bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEVELOPMENT OF CROHN'S DISEASE IN PATIENT PRESENTING WITH COMPLEX PERIANAL FISTULA TO A TERTIARY MEDICAL CARE CENTER
Authors: Sangmo Lodoe , Quraishi Baseer , Rajauria Palak , Ungaro Ryan , Wong Serre-Yu 
Published: January 2024

Abstract

BACKGROUND
Approximately 20% of patients with Crohn’s disease (CD) will develop a perianal fistula (PAF), most of which are complex fistulas1-4. Studies have shown that 4-5% of patients with CD present with perianal fistula without luminal disease, termed isolated perianal Crohn’s disease4,5,6. However, little is known about the natural history of isolated complex PAF (iPAF). We therefore aimed to evaluate the clinical course of patients who presented with iPAF including describing those who subsequently developed luminal CD.

METHODS
We performed a retrospective cohort study of patients seen within the Mount Sinai Health System (New York) with an ICD-10 diagnosis code for PAF between 7/22/2008 and 7/22/2022. Medical record review was conducted to identify patients with complex PAF who did not have evidence of luminal disease and had &gt; 6 months of follow-up (Table 1). Luminal disease was defined as any evidence of ulcers, erosions, or strictures on endoscopic or video capsule exam or MRE with evidence of inflammation consistent with luminal CD. Demographics, comorbidities, imaging, endoscopy, surgeries, hospitalizations and medication data were collected. Descriptive and univariate analyses were performed. Complicated disease course was defined as a composite of any major CD-related surgery, PAF/IBD-related hospitalization or biologic use.

RESULTS
Among 887 patients with PAF, 62.2% (n=552) patients underwent luminal evaluation, of whom 80 patients (14.5%) were found to have no luminal disease (Table 1). Of these, 57 patients had &gt;6 months of follow-up with 22.8% (n=13) going on to develop luminal disease. Luminal CD was diagnosed at a mean time of 4.2 (SD=3.8) years after iPAF presentation. Compared to patients who developed luminal CD, patients with solely iPAF were less likely to be &lt;30 years old at PAF diagnosis (p=0.0225) or have concomitant autoimmune conditions (p=0.046) (Table 2). Patients with iPAF were less likely to have &gt;2 fistulas (p=0.002) or have CD/PAF-related hospitalization (29.5% vs 61.5%, p =0.0356) compared to those who developed luminal CD (Table 2). Patients with iPAF were significantly less likely to have a complicated disease course than those who later developed luminal CD (2.3% vs 30.8%, p=0.007).

CONCLUSION
We observed that approximately 1 in 4 patients who presented with iPAF went on to develop luminal CD. Patients who went on to develop luminal CD were more likely to be &lt;30 at PAF diagnosis, have concomitant autoimmune conditions and were more likely to have IBD-related adverse outcomes. The majority of patients with iPAF did not experience a complicated disease course and may represent a specific sub-phenotype of CD.
PREVALENCE OF FRAILTY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. A PILOT STUDY
Authors: Ballart Maria Jesus , Grandon Francisca , Nieto Rodrigo , Alvarez Manuel 
Published: January 2024

Abstract
Frailty is a multidimensional syndrome that leads to greater vulnerability to stress, increasing the risk of adverse health outcomes. It is a dynamic process, with transitions between being robust, pre-fragile and fragile over time, suggesting that it is modifiable.
Inflammatory bowel disease (IBD) results in altered immune function with amplified inflammation. When severe, it manifests with features associated with frailty, such as weight loss, fatigue, and sarcopenia. The first studies on frailty in IBD were carried out in a surgical context. Subsequent studies have associated frailty with increased risk of mortality as an independent factor in IBD patients. Of the available evidence, all are retrospective -except one- and the majority measures frailty with associated ICD-10 diagnoses, which can underestimate its prevalence in younger patients.
There is no consensus in the literature on the best tool to measure frailty, however, this pilot study will objectively evaluate, using a risk score, the prevalence of this syndrome, which will allow, in the future, to carry out prospective studies that characterize frailty in IBD, understand the dynamic and longitudinal relationship between frailty and disease activity and, if appropriate, design and test interventions to alleviate this syndrome and its consequences in this population.
This was a descriptive study, with the objective to determine the prevalence of frailty in IBD patients in a teaching hospital in Chile. We also compared the characteristics of frail vs non-frail IBD patients.
Frailty was measured using SHARE-FI tool, which is a validated score to measure frailty in primary care, even in patients under 65 years of age.
64 patients were recruited, 28 had ulcerative colitis, 33 had Crohn’s disease and 3 had indeterminate colitis. 62.5% were female, with an average age of 42,3 ± 13,65 years. Average years since diagnosis were 11,6 ± 9,89.
The prevalence of frailty was 40,62%. No association was observed between the presence of frailty and the type of IBD, IBD activity indices, use of corticosteroids, use of biologic therapy, surgeries associated with IBD, IBD flare-ups with hospitalization within the last year, calprotectin levels, vitamin D levels. The odds of the presence of frailty in women are 4,2 times greater than in men, being women a possible risk factor for frailty. The frailty group had worse quality life measured with the IBD Questionnaire 9 (OR 0,86 [IC95% 0,79-0,94).
In conclusion, the prevalence of frailty in IBD was 40,62%. Contrary to what might be assumed, frailty turned out to be a condition independent of the type of IBD, time of evolution, activity and treatment, mostly associated with female sex and a worse quality of life. New studies are required to determine factors predisposing to frailty in IBD patients and prevent its appearance in order to improve their prognosis.
THE IMPACT OF OBESITY ON THE PREVALENCE AND SEVERITY OF PERIANAL COMPLICATIONS OF CROHN'S DISEASE
Authors: Youn Jennifer , Hsia Katie , Khadilkar Surya , Zeina Tanya , Rai Puja , Rastogi Akash , Adavelly Pranay , Hussani Sureya , Yanes Jason , Kotlier Jacob , Spence Samara , Levy Alexander , Friedman Sonia 
Published: January 2024

Abstract

INTRODUCTION
The incidence of obesity in patients with inflammatory bowel disease (IBD) is increasing and there is limited data on the effects of obesity on disease phenotype. Several studies have investigated the association of obesity with perianal fistulizing disease with conflicting results. In this study, we aim to examine the relationship between obesity and the prevalence and severity of perianal complications in patients with Crohn’s disease (CD).

METHODS
We conducted a cross-sectional study of CD patients treated at a tertiary care center from 2012 to 2022. Collected data included sex, race, smoking history, family history, maximum body mass index (BMI), and Montreal classification (Table 1). Obesity was defined as maximum BMI ≥30kg/m2 and further subdivided into 5 BMI categories (Table 2). The prevalence of perianal disease was defined by a history of perianal fistula. The severity of perianal disease was measured by four variables including history of perianal fistula surgery, number of perianal surgeries, history of fecal diversion, and median time to first anal surgery. Perianal fistula surgeries included abscess incision and drainage, seton placement, fistulectomy, and/or fistulotomy. Pearson’s chi-squared test was used to compare 2 categorical variables (non-obese vs obese). Exact Cochran-Armitage trend test was used to compare 5 BMI categorical variables. A 95% confidence interval was used with an alpha of 0.5. Values of p &lt;0.05 was considered statistically significant. Data analysis was performed using Excel.

RESULTS
A total of 704 patients with CD were treated. In all, 68.9% were non-obese and 31.1% were obese. Furthermore, 2.8% were underweight, 36.5% normal weight, 29.5% overweight, 17.9% obese, and 13.2% severely obese. Non-obese patients were more likely to have a family history of IBD (p=0.043). Obese patients were more likely to have extraintestinal manifestations (p=0.004) and/or be former smokers (p=0.004). There was no significant association between obesity and prevalence of perianal fistula (p=0.719), history of perianal surgery (p=0.146), history of one or more perianal surgeries (p=0.220), history of fecal diversion (p=0.705) or median time to first perianal surgery (p=0.192) (Table 1). Increasing BMI category was not associated with the prevalence of perianal fistula (p=0.944), perianal surgery (p=0.583), more than one perianal surgery (p=0.114), fecal diversion (p=0.542) or median time to first perianal surgery (p=0.486) (Table 2).

DISCUSSION
In conclusion, there was no significant correlation between obesity and prevalence of perianal disease. Additionally, there was no significant correlation between obesity and severity of perianal disease. The overall impact of obesity on CD complications is still unknown and warrants further investigation.
REAL-WORLD LONG-TERM TREATMENT PERSISTENCE AMONG BIO-NAÏVE PATIENTS WITH CROHN’S DISEASE AND HISTORY OF FISTULA INITIATED ON USTEKINUMAB
Authors: Zhdanava Maryia , Kachroo Sumesh , Boonmak Porpong , Burbage Sabree , Shah Aditi , Jiang Zhuohan , Lefebvre Patrick , Kerner Caroline , Pilon Dominic 
Published: January 2024

Abstract

BACKGROUND
Fistula is a common complication of Crohn’s disease (CD). Treatment with certain biologics have been associated with fistula healing and closure, reduction of symptoms and need for surgical treatments. In clinical practice, biologic persistence and effectiveness are correlated. This study described long-term persistence among bio-naïve patients with CD and history of fistula who were initiated on ustekinumab (anti-interleukin 12/23 antibody).

METHODS
Adults with CD and history of intestinal fistula initiated on ustekinumab (index date) between 9/23/2016 and 3/2/2022 were selected from the IQVIA PharMetrics® Plus database and followed for the maximum of 24 months. Patients were bio-naïve (i.e., no claim for CD-indicated biological agents) in the 12-month baseline period before the index date. Patients with other auto-immune diseases during the baseline period were excluded. Persistence on ustekinumab was defined as the absence of gaps between days of therapy supply of &gt;120 days (i.e., over twice the duration of the US label maintenance cycle of 8 weeks or 60 days). Composite endpoints of being persistent while on monotherapy (no immunomodulators or biologics other than ustekinumab) and persistent while corticosteroid-free (&lt;14 consecutive days of corticosteroid supply after day 90 post-index) were also assessed. Persistence endpoints were assessed from the index date until the earliest of discontinuation (event), immunomodulator or non-index biologic use (event), corticosteroid use (event), 24 months follow-up or data end (censoring) using Kaplan-Meier analyses.

RESULTS
The sample included 445 patients (mean age: 42.8 years; 56.6% female; Fig. 1). Among these, 63.1% had CD involving the small intestine, and 59.6% had CD involving the large intestine. The most common type of fistula was anal fistula (36.0%). At 24 months after ustekinumab initiation, 64.2% of patients remained persistent (95% confidence interval [CI]: 55.8-71.4; Fig. 2a). Furthermore, 53.3% of patients were persistent while on monotherapy (95%CI: 45.1-60.7; Fig. 2b). Finally, 45.6% of patients were persistent while being corticosteroid-free (95%CI: 36.9-53.8; Fig. 2c).

CONCLUSIONS
This study quantified long-term persistence on ustekinumab among bio-naïve patients with CD and history of fistula. Over half of patients initiated on ustekinumab were persistent and persistent while on monotherapy 24 months after the treatment initiation. These findings support ustekinumab as a treatment option for long-term management of CD with history of fistula.

Figure 1 Selected baseline characteristics

Figure 2 (a) Persistent on ustekinumab, (b) persistent and on monotherapy, c) persistent and corticosteroid-free
DIFFERENCE IN HEALTHCARE OUTCOMES BETWEEN TEACHING AND NON-TEACHING HOSPITALS FOR PATIENTS ADMITTED WITH CROHN'S DISEASE
Authors: Salazar Miguel , Flocco Gianina , Al-Smadi Khaled , Saffouri George , Hammami Bader 
Published: January 2024

Abstract

BACKGROUND
The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Crohn’s disease (CD) is a costly disorder among hospitalized patients. Its complications often require endoscopic interventions, surgery, and advance levels of care, for which approaches are not standardized.

METHODS
We queried the National Inpatient Sample (NIS)[GS1] 2016-2019 using ICD10-PCS codes. Patients were subsequently divided based on the concomitant diagnosis of CD and subcategorized between teaching and non-teaching institutions. In-hospital mortality, total hospital cost, length of stay, and in-hospital complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders.

RESULTS
A total of 141,865 discharges with diagnosis of CD were identified, of which 108,735 (76.6%) were admitted to a teaching institution and 33,130 (23.4%) to a non-teaching institution. Those admitted to a teaching hospital were most likely to be black (10.0% vs 15.1%; P&lt;0.01), Hispanic (4.4% vs 5.6%; P&lt;0.01), have a Charlson score of ≥3 (27.1% vs 31.3%; P&lt;0.01), belong to the highest income bracket (17.8% vs 24.7%; P&lt;0.01), have private insurance (43.7% vs 51.3%; P&lt;0.01), and be located in the northeastern U.S. (14.9% vs 23.8%; P&lt;0.01). Those admitted to a teaching institution were more likely to have fistulizing disease (7.8% vs 15.6%; P&lt;0.01), require parenteral nutrition (3.0% vs 6.1%; P&lt;0.01), have severe malnutrition (4.8% vs 8.3%; P&lt;0.01), undergo colonoscopy (10.4% vs 12.8%; P&lt;0.01), and undergo bowel resection including large bowel (6.4% vs 11.4%; P&lt;0.01) and small bowel (1.6% vs 2.4%; P&lt;0.01), and were more likely to require conversion from laparoscopy to open laparotomy (0.8% vs 1.9%) during surgery.
On multivariate analysis, there was no significant difference in mortality [aOR 0.84; (P=0.59)] between teaching and nonteaching institutions. However, we found worse outcomes within teaching institutions such as a prolonged mean length of stay (4.5 days vs 5.6 days; P&lt;0.01), more likely to need surgical bowel resection including small [aOR 1.39; (P&lt;0.01)] and large [aOR 1.66; (P&lt;0.01)], to develop venous thromboembolism [aOR 1.97; (P&lt;0.01)], and to require conversion to open surgery during laparoscopy [aOR 2.3; (P&lt;0.01), and ileus (aOR 1.18; (P&lt;0.01)], they were less likely to require endotracheal intubation [aOR 0.63; (P=0.02)].

CONCLUSIONS
Institutional designs impact outcomes in CD, albeit no difference in mortality. In general, complication rates and resource utilization are higher in teaching centers when compared to non-teaching.
FROM ACADEMIA TO ANECDOTES: ASSESSING THE QUALITY OF ULCERATIVE COLITIS CONTENT ON YOUTUBE
Authors: Mohan Raj Mohan Ram , Joy Melvin , Magam Sai Greeshma , Natt Dilman , Magam Sai Reshma , Desai Jiten , Jiyani Rucha , Mustacchia Paul 
Published: January 2024

Abstract

INTRODUCTION
This study examines the varying impact of YouTube videos on Ulcerative Colitis (UC) from academic and private institutions. While academic channels offer evidence-based, scientifically vetted information, private sources may lack rigorous scrutiny and sometimes prioritize commercial or anecdotal content. With YouTube's massive user base, the absence of an editorial process can result in misinformation. This content quality and credibility discrepancy can significantly affect patient education and treatment outcomes for UC.

METHODS
We conducted a search on YouTube using the keywords "Ulcerative Colitis" and "UC IBD" to identify relevant videos. Exclusions were made for videos that were not in English, irrelevant, or lacked audio. We documented various video attributes such as views, likes, dislikes, comments, and the nature of the source (academic or private). The videos were then classified as reliable or unreliable based on the scientific accuracy of their content. We employed DISCERN, Global Quality Score (GQS), and the Patient Education Materials Assessment Tool (PEMAT) to evaluate video quality. The consistency among seven investigators in applying DISCERN, GQS, and PEMAT was measured using intraclass correlation.

RESULTS
We reviewed 21 YouTube videos that appeared in the search results, of which 11 (52.3%) were academic and 10 (47.6%) were private. Academic videos received higher DISCERN scores than private ones (317.5 vs. 23.64 5.07, p=0.018). The Global Quality Score was also higher for academic videos (3.9 vs. 2.2, p&lt; 0.01), as was the PEMAT score (4.1 vs. 2.7, p= 0.022). Furthermore, academic videos were found to have a positive correlation with the number of likes (OR: 0.75, P&lt; 0.001), subscribers (OR:0.68, P&lt; 0.0001), and views (OR:1.52, P&lt; 0.001).

CONCLUSION
Our study reveals significant quality discrepancies in YouTube videos on Ulcerative Colitis. Academic sources consistently outperformed private ones in accuracy and reliability, as indicated by higher DISCERN, Global Quality Score, and PEMAT ratings. The data also showed a positive correlation between academic sources and user engagement metrics like likes, subscribers, and views. These findings highlight the necessity of directing patients to academically-backed information to minimize the risk of misinformation.
HEALTH INSURANCE KNOWLEDGE AND HEALTH INSURANCE SELF-EFFICACY IN ADOLESCENTS AND YOUNG ADULTS WITH IBD
Authors: Huang Jeannie , Cruz Breanna Lopez , Rosales Daniela , Chuang Jonah , Cruz Rusvelda 
Published: January 2024

Abstract

BACKGROUND AND AIMS
In the United States, health insurance is a prerequisite for healthcare affordability. Adolescents and young adults with inflammatory bowel disease (AYA-IBD) often require costly therapies, and health insurance knowledge and health insurance self-efficacy are essential for a successful transition from pediatric to adult centered care. Nevertheless, little is known about AYA-IBD knowledge of and familiarity with health insurance.

METHODS
English-proficient AYA-IBD 15 years and older receiving care at an academic pediatric practice were invited to participate. Participants performed surveys on health insurance knowledge and health insurance self-efficacy. Descriptive statistics were performed to report survey results. Analyses of responses by demographic categories were performed using ANOVA analyses.

RESULTS
Fifty AYA-IBD completed the surveys. Thirty AYA-IBD were 15-17y and twenty were 18-22y. The majority of respondents were male (27), white (38), non-Hispanic (34), and had Crohn's disease (33). The median (interquartile range) disease duration was 33 (13, 61) months. Most had been on biologic or small molecule IBD therapy (46). All had health insurance: 32 had private insurance, 5 military insurance, and 13 government insurance. The majority (58%) of AYA-IBD answered less than half of the health insurance knowledge questions correctly (Table 1). Reported self-efficacy in choosing and using health insurance was slight to moderate (Table 2). Answers did not vary by demographic groupings.

CONCLUSIONS
AYA-IBD demonstrated suboptimal health insurance knowledge and slight to moderate health insurance self-efficacy. Our findings identify an important opportunity to provide much-needed health insurance education to help prepare AYA-IBD to manage the costs of medical care.

Table 1 AYA-IBD Health Insurance Knowledge Survey Responses

Table 2 Health Insurance Literacy Measure (Self-efficacy) Questions and Response Distributions
EVALUATION OF THE CLINICAL STAGE FXR AGONIST FXR314 IN HUMAN PRIMARY CELL 3D MODELS OF CROHN’S DISEASE AND ULCERATIVE COLITIS
Authors: Mon Aye , Gervacio Sherwin , Aidnik Haylee , Oxford Samantha , Rosette Caridad , Piu Fabrice 
Published: January 2024

Abstract
There is a critical need for novel approaches to treat inflammatory bowel disease (IBD) that extend beyond modulating the immune response. These innovative strategies should also focus on enhancing the integrity of the intestinal barrier and addressing fibrotic tissue development throughout the course of the disease, both critical components of IBD, to improve long term outcomes. Targeting the ligand-activated nuclear Farnesoid X Receptor (FXR) represents such an emerging opportunity.
Intestinal epithelial cells exhibit high expression of FXR which is pivotal for intestinal function by regulating the innate immune response, reducing bacterial translocation into the intestinal wall, preserving the integrity of the epithelial barrier, and potentially reducing fibrotic deposition. We have developed a human 3D co-culture model of multiple cell types derived from Crohn’s disease (CD) or ulcerative colitis patients (UC). These 3D-culture CD and UC models faithfully replicate various aspects of the IBD disease state, including differences in gene expression patterns relative to intestinal tissues from healthy donors, compromised epithelial barrier integrity (as measured by Fluorescein isothiocyanate-dextran and TEER assays) and disrupted fibrotic deposition (as determined via fibrosis biomarkers and quantitative collagen deposition).
FXR314 is an orally administered non-bile acid FXR agonist that has completed a Phase 2a clinical trial in NASH and is being considered as a novel therapeutic approach for IBD. We assessed the capacity of FXR314 to improve disease biomarkers in 3D models of human IBD. Specifically, its effects were characterized in five CD donors and three UC donors. Target engagement was demonstrated in all CD and UC donors tested through activation of FGF19, a well-accepted target of FXR activation. In CD donors, FXR314 broadly improved measures of epithelial barrier function in a subset of donors, and fibrotic markers in all five donors. In UC donors, FXR314 improved epithelial barrier function and fibrotic activity in all three donors. As anticipated, the effects seen across the different metrics were concentration dependent.
These primary multicellular 3D human IBD models (CD, UC) constitute a powerful tool to more accurately predict the relevance of specific targets and assess the efficacy of therapeutic candidates. Consequently, this could enhance the probability of success when conducting clinical trials. In this study, we demonstrated that the non-bile acid FXR agonist FXR314 improves multiple aspects of Crohn’s disease and ulcerative colitis in human donors, thereby strengthening its potential as a novel therapeutic approach for IBD.