bluuebunny/crossref_metadata_2025_split huggingface dataset:
P202 Performance characteristics of serum FGF19 measurement compared with the Se-HCAT retention test in the diagnosis of bile acid diarrhoea in Crohn’s Disease
Authors: Ruiz-Cerulla A , Blat Serra R , Sánchez-Pastor E , Notta P C , Rodríguez-Alonso L , Aràjol Gonzalez C , Serra Nilsson K , Antón Güell S , Serrano Santacruz I , Luque Gómez A , Aran J M , Rodríguez-Moranta F , Guardiola Capon J 
Published: January 2022

Abstract

Background
Bile acid diarrhoea (BAD) is common in patients with Crohn’s disease (CD), but its recognition is challenging since symptoms are similar to those of active inflammatory disease. The current clinical gold standard for diagnosing BAD is the Se-HCAT test, however, it is inconvenient to the patient and has limited availability. FGF19 is a hormone produced in the enterocytes of the ileum in response to absorbed BAs. Serum FGF19 levels are a direct marker of BA absorption, and they are reduced in BAD. The aim of this study was to evaluate the performance of FGF19 as a diagnostic tool for BAD in Crohn’s disease.

Methods
Fasting serum FGF19 levels and Se-HCAT retention were measured before bowel preparation in 63 consecutive Crohn’s disease patients referred for an ileocolonoscopy. Clinical, endoscopic and biologic data were prospectively recorded. BAD was defined as an abdominal retention &lt;10% and severe BAD as &lt;5% at day seven.

Results
BAD was present in 60% of non-resected CD (NR-CD) patients and in 93% of ileal-resected (IR-CD) patients. FGF19 levels were lower in IR-CD patients (median 23 pg/ml; IQR, 3–44) than in the NR-CD patients (61 pg/ml; IQR, 18–121) (p = 0.02). FGF19 levels were inversely related with ileal resection length in IR-CD patients (rs = -0.52, P = 0.01). FGF19 and Se-HCAT values were positively related (rs = 0.57, P &lt; 0.0001), whereas FGF19 was inversely related with the number of bowel movements (rs = -0.31, P=0.01) and Bristol scale (rs = -0.27, P= 0.04). No significant relation was found between FGF19 and clinical (CDAI) nor endoscopic (SES-CD) scores. Area under the ROC curve for FGF19 to detect SeHCAT at &lt;10% and &lt;5% were 0.75 (95% CI 0.62–0.88) and 0.81 (95% CI 0.71–0.92) respectively.

Conclusion
Serum FGF19 can be used as a simple blood test to the diagnostic of BAD in CD. FGF19 measurement could be an adjunct in guiding treatments for diarrhoea in CD.
P205 Eliakim and CECDAIic scores are useful pan-intestinal tools for CD diagnosis and activity monitoring
Authors: Freitas M , Capela T , Macedo Silva V , Arieira C , Xavier S , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Rosa B , Moreira M J , Cotter J 
Published: January 2022

Abstract

Background
Capsule endoscopy is a valuable tool in the diagnosis and monitoring of Crohn’s disease (CD). Recently, a new panenteric capsule (pan-CE), PillCam Crohn’s (Medtronic, USA) was approved. A novel quantitative score of inflammation for PillCam Crohn’s, the Eliakim score, has emerged. However, the optimal index for panenteric monitoring disease activity is far from being completely defined. We aimed to evaluate the correlation and accuracy between the pan-CE Eliakim and capsule endoscopy Crohn’s disease activity index (CECDAIic) scores and inflammatory parameters.

Methods
Retrospective study, including a cohort of consecutive patients with suspected or established CD that underwent Pan-CE PillCam Crohn’s over 4 years. The Eliakim and CECDAIic scores were calculated. Spearman correlation (rs) was used to access the correlation between the scores and inflammatory biomarkers.

Results
Thirty-two patients were included, 71.9% females, with mean age of 35±13 years, 59.4% with suspected CD. The median Eliakim and CECDAIic scores were 5.5 (0–13) and 6.5 (0–15.5), respectively. The diagnosis of CD was established in 31.6% of patients with suspected CD. We found a very good correlation between Eliakim and CECDAIic scores (rs=0.87; p&lt;0.001), and a moderate correlation between Eliakim and CECDAIic scores with C-reactive protein (rs=0.53; p=0.003), (rs=0.44; p=0.02), and fecal calprotectin (rs=0.46; p=0.02), (rs=0.54; p=0.01), respectively. In patients with suspected CD, an Eliakim ≥3.5 and CECDAIic score ≥5.5 had a sensitivity of 100%, and specificity of 84.6%, and 75.0%, respectively, for the diagnosis of CD.

Conclusion
The Eliakim and CECDAIic scores have a strong correlation in assessing panenteric CD activity, and a moderate correlation with inflammatory biomarkers. The application of Eliakim ≥3.5 and CECDAIic score ≥5.5 as the cutoff values for the presence of significant inflammatory activity in patients undergoing pan-CE for suspected CD may be useful to establish the diagnosis.
P210 Assessment of disease specific knowledge and quality of life among patients with Inflammatory Bowel Disease
Authors: Sequeira C , Santos I , Coelho M , Teixeira C , Mangualde J , Cremers I , Oliveira A 
Published: January 2022

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting the gastrointestinal tract that leads to a marked decrease in quality of life. Patients should develop coping strategies. Higher levels of IBD-related knowledge are associated with lower disease-related helthcare costs and less need for a step-up strategy.

Aims
To determine individual factors influencing the level of patient knowledge and whether this has an impact on therapeutic adherence and quality of life.

Methods
The IBD-KNOW, Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and Morisky Medication Adherence Scale (MMAS-8) questionnaires were applied to IBD patients who were consecutively assessed at outpatient consultation or day-care hospital. Factors associated with higher levels of knowledge about IBD were analysed

Results
We included 74 patients (male: 51%; median age: 46 years [interquartile range (IQR): 25–67]), 54% (n=40) had Crohn’s Disease. The median duration of IBD was 5 years (IQR: 1–16 years). Physicians/nurses (n=67) and the internet (n=26) were considered the main sources of knowledge. Median IBD-KNOW score was 13 (IQR: 7–19), the percentage of correct answers was highest in the areas of vaccination (78%), epidemiology (43%) and anatomy (27%) and lowest in knowledge regarding reproduction (21%), lifestyle (21%), physiology (14%) and surgery (14%). Most patients (68%, n= 53) know that IBD with several years of evolution is a risk factor for colorectal cancer and recognize the importance of screening. The IBD-KNOW median score was statistically significantly higher in patients with previous hospitalisation (p=0.01), bowel surgery (p=0.04) and disease with more than 5 years of evolution (p=0.04). No differences were identified according to educational level. Patients adherent to therapy (MMAS-8=8) did not present higher scores (p=0.09) and no positive correlation was found between IBD-KNOW score and SIBDQ (p=0.415).

Conclusion
A longer duration of disease and previous hospitalisation/surgery related to the disease were associated with a higher level of knowledge. There was no association between quality of life and therapeutic adherence and level of knowledge. The authors intend to use this analysis to target future promotion of health education programmes to address the areas with the greatest knowledge deficits.
P216 Effect of the Crohn’s disease exclusion diet (CDED) on the fecal calprotectin level in children with active Crohn’s disease
Authors: Matuszczyk M , Meglicka M , Wiernicka A , Jarzebicka D , Osiecki M , Kotkowicz-Szczur M , Kierkus J 
Published: January 2022

Abstract

Background
The CDED + PEN (partial enteral nutrition) is a promising method of nutritional treatment in active Crohn’s disease (CD). An increase of fecal calprotectin (FCP) level - a marker of mucosal inflammation – happens to be the first evidence of the Crohn’s disease exacerbation, ahead of clinical symptoms, and usually accompanies clinical symptoms. In this study we present our own experience with using the CDED + PEN in treatment of children with CD and higher FCP level.

Methods
Forty eight children (male/female: 27/21) in age 4–18 years (median value = 13.6; IQR=3.7) were treated with CDED + PEN. The main inclusion criteria to the study was active CD defined as FCP level ≥ 250 µg/g. Patients with severe clinical manifestation of CD (PCDAI &gt;40) or who started any new concomitant CD’s treatment together with the dietary intervention were excluded from the analysis. The PCDAI and fecal calprotectin level were assessed at week 0 and 12. The primary endpoint was ITT normalization of FCP level that is result&lt; 250 µg/g at week 12. Wilcoxon Matched Pairs Test was used for statistical analysis.

Results
The normalization of FCP level was obtained in 35 % (17) of children and the minimum 50% decrease of FCP level in 56% (27). The reduction of fecal calprotectin level between week 0 and week 12 was statistically significant with median value = 1045 µg/g; IQR=1188 and 363 µg/g; IQR=665, respectively (p&lt;0.05). In the group of 29 patients who were not in clinical remission (PCDAI≥10) at baseline 16 (55%) obtained clinical remission (PCDAI&lt;10) at week 12 and 20 (69%) clinical response defined as a drop in PCDAI of at least 12.5 points or PCDAI&lt;10 points. The reduction of PCDAI between baseline and week 12 was statistically significant (median value = 20 points; IQR=7.5 and 5 points; IQR=6.2, respectively (p&lt;0.05)). All patients with normal FCP level at week 12 were in clinical remission. In 10 children (21%) the full course of 12 weeks with CDED+PEN was not completed or the concomitant therapy had been started before week 12 due to the lack of efficacy/ intolerance of nutritional treatment.

Conclusion
The 12-weeks course of treatment with the CDED + PEN has a beneficial effect on the fecal calprotectin level in children with active CD. Dietary intervention leaded to significant decrease in the FCP level in studied group and to the normalization of this parameter in every third patient.
P221 Association between Irritable Bowel Syndrome-type symptoms and Ulcerative Colitis: is it real?
Authors: Silva A P , Madeira J , Sant’Anna M , Temido M J , Fernandes A , Lopes S , Ferreira A M , Mendes S , Ferreira M , Silva M R , Cipriano M A , Figueiredo P , Portela F 
Published: January 2022

Abstract

Background
The origin of gastrointestinal symptoms compatible with irritable bowel syndrome (IBS) in patients with inflammatory bowel disease in remission is a challenge. Our aim was to prospectively determine the relation of IBS symptoms with calprotectin levels (FC), endoscopic Mayo score and histologic findings, in patients with ulcerative colitis (UC) in clinical remission.

Methods
Patient recruitment was between January – March of 2020 and November of 2020 - August of 2021 and included consecutive UC patients in clinical remission and scheduled for a colonoscopy. Clinical remission was defined by a stool frequency ≤3/day with no bleeding, ulcerative colitis activity index &lt;4 and serum C-reactive protein lower than 1mg/dL. Exclusion criteria were therapeutic with corticosteroids over the prior 6 months or initiation of biological agents in the last 6 months. IBS diagnosis was evaluated by Roma IV criteria (IBS-like group). FC level was assessed before colonoscopy and during the exam Mayo endoscopy subscore was applied and random biopsies of all segments of colon and rectum were made to achieve histologic activity using Geboes index. This study was approved by Centro Hospitalar e Universitário de Coimbra Ethics Committee.

Results
A total of 106 patients (50% women; mean age 51 years ±14.8) were included. The mean of disease duration was 15.7 years (±9.06) and 13 of them (12.3%) had proctitis, 64 (60%) left-sided colitis and 29 (27.4%) extensive colitis. Regarding disease activity: mean FC was 189.48mg/Kg (±382), endoscopic Mayo score lower than 1 was found in 63 patients (59.4%) and Geboes index lower than 1.1 was found in 66 patients (62.3%). Rome IV criteria for IBS were fulfilled by 29 patients (27.4%). The IBS-like group showed FC levels significantly higher (303±483mg/Kg vs. 139±319mg/Kg; P&lt;0.05), with greater histologic activity (Geboes index &gt;1.1 in 65,5% vs. 27.3%, P&lt;0.05). Besides, in the same group (IBS-like group), Mayo endoscopy subscore was numerical higher but with no statistical significancy (subscore ≥1: 55.2% vs. 36.4%; P&gt;0.05).

Conclusion
IBS-like symptoms are common in patients with UC considered to be in clinical remission. Higher levels of FC and histological activity support the idea of the presence of subclinical inflammation rather than coexistent IBS.
P223 Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patient with intestinal Behçet’s disease as a marker of disease activity and prognosis
Authors: Jung B W , Kang E A , Park S J , Park J J , Cheon J H , Kim T I , Park J 
Published: January 2022

Abstract

Background
The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are used as a diagnostic marker, disease activity marker, and prognostic marker in patients with Crohn’s disease and ulcerative colitis. We aimed to investigate the NLR and PLR as a marker of inflammation and prognostic biomarker in intestinal Behçet’s disease (BD).

Methods
A total of 1712 diagnostic tests with 621 intestinal BD patients who underwent both blood examination and endoscopic examination at the Inflammatory Bowel Disease Clinic of Severance Hospital, Seoul, Korea between March 2005 to November 2020 were analyzed in our study. We analyzed to identify the independent risk factors of the clinical remission (CR) and endoscopic remission (ER). Moreover, for 435 patients who underwent a series of blood and endoscopic examination, we performed Kaplan-Meier (K-M) analyses to identify the NLR and PLR as a marker of prognosis in intestinal BD.

Results
The NLR levels were higher in non-CR group compared to CR group (3.3±2.7 vs. 2.0±1.2, p&lt;0.001). The PLR levels were higher in non-CR group compared to CR group (192.9±113.8 vs. 139.6±63.757, p&lt;0.001). The NLR levels were higher in non-ER group compared to ER group (2.8±2.2 vs. 2.0±1.3, p&lt;0.001). The PLR levels were higher in non-ER group compared to CR group (171.5±171.5 vs. 136.3±54.4, p&lt;0.001). In the CR group and the ER group, NLR and PLR were meaningful indicators for predicting each remission. We obtained the cut-off values of NLR(CR group 3.17, ER group 2.53) and PLR(CR group 187.28, ER group 124.27). There was a significant difference in the duration of CR/ER remission when the NLR/PLR high group and low NLR/PLR group were applied with the K-M curve based on cut-off.

Conclusion
The NLR and PLR were higher in patients with active intestinal BD compared to those with inactive intestinal BD. And the NLR and PLR showed a promising role as marker for prediction of disease prognosis. Therefore, the NLR and PLR might be effective, readily available, and low-cost biomarkers for inflammation in intestinal BD patients.
P234 Remission state in Inflammatory Bowel Disease patients on anti TNF or vedolizumab: a confocal endomicroscopy study
Authors: Loly J P , Vieujean S , Reenaers C , Van Kemseke C , Seidel L , Somja J , Louis E 
Published: January 2022

Abstract

Background
Confocal endomicroscopy is a technique allowing the in vivo assessment of the superficial layers of the mucosa, including the epithelium, the surrounding connective tissue and blood vessels. Some of the features observed by endomicroscopy can’t be assessed by classical histology. Preliminary studies have already suggested its added value in the assessment of endoscopic remission in IBD. However, most of these studies were performed on patients still having some endoscopic activity. Furthermore, to our knowledge, no study has used endomicroscopy to compare the state of remission in IBD patients under vedolizumab and anti TNF. Our aim was to disclose persisting endomicroscopy anomalies in patients with full endoscopic healing and to compare them between vedolizumab and anti-TNF.

Methods
we screened patients with CD or UC treated for more than 6 months by adalimumab, infliximab, or vedolizumab, and being in steroid-free clinical (PRO2) and biological remission (CRP&lt;5 mg/l and F Cal &lt;250 microg/g). Confocal endomicroscopy analysis was performed in the ileum, right colon, transverse colon, left colon and rectum. In each ileal segment, we recorded fluorescein leakage, the presence of epithelial erosions, gap junction anomalies and vessel diameter. In each colonic segment, we recorded the presence of fluorescein leakage, crypt dilatation, vessel diameter, and hypervascularization. Patients were prospectively follow-up and clinical relapses (PRO2 + one objective marker) were recorded.

Results
72 CD and UC patients treated by biologic therapy and in clinical remission were screened. 37 of them were also in endoscopic remission (eMayo=0 in UC and absence of ulcer or erosion in CD) and were included in our study. Their treatment were infliximab (n=5), adalimumab (n=16), vedolizumab (n=15) and ustekinumab (n=1). We found a persistence of residual endomicroscopy anomalies in the different segments in a substantial number of patients (table 1). These persisting abnormalities were not significantly associated with any demographic or clinical characteristics including the treatment (anti-TNF or vedolizumab), nor with histologic parameters (almost all patients were in histologic remission), levels of CRP or F Cal.
The average follow-up time was 33.4 (+/- 9.5) months. Among the 37 patients, 7 (18.9%) relapsed. The risk of relapse was not associated with any clinical, biological, histologic or endomicroscopy factor.

Conclusion
Despite endoscopic, biological and even histologic remission, we found a high prevalence of endomicroscopic abnormalities, which were not different between anti-TNF and vedolizumab treated patients. The clinical significance of these anomalies remains to be clarified.
P238 Symptom burden and indolent disease in newly diagnosed patients with ulcerative colitis and Crohn’s disease - a Copenhagen IBD Inception Cohort Study
Authors: Attauabi M , Madsen G R , Bendtsen F , Wilkens R , Ilvemark J F K F , Theede K , Boysen T , Bjerrum J T , Seidelin J B , Burisch J 
Published: January 2022

Abstract

Background
The early course of ulcerative colitis (UC) and Crohn’s disease (CD) is difficult to predict, particularly regarding identifying patients for whom an indolent course might be expected. Therefore, we aimed to investigate the initial course of UC and CD and clinical predictors hereof in a generalizable population-based inception cohort.

Methods
We initiated a prospective population-based inception cohort of newly diagnosed patients with UC and CD between May 1st, 2021 and November 1st, 2021, according to the Copenhagen IBD Criteria within the geographical uptake area of Hvidovre University Hospital and Herlev University Hospital. All patients were examined systematically by IBD specialists at diagnosis using endoscopy, magnetic resonance (MR) enterography, and patient-reported measures including Simple Clinical Colitis Index (SCCAI) and Harvey-Bradshaw Index (HBI) for UC and CD, respectively. Indolent disease presentation was defined as the absence of UC or CD-related hospitalization, surgery, or decision to start steroid, immunomodulator, or biologic therapy within three months of follow-up. In addition, well-recognized predictors of long-term disease course of UC and CD were a priori defined and implemented in a univariate logistic model, and factors with a p-value smaller than 0.10 were included in the multivariate model.

Results
The study included 63 adult patients with UC and 50 with CD. At diagnosis, 23 (36.5%) and 13 (26.0%) patients with UC and CD were in clinical remission according to their SCCAI or HBI score, respectively (Table 1). The symptomatic disease burden is outlined in Table 2–3. Interestingly, well-recognized risk factors for the long-term disease course of UC and CD, including disease extent, behavior, baseline endoscopy, MR enterography, and serologic data, did not predict the initial disease course in a multivariable analysis (Table 4). However, C-reactive protein &lt;10 mg/L were associated with an indolent course of UC (adjusted odds ratio=6.2 (95% confidence interval 1.3–38.9), p=0.03).

Conclusion
The preliminary data from the ongoing prospective population-based cohort study indicate that very heterogenous disease course patterns might be experienced very early. As initial disease control is considered critical for long-term outcomes, this study highlights the inapplicability of long-term predictors for the short-term disease course. It emphasizes the need for further development of simple clinical tools or biomarkers for early patient stratification.
P239 Ulcerative Colitis Index of Severity is a better predictor of histologic activity than Mayo endoscopic subscore, an Asian cohort study in ulcerative colitis
Authors: Tay S , Teh K K J , Wang L M , Tan M 
Published: January 2022

Abstract

Background
Targets of therapy in ulcerative colitis (UC) have undergone a shift from clinical remission to endoscopic healing (EH). Recent STRIDE II guidelines1 have recommended stricter criteria for EH, Ulcerative Colitis Index of Severity (UCEIS) ≤1 or Mayo endoscopic subscore (MES)=0, with histologic healing (HH) as an adjunctive endpoint. We aim to ascertain the strength of correlations between EH and HH using validated indices in an Asian cohort.

Methods
A single-centre cohort study was performed in a tertiary centre. Patients with a diagnosis of UC were prospectively enrolled into a database from January 2017 to June 2020. Patient demographics, clinical classification, endoscopic and histological assessments were collected retrospectively and analysed. Endoscopic scores in the worst affected segments by two independent gastroenterologists. Histological activity was assessment by a single gastrointestinal histopathologist using the Nancy Histological Index (NHI). Analysis was done using SPSS v23. Spearman correlations between UCEIS, MES and NHI was performed.

Results
A total of 88 patients with UC were enrolled (Figure 1). Seven patients were excluded as no biopsies were done during endoscopy. Analysis was done for 163 pairs of endoscopy and histology. The distribution of UCEIS, MES and NHI scores for all endoscopies are shown in Figure 2. Both MES and UCEIS had modest correlations with NHI but UCEIS had a stronger correlation to NHI (r=0.640, p&lt;0.01) than MES (r=0.538, p&lt;0.01) (Figure 3). When evaluating patients in EH (UCEIS≤1 or MES=0), both endoscopic scores had similar distribution of NHI scores (Figure 4a & 4b). Despite appearing to be endoscopically inactive, more than half of patients had histologically active disease, with NHI≥2 (14/27 [51.8%] in the UCEIS≤1 group, 9/17 [52.9%] in the MES=0 group). When using the older definition of EH (MES≤1), 49 of 66 patients (74%) had histologically active disease with NHI≥2 (Figure 4c).

Conclusion
UCEIS ≤1 is slightly more predictive of HH than MES=0 but endoscopic correlation with HH is poor. Biopsies should still be performed if HH is a desired treatment outcome. The more stringent criteria change for EH in STRIDE II from MES≤1 to MES=0 results in higher rates of HH.

Reference
1. Turner D, et al.; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570–1583.