bluuebunny/crossref_metadata_2025_split huggingface dataset:
P171 PSC/IBD and IBD have similar type and location of colonic lesions, but Dye ChromoEndoscopy (DCE) increases detection rate compared to White Light Endoscopy (WLE)
Authors: Labarile N , Parigi T , Smith S C , Hejmadi R , Nardone O M , Cannatelli R , Shivaji U , Ghosh S , Iacucci M 
Published: January 2022

Abstract

Background
Inflammatory bowel disease (IBD) increases the risk of colorectal cancer proportionally to the extent and duration of the disease. Moreover, up to 5% of IBD patients have concomitant PSC, an additional risk factor, especially for right colon cancer. To mitigate this risk patients with PSC-IBD undergo stricter annual surveillance colonoscopy. We aimed to analyze differences in incidence, location and type of lesions detected during surveillance colonoscopies in PSC/IBD and only IBD. In addition, we assessed the impact of dye spray chromoendoscopy on detection rates.

Methods
In a retrospective single-center study, we collected all surveillance colonoscopies performed at Birmingham University Hospital between January 2014 and August 2019. The procedures were divided for patient diagnosis in PSC-IBD or IBD-only. Demographic, clinical, endoscopic and histologic data were retrieved from electronic medical records. Categorical variables are presented as absolute and relative frequencies and compared using chi-square test and Fisher’s exact test. Continuous variables are presented as mean and compared by Student t-test after testing for normality.

Results
We retrieved 856 colonoscopies from 622 patients, of these 282 colonoscopies were performed in 147 patients with PSC, the remaining 574 in 475 patients with IBD-only. Demographic data are presented in (Table 1).
In 64 (22%) colonoscopies in PSC/IBD and 173 (30%) in PSC/IBD at least one lesion was found (p=0.02). The total number of lesions was 70 for PSC/IBD (0.248 lesions per procedure) and 226 for IBD-only (0.394 per procedure) (p=0.02). While these differences were statistically significant, PSC/IBD patients had 58% (1.2 vs 1.9) more colonoscopies, due to the stricter surveillance regimen, thus likely reducing the rate of lesions per procedure (Table 2 and 3).
There was no statistically significant difference in histologic type and localization of lesions between the two groups (Table 3).
Dye spray chromoendoscopy (DCE) was used in 52% of procedures in the IBD-only group, and 65% of the PSC-IBD. Colonoscopies with DCE were significantly more likely to detect lesions both in PSC-IBD and IBD-only cohorts (both p&lt;0.05). Table 4.

Conclusion
We found a higher detection rate of colonic lesions in colonoscopies of the general IBD population compared to those PSC-IBD patients, though this might be influenced by the frequency of surveillance. The location and type of polyps were similar between groups. DCE increased the rate of detection compared with no DCE regardless of disease phenotype.
P175 Low relapse rates after biologic therapy discontinuation in a large real life cohort of IBD patients with initial severe disease: do biologics alter the natural history of disease?
Authors: Banerjee R , Pal P , Akki Y , Adigopula B , Reddy D N 
Published: January 2022

Abstract

Background
Discontinuation of biologic therapy has been associated with high risk of relapse. However indefinite biologic therapy is often not feasible in low resource settings of the developing countries where tuberculosis (TB) is endemic and cost is prohibitive. There is very limited data on the course of disease after stopping biologics from this region. We analysed the predictors of relapse including the rate and severity post withdrawal of biologics in a large real-world cohort of patients from India.

Methods
Prospectively collected data of consecutive patients treated with biologics from the IBD registry of a large tertiary care centre from India was analyzed. Demographic and disease characteristics, reasons for biologic discontinuation and relapse rate and severity post withdrawal including its management were analyzed. Cox proportional hazard analysis was done to identify predictors of relapse.

Results
403 patients (Median age-35 yrs, range 6–75, 62.5% male, 58% Crohn’s disease:CD, 42% Ulcerative colitis:UC) received biologics for moderate-severe disease (steroid dependent or with complications) with a median follow up of 23 months (IQR-7–48 m, range- 3–228 m). 274 patients (68%) discontinued biologics. 77(28 %) were primary or secondary non-responders. 65 (24%) stopped due to financial constraints. 98 (36%) stopped after clinical and/or endoscopic remission. The other reasons included TB reactivation 8 (2.6%), non-TB infection-5 (2%); infusion reactions: 4 (1.5%); non compliance 14 (5%), aggravated psoriasis 2(1%) and death(1).
87/274 (32%) relapsed after stopping biologics. 187/274 (68%) were in remission over a median follow up of 24 months (IQR: 10–51 months). 52/87(60%) relapsed in first year and 67/87(77%) in 2 years. Most relapses were mild and responded to steroids 43 (49.4%) or re-treatment with biologics 34 (39%). 10 patients (11%) needed surgery. On Cox proportional hazard analysis, perianal/fistulizing disease (HR-2.03, 95% CI-1.1–3.8, p=0.027) and steroid dependent/resistant disease (HR-1.79, 95% CI-1.1–2.9, p=0.019) were associated with a higher risk of relapse after withdrawal of therapy. Patients who stopped after clinical and endoscopic remission had lower likelihood of relapse after biologics discontinuation(HR-0.48, 95% CI-0.29–0.80, p=0.005).

Conclusion
The relapse rates on discontinuation of biologic therapy was low in patients with clinical and endoscopic remission particularly in non-fistulizing, disease. Most relapses were mild. Majority of the patients with an initial severe disease had a milder course post withdrawal of biologic therapy suggesting that biologics could alter the natural course of the disease. Further multi-centre and long term studies are warranted.
P228 Appendiceal Orifice Inflammation Is Associated with Lower Rate of Complete Endoscopic Remission in Patients with Ulcerative Colitis
Authors: Oh C K , Lee H H , Kim J S , Lee B I , Cho Y S 
Published: January 2022

Abstract

Background
Appendiceal orifice inflammation (AOI) is commonly considered a skip lesion in ulcerative colitis (UC). However, the clinical significance of AOI in UC patients remains controversial. This study aimed to evaluate the clinical feature and long-term outcomes of AOI by comparing UC patients with and without AOI.

Methods
This study was conducted as a retrospective design of patients who were newly diagnosed or referred within 3 months after diagnosis at Seoul St. Mary’s Hospital from January 1, 2001 to December 31, 2020. All patients underwent index and follow-up colonoscopies. The long-term outcomes involved achieving complete endoscopic remission (ER), use of biologics, hospitalization, and proximal disease extension. Complete ER was defined as Mayo endoscopic subscore 0.

Results
In total, 318 UC patients were included, of which 140 had AOI. The baseline characteristics were not significantly different between AOI and non-AOI groups. The cumulative risk of complete ER was a significant difference between AOI and non-AOI groups (p=0.041). The other cumulative risks of disease outcomes were not significantly different between AOI and non-AOI groups (use of biologics, p=0.542; hospitalization, p=0.795; proximal disease extension, p=0.403). The multivariate Cox regression analysis also revealed that AOI was the only significant factor of complete ER (hazard ratio, 0.636; 95% confidence interval, 0.446–0.906; p=0.012) in UC patients.

Conclusion
AOI shows a significant association with lower rate of complete ER in UC patients. Therefore, a meticulous treatment strategy may be recommended to achieve complete ER in UC patients with AOI.
P245 Dynemics of the Immune-transcriptome and Microbiome in Paediatric Inflammatory Bowel Disease
Authors: Elawad M A , Kumar M , Saadaui M , Elhag D , Akobeng A , Al-Mudahka F , Hendaus M , Al Khodor S 
Published: January 2022

Abstract

Background
Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU) is characterized by a chronic relapsing inflammation of the gastrointestinal tract, resulting from the complex interplay between genetic make-up, microbiome, environmental factors, and immune response. The potential role of the immune response and microbiome in the development and progression of IBD has been extensively studied, however, markers that can predict disease relapse remain scarce, especially in children with IBD. Developing non-invasive monitoring tools are also extremely needed in the field.

Methods
Multi-omics analysis provides a global view of changes in immune, microbial, and environmental factors. In this study, we enrolled a total of 85 IBD patients and 57 matching controls living in Qatar and attending Sidra Medicine IBD clinic. Patients were followed- up every 3 months and when they felt unwell. In addition to the phenotypic and clinical data, saliva, blood, and stool samples were collected at each visit. Salivary and gut microbiome analysis was performed using high throughput 16S rRNA gene sequencing. Blood samples were stimulated with a total of 14 ligands before being processed for immune transcriptomics and proteomics. Patients were compared to their matching healthy controls.

Results
Reduced microbial diversity and increased variability in the microbiome composition was observed in both CD and UC patients compared with controls. Our preliminary data show that Bacteroidetes, Firmicutes, Actinobacteria and Proteobacteria are the common phyla present in both patients and controls. Interestingly, the longitudinal microbiome analysis revealed reduced temporal microbial stability in both CD and UC patients, particularly in patients with changes in disease activity. The microbiome composition of patients in remission appeared similar to healthy controls, whereas dysbiosis was mostly observed in patients with increased disease activity. We then characterized the spectrum of transcriptional responses in blood collected from healthy controls and IBD patients stimulated for 6 hours with 14 ligands. Blood transcriptomics analysis separated patients from controls and a clear clustering was observed when the same patient was in relapse or remission. We aim to identify microbial and immune signatures that can classify patients CD, UC and IBD-U and predict onset of both remission and relapse.

Conclusion
This is the first paediatric data to show that, by integrating various multi-omics datasets collected from CD, UC and IBD-U patients and comparing their profiles with their matching controls, we are able to identify specific non-invasive predictive markers for disease remission and relapse.
P275 New non-invasive biomarkers of intestinal inflammation in pediatric inflammatory bowel diseases and their correlation with fecal calprotectin – pilot study
Authors: Szymanska E , Bierla J , Wierzbicka A , Dadalski M , Konopka E , Cukrowska B , Kierkus J 
Published: January 2022

Abstract

Background
Current data indicates that increased intestinal permeability leading to intestinal damage plays a key role in the pathogenesis of inflammatory bowel diseases (IBD) and correlates with disease flare. Therefore, recently, the role of non-invasive biomarkers in both diagnosis and monitoring IBD is emphasized.
Zonulin is the protein that increases permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions.
Fatty acid binding proteins (FABPs) are intracellular proteins expressed in several tissues including intestine. Intestinal FABP (I-FABP) is a plasma and urine marker of intestinal damage.
The aim of this study was to investigate fecal and serum zonulin and I-FABP in pediatric IBD patients and theircorrelation with fecal calprotectin (FCP).

Methods
Seventy-one individuals: 32 Crohn’s disease (CD) patients, 33 ulcerative colitis (UC) patients and 6 controls were examined for fecal and serum zonulin and plasma I-FABP. Values were correlated to FCP and to each other for all children included in the study. A stool specimen and blood samples were collected during check-up visit at hospital. Then fecal and serum zonulin, I-FABP and FCP were tested by ELISA test. Non-parametric statistical tests were used for data analysis.

Results
The level of fecal zonulin and FCP were higher in IBD patients compared to control group (CG): median for CD – 113.6(53.6–150) ng/mL, 46 (7–551) ug/g; UC – 115.3 (50.7–150.4) ng/mL, 40 (16.0–251.2) ug/g; CG – 60.8 (31.8–81.2) ng/mL, 41.5 (31.0–97.7) ug/g, respectively, (P&lt;0.05). No statistically significant difference in concentrations of serum zonulin and I-FABP was reported between patients and CG (P=0.55). The only correlation that has been reported was between fecal zonulin and FCP and the strongest one was in CD: CD – R = 0.73, UC – R = 0.67, All – R=0.67, CG – R=0.65.

Conclusion
Accordnig to our results it seems that only fecal zonulin may serve as another, next to FCP, biomarker of intestinal damage in IBD. However, both fecal and serum zonulin as well as I-FABP need further studies to assess their usefulness in diagnostics and monitoring in IBD.
P284 Prophylactic medication for the prevention of endoscopic recurrence after ileocolonic resection in Crohn’s disease: a prospective study based on clinical risk stratification
Authors: Arkenbosch J H , Beelen E M J , Dijkstra G , Romberg-Camps M , Duijvestein M , Hoentjen F , van der Marel S , Maljaars P W J , Jansen S , de Boer N K , West R , Horjus C , Stassen L P S , van Schaik F , van Ruler O , Jharap B J H , Erler N E , Doukas M , Ooms A H A G , Kats-Ugurlu G , van der Woude J , De Vries A C 
Published: January 2022

Abstract

Background
In patients with Crohn’s disease (CD), postoperative prophylactic medication based on clinical risk stratification is recommended in international guidelines to prevent recurrence after ileocolonic resection (ICR). This study aimed to evaluate the risk of endoscopic recurrence after implementation of a predefined management algorithm after ICR incorporating clinical risk stratification.

Methods
In this multicenter, prospective clinical cohort study, CD patients (≥16 years) were included who were scheduled for ICR and gave informed consent. Endoscopy-guided treatment (no prophylactic medication directly after ICR) was recommended in patients at low risk (LR) of postoperative recurrence, and prophylactic medication (immunosuppressant/biological) in high risk (HR). HR was defined as ≥1 risk factor: smoking, penetrating disease, re-resection. Clinical and histologic risk factors for endoscopic recurrence (Rutgeerts’ score ≥i2) were assessed using logistic regression models and ROC curves based on predicted probabilities.

Results
In total 213 CD patients were included (median age 34.5 years, 65.3% women): 93 (43.7%) at LR and 120 (56.3%) at HR (smoking 45 (21.3%); penetrating disease 51 (23.9%); re-resection 51 (23.9%)). Adherence to the proposed management algorithm was 65%; 76/93 (81.7%) in the LR (no prophylaxis) and 61/120 (50.8%) in the HR population (prophylaxis). Endoscopic recurrence in LR patients was 69% without prophylaxis versus 48% with prophylaxis (p=0.070); in HR 78% without prophylaxis versus 55% with prophylaxis (p=0.019). Clinical risk stratification corresponded with an area under the curve (AUC) of 0.64 (95%CI 0.55–0.73) (Figure 1). Clinical factors combined with histology (active inflammation, granulomas, plexitis in resection margins) increased the AUC to 0.69 (95% CI 0.61–0.88) (Figure 1).

Conclusion
This prophylactic medication algorithm in CD patients based on clinical risk stratification after ICR, results in an absolute risk reduction of endoscopic recurrence of 23% in HR versus 21% increase in LR patients in whom medication is omitted. For this latter population, further refinement of risk stratification is required, and may include histologic assessment.
P318 Safety of Biological Therapies in Elderly IBD: a Systematic Review and Meta-analysis
Authors: Drügg Hahn G , Golovics P , Wetwittayakhlang P , Santa Maria D , Britto U , Wild G , Afif W , Bessissow T , Bitton A , Lakatos PhD P L 
Published: January 2022

Abstract

Background
There was a significant progress in the medical therapy of inflammatory bowel diseases(IBD) with the advent of biological compounds, yet patients may experience adverse events(AE): infusion/injection reactions, infections and malignancies, understudied in vulnerable patient populations (e.g. elderly).

Methods
We systematically searched PubMed/Medline and conferences proceedings between January, 1, 2010, and June, 1, 2021, to identify eligible studies that examined the safety of biologic therapies in elderly patients with IBD. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Search was focused on MESH Terms including IBD/CD/UC, biological therapy, adverse events, infections, infusion/injection reaction and malignancy and elderly.

Results
Our search identified, 2885 articles and, 12 congress abstracts trough the data base search, finally, 14 peer reviewed papers and, 3 abstracts met the inclusion criteria. Most studies were retrospective, merging CD and UC patients, with an age limit of, 60 or, 65 years for elderly, from Europe or North America. According to our meta-analysis the rates of AE were not different according to the type of biologics (mean rate:, 11.3 (CI, 95%, 9.9–12.7)/100 pts years; p=0.11) in elderly IBD patients with the use of anti-TNF, vedolizumab(VDZ) and ustekinumab(UST). Similarly, rates of infection (mean rate:, 9.5 (CI, 95%, 8.4–10.6)/100 pts years; p=0.56). On the other hand, regarding infusion/injection rates were more common in patients on anti-TNFs (mean rate:, 2.51 (CI, 95%, 1.7–3.4/100 pts years; p=0.02) and malignancy rates were higher in elderly patients on VDZ/UST (mean rate:, 2.14 (CI, 95%, 1.6–2.8)/100 pts years; p=0.01). Two studies directly comparing anti-TNF and VDZ reported similar efficacy and safety in the elderly IBD population.

(p=0.56; Total: reflects patient year of follow-up.)

Conclusion
We report the first meta-analysis on the comparative safety of biological therapies in elderly IBD patients. Rates of adverse events and infections were not different across the biologics. In contrast, infusion/injection reactions were more common in patients on anti-TNFs. Current data are insufficient to suggest sequencing among biologicals in the elderly based on the safety, larger studies in elderly IBD population are warranted.
P325 Performance of new MRI scores: the modified Van Assche Index and the MAGNIFI-CD in the evaluation of the response to anti-TNFα in anoperineal fistulas in Crohn’s disease
Authors: Mtir M , Hassine H , Kahlaoui F , Cherif D , Tlili R , Kchir H , Maamouri N 
Published: January 2022

Abstract

Background
Despite considerable therapeutic advances over the last two decades in the management of Crohn’s disease(CD), complex anoperineal fistulas(APF) still constitute a real therapeutic challenge for the practitioner. Treatment is mainly medico-surgical, combining seton drainage and biotherapy. The ultimate goal is to obtain a deep remission, which combines clinical remission and a normal perineal MRI. Thus, several MRI scores have been proposed to assess the therapeutic response of APF to biotherapy.
The aim of this study was to investigate the reliability of the new MRI scores: the modified Van Assche Index(mVAI) and the MAGNIFI-CD in the evaluation of the response of APF to anti-TNFα, by comparing them to the old version of the Van Assche Index(VAI).

Methods
We conducted a retrospective study, including all patients followed up for CD with APF treated with anti-TNFα over a, 10-year period [2010–2020]. Clinical, biological, morphological and evolutionary data were collected. VAI, mVAI and MAGNIFI-CD scores were calculated from data provided by perineal MRI: number, locations, extensions and lengths of fistulous tracts, characteristics of collections. Clinical response to anti-TNFα was assessed by proctological examination, at the end of which the patients were classified into two groups:
• Responders(26): having a complete remission (closure of all initially productive fistulous orifices) or partial response (closure of more than, 50% of orifices)
• Non-responders(12): closure of less than, 50% of the initially productive fistulous orifices
A statistical study was carried out to compare the performance of the different scores in assessing the response to treatment by calculating the area under the ROC curve with a, 95% confidence interval.

Results
A total of, 38 patients were included. The mean age was, 42 years [26–73] and the sex-ratio M/F was, 0,4. All patients had received anti-TNFα after disappearance of perineal collections if initially present (Infliximab in, 35 cases(92,1%) and Adalimumab in, 3 cases(7,9%)) combined with thiopurines in, 97,4%. The average duration of anti-TNFα therapy was, 46 months [5–180]
The means of the different scores were calculated in responders and non-responders before and after anti-TNFα treatment respectively:

A decrease in all three scores was observed after anti-TNFα treatment in the responders, in contrast to the non-responders, thus confirming therapeutic failure.
Furthermore, the AUROC of the VAI, mVAI and MAGNIFI-CD scores in the assessment of response to anti-TNFα in APF were, 0,925, 0,908 and, 0,869 respectively.

Conclusion
Our results suggest that the old version of the VAI, as well as the mVAI and MAGNIFI-CD, are reliable scores with comparable performance in the assessment of response to treatment in APF in CD.