bluuebunny/crossref_metadata_2025_split huggingface dataset:
P064 Receptive anal intercourse in patients with inflammatory bowel disease: The role of sexually transmitted infections
Authors: Ian Karrington , Jordan Axelrad , Shannon Chang , Richard Greene , Lisa Malter 
Published: July 2019

BACKGROUND:
Receptive anal intercourse (RAI) is a common practice in both men who have sex with men (MSM) and heterosexual populations. While inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), affects over 1 million people in the United States, there have been no studies linking IBD and sexually transmitted infections (STIs). IBD can lead to an inflamed and leaky colonic epithelial barrier, which may increase the risk of rectal STI acquisition. The increased risk of HIV seroconversion in MSM with untreated rectal gonorrhea (GC) and chlamydia (CT) may support this theory.

CASES:
Our first case is of a 24-year-old MSM who was diagnosed with left-sided UC at age 21 in the setting of bloody diarrhea and tenesmus. He was originally treated with topical and oral 5-ASA, and topical steroids, but developed a mesalamine-associated rash and consequently discontinued these agents. At 24, the patient presented to clinic with recurrence of bloody diarrhea and tenesmus, and on questioning was found to engage in RAI. Rectal swab and enteric pathogen PCR panel revealed rectal gonorrhea and shigella. The patient was treated with ceftriaxone and azithromycin and symptoms completely resolved. Our second patient is a 23-year-old MSM male with UC from rectum to 50 cm who had achieved deep remission on adalimumab monotherapy, and presented with tenesmus, increased mucous, and a history of RAI. The patient tested positive for rectal CT and was treated with doxycycline. The patient’s symptoms resolved completely after treatment.

DISCUSSION:
Rectal STIs may complicate IBD. Underlying IBD, especially the presence of active proctitis and the utilization of immunosuppression, may increase susceptibility to STI acquisition via RAI. These cases indicate the importance of careful history taking and frequent rectal STI testing in IBD patients who engage in RAI. Future studies are required to continue to explore the influence of STIs on IBD patients who engage in RAI, including qualitative data on how IBD patients navigate RAI and STIs and quantitative data to gauge how prevalent STIs are in IBD patients compare to the general population.
P066 The relationship between serum adalimumab and corresponding anti-adalimumab antibody levels: analysis of over 20,000 patient results
Authors: Kelly Chun , Imir Metushi , Jeanne Eby , Stephen Phagoo , Morgan Herle , James Iha , Jane Yang 
Published: July 2019

BACKGROUND:
Adalimumab (ADL) is a TNF inhibitor administered by injection. Serum assays of ADL and its anti-drug antibodies (ADAb) are utilized to manage failure to respond and loss of response. These monitoring assays may also be used to proactively titrate doses and dosing intervals (1). Here, 22,012 adalimumab (ADL) patient results were analyzed.

METHODS:
Measurements of drug and ADAb levels were performed by lab developed chemiluminescent immunoassays (2). The lower limits of quantitation are 0.6 μg/mL for adalimumab and 25 ng/mL for anti-adalimumab antibodies. Drug assays measure free (ADAb-unbound) drug while ADAb assays detect total antibodies (including IgM and IgG subtypes) and are drug- tolerant to the presence of up to >20 μg/mL of drug. Clinical histories and blood collection timing are unknown.

RESULTS:
Of 22,012 measured adalimumab samples, 60% (13,176) were ADAb-free and 40% (8,836) had measurable anti-adalimumab antibodies. Of all ADAb-free samples, the majority (10,171 or 77%) had ADL concentrations between 3 and 30 μg/mL while drug levels were <3 μg/mL in 2,495 (19%). Of ADAb-positive samples, most were positive in the low to intermediate titer range (25 to 200 ng/mL) Furthermore, as ADAb increase, their corresponding mean drug concentrations diminish. Low concentrations of ADAb (<100 ng/mL) appear to have minimal impact on mean drug levels where the baseline mean adalimumab (6.1 μg/mL) was calculated from 11,085 ADAb-free samples with adalimumab from 0.6 to 15 μg/mL. ADAb titers between 100 and 300 ng/mL are associated with a moderately diminished mean adalimumab (3.4–5.6 μg/mL) while high ADAb titers (>300 ng/mL) are invariably associated with diminished free ADL concentrations <30% of the mean.

CONCLUSION(S):
Of 22,012 samples, 60% were ADAb-free. Of those, about one third (37%) were within the target range of 5–10 μg/mL for adalimumab while 36% of samples were subtherapeutic at <5.0 μg/mL. Anti-adalimumab antibodies occurred in 40% of samples, and ADL drug concentrations were inversely related to anti-adalimumab antibody titers where low titer ADAb may have little or no impact on free drug levels while high titer ADAbs are associated with very diminished or absent drug. These findings are consistent with American Gastroenterological Association Critical Care Pathways for Crohn's Disease and Ulcerative Colitis where low and high antibody scenarios are managed very differently. It may be possible to treat away low titer ADAb by increasing drug or adding an immunomodulator (3). Therefore, drug-tolerant anti-drug antibody assays that have been designed both (1) to detect low level ADAb and (2) to distinguish low to intermediate to high titers with high resolution (from 25 to 2,000+ ng/mL) may be most helpful in preventing, managing and treating immunogenicity.
P068 The utility of contrast-enhanced trans-abdominal ultrasound in the assessment of ileal Crohn's disease
Authors: Samuel Kallus , Mohammad Aboelsoud , Aline Charabaty 
Published: July 2019

BACKGROUND:
While ileo-colonoscopy remains the gold standard for luminal evaluation of Crohn’s ileitis, repeated colonoscopies to reassess disease activity can be inconvenient (prep, lost time from work) and put the patient at additional procedure risk and increase health care cost. MRI and CT enterography can be used to assess ileal disease, but the tests involve contrast use, radiation exposure, and are lengthy and costly. Contrast-enhanced ultrasound (CEUS) has been promoted in Europe and Asia as a promising tool for assessment of disease activity with lower cost and no radiation exposure.

METHODS:
This is a prospective study currently enrolling patients with active Crohn's ileitis. All patients underwent evaluation with ileo-colonoscopy and serum inflammatory marker (CRP). Subsequently, all patients underwent CEUS by an independent radiologist who was blinded to the endoscopy results. Ultrasound contrast agent sulfur hexafluoride with gas-filled microbubbles was used (4.8 mL of IV Lumason, Bracco Diagnostics Inc), with real-time visualization of bowel wall microvascularization and perienteric tissue. Bowel wall thickness was measured and a time-signal intensity curve was obtained after calculating the peak enhancement and area under the curve. Prior groups (1) used a cut off point of 18.2 dB for moderate activity and 23.0 dB for severe activity. CEUS findings were compared to the endoscopic findings to assess for correlation in assessing disease activity and severity.

RESULTS:
Four male patients (age 22–65, 3 AA and one Caucasian) with symptomatic Crohns ileitis were enrolled in our study thus far. Patient A had moderate inflammation on CEUS with a peak intensity of 22 dB correlating with Rutgeerts i3 ileitis (large ulcers) above the ileoclonic anastomosis. Patient B had severe inflammation on CEUS with a peak intensity of 27 dB that correlated with moderate to severe ileitis with an inflammatory stricture on endoscopy. Patient C and D both had mild enhancement of distal ileum with a peak intensity of 17 dB; correlating with the findings of aphthous and larger ulcers on endoscopy. Only the 2 patients with a peak intensity of 27 dB had elevated CRP.

CONCLUSION(S):
In our limited experience, CEUS correlates with endoscopic findings of active ileitis and disease severity in Crohn's patients. With further patients enrollment and follow up, we aim to confirm this finding and to assess whether CEUS imaging can also evaluate inactive ileitis in treated Crohn's patients.
P069 Listeria monocytogenes bacteremia in a pregnant ulcerative colitis patient treated with adalimumab and azathioprine
Authors: Sang-Bum Kang , Hoon Jung Sung , Bum Kim Dae , Kang-Moon Lee , Sung-Ae Jung 
Published: July 2019

BACKGROUND:

Listeria monocytogenes is an aerobic gram-positive intracellular bacillus, often foodborne and found elsewhere. Although it is an uncommon cause of illness in the general population, it is an important cause of severe infection in neonates, pregnant women, elderly and immunosuppressed patients. Invasive listeriosis, meningitis and meningoencephalitis, bacteremia with or without joint, eye or heart focalization are clinical manifestations of the disease. Maternal listeriosis may develop intrauterine infection of fetus which can lead to severe complications such as amnionitis, preterm labor, spontaneous abortion, stillbirth and neonatal sepsis. Anti-TNF therapy has changed treatment paradigm of inflammatory bowel disease for decades. TNF-α acts as a mediator of local inflammation to contain infection and is crucial in host's response against various microorganisms, particularly intracellular agents like Mycobacterium and Listeria monocytogenes. We report a case of Listeria monocytogenes bacteremia in pregnant ulcerative colitis (UC) patient treated with adalimumab and azathioprine.

CASE:
A 33-year-old pregnant UC patient was hospitalized with high fever after a trip to China. She is at 17 weeks pregnant and being treated with adalimumab and azathioprine for 2 years. The colonoscopy was performed at 6 months before and showed mucosal healing of large intestine. She is currently in clinical remission despite fever. Laboratory finding shows leukocytosis (18,000/mm3), mild anemia (11.2 g/dL) and high CRP (12.5 mg/L). Listeria monocytogenes was identified with her blood culture, and the ampicillin was administered immediately. We decided to stop adalimumab and azathioprine until delivery because of concerns that anti-TNF can go through placenta and may cause an intrauterine infection. After antibiotics were administered to her for 2 weeks, her infection was treated and laboratory findings were normalized. She is currently undergoing routine antenatal visits to the obstetrician, has no evidence of intrauterine infection, and still maintains clinical remission.

DISCUSSION:
We report the first case of Listeria monocytogenes bacteremia in a pregnant UC woman receiving adalimumab and azathioprine. We hope that the treatment policy for discontinuation and re-administration of biological agents will be established in this case in the future.
P070 Stricturing Crohn's disease: Can we predict need for surgery at first hospitalization?
Authors: Sofia Xavier , Tiago Curdia Gonçalves , de Castro Francisca Dias , Joana Magalhães , João Moreira Maria , José Cotter 
Published: July 2019

BACKGROUND:
Patients with stricturing Crohn’s disease (CD) are frequently hospitalized and a significant percentage requires surgery in the course of the disease. We aimed to assess if there are any predictors of surgical management by the time of the first admission to hospital with obstructed bowel symptoms.

METHODS:
Retrospective unicentric study. Patients over 18 years old, with structuring ileal or ileocolonic involvement, with at least one hospitalization and a minimum follow up of 1 year were included. Excluded patients with penetrating disease, those who had their first hospitalization before anti-TNF agents became available in our center and those without appropriate records. Several clinical, analytical and radiological variables were assessed. Statistical analysis was performed using SPSS v23.0.

RESULTS:
Included 43 patients of which 53.5% underwent surgery to treat structuring disease. Patients had a mean age of 43.3 ± 10.8 years, 53.5% were females and the median follow up time was 11.0 ± 7.0 years. Comparing patients with and without need for surgery, no significant differences were found between groups regarding age at diagnosis, presence of perianal disease, family history and smoking habits, however females were more frequently submitted to surgery (73.9% vs 30.0%, P = 0.004) as well as patients who already had a structuring behavior at diagnosis when compared with those with inflammatory behavior at diagnosis (65.6% vs 18.2%, P = 0.006). At the first hospitalization, patients with need for surgery were less frequently under anti-TNF (0.0% vs 20.0%, P = 0.039), presented with longer-standing obstructed bowel symptoms (3.0 ± 1.5 days vs 1.0 ± 1.0 days, P = 0.010), higher leukocytes count (12.0 ± 5.3 × 103/μL vs 9.2 ± 6.9 × 103/μL, P = 0.037) and admission computerized tomography (CT) more frequently showed proximal small bowel dilation (86.4% vs 40.0%, P = 0.002) and longer extent of small bowel involved (8.0 ± 12.0 cm vs 5.0 ± 7.0 cm, P = 0.016). Also, patients that were diagnosed by the time of the first hospitalization were more frequently submitted to surgery than those who already had a CD diagnosis (60.9% vs 39.1%, P = 0.043).

CONCLUSION(S):
Females, patients with structuring behavior from diagnosis and those diagnosed in the first hospitalization were more frequently submitted to surgery. Small bowel dilation and extent of small bowel involved in admission CT, leukocyte count and duration of obstructed bowel symptoms at the first admission were also predictors of need for surgery. Anti-TNF therapy before the first admission seems to reduce need for surgery in this group of patients.
P071 Quality of life of patients treated in an Inflammatory Bowel Disease Program in Chile
Authors: Daniela Simian , Lilian Flores , Rodrigo Quera , Patricio Ibáñez , Jaime Lubascher , Carolina Figueroa , Gonzalo Pizarro , Udo Kronberg 
Published: July 2019

BACKGROUND:
Inflammatory Bowel Disease impacts patient's quality of life (QoL). Its chronic nature, flares, extraintestinal manifestations, the risk of surgery and cancer, affects their QoL, however, the results depends on each population. The aim of this study was to determine QoL of patients treated in an Inflammatory Bowel Disease Program in Chile.

METHODS:
A descriptive, cross-sectional study was performed between March and July 2018. All patients with Crohn’s Disease (CD) or Ulcerative Colitis (UC) who attended a medical consultation in the IBD Program were evaluated for QoL with the shortened Spanish version of the IBDQ. The IBDQ-9 survey consists of 9 items assessing different aspects of life in IBD patients. Each question has 7 different possible answers, scoring from 1 (poorest) to 7 (best). Higher scores correspond to a better QoL. IBD clinical variables, clinical disease activity and fecal calprotectin were also evaluated in the medical consultation. Patients with a Harvey-Bradshaw score >4 for CD and a Mayo Subscore >2 for UC, and fecal calprotectin >250 μg/g were considered with active disease. Statistical analysis was performed using frequency, medians and Mann Whitney test (P < 0.05).

RESULTS:
During the study period 1,051 medical consultations were performed, assessing QoL in 457 patients; 78 in their first visit in the IBD Program (17%) and 379 follow-up patients (83%). Demographic and clinical variables were: 60% female, median age 35 years (r: 15–88), 326 patients with UC (71%) and 131 with CD (29%), median duration of disease 5 years (r: 0–43), 224 with extraintestinal manifestations (49%). Related to disease activity, 45% were clinically active. From all patients, fecal calprotectin was determined concomitant to the medical consultation in 264 patients (58%), 118 of them with fecal calprotectin >250 μg/g (45%). Of all patients, 4% showed low QoL, 41% medium and 58% high. The median of QoL was lower in patients consulting for the first time in the IBD Program than patients in regular follow-up (38 vs 46; P = 0.005). Patients with active disease showed statistically significant lower QoL than patients in remission, in both groups (33 vs 41; P = 0.002 in the first visit and 35 vs 47; P < 0.0001 in follow-up patients). In addition, in the follow-up group, female gender, CD, presence of extraintestinal manifestations, fecal calprotectin >250 μg/g and not being treated with biological therapy, were significantly associated with lower QoL.

CONCLUSION(S):
A high percentage of patients with IBD refers a low or medium QoL (45%), even more in severe patients. The QoL should be evaluated as an integral part of the management of patients with IBD, considering that the improve of patient’s perception of QoL is one of the goals of the treatment in IBD.
P073 Male gender, smoking and stenosis are risk factors for postoperative endoscopic recurrence after ileocaecal resection for Crohn's disease
Authors: Michel Camargo , Barbara Correa , Daniela Magro , Marcello Rabello , Priscilla Oliveira , Raquel Leal , Maria de Lourdes Ayrizono , Augusto Martinez Carlos , Claudio Coy 
Published: July 2019

BACKGROUND:
Colonoscopy is an important exam for diagnosis and follow-up of Crohn’s disease (CD). It has a relevant role in the management of patients after ileocaecal resection (IR), evaluating ileocolonic endoscopic recurrence (ER), performing biopsies and endoscopic dilations. This study describes the colonoscopies performed in patients previously submitted to IR for CD complications, evaluating its impact in the management and evolution of the disease.

METHODS:
Between January 2014 and May 2018, a total of 116 colonoscopies were performed in 62 patients with previous IR for CD. This study describes demographic data, personal and family history, use of medications, Harvey-Bradshaw index (HBI), endoscopic findings, post-colonoscopy alterations of medical treatment and need of new surgery. For endoscopic classification, Rutgeerts index for severity of post-operative CD was used, and ER was defined as scores 3i2. For statistical analysis, software SPSS 20.0 was used. It was considered statiscally significant values of p£0.05.

RESULTS:
Among all patients, 38.7% were male gender, which was a risk factor for ER (P < 0.05). Mean time of CD was 156 months (12–385). Prevalence of smoking was 17.7%, which also was a risk factor for ER (P < 0.05). Family history for CD was positive in 9 cases (14.5%). HBI showed low sensibility for predicting ER. Forty-five patients refered regular use of medication prescribed, while eight patients were in irregular use. Nine patients were without medication. Although there was no statistical significance (P = 0.15), the use of combotherapy was less associated with ER, when compared to other therapies. Regarding ER, 36 cases were i0; 18 cases i1, 38 cases i2; 5 cases i3; and finally, 16 cases i4. On follow-up, patients with ER more frequently had drug optimization or change of medication (P < 0.05). None of the patients classified as i0, i1, i2 e i3 needed new surgery on follow-up. Two cases classified as i4 had indication of new surgery. Ileocolonic stenosis was a risk factor for ER (P < 0.05): in a total of 23 cases, 16 were active disease with ulcerated stenosis. One balloon dilation was done in a patient with non-ulcerated ileocolonic stenosis. There were no cases of bleeding and perforation.

CONCLUSION(S):
Postoperative endoscopic follow-up after ileocaecal resection should be routinely performed. In our study, approximately 46% of the patients were in endoscopic remission. In contrast with previous reports, the majority of our i3 and i4 cases were managed clinically, with a low rate of new surgery (around 5%) Male sex, smoking and stenosis were risk factors for ER.
P076 Cyto-regenerative effect of serum derived bovine immunoglobulin's in DSS induced IBD mice model
Authors: Lubna Majeed , Muhammad Faisal , Wafa Majeed , Alishbah Roobi , Noreen Aslam , Humaira Muzaffar , Aisha Mahmood , Haseeb Anwar , Aziz Rahman , Faqir Muhammad 
Published: July 2019

BACKGROUND:
Inflammatory bowel disease is chronic inflammation of the GUT and having 2 major forms such as, UC (Ulcerative colitis) and CD (Crohns disease) derived after oxidative stress in the lumen of the GUT. Serum derived bovine immunoglobulin is a dairy free dietary supplement that is used for dietary management of gastrointestinal disorders. Contemporary study was designed to elucidate the effect of serum derived bovine immunoglobulins on gastrointestinal physiology in DSS induced IBD mice model.

METHODS:
A 3 week research study was planned, 3 groups of mice were arranged, entitled as negative control group, positive control group that was treated with 0.5 mL of 5% DSS solution each day and treatment group was treated with serum derived bovine immunoglobulin's (SBI) after IBD induction with DSS with 3 replicates.

RESULTS:
Physiological parameters revealed highly significant differences (P < 0.001). Hematological analysis (RBCs, WBCs, platelet count, MCHC, MCH and lymphocyte concentration) indicated significant differences (P < 0.05) where as other parameters indicated non-significant results (P > 0.05). White blood cells concentration was raised in positive control group and restoration was occurred in SBI treatment group while Red blood cells were declined in positive control group and recovered in treatment group, showed highly significant difference (P < 0.001). Platelet count were also increased in IBD induce group and improvement was observed in SBI treatment group (P < 0.05). Serum profile testing (TAC, total antioxidant capacity TOS total oxidative status) and histopathological investigation was also done and showed significant results (P < 0.05). mRNA expression level of TRAF-4, TRAF-6 and MAPK8 is MAPK downstream JNK Pathway and calcium signaling (Pias-1, Gerk-2 and Calm-2) cascade were studied through qRT-PCR. In positive control group the mRNA expression level of TRAF-4, TRAF-6, MAPK8, Pias-1, Gerk-2 and Calm-2 was significantly (P ≤ 0.01) increased in comparison to control and SBI treated group. Low mRNA expression level was studied in control as well in SBI treated individuals. All the data attained for each parameter was analyzed using appropriate one-way (ANOVA) and Duncan's Multiple Range (DMR) test by keeping the level of significance at 5% and graph pad prism 6 were used for graph.

CONCLUSION(S):
It is concluded that disruption of mucosal layer of gut was examined in DSS induced positive control group which decreased nutrients absorption by disturbing tight junctions proteins between epithelial cells and caused immune imbalance in mucosal layer while restoration and regeneration of epithelial lining and villi observed in SBI treatment group. Mucosal regeneration normalized the nutrients absorption, immune homeostasis.