bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1093 Early life exposure to agriculture and biodiversity influences Crohn’s disease risk in a population-based cohort study
Authors: Agrawal M , Vinkel Hansen A , Colombel J F , Jess T , Allin K 
Published: January 2024

Abstract

Background
Specific pollutants and environmental exposures are implicated in modulating inflammatory bowel disease (IBD) risk. Crohn’s disease (CD) clustering has been reported in agricultural areas. However, the role of environmental exposures, particularly in early life, towards IBD risk, has not been systematically evaluated.

Methods
We conducted a nationwide population-based cohort study during the study period extending from January 1, 1995, to September 1, 2020, using cross-linked Danish registers, maps, and inventories to ascertain the impact of agricultural land use, biodiversity, green space, urban space, blue space, and natural vegetation density index during pregnancy and the first two years of life on IBD, CD, and ulcerative colitis (UC) risk, using adjusted Cox proportional hazards regression analyses. We adjusted for the following covariates: sex, maternal age at delivery, calendar year of birth, municipal-level socioeconomic status, and first-degree relative with IBD.

Results
Of 1,438,487 individuals included in the study who were followed from age 2 years until a median (IQR) age of 14 (8-20) years, 3,768 individuals were diagnosed with IBD. Exposure to the highest and third quartiles of agriculture land use during early life, relative to the lowest quartile, were associated with increased IBD risk (aHR 1.16, 95% CI 1.02, 1.31 and 1.19, 95% CI 1.07, 1.32, respectively). Conversely, exposure to the highest and third quartiles of biodiversity in early life, compared to the lowest quartile, were associated with a lower IBD risk (aHR 0.90, 95% CI 0.82, 1.00 and 0.90, 95% CI 0.82, 0.99, respectively). These associations were driven by differences in CD risk (Figure), but there was no association with UC risk. Other environmental exposures were not associated with IBD risk.

Conclusion
In a nationwide cohort with long-term follow up data, early life exposure to agriculture land use was associated with an increase in CD risk, while higher biodiversity was protective.
P1105 Short-term exposure to environmental air pollution and inflammatory bowel disease flares: a time-stratified case cross-over study
Authors: Noviello D , Fedrizzi L , Fracas E , Pessarelli T , Conforti F , Pier Mannuccio M , Pesatori A C , Vecchi M , Carugno M , Caprioli F 
Published: January 2024

Abstract

Background
Some epidemiological studies suggest that long-term exposure to environmental air pollutants, such as particulate matter (PM), could have a role in inflammatory bowel disease (IBD) incidence and pathogenesis. However, less is known about the potential effect of short-term air pollution exposure. The aim of this study is to investigate whether short-term exposure to environmental air pollution is associated with the occurrence of IBD flares.

Methods
Anonymized hospital discharge records (HDR) with ICD-9-CM codes 555 (Crohn’s disease) and 556 (ulcerative colitis) for years 2002-2009 from all hospitals of the Lombardy region were collected. All HDR of adult patients (18-75 years) resident in Milan were included, except for recurrent hospitalizations within 6 months. Each record was assigned daily PM ≤10 µm (PM10) concentrations at municipality level by averaging PM10 levels of the day of admission with the levels of the day before (lag01) and of each preceding day up to six days before (lag06). To evaluate the association between PM10 and IBD-related hospitalizations, a time-stratified case-crossover study design was applied. Conditional logistic regression models, calculating Odds Ratios (OR) and 95% Confidence Intervals (95%CI) per increments of 10 µg/m3 of PM10, were performed.

Results
Overall, 2,176 hospital admissions (males=1,137, Crohn’s disease=1,264, ulcerative colitis=912) were included. In the entire population no clear association between PM10 and IBD-related hospitalization was identified, notwithstanding a small risk increase for males (OR: 1.03; 95%CI: 0.99-1.08 at lag04). When further stratifying for ICD code, an increased risk of hospitalization for "left-sided ulcerative colitis" (ICD code: 556.5) was found in males only, for exposures in all days preceding hospitalization up to lag04 (1.28; 1.05-1.28; 59 cases, 207 controls) (Figure 1). In females, the association was weaker, although positive (1.14; 0.91-1.42; 49 cases, 164 controls). No relevant findings emerged when looking at other ICD codes.

Conclusion
We observed an increased risk of IBD-related hospitalization in male patients with left-sided ulcerative colitis per increasing levels of air pollution in the days preceding hospital admission. Although preliminary, our findings suggest the possible role of sex as an effect modifier of the influence that air pollution might exert on IBD flares. Further studies are needed to better comprehend the complex framework characterizing the interplay between environmental and individual factors contributing to IBD.
P1107 Clinical characteristics and prognosis of very young adult-onset Crohn's disease: Results from the Prospective CONNECT Study
Authors: Kim M K , Jung Y , Jang B I , Jung S A , Im J P , Cheon J H , Kim Y S , Kim Y H , Kim J S , Ye B D 
Published: January 2024

Abstract

Background
Although the A2 group according to the Montreal classification accounts for the largest proportion among patients with Crohn’s disease (CD),1 there has been a lack of studies comparing the clinical characteristics and prognosis according to the age at diagnosis within the A2 group.

Methods
We utilised data from the prospective CONNECT study—a nationwide, multicentre cohort study of CD patients in Korea.2 Of 1,175 participants, a total of 945 patients (80.4%) were categorised as Montreal classification of age A2 (≥17 and &lt;40 years at diagnosis). They were further divided into two groups based on the age at diagnosis: very young adult-onset group (≥17 and &lt;20 years, n=275) and young adult-onset group (≥20 and &lt;40 years, n=670).

Results
Isolated ileal diseases were more common in the young adult-onset group (21.5% vs. 30.7%), whilst the frequency of stricturing (B2) or penetrating (B3) behaviours was tended to be lower in the very young adult-onset group than in the young adult-onset group (16.7% vs. 29.7%) (Table 1). Twenty-five patients (9.1%) in the very young adult-onset group underwent intestinal resection compared to 91 patients (13.6%) in the young adult-onset group (p=0.072). The very young adult-onset group had a longer intestinal resection-free survival than the young adult-onset group (p=0.04) (Figure 1a). More patients in the very young adult-onset group received systemic corticosteroids compared with those in the young adult-onset group (62.2% vs. 48.8%, p&lt;0.001) and the corticosteroid-free survival was shorter in the very young adult-onset group compared with the young adult-onset group (p&lt;0.01) (Figure 1b). Complicated behaviors (B2, adjusted hazard ratio [aHR] 4.03, 95% confidence interval [CI] 2.42–6.70, p&lt;0.001; B3, aHR 6.39, 95% CI 4.21–9.72, p&lt;0.001) was independently associated with the risk of intestinal resection.

Conclusion
The very young adult-onset group exhibited distinct disease behaviour at diagnosis and different clinical outcomes compared with the young adult-onset group. Within the A2 group (≥17 and &lt;40 years at diagnosis), the risk of intestinal resection appears to be driven by the intestinal complications.
References
1. Silverberg MS, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19 Suppl A:5A–36A.
2. Hong SW, et al. Clinical features and long-term prognosis of Crohn's disease in Korea: Results from the Prospective CONNECT Study. Gut Liver 2022;16(6):907–920.
Financial support: This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency (2022ER050400).
P1119 Increased risk of chronic respiratory disease among individuals with Inflammatory Bowel Disease in a prospective cohort study
Authors: Dan L , Xie Y , Fu T , Sun Y , Chen X , Wang X , Wu C , Chen J , Li X 
Published: January 2024

Abstract

Background
Cross-sectional evidence suggests a higher burden of chronic respiratory diseases in people with inflammatory bowel disease (IBD), but there is a lack of prospective evidence to clarify the direction of their associations. This study aimed to investigate the association of IBD with the risk of two major chronic respiratory diseases, chronic obstructive pulmonary disease (COPD) and asthma.

Methods
We included 430,414 participants from UK Biobank and followed them from recruitment (2006-2010) to 2021. COPD and asthma cases were obtained from inpatient data and death register. Using Cox proportional hazards models, we estimated the multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CIs) of developing COPD and asthma in participants with IBD compared with IBD-free groups. We also investigated the association among Crohn's disease (CD) and ulcerative colitis (UC) with the risk of COPD and asthma.

Results
Over a median follow-up of 143 months, there were 11,196 incident COPD and 9831 asthma cases. The adjusted HRs of developing COPD (HR=1.54, 95% CI: 1.33-1.79) and asthma (HR=1.52, 95% CI: 1.29-1.79) were higher for those with IBD when compared with IBD-free participants. Participants with CD and UC were also found to have a higher risk of COPD (CD: HR=1.71; 95% CI: 1.36-2.15; UC: HR=1.45; 95% CI: 1.20-1.75) and asthma (CD: HR=1.73; 95%CI: 1.33-2.25; UC: HR=1.41; 95%CI: 1.15-1.73) when compared with those free of IBD (Table 1).

Conclusion
This study suggested that individuals with IBD have a higher risk of developing COPD and asthma, highlighting the importance of preventing chronic respiratory diseases among IBD patients.
P1124 Nutritional assessment and validation of GLIM Criteria in Inflammatory Bowel Disease patients
Authors: Belén Galipienso O , Bernabeu P , Amrani R , van-der Hofstadt C , Abad A , Cameo J I , Madero L , Gutiérrez A , García del Castillo G , García Sepulcre M F , Zapater P , Bernal L , Moreno V , Jover R , Sempere R 
Published: January 2024

Abstract

Background
There is currently no validated method of assessing nutritional status in non-hospitalised patients with inflammatory bowel disease (IBD). The Global Leadership Initiative on Malnutrition (GLIM) has developed criteria for malnutrition including phenotypic criteria (low BMI, and reduced fat-free mass index (FFM)) and etiologic criteria: reduced food intake or malabsorption and chronic inflammation. In the GLIM algorithm, malnutrition is diagnosed by a combination of at least one phenotypic and at least one etiologic criterion. Gender differences in nutritional indices may be relevant, especially variables assessing weight loss, nutritional intake and digestive symptoms, where different eating habits and symptom expression are known between the sexes. The aim of the study is to validate the GLIM criteria in patients with IBD, including the gender perspective, and to assess the influence of psychosocial factors.

Methods
Multicentre, prospective, observational, analytical study in non-hospitalised IBD patients. A total of 368 patients with a 1:1 male to female ratio will be included. At the baseline visit GLIM criteria will be assessed along with other nutritional parameters, clinical and demographic characteristics of IBD. Validation of the GLIM criteria will be done with the 6 and 9 month incidence of complications associated with malnutrition (hospitalisations, emergency department visits, medical consultations, IBD complications, surgery and quality of life impairment), with specific analysis by gender and type of IBD.

Results
To date, a total of 204 IBD patients have been included (104 women; 104 with Crohn's disease [CD], 97 with ulcerative colitis [UC] and 3 with non-specific colitis); with a median age of 52 (SD 14.3) years. The prevalence of malnutrition according to GLIM criteria was 18.1% and 44.1% of patients were at risk of malnutrition, 20.1% by phenotypic criteria and 24% by etiological criteria. In the subgroup analysis, 20.2% of CD patients and 16.5% of UC patients were malnourished according to GLIM criteria. Risk of malnutrition was found in 45.1% and 39.2% in CD and UC, respectively.

Conclusion
The prevalence of undernutrition according to GLIM criteria is higher in CD than in UC.
P1128 Reducing diagnostic delay of Extra-Intestinal Manifestations in patients with Inflammatory Bowel Disease: a comparative study between a multidisciplinary immune-mediated diseases outpatient clinic and conventional referral specialists
Authors: Nardone O M , Calabrese G , Peluso R , Foglia F , Megna M , Cacciapuoti S , La Mantia A , D'Alessandro E , Ferrante M , Villani G , Testa A , Bonacci L , Leo C , Rispo A , Castiglione F 
Published: January 2024

Abstract

Background
Extraintestinal manifestations (EIMs) can occur in up to 47% of patients diagnosed with inflammatory bowel disease (IBD); hence the early detection of EIMs in IBD patients is crucial to prevent structural damage. However, there is a substantial variation in the reported time to diagnosis of EIMs due to a lack of a standardised approach. We, therefore, evaluated the length of time to diagnose EIMs through an integrated immune-mediated diseases (IMIDs) outpatient clinic (IMID-C) compared to a standard outpatient clinic (SO-C). Secondary endpoint included the impact of diagnostic time on the time to therapy, thereby aiming for an early control of disease

Methods
We conducted a single-centre cohort observational study including IBD patients ≥18 yo presenting red flags for EIMs who underwent outpatient visits through a multidisciplinary IMIDs clinic between 2018-2022 and we compared this group to a historical cohort, with similar clinical features, who underwent conventional visits by individual referral specialists from 2017 to 2022. Diagnostic delay was defined as the period from the occurrence of red flags to diagnosis of EIMs. Survival curves were plotted for assessing the differences in terms of diagnostic delay and time to treatment between IMID-C and SO-C within 18 months.

Results
We enrolled 238 IBD patients; 127 were referred to the IMIDs Clinic Group (IMID-G) and 111 to the Standard Outpatient Clinic group (SO-C). Demographic details are summarised in Table 1. The average time to EIMs diagnosis was 2,48±1,8 months for IMID-C and 5,36±2,3 months for SO-C (p=0.005). In both groups, most patients (38,6% in IMID-C and 44 in SO-C) referred red flags for peripheral arthritis (PA). In IMID-C, chronic back pain was reported by 23,6% of patients, similarly in SO-C 27,9% had chronic back pain. Overall, the majority of patients received a diagnosis of PA (IMID-C=37,5%; SO-C=33,7%) and spondyloarthropathy (IMID-C=32,1%; SO-C=33,7%). Significantly, more patients in the IMID-C group (34, 26,8%) received treatment with immunomodulators in addition to their ongoing therapy compared to the SO-C group (17, 17,3%; p=0.04). Details of therapeutic strategies are summarized in Table 2. Survival curves revealed a significant reduction of diagnostic delay and time to therapy in IMID-C compared to SOC-C group (log-rank test, p&lt;0.001)

Conclusion
Attending a dedicated IMIDs clinic can enhance the diagnostic process for EIMs in IBD patients, thereby reducing diagnostic delays. Disease-modification trials are eagerly awaited to assess the long-term impact on disease progression, quality of life and disability
P1190 Inflammatory Bowel Disease Treatment Economics: Assessing the Financial Ramifications and Striving for Healthcare Equity
Authors: Dosal Limon S K , Sánchez Rosado R R , Soto Llanes J O , Vela Torres A , Ramírez García G , Jiménez Bobadilla B , De León Rendón J L 
Published: January 2024

Abstract

Background
Inflammatory Bowel Disease (IBD) has emerged as a public health challenge. In addition to the health effects on patients, IBD also carries a significant economic impact. The diagnosis, treatment, and follow-up of IBD entail considerable costs for both patients and the healthcare system. Therefore, understanding the economic impact of this disease is crucial for making informed decisions about its management and resource allocation. The aim of this study was to determine the short-term (one month) and long-term (twelve months) economic impact of medical care and surgical treatment in patients diagnosed with IBD at a tertiary-level hospital in Mexico.

Methods
A retrospective study was conducted, which included 118 patients diagnosed with IBD and treated at the IBD Clinic of the "Dr. Eduardo Liceaga" General Hospital in Mexico over the past 12 months. The economic impact of both medical treatment (conventional and biological) and surgical treatment in managing IBD was evaluated. For the calculation of medical treatment costs, the unit costs of medications were based on maximum retail prices at a conventional pharmacy. Surgical treatment costs were based on the hospital's provided costs. Individual costs for each patient were recorded and tabulated, and the total cost for each treatment regimen was calculated at one and twelve months. Descriptive statistical methods were used to analyze the data to obtain measures of central tendency and dispersion.

Results
The average monthly cost of medical treatment for a patient with IBD is estimated to be $11,612.45 Mexican pesos (MXN), resulting in a total cost of $139,349.40 MXN over 12 months. Considering all our patients, the total cost of medical care reaches $16,443,229.20 MXN in 12 months. Regarding surgical treatment, there is an average cost of $626,847.45 MXN per surgical event in patients with IBD. The total cost of surgical treatment for our IBD patients, encompassing a total of 24 patients, amounts to $15,043,379 MXN. Therefore, medical treatment appears to be more cost-effective compared to surgical treatment (the total cost of medical treatment for the 121 patients over one year is $16,443,229.20 MXN, while the total cost of surgical treatment for the 24 patients is $15,043,379 MXN). In our institution, 95% of the IBD Clinic patients receive free medical care. This represents significant cost savings for patients.

Conclusion
This study provides evidence regarding the economic impact of medical and surgical treatment in patients with IBD. The results support the consideration of medical treatment as the more cost-effective option while emphasizing the significance of free medical care in improving equitable access and alleviating the financial burden on patients and their families.
P1204 Oral Streptococcus mutans isolates aggravated colitis in mice
Authors: Chen J , Yang C , Xu Y , Zhao Y , Wu J , Liu Y , Chen N 
Published: January 2024

Abstract

Background
The incidence of inflammatory bowel disease (IBD) is increasing year by year and the mechanism is unclear. A great number of studies have shown that the gut microbiota composition of IBD patients has changed and the diversity of gut microbiota decreases. The abundance of firmicutes decreases, and the abundance of Proteobacteria increases, which eventually leads to the immune disorders and intestinal inflammation. The mouth is the "gateway" of the digestive tract, which has various microbiota. The entry of extraneous microbiota from the mouth into the intestines play an important role in influencing the composition of the gut microbiota. The continuous disorder of the oral microenvironment (such as periodontitis and dental caries) are also closely related to intestinal inflammation.

Methods
A series of in vivo and in vitro experiments were conducted to investigate the effect and mechanism of S. mutans on colitis mice.

Results
S.mutans strain UA159 which is closely related to dental caries significantly aggravated colitis in DSS induced mice, as shown by body weight loss, shorter colon length, and increased inflammatory histological scores (Fig1A). UA159 up-regulated intestinal pro-inflammatory cytokines and inhibited the expression of barrier molecules in DSS mice (Fig1B). The proportion of adaptive immune cells (Th1, Th17) was up-regulated in intestinal lamina propria of UA159-administered mice (Fig1C-D).The fecal microbiota composition of UA159 mice was different from control group. The pro-inflammatory effects of UA159 on DSS mice disappeared when antibiotics were used to eliminate the intestinal microbiota. It is suggested that S.mutans may play a proinflammatory role by influencing the intestinal microbiota of mice (Fig1E).
We followed 55 IBD patients for more than 1 year and found that IBD patients with poor control had a higher proportion of S.mutans in saliva (Fig1F). S.mutans strains were isolated from IBD saliva samples and were found to cluster in different branches in the phylogenetic tree (Fig1G). S.mutans isolates have different pro-inflammatory effects on colitis mice and intestinal epithelial cells (Fig1H-I). Subsequent experiments are under way to further explore the mechanism leading to the differences of the pro-inflammatory effects.

Conclusion
Our study were the first to find that oral S.mutans has aggravated intestinal inflammation. S.mutans UA159 aggravated colitis in mice through damaging intestinal mucosal barrier function, enhancing immune response and disrupting intestinal microbiota (Fig1J). The difference in pro-inflammatory effect of S.mutans derived from different IBD patients saliva may be related to the individual clinical outcome.