bluuebunny/crossref_metadata_2025_split huggingface dataset:
P364 Faecal calprotectin testing in patients presenting with lower gastrointestinal symptoms; a retrospective primary care study in the United Kingdom
Authors: Umar N , Wambua S , Adderley N J , Haroon S , Trudgill N 
Published: January 2024

Abstract

Background
Faecal calprotectin (FC) is of value in differentiating Inflammatory Bowel Disease (IBD) from other causes of lower gastrointestinal (GI) symptoms and is recommended in national guidance. This study aims to examine the role of and factors associated with faecal calprotectin requesting in primary care.

Methods
Retrospective open cohort study using Clinical Practice Research Datalink (CPRD Aurum) of adults aged 18 years and above with lower GI symptoms between 2015 and 2019. FC requested 30 days before to 3 months after a lower GI symptom record in primary care were included. Logistic regression model was used to explore patient level factors associated with FC testing. Referral pathways and outcomes in terms of IBD diagnoses of patients with and without FC testing were also examined.

Results
Of 741,190 symptomatic patients, only 18,320 (2.5%) patients had a FC requested in primary care: median age 38.3 (IQR 28.9-50.7); 51.4% females. The percentage of FC requests in symptomatic patients increased from 0.02% in 2010 to 4.4% in 2019 (p=0.001).
FC value of &lt;50 ug/g and 50-200 ug/g were predominantly seen in patients with abdominal pain (42.1% and 37.9% respectively) while FC &gt; 200 ug/g was predominantly seen in patients with diarrhoea (45.3%). The only patients with a significant risk of IBD with a FC 50-200ug/g were patients with rectal bleeding (8%).
Factors associated with less FC requesting included: increasing age (&gt;70 years aOR 0.16 ( 95% CI 0.15-0.18); female (0.89,0.86-0.92); Black (0.61, 0.56-0.66) or Asian (0.75, 0.70-0.80) ethnicity; obesity (0.89,0.85-0.93); lower socioeconomic status (0.91,0.86-0.98); comorbidity score &gt;2 (0.73,0.68-0.79); and current smoking (0.89,0.85-0.92). Patients with change in bowel habit (7.31,6.90-7.75); rectal bleeding (2.04,1.95-2.13); diarrhoea (2.88,2.78-2.99) as a presenting symptom compared to abdominal pain and ex-smokers (1.06,1.03-1.11) had more FC requests.
Of patients referred with a FC &gt;200 ug/g, 21.5% were diagnosed with IBD but only 2.9% of patients with a FC 50-200ug/g. 27.8% patients with a normal FC test result were still referred to secondary care, of which only 0.4% had IBD.

Conclusion
Despite an increase in FC requests in recent years, only 4.4% of patients with relevant lower GI symptoms had an FC requested in primary care as recommended. Despite a negative FC test, 27.8% of patients were still referred to secondary care with very few patients diagnosed with IBD (0.4%).
P374 Real-life effectiveness and safety of ustekinumab treatment in patients with ulcerative colitis: An Asan-Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD) multicenter cohort study
Authors: Baek J E , Kim E S , Kim K O , Jo H H , Hwang S W , Park S H , Jang B I , Kim E Y , Yang S K , Kim S K , Ye B D 
Published: January 2024

Abstract

Background
The real-life data on ustekinumab (UST) for Asian patients with ulcerative colitis (UC) are limited. We aimed to assess effectiveness and safety of UST for Korean patients with UC.

Methods
This was a multicenter retrospective study on patients with UC who received UST at 4 academic centers in Korea between January 2021 and April 2023. The primary endpoint was clinical remission defined as partial Mayo score (PMS) ≤2 and no subscore &gt;1 at week (W) 8 of therapy. Secondary endpoints included clinical remission (W16–20 and W52–56), corticosteroid-free clinical remission (W8, W16–20 and W52–56), clinical response defined as reduction of PMS ≥3 and at least 30% from baseline with either a decrease in rectal bleeding subscore ≥1 or an absolute rectal bleeding subscore ≤1 (W8, W16–20 and W52–56), endoscopic remission defined as Mayo endoscopic subscore 0–1 (W16–20 and W52–56), durability of UST at W52–56 and adverse events.

Results
A total of 55 patients were included and 54 were analyzed excluding one in clinical remission at baseline (Male, 66.7%; Median age at UST initiation, 44.5 years; Disease duration at UST initiation, 7.5 years; Previous exposure to biologics/small molecules, 70.4%; Extensive colitis, 64.8%; Median baseline Mayo score, 8; Concomitant use of systemic corticosteroids, 48.1%; Concomitant use of immunomodulators, 38.9%). Out of 54 patients, 27 patients (50%) reached to W52–56 or stopped UST, while remained 27 patients still under maintenance UST therapy, not reaching W52–56. At W8, W16–20, and W52–56, 53.7% (29/54), 63% (34/54), and 44.4% (12/27) achieved clinical remission and 68.5% (37/54), 70.4% (38/54), and 51.9% (14/27) showed clinical response, respectively (Figure 1). Endoscopic remission rates at W16–20 and W52–56 were 57.4% (31/54) and 37% (10/27), respectively (Figure 1). The durability of UST at W52–56 was 74.1% (20/27). Multivariable analysis revealed that previous exposure to biologics/small molecules was negatively associated with clinical remission at W8 (OR: 0.10; 95% confidence interval [CI] 0.02–0.57; p=0.01) and W16–20 (OR: 0.18; 95% CI 0.04–0.91; p=0.04), whereas the concomitant use of immunomodulators showed a positive association with clinical remission at W8 (OR: 4.19; 95% CI 1.11–15.77; p=0.03). Adverse events occurred in 23 patients (42.6%) and serious adverse event in one patient (1.9%) (Table 1).

Conclusion
UST was effective with an acceptable safety profile for Korean patients with UC. Previous exposure to biologics/small molecules was negatively associated with clinical remission at both W8 and W16–20.

Financial Support
This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (NRF-2021R1A2C2095096).
P382 The burden of anxiety, depression and perceived stress in patients with inflammatory bowel disease: a cohort study from north India
Authors: Bhardwaj A , Singh D.M. A , Midha V , Mahajan R , Bansal N , Sood A 
Published: January 2024

Abstract

Background
Patients with Inflammatory bowel disease (IBD) are susceptible to psychiatric co-morbidities. We aimed to ascertain the burden of anxiety, depression, and perceived stress in patients with IBD from north India.

Methods
Consenting adult patients with an established diagnosis of IBD were enrolled. The enrolled patients filled the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) questionnaires. The patient and disease characteristics were analyzed to determine the correlations and predictors of psychiatric comorbidities. Spearman’s rho (ρ) was used for assessment of correlation between disease attributes and psychological disorders.

Results
A total of 318 patients (255 UC, 63 CD; mean age 40.13±12.06 years, 168 [52.8%] males; mean partial Mayo score 2.10±2.35; and mean HBI 2.77±2.13) were enrolled. The prevalence of anxiety, depression and moderate to high perceived stress was 14.15%, 12.57%, and 41% respectively. Females had higher mean perceived stress, anxiety and depression scores compared to males. The partial Mayo score (PMS) correlated poorly with anxiety (ρ=0.083, p=0.187), depression (ρ=0.123, p=0.49) and perceived stress (ρ=0.169; p=0.007). The Harvey Bradshaw index (HBI) correlated fairly with anxiety (ρ=0.336, p=0.007) and poorly with depression (ρ= 0.287, p=0.022) and perceived stress (ρ=0.20; p=0.117). Younger age (OR 0.93, 95% CI 0.90-0.97; p=0.001) and hand grip strength (OR 4.63, 95% CI 1.88-11.42; p=0.001) predicted anxiety in patients with UC while rural area of residence (OR 4.75, 95% CI 1.03-21.98; p=0.046) and HBI (OR 1.60, 95% CI 1.12-2.29; p=0.009) were significant predictors of anxiety in patients with CD.

Conclusion
Psychiatric comorbidities are common in patients with IBD, with higher prevalence in females. Young adults with UC and sarcopenia; and individuals with active CD living in rural areas are at an increased risk of anxiety.
P394 Unsuitability of the Oxidation-Reduction Potential measurement for the quantification of fecal redox status in Inflammatory Bowel Disease
Authors: Geertsema S , Jansen B H , van Goor H , Dijkstra G , Faber K N , Bourgonje A R 
Published: January 2024

Abstract

Background
Oxidative stress is a key pathophysiological process associated with the development and progression of inflammatory bowel disease (IBD). Biomarkers for oxidative stress, however, are scarce, as are diagnostic tools that can interrogate an individual’s gut redox status. Oxidation-Reduction Potential (ORP) measurements can provide insight into the redox (oxidation-reduction) status, which is relevant in understanding oxidative stress and associated pathophysiological processes. Until date, ORP analyses have not been explored in the context of IBD. This proof-of-concept study aimed to assess the potential utility of an ORP measurement probe in quantifying redox status in the fecal water of both IBD patients and healthy controls.

Methods
This proof-of-concept study recruited patients with Crohn's disease (CD), ulcerative colitis (UC), and healthy controls. Fecal samples were collected and analyzed for oxidation-reduction potential (ORP) using the PCE-228 redox probe at specific timepoints. Furthermore, the stability of ORP measurements was assessed across various test solutions with known ORPs by doing nine ORP measurements every 15 minutes.

Results
No significant differences in ORP measurement values were observed between patients with CD (n=5) (45 [30.0–62.0] mV), patients with UC (n=5) (48 [42.0–59.0] mV) and healthy controls (n=5) (25 [8.0–52.0] mV; p = 0.221) (Fig. 1A). Strikingly, ORP measurements exhibited high instability and rapidly fluctuated throughout time, presenting with values varying from +24 to +303 mV (Fig 1B). These fluctuations, potentially influenced by biological processes and limitations of the measuring equipment, precluded reliable measurements of ORP in fecal samples of patients with IBD.

Conclusion
ORP quantification may not be a reliable tool for assessing fecal redox status in patients with IBD or healthy controls. Our findings do not support further exploration of the specific ORP redox probe used in this study for determining fecal redox status. Future studies should focus on more sensitive methods to quantify fecal redox status and examine its biomarker potential in the context of IBD.

Funding
This study was supported by Janssen Research & Development LLC.
P395 The frequency of SARS-CoV-2 infection and the impact of vaccination on the disease morbidity in Polish pediatric patients with Inflammatory Bowel Disease treated with biologic therapies
Authors: Derda E , Szymanska E , Meglicka M , Wiernicka A , Osiecki M , Kierkus J 
Published: January 2024

Abstract

Background
Little is known about morbidity of Covid-19 infection in pediatric patients with inflammatory bowel diseases (IBD) treated with biologic medications. The aim of this study was to evaluate the frequency of SARS-CoV-2 infection in children with IBD who received biologic therapies.

Methods
A prospective, observational cohort study to evaluate coronavirus disease 2019 (COVID-19) vaccination state, and its effect on the disease course among pediatric patients with IBD. The questionnaire included information concerning numbers of vaccine doses, patients’ medication and disease activity. Disease flare was defined by worsening IBD symptoms and change in IBD medications. Outcomes were stratified by vaccine type and IBD medication classes.

Results
A total of 320 children with IBD, 169 with Crohn’s disease (CD)-52,8%, 150 with ulcerative colitis (UC) - 46,9%, 1 unclassified -0,3%, responded to the questionnaire concerning COVI-19 vaccination. In our cohort 141 (49,7%) patients received biologic therapy: 13 patients (9,2%) adalimumab (ADA), 54 (38,3%) infliximab (IFX), 27 (19,1%) vedolizumasb (vedo), 29 (20,6%) ustekinumab (ust), 6 - vedo + ADA (4,3%), 1 - IFX + vedo (0,7%), 11 - ust + ADA (7,8%). 32 (22,7%) patients had COVID-19 infection during biological therapy (ust 6- 4,3%, vedo 7- 5,0%, ada 2-1,4%, ifx 12- 8,5%, ust + ada 2- 1,4%, vedo + ada 3- 2,1%). Among the patients on biologic treatment suffering from COVID-19, 25 (78,1%) children had mild course of the infection, 4 moderate (12,5%), 2 severe (6,3%), and 1 unknown (3,1%). A total of 127 (39,7%) patients received at least 1 COVID-19 vaccine, and among them 8 (6,3%) patients who received 1 dose of COVID-19 vaccine got the infection during biologic therapy. In our group, 193 (60,3%) patients have not been vaccinated against COVI-19, and 24 (12,4%) suffered from the disease during biologic therapy.

Conclusion
Based on the outcomes from our questionnaire concerning COVID-19 vaccination state on the large cohort of pediatric patients with IBD, we conclude that unvaccinated patients get sick more often than vaccinated ones, and that the use of biological treatment has no impact the frequency of covid infections or their course.
P397 Distinct blood protein profiles associated with ileal and colonic ulcers in Crohn’s disease
Authors: Pierre N , Huynh-Thu V A , Baiwir D , Vieujean S , Bequet E , Reenaers C , Van Kemseke C , Salée C , Massot C , Fléron M , Mazzucchelli G , Trzpiot L , Eppe G , De Pauw E , Louis E , Meuwis M 
Published: January 2024

Abstract

Background
Ileal and colonic Crohn’s disease (CD) are nowadays considered as separate entities. Studies are needed to better characterise the biological specificities of these subphenotypes. In fine, this research should offer opportunities for the development of personalised medicine.

Methods
By combining different technologies (proximity extension assay, selected reaction monitoring and high-sensitivity turbidimetric immunoassay (hsCRP)), 207 serum proteins were measured in CD patients presenting no endoscopic lesions (endoscopic remission) (n=23), isolated ileal ulcers (n=17) or isolated colonic ulcers (n=16) (Table 1). To compare the endoscopic activity between the ileum and colon, and in order to obtain an assessment of the overall lesion burden, we used the Crohn’s disease endoscopic index (CDEIS) without dividing its total score (sum of each gut segment) by the number of inspected segments. The data analysis was conducted using Wilcoxon-Mann-Whitney test and area under the receiver operating characteristics curve (AUROC). The AUROC were compared using the bootstrap test (2000 replications).

Results
The median of the total CDEIS was higher in CD patients with isolated colonic ulcers than those with isolated ileal ulcers (23.1 vs 8.0) (Table 1). When compared to endoscopic remission, the presence of isolated ileal ulcers and isolated colonic ulcers were specifically associated with the level of 6 and 18 serum proteins, respectively: (high: JUN, CNTNAP2; low: FCRL6, LTA, CLEC4A, NTF4) (Figure 1A); (high: hsCRP, IL6, APCS, CFB, MBL2, IL7, IL17A, CCL19, CXCL10, CSF3, IL10, CLEC4G, MMP12, VEGFA; low: CLEC3B, GSN, TNFSF12, TPSAB1) (Figure 1B). No protein was associated with both isolated ileal ulcers and isolated colonic ulcers (Figure 1).
All CD patients in endoscopic remission showed a normal level of hsCRP (&lt;5 mg.L-1). Compared to CD patients in endoscopic remission, CD patients with isolated colonic ulcers showed an increased median level of hsCRP (1.3 vs 5.9 mg.L-1, p-value=0.0045) and this was not the case for CD patients presenting isolated ileal ulcers (1.3 vs 2.2 mg.L-1, p-value=0.13). hsCRP detected ileal and colonic ulcers with an AUROC of 0.64 (p-value=0.07) and 0.77 (p-value=0.001), respectively. When compared to hsCRP (AUROC), the best marker pairs for detecting ileal or colonic ulcers were respectively CLEC4A×LTA (0.82 vs 0.64, p-value=0.06) or hsCRP×CSF3 (0.85 vs 0.77, p-value =0.02).

Conclusion
In CD patients, ileal and colonic ulcers were associated with distinct systemic responses. hsCRP showed a better capacity to detect patients with colonic than ileal ulcers. Some markers might help to detect ileal ulcers or to improve the ability of CRP for detecting colonic ulcers.
P404 Monocyte distribution width differentiates bacterial gastroenteritis from Acute Severe Ulcerative Colitis in patients presenting with diarrhoea
Authors: Li Wai Suen C , Kaul S , Tan E , Con D , Taylor M , Wiid J , Hogan C , Choy M , Visvanathan K , De Cruz P 
Published: January 2024

Abstract

Background
Monocyte distribution width (MDW) is a haematological parameter that can be generated by newer generation blood analysers on routine full blood examination. It reflects the variation in the size of monocytes and is elevated in the setting of infection, however its utility in inflammatory disorders in unknown.
We aimed to assess whether MDW can help differentiate bacterial gastroenteritis from Acute Severe Ulcerative Colitis (ASUC) among patients presenting to the Emergency Department (ED) with diarrhoea. We further aimed to assess whether MDW correlated with disease activity and clinical outcomes in ASUC.

Methods
We conducted a retrospective cohort study comprising three patient groups: (1) ASUC, (2) bacterial gastroenteritis and (3) a control group of patients without active inflammation. The control group consisted of outpatients with chronic hepatitis B in immune control phase with normal liver transaminases and suppressed viral load &lt; 2000 IU/mL. Clinical outcomes, routine biomarkers and MDW were recorded.

Results
A total of 176 patients were identified (53 ASUC, 70 bacterial gastroenteritis and 53 controls).
At time of ED presentation, patients with bacterial gastroenteritis had the highest MDW (median 23.6, IQR 20.7-25.8) compared to ASUC (19.0, IQR 17.9-21.2) and controls (16.8, IQR 15.9-18.0; P&lt;0.001). On receiver operator characteristic curve analysis, MDW discriminated bacterial gastroenteritis from ASUC with an area under the curve (AUC) of 0.78 (95% CI 0.70-0.87, P&lt;0.001). Using Youden’s index, a MDW threshold &gt; 22.3 had 64.3% sensitivity, 84.6% specificity, 63.8% negative predictive value and 84.9% positive predictive value for bacterial gastroenteritis.
Of the 53 patients with ASUC, 25 responded to intravenous hydrocortisone while 28 were steroid non-responders and required infliximab (IFX). 24 patients responded to IFX rescue, while the 4 IFX non-responders received tofacitinib sequential therapy. In ASUC, MDW correlated positively with established markers of disease activity including CRP (Spearman rank correlation, rho=0.54, P&lt;0.001), platelet count (rho=0.36, P=0.009) and faecal calprotectin (rho=0.35, P=0.02). A lower MDW on the day of IFX administration appeared to predict IFX response (AUC 0.80, 95% CI 0.61-1.00, P=0.002). At follow-up (median 85 days), MDW was predictive of biochemical remission with a faecal calprotectin &lt; 100 µg/g (AUC 0.80, 95% CI 0.64-0.95, P&lt;0.001).

Conclusion
MDW is a novel biomarker that may help distinguish ASUC from bacterial gastroenteritis at time of ED presentation in patients with diarrhoea. In ASUC, MDW correlates with existing markers of activity and may help predict IFX response.
P416 Turning Point: Declining surgery rates and predictors for surgery in a three-year prospective inception cohort of Crohn's Disease in China
Authors: Hu W , Li S , Chen Z , Luo J , Yu Y , Liao X , Shen K , Luo J , Yan Z , Wang Q , Lu S , Xu D , Yu Q , Zhang H , Wang X , Li J , Chen Y 
Published: January 2024

Abstract

Background
Surgery in Crohn's disease is a critical management outcome. China currently faces a notable surge in CD incidence, making it an integral phase for improving diagnostic and therapeutic competencies. Analysing the rates of CD-related bowel surgeries in a prospective cohort offers significant insights for evaluating and optimizing disease management.

Methods
We conducted a single-centre, prospective inception cohort of CD patients since July 2019 at the Second Affiliated Hospital, Zhejiang University School of Medicine (ClinicalTrials.gov identifier NCT04135027). Annual follow-ups were performed. Survival analysis was used to identify predictors for bowel surgical outcomes. Bowel surgery encompassed gastrointestinal resections addressing complications such as obstruction, fistula, free perforation, and bleeding.

Results
A total of 438 newly diagnosed CD patients, predominantly male (73.5%), with a median age at diagnosis of 28.1 years were enrolled. Among them, 68 patients underwent surgery within three years. Surgery rates at one, two, and three years were 11.8%, 14.3%, and 15.4%, respectively. Specifically, patients enrolled in 2019-2020, 2020-2021, and 2021-2022 displayed surgery rates of 18.4%, 14.2%, and 5.3%, respectively during their first year in the study. Multivariate Cox regression demonstrated the enrolment timeframe (Hazard ratio 0.46, 95% Confidence Interval [CI] 0.22-0.96, P=0.039), smoke (Hazard ratio [HR] 3.98, 95% CI 2.02-7.87, P&lt;0.001), and disease behaviour (stricturing, HR 29.75, 95% CI 10.34-85.56, P&lt;0.001; penetrating, HR 39.13, 95% CI 13.18-116.17, P&lt;0.001) and low albumin (HR 2.07, 95% CI 1.22-3.51, P=0.007) as significant predictors of surgery. Further analysis within the stricturing/penetrating subgroup maintained the enrolment timeframe (HR 0.45, 95% CI 0.21-0.95, P=0.035), smoke (HR 3.34, 95% CI 1.68-6.61, P&lt;0.001), and low albumin (HR 2.03, 95% CI 1.19-3.48, P=0.01) as independent predictors. Propensity score matching confirmed smoke and low albumin as significant contributors to surgical risk.

Conclusion
A declining trend in the surgery rate among newly diagnosed patients was observed over the three years. Disease behaviour significantly stratified surgical outcomes. The enrolment timeframe, smoke, and low albumin emerged as independent predictors for surgeries in both the general cohort and the stricturing/penetrating subgroup.