bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0780 Impact of Hyperbaric Oxygen Therapy on Perianal Fistulas in Crohn’s Disease: Clinical Outcomes and Remission Rates
Authors: Piotrowicz G , Rudnik A , Kot J , Babicki A , Banaszkiewicz P , Piotrowicz A , Rzeszutek M , Zientara P , Adamska-Mieruszewska J , Rydzewska G 
Published: January 2025

Abstract

Background
Crohn's disease (CD) is a chronic inflammatory bowel disorder with debilitating complications such as perianal fistulas, affecting 14-38% of patients (1). Conventional treatments often achieve limited success, necessitating adjunctive approaches (2,3). Hyperbaric Oxygen Therapy (HBOT), known for its wound-healing and anti-inflammatory properties, has emerged as a potential therapy for complex CD cases (4,5). This study evaluates the efficacy of HBOT in combination with standard treatments for reducing perianal fistula activity and achieving clinical remission in patients with CD.

Methods
A cohort of 11 patients with CD-associated perianal fistulas underwent surgical preparation followed by 30 sessions of HBOT (2.5 ATA, 90 minutes per session). Disease activity was assessed using the Crohn’s Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD), Perianal Disease Activity Index (PDAI), and laboratory markers (CRP, fecal calprotectin, hemoglobin, and serum iron). Outcomes were evaluated at baseline, post-treatment (6 weeks), and follow-up (9 months).

Results
Clinical Improvement: 81.8% of patients demonstrated a significant reduction in CDAI scores. Remission Rates: 54.5% achieved remission (SES-CD, PDAI). 72.8% exhibited normalized fecal calprotectin levels (≤250 µg/g). Improvements were maintained 9 months post-treatment. Minimal side effects, including transient hearing impairment and headaches, were reported.

Conclusion
HBOT as an adjunctive therapy significantly improves clinical outcomes in CD patients with perianal fistulas. It enhances remission rates, reduces inflammation, and sustains benefits over long-term follow-up. This study highlights the potential of HBOT as a therapeutic option for refractory CD cases. Further randomized controlled trials are warranted to validate these findings.

References
1.Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P. Comparison of the efficacy of the various treatment modalities in the management of perianal Crohn’s fistula: a review. Cureus. 2020;12(12).
2.Cheifetz AS. Management of active Crohn disease. Jama. 2013;22;309(20):2150-8.
3.Cushing K, Higgins PD. Management of Crohn disease: a review. Jama. 2021;325(1):69-80.
4.Parra RS, Féres O, Lansdorp CA. Hyperbaric oxygen therapy: More hope than hype for future treatment of perianal fistulizing Crohn's disease?. United European Gastroenterology Journal. 2022;10(3):346.
5.Adamina M, Minozzi S, Warusavitarne J, Buskens CJ, Chaparro M, Verstockt B, Kopylov U, Yanai H, Vavricka SR, Sigall-Boneh R, Sica GS. ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. Journal of Crohn's and Colitis. 2024;18(10):1556-82.
P0782 Resetting the Clock: Does Redo IPAA Restore Quality of Life? Patient Reported Outcomes Before and After Redo Ileoanal Pouch Surgery
Authors: Holubar MD- MS S , Lavryk O , Lipman J , Kanters A , Cohen B , Falloon K , Rieder F , Qazi T , Gorgun E , Steele S , Liska D 
Published: January 2025

Abstract

Background
Patient-reported outcomes (PROs) after ileoanal pouch (IPAA) salvage with redo pouch procedures are known to be worse compared to after primary (index) pouch surgery. Although pouch failure is associated with decreased pouch function and quality of life (QoL), PROs prior to redo IPAA have not been reported. We aimed to report on PRO before and after redo IPAA. We hypothesized that redo IPAA is associated with improved quality of life.

Methods
Our pouch registry was queried for adults who underwent redo IPAA between 1984 and 2024, who had at least one pouch survey before and after redo pouch surgery. Pouch surveys were mailed to all patients annually and also collected in clinic (paper survey), and several items were administered electronically from to 2015-2019 (electronic survey). Our primary outcome was the Cleveland Global QoL index (CGQLI), a composite of QoL, quality of health (QoH), and quality of energy (QoE), each of which was scored from 0 (lowest) to 10 (highest). These three scores were then summed and divided by 30 to obtain an overall score ranging from 0 (lowest) to 1 (highest). Before and after survey responses were compared using univariate analysis with t-tests and Wilcoxon rank-sum tests, and matched paired analysis, using JMP v18.1.

Results
A total of 659 redo pouch procedures, including pouch excision with neo-IPAA in 387 (58%) and pouch repair with neo-IPAA in 272 (41%), were included, of which 472 (72%) had survey data available and were analyzed. Results from the paper survey (Table 1) revealed bowel frequency, urgency, incontinence, seepage, pad usage, fiber, and anti-diarrheal usage were not significantly different after, compared with before, redo IPAA. After redo IPAA, 87% would undergo redo surgery again and 89% would recommend IPAA. Happiness with surgery was higher after redo IPAA (from 8 to 9, p=0.02 overall; p=0.08, pairwise). Matched pair analysis of the electronic survey responses (Table 1) revealed after redo IPAA, dietary restrictions increased (from 51% to 54%, p=0.03), social restrictions decreased (from 44% to 34%, p=0.05), whereas work and sexual restrictions remained unchanged. After redo IPAA, QoL (from 7 to 8, p=0.0004), QoH (from 7 to 8, p=0.0003) and CGQLI (from 0.57 to 0.67, p=0.003) and were significantly higher after, compared with before, redo IPAA.

Conclusion
Redo IPAA, on matched pair analysis, was restorative for the decreased quality of life and social restrictions observed prior to redo pouch surgery, without sacrificing functional outcomes for most patients. This novel view of PROs after redo IPAA compared with before redo IPAA sheds new light on what may be reasonably be expected after redo IPAA for patients with failing pouches contemplating redo IPAA surgery.
P0783 High risk of adrenal insufficiency in patients with Inflammatory Bowel Disease treated with a conventional course of systemic corticosteroids: Results from a prospective study
Authors: Navarro Llavat M , García-Bosch O , Castro-Poceiro J , Bargalló García A , Blasco Pelicano A , Albareda Riera M , Domènech Morral E 
Published: January 2025

Abstract

Background
Corticosteroids (CS) remain the first-line treatment for inflammatory bowel disease (IBD) although they can cause adrenal insufficiency (AI) due to the alteration of the hypothalamic-pituitary-adrenal (HPA) axis. Assessing this risk is essential, as these patients are often in stressful situations, and AI can mimic IBD symptoms, leading to misdiagnosis. However, there is a lack of studies adequately assessing adrenal function in these patients. The objectives of this study were to determine the proportion of IBD patients who present HPA axis suppression following CS treatment, assess the time required for axis recovery, and identify risk factors for AI.

Methods
A prospective observational study was conducted including adult patients with active IBD who started systemic CS treatment and with no exposure to CS within the last 6 months. They all followed a pre-defined regimen of 1 mg/kg/day of prednisone (maximum 60mg) for 2 weeks, tapering by 10 mg weekly until reaching 20 mg, then tapering by 5 mg weekly. The HPA axis was assessed 24 hours after CS discontinuation by the measurement of baseline cortisol and ACTH, and cortisol 30 and 60 minutes after stimulation with 250 mcg of ACTH. HPA axis recovery was evaluated 3 and 6 months after CS discontinuation. The association between clinical and demographic variables and the occurrence of AI was analysed.

Results
Ninety-two patients were included (58% Crohn's disease, 39% ulcerative colitis, mean age 39.8±16 years, 50% women), who received a total CS dose of 2000.7±543.1 mg for 63.5±14.1 days. Forty patients (43.5%) were diagnosed with AI (32 partial, 8 complete). The recovery test was not performed in 10/40 patients (5 due to loss of follow-up, 5 due to need of a new course of CS). 23/30 patients recovered the adrenal function 3 months after stopping CS, and 27/30 patients after 6 months. In the univariate analysis, only fecal calprotectin at the end of CS treatment was associated with AI (P=0.026).

Conclusion
A high proportion of IBD patients treated with a conventional CS treatment schedule develop HPA axis suppression, although most of them recover adrenal function within six months. The development of AI was not associated with any of the studied variables, except for faecal calprotectin levels. Our results highlight the potential risks associated with prolonged CS use and underscore the importance of considering AI in this context, particularly when the patient faces physical stress.
P0786 The short-term efficacy of Filgotinib on antibiotic-dependent/resistant pouchitis in patients with ulcerative colitis
Authors: Uchino M , Ikeuchi H , Horio Y , Kuwahara R , Kusunoki K , Nagano K , Tomoo Y , Nomura K 
Published: January 2025

Abstract

Background
In surgeries for ulcerative colitis, total colectomy and ileal pouch-anal anastomosis are the standard procedures, but one of the postoperative issues is developing pouchitis. It is believed to be related to dysbiosis, and antibiotic therapy is often effective. However, antibiotic dependency/resistance is a problem in clinical practice, making treatment challenging. In this study, we aimed to evaluate the therapeutic effect of filgotinib on cases of antibiotic-dependent/resistant pouchitis.

Methods
We targeted cases of antibiotic-dependent/resistant pouchitis since July 2022. Antibiotic dependency was defined as cases where antibiotics could not be discontinued for more than 4 weeks or cases of relapse occurring 3-4 times per year, while antibiotic resistance was defined as cases that did not improve with 4 weeks of antibiotic treatment. Pouchitis was diagnosed using the modified Pouchitis Disease Activity Index (m-PDAI), with a score of 5 or more considered indicative of pouchitis. Treatment involved filgotinib at 200 mg/day, and during the first 2-4 weeks of treatment, concomitant use of antibiotics or local steroids was allowed. The endpoint was set as cases where clinical symptoms improved based on the m-PDAI, and CRP became negative 8 weeks after the start of treatment, with these cases being classified as responders.

Results
Ten patients received treatment. The male-to-female ratio was 7:3, with an average age of 44.6 ± 11.1 years and an average of 51 ± 44 months since pouch formation. Nine patients had antibiotic-dependent pouchitis, and one had antibiotic-resistant pouchitis. All patients were treated with ciprofloxacin at 600 mg/day, and two patients also received local steroids at the induction of filgotinib. After 8 weeks, six patients showed improvement in clinical symptoms and CRP negativity. Among the responders, the clinical symptom score of the PDAI decreased from 4.3 ± 0.2 to 1.7 ± 0.6 (P&lt;0.01), and CRP levels decreased from 2.9 ± 0.6 mg/dL to 0.6 ± 0.3 mg/dL (P&lt;0.01). No adverse events were observed in these series.

Conclusion
In the short term, about 60% of patients showed improvement with filgotinib treatment. Further investigation into long-term relapse rates, maintenance rates, adverse events, and the possibility of dose reduction for maintenance therapy is necessary.
P0787 A large-scale comparison of clinical response to IBD therapies in white and non-white ethnicities
Authors: Balarajah S , Martinez-Gili L , Alexander J L , Mullish B H , Perry R W , Li J V , Marchesi J R , Parkes M , Orchard T R , Hicks L C , Williams H R 
Published: January 2025

Abstract

Background
IBD phenotypes differ between non-White (NW) and White (WH) populations. Ethnic differences can influence the effectiveness of non-IBD medications, and IBD therapies differ by IBD phenotype. An unanswered question is whether IBD therapies are equally efficacious, with a similar side effect profile, for all ethnic groups. This multi-centre cohort study sought to compare the effectiveness and adverse events (AEs) of IBD therapies in WH and NW patients.

Methods
Phenotypic and outcome data were extracted from the UK IBD BioResource, a large-scale IBD database enrolling patients across the UK. Response and AEs to 5-ASAs, thiopurines, anti-TNFs and anti-integrins were assessed. Treatment effectiveness was defined as treatment persistence free of discontinuation or failure, and evaluated using Kaplan-Meier survival and Cox regression analysis. The risk of experiencing any AE (and individual AEs with a given treatment) was assessed using Cox regression analysis. Models were adjusted for sex, smoking status, IBD subtype, disease duration, disease location/extent, disease behaviour (CD), perianal disease (CD), co-morbidities, presence of extra-intestinal manifestations, age at commencing therapy, steroid and concomitant immunomodulator use, and the occurrence of an AE (in treatment response models).

Results
In total 27,433 patients were included [51.1% females; median age at diagnosis 30 years (IQR 21-43); 94.7% WH, 5.3% NW (71.3% South Asian)].
NW were diagnosed at a younger age, exhibited different disease phenotypes, and were younger at treatment initiation therapy than WH. However, no differences in treatment persistence between WH and NW were identified for all therapies analysed, in either CD or UC (Table 1). NW were at significantly increased risk of AEs when treated with thiopurines [HR 1.16 (95% CI 1.00-1.35), p=0.046] and a similar trend was observed for anti-TNFs [HR 1.25 (95% CI 0.99-1.56), p=0.057]; Table 2]. Specifically, NW were at increased risk of developing leucopenia [HR 1.66 (95% CI 1.10-2.42), p=0.01] and pancreatitis [ p=0.009] with thiopurines, and renal dysfunction with anti-TNFs [HR 2.33 (95% CI 1.11-4.38), p=0.02].

Conclusion
This is the first large-scale study focussing on ethnic differences in IBD treatment response. No differences were observed in treatment response, but we have shown that thiopurines are associated with increased risks of leucopenia and pancreatitis, whilst anti-TNFs are associated with a higher risk of renal dysfunction in NW patients. These findings underscore the importance of thorough pre-treatment risk assessment and patient counselling by clinicians, and the need for more diverse patient representation in research.
P0790 Effectiveness of Tofacitinib and Filgotinib as An Induction Therapy for Patients with Moderate-to-Severe Ulcerative Colitis: Real-World Comparison in Propensity Score-Matching Analysis
Authors: Yagi S , Fukui H , Ikenouchi M , Shiraishi T , Wakita M , Takagi Y , Sato T , Kawai M , Kamikozuru K , Yokoyama Y , Takagawa T , Tomita T , Shinzaki S 
Published: January 2025

Abstract

Background
There are few data comparing the efficacy and safety of each Janus kinase (JAK) inhibitors in ulcerative colitis (UC) patients. We aimed to compare the real-world effectiveness and safety of tofacitinib (TOF) and filgotinib (FIL) which are JAK inhibitors applied for induction therapy in patients with UC.

Methods
We investigated the medical records of all UC patients who received TOF or FIL treatment as induction therapy between May 2018 and October 2023. We next selected the moderate to severe UC patients who matched the following criteria: partial Mayo Score (PMS) ≥3 or PMS =2 and a rectal bleeding subscore ≥1. A clinical response was defined as a reduction in PMS of ≥2 from baseline, with a rectal bleeding subscore ≤1 or a decrease of ≥1 from baseline. A clinical remission was defined as PMS ≤2, each subscore ≤1 and a rectal bleeding subscore of 0. The primary outcome was the clinical response at week 8 after therapy induction. The secondary outcomes were clinical response and remission at weeks 8 in patients without clinical response at week 4 after TOF or FIL administration and the safety during observation period.

Results
We identified 230 patients with moderate to severe UC who received either TOF (n = 197) or FIL (n = 33). Using propensity score-matching (PSM), thirty-three patients in both the TOF and FIL groups were isolated. PSM analysis showed that the rates of clinical response gradually increased to 72.2% at 8 weeks in the TOF group, whereas it tended to decrease to 48.5% in the FIL group. The clinical remission rates increased from 2 (36.7% in both groups) to 8 weeks (63.6% in the TOF group vs 48.5% in the FIL group). The rates of clinical response were higher in the TOF group than in the FIL group at week 8 in patients who did not achieve a clinical response at week 4 (38.5% vs. 0%; P = 0.011). The rates of clinical remission were also higher in the TOF group than in the FIL group at week 8 in patients who did not achieve clinical remission at week 4 (50.0% vs. 16.7%; P = 0.046). At least 1 adverse event occurred in 106 of 197 (53.8%) of patients in the TOF group and 11 of 33 (33.3%) in the FIL group.

Conclusion
TOF, unlike FIL, has the potential to benefit from continued treatment even if the patients did not show a significant clinical response/remission at 4 weeks after induction.
P0791 Development and validation of a nomogram for predicting the short-term effectiveness of Ustekinumab in patients with moderate to severe Crohn's disease
Authors: Su T , Wu H , Zhi M , Yao J 
Published: January 2025

Abstract

Background
Ustekinumab (UST) is recommended as the first-line treatment for patients with moderate to severe Crohn's disease (CD). The effectiveness of certain patients, however, may be suboptimal and necessitate intensive treatment or modification of the treatment regimen. We sought to establish a nomogram model to predict the short-term effectiveness of UST in moderate to severe CD patients.

Methods
We established a derivation cohort comprising patients diagnosed with CD and treated with UST at the Sixth Affiliated Hospital of Sun Yat-sen University between May 2020 and July 2023. The patient data, including demographic and clinical characteristics as well as treatment details, were systematically collected. The achievement of clinical remission (Crohn's Disease Activity Index, CDAI &lt; 150) after induction therapy was the endpoint observed during follow-up. Potential predictors were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis. Multivariate logistic regression analysis was performed to develop a nomogram model. The predictive accuracy and discriminative power of the model were evaluated using Receiver Operating Characteristics (ROC) curves and calibration curves. Decision curve analysis (DCA) was employed to assess the clinical utility of the model.

Results
A total of 162 moderate to severe CD patients were included in the derivation cohort. Prognostic factors, including duration, body mass index (BMI), smoking, extraintestinal manifestations (EIMs), perianal lesions (P), history of Vedolizumab therapy, and albumin levels (ALB), were identified and included in the nomogram. The model showed good discrimination and calibration on internal validation based on the bootstrap method (C-index: 0.843, 95% confidence interval [CI]: 0.768-0.903). Moreover, DCA demonstrated that the nomogram was clinically beneficial.

Conclusion
Our model is a useful tool for accurately predicting the short-term effectiveness of UST in moderate to severe CD patients and aids clinicians in formulating personalized treatment plans.
P0796 Comparison of Disease Severity, Treatment, and Outcomes in Elderly and Younger Patients Hospitalized with Acute Severe Ulcerative Colitis (ASUC)
Authors: Ollech J , Lev Kolnik R , Dotan I , Yanai H 
Published: January 2025

Abstract

Background
Acute severe ulcerative colitis (ASUC) is a life-threatening complication that requires prompt and effective treatment. Disease severity, treatment approaches, and outcomes may differ between elderly patients (aged ≥60 years) and younger patients. This study aims to compare these factors in a cohort of hospitalized ASUC patients.

Methods
A retrospective cohort study was conducted including all patients admitted between 1/2018-12/2023, with ASUC who failed oral steroid therapy to Rabin Medical Center in Israel, a large tertiary referral center. Baseline disease severity was assessed using hemoglobin, albumin, and C-reactive protein (CRP). Treatments analyzed included the use of rescue therapies such as infliximab and calcineurin inhibitors for patients failing intravenous corticosteroid therapy. Outcomes such as colectomy and mortality associated with ASUC were recorded.

Results
158 patients met the inclusion criteria and were stratified into two groups: elderly patients (≥60 years, n=16) and younger patients (&lt;60 years, n=142).Elderly patients had a mean age of 72.9 years compared to 32.1 years in younger patients. Baseline hemoglobin levels were similar between the two groups (11.7 g/dL in elderly vs. 11.8 g/dL in younger patients). Albumin levels were also similar in elderly patients (3.6 g/dL) compared to younger patients (3.8 g/dL) as were CRP levels (5.7 mg/dl vs 5.8 md/dl) respectively. The use of infliximab was less common in elderly patients (12.5%, n=2) compared to younger patients (24.6%, n=35). Calcineurin inhibitors (ciclosporin or tacrolimus) were used in only 1 elderly patient (6.25%) but were used in almost 15 % (n=19) of younger patients. No elderly patients underwent colectomy during admission, while 7.0% (n=10) of younger patients did. Mortality was higher in elderly patients, with a case fatality rate of 12.5% (n=2), compared to no reported mortality in younger patients.

Conclusion
Elderly patients hospitalized with ASUC had similar baseline disease severity but received less rescue therapies and had worse outcomes compared to younger patients, including a higher mortality rate. These findings suggest that while disease severity may be comparable across age groups, elderly patients may experience greater complications, underscoring the need for tailored treatment approaches in this population.