bluuebunny/crossref_metadata_2025_split huggingface dataset:
P146 Initial response to induction treatment more important than type of induction treatment for achieving sustained steroid free remission at 1 year in new-onset paediatric Crohn’s disease
Authors: Klomberg R , van der Wal H , Sarbagili C , Kemos P , Ruemelle F , Croft N , de Ridder L , Levine A 
Published: January 2022

Abstract

Background
For paediatric patients with high risk of complicated Crohn’s disease (CD) [stricturing or penetrating disease], paediatric guidelines recommend upfront anti-tumor necrosis factor-alpha (ATA). Early ATA therapy has been demonstrated to result in higher steroid- and surgery-free remission rates at 1 year than induction with conventional treatment (CONV) [Exclusive Enteral Nutrition (EEN) or corticosteroids followed by immunomodulatory therapy]. However, it is unknown whether either type of induction treatment or achieving steroid free remission (SFR) at 3 months is a more important predictor of sustained SFR (SSFR) at 1 year. Therefore, we aimed to evaluate the independent effect of early ATA use after achieving induction of remission on sustained SFR (SSFR) rates at 1 year in an international prospective observational study.

Methods
Since January 2017, children (0–18 years) with newly-diagnosed CD were prospectively enrolled in 28 European and Asian paediatric IBD centers. Extensive demographic and clinical data were collected at baseline, and at 1, 3, 6 and 12 months. The primary outcome was SSFR at 1 year, defined as a weighted Paediatric CD Activity Index (wPCDAI) &lt;12.5 without steroids at 3, 6, and 12 months. Secondary outcomes included SFR at 3 and 12 months, and treatment escalation to ATA. Outcomes were compared between the early ATA induction treatment group (defined as ATA within 3 months after diagnosis) and the CONV induction treatment group (EEN or corticosteroids), using χ 2 tests.

Results
Up to July 2021, 235 children with new-onset CD were included and completed at least 1 year of follow-up (61.7% male, median age 13.7 [IQR 11.4–15.0]). At 1 year, 62/203 (30.5%) achieved SSFR. Patients that received early ATA were more likely to achieve SSFR compared to patients with CONV (35/79 [44%] vs. 27/110 [25%], p=0.004). After induction treatment, 99/213 [47%] achieved SFR at 3 months. Patients with early ATA had higher rates of SFR at 3 months (48/84 [57%]) than those with CONV (51/129 [40%], p=0.012), and higher rates of low faecal calprotectin (67% vs. 17%, p&lt;0.001) or low CRP (&lt; 5 mg/l) (82% vs. 53%, p&lt;0.001). Of those patients in SFR at 3 months, 71% achieved SSFR, which was not significantly different between those in SFR at 3 months with early ATA vs. with CONV (35/45 [78%] vs. 27/43 [63%], p=0.12).

Conclusion
While only one-third of paediatric CD patients achieve SSFR at 1 year, 71% of patients achieve SSFR after having achieved SFR at 3 months. Patients with early ATA had higher rates of SFR at 3 months and SSFR at 1 year than those without early ATA. Remission at 3 months was found to be more important for SSFR than type of induction treatment, highlighting the importance of initial response to induction treatment.
P153 The impact of seton use on clinical and patient-reported outcomes in Crohn’s disease perianal fistulas: findings from a systematic literature review
Authors: White I , Karki C , Geransar P , Worsfold A , Leisle L , Junker S , Fleshner P 
Published: January 2022

Abstract

Background
Complex perianal fistulas are a common complication of Crohn’s disease, and are treated with both surgical and medical intervention. Irrespective of treatment strategy, seton placement is used to facilitate fistula drainage and prevent recurrent abscess formation. The aim of this systematic literature review was to summarize available evidence on clinical outcomes associated with seton use for symptomatic relief and treatment of complex Crohn’s perianal fistula (complex CPF).

Methods
Electronic databases (MEDLINE, Embase, EBM Reviews and Econlit) were searched for articles (1980–present) reporting data on the use of seton in patients with complex CPF. Seton use as a preparatory procedure for surgery was excluded. Articles were screened for relevance using pre-defined PICOS-T criteria and data on outcomes of interest including clinical remission, fistula recurrence, adverse events, and patient-reported outcomes (PROs) were extracted. Data were summarized qualitatively and analysed using descriptive statistics.

Results
Overall, 56 articles underwent data extraction (43 full texts, 13 congress abstracts; 50 observational studies, 6 clinical trials). Duration of seton use was reported in 23 studies (range: 4–277 weeks). Clinical response and/or remission following seton use or seton use + biologics were defined by 35 articles. Definitions were variable, with most relating to fistula closure, symptom improvement or cessation of fistula drainage. Remission rates in patients treated with seton only and seton + infliximab were 13–75% (9 articles) and 23–100% (14 articles), respectively (Figure). Definitions of recurrence (e.g. fistula discharge or reopening) were reported in 16 observational studies and varied. Most articles defined clinical outcomes (e.g. prior removal of seton, closure or healing of the fistula tract, or response) before recurrence was measured. Overall, recurrence rates in patients treated with seton only and seton + infliximab were 4–68% (9 articles) and 0–50% (12 articles), respectively (Figure). The rate of recurring abscesses (3 articles) or local sepsis (2 articles) and the frequency of new abscess (7 articles) or fistula development (3 articles) was 7–43%, 31–61%, 10–47% and 9–26%, respectively. Rates of adverse events or complications after seton use (14 articles) ranged from 0–77%. PROs measuring functional outcomes, faecal incontinence and quality of life were reported by 6 articles.

Conclusion
Owing to a lack of standardized definitions for clinical outcomes following seton use in complex CPF, comparison of study results was not possible. Standard clinical outcome definitions are needed to permit data comparability, and are vital to guide treatment plans to improve outcomes for patients with complex CPF.
P155 Incidence and significance of vitamin D deficiency at Inflammatory Bowel Disease inception in the COVID era
Authors: Rimmer P , Cheesbrough J , Palmer L , Meade I , Zaman Mim M T , Mohamed Z , Shariff S , Sharma N , Cooney R , Quraishi M N , Iqbal T 
Published: January 2022

Abstract

Background
Vitamin D, a key regulator of immune response, is known to be lower in Inflammatory Bowel Disease (IBD) patients than the general population. Disparity in the incidence of deficiency between ethnic groups has previously been demonstrated. We measured vitamin D in a unique multi-ethnic inception cohort to correlate this with traditional IBD scores and patient reported outcome measures including the ‘IBD Disk’.

Methods
Data regarding demographics, ethnicity, faecal calprotectin (FCAL) and baseline blood results including Vitamin D was collected prospectively from January-October 2021, from adults presenting with suspected IBD. Montreal classification, Harvey-Bradshaw Index or Partial Mayo score, endoscopic disease severity indices and IBD Disk score were documented in those with confirmed diagnosis at endoscopy. Vitamin D deficiency was defined as &lt;50nmol/l.

Results
179 patients had a Vitamin D level recorded; 58 Ulcerative colitis (UC), 58 Crohn’s disease (CD), 53 non-IBD controls and 10 still awaiting diagnosis. 44(76%) CD, 32(55%) UC and 28(53%) non-IBD control patients were Vitamin D deficient at first presentation. Median levels were lowest in CD, with a significant difference between CD and non-IBD (median 35nmol/l; IQR 24.05 vs. median 48.9nmol/l; IQR 49.1; p=0.004). Regression analysis demonstrated patients with Crohn’s disease were four times more likely to have Vitamin D deficiency compared to UC (OR 4.08; 95% CI 1.35–12.36) at diagnosis. No correlation was seen between absolute vitamin D levels or vitamin deficiency state and faecal calprotectin when controlled for various factors regardless of the IBD subtype. The cohort distributions are demonstrated in Figure 1.

Within the IBD cohort, Vitamin D levels were significantly lower in Black or Asian patients vs White patients (median 28.5; IQR 20.85 vs median 43.3; IQR 33.95; p=0.004). Figure 2 provides an overview of the cohort distributions.

Vitamin D levels at presentation, as demonstrated in Table 1, did not correlate with Disease activity markers (DAMS) whereas baseline haemoglobin did, albeit weakly. Interestingly, Vitamin D and Haemoglobin correlated without reaching statistical significance (Spearman’s rho 0.149; p=0.08).

Conclusion
Our inception dataset demonstrates high rates of Vitamin D deficiency comparable to prior studies in IBD patients. Both CD and Black or Asian ethnicity were strongly associated with Vitamin D deficiency. Baseline Vitamin D did not correlate with disease activity markers whereas anaemia showed consistent weak association. Our study demonstrates the problem of hypovitaminosis D and the importance of measurement and supplementation, particularly in Black and Asian CD patients, from diagnosis.
P158 Disease and non-disease-related risk factors for inadequate bowel preparation in patients with inflammatory bowel disease: should the strategy be different?
Authors: Capela T , Macedo Silva V , Freitas M , Sousa Magalhães R , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J 
Published: January 2022

Abstract

Background
Colonoscopy is of utmost importance in the management of inflammatory bowel disease (IBD) and is a critical tool for diagnostic and therapeutic decision-making. The quality of bowel preparation is important for the efficacy of colonoscopy and inadequate bowel preparation (IBP) is associated with increased costs and inconvenience. Most studies on IBP have not specifically evaluated the impact of concomitant conditions, such as IBD, on the quality of bowel preparation. We aimed to identify disease and non-disease related factors for IBP in patients with IBD submitted to colonoscopy.

Methods
Retrospective cohort-study which included adult IBD patients submitted to colonoscopy between 2016–2021. Patients’ demographic, comorbidities, clinical, biochemical, and colonoscopy data were recorded. IBP was defined as a final Boston Bowel Preparation Scale (BBPS) ≤5 or ≤1 in at least one segment. A univariable analysis tested the association between covariables and the outcome (IBP) in general and considering Crohn’s disease (CD) and ulcerative colitis (UC) patients separately. Statistically significant variables were included in multivariable logistic binary regression.

Results
Of 309 patients, 52.4% were female with a mean age of 43.7±13.7 years. Fifty one percent (n=158) had UC and 48.9% (n=151) had CD. Twenty-seven percent of the patients (n=82) had IBP which was not significantly different between UC and CD patients (40vs42, p=0.699, respectively). The presence of diabetes mellitus (adjusted OR 13.9 [95% CI 1.388–139.624], p&lt;0.05) and antidepressant use (adjusted OR 4.1 [95% CI 1.247–13.625], p&lt;0.05) were independently associated with the outcome in general. In contrast, only previous history of IBP (adjusted OR 3.1 [95% CI 1.184–8.271], p&lt;0.05) was independently associated with the outcome in UC patients. Disease-related factors such as previous surgery, steroids, immunosuppressors or biologics and endoscopic activity were not associated with IBP.

Conclusion
This study demonstrates that the presence of diabetes mellitus and antidepressant use are predictors of inadequate bowel preparation for colonoscopy in patients with inflammatory bowel disease. Disease-related factors seem to have no influence in the quality of bowel preparation suggesting that a specific approach is unnecessary in these patients.
P163 Abdominal X-ray: an invaluable tool in Acute Severe Ulcerative Colitis
Authors: Correia J , Gomes C , Afecto E , Estevinho M , Rodrigues A , Silva A P , Fernandes C , Ponte A , Silva J C , Freitas T 
Published: January 2022

Abstract

Background
Intravenous steroids (IV-S) remain the cornerstone of treatment of Acute Severe Ulcerative Colitis (ASUC). However, one-third of these patients are refractory to this treatment. Several indices have been developed to predict the failure of IV-S for ASUC, using clinical data at day 3 of treatment. However, indices able to predict IV-S failure based on admission data are lacking.

Methods
A retrospective analysis of all consecutive hospital admissions due to ASUC, in a Portuguese tertiary centre, between February 2007 and April 2021 was performed. Only patients receiving IV-S for at least 3 consecutive days were included in this study. IV-S non-response was defined as the need for a second-line therapy or surgery. The following clinical data was collected from each patient: age, gender, disease duration, Montreal disease extension, previous ASUC, previous and on admission medical therapies (oral mesalazine, rectal mesalazine, oral steroids, immunosuppressants and monoclonal antibodies), fever on admission and weeks of symptoms’ worsening before admission. The following parameters on admission were also registered: C-reactive protein, albumin level, hemoglobin, leucocytes count, platelets count, Mayo endoscopic subscore and presence of transverse colonic dilatation on abdominal X-ray ≥5.5 cm. Univariate analysis was used to identify predictive factors of IV-S failure.

Results
68 patients (64.7% female), with a mean age of 40.4 (±16.2) years, were included in this study. 9 patients (13.2%) did not respond to IV-S therapy. On univariate analysis, only transverse colonic distension on X-ray was more frequent in IV-S non-responders (33.3% vs 6.8%, p=0.04).

Conclusion
Clinical data on admission, including previous medication, analytical parameters and endoscopic activity were not predictive of IV-S refractoriness in this population. However, abdominal X-ray showed to be useful to predict the need for a rescue therapy. These findings highlight, in one hand, the need of larger studies to identify on admission predictors of IV-S refractoriness and, in other hand, the importance of abdominal X-ray, in patients admitted due to ASUC.
P172 Examining dysplasia surveillance in Inflammatory Bowel Disease and Primary Sclerosing Cholangitis - a real world experience
Authors: Seah D , Gow P , Vaughan R , Grace J , De Cruz P , Choy M 
Published: January 2022

Abstract

Background
Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are at high risk of developing colorectal cancer (CRC). Current guidelines recommend annual colonoscopic surveillance immediately following the diagnosis of PSC. This study aimed to assess the surveillance strategy and outcomes in IBD-PSC patients undergoing surveillance for colonic neoplasia (CN).

Methods
We performed a retrospective audit of all patients with IBD-PSC at an IBD and liver transplantation referral centre from 2013–2021, to determine the prevalence and management of dysplasia and CRC and evaluate the adequacy of colonoscopic surveillance. Surveillance was considered up-to-date if colonoscopy was performed at 12 month intervals +/- 3 months.

Results
Ninety-three patients diagnosed with IBD-PSC were identified. Patients who had undergone colectomy prior to enrolment or had colonoscopy performed externally were excluded. Sixty-nine patients were included in the final analysis. Thirty-three percent (23/69) of the cohort developed CN, with an overall rate of dysplasia of 25% (17/69) and CRC in 10% (7/69). Median time to development of CN from IBD diagnosis was 18 years (IQR 10.5–23.75). Only 23% (12/53) of patients were up-to-date with annual colonoscopic surveillance and following detection of neoplasia, chromoendoscopy was utilised in 9% of patients (2/23).
The rate of CN in patients with up-to-date surveillance was 6/12 (50%), three with low grade dysplasia (LGD) and three indefinite for dysplasia (IND), versus 10/41 (24%, p=0.89) in those without up-to-date surveillance, 6 with LGD, 1 with IND and 2 with CRC.
Rates of CN were not significantly different between patients who had or had not undergone liver transplantation (18/44 (41%) vs 6/25 (24%), p=0.16). Most patients were managed in Liver Transplant Unit (LTU) clinic (33/69, 48%). Forty-one percent (28/69) were seen in both LTU and IBD clinics, whilst a small number were seen in General Liver clinic (3/69, 4%) and IBD clinic (5/69, 7%) only. The rate of up-to-date surveillance was highest amongst those who were seen in both LTU and IBD clinics (8/28, 29%). In patients with CN, surgery was performed in 46% of cases (11/24): 25% (6/24) underwent sub-total colectomy; whereas, 21% (5/24) underwent segmental colectomy. Two patients developed recurrent dysplasia following segmental colectomy.

Conclusion
In this cohort of IBD-PSC, rates of dysplasia and CRC were high. Adherence to annual colonoscopy surveillance and chromoendoscopy was low. Surgical management of dysplasia or CRC varied. Multidisciplinary coordination between hepatology and IBD specialist services should be implemented to optimise dysplasia surveillance and management.
P199 Ileal pouch-anal anastomosis in women of childbearing age affected by ulcerative colitis: a single-centre study on the risk factors for infertility and outcomes of pregnancy over 17 years
Authors: Rottoli M , Pezzuto P , Fallani G , Pellino G , Rizzello F , Gionchetti P , Poggioli G 
Published: January 2022

Abstract

Background
The impact of Ileal Pouch-Anal Anastomosis (IPAA) on the fertility of women affected by ulcerative colitis (UC) is still debated in the literature. The primary aim of this study was to assess the risk factors for infertility in women undergoing IPAA. The second aim was compare the outcomes of pregnancy before and after IPAA.

Methods
Retrospective study including women (18–45 years) undergoing IPAA for UC (2004–2020). Univariate comparison was carried out as appropriate. Cox regression analysis was used to identify significant predictors of infertility over the follow-up (defined as the conceiving time starting one year after IPAA surgery).

Results
Some 149 patients answered the questionnaire and were included in the study. Table 1 shows the comparison between fertile (23, 15.5%) and infertile (20, 13.4%) women after IPAA surgery. At the cox regression analysis, only the Mayo endoscopic score of 3 was associated with the risk of postoperative infertility (OR 4.16, 95% CI 1.07–16.6, p=0.040).

Table 2 shows the comparison between pregnancies before (72) and after (27) IPAA. Pregnancies after IPAA were more likely to require assisted conception treatment (25.9% vs 2.7%, p&lt;0.001), and to be carried out without any UC drug regimen (85.2% vs 61.1%, p=0.17), since they were less likely to trigger an exacerbation of the disease both during (8% vs 22.2%, p=0.09) and after pregnancy (24% vs 45.8%, p=0.044).

Of the 61 nulliparous women who did not try to conceive after IPAA, 11 (18%) feared physical consequences, 10 (16.4%) were afraid to transmit the disease, while 3 (4.9%) were recommended by their gynecologist.

Conclusion
IPAA surgery is associated with a reduction of the fertility of 46.5%, and the preoperative severity of the disease seems to be the strongest predictor of infertility. Although the pregnancy after IPAA requires a longer conceiving time, it is safe for both the mother and the child, at least when carried out through caesarean delivery. A great proportion of women of childbearing age affected by UC still refer confusion regarding the risks of complications and infertility associated with IPAA. A dedicated counsel pathway should be mandatory in all referral centres. A larger multicentric study will be required to assess the outcomes in a larger population.
P213 Risk factors associated with NAFLD and liver fibrosis in patients with Inflammatory Bowel Disease: a prospective cohort study
Authors: Martínez-Domínguez S J , García Mateo S , Gallego Llera B , Gargallo-Puyuelo C J , Refaie E , Arroyo Villarino M T , Laredo de la Torre V , Alfambra Cabrejas E , Gomollón García F 
Published: January 2022

Abstract

Background
Non Alcoholic Fatty Liver Disease (NAFLD) prevalence is increasing quickly all over the world. A higher prevalence has been reported in Inflammatory Bowel Disease (IBD) patients. NAFLD is associated with increased mortality from liver and cardiovascular causes, so defining risk factors is clinically very relevant.

Methods
Consecutive IBD patients ≥ 18 years were evaluated at a reference center from October 2020 to April 2021, after giving their informed consent. They were investigated the presence of NAFLD by hepatic ultrasonography and Controlled Attenuation Parameter (CAP) performed by two trained gastroenterologists, considering steatosis in case of any degree of ultrasound steatosis or CAP &gt; 245 dB/m. Risk of advanced liver fibrosis was considered if transient elastography was ≥ 8 kPa. Patients with risk alcohol consumption, secondary causes of steatosis or any chronic hepatic disease were excluded. In addition, a blood sample was obtained for biochemical parameters, clinical variables were recovered prospectively and medical records were reviewed. A descriptive analysis was carried out and factors potentially associated with NAFLD and liver fibrosis were analysed through logistic regression multivariate analyses. For all tests a two-sided p value &lt;0.05 was considered statistically significant. The study was approved by local Ethical Committee.

Results
700 patients (50% women) with a median age of 50 (IQR (40–60)) years were included. In 377 (53.9%) the diagnosis was Ulcerative Colitis and in 323 (46.1%) Crohn′s Disease, the median age at diagnosis was 33 (IQR (22–42)) years. 131 (18.7%) had obesity and 238 (34%) had overweight. The prevalence of NAFLD was 42.57% and the prevalence of liver fibrosis was 7.31%.
In multivariate analysis, NAFLD was significantly associated with older age (OR (CI 95%) 1.04 (1.02–1.06), p &lt;0.001), obesity/overweight (OR (CI 95%) 0.26 (0.17–0.39), p &lt;0.001), waist-to-hit ratio (OR (CI 95%) 0.32 (0.21–0.48), p &lt;0.001) and absence of active lifestyle (OR (CI 95%) 2.41 (1.44–4.05), p&lt;0.001). No significant association was found between NAFLD and type of IBD, location, extension, pattern or the treatment of the disease. Hepatic fibrosis was significantly associated with hypertension (OR (CI 95%) 0.07 (0.10–0.45), p= 0.006) and surgical reintervention for IBD (OR (CI 95%) 6.41 (1.06–38.83), p= 0.043) in multivariate analysis, without significant association with other comorbidities, type and location of IBD or pharmacological treatment.

Conclusion

NAFLD is very prevalent in IBD and seems to be associated with the same risk factors than in the general population. Screening for NAFLD seems warranted in all IBD patients.