bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1151 Incidence and risk factors of thromboembolic events in Pediatric-Onset Inflammatory Bowel Disease: a population-based study
Authors: Richard N , Leroyer A , Ley D , Dupont C , Bertrand V , Wils P , Gower-Rousseau C , Turck D , Guillon N , Sarter H , Savoye G , Fumery M 
Published: January 2024

Abstract

Background
Patients with inflammatory bowel disease (IBD) are known to be more susceptible to thromboembolic events. However, limited data on the incidence and risk factors for both venous (VTE) and arterial thromboembolic events (ATE) have been documented at the population level, especially in pediatric-onset IBD.

Methods
All patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) before the age of 17 years from 1988 to 2011 in a prospective population-based registry were retrospectively followed until 2013. Every VTE and ATE occurring during the follow-up period were included. Cox proportional hazard models with hazard ratio (HR) were performed using time dependent variable except for patient’s characteristics at diagnosis.

Results
A total of 1,344 patients diagnosed with IBD between 1988 and 2011, including 1,007 (75%) patients with CD and 337 (25%) with UC, with a median age at diagnosis of 14.3, IQR [11.7-16.0] years were included. After a median follow-up of 8.3, IQR [4.3–13.9] years, 15 (1.1%) VTE and 2 (0.15%) ATE occurred at a median age of 20.4, IQR [16.6-24.5] years (younger age: 14.8 years). The global incidence rate for both VTE and ATE was 1.32 per 1000 person-years, 95%CI [0.77 - 2.11]. In CD patients, the incidence of VTE was 1.41 per 1000 person-years, 95%CI [0.77 - 2.37], whereas it stood at 0.33 per 1000 person-years, 95%CI [0.01 - 1.85] in UC patients. The risk of VTE and ATE did not change over the study period. Periods of active disease (HR 8.4 [2.3-30.5], p=0.0002), the 3-months postoperative period (HR 16.4 [5.2-52.3], p=0.0002) and hospitalization (HR 21.7 [7.5-62.9], p&lt;0.0001) were found to be associated with an increased risk of VTE.

Conclusion
The risk of both arterial and venous thromboembolism was low in this pediatric-onset IBD population-based cohort. VTE were strongly associated with active disease, surgery and hospitalization among IBD patients.
P1152 Health-related quality of life among Irish Inflammatory Bowel Disease patients: a cross-sectional survey using the EQ-5D-5L
Authors: Mallon K , Doherty G , Burns R 
Published: January 2024

Abstract

Background
Inflammatory Bowel Disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic, lifelong illness that has multiple impacts on patients’ physical and mental health. Approximately 40,000 individuals in Ireland have IBD and the burden on quality of life is expected to be substantial. Health-related quality of life (HRQoL) utilises quality weights (utilities), measured on a ‘0’ to ‘1’ scale where ‘0’ is defined as a health state equivalent to being dead and ‘1’ is full health, and is often used as a measure of population health status to inform public health and health care policy. Previous evidence has shown that a reduced HRQoL in patients with IBD is associated with higher disease activity, increased medication use, increased sick leave, decreased work participation, smoking, rheumatic symptoms, female gender, and having CD. Despite this evidence, there is a paucity of data on the impact of IBD on the HRQoL of IBD patients in Ireland.

Methods
A cross-sectional, online study was developed aimed at IBD Patients in Ireland and patients were recruited through study invites advertised on The Crohn's and Colitis Ireland social media channels and among patient representatives of INITIative IBD. Information on quality of life was collected using the EuroQol EQ-5D-5L questionnaire. Descriptive statistics describe sociodemographic and clinical characteristics. Categorical variables are summarized as frequencies and percentages. Utility scores are presented as the mean and standard deviation (SD). To evaluate factors correlating with HRQoL in IBD patients, a univariate regression model was applied. Significant variables (p&lt;0.05) were further included in a multivariable ordinal least squares regression model.

Results
A total of 161 IBD patients were recruited. The average EQ-5D-5L utility score was 0.76. Average utility scores were similar for UC (0.76) and CD (0.75) patients, with IBDU patients scoring slightly higher (0.80). Average utility scores were highest for those aged 50-59 years (0.93), with an average utility score for those aged 30-39 of 0.71. Average utility scores were higher in males (0.78). Utility scores ranged from .133 to 1. When compared with those in remission, patients with severe disease severity had significantly lower utility scores (β=-.261; p=0.000).

Conclusion
Findings suggest that HRQoL in IBD patients in Ireland varies according to disease severity. These findings may indicate that follow-up care should include generic HRQoL measurements along with disease-specific as an objective tool for monitoring IBD disease course. This research offers important information for policy-makers for developing better strategies for IBD patients, as well as clinicians, academics and IBD patients.
P1179 Long-term impact of COVID-19 on the disease course of IBD: a meta-analysis
Authors: Vitus E S , Mann S , Lees C , Jess T , Elmahdi R 
Published: January 2024

Abstract

Background
Viral infections have been implicated in the exacerbation of immune-mediated inflammatory diseases like inflammatory bowel disease (IBD). The COVID-19 pandemic, therefore, sparked interest in whether infection with the virus has an adverse effect on the course of IBD. Since the existing evidence is conflicting and limited by a small sample size, we performed the very first meta-analysis to study the long-term impact of SARS-CoV-2 infection on the disease course of IBD.

Methods
We performed a systematic literature search in MEDLINE and EMBASE for studies that explored the risk of adverse IBD outcomes following a SARS-CoV-2 infection. We used the random effects model meta-analysis to calculate the pooled hazard ratio for the risk of IBD flares following the acute phase of COVID-19. Subgroup meta-analysis was carried out for the risk of the outcomes by IBD subtype. Meta-regression was carried out for sex and duration of follow-up. The ROBINS-E tool for observational studies was used to assess the quality of the studies.

Results
A total of 5 studies were included in the meta-analysis. The studies were based on cohorts from Denmark, Italy, the US, and a cohort from a consortium of the EU comprising a total of 34977 SARS-CoV-2 positive IBD patients and 53270 IBD patients without the infection as controls. Two of the studies had a high risk of bias according to the quality assessment tool. The meta-analysis did not show an increased risk of IBD-related outcomes in IBD patients who contracted a SARS-CoV-2 infection compared to those who did not (HR: 1.0514, CI: 0.7547- 1.4646, p= 0.7671). There was substantial heterogeneity between the included studies (91%, p&lt;0.01). There was no significant difference between CD and UC patients in terms of disease flare (CD- HR: 0.9134, CI: 0.8163-1.0220; UC- HR: 0.8257, CI: 0.7549-0.9032). Neither sex nor the duration of follow-up was a predictor of the overall effect size.

Conclusion
In this group of patients, SARS-CoV-2 infection does not increase the risk of adverse outcomes related to IBD. High-quality studies with longer follow-up duration are required to understand the long-term impact of SARS-CoV-2 infection on IBD prognosis.
P1185 IBD Has No Age: Preliminary results of an international survey among older patients with Inflammatory Bowel Disease (IBD)
Authors: Fons A , Girardi P , Savini C , Maljaars J , Haaf I , Avedano L , Asscher V 
Published: January 2024

Abstract

Background
Future research and health policy can benefit from a better understanding of the characteristics of a globally growing, but often underrepresented, older population with Inflammatory Bowel Disease (IBD). The aim is to evaluate the characteristics of this population, including frailty, comorbidity, and reported therapy goals through a survey.

Methods
An international, anonymous online survey was conducted among older patients (aged ≥ 60 years) with Crohn’s disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBD-U). The survey was developed by the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA), translated in 21 languages and distributed in 46 countries through national IBD associations affiliated with the EFCCA. The survey contained questions about demographic- and IBD characteristics, IBD-therapy and symptoms. Clinical disease activity was assessed by the Harvey-Bradshaw Index (HBI) (≥ 4) for CD, and 6-point Mayo score (≥ 1.5) for UC and IBD-U. Self-reported versions of the Geriatric-8 (G8) questionnaire and Charlson Comorbidity Index were included to assess frailty (G8 ≤ 14) and comorbidity, respectively. Respondents were asked to choose three out of the following 12 therapy goals they considered most important: to experience less abdominal pain, decrease inflammation, prevent/postpone IBD surgery, not feel fatigued, stop using corticosteroids, decrease diarrhea/incontinence, maintain or get to their preferred weight, be comfortable with their body image, or to preserve/restore their mobility, social life, good mood or sexual activity. Descriptive analyses were performed using R, version 4.3.

Results
Out of 2191 respondents, 1785 (81.4%) completed the survey for the variables of interest and were retained for analyses. Respondents were mainly from the Netherlands (47.2%), Norway (9.1%) and Italy (8.4%). Mean age was 67.3 years (Standard Deviation (SD) 5.9), 61% was female, and 58.1% was retired. The most common type of IBD was CD (50.9%). Clinical disease activity was found in 33% of respondents. Therapy with aminosalicylates was most common among patients with UC (58%), biological therapy among patients with CD (44%). Frailty was reported by 39% of respondents and 64% of respondents reported to have one or more comorbidities. Three therapy goals that were most frequently reported were: to not feel fatigued (56.1%), to be of good mood (42.2%) and decrease in diarrhea/incontinence (31.1%).

Conclusion
Preliminary results from the "IBD Has No Age" survey suggest that it will contribute a wealth of knowledge to the IBD landscape, providing insight in a range of IBD characteristics, frailty, comorbidity and therapy goals in an older population with IBD.
P1209 Baseline gut microbiota composition and function reflect response to 5-ASA treatment in Ulcerative Colitis
Authors: Radhakrishnan S T , Alexander J L , Mullish B H , Danckert N P , Valdivia-Garcia M A , Serrano-Contreras J I , Balarajah S , Perry R , Gallagher K I , Hicks L C , Powell N , Li J V , Marchesi J R , Williams H R T 
Published: January 2024

Abstract

Background
Mesalazine (5-ASA) is a key initial treatment of ulcerative colitis (UC); recent studies have highlighted the role of the gut microbiota in 5-ASA metabolism. There is no established means of predicting treatment outcome. We sought to investigate changes in the gut microbiota and metabolome with 5-ASA treatment, and whether such changes may reflect clinical outcomes.

Methods
Longitudinal faeces, serum and urine samples were collected from patients with newly diagnosed UC before and after 5-ASA treatment. We documented longitudinal microbiota and metabolome changes with 5-ASA treatment and compared baseline gut microbiota and metabolome in responders (simple clinical colitis activity index (SCCAI) of &lt;4 and faecal calprotectin (FC) of &lt;100 µg/g) and non-responders to 5-ASA. Stool bacterial profiling was performed via 16S rRNA gene sequencing of the V1/V2 hypervariable regions. Host and microbial metabolites in stool, serum and urine were detected and semi-quantitated using liquid chromatography mass spectroscopy (LC-MS) and nuclear magnetic resonance spectroscopy (1H-NMR). Kruskal-Wallis tests and paired analyses using a Wilcoxon rank test were used and p values were adjusted using Benjamini-Hochberg false discovery rate (FDR) correction.

Results
37 patients newly diagnosed with UC were recruited. Samples were collected at baseline and a median of 83 days (IQR 22.5 days) later; there were 27 responders and 10 non-responders. Comparing pre- and post- 5-ASA treatment samples demonstrated a reduction in gut microbial α diversity (P=0.01) (Fig 1). Faecal methionine increased with 5-ASA (P=0.04) in all patients, and isovalerate reduced with 5-ASA (P&lt;0.01). Similar reductions after 5-ASA were noted in serum glycoprotein B (GlycB) (P=0.02).
At baseline, responders tended to have increased α diversity compared to non-responders, but not statistically significantly (P=0.09). Similarly, there were β diversity differences, although these did not reach significance (P=0.06). At baseline non-responders had a higher relative stool abundance of Bacteroidetes and Firmicutes (P&lt;0.01) compared to responders. Agathobacter, Coprococcus and Blautia genera were enriched in non-responders (P=0.05). At baseline, urinary hippurate was higher in patients going on to respond to 5-ASA compared to non-responders (P=0.04); faecal lysine (P&lt;0.01) and putrescine (P=0.01) levels were also higher in non-responders at baseline. 5-ASA responders had reductions in faecal 2-methylbutyrate and isobutyrate (P=0.02) longitudinally.

Conclusion
We have shown that baseline relative abundance of certain taxa (such as Blautia), urinary Hippurate and faecal lysine reflect response to 5-ASA. Alterations in the gut microbiome and metabolome are associated with 5-ASA treatment.
P1229 The Role and Niche-Specific Adaptation of Malassezia in patients with Ulcerative colitis
Authors: Shin Shin S , Cho Y J , Yang J , Kim H K , Rintarhat P , Park M , Lagree K , Underhill D M , Yang C S , Moon J M , Seo J , Kim K , Jung W H , Choi C H 
Published: January 2024

Abstract

Background
Accumulating evidence has underscored the role of gut fungal microbiota (mycobiota) in the development of inflammatory bowel disease. We aimed to isolate a Malassezia strain directly from the human intestine mucosal surface from the patients with ulcerative colitis (UC) and investigated its genome and virulence in comparison with the same fungal species isolated from the human skin.

Methods
Mucosal lavage samples were collected separately from colonic areas with and without inflammation in patients with UC. Samples from healthy individuals (HT) were obtained in the same manner as from patients with UC at sigmoid or descending colon. Skin samples were taken from HT in our previous work. DNA was extracted from these lavage samples, and fungal isolation was conducted using PCR amplification with ITS4 and ITS5 primers. Comprehensive analysis and comparison of the genomes, transcriptomes, and virulence between M. globosa gut isolates and those of M. globosa strains isolated from the skin were performed. To determine the contribution of M. globosa gut isolates to exacerbating inflammation, 1107 fungal cells were orally gavaged to DSS-induced colitis mouse model for three days.

Results
Total 56 and 11 intestinal water-lavage samples from 29 UC patients and 11 HT were obtained respectively. The α- and b-diversities of mycobiota showed no significant differences between the groups, patients with UC vs. HT or the sites with inflammation vs. non-inflammation of the patient with UC. Malassezia was the fifth most frequently found fungal genus throughout the samples, and live fungal strains belong to 28 and 7 different species were isolated from the patients with UC and HT, respectively. The patients with UC tend to have higher frequency of M. globosa and M. restricta than HT in their gut mucosal surface with inflammation. Whole genome sequencing showed no specific genomic characteristics between gut-isolated M. globosa and skin-isolated M. globosa. However, gut-isolated M. globosa were suffered more from the higher oxygen levels than the skin isolates in different oxygen concentrations. In a mouse model, gut-isolated M. globosa exhibited a more pronounced exacerbation of DSS-induced colitis and elevated production of inflammatory cytokines, including TNF-a, IL-6, IL-12p40, IL-1b, and IL-18, while the skin isolates showed no difference compared to the negative control (Figure).

Conclusion
Our data shed new light on the pivotal role of M. globosa in the pathogenesis of UC, highlighting the potential influence of niche-specific adaptations on the virulence of this fungus. These findings provide critical insights into the complex interplay between the member of the gut mycobiota and host health.
P1238 Exploring the Role of Klebsiella variicola and Klebsiella pneumoniae in Pediatric Ulcerative Colitis Pathogenesis
Authors: Arjomand Fard N , Bording-Jorgensen M , Cheng C , Kerr K , Aujla H , Mansour S , Elhenawy W , Perry T , Wine E 
Published: January 2024

Abstract

Background
Recent studies indicated that Klebsiella (K) pneumoniae (isolated from the stool of IBD patients) and K. variicola (isolated from the mesenteric tissue of Crohn disease patients) have the potential to induce inflammation in epithelial and preadipocyte cells, exacerbating colitis in murine models. We isolated these strains from pediatric ulcerative colitis (UC) patients' appendix (relevant to UC pathogenesis given the protective effects of appendectomy) and other non-inflamed colon sections. We hypothesized that these isolates are invasive and induce inflammation in UC. These strains have not been previously studied in UC.

Methods
K. variicola and K. pneumoniae were isolated from two pediatric UC patients' appendices and other non-inflamed colon sections and identified using 16S DNA Sanger sequencing. Virulence of the two strains was determined by infecting Caco2 cell lines and performing adhesion and invasion assays, quantifying biofilm formation, and assessing barrier functions using transepithelial electrical resistance (TEER) measurement. Importantly, we monitored the production of pro-inflammatory (e.g., IL-8, TNF-α) and anti-inflammatory (IL-10) cytokines using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR).

Results
K. variicola and K. pneumoniae exhibited high levels of biofilm formation compared to adherent-invasive Escherichia coli (AIEC), which are commonly isolated from IBD patients. Furthermore, the Klebsiella strains adhered to epithelial cells within 2-3 hours post infection. TEER experiments showed compromised barrier integrity after 6 hours and overnight infection. Except for K. pneumoniae isolated from the ascending colon, the tested strains exhibited a significant increase in IL-8 expression. Similarly, K. variicola from the peri-appendicular region demonstrated elevated TNF-α gene expression.

Conclusion
K. variicola and K. pneumoniae isolated from UC patients have the potential to form biofilms, disrupt barrier integrity, and trigger inflammatory responses. These findings unravel a potential role for pathogenic Klebsiella strains in driving UC pathogenesis. Importantly, these data shed light on the role of appendix-associated bacteria in the development of UC. Future work includes using comparative genomics to map the virulence determinants of these bacteria.
P1239 Characterization of Clostridioides strains and antibiotic resistance profile in Inflammatory Bowel Disease patients with Clostridioides infection
Authors: Oliveira R , Tavares de Sousa H , Roseira J 
Published: January 2024

Abstract

Background
There is an increasing incidence of community-acquired Clostridioides difficile infection (CDI), particularly in IBD. Due to a suspected community outbreak in mid-2023, we aimed to investigate the microbiological and antibiotic resistance profile of CDI in an IBD cohort, employing blind central reading, in order to better understand its epidemiology.

Methods
This was a prospective study of a University Tertiary Hospital in collaboration with the Infection Control Unit and a central laboratory at the forefront of Infectious Diseases investigation in Portugal (Instituto Ricardo Jorge [IRJ]). Faecal samples from all IBD-related CDI from Apr to Oct 2023, were analysed at IRJ, including isolation and identification of C. difficile strains and testing for antimicrobial susceptibility. Infectious diseases investigators were blinded to patients’ data.

Results
Eleven patients with IBD (median 42 years, 60.0% female) had at least one episode of CDI, comprising 15 IBD-related CDI cases, which represents 26.3% of all CDI cases in this 6-month period. Moreover, this compares to only 14 cases of IBD-related CDI in the previous four years combined. All patients had UC (66.7% extensive), with a median diagnosis of 11 years. All cases were community-acquired, diagnosed in the context of acute worsening of UC symptoms; 40% required hospitalization. Remarkably, only 2 patients had recent antibiotic therapy, while 3 had a recent visit to the emergency department. No predominant ribotype (RT) was recognised: RT 002/2, RT 017, RT 039, RT 078, RT 106 and RT 839 were identified in similar proportions. There were two new RTs detected, which are under characterization. All isolates were susceptible to vancomycin and metronidazole, but 46.7% were resistant to moxifloxacin, which is higher than ever reported in Portugal. Most cases (n=12) were prescribed vancomycin and followed a taper-and-pulse dosing (n=9). None of the three patients who had a recurrence had received taper-and-pulse dosing. Optimization of UC therapy was performed in all cases, including concomitant immunosuppressive therapy escalation when needed, as recommended. Interestingly, one case, despite having tested positive for C. difficile, had a Clostridioides hathewayi isolated in the culture instead. To our knowledge, this is the first case of C. hathewayi associated diarrhoea resolving upon treatment with vancomycin.

Conclusion
The absence of a predominant ribotype, excluding a community outbreak, demands heightened CDI vigilance in IBD even in absence of traditional risk factors. Alarming moxifloxacin resistance underscores evolving dynamics. A novel C. hathewayi-associated diarrhoea case and the emergence of two new ribotypes adds complexity.
P1240 Systematic review with meta-analysis: faecal microbiota transplantation as treatment of chronic pouchitis
Authors: Cold F , Halkjær S I , Lo B , Lauridsen K G , Kousgaard S J , Thorlacius-Ussing O , Petersen A M 
Published: January 2024

Abstract

Background
Pouchitis is inflammation of the ileal pouch-anal anastomosis after proctocolectomy in the surgical treatment of ulcerative colitis. Cohort studies have found evidence that allogenic faecal microbiota transplantation (FMT) can induce short term beneficial effects in patients with chronic pouchitis. Until recently results from randomized controlled trials (RCTs) have been missing. In this systematic review and meta-analysis, we investigated whether FMT treatment was superior to placebo in inducing remission in patients with chronic pouchitis.

Methods
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to 15th of November 2023, for RCTs assessing the efficacy of allogenic FMT in the treatment of chronic pouchitis. Autologous FMT or placebo was accepted as control treatment. The primary outcome was the improvement of symptoms as defined by the authors following four weeks.

Results
The systematic literature search identified a total of three RCTs on the efficacy of FMT in chronic pouchitis comprising 62 patients with 32 patients treated with FMT. Both treatments (FMT and Placebo) and definition of treatment response varied between studies (Table 1). Meta-analysis revealed that FMT was not superior to placebo (risk ratio=0,68;95% CI=(0,47-0,99); p=0.35) in improvement of symptoms four weeks following treatment (Figure 1).

Conclusion
FMT was not superior to placebo in inducing short-term beneficial effects four weeks after initial treatment in patients with chronic pouchitis. Whether FMT may induce long-term beneficial effects remains to be established.