bluuebunny/crossref_metadata_2025_split huggingface dataset:
CORTICOSTEROIDS AND 5ASA VERSUS CORTICOSTEROIDS ALONE FOR ACUTE SEVERE ULCERATIVE COLITIS: A RANDOMIZED CONTROLLED TRIAL
Authors: Ben-Horin Shomron , Har-Noy Ofir , Katsanos Konstantinos , Roblin Xavier , Chen Min-Hu , Gao Xiang , Schwartz Doron , Cheon Jae Hee , Cesarini Monica , Bojic Daniela , Protic Marijana , Theodoropoulou Angeliki , Abu-Kaf Heba , Engel Tal , Tang Jian , Veyrard Pauline , Lin Xiaoqing , Mao Ren , Christodoulou Dimitrios , Karmiris Konstantinos , Knezevic-Ivanovski Tamara 
Published: January 2022

Abstract

BACKGROUND
Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC). However, whether the addition/continuation of 5-aminosalicylates (5ASA) with corticosteroids during hospitalization is superior to corticosteroids alone is unknown

METHODS
This was a randomized controlled investigator-blinded clinical trial conducted in ten centers in six countries. Patients hospitalized with ASUC (Lichtiger score ≥10) were eligible. Patients received corticosteroids alone or corticosteroid+5ASA (4gr/day mesalamine) by a stratified randomization according to 5ASA use prior to admission. The primary outcome was the percentage of patients who responded to treatment by day 7, defined by a drop&gt;3 points in the Lichtiger score and an absolute score&lt;10 without the need for rescue medications or colectomy.

RESULTS
346 patients were screened and 149 were included (70/149 females, median age 41). Of these, 73 received corticosteriods+5ASA and 76 corticosteroids alone. For the primary outcome, 53/73 (72.6%) of patients receiving corticosteroids with 5ASA responded versus 58/76 (76.3%) of patients on corticosteroids alone (OR 0.82 95%CI 0.39-1.72, p=0.60). There was no difference between groups in duration of hospitalization or CRP normalization rate. Colectomy rate up to day 90 was similar, but the need for biologics among patients receiving combination corticosteroids with 5ASA was numerically lower by day 30 (p=0.11) and day 90 (p=0.07).

CONCLUSION
In this randomized controlled trial, combination 5ASA with corticosteroids did not benefit hospitalized patients with ASUC more than corticosteroids alone. An exploratory finding of a reduced need for biologics at 90 days in the combination group merits further evaluation.
WHEN CROHN’S COMES TO RADIOLOGIST- THE ROLE OF MR ENTEROGRAPHY (MRE) IN THE DIAGNOSIS OF PENETRATING CROHN’S DISEASE IN PEDIATRIC AND ADULT PATIENTS
Authors: Cyranka Weronika , Kuczynska Maryla , Zbroja Monika , Nowakowska Malgorzata , Piekarska Monika , Siejka Karolina , Grzegorczyk Magdalena 
Published: January 2022

Abstract

INTRODUCTION
Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract. The typical clinical scenario is a young patient presenting with abdominal pain, chronic diarrhea and fatigue. The diagnosis is typically made with endoscopic and/or radiologic findings. Nowadays, non-invasive imaging examination (like MRE) plays an increasingly important role.

AIM
The aim of the study is to assess the usefulness of the MRE in the diagnosis and monitoring of penetrating Crohn’s disease in comparison to adult and pediatric patients.

METHODS
The study included 146 adults (82 women and 64 men) and 23 pediatric patients (10 boys, 13 girls) diagnosed with Crohn’s disease, who underwent MRE with intravenous administration of a contrast agent. All MRE findings were further confirmed by colonoscopy, or intraoperatively if applicable.

RESULTS
In the adult group 30 fistulas were identified: 6 complex perianal, 16 simple intestinal (7 blind and 9 ileo-colonic) and 8 complex intestinal (3 ileo-cecal and 5 ileo-colonic). Peri-intestinal abscesses were observed in 9 patients. In the pediatric group in 5 patients small intestine fistulas were found, whereas abscess was observed in another 5 patients. In 12 children inflammatory infiltration of peri-intestinal fat was depicted.

CONCLUSION
In MRE, we can observe the entire intestinal wall, which allows for an accurate assessment of changes in the digestive system. Our research shows that the incidence of Crohn’s disease complications differs between adult and pediatric patients - perianal abscesses are diagnosed more often in children, while peri-intestinal location is more common in adults. The presence of fistulas was found with the same frequency in both study groups.
EFFICACY OF A DIGITALLY DELIVERED PERSONALIZED ELIMINATION DIET FOR THE SELF-MANAGEMENT OF INFLAMMATORY BOWEL DISEASE AND IRRITABLE BOWEL SYNDROME
Authors: Jactel Samuel , Olson Joseph , Brown Jordan , Wolin Kathleen , Jagiella Valerie 
Published: January 2022

Abstract

BACKGROUND
A large majority (60-80%) of Inflammatory Bowel Disease (IBD) and irritable bowel syndrome (IBS) patients report that symptoms originate from, or are exacerbated by “trigger foods”, and modify their diets to alleviate discomfort. Dietary interventions appear to be a reasonable complementary treatment to traditional clinical care. Despite demand, there is no consensus on what diet is best for IBD or IBS patients. Popular diets, such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet (FODMAP) have notable limitations (e.g., implementation cost, length, complexity) and are not personalized to an individual.

OBJECTIVE
The purpose of this study was to evaluate the feasibility, desirability, and impact on gastrointestinal symptoms and quality of life (QoL) of a digitally delivered personalized elimination diet for IBD and IBS patients.

METHODS
This was a single-center open-labeled uncontrolled prospective cohort study. Participants were recruited online and were provided access to Agora Health, LLC’s digital personalized nutrition tool (N=37; CD = 9, UC = 12, IBS = 16). Over a period of 9 weeks, participants followed Agora’s 4-step elimination diet protocol: identification, elimination and reintroduction of trigger foods, followed by a maintenance phase. At baseline, daily, and at conclusion, symptom scores were calculated. The Patient-Based Simple Clinical Colitis Activity Index (P-SCCAI) and Mobile Health Index for Crohn’s Disease (mHI-CD) were used to calculate IBD disease severity. The Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) was used to assess IBS symptomatology. In addition to IBD & IBS symptoms, participants provided qualitative assessments of energy, stress, physical activity, and QoL.

RESULTS
The digital personalized elimination diet program improved symptoms and received strong positive reviews. Significant symptom improvement (p&lt;0.05 two-tailed t-test, Bonferroni-corrected) was seen for 81% of participants at week 5 (phase 2) and persisted for 70% at week 9 (phase 4), measured by the relevant symptom severity score. Clinically significant symptom improvement (&gt;25% reduction in P-SCCAI or mHI-CD scores, &gt;35-point reduction in IBS-SSS) was observed in 78% of participants at week 5 and 62% at week 9. Ninety-five percent of participants felt more empowered and in control of their digestive health and 89% felt their quality of life improved due to the program. Sixty-two percent reported improved energy, 68% reported lower stress and 60% reported more physical activity after completing the program. Daily engagement was seen for 95% of participants and 92% were satisfied with the program.

CONCLUSIONS
Dietary elimination can improve symptoms in patients with IBD and IBS and digital tools can improve adherence and engagement. Randomized controlled trials are warranted.
ACUITY OF PEDIATRIC INFLAMMATORY BOWEL DISEASE ADMISSIONS PRE AND DURING THE COVID-19 PANDEMIC
Authors: Waschmann Malika , Stuart Ariana , Lin Henry , Hunter Anna 
Published: January 2022

Abstract

BACKGROUND
The COVID19 pandemic has introduced new challenges to the diagnosis and management of pediatric Inflammatory Bowel Disease (IBD). Many patients have had limited access to their providers through telemedicine and may choose to delay non-emergent treatment for fear of risking exposure in healthcare settings. Additionally, the “hygiene hypothesis” would suggest that decreased microbial exposure secondary to social isolation may result in greater incidence of new IBD diagnoses and worsened exacerbations of preexisting disease, particularly in urban populations. We hypothesize that these factors resulted in worsened disease status upon admission.

METHODS
We conducted a retrospective chart review of pediatric patients with IBD admitted to a tertiary care center before the onset of the COVID19 pandemic (01/01/18 – 03/01/20) and during the pandemic (03/01/20 – 08/01/21). All patients ≤18 yrs old who were admitted for a flare or new diagnosis of IBD were included. Variables collected included: demographics, admission indication, length of stay, laboratory markers of disease severity, surgical or endoscopic procedures performed during admission, and new treatments started on discharge. Data were analyzed using paired t-tests. Study was IRB approved.

RESULTS
The pre-COVID (N=50) and during-COVID (N=52) populations were similar in regard to demographic and clinical characteristics. More patients during-COVID19 underwent major surgical interventions (11.5% vs. 0%, p=0.007), and were started on biologic therapies or steroids (38.5% vs. 26%, p=0.09 and 11.5% vs. 0%, p=0.007 respectively). Length of stay was also increased during-COVID (5.5 days vs. 4.9 days, p=0.3). UC patients admitted during-COVID exhibited more severe thrombocytosis (483 vs. 419, p=0.2) while CD patients admitted during-COVID exhibited more severe anemia (10.7 vs. 11.6, p=0.1) and hypoalbuminemia (2.7 vs. 3.1, p=0.04). Although not significant, more patients during-COVID were admitted from urban areas (63.5% vs. 56%, p=0.2).

DISCUSSION
Increased length of stay and incidence of major surgical interventions and biologic therapy initiation suggest that pediatric patients admitted for a flare or new diagnosis of IBD during the COVID19 pandemic experienced worsened disease severity. More severe thrombocytosis, anemia, and hypoalbuminemia upon admission supports this correlation. We hypothesize that many families chose to delay presentation given fear of exposure to COVID19. Furthermore, partial department closures may have led to delays in seeing patients in-person and ultimately admission. Lastly, we suspect that during-COVID fewer patients were admitted from rural areas given they experienced less emotional stress and physical isolation than their urban peers. Uninterrupted exposure to farm animals and peers at school may have had a protective effect on microbiome balance and stress level.
INFLAMMATORY BOWEL DISEASE RISK STRATIFICATION AND MANAGEMENT IN A COMMUNITY PRACTICE SETTING
Authors: Collins Angelina , Swift Sadie , Recht Adam , Prime Rose , Topp Robert , Beltyukova Svetlana , Goldklang Robert , Gaylis Franklin 
Published: January 2022

Abstract

INTRODUCTION
Risk stratification of patients with Inflammatory Bowel Disease (IBD) is integral for patient management according to care pathways and IBD guidelines. We examined explicit IBD risk stratification and the extent of its influence on patient management in a community-based practice setting.

MATERIAL AND METHODS
This was a single-center, retrospective study of adult patients with IBD followed at Genesis Healthcare Partners between January 1, 2016 and December 31, 2018. 250 consecutive IBD charts were reviewed for (a) patient demographics; (b) disease characteristics; (c) explicit risk stratification and disease activity documented by clinician provider; (d) management and treatment. Patients were independently risk stratified based on AGA clinical care pathway risk factors (implicit risk stratification). CD high risk factors include: age under 30 at diagnosis, extensive anatomic involvement, perianal and/or severe rectal disease, deep ulcers on endoscopy, stricturing and/or penetrating behavior, prior surgical resection. UC high risk factors include age under 40 at diagnosis, extensive anatomic involvement, deep ulcers on endoscopy, high CRP and/or ESR, steroid requiring disease, C Difficile or CMV infection, prior hospitalization for UC.

RESULTS
211 eligible patients: 77 (36.5%) with Crohn’s Disease (CD) and 134 (63.5%) with Ulcerative Colitis (UC) were included; 52% female, 85% Caucasian, median age at diagnosis was 33 years, median length of CD was 16 years, and the median length of UC was 8 years. 18 (2%) had explicit risk stratification documented. Implicit risk stratification was: CD: 9 (12%) low risk [zero high risk factors], 68 (88%) high risk [one or more high risk factors].
UC: 27 patients (20%) low risk [zero high risk factors]; 107 patients (80%) high risk [one or more high risk factor]. Medication management for low-risk CD: 5-ASAs: 5 (56%); locally acting steroids: 5 (56%); systemic steroids: 1 (11%); immunomodulators (IMM): 2 (22%); and biologics: 4 (44%) and high-risk CD: 5-ASAs: 17 (25%); locally acting steroids 18 (27%); systemic steroids 20 (30%); IMM: 21 (31%); biologics: 46 (69%). Medication management for low-risk UC: 5-ASAs: 24 (92%); locally acting steroids: 5 (19%); systemic steroids: 4 (15%); IMM: 2 (8%); biologics: and 1 (4%) and high-risk: 5-ASAs: 97 (91%); locally acting steroids: 42 (39%); systemic steroids: 45 (42%); IMM: 16 (15%); biologics: 44 (41%). Of 182 UC endoscopy procedures explicit Mayo endoscopic sub-scores was documented in 3 (2%). Implicit Mayo Scoring was: 21% Mayo 0, 34% Mayo 1, 26% Mayo 2 and 16% Mayo 3.

CONCLUSIONS
Explicit risk stratification and Mayo endoscopy scoring was infrequently documented. Embedding risk stratification tools and standardized Mayo endoscopy scoring into EMRs would help to standardize documentation.
CROHN’S DISEASE AND ACUTE PANCREATITIS; ASSOCIATION, OUTCOMES, AND PREDICTORS OF 90-DAY READMISSION WITH ACUTE PANCREATITIS. INSIGHTS FROM THE NATIONWIDE READMISSION DATABASE
Authors: Abomhya Ahmed , Clemeston Elizabeth , Gayam Vijay , Khan Farrah , Etienne Denzil 
Published: January 2022

Abstract

INTRODUCTION
It’s a controversy if pancreatitis can be considered one of the extraintestinal manifestations of Crohn’s disease (CD). (Barthet et al AJG) CD patients have a fourfold increase in the risk of acute pancreatitis (AP) compared to the general population. (Rasmussen et al Scan J Gastroenterol) The annual incidence of AP in the general population ranges from 13 to 45/100,000 persons. (Dhiraj et al Gastroenterology)

METHODS
We collected data from the publicly available Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Databases (NRD) 2017-2018. We identified individuals discharged with a diagnosis of CD or one of its complications. The case selection process is summarized in Figure 1. We studied the burden of AP in patients with Crohn’s disease, hospitalization outcomes, and predictors of hospital readmissions with AP. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. We performed a binary logistic regression analysis for predictors of 90-day readmission with AP. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA).

RESULTS
We analyzed 147,501 index hospital discharges with Crohn’s disease or one of its complications, 0.9% had chronic pancreatitis, and 1.6% had a diagnosis of AP. Around 14% of AP was biliary, 13% was Alcohol-induced, 7% was drug-induced, while 66% was classified as idiopathic, other, or unspecified AP. Table 1 shows a Comparison between CD patients with AP and CD patients without AP. Having AP on index hospitalization wasn’t related to CD complication status as those without AP had a higher prevalence of complications (P values &lt;0.001). After excluding those who died in index hospitalization, those with Chronic Pancreatitis, and those discharged in Oct-Dec, 0.3% of patients had 90-day readmission with AP. Characteristics of CD patients with 90-day readmission with AP are illustrated in Table 2. A binary logistic regression for predictors of 90-day readmission with AP is illustrated in Table 3. The chi-square test results indicate that our regression model is a significant improvement in fit relative to an intercept-only model (χ2= 498.489, p&lt;.001).

CONCLUSION
AP is associated with higher morbidity and mortality in patients with CD. Age, number of comorbidities, and having AP in index hospitalization are significant predictors of 90-day readmission with AP. Further biochemical studies would be needed to investigate the association between AP and CD. The study was limited by the lack of a specific ICD-10 code for autoimmune pancreatitis and the inability to account for common CD drugs associated with Pancreatitis.
ILEAL ENTEROCYTE BRUSH BORDER ABNORMALITIES ASSOCIATE WITH PROGRESSIVE DISEASE COURSE IN PEDIATRICS CROHN’S DISEASE
Authors: Haberman Yael , Vallance Jefferson , Baverman Julie , Liu Ta-Chiang , Kugathasan Subra , Denson Lee , Van Dussen Kelli 
Published: January 2022

Abstract

BACKGROUND
Biomarkers are needed to identify the subset of Crohn’s disease (CD) patients at-risk for severe, treatment-refractory disease. Short ileal microvillus length (MVL) is an epithelial biomarker that predicted non-response to treatment in adult CD. Here, we hypothesized that short MVL phenotype would occur in pediatric CD and associate with more severe disease.

METHODS
H&E-stained ileal tissue sections were obtained from 3 pediatric cohorts: WashU, CCHMC, and RISK (n=58 controls, n=377 CD). MVL was measured in regions not involved in acute inflammation. RISK had baseline “pre-treatment” and follow-up “post-treatment” sampling, clinical phenotyping, and transcriptomic data. Transmission electron microscopy (TEM) and immunofluorescence was performed on paired samples from 6 CD and 6 controls.

RESULTS
Ileal MVL was shorter in pediatric CD (mean: 1.44 μm) vs. controls (mean: 1.64 μm; P&lt;0.0001). MVL did not associate with body mass index, disease location, endoscopic deep ulcers, or disease activity index scores. Histological inflammation scores were greater in baseline CD vs. controls, but similar between CD with short (defined as &lt;1.46 μm, 10th percentile of controls) or normal MVL. Progression from B1 inflammatory disease behavior to B2 stricturing or B3 internal penetrating disease behavior was more likely to occur in patients with shorter MVL (n=91 follow-up samples collected prior to disease progression event; B2: P=0.0077, B3: P=0.0186). Additionally, progression to B2 occurred sooner in those with short follow-up MVL (P=0.0206). In contrast, associations with disease behavior progression based on baseline MVL were not observed. RNA-seq analysis identified 92 genes differentially expressed between CD and controls and correlated with MVL. Gene function analysis showed enrichment (P&lt;0.001) for actin cytoskeleton, transporter activity, and plasma membrane among the 43 genes positively associated with MVL, and enrichment for myeloid cell, response to bacterium, and extracellular matrix among the 49 genes negatively associated with MVL. TEM showed thinning of the terminal web in CD, with diminished microvillus rootlet length and organelle-free zones, features associated with shortened or disorganized microvilli in mouse models. We next assessed terminal web-associated proteins, PLS1 and MYH14, and found that both were altered in CD samples; PLS1 was abnormally enhanced at the brush border, and MYH14 was aberrantly localized in the cytoplasm. Misexpression of MYH14 was associated with terminal web thinning and shorter MVL.

CONCLUSIONS
This study supports short ileal MVL phenotype in follow-up CD samples as an epithelial biomarker for more severe disease prognosis, particularly for progression to stricturing disease. Our data suggest that terminal web alterations underlie the short MVL phenotype.
FECAL MICROBIOTA OF PEOPLE WITH CROHN’S DISEASE DOES NOT CHANGE WITH ILEOCECAL RESECTION
Authors: Moutsoglou Daphne , Khoruts Alexander , Vaughn Byron 
Published: January 2022

Abstract

INTRODUCTION
Up to 80% of people with ileal Crohn’s disease (CD) will require an ileocecal resection (ICR). CD recurrence following surgery is common, although antibiotics can reduce short term recurrence rates. Following an ICR, it is unknown what happens to the fecal microbiota and how the microbiota relates to CD recurrence. To further investigate this, we analyzed fecal microbiomes of patients with CD (with and without an ICR) and compared to healthy controls.

HYPOTHESIS
Patients with CD and active inflammation have more dysbiosis of their fecal microbiomes, and ileocolonic resection (ICR) improves this dysbiosis.

METHODS
We performed a cross sectional study of fecal samples patients with CD (stratified by ICR status) and healthy controls. DNA was isolated and the V4 hypervariable region of the 16S rRNA gene was amplified and sequenced using the Illumina platform. Ecological metrics were applied to characterize fecal microbiomes. In our comparison, CD patients were further stratified based on their most recent colonoscopy into the following groups: 1) history of ICR versus surgically naïve CD patients, 2) active inflammation (in either the ileum and/or colon), and 3) active ileal inflammation versus none (colonic inflammation excluded).

RESULTS
Twenty-four CD patients (n=14, 58 % with ICR) and 38 healthy controls provided fecal samples. Global trends demonstrated that CD patients have significantly reduced richness (or observed taxonomic units) (Figure 1 A, p&lt;0.0001) and significantly reduced Shannon diversity indices (Figure 1 B, p&lt;0.0001) in their fecal microbiomes compared to healthy controls. Community diversity based on principal component analysis of Bray-Curtis pairwise dissimilarity indices is shows distinct clustering between healthy controls and CD patients (Figure 1 C). Richness and Shannon diversity index is not significantly different between CD patients that are surgically naïve compared with those that have undergone ICR (Figure 2 A and B). Richness and Shannon diversity indices are not significantly different between CD patients without versus with active inflammation (Figure 2 C and D) and is also not significant in CD patients without vs with ileal inflammation (Figure 2 E and F).

CONCLUSION
CD is characterized by fecal microbiota dysbiosis. ICR did not impact the fecal microbiota and fecal samples could not distinguish ileal inflammation. ICR paired with therapies to improve dysbiosis may affect CD recurrence.