bluuebunny/crossref_metadata_2025_split huggingface dataset:
P693 Willingness and hesitancy to the telemedicine in patients with inflammatory bowel disease during COVID-19 outbreak. Preliminary results of a survey in an Italian IBD Center
Authors: Bossa F , Guerra M , Carparelli S , Antonella M , Terracciano F , Costantino A , Caprioli F , Valvano M R , Martino G , Nardella M , Perri F 
Published: January 2022

Abstract

Background
Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services.Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services.
The aim of this survey was to explore the willingness and hesitancy of patients with inflammatory bowel disease (IBD) to the use of telemedicine during COVD-19 outbreak.

Methods
A paper-and-pencil questionnaire was proposed to all consecutive patients observed at our tertiary IBD center in San Giovanni Rotondo (Italy) from February to May 2021. The survey investigated 20 items that can be grouped into 5 areas: socio-demographic data, clinical data, informatics competence, devices and network utilized for the internet connection, attitude to the telemedicine, and the impact of COVID-19 pandemic.

Results
A total of 156 patients completed the questionnaire (100 males). One hundred forthy-three patients (91.7%) were under 65 years and only 15 (9.6%) were graduates. Forthy-seven patients (30%) were single, 101 married (65%). Eighteen patients (11.5%) felt they had no IT skills. Eight patients (5.1%) had a previous experience of telemedicine. One hundred twenty-three patients (78.8%) consider the support of telemedicine useful for the management of their pathology and 134 (85.9%) would like the Center where they are followed up to have the possibility of offering a telemedicine service. One hundred three patients (66.0%) would like to have a teleconsultation with figures other than the Gastroenterologist. Ninety-seven patients (62.2%) agree that the ongoing coronavirus pandemic has a major impact on the need to implement telemedicine. Regarding the confidence with telemedicine, 106 patients (67.9%) were partially or totally agreeing telemedicine can properly resolve health problems, and 98 (62.8%) agree that technologies guarantee the privacy of the health data. One hundred twenty-five patients (80%) agree that telemedicine should be developed independently of the pandemic, however only 48 patients (31%) believe that telemedicine guarantee the same level of assistance of visit in presence.

Conclusion
Italian IBD patients showed a positive attitude towards telemedicine and consider that useful for the management of their disease. The majority of patients would like the center where they are followed up offering a telemedicine service, regardless of the ongoing pandemic. However only one third of patients believe that telemedicine can offer the same level of assistance of in-presence visit.
P697 Examining the regulatory role of epigenetic and transcriptomic alterations in anti-TNFα treatment response and disease progression in patients with Ulcerative Colitis
Authors: Lawal O , Stack R , Ciara E , Tosetto M , McDonnell C , Rodriguez-Sosa A , Yochum G , Koltun W , Boland K , Sheahan K , Doherty G , Das S 
Published: January 2022

Abstract

Background
Ulcerative colitis (UC) is a chronic inflammatory condition characterized by significant morbidity and escalating economic costs. Effective patient management is severely hampered by a lack of unambiguous molecular biomarkers that can predict response to anti-TNFα treatment such and/or disease progression. While, both genetic and epigenetic factors have been reported to impact UC pathogenesis, their role in regulating disease progression and treatment response remains unclear.

Methods
Here, we applied methyl-capture sequencing and RNAsequencing to mucosal biopsies derived from clinical cohorts of patients with mild-to-moderate and severe UC with the aim of identifying various regulatory factors that orchestrate treatment response and disease severity in these patients.

Results
First, differential gene expression analysis between responders and non-responders to infliximab and vedolizumab (anti-TNFα) enabled identification of disease-associated genes that were either up- or down-regulated in responders to both these anti-TNFα agents. Next, upstream analysis of these differentially expressed genes revealed that both up- and downregulated genes in responders are intricately regulated by “master regulators” (MRs) including chemokine ligands and receptors such as FGFR2 and IL8 respectively. Moreover, we show that these MRs play a pivotal role in regulating gene expression through a complex signalling network mediated by transcription factors (TFs) such as FYN and ICAM1. These results for the first time provide evidence of impact of MRs and TFs on genes involved in differential response to anti-TNFα agents in patients with UC. In parallel, targeted DNA methylation profiling of mucosal biopsies derived from mild-to-moderate (n=85) and severe UC (n=33) patients enabled identification of a wide-spread DNA methylation alterations at regulatory regions such as promoters and enhancers. Moreover, we identified distinct significant methylation differences between UC patients who progress in their disease course leading to treatment with anti-TNFα/immunodulators agents vs. patients who are on 5’Asa maintenance treatment. Indeed, similar differences was also observed between responders and non-responders of anti-TNFαagents.

Conclusion
Taken together, our preliminary results for the first time highlight the regulatory role of master regulator-mediated signalling networks involving transcription factors that regulate gene expression underpinning response to anti-TNFa in UC patients. In parallel, these results identify specific DNA methylation alterations that impact treatment response and disease severity and therefore could ultimately enact as predictive biomarkers in UC.
P703 Gut bacteria composition and familiality echo Inflammatory Bowel Disease type and pathological spectrum
Authors: Martinez-Gili L , Gordon H , Blad W , McDonald J A K , Holmes E , Marchesi J R , Harbord M 
Published: January 2022

Abstract

Background
Inflammatory bowel disease (IBD) aetiology encompasses genetic and environmental factors. Twin studies provide valuable insights to the familial degree (shared genetics and environment) of observed phenotypes. We characterised the gut bacterial composition of twins with IBD to find taxa associated with disease and estimate their familiality.

Methods
Faecal samples were collected from 88 monozygotic (MZ) and dizygotic (DZ) twin pairs concordant or discordant for Crohn’s disease (CD; 26 MZ; 19 DZ) or ulcerative colitis (UC; 16 MZ; 27 DZ). The 16S rRNA gene was sequenced and amplicon sequence variants (ASV) generated. ANCOM software was used to assess differences in IBD vs. non-IBD, stratifying by disease type (CD/UC) and adjusting for age, gender and smoking. Twin pair and zygosity were added as random effects to estimate familiality, defined as percentage of variation due to common environment and genetics. IBD-affected twins were used for differences in disease location or treatment. Participants reporting antibiotic/probiotic treatment within the last 3 months or with a stoma/pouch were not included. In UC, surgery-naive patients were compared to an excluded subset who underwent ileostomy or pouch surgery without any recent antibiotic courses.

Results
Disease concordance in MZ twins was higher in CD (54%) than UC (19%). Alpha diversity was lower in CD, but not UC, and in ileostomy and pouch vs. surgery-naive UC. Principal component analysis showed that CD-affected twins clustered apart from non-IBD ones (Figure 1A). Familiality was lower in CD, with 5% of ASVs having familiality &gt; 50%, compared to 17% in UC (Figure 1B). Two Lachnospirales order ASVs were less abundant in UC, while 15 ASVs from Clostridia, Bacteroidia, Bacilli and Coriobacteriia classes differentiated CD from non-IBD. Firmicutes were higher in CD (β= 0.95; 95%CI [0.34,1.56]), while no phyla changed in UC. Veillonella, Barnesiella, Faecalimonas and Holdemania genera had opposite trends in ileocolonic or colonic CD vs. ileal, and two Clostridia ASVs were lower in extensive and left-sided UC. Gemmiger and Butyricicoccus_A genera were reduced in UC patients taking aminosalicylates compared to untreated. No treatment differences were found in CD. Patescibacteria was higher in ileostomy and Verrucomicrobiota in pouch, while Bacteroidota and Firmicutes_A were lower in both surgeries.

Conclusion
Despite higher disease concordance, gut bacteria familiality in CD was lower than UC, indicating that bacterial composition is an information-rich matrix which captures the heterogeneity of IBD clinical manifestations. Accordingly, we found taxonomic changes specific to IBD presence, but also location, medication, or surgery.
P708 Ileal involvement defined by Montreal classification in Crohn’s disease is associated with a distinct microbial composition in ileal and colonic mucosa
Authors: Hernandez-Rocha C , Nayeri S , Turpin W , Borowski K , Stempak J , Silverberg M S 
Published: January 2022

Abstract

Background
The Montreal classification of inflammatory bowel disease (IBD) recognizes distinct subgroups based on location of disease, age at onset and behaviour for Crohn’s disease (CD) and extent in ulcerative colitis (UC). CD with ileal involvement is in part genetically determined and tends to progress to surgery and to be more refractory to medical therapy compared to colonic disease location. We investigated the association of different aspects of the Montreal classification with the ileal and colonic mucosa-associated microbiota.

Methods
Healthy control (HC) and IBD patients underwent colonoscopy with biopsy samples taken from terminal ileum, ascending and sigmoid colon. Mucosal 16s rRNA gene profiling was analysed and an amplicon sequence variant table was generated and normalized. Patients with prior intestinal resection, IBD-unclassified and recent antibiotic exposure were excluded. Endoscopic activity was defined as a segmental Mayo endoscopic subscore &gt; 0 in UC and a simple endoscopic score &gt; 2 in CD. Blood samples were drawn for genotyping and a weighted genetic risk score (GRS) was built based on 169 IBD risk variants. Pooled ileal and colonic samples were analysed for taxonomic differential abundance (DA) among the variables of the Montreal classification using a linear mixed-effects model (MaAsLin2) with age, sex, biopsy site, endoscopic activity and GRS as covariates. P-values were corrected for false discovery rate (FDR) and &lt; 5% was considered significant.

Results
A total of 546 biopsy samples from 201 IBD patients and 48 HC were analysed. The characteristics of the cohort and Montreal classification are depicted in the Table. At colonoscopy 168 samples (31.4%) showed endoscopic activity. The multivariate analysis revealed that the genera Agathobacter and Faecalibacterium, as well as the family Ruminococacceae and the order Oscillospirales were significantly reduced in CD with ileal involvement (L1+L3) when compared to either isolated colonic CD (L2), UC (any extent) and HC independent of age, sex, endoscopic activity, biopsy site, and GRS (Figure). Samples from UC and isolated colonic CD patients did not show differences in their microbial profile irrespective of biopsy site. No differences in DA were observed in subgroups based on age at onset and disease behaviour in CD or extent in UC. GRS was not associated with microbial composition.

Conclusion
These data suggest that CD with ileal involvement (Montreal L1+L3) is a major determinant of the tissue-associated microbial composition in both ileal and colonic mucosa irrespective of variables such as endoscopic activity and GRS. The reduction of several beneficial microbes in CD with ileal involvement might partially explain the more progressive phenotype in such patients.
P720 Similar risk of infection with SARS-CoV-2 in immunocompromised and immunocompetent patients with inflammatory bowel disease and healthy controls
Authors: Kante B , Vuyyuru S K , Gupta R , Dwivedi T , Kumar P , Mundhra S , Golla R , Virmani S , Verma M , Makharia G , Ahuja V , Kedia S 
Published: January 2022

Abstract

Background
The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in immunocompromised and immunocompetent IBD patients and healthy controls.

Methods
Patients with IBD under follow-up at the IBD clinic, All India Institute of Medical Sciences, New Delhi, were included. After obtaining informed consent, patients underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Seimens kit IgG against antigen S1RBD) and information on demography, drug history, past history of COVID infection and vaccination status were noted. Patients with IBD on 5-aminosalicylic acid or not on any treatment were considered immunocompetent and those who had received steroids, thiopurines or methotrexate within 6 months of sample collection were considered immunocompromised.

Results
235 patients (51.9%-males; mean age at enrolment-38.7±12.4 years; median disease duration-60 months [IQR:36–120]) (UC-69.4%, CD-28.9%, IBDU-1.7%) and 73 healthy controls (HCs- mean age-39.6± 10.9 years, 79% males) were enrolled from July 2020 - April 2021 (Table1). 128 (54.5%) patients were immunocompromised and 107 were immunocompetent (treatment details: 5 ASA-72.3%, steroids-15.3%, Thiopurines-40%, methotrexate-2.6%). Seventy-four (31.5%) patients were positive for IgG antibody against SARS CoV2, 2 patients (0.9%) had previous history of COVID infection and none received COVID vaccine. Seroprevalence rates between immunocompromised and immunocompetent patients with IBD and healthy controls was similar (28.1% vs 36% vs 28%, p&gt;0.05) (Figure1). Demographic and disease characteristics such as age, gender, disease type, disease activity in last 6 months, disease duration and medication use was similar between patients with positive and negative serology (Table2). There was progressive increase in seroprevalence from July 2020 to April 2021

Conclusion
Upto 1/3rd patients with IBD were seropositive for IgG SARS Cov2 antibody indicating asymptomatic COVID-19 infection. The seroprevalence was similar to healthy controls and was not different between immunocompromised and immunocompetent patients with IBD.
N11 Development of a young person clinic for 16-24-year-olds with Inflammatory Bowel Disease (IBD), using a multidisciplinary team (MDT) approach
Authors: Hamzawi M , Hickey Y , Brannick S , Brett Kilmurray O , Jones F , Sheridan J , Cullen G 
Published: January 2022

Abstract

Background
In Ireland, the transition process is ad hoc with no formal guidelines on how to conduct transition clinics. This nurse-led project, aimed to develop a specific young person clinic for adolescents and provide information to adolescents and their families on the service they were joining, before their first clinic visit, subsequently reducing anxiety and improving outcomes.
Providing the right care for young people with IBD, in the right place, at the right time, where the patient is a priority, is the end goal.

Methods
The successful implementation of this project is due to the collaborative work of a multidisciplinary team using the Health Service Executive (HSE), Peoples Needs Defining Change Guide (2018). This change model provides clear definitive steps to Define, Design and Deliver innovative projects.
The model was applied as follows:

Define
Raise awareness of the need for adolescent clinic
Activate a core change team
Develop a vision in line with the organisational culture

Design
Propose a care pathway for adolescents including transition.
Design an informative ‘Welcome Booklet’
Arrange Virtual Meet and Greet (due to Covid restrictions)

Deliver
Open communication with all relevant stakeholders
Determine a time suitable for recurring adolescent clinic
Seek input from patients, colleagues and communication team to develop an informative ‘Welcome Booklet’

Results
The CIPP evaluation model, Context, Input, Process and Product, complimented this change model as formative evaluation throughout. This ensured the change process was streamlined with the values and vision of all stakeholders involved.
Context –SWOT analyses was undertaken, and Goals defined
Input – Strategy was defined and stakeholder analyses
Process –Monthly MDT meetings, design model of care, welcome booklet. Plan virtual introductory meetings due to Covid unable to meet face to face in the paediatric hospital
Product – Dedicated recurring clinic time for 16–24-year-olds with IBD to include transition clinics.
100% of parents and 80% of adolescents found the welcome booklet informative and useful.
100% both adolescents and parents found the introductory WebEx meeting beneficial.
Commenced RCT to look at best format for transition clinics going forward

Conclusion
(HSE), Peoples Needs Defining Change Guide (2018) provided the essential toolkit to ensure leadership, teamwork, the importance of stakeholders while keeping the patient central to all decisions made in developing young person’s clinics for 16-24-year-olds with IBD.
N12 Systematic Review: The role of psychological stress in Inflammatory Bowel Disease
Authors: Black J , Sweeney L , Yuan Y , Singh H , Norton C , Czuber-Dochan W 
Published: January 2022

Abstract

Background
Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in Inflammatory Bowel Disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured. This study aims to explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD.

Methods
A systematic review was performed. Medline, CINAHL, Embase, and PsycInfo databases were searched. Prospective studies recruiting people with IBD 16 years old or over and measuring psychological stress or distress were included.

Results
Thirty-eight studies, from 41 reports, with 4757 people with IBD were included in the review. Studies used thirty-six different instruments to measure stress. Perceived stress was the most frequently studied concept and was found to precede IBD disease exacerbation. Depression and helplessness were positively associated with perceived stress, while social support, resilience, and quality of life were negatively associated. Cognitive-behavioural group programmes may reduce stress and education, stress management, and exercise and other group programmes may reduce disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits.

Conclusion
Psychological stress appears to precede IBD disease exacerbation, though what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research is needed to examine the differential effects of stress on disease subtypes and IBD in flare and remission.
N16 ‘Same storm, different boat’… Exploring the impact of the COVID-19 pandemic on patients with Inflammatory Bowel Disease, with or without shielding: a qualitative study
Authors: Kemp K , Avery P , Bryant R , Cross A , Danter K , Kneebone A , Morris D , Walker A , Whitley L , Dibley L 
Published: January 2022

Abstract

Background
During the Covid-19 pandemic, patients with Inflammatory Bowel Disese (IBD) were advised about shielding based on clinical risk assessment. We explored experiences of IBD patients who did or did not shield during three UK lockdowns.

Methods
Participants aged 18 years+ with a confirmed diagnosis of Crohn’s disease, Ulcerative Colitis or IBD-Unclassified, who had shielded or not during any lockdown period were recruited from Crohn’s and Colitis UK. Semi-structured online or phone interviews (captured February-May 2021) were audio-recorded, transcribed professionally, and analysed using thematic analysis.

Results
Of 43 participants, 24 shielded; median age 38 years (19–63 years); 27 (62.7%) females; diagnosed with Crohn’s Colitis (n=2), Crohn’s disease (n=21), Ulcerative colitis (n=18) and IBD-Unclassified (n=2). Median disease duration 13 years (0.6–36 years). Participants were assessed as high (n-=10), moderate (n=23) and low (n=10) risk. Four main themes emerged: Vulnerability and Risk; IBD Preparedness; The Two Faces of Janus and Transitions.

Vulnerability and Risk
The ‘Clinically Extremely Vulnerable’ label caused alarm, despite bringing benefits. Conflicting information caused confusion; some made their own decision about risk which did not always match official advice. Participants felt vulnerable to higher risk caused by others’ behaviour. Some feared catching Covid.

IBD Preparedness
Living with IBD prepared participants for shielding/social distancing. Many felt others now appreciated their usual world of periods of isolation and missing out on social events. Some realised the need to take their IBD more seriously.

The Two Faces of Janus
The pandemic brought benefits and challenges to most participants. Working/studying from home often impacted positively on symptoms such as urgency and fatigue, as work and travel-related stresses eased. Loss of physical social contact with others was very distressing; many adopted new wellbeing activities to overcome social isolation. Few found the pandemic experience wholly positive.

Transitions
the experience of lockdown changed over time, as did shielding patterns. The easing of restrictions (March-June 2021) left shielding and non-shielding participants feeling confused, since they felt the risk remained. Some participants continued to shield or be socially distant, often mistrusting others to behave responsibly.

Conclusion
The pandemic had positive and negative effects for shielding and non-shielding participants alike. Adherence to Government shielding and/or social distancing guidelines was threatened by rising concerns about mental health and wellbeing. Any patient, regardless of official risk status, may need support to re-integrate socially.