bluuebunny/crossref_metadata_2025_split huggingface dataset:
P046 Complementary and alternative medicine in patients with inflammatory bowel disease 20 years after diagnosis: Results from the IBSEN study
Authors: Randi Opheim , Jørgen Jahnsen , Tomm Bernklev , Ole Høie , Gert Huppertz-Hauss , Bjørn Moum 
Published: July 2019

BACKGROUND:
Use of complementary and alternative medicine (CAM) is common among IBD patients (1). The CAM modalities used include a wide specter of health care practices and therapies (2). In a previous study from this population, we found that almost one third of the patients used CAM 10 years after diagnosis (3). The aim of this follow-up study was to assess CAM use in IBD patients 20 years after diagnosis.

METHODS:
The Inflammatory Bowel South-Eastern Norway (IBSEN) study is a population based study with a prospective design. From January 1990 to December 1993, all newly diagnosed patients with IBD from a well defined area in South Eastern Norway were included in the cohort. The 20-year follow-up was conducted between 2011 and 2014 and included a structured interview, a review of patient records, a clinical examination, laboratory tests, and a questionnaire regarding CAM use.

RESULTS:
Of the 599 invited to attend the 20-year follow - up visit, 78.5% (UC = 314, CD = 156) participated in the follow- up study, whereof 93% (UC = 293 and CD = 146) completed the CAM questionnaire, 49% men. In total 122/439 (28%) reported use of CAM for their IBD, and 6% reported current CAM use. A significantly higher proportion women than men (60% vs 40%, P = 0.02) reported to use CAM. CAM users were younger (49 years) than the non-users (56 years), P < 0.001. A significantly higher proportion CD patients compared to UC patients (34% vs 25%, P = 0.04) reported CAM use. Treatment with CAM occurred more frequently in patients with more than one relapse the last year than in patients in remission (35% vs 21%, P = 0.003). The 3 most commonly used types of CAM were acupuncture 63/122 (52%), homeopathy 49/122 (40%) and herbal medicine 47/122 (39%). The 2 most common reasons for using CAM was as (1) a supplement to conventional treatment (41%) and (2) lack of effect from conventional medicine (32%).

CONCLUSION(S):
One third of the IBD patients reported CAM use 20 years after diagnosis. Prevalence of CAM use was comparable in the 10-year and 20-year follow- up. CAM use was more common among women, in younger patients, in UC patients, and in those with disease activity.
P047  Relevant factors and significant endoscopic findings for detecting UC-associated neoplasms using pan-colonic NBI surveillance colonoscopy: A sub-analysis of navigator study
Authors: Kenji Watanabe , Reo Kawano , Masakazu Nishishita , Fumio Shimamoto , Takumi Fukuchi , Esaki Motohiro , Shiro Oka , Shigehiko Fujii , Fumihito Hirai , Kazuki Kakimoto , Takuya Inoue , Ryoich Nozaki , Hiroshi Kashida , Ken Takeuchi , Naoki Ohmiya , Masayuki Saruta , Shoichi Saito , Shinji Tanaka , Yoichi Ajioka , Hisao Tajiri 
Published: July 2019

BACKGROUND:
We recently reported the results of a prospective multicenter randomised controlled trial comparing pancolonic observation using a newly developed NBI (CF-HQ290I) and panchromoendoscopy (PCE) for surveillance colonoscopy in UC patients. The results revealed that the NBI observation was not inferior to PCE for the detection of both neoplastic lesions (13.4% vs 9.0%; P = 0.33) and colitis-associated dysplasia or cancer (CC/D) (6.3% vs 4.9%; P = 0.86). Moreover, the total examination time of NBI (15.0 min) was significantly shorter than that of PCE (19.8 min) (P < 0.01). This sub-analysis aimed to evaluate the relevant factors or NBI findings of the background mucosa of CC/D in the preceding Navigator Study (UMIN000013527).

METHODS:
In total, 263 patients were randomised to the PCE group (n = 130) and the NBI group (n = 133). Surveillance colonoscopy in both groups was performed mainly with targeted biopsy. The pathological diagnoses were made by 2 expert pathologists who performed including immunohistochemical staining (p53, Ki-67) while being blinded to clinical information.

RESULTS:
A total of 21 sporadic adenoma, 3 traditional serrated adenoma, 2 sessile serrated adenoma/polyp, 10 indefinite for dysplasia, 9 low grade dysplsisadysplasia, and 7 high grade dysplasia or cancer cases were detected. There was no statistical difference for in the contents of these detected lesions between the 2 groups (P = 0.91). The median number of biopsy samples was not different between the 2 groups (1.80/case in NBI, 1.85/case in PCE; P = 0.88). Multivariate analysis demonstrated that age (OR 1.05, 95% CI 1.02–1.08, P < 0.01) and past history of CC/D (OR 4.26, 95% CI 1.29–14.05, P = 0.02) were the relevant factors for the detection of neoplastic lesions, and past history of CC/D (OR 5.70, 95% CI 1.33–24.50, P = 0.02) was the relevant factor for the detection of CC/D. CC/D was significantly more frequently detected than sporadic adenoma in cases in which the background mucosa had an obscure vascular pattern or scar rather than a fair view of the vascular pattern or out of range for inflammation (OR 25.0, 95% CI 3.80–164.4, P < 0.01).

CONCLUSION(S):
In the Navigator Study, a past history of endoscopic resection or detection of dysplasia on random biopsy was the relevant factor for the detection of CC/D. The NBI findings of the background mucosa were useful in differentiating CC/D and sporadic adenoma.
P050 Clinical outcomes of refractory Crohn's disease following hematopoietic stem cell transplantation: A single center experience
Authors: Natália Queiroz , Luisa Barros , Matheus Azevedo , Alexandre Carlos , Luciane Milani , Beatriz Rocha , Jane Oba , André Leite , Aytan Sipahi , Adérson Damião 
Published: July 2019

BACKGROUND:
Hematopoietic stem cell transplantation (HSCT) has recently been described as an option for treatment of patients with refractory Crohn’s disease in whom surgical treatment is not possible or desired (1). However, the reported long term follow up of patients submitted to this treatment is usually no longer than12 months (2).

METHODS:
Data from 5 patients who had undergone HSCT due to refractory Crohn's disease followed in the IBD unit of Gastroenterology Division of the Clinics Hospital of the University of São Paulo was retrospectively collected based on medical records.

RESULTS:
From 2014 to 2016, 5 patients were transplanted: 4 male and one female. Median age was 27 years old [20–43] and mean disease duration was 6 years [3–8]. Two of them were active smokers. Location of disease was ileocolonic in 4 patients and colonic in the other. Three of them had inflammatory behavior, one stricturing and the other penetrating disease (perianal fistula). One patient had had previous right colectomy before HSCT. All patients had failed at least one immunosuppressor (Azathioprine and/or Methotrexate) and 2 anti-TNFs (Infliximab and Adalimumab). Only one patient was treated with anti-integrin (Vedolizumab) prior to HSCT. Patients underwent annual lower GI endoscopies after transplantation during a 36-month median follow-up. After HSCT, all patients had clinical remission for at least 6 months. Endoscopic remission (defined by absent of ulcers) was observed in only one patient in the first year. This patient was non smoker, had colonic inflammatory disease and no surgical history. Four patients relapsed during the first year and required retreatment with immunomodulator and/or anti-TNF. Half of them (n = 2) achieved deep remission after 36 months of follow up. None required surgery or died after HSTC.

CONCLUSION(S):
This long term follow-up case series have demonstrated that HSCT may be a reasonable option to very refractory CD patients in order to avoid radical surgical procedures. Even when endoscopic remission is not obtained after transplantation, refractory patients can become responders to medications previously used.
P051 MR-enterography with diffusion weighted imaging and apparent diffusion coefficient map for assessing inflammatory bowel disease in children and adolescents
Authors: Itsuhiro Oka , Osamu Miyazaki , Ichiro Takeuchi , Hirotaka Shimizu , Toshiaki Shimizu , Katsuhiro Arai 
Published: July 2019

BACKGROUND:
Endoscopy has been considered as the gold standard for the assessment of gastrointestinal inflammation, however, it can only evaluate superficial mucosal layers. Crohn's disease could cause transmural inflammation in any part of the gastrointestinal tract. As a result, stenosis, perforation, and internal/external fistula formation can complicate with this inflammation, and assessing the inflammatory activity of the bowel wall, not limited to the superficial intestinal mucosa, would lead to the proper diagnosis as well as management to minimize complication in patients with inflammatory bowel disease (IBD). Small bowel inflammation can be evaluated by both magnetic resonance imaging (MRI) and computed tomography (CT), and they have shown similar accuracy and sensitivity for the detection of active inflammation. Recent studies have addressed the utility of Diffusion Weighted Imaging (DWI) and apparent diffusion coefficient (ADC) map in adult, while there have been few studies using these modalities in children and adolescents. The aim of this study was to explore the usefulness of ADC values in children with IBD.

METHODS:
Children and adolescents with IBD that required MR-enterography (free-breathing axial DWI with 2 b (0 and 800 s/mm2) was included) for the assessment of small intestinal lesion at a Japanese children's hospital were retrospectively reviewed. A total of 14 children and adolescents with IBD (12 CD and 2 UC), aged 5 to 23 years who had undergone MR-enterography from 2017 to 2018. Mean restricted ADC (r-ADC) value was obtained in a set of value (3 points of thickened bowel wall in all patients [n = 14]). Also, mean non-restricted ADC (nr-ADC) value was obtained from normal bowel wall as well as r-ADC described above. Fourteen age-matched control patients that had undergone MR-enterography were identified. In addition, mean ADC value of non-IBD patients (ni-ADC) was obtained from normal intestinal wall as a control group (e.g., neuroblastoma, n = 14). These values were compared using t-test. P < 0.05 were considered to indicate statistical significance.

RESULTS:
The r-ADC values were significantly lower than the nr-ADC values (1.118 ± 0.271 × 10−3 mm2/s vs 2.119 ± 0.252 × 10−3 mm2/s; P < 0.01). However, there was no significant difference between ni-ADC and nr-ADC (2.15 ± 0.217 × 10−3 mm2/s vs 2.119 ± 0.2519 × 10−3 mm2/s; P = 0.556).

CONCLUSION(S):
DWI and ADC map were useful in locating actively inflamed bowel segments. MR-enterography with DWI and ADC map appeared an excellent modality to assess intestinal inflammation that can be repeatedly used without radiation exposure, even in pediatric patients. Further studies to investigate for the threshold of ADC value that can be used for children with IBD should be considered.
P054 Use of corticosteroids at time of diagnosis in ulcerative colitis is common and this practice remains unchanged over time
Authors: Arne Carlsen , Roald Omdal , Lars Aabakken , Normann Karlsen Lars , Terje Kvaløy Jan , Oyvind Steinsbø , Tore Grimstad 
Published: July 2019

BACKGROUND:
Corticosteroids (CS) have been the mainstay for treatment of moderate to severe ulcerative colitis for more than 60 years. Side effects and complications are increasingly recognized, and the aim in clinical practice is generally to minimize its use. The aims of this study were to describe whether the practice of administering CS as standard tapered courses at the time of diagnosis had changed during a 6-year period (2012–2017), and also to investigate if patients selected for this regimen overall had more severe and extensive disease.

METHODS:
In total, 203 patients, aged 16 years and above, were consecutively included at time of UC diagnosis in a single center cross sectional study conducted at Stavanger University Hospital, Norway, from 2012 to 2017. Demographic data, medication, CRP, albumin, fecal calprotectin and Partial Mayo Score (PMS) were recorded. In addition, disease distribution (Montreal Classification) and severity (Mayo Endoscopic Score, MES-UC) were assessed at index colonoscopy. A time trend analysis for yearly CS administration was performed using logistic regression, other variables were compared pairwise.

RESULTS:
Overall median (range) age was 34 (16–76) years, and 59% were males. Median CRP concentration was 5.5 mg/L (1–184), albumin 39.5 g/L (10.3–49.6) and fecal calprotectin 695 mg/kg (17–5,466), whereas median PMS was 5 (0–9). Proctitis (E1) was diagnosed in 27.7% of the patients, whereas 28.2% had left sided colitis (E2) and 44.6 % had pancolitis (E3). All patients received 5-ASA treatment (12.5% topical, 35% oral, and 52.5% combined). Antibiotic treatment was prescribed in 13.3 % of the patients, whereas 6.4% received a biological agent and 2% conventional immunosuppressive drugs. CS treatment rate at time of diagnosis was 41.9%, with no significant year-to-year variation, ranging from 30% to 50%, in the selected time period, P = 0.32. Patients treated with CS had higher median CRP (22 vs 2.9 mg/L, P < 0.001), fecal calprotectin (1,052 vs 575 mg/kg, P = 0.02) and PMS (6.5 vs 4, P < 0.001), and a lower albumin (36.0 vs 41.8 g/L, P < 0.001) than patients not receiving CS. CS-treated patients were also more likely to have pancolitis (E3) than left sided colitis (E2), P = 0.001, and more severe disease activity (MES-UC score 3 vs 2), P < 0.001.

CONCLUSION(S):
The practice of administering CS courses at time of diagnosis in UC remained high, with no significantly yearly variation in treatment rate during the selected 6-year period. Commencing CS courses was associated with higher disease activity and more extensive disease. This indicates that CS treatment still has an essential role in the treatment of severe UC disease.
P058 Serum infliximab and corresponding anti-infliximab antibody: Analysis of over 30,000 patient results using lab developed chemiluminescent immunoassays
Authors: Kelly Chun , Imir Metushi , Jeanne Eby , Stephen Phagoo , Morgan Herle , James Iha , Jane Yang 
Published: July 2019

BACKGROUND:
Assays to measure TNF inhibitors and anti-drug antibodies (ADAb) in patient serum are being 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, 37,165 infliximab (IFX) patient results over 4 years were analyzed.

METHODS:
Measurements of drug and ADAb levels were performed by lab developed chemiluminescent immunoassays (2). The lower limits of quantitation are 0.4 μg/mL for IFX and 22 ng/mL for its ADAb. 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 >50 μg/mL of drug. Clinical histories and blood collection timing are unknown.

RESULTS:
Of 37,165 measured IFX samples, 55% (20,359) were ADAb-free and 45% (16,806) had measurable anti-infliximab antibodies, ranging in concentration from 22 to 3.5 million ng/mL. In the absence of ADAb, IFX concentrations were from 0.4 to >50 μg/mL, with the majority (>60%) between 3.0 to 20 μg/mL. In the presence of ADAb, an inverse relationship between IFX concentrations and anti-IFX antibodies was demonstrated. As a baseline reference, an ADAb-free mean drug level from 16,463 samples with IFX between 0.4 and 30 μg/mL was found to be 10.0 μg/mL. Mean IFX concentrations decreased in samples with increasing ADAb. Low ADAb (<200 ng/mL) appears to have minimal impact on mean drug levels while high ADAb (>1,000 ng/mL) is invariably associated with severely diminished IFX (10% or less than the mean).

CONCLUSION(S):
Upon analysis of 37,165 infliximab patient samples, 45% exhibited anti-infliximab antibodies. Though collection timing and clinical histories are not known, we found that of all ADAb- free samples, about one third (36%) were within the target range of 3–10 μg/mL for infliximab and 36% of samples were subtherapeutic at <3.0 μg/mL. High titer ADAb are almost invariably associated with very low or absent IFX levels. In contrast, low titer antibodies have little or no impact on drug levels. Our 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 (increase drug dose/consider immunomodulatory vs switch within class). 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 22 to 2,000+ ng/mL) may be most helpful in preventing, managing and treating immunogenicity.
P059 Potential cost avoidance benefits of the early identification of and differentiation Between IBD and IBS
Authors: Thomas Koshy , Sarah Gupta , Philip Cyr , Jessica Richman , Elisabeth Bik , Samantha Tyrrell , Christina Palmer , Daniel Almonacid , Leo Treyzon , Alan Greene 
Published: July 2019

BACKGROUND:
Changes in distribution and composition of microbiome species may be associated with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD, which includes ulcerative colitis (UC) and Crohn's disease (CD) is an immune-mediated inflammatory disease. IBS is a chronic functional disease characterized by a series of symptoms such as cramping, diarrhea, and constipation. There are specific medications for IBD used to treat the underlying disease and keep it in remission, whereas IBS is more commonly addressed by treating the symptoms and adjusting one's lifestyle to avoid triggers of the condition. Thus, distinguishing between these 2 conditions is important. To address this need uBiome® has developed SmartGutTM, a sequencing-based clinical microbial test that can detect beneficial and pathogenic microorganisms associated with IBS and IBD and help distinguish between these conditions. In this study we developed a model to estimate the cost impact of using SmartGutTM in a US population of patients with gastrointestinal distress.

METHODS:
A model was developed from the perspective of a US payer that provides SmartGutTM as a screening tool for beneficiaries. The model estimates the incidence of gastrointestinal distress from the combined incidence rates of IBD, IBS, and other causes. Utilization was informed by manufacturer patient analysis. The cost of SmartGutTM was based on test costs from the manufacturer.

RESULTS:
For a hypothetical US payer covering 1,000,000 lives, the annual incidence of patients with chronic gastrointestinal distress is estimated to be 68,820 215,820, of which 27% are expected to receive repeat testing with an average of 2.35 SmartGutTM screenings per patient for a total of 93,905 annual screenings. This costs the plan $48,318,761 annually, equating to an additional $4.03 per member per month compared to usual care. However, the SmartGutTM test report details the presence and quantity of microorganisms associated with IBS and IBD. The report includes recommendations for healthcare providers on treatment, lifestyle, and diet that can be discussed with the patient. Testing in these patients may lead to earlier identification of IBS or IBD, which may result in improved downstream outcomes and more efficient use of healthcare resources. Further research is being conducted in order to clearly delineate the test specifications of IBS and IBD as well as downstream health outcomes.

CONCLUSION(S):
Here we present our initial investigations to estimate the cost avoidance benefits of the early identification of and differentiation between inflammatory bowel disease and irritable bowel syndrome using SmartGutTM in a US population of patients, highlighting test costs and improved outcomes.
P060 Is the thickness of the psoas muscle a marker of poor prognosis in Crohn's disease?
Authors: Cátia Arieira , de Castro Francisca Dias , Joana Magalhães , João Moreira Maria , José Cotter 
Published: July 2019

INTRODUCTION:
Recent studies point to an association between body composition and clinical outcomes in Crohn's disease (CD).

OBJECTIVE:
To determine the relationship between psoas muscle thickness (PSOAS) as a marker of nutritional status and the prognosis of patients with CD.

METHODS:
Retrospective study, including patients with CD who underwent computed tomography (CT) at diagnosis and with a minimum follow-up of 1 year. The axial (AT) and transverse (TT) thickness of the right PSOAS was measured at the cross-sectional level of L3-L4. AT corresponds to the maximum diameter of the PSOAS on the axial axis. TT corresponds to the diameter of the PSOAS perpendicular to the axial diameter. The thickness was normalized for height. Poor prognosis was defined as the need for surgery and/or introduction of immunosuppressive therapy and/or development of perianal disease and/or altered disease behavior.

RESULTS:
Included 104 patients, 62 (59.6%) female with a mean age at diagnosis of 33.9 ± 12.17 years. Patients were submitted to surgery in 37.5%. We observed a behavior change in 15.4%, development of perianal disease in 22.1% and introduction of immunosuppressive therapy in 76.9%. We found that patients who underwent surgery had lower values ​​of AT (25.23 vs 26.78 mm/m; P = 0.024) and TT (18.70 vs 20.69 mm/m; P = 0.008). The same was observed in patients who presented change in the disease behavior of AT (24.44 vs 26.51 mm/m; P = 0.024) and TT (17.43 vs 20.40 mm/m; P = 0.003).

CONCLUSIONS:
We identified that patients submitted to surgery or with behavior change had lower values ​​of AT and TT at diagnosis. These parameters may identify patients with CD who may progress with worse prognosis, and constitute an extra tool in monitoring patients with CD.