bluuebunny/crossref_metadata_2025_split huggingface dataset:
P818 Survival of ustekinumab treatment based on concomitant immunomodulator use
Authors: García Ramírez L , Suárez Ferrer C , Rueda Garcia J L , Martín-Arranz E , Poza Cordón J , Sánchez-Azofra M , Martin-Arranz M D 
Published: January 2023

Abstract

Background
Given the low immunogenicity of ustekinumab (UST), it has been suggested that it is not necessary to add an immunomodulator (IMM). However, there is little scientific evidence on whether the efficacy of combined UST+IMM treatment may be greater than in monotherapy, due to the concomitant action of both drugs. The aim of the study was to evaluate the survival of UST treatment with and without concomitant IMM.

Methods
Patients with stable follow-up at Hospital Universitario La Paz (Madrid), with Crohn’s disease (CD) and previous or current treatment with UST, since May 2016, were retrospectively included.

Results
A total of 137 patients were included. Table 1 shows the baseline characteristics.

In 98 patients (71.53%) UST indication was induction of remission; in 22 (16.06%) post-surgical recurrence treatment; in 5 (3.65%) it was prescribed as post-surgical recurrence prophylaxis; and in the remaining 12 (8.76%) the indication was for other reasons.
At the time of analysis, 91 (66.42%) patients were still on active treatment and 46 (33.58%) had discontinued treatment (of which 9 due to primary failure, 27 due to secondary loss of response, 9 due to adverse events, 1 due to remission).
89 patients (64.96%) did not receive concomitant IMM. Whilst, 48 (35.04%) received concomitant treatment with an IMM. The mean time of IMM treatment was 9.16 years (SD 6.76).
UST treatment had a mean duration of 2.19 years (SD 1.35) in patients receiving concomitant IMM; while it was of 1.67 years (SD 1.02) in those who did not receive concomitant IMM; being this statistically significant (p=0.0124) (Figure 1).

When performing a multivariate analysis by linear regression, the only variables that negatively influenced UST survival were age at diagnosis (Coef. -0.36; p=0.028), perianal disease (Coef. -0.29; p=0.198) and location rather than L1 (Coef. 0.2; p=0.072). However, concomitant IMM use had a positive influence (Coef. 0.45; p=0.032).

Conclusion
In our experience, the survival of ustekinumab is greater in combined treatment with immunosuppressant, being also the only independent variable associated with a greater durability of the drug.
P821 Improving outcome after Inflammatory Bowel Disease surgery in an Enhanced Recovery After Surgery setting
Authors: Juvik A F , Poulsen J K , Roikjaer O , Fransgaard T 
Published: January 2023

Abstract

Background
Enhanced Recovery After Surgery (ERAS) has been known to improve patient outcome after colorectal cancer surgery. However, far less data exists on ERAS used in patients undergoing surgery for Inflammatory Bowel Disease (IBD).

Methods
From March 2020 our surgical IBD patients were admitted to a dedicated colorectal ward instead of a general surgery ward. The colorectal unit already had a history of ERAS for colorectal cancer patient and has specialized ERAS-nurses. The goal was also that IBD-surgery preferably was done by two surgeons from the colorectal team.
Data on all elective IBD surgery in our department from January 2018 through June 2022 was collected from our local IBD-surgery database in order to compare Length of Stay (LOS), readmission rates, surgical approach and complication rates before and after March 2020.

Results
In total 233 patients underwent resections on small bowel, colon or rectum in our institution in a 4.5 year period. Patients undergoing emergency surgery were excluded. In the first period until March 2020, 105 patients were operated and in the second period until June 2022, 128 patients went to surgery. The demographic data (Table 1) show two comparable groups as it does for type of surgery (Table 2).
The median LOS decreased from 6 to 4 days over time and the readmission rate was not significantly changed in the same period. Laparoscopic surgery was done on a larger percentage of the patients in the later period and the conversion-rate was significantly decreased in the same period. There was no difference in surgical complication rate (Table 3).

Conclusion
Admitting IBD patients undergoing surgery to a dedicated unit with specialized surgeons and nurses in an ERAS setting can reduce LOS and improve the surgical technique.
P829 The Burden of Colorectal Cancer in Patients with Ulcerative Colitis – Incidence and Risk factors from a Population-based Inception Cohort from Veszprem county, Western Hungary, from 1977–2020
Authors: Wetwittayakhlang P , Golovics P , Gonczi L , Khoury A , Kurti Z , Pandur T , David G , Erdelyi Z , Szita I , Lakatos L , Lakatos P L 
Published: January 2023

Abstract

Background
Limited data are available on the incidence and risk of colorectal cancer (CRC) in ulcerative colitis (UC) from population-based studies in Eastern Europe. We aimed to identify the long-term incidence trends and predictors of CRC in a prospective population-based inception cohort from Veszprem, Western Hungary.

Methods
Patient inclusion for the inception cohort was between January 1,1977 and December 31,2018, and follow-up ended December 31,2020. The risk of CRC was estimated using standardized incidence ratios (SIRs). Age-and gender-specific CRC rates of the background population were derived from the National Cancer Registry.

Results
A total of 1,370 incident UC patients were included [male:51.2%, median age at diagnosis:37years). During a median follow-up of 17 years(IQR9-24), CRC was diagnosed in 41 UC patients(2.99%), equaling 1.76/1000 person-year(py).Median age at CRC diagnosis was 59(IQR:50.0-67.5) years. Overall SIR of CRC was 2.02(CI95%:10.1-12.1). SIRs were higher in extensive colitis (SIR:3.77, CI95%:2.41-5.91). The cumulative probability of CRC at 10-,20 and 30 years was 0.9% (95%CI0.6-1.2), 3.5%(95%CI2.8-4.2), and 6.5%(95%CI5.4-7.6), and there was no difference in the risk of CRC over different decades of UC diagnosis in a Kaplan Meier analysis(Log-rank=0.693). In multivariate analyses, co-existing PSC(HR4.19;95%CI1.72-10.20), colonic dysplasia(3.42;95%CI1.04-11.26), and extensive colitis (HR2.15;95%CI1.29-3.60) were identified as a significant predictor for CRC.

Conclusion
We report an increased CRC risk in UC patients with a standardized incidence ratio of approximately 2 folds, with a stable CRC risk over four decades. Disease extent, co-existing PSC and dysplasia were identified as predictors of CRC.
P846 Epidemiological and Clinical Characteristics of Inflammatory Bowel Diseases in Patients from Greece
Authors: Liava C , Sinakos E , Dimitroulas T , Navrozidou C , Akriviadis E 
Published: January 2023

Abstract

Background
There are few reports from Greece about the epidemiological and clinical features of inflammatory bowel diseases (IBD), which were mainly evaluated in retrospective studies with data collection from hospital registries. We aimed to determine the epidemiological profile and clinical features as well as to detect any differences between patients with Crohn’s disease (CD) and ulcerative colitis (UC), based on retrospectively-prospectively collected data from a cohort of IBD patients followed in daily clinical practice.

Methods
Patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2022. Logistic regression analysis and chi-squared test were used to compare the frequency of epidemiological and clinical characteristics between patients with UC and CD.

Results
We collected 300 patients diagnosed with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis). The median age of IBD patients was 42 years. The onset of disease in CD group was observed between 17 and 40 years of age in the majority of patients (58%). Ileocolonic location of CD was present in 70% of CD patients; 39% had stricturing behavior and 29% had perianal disease (abscesses and fistulas). CD patients developed more often aphthous stomatitis (34%) than patients with UC (13%, OR 3.45; 95% CI: 1.76-6.78; P&lt; .001). Patients with CD had a 20-fold increased risk to undergo a surgical procedure (OR 19.87; 95% CI: 6.03-65.48; P&lt; .001), mainly enterectomy (26%), as shown in table 1. At study entry, C-reactive protein (CRP) elevation was more frequently present in CD compared to UC patients (OR 1.93; 95% CI: 1.04-3.59; P&lt; .05). Most patients with UC had extensive colitis (56%). Mesalamine was predominantly used in UC patients (81% vs 46% in CD, P&lt; .005), and sulfasalazine and thiopurines in CD patients (60-70% vs 9-13% in UC, P&lt; .005), as shown in table 2. The most commonly used anti-TNF agent was Infliximab, mainly in CD patients (24% vs 4% in UC, OR 0.12; 95% CI: 0.04-0.34; P&lt; .001). Adalimumab was used in 12% of IBD patients and Vedolizumab in 8%. Around 4% of patients with complicated CD received Ustekinumab. Tofacitinib was used in 2% of patients with severe complicated UC and extraintestinal manifestations. Enteral diet (Modulen®) was used in 6% of CD patients and in only 2% of UC patients with severe UC pancolitis.

Conclusion
In this retrospective-prospective cohort study of 300 patients with IBD, CD patients had a significantly higher risk of developing aphthous stomatitis and increased levels of CRP. CD patients also required more often treatment with anti-TNF agents and immunosuppressants, and a surgical procedure, mainly enterectomy.
P849 Exposure to metals and minerals in hair samples of patients with preclinical inflammatory bowel disease
Authors: Rodríguez-Lago I , Rodríguez A , Elorza A , Sampedro B , Jiménez I , Erdozáin I , Rodríguez P , Fraga A , De Castro L , Oyón D , Huerta A , Carmona M , Esáin A , Cabriada J L , Barreiro-de Acosta M 
Published: January 2023

Abstract

Background
Previous data have shown that the inflammatory process underlying ulcerative colitis (UC) and Crohn’s disease (CD) can start years before the diagnosis, but the role of triggering factors and environmental exposures is still unknown. Hair element analysis is a valuable and inexpensive screen for physiological excess or deficiency of certain elements. Our aim was to determine if patients with an incidental diagnosis of UC or CD demonstrate exposure of minerals or toxic metals in the years preceding the symptomatic onset of the disease.

Methods
We performed a prospective single-center study including all asymptomatic subjects with a diagnosis of UC or CD during the colorectal cancer screening program between January 2021 – June 2022 in Vizcaya (Basque Country, Spain). The diagnosis of IBD was established by a combination of clinical data, endoscopic findings suggestive of UC or CD, and after histologic confirmation. Cases were compared with a healthy non-IBD control population. An approximate hair sample of 0.25 g was obtained up to 3 months since diagnosis. We used a commercial kit that allows the investigation of 17 metals (Al, Sb, As, Ba, Be, Bi, Cd, Pb, Hg, Pt, Tl, Th, U, Ni, Ag, Sn, Ti) and 22 minerals (Ca, Mg, Na, K, Cu, Zn, Mn, Cr, V, Mo, B, I, Li, P, Se, Sr, S, Co, Fe, Ge, Rb, Zr). Descriptive statistics and non-parametric tests were used for comparisons between both groups.

Results
Three patients with preclinical IBD were included (median age 53 years; 67% male; all former smokers). Two of them had a diagnosis of UC (one left-sided colitis and one extensive colitis) and one with ileal CD. Extraintestinal manifestations were observed in one patient (33%). No family history of IBD was reported. Thirteen healthy controls with no relevant environmental exposures (median age 34 years; 69% female; 92% non-smokers). We found that cases demonstrated statistically significant higher concentrations of bismuth, sodium and boron compared to controls (Figure). In contrast, there was a lower exposure to uranium, zinc and germanium, with a trend towards lower copper levels among cases.

Conclusion
A range of environmental exposures can be identified during the preclinical phase of IBD. However, their relationship with the symptomatic onset and disease progression should be further explored.
P867 Cost-effectiveness and cost-only studies for Inflammatory Bowel Disease surgery: a scoping review
Authors: Leeds I , Prien C , Dill-Macky A , Li H , Lincango E , Holubar S 
Published: January 2023

Abstract

Background
Studies examining the relative cost-effectiveness of surgical procedures and surgery-related interventions for patients with inflammatory bowel disease (IBD) remain limited. This dearth of studies hampers decision-makers’ assessment of surgery-related interventions for IBD patients. The purpose of this study was to conduct a scoping review of available literature for cost-effectiveness analyses of IBD-related surgery.

Methods
We performed a comprehensive search of English-language articles in MEDLINE, EMBASE, Cochrane Reviews, and Scopus from each database's inception to May 1, 2022. Preplanned controlled vocabulary related to IBD and its subtypes, surgery, and measures of costs were used. We defined study selection criteria to include all IBD-related surgical interventions (including preoperative, intraoperative, and postoperative) in all age groups that also reported a measure of costs of care. Studies comparing medical versus surgical interventions for refractory IBD were excluded. All search findings were screened by two reviewers using titles, abstracts, and ultimately full-length manuscripts. Full screened studies were then extracted for study characteristics and findings to facilitate a qualitative synthesis of results.

Results
We identified 1,804 citations for screening and ultimately found 10 formal cost-effectiveness studies and 56 cost-only studies. Cost-effectiveness studies assessed intraoperative (50%) and postoperative interventions (50%) mostly in patients with Crohn's disease (60%). Topics included comparisons of surgical approach (50%), venous thromboembolism prophylaxis (30%), and surveillance for postoperative recurrence (2%). Of the cost-only studies, the majority focused on intraoperative interventions (89%), particularly in ulcerative colitis patients (60%). Areas of interest included costs associated with healthcare resource utilization during a surgery-related admission (89%), venous thromboembolism prophylaxis (4%), and others (7%). Pre-defined areas of interest with no reported interventions included IBD-specific roles of Enhanced Recovery After Surgery interventions such as alvimopan, robotic surgery, timing to surgery, surgical therapies for perianal disease, pediatric Crohn's Disease, and genetic testing.

Conclusion
A scoping review found minimal literature using cost-effectiveness techniques to inform IBD-related surgical care. There are many more cost-only than cost-effectiveness studies related to these clinical topics. This asymmetry highlights immediately available opportunities for broadening the use of cost-effectiveness analysis of IBD-related surgical interventions.
P868 Clinical features of chronic enteropathy associated with SLCO2A1 gene
Authors: Umeno J , Fuyuno Y , Torisu T , Matsuno Y , Esaki M , Yanai S , Ohmiya N , Hisamatsu T , Watanabe K , Hosoe N , Ogata H , Hirai F , Hisabe T , Matsui T , Kitazono T , Matsumoto T ,   CEAS study group
Published: January 2023

Abstract

Background
Chronic enteropathy associated with the SLCO2A1 gene (CEAS) is a hereditary disease caused by mutations of the SLCO2A1 gene which encodes a prostaglandin transporter. This disease is rare and intractable characterized by persistent blood and protein loss. There are few reports from Europe, and most reports are from Asian countries such as South Korea, China, and Japan. Because CEAS and Crohn's disease (CD) present ileal ulcers and stenoses, it is often difficult to distinguish CEAS from CD. Evaluation of characteristic upper gastrointestinal lesions observed in CEAS and extraintestinal findings, such as digital clubbing, periostosis, and pachydermia, can trigger suspicion of this disease, and genetic testing can be performed to confirm the diagnosis. Since little is known about the clinical features of CEAS, we conducted a nationwide survey in Japan.

Methods
All study participants provided written informed consent for genetic analysis. The present study was approved by the ethics committee of each institution. During the period between 2012 and 2022, 188 patients suspected of CEAS were enrolled in this study and checked to have SLCO2A1 gene mutations. We reviewed the clinical information of genetically confirmed CEAS patients.

Results
We confirmed the genetic analysis of 69 CEAS patients (24 males and 45 females) and found 19 different types of SLCO2A1 mutations. The median age at disease onset and diagnosis was 19 (range 1-69) and 42 (range 7-70) years, respectively. Parental consanguinity was present in 19 patients (26%). Although anaemia was present in almost all patients, only two patients experienced gross haematochezia. The median haemoglobin and serum total protein levels at diagnosis were 9.7 (range 2.3-14.4) and 5.3 (2.7-8.2) g/dl, respectively. Thirty-seven patients (54%) had undergone intestinal surgery. The most frequently involved gastrointestinal site was the ileum (94%), but the terminal ileum was rarely involved (4%). The lesions were shallow ulcers, varying in shape from circular, oblique, to longitudinal, sometimes forming pseudodiverticulum or luminal stenosis. The Gastric lesions were observed in 15 patients (22%) and duodenal lesions in 30 patients (43%). 20 patients (30%) had either mild digital clubbing, periostosis, or pachydermia. The extraintestinal findings, were more frequently found in males than in females (digital clubbing 52% vs 9%; periostosis 50% vs 10%; pachydermia 57% vs 0%).

Conclusion
Examination of the clinical features of CEAS reveals that ileal lesions are uniform and characteristic, but clinical features are diverse. Thirty per cent of patients with CEAS have extraintestinal features. There is a significant gender difference in extraintestinal features in CEAS patients.
P870 What had the greatest impact on the quality of life of IBD patients on intravenous biological therapy in Montenegro during COVID-19?
Authors: Smolovic B , Lukic M , Djurovic M , Muhovic D , Bojovic S 
Published: January 2023

Abstract

Background
COVID-19 has affected the quality of life (QoL) of patients with chronic diseases, including patients with IBD. The aim of this study is to evaluate the QoL of patients with IBD on intravenous biological therapy (IvBT), through the Short Inflammatory Bowel Disease Questionnaire (sIBDQ), and to correlate the results with sociodemographic data of the patients.

Methods
This study was comprised of patients older than 18 years of age, with a pathohistologically confirmed diagnosis of IBD (Ulcerative Colitis (UC), and Crohn’s Disease (CD)). The study was conducted on September and October 2020, during one of the highest incidences period of COVID-19 in our country. Patients completed the sIBDQ, and DASS-21 (Depression, Anxiety and Stress Score-21) questionnaire too, assessing their level of depression, anxiety and stress. For significant symptoms (DASS-21), we used at least moderate DASS-21 subscale score: DASS-21 Depression (≥ 14), DASS-21 Anxiety (≥ 10) and DASS-21 Stress (≥19). The Simple Clinical Colitis Activity Index was used to assess the disease activity of UC; for CD, the Harvey-Bradshaw Index was used. Patients who scored below 50 on the sIBDQ were those labeled with worse QoL. We also examined demographic data, data on IBD characteristics and COVID-19 data and their impact on quality of life.

Results
Of the total number of patients (94), there were 40 (42.5%) females, 42 (44.6%) with CD. All patients have been receiving IvBTh (anti TNFα: infliximab-originator and biosimilar (59 patients) and anti-integrins: vedolizumab (35 patients)) for at least 6 months prior. The results indicated worse QoL in 25 (27%) patients. Multivariate analysis showed that the greatest impact on poor QoL during the COVD-19 pandemic were: active disease (p= 0.002), significant symptoms on the DASS21 score (p= 0.013), patients who did not regularly go to work or were not employed (p=0.017), if they had a patient with COVID-19 in their immediate environment (p=0.024) and those who had a higher degree of health concerns about coming to regular admission to biological therapy at the IBD unit. (p=0.046).

Conclusion
27% of IBD patients on IvBT had worse QoL during the COVID 19 pandemic. In addition to disease activity and significant psychological disturbances, other reasons for lower QoL were identified during the pandemic and are directly related to it.
P881 Is occupation a risk factor for developing Inflammatory Bowel Disease? A case-control study
Authors: Mauriz Barreiro M V , Ruano-Ravina A , Ferreiro-Iglesias R , Baston-Rey I , Porto-Silva S , Nieto-Garcia L , Martinez-Seara X , Martin-Gisbert L , Dominguez-Munoz J E , Barreiro-de Acosta M 
Published: January 2023

Abstract

Background
The role of occupation is well established for different diseases. Nevertheless, there is a lack of information on the role of occupation on the onset of inflammatory bowel diseases. Many occupations entail the exposure of different toxic substances that may reach the bowel through different biological pathways (bloodstream or digestive tract) and act as possible triggers of such diseases, mainly Crohn′s disease and ulcerative colitis. The aim of this study is to identify if there is a role of occupation on the onset of IBD using a case-control study.

Methods
A prospective case-control, single-center study was designed. All Incident cases with any of the main IBD diseases (ulcerative colitis, Crohn’s disease and unclassified colitis) were consecutively included. Controls were patients selected from the consults and endoscopic room of the Digestive Unit of Clinical Hospital of Santiago de Compostela without any autoimmune chronic disease. Cases are patients with IBD disease diagnosed 3 or less months prior to the inclusion and over 18 years old. Cases and controls were recruited simultaneously and controls followed a sex and age frequency matching with cases. All participants were recruited from June 2020 to September 2022. A detailed questionnaire describing the occupations held and time of them was used. Blue-collar jobs have been defined as those entailing the highest risk occupational exposures and are also mentioned as manual workers. White-collar jobs are usually those with more office-related work, but also with teaching or health sector. To analyze the results, we used a logistic regression. A subgroup analysis was performed by each of the three diseases considered.

Results
129 patients with incident IBD (73 with ulcerative colitis, 51 with Crohn’s disease and 5 with indeterminate colitis) and 114 controls were included. Comparing patients with IBD with controls, there were no statistically significant differences between type of work, working hours, contact with animals or physical activity at work. Among the patients with IBD, there were no differences in the number of flares between groups (blue collar workers vs. white collar (p&gt;0.05), outside workers vs. indoor ones (p&gt;0.05), sedentariness vs. moderate activity or high activity (p&gt;0.05) or animal contact vs. no contact (p&gt;0.05)). Taking into account only patients with current work activity, the results did not change. After stratifying results according to type of IBD, there were no statistically significant differences either (table 1).

Conclusion
In this study, differences between type of work, working hours, contact with animals or sedentariness were not associated with the risk of IBD nor with the activity of this disease.