bluuebunny/crossref_metadata_2025_split huggingface dataset:
P313 Understanding Inflammatory Bowel Disease patients’ experiences, expectations, and insights in identifying and managing anxiety and depression.
Authors: Zelinsky S , Daley K , Patel A , Jeffs L , Zeng L , Targownik L 
Published: January 2023

Abstract

Background
Patients living with Inflammatory Bowel Disease (IBD) commonly experience mental health (MH) challenges, specifically anxiety and/or depression. Although, there is a growing awareness of the relationship between IBD and MH; detection, treatment, and management amongst care providers is limited. The purpose of this patient-oriented, qualitative study was to explore IBD patient experiences, perspectives, and insights of living with MH challenges and to understand their interactions with GI clinicians, from diverse care settings, to determine how to best support IBD and MH in IBD care.

Methods
Convenient and snowball sampling was used to recruit adult participants diagnosed with IBD and who had experience of living with MH challenges and were seeing a Gastroenterologist in Canada. This qualitative descriptive study used online focus groups to collect data. Focus groups were audio recorded and transcribed verbatim. Data was analyzed using thematic analysis.

Results
Twenty-four participants from across Canada, both from rural and urban locations, participated in the study. IBD patient participants indicated that MH should be discussed by GI’s as part of routine clinical practice. All participants indicated that there is a lack of resources and access to MH services for IBD patients. Four main themes emerged from the data: 1) experiences with IBD: difficulties related to reintegrating into social settings, feelings of loneliness; 2) expectations around mental health support: the need to develop their own resiliency strategies due to the lack of structural resources regarding mental health and IBD in the clinical space; 3) GI engagement: HCPs were dismissive of mental health symptoms, often gaslighting patients when mentioning mental health concerns during clinical encounters; and 4) expectations: a need to standardize mental health care across IBD care settings with a focus on integrating specialized healthcare providers as part of multidisciplinary care teams to help address the need for mental health supports for IBD patients in Canada.

Conclusion
Effective detection, awareness, management, and the integration of patients’ perspectives and insights can help inform the development of mental health supports and services to help improve IBD care to a more wholistic approach to care. Results from this study will be interpreted in line with insights gathered from upcoming interviews of gastroenterologists and HCPs.
P317 Patient satisfaction in a joint fistula clinic at a tertiary Inflammatory Bowel Disease centre in the United Kingdom
Authors: Mukhtar M S H , Lim W J , Tozer P , Hart A 
Published: January 2023

Abstract

Background
Patients with fistulising perianal Crohn’s disease experience significant impairments in their sexual and social relationships, work, and overall life quality. The presence of perianal disease can result in patients avoiding sex, ending intimate relationships, and feeling inadequate or guilty towards their partners. Some participants also report partners’ refusal to engage in sex(1).
Access to joint fistula clinics, where patients can simultaneously meet gastroenterologists and surgeons, may yield better care. However, sharing intimate details about the sexual-, social-, and mental-health effects of fistulising disease can be particularly difficult and anxiety-provoking for patients, when there are multiple healthcare workers present.

Methods
An evaluation questionnaire was developed to assess patients’ overall perception and satisfaction regarding the joint fistula clinic at St. Mark’s Hospital in London. All patients who attended in person and were able to understand English and provide verbal consent were invited to provide their feedback. The questionnaire included items assessing overall comfort, ease of discussing intimate social and sexual topics, and other aspects of provided services.

Results
Between January and August 2022, a total of 25 patients provided their evaluations. Of these participants, 17 (68%) were females. The mean age of participants was 40.2 (+/-13) years. About 56% of these patients attended the clinic accompanied by their partners, parents, or other family members. About 70% of clinic encounters had 3 or more healthcare workers present. Details of encounters are illustrated in table 1. Responses to questionnaire statements are summarized in table 2, graph 1 and 2.

Conclusion
The joint fistula clinic was positively perceived by patients, the majority of whom reported feeling comfortable discussing intimate sexual issues. Contrary to what was expected, the presence of multiple healthcare workers during an encounter did not generally make discussions more difficult.
References:
(1) Spinelli A, et al. “The impact of perianal fistula in Crohn’s disease on quality of life: Results of a patient survey conducted in Europe”. Poster presentations: Clinical: Therapy and Observation 2021
P338 Transmural healing is not associated with less disability than complete endoscopic mucosal healing: a prospective study in a patient with Crohn's disease
Authors: Yzet C , Brazier F , Hautefeuille V , Grados L , Decrombecque C , Diouf M , Fumery M 
Published: January 2023

Abstract

Background
Crohn's disease (CD) is associated with disability by affecting physical and emotional well-being, and by altering social interactions. In the era of treat to target, endoscopic remission has become the therapeutic target to prevent parietal destruction and disability. A deeper remission such as transmural healing would reduce long-term complications related to CD. The impact of transmural healing on disability is currently unknown.

Methods
We conducted a monocentric cross-sectional study between September 2019 and January 2022. Patients followed for CD in endoscopic remission (CDEIS &lt;4) who underwent within &lt; 4 weeks an intestinal ultrasound (IUS) and a disability assessment by an IBD-disk were consecutively included. Four groups were considered: (A) transmural healing defined by the combination of complete endoscopic healing (CDEIS=0) and ultrasound healing (bowel wall thickness (BWT) less than 3 mm), (B) complete endoscopic healing, (C) ultrasound healing and (D) no healing. Moderate to severe disability was defined as an overall score ≥ 40.

Results
A total of 85 patients were included. Forty-four (51.7%) were female, the median age and disease duration were respectively 38 years (interquartile range [IQR], 33-44) and 12.0 years (IQR, 5-20). There was no difference between the four groups in terms of age, sex, BMI, smoking status, disease location or phenotype or number of biologics failure. The median global IBD-Disk score was 25 (IQR, 9-41) and 24 patients (28.2%) had moderate to severe disability. Transmural healing (group A) was observed in 40 patients (47.1%). Moderate to severe disability was identified in 17.5% (7/40) of patients with transmural healing, 25% (4/16) with endoscopic healing, 44.4% (8/18) with ultrasound healing and 45.4 % (5/11) without healing. In univariate analysis, transmural healing reduced the risk of severe disability (group C vs A OR = 3.77, 95% CI [1.10, 13.45], p = 0.035), group D vs A OR = 3 .75, 95% CI [0.91, 17.12], p=0.063). There was no difference in terms of severe disability between patients with transmural healing and complete endoscopic healing (group B versus A OR = 1.57 95% CI [0.36, 6.23], p = 0.525).

Conclusion
Transmural healing did not provide any benefit in terms of disability compared to complete endoscopic healing. Mucosal healing therefore remains the objective to be achieved in order to reduce the risk of short-term disability.
P344 Diverting ileostomy in Inflammatory Bowel Disease's surgery: the real clinical cost analysis
Authors: Ascari F , Barugola G , Ruffo G 
Published: January 2023

Abstract

Background
A loop ileostomy does not prevent an anastomotic leak and it is not risk-free, but it can decrease the clinical impact of dehiscence. Inflammatory bowel disease condition is more complex than other benign situations candidated to colorectal surgery. The aim of our study was to assess the risk of complications related to the stoma presence and to identificate variables related with complications in a series of IBD’s patients undergoing various colorectal surgeries along with primary diverting stoma.

Methods
We conducted a retrospective study of patients who underwent sphincter-preserving elective surgery for IBD between January 2014 to December 2020 at IRCCS Sacro Cuore Don Calabria Hospital. Data were collected regarding baseline demographics, operative techniques and complications. Ileostomy-related complications were separated into three categories: complications related to stoma creation at the time of index surgery within 30 days; complications of having an ileostomy; complications of ileostomy closure.

Results
Fifty-six diverting loop ileostomies were performed and included in our study (table 1). Seventeen patients (30%) at index procedures had the following complications: 5 had anastomotic leak or pelvic abscess (8.9%), 3 had bowel obstruction (5.4%) and 7 (12.5%) bleeding requiring transfusion. Two patients had complications related to ileostomy creation: 1 had prolapse (1.8%) and 1 rotation with obstruction (1.8%). Seven patients (12.5%) required reoperation. Seven patients (12.5%) were readmitted within 30 days after index surgery for dehydratation. Twenty-four patients (42.1%) suffered during the same time from ileostomy management’s problems. Eighteen patients (32.1%) at stoma closure had the following complications: 6 had anastomotic leak or pelvic abscess (10.7%), 7 had SSI (12.5%), 5 had bowel obstruction (8.9%) and 2 bleeding requiring transfusions (3.6%). Nine patients (16%) required reoperation. At univariate analysis complications of ileostomy status are more frequent in male (p=0.01) and in patients who had ileostomy creation complications (p=0.04). Ileostomy closure complications are more common in male patients (p=0.005). Complications at the time of ileostomy creation were found at multivariate analysis statistically related to complications during ileostomy maintenance.

Conclusion
Ileostomy alone cannot mitigate the overall high rate of complications expected in IBD’s patients, also in consideration of potential problems stoma it-self related. Even if our study is retrospective and presents a small court, when resection is necessary despite patient's conditions we propose to resect without anastomosis at the time of index procedure and restore the bowel continuity only after patient's status optimization.
P420 Safety & feasibility of targeted mesenteric approaches to ileocolic resection and anastomosis in Crohn’s Disease
Authors: Holubar S , Cohen B , Uchino T , Lincango E , Prien C , Joseph A , Achkar J P , Gunter R , Lashner B , DeLaney C , Ban K , Bolshinsky V , Lipman J , Liska D , Philpott J , Naseer M , Kanters A , Braga-Neto M , Rieder F , Somovilla J , Qazi T , Regueiro M , Hull T , Steele S 
Published: January 2023

Abstract

Background
More than 80% of patients with Crohn's disease (CD) require surgical intervention during their lifetime. High rates of disease recurrence often necessitate repeat surgery. Recurrence is typically observed at or immediately proximal to the anastomosis, raising the question of whether surgical techniques have the potential to decrease recurrence rates. In addition, the mesentery has recently been implicated in the pathophysiology of CD, and several techniques have been developed to reduce its influence on recurrence. We aimed to describe the short-term safety and feasibility of these approaches.

Methods
This is a comparative retrospective single-center cohort study of consecutive CD patients undergoing primary or redo ileocolic resection with mesenteric excision and exclusion (MEE), extended mesenteric excision (EME) only, or Kono-S anastomosis (KSA) only from 2015-2022. Patients undergoing both EME plus KSA were considered to have MEE. Patients' characteristics, perioperative data, and short-to-midterm outcomes were collected. Univariate analysis was performed.

Results
A total of 186 patients underwent MEE (n=46), EME (n=66), or KSA (n=74). All three groups had comparable (p&gt;0.05) risk factors in terms of mean age at diagnosis and surgery (25.4 and 37.5 years old, respectively), preoperative biologics (63.4%) and corticosteroids (22.6%), smoking, and associated perianal disease. However, the MEE group had more penetrating disease compared to the other groups (MEE 50.0% vs. EME 34.8% vs. KSA 20.4%; p&lt;0.01). Overall there were no differences (p&gt;0.05) in rates of emergency surgery (4.8%), ileostomy creation (14%), and laparoscopy (64.5%) Table 1. Estimated blood loss and length of stay were also comparable between groups (p&gt;0.05). Operative time in the MEE group was longer (median: 187, range: 67-360 minutes) compared to the other two groups (KSA: 170 (56-487); EME: 152 (63-436, p&lt;0.01). Post-operatively, the groups had similar lengths of stay (4 days), rates of readmissions (9.1%) and major postoperative complications (6.5%). After a median overall follow-up of 8 months (0-86), endoscopic (18.8%) and surgical recurrences (1.1%) did not differ between groups (p&gt;0.05) Table 2.

Conclusion
Targeting the mesentery with novel surgical approaches to ileocolic Crohn's disease was observed to be safe and feasible on short-term follow-up. Long-term follow-up is needed to assess the impact of these techniques on post-operative anastomotic disease recurrence.
P423 Effect of tofacitinib on colectomy risk in anti TNF-alfa refractory ulcerative colitis
Authors: Romeo S , Carvalhas Gabrielli A M , Ferretti F , Piazza O Sed N , Mazzola A M , Alicante S , Berté R , Scribano M L , Buscarini E , Ricci C , Caprioli F , Ardizzone S , Cannatelli R 
Published: January 2023

Abstract

Background
Tofacitinib is an oral janus kinase inhibitor (JAK) approved for patients with moderate to severe ulcerative colitis (UC) and either inadequate response or loss of response or intolerance to conventional or biologic therapy. The 5-year and 10-year cumulative risk of colectomy in UC is 10%–15%.1 Due to the increasing number of anti tumor necrosis factor (TNF)-alfa non responders, tofacitinib seems a valuable therapeutic alternative. This study aims to assess the effectiveness of tofacitinib in preventing colectomy in patients with moderate-to-severe UC refractory to anti TNF-alfa agents.

Methods
We performed an observational retrospective and prospective multicenter study in five Italian IBD referral units including adult patients with confirmed diagnosis of moderate-to-severe UC (defined by a total Mayo score ≥ 6), treated with tofacitinib because of response failure or intolerance to anti TNF-alfa agents. Primary aim was the effectiveness of tofacitinib in preventing colectomy during a follow-up of 52 weeks. Secondary aims were: survival without colectomy, survival without tofacitinib discontinuation, clinical remission (defined as Mayo partial score ≤ 2) at week 8, 24 and 52, endoscopic remission (defined as Mayo endoscopic score ≤ 1) and steroid-free clinical remission (Mayo Partial score ≤ 2 without steroid) at week 52; adverse events (AE) to tofacitinib. Descriptive statistics and Kaplan Meier analyses of survival were performed.

Results
From January 2021 to October 2022 45 patients were included. During the follow-up, 6 patients (13%) underwent colectomy and all of them before week 24. Survival without colectomy and survival without tofacitinib discontinuation are represented in Figs.1-2. Clinical remission was reached by 17 patients (37.7%) at week 8, by 20 (44.4%) at week 24, and by 22 patients (48.8%) at week 52. Among the 11 patients with an endoscopic evaluation available after completing 52-week treatment, 9 (82%) achieved endoscopic remission. At week 52, 22 patients (49%) maintained steroid-free clinical remission. In eighteen patients (40%) tofacitinib was interrupted, because of failure in 15 and because of a severe AE in 3. AE occurred in 9 patients (20%), but in 3 only (6.7%) were severe and entailed treatment interruption.

Conclusion
These data confirm effectiveness and safety of tofacitinib in preventing colectomy in moderate-to-severe UC refractory to anti TNF-alfa agents.
P424 Do antiTNF through levels correlate with joint extraintestinal manifestations (EIM) activity in Inflammatory bowel disease (IBD) patients?
Authors: Madero Velázquez L , Jovani V , Andrés M , Más P , Aguas M , Vicens E , Ojeda A , Noguera-Pons J R , Ranieri L , Zabana Y , Pujol M , Barreiro de Acosta M , Pérez-Pampin E , Bernal L , Belen O , Moreno V , García M F , Sempere L , Zapater P , Gutiérrez Casbas A 
Published: January 2023

Abstract

Background
Inflammatory arthropathies are the most common EIM associated to IBD with a prevalence of 20-50% for axial inflammation and 5-20% for peripheral arthritis. AntiTNF is the preferred treatment in patients with axial spondiloarthritis (AxSp) intolerant or refractory to NSAIDs and has shown efficacy in peripheral arthritis (pSp) as well. Nevertheless, an optimal antiTNF through level has not been yet stablished in this clinical setting. Thus, our aims were to evaluate the correlation between antiTNF through levels and joint EIM activity in IBD patients.

Methods
We conducted a prospective, multicenter cohort study. IBD patients diagnosed with articular EIM (AxSp, pSp or both) under antiTNF treatment at least 6 months were included. Anti-TNF concentrations were measured using ELISA. Blood samples were obtained just before the administration of the drug (trough levels), and an simultaneous evaluation by a reumatologist was performed. Definitions: inactive AxSp = ASDAS-CRP &lt;1,3 and BASDAI&lt;2 , low active AxSp: ASDAS-CRP &lt;2,1 and BASDAI&lt;4; inactive pSp=arthritis, enthesitis and dactylitis=0, low active pSp: arthritis, enthesitis and dactylitis ≤1. IBD activity was based on partial Mayo score for ulcerative colitis (UC) patients and on Harvey-Bradshaw score for Crohn′s disease (CD) patients.

Results
A total of 78 patients were included: Median age 52 ±15, 45% women, 82% CD (56% ileal; 18% colic; 24% ileocolic; 2% upper gastrointestinal involvement; 22% stricturing behaviour; 16% penetrating; 14% perianal disease), 18% UC (61% extensive, 15% left-sided, 23% proctitis), 11% had another EIM. HLA B-27 was present in 26% patients. Distribution of spondiloartrhopaties was: AxSp 42%, pSp 37%, or both 20%. Among CD patients, 18,9% presented clinical activity (n=14). Mean IBD disease duration was 11± 9,7 years. Fourteen patients (18%) were also under immunosupressive treatment .Through levels distributed by joint activity are shown in table 1.Figure 1 shows distribution of adalimumab through levels by AxSp activity.

Conclusion
No correlation between antiTNF through levels and joint EIM activity was found in these preliminary results. However, patients with active axial Sp treated with adalimumab had lower through levels than those with inactive axial Sp.
P426 Sex and sexuality in IBD - the pediatric gastroenterologists’ point of view
Authors: Anafy A , Cohen S , Matar M , Shouval D S , Shamir R , Weintraub Y 
Published: January 2023

Abstract

Background
Although sexual dysfunction (SD) and sexually transmitted infections (STI) are occasionally encountered in patients with inflammatory bowel disease (IBD), physicians may be embarrassed to discuss these issues. This is especially true in adolescent patients, where parents are active participants in clinic visits. In addition, data in the literature about SD in this age group is limited. Our aims were to assess pediatric gastroenterologists (PedGI) knowledge and common practice regarding sexual advice and STI in pediatric patients with IBD.

Methods
A questionnaire was sent to all registered PedGI in Israel, and included 24 questions addressing knowledge of adolescent sexual behavior, SD, receptive anal intercourse (RAI) and STI in pediatric patients with IBD.

Results
Overall, 52 physicians completed the questionnaire (27 males, 52%). Only 50% provided the correct answer regarding the mean age at which Israeli youth start practicing sexual activity, whereas none were correct regarding the mean age when RAI is practiced. Fifty eight percent rightfully stated that SD is equally distributed among males and females and 38% responded that it is equally prevalent among patients with Crohn’s and those with Ulcerative Colitis. The most quoted, incorrectly, risk factor for SD was perianal disease. Seventy five percent thought that providers should talk about sex with their patients, but only 19% actually do so, most often in response to a patient’s query. Ninety six percent felt they do not have enough knowledge about SD in IBD. Finally, only 2% routinely obtain bacterial swabs for STI in patients with refractory proctitis, although 15% encountered such as a problem in clinic.

Conclusion
Sexuality and SD are not discussed routinely in the pediatric IBD clinics by the majority of PedGI. Providers should obtain more knowledge in the field, and proactively discuss these issues with teenagers with IBD.
P474 Postoperative disease course after appendectomy as experimental treatment for patients with therapy refractory moderate to severe ulcerative colitis
Authors: Reijntjes M , Heuthorst L , Stellingwerf M , d'Haens G R , Bemelman W A , Buskens C J 
Published: January 2023

Abstract

Background
Increasing evidence suggests appendectomy as a potential experimental therapy for ulcerative colitis (UC). A prospective cohort study of laparoscopic appendectomy for treatment of therapy refractory UC showed a clinical response in nearly half of the patients with a substantial proportion of patients in endoscopic remission, after a postoperative follow-up of 3.7 years1. The current study aimed to explore disease course during long-term follow-up in patients undergoing appendectomy for therapy-refractory UC.

Methods
In this monocenter cohort series, all patients with therapy refractory UC referred for (procto)colectomy between 2012-2015 were counselled to undergo laparoscopic appendectomy instead. The primary endpoint was long-term clinical (≥3 points decrease in partial mayo score) and endoscopic response (Endoscopic Mayo score ≤1) displayed in individual time lines. Secondary endpoints included duration and loss of clinical and endoscopic response, de-escalation of medication, and failure (medical treatment switch or colectomy).

Results
A total of 25 patients (12 men; median age 41.0 years) underwent appendectomy. The median postoperative follow-up time was 7.5 [IQR 6.4-8.6] years. Clinical response was observed in 60% (15/25) after a median follow-up of 4.0 [IQR 3.0-7.0] months, and was 32% (8/25) at the end of follow-up. Endoscopic response was observed in 48% (12/25) after a median follow-up of 17.5 [IQR 3.3-38.8] months and was 24% (6/25) at the end of follow-up. The median duration of clinical and endoscopic response was 80.0 [20.0-93.0] an 45.5 [21.8-56.8] months, respectively. Six (24%) patients de-escalated medication during follow-up, five of which without subsequent failure. Seventeen (68%) patients failed during postoperative follow-up after appendectomy, of which nine patients (36%) required colectomy a median of 5.0 [IQR 2.0-13.5] months after appendectomy.

Figure 1. Disease course after appendectomy per patient.

Conclusion
During the postoperative course following appendectomy for refractory UC, approximately half of the patients demonstrated long-lasting endoscopic response, more than half demonstrated long-lasting clinical response, and one third underwent colectomy.
1Stellingwerf ME, Sahami S, Winter DC, Martin ST, D'Haens GR, Cullen G, Doherty GA, Mulcahy H, Bemelman WA, Buskens CJ. Prospective cohort study of appendicectomy for treatment of therapy-refractory ulcerative colitis. Br J Surg. 2019 Nov;106(12):1697-1704.