bluuebunny/crossref_metadata_2025 huggingface dataset:
P168 Development of predictive model for early detection of Inflammatory Bowel Disease in Korea
Authors: Lee C , Koh S J , Choi K , Lee H J , Im J P , Kim J S
Published: January 2023

Background

Diagnostic delay in inflammatory bowel disease (IBD) was frequent and may be associated with poor outcomes. The aim of this study was to develop a predictive model for early diagnosis of IBD.

Methods

From March 2020 to January 2022, a 15-item Red Flags questionnaire was administered to all patients who visited outpatient clinic with gastrointestinal symptoms suspected of IBD. All patients underwent additional diagnostic tests to confirm IBD. We estimated a model that could predict the early diagnosis of IBD using questionnaire and laboratory test results.

Results

A total of 186 patients were enrolled in this study and 114 (61.2%) patients were finally confirmed with IBD. The logistic regression identified 4-item independently associated with a diagnosis of IBD. 1) Perianal fistula/abscess or perianal lesions (apart from hemorrhoids) (OR, 2.6; p=0.044). 2) Chronic abdominal pain/discomfort (>3 months) (OR, 0.3; p=0.013). 3) Rectal bleeding (OR, 7.4; p<0.001). 4) First-degree relative with confirmed IBD (OR, 12.0; p=0.033). A receiver operating characteristic curve was used to evaluate predictability of the model for diagnosis of IBD and each area under the curve was as follows. 1) Questionnaire only : AUC 0.831 (95% confidence interval; 0.766-0.896), 2) Questionnaire and serum laboratory tests including blood cell counts, erythrocyte sedimentation rate and C-reactive protein : AUC 0.885 (95% C.I.; 0.834-0.936), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.895 (95% C.I.; 0.845-0.944). This model confirmed that the predictive value was particularly excellent for early diagnosis of Crohn's disease. 1) Questionnaire only : AUC 0.891 (95% C.I.; 0.818-0.964), 2) Questionnaire and serum laboratory tests : AUC 0.960 (95% C.I.; 0.914-1.000), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.975 (95% C.I.; 0.944-1.000).

Conclusion

The predictive model for early diagnosis of IBD has a high predictive value. The model allows for early detection of IBD from non-IBD patients.
P182 Modified Multiplier SES-CD (MM-SES-CD) and laboratorial Crohn’s disease activity parameters: is there any association?
Authors: Capela T , Ferreira A I , Macedo Silva V , Freitas M , Arieira C , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J
Published: January 2023

Background

Contrary to the Simple Endoscopic Score for Crohn’s Disease (SES-CD), Modified Multiplier SES-CD (MM-SES-CD) is a new endoscopic severity assessment tool that was able to predict one-year endoscopic remission in patients with Crohn’s Disease (CD) on active therapy. Unlike SES-CD, MM-SES-CD accounts for the number of segments affected and the different prognostic weight of individual SES-CD parameters according to disease location. Nevertheless, there is scarce information regarding its relationship with laboratorial parameters, namely C-reactive protein (CRP) and fecal calprotectin (FC). We aimed to analyze the association between MM-SES-CD and these laboratorial parameters.

Methods

Retrospective cohort-study including all ileocolonoscopies performed in adult CD patients between January 2020 and October 2022 with CRP (mg/dL) and FC (ug/g) collected within one month. Patients with previous intestinal surgery or inadequate bowel preparation were excluded. MM-SES-CD, ranging from 0 to 130.5, was calculated and different severity categories were defined as follows: remission (<14), mild (≥14 to <31), moderate (≥31 to <45), and severe (≥45). MM-SES-CD values were correlated and compared, according to severity categories, with laboratorial biomarkers.

Results

A total of 272 ileocolonoscopies from 218 CD patients were included, most females (54.1%) with a mean age of 41 years old. Most patients were A2 (72.8%), L1 (51.1%) and B1 (73.9%), according to Montreal classification. Median MM-SES-CD, CRP and FC was 12.0, 2.9 and 222.0, respectively. Despite MM-SES-CD values correlated weakly with CRP (r=0.376, P<0.001) and moderately with FC (r=0.531, P<0.001), patients with endoscopic remission had significantly lower median CRP (2.9 vs 7.7, P<0.001) and FC (128 vs 587, P<0.001) than patients with active disease. Additionally, median CRP (2.9 vs 6.0 vs 16.0 vs 30.7, P<0.001), and median FC (128 vs 531 vs 637 vs 877, P<0.001) were significantly different between MM-SES-CD severity categories (remission vs mild vs moderate vs severe), respectively. CRP and FC optimal cut-offs for endoscopic remission were 8.5 mg/dL (Sensitivity 74.7%, Specificity 43.6%, negative predictive value (NPV) 77.4%, positive predictive value (PPV) 40.0%) and 471.5 ug/g (Sensitivity 62.6%, Specificity 87.3%, NPV 82.3%, PPV 71.3%), respectively.

Conclusion

To the best of our knowledge, this is the first study reporting an association between CRP and FC and increasing degrees of disease activity assessed by MM-SES-CD. A CRP <8.5 mg/dL and a FC <471.5 ug/g are suggested as cut-offs associated with endoscopic remission.
P183 Development of a new simple ultrasound activity score for intestinal Behçet's Disease
Authors: Yaguchi K , Kunisaki R , Sato S , Izumi M , Fukuno Y , Ebina T , Matsune Y , Hama T , Onishi M , Kobayashi K , Shibui S , Toritani K , Nishida D , Matsubayashi M , Nakamori Y , Nishio M , Umezawa S , Ogashiwa T , Sasaki T , Fujii A , Kimura H , Numata K , Maeda S
Published: January 2023

Background

Intestinal Behçet's disease (BD) is a relapsing-remitting disease typically associated with punched-out ulcers in the ileocecal region. Optimal monitoring of disease activity is necessary; however, ileocolonoscopy cannot be performed on a regular basis as it is invasive, resource-intensive and causes considerable patient discomfort. Furthermore, there are risks of intestinal bleeding and perforation caused by pretreatment laxatives and air insufflation during the examination. Hence, other follow-up examinations are required. Intestinal ultrasonography (IUS) is a minimally invasive imaging method, but there are no previous reports of comparisons between IUS and endoscopy for intestinal BD. This study aimed to evaluate the usefulness of IUS in assessing the activity of ileocecal ulcers in intestinal BD.

Methods

This retrospective single-centre study included patients with intestinal BD who underwent colonoscopy and IUS within 2 weeks, from 2007 to 2020. Correlations between the corresponding endoscopic activity using the Sakita–Miwa classification and six IUS variables (bowel wall thickness [BWT], vascularity, bowel wall stratification, intramural and extramural abscesses, fistulas and mesenteric lymphadenopathy) were assessed and used to select the variables that should be included in the new simple score. IUS findings were also compared with biomarker (C-reactive protein [CRP]) concentrations and clinical severity indices (Crohn’s disease activity index and disease activity index for intestinal BD [DAIBD]).

Results

Seventy-nine IUS examinations from 53 patients were included. Univariate analysis revealed that CRP and DAIBD and the IUS findings BWT, vascularity and bowel wall stratification and intramural and extramural abscesses differed significantly according to endoscopic ulcer activity. Multivariate analysis using a logistic regression model revealed that only BWT and vascularity were statistically different; therefore, a new simple score ([2*BWT] + [5*vascularity]) was constructed. Receiver operating characteristic curve analysis revealed an area under the curve of 0.91 for detecting endoscopic activity, which was superior to those of CRP (0.80; P=0.069), Crohn’s disease activity index (0.69; P=0.002) and DAIBD (0.67; P<0.001).

Conclusion

A new simple ultrasound activity index for intestinal BD comprising BWT and vascularity was constructed and correlated well with endoscopic disease activity. This is the first report describing the usefulness of IUS for intestinal BD, and we believe the findings will have many implications in clinical practice.
P194 Characterization of Protein Disulfide Isomerases in adult and pediatric Crohn’s Disease and association with inflammation and fibrosis
Authors: Bequet E , Salée C , Bletard N , Vieujean S , Massot C , Fonzé F , Sarter H , Ley D , Colinet S , Delvenne P , Seghaye M C , Louis E , Meuwis M A ,   with the participation of EPIMAD group
Published: January 2023

Background

Evolution of Crohn’s disease (CD) is often marked by fibrostenotic complications and available biotherapies cannot prevent or treat intestinal fibrosis. The pathophysiological mechanisms of intestinal fibrosis are multiple and poorly understood. The intestinal epithelium probably plays a key role. The endoplasmic reticulum stress (ERS) is involved in the pathophysiology of IBD and in fibrosis. Protein disulfide isomerases (PDIs) take part in the ER stress response, but their precise roles and associations with CD remain poorly characterized. We investigated the distribution of selected PDIs within the ileum and colon of adult and pediatric patients with inflammatory or stenosing CD.

Methods

Tissues from 72 pediatric and 47 adult CDs, and 26 pediatric and 48 adult patients without IBD were included from 4 tertiary hospitals. The degree of fibrosis and inflammatory infiltrate were evaluated. The distribution of 4 PDIs (AGR2, BiP, PDIA6, ERP44) within the tissues was studied by immunohistochemistry (IHC) using a semiquantitative scoring scale (0 to 4). Statistical tests used were ANOVA or Kruskal-Wallis (with post hoc test), T-Student and Mann-Whitney.

Results

The clinical characteristics of the patients included are described in Table 1. The PDIs provide an IHC signal which was mainly epithelial. The distribution of PDIs differed according to the segment studied (colon or ileum), the age of CD onset, location in the epithelium (surface, median crypt, or bottom of crypt), and the normal, inflammatory, and/or fibrotic features of the tissues. In the ileum of adult and pediatric CDs, the distribution of AGR2 was significantly higher in the epithelium adjacent to fibro-inflammatory tissues (p<0.01). In pediatric cases, AGR2 increased significantly with the fibrosis grade within the surface epithelium of the ileum (Fig. 1). The distributions of the other PDIs (BiP, ERP44 and PDIA6) were rather influenced by the inflammatory infiltrates and varied in adult and pediatric CD. The distribution of BiP was significantly higher in tissues with acute and/or chronic inflammation and independent from fibrosis. In adults, the distribution of PDIA6 in the colonic epithelium was significantly higher in CD cases compared to non-CD cases.

Conclusion

Our results suggest that the studied PDIs may have different roles in the ERS response within the intestinal epithelium in adult and pediatric CD. These PDIs need to be functionally explored further to better understand their specific involvement in inflammation and fibrosis in CD. The increase of AGR2 in fibro-inflammatory tissues, not observed with other PDIs, suggests a specific link between AGR2 and intestinal fibrosis.
P202 Accuracy of blood-PCR for diagnosing CMV Colitis in patients with Inflammatory Bowel Disease
Authors: Serra-Ruiz X , Herrera-de Guise C , Esperalba J , Mayorga Ayala L , Céspedes Martínez E , Robles Alonso V , Casellas F , Pérez Martínez Z , Oller E , Borruel Sainz N
Published: January 2023

Background

Current guidelines in inflammatory bowel disease (IBD) advocate for endoscopic biopsies to confirm cytomegalovirus (CMV) colitis by means of immunohistochemistry (IHC) or tissue polymerase chain reaction (tPCR). Clinical usefulness of whole-blood PCR (bPCR) remains controversial. Our aim was to asses diagnostic accuracy of bPCR to predict CMV colitis.

Methods

We extracted data from all patients between 2017 and 2022 with ulcerative colitis (UC), Crohn’s disease (CD) or unclassified colitis presenting with a moderate-to-severe flare of IBD, and who were tested for CMV infection with both IHC and bPCR at the same time. IHC was considered reference standard and was used to evaluate diagnostic accuracy of bPCR.

Results

89 patients were included, of which 44 (49,4%) were women, and median age was 49 years (Figure 1). 48 (50,6%) had UC, 16 (19,1%) had CD, and 25 (29,2%) had unclassified colitis. 46 (51,7%) were receiving any IBD treatment by the time of enrolment, of which 34 (67,4%) were on corticosteroids. Among patients in the CMV colitis group we found a higher proportion of leucocyte counts in the normal concentration range (p=0,035) and higher endoscopic activity using the Mayo endoscopic score in CU (p=0,027).

Of the study subjects, 25 (28,2%) had CMV colitis; and bPCR was positive in 23 (25,8%). Diagnostic accuracy of bPCR was 75,3%, being sensitivity and specificity 52% and 84,4%, respectively. The positive predictive value and negative predictive value were 56,5% and 81,8%. Numerically, patients in the CMV colitis group showed higher concentrations of CMV DNA PCR without reaching statistical significance (6416,2 copies/mL vs. 2256 copies/mL, p=0,295).

The area under the receiver operating characteristic curve value was 0,646 (p=0,239). When setting a threshold of above 1336 copies/mL, sensitivity and specificity values were 40% and 92,2%, respectively, and the positive likelihood ratio (LR+) was 5,13 (Figure 2).

Conclusion

Although bPCR showed high specificity for diagnosing CMV colitis, the sensitivity values were low. In agreement with current guidelines, blood-based tests should not replace IHC or tPCR for detecting CMV reactivation in IBD. A threshold of above 1336 copies/mL showed a moderately high LR+, thus it should prompt consideration of early antiviral treatment.
P203 Oral omeprazole and diclofenac intake is associated with increased faecal calprotectin levels: a randomised open-label clinical trial
Authors: Rendek Z , Falk M , Grodzinsky E , Kechagias S , Hjortswang H
Published: January 2023

Background

Non-steroidal anti-inflammatory drugs and proton pump inhibitors are known to affect the diagnostics of gastrointestinal disorders. The aim of this study was to investigate to what extent omeprazole, diclofenac or co-administration of these affects faecal calprotectin (FC) levels, and the normalisation interval after cessation.

Methods

Participants received 20 mg omeprazole daily for two weeks in the first sequence, 50 mg oral diclofenac three times daily for two weeks in the second and co-administration of these for two weeks in the third, with washout periods in between. The first two sequences were randomised to a different order. FC was measured on day 0, 4, 7, 14, 21, 28 and 35 and thereafter at 7-day intervals until normalisation in each sequence.

Results

Thirty-two healthy volunteers were included. During drug intake, 39% on diclofenac (median 70.8 µg/g; range 50.2-1080 µg/g), 53% on omeprazole (median 85.3 µg/g; range 51.1-249 µg/g) and 69% on omeprazole + diclofenac (median 101.5 µg/g; range 51.5-532 µg/g) had FC levels above normal. In the diclofenac sequence, FC returned to normal in all participants within two weeks of cessation and in the omeprazole and co-administration sequences, within three weeks of cessation. No statistical significant difference was found with respect to drug order.

Conclusion

Short-term intake of omeprazole, diclofenac or co-administration appears to increase FC levels. In patients with increased FC on omeprazole alone or in combination with diclofenac, a repeated FC test is recommended at least three weeks after cessation. On diclofenac alone, it is sufficient to repeat the FC test two weeks after cessation.
P209 Delayed IBD diagnosis increases risk of requiring biologics in first 4-years - an Inception cohort study
Authors: Rao A , Bazarova A , Mitra P , Parigi T , Majumder S , Ghosh S , Iacucci M , Shivaji U
Published: January 2023

Background

Delays in diagnosis can be due to patient and health-system related factors. The impact of such delays in Inflammatory Bowel Diseases (IBD), particularly on biological therapies, continues to be of interest. The aim of the study was to investigate if delays could predict need for biologics and report on related adverse outcomes (AOs).

Methods

New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For this study, delay-types and cut-off times for each type were set based on best average hospital waiting times. The reasons for delays until start of treatment were recorded; data on the start of biologics, duration, and reasons for switch (if required) were recorded. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether any delay-types could predict need for biologics and compare the risk between patients with or without delay.

Results

105 patients were identified using stringent criteria (M=58; median age=32y) with a median follow-up of 55 months. 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn’s disease, and Unclassified colitis respectively, and were analysed collectively.

A model that combined delay in seeking medical attention, and time taken from specialty review to index endoscopy exhibited the best predictive power with average AUROC of 0.67.

When individual delay-types were analysed, it was noted that most delay-types increased the risk of biologic use: a) delay in seeking medical attention [OR-1.08(1.03 1.17)] b) delay from GP referral to specialty review [OR-1.10(1.0 1.23)] c) delay from specialty review to index endoscopy [OR-1.09(1.01 1.21)]

On further analysis, there was a statistically significant increase noted in the risk of requiring biologics at any time during the follow-up period. Fig 1A illustrates survival without biologics when there is a delay of >2 weeks in seeking medical attention (p=0.042). Figure 1B illustrates survival without biologics when there is delay of >6 weeks from GP referral to index endoscopy (p=0.021).

Figure 1A- Patient-related delay of >2weeks and risk of needing biologics (p=0.042)

Figure 1B- Health-system related delay of >6weeks and risk of needing biologics (p=0.021)

Conclusion

The risk of requiring biologic therapy is higher in those patients who have faced any type of delay in their diagnosis of IBD. A patient-related delay of >2weeks and cumulative health-system related delay of >6weeks increase the risk of requiring biologic therapy at any time during their follow-up. Both primary and secondary care must work to reduce any delays as this has long-term implications for patients and economic implications for health care providers.
P221 Validity of the Self-administered Comorbidity Questionnaire in patients with Inflammatory Bowel Disease
Authors: Van Linschoten R , Huberts A S , van Leeuwen N , Hazelzet J A , van der Woude C J , West R L , van Noord D
Published: January 2023

Background

The International Consortium for Health Outcomes Measurement (ICHOM) has defined a standard set of outcome measures for inflammatory bowel disease (IBD) to capture effectiveness of care delivery processes by systematic collection of outcomes. However, several case-mix variables can confound the outcome measures and should be adjusted for before interpreting and comparing outcomes. To account for the impact of comorbidities, the self-assessed comorbidity questionnaire (SCQ), containing 36 questions on presence, treatment and limitation of thirteen diseases, was selected by ICHOM. As the SCQ has been validated for other diseases, but not for IBD, we aimed to assess the validity of the SCQ for measuring comorbidities in a population of IBD patients.

Methods

Data in this study was extracted from a prospective study evaluating quality of care of IBD patients treated with a biologic or new small molecule. We assessed criterion validity by comparing patient-reported and clinician-reported presence (as noted in the electronic health record) of the thirteen diseases of the SCQ using Cohen’s kappa. Construct validity was assessed by evaluating the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life (EQ-5D-5L), IBD-related healthcare and productivity costs and prevalence of disability. We assessed responsiveness by measuring the correlation between changes in the SCQ and changes in healthcare costs, productivity costs and quality of life after 15 months.

Results

A total of 642 patients were included. Median age was 49, 56% were female and 60% had Crohn’s disease. Median SCQ at baseline was 1.75 (IQR: 0.01 – 4.00) and increased to 2 (IQR: 0.26-4.00) after 15 months of follow-up. Fair agreement was found for most comorbidities, but agreement was poor for back pain, arthritis, blood diseases, stomach diseases, kidney diseases and depression (Table 1). Significant correlations were found between the SCQ and CCI, clinician-reported SCQ, quality of life, prevalence of disability and productivity costs, but not with healthcare costs (Table 2). A change in the SCQ after 15 months was negatively correlated with a change in quality of life, but not with a change in healthcare or productivity costs.

Conclusion

The SCQ seems a useful tool to adjust for case-mix for health-related quality of life in IBD patients, but does not relate to IBD-attributable healthcare or productivity costs. The SCQ does not always agree with the electronic health record, which may be due to inadequate capture of comorbidities in the electronic health record or because patients may confuse comorbidities and complications of IBD.
P226 Dietary patterns differ in the newly diagnosed IBD cohort with ethnicity as a key confounding variable, a case control study
Authors: Dyall L , Kyle J , Misra R , Clark H , Limdi J , Cooney R , Brookes M , Fogden E , Pattni S , Sharma N , Iqbal T , Munkholm P , Burisch J , Arebi N
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) is driven by the interaction of the genome, environment, and diet. Our understanding of dietary risk factors is limited with a paucity of literature on specific dietary triggers for IBD. Furthermore, the role of food groups in driving inflammatory activity is conflicting compounded by independent consumption of macro- and micro-nutrients. We studied the dietary patterns of a newly diagnosed IBD cohort.

Methods

A case-controlled study with newly diagnosed IBD patients, defined as patients with symptoms, confirmatory tissue biopsy, not previously known to a gastroenterology/IBD service. Food intake within the 3 months preceding the diagnosis was measured using the Scottish Collaborative Group Food Frequency Questionnaire (FFQ). The FFQ is a validated objective tool to estimate the habitual diet. The IBD cases were matched for age and gender with controls. Principal components analysis (PCA) was used to identify dietary patterns. Factor loadings <-0.3 and >0.3 were used to select for food groups, which were infrequently and frequently consumed respectively. Binary logistic regression analysis (adjusted for age, gender, ethnicity, and total energy) was used to study differences.

Results

179 IBD cases (54 Crohn’s disease) and 144 controls were enrolled. Table 1a and 1b show the baseline population and IBD characteristics. 5 dietary patterns were identified. These were classified as: Healthy Balanced (HB), Ultra-processed (UP), Meat/Fish (MF), Pescatarian (P) and Unbalanced (UB). The food groups contributing to the patterns are listed in Table 2. Consumption of the HB and UP dietary patterns were less commonly observed in the IBD population compared to control (p<0.001, p=0.003, respectively). These observations were independent of age, gender, and total energy. No differences were observed for the MF and P diets. The UB diet was predominantly consumed by the IBD cohort (p<0.001).

When comparing the dietary pattern intake between IBD and non-IBD Caucasian groups, there was a lower consumption of the UP dietary pattern for IBD (p<0.001). This observation was not replicated in the non-Caucasian cohort.

Conclusion

Newly diagnosed IBD patients follow an UB dietary habit, which is not entirely driven by an UP diet. Caucasians with IBD were less likely to adopt a UP diet than non-IBD controls. Ongoing analysis into the macro- and micro- nutrient intake compared to the nationally recommended UK guidelines, with the pro-inflammatory burden of nutrients, may offer insights into the dietary triggers for the development of IBD with potential therapeutic benefit.
P231 Impact of age of Inflammatory Bowel Disease diagnosis on disease phenotype and severity in elderly patients
Authors: Orfanoudaki E , Chlorakis G , Foteinogiannopoulou K , Drygiannakis I , Theodoraki E , Tsafaridou M , Koutroubakis I
Published: January 2023

Background

Up to fifteen percent of inflammatory bowel disease (IBD) patients are diagnosed after the age of 60 years (elderly onset-EO). Additionally, due to the ageing of population and the increasing prevalence of IBD the number of elderly patients (>60) with an earlier diagnosis (adult onset-AO) is rapidly increasing. We aimed to compare disease characteristics and management between EO and AO elderly IBD patients.

Methods

Data of a prospective longitudinal registry of IBD patients followed in a tertiary center over a ten-year period (2012-2022) were analyzed. Consecutive IBD patients aged over 60 years at study entry were included. They were divided into two groups according to their age at diagnosis <60 (AO) and ≥ 60 (ΕΟ) years. The two groups were compared as for their demographic and clinical characteristics, their treatment and outcomes (disease related surgeries, development of malignancy, death).

Results

Out of 1104 patients recorded in the IBD registry, 325 were currently ≥ 60 years old (29%) and among them 267 had complete data and were included in the study (Table 1). ΕΟ had 100 (37%) and ΑΟ 167 (63%). Median age at diagnosis (IQR) was 47 years (37-53) for AO and 66 years (62-71) for EO (p<0.0001) whereas median disease duration was 23 (15-31) and 9 (5-14) years respectively (P<0.0001). Male gender (AO:61%, EO:68%) and ulcerative colitis (UC) (AO: 60%, EO: 53%) predominated in both groups. Family history of IBD and extraintestinal manifestations were lower in the EO than the AO group (p=0.02 and p=0.01 respectively). UC localization was most commonly proctitis and left sided in both groups. CD was most often ileal in EO patients when compared with AO (p=0.028) and inflammatory phenotype was more prevalent in both groups (ΑΟ:69% and ΕΟ:79% respectively). Immunomodulators were less frequently used in EO (17% vs 40.8%, p=0.0001) which was not the case for biologics (40.1% vs 32%, p=0.18) and prednisolone (21.5% vs 16%, p=0.27). During a median disease duration of 16 (8-25) years, comparable rates of IBD-related surgeries (12.5% ΑΟ vs 9% EO) and total malignancies (18.5% ΑΟ vs 14% ΕΟ) were observed but there were more deaths in the ΕΟ group (20% vs 8.3%; p=0.0063).

Conclusion

There are some distinct differences in demographic, clinical characteristics, treatment and mortality between EO and AO elderly IBD patients. The comparable rates of biologic use and IBD-related surgeries probably indicate that EO-IBD does not have a mild disease course. The clinical implication of these findings needs further validation.
P233 Malnutrition diagnosis based on the GLIM criteria and patients’ dietary beliefs and practices impact negatively the quality of life of IBD patients
Authors: Kijora-Jaroszewska O , Neubauer K
Published: January 2023

Background

Inflammatory bowel disease (IBD) is an umbrella term describing unpredictable conditions of the digestive tract, affecting the quality of life (QoL), and nutritional status of patients. It implies, that dietary factors may take part in complex IBD pathogenesis. Furthermore, nutrition is an integral part of the therapeutic strategy in IBD, whereas patients' dietary beliefs and practices, through multiple eliminations may lead to the development or worsening of malnutrition. We aimed to investigate the impact of nutritional status, as well as patients` beliefs and practices on QoL in IBD.

Methods

The studied group consisted of 109 IBD patients (52 ulcerative colitis; 57 Crohn`s disease) hospitalized in the Department of Gastroenterology and Hepatology, Wroclaw Medical University. QoL was measured by a self-administered Inflammatory Bowel Diseases Questionnaire (IBDQ). Malnutrition was diagnosed and graded with GLIM (Global Leadership Initiative on Malnutrition) criteria. Patients' dietary beliefs and practices were assessed by an adapted eleven items questionnaire [1].

Results

Based on the GLIM criteria 54.6% of subjects were malnourished (30.6% mildly to moderately, 24% severely). The mean IBDQ score was 143 points (SD = 41.23). The mean number of eliminated food groups during remission was 5.44 (SD = 2.99), and during flare 7.07 (SD = 3.23). IBDQ score correlated well with GLIM malnutrition assessment for the whole group, as well as in CD and UC patients (r = -0.32, p <0.001; r = -0.31, p = 0.021; r = -0.39, p = 0.005 respectively). Similarly to the total IBDQ score, every IBDQ domain correlated with GLIM: bowel system (r = -0.27, p = 0.005), emotion health (r = -0.25, p = 0.009), systemic system (r = -0.37, p < 0.001), social function (r = -0.32, p <0.001). The number of food groups avoided during remission and flare was correlated with IBDQ total score (r = -0.22, p =0.021 and r = -0.23, p = 0.017 respectively). Higher elimination rate during remission and flares of IBD was also connected with emotion health (r = -0.26, p = 0.006; r = -0.21, p = 0.032 respectively) and social function (r = -0.26, p = 0.006; r = -0.025, p = 0.010).

Conclusion

Malnutrition negatively affects the quality of life of IBD patients in general as well as in every measured QoL area. Dietary beliefs leading to a high number of eliminated food groups may also influence QoL, especially emotional health and social function.

[1] Casanova M.J. et. al. Prevalence of Malnutrition and Nutritional Characteristics of Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017, 11, 1430-1439.
P243 The association between serological markers ASCA and ANCA and response to induction treatment in therapy-naïve children with inflammatory bowel disease: an international prospective study
Authors: Klomberg R , Kaper D , Barendregt D , Vuijk S , Schreurs M , Charrout M , Ruemmele F , Kemos P , Croft N , Samsom J , de Ridder L ,   PIBD-SETQuality consortium
Published: January 2023

Background

Pediatric-onset inflammatory bowel disease (PIBD) is a chronic disease with a heterogeneous spectrum. A better understanding of predicting factors for therapy response could improve personalized care and reduce complications. Possible predicting factors of a complicated disease behavior in PIBD are the presence of anti-Saccharomyces cerevisiae (ASCA) and antineutrophil cytoplasmic antibodies (ANCA) in the serum, though existing evidence is inconclusive. We aimed to investigate the association of serological markers ASCA and ANCA with short-term therapy response at 3 and 6 months in PIBD patients.

Methods

As part of the multicenter prospective observational PIBD-SETQuality study, blood from therapy-naïve PIBD patients (n=162) with a minimum follow-up of 6 months was analyzed for 3 serological markers (ASCA IgA, ASCA IgG and/or ANCA) at diagnosis. Outcome measures included clinical remission and biochemical remission (remission with CRP <0.5 mg/dl or fecal calprotectin < 300 mcg/g), small or moderate improvement after induction treatment, and therapy use at 3 and 6 months. To evaluate effect of ASCA titers, serology sum scores (SSS) were obtained by combining results of ANCA status and scores of ASCA titer quartiles, and compared between outcomes.

Results

ASCA IgA and IgG were more prevalent in Crohn’s disease (CD) patients [47% vs. 2% for IgA; 75% vs. 5% for IgG, p<0.001] and ANCA in ulcerative colitis/inflammatory bowel disease unclassified (UC/IBD-U) [43% vs. 11%, p<0.001] patients. ASCA IgA and IgG were not associated with markers of disease activity (albumin, CRP, wPCDAI) at diagnosis in children with CD, but ASCA IgG positivity was more prevalent in patients with an ileocolonic distribution (L3 57%, L2 6%, L1 37%, p=0.024). ANCA positivity was not associated with any disease characteristic at diagnosis. No association was found between clinical or biochemical remission status at 3 and 6 months and ASCA and ANCA positivity. Additionally, no association was found between ASCA and ANCA positivity and small or moderate response to induction therapy at 3 and 6 months. ASCA IgG positive patients had higher rates of anti-TNF use at 6 months compared to ASCA IgG negative patients [84% vs. 50%, p=0.041]. Patients with higher SSS did not tend to have poorer outcomes at 3 and 6 months compared to patients with lower SSS.

Conclusion

While serological markers ASCA and ANCA may provide a way to better differentiate between CD and UC/IBD-U in PIBD, this study did not find any association between ASCA and ANCA and short-term therapy response. ASCA IgG patients were more likely to have used anti-TNF at 6 months, possibly reflecting more severe disease.
P266 Potential oral microbial markers for differential diagnosis of Crohn’s disease and ulcerative colitis using machine learning model
Authors: Park S K , Kim H , Kim S , Lee C W , Jung Y , Choi C H , Kang S B , Kim T O , Bang K B , Chun J , Cha J M , Im J P , Ahn K S , Park D I
Published: January 2023

Background

Although the gut microbiome dysbiosis have independently been shown to be associated with inflammatory bowel disease (IBD), less is known about the relationship between oral microbiota and IBD. This study aimed to elucidate unique microbiome patterns in saliva from patients with IBD and investigate potential oral microbial markers for differentiating Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

A multicenter, prospective cohort study recruited patients with IBD (UC, n=175, CD, n=127) and unrelated healthy controls (HC, n=100) to examine microbiota within the oral microenvironments. We used 16S rRNA gene sequencing data as features in training machine learning models (sPLS-DA, Sparse Partial Least-Squares Discriminant Analysis) to classify CD and UC.

Results

The V3-V4 amplicon reads of the saliva 16S rRNA sequencing data were taxonomically classified to a total of 2839 taxa (2270 genera) using Kraken2 based on Silva 138.1 reference. The sequences that were not classifiable down to family level were removed, and the samples having sequence depth less than 30000 were also removed, resulting in 2616 taxa for 390 samples (UC, n=168, CD, n=124, HC, n=98).

The alpha diversity analysis revealed that the microbiome in IBD patients were significantly less rich than the healthy controls, while CD samples were slightly richer then UC samples (Figure 1, Observed, P = 0.01, Shannon index, p=0.02, Chao index, P=0.0001). An sPLS-DA model with 470 taxa as features was able to distinguish IBD vs control with high performance (AUROC=0.9774), while a separate sPLS-DA model with 130 features classified CD vs UC with an AUROC of 0.8755 (Figure 2,3).

Conclusion

Collectively, oral microbial profiles can serve as a diagnostic marker to discriminate patients with IBD from HC, and patients with CD from UC. As obtaining oral samples is relatively easier than obtaining stool or intestinal biopsies, an opportunity exists to perform oral microbiome-based studies in larger cohort sizes, preferentially in a longitudinal fashion.
P273 Severity of colitis and clinical outcomes for patients admitted with acute UC in 2 large UK centres
Authors: Al Sulais E , Mukhtar M S H , Parkes G , Hart A , Raine T
Published: January 2023

Background

Acute severe ulcerative colitis (ASUC) is a challenging complication of ulcerative colitis (UC) that can result in colectomy and even death. Management and recognition of the condition is based on criteria that have changed little since the 1950s (Truelove and Witts criteria). Patients may be admitted to hospital with acute colitis that does not meet criteria to be classed as severe. We hypothesised that such patients might be at risk of “over-management” if treated according to standard ASUC pathways.

Methods

We performed a retrospective review of inpatients managed for acute UC flares in two UK tertiary centres. We collected their baseline and outcome data. We assessed the proportion of patients meeting criteria for severe disease and compared outcomes between severe and non-severe groups.

Results

A total of 243 admissions for 200 unique patients were identified for analysis. A formal documentation of disease severity according to Truelove and Witts criteria was present in only 10/243 (4%). 121/243 (50%) met formal criteria for severe disease. Baseline demographic and disease characteristics were similar between patients with severe and non-severe disease (table-1). The use of rescue therapy was more common in the severe group (48% vs 34%, p=0.032). All other outcomes, including hospital length of stay, colectomy rates, and need for readmission were comparable (table-2).

Conclusion

Patients admitted for acute colitis may frequently not meet criteria for severe disease. It is possible that earlier discharge or admission avoidance may be possible for this group. Baseline demographics do not appear to identify patients with less severe symptoms who nonetheless get admitted. Although rescue therapy was less common for non-severe patients, other outcomes were comparable, including length of stay and colectomy rates. There is a risk that once admitted, non-severe patients may receive management according to standard algorithms for severe disease, risking overtreatment for a subgroup of patients.
P277 Predicting disease relevant features in Crohn’s Disease and Ulcerative Colitis from Haematoxylin & Eosin stained whole slide images using self-supervised deep learning
Authors: Mokhtari R , Hamidinekoo A , Lewis A , Sutton D , Angermann B , Gehrmann U , Lundin P , Khachapuridze N , Adissu H , Marks D , Cairns J , Burlutskiy N
Published: January 2023

Background

Histopathological endpoints are evolving as a treatment target in Inflammatory Bowel Disease (IBD). Use of histology to screen entrants could add value in IBD clinical trials; for example, by refining eligibility criteria to ensure studies recruit patients with definitive active inflammation at the microscopic level. Several histopathological indices have been developed, but the relative complexity of available scores hinders the development of an AI algorithm without large-scale labour-intensive annotation by a pathologist. We aimed to develop computer vision tools to assist decoding the complex clinical disease features at the histological level for both Crohn’s Disease (CD) and Ulcerative Colitis (UC). This will inform understanding of disease pathology and patient stratification to support clinical trial development strategies.

Methods

A total of 1397 clinically annotated Haematoxylin & Eosin (H&E) images were included from 418 CD and 218 UC patients enrolled in a multicentred longitudinal Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. We developed an image quality control (QC) algorithm to automatically identify image and tissue processing/staining artefacts negatively impacting analysis (e.g., out-of-focus, tissue folds, overstained regions) and excluded these regions (Fig. 1). Next, a self-supervised learning (SSL) deep learning computer vison model was developed and trained to predict disease relevant features including disease diagnosis and lesional macroscopic appearance (inflammation, erosions and ulcers). Finally, to better understand the model’s predictions, we generated heatmap overlays on the tissue that show regions which the model considers to be most predictive (Fig. 2) and shared these with pathologists for qualitative evaluation.

Results

We find that the SSL model performs well on different downstream classification tasks such as UC vs CD (area under curve (AUC) = 0.79) and normal vs lesional tissue (AUC = 0.76). Specialist pathologist collaboration further confirmed that the heatmap overlays identified clinically relevant tissue features, including inflammatory cell infiltrates (Fig. 2).

Conclusion

These encouraging results support further exploration of this deep-learning algorithm to distinguish disease specific characteristics in this set of images from CD and UC patients. Further work is ongoing to validate the heatmap approach on endoscopic scores, we also plan to validate our model on IBD clinical trial datasets.
P295 Hocus Pocus: The Role Of Hand-Held Ultrasonography In Predicting Disease Extension And Endoscopic Activity In Ulcerative Colitis
Authors: Rispo A , Calabrese G , Testa A , Patturelli M , Imperatore N , Nardone O M , Guarino A D , Cantisani N M , Toro B , Castiglione F
Published: January 2023

Background

Ulcerative colitis (UC) diagnosis and monitoring still require ileo-colonoscopy (IC) as the reference standard. Bowel sonography (BS) has recently emerged as a non-invasive assessment tool, and Milan Ultrasound Criteria (MUC) score has been validated to estimate and predict UC disease activity. Recently, hand-held BS (HHBS) has been used effectively in several clinical settings (e.g. cardiology, orthopedy, gynaecology), while data about its use in UC are still limited. We aimed to evaluate the diagnostic accuracy of HHBS compared to conventional bowel sonography (BS) in predicting UC extension and activity compared to endoscopy.

Methods

From November 2021 to September 2022, we prospectively enrolled consecutive UC patients afferent to our third-level IBD Unit for IC evaluation. Patients underwent IC, HHBS, and BS, and the operators were blinded by the other procedure results. Endoscopy was considered the reference standard for UC extension. Cohen’s k test was applied after MUC dichotomization to test the concordance between BS-MUC and HHBS-MUC following Allocca et al. (MUC >6.2: yes/no).

Results

At the end of the study, 86 patients with UC were examined. No significant difference was recorded between BS and HHBS in terms of UC at the per-segment extension (p: N.S.) (table 1), and both procedures were comparable regarding colonic wall thickness (CWT) and colonic wall pattern (CWP) assessment (figure 1 and 2). Regarding the prediction of endoscopic activity, BS and HHBS displayed excellent agreement when applying the MUC score system (k = 0.86, p<0.01) (figure 3).

Conclusion

Hand-held bowel sonography and BS are comparable in defining UC extension and MUC evaluation in the UC setting. HHBS could be reliable for detecting disease activity and estimating its extension, providing close monitoring of the treat-to-target paradigm. It also represents a non-invasive, easily practicable investigation during a physical examination, allowing immediate medical decisions with significant time and cost advantages.
P297 The Toronto IBD Global Endoscopic Reporting (TIGER) Score and its Ability to Predict Outcomes Regarding Steroid and Biologic Use in Ulcerative Colitis and Crohn’s Disease Patients – A Construct Validation Study
Authors: Zittan E , Levy M , Saban L , Vered S , Steinhart A H , Milgrom R , Gralnek I M , Silverberg M S , Zelber-Sagi S
Published: January 2023

Background

The recently developed TIGER endoscopy score was established to reliably describe disease severity as it can be utilized for both Ulcerative Colitis (UC) and Crohn’s disease (CD) patients.1The aim of this prospective study was to assess the TIGER score’s ability to predict UC and CD patient outcomes including biologic and steroid use.

Methods

A cohort of 78 patients with UC (n=40) and CD (n=38) were included in a 52-week multiple visit prospective study. Each visit included patient interviews using the IBD disk questionnaire, blood draws for C-reactive protein (CRP), and fecal calprotectin (FC). Endoscopy assessment was performed at baseline. Administration of steroids, immunomodulators (IMN), biologics, and dose escalations were recorded. Baseline total TIGER scores were dichotomized as <100 points (remission-mild endoscopic activity) or ≥100 points (moderate-severe endoscopic activity) as a predictor of therapeutic outcomes.

Results

At baseline, compared to patients with TIGER scores <100, UC patients with TIGER scores ≥100 had significantly higher CRP (p<0.0005), FC (p<0.0001), and IBD disk (p<0.0001). In CD patients, at baseline, compared to patients with TIGER scores <100, patients with TIGER scores ≥100 had significantly higher CRP (p<0.0006), FC ( p<0.006), and IBD disk ( p<0.0001). At 52-weeks, compared to patients with baseline TIGER scores <100, UC and CD patients with baseline TIGER scores ≥100 had a significantly increased likelihood of requiring steroids as therapy (p<0.0001). Specifically, 7.1% and 0% of UC and CD patients with baseline TIGER scores <100 required steroids compared to 73.1% and 48.3% of UC and CD patients with baseline TIGER scores ≥100, respectively. Moreover, at 52-weeks, compared to patients with baseline TIGER scores <100, UC and CD patients with baseline TIGER scores >100 both had a significantly increased likelihood of being prescribed or having to subsequently escalate biologic therapy (p<0.0001). More specifically, 7.1% and 11.1% of UC and CD patients with baseline TIGER scores <100 required biologic therapy compared to 92.3% and 100% of UC and CD patients with baseline TIGER scores ≥100, respectively.

Conclusion

The TIGER endoscopy score demonstrates significant association with CRP, FC and IBD disk in UC and CD patients. Moreover, the TIGER endoscopy score can be utilized as a measure to predict the likelihood of UC and CD patients with moderate-to-severe disease burden requiring certain therapeutic interventions. These data suggest that the TIGER score reflects disease burden and the subsequent need for pharmacologic intervention in both UC and CD patients.

1. Zittan E, et al. J Crohns Colitis 2022;16:544-553.