bluuebunny/crossref_metadata_2025_split huggingface dataset:
P308 A new endoscopic scoring system corresponding to histological healing using linked color imaging in ulcerative colitis: SOUL study
Authors: Saito D , Hirai F , Uchiyama K , Takagi T , Naito Y , Takatsu N , Tanabe H , Kishimoto M , Matsuura M , Miyoshi J , Watanabe K , Esaki M , Naganuma M , Hisamatsu T 
Published: January 2023

Abstract

Background
An important therapeutic aim in ulcerative colitis (UC) is endoscopic remission. Although an endoscopic score with white light imaging (WLI) is mainly used to evaluate endoscopic findings, recently, the usefulness of linked color imaging (LCI) has been reported. We evaluated the relationship between LCI and histopathological findings and attempted to establish a new LCI endoscopic evaluation index for UC.

Methods
This study was conducted at Kyorin University, Kyoto Prefectural University, and Fukuoka University Chikushi Hospital. Ninety-two patients (median age, 46 years; male/female ratio, 48/34) with a Mayo endoscopic subscore (MES) ≤1 who underwent colonoscopy for UC in clinical remission between November 2016 and January 2019 were included. LCI index was defined as degree of redness (R) (grade 0–2), area of inflammation (A) (grade 0–3), and visibility of lymphoid follicles (L) (grade 0–3). Endoscopic scores were determined by three central endoscopic judgment committee members who are experts in colonoscopy for UC. Discussions were held among the three members, and when two or more of them had the same judgment this was adopted as the final evaluation. Each biopsy was performed from an identical site of colonoscopic image. Histological healing was defined as Geboes score &lt;2B.1. Histopathological scores were also determined by central judgment.

Results
In 92 patients, 85 biopsies from the sigmoid colon and 84 biopsies from the rectum (total 169 biopsies) were evaluated. Percentage of judgments that were consistent in two or more central endoscopic judgment committee members were 167/169 (98.8%) cases in MES, 164/169 (97.0%) cases in LCI index-R, 152/169 (89.9%) cases in LCI-index-A, and 150/169 (88.8%) cases in LCI-index-L. Regarding the κ-score in diagnosing by the two pathologists, “Chronic inflammatory infiltrate”, “Crypt destruction”, and “Crypt destruction” had a moderate agreement, and others had a stationary agreement. The overall histological healing rate was 84.0% (142/169). There were 22/117/30 cases of grade 0/1/2 in LCI index-R, 113/34/17/5 cases of grade 0/1/2/3 in LCI index-A, and 124/27/14/4 cases of grade 0/1/2/3 in LCI index-L. Histological healing was achieved in 84.1% (142/169) of the cases, and there were significant associations with histological healing/non-healing in LCI index-R (P=0.013) and A (P=0.0014).

Conclusion
A new LCI index is useful for predicting histological healing in UC patients with MES ≤1 and clinical remission.
P310 Smoking is not an independent risk factor for surgery in patients with Crohn’s Disease on biologic therapy
Authors: Sharara A , Halablab S , Sadaka C , Slika H , Adra N , Ghusn W , Shmeis M , Al Razim A 
Published: January 2023

Abstract

Background
To examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy.

Methods
Retrospective study of adult patients with CD at a University Medical Center over a 20-year period.

Results
A total of 251 patients were included (mean age 35.9 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (&gt;2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received &gt; one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 57 before, and 41 after starting biologics. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving &gt; one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006).

Conclusion
In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.
P316 Inflammatory Bowel Disease and malignancy: What are the predictors of malignancy in Inflammatory Bowel Disease?
Authors: Istemihan Z , Çavuş B , Bardak A E , Kırkoğlu A M , Kızıltaş C , Silay R , Şenkal İ V , İmanov Z , Nuriyev K , Rüstemzade A , Genç S , Güllüoğlu M , Çifcibaşı Örmeci A , Demir K , Beşışık F , Kaymakoğlu S , Akyüz F 
Published: January 2023

Abstract

Background
The aim of this study is to investigate the incidence of malignancy in patients with inflammatory bowel disease (IBD) followed up in a tertiary reference center.

Methods
IBD patients who were with at least 6 months of follow-up between the 1991-2022 from the gastroenterology clinic were evaluated retrospectively. Descriptive statistics for continuous variables in the study; expressed as mean (mean), standard deviation (SD), minimum, maximum, number (n) and percent (%). “Independent T-test” was used to compare continuous measurement values according to categorical groups. Chi-square test was used to determine the relationships between categorical variables.

Results
There were 696 patients in the study totally. 319 (45.83%) of these patients were female. Mean age of the patients were 48.27±14.58 years. IBD type was changed as; 307 (44.1%) had ulcerative colitis, 377 (54.1%) had Crohn's disease, 12 (1.8%) had indeterminate colitis. Before the diagnosis of IBD, 8 patients (1.1%) had a history of malignancy. The prevalence of malignancy after the diagnosis of IBD was 13 (1.86%). The characteristic of these 13 patients are described in Table 1. When the relationship between malignancy and gender, age, body mass index (BMI), disease age, and disease type in patients who developed malignancy in inflammatory bowel disease was examined, a statistically significant relationship was found in the elderly and those with high BMI (p=0.0019, p=0.004, respectively). When we look at the relationship between the risk of developing malignancy in IBD and the age of the disease at 10 and 8 years period, it was seen that there was no statistically significant relationship (p=0.245, p=0.343). When the patients who developed malignancy in IBD were compared in terms of the immunomodulators and biological agents used by the patients who did not develop malignancy, there was no statistical difference between the two groups (p&gt;0.05). (Fig.1 Graphical abstract).

Fig.1 Graphical abstract

Conclusion
Higher BMI and being older age found to be risk for the development of malignancy in IBD patients, although no relationship was found with the use of immunomodulator, biological agents, or disease type. The risk of malignancy, especially colorectal cancers, is increased in IBD. Therefore, close follow-up of these patients is important.
P320 Confocal Laser Endomicroscopy to predict the efficacy of vedolizumab as first-line biotherapy in ulcerative colitis
Authors: Quénéhervé L , Trang-Poisson C , Fantou A , Flamant M , Durand T , Bouguen G , Bregeon J , Oullier T , Amil M , Dewitte M , Bardot S , Braudeau C , Josien R , Neunlist M , Bourreille A 
Published: January 2023

Abstract

Background
There is no biomarker to guide first-line of biotherapy in ulcerative colitis (UC). The main objective of this multicenter pilot study was to demonstrate the feasibility of identifying a4b7 and/or TNF-a expressing cells by dual-band confocal endomicroscopy (CLE) into the mucosa to predict the response to vedolizumab as first-line biotherapy. NCT02878083.

Methods
Patients with moderate to severe UC, naïve of biotherapy were prospectively included and received vedolizumab. Patients were evaluated clinically, biologically, endoscopically and histologically at week 22. Nonresponding patients were subsequently treated by adalimumab and were evaluated at week 30. Prior to the initiation of vedolizumab, during endoscopy, 8 biopsies were taken for extemporaneous and ex vivo analysis by CLE, histology and confocal microscopy. Fresh biopsies were treated with vedolizumab coupled with FITC and adalimumab coupled with Alexa-Fluor to analyze their respective fluorescence (figure) in one step with the Dual-band CLE system (Mauna Kea Technologies, France). The number and the surface of positive stained areas visualized by CLE were counted and compared between responders and non-responders. Blood samples were collected before each infusion and were used to analyze the immune cells (LT, LB, NK, monocytes) by FACS and vedolizumab trough levels. Frozen biopsies were analyzed by confocal microscopy (Opal Akoya multiplexing; Tyramide signal amplification) after labeling by an anti-a4b7 antibody.

Results
19 patients out of the 20 initially planned were included. Clinical remission, endoscopic improvement (Mayo ≤ 1), endoscopic remission (Mayo 0) at W22 were respectively 58%, 58% and 45%. 18 out of 19 patients (95%) could be analyzed by CLE. The number and surface of vedolizumab-FITC stained areas were numerically superior in responder patients at week22; by contrast, no difference was found for the areas marked by adalimumab-Alexa-fluor. A threshold value of 6 areas marked in CLE by the vedolizumab-FITC at week 0 discriminated responders and non-responders at week 22 with a Se of 78% and a Sp of 85%. No difference of circulating cell population has been identified between responders and non-responders and the vedolizumab trough levels were not predictive of the response. In confocal microscopy, 15 patients have been analyzed; the percentage of a4b7-binding cells was not different between responders (n=9) and non-responders (n=6)

Conclusion
This study confirms the feasibility of extemporaneous identification by dual-band CLE of the mucosal cells expressing a4b7 and/or TNF-a. Results suggest that only the proportion of cells binding vedolizumab-FITC in the mucosa was indicative of the response to vedolizumab
P322 Mycobiome signature in pediatric patients with Inflammatory Bowel Disease
Authors: Murugesan S , Kumar M , Saadaoui M , Elhag D A , Hendaus M A , Ibrahim N , Al-Mudhaka F , AbuHazima K , Akobeng A , Elawad M , Al Khodor S 
Published: January 2023

Abstract

Background
Inflammatory bowel disease (IBD) encompasses dysregulation of mucosal immunity involving multiple factors including diet, medication, family history, and the gut microbiome. The symptoms of Pediatric IBD are different from an adult-onset disease. Based on the clinical conditions, IBD can be classified into three categories: Crohn’s disease (CD), Ulcerative colitis (UC), and IBD-unclassified (IBDU). The gut bacteriome alteration is widely reported in IBD. But the gut mycobiome link to the disease remains sparse. This study compared mycobiome profile changes in pediatric patients with IBD and healthy controls.

Methods
Stool samples were collected from patients with CD (n = 110), UC (n=64), IBDU (n=23), and healthy control subjects (n = 42). ITS-2 (Internal Transcribed Spacer) libraries were sequenced and analyzed using the QIIME pipeline to assess the gut mycobiome composition. Lefse analysis was performed to identify the signature members among the study groups.

Results
Ascomycota and Basidiomycota were the most common phyla among the study groups. Saccharomyces cerevisiae and Candida albicans were the most abundant species in the gut. Patients with IBDU and CD had significantly lower alpha and beta diversities compared to the controls.

Conclusion
Pediatric IBD is associated with reduced alpha and beta gut fungal microbiome diversity. Specific Candida taxa were found to be increased in abundance in the IBD samples. These results emphasize the potential importance of fungal microbiota signatures as biomarkers of pediatric IBD, supporting their possible role in disease pathogenesis.
P324 Long-term impact of the COVID-19 pandemic on Inflammatory Bowel Disease healthcare utilization: A two-year nationwide update
Authors: Derks Eduarda Wilhelmina M , van Lierop L , te Groen M , Kuijpers C , Nagtegaal I D , Hoentjen F 
Published: January 2023

Abstract

Background
The COVID-19 pandemic has profoundly impacted utilization of inflammatory bowel disease (IBD) healthcare, with a large reduction in scheduled procedures in the early phase of the pandemic, as shown in our previous study1. In this current nationwide study, we aimed to determine the impact of consecutive COVID-19 waves on IBD healthcare utilization including IBD-related diagnoses and procedures during the first two years of the COVID-19 pandemic.

Methods
We conducted a search in the Dutch nationwide pathology databank (PALGA) to identify IBD patients who underwent an IBD-related procedure between March 1, 2018 and February 28, 2022. We determined the incidence of IBD-related endoscopic and surgical procedures, new IBD diagnoses and neoplasia diagnoses (indefinite (IND), low-grade (LGD), high-grade dysplasia (HGD) and colorectal cancer (CRC)) during the first two years of the COVID-19 pandemic in the Netherlands (March 2020 – February 2022). The mean incidence of the previous two years (March 2018 – February 2020) served as a comparator.

Results
Our search yielded 89,401 (94.2%) endoscopic and 5,462 (5.8%) surgical procedures. We calculated a net reduction of 2.9% (1,391 IBD procedures) after the first two years of the COVID-19 pandemic compared to the two pre-pandemic years (endoscopic procedures: -3.1%, n=1,409; surgical procedures: +0.7%, n=18, figure 1). For both endoscopic and surgical procedures, an initial net decrease after the first pandemic year was followed by a net increase after the second year (-6.2% (n=1,413) versus +0.02% (n=4) and -1.3% (n=18) versus +2.7% (n=36), respectively). A net reduction of 0.9% (n=54) in new IBD diagnoses was observed over the first two years of the COVID-19 pandemic (first year: -0.8%, n=24; second year: -1.0%, n=30). A net reduction of 1.9% (n=74) in IND/LGD diagnoses was observed after the two-year pandemic period (first year: -10.9%, n=213: second year: +7.1%, n=139). No net decrease was seen for HGD and CRC diagnoses.

Conclusion
In this nationwide cohort study covering the first two pandemic years, we observed a mitigation of the initial reduction of IBD-related procedures after the first COVID-19 wave. This illustrates the rapid adaptation of the national IBD healthcare system during subsequent COVID-19 peaks.
References:
1 te Groen M, Derks MEW, Kuijpers CCHJ, Nagtegaal ID, Hoentjen F. Reduction in Inflammatory Bowel Disease Healthcare During the Coronavirus Disease 2019 Pandemic: A Nationwide Retrospective Cohort Study. Gastroenterology. 2021;160(3):935-7.e1
P325 Proton pump inhibitors are associated with a disabling course of Crohn’s disease
Authors: Barrau M , Duru G , Nancey S , Phelip J M , Cheifetz A , Papamichael K , Paul S , Xavier R 
Published: January 2023

Abstract

Background
The impact of proton pump inhibitors (PPIs) on the evolution of inflammatory bowel disease (IBD) remains debated with only sparse data available. The primary objective of this study was to analyze the impact of PPIs on the course of IBD.

Methods
This was a single-center, retrospective cohort study. We included consecutive adult patients diagnosed with Crohn disease (CD) or ulcerative colitis (UC) who were followed prospectively in our day hospital over a 4-month period (from May to August 2022). PPI exposure was defined as PPI use for a cumulative duration of more than seven days from the date of IBD diagnosis until the end of follow-up. We performed a time to event analysis to investigate the association of PPI exposure with treatment failure defined as an IBD-related surgery or hospitalization and/or failure for more than four biologic treatment (Anti TNF, Vedolizumab, Ustekinumab).

Results
Among the 281 patients identified, 244 patients were eligible for analysis of the primary objective (152 with CD, mean age 45 years, sex ratio 1:1). 113 (46%) patients had been previously exposed to a PPI. PPI-exposed patients were significantly older (p=0.013), more often women (p=0.029), with more frequent active smoking (p=0.001). A total of 152 patients (62%) had treatment failure. Using Cox regression analysis, (Table 1), PPI use identified as an independent factor associated with treatment failure (HR = 1.920; 95% CI [1.084-3.403]; p0.025). In a subgroup analysis by IBD type, this remained statistically significant only for CD (HR = 3.190; 95% CI (1.412-7.206); p 0.005) but not for UC (HR = 0.981; 95% CI (0.384-2.504); p0.968). Survival without treatment failure (Figure 1) was significantly higher in patients without PPI exposure compared to patients with PPI exposure, (325 months vs. 228 months, respectively, p=0.022 (Log-Rank). In a subgroup analysis of infliximab-treated patients, PPI use was not associated with risk of immunogenicity (HR = 1.071; 95% CI (0.515-2.226); p0.854).

Conclusion
This study demonstrates the negative impact of PPIs on the disease course in patients with CD. The use PPIs should better be discussed on a case-by-case basis.
P329 Stool multiplex molecular PCR assay in comparison to conventional stool tests for detecting gastrointestinal infections as cause of flares in Inflammatory Bowel Disease
Authors: Kutar M , Desai D , Abraham P , Gupta T 
Published: January 2023

Abstract

Background
Inflammatory bowel disease (IBD) is characterized by unpredictable flares. Other than natural history, flares can be caused by superadded gastrointestinal (GI) tract infections. Diagnosis of infection is conventionally made by microscopy and culture of stool specimens. These are limited by lengthy turnaround time, low sensitivity, inability to detect agents other than bacteria, and effect of pre-test antibiotic usage.Stool multiplex molecular PCR assay allows simultaneous detection of nucleic acids from 23 bacteria, viruses and parasites.

Methods
We aimed to:
1. Compare infectious organisms detected by stool multiplex PCR assay and conventional stool tests during flare in patients with IBD.
2. Determine impact of detection of infective agents in the management of flares, as measured by use of anti-infective agents.
In this single centre, prospective, cohort study, every patient underwent conventional stool tests (microscopy, culture and Clostridioides Difficile toxin assay) and multiplex PCR assay by Biofire® FilmArray test. Consenting patients above 18 years with IBD flare were included. Patients with colorectal cancer, toxic megacolon, intestinal perforation, previous IBD surgery were excluded.

Results
Of 60 patients, 53 patients were of Ulcerative colitis (UC) and 7 were of Crohn’s disease (CD). The mean age of patients with UC was 42.32 years and that of CD was 37.5 years. Of the patients with UC, 26 were male and 27 were female. In CD, 4 were male and 3 were female.
Stool Biofire® resulted in better organism detection rate (Table 1) and more frequent need for change in management (Table 2) as compared to conventional tests.
The cost per stool Biofire® was INR 12000 (€142) and that of conventional stool tests INR 4300 (€51). However, the cost to achieve one positive result on stool Biofire® that led to change in management was INR 65,454 (€773) as compared to INR 86,000 (€1015) for conventional stool tests.

Conclusion
Stool Biofire® resulted in significantly more organism detection (33 vs 6 pts). It also led to more frequent need for change in management as compared to conventional stools tests (11 vs 3 pts). It also proved more cost-effective than conventional stool tests in terms of change in management of flare in patients with IBD.
P330 Ultrasound remission after biologic induction predicts long-term endoscopic remission in Crohn’s disease
Authors: Allocca M , Dell’Avalle C , Furfaro F , Zilli A , Radice S , D’Amico F , Peyrin-Biroulet L , Fiorino G , Danese S 
Published: January 2023

Abstract

Background
Intestinal ultrasound (IUS) is accurate and non-invasive to detect and monitor disease activity in Crohn’s disease (CD). The Bowel Ultrasound Score (BUSS= 0.75 × bowel wall thickness + 1.65 × presence (1) or absence (0) of bowel wall flow) demonstrated high accuracy in detecting therapy-related changes, and good correlation with the Simple Endoscopic Score for CD (SES-CD). The most accurate cutoff value for BUSS was 3.52 for endoscopic remission (SES-CD ≤ 2).This study aimed to prospectively evaluate ultrasound remission as a relevant treatment target.

Methods
Consecutive patients with active CD (SES-CD &gt; 2) starting biologic treatments were included. Patients underwent colonoscopy and IUS at baseline and after 1 year of treatment. Clinical, biochemical and ultrasound assessments were additionaly performed at week 12. Primary outcome was to evaluate whether ultrasound remission at week 12 could predict endoscopic remission at week 54. Endoscopic remission was defined as SES-CD ≤ 2, ultrasound remission was defined by BUSS ≤ 3.52, clinical remission was defined by HBI (Harvey-Bradshaw Index) &lt; 5, and biochemical remission was defined by normalization of C-reactive protein (&lt; 5 mg/L) and fecal calprotectin (three different thresholds were assessed: &lt; 250 µg/g, &lt; 100 µg/g, &lt; 50 µg/g).

Results
Ninety-three patients were included (8 under infliximab, 40 under adalimumab, 5 under vedolizumab and 40 under ustekinumab). Eighteen patients (19%) and 36 patients (39%) achieved endoscopic remission and ultrasound remission at week 54, respectively. CD patients with ultrasound remission at week 12 were more likely to achieve endoscopic remission (odds ratio [OR] 6.88 [2.14–22.04]; p = 0.001) and ultrasound remission (OR 4.26 [1.61–11.24]; p = 0.003) at week 54. Calprotectin value &lt; 50 µg/g at week 12 predicted endoscopic remission at univariable (OR 3.14 [1.04–9.45]; p = 0.041), but not at multivariable analysis. No other clinical or biochemical variables at week 12 predicted endoscopic and/or ultrasound remission at week 54.

Conclusion
Ultrasound remission achieved at week 12 may predict long-term endoscopic remission and may be a strategic treatment target, both in clinical practice and in clinical trials.