bluuebunny/crossref_metadata_2025_split huggingface dataset:
P827 SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with Inflammatory Bowel Disease: A systematic review and meta-analysis
Authors: Van De Pol N , Pan Q , Derikx L A A P , Bakker L , van der Woude C J , de Vries A C 
Published: January 2023

Abstract

Background
Patients with inflammatory bowel disease (IBD) have reduced seroconversion rates to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of (severe) COVID-19. We evaluated SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients.

Methods
A systematic literature search was performed for studies which reported SARS-CoV-2 breakthrough infection rates and/or the disease course of COVID-19 in patients with IBD after COVID-19 vaccination. Primary outcome was the rates of breakthrough infection per time period. In meta-analyses, the pooled relative risk was calculated with a random effects model for vaccinated patients compared to vaccinated controls, to partially vaccinated and unvaccinated patients with IBD.

Results
A total of 16 studies were included in analysis. The study period ranged from January 2020 to October 2021, and a follow-up time ranges from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in IBD patients within the study follow-up time. Strikingly, only studies with vaccination prior to December 2021 showed a breakthrough infection rate above 2%. (Figure 1). The disease course of a breakthrough infection is generally mild, with mild constitutional and respiratory symptoms in 85% of infected IBD patients. Hospitalization and mortality rates are low (0-8.7% and 0-4.3% respectively). Meta-analyses showed a significantly lower pooled relative risk of breakthrough infection for vaccinated as compared to unvaccinated IBD patients (RR 0.07, 95% CI 0.03; 0.18). No difference was observed in risk of breakthrough infections between IBD patients and non-IBD controls (RR 1.01, 95% CI 0.92; 1.10), and no difference between vaccinated and partially vaccinated IBD patients (RR 0.67, 95% CI 0.38; 1.18). The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. One study reported higher breakthrough infection rates for patients treated with infliximab in comparison to vedolizumab (P&lt;.05). Other studies showed no impact on the breakthrough infection rates for immunosuppressive treatment vs no treatment, anti-TNF-α/corticosteroids vs without anti-TNF-α/corticosteroids and other biologics vs anti-TNF-α.

Conclusion
Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time. Data on the impact of IBD medication on the rate of breakthrough infections and disease course require further elucidation.
P828 Incidence and predictors of arterial and venous thromboembolic events in hospitalized patients with inflammatory bowel disease compared to patients with acute infective gastroenteritis and colitis: a propensity score-matched study
Authors: Papa A , Lopetuso L R , Mignini I , Settanni C R , Scaldaferri F , Pugliese D , Laterza L , Covino M , Franceschi F , Gasbarrini A 
Published: January 2023

Abstract

Background
Arterial and venous thromboembolic events (ATEs and VTEs) represent a common complication of inflammatory bowel disease (IBD) with significant morbidity and mortality. Risk factors for thromboembolic complications may differ in IBD patients from those in the general population. This study aimed to assess the incidence and risk factors for ATEs and VTEs in a cohort of hospitalized patients with IBD compared to patients with acute infective gastroenteritis or colitis (AIGEC).

Methods
The clinical records of patients with IBD and AIGEC admitted to our Academic Hospital over six years were reviewed. We compared the incidence and risk factors of ATEs and VTEs between the two cohorts (1203 patients with IBD and 2652 with AIGEC) and propensity score-matched (PSM) subpopulations, including 831 patients for each group. In addition, we assessed the effect of IBD itself on the occurrence of ATEs and VTEs.

Results
In the PSM cohort, the ATEs rate was significantly higher in patients with IBD than in controls (10.1% vs. 5.5%, p=0.001), as well as the incidence of ischemic heart disease (IHD) (7.9% vs. 3.6%, p&lt;0.001). On the contrary, the incidence of VTEs was similar between the two study groups. IBD diagnosis, male sex, hypertension, diabetes, and the Charlson Index were independently associated with ATEs. In patients diagnosed with IBD, the adjusted odds ratio (OR) for an ATE occurrence was 2.21 [1.47 – 3.31] compared to controls. Age emerged as the only factor significantly associated with VTEs.

Conclusion
Compared to patients with AIGEC, IBD patients showed an increased risk of ATEs but not VTEs, probably for implementing venous thrombosis prophylaxis. IBD itself represents an independent risk factor for ATEs, particularly for IHD. These findings confirm that chronic inflammation is a consistent trigger for the cardiovascular atherothrombotic disease. Consequently, tight control of inflammation must be considered an essential target to reduce cardiovascular risk.
P834 Physical activity in people with Inflammatory Bowel Disease – towards precision prevention
Authors: Villumsen M , Poulsen A , Thomsen T , Jess T , Aadahl M , Allin K 
Published: January 2023

Abstract

Background
Existing evidence suggests that physical activity, in addition to medical treatment, can counteract physical symptoms and improve the quality of life in patients with inflammatory bowel disease (IBD). We aimed to understand patients' patterns of physical activity to guide the development of an evidence-based personalised intervention for the promotion of physical activity and reduction of sedentary behaviour in patients with IBD.

Methods
We included a population of 207,959 participants who responded to The Danish Capital Region Health Surveys during the period 2007 to 2021. The population included 1777 individuals with prevalent IBD [705 with Crohn’s disease and 1072 with ulcerative colitis]. Information on sedentary behaviour and physical activity was obtained from self-reported questionnaires, the Physical Activity Scale version 2.1., and sociodemographic information from central nationwide registers. Self-rated physical and mental health was measured with SF-12. Data were weighted for survey design and were analysed by multiple regression analyses.

Results
The proportion that adopted the recommended physical activity level of at least 4 hours of low, moderate, or high intensity was lower among patients with IBD compared to the background population, also when adjusting for sociodemographic variables and population weights (OR=0.86; 95% CI 0.84-0.88). Among patients with IBD, more women than men were physically active. Crohn’s disease, living alone, having non-western ethnicity, having a BMI&lt; 18.5 or BMI &gt;30, having an unhealthy diet, being outside the labour market, and having small children were all associated with lower levels of physical activity. Moderate to high level of physical activity among patients with IBD was associated with higher self-rated physical health than low levels of physical activity (p&lt;0.001). The highest mental quality of life score was among IBD patients with moderate physical activity compared to high or low physical activity (p&lt;0.001).

Conclusion
Patients with IBD, especially those with Crohn’s disease, have lower levels of physical activity and more sedentary behaviour compared to non-IBD individuals. Moderate physical activity is associated with a higher physical and mental quality of life score in individuals with IBD compared to high or low levels of physical activity. These results can guide clinicians when IBD patients ask for advice on physical activity. Furthermore, we will use the results to guide the development of an evidence-based personalised intervention for the promotion of physical activity and reduction of sedentary behaviour in patients with IBD.
P835 Visceral adiposity independently predicts time to flare in inflammatory bowel disease, but BMI does not
Authors: Sehgal P , Su S , Zech J , Nobel Y , Luk L , Economou I , Shen B , Kiran P , Freedberg D 
Published: January 2023

Abstract

Background
Obesity is rising globally and has been associated with increased IBD disease severity, prolonged hospital stay and increased development of extra-intestinal manifestations. Measuring “visceral adiposity” by CT scan may be a more meaningful way of classifying obesity compared to traditional measures such as BMI. This study compared visceral adiposity measured by CT scan versus BMI as a predictor of time to IBD flare among patients with CD and UC.

Methods
This was a retrospective cohort study. Consecutive adults with IBD were included if they had a colonoscopy to evaluate IBD flare and a CT scan within a 30-day window of the colonoscopy from 2010 to 2022. Charts were reviewed until 100 patients with Crohn’s and 100 with UC had been identified. Patients were followed for up to 6 months after the index CT scan for IBD flare, which was characterized by hospitalization/ER visit related to IBD, initiation of steroids, dose escalation, change in IBD medication, or IBD surgery. The primary exposure was the visceral adipose tissue to subcutaneous adipose tissue ratio (VAT:SAT) which was obtained from the index CT scan using TomoVision slicOmatic software. BMI was calculated based on height and weight at the time of the index CT scan. Cox proportional hazard modeling was used to test VAT:SAT and BMI as predictors of time to IBD flare, after adjusting for other factors.

Results
100 CD and 100 UC patients were included. The median age was 43 (IQR 31-58), 41% of the population was female, and most were White (55%) or Hispanic (26%). Overall, 20% of the cohort flared with a median time to flare of 88 days (IQR 42.5 – 118.5) among those who flared. For all patients, VAT:SAT was significantly associated with time to flare as seen in Figure 1 (HR 4.8, 95% CI 1.67 to 13.7 for VAT:SAT≥1.0 vs VAT:SAT&lt;1.0), but BMI was not (HR 0.88 95% CI 0.35 to 2.18 for BMI ≥25 vs BMI &lt;25). After stratifying the cohort into CD and UC cohorts, a significant association between VAT:SAT ≥1.0 and time to flare remained for CD (HR 7.68, 95% CI 0.93 – 63.2) but not for UC (HR 0.26, 95% CI 0.018 – 3.70). BMI was not associated with time to flare in either CD or in UC patients (Figure 2).

Conclusion
Visceral adiposity (VAT:SAT ratio on CT scan) was associated with decreased time to IBD flare, but BMI was not. This relationship may be stronger among Crohn’s compared to Ulcerative colitis patients. Future studies should investigate the mechanisms by which visceral adiposity may contribute to IBD disease activity.
P836 Trends in the prevalence of Inflammatory Bowel Disease in Lithuania during 2001-2020
Authors: Karpavičiūtė V , Kiudelis G , Kupčinskas J , Kupčinskas L 
Published: January 2023

Abstract

Background
The prevalence of inflammatory bowel disease (IBD) is increasing worldwide, affecting millions of individuals. The highest incidence and prevalence are found in Northern Europe and Northern America. There is a lack of new epidemiological studies in the Eastern European region. The objective of this study was to assess changes in the prevalence of IBD in Lithuania during two last decades.

Methods
Data on the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) (ICD-10 code K50, K51) in Lithuania during 2001-2020 were obtained from the Institute of Hygiene, where the data were systematized from the Mandatory Health Insurance Information System. Changes in the prevalence trends in men and women, children and adults during 2001-2020 were assessed using Joinpoint regression analysis.

Results
In 2020, the overall prevalence of CD was 33/100,000 and the prevalence of UC was 117/100,000. Gender differences in the prevalence of IBD were not significant. The prevalence of CD among adults in Lithuania has increased 3-fold over 20 years, while the prevalence of UC has increased 4-fold. During 2001-2020, the average annual increase in UC prevalence (8.0%/year, p&lt;0.001) was higher than in CD (6.3%/year, p&lt;0.001). Also, it shows increased UC/CD ratio: in 2001, the ratio was 2.5:1, while in 2020, was observed a higher UC/CD ratio 3.5:1. When comparing changes in the prevalence of IBD, some differences were observed between adults and children. During 2001-2020, the average annual growth rate of CD in children increased not significantly (2.1%/year, p&gt;0.05), while for adults, a significant increase was observed (6.8%/year, p&lt;0,001). Similar trends were noticed in the assessment of the prevalence changes of UC: during 2001-2020, the prevalence of UC in children increased slightly (3.1%/year, p&gt;0.05), while significant growth was observed for adults (7.8%/year, p&lt;0.001). When comparing the children prevalence ratio of CD and UC, it remained almost the same over 20 years, and it was found that CD is more commonly diagnosed in children than UC (CD/UC ratio in 2001 was 1.8:1, while in 2020, it was 1.7:1). In adults, CD/UC ratio was opposite of children, and has changed during 2001-2020: CD/UC ratio in 2001 was 1:2.9, while in 2020, it was 1:3.7.

Conclusion
The results show that the prevalence of IBD in adults is steadily increasing, while the number of cases in children has not changed significantly over 20 years. Also, it was observed, that Crohn's disease is diagnosed at younger age than ulcerative colitis, which is more commonly diagnosed in older age.
P853 Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in the Faroe Islands compared to inflammatory bowel disease patients in Eastern and Western Europe – An Epi-IBD study
Authors: Nielsen K R , Midjord J , Hammer T , Vang A , Berbisá M Á F , Johannesen H , Burisch J 
Published: January 2023

Abstract

Background
The incidence of inflammatory bowel disease (IBD) in the Faroe Islands is the highest in the world and has increased dramatically over the past sixty years - possibly due to changes in environmental factors towards a more “westernised” standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in the Faroe Islands, and to compare the results to Eastern and Western European IBD patients.

Methods
The Faroese Epi-IBD study group is a nationwide, prospective inception cohort of 388 unselected IBD patients from the Faroe Islands covering a background population of 53,000 inhabitants. Patients were diagnosed between 2010 and 2021. At the time of diagnosis patients were asked to complete the 87-item IOIBD questionnaire concerning environmental factors. Findings were compared to Eastern and Western European IBD patients from the Epi-IBD cohort.

Results
A total of 311 patients (80.2 %) answered the questionnaire, 46 (14.8 %) had Crohn’s disease (CD), 217 (69.8 %) had ulcerative colitis (UC), and 48 (15.4 %) had IBD unclassified (IBDU). The number of former smokers, breastfeeding, coffeine intake, and oral contraceptive was higher than both Eastern and Western Europe. Vaccination against tuberculosis, measles, and rubella was similar to Western Europe; while vaccination against pertussis, diphtheria, tetanus, and polio was similar to Eastern Europe. Childhood diseases of measles, pertussis, rubella, mumps were higher than both Eastern and Western Europe.
Fruit and vegetable intake was lower than both Eastern and Western Europe. High sugar intake, and fast-food intake was similar to Eastern Europe.

Conclusion
Faroese IBD patients differ in terms of exposure to environmental factors prior to the diagnosis to both Eastern and Western Europe patients. Analysis of the impact of environmental factors on difference in disease course and incidence between the Faroese Epi-IBD study group and the Eastern Europe and Western Europe Epi-IBD cohort are currently in progress.
P880 High incidence of inflammatory bowel disease in Northern Australia: a prospective community population-based Australian incidence study in the Mackay-Isaac-Whitsunday region
Authors: Flanagan A , O'Connor S , Allsop S , Tobin J , Pretorius C , Brown I , Bell S , Daveson A J 
Published: January 2023

Abstract

Background
The Mackay-Isaac-Whitsunday region encompasses 173,892 people within a 400 km (250mile) radius in Queensland, Australia. We aimed to determine the incidence of Inflammatory Bowel Disease (IBD) in this region in northern Australia (-21.14°S) and to allow a comparison with southern Australian and New Zealand data (Geelong, Australia -38.14°S; Tasmania -41.43°S and -42.88°S [Launceston and Hobart] and Canterbury, New Zealand -43.46 °S).

Methods
A prospective observational community population-based IBD study was conducted between 1 June 2017 and 31 May 2018. Primary outcome measures include the crude annual incidence rate of IBD, Crohn's disease (CD), Ulcerative colitis (UC) and infammatory bowel disease unspecified (IBDU), while secondary outcomes includes disease phenotype and behaviour. All new cases were identified through primary health care referrals and public and private hospital referrals into the clinic. All new cases of IBD were prospectively defined using rigorously recognised and accepted criteria and categorised using the Montreal Classification.

Results
Fifty-six new cases of IBD were identified. Twenty-three were CD, 30 were UC and 3 were IBDU. The crude annual incidence rate per 100 000 for IBD, CD, UC and IBDU was 32.2 (95% confidence interval (CI): 24.78–41.84), 13.23 (95% CI: 8.79– 19.90), 17.25 (95% CI: 12.06–24.67) and 1.73 (95% CI: 0.56–5.35). When directly age-standardised to the World Health Organisation Standard Population Distribution, the overall CD, UC and IBDU incidence were 13.19, 17.34 and 1.85 per 100 000, with an overall age-standardised IBD incidence of 32.38.

Conclusion
This is the first study to define the incidence of IBD in a Northern Australian cohort and to allow a comparison between North and Southern Australia. The IBD crude is the highest reported in Australia. Like others, we found a high and low incidence of upper gastrointestinal Crohn's disease and complicated disease at diagnosis respectively, likely reflective of the increased availability and early uptake of endoscopic procedures.
P887 Epidemiology of perianal fistulising Crohn’s disease: a systematic literature review
Authors: McKay C , Pacis S , Bolzani A , Geransar P , Panés J 
Published: January 2023

Abstract

Background
Complex Crohn’s perianal fistulas (CPF) are a debilitating complication of Crohn’s disease (CD). Data about the epidemiology of complex CPF are limited. This systematic literature review (SLR) aimed to understand the epidemiology of CPF in adult and paediatric CD populations globally.

Methods
Electronic databases (MEDLINE, Embase, EBM Reviews, EconLit) were searched. PICOS-T (population, interventions, comparators, outcomes, study design, time) selection criteria were used to identify relevant studies, and two reviewers independently screened and extracted data. Articles included observational studies with &gt;50 patients published in English from 1 Jan 2015 to 17 Feb 2022. The study was still included if complex CPF was not defined. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias/quality of studies (good, fair or poor). Outcomes of interest were the prevalence and incidence of CPF. Studies reporting epidemiology as an objective were considered primary epidemiology studies. Data were summarized using descriptive statistics.

Results
In total, 140 studies were included, of which most were of good (n=14) or fair (n=98) quality regarding risk of bias. Few studies (n=24) defined complex CPF; hence, outcomes included all types of CPF. An epidemiology outcome was reported in 86 studies (covering all major geographic regions and age groups; Table 1), including 36 population-based studies and 20 primary epidemiology studies. CPF prevalence, reported in 84 studies, varied widely (Table 2). For adult studies (including those not reporting an age range; n=44) and paediatric-only studies (n=15), CPF prevalence (interquartile range) was in the range 1.5–81.0% (10.5–30.1%) and 5.5–47.3% (13.1–19.9%), respectively. Complex CPF prevalence (range) was reported in 18 studies and varied widely (3.4–54.6%); of these, four were primary epidemiology studies (3.4–29.3%). CPF incidence was reported in 15 studies: two studies reported incidence in person-years (PY) as 133.83 per 100 000 PY and 1100 per 100 000 PY. Of studies reporting cumulative CPF incidence at specific timepoints, incidence at 1 year after CD diagnosis was most frequently reported (n=8, range 3.5–50.1%; Table 3).

Conclusion
This SLR highlights a wide range in prevalences and incidences of CPF, potentially due to a lack of standardized definitions for CPF alongside a range of reported timepoints. Prevalences were up to 81.0% for CPF and 54.6% for complex CPF, and CPF incidences reached 1100 per 100 000 PY. This SLR demonstrates that understanding the burden of CPF in CD populations globally is challenging and consistent definitions are required to permit cross-study comparisons.
Funding: Takeda Pharmaceuticals USA, Inc.