bluuebunny/crossref_metadata_2025 huggingface dataset:
P0507 pTRACK generated normalised average T2 signal is an accurate and sensitive measure of Perianal Crohn’s disease activity
Authors: Naim I , Menys A , Bhatnagar G , Greer C , Lindsay L , Carter L , Moran G
Published: January 2025

Background

Magnetic resonance imaging (MRI) is the gold standard for diagnosing, classifying, and monitoring perianal Crohn’s disease (pCD). Fistula T2 signal intensity and volume/complexity are predictive of treatment response. We developed pTRACK, an interactive tool that enables radiologists to measure fistula volume, normalised average T2 signal intensity, and anatomical relationships to generate 3D digital models of pCD within minutes. This study aimed to evaluate pTRACK-generated MRI metrics against MAGNIFI-CD and assess their predictive value for clinical outcomes.

Methods

We retrospectively included consecutive adult patients (>18 years) with pCD who underwent pelvic MRI and clinical assessment. Two independent, blinded abdominal radiologists scored MAGNIFI-CD and pTRACK metrics (figure 1) on axial T2 STIR TSE sequences. Clinical outcomes (remission, response, non-response) were scored using the fistula drainage assessment (FDA). Correlations, unpaired two-tailed t-tests, and leave-one-patient-out cross-validation (LOPOCV) performance metrics were used to compare MRI metrics (fistula volume, normalised average T2 signal intensity, MAGNIFI-CD score) and predict FDA categories. T2 signal intensity was normalised using an ROI in adjacent pelvic muscles.

Results

36 patients having 77 MRI scans were included. Mean C-reactive protein at the time of assessment was 12.9 ± 22 mg/L. 38.2% of patients had class 1 disease, 42.7% had class 2a disease with a minority having more complex disease. 58.4% of patients experienced non-response, with 14.3% experiencing response and 27.3% experiencing remission.

Significant differences were observed across metrics when dichotomized into remission and active groups (responding and non-responding): normalised T2 signal (1.65 ± 1.10 vs. 2.98 ± 1.52, p<0.001), fistula volume (1.58 ± 3.08 mL vs. 4.55 ± 8.66 mL, p=0.03), and MAGNIFI-CD scores (5.86 ± 4.70 vs. 12.41 ± 5.80, p<0.001). Fistula volume and average T2 signal intensity showed moderate correlation to MAGNIFI-CD (r=0.72, p<0.001; r=0.49, p<0.001 respectively). LOPOCV AUC for normalised average T2 and fistula volume were 0.77 and 0.74, respectively, with sensitivities of 87% and 95%, and specificities of 62% and 52%. For MAGNIGI-CD, LOPOCV AUC was 0.84, with a sensitivity of 77% and specificity of 81%.

Conclusion

pTRACK’s normalised T2 signal and fistula volume demonstrated comparable accuracy to MAGNIFI-CD, with higher sensitivity for predicting pCD activity and distinguishing active from non-active disease. These findings underscore pTRACK’s potential utility, warranting prospective validation in cohorts with more severe disease.
P0509 Fecal calprotectin diagnostic level gradient along the small bowel in patients with Crohn’s disease
Authors: Ukashi O , Kopylov U , Ungar B , Talan Asher A , Shachar E , Engel T , Albshesh A , Yablecovitch D , Lahat A , Eliakim R , Ben-Horin S
Published: January 2025

Background

Fecal calprotectin (FC) is known to be a sensitive biomarker of colonic inflammation but to a lesser degree of small bowel (SB) inflammation. Moreover, data on FC’s diagnostic levels in different SB segments are scarce. We aimed to examine FC’s diagnostic levels along the SB-axis in CD.

Methods

This was a post-hoc aggregated analysis of five prospective studies of adult CD patients, who underwent FC testing and SB video capsule endoscopy (VCE). Lewis score (LS) inflammation in different SB segments was tested for correlation with FC level after exclusion of colonic disease. The diagnostic levels of FC for SB inflammatory topographical-gradient were assessed using a receiver operating characteristic.

Results

214 patients were included (age:30 [24-43] year-old, males-57%). For a similar SB inflammatory-activity (LS≥135), FC levels incrementally increased from proximal to distal SB segments (63 [30-121] versus 190 [78-549], p=0.005) and from distal SB segment to the colon (190 [78-549] versus 542 [185-1000], p=0.010). The best FC cutoffs to identify isolated mild proximal/distal SB-inflammation (LS≥135) were 77 and 123, respectively. A cutoff of 234 was best to detect more significant proximal inflammation (LS≥350) when only mild distal SB-inflammation was present. In sensitivity analyses, this proximal-to-distal FC gradient was maintained when LS≥350 and LS≥790 were used as the inflammatory reference-values. Unlike FC, the magnitude of CRP elevation was unrelated to the topography of inflammation along the SB-axis.

Conclusion

FC may serve as a topographical biomarker of CD-activity, with its sensitivity to identify mucosal inflammation increases from proximal to distal SB segments.
P0517 Role of radiomics in predicting the degree of intestinal fibrosis in patients with Crohn’s Disease
Authors: Laterza L , Maresca R , Varca S , Tran H E , Boccia E , Larosa L , Sessa G M , Mignini I , Sacchetti F , Giustiniani M C , Boldrini L , Sofo L , Minordi L M , Cammarota G , Papa A , Gasbarrini A , Scaldaferri F
Published: January 2025

Background

During their lifetime, patients with Crohn’s disease (CD) frequently develop strictures as a complication, where various degrees of inflammation and fibrosis coexist. Distinguishing between inflammatory and fibrotic strictures is crucial for deciding on surgery or treatment changes, yet it is currently challenging in clinical practice. Cross-sectional imaging techniques (e.g. magnetic resonance imaging MRI) provide a reasonably accurate estimate of bowel wall fibrosis. However, only histopathological examination can determine its true extent. Radiomics uses artificial intelligence to analyze quantitative features from diagnostic images and can predict clinical outcomes. This study aims to assess the role of radiomics in classifying patients according to the degree (no/mild vs severe) of intestinal fibrosis in a cohort of CD patients who underwent surgery for strictures disease

Methods

We retrospectively selected 48 CD patients who underwent MR-enterography and subsequent surgery within 4 months between 2017-2023. An expert pathologist evaluated the degree of fibrosis in histopathological specimens from surgical samples using the Chiorean scoring system from 0 (no fibrosis) to 2 (severe fibrosis), and the degree of inflammation using Geboes score. For each MR-enterography, typical lesions of CD were searched by an expert radiologist on T2-weighted axial images generating a region of interest (ROI) segmentation for each lesion. We extracted 100 radiomic features from each ROI of the pre-processed MRI images using Pyradiomics. Feature selection included univariate analysis (Wilcoxon-Mann-Whitney test) and Spearmann correlation to exclude highly correlated features. A logistic regression model with stepwise regression was built with the selected features and evaluated by computing the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Model’s sensitivity and specificity were calculated using the best cut-off according to the Youden index method.

Results

Among the 48 patients, 48% (n=23) showed severe fibrosis on the surgical specimen, whereas 52% (n=25) had either no or mild fibrosis. Two radiomic features were selected and resulted statistically significant in the fitted logistic regression model(p < 0.05): original_shape_Maximum2DDiameterColumn and original_firstorder_90Percentile. Results with their 95%CI were: AUC 0.79(0.64-0-90), sensitivity 0.69(0.50-0.75) and specificity 0.84(0.66-0.94). Bootstrap corrected (mean optimism) values of AUC and metrics were: AUC 0.77 (0.02), sensitivity 0.68(0.01), specificity 0.81(0.02).

Conclusion

Our study suggests that MRI-based radiomics modeling could help predict the degree of intestinal fibrosis. Future research will confirm these findings in a larger cohort
P0518 Study of the prevalence of defecatory disorders in patients with quiescent ulcerative colitis using high resolution anorectal manometry
Authors: Abdelaty K ,   Hussein Saad Eman Abu El-Soud Ezzat Ali
Published: January 2025

Background

Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. Initially, it affects the rectum, and it may progress in a proximal and continuous manner to encompass other sections of the colon. Anorectal manometry quantifies and evaluates various aspects of the intricate and multifactorial mechanisms that regulate defecation and continence.

Methods

This study was carried out on 50 ulcerative colitis patients aged from 19 to 76 years old, both sexes, patients who have documented disease remission or mild activity clinically and by colonoscopy for the last six months and had persistent defecatory disorder symptoms. All patients were subjected to detailed history taking, systemic physical examination, laboratory investigations, colonoscopy showing remission or mild activity for the last six months based on Mayo score, and high-resolution anorectal manometry.

Results

There were statistically significant differences regarding relation between fecal incontinence and duration of the disease (P=0.008), while no significant differences were observed with the ulcerative colitis extension, and the treatment used. Regarding constipation, urgency, incomplete evacuation and proctalgia; there was no statistically significant differences with the duration of the disease, the ulcerative colitis extension, and the treatment used.

Conclusion

Many ulcerative colitis patients still experience defecatory disorders even at the quiescent stage, and this could be explained by the long-term neuromuscular effect of prolonged inflammation. High resolution anorectal manometry is the most important test to assess anal tone and contractility, recto-anal coordination and rectal sensation. Fecal incontinence in quiescent ulcerative colitis patients is significantly associated with the duration of the disease.

References

Gajendran M, Loganathan P, Jimenez G, Catinella AP, Ng N, Umapathy C, et al. A comprehensive review and update on ulcerative colitis. Dis Mon. 2019; 65:100-51.

Kang HR, Lee JE, Lee JS, Lee TH, Hong SJ, Kim JO, et al. Comparison of high-resolution anorectal manometry with water-perfused anorectal manometry. J Neurogastroenterol Motil. 2015; 21:126-32.

Torresan F, Mandolesi D, Bonventre S, Usai P. Differences between conventional anorectal manometry and high resolution\high-definition anorectal manometry. In: Bellini M, editor. High resolution and high-definition anorectal manometry. 5. Cham: Springer; 2020. p.49-68.
P0530 Relationships and sexuality in patients with inflammatory bowel disease – The perspective of healthcare professionals
Authors: Jäghult S , Druvefors E , Bello F , Florwald E , Forsell A , Myrelid P , Almer S
Published: January 2025

Background

Previous studies have shown that inflammatory bowel disease (IBD) has a negative impact on intimacy and sexuality related questions, and many IBD-patients experience that the disease impair the possibility of creating relationships. A recent Swedish study revealed that a large part of IBD-patients experience difficulties concerning relationships and sexuality, and many wish for a more active support from healthcare professionals. The aim of this Swedish follow up study was therefore to explore the current situation concerning intimacy and sexuality from the perspective of the healthcare professionals.

Methods

A digital, anonymous questionnaire was sent to healthcare professionals in Sweden through the different professional associations working with IBD-patients. The questionnaire contained 19 questions concerning problems that patients raise concerning intimacy and sexuality and how they are handled.

Results

A total of 118 respondents answered the questionnaire, the majority were women (73%), the mean age was 51 years. About half of the respondents (54%) were nurses, while 28% were gastroenterologists, 11% were surgeons, and 7% had another profession. The different professions were overall consistent in their answers why the results are presented for the whole group.

Half answered that they raise questions concerning relationships and sexuality on single occasions, while 23% stated that they never raise the topic with their patients (Figure 1). A total of 56% indicated that their patients ask questions concerning intimacy on single occasions, while 19% stated that it never happens (Figure 1). About 16% of the respondents stated that they had access to sexologist and 42% answered that they had possibility to refer to a psychologist or psychotherapist.

Many of the responders indicated that IBD-patients rarely raise questions concerning relationships and sexuality. Issues still being raised are mainly concerns about fertility in women, and erection problems in men. According to the healthcare professionals, both male and female patients report decreased sexual desire, a sense of not feeling attractive, and concerns about intestinal leakage. Women, also mentioned concerns regarding pain during intercourse, related to perianal fistulas and abdominal pain.

Conclusion

Healthcare professionals state that conversations concerning relationships and sexuality rarely happen. The conversations are mainly focused on fertility and erection problems. In our previous study, 78% of the patients stated problems concerning intimacy and 64% requested more active support from the healthcare professionals. Our results indicate a need for an increased knowledge and awareness about these questions among healthcare professionals.
P0532 Exploring biomarkers of systemic oxidative stress and placental insufficiency in pregnant women with Inflammatory Bowel Disease
Authors: Holstein H J , Bouwknegt D G , Visschedijk M C , Bulthuis M L C , Reinders-Luinge M , Schoots M H , van Goor H , Gordijn S J , Dijkstra G , Bourgonje A R
Published: January 2025

Background

Inflammatory bowel disease (IBD) often presents during the fertile age and may affect pregnancy outcomes. Both IBD and selected pregnancy complications involve oxidative stress. Soluble FMS-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) serve as biomarkers of placental insufficiency, while free thiols (FT) reflect systemic oxidative stress. This study aimed to assess the dynamics of FT, sFlt-1, and PlGF before, during, and shortly after pregnancy, and their relationships with disease- and pregnancy outcomes in patients with IBD.

Methods

This retrospective cohort study included pregnant women with and without IBD (Figure 1). FTs were measured with colorimetric detection; sFlt-1 and PlGF were measured using immunofluorescent assays. Extensive clinical data were collected, including pregnancy complications and IBD parameters. Differences between groups during pregnancy were assessed using nonparametric tests. Linear mixed-effects models were used to assess longitudinal changes of biomarkers before, during, and after pregnancy.

Results

A total of 40 patients and 14 non-IBD controls participated, covering 57 IBD and 14 control pregnancies. Serum FT levels were significantly lower in patients with ulcerative colitis during pregnancy (p=0.007, Fig. 2A) and decreased compared to pre-conceptional levels (p=0.005, Fig. 2B), indicating increased oxidative stress. Conversely, sFlt-1/PlGF ratios were not significantly different across groups (Fig. 2C). sFlt-1/PlGF ratios were higher in patients with small-for-gestational-age infants (p=0.015, Fig. 2D). Post-pregnancy FT levels were lower in patients experiencing disease exacerbations during pregnancy (p=0.046, Fig. 2E), whereas sFlt-1/PlGF ratios were numerically higher (p=0.063, Fig. 2F). IBD severity correlated with lower FT levels, as reflected in patients with a surgical history (p=0.066, Fig. 2G) and those using biologics at time of sampling (p=0.033, Fig. 2H).

Conclusion

This study demonstrates increased systemic oxidative stress in patients with IBD during pregnancy, as reflected by lower FT levels compared to pre-conceptional values and non-IBD controls. This was especially pronounced in patients with higher disease activity and severity. Prospective validation is required to evaluate the utility of these biomarkers in predicting pregnancy complications and informing clinical decision-making.
P0535 Crohn’s Anal Fistula - Quality of Life (CAFQOL) for disease control and remission in patients with perianal fistulizing Crohn’s disease: a new standard in assessing clinical outcome?
Authors: Mulders L , Beek K , Tielbeek J , Zwart M , Rietdijk S , Jansen J , Stoker J , Buskens C , D’Haens G , Gecse K ,   AMFIBIO study group
Published: January 2025

Background

Perianal Fistulizing Crohn’s Disease (PFCD) has a major impact on quality of life (QOL). QOL improvement is a key clinical goal, whether the aim is surgical repair, or symptom control. This prospective study evaluated the CAFQOL (Crohn’s Anal Fistula-QOL) questionnaire for disease monitoring in PFCD patients.

Methods

This study included patients with PFCD starting on anti-TNF therapy, mesenchymal stem cell injection, or hyperbaric oxygen therapy followed by surgical closure. We collected patient-reported CAFQOL and IBDQ-32, as well as Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI) and MRI (MAGNIFI-CD) outcomes at baseline, and at weeks 9, 26, and 52. QOL changes over time were analyzed using a linear mixed-effects model, and correlations between outcomes were assessed using Spearman correlation coefficients. Internal consistency was assessed with Cronbach’s alpha. The underlying structure of CAFQOL was evaluated with exploratory factor analysis (EFA) to identify distinct dimensions of quality of life. Responsiveness of CAFQOL and PDAI were reported in standardized response mean (SRM). Target CAFQOL values at week 52 for patients in complete remission by week 26 (PDAI≤4, MAGNIFI-CD=0) were calculated with a linear mixed-effects model. Receiver Operating Characteristic (ROC) model was used to evaluate CAFQOL in relation to clinical remission (FDA).

Results

We included 62 patients with a mean CAFQOL of 59.8 (SD 16.4) at baseline (Table 1). CAFQOL showed significant improvement over time, with average improvements of 8 points (95% CI 4 – 11) at week 9, 12 points (95% CI 8 - 16) at week 26, and 22 points (95% CI 18 - 26) at week 52 (all p<0.0001) (Figure 1). CAFQOL was strongly correlated with IBDQ-32 (r = -0.78; p<0.001) supporting convergent validity, while correlations with FDA (r = 0.48; p<0.0001), PDAI (r = 0.33; p=0.131), and MAGNIFI-CD (r = 0.11; p=0.548) were weak to negligible, supporting discriminant validity. A Cronbach’s alpha of 0.80 supported internal consistency. EFA revealed three main factors: social-practical impacts, emotional-mental health impacts, and physical discomfort explaining 53% of the QOL variance. By week 52, SRM of CAFQOL and PDAI were -1.26 and -1.79 respectively, suggesting large effect sizes. CAFQOL ≤ 37 was associated with complete fistula remission (PDAI≤4, MAGNIFI-CD=0), and was able to detect clinical remission with 80% (95% CI: 58–92) sensitivity and 56% (95% CI 39–71) specificity (AUROC=0.735; p=0.0038).

Conclusion

The CAFQOL is a reliable and consistently responsive tool that captures meaningful changes in quality of life over time regardless of the treatment modality.
P0538 Histologic remission predicts relapse in patients with Ulcerative Colitis
Authors: Lopes S , Teixeira M , Tomás D , Sequeira C , Teixeira C , Gamito É , Alves A L
Published: January 2025

Background

Histologic remission is not currently established as a formal treatment target in ulcerative colitis (UC). However, growing evidence indicates that histologic activity is associated with increased rates of relapse, hospitalization, and colectomy1.

We aimed to evaluate the predictive value of histologic remission in UC patients and its potential role in guiding disease management.

Methods

A unicentric retrospective study was conducted, including all patients with UC who achieved endoscopic remission (Mayo Endoscopic Subscore ≤1) on colonoscopy between January 2020 and June 2023. Histologic remission was defined as the absence of neutrophils in the lamina propria or epithelium. Clinical activity was assessed using patient reported outcomes (PRO-2) for stool frequency or rectal bleeding (PRO-2>0). Clinical relapse was defined as the need for therapy optimization, switching therapy, or corticosteroid use.

Factors associated with relapse were assessed using chi-square tests for categorical variables and t-tests for continuous variables. A binary logistic regression model was applied to further evaluate these associations.

Results

A total of 90 patients were included (58% male; mean age: 55 ± 15 years), with a median disease duration of 15±9 years. Among patients in endoscopic remission, 61% had a Mayo endoscopic subscore of 0, and 39% had a score of 1. Histologic remission was observed in 74% of patients (table 1).

During follow-up, 23% (n=21) of patients experienced a relapse. Histologic activity was statistically associated with a higher risk of clinical relapse (p=<0.001). No differences were found in relapse rates between patients with Endoscopic Mayo Subscores of 0 or 1 (p=0.073). Younger age (p=0.009), shorter disease duration (p=0.002), and previous failure of advanced therapies (p=0.049) were also associated with a higher risk of clinical relapse. Multivariate analysis identified histologic remission as the sole independent predictor of relapse (odds ratio: 0.173, 95% CI: 0.053–0.571, p=0.004).

Conclusion

These observational data suggest that histologic remission may predict clinical relapse in patients with UC. In this cohort, histologic remission was identified as the sole predictor of relapse, outperforming endoscopic remission.

References

Lobatón T, Bessissow T, Ruiz-Cerulla A, De Hertogh G, Bisschops R, Guardiola J, Van Assche G, Vermeire S, Ferrante M. Prognostic value of histological activity in patients with ulcerative colitis in deep remission: A prospective multicenter study. United European Gastroenterol J. 2018 Jun;6(5):765-772. doi: 10.1177/2050640617752207.
P0540 Assessment of Metabolic-Associated Liver Disease in Patients with Crohn’s Disease in Long-Term Remission
Authors: Amiama Roig C , Cristina S F , Laura G R , Jose Luis R G , Maria S A , Eduardo M A , Joaquin P C , Irene G D , Carmen A C , Maria Dolores M A
Published: January 2025

Background

Previous studies have shown that patients with Crohn’s disease(CD) have an increased risk of metabolic liver disease(MASLD) even in the absence of cardiovascular risk factors. This increased prevalence is attributed to the inflammatory bowel activity itself.

However, there is less evidence on whether CD could be an independent risk factor for MASLD in patients in long-term remission

Methods

A cross-sectional study was conducted, including two cohorts: one of patients with CD in deep remission and another of healthy controls. All participants underwent blood tests, abdominal ultrasound with shear wave elastography(SWE) and FibroScan®. Additionally, CD patients were evaluated to determine clinical, biochemical, and radiological remission(using intestinal ultrasound). Only patients with CD in clinical remission for at least one year, and not receiving immunosuppressive or biological treatments, were included.

Patients with clear predisposing risk factors to metabolic liver disease(such as corticosteroid treatment or diabetes) were excluded

Results

47 patients were included: 29 controls(61.7%) and 18 with CD in remission(38.3%). The baseline characteristics are summarized in Table1.

Regarding the CD remission: Harvey index median was 0(IQR 0-1). Faecal calprotectin mean was 38.8 µg/g(IQR 20.7-57.4), C-reactive protein mean was 0.6mg/dL(IQR 0.5-2.1), and intestinal ultrasound showed normal bowel wall thickness in all patients.

The lipid and liver profile is presented in Table2.

Considering all included patients, regardless of the presence of steatosis, Fibroscan values were significantly higher in the control group compared to CD patients, although there were no advanced fibrosis in either group(4.9kPa vs 4.1kPa,p=0.04). This was consistent with SWE data(4.3 kPa vs 4.15 kPa), although this difference did not reach statistical significance(p=0.58). ATI values were 0.54 in controls vs 0.58 in CD patients(p=0.38).

Considering only patients with steatosis, there was no greater prevalence of steatosis among patients with CD(23.5%) compared to controls(20.8%),p=0.84. By ultrasound, all cases were classified as mild steatosis, except for one patient who was reported as severe, belonging to the CD group.

In our sample, among patients with steatosis, those with CD were more frequently diagnosed with dyslipidaemia(75%) compared to controls(0%),p=0.018.

Fibroscan values were lower in patients with CD and steatosis(3.9kPa) compared to controls(5.3kPa),p=0.26. Similar to SWE (4.02kPa vs 4.56kPa, p=0.43) and ATI(0.73 vs 0.69,p=0.74) values

Conclusion

In our experience, there is no increased prevalence of MASLD in CD in the absence of activity, and when present, it may be secondary to underlying cardiovascular risk factors, as in our case was dyslipidaemia
P0546 Surgical recurrence following repeated ileocolic resection for Crohn’s disease: a retrospective single center cohort study
Authors: Haanappel A , Moojen T , Vlug M , Hompes R , Buskens C , Bemelman W
Published: January 2025

Background

Surgical recurrence after primary ileocolic resection (ICR) for CD is common. (1) However, data on long-term outcomes following first resection of the neoterminal ileum (re-ICR) are scarce. The present study evaluated the risk on surgical recurrence following first re-ICR in CD patients. In addition we aimed to assess changes in medical treatment strategies and its effect on postoperative outcomes.

Methods

A retrospective cohort study was conducted in the Amsterdam UMC, including all CD patients undergoing first re-ICR between 2000-2021. The primary outcome was the need for re-ICR due to disease recurrence at the neoterminal ileum. Two time periods were created to assess changes in surgical recurrence and short-term outcomes over time, C1: 2000-2009 and C2: 2010-2021.

Results

in total, 110 patients were included, comprising 69 females (62.7%) with a median age at time of re-ICR of 39 years (IQR 30.0 – 50.3). Time from primary ICR to re-ICR increased significantly over time. Most patients presented with stricturing disease at time of first re-ICR (64.5%). Rates of surgical recurrence were 13.0% and 24.9% after 5 and 10 years, respectively. Over time an increased use of prophylactic biological use was observed (C1: 16.4% vs C2: 41.7%, p=0.004). Over time, no significant differences in 5-year, and 10 year surgical recurrence rates were observed between C1 and C2, (12.5% vs 11.5%, p=0.636), and (28.6% vs 18.7%, p=0.341), respectively.

Conclusion

This study demonstrated an overall 10-year surgical recurrence rate of 24.9% in patients undergoing first re-ICR. Over time, postoperative disease management has evolved towards increasing use of biological therapy. However, no significant difference in surgical recurrence rates over time have been observed.

References

1.Beelen EMJ, van der Woude CJ, Pierik MJ, Hoentjen F, de Boer NK, Oldenburg B, et al. Decreasing Trends in Intestinal Resection and Re-Resection in Crohn’s Disease: A Nationwide Cohort Study. Ann Surg. 2021;273(3):557-63.

Figure 1. Kaplan-Meier curve for surgical recurrence according to time period, log-rank: p= 0.450
P0547 Use of MUC score in the activity evaLuation by Pediatric intestinal ultrasound and their corrElation with other clinical and ultrasounD scores (ULPED)
Authors: Parra Izquierdo V , Ernest Suarez K , Argollo M , Frías-Ordoñez J , Orduz G , Cubillos S , Vargas M , Verstockt B
Published: January 2025

Background

Inflammatory bowel diseases (IBD) are diagnosed during childhood and adolescence in up to 20% of patients. Invasive studies are mandatory for diagnosis, but monitoring strategies should ideally be non-invasive to reduce anxiety and stress, especially in children. Hence, intestinal ultrasound (IUS) is increasingly being used as a cheap, noninvasive tool for monitoring disease activity in children with IBD. However, scoring systems have mostly been developed and validated for adults. We aimed to evaluate the performance of the Milan Ultrasound Criteria (MUC) and simple pediatric activity ultrasound score (SPAUSS) in pediatric ulcerative colitis (UC) patients, and correlate them with the PUCAI (Pediatric Ulcerative Colitis Activity Index) score.

Methods

Patients <18 years with an established diagnosis of UCwere prospectively enrolled in Colombia. IUS assessment was performed (including measurement of Bowel Wall Thickness and Colour Doppler Sign), with subsequent collection of Mayo endoscopic score (MES) and PUCAI scores (The information was recorded with data from a colonoscopy performed ± 30 days). Appropriate uni- and bivariate analyses were performed, as well as Pearson correlation.

Results

Sixteen ambulatory pediatric patients with UC (50.0% girls median age 13.3 years [9-17], median disease duration 5.1 years [0.7-13.7]) were enrolled. The PUCAI score has a significant statistical relationship with MES (p=0.001) and the MUC (p=0.001). Likewise, the PUCAI score was associated with the presence of a Doppler signal (p=0.001). The SPAUSS score correlated strongly with the MUC score (r=0.938), (p=0.001). The median MUC score in children with MES 0-1 versus MES≥2 was 3.08 and 6.87 respectively. Based on additional ROC analysis (Figure 1), we propose a MUC cutoff of 4.85 with 100% sensitivity and specificity to differentiate MES 0-1 from MES≥2 (p=0.003) (Figure 2).

Conclusion

The MUC score in pediatric UC patients correlates well with endoscopic disease activity and with the SPAUSS score. We propose a MUC score cutoff of 4.85 for pediatric UC patients. Larger, independent studies are needed to confirm this cutoff, which is different to the MUC 6.2 cutoff in adult UC patients.
P0550 Introducing Intestinal ultrasound in the UK NHS – the first 6-months
Authors: Ali N , Flower A , McCoubrie P , Gupta V , Griffiths L , Murray S , Meade S
Published: January 2025

Background

Intestinal ultrasound (IUS) has been integrated into inflammatory bowel disease (IBD) practice outside of the UK for several years. The NHS has been slow to adopt this and there is ongoing scepticism with regards to its utility.

Methods

We performed a retrospective service evaluation to demonstrate the utility of IUS in the NHS. IUS was requested additionally to tests performed as standard of care to enable internal audit. We assessed the proportion of cases where IUS altered decision making. Secondary outcomes included the additional value of IUS to faecal calprotectin (fcal) and the accuracy of IUS in terms of the presence, activity and extent of disease. Similar to the METRIC study,1 IUS accuracy was determined after accounting for all available investigations performed in each patient and recorded as a binary outcome. Where pathology was missed, changes in management were recorded. Data collected included demographic, disease phenotype, body mass index, pregnancy, indication for IUS and scan adequacy.

Results

We performed 74 IUS on patients with: Crohn’s disease (53) [L1–40; L3–13; B1–11; B2–32; B3–10; p1], ulcerative colitis (17) [E1–2; E2–5; E3–10] and suspected CD (4). Mean age 45.5 years; 45 (61%) female, mean BMI 25.2, pregnant [mean 29/40 weeks] 7 (9.4%). Indications included disease flare (34, 46%), asymptomatic with raised fcal (4, 5%) or disease monitoring (36, 49%). In total, 10 (13%) were deemed inadequate due to (gravid uterus obscuring view [3, 4%), BMI >26 (4, 5%), difficult scan (3, 4%). All 10 patients had mild (6, 8%) or quiescent disease (4, 5%). Table 1 shows the outcomes of the remaining 64 scans. In 52/64 (81%) cases the IUS altered immediate treatment decisions. In 38/64 cases, the IUS added additional value compared to using the subsequently resulted fcal alone. The presence, activity and extent of disease was concordant with standard tests (92%, 92% and 62% of cases, respectively). Missed pathology requiring alternative treatment was identified in 6/63 (9.5%) cases (mild aphthous ulceration seen on VCE [normal MRE] [4], lymphoma [1] and ileorectal anastomotic stricture [1]). The latter two cases required cross-sectional imaging irrespective of the IUS result. Time to definitive treatment decision was reduced by an average of 57 (24-92) days.

Conclusion

Despite limited experience in IUS, our outcomes are similar to results from the METRIC trial. The NHS should expedite the adoption of IUS to avoid invasive/expensive tests, add value to the clinical consultation and streamline IBD care.

References

Taylor SA, Mallett S, Bhatnagar G, et al. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 2018;3(8):548-558. (In eng). DOI: 10.1016/s2468-1253(18)30161-4.
P0553 MRI neurophenotype reflecting brain-gut interactions to predict intestinal disease progression in patients with Crohn’s disease
Authors: Zhang R , Shen X , Huang L , Feng S T , Mao R , Li X
Published: January 2025

Background

There is considerable recent interest in the role of brain-gut axis in the pathogenesis and manifestations of Crohn’s disease (CD). We developed a multimodal neuroimaging-based model to characterize the neurophenotype of CD patients and predict intestinal disease progression, using multi-omics data to demonstrate its validity.

Methods

This prospective study enrolled 109 CD patients who underwent baseline tests (including multimodal neuroimaging, psychological scales, MR enterography, ileocolonoscopy) and fecal/blood samples collection within one week. The neurophenotype of patients with different intestinal inflammation levels was characterized using a radiomics model, developed from 13 out of 13,870 neuroimaging features. This neurophenotype in predicting disease progression during follow-up was evaluated using Kaplan-Meier curves and Cox regression analysis. Multi-omics data (including fecal microbiome, fecal/blood metabolomics, intestinal/blood-brain-barrier permeability, and blood neurotransmitter) were used to elucidate how this neurophenotype reflecting brain-gut interactions (see Graphic Abstract in Fig 1).

Results

The model enabled accurate characterization of neurophenotypes in patients with different intestinal inflammation levels in training and test cohorts (AUC=0.824-0.842, both P<0.05). Neurophenotype was the most important predictor of disease progression (HR=29.05, P=0.033), surpassing psychological traits (HR=0.95-1.09, all P>0.05). Multi-omics analysis revealed that elevated intestinal inflammation was correlated with increased intestinal permeability and specific gut microbiota (e.g., Enterococcus) and metabolites (e.g., caproic acid), which collectively contributed to high-risk neurophenotype (all P<0.05). High-risk neurophenotype subsequently associated with intestinal disease progression by establishing correlations with six blood neurotransmitters (e.g., tryptophan) (all P<0.05).

Conclusion

The neurophenotype varies among CD patients with different intestinal inflammation levels and can predict intestinal disease progression. Multi-omics data offer biological evidence to support its validity. Our neurophenotype characterization model effectively illuminates these brain changes and accurately stratifies their neurophenotypic risk, paving the way for the implementation of new strategies to initiate transformative advancements.

References

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P0558 An Integrative Blood-Based Risk Score Predicts Development of Crohn's Disease
Authors: Ungaro R , Rajauria P , Torres J , Porter C , Magee J , Agrawal M , Dervieux T , Gnjatic S , Colombel J F , Petralia F
Published: January 2025

Background

Individual blood markers have been associated with future risk of Crohn's disease (CD). However, there is a need to understand which combination of biomarkers will be most predictive to facilitate CD prevention trial recruitment. We aimed to develop and validate a blood-based integrative risk score for CD development.

Methods

We analyzed data from 200 patients with CD and 100 age, sex, and race-matched healthy controls (HC) from PREDICTS, a nested case-control study of US active-component service members (ACSM). Longitudinal serum samples were collected at four time points up to 6+ years prior to diagnosis. Anti-microbial antibodies (Prometheus), proteomic markers (Olink inflammation panel), and anti-granulocyte macrophage-colony stimulating factor autoantibodies (anti-GM-CSF) were assayed in each sample. Participants were randomly divided into equal sized training and testing sets. Time-varying trajectories of marker abundance were estimated for each biomarker. Logistic regression modeled disease status as a function of each marker for different time points and multivariate modeling was performed via logistic lasso regression. A risk score to predict CD onset within 2 years was developed using penalized mixed-effects logistic regression. Prediction models were fit on the testing set and predictive performance evaluated via receiver operating characteristic (ROC) curves and area under the curve (AUC).

Results

The AUCs of individual markers were dynamic over time, with some having stable predictive capacity and others increasing or decreasing closer to time of diagnosis (Figure 1A). The AUCs for a model combining antibodies (Prometheus and anti-GM-CSF) and proteins were consistently above 0.8 starting 4 years prior to diagnosis, primarily driven by proteomic markers (Figure 1B). An integrative model predicting CD onset within 2 years incorporated 10 biomarkers and significantly associated with CD onset (Figure 1C). The model resulted in an AUC of 0.87 with a specificity of 99% and positive predictive value of 84% at a classification threshold of 0.7 (Figure 1D). Stratifying the integrative model scores into quartiles revealed a clear gradient in CD incidence within 2 years, increasing from 2% in the first quartile to 57.7% in the fourth quartile (Figure 1E). The relative risk (RR) for developing CD among ACSM in the top quartile, compared to the lower quartiles, was 10.4 (95% CI 6.9, 15.6).

Conclusion

An integrative blood-based model combining anti-microbial antibodies and proteins predicts onset of CD. Serologic and proteomic markers have dynamic changes years before diagnosis, highlighting the varying preclinical phases of CD and how leveraging biomarker dynamics can predict time to diagnosis.

Figure 1
P0559 Endoscopic healing at 1-year and association with long-term quality of life in ulcerative colitis: A pooled clinical trial analysis adjusting for 1-year clinical remission status
Authors: Sanon M , Neff-Baro S , Gauthier A , Kachroo S , Wirth D , Eisele L , Naessens D
Published: January 2025

Background

Therapeutic goals and clinical guidelines in inflammatory bowel disease have evolved to include endoscopic outcomes being a key prognostic parameter in disease management. STRIDE-II guidelines are comprised of clinical and patient-reported outcome remission, along with biomarker normalization and endoscopic healing. While available publications have correlated achievement of endoscopic outcomes with long-term outcomes, few if any have adjusted for clinical remission status. The objective of this analysis was to assess the impact of endoscopic healing at the end of 1-year and 2-year quality of life while adjusting for clinical remission status at 1-year using clinical trial data.

Methods

Data from four randomized ulcerative colitis clinical trials (UNIFI:NCT02407236, PURSUIT:NCT01863771, ACT-1:NCT00036439, ACT-2:NCT00096655) were pooled to assess the impact of endoscopic healing at 1 year on patients’ quality of life as assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). This post-hoc analysis assessed endoscopic healing at the end of maintenance (EOM) (~42 weeks) and IBDQ remission in the long-term (LTE) duration (~126 weeks). Endoscopic healing was based on endoscopy sub-score of the Mayo score = 0 or 1 and IBDQ remission was defined as IBDQ total score>=170. Patients without LTE IBDQ data and placebo treated patients were excluded. Multivariate analyses with trial as a random effect were conducted and adjusted for treatment arm during maintenance, clinical remission status at end of maintenance (EOM), and endoscopic healing at EOM.

Results

A total of 591 patients had available endoscopy and clinical remission status at EOM. The percentage of patients with endoscopic healing reaching LTE IBDQ remission was 80.7% whereas 56.2% of those without endoscopic healing reached IBDQ remission. Results of the multivariate analyses showed that endoscopic healing at EOM was significantly associated with higher odds of LTE IBDQ remission with an OR of 1.78 and a corresponding p value below 0.05.

Conclusion

This analysis used clinical data from robust trials and adjusted for patients’ clinical remission status at the end of maintenance to isolate the benefit of endoscopic healing in predicting long-term outcomes in UC. Endoscopic healing is significantly associated with a higher likelihood of experiencing a better quality of life.
P0560 Levels of disease-associated anti-integrin αVβ6 are substantially reduced after proctocolectomy in ulcerative colitis but persist in primary sclerosing cholangitis
Authors: Roth D , Düll M , Horst L , Lindemann A , Elsner X , Koop K , Zundler S , Vetter M , Jefremow A , Atreya R , Geppert C , Weidemann S , Waldner M , Dietrich P , Günther C , Munoz L , Herrmann M , Neurath M , Siebler J , Schramm C , Kremer A , Leppkes M
Published: January 2025

Background

Recently, autoantibodies directed against the epithelial adhesion protein integrin αVβ6 have been identified that strongly associate with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) with potential disease-driving effects. The presence of anti-αVβ6 in PSC without IBD is under debate. Moreover, data on the effect of proctocolectomy on autoantibody levels remains scarce.

Methods

Anti-αVβ6-directed autoantibodies were detected by a commercial enzyme-linked immunosorbent assay in patient sera, including healthy controls (N = 62), ulcerative colitis (N = 36), Crohn’s disease (CD, N = 65), PSC with concomitant IBD (78 samples from N = 41 patients), PSC without clinically manifest IBD (41 samples from N = 18 patients). Additionally, sera after proctocolectomy were studied (44 samples / N= 10 patients: 5 with UC, 5 with PSC). Immunofluorescent analyses of the target autoantigen were performed in liver, large bile ducts from surgical resections and colon tissue samples of PSC patients and single-cell RNA seq datasets were studied.

Results

The target autoantigen is expressed in disease-associated epithelia in the colon, in cholangiocytes in fibrotic portal fields and periductular glands of the large bile ducts as detected in immunofluorescence and single-cell RNA sequencing datasets. Anti-αVβ6 antibodies occur in 74% of patients with PSC with IBD, but also in 39% of patients with PSC without manifest IBD with lower levels. Anti-αVβ6 levels correlate with intestinal disease activity in patients with primary sclerosing cholangitis. Interestingly, proctocolectomy reduces autoantibody levels more strongly in UC than in PSC patients.

Conclusion

Disease-associated anti-integrin αVβ6 autoantibodies are also present in PSC without IBD with lower levels, assay sensitivity being a crucial determinant of detection. Moreover, proctocolectomy more strongly reduced autoantibody levels in UC than in PSC. Preferential autoantibody persistence in PSC after proctocolectomy might explain the increased incidence of chronic pouchitis in PSC.
P0566 Submucosal, but not mucosal, wall thickness and stiffness correlate with bowel urgency in Ulcerative Colitis
Authors: Serizawa K , Sagami MD- PhD S , Shibui S , Umeda S , Asonuma K , Komatsu M , Maeda M , Nogami A , Karashima R , Nakano M , Maeda I , Hibi T , Kobayashi T
Published: January 2025

Background

Patients with ulcerative colitis (UC) may have bowel urgency (BU), which has been recognised as important due to its links with anxiety, depression, and reduced social quality of life. This study examines intestinal ultrasound (IUS) findings associated with BU, comparing them to endoscopic findings and biomarkers.

Methods

This prospective, single-centre study included UC patients undergoing colonoscopy from January to September 2023. Transabdominal and transperineal IUS was performed, assessing bowel wall thickness (BWT), colour Doppler signal (CDS), and shear wave elastography (SWE) in the sigmoid colon. The thickness of each layer of the sigmoid colon was also measured. Patients were grouped by urgency status per the Simple Clinical Colitis Activity Index. Statistical methods included the Wilcoxon rank-sum test, logistic regression, and ROC curve analysis.

Results

A total of 59 patients were enrolled, of which 33 patients (56%) had BU. CRP, MES, BWT (descending, sigmoid colon and rectum), thickness of submucosa and muscularis propria, CDS (sigmoid and rectum), and SWE were significantly higher (P<0.05) in patients with BU, while faecal calprotectin (FC). was not different (P=0.48). Logistic regression adjusted for MES identified BWT (sigmoid and rectum) and SWE as factors associated with BU. Interestingly, thickness of submucosa (p<0.01) and muscularis propria (P=0.03) but not mucosal layer (P=0.97) correlates with BU (Table). ROC analysis showed that thickness of submucosa predicted BU with high accuracy, outperforming mucosal thickness (P<0.05) (Figure).

Conclusion

Sigmoid BWT, especially submucosal thickness and wall stiffness assessed via IUS, correlates strongly with BU, independent of endoscopic severity. These findings provide important insights into the pathophysiology of BU in UC.