bluuebunny/crossref_metadata_2025_split huggingface dataset:
P470 Evolution of asymptomatic unresected lesions in patients operated for multifocal Crohn’s disease.
Authors: Abdalla S , Lelievre O , Carbonnel F , Penna C , Benoist S , Brouquet A 
Published: January 2023

Abstract

Background
Surgery for Crohn’s disease (CD) aims to treat symptomatic lesions. In multifocal CD, when surgery is required for a specific symptomatic location, should asymptomatic lesions be resected during the same procedure?

Methods
In this retrospective cohort study, all consecutive patients undergoing bowel resection from 2012 to 2021 for multifocal CD and for which CD lesions were not resected (anoperineal disease excluded) were included. Primary endpoint was recurrence on the unresected CD lesions requiring medical treatment intensification or surgery. Univariate analysis of the risk factors for recurrence on the unresected lesions was carried out.

Results
Among 318 patients operated for CD, 28 (9%) were included. Median CD evolution duration was 9.5 years. Twenty-five patients (89%) had at least one medical treatment line and 7 (25%) had previous bowel resection for CD. Indication for surgery was complicated CD (stricture, internal fistula) in 24 patients (86%) and CD refractory to medical treatment in 4 patients (14%). Surgery consisted in small bowel resection in 3 patients (11%), ileocolic resection in 13 (46%) and colectomy in 12 (43%). The unresected lesions were located in the small bowel in 7 patients (25%), colon and/or rectum in 12 (43%) and both in the small bowel and colon in 9 patients (32%). At 6 months, clinical improvement was obtained in 18 patients (64%). After un median follow-up of 58.5 months, 13 patients (46%) required treatment step-up, among which 6 (31%) required surgery targeting symptomatic unresected CD lesions refractory to medical treatment. Median progression-free duration was 43.5 months. Risk factors for recurrence on the unresected lesions were associated anoperineal CD (n=8/10, 80% vs n=5/18, 27.8%, p=0.016) and number of preoperative treatment lines≥3 (n=7/8, 87.5% vs n=6/20, 30%, p=0.011).

Conclusion
In complicated or refractory multifocal CD, surgery targeting most severe lesions allows clinical improvement in 65% of patients at 6 months. Although nearly half of the patients require medical treatment adaptations for the unresected lesions, only 21% require surgery for these lesions. This strategy combining targeted surgery and medical treatment could be more widely suggested in multifocal CD.
P472 Cyclosporine versus infliximab in patients with Acute Severe Ulcerative Colitis: A single-centre retrospective study
Authors: Karpavičiūtė V , Kiudelis G , Kupčinskas J , Kupčinskas L 
Published: January 2023

Abstract

Background
In steroid refractory acute severe ulcerative colitis (ASUC), cyclosporine or infliximab are potential rescue treatments to avoid colectomy. Our objective is to assess the short-term and long-term efficacy and safety of cyclosporine versus infliximab as rescue agents.

Methods
We performed a retrospective analysis of 121 patients admitted with ASUC to a single gastroenterology centre during 2010-2020. ASUC was defined by the Truelove & Witts criteria. Primary outcome was short-term colectomy-free rate, secondary outcomes were severe adverse events, re-hospitalization or need of treatment with steroids within 2 years due to flare ups and colectomy rate at 2-year follow-up.

Results
119 patients initially received intravenous corticosteroids, while 2 patients underwent emergency colectomy on the first day. Sixty-four (53%) were females, median age of all patients was 33 (IQR 27-49) years. 66 (55%) patients responded to intravenous corticosteroids (IVS), while 53 (45%) failed to respond to steroid therapy: 45 (37%) patients received second-line rescue therapy (29 with cyclosporine, 16 with infliximab). Evaluating the short-term efficacy of treatment there was no significant difference between cyclosporine and infliximab: during admission colectomy was performed in 10.3% vs. 12.5% of patients, respectively (p=0.826). In terms of long-term outcomes, the colectomy rate was higher in the infliximab group at 2-year follow-up, although the difference did not reach statistical significance (10.3% vs. 31.2%, p=0.079). The need for oral steroids during follow-up was comparable in both groups (38,5% vs. 50%, p=0.481). Comparing patients who did not undergo colectomy, patients in the infliximab group were more often re-hospitalized due to the need for IVS at 2-year follow-up (7.7% vs. 50%, p=0.002). No severe side effects due to infliximab and cyclosporine were observed.

Conclusion
In the treatment of steroid refractory ASUC infliximab and cyclosporine were equally effective in short-term period and there was no difference in safety, however cyclosporine treated patients trended to have better long-term outcomes, with significantly rarer re-hospitalization. Additional analysis is needed for other factors that may have contributed to differences in long-term outcomes between the cyclosporine and infliximab groups.
P475 Infections and malignancies during anti-TNF therapy in IBD patients affect all age groups – results from a 13-yr real-world retrospective study
Authors: Majumder S , Melanie L , Joanne D , Naveen S , Quraishi M N , Cooney R , Ghosh S , Iacucci M , N Shivaji U 
Published: January 2023

Abstract

Background
Anti-TNFα is the first class of biologics approved for treatment of moderate-to-severely active Inflammatory Bowel Disease (IBD). More than two decades on, anti-TNFs remain one of the most commonly used biologics for both Ulcerative Colitis (UC) and Crohn’s Disease (CD), and often as first-line therapy. Although effective, they cause several adverse events (AEs), sometimes requiring withdrawal of therapy. We aimed to report on AEs with a focus on risk of infections and malignancies in this large cohort.

Methods
All IBD patients exposed to anti-TNF therapy were identified from EMR at two centres of a large tertiary referral centre between January 2009 and June 2022. All relevant demographic and clinical data were collected for those patients with well recorded AEs and follow-up. Data on cumulative AEs directly attributed to anti-TNFs that ranged from mild reactions to serious AEs (defined as those requiring review/withdrawal of anti-TNF), were collected. The data were analysed and statistical analysis carried out using the IBM® SPSS® Statistics software package Version: 28.0.0.0.

Results
Total of 844 patients (M=408, 48%; median age 37years) were included, of which 61% were Caucasian. Majority had CD (608;72%) with mean age at diagnosis of 27y (SD 15y) and a median disease duration of 12years. About 50% of patients were on monotherapy and adalimumab was most frequently used (52%).There were 392 cumulative AEs recorded in this cohort with 78 infections (20% of all AEs). Among these, majority were bacterial infections, followed by Clostridium difficile. Tuberculosis(TB) was diagnosed in 5 patients. Infections were distributed evenly across all age groups with no significant difference between monotherapy or combination therapy. Majority of infections responded to anti-microbials and patients were able to resume anti-TNFs without major complications. One death recorded due to viral hepatitis. Detailed breakdown is given in Table 1. Malignancies were recorded in 16 (2%) patients and 6 were on combination therapy. Skin cancers were most common and there were no lymphomas noted. The details of malignancy are given in Table 1.

Conclusion
In this large cohort, infections were one of the commonest AEs recorded during exposure to anti-TNF therapy.Bacterial infections were most frequent across all age groups requiring pause of anti-TNF in most cases and withdrawal in very few. Opportunistic infections were few and reported TB cases was as low as 0.5% of total cohort. Skin cancer was the most common malignancy and no lymphomas were reported in this cohort. Clinicians need to be aware of these risks in younger patients as anti-TNFs result in infections and malignancies across all age groups and not particularly limited to the elderly.
P477 Patient satisfaction and cost saving analysis of telemedicine in patients with inflammatory bowel disease.
Authors: Bossa F , Carparelli S , Guerra M , Cocomazzi F , Martino G , Annese M , Nardella M , Bellucci N , Gagliardi R , Terracciano F , Pacilli L , Perri F 
Published: January 2023

Abstract

Background
Crohn’s disease (CD) and Ulcerative Colitis (UC) are chronic inflammatory bowel diseases (IBD). Telemedicine (TM) is particularly useful in patients with chronic diseases who need frequent monitoring to achieve therapeutic outcomes and improve their quality of life. We examined the differences in patient satisfaction comparing telemedicine versus traditional in-person visits. We also examined the potential cost savings benefits of utilizing telemedicine.

Methods
All consecutive patients with IBD in clinical remission evaluated by Partial Mayo Score (PMS) for UC and Harvey Bradshaw Index (HBI) for CD were considered eligible (PMS&lt;2 or HBI&lt;5). Patients were randomized into two arms: telemedicine or in-person visits after a questionnaire investigating the Information and communication technology (ICT) skills . All patients were asked to respond to an 11-items survey investigating their trust in telemedicine at first in-person visit. Enrolled patients performed after 3 months a telehealth or an in-person visit. All patients answered a standard questionnaire to evaluate the indirect costs of managing their disease. Patients randomized into telemedicine arm answered a specific 28-item survey investigating their degree of satisfaction.

Results
We enrolled 30 patients with IBD randomized to telemedicine (n. 22; 11 CD; 13 female; mean age 45 years) or in-person visits (n. 8; 5 CD; 3 female; mean age 52 years). All patients randomized in TM (100 %) showed interest in this new clinical practice and were satisfied of the received information about telemedicine management. No patients thought that telemedicine would have no positive effects on their health status. Regarding demographic data, 6 out of 22 patients randomized to TM (27.2%) lived in a different province than our hospital’s and16 patients (72.7%) had high school diploma or degree. All TM patients (100%) were satisfied of the televisit and considered clear the information received during conversation with physician. From a technical point of view, only one patient had problems of connection and three patients needed the support of a caregiver. Eighteen patients (81.8 %) thought that the efficacy of the televisit was equivalent to the in-person visit. Nineteen patients (86.3 %) were convinced that televisit is a tool to be promoted for future clinical practice. Patients randomized to telemedicine had an average saving of 125 €. Data shown are illustrated in the figure 1.

Conclusion
In patients with IBD in remission, telemedicine is feasible and effective in the majority of patients. In addition, TM has allowed a significant cost savings without reducing the quality of the health assistance.
P481 Visceral fat to skeletal muscle area ratio predicts for Ustekinumab loss of response.
Authors: Tan Z , Chin A , Welman C J , Thin L W Y 
Published: January 2023

Abstract

Background
Loss of response (LOR) to anti-TNFα therapy in inflammatory bowel disease (IBD) is common and biologic therapies such as anti-IL12/23 agents have shown greater durability in efficacy. Anti-TNFα LOR is increased in higher body mass index (BMI) patients however the evidence for the association between body composition or BMI and Ustekinumab’s (Ust) therapeutic response is limited, with the latter not impacting clinical efficacy in the ‘IM-MUNITI’ post-hoc analyses. This study’s primary aim was to evaluate the impact of body composition on time to LOR to Ustekinumab in Crohn’s disease (CD) patients.

Methods
99 adult CD patients aged ≥16 yrs. from two tertiary IBD centres were studied retrospectively. Included patients had received Ust ≥12 weeks, abdominal imaging (CT or MRI) within 6 months of Ust induction, and documented follow up until 30th April 2022. A single experienced abdominal radiologist blinded to the clinical information measured the area of visceral fat (VFA), skeletal muscle (SMA), and subcutaneous fat at the mid L3 vertebral level. Each compartment was corrected for height2 to derive visceral fat (VFI), skeletal muscle (SMI) and subcutaneous fat (SFI) indices. VFA:SMA ratio was also calculated. Clinico-demographic details including therapeutic and surgical history were recorded. Kaplan Meir survival analyses, univariate and multivariate cox regression analyses were performed to evaluate factors predictive of Ust LOR.

Results
99 patients met the inclusion criteria with mean age (±SE) 46.6yrs (±1.6) and 49 (49.5%) male. 63 (63.6%) patients were bio-experienced. Univariate Cox regression analyses of age, sex, BMI, peak C-reactive protein (CRP) and nadir Albumin level within 3 months of the CT/MRI scan, disease duration, prior biologic failure and concurrent immunomodulator used within 6 months of Ust induction showed that none of these were predictive of Ust LOR (P&gt;0.05). There was a numerical trend for the middle VFI tertile (40.01-79.99cm2/m2) to having a lower risk for LOR compared to the lowest and highest VFI tertile (Fig. 1a), (HR=0.37, 95%CI= 0.13, 1.11, P=0.08), as well as a higher SMI for having a lower risk of LOR (Fig. 1b), (HR= 0.6, 95%CI= 0.24,1.31, P= 0.18), but these were not statistically significant. A higher VFA: SMA ratio however, was a significant predictor of LOR (HR=2.98, 95%CI 1.2,7.3, P= 0.02) (Fig. 1c), which persisted when it was adjusted on multivariate analysis for age, sex, albumin, CRP, BMI, disease duration, prior biologic failure and concurrent immunomodulator use (HR= 10.6, 95%CI 2.8-39.8, P=&lt;0.0001).

Conclusion
The ratio of VFA:SMA, but not BMI, is a superior predictor of losing response to Ustekinumab.
P486 Improving enhanced recovery after surgery (ERAS): the effect of a patient-centred mobile application on patient participation in colorectal surgery
Authors: Van Der Storm S L , Jansen M , Marsman H A , Molly G P , Consten E C , Groot L M , Boer F C , Corver M , Oosterling S J , Tuynman J B , Bemelman W A , Buskens C J , Schijven M P 
Published: January 2023

Abstract

Background
Perioperative care in colorectal surgery is systematically established in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improved perioperative colorectal care in a multidisciplinary and multimodal manner, simulating early and safe hospital discharge. In general, compliance with the ERAS protocol is adequate; however, there is still room for improvement in compliance by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could be improved by actively involving patients in the ERAS colorectal care pathway using a patient-centred mobile application.

Methods
This multicentre, randomised controlled trial was conducted in accordance with the CONSORT statement. Patients aged 18 years or older who underwent elective colorectal surgery and had a smartphone were included. Patients in the intervention group used a mobile application combined with an activity tracker to be guided and simulated through the ERAS pathway. Patients in the control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with the selected active elements of the ERAS protocol. Secondary outcomes included length of hospital stay, number of complications, reintervention, and readmission rates, and patient-reported outcome measures (PROMs) such as quality of life, and patient satisfaction with received care.

Results
Between October 2019 and September 2022, 170 participants were enrolled and randomised to either the intervention (n=84) or control (n=86) groups. Thirty participants (17.6%) were lost to follow-up and 140 participants were included in the primary outcome analysis. Compliance with the selected active ERAS elements was 76.8% and 63.7% in the intervention and control groups, respectively (p&lt;0.001). Complications or patient reported outcomes did not differ between the groups.

Conclusion
A patient-centred mobile application improved compliance with the active elements of the ERAS protocol. The implementation of this mobile application is recommended for patients undergoing elective colorectal surgery.
P489 Surgery for enterocutaneous fistula: the strongest predictor of postoperative mortality in Crohn’s disease patients
Authors: Iesalnieks I , Adamou A , Bercher M 
Published: January 2023

Abstract

Background
To access the risk of bowel resection in Crohn’s disease patients with enterocutaneous fistulae.

Methods
Consecutive patients undergoing intestinal resections for Crohn’ disease between 1992 and 2021 were included in the present prospective observational study. Exclusion criteria were: a) abdominoperineal resections for perianal disease, b) surgery for colorectal cancer complicating Crohn’s disease, c) abdominal surgery without intestinal resection (e.g. stoma formation or closure, mere adhesiolysis etc. Enterocutaneous fistulae occurring after previous bowel resection were named “postresection fistulae”, all other – “non-postresection fistulae”.

Results
750 patients were included. At all, 70 patients (9%) underwent intestinal resections due to enterocutaneous fistulae. The frequency of surgery for enterocutaneous fistula decreased significantly during the last decade of the study (1992-2000: 13% of surgeries, 2001-2010: 12% of surgeries, 2011-2021: 6% of surgeries; p=0.05). The postoperative intraabdominal septic complication rate was 15% (n=111), six patients (0.8%) died. The mortality rate was 7% (5 of 79%) in patients with enterocutaneous fistulae. All latter death occurred only in patients with postresection fistulae. By multivariate analysis, surgery for enterocutaneous fistula (Hazard ratio 27.4, 95% CI: 2.9 – 255.6; p=0.004), age of 50 years and older (Hazard ratio 13.2; 95% CI: 2.0 – 87.7; p=0.008) and presence of intraabdominal abscess (Hazard ratio 11.8; 95% CI: 1.2 – 116.5; p=0.035) were associated with an increased risk of postoperative death. Age over 50 years was associated with an increased risk of death in patients with enterocutaneous fistulae (mortality rate 20% vs. 3.6%, Hazard ratio 16.61; 95% CI: 1.28 – 216.07; p=0.032).

Conclusion
Surgery for enteroctunaeous fistulae still poses significant risks, specially, when they occurred after bowel resection and in older patients.
P494 Impact of early optimization of ustekinumab on mid-term targets in severe Crohn’s disease: THE MUST study
Authors: Abdelmoula A , Chateau T , Hupe M , Boschetti G , Roblin X , Nancey S , Mathieu N 
Published: January 2023

Abstract

Background
As a substantial proportion of patients with Crohn’s disease (CD) experiences a refractory disease course, immediate drug intensification may be an option to optimize the effectiveness of current biotherapies. Aim : to compare the one-year efficacy of immediate dose escalation of ustekinumab 90 mg to 4-weekly with that of 8-weekly dosing after intravenous (iv) induction in severe active CD patients.

Methods
The MUST (meta-optimization of Ustekinumab) study is a real-life multicenter observational French retrospective cohort study including patients with severe active CD. All patients from three academic IBD centers who received induction therapy with IV ustekinumab followed with subcutaneous (sc) UST 90 mg, either 4-weekly (MUST group) or 8-weekly (STD group) were included from Jan 2019 to Dec 2020. The choice of treatment regimen was left at the physician’s discretion. Severe active CD was defined by HBI &gt; 16 and stool frequency (SF) ≥ 4 and abdominal pain (AP) ≥ 2 over one week and at least one objective evidence of inflammation (CRP ≥ 5 mg/L and/or FCal ≥ 250 μg/g and/or radiologic and/or endoscopic signs of disease activity). The primary endpoint was PRO-2 based clinical remission defined by SF≤2-8 and AP ≤1, and either FCal &lt;250 μg/g and/or CRP &lt;5 mg/L at week 52. Key secondary endpoints were PRO-2 remission, endoscopic improvement and steroid-free clinical remission at week 52.

Results
203 adult patients were included, either in the MUST group (n = 59) or in the STD group (n = 144). Baseline patient demographics and disease characteristics were similar between groups. Median disease duration was 9 years (IQR: 5 – 14 yrs), 66% were females. Disease location according to the Montreal classification was L1 and L3 in 36% and 44 % of patients. All had previously been exposed to more than one biotherapy, 27% experienced perianal CD, and 35% had undergone previous CD-related surgery. At week 52, the adjusted difference between the two groups for the primary endpoint was 15.8% (95% confidence interval (CI) 0.21 – 0.94; p = 0.029) with significantly higher clinical remission in the MUST group. The adjusted difference for PRO-2 remission was 3.7% (CI 0.45 - 1.66; p = 0.64). All patients, except one in the STD group, were weaned off steroids at week 52. Endoscopic improvement was similar in both groups (61.9% vs. 61.5%, p=0.98). Adverse events were not significantly different in both arms (42.4% vs 34.7%, p=0.338).

Conclusion
In the treat-to-target era, our real-life study shows that immediate escalation of ustekinumab therapy to 4-weekly dosing could achieve higher clinical remission at one year than 8-weekly dosing in severe CD. These findings should be confirmed in a dedicated prospective randomized trial.