bluuebunny/crossref_metadata_2025_split huggingface dataset:
P226 Disability in Crohn’s Disease Patients at diagnosis: Findings from the CROCO (Crohn´s Disease Cohort) study
Authors: Revés J , Roager Madsen G , Burisch J , Wong C , Arebi N , Bonnet-Dodel M , Buisson A , Gatt K , Ellul P , Vieujean S , Ordas I , Duricova D , Rodríguez-Lago I , Sebastian S , Mocanu I , Kaimakliotis I , Goldis A , Hernandez V , Nachury M , Fumery M , Alloca M , Pedersen N , Barberio B , Guedes A , Ribeiro R , Ungaro R , Mary J Y , Bigot N , Lambert J , Colombel J F , Torres J 
Published: January 2024

Abstract

Background
Crohn’s disease (CD) can lead to progressive bowel damage and disability. Disability has been proposed by the SPIRIT-IOIBD consensus as an endpoint in disease-modification trials. Despite this, there is scarce data on disability at CD diagnosis.

Methods
The Crohn´s Disease Cohort (CROCO) is an ongoing prospective cohort study with newly diagnosed CD patients (within 12 months of diagnosis) aiming to assess the evolution of bowel damage and disability over time. Disability evaluation was conducted via the validated IBD-Disability Index (IBD-DI), which encompasses 14 questions ranging from 0-100 intended to measure overall health, sleep and energy, affect, body image, pain, defecation, interpersonal activities, and work and education.1 This study explored disability scores (DS) and their association with disease features and activity at diagnosis in patients with newly diagnosed CD. The IBD-DI was categorized as previously reported in no disability (scores 0-20), mild disability (scores 21-35), and moderate-severe disability (scores 36-100).2

Results
From a cohort of 261 patients [58% male, median age at diagnosis of 35yo (IQR 25-49)], 224 completed the IBD-DI at inclusion. Median time from inclusion to baseline visit was 4 months (IQR 1.7-7.8). Most patients presented with ileal or ileocolonic disease location (87%) and an inflammatory phenotype (69%); 16% had perianal disease and 27% had extraintestinal manifestations. At inclusion, 21% had been hospitalised, and 10% had a CD-related surgery. Treatments included steroids (56%), immunosuppressants (34%), and anti-TNF therapy (40%). The median DS at inclusion was 22.2 (IQR 10.4-37.9), with 48% exhibiting no disability and 30% displaying moderate-severe disability (Figure 1). Moderate-severe disability at baseline visit was associated with female gender (OR 3.65, 95%CI 2.01-6.62, p&lt;0.001), stricturing behaviour (OR 2.34, 95%CI 1.1-4.98), Harvey-Bradshaw Index (OR 1.36, 95%CI 1.23-1.5, p&lt;0.001), extraintestinal manifestations (OR 2.61, 95%CI 1.41-4.84, p&lt;0.002), and steroid use (OR 1.89, 95%CI 1.04-3.45, p=0.034). No significant associations were found with age, smoking, or biomarkers (Table 1).

Conclusion
One-third of newly diagnosed CD patients have moderate-severe disability. Disability was associated with female gender, disease phenotype, clinical severity, extraintestinal manifestations, and steroid usage. Disability is an important feature of newly diagnosed CD and may characterize a unique group of patients at diagnosis.

References
1 - PMID: 26646934
2 - PMID: 27516406
P272 Healing of Perineal Wounds after Proctectomy for Crohn's Disease: A Systematic Review and Meta-Analysis
Authors: Alipouriani A , Erozkan K , Schabl L , Holubar S 
Published: January 2024

Abstract

Background
Non-healing perineal wounds are common in patients undergoing proctectomy for Crohn’s disease. We systematically reviewed the literature and performed a meta-analysis to estimate the pooled proportion of perineal wound healing after proctectomy for Crohn’s disease.

Methods
A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases to identify relevant studies reporting perineal wound healing after proctectomy in patients with Crohn’s disease from 2010 to 2023. Articles were screened and those reporting perineal wound healing rates after proctectomy were included. Data on the study characteristics and proportion of healed wounds were extracted. Random effects meta-analysis was performed to estimate the pooled proportion and 95% confidence intervals using the ‘meta’ package in R. Heterogeneity was assessed using the I2 statistic.

Results
The literature search yielded 501 articles, of which 252 articles remained after removing duplicates. After screening the titles and abstracts, four retrospective cohort studies involving 332 patients with Crohn’s who underwent proctectomy were included in the meta-analysis. Across the four studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%) and at 12 months was 70% (95% CI 60%-83%). Significant heterogeneity was found between studies (I2=86% at 6 months). Only one study examined the predictors of impaired healing after proctectomy. Factors such as age, sex, BMI, smoking, steroid use, presence of high fistula-in-ano, and surgical technique were not significantly associated with impaired healing in univariate and multivariate analyses in this study. However, preoperative perineal sepsis was independently associated with impaired healing in the univariate and multivariate analyses in this study (p = 0.001). Study 4 included both Crohn's disease (n=54) and ulcerative colitis (n=20) patients who underwent proctectomy and reported fewer overall perineal complications in patients with UC than in those with Crohn’s disease (15% vs. 46.3%, p=0.01).

Conclusion
This meta-analysis revealed complete perineal healing in 70% of patients with Crohn's 12 months after proctectomy. Significant heterogeneity was observed between the studies. This review highlights the gaps in the best practices for optimizing perineal wound healing after proctectomy. These findings suggest the need to study techniques, such as vacuum-assisted closure and flap reconstruction. Further research is needed to identify modifiable factors to increase healing rates and develop evidence-based protocols for surgical approach, wound closure, and postoperative care in Crohn's disease patients.
P278 Radiation exposure in patients with inflammatory bowel disease
Authors: Jorissen T , Fierens L , Bosmans H , Verstockt B , Sabino J , Vermeire S , Vanbeckevoort D , Ferrante M 
Published: January 2024

Abstract

Background
Radiological imaging plays an important role in diagnosis and follow-up of patients with IBD. Due to the progressive character of the disease, repeated imaging may be necessary. A cumulative effective dose (CED), meaning the total diagnostic radiation received, of 75 mSv is often described as the risk level one needs to try not to exceed. However, data on cumulative exposure are limited in IBD. In this retrospective study, we analysed the cumulative radiation exposure of patients with IBD in a Belgian tertiary referral centre.

Methods
Electronic health records (EHRs) from all IBD patients followed at the tertiary referral centre between January 1st 1990 and December 31st 2021 were searched for examinations with radiation exposure and received doses in house or in any of 27 collaborating Nexuz hospitals working with the same EHR. Both the annual effective dose (AED) and CED were calculated. A sub-analysis of patients diagnosed after January 1st 2007 was performed, as detailed radiation doses were maintained prospectively from that date onwards.

Results
In total, 3429 IBD patients were included. The median (IQR) AED was 0.39 (0.01-1.66) mSv/year, and was higher in patients with CD than in patients with UC [0.58 (0.01-1.81) vs. 0.17 (0.01- 1.24) mSv/year, p=0.028]. During the first 20 years after diagnosis, the received CED were found higher in patients with CD than UC (Figure, p&lt;0.01). In 5.5% of patients, a CED ≥75 mSv was reached after a median (IQR) of 24 (13-34) years of follow-up. Sub-analysis of 1633 patients diagnosed after January 1st 2007 showed a median (IQR) AED of 0.44 (0.01- 2.12) mSv/year, again higher in patients with CD than in patients with UC [0.82 (0.02-2.38) mSv/year vs. 0.12 (0.01-1.47) mSv/year respectively, p=0.040]. Here, 3.3% patients reached a CED ≥75 mSv during a median (IQR) of 9 (6-12) years of follow-up. Most common reasons for high radiation exposure were comorbidities like malignancy and postoperative complications. Chart review by an IBD expert showed that the indication for most of these examinations was appropriate and that no alternative examination was available in a timely manner.

Conclusion
Up to 5.5% of patients with IBD were exposed to a CED of ≥75 mSv. Although most decisions to perform imaging with radiation exposure were appropriate, vigilance for unconsidered and excessive imaging should be maintained.
P282 High Correlation Between Fecal Immunochemical Test and Fecal Calprotectin for the Evaluation of Activity in Inflammatory Bowel Disease
Authors: Yamamoto-Furusho J K , Torres-Diaz J A 
Published: January 2024

Abstract

Background
Fecal calprotectin (FC) is one of the most widely used biomarkers in IBD. The evidence suggest it has a good correlation with clinical disease activity, endoscopic and histological indices, thereby it can be used as treatment target. However, the availability and cost of the FC, makes it unattainable in some regions. We aimed to assess the correlation of noninvasive Fecal Immunochemical Test (FIT) and FC for activity prediction in IBD.

Methods
Consecutive outpatients with Crohn’s disease or ulcerative colitis were clinically evaluated and stool samples for FIT and FC were collected. The Mayo endoscopic sub-score and SES-CD were used to define endoscopic activity. Spearman’s rank correlations were used to evaluate the association between FIT and FCP. Receiver operator characteristic (ROC) curves were constructed to calculate the accuracy of FIT and calprotectin in discriminating patients with endoscopic inflammation.

Results
Two hundred and six patients (148 ulcerative colitis and 58 Crohn’s disease) were enrolled. There was a good correlation between FIT and FC (Spearman rank correlation coefficient rs = 0.71, P &lt; 0.01). For calprotectin, a cutoff value of 250 mg/g predicted endoscopic inflammation with 75% sensitivity, 90% specificity, 97% positive predictive value, 50% negative predictive value, and an area under the curve of 0.861. For FIT, a cutoff value of 20 mg/g indicated endoscopic inflammation with 62.5% sensitivity, 90% specificity, 96% positive predictive value, 60% negative predictive value, and an area under the curve of 0.82.

Conclusion
Fecal Immunochemical Test has a good correlation with fecal calprotectin and can identify patients with IBD with endoscopic activity with a predictive accuracy similar to fecal calprotectin.
P286 Variation of outcomes in inflammatory bowel disease at ten Australasian centres - Crohn's Colitis Cure (CCC) Data Insights Program
Authors: Mcnamara J , Wilson W , Pipicella J , Ghaly S , Gearry R , Begun J , Ng W , Lynch K , Lawrance I , Schultz M , Walker G , Radford-Smith G , Andrews J M , Connor S J 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is a global health issue with Australia having amongst the highest prevalence rates worldwide. Our study examined the quality, safety and equity of care amongst ten Australasian centres using Crohn’s Colitis Care electronic management record. The aim was to describe current care delivery at each centre for a range of performance indicators to provide a baseline from which to engage in a regional care quality benchmarking initiative

Methods
Deidentified data prospectively entered by clinicians during routine clinical practice throughout 2022 were retrospectively analysed. Only centres with &gt;100 eligible people with IBD and an assessment during the trial period were included. Sites from Australia and New Zealand were a mixture of public and private IBD referral centres

Results
The cohort included 7172 people with IBD from 10 centres; 58.6% with Crohn’s disease (CD), 39.1% ulcerative colitis (UC) and 2.3% IBD-unclassified (IBDU). Mean age was 44.3 (SD +/- 18.0) with an even gender balance (50.7% female). The number of people with IBD per centre ranged from 201 to 2151 (median 566).
In the total cohort, 38.3% were currently on advanced IBD therapy (biologics or new small molecules), with centre variation from 30.8% to 43.5% (p&lt;0.001). Of those on advanced therapy, 42% were on dose escalated therapy which varied between centres substantially from 18% to 64%. Current steroid use ranged from 0.3% to 6.1% (median 1.6%; p&lt;0.001). Documented IBD surgical rates varied from 0.1% to 7.2% (median 2.0; p&lt;0.001). IBD admission rates ranged from 0.1% to 13.6% (median 1.2; p&lt;0.001) while current smokers comprised 1.7% to 12.5% (p&lt;0.001) of the cohort with a mean of 6.0% across all ten centres. A total of 3,379 faecal calprotectin’s (FCP) with an overall remission rate (&lt; 250μg/g) of 71% varying from 63.4% to 83.1% (median 69.1; p=0.001); 2,616 lower endoscopies were performed with an observed remission rate of 56%; this varied between sites from 0% to 69%.
Recorded Influenza vaccination rates varied from 6.3% to 54.4% (median 19.8) and Covid vaccination rates from 14% to 78.5% (median 43.4). Skin care check completion rates ranged from 16.3% to 32.3% (median 22.9). The centre with the highest documented healthcare maintenance completion rate across all three domains was private.

Conclusion
Despite advances in treatment and much literature addressing care guidelines and targets, significant disparity in care documentation and outcomes remains for people with IBD in routine care. CCCare as an IBD-specific EMR supports easy, serial examination of these measures at scale and is therefore a useful tool to measure and drive efforts to improve these deficiencies and reduce unwarranted care variation
P306 Rectal bleeding and stool frequency are strong predictors of endoscopic and histologic activity in ulcerative colitis patients, a prospective cohort study
Authors: Alenezi T , Almushir S , Afif W , Wild G , Lakatos P , Brassard P , Bitton A , Bessissow T 
Published: January 2024

Abstract

Background
Rectal bleeding and increased stool frequency are the most common symptoms patients with UC report, and they are key components in most of disease activity scores. It is unclear whether the severity of patient reported outcomes (rectal bleeding or diarrhea) correlate with endoscopic or histological disease activity. The aim of this prospective study is to evaluate the role of rectal bleeding and increased stool frequency as predictors for endoscopic and mucosal activity in patients with UC.

Methods
A single-center prospective observational study was conducted from July 2012 to July 2020. Adult patients aged 18 or older, with a confirmed UC diagnosis in clinical remission for at least 3 months, presenting to the endoscopy unit for disease activity evaluation or surveillance, were included. The partial Mayo score assessed rectal bleeding and stool frequency, considering scores of zero for each as clinical remission. Active endoscopic findings were defined by an endoscopic Mayo score &gt; 1, and active histology was assessed using the Geboes score (active disease defined as Geboes score ≥ 3.1) from rectal biopsies. Logistic regression analysis and generalized estimated equation (GEE) were employed to evaluate the predictive impact of rectal bleeding and stool frequency at different time points on endoscopic and histologic disease activity at 12 months.

Results
The study enrolled 253 patients and the analysis revealed a significant association between rectal bleeding and stool frequency scores with 12-month endoscopic and histologic activity at different time points. Rectal bleeding at 9 months (OR: 7.64, 95% CI: 1.43 - 40.90, p = 0.0175) and 12 months (OR: 19.89, 95% CI: 3.98 - 99.52, p = 0.0003) showed a significant association with active endoscopic findings at 12 month in the multivariate analysis. At 12 months, the multivariate model of rectal bleeding revealed a significant association with active histology, with OR of 11.87 (95% CI: 1.26-112.03, p = 0.0307). On the other hand, stool frequency at 12 months exhibited significant associations with the 12 months endoscopic and histologic activity with OR of 7.31 (95% CI: 2.38 - 22.49, p = 0.0005) and OR of 13.02 (95% CI: 1.60-105.74, p = 0.0163), respectively.

Conclusion
Rectal bleeding and stool frequency scores are useful tools to predict endoscopic and histological activity in UC patients.
P337 Proactive therapeutic drug monitoring of Adalimumab, but not HLADQ*A1 determination, predicts inflammatory bowel disease outcome and persistence of treatment
Authors: Carrillo Palau M , Alonso I , Morant A , Vela M , Vera B , Ramos L , Reygosa C , Medina Chico J S , Barrios Y , Franco A , Gutiérrez-Nicolás F , Jiménez A , Hernández-Guerra M 
Published: January 2024

Abstract

Background
Anti-TNF drugs have proven effective in managing Inflammatory Bowel Disease (IBD), but a significant percentage of patients exhibit primary or secondary non-response. Therapeutic drug monitoring (TDM) is a valuable tool for optimizing patient management. HLA-DQA1*05 gene has been investigated as a potential marker for immunogenicity and loss of response to anti-TNF therapy.This prospective, multicentric study aimed to assess the clinical impact of determining Adalimumab (ADA) levels and anti-adalimumab antibodies (Abs) in IBD patients and the influence of the HLA-DQA1*05 allele on the response and maintenance of ADA treatment over a 24-month follow-up.

Methods
Patients initiating ADA treatment between October 2020 and October 2022 were enrolled. Demographic data and IBD characteristics were recorded. Clinical Activity Index, C reactive protein (CRP), faecal calprotectin (FC), endoscopy or radiological activity, Global Physician Assesment (GPA) and PRO (by IBDQ-9) were prospectively collected at baseline and at the same time that ADA levels: week 4, 10, 30 and 12 months. HLA-DQA1*05 was genotyped at baseline. Pearson coefficient was utilized to assess correlations between ADA levels and disease activity.

Results
We included 170 (age 42±17 years, 54% female) IBD patients (74% Crohn`s Disease, 24% Ulcerative Colitis and 2% Indeterminate colitis) who started ADA (85% naïve to anti-TNF). At baseline, 80% had an active disease (GPA=1); CRP and FC were 10.72 ±17.85 mg/L and 568 ±775 µg/g; PRO at baseline was 63±8.6. HLA was determined in 167 patients, of whom 71 (42%) were HLA-DQA1*05 positives. Median follow up was 17 months. No correlation between HLA and drug levels or Abs was founded. ADA levels at the end of induction was correlated with ADA levels during follow up. ADA serum concentration &gt;7 µg/mL at weeks 4 and 10 correlated with improved clinical response at corresponding time points (p&lt;0.001). Patients with ADA levels &gt;7 µg/mL at week 10 demonstrated better disease control at 12 months. 41 patients stopped ADA. It was associated with active disease, low ADA levels, and adverse clinical and laboratory markers. HLA-DQA1*05 positivity did not correlate with adverse reactions or Abs during the observational period. A significative improvement in PROs in patients who started treatment with ADAL (62.73 at baseline and 69.42 at week 30) (p&lt;0.001) was observed.

Conclusion
Early Drug level monitoring of Adalimumab may improve the management of IBD patients. PCR, CF and GPA at week 10 may predict treatment failure. ADA levels &gt;7 µg/mL is associated with a better clinical response in short and long-term, independent of HLADQA1*05.
P341 Clinical Characteristics and Outcomes of Crohn’s Disease with Upper Gastrointestinal Involvement: A Comprehensive Retrospective Cohort Study
Authors: Hsu W C , Le P H , Kuo C J , Yeh P J , Lai M W , Wu R C , Chen C M , Chiu C T , Su M Y , Pan Y B 
Published: January 2024

Abstract

Background
Crohn's Disease (CD) affects the entire gastrointestinal tract, predominantly involving the terminal ileum and colon. However, the incidence and implications of upper gastrointestinal tract involvement in CD are often underestimated and underreported, especially in Asian populations. This study provides a comprehensive evaluation of the clinical characteristics and outcomes associated with UGI involvement in CD.

Methods
We conducted a retrospective cohort study at Chang Gung Memorial Hospital, Linkou, from January 2001 to June 2023, including CD patients with consistent follow-up records. Patients were categorized into two groups based on UGI involvement: Montreal L4 and non-L4. Comparative analyses were performed between the groups regarding baseline characteristics, new-onset complications post L4 disease diagnosis, and clinical outcomes.

Results
The study included 223 CD patients, 114 in the L4 group and 109 in the non-L4 group, with an average follow-up of 40.6 months. Initially, the L4 group showed higher smoking prevalence (21.1% vs. 5.5%, P&lt;0.001), higher Crohn’s Disease Activity Index (CDAI) scores (302.6±85.6 vs. 272.8±106.3, P=0.023), increased stricture disease (Montreal B2) incidence (55% vs. 48.2%, P&lt;0.001), and more frequent use of biologics (12.3% vs.3.7%, P=0.021) and proton pump inhibitors (64.9% vs. 52%, P=0.014). They also had lower albumin levels (3.6±0.8 vs. 3.9±0.7, P=0.011) and reduced peri-anal (14.9% vs. 26.8%, P=0.026) and fistulizing disease incidences (14% vs. 26.6%, P=0.016). At follow-up end, the L4 group continued to exhibit higher CDAI scores (153.6±98.7 vs. 114.4±71.8, P = 0.001), increased hospitalization rates (0.6±1.1 vs. 0.3±0.5 times/year, P=0.009), elevated C-reactive protein levels (15.2±37.8 vs. 6.9±15.1, P=0.036), and decreased albumin levels (4±0.7 vs. 4.2±0.4, P=0.018). Though they had a lower incidence of new-onset perianal fistula (6.7% vs. 3.7%, P=0.041), the L4 group had higher incidences of most new-onset CD-related complications, including strictures (44% vs. 20.2%, P&lt;0.001), enter enteral fistulae (11.9% vs. 3.5%, P=0.036), and intraabdominal abscesses (17.4% vs. 5.3%, P=0.009).

Conclusion
CD with UGI involvement is associated with higher disease activity and an increased risk of IBD-related complications. Comprehensive assessments at diagnosis and aggressive treatments are crucial for these patients to mitigate poorer outcomes.