bluuebunny/crossref_metadata_2025_split huggingface dataset:
P161 Implementation of Outcome Measurement – Case Finnish IBD register
Authors: Mustonen A , Asikainen S , Hermansson L L , Jussila A 
Published: January 2022

Abstract

Background
Inflammatory bowel diseases (IBD) are becoming increasingly common. In Finland, during 2020, in total of 54 000 patients were diagnosed with IBD, and over 2000 new diagnoses are made every year. The Finnish university hospitals in collaboration with BCB Medical Ltd have built disease-specific registers to support and monitor the quality and effectiveness of health care. The IBD register (IBDR) collects data on the effectiveness of IBD treatments and their follow-up, where e.g. disease severity, treatment and outcomes are profoundly monitored. As combination, IBDR, MyHealth service, and IBD Symptom Diary enables patients’ health, functional status, experience and QoL monitoring to reach the health care goals. The service supports patient treatment pathway and makes designing more personalized treatments for IBD possible.

Methods
The IBDR is a web-based system integrated with electronic health record (EHR) systems, through which patient data is captured. Nationally convergent register allows for peer review of treatment outcomes. To complement registers’ clinical data, PROMs are collected with online MyHealth service to enable automatic, recurring data collection directly from the patient. The first questionnaire is activated 14 days before the visit, whereas new questionnaire is sent to the patient two months after visit, and then at time points according to the disease activity index calculated from the questionnaire. The disease activity is reflecting the severity of the IBD symptoms[1]. Captured measures are immediately available for clinician review.

Results
MyHealth for IBD is actively used in four Finnish university hospitals and two central hospitals with some inter-regional variation. By November 2021, the questionnaires were answered 31 506 times since the beginning of the implementation in 2019. The response rate is yearly increasing (Figure 1). Distribution of disease activity index among IBD patients in Tampere University Hospital is shown in Figure 2.

Conclusion
IBDR enables the evaluation and comparison of patient care quality, which is not accessible through EHR systems alone. Our electronic data collection model brings out the patients’ voice and saves resources since cyclic questionnaires are automatically send to patients, and answers are immediately reached by clinician. In future, international comparison and monitoring of treatment outcomes will be emphasized. As MyHealth deployment proceeds across hospitals, the availability of the patient reported outcomes data will increase. International research and peer development will continue to be an essential part of our activities.

Reference
1. Puolanne A-M et al. Dig Dis Sci (2017) 62:3123–3130.
P166 Predictive markers of Crohn’s disease in small bowel capsule endoscopy
Authors: Mattila J , Stenholm T , Löyttyniemi E , Koffert J 
Published: January 2022

Abstract

Background
To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and Crohn’s disease (CD) can be a burden. The diagnosis is based on symptoms and findings in laboratory tests, endoscopy and imaging. As CD can be limited to small bowel, the diagnosis often requires small bowel capsule endoscopy (SBCE), which is time consuming for both the patient and clinician.

Methods
To answer this problem, we conducted a retrospective study of 374 patients who underwent SBCE for suspected small bowel CD in Turku University Hospital between 2012 and 2020 and gathered data on the patient’s laboratory, imaging and endoscopic findings at the time of SBCE. The patient’s history, medications and procedures related to CD were also documented after SBCE. SBCE findings were graded along CECDAI (Capsule Endoscopy Crohn’s Disease Activity Index) -scoring system. The main goal was to find predictive markers to rule out clinically significant small bowel CD without proceeding to SBCE.

Results
Small bowel CD was diagnosed in 110 (29.4%) patients (CD-group). The mean follow-up time for the whole population was 4.4 years. Fecal calprotectin (FC), serum albumin (Alb) and erythrocyte sedimentation rate (ESR) were significantly different between CD and non-CD-groups (p=&lt;0.001, 0.025 and 0.022). Hemoglobin (Hb) and C-reactive protein (CRP) had no significant differences between the two groups (p=0.59, 0.24). FC &lt;50ug/g had sensitivity 96.4%, specificity 19.6%, positive predictive value (PPV) 34.6% and negative predictive value (NPV) 92.5% for small bowel CD. 13 (11.8%) patients in CD-group had FC &lt;100ug/g. CECDAI-score has no previously established clear cut-off-value for the diagnosis of CD. In this study 98.2% of patients in CD-group had CECDAI of 3 or more whereas 90.5% of patients in non-CD-group had CECDAI less than 3 (PPV=81.1%, NPV=99.1%). Sensitivity and specificity were the highest between CECDAI 2.5 and 3.5. Small bowel imaging also had relatively low sensitivity (65.1%) and specificity (72.7%) considering small bowel CD (PPV=52.2%, NPV=81.8%).

Conclusion
These findings underline our experience, that diagnosis of small bowel CD can be difficult. In this study, we found out that clinically relevant small bowel CD is possible even with FC&lt;100ug/g. Based on our results, we suggest for a follow-up with FC before SBCE for patients with no endoscopic ileitis, negative imaging results and FC &lt;50 ug/g. CECDAI-score of 3 would be a reasonable cut-off value for small bowel CD.
P170 Point-of-care ultrasound accurately quantifies skeletal muscle index in patients with Inflammatory Bowel Disease
Authors: Nguyen A , Burns M , Lambell K , Holt D , Herath M , Gibson P R , Ebeling P , Milat F , Moore G 
Published: January 2022

Abstract

Background
Body composition is frequently altered in patients with Inflammatory Bowel Disease (IBD) and difficult to quantify without expensive and radiation-prone techniques. Low skeletal muscle index (SMI) has been associated with increased surgical complications and poor quality of life. Aim: To develop a portable ultrasound (US) protocol to estimate SMI, to compare this with SMI from paired whole-body dual-energy X-ray absorptiometry (DXA) in patients with IBD and controls, and to assess its responsive to change over time.

Methods
Adult patients with IBD and gender-matched controls underwent prospective assessment of body composition by US (Philips Lumify) and DXA (GE Lunar Prodigy) for which low SMI was defined as men ≤7.26 kg/m2 and women ≤5.45 kg/m2. Sonographic muscle thickness of the dominant arm and bilateral thighs (Figure 1) were multiplied by respective bone lengths (humerus or femur) and described in cm2. Results were analysed by Spearman correlation and receiver operating characteristic (ROC) curves using just arm measurements (USarm) or combined arm and thigh measurements (UScombined). A subgroup of patients with active IBD (faecal calprotectin of ≥150 µg/g) were assessed again ≥14 weeks after initiating biologic induction therapy. Response was defined with faecal calprotectin reduction of ≥50%.

Results
48 patients with IBD had similar SMI compared with 30 controls (7.1 vs 7.7 kg/m2), but a higher proportion had low SMI (19% vs. 3%, p=0.048). In both IBD and control participants, DXA-derived SMI was strongly associated with USarm measurements (r=0.89 and r=0.88, p&lt;0.0001) and UScombined measurements (r=0.90 and r=0.87, p&lt;0.0001).

On ROC analysis in patients with IBD, low SMI was identified best with USarm &lt;73 cm2 in women (AUC 0.93, sensitivity 100%, specificity 89%) and &lt;117 cm2 in men (AUC 0.88, sensitivity 100%, specificity 81%). In 7 of 14 patients who responded to biologic induction, only DXA-SMI increased significantly (7.9 to 9 kg/m2) compared to USarm (109 to 124 cm2, p=0.249) and UScombined (270 to 323 cm2, p=0.080). Including both responders and non-responders, change in UScombined correlated well with change in DXA-SMI (r=0.77, p=0.007).

Conclusion
Sonographic measurement of the dominant arm ± bilateral thigh muscle thickness accurately assesses DXA-derived SMI at the point-of-care. In preliminary evaluation, it was responsive to change after biologic induction therapy, but larger sample sizes and longer follow up are needed to evaluate its monitoring role.
P178 Fecal incontinence and rectal anal function in Crohn’s Diseases patients
Authors: Góes de Codes L M , Costa de Jeus A C , Góes de Codes J J , da Silva Beda Sacramento C , Dias Marques da Cruz I , Freitas Ferreira R , Baqueiro Sena N , Moreira Gusmão V , Araujo Mota J , Pamponet Motta M , Martins Netto E , Oliveira santana G 
Published: January 2022

Abstract

Background
Anoperineal damage in Crohn’s Disease (CD) is caused by inflammation, its sequelae, and the surgery’s sequelae. Fecal incontinence (FI) is an important complaint reported by patients with CD. Literature data regarding to FI, anatomical and functional abnormalities and its associated clinical factors are controversial, with few surveys with a limited number of participants.1 The aim of this study is to analyze FI and the associated manometric and clinical findings in patients with CD.

Methods
Observational, cross-sectional study in patients older than 18 years old with CD under outpatient follow-up at a tertiary center, who, after sign informed consent, were submitted to specific questionnaire, anorectal manometry and medical record review.
The Jorge and Wexner Fecal Incontinence Scale was applied to grade incontinence.2
SPSS 21.0 (SPSS, Chicago, IL, USA) was used for statistical analysis, with description of categorical variables with absolute and relative frequency, and continuous variables with median and interquartile range (IIQ). To study the association, we used Pearson’s Chi-Square and Mann Whitney test. The null hypothesis was rejected with p&lt;0.05.

Results
Of 104 patients with CD, 51% were male, median age of 41 years old (IIQ 29.2–50.0) and median disease duration of 6.1 years (IIQ 2.5 to 11 .5). Most of the sample was diagnosed between 17 and 40 years old, (68.3%), with non-penetrating, non-stricturing disease (63.4%), with colonic location (77.9%), isolated (30.8%) or with ileal involvement (47.1%); 78.8% had disease in remission and 11.5% had mild disease, representing 90,4% of our casuistic, according to the Harvey Bradshaw Index. Among patients; 41.3% had perianal disease, and 49% were incontinent, of these 66.7% had mild incontinence and 33.3% had moderate and severe incontinence. It was found association between FI and lower mean resting pressures (p=0.04) and lower mean squeeze pressures (p=0.04) along the anal canal. There was also association between FI and perianal disease (p=0.02), and FI and disease activity (p&lt;0.01).

Conclusion
The study, unprecedented in America Latin, showed a high frequency of FI and found its association with disease activity, structural abnormalities (perianal disease) and anorectal disfunction (lower resting and squeeze pressures), reenforcing the importance of controlling CD activity. Furthermore, the data showed to be crucial during follow-up of CD patients the adequate manometric assessment and specialized evaluation for the management of FI.
References
1. Litta, F, Ratto C, et al. Anorectal function and quality of life in IBD patients with a perianal complaint, J Invest Surg. 2019 Oct 18;1–6
2. Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97
P208 Enthesopathies in patients with inflammatory bowel diseases
Authors: Gainullina G , Abdulganieva D , Kirillova E , Odintsova A 
Published: January 2022

Abstract

Background
Background. The aim of study was to evaluate the enthesis in patients with inflammatory bowel diseases (IBD) and to assess the involvement of enthesis in different IBD behavior.

Methods
Methods. 95 IBD pts were prospectively enrolled into the study: 55 pts with ulcerative colitis (UC) and 40 - with Crohn’s disease (CD). The average duration of the disease was 48 (12; 102) months in UC, and 42 (18; 87) months in CD. The severity of UC exacerbation was assessed by the Mayo index, in CD – by Harvey-Bradshaw index. In UC, moderate and severe exacerbation was revealed in 40 pts (73%), in CD - in 17 (43%). Among 95 pts with IBD, extraintestinal manifestations occurred in 67 pts (71%), of which 34 (62%) pts with UC and 33 (82%) pts with CD. 70 enthesis were evaluated clinically and by US in each pt. The clinical examination included tenderness of enthesis, US examination with power Doppler detected inflammatory (hypoechogenicity of enthesis, thickening of enthesis, presence of vascularization) and structural (erosion, enthesophyte) changes in enthesis. Fisher’s exact test, Spearman’s coefficient and binary logistic regression to determine the odds ratio (OR) were used to calculate differences.

Results
Results. The duration of IBD course directly correlated with the number of tender entheses (SR = 0.24; p = 0.017), as well as the number of enthesophytes (SR = 0.20; p = 0.044). The severity of IBD exacerbation and enthesis involvement didn’t have statistically significant correlation. However, the inflammatory lesions of entheses (the number of erosions with vascularization) correlated with CRP level (SR = 0.25; p = 0.01). We also identified a relationship between the presence of extraintestinal manifestations and the enthesis involvement: for example, the presence of at least one extraintestinal manifestation increased the likelihood of detecting erosions by 4.77 times (95% CI 1.6–13.9, p = 0.003). The presence of joint pain increased the likelihood of detecting erosions of entheses by 3.37 times (95% CI 1.18–9.65, p = 0.02). Clinical signs of musculoskeletal system involvement (tenderness of enthesises on palpation) significantly increased the frequency of enthesitis, including vascularized enthesitis (p = 0.01).

Conclusion
Conclusion. In IBD pts with long disease duration and the presence of extraintestinal manifestations, structural (erosion, enthesophytes) changes in enthesis were observed significantly more often. The frequency of entheses erosions was higher in the presence of pain in the joints, and the number of erosions with vascularization with an increase in laboratory markers of inflammation (CRP).
P212 The DUBLIN Score is a Useful Tool for Predicting Disease Course in Patients with Ulcerative Colitis
Authors: Doherty J , Stack R , O Morain N , Mc Namara D , Coe C , Kevans D , Doherty G 
Published: January 2022

Abstract

Background
The DUBLIN (Degree of Ulcerative colitis Burden of Luminal Inflammation) is a novel simple clinical score of inflammation in patients with Ulcerative Colitis (UC) which can be used easily in outpatients and at the bedside.

Methods
We sought to validate the clinical utility of scoring UC inflammatory burden at diagnosis in predicting disease outcomes using the DUBLIN score (DS). We performed a multicentre retrospective study of patients recruited to the Genuity medicine IBD research project at three centres. DS at diagnosis was calculated based on disease extent and endoscopic severity. Study outcomes were need for immunomodulators and/or biologic therapy and need for surgery. We also examined the association between DS and FCP, albumin and C-reactive protein.

Results
679 patients with confirmed UC were identified. 291 had data allowing calculation of DS at diagnosis (median age 38.9 years, 53% male). Median DS was 4 [1–9]. 122 patients were treated with biologic therapy during follow-up. Median DS at diagnosis was significantly higher in patients requiring biologic therapy compared to those not requiring biologic therapy [4 versus 3, p = &lt; 0.001]. Of patients requiring biologic therapy patients with a DS &gt; 3 had a significantly shorter time on 1st biologic therapy [2.1 versus 3.9 years, p = 0.005]. There was no difference in median DS dependent on immunomodulator use. Similarly median DS at diagnosis was significantly higher in patients requiring colectomy compared to those not requiring colectomy [6 versus 4, p = 0.001].
There was a weak positive correlation between both DS and faecal calprotectin [correlation coefficient 0.27, p = 0.001] and C-reactive protein [correlation coefficient 0.7, p = 0.01] and a weak negative correlation between DS and albumin level [correlation coefficient -0.22, p = 0.04].

Conclusion
Our study validates the clinical utility DS is an accurate clinical tool at diagnosis and during a patients’ disease course for identifying disease burden. A higher DS correlates with an increased need for biologic therapy, need for colectomy and increased biomarkers of disease activity. This is a useful tool for day to day use in clinical practise providing personalised management of patients with UC.
P220 CROHN’S DISEASE (CD): The predictive value of Montreal clinical patterns, and biological treatment in a Latin American IBD reference center
Authors: Sambuelli MD A , Gil A , Tirado P , Huernos S , Negreira S , Goncalves S , Rothwain M J , Candel I 
Published: January 2022

Abstract

Background
CD is a potencially disabling condition, with high rate of complications and surgical requirement. Biological treatments have revolutionized the CD treatment management, but their efficacy and predictive factors could be influenced for epidemiological and environmental conditions which should be locally analyzed wordly.

AIMS
to describe by a retrospective study in a Latin American IBD reference center, clinical features of the CD casuistic, predictive Montreal patterns for surgical risk and efficay of biologs and immunosuppressant drugs.

Methods
Data of CD patients (pts) assisted from 1990-June 2020 (CD duration ≥1 yr), categorized by Montreal classification, and by biological and IMM treatment in the prevention as first mayor surgery. Clinical patterns were evaluated as predictive factors at the basal time (up to 90 days from debut) in: Age at diagnosis (A)A1:≦16yrs, A2:17–40, A3:&gt;40, Behavior (B): nonstricturing nonpenetrating (B1), stricturing (B2), penetrating (B3), perianal disease modifier (p), Location (L): L1: ileal, L2: colonic, L3: ileocolonic, L4: upper G.I. Incidence rates of surgery and preventive treatment efficacy were estimated by a Cox regression model.

Results
598 CD pts (M 313, F 285) with mentioned available data, CD median duration 13.9 yr (IQR 7.1–21.2) were analyzed. Montreal patterns A1: n 93 (15.6%), A2: n 335 (56.0%), A3: n 170 (28.4%), B1: n 523 (87.5%), B2: n 52 (8.7%), B3: n 23 (3.8%) L1: 52 (8.7%), L2: n 368 (61.5%), L3: n 176 (29.4%), L4: iUGI: n 2 (0.33%) and L4 combined with L1, L2, L3: n 47 (7.9%) Perianal disease (p) n 286 (47.8%). Biologics (before first surgery) in 202 pts, primary non response in 45 pts. Major surgery was performed in 304/598 pts (50.8%) Kaplan Meier estimates: Major surgery incidence rate was 5.1 per 100 person/yrs. Median survival without surgery: 14.2 yrs. Signifficant variables of Cox model for surgery risk were: B1 HR 1 (reference), B2 HR 3.03 (95%CI 2.14–4.29, p=0.000), B3 HR 3.27 (95%CI 2.03–5.29, p=0.000), L2 HR 1 (reference), L1 HR 2.025 (95%CI 1.37–2.99, p=0.000), L3 HR 2.51 (95%CI 1.95–3.23, p=0.000), A1 HR 1 (reference), A2 HR 1.48 (95%CI 1.05–2.10, p=0.027), A3 HR 1.89 (95%CI 1.27–2.83, p=0.002), Biologics (mainly Anti-TNFs) only induction 1.49 (95%CI 1.005–2.195, p=0.047). Induction plus maintenance HR 0.388 (95% CI 0.27–0.55), p=0.000. Non signifficant variables involved in the risk for surgery were: gender, perianal complication, and IMM treatment.

Conclusion
In our CD population we found: 1) Montreal patterns associated with surgical risk (fistulizing and stricturing behaviors), ileal and ileocolonic locations, A2, but also A3 (debut beyond 40 yrs). 2) Biologics showed a reduction in surgical risk (induction plus maintenance versus only induction).
P229 Capsule endoscopy is useful in the diagnosis and monitoring of postoperative recurrence in Crohn’s disease. Analysis from an 11-year cohort
Authors: Elosua Gonzalez A , Rullan M , Rubio S , Elizalde I , Rodríguez C , Aznárez M R , Vicuña M , Juanmartiñena J F , Fernández-Urién I , Nantes Ó 
Published: January 2022

Abstract

Background
Small bowel capsule endoscopy (SBCE) has been proposed as a non-invasive method to detect endoscopic postoperative recurrence (POR). To date, few studies with small-sized cohorts have evaluated the role of SBCE in monitoring patients with CD in the postoperative setting, targeting the early POR (≤ 12 months). Our aim was to conduct a retrospective analysis of the performance of SBCE in assessing POR comparing three different situations encountered in clinical practice: detecting early POR, monitoring for late POR (≥ 12 months) and assessing response to treatment in patients with previous endoscopic-POR.

Methods
We included all patients with known CD with previous ileocolonic resection followed in the Inflammatory Bowel Disease Unit of Hospital Universitario de Navarra from 01/01/2008 to 31/12/2019 in which a SBCE was performed. Patients were divided in three groups (early POR, late POR and monitoring POR)

Results
A total of 113 SBCE procedures were included after excluding 18 cases (13.7%) due to a negative SB patency test. Patients were divided in early-POR group (n= 34), late-POR group (n=44) and monitoring-POR group (n=35). A total of 105 procedures (92.9%) were complete and 97 SBCE (85.5%) were considered conclusive since they allowed a correct assessment of the neoterminal ileum.
Disease activity in the neoterminal ileum according to the Rutgeert’s score is shown in figure 1. SBCE assessment was feasible for early (85%) and late (89%) detection of POR but with significant differences in the results. While in the Early-POR most patients (85%) had disease activity in the neoterminal ileum, only 64% of patients assessing late-POR had mucosal lesions (p= 0.03). There was relevant POR (Rutgeert’s ≥i2) in 58.8% of the early-POR group compared to 27.3% in the late POR (p=0.02).
For patients with previous POR, assessment with SBCE is also feasible with conclusive results in 83% of the patients. The predominant score was i2 with 26% of the group with similar proportions in the remaining scores (figure 1). Within the Monitoring-POR group, for those with previously assessed POR by endoscopy (either ileocolonoscopy or SBCE), the Rutgeerts Score improved in 43.5% of patients, worsened in 26% and remained unchanged in 30.5%. Overall, 45.7% of patients had relevant POR with 60% classified as i2.
No adverse events occurred in our cohort.

Conclusion
SBCE is a safe and effective method to assess the postoperative recurrence after an ileocecal resection in the early (≤ 12 months) and late setting in clinical practice. SBCE is a safe and effective method to assess the response to treatment in patients with previous endoscopic POR