bluuebunny/crossref_metadata_2025 huggingface dataset:
P0333 Predictive factors for thiopurine treatment failure in anti-TNF naïve IBD patients: Insights from a tertiary care Hepato-Gastroenterology center experience
Authors: Adamou Mainassra F , Hassini A , Essadi B , Koulali H , Elmqaddem O , Zazour A , Zahi I , Kharrasse G
Published: January 2025

Background

Chronic Inflammatory Bowel Diseases (IBDs) pose a significant challenge due to their chronic nature and the characteristic pattern of relapse and remission. The maintenance’s goal therapy is to prolong remission as much as possible. Immunosuppressants, particularly thiopurines, are widely employed for this purpose. However, Nearly half of patients on these drugs lose remission or fail to maintain it, with the causes still unclear. This study explores patient-related factors linked to thiopurine failure.

Methods

This retrospective study, conducted over five years and two months (January 2018 to March 2023), included IBD patients treated with thiopurines who had not previously received anti-TNF therapy. Patients were followed for 1 to 5 years after starting thiopurines, with treatment failure defined as requiring two or more corticosteroid courses in a year, escalation to anti-TNF therapy, or surgical intervention. Data were collected from medical records and analyzed using SPSS software, employing the chi-square test and multivariate logistic regression to assess relationships

Results

We analyzed 165 patients, including 119 with Crohn’s disease (CD) and 46 with ulcerative colitis (UC), with a median age of 39.05 years and a female predominance (sex ratio 0.81). All patients consumed tea (100%), smoking was present in 15.15%, alcohol consumption in 6%, and NSAID use in 10%.

Among UC patients, 13 failed thiopurine treatment, with 3 requiring colectomy and 10 escalating to anti-TNF therapy, all diagnosed with UC E3. For CD patients, 99 experienced treatment failure, including 15 ileocolectomies, 30 ileocecal resections, and 54 cases requiring anti-TNF therapy.

Hypoalbuminemia (<35 mg/L) at diagnosis was a significant risk factor for thiopurine failure (p=0.05). Non-smoking UC patients (p=0.06) and UC E3 patients with frequent flares (p=0.09) showed a strong, though not statistically significant, trend towards failure. In CD, smoking (p=0.05), NSAID use (p=0.08), and active inflammatory colonic disease with over two flares annually (p=0.04) increased failure risk.

Common factors for both UC and CD included anemia (p=0.001), tea consumption (p=0.003), phytotherapy (p=0.06), and younger age (17–32 years, p=0.09)

Conclusion

Our findings demonstrate that hypoalbuminemia, anemia, and young age at diagnosis pose an increased risk of thiopurine treatment failure. Moreover, some patients characteristics such as smoking, frequency of flares, NSAID use, and phytotherapy may also serve as predictive factors for thiopurine treatment failure. These factors should be regarded as markers of non-response to thiopurines as monotherapy in patients with moderate to severe colonic CD or UC E3.
P0337 Incidentally Diagnosed Inflammatory Bowel Disease: Prevalence and Long-Term Outcomes
Authors: Tubal Bronze S M , Shenoy S , Agrawal M , Colombel J F , Rodríguez-Lago I , Ungaro R C
Published: January 2025

Background

Incidentally diagnosed inflammatory bowel disease (IBD) can be found in asymptomatic individuals undergoing endoscopic examinations performed for various reasons such as colorectal cancer (CRC) screening. We aimed to characterize the prevalence of incidental IBD in individuals undergoing non-diagnostic colonoscopy and describe its clinical characteristics, disease course, and medium to long-term outcomes.

Methods

Retrospective cohort study including all asymptomatic adults who underwent colonoscopy for CRC screening or polyp surveillance between 2009 and 2023. Incidental IBD was considered any case with endoscopic and histologic findings suggestive of IBD. The endoscopic lesions considered were erythema, erosions, loss of vascular pattern, ulcerations, strictures, and pseudopolyps. On the other hand, the microscopic criteria were transmural inflammation, non-caseating granulomas, ulcers, crypt distortion and abscesses, cryptitis, Paneth cell metaplasia, and basal plasmacytosis. Clinical data and disease characteristics were collected. Tests for categorical variables were performed using the Fisher-Freeman-Halton Exact Test, while for quantitative variables the ANOVA and Kruskal-Wallis Test were utilized. Statistical analyses were conducted using R, with significance at p<0.05.

Results

Out of 40,573 colonoscopies, a total of 60 patients with incidental IBD were identified: 40 patients (67%) with Crohn’s disease (CD), 10 (18%) with ulcerative colitis (UC), and 10 (18%) with IBD-unclassified (IBD-U). Most CD patients presented with ileal (L1) involvement (98%) and inflammatory (B1) behavior (98%), while 60% of UC patients exhibited extensive (E3) disease. UC and IBD-U patients had lower hemoglobin values than those with CD (11.67 +/-1.97; 11,73 +/- 1.25; 13.74 +/- 1.93; respectively, p=0.019). Follow-up data was available from 27 patients (45%), after a mean follow-up of 27.9 +/- 34.7 months in CD patients, 20% (N=8) developed new-onset symptoms (diarrhea [n=3, 38%], abdominal pain [n=3, 37.5%], bloating [n=2, 25%], fatigue [n=1, 12.5%], weight loss [n=1, 13%]), while only one patient (10%) with UC reported symptoms (diarrhea and abdominal pain). A total of 5 patients (8%) initiated medical therapy, in most cases after symptom onset. Two patients (3%) with CD received oral corticosteroids, one (2%) with CD received sulfasalazine, and two patients (3%) with UC were started on oral mesalamine. No hospitalizations or surgeries were noted.

Conclusion

In our experience, the prevalence of incidental IBD was 0.2% with two-thirds receiving a diagnosis of ileal CD with inflammatory behavior. A low proportion of patients developed symptomatic disease (5% for CD and 2% for UC) after 2 years of follow-up and generally had milder disease course.
P0340 Endo-Histo Foundational Fusion Model: A Novel Artificial Intelligence Approach for Predicting Histologic Remission and Early Response to Therapy in a Phase 2 Ulcerative Colitis Clinical Trial
Authors: Iacucci M , Santacroce G , Meseguer P , Del Amor R , Diéguez A , Kolawole B B , Chaudhuri U , Zammarchi I , Hayes B , Crotty R , Zardo D , Maeda Y , Puga-Tejada M , Ditonno I , Vadori V , Burke L , Gottlieb K T , Owen C , Eastman W J , Ghosh S , Grisan E , Naranjo V
Published: January 2025

Background

Artificial Intelligence (AI)- enabled endoscopy and histology offer accurate, objective, and rapid assessment of disease activity in Ulcerative Colitis (UC). Emerging multi-source AI models integrating diverse datasets may enhance standardised disease evaluation and outcome prediction. This study aimed to develop a novel AI model fusing endoscopic and histological findings to improve the assessment of disease remission and predict early response to therapy in UC clinical trials.

Methods

A novel multimodal AI fusion algorithm was developed by integrating paired endoscopic videos and histological whole-slide images (WSIs) from the phase 2 clinical trial of Mirikizumab in UC (NCT02589665). The endoscopy branch of the model was trained with 291 white-light videos, using a convolutional neural network to select informative frames and the BioMedCLIP foundational model to extract features. The histology branch utilised the CONCH foundational model and was fine-tuned on 291 WSIs to obtain patch-level features. Features from both modalities were aggregated and fused using multi-head self-attention. The model’s ability to assess histological remission and response to therapy at weeks 12 and 52 was evaluated. Histological remission was defined as Geboes ≤2B.0, while a response to therapy at different time points was based on histological remission or improvement (Geboes <3.1).

Results

The fusion model outperformed single-modality assessments for histological remission, achieving a sensitivity of 89.72% (95% CI: 82.35–94.76), specificity of 89.67% (95% CI: 84.34–93.67), and accuracy of 89.69% (95% CI: 85.61–92.94). It demonstrated remarkable performance in assessing response to therapy at 12 and 52 weeks, with sensitivity of 97.96% (95% CI: 89.15–99.95), specificity of 86.84% (95% CI: 71.91–95.59) and accuracy of 93.10% (95% CI 85.59 – 97.43) for histological remission at week 52. Substantial agreement was observed between the AI fusion model and central readout.

Conclusion

This innovative multimodal fusion AI model enhances the assessment of histological remission and accurately predicts response to therapy. By potentially standardising central readouts and enabling automated disease assessment, this novel tool marks a significant advancement towards precision medicine in clinical trials.
P0343 Gender Identity and Inflammatory Bowel Disease: The Patient Perspective
Authors: Colwill M , Jacob K , Pollok R , Poullis A
Published: January 2025

Background

The experience of transgender and gender non-conforming (TGNC) individuals in healthcare is under-researched particularly in relation to the impact of chronic diseases such as inflammatory bowel disease (IBD). IBD is believed to affect 1 in 123 individuals in the United Kingdom (UK)(1) and can have a profoundly negative impact upon both quality of life and mental health. However, the impact of the duality of suffering from IBD and identifying as TGNC is poorly understood and there is no data examining the experiences of these patient groups nor the specific challenges that they face when engaging with IBD healthcare services. We therefore aimed to explore the experiences of TGNC individuals with IBD (TGNC-IBD) in the UK healthcare system.

Methods

A literature review was performed to identify themes for discussion which were used to create an interview guide. Individuals who identified as TGNC and suffered from IBD were recruited through the charity Crohn’s and Colitis UK.(2) Participant information sheets were distributed to potential participants and once consented, an in-depth semi-structured focus group was performed with all participants. A second independent researcher reviewed the transcript and audio-visual recordings to ensure validity of the findings. Inductive thematic analysis was used to identify recurrent themes. Ethical approval was obtained from St. George’s University of London.

Results

Seventeen individuals contacted the team expressing interest in participating. Six respondents continued to engage and two pulled out on the preceding day. Four TGNC-IBD patients participated in the study with their demographics summarised in table 1. Six main themes emerged when discussing their experiences of healthcare encounters:

1. Healthcare professionals’ assumptions about gender identity

2. Inadequate mental health care provision

3. A lack of research and evidence-based practice specific to TGNC-IBD individuals

4. Distressing experiences due to gender-specific healthcare facilities

5. Transphobic comments from healthcare staff

6. The need for greater staff training.

Participants reported that these factors contributed to negative healthcare experiences and exacerbated both the physical and mental health challenges they faced.

Conclusion

TGNC-IBD individuals face unique challenges that negatively affect their healthcare experiences. Key areas for improvement include increased staff training, the creation of gender-neutral facilities and more research into the interplay between a TGNC identity and IBD. Addressing these concerns will enhance the quality of care and improve patient experiences for this underserved minority.

References

1.Crohn’s disease and ulcerative colitis in the UK. [Internet]. Available from: https://crohnsandcolitis.org.uk/news-stories/news-items/new-research-shows-over-1-in-123-people-in-uk-living-with-crohn-s-or-colitis

2.Crohn’s & Colitis UK [Internet]. [cited 2024 Oct 2]. Available from: https://crohnsandcolitis.org.uk
P0346 Pouch Fistulas: Experience From a Tertiary Center
Authors: Tubal Bronze S M , Wong S Y , Waite H , Plietz M , Hahn S , Greenstein A , Sylla P , Khaitov S , Colombel J F , Kayal M
Published: January 2025

Background

Ileoanal pouch-related fistulas (IAPRF) occur in up to 15% of patients with ulcerative colitis (UC) who undergo total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). This study aimed to describe the frequency, risk factors, and outcomes of IAPRF in a large, single-center cohort of patients.

Methods

This is a retrospective study of patients who underwent TPC with IPAA at Mount Sinai Hospital between 2007 and 2022. The outcomes of interest were fistula development and remission defined as the resolution of both pain and drainage and closure of all external openings confirmed by imaging. Categorical data were presented as frequencies/percentages and quantitative data as mean ± SD. Associations were tested using chi-squared tests for categorical and Wilcoxon rank-sum for quantitative variables.

Results

Of the 772 patients who underwent IPAA at Mount Sinai Hospital, 98 (12.7%) developed pouch fistula. Among these, 34 had early-onset fistulas (within 12 months of the final surgical stage) and 64 had late-onset (beyond 12 months of the final surgical stage). The mean time to fistula occurrence was 3.8 months in the early-onset group and 5.1 years in the late-onset group. Of the 98 patients with IAPRF, 108 fistulas were identified, with the most common types being perianal (59.2%), pouch-vaginal (20.4%), enterocutaneous (11.1%), and enteroenteric (6.5%). Patients with early-onset IAPRF had higher rates of postoperative complications, including pelvic sepsis (5% vs. 2%, p=0.018), abscess formation (20% vs. 9%, p<0.001), anastomotic leak (13% vs. 7%, p=0.017), abdominal pain (42% vs. 13%, p<0.001), and fever (47% vs. 29%, p<0.001) compared to those with late-onset IAPRF. In contrast, patients with late-onset IAPRF had higher rates of Crohn’s disease-like pouch inflammation (CDLPI) diagnosis (72% vs. 32%, p<0.001) compared to those with early-onset IAPRF. Fistula remission occurred in 56% of early-onset and 38% of late-onset patients, and the incidence of pouch failure was similar (20.6% early-onset vs. 26.6% late-onset, p=0.53).

Conclusion

Early-onset fistulas were associated with post-operative complications, while late-onset were linked to CDLPI, highlighting the importance of understanding patient’s surgical history for accurate diagnosis and treatment.
P0347 Correlation between histologic disease activity in the distal and proximal colon in Ulcerative Colitis: A flexible sigmoidoscopy is insufficient to assess histology
Authors: De Marco D , Meadler Kron C , Marcus V , Bitton A , Lakatos P , Wild G , Afif W , Bessissow T
Published: January 2025

Background

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation of the colon. Current therapeutic goals emphasize clinical and endoscopic remission; however, histological remission has emerged as an important target due to its association with reduced relapse rates and improved long-term outcomes. Despite this, limited data exist on the concordance of histological activity between colonic segments, especially in UC patients in clinical remission. This study investigates the correlation between histological disease activity in the rectosigmoid colon (RSC) and other colonic segments in patients with UC in clinical remission.

Methods

This prospective study analyzed data from 203 UC patients in clinical remission, defined as a partial Mayo score ≤2 and rectal bleeding score = 0 for at least three months. Colonoscopies with segmental biopsies were performed, and histological activity was assessed using the Geboes score. Histological remission was defined as a Geboes score <2A.0, while active disease was classified as ≥3.1. Correlation between histological activity in the RSC and other colonic segments was evaluated using Spearman’s correlation coefficients and logistic regression. Statistical significance was defined as p < 0.05.

Results

Among the 203 patients, the median age was 45 years, with 55.1% having pancolitis. Histological activity in the RSC showed poor correlation with other colonic segments. In patients with a RSC Geboes score of ≥3.1, the correlation coefficient between the RSC and descending colon was 0.05 (p = 0.62), between the RSC and transverse colon was -0.03 (p = 0.71), and between the RSC and right colon was 0.12 (p = 0.09). In patients with a RSC Geboes score of <2A.0, the correlation coefficient between the RSC and descending colon was 0.12 (p = 0.22), between the RSC and transverse colon was 0.05 (p = 0.59), and between the RSC and right colon was 0.18 (p = 0.01). Even among patients with pancolitis, histological concordance between segments remained low. These findings underscore substantial segmental variability in histological activity.

Conclusion

Flexible sigmoidoscopy (FS) is commonly used to monitor UC due to its practicality; however, our findings suggest FS may not reliably reflect proximal histological disease. The lack of concordance highlights the limitations of FS in accurately assessing histological remission, including in patients with pancolitis or extensive colitis. Full colonoscopy with segmental biopsies remains the gold standard for comprehensive disease evaluation and management. Further research is warranted to refine histologic assessment strategies in UC.
P0354 Mild cognitive impairment occurs in patients with inflammatory bowel disease irrespective of disease activity
Authors: Compare D , Sgamato C , Minieri S , Marchitto S A , Cinque S , Ambrosio C , Zerella G , Nardone G
Published: January 2025

Background

Inflammatory bowel disease (IBD) has been linked to a heightened risk of mood, behavioral, and neurological disorders. Limited research has focused on cognitive function in these patients, with inconsistent findings. We aimed to assess mild cognitive impairment in IBD patients compared to healthy controls (HC) matched for age, sex, and education.

Methods

This single-center observational study included adult IBD patients. Demographic and clinical data were collected. Clinical remission was defined as a Harvey-Bradshaw Index <5 for Crohn’s disease (CD) and a Partial Mayo Score <2 for ulcerative colitis (UC). Healthy controls were recruited from friends and relatives of the physicians involved in the study. Exclusion criteria included psychiatric or neurological disorders, language barriers, sleep disturbances, previous surgery, significant comorbidities, alcohol abuse, and use of steroids or other neuropsychologically active medications within 3 months before enrollment. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), with a score >26 considered normal. Anxiety and depression were screened using the Hospital Anxiety and Depression Scale (HADS). Statistical analyses included the Mann-Whitney rank-sum or t-test for continuous variables and the Chi-square or Fisher’s exact test for categorical variables. Multiple logistic regression was employed to identify baseline clinical-psychometric factors associated with abnormal MoCA scores.

Results

A total of 112 IBD patients (57 CD and 55 UC) and 68 HC were enrolled. No significant differences were observed between IBD patients and HC regarding sex (p=0.231), age (p=0.248), or education (p=0.267). A significantly higher proportion of IBD patients had a pathological MoCA compared to HC (58% vs. 41%, p=0.033), even after excluding individuals with probable anxiety or depression as identified by HADS (46% vs. 24%, p=0.021). UC patients scored lower in the memory domain than HC (mean score 2.4 vs. 3.2, p=0.041). Factors associated with a pathological MoCA included age (p=0.032), education (p=0.002), and UC (p=0.034). In multivariate analysis, age (OR 1.04, 95% CI 1-1.1, p=0.015) and UC (OR 2.2, 95% CI 1.4-5.3, p=0.039) emerged as independent predictors of a pathological MoCA.

Conclusion

IBD patients exhibited a significantly higher prevalence of mild cognitive impairment compared to controls, as measured by the MoCA. Specifically, UC patients demonstrated impairments in the memory domain. Our findings support the concept of a gut-brain axis and suggest that colonic, rather than small bowel inflammation may play a role in the development of cognitive impairment in IBD. A multidisciplinary approach to IBD management should incorporate cognitive function assessment.
P0356 A case of pulmonary nodules in Ulcerative Colitis and primary sclerosing cholangitis: is it drug or disease?
Authors: Badrulhisham F , Bhushan A , Djouider Y , Metwally A , Digby-Bell J
Published: January 2025

Background

Pulmonary manifestation of inflammatory bowel disease (IBD) is rare, with a broad range of lung diseases including airways, parenchymal, pleural, and pulmonary vascular disease. It is commonly associated with concurrent use of disease-modifying drugs. We present a case of a 26 year old man with ulcerative colitis and primary sclerosing cholangitis (PSC) who developed lung nodules.

Methods

Case summary:

He was diagnosed with PSC in 2017 and ulcerative colitis in 2018. He had active colitis while on an escalated dose of adalimumab, therefore he was switched to vedolizumab. His faecal calprotectin improved but due to ongoing rectal bleeding, the dose of vedolizumab was escalated from 8 to 4 weekly. 5 months after starting vedolizumab he developed night sweats, dry cough, and breathlessness. He has no history of foreign travel, exposure to tuberculosis, industrial exposure, or bird keeping.

Results

His initial investigations showed a raised CRP and bilirubin. His CT chest showed numerous lung nodules in both lower lobes. His sputum culture, AFB, and fungal blood markers were negative. Samples were also sent from a bronchoalveolar lavage fluid including for pneumocystis jirovecii, which were negative. He was treated with antimicrobials and antifungal, without improvement. He subsequently underwent a lung biopsy, which showed inflammatory changes in an interstitial pattern, which could be related to the biologic therapy, or underlying disease. Staining for fungus, EBV, CMV, HSV were negative.

He was treated as bronchiolitis obliterans organising pneumonitis induced by vedolizumab. Vedolizumab was stopped and prednisolone 40mg was started. His symptoms and inflammatory markers improved, and subsequent pulmonary imaging showed a reduction in the size of the lung nodules. Tapering the prednisolone dose to 10mg unfortunately caused a progression in the lung nodules, despite cessation of vedolizumab, which makes it less likely as the culprit drug. Prednisolone was then increased back up to 40mg, resulting in almost complete resolution of the lung nodules, with the plan for a much slower tapering. Despite the high doses of steroid his colitis is still moderately active on colonoscopy. However, further advanced therapy had to be put on hold while waiting for his lung nodules to resolve.

Conclusion

It remains difficult to determine whether his pulmonary disease is secondary to the biologic drugs, or the underlying disease process of ulcerative colitis. While pulmonary disease associated with IBD has been widely reported, there is currently unclear understanding of its pathophysiology and treatment. Clinicians need to be aware of this rare entity in IBD in order to improve patient outcomes.
P0358 The effects of reading experience on small intestine capsule endoscopy scoring of Crohn’s disease
Authors: Wada H , Omori T , Mitsui T , Hayashida M , Matsuura M , Hisamatsu T
Published: January 2025

Background

Small bowel capsule endoscopy (SBCE) is a less invasive modality for the evaluation of small bowel lesions in Crohn’s disease (CD). The CD small bowel lesions that are visualized include inflammation and stenosis, and standardized scores are used for objective assessment of activity. On the other hand, it is not clear whether experience or individual differences influence the scoring. We assessed the correlation of each investigator and interobserver agreement in the SBCE scores.

Methods

Retrospective study including 15 CD patients who underwent SBCE from 2015 to 2022 after confirming patency with a patency capsule. The patient information was blinded and assessed independently by three physicians, with no experience reading SBCE (Beginner A), less than 10 years of experience (Intermediate B), and more than 10 years of experience (Expert C). The activity of inflammation was calculated independently by individual physicians according to Lewis score (LS), capsule endoscopy Crohn’s disease activity index (CECDAI), and Crohn’s disease activity in capsule endoscopy (CDACE). The correlation was compared between the scores for each investigator individually. The interobserver agreement of scores between physicians (A to C) and those with at least 10 years of reading experience and at least 500 SBCE scoring experiences (Expert D as standard control) for LS > 350 and CDACE > 420 scores, which have been reported to predict relapse outcome, were compared using kappa coefficients for each. The correlation between LS, CECDAI, and CDACE scores and Harvey-Bradshaw index (HBI) and CRP was assessed by Expert D as the standard.

Results

Seven male patients, median age (min-max) 21 (14-72) years, disease duration 4 (2-38) months, HBI 3 (0-9), Montreal Classification B1: 14 (93.3%), B2: 1 (6.7%), L1: 4 (26.7%), L3: 11 (73.3%). Reading time differed significantly among readers, with the beginner taking the longest (median reading time of 60 minutes for the beginner, p<0.0001). The correlation between each score per investigator regardless of experience was good, with the highest correlation between CECDAI and CDACE (Beginner A: ρ=0.87, Intermediate B: ρ=0.90, Expert C: ρ=0.93, Expert D: ρ=0.91, Spearman’s rank correlation coefficient). All physicians (A to C) showed moderate to high concordance (kappa coefficient 0.47 to 0.84) with Expert D for CDACE > 420. However, all physicians (A to C) did not show agreement with Expert D (kappa coefficient -0.05 to 0.11) for LS>350. There is no correlation was found between each score and HBI or CRP.

Conclusion

Reading time was affected by experience of SBCE, but the intraobserver correlation of each score was observed regardless of years of experience. Interobserver agreement was higher in CDACE compared to LS.
P0360 Bowel Ultrasonography and Computed Tomography tell the same story using different languages in analizing Crohn’s disease lesions
Authors: Les A , Sarbu A M , Dumitru R , Saizu R , Gheorghe L , Gheorghe C
Published: January 2025

Background

Inflammatory bowel diseases (IBD) are chronic diseases that require multiple endoscopic and imaging assessments, being diseases that not only involve a multitude of medical resources but patient compliance too. Bowel ultrasonography (BUS) and computed tomography (CT) have similar sensitivities (89.7% and 84.3%) and specificities (95.6% and 95.1%) in assessing IBD patients.Current guidelines recommend BUS altogether with other cross-sectional imaging methods to diagnose, monitor IBD patients and also for detecting complications and post-surgery recurrence

Methods

36 Crohn’s disease patients with established endoscopic and histologic diagnosis were included in the study. Patients with moderate and severe disease were prospectively evaluated using two cross-sectional imaging methods (CT and BUS) by two different examiners. Patients with superimposed infection or with surgical history were excluded. The BUS examination was performed using 5-12 MHz micro-convex transducer with no special preparation before, while CT examination was performed using both intra-venous and oral contrasts. Both examiners were blinded to each other’s data. Different bowel wall characteristics were noted using the two methods. A subjective overall assessment of the obtained images was noted according to each examiner.

Results

A moderate correlation was observed between the measurements of bowel wall thickness using BUS and CT (Spearman’s equation, r= 0.504, p<0.01). Regarding bowel wall stratification, no corrrelation was observed using the two methods. Regarding the comb sign, there was no BUS surrogate for the CT observation. Doppler signal correlated well with the presence of bowel wall stratification observed using CT ( K= 0,36, p p<0.006). A very good agreement was noticed regarding mesenteric fat densification using the two imaging techniques ( k=0,55, p p<0.00006). A low but significantly statistic inter-observer agreement was obtained when lymph nodes were searched ( k=0.28, p p<0.03). When comparing the overall assessment of the examinators, we obtained a good inter-rater agreement (k=0.58, p<0.001) between the two cross-sectional techniques.

Conclusion

Several BUS and CT observations do not overlap even though the general aspect is similar. This happens when analizing bowel wall stratification that should be understood and applied in clinical pactice differently. The good inter-rater agreement between the two methods prooves that both investigations are useful and should be used according to availability.
P0363 Explore the application value of serum GOLM1 in the diagnosis of Inflammatory Bowel Disease
Authors: Zhao Y , Pan L , Pu T , Wen H
Published: January 2025

Background

Current biomarkers used to monitor the disease activity of inflammatory bowel disease (IBD) have several limitations in specificity and sensitivity, and there is an urgent need to identify novel biomarkers. Previously, Golgi membrane protein 1 (GOLM1) has been proven to protect against colitis by modulating the equilibrium of Notch signaling pathway. Therefore, we aimed to explore the possible value of serum GOLM1 in the clinical diagnosis and disease activity assessment of IBD.

Methods

Collected clinical data, including serum GOLM1 and inflammatory markers (ESR, CRP, and Interleukin-6 [IL-6]), from 60 IBD patients (30 UC and 30 CD) and 30 control subjects (patients with colon polyps) at the First Affiliated Hospital of Zhengzhou University between August 2023 and August 2024. Mayo score and Crohn’s Disease Activity Index (CDAI) were used to evaluate the clinical disease activity of UC and CD, respectively. In UC, endoscopic disease activity was determined by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and in CD, it was measured by the Endoscopic Score for Crohn’s Disease (SES-CD). The level of serum GOLM1 was compared between IBD and the control subjects, as well as among different subgroups of IBD patients. Analysed the correlations between serum GOLM1 level and inflammatory markers, and between serum GOLM1 level and disease activity indices.

Results

1. Serum GOLM1 levels were all elevated in IBD patients (p < 0.001), UC patients (p < 0.001), and CD patients (p = 0.050) compared with the control patients, and this trend was more pronounced in UC (Figure 1). Serum GOLM1 levels did not differentiate between UC and CD. Also, there was no significant difference in serum GOLM1 levels between remissive and active IBD patients, whether assessed clinically or endoscopically.

2. The level of serum GOLM1 was positively correlated with ESR (r = 0.491, p < 0.001), CRP (r = 0.397, p = 0.002) and IL-6 (r = 0.493, p < 0.001) in IBD patients. The same trend was also observed in UC. Serum GOLM1 level was also positively correlated with UCEIS in endoscopically active UC patients (UCEIS ≥ 1) (r = 0.489, p = 0.048), but not with Mayo score in clinically active UC patients (Mayo ≥ 3) (Figure 2). In CD, serum GOLM1 level was only positively correlated with ESR (r = 0.437, p = 0.016) and IL-6 (r = 0.377, p = 0.040). In endoscopically active CD patients (SES-CD ≥ 3), serum GOLM1 level was not associated with SES-CD. Similarly, no association was found between serum GOLM1 level and CDAI in clinically active CD patients (CDAI ≥ 150).

Conclusion

This study revealed a significant increase in the serum GOLM1 level in IBD, especially in UC. GOLM1 may be involved in the inflammatory process of IBD and may serve as a potential biomarker of IBD.
P0367 A Clustering approach to discriminate slow and rapid biologics switchers in difficult-to-treat Crohn’s Disease patients
Authors: Vuckovic C , Cremer A , Minsart C , Amininejad L , Bottieau J , Franchimont D , Liefferinckx C
Published: January 2025

Background

CD patients exhibit highly variable responses to biologics. While some patients achieve sustained remission with only one biologic over the course of their disease, other will require the sequencing of multiple biologics (“difficult-to-treat” patients) for optimal disease control. The aim of this study was to delineate the profile of treatment regimen of the biological exposed CD patients with luminal disease.

Methods

Among CD patients diagnosed between 1999 and 2019 with B1 phenotype at diagnosis, 203 patients who maintained this phenotype at maximum follow-up (FU, median 11y [8–15]) were selected, based on inclusion criteria. All events were recorded from date of diagnosis to maximum FU, from disease characteristics to treatment adaptations. A temporal clustering approach using k-means was applied to determine biologics treatment regimen profiles. Patient profiles were compared using the Dynamic Time Warping (DTW) similarity measure, considering 3 successive cumulative biologic exposures (for primary/secondary non response only). Clusters number was chosen to balance maximizing silhouette score while ensuring sufficient individuals per cluster. Cumulative biologic exposures were summarized as cluster profiles, represented by their corresponding barycenters computed with soft-DTW distance. Clustering approach was performed using Python (tslearn).

Results

The 203 patients were clustered in 5 distinct profiles, based on their cumulative biologics exposure in the first 10 years after CD diagnosis (Figure 1). Patients in Cluster 1 were not exposed to biologics (n=55). Patients in Cluster 2 were treated late with one biologic (n=51) while patients in Cluster 3 were treated early with one biologic (n=53). Patients from Cluster 4 (n=23) and Cluster 5 (n=21) were both treated early with multiple biologics. Patients from Cluster 2 were exposed to biologics later after CD diagnosis than patients from Cluster 3 to 5 (Median 5.7y [3.6–6.9] vs 0.7y [0.2-1.8], p<0.0001), as also shown by their lower biological exposure compared to those of Cluster 3 to 5 (median 48% [37-58] vs 80% [60-89], p<0.0001). Most interestingly, patients from Cluster 5 required faster biologics changes compared to patients from Cluster 4 (Figure 2). In Cluster 5 (rapid switchers), patients were exposed earlier compared to patients in Cluster 4 (Slow Switchers) to the first (p<0.005), second (P<0.005) and third biologic (p=0.01), introducing the concept of rapid and slow biologic switchers among CD patients.

Conclusion

This clustering approach highlights the highly variable pattern of response to biologics in luminal CD patients. Furthermore, this study discriminatessingle and multiple biologics-exposed patients, in whom we identified slow and rapid biologic switchers.
P0373 CLINICAL RECURRENCE AFTER ILEOCOLIC RESECTION FOR CROHN’S DISEASE: Interest of the REMIND group’s endoscopic score
Authors: Amal J , Abdelwahab N , Sonia B , myriam A , zeineb B , nessrine H , bochra B , taieb J , rym E , Med Hedi D
Published: January 2025

Background

The Rutgeerts score is the most commonly used score for assessing endoscopic recurrence after ileocolic resection in Crohn’s disease. However, a significant drawback of this score is that it combines lesions localized to the anastomosis with those in the neo-terminal ileum in the same category, assigning them equal prognostic significance. The aim of this study was to evaluate the performance of the REMIND score in predicting postoperative recurrence of Crohn’s disease and compare its performance with the Rutgeerts score.

Methods

We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. The REMIND score was derived from endoscopic details documented in the colonoscopy reports. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-abdominal collection or occlusion, or subsequent surgery Postoperative. Statistical analysis was performed using SPSS.25 for Windows.

Results

Eighty patients were included, with a mean age of 35.7 years, and a gender ratio H/F=2,2. Median follow-up was 5 years from surgery. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p<0,001 and not significantly different between patients without anastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p<0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49).

Conclusion

In contrast to the Rutgeerts and A(x) scores, the I(x) score seems to exhibit superior performance in predicting postoperative recurrence. Therefore, the use of a score describing separately ileal and anastomotic lesions might be more appropriate to define postoperative endoscopic recurrence.

References

Hammoudi N, Auzolle C, Tran Minh ML, Boschetti G, Bezault M, Buisson A, et al. Postoperative endoscopic recurrence on the neoterminal ileum but not on the anastomosis is mainly driving long-term outcomes in crohn’s disease. Am J Gastroenterol. 2020 Jul;115(7):1084-93.
P0378 Normalization or reduction of at least 50% in faecal calprotectin levels after 3 months of treatment predicts clinical and endoscopic remission at 1 year in patients with ulcerative colitis: results of the prospective MIROIR study
Authors: Buisson A , Coban D , Bazoge M , Dodel M , Pereira B
Published: January 2025

Background

The STRIDE-2 consensus considers the improvement of faecal calprotectin (Fcal) (biochemical response) as an intermediate goal in ulcerative colitis (UC). However, no consensual definition of biochemical response is currently available.

MIROIR study evaluated the performance of Fcal levels three months after initiating treatment to predict clinical and endoscopic remission at 12 months in UC.

Methods

In this prospective longitudinal prediction study, any adult UC patient with partial Mayo score (>2) and endoscopic Mayo score (MES) ≥2, requiring starting therapy for UC was included. Patients with acute severe colitis or prior colectomy were excluded.

Clinical and biological data, including Fcal levels, were collected, at baseline, month 3 (M3), M6, M9, and M12. Endoscopic and histological (Nancy index) evaluations were performed at inclusion, 3 months, and 12 months. Physicians were blinded from Fcal levels.

The primary endpoint was Fcal level at 3 months, while the primary dependent variable was therapeutic success defined as clinical remission (total Mayo score ≤ 2 with endoscopic Mayo score (MES) = 0 or 1) at M12, without dose escalation or treatment discontinuation due to failure.

Results

Among 62 included patients, the mean age at inclusion was 43.9 ± 14.4 years, with 55.5% being male. UC extent was proctitis (E1) in 13.7%, left-sided colitis (E2) in 39.2%, and pancolitis (E3) in 47.1%. At baseline, endoscopic activity was Mayo 2 and Mayo 3 in 46.3% and 53.7%, respectively. and median ffcal level was 665 µg/g [296-1800].

Initiated therapies were 5-ASA (13.0%), corticosteroids (13.0%), immunosuppressants (5.5%), anti-TNF agents (26.4%), vedolizumab (22.6%), ustekinumab (35.8%), and tofacitinib (3.7%).

At M3, 10 patients (18.5%) achieved endoscopic remission (MES 0), 23 (42.6%) showed endoscopic improvement (MES 0 or 1), while 10 (18.5%) and 13 (24.1%) still had endoscopic activity, MES 2 or 3, respectively.

The median Fcal level at M3 correlated with MES at M3: 27 [14-142], 115 [20-460], 665 [135-1830], 755 [472-1340] (p = 0.0006) for MES 0, 1, 2 and 3, respectively, and with endoscopic activity (MES ≥2) at M3 (90 [18-192] vs. 679 [428-1830], p = 0.0001) with a substantial effect size (1.32 [0.72-1.91]).

Fcal level <150 µg/g at M3 was the best threshold to predict therapeutic success at M12. A decrease of at least 50% in Fcal level at M3 was the best threshold for predicting therapeutic success at M12, with high negative predictive value: 92.3%[74.9% - 99.1%].

Conclusion

Our study demonstrates that normalization or reduction of at least 50% in Fcal level after 3 months of treatment predicts therapeutic success at 1 year in ulcerative colitis. This could therefore be proposed as a definition of biochemical response.
P0381 Correlation Between Rectal Endoscopic and Histological Involvement and the Prevalence and Severity of Ano-Perineal Lesions in Inflammatory Bowel Disease
Authors: Elommal H , Koulali H , Elmqaddem O , Zazour A , ismaili Z , Kharrasse G
Published: January 2025

Background

Rectal involvement in inflammatory bowel disease (IBD), assessed through endoscopic and histological findings, may correlate with the development and severity of ano-perineal lesions (APLs) such as fistulae, abscesses, fissures, and thrombosed hemorrhoids. This study aimed to evaluate the relationship between rectal inflammation, histological abnormalities, and the prevalence and severity of APLs in IBD patients.

Methods

A retrospective analysis was conducted on IBD patients with documented rectal endoscopic and histological findings. Endoscopic involvement was categorized based on ulceration, erythema, and mucosal friability. Histological abnormalities were defined as crypt abscesses, epithelial damage, or infiltration of inflammatory cells. The prevalence and severity of APLs were assessed using clinical and imaging data. Correlations were analyzed using multivariate logistic regression.

Results

• Prevalence of rectal involvement: Rectal endoscopic abnormalities were present in 72% of patients, while histological abnormalities were detected in 65%.

• Association with APLs: Patients with rectal endoscopic involvement had a higher prevalence of APLs (68%) compared to those without (32%, p < 0.01). Histological abnormalities also strongly correlated with APL prevalence (OR: 2.4, p < 0.01).

• Severity correlation: Severe APLs, characterized by complex fistulae or abscesses, were more frequent in patients with severe rectal endoscopic (45%) and histological abnormalities (40%). Combined endoscopic and histological involvement further increased the odds of severe APLs (OR: 3.2, p < 0.01).

• Subtype associations: Fistula openings and abscesses were the most common lesions in patients with combined rectal abnormalities, highlighting a direct link with rectal inflammation.

Conclusion

Rectal endoscopic and histological abnormalities are strongly associated with the prevalence and severity of ano-perineal lesions in IBD. The combined presence of these abnormalities significantly increases the risk of complex lesions, emphasizing the importance of systematic rectal evaluation in IBD patients. These findings underscore the role of rectal inflammation as a critical factor in the pathogenesis of APLs and guide early therapeutic strategies.
P0383 Factors associated with steatotic liver disease associated with metabolic dysfunction (MASLD) in patients with Inflammatory Bowel Disease (IBD)
Authors: Oliveira E C S D , Lopes M A , Beraldo R F , Castelhano N S , Baima J P , Herrerias G S P , Quaglio A E V , Di Stasi L C , Barbosa W F , Silva G F , Sassaki L Y
Published: January 2025

Background

IBD is characterized by a systemic inflammatory state. The dysbiosis found in these patients may lead to a possible increased risk of MASLD through intestinal bacterial translocation, and increased entry of lipopolysaccharides, free fatty acids and other toxins directly to the liver via the portal vein. The objective of this study is to evaluate the prevalence of MASLD in patients with IBD and the factors associated with this condition.

Methods

The presence of MASLD was based on the presence of hepatic steatosis associated with at least 1 metabolic criterion, and the exclusion of other liver disease in outpatients with IBD. Patients with BMI < 18.0 or BMI > 40 kg/m2, alcohol use or prednisone use > 20 mg/d were excluded.

Results

A total of 179 IBD patients were included: 95 with ulcerative colitis (UC) (53.1%) and 84 with Crohn’s disease (CD) (46.9%). The mean age was 45.1±14.4 years, 65.4% were female, and the mean disease duration was 10.9±7.8 years. Clinical activity was observed in 40. 45% and endoscopic activity in 49.70%. Biological therapy was used by 35.8% of UC patients and 71.4% of CD patients. In total, 72 (40.22%) patients had MASLD; 4 (2.23%) had MASH and 9 (5.02%) had liver fibrosis. Patients with MASLD were significantly older (48.3±12.6 vs. 43.0±15.2 years, p=0.0148) and had a higher prevalence of comorbidities, including diabetes (20.8% vs. 6.5%, p=0.0043), hypertension (30.6% vs. 12.2%, p=0.0023), dyslipidemia (25.0% vs. 7.5%, p=0.0011), and insulin resistance (61.4% vs. 19.4%, p<0.0001). MASLD patients also had higher BMI (29.1±3.6 vs. 24.5±4.0, p<0.0001), elevated blood glucose (100.1±23.8 vs. 87.3±17.9, p<0.0001), and triglycerides (186.9±107.5 vs. 117.6±59.9, p<0.0001), along with lower HDL-cholesterol (51.0±16.6 vs. 57.0±15.3, p=0.0098). Laboratory parameters including hematocrit (p=0.0035), hemoglobin (p=0.003), creatinine (p=0.017), CRP (p=0.0444), AST (p=0.0033), ALT (p<0.0001), gamma-GT (p<0.0001), and ferritin (p=0.0003) were also elevated in MASLD patients. There was no difference in disease characteristics such as extent of the inflammatory process, clinical (p=0.6131) or endoscopic activity (p=0.3877) or use of medications (p>0.05) between the groups.

Conclusion

We found a high prevalence of MASLD in patients with IBD, with a strong association to metabolic risk factors rather than disease activity. Therefore, early identification and management of metabolic syndrome and MASLD are critical to preventing liver disease progression and related complications in IBD patients.