bluuebunny/crossref_metadata_2025 huggingface dataset:
P0379 Characteristics of histologically confirmed upper gastrointestinal lesions in patients with Crohn’s disease in Korea
Authors: Na S Y , Ji J S , Choi H
Published: January 2025

Background

Crohn’s disease (CD) is a chronic, relapsing bowel disease that affects the entire gastrointestinal tract, from the mouth to the anus. Various lesions in the esophagus, stomach, and duodenum have been reported through upper gastrointestinal (UGI) endoscopy, and it is known that CD patients with UGI lesions have a poorer prognosis. This study aimed to investigate the characteristics of UGI lesions in CD patients in Korea.

Methods

This retrospective study enrolled CD patients diagnosed and followed up at Incheon St. Mary’s Hospital of The Catholic University of Korea from January 1991 to December 2020. We analyzed the characteristics of endoscopic findings and pathologic results of tissue biopsy of those who performed UGI endoscopy in patients with CD.

Results

Of a total of 282 CD patients, 157 underwent EGD, and endoscopic abnormalities were observed in 59 patients (37.6%) for whom biopsies were performed. The frequency of UGI lesions by age at diagnosis was 50% and 33.3% for A1 and A2+A3, respectively, showing no significant difference (p=0.06). The most common lesion was gastric bamboo-joint appearance (76.8%). In the esophagus and duodenum, ring-like appearances and longitudinal ulcers/erosions were mainly observed in 19.6% and 23.2% of patients, respectively. Gastric nodularity/cobblestoning and duodenal fistulas were each found in one patient (Fig). Biopsy results showed that focally enhanced gastritis was the most frequent finding (30.4%), followed by cryptitis or crypt abscess in the stomach (28.6%). In the esophagus and duodenum, lymphocytic esophagitis and microgranulomas were mainly observed in 10.7% and 19.6% of patients, respectively (Table). H. pylori infection was detected in only 5.4% of patients.

Conclusion

UGI lesions in CD are relatively common and are not affected by age at diagnosis. The bamboo-joint appearance was the most characteristic lesion in the UGI tract. Despite a significantly lower prevalence of H. pylori infection compared to the general population in Korea, many CD patients exhibited UGI lesions. Future studies are warranted to investigate clinical implications based on the distinctive features of UGI lesions.

References

1.So H, Ye BD, Park YS, et al. Gastric lesions in patients with Crohn’s disease in Korea: a multicenter study. Intest Res 2016;14:60-8.

2.Graca-Pakulska K, Błogowski W, Zawada I, et al. Endoscopic findings in the upper gastrointestinal tract in patients with Crohn’s disease are common, highly specific, and associated with chronic gastritis. Sci Rep 2023 13;13:703.

3.Greuter T, Piller A, Nicolas Fournier N, et al. Upper Gastrointestinal Tract Involvement in Crohn’s Disease: Frequency, Risk Factors, and Disease Course. J Crohns Colitis 2018;12:1399-1409.
P0380 Mild Hyperemia in the Absence of Bowel Wall Thickening on Intestinal Ultrasound is Associated with Biochemical Disease Activity and Worse Disease Outcomes in Patients with Crohn’s Disease and Ulcerative Colitis
Authors: Krugliak Cleveland N , Bhondwe K , Duty C , Fear E , George T , Ayoub Q N , McDonald B , Kellar A , Rubin D T
Published: January 2025

Background

Bowel wall thickness (BWT) and hyperemia measured by intestinal ultrasound (IUS) predict endoscopic disease activity in Inflammatory Bowel Disease (IBD). The clinical significance of mild hyperemia (mLim1) without BWT is unknown. We previously described the short-term predictive value of mLim1 without BWT. Here we compare biochemical disease activity and longer-term outcomes in IBD pts with mLim1 to those with normal IUS.

Methods

We reviewed index IUS exams of pts with IBD at the University of Chicago from 7/18/2022 to 5/7/2024 and included pts with normal BWT (≤3.0mm) + mLim1 and compared them to pts with normal BWT + no hyperemia (mLim0). We excluded pts with mLim2 or 3, BWT>3mm anywhere on index IUS or pts with mLim1 at surgical anastomoses only. Clinical Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI)) and biochemical disease activity (faecal calprotectin (FCP) or C-reactive protein (CRP)) were assessed at the time of index IUS. Clinical remission was defined as HBI of <5 or SCCAI of ≤2, FCP<150 μg/g, CRP<5 mg/L. Primary analysis was poor disease outcome (PDO) within 12 mo of follow-up, defined as: IBD medication change/escalation, prescription of corticosteroids, IBD-related surgery, or IBD-related hospitalization.

Results

45 pts with mLim1 (38 Crohn’s disease (CD), 7 Ulcerative colitis (UC)) and 61 pts with mLim0 (52 CD, 9 UC) at index IUS were included (Table 1). At baseline IUS, mLim1 pts had elevated median FCP but normal median HBI/SCCAI, while mLim0 pts had normal median FCP and HBI/SCCAI (Table 1). Of mLim1 CD pts, 14/38 (36.8%) had a PDO within 3 months (mo), 18/38 (47.4%) within 6 mo, and 18/30 (60%) within 12 mo, with median time to PDO of 37 d (IQR 28.5-112.5). Of the mLim0 CD pts, 5/52 (9.6%) had a PDO within 3 mo, 9/46 (19.6%) within 6 mo, and 14/45 (31.1%) within 12 mo, with median time to PDO of 91 d (IQR 93-184). Rates of PDO between mLim1 and mLim0 in CD pts at 12 mo were statistically significant (stat sig), p = 0.013. Of the mLim1 UC pts, 3/7 (42.9%) had a PDO within 3 mo and 2/3 (66.7%) had a PDO within 12 mo, with a median time to PDO of 139 d (IQR 93-184). Of the mLim0 UC pts, one had a PDO at 3 mo with no further events noted at 6 mo (0/8) or 12 mo (0/4). Rates of PDO between mLim1 and mLim0 in UC pts at 12 mo were not stat sig, (p = 0.270).

Conclusion

Mild hyperemia without BWT is associated with biochemical disease activity in both CD and UC and predicts PDO in CD. Although PDO in UC was numerically higher in mLim1 compared to mLim0, this was not stat sig likely due to small cohort size. These findings support the consideration of treatment adjustments when this isolated parameter is identified and inform future IUS treat-to-target strategies.
P0382 Identifying atypical disease phenotypes in paediatric Ulcerative Colitis: Insights from the real world PIBD-SETQuality cohort
Authors: Camman A , Klomberg R , Peters P , Christos T , Koletzko S , Russell R , Nedelkopoulou N , Croft N , de Ridder L
Published: January 2025

Background

The heterogeneity of paediatric ulcerative colitis (P-UC) can complicate diagnosis and prompt start of optimal induction treatment, which is crucial for adequate disease control. Recognizing and understanding atypical disease patterns in P-UC will decrease misclassification and contribute to the development of standardized classification tools. This study aims to provide insight in the real world prevalence of atypical phenotypes in newly diagnosed P-UC patients.

Methods

Data were collected from the Paediatric Inflammatory Bowel Diseases Network for Safety, Efficacy, Treatment and Quality improvement of care (PIBD-SETQuality) cohort, a multicenter, international, prospective, observational study including therapy naive children <19 years old with IBD. Patients diagnosed with UC between January 1st 2017 and June 14th 2024 were enrolled. Diagnostic criteria and macroscopical atypical disease were based on the validated PIBD-classes algorithm by revised Porto Criteria1. The Mann-Whitney U test and Chi-square tests were used to compare, respectively, numerical and categorical data between patient groups.

Results

Baseline data of 197 P-UC patients were included. At diagnosis, 68% of the patients presented with pancolitis. Atypical disease occurred in 35.0% (69/197) of the patients of which relative rectal sparing was most common (Table 1). Aspecific upper gastrointestinal inflammation occurred in 10.6% (17/161) of the patients, of whom 6 also exhibited atypical disease phenotypes. Approximately 1 out of 10 patients with atypical disease presented with multiple atypical phenotypes. Patients with atypical disease did not show significant differences compared to patients without atypical disease in time to diagnosis (107 days vs. 104 days, P=0.19), absolute PUCAI score (40 [IQR 30-55] vs. 35 [IQR 25-58.75], p=0.10), initial induction therapy and need for treatment intensification during induction therapy (8 vs. 4 patients, p=0.22).

Conclusion

Atypical disease presentations are common in P-UC in this real world cohort, as is the presence of combined atypical disease features. Recognition of atypical disease features in P-UC, and understanding their impact on disease course, are crucial for prompt start of optimal tailored therapy. In this cohort, the presence of atypical disease did not result in a diagnostic delay or treatment intensification during induction period.

References

1.Birimberg-Schwartz L, Zucker DM, Akriv A, et al. Pediatric IBD Porto Group of ESPGHAN. Development and validation of diagnostic criteria for IBD subtypes including IBD-unclassified in children: a multicentre study from the Pediatric IBD Porto Group of ESPGHAN. J Crohns Colitis. 2017;11(9):1078-1084. doi:10.1093/ecco-jcc/jjx053.
P0388 Can intestinal ultrasound guide us in the treatment of inflammatory bowel disease?
Authors: Tejerizo García L , Prieto Vicente V , Piñero Pérez M C , Fernandez Pordomingo A , Dominguez Gómez R , Gómez Hidalgo R , Velasco Guardado A , Garcia-Alvarado M , Muñoz Nuñez F
Published: January 2025

Background

Intestinal Ultrasonography (IUS) is a useful method for monitoring inflammatory bowel disease. The role of Shear Wave Elastography (SWE) and the relationship with other parameters indicating activity are not yet well understood.

Methods

The aim was to describe the ultrasound characteristics observed in a cohort of patients with Crohn’s disease (CD) and the changes in therapeutic attitude derived from the results of this imaging test.

To evaluate the usefulness of SWE in patients with intestinal strictures to detect fibrosis in comparison with analytical and ultrasound parameters of inflammatory activity.

We conducted a single-center, retrospective, observational study of a baseline study including IUS examinations performed in CD patients between May 2022 and February 2023.

Results

We included 63 IUS in CD patients (60.9% male; mean age 43 ± 17 years). The mean HBI-score was 2.77 (± 2.6). A change in therapeutic approach was made in 32.8% of cases following IUS.

Stricture was found in 22 IUS (34.9%), with a mean length of 5.6 ± 2.59 cm. Fat wrapping was observed in 40.9% of cases, and loss of wall stratification in 9.1%. Median SWE of the stricture was 9.05. Calprotectin is directly related to the Limberg scale (p<0.001) and indirectly with the SWE value (p<0.05). Inverse correlation between Limberg scale and SWE value (p<0.05) was observed.

Conclusion

intestinal ultrasonography facilitates a proactive monitoring in CD because immediate changes in therapeutic approach can be made. The combination of the Limberg scale and the SWE value allow the definition of intestinal strictures. Comparative studies are needed to clarify the usefulness in predicting the degree of fibrosis.
P0389 Cardiovascular risk assessment and ultrasound-assisted reclassification in patients with Inflammatory Bowel Disease (IBD): a single-centre study
Authors: Blando G , Viola A , Patanè L , Toscano A , Costantino G , Squadrito G , Mandraffino G , Fries W
Published: January 2025

Background

Patients with inflammatory bowel disease (IBD) have an increased cardiovascular risk (CVR) and cardiovascular disease (CVD) is the leading cause of mortality in IBD patients. A more in-depth screening of patients has become important with the EMA warning for JAK-inhibitors. The current CV risk stratification algorithms are based on traditional risk factors not considering subclinical atherosclerosis. This study aimed to stratify the CVR of IBD patients according to the European Society of Cardiology (ESC 2021/23) and European Society of Atherosclerosis (EAS), together with the evaluation of the presence of previously subclinical atherosclerosis by carotid ultrasound.

Methods

Demographic and disease-related data were collected from consecutive IBD patients aged over 40 years, including systolic blood pressure, body mass index (BMI), lipid panel, and cardiovascular comorbidities. Asymptomatic atherosclerotic disease was assessed by carotid ultrasound in order to measure the carotid intima-media thickness (cIMT) and to detect the presence of plaques. CVR was stratified based on the latest guidelines on dyslipidemias (EAS/ESC 2019), cardiovascular prevention (ESC 2021), and the management of cardiovascular disease in patients with diabetes (ESC 2023). Moreover, additional IBD-related parameters potentially associated with an increased CVR were investigated, such as disease activity, current therapies, duration of disease, and extraintestinal manifestations.

Results

A total of 120 IBD patients were included (UC: 67 patients, CD: 53 patients) Baseline characteristics are presented in Table 1. Patients with UC had significantly higher mean values of total cholesterol (C-TOT) and low-density lipoprotein cholesterol (C-LDL) (p<0.001 and p=0.001 respectively). At baseline, 48% of patients were classified as having intermediate CVR, 34% as high risk, and 18% as very high risk (Table 2). Following carotid ultrasonography, subclinical atherosclerosis was diagnosed in 48.3% of patients. Based on these findings, CVR re-stratification was performed in 21% of patients resulting in 71% of patients with high and very high risk, compared to 50% at baseline. Additional risk factors for an increased CVR identified by multivariate regression analysis were having active disease (p=0.047) and concomitant spondiloathropathies (p=0.03).

Conclusion

Our study demonstrates that carotid ultrasound contributed to re-classify the CVR in patients who were previously considered to be in lower risk categories confirming that the use of traditional risk scores underestimates CVR in IBD patients. Having active intestinal disease and concomitant spondiloarthritis increases further the CV risk.
P0393 Radiological healing in perianal fistulising Crohn’s disease: MRI predictors and disease course
Authors: Delmotte V , Gillard R , Louis E , Defraigne-Peigneur E , Meunier P , Reenaers Dr C
Published: January 2025

Background

Perianal fistulising Crohn’s disease (CD) is a disabling condition affecting up to 30% of patients. Studies suggest that greater fibrosis in the fistula tract is linked to improved clinical outcomes. This study aims to describe the natural history of perianal fistulising CD, including MRI parameters, and to identify clinical and radiological predictors of relapse and radiological healing

Methods

Pelvic MRIs for perianal fistula performed at CHU Liège, Belgium, from 2018 to 2023 were collected. MRI protocols used 1.5T [Siemens Aera/Sola] or 3T [Siemens Vida] machines, with sequences including T2 TSE, T2 TSE FS, and T1 TSE FS before and after gadolinium injection. The MAGNIFI-CD and modified Van Assche (VA) indices were assessed for each patient. Two blinded radiologists evaluated fistula tract fibrosis. For patients with perianal flare, only the first MRI was analysed (MRI 1). For others, the first and last MRI (MRI 2) within the study period were assessed. Perianal flare was defined as abscess drainage or stoma creation for active perianal CD, and radiological healing as ≥80% fistula fibrosis or a MAGNIFI-CD score of 0.

Results

A total of 102 pelvic MRIs from 84 patients were included. The median patient age was 39 years (31–51), with 40% female. The median duration of perianal CD was 52 months (2–144); 26% had a seton at MRI 1, 7% had a stoma, and 41% were on anti-TNF therapy. During follow-up, 22% required abscess drainage. No clinical factors were associated with perianal flare. Univariate analysis identified several MRI 1 radiologic predictors of flare: fibrosis percentage (OR=0.72, p=0.033), VA hyperintensity T2 (OR=3.22, p=0.028), VA rectal involvement (OR=1.75, p=0.040), VA inflammatory mass (OR=1.42, p=0.022), VA T1 post-contrast hyperintensity (OR=3.68, p=0.045), MAGNIFI-CD score (OR=1.13, p=0.022), MAGNIFI T1 post-contrast hyperintensity (OR=1.77, p=0.031), and MAGNIFI inflammatory mass (OR=1.40, p=0.033). In multivariate analysis, only MAGNIFI T1 post-contrast hyperintensity remained significant (OR=1.77, p=0.031). Radiological healing was achieved in 30% at MRI 1 (25/84) and 44% at MRI 2 (8/18). No factors at MRI 1 predicted healing at MRI 2, though T1 post-contrast hyperintensity at MRI 1 showed a trend towards predicting lack of healing (OR=0.11, p=0.071).

Conclusion

One-fifth of patients experienced perianal flare during follow-up. Clinical and therapeutic factors did not predict outcomes; only persistent MRI inflammation and low fistula fibrosis were linked to future abscess drainage. Specific MRI features may serve as therapeutic targets in perianal CD management, pending validation in a prospective cohort.
P0400 Automated real-time detection of intestinal tract and inflammatory bowel disease in intestinal ultrasound with the vision transformer (ViT)
Authors: Delaire J , Mohtaram N , Yzet C , Brazier F , Chaidron C , Fumery M
Published: January 2025

Background

Intestinal ultrasound is a powerful tool for diagnosing and monitoring inflammatory bowel disease (IBD). Although access to training is improving, the detection and interpretation of ultrasound images in IBD remains complex. The aim of this study was to develop and validate an artificial intelligence module to automatically detect the intestinal tract and active IBD in order to simplify the use of ultrasound in IBD.

Methods

Vision Transformers (ViTs), recently introduced as a competitive alternative to Convolutional Neural Networks (CNNs), were used to automate the real time detection and segmentation of the normal and inflamed intestinal tract. ViTs were chosen for their ability to better capture global relationships in images, which is particularly useful for recognizing complex patterns in medical images. The ViT model was trained on a dataset consisting of 17,488 intestinal ultrasound images from 46 patients, including 11,396 images of active IBD and 6,092 inactive IBD evaluated by two gastroenterologists.

Results

The sensitivity, specificity and accuracy for the detection of inactive and active IBD calculated from two intestinal ultrasound loop containing a total of 617 images of inactive IBD and 339 images of active IBD were 95%, 94% and 95% respectively. Some limitations were identified, notably a decrease in sensitivity in the detection of minor anomalies, in areas of low contrast and during variations in scale. These points suggest that the model could benefit from further refinement of its spatial processing capabilities, particularly in complex clinical situations.

Conclusion

We have developed a model based on the pre-trained Vision Transformer (ViT) architecture that is able to detect the active and inactive IBD. This approach could eventually make it easier for inexperienced operators to use intestinal ultrasound to detect and monitor IBD. Further in-depth tests on a larger set of images and videos are under way to validate the model’s performance.
P0401 The IBD-disk accurately assesses disability and psychological burden at IBD diagnosis and predicts adverse outcomes in both UC and Crohn’s disease during the first year of treatment
Authors: Rimmer P , Stoica V , Ibrahim M , Javed A , Hazel K , Owusu M , Regan-Komito D , Cooney R , Iqbal A J , Chapple I , Harvey P , Iqbal T
Published: January 2025

Background

Inflammatory bowel disease (IBD) is linked with increased prevalence of mental health diseases (MHD), particularly anxiety and depression. How this influences treatment outcomes is poorly studied at IBD diagnosis. The IBD disk is a patient-reported outcome measure that quantifies disease-associated disability. We aimed to determine if the disk can be used pre-diagnosis to screen for mental health symptoms and predict treatment outcomes.

Methods

Patients with suspected IBD were seen in a rapid-access clinic. An IBD disk was completed upon review, pre-diagnosis. A subgroup simultaneously completed the Hospital Anxiety and Depression scale (HADS). Repeat disks were completed after diagnosis, with 12-month outcomes collected prospectively.

Results

188 patients completed a baseline disk (97 Crohn’s disease [CD], 91 Ulcerative colitis [UC]), 95 completed a simultaneous HADS and 82 completed a repeat disk. Both a pre-existing MHD diagnosis (CD 22%, UC 11%, X2 p=0.049) and an active anti-depressant prescription (CD 16%, UC 7%, X2 p=0.035) were more common at CD diagnosis than UC. The ‘Emotions’ domain correlated with HADS depression (rs=0.607 p<.001), anxiety (rs=0.586 p<.001) and reliably identified HADS defined moderate-severe depression (Area under the curve 0.873). A score ≥7 identified all patients meeting this HADS threshold (Sensitivity 100%, specificity 60.5%, Youden’s index 0.601). This is shown in Figure 1.

Whilst the IBD Disk did not outperform traditional disease severity indices, elevated baseline disk scores in UC predicted the subsequent need for advanced therapies (p=0.019), persistent active disease at 12 months (p=0.023) and need for inpatient treatment (p<.001). In CD, elevated disk scores predicted need for advanced therapies (p=0.014), persistent active disease (p=0.015) and showed a weak association with the need for surgical resection within 12 months (p=0.064). These results are summarised in Table 1.

After diagnosis and treatment, ongoing disability and psychological symptoms were driven by disease activity. In both UC and CD, the ‘Emotions’ domain fell significantly in those in remission at first follow-up (CD p<.001; UC p=0.008) but was unchanged when the disease remained active (CD p=0.71; UC p=0.72).

Conclusion

The IBD disk reliably screens for symptoms of depression and anxiety and identifies risk of adverse treatment outcomes at IBD presentation. Its use in the outpatient setting can support holistic disease assessment and identify those who are most likely to benefit from additional psychological support. Moreover, particularly in UC patients, elevated baseline IBD disk scores should prompt the consideration of treatment escalation early in the disease course.
P0404 Ileal Thickening in a TB-endemic Country : Crohn’s or Tuberculosis? Serial Intestinal Ultrasound Holds the Answer
Authors: Kulkarni A , Joshi H , Giri S
Published: January 2025

Background

In countries like India, which are endemic for Tuberculosis (TB), every symptomatic ileal thickening may not implicate a straightforward diagnosis of Crohn’s disease. In fact, most of these symptomatic findings are attributable to TB, and anti-tuberculosis therapy (ATT) leads to symptomatic as well as endoscopic improvement. In patients with Crohn’s Disease (CD), on the other hand, ATT leads to a deceptive symptomatic improvement; however, multiple studies from India found that it is not accompanied by endoscopic improvement, and if this is not picked up, there are higher chances of the patient later developing structuring CD. A colonoscopy at the end of two months of empirical ATT is the current protocol in India, to differentiate between TB and CD. This is resource-intensive for the patients as well as healthcare facilities. We explored the role of Intestinal Ultrasound (IUS) in differentiating ileo-cecal TB and CD.

Methods

All adult patients presenting to our centre with a symptomatic ileal or ileo-cecal thickening were subjected to IUS in addition to the standard of care evaluation (Inflammatory markers such as CRP and ESR, CT or MR Enterography, Ileo-colonoscopy with biopsy). After the evaluation, these patients were administered empirical ATT for two months, followed by a repeat IUS. The baseline ileal wall thickness, vascularity were noted. The patients received their diagnosis (TB or CD) based on the presence of endoscopic response at the end of the two-month ATT course.

Results

The mean ileal wall thickness, as measured in the baseline IUS, before ATT, was 2.9 mm for patients with ileo-cecal TB compared to 4.2 mm for CD (p < 0.0001). At baseline, the mean Limberg Score in patients with TB was 1 compared to 2.7 in those with CD (p < 0.0001). At the end of two months after the ATT course, the average decline in the wall thickness was 0.6 mm for TB compared to 0.09 mm for CD (p < 0.0001). This also correlated with persistent endoscopic findings after ATT, signifying presence of CD. The average Limberg score calculated at the end of the ATT for two months was 0.38 for TB compared to 2.7 for CD (p < 0.0001).

Conclusion

The higher baseline wall thickness and prominent vascularity is a significant predictor of CD in patients with ileo-cecal thickening. A lack of decline in the wall thickness and vascularity with ATT correlates with the lack of endoscopic response, and thus is able to differentiate between TB and CD.
P0409 Clinical and serological characteristic of Crohn’s Disease patients with gastrointestinal strictures
Authors: Dudek P , Borkowska A , Małecka-Wojciesko E , Talar-Wojnarowska R
Published: January 2025

Background

Processes of inflammation and fibrogenesis in Crohn’s Disease (CD) contribute to development of strictures and subsequent complications, constituting a significant medical issue. The primary objective of the study was to identify clinical parameters associated with the occurrence of gastrointestinal stenosis, as well as to determine the clinical utility of promising biomarkers of fibrosis in a cohort of patients with CD.

Methods

A single-center cohort study was performed on 78 adults diagnosed with different phenotypes of CD. The study cohort included 36 subjects (46.2%) with gastrointestinal strictures identified by endoscopic or radiological methods, while the control group comprised 42 individuals (53.8%) without stenosis. The assessment of clinical factors, like gender, age of disease onset, disease duration, comorbidities, disease location, extra-intestinal symptoms was undertaken to explore potential associations with the presence of gastrointestinal strictures. Serum levels of candidate biomarkers of fibrosis, including granulocyte-macrophage colony stimulating factor antibodies (GM-CSF Ab), hepatocyte growth factor activator (HGFA), fibronectin isoform ED-A and cartilage oligomeric matrix protein (COMP) were measured using ELISA test.

Results

The overall cohort consisted of 47.44% females (n=37) and 52.56% males (n=41). The median age of disease onset was similar between the stenosis group (25.00 years, IQR: 19.00–37.00) and the non-stenosis group (26.00 years, IQR: 21.00–33.00). A proportion of 44.44% of the stenosis group required surgical or endoscopic treatment due to strictures. The most common sites of stenosis comprised the large intestine (52.78%) and the ileocecal valve region (50%), ranking ileocecal valve involvement as a significant predictor for stricture formation, with OR=3.65 (95% CI: 1.11–13.43, p=0.039). Fibronectin ED-A, with a cut-off of ≤14.52 ng/mL, was significantly associated with strictures occurrence, with OR=0.96 (95% CI: 0.92–1.00, p=0.036). Some trends in GM-CSF Ab levels were observed in patients with ileocecal involvement (median 1.75 ng/mL) compared to those without (median 1.37 ng/mL), nearing statistical significance (p=0.061).

Conclusion

The performed study provided some significant data about stricturing course of CD, with ileocecal valve involvement as a marker of stricture formation among CD patients. Evaluated serum biomarkers, especially fibronectin isoform ED-A, seem to be a promising diagnostic tool, however obtained data are inconsistent and demand further trials.
P0412 Predicting outcomes of disease in patients with Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: a retrospective multicentric study
Authors: Oliveira R , Viegas M I , Abrantes D , Vaz Conde P , Saraiva M , Espinheira M D C , Trindade E , Carvalho I , Perdigoto D , Tavares de Sousa H , Roseira J
Published: January 2025

Background

The impact of coexistent IBD and PSC on disease progression and prognosis is unclear. This study evaluates outcomes in patients with both conditions, using the novel PSC Risk Estimate Tool (PREsTO) for PSC prognosis.

Methods

A retrospective multicentric study identified IBD-PSC patients through a national survey. PREsTO was calculated to predict PSC-related liver decompensation, and IBD progression was tracked via composite outcome measures.

Results

Among 77 identified patients from six nationwide participating centres, 59 were included, predominantly with ulcerative colitis (77%) and pancolitis (89%). Median ages at diagnosis were 22.3 for IBD and 29.8 for PSC, with follow-ups of 12.0 and 6.9 years, respectively.

PREsTO predicted a median 5-year risk of liver decompensation of 5.3% according to baseline characteristics. However, within this period only 1 patient experienced variceal bleeding; no other liver decompensation events were reported. Notably, over full follow-up, there were 20 additional events: jaundice (7), variceal bleeding (1), cholangitis (5), pruritus (7). One patient (1.7%) ultimately required liver transplant.

For IBD, during follow-up, 10 patients (17%) were hospitalised for IBD-related reasons (1 bowel subocclusion, 9 flare-ups). Twelve patients (21%) required at least one course of corticosteroids, and 34% started advanced medical therapy, of whom 57% needed either dose optimisation or modification. Three patients underwent surgery due to refractory disease activity (1 colectomy, 2 proctocolectomies). Importantly, 39% of patients showed subclinical disease activity at the last follow-up, indicated by faecal calprotectin above 250µg/g.

Conclusion

PREsTO may overestimate liver decompensation risk in our IBD-PSC population, which may be due to a young population. However, the impact of PSC extends beyond portal hypertension complications. Nonetheless, the high prevalence of IBD subclinical inflammation in this group raises concerns about potential disease progression and increased cancer risk.
P0416 Efficacy and safety of oral sulphate tablet for bowel preparation in patients with moderate to severe ulcerative colitis: a multicenter cohort study
Authors: Song J H , Shin J , Kong S M , Cha B , Hong J T , Kwon K S
Published: January 2025

Background

Proper bowel preparation is essential factor for accurate, high-level colonoscopy. Poor bowel preparation has been reported in up to 30% of patients due to intolerance to high doses of preparation agent. Orafang [Pharmbiop Korea] is a novel sulphate tablet launched in Korea and is being used safely and effectively. According to a previous study, this oral sulphate tablet(OST) has shown effective bowel cleansing results and safety in patients with inactive IBD. However, data on efficacy and safety in patient with active UC are insufficient. We evaluated the efficacy and safety of OSTs in patients with moderate to severe UC.

Methods

Between January 2022 and July 2024, patients with UC who underwent bowel preparation with OST spilt-dose regimen were enrolled at the Inha university hospital, Samsung Changwon Hospital, and Konkuk University Medical Center. A total 63 patients were retrospectively reviewed. Patients were allocated by disease activity to inactive UC (n=39, 61.9%) or active UC (n=24, 38.1%). We reviewed clinical characteristics, bowel cleansing success rate defined as Boston bowel preparation scale (BBPS) ≥ 8 and safety as assessed by laboratory abnormalities and UC associated complications.

Results

Both the active and inactive inflammation groups showed high cleansing success rates as measured by the BBPS (87.5% vs. 89.7%, p=0.784), with no statistical difference. No clinically significant laboratory abnormalities were found in either group, except for elevations of uric acid above the upper limit observed in two inactive group patients. No endoscopy related complication or UC related hospitalizations occurred in either group.

Conclusion

OST was a low-volume agent for colonoscopy that demonstrated a safe and success bowel cleansing rate regardless of UC activity. Our study results suggest that the OST split-dose regimen is effective and safe even in patients with active UC.

References

Kim, Kyeong Ok, et al. "Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study." Journal of Crohn’s and Colitis 16.11 (2022): 1706-1713.

Manes, Gianpiero, et al. "Appropriateness and diagnostic yield of colonoscopy in the management of patients with ulcerative colitis: a prospective study in an open access endoscopy service." Inflammatory bowel diseases 14.8 (2008): 1133-1138.

Yang, Hyo-Joon, et al. "Novel sulfate tablet PBK-1701TC versus oral sulfate solution for colon cleansing: A randomized phase 3 trial." Journal of Gastroenterology and Hepatology 35.1 (2020): 29-36.

Calderwood, Audrey H., et al. "Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness." Gastrointestinal endoscopy 80.2 (2014): 269-276.
P0417 Impact of Cytomegalovirus infection on patients with Inflammatory Bowel Disease in the Southern Area of Gran Canaria: a case-control study
Authors: Peñate Bolaños PhD M , Tosco-Nuñez T , Hernández Expósito N , Rodríguez Castellot J , Ciordia Nalda I , Alemán Gonzalez H , Quevedo Ruano R , Monescillo Francia A
Published: January 2025

Background

Inflammatory Bowel Disease (IBD) is a chronic condition affecting the digestive tract. During refractory flare-ups, cytomegalovirus (CMV) infection should be ruled out. Objectives: To analyse the characteristics, risk factors, and subsequent outcomes of IBD associated with CMV infection.

Methods

A retrospective case-control study included 50 cases and 50 randomly selected controls with IBD flare-ups between January 2018 and December 2023. CMV infection was diagnosed using PCR on colonic mucosa samples. Epidemiological, clinical, and complication data were analysed.

Results

No differences were observed regarding sex or type of IBD. Significant differences (p<0.05) were found between cases and controls: age during the episode 51 vs 41 years; age at IBD diagnosis 47 vs 36 years; clinical presentation with bloody diarrhea 90% (45) vs 32% (16)); prior immunosuppressive therapy 30% (15) vs 16% (8); clinician-driven biopsy indication 70% (35) vs 60% (30); and hospital-based diagnosis 52% (26) vs 12% (6). The onset of IBD during the episode was less frequent in cases, 16% (8) vs 30% (15), and complete colonoscopy was performed less often, 24% (12) vs 72% (36). Multivariate analysis identified independent risk factors, including treatment with intravenous methylprednisolone, moderate-severe clinical presentation, and corticosteroid-refractory disease.

Conclusion

In our patients, CMV infection during IBD flare-ups was associated with (1) treatment with intravenous methylprednisolone, moderate-severe clinical severity, and corticosteroid refractory; (2) when the indication for a biopsy is based on clinical criteria; and (3) it does not lead to future therapeutic escalations, although it does higher rates of colectomy.

References

1.Dutta S, Ray U. Cytomegalovirus (CMV) as a cause of exacerbation of ulcerative colitis (UC). An approach to diagnosis and management. Indian Journal of Medical Microbiology. noviembre de 2023;46:100469.

2.Kwon J, Fluxá D, Farraye FA, Kröner PT. Cytomegalovirus-related colitis in patients with inflammatory bowel disease. International Journal of Colorectal Disease. 1 de marzo de 2022;37(3):685-91.

3.Mourad FH, Hashash JG, Kariyawasam VC, Leong RW. Ulcerative Colitis and Cytomegalovirus Infection: From A to Z. Journal of Crohn’s and Colitis. 7 de septiembre de 2020;14(8):1162-71.

4.Hazır-Konya H, Avkan-Oğuz V, Akpınar H, Sağol Ö, Sayıner A. Investigation of Cytomegalovirus in Intestinal Tissue in a Country With High CMV Seroprevalence. Turk J Gastroenterol. 1 de febrero de 2021;32(2):123-32.
P0419 Impact of psychopathology and gut-microbiota on disease progression in Ulcerative Colitis: a five-year follow-up study
Authors: D’Onofrio A M , Chiera E , Gomez-Nguyen A , Di Vincenzo F , Spagnolo G , Ferrarese D , Cammarota G , Camardese G , Scaldaferri F
Published: January 2025

Background

Psychological distress and gut dysbiosis are key factors in patients with IBD. This study aimed to assess whether specific psychopathological and gut microbiota features could predict adverse outcomes in patients with UC.

Methods

In this prospective longitudinal cohort study, we enrolled 35 adult patients with UC. At baseline, patients completed a psychometric evaluation and provided a stool sample for gut microbiota analysis. For the purposes of this study, only trait-focused scales (MMPI-2, TAS-20, CD-RISC, STAI-Y2) were considered, while state-focused assessments were excluded. Five years later we reconstructed each patient’s clinical history, focusing on adverse outcomes including failure of biological therapy, UC-related hospitalizations, and UC-related surgeries.

Results

Patients with failure of biological therapy exhibited increased levels of Proteobacteria (p = 0.006), Fusobacteria (p = 0.042), Enterobacteriaceae (p = 0.025), and Trabulsiella (p = 0.011), while Firmicutes were found to be less abundant (p = 0.036). UC-related hospitalized patients presented lower levels of Rikenellaceae (p = 0.011), Ruminococcaceae (p = 0.004), Faecalibacterium (p = 0.004), Lachnospira (p = 0.005), Methanobrevibacter (p = 0.036) and Phascolarctobacterium (p = 0.011), compared to non-hospitalized patients. Considering the psychometric scales, UC-related hospitalized patients had higher scores on the Sc clinical scale (p = 0.032) and higher scores on the OBS (p = 0.044) and HEA (p = 0.026) content scales. Acidaminococcus (p = 0.023) and Bilophila (p = 0.045) were significantly more abundant in patients that underwent UC-related surgery compared to patients who do not. A PCA analysis, specifically conducted on the phyla, revealed differences only between patients who experienced at least one biological failure and those without therapy failure (PERMANOVA: F = 24.2, p = 0.049, explained variance = 48.89%). Other PCA analyses did not show significant differences between the various groups. At the binary logistic regression, Fusobacteria was negatively correlated with the failure of three or more biologics (OR = 0.000; B = -10,584.860, p = 0.028). Hy and Pd were positively correlated with the failure of three or more biologics (OR = 2.167; B = 0.773, p = 0.044) and 2.639 (B = 0.971, p = 0.024). Conversely, Pa and Pt were negatively correlated with multifailure, associated with odds ratios of OR = 0.622, B = -0.476, p = 0.041 and OR = 0.152, B = -1.886, p = 0.021 respectively.

Conclusion

Psychopathological features related to obsessiveness, health concerns, and somatization, along with specific microbiota characteristics (a lower abundance of SCFA-producing bacteria), may act as predictive factors for UC-related adverse outcomes.
P0426 Lumeneye digital proctoscopy is safe, and streamlines management of immune checkpoint inhibitor-induced colitis
Authors: Ibraheim H , Alexander J L , Balcorta M , Dolina G , Harrison Z , Young K , Powell N
Published: January 2025

Background

Immune checkpoint inhibitors (CPI) have transformed cancer outcomes, but trigger CPI-colitis in up to 46%, frequently incurring morbidity and CPI discontinuation. Diagnosis is via endoscopy, with >90% involving distal colonic inflammation. Timely diagnosis and treatment improve outcomes and reduce corticosteroid (cs) duration. The rising prevalence of CPI-colitis strains endoscopy services, risking delays in care. The Lumeneye, a cost-effective GI digital proctoscopy tool with biopsy capability, could streamline patient management pathways.

Methods

A prospective observational feasibility study was conducted at the Royal Marsden Hospital, UK. Patients with suspected CPI- colitis underwent Lumeneye proctoscopy with rectal biopsy sampling in an outpatient setting. Digital images were captured, and clinical data retrieved from electronic medical records. Patient comfort was evaluated using the Modified Gloucester Comfort Scale (MGCS) and, when applicable, compared to standard lower GI endoscopy performed within the previous 6 months. Clinical findings from Lumeneye and standard endoscopy were evaluated for concordance in patients who underwent both within 3 weeks.

Results

Forty Lumeneye procedures were performed on 37 patients (17 males and 20 females, median age 66 years). Cancers included melanoma (n=17), renal (n=4), lung (n=5), and “other” (n=11). CPI therapies included dual anti-CTLA-4/PD-1/L1 (n=14), and anti-PD-1/L1 monotherapy (n=23).

The mean time from referral to examination was shorter for Lumeneye (5 days, IQR 3-7) compared to lower GI endoscopy (21 days, IQR 14-26; p<0.001). The mean procedure time or Lumeneye was 6 (IQR 4-8) minutes. Lumeneye was associated with a lower MGCS score compared to lower GI endoscopy (2 -minimal discomfort vs 3-mild discomfort, p<0.001).

Endoscopic findings revealed normal mucosa in 19 patients; the remainder showed varying degrees of oedema, erythema, and erosions (Figure 1). In 5 cases, views were suboptimal. Concordance between Lumeneye and standard endoscopy was observed in 10/13 patients (83%), with histological agreement in 11/13 (85%).

In 11 cases, normal mucosal findings informed the rationale for rapid cs taper and administration of topical cs (Clipper). In 3 cases, Lumeneye expedited the diagnosis of severe CPI-colitis, leading to timely anti-TNFa escalation. In one case, suspected melanoma deposits in the rectum prompted investigation of metastatic disease.

Conclusion

Examination of patients with CPI-colitis in the physician’s office using Lumeneye was safe, well tolerated and reduced the burden on endoscopy services. Lumeneye streamlined the patient pathway by facilitating early, accurate diagnosis and allowing timely escalation or de-escalation of immunosuppressive therapy.
P0427 Nutritional factors associated with the presence of non-alcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD)
Authors: Castelhano N S , Oliveira E C S D , Lopes M A , Beraldo R F , Baima J P , Herrerias G S P , Quaglio A E V , Di Stasi L C , Barbosa W F , Silva G F , Sassaki L Y
Published: January 2025

Background

Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent in patients with inflammatory bowel disease (IBD), not only due to the presence of chronic inflammation, but also due to the presence of dysbiosis and risk factors for metabolic disease. Due to the complications of NAFLD, evaluation of at-risk patients is recommended. Therefore, the objective of the study is to evaluate the nutritional status and body composition in IBD patients, comparing groups with and without NAFLD, and identifying the factors associated with NAFLD.

Methods

A cross-sectional study was conducted, assessing clinical data, metabolic syndrome presence, nutritional status, and biochemical markers. Patients were categorized into IBD+NAFLD and IBD-only groups based on hepatic ultrasound findings. Statistical analysis included descriptive statistics and logistic regression.

Results

In total, 129 IBD patients were included, 67 (51.94%) UC and 62 (48.06%) CD, 89 (68.99%) female, 31 (24.03%) with high blood pressure, 18 (13.95%) with dyslipidemia, and 16 (12.40%) with diabetes. Biological therapy was indicated in 65 (50.39%) patients. Clinical activity was observed in 60 (46.51%) of the patients. Presence of NAFLD was observed in 57 (44.19%) patients, being mild (43.86%), moderate (43.86%) or severe (12.28%). Factors associated with the presence of NAFLD were BMI (p<0.0001), overweight or obesity (p<0.0001), waist circumference (p<0.0001), arm circumference (p=0.0002), arm muscle area (p= 0.0136), waist-hip ratio (p=0.0215), calf circumference (p=0.0003), triceps skinfold (p=0.0086), fat mass (p=0.0001), visceral fat (p<0.0001), and hang- grip (p=0.0071). Regarding biochemical tests, patients with NAFLD presented alterations in creatinine (p=0.0343), AST (p=0.0018), ALT (p<0.0001), gammaGT (p<0.0001), ferritin (p=0.0107), glycemia (p=0.0017), glycated hemoglobin (p=0.0064), triglycerides (p<0.0001), basal insulin (p=0.0012). The presence of NAFLD was not associated with IBD activity (p=0.59) or with the use of medications (p>0,05).

Conclusion

The prevalence of NAFLD was high in the IBD population. Risk factors for NAFLD are related to metabolic syndrome. Patients should be investigated for the presence of NAFLD with the aim of controlling risk factors to avoid progression to complications such as liver cirrhosis.
P0448 Unravelling genetic versus environmental factors determining disease course in Inflammatory Bowel Disease: a population-based cohort study in first- and second-generation immigrants
Authors: D’hooghe A T , Poulsen G J , Sørensen C N , Tandon P , Andersen N N , Vermeire S , Verstockt B , Jess T
Published: January 2025

Background

Inflammatory bowel diseases (IBD) incidence in immigrants approximates that of the host country in progressive generations.1 We investigate how immigrant generation affects IBD outcomes.

Methods

In this population-based cohort study, IBD-related hospitalizations, major and minor surgery, targeted therapies, and perianal disease were compared between first- and second-generation immigrants (stratified into Western/non-Western) and native Danes. Their sex, age at diagnosis and time of diagnosis were used to estimate adjusted hazard ratios (aHRs) using Cox proportional hazard regression.

Results

First-generation immigrants had lower risk of major surgery (aHRWestern 0.89; 95% confidence interval [CI] 0.75–1.05, aHRnon-Western 0.79; 95% CI 0.67–0.92) and targeted therapy (aHRWestern 0.87; 95% CI 0.76–0.99, aHRnon-Western 0.83; 95% CI 0.74–0.93) than native Danes, whereas second-generation immigrants resembled native Danes. However, second-generation immigrants had higher risk of hospitalization than native Danes (aHRWestern 1.28; 95% CI 1.05–1.55, aHRnon-Western 1.40; 95% CI 1.28–1.54), whereas in first-generation immigrants this was only observed in non-Western ulcerative colitis (UC) patients (aHR 1.19; 95% CI 1.08–1.32). Across both generations, non-Western immigrants had higher risk of minor surgery (Crohn’s disease [CD]: aHRfirst-generation 1.39; 95% CI 1.10–1.75, aHRsecond-generation 1.53; 95% CI 1.18–1.97), mainly due to increased incidence of perianal disease (CD: aHRfirst-generation 1.55; 95% CI 1.25–1.92; aHRsecond-generation 1.58; 95% CI 1.25–2.01).

Conclusion

Disease outcomes change across immigrant generations, pointing to environmental factors possibly impacting disease course, which needs further investigation. In contrast, non-Western immigrants have more perianal disease in both generations, suggesting a possible role of genetics for this debilitating phenotype.

References

1.Agrawal M, Corn G, Shrestha S, et al. Inflammatory bowel diseases among first-generation and second-generation immigrants in Denmark: a population-based cohort study. Gut. 2021;70(6):1037-43. doi: 10.1136/gutjnl-2020-321798.