bluuebunny/crossref_metadata_2025_split huggingface dataset:
P212 The Impact of Crohn’s Disease in Patients with Colorectal Cancer: A Danish Nationwide Cohort Study, 2009-2019
Authors: Johansen M P ,   Martha Pollen Johansen Mads Damsgaard Wewer Peter-Martin Krarup Johan Burisch and Andreas Nordholm-Carstensen
Published: January 2023

Abstract

Background
Previous nationwide cohort studies have substantiated that patients with Crohn’s disease (CD) have an increased risk of colorectal cancer (CRC) compared with non-CD patients with CRC. In addition, when comparing mortality in patients with CD and CRC and patients without CD and CRC, the hazard ratio was significantly higher for CD patients with CRC.

Methods
Patient- and CRC characteriscs were extracted from the Danish Colorectal Cancer Group registry and merged with a nationwide cohort of patients with inflammatory bowel disease (IBD). Patients diagnosed with CRC from January 1st 2009 to December 31st 2019, were included. All individuals with IBD were identified, using registrations of diagnostic codes, pathology codes and specific surgeries or medications for IBD.

Results
In this nationwide cohort study, 38 154 patients were eligible for inclusion. In the CD cohort and CRC cohort, 160 (52%) and 17343 (46%) were female (p=0.024) (table1). Patients with CD had a statistical significant lower age at cancer diagnosis, 69 years (60-76), compared with sporadic CRC 71 years (64-78)(p=&lt;0.001). In the age group analysis, 81 (26%) of the patients in the CD cohort were diagnosed before the age of 60. In comparison, 6531 (17%) of the patients in the sporadic CRC cohort were diagnosed before the age of 60, (p&lt;0.001). Colon cancer was more frequent in the CD and CRC cohort (234 (76%) vs. 26753 (71%), p=0.027). A higher percentage of CD patients presented with a UICC stage III (88 (29%), 9529 (25%)) (p=0.014), whereas more patients in the sporadic CRC cohort presented with UICC IV (10 704, 28%, 61, 20%). CD patients had a statistically significant higher frequency of deficient Mismatch repair (dMMR) expression compared with non-CD CRC, 63 (23%) vs. 4370 (14%), p&lt;0.001. Poor differentiated adenocarcinoma was more common in the CD -CRC, than in the non-CD CRC, 35 (13%) vs. 2113 (6.7%), p&lt;0.001. CRC located in the right hemicolon, was more common in the CD-CRC patients. Rectal cancer was more common in non-CD CRC patients, p=0.027.
In a Cox regression analysis, higher age at cancer diagnosis was significantly associated with increased mortality when including all patients with CRC, hazard ratio (HR): 1.04, 95% CI: [1.04-1.04], P=&lt;0.001. Female sex was associated with reduced mortality HR: 0.89 [0.86-0.91], p=&lt;0.001. Presence of CD was not associated with increased mortality. CD diagnosed before the age of 60 was not associated with higher risk of mortality by CRC among CD patients.

Conclusion
No statistically significant difference was found in the mortality in CD associated CRC and sporadic CRC. A higher percentage of CD patients had a UICC III stage tumor, suggesting a more progressive disease.
P213 High prevalence and risk factors for nonalcoholic fatty liver disease in patients with Crohn's disease
Authors: Flores C , Souza R K , De Bona L R , Deconto M D , Arrojo R S , Gazzoni F F , Oliveira T F 
Published: January 2023

Abstract

Background
Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with Inflammatory Bowel Disease (IBD), particularly Crohn's Disease (CD). Despite this, the mechanisms and risk factors of NAFLD in IBD are still poorly understood and controversial. The aim of this study was to assess the prevalence and risk factors for NAFLD in patients with CD.

Methods
Prospective study conducted among consecutive patients with CD and treated at the Inflammatory Bowel Diseases outpatient clinic at University Hospital between July 2021 and May 2022. Demographic, anthropometric and CD characteristics, food intake, previous and current medications, pre-existing diseases, laboratory tests, plasma levels of trimethylamine oxide (TMAO) data were collected. All participants underwent ultrasound (US) of the upper abdomen for evaluation and classification of NAFLD.

Results
One hudndred and three patients with a mean age of 45.2 ± 15.0 years, 35.9% (n=37) were male. The prevalence of NAFLD was 40.8% (n=42) and overweight (BMI&gt;25kg/m²) was present in 62.1%. Other associated diseases were present among NAFLD patients: systemic arterial hypertension (SAH) 4.9% (p&lt;0,001), dyslipidemia 11.9% (p=0,040) and diabetes (DM) 19% (p=0,009). There were no statistically significant differences between CD characteristics or activity, previous or current CD treatment and food consumption with NAFLD. The presence of comorbidities such as SAH, DM and dyslipidemia, anthropometric markers such as Body Mass Index (BMI), waist circumference (AC), sagittal abdominal diameter (SAD), laboratory tests such as C-reactive protein (CRP), triglycerides (TG) and Liver enzymes were positively associated with the diagnosis of NAFLD. Plasma levels of TMAO showed no significant association with the presence of NAFLD and with CD activity but correlated with SAD (p 0,047). After adjusting for the multivariate model, only the variables SAH (p 0,046), DM (p 0,017), active CD (p 0,023), overweight (p 0,025) and obesity (p&lt;0,001) remained associated to the presence of NAFLD.

Conclusion
The prevalence of NAFLD in patients with CD was 40.8%, higher than the global prevalence. The main risk factors for NAFLD in this population were like those in the general population such as systemic arterial hypertension, diabetes, dyslipidemia, visceral fat by sagittal abdominal diameter, overweight and obesity. The characteristics of CD, nutrient intake, and plasma levels of TMAO showed no relation with the presence of NAFLD. Crohn's disease activity by IHB and PCR showed a positive correlation with NAFLD. The high prevalence of NAFLD among CD patients should raise this concern for patient care.
P214 Cine MRI assessment of colonic motility in patients with ulcerative colitis associated constipation.
Authors: Miller C , Taylor S , Emmanuel A , Zarate-Lopez N , Pakpoor J , Fitzke H , Menys A , Holmes J , Atkinson D , Markus J , Blad W , Bloom S 
Published: January 2023

Abstract

Background
Constipation may be a feature of ulcerative colitis (uc) especially in left sided or distal disease. UC associated constipation (UCAC) can cause significant morbidity; treatment is typically with dietary fibre changes and laxatives. Diagnosis may be challenging but adequate treatment may improve clinical outcomes. The cause is incompletely understood with few studies of motility and transit. Study populations often having heterogenous groups, with limited assessment of right sided colonic motility. Cine MRI is a novel technique that can assess pan-colonic motility. Using this technique, We aim to investigate regional colonic motility in patients with active disease and UCAC symptoms.

Methods
The study was performed prospectively with 30 participants at a single-centre. Disease extent was confirmed to be distal to the splenic flexure. Active disease was defined as a faecal calprotectin &gt;250, partial Mayo score ≥ 4 (rectal bleeding score ≥ 1) or an endoscopic mayo score &gt;1. The 3 groups comprised 10 healthy controls with no symptoms of IBS/ constipation, 11 patients with active uc with symptoms of UCAC, and 9 patients with active uc without symptoms of UCAC. UCAC subjects met American Gastroenterology Association constipation criteria. Exclusion criteria comprised the use of drugs affecting motility, concomitant GI conditions, and recent laxative use. Subjects underwent two constipation questionnaires. Subjects were fasted &gt; 8 hours and subjects consumed 1.4 litres of 2% mannitol over 90 minutes prior to a morning MRI scan. Post drink cine MRI was not acquired until the mannitol had reached the ascending colon (AC). Images were acquired over the entire abdomen for 10 minutes and using GI Quant software®(Motilent) regional colonic motility was assessed (Figure A), generating a motility index (MI) score (range 0-1000). Kruskal-Wallis and Mann-Whitney U (with Holm-Bonferroni correction) statistics were used.

Results
Baseline characteristics and questionnaire scores are outlined in Figure B and MI scores in Figure C.

There was no clear trend for differences in motility in the caecum or AC. In the transverse colon (TC) there was a trend to reduced MI in patients with UCAC compared to controls which was nearly significant (p=0.06).

Conclusion
We present a new technique for assessing regional colonic motility in patients with uc with a 10-minute scan, and offers a method to study the dysmotility that underpins UCAC. Motility appears to be reduced in the TC in patients with left sided uc and symptoms of UCAC compared to controls. Although not statistically significant this suggests hypomotility may be a contributing factor to UCAC. It suggests that stimulants/prokinetic may be more effective than change to dietary fibre in its treatment.
P218 It is time to grow up: readiness is associated with better outcomes in a prospective study of pediatric transition patients with Inflammatory Bowel Disease
Authors: Nardone O M , Martinelli M , De sire R , Calabrese G , Caiazzo A , Fioretti M T , Testa A , Limansky L , Rispo A , Di Luna I , Miele E , Staiano A , Castiglione F 
Published: January 2023

Abstract

Background
Approximately 25% of patients with inflammatory bowel disease (IBD) are diagnosed before age 20, making the transition from paediatric to adult healthcare challenging due to the high burden of these diseases at a critical time, such as adolescence. We aimed to assess patients’ readiness to transition from paediatric to adult IBD services and the impact on clinical outcomes. We further investigated adherence and quality of life at 12 months post- structured transition clinic

Methods
An observational, prospective study was conducted in a tertiary adult and paediatric IBD centre including adolescent aged≥17yo with a confirmed diagnosis of IBD before 16yo and in clinical remission who underwent “structured transition”. We collected demographics and clinical data 12 months before and after the transition visit. At the time of recruitment patients filled out the Transition Readiness Assessment Questionnaire (TRAQ) and they were defined ready based on a mean TRAQ value ≥ 3.0. The Morisky Medication Adherence Scale (MMAS) and the Short Form Health Survey (SF36) Questionnaire were completed baseline and 12 months after transition clinic. Receiving operating characteristics (ROC) curve was used to determine cut-off values of TRAQ for predicting medication adherence.We further investigated which demographic and clinical parameters could predict medication adherence.

Results
We enrolled 60 patients in clinical remission based on Crohn’s Disease Activity Index (CDAI) score of 115±124 for CD and pMayo 2,85±1,3 for UC, who had transitioned throughout transition clinic to adult care and completed 12 months follow-up [Table1].

Overall 42 patients (70%) were considered ready for transition, with a mean TRAQ score=3,2±0,5. The number of outpatient visits(1,86±0,75vs2,28±1,2;p&lt;0,02) as well as the number of clinical relapses (0,38±0,4vs1,06±0,9;p&lt;0,02) and hospitalizations (0,05±0,1vs0,33±0,33;p&lt;0,05) at 12 months were significantly lower in ready than in not-ready patients. The quality of life did not differ pre-and 12 months post-transition clinic(p=0,09) and between ready and not-ready patients (p=0,71)[Table2].

Based on ROC curve a TRAQ cut-off≥3,46 could predict medication adherence with a sensibility of 55%,specificity 86% and an AUC=0,71(0,57-0,85;p=0,008)[Fig1].

At multivariate analysis, a high mean TRAQ value was associated with medication adherence at 12 months (OR:7,042CI:1,68-29,54,p=0.008)

Conclusion
Patients ready for transition were more likely to have fewer outpatient visits,disease flares and hospitalizations compared to not-ready patients. The quality of life did not differ pre- and post transition and between ready and not-ready patients.TRAQ score could be a reliable tool with high specificity to predict medication adherence
P220 Patient’s disease perception and health-related quality of life with IBD: Results from a Spanish cohort with 15 years of follow up
Authors: Elosua Gonzalez A , Rubio S , Irisarri R , Campillo A , Nantes Ó , Vicuña M , Angós R , Zozaya J M , Rodríguez C 
Published: January 2023

Abstract

Background
Crohn’s Disease (CD), ulcerative colitis (UC) and IBD unclassified (IBD-U) may affect the health-related quality of life (HRQoL). We evaluated HRQoL and patient’s disease course perception in the Navarra Incident Cohort (includes all new diagnosis from 2001-2003 in Navarra, Spain)

Methods
All patients were invited to complete two HRQoL questionnaires: the generic EuroQoL-5 dimensions (EQ-5D-3L) and the Inflammatory Bowel Disease Questionnaire (IBDQ-36). Patients’ disease course perception was evaluated using the four disease curves from the IBSEN cohort

Results
From 285 patients initially diagnosed, we obtained 158 questionnaires (72% response rate after excluding deaths and lost to follow-up); 103 UC, 50 CD and 5 IBD-U, 40% women and median age 52 (22-84). Most patients were in remission (99% UC/ 88% CD/ 100% IBD-U).
In EQ-5D-3L, 55% answered not having, 41% having some and 4% having significant impairment in at least one dimension. “Pain/discomfort” and “anxiety/depression” were the most affected dimensions with no differences by diagnosis. However, 91% of UC and 85% of CD patients considered their health status to be the same or better compared to the previous year.
Median IBDQ-36 score in UC was significantly higher than CD (227 vs 212, p=0.04). No differences were found in partial median scores in bowel symptoms and social impairment with significantly higher median scores in UC compared to CD in systemic symptoms, emotional function and functional impairment. Similar results between UC and IBD-U were obtained (table1).
Regarding disease course, 67% of UC and 54% of CD patients chose to have a progressive decrease in the intensity of symptoms since onset (p=0.2). Significantly more CD that UC patients considered a disease with recurrent flares of activity (40% vs 23%, p=0.015). The increase in symptoms throughout the evolution was the pattern chosen by 8% of UC and 4% of CD patients, while only 2% in each disease defined its situation as persistent chronic activity throughout the follow-up.

Conclusion
- Patients have a significant impact in their HRQoL despite being in remission
- Systemic symptoms, emotional function and functional impairment were more affected in CD patients.
- Most patients considered their disease as a progressive decrease in the intensity of symptoms with significantly more CD patients considered having recurrent flares of activity.
P222 Chronic pain is common in Paediatric Inflammatory Bowel Disease and impacts quality of life
Authors: Mardare R , Eskell L , Machta J , Fell J M E , Thangarajah D 
Published: January 2023

Abstract

Background
Prevalence of chronic pain (CP) is reported as 38% in adult inflammatory bowel disease (IBD), with a significant impact on quality of life, functional and social outcomes 1,2,3. Prevalence and attributes of chronic pain are unknown in paediatric IBD.

Aim
evaluate the prevalence, disease related factors, and impact on quality of life (QOL) of CP.

Methods
Prospective, cross-sectional single centre study included 41 children, (8 -18 years), of a predominantly CD cohort 29/41, (70%). Patients and their parents completed validated age-appropriate pain questionnaires4 and IMPACT III QOL questionnaire for IBD5. CP was defined mild and moderate to severe, as per von Korff scale6. Disease specific parameters were recorded. CP and NP medians were compared using Mann-Whitney tests and proportions using Chi squared test (p&lt;0.05).

Results

CP was prevalent in 33/41 (80%) patients. Abdominal CP was common in 30/33 (90%), joint pain was present in 2/33, (6%) and headache in 1/33, (3%). CP subjects were adolescents with extensive and established disease, predominantly on biologics 26/33 (79%). Analgesia use was low 15/33 (45%), and there was no opiate use. There was no difference in Disease activity CP vs NP, defined by PCDAI, PUCAI, CRP and Faecal calprotectin. QOL life score was significantly lower in CP, there was no difference in body image QOL domain score in CP vs NP. Comorbidity was common 16/33 (48%) in the CP cohort, 5/16 (31%) had diagnoses that maybe associated with comorbid pain.
We have shown that anaemia and sleep disturbance may be a signal associated with CP (Fig 1).

Conclusion
CP is common in paediatric IBD, more common than previous adult studies. Unlike historic adult IBD cohorts, it is not associated with disease activity or related biomarkers. It is unknown whether functional pain co-exists in our cohort. CP significantly impacts emotional, wellbeing and social functioning in children with IBD. This is the first study to report on CP in children with IBD, strategies should target psychosocial intervention. Further studies are needed to evaluate potential effects of socioeconomic status, physical activity, anaemia and prevalence of functional pain in children with IBD. We recommend screening for CP in children with IBD as it is common.
P225 The accuracy of different intestinal ultrasound parameters in detecting endoscopic activity in patients with inflammatory bowel disease
Authors: Katsaros M , Palmela C , Kalogirou M , Frias Gomes C , Katsoula A , Torres J , Giouleme O 
Published: January 2023

Abstract

Background
Intestinal ultrasound (IUS) is considered an accurate tool for assessment of disease activity in inflammatory bowel disease (IBD) patients. We investigated the accuracy of IUS to detect active disease as compared to ileocolonoscopy.

Methods
We performed a two-center international cross-sectional study that included formally diagnosed IBD patients who underwent IUS and ileocolonoscopy, within a 4 weeks interval. Active disease on IUS was defined as bowel wall thickness (BWT) &gt;3 mm in the most affected bowel segment. Additional IUS parameters evaluated included increase in Doppler color flow in the bowel wall (modified Limberg score &gt; 0), presence of inflammatory fat (FW) and loss of bowel wall stratification (BWS). Active disease at endoscopy was defined as Simple Endoscopic Score for Crohn’s Disease (SES-CD) &gt;2 and Mayo endoscopic score &gt;0. The accuracy of IUS compared to ileocolonoscopy was estimated using sensitivity, specificity, and Cohen’s kappa coefficient analyses.

Results
We included 85 patients (table 1) performing IUS for disease monitoring (69.4%) and symptoms suggestive of IBD flare (30.6%). Disease was active in IUS in 38/42 (90.5%) of clinically active [Harvey Bradshaw index (HBI) ≥5, Simple Clinical Colitis activity index (SCCAI) &gt;2] and 22/43 (51.2%) of clinically inactive patients (kappa coefficient 0.391, p&lt;0.001). C-reactive protein (CRP) level was 6.95 mg/dl [IQR 2.19-17.75] vs 1.8 mg/dl [IQR 0.85-3.75] in active vs inactive disease on IUS respectively (p&lt;0.001). All patients underwent both endoscopy and IUS, with 63/85 (74.1%) exhibited endoscopic activity. IUS demonstrated 92.1% sensitivity, 90.9% specificity, 96.7% PPV, 80% NPV and kappa coefficient 0.79 in detecting endoscopically active disease (p&lt;0.001). IUS detected 58/63 (92.1%) of endoscopically active cases, and identified the most affected bowel segment in 50/63 (79%) of them. Inability of IUS to identify the most affected bowel segment at endoscopy included rectal involvement (53.8%), complex surgical history (15.38%), stenosis of ileocecal valve (7.69%) and limitations due to obesity (23.07%). Mean BWT of the most affected segment was 4.49 (±1.16) vs 2.33 mm (± 0.63) in endoscopically active vs inactive patients respectively (p&lt;0.001). We furthermore evaluated the accuracy of additional IUS parameters (increased color Doppler flow, FW and loss of BWS) in predicting endoscopic activity (table 2).

Conclusion
IUS represents a non-invasive tool that can accurately identify disease activity both in Crohn’s disease and ulcerative colitis, when compared to ileocolonoscopy. The most sensitive parameter to detect endoscopic activity was an increased BWT.
P227 Patient experiences in ulcerative colitis: conceptual model and review of patient-reported outcome measures
Authors: Kim C , Brown F L , Burk C , Anatchkova M , Sargalo N , Kaushik A 
Published: January 2023

Abstract

Background
Symptoms of ulcerative colitis (UC) negatively affect patients’ health-related quality of life (HRQoL). The aim of this study was to identify symptoms and impacts experienced by patients with UC, develop a conceptual model (CM) and evaluate available patient-reported outcome (PRO) measures for appropriateness for inclusion in UC clinical studies.

Methods
We conducted a landscape assessment that included: targeted literature reviews (TLRs) to identify concepts of interest and frequently used PRO measures among patients with UC; label claims searches for US and European regulatory and health technology assessment (HTA) submissions; and US and European clinical trial database searches to identify PRO measures used as primary and secondary endpoints in ongoing clinical trials. Results from the TLR informed a CM of UC. Concepts from the CM were mapped to selected PRO measures. Appropriateness of selected PRO measures for UC populations was evaluated via a gap analysis.

Results
Fifty-two symptoms and 72 impacts of UC were identified from the TLR. The most frequently reported symptoms were diarrhoea, incontinence/leaking/lack of bowel control, urgency, rectal bleeding, frequent bowel movements and fatigue. The most frequently reported impacts were anxiety, depression, inability to conduct daily activities, embarrassment and affected relationships with others. The CM grouped the 52 symptom concepts into eight dimensions, the 29 impacts proximal to UC into two dimensions and the 43 impacts distal to UC into five dimensions (Figure 1). Of the 69 PRO measures identified, eight were selected for conceptual analysis based on being disease-specific and having evidence of use in regulatory label claims, HTA submissions, as UC clinical trial endpoints and/or having US Food and Drug Administration (FDA) qualification status. The five PRO measures that covered the most concepts when mapped against the CM and included in the gap analysis were: the Inflammatory Bowel Disease Questionnaire (IBDQ); Symptoms and Impacts Questionnaire for UC (SIQ-UC); UC-PRO symptoms modules (UC-PRO-Signs and Symptoms [UC-PRO/SS] and UC-PRO-Systemic Symptoms); UC-PRO impact modules (UC-PRO-Daily Coping [UC-PRO-DC], UC-PRO-Daily Life Impact [UC-PRO-DLI] and UC-PRO-Emotional Impact [UC-PRO-EI]); and Crohn’s and Ulcerative Colitis Questionnaire (CUCQ) (Table 1). All five PRO measures had good or excellent support for content validity; the UC-PRO/SS fully met FDA PRO guidance for content validity and most psychometric properties.

Conclusion
Based on the CM and PRO measures review, the IBDQ plus UC-PRO/SS are recommended to capture UC symptoms and IBDQ plus UC-PRO impact modules to capture proximal impacts. All PRO measures reviewed require further psychometric evaluation.