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Optimising transitional care

Johanna Escher 1

1 Erasmus Medical Center, Rotterdam, Netherlands

Event

UEG Week Copenhagen 2023

Topics

Education & Training IBD Primary Care Standards & Guidelines

Session

Therapy update: The integrated approach to optimising care of the patient with IBD

Published

2023

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STANDARD VERSUS DOUBLE DOSE OF HEPATITIS B VACCINE IN INFLAMMATORY BOWEL DISEASE: A RANDOMIZED TRIAL

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Introduction

Response to hepatitis B vaccine (HBV) is variable in inflammatory bowel disease (IBD) patients with seroconversion rates of 34-89%. Strategies suggested to improve the seroconversion rates are double dose, accelerated schedule, or addition of booster dose with variable results. This study compared the standard (20 µg) dose and double (40 µg) dose of HBV vaccination in IBD patients.

Aims & Methods

Patients of IBD were randomized to 1:1 to receive standard or double dose of HBV at 0, 1 and 6 months. Anti-HBs titers were assessed at 1 month after the third dose. Response was defined as an adequate immune response (AIR, anti-HBs titer >10 mIU/mL) and effective immune response (EIR, anti-HBs titer >100 mIU/mL). Total mayo score and Crohn’s disease activity index (CDAI) was used to identify the active disease. IBD medications with immunosuppressive effects were categorized as immunomodulators, corticosteroids, tofacitinib and biologic group. Multivariable logistic regression analysis was done to identify the predictors of AIR and EIR.

Results

Eighty-eight patients of IBD were randomized to receive standard (45, 51.1%) or double (43, 48.9%) dose of HBV. 79 of 88 patients had ulcerative colitis (UC) and 9 had Crohn’s disease (CD). 49 (55.7%) patients had active disease while 39 (44.3%) were in remission. At the end of the study, total 63 (71.61%) patients achieved AIR and 51 (60%) achieved EIR. AIR (88.4 % vs. 55.6 %, p 0.001) and EIR (69.8% vs. 46.7%, p = 0.028) rates were significantly higher with double dose compared to standard dose of HBV. Patients with active IBD had higher AIR (87.5% vs. 44%, p = 0.001) and EIR (70.8% vs. 32%, p = 0.007) rates with double dose of HBV. Patients with IBD in remission also had higher AIR (89.5% vs. 70%) and EIR (78.4% vs. 65%) rates with double dose of HBV, though statistically non-significant.
Multivariable analysis identified the use of double dose of HBV {odds ratio (OR) 10.865, 95% confidence interval (CI): 2.418-48.817} and biologic (OR 0.022, 95% CI: 0.001-0.421) as predictors to achieve AIR. Similarly, double dose of HBV (OR 3.0, 95% CI: 1.087-8.280) and use of biologic (OR 0.074, 95% CI: 0.006-0.931) also predicted the EIR.

Conclusion

Double dose of HBV vaccine demonstrated a superiority over standard dose of vaccine for achieving both AIR and EIR. Use of biologic impaired the response. Double dose of HBV should be used in IBD patients to improve the seroconversion rates.

Disclosure

No conflict of Interest

STANDARD VERSUS DOUBLE DOSE OF HEPATITIS B VACCINE IN INFLAMMATORY BOWEL DISEASE: A RANDOMIZED TRIAL

Anupam Kumar Singh 1, Roop Kishor Soni 1, VANEET JEARTH 1, Jimil Shah 1, Ritin Mohindra 1, Vikas Suri 1, Arun Kumar Sharma 1, Vishal Sharma 1, Usha Dutta 1

1 Post Graduate Institute of Medical Education and Research, Chandigarh, India

Event

UEG Week Berlin 2025

Topics

Hepatobiliary IBD Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Predicting and understanding early stages of advanced liver disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Future trends in diagnosis and management of coeliac disease

Fabiana Zingone 1

1 University of Padua, Padua, Italy

Event

UEG Week Berlin 2025

Topics

Immunology Small Intestine & Nutrition

Session

Coeliac or non-coeliac enteropathy?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Standard Poster

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Introduction

Managment of functional hepatobillary pain remains a significant challenge for physicians. Botulinum toxin injection of the ampulla of vatter and endoscopic sphincterotomy has been shown to be an effective treatment with diagnostic and prognostic benefit, however, it has a relatively high complication rate.

Aims & Methods

To assess the effectiveness and complication rate of botox injection and sphincterotomy for treatment of sphincter of oddi dysfunction (SOD). And assess if response to botox injection is predictive of durable response to completion sphincterotomy. Patients were identified from a single centre endoscopy database from January 2014 until October 2024 using the keyword searches “Botox” and “Botulinum”. Studies were included if 100IU botox injection to the ampulla was done at endoscopy for the purpose of treating SOD. SOD was defined as per the ROME IV criteria and classified as per Milwaukee classification. Baseline clinical, demographic, endoscopic, and radiological data were collected. Symptomatic response was assessed through interrogation of clinical notes post procedure. Patients who progressed on to sphincterotomy were identified, and symptomatic response to this was obtained from clinical review of notes at 3 months and 1 year post procedure. For categorical variables Fisher’s exact test was used.

Results

364 duodenoscopies were identified from the database, 74 duodenoscopies from 52 patients were included. 13 patients had more than one botox injection. 77% (40 patients) were female, and the median [range] age at first procedure was 41.2 [21.7 - 66.6] years. 1 (1.9.%), 44 (84.6%), and 7 patients (12.5%) had type I, Type II, and Type III SOD respectively. Diclophenac was given at time endoscopy in 26 (36%) procedures. Four patients were admitted for 24 hours with non-pancreatitis related abdominal pain post procedure. Three patients had no data on response post botox injection. 42 (85%) patients reported improvement in their symptoms following botox injection. 35 of the 44 patients with type II SOD responded. 6 of the 8 patients with type III, and the only type I patient responded. 25 (48%) patients in total progressed on to sphincterotomy (one type I, 22 type II, and 2 Type III). 10 patients with no response to botox progressed on to sphincterotomy. 10 patients had >1 sphincterotomies for treatment of SOD. 36 post botox sphincterotomies were included, 8 (22%) had complications. There were 5 (14%) micro-perforations, there was one (2.8%) pancreatitis and two (5.5%) admissions for abdominal pain without evidence of pancreatitis. No patient had requirement for ICU or surgery. Initial response to sphincterotomy was at 3 months was 72% (18). Twelve (48%) patients (11 type II SOD, and one Type III) had durable response at one year.
There was a trend that patients who responded to botox injection were more likely to have response from sphincterotomy at one year, 10 patients (55%) compared to two (28%) Patients who did not respond to botox injection responded to sphincterotomy at one year. However, this was not statistically significant (p=0.37).

Conclusion

Our data indicated a low incidence of complication to botox injection with no recorded cases of pancreatitis. There was a trend that patients who responded to botox injection may be more likely to respond to sphincterotomy. Further data is required, however there was a trend towards patients who responded to botox injection being more likely to benefit from sphincterotomy.

Disclosure

Nothing the disclose

RETROSPECTIVE REVIEW OF THE ROLE OF BOTOX INJECTION AND SPHINCETROTOMY IN THE MANAGEMENT OF FUNCTIONAL HEPATOBILLARY PAIN

Jim O'Connell 1, Amer Al-Joudeh 1

1 Sheffield Teaching Hospitals, Sheffield, United Kingdom

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

BILIARY (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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RANDOMIZED CONTROLLED TRIAL COMPARING ENDOSCOPIC BALLOON DILATION VERSUS ENDOSCOPIC STRICTUROTOMY FOR SHORT STRICTURES (&LT; 3 CM) RELATED TO CROHN’S DISEASE (THE BEST-CD TRIAL) (NCT05521867)

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Introduction

Although endoscopic balloon dilation (EBD) remains the standard intervention for Crohn’s disease (CD)-associated strictures, its efficacy is limited by high recurrence and surgery rates. Retrospective analyses suggest endoscopic stricturotomy (ES) may offer superior outcomes, particularly in anastomotic strictures. However, no randomized trials have directly compared EBD and ES for short CD-related strictures.

Aims & Methods

This single-center, randomized controlled trial (August 2022–March 2025) enrolled adult CD patients (18–65 years) with symptomatic, predominantly fibrotic or mixed, short strictures (<3 cm), including both de novo and anastomotic types, accessible via standard endoscopy. Patients with multiple (>2) strictures, strictures beyond endoscopic reach, or prior stricturotomy were excluded. Participants were randomized to undergo either EBD or ES. The primary outcome was clinical recurrence at 1 year. Secondary outcomes included re-intervention, surgery, emergency visits, hospitalization, technical success, and adverse events.

Results

Out of 70 randomized patients, 69 were analyzed (EBD: 35; ES: 34). Baseline characteristics were comparable between groups. Technical success was similar (EBD: 91.4%, ES: 94.1%). On time to event analysis, clinical recurrence was significantly lower in the ES group (OR=0.343, 95% CI: 0.134–0.881; p=0.026). Re-intervention rates favored ES (EBD: 25.7%, ES: 8.8%; OR=0.337, 95% CI: 0.131–0.870; p=0.025). Surgery rates were numerically lower with ES (EBD: 11.4%, ES: 5.9%) but not statistically significant (p=0.581). Hospitalization was significantly more frequent in the EBD arm (OR=0.276, 95% CI: 0.091–0.840; p=0.023). ED visits also trended lower with ES, though not statistically significant (p=0.062) (see table). Adverse events occurred in 25.7% of EBD patients (bleeding n=3 [1 hemoclip], pain with admission n=3, micro-perforation n=1, post-procedure pain n=2) and 14.7% of ES patients (bleeding n=3 [1 self-limited, 1 coagrasper, 1 hemoclip], none required transfusion, suspected perforation n=1, mild pain n=1).

Outcome	EBD (n=35)	ES (n=34)	p-value	Odds Ratio (95% CI)
Technical Success (%)	91.4% (32/35)	94.1% (32/34)	0.70	-
Clinical Recurrence (%)	48.6%	23.5%	0.026	0.343 (0.134–0.881)
Re-intervention Rate (%)	25.7%	8.8%	0.025	0.337 (0.131–0.870)
Surgery (%)	11.4%	5.9%	0.581	0.707 (0.207–2.422)
Stricture-related ED Visits (%)	20.0%	11.8%	0.062	0.404 (0.156–1.047)
Stricture-related Hospitalizations (%)	25.7%	8.8%	0.023	0.276 (0.091–0.840)
Any Adverse Event (%)	25.7% (9/35)	14.7% (5/34)	0.45	-

Conclusion

In this interim analysis, ES was associated with significantly lower clinical recurrence, re-intervention, and hospitalization compared to EBD for short CD-related strictures, with similar safety outcomes. These findings support ES as a potentially superior first-line endoscopic strategy over EBD in selected patients with Crohn’s disease strictures. (NCT05521867)

References

Lan N, Shen B. Endoscopic Stricturotomy Versus Balloon Dilation in the Treatment of Anastomotic Strictures in Crohn's Disease. Inflamm Bowel Dis. 2018 Mar 19;24(4):897-907. doi: 10.1093/ibd/izx085. PMID: 29546384.