bluuebunny/crossref_metadata_2025_split huggingface dataset:
P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis
Authors: Brunet E , Melcarne L , Llovet L P , Garcia-Sague B , Vela E , Cleries M , Pontes C , García-Iglesias P , Puy A , Villoria A , Calvet X 
Published: January 2023

Abstract

Background
Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia.

Methods
Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD.
Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC).

Results
Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals.
The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient.

Conclusion
Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.
P837 Incidence, evolution of disease phenotype, time to biological therapy and medium-, long-term surgery rates in IBD-U patients in Western Hungary – a population-based study between 1977–2020, data from the Veszprem county cohort
Authors: Gonczi L , Lakatos L , Golovics P A , Pandur T , David G , Erdelyi Z , Szita I , Lakatos P L 
Published: January 2023

Abstract

Background
The number of epidemiological population-based studies on unclassified inflammatory bowel disease (IBD-U) patients are very limited. The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course of IBD-U since 1977. Our aim was to evaluate incidence, prevalence, disease course, time to biological therapy and surgery rates in a prospective population-based database of incident IBD-U patients diagnosed between 1977 and 2018, with follow-up until 2020.

Methods
Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, time to first biological therapy, disease progression, and colectomy was registered.

Results
Data of 119 incident IBD-U patients were analyzed (male/female: 55/64; median age at diagnosis: 34 years(y) (IQR: 24-47)). Adjusted mean incidence rate was 0.76 (CI95%: 0.63-0.9) /105 person-years in the total study period, and 0.96 (CI95%: 0.79-1.16) /105 person-years between 1990-2018. Disease extent at diagnosis was proctitis in 7.6%, one-sided colitis (left-sided colitis, or isolated right-sided colitis) in 36.1%, and extensive (pancolitis) in 56.3%. The probability of progression in colonic disease extent was 6.7% (SE:2.3) at 3 years, 10.3% (SE:2.8) at 5 years and 15.3% (SE:3.4) at 10 years. Figure 1. The probability of developing terminal ileitis, thus disease classification change – Crohn’s disease was 2.6% (SE:1.5) at 5 years and 3.5% (SE:1.7) at 10 years. Figure 2. Perianal disease developed in 5% (n=6) of all patients during the total follow-up. The probability of receiving biological therapy in patients diagnosed after the year 2000 (n=62), was 15.5% (SE:4.8) at 5 years, and 19.4% (SE:5.3) at 10 years. Figure 3. The overall resective surgery rate was 16.8% at the end of follow-up. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal- or total colectomy. The cumulative probability of resective surgery was 7.6% (SE:2.4) at 1 year, 9.3% (SE:2.7) at 5 years, 13.5% (SE:3.3) at 10 years, and 18.5% (SE:3.9) at 20 years. Figure 4.

Conclusion
Initial disease phenotype was severe in most cases of IBD-U and colonic progression is substantial over time. Disease classification change to Crohn’s disease with development of terminal ileitis or perianal disease was low. High rates of biological therapy and surgery are suggestive of a severe disease course of IBD-U.
P839 Clinical activity in inflammatory bowel diseases is associated with consumption of processed foods
Authors: Sarbagili Shabat C , Zelber-Sagi S , Fliss Isakov N , Hirsch A , Ron Y , Thurm T , Maharshak N 
Published: January 2023

Abstract

Background
Western diet and its food components have been suggested to influence inflammatory bowel diseases (IBD) clinical course. However, the association of dietary processing factors and disease activity is uncertain. We aimed to evaluate whether intake of foods with varying processing levels is associated with disease activity in IBD patients.

Methods
A cross-sectional study of adult patients with IBD was performed at a tertiary center between August 2019 to June 2022, by collecting clinical and dietary data from consecutive patients who signed an informed consent form. Clinical activity was defined using HBI (Crohn's disease) and SCCAI (ulcerative colitis). Dietary intake was assessed using a dedicated validated processed food questionnaire (PFQ) that categorizes dietary intake into three groups of processed food levels: unprocessed or minimally processed, processed, and ultra-processed. Adjusted odds ratios for disease activity were determined using a multivariate logistic regression.

Results
A total of 242 IBD patients (62.8% Crohn’s disease patients) were enrolled, of whom 73.1% were in clinical remission. Comparing the higher tertile to the lowest tertile of foods consumption - unprocessed foods (OR 0.29, 95% CI 0.13-0.65) and processed foods (OR 0.40, 95% CI 0.19-0.82) were negatively associated with disease activity, while high consumption of ultra-processed foods was positively associated with active disease (OR 2.24, 95% CI 1.05-4.77). All ultra-processed food subgroups were positively associated with higher odds of active disease.

Conclusion
Higher intake of unprocessed or minimally processed foods was associated with lower odds of clinically active IBD, while higher ultra-processed foods intake was associated with higher odds of active disease. Further studies are needed to evaluate the impact of different levels of food processing on disease activity.
P840 Longitudinal bidirectional association of physical activity and disease activity in children with Inflammatory Bowel Disease: a cohort study
Authors: Dehbidi Assadzadeh L , Youn E Y J , Huang F , Djani L , Belmesk L , Madagh S , Kanters C , Yang X , Chennou F , Geng S Y , Bouthot J , Colette D , Jantchou P 
Published: January 2023

Abstract

Background
Studies have shown that regular physical activity (PA) can contribute to lower inflammatory markers over time in pediatric patients with an inflammatory bowel disease (IBD). However, patients with active disease may be less prone to engage in PA and therefore, develop sedentary habits. No study so far, have investigated if clinical disease activity (CDA) can affect PA longitudinally and if PA may impact disease outcomes. The aim of this study was to investigate the bidirectional association between PA and CDA in a cohort of children and adolescents with IBD.

Methods
IBD patients of CHU Sainte-Justine pediatric hospital were prospectively surveyed using the Canadian Health Measures Survey Children’s Physical Activity Questionnaire during outpatient visits every three months for one year. PA levels were classified according to Canadian moderate-to-vigorous PA (MVPA) recommendations. Clinical data was collected retrospectively through patients’ files. CDA was determined at baseline and at each follow-up visit.

Results
A total of 247 IBD patients (median age [IQR], 15 years [13-17]; 55% male) were included. Among them, 167 (68%) were diagnosed with Crohn’s disease and 80 (32%) with ulcerative or indeterminate colitis. At the initial visit, 65% of patients were considered in clinical remission, 28% of patients were considered “sedentary”, 21% “moderately active”, 31% “extremely active” and 25% “vigorously active”. Patients classified as “extremely active” (34-74 minutes of daily MVPA) at initial visit were less likely to have active CDA at follow-up (odds ratio (OR) [95% CI]: 0.30 [0.09-0.96]). Inversely, CDA at baseline did not correlate with PA levels at follow-up. BMI, sex and age did not significantly affect PA level or CDA between follow-ups.

Conclusion
This study demonstrates a possible protective association between higher PA level and CDA over time in pediatric IBD. These findings stress the importance to engage children with IBD in regular physical activity.
P841 Implication of Clostridioides difficile in the diagnosis and evolution of patients with pediatric inflammatory bowel disease
Authors: Palomino Pérez L M , Delgado Fernández-Valdés M , Velasco Rodríguez-Belvís M , Cañedo Villarroya E , De la Mano Hernández A , Dominguez Ortega G , Martínez Pérez J , Martinez Navarro G , Martín Fernández C , Di Campli Zaghlul M , García Hernández P , Sánchez Llorente P , Muñoz Codoceo R A 
Published: January 2023

Abstract

Background
In the recent decades, the incidence of Clostridioides difficile (Cd) infection in children with inflammatory bowel disease (IBD) has increased, possibly due to underlying dysbiosis. The main objective of this study is to compare the prevalence of this infection in patients with IBD and without it, as well as secondarily to describe risk factors for Cd and its impact on the evolution of IBD.

Methods
Unicentric, observational and retrospective study of paediatric patients (&lt;18 years old) undergoing Cd screening at the Hospital Infantil Universitario Niño Jesús in the last 5 years. Patients with IBD were those who met the Porto criteria. Statistical analysis was performed using SPSS.

Results
3,360 paediatric patients were included. Of the 150 patients whose screening was requested by the Digestive Section, 87 had IBD. There were no statistically significant differences in the prevalence of infection in patients with IBD compared to other patients (p=0,061).
According to the Paris Classification, no differences were found in relation to the prevalence of Cd infection, except for patients with growth impairment (G1), with a higher prevalence of infection compared to those without (G0) (33.3% vs. 13.9%) p&lt;0.05. Regarding treatment, a higher prevalence of Cd infection was observed in patients receiving aminosalicylates monotherapy (42.9% vs. 13.4%) p&lt;0.05 and in patients receiving NEE in monotherapy (60% vs. 15.8%) p&lt;0.05. In contrast, a lower prevalence of Cd was observed in patients treated with azathioprine (with or without other therapies) compared to those not receiving azathioprine (10.3% vs. 26.2%) p&lt;0.05. A lower prevalence of positives was also observed among those treated with biologics (with or without other therapies) (8% vs. 23.2%) p&lt;0.05.
Patients with IBD in whom the test was positive required more frequent changes in their baseline treatment than those who had negative screening (72.2% vs. 14.9%, p&lt;0.05).

Conclusion
Although it has not been demonstrated that Cd is more prevalent in patients with IBD, it does seem to condition the course of the disease, being patients in whom more treatment changes have been made. Given the complexity of the data related to infection rates in relation to the different treatments, further studies in pediatric patients with concomitant IBD and Cd are considered necessary to confirm such differences and explain the possible pathophysiology.
P845 Increased incidence of herpes zoster in patients with Inflammatory Bowel Diseases in Europe
Authors: Marijam A , Vroom N , Bhavsar A , Posiuniene I , Lecrenier N , Vroling H 
Published: January 2023

Abstract

Background
Immunocompromised (IC) patients, including those with autoimmune Inflammatory Bowel Diseases (IBD), are at increased risk for herpes zoster (HZ). HZ affects one in three adults aged ≥50 years, with complications of post-herpetic neuralgia (PHN) in around one in ten affected adults. PHN impacts patients’ health-related quality of life and is difficult to treat. Both HZ and PHN place a financial burden on healthcare systems. The objective was to systematically review the incidence of HZ in IC populations.

Methods
A systematic literature review was performed to identify observational studies reporting on the HZ incidence in a broad range of IC populations in the European Union/European Economic Area, Switzerland and United Kingdom (2002-2022). The results for IBD patients are reported here.

Results
Overall, 26 studies reported HZ incidence rates, with three reporting on IBD patients.
In Valencia, Spain, using hospital and primary care data in adult patients (≥18 years), HZ incidence rates were higher in IBD patients versus non-IC patients, and increased with age (Table 1). In this study, IBD versus non-IC patients had significantly higher rates of HZ complications (7.67 [3.51-14.57] vs. 2.64 [2.42-2.86] per 100,000 person-years [PY]) and of HZ recurrence (2.48 [2.06-2.96] vs. 1.56 [1.53-1.59] per 100 PY), driven by high rates in patients ≥60 years.1
In England, data from the Clinical Practice Research Datalink matched IBD patients (≥18 years) to non-IC patients. HZ incidence was higher in IBD versus non-IC patients and increased with age (Table 1).2
From German claims data (2012) in over ten million adults (≥18 years), HZ incidence in patients with ulcerative colitis and Crohn’s disease were higher than in the non-IC population (Table 1).3
Table 1. HZ incidence rate (per 1,000 person-years) in IBD versus non-IC patients

Conclusion
Three large real-world studies confirmed significantly higher HZ incidence rates in IBD versus non-IC patients, with higher rates in older age groups. These findings support healthcare providers and guideline committees in reinforcing HZ prevention strategies for IBD patients. An adjuvanted recombinant HZ vaccine is the first approved for use in IC populations, and may help reduce the healthcare system and patient burden.
References:
1Muñoz-Quiles et al. BMC Infect Dis 2020; 20(1): 905;
2Yanni et al. BMJ Open 2018; 8(6): e020528;
3Schröder et al. J Infect 2017; 75(3): 207-15.
Funding: GlaxoSmithKline Biologicals S.A. funded this study and all costs related to publications development.
P848 Risk of Orthorexia Nervosa in Patients with Inflammatory Bowel Disease: A Link with Eating Disorders?
Authors: Di Giorgio F M , Modica S P , Ciminnisi S , Saladino M , Muscarella S , Melatti P , Brinch D , Petta S , Cappello M 
Published: January 2023

Abstract

Background
Self-imposed food restrictions are common in patients with inflammatory bowel disease (IBD) because oftheir erroneous belief of the role of food in disease worsening and, recently, eating disorders have alsobeen described. Orthorexia nervosa is characterized by the obsession of eating healthy and natural foods.Only a few studies have assessed orthorexia in patients with digestive disease and there are no studies inIBD. The aim of this study is to assess the risk of orthorexia in patients with IBD.

Methods
158 consecutive subjects were prospectively recruited from February to October 2022 in a tertiary referralcenter: 113 patients with IBD and 45 healthy controls. The cohort of IBD patients consisted of 74 patientson biologic drugs, 28 patients on conventional therapy, and 12 patients admitted to the ward for diseaseflares. Demographic and clinical data were collected, and the ORTO-15 questionnaire, validated by Doniniet al., was used to assess the risk of orthorexia.

Results
Patients with IBD had a prevalence of orthorexia of 77%, significantly higher than the 47% observed in thecontrol group (p &lt;0.001). No statistically significant differences between patients with and without risk oforthorexia in relation to age (p=0.66), gender (p=0.37), marital status (p=0.78), educational status (p=0.88),and occupation (p=0.64) were found, although a nonsignificant trend could be observed for a lower BMI inpatients with risk of orthorexia compared with those without orthorexia (mean BMI 26.7 VS 25 kg/m2,p=0.12). The prevalence of orthorexia did not differ in relation to the diagnosis of UC or CD (p=0.98), nor tothe duration (p=0.75), the type of biological or conventional therapy (p=0.42), disease activity as measuredby Mayo score/HBI (p=0.47), and the presence of ostomy (p=0.33). The only statistically significantdifference observed concerned the history of previous surgery for IBD in patients with orthorexia (19.5percent), versus 3.8 percent in patients without orthorexia (p=0.05).

Conclusion
Our study showed that most patients with IBD has a risk of orthorexia and that this is associated with alower BMI and a history of previous surgery for IBD. Further research is warranted to evaluate the clinicalimpact of orthorexia in patients with IBD and its relationship with the avoidant restrictive food intakedisorder (ARFID) or other eating disorder. Evidence based counselling by a qualified dietician is stronglywarranted in IBD clinics.
P851 Impact of an integrated model of care for inflammatory bowel disease on direct healthcare costs: A population-based matched cohort study from Saskatchewan, Canada
Authors: Maldonado F , Penz E , Jones J , Pena-Sanchez J N 
Published: January 2023

Abstract

Background
Integrated models of care (IMC) for IBD lead to reduced hospitalizations, surgeries, comorbidities, and overall improved outcomes. There are limited studies assessing the impact of IMC on direct healthcare costs. We aimed to estimate the impact of exposure to an IMC on direct healthcare costs among individuals diagnosed with IBD.

Methods
We conducted a quasi-experimental difference-in-difference (DID) cost analysis using administrative health data from Saskatchewan, Canada. We included individuals ≥18 years old meeting a validated administrative IBD case definition between January 2009 and March 2015. IBD cases were classified as exposed or non-exposed to the Saskatchewan IMC and required to have three years of healthcare coverage after baseline (i.e., first visit with an IMC [exposed] or a non-IMC [non-exposed] gastroenterologist). The direct healthcare costs were derived from the administrative databases, adjusted to 2014/15 Canadian dollars, and categorized into hospitalizations, physician visits, and medication claim costs (i.e., immunomodulators [IMM], biologics [BIOL], aminosalicylates[5-ASA]). Propensity scores (PS) were calculated based on healthcare utilization and comorbidities in the 12 months before baseline. Cases (exposed) were matched 1:5 controls (non-exposed) based on PS and disease duration. DID estimators were determined for each cost category using mixed linear regression models including age, sex, disease type, and area of residence as covariables.

Results
In total, 2905 IBD cases were included in the study, 597 exposed and 2308 non-exposed individuals (Figure); the majority were females (52%), lived in urban areas (74%), and had Crohn’s Disease (61%). The mean age was 44.6 years (SD=15.5) and the average disease duration at baseline was 5.7 years (SD=5). In comparison to the non-exposed group, the costs of physician visits (IBD-related [DID= $-139, 95%CI -209 to -68], IBD-specific [DID=$-155, 95%CI -212 to -97], and specialty visits [DID=$-135, 95%CI -201 to -69]); and IMM dispensations (DID=$-18, 95%CI -35 to -2) were lower in the exposed group. Conversely, we identified higher total healthcare costs (DID=$1707, 95%CI 369 to 3044); IBD-related medication (DID=$2341, 95%CI 1484 to 3197) and BIOL (DID= $2467, 95%CI 1605 to 3328) dispensations costs in the exposed group. There were no other statistically significant differences between the groups.

Conclusion
We identified lower physician visit and IMM costs in the exposed group than in the non-exposed one. Total healthcare costs were higher among the exposed group, largely driven by higher BIOL costs. These results highlight the potential cost impact of IMC for IBD and the need for cost-effectiveness studies of IMC to further assess value of this care model.
P855 The impact of the severe financial crisis on drug persistence and disease course in IBD patients in Lebanon
Authors: Sharara A , Ibrahim M A , Allam J , Haidar-Ahmad D , Chalhoub C , Francis R 
Published: January 2023

Abstract

Background
Lebanon is currently going through an unprecedented financial crisis (considered as one of the worst in the world in modern times) that has affected all aspects of everyday life. In particular, the economical crash has significantly crippled the Lebanese healthcare sector, resulting in severe shortages of basic drugs and medications, most of which cannot be produced locally. Patients with chronic diseases including those with Inflammatory Bowel Disease (IBD) have been impacted most given their need for costly and chronic treatment including biologics.

Methods
We collected data using a 12-question web survey disseminated through social media platforms of the patient organization, I Battle Disease. The questions aimed to explore the patients’ ability to acquire the necessary medications, whether they had to alter or completely stop their treatment, and any resulting complications (forced corticosteroid use, hospitalization, or surgery) it had on the course of their disease.

Results
102 patients completed the survey. The patients were nearly evenly split between Crohn’s disease (53%) and ulcerative colitis (47%). Adalimumab was the most commonly used medication before the economic crisis (30%), followed by infliximab (18%), vedolizumab (10%), ustekinumab (8%), and tofacitinib (8%). Azathioprine and 5-ASA monotherapy were used by 8% and 19% of patients respectively. All biologics and small molecules used to be covered fully by third party payors including the National Social Security Fund (38%), the Ministry of Public Health (22%), and private insurance (18%). As a result of the crisis, the majority of patients (69%) declared stopping or interrupting their treatment in the past 3 years, with most (46%) having interrupted treatment for &gt;12 months. 22% of patients reported switching to azathioprine due to issue in access to biologics. Additionally, 69% of patients reported worsening of their condition after stopping treatment, resulting in forced steroid use (36%), switching to another medication (36%), or unscheduled hospital admission (15%). Further, 66% of participants confirmed that they had to purchase their medications from abroad or through a local private vendor using out-of-pocket foreign currencies. Finally, 12% of patients reported that they had to immigrate or seek employment abroad due to difficulty with drug access.

Conclusion
The recent financial and economic events in Lebanon have imposed significant challenges on patients with IBD, affecting their adherence to therapy and consequently the control of their disease. There is an urgent need for action within the public health context to improve IBD medication availability and accessibility for the Lebanese population.