bluuebunny/crossref_metadata_2025_split huggingface dataset:
P707 Using urgent small bowel ultrasound (SBUS) as a tool for decision-making in patients with inflammatory bowel disease (IBD): retrospective analysis of United Kingdom (UK) patients' outcome.
Authors: Lehmann A , Nandra G , Power N , Lindsay J O ,   James Oliver Lindsay
Published: January 2023

Abstract

Background
In the UK, magnetic resonance enterography (MRE) and colonoscopy are the gold standard assessment for mucosal disease activity in IBD. Both techniques require bowel preparation, may be poorly tolerated and are often subject to delay due to capacity issues. In several European centres, ultrasound is used as an alternative tool for disease activity monitoring and clinical decision-making. Recent studies confirm excellent sensitivity, specificity, correlation with MRE / colonoscopy and robust inter-observer agreement. In the UK, a lack of US training in IBD physicians has hindered development of accessible SBUS. In view of issues with MRI capacity during the covid pandemic, a dedicated small bowel ultrasound list with a gastroenterology fellow and a specialist radiology consultant for urgent IBD patients was initiated.

Methods
Records of IBD patients undergoing SBUS between June 2022 and November 2022 were reviewed. SBUS assessed disease activity (vascularity, bowel wall thickness, mesenteric fat and lymphnodes), length of disease, presence of obstruction or fistulating disease. Patients were then retrospectively asked to rate their SBUS experience compared to previous MREs.

Results
53 SBUS's (46 (86.7%) CD; 2 (3.7%) UC) were performed on a dedicated SBUS list by a gastroenterology fellow and specialist radiology consultant during the study. In 29 patients (54.7%), the area of interest was the terminal ileum. SBUS detected disease complications in 7 (2 (3.7%) patients with obstructive disease, and 5 (9.4%)) patients with penetrating disease. The average waiting time from the point of referral to SBUS was 4.7 weeks, compared to an average waiting time for MRE of 20 weeks. Treatment response was assessed in 18 patients (33.9%). We were able to make treatment decisions with 32 patients (60.3%) based on their SBUS results without further assessment. In 10 patients (18.8%), SBUS was used to confirm a diagnosis in addition to colonoscopy. 18/22 ( 81%) patients reported a preference for SBUS compared to MRE (preference score of 4.5 on scale of 1-5).

Conclusion
We developed an urgent SBUS service to aid timely clinical decision-making for IBD patients. In our practice, SBUS is an accurate tool to assess disease activity, significantly reduces patients waiting times and is the patient’s preferred investigation. There is a clear unmet need to train IBD doctors and radiologists in SBUS.
P730 Anti tumor necrosis factor treatment in Ulcerative Colitis: Real-world data and evaluation of current treatment targets (STRIDE II)
Authors: Lundekvam J A , Lie Høivik M , Anisdahl K , Cvancarova Småstuen M , Medhus A W ,   Inflammatory Bowel Disease Research Group - Oslo University Hospital
Published: January 2023

Abstract

Background
In 2021, the Selection of Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative proposed updated recommendations for treatment targets for ulcerative colitis (UC) patients. The recommendations introduce clinical remission as a short/medium term target, normalisation of CRP and Fecal Calprotectin (FC) as an intermediate target, and advice that change of treatment should be considered if targets are not met. In this single-centre study, we report real-world experience with proactive therapeutic drug monitoring (TDM) strategy for UC patients with first-line anti tumor necrosis factor (TNFi) treatment, and reflect on how implementation of the STRIDE II recommendations might affect clinical practice.

Methods
Adult, biologically naïve UC patients starting TNFi between 2014 and 2021 at Oslo University Hospital were included in a medical chart review study, and data were recorded at three and twelve months. Clinical remission was defined as a patient-recorded outcome (PRO-2) ≤1. Biochemical remission was defined as CRP &lt;5 mg/L and FC &lt; 250 µg/g. Combined remission was defined as clinical and biochemical remission. Target serum drug levels were defined as ≥7.5 mg/L (adalimumab [ADA]) and ≥5 mg/L (infliximab [IFX]). Logistic regression was applied for association analyses.

Results
A total of 141 patients were included. Of these, 60% were male, median age was 25 years. In total, 67% received IFX and 32% received ADA. One third (n=39) patients discontinued TNFi or added a second biologic agent during follow-up and were considered in non-remission, resulting in 102 (72%) persistent patients. Percentages [95% CI] in remission at 3 and 12 months are summarized in Table 1, and for drug-persistent patients in Table 2. Target drug level at 3 months was associated with clinical remission at 12 months (OR 2.97, 95% CI [1.24 – 7.12]), biochemical remission at 12 months (OR 2.64, 95% CI [1.03 – 6.77]) but not with combined remission. In total, 125 dosage adjustments were recorded. Of these, 70 (56%) were classified as adjustments related only to serum drug levels.

Conclusion
Combined remission rates at 3 and 12 months for persistent patients suggest that 60% and 46% of our cohort should have been considered for a change of treatment according to the STRIDE II recommendations. A majority of dosage adjustments were made proactively, and as target drug levels at 3 months were associated with remission outcomes at 12 months, our data support the use of a proactive TDM strategy.
P798 Understanding anti-TNF treatment failure: mechanisms and management of loss of response to anti-TNF therapy, three-year data from the PANTS study
Authors: Chanchlani N , Lin S , Hamilton B , Bewshea C , Thomas A , Smith R , Roberts C , Nice R , McDonald T J , Goodhand J R , Ahmad T , Kennedy N A ,   PANTS Consortium
Published: January 2023

Abstract

Background
PANTS (Personalised Anti-TNF Therapy in Crohn’s disease) is a prospective observational UK-wide study investigating the effectiveness of infliximab (IFX) and adalimumab (ADL) in active luminal Crohn’s disease. Here we report remission rates through three years of follow up; rates of and the factors that predicted loss of response (LOR); and the effect of dose intensification on drug persistence.

Methods
Remission was defined as CRP of ≤3 mg/L and HBI of ≤4 points (sPCDAI ≤15 in children), without corticosteroid therapy or exit for treatment failure.
LOR was defined in patients who initially responded to anti-TNF therapy at week 14 and continued in the PANTS extension, by symptomatic IBD activity that warranted an escalation of corticosteroids, immunomodulatory or anti-TNF therapy, resectional surgery, or exit due to adverse events.
The effect of dose intensification at the time of LOR on drug persistence was stratified by optimal anti-TNF drug level (IFX 7, ADL 12) (mg/L) and presence of antibodies (anti-IFX 9, anti-ADL 6) (AU/mL), measured using IDKmonitor® ELISA assays.

Results
Between March 2013 and July 2016, 1610 patients were included in PANTS: 358/955 (37%) treated with IFX (221/358 [62%] originator and 137/358 [38%] with biosimilar) and 187/655 (29%) treated with ADL, who had not exited for treatment failure at the end of year 1, opted to enrol in the extension.
Overall, 41.8%, 39.4%, and 41.3% of IFX- and 38.2%, 39.7%, and 39.2% of ADL-treated patients were in remission at year 1, 2 and 3, respectively. For both drugs, we observed a dose response association between week 14 drug concentration and remission status at the later timepoints (A).
34.3%, 54.0%, and 60.3% of IFX-, and 31.9%, 47.3%, and 69.0% of ADL-treated patients lost response at year 1, 2 and 3, respectively. Multivariable regression analyses showed that low drug concentration was the major independent risk factor associated with LOR for both drugs (B).
In patients who developed immunogenicity, factors associated with subsequent drug clearance were lower week 14 drug level (p&lt;0.01), non-immunomodulator use (p=0.04), and obesity (p&lt;0.01), but not carriage of HLA-DQA1*05 (p&lt;0.34).
In the setting of LOR (n = 686 episodes), 42% patients had their anti-TNF dose intensified and 29% exited the study without further action (C). Compared to patients who experienced LOR with optimal drug levels, dose intensification was associated with lower rates of drug persistence in patients with immunogenic-pharmacokinetic and non-immunogenic pharmacokinetic treatment failure in patients treated with IFX, but not ADL (D).

Conclusion
Long term remission was observed in about 40% of patients treated with IFX and ADL. Loss of response and non-remission was predicted by low drug levels.
P820 Comparison of three nutritional screening tools with the new GLIM criteria for malnutrition among definitive and elective surgery Crohn’s patients in China
Authors: Zhao Z , Chen C , Li Y , Ye X , Zhu W ,   Research institute of General Surgery, Jinling Hospital, Medical School of Nanjing University
Published: January 2023

Abstract

Background
The aim of this study was to evaluate and compare three nutritional screening tools with the new GLIM criteria for malnutrition among definitive and elective surgery Crohn’s patients in China.

Methods
Nutritional screening tools, including the nutritional screening tool for IBD (NS-IBD), the Nutritional Risk Screening 2002 (NRS 2002), the Prognostic Nutrition Index (PNI) were applied to 212 patients with definitive and elective surgery Crohn’s patients in China. We compared the diagnostic values of these tools for malnutrition, using the new GLIM criteria for malnutrition as the ‘gold standards’.

Results
According to the new GLIM criteria for malnutrition, 81(61.79%) of the patients were diagnosed as malnutrition. With the use of NRS-2002, 140(66.10%)of the patients were found to be at high risk of malnutrition; with the use of NS-IBD, 181(85.30% )of the patients were found to be at moderate/high risk of malnutrition; and according to PNI, 94(44.0%)of the patients were found to be at moderate/high nutritional risk. The comparison of each nutritional risk tool showed sensitivity of 83.26%,85.74%,79.83%, and specificity was 62.91%,54.62%,57.34% for NRS-2002, NS-IBD and PNI, respectively. NS-IBD was best correlated with the ESPEN diagnostic criteria (К=0.388, p&lt;0.001) compared with PNI (К=0.208, p=0.007) and NRS-2002 (К=0.744, p&lt;0.032).The receiver operating characteristic curve of PNI had the highest area under the curve (AUC) compared with NRS 2002 and NS-IBD.

Conclusion
In the future, the combined application of GLIM criteria and two nutritional screening tools can better reflect the nutritional status for definitive and elective surgery Crohn’s patients.
P858 Prevalence of sarcopenia in patients with inflammatory bowel disease and factors associated with it
Authors: Dharap V , Abraham P , Desai D , Gupta T , Dhoble P , Mehta N , Modhe J ,   Inflammatory bowel disease
Published: January 2023

Abstract

Background
Sarcopenia is a progressive and generalized skeletal muscle disorder with significant reduction in skeletal muscle mass associated with low muscle strength and physical performance. Multiple factors contribute to sarcopenia in active as well as quiescent inflammatory bowel disease (IBD). It has been implicated in disease complications and surgical outcomes

Methods
Inclusion criteria: Consecutive consenting patients &gt; 18 years old with IBD attending the division of Gastroenterology between June 2021 and June 2022
Exclusion criteria: Associated systemic diseases, patient with prior surgery for IBD, that could contribute to sarcopenia were excluded
All patients had anthropometric measurements, calculation of body mass index (BMI), and measurement of mid-arm muscle circumference. The muscle strength was measured by hand-grip strength by hand-held dynamometer. The physical performance was measured by gait speed by 4-meters walk test. The muscle mass was calculated by measuring skeletal muscle index (SMI) with single slice of CT scan at the level 3rd Lumbar vertebra.
Patients were categorized according to the European Working Group on Sarcopenia in Older People, 2018 definition, into probable sarcopenia (low muscle strength), sarcopenia (low muscle strength and low muscle mass), and severe sarcopenia (low muscle strength, low muscle mass, and low physical performance1. Factors evaluated for association with sarcopenia were age, gender, disease subtype (Crohn’s disease [CD], ulcerative colitis [UC] or IBD-U (unclassified), activity and nutrition. SMI value of &lt;42 cm2/m2 for men and &lt;38 cm2/m2 for women were taken as per a recent Indian study2.

Results
Of 117 patients, 73 had ulcerative colitis (UC), 42 Crohn’s disease (CD), and 2 IBD- unclassified (IBD-U). Forty (34.2%) patients had probable sarcopenia; 47 (40.2%) patients had sarcopenia (29 UC, 18 CD) including 10 with severe sarcopenia. Ten (21.3%) patients with sarcopenia were in disease remission. On univariate analysis BMI, disease activity, low hemoglobin, and biologic use were significantly associated with sarcopenia (Table1); on multivariate analysis, only BMI showed significant association with sarcopenia. (Table 2)

Conclusion
Sarcopenia was detected in over 40% of patients with IBD and a fifth had severe sarcopenia. One-fifth of them were in clinical remission. Low BMI significantly correlated with sarcopenia. Screening for sarcopenia should be considered in all patients with IBD.
1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis.Age Ageing.2019;48:16-31
2. Sidhu S, Saggar K, Goyal O, Kishore H, Sidhu SS. Normative values of sarcopenia in the Indian population. Indian J Gastroenterol. 2018;37(suppl 1): A1–A137
P862 Dietary risk factors associated with onset of IBD: a systematic literature review and meta-analysis
Authors: Mallon K , McBride C , Doherty P G , Burns D R ,   The Health and Biomedical Research Centre (HEAL) Atlantic Technological University Sligo Ireland
Published: January 2023

Abstract

Background
Several potential risk factors for Inflammatory Bowel Disease (IBD) have been highlighted, including dietary factors. Previous evidence has highlighted associations between high fibre, fruit, and vegetable intake and decreased risk of IBD. Conversely, low intake of dietary fibre, and low vitamin D levels are associated with incident IBD. One systematic review reported that high intake of total fats, PUFAs, and omega-6 fatty acids, were associated with an increased risk of Crohn’s Disease (CD) and Ulcerative Colitis (UC), whereas high fibre and fruit intakes were associated with decreased CD risk, and high vegetable intake was associated with decreased UC risk. Despite this evidence, there remains a paucity of literature reporting on the various dietary risk factors for IBD systematically and quantitatively. Thus, the purpose of this systematic review is to determine whether dietary factors are associated with risk of developing IBD

Methods
We conducted searches in the following electronic databases: Ovid MEDLINE, Web of Science, and the Cochrane Library. Keywords and search terms related to ‘diet’ and ‘inflammatory bowel disease’ were applied. This review includes case-control, cohort studies, and RCTs investigating the association between dietary factors and onset of IBD.
Study protocol details have been published on the International prospective register of systematic reviews (PROSPERO). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290798Databases

Results
Our search identified 14,809 relevant articles to include, outlined in Figure 1. After title and abstract screening there were 119 articles that met the eligibility criteria. Overall, 24 articles were deemed suitable for study synthesis. When compared with those consuming the highest intake of carbohydrates, those consuming the lowest levels of carbohydrates had an overall reduced risk of IBD of 30% (RR 0.70, 95% CI 0.51-0.89) and a reduced risk of CD of 37% (RR 0.63, 95% CI 0.32-0.94). When compared with those consuming the lowest intake of vegetables, those consuming the highest levels of vegetables had an overall reduced risk of IBD of 42% (RR 0.58, 95% CI 0.53-0.63). When stratified by sub-group, those consuming the highest intake of vegetables compared with the lowest had a reduced risk of 87% of IBD (RR 0.13, 95% CI 0.04-0.22), 52% of UC (RR 0.48, 95% CI 0.24-0.71) and a reduced risk of CD of 18% (RR 0.82, 95% CI 0.76-0.88).

Conclusion
This systematic review provides a detailed summary of dietary factors associated with the onset of IBD. This evidence will inform on potential preventative strategies for IBD and will inform the academic community, patients, and policy makers about the role of dietary factors in the development of IBD.
P865 Anxiety and Depression is Associated with Poor Sleep Quality in patients with Inflammatory Bowel Disease (IBD)
Authors: Connaughton R , Kafienah Y , Ramkalawan K , Stacey W , Walker C , O'Donnell S , Ryan B , O'Connor A ,   Tallaght University Hospital Dublin Ireland
Published: January 2023

Abstract

Background
Sleep disturbances affect 40-50% of patients with IBD and are associated with disease flares. Symptoms, treatment side effects and pro-inflammatory status have been shown to have an effect on sleep quality and duration. Anxiety and Depression disorders are also common with both conditions affecting approximately 20% of IBD patients. These disorders may also be associated with sleep disturbance

Aim
Our primary aim was to assess for a correlation between sleep quality and mood disorders in people with IBD. Our secondary aim was to assess the impact of these factors on quality of life.

Methods
87 patients with IBD were invited to complete an online survey. This survey included general demographic information, inflammatory bowel disease information, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), disease activity scores (Harvey Bradshaw Index and partial MAYO score), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). One-way ANOVA tests, Fisher’s test and unpaired t-tests were used to calculate the statistical significance.

Results
Mean age 43years. 46% male (n=40) and 54% female (n=47). Ulcerative Colitis 35.6% (n=31), Crohn’s Disease 62.1% (n=54), and indeterminate 2.3% (n=2).
The mean global PSQI score was 7.66, with 62% (n=54) of participants having a global PSQI score &gt;5, indicating poor sleep quality.
Poor sleep quality was not associated with age or disease duration. However unsurprisingly, it was associated with increased disease activity; Remission 5.89, mild activity 7.53, and moderate activity 10.61 (p&lt;0.001). See FIGURE 1
Participants with poor quality of sleep had significantly higher rates of anxiety (HADSA &gt;8) with a mean HADS anxiety score of 10.78 with 79% (n=39/49) reporting anxiety, compared to those with good reported sleep with mean scores of 4.97 and 21% (n=7/33).reporting anxiety p&lt;0.001. They also had higher rates of depression, 42%(n=21/49) versus 6%(n=2/33), p&lt;0.001.

Conclusion
Poor sleep quality increases levels of anxiety and depression, which in turn impacts quality of life in patients with IBD. Physicians should enquire about sleep & mood when treating patients with IBD to improve sleep quality.
P879 Clinical significance of plasma interleukin-22 as a biomarker of inflammation in patients with Crohn’s disease and ulcerative colitis
Authors: Cabrera-Moksnes C , Fernandez-Llaneza D , Neisen J , Angermann B R , Gehrmann U , Olsson M , Cairns J , Powell N 
Published: January 2023

Abstract

Background
IL-22 is a key cytokine in the pathogenesis of inflammatory bowel disease (IBD). While evidence underpinning its central role as a biomarker of pathway activation, diagnosis, severity and activity for IBD has been accumulating, little is known about its application as a biomarker in IBD in real-world practice. Here, we characterize for the first time the relationship between IL-22 plasma concentrations and the clinical characteristics of a large, real-world population of patients with IBD.

Methods
This is a descriptive analysis of patients in the Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) obtained from the IBD Plexus registry of the Crohn’s & Colitis Foundation in the United States. The SPARC registry includes patients with a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC). This study evaluated baseline data collected within ± 30 days from consent date. Assessments included demographics, clinical characteristics and IL-22 plasma concentrations. Disease severity was assessed using short CD Activity Index (sCDAI; scores &lt;150 define remission, 150–219 mild activity, ≥220 moderate-severe activity) or 6-point UC Disease Activity Index (UCDAI; scores ≤1 define remission, 2–3 mild activity, ≥4 moderate-severe activity) disease severity categories.

Results
A total of 2667 patients with CD and 1326 patients with UC were eligible for inclusion in the study. For patients with CD, median age was 39 years, 57% were female and median disease duration was 13 years (Table 1). For patients with UC, median age was 40 years, 51% were female and median disease duration was 9 years (Table 1). In total, 1604 patients with CD and 836 patients with UC had valid IL-22 samples at baseline, of which 33% and 25%, respectively, were above the lower limit of quantification (LLOQ; 7.8 pg/mL). There was a trend toward fewer patients with IL-22 levels below the LLOQ among patients with high disease severity compared with those with lower disease severity both in patients with CD and those with UC (Figure 1). Additionally, there was an increase in the percentage of patients with IL-22 levels greater than the third quartile (overall Q3 = 10.8 pg/mL in CD, and = 7.9 pg/mL in UC) with increased disease severity (Figure 2). Comparison of subgroups of patients with low and medium/high IL-22 levels showed a consistent pattern with fewer patients in remission and more moderate-severe patients in the medium/high IL-22 group than in the low IL-22 group (Table 2).

Conclusion
Higher IL-22 levels tended to be associated with higher disease activity in this real-world population of IBD patients.
Time for Justice? Reflections on Narrative Absences and Presences in the Special Tribunal for Lebanon’s Ayyash Decision
Authors: Burgis-Kasthala Michelle 
Published: January 2023

Abstract
After a tumultuous inception and drawn-out in absentia trial, the Trial Chamber of the Special Tribunal for Lebanon finally handed down its key judgment in August 2020. This article offers a critical appraisal of the tribunal and the decision, first, by situating the finding within Lebanon’s political context and, second, by adopting a close narrative reading of the text itself. It argues that the judgment is structured around a series of presences and absences that build the Chamber’s narrative about post-civil war Lebanon and its need for justice. The article suggests that, while the Chamber succeeds in convicting one of the co-accused for his role in the terrorist conspiracy to assassinate Rafiq Hariri, it fails to produce a convincing narrative about the role of international criminal justice in the fractured polity of modern Lebanon.