bluuebunny/crossref_metadata_2025_split huggingface dataset:
P081 Use of immunologic fecal occult blood test as a biomarker in patients with ulcerative colitis
Authors: Udo Kronberg , Daniela Simian , Lilian Flores , Mauricio Moreno , Patricio Ibáñez , Jaime Lubascher , Carolina Figueroa , Rodrigo Quera , Ana Wielandt , Gonzalo Pizarro , Francisco López-Köstner 
Published: July 2019

BACKGROUND:
The use of biomarkers for the assessment of inflammatory activity is an important part of current management of Ulcerative Colitis (UC). Fecal calprotectin (FC) has shown to correlate adequately with inflammatory activity, but at an elevated cost in some countries. An immunologic fecal occult blood test (iFOBT) as used in colorectal cancer screening is clearly cheaper, and there have been initial reports about its use in UC. The aim of this study was to determine the diagnostic performance of iFOBT for the assessment of inflammatory activity in UC patients, and to compare it with FC.

METHODS:
A diagnostic, observational, analytic study was performed. UC patients who required colonoscopy were prospectively enrolled between May 2017 and May 2018. FC and iFOBT were determined simultaneously just before starting the bowel preparation for colonoscopy, and patients were asked about their type of test preference. Inflammatory activity was assessed using the Mayo endoscopic sub score, and patients with score 2 or 3 were classified as endoscopically active. In order to identify the cut-off value for iFOBT, logistic regressions and ROC curves and tables were performed, and the value was chosen in order to achieve the highest sensitivity and positive predictive value as desired for a screening test. For the analysis, FC validated standard cut-off value was used (250 mg/g).

RESULTS:
During the above mentioned time period, a total of 50 patients were enrolled, 26 females, with a median age of 33 years (i:19–64). In 38/50 patients (76%) endoscopic activity was observed (Mayo score 2-3). The cut-off value for iFOBT was determined in 50 ng/mL. In terms of diagnostic performance regarding inflammatory activity, iFOBT showed a sensitivity of 89.5%, a specificity of 75%, a PPV of 91.9% and a NPV of 69.2%, with a diagnostic accuracy of 86%, meanwhile, FC showed a sensitivity of 71%, a specificity of 91.7%, a PPV of 96.4%, a NPV of 50% and a diagnostic accuracy of 76%. All the patients (100%) preferred iFOBT over FC in terms of easier sample taking and safer transportation.

CONCLUSION(S):
The diagnostic performance of iFOBT is similar to FC. Further studies performed in a larger sample of patients including follow-up, will allow to confirm that iFOBT could be used as another biomarker for the assessment of inflammatory activity in IBD patients.
P086 Kock pouches in the 21st century: A descriptive study of short-term (30-day) outcomes in a national cohort of 177 patients
Authors: Sherief Shawki , Scott Steele , Jeremy Lipman , Hin Angus Lee Chun , Tracy Hull , Emre Gorgun , Stefan Holubar 
Published: July 2019

BACKGROUND:
In 1972, Professor Nils Kock in Gothenburg Sweden developed the continent ileostomy (Koch pouch or KP) as an alternative to permanent end ileostomy. However, the KP was largely supplanted by the ileal pouch-anal anastomosis (IPAA). In the 21st century, KP's are rarely performed, and often only in highly select patients who are a not candidate for an IPAA. Presently, there are only single institution case series with which to guide surgeons' and patients' expectations for postoperative outcomes including length of stay, readmission and complication rates. Thus we aimed to report surgical outcomes in a large national retrospective cohort using the National Surgical Quality Improvement Project (NSQIP).

METHODS:
Using the NSQIP Participant User File from 2005 to 2017 we identified patients who underwent a KP (CPT 44386). Baseline characteristics, operative variables, and postoperative outcomes are reported. Figures represent frequency (proportion) or median (interquartile range).

RESULTS:
Over an 11-year period, a total of 907,146 colorectal operations were performed; of these, we identified a sample of 177 patients who underwent Kock pouch procedures. The median age was 56 (46–76), 50.2% were women, and the median body mass index was 25.3 (22–29.6) kg/m2. Any comorbidity was present in 105 (59%), with a median of 1 (0–2) comorbidities. A total of 13 (7.3%) and 16 (8.5%) were on steroids or had recent weight loss, respectively, and the median albumin was 3.8 (2.9–4.1) mg/dL. Most patients were ASA class 2 (78, 44%). Operative time was 198 (129.5–298.5) minutes, and 127 (72%) had other procedures by the same surgical team, while only 24 (14%) had concurrent procedures by a different surgical team. In terms of short-term outcomes, reoperation was required in 19 (10%) of patients, the post-operative length of stay was 8 (5–14) days. Readmission occurred in 14 (7.9%) of patients. VTE occurred in 4 patients (2.3%). Overall any complication of any severity occurred in 67 (38%) patients. The 30-day mortality rate was 3.4% (6 patients).

CONCLUSION(S):
The Kock pouch procedure, despite its technical complexity, has an acceptable short-term safety profile, and remains an option for a selective group of motivated patients who cannot have IPAA and/or who defer end-ileostomy.
P090  Risk of cancer in pediatric onset inflammatory bowel disease: A nationwide cohort study 1977-2014
Authors: Victoria Kjærgaard , Camilla Jensen , Johan Burisch , Kristine Allin , Tine Jess 
Published: July 2019

BACKGROUND:
The prognosis of pediatric onset inflammatory bowel disease (IBD) remains uncertain. We examined the overall and site-specific cancer risk among pediatric onset IBD patients as compared to non-IBD individuals from the general population.

METHODS:
Based on diagnoses from the Danish National Patient Register, we established a nationwide cohort (1977–2014) including all individuals with an IBD diagnosis before the age of 18 (n = 4,221) and 42,210 randomly selected age and sex matched individuals from the general population. The risk of cancer was determined by using Cox proportional hazard regression.

RESULTS:
During 59,563 person-years of follow-up, 126 of 4,221 pediatric onset IBD patients developed cancer (2.1 cases per 1,000 person-years) as compared to 554 of 42,210 non-IBD individuals (1.0 case per 1,000 person-years). Accordingly, the hazard ratio (HR) of any cancer was 2.16 (95% CI, 1.77–2.62). When examining site-specific cancers, the risk was significantly increased for non-melanoma skin: HR, 2.21 (95% CI, 1.41–3.46), liver: HR, 32.83 (95% CI, 9.23–116.78), small bowel, mouth, upper gastrointestinal: HR, 8.4 (95% CI, 2.70–26.14) and colorectal cancer: HR, 18.26 (95% CI, 9.16–36.39). Males with pediatric onset IBD had a significantly higher risk of cancer than females: HR, 3.17 (95% CI, 2.33–4.29) vs 1.71 (95% CI, 1.32–2.21). A slightly higher risk of cancer was observed for Crohn's disease patients than for ulcerative colitis patients: HR, 2.45 (95% CI, 1.82–3.30) vs 1.96 (95% CI, 1.51–2.55).

CONCLUSION(S):
In this nationwide cohort study, individuals with pediatric IBD had significantly increased risk of cancer, especially liver, small bowel, mouth, upper gastrointestinal, and colorectal cancer, but absolute numbers were low. The impact of chronic inflammation, respectively, IBD treatments on cancer risk in early onset IBD merits further investigation.
P091  Preoperative neutrophil to lymphocyte ratio in ulcerative colitis is associated with denovo Crohn's disease after ileal pouch-anal anastomosis
Authors: Phillip Fleshner , Karen Zaghiyan , Talia Kamdjou 
Published: July 2019

BACKGROUND:
About 5% to 10% of patients undergoing ileal pouch-anal anastomosis (IPAA) with a diagnosis of ulcerative colitis (UC) at the time of surgery are subsequently diagnosed with denovo Crohn's disease (CD). Previous studies have shown that the neutrophil to lymphocyte ratio (NLR) has high sensitivity, specificity, and predictive values to differentiate CD patients from non-CD controls. The aim of this study was to examine the association of preoperative NLR and denovo CD after IPAA.

METHODS:
Consecutive UC patients undergoing IPAA by one surgeon at a tertiary referral center were prospectively enrolled into a longitudinally updated database. Demographic and clinical factors were tabulated immediately after surgery. Preoperative NLR was collected and calculated from their CBC drawn up to 2 weeks before surgery, without knowledge of the patient's surgical outcome. A cutoff of 1.65, from a previously published study (Forget et al., BMC Research Notes 2017) was used as the reference value. Denovo CD was defined by inflammation involving the small-bowel mucosa proximal to the ileal pouch or when a pouch fistula or other perianal complications developed more than 3 months after ileostomy closure.

RESULTS:
The study cohort of 264 patients had a median age of 42 (5–79) years and included 139 (53%) males. Forty-four patients (17%) developed denovo CD on the basis of afferent limb inflammation (n = 30), perianal disease (n = 8), or both (n = 6). Median length of time to denovo CD until final diagnosis was 9 months after stoma closure. Median NLR of the study cohort was 3.58 (0–54.3). Preoperative clinical features were similar between patients who had a normal (n = 39; 15%) or elevated NLR (n = 225; 85%). Denovo CD developed in 42 patients (19%) with an elevated NLR compared to only 2 patients (5%) with a normal NLR (P = 0.03).

CONCLUSION(S):
This first ever study examining the value of preoperative NLR and surgical outcomes after IPAA showed a significant association of preoperative NLR and denovo CD. An elevated preoperative NLR may be a relatively easy and low-cost clinical biomarker for the development of denovo CD following IPAA in UC patients.
P092 Induction of clinical remission with certolizumab pegol in patients with ulcerative colitis who are not responders in Mexican population
Authors: Tomas Cortes Espinosa , Korely Trujillo de la Fuente , Roxana Rodriguez Romo , Yahaira Rivera Vicencio , Jorge Pineda Castillejos , Dassaev Aleman Abitia , Jesús López Goméz , Mayra Ramos Gómez , Eduardo Ramos Raudry , Rodolfo Ramirez del Pilar , Christian Navarro Gerrard , Jhonatan Aguilar Hernandez 
Published: July 2019

BACKGROUND:
The TNF alpha inhibitor have revolutionized the treatment of inflammatory bowel disease (IBD), both in ulcerative colitis (UC) and in Crohn's disease (CD), achieving not only clinical remission even the healing of the affected mucosa. In our population, 70% of patients with IBD are diagnosed as UC and 30% CD. Currently, there are only 2 biologics approved for UC: infliximab and adalimumab. One third of patients will not respond to anti-TNF after induction and up to 50% of them will lose efficacy in the first year. Certolizumab pegol (CZP) has shown therapeutic efficacy in CD. In our country there are no studies that evaluate its use in UC. The aim of this work is to assess the efficacy of CZP in patients with UC with secondary failure to 2 anti-TNF alpha.

METHODS:
Study proof of concept. Six patients with UC diagnosis referred to our hospital center due to secondary failure to 2 anti-TNF alpha were studied. The severity of the disease was staged according to the Mayo score. Prior authorization of the patient for treatment with CZP, we administered it, at a dose of 400 mg subcutaneously at week 0, 2 and every 4 weeks, for 12 weeks. Clinical response was reviewed at 8 and 12 weeks after the beginning of the application of the biological and also endoscopically at 8 and 12 weeks.

RESULTS:
50% corresponded to female sex with a female: male 1 to 1. The median age was: 52.50 [23–63] years. Of the 6 patients, 5 had left colitis and 1 had pancolitis. 4 patients fulfilled criteria of Mayo for severe activity and 2 with moderate activity. 4 patients with an endoscopic subscore Mayo 2 and 2 patients with endoscopic subscore Mayo 3. At the baseline measurement, 50% (3) had a normal CRP and 100% had albumin within normal parameters. At 8 weeks of follow-up, 50% of patients entered clinical remission by Mayo score. 4 patients had an endoscopic subscore May 1 or lower. At 12 weeks of biological application, the same results were observed. By laboratory it was observed at 12 weeks that 83.3% had CRP within normal parameters and 66.7% had normal albumin. No secondary events were observed during the 12 weeks of treatment.

CONCLUSION(S):
In this work proof of concept, CZP seems to be an option in patients with UC who have had secondary failure to other anti-TNF; however, because of the small size of the sample, a prospective and randomized study is required to confirm these findings. The present work does not have conflict of interests.
P094 Henoch–Schonlein purpura and inflammatory bowel disease
Authors: Anshu Maheshwari , Mohammad Yaseen , Ian Kang , Christina Lowrance 
Published: July 2019

BACKGROUND:
Approximately 7.5% of children with inflammatory bowel disease (IBD) develop cutaneous extra-intestinal manifestations, with erythema nodosum, pyoderma gangrenosum, and psoriasis being the most common. Although rare, cases of cutaneous small-vessel vasculitis in children with IBD have been reported.

CASE:
An 8 Y/M with ileo-colonic Crohn disease presented with 3 days of bilateral lower extremity swelling and 1 day of tender palpable rash on the right arm, chest and dorsal surface of the right foot. Crohn disease was diagnosed at age 5 years and was on mesalamine for treatment at the time of presentation. A year ago he had been on infliximab infusions, but had to stop the treatment after a severe infusion reaction. On exam, patient was uncomfortable, unable to bear weight, afebrile, and without abdominal pain or tenderness to palpation. He had limited range of motion of right foot secondary to pain. No joint swelling was noted. He had a palpable purpuric rash on his right arm, chest and dorsal surface of the right foot. Urinalysis was positive for trace protein and ketones. His ANA titers were positive and rheumatoid factor was negative. A clinical diagnosis of Henoch-Schonlein purpura (HSP) was made based on the typical rash and urinalysis. He was treated symptomatically with acetaminophen and did well subsequently

DISCUSSION:
HSP occurs in approximately 10–22 persons/100,000 each year. More than 90% of patients are children younger than 10 years, with a peak incidence at 6 years of age. HSP is the most common vasculitis in children and has a slight predominance in males. The clinical features of HSP are a consequence of widespread leukocytoclastic vasculitis owing to immunoglobulin A deposition in vessel walls. In 15% to 20% of patients, the gastrointestinal symptoms precede the diagnostic rash by a number of days. In such patients, IBD is a diagnostic consideration, even though the coexistence of HSP and IBD is quite uncommon. In this report, we describe a child with Crohn disease who developed HSP 3 years after diagnosis. HSP can be seen as a complication of infliximab or adalimumab therapy, but our patient was not on biologic therapy at the time HSP diagnosis.
P095 Unusual side effects of systemic steroids in children with inflammatory bowel disease
Authors: Anshu Maheshwari , Ian Kang , Mohammad Yaseen , Christina Lowrance 
Published: July 2019

CASE:
14 Y/M diagnosed with ileo-colonic Crohn disease at 5 Y of age. He was initially treated with oral prednisone (2 mg/kg/day) for 2 weeks and oral mesalamine. The steroids were weaned over a period of 2 months. As he continued to have persistent symptoms, he was started on infliximab infusions. After his third infliximab infusion he developed severe bilateral lower extremity pain and bilateral knee swelling requiring inpatient admission. X ray of bilateral knee joints was normal. The symptoms were attributed to an infusion reaction and he was then switched to mercaptopurine, which he did not tolerate. He was started on adalimumab, but developed antibodies within 2 months of therapy. He was also given 2–3 courses of oral steroids over 1–2 years to induce remission. The dose was 2 mg/kg/day for 1–2 weeks with weaning over 1–2 months. He developed necrosis of the left femoral head when he was 9Y. The diagnosis was based on typical x ray appearance. His BMI was 82 percentile when he developed osteonecrosis and his last course of steroid was >6 months ago. He was on apriso when he developed osteonecrosis. His symptoms improved with physiotherapy over the next 1–2 years. After he failed therapy on Humira, he was started on oral budesonide (6 mg daily) as he continued to have diarrhea and his repeat colonoscopy showed worsening disease. He was on the oral budesonide for 6–7 weeks and developed typical steroid facies—moon face, supraclavicular fat pads and gained 6 lbs in 6 weeks. His blood pressure was normal. The budesonide was quickly weaned and he was switched to subcutaneous methotrexate followed by entyvio due to lack of clinical response on methotrexate. Currently he is in remission on entyvio. He continues to walk with a limp and is not complaining of any limb pain.

DISCUSSION:
Osteonecrosis of the femoral head (ONFH) is a disabling condition of the hip joint that primarily affects adults (avg: 36–38 Y). Risk factors for ONFH include chronic corticosteroid administration, chronic alcohol ingestion, smoking, and various chronic diseases (renal disease, hematological disease, inflammatory bowel disease (IBD), post organ transplantation, hypertension, and gout). Although ONFH is seen in children with malignancy, post stem cell transplant and sickle cell disease, it is not commonly reported in children with IBD. The exact incidence of ONFH in children on chronic steroids with IBD is unknown. In our patient, we are not sure if the ONFH was from chronic steroid use or underlying IBD. He also developed steroid facies within 6 weeks on oral budesonide which is unusual. Iatrogenic Cushing's syndrome is not expected with budesonide because a “first pass effect” removes the drug from the circulation. Multi center studies are needed in children with IBD looking at serious side effects of all types of systemic steroids as they are frequently prescribed.
P097 Polypharmacy and drug-drug interactions among patients with ulcerative colitis
Authors: Esteban Figueroa , M Overby , Brian Behm , Takahiro Nakamura , Brian Wentworth 
Published: July 2019

BACKGROUND:
Ulcerative colitis (UC) is a complex chronic disease potentially requiring the use of multiple medications. Older patients with UC and those with comorbidities are at higher risk of polypharmacy. With increasing polypharmacy there is a greater risk for adverse drug-drug interactions (DDIs). The aim of this study was to determine if age, comorbidity, and number of DDIs differed based on the severity of polypharmacy among our UC patient population.

METHODS:
A retrospective chart review UC patients at our institution from 2006 to 2011 was performed. Patient demographics, medical and surgical history, medications, and treatment history were obtained from the electronic medical record. Polypharmacy was classified as mild (2–4 medications), moderate (5–9 medications), and severe (>10 medications). Comorbidity was quantified using the Charlson Comorbidity Index (CCI). Potential DDIs were identified using Lexicomp® Online. The primary outcomes of interest were the proportion of patients with severe polypharmacy, number of DDIs, and number of DDIs involving UC medication for each of the 3 polypharmacy groups.

RESULTS:
A total of 488 patients were included in the analysis. Moderate and severe polypharmacy was present in 38.3% and 11.1% of patients respectively. Polypharmacy was associated with increasing age (P < 0.01), functional GI disorders (P < 0.01), and psychiatric disease (P < 0.01). Charlson Comorbidity Index, number of DDIs, and number of DDIs involving a UC medication increased with greater polypharmacy severity. There were statistically significant differences in mean age, CCI, number of DDIs, and number of DDIs involving a UC medication among the 3 polypharmacy groups. A UC medication was involved in 30.2% of all DDIs.

CONCLUSION(S):
Among our UC patient population, those with more severe polypharmacy were older, had increased comorbidity, and a greater number of DDIs, including a significant proportion involving UC medications. These factors should be considered when initiating IBD therapy in UC patients.
P098 Anti-TNF biologic therapy does not increase postoperative morbidity in pediatric Crohn's patients
Authors: Ahmad Alsughayer , Nicholas McKenna , Edward Loftus , Laura Raffals , William Faubion , Amy Lightner 
Published: July 2019

BACKGROUND:
Limited knowledge exists as to what impact preoperative biologic therapy has on post-operative complications in pediatric patients undergoing abdominal surgery for Crohn's disease (CD). Therefore, we sought to determine the 30-day postoperative infectious complication rate among pediatric CD patients who received biologic therapy within 12 weeks of an abdominal operation.

METHODS:
A retrospective chart review was performed on pediatric (<18 years of age) CD patients who underwent an abdominal operation between 1/1/2008 and 12/31/2017. Patients were grouped according to whether they received an anti-TNF (infliximab, adalimumab, certolizumab pegol) or no biologic therapy within 12 weeks prior to the operation. The primary outcome was a the overall 30-day postoperative infectious complication rate. Secondary outcomes included 30-day readmission rate and return to the operating room (ROR).

RESULTS:
A total of 69 pediatric CD patients met inclusion criteria (n = 54 anti-TNF therapy, n = 15 received no biologic therapy). There were no differences between the anti-TNF and no biologic cohorts with respect to demographics or CD characteristics. No significant differences in overall 30-day postoperative infectious complications existed between patients exposed to anti-TNF agents and those with no preoperative exposure, or in its subcategories of surgical infectious complications and non-surgical infectious complications. There was also no difference in the rate of ileus, readmission, or ROR.

CONCLUSION(S):
Preoperative exposure to anti-TNF biologic therapy does not add to overall or infectious 30-day postoperative morbidity in pediatric CD patients.