bluuebunny/crossref_metadata_2025_split huggingface dataset:
P113 Defining the Safety of Early Ileostomy Closure After IPAA
Authors: Clancy C , Connelly T , Jia X , Lipman J , Lightner A , Hull T , Steele S , Holubar MD- MS S 
Published: January 2022

Abstract

Background
Patients undergoing ileal pouch-anal anastomosis commonly wish to have their ileostomy reversed as quickly as possible. The safety of ileostomy reversal (DLI-R) within 8 weeks of surgery has not been established. Our hypothesis is early closure before 8 weeks is associated with negative outcomes.

Methods
Patients who underwent primary IPAA with DLI from 2000 – 2021 from our Pouch Registry were retrospectively reviewed and stratified into groups based on timing of ileostomy closure: very early, routine (&lt; 8 weeks, 56–116 days, respectively). Reasons for early closure were reported. Our primary outcome was overall complication rates according to timing of closure. Univariate analysis was used to compare categorical variables between groups.

Results
2,000 patients underwent DLI-R following IPAA at a very early or routine timepoint: 3-stage 62%, 2-stage 38%; median age 39.2. DLI-R was performed very early in 92 patients and early routine in 1,908. Median time to closure in the very early group is 49 days and in the early routine group was 93 days. There were no differences between the two groups in age or BMI, but the very early group had a higher proportion of females (62% vs 41.5% p&lt;0.001) and a higher proportion of patients with ASA 1–2 (65.2% vs 51.9% p&lt;0.02). Reasons for DLI-R in the very early group were stoma related problems in 39 patients (43.3%) with scheduled closure in 51 patients (56.7%). Complications following DLI-R occurred in 11.3% of patients overall. The complication rate in the very early group was 17.4% compared to 11% in the routine group (p=0.09) and are shown in Table 1. When the patients in the very early group were stratified according to reason for DLI-R those reversed early for stoma related problems had a complication rate of 25.6% compared to 11% in the early routine group (p=0.03). Patients undergoing scheduled DLI-R in the very early group did not have higher complication rates than the routine group (11.8% vs 11% respectively, p=1.0).

Conclusion
DLI-R at &lt;8 weeks following IPAA does not appear to be associated with a statistically higher rate of complications compared to closure in a standard time frame. However, when patients were reversed early due to complications associated with their stoma they had worse outcomes.
P127 Type I collagen degradation fragments (C1M) and human neutrophil elastase-derived fragments of calprotectin (CPa9-HNE) reflect biochemical and endoscopic disease activity in patients with Inflammatory Bowel Disease
Authors: Bourgonje A R , Alexdottir M , Loveikyte R , Pehrsson M , Bay-Jensen A C , van Dullemen H M , Visschedijk M C , Festen E A M , Weersma R K , Karsdal M A , Faber K N , Mortensen J H , Dijkstra G 
Published: January 2022

Abstract

Background
Crohn’s disease (CD) and ulcerative colitis (UC) are characterized by intestinal inflammation and increased extracellular matrix (ECM) remodeling, which are key pathophysiological mechanisms in patients with IBD and highly related to mucosal damage. Alterations in intestinal ECM turnover as well as macrophage and neutrophil activity may be reflected by secreted products that are released into the systemic circulation. In this study, we aimed to investigate associations between serum biomarkers of neutrophil activity (serum calprotectin) and collagen degradation (mucosal damage), and disease activity in patients with IBD.

Methods
Serological biomarkers of collagen formation (PRO-C3, PRO-C4, PRO-C6), matrix metalloproteinase (MMP)-mediated collagen degradation (C1M, C3M, C4M, C4G, C6Ma3) and intestinal inflammation (VICM [macrophage activity], human neutrophil elastase-derived fragment of calprotectin (CPa9-HNE [serum calprotectin, neutrophil activity]) were measured using Protein FingerPrint assay (PFA) technology in 100 patients with IBD (CD: n=44; UC: n=56). Biochemical disease activity was assessed using C-reactive protein (CRP) levels and available faecal calprotectin (FCal) levels. Endoscopic disease activity was determined using the Simple Endoscopic Score for CD (SES-CD) and Mayo endoscopic subscore for UC.

Results
C1M strongly associated with elevated CRP levels (defined as &gt;5mg/L, P&lt;0.001) in patients with IBD and significantly associated with faecal calprotectin levels in patients with UC (Spearman’s ρ=0.75, P&lt;0.001). In patients with CD, C1M reasonably discriminated between patients with mild and moderate-to-severe endoscopic disease activity (AUC=0.73, P=0.01), whereas this discrimination was more subtle in patients with UC (AUC=0.68, P=0.08). CPa9-HNE levels were significantly increased in patients with elevated CRP levels (P=0.002 for both CD and UC) and associated best with faecal calprotectin levels in patients with CD compared with UC (CD: ρ=0.43, P=0.06; UC: ρ=0.20, P=0.45). Finally, CPa9-HNE levels were able to discriminate between mild and moderate-to-severe endoscopic disease activity in patients with CD (AUC=0.75, P&lt;0.01).

Conclusion
C1M and CPa9-HNE levels associate with biochemical (CRP, FCal) and endoscopic disease activity in patients IBD, where C1M demonstrated higher accuracy in UC and CPa9-HNE appeared to be more useful in CD in this cohort. Therefore, C1M and CPa9-HNE could serve as surrogate biomarkers for the assessment of disease activity in patients with UC and CD, respectively. Our results should be validated in additional prospective, larger patient cohorts to corroborate these findings.
P132 An audit of quality of histopathology reporting of colorectal mucosal biopsies for the diagnosis and assessment of Inflammatory Bowel Disease
Authors: Mcalinn J , Feakins R 
Published: January 2022

Abstract

Background
Inflammatory Bowel Disease (IBD) biopsies form a large part of the reporting workload of most histopathology departments. Published UK and European guidelines include recommendations on how best to report these biopsies for IBD diagnosis and assessment 1,2. The purpose of this audit is to assess whether biopsies reported at our institution adhere to these guidelines and to discuss potential improvements in IBD histology reporting.

Methods
An electronic search of histopathology records was conducted using diagnostic results coded for Inflammatory Bowel Disease. The search yielded 56 cases. Percentage compliance was measured for 24 criteria under the following headings: Clinical details and processing; Macroscopic description/processing; Microscopic report; and Summary/conclusion. Satisfactory compliance was set at 90%, using the recommendations from the UK Royal College of Pathologists3.

Results
Of the 24 criteria, 14 were accepted as adhering to the guidelines. Noteworthy results for non-compliance were:
Duration of disease stated: 86%
Endoscopy findings provided: 79%
Actual copy of endoscopy report provided: 4%
Endoscopist states probability of IBD: 63%
Sampling is adequate and appropriate: 50%
Distribution within sites is recorded: 68%
Comment on presence or absence of basal plasmacytosis is made: 32%
Preference for Ulcerative Colitis or Crohn’s disease is stated, or inability to subclassify is recorded: 71%

Conclusion
There is potential for improvement in IBD reporting at our site.
Problems identified included lack of access to endoscopy reports, inappropriate sampling at endoscopy, and absence of endoscopy comments on the probability of IBD. Discussion of audit results with the endoscopists and creation of a regular IBD multidisciplinary team meeting (MDTM) could help to promote communication between departments and provide a route towards higher quality reporting.
Areas of concern regarding microscopic reporting and interpretation included failure to describe distribution of inflammation within sites, absence of a record of basal plasmacytosis, and failure to state a preference for Ulcerative Colitis or Crohn’s disease. A lack of clarity in these areas has the potential to impact patient management negatively. Recommendations included consideration of a structured histology reporting system such as a template or the PAID approach available in the British Society of Gastroenterology guideline2.
References
1. F Magro et al ‘European consensus on the histopathology of inflammatory bowel disease’
2. RM Feakins, ‘IBD biopsies: updated BSG reporting guidelines’
3. RM Feakins, RCPath Cellular pathology audit template ‘An audit of quality of reporting of colorectal mucosal biopsies taken for the diagnosis and assessment of IBD’
P157 Biologic therapy and short disease duration correlate with no dysplasia when colectomy performed for ulcerative colitis
Authors: Ori B , Shlomo Y , Petachia R , Eran G , Koslowsky B 
Published: January 2022

Abstract

Background
15–20% of ulcerative colitis (UC) patients will eventually undergo total proctocolectomy (TPC) with or without a restorative pouch following. The two main indications include refractory UC and advanced colonic neoplasia. Risk factors associated with TPC in the biological era are not clarified. The aim of the study was to compare TPC performed with a finding of neoplasia to all other indications.

Methods
An observational retrospective analysis of all TPC performed at a single tertiary referral medical center between 2003–2020, was performed.

Results
Seventy-nine patients were included, 25 (31%) with neoplasia and 54 (69%) for all other indications. Average age was 42, 62% men, and 12.5 years of disease prior to surgery. Out of the neoplasia group, only 6 (24%) and 8 (32%) were exposed to biologics and steroids prior to surgery, opposed to 36 (66.6%) and 38 (70%) in the controls, p=0.005 and 0.001 respectively. Average years of disease was 18.7± 13 for neoplasia group compared to 9.7± 11 years for the controls, p&lt;0.001. The major indications for TPC in the neoplasia group were a finding in colonoscopy 16 (64%) and treatment failure 5 (20 %), opposed to 4 (7%) and 43 (80%) in the controls, p&lt;0.001 for both, respectively. Short term complications and long term complications occurred in 15 (60%) and 6 (24%) of in the neoplasia group compared to 39 (72%) and 33 (61%) in the controls, p=0.27 and 0.002, respectively. Hemoglobin was higher and albumin lower in the neoplasia group. Two-step procedures and three-step procedures were performed on 12 (48%) and 1 (4%) of patients in the neoplasia group compared to 27 (50%) and 16 (29%) in the controls, p=0.86 and 0.01, respectively.

Conclusion
Even in the biologic era, neoplasia encounters nearly one-third of TPC procedures. Short disease duration and use of biologics are correlated with a decreased risk for neoplasia. Long term complications are less common when TPC performed due to neoplasia.
P176 The effect of induction therapy with infliximab or vedolizumab on hepcidin and iron status in patients with Inflammatory Bowel Disease
Authors: Loveikyte R , Bourgonje A R , van der Reijden J J , Bulthuis M L C , Hawinkels L J A C , van Goor H , van der Meulen-de Jong A E , Dijkstra G 
Published: January 2022

Abstract

Background
Differentiating absolute iron deficiency from functional iron restriction is challenging in active Inflammatory Bowel Disease (IBD). Hepcidin, the systemic iron regulator, could be the key in the diagnosis and management of absolute iron deficiency. In this study, we assessed hepcidin as a diagnostic iron deficiency marker and we explored the relationship between hepcidin, inflammation, hypoxia, and iron deficiency in patients receiving induction therapy with infliximab (IFX) or vedolizumab (VEDO).

Methods
130 patients with IBD, who received induction therapy with IFX or VEDO for active disease, were included in this study. Clinical and biochemical data were extracted from medical records. Serum samples at baseline and week 6 of induction therapy were retrieved from the University Medical Center Groningen (UMCG) biobank and analysed for: hepcidin, inflammation (e.g., interleukins [IL] 6, 10, and Tumour Necrosis Factor-α [TNFα]), oxidative stress (free thiols), and hypoxia (e.g., erythropoietin [EPO], Macrophage Inflammatory Protein-3α [MIP3α]). For comparison, serum samples from 50 age- and gender-matched healthy controls were obtained from pre-donation biobank at the UMCG. Response to therapy was defined by either General Physician’s Assessment at week 14 of induction therapy, normalisation or at least a three-point decrease in clinical scores: Harvey-Bradshaw Index (HBI) for Crohn’s Disease, Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis.

Results
Hepcidin correlated with ferritin and sTfR/log ferritin index [ρ = 0.74 and ρ = -0.79, respectively; P&lt;0.001 for both markers], while inflammation- and hypoxia-associated markers showed only marginal correlations. Hepcidin accurately identified absolute iron deficiency: AUC(hepcidin) = 0.89 [95% CI: 0.82–0.95; P&lt;0.001]. Induction with either IFX or VEDO decreased hepcidin [13.5 ng/mL vs. 9.5 ng/mL; P&lt;0.001], ferritin [45.5 ug/L vs. 37.0 ug/L, P&lt;0.05], and inflammatory markers at week 6, while transferrin increased [2.4 g/L vs. 2.5 g/L, P&lt;0.001]. In total, 75.4% of patients responded to the induction therapy. Hepcidin and ferritin decreased, while transferrin increased (P&lt;0.001 for all changes) in patients who responded to the therapy. In addition, hypoxia (EPO and MIP3α) and inflammatory markers such as faecal calprotectin, IL-6, IL-22, and TNFα improved significantly. In contrast, none of these improvements were observed in patients who did not respond to the therapy.

Conclusion
Hepcidin reflects iron deficiency in active IBD, but inflammation masks the severity of the deficiency. Induction therapy with either IFX or VEDO modulates hepcidin and iron indices, especially in patients who respond to the therapy.
P187 Major Depression in patients with Ulcerative Colitis and its relationship with clinical activity
Authors: Facanali C , Sobrado C W , Meirelles Carregaro B , Borba M R , Nahas S C 
Published: January 2022

Abstract

Background
In the last decade, there has been an increase in manuscripts published around the world related to psychological aspects in patients with IBD, suggesting a relationship between depression and IBD. Depressive symptoms seem to be able to aggravate ulcerative colitis (UC)¹, however there is a need for a clearer characterization of the sample and disease activity²,³. The aim of the study is to estimate the prevalence of major depression (MD) in patients with UC and to evaluate its relationship with the clinical activity and other diseases characteristics.

Methods
From October 2020 to May 2021, 299 patients with UC were evaluated using the Patient Health Questionnaire-9 (PHQ-9) scale, where absent depressive symptoms range from 0–4 points, mild depressive symptoms 5–9, moderate depressive symptoms 10–14, moderately-severe depressive symptoms 15–20, severe depressive symptoms greater than 20. MD was defined by PHQ-9 ≥10.
Data were prospective analyzed,regarding socio-demographic characteristics, surgeries, current treatment; clinical activity and extent of disease were assessed by montreal classification. The association of characteristics with the MD risk was verified using chi-square tests or Fisher’s exact tests or likelihood ratio, and quantitative characteristics were compared according to MD risk categories using Student’s t-tests or Mann-Whitney tests. All statistical tests were performed with a 5% significance level.

Results
The prevalence of MD in UC patients was 35.8%. The main socio-demographic characteristics and MD risk are described in Figure 1. Figure 2 shows that, separately, sex, disease activity, hemoglobin and hematocrit statistically influenced the risk of MD (p &lt; 0.05). There was no association between disease extension, surgeries performed along the disease course or current drug treatment with MD (p &gt; 0.05).
Together, gender influenced the MD risk in UC patients, regardless of the other characteristics evaluated, with female patients having a 2.63 times the chance of MD than male patients (Odds Ratio [OR] 2.63. 95% confidence interval [CI] 1, 41–4.89; p 0.002).

Conclusion
Our study confirms the high risk of MD among UC patients and is significantly related to the disease clinical activity. Psychological assessment of UC patients, in addition to objective measures of disease activity as an integral part of IBD care, is necessary, aiming to help improve the quality of life and maintain remission.
P190 Implementation of IBD symptom diary – Case Finnish IBD register
Authors: Mustonen Real World Data Manager A , Asikainen S , Toivonen T , Jussila A T 
Published: January 2022

Abstract

Background
BCB MyHealth application is a digital monitoring system of patient reported outcomes (PROMs) fully integrated and synchronized with the Finnish IBD Register, which delivers information about the patients’ disease and state of health. Our system monitors patients’ symptoms and well-being only at one point. There is a need to monitor patients’ symptoms and well-being more closely between follow-up visits. Therefore, we developed a digital daily self-monitoring symptom diary service, Feeling application, which is suitable for all patients with IBD in everyday practice. In addition, our goal was to create a system that allows IBD-patients to view their own parameters used to monitor treatment.

Methods
As a part of MyHealth, we developed the Feeling app (Figure 1) with Tampere University Hospital. Project group included gastroenterologists, IBD-nurses, and the hospitals’ senior medical advisor of health technology assessment. The Feeling app is a digital daily self-monitoring symptom diary service intended for IBD-patients. The system supports biometric authentication (Figure 2) and saves responses to IBD Register database.
Figure 1. IBD Symptom Diary

Figure 2. Biometric authentication

Results
Feeling app enables continuous home-monitoring of patients with IBD. This symptom diary allows patients to monitor their symptoms and well-being daily. They can see their own answers and how their symptoms and well-being have developed weekly, monthly, or annually. During treatment follow-up, the Feeling app also visualizes lab parameters used to monitor treatment, such as CRP, calprotectin and hemoglobin values, which are derived from the IBD register (Figure 3). In addition, certain endoscopy related parameters, such as SES-CD and Mayo Score are visualized for the patient. Health care professionals (HCPs) can see summary view all the data that the patient has inserted in the Feeling app in IBD register and the data is visualized in real time. Tampere University Hospital started to use the Feeling app in 2021.
Figure 3. Summary view

Conclusion
The Feeling app provides new ways to support patient care and is an efficient tool for long-term data collection. The opportunity of patients to monitor the development of their symptoms and well-being, and to see the lab parameters used to monitor treatment may improve adherence to treatment. With efficient data collection we have increased opportunity to utilize the data for AI activities such as synthetic data and outcomes prediction.
P192 First event of acute intestinal inflammation and the risk of progression to Inflammatory bowel disease: a retrospective analysis
Authors: Levartovsky A , Ovdat T , Barash Y , Ben-Shatach Z , Skinezes Y , Jesin S , Klempfner R , Grossman E , Kopylov U , Ben-Horin S , Ungar B 
Published: January 2022

Abstract

Background
Episodes of acute ileitis or colitis have been associated with future development of inflammatory bowel diseases (IBD). Nevertheless, the incidence of IBD among patients diagnosed with acute intestinal inflammation is currently unknown. We aimed to assess the risk for future development of IBD based on clinical and radiographical features of patients presenting with abdominal symptoms to the emergency department (ED) and undergoing urgent computerized tomography (CT) of the abdomen.

Methods
We created an electronic data repository of all patients visiting the ED at our medical center and undergoing abdominal CT between 2011–2020. We searched the computerized database for patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) during a visit to the gastroenterology department within maximal follow-up time of 9 years from the index-admission to the ED. Statistical analysis including multivariate models identified the risk and possible predictors of patients to develop IBD.

Results
Overall, 1551 patients visited the ED and underwent abdominal imaging with abnormal findings. The radiographic parameters reported the most on abdominal CT scans were bowel wall thickening, fat infiltration, and abdominal free fluid. Twenty-three patients (1.5%) were eventually diagnosed with IBD (19 CD, 4 UC) at gastroenterological follow-up with a median of 60 days (IQR 30–120) from the time of the ED admission. Patients with a future IBD diagnosis were significantly younger (28 vs 51 years, p&lt;0.001) and had higher rates of diarrhea as a presenting symptom (17.4% vs 2.6%, p&lt; 0.001) compared to patients who did not develop IBD. On multivariate analysis, age (p&lt; 0.001(and colitis on imaging (p=0.001) were associated with the development of IBD.

Conclusion
IBD would be eventually diagnosed only in a minority of patients presenting with ileitis or colitis on abdominal CT. Younger age, diarrhea as a presenting symptom and colitis on imaging are predisposing factors.
P201 Crohn’s Disease of the terminal ileum associated with ileo-sigmoid fistula: risk factors for ileostomy formation and postoperative complications during the years of biologics
Authors: Belvedere A , Gerti D , Canavese A , Pulcina G , Romano A , Poggioli G , Rottoli M 
Published: January 2022

Abstract

Background
Ileo-sigmoid fistula (ISF) is a complication of Crohn’s disease occurring in a significant proportion of patients. The aim of this study was to describe the perioperative outcomes of patients affected by ISF and to identify the risk factors for complications and ileostomy formation.

Methods
Consecutive patients operated for ISF between 2004 and 2021 in a single referral centre were included. Considering the presence of a large number of regressors the variables to include in the models were selected using the least absolute shrinkage and selection operator (LASSO) method. The multivariate analyses of the independent variables associated with the risk of ileostomy formation and post-operative complications were conducted using logistic regression.

Results
Of the 208 patients who underwent ileocolic resection for ISF (Table 1), 161 (77.4%) also underwent sigmoid resection, while 47 (22.6%) underwent a conservative treatment of the target sigmoid colon. ISF was detected preoperatively with CT scan in 121 (58%) patients and with colonoscopy in 63 (30%) patients.

Significant risk factors for ileostomy (performed in 63 patients - 30%, Table 2) were the preoperative diagnosis of ISF (Odds Ratio - OR - 2.22, 95% Confidence Interval - CI – 1.02–4.78), surgery for a recurrence (OR 6.71, 95% CI 1.46–30.86), the presence of an intrabdominal abscess (OR 3.03, 95% CI 1.44–6.35), and additional small bowel surgery (OR 2.6, 95% CI 1.08–6.25).

Anastomotic leak occurred in 19 (9%) patients. Postoperative complications classified grade 2 or higher according to Clavien-Dindo (71 patients, 34.1%) were significantly associated with additional small bowel surgery (OR 2.42, 95% CI 1.11–5.3), the presence of an intrabdominal abscess (OR 2.45, 95%CI 1.44–6.35), and the localization of Crohn’s disease to the left colon (OR 1.98, 95%CI 1.03–3.8).

Conclusion
Although a diverting ileostomy was more likely to be performed in those patients identified perioperatively as high-risk subjects (more clinically relevant ISF, recurrent disease, addition bowel surgery or abdominal sepsis), this did not prevent the onset of postoperative complications, which seem to be associated with a more disseminated disease (either to the colon or to other locations of the small bowel) or with the presence of untreated intra-abdominal sepsis.