bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0552 Incisional and parastomal hernia after surgical management of inflammatory colitis: a common complication presenting a real therapeutical challenge in a tertiary expert center
Authors: Lelièvre O , Abdalla S , Meyer A , Amiot A , Carbonnel F , Penna C , Benoist S , Brouquet A 
Published: January 2025

Abstract

Background
Surgical management of inflammatory colitis often requires a staged approach involving multiple interventions with or without stoma creation. Data on the incidence, risk factors, impact and management of incisional and parastomal hernias (IH and PSH) in UC patients are limited. This study aims to assess the incidence of IH and PSH after surgical completion in colitis patients and to identify associated risk factors.

Methods
All patients undergoing surgical management for inflammatory colitis between March 2010 and May 2024 were eligible. The primary endpoint was the incidence of IH and/or PSH and/or and/or stoma prolapse. Risk factors of hernia (IH and/or PSH) were analysed using univariate and multivariate analyses.

Results
A hundred and nine patients had surgical management for inflammatory colitis and were included in the analysis (87 UC [80%], 6 Crohn’s disease [5.5%], 14 indeterminate [13%], 2 drug-induced [1.8%]). Mean age was 46 ± 17 years. Indications included refractory colitis (n=32, 29%), severe acute colitis (n=58, 54%), and dysplasia (n=19, 17%). Procedures performed were ileal pouch anal anastomosis (IPAA) in 73(67%) patients, ileorectal anastomosis (IRA) in 23(21%), and non-restorative proctocolectomy with end ileostomy in 13(12%). Patients underwent a mean of 2.7±0.96 procedures with 99 patients requiring 2 or more procedures. Temporary stomas were created in 84(77%), and 19(17%) had permanent stomas. Median follow-up time was 44[21-91] months. 25(23%) patients had parietal complications after a median delay of 25[11-35] months following the last procedure: 22(20%) IH, 4(3.6%) PSH, and 3(2.8%) stomas prolapse*. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Among 25 patients with parietal complications, 20 underwent abdominal wall repair. Of these, 6(30%) had recurrence requiring redo abdominal wall surgery in 3(15%). Adjusted risk factors for parietal complications included BMI≥25 (OR=3.13;95%CI=1.11-8.82;p=0.031) and permanent stoma (OR=5.86;95%CI=1.83-18.80; p=0.003). The type and number of procedures, and surgical indications were not associated with parietal complications.
* Several patients had several complications

Conclusion
Parietal complications represent a major clinical challenge in the surgical management of inflammatory colitis. Nearly one-quarter of patients develop abdominal incisional or parastomal hernias, and one-third of patient experience recurrence following abdominal wall repair. Prophylactic mesh placement at the stoma closure site should be studied as an option to reduce this risk.

References
None
P0563 Prevalence and clinical impact of abnormal hepatobiliary biochemistry in newly diagnosed inflammatory bowel disease – a prospective population-based inception cohort study
Authors: Attauabi M , Madsen G R , Bendtsen F , Seidelin J B , Burisch J 
Published: January 2025

Abstract

Background
Abnormal hepatobiliary biochemistry is frequently observed in patients with inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD). However, its prevalence and clinical implications in IBD remain unclear. We aimed to determine the occurrence and clinical impact of abnormal hepatobiliary biochemistry in patients with newly diagnosed IBD.

Methods
Between May 1, 2021, and April 30, 2023, all adult and pediatric patients with incident IBD within a catchment area covering 20% of Denmark were enrolled in the prospective, population-based Copenhagen IBD Inception Cohort.1 Herein, all adult patients underwent hepatobiliary blood tests (alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and INR) at IBD diagnosis. Multivariate Cox proportional hazard analyses adjusting for age, sex, smoking, and disease phenotype were performed (adjusted HR, aHR, 95% confidence interval).

Results
A total of 527 patients (UC: 326; CD: 201) were included in the cohort, with 290 (89.0%) and 189 (94.0%) undergoing blood tests, respectively, within a median of two days (interquartile range: -14 - 6) before IBD diagnosis. No demographic or clinical phenotypical differences were observed between patients who underwent blood test and those untested.
Abnormal hepatobiliary biochemistry was found in 49 (16.7%) and 46 (24.3%, p&lt;0.01) patients with UC and CD, respectively, primarily driven by higher median ALP levels in CD (80 U/L [IQR 69-97]) versus UC (74 U/L [IQR 61-90], p&lt;0.01). No associations were observed between abnormal hepatobiliary biochemistry and sex, age, initial extent or location of IBD, or disease activity (Table 1). However, stricturing or penetrating CD was significantly associated with abnormal hepatobiliary biochemistry (adjusted OR = 4.62 [1.70; 12.54]).
During a follow-up of 2.1 years (IQR 1.6-2.6), abnormal hepatobiliary biochemistry was not associated with the initial course of UC; however, an increased risk of requiring resective surgery for CD was observed (aHR= 3.27 [1.04-10.24], Table 2).

Conclusion
In this prospective, population-based cohort, abnormal hepatobiliary biochemistry was present in approximately one in six patients with UC and one in four patients with CD at diagnosis, with no association with IBD disease activity. Although it did not correlate with the initial course of UC, these findings underscore the need for increased attention to hepatobiliary biochemistry in patients with CD.

References
1.Attauabi M, Madsen GR, Bendtsen F, et al. Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. 2022;12(6):e055779. doi:10.1136/bmjopen-2021-055779
P0642 Assessment of the real-world effectiveness of upadacitinib in patients with moderate-severe ulcerative colitis in a global real-world setting
Authors: Seidelin J B , Marin-Jimenez I , Dawod F , Lukanova R , Jones W , Morriset P , Sharma D , Siegel C 
Published: January 2025

Abstract

Background
Upadacitinib (UPA), a Janus kinase inhibitor, was approved in 2022 to treat adults with moderate-severe ulcerative colitis (UC). While clinical trials have shown its efficacy, there are limited real-world data on the utilization and effectiveness of UPA in routine clinical practice across different countries. This study aimed to assess the real-world impact of UPA on disease remission and symptom control for optimizing treatment outcomes in patients with UC.

Methods
Data were drawn from the Adelphi Real World UC Disease Specific Programme, a cross-sectional survey with retrospective data collection of gastroenterologists (GIs) in France, Germany, Italy, Spain, the United Kingdom, and the United States of America from February 2023 – October 2024. GIs reported data on their patients with subjectively classified moderate-severe UC at initiation of UPA, including demographics, clinical characteristics (incl. derived partial Mayo score (pMayo)) and symptoms at UPA initiation and at the most recent consultation. Analyses were descriptive, Wilcoxon signed rank and McNemar tests were used to compare severity and symptoms at UPA initiation and at most recent consultation, respectively.

Results
Overall, 215 GIs reported data on 357 patients with moderate-severe UC receiving UPA. Mean (standard deviation; SD) patient age was 39.2 (12.4) years, 65% were male, 43% had pancolitis. Mean (SD) disease duration was 4.5 (5.1) years; 45% were advanced therapy (AT) naïve and 55% AT experienced.
Among those who were receiving UPA for ≥6 months (n=129), 59% were in clinical remission, as defined by pMayo at their most recent consultation. Among all patients on UPA, an increasing proportion of patients in remission, as defined by pMayo, was observed with increasing duration of UPA use (Figure 1A).
GI-reported disease severity significantly reduced from UPA initiation to most recent consultation (p&lt;0.0001; Figure 1B). As duration of UPA use increased, the proportion of patients experiencing key symptoms since UPA initiation to most recent consultation decreased (Figure 2).

Conclusion
In a real-world global setting, UPA demonstrated significant efficacy in reducing disease activity, severity and UC-related symptoms over time. Remission rates and symptom reduction increased with longer treatment duration, with improvements seen as early as four weeks for key symptoms, and continued symptom relief observed through 52 weeks. These findings underscore the effectiveness of UPA treatment for long-term disease management in patients with moderate-severe UC.
P0649 Acceptability and Tolerance of Risankizumab Treatment Administered via On-Body Injector in Patients with Crohn’s Disease: Results of the Nationwide ACCEPT-OBI Study
Authors: Buisson A , Gebara K , Peyrin-Biroulet L , Boschetti G , Gilletta de Saint Joseph C , Brixi H , Juillerat P , Serrero M , Vuitton L , Hébuterne X , Caillo L , Blain A , Laharie D , Pereira B , Fumery M ,   GETAID
Published: January 2025

Abstract

Background
Risankizumab (RZB) has been available in our country for Crohn’s disease (CD) patients through an early access program and is now administered using an innovative medical device known as an on-body injector (OBI).
We assessed the acceptability and the tolerance of RZB administration via OBI and compare its acceptability with other modalities of CD treatments, and searched for factors associated with the OBI acceptability.

Methods
This was a prospective, multicenter longitudinal study. All CD patients from the early access cohort treated with RZB via OBI starting in February 2024 were assessed at the time of the switch to OBI (week 0 = W0) and at W8, W16, and W24.
The primary endpoint was acceptability, evaluated using a acceptability numerical scale (ANS) ranging from 0 (completely unacceptable) to 10 (perfectly acceptable).

Results
A total of 58 multi-refractory patients were included (mean age : 42.8 ± 13.8 years; 57.9% were women, 17.3% were smokers, 64.7% had a history of intestinal resection, and 78.2% were in PRO2-clinical remission).
Therapeutic education sessions were conducted concurrently for 36.2% (21/58) of patients. OBI was applied to abdomen, thigh, or another site in 43.9%, 52.6%, and 3.5% of patients, respectively.
RZB administration via OBI was well tolerated in 57.4%, with possible mild application-site pain (20.4%, mild in 90% of cases), localized erythema (22.2%), pruritus (16.7%), edema (16.7%). No factors affected the acceptability of risankizumab administration via OBI in more than 15% of patients.
RZB acceptability via OBI was very high (9.5 ± 1.2) at W0, significantly better than RZB subcutaneous injections (6.98 ± 2.57; p &lt; 0.0001). OBI acceptability remained stable over time: 9.6 ± 1.2 at W8, 9.6 ± 1.4 at W16, and 9.6 ± 0.8 at W24 (p = 0.97). OBI acceptability as a medical device was better than other injectable administration modalities for IBD treatments: IV infusions (p &lt; 0.0001), pen injectors (p &lt; 0.001), and syringes (p &lt; 0.001).
Overall, patients preferred OBI (64.0%), followed by oral administration (28.0%), subcutaneous injections (6.0%), and IV infusions (2.0%).
When adjusted for administration frequency, RZB every 8 weeks via OBI was the most preferred method (ANS = 9.2 ± 2.0), compared to long interval subcutaneous injections (every 12, 8, or 4 weeks), more frequent injections (weekly or eow), and IV infusions every 4–8 weeks (p &lt; 0.001 for all comparisons).

Conclusion
In this cohort of refractory patients, the administration of risankizumab via OBI was highly acceptable to CD patients with excellent tolerance, suggesting that this new medical device could promote the use of risankizumab in clinical practice.
P0877 Machine Learning and Mendelian Randomization Analysis for Predicting Endoscopic Restenosis in Patients with Crohn's Disease after Endoscopic Balloon Dilation
Authors: Su T , Wu H , Wu L , Zhi M , Yao J 
Published: January 2025

Abstract

Background
Endoscopic balloon dilation (EBD) is a safe and effective procedure for treating stenosis in patients with Crohn's disease (CD). This study aimed to evaluate factors associated with endoscopic restenosis after EBD and construct a prognostic model.

Methods
We retrospectively collected and analyzed data on patients receiving EBD treatment at the Sixth Affiliated Hospital of Sun Yat-sen University from 2013 to 2024. Seven machine learning (ML) algorithms were used to construct a prognostic model. And explore potential biomarkers of intestinal stricture using Mendelian randomization (MR).

Results
A total of 135 patients were included in the statistical analysis. 53% occurred endoscopic restenosis, with an average restenosis time of 183 days. COX and logistic regression analysis showed that 4 features including ever-use glucocorticoids, stenosis position, technical success, and albumin level were associated with restenosis risk. When comparing different ML models, CoxPH and LASSO models performed better on various evaluation metrics, including C-index which was greater than 0.7 in the train and test set. Based on SHapley Additive exPlanations (SHAP), stenosis position, balloon diameter, and albumin level were identified as the top 3 important features associated with prognosis. Two-sample MR analysis identified 50 potential biomarkers of intestinal stricture. However, two-step MR analysis did not find any mediating effect between CD and intestinal stricture.

Conclusion
ML-based prognostic models have good predictive performance and can accurately assess the risk of endoscopic restenosis after EBD treatment. However, MR analysis did not identify reliable stenosis-related biomarkers in CD.
P0884 Environmental impact and costs of a switching program of intravenous to subcutaneous infliximab in Inflammatory Bowel Disease
Authors: Oliveira R , Roseira J , Araújo N , Cavaco C , André J , Sousa M , Tavares de Sousa H , Cunha M 
Published: January 2025

Abstract

Background
We aimed to compare real-life direct and indirect costs and the environmental impact of switching IBD patients from IV to SC infliximab (IFX).

Methods
Adult IBD outpatients in clinical remission who switched from IV to SC IFX were studied. Data on direct and indirect costs for the hospital (€), and environmental impact (Carbon dioxide equivalents [CO2e]), were evaluated before and after switching. Patients also completed an anonymous pilot questionnaire designed to assess the indirect costs associated with their own drug administration. A consecutive sample of patients was used to calculate costs over 6 months of both therapy regimens.

Results
Twelve patients switched to SC IFX (91.7% were under-optimised IV dosage). Before switching, most missed work (58.3%) or changed shifts for infusions (25%), leading to a median of 4 missed workdays over 6 months, translating to an estimated median loss of 328€ in self-earnings. Patients spent a median of 92.5 min travelling to and 720 min at the hospital. Post-switch, hospital time decreased to 195 min (p=0.005). However, due to pharmacy stock rules requiring frequent hospital visits to collect SC therapy, both travel time (190 min; p=0.009) and travel frequency (4.0 vs 6.0 visits; p=0.004) increased. Estimated travel costs for patients rose from 89.6€ to 196.0€ over 6 months (p=0.007).
Median direct costs were 1321.34€ for IV IFX and 2604€ for SC IFX (p=0.008), while indirect costs dropped as preparation time fell from 140 min for IV to 70 min for SC (p=0.001), corresponding to an estimated cost reduction of 9.59€ (p&lt;0.001). Similarly, nursing staff time significantly reduced from 600 min with IV to 40 min with SC (p=0.002), corresponding to 95.01€ reduction (p&lt;0.001), respectively. Over 6 months, IV IFX had a median carbon footprint of 20.95 kg CO2eq (11.6 kg from infusions; 9.35 kg from patient travel), while SC IFX generated 24.15 kg CO2e (3.6 kg from injections; 20.55 kg from patient travel) per patient (p=0.859).

Conclusion
Our analysis shows SC IFX incurs higher direct costs than IV IFX without reducing the carbon footprint. However, reduced indirect patient costs and improved pharmacy and day hospital efficiency may offset these expenses. To maximise benefits, pharmacies should adjust stock management policies and minimise patient travel. These factors should be evaluated locally in a switching program design.
P0903 Structured yoga practices significantly improve quality of life in patients with Ulcerative Colitis in clinical remission: a randomized controlled trial
Authors: Kalum J D B S , Narang H , Virmani S , Shukla A , Verma M , Madan D , Kumar P , Mathew D , Prasad S , Mubunnu M , Kedia S , Makharia G , Sharma G , Ahuja V 
Published: January 2025

Abstract

Background
Ulcerative colitis (UC) significantly affects quality of life, compromising health-related well-being and life satisfaction, regardless of disease activity. There are anecdotal studies on effect of yoga in patients with ulcerative colitis. We investigated the effect of yoga on health-related quality of life and disease activity in UC patients in remission.

Methods
Patients with UC in remission (SCCAI &lt;3 and fecal calprotectin&lt;150 µg/mg) were randomly assigned to either IBD-specific yoga therapy (45 minutes/day, five days/week) or brisk walking (150 minutes/week), in addition to standard medical treatment, for 6 months. Primary outcome was the effect of yoga on quality of life using the World Health Organization Quality of Life – BREF (WHOQOL-BREF), Hamilton Anxiety Rating Scale (HAM-A), and Perceived Stress Scale (PSS) questionnaires at 6 months. Secondary outcome was relapse rates at 6 months.

Results
One hundred patients were randomized with 50 in each arm and 5 were lost to follow up. Baseline clinical and demographic characteristics and WHOQOL BREF, PSS and HAM-A scores were similar. At 6 months, patients in yoga group showed significantly lower PSS (16.70±1.44 vs. 17.34±1.5, p=0.03) and anxiety scores (1.51±0.68 vs. 1.89±0.79, p=0.01) compared to walking. Yoga also significantly improved physical (71.29±2.94 vs. 69.65±3.4, p=0.014) and psychological well-being (71.55±4.28 vs. 68.34±4.77, p=0.001), with similar social scores (63.85±6.98 vs 63.47±6.68 p=0.79). One patient in each group had disease relapse.

Conclusion
Yoga showed greater reductions in stress and anxiety, and improved quality of life in both physical and psychological domains, compared to walking. Both groups had similar disease relapse rates. Yoga can be considered an effective ancillary intervention to improve the quality of life in patients with UC in remission.

References
1.Sharma P, Poojary G, Dwivedi SN, Deepak KK. Effect of Yoga-Based Intervention in Patients with Inflammatory Bowel Disease. Int J Yoga Ther. 2015 Jan 1;25(1):101–12.
2.Cramer H, Schäfer M, Schöls M, Köcke J, Elsenbruch S, Lauche R, et al. Randomised clinical trial: yoga vs written self-care advice for ulcerative colitis. Aliment Pharmacol Ther. 2017 Jun;45(11):1379–89.
P0951 The effects of delayed surgery in Inflammatory Bowel Disease – a health economic analysis
Authors: Åberg H , Bengtsson J , Park J , de la Croix H , Hermanson M 
Published: January 2025

Abstract

Background
To manage the COVID 19 pandemic, surgeries that were not immediately life threatening were delayed. Patients with Inflammatory Bowel Disease (IBD) are still affected, which can have effects on patients’ individual physical and mental health as well as on health economics. This includes the risk of complications and possible needs of both acute and planned care during the waiting time for surgery, need for sick leave, prescription of medications and aid; all that could have been diminished with surgery being performed in a timely manner.

Methods
All patients with IBD who either were scheduled for surgery and had a waiting time of 90 days or more (cases) or had elective surgery within 90 days of waiting (controls), between 2017-2023 at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the study (figure 1). Consumed health care during waiting time for surgery (cases) or after surgery (controls) were registered, as well as drugs prescribed and use of supporting products such as stoma bags. Days of sick leave were registered.

Results
A total of 189 individuals were included, 40 (mean age 43.6 years, 18 women) controls and 149 (mean age 41.6 years, 46 women) cases. Forty-six (24.3%) patients had Crohn’s disease, 140 (74.1%) ulcerative colitis and 3 (1.6%) IBD-unclassified. Number of primary care visits at 24-36 months were 4.9 (CI 3.49-6.45) and 3.6 (CI 1.51-5.83) for the cases and controls respectively. The corresponding number of specialized outpatient visits at 24-36 months was 5.1 (CI 3.66-6.69) and 4.1 (CI 1.12-6.05). The mean direct healthcare cost per person were higher for the control group for the first months, it then shifted to be higher in the cases group (table 1). After 24-36 months the cost for the cases were 8 509 and 5 469 euro for the controls. Mean household income was 36 027 euro (CI 27 310–44 743) for the control group and 28 688 euro (CI 25 844–31 532) for the case group. In total, 90% (n=36) were born in Sweden in the control group vs. 75.2% (n=112) in the case group. There was no difference in terms of sick leave between the groups.

Conclusion
Health care cost for patients with IBD waiting for surgery is similar to patients who have had elective surgery. Since patients waiting for surgery still have the postoperative costs to come, this means that the total cost for the healthcare system and society is a lot higher for this group, compared to patients that have had elective surgery within 90 days. A short period of time between surgical decision and surgical date is therefore advisable.