bluuebunny/crossref_metadata_2025_split huggingface dataset:
P826 Exclusive Enteral Nutrition versus Crohn's Disease Exclusion Diet in pediatric patients with Crohn's Disease
Authors: Mora Massó L , Martín Adrados A , Fernández Leal A , Velasco Rodríguez-Belvís M , Palomino Pérez L M , Di Campli Zaghlul M , Martín Fernández C , Muñoz Codoceo R A 
Published: January 2024

Abstract

Background
Crohn's disease exclusion diet (CDED) has emerged as an alternative to exclusive enteral nutrition (EEN) to induce remission in pediatric CD patients. CDED is better accepted by the patients, thus improving adherence, and can represent a long-term strategy, as opposed to EEN. The aim is to compare the outcomes of both diets in our clinical setting.

Methods
We conducted a retrospective and observational study on CD patients who were under follow-up in a pediatric Inflammatory bowel disease (IBD) Comprehensive Care Unit from a tertiary hospital from June to October 2023. We included pediatric CD patients (under 18 years of age) who had received one of these two diets as induction treatment both as monotherapy and in combination with other drugs. Anthropometric values, inflammatory markers and clinical activity indexes were compared in both groups in three different time points: prior to induction (time 0), and three (time 1) and six months (time 2) after the induction. The study was approved by the Ethics Committee of HIUNJ. Data were analyzed with the SPSS software (v.25).

Results
A total of 53 patients were included: 24 in the CDED group and 29 in the EEN group. Up to 48 patients (90,6%) simultaneously started another drug as part of the maintenance strategy. Results are shown in table 1. The decrease of faecal calprotectin (FC) was more striking in the CDED group but kept elevated in both, whereas C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) descended to normal values after both diets (figure 1). However, there were no statistically significant differences regarding anthropometric values, inflammatory markers, or clinical activity indexes between the two groups at each time point (table 1).

Conclusion
Although the concomitant use of other drugs limits the drawing of conclusions, the therapeutic use of both the CDED and EEN diets seem to be useful to achieve clinical, analytical, and anthropometric improvement in pediatric CD patients. Conducting more studies on larger samples would help to confirm the role of CDED as an effective alternative to EEN.
P830 The potential role of artificial intelligence in selecting the modality of biological therapy in patients with inflammatory bowel disease
Authors: Mitrovic M , Milić A , Marković S , Svorcan P 
Published: January 2024

Abstract

Background
Selecting an appropriate treatment strategy for inflammatory bowel disease (IBD) is an important task that can significantly alter the clinical course of the disease. Advanced artificial intelligence language models, such as ChatGPT, represent a potential future option that can assist practitioners. ChatGPT can help search the internet for medical facts by summarizing information from medical sources and providing concise explanations, simplifying the process of accessing and understanding medical information.

Methods
A ChatGPT-guided analysis of 89 IBD patients treated at the Clinical Department of Gastroenterology and Hepatology at University Medical Center "Zvezdara", Belgrade was conducted, considering further treatment with some biological drugs. A treatment modality proposal was obtained through communication with the interactive software ChatGPT (OpenAI, CA USA) and providing complete clinical and laboratory data. The alignment of decisions was analyzed, along with an assessment of treatment success in the group with matching and differing choices.

Results
In 72 patients (81%), there was concordance in the choice of therapy between ChatGPT and the medical consultation, while in 17 patients, ideas about the treatment approach differed. The most common difference in the choice of therapeutic modality related to the software's selection of ustekinumab compared to our choice of vedolizumab in patients with Crohn's disease who were not biologically naive, affecting seven patients with these characteristics. In 4 patients with severe ulcerative colitis, ChatGPT recommended using cyclosporine in combination with vedolizumab, contrary to the medical consultation's decision to use Anti-TNFα therapy. The group of patients in whom the artificial intelligence advice differed from the medical consultation was in a clinically more severe stage of the disease (CRP 10.4 vs. 9.1, p=0.0293), with worse endoscopic findings (proportion of severe endoscopic disease SES CD≥33/Mayo score&gt;2, 53% vs. 24%, p=0.019). Taking into account the baseline differences in these patient groups, multiple analyses of covariance did not reveal a significant difference in the ultimate treatment outcome - proportions of endoscopic (p=0.773) and clinical remission (p=0.296) between patient groups.

Conclusion
The integration of advanced artificial intelligence language models may represent a future tactic with the potential to assist practitioners in making decisions about the treatment modality for IBD patients, but clinical experience should be considered.
P837 Improving Vaccination Rates in Patients with Inflammatory Bowel Disease: A Single Centre Audit and Quality Improvement Project
Authors: Leong J , Jiang B , Qiu T Y , Wang L Z , Tan C K , Ong J 
Published: January 2024

Abstract

Background
Patients with inflammatory bowel disease (IBD) are at an increased risk of infections. Vaccine preventable diseases in patients with IBD are associated with high rates of hospitalizations, costs, mortality and longer hospitalizations. Despite societal recommendations, the uptake of vaccinations is still suboptimal. We aimed to conduct an audit of vaccination status in patients with IBD followed by a quality improvement project (QIP) to improve the vaccination rates in the outpatient clinic setting.

Methods
This is a retrospective cohort study in a tertiary hospital in Singapore. Patients with a confirmed diagnosis of IBD aged &gt;18 years’ old who attended outpatient clinics between June to September 2022 were identified, and their influenza (IFV) and pneumococcal (PCV) vaccination status was assessed. A QIP was instituted to increase the rate of IFV and PCV coverage in this ambulatory population. Interventions were directed at both the provider and the patient. All providers were educated on vaccination schedules and a standardized electronic template was implemented for clarity of documentation. Laminated posters of vaccination guidelines were placed in each consultation room. All patients were issued with a personalized vaccination card documenting their vaccination status and serving as a prompt for subsequent consultations. We analysed the rate of IFV and PCV coverage post implementation from November 2022 to June 2023.

Results
70 patients were identified in the pre-intervention cohort. 30 patients were either &gt;65 years old or on immunosuppression, of which 6/30 (20%) received IFV and 11/30 (36.7%) already received PCV. In the post-intervention cohort, we assessed 187 consecutive patient clinic visits which comprised 115 unique patients. Baseline characteristics are detailed in Table 1. 73 patients were either aged &gt; 65 years old or on immunosuppression, 65 patients had no IFV within 1 year, of which 20/65 (30.7%) obtained vaccination coverage for IFV in the post-intervention period (p=0.01). 63 patients were eligible for PCV and 12/63 (19%) received either pneumococcal conjugate vaccine 13 or pneumococcal polysaccharide vaccine 23 during this period (Fig. 1).

Conclusion
A structured QIP with an established protocol engaging patients and guiding providers significantly increased the rate of IFV but not PCV in our cohort. A major hurdle to timely PCV uptake was the erroneous perception of a wider window period by patients and providers given its 5-yearly interval, as compared to IFV. Overall adherence to societal guidelines and uptake of vaccinations is still suboptimal and more work needs to be done to educate providers and patients, increase vaccination uptake and reduce vaccine preventable diseases in patients with IBD.
P838 Determing factors that influence Vedolizumab Response in Inflammatory Bowel Diseases: A Prospective Study
Authors: Knezevic T , Dobrosavljevic A , Odanovic O , Sreckovic S , Kralj Đ , Mitrović M , Svorcan P , Markovic S 
Published: January 2024

Abstract

Background
In recent years, the development of biologic agents, including Vedolizumab, has offered new avenues for the treatment of IBD Understanding the factors that influence the response to Vedolizumab therapy is of paramount importance in optimizing patient care and treatment outcomes. However, for a drug like Vedolizumab, the exact concentration indicating the need for optimization and what influences it are still unknown.
The aim of this research is to evaluate what parameter has influence on good response to Vedolizumab in patients with inflammatory bowel diseases.

Methods
160 patients with Crohn's disease and ulcerative colitis were included in this prospective study, who were treated with Vedolizumab biological therapy from October 2018 to February 2023 at a tertiary center for inflammatory bowel diseases. All patients were followed for a minimum of 14 weeks or until therapy discontinuation. Biochemical parameters (CRP, fecal calprotectin, hemoglobin, ferritin), clinical parameters (MTWS, HBI) were monitored in all patients before and during treatment. Vedolizumab concentration was measured in half of the patients during treatment with this drug. All data were processed using the statistical program SPSS 23.0 (Chicago, IL).

Results
Of the 160 patients, there was almost an equal distribution between male and female (males, 160/86 (53.7%)), with an average age of 51.5 years (± 16.51 SD). After one year of therapy, a statistically significant reduction in inflammation parameters was observed (FCP- p=0.007, Z= -2.694; CRP- p=0.008, Z= -2.646), as well as a statistically significant clinical response to therapy by reducing the disease activity index (p &lt; 0.000, Z= -4.818). Using logistic regression duration of disease nor disease localization are predictive parameters for response to therapy (p = 0.330, Exp B 1.190) In a group of 80 patients, Vedolizumab concentration was measured in a cross-sectional analysis. Our cohort of patients had a median Vedolizumab concentration of 20.73 µg/ml. Patients who achieved remission had statistically similar Vedolizumab concentrations compared to patients with active endoscopic disease (Vedolizumab concentration UC 25.6541 vs 28.8152; p = 0.614; CD 20.0232 vs 18.3346 µg/ml; p = 0.729). Patients on Vedolizumab who had previously received anti-TNF therapy had a lower mean drug concentration compared to bio-naive patients (16.05 ug/ml / 20.34 ug/ml).

Conclusion
Previous anti-TNF therapy may have an impact on drug concentration and response to therapy, but it is necessary to determine other parameters that can also independently influence drug concentration
P842 Assessment of body composition parameters in patients with inflammatory bowel disease treated with biological therapy
Authors: Spirić J , Topličanin A , Vuksanović S , Nikolić A , Jovičić I , Đuranović S , Popović D , Đelić M , Dragašević S , Sokić Milutinović A 
Published: January 2024

Abstract

Background
There is growing evidence of the role of biological therapy (BT) in improving body composition parameters (BCP) in inflammatory bowel disease (IBD) patients. Since myopenia and high adiposity affect prognosis and could lead to treatment failure, there is the need for expanding the assessment of BCP in clinical practice beyond traditional measures like body mass index (BMI).

Methods
A cross-sectional study included 151 IBD patients treated with BT (80 males, 83 Crohn`s disease, 68 ulcerative colitis, mean age 37). Bioelectrical Impedance Analysis (InBody170) was done to estimate: body weight, BMI, skeletal muscle mass (SMM), body fat mass (BFM), percent body fat (PBF), fat free mass (FFM). Dividing SMM, FFM and BFM by height squared, we calculated the skeletal muscle mass index (SMI), fat-free mass index (FFMI) and fat mass index (FMI).

Results
In relation to BMI, 84 (55.6%) patients had healthy weight, 41 (27.2%) were overweight, 13 (8.6%) were obese and 13 (8.6%) were classified as underweight. Clinical remission was present in 139 (92.6%) patients. The average values of the measured BCP are as follows: body weight 71.7kg (41.4-123.7); body height 174.6±10.9cm; BMI 23.7kg/m2 (15.1-36.9); PBF 24.6% (5-48); SMI 9.7kg/m2 (6.3-13.5); FFMI 17.5kg/m2 (12.0-23.5); FMI 5.7kg/m2 (1.0-17.3). Muscle mass parameters were significantly higher in the group of patients treated with BT longer than 3 months (SMI p=0.01, FFMI p=0.02), while in the group of patients treated longer than 1 year we observed, apart from muscle mass parameters, a significant increase in adiposity parameters (FMI p=0.02, PBF p=0.06). [WU1] Patients who previously had the need for change of BT type had significantly higher values of FMI (p=0.04). Patients with extraintestinal manifestations (EIMs), compared to the group without EIMs, had statistically significantly lower values of body weight (p=0.02), SMI (p=0.01), and FFMI (p= 0.01). There was no statistically significant difference in BCP by IBD subtype, presence of clinical remission, BT type and protocol, previous operations, corticosteroids, mesalazines and azathioprine use.

Conclusion
The duration of treatment with BT can significantly affect muscle mass and adiposity parameters, leading to improved muscle mass parameters after 3 months of therapy, while an increase in adiposity markers is observed after 12 months of BT. Our findings suggest a potential association between EIMs and muscle mass alterations, as well as a relationship between the need for a change in BT type and higher adiposity parameters.
P853 Factors associated with intestinal tissue levels of anti-TNF in pediatric patients with Crohn's Disease
Authors: Dotlacil V , Coufal S , Lerchova T , Zarubova K , Kucerova B , Tlaskalova-Hogenova H , Kverka M , Bronsky J , Skaba R , Hradsky O , Rygl M 
Published: January 2024

Abstract

Background
Despite advancements, understanding the tissue pharmacokinetics of Anti-tumour necrosis factor alpha monoclonal antibodies (aTNF) and addressing cases of primary non-response, secondary loss of response, and unexplained treatment failures in some patients pose ongoing challenges.
The aim of this study was to investigate factors associated with intestinal tissue levels of aTNF, anti-drug antibodies and cytokines in paediatric patients with Crohn's Disease (CD).

Methods
A prospective study of paediatric CD patients treated with aTNF, who underwent ileocecal resection or colonoscopy between June 2020 and January 2023 was performed. Tissue drug levels of aTNF, anti-drug antibodies and pro-inflammatory cytokines ((TNF alpha (TNF-α), interleukin-17 (IL-17), interleukin-1 beta (IL-1β), interferon gamma (IFN-γ)) were analysed in tissue culture supernatant using ELISA.
Logistic regression estimated odds ratios (OR) adjusted for potential confounding from disease localization, way of sampling, presence of inflammation, and type of anti TNF (aOR).

Results
Twenty-seven CD patients (18 females, 66.7%) with a median disease duration of 50 (Interquartile range [IQR] 23 – 69) months were analysed. Fourteen (52%) received adalimumab (ADA), thirteen (48%) received infliximab (IFX), with a median aTNF therapy duration of 17 (IQR 4.5 – 41.5) months. Tissue aTNF detection was 100% in ADA-treated and 81.8% in IFX-treated patients.
A positive association between intestinal inflammation and the level of free aTNF in tissue was observed (aOR=3.03, 95% CI=0.82-5.29). The ratio of aTNF level in tissue to serum was higher in the inflamed tissue (aOR=0.21, 95% CI=0.039-0.38).
Despite an adequate level of aTNF in the serum, no measurable level was detected in the tissue in 13 patients.
When comparing anti-drug antibodies levels in serum and tissue, we found a notable discrepancy, with 19 patients having undetectable serum levels, while tissue levels were measurable.
We found higher tissue IL-17 levels in patients who had been treated with aTNF therapy for a longer period (aOR=0.15, 95% CI=0.031-0.274), independent of disease duration and patient age.
An association was found between the level of IFN-γ and the duration of follow-up, as well as with the duration of aTNF administration. However, it was not possible to determine which of these associations is responsible for this relationship.

Conclusion
Our study highlights significantly elevated free drug levels in inflammatory tissue compared to non-inflammatory tissue. Our findings also align with recent insights linking aTNF failure to upregulation of mucosal IL17, providing a possible molecular rationale for improved treatment response with treatment targeting the IL-23 receptor after aTNF treatment failure.
P880 The real-world use of five-aminosalicylate (5ASA) treatment for Ulcerative Colitis in Australia and New Zealand: Crohn’s Colitis Cure (CCC) data insight’s program
Authors: Pipicella J L , McNamara J , Wilson W , Lynch K , Walker G , Begun J , Lawrance I , Ghaly S , Radford-Smith G , Williams A J , Gearry R , Schultz M , Brett L , Andrews J M , Connor S J 
Published: January 2024

Abstract

Background
Five-aminosalicylates (5ASAs) promote & maintain remission in people with ulcerative colitis (UC) and are administered orally or rectally, with combination therapy (oral + rectal) more effective than oral monotherapy, especially when treating flares1. 5ASAs may be perceived as out-dated and thus neglected. With increasing UC incidence & prevalence in emerging nations, understanding real-world 5ASA use and value is vital.

Methods
Crohn’s Colitis Care is a cloud-based electronic medical record used in Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September 2023. People with UC under active care (encounter within 14 months) were included.

Results
Of the 2,522 eligible people, 78.4% resided in Australia & 21.6% in New Zealand (NZ). The median age was 41 years (IQR 31-56), with an even gender distribution (50.3% female). Median disease duration was 9 years (IQR 4.4-16.7). Median duration of follow up was 25.9 months (IQR 13.0-41.4). Overall, 39.2% (n=989) had no documentation of 5ASA therapy (42.0% in Australia, 28.9% in NZ; Table 1). In those with documented 5ASA therapy (60.8%, n=1,534), the average 5ASA treatment duration was 9 years (IQR 4.4-16.7) and women were more likely to receive rectal administration than men (p&lt;0.05). In those who ceased 5-ASA therapy, 782 (44.8%) had a reason documented, with the most common being medication rationalisation and/or deep remission (40.0%) (Figure 1), usually due to up-titration to a more advanced therapy.
A total of 608 (39.6%) were recorded as already receiving additional IBD therapy at CQR entry (immunomodulators [IMs]/biologics/small molecules). Of those receiving 5ASAs alone at CQR entry (n=926), 5ASAs were subsequently judged to have failed in 37.8% (n=350). 5ASA failure was defined as the need for additional IBD therapies (99.1%, n=230 for IMs/biologics/small molecules and n=117 for steroids, total n=347); hospitalisation (n=3, 0.9%) or IBD surgery (n=0).

Conclusion
Despite not working for everyone, the long duration of 5ASA therapy indicates they are well tolerated & perceived as beneficial by consumers. There was greater 5ASA utilisation in NZ, possibly due to restricted advanced therapy access. Gender-specific trends in 5ASA administration were identified, raising the question as to why this should be so, given this is not obviously explained by disease phenotype. Further analysis is needed to tease out how such trends interact with other therapeutic access, choices and outcomes.
1 - Probert C et a. Combined oral and rectal mesalazine for the treatment of mild-to-moderately active ulcerative colitis: rapid symptom resolution and improvements in quality of life. J Crohns Colitis. doi:10.1016/j.crohns.2013.08.007
P910 Salivary calprotectin as a prognostic biomarker in Early Onset Inflammatory Bowel Disease: a cohort study
Authors: Liguori S , Musella G , Coppola N , Adamo D , Cantile T , Spagnuolo G , Del Giudice C , Miele E , Staiano A , Mignogna M D , Leuci S 
Published: January 2024

Abstract

Background
Inflammatory Bowel Disease (IBD), including Ulcerative Colitis (UC) and Crohn’s Disease (CD) affects children in 25% of cases. In Early Onset IBD (EOIBD) oral involvement is common and oral manifestations (OM) are frequently the first presenting sign of disease.
This study compared salivary calprotectin (SCp) between EOIBD and healthy controls (HC), differentiating patients based on their history of OM. Furthermore, this report correlated salivary and faecal calprotectin (FCp) in EOIBD and assessed the prognostic accuracy of SCp in predicting disease relapses.

Methods
A cohort study was conducted; 9 HC and 27 EOIBD (18 UC and 9 CD) were recruited at the University of Naples Federico II. EOIBD were divided in two subgroups based on the history of OM.
A sample of stimulated whole saliva was collected by each participant by spitting. The samples were then processed by ELISA for determining SCp.
For each patient clinical disease activity was measured through Paediatric Ulcerative Colitis Activity Index (PUCAI) and Paediatric Crohn’s Disease Activity Index (PCDAI), at baseline and during follow-up (4/8/12 weeks).
At baseline, patients provided a stool specimen for FCp determination.
SCp levels were compared between groups. In EOIBD SCp was correlated to clinical data and to FCp.

Results
At baseline all the patients were in treatment with immunosuppressive drugs; 19 were in clinical remission (PUCAI/PCDAI &lt;10) and 8 had mild disease (PUCAI/PCDAI&lt;35). 13 EOIBD had an history of OM: 12 suffered from aphthous-like manifestations while 3 reported granulomatous lesions; 10 experienced oral involvement before IBD diagnosis. OM were more prevalent in CD than in UC and were associated to ileocolic, perianal and upper gastrointestinal tract involvement.
EOIBD with OM reported significantly higher SCp than EOIBD without OM and HC: 155,79±60,08 pg/mL in EOBD with OM vs 82,95±51,58 pg/mL in EOIBD without OM (P&lt;0,01**) and 98,21±39,67 pg/mL in HC (P=0,21).
Despite the systemic therapy and the clinical remission, in 7 EOIBD with OM oral lesions persisted. These patients had higher SCp compared to those who experienced OM remission (P&lt;0,05*).
In EOIBD with OM higher SCp was associated to higher FCp (P&lt;0,05*) while in EOIBD without OM this correlation was not described.
No correlation was found between SCp values and PUCAI/PCDAI at baseline.
EOIBD with OM who reported higher SCp were found to have increased risk of relapse (P&lt;0,05*) while no association was reported in EOIBD without OM.

Conclusion
In EOIBD with OM SCp is significantly higher, mirrors intestinal inflammation and predicts relapses. Our results suggest the use of SCp as a prognostic biomarker in EOIBD with OM although more studies are needed.