bluuebunny/crossref_metadata_2025_split huggingface dataset:
P339 Zonulin concentration in patients with ulcerative colitis with and without COVID-19 infection
Authors: Knyazev O , Kulakov D , Kagramanova A , Tishaeva I , Baranova T , Poletova A 
Published: January 2023

Abstract

Background
Zonulin is a protein, reversibly increasing the permeability of the intestinal wall by changing the structure of tight junctions of the lateral surfaces of intestinal epithelial cells. Fecal zonulin is used for noninvasive assessment of increased intestinal permeability. Normal values of zonulin in stool (≤ 110 ng/ml) indicate the absence of damage of the intestinal villous mucosal surface and normal density of intercellular contacts.
The aim of the study was to determine the level of fecal zonulin (FZ) in the feces of ulcerative colitis (UC) patients with exacerbation of the disease and the presence of COVID-19 in the acute period and without COVID-19 to assess the degree of intestinal permeability.

Methods
46 patients with IBD without COVID-19 (Me age — 36 years) and 31 patients with UC with the presence of COVID-19 infection in the acute period (Me age — 42 years) were examined. Untreated stool samples of patients were frozen and stored at a temperature of 80 °C. FZ was measured by ELISA (IDK ® Zonulin ELISA Kit, Immunodiagnostik AG, Germany) in ng/ml. Reference values: &lt; 83.15 ng/ml - a variant of the norm, 83.15-110 ng/ml - an elevated level, 110 ng/ml - a high level

Results
In the stool samples of patients with UC exacerbation without COVID-19 FZ was detected from 172.6 to 460.8 ng/ml (Me - 316), the average value was 322.4±14.6 ng/ml. In the stool samples of patients with UC exacerbation and COVID-19 infection, FZ was detected from 354.8 to 628.3 ng/ml (Me – 489.9), the average value was 472.9±18.4 ng/ml (p=0.000001).

Conclusion
FZ concentration in the feces of UC patients is significantly higher in UC patients with the presence of COVID-19 infection in the acute period, which indicates a higher permeability of the intestinal wall.
P341 Fracture risk in middle-age and older patients with inflammatory bowel disease: A Korean nationwide population-based cohort study
Authors: Lee J , Lee K M , Han K D 
Published: January 2023

Abstract

Background
Fracture risks and associated factors in middle-age and older Asian populations with inflammatory bowel disease are poorly understood. We investigated fracture risk and the effects of comorbidities and lifestyle habits on the risk of developing fractures in middle-age and older Korean patients with inflammatory bowel disease.

Methods
We conducted a nationwide population-based cohort study using data from the National Health Insurance Corporation Database. We included patients aged over 40 years with inflammatory bowel disease who received the National Screening Program. We compared patients with age- and sex-matched controls. The incidence of fractures, including vertebral, hip, and other sites was determined using claims data.

Results
The risk of total fractures and vertebral fractures was significantly higher in the inflammatory bowel disease group [adjusted hazard ratio=1.31, 95% confidence interval=1.16–1.48; adjusted hazard ratio=1.59, 95% confidence interval=1.33–1.92, respectively]. Obesity, diabetes, hypertension, and lack of exercise were associated with an increased risk of fracture in patients with ulcerative colitis. In contrast, risk tended to increase regardless of comorbidities and lifestyle habits in patients with Crohn’s disease.

Conclusion
The risk of bone fracture, especially vertebral fracture, is high in middle-age and older Korean patients with inflammatory bowel disease. Obesity, diabetes, hypertension, and lack of exercise are risk factors for bone fracture in patients with ulcerative colitis. These findings may be helpful for clinicians to educate patients with inflammatory bowel disease on bone health and raise awareness of bone fractures in patients with ulcerative colitis who have specific risk factors.
P342 Treatment experience 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
The treatment of complex Crohn’s perianal fistulas (CPF) is challenging, requiring both medical and surgical approaches. The treatment goal is fistula closure, but long-term success rates are modest and recurrence is high after both medical and surgical interventions. This systematic literature review (SLR) aimed to better understand the treatment patterns and outcomes associated with complex CPF.

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 therisk of bias/quality of studies (good, fair or poor). All interventions were of interest. Treatments were grouped into 16 intervention categories, and treatment responses into 4 healing and 7 failure categories. Data on five morbidity categories (faecal incontinence, abscess, anorectal stricture, proctitis and sepsis) were extracted and 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. Included studies reported on treatment patterns, failures and responses (n=63) and morbidity (n=30). Loose seton was the most commonly recorded first- and second-line intervention given in a study. Among drug therapies, immunomodulators and biologics were the most common first- and second-line interventions, respectively (Table 1). Across all categories, healing rates ranged from 10.5% to 80.2% and failure rates from 3.6 to 83.0% (Table 2). Of the top five most frequent intervention categories, fistulectomy/-otomy was associated with the highest rate of healing (fistula healing/closure), and loose seton placement was associated with the highest rate of failure (recurrence) (Table 3). Reporting of morbidity varied widely; of which, abscesses were the most common reported at CPF diagnosis, followed by proctitis (Table 4).

Conclusion
This SLR detailed a broad range of current therapies, healing and failure rates, and heterogeneity in timing and treatment sequencing in patients with CPF. These results reflect the challenging nature of treating CPF with current therapies and highlight an unmet need for reliable treatment options to improve outcomes for patients with CPF.
Funding: Takeda Pharmaceuticals USA, Inc.
P345 Capsule endoscopy in the diagnostic process of suspected Crohn's Disease
Authors: Hennlich B , Madl C , Pachofszky T 
Published: January 2023

Abstract

Background
Since more than 20 years, capsule endoscopy (CE) complements endoscopic and radiological examinations, to diagnose diseases of the small bowel (SB), for it allows the direct visualisation of the intestinal mucosa. Although nearly 30% of people suffering from Crohn’s Disease (CD) are affected by an inflammation solely in the SB, this minimally invasive approach is mostly used late in the diagnostic algorithm. Studies concerning indicators of quality of the CE system exist above all for the indication of obscure gastrointestinal bleeding (OGIB), therefore, the aim of this study is to analyse the detection, completion, and complication rate as well as visibility and passage times of the CE in a cohort with suspected CD. Additionally, the different CE models should be compared regarding these parameters and an assessment, which influence the intraobserver-variability exercises on the diagnostic accuracy should be conducted.

Methods
For this purpose, corresponding data out of written CE records from 430 patients in a tertiary hospital in the eastern part of Austria were retrospectively analysed. “Major Lesions” contained aphthoid, ulcerating and stenosing pathologies whereas “Minor Lesions” consisted of mucosal and villous abnormalities. In addition, the diagnose made after a follow-up period of six months was extracted from the individual medical records.

Results
52,8% of the examinations were performed using the CapsoCam system, altogether there was a detection rate of 35,1%, the most frequent detected lesions being aphthoid abnormalities (76,8%). There was a completion rate of 95,4% and an average passage time of 266,94 ± 121,11 minutes. In 1,2% of the cases, a capsule retention occurred with a 1696 times higher chance in the presence of a stenosis. The visibility was rated “good” in 72,6% and the comparison between CapsoCam, PillCam, MiroCam and EndoCapsule showed, that only the completion rate has been associated with the choice of the CE model. After six months, CD has been diagnosed within 26,5% of the patients, resulting in a sensitivity of 70,2%, a specificity of 81,5% and a negative predictive value (NPW) of 84,2%.

Conclusion
Bearing in mind the increasing global incidence of CD and the association between an isolated inflammation in the SB with a poorer prognosis, CE can be highly contributing to an early diagnosis. The method is minimally invasive, patient-friendly, with a low complication rate due to a selective patient evaluation for the indication of suspected CD and the technology is constantly developing. The lack of standardized diagnostic criteria may be an important limitation, especially regarding the diagnostic accuracy, but special endoscopic indices are coming more and more into effect.
P350 Endoscopic sedation in IBD patients: a propensity score-matched retrospective study
Authors: Levartovsky A , Cohen T , Klang E , Ben-Horin S , Kopylov U 
Published: January 2023

Abstract

Background
Colonoscopy plays an essential role in the prevention of colorectal cancer screening and the management of inflammatory bowel disease (IBD). For patients with IBD, colonoscopy is advocated for detection of complications, guiding clinical decisions, and cancer surveillance. In most cases, sedation is a fundamental constituent of the procedure, reducing peri-procedural discomfort and improving examination quality. We aimed to compare the dosing of sedative medications and the duration of procedure for IBD patients compared to non-IBD controls in a large-volume endoscopic center.

Methods
This was a propensity score–matched retrospective study that took place at a high-volume gastroenterology department between June 2020 and September 2021. Colonoscopy data of patients with established IBD including medications and duration of procedure was collected, compared to a 1:2 propensity-scored matched cohort of non-IBD patients. Patients with polyposis, past abdominal surgery, known or suspected malignancy, suspected IBD, incomplete colonoscopies and colonoscopies with inadequate preparation were excluded. The sedation protocol in our institution includes an induction of Midazolam 1-2 mg and Fentanyl of 0.025-0.05 mg administered five minutes prior to procedure. An initial dose of 10-30 mg Propofol is initiated as well, with subsequent increments of 10-20 mg every 1-2 minutes, depending on sedation depth.

Results
During the study period, 14502 patients including 996 patients with IBD underwent colonoscopy and 4933 patients were excluded in accordance with the exclusion criteria. Propensity score matching was conducted using four characteristics - patient age, gender, American Society of anaesthesiologists score determined by the endoscopist, and endoscopists’ experience. A total of 2289 patients were included in the final analysis (763 IBD patients, 1526 control patients). The groups were similar in administered Propofol sedation doses [IBD- median dose of 100 mg, interquartile ratio (IQR) 70-150 vs control, 100 mg, IQR 80-150, p=0.2). In addition, total procedure time (considered the time from procedure start and end as recorded by the endoscopy nurse) was significantly longer in the IBD group (23 median minutes, IQR 18-30 vs 20 median minutes, IQR 16-27, p&lt;0.0001). There were no differences in terminal ileum intubation rates between the groups (51% in IBD vs 49.5% in control, p=0.5).

Conclusion
In a retrospective analysis from a large-scale tertiary center cohort, colonoscopies of patients with IBD were significantly longer despite comparable terminal intubation rates; IBD patients did not require more intensive sedation than controls.
P352 Occurrence of moderate to severe anaemia and utilization and efficacy of intravenous iron therapies in a nationwide cohort of Inflammatory Bowel Disease patients
Authors: Khan N , Patel M , Sundararajan R 
Published: January 2023

Abstract

Background
Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD), and iron deficiency is the leading cause of IBD-associated anaemia. It is associated with impaired physical and cognitive functioning, increased hospitalization rates, and reduced quality of life. With the advent of newer formulations of intravenous (IV) iron the management of anaemia has undergone a transformation. Our aim was to evaluate the percentage of patients with IBD who developed moderate to severe anaemia over the course of their disease as they are the subset who would benefit most from IV iron. We also evaluated the utilization and efficacy of IV iron therapies among this group of patients in a real-world setting.

Methods
We conducted a retrospective cohort study utilizing the Veteran Affairs Healthcare System (VAHS) to identify patients who had IBD and were followed in the VAHS. IBD patients who had moderate to severe anaemia over the course of their disease based on WHO criteria (Hemoglobin level: &lt;10g/dl) were included in this study. Among this group of patients with moderate to severe anaemia, we determined how many patients were treated with different IV iron formulations (ferric carboxymaltose, ferumoxytol, iron dextran, iron sucrose and sodium ferric gluconate). From this set of patients treated with IV iron formulations, improvement of Hb levels post therapy defined as achieving a Hb ≥12 g/dl, was ascertained.

Results
A total of 71,137 patients diagnosed with IBD were identified in the VAHS. Of this group 65, 599 (92.22%) were male. Over the course of their disease the majority were treated with mesalamine (92%) followed by biologics (35%) and thiopurines (25%). Among this group, 21,159 (29.74%) patients developed moderate to severe anaemia over the course of their follow up. Among patients with moderate to severe anaemia, 3,533 (16.7 %) patients received IV iron therapies for the management of their anaemia. 1,132 (32%) of these patients achieved a Hb level ≥12 g/dl post IV iron therapy.

Conclusion
Almost a third of IBD patients develop moderate to severe anaemia over the course of their disease. Less than a fifth of these patients were treated with IV iron, and among those treated, about a third achieved a Hb level ≥ 12g/dl. Our findings suggest that in the real-world setting, moderate to severe anaemia despite being prevalent is not managed aggressively and efforts should be made to rectify this situation as anaemia has a profound effect on multiple aspects of a patient’s life.
P353 Ulcerative Colitis in the IBSEN III study: Frequent use of biologics and low colectomy rates first year of disease.
Authors: Strande V , Lund C , Småstuen M C , Bengtson M B , Cetinkaya R B , Detlie T E , Frigstad S O , Medhus A W , Henriksen M , Holten K I A , Hovde Ø , Huppertz-Hauss G , Johansen I , Olsen B C , Pallenschat J , Perminow G , Ricanek P , Torp R , Tønnessen T , Vatn S , Aabrekk T B , Opheim R , Høivik M L , Kristensen V A 
Published: January 2023

Abstract

Background
Biological therapy of ulcerative colitis (UC) has become more common in recent years, and colectomy rates have declined during the same period. The aim of this study was to describe the use of first-line biologic therapy and to estimate the colectomy rate in a population-based inception cohort during first year of disease.

Methods
Inflammatory Bowel Disease in South-Eastern Norway III (IBSEN III) is a population-based inception cohort with a prospective follow-up of newly diagnosed patients with inflammatory bowel disease from the South-Eastern Health Region of Norway, including from 2017 to 2019. In this project, we studied patients≥ 18 years with a verified UC diagnosis at baseline and at one-year follow-up. Baseline characteristics, use of biological therapy, and need for surgery during the first year after diagnosis were analysed. Kaplan-Meier plot was used to estimate the time to first-line biologic therapy.

Results
A total of 889 UC patients (45.9% female, median age 36 years (range 18-84), 6.2% smokers) were included in the study and met for one-year follow-up. Totally 129 (14.5%) patients started on biological therapy due to UC, during the first year of disease. Time from diagnosis to start of first-line biologic therapy is depicted in Figure 1 (Kaplan-Meier plot). In addition, four patients received biologics due to other indications than UC (not depicted in Figure 1). The colectomy rate at one-year follow-up was 0.9% (8/889).
Figure 1: Cumulative incidence of biologic therapy.

Conclusion
In this population-based inception cohort, colectomy rates during first year of disease were low compared to a prior population-based study from the same geographic area in the pre-biologic era (the IBSEN study)1, while the proportion starting on biological therapy was higher than reported in comparable inception cohorts2.
References:
1. Moum B, Ekbom A, Vatn MH, et al. Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease. Results of a large, prospective population-based study in southeastern Norway, 1990-93. Scand J Gastroenterol 1997; 32: 1005-1012.
2. Burisch J, Katsanos KH, Christodoulou DK, et al. Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study. Journal of Crohn's & colitis 2019; 13: 198-208. 2018/10/06. DOI: 10.1093/ecco-jcc/jjy154.
P358 Long-term clinical outcomes of intestinal Behçet’s disease: a 30-year cohort study at a tertiary hospital in South Korea
Authors: Park J , Park S J , Park J J , Kim T I , Kim W H , Cheon J H 
Published: January 2023

Abstract

Background
Long-term clinical data on intestinal Behçet’s disease (BD) are scarce because of the rarity of this disease, and many issues remain unresolved due to the difficulty in performing a well-designed clinical trial or epidemiologic study. We aimed to investigate the long-term clinical outcomes of patients with intestinal BD with a 30-year cohort study at a tertiary hospital in South Korea, a hospital with the largest number of patients with intestinal BD worldwide. Additionally, we aimed to identify factors that could predict various clinical outcomes, including anti-tumor necrosis factor-alpha (anti-TNF-α) agent use, intestinal surgery, hospitalization, and emergency room visits.

Methods
A cohort of 780 patients with intestinal BD between 1997 and 2021 was investigated to determine the long-term clinical outcomes and prognostic factors at the inflammatory bowel disease Clinic of Severance Hospital, Seoul, Korea.

Results
During the median follow-up period of 12.7 ± 7.2 years, 5-aminosalicylic acids, corticosteroids, immunomodulators, and anti-tumor necrosis factor-alpha (TNF-α) agents were required in 94.9%, 67.2%, 43.8%, and 14.6% of the patients, respectively. The cumulative rates of anti-TNF-α use were 3.7%, 7.5%, 8.5%, 12.1%, 17.6%, and 24.0%, and that of abdominal surgery were 5.7%, 10.9%, 12.6%, 16.5%, 21.6%, and 28.3%, at 1, 3, 5, 10, 20, and 30 years, respectively, after the initial diagnosis of intestinal BD. The cumulative rates of hospitalization were 11.8%, 21.9%, 27.9%, 38.8%, 54.4%, and 74.8% and that of emergency room visits were 10.0%, 19.8%, 22.7%, 31.6%, 50.0%, and 65.0% at 1, 3, 5, 10, 20, 30 years. Older age at primary diagnosis, previous appendectomy history, higher disease activity index for intestinal Behçet’s disease score, systemic BD, multiple intestinal ulcers, deep intestinal ulcers, higher C-reactive protein, lower hemoglobin, and lower albumin levels were associated with poor prognosis. Married status, higher body mass index, oral ulceration, and arthritis were negatively associated with a poor prognosis.

Conclusion
The data on the long-term clinical outcomes of intestinal BD and their prognostic factors could guide physicians for adequate patient monitoring and optimizing individualized treatments.
P359 Evaluation of usability and performance of home fecal sampling using a dedicated device
Authors: Solhaug H , Haukø I , Mørk E 
Published: January 2023

Abstract

Background
Monitoring faecal calprotectin (fCal) levels is important in treating patients with inflammatory bowel disease (IBD). Analysis of faecal samples can be divided into sample collection and sample extraction, of which the former is very time-consuming and tedious work for the lab personnel. This step can easily be improved by allowing the patient to perform the sample collection at home with required amount of sample directly into the extraction buffer. Any home faecal collection device needs to show conformity to the golden standard of weighing method. Home sampling presents a solution but requires clear instructions to the user. The collected sample is also required to maintain stability during transportation.

Methods
The present study aimed to determine the usability of EasyExtractTM and a quick guide for home sampling performed by lay users. The usability study was conducted according to FDA guidelines on usability engineering. Twenty-four participants without prior knowledge of the product or procedure received an EasyExtractTM, a simulated human faecal sample, and a quick-guide to perform the home sampling. Matched participant-observer questionnaires were assessed to determine the usability. Performance studies of EasyExtractTM included consistent sample uptake, agreement with the weighing method, and stability (at room temperature, after transportation, and after freeze-thaw cycles). All samples were analysed with CalproLab ELISA (CALP0170) to determine fCal concentration. Appropriate statistical methods were used to quantify and visualize the results.

Results
100% of the participants in the usability study completed sampling successfully. EasyExtractTM and the quick guide got an average rating of 4.8 on a scale of 1-5 (1=difficult, 5= easy). In-house performance studies show that the average sample weight collected 29.2 mg with a CV of 2.7%. It also showed that the extracts remained stable during transport at RT for 5 days, and no changes after repeated freeze-thaw cycles. The collection device also shows strong agreement with the established weighing method.

Conclusion
EasyExtractTM and the quick guide enabled participants to sample accurately without prior experience with the device. Additionally, EasyExtractTM allows for consistent weight and agrees with the golden standard of weighing method. Furthermore, fCal stability is maintained at RT for 5 days and repeated freeze-thawing cycles. EasyExtractTM is a useful tool for home-sampling of fCal.