bluuebunny/crossref_metadata_2025 huggingface dataset:
P158 Intestinal Ultrasound at IBD diagnosis predicts surgery – a Copenhagen IBD cohort study
Authors: Madsen G R , Attauabi M , Wilkens R , Ilvemark J F K F , Theede K , Bjerrum J T , Bendtsen F , Seidelin J B , Boysen T , Burisch J
Published: January 2023

Background

The disease course of inflammatory bowel disease (IBD) is heterogeneous and unpredictable. Currently, we are unable to predict which patients will need IBD-related bowel resection in the first year after diagnosis. Intestinal Ultrasound (IUS) has been proven as a non-invasive modality for assessing disease activity in IBD. However, the evidence for IUS as a predictor of disease course is still limited. Here we present novel data on the predictive value of IUS performed at the time of IBD diagnosis.

Methods

Patients with new-onset IBD are currently being included in the ongoing multicentre prospective inception cohort study, the IBD Prognosis Study (May 2021 – April 2023). IUS is performed at the time of diagnosis and the patients are followed prospectively. Patients with proctitis are not assessed with IUS. The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) is calculated for the most inflamed segment with a high score indicating severe disease activity. IBUS-SAS (0-100) incorporates the bowel wall thickness (BWT), bowel wall stratification, colour Doppler signal, and inflammatory fat. Surgery was defined as an IBD-related bowel resection. Patients treated with corticosteroids for > 72 hours or with any IBD-treatment > two weeks prior to IUS were excluded from analysis. In this abstract, we report our preliminary results after including patients for 16 months.

Results

IBUS-SAS at diagnosis was available in 133 patients (out of 242 included). 68 patients were diagnosed with Crohn’s disease (CD) (ilieal: 22, colonic: 23, ileocolonic: 23) and 65 patients were diagnosed with ulcerative colitis (UC) or unclassified IBD (left-sided colitis: 20, extensive colitis: 45). Median follow-up was 226 days. During follow-up 10 patients underwent surgery (7.5%). These included 4 patients with UC (extensive colitis: 3, left-sided colitis: 1) and 6 patients with CD (ileal: 2, colonic: 2, ileocolonic: 2). Mean IBUS-SAS at diagnosis was 92.6 among patients who underwent surgery during follow-up vs. 48.8 for patients who did not undergo surgery (p<0.0001). Distribution of scores is shown in Figure 1. Mean BWT at diagnosis was 8.3 mm among patients who underwent surgery during follow-up vs. 5.0 mm for patients who did not undergo surgery (p<0.0001). In total, 12 patients had an IBUS-SAS > 90 at diagnosis and among these 7 (58.3%) were operated during follow-up. Figure 2 shows a Kaplan-Meier Curve of surgical free survival stratified by IBUS-SAS at diagnosis.

Conclusion

IUS activity at diagnosis of IBD seems to have the capability to predict short term risk of IBD-related surgery. Our results suggest IUS might be used at diagnosis to identify patients at high risk of IBD-related surgery.
P161 Simplified Endoscopic Mucosal Assessment for Crohn’s Disease (SEMA-CD): External Application and Prognostic Value Definition
Authors: Macedo Silva V , Ferreira A I , Lima Capela T , Arieira C , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Moreira M J , Cotter J
Published: January 2023

Background

In 2022, the Simplified Endoscopic Mucosal Assessment for Crohn’s Disease (SEMA-CD) was created and internally validated, aiming to simplify endoscopic activity assessment in ileocolonoscopies for CD. This score was shown to be easier and faster to apply than previously used Simple Endoscopic Score for CD (SES-CD). In our investigation, we aimed to apply this score on a European population and to assess if its prognostic value was the same as SES-CD.

Methods

Longitudinal study of consecutive CD patients undergoing ileocolonoscopy for assessment of endoscopic activity. Patients with previous ileocecal resection were excluded. CD endoscopic activity was classified according to both SES-CD and SEMA-CD.

A minimum follow-up period of 12 months was required. Treatment escalation, hospitalization and bowel resection were assessed during the follow-up period.

Results

The initial sample included 265 patients, with 61 being excluded for having previous ileocecal surgery. Final sample included 204 patients, 113 (54.9%) female, with a mean age of 43±14 years.

SEMA-CD had a nearly-perfect correlation with SES-CD (r=0.998; p<0.001). SEMA-CD performed similarly to SES-CD in predicting treatment escalation (AUC=0.905 vs AUC=0.908), bowel resection (AUC=0.517 vs AUC=0.516), and hospitalization (AUC=0.605 vs AUC=0.610) (p>0.05). Optimal SEMA-CD cut-off predicting treatment escalation during the subsequent year was a SEMA-CD ≥2 (sensitivity 88%; specificity 86%).

Conclusion

In our sample, SEMA-CD perfectly correlated with SES-CD, having similar performances in predicting treatment escalation, surgery and hospitalization in CD patients. We first defined a SEMA-CD ≥2 as a possible guide to treatment escalation. Our study confirms SEMA-CD as a potentially helpful tool in CD patients’ follow-up.
P164 Dysplasia detection rates in a surveillance program real-world data from a tertiary referral center for inflammatory bowel diseases
Authors: Snir Y , Ollech J E , Peleg N , Avni-Biron I , Eran-Banai H , Broitman Y , Sharar-Fischler T , Goren I , Zohar L , Dotan I , Yanai H
Published: January 2023

Background

Patients with inflammatory bowel diseases (IBD) with an increased risk of developing colorectal carcinoma should undergo periodic surveillance colonoscopies. There is no quality metric for dysplasia detection rate (DDR) in IBD surveillance. We evaluated DDR in a dedicated surveillance program at a tertiary IBD referral center.

Methods

This cross-sectional study assessed DDR among consecutive patients with quiescent colitis enrolled in our surveillance program. Patients underwent high-definition colonoscopy with dye chromoendoscopy (DCE). A single specialized operator performed the procedures. Advanced dysplasia (AD) was defined as low-grade dysplasia ≥ 10mm, high-grade dysplasia, or colorectal cancer. We evaluated risk factors for dysplasia detection.

Results

Overall, 119 patients [female: 39.5%; median age: 54 years (IQR 43-66); median disease duration: 20 years (IQR 14-29)] underwent 151 procedures that revealed 206 lesions, of which 40 were dysplastic, and seven were considered AD. Per-procedure and per-lesion DDR were: 20.5%, and 19.4%, respectively. Per-procedure AD detection rate (ADDR) was 4.6%. Per-procedure dysplasia detection was associated with increased age at diagnosis at the index colonoscopy and past dysplasia or indefinite dysplasia, however, on multivariable analysis, only past dysplasia or indefinite dysplasia maintained a significant association (AdjOR 4.84, 95% CI 1.52-15.45, p=0.008). A Kudo pit pattern of II-V had a sensitivity of 92.5% for per-lesion dysplasia detection but a false positive rate of 64.8% (p<0.001).

Conclusion

DDR in a dedicated surveillance program in a real-world setting reached 20%. DDR should be considered a quality measure while surveying high-risk patients with IBD.
P165 Vitamin D deficiency is associated with poor sleep quality in patients with Crohn’s disease
Authors: Walker C , Stacey W , Ramkalawan K M , Kafienah Y , Connaughton R , Breslin N , McNamara D , O'Donnell S , Ryan B , O'Connor A
Published: January 2023

Background

Sleep disturbances affect 40-50% of patients with Crohn’s Disease and are associated with disease flares. Symptoms, treatment side effects and pro-inflammatory status have been shown to have an effect on sleep quality and duration. Vitamin D deficiency affects between 18% and 70% of inflammatory bowel disease (IBD) patients and is independently associated with lower Health Related Quality of Life and greater disease activity. Our primary aim was to assess for a correlation between sleep quality and Vitamin D deficiency in people with IBD. Our secondary aim was to assess the impact of these factors on quality of life.

Methods

54 patients with Crohn’s Disease were invited to attend for Vitamin D testing and complete a survey. Vitamin D deficiency was defined as a serum Vitamin D less than 30 nmol/L. The survey included general demographic information, inflammatory bowel disease information, Pittsburgh Sleep Quality Index (PSQI), disease activity score (Harvey Bradshaw Index), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). One-way ANOVA tests and unpaired t-tests were used to calculate the statistical significance.

Results

· Median age 42.5 years. 50% female (n=27) and 50% male (n=27).

· Mean duration of IBD was 17 years

· 46% of patients were in clinical remission per HBI, 13% had mild activity, 37% moderate activity and 4% severe disease.

· The mean global PSQI score was 7.7, with 61% (n=33) of participants having a global PSQI score >5, indicating poor sleep quality.

· 24% of patients (n=15) had Vitamin D deficiency

· Mean PSQI of patients with Vitamin D deficiency was 10.5 compared to 6.7 in those without (P= 0.008).

Conclusion

Vitamin D deficiency is associated with poorer sleep quality in IBD, which in turn impacts quality of life in patients with IBD. IBD patients presenting with fatigue and sleep difficulties should be assessed for Vitamin D levels and treated where deficient.
P167 Ileocecal valve that cannot be intubated during colonoscopy in patients with Crohn’s disease: Is this a sign of poor prognosis?
Authors: Durak M B , Simsek C , Inan B , Yuksel I
Published: January 2023

Background

In Crohn's disease (CD) the inability to intubate ileocecal valve during colonoscopy may be correlated with disease prognosis. We aimed to compare the long-term outcomes of CD patients with or without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter.

Methods

Data were retrospectively collected in CD with isolated ileal involvement between January 1993 and July 2022. Patients who underwent ileal resection were excluded. Basal characteristics as well as long-term clinical outcomes including steroid dependence, CD-related hospitalization, biological treatment and abdominal surgery were compared between the two groups of patients with intubated and non-intubated ileocecal valve during colonoscopy.

Results

A total of 155 CD patients were included. Median age at disease onset was 35 years and 63.9% was male. Out of 155, 97 (62.5%) were in intubated and 58 (37.5%) were in non-intubated group. The median follow-up of cohort was 3.81 years (1.44-7.63). Non-intubated group was older at diagnosis (39.0 vs 30.5 age; p=0.002) while other baseline characteristics such as sex, smoking status, family history of IBD, disease duration, perianal disease, upper gastrointestinal and extraintestinal involvements were similar. At baseline, serum hemoglobin (12.3 vs. 13.3 mg/dL; p=0.029), albumin (4.1 vs. 4.3 g/dL; p=0.001), CRP (14 vs. 7.8 mg/L; p=0.005) and CDAI score (301 vs. 208; p<0.001) were all statistically significantly higher in the non-intubated group than in the intubated group.

Non-intubated group had more frequent stenosing (41.4% vs. 10.1%) and penetrating (29.3% vs. 5.2%; p<0.001) disease course. On the other hand, intubated group had more inflammatory disease behavior (84.5% vs. 29.3%; p<0.001). Budesonide (37 vs. 13; p=0.043) and methotrexate use (32 vs. 9; p=0.017) was more common the intubated group, while 5-ASA, steroid, and thiopurine use was similar. Non-intubated group had higher rates of steroid dependence (67.2% vs. 46.4%; p=0.012), biologic treatment (89.7% vs. 58.8%; p<0.001), CD-related hospitalization (81% vs. 24.7%; p<0.001), and major abdominal surgery (58.6% vs. 15.5%; p<0.001).

In logistic regression analysis, positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), whereas negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior.

Conclusion

In CD patients with isolated ileal involvement, the inability to intubate the ileocecal valve during colonoscopy may indicate a poor prognosis.
P170 Can histological activity of ulcerative colitis be predicted by assessment of the rectosigmoid colon?
Authors: Temido M J , Gama J , Caetano Oliveira R , Silva A , Lopes S , Mendes S , Ferreira M , Ferreira M , Narra Figueiredo P , Portela F
Published: January 2023

Background

Rectosigmoidoscopy is frequently used to assess disease activity in patients with ulcerative colitis (UC). Most recent guidelines suggest that the inflammatory activity of the whole colon can be inferred by endoscopic findings in the rectosigmoid colon. Nevertheless, whether the right colon can have endoscopic or histological activity when there is endoscopic and histological remission in the left colon, is yet to be completely determined.

Aim

To assess whether UC histological activity (HA) and improvement (HI) can be deduced by the findings in the rectosigmoid colon.

Methods

Retrospective single center cohort study. Consecutive patients with previously diagnosed UC undergoing endoscopic assessment, from January 2014 to September 2022, were included. Inclusion criteria were: a complete colonoscopy with adequate bowel preparation and biopsies made in all the four segments of the colon and in the rectum. Demographic, clinical, endoscopic (Mayo endoscopic subscore (MES)) and histological (Geboes score (GS)) data at the time of the colonoscopy was collected. Agreement and correlation between findings in the rectosigmoid and the whole colorectum were calculated with the kappa coefficient (k) and the Spearman correlation coefficient (r).

Results

Inclusion of 264 patients (49.2% male). Median age was 5015.7years. Smoking history in 33.5% of patients. Extension of UC was: proctitis in 13 (4.9%), left colitis in 109 (41.3%) and extensive colitis in 142 (53.8%) patients. MES was 0 in 139 (53.7%) patients, 1 in 52 (20.1%), 2 in 36 (13.9%) and 3 in 32 (12.3%). GS was 0 in 19 (7.3%), 1 in 124 (47.5%), 2 in 50 (19.1%), 3 in 40 (15.3%), 4 in 10 (3.8%) and 5 in 18 (6.9%). Regarding endoscopic activity, a very high correlation was found between MES of the whole colorectum and MES of the left colon (k=0.88, r=0.92). As far as HA (GS1.1) is concerned, HA in the whole colorectum was highly correlated with HA in the rectosigmoid colon (k=0.8, r=0.82), both in the whole cohort and in the subgroup of patients with extensive colitis (k=0.8, r=0.82). When assessing HI (GS<3.1) moderate coefficients (k=0.66, r=0.69) were found in the whole cohort. Patients with extensive colitis revealed similar agreement and correlation coefficients (k=0.69, r=0.71).

Conclusion

Endoscopic and histological activity in the rectosigmoid colon of patients with UC has a high correlation with activity in the whole colorectum. Therefore, UC activity can be inferred by analysis of the distal segments of disease. These findings reinforce that inflammatory activity in patients with UC can be assessed with rectosigmoidoscopy alone.
P171 Subfertility in young patients with Crohn′s disease. A case-control study.
Authors: Gutiérrez Casbas A , Bernal L , Zapater P , Herreros B , Rodríguez A , Muñoz R , Madero L , Orts B , Belen O , Sempere L , Torregrosa M E , Moreno-Pérez O , Francés R
Published: January 2023

Background

Inflammatory bowel disease (IBD) commonly affects women and men during the reproductive years.The effect of the disease burden on fertility in these patients is a common concern for them. ECCO guidelines establish that active disease is associated with decreased fertility in women but studies regarding this topic are of low quality and outdated.

Aims

to investigate the effect of CD on fertility, studying ovarian reserve in women as well as global Sertoli cell function in men, - To compare these results of CD patients with the healthy control group. (HC) - To assess the related factors to subfertility in women and males with CD.

Methods

This was a cross-sectional, prospective and case-control study, including CD patients, aged 18-40 years-old, and HC matched by gender and age (ratio 2:1). Morning baseline IB was measured in men using ELISA. Serum anti-Müllerian hormone (AMH) was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected.Subfertility was defined as IB < 89pg/mL, AMH <1.66 ug/L in 0-24 years old group; <1.18 ug/L in 25-29 years old group; <0.67 ug/L in 30-34 years old group; <0.77 ug/L in 35-39 years old group; and <0.01 ug/L in 40-44 years old group. AMH <2 ug/L in women under 40 was considered low.

Results

A total of 163 individuals were included: 83 men (58 CD, median 28 years old, RIQ 24-36; 25 HC, median 31 years old, RIQ 26-37) and 80 women (50 CD, median 26 years old, RIQ 21-36; 30 HC, median 28, RIQ 26-32). Sedentary lifestyle was more frequent in women with CD vs HC (46% vs 3,3%, p<0,001). 24% of women with CD and 8% of males had clinical activity (IHB >4). Low AMH (<2ug/L) in women older than 30 was more frequent in CD vs HC: 95% (18/19) vs 44% (4/9) p=0.001, with an OR of presenting AMH < 2 ug/L of 3.28 (IC 95%, 1.6-6.4) for women with CD >30 years old. The average AMH serum level was similar between women with CD and HC [1.83 (1.04-3.34) vs. 2.74 (1.05-4.12) g/L, p=0.4]. Abnormal AMH rate by age rank was not different between groups in global population (11/50, 22% EC vs. 7/30, 23% in CS, p=0.9,). IB levels were significantly lower in men with CD vs HC [169 (140-217) vs 232 ug/L (178-274) p=0.001]. IB <89 pg/mL was not detected in any control vs 6% (n=3) in CD. In multivariate analysis, only AMH was associated with lower levels of IB in CD men, no association with clinical activity or treatments in CD was found.

Conclusion

Women with CD and >30 years old have a higher risk than general population of presenting low AMH (<2).These data could be helpful at council of women with CD that desire to have progeny. IB concentration was lower in men with CD compared to HC.
P173 Patency capsule: A novel independent predictor for long-term outcomes among patients with quiescent Crohn’s disease
Authors: Ukashi O , Kopylov U , Ungar B , Haj-Natour O , Selinger L , Neuman S , Yanai H , Dotan I , Yablecovitch D , Lahat A , Eliakim R , Ben-Horin S
Published: January 2023

Background

Patency capsule (PC) is a recommended procedure to rule-out small-bowel stenosis before video capsule endoscopy (VCE).We examined future clinical outcomes among patients with failed-PC versus patients in whom PC had passed (passed-PC).

Methods

A Post-hoc analysis of two prospective cohort studies of adult patients with quiescent small-bowel CD that underwent PC between 2013-2020. The primary composite-outcome was the need for intestinal-surgery or endoscopic-dilation during follow-up in patients with or without failed-PC.

Results

A total of 191 patients were included (47-failed PC, 144-passed PC, median follow-up 34.12 months). Patients with a failed-PC had higher rates of the primary composite-outcome (21.3% vs. 1.4%, Hazard ratio [HR] 20.4, 95% confidence interval [CI] 4.4-94.1, p<0.001) and also secondary outcomes including intestinal-surgery (14.9% vs. 0.70%, p<0.001), endoscopic-dilation (14.9% vs. 0.70%, p<0.001), admissions (23.3% vs. 5.7%, p<0.001) and clinical-flares (43.9% vs. 27.5%, p=0.005) during follow-up compared with controls. Failed-PC was the only statistically significant factor for surgery and/or endoscopic-dilation, regardless of a B2/B3 phenotype at baseline. In sensitivity-analyses restricted only to patients with stricturing phenotype (n=74), failed-PC still predicted worse long-term composite-outcome (HR 23.1 95% CI 2.3-228.0, p=0.007). Of the 191 patients ingesting a PC, only one patient with a failed-PC had 48 hours of self-limiting mild symptoms

Conclusion

Clinically-stable CD patients with failed-PC have worse long-term clinical outcomes than those without, independently of CD phenotype. Standalone PC may serve as a novel, safe and affordable prognostic examination to stratify patients with CD for future risk of poor outcomes and potentially guide pre-emptive management decisions.
P177 C-reactive protein/albumin ratio: a novel biomarker for monitoring of the disease activity in Ulcerative Colitis patients
Authors: Tomasic V , Biscanin A , Ćaćić P , Palac L , Dorosulic Z , Kralj D , Babic F , Ogresta D , Hrabar D
Published: January 2023

Background

Fecal calprotectin (FC) is a reliable laboratory test for non-invasive assessment of disease activity in ulcerative colitis (UC) patients; it's high cost, absence of widespread availability and low patient adherence limits it's use as a potential surrogate for endoscopy. The association of higher C-reactive protein (CRP) and low albumin levels, both obtained from patient's sera, with disease acitivity in UC, is well established. C-reactive protein/albumin ratio (CAR) is suggested as a biomarker for evaluating disease activity in various inflammatory conditions. We aimed to evaluate association between CAR, FC, CRP and serum albumin values with disease activity in UC patients.

Methods

A single center, noninterventional retrospective chart review of adult UC patients treated with biologics at a tertiary center was performed. Routine clinical (stool frequency score – SFS, and rectal bleeding score – RBS), biochemical (CRP, serum albumin, FC), and endoscopic (Mayo Endoscopic Subscore – MES) findings were assessed prior to initiating biologics. Active UC was defined as SFS 2/3 + RBS 2/3 + MES 2/3. Differences between continuous variables were calculated using independent sample t-tests and Mann–Whitney U test. Sperman’s correlation and ROC curve analysis were carried out. The Z statistic was used to compare correlation coefficients and AUC.

Results

Total of 82 patients (52.2% females, mean age 40.3 ± 15.3 years, smokers 16.9%) with dominantly extensive UC (57.3%) were analysed. The CAR (0.175 vs 0.025; p=0.02) and FC (1363.5 vs 65.5; p=0.01) levels were significantly higher in active vs inactive UC patients. Positive correlation was observed between CAR (rs = 0.354, p = 0.01), FC (rs = 0.448, p = 0.001) and CRP (rs = 0.316, p = 0.005) with active UC. Although serum albumin (r's = - 0.093, p = 0.532) negatively correlated with disease activity it didn't reach statistical significance. There was no statistically significant difference between CAR and FC correlation coefficients. The area under the curve (AUC) for the diagnosis of active UC was 0.896 (SE: 0.058; 95% CI 0.73 - 0,983, p=0.015) and 0.994 (SE: 0.009; 95% CI 0.98 - 1, p=0.001) for CAR and FC, respectively. Although AUC for FC was higher compared to CAR it didn’t reach statistical significance (p = 0.1).

The cut-off value associated with the active UC for CAR was 0.06 (sensitivity 77,2%, specificity 100%), and 120 mcg/g for FC (sensitivity 97.6%, specificity 100%).

Conclusion

There is good correlation between CAR and clinical as well as endoscopic disease activity in patients with UC, comparable to FC. CAR could be offered as a cheap and practical biomarker for detection of active UC disease.
P178 Evaluation of the Ulcerative Colitis Intestinal Ultrasound (UC-IUS) Index in Pediatric patients with newly diagnosed ulcerative colitis
Authors: Hudson A , Ma H , Lo C , Kim J , Kuc A , Novak K , Carroll M , Wine E , Isaac D , Huynh Dr H
Published: January 2023

Background

Transabdominal bowel ultrasound (TABUS) is a non-invasive tool that can be used to assess bowel inflammation in ulcerative colitis (UC). It is particularly attractive for use in children, given the need for general anesthesia when undergoing endoscopic assessment of bowel inflammation. A standardized TABUS scoring system in UC has only been developed in adults (the UC Intestinal Ultrasound (UC-IUS) Index). Our aim was to evaluate the UC-IUS Index in Pediatric patients.

Methods

Pediatric patients (<18 years old) with suspected UC were prospectively enrolled. TABUS was performed for the right side colon, transverse, descending, and sigmoid colons. UC-IUS Index scores were calculated: bowel wall thickness (BWT) (>2mm=1, >3mm=2, >4mm=3), Doppler signal (spots=1, stretches=2), haustrations (abnormal=1), and fat wrapping (present=1). Mayo endoscopic subscore (for each segment), Pediatric Ulcerative Colitis Activity Index (PUCAI), and inflammatory biomarkers were collected. Non-parametric tests were used to correlate UC-IUS and BWT with Mayo endoscopic subscores. Receiver operating characteristic (ROC) analyses evaluated the UC-IUS Index BWT cut-offs.

Results

Fifty-two patients (56% male) were included (Table 1). Data for 206 colonic segments were analyzed (2 segments missing due to 1 incomplete colonoscopy). Total UC-IUS scores significantly correlated with CRP (rho=0.61), albumin (rho=-0.49), PUCAI (rho=0.54), FCP (rho=0.41). UC-IUS Index scores and mean BWT for each segment showed significant moderate correlations with Mayo sub-scores of that segment (rho=0.60 and rho=0.58, respectively) (p<0.001) (Fig 1). These correlations were strong in the right colon (rho=0.77, rho=0.69), and moderate in the transverse (rho=0.52, rho=0.56), descending (rho=0.43, rho=0.50), and sigmoid (rho=0.50, rho=0.46) colons (p<0.01). The adult UC-IUS 2mm cut-off (Mayo 0 vs. Mayo 1-3) performed similarly in our Pediatric patients (sensitivity 80%, specificity 96%, area under the curve (AUC) 0.92). The 3mm (Mayo 0-1 vs. Mayo 2-3) and 4mm (Mayo 0-2 vs. Mayo 3) cut-offs had lower sensitivity (sensitivity 44%, specificity 98%, AUC 0.87; sensitivity 59%, specificity 92%, AUC 0.80) (Fig 2). Thinner BWT cut-offs performed better: 2.5mm (sensitivity 65%; specificity 89%) and 3.5mm (sensitivity 71%; specificity 86%).

Fig 1:

Fig 2:

Conclusion

In Pediatric patients with newly diagnosed UC, TABUS was a useful tool, with the UC-IUS and BWT correlating well with their endoscopic, clinical, and biochemical disease activity. Compared to the adult UC-IUS Index, Pediatric patients need a thinner BWT cut-off to better discriminate between mild vs. moderate/severe disease (2.5mm instead of 3mm) and mild/moderate vs. severe disease (3.5mm instead of 4mm).
P181 infliximab exposure during induction associate with time to remission and disease control of inflammatory bowel disease
Authors: Laharie D , Rabizadeh S , D’Haens G , Dubinsky M , Panetta J C , Everts-van der Wind A , Dreesen E , Spencer E , Vermeire S , Dervieux T
Published: January 2023

Background

Infliximab (IFX) exposure is established predictive factor of pharmacokinetic (PK) origin in inflammatory bowel disease, and expert consensus is to achieve adequate exposure during induction (1). We evaluated the performance of a Bayesian PK tool in IBD patients starting IFX.

Methods

Trough IFX collected immediately before the third and fourth infusion (corresponding to week 6 and 14 on a standard dosing schedule, respectively) were evaluated from 307 IBD patients starting IFX and enrolled in three cohorts of IBD. The first cohort patients was adult CD enrolled in the TAILORIX trial (n=101, mean age [SEM]: 35.0±1.4 years, 60% female) (2), a second cohort was from the PRECISION trial (n=158, mean age 15.8±0.5, 75% CD, 46% female) (3) and a third cohort consisted of pediatric patients (n=45, mean age 13.2±0.5, 71% CD, 40% female). Forecasted IFX concentration at the 4th infusion were estimated using serum IFX, antibodies to IFX and albumin determined at the third infusion using population PK calculator with Bayesian prior. The outcome variable was a CRP-based clinical remission during follow-up with CRP levels below 3 mg/L in the absence of symptoms (corresponding to remission). Sustained CRP-based clinical remission status over the maintenance period was also calculated. Statistics consisted of Kaplan Meier analysis with calculation of Hazard ratio (HR), and logistic regression.

Results

IFX concentration above 15 µg/mL before the third infusion had shorter time to CRP-based clinical remission as compared to IBD with IFX concentration below 15 µg/mL (mean followup: 182±11 days). Measured IFX concentrations above 10 µg/mL before the 4th infusion were also associated with a higher rate and shorter time to remission (p<0.01). Similar results were observed with forecasted concentration above 10 µg/mL at the 4th infusion (p<0.01). In the presence of IFX concentration above 15 µg/mL there was a 2.5-fold higher likelihood of sustained CRP based clinical remission status during maintenance as compared to IFX concentrations below 15 µg/mL (p<0.01). Forecasted IFX level above 10 µg/mL at 4th infusion associated with 3.9-fold higher likelihood of CRP-based clinical remission. (p<0.01).

Conclusion

These data further support that IFX concentrations above recommended cutoffs are best to predict enhanced disease control. Patients presenting with low forecasted exposure may benefit from dose intensification sooner than the scheduled standard infusion.

References:

(1) Cheifetz AS et al. Am J Gastroenterol. 2021 116:2014-2025. (2) D’Haens G et al., Gastroenterology. 2018 154:1343-1351. (3) Dubinsky M et al. Inflamm Bowel Dis. 2022 28:1375-1385
P186 Impact of tofacitinib maintenance therapy on key Ulcerative Colitis patient-reported outcomes of fatigue, urgency, abdominal pain and sexual dysfunction using IBDQ and SF-36 individual items as proxies
Authors: Dubinsky M C , Gardiner S , Hur P , Guo X , Paulissen J , Cappelleri J C , Bushmakin A G , Panés J
Published: January 2023

Background

Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). This novel analysis evaluated tofacitinib outcomes using items from the Inflammatory Bowel Disease Questionnaire-32 (IBDQ) and Short Form-36 Health Survey (SF-36) as proxies for key UC patient-reported outcomes (PROs) of fatigue, urgency, abdominal pain and sexual dysfunction over 52 weeks of maintenance treatment.

Methods

Data from 593 patients with UC in OCTAVE Sustain (NCT01458574) were included.1 PROs were assessed via self-reported proxy items for each UC symptom/dysfunction of interest in the IBDQ and SF-36. A longitudinal mixed-effects model compared tofacitinib 5 and 10 mg twice daily (BID) vs placebo up to 52 weeks for change from baseline (CFB) in each predefined IBDQ and SF-36 item. Least squares (LS) mean differences and standardised effect sizes (ES; LS mean difference divided by the standard deviation [SD] of baseline item scores) were calculated for tofacitinib vs placebo; ES of 0.1, 0.2, 0.5 and 0.8 were trivial, small, medium and large, respectively, with ES categorisation intervals defined as the midpoints between these absolute values.2 LS means and ES (LS mean/SD of baseline item scores) for both tofacitinib doses and placebo at Week 52 vs baseline were calculated. p<0.05 denoted statistical significance.

Results

At Week 52, all IBDQ proxies were improved with tofacitinib 5 and 10 mg BID vs placebo, with significant LS mean differences. Large ES were reported for fatigue and urgency proxies; abdominal pain and sexual dysfunction proxies had medium ES (Figure 1). For SF-36 proxy items, LS mean differences vs placebo were significant at Week 52, except for the SF-36 fatigue proxies, ‘Did you feel worn out?’ and ‘Did you feel tired?’ (both 5 and 10 mg BID). Small to large ES were reported for fatigue proxies; the abdominal pain proxy had medium to large ES (Figure 2). Regarding CFB, tofacitinib 5 and 10 mg BID maintained responses in IBDQ and SF-36 proxies at Week 52. LS mean changes from baseline in IBDQ items were generally not significant with tofacitinib; this was not as evident for SF-36 items. Trivial to small ES were reported for tofacitinib 5 and 10 mg BID, and medium to large ES for placebo. Significant worsening was observed with placebo for all items of interest.

Conclusion

Compared with placebo, tofacitinib 5 and 10 mg BID had better IBDQ and SF-36 proxy item responses at Week 52, as reflected through ES. Responses were maintained over 52 weeks with tofacitinib therapy but worsened with placebo. Proxy items have not been validated to measure the symptom PROs of interest.

1. Sandborn WJ et al. N Engl J Med 2017;376:1723–1736.

2. Dubinsky MC et al. Inflamm Bowel Dis 2021;27:983–993.
P188 Middle small-bowel segment Lewis score may predict long-term outcomes among patients with quiescent Crohn’s disease
Authors: Ukashi O , Yablecovitch D , Lahat A , Selinger L , Neuman S , Eliakim R , Ben-Horin S , Kopylov U
Published: January 2023

Background

Video capsule endoscopy (VCE) has been proven to accurately diagnose small-bowel inflammation and predict flares among patients with quiescent Crohn’s disease (CD). In this study we aimed to predict worse clinical outcomes over an extended follow-up.

Methods

This was a post-hoc analysis of adult patients with quiescent small-bowel CD who were followed with VCE, inflammatory biomarkers and magnetic resonance enterography (MRE) in a prospective study (between 2013-2018). We extracted extended clinical data from our hospital electronic health records to include the most recent follow-up (until Apr 2022). The primary composite outcome was clinical exacerbation defined as either intestinal-surgery, endoscopic dilation, CD-related admission, need for corticosteroids or biological/immunomodulator treatment change during the follow-up.

Results

Out of the 61 patients who were included in the study (median age of 29 [24-37] years, male–57.4%, current biologic treatment–46.7%), 18 patients met the composite outcome during an extended long-term follow-up (median of 58 [interquartile range 35-93] months). On univariable analysis, complicated (Hazard ratio [HR] 7.348, p=0.002) and stricturing disease-phenotype (HR 5.305, p=0.001) were associated with higher risk for clinical exacerbation during follow-up. A baseline VCE middle small-bowel segment Lewis score (midLS) of≥135 identified patients with future exacerbation (AUC of 0.767, 95% CI 0.633-0.902, p=0.001, HR 6.317, negative predictive value [NPV] of 93%), while the conventional Lewis score had an AUC of 0.734 (CI 0.589-0.879, p=0.004). Performing sensitivity analysis restricted to patients with either complicated (n=34) or stricturing disease-phenotype (n=26), we revealed that midLS still predicted disease exacerbation during the extended follow-up (AUC of 0.747 and 0.753, respectively) in these patients.

Conclusion

MidLS predicts treatment failure in quiescent Crohn's disease patients (median follow-up 5 years) independently of disease-phenotype.
P190 Delayed IBD diagnosis leads to worse outcomes over years, with multiple implications on service delivery
Authors: Rao A , Bazarova A , Mitra P , Majumder S , Parigi T , Ghosh S , Iacucci M , Shivaji U
Published: January 2023

Background

Delays in diagnosis can be patient and health-system related. Such delays have been reported to increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as hospitals currently face challenges with long waiting lists in the post-COVID-19 era.

Methods

New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. A cut-off time was set for each delay-type based on best average hospital waiting times. Reasons for delays until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine if there was a difference in survival without AOs between patients with and without delay.

Results

105 patients were identified using strict criteria (M=58; median age=32y) with a median follow-up of 55 months. The most frequent presenting complaints were abdominal pain (44, 41.9%), loose stools (40, 38.1%), bloody diarrhoea (37, 35.2%) and bleeding per-rectum (33, 31.4%). 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn’s disease and Unclassified colitis respectively, and were analysed jointly.

The longest delay-types noted: patients seeking medical attention (median=4 months; range 1 to 84 months); arranging gastroenterology clinic review after GP referral (median=5 weeks; 1 to 30 weeks); and waiting for index endoscopy (median=3 weeks; 1 to 36 weeks).

Patient stratification based on delay-type, using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay vs no delay).

- delay in seeking medical attention (cut-off=1m; p=0.004) (Fig 1A)

- delay in GP referral to specialty review (cut-off=1w; p=0.048)

- delay in index endoscopy (cut-off=4w; p=0.01) (Fig 1B)

- delay in starting treatment (cut-off=4w; p=0.03)

Fig 1A-Time to seek medical attention (survival without AOs; p=0.004)

Fig 1B-Time from clinic review to index endoscopy (survival without AOs; p=0.01)

Conclusion

Several bottlenecks of delays increase AOs in IBD over the follow-up period. A delay as short as a week, between GP referral to specialty review, is significant in determining AOs, relevant for specialist IBD centres particularly in the post-Covid period. Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. Long delays observed in patients seeking medical attention highlights the need for better patient education in the community.
P191 Robotic Surgery shows significant promise in delivering superior outcomes for patients with Inflammatory Bowel Disease
Authors: Karri R , Grewal C , Yassin N
Published: January 2023

Background

Robotic surgery is a relatively novel surgical advancement in minimally invasive surgery for patients with Inflammatory Bowel Disease (IBD). The pathophysiology of the disease inherently makes these surgeries more complex with high complication rates. This study aimed to the evaluate the efficacy of robotic procedures for such patients and compare the short-term outcomes with laparoscopic surgery in patients with IBD.

Methods

A retrospective review was conducted of all patients who underwent robotic and laparoscopic surgery for IBD between November 2018 and April 2022 at a single institution. Demographics, peri-operative, intra-operative and post-operative data were analysed.

Results

24 robotic cases were performed in the time period (75% Crohn’s) whilst 18 cases were performed laparoscopically (39% Crohn’s). Majority of the robotic patients had a Right Hemicolectomy (63%) with stoma formations in 38% of the procedures. 44% of the laparoscopic patients had a Total Colectomy and 39% had a Right Hemicolectomy with 78% of them having stomas. There was no significant difference in the patients age or BMI with a median age of 30 and BMI of 24.1 in the laparoscopic surgeries and a median age of 36 and BMI of 24.8 in the robotic group. The median operative time for the laparoscopic procedures was longer with 250 minutes versus 220 minutes in the robotic patients. The length of hospital stay for the patients was also greater for laparoscopic patients with a median of 9 compared to 6 days for robotic patients. 3 patients necessitated return to the ward within 30 days after laparoscopic surgery (17%) compared to only one robotic case (4%). However, 2 patients had a Clavin Dindo Grade 3 complication after robotic surgery compared to one in the laparoscopic set. In both sets of patients, one patient required surgery within 30 days: the robotic patient requiring laparotomy for adhesion-lysis and the laparoscopic patient for wound closure post wound dehiscence. Zero cases across all the patients necessitated conversion to open surgery and the mortality rate was 0%.

Conclusion

The results of this single centre study provide further support to studies demonstrating the feasibility and efficacy of robotic surgery in IBD patients. Patients operated robotically had a comparable safety profile with a similar complication rate whilst having whilst having shorter operating times and shorter length of hospital stay. Length of stay in hospital is a surrogate marker for early recovery post-surgery and carries significant benefit in the modern-day demand for hospital bed spaces. Therefore, robotic surgery offers a potentially superior alternative in minimally invasive surgery.
P199 Clonal patterns between pouch neoplasia and prior colorectal neoplasia in Inflammatory Bowel Disease patients: an exploratory cohort study
Authors: Van Lierop L , te Groen M , Derikx L , Ylstra B , Hoentjen F , Nagtegaal I , Simmer F
Published: January 2023

Background

Inflammatory Bowel Disease (IBD) patients with an ileo-anal pouch anastomosis (IPAA) bear an increased risk of pouch neoplasia, with prior colorectal neoplasia as the strongest predictor. It is unknown if pouch neoplasia develops independently or is derived from prior colorectal neoplasia. Therefore, we aimed to elucidate the pathogenesis of pouch neoplasia by assessment of clonality between prior colorectal neoplasia and pouch neoplasia in IPAA patients with IBD.

Methods

In this explorative study we used the Dutch Nationwide Pathology Databank to identify IBD patients with both pouch neoplasia and prior colorectal neoplasia. Clonality was assessed on tissue with shallow whole genome sequencing based copy number aberration (CNA) analysis and validated with immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).

Results

Three out of 13 included patients showed clonally matching CNA profiles between colorectal neoplasia and pouch neoplasia, validated with matching IHC and FISH for p16 and HER2. Patients with clonal samples corresponded with concordant histology pre- and post IPAA, positive resection margins, metastasized disease or a short interval (<2 years) between colorectal and pouch neoplasia diagnoses.

Conclusion

CNA provides a feasible method for clonality assessment in patients with colorectal neoplasia and subsequent pouch neoplasia. Most pouch neoplasia in our cohort were molecularly different from their prior colorectal neoplasia. This may indicate a multifactorial pathogenesis of pouch neoplasia.
P201 Assessment of factors associated with cumulative bowel damage in surgically naïve patients using Lemann index and global MaRIA index in Crohn’s disease
Authors: Domislović V , Hrabric Sonje K , Brinar M , Cukovic-Cavka S , Turk N , Grgic D , Barisic A , Jelakovic M , Prutki M , Krznaric Z
Published: January 2023

Background

The Lémann index (LI) is a unique tool that measures cumulative bowel damage in Crohn’s disease (CD) and is composed of surgical procedures and severity and extent of bowel lesions according to endoscopy and MR enterography (MRE). Since there is a significant contribution of previous surgery in LI calculation, our aim of this study is to investigate factors associated with cumulative bowel damage using LI in both total population and surgically naïve patients.

Methods

In this cross-sectional study, LI was calculated evaluating 20 small bowel, 7 large bowel and 3 upper GI segments. For each segment bowel resections, inflammatory, stricturing or penetrating lesions were considered using MRE and upper and lower endoscopy. Global MaRIA (gMaRIA) index was calculated using following parameters on 6 bowel segments on MRE: bowel wall thickness, ulcers, edema, and relative contrast enhancement. Longstanding disease was ≥10-year duration. Disease activity was defined as CRP>5 or HBI≥5. Extent and disease behavior were assessed using Montreal classification. Multivariate logistic regression adjusted for confounders was performed (age, gender, BMI, smoking status, CRP, disease behavior and extension, biological therapy, gMaRIA score, and HBI).

Results

This study included 320 CD patients [age 36 (24-46), 54.6% males, disease duration 7.2 (1-14) years, BMI 21.3 (17.4-24.8) kg/m2]. There were 142 (44.4%) surgically naïve and 128 (40%) patients with longstanding disease. In total population, higher LI values were observed among those with longstanding disease (10.31 vs 5.35 years, p<0.001), patients treated with biological therapy (9.7 vs. 6.4, p=0.005) and prior surgery (11.81 vs. 1.62, p<0.005). There was no difference in LI according to activity (p=0.921) and smoking status (p=0.336). Multivariate analysis on total population revealed independent predictors of elevated LI which were BMI (β=-0.268, p<0.02), disease duration (β=0.120, p=0.041) and prior surgery (β=5.42, p<0.001). Hence, separate multivariate analysis was performed on surgically naïve which revealed following predictors of LI (other than surgery): current smoking (β=1.14, p=0.010), perianal disease (β=1.39, p=0.02) and gMaRIA score (β=0.093, p<0.001).

Conclusion

Positive predictors of cumulative bowel damage in surgically naïve patients were smoking, perianal disease, and radiological activity (gMaRIA), while in total population longer disease duration, BMI and prior surgery. There are several important contributing variables on cumulative bowel damage which were revealed after removing previously operated patients, which would otherwise remain unrecognized. This risk factors in CD could stratify patients at high risk for complicated course of disease.
P211 Factors associated with estimated cardiorespiratory fitness in patients with Inflammatory Bowel Disease: an exploratory analysis of real-world data
Authors: Demers K , Rezazadeh Ardabili A , Bongers B C , Romberg-Camps M J L , van Bodegraven A A , Jonkers D M A E , Pierik M J , Stassen L P S
Published: January 2023

Background

Cardiorespiratory fitness (CRF) as a potential predictor of disease outcome in Inflammatory Bowel Disease (IBD) is understudied, as are risk factors for impaired CRF. Lifestyle interventions focusing on improving CRF may aid in enhancing subjective health, decreasing disability, or even controlling inflammation. The aim of this exploratory study was to investigate risk factors for low estimated CRF (eCRF), as well as the association between eCRF and patient-reported outcomes of IBD in a real-world cohort.

Methods

A cross-sectional multicenter study was performed between 26 Oct 2021 and 19 Oct 2022, enrolling IBD patients using the remote monitor platform myIBDcoach. Patients reported on disease activity, lifestyle factors, and psychosocial functioning. The four-question Modified Duke Activity Status Index (M-DASI-4Q) was used to assess eCRF, which is a simple screening tool for detecting the risk of impaired CRF as objectively measured with physical exercise tests. The number of positive responses to each of the four questions determines the final score, ranging from 0 to 4. To date, no accepted cut-off for (e)CRF has been identified for patients with IBD. Therefore, an M-DASI-4Q score below the 25th percentile of the study population was exploratively used to define low eCRF. Multivariable logistic regression analysis was performed to identify factors associated with eCRF.

Results

In total, 410 patients were included, of which 91 (22.2%) had low eCRF. The median M-DASI-4Q score was 3 (IQR 2-4). Low eCRF was characterized by higher age, female sex, higher BMI, and more comorbidities compared to patients with adequate eCRF (Table 1). Patients with low eCRF reported statistically significant higher levels of fatigue and stress, lower subjective disease control, and, remarkably, higher physical activity levels (Table 2). Multivariable logistic regression showed that female sex (adjusted Odds Ratio [aOR] 3.09), higher BMI (aOR 1.06), more comorbidities (aOR 3.77, aOR 8.52), fatigue (aOR 2.26), lower subjective disease control (aOR 0.90), and higher physical activity levels (aOR 2.29) were associated with low eCRF (Table 3).

Conclusion

In this exploratory study, we described an association between eCRF and patient- and clinical characteristics (sex, BMI, and comorbidities), as well as patient-reported outcomes of IBD (fatigue, and subjective disease control). Future research should investigate the validity of the M-DASI-4Q and determine thresholds for referral for further objective assessment for patients that might benefit from personalized interventions. Furthermore, future studies should further elucidate the interaction between physical activity and (e)CRF in patients with IBD to define recommendations.