bluuebunny/crossref_metadata_2025_split huggingface dataset:
P392 To study the prevalence of depression and anxiety in patients of Inflammatory Bowel Disease (IBD) and the efficacy of psychopharmacotherapy in these patients: A pilot study
Authors: Patel A , Joshi H , Wagh A , Bhatt C 
Published: January 2022

Abstract

Background
There is high prevalence of psychiatric disorders amongst IBD patients which independently affect quality of life. Studies have shown psychological stress leads to IBD flare. Non pharmacological psychotherapy has been studied in treatment of IBD, but not psychopharmacotherapy. We feel treatment for mental disorders in IBD patients may improve outcomes.

Methods
This is a prospective, observational single centre pilot study. After ethics committee approval, 200 patients were accrued between November, 2019 & June, 2021, with, 1 year follow up for patients with anxiety or depression. All patients &gt;18 years with Ulcerative Colitis (UC)/Crohn’s disease (CD) were enrolled. We excluded patients with IBD-Unclassified, post ileostomy/colostomy, on biologicals, malignancy. For assessing disease activity in UC we used UCEIS & pMAYO scores; CDEIS & Harvey-Bradshaw scores for CD. HADS-A & HADS-D scores were used to determine anxiety and depression, respectively. Patient with HADS-A or HADS-D &gt;, 7 were considered to have significant anxiety/depression, were given psychopharmacotherapy as per psychiatrist. All patients received IBD therapy as per standard of care. These patients were followed up at, 3, 6, 9 and, 12 months to assess the clinical parameters and HADS scores at each visit. Colonoscopy was repeated after a year to assess endoscopic activity.

Results
In our pilot study of, 200 patients CD was seen in, 84 (42.0%) & UC in, 116 (58.0%). Prevalence of Anxiety was, 15%, Depression, 7% & pooled prevalence, 22%., 86 patients (43.0%) received only IBD therapy., 66 (33.0%) received, 1 antipsychotic drug, 33 received, 2 (16.5%), 15 (7.5%) were prescribed, 3. Patients receiving psychopharmacotherapy, showed significant improvement in HADS-A or HADS-D scores at, 3, 6,9 and, 12 months. Amongst patients with UC, there was a significant improvement in UCEIS score (4.73 to, 2.36) in patients who received psychopharmacotherapy in addition to IBD standard of care after, 1 year (p&lt;0.05). Similarly, the mean p-MAYO score dropped from, 4.91 to, 2.17 in patients receiving psychopharmacotherapy (p&lt;0.05). The same pattern was observed in patients with Crohn’s disease receiving psychopharmacotherapy, in whom the mean CDEIS score dropped from, 5.43 to, 2.16 after, 1 year. Also, the mean Harvey-Bradshaw score dropped from, 5.57 to, 2.86. Both in UC & CD; clinical, endoscopic scores significantly improved in patients who were given psychopharmacotherapy in addition to SOC.

Conclusion
Our study confirmed the high prevalence of anxiety and depression amongst Indian IBD patients. IBD patients with significant anxiety or depression benefit from Psychopharmacotherapy in addition to standard of care treatment, showed improvement in clinical as well as endoscopic disease activity.
P414 Stoma in patiens with IBD: friend or foe? -\tEffect of stoma on course of disease, psychological well-being and working capacity
Authors: Bianchi R , Von Känel R , Roth R , Schreiner P , Rossel J B , Barry M P , Dora B , Kloth P , Juillerat P , Greuter T , Misselwitz B , Schoepfer A , Scharl M , Rogler G , Biedermann L 
Published: January 2022

Abstract

Background
Knowledge on the impact of stoma formation surgery on course of disease, psychological well-being, quality of life (QoL) and working capacity in patients with IBD is scarce.

Methods
To investigate this, we analysed prospectively followed-up patients from the Swiss inflammatory bowel disease cohort study (SIBDCS), comparing ulcerative colitis (UC) and Crohn’s disease (CD) with vs without stoma surgery, for both temporary and permanent stoma formation.

Results
From a total of, 3825 SIBDCS patients, 352 patients were included in our analysis -, 176 with stoma surgery (52.8% and, 47.2% with CD and UC, respectively) - amongst these, 111 with permanent and, 65 with temporary stoma - matched with, 176 patients without stoma. Mean and maximal disease activity was lower in patients with vs. without stoma overall in CD but not in UC (Fig., 1, A/B). However, in UC, disease activity was lower in permanent vs. temporary stoma patients (Fig., 1, C/D).

Figure, 1 A-D: Average disease activity with mean Crohn’s disease activity index (CDAI; A) in CD and Modified Truelove & Witts activity index (MTWAI; B) and UC for patients with vs. without stoma as well as (within the stoma group) permanents vs. closed ostomy (C,D).
Furthermore, active EIM as well as need for steroids, immuno-modulators and biologics were lower in stoma vs. control patients. Amongst stoma patients, quality of life and psychological wellbeing was similar in permanent vs. closed stoma (Inflammatory Bowel Disease Quality of Life questionnaire Total score (IBDQ); Hospital Anxiety and Depression Scale Total Score (HADS); Posttraumatic Diagnostic Scale Total Score (PDS); and effort-reward ratio – all mean values obtained during prospective SIBDCS follow-up). However, we found a significantly lower (i.e. more favourable) PDS avoidance score in permanent vs. closed ostomy (Fig., 2A). Working capacity was lower in permanent vs. closed stoma patients (Fig. 2B).

Figure, 2 A,B: IBDQ, HADS total, PDS total and Effort-Reward ratio (A), Working status, absentism from work and need for disability insurance (B) in permanent vs. closed IBD patients with stoma.

Conclusion
In CD patients with stoma surgery disease activity was significantly reduced after ostomy. Moreover, in UC we observed a benefit of patients with permanent compared to their counter-parts with temporary stoma to control disease activity. We found no differences in psychological functioning and QoL between temporary and closed stoma, with the exception of higher avoidance indicative of posttraumatic stress in the latter. In contrast, working capacity revealed to be higher closed vs. permanent ostomy.
P417 Seroconversion after COVID-19 Vaccination in Inflammatory Bowel Disease Patients
Authors: Horvath M , Csontos Á A , Sárközi M , Cseprekal O , Szijártó A , Miheller P 
Published: January 2022

Abstract

Background
Data about the effect of different immunosuppressive treatments of IBD patients on seroconversion and on different SARS-CoV-2 vaccinations are scarce. To avoid impaired vaccine responses and worse outcome of COVID-19, factors attenuating protective immunity shoud be shought.

Methods
Anti SARS-CoV-2S antibody levels of IBD patients in remission were measured by immunoassay (Roche) before vaccination and on the second week. Antibody responses were compared among different treatment groups (biologics, combination, azathioprin, without immunomodulation) and between mRNA and other type of vaccines. Anti TNF alpha levels were also assesed, 24 hours before vaccination considering correlation with seroconversion.

Results
Thirty-eight (31.7%) ulcerative colitis and eighty-two (68,2%) Crohn’s disease patients were included (median age, 39.1 years, 53.3% female). No serious comorbidities were present. Eighty-two patients (68.3%) were on biological therapy, fifty-two (43%) were treated with azathioprine alone or in combination. Two doses of mRNA vaccines were administered to ninty-eight patients ((81,7%) Moderna:, 20, Pfizer:, 78). The other type of vaccines were AstraZeneca (16) Sputnik V (3) and Sinopharm (3). The median anti-SARS-CoV-2S antibody level was, 2733 U/mL (IQR:, 535–7764) on the, 14th day after vaccination (IQR:, 14–17). Significant differences were revealed between the groups of patients treated with biological agents or non-biological therapy (median:, 1649 U/ml vs., 5711.5 U/ml; p=0.013) and between patients recieving mRNA and non-mRNA vaccine (median:, 3367.5 U/ml vs., 392.6 U/ml;p&lt;0.001). Considering the varying effect of immunosupression related to combination therapy, biological drugs, azathioprin and other non-immunomodulating treatments antibody response were assesed in these groups also. The median antibody levels were, 850,5 U/ml (IQR:, 251.0–4899.5), 1837 U/ml (IQR:, 544.5–5902), 3141 U/ml (IQR:, 1066–7988), 7764 U/ml (IQR:, 5601–13808) demonstrating significant differences among them (p&lt;0.001). No correlation between anti-TNF-alpha serum level and antibody response were found.

Conclusion
Altough all vaccines cause seroconversion in IBD patients who are in remission, the rate of seroconversion is lower in patients treated with immunosupressant, biological agent or combo therapy or recieving non-mRNA vaccines. As the level of anti-TNF-alpha agents do not affect the rate of seroconversion there is probably no need for matching the time of vaccination and anti-TNF therapy.
P421 Correlation of bowel activity parameters in intestinal ultrasound to drug retention and trough drug levels in Crohn’s disease
Authors: Albshesh A , Ungar B , Kopylov U , Ben-Horin S , Carter D 
Published: January 2022

Abstract

Background
Introduction: Intestinal ultrasound can be used to assess transmural healing and response in Inflammatory bowel disease (IBD). Bowel wall thickness (BWT) appears to be the most applicable parameter for defining inflammation. Other parameters include amplified color Doppler signal, disappearance of the normal bowel wall layers and proliferation of mesenteric fat. The implication of incorporating these parameters in defining transmural healing and response is not clear. Our aim was to examine the significance of combining these parameters with BWT for defining transmural healing and response.

Methods: Methods
A post-hoc analysis of data from, 2 trials was used to examine the correlation of the different IUS parameters on drug retention and trough drug levels.

Results: Results
The study cohort included, 94 patients (median age, 24.5) with Crohn’s disease., 44 patients were treated with adalimumab (ADA) and, 50 with infliximab (IFX). There was a significant correlation of failure of drug retention and terminal ileum (TI) BWT &gt;, 3 mm (P=0.07), amplified doppler sign (p&lt;0.001), abnormal bowel wall stratification (p=0.005) and fat hypertrophy (p=0.001). This correlation remained significant when adding any other single abnormal parameter to the BWT (p&lt;0.001), 2 abnormal parameters (p&lt;0.001) or, 3 abnormal parameters (p=0.003). There was also a significant correlation between sufficient trough drug levels (ADA&gt;7.1, IFX&gt;5) and terminal ileum BWT &lt;, 3 mm (P&lt;0.001). However, there was no significant correlation between sufficient trough drug levels and the other ultrasonographic parameters and no significant correlation when combining any other ultrasonographic variables with the BWT.

Conclusion
Conclusions: Increased BWT was correlated with failure of drug retention. The addition of other ultrasonographic activity parameters did not significantly improve the predictive model. Therefore, TI-BWT should be used as the main target in the definition of transmural healing and response.
P423 Azathioprine still remains the first step-up therapy in patients with Inflammatory Bowel Disease in low-middle income countries
Authors: Ranjan M K , Kumar P , Vuyyuru S K , Kante B , Sahu P , Mundhra S , Golla R , Singh M , Virmani S , Sharma R , Panwar R , Das P , Makharia G , Kedia S , Ahuja V 
Published: January 2022

Abstract

Background
Inflammatory bowel disease (IBD) including Ulcerative Colitis (UC) and Crohn’s Disease (CD) is characterized by remitting/relapsing course. A proportion of patients with UC, and almost all patients with CD require long-term immunosuppression to maintain endoscopic and clinical remission and prevent disease progression. The present study aimed to evaluate the long-term efficacy of thiopurines, their predictors, and the effect of the early use of thiopurines on disease outcomes in patients with IBD.

Methods
A retrospective cohort analysis of patients with IBD following up in IBD clinic at AIIMS, New Delhi, India from, 2004–2020. Efficacy was defined as a state of not requiring hospitalization, anti-TNF agents, surgery, and only minimum (≤, 1 steroid course in, 2 years) steroid requirement during follow-up. Early and late thiopurine initiation was defined as commencement of thiopurines ≤2 and &gt;2 years of disease onset, respectively.

Results
Of, 1264 consecutive patients on thiopurines (both, 6-MP and azathioprine), 988 (UC:720, CD:268) were considered for efficacy analysis (males-60.8%, mean age at disease onset-31.69±12.34 years and thiopurine initiation-35±13.14 years). Time to event analysis showed a median efficacy rate of, 79%, 72% and, 68%, 61% at, 5 and, 10 years in UC and CD patients respectively after thiopurine initiation. On multivariate analysis, only the male sex was found to be a significant predictor of relapse (HR:, 1.49, 95% CI:, 1.021–2.194; P=0.039) in UC and Ileal involvement (HR:, 0.391, 95% CI:, 0.176–0.86; P=, 0.021) and steroid-dependent disease (HR:, 0.429, 95% CI:, 0.186–0.965; P=, 0.041) were associated with decreased risk of relapse and presence of any adverse event was associated with increased risk of relapse (HR:, 2.37, 95%CI:, 1.39–4.05; P=0.008). Kaplan Meier survival analysis showed no difference between the efficacy of early and late thiopurine groups, both in UC (Log-rank test P = 0.72) and CD (Log-rank test P = 0.76).

Figure, 1: Kaplan Meier curve showing relapse-free survival on thiopurine in ulcerative colitis and Crohn’s disease.
Figure, 2: Kaplan Meier survival analysis comparing relapse-free survival in early vs late thiopurine initiation group in UC (Log-rank test P = 0.72).

Figure, 3: Kaplan Meier survival analysis comparing relapse-free survival in early vs late thiopurine initiation group in CD (Log-rank test P-value:, 0.764).

Conclusion
Thiopurines still remains a viable long-term option for maintenance of remission in patients with IBD, especially in resource-limited countries. Their use can be further enhanced by optimizing their therapy and regular monitoring for adverse events.
P426 Association Between vedolizumab therapy outcome and Pre-treatment DUBLIN Score & CRP-Albumin Ratio in Ulcerative Colitis
Authors: McCormick E , Singh P , Kevans D 
Published: January 2022

Abstract

Background
The DUBLIN score is a measure of ulcerative colitis (UC) inflammatory burden and is associated with clinical outcomes. A high CRP/albumin ratio (CAR) is associated with disease severity in IBD. The aim of our study was to evaluate if there was an association between vedolizumab therapy outcome and pre-treatment DUBLIN score and CAR in UC.

Methods
35 patients with UC initiating vedolizumab with available pre-treatment DUBLIN score and CAR data were identified. Baseline characteristics, biochemistry and endoscopic findings were defined by retrospective review. A previously validated DUBLIN score threshold of ≥3 and CAR threshold &gt;0.6 were utilised to categorise patients with high inflammatory burden. Clinical response at, 3-months and corticosteroid-free remission at, 6-months were recorded. The association between, 3-month clinical response and, 6-month remission rates & pre-treatment DUBLIN score and CAR ratio were evaluated. P values &lt;0.05 were considered significant.

Results
Baseline characteristics of the study cohort: age [median, range], 53 [19 -87] years;, 60% male; disease duration [median, range], 11 [2–41] years. A pre-treatment DUBLIN score ≥3 and CAR &gt;0.6 were observed in, 65% and, 51% of patients respectively., 3-month clinical response and, 6-month corticosteroid-free remission rates were observed in, 79% and, 67% of the cohort respectively. There was no significant difference between rates of, 3-month clinical response and, 6-month corticosteroid-free remission comparing high and low pretreatment DUBLIN score and CAR groups, p=0.59 and p=0.16 respectively.

Conclusion
Vedolizumab was an effective therapy in patients with a significant inflammatory burden assessed by DUBLIN score and CAR. Pre-treatment DUBLIN score and CAR were not associated with therapy outcome.
P445 Is objective disease monitoring strategy tailored to the presence of clinical symptoms, a prospective cohort study from a tertiary IBD center from Hungary
Authors: Lontai L , Gonczi L , Komlodi N , Balogh F , Barkai L , Ilias A , Lakatos PhD P L 
Published: January 2022

Abstract

Background
Emerging data suggest that a treat-to-target approach and early therapeutic intervention using regular objective disease assessment leads to improved outcomes. Our aim was to evaluate the value of objective disease monitoring during regular follow-up.

Methods
Patients presenting in our IBD center between January and December in, 2018 were included and followed up for, 1 year. Data from clinical visits, clinical disease activity using Crohn’s Disease Activity Index and partial Mayo Score, biomarkers (CBC, CRP, FCAL), stool culture, colonoscopy/sigmoidoscopy, CT/MRI scans, abdominal US, total number of visits, hospitalization or surgery rates, and change in medical therapy were collected. We compared monitoring strategy according to the clinical disease activity in the given quarter-year period based on the patient’s status of clinical disease activity (remission/ flare / post-flare/ continuous activity).

Results
N=161 patients were included (CD:118/UC:43; male:, 56%), with predominantly moderate-to-severe disease phenotype (70% on biological therapy). In total, n=644 quarter year periods (n=, 554 with patient visit) were evaluated (remission, 57%; continuous activity, 19%; post-flare, 11%; flare, 13%). CBC and CRP were performed in, 82.9% and, 83.9% of all patients with at least one clinical visit in a quarter-year period, regardless of clinical activity in IBD. Colonoscopy was performed in patients with flare or continuous disease activity in, 21.1% and, 18.9%, but, 10.1% of the patients in clinical remission also underwent colonoscopy in a given quarter-year period. In a sub-analysis of UC patients, 24.1% of the patients presenting with disease flare had colonoscopy in a given period. Stool culture and C.difficile stool tests were performed in, 17.2% of UC patients with flare. CT scans were performed at a low rate of, 2.4% in CD patients with disease flare, while MRI scans were similar in all subgroups of CD patients (7.7–16.7%)., 13.2% of patients with cont. activity and, 24.5% of patients with flare needed initiation or dose optimization of corticosteroids, while biological start or dose optimization was needed in, 31.1% and, 33.8% in a given quarter-year period. Mean number of follow-up visits per quarter-year period was high(1.6) even for patients in remission, and, 2.4 in flare.

Conclusion
Our study confirmed the use of regular objective biomarker monitoring, independent of clinical activity. We report high utilization of c-scope/sigmoidoscopy as well as MRI (in CD) in the objective evaluation of patients with clinical symptoms or even as part of routine monitoring. CT was reserved for emergency situations, while the use of US was relatively low. Objective monitoring resulted in frequent and early optimization of the therapeutic strategy.
P448 Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis
Authors: Kim K , Hong H S , Oh K , Lee J Y , Hong S W , Park J H , Hwang S W , Yang D H , Byeon J S , Ye B D , Myung S J , Yang S K , Park S H 
Published: January 2022

Abstract

Background
We aimed to investigate the efficacy of oral beclomethasone dipropionate (BDP) as an add-on therapy to concomitant drugs and to clarify the predictive factors for response to oral BDP in Korean patients with ulcerative colitis (UC).

Methods
Patients with a stable concomitant drug regimen with exposure to oral BDP (5 mg/day) within 30 days before initiation were included. The partial Mayo score (pMS) was used to evaluate response to oral BDP. Clinical remission (CREM) was defined as a posttreatment pMS ≤1 point. Clinical response (CRES) was defined as an at least 2-points decrease in the posttreatment pMS and an at least 30% decrease from the baseline pMS. Patients without CREM or CRES were considered nonresponders (NRs).

Results
Of total 100 patients, 37 showed CREM, 19 showed CRES, and 44 were NRs (Table 1). The CREM group included more patients with mild disease activity (75.7% vs. 43.2%, P=0.011) than the NR group. In contrast to NR group, responders including CREM and CRES showed significant improvement of posttreatment ESR and CRP (ESR with P=0.001, CRP with P=0.004, respectively). Moreover, initial rectal bleeding subscore (RBS) was significantly different between CREM and CRES, or NR (both with P&lt;0.001). In multivariate logistic regression analysis, initially mild disease activity was the only predictive factor for CREM (odds ratio, 3.580; 95% confidence interval, 1.342–9.548) (Table 2).

Conclusion
Oral BDP is efficacious as an add-on therapy in Korean UC patients. In case of acute aggravation, patients with mild disease activity, especially low RBS, may be good candidates for oral BDP.
P453 Underutilisation of novel and alternative oral iron preparations may incur unnecessary cost in iron deficiency anaemia treatment in inflammatory bowel disease
Authors: Sharma E , Kotecha J , Akintimehin A , Ray S , Anderson S H , Mawdsley J , Irving P M , Samaan M A 
Published: January 2022

Abstract

Background
Iron deficiency anaemia (IDA) is a common extraintestinal manifestation of inflammatory bowel disease (IBD). Ferric salts are the cheapest preparations at approximately £2 per treatment course compared to more costly alternative oral preparations including ferric liquid (£30) and ferric maltol (£140) which tend to be better tolerated. Intravenous (IV) treatment costs approximately £1500 including the infusion cost. The aim of this service evaluation was to review local practices related to the treatment of IDA in IBD according to a locally developed iron pathway to help guide more efficient healthcare utilisation in this regard.

Methods
We performed a retrospective review of prospectively collected clinical records of 124 patients with IBD (47 (38%) UC, 71 (57%) CD and 6 (5%) IBDU) who received IV ferric carboxymaltose (Ferinject) between April 2019 and March 2020. Demographic data, previous oral iron use, reason for referral and dose received were recorded. The history of oral iron use, haemoglobin (Hb) at time of referral and local iron treatment pathway (Figure 1) were used to determine whether patients were suitable for an alternative iron formulation.

Results
The majority (94, 76%) of the cohort (described in Table 1) were receiving advanced IBD therapies and 56 (45%) had undergone prior surgery. Reasons for referral were marked IDA (54 (44%)) unsuitability for oral iron (54 (44%)) or other / no stated reason (16 (12%)). 109 (88%) patients received the full calculated dose of whom 48 (44%) required two visits and 61 (54%) required one visit to the infusion unit in order to receive their full IV iron treatment. Hb at referral is described in Table 2; the majority of patients (78, 63%) had mild IDA (Hb 100–139 g/L). Sixty-four (52%) patients had previously tried ferric salts, 6 (5%) received ferric liquid and 13 (10%) had previously tried ferric maltol. Forty (33%) patients who received IV iron were suitable for standard oral iron and a further 68 (56%) patients were suitable for ferric maltol.

Conclusion
Our cohort was largely on advanced therapies suggesting the need for closer monitoring of IDA in this cohort. Ferric liquid and ferric maltol appear underutilised in patients who have not tolerated ferric salts and offer significant cost savings compared to IV iron preparations. Depending on its effectiveness, if ferric maltol was prescribed over IV iron in those in whom it was suitable this would correspond to a cost saving of up to £93,000. More frequent use of these oral iron preparations, according to the local pathway, would also facilitate more efficient use of IBD infusion unit capacity.