bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1085 Machine learning to predict the efficacy of ustekinumab for ulcerative colitis
Authors: Morikubo H , Tojima R , Maeda T , Matsuoka K , Matsuura M , Miyoshi J , Tamura S , Hisamatsu T 
Published: January 2024

Abstract

Background
Ustekinumab (UST), an anti-IL12/23p40 monoclonal antibody, is now widely used for ulcerative colitis (UC). Meanwhile, there are no established models to predict the efficacy of UST for UC. We previously demonstrated that the machine-leaning approach was useful for finding predictors and developing a prediction tool in vedolizumab (VDZ) treatment for UC (Miyoshi et al. Sci. Rep. 2021). In this study, we aimed to develop a new prediction model for UST in patients with UC.

Methods
UC patients who started UST as a remission induction therapy in Kyorin University Hospital were enrolled as the training cohort (Cohort 1), and at Toho University Sakura Medical Center were enrolled as the test cohort (Cohort 2). Clinical information of 44 items including age, sex, past/concomitant therapy for UC, clinical and endoscopic activity for UC, blood sample, and so on, in week 0, and clinical activity for UC in week 22 were collected. The outcome was defined as steroid-free clinical remission (SFCR) in week 22. Clinical remission was defined as the Lichtiger index (LI) of four or lower. Patients who terminated UST or needed surgery before week 22 were regarded as not achieving SFCR. Random Forest was used for the clinical data in Cohort 1 to identify the promising predictors to achieve SFCR in week 22. Prediction models were developed with these predictors and their prediction ability was validated in Cohort 2.

Results
25 patients (SFCR/non-SFCR=13/12 patients) and 46 patients (SFCR/non-SFCR=27/19 patients) were enrolled as Cohort 1 and Cohort 2, respectively, in this study. First, we examined if a VDZ prediction model that we previously reported could work for predicting the UST efficacy. In Cohort 1, the model showed a positive predictive value (PPV) of 56.3% and a negative predictive value (NPV) of 62.5%. This supports the notion that a prediction model for UST should be different from that for VDZ. From the 44 clinical information, 10 clinical features with the highest contribution to SFCR with UST were detected in Cohort 1. These clinical features included serum albumin, monocyte fraction, height, MCV, total protein, LI, white blood cell count, MCHC, partial Mayo score, and CRP (Figure 1). With these 10 clinical features, the seven prediction models for UST were developed using different algorithms. These models were applied to Cohort 2 to validate the prediction ability. The model that showed the best prediction ability was a support-vector machine polynomial model with PPV 68.8% and NPV 71.4%, respectively.

Conclusion
We developed a new prediction model for the middle-term efficacy of UST in patients with UC. Further studies are needed to develop a prediction model for each molecular-targeted drug.
P1102 Adherence to a Mediterranean dietary pattern in patients with Crohn's disease in remission is associated with lower fecal calprotectin levels
Authors: Mor-Sasson L , Sarbagili-Shabat C , Sherf-Dagan S , Aviv Cohen N , Ron Y , Hirsch A , Thurm T , Maharshak N , Fliss-Isakov N 
Published: January 2024

Abstract

Background
The Mediterranean Diet (MD) was recently found to be beneficial for Crohn’s Disease CD patients in various stages of the disease. The MD emphasizes the intake of foods that are fiber-rich and high in polyphenols, along with avoidance of ultra-processed foods (UPF) and a low intake of red meat. Previous data show that these dietary patterns could promote gut health and mucosal healing. However, little is known about the overall adherence to the MD and its association with biochemical activity in CD patients in remission. Therefore, we aimed to assess overall adherence to the MD and to investigate the association between adherence to the MD and fecal calprotectin (FC) levels in patients with CD in clinical remission and fecal biochemical inactivity.

Methods
A cross-sectional analysis of a prospectively maintained database of patients with CD in clinical remission [Harvey-Bradshaw Index (HBI)&lt;5] and fecal biochemical inactivity (FC &lt;250µg/g). FC levels of ≤150µg/g was further categorized as significant biochemical inactivity.
Patients were assessed for their medical status, clinical and biochemical disease activity, and nutritional intake by using a Food Frequency Questionnaire (FFQ). The Israeli Mediterranean dietary screener (I-MEDAS) was used to assess adherence to the MD. A positive score for each food component was assigned when a specific cut-off criterion was met. For overall adherence to the MD, the median score of the study sample was used as a cut-off for the classification of “adherence” or “non-adherence”.

Results
A total of 88 patients were included in this analysis. A high proportion of patients qualified for a positive score for low consumption of butter and margarine (96.6%), salty snacks (94.3%), and savory pastries (83.0%), while a low proportion of patients qualified for a positive score for high intake of whole grains (8.0%), fish (20.9%), fruit (9.1%), and legumes (28.4%) (Figure 1). Twenty-nine patients (32.9%) were adherent to the MD. This group of patients had higher rates of significant biochemical inactivity (i.e., FC≤150µg/g), compared to non-adherent patients (96.6% vs. 79.7% respectively, p=0.036) and lower occurrence of soft/liquid stool (p=0.044). Furthermore, low intake of savory pastries and red/processed meat was associated with significant biochemical inactivity [p=0.026 and p=0.020, respectively.

Conclusion
Overall adherence to the MD among patients with CD in clinical remission and biochemical inactivity is relatively low, with a low intake of beneficial food groups on one hand, and a low intake of UPF on the other hand. Adherence to the MD was associated with lower FC levels. Future studies should examine the long-term effects of the MD on the maintenance of clinical and biochemical remission.
P1103 Incidence of Crohn's disease in patients with perianal fistula surgery
Authors: Kim S , Kim S P , Park Y , Kim S H , Kim Y E , Choi H , Oh S , Yu C S , Yoon H J , Kim K 
Published: January 2024

Abstract

Background
Perianal fistula (PAF) is one of the most common complications of Crohn's disease (CD) and is more frequent in Asian countries. However, there is a lack of data about the prevalence of CD in patients with PAF. We aimed to investigate CD incidence and risk factors in patients who underwent anal fistula surgery.

Methods
National health insurance service databases from 2013-2017 were used to identify patients with PAF surgery. The case definition comprises operation codes or diagnosis-related groups of anal fistula. The incidence of CD was investigated among the patients who underwent PAF surgery. We analyzed the risk factors associated with Crohn's disease in patients who received anal surgery. The time interval from surgery to CD diagnosis and the cumulative incidence of PAF after diagnosis of CD were investigated.

Results
172,397 PAF surgeries were performed during the study period (male 146,643, female 25,754). The incidence of PAF surgery in the general population was 6.77 (95% CI 6.73-6.8) per 10,000 person-years. (11.48 (11.42-11.54) for males, 2.03 (2.00-2.05) for females). The rate of CD was higher in a person who had undergone multiple PAF surgeries, females, and teenagers. More than 50% of teenagers who received three or more PAF surgeries were diagnosed with CD. The median time from PAF to a diagnosis of CD was 14.4 months (4-40.4 months). The prevalence of PAF at CD diagnosis was 48.2% (male 52.8%, female 36.8%), and the cumulative incidence rate at the 5-year follow-up was 61.4% (male 67.6%, female 43.6%).

Conclusion
This study reveals the relationship between CD and PAF surgery in Korea. The incidence of CD in patients with PAF is relatively high, and children, women, and patients with multiple surgeries are more likely to be accompanied by Crohn's disease. These features could be used to monitor the patient to allow timely diagnosis of CD.
P1116 Risk of fractures in children and adults with inflammatory bowel disease: A report from the epi-IIRN
Authors: Orlanski Meyer E , Buchuk R , Ben Tov A , Ledderman N , Loewenberg Weisband Y , Matz E , Dotan I , Turner D , Assa A 
Published: January 2024

Abstract

Background
Both adult and pediatric patients with inflammatory bowel disease (IBD) are at risk of osteopenia and osteoporosis, nevertheless, whether patients with IBD are subjected to a higher risk for bone fractures is debated. Thus, we aimed to assess the risk for bone fractures, osteopenia and osteoporosis in IBD vs non-IBD patients, using the epi-Israeli IBD Research Nucleus (IIRN) data.

Methods
Data of patients with IBD and non-IBD matched controls (approximately 3 non-IBD controls per case) were retrieved from the epi-IIRN cohort (January 2005- June 2020) that maintain data on all patients with IBD from the four Israeli HMOs. Data included demographics, osteoporosis medications, fracture data and IBD related characteristics. Patients were stratified by age group (0-17,18-49, and ≥50). Patients with known osteopenia or osteoporosis before IBD diagnosis were excluded.

Results
We included 32,263 patients with IBD and 89,423 non-IBD controls [48% female, 56% Crohn’s disease (CD)]. Time to first fracture was significantly shorter in female pediatric patients (p=0.01), in both female (p=0.0004) and male (p=0.003) adult and elderly patients (p&lt;0.0001) (Figure 1). Time to diagnosis of osteopenia/osteoporosis in patients with IBD was significantly shorter in all age groups and genders. Rate of fractures was significantly higher in patients with IBD versus controls for all groups, and rate of osteopenia/osteoporosis was also higher in patients with IBD in all groups (Table 1). In a subgroup analysis, fracture rate did not significantly differ between CD and ulcerative colitis (UC) for all age groups, but osteopenia and osteoporosis were significantly higher in CD compared to UC in all age groups. The hazard ratio for fractures in the pediatric IBD population was 1.02 (0.88-1.16) for males and 1.17(0.95-1.44) for females, in adults 1.08 (0.99-1.16) for males and 1.12 (1.02-1.21) for females, and in the elderly 1.2 (1.08-1.32) for males and 1.19 (1.08-1.31) for females. Arthritis was significantly associated with fracture risk [HR: children 1.47 (1.15-1.88); adults 1.3 (1.17-1.44); elderly 1.19 (1.07-1.30)]. In adults and elderly, older age at diagnosis, chronic obstructive pulmonary disease, diabetes and long-term proton pump inhibitors usage were also associated with a significant increase in fracture risk.

Conclusion
In this large nationwide cohort, patients with IBD had significantly higher risk for bone fractures than matched controls in almost all age groups, with no difference between CD and UC. Additionally, the rate of osteopenia and osteoporosis was higher in patients with IBD, suggesting that further efforts need to be invested in bone health of this at-risk population.
P1120 New-onset Inflammatory Bowel Disease is uncommon in patients with psoriasis, psoriatic arthritis and spondylarthritis treated with secukinumab: a retrospective cohort study in a tertiary centre
Authors: Masic N , Anjie S I , Sungur R , D'Haens G R A M , van de Sande M G H , van der Laken C J , de Boer N K 
Published: January 2024

Abstract

Background
Secukinumab (SEC) is an IL-17A inhibitor prescribed in patients with immune mediated inflammatory diseases like psoriasis (PsO), psoriatic arthritis (PsA) and spondylarthritis (SpA). Conflicting data are available on the onset of inflammatory bowel disease (IBD) among patients after the start of SEC. We aimed to provide data evaluating pre-existing and newly diagnosed IBD in patients being treated with SEC.

Methods
All patients receiving SEC at a single tertiary centre in The Netherlands between 2012-2022 were identified through the pharmacy registry. Data from electronic medical records were retrospectively collected: baseline (i.e. at initiation of SEC) characteristics, medical history (including pre-existing IBD), use of (disease modifying) concurrent medication, clinical symptoms, biochemistry (C-reactive protein, faecal calprotectin), endoscopy with pathology and cross-sectional imaging (CT, MRI, intestinal ultrasound). Patients were excluded if they received ≤3 doses of SEC.

Results
A total of 351 patients were included with one or more of the following indications for SEC treatment: PsO in 166/351 (47%), PsA in 130/351 (37%), axial SpA in 130/351 (37%), peripheral SpA in 31/351 (9%) and juvenile idiopathic arthritis in 1/351 (0.3%). Frequently used co-medication were NSAIDs (44%), topical corticosteroids (37%) and methotrexate (16%). Median follow-up time was 48 months (IQR 22,74). In total, ten patients with IBD were identified: 5/351 (1.4%) patients had pre-existing IBD (2/5 Crohn’s disease, 3/5 ulcerative colitis) and 5/351 (1.4%) patients developed IBD after SEC initiation (3/5 Crohn’s disease, 1/5 ulcerative colitis, 1/5 IBD-unclassified) (Table 1). All new-onset IBD cases were confirmed with endoscopy and pathology. Predominant clinical symptoms were diarrhoea, abdominal pain and haematochezia. In patients with new-onset IBD median time from initiation of SEC to development of clinical symptoms was 1.3 months (range 0-12) and median time to diagnosis was 7.5 months (range 3-16). Out of patients with pre-existing IBD in remission 2/5 developed clinical symptoms after start of SEC with a median time to development of 9 months (range 6-12); 3/5 patients sustained remission. After starting SEC 25% of patients reported gastrointestinal symptoms, however diagnostic work-up took place in only 52% of these patients revealing no signs of IBD.

Conclusion
In our cohort new-onset IBD after SEC initiation was uncommon (&lt;2%) with a short median time to onset. IBD seemed equally distributed among indications. Caution and monitoring of gastrointestinal symptoms during SEC treatment is warranted in patients with pre-existing IBD, considering the possibility of an exacerbation.
P1133 Relative survival and cause-specific mortality of a Chilean Inflammatory Bowel Disease cohort
Authors: Hernandez-Rocha C , Chahuan J , Uslar T , Salas R , Sepúlveda I , Pavez C , Perez T , Cofre C , De la Cruz R , Quintana C , Álvarez-Lobos M 
Published: January 2024

Abstract

Background
In the past two decades, multiple studies have shown an improvement in outcomes of inflammatory bowel disease (IBD) patients including a decreasing mortality associated with new treatments, surveillance, and healthcare support. There are no large studies in Latin-American countries addressing survival and death causes in IBD patients. We aimed to assess relative survival (RS) and causes of death in Chilean IBD patients.

Methods
IBD patients treated in a tertiary reference centre (Pontificia Universidad Católica of Chile, Santiago, Chile) since January 1990 were included in a local database. Death certificates were analysed to obtain the date and specific cause of death. The recorded time started on the date of definitive diagnosis and lasted until death or censoring on December 31st, 2020. The survival of IBD patients was compared with the life expectancy of the Chilean general population based on official life tables collected in the Human Mortality Database (www.mortality.org). The RS was computed using the Ederer II method implemented in the RELSURV package of the R software. A RS greater than 1.0 indicates that the analysed cohort has a higher survival than the expected survival of the reference population for the same age, sex and date at which age was coded. Inclusion of 1.0 within 95% CI indicates no difference between observed and expected survival. Data were also expressed graphically as the observed cumulative survival curves over time and the 95% confidence interval (CI) and compared to the reference population.

Results
We included 1,289 IBD patients with a media age at diagnosis of 35.9±14 years, 40.9% males and a follow-up of 22,525 patients-year. Ulcerative Colitis, Crohn’s disease and IBD unclassified patients comprised 50.2%, 43.1% and 6.7% of the cohort, respectively. A total of 106 patients (8.9%) died during the study period. Compared with the general population, the survival of IBD patients was higher (RS = 1.04; 95% CI: 1.02-1.07) at 20 years of follow-up (Table and Figure). This higher RS in IBD patients was observed in males and females, as well as CD patients and IBD patients older than 40-year-old (Table). The main causes of death in IBD patients were cancer (34%), infections (27.7%) and cardiovascular diseases (21.3%).

Conclusion
Compared to the general population, a higher long-term survival was observed in this large cohort of Chilean IBD patients. These findings may be due to a closer surveillance of this group of patients. Causes of death mirrored those in previously reported cohorts; therefore, a special care should be pay on their prevention in Latin-American countries as well.
P1142 Antibiotic use in the twelve months prior to ileal pouch-anal anastomosis increases the risk for pouchitis: A population-based Danish cohort study
Authors: Barnes E , Karachalia Sandri A , Herfarth H , Jess T 
Published: January 2024

Abstract

Background
Pouchitis is the most common complication after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), however clinical and environmental risk factors for pouchitis remain poorly understood. We explored the relationship between specific clinical factors and the incidence of pouchitis.

Methods
We established a population-based cohort of all adult persons in Denmark undergoing proctocolectomy with IPAA for UC between January 1, 1996 and May 31, 2020. We used Cox Proportional Hazard modeling and logistic regression to assess the impact of antibiotic and non-steroidal anti-inflammatory drug (NSAID) exposure and appendectomy on the primary outcome of diagnosis of acute pouchitis in the first 2 years after IPAA surgery. A 2-year time window was utilized given the clinical relevance of early pouchitis and to mirror prior studies in both administrative claims and the Danish health registers.

Results
Among 1,616 eligible patients, 738 (46%) developed pouchitis in the first 2 years after IPAA. Among all patients undergoing IPAA surgery for UC, 51% were prescribed antibiotics in the 12 months prior to the index date and 17% were prescribed NSAIDs in the 12 months prior to the index date. In Kaplan-Meier analyses, those persons who were prescribed antibiotics in the 12 months prior to the final stage of IPAA surgery were significantly more likely to develop pouchitis in the 2 years after the index date when compared to patients who were not prescribed antibiotics (p&lt;0.001, Figure 1B). Additionally, male patients demonstrated a decreased risk for pouchitis in the first 2 years after the index date when compared to female patients (p=0.014, Figure 1A). Antibiotic exposure in the 12 months prior to IPAA was associated with an increased risk of pouchitis (adjusted Hazard Ratio [aHR] 1.40, 95% CI 1.21-1.62) after adjusting for year of surgery and sex (Table 1). In a secondary analysis, compared to persons without any antibiotic prescriptions in the 12 months prior to IPAA, the risk of pouchitis was increased in those with 1 or 2 courses of antibiotics in that period (aHR 1.29, 95% CI 1.10-1.51) and 3 or more courses (aHR 1.79, 95% CI 1.43-2.23, Figure 1C). NSAID exposure in the 12 months prior to IPAA and appendectomy were not associated with risk of acute pouchitis (p=0.201 and p=0.865 respectively).

Conclusion
In this population-based cohort study, we demonstrated that antibiotic exposure in the 12 months prior to IPAA is associated with an increased risk of acute pouchitis. Future prospective studies may isolate specific microbial changes in at-risk patients to drive earlier interventions.
P1146 Familial Coaggregation of Inflammatory Bowel Disease with Cardiovascular Disease: a Nationwide Multigenerational Cohort Study
Authors: Sun J , Yao J , Ludvigsson J 
Published: January 2024

Abstract

Background
Genetics contribute to the development of both inflammatory bowel disease (IBD) and cardiovascular disease (CVD). Although an increased risk of CVD has been documented in IBD patients, little is known about the risk of CVD in family members of patients with IBD.

Methods
In this Swedish nationwide multigenerational cohort, we identified patients with biopsy-confirmed IBD (≥18 years) who had at least one family member living in Sweden at their date of diagnosis from 1969 through 2017. Each patient was matched with up to five IBD-free reference individuals from the general population. We then identified 205,642 first-degree relatives (FDRs: father, mother, full-siblings, offspring) and 44,790 spouses of IBD patients as well as 1,015,010 FDRs and 222,969 spouses of their reference individuals. These family members were followed from the later date of turning 18 years or their linked IBD patients/reference individuals being diagnosed/matched (i.e., index date), until the interested CVD outcome, heart transplant, emigration, death, or 31/12/2020, whichever came first. The primary outcome was any incident CVD and CVD mortality. Secondary outcomes included incident ischemic heart disease, heart failure, cerebrovascular disease, deep vein thromboembolism, pulmonary embolism, and atrial fibrillation/flutter. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) with 95% confidence interval (CI).

Results
FDRs of IBD patients were at higher risks of incident CVD (aHR=1.04, 95%CI: 1.03 to 1.05) and CVD mortality (aHR=1.03 [1.00 to 1.06]) than FDRs of reference individuals (Figure 1). The increased risks were significant for almost all secondary outcomes, with point estimates hovering around a two to eight percent increased risk. Similar patterns were observed by IBD subtypes, sex, age and calendar period at index date, and family relationship of FDRs. In contrast, spouses demonstrated no increased risks of incident CVD or CVD mortality.

Conclusion
Relative risks of incident CVD and CVD mortality were only slightly increased in FDRs of patients with IBD, but not at all in spouses, suggesting no need for extra vigilance for CVD among family members of IBD patients.