bluuebunny/crossref_metadata_2025 huggingface dataset:
P248 Feasibility, accuracy and reproducibility of the ultrasound measurement of psoas muscle compared to bioelectrical impedance analysis for the evaluation of skeletal muscle mass in patients with IBD
Authors: Fichera A , Costantino A , Piagnani A , Baldrighi S , Roncoroni L , Vecchi M , Caprioli F , Fraquelli M
Published: January 2024

Background

Sarcopenia is characterized by the loss of muscle mass and it is a strong predictor of disability and poor outcomes in several chronic gastrointestinal diseases such as inflammatory bowel diseases (IBD). Therefore, it is useful to evaluate muscle mass in patients with chronic gastrointestinal diseases at risk for sarcopenia. Radiological evaluation of muscle mass is obtained with computed tomography (CT), magnetic resonance (MRI) and bioelectrical impedance (BIA).

We aimed at assessing the feasibility, reproducibility and diagnostic accuracy of ultrasound (US) measurement of psoas muscle thickness adjusted for body mass index (BMI) compared to skeletal muscle mass (SMM) evaluated with BIA normalized to height2 in the quantification of muscle mass among patients with IBD.

Methods

We enrolled a total of 86 consecutive patients with IBD (males 68.6%, mean age 50.4 ± 17.6, 7.4% with Crohn’s disease) who underwent US evaluation of psoas muscle thickness and BIA during the same day.

US measurement (Philips Epiq, Bothell, USA) was performed by two sonographers, blind to each other. BIA was performed with the Seca mBCA 525 (Hamburg, Germany).

A cut-off of 6.68 and 8.97 of SMM normalized to height2 was considered as normal value for women and men respectively.

Sensitivity, specificity, positive and negative predictive values(PPV and NPV), positive and negative likelihood ratios (LR+ andLR−) were calculated, all with the respective 95% confidence inter-vals (95% CI).

The reproducibility between the US operators was evaluated by intra-class correlation coefficient(ICC) for the quantitative variables of psoas muscle.

The study was approved by our local ethics committee and partially funded by the Italian Ministry of Health.

Results

US psoas muscle thickness measurement was feasible in all the 86 enrolled patients.

There was a significant correlation between US measurement and BIA with a Pearson r coefficient of 0.54 (p= <0.0001). Among men a cut off of 108.18 cmxkg/m*2 showed a sensitivity of 93.5% and a specificity of 53,6% in the detection of low SMM at BIA (Figure 1). Among women a cut off of 66.9 cmxkg/m*2 showed a sensitivity of 78.5% and a specificity of 69.2% in the detection of low SMM at BIA (Figure 2).

Reproducibility among the operators had an ICC of 0.95 (CI 0.93-0.96).

Conclusion

Sarcopenia is a prognostic factor of poor outcomes in IBD, therefore it is important to identify patients at risk for it. Nowadays, assessment of muscle mass and eventually sarcopenia relies on radiological techniques (CT/MRI and BIA). At this purpose we propose a simple, non-ionizing, fast and reproducible US technique that compared to BIA showed a high sensitivity and thus can be used in clinical ractice to screen for muscle mass reduction in IBD patients.
P254 Outcomes of endoscopic and histologic remission in ulcerative colitis under advanced therapy
Authors: Rodrigues I , Bronze S , Fernandes S , Saraiva S , Bernardo S , Gonçalves A R , Moura Santos P , Valente A , Araújo Correia L
Published: January 2024

Background

Current expert-based recommendations suggest that clinical and endoscopic remission should be pursued as treatment targets in ulcerative colitis (UC). However, combined endoscopic and histologic remission may be associated with improved outcomes.

Methods

Retrospective single-center cohort study including consecutive patients with UC under advanced therapy (biologics and small molecules) with endoscopic and histologic evaluation. We evaluated the rates of hospitalization, surgery, steroid-free remission, and treatment discontinuation after 1-year of follow-up according to the type of remission. Endoscopic remission was defined as a Mayo endoscopic subscore of 0. Histologic remission was defined as the absence of ulcers, erosions and neutrophils in the lamina propria.

Results

One hundred and six patients were included. Thirty-five patients (33.0%) achieved combined endoscopic and histologic remission, 21 patients (19.8%) endoscopic but not histologic remission and 50 patients (47.2%) did not achieve endoscopic remission. At the end of 1-year, 85 patients (79.4%) achieved steroid-free remission, 14 (13.0%) required hospitalization, 4 (3.7%) surgery, 15 (14.1%) discontinued treatment. A compound outcome was reached by 31 (29.2%) patients.

In multivariate analysis including age at diagnosis, age at biologic, type of advanced treatment, disease duration, immunomodulation, previous biologic exposure and type of remission, only the type of remission was associated with a lower chance of reaching any unfavourable outcome (reference no remission) - combined endoscopic and histologic remission (OR 0.162 95%CI 0.05-0.528, P=0.003) and isolated endoscopic remission (OR 0.286 95%CI 0.084-0.971, P=0.045). Kaplan-Meier analysis showed longer outcome-free survival in patients with combined endoscopic and histologic remission.

Conclusion

Achieving combined endoscopic and histologic remission is associated with better clinical outcomes after 1 year of advanced treatment compared to no remission. However, we could not confirm a significant advantage of combined endoscopic and histologic remission over endoscopic remission alone.
P255 Association of penetrating disease and hypoalbuminemia with Crohn's disease anastomotic recurrence in the biological era: results of a long-term experience from a tertiary IBD center
Authors: Cardelli S , Gerti D , Calini G , Amato A , Sissa L , Serafini L , Rizzello F , Gionchetti P , Poggioli G , Rottoli M
Published: January 2024

Background

Crohn's disease (CD) anastomotic recurrence remains a clinical challenge with significant consequences. Its relationship with perioperative factors is controversial. This study investigates factors associated with surgical and endoscopic recurrence in a large historical cohort during the biological era.

Methods

Retrospective series of consecutive patients who underwent primary ileocecal resection for CD and the subsequent follow-up at our institute between 2004 and 2021. Follow-up or surgery for recurrence carried out in other centres were exclusion criteria. Primary outcome: identifying the variables associated with the surgical recurrence defined the need for surgery for the recurrence of disease at the site of the previous anastomosis. Secondary outcome: identifying the variables associated with the endoscopic recurrence, according to Rutgeert's score. Univariate comparisons and multivariable Cox regression survival analyses were performed accordingly.

Results

Out of 417 patients followed in our centre with a median follow-up time of 85 months (IQR 47-114), 170 presented with an endoscopic recurrence after a median time of 46 months (IQR 13-79). Surgical recurrence was observed in 65 patients at a median time of 85 months (IQR 47-114). The five-year surgical and endoscopic recurrence-free survival rates were 92.7% and 68%, respectively, while the 10-year surgical and endoscopic recurrence-free survival rates were 78% and 47%, respectively (Figure 1).

At the multivariate Cox regression, the risk of endoscopic recurrence was significantly associated with male gender (HR 1.47, 95%CI 1.03–2.09, p=0.03) and current smoking (HR 1.47,95%CI 1.03–2.09, p=0.03). Penetrating disease behavior was significantly associated with a lower risk of both endoscopic (HR 0.71, 95%CI 0.5–0.99, p=0.04) and surgical recurrence (HR 0.44, 95%CI 0.25–0.8, p=0.007), as well as the albumin levels at the time of primary surgery (HR for endoscopic recurrence: 0.7, 95%CI 0.52 –0.92, p=0.01; HR for surgical recurrence 0.6, 95%CI 0.36–0.96, p=0.03) (Table 1).

Conclusion

The role of penetrating disease as a risk factor for recurrence should be reassessed in the biological era. Hypoalbuminemia could represent a useful indicator in the stratification of patients at high risk of recurrence.
P257 Clinical characteristics and outcome of Hirschsprung's disease-associated inflammatory bowel disease: experience from 33 years of practice in a single institution
Authors: Gang S , Kwon H , Park J , Kim D Y
Published: January 2024

Background

Hirschsprung-associated Inflammatory Bowel Disease (H-IBD) is a very rare condition, occurring in approximately 2% of individuals with Hirschsprung's disease. The etiology remains unclear. In a recent study by Wang et al., nine genes were identified as consistently overexpressed in patients with both Crohn's disease and Hirschsprung's disease. Notably, all of them possess proinflammatory properties (IL1B, IL10, CXCL10, ICAM1, EGR1, FCGR3A, S100A12, S100A9, and FPR1). This suggests that chronic inflammation in HD patients may be involved in the progression to IBD. However, due to its low prevalence, there is currently a lack of knowledge about its course and response to treatment. In this study, we aimed to describe our initial experience with H-IBD by analyzing 378 patients operated on for HD at our institution.

Methods

We retrospectively reviewed all patients who underwent operation for HD from January 1989 to December 2021 in a single institution. Of 378 patients, 13 patients were suspected of H-IBD. The diagnosis of H-IBD was based on the criteria described in Sutthatarn et al. We analyzed patient characteristics and outcome.

Results

Of the 13 patients, 8 (61.5%) were boys. All patients had a final diagnosis of total colonic aganglonosis (TCA, long segment HD). One patient was accompanied by an imperforate anus and this patient got colonic segmental resection. Duhamel was performed in 4 patients, endorectal pull-through in 5 patients, and Swenson in 1 patient. Seven patients underwent a re-do pull-through operation. H-IBD was diagnosed by bloody stools in 4 patients, diarrhea in 5 patients, repeated Hirschsprung-associated enterocolitis (HAEC) in 3 patients and iron-deficiency anemia in 1 patient. Seven patients started treatment, and all but one with recurrent flare-ups improved. Immunologics were used in 2 patients, and the remaining patients were maintained with steroids, mesalazine, and antibiotics. Additional surgeries for H-IBD were not performed in all patients.

Conclusion

In our experience, H-IBD was diagnosed in 13 of the 46 children operated on with TCA. (28.3%) Progression to H-IBD should be suspected in patients with recurrent postoperative HAECs and poor response to antibiotic therapy. In addition, in patients older than 5 years of age who require stoma formation due to diarrhea or hematochezia, it may be helpful to screen for the possibility of H-IBD and initiate appropriate therapy.
P261 Co-infection of Clostridioides Difficile Aggravates Poor Outcomes in Inflammatory Bowel Disease with Cytomegalovirus Colitis
Authors: Hsieh C R , Le P H , Yeh P J , Chiu C T , Chiu C H
Published: January 2024

Background

Inflammatory bowel disease (IBD) prognosis is adversely affected by both Cytomegalovirus (CMV) colitis and Clostridioides Difficile (CD) infection. This is the first study in Asia to investigate the clinical impact and risk factors associated with their co-infection in IBD patients.

Methods

We conducted a retrospective cohort study at Linkou Chang Gung Memorial Hospital from January 2000 to May 2021, involving 53 IBD patients diagnosed with CMV colitis through colonic CMV immunohistochemistry staining. Based on stool toxin A/B tests, patients were divided into two groups: CMV only and CMV+CD co-infection. We compared baseline characteristics, clinical manifestations, risk factors, and outcomes between these groups. Logistic regression was used to analyze independent risk factors, and Kaplan-Meier methods evaluated cumulative incidence of remission rates.

Results

The study included 53 patients (37 in the CMV group and 16 in the Co-infection group). Diarrhea (93.8%) and abdominal pain (87.5%) were more prevalent in the co-infection group. Compared to the CMV group, the co-infection group had higher hospitalization times (2.5 vs. 1, p=0.005), more frequent CMV recurrences (1 vs. 0, p<0.001), and longer durations to achieve clinical (5 vs. 1 months, p<0.001), steroid-free (10 vs. 4 months, p=0.001), endoscopic (17.5 vs. 8.3 months, p=0.011), and histological remission (18 vs. 11 months, p=0.021) (Table 1-1). Kaplan-Meier analysis also indicated similar trends in Figure 1. The use of biologics was identified as an independent risk factor for co-infection (Odds Ratio 13.33, Confidence Interval 1.52-117.15, P=0.02) (Table 1-2).

Conclusion

Co-infection with CMV and CD in IBD patients leads to significantly worse outcomes. Early identification and aggressive treatment of co-infection in high-risk patients are vital for improving their prognosis.
P267 Prospective validation of the IBD - Distribution, Chronicity, Activity (DCA) histological score for Ulcerative Colitis and correlation with UCEIS and MES
Authors: Egong D , Hanly M , McGrath E , Cotter M B , Cullen G , Sheridan J , Doherty G , Sheahan K
Published: January 2024

Background

Histological assessment is not currently recognised as an independent parameter to guide personalised treatment for patients with ulcerative colitis (UC). The development of the Inflammatory Bowel Disease – Distribution, Chronicity, Activity (IBD-DCA) score allows a pragmatic approach to quantitatively evaluate mucosal injury and healing in UC, compared with other pre-existing histological scores (Lang-Schwarz et al., J Crohns Colitis, 2021). This scoring system facilitates a template-based reporting to produce consistent reports with information representing UC severity. Each domain of the IBD-DCA is scored as one of 0 (normal), 1 (mild), or 2 (moderate to severe) based on the presence of established histological UC findings (Figure 1). This project aims to prospectively validate the IBD-DCA score for routine clinical deployment and correlate with endoscopic scores – UC Endoscopic Index of Severity (UCEIS) and Mayo Endoscopic Score (MES).

Methods

Colonoscopic biopsies from patients with a previously confirmed diagnosis of UC attending one of four hospitals in a single healthcare group from August 2022 to January 2023 were reported using the IBD-DCA histological score, and the corresponding, clinician-reported UCEIS and MES scores were recorded. The histopathology reports were assessed based on the completeness of information in their respective D, C, and A domains. The proportion of reports with information fully represented by the IBD-DCA reporting template and the distribution of biopsy sites were described. The correlation between IBD-DCA with UCEIS and MES was quantified via Kendall’s tau (τ) using the R statistical package v4.3.2.

Results

Of the 151 cases reported, 70 (46.4%) patients were female and 81 (53.6%) were male. 12 patients (7.9%) had full colonic biopsies, while the remaining cases were assessed with selective biopsies. Rectal biopsy was most often performed (83.4%). The IBD-DCA components were reported for every biopsied sites in 133 (88.1%) cases. Notable correlations included UCEIS vascular pattern with histological chronicity (τ = 0.3891), UCEIS erosions/ulceration with histological activity (τ = 0.3252), and histological activity with the total UCEIS score (τ = 0.3450). MES showed the strongest correlation with histological disease distribution (τ = 0.3450)(Table 1). All p-values < 0.001.

Conclusion

These data show encouraging uptake of this simple histological reporting template in UC in daily routine use. The findings suggest that the IBD-DCA score may be a useful addition in the clinical management in patients with UC.
P277 Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn’s disease
Authors: Bak M , Hammoudi N , Allez M , Silverberg M , Schellekens I , Erler N , Dijkstra G , Romberg-Camps M , de Boer N , Jansen S , van der Marel S , Horjus C , Goetgebuer R , van Dop W , Hoekstra J , Bodelier A , Molendijk I , Derikx L , van Schaik F , West R , Duijvestein M , van der Woude J , van Ruler O , de Vries A
Published: January 2024

Background

The modified Rutgeerts’ score (mRS) is widely used for the assessment of endoscopic postoperative recurrence (ePOR) in Crohn’s disease (CD) after ileocolic resection to guide therapeutic decisions. To improve the validity and prognostic value of this endoscopic assessment, two new scores have been proposed. This study assessed the interobserver agreement of the current (mRS) and new endoscopic scores for ePOR in CD.

Methods

Sixteen academic and non-academic IBD specialists assessed endoscopic videos (n=71) of postoperative CD patients (n=66) retrieved from nine Dutch centers. Each video was assessed for the degree of inflammation by four gastroenterologists using the mRS, REMIND score (separate score of anastomosis and neoterminal ileum) and anatomic score (separate score of lesions at the anastomotic line, ileal body, ileal inlet, neoterminal ileum, colonic and/or ileal blind loop). Interobserver agreement was assessed using Fleiss’ weighted kappa.

Results

Fleiss’ weighted kappa for the mRS was 0.67 (95% confidence interval [CI] 0.59–0.74). The weighted kappa for the REMIND score was 0.73 (95% CI 0.65–0.80) for lesions in the neoterminal ileum and 0.46 (95% CI 0.35–0.58) for anastomotic lesions. In the anatomic score, the weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, colonic and ileal blind loop was 0.61 (95% CI 0.49–0.73), 0.63 (95% CI 0.54–0.72), 0.61 (95% CI 0.49–0.74), 0.83 (95% CI 0.62–1.00) and 0.68 (95% CI 0.46–0.89), and 0.44 (95% CI 0.32–0.55) for lesions at the anastomotic line.

Conclusion

The interobserver agreement of the mRS is substantial. Similarly, the interobserver agreement is substantial for lesions in the neoterminal ileum according to both the REMIND and anatomic score, whereas only moderate for anastomotic lesions. Since therapeutic decisions in clinical practice are based on these assessments and these scores are used as outcome measure in clinical studies, further improvement of agreement is essential.
P285 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: European and US Patient and Health Care Professional Perspectives on the Broad Impact of Bowel Urgency in Ulcerative colitis
Authors: Travis S , Potts Bleakman A , Panni T , Schreiber S , Dubinsky M , Panaccione R , Hibi T , Kayhan C , Hunter Gibble T , Flynn E , Atkinson C , Rubin D T
Published: January 2024

Background

Bowel urgency (BU) affects quality of life and psychosocial function of patients with moderate-to-severe ulcerative colitis (UC). This study used data from the Communicating Needs and Features of IBD Experiences (CONFIDE) survey to explore the patient and health care professional (HCP) perceptions on the broad impact of BU on patients’ emotions and daily lives.

Methods

Online, quantitative, cross-sectional surveys were conducted among patients with moderate-to-severe UC and HCPs in Europe (France, Germany, Italy, Spain, UK), the United States (US) and Japan. Data from Europe and US are presented here. A 7-point scale was used to rate the emotional impact of BU (Patients: 1=does not make me feel like this at all, 7=makes me feel like this a great deal; HCPs: 1=patients do not experience at all, 7=patients experience a great deal) and interference of BU with 12 different aspects of patients’ daily lives (Patients: 1=does not interfere, 7=interferes a great deal; HCPs: 1=no impact on patients and 7=impacts patients a great deal).

Results

Surveys were completed by 556 patients and 503 HCPs in Europe and 200 patients and 200 HCPs in the US. Among patients experiencing BU in the past month (Europe:30%, US:47%), most reported emotional impacts due to BU (mean rating [MR]≥4.1), as did the HCPs (MR≥5.2). In Europe, patients felt embarrassed when having to run to the bathroom due to BU (MR=5.0); HCPs reported that patients felt anxious/nervous due to BU as well as panic and embarrassment when having to run to bathroom due to BU (MR=5.8 each; Figure). In the US, similar to patients (MR=4.8), HCPs (MR=5.8) perceived their patients felt anxious/nervous due to BU.

Impacts of BU on daily life were reported by patients (MR≥4.2) and HCPs (MR≥4.6). In Europe, patients reported a high impact on spontaneous activities (MR=5.1); HCPs reported a high impact on patients’ ability to travel (MR=5.8; Table). In the US, patients reported a high impact of BU on the choice (variety) and quantity of food/drinks (MR=5.2 each); HCPs perceived a high impact on patients’ spontaneous activities and ability to travel (MR=5.7 each). While most HCPs (Europe:58%, US:54%) ranked BU among top five most impactful symptoms, it was not among the top three most impactful symptoms on treatment decisions.

Conclusion

In both Europe and US, BU affected patients emotionally and limited their ability to travel and make spontaneous plans. Despite the broad impact of BU from both HCP and patient perspectives, with HCPs perceiving (numerically) a higher impact than patients, it was not among the top three most impactful symptoms on HCPs’ treatment decisions. Increased awareness of BU among HCPs is needed when making treatment decisions for patients with UC.
P288 Fecal leukocyte esterase level can predict endoscopic activity for Inflammatory Bowel Disease patients
Authors: Weng M T , Tsai F P , Tung C C , Wu H Y , Chen Z C , Wei S C
Published: January 2024

Background

The urine leukocyte esterase (LE) strip is widely employed to detect leukocyte presence in human body fluids due to its simplicity, speed, and cost-effectiveness. Our previous study demonstrated that fecal LE (FLE) correlated with fecal calprotectin (FC) which serves as a surrogate marker reflecting disease activity in inflammatory bowel disease (IBD) patients. This study aims to assess the correlation between FLE and endoscopy severity.

Methods

This prospective study included IBD patients at National Taiwan University Hospital from December 2021 to November 2023. FLE and FC in the same stool sample, which was collected within one month of endoscopy, were analyzed. The correlation between FLC, FC, and endoscopic severity scores was assessed using the Pearson method. Active disease in ulcerative colitis (UC) and Crohn's disease (CD) patients was defined as Mayo endoscopic score (MES) ≥ 2 and simple Endoscopic Score for Crohn's Disease (SESCD) ≥ 8, respectively. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and the Area Under the Receiver Operating Characteristic curve (AUROC) were analyzed by using SPSS.

Results

A total of 177 IBD patients (93 with UC, 84 with CD) were included. The correlation between FLE and FC levels was moderately positive (r=0.305, p<0.001). The correlation between FLE and endoscopic severity in UC and CD patients was 0.442 (p<0.001) and 0.293 (p=0.007), respectively. Among UC patients, the area under the receiver operating characteristic curve (AUROC) for predicting MES ≥ 2 by FLE and FC was 0.717 and 0.787 (p=0.241), with an optimal cutoff of 2+ for FLE and 42.5 mg/kg for FC, respectively. At this cutoff point, FLE demonstrated a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for predicting MES ≥ 2 as 52.3%, 81.6%, 71.8%, and 65.6%, respectively. For CD patients, the AUROC for predicting SESCD ≥ 8 by FLE and FC was 0.761 and 0.869 (p=0.203), with an optimal cutoff of 2+ for FLE and 225 mg/kg for FC, respectively. FLE exhibited a sensitivity, specificity, PPV, and NPV of 81.8%, 64.4%, 74.3%, and 95.9% for predicting SESCD ≥8 respectively, at this cutoff.

Conclusion

Our results demonstrated that FLE can predict endoscopic activity, which is a cheaper and widely available monitoring tool, might be an alternative choice to FC for IBD monitoring.
P289 Bowel Stiffness Assessed by Shear-wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients with Crohn’s Disease
Authors: He J , Chen Y , Chen M , Xie X , Mao R
Published: January 2024

Background

There is a lack of reliable predictors of disease behavior progression in patients with Crohn’s disease (CD). Real-time shear-wave elastography (SWE), a novel method for evaluating tissue stiffness, is reportedly helpful in determining the prognosis of liver cirrhosis or breast cancer. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression.

Methods

We retrospectively collected data from CD patients with the non-stenotic non-penetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound with SWE measurement at baseline and were followed up. The endpoint was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. A multivariate Cox regression model was used to explore the association between baseline SWE and subsequent outcome. We also established a multivariate nomogram to predict the risk of disease behavior progression and evaluated its performance with receiver operating characteristic curve and decision curve analysis.

Results

A total of 130 CD patients with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE ≥12.75 kPa was the only independent predictor of disease behavior progression (HR 1.08, 95% CI 1.03-1.12, P=0.001, Fig 1A). A restricted cubic spline with multiple covariates adjusted showed an approximately linear positive correlation between SWE and the risk of disease behavior progression, with a cut-off of 12.75 kPa (Fig 1B).

We further established a multivariate nomogram incorporating SWE and other clinical characteristics to predict the risk of disease behavior progression quantitatively (Fig 1C). Compared to the model composed solely of SWE, the multivariate nomogram showed a higher but less significant performance (0.738 vs. 0.792, p=0.169, Fig 1D). However, the decision curve analysis showed that the model outperformed the single indicator of SWE in predicting endpoint events, especially those occured after 12 months of baseline (Fig 1E).

Conclusion

Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. CD patients with SWE ≥12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases, which warrants timely intervention.
P290 Evaluation of response to chronic and acute stress in patients with Crohn’s disease
Authors: Laoudi E , Papalouka D , Gkizis M , Kokkotis G , Chatzinicolaou M L , Mantzou A , Lyrakos G , Vlachogiannakos I , Papakonstantinou I , Bamias G
Published: January 2024

Background

Impaired response to stress in patients with chronic inflammatory disease, such as rheumatoid arthritis, is associated with decreased cortisol secretion. The aim of this study was the evaluation of response to chronic and acute stress in patients with Crohn’s Disease (CD).

Methods

Data was collected from patients who underwent surgery due to complications of Crohn’s (n=26)(CD group) or due to other indications (n=31) (control group). Patients on corticosteroid treatment during last 3 months and other immunological comorbidities were excluded. Cortisol concentration of the hair (proximal 3cm to the sculp) was measured as an indicative marker of stress taking place the last 3 months (chronic stress). Cortisol concentration in the saliva was measured at day 2 post surgery in a daily fluctuation manner (6 measurements in 24h), as an indicative marker of response to acute stress. The chemiluminescence method was used for cortisol measurements. Cortisol concentrations were correlated with DASS 21 questionnaire (validated Greek version),consisting of 21 questions which correspond to separate measurment scales for stress, anxiety or depression. SPSS was used for statistical analysis.

Results

Hair samples were measured from 17 CD patients and 20 controls. CD patients had significant lower concentrations of hair cortisol (median = 6.375 pgF/mg, IQR = 4.821 - 9.949) compared to control group (median = 9.643 pgF/mg, IQR = 6.602-14.637) (Mann-Whitney U-test P = 0.034). Saliva samples were measured from 21 CD patients and 27 controls. In regards to the post surgical cortisol fluctuation (acute stress), there was no significant difference between the two groups. No significant difference was observed between cortisol concentrations, and questionnaires results.

Conclusion

In CD, as in other immunological diseases, hypothalamic-pituitary–adrenal axis appears to be affected, leading in decreased response to chronic stress. This observation may have important implications for the pathophysiology, prognosis and treatment of CD.
P291 Longitudinal assessment of Illness Identity in patients with Inflammatory Bowel Disease
Authors: Knödler L L , Atanasova K , Fischer L , Thomann A , Ebert M , Lis S , Reindl W
Published: January 2024

Background

The concept of Illness Identity (IID) describes the way a patient integrates a chronic illness into the self-concept and has been examined in several chronic diseases. We distinguish four IID dimensions: acceptance, enrichment, engulfment and rejection. In patients with Inflammatory Bowel Diseases (IBD) IID engulfment has been shown to be associated with quality of life (QoL) and important psychosocial factors like anxiety and depression.

As IBD often show a relapsing course with varying disease activity and symptom burden, it is unclear whether IID is a stable concept or whether it changes over the disease course.

Methods

In 2018 we started to recruit patients with active Crohn´s Disease or Ulcerative Colitis before the beginning of a new therapy with biologics (t1) and did follow-up examinations 6- 12 months (t2) and 2-3 years (t3) after the baseline examination. Until now we were able to reassess 71 of 83 at t2 and 16 of 83 patients at t3

We assessed IID with the Illness Identity Questionnaire (Oris et al.). Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and QoL was assessed with the IBDQ.

We analysed correlations between these factors at t1, t2 and t3 and calculated linear mixed-effects models to analyse the stability of IID over time. Pearson correlation between changes in IID and changes in disease activity were also examined.

Results

IID engulfment is associated with poorer QoL (r= -0.696, p= 0.003) at t3. Higher anxiety scores are linked to poorer QoL (r= -0.630, p=0.009) and higher depression scores are linked to poorer QoL (r= -0.502, p= 0.048) at t3.

In the linear mixed-effects models of IID dimensions we found no significant changes in IID over time (IID enrichment : mean difference of 1.03, p= 0.297; IID acceptance : mean difference of -0.19, p= 0.824; IID rejection : mean difference of 0.69, p= 0.259; IID engulfment : mean difference of -0.22, p= 0.771. Changes in IID engulfment correlated positively with changes in disease activity (r= 0.626; p = .0095), whereas no significant correlations were found for the other IID dimensions (Fig 1.))

Conclusion

Our preliminary results suggest stability of IID in patients with IBD over a period of up to 3 years. These results confirm our previous findings, demonstrating that especially IID engulfment is linked with a poorer QoL and changes in IID engulfment correlate with changes in disease activity.
P293 Safety and diagnostic yield of wireless video capsule endoscopy in early onset inflammatory bowel disease (EOIBD) in children under the age of 6 years in a tertiary paediatric IBD centre
Authors: Green S , Hammond J , Gaynor E , Kiparissi F
Published: January 2024

Background

Wireless video capsule endoscopy (VCE) is a well-established diagnostic tool used in the evaluation of small bowel disease in paediatric IBD. Patients usually swallow the capsule. Young children are rarely able to swallow the capsule and these therefore need to be placed with the help of an OGD and an ACORN device. 2 capsule systems were used: PillCam and MiroCam. The aim of this study was to look at the safety of capsule insertion in children less than 6 years of age and to also look at the diagnostic yield.

Methods

We conducted a retrospective review of our VCE data base over a 7 year period from April 2016 to August 2023.

Results

We conducted a retrospective review of our VCE data base over a 7 year period from April 2016 to August 2023. 22 patients (14 male) and 27 capsule episodes were included into the study with a an age range at point of capsule insertion between 2 years and 5 months and 5 years and 8 months (median 5 years). All capsules were inserted with an ACORN device. All patients had a histologically proven diagnosis of EOIBD; during this period 4 patients had 2 VCEs and 1 patient 3 VCEs placed. All patient had genetic tests performed, only 1/24 patients had a monogenic mutation confirmed. 15/27 (56%) of all capsules were normal, 8/27 (30%) showed small bowel ulcerations only, 2/27 (7%) showed both small bowel and colonic ulcerations and 5/27 (19%) showed colitis only. We were able to insert the capsule in all 27 capsule episodes without any complications. All studies were complete with the capsule entering the colon and no capsule got stuck.

Conclusion

Wireless video capsule endoscopy in early onset inflammatory bowel disease in children under the age of 6 years is safe with a diagnostic yield of around 50%. This modality should be used in the diagnostic pathway of EOIBD.
P302 Diagnostic Delayed is Associated with a Poor Prognosis in Patients with Crohn's Disease
Authors: Kiliç V , Kivrakoglu F , Ergin M , Kucuk H , Yuksel I
Published: January 2024

Background

The studies show that diagnostic delay, especially in Crohn’s disease (CD), is associated with a higher risk of complications and major surgery. We aimed to investigate timing of the diagnostic delay (DD) and its impact on the CD outcomes.

Methods

We retrospectively evaluated demographic and clinical features of CD patients between June 1993 and October 2023. Diagnostic delay was defined as the time interval from the onset of the first symptoms to the making of the CD diagnosis. The first CD related symptoms were evaluated by a review of the physician’s notes and medical record. Specific symptoms of CD included chronic or recurrent bloody or non-bloody diarrhea, and/or abdominal pain accompanied by noticeable weight loss, general weakness, and fever.

Results

514 patients with CD were included in the study. The median age of disease onset was 34.14 years (16–84 years). Male sex was 299 (58.2%). DD was detected median 13 months (5-47) (14 months in male and 12 months in female). DD was 12 months for diseases with onsets before the age of 40 and 15 months for diseases with onsets after the age of 40. DD was 25 months in isolated ileal involvement, in terminal ileal involvement was 21.5 months, ileo-colonic involvement was 20 months, and colonic location was 10 months. Ileal involvement was found to have a longer duration for DD than colonic involvement. Compared to stenosing behavior (20 months) and penetrating behavior (17 months), DD was shorter in non-stenosing non-penetrating behavior (12 months). DD was longer in perianal disease (18 months) than in those without (12 months). Current smokers had a longer duration of the DD (20 months) compared to non-smokers (11.5 months) and ex-smokers (10 months). The duration of DD (18 months) was longer in CD patients with extraintestinal manifestations than in those without (12 months).

Regarding the biological treatment, CD patients who experienced multiple biologics and resistance had longer DD (24 months) than those who experienced biologic monotherapy and responded (12 months). Compared to patients who had not had surgery (12 months), DD was longer in CD patients who had undergone surgery (15 months).

Conclusion

Our study showed that ileal involvement, stenosing-penetrating behavior, perianal disease, current smoking and existing extraintestinal manifestations were connected with DD. DD was also associated with multiple biologic needed and surgery. DD may have a role a significantly increased risk of bowel damage.
P303 Determining the threshold for moderate-to-severe disability in inflammatory bowel disease using IBD-Disk
Authors: Kallel H , Elleuch N , Dahmeni W , Limam R , Hammami A , Braham A , Ksiaa M , Jaziri H , Ben Slama A
Published: January 2024

Background

The IBD-Disk is a validated 10-question visual scale, which has been shown to measure functional disability associated with inflammatory bowel diseases (IBD). The aim of this study is to assess the correlation between the IBD-Disk, the daily-life burden associated with IBD, and disease activity.

Methods

We conducted a cross-sectional study over 6 months between April and September 2023. IBD patients responded to the IBD-Disk and 2 visual analog scales (VAS): 1) Daily-life IBD burden (scored from 0 to 10, score > 5 indicates high burden) 2) Overall perceived health status (0=poor, 10=good). Means were compared using the Wilcoxon-Mann-Whitney test. The correlation of the overall IBD-Disk with daily-life IBD burden and overall health was analyzed using Spearman's correlation coefficient. The diagnostic performance of IBD-Disk in detecting severe disability was studied using the area under the Receiver Operating Characteristic (ROC) curve.

Results

We included 142 patients, 55.6% male and 72.5% with Crohn's disease. The median age of the series was 38 years [30 - 48]. The mean IBD-Disk total score was 35.7 ± 21.6. Energy, Emotion, and Sleep obtained the highest scores. Mean values for daily-life burden and self-rated overall health status were 4.9 ± 3.1 and 5.9 ± 2.6 respectively. There was a significant difference in means between the overall IBD-Disk score, IBD daily-life burden and overall health status between patients in clinical remission and patients with active disease (Table 1). We observed 43.7% patients (n=62) with a high daily-life burden. The correlation between the overall IBD-Disk score and the VAS of daily-life burden was r=0.787 (p<0.001) and was inversely related to the VAS of overall health status with a coefficient r=-0.632 (p<0.001). At an optimal overall IBD-Disk score cut-off equal to 38/100, the area under the receiver operating characteristic curve (AUROC) for high IBD daily-life burden [VAS>5] was 0.907 (95% confidence interval [CI]: 0.858-0.955; p<0.001) (Figure 1)

Conclusion

Our work has demonstrated excellent item homogeneity in the classical Arabic version of the IBD-Disk, and a good correlation between each item and the remaining total score. However, a prospective measurement of the intra-class correlation coefficient of the classical Arabic version will be necessary to assess its reproducibility over time.
P308 CPa9-HNE: A NEUTROPHIL-DERIVED FRAGMENT OF CALPROTECTIN MEASURED IN SERUM CAN MONITOR ENDOSCOPIC AND CLINICAL DISEASE ACTIVITY IN ULCERATIVE COLITIS
Authors: Sorokina Alexdóttir M , Poulsen A , Pehrsson M , Karsdal M A , Bay-Jensen A C , Seidelin J B , Mortensen J H
Published: January 2024

Background

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) presenting in remitting ulcerations of the colonic mucosa and submucosa. Mucosal healing is therefore an important treatment target. While fecal calprotectin is a common biomarker used to monitor mucosal healing in UC, patient compliance is low due to a preference for serological markers. This study aimed at investigating the association of serum calprotectin [CPa9-HNE], a non-invasive neo-epitope biomarker of neutrophil activity, with both clinical and endoscopic disease activity in UC.

Methods

The cohort included 49 patients with active UC and 50 and healthy controls (HC). Endoscopic and clinical disease activity was assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the full Mayo score. Serum calprotectin [CPa9-HNE] was measured, reflecting a human neutrophil elastase-derived fragment of calprotectin. Spearman’s rank correlation was applied. Group differences were evaluated using Kruskal-Wallis with Dunn‘s test, bonferroni corrected for MCP. Diagnostic and discriminative capabilities were assessed using receiver operating characteristic (ROC) statistics with are under the curve (AUC).

Results

CPa9-HNE was significantly elevated in patients with UC compared to HC (ng/ml [IQR]: 32.4 [29.0–52.3] vs. 26.0 [22.6–29.0], p<0.0001) and presented acceptable discriminative capabilities (AUC [95% CI]: 0.77 [0.67–0.87], p<0.0001). CPa9-HNE showed a moderate positive correlation to UCEIS and Mayo (ρ=0.42; ρ=0.48, both p<0.01). When patients were stratified according to endoscopic disease activity (UCEIS), CPa9-HNE was significantly elevated in patients with severe disease compared to those with mild disease (ng/ml [IQR]: 55.6 [40.9–66.4] vs. 28.9 [24.6–31.1], p<0.01) and could accurately discriminate between the two groups (fig 1A-B). Similarly, when patients were grouped according to the full Mayo score, CPa9-HNE was significantly elevated in patients with mild vs. severe disease (29.1 [24.3–32.4] vs. 62.9 [55.2–67.5], p<0.01) and moderate vs. severe disease (32.0 [29.2–39.2] vs. 62.9 [55.2–67.5], p<0.01), and could accurately discriminate between the groups (fig 1C-E).

Conclusion

CPa9-HNE was elevated in patients with UC compared with healthy subjects. Furthermore, CPa9-HNE accurately discriminated between patients with mild and severe endoscopic disease based on the UCEIS score, as well as between patients with mild, moderate, and severe clinical disease activity according to the full Mayo score. These findings highlight the potential use of CPa9-HNE as a non-invasive tool to monitor both endoscopic and clinical disease activity in UC, with the potential of guiding treatment decisions and better aligning with patient preferences.
P311 Prevalence and impact of sarcopenia in patients with inflammatory bowel diseases: a prospective cohort study
Authors: Nuzzo A , Adam Hassan F , Dermine S , Mohamed Gouse A , Billiauws L , Bourdillel J , Joly F
Published: January 2024

Background

Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of this study was to prospectively evaluate sarcopenia by combining morphological and functional criteria in an outpatient IBD population.

Methods

In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of our department between March 1st and 31st, 2023. Patients with short bowel syndrome were not included. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter, and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement < 16 to 26, and myopenia was defined by an appendicular muscle mass index (AMMI) < 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) < 15 to 17 in women or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patients were followed-up at 6 months to measure a composite criterion of disease activity combining one of the factors: FC > 250µg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-related surgery.

Results

In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) or UC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic (48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%) involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologics administered were infliximab (61%), vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopenia was 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years, p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%, p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significant difference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tended to be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs. 21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to the composite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline). Myopenia indices were strongly correlated with handgrip values (r=0.7, p<0.001).

Conclusion

In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in 11% and myopenia in 20% of cases, and associated with an increase in morbidity.
P330 Rate of disability at diagnosis in patients with inflammatory bowel diseases: Results from a prospective population-based inception cohort, IBD Prognosis Study
Authors: Attauabi M , Madsen G R , Bendtsen F , Seidelin J , Burisch J
Published: January 2024

Background

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic, progressive diseases associated with a high level of disability over time. In the current study, we aimed to investigate the occurrence of disability at the time of IBD diagnosis and determine its association with the initial disease presentation.

Methods

Incident adult patients (≥18 years old) with newly diagnosed UC or CD according to the Copenhagen IBD Criteria were included in the IBD Prognosis Study, a prospective, population-based, inception cohort covering a catchment areas of approximately 20% (1.1 million) of the Danish population. Disability was assessed using the validated IBD-Disability Index version 2.1 We defined no, moderate, and severe disability scores as 0-20, 36-50, and 51-100 points.2 A severe disease presentation was defined by the need for glucocorticoids, immunomodulators, biologics, or surgery within three months of disease. Multivariable logistical regression analyses were conducted by adjusting for gender, age, and IBD phenotype.

Results

Out of the original cohort, 208 (67.5%) and 128 (63.1%) patients with incident UC and CD, respectively, responded to the questionnaires. In comparison to non-responders, the former differed only in a higher proportion of female patients and never-smokers with UC, while a higher proportion of current smokers among patients with CD responded.

The mean IBD Disability scores differed significantly between UC (24.2, standard deviation (SD) 18.1) and CD (28.8, SD 18.6, p=0.01), with every fourth and third patient, respectively, experiencing moderate or severe disability (moderate: UC: 9.9%, CD: 22.4%, p=0.002); severe: UC: 12.3%, CD: 11.2%, p=0.77).

Independent factors associated with disability were extensive UC as well as female gender and extra-intestinal manifestations in both UC and CD (Table 1).

In multivariable logistical regression analyses adjusting for age at disease onset, gender, and disease phenotype, severe disability was significantly associated with a severe initial presentation of IBD, including IBD-related hospitalization and initiation of biological therapies (Figure 1).

Conclusion

In this prospective population-based inception cohort of unselected patients with newly diagnosed IBD, we found every third and every fourth patient with UC and CD to experience moderate-to-severe disability at the time of diagnosis, which was independently associated with a severe disease presentation. These findings have implications for patient management and surveillance strategies.

References

1 Peyrin-Biroulet L, et al. Gut. 2012. doi: 10.1136/gutjnl-2011-300049.

2 Gower-Rousseau C et al. Gut. 2017. doi: 10.1136/gutjnl-2015-310151.