups (NPU=reference group). Kaplan Meier curves and log-rank tests were used to assess time to first treatment change between urgency status groups.

Results
The urgency status groups (n=400) included: 44% NPU (n=175), 21% UN (n=86), 14% NU (n=56), and 21% PU (n=83). A higher proportion of UN (47%, p=0.03) and PU (51%, p=0.01) pts received two or more treatments compared to NPU (33%) pts. Compared to NPU pts, pts in all three groups, UN (52% vs. 27%, p&lt; 0.001), NU (45% vs. 27%, p=0.02), and PU (53% vs. 27%, p&lt; 0.001) were more likely to change treatment between enrollment and the 6M visit. Similarly, a higher proportion of pts on a biologic at enrollment, UN (24% vs. 11%, p=0.01), NU (23% vs. 11%, p=0.03), and PU (35% vs 11%, p&lt; 0.001), changed treatment between enrollment and the 6M visit vs. NPU pts. The time to first treatment change was shorter for all other urgency status groups when compared to NPU pts (log-rank tests, all p&lt;0.02) (Figure 1). Among pts without urgency at enrollment, the time to first treatment change was shorter for NU vs. NPU pts (p=0.01) whereas it was similar for pts with urgency at enrollment, UN vs. PU pts (p=0.93) (Figure 1).

Conclusion
Among UC pts in a real-world setting, there were significant differences in change of treatment and time to treatment change between pts who experienced urgency either at their enrollment visit, 6M, or both, compared to those without urgency. Urgency at any time point is a symptom of great concern to UC pts and is a sign of inadequate therapy, and often is an indication to switch treatment therapy.
P252 Medication adherence in inflammatory bowel diseases in the era of biotherapies
Authors: Hassine A , Hammami A , Ben Ameur W , Dahmani W , Elleuch N , Ben Slama A , Braham A , Ksiaa M , Bannour R , Jaziri H , Jmaa A 
Published: May 2021

Abstract

Background
Failure or poor adherence to therapy is a general problem ofpublic health, particularly common in chronic inflammatory bowel disease (IBD). In these pathologies, good compliance is, however, one of the keys to obtaining remission and in preventing relapses and complications. The objective of this study was to assess treatment compliance in our patients followed for IBD.

Methods
We conducted a single-center cross-sectional study, including all patients with IBD, who presented to our consultation during the three months preceding the study. We used the Morisky questionnaire to assess treatment adherence. This was considered low if the score is less than 6, medium if the score is between 6 and 8, and good if the score is equal to 8.

Results
We collected 100 patients, average age of 42.18 ± 15.71 years and a sex ratio (M / F) = 1.5. Sixty eight patients (68%) had CD and thirty two patients (32%) had UC. The mean duration of IBD progression was 9.02 ± 6.57 years. Anoperineal lesions were present in 38.2% of cases. Fourteen patients (20.6%) followed for CD and ten patients (31.3%) with UC had severe disease activity. The history of surgical resection was noted in 18.75% of patients followed for UC and 47.05% of those followed for CD. Extensive ileal resection was noted in 6.5% of patients with CD. At the time of the study, 20% of patients were on systemic corticosteroid therapy, 22% on Azathioprine, 4% on Salazopyrine, 8% on 5-ASA and 46% on Anti-TNFα in combination therapy. The mean Morisky score was 6.78 ± 1.31. Adherence to treatment was poor in 42% of cases, average in 34% of cases, and good in 24% of cases. Good treatment adherence was observed in 34.78% of patients taking Anti-TNFα vs. 14.81% in other patients with no statistically significant difference (p = 0.077). Morisky score was correlated with age (p = 0.032, r = 0.38). In addition, no significant association was found, with the duration of evolution (p = 0.75), the existence of other chronic diseases (p = 0.3), the number of outbreaks of IBD (p = 0.52), and disease activity (p = 0.38 for CD, p = 0.22 for UC).

Conclusion
The overall rate of treatment non adherence in IBD patients was significant in our series. It concerns nearly one in two patients. Prescribing Anti-TNFα does not appear to improve compliance. The integration of therapeutic education into our therapeutic strategy should be an asset major in improving treatment adherence.