bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1112 Clinical features between familial versus sporadic inflammatory bowel disease: a retrospective single centre study
Authors: Dottor F , Marino M , Colombo A , Navarria L , Solito S , Berretti D 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract. The two main types of IBD are Crohn's disease (CD) and ulcerative colitis (UC). Both conditions have a complex and multifactorial etiology, involving a combination of genetic, environmental, and immunological factors. If there is a family history of IBD, particularly in first-degree relatives (parents, siblings), there may be a higher risk for other family members to develop the disease. A retrospective cohort study was conducted between 2010 and 2022, to assess clinical features between familial versus sporadic inflammatory bowel disease

Methods
This observational monocentric retrospective study, includes 903 patients: 794 with IBD, with and without familiarity, referring to the Gastroenterology Service of the "Azienda Sanitaria Universitaria del Friuli Centrale". 10,6% of the patients have familiarity (54,2% with a first degree and 44,8% with a second degree relative). Table 1 provides data on patients and disease characteristics.

Results
The mean age of patients with familiarity for IBD was significantly lower compared to subjects without familiarity. Unexpectedly in our cohort familiarity in CD vs UC subjects were similar (respectively 10.7% vs 11.8%). A slight increase of women in the group with familiarity was detected although not statistically significant. EIMs occurred predominantly in the cohort with familiarity but the difference was not statistical significant. IBD subjects with familiarity need less surgery if compared with those with non familiarity (respectively 14,6% vs 18,2%), but the difference was no significant. Biological drugs have been used earlier and more frequently in patients with familiarity compared with those with not familiarity (29,3% vs 38,5%) although also in this case non significant. No differences on IBD phenotype have been noted between familial IBD vs sporadic IBD. Main data described in Table 2.

Conclusion
In this retrospective cohort study, family history of IBD was present in similar percentage between CD and UC. The only significant data in our cohort was the early age of onset of IBD in patients with familiarity. However IBD familiarity was associated with a trend of decreased risk of surgical procedures, increased use of biological medications and a trend for developing EIMs. While some data, for example the earlier and larger use of biologics could explain the less need of surgery in IBD patients, larger cohorts are essential to define the similarities and differences more robustly between familial and sporadic IBD.
P1121 The risk of inflammatory bowel disease following serious infectious mononucleosis: A Danish nested case-control study
Authors: Harper S , Ebert A , Mitchell W , Elmahdi R 
Published: January 2024

Abstract

Background
Epstein-Barr virus (EBV) infects ~95% of adults globally and limited early life transmission opportunities can delay EBV exposure till adolescence/early adulthood, increasing the risk of severe EBV infection, which most commonly manifests as infectious mononucleosis (IM). This study sought to investigate a potential aetiological association between IM and inflammatory bowel disease (IBD).

Methods
In this longitudinal nested case-control study, Danish nationwide registries were used to identify 37,156 IBD patients and 222,936 sex- and age-matched healthy controls, between 2005-2021. Logistic regression was used to calculate the odds ratio (OR) for IM hospitalisation prior to IBD diagnosis stratified by sex, age at IM diagnosis, age at IBD diagnosis, and IBD subtype (Crohn’s disease [CD] or ulcerative colitis [UC]). Additionally, exposure-controlled time-to-event analyses were used to explore the association between IM hospitalization and poor IBD prognosis. This association was measured using the occurrence of IBD-related hospitalization, surgery, complication and/or anti-TNF therapy commencement up to 10 years post-IBD diagnosis.

Results
Previous IM hospitalisation was significantly associated with the development of both CD (OR: 1.44, 95% CI: 1.20-1.73) and UC (OR: 1.27, 95% CI: 1.09-1.47). Sex was not found to be a significant effect modifier of this association for either CD (p=0.4) or UC (p=0.9). Those hospitalised with IM at a younger age had a higher odd of developing CD than those hospitalised in early adulthood (0-14-years OR: 2.60 [95% CI: 1.41-4.59]; &gt;20-years OR: 2.04 [95% CI: 1.23-3.25]). A similar pattern was observed for UC development (0-14-years OR: 2.62 [95% CI: 1.44-4.55]; &gt;20-years OR: 1.50 [95% CI: 0.97-2.25]). Poor disease prognosis following hospitalisation with IM within 10 years post-IBD diagnosis was only seen in CD (CD IRR: 1.52 [95% CI: 1.20-1.92]; UC IRR: 0.87 [95% CI: 0.65-1.16]).

Conclusion
This study demonstrated an association between IBD development and prior hospitalisation with IM, indicating the possibility of EBV infection as a significant contributor to IBD development. Strengthening understanding of IBD development can contribute to the prevention of IBD and improve management.
P1125 Incidence and Neoplastic Risk Associated with Colonic Stricture in Pediatric-Onset Crohn's Disease: A Population-based Study
Authors: Richard N , Leroyer A , Dupont C , Turck D , Bertrand V , Wils P , Gower-Rousseau C , Guillon N , Savoye G , Ley D , Sarter H , Fumery M 
Published: January 2024

Abstract

Background
The identification of colonic stricture in patients with Crohn's disease (CD) often leads to surgery due to concerns about associated neoplasia. Nevertheless, information regarding the neoplastic risk associated to colonic stricture is still limited. The objective of this study was to assess both the incidence of colonic stricture in pediatric-onset CD and the associated neoplastic risk at the population-based level.

Methods
All patients diagnosed with CD before age 17 between 1988 and 2011, and included in a population-based registry, were followed until 2013. Colonic stricture was defined as a narrowing of the digestive lumen observed on endoscopic or radiological examination. Excluded were stricture in the ileocaecal valve, anal canal, or low rectum. Univariate risk factors for colonic stricture were explored using Cox proportional hazards models with time-dependent variables, and a multivariable Cox model analysis was performed.

Results
A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median age at diagnosis was 14.5 years [IQR: 12.0-16.1]. Throughout the follow-up period (median follow-up, 8.8 years [4.6-14.2]), patients were predominantly exposed to 5-aminosalicylates (88.1%), immunosuppressants (70.6%), and biologics (47.9%). Colonic stricture was diagnosed in 52 patients, including 11 at CD diagnosis. The cumulative incidence of colonic stricture in CD was 2.9% [1.8%-4.0%] at 5 years. The overall incidence rate of colonic stricture in CD was 5.4 cases/1000 person-years, 95% CI [4.1-7.1]. In multivariable analysis, an increased risk of colonic stricture was observed during periods of active disease (HR = 2.62, [1.40-4.89], p&lt;0.01). Conversely, the absence of colonic involvement at diagnosis (HR = 0.18, [0.04, 0.80], p&lt;0.05) or treatment with aminosalicylates (HR = 0.39, [0.19-0.79], p&lt;0.05) was associated with a lower risk of colonic stricture. After a median follow-up of 6.4 [2.4-12.7] years, colonic stricture surgical resection was performed in 29 patients (55.8%). Colon adenocarcinoma was detected in one patient (1.9%) within 6 months after the diagnosis of colonic stricture.

Conclusion
In this population-based study of pediatric-onset Crohn's disease, 52 patients (5%) experienced colonic stricture, with a 2.9% incidence rate observed after 5 years of follow-up. Additionally, one patient (2%) presented with an associated adenocarcinoma.
P1157 Burden of herpes zoster in patients with inflammatory bowel disease treated with immunosuppressive agents
Authors: Chan P , Jorga A , Caldera F , Powell N , Yun H 
Published: January 2024

Abstract

Background
Patients with inflammatory bowel disease (IBD) are at increased risk of infections such as herpes zoster (HZ) due to immunosuppressive (IS) therapy. We conducted a targeted literature review to identify the burden of HZ in patients with IBD treated with IS agents.

Methods
We conducted a PubMed search to collate publications reporting on HZ in patients with IBD receiving IS treatment (from 01/01/2013 to 01/11/2023; excluding preclinical studies, narrative reviews and case reports). Findings were supplemented with a second PubMed search specific to paediatric patients with IBD (aged ≤18 years). Additional publications were included based on authors’ expertise as well as relevant abstracts presented at ECCO and DDW in 2022 and 2023.

Results
Overall, 178 publications were identified and 77 were included, along with ten recent congress abstracts. The most common IS treatments were Janus kinase inhibitors (JAKi), including tofacitinib and upadacitinib, followed by tumour necrosis factor inhibitors (TNFi). Additional treatments included anti-interleukin (IL)-23 agents (risankizumab, ustekinumab, mirikizumab) and sphingosine-1-phosphate (S1P) receptor modulators (etrasimod, ozanimod). HZ incidence rates are typically higher in patients with IBD compared with non-IBD populations (7.02–18.34 vs 3.22–11.29 per 1000 patient years, respectively). In paediatric patients, incidence rates are as high as 8.49/1000 patient years, with a standardised incidence ratio of 3.38 compared with the general population. Two studies reported a significant association between IBD and risk of hospitalisation for HZ in children and adolescents. Patients with IBD aged &lt;50 years may have higher incidence of HZ compared with those aged &gt;60 years without IBD. Risk factors for HZ in IBD patients include older age, lower weight, geographic region, prior TNFi failure and use, dose, and combination of IS medications. Increased incidence of HZ is associated with IS medication, particularly JAKis. Limited data exists on novel anti IL-23 agents and S1P receptor modulators, with some studies reporting a similar risk of HZ in treated patients compared with placebo, and others reporting an increased risk. HZ-related discontinuation is rare. Vaccination can reduce the risk of HZ in treated IBD populations, and studies have identified areas to improve vaccination adherence.

Conclusion
Patients with IBD of all ages, but specifically those aged &lt;50 years, are at higher risk of HZ compared with non-IBD cohorts, and IS medications contribute to this risk. Vaccination against HZ prior to initiating IS treatment could benefit patients with IBD.
P1182 What has changed in Inflammatory Bowel Disease during last three decades?
Authors: Altın S , Kemeç G , Kayıkçı K , Deniz D , Çelik A O , İstemihan Z , Nuriyev K , Rüstamzade A , Genç S , Cavus B , Çifcibaşı Örmeci A , Akyüz F , Demir K , Beşışık F , Kaymakoğlu S 
Published: January 2024

Abstract

Background
With its increasing incidence, IBD varies epidemiologically both over the years and geographically. The increase in treatment alternatives over the years has led to differences in the management of patients. Revealing the impact of years on IBD from past to present and realizing the paths we have gone through will make us more conscious of future paths. Therefore, we aimed to reveal the epidemiological findings in our IBD patients over three decades.

Methods
IBD patients followed up at our university hospital, a tertiary center, were included in our study. The demographic, epidemiological and medical data of the patients were recorded retrospectively from the patient files. Descriptive statistics for continuous variables in the study; expressed as mean, standard deviation (SD), number (n) and percentage (%). "Independent T-test" and "One-Way Analysis of Variance (ANOVA)" were calculated to compare continuous measurements according to categorical groups. In the calculations, the statistical significance level was taken as p&lt;0.05 and SPSS (IBM SPSS for Windows, ver.26) statistical package program was used for analyses.

Results
A total of 346 IBD patients, 198 of whom (57.2%) had Crohn's disease and were followed up from the gastroenterology outpatient clinic, were included in the study. The mean age of the patients was 49.07±13.82 years and the mean BMI was 23.02±4.58 kg/m2. 182 (52.6%) of the patients were male. The disease duration was 34.46±12.74 years. The patients were divided into three-decade groups according to their diagnosis dates as years: a total of 84 patients was diagnosed in 1985-2003, 192 patients in 2004-2013, and 70 patients in 2014-2023. The patients were compared within these date groups in terms of age at diagnosis, gender, first biological agent preference, and the time when the first biological agent was started (Fig.1). From the first decade to the third decade, the proportion of patients diagnosed with Crohn's disease was 50%, 57.3%, 65.7%, respectively, and the proportion of patients diagnosed with UC was 50%, 42.7% and 34.3%, respectively (p&lt;0.05). The rates of requiring hospitalization at initial diagnosis were 48%, 42.2%, and 40%, respectively, from the first decade to the third decade (p&lt;0.05). The need for bowel surgery at diagnosis (for Crohn's disease patients) was 33.3%, 26.36% and 13.04% within 3 decades, respectively (p&lt;0.05).

Conclusion
While the rate of patients diagnosed with Crohn's disease has increased compared to 30 years ago, the rate of patients diagnosed with UC was decreased. While the need for hospitalization at diagnosis and the need for surgery in CD have decreased in the last decade compared, biological agents have been started earlier in IBD patients in the last decade.
P1187 Persistence of Advanced Therapies in Patients with Inflammatory Bowel Disease: Retrospective cohort study using large healthcare claims database in Japan
Authors: Matsuoka K , Kawamura S , Zhang Y , Chung H , Wahking B , Tan J Y , Qiu H , Nakajo K 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is a lifelong disease and strategically utilizing advanced therapies is essential. Few studies exist to inform the drug utilization of biologics or JAK inhibitors in Japan. The objective is to describe persistence of index and subsequently used biologics or JAK inhibitors in patients with Crohn’s disease (CD) or ulcerative colitis (UC) in Japan.

Methods
This retrospective cohort study used the Japan Medical Data Center database, which contains claims data from 14 million individuals in Japan. Patients who were diagnosed with CD or UC, and received advanced therapy, including biologics and JAK inhibitors, between January 1, 2010 and September 30, 2022 were included. Patients aged at least 15 years old were required to have no treatment with advanced therapies within 6-month prior to the initiation of index treatments of interest: adalimumab, infliximab, vedolizumab, golimumab, ustekinumab and tofacitinib for CD and UC in Japan. Persistence was defined as having continuous treatment with each therapy over a specified follow-up period (i.e., 6 months, 12 months, 18 months, or 24 months since the index date), without the presence of a pre-defined treatment gap, i.e., 1.5 times the number of days covered by the prior day’s supply.

Results
The numbers of eligible patients with CD and UC during the study period were 1,115 and 1,942, respectively. Among patients with CD, the distribution of index treatment for adalimumab, infliximab, ustekinumab and vedolizumab was 41.4%, 37.4%, 18.2%, and 3.0%, respectively. Among patients with UC, the distribution of index treatment for infliximab, adalimumab, vedolizumab, golimumab, tofacitinib and ustekinumab was 33.6%, 24.8%, 17.5%, 11.2%, 7.3% and 5.6%, respectively. For CD cohort, persistence of ustekinumab was numerically highest in all periods (94.7% at 6 months, 91.3% at 12 months, 88.2% at 18 months and 80.4% at 24 months), followed by infliximab (94.1%, 87.7%, 82.0% and 76.8%, respectively). For UC cohort, highest persistence was observed in ustekinumab through all periods (95.1% at 6 months, 84.0% at 12 months, 81.6% at 18 months and 75.0% at 24 months), followed by vedolizumab (82.0%, 69.7%, 64.2% and 59.4%, respectively). As subsequent treatments, persistence of ustekinumab and infliximab were comparable for CD while the highest persistence was observed for ustekinumab through all periods for UC.

Conclusion
Persistence of advanced IBD treatments available in Japan was investigated. As an index treatment, ustekinumab maintained high persistence through 2 years from the index date both in CD and UC. This data provides valuable information on the management of patients living in Japan with IBD under real-world setting.
P1188 Epidemiology and direct healthcare costs of patients with Inflammatory Bowel Disease (IBD) in an Asian cohort in the first year following diagnosis
Authors: Qiu T Y , Tan Y Y , Tan M T K , Wong R S M , Lee J H Y , Chan W P W 
Published: January 2024

Abstract

Background
Inflammatory Bowel Disease (IBD) is a chronic condition requiring multi-disciplinary care with significant investigation and treatment burden. Indeed, the global treatment market has exceeded US$ 20 billion and is expected to exceed 27 billion in 2030. We aim to study the epidemiology and direct healthcare costs of newly diagnosed IBD patients in their first year of diagnosis in Singapore General Hospital (SGH) and identify factors associated with high direct healthcare costs.

Methods
The study included patients identified from a prospectively maintained IBD registry of SGH. We enrolled patients newly diagnosed with IBD from 2015 to 2022. Patients who received prior treatment or investigation at other institutions were excluded. Data on clinical characteristics and direct costs (investigations, medications, clinic visits, hospitalisations and surgeries) were collected.

Results
A total of 199 patients were enrolled across 2015 - 2022. 96 patients had Ulcerative Colitis (UC) and 103 had Crohn’s disease (CD) (Table 1).
There were 26 (20-28) new cases of IBD diagnosed at SGH yearly. Direct healthcare costs of patients in their first year of diagnosis remained steady with an overall 7.1% change in total expenditure from 2015 through 2022. A drop in expenditure happened in 2020 and 2021 due to COVID outbreak and country lockdown. (Fig 1A)
The mean cost per patient-year (PPY) was US$12995 for CD US$104345 for UC. 10 (8-11) patients required admission within the first year of diagnosis, with a mean hospitalisation cost PPY of $269717 (± 73771). Overall, inpatient costs accounted for 39.3 % (IQR 34.8 - 44) of yearly expenditure (Fig 1B). A median of 16.7% (14.6-22.1) of patients were started on biologics within the first year of diagnosis.
Patients with CD had significantly greater mean expenditure than those with UC on imaging ($1036 vs $328, p = 0.001) and biologics ($1535 vs $603, p = 0.033).
Patients above the 75th percentile of mean cost PPY were defined as having high healthcare cost. This was $12265 and $15957 for UC and CD respectively. Factors associated with high costs were hospitalisation (p &lt; 0.001), biologics (p = 0.001), surgery (p = 0.01) for both UC and CD. UC extent, CD behaviour, history of smoking and age&gt; 40 were not predictive of high costs.

Conclusion
Patients with CD have greater expenditure compared to patients with UC in the first year following diagnosis. Biologics use, surgery and hospitalisation are significant drivers of costs. The proportion of newly diagnosed patients requiring admission and their corresponding costs have remained consistent during our period of study. These findings encourage early identification of at-risk patients with institution of treatment to minimise hospitalisation and surgical burden.
P1210 Gut microbiota profiling and disease course in patients with ulcerative colitis in clinical remission
Authors: Singh A , Sundharam S S , Midha V , Singh D , Mahajan R , Krishnamurthi S , Sood A 
Published: January 2024

Abstract

Background
The inflammatory bowel diseases, encompassing ulcerative colitis (UC) and Crohn’s disease (CD) are characterized by a relapsing-remitting disease course. Despite achieving remission, approximately one-third of the patients relapse annually and yet the microbiota associated with relapse remains elusive. We hypothesized that distinctions in gut microbial composition among patients in clinical remission could potentially influence the disease course. We aimed to discern a distinctive microbial signature in patients with UC in clinical remission, which could serve as a predictive marker for the sustained clinical remission.

Methods
This was a prospective observational cohort study conducted as a collaborative work between Dayanand Medical College and Hospital (DMCH), Ludhiana, and Institute of Microbial Technology (IMTECH), Chandigarh. Adult (≥18 years age) patients with an established diagnosis of mild UC (defined as no previous requirement of immune-modulators or biologics to induce or maintain remission) and in clinical remission, were included between January 2019 and December 2020 and followed for one year. The clinical remission was defined as partial Mayo score &lt;2 for at least 6 months, with endoscopic Mayo score 0 and fecal calprotectin &lt;100 µg/g within 4 weeks of enrolment. Utilizing using 16S rRNA metabarcoding based metagenome analysis, the bacterial composition of the collected stool samples were determined.

Results
During the study period, 34 patients (mean age 41.41±13.89 years, 20 [58.82%] males) meeting the eligibility criteria were included for analysis and followed up for one year. (Figure 1) The majority of the patients (21, 61.76%) had left sided colitis. On follow-up, 14 patients (41.17%) experienced a disease relapse (median time to relapse 6 [3-8.25] months). The phyla Firmicutes, Actinobacteria, Bacteroidetes and Proteobacteria were abundant in both the groups [sustained remission (n=20) and disease relapse (n=14)], but specific phyla were enriched in each cohort, Actinobacteria in remission and Proteobacteria in relapse groups. The genera Escherichia, Klebsiella, Enterobacter, Enterococcus, Streptococcus were enriched in relapse group. Interestingly the genus Clostridium was enriched in relapsed cohort whereas genera like Bifidobacterium, Prevotella, Bacteroides, Alistipes, Faecalibacterium were abundant in the remission cohorts.

Conclusion
There are inter-individual differences in the gut microbiota profile of patients with UC in clinical remission. These microbial differences can serve as determinants of the disease course.