bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1206 The Incidence and Disease Course of Perianal Disease in Paediatric-Onset Crohn's Disease: A Danish Nationwide Cohort Study Covering 1980-2022
Authors: Ström A , Jansson S , Wewer M D , Burisch J , Malham M , Wewer V ,   The Copenhagen IBD Center
Published: January 2025

Abstract

Background
Perianal Crohn's disease (CD) is characterised by fistulae and/or abscesses in the anal region and leads to significant morbidity. We aimed to estimate the incidence and describe the disease course of perianal disease in paediatric-onset CD patients (&lt;18 years at CD diagnosis).

Methods
In a nationwide registry-based cohort study, we identified all incident patients with paediatric-onset CD in Denmark from 1980 to 2018. We followed the patients until emigration, death, or December 31, 2022, and recorded the cumulative incidence of perianal disease based on data from the National Patient Registry. Using perianal disease as an exposure, we further assessed the risks of major abdominal surgeries, colorectal and anal cancer, and mortality. We used multivariate Cox regression analysis with biological age as the timescale to estimate hazard ratios adjusted (aHR) for sex, family income, and calendar year of CD diagnosis.

Results
We identified 2,356 paediatric-onset CD patients, of whom 769 (32.6%) were diagnosed with perianal CD. Total follow-up time was 38,584 person-years. The cohort is described in detail in Table 1.
The cumulative incidence of perianal CD was 14.0%, 21.1%, and 28.1% after 1, 5, and 10 years after CD diagnosis, respectively. The incidence density during the study period was 29 (95% confidence interval [CI]: 26.8–30.9) per 1,000 person-years, corresponding to 45.2% after 30 years of follow-up. Among the 769 patients with perianal CD, 460 (59.8%) had perianal abscesses, 399 (51.9%) perianal fistula, and 627 (81.5%) patients underwent perianal surgery. Of CD patients with perianal disease, 308 (40.1%) required a stoma compared to 147 (9.3%) of patients without, corresponding to an aHR of 2.8 (95% CI: 2.3-3.4). When comparing CD patients with perianal disease to those without, the aHRs for major abdominal surgery, cancer, and mortality were 1.5 (95%CI: 1.3–1.8), 0.8 (95% CI: 0.2–2.7), and 1.5 (95%CI: 0.9–2.7), respectively. Of the 68 patients that died, 35 (2.2/1,000 person-years) had perianal disease, whereas 33 (1.4/1,000 person-years) had not. Further risk analysis is presented in Figure 1.

Conclusion
In this nationwide cohort of patients with paediatric-onset CD (&lt;18 years at CD diagnosis), 29 patients per 1,000 person-years developed perianal disease between 1980-2022. Patients with perianal CD were more likely to require major abdominal surgery, including stoma surgery, and had a higher risk of mortality compared to patients without perianal CD. Our study underlines the severity of perianal disease in paediatric-onset CD.
P1218 Pancreatic Involvement in Patients with Inflammatory Bowel Disease: A Cohort Study of 474 IBD Patients
Authors: Darkaoui D , Koulali H , Zazour A , Ouiam E , Ismaili Z , Kharrasse G 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is a systemic condition that extends beyond the gastrointestinal tract, affecting multiple organ systems, including the skin, musculoskeletal system, and eyes... . The pancreas is one such organ that can be affected, exhibiting diverse manifestations through various pathophysiological mechanisms. These manifestations range from asymptomatic elevations of pancreatic enzymes to severe conditions such as acute pancreatitis (AP), autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic cancer. This study evaluates the prevalence and characteristics of pancreatic involvement in patients with IBD.

Methods
This retrospective, descriptive, analytical study spanned nine years (January 2016–December 2023) and included regular follow-up of patients with a confirmed diagnosis of IBD. We specifically investigated different pancreatic involvements in IBD patients, excluding asymptomatic elevations of pancreatic enzymes.

Results
A total of 474 IBD patients were analyzed: 291 with Crohn's disease (CD), 178 with ulcerative colitis (UC), and 5 with indeterminate colitis. Pancreatic involvement was observed in 6 patients (4 women and 2 men), comprising 3 with Crohn's disease and 3 with ulcerative colitis, resulting in an overall prevalence of 1.26%. The mean age of presentation for pancreatic manifestations was 42.5 years (range 23–59 years), with a male-to-female ratio of 0.5. The prevalence among CD patients was 1.03%, compared to 1.68% in UC patients.
Five cases of acute pancreatitis were documented:Medication-related AP: Two patients developed acute pancreatitis related to 6-mercaptopurine and azathioprine.
Biliary and medication-related AP: One patient treated with 5-ASA presented with a bile duct stone, suggesting a biliary or drug-related cause.

Morphological anomaly
Another case was linked to mesalazine or pancreas divisum.
Autoimmune pancreatitis (type 2): One case was identified, associated with exocrine pancreatic insufficiency.
Diffuse abdominal pain with elevated lipase: One patient exhibited elevated lipase levels and acute renal failure without imaging abnormalities.

Conclusion
Pancreatic abnormalities in patients with IBD encompass diverse clinical manifestations and etiologies. Our findings indicate that acute pancreatitis is the most common presentation, primarily linked to medications such as azathioprine, 6-mercaptopurine, and mesalazine, as well as biliary causes and autoimmune disorders. The identification of type 2 autoimmune pancreatitis underscores the importance of further research into the pathophysiology of pancreatic involvement in IBD.
P1225 A cross-sectional study of Inflammatory Bowel Disease in older people across Australasia, a Crohn’s Colitis Cure data insights program
Authors: Seng C , Su W K , Wilson W , Connor S J , Andrews J M , Walker G 
Published: January 2025

Abstract

Background
There is an increasing population of older people with inflammatory bowel disease (IBD) owing to both increasing incidence over 70 years of age and an overall ageing IBD population. The management of older people with IBD can be challenging especially considering higher rates of comorbidity, polypharmacy, frailty, infection risk and malignancy. Furthermore, this cohort is mostly excluded from registry clinical trials for novel therapies, limiting the applicability of trial findings. Here, we aimed to establish the characteristics of IBD and its management with a focus on older people across Australasia.

Methods
Crohn’s Colitis Care (CCCare) is a cloud-based electronic medical record used in Australasia since 2018. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September of 2024. People with IBD under active care (encounter within 14 months) were included. The cohort was divided into three age groups: &lt; 40 years, 40 – 69 years and ≥ 70 years.

Results
Of 7506 eligible people, the median age was 42 years (IQR 31 – 56). Those ≥70 years comprised 8.1%. Analysis of the most common comorbidities found cardiovascular related diseases to be the most common amongst those ≥70 years (Table 1). Hypertension was the most commonly reported (24.7%), followed by hyperlipidaemia (14.0%), gastro-oesophageal reflux disease (11.7%) and ischaemic heart disease (10.7%). This contrasts with those aged &lt; 40 where anxiety (4.9%), asthma (4.6%), iron deficiency (4.2%) and depression with anxiety (3.7%) were the most common comorbidities. Medical management characteristics are summarised in Table 2. There was lower use of immunomodulators (IMS), steroids and advanced therapies in older people compared with both younger cohorts. In those receiving an advanced therapy in the older cohort, vedolizumab (12.4%) was the most often prescribed followed by infliximab (8.7%) and ustekinumab (8.6%). There was no significant difference in the rates of endoscopic or radiological remission across the three cohorts.

Conclusion
These data are important for demonstrating real worse disease and management characteristics across the age spectrum in IBD, in a large binational cohort under routine care. Despite lower rates of steroid, immunomodulatory and advanced therapy in the older cohort, there were no significant differences in rates of achieving radiological or endoscopic remission across the three cohorts. This may be in part due to a difference in phenotype for those diagnosed with IBD in later life. This overview demonstrates the potential of a database such as CCCare in informing ongoing management practices in this growing population.
P1226 Inflammatory Bowel Diseases and Prior Malignant Diagnoses - A Danish Nationwide Cohort Study 1996-2022
Authors: Plovgaard J , Damsgaard Wewer M , Bendtsen F , Burisch J 
Published: January 2025

Abstract

Background
Due to the increasing prevalence of inflammatory bowel diseases (IBD), an ageing population and the increased risk of cancer associated with IBD, the number of patients diagnosed before or while having their IBD is increasing. We aimed to describe the treatment of IBD patients with a prior malignant diagnosis relative to IBD patients without.

Methods
Danish national registers were used to identify all incident Crohn’s disease (CD) and Ulcerative Colitis (UC) patients in Denmark, their exposure to drugs and surgeries, and cancer status, between 1996-2022.
Cox regressions compared the risk of exposure to medications and the risk of surgery for patients with malignant comorbidity.

Results
58,402 incident IBD patients (18,383 CD (31.5%), 40,019 UC (68.5%)) were included and followed for a median of 10 years (IQR: 5, 17 yrs). 2,370 (4.1%) had cancer prior to IBD. Of the remaining 56,032 IBD patients, 4,445 (7.9%) had their first cancer diagnosis after their IBD diagnosis. Anti-TNF therapy was used in 16% (n = 92) of CD patients with cancer prior to IBD and in 41% (n = 6,857) of CD patients without cancer. Anti-TNF was used in 9.0% (n = 161) of UC patients with cancer prior to IBD and in 20% (n = 7,159) of UC patients without cancer. Immunomodulators were used in 27% (n = 159) of CD patients with cancer prior to IBD and in 52% (n = 8,594) of CD patients without cancer. Immunomodulators were used in 12% (n = 220) of UC patients with cancer prior to IBD and in 27% (n = 9,555) UC patients without cancer.
Exposure to medical therapy was visualised in Figure 1
Being diagnosed with cancer prior to CD diagnosis was negatively associated with exposure to immunomodulators (p = 0.005), while it increased the risk of receiving no medical treatment compared to CD patients without prior cancer (p &lt; 0.001). The need for surgery was not associated with having cancer prior to CD diagnosis (p = 0.705). In UC patients, a negative association was found for both immunomodulators (p = 0.001) and for receiving no treatment (p &lt; 0.001), while a positive association was found for both anti-TNF (p = 0.027) and anti-integrin therapy (p &lt; 0.001) for UC patients with prior cancer. Prior cancer increased the risk of requiring surgery for UC patients (p &lt; 0.001)

Conclusion
Patients with cancer prior to IBD were treated differently than patients without prior cancer as they received less immunomodulator therapy and more often received no medical therapy at all. UC patients more often required surgery, while this was not the case for CD patients. This supports the need for an individualised approach to immunosuppressive treatment for IBD patients with cancer.
P1229 Updated Epidemiology of Osteoporosis in the Inflammatory Bowel Disease Population and Associated Risk Factors: Insights from a Retrospective Cohort Analysis
Authors: Khataniar H , Desai A , Kochhar G 
Published: January 2025

Abstract

Background
Osteoporosis is a prominent extra-intestinal complication in patients with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of osteopenia and osteoporosis among patients with IBD varies widely, ranging from 22%-77% and 17%-41%, respectively, depending on population characteristics, geographic location, and study design [1]. Despite these variations, the burden of osteoporosis in IBD is unequivocal, impacting quality of life and increasing the risk of fractures.

Methods
We conducted a retrospective cohort study using the TriNetX database to assess the incidence of osteoporosis in patients with IBD between 2013 and 2023. Data were stratified by age, sex, and race. A comparative analysis of osteoporosis risk in IBD versus non-IBD populations was performed, along with an exploration of risk factors specific to UC and CD cohorts. Propensity score matching was employed to adjust for confounders, including age, sex, race, BMI, smoking, primary sclerosing cholangitis (PSC), steroid use, autoimmune diseases, IBD medications, and surgical history. Risk was quantified as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results
A total of 120,396 patients with IBD (mean age 43.8 ± 19.4, female sex 53.073%, White race 79.01%) were analyzed. The five-year incidence of osteoporosis was significantly higher in the IBD cohort (aOR: 1.43, 95% CI: 1.38-1.48) compared to the non-IBD cohort. Among IBD subtypes, CD patients exhibited a higher risk (aOR: 1.53, 95% CI: 1.46-1.60) compared to UC patients (aOR: 1.38, 95% CI: 1.32-1.44) [Figure 1].
Osteoporosis incidence was notably higher in females (IBD: 9.78%, UC: 10.48%, CD: 9.38%) than in males (IBD: 3.55%, UC: 3.67%, CD: 3.87%) and increased significantly with age, reaching 21.67% in patients over 80 years old. Racial disparities were evident, with the highest incidence observed among White patients (7.35%). Significant risk factors for osteoporosis in IBD included long-term corticosteroid use (aOR: 2.29, 95% CI: 2.25-2.32), malnutrition (aOR: 1.56, 95% CI: 1.53-1.59), use of TNF-alpha inhibitors (aOR: 1.40, 95% CI: 1.36-1.43), PSC (aOR: 2.30, 95% CI: 2.08-2.54), intestinal surgery (aOR: 1.21, 95% CI: 1.18-1.23), hemoglobin levels of &lt;10 g/dL (aOR: 1.20, 95% CI: 1.19-1.21), albumin levels of &lt;2.5 g/dL (aOR: 1.07, 95% CI: 1.05-1.08), and mood disorders (aOR: 1.16, 95% CI: 1.15-1.17) [Figure 2].

Conclusion
Osteoporosis is a significant concern for patients with IBD, with females, older adults, and CD patients being most at risk. Early and targeted interventions are crucial to reducing bone loss and improving long-term outcomes in this vulnerable population.

References
1.Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009 Jul;122(7):599-604. doi: 10.1016/j.amjmed.2009.01.022. PMID: 19559158; PMCID: PMC2894700.
P1231 Cross-sectional assessment of body composition and muscle function in Crohn's disease patients, stratified by presence and extent of intestinal resection
Authors: Becherucci G , Parisio L , Profeta F , Foscarini E , Covello C , Del Gaudio A , Di Vincenzo F , Iaccarino J , Pizzoferrato M , Petito V , Masi L , Troisi S , Pane C , Calvez V , Laterza L , De Biasio F , Marmo C , Mignini I , Turchini L , Amatucci V , Giordano L N , Ribaudi E , Biamonte F , Cammarota G , Pugliese D , Lopetuso L , Gasbarrini A , Papa A , Scaldaferri F 
Published: January 2025

Abstract

Background
Crohn's disease (CD) is a leading cause of short bowel syndrome (SBS) in adults, which can result in intestinal failure (IF) when intravenous nutritional or electrolyte supplementation is required. SBS is frequently associated with sarcopenia, characterized by loss of muscle mass and function, which adversely impacts quality of life and increases the risk of complications. This study aimed to evaluate differences in body composition and muscle strength among CD patients at varying risk levels for SBS.

Methods
We conducted a cross-sectional study involving consecutive CD outpatients. The participants were divided into two groups. Group A consisted of CD patients diagnosed with SBS and patients who had undergone two or more bowel resections, or a resection of more than 50 cm. Group B included patients who had never undergone surgery or those who had undergone a resection of less than 50 cm. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured via hand grip testing with a dynamometer, recording the best result of three attempts with the dominant hand. We administered food frequency questionnaire (FFQ) to assess eating habits. Statistical analyses, including t-tests or Mann-Whitney tests, were used as appropriate, with a significance threshold of p &lt; 0.05.

Results
The study cohort included 150 patients (mean age 53 years [±19,2]; 24% female). Group A showed an average BMI of 23,7±4 kg/m2, whereas group B showed an average BMI of 24.6±5 kg/m2. Muscle strength measured between groups was reduced in group A showing significant differences in hand grip test compared to group B (p-value&lt;0.001). However, no significant differences were observed in BIA parameters, including muscle mass, or in eating habits across the groups.

Conclusion
Our study revealed that SBS patients and CD patients resected two or more times or with a resection greater than 50 cm had reduced muscle strength without a corresponding reduction in muscle mass, indicating impaired muscle function. Further research is needed to better understand the relationship between Crohn's disease-related resections and their impact on both muscle quality and quantity.
Funded by:2.1 "Rafforzamento e potenziamento della ricerca biomedica del SSN",finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project "Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets"code:PNRR-MAD-2022-12376791
P1232 A Novel Inflammatory Bowel Disease Registry Powered by Artificial Intelligence and Natural Language Processing
Authors: Liu J , Massaro C , Cruz E , Kalisky I , Lunken G , Leung Y , Bressler B , Rosenfeld G 
Published: January 2025

Abstract

Background
Accurate data registries may assist clinicians and researchers to gain insights into inflammatory bowel disease(IBD) and provide opportunities to improve overall patient care. However, most data registries are limited by the amount of time needed to collect and record patient-level data. Machine learning and natural language processing(NLP) can facilitate data collection, storage, and retrieval, reducing or even eliminating the need for human data entry. The aim of this study was to describe and validate a novel IBD repository(IBD Data Lake), leveraging machine learning and NLP techniques, as useful tools to curate and retrieve pertinent, real time clinical data in the IBD patient population.

Methods
The IBD Data Lake was created by medical professionals, translational researchers, and data strategists at the IBD Centre of British Columbia. Structured and unstructured data were extracted from patients’ electronic medical record and were transferred to a secure cloud infrastructure and curated into a searchable database. A customized user interface was created to search the IBD Data Lake. An advanced NLP service(Comprehend MedicalTM) was employed to extract clinical information from the unstructured text and data from medical documents in PDF format. Manual chart review was used as the gold standard to validate all information from the IBD Data Lake.

Results
A list of 208 patients(104 IBD patients matched to 104 non-IBD patients) from the IBD Data Lake was generated between July 1, 2018 and July 31, 2023. After a thorough chart review, the IBD cohort comprised 101 IBD patients and the non-IBD cohort included 102 non-IBD patients. The IBD Data Lake’s performance metrics for identifying IBD patients were as follows: sensitivity 98.1%, specificity 97.1%, positive predictive value 97.1%, and negative predictive value 98.1%.The machine learning and NLP components of the IBD Data Lake demonstrated high performance in analyzing key IBD unstructured clinical characteristics: for distinction of ulcerative colitis or Crohn’s disease, sensitivity was 100% and specificity 98.2%; for smoking status, sensitivity was 100% and specificity 96.9%; and for extraintestinal manifestations, sensitivity was 92% and specificity 100%.

Conclusion
A novel IBD Data Lake that integrates machine learning and NLP techniques has been validated. IBD patients have been identified with great accuracy and the machine learning/NLP components of the IBD Data Lake allow for a comprehensive and timely extraction and organization of unstructured data. This will ultimately lay the groundwork for recruitment of specific IBD cohorts of interest to address the gaps that remain in our knowledge. It has the potential to drive innovation in the field of IBD and gastroenterology.
P1237 Musculoskeletal involvement is frequent in bio-naïve patients with IBD initiating biological treatment– a prospective cohort study
Authors: Vladimirova N , Zhao M , Ørnbjerg L M , Møller J M , Attauabi M , Nielsen Y J W , Saboori S , Burisch J , Østergaard M 
Published: January 2025

Abstract

Background
Musculoskeletal (MSK) involvement in IBD patients contributes to poorer outcomes and reduced quality of life (QoL). Recognising MSK involvement is important before initiating biologics, as their effects can differ between the gut, peripheral joints and spine. We aimed to describe the prevalence and distribution of peripheral and axial MSK symptoms and clinical findings in IBD patients starting biological treatment.

Methods
Bio-naïve IBD patients were consecutively recruited. Musculoskeletal symptoms were assessed using questionnaires and a structured interview. A rheumatologist conducted a clinical evaluation of peripheral joints, entheses, and spine mobility and considered various differential diagnoses.

Results
Of 82 patients (ulcerative colitis (UC): 33, Crohn’s disease (CD): 49), 51(62%) had musculoskeletal symptoms and 51(62%) had clinical findings (Table 1). Peripheral joint pain was reported by 39(48%) patients, usually affecting the hands, followed by the knees and ankles. Entheseal pain was present in 15(18%) patients, most often affecting the lateral hips, followed by the Achilles and patella tendons. Back pain was reported by 33(40%) patients. In 16 of these patients, the assessing rheumatologist could attribute the symptoms to competing differential diagnoses, such as degenerative spine disease (n=15), osteoarthritis (n=3) and overuse injury (n=2). Patients with CD suffered from significantly more MSK symptoms, particularly joint pain, compared to UC patients (67% vs. 40%, and 65% vs. 30%, respectively, p-values=0.01).
Clinical evaluation revealed arthritis in 24(29%) patients and enthesitis in 50(61%). The small peripheral joints were predominantly involved in an oligo- and polyarticular pattern. Achilles tendon insertions were the most frequently affected entheses; enthesitis was asymptomatic in 72% of the cases. The Assessment of Spondyloarthritis international Society (ASAS) classification criteria for peripheral spondyloarthritis were met in 44% of patients; and for fibromyalgia in 8.5% of patients, all with clinically active IBD. Being female was associated with more frequent musculoskeletal symptoms and clinical findings. No other differences in clinical findings were observed between UC and CD, nor between those with active and inactive IBD. Patients with MSK involvement had significantly lower EQ-5D scores than those without.

Conclusion
Two-thirds of IBD patients scheduled for their first biological treatment exhibited musculoskeletal involvement, sometimes asymptomatically. Axial and peripheral symptoms were equally common. A multidisciplinary approach is crucial for early detection and integrated treatment aiming for remission in all disease domains to improve patients’ QoL.