bluuebunny/crossref_metadata_2025 huggingface dataset:
P384 Serum biomarkers of proteolytic type III and type IV collagen remodeling differentiate patients with Inflammatory Bowel Disease according to infliximab treatment response or non-response
Authors: Pehrsson M , Alexdottir M S , Steenholdt C , Boye T L , Karsdal M A , Bay-Jensen A C , Ainsworth M , Mortensen J H
Published: January 2024

Background

Characterized by chronic inflammation, patients with Inflammatory Bowel Disease experience detrimental remodeling of their intestinal extracellular matrix (ECM). Treatment with anti-inflammatory drugs can reduce the inflammation, leading to remission and tissue healing. However, adequate monitoring of patients is critical to ensure and maintain treatment response. As potential surrogate markers of ECM remodeling, we investigated blood-based neoepitope biomarkers of type III and type IV collagen in patients with IBD. We aimed to determine the value of the biomarkers for monitoring and predicting response to infliximab (IFX).

Methods

A total of 160 IBD patients initiating IFX treatment at visit 1 were included, having blood drawn at visits 1, 2, and 3, with treatment response evaluated at visit 3 using the Physicians Global Assessment (PGA) score. The response was defined as a PGA of 0 at Visit 3. Measuring the biomarkers C3M (MMP-9 degraded type III collagen) and C4A3-HNE (neutrophil elastase degraded type IV collagen α-3 chain) in the blood, we evaluated their ability to differentiate responders and non-responders to IFX induction therapy. The serum biomarker levels at each visit between responders and non-responders were statistically assessed using a mixed-effects model correction applying Bonferroni’s multiple comparison test and receiver operating characteristics (ROC).

Results

At all three visits, patients not responding to IFX treatment had significantly elevated C3M levels (p<0.001, <0.01, and <0.01) (Figure 1A). Quantifying serum C4A3-HNE demonstrated an elevation in responders at visits 1, 2, and 3, with a significant biomarker increase at visit 2 compared to non-responders (p<0.05) (Figure 1B). Determining the serum C3M levels at Visit 3 resulted in identifying non-responders with an area under the curve of 0.695 (sensitivity: 74.4% and specificity: 60.0%, p=0.009).

Conclusion

Quantifying the MMP-9 degraded C3M biomarker in the serum of IBD patients could differentiate responders and non-responders at visit 1 upon initiating IFX treatment. Serum C3M remained elevated in non-responders throughout the study period and applying ROC analysis quantifying C3M at Visit 3 could assist in identifying non-responders to IFX treatment. The C4A3-HNE biomarker was elevated in responders at all three visits, being statistically elevated at visit 2, indicating potential as a surrogate marker of IFX treatment response. Our data suggest differences in the proteolytic remodeling of type III and IV collagen quantified by neoepitope biomarkers between responders and non-responders to IFX treatment. The differences were quantifiable already at treatment initiation (visit 1).
P398 The Burden of Psychiatric Manifestations in Inflammatory Bowel Diseases: A Systematic Review with Meta-analysis
Authors: Massironi S , Pigoni A , Vegni E A M , Keefer L , Dubinski M C , Brambilla P , Delvecchio G , Danese S
Published: January 2024

Background

Psychiatric manifestation in individuals with inflammatory bowel disease (IBD) has been the subject of extensive research, but uncertainties remain regarding its precise magnitude, its impact on intestinal disease, and the whole burden of psychiatric manifestations.This systematic review aims to synthesize available evidence on the prevalence and impact of psychiatric disorders in patients with IBD.

Methods

A systematic search of PubMed/MEDLINE, EMBASE, and SCOPUS databases was performed to identify relevant studies published between January 2010 and January 2023. Cross-sectional, case-control, cohort, registry, and population studies that addressed the prevalence of depression, anxiety, bipolar disorder, and schizophrenia in patients with IBDs and that met the specific inclusion criteria were selected. A meta-analysis to assess the strength of association between IBD and selected psychiatric disorders was also performed. Data extraction and quality assessment were performed.

Results

The search yielded a total of 3209 articles. 193 met the inclusion criteria, but only 26 studies provided the complete data for the analysis (Table 1).

Overall, the prevalence of psychiatric comorbidities was found to be significantly higher in IBD compared with the general population. The analysis revealed a moderate but significant association between IBD and depression, with a pooled odds ratio (OR) of 1.42 (95%CI 1.33-1.52). (Fig.1)

Also, anxiety emerged as a prevalent comorbidity in IBD with a pooled OR of 1.3 (95%CI =1.22-1.44). Evidence on the relationship between bipolar disorders and IBD was limited and mixed, with a pooled OR of 1.64 (95%CI=1.20-2.24), despite a substantial heterogeneity (I2=94.01%). Only three studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR (p= 0,73), estimated at 0.93 (95%CI=0.62-1.39).

Conclusion

This systematic review with meta-analysis highlights that patients with IBD, both CD and UC, frequently experience psychiatric comorbidities such as depression, anxiety, bipolar disorders, and, to a lesser extent, schizophrenia. These disorders are more prevalent in IBD patients than in the general population. Depression and anxiety are particularly prevalent. Bipolar disorder is still an underexplored area in the context of IBD. Data on the relationship between schizophrenia and IBD is sparse and inconclusive and requires further research. Given the high prevalence of psychiatric comorbidities in IBD patients, the results of this systematic review underscore the need for a deeper understanding of these associations and early identification and tailored interventions for mental health in patients with IBD to improve their quality of life.
P411 Is transmural healing better than mucosal healing in pediatric Crohn’s disease?
Authors: D'Arcangelo G , Carnevale L , Oliva S , Maccioni F , Russo G , Busato L , Aloi M
Published: January 2024

Background

While the long-term benefit of achieving mucosal healing (MH) in Crohn’s disease (CD) has been demonstrated, data on transmural healing (TH), assessed by non-invasive imaging modalities (i.e. magnetic resonance enterography, MRE) are scarce, particularly in the pediatric setting. Nonetheless it has been deemed as an adjunctive target for CD by the STRIDEII consensus. We aimed to investigate the outcomes of pediatric CD patients with TH comparing them to those with MH and with “no healing”.

Methods

Prospective, single-center, observational study conducted at the Pediatric Gastroenterology and Liver Unit of the Umberto I Hospital, Sapienza University of Rome. Children with an established diagnosis of CD and under biological therapy undergoing an MRE and an ileocolonoscopy performed within a 3-month interval were consecutively enrolled. Transmural healing was defined as the complete healing of both the mucosa at endoscopy (absence of ulceration) and of the bowel layers at the MRE. In the presence of a normal colonoscopy but an active MRE children were deemed as MH. The group “no healing” (NH) included children with an active endoscopy, regardless of the MRE classification. At 6, 12, and 24 months, the following outcomes were evaluated and compared in the three groups: disease flares, CD-related hospitalization, CD-related surgery, need for step-up treatment, and occurrence of complications.

Results

93 children were included (30% female, mean age 11,2±3,8). Twenty-three (25%) were classified as TH, 27 (29%) as MH and 43 (46%) as NH. Overall, at the Kaplan Meier analysis, the risk of any unfavorable outcome was significantly lower in both TH and MH patients compared to NH (Log Rank p<0.0001 and p=0.002, respectively). Specifically, children with TH were at lower risk of hospitalization (p=0.02), and complications (p=0.007) compared to those with NH. No difference was found between MH and NH children for the same outcomes. Both TH and MH children were at lower risk of step-up treatment (p<0.0001 and p=0.0.0002, respectively) compared to NH. No difference was found between TH and MH patients for all the outcomes evaluated.

Conclusion

Achieving transmural healing in pediatric CD is associated with better long-term outcomes, although the additional benefit compared to reaching MH alone does not appear significant. However, the persistence of inflammation is associated with worse outcomes in all patients.
P412 Faecal Calprotectin as a predictor of endoscopic and histologic remission in patients with Ulcerative Colitis
Authors: Drügg Hahn G , Flores C , Afif W , Wild G , Bitton A , Lakatos P L , Bessissow T
Published: January 2024

Background

Faecal calprotectin (FCP) is a reliable surrogate marker for disease activity in ulcerative colitis (UC). However, there are no consensus cut-off values for histoendoscopic remission. The aim of the study is to correlate FCP with Mayo Endoscopic Score (MES) and histological disease activity (Geboes score) of UC patients in clinical remission.

Methods

We performed a prospective study including adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission (partial Mayo score ≤2) or disease relapse, undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FCP was collected. MES was documented during colonoscopy. Biopsies were taken throughout the colon and histological activity was assessed using Geboes score (GS) by a blinded expert gastrointestinal pathologist.

Results

The study included 253 patients, of which 117 (46%) were male with a mean age of 38.2 years (standard deviation [SD] ± 24.8). 46% of the patients had pancolitis at the time of colonoscopy. 5-aminosalicylate were used by 68.4% of patients while 20.9% were on immunomodulators, 19% on biologics and 0.4% on small molecules as treatment. Regarding endoscopic correlation, it showed that an FCP ≥ 200 μg/g predicts MES > 1 despite clinical remission, yielding sensitivity of 59% and specificity of 74%. A FCP ≥ 123 predicts MES > 0 despite clinical remission (58% sensitivity and 70% specificity), also aiding to differentiate MES 0 from MES 1 (61% sensitivity and 70% specificity). As to histologic correlation, a FCP ≥ 80 μg/g identified histological disease activity using Geboes criteria (GS score > 3.1) in patients with clinical remission, yielding 64.7% sensitivity, 58.7% specificity and 77% positive predictive value (Figure 1). When using a GS score threshold of > 2, a cut-off value of FCP ≥ 50 μg/g, appears to be the most clinically relevant to identify patients in clinical remission who continue to have active histologic inflammation, with an 49.6% sensitivity, 41.6% specificity and 40% positive predict value. Results are summarized in Table 1.

Conclusion

FCP correlates very well with endoscopic and histologic disease activity and can be used as a surrogate marker for disease activity. Our study prospectively demonstrated the optimal cut-off values helping to discriminate endoscopic healing and histologic remission.
P415 The influence of bowel urgency on the quality of life in individuals with ulcerative colitis
Authors: Karakan T , Dede A , Özgül S , Karataş A , Cindoruk M
Published: January 2024

Background

Ulcerative colitis (UC) is a persistent inflammatory condition marked by periods of relapse and remission, significantly impacting overall quality of life (QoL). Among the various symptoms influencing this quality, bowel urgency (BU) stands out as particularly distressing. BU manifests with profound negative implications on physical health, psychological well-being, and social aspects. Furthermore, bowel urgency (BU) is often omitted from the majority of disease activity scoring systems and is not consistently considered as a treatment outcome. Our objective was to explore the impact of BU on specific subgroups of QoL measures and its correlation with the partial Mayo score.

Methods

During this cross-sectional study, patients were categorized based on both BU and the concurrent partial Mayo score. The patients completed the Whoqol Bref questionnaire for assessing their QoL. Long-term outcomes, such as steroid use, hospitalization and colectomy, were evaluated at the 6-month follow-up.

Results

The study included 154 patients diagnosed with UC. When comparing BU with the partial Mayo score in terms of QoL, significant differences were found in the physical health domain (p<0.001), psychology domain (p<0.001), social relationship domain (p<0.014), and environmental domain (p<0.001). Among patients in remission according to the partial Mayo score (25/117, 21.3%), a notable proportion experienced bowel urgency (BU). BU was identified as a predictor for both steroid requirement (OR: 4.7; 95% CI [2.3-9.7], p<0.001) and hospitalization (OR: 4.7; 95% CI [2.3-9.7], p<0.001) during the six-month follow-up period. None of the patients required surgical intervention. Notably, even among patients in remission according to the partial Mayo score (25/117, 21.3%), bowel urgency (BU) persisted.

Conclusion

We noted that the existence of BU significantly impairs the quality of life for individuals with UC. Moreover, it is associated with an increased probability of future steroid use and hospitalization. Notably, some patients still experienced BU even while in remission. Further investigations are necessary to elucidate the mechanisms contributing to the persistence of these symptoms in these individuals.
P417 1 year follow-up of pediatric ulcerative colitis using intestinal ultrasound
Authors: Thornton S , Isaac D , Hudson A , Mckay D , Kuc A , Carroll M , Wine E , Huynh Dr H
Published: January 2024

Background

Intestinal ultrasound (IUS) is an emerging tool that offers a non-invasive method for monitoring inflammatory bowel disease in pediatric patients, with increasing popularity worldwide. Assessment of IUS for monitoring pediatric Ulcerative Colitis (UC) has been limited to small samples of patients with no long-term follow up. Our aim is to utilize intestinal ultrasound assessments obtained at routine time points to determine changes in IUS parameters within 12 months of study enrollment in newly diagnosed children with UC, and their relationship to biochemical markers, clinical assessments, and endoscopic findings.

Methods

Pediatric patients with suspected ulcerative colitis were prospectively enrolled through the Edmonton Pediatric IBD Clinic. Participants underwent IUS, clinical assessments, bloodwork for biomarkers, and fecal calprotectin (FCP) testing at baseline, 1-, 3-, 6-, and 12-month visits, as well as endoscopy at baseline and 6-12 months. In each IUS assessment, the bowel wall thickness (BWT), presence of hyperemia, abnormal haustrations, and fat wrapping was determined in 4 bowel segments (right, transverse, descending, and sigmoid colon). The Pediatric Ulcerative Colitis Activity Index (PUCAI) scores and Ulcerative Colitis Intestinal Ultrasound Scores (UC-IUS) were calculated at each visit.

Results

42 patients (55% male) were included. Median UC-IUS total scores and BWT alone improved in all bowel segments over the study period. For the most affected bowel segment for all patients, median percent reduction of BWT was 39.6%, 34.2%, 33.7%, and 42.5%, at the 1-, 3-, 6-, and 12-month assessment respectively. The biggest decrease in UC-IUS scores and BWT occurred with the initiation of therapy between baseline and 1-month. UC-IUS scores significantly correlated with endoscopy at 12-months, clinical assessments at all time points, and biochemical markers of disease at all time points over the 12-month study period (p<0.05). BWT measurement alone also had significant correlation with endoscopy at 12 months; clinical assessment at 1-, 3-, and 6-months; and with biochemical markers at every time point (p<0.05). Patients with inflammatory bowel markers (indicated by elevated FCP (>250)) at 12-months were found to have significantly thicker BWT and UC-IUS scores at 3- and 6-months.

Conclusion

BWT and UC-IUS performed well in pediatric patients with newly-diagnosed UC, with UC-IUS scores and BWT measurements alone correlating significantly with endoscopic, clinical, and biochemical disease activity over the 12-month study period. BWT alone performed similarly to total UC-IUS scores. This data suggests that IUS can offer a non-invasive method to monitor long-term pediatric UC disease severity.
P418 Lipopolysaccharide-Binding Protein (LBP) in Crohn's Disease (CD) Patients: A Promising Non-Invasive Biomarker Monitoring Disease Activity
Authors: Minsart C , Toris L , Husson C , Franchimont D , Liefferinckx C
Published: January 2024

Background

Current biomarkers of inflammatory bowel disease (IBD) monitoring (serum C-reactive protein (CRP) and faecal calprotectin (FC)) have limitations in terms of specificity (SP) and sensitivity (SE), especially for Crohn’s disease (CD) patients. Lipopolysaccharide-binding protein (LBP) is a soluble acute-phase protein and is thought to partly reflect intestinal permeability by binding to bacterial lipopolysaccharides. The search for new biomarkers to monitor disease activity would improve the management of IBD patients.

Methods

This is a retrospective study including 69 IBD patients (43 CD and 26 ulcerative colitis (UC)) and 21 healthy controls (HC). Serum LBP levels were measured by enzyme-linked immunosorbent assay. Clinical, biological and endoscopic parameters were analysed for IBD patients. Statistical tests, including nonparametric tests and receiver operating characteristic (ROC) curve analysis, were used to evaluate the diagnostic accuracy of LBP.

Results

Demographics and baseline data of the overall cohort is presented in Table 1. IBD patients displayed a significantly higher LBP median (29.6 µg/mL [19.8-38.8] in CD and 22.8 [13.7-38.8] in UC) than HC (5.5 [4.4-6.5], P < 0.001) with no overlapping distributions, a finding supported by an AUC of 0.997 and 0.989, respectively for CD and UC patients (Figures 1A).

In CD patients, LBP levels gradually increased with endoscopic severity, demonstrating a 1.7-fold rise in active patients compared to remitter patients (P=0.02) (Figure 1B). LBP levels were higher in Montreal B1 compared to B2 and B3 CD patients (P < 0.001) (Figure 1C). Overall, a robust correlation was observed between LBP and CRP (ρ=0.75, P < 0.001). The correlation increased upon the exclusion of cases with normal CRP levels but active endoscopic disease (ρ=0.79, P < 0.001). In those endoscopically active patients with normal CRP, LBP level was higher than in remitter patients (34.3 [29.4-37.6] vs 19.1 [10-24.7], P=0.01) with a discriminative cut-off of 25 µg/mL (SE of 100%, SP of 89%).

Likewise, LBP level exhibited a positive correlation with FC (ρ=0.42, P < 0.01) which was further strengthened after excluding cases where FC measurements did not align with endoscopic activity (ρ=0.53, P < 0.01). The median LBP for those patients was 25.6 [18.5-31.5], reflecting again the interest of LBP measurement to evaluate CD activity when FC lacks sensibility.

Conclusion

Our study suggests that LBP might be a promising non-invasive biomarker for monitoring disease activity, especially in CD patients. Furthermore, in clinical situations where current biomarkers (CRP and FC) lack sensitivity for assessing disease activity, LBP could be discriminative and help filling the gap for reliable therapeutic decisions.
P420 Natural history of intra-abdominal inflammatory masses (phlegmons) in Crohn’s disease
Authors: Djalal A , Sehgal P , Shenoy S , Benson C , Rajauria P , Agrawal M , Colombel J F , Lewis J , Ungaro R
Published: January 2024

Background

Intra-abdominal inflammatory masses (phlegmons) are a feature of penetrating Crohn’s disease (CD). However, there are few data on the natural history and outcomes of inflammatory masses in CD. We aimed to describe clinical outcomes and predictors of surgery in individuals with CD and intra-abdominal inflammatory masses (IAIM).

Methods

We conducted a multi-center retrospective cohort study. Patients with a diagnosis of CD or inflammatory bowel disease unclassified (IBD-U) and a finding of phlegmon, phlegmonous change or inflammatory mass on cross-sectional imaging with IV contrast (MR or CT) at two tertiary care centers were included between July 2006 and April 2023. Data collected included demographics, clinical characteristics, Montreal CD classification, treatments at the time of and after IAIM diagnosis, and size and location of the IAIM. Primary outcome was surgery defined as any CD-related resection or surgical drainage. Bivariate comparisons between patients who did or did not undergo surgery were performed. Multivariable logistic regression was performed with backward selection of variables to identify those associated with surgery.

Results

A total of 100 patients were included, and comparison between those who did or did not undergo surgery is given in Table 1. Most were white (80%), 44% were women, and 12% were current smokers. A majority had ileocolonic disease location (77%) and 50% were on a biologic at time of diagnosis. Mean size of IAIM was 3.4 cm and the majority (72%) were located adjacent to small bowel. Radiologic evidence of intra-abdominal fistula was seen in 40%, and 30% of patients had a stricture adjacent to the IAIM.

A large proportion required hospitalization (75%) and received intravenous antibiotics (64%); 13% progressed to an abscess, and the mean (SD) time to abscess was 108 (119.4) days. The majority (65%) underwent surgery, with a mean (SD) time to surgery of 59 (97.8) days. Seven patients developed sepsis, all of whom subsequently required surgery. On multivariable analysis, patients were more likely to require surgery if there was a concomitant stricture (aOR = 3.12, 95% CI 1.01 – 11.9) and less likely to require surgery if treated with steroids (aOR = 0.15, 95% CI 0.03 – 0.61). Antibiotic use was not associated with surgery (aOR 1.22, 95% CI 0.53 – 2.81) nor was IAIM size.

Conclusion

In this large retrospective cohort, most intra-abdominal inflammatory masses required surgery, particularly if there was a concomitant stricture. Patients treated with steroids were less likely to require surgery though this may be confounded by severity of disease.
P427 Inflammatory bowel disease after liver transplantation: a retrospective cohort study from Latin America
Authors: Penna F G C E , Bayma L R , Azzi L L M , Faria A A D , Campos J F , Ferrari M D L D A , Daguer F B R , Azevedo M F C D , Carlos A D S , Cançado E L R , Terrabuio D R B , Damião A O M C , Barros L L
Published: January 2024

Background

The management of inflammatory bowel disease (IBD) in the setting of liver transplantation (LT) is a significant challenge. Previous data have described conflicting results on the incidence of relapses, risk of colectomy and post-transplant prognosis. In addition, there is no guidelines to recommend specific immunosuppressive regimens in this scenario. Our aim is to describe the IBD course in a cohort of liver transplanted patients in Latin America.

Methods

Medical records from two quaternary centers were reviewed using informatics tools to identify patients with Crohn’s Disease (CD) and Ulcerative Colitis (UC), associated with LT, from January 2010 and July 2023. Data on demographics, IBD phenotype, immunosuppressive therapy and infections were extracted.

Results

Among 1,683 patients that underwent LT, 45 had concomitant IBD diagnosis. Most for them (55%) were diagnosed with IBD prior to the LT. The median age at IBD diagnosis was 45 years and 57% were male. The majority had UC (80%). The causes of LT were primary sclerosing cholangitis in 24 (53.3%) patients, overlapping with autoimmune hepatitis (AIH) in 15 (33.3%), isolated AIH in 9 (20%), AIH with or without primary biliary cholangitis (PBC) in 4 (8.8%), viral hepatitis in 3 (6,6%) and other causes in 2 (4.4%) patients. Regarding immunosuppression, 19 (42.2%) patients were treated with tacrolimus, 10 (22.2%) with tacrolimus and mycophenolate mofetil, 8 (17.7%) with tacrolimus and azathioprine, 3 (6.6%) tacrolimus and everolimus, 3 (6.6%) with mycophenolate mofetil and cyclosporine, 2 (4.4%) patients with cyclosporine monotherapy. Before LT, 13 (28.8%) patients were treated with aminosalicylates and/or thiopurines, while 2 (4.4%) of them were on biologics. After LT, 20 (44.4%) patients required biological therapy, 11 (24.4%) were treated with anti-TNF (infliximab and adalimumab), 5 (11.1%) with vedolizumab, 3 (6.6%) with ustekinumab and 1 with tofacitinib. Seven (15.5%) patients required total colectomy for refractory disease, 75% after LT. Sixteen (35.5%) patients developed serious infections and the most frequent were cholangitis and cytomegalovirus (68.7%). Two patients developed adverse events, such as infliximab-induced autoimmune hepatitis and thrombocytopenic purpura related to the tacrolimus. Eight (17.7%) patients had malignancies, 3 of them related to the baseline conditions such as hepatocellular, gallbladder carcinoma, colorectal cancer, while 4 patients died during the follow-up.

Conclusion

In our experience, IBD patients undergoing LT exhibited an aggressive disease course and required concomitant biological therapy, despite the ongoing immunosuppressive regimens.
P429 Explainable AI identified metabolome and diet interactions in the blood and faceal samples
Authors: Acharjee A , Onwuka S , Bravo L , Gkoutos G
Published: January 2024

Background

Background: Inflammatory Bowel Disease (IBD) represents a multifaceted condition that can be characterised by the interplay of four primary elements: immunity, genetics, microbiome and environmental factors. Among these, the relationship between nutrition and the metabolome is pivotal and a number of machine learning based approaches have been developed in an effort to gain a better understanding of this relationship. Nevertheless, to date, these approaches suffer from interpretability, thereby restricting their practical applicability within clinical settings.Hence, in this study, we leverage two publicly available datasets, the UK Biobank (UKB) and the Human Microbiome Project Phase II IBD Multi’Omics Database (HMP2), to perform metabolomics-based IBD disease predictions. We apply explainable an AI (XAI) based framework to understand these predictions and explore the diet-metabolite relationships in IBD and non-IBD individuals.

Methods

4,137 plasma samples (2,099 IBD, 2,038 non-IBD) from UKB and 546 fecal samples (411 IBD, 135 non-IBD) from HMP2 with complete dietary data were used in the analysis. Random forest classification, optimized by grid search and estimator retraining was then trained to predict disease with Shapley Additive exPlanations (SHAP) included downstream to generate further insight on the model’s predictions. Finally, diet-metabolite associations were examined using Spearman-based correlations.

Results

From the plasma dataset, inflammatory markers, HDL and LDL cholesterols and omega 3 fatty acids were identified in relationship with IBD diagnosis. Within the feces samples, the discriminatory metabolites identified included B vitamins, phospholipids, urobilin, and taurine, and these latter provided a better predictive power than the plasma derived biomarkers (AUC: fecal 0.90.(95% CI: 0.84-0.96), plasma 0.66 (95% CI: 0.61-0.71). Regarding diet contribution, fish, fruit, vegetables, and processed foods exhibited a strong correlation with metabolites in both datasets, with correlations in fecal samples exhibiting a stong difference between IBD and non-IBD patients.

Conclusion

While this study has certain limitations, these results suggest that, compared to healthy individuals, IBD patients are characterised by a distinct gut profile primarily influenced by diet. It also suggests that disease, or health, influences how the gut responds to food intake. Future studies should confirm these findings using XAI and analysing both gut and blood matrices in same individuals along with their dietary intake for personalized IBD therapy development.
P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype
Authors: Avellaneda N L , Pellino G , Maroli A , Tottrup A , Bislenghi G , Colpaert J , D'Hoore A , Giorgi L , Juachon P , Harsløf S , de Buck Van Overstraeten A , Olivera P , Gomez J , Holubar S , Lincango Naranjo E , Steele S , Merchea A , Shacker A , Marti Gallostra M , Kraft M , Kotze P G , Yuki Maruyana B , Wexner S , Garoufalia Z , Zhihui C , Hahnloser D , Rrupa D , Buskens C , Haanappel A , Warusavitarne J , Williams K , Christensen P , Spinelli A
Published: January 2024

Background

Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease.

Methods

A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study.

Results

2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: < 0.001), and low albumin (11.3 vs. 2.6%, p: < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: < 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030).

Conclusion

Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.
P443 Transmural Remission Associates with a Lower Risk of Phenotype Progression in Crohn’s Disease
Authors: Fernandes S R , Rodrigues I , Saraiva S , Bernardo S , Rita Gonçalves A , Moura Santos P , Valente A , Correia L , Cortez-Pinto H , Magro F
Published: January 2024

Background

Patients with Crohn’s disease (CD) are at risk of progressing from inflammatory to stricturing and penetrating phenotypes. The influence of the type of remission on phenotype progression has not been adequately evaluated.

Methods

Retrospective cohort study including surgically naïve CD patients with inflammatory or stricturing phenotype evaluated concomitantly by magnetic resonance enterography and colonoscopy. The degree of remission was correlated with the risk of progressing to stricturing and penetrating phenotypes.

Results

381 CD patients were included, 21.8% with transmural remission, 21.3% with isolated endoscopic remission, 10.5% with isolated radiologic remission, and 46.5% without remission. Patients with transmural remission presented the lowest rates of phenotype progression (1.2%), with a significant difference compared to isolated endoscopic remission (18.3%, P≤ 0.001), isolated radiologic remission (17.5%, P=0.002), and no remission (36.9%, P≤0.001). In multivariate regression analysis, transmural remission (OR 0.023 95%CI 0.003-0.171, P<0.001), isolated radiologic remission (OR 0.342 95%CI 0.141-0.826, P=0.017), and isolated endoscopic remission (OR 0.441 95%CI 0.220-0.881, P=0.020) resulted in lower rates of phenotype progression compared to no remission.

Conclusion

The degree of intestinal remission correlates with the risk of phenotype progression. Patients with transmural remission are at the lowest risk of progressing to stricturing and penetrating phenotypes.

Figure 1 presents the Kaplan-Meier estimates of remaining free of penetrating complication (upper curve) and free of stricturing and/or penetrating complication (lower curve) after the baseline assessment in patients with no remission (A), isolated endoscopic remission (B), isolated radiologic remission (C), and transmural remission (D). B1, non-stricturing non-penetrating phenotype; B2, stricturing phenotype; B3, penetrating phenotype.
P444 Active perianal Crohn’s disease negatively impacts patients’ quality of life, psychosocial wellbeing and is associated with barriers related to social determinants of health
Authors: Shenoy S , Debroff J , Lacoste J , Giselbrecht E , Keefer L , Wong S Y
Published: January 2024

Background

Perianal fistulizing Crohn’s Disease (PFCD) is associated with poor quality of life (QoL) and increased healthcare utilization. However, the effect of PFCD on patients’ lives remain incompletely understood. We conducted a survey-based study of patients with PFCD to examine the impact of perianal fistula disease activity on QOL, psychosocial wellbeing, and barriers related to SDOH.

Methods

Patients aged 18 years and above with a diagnosis of PFCD were included between July and November 2023 at Mount Sinai Hospital. Patient data, including demographics and clinical data, were obtained from patients and chart review. Perianal disease classifications were assessed through chart review. Crohn’s anal fistula quality of life (CAFQOL) scale, PROMIS scale for anxiety and depression, Internalised stigma for mental illness (ISMI), Everyday discrimination scale, health first screening tool for SDOH and the Cantril ladder of life scale were administered to patients. Patients with active PFCD, defined as perianal pain and/or drainage, were compared to patients with inactive PFCD, defined as lack of perianal pain or drainage. Descriptive statistical analysis was performed using SPSS

Results

A total of 50 patients were included in the study, of whom 39 had active disease and 11 inactive disease (Table 1). Annual household income was lower among patients with active PFCD (p=0.017). Disease characteristics such as Montreal classification, HBI and perianal disease classification, presence of proctitis, surgical history were similar across both groups. Overall, patients with active PFCD compared to inactive PFCD had higher CAFQOL scores (mean active:inactive;1.82:0.44, p<0.001). Patients with active PFCD also had higher rates of depression and anxiety (mean 2.06:1.23, p=0.020). Internalised stigma was higher among patients with active PFCD. There was no difference in discrimination faced as a consequence of PFCD. 20.5% and 12.8% patients with active PFCD reported facing social isolation and food insecurity respectively. By the Cantril ladder, patients with active PFCD had lower current life satisfaction compared to inactive PFCD (mean 6.03:7.60, p=0.024). However, there was no difference in their outlook on life satisfaction in 5 years.

Conclusion

In our cohort, perianal disease activity alone results in significantly worse quality of life and negatively impacts psychosocial wellbeing. Patients with active PFCD are at risk for barriers related to SDOH which are known to have implications on health equity.
P446 Influence of seasonal vitamin D deficit in clinical course of inflammatory bowel disease patients
Authors: Baz-Lopez A , Baston-Rey I , Martí-Marqués E , Calvino-Suarez C , Santos-Blanco E , Ferreiro-Iglesias R , Blanco-Hortas A , Lopez-Roses L , Dominguez-Munoz J E , Barreiro-de Acosta M
Published: January 2024

Background

Vitamin D deficiency is common in healthy subjects and it is even more prevalent in inflammatory bowel disease (IBD). Vitamin D (VitD) may influence disease behavior. Whether a deficient vitamin D status facilitates flares or flares consume vitamin D is still a burning question. Data on seasonal variations of VitD levels in IBD are scarce. The aim of this study was to evaluate VitD deficit in IBD patients compared with general population and the influence of seasonal variation in their evolution.

Methods

A prospective two center study was performed. Patients with Crohn disease (CD) or ulcerative colitis (UC) and no comorbilities that may have influenced VitD were consecutively included from two IBD centers with geographical proximity (less than 100 kms) in order to have comparable solar radiation. Clinical and biochemical characteristics of patients were recorded. Patients were followed for two consecutive seasons, VitD was measured twice: during winter and during summer. VitD levels from general population were also available. Both hospitals share the same methodology for VitD testing. VitD levels were defined as normal (>30 ng/ml), insufficient (20-30 ng/ml), or deficient (<20 ng/ml). Data were analyzed and Mann-Whitney U test was applied using R to compare subsets of patients.

Results

199 patients with IBD were consecutively included (38.7% CD, 61.3% UC). 165 (83%) patients have consecutive determinations of VitD (both in summer and winter). Mean age was 47.1, being 54.8% males and 45.2% females. Median value of VitD in winter was 14 ng/ml, and 21 ng/ml in summer. Lab tests in our center for general population in winter presented a median value was 21.2 ng/ml in winter and 24 ng/ml in summer (Figure 1). According values of our laboratory in winter, just 31% of the general population presented VitD values > 30 ng/ml in summer and 26.7% do so in winter. For our cohort of patients with IBD, the results are more pronounced: only 3.8% presented normal values in winter and 23.2% in summer (Table 1). The average variation in VitD values has been 9.26 ng/ml between the two seasons. No statistically significant relationship was found between the factors analyzed (BMI, location, calprotectin levels or disease duration) and VitD levels, neither in summer nor in winter. Most patients remained in remission despite having low VitD levels (82,8% in winter and 80,3% in summer).

Conclusion

VitD deficit was frequent in summer and in winter in IBD and more prevalent than in general population. Despite frequent deficit only a small percentage of patients presented disease activity. No relationship was observed between VitD deficit and patients characteristics or calprotectin levels.
P450 Influence of radon levels at home in the clinical course of inflammatory bowel disease incident patients
Authors: Mauriz Barreiro M V , Ruano-Raviña A , Ferreiro-Iglesias R , Baston-Rey I , Calvino-Suarez C , Nieto-García L , Porto-Silva S , Martinez-Seara X , Peón-González J , Dominguez-Munoz J E , Barreiro-de Acosta M
Published: January 2024

Background

Inflammatory Bowel Diseases (IBD) are a group of pathologies of unknown etiology associated with some environmental factors, only partially identified. The role of indoor radon, a radioactive gas, has not been formally studied and it might play a role on the evolution of the disease. The aim of this study is to analyze if residential radon exposure is associated with the evolution and development of flares or hospitalizations of IBD new diagnosed patients in a radon-prone area.

Methods

An observational prospective study was developed between June 2020 and September 2023, including incident cases with IBD that had been living at least 5 years in the same dwelling, those with a change of address in the last 5 years prior to diagnosis were excluded. All patients were followed-up through one year to assess the evolution of the disease. Hospitalizations related with the disease during the period, and number and severity of flares (measured by Partial Mayo Score and Harvey- Bradshaw) were collected. Radon levels were measured over three months in the participants’ home. Each individual was provided with a residential radon meter (a RSKS trace detector), given and read by the Galician Radon Laboratory, a certified radon laboratory. Radon concentrations were categorized into three groups, 0-99 Bq/m3, 100-299 Bq/m3 and >299 Bq/m3. Results are expressed as Odds Ratios with their 95%CI obtained through logistic regression.

Results

136 patients with IBD (78 ulcerative colitis, 52 Crohn’s disease and 6 unclassified colitis) were included and prospectively followed, with a median age of 52 years old (IQR 40 – 59). 50% were females. There were no statistically significant differences in radon levels, taking levels of 0-99 Bq/m3 as reference, between patients hospitalized compared with non-hospitalized (OR 0.8 95%CI 0.3-2.1 for 100-299 Bq/m3, OR 1.7 95%CI 0.6-5.0 for >299 Bq/m3) nor in patients with a flare compared with patients without flares during the follow-up year (OR 0.4 95%CI 0.0-4.5 for 100-299 Bq/m3, OR 5.4 95%CI 0.8-34.3 for >299 Bq/m3). Radon levels were not associated with the number of flares either (OR 0.6 95%CI 0.3-1.7 for 100-299 Bq/m3, OR 1.5 95%CI 0.5-4.5 for >299 Bq/m3). Results are shown in table 1. Stratifying by type of IBD, results do not vary. For Crohn’s disease, OR for flare are 2.5 (95%CI 0.4-16.1) and 4.1 (95%CI 0.6-27.9), and for hospitalization 1 and 6.5 (OR95% (0.2-205-2). For ulcerative colitis, OR for flare are 0.6 (95%CI 0.2-1.8) and 1.8 (95%CI 0.4-7.8) and for hospitalization 0.9 (95%CI 0.1-17.1) and 9.3 (95%CI 0.6-134.0).

Conclusion

Indoor radon concentration seems to be not associated with an initial worst evolution of IBD patients in terms of hospitalizations or flares.
P467 Towards AI-Augmented Clinical Decision Making: An Examination of ChatGPT's Utility in Acute Ulcerative Colitis Presentations
Authors: Levartovsky A , Ben-Horin S , Kopylov U , Klang E , Barash Y
Published: January 2024

Background

ChatGPT is a large language model based chatbot created by OpenAI. Since its release, ChatGPT has gained widespread attention among the healthcare community regarding its potential utility as a medical practice tool. In addition, ChatGPT can be adapted to serve as a clinical-decision support tool. In this study we explored the potential of ChatGPT as a decision support tool for acute Ulcerative Colitis (UC) presentations in the setting of the emergency department (ED).

Methods

Our investigation centered around 20 distinct acute UC presentations to the ED, accumulated over two years. Case summaries - embodying crucial data points such as symptoms, vital signs, and laboratory results - were processed by ChatGPT. For each case, we asked ChatGPT to assess disease severity based on the TrueLove and Witts classification, substituting erythrocyte sedimentation rate ≥30 with C-Reactive protein ≥12. Furthermore, it was to recommend hospitalization or outpatient care for each case based on the disease severity. The answers were compared with assessments made by our department's gastroenterologists and the actual decision made by the physician in the ED.

Results

Overall, ChatGPT categorized 12, 7 and 1 patient with severe, moderate and mild disease, respectively. For each case, ChatGPT supplied a detailed answer depicting severity of every variable of the criteria and an overall severity classification (table 1). Compared to our gastroenterologists’ assessments, ChatGPT graded 16/20 (80%) of the patients with the same severity. A high degree of reliability was found between the two assessments as the average measure intra-class correlation coefficient of absolute agreement was 0.839 (95% confidence interval 0.588-0.937, F= 5.95, p<0.001). Inconsistencies in four cases stemmed primarily from inaccurate cut-off values for systemic variables. Following severity assessment, ChatGPT leaned towards hospitalization for 16 out of 18 (88.9%) patients. For two moderate UC cases, however, it could not provide a decisive recommendation. Comparatively, only 12 out of the 20 patients were hospitalized in actual clinical practice.

Conclusion

In this unique study, findings suggest that Chat-GPT, has potential as a clinical decision-support tool in assessing UC severity and recommending suitable settings for further treatment. While this concept warrants further investigation and validation, its ability to evaluate a clinical scenario based on established criteria could greatly benefit the field of Inflammatory bowel disease and gastroenterology.
P476 Correlation between fecal calprotectin and inflammation on ultrasound in fibrostenotic Crohn’s Disease
Authors: Gulhati V , Rosentreter R , Motamedi M , Macci A , Ingram R , Kaplan G , Ma C , Seow C , Novak K , Panaccione R , Lu C
Published: January 2024

Background

Fibrostenotic Crohn’s Disease (CD) is a challenging phenotype particularly due to the absence of intestinal anti-fibrotic therapies. Differentiating between strictures that are predominantly fibrotic versus inflammatory remains a diagnostic dilemma. The ability to make this differentiation is critical to inform therapeutic decisions. Fecal calprotectin (FC) is a stool marker reflective of intestinal inflammation. Very few studies have evaluated the relationship of FC concentration in ileal CD strictures and parameters of inflammation on intestinal ultrasound (IUS). Strictures on imaging are defined as 1) increased bowel wall thickness (BWT), 2) narrowed luminal apposition, and 3) pre-stenotic dilation (PSD). BWT and hyperemia (color Doppler signal (CDS)) are the most sensitive markers for CD inflammation on IUS. It is predicted that FC will match CDS in ileal strictures, similar to non-stricture phenotypes. We aim to correlate FC levels with IUS inflammation of ileal CD strictures.

Methods

We performed a retrospective cohort pilot study exploring the relationship between FC levels and IUS inflammatory parameters in ileal strictures. FC levels were obtained ≤ 60 days of index IUS in fibrostenotic ileal CD patients. Individuals who underwent medication changes or experienced a clinical flare during this period were excluded. Inflammation was measured as BWT and CDS using a modified Limberg (ML) score. Pearson correlation for continuous variables, Spearman rank correlation and a Kruskal-Wallis test for FC and Limberg scale were completed.

Results

A total of 25 fecal samples were obtained from 17 patients with ileal strictures (47% male, median age 59 years (range 18-76)) were assessed. Median FC concentrations was 204.9 ug/g, IQR: 250.4. Median ileal stricture BWT was 7.0 mm (range 3.0–10.0). 40% (10/25) had ML1 (short chains in bowel), 32% (8/25) ML2 (long chains in bowel), and 28% (7/25) ML3 (long chains and perienteric fat). There was no correlation between FC and BWT (r=0.02, p=0.92), nor FC with ML scores (r=0.20, p=0.25). In those with ML1, median FC was 232.4, while those with ML2 or 3, had a FC of 155.6 and 469.7, respectively. FC values were significantly different between the ML scores, p<0.0001.

Conclusion

FC levels were not correlated with inflammatory parameters as seen on IUS in ileal CD. This unexpected finding may be due to ML2 scores having lower FC than anticipated, and small sample size. Other imaging factors such as loss of wall stratification need to be taken into account, and are perhaps more reflective of inflammation than BWT and CDS. This study provides the initial data to assess accuracy of FC and hyperemia of ileal CD strictures on IUS compared to histologic measures of inflammation on resected specimens.