bluuebunny/crossref_metadata_2025_split huggingface dataset:
P465 Upadacitinib is effective and safe for the treatment of ulcerative colitis and Crohn’s disease: 1-year prospective real-world experience
Authors: Krugliak Cleveland N , Choi N K , Klein J A , Fear E N , Fine Z D , Garcia N M , Picker E A , Friedberg S R , Cohen R D , Dalal S R , Pekow J , Choi D , Rubin D T 
Published: January 2024

Abstract

Background
Upadacitinib (UPA) is a novel selective Janus kinase 1 inhibitor that has shown efficacy and received approval for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). We previously reported a large real-world experience of UPA induction in UC and CD (Friedberg, CGH. 2023). Here we report our 1-year real-world experience.

Methods
This is a prospectively collected study of clinical outcomes of UPA treatment in patients with UC and CD using predetermined intervals at weeks 0, 2, 4, 8, then every 3 months until week 52 as part of a formalized treatment protocol at our institution. We used the Simple Clinical Colitis Activity Index and the Harvey-Bradshaw index, as well as C-reactive protein and faecal calprotectin to assess efficacy, and also recorded treatment-related adverse events and serious adverse events.

Results
110 patients were initiated on UPA and followed for a one-year period (CD=57, UC=44, IBDU=5, pouchitis=4). 109/110 (99%) were biologic exposed and 31/110 (28.2 %) were tofacitinib exposed. 99/110 (90%) were initiated on UPA for luminal disease (Table 1). 54 patients remained on UPA therapy at 1 year. In UC: week 8 clinical response and remission was 24/47 (51.1%), 39/47 (83%), respectively; week 26 clinical response and remission was 20/34 (58.8%), 24/34 (70.6%), respectively; 52 week clinical response and remission was 17/30 (56.7%), 29/30 (96.7%), respectively. In CD: week 8 clinical response and remission was 14/32 (43.8%), 25/32 (78.1%%), respectively; week 26 clinical response and remission was 9/22 (40.9%), 15/22 (68.2%), respectively; 52 week clinical response and remission was 10/17 (58.8%), 13/17 (76.5%), respectively. 56 patients discontinued UPA prior to the 1 year follow-up, 13 were due to adverse events[DR1] . The most commonly experienced AEs leading to discontinuation was dermatological side effects (CD=2, UC=2). One instance of shingles occurred leading to discontinuation. No other serious infections or serious adverse events including VTE, MACE, or malignancies occurred.

Conclusion
In this large 1-year real-world experience in medically resistant patients with UC or CD, we report that UPA is both effective and safe, including in those who had prior exposure to tofacitinib.
P466 Ultrasound muscle assessment for sarcopenia screening in patients with Inflammatory Bowel Disease: A prospective study (SarcUS-IBD)
Authors: Mulinacci G , Pirola L , Gandola D , Ippolito D , Viganò C , Laffusa A , Gallo C , Invernizzi P , Danese S , Massironi S 
Published: January 2024

Abstract

Background
Sarcopenia is prevalent among patients with Inflammatory Bowel Disease (IBD) and impacts IBD patient’s surgical and therapeutic outcomes, thus necessitating effective diagnostic tools to assess muscle mass and function in this population.

Methods
A total of 153 consecutive patients were enrolled, 100 in the "training cohort" and 53 in the "study cohort". Three superficial muscles (Rectus Femoris (RF), Rectus Abdominis (RA) and Biceps Brachii (BB)) were chosen for sarcopenia detection with muscle ultrasound (US). The "training cohort" served for feasibility and interobserver variability assessment of US measurement. In the "study cohort", muscle ultrasound (US), bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI) were employed to measure muscle parameters. BIA served as the reference standard for comparison. Accuracy of a self-reported questionnaire for sarcopenia screening was assessed.

Results
The prevalence of sarcopenia in IBD patients was 50%. Muscle US demonstrated good diagnostic accuracy in detecting sarcopenia compared to BIA, with Area Under the Receiver Operating Characteristic Curve (AUROC) values of 80% and 85% for RA and BB thickness, respectively. Moreover, an Ultrasound Muscle Index (USMI) was defined by the sum of RA, BB, and RF thickness measurements divided by the square of the patient's height, resulting in an AUROC of 81%. Several muscle cutoffs for sarcopenia were recognized, with those of RA and USMI being correlated with the highest positive (84.3%) and negative (99%) predictive values, respectively. Excellent inter-rater and intra-rater reliability (ICC &gt; 0.95) were observed for US measurements. Additionally, the agreement between the US and magnetic resonance measurements of rectus abdominis was excellent (ICC 0.96).

Conclusion
The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. The study provides cutoff values for US measurements, aiding clinicians in accurate diagnosis. Self-reported questionnaires showed limitations in identifying sarcopenia, underlining the importance of objective measures like US or BIA. Muscle loss in IBD patients appears to be associated with disease activity rather than systemic inflammatory markers. This research has significant implications for disease management in IBD patients and underscores the need for further investigations with larger cohorts and long-term follow-ups to validate these findings.
P470 Crohn’s disease patients with Ustekinumab-induced remission are characterized by high baseline p35 cytokines subunits in LPMC and high IL-23 receptor expression in the lamina propria Th1 cells
Authors: Onali S , Di Petrillo A , Raho N , Favale A , Carpineti C , Cadoni M , Loddo E , Fantini M C 
Published: January 2024

Abstract

Background
Crohn’s disease (CD) is a chronic relapsing disorder of the gastrointestinal tract characterized by excessive inflammation sustained by the induction and expansion of Th1 and Th17 cells. Ustekinumab (UST), a fully humanized monoclonal antibody, is currently used for the therapy of CD patients. It acts by neutralizing both IL12 and IL23, essential for the maturation and expansion of Th1 and Th17 cells, by binding the common subunit p40. To be effective UST needs, in addition to the expression of target cytokines, the presence of cells responsive to IL12 and IL23, thus cells with IL12 and IL23 receptors.

Methods
This is a prospective, observational, single-center open-label study. All CD patients with clinical indications to receive UST for active luminal disease were enrolled. Patients had baseline endoscopy to confirm disease activity by SES-CD and to collect biopsies to isolate LPMC. Real-time pcr was performed to evaluate IL12 (p40 and p35) and IL23 (p40 and p19) cytokines subunits and IL12 (IL12Rb1 and IL12Rb2) and IL23 (IL12Rb1 and IL23R) receptors subunits expression in remitters (R) and not remitters (NR). Moreover, LPMCs were analyzed by flow cytometry, and IL12Rb2 and IL23R expression in Th1, Th17, and type 1 Innate lymphoid cells (iLC) cells were evaluated. Results were analyzed for clinical remission status (HBI&lt;5) at week 16. Differences between groups were analyzed by Mann-Whitney test and statistical significance was considered for p&lt;0.05.

Results
From April 2019 to November 2022, 13 CD patients were enrolled, whose clinical and demographic characteristics are enclosed in Table 1. At baseline there was no difference in IL12Rb2, ILRb1, and IL23R expression between R and NR (Fig.1). Regarding cytokines subunits, there was no difference in p19 but there was a significantly higher expression of p35 subunits in R than in NR (mean 1,52 vs 0,34; p=0,001) (Fig.1). Flow cytometry showed no difference in Th and ILCs subgroups frequency between R and NR. IL12Rb2 and IL23R were also equally expressed by Th17, Th1/Th17 and ILC1 cells in the two groups. In contrast, Th1 cells, IL23R expression was higher in R group as compared to NR (mean 20,6% vs 6,8; p=0.009) (Fig.2).

Conclusion
In CD patients treated with UST, higher expression p35 in LPMC and higher expression of IL23R in the lamina propria Th1 cells was associated with remission at week 16.
P479 The prevalence and risk factors of hematologic malignancy in patients with intestinal Behçet’s disease
Authors: Choi S , Ji J H , Park S J , Park J J , Cheon J H , Kim T I , Park J 
Published: January 2024

Abstract

Background
The association of intestinal Behçet’s disease (BD) with the risk of hematologic malignancy is still unclear. We aimed to assess the prevalence and determine risk factors of hematologic malignancy in intestinal BD.

Methods
Using a cohort of patients with intestinal BD between 1997 and 2021, the prevalence and risk factors of hematologic malignancy were analysed by logistic regression analysis at inflammatory bowel disease centre of Severance Hospital, Seoul, Korea.

Results
Among 780 intestinal BD patients, 23 patients developed hematologic malignancy. Myelodysplastic syndrome (MDS) (n=12) was the most common hematologic malignancy, followed by aplastic anemia (AA) (n=7), leukemia (n=2), and lymphoma (n=2). Eight patients had developed hematologic malignancy before their intestinal BD diagnosis and 15 patients developed hematologic malignancy after their intestinal BD diagnosis. Of the 772 patients without previous hematologic malignancy, patients smoking history (p-value 0.019, odds ratio [OR] 49.513, 95% confidence interval [CI] 1.925-1273.4), history of at least one emergency room (ER) visit (p-value 0.025, OR 26.360, CI 1.501-462.92), and albumin lower than 3.3g/dL (p-value 0.046, OR 603.013, CI 0.108-328191.23) at diagnosis were positively associated with subsequent hematologic malignancy. Body mass index (BMI) (p-value 0.030, OR 0.569, CI 0.342-0.947) was negatively associated with hematologic malignancy.

Conclusion
The physicians who care for intestinal BD patients with risk factors should be aware and provide careful monitoring of the elevated risk of hematologic malignancy.
P480 Prevalence of Peripheral Joint Manifestations among Ulcerative Colitis Patients in the Middle East: A Systematic Review and Meta-Analysis
Authors: Albadrani A , Albadrani Ahmed A , Alshahrani Abdulaziz S , Alamri Turki A , Al Abdulqader Abdulrahman K 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD), specifically ulcerative colitis (UC), is a chronic gastrointestinal disorder often accompanied by various extraintestinal manifestations. Peripheral joint manifestations represent a common extraintestinal complication, contributing to patient morbidity. This study aimed to systematically analyse the prevalence of peripheral joint manifestations among UC patients in the Middle East, providing insights into regional variations and potential clinical implications.

Methods
A comprehensive search was conducted in electronic databases to identify relevant studies. Inclusion criteria were studies reporting the prevalence of peripheral joint manifestations in UC patients in Middle Eastern countries. Twelve studies were selected for quantitative synthesis, involving a total of 2086 UC patients. Random-effects meta-analysis was performed, and the prevalence of peripheral joint manifestations was calculated with a 95% confidence interval (CI).

Results
The overall prevalence of peripheral joint manifestations in Middle Eastern UC patients was 18.0% (95% CI: 12.0% to 24.0%). The individual study prevalence rates ranged from 3.2% to 52.3%. A symmetrical funnel plot indicated the absence of significant publication bias. Heterogeneity among the studies was substantial (I² = 95%). Regional variations among the individual studies findings were observed, with Saudi Arabian studies reporting relatively higher prevalence rates compared to studies from Kuwait and Turkey. Gender disparities were noted, but they were not consistent across all studies. No substantial publication bias was identified in the analysis.

Conclusion
This meta analysis reveals that peripheral joint manifestations are a common extraintestinal complication in Middle Eastern UC patients. Recognizing the regional differences and gender disparities is essential for healthcare providers in the region. Further research is needed to explore the underlying factors and to improve patient care. These findings contribute to a better understanding of the clinical burden of UC in the Middle East.
P507 Can systematic upper gastrointestinal endoscopy benefit patients with Inflammatory Bowel Disease?
Authors: Koulali H , Zazour A , Elmqaddem O , Ismaili Z , Kharrasse G 
Published: January 2024

Abstract

Background
In the context of Inflammatory Bowel Disease (IBD), a comprehensive understanding of disease extent and related complications is essential for effective clinical care. While Crohn’s disease (CD) can affect the digestive tract from mouth to anus, ulcerative colitis (UC) is limited to the rectum and colon. This study investigates the potential utility of systemic gastroscopy in IBD management.

Methods
We conducted a retrospective cohort study using data from our gastroenterology department. Patients diagnosed with IBD who underwent systematic upper gastro-intestinal endoscopy (UGE) were included. Clinical, endoscopic, and histopathological data were gathered and analyzed.

Results
141 CD and 61 UC patients were included. The mean age was 40,7 years, and the female to male ratio was 1,33. 95.5% of these patients had no upper gastrointestinal symptoms prior to undergoing UGE. Among the symptomatic participants, the most frequent complaints were dyspepsia and pyrosis. In 73.9% of asymptomatic patients, UGE showed a normal mucosa, the abnormalities found in these patients were: non-specific gastro-duodenal erosions and ulcerations (8.5% of cases), mild esophagitis (4% of cases), aphthoid ulcerations (2% of cases) and duodenal stenosis (0.5% of cases). In symptomatic participants, UGE was normal in 4 cases, it showed atrophy of the fundus mucosa in 1 case, esophageal hernia in 2 cases, and esophageal aphthoid ulcerations in 1 case. Gastro-duodenal biopsies were consistently undertaken, among asymptomatic patients, histopathological abnormalities included: lymphoplasmacytic Infiltrate (47,7%) and helicobacter pylori (HP)(38,1 %), nonspecific duodenitis (44,7%), gastric metaplasia, focal gastritis, atrophic villi and crypt hyperplasia were objectified in 3,5%, 3%, 1,5% and 0,5% of cases. Granulomas were noted in only 1% of cases, and Cryptitis and crypt abscess in 0,5%. In symptomatic participants, histologic abnormalities included metaplasia in the fundus (0.5%), lymphoplasmacytic infiltrate (2.5%), HP (2,4%), atrophic villi in the duodenum (0.5%) and glandular atrophy (0.5%). Our analysis did not reveal any significant associations between endoscopic lesions and UC (p=0.36) or CD (p=0.09) nor the presence of symptoms (p=0.08), however, a significant association was identified between male gender and the presence of endoscopic lesions (p=0.033).

Conclusion
Although IBD patients might be asymptomatic, UGE and histopathological examination may reveal upper gastrointestinal abnormalities and aid to a better assessment and management of IBD patients.
P517 Endoscopic mucosal resection (EMR) in treatment of colitis associated neoplasia (CAN): a single-centre experience from Leuven, Belgium
Authors: Panic N , Vermeire S , Ingrid D , Joao S , Tarabar D , Bisschops R 
Published: January 2024

Abstract

Background
Endoscopic resection has been recommended as preferable therapeutic approach for colitis associated neoplasia (CAN) in inflammatory bowel disease (IBD) patients. However, endoscopic resection of these lesions can be challenging due to ongoing inflammation, mucosal scarring, and submucosal fibrosis. We report long-term, single centre experience on performance of endoscopic mucosal resection (EMRs) for treatment of CANs .

Methods
Hospital electronic database was searched in order to identify all the patients diagnosed with CANs in period 01.01.2009-30.09.2023. Data on the lesion characteristics, therapeutic approach, treatment outcomes and follow-up were collected and used for the descriptive analysis.

Results
During the study period 32 CANs have been treated with EMR in 19 patients. Mean diameter of the lesion was 18.2±9.09mm (8-50mm). Nine lesions were removed en-bloc (28.1%) while 23 (71.9%) were removed piece meal. One EMR (3.1%) was associated with post-procedural bleeding, which was treated endoscopically by the use of caograsper. Another 2 EMRs (6.2%) were associated with intraprocedural perforations which were resolved by placement of the endoclips. Histopahtological examination disclosed adenomas with low grade dysplasia in 19 lesions (59.4%), adenomas with high grade dysplasia in 7 lesions (21.9%), sessile serrated lesion with high grade dysplasia in one lesion (3.1%) and sessile serrated lesion without dysplasia in 4 lesions (12.5%). One lesion (3.1%) was identified as adenocarcinoma with deep submucosal invasion and patient was referred to surgery. All the other patients were subjected to follow-up, during which 4 cases of local recurrence at the site of resection were observed (12.5%), of which 3 were treated with new EMR while one was referred to surgery. Apart from recurrent lesions, six metachronous CANs were observed during the follow-up in 3 patients (15.8%), all removed by EMR and included in this analysis. All together 2 out of 19 patients (10.5%) included in the study underwent colorectal surgery for CAN treatment.

Conclusion
EMR appears to be safe and effective in treatment of CANs, both in terms of short and long-terms outcomes, as well as need for additional colorectal surgery.
P523 The performance indicator of colonic intubation (PICI) in an Irish Inflammatory Bowel Disease (IBD) cohort
Authors: Jones F , Lavelle A , McCarthy F , Patchett S , Morcos A , Moloney M , Cullen G , Slattery E , Leyden J , O' Morain C , Egan L , Doherty G A 
Published: January 2024

Abstract

Background
Comprehensive assessment of endoscopic disease activity and mucosal healing is central to therapeutic decision making in IBD. Data suggests that IBD patients may have a poorer experience of endoscopy with a higher burden associated with bowel preparation, higher GI specific anxiety and increased procedure related pain. Existing KPIs may be inadequate in capturing appropriate patient outcomes in IBD patients. PICI is a novel composite endpoint incorporating patient safety and comfort to ensure targets are met without compromising patient safety.

Methods
The aims of this study were to assess the safety, tolerability, and feasibility of colonoscopy in patients with IBD compared to non-IBD patients in Ireland using PICI, defined as successful caecal intubation with nurse assisted comfort score ≤3 and midazolam dose ≤2. We reviewed de-identified national endoscopy procedure data on all colonoscopies performed over a 6 year period in 24 hospitals nationally using the EndoRAAD reporting system. Procedures were categorised into IBD and non-IBD procedures on the basis or procedure indication (IBD surveillance or assessment) or a new diagnosis of IBD.

Results
Procedure data from 261,889 colonoscopies from 2014-2020 were analyzed (IBD: n=18,675; non-IBD: n=243,214 procedures). The Odds Ratio (OR) of achieving PICI was significantly lower in IBD patients compared to non-IBD patients, particularly in patients with Crohn’s Disease (0.74, 0.68-0.81, p&lt;0.001). Male gender was associated with a significantly higher OR of achieving PICI (1.32 (1.29-1.35, p&lt;0.001). Poor bowel prep was associated with reduced PICI (OR 0.78, p&lt;0.001). Additionally, procedures performed by supervised trainees had significantly reduced PICI (OR 0.69, p=0.032). The extent of colonic inflammation had no significant impact on PICI in IBD patients (OR moderate and severe inflammation 1.08 (p=0.66); and 1.06 (p=0.79) respectively). Mean procedure time was slightly longer for IBD patients (28.7 min versus 26.7 min, p&lt;0.001), with 91.1% of IBD patients having mucosal biopsies compared to only 26.3% of non-IBD patients (p &lt; 0.001).

Conclusion
This large retrospective cohort study utilises the novel composite measure of PICI to assess the safety, tolerability, and feasibility of colonoscopy in IBD patients compared to non-IBD patients. We have identified significantly poorer comfort scores and higher sedation rates required to achieve caecal intubation at colonoscopy in IBD patients, particularly in patients with Crohn’s Disease. Further exploration is required to identify factors to improve the safety and quality of endoscopy in IBD patients.
P528 Re-induction of intravenous ustekinumab to maintain drug persistence. A UK experience
Authors: Muir J , Hazir Y , Butterworth J 
Published: January 2024

Abstract

Background
In this study we seek to add to the body of knowledge on the practical use of ustekinumab in patients with Crohns and Colitis. Patients commencing ustekinumab will mostly have failed, or are intolerant to, conventional biologic agents and therefore have a limited number of medical options available to manage their disease. Results from the IM-UNITI long-term extension study have shown that a proportion of patients will lose response to maintenance dose therapy, and a small number of studies have suggested that repeated induction doses of this therapy can prolong its effective use and allow patients a greater period of disease free remission.
Shrewsbury and Telford hospital NHS trust is a multi-site UK hospital serving a large population in the west-midlands region which has established the routine use of usetkinumab therapy over 5 years ago and by reviewing data on our patient cohort we aimed to identify characteristics amongst patients who have required reinduction doses and how effective they have been in maintaining remission.

Methods
In this retrospective, interventional study two researchers gathered data including baseline characteristics, disease type and distribution, previous surgical and medical therapies and time from diagnosis on all patients who had received ustekinumab therapy over the past five years. We used biochemical and endoscopic data, as well as clinical records, to determine the efficacy of ustekinumab on the disease course. We identified the subgroup of patients requiring reinduction doses and noted whether this was a successful intervention and sought to describe similarities which could help identify patients at risk of failing maintenance therapy in future.

Results
Data from 213 patients was gathered (Crohns: 150, UC: 61, IBDU: 2) and of which 87 (Crohns: 63, UC: 24) received reinduction doses. Average time to reinduction from therapy commencement was 19.5 months (Crohns) and 16.3 months (UC) respectively. Of the reinduction group 63% showed improvement in their disease control and a variety of characteristics were noted amongst the successful patients for discussion including disease location, presence of perianal disease and time from diagnosis.

Conclusion
Ustekinumab reinduction is an important area for further research as it allows patients to prolong their successful therapy and delay the need for surgical intervention for difficult to manage disease. This study suggests characteristics which could inform further trials and establish protocols to aid clinicians when making decisions about switching biologic therapies.