bluuebunny/crossref_metadata_2025_split huggingface dataset:
P249 Serum calprotectin is useful to confirm Inflammatory Bowel Disease activity but is not effective to predict relapse
Authors: Veyrard P , Roblin X , Mao R , Nancey S , Waeckel L , Berger A E , Williet N , Bastide L , Barrau M , Tournier Q , Paul S 
Published: January 2022

Abstract

Background
Serum calprotectin (SC), a novel biomarker of inflammatory bowel diseases (IBD), has been recently investigated with conflicting results. The purpose of this study was to assess the ability of SC for predicting disease relapse in patients with IBD treated by biologic therapies, and to evaluate the correlation between SC and clinical and endoscopic relapse and with other biomarkers including fecal calprotectin (FC) and C-reactive protein (CRP).

Methods
All consecutive IBD patients in deep remission (clinical and endoscopic or imaging remission) were recruited in this prospective study and followed 12 months. Blood and stool samples were collected for SC, serum CRP and FC measurement. SC was measured the day of inclusion (baseline, D0), 3 months (M3) and 6 months (M6) later and in case of relapse during the study period. Relapse was defined as clinical, biomarkers, or endoscopic/imaging activity. So, firstly, we looked at evolution of SC before relapse to analyze a predicting value of loss of response (LOR). We also compared SC for patients with active IBD and those with symptoms without inflammation.

Results
Among the 119 patients included, 54 (46.4%) patients experienced a disease relapse during follow-up. When we looked at the kinetic of SC during follow-up, median SC levels did not increase in patients who relapsed: 3.15 µg/l at baseline, 3.38 µg/l at M3, 3.33 µg/l at M6 and 3.99 µg/l in case of relapse (p=0.63).
We compared SC during relapse with patients in endoscopic remission but clinical symptoms which defined secondary Irritable Bowel Syndrome, we found that SC levels were higher in active IBD and similar between the groups of patients with IBS or deep remission (3.05µg/l IBS vs 2.99µg/l remission vs 5.1µg/l for relapsers, p=0.04). In patients with clinical symptoms, SC presents a good predictive value for relapse. (AUROC 0.764, IC95: 0.68–0.88), giving a sensitivity of 72% with a specificity of 77%, using a cut-off value of 4.45mg/ml. A weak, but significant correlation was found between SC and FC levels (r=0.35, P= 0.001). A combined score with CRP, FC and SC didn’t improve its diagnostic accuracy.

Conclusion
SC was significantly higher in patients with relapse compared to those in endoscopic remission with or without clinical symptoms. It seemed that it permit to oppose patients with active IBD and those with symptoms of IBS. However, it failed to predict relapse.
P258 Impact of inflammatory bowel diseases on the phenotype and severity of primary sclerosing cholangitis - a systematic review with meta-analysis
Authors: Attauabi M , Wewer M D , Bendtsen F , Seidelin J B , Burisch J 
Published: January 2022

Abstract

Background
Data regarding the impact of co-occurring inflammatory bowel diseases (IBD) on the phenotype and severity of primary sclerosing cholangitis (PSC) are emerging. The purpose of our study was to characterize the phenotype and disease course of PSC in relation to co-occurring IBD.

Methods
The purpose of our study was to characterize the phenotype and disease course of PSC in relation to co-occurring IBD. The systematic review and meta-analysis were conducted according to Cochrane’s recommendations. PubMed and EMBASE were searched from database inception till January 2020 for studies reporting disease phenotype and severity of PSC in association with co-occurrence of IBD. Meta-analyses were performed using a random-effects model. The quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS).

Results
The electronic search yielded 12,220 studies which were narrowed down to 132 after screening based on study titles and abstracts. Of these, a full-text review identified 42 eligible studies, including a total of 8,081 and 5,728 patients with PSC and with or without co-occurring IBD, respectively (Figure 1). The mean NOS score was 6.4 ad included 23 (54.8%) and 18 (42.9%) studies of moderate and high methodological quality, respectively.
The meta-analysis demonstrated that co-occurrence of IBD was associated with significantly less frequent involvement of the extra-hepatic ducts (risk ratio (RR)=0.50 (95% CI 0.33–0.75), p&lt;0.01, I2=0%) as compared with patients without co-occurring IBD. However, IBD-PSC and PSC without IBD had similar rate of small-duct PSC, histologic stages of PSC, risk of developing cirrhosis, and features of decompensation. Furthermore, in comparison to patients with isolated PSC, co-occurring IBD was associated with an increased overall risk of malignancies (RR=1.53 (95% CI 1.01–2.32), p=0.04, I2=46%), which was ascribed to colorectal cancers (RR=4.77 (95% CI 2.50–9.09), p&lt;0.01, I2=0%) and not cholangiocarcinomas (RR=0.88 (95% CI 0.59–1.31), p=0.54, I2=31%), gallbladder cancers (RR=2.28 (95% CI 0.39–13.21), p=0.36, I2=0%), or hepatocellular carcinomas (RR=4.49 (95% CI 0.57–35.46), p=0.15, I2=0%). Regarding long-term PSC outcomes, having IBD was not associated with the need of liver transplantation (RR=0.84 (95% CI 0.50–1.41), p=0.52, I2=60%) or mortality (RR=0.74 (95% CI 0.37–1.50), p=0.40, I2=37%), but was associated with a longer liver transplantation-free survival (hazard ratio = 0.70 (95% CI 0.60–0.82), p&lt;0.01, I2=5%).

Conclusion
This systematic review with meta-analysis suggests that IBD is associated with a distinct phenotype and course of PSC, thus emphasizing the importance of a multidisciplinary approach to patients with co-occurring PSC and IBD.
P273 Inflammatory Bowel Disease and COVID-19 vaccine
Authors: Zahra Bianco E , Tabone T , Cassar P , Agius D , Zammit D , Vella Baldacchino A , Scicluna C , Gatt K , Ciantar M , Montebello B , Ellul P , Sciberras M 
Published: January 2022

Abstract

Background
Owing to the COVID-19 pandemic, inflammatory bowel disease (IBD) patients are strongly encouraged to vaccinate against SARS-COVID-19. In fact, the uptake of this vaccine in IBD cohorts has been greater than the general population. The adverse events of this vaccine are predicted to be low. The aim of this study was to assess the percentage of IBD patients who took the COVID-19 vaccine- including booster- and any significant adverse events. Any possible correlation with lifestyle habits, treatment and disease activity was also established.

Methods
Data was collected prospectively. 200 patients with a histological diagnosis of IBD were randomly recruited through our local database. Data was gathered using electronic case summaries and direct patient contact. Data collected included; diagnosis, type and number of COVID-19 vaccines taken, demographics, lifestyle habits, treatment and any adverse events to the vaccine. Patients were also asked about any concerns regarding this vaccine.

Results
187 patients (57.8% male) were recruited. 73.8% of which had Crohn’s disease (CD), 25.7% had Ulcerative colitis (UC) and 0.5% were unclassified. Mean age was 41.96 (SD ±16.56). 37.8% were on Azathioprine/6- Mercaptopurine, 93.5% were on biologicals and 33.2% were on both. 61% had quiescent IBD while 2.1% had severe IBD. 19.7% were current smokers while 15.8% were ex-smokers. 98.9% received at least one COVID-19 vaccine.
Table 1 illustrates the type of vaccine administered to IBD patients.

17% of patients were concerned regarding the effectiveness of the vaccine due to IBD treatment. 19.8% of IBD patients believed that the vaccine may trigger a flareup of their disease. 11.8% of patients felt that not enough information was available to make an informed choice. 7.1% of IBD patients had treatment altered in response to the COVID-19 vaccine.
Graph 1 shows the percentage of both local and systemic adverse events to 1st, 2nd and 3rd Covid-19 vaccine in IBD patients.

Conclusion
This study demonstrates that the uptake of COVID-19 vaccine in IBD patients was high. The most commonly report adverse events were pain at the injection site and fever. Increased in temperature at the injection site occurred more frequently with the 3rd dose. A number of patients had a change in their medication in response to at least one the vaccines. Larger studies are needed to decipher whether data can be extrapolated on a larger scale.
P276 Prevalence, clinicopathological, and biological characteristics of serrated polyps in patients with ulcerative colitis
Authors: Nishio M , Kunisaki R , Shibata W , Ajioka Y , Hirasawa K , Takase A , Chiba S , Inayama Y , Ueda W , Okawa K , Tsunoda S , Azuma D , Yaguchi K , Fujii K , Nakamori Y , Madarame A , Nishida D , Fuse M , Araki K , Saigusa Y , Kimura H , Kato J , Maeda S 
Published: January 2022

Abstract

Background
Serrated polyps are recognized as precursors of colorectal cancer in general population and have recently been reported in patients with ulcerative colitis (UC). However, their prevalence and detailed characteristics remain unclear.

Methods
The prevalence and clinicopathological and biological characteristics of serrated polyps in patients with UC were retrospectively examined in a single tertiary inflammatory bowel disease centre in Japan from 2000 to 2020.

Results
In total, 252 neoplasms, including 36 serrated polyps (26 in colitis-affected segments, 10 in colitis-unaffected segments), were identified in 187 patients with UC. The proportion of serrated polyps was significantly higher from 2010 to 2020 (35/213, 17%) than from 2000 to 2009 (1/39, 3%; p = 0.023). Serrated polyps in colitis-affected segments were common in patients with extensive colitis (88%), a history of persistent active colitis (58%), and a long duration of UC (12.1 years). Serrated polyps in colitis-affected segments were more common in men (88%). Of 26 serrated polyps in colitis-affected segments, 15, 6, and 5 were categorized as sessile serrated lesion (SSL)-like dysplasia, traditional serrated adenoma (TSA)-like dysplasia, and serrated dysplasia not otherwise specified (SD NOS), respectively. SSL-like dysplasia was common in the proximal colon (67%) and with BRAF mutation (62%), whereas TSA-like dysplasia and SD NOS were common in the distal colon (100% and 80%) and with KRAS mutations (100% and 75%). CpG island hypermethylation phenotype-positive status was observed in 60% cases of TSA-like dysplasia but in only 25% cases of SSL-like dysplasia and SD NOS.

Conclusion
Serrated polyps have recently been increasing in patients with UC. Serrated polyps in colitis-affected segments were common in men with extensive and longstanding colitis, suggesting that chronic inflammation is involved in the development of serrated polyps in patients with UC.
P279 Prevalence of iron deficiency in inflammatory bowel disease
Authors: Resál T , Bacsur P , Lupas D , Szántó K , Rutka M , Fábián A , Bor R , Szepes Z , Farkas K , Varga M , Molnár T 
Published: January 2022

Abstract

Background
Iron deficiency (ID) is one of the most common extraintestinal manifestation of inflammatory bowel disease, which often remains untreated, despite the fact, that ID significantly impairs patients’ quality of life. Since anaemia develops through several pathomechanisms (e.g., occult bleeding, chronic inflammation, medicines), treating anaemia requires to manage the underlying pathological changes as well.

Methods
In our prospective, two-centers study, we assessed the frequency of ID among our IBD patients. The diagnosis of iron deficiency (iron deficiency anaemia [IDA], anaemia of chronic inflammation [CDA], anaemia of mixed origin [AMO]) was based on the ECCO’s anaemia guideline. According to the guideline, haemoglobin, CRP, ferritin, transferrin saturation, serum iron values, total iron binding capacity, hematocrit, and platelet counts were collected from our patients on a one-off basis. We aimed to compare the frequency of ID in a biologic centre, and in a non-biologic centre hospital as well. In addition, we assessed the frequency of the need for oral and intravenous iron replacement, respectively, based on the guideline as well.

Results
720 patients were included in our study (CD 58.8%, UC 41.2 %). Average age was 43.3 years. We found, that 26.6% of our patients had anemia. There was no significant difference in the prevalence of ID (p=0.65) between CD and UC patients. Based on the ECCO criteria, 61.8% of them have ID (33.0% IDA, 23.0% AMO, 5.8% CDA), and in the rest of the cases (38.2%) it was classified to be anaemia of other origin (AOO), however, in 68.5% of these cases ID can be suspected at some degree, as ferritin was &lt; 100 mg/l and/or transferrin saturation ≤ 20%. In total, 133 patients (69.6%) had anaemia in remission, and 58 patients (30.4%) in case of activity (CRP ≥10 mg/l). In addition, we found an association between elevated CRP levels and the prevalence/severity of anemia (p&lt;0.001) as mean CRP was 5.9 mg/l in the non-anaemic, 9.9 mg/l in the anaemic, and 16.0 mg/l in the severe anaemic group. Anemia (p&lt;0.001) and iron deficiency anemia (p&lt;0.001) were significantly more common in patients treated in a clinical/biological centre, compared to a non-biological hospital. Patients with active disease received iv. ferric-carboximaltose, which turned to be efficient (Hgb&gt;120–130 g/l) already after 2 months in 76.5% of the cases.

Conclusion
Based on our results, anemia and iron deficiency are common complications of IBD and correlate well with disease activity. Consequently, we suggest, that iron deficiency should be a part of the treat to target approach, and in case of ID, iv. ferric-carboximaltose is efficient in activity as well.
P281 TELEIBD: A telematic fast-track pathway for patients with high suspicion of Inflammatory Bowel Disease in primary care
Authors: Pradera Cibreiro C , Ramos Alonso M , Fernández López M , Molina Arriero G , Fraga Iriso R , González Furelos T , Ollero Pena V , Echarri Piudo A 
Published: January 2022

Abstract

Background
The incidence and prevalence of Inflammatory bowel disease (IBD) are increasing in the last years.
In primary care (PC) patients often present with confusing and non-specific symptoms which can often be a delay in referring and diagnosing suspected IBD. The average time from symptom onset to diagnosis of IBD is longer than five years in up to 18% of cases and 64% of patients presenting to emergency care with symptoms of IBD prior to the diagnosis.
Shared care protocols and closer working with integrated care teams can bridge the gap between primary and specialized care, improving their assistance

Methods
This is a retrospective study that evaluates the results of TELEIBD (telematic circuit care) in patients with high diagnostic suspicion of IBD between PC and IBD Unit of our health area since its implementation in August 2019 to October 2020.
The number of telematic consultations, average resolution time, adaptation to referral criteria, complementary tests requested and diagnostic confirmation were evaluated.
TELEIBD establishes the issuance of a telematic consultation through the electronic clinical history when a patient meets previously established criteria.
Specialized IBD physician who evaluates the case, can advise a diagnostic or therapeutic attitude either by electronic means or face-to-face with the patient.

Results
A total number of 77 care consultations from 77 patients (58,4% females) have been made. The average age was 49,2 years and the average reponse time were 7,5 days.
After teleconsultation, 46 patients (59.7%) were not requested medical test. Lower gastrointestinal endoscopy (LGE) was performed in 25 patients, blood and faecal calprotectin testing in 7 patients, magnetic resonance (MR) or computer tomographic (CT) enterography in 6 patients.
Taking into account the criteria for referral to a specialist, a total of 15 patients (19,5%) fully met the criteria, 13 patients (16,9%) partially met the criteria and 49 patients (63,6%) did not meet it. The main reason fot not meeting the criteria were the inadequated use of TELEIBD (53,1%).
Of the 25 LGE requested, 3 were suggestive of Ulcerative Colitis (UC) and 1 of Crohn’s Disease (CD). Diagnosis of CD was confirmed in 2 patients, using MR or CT enterography.
Diagnoses were reached in 4 patients, 3 of the group that met referral criteria (20%) and 1 of the group that partially met it (7.7%). The diagnosis was not achieved in any patient who did not partially and/or fully meet the referral criteria.

Conclusion
TELEIBD can be a useful tool for the quick assessment of patients who meet the criteria for high suspicion of IBD. Training primary care physicians in the referral criteria of the pathway is essential to improve the functioning of the circuit.
P288 Recurrence rates of advanced neoplasia after endoscopic or surgical resection in Inflammatory Bowel Disease patients: a retrospective cohort study
Authors: Derks M , te Groen M , Peters C P , Dijkstra G , de Vries A C , Römkens T E , Horjus C S , de Boer N K , Nagtegaal I D , Derikx L A , Hoentjen F 
Published: January 2022

Abstract

Background
Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (AN) including high grade dysplasia (HGD) and colorectal cancer (CRC). Historically, a (sub)total colectomy was recommended in these patients, but alternatively, endoscopic resection or partial colectomy can be considered as well. We aimed (1) to identify factors associated with AN treatment choice and (2) to assess AN recurrence rates following different treatment modalities.

Methods
In this retrospective multi-center cohort study we used the Dutch nationwide histopathology registry (PALGA) to identify ulcerative colitis (UC), Crohn’s disease (CD) and IBD-unclassified patients diagnosed with colonic AN between 1991 and 2020 in seven hospitals in the Netherlands. Exclusion criteria were familial CRC or AN prior to IBD diagnosis. Data regarding the first (index) AN, treatment and endoscopic and surgical follow-up were collected. Recurrence was defined as colorectal AN (independent of colonic location) detected after treatment of index AN. Multinomial logistic regression and cox regression analysis were used to assess in respective associations with treatment choice and recurrence free survival.

Results
We included 189 patients with index AN (n=81 HGD, n=108 CRC) with a median follow up of 27 months (IQR 7–69 months). (Sub)total colectomy was performed in 79 patients (41.8%; n=33 HGD, n=46 CRC), whereas 55 patients (29.1%; n=12 HGD, n=43 CRC) had a partial colectomy. Endoscopic resection was performed in 38 patients (20.1%; n=35 HGD, n=3 CRC), of which EMR/ESD n=12 (6.3%). Seventeen lesions (8.9%; n=1 HGD, n=16 CRC) were not removed, due to comorbidity or metastatic disease. CRC, primary sclerosing cholangitis (PSC), extensive disease and younger age at time of index AN were associated with (sub)total colectomy (Table 1). Twenty-one patients (12.2%) developed recurrence AN (n=12 HGD, n=9 CRC), after a median of 24 months (IQR 14–48; figure 1). Endoscopic resection was associated with recurrence (adjusted hazard ratio 4.0, confidence interval [1.3–12.2], p=0.02), as 14/21 patients (66.7%) with recurrence were initially (for index AN) treated with endoscopic resection. In addition, 3 patients (14.3%) were treated with partial colectomy and 4 (19.0%) with (sub)total colectomy. In 11/21 patients (52.4%) recurrence was treated with surgical resection.

Conclusion
Factors associated with AN treatment with (sub)total colectomy were CRC, PSC, extensive disease and younger age. After AN treatment, 1 out of 10 IBD patients developed recurrence of AN, mainly after endoscopic resection. This underlines the importance of stringent endoscopic surveillance following treatment of AN, especially after endoscopic resection with residual colon in place.
P300 Very early onset Inflammatory Bowel Diseases: Review of the Genoa-Messina joint clinical experience. Therapeutic approach: Part II
Authors: Gramaglia S M C , Cucinotta U , Dipasquale V , Serena A , Gandullia P , Romano C 
Published: January 2022

Abstract

Background
Pediatric inflammatory bowel diseases (pIBD) have specific phenotypes compared to Inflammatory Bowel Diseases (IBD) in adults. The Very Early Onset-IBD (VEO-IBD) is considered a diagnosis of IBD in children before age, 6 years old with, 15% of prevalence.

Methods
The objective of this study was to compare the clinical and endoscopic features of VEO-IBD compared to pediatric IBD (diagnosis &gt;, 6 years old) also in terms of natural history and response to treatment.
The VEO patients followed at the IBD-Centers of Messina and Gaslini were enrolled retrospectively. We compared the results of this population with what is reported in the literature in terms of therapeutic approach and surgery. Percentage comparison of data was performed.

Results
74 VEO-IBD patients were enrolled. At the onset of the disease, during induction therapy, we found, 15–21% of VEO-IBDs are corticoresistant, remission was with Infliximab (table 1). During disease follow-up of at least, 5 years from onset: CD, 47,4% and CU, 61,1% of VEO-IBDs remain in therapeutic maintenance with, 1st line drugs (Mesalazine and Azathioprine; table 2). This result highlights how the VEO-IBDs also maintain clinical, histological and endoscopic remission even with, 1st line drugs, the only exception being the monogenic forms that may also require HSC transplantation.
The surgical approach, according to our data, is far superior to that reported in the literature, although there are several conflicting studies in this regard. Patients undergoing major surgery (colectomy, ileostomy, ileorectoanastomosis, J pouch) are CD, 36.8% and CU, 18.5%, if we also consider minor surgery (perianal surgery; CD, 36.8%) the percentage of patients with Crohn’s disease undergoing surgery increases to, 52.6%. These numbers are far above what is reported in the literature:, 14–15% after, 5 years from diagnosis. It is likely that this result is due to the high numbers of procedures performed at Gaslini Institute, National Center for these diseases.
A monogenic form of VEO-IBD was found in, 5.4% frequently linked to immunedeficiency, 2 cases (2,7%) required allogeneic HSC transplantation (XIAP, WAS) with complete recovery from disease.

Conclusion
VEO-IBDs represent a challenge for the pediatric gastroenterologist. Therapy is no different in terms of response from pediatric inflammatory bowel diseases, with the exception of monogenic forms who may need HSC transplant. Many VEO IBDs maintain remission with, 1st line drugs. Further studies will be needed to define the best therapeutic and diagnostic approach for these diseases.