bluuebunny/crossref_metadata_2025_split huggingface dataset:
P347 A Trend Analysis of Inflammatory Bowel Disease in Non-Endemic Era (1993-2023)
Authors: Çagir Y , Durak M B , Coskun O , Tenlik I , Yurekli O T , Hamamci M , Atay A , Yildirim A , Ergul M , Kalkisim A F , Yilmaz A , Keskin E T , Ince M M , Ozturk O , Fedai A B , Gokbulut V , Kalkan C , Ozturk O , Bolat A D , Yuksel M , Koseoglu H T , Yuksel I 
Published: January 2024

Abstract

Background
In this study, we aimed to evaluate the demographic and epidemiological trends of Ulcerative Colitis (UC) and Crohn’s Disease (CD) in non-endemic era for inflammatory bowel disease (IBD) during the past three decades.

Methods
UC and CD patients who had follow-up at least 6 months between June 1993 and February 2023 were evaluated retrospectively. Electronic medical databases, personal queries and IBD registries have all been used to collection data on the clinical and demographic characteristic of all patients.

Results
A total of 1549 adult patients with UC and CD were admitted to study. UC was diagnosed in 873 (56.4%) patients (Male 538, 61.6%) and CD was diagnosed in 676 (43.6%) patients (Male 404, 59.8%). The median follow-up duration was 8.3 years for UC patients and 6.8 years for CD patients. In patients with UC, proctitis was 154 (17.6%), left sided colitis was 410 (47%) and extensive colitis was 309 (35.4%). In CD patients, ileal involvement was found in 297 (43.9%), colonic in 76 (11.2%), ileo-colonic in 299 (44.2%) and isolated upper GI involvement in 4 (0.6%) cases. 529 (78.3%) patients had non-stenosing non-penetrating behavior, 45 (6.7%) had stenosing behavior, 102 (15.1%) had penetrating behavior, as well as 196 (29%) patients had perianal disease. Mesalazine 658 (75.4%) and thiopurine 397 (45.5%) were the most frequently used conventional treatments for UC, while thiopurine 304 (45%) was most commonly used for CD patients. In the last two-decade, proportion of the biologic usage were 27.9% and 32.1% in UC patients 28.5% and 31.4% in CD patients respectively. Over the three decades, abdominal surgery was 49.2%, 27.8% and 36.3% in CD and colectomy rates was 2.0%, 2.7% and 3.7% in UC patients.
While the rate of UC patients has slightly decreased to 98 (61.6%), 401 (58.5%) and 374 (53%) frequency of CD patients has increased to 61 (38.4%), 284 (41.5%) and 331 (47%). Over the course of three decades, there were more UC patients than CD patients, however proportion of UC/CD has been continuously decreased (1.61, 1.41 and 1.13) for three decades respectively.

Conclusion
Our study showed that the frequency of UC and CD has significantly increased during the previous three decades in non-endemic era for IBD. While the frequency of UC patients has slightly decreased, that of CD patients has steadily increased over the past three decades. Although the use of biologics has significantly increased, proportions of the abdominal surgeries and colectomies has not prominently changed.
P351 The Histo-endoscopic Spectrum in Ulcerative Colitis reveals a Distinct Mucosal Transcriptome for Histo-endoscopic Remission
Authors: Lenfant M , De Hertogh G , Sabino J , Verstockt B , Ferrante M , Verstockt S , Vermeire S 
Published: January 2024

Abstract

Background
Aiming for histological remission on top of endoscopic remission, is an aspiring target in ulcerative colitis [UC]. We investigated the mucosal transcriptional profiles in UC patients with varying depths of histologic activity as compared to healthy controls.

Methods
UC patients with endoscopic improvement (Mayo endoscopic score [MES] 0 or 1) were recruited. Endoscopies were video-recorded and biopsies from the most affected segment were collected for histological assessment and bulk RNAseq (Illumina HiSeq 4000, single read). Geboes Score [GS] was determined by two pathologists blinded for endoscopic scores. The included patients were divided into endoscopic improvement with histologic activity [EIHA] (MES ≤1, GS ≥2B.1) and histo-endoscopic mucosal remission [HEMR] (MES ≤1, GS &lt;2B.1). We distinguished a subpopulation within the HEMR group that we labelled as histo-endoscopic mucosal normalization [HEMN] (MES ≤1, GS ≤0.1).
As comparators, 50 healthy individuals [HV] and 50 UC patients with active disease (MES 2-3, independent, matched by treatment) [AD] were included. Normalised RNA counts were analysed by principal component analysis [PCA] and differential expression analysis. Genes with a |log2 FC|&gt;1 and a FDR &lt;0.05 were considered as differentially expressed [DEG], and were selected for pathway analysis (R 4.3.2, DEseq2; QIAGEN IPA).

Results
In this study cohort 172 patients were included (Table). PCA analysis showed clustering patterns for each study group (Figure). In particular, separation along the PC1 axis tended to follow the different degrees of histo-endoscopic activity. Interestingly, besides inflammatory and tissue remodeling markers (e.g., DUOX2, MMP 3, CHI3L1) for PC1 and epithelial and metabolic markers (e.g., SLC9A3, LPIN3) for PC2, the gene with the highest variance for both PC1 and PC2 was Aquaporin-8 (AQP8). This gene encodes for a water transporter at the apical surface of the colon, and its mucosal expression level indeed follows a spectrum of histo-endoscopic activity (Figure).
Differential expression analyses identified 1261 DEG in HEMN, 1684 DEG in HEMR (not HEMN), 2178 DEG in EIHA, all compared to HV. A total of 1014 overlapping DEG were identified for all these comparisons, being enriched for pathways related to inflammation, metabolic epithelial functions (lipid metabolism, bile acid regulation) and wound healing.

Conclusion
UC patients with histo-endoscopic remission have a mucosal transcriptional profile which significantly differs from that of healthy individuals, even in UC patients whose biopsies appear normal upon histological evaluation. The histo-endoscopic spectrum of the mucosal transcriptome in UC is nicely illustrated by the gene expression of Aquaporin-8 (AQP8).
P358 Impact of end-ileostomy versus ileal pouch-anal anastomosis on graft-survival following liver transplantation for primary sclerosing cholangitis
Authors: Schabl L , Maspero M , Holubar S , Hull T 
Published: January 2024

Abstract

Background
IBD-PSC patients may require both liver transplantation and ileoanal pouch (IPAA) construction. Recently, concerns have been raised regarding an increased rates of hepatic artery thrombosis, biliary strictures, and graft loss in individuals who underwent IPAA after liver transplantation compared to those who underwent end-ileostomy (EI). We hypothesized that graft survival was not negatively affected by IPAA compared with EI.

Methods
A prospectively maintained database from a large tertiary center was searched for patients meeting the inclusion criteria for liver transplantation, primary sclerosing cholangitis, ulcerative colitis, and total colectomy with IPAA or EI. Univariate analysis and Kaplan-Meier survival curves were calculated.

Results
Between January 1990 and December 2023, 55 patients met inclusion criteria. Of these, 46 (83.6%) underwent IPAA, and 9 (16.4%) underwent EI. The average age at colectomy (41.7 vs. 45.7 years; p=0.44), sex distribution (female: 26.1% vs. 22.2%, p=1), and MELD score before transplantation (20.3 vs. 14; p=0.06) were comparable between patients with IPAA and EI patients. The rates of re-transplantation (21.7% vs. 22.2%; p=1), hepatic artery thrombosis (8.7% vs. 0; p=1), episodes of acute rejection (32.6% vs. 44.4%; p=0.7), chronic rejection (4.3% vs. 11.1%; p=0.42), recurrence of primary sclerosing cholangitis (23.9% vs. 22.2%; p=1), and biliary complications (21.7% vs. 33.3%; p=0.43) were similar between the IPAA and EI groups, respectively. None of the EI patients developed parastomal varices. Survival analyses for time to re-transplantation (p=0.97), overall survival (p=0.3), and time to graft loss or mortality (p=0.73) were similar.

Conclusion
In contrast to a previous study, we observed similar rates of liver transplant graft loss, biliary complications, and recurrent PSC after IPAA compared to those after end-ileostomy. IPAA may be associated with an increased rate of hepatic artery thrombosis.
P359 Persistence of severe fatigue in adults with Crohn's disease in remission
Authors: Sartain S , McDonnell M , Dingwall M , Westoby C , Katarachia V , Davis C , Heinson A , Wootton S , Cummings F 
Published: January 2024

Abstract

Background
Fatigue is a frequent manifestation in patients with Inflammatory Bowel Disease (IBD), including those in remission. The persistence of fatigue over time in inactive disease is not well known. We aimed to determine the prevalence and continuation of severe fatigue at baseline and at 12 months follow-up in a cohort of patients with Crohn’s disease (CD) in remission.

Methods
Adult patients with CD in remission, defined by age ≥18 years, HBI &lt;5 and faecal calprotectin &lt;250mcg/g, were recruited to the INTICO2 observational study. Baseline assessment included SF36, FACIT-F and IBD Control patient-reported outcome measures. After 12 months in routine care, participants were invited to repeat FACIT-F. Severe fatigue was defined as scoring FACIT-F &lt;30. Baseline data was analysed for factors associated with the persistence of severe fatigue at 12 months.

Results
A total of 198 patients were studied at baseline, of which 141 completed both baseline and 12-month assessments. The correlation between FACIT-F scores at baseline and 12 months was r = 0.79 (p &lt; 0.001). Twenty-five (17.7%) patients were severely fatigued at both baseline and 12-month follow-up, and 99 (72.1%) were not severely fatigued at either time. Of the 34 patients severely fatigued at baseline, 9 (26.5%) were not severely fatigued at 12 months. From the 107 patients who were not severely fatigued at baseline, 12 (7.5%) became severely fatigued at 12 months. Participants with ongoing severe fatigue at baseline and 12 months had significantly worse SF36 Mental Health scores, 64 v 80 (p &lt;0.001), and more night waking due to IBD, 32.0% v 7.1% (p = 0.011), at baseline assessment than those not severely fatigued at either assessment, see Table 1. Eight patients had a clinical disease flare during the 12-month follow-up period.

Conclusion
Most patients in this cohort in remission continued to have similar fatigue severity at 12-month follow-up. A higher proportion of severely fatigued patients at baseline improved at 12 months than non-severely fatigued patients at baseline developing severe fatigue at 12 months. Factors at baseline associated with persistent severe fatigue were worse mental health and poor sleep secondary to IBD. These may represent areas where intervention could improve reported fatigue levels in remission.
P367 Are patients with Inflammatory Bowel Disease and two or more associated Immune-Mediated Inflammatory Diseases different from those with no or one associated disease?
Authors: De Francisco Garcia R M , Pérez-Martínez I , Castaño-García A , Carballo-Folgoso L , Flórez-Díez P , García-Pérez C , Fernánez-González E , González-Sánchez H , Chiminazzo V , Queiro R , Alonso-Castro S , Santos-Juanes J , Gueimonde M , Riestra S 
Published: January 2024

Abstract

Background
It is well known that immune-mediated inflammatory diseases (IMIDs) are frequently diagnosed in patients with inflammatory bowel disease (IBD). However, few studies have taken into account whether the number of associated IMIDs influences IBD. Our aim was to evaluate the clinical, demographic, and drug needs of patients with IBD based on the number of other IMIDs they present.

Methods
Cross-sectional study that included patients treated at the IBD Unit of the Central University Hospital of Asturias (Spain) between August 2020 and December 2021. Demographic data and disease characteristics were collected and IMID diagnosis was confirmed in the medical records of each patient. Patients were split into three groups: non-IMID, 1-IMID, and two or more associated IMIDs. Hospitalizations, drugs and surgery requirement were analyzed. The comparison between groups was carried out using the Kruskal-Wallis test, and Pearson's Chi-square test or Fisher's exact test. When there was a significant difference between any of the groups, a post-hoc test was performed with p-value correction following the Benjamini and Hochberg method.

Results
A total of 1,620 patients were included in the analysis. 1,067 (66%) had no IMID, 394 (24%) had one IMID, and 159 (9.8%) had two or more IMIDs. Overall, the most frequent IMIDs were spondylarthritis (14%), psoriasis (7.5%), erythema nodosum (4.3%), intrinsic asthma (2.8%), and uveitis (2.5%). The presence of an IMID was associated with older age, longer duration of IBD, female sex, and Crohn's disease (Table 1). The use of steroids, immunomodulators, and biologics, as well as the need for hospitalizations, was higher in patients with several IMIDs. When we analyzed the groups of patients with one and with two or more IMIDs, the only significant differences were a longer duration of disease, a greater prevalence of Crohn's disease, and a higher use of steroids, immunomodulators, and biologics among patients with two or more IMIDs. The percentage of patients with joint (spondylarthritis, psoriasic arthritis, juvenile idiopathic arthritis), cutaneous (psoriasis, hidradenitis suppurative, erythema nodosum, pyoderma gangrenosum) and ocular (uveitis and episcleritis) IMIDs and intrinsic asthma was higher in the group with two or more IMIDs than in the group with one IMID.

Conclusion
10% of patients with IBD have two or more associated IMIDs. The duration of IBD and the need to use steroids, immunomodulators and biologics is greater than in patients with one IMID.
P370 Quality of life in inflammatory bowel diseases – is the flare all that matters?
Authors: Topala M , Ionescu V , Iacob R , Gheorghe C 
Published: January 2024

Abstract

Background
Burden in inflammatory bowel diseases (IBD) is high and affects both physical and psychological status. Short inflammatory bowel disease questionnaire (SIBDQ) is a self-administered health-related quality of life questionnaire that evaluates social, bowel, emotional and systemic dimension. Our aim is to evaluate the impact of IBD status on patients’ daily life.

Methods
We analysed 82 patients diagnosed with Crohn’s disease or ulcerative colitis or that were admitted between March 2021 and April 2022 in Fundeni Clinical Institute, Bucharest. SIBDQ consists of ten questions, with score ranging from 10 (poor) to 70 (optimal). Patients completed SIBDQ and we assessed disease status and determined biological and clinical markers.

Results
51% of patients were diagnosed with Crohn’s Disease. 79% were in clinical remission. The mean age was 39.53±12.9 years old and 52.4% were men. Mean illness duration was 8.03±7.18 years. Mean SIBDQ score was 50.25±14.51, with significantly higher scores in the remission subgroup (55.26±10.30 vs. 31.11±12.24, p&lt;0.001) and it correlated with faecal calprotectin level (ρ=-0,502) and C-reactive protein level (ρ=- 0,531), without regard to disease type or sex. There were no correlations between SIBDQ score and Crohn’s disease or ulcerative colitis phenotype, duration since diagnosis, presence of extraintestinal manifestations or history of abdominal surgery related to IBD.

Conclusion
Patients with IBD flares have low quality of life and SIBDQ scores correlate with markers of disease severity, comparable to previously-published literature. Patients in clinical remission presented with higher SIBDQ scores, independently of IBD phenotype or previous surgery. Acute flares of IBD have a major impact on daily life, additional psychological and social support is needed in order to improve management.
P381 Intestinal ultrasound in newly diagnosed Ulcerative Colitis predicts the need for colectomy
Authors: Madsen G R , Attauabi M , Wilkens R , Ilvemark J F K F , Theede K , Bjerrum J W , Bendtsen F , Seidelin J B , Boysen T , Burisch J 
Published: January 2024

Abstract

Background
Upon diagnosis of ulcerative colitis (UC), it remains challenging to predict who will have a severe disease course, ultimately necessitating colectomy. Predictive tools capable of risk-stratifying patients and individualize treatment are warranted. The aim of this study was to assess whether Intestinal ultrasound (IUS), performed at the onset of UC, could help predict the need for colectomy within the first year of diagnosis.

Methods
In a Danish prospective inception cohort, all new-onset adult patients with UC (including unclassified IBD) with left-sided or extensive colitis underwent IUS near the diagnostic endoscopy. The assessment included the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and the bowel wall thickness (BWT) of the most inflamed segment. Besides IUS, we recorded age, gender, smoking, BMI, the Mayo endoscopic score (MES), the Simple Clinical Colitis Activity Index (SCCAI), and biomarkers hemoglobin (hgb), C-reactive protein (CRP), albumin and fecal calprotectin.

Results
During inclusion (May 2021 – April 2023), we included 193 UC patients with Montreal classification E2 or E3. In total, 12/193 (6%) underwent colectomy within the first year or during follow-up (min. 6 months). Baseline characteristics are presented in Table 1.
Univariable analyses identified high MES, CRP, SCCAI, IBUS-SAS, and BWT, along with low Hgb and albumin, as significantly associated with an increased colectomy risk. Multivariable analysis with stepwise reduction identified only SCCAI (OR: 2.0, CI 1.2–3.3, p&lt;0.005) and BWT (OR: 1.6, CI 1.1–2.3, p=0.01) as independent predictors. Through ROC analysis, BWT presented the highest accuracy (AUC: 0.89), and the optimal cut-off by Youden Index for colectomy prediction was &gt; 6.1 mm. Combining all the significant non-IUS predictors, CRP, MES, SCCAI, hgb, and albumin yielded an AUC of 0.88. The highest accuracy was found by combining SCCAI and BWT, with an AUC of 0.94. Kaplan-Meier curve for colectomy-free survival is presented in Figure 1.
Among patients with BWT&gt;6.1mm, 18/21 (86%) started systemic steroids within the first week, compared to 43/125 (34%) of patients with BWT ≤ 6.1, p=0.007. Among patients with BWT &gt; 6.1mm, 11/21 (52%) started biologics within the first 31 days, compared to 5/125 (4%) of patients with BWT≤6.1mm, p&lt;0.001.
Despite more aggressive treatment, 8/21 (38%) with BWT&gt;6.1mm had a colectomy compared to 2/125 (2%) with BWT≤6.1mm.Conclusion
IUS at UC onset, specifically BWT, is a robust predictor of colectomy risk within the first year of diagnosis. Combining clinical symptom scores with IUS enhances predictive accuracy. It can accurately identify patients at an increased risk of colectomy, guiding early treatment decisions for improved patient outcomes.
P387 Short and long-term outcomes of surgery for inflammatory (uncomplicated) ileocecal Crohn’s disease: multicentric retrospective analysis of 211 patients
Authors: Avellaneda N L , Maroli A , Tottrup A , Buskens C , Kotze P G , Pellino G , Dige A , Haase A M , Haanappel A , Giorgi L , Carvello M , Yuki Maruyama B , Christensen P , Spinelli A 
Published: January 2024

Abstract

Background
Surgical management for patients with inflammatory ileocecal Crohn’s disease (CD) could be a reasonable alternative to second-line medical treatment.

Methods
A retrospective analysis of patients intervened for primary ileocecal CD with uncomplicated (inflammatory) phenotype at four referral hospitals during 2012-2021 was performed. The objective was to assess short and long-term outcomes of patients operated on for inflammatory, ileocecal CD.
Patients operated on due to inflammatory ileocecal CD (last 50 cm of the terminal ileum and cecum), were considered eligible to participate in this study. Operations performed during a 9-year period (2012-2021) were considered for the study. Patients who were operated for CD for advanced structural bowel damage (fibrotic strictures or penetrating phenotype), those who had had previous abdominal CD-related procedures, and patients who had disease activity in other anatomical regions at the time of surgery, were excluded from the study.

Results
211 patients were included. 43% of patients underwent surgery more than 5 years after diagnosis, and 49% had been exposed to at least one biologic agent preoperatively. 89% were operated by laparoscopy, with 1.6% conversion rate. The mean length of stay for patients was 5 days, with only 24 patients (11%) requiring a prolonged hospitalization. The complication rate was 23.7% (50 patients), but most complications were minor (Clavien-Dindo &lt; IIIa), with only 11 patients (5%) presenting with major complications. Leak rate for patients who received a primary anastomosis was 2.9%. The median length of the resected bowel was 25 cm (7-92) and three patients (1.43%) received a stoma. Median follow-up was 36 (17-70) months. The endoscopic recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 56%, 52%, 45%, 38%, and 33%, respectively. The clinical recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 83%, 79%, 76%, 74%, and 74%, respectively. In multivariate analysis, previous biological treatment (HR=2.01; p=0.001) was associated with a higher risk of overall recurrence.

Conclusion
In this study, surgery in patients with primary inflammatory ileocecal CD is associated with good postoperative outcomes, low postoperative morbidity with reasonable recurrence rates. Further studies need to validate the present results.