bluuebunny/crossref_metadata_2025_split huggingface dataset:
P260 Care pathway modelling and economic analysis of a single NHS IBD Service following introduction of Small bowel ultrasound.
Authors: Radford S , Tench C , Moran G 
Published: January 2023

Abstract

Background
Small bowel ultrasound (SBUS) is an accurate, inexpensive and non-invasive method of diagnosing and monitoring IBD. The service delivery and economic implications of SBUS implementation on NHS IBD services have not previously been explored.

Methods
This study took the form of a service evaluation. Analysis of patient care episodes and flow through the established imaging (MRE and SBUS) and IBD care pathways was undertaken, data relating to patient flow, waiting times, resource use and healthcare engagement of patients were collected from care episodes between 01/01/2021 – 30/03/2022. Costs were calculated per care episode.

Results
Data from a service evaluation relating to 192 imaging referrals from IBD clinics for patients with Small bowel Crohn's disease (SBCD), and patient flow through the pathway were collected. Per scan, MRE was almost 5 times more costly than SBUS examinations (£305 versus £51 respectively). Patients from the SBUS pathway had fewer healthcare interactions across all three categories (Helpline, IBD Nurse or IBD Consultant appointments). Patients from the MRE pathway. Estimated costs per patient in the SBUS pathway were £81.72, and £379.58 per patient in the MRE pathway. Further to this the waiting times for MRE were significantly longer than those for SBUS.

Conclusion
The use of SBUS is a potential cost saving option when compared to MRE for adult patients with SBCD. There was a difference between the SBUS and MRE pathways in the waiting times for both the medical imaging scans, the reports of the scans and the initiation of an appropriate treatment plan. SBUS waiting times were shorter in all aspects except for the time between scanning report and the treatment initiation, indicating that it is the waiting times for the scans and the respective reporting that cause delays in treatment initiation. Future research in this area should attempt to consider the wider impact on cost effectiveness of the use of SBUS through investigation of costs including treatment costs, including the timing and use of biologic and immunomodulator treatments, impact of delays on service use and healthcare interactions of patients, work productivity and quality adjusted life years.
P261 Rate of Community Acquired Pneumonia, related hospitalization, and mortality among younger unvaccinated Inflammatory Bowel Disease patients
Authors: Khan N , Trivedi C , Shah Y , Patel M , Sundararajan R , Xie D , Yang Y X 
Published: January 2023

Abstract

Background
Community Acquired Pneumonia (CAP) is among the most common infections among Inflammatory Bowel Disease (IBD) patients. Current vaccine guidelines recommend vaccination at a younger age in individuals with IBD on immunosuppressive medications. Our aim was to determine the absolute and relative risk of CAP, related hospitalization, and death among unvaccinated IBD patients under the age of 65 years and compare the rates between those exposed and unexposed to immunosuppressive medications. We also sought to determine if exposure to immunosuppressive/immunomodulatory medications was associated with an increased risk of CAP in this group.

Methods
We conducted a retrospective cohort study utilizing a nationwide cohort of IBD patients under the age of 65 in the Veteran Affairs Healthcare System (VAHS) who were pneumococcal vaccine naive. The unexposed group included those patients on 5-ASA medications only. Exposure was administration of any immunosuppressive medication. The primary outcome was the first occurrence of pneumonia. Secondary outcomes were pneumonia related hospitalization and mortality. We reported event rate per 1000 person-years, hazard ratio, and 95% confidence intervals (CIs) for each outcome.

Results
A total of 26,707 patients were included in our study. 513 of these patients developed pneumonia (Table 1). The overall crude incidence rate of CAP was 3.2 per 1000 patient-years (4.04/1000 patient years in the exposed vs 1.45/1000 patient-years in the unexposed). The overall crude incidence rates for pneumonia-related-hospitalization and mortality were 1.12 and 0.09 per 1000 patient-years, respectively (Table 2). In Cox regression, exposed group was associated with an increased risk of pneumonia (AHR 2.85; 95% CI 2.21 – 3.66, p &lt; 0.001) and pneumonia-related-hospitalization (AHR 3.46; 95% CI 2.20 – 5.43, p &lt; 0.001) (Table 3).

Conclusion
Overall incidence of CAP among younger unvaccinated IBD patients was 3.2 per 1000 PY. We observed that while the incidence rates of CAP and CAP-related hospitalization were low overall, they were higher among those who received immunosuppressive therapy compared to those who only received 5-ASA medications. Knowing the exact risk of developing CAP among younger IBD patients will help patients and their physicians make informed decisions during these times of complex vaccine recommendations.
P269 Predicting IBD years before diagnosis using routine blood tests
Authors: Lev Zion R , Dolev A S , Greenfeld S , Kariv R , Ledderman N , Matz E , Dotan I , Kopylov U , Turner D , Lerner B 
Published: January 2023

Abstract

Background
Recent studies such as the GEM project have identified microbial, serological and metabolomic markers that may help predict inflammatory bowel disease (IBD) well in advance of diagnosis, with the ultimate goal of pre-disease prevention. In this population-based study, we used the epi-Israeli IBD Research Nucleus (IIRN) validated cohort to explore the utility of routine blood tests as markers for pre-diagnostic IBD prediction.

Methods
We included all blood tests from all IBD patients diagnosed from 2005-2020 insured in three of the four Israeli health maintenance organizations (HMOs), and individually matched each to two non-IBD controls. Test results were collected and collated by number of months pre-diagnosis, then reported over time until diagnosis. Means were compared using Welch's t-test with false discovery rate correction to account for multiple comparisons. Trends over time were analyzed to detect tests that showed divergence between cases and controls at least one year before diagnosis.

Results
Pre-diagnosis results from 142 different blood tests were collected for 7,630 Crohn’s disease (CD) patients and 6,026 ulcerative colitis (UC) patients (mean age 33.3±17.4 years for CD and 38 ± 17.9 years for UC).
Median duration of pre-diagnosis data collection was 50 (IQR 11-96) months for CD and 48 (IQR11-96) months for UC. Of the 142 tests, 24 (17%) showed significant differences between CD and controls at least one year pre-diagnosis (Figure 1); these included not only inflammation-related tests such as ESR, hemoglobin and albumin, but also seemingly unrelated tests such as bilirubin, cholesterol and creatinine.
In UC patients, no tests showed statistically significant differences at least one year pre-diagnosis.

Conclusion
We were able to detect changes in blood tests collected as part of routine care long before CD diagnosis, opening the possibility of detecting early signals of future CD in patients undergoing routine blood tests. These may be used for developing screening and prediction models for prevention strategies.
This research was partially supported by the Israeli Council for Higher Education (CHE) via the Data Science Research Center, Ben-Gurion University of the Negev, Israel. The epi-IIRN project has been funded by an educational grant from the Leona M. and Harry B. Helmsley Charitable Trust.
P272 Reduced delay in diagnosis of Crohn’s disease in patients presenting with perianal disease: results of a retrospective cohort study at a non-academic, IBD-expert centre in the Netherlands
Authors: Munster L , de Groof E J , van Dieren S , Mundt M W , D’Haens G R A M , Bemelman W A , Buskens C J , van der Bilt J D W 
Published: January 2023

Abstract

Background
In up to 10% of patients with Crohn’s disease (CD), a perianal fistula (PAF) or perianal abscess (PAA) is the first presenting symptom. Delay in diagnosis in those patients is common and twice as long as in the general CD population. For the majority of patients (&gt;70%) diagnosis takes &gt;12 months. Delay is associated with more complex fistula formation impairing opportunities for clinical and radiological fistula closure, currently only successful in 65% and 30% respectively (combining anti-TNF and surgery). Moreover, delay in diagnosis is associated with worse outcomes and impaired quality of life (QoL). Since 2017, a low threshold for diagnostic work-up (ileocolonoscopy) for CD in patients presenting with perianal disease was introduced by a dedicated IBD surgeon in order to reduce delay in diagnosis of CD.

Methods
Patient records of all consecutive patients ≥16 years presenting with perianal disease (before diagnosis of CD) were retrospectively assessed. Differences in delay of diagnosis, defined as the time between first presentation with a PAA/PAF and confirmed diagnosis of CD, and differences in outcome measurements between the period 2007-2016 and 2017-2021 were determined in those eventually diagnosed with CD.

Results
A total of 25 patients were included in this study (n=13 in 2007-2016 and n=12 in 2017-2021, 52% male) with median age at presentation of 27 years (IQR 21,5-38,5). In the period 2007-2016, a median delay of 33 months (IQR 23-64) in CD diagnosis was observed and less than 20% of patients were diagnosed within one year after the first perianal surgical procedure. In the period 2017-2021 the median time to diagnosis significantly decreased to only 3 months (IQR 0-5, p=,000) and the proportion of patients diagnosed within one year increased drastically up to 79% (p=,000). Due to the relatively limited number of patients, no significant differences in outcome measurements (e.g. (re)interventions before CD diagnosis, number of successful fistula closure rates (clinical/radiological), and stomas/proctectomies) could be demonstrated between the two periods.

Conclusion
This study showed a significantly reduced delay in diagnosis of CD in patients presenting with perianal disease by introducing a low threshold for diagnostic work-up for CD. The promising results of this study were reason to continue data collection in a larger prospective study (currently ongoing) that forms the basis for the international development of an evidence based clinical decision tool including a perianal Red Flag Index and calprotectin measurement to select those at risk of having CD. Reducing delay in diagnosis by using such a clinical decision tool may improve outcomes and QoL in patients with perianal Crohn de novo.
P274 Clinical manifestations, risk factors and prognostic factors of Cytomegalovirus Colitis in Inflammatory Bowel Disease patients
Authors: Hsieh C R , Le P H , Kuo C J , Yeh P J , Chiu C T 
Published: January 2023

Abstract

Background
CMV colitis is associated with acute flare-up and poor prognosis in inflammatory bowel disease (IBD). However, few studies showed the clinical manifestations, risk factors, prognostic factors and the impact of anti-viral treatment of CMV colitis in IBD inpatients. Therefore, we aimed to comprehensively analyze these issues in this largest cohort study in Asia.

Methods
We retrospectively enrolled 118 IBD patients, including 42 CMV colitis and 76 non-CMV colitis, confirmed by CMV immunohistochemistry (IHC) staining from colonic tissue biopsy, from the pathology database in a 4000-bed tertiary medical center between January 2000 and May 2021. The patient characteristics, clinical manifestations, risk factors, prognostic factors and the impact of anti-viral treatment were analyzed.

Results
Major clinical manifestations in the CMV group included bloody stool (75.6%), diarrhea (68.3%) and abdominal pain (61%). The risk factors of CMV colitis were hypoalbuminemia (p=0.008) and antibiotic exposure (p=0.029) (Table 1). Seventy-nine percent of patients with CMV colitis received anti-viral treatment. In view of overall IBD complications, biological failure (OR 4.034, CI 1.659-9.805, P=0.002) and antiviral agents use (OR 0.08, CI 0.008-0.787, P=0.03) were independent prognostic factors in multivariate analysis (Table 2). In CMV group, the patients receiving adequate anti-viral treatment (≧ 14 days) had significantly lower IBD complications (29.2% vs. 72.2%) than inadequate or no treatment, especially in Crohn’s disease (Table 3).

Conclusion
Hypoalbuminemia and antibiotics use were the risk factors for CMV colitis in IBD patients. CMV colitis and biological failure lead to more overall IBD complications. However, definitive diagnosis and adequate anti-viral therapy can decrease the overall IBD related complications.
P276 Development and validation of a computed tomography-based radiomic nomogram to predict early-onset surgery risk in patients with Crohn’s disease
Authors: Yao J , Zhong Y , Zhou J , Zhi M 
Published: January 2023

Abstract

Background
Identifying patients with aggressive Crohn’s disease (CD) threatened by a high risk of early onset surgery is challenging. We aimed to establish and validate a radiomic nomogram to predict one-year surgery risk after the diagnosis of CD, thereby facilitating therapeutic strategies making.

Methods
Patients with CD who had undergone computed tomography enterography (CTE) examination at diagnosis were recruited and randomly divided into training and test cohorts at a ratio of 7:3. Arterial phase CTE images were obtained. Inflamed segments and mesenteric fat were semiautomatically segmented, followed by feature selection and signature building. A radiomic nomogram was constructed and validated using a multivariate logistic regression algorithm. (Figure 1)

Results
A total of 268 eligible patients were retrospectively included, 69 of whom underwent surgery one-year after diagnosis. A total of 1208 features from inflamed segments and 1100 features from peripheral mesenteric fat were extracted, and reduced to 11 and 16 potential predictors, respectively, to construct two radiomic signatures. By incorporating the radiomics signatures and clinical factors, the radiomic-clinical nomogram showed favorable calibration and discrimination in the training cohort, with an area under the curve (AUC) of 0.957, which was confirmed in the test set (AUC, 0.917). Decision curve analysis and net reclassification improvement index demonstrated the clinical usefulness of the nomogram. (Figure 2)

Conclusion
We successfully established and validated a CTE-based radiomic nomogram with both inflamed segment and mesenteric fat simultaneously evaluated to predict one-year surgery risk in CD patients, which assisted in clinical decision-making and individualized management.
P279 Ileo-caecal stenosis in Crohn's disease: correlation between imaging, biology and endoscopy : preliminary results of a prospective study
Authors: Azzouzi D , Azzouzi D , Berhili C , Lagdali N , Benelbarhdadi I , Borahma M , Ajana F 
Published: January 2023

Abstract

Background
Stenosis is the most common complication of Crohn's disease (CD). Imaging of the ileo-caecal junction is mainly based on endoscopy, ultrasound, CT-enteroclysis or entero-MRI. The aim was to evaluate the performance of digestive ultrasound in the monitoring of Crohn's disease.The purpose of this work is to show the performance of digestive ultrasound and fecal calprotectin in the monitoring of CD. We compared the results of digestive ultrasound, enteroscan or enteroIRM with endoscopy and biology

Methods
This is a prospective study including 42 patients, spanning between July 2021 and July 2022. Clinical, biological, radiological and endoscopic data were studied. Khi-2 test was used with a value of p&lt;0.05 which was considered statistically significant.

Results
We included 42 patients in our study, divided into 18 men 24 women (sex ratio M/F is 0.75), mean age was 43.2 years, with a CD of L1 or L3 location, according to the Montreal classification were prospectively included. The main risk factor found was smoking in 61.9% of patients.
The majority of patients (80.95%, n = 34) had koenig syndrome. All patients underwent digestive ultrasound, CT-enteroclysis and colonoscopy with an average delay of 15 days between the examinations.
Digestive ultrasound showed intestinal thickening in 85.71% (n=36), of the small intestines in 57.14% of patients and localized at the terminal ileum (21.42%). Loss of stratification was found in 40.47% of patients, ileo-caecal stenosis in 57.14%, a directed fistula in 23.80% of patients, a deep collection in 28.57% (n=10). The CT-enteroclysis showed stenosing thickening of the ileo-caecal junction in 66.67% (n=28), a deep collection in 38.09%, a combed aspect of the mesentery in 33.33% and intestinal thickening associated with a fistulous path in 35.71%.
Colonoscopy was performed with catheterisation of the last ileal loop in the majority of patients (73.80%, n=31). It showed ulcerations in 88.09% (70.5% deep and 17.6% superficial) and a stenosis that could not be crossed by the colonoscope in 40.47% (n=17). The mean level of faecal calprotectin was 532.5 with a standard deviation of 265.1 reflecting moderate to severe disease activity.
There was a correlation between ultrasound and endoscopy in 71.4% of cases (n=30). There was significant correlation between endoscopic and ultrasound inflammatory activity (p=0.01) and between the location of intestinal thickening and ulcerations on endoscopy (p=0.01).

Conclusion
Ultrasound is non-radiating, reproducible and available, coupled with fecal calprotectin constitutes an accessible and easy monitoring tool. Our preliminary results are satisfactory and the study is still in progress to confirm the interest of ultrasound in the follow-up of patients with CD.
P283 Awareness and perceptions of colorectal cancer risk and screening in Inflammatory Bowel Disease
Authors: Liu E , Erande A , McLaughlin J , Limdi J K 
Published: January 2023

Abstract

Background
Patients with inflammatory bowel disease (IBD) are at higher risk of developing colorectal cancer (CRC). Guidelines recommend periodic endoscopic surveillance to detect and manage dysplasia. We aimed to explore patient knowledge and perceptions of CRC risk and colonoscopic surveillance and identify potential barriers to surveillance practice.

Methods
A 44-item questionnaire was administered to IBD patients with colonic involvement attending gastroenterology clinics between July 2021 and April 2022.

Results
Of 418 respondents (demographics see table 1), 266 (64%) had ulcerative colitis and 145 (34%) had Crohn’s disease, with 177 (42%) diagnosed for ≥10 years. Two hundred and sixty-five (66%) patients rated their IBD control moderate/good (score ≥7/10), and 314 (75%) self-rated their understanding of IBD as good/excellent. Two hundred and ninety-eight patients (71%) recognised that CRC risk is higher in IBD but 83 (20%) felt the risk of CRC was lower in IBD or were unsure. Age (p=0.02), being a Crohn’s and Colitis UK (CCUK) member (p&lt;0.001), patient rated IBD control (p=0.04) and self-rated understanding of IBD (p=0.01) were associated with better CRC risk awareness. One hundred and forty-nine (36%) respondents stated that their IBD healthcare professional (HCP) had previously discussed CRC risk with them; this was associated with better CRC knowledge (p=0.001). On multivariate analysis CCUK membership (OR 2.75; 95% CI 1.57- 4.83; p&lt;0.001), prior HCP discussion (OR 1.57; 95% CI 0.85-2.87; p=0.01) and age ≥65 years (OR 0.3; 95% CI 0.09- 0.99; p=0.05) were predictive of greater CRC risk awareness. Concerning the most appropriate screening test for dysplasia, 369 patients (88%) stated colonoscopy, but only 29 (7%) were aware that colonic surveillance should commence 8-10 years after diagnosis; 153 (37%) recognised that optimal timing is when IBD is in remission. Patient reported information sources included gastroenterology HCPs (43%), patient support groups (28%), and patient leaflets (17%). The majority (78%) stated they would agree to have surveillance colonoscopy if advised by their HCP. Bowel preparation (50%) and discomfort (45%) were factors most likely to dissuade patients from agreeing to surveillance.

Conclusion
Patient knowledge of CRC risk and surveillance practice in IBD is variable. Modifiable factors associated with improved knowledge are discussion with HCPs and CCUK membership. Our findings underscore the need for better patient education to aid informed decision-making between patients and HCPs and improve adherence to colonoscopic surveillance.
P292 Complications in elderly-onset Inflammatory Bowel Diseases – A population-based study from the epidemiological database of the Israeli IBD Research Nucleus (Epi-IIRN)
Authors: Ben Hur D , Lebedenko B , Issaschar G , Moshe R , Lujan R , Focht G , Loewenberg Weisband Y , Kariv R , Ledderman N , Matz E , Dotan I , Turner D , Pinto G , Waterman M 
Published: January 2023

Abstract

Background
The population of elderly-onset (diagnosis &gt;=65 years old) inflammatory bowel disease (IBD) is growing worldwide. Management of this population poses challenges, given the overall increased morbidity at the elderly age. Data related to complications in this population are limited. We performed a population-based study of elderly IBD patients to characterize complications compared with non -IBD matched individuals.

Methods
As part of the validated epidemiological cohort of the Israeli IBD Research Nucleus (epi-IIRN), we included all elderly-onset IBD patients (age at diagnosis &gt;65 years) from the four Israeli health funds diagnosed from 1.1.2005 until 30.06.2020, covering 98% of the Israeli population. Each IBD case was matched at diagnosis to 3 non-IBD individuals by year of birth, sex, geographic district, and health fund. Comparison of incidence of pneumonia, osteoporotic fractures, bacteremia/septicemia and venous thromboembolism events were made. Time to complication was compared using the Kaplan-Meier survival analysis, stratified by IBD subtype, sex and any exposure of &gt;3 months to immunosuppressive IBD medications. Cox proportional hazard models were sought to explore complications risk adjusted by comorbidities (chronic obstructive pulmonary disease, ischemic heart disease and other diseases).

Results
A total of 2,163 elderly-onset IBD patients were identified (46% males; 48% with Crohn’s disease, median (IQR) age at inclusion 71 [68, 76] years, exposure to &gt;3 months of systemic CS 25%, thiopurines 10%, methotrexate 3.3%, anti-TNF 10.2%, Vedolizumab 5.7%, Ustekinumab 1.7%) and compared to 6,489 matched non-IBD controls. Median (IQR) follow-up time was 74 (40, 118) months. Incidence rates of pneumonia, fractures, bacteremia and venous thromboembolism are shown in table 1. On univariate analysis event-free survival analyses were similar in IBD and controls in pneumonia (p=0.72), osteoporotic fractures (p=0.79), bacteremia (p=0.085) and venous thromboembolism (p=0.14) Figure 1. Survival analysis remained similar when stratified by sex, IBD subtype and drug exposure. Using the comorbidity adjusted Cox model, the overall HR of pneumonia was 1.04 (95% CI 0.835-1.294), for osteoporotic fractures was 1.026 (95% CI 0.815-1.293); of bacteremia 2.161 (95% CI 0.865-5.397) and of venous thromboembolism 0.579 (95% CI 0.272-1.23).

Conclusion
In this population-based nation-wide study elderly onset IBD was not associated with increased risk of pneumonia, bacteremia, venous thromboembolism, and osteoporotic fractures compared with matched non-IBD elderly individuals. Studies in other populations are still needed to assess complications risk in diverse populations.