bluuebunny/crossref_metadata_2025_split huggingface dataset:
P361 Risk of persistent gastrointestinal inflammation after treatment with immune checkpoint inhibitors
Authors: Jeay M , Carbonnel F , Robert C , Bellanger C , Meyer A 
Published: January 2023

Abstract

Background
Immune checkpoint inhibitors (ICI) can cause immune-mediated gastrointestinal toxicity, but the long-term persistence of this toxicity is unknown. We aimed to describe the characteristics of patients with gastrointestinal inflammation persisting more than six months after discontinuation of ICI.

Methods
We included consecutive patients treated between October 2010 and March 2022 for endoscopic or histological gastrointestinal inflammation persisting at least six months after the last administration of ICI.

Results
Among 178 patients treated for a gastrointestinal immune-mediated adverse event during ICI therapy, 14 (8%) patients had chronic lesions persisting more than 6 months after the last ICI administration. The median follow-up time was 13 months after discontinuation of ICI. The most common symptom was watery diarrhea (54%). Ten (77%) patients had colon involvement and three (21%) had ileal involvement. Ten patients (77%) had an inflammatory phenotype, while two (15%) had a penetrating and one had (8%) a stricturing phenotype. All patients had lymphoplasmacytic infiltrate and basal plasmacytosis, and s54%) had crypt distortion. Two (15%) patients underwent surgery and nine (69%) received specific treatment, including five treated with vedolizumab. Among the patients who were followed up for at least one year, endoscopic lesions persisted at 1 year after stopping ICI in 4/6 patients, and at 2 years in 3/4 patients.

Conclusion
Eight percent of patients who had gastrointestinal toxicity due to ICI develop chronic inflammatory bowel disease characterized by watery diarrhea, colitis and lymphoplasmacytic infiltrate.
P364 Presence of malnutrition adversely affects short-term clinical outcomes in a sample of patients with Crohn's disease (CD)
Authors: Karachaliou A , Lekakis V , Bletsa M , Mantzaris G J , Tzouvala M , Bamias G , Kontogianni M D 
Published: January 2023

Abstract

Background
Malnutrition in patients with CD has been suggested to affect the disease course, leading to more frequent flare-ups, disease-related complications and longer hospitalizations. The aim of the present study was to assess the effect of malnutrition on several clinical outcomes of patients with CD.

Methods
Data regarding medical history, disease classification and basic anthropometric characteristics were collected at baseline. Disease activity was assessed endoscopically and using the Harvey-Bradshaw Index (HBI&lt;5 indicates remission). Malnutrition was assessed with the GLIM (Global Leadership Initiative on Malnutrition) criteria and SGA (Subjective Global Assessment). Patients were followed-up at 6 and 12 months and clinical outcomes (need for hospitalization, corticosteroids and antibiotics’ use, change of biologic agents, surgery) were recorded.

Results
At baseline 237 patients (54.8% males, 41.2±14.1 years, 37.2% with active disease) were evaluated. Prevalence of malnutrition at baseline was 13.5% and 22.9% based on GLIM and SGA, respectively, and was higher in active disease compared to remission (GLIM: 25% vs. 6.7%, p&lt;0.001, SGA: 41.9% vs. 11.5%, p&lt;0.001). Outcomes of 237 patients were recorded at 6 months and of 233 at 12 months. Presence of malnutrition at baseline, according to GLIM criteria, was associated with an increased likelihood of need for intensification or change of biologic agent (OR: 2.66, 95% CI: 1.14-6.24, p=0.02], surgery (OR: 3.73, 95% CI: 1.02-13.70, p=0.04) and overall adverse outcome (OR: 2.33, 95% CI: 0.99-5.49, p=0.05) after adjustment for age, sex, disease location and disease activity at baseline. Similar results were observed when malnutrition was diagnosed with SGA only for need for intensification or change of biologic agent (OR: 5,78 (1,52, 21,92), p=0,01] after adjustment for age, sex, disease location and disease activity at baseline. No statistically significant associations were observed between presence of malnutrition (either diagnosed with GLIM criteria or SGA) and disease-related outcomes at 12 months.

Conclusion
Presence of malnutrition was associated with short-term (within 6 months) adverse clinical outcomes, such as need to intensify the therapeutic regimen, need for surgical interventions due to disease complications and a worse overall disease outcome in CD patients. No effect of malnutrition diagnosis on the examined clinical outcomes was observed at 12 months of follow-up.
P366 genomics analysis and differentiation of Crohn's Disease, Intestinal Tuberculosis and Primary Intestinal Iymphoma
Authors: Lin L , Qu Y , Zhao X 
Published: January 2023

Abstract

Background
Crohn’s disease(CD), intestinal tuberculosis(ITB) and primary Intestinal Lymphom(PIL) are very similar in many aspects, and differential diagnosis of them remains a major clinical challenge. The purpose of this study is to perform genomic analysis of tissue wax blocks in patients by DASL analysis and screen out potential diagnostic genes for diseases.

Methods
Tissue wax blocks from 31 patients with CD, 33 patients with ITB, 25 patients with PIL and 12 healthy controls were collected to detect the expression of genes in the samples by DASL analysis. The data were then normalized, followed by differential expression analysis and GO and KEGG enrichment analysis. Based on the above results, potential diagnostic genes are screened out and then verified by immunohistochemistry.

Results
We obtained the expression intensity of 19869 genes in the intestinal tissues of 4 groups of patients. By differential expression analysis, the differentially expressed genes(DEGs) between these four groups of samples were obtained. GO and KEGG enrichment analysis showed that these DEGs had different effects on metabolic function, immune response, chemotaxis, growth and development, etc. According to the DEGs between the groups screened earlier, combined with the results of KEGG enrichment analysis, a total of seven potential diagnostic genes were screened, included EPHB3, CD70, CHST10, CXCL13, CEL, SCGB2A1 and SCGLEC10. Finally, the significant upregulation of EPHB3 in the intestinal mucosa of CD patients was verified by immunohistochemistry.

Conclusion
CD, ITB and PIL have significant differences in genome expression, and EPHB3 has been confirmed to be significantly upregulated in CD, which is expected to become one of the indicators for disease differential diagnosis. At the same time, Based on the results of our GO enrichment analysis and the results of previous researchers, we believe that EPHB3 may participate in the occurrence and development of Crohn's disease through the regulation of the development of the digestive tract and digestive system, cell adhesion, and epithelial-to-mesenchymal transition.
P367 Significant impact on health care utilization upon implementation of an electronic IBD care management program.
Authors: Koppelman L , Roozemond S , Cornelissen L , Hommes D , Voorneveld P , Maljaars J , Kubben F , Verweij E , van der Meulen - de Jong A 
Published: January 2023

Abstract

Background
The management of Inflammatory Bowel Diseases (IBD) remains to be a significant challenge because of its unpredictable clinical course and high associated costs. Recently, we implemented an electronic IBD care management program, provided by DEARhealth BV, which offers care-pathways that configurate according to individual IBD risk profiles, called THINK. High-risk (HR) IBD patients (current biochemical disease activity) will receive more intense monitoring and provider interactions compared to Low-risk (LR) (&gt;3 years in remission) and Intermediate-risk (IR) (other patients) individuals (figure 1). In this project, before implementation of THINK, we aimed to assess whether 1. Current healthcare utilisation (HCU) (consultations, lab tests, calprotectin) differs between risk groups and 2, what the effect of implementing THINK would be on HCU (focused on consultations and laboratory tests) in a retrospective-analysed population.

Methods
161 consecutive IBD patients in hospital A, categorized in either the HR or IR group, were studied prospectively during 1 year before implementation of THINK. HCU was captured using an electronical medical record (EMR) and included consultations, blood tests and calprotectin. Furthermore, HCU in the years 2018-2019 in the IBD population of hospital B was studied (extraction of EMR). This historical data was compared to the THINK care path (see figure 1) when optimal implemented. The analysis focused on the activities present in de THINK care pathway (consultations and laboratory tests) to uncover the potential of the electronic IBD care management program.

Results
Baseline characteristics for hospital A cohort (N=161) are summed in Table 1. We followed 102 patients (60 Crohn) in the IR group and 59 patients in the HR group (29 Crohn). As expected, significant more HCU was present in the HR group (table 2). In hospital B, the utilization impact assessment was performed in the IBD cohort of 543 Crohn and 495 colitis patients. A difference in clinic consults was observed of -52,7% (HR), -53.5% (IR) and -29,3% (LR). The difference in laboratory tests utilization was found -54,0% (HR), -27.8% (IR) and -3,1% (LR).

Conclusion
Our initial experiences with a novel IBD management program demonstrated the feasibility of accurate remote disease activity monitoring and significant impact on utilization patterns due to the risk-based care pathway configurations. However, the analysis shows the ideal fictive situation when using standardized care pathways which cannot fully be considered the real-time situation. In this analysis no unexpected events are included. Future research should investigate the realization of these predictions.
P371 Assessment Of Postoperative Complications Following Ileocecal Resection In Crohn’s Disease From A Low-To-Middle Income Country
Authors: Benammi S , Naddouri J , Bakkali Y , Alaoui M , Sebbah F , Raiss M , Hrora A 
Published: January 2023

Abstract

Background
Our study aims to assess risk factors of postoperative complications following ileocecal resection of Crohn’s disease from a low-to-middle income country perspective. We aimed to provide local data demonstrative of inner conditions and challenges.

Methods
This was a retrospective study conducted in a referral colorectal center in a low-to-middle income country from 2014 to 2020. We included all patients with Crohn’s disease admitted to our department for ileocecal resection. Patient’s and Crohn’s disease, surgical and postoperative characteristics were collected using chart review. We excluded all patients with missing data. We defined perioperative hemorrhage as blood loss≥200cc. Our primary outcome was immediate&lt;90-days post-operative complications risk factors assessment.

Results
We included 83 patients with complete data. The median age was 34(18-75) and 54.2%(n=45) were female. Patients were 94.6%from urban areas and 5.4%(n=4) rural. Among all included surgeries, 83.1%(n=69) were elective and 16.9%(n=14) were emergency cases. Open surgery was conducted in 46 cases(55.4%), 30patients had laparoscopic ileocecal resection (36.1%), and 7(8.4%) had conversion. Immediate postoperative complications were reported in 16.9%(n=14);anastomotic leak 2(2.4%), surgical site infection 8(9.6%), entero-cutaneous fistula 2(2.4%), and postoperative hemorrhage 2(2.4%). Long-term outcomes with surgical reoperation were conducted in 5 cases(5.8%) excluding stoma removal. The total length of stay median was 6 days (4-31). Immediate postoperative complications were associated with postoperative bleeding(OR=27.8; 95% CI[1.26-614];p=0.001,Fisher’s=0.027), required transfusion during surgery or at postoperative follow-up(OR=18.3;95% CI[3.09-109];p&lt;0.001,Fisher’s=0.001), hospital length of stay(t-test&lt;0.001), pre-operative hemoglobin(t-test0.031).

Conclusion
Considering the accessibility of hemoglobin management in a low-to-middle income country, it represents an impactful tool in surgical quality enhancement.
P385 Risk-benefit assessment of IBD drugs: a physicians and patients survey
Authors: D'Amico F , Caron B , Vieujean S , Peyrin-Biroulet L , Danese S 
Published: January 2023

Abstract

Background
Treatment choices for patients with inflammatory bowel disease (IBD) are based on the balance between risks and benefits. To date, there are no globally accepted methods for assessing the risk-benefit ratio. Our aim was to compare the perspectives of patients and physicians in evaluating the risks and benefits before initiating therapy for IBD.

Methods
An anonymous survey was conducted between March and August 2022. Multiple choice questions, similar for physicians and patients, were formulated. The questionnaire was developed in English and was later translated in Italian and French by native speakers. All patients with a confirmed diagnosis of IBD who were followed up at the IRCCS San Raffaele Hospital (Italy), Nancy University Hospital (France), and University Hospital CHU of Liège (Belgium) were invited to participate. All physicians who attended an IBDscope webinar were invited to participate by email.

Results
In total, 367 patients and 146 physicians participated in the survey from 34 countries worldwide (Tables 1 and 2). For most patients (71.4%) and physicians (89.0%), efficacy and safety were equally important in choosing a therapy. Clinical improvement and clinical remission were the most relevant outcomes for patients (90.9 and 88.4 Likert scales), while clinical remission and endoscopic remission were for physicians (90.0 and 87.6 Likert scales). The main factors in the benefit-risk assessment for patients were quality of life (95.1%), disease activity (87.5%), and presence of comorbidities (84.5%). The main factors for physicians were presence of comorbidities (99.3%), disease activity (97.9%), prior failure to biologics or small molecules (96.6%). Disease duration, family history of IBD, administration interval, therapy duration, and administration route had a limited role for both physicians and patients. Based on patients' and physicians’ opinions, the risk of serious infections (90.5% and 98.6%), malignancies (90.5% and 100.0%), cardiovascular events (88.8% and 98.6%), death (86.4% and 91.8%), relapse (86.1% and 94.5%), all infections (86.1% and 100.0%), surgery (83.1% and 93.1%), and hospitalization (76.6% and 88.4%) should be included in the benefit-risk assessment. The risk percentages considered acceptable by patients and physicians are reported in Figures 1 and 2. Infliximab was the most effective drug for physicians in inducing and maintaining disease remission in both Crohn’s disease and ulcerative colitis, while ustekinumab and vedolizumab were equally considered the safest drugs.

Conclusion
Physicians and patients have different priorities in evaluating the benefit-risk balance of a new therapy. Treatment decisions should be discussed and shared with patients.
P392 Risk factors for postoperative recurrence after ileocolic resection for Crohn’s Disease: long-term results from a population-based cohort.
Authors: van Renterghem A , van der Holst A , van Kuijk S , Pierik M , Belgers E , Romberg-Camps M , Jeuring S , Demandt D , Stassen L 
Published: January 2023

Abstract

Background
Crohn’s disease (CD) patients often require surgical interventions and post operative recurrence is common. Data regarding risk factors for recurrence in representative cohorts are scarce. We assessed the risk-factors of recurrence of CD after ileocolic resection (ICR) in a population based cohort.

Methods
Patients who underwent a primary or re-resection for ileocolic CD between 2003 and 2017 were included. The primary endpoint was clinical recurrence. The secondary outcome was surgical recurrence. A Cox regression model was used to assess recurrence free survival.

Results
289 patients were included of which 120 male (41.5%). Most common indication for ICR was stricturing (B2) disease in 146 (50.5)%), followed by penetrating (B3) disease in 101 (34.9%). Recurrence occurred in 189/289 patients (65.4%) after a median follow up of 2.3 years and surgical recurrence in 22 (7.6%) after median follow up of 4.8 years. Multivariate analysis showed a significant higher chance of clinical recurrence in smokers (HR: 1.659 (95% CI: 1.230; 2.238)) (p&lt;0.05), patients with prior resections (HR: 1.514 (95% CI: 1.014; 2.261)) (p&lt;0.05), perianal involvement (HR: 1.453 (95% CI: 1.033; 2.044)) (p&lt;0.05) and isolated involved proximal resection margin (HR: 1.615 (95% CI: 1.039; 2.509)) (p&lt;0.05). B2 and B3 disease behaviour and post-operative medication was associated with less recurrence, respectively (HR 0.397 (95% CI: 0.253; 0.624)) (p&lt;0.05), (HR 0.443 (95% CI: 0.282; 0.696)), (p&lt;0.05) and (HR: 0.658 (95% CI: 0.473; 0.916)) (p&lt;0.05). Considering surgical recurrence, underweight and overweight BMI and open surgery decreased the chance on recurrence.

Conclusion
Our study in a population based cohort confirmed risk factors for recurrence consistent with current evidence, but also identifies novel and less frequently found risk factors. Medical therapy reduces the risk for recurrence on a population level. We found an association between involved resection margin and recurrence. Differences between studies may be caused by differences in patient selection or definition of recurrence. Confirmation of this finding in independent representative cohort is necessary. This indicates a need for a standardised scientific database for future prospective research.
P395 Short-term clinical efficacy and safety of teduglutide for Crohn’s disease patients with short bowel syndrome
Authors: Kaku K , Sato T , Takeuchi J , Uchino M , Fujihira Y , Shimizu K , Yokoyama K , Yagi S , Takashima Y , Ikenouchi M , Kojima K , Kawai M , Nagase K , Kamikozuru K , Yokoyama Y , Takagawa T , Ikeuchi H , Watanabe K , Shinzaki S 
Published: January 2023

Abstract

Background
The short-term effects of teduglutide (TED) for short bowel syndrome with chronic intestinal failure (SBS–IF) in patients with Crohn’s disease (CD) remain unknown and real-world data have not been scarce. This study aimed to investigate the short-term efficacy and safety of TED in CD patients on parenteral support (PS) for SBS–IF.

Methods
We retrospectively investigated the medical records of CD patients with SBS–IF who initiated TED between January 2020 and October 2022 in Hyogo Medical University hospital. The primary outcomes were the change in PS volume and proportion of patients with a reduction of PS volume by ≥20% at week 4. Secondary outcomes were the changes in body mass index (BMI), estimated glomerular filtration rate (eGFR), albumin, hematocrit (Ht), PS calorie requirements, withdrawal from PS, and adverse events during the observation period.

Results
Of 605 CD patients, 23 who underwent home PS for SBS–IF were included in this study. Twenty patients continued TED throughout the observation period. The median PS duration was 11.6 (range 1.0-20.0) years and the observation period after starting TED was 48.0 (7.0-60.0) weeks. TED significantly reduced the PS volume from 17989(570-49000) mL/week to 14257(0-42000) mL/week at week 4 (p = 0.0013), and the PS volume decreased by ≥20% in 8 patients (40.0%) at week 4 and in 16 patients (80.0%) during the observation period after TED administration. The BMI significantly increased from 17.9 (12.9–23.9) kg/m2 before TED administration and 18.9 (14.6–25.4) kg/m2 after TED administration (p = 0.014). Although there were no significant differences in albumin (p = 0.53), eGFR (p = 0.66), and Ht (p = 0.089), the PS calorie /week was significantly decreased from 6581 (244–14000) kcal to 3747(0– 8820) kcal after TED administration (p = 0.0001). Ten patients (50.0%) experienced gastrointestinal stoma complications, including stoma swelling and/or prolapse during the observation period. Abdominal pain occurred in 7 cases (35.0%), catheter-related infection in five patients (25.0%), oedema in 4 patients (20.0%), nausea in 2 patients (10.0%), abdominal distension in 3 patients (15.0%), and upper respiratory tract infection in 1 patient (5.0%). All the symptoms were transient and tolerable. Although 3 patients discontinued TED due to nausea and abdominal pain and were excluded from this analysis, these symptoms improved after the discontinuation.

Conclusion
TED reduced PS volume at week 4 in CD patients with SBS–IF, and the BMI and the PS calorie requirement were improved during the observational period without serious adverse events.
P399 Detection of iron restricted erythropoiesis in patients with IBD: How can we disentangle effects of inflammation?
Authors: Aksan A , Mangold C , Stötzel J , Tessmer L , Schröder O , Stein J M 
Published: January 2023

Abstract

Background
Iron deficiency and anaemia are among the most common complications of IBD. While the distinction between functional and absolute iron deficiency (AID) is vital for therapeutic decision-making, inflammation is a frequent confounder in their diagnosis: An indirect indicator of body iron stores, serum ferritin is the most specific biomarker of AID. However, it is also an acute-phase reactant and can thus be obscured by IBD-related inflammation. Patients with active IBD often have anaemia of inflammation (AOI), i.e., reduced availability of iron for erythropoiesis (iron-restricted erythropoiesis, IRE) despite adequate stores. ECCO guidelines suggest adding biomarkers to distinguish functional from absolute ID in AOI. Here, we compared the utility of red cell indices and biochemical markers to detect IRE in IBD and define a decision threshold for the selection of biomarkers to discriminate AID and iron sequestration.

Methods
In an observational cross-sectional study, routine blood samples of patients with IBD were collected. CBC, iron status (serum ferritin, SF; transferrin saturation, TSAT; serum iron % of hypochromic red cells, %HYPO; reticulocyte haemoglobin content, CHr; soluble transferrin receptor, sTfR) and high sensitivity CRP (hsCRP) as inflammatory marker were determined by standard methods. sTfR-F index was calculated (sTfR (mg/L)/log10 SF(μg/L)). Patients with SF&lt;30μg/L were assigned as AID-consistent controls to define decision thresholds for iron markers in patients with SF≥30μg/L which were then used to evaluate IRE in patients with SF≥30μg/L. The accuracy of the markers in the presence/absence of inflammation were assessed and contextual diagnostic thresholds determined.

Results
Samples were collected from 312 patients with IBD (159f/153m;163CD/149UC;42.7±14.5y), of whom 122(39.1%) had inflammation. 43 patients with SF&lt;30μg/L were selected as AID-control group. Results in this group were: TSAT (cut-off 20%; AUCROC 0.730; sens.65%, spe.34%), %HYPO (3.5%; 0.733; 42%, 93%), CHr (32pg; 0.713; 51%, 86%), sTfR (2.70mg/L; 0.775; 81%, 63%), sTfR-F (2.01; 0.914; 88%, 88%). sTfR-F was used as reference for IRE in patients with SF ≥30μg/L. Accuracy of the markers as detectors of IRE is shown in Table 1.

Conclusion
sTfR was the most accurate sole marker of IRE in patients both with and without inflammation, its cut-off being higher in the presence of inflammation. In patients without inflammation, SF was a valuable additional parameter. Relative cost-effectiveness of the markers alone or in combination is under investigation.