bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1239 Microplastics are associated with biomarker of intestinal inflammation in a pilot analysis of the PLANET Study
Authors: Lykkemark J , Picker M , Kim T , Nguyen I , Weinstein K , Chen R , Simon-Sánchez L , Lordachescu L , Torres J , Stone J , Bianco A , Shaw L , Tavella N , Jess T , Allin K , Peter I , Colombel J F , Vianello A , Vollertsen J , Agrawal M 
Published: January 2025

Abstract

Background
Micro- and nanoplastics are pollutants of growing concern, given the ongoing rise in their production and accumulation in the environment. Emerging data implicate microplastics (MP) in adverse health outcomes. However, their role in intestinal inflammation and inflammatory bowel disease (IBD) is not well studied.

Methods
We established the Exploring the Role of Plastics and Toxins in Intestinal Inflammation (PLANET) Study to understand the impact of MP on intestinal inflammation and Crohn’s disease (CD) in women with and without CD and their offspring. We prospectively recruited pregnant women with and without CD in the third trimester, obtained clinical and survey data, and collected stool samples without the use of plastic materials, taking strict precautions to avoid ambient MP contamination in processing. Using a well-established protocol for MP analyses, consisting of multi-step enzymatic and oxidative treatment and state-of-the-art µFourier Transform Infrared Spectroscopy (µFTIR) imaging, we measured the number, estimated mass, and types of MP larger than 10 µm in stool samples. Then, using an ELISA assay, we measured fecal calprotectin. We conducted Spearman’s partial correlation analyses while controlling for IBD status.

Results
Of the 11 study participants in this pilot analysis, four individuals had IBD. The median (IQR) age at enrollment was 38 years (IQR 34, 29). MPs were detected in all third trimester stool samples, with a count ranging from 34-410 particles/g dry weight of stool. The distribution of types of MP is reported in Figure(a). The median fecal calprotectin level for those with and without IBD was 48.1 µg/g and 13.2 µg/g, respectively. The counts and total mass of MP in stool samples were positively rank correlated with fecal calprotectin concentration on controlling for IBD status (Spearman’s r = 0.65, p = 0.04 and 0.48, p = 0.16, respectively; Figure(b)).

Conclusion
MP were detected in all stool samples in our pilot analysis of pregnant women with and without CD, and higher MP count was correlated with fecal calprotectin, indicative of intestinal inflammation. Further exploration of MP in intestinal inflammation and IBD, including transgenerational impact, is ongoing.

Figure: (A) Distribution of microplastics and their subtypes across stool samples from study participants (B) Correlation between microplastic count and fecal calprotectin concentration.
P1247 An argument for screening? Disordered eating patterns are highly prevalent in Inflammatory Bowel Disease (IBD)
Authors: Grande E , Barnes A , Mountifield R 
Published: January 2025

Abstract

Background
The complex relationship between body image perception, disordered eating behaviours, and quality of life (QoL) has been poorly examined in patients with IBD. Although individuals with chronic gastrointestinal conditions are at an increased risk for disordered eating behaviours, the prevalence and risk factors associated with these attitudes remain underexplored in IBD. Therefore, this study aimed to investigate the relationship between IBD activity, body image perception, and disordered eating behaviours to determine clinical features that impact patient QoL.

Methods
An online questionnaire was administered through a tertiary centre IBD clinic in South Australia. Disordered eating behaviours were assessed via the validated Eating Disorder Examination-Questionnaire (EDE-Q7). Clinically significant eating disorder attitude is defined as EDE-Q7 score &gt;3.5. Univariate and multivariate logistic regression analyses were performed to correlate clinically significant disordered eating behaviours with patient sex, disease activity, and the presence of clinical depression or anxiety.

Results
In a cohort of 210 respondents, clinically significant disordered eating behaviours were observed in 33.2% of respondents. Higher global EDE-Q7 scores were significantly associated with female sex (P&lt;0.0001), active IBD (P=0.0169), and clinical depression (P&lt;0.0001) and anxiety (P&lt;0.0001). High global dietary restraint, shape/weight overevaluation, and body dissatisfaction subscores were significantly associated with female sex (P=0.0063; P=0.0001; P&lt;0.0001), patients with clinical depression (P=0.0142; P&lt;0.0001; P&lt;0.0001), and patients with clinical anxiety (P=0.0003; P&lt;0.0001; P&lt;0.0001). IBD activity and Crohn’s disease were significantly associated with high global shape/weight overevaluation subscores (P=0.0216; P=0.0175) and body dissatisfaction subscores (P=0.0063;P=0.0117). Furthermore, clinically significant disordered eating behaviours were significantly associated with IBD activity (OR, 2.2; 95% CI, 1.3-4.0; P=0.007), clinical anxiety (OR, 7.7; 95% CI, 4.0-14.7; P&lt;0.0001) and clinical depression (OR, 4.6; 95% CI, 2.4-8.7; P&lt;0.0001). Multivariate regression analysis showed that the odds of high global EDE-Q7 scores are significantly increased by clinical anxiety (OR, 8.9; 95% CI, 4.3-18.4; P&lt;0.0001).

Conclusion
This study demonstrates that disordered eating behaviours are highly prevalent in patients with IBD. Collectively, these findings provide important insight into the eating and body image behaviours that impact the QoL of patients with IBD.
P1249 Higher dietary glycemic index, but not glycemic load, is associated with increased risk of ulcerative colitis: a prospective cohort study
Authors: Ye S , Fu T , Tu Y , Wellens J , Chen X , Larsson S C , Sun J , Dan L , Wan X , Chen J , Magro F 
Published: January 2025

Abstract

Background
Previous epidemiological studies observed inconsistent effects of carbohydrate intake on incident inflammatory bowel disease (IBD). We aimed to evaluate the effects of glycemic index and glycemic load, the two main indicators to measure the quality and quantity of carbohydrates, on the risk of two main subtypes of IBD, Crohn’s disease (CD) and ulcerative colitis (UC).

Methods
This analysis included 121,148 participants who were free of IBD at baseline in the UK Biobank. We collected dietary information from a validated web-based 24-hour dietary recalls questionnaire and estimated dietary glycemic index and glycemic load based on carbohydrate foods. The primary outcome was the incident CD and UC. Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Substitution analyses were conducted to test associations with risk for CD and UC after replacing medium or high glycemic index foods with low glycemic index foods.

Results
In the current analysis, participants with lowest quartile of glycemic index were more likely to be females, and with lower BMI, and those with highest quartile of glycemic load were more likely to be none to moderate alcohol consumers and non-smokers. During a median follow-up of 10.6 years, 133 incident CD and 335 incident UC cases were identified. In the fully multivariable-adjusted model, a 13% (95% CI 1%-27%) higher risk of UC was associated with each 1-SD increment of dietary glycemic index. Comparing the lowest glycemic index, we found that highest dietary quartile of glycemic index was associated with increased risk of UC (HR 1.46, 95%CI 1.07-1.99, P = 0.016; P for trend = 0.005), but not with CD. We did not find significant associations between dietary glycemic load with risk of CD and UC. Additionally, replacing medium or medium and high glycemic index foods with low glycemic index foods was associated with a lower risk of UC, respectively.

Conclusion
Conclusion: Our findings provide evidence that a higher dietary glycemic index, but not glycemic load, was associated with an increased risk of UC, further demonstrated by the substitution analyses, suggesting the importance of dietary glycemic index in dietary recommendations for UC prevention. Therefore, the large interventional trial should be considered to evaluate the role of low glycemic index diets in preventing UC and expected to be applied in dietary recommendations for UC prevention.
P1251 A Care Pathway for Inflammatory Bowel Disease can Reduce Healthcare Costs and is Cost-Effective
Authors: Visser E , Oude Voshaar A M , van Linschoten R , Bodelier A , Fitzpatrick C , de Jonge V , Vermeulen H , Verweij E , van der Wiel S , van der Horst D , van der Woude C J , West R L , van Noord D ,   Southwest Netherlands IBD Study Group
Published: January 2025

Abstract

Background
Hospitals in the southwest of the Netherlands collaborate to improve inflammatory bowel disease (IBD) care. As part of this initiative, a standardised care pathway (CP) for the treatment of IBD with biologics and small new molecules has been developed. The CP addresses initiation, switching, and discontinuation of therapy, as well as diagnostic testing and treatment follow-up. The CP has been implemented in six of the eight hospitals to improve patient outcomes, standardise care and reduce healthcare costs. This natural experiment provides an opportunity to evaluate the cost-effectiveness of the CP using a quasi-experimental design. We aimed to estimate the causal effect of CP implementation on costs and health outcomes.

Methods
A cost-utility analysis with a societal perspective was conducted. Adult patients with an IBD diagnosis for at least 3 months and treated with biologics and small new molecules were eligible for inclusion. Costs were assessed for both standard care (December 2020 - December 2021) and the CP over a one-year period (March 2022 – March 2023), without discounting costs and effects and standardizing costs to 2022. Missing data were handled using single imputation nested within a bootstrap procedure. The analysis employed a difference-in-differences (DiD) approach to estimate causal effects of the CP implementation, controlling for pre-existing differences between hospitals and general time trends that would have occurred without the intervention. For the cost-effectiveness analysis, we utilized the cumulative incremental costs and mean incremental quality adjusted life years (QALYs) from the post-intervention DiD effects. The DiD-derived incremental costs and QALYs were used to calculate the incremental cost-effectiveness ratio (ICER) and construct cost-effectiveness acceptability curves using normal approximation.

Results
Approximately 25% of the eligible population was included. At baseline, patients in intervention (n=842) and control hospitals (n=331) had comparable characteristics in terms of age, sex, diagnosis and comorbidities. The DiD-analysis showed cost savings primarily driven by reduced hospital costs (-€1,107; 95%CI: -€2,130 to -€109) while maintaining quality of life (QALY difference: 0.01; 95%CI: -0.02 to 0.04). The ICER was located in the southeast corner of the cost-effectiveness plane, indicating that the treatment with the CP is a dominant strategy compared to standard care (Figure 1).

Conclusion
A CP for the treatment of IBD with biologics and small new molecules was developed to improve IBD care and reduce healthcare costs. Our results showed that standardising IBD care is effective for reducing healthcare costs, while maintaining quality of life.
P1254 The impact of vitamin D supplementation on clinical outcomes in Inflammatory Bowel Disease: a regression discontinuity analysis
Authors: Sninsky J , Sansgiry S , Taylor T , Perrin M , Kanwal F , Hou J 
Published: January 2025

Abstract

Background
Vitamin D deficiency is prevalent among patients with Inflammatory Bowel Disease (IBD) and is associated with adverse clinical outcomes. While vitamin D's immunomodulatory and anti-inflammatory properties suggest potential therapeutic benefits, its effect on IBD management remains uncertain. This study evaluates the impact of vitamin D supplementation on corticosteroid use, emergency department (ED) visits, and hospitalisations using a quasi-experimental regression discontinuity design (RDD).

Methods
A retrospective cohort of IBD patients within the United States Veterans Health Administration was analysed from 2000–2024. Patients prescribed vitamin D within three months after a serum 25-hydroxyvitamin D assay were included, excluding those with prior supplementation or subtherapeutic dosing (&lt;1,000 IU/day). Outcomes were assessed 3–15 months post-assay. Using the 30 ng/mL vitamin D threshold, RDD was employed to estimate causal effects, adjusting for covariates (age, gender, and IBD type). Statistical analysis was performed with the RDrobust statistical package.

Results
Among 5,021 IBD patients (median age 63 years; 89% male; 58% Ulcerative Colitis, 39% Crohn’s Disease, 3% Indeterminate Colitis), the median vitamin D level was 23 ng/mL. Approximately 41% of patients were prescribed vitamin D. Patients with vitamin D levels just below the 30 ng/mL threshold were significantly more likely to receive supplementation compared to those above the threshold (35% vs 24%, p = 0.02)(Fig 1A). Vitamin D supplementation demonstrated a 36% absolute risk reduction (ARR) in corticosteroid use at the 30 ng/mL threshold (95% CI: [-0.72, 0.00], p = 0.05)(Fig 1B). Trends towards reduced ED visits (ARR 17%) and hospitalisations (ARR 3%) were observed, though these findings did not achieve statistical significance.

Conclusion
Vitamin D supplementation at levels near the 30 ng/mL threshold significantly reduces corticosteroid use in IBD patients. While trends towards reduced ED visits and hospitalisations were not statistically significant, the directionality supports potential broader benefits. This study highlights the utility of vitamin D as a low-cost, accessible adjunct therapy in IBD management, particularly for those with deficiency. Further prospective studies are warranted to confirm these findings, optimise dosing strategies, and establish the ideal therapeutic targets for vitamin D in this population.
P1256 Prevalence and Predictive Factors of Cutaneous Manifestations in IBD Patients: A Cohort Study
Authors: Darkaoui D , Benmoussa M , Koulali H , Zazour A , Elmqaddem O , Ismaili Z , Kharrasse G 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is a systemic disorder affecting multiple organ systems, including the skin, musculoskeletal, and ocular systems. the clinical manifestations range from mild and transient to severe, with significant impacts on morbidity, quality of life, and healthcare costs. This study aims to evaluate the prevalence and predictive factors of cutaneous manifestations in IBD patients.

Methods
This retrospective study, conducted over eight years from January 2016 to December 2023, included IBD patients. Dermatological lesions (excluding anoperineal lesions) were diagnosed by dermatologists through clinical examinations, cultures, and biopsies as needed. Data were extracted from medical records and analyzed using SPSS version 21.0.

Results
A total of 273 IBD patients were included, with a median age of 41 years (range 15–72, SD ±13). Among them, 141 (51.6%) were female, resulting in a female-to-male ratio of 1.06. Crohn's disease (CD) was diagnosed in 175 patients (64%) and ulcerative colitis (UC) in 98 (36%). Cutaneous manifestations occurred in 89 patients (32.6%), with a median age of 39 years (range 15–70, SD ±13).

Gender and Contraception
Of the 89 patients with dermatological symptoms, 45 (50%) were female, with no significant gender association (p = 0.8). However, 40% of the females with cutaneous manifestations were using contraception (p = 0.05).

IBD Subtypes
Cutaneous manifestations were more common in CD patients (35%) than in UC patients (27.6%), but this difference was not significant (p = 0.18).

Medication and Lifestyle Factors
NSAID use was significantly associated with cutaneous manifestations (44%, p = 0.03), while smoking (35%, p = 0.61) and alcohol use (24%, p = 0.34) showed no significant associations.

Inflammatory Markers and Perianal Disease
Elevated CRP levels were linked to dermatological symptoms (39.5%, p = 0.04). Among CD patients with perianal manifestations, 26 out of 51 developed cutaneous symptoms (p = 0.008).

Other Factors
Family history of IBD (10%, p = 0.69), history of abdominal surgery (36.9%, p = 0.2), corticosteroid use (34.1%, p = 0.66), and vitamin D deficiency (33.6%, p = 0.64) were not significantly associated with cutaneous manifestations.

Conclusion
Cutaneous manifestations were observed in 32.6% of IBD patients, more often in CD than UC. Significant predictors of dermatological symptoms included contraceptive use, NSAID use, and elevated CRP levels. In CD patients, perianal manifestations were strongly linked to cutaneous symptoms (p = 0.008). These findings emphasize the need for gender and management of IBD-related skin issues, along with further research to explore underlying mechanisms and develop targeted therapies.
P1258 Disease course of inflammatory bowel disease unclassified during the first ten years following diagnosis: A prospective European population-based inception cohort – the Epi-IBD cohort
Authors: Wewer M D , Lophaven S , Lakatos P L , Gonczi L , Salupere R , Kievit H A L , Nielsen K R , Midjord J , Domislovic V , Krznarić Ž , Pedersen N , Kjeldsen J , Halfvarson J , Sebastian S , Goldis A , Arebi N , Oksanen P , Neuman A , Andersen V , Katsanos K H , Koukoudis A , Turcan S , Ellul P , Kupcinskas J , Kiudelis G , Fumery M , Kaimakliotis I P , D’Inca R , Lombardini S , Hernandez V , Fernandez A , Langholz E , Munkholm P , Burisch J ,   Epi-IBD group
Published: January 2025

Abstract

Background
The Epi-IBD cohort is a prospective European population-based cohort of 1,508 patients diagnosed in 2010 and 2011 with inflammatory bowel disease (IBD) according to Copenhagen criteria in centres across 17 European countries. The study aims to describe treatment strategies, disease course and prognosis of IBD unclassified (IBDU) across Europe.

Methods
Patients with IBDU were defined as not fulfilling the Copenhagen diagnostic criteria of Crohn’s disease (CD) or ulcerative colitis (UC), but still required IBD related treatment and monitoring. They were followed prospectively from the time of diagnosis until December 31st, 2020, death, emigration or loss of follow-up. Clinical data on surgery, hospitalizations, and medical treatment were captured throughout the follow-up period and entered into a validated web-database, www.epi-ibd.org. Patients with IBDU were categorised as CD-like, UC-like or mixed CD-UC based on disease location and continuity of the affected bowel segments at diagnosis.

Results
In total, 129 IBDU patients aged ≥15 years from 22 centres were included. They comprised 8.5% (N=129/1,508) of the total cohort. The disease location was reported in Table 1 where 4 patients had unknown disease location at baseline. At diagnosis, 16% (N=25/129) were CD-like, 52% (N=62/129) were UC-like and 32% (N=42/129) were mixed CD-UC.During the 10-year follow-up, 32% (N=41/129) were re-classified as either CD (N=16) or UC (N=25). The crude 1-, 5-, and 10-year rates for re-classification of diagnosis were 19%, 26% and 32%. The time to initiation of therapies and the distribution of therapies according to re-classification of IBDU diagnosis at baseline are presented in Figure 1 A-B . Advanced therapies were used in 13% (N=17/129) of patients over the 10-year follow-up, and was initiated after a median period of 1.9 years (inter-quartile range 0.9-8.1). An intestinal resection was required in 7% (N=9/129). After 1, 5, and 10 years, 9%, 19% and 26% of the patients diagnosed with IBDU at baseline, respectively, required hospitalisation.

Conclusion
After 10 years of follow-up, a third of patients initially diagnosed with IBDU were re-classified as either CD or UC. The disease course was in general mild with a low number of patients requiring advanced therapy, intestinal resection, and hospitalization. However, patients who were re-classified as CD or UC were more frequently treated with medical therapies.
P1267 Risk of hospital-treated infections in patients with cancer and inflammatory bowel disease
Authors: Dahl S A M , Ehrenstein V , Pedersen L , Sørensen H T , Siegel C , Erichsen R 
Published: January 2025

Abstract

Background
Both cancer and inflammatory bowel disease (IBD) are risk factors for infection leading to elevated infection-related mortality. We investigated the effect of IBD on infection risk in patients with cancer.

Methods
This population-based Danish nationwide cohort study included adults diagnosed with incident solid cancer between 2004 and 2021. IBD and first-time post-cancer infections were identified using discharge diagnosis codes. Patients were followed from the cancer diagnosis until the first post-cancer infection, emigration, death, or end of follow-up, whichever came first. The cumulative incidence of hospital-treated infections was calculated, considering death a competing risk. Adjusted hazard ratios (HRs) were calculated for infections in patients with versus without IBD. Among patients with cancer and IBD, we examined the effects of immunomodulatory medication on infection risk.

Results
Among 638,089 cancer patients, 7,120 (1.1%) had IBD. The overall 3-month, 1-year, and 5-year cumulative incidence of infection in patients without IBD was 3.6% (95% CI, 3.6–3.6), 8.2% (95% CI, 8.2–8.3), and 18.3% (95% CI, 18.2–1.4%), respectively, and in patients with IBD it was 4.1% (95% CI, 3.7–4.6%), 9.8% (95% CI, 9.1–10.4%), and 21.8% (95% CI, 20.8–22.8%), respectively (Figure 1). IBD was associated with 3-month, 1-year, and 5-year infection HRs of 1.06 (95% CI, 0.94–1.20), 1.13 (95% CI, 1.05–1.23), and 1.21 (95% CI, 1.15–1.28) (Figures 1 and 2). Moreover, cancer-specific HRs at three months indicated an increased risk of hospital-treated infection among individuals with oropharyngeal, digestive tract, and male genitalia cancers (Figures 1 and 2). Furthermore, among patients with IBD, corticosteroids and combination therapy were associated with increased infection risk (HR 1.54; 95% CI, 1.03–2.31 and HR 1.64; 95 CI, 1.06–2.54, respectively), while biological agents reduced it (HR 0.66; 95% CI, 0.48–0.91).
Abbreviations: IBD = inflammatory bowel disease
*Adjusted for age, sex, CCI score, highest education, index years, T, N and M status
Abbreviations: IBD = inflammatory bowel disease

Conclusion
In cancer patients, IBD was associated with an elevated long-term risk of infections. In cancer patients with IBD, the use of corticosteroids increased the infection risk, while biological agents reduced it.

Figure 1: Cumulative incidence of hospital-treated infection in individuals with cancer with versus without IBD, according to cancer type, 2004–2021 (n= 638,089)

Figure 2: Adjusted HRs* (95% confidence intervals) for the association between IBD and hospital-treated infection in individuals with cancer with versus without IBD, 2004–2021 (n= 638,089)