bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1046 Home calprotectin testing: An east London experience
Authors: Blakey L , Ronquillo F L V , King J J , Vinayaga-pavan M , Tai C K , Jawad N 
Published: January 2024

Abstract

Background
Monitoring of inflammatory bowel disease (IBD) using home faecal calprotectin (FCP) testing kits was adopted widely during the Sars-Cov-2 pandemic. CalproSmart is a kit which allows patients to measure FCP at home and upload the results to a smart phone application allowing remote monitoring. Recent NHS long term recovery plan has highlighted the importance of ensuring equity of access with service development1. Following the British Society of Gastroenterology guidance during the pandemic we introduced the system to our hospital in Newham, one of the most ethnically diverse regions of the UK2. The aim of this pilot study was to evaluate the uptake of the kits, patient acceptability and how they impacted on IBD care.

Methods
62 patients with stable IBD were invited to take part in the study over a 12 month period. They were sent four FCP tests and instructions on how to enrol onto the CalproSmart portal. The participants who enrolled on the portal were then sent a post-study questionnaire.

Results
28 of the 62 patients invited (45%) enrolled onto the CalproSmart portal. 14 of these 28 patients (50%) completed the post-study questionnaire.
The patients invited to take part were from a variety of ethnic backgrounds, the average age was 36 and there were a mix of Ulcerative Colitis (60%) and Crohn’s (40%) diagnoses. When comparing those invited and those who used the home kit, uptake varied according to gender and ethnicity. 57% of women invited used the home kit compared to 34% of males. Additionally, despite 69% of the borough’s population being non-white, 50% of those using the home tests were white (see table 1).
The post –study questionnaire showed that both the sample kit and the application were found easy to use by 12 (86%) and 13 (93%) of the patients, respectively. 11 patients (79%) reported they found the results of the FCP home kit helpful and 6 patients (50%) felt the FCP home kit improved the treatment of their disease (see figure 1).10 patients (71%) reported they preferred a home test to dropping stool samples at the hospital. The reasons for this were the convenience of not having to visit the hospital (90%) and the speed in which they got the results (80%).

Conclusion
This study demonstrates that home FCP tests are an easy-to-use tool and patients prefer them to attending the hospital. The home kit was well received in a diverse area of London with a mix of ethnic groups and socio-economic backgrounds.
However, the ethnicity of patients using the home tests did not reflect the diversity of the invited participants or the borough. This suggests there needs to be additional exploration into their barriers to access and consider any extra support needed to improve uptake of patient initiated monitoring.
P1047 Observational study of tofacitinib in Ulcerative Colitis in Sweden (ODEN) – Interim analysis of health-related quality of life and fatigue
Authors: Nyberg L , Söderling J , Olén O , Strid H , Jäghult S , Halfvarson J , Hedin C , Jónsdóttir S , Hjortswang H , Cappelleri J C , Henrohn D , Seddighzadeh M , Marsal J , Grip O 
Published: January 2024

Abstract

Background
Ulcerative colitis (UC) has a major impact on daily life. The Janus Kinas (JAK) inhibitor tofacitinib is effective in achieving remission in UC, but prospective real-world evidence concerning the effect on health-related quality of life (HRQoL) and fatigue are still scarce. Fatigue is a component of UC that is notoriously difficult to treat and not unambiguously related to inflammatory activity. ODEN is an ongoing Swedish multicentre prospective observational study of tofacitinib in UC. In this interim analysis, we assessed the effectiveness on HRQoL and fatigue during the first 16 weeks.

Methods
Patients with UC and active inflammation were enrolled 2020-2023 when starting tofacitinib as per clinical indication. To measure various aspects of impairment of daily life, the validated questionnaires Short Health Scale (SHS), EQ-5D-5L [Swedish value set], and IBD-fatigue scale (IBD-F) were used. These data and information concerning clinical, biochemical, and endoscopic outcomes were collected in an e-CRF linked to the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG). For HRQoL outcomes, per protocol analysis was applied. Paired t-test and Wilcoxon’s signed-rank test were used for mean and median differences, respectively.

Results
In total, 103 patients were included. Baseline data are shown in Table 1a. For patients still on tofacitinib treatment, all four dimensions of the SHS (symptoms, social function, disease related worry, and general well-being) improved significantly, Table 1b. A median decrease of one point from baseline was seen at week 8 in each of the parameters, which was maintained through week 16 with a tendency towards further improvement. EQ-5D-5L showed an impairment mainly in the aspects of pain/discomfort and ability to participate in common daily activities. Improvement in these dimensions was seen from baseline to week 16. The overall EQ-5D-5L index improved significantly from baseline (0.80) to week 8 (0.86) and week 16 (0.89), as did the EQ VAS 0-100 reflecting overall health (58, 71, and 74, respectively). A significant improvement in IBD-F part 1 and 2 was seen at week 8 and 16, Figure 1.

Conclusion
This study demonstrates that tofacitinib treatment covariates with positive changes in a variety of measures of patients’ quality of life, including improvements in self-assessed overall wellbeing. Finally, fatigue significantly improved during tofacitinib treatment. Thus, tofacitinib treatment shows association with meaningful improvements in multiple aspects of quality of life during the first 16 weeks of treatment.
P1059 Use of preoperative transjugular intrahepatic portosystemic shunt (TIPS) in patients with Inflammatory Bowel Disease and cirrhosis
Authors: Karime C , Vattikonda A , Hashash J G , Merchea A , Stocchi L , Farraye F A 
Published: January 2024

Abstract

Background
Colorectal surgery in patients with inflammatory bowel disease (IBD) and cirrhosis is associated with high morbidity related to portal hypertension. Thought to reduce surgical risk, transjugular intrahepatic portosystemic shunt (TIPS) may be used to decrease portal pressures. In this study, we aimed to characterize surgical outcomes of patients with IBD and cirrhosis who underwent preoperative TIPS at a large tertiary care center.

Methods
We retrospectively identified patients with IBD and cirrhosis who had undergone TIPS between 2010-2023 for portal decompression prior to colorectal surgery. All other indications for TIPS led to patient exclusion. Demographic and medical data was collected, including surgical indication and portal pressure measurement. Data on surgical outcomes were compiled through chart review.

Results
We identified 10 patients (60% male) with IBD and history of decompensated cirrhosis who underwent preoperative TIPS for portal decompression (Table 1). Surgical indications were colonic dysplasia (50%), refractory IBD (50%), and stenosis or stricture (30%). All patients were deemed nonsurgical candidates due to significant surgical risk from portal hypertension. Following multidisciplinary coordination, patients underwent TIPS for portal decompression at a median of 47 days (IQR 34-80) prior to colorectal surgery. TIPS was associated with significant reduction in portal pressure (22.5 vs 18.5mmHg, p&lt;0.01) and portosystemic gradient (12.5 vs 5.5mmHg, p&lt;0.01) in all patients. Of 10 patients, 30% had TIPS-related complications (transient fluid overload and encephalopathy). In terms of surgical complications, 40% of patients required intraoperative blood transfusion (range: 1-4 units). Postoperatively, 30% of patients had surgical site bleeding and 10% had wound dehiscence, although none required reoperation. Systemic complications occurred in 30% of patients, with systemic signs of infection being the most common. Transaminitis (50%) and coagulopathy (40%) were also common. Median hospital stay was 7 days (IQR 5.5-9.3), with 40% of patients being readmitted within 30 days. Most common cause of readmission was systemic infection (75%), abdominal abscess (50%), or electrolyte abnormality (50%), with one patient requiring reoperation for wound dehiscence. Ninety-day and 1-year survival was 100% and 90% respectively.

Conclusion
In our series of patients with IBD and cirrhosis requiring surgery but deemed nonsurgical candidates, preoperative TIPS lead to portal decompression and facilitated successful surgical intervention despite heightened risk. Nevertheless, significant operative and postoperative complications were noted. Future studies are needed to determine optimal surgical timing following TIPS placement.
P1065 Endoscopic Submucosal Dissection for High-Risk Colorectal Colitis-Associated Neoplasia in Inflammatory Bowel Disease: a Real-World Multicenter Study
Authors: Maselli R , de Sire R , Barbaro F , Cecinato P , Andrisani G , Rosa Rizzotto E , Sferrazza S , Fiori G , Azzolini F , Pugliese F , Facciorusso A , Repici A , Armuzzi A 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) patients have a 2-3-fold increased risk of developing colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN), including non-polypoid lesions and large non-pedunculated colon polyps, are often not amenable to conventional resection techniques. Aim of this study was to evaluate effectiveness and safety of endoscopic submucosal dissection (ESD) of HR-CANs.

Methods
In this real-world, multicenter, retrospective study, we included consecutive IBD patients referred to nine Tertiary Italian Endoscopy Centers (January 2014 - April 2023) to undergo an ESD or a hybrid-ESD (hESD), for HR-CANs. The primary outcome was rate of en bloc, R0 resection and adverse events (AEs). The secondary outcome was rate of local recurrence, metachronous lesions, and post-dissection surgery.

Results
96 HR-CANs (89.6% non-polypoid, 79.2% left-side colon, 34.8 mm ± 16.2 mm, 15.6% invasive pit-pattern) in 91 patients with colonic IBD (58.2% male, 60.8 ± 12.2 years, 83.4% ulcerative colitis, disease duration of 183 ± 104 months, 14.3% endoscopic activity) were included. ESD and hESD were performed in 82.3% and 17.7% of cases. The final histopathological diagnoses were serrated sessile lesions in 14.6%, low-grade dysplasia in 32.3%, high-grade dysplasia in 38.5%, adenocarcinoma in 14.6%. Overall, en bloc and R0 resection were achieved in 95.9% and 85.4% of cases. AEs occurred in 12.5% of cases, all managed endoscopically and conservatively. After a mean follow-up of 23.4 months, local recurrence and metachronous lesions occurred each in 3.1% (n=3) of cases. Post-dissection surgery was required in 11.5% (n=11) of cases (7 for histopathology, 2 for recurrences, 2 for refractory IBD). At univariate analysis the left site was identified as a predictor of higher rate of en bloc resection (OR 0.07; 0.007-0.77; p=0.02), while the female sex as a predictor of lower rate of AEs (OR 0.17; 0.03-0.81; p=0.02). Further, the invasive pit pattern was associated with higher rate of post-dissection surgery (OR 6.25; 1.6-24.3; p=0.008).

Conclusion
Our findings showed that ESD of HR-CANs, when performed in Tertiary Endoscopy Centers, was effective and safe in patients with colonic IBD. However, further prospective studies including a long-term follow-up are still required to highlight the impact of ESD for IBD patients’ dysplasia-free survival.
P1077 Patients’ and Gastroenterologists’ Preferences on Outcomes and Medication Attributes for Ulcerative colitis
Authors: Katsoula A , Paschos P , Giouleme O , Toumbalidou M , Mainou M , Malandris K , Tsapas A 
Published: January 2024

Abstract

Background
Gastroenterologists’ perceptions regarding importance of treatment outcomes and medication attributes for ulcerative colitis (UC) may differ from inflammatory bowel disease (IBD) patients’ preferences. The objective of the study was to explore and compare patients’ and health care professionals’ attitudes in the decision-making process for available UC treatments.

Methods
A qualitative study was conducted using patients’ focus groups and gastroenterologists’ interviews. Participants who had been diagnosed with ulcerative colitis were recruited for the purposes of this study. Gastroenterologists (GIs) were identified from the Hellenic Group for the study of IBD. Focus groups discussions and interviews were audiotaped and transcribed verbatim. Thematic analysis was used to identify patients’ and clinicians’ important outcomes.

Results
Eight gastroenterologists and 23 individuals with IBD participated in semi-structured interviews and focus-group discussions, respectively. Categories that emerged from the data analysis included outcomes related to UC, the impact of UC on daily life, drug-related attributes, and the patient-doctor relationship. Within these themes, divergences between the opinions of GIs and patients were observed on two primary issues. In terms of UC-related outcomes, physicians aimed for clinical remission and focused on long-term objectives such as mucosal healing defined by endoscopic improvement and histologic remission. In contrast, patients' expectations were of shorter term and focused on symptomatic response, defined as early and sustained relief of the symptoms and improvement in quality of life. Regarding specific drug attributes, patients were mainly focused on the impact on daily life, considering factors such as route of drug administration, dosage, and the need for daily hospitalization. In contrast, GIs appeared more concerned about drug adverse events and the risk of losing responsiveness.

Conclusion
Individuals receiving healthcare and healthcare providers may have varying views on the significance of different treatment outcomes and features of medications. Patients often prioritize factors that directly impact their quality of life. It is crucial to address these concerns and preferences in clinical discussions when determining the most suitable treatment approach for ulcerative colitis.
P1078 The influence of different 5-aminosalicylic acid preparations on mercaptopurine metabolism
Authors: Anjie S , Hettinga J , Volkers A G , van Gennep S , Clasquin E , Duijvestein M , van Bodegraven A A , van der Zanden E P , Jansen J M , van Asseldonk D P , West R L , D'Haens G R A M , Löwenberg M , de Boer N K 
Published: January 2024

Abstract

Background
5-aminosalicylic acid (5-ASA), the cornerstone treatment for ulcerative colitis (UC), can impact thiopurine S-methyltransferase (TPMT) activity and thiopurine metabolism. We performed a post-hoc analysis of OPTIC, a randomised prospective controlled trial comparing mercaptopurine (MP) to placebo while continuing 5-ASA treatment in UC, to provide insight into the influence of different 5-ASA preparations on 6-thioguaninenucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP) levels.

Methods
UC patients with active disease, despite ≥2 g/day 5-ASA treatment, received remission induction therapy with corticosteroids and conjunctively started weight-based MP therapy (1-1.5 mg/kg of bodyweight). For this analysis, the initial TDM measurement, using the Dervieux method, at week 6 was selected to exclude subsequent time points where dose adjustments were made. Different 5-ASA preparations were used, including time-dependent release (Pentasa® 4 g/day), Multi-Matrix (MMX) (Mezavant® 2.4, 3.6 or 4.8 g/day) and pH-dependent release (Salofalk® 3 or 4 g/day). Associations between 6-TGN and 6-MMP levels and 5-ASA preparations were analysed.

Results
In total, 29 patients started MP treatment, 27 patients reached the initial TDM measurement (41% female, median age 46 years [IQR 26-58], median disease duration 6 years [IQR 1-14]). Median 5-ASA dose was 4 g/day (IQR 3-4), the majority was treated with MMX 5-ASA (13/27), followed by time-dependent release 5-ASA (9/27) and pH-dependent release 5-ASA (5/27). Distribution of MP dose, body weight and age were similar across the different 5-ASA groups. At week 6, patients using an MMX 5-ASA formulation were more likely to have toxic 6-MMP concentrations (&gt;5700 pmol/8×108 RBC), but not 6-TGN levels, compared to time-dependent release formulation users (91% vs 38%, P=0.041) as well as an unfavourable 6-MMP/6-TGN ratio (P=0.024). This effect was not dose-dependent. Median 6-MMP levels at week 6 varied statistically significantly between the different 5-ASA preparations: i.e. MMX 5-ASA showed the highest and time-dependent release 5-ASA the lowest 6-MMP level (19000 [IQR 10519-31000] vs 3950 pmol/8×108 RBC [IQR 2200-31000], resp., P=0.026, Figure 1). MP treatment persistence up to week 52 differed numerically between different 5-ASA preparations (MMX: 46%, time-dependent release: 78%, pH-dependent release: 60%), while no differences in hepatotoxicity or leukopenia were seen between 5-ASA formulations.

Conclusion
In UC patients receiving MP treatment, concomitant use of MMX 5-ASA was associated with higher toxic 6-MMP concentrations accompanied with an unfavourable 6-MMP/6-TGN ratio compared to time-dependent release 5-ASA leading to higher MP discontinuation rates.
P1087 A retrospective study on the GLIM criteria for assessing malnutrition in patients with Crohn's Disease and its correlation with clinical outcomes
Authors: Song X , Zhou X , Yang J , Guo H 
Published: January 2024

Abstract

Background
It is a common occurrence for patients with Crohn's disease (CD) to suffer from malnutrition. A novel approach to assessing malnutrition has been devised by the Global Leadership Initiative on Malnutrition (GLIM). Therefore, the objective of this study was to investigate the prevalence of malnutrition in CD patients using GLIM criteria and evaluate the clinical utility of GLIM in this population.

Methods
A retrospective cohort study was conducted with 386 patients with Crohn's disease. Data were extracted from the medical records, including demographic and clinical characteristics. All patients were evaluated using the nutritional screening and diagnosis criteria of the NRS 2002 and the GLM criteria. The prevalence of malnutrition was reported and the relationship between malnutrition and clinical outcome was analyzed.

Results
The prevalence of malnutrition among CD patients was 73.6% and 35.1% in mild malnutrition, 35.4% in moderate malnutrition, and 35.4% in severe malnutrition. The majority (143, 50.4%) of malnourished patients were categorized as B2 or B3 phenotype, with a significant difference (P= 0.001). The malnourished group had significantly higher CDAI scores than the non-malnourished group (122.9±70.5 vs. 77.3±61.3, P&lt;0.001). In the primary cohort, patients at risk of malnutrition with inflammatory load exhibited a significantly worse clinical outcome compared to those without inflammatory load (OR 4.07, 1.56-10.7; P=0.004).

Conclusion
Malnutrition caused by Crohn's disease is a significant issue for numerous patients. Malnutrition identified using the GLIM criteria was found to be associated with CDAI, age, and behavior, providing prognostic value for clinical outcomes.
P1088 Real-world data on the treatment with Upadacitinib in a biological-experienced Crohn's disease cohort
Authors: Kubesch A , Lande R , Farrag K , Jungheim F , Dienethal A , Sprinzl K , Zeuzem S , Blumenstein I 
Published: January 2024

Abstract

Background
Upadacitinib was approved for the treatment of Crohn's disease in June 2023. However, real-world data, especially in biological-experienced patients, is scarce. We aimed to determine the treatment efficacy and persistence of Upadacitinib in treatment-experienced Crohn's disease (CD) patients

Methods
All patients treated for Crohn's disease in the IBD outpatient clinic of the University Hospital Frankfurt from 06/23-11/23 were retrospectively analyzed. Data on clinical (Harvey-Bradshaw index (HBI)) and biochemical disease activity (fecal calprotectin FC), as well as patient history, were collected. Patients were followed up for at least 12 weeks.

Results
Twenty patients with CD were included. All patients had already received at least one biological agent before starting upadacitinib. Six patients reported extraintestinal manifestations, most commonly arthralgia. Five patients had stenosis of the terminal/neoterminal ileum, and one patient underwent surgery during Upadacitinib induction. Five patients had preexisting fistulae; four reported fistulae activity at treatment initiation. The median Harvey-Bradshaw Index was 11. We report an HBI reduction after induction (8.5). The median FC level at induction was 719 ug/g. After the induction, the median FC was 216 ug/g. Nineteen of the twenty patients completed the induction period of 12 weeks at the time of this interim analysis. All patients continued with 30mg of Upadacitinib post-induction. The most common adverse event was acne. No significant changes in the patients' lipid status were observed.

Conclusion
We report preliminary real-world data on the treatment with upadacitinib. In our interim analysis, Upadacitinib is an effective and safe treatment in biological-experienced CD patients.
P1097 The effect of lockdowns during the COVID-19 pandemic on the epidemiology of inflammatory bowel diseases: a comparison of two nationwide cohorts
Authors: Atia O , Bryder N , Mendelovici A , Ledderman N , Ben-Tov A , Osooli M , Forss A , Loewenberg Weisband Y , Matz E , Dotan I , Turner D , Olén O 
Published: January 2024

Abstract

Background
Mechanistic evidence suggest a link between COVID-19 infections and the development of immune mediated diseases. Additionally, the lockdowns during the pandemic limited the accessibility to medical care, possibly leading to reduced number of diagnosed patients with inflammatory bowel disease (IBD). We aimed to explore these contending trends on the epidemiology of IBD during the COVID-19 pandemic in two countries with different lockdown policies.

Methods
We utilized nationwide IBD cohorts in Israel and Sweden to explore the incidence of IBD during the pandemic (2020-2021) compared to three years prior (2017- 2019). We examined temporal trends through the presence of inflection points by Joinpoint regression analysis and reported average monthly percentage changes (AMPC).

Results
A total of 155,837 patients with IBD were included (Israel, 58,640; Sweden, 97,197). The incidence of IBD was stable during the three years prior to the beginning of the COVID-19 pandemic in February 2020 (AMPC: Israel 0.0% [95%CI -0.5% to 0.4%]; Sweden 0.2% [95%CI -0.3% to 0.7]). Thereafter, the incidence rate in Israel remained stable until November 2020 (AMPC 2.3% [95% CI -13.4% to 29.9%]) and then decreased sharply (AMPC -6.4% [95%CI-20.8% to 17.0%]) until February 2021 and -20.1% [95%CI -38.9% to -4.7%]) from February 2021), while in Sweden, which had a less stringent lockdown policy, the incidence rate decreased slightly until July 2020 (AMPC -3.3% [95%CI -21.6% to 20.3%]), but increased thereafter (AMPC 13.6% [95%CI -12.6% to 27.0%]; Figure).
In Israel, the reduced incidence rate during the pandemic (February 2020 to July 2021) was notable mainly in the adult-onset disease, while in Sweden, although the overall incidence rate increased steadily across all age groups, the largest change was apparent among the elderly.

Conclusion
In this study of two nationwide cohorts we found that the initial decrease in incidence of IBD was most apparent in Israel with a more stringent lookdown policy and among elderly in Sweden, the only population there with significant social restrictions during the pandemic. Taken together, it is likely that the reduced incidence stemmed from the limited access to the healthcare system. Future studies are needed to determine the long-term effect of the pandemic on IBD incidence.