bluuebunny/crossref_metadata_2025_split huggingface dataset:
P230 Adalimumab in Crohn’s disease is protective against periodontitis based on a validated oral health questionnaire
Authors: Saravanapavan H , Rath S , Inniss S , Ong M , Sabalić M , D’Aiuto F , Rahman F , Smith A M 
Published: January 2023

Abstract

Background
Crohn’s disease (CD) is associated with a 3-4 fold increased risk of periodontitis compared to the general population1 though periodonitis is poorly recognised and diagnosed. Evidence from mouse models highlight an important link between oral and gut health. Periodontitis has been shown to lead to ectopic colonization of oral pathogens and oral Th17-T cells that activate lamina propria macrophages and exacerbate gut inflammation2. Very little is known about the patient demographics of those at risk of periodontitis. This study aimed to assess the risk factors for periodontitis in CD patients.

Methods
We conducted a cross-sectional study recruiting CD patients at UCLH through myCare, an online platform for patients linked to their clinical records. Patient data were obtained using EpicCare, a web-based electronic patient record database. Patient risk of periodontitis was determined using a previously validated oral health questionnaire3. Statistical tests were conducted using IBM SPSS Statistics 27.

Results
This single centre study included 89 CD patients; 54% female and median age of 40 (IQR 19-82). Patients predominantly identified as White British (56%). The majority had ileocolonic CD (51%) with non-stricturing/non-penetrating behaviour (70%) and were on biologic therapy (52%) (Tab 1). The oral health questionnaire identified 37% of CD patients at risk of periodontitis. There was no statistically significant association between periodontitis risk and age, gender, age at CD diagnosis, disease duration, CD phenotype, family history, body mass index (BMI) or smoking status. Current steroid, immunomodulator use and number of prior biologics also showed no association. Current use of adalimumab and ustekinumab were both independently correlated with risk of periodontitis (χ2 p=0.004 & χ2 p=0.044, respectively). 90% of patients receiving adalimumab were not at risk of periodontitis (Fig 1). In contrast, 60% of patients on ustekinumab were at risk of periodontitis. Logistic regression analysis showed that patients receiving adalimumab were 86% less likely to be at risk of periodontitis compared to patients not receiving adalimumab (OR 0.14 (CI 0.029 - 0.633, p=0.011)). 75% of the adalimumab group was anti-TNF naïve, but no association was seen between prior biologic use and periodontitis risk (p=0.91).

Conclusion
The questionnaire has identified a third of patients who are at risk of periodontitis in the CD cohort. Adalimumab shows benefit in mitigating this risk and may be a drug of choice in patients with oral disease. The questionnaire is a helpful tool to identify and refer at-risk patients.
P232 Serum neutrophil gelatinase associated lipocalin (NGAL) as a marker of activity of Inflammatory Bowel Disease
Authors: Ali K , Bahgat M , Borg A , Maher M , Abozeid F 
Published: January 2023

Abstract

Background
Inﬂammatory bowel disease (IBD) is a disease of activity and remission. Lipocalin 2 (LCN2), the coding gene for NGAL is one of the most over-expressed genes in the colonic mucosa in ulcerative colitis (UC) and crohn’s disease (CD). In our research we investigated the utility of serum level of Lipocalin 2 in assessing the activity of IBD

Methods
This was a single center case control study.It was conducted on 60 IBD patients, 50% (30 patients) were in remission and 50% were active.There were about 28 healthy control. Patients with IBD either UC or CD were enrolled from IBD clinic Mansoura specialized medical Hospital, Egypt.
All patients and control group were subjected to investigations including complete blood count (CBC) ,Erythrocyte Sedimentation Rate (ESR) ,C-reactive protein (CRP),Fecal calprotectin and serum neutrophil gelatinase associated lipocalin (NGAL) by ELISA.Patients only were subjected to sigmoidoscopy or ileo-colonoscopy.The activity of IBD was assessed for UC by MAYO score and CD by CDAI.

Results
NGAL showed significant increase among active IBD patients by mean± SD ng/ml (37.04 ± 9.63) than patients in remission (20.65± 4.35).It showed highly significant correlation with clinical and endoscopic activity of IBD r= 0.80, P&lt;0.0001. Serum NGAL can easily discriminate patients with active IBD from healthy controls with AUC 95% C.I =1.00 (0.94-1.0), at the cutoff 18.52 , P&lt; 0.0001, with sensitivity 100% and specificity 100%. While AUC of NGAL which can discriminate patients with active IBD and those in remission at the cutoff 26.95 was 0.97, P&lt; 0.0001, with sensitivity 93.3% and specificity 93.3%.
In relation to fecal calprotectin, there was highly significant correlation between fecal calprotectin and serum NGAL (r=0.69 , P&lt; 0.0001).Both CRP and ESR were positively correlated to NGAL by r=0.38 and r=0.29 (P&lt;0.05) respectively.
Figure (1): NGAL ROC curve among active IBD cases versus healthy controls.

Conclusion
Serum NGAL can easily discriminate patients with active IBD from healthy controls as well as among patients in active or remission of IBD. NGAL in comparison to other markers as fecal calprotectin or CRP or ESR shows better statistical performance for activity of IBD. This clarifies its ability to be a highly significant predictor of activity of IBD besides its lower cost.
P236 Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn’s Disease: The Challenges of Accurate Endoscopic Scoring
Authors: Van Der Does De Willebois E , Duijvestein M , Wasmann K , D'Haens G , van der Bilt J , Mundt M , Hompes R , van der Vlugt M , Buskens C , Bemelman W ,   DETECT study group
Published: January 2023

Abstract

Background
Adequate endoscopic scoring in Crohn’s disease (CD) is crucial, as it dictates the need for initiating postoperative medical therapy and is utilised as outcome parameter in clinical trials. We aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses.

Methods
Two prospective patient cohorts were included: ileocolic resection (ICR) for CD, and right-sided colon resection for colorectal cancer (CRC). Videos taken during colonoscopy six months postoperatively were evaluated. The SES-CD and modified Rutgeerts score were determined. Primary outcome was the presence of ulcerations in CD patients on both the inverted and everted stapled lines, fig1. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line.

Results
Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 (76·8%) at the inverted- versus 1/71 (1·4%) at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 (67·7%) at the inverted versus 0/6 (0%) at the everted stapled line. 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line.

Conclusion
Inverted stapled lines heal with ulcerations, whereas the everted stapled line heal without any ulcerations, both in CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients’ quality of life and on health-care costs if postoperative treatment is initiated incorrectly.
P244 Prognostic Value of post-biological induction fecal calprotectin concentration on the long-term outcomes of Crohn’s disease
Authors: Gagnaire M , Bendavid C , Dewitte M , Brunet T , Desfourneaux V , Bordet M , Siproudhis L , Bouguen G 
Published: January 2023

Abstract

Background
Endoscopy remains the gold standard in Crohn’s disease (CD) to assess mucosal healing but remains invasive and costly. Mucosal healing is the target to reach in current therapeutic strategies because of its association with improve CD outcomes. Fecal calprotectin is still only a surrogate marker due to the lack of data on its ability to predict disease progression. The main objective of this study is to assess whether the value of fecal calprotectin after introduction of biologic is predictive of long-term outcomes of Crohn’s disease.

Methods
From a prospective database, all patients followed for Crohn’s disease in a tertiary referral center were assessed. We included those in whom fecal calprotectin was measured 3 to 6 months after the introduction of a biologic. Patients were separated into two groups according to the value of fecal calprotectin (more or less than 250 µg/g). Disease outcome was assessed by a composite criterion including: the need for abdominal surgery, progression to complicated phenotype (B2, B3) and a change in therapy due to non-response.

Results
A total of 198 fecal calprotectin were measured within 3 to 6 months after introduction of biotherapy. Our study population was 61% female (n=120) with a mean age of 39 years. The average duration of the disease was 10 years, 41% (n=82) had never received biotherapy. The treatment initiated was an anti-TNF in 59% of cases (n=117), ustekinumab (n=64; 32%) or vedolizumab (n=17; 9%). A total of 127 (64%) fecal calprotectin were below 250 µg/g. We identified a strong association between postinduction fecal calprotectin value and the long-term outcome in Crohn’s disease patients. Fecal calprotectin was significantly associated with clinical remission without steroids at 1 year from initiation of treatment (p=0,014). In our population, 20 (10%) patients required surgery, 45 (23%) required a change in treatment, 13 (7%) had a change in phenotype and 61 (31%) had at least one of the three events described above. A fecal calprotectin level above 250 µg/g was associated with more abdominal surgery, phenotype and treatment change (HR 2.47 [1.4; 4,36] p:0,0018) (figure 3). In the subgroup of 82 (41%) patients with an available and elevated fecal calprotectine concentration before treatment initiation, the prognostic value of post-induction fecal calprotectin was even better (HR 4,83 [2,02; 11,6] p&lt;0,001) (figure 1). Fecal calprotectin was the only factor significantly associated in uni and multivariate with long-term disease outcome.

Conclusion
Post induction fecal calprotectin seems to be a good prognostic marker of long-term evolution of Crohn’s disease. These data could lead to limit the use of colonoscopy currently recommended to 6 to 9 months after the start of treatment.
P245 The Relationship Between the Endoscopic Healing Index and Magnetic Resonance Enterography In Crohn’s Disease Patients
Authors: Smith E , Chen J , Pan Y , Mahtani P , Lukin D , Ahmed W , Longman R , Burakoff R , Scherl E , Battat R 
Published: January 2023

Abstract

Background
The endoscopic healing index (EHI) is a serum biomarker panel that identifies endoscopic Crohn’s Disease (CD) activity. Endoscopy and biomarkers are limited in assessing small bowel disease compared to magnetic resonance enterography (MRE). The Simplified Magnetic Resonance Index of Activity (MaRIAs) is validated to detect CD activity. Data are lacking on the relationship between EHI with other endpoints. This study performed the first assessment of EHI to diagnose CD-related intestinal inflammation on MRE using the MaRIAs score.

Methods
Data were extracted on CD patients with EHI within 90 days of MRE. We assessed the diagnostic accuracy of EHI for any (MaRIAs≥1) or severe (MaRIAs≥2) MR inflammation identified on MRE using area under the receiver operator characteristic (AUROC) curve analyses. Proportions with inflammation on MRE were compared between groups above and below the identified EHI and FCAL threshold. Analyses were repeated between EHI and active endoscopy (SES-CD≥5), fecal calprotectin (FCAL&gt;50, &gt;250), and clinical symptoms (CD PRO-2≥8).

Results
241 MREs uniquely paired to either EHI or FCAL from 155 patients, mean age was 42 years, 50.3% were female, 83.2% of patients had small bowel involvement, and 29.7% had penetrating disease. The mean time between EHI to MRE was 28 days, and the mean time between FCAL and MRE was 24 days. Both EHI and FCAL had similar accuracy to diagnose inflammation (AUROC: EHI:0.635-0.651, FCAL:0.680-0.708). Optimal EHI values were 42 and 26 for inflammation on MRE and endoscopy, respectively. Patients with EHI≥42 (100% vs. 63%, p=0.002), FCAL&gt;50µg/g (87% vs. 64%, p&lt;0.001) and FCAL&gt;250µg/g (90% vs. 75%, p=0.02) had higher rates of MaRIAs≥1 compared to lower values. EHI differentiated ileitis more than FCAL (delta: 24-25% vs. 11-21%). Patients with low FCAL had high rates (59-69%) of active endoscopic disease, whereas those with low EHI rarely (6%) with endoscopic activity. Patients with FCAL≥50µg/g had higher rates of severe inflammation compared to FCAL&lt;50µg/g (75% vs. 47%, p&lt;0.001) whereas smaller differentiation existed for EHI. In patients with CD PRO-2 scores, clinical remission was not associated with disease activity corresponding to active EHI, endoscopy, or MRE.

Conclusion
In CD patients predominantly with ileal involvement, EHI&gt;42 and FCAL&gt;50 were both specific to confirm inflammation on MRE. Lower EHI values (&lt;42), but not low FCAL (&lt;50), were associated with lower rates of severe radiologic inflammation. MRE inflammation was frequently present in the presence of low EHI and FCAL with similar proportions of false negative MRE results. However, the absence of endoscopic inflammation was only associated with low EHI, but not low FCAL values.
P246 2D Shear Wave Elastography as novel tool for the assessment of disease severity in patients with IBD
Authors: Demir E , Cindoruk M , Karataş A , Karakan T , Kılıç G , Ergin M , Cerit M N , Ozbas C , Oktar S O , Ucar M , Gulbahar O , Demir B 
Published: January 2023

Abstract

Background
Intestinal Ultrasound (IUS) is a non-invasive modality capable of assessing disease activity in IBD. IUS is reliable, patient-friendly, and allows frequent monitoring of disease activity. Elastography is a measure of tissue stiffness, that is usually studied for the evaluation of intestinal fibrosis in previous studies. However, the addition of elastography to standard IUS for assessing disease severity is still limited. Here we present novel data on the diagnostic value of 2D shear-wave elastography (SWE) in the evaluation of disease severity in patients with IBD.

Methods
In this prospective descriptive study performed in a single center, consecutive 38 patients with UC and 22 CD were included. Disease activities of UC patients were evaluated by Mayo score and Endoscopic Activity Index (EAI) while Crohn’s Disease Activity Index (CDAI) and Harvey-Bradshaw Index (HBI) evaluated disease activation of CD patients. The bowel wall thickness (BWT) and Limberg score were also measured. The intestinal segment held by an experienced single operator with the 2D-SWE technique was estimated, and its value in kilopascal (kPa) was recorded.

Results
A statistically significant correlation was found between the stiffness values obtained with SWE, BWT and disease activity scores. Tissue stiffness (kPa) was correlated with HBI (r=0.772, p&lt;0.01), CDAI (r=0.817, p&lt;0.01), C-reactive protein (r=0.503, p=0.02) in CD. In UC, tissue stiffness was correlated with Mayo score (r=0.491, p=0.002), EAI (r=0.481, p=0.003) and C-reactive protein (r=0.423, p=0.009). The correlation of BWT and tissue stiffness was (r=0.797, p&lt;0.05 and 0.698, p&lt;0.05 in CD and UC, respectively). Limberg score was correlated with tissue stiffness values (r=0.743, p&lt;0.05 and r=801, p&lt;0.01 in CD and UC, respectively). The duration of illness was correlated with tissue stiffness values in patients with UC (r=0.665, p&lt;0.05), however it was not correlated in CD patients.

Conclusion
2D-SWE is a promising tool in assessing disease activity in patients with CD and UC. Further studies are needed to understand the additive value of elastography in the clinical assessment of patients with IBD.
P255 Diagnostic delay and economic burden in Inflammatory Bowel Disease: a single-centre experience in patients treated with biologics
Authors: Todeschini A , Angelini C , Tessari R , Ossato A , Lunardi G , Geccherle A , Zuppini T , Variola A 
Published: January 2023

Abstract

Background
Inflammatory Bowel Disease (IBD), Crohn's Disease (CD) and Ulcerative Colitis (UC), are chronic and immune-mediated diseases with a relapsing-remitting trend. The overall incidence of these diseases is increasing. However, it is estimated that more than one third of patients experienced symptoms for more than one year before diagnosis. Delay in IBD diagnosis has several clinical, therapeutic and economic implications. Early diagnosis and proper treatment are the cornerstones for improving the standard of care for these patients.This study aims to evaluate the diagnostic delay in patients with IBD and to analyze the clinical and economic burden of the delay in IBD diagnosis in patients treated with biological drugs.

Methods
An observational and retrospective study was performed in IBD patients, regularly followed in our IBD Unit. Data regarding delay in IBD diagnosis were assessed through a questionnaire evaluating the disease course. Moreover, data about biologics dispensation were obtained from the medical records in the period 2014-2020.

Results
606 IBD patients were enrolled. The median delay in IBD diagnosis was 5.0 months (IQR:1.0 11.0); it was statistically lower in UC patients (4 months (IQR: 1.0 12.0)) compared to CD (6 months (IQR: 2.0 12.0)) ( p =0.041). Of these 606, 229 patients were treated with biological therapy; in this subgroup 58.9% showed a diagnostic delay. The statistical analysis showed that the diagnostic delay was statistically significant associated with biological drugs (p=0.041). Conversely, there was no association with surgical treatment. Moreover, it has appeared that the diagnostic delay is associated, with a trend of statistical significance, with need to switch or swap to other biologics (p=0.058). Regarding economic burden, patients with delayed diagnosis have significantly higher median annual cost of biological therapy than patients without diagnostic delay (€7179.26 vs € 5131.51 p= 0.009).

Conclusion
The diagnostic delay in IBD represents a challenge with clinical, therapeutic and economic impact. It’s crucial to cooperate with general practitioner and gastroenterologists not dedicated to IBD in order to reduce the diagnostic delay and guarantee an effective, appropriate and early treatment that will improve the patients’ quality of life and meanwhile reduce the health care system costs.
P256 Urinary lithogenic profile and gut and urinary microbiota in patients with inflammatory bowel diseases
Authors: Mignini I , Masucci L , De Maio F , Laterza L , Scaldaferri F , Settanni C R , Napolitano D , Baroni S , Garcovich M , Riccardi L , Gasbarrini A , Ferraro P M , Papa A 
Published: January 2023

Abstract

Background
Nephrolithiasis (NL) is a common extra-intestinal complication of inflammatory bowel disease (IBD) with recognizable morbidity and mortality. However, its pathogenesis and risk factors are not completely elucidated yet. Because of intestinal malabsorption, enteric hyperoxaluria is a crucial pathogenic mechanism responsible for developing urinary stones in IBD patients. In recent decades, growing evidence has highlighted the association between gut microbiota and NL, with a particular emphasis on the role of some oxalate-degrading bacteria, such as Oxalobacter formigenes, representing the mainstay of the so-called “gut-kidney axis.” More recent studies also hypothesize the involvement of urinary microbiota, but no data on IBD patients are available. Thus, we conducted a pilot study to analyse the urinary lithogenic profile in IBD patients and its relationship with gut and urinary microbiota.

Methods
Consecutive patients with IBD were prospectively enrolled. The presence of ileoanal pouch, ileostomy, colostomy, or short-bowel syndrome were exclusion criteria. Demographic and clinical data, including previous episodes of NL, were collected. Disease activity was evaluated using Harvey-Bradshaw and Mayo scores for Crohn’s disease (CD) and ulcerative colitis (UC). All patients underwent abdominal ultrasound for NL detection, and blood tests of kidney function (creatinine, blood urea nitrogen, creatinine clearance, electrolytes) were also measured, together with 24h-urine collection for lithogenic profile analysis, including calcium oxalate relative saturation ratio (RSRCaOx). In a subgroup of patients, urinary and faecal microbiota were also analysed through 16S rRNA sequencing.

Results
36 patients (20 CD and 16 UC) were enrolled. NL was more frequent in CD than in UC (25% vs. 6.25%). 24-h oxaluria was significantly increased in patients with previous or present NL (p=0.02), and RSRCaOx was significantly higher in CD than in UC (p=0.02) (Figure 1). Gut microbiota analysis revealed a higher relative abundance of Bacteroidetes and a lower abundance of Firmicutes in patients with an elevated RSRCaOx, defined for values more than the median (Figure 2). No statistically significant differences were observed in urinary microbiota composition in relation to high or low levels of RSRCaOx.

Conclusion
NL is more common in IBD patients with higher oxaluria levels, confirming oxalate excretion's crucial role in NL pathogenesis. Furthermore, our study reports an association between urinary stone development and Firmicutes/Bacteroidetes imbalance in the gut microbiota, suggesting possible further studies to identify patients at higher risk of NL.
P258 The association between dietary quality and disease severity in Korean young adult patients with Crohn’s disease: A pilot study
Authors: Jeong E S , Lee Y J , Song E M , Byeon J R , Lee A , Choe A R , Hong J T , Park Y H , Tae C H , Moon C M , Jeong H K , Shim K N , Jung S A , Kim Y , Kim S E 
Published: January 2023

Abstract

Background
Although associations between various single nutrients and exacerbation of inflammatory bowel disease (IBD) have been reported, more recent attention has focused on overall dietary patterns and quality rather than a single nutrient. This study was to investigate the association of dietary inflammatory potential and dietary quality with disease severity in young adult Crohn’s disease (CD) patients.

Methods
Non-consecutive 3-day food records were investigated in 25 patients with CD aged 19-40 years. Patients with moderate or severe active disease were excluded to investigate their usual dietary habits. A survey on dietary behavior was conducted and clinical data including the disease progress were collected. To investigate potential pro-inflammatory dietary habits in a patient's usual diet, food-based index of dietary inflammatory potential score (FBDI), glycemic index (GI), and glycemic load (GL) were calculated. Diet quality was evaluated using a tool called Diet Quality Index-international (DQI).

Results
Although most patients showed adequate caloric intake, 72% of the enrolled patients had a potential pro-inflammatory pattern identified as FBDI. The FBDI was significantly associated with intake of mixed coffee and sweeten drinks, beef, and pork (P &lt; 0.05). Patients who had a serious clinical course such as history of surgery or the use of biologics, tended to have a higher FBDI (6.45 vs 2.44, P = 0.08), and showed a higher proportion with a low DQI (53% vs 20%, P = 0.06). Only 30% of the high FBDI group showed deep remission after 12 to 18 months of follow-up endoscopic or image study, whereas 72.7% of the low FBDI group showed deep remission (P =0.05). A significantly positive correlation was derived between FBDI and GL (r =0.452, P = 0.02).

Conclusion
For the care of patients with CD, it is necessary to evaluate the dietary quality as well as the total nutrient intake, and we need to educate the patients that dietary habits can affect the disease prognosis.