bluuebunny/crossref_metadata_2025 huggingface dataset:
P263 Raman spectroscopy analysis of saliva combined with an artificial neural network algorithm could discriminate between Ulcerative Colitis and Crohn’s disease
Authors: Buchan E , Majumder S , Nardone O , N Shivaji U , Abdawn Z , Hejmadi R , Iacucci M , Goldberg Oppenheimer P
Published: January 2023

Background

Early and accurate detection of inflammatory bowel disease (IBD) is crucial for proper intervention.The IBD diagnostic process can be both time-consuming and invasive and lacks a gold standard in disease differentiation. Saliva analysis has gained interest as a potential non-invasive source of disease biomarkers due to its positive correlation with blood-based constituents (e.g. interleukins) at a molecular level. We systematically studied the molecular fingerprint of saliva and tissue biopsy, including how they compare as well as changes associated with disease state-IBD vs non-IBD and Ulcerative colitis (UC) vs Crohn’s disease (CD).

Methods

After obtaining informed consent Saliva and colon biopsies were collected from patients undergoing endoscopy as a standard of care procedure at University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK. The samples were correlated with their tissue pathology markers and findings of the endoscopic evaluation. By combining Raman spectroscopy and an artificial neural network algorithm, Self-Optimising Kohonen Index Network (SKiNET), we have developed a non-destructive molecular profiling tool that assesses both salivary and colonic biopsy changes, which helps to determine the diseased state of the sample source. The collected Raman spectra were analysed using SKiNET as a decision support tool to identify spectral markers and discriminate between healthy and IBD disease classes [1].

Results

This pilot study characterised the spectral signatures of 101 saliva samples (healthy = 50, UC = 27 and CD =24) and 44 tissue biopsy samples (healthy = 12, UC = 17 and CD = 15). The algorithm reached 87.5% sensitivity and 89% specificity when classifying saliva and 83.9% sensitivity and 84.6% specificity when classifying tissue biopsy. When comparing the spectral fingerprints of saliva to tissue biopsy, the UC spectra are of similar forms with comparable intensities at each of the primary peaks; 1003 cm1(phenylalanine), 1440 cm-1 (Lipids) and 1656 cm-1 (Amide I). In contrast, CD saliva and tissue biopsy indicate significant variance throughout the Raman spectral fingerprint region, with intensity changes observed at each of the primary peaks and the presence of additional shoulder peaks associated with proteins and lipids. In identifying markers of disease IL-4, IL-8 and IL-10 were identified as having important and designatory Raman bands which could serve in the discrimination of IBD in individuals.

Conclusion

This unique combination of Raman spectroscopy and advanced machine learning represents significant progress towards improved, non-invasive and rapid classification of IBD.This technique also lays the foundation for future applications in disease diagnosis, monitoring and therapeutics.
P270 A global consensus on the definitions, diagnosis and management of fibrostenosing small bowel Crohn’s disease
Authors: Bettenworth D , Baker M E , Bemelmann W , Bruining D , D’Haens G , D’Hoore A , Dignass A , Dotan I , Feagan B G , Feakins R , Fleshner P , Fletcher J G , Gordon I , Ha C , Gaylyn H , Jairath V , Lu C , Lyu R , Ng S C , Panes J , Rogler G , Mao R , Rimola J , Sandborn W J , Siegmund B , Silverberg M S , Taylor S , Verstockt B , Rieder F
Published: January 2023

Background

Small bowel fibrostenotic strictures are common in patients with Crohn’s disease (CD). No global consensus recommendations on definitions, diagnosis and clinical management are available.

Methods

Several systematic reviews followed by a RAND/University of California Los Angeles appropriateness study on the definitions, diagnosis and clinical management of fibrostenosing CD in clinical practice were performed. A panel of 28 global experts and a patient representative were convened. They assessed a total of 152 candidate items. The items were subsequently evaluated for appropriateness.

Results

No accurate predictive biomarkers are available for naïve or anastomotic fibrostenosing strictures. Accurate diagnosis of fibrostenosing CD requires cross-sectional imaging which should evaluate bowel wall thickness, luminal narrowing and prestenotic dilatation. A potential inflammatory component should be assessed. Abdominal cross-sectional imaging was considered necessary prior to any treatment decision. The panel proposed an approach to medical, endoscopic, and surgical therapies (Figure 1 and Table 1). Technical characteristics for endoscopic balloon dilation and follow up strategies after successful dilation therapy were identified. Appropriateness, types and performance of different surgical approaches in various settings were evaluated.

Conclusion

This global consensus provides clinical guidance for the diagnostic and therapeutic management of patients with fibrostenotic CD.
P271 Variability in histologic activity of paired same-segment biopsies in Crohn’s disease dictates multiple biopsies needed to accurately evaluate histological status
Authors: Lenfant M , Vermeire S , Sabino J , Ferrante M , Verstockt B , De Hertogh G
Published: January 2023

Background

At present, the significance of histologic remission in Crohn’s disease [CD] is unclear. One of the main reasons is the heterogeneous distribution of the lesions. This contrasts with ulcerative colitis, where histologic scoring systems have been applied with success on limited numbers of biopsies. We assessed the variability of histologic activity in paired same-segment biopsies from CD patients.

Methods

All CD patients undergoing ileocolonoscopy between January 2020 and July 2022 at our tertiary referral center were eligible for inclusion. Clinical data were retrospectively collected from medical records. Endoscopies were video-recorded and the Simple Endoscopic Score for Crohn’s Disease [SES-CD] was used to evaluate endoscopic activity. Paired biopsies were taken within the most affected area per segment, in accordance with ECCO guidelines.

The Global Histology Activity Score (GHAS), the Geboes Score [GS], the Robart’s Histopathology Index [RHI] and the Nancy Histological Index [NHI] were determined for each biopsy by an experienced IBD pathologist [GDH] blinded to the endoscopic scores. The cut-off values for histologic remission were set at GHAS ≤4, GS <2B.1, RHI ≤3 and NI ≤1 (absence of neutrophils for RHI and NI).

Variability was assessed by intraclass correlation coefficient [ICC] and Kappa statistics. Association between histologic and endoscopic scores was studied with Spearman’s rank correlation coefficient.

Results

A total of 151 biopsy pairs from 128 patients were analysed. Patient characteristics are summarised in Table 1. Endoscopic activity was observed in 79% of segments. In patients with endoscopic remission, histologic activity (presence of neutrophils) was found in 29% of cases. There was a moderate association between the endoscopic and histologic assessment, with correlation levels ranging from 0.48 to 0.52 [p<0.001].

Histologic indices showed fair agreement between paired biopsies [Table 2]. Looking at the predefined cut-offs, moderate variability across the different histological scores was seen [Table 3]. When comparing biopsies from segments with endoscopic activity and those without, overall higher variability in active segments and substantial agreement in paired biopsies from inactive segments was observed [Table 4].

Conclusion

The patchy nature of microscopic inflammation in CD is reflected in the histologic scores of paired same-segment biopsies, with only moderate agreement across histologic scoring indices, although lower variability was seen in biopsies from endoscopic inactive segments. Endoscopic activity only moderately reflects histological status. Multiple biopsies per segment are therefore needed for accurate histological evaluation, the optimal number necessary remains to be explored.
P280 Quality of life in military patients with Inflammatory Bowel Disease
Authors: Ben Safta N , Medhioub A , Mohamed G , Boughoula K , Ben Slimane B , Ben Abdallah H , Bouali R , Bizid S , Abdelli M N
Published: January 2023

Background

Inflammatory Bowel Disease (IBD), represented by Crohn's disease (CD) and Ulcerative Colitis (UC), are chronic conditions that can impair quality of life (HRQOL). Active military personnel are particularly at risk, given the strain of their work and military missions. The aim of our study was to evaluate the HRQOL of active military patients with IBD and to search for factors related to its alteration.

Methods

This was a prospective cross-sectional study, over a period of 5 months [February 2022 - June 2022], including male military patients that were still serving. The HRQOL of these patients was assessed by the IBD-Disk, which is a visual scale that consists of 10 items (Abdominal pain, diarrhea, social behavior, education and work, sleep, energy, emotions, body image, sexual activity, joint pain). It is validated for the assessment of HRQOL in IBD patients. Each dimension is scored from 0 to 10, with a total score of 0 to 100. The higher the score, the more impaired the HRQOL. The overall IBD-Disk score was considered impaired if it was higher than 40.

Results

We included 30 patients. The most represented age range was from 31 to 40 years. Ten patients were smokers. Twenty-four patients had CD and 6 had UC. The majority of CD was isolated ileal (n=16) with an upper gastrointestinal tract involvement in one patient and anoperineal manifestations in 5 patients. UC was distal in 3 patients and extensive in the other 3. Nine patients had extra-intestinal involvement, principally rheumatological (n=8). The mean overall IBD-Disk score was 21.6 [6 - 66]. We noted that CD was associated with the alteration of the dimensions related to urgent stools (p=0.001), social life (0.002) and sleep (p=0.004). The presence of anoperineal lesions during CD was associated with impairment of the social (p=0.002) and energy (p=0.006) dimensions. The presence of extra-intestinal manifestations was associated with elevated social dimension score (p=0.002). Azathioprine treatment was associated with impaired sleep dimension (p=0.048). Patients with a disease that had been evolving for more than 5 years had an alteration in the dimension related to urgent stools (diarrhea) (p=0.036), energy (p=0.048) as well as the dimension of sexual life (p=0.042). History of hospitalization for IBD was associated with impaired body image (p=0.030). History of surgical resection was associated with impaired energy (p=0.029), sexuality (p=0.015) and overall quality of life (p=0.02).

Conclusion

In our active military patients, HRQOL was not impaired overall, but several factors, related to severe forms, were associated with lower HRQOL.
P284 Assessing Patient Experience in an Inflammatory Bowel Disease service. Can we measure an effect from socioeconomic deprivation – experience from the AWARE-IBD programme?
Authors: Sheldon E , Roman S , Bursnall M , Hawkins R , Lobo A , Hind D , Randall K , Wakeman R , Ainley R
Published: January 2023

Background

There is increasing international attention on delivery of services for people with Inflammatory bowel diseases (IBD). Experience of care is defined and measured as ‘what’ happened, ‘how’ and ‘how often’ and is an important facet of service provision. Socioeconomic deprivation may be associated with poor disease-related outcomes and sub-optimal utilisation of services but its effect on experience of care in people with inflammatory bowel disease has not been reported.

Methods

An invitation to participate in a research study nested within the AWARE-IBD quality improvement programme was sent to 4082 patients attending the IBD service at a single UK teaching centre in October 2021. A second invitation was sent in May 2022 followed by telephone recruitment targeted to those from the most deprived deciles based on the index of multiple deprivation (IMD), a measure of relative deprivation for small areas in England (‘lower-layer super areas’, approximately 1500 residents). Participants returned an IBD specific patient reported experience measure (PREM) via a web application comprising 38 items across 3 domains: ‘My Care Team’, “What matters to me’, ‘Living with Crohn’s or Colitis’. Each item was scored 1 (poorest experience) to 5 (best experience). Median scores for individual items and by domain was compared in the following demographic groups: IMD decile IMD (1 = most deprived; 10 = least deprived), age, gender, disease type (ulcerative colitis or Crohn’s disease).

Results

PREM responses were received from 249/4,082 (6%) patients. Patients from the most deprived decile were underrepresented in respondents compared to the invited cohort (Decile 1 22/249 (9%) vs 667/4,063(16%) p=0.002) and patients from the least deprived decile were over-represented; Decile 10: 38/249 (15%) vs 379/4063(9%) p=0.002). Respondents were otherwise broadly comparable to the invited cohort in terms of age, gender and disease type. Experience of care for respondents for individual PREM items or by domain did not differ according between IMD deciles (Figure 1), age, gender or disease type.

Conclusion

Measuring experience of care is an important part of IBD service quality improvement. No effect from socioeconomic deprivation was demonstrated. This finding conflicts with the literature on links between socioeconomic factors and quality of care and results across a service should be interpreted with caution. Experience of those at greatest risk is difficult to elicit with survey based experience measurement. Instead, tailored engagement exercises are required including qualitative and ethnographic approaches to better understand the impact of deprivation on experience.
P285 Correlation between the endoscopic scoring system SES-CD for Crohn’s disease with histological and clinical outcomes
Authors: Gibbons E , Afridi I , Sheehan T , Smyth C , Farrell R , Hall B , Kelly O B
Published: January 2023

Background

There is a growing body of literature demonstrating that persistent histological activity, despite endoscopic remission, may be associated with increased risk of relapse in IBD. Much of this research has focused on outcomes in UC. The primary aim of this study was to examine the correlation of the endoscopic scoring system, SES-CD with histological outcomes and their association with flare/hospitalisation in the ensuing twelve months.

Methods

We selected 82 random colonoscopies performed for Crohn’s surveillance/assessment between 2017-2019. Adult patients with a complete colonoscopy were included. All reports were reviewed and blindly scored by 2 expert endoscopists using SES-CD scoring system. Histology was classified as normal, mild, moderate and severe by an experienced gastrointestinal histopathologist. Clinical/ IBD demographics, flare episodes and hospitalisations were recorded. Correlation between endoscopic and histologic activity was tested. Comparisons were made between patients with histologic and endoscopic remission, those in endoscopic remission with histologic activity and those with both endoscopic and histologic activity.

Results

82 patients with Crohn’s disease (median age 44; M:F 38:44) were included. A wide range of SES-CD scoring was noted (median score 3), with 47.5% in remission (0-2), 30.5% mild activity (3-6), 18% moderate activity (7-15) and 3.5% severe disease activity scoring > 16. Patient groups were similar, p=ns for demographic variables. 29/82 (35%) were in both endoscopic and histologic remission, 10/82 (12%) were in endoscopic remission with persistent histologic activity, and 33/82 (40.2%) had both endoscopic and histologic activity. Histologic activity was independently associated with steroid use/ flare within six months (Z= -2.6, p=0.0075) as was endoscopic activity (Z=-2.76, p=0.0058). Chi analysis of the three groups showed significant differences in the groups, 8.2 p- 0.016 for change in treatment, 9.5 p= 0.008 for steroid use/ flare. 2 way analysis, however, of histologic activity versus deep remission is p=ns, though a trend is apparent.

Conclusion

There is now a growing body of evidence that histological remission is an important endpoint. The extent that histologic remission affects outcomes is unclear to date. In a recent 2021 meta-analysis only one study focused on outcomes in Crohn’s was included. Further studies are required incorporating greater numbers of patients and robust histologic scoring systems.
P287 Clinical characteristics and outcomes of ileal pouch–anal anastomosis (IPAA) inflammation in a Latin American (LA) IBD reference Center (I.
Authors: Sambuelli A , Gil A , Rohwain M J , Candel I , Huernos S , Tirado P , Negreira S , Balaban E
Published: January 2023

Background

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) can be associated with a wide spectrum of complications, ranging from a frequently mild acute pouchitis (AP) to Chronic pouch inflammation (CPI, either antibiotic dependent or refractory, CADP and CARP respectively) and Crohn's disease like pouch inflammation (CDLPI). The pathogenesis, still largely unknown, probably is multifactorial, and environment may play a role.

We aimed to describe clinical characteristics and outcomes of IPAA inflammation in a Latin American (LA) IBD reference Center. Our main focus is CDLPI, because, despite of UC is reported more frequent in LA, epidemiology is changing, and notably, colon location (within CD) reach the half of the CD casuistic in our hospital, as well as other Argentina locations (Cordoba) and Uruguay, a neighbor Country. Probably, this epidemiological feature could impact in our patient′s evolution.

Methods

Our hospital has a Coloproctology Team pioneer of IPAA surgery in Argentine and as Clinical IBD Service, we performed a revision in our electronic data base (included from 1990 to current date, and detected 437 pts. with IPAA. Criteria were; modified PDAI (for disease activity), for CPI and CDLPI we adopted that of Shen B, Clin. Gastrienterol hepatol 200, 6:145-58.

Results

Results

We compare 46 CDLPI with 24 CPI pts. (CADP and CARP) and 24 AP. A total of 55 M, 39 F, were evaluated for demographic data and disease complications. Mean age ±SD at complication: CDLPI 33.8±13.8, CPI 34.2±11.2, AP 40.1±13.7, (NS for gender and Age). Median time (IQR) up to each one of 3 complications: 1.6 (4.19), 2.09 (7.17) and 1.34 (2.67), respectively (NS, Median test). Follow–up time was similar: 20.11 (10.9), 13.7 (12.2), 13.9 (15.6), respectively. CDLPI presented inflammatory pattern in: 37 (80.4%), stricturing in 6 (13.04%), fistulizing in 16 (34.8%) Perianal complication: 43.5%.

Pre-pouch ileitis in CDLP: 26 (56 5%) vs. CPI 1(4.2%), in AP 0% (p.00000), prepouch strictures (13.04% vs. 0%), significant different, as well as prepouch fistulas (17.4%), with suboclusion in 29% Pouch vaginal fistulas and pouch-cutaneous in 1/5 of patients. Cuffitis in 19%. The original IBD was more severe and extensive p <0.02 in the mentioned subgroup.

As regard treatment, IMM treatment in CDLP: was required in 70% vs. 26% in CPI and biologics en 2/3 0.00016, 11% ≥2 biologics. Pouch failure (diversion and resection) was observed in 30% and 13% respectively.

Conclusion

We are a LA center with high CD prevalence. The complications of surgery must be taken into account. IPAA revolutionized UC surgery, but close monitoring, and new research are required with the future hope of acting proactively.
P288 Application of a new classification of Fistulizing Perianal Crohn’s Disease (FPCD) in clinical practice: evaluating the correlation between clinician and patient’s assessments and FPCD patient′s quality of life
Authors: Rodrigues C , Valério F , Casimiro C , Soares C , Ventura S , Domingues Â , Silva A , Cancela E , Ministro P
Published: January 2023

Background

FPCD remains a challenging condition with negative impact on quality of life. Recently, a novel classification was proposed intending to optimize and standardize the management of these patients (Geldof J, et al. Lancet Gastroenterol Hepatol. 2022 Jun;7(6):576-584). We aimed to characterize and classify a population of patients with FPCD according to this recent classification, evaluate the agreement between patient and clinician perspectives regarding disease treatment goals and correlate the new classification with patient’s quality of life.

Methods

Cross-sectional study which consecutively included FPCD’ adult patients (diagnosis > 6 months) followed at a gastroenterology consultation, from September to November 11, 2022. A Portuguese translated diagram of the new classification was presented to included patients, which had to select the class that most faithfully represents the current moment of their disease status. Subsequently, the IBDQ-32 questionnaire was completed. A separate form completed by a senior gastroenterologist include all the demographic and clinical data of each patient and the respective blindly chosen class.

Results

23 patients (mean age of 34.4 ± 13.8 years, 60.7% woman) with FPCD were included. Disease location (Montreal Classification) was L1 in 9/23 patients, L2 in 5/23 patients and L3 in 9/23 patients. Two patients had also upper gastrointestinal tract involvement (L4). Crohn’s disease duration was 8.87 ± 8.176 years and fistula duration 4.26 ± 3.063 years (table 1). Therapy data including surgery is shown in Table 2. Most patients had a transphincteric (13/23) and complex fistula (20/23). Mean PDAI was 6±2.6 and HBI 2.2±1.65. Class 2a (repair) was the most frequently chosen by patients and clinician (62.5% and 58.3% respectively) (table 3). Mean IBDQ32 score was 97.6 ± 16.9 (table 4). A slight agreement between patient and clinician regarding the new classification system was found (Cohen’s Kappa of 0.176), and a negative correlation between the class chosen by the patient and the respective IBDQ-32 score (Kendalls’ Tau correlation coefficient -0.359, p = 0.033 (p<0,05)).

Conclusion

The low level of concordance between patient and clinician (with the limitation of a small sample size) draws attention to a gap in the treatment decision-making process of FPCD patients. A turning point in the management of these patients may occur with a progressive implementation of this classification into clinical practice after its validation, as it may allow for a shared discussion and greater patient responsibility in therapeutic decisions. The significant disease burden carried by these patients is underscored by the progressive lower IBDQ32 scores associated with higher class in this new system classification.
P289 Hyperoxaluria in patients after ileocolic resection
Authors: Navrátil V , Pipek B , Krivinka J , Gregar J , Kunovsky L , Falt P
Published: January 2023

Background

Oxaluria is one of the risk factors for developing urolithiasis and oxalate nephropathy, which may lead to renal failure. Patients with Crohn's disease (CD) who underwent an ileocolic (IC) resection are at increased risk. The aim of the study is to determine the incidence of hyperoxaluria in these patients in comparison to CD patients with IC involvement without the resection.

Methods

Patients with CD of age over 18 years after IC resection were included into the study and patients with IC involvement without resection were included as a control group. Exclusion criteria were concomitant citrate treatment, severe chronic kidney disease (G4-5 KDIGO with GFR <30ml/min/1,73 m2) and patients with more than two intestinal resections, with colectomy or with short bowel syndrome. Patients filled out a questionnaire form, a blood sample and fresh urine sample were taken, abdominal ultrasonography for assessment of kidneys and gallbladder was performed and finally, patients collected urine for 24 hours for examination of oxaluria and citraturia. Oxaluria over 0,6 mmol/24 hours and citraturia under 1,6 mmol/24 hours were considered significantly pathological.

Results

40 patients were included in the study until now. There were 45% after IC resection, 57.5% were female (77.8% in the resection group and 40.9% in the control group), mean age was 41,5 years +/-13,1. 7 patients were receiving corticosteroid treatment, 26 had immunosuppressants and 4 patients had biologics. Hyperoxaluria has been detected in 27.5% (of all patients), in 22% in the resection group and in 31.8% in the control group (p=0,34). Hypocitraturia has been found in 32.5%, in 38.9% in the resection group and 27.3% in the control group (p=0,41). No patient with urolithiasis and one with cholecystolithiasis was detected with ultrasonography and one patient had urolithiasis in medical history.

Conclusion

Hyperoxaluria was detected in 27.5% of patients and there was no significant difference between the groups with and without IC resection. Hypocitraturia was detected in 32.5% with nonsignificant predominance in the resection group. Recruitment of patients is still going on, as now we can't determine the role of routine testing for hyperoxaluria and hypocitraturia in daily practice.
P290 Development of an artificial intelligence model using stool pictures for predicting endoscopic mucosal inflammation in patients with Ulcerative Colitis; KASID multicenter study
Authors: Kim E S , Lee J W , Kim S K , Lee H S , Lee Y J , Kim J , Kim K O , Jang B I , Kim E Y , Jung Y J , Park S K , Park D I , Woo D , Jeong S ,   IBD Research Group of KASID
Published: January 2023

Background

Disease monitoring through objective measures including fecal calprotectin and endoscopy is crucial for the management of ulcerative colitis (UC). The role of stool pictures taken by smart phones in the disease monitoring of UC is not known. We aimed to develop artificial intelligence (AI) model using stool pictures for predicting endoscopic mucosal inflammation in patients with UC.

Methods

This was a prospective multicenter study conducted in 6 tertiary referral hospitals. Patients scheduled to undergo endoscopy for monitoring of mucosal inflammation were included in the study. They were asked to send their stool photos taken at the toilet using smartphones within ± 5 days from the day of endoscopy. Endoscopic activity was assessed with Ulcerative Colitis Endoscopic Index of Severity (UCEIS). 80% and 20% of total data were randomly selected as training and validation set, respectively and this process repeated 4 times on different iterations for cross-validation. Accuracy of AI model for predicting endoscopic healing was compared with that of fecal calprotectin (Fcal).

Results

A total of 2463 stool pictures from 293 patients with UC were collected (mean age, year, 44±15.2; female, 108 (36.9%)). Endoscopic healing was found in 165 patients (56.3%). In validation set, the mean area under the receiver operating characteristic (AUROC) for predicting endoscopic activity using AI model was 0.78±0.02 (p=0.001) which was not statistically different from the AUROC of Fcal (0.81±0.08, p=0.01; AI model vs. Fcal p>0.05). When we excluded rectal sparing cases (20, 6.8%), the mean AUROC of AI model increased to 0.85±0.05 (p=0.0007). Accuracy, sensitivity and specificity of AI model for predicting endoscopic activity in all patients and without rectal sparing cases were 0.739, 0.643, and 0.826, and 0.798, 0.711, and 0.872, respectively.

Conclusion

Stool photos of UC patients with deep learning technology demonstrated similar accuracy to Fcal in speculating endoscopic activity with better accuracy in patients without rectal sparing. The potential of simple stool pictures as a possible monitoring tool for UC activity is hopefully presented in this study.
P293 Correlation between clinical measures to capture disease burden and prediction of the initial course of Crohn’s disease - findings from a Copenhagen IBD Inception Cohort Study (IBD Prognosis Study)
Authors: Attauabi M , Madsen G R , Bendtsen F , Bjerrum J T , Wilkens R , Theede K , Ilvemark J F K F , Boysen T , Seidelin J B , Burisch J
Published: January 2023

Background

The initial disease burden of Crohn’s disease (CD) is dissimilar across patients; however, the ability to capture and predict the disease burden at diagnosis is scarcely investigated. The aim of the current study was to describe the initial disease burden of Crohn’s disease.

Methods

IBD Prognosis Study is an ongoing prospective population-based inception cohort of newly diagnosed patients with CD between May 1st, 2021, and November 1st, 2022, according to the Copenhagen IBD Criteria.1 We defined an indolent disease presentation as no need for CD-related surgery, hospitalization, nor initiation of steroid, immunomodulatory, or biologic therapies within the first 30 days after diagnosis, while a complicated course was defined as the opposite.

Results

The study included 134 patients with adult-onset CD, of whom approximately one-third (44/134, 33%) had an early indolent course, with 26 patients (19%) not requiring any medication (Tables 1-2). In demographic factor adjusted analyses, a colonic phenotype (adjusted odds ratio (aOR) =4.5 (95% confidence interval (CI) 1.6-15) and a low symptom load measured with Harvey-Bradshaw Index (HBI) <5 (aOR = 3.1 (CI 1.0-10) were independently associated with an indolent course. In contrast, a C-reactive protein (CRP) level higher than 10 mg/L was the only parameter associated with a complicated onset of CD (aOR = 4.7 (CI 2.1-12)). Pearson’s correlation analyses demonstrated a significant, moderate correlation between fecal (F-) calprotectin, CRP, and endoscopic lesions, measured with Simple Endoscopic Score for CD (SES-CD) (Table 3). HBI and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) exhibited a significant but weak correlation with CRP. In a sensitivity analysis allowing exposure to anti-inflammatory therapy for only up to seven days, the platelet count, F-calprotectin, and bowel wall thickness measured in IBUS-SAS demonstrated a significant and moderate correlation with SES-CD. The total IBUS-SAS and CRP showed a significant but weak correlation, and other measures included in the IBUS-SAS did not yield significant correlations.

Conclusion

Preliminary data from the ongoing population-based cohort indicate that one-third of patients with newly diagnosed CD have an early indolent course. This study identified colonic disease location and CRP levels to be associated with the early course, while platelet count, bowel wall thickness, and CRP were correlated with endoscopic lesions at the onset of CD.

References:

1. Attauabi M et al. Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. doi:10.1136/bmjopen-2021-055779
P294 Assessment of Fatigue and Associated Factors in Patients with Inflammatory Bowel Disease: A Questionnaire-based Study
Authors: Kang S B , Jung S H , Kim T O
Published: January 2023

Background

Although fatigue is common in patients with inflammatory bowel disease (IBD), it often goes unrecognized and untreated. We investigated the degree of fatigue, and associated factors, in patients with IBD.

Methods

A multicenter study involving 147 IBD patients was conducted at five academic hospitals from August 2019 to December 2021. Demographic, clinical, and laboratory data were collected. Disease activity was assessed by the Mayo score or Crohn’s Disease Activity Index, as appropriate. Fatigue was evaluated using the validated Korean version of the Multidimensional Fatigue Inventory (MFI-K). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale.

Results

Among 97 ulcerative colitis and 50 Crohn’s disease patients, the mean total MFI-K score was 59.0 ± 5.5. Age, sex, body mass index, disease duration, anemia, hypoalbuminemia, and use of steroids did not affect the total MFI-K score. The anxiety and depression scores did not correlate with the fatigue score. Moderate and high disease activity significantly increased the MFI-K general and physical fatigue subscale scores compared to remission and mild disease activity (17.6 ± 1.7 vs. 16.7 ± 2.0, P = 0.009), while the use of biologics significantly decreased the total MFI-K score (57.3 ± 5.0 vs. 59.5 ± 5.5, P = 0.031). Multiple linear regression showed that fatigue was significantly increased by a history of surgery for IBD and decreased by the use of biologics.

Conclusion

The degree of fatigue in patients with IBD is high, and disease activity is the most important contributing factor.
P300 Overweight and obesity in Inflammatory Bowel disease: epidemiology, disease course and treatment outcomes
Authors: Khemiri W , Ben Mustapha N , Ben Safta N , Serghini M , Laabidi S , Fekih M , Labidi A , Boubaker J
Published: January 2023

Background

The incidence of Inflammatory Bowel Disease (IBD) is increasing in parallel with overweight and obesity. Contrary to conventional belief, a considerable number of IBD patients are at least overweighted. This may contribute to the development of IBD. The objectives of our study were to estimate the prevalence of overweight and obesity in IBD and to compare the epidemiological, evolutive and therapeutic profiles in these patients with those of a BMI (Body Mass index) of less than 25 kg/m².

Methods

We conducted a retrospective, descriptive and comparative study including patients hospitalized for IBD over a 9-year period [January 2011-January 2020]. Patients with less than 2 years of follow-up were excluded. Patients with a BMI of less than 25kg/m² represented group 1 and patients with a BMI ≥ 25kg/m² represented group 2.

Results

We included 225 men and 227 women. We enrolled 341 patients diagnosed with Crohn’s disease (CD) and 111 patients with ulcerative colitis (UC). BMI was less than 18.5kg/m², between 18.5 and 25kg/m², between 25 and 30kg/m² and ≥30kg/m² in 27.1%, 48.3%, 19.1% and 5.5% of the patients respectively, resulting in 340 patients in group 1 and 112 patients in group 2. The mean age at diagnosis was 36.15 ± 12.74 years. It was significantly lower in group 1 (32.24 years vs 40.06 years, p<0.001). Smoking was noted in 34.1% of patients and 15.9% were alcohol users, the difference in these habits was not significant between the two groups. Diabetes and hypertension were significantly higher in group 2 (p<0.001 and p=0.002 respectively). The percentage of patients followed up for UC was higher in group 2 (31.8% vs 20.54%, p=0.04). For CD, patients with upper GI tract involvement were more numerous in group 1, without a significant difference between the two groups (16.22% vs. 7.8%, p=0.068). The mean level of albumin was lower than normal in both groups (31.57g/L in group 1 and 34.02g/L in group 2) with a significantly lower level in group 1 (p=0.002). The use of surgical treatment was significantly higher in group 1 (p=0.003). However, there was no significant difference between the two groups in the use of corticosteroid, immunosuppressive agents, anti-TNFα therapy and the responses to these different treatments. The maximum duration of hospitalization was statistically longer in group 1 compared to group 2 (20.95 days vs. 15.32 days, p=0.003). The ratio of years of follow-up to years of active disease was significantly higher in group 2 (5.8 vs. 4.7, p=0.014), reflecting a better disease course in group 2.

Conclusion

In our series, one fifth of the patients were either overweighted or obese. IBD in these patients was, overall, less severe.
P301 Outcomes following colectomy for patients with Ulcerative Colitis, ten years of data from a tertiary referral centre
Authors: Gallagher A , Sheridan J , Doherty G , Mulcahy H , Cullen G
Published: January 2023

Background

Patients who undergo subtotal colectomy for Ulcerative Colitis (UC) have a persistent risk of colorectal cancer (CRC) in the retained rectum and this increases overtime. There are currently no guidelines for rectal surveillance in this group. We aimed to assess the outcome following colectomy for patients with UC over a ten year period.

Methods

We conducted a retrospective analysis of patients with UC who underwent colorectal surgery in a tertiary referral centre. The Hospital In-Patient Enquiry system and the St Vincent's Hospital IBD Database were used to identify patients. Patients with colorectal cancer were excluded.

Results

In a six year period one-hundred and seventy six bowel surgeries were carried out for patients with Inflammatory Bowel Disease. Sixty five of these procedures were performed on patients with UC, eight of which would subsequently be re-diagnosed with Crohn’s Disease.

73.6% (n=42) had a completion proctectomy within ten years, 12% (n=7) were lost to follow up and 5% (n=3) died from non-gastrointestinal disorders. 8.7% (n=5) retained their rectum after ten years.

For patients who had a completion proctectomy the median time to surgery was two years. Most of these patients did not have surveillance within the twenty four month time frame. Patients who had a completion proctectomy between three and ten years underwent surveillance endoscopy on average two occasions.

All patients in the retained rectum group had surveillance proctoscopy with a median frequency of 2.4 years. The risk of further surgery was a factor for two patients due to obesity and decompensated liver disease. A third patient had an ileorectal anastamosis abroad and continues to have active rectal disease.

Dysplasia was found in the rectum of the fourth patient thirteen years post colectomy. The final patient refused surgery but agreed to endoscopic surveillance. A rectal adenocarcinoma was diagnosed ten years post-operation.

Conclusion

Despite the absence of guidelines for completion proctectomy and/or surveillance of the retained rectal stump, three quarters of our UC patients had undergone completion proctectomy within ten years. A small but significant number of patients have a residual rectal stump after ten years, they require CRC surveillance and clear guidelines on this are needed.
P303 Ultrasound is effective to identify mucosal healing in Crohn’s disease patients : results of a cross-sectional study
Authors: Yzet C , Brazier F , Hautefeuille V , Decrombecque C , Sarba R , aygalenq P , Venezia F , Buisson A , Pichois R , Michaud A , Fumery M
Published: January 2023

Background

Endoscopy is still the gold-standard to assess disease activity in Crohn’s disease (CD). Its invasiveness, acceptability and cost limit its use in the era of tight control and treat-to-target. Fecal calprotectin and intestinal ultrasound (IUS) are non-invasive alternatives to colonoscopy to assess disease activity. The objective of this study was to evaluate the performance of IUS and fecal calprotectin to assess mucosal healing in CD.

Methods

All consecutive CD patients who underwent colonoscopy for mucosal healing assessment and IUS and/or calprotectin within 4 weeks between September 2019 and April 2022 were included in a prospective cohort. Bowel wall thickness (BWT) and color doppler signal (CDS) were assessed on each segment. Endoscopic mucosal healing was defined by a CDEIS score < 3.

Results

A total of 153 patients were included, of whom 122 had endoscopic mucosal healing. Eighty-two (53.6%) were female, the median age and disease duration were respectively 36 years (IQR, 28-46) and 10 years (IQR, 4-19). Respectively 56 (56/120, 46.7%) and 93 (93/120, 77.5%) patients presented a BWT < 3 mm and an absence of CDS. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of BWT < 3 mm to predict endoscopic mucosal healing were 56%, 88%, 95% and 36% (patients misclassified as endoscopic mucosal healing 2.5%). The association of an absent of CDS with a normal BWT did not modify the performances. For a calprotectin < 250 µg/g , The Se, Sp, PPV and NPV were respectively 91%, 63%, 90% and 67% for (patients misclassified 8%). The association of a calprotectin < 250 µg/g, with a BWT < 3 mm and the absence of CDS increased the specificity and the PPV (Se 58%, Sp 95%, PPV 97%, VPN 43%, patients misclassified 1%).

Conclusion

Ultrasound is an efficient non-invasive tool to identify patients with Crohn’s disease who have achieved endoscopic mucosal healing.
P306 Serum tryptophan metabolites as a biomarker for disease severity in patients with IBD
Authors: Karakan T , Karatas A , Cindoruk M , Gulbahar O
Published: January 2023

Background

The levels of tryptophan (TRP) metabolites such as kynurenine (KYN), kynurenic acid (KYNA), quinaldic acid, 3-hydrocynynene, anthranilic acid, picolinic acid (PA) and xanthurenic were determined systematically in inflammatory bowel disease (IBD). Previous studies found a negative correlation with TRP levels and IBD disease activity. However, there is no data about serum levels of TRP metabolites and their correlation with severity of IBD. We aimed to determine the correlation between the levels of TRP, its metabolites and the clinical, laboratory, and endoscopic findings of the disease activation including fecal calprotectin.

Methods

A total of 115 patients, 77 (66.4%) with UC and 38 (33.6%) with CD, were included. Forty three % (n=49) of the patients were female. 57 % (n=66) were male. The mean age of females and males were 42.07±13.39 and 44.23± 10.04 years, respectively. Patients were categorized according to their disease activity: Sixty-five (57%) of the patients were in remission and 50 (43%) were active. The predictive value of the disease activity was evaluated by the levels of serum tryptophan, its metabolites and the fecal calprotectin levels.

Results

At a cut-off value of ≤11328.41 ng/ml of tryptophan, the sensitivity to predict disease activation is 76.9% and the specificity is 71.7%. On the other hand, at a cut-off value of ≥89.60 µg/g of fecal calprotectin, the sensitivity of detecting disease activation was 88.1% and the specificity was 80.0%. Calprotectin, sedimentation, CRP, KYN/TRP values were found to be significantly higher in patients in the active period than in patients in remission (p<0.001, p<0.001, p<0.007 respectively). KYNA, TRP, and PA values were found to be statistically significantly lower in patients in the active phase compared to those in remission (p=0.01, p<0.001, p=0.022 respectively).

Conclusion

Serum TRP levels were lower in increased disease activity. Quinolinic acid levels did not differ between active patients and patients in remission. Quinolinic acid, which is the metabolite of TRP degradation, was increased with active disease. However, fecal calprotectin still had superior predictive value for IBD disease activity. Further studies are needed to assess the TRP pathway for the disease severity and disease course in IBD.
P307 High frequency of Deep Infiltrating Endometriosis in patients with Inflammatory Bowel Disease: a nested case-control study
Authors: Neri B , Russo C , Mossa M , Martire F G , Aikaterini S , Mancone R , Calabrese E , Rizzo G , Exacoustos C , Biancone L
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) and endometriosis are chronic inflammatory diseases occurring in young women, sharing some clinical manifestations. We aimed to investigate, in a multidisciplinary approach, symptoms, type and site of pelvic endometriosis in IBD patients versus non-IBD Controls with endometriosis.

Methods

In a prospective nested, case-control study, all female premenopausal IBD patients showing symptoms compatible with endometriosis were enrolled. Patients were referred to dedicated gynecologists for assessing pelvic endometriosis by transvaginal sonography (TVS). Each IBD patient with endometriosis (Cases) was retrospectively matched for age (±5 years) and body mass index (±1) with 4 patients with endometriosis at TVS, but no-IBD (Controls). Data were expressed as median [range], the Mann-Whitney or Student-t and χ2 tests were used for comparisons.

Results

Endometriosis was diagnosed in 25 (71%) out of 35 IBD patients with compatible symptoms including 12 (52.6%) Crohn’s Disease and 13 (47.4%) Ulcerative Colitis patients. Dyspareunia and dyschezia were significantly more frequent in Cases vs Controls (25 [73.7%] vs 26 [45.6%]; p=0.03). At TVS, deep infiltrating endometriosis (DIE) and posterior adenomyosis were significantly more frequent in Cases vs Controls (25 [100%] vs 80 [80%]; p=0.03 and (19 [76%] vs 48 [48%]; p=0.02).

Conclusion

Endometriosis was detected in two/thirds of IBD patients with compatible symptoms. The frequency of DIE and posterior adenomyosis was higher in IBD than in Controls. A diagnosis of endometriosis, often mimicking IBD activity, should be considered in subgroups of female patients with IBD.
P308 A new endoscopic scoring system corresponding to histological healing using linked color imaging in ulcerative colitis: SOUL study
Authors: Saito D , Hirai F , Uchiyama K , Takagi T , Naito Y , Takatsu N , Tanabe H , Kishimoto M , Matsuura M , Miyoshi J , Watanabe K , Esaki M , Naganuma M , Hisamatsu T
Published: January 2023

Background

An important therapeutic aim in ulcerative colitis (UC) is endoscopic remission. Although an endoscopic score with white light imaging (WLI) is mainly used to evaluate endoscopic findings, recently, the usefulness of linked color imaging (LCI) has been reported. We evaluated the relationship between LCI and histopathological findings and attempted to establish a new LCI endoscopic evaluation index for UC.

Methods

This study was conducted at Kyorin University, Kyoto Prefectural University, and Fukuoka University Chikushi Hospital. Ninety-two patients (median age, 46 years; male/female ratio, 48/34) with a Mayo endoscopic subscore (MES) ≤1 who underwent colonoscopy for UC in clinical remission between November 2016 and January 2019 were included. LCI index was defined as degree of redness (R) (grade 0–2), area of inflammation (A) (grade 0–3), and visibility of lymphoid follicles (L) (grade 0–3). Endoscopic scores were determined by three central endoscopic judgment committee members who are experts in colonoscopy for UC. Discussions were held among the three members, and when two or more of them had the same judgment this was adopted as the final evaluation. Each biopsy was performed from an identical site of colonoscopic image. Histological healing was defined as Geboes score <2B.1. Histopathological scores were also determined by central judgment.

Results

In 92 patients, 85 biopsies from the sigmoid colon and 84 biopsies from the rectum (total 169 biopsies) were evaluated. Percentage of judgments that were consistent in two or more central endoscopic judgment committee members were 167/169 (98.8%) cases in MES, 164/169 (97.0%) cases in LCI index-R, 152/169 (89.9%) cases in LCI-index-A, and 150/169 (88.8%) cases in LCI-index-L. Regarding the κ-score in diagnosing by the two pathologists, “Chronic inflammatory infiltrate”, “Crypt destruction”, and “Crypt destruction” had a moderate agreement, and others had a stationary agreement. The overall histological healing rate was 84.0% (142/169). There were 22/117/30 cases of grade 0/1/2 in LCI index-R, 113/34/17/5 cases of grade 0/1/2/3 in LCI index-A, and 124/27/14/4 cases of grade 0/1/2/3 in LCI index-L. Histological healing was achieved in 84.1% (142/169) of the cases, and there were significant associations with histological healing/non-healing in LCI index-R (P=0.013) and A (P=0.0014).

Conclusion

A new LCI index is useful for predicting histological healing in UC patients with MES ≤1 and clinical remission.