bluuebunny/crossref_metadata_2025_split huggingface dataset:
P876 Disease course of Inflammatory Bowel Disease Unclassified in adult patients : a population-based study (1988-2014)
Authors: Jougon J , Leroyer A , Wils P , Guillon N , Sarter H , Gower-Rousseau C , Savoye G , Turck D , Fumery M , Ley D 
Published: January 2023

Abstract

Background
Inflammatory bowel disease unclassified (IBDU) represents 1 to 20 % of inflammatory bowel disease (IBD). There are few data on the natural history of IBDU. The aim of this study was to evaluate the disease course of IBDU in a population-based cohort.

Methods
All patients diagnosed with IBDU between 1988 and 2014, aged &gt; 17 years at diagnosis, and prospectively enrolled in a population-based registry, were followed until diagnostic reclassification as Crohn’s disease (CD) or ulcerative colitis (UC), or date of loss of follow-up. Clinical presentations at diagnosis of IBDU, CD or UC were compared. The probability of diagnostic reclassification of IBDU during follow-up was studied by the Kaplan-Meier method, and its variation factors by Cox models.

Results
A total of 480 patients with an initial diagnosis of IBDU were included, representing 3.6% of incident IBD cases in the registry. The probability of IBDU diagnosis within IBD significantly decrease over the study period (6.2% from 1988 to 1996, 3.3% from 1997 to 2005 and 2.1% from 2006 to 2014, p&lt;0.0001). Small bowel exploration and gastroscopy rates at diagnosis were significantly lower in IBDU than in UC and CD. Of these 480 patients, 388 were followed up, with a median duration of 2.4 years (IQR: 0.5-9.5). The cumulative probability of reclassification of IBDU was 17% at 1 year, 41% at 5 years, and 54% at 10 years (median time since initial diagnosis: 8.0 years (IQR: 6.3-12.0)); the probability of reclassification to UC was 10% at 1 year, 22% at 5 years, and 30% at 10 years, and to CD was 5%, 13%, and 18%, respectively. The median time to diagnostic reclassification decreased over the study period (14.3 years (IQR: 9.0-17.2) in 1988-1996, 5.1 years (3.1-9.4) in 1997-2005, and 5.6 years (3.4-8.3) in 2006-2014, p&lt;0.0001), in parallel with an increased rate of reclassification during the most recent periods of diagnosis (HR: 1.76 in 1997-2005 and 1.67 in 2006-2014). Presence of rectal bleeding at diagnosis and 1st degree family history of IBD were respectively associated with risk of reclassification to UC (HR: 1.65, p=0.044) and CD (HR: 2.72, p=0.0134). Exposure to anti-TNF increased significantly after diagnostic reclassification (HR: 4.05, p&lt;0.0001). During follow-up, 13.4 % of patients with IBDU required surgery.

Conclusion
In this population-based study, almost half of the patients with an initial diagnosis of IBDU were reclassified during follow-up, after a median time from diagnosis of 8 years. The rate of IBDU and the delay to diagnostic reclassification decreased over the study period, presumably due to an improvement in primary diagnostic evaluation.
P878 Country is the main determinant of differences in nutritional therapy practices across Europe: Results of the Y-ECCO ClinCom Survey 2022
Authors: Selin K A , Andersson S , Bilén K , Strid H , Björk J , Bresso F , Hedin C 
Published: January 2023

Abstract

Background
Diet is known to affect inflammatory bowel disease (IBD), but the optimal nutritional therapy during a severe flare is uncertain. The goal of this study was to describe variation in nutritional practices across Europe, between professions, types of hospitals and healthcare systems, as well as between ulcerative colitis (UC) and Crohn’s disease (CD).

Methods
A novel questionnaire comprising 17 questions, of which 5 concerning demographic data, was distributed digitally in the ECCO Congress 2022 and via the ECCO country representatives. In the comparisons of categories (e.g., countries), only categories with at least 25 responses were considered, and Chi-squared test was used.

Results
The survey was completed by 313 participants. Table 1 summarises their main characteristics.
Physicians and dietitians were most commonly responsible for determining nutritional therapy for IBD inpatients (Table 2). The commonest form of nutritional therapy was oral nutritional supplements (ONS) on top of easy to digest food. Total parenteral nutrition (TPN) was used by 10% of respondents for UC patients and 7% for CD. Almost a quarter of respondents reported less than 25% of patients being assessed by a dietitian in the first 3 days of a flare. Energy intake, stool frequency and inflammatory biomarkers were the commonest factors to determine when to change nutritional therapy. No specific nutritional screening tool was used by 45% of respondents.
There was significant variation between different European countries and healthcare professions for all the outcomes measured (p&lt;0.050). However, in 7 of total 12 questions the variation between professions was only caused by variation in selecting the “I don’t know” alternative. When countries were grouped by healthcare index (HI), countries with high HI showed higher proportion using ONS on top of easy to digest food in CD (p=0.008), being more likely to use a specific nutritional screening tool for assessment (p&lt;0.001) and using more approximate nutritional monitoring in UC instead of reporting all intake (p=0.002). Moreover, nutritional therapy management did not vary according to hospital type (university versus general), apart from criteria of changing nutritional therapy in CD (p=0.021) and monitoring intake in UC (p=0.046).
During the first three days of a severe flare, a diet consisting exclusively of ONS was significantly more frequently used for CD than UC (p=0.018, Figure 1). Otherwise, similar nutritional therapy strategies were reported for CD and UC including using TPN to a similar extent.

Conclusion
Country is the main determinant of differences in nutritional practice across Europe. Diet consisting exclusively of ONS is more common during a flare of CD than UC.
P891 Estimating diet’s quality in patients with Crohn’s disease during remission
Authors: Karachaliou A , Yannakoulia M , Bletsa M , Mantzaris G J , Tzouvala M , Bamias G , Kontogianni M D 
Published: January 2023

Abstract

Background
Patients with Crohn’s disease (CD) experience inadequate energy and nutrients’ intake and food restrictions especially during active disease, but in remission it is recommended to follow guidelines for the general population. However, sparce data support patients’ reluctance to abandon restrictions they usually follow during disease flare-ups. The aim of the study was to evaluate dietary intake in terms of macronutrients, food groups and adherence to healthy dietary patterns in a sample of patients with CD in remission.

Methods
Disease activity was assessed endoscopically and using the Harvey-Bradshaw Index (HBI&lt;5 indicates remission). Nutrients’ intake was assessed through two non-consecutive 24-hour dietary recalls and food groups consumption through a validated food frequency questionnaire. Dietary intake was compared to relevant recommendations (ESPEN’s guidelines for protein intake, EFSA’s recommendations for healthy adults for other macronutrients’ intake and national dietary guidelines for adult Greek population for food groups’ consumption). Adherence to the Mediterranean diet was estimated using MedDietScore (values 0-55, higher values indicate higher adherence) and to the European dietary guidelines for cardiovascular disease prevention with CVD-score (values 0-11, higher values indicate higher adherence).

Results
148 patients (50.7% males, 40.8±13.7 years) were evaluated. 14% reported lower protein intake than recommended. Carbohydrate intake was lower (42.3±8.3 %), sugars intake was higher than the recommended threshold of 10% [13.1 (9.3, 16.4) %] and total fat (39.3±7.5%) and saturated fat [12.7 (10.5, 14.6) %] intakes were higher than recommended. Also, fibers intake was lower than the recommended values of 25-30g/day [15.7 (11.5, 21.2) g/day] and remained low even when excluding those with structuring disease (n=71) [median intake 15.2 (11.1, 21.5) g/day]. Regarding food groups’ consumption, patients reported lower dairy [1.60 (0.96, 2.28) portions/day], non-refined cereals [0.21 (0.02, 0.70) portions/day], fruits [1.06 (0.42, 1.92) portions/day], vegetables [1.11 (0.64, 1.84) portions/day] and legumes [1.26 (0.00, 3.71) portions/week] consumption and higher total red meat [4.23 (2.94, 6.22) portions/week] and sweets [4.97 (1.96, 8.96) portions/week] consumption than the recommended. Mean MedDietScore was 28.7±5.5 and mean CVD-score was 5.42±1.39, both reflecting a low-to-moderate diet’s quality.

Conclusion
Contrary to European dietary guidelines encouraging patients with CD to follow a healthy, without restrictions, dietary pattern during remission, patients fail to adhere to these recommendations and follow a diet of low-to moderate quality.
P895 Differences in ulcerative colitis patients regarding COVID-19 status
Authors: Straume Z , Krūmiņa N , Ozoliņa J , Krūmiņa A , Skuja V 
Published: January 2023

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 is the novel coronavirus that caused the coronavirus disease 2019 (COVID-19) outbreak. Studies have increasingly reported the involvement of other organs, including the gastrointestinal system, in addition to the respiratory system. Ulcerative colitis is an inflammatory bowel disease with an unknown cause. Emerging data suggest that the gastrointestinal system may be influenced by COVID-19 via the expression of angiotensin-converting enzyme-2, but data on the association between COVID-19 and ulcerative colitis, are lacking.

Methods
In 6-month time (June to December 2021) 49 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital were included in a cross-sectional study. All patients were divided into groups according to medically proven COVID-19 status (COVID-19+ vs COVID-19-) in the last 6 months. Information about diet, IBD medications, food supplements, vitamins, sports activities, marital status, education level, and income level was collected. Data were analyzed with SPSS 20.0.

Results
Out of 49 patients, 33(63.3%) were males and 13(36.7%) were females, median age was 38.0 [IQR=17] years. Fourteen patients (28.6%: 7(50%) in each gender) were Covid-19+ within last 6 months. Median time patients suffered from COVID-19 was 7 [IQR=15.3] days. The most common symptoms were: 11(19.6%) fever, 6(10.7%) rhinitis and 5(8.9%) weakness. The most common diet among all patients was IBD diet 33(67.3%) from those 12(21.4%) were COVID-19- and 4(78.6%) were COVID-19+, p=0.00. Out of 49 patients, 25(44.6%) were using food supplements (fish oil, curcumin, collagen, zinc, calcium) of those 17(30.4%) patients were COVID-19-, 8(14.3%) COVID-19+, p=0.00. Most commonly used vitamins were vitamin D 18(64,3%), from those 15(42.9%) were COVID-19-, 3(21.4%) COVID-19+, p&gt;0.5; vitamin C – 7(32,8%), from those 4(11.4%) were COVID-19-, 3(21.4%) COVID-19+, p&gt;0.5. Twenty-four (49%) were doing sports, of those 18(51.4%) were COVID-19-, 6 (42.9%) COVID+; p&gt;0.5. Most common sports activities were cycling 8(16.3%), running 8(16.3%) and fitness 6(12.2%). Most commonly used IBD medications were mesalazine 35(71.4%), azathioprine 7(14.3%) and biologics 4(8.16%), there were no statistically significant differences between COVID-19+ and COVID-19-. There were no statistically significant differences between marital status, education level, and income regarding COVID-19 status.

Conclusion
COVID-19 was less common among patients who were using food supplements and followed IBD diet.
P898 Uncovering of tissue-associated risk factors that lead to different genetic risk profiles across Inflammatory Bowel Disease patients
Authors: Gaite A , Sánchez-Mayor M , Bujanda L , Marigorta U M 
Published: January 2023

Abstract

Background
Polygenic risk scores (PRSs) are emerging as a tool of choice to summarize the risk of disease in each individual. The calculation of PRSs is based on genetic variants and effect sizes obtained from large studies using many different cohorts of patients. In inflammatory bowel disease (IBD), GWAS meta-analysis based on over 75.000 IBD patients from different multi-ethnic cohorts has discovered around 300 independent associated variants. This information can be used to estimate genetic risk and detect individuals with several higher odds of developing the disease during their lifetime. However, PRSs usually do not incorporate functional information about causal variants, and the potential for heterogeneity in effect sizes among subgroups of individuals is disregarded entirely. Hence, PRSs might be ill-suited to capture subcomponents of genetic risk that may account for key differences among specific etiological profiles of patients. Fine mapping of GWAS causal variants show an enrichment in variants associated with changes in gene expression in specific tissues, suggesting that risk of complex diseases is led by an accumulation of variants that change the transcriptome towards a pathogenic profile. To explore the biological nature of IBD risk we propose a tissue transcriptional risk (t-TRS) score

Methods
We perform Transcription Wide Association studies (TWAS) based on gene expression prediction models in nine IBD relevant tissues and a meta-analysis of European IBD GWAS. We next estimated the t-TRS of people from UK biobank and compared its prediction performance against PRS measuring the area under the curve (AUC)

Results
We performed nine TWAS studies and obtained 636 genes that are genome wide significant in at least one tissue. Although eQTL weights are shared across tissues, we observe a high number of tissue specific signals, specifically in terminal ileum and lymphocytes. Pathway enrichment analysis on the 600-gene set showed enrichment of immune functions like “Signaling by interleukins” and “Antigen presentation”. We also show the predicting value of t-TRS is better than the PRS in all tissues. In addition, clustering of individuals according with t-TRS yield 3 subgroups of patients

Conclusion
Functionally informed genetic predictors allow not only to better stratify patients, but also to discover which are the biological pathways that accumulate risk variants in subgroups of IBD patients
P903 Lactase non-persistence and Inflammatory Bowel Disease in a Basque cohort
Authors: Garcia-Etxebarria K , Merino O , Ezcurra A , Segues N , Arzallus T , Marigorta U M , Vignau R , Bujanda L 
Published: January 2023

Abstract

Background
Patients with inflammatory bowel disease (IBD) experience symptoms (e. g. abdominal pain, bloating, or diarrhoea) that could be partially due to food intolerances or malabsorption. Thus, those patients could restrict some foods in their diet to avoid the symptoms. Among others, they could restrict their intake of dairy products, since lactose intolerance is one of the most prevalent intolerances. Although the role of lactose intolerance in IBD has been studied, the results are not entirely conclusive.
Recently, we analysed the genetic basis of IBD in a Basque cohort and we have taken advantage of the data we had available to study the role of the lactase non-persistence in IBD.

Methods
The genotype of the single nucleotide polymorphism (SNP) rs4988235 was retrieved from 1427 individuals (492 IBD cases and 935 controls from the general population) studied previously in a Basque cohort. The G allele of that SNP is associated with the non-persistence of lactase and the individuals were classified as carriers and non-carriers of that allele.
The effect of the carriership of that allele in the risk of IBD was analysed through generalized linear models, adjusting by the first four principal components of the genetic distance between individuals. In addition, IBD subtypes and behaviour and location of Crohn’s Disease (CD) were analysed.

Results
On the whole, 1089 individuals (76.31%) were carriers of the non-persistent lactase allele. This high prevalence is due to the effect of the mixture of modern European (where the 68.08% was carrier) and ancient European (87.45%) ancestries of the actual Basque population.
Although there is a trend, the carriers of the non-persistent lactase allele did not show a significantly higher risk of developing IBD (OR=1.5, 95%CI: 0.9-2.5, P=0.0749). When subtypes were analysed, there was no higher risk of developing Ulcerative Colitis (P=0.4261), while the risk of developing CD approached formal significance (OR=1.4, 95%CI: 0.99-1.9, P= 0.0584).
Considering this result, we further analysed the effect of the non-persistent lactase allele regarding the behaviour or location of CD. The carriers of the non-persistent lactase allele had a higher risk of penetrating CD (OR=2.7, 95%CI: 1.1-7.9, P=0.0437) and of colonic CD (OR=4.7, 95%CI: 1.4-29.4, P=0.0375).

Conclusion
Although the sample size was limited, the carriers of the non-persistent lactase allele were higher in penetrating CD and colonic CD than in the general population. Thus, lactose consumption could affect those cases of CD and, therefore, follow-up analyses are needed to validate these results.
P909 Microbiome dynamics leading up to and during pregnancy in a matched IBD-control cohort
Authors: Binyamin D , Turjeman S , Koren O , Ben Ya'acov A , Gold G , Goldenberg R , Bar-Gil Shitrit A 
Published: January 2023

Abstract

Background
A common feature of inflammatory bowel diseases (IBD) is dysbiosis of gut microbiota. IBD usually affects women during their childbearing years, but successful pregnancy outcomes have become a reality for many women with IBD. Pregnancy in general and pregnancy in IBD in particular, has been reported to dramatically affect gut microbial composition and function. In the present study, we have characterized the changes in the gut microbiota that occur from preconception to the first trimester of pregnancy in healthy women and in women with IBD.

Methods
Fecal samples were collected from 39 pregnant IBD patients and 38 pregnant healthy controls at two time-points: preconception and during the first trimester. Bacterial DNA was extracted, amplified, cleaned and sequenced (16S rRNA gene). Then, microbiome analysis was performed using QIIME2 to compare profiles between the groups and across the time points.

Results
The microbiomes of IBD patients were significantly different than those of healthy controls, and bacterial richness was significantly lower than controls both in preconception and first trimester samples. Even though no significant differences were observed between sampling time points, the shift in the bacterial population from preconception to the first trimester in the IBD groups was significantly larger compared to the shift in the control group. We also found that the genus Sutterella was significantly more abundant in healthy controls in samples collected during the first trimester compared to IBD patients. When specifically focusing on this genus in preconception samples, we found the same pattern of increased abundance in the control group.

Conclusion
While there were no differences in the microbiota across time points, the increased delta between IBD versus controls may suggest that disease phenotype permits increased microbiome plasticity than the control group. Furthermore, the results may be related to modulation of immune response that may be associated to inflammatory state and medical treatments; however, further studies are warranted.
P912 Increased Primary Bile Acids with Ileocolonic Resection Impact Ileal Inflammation and Gut Microbiota in Inflammatory Bowel Disease
Authors: Battat R , Scherl E , Lukin D , Charilaou P , Mahtani P , Gerber J , Gandara J , Dündar F , Zumbo P , Betel D , Guo C J , Longman R ,   Jill Roberts Institute Live Cell Bank
Published: January 2023

Abstract

Background
A majority of Crohn’s disease (CD) patients require surgery. Ileitis recurs after most ileocolectomies and is a critical determinant for outcomes. The impact of ileocolectomy-induced bile acid (BA) perturbations on intestinal microbiota and inflammation are unknown. We characterized relationships between ileocolectomy, stool BA, microbiota, and intestinal inflammation in inflammatory bowel disease (IBD).

Methods
Validated IBD clinical and endoscopic assessments were prospectively collected. Matched primary and secondary BA concentrations measured in stool using Agilent Quadrupole Time of Flight Liquid chromatography-mass spectrometry were compared based on ileocolectomy and ileitis status. Primary BA thresholds for ileitis were evaluated using area under the receiver operating characteristic curve analyses. In CD, endoscopic remission was defined as SES-CD &lt;3 or Rutgeerts &lt;i2b. Ileal ER was defined as ileal SES-CD ≤ 1 and colonic ER was defined as colonic SES-CD≤2 without any segment &gt;1. In UC, ER was defined as UC-ESS ≤ 1. Metagenomic sequencing profiled microbial composition and function. Relationships between ileocolectomy, BA and microbiota were assessed.

Results
In 166 patients, elevated primary and secondary BA existed with ileocolectomy. With ileitis, only primary BA (795 nMol/g vs 398 nMol/g, p=0.009) were higher compared to without ileitis. The optimal primary BA threshold (≥228nMol/g) identified ileitis on multivariable analysis (OR=2.3, p=0.04). Similar primary (471 nMol/g vs. 606 nMol/g, p=0.8) and secondary (382 nMol/g vs. 242 nMol/g, p=0.2) BA concentrations existed with and without colonic inflammation. Microbial diversity (Shannon index, p=0.0006), Faecalibacterium prausnitzii and O-acetylhomoserine aminocarboxypropyltransferase (MetY, p=0.0002) were decreased with elevated primary BA.
Amongst ileocolectomy patients, only those with elevated primary BA had diversity (p=0.01), F.prausnitzii and MetY (p=0.04) reductions.
Those with both ileocolectomy and intermediate (p=0.002) or high (≥228nMol/g, p=9.1e-11) ) primary BA had reduced F.prausnitzii compared to without ileocolectomy (Figure 1). Those with ileocolectomy and low (&lt;29.2nMol/g) primary BA had similar F.prausnitzii as those without ileocolectomy (P=0.13). MetY was reduced with ileitis (p=0.02).

Conclusion
Elevated primary bile acids were associated with ileitis, and reduced microbial diversity, F.prausnitzii abundance, and enzymatic expression of MetY (acetate and L-methionine producing enzyme expressed by F.prausnitzii) and were the only factor associated with these findings after ileocolectomy.