bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0751 The effects of high and low emulsifier diets in active Crohn’s disease: A pilot double-blinded randomised feeding trial
Authors: Fitzpatrick J A , Gibson P R , Taylor K M , Anderson E J , Friedman A B , Ardalan Z S , Smith R L , Halmos E P 
Published: January 2025

Abstract

Background
Preclinical studies implicate dietary emulsifiers as detrimental to patients with Crohn’s disease. We aimed to examine the effect of high- and low-emulsifiers diets on intestinal inflammation in adults with ileal Crohn’s disease.

Methods
In a pilot double-blinded, randomized, controlled feeding study, patients with symptomatic and sonographically active Crohn’s disease with ileal involvement on stable medical therapy were randomized to received four weeks of an isocaloric high (HED) or low (LED) emulsifier diet modelled on Australian healthy eating guidelines. Evaluation of objective markers (faecal calprotectin, C-reactive protein, sonographic indices), clinical disease activity (Harvey Bradshaw Index), body composition (waist circumference, visceral adipose tissue via bioimpedance and quantitative muscle ultrasound) and quality of life were measured at baseline and at study completion.

Results
Of 116 patients screened, 24, mean age 37 (95% CI 32, 41) years, 12 male, were randomized. Five participants (2 HED, 3 LED) withdrew due to increased gastrointestinal symptoms. Dietary adherence was excellent. On ultrasound, IBUS-SAS fell from 51 (35, 68) to 33 (15, 51) on HED (p=0.014) and from 57 (38, 76) to 44 (29, 59) on LED (p=0.010) with no difference between diets (p=0.28). C-reactive protein and faecal calprotectin did not change overall. 9/12 on HED and 7/12 on LED entered clinical remission (Harvey Bradshaw Index ≤4). Quality of life improved on both diets (both p&lt;0.003) as did fatigue (both p≤0.050). The HED and LED reduced weight by 2.2 [1.3,3.2] kg (p=0.009), waist circumference by 4% (p&lt;0.001) and visceral adipose tissue by 16% (p&lt;0.001) without a change of quantitative muscle ultrasound (p=0.78).There was no difference in any outcomes between the diets.

Conclusion
Emulsifiers in the food supply have no effect on intestinal inflammation in patients with active ileal Crohn’s disease, but a diet that follows healthy eating principles was associated with reduction of intestinal inflammation, clinical remission, improved quality of life and fatigue scores with reduction of visceral adipose tissue whilst maintaining lean muscle mass. Australian New Zealand Clinical Trials Registry (ACTRN12619000980134).
P0762 Early ustekinumab use improves clinical outcomes in biologic-naive Crohn’s Disease patients: A retrospective multicenter cohort study in Taiwan
Authors: Chang Y C , Chuang C H , Huang T Y , Chung C S , Kuo C J , Pan Y B , Sheng W J , Lin S H , Le P H 
Published: January 2025

Abstract

Background
Crohn’s disease (CD) is a progressive condition, and early treatment with infliximab combined with an immunosuppressant within six months has been shown to improve clinical outcomes. However, the impact of early ustekinumab (UST) use in biologic-naïve CD patients remains unclear. This study aims to address this gap by evaluating the clinical outcomes of early UST intervention in such patients.

Methods
In this retrospective cohort study, we included biologic-naïve CD patients treated with UST, with a clinical follow-up period of at least six months, from October 2020 to January 2024 across four medical centers in Taiwan. Patients who received UST within six months of CD diagnosis were categorized into the early-UST group, while the rest formed the control group. The primary endpoint was the improvement of clinical outcomes at six months.

Results
A total of 60 biologic-naïve CD patients were enrolled. Baseline characteristics were comparable between the two groups. At six months, the early-UST group (n=24) demonstrated significantly lower Crohn’s Disease Activity Index (CDAI) scores (73.03 vs. 112.42, p=0.038), lower Harvey-Bradshaw Index (HBI) scores (1.46±1.69 vs. 2.72±2.17, p=0.020), higher rates of clinical remission (91.7% vs. 63.9%, p=0.017), and higher rates of steroid-free clinical remission (79.2% vs. 50.0%, p=0.031) compared to the control group (n=36). Extending the evaluation to one year, the early-UST group continued to show lower CDAI scores (39.94 vs. 91.48, p=0.005). Adverse event rates were similar between the two groups.

Conclusion
Initiating ustekinumab within six months of CD diagnosis is associated with improved clinical outcomes and enhanced quality of life in biologic-naïve Crohn’s disease patients.
P0769 Impact of Nurse-Led Day Case Management of Acute Inflammatory Bowel Disease Flares on Admissions to Hospital
Authors: Lloyd-Ford G , Bowler N , Lewis A , Gordon M , Haviland S , Hill J 
Published: January 2025

Abstract

Background
To assess the impact on admissions to hospital when patients are treated on a nurse led day case unit for inflammatory bowel disease flares over a 1-year period.

Methods
During the COVID 19 pandemic, patients were reluctant to be admitted to hospital and where possible wanted care as day case patients. This has continued due to the pressures of the acute gastroenterology hospital ward and demand for bed spaces. The Gastroenterology and Medical Ambulatory Care Unit allowed for rapid assessment, diagnosis, and treatment with appropriate safety netting for this group of patients. 63 patients where identified. Those who needed admission were advised to do so based on presenting symptoms and response to treatment.

Data Collection and Results
63 patients presented to the Unit with a pre-existing diagnosis of IBD, 88% (n=55) where Ulcerative Colitis and 12% (n=8) Crohns Disease and had failed to suppress the flare with oral steroid and topical therapies. Symptoms varied from loose stools, urgency, bleeding, pain, lethargic and dehydration, common signs of an IBD flare, (Sturm and White 2019). Patients were offered admission, however all wanted to be treated as a day case on the proviso that if needed admission would be arranged. The aim was to give the same initial flare treatment as would be received on the ward. Hydrocortisone 200mg IV am followed by 500mls of IV fluids and a further Hydrocortisone 200mg IV in the pm. Patients were also supported by the team on the Unit during their flare allowing perspective to be placed on their disease and management as a whole. Open dialogue was held with the Unit and IBD nursing teams further enhancing patient care. Bloods and faecal calprotectin were checked as a baseline for our interventions.

Results
Of the 63 only 9.5% (n=6) did not respond and needed admission.

Conclusion: Outcome and Recommendations
Overall patients were happy with and responded to treatment in the day case unit. This saved at least 171 bed days in hospital based on a minimum of 3 days per patient treated. Being able to access support as well as treatment worked well. Day case assessment treatment and care has a clear future for this group of patients providing patients are selected appropriately.

References
Sturm A and White L (2019) Inflammatory Bowel Disease Nursing Manual. Springer
P0770 Assessing the level of anxiety among patients attending an IBD surveillance
Authors: White L , Sundramoorthi R , Mohan S , Johnston E 
Published: January 2025

Abstract

Background
The aim of the project was to assess the level of anxiety among patients attending an IBD surveillance colonoscopy as well as their views on the bowel preparation, their understanding of the purpose of the procedure and their perceived risk of colorectal cancer. We hypothesised that there is a link between the anxious state and the perceived risk of colon cancer.

Methods
Questionnaires were conducted immediately pre-endoscopy. Anxiety was assessed quantitatively using the State Trait Anxiety Inventory (STAI)(1) as well as through qualitative feedback. Tolerance of bowel preparation was also assessed through a combination of qualitative and quantitative assessment, including a visual analogue scale (VAS 0=worst to 100=best). Perceived risk of colorectal cancer in the next ten years was assessed using a visual analogue scale (VAS 0 to 100% risk).

Results
A total of 42 patients participated. 38% of respondents reported feeling anxious about their colonoscopy however the mean STAI score for the cohort was relatively low (STAI score 34 SD=11.6) being comparable to normal working adults (mean STAI=35)(1). 45% reported anxiety regarding bowel preparation and 33% felt they tolerated it poorly (VAS ≤50). 100% of respondents reported that the purpose of surveillance had been explained to them, however only 10% of respondents mentioned the word "cancer" when asked to clarify their understanding of this. The range of cancer risk perception over the next ten years was 0% to 70% risk, and the median was 0.9% (SD=24). There was no correlation between STAI scores and perceived cancer risk (Pearson correlation coefficient (r) = 0.43).

Conclusion
IBD patients attending surveillance colonoscopy have low levels of anxiety and lower than those attending colorectal cancer screening (mean STAI=45)(2). There is a wide range of perceived colorectal cancer risk and our results suggest there is an opportunity for patient education on the purpose of surveillance and estimates of their risk of colorectal cancer. There is no correlation between anxiety and perceived cancer risk in our cohort. Bowel preparation is a common cause of anxiety and a third of patients tolerate it poorly. Approaches to address this would have a significant benefit on patient experience in IBD surveillance endoscopy.

References
(1)Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press
(2)Shaikh AA, Hussain SM, Rahn S, Desilets DJ. Effect of an educational pamphlet on colon cancer screening: a randomized, prospective trial. Eur J Gastroenterol Hepatol. 2010 Apr;22(4):444-9. doi: 10.1097/MEG.0b013e328333fca6. PMID: 19940781.
P0773 Real-World Application of Intestinal Ultrasound for Monitoring Ulcerative Colitis in South Korea
Authors: Kim K W , Jeong J , Noh H D , Lee H J , Koh S J , Kang H W , Im J P , Kim B G , Kim J S , Lee K L , Kim J W 
Published: January 2025

Abstract

Background
Intestinal ultrasound (IUS) has emerged as a valuable tool for monitoring ulcerative colitis (UC).1 However, a few studies have explored the practical application of IUS in UC within Asian countries, particularly South Korea.

Methods
We conducted a cross-sectional study at two academic medical center involving patients with UC who received IUS and simultaneous clinical exams including endoscopy. The primary endpoint was to assess the predictive accuracy of IUS for disease activity, defined by the Mayo score with endoscopic disease activity by Mayo endoscopic subscore (MES). IUS parameters were evaluated with Milan ultrasound criteria (MUC) and bowel wall thickening (BWT).

Results
A total of 81 patients were enrolled in this study. The numbers of low- and high-MUC groups were 35 and 46, respectively. The median ages were 40 and 43.5 years old, respectively. The proportion of males in each group was 60% and 76%. There were no significant differences between the two groups in terms of body mass index, smoking status, age at disease onset, disease duration, or current medication such as 5-aminosalicylic acid, steroid, immunomodulator, and advanced therapies.
Compared with the low- and high-MUC groups, biochemical parameters with C-reactive protein and fecal calprotectin were significantly different {median with interquartile range: 0.05 (0.02-0.13) vs. 0.10 (0.07-0.65), p = 0.043; 99.00 (98.50-372.25) vs. 496.00 (90.00-1870.50), p &lt; 0.001, respectively}. Disease activities as Mayo score, partial Mayo subscore, and endoscopic Mayo subscore also showed significantly differences between the two groups {2 (1-5) vs. 5 (4-8), p &lt; 0.001; 2 (0-3) vs. 3 (2-6), p &lt; 0.001; 1 (0-2) vs. 2 (1-2), p &lt; 0.001, respectively}.
Analyzing the predictive accuracy of IUS parameters and biochemical markers for disease activity measured by the Mayo score and MES, revealed that BWT and MUC were comparable to biochemical markers. The cut-off values determined using Youden’s index for predicting clinical and endoscopic remission in MUC were 5.7 and 7.1, respectively, while those for BWT were 4.0 and 5.0.

Conclusion
IUS parameters in the patients with UC demonstrated trends similar to classic markers and provided comparable predictions of clinical and endoscopic disease activity. Although the cut-off values of IUS parameters related to disease activity appeared to differ slightly from those reported in Western studies, further prospective research exploring the relationship between IUS findings and various clinical courses of UC is needed to establish robust evidence in Asia, particularly South Korea.

References
1.Allocca M, Dell'Avalle C, Furfaro F, et al. Early Intestinal Ultrasound Predicts Long-Term Endoscopic Response to Biologics in Ulcerative Colitis. J Crohns Colitis. 2023;17(10):1579-1586.
P0775 The IBD Specialist Pharmacist actively contributes to the IBD clinical team, providing significant benefits and enhancements to patient care
Authors: Garcia Fuertes F , Lee H , Sundar N , Shirazi-Nejad A , Bullas D , Hyde L , Gray R , Atkinson R 
Published: January 2025

Abstract

Background
The prevalence of IBD is rising globally, and in the UK has risen from 328/100,000 in the 90s to 970/100,000 in 2017 [1]. This, together with a rapidly expanding and more complicated range of therapeutic options has necessitated the need for proactive management, intervention and monitoring of patients. Through a combination of Physician, Nurse and Pharmacist clinics, we provide a comprehensive IBD outpatient service to meet these requirements in line with UK IBD standards [2]. Our pharmacist-led clinic prescribes initial treatments (JAK inhibitors, immunomodulators and ongoing prescribing of biologic therapy infliximab and vedolizumab) to ensure effective close monitoring, correct dose adjustments, therapeutic drug monitoring and early identification of possible side effects to the new treatments.

Methods
The study aims to identify all referrals and clinical outcomes to the pharmacist clinic during the period between January to August 2024. All patients are appointed from our weekly IBD Multidisciplinary team (MDT) meeting. The data is obtained from the IBD MDT log.

Results
During the period analysed of the pharmacist clinic activity, the drug distribution was as follows: JAK inhibitor 35.9% (14 patients), thiopurines monotherapy 25.6% (10 patients) and combination therapy anti-TNF + immunomodulators and allopurinol if shunting 38.5% (15 patients). The total number of patients reviewed during this period was 39, accumulating a total of 289 appointments which equates to an average 7.4 appointments per patient over this period. During the analysed period 234 cases were discussed at IBD MDT. 39 cases (16.7%) were referred to the pharmacist to conduct treatment initiation and drug monitoring. The pharmacist referred 21 cases (7.27%) to IBD MDT for new discussion resulting in 26 agreed-upon outcomes by the IBD team as detailed below. Some patient reviewed had more than one outcome.

Conclusion
Two specialist IBD pharmacists (Whole Time Equivalent (WTE) 0.6) are the essential part of the IBD multidisciplinary team, providing early identification of treatment failure or serious adverse effects, and closer monitoring of patients with monthly appointment on average. The 26 clinical outcomes demonstrated an effective model for more personalised medicine. Therefore, it integrates an additional pathway for patients' management. The model of care aligns with UK national recommendations and showcases the positive impact that specialist pharmacists as non-medical prescribers can assist in over-stretched conventional IBD services.

References
1.King D, et al., Changing patterns in the epidemiology and outcomes of inflammatory bowel disease in the United Kingdom: 2000–2018. Aliment Pharmacol Ther. 2020;51(10):922–34
2.IBD UK. IBD standards 2019. www.IBDUK.org (accessed August 2024).
Table 1. Outcomes of the referrals submitted by pharmacist at IBD MDT
P0777 Sonographic transmural induction outcomes across advanced therapies in Crohn’s Disease
Authors: Smyth M , Dolinger M , Dubinsky M 
Published: January 2025

Abstract

Background
Intestinal ultrasound (IUS) is increasingly being used to evaluate induction efficacy in both clinical practice and clinical trials. The differential healing rates across advanced therapies (AT) remains unknown. We aimed to quantify the rates of early post induction IUS transmural (TM) remission and response across AT in Crohn’s Disease (CD).

Methods
Single center retrospective review of patients with CD initiating AT who underwent IUS pre and post induction and had disease activity and biomarker data available. Patients with normal pre-AT IUS or post op were excluded. Primary outcome was post-induction TM response of the most affected segment (segmental response compared to baseline: &gt;25% decrease in bowel wall thickness (BWT), absolute BWT decrease &gt;2mm, or absolute decrease &gt;1mm with ≥1-point improvement in Modified Limberg Score (MLS)). Secondary outcomes were segmental and complete (all bowel segments) TM remission (BWT ≤ 3.0mm and MLS 0). Descriptive statistics summarized data (median [IQR]), univariate and multivariate analysis tested associations.

Results
101 patients (53% female, age 17.4 [15.0-21.1] years); disease duration 0.80 years [0.17-3.96]; post induction IUS performed 78 days [56-102] on AT (44% anti-TNF, 53% AT naïve). Segmental TM induction response across all AT was 63%. Segmental and complete TM remission was 36% and 35%, respectively (figure). Complete TM remission was seen at a higher rate with upadacitinib (UPA) than ustekinumab (UST) (p=0.009) and risankizumab (RZB) (p=0.032) but not anti-TNF (NS). Patients with severe IUS inflammation (MLS 3) at baseline were less likely to achieve TM remission independent of AT (aOR 0.21 [0.059-0.76]). Complete TM remission was independently associated with infliximab (IFX) (aOR 11.7 [2.2-62.4]) and UPA (aOR 5.22 [1.0-27.2]). Rates of segmental TM response were greater for colonic than ileal disease in UST/RZB (88% vs 47%, p=0.038), but no different in TNF/UPA. Patients started on UST/RZB after &gt;1 failed prior AT had a trend for lower rates of TM outcomes (NS), while number of prior therapies had no impact on UPA response or remission rates.

Conclusion
Post-induction TM outcomes are achievable across AT: 2/3 of patients achieve segmental TM response and 1/3 achieve complete TM remission. This data, combined with the high correlation between IUS and endoscopy, suggests that IUS response could be considered as a clinical trial endpoint.
P0779 Resting-state MRI data fusion reveals distinct disease-state dependent patterns for fatigue, depression and anxiety in Crohn’s Disease
Authors: Thomann A , Schmitgen M , Stephan J C , Knoedler L L , Thomann P A , Ebert M P , Szabo K , Reindl W , Wolf R C 
Published: January 2025

Abstract

Background
Many persons with Crohn’s Disease (CD) suffer from symptoms not directly linked to the gastrointestinal tract. Among these extraintestinal symptoms (EIS), fatigue, depression and anxiety are the most prevalent, especially during active disease. Growing evidence links disturbed brain-gut-interactions to EIS. We examined intrinsic brain activity in patients with active and remitted CD using a multivariate MRI data fusion approach, evaluated the relationship of functional joint components with EIS and inflammatory markers, and explored the components’ associated neurotransmitter systems.

Methods
Patients (n=71) with active (aCD, n=47) or remitted disease (rCD, n=24) and healthy controls (HC, n=35) underwent resting-state functional magnetic resonance imaging and completed questionnaires for symptoms of fatigue, depression and anxiety. Patients provided stool samples for faecal calprotectin (fC) analysis. A joint independent component analysis (jICA) of intrinsic brain function (ALFF and ReHo) was conducted to detect convergent neural activity patterns in functionally distinct neural networks (components) that differ between aCD, rCD, and HC. Functional connectivity strength (FCS) in networks with disease state-dependent changes were correlated with EIS and fC, and we performed cross-modal correlations between MRI components and specific PET/SPECT receptor probability maps.

Results
JICA identified two components that differed between aCD and rCD. One showed a pattern of predominantly orbitofrontal-cingulate cortex connectivity, with lower FCS in aCD vs rCD and HC (Fig. 1A top). This component related to serotonergic and dopaminergic transmission with significant associations between FCS and fatigue as well as fC (Fig. 1B). The other component revealed lower FCS in a sensorimotor network (Fig. 1A middle) with predominantly dopaminergic neurotransmission in rCD vs aCD and HC that was associated with anxiety and depression (Fig. 1B). A third component, predominantly involving cortical midline regions attributed to the so-called “default mode network” was found to differ between HC and CD irrespective of disease status (Fig. 1A bottom). Here, FCS was not associated with EIS (Fig 1B).

Conclusion
Functional connectivity of distinct resting-state networks differs between disease states and differentially relates to EIS. A sensorimotor network is associated with symptoms of depression and anxiety and dopaminergic neurotransmission, while an affective network correlates with fatigue and serotonergic/dopaminergic neurotransmission. The latter shows the relationship with fatigue only in rCD, suggesting a contribution of disturbed brain-gut-interactions especially in fatigue during remission.