bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1054 Clinical outcomes for ulcerative colitis patients stopping 5-aminosalicylates starting biologics and/or immunomodulator therapy: A Systematic review and meta-analysis
Authors: Moon J R , Na J E , Ji J H , Lee H S , Park J J 
Published: January 2024

Abstract

Background
Although 5-aminosalicylic acid (5-ASA), a crucial agent in the treatment of ulcerative colitis (UC), its role in the context of more advanced therapies, including immunomodulators and/or biologics, is not well defined. We sought to perform a systematic review and meta-analysis to assess the pooled consequences of discontinuing 5-ASA in patients with UC undergoing treatment with immunomodulators or biologics.

Methods
We searched MEDLINE, EMBASE, and the COCHRANE library to identify articles analyzing clinical outcomes associated with either discontinuing or maintaining 5-ASA in UC patients receiving immunomodulators or biologic treatments. A meta-analysis was performed using a random-effects model to pool estimates and report hazard ratios [HRs] or odds ratios [ORs], following the data format specified in the individual studies.

Results
A total of 6 studies were identified as eligible for the meta-analysis. In UC patients receiving immunomodulators and/or biologics, stopping 5-ASA was not associated with steroid use (HR 0.86, 95% confidence interval [CI] 0.65-1.14 and OR 0.84, 95% CI 0.47-1.51), UC-related hospitalization (HR 0.92, 95% CI 0.69-1.22), UC-related surgery (HR 0.88, 95% CI 0.65-1.18), one-year clinical (OR 0.93, 95% CI 0.63-1.39) and endoscopic (OR 1.24, 95% CI 0.30-5.08) remission.

Conclusion
The cessation of 5-ASA in UC patients treated with immunomodulators and/or biological agents is not related to worsening of clinical outcomes. This finding suggests a limited role for 5-ASA in the setting of more advanced therapies
P1067 Pan-enteric mucosal inflammation in CD patients treated with vedolizumab assessed by capsule endoscopy– interim results of a prospective observational study
Authors: Ukashi O , Lahat A , Ungar B , Levy H , Eidler P , Ben-Horin S , Eliakim R , Kopylov U 
Published: January 2024

Abstract

Background
Mucosal healing (MH) is a paramount treatment goal in Crohn’s disease (CD). The vast majority of data pertains to MH in the colon and terminal ileum; nonetheless, proximal small-bowel involvement can be detected in up to 50% of CD patients assessed by capsule endoscopy (CE). Data regarding pan-enteric MH among patients with active CD who were treated with vedolizumab (VDZ) are lacking. We aimed to evaluate the efficacy of VDZ for achieving pan-enteric MH using pan-enteric CE.

Methods
This was a prospective open-label observational study. Patients with CD who have started on VDZ, were included. Patients underwent small-bowel patency-assessment using patency capsule (PC) and were followed by CE (PillCam Crohn’s, Medtronic, USA) before /within 40 days of treatment onset and after 14 and 52 weeks. In patients with exclusive small-bowel involvement, colonic preparation was not performed and colon was not assessed in subsequent CE. Accordingly, Lewis score (LS) and Pan-enteric Pillcam score (PS) were calculated, when available. The primary outcome was pan-enteric MH defined as LS&lt;135 and LS&lt;135 & PS&lt;4 for CE confined to the SB/SB &colon, respectively. The main secondary outcomes were small-bowel MH (LS&lt;135) and colonic-MH (colonic PS&lt;4).

Results
57 patients were recruited, 41 patients were enrolled (median age: 28 [23-45] years, male-44%) and 16 patients were excluded (6- retained PC, 1- technical reason, 2 -did not start VDZ, 7-withdrew consent). Of them, six patients (1- retained PC, 1- multiple strictures, 1- lost to follow-up, 3- clinical flare) and eight patients (4- discontinued VDZ, 2- capsule adverse events, 1- lost to follow-up, 1- clinical flare) were dropped-out before week 14 and week 52, respectively. Pan-enteric MH was observed in 7/39 (18%) patients at week 14, and in 7/30 (23%) patients at week 52 (two patients and 11 patients have not yet reached 14/52-week, respectively). We observed higher rates of both small-bowel MH and colonic-MH during follow-up compared to baseline (Figure 1), and it was consistent with significant improvement at week 14 in both LS (900 [225-900] vs. 450 [0-900], p&lt;0.001) and PS (12 [2-18] vs. 6 [0-14], p=0.001) compared to baseline. Improvement was even more prominent at week 52 (LS- 0 [0-300] PS- 2 [2-6]). No cases of retained capsule were observed during follow-up.

Conclusion
VDZ induces MH in both the small-bowel and the colon among patients with CD, and this effect may persist up to 52 weeks of treatment.
P1086 Re-administration of infliximab in patients with extremely refractory perianal Crohn’s disease
Authors: Mousourakis K , Veretanos C , Arvanitis K , Georgiadi T , Nousias G , Kozompoli D , Mylonas I , Paparizou A , Karaouzas L , Kalogiros G , Patsi M , Provi D , Christidou A , Mela M , Archavlis E , Papastergiou V , Varytimiadis K , Katopodi K , Chatzievangelinou C , Viazis N 
Published: January 2024

Abstract

Background
This study aims to evaluate the efficacy of infliximab re-administration to a cohort of patients with extremely refractory perianal Crohn's Disease (CD).

Methods
Retrospective analysis of prospectively collected data in CD patients with perianal disease, who despite being treated with infliximab, had to change treatment either because of primary non-response, secondary loss of response, or due to the occurrence of an allergic reaction. They then became resistant to the other therapies tested, resulting in Infliximab being given again. We then evaluated the clinical response to fistula management (Perianal Disease Activity Index PDAI ≤ 4), as well as the occurrence of adverse reactions in these patients.

Results
We included 14 patients (8 women), with a mean age (SD) of 38.2 (9.5) years. According to the Montreal classification our patients had L1 (n=2), L2 (n=2) and L3 (n=10) disease. After the initial Infliximab failure (even after dose escalation), patients received vedolizumab, ustekinumab and adalimumab without response or with secondary loss of response. Therefore, it was decided to re-administer infliximab with concomitant administration of azathioprine. After 1 year of follow up clinical response (PDAI ≤ 4) was seen in 4 patients (28.5%). Re-administration of infliximab was discontinued in 2 patients due to severe allergic reaction; however, the remaining patients did not experience side effects.

Conclusion
Re-administration of Infliximab may be able to help a small percentage of treatment resistant patients with perianal CD.
P1091 Cross-domain dynamics of the fungal-bacterial microbiome in patients with ulcerative colitis
Authors: Jangi S , Hsia K , Zhao N , Michaud D 
Published: January 2024

Abstract

Background
Background: Candida in the gut has been recently linked to inflammatory activity in UC. However, the relationship between Candida abundance and the bacterial microbiome remains poorly understood, and how these relationships evolve over disease course in UC is unknown.

Methods
Methods: We utilized data from the Study of a Prospective Adult Research Cohort with IBD (SPARC-IBD) from IBD Plexus to examine the taxonomic composition of the fungal mycobiome and bacterial microbiome cross-sectionally and longitudinally in time. Differential abundance was assessed using a log-transformed linear model on microbial relative abundances, with a false discovery rate of &lt;0.25. Spearman’s correlations and co-abundance networks were utilized to examine relationships between fungi, bacteria, and disease activity. Changes in fungi and bacteria within-subjects was assessed over 2 timepoints, with respect to clinical inflammatory status, and abundances were compared using Wilcoxon signed rank tests.

Results
Results: Among 212 patients with UC, 166 patients were in clinical remission (78.3%) while 46 demonstrated clinical activity (21.7%). During clinical activity, there were increases in Candida (q-val&lt;0.05), bacterial family Desulfovibrionaceae (q-val&lt;0.05), and genus Bilophilia (q-val&lt;0.05) [Fig 1A]. During remission, there were reductions in Candida, with increases in family Lachnospiraceae (q-val&lt;0.05), including genus Anaerostipes (q-val=0.09), Blautia (q-val=0.09) and Roseburia (q-val=0.21) [Fig 1B]. Active disease positively correlated with Candida and Desulfovibrionaceae, and negatively correlated with family Lachnospiraceae. During remission, a positive network was present between family Lachnospiraceae, Bifidobacteriaceae, and Eggerthellaceae, which was disrupted during activity, while an antagonistic relationship was evident between Candida and Saccharomyces during remission.
Among 25 patients with persistent remission over time (median time interval ~ 4 months), there were no changes in fungal abundances over timepoints. Among patients evolving from activity to remission (n=7), Saccharomyces significantly increased (p-val&lt;0.05), with no significant change in Candida, although there was a trend towards reduction (mean relative abundance at t1=0.28 vs t2=0.11). Concurrently among bacteria, both Bifidobacterium and Anaerostipes significantly increased (p-val&lt;0.05).

Conclusions
Candida and bacteria from families Lachnospiraceae may have opposing associations with inflammatory status in ulcerative colitis, suggesting they may demonstrate competitive ecological niches. Whether reduction of Candida species may expand protective bacteria should be tested adjunctive to immunosuppressive or microbial modulation therapies.
P1094 Rectal cancer in patients with inflammatory bowel disease - a nationwide cohort study
Authors: Lundqvist E , Westerberg K , Dietrich C , Martling A , Myrelid P , Nordenvall C 
Published: January 2024

Abstract

Background
Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer. The aim of this study was to investigate surgical outcome and survival in patients with rectal cancer (RC) with and without IBD.

Methods
The study was performed as a national population-based cohort study based on the Colorectal Cancer Data Base (CRCBaSe). All patients ≥18 years of age with a diagnosis of stage I-III RC treated with curative intent during the period 1997-2021 were included, with preliminary data for 1997-2016 available. Overall and disease-free survival after surgery was compared between patients with and without a previous diagnosis of IBD. Adjusted flexible parametric survival models were used to estimate proportional and time-dependent hazard ratios (HRs) with 95% confidence intervals (CIs). Updated data until 2021 with addition of cause-specific survival and perioperative data will be made clear by the time of the ECCO congress.

Results
In all, 16,263 patients with RC were included in the study, 1997-2016, among whom 235 had IBD. Patients with IBD were significantly younger, had a higher CCI, and lower tumours at diagnosis of RC, compared with patients without IBD. Among IBD patients, 45 (19.2%) were previously operated with colectomy, and 14 of these were reconstructed with ileorectal anastomosis. Among IBD patients, pT4 tumours were more prevalent (8.9%) than in patients without IBD (5.1%). Clear resection margins were less common in patients with IBD (90.6%) versus patients without IBD (95.1%). From preliminary adjusted analyses allowing the relative mortality rate to vary over follow-up time, RC patients with IBD experienced worse progression-free survival during the second year after surgery, after which their progression-free survival was superior in comparison with IBD-free patients.

Conclusion
The prognosis in RC patients with and without IBD varied over time. RC patients with IBD had an inferior progression-free survival initially, followed by an improved prognosis for the majority of the follow-up time. Despite a higher rate of pT4 tumours, R1-resections and lower tumors among IBD patients, unadjusted overall survival did not differ significantly compared to non-IBD CRC patients.
P1095 Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide cohort study 2003-2021
Authors: Eriksson C , Sun J , Bryder M , Bröms G , Everhov Å H , Forss A , Jernberg T , Ludvigsson J F , Olén O 
Published: January 2024

Abstract

Background
There are conflicting data on the risk of acute coronary syndrome (ACS) in patients with inflammatory bowel disease (IBD) and only a few previous reports include patients diagnosed in the last decade. The aim of this study was to assess the risk of ACS in a modern population of IBD patients vs general population comparators.

Methods
In this cohort study, we used nationwide registers to identify patients diagnosed with IBD in Sweden 2003-2021. Every patient was matched by birth year, sex, calendar year of diagnosis, and area of residence with up to ten general population comparators. The primary outcome was incident ACS (i.e. ST-segment elevation myocardial infarction [MI], non–ST-segment elevation MI, unspecific MI and unstable angina). Cox proportional hazard models were used to estimate hazard ratios (HRs).

Results
Overall, 76,517 patients with IBD (Crohn's disease (CD), N=22,732; ulcerative colitis (UC), N=42,194 and IBD-unclassified, N=11,591) and 757,141 comparators were identified (Table 1). During a median follow-up of 8 years, 2546 patients with IBD (37.5/10,000 person-years) were diagnosed with ACS as compared with 19,598 (28.0/10,000 person-years) in the general population comparators. This corresponded to an HR of 1.30 (95% confidence interval [CI]: 1.24-1.35) after adjustings for potential confounders, and approximately 1 extra case of ACS in 100 IBD patients followed for 10 years. HRs for ACS were higher during the first year of follow-up but remained increased even after 5 years of follow-up (Figure 1). The highest HRs for ACS were observed in patients with elderly onset IBD (≥60 years; HR: 1.35; 95% CI: 1.28-1.43) and in patients with CD and UC with extra-intestinal manifestations (HR in CD: 1.58; 95% CI: 1.20-2.09; HR in UC: 1.98; 95% CI: 1.63-2.40). When restricting analyes to patients with elderly onset IBD, the absolute risk increase corresponded to 1 additional case of ACS for every 30 IBD-patient followed for 10 years. In contrast, no increased HRs were observed in patients diagnosed with IBD before the age of 40. But of note, just a few of the patients diagnosed with IBD before 40 years of age were followed-up beyond 50 years of age. HRs for ACS were stable during the whole study period 2003-2021 with no signs of leveling off during recent years.

Conclusion
In this contemporary cohort of patients with IBD, exposed to modern IBD-care, an increased risk for ACS was observed as compared with individuals of the general population. The highest HRs were observed in patients with elderly onset IBD and in patients with CD and UC with extra-intestinal manifestations.
P1096 Increased incidence of IBD over 22 years in an Argentine cohort
Authors: Sanchez M B , Gonzalez Sueyro R , Sobrero M J , Etchevers M J , Martinez Elhelou S , Manduca P A , Mulinaris A B , Musso Enz V , Ligo M C , Brave C , de Paula J A , Marcolongo M M 
Published: January 2024

Abstract

Background
A considerable variation of IBD epidemiology around the world has been observed with certain regions showing a notable predisposition. The association between IBD and industrialized nations is well-known. However, a global increase of the incidence of such pathologies has been described, even in those regions with low incidence such as developing countries. Few data exist concerning the incidence of these pathologies in Argentina and Latin America during the last decades. Our objective is to determine the trend of incidence of IBD during a long term in an Argentine cohort.

Methods
A trend incidence study on a retrospective cohort was conducted. The study population comprised of affiliates of the Italian Hospital Medical Care Program (IHMCP), a prepaid health maintenance organization (HMO) with over 180,000 affiliates, of an urban area of Buenos Aires, Argentina. Patients with a diagnosis of IBD established between January 1st 2000 to December 31st 2022 were included. Data were extracted from the Institutional Registry of IBD (IRIBD) on a RedCap platform. Adjusted and raw cumulative incidence of IBD was calculated annually, using as denominator yearly affiliates to the IHMCP. Direct standardization was done considering the World Standard Population according to World Health Organization. Incidence was calculated over 100,000 persons with 95% confidence interval (95% CI). We evaluated the trend of incidence of IBD between 2000 and 2022, using a joinpoint regression analysis. The annual percentage change (APC) with 95% CI was calculated to detect increasing or decreasing trends according to an APC statistically different from zero (alpha 0,05), using Joinpoint Regression Program 4.5.0.1.

Results
Out of 530 affiliates of the IHMCP included in the IRIBD, 286 were diagnosed with IBD during the study period. One hundred and sixty two were women (56,6%). Mean age at diagnosis was 45,3 years (SD 22,2); 26 patients were diagnosed during pediatric ages (9%). Regarding the subtype of IBD, 78% were Ulcerative Colitis, 17% Crohn's disease and 5% IBD unclassified. Adjusted incidence rates of IBD over 100,000 persons per year are detailed in table 1, showing an incidence of IBD of 4,3 (95% CI 0.02 - 8.6) by 2000 and 11,8 (95% CI 5.9 - 17.7) by 2022. The adjusted trend of incidence of IBD showed an annual increase with a calculated APC of 6,4% (95% CI 0,9 – 12,2; p=0,023) (Figure 2).

Conclusion
Our study shows an increasing incidence of IBD with a sustained trend over the last 22 years in an argentine population. One of the strengths of this study is the long term analysis of a known cohort belonging to a centralized HMO. The detected increase in incidence reinforces reported evidence of a changing epidemiologic scenario of IBD in Latin America.
P1100 A multivariate time-dependent proportional hazard model to predict development of intestinal failure from Crohn’s Disease
Authors: Wu T H , Brandt C F , Scheike T , Burisch J , Jeppesen P B 
Published: January 2024

Abstract

Background
Intestinal Failure (IF) is a rare but severe complication of Crohn’s disease (CD). Advancement in therapy has not eliminated incident IF from CD (CDIF), and risk factors for developing IF from CD are not well characterised. The Copenhagen Intestinal Failure Database contains one of the largest, comprehensively described adult CDIF cohort1 from 1973 to 2018, which can be linked with a Danish nationwide CD cohort2 to explore healthcare utilisation patterns associated with developing IF from onset of CD.

Methods
CDIF patients from Copenhagen Intestinal Failure Database and a nationwide CD cohort without IF were followed from CD diagnosis until IF, death, or censoring on 31/12/2018. Hospital contacts, surgeries, medication use and employment status were extracted from multiple Danish population-based registries. Unplanned hospitalisation or emergency department attendance (inpatient-contact), CD-related abdominal surgery, and stopping work for 6 months or more (in working-age CD patients, excluding full-time study and parental leave) were considered time-dependent covariates and tested for significance (p&lt;0.05) in univariate proportional hazard models. Significant covariates were then modelled together with additional non-time-dependent clinical and demographic variables in multivariate proportional hazard models. Backward variable selection was performed to derive a final predictive model.

Results
175 CDIF and 22845 CD patients from whom data was available were followed for 2283.1 and 293536.5 patient-years, respectively. Univariate time-dependent proportional hazard models showed that every instance of unplanned IBD inpatient contact, CD-related abdominal surgery, and stopping work was significantly associated with increased hazard of developing IF, with a hazard ratio of 4.91 (95% CI 3.54-6.80, p&lt;0.001), 29.79 (95% CI 9.70-91.48, p&lt;0.001) and 1.61 (95% CI 1.15-2.26, p=0.005). In multivariate analysis, earlier decade of IBD onset, unplanned IBD inpatient contacts, length of stay of the inpatient contact, CD-related abdominal surgery, complicated surgery, number of previous admissions and surgeries and previous median-long term unemployment increased the rate of developing IF (Table), whereas age and comorbidity level at CD onset, non-IBD inpatient contacts, type of surgery, biologics use, and current employment status were not found to be significantly associated with IF development.

Conclusion
This is the first study to demonstrate significantly increased risks of developing IF from CD from increased healthcare utilisation patterns.
References:
1. Brandt et al.JPEN 41(4),566-574. https://doi.org/10.1177/0148607115612040
2. Lo et al. Scand.J.Gastroenterol.55(10),1171-1175. https://doi.org/10.1080/00365521.2020.1807598
P1118 High Crohn’s Disease burden but disproportionally low use of biologics in Crohn’s Disease patients with Intestinal Failure: a longitudinal comparative study from 1973-2018
Authors: Wu T H , Brandt C F , Scheike T , Burisch J , Jeppesen P 
Published: January 2024

Abstract

Background
Patients with Crohn’s Disease (CD) complicated by Intestinal Failure (CDIF) are considered to be among those with the most severe form of CD. Their clinical course before IF onset has not been well characterised. We aimed to describe and compare CD-specific natural history, disease burden and treatment between CDIF patients and CD patients without IF over a 40-year period.

Methods
CDIF patients from Copenhagen Intestinal Failure Database (1973-2018) and a Danish nationwide CD cohort without IF (1977-2018) were followed from onset of CD until IF, death, or 31/12/2018. Hospital contacts, surgeries, prescription dispensation, employment and mortality data were extracted from multiple population-based registries. Groups were compared using logistic regression for proportions and Poisson regression for rates. Standard mortality ratio (SMR) was calculated against age, gender and year-matched Danish population references, and an adjusted mortality rate ratio between CDIF and CD patients was obtained from Cox models.

Results
182 CDIF and 22845 CD patients were followed for 3035.7 and 293536.5 patient-years, respectively. At CD diagnosis, CDIF patients were younger (median age 24 years vs 35 years, p&lt;0.0001), from earlier decades (71.5% vs 16.5% before 1991, p&lt;0.0001), and had fewer comorbidities (6.9% vs 20.4%, p&lt;0.0001). The 10-year cumulative incidence of IF declined from 2.7% in patients diagnosed with CD prior to 1980 to 0.2% in patients diagnosed after 2000, but the number of new CDIF patients has not declined over the decades (Table). A greater proportion CDIF patients received at least 1 course of steroids (70.8% versus 59.8%, p=0.02) and immunomodulators (59.3% vs 48.7%, p=0.03), had IBD-related hospital contacts (98.2% vs 55.2%, p&lt;0.0001) and abdominal surgeries (94.9% vs 47.6%, p&lt;0.0001), and stopped working for &gt;6 months (65.8% vs 57.8% of working-age patients, p=0.05). However, in the biologics era (after 2000), CDIF patients were not treated with biologics more often (20.4% vs 21% had any biologics, p=ns). In those who were treated, CDIF patients had less cumulative time on biologics (3.9 years vs 11.2 years per 100 patient-years, p=0.001). CDIF and CD patients had a SMR of 3.7 (97.5% CI 2.79,4.72) and 1.7 (97.5% CI 1.61, 1.72), respectively. After adjusting for age, sex and co-morbidity, CDIF patients were at 3.42 times risk of dying compared to CD patients.

Conclusion
The incidence of CDIF has reduced in newly diagnosed CD patients, however the number of new CDIF patients has not yet declined due to increasing CD prevalence. Despite CDIF patients experiencing a significantly higher burden of CD before the onset of IF, they were not more likely to receive biologics. They also appear more refractory to biologics.