bluuebunny/crossref_metadata_2025_split huggingface dataset:
P042 Inflammatory bowel disease is no longer a contraindication for radiation therapy: A systematic review of outcomes with modern RT techniques
Authors: Gaurav Bahl 
Published: July 2019

BACKGROUND:
Inflammatory bowel disease (IBD) continues to be considered a contraindication to the use of Radiation Therapy (RT). Oncologists are often unwilling to deliver RT, due to a perceived risk of severe bowel toxicity, or IBD exacerbation. Modern precision RT techniques allow significant reduction in dose to normal organs, and several studies have reported low toxicity rates. We performed a systematic review of recent studies to summarize the current evidence regarding RT toxicity in cancer patients with IBD.

METHODS:
MEDLINE and EMBASE databases were searched, using combinations of key terms, for relevant studies published over the past 10 years (2008–2018). Reference lists of eligible articles were also hand-searched. A total of 278 articles were screened, and 9 studies met our search criteria to be included in this review.

RESULTS:
From the 9 relevant studies, 198 patients with IBD, treated using radiation therapy, and with outcome data available, were included. The reported median follow-up was 55.2 months. The majority of patients (n = 148, 75%) were male; 113 (57%) had Ulcerative Colitis, 81 (41%) had Crohn's Disease, and 4 patients had IBD NOS. Nineteen patients (9.5%) were reported to have active IBD within 6 -12 months prior to starting RT. Colo-rectal carcinoma was the most common malignancy (n = 91, 46%), followed by prostate cancer (n = 83, 42%), anal-canal (n = 10, 5%), and gynecological malignancies (n = 6, 3%). External beam RT was used as part of treatment for 173 patients (87%), while 25 received brachytherapy alone. About 28% (n = 55) also received concurrent chemotherapy. From studies that reported the RT technique used, about 43% of patients were treated with Intensity Modulated RT (IMRT). RT dose ranged from 25 Gy/5 for pre-op rectal cancers to over 70 Gy for prostate cancers. Median BED (a/b = 3, rectum) was calculated to be 83.3 Gy. Acute toxicity data was available for 190 patients: clinically significant acute toxicity, ≥Grade 3, was reported in 29 patients (15.3%). Late RT toxicity data was available for 115 patients: ≥Grade 2 GI toxicity was reported in 21 (10.5%), and ≥Grade 3 in 7 (3.5%) of patients.

CONCLUSION(S):
With the use of modern RT techniques, GI toxicity is relatively low for patients with IBD, and is not numerically different from that reported for patients without IBD. Patient selection and meticulous RT planning is important, however, evidence does not suggest that IBD in itself is a contraindication for RT.
P053 Comparison of accuracy between fecal immunochemical test and fecal calprotectin for predicting mucosal healing in quiescent ulcerative colitis patients
Authors: Young Kim Eun , Soo Kim Eun , Seok Lee Hyun , Ik Jang Byung , Ok Kim Kyeong , Jin Lee Yoo 
Published: July 2019

BACKGROUND:
Non-invasive stool tests including fecal immunochemical test (FIT) and fecal calprotectin (FC) are known to be a reliable biomarker for mucosal healing (MH) in ulcerative colitis (UC). However, direct comparison of these fecal tests for predicting MH in inactive UC patients has yet to be evaluated. We aimed to compare the accuracy of FIT and FC for predicting MH in UC patients in clinical remission.

METHODS:
This was a prospective, multicenter study conducted in 3 tertiary hospitals between February 2016 and January 2018. UC patients in clinical remission for at least 3 months or more underwent colonoscopy and MH was evaluated using Mayo endoscopic subscore (MES). Fecal samples were collected for FIT and FC 24 hours before colonoscopy. Receiver operating characteristic (ROC) curve and cut-off value of the best accuracy for predicting MH was assessed in each test. Independent predictive factors for MH were identified by logistic regression analysis.

RESULTS:
Among 127 patients (male 86, median age of diagnosis 44 [range 14–77]) of UC in clinical remission, only 65 (51.2%) showed complete MH (MES = 0). Area under curve (AUC) of FC was significantly higher than FIT (AUC 0.858 vs 0.707, P < 0.001) whereas this difference disappeared when MH was defined as MES 0 or 1 (AUC 0.820 vs 0.813, P = 0.891). When cut-off value was set as 70 μg/g for FC and 10 mg/mL for FIT, sensitivity, specificity, positive predictive value and negative predictive value were 89.2, 71, 76.3, and 86.3 and 92.3, 50, 65.9, and 86.1, respectively. Multivariate logistic regression analysis showed that age of diagnosis >45, hematocrit >44, FC <70 μg/g, and FIT <10 mg/mL were identified as independent predictive factors for MH (MES = 0).

CONCLUSION(S):
Our study demonstrated that FC is more sensitive than FIT for predicting complete MH in quiescent UC patients. The best cut-off value of FC and FIT for MH in these patients is found as 70 μg/g and 10 mg/mL, respectively. Age of diagnosis and hematocrit are additional predictors for MH.
P056 Autoimmunity against type I collagen in ulcerative colitis
Authors: Dilyara Mukhametova , Diana Abdulganieva , Oleg Zinkevich , Nellya Saphina , Marina Koporulina , Alfiya Odintsova 
Published: July 2019

BACKGROUND:
Immunological disorders play an important role in the pathogenesis of ulcerative colitis (UC). Collagen is the main component of the intercellular matrix of connective tissue. It can be assumed that the immune disorders leading to the production of autoantibodies to collagen play a role in the pathogenesis of UC. Aim: to study the level of IgM and IgG to type I collagen (COL1) in UC.

METHODS:
We prospectively included 61 patients with UC and 30 healthy controls. Mean age in UC was 37 ± 1.5 years and in control group—30 ± 1.5. Severity of UC was assessed by Mayo score: remission—5, mild—25, moderate—26, severe—5. Extraintestinal manifestations of UC were in 24 patients (39%). Level of serum IgM and IgG to COL1 was assessed by enzyme immunoassay.

RESULTS:
In active UC levels of IgM to COL1 was increased (0.17 [0.10; 0.20] mkg/mL) compared with healthy (0.09 [0.07; 0.12] mkg/mL; P < 0.01). The difference between remission (0.1 [0.09; 0.19] mkg/mL) and exacerbation, remission and control group was not detected (P > 0.05). In patients with severe UC IgM to COL1 was 0.19 [0.18; 0.25] mkg/mL, which was higher than in moderate UC—0.12 [0.08; 0.17] mkg/mL (P < 0.05) and mild—0.18 [0.11; 0.20] mkg/mL (P > 0.05). There was a tendency to increase of IgM to COL1 in patients with extraintestinal manifestations (0.17 [0.10; 0.22] mkg/mL) than without them (0.12 [0.09; 0.18] mkg/mL). The level of IgG to COL1 in active UC (24.69 [16.36; 99.12] mkg/ml) was higher than in the control group 11.36 [6.93; 19.83] (P < 0.05) and remission—13.15 [8.88; 26.21] (P > 0.05). There was not revealed the difference of IgG levels depending on the severity of disease. There was a tendency to increase of IgG to COL1 in patients with extraintestinal manifestations (16.18 [9.46; 26.21] mkg/mL), than without them (12.78 [8.81; 28.31] mkg/mL). There was increasing of ESR (r = 0.36; P < 0.05) and leukocytosis (r = 0.32; P < 0.05) with increase of IgM level to COL1.

CONCLUSION(S):
In active UC the level of serum antibodies of class IgM and IgG to COL1 increased compared with healthy. The maximum increase was found in the group of patients with severe relapse and in the presence of extraintestinal manifestations.
P061 Ulcerative colitis: Risk factors for relapse in clinical remission patients
Authors: Cátia Arieira , Henrique Guimarães , de Castro Francisca Dias , João Moreira Maria , José Cotter 
Published: July 2019

BACKGROUND:
Ulcerative colitis (UC) is a chronic inflammatory bowel disease, characterized by periods of remission and relapse. The aim of this study was to identify factors associated with a higher risk of relapse in patients in clinical remission.

METHODS:
retrospective study, including UC patients in clinical remission with minimum follow up of 2 years. Clinical relapse was defined as a need for therapeutic escalation and UC-related hospitalization or surgery. Statistical analysis was carried out by means of t-test and chi-square (univariate analysis) and logistic regression (multivariate analysis). A P value < 0.05 was considered statistically significant.

RESULTS:
169 patients were included, 51.5% female. Clinical relapse was observed in 30,2% of the patients. In the univariate analysis, relapse was more frequent in patients with higher number of previous relapses (2.7 vs 1.0; P < 0,.001), younger age at diagnosis (36.6 vs 41.2 years; P = 0.045) and with therapeutic non-adherence (82.4% vs 17.6%; P < 0.001). Patients who presented at clinical remission with a Mayo Endoscopic Score (MES) of 0 had a recurrence rate of 5.6%, significantly lower than the rate of 43.2% presented by the group with mild endoscopic disease activity (MES 1) and also lower than the rate of relapse of 73.3% presented by the group with moderate endoscopic disease activity (MES 2) (P < 0.001). In the multivariate analysis, therapeutic non-adherence (HR 24.6 CI 95% 2.0–296.6; P = 0.012) and MES > 0 (HR 16.6; CI 95% 2.9–94.2; P = 0.002) were the only independent risk factors associated with relapse.
P074 Review of patients with inflammatory bowel disease at the university hospital of the West Indies between 1980-June 2018
Authors: Yvonne Dawkins , Michael Lee , Trevor Ferguson , Mike Mills , Milton Arthurs , Kildare Donaldson , Trevor Murphy 
Published: July 2019

BACKGROUND:
There are limited data on the incidence and prevalence of Inflammatory bowel disease (IBD) in Jamaica and other Caribbean countries. The aim of this study is to determine the clinical features, course and outcomes of patients with IBD in Jamaica.

METHODS:
A retrospective chart review of patients who were diagnosed with IBD and seen at the University Hospital of the West Indies between the period January 1980 to June 2018 was conducted. Data collected included: demographic characteristics and symptoms, endoscopic disease activity at last endoscopy, treatment and response to therapy, and surgical requirement. Descriptive statistics was computed using Stata 14 statistical software.

RESULTS:
We identified 115 patients with IBD during the study period. Mean age was 48.2 ± 17.7 years, 61.7% were females and mean disease duration was 12.5 ± 10.2 years. Forty-three patients (37.4%) had Crohn's disease (CD) and 72 (62.6%) had ulcerative colitis (UC). The most common presenting symptom was diarrhea (86 patients, 78.2%) and was more common in females (88% vs 62%; P value 0.001). Most patients with UC had pancolitis (54.2%), 19.4% left sided colitis and 18.1% had proctitis/proctosigmoiditis. Disease distribution in CD was mainly ileal in 37.2%, ileo-colonic in 34.9% and colonic in 23.3%. CD phenotype was inflammatory in 37.2% of patients, stricturing in 25.6% and penetrating in 32.6%. The majority of patients had moderate/high risk disease (66.1%). Eighty-nine patients (78.1%) were treated with 5-aminosalicylates, 37 (32.2%) with immunomodulators, 1 (0.9%) with a biologic agent, 48 (41.7%) were on chronic steroids and 7 (6.1%) were not on any medications. Chronic steroid use was associated with side effects in 36.4% of patients with steroid induced diabetes mellitus being the most frequent side effect occurring in 9 patients, all of whom were females (16.4% vs 0%; P value 0.007). Twenty six patients required surgical therapy for IBD. The most common indication for surgery in patients with CD was bowel obstruction (45.8%) whereas 2 patients with UC had surgery for failed medical management and spontaneous perforation respectively. Over the last 2 years patients with CD required more frequent hospital admissions for disease flares than patients with UC (0.9 ± 1.3 vs 0.3 ± 0.7; P value 0.005). Clinical remission was achieved by 75% of patients at their last clinic visit.

CONCLUSION(S):
Only 115 patients with IBD were identified over a 38 year period at a single referral center in Jamaica. UC was more commonly diagnosed than CD. The most common presenting symptom was diarrhea. Most patients with UC had pancolitis whereas most patients with CD had inflammatory ileal disease. A third of patients were maintained on chronic steroids. Most patients achieved clinical remission at their last clinic visit.
P075 Prospective validation of CD4+CD25+FOXP3+ T-regulatory cells as an immunological marker to differentiate intestinal tuberculosis from Crohn's disease
Authors: Ritika Rampal , Saurabh Kedia , Deepak Madhu , Govind Makharia , Vineet Ahuja 
Published: July 2019

BACKGROUND:
Crohn’s disease (CD) and intestinal tuberculosis (ITB) are difficult to differentiate. We have previously documented high diagnostic accuracy of peripheral blood frequency of CD4+CD25+FOXP3+ T-regulatory cells (T-regs) in differentiating CD and ITB. The present study was designed to validate the results of the previous study prospectively. Crohn’s disease (CD) and intestinal tuberculosis (ITB) are difficult to differentiate. We have previously documented high diagnostic accuracy of peripheral blood frequency of CD4+CD25+FOXP3+ T-regulatory cells (T-regs) in differentiating CD and ITB. The present study was designed to validate the results of the previous study prospectively.

METHODS:
Seventy treatment naïve patients of CD (n = 23) and ITB (n = 47) (diagnosed by standard criteria) were recruited prospectively from October 2016 till May 2017. Patients with history of ant-tubercular therapy in the past were excluded. The frequency of T-reg cells in peripheral blood as determined by flow cytometry and was compared between CD and ITB.

RESULTS:
Frequency of T-reg cells in peripheral blood was significantly increased in ITB as compared to CD [40.9 (IQR: 33–50) vs 24.9 (IQR: 14.4–29.6), P < 0.001]. There was good diagnostic accuracy of T-reg cell frequency in differentiating CD and ITB with an area under the curve (AUC) on ROC curve of 0.77 (0.65p0.9). The cut-off obtained on the ROC curve, to differentiate CD and ITB in the present study (32%) was like the previous study (32.5%) with a sensitivity, specificity, positive and negative predictive value of 81%, 83%, 90%, 65% respectively for the diagnosis of ITB.

CONCLUSION(S):
CD4+CD25+FOXP3+ T-regulatory cells frequency in peripheral blood has a good diagnostic accuracy and can be used as a simple test in differentiating CD and ITB.
P083 Improvement in thiopurine dosing in pediatric inflammatory bowel disease by participation in a national collaborative
Authors: Christina Lowrance , Keith Hanson , anshu Maheshwari , Christopher Mullett , Mohammad Yaseen , Sandeep Gupta , Ian Kang 
Published: July 2019

BACKGROUND:
Pediatric Inflammatory Bowel Disease (IBD) is a chronic disease with several treatment options. Medication optimization is key to patient-centered, efficacious management of IBD. Thiopurines, including azathioprine and 6-mercaptopurine, are a mainstay of treatment and are dosed based on weight. As part of a national IBD collaborative, ImproveCareNow, we identified an opportunity to improve weight-based dosing in this patient population. The specific aim of the project was to increase the percentage of patients meeting weight-based thiopurine dosing targets to 80%.

METHODS:
We undertook a rapid quality improvement project to improve this metric, using standard quality improvement techniques and resources from the ImproveCareNow collaborative. Inclusion criteria were IBD patients with a clinic visit in the preceding 13 months and known weight and medication dose. Exclusion criteria included patients with low or unknown TMPT activity, treatment with a biologic agent, and treatment with allopurinol. Interventions focused on pre-visit planning, standardized visit templates, increasing frequency of visits, obtaining labs prior to the visit, and provider/patient education. Performance was continually monitored via ImproveCareNow's data management program, which tracks metrics on a monthly basis.

RESULTS:
This study was conducted over a 20-month period (June 2016 to January 2018). 31 unique patients on thiopurine therapy met study criteria and were enrolled. 19 (61%) were males, with ages ranging from 2.4 to 21.7 years (mean age 15.0 years). Since patients both started and stopped thiopurine therapy during the study, the total number of patients varied over time; the number of patients per month on thiopurines ranged from 16 to 21 during the study period. On average approximately 30% of IBD patients at our center were on thiopurines each month. The percentage of patients who met weight-based dosing guidelines increased from 56% at the start of the project to the target of 80% within 15 months, exceeding performance from the national cohort. Target performance was maintained for the remainder of the study period.

CONCLUSION(S):
Participation in a national collaborative allowed the identification of an unmet need in our IBD clinic, as we were not consistently meeting weight-based dosing recommendations for thiopurines. Using standard quality improvement methodology and resources from a national collaborative, we not only improved our weight-based dosing recommendations for thiopurines but also exceed that of the national cohort and maintained this for duration of study. Future work will examine whether these changes led to improvements in thiopurine serum metabolite levels and disease control.
P089 Small bowel Clostridium difficile masquerading as Crohn's disease
Authors: Cecelia Zhang 
Published: July 2019

CASE:
A 38-year old man with a history of perforated diverticulitis s/p sigmoid colectomy presented to the emergency room with 2 days of abdominal pain. He was without any symptoms of diarrhea, hematochezia or melena. He was previously admitted to the hospital for 4 days approximately one month prior to presentation with similar symptoms of abdominal pain. He had a CT scan of the abdomen and pelvis performed during that admission with wall thickening of the terminal ileum, but no colonic inflammation seen. He was treated with a week of ciprofloxacin and metronidazole with transient improvement in his symptoms. He denied any significant social history. Family history was negative for inflammatory bowel disease. He denied any NSAID use, but he did report a 3-day course of clindamycin approximately 3 weeks ago for a dental procedure. His lab values were notable for a mild leukocytosis of 12.6 × 109/L (ref range 4.8–10.8 × 109/L), elevated C-reactive protein at 1.89 mg/dL (ULN ≤ 0.60 mg/dL), normal lactate at 1.0 mmol/L (ref range 0.6–2.2 mmol/L), and a negative QuantiFERON TB Gold Plus. He had CT imaging repeated of his abdomen and pelvis that was significant for multiple loops of ileal wall thickening consistent with severe ileitis without any inflammation of the large intestine. Given the concern for Crohn's disease, a colonoscopy was performed and a normal terminal ileum was seen for 30 cm. There were multiple small-mouth diverticula seen in the descending, transverse and ascending colon along with a prior end-to-end colo-colonic anastomosis in the sigmoid colon. The mucosa appeared to be normal and healthy in the colon. Random biopsies taken of the terminal ileum and colon were negative for any significant pathological diagnosis. No antibiotics were given prior to colonoscopy. Stool studies returned with a positive Clostridium difficile result, but negative stool culture and parasite screen. He was treated with a 14-day course of metronidazole 500 mg Q8H with resolution of his symptoms.

DISCUSSION:
This case is atypical given the patient's lack of significant diarrhea, CT imaging findings of distal ileal involvement without any colonic inflammation, and normal findings on both endoscopic evaluation and pathology. While C. difficile is the most common cause of healthcare associated infectious diarrhea, small bowel infection with C. difficile is a rare presentation. The pathophysiology of C. difficile enteritis is not well understood, but most cases reported in the literature have been described in patients with altered bowel anatomy such as colectomy, pouch construction or other large and small bowel surgery. In these cases, the small bowel is postulated to be more susceptible to colonization and infection in the setting of surgical intervention. This case highlights that C. difficile can solely affect the small bowel of patients with limited colonic resections which is important for practicing gastroenterologists.
P093 Stressful events possibly related to the onset of IBD
Authors: Beatriz Pernalete , Guillermo Veitia 
Published: July 2019

BACKGROUND:
Inflammatory Bowel Disease (IBD) is a multifactorial disease. There may be mentioned a bacterial antigen act as trigger the clinical picture in a genetically predisposed patient with a mucosal permeability altered by an inappropriate immune response. Often stress is perceived by patients with IBD as the leading cause of their disease, as Psychosomatic theory says. Studies have shown that chronic stress have a significant effect on the immune system illness as its ultimate manifest. It rises catecholamines and suppressor T cells levels, which suppresses the immune system. So we asked the question: was there be a stressful event that may have been related to the onset of IBD in our patients? The aim of study was to assess whether stress, though life events, are associated with onset IBD.

METHODS:
112 patients with IBD (83 with ulcerative colitis (UC) and 29 with Crohn´s Disease (CD), aged between 18 and 65 years, from 3 university hospitals in 2 cities of Venezuela (Caracas and Maracaibo) were given a survey with dichotomous items, simple selection and filling of information, easy management, simple language and short duration. The study of the collected data was performed using the statistical method of frequency analysis.

RESULTS:
16.7% of the sample analyzed denied stressful event before the start of IBD. 83.03% reported stressful situations during the year before the onset of the disease (35 patients reported stress economic situation, labor problems 21, lost close family member 17, divorce 13, domestic violence 8, sexual abuse 3).

CONCLUSION(S):
Due to the high percentage of patients reporting stressful events prior to the onset of IBD stressful events, when we talk about the theories related to the pathogenesis of these diseases, it would be interesting to mention the psychosomatic theory. We recommend that all Multidisciplinaries IBD teams should have a psychologist and/or psychiatrist conducting psychiatric and/or psychological evaluation to conclude the presence or absence of psychological disorders i IBD patients and give them appropriate treatment. This would help significantly to patient management and most likely to get that improvement related to the comprehensive evaluation over all.