bluuebunny/crossref_metadata_2025_split huggingface dataset:
P856 Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDs with Inflammatory Bowel Disease: results from the Prospective Urban Rural Epidemiology (PURE) study
Authors: Narula N , Wong E C L , Pray C , Marshall J K , Rangarajan S , Islam S , Bahonar A , Alhabib K F , Kontsevaya A , Ariffin F , Co H U , Al Sharief W , Szuba A , Wielgosz A , Diaz M L , Yusuf R , Kruger L , Soman B , Li Y , Wang C , Yin L , Mirrakhimov E , Lanas F , Davletov K , Rosengren A , Lopez-Jaramillo P , Khatib R , Oguz A , Iqbal R , Yeates K , Avezum Á , Reinisch W , Moayyedi P , Yusuf S 
Published: January 2023

Abstract

Background
Several medications have been considered to contribute to the aetiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.

Methods
This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results
During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p&lt;0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.

Conclusion
Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.
P864 Frailty is associated with fatigue in older patients with Inflammatory Bowel Disease
Authors: Fons A , Asscher V , van der Meulen-de Jong A , Stuyt R , Baven-Pronk M , van der Marel S , Jacobs R , Mooijaart S , Kalisvaart K , Maljaars J 
Published: January 2023

Abstract

Background
Fatigue is a common and debilitating symptom experienced by patients with inflammatory bowel disease (IBD). Studies focusing on fatigue in IBD were conducted in a relatively young population. However, little is known about the prevalence and factors associated with fatigue in the older population with IBD and how it relates to frailty.

Methods
The aim of this study was to determine the prevalence of fatigue and to identify factors associated with fatigue in older patients with IBD. Data were used from a prospective, multicenter cohort study, that included both older patients with IBD (aged &gt; 65 years) and younger patients with IBD (aged &lt; 65 years). Patients aged &lt; 65 years served as a control group to compare the fatigue prevalence found in older patients. A geriatric assessment (including the Geriatric 8 (G8) questionnaire) was performed to measure frailty at baseline in older subjects. Fatigue was evaluated using one item from the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Univariable and multivariable regression analysis were performed to assess factors associated with fatigue in older patients with IBD. Active disease was defined as the presence of clinical or biochemical disease activity.

Results
Fatigue prevalence in 405 older patients with IBD varied between 45.8% (71/155) in patients with active disease to 23.6% (59/250) in patients with disease in remission. In younger patients, fatigue prevalence varied between 59.5% (47/79) in active disease to 55.3% (42/76) in disease in remission. Multivariable analysis showed a significant association between fatigue and depression (Odds ratio (OR) 2.98, 95% confidence interval (CI) 1.23-7.17), sleeping disturbances (OR 4.25, 95% CI 2.40-7.54), use of immunomodulators (OR 2.24, 95% CI 1.15-4.38), and an abnormal frailty screening (G8) (OR 2.02, 95% CI 1.14-3.57). Frailty measured by geriatric assessment (OR 2.47, 95% CI 1.49-4.12) was also independently associated with fatigue. No association was found between fatigue and disease activity in multivariate analysis.

Conclusion
Fatigue has a lower prevalence in older patients with IBD compared to younger patients with IBD, but the prevalence increased sharply when active disease is present. Fatigue in older patients is associated with depression, sleeping disturbances and use of immunomodulators. Moreover, both risk of frailty in frailty screening and frailty measured in a geriatric assessment associate with fatigue in older patients with IBD.
P866 Skin lesions among consecutive Inflammatory bowel disease patients in outpatient setting
Authors: Jonaityte I R , Kiudelis G , Valiukeviciene S , Kupcinskas J , Jonaitis Prof. L 
Published: January 2023

Abstract

Background
It is well known that skin lesions may be frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). During literature analysis we found out that there is an obvious lack of epidemiological data regarding this issue. Therefore, the aim of our study was to establish the prevalence of skin lesions among consecutive IBD patients in outpatient department.

Methods
Prospective study included out-patients with IBD who were managed in the hospital of Lithuanian University of Health Sciences from January to October of 2022. Patients completed the questionnaires including the demographic and the IBD data and history or present state of cutaneous lesions. We considered skin lesions related to IBD or its treatment if they were diagnosed following the diagnosis of IBD. Skin lesions which were reported before the diagnosis of IBD were considered as not related to IBD.

Results
152 patients were included, mean age (MA) – 42.0±13.9 years. There were 88 (57.9%) males and 64 (42.1%) females. Ulcerative colitis (UC) was diagnosed in 110 (72.4%) patients, Crohn’s disease (CD) – in 42 (27.6%) patients. MA of UC patients was 42.3±13.6, CD – 41.1±14.9, p&gt;0.05. In total, skin lesions were indicated by 65 (42.8%) subjects. According to our criteria, in 46 (30.3%; 95% CI: 23-38%) cases, skin lesions were considered as obviously related to IBD or its treatment. We further analyzed latter cases.
Among UC patients, 32 (29.1%; 95% CI: 20-38%) had skin lesions related to IBD, among CD patients – 14 (33.3%; 95% CI: 18-48%), p&gt;0.05.
Erythema nodosum was diagnosed in 6 (3.9%) patients, pyoderma gangrenosum – 5 (3.3%), acne – 1 (0.7%), psoriasis – 9 (5.9%), vitiligo – 2 (1.3%), epidermolysis bullosa acquisita – 1 (0.7%), hemorrhagic vasculitis – 1 (0.7%), eczema – 9 (5.9%), allergic rash – 4 (2.6%).
The comparison of different skin lesions among UC and CD patients is presented in table 1.

Among the patients with UC proctitis, skin lesions were reported in 2 of 15 (13.3%) patients; among left-sided colitis – in 8 of 27 (29.6%); among pancolitis – in 22 of 67 (32.8%), p=0.03 between the groups of proctitis and pancolitis.
Comparing the different forms of CD, skin lesions were reported in 3 of 15 (20.0%) patients with ileitis, 4 of 10 (40.0%) patients with colitis and 7 of 17 (41.2%) patients with ileocolitis; p&gt;0.05 between different groups.

Conclusion
In our series the prevalence of skin lesions obviously related to IBD or its treatment is 30.3%. There were no differences in the prevalence of skin lesions between the UC and CD patients. The most common skin lesions in UC were psoriasis and skin eczema, in CD – erythema nodosum and skin eczema. Cutaneous lesions were significantly more prevalent in extensive UC compared to distal disease.
P869 Prevalence of Depression and Anxiety before and during the COVID-19 Pandemic in Puerto Ricans with Inflammatory Bowel Disease
Authors: Rivera Roman J G , López-Marte P , Vallejo-Tagle G , Hernández-Torres J , Torres E A , Viñas-Joy G 
Published: January 2023

Abstract

Background
A higher rate of anxiety and depression is present in patients with inflammatory bowel disease (IBD). The COVID-19 pandemic has negatively impacted mental health in the general population. This study aims to compare the prevalence of depression and anxiety in patients with IBD during the pre-pandemic period and the pandemic period, and to explore trends in patients' specific IBD-related needs during the pandemic era.

Methods
Data was collected from subjects with IBD in two different timepoints: 2016 and 2021-2022. Self-administered questionnaires were given to adults with confirmed IBD attending an academic IBD Clinic. Data collected included demographic information, Patient Health Questionnaire-9 (PHQ-9) for major depressive disorder (MDD), General Anxiety Disorder-7 (GAD-7) questionnaire and subject’s need for referrals to other services such as nutrition, pain management, mental health services. Scores of 10 or more in the GAD-7 or PHQ-9 indicate need for professional evaluation. Statistical analysis was performed using R Studio v.4.2.1. This study is approved by the UPR MSC-IRB.

Results
Two hundred-fifty-two questionnaires were collected in 2016 and 196 during the 2021-22 pandemic period. The majority of subjects were male (54.6%) and had Crohn’s disease (69.9%). Mean ± SD age was 40.2 ± 14.6. In the PHQ-9, 33.7% (n=91) during 2016, and 16.33% (n=32) during 2021-22 screened positive for MDD. For the GAD-7, 30.7% (n=83) during 2016, and 12.76% (n=25) during 2021-22 screened positive for generalized anxiety disorder (GAD). Sex and age differences were not detected for MDD and GAD screening, with exception for age differences in MDD during 2021-2022. The most frequent needs for referrals during 2021-2022 were nutrition evaluation (n = 74), access to IBD education (n = 73), psychology services (n = 71) and participation in research for IBD studies (n = 66)

Conclusion
The frequency of depression and anxiety in Puerto Ricans with IBD during the pandemic period was lower than pre-pandemic. Possible factors related to this include active use of telemedicine providing regular follow-up, integrated psychological support as part of the regular clinic services, and access to information regarding COVID-19 and IBD.
P877 Risk of gastric cancer among patients with incident ulcerative colitis: A nationwide population based study
Authors: Kim H S , Kim H , Kim K 
Published: January 2023

Abstract

Background
Few studies have investigated the risk of gastric cancer (GC) in ulcerative colitis (UC), with inconsistent results. This study assessed GC risk in patients with newly diagnosed UC.

Methods
Using claims data of the Korean National Health Insurance (NHI) from January 2006 to December 2015, we identified incident UC patients. UC was defined using the International Classification of Diseases-10 codes and UC-specific prescriptions. Age and sex-matched non-UC individuals during the same period were randomly selected as controls from the NHI database. Hazard ratios (HRs), adjusted for covariates, were calculated using multivariate Cox proportional-hazards regression.

Results
From 2006 to 2015, 30,546 patients diagnosed with UC and 88,829 matched non-UC individuals were included. GC developed in 77 (0.25%) UC and 383 (0.43%) non-UC individuals. The HR for GC in UC patients was 0.60 (95%CI: 0.47–0.77) compared to non-UC individuals. When stratified according to age and sex, the HR for late-onset UC (≥40 years) was 0.63 (95%CI: 0.49–0.80) compared to non-UC for the same age, and the HR of male UC patients was 0.55 (95%CI: 0.33– 0.89), compared to non-UC men. Among UC patients, the HR for age ≥40 years was 23.37 (95%CI: 6.38–85.64).

Conclusion
UC patients had a decreased GC risk compared to non-UC individuals. In particular, UC patients aged ≥40 years and male UC patients had a decreased risk of GC compared to non-UC individuals. However, among UC patients, late-onset UC (≥40 years) had a higher risk of GC than early-onset UC.
P882 Regional differences in biologic and surgical treatment of inflammatory bowel disease in Norway 2011–2019
Authors: Anisdahl K , Lirhus S S , Medhus A W , Moum B , Melberg H O , Høivik M L 
Published: January 2023

Abstract

Background
We have previously reported regional differences in biologic and surgical treatment for inflammatory bowel disease (IBD) patients diagnosed 2010–2012. In this study, our aim was to explore whether regional differences in the use of biologics and surgery were consistent over time.

Methods
We performed a nationwide, observational study using linked data from the Norwegian Patient Registry (NPR) and the Norwegian Prescription Database (Nor-PD). Incident cases were defined as ≥2 IBD diagnosis codes in the NPR, or ≥1 IBD diagnosis code in the NPR and ≥2 IBD prescriptions in the NorPD. Kaplan-Meier estimates were used to calculate time from diagnosis to first biologic and/or major surgical event. The log-rank test was used to test for statistical significance. Patients were stratified by health region affiliation (Northern [NR], Central [CR], Western [WR] and South-Eastern [SER]), and grouped as Cohort I (2011–2014) or Cohort II (2015–2019) depending on year of diagnosis.

Results
We included 7306 patients with Crohn’s disease (CD) and 13688 patients with ulcerative colitis (UC). Results are shown in Figure 1 (CD) and Figure 2 (UC). All cumulative incidences (%) reported below are measured five years after diagnosis.
CD patients:
In Cohort I, SER had the highest (40%) and CR had the lowest (35%) cumulative incidence of patients starting biologics (p=0.02). In Cohort II, WR had the highest cumulative incidence (53%), and differed significantly from NR and SER (p≤0.04).
In Cohort I, there were large regional differences in surgical treatment. NR had lower use of surgery (11%) than all other regions (p≤0.03). In Cohort II, the proportion undergoing surgery had decreased in all regions, except in NR (14%). The use of surgery was lowest in SER (12%), and differed significantly from CR and WR (p≤0.03).

UC patients:
In Cohort I, SER had the highest cumulative incidence of patients starting biologics (18%), and differed significantly from CR and WR (p≤0.01). In Cohort II, the use of biologics was lower in CR (20%) when compared to all other regions (p≤0.01), while differences between the three other regions were non-significant.
CR had the largest proportion of patients undergoing surgery in both Cohort I (8%) and Cohort II (7%), and differed significantly from all other regions in Cohort I (p≤0.05), and SER and WR (p&lt;0.01) in Cohort II. Differences between the three other regions were non-significant.

Conclusion
The study revealed important, sustained regional differences in the use of both biologics and surgery, especially for UC. Pursuing whether geographical treatment variation impacts outcome will aid in ensuring equal access to best clinical care.
P886 Clinical course and therapeutic management 5 years after diagnosis, in a cohort of Spanish patients with Crohn′s disease diagnosed in the 21st century
Authors: De Castro Parga M L , Dagraza M , Hernández V , García-Morales N , Pineda J R , Rodriguez-Prada I 
Published: January 2023

Abstract

Background
There are now serious doubts about the validity of the classical understanding of the natural history of Crohn′s disease (CD), as it is mainly based on retrospective studies that used old phenotypic classifications and that were carried out in a period of time when there were no biological drugs and little use of immunosuppressants. We aimed to evaluate the natural disease course 5 years after diagnosis of a cohort of CD patients diagnosed in the 21 st century in the North-West of Spain,

Methods
We performed an epidemiological, descriptive, prospective, incident cohort, population-based study. Patients diagnosed with Crohn's disease between 2010 and 2011 in Vigo healthcare area, belonging to the Epi-IBD study (formerly EpiCom) were followed up until December 31, 2016. Their electronic medical records were reviewed, and changes in location and behaviour CD phenotypic patterns, treatments received, as well as the presence of outbreaks with and without hospitalisation and the need for surgery were recorded.

Results
Between 2010 and 2011, 91 patients were diagnosed with CD, but only 75 of them were followed up until 2016. At 5 years, 20% CD patients had changed location and 34.7% their behaviour. Patients with ileal L1 or colonic L2 involvement at diagnosis maintained initial CD location more frequently (94.3% and 82.4%, respectively), but 31.6% ileocolonic L3 decreased location to L1 (15.8%) or L2 (15.8%) (p&lt;0.05). (Figure 1). Even more, patterns B3 at diagnosis greatly modified during follow-up: 22.2% changed to B1, 44.4% to B2 and 22.2% to B2-B3 (p&lt;0.05 for B1 and B2). (Figure 2 ). Initial location L1 was associated with stenosing pattern at 5 years follow-up (p&lt;0.05), and both phenotypes (L1 and B2) with need for surgery (p&lt;0.05).
Five years after diagnosis 54.7% of CD patients had received 5-ASA, 64% local corticosteroids, 74.7% systemic corticosteroids, 77.3% immunosuppressants, 33.3% biologics, and 20% surgery. At that time 48% had suffered an outbreak and 49.3% needed to be hospitalized. There were differences between the initial phenotypic pattern and use of biologics in the first year of follow up (55.6% of patients with B3 (p&lt;0.05 compared to B1 and B2) and 100% B2-B3 required this therapy compared to 20% of B2 and 18% B1, with no differences at 5 years.

Conclusion
Natural history of Crohn′s disease in the 2010-2011 Vigo cohort showed an improvement in their behaviour and location 5.years after diagnosis, with a decrease in penetrating behaviour and ileocolonic location. This fact could be explained by and early and high use of biologics drugs in the more aggressive phenotypes.
P901 A genetic analysis of familial aggregation in Inflammatory Bowel Disease multiplex families
Authors: Jans D , Lee H S , Ferrante M , Vermeire S , Cleynen I 
Published: January 2023

Abstract

Background
Relatives of patients with inflammatory bowel disease (IBD) have a higher risk to develop IBD than the general population. In some families, even a remarkably high prevalence of disease is found. Here, we aim to determine the role of the known IBD risk loci in familial aggregation of disease, as well as to study if there are common variants specific to familial IBD.

Methods
Imputed immunochip genotypes of 55 families [157 Crohn’s disease (CD), 29 ulcerative colitis (UC) and 138 unaffected relatives] that have at least three affected, first-degree relatives were used. A sporadic dataset (1705 CD, 917 UC, 873 controls) was used for comparison. For each individual, a polygenic risk score (PRS) was calculated with PRSice based on the IBD summary statistics of de Lange et al (2017), a p-value threshold ≤0.01 and MAF≥0.01. The mean PRS of all relatives of one family is denoted the familial PRS. Family-based association analyses were performed with SAIGE. The significance threshold for association used was p&lt;1e-4.

Results
As a group, unaffected relatives have a lower PRS than affected relatives (p=1.36e-5, β(se)=-0.60(0.14)), but still higher than unrelated controls (p=2.07e-4, β(se)=0.39(0.11))(fig 1). Twenty-four families have a familial PRS that is higher than the mean PRS of sporadic cases, and seven families have a familial PRS that is lower than the mean PRS of unrelated controls, the low PRS families (fig 2A). In most families, the affected members have a higher mean PRS than the unaffected members (fig 2B). This relationship however is sometimes reversed, especially in the low PRS families. SAIGE found nine variants to be associated with familial IBD (fig 3A, table 1). Two independently associated variants, rs2241130 in IL1RL2 (p=1.19 e-5, β(se)=1.21(0.28)) and rs144641193 in IL1RL1 (p=8.23e-5, β(se)=1.29(0.33)) reside in a known IBD locus (IL18RAP). Some other identified variants were also located in genes previously implicated in IBD, either through GWAS [rs72781786 in PRKCQ (p=2.93e-5, β(se)= -0.95(0.23))], or via functional studies (rs2242601 in EPHA1 and rs2272766 in CTSB). A restricted analysis of the low PRS families identified only one significant variant: rs11579543, located between RPE65 and DEPDC1 (p=6.12e-5, β(se)=-2.71(0.68))(fig 3B, table 1).

Conclusion
Our analysis indicates that common risk variants play an important role in familial aggregation of disease in many multiplex families. Some families however have a very low polygenic risk, indicating shared environmental factors might be relatively more important, or genetic factors not captured by the score, e.g. rare variants, may have contributed. Also, a few loci are specifically implicated in familial IBD, some related to the immune system, e.g. CLECL1 and CD69.
P915 Uncovering the role of Archaea in the pathogenesis of Inflammatory bowel disease
Authors: Singh P , 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
Microbial dysbiosis is a major factor that contributes to the course of Inflammatory Bowel Disease (IBD), a complex class of relapsing-remitting chronic inflammatory diseases. The body's overall homeostasis is significantly influenced by the human microbiota, which is a diverse population of bacteria, viruses, fungi, protists, and archaea. Recent research shows that archaea can affect both health and disease, by directly interacting with the host as well as other members of the microbial community. Although the role of bacteria, viruses, and fungi has already been studied, the archaeome remains the under-discovered part of the gut microbiota, especially in the context of IBD.

Methods
In this study, we profiled the gut archaea using archaeal 16S rRNA gene region in a cohort of pediatric patients with different forms of IBD including Ulcerative colitis (UC), Crohn’s disease (CD), unclassified IBD (IBDU) and healthy controls. We determined the compositional, diversity, and taxonomic alterations of archaea in pediatric patients with IBD and compared to healthy controls.

Results
Euryarchaeota, and Crenarchaeota, were the major archaeal phyla identified in our samples, other minor phyla identified were Halobacterota and Thermoplasmatota. At the genus level, Methanobrevibacter and Methanosphaera were the most abundant archaea, respectively. Overall, we did not observe any significant difference in the archeal alpha diversity within the various groups. There was however a significant difference between the overall community structure of the archaea between controls and IBD patients (p&lt;0.05).

Conclusion
A thorough understanding of the role played by the archaea during the pathogenesis of IBD may open the door to the identification of new processes and, ultimately, the development of creative therapeutic targets that can complement the currently used treatments for IBD patients.