bluuebunny/crossref_metadata_2025 huggingface dataset:
P331 Photoplethysmography waveform analysis detects inflammatory status in patients with inflammatory bowel disease
Authors: Chowers Y , Banai-Eran H , Akavia L , Ollech J E , Peleg N , Snir Y , Avni-Biron I , Saidov G , Yanai H , Dotan I
Published: January 2024

Background

Early detection of inflammatory flares and corresponding treatment adjustment were shown to improve inflammatory bowel disease (IBD) patient care. Current episodic inflammatory biomarker testing allows limited monitoring and is associated with suboptimal compliance. We aimed to test the feasibility of monitoring patient inflammatory status by non-invasive photoplethysmography (PPG) waveform analysis.

Methods

Patients hospitalized due to IBD flares and flaring outpatients treated with IV biologics were continuously monitored using a finger-based PPG device. Flares were defined as Harvey Bradshaw index>5, or partial Mayo score> 3, or fecal calprotectin >250mcg/gr, or C-reactive protein (CRP)>1.5X the upper normal limit. We extracted and analyzed features from the raw PPG waveform to predict levels of CRP, erythrocyte sedimentation rate (ESR), and platelet counts during hospitalization. Ambulatory patients were assessed at each scheduled infusion. Models were developed using support vector machines (SVMs). The dataset was partitioned into a training set, comprising 75% of the data, and a validation set, comprising the remaining 25%. Principal component analysis (PCA) on the PPG waveform features was conducted to assess potential distinctions correlating with levels of inflammatory markers.

Results

Monitoring results were available from twenty-six patients (14 Crohn's disease, 12 ulcerative colitis). Analysis of all pooled PPG measurements revealed that the PPG waveform analysis enabled prediction of ESR results with R2 0.91, and root mean square error (RMSE) 5.6; of platelet count with R2 0.87 RMSE 59.1; and CRP with R2 0.69 RMSE 1.55. Analysis of individual patient data demonstrated that PPG features reflected different ESR values along the treatment course as depicted in a representative example in Figure 1. Dynamics of PPG measurements were demonstrated in all monitored patients as compared to partial detection of inflammatory dynamics by conventional biomarkers.

Conclusion

Analysis of PPG waveform features allowed continuous passive monitoring of the inflammatory status in patients with IBD and was sensitive to daily dynamics in a heterogenous patient population. This technology may allow feasible, sensitive and continuous patient inflammatory state monitoring and support optimized IBD patient care.

Figure legend:

PPG signal features reflect the changes in ESR values across treatment days

Each dot represents a single measurement. Colors represent different days. Dot diameter is proportional to ESR values.
P347 A Trend Analysis of Inflammatory Bowel Disease in Non-Endemic Era (1993-2023)
Authors: Çagir Y , Durak M B , Coskun O , Tenlik I , Yurekli O T , Hamamci M , Atay A , Yildirim A , Ergul M , Kalkisim A F , Yilmaz A , Keskin E T , Ince M M , Ozturk O , Fedai A B , Gokbulut V , Kalkan C , Ozturk O , Bolat A D , Yuksel M , Koseoglu H T , Yuksel I
Published: January 2024

Background

In this study, we aimed to evaluate the demographic and epidemiological trends of Ulcerative Colitis (UC) and Crohn’s Disease (CD) in non-endemic era for inflammatory bowel disease (IBD) during the past three decades.

Methods

UC and CD patients who had follow-up at least 6 months between June 1993 and February 2023 were evaluated retrospectively. Electronic medical databases, personal queries and IBD registries have all been used to collection data on the clinical and demographic characteristic of all patients.

Results

A total of 1549 adult patients with UC and CD were admitted to study. UC was diagnosed in 873 (56.4%) patients (Male 538, 61.6%) and CD was diagnosed in 676 (43.6%) patients (Male 404, 59.8%). The median follow-up duration was 8.3 years for UC patients and 6.8 years for CD patients. In patients with UC, proctitis was 154 (17.6%), left sided colitis was 410 (47%) and extensive colitis was 309 (35.4%). In CD patients, ileal involvement was found in 297 (43.9%), colonic in 76 (11.2%), ileo-colonic in 299 (44.2%) and isolated upper GI involvement in 4 (0.6%) cases. 529 (78.3%) patients had non-stenosing non-penetrating behavior, 45 (6.7%) had stenosing behavior, 102 (15.1%) had penetrating behavior, as well as 196 (29%) patients had perianal disease. Mesalazine 658 (75.4%) and thiopurine 397 (45.5%) were the most frequently used conventional treatments for UC, while thiopurine 304 (45%) was most commonly used for CD patients. In the last two-decade, proportion of the biologic usage were 27.9% and 32.1% in UC patients 28.5% and 31.4% in CD patients respectively. Over the three decades, abdominal surgery was 49.2%, 27.8% and 36.3% in CD and colectomy rates was 2.0%, 2.7% and 3.7% in UC patients.

While the rate of UC patients has slightly decreased to 98 (61.6%), 401 (58.5%) and 374 (53%) frequency of CD patients has increased to 61 (38.4%), 284 (41.5%) and 331 (47%). Over the course of three decades, there were more UC patients than CD patients, however proportion of UC/CD has been continuously decreased (1.61, 1.41 and 1.13) for three decades respectively.

Conclusion

Our study showed that the frequency of UC and CD has significantly increased during the previous three decades in non-endemic era for IBD. While the frequency of UC patients has slightly decreased, that of CD patients has steadily increased over the past three decades. Although the use of biologics has significantly increased, proportions of the abdominal surgeries and colectomies has not prominently changed.
P351 The Histo-endoscopic Spectrum in Ulcerative Colitis reveals a Distinct Mucosal Transcriptome for Histo-endoscopic Remission
Authors: Lenfant M , De Hertogh G , Sabino J , Verstockt B , Ferrante M , Verstockt S , Vermeire S
Published: January 2024

Background

Aiming for histological remission on top of endoscopic remission, is an aspiring target in ulcerative colitis [UC]. We investigated the mucosal transcriptional profiles in UC patients with varying depths of histologic activity as compared to healthy controls.

Methods

UC patients with endoscopic improvement (Mayo endoscopic score [MES] 0 or 1) were recruited. Endoscopies were video-recorded and biopsies from the most affected segment were collected for histological assessment and bulk RNAseq (Illumina HiSeq 4000, single read). Geboes Score [GS] was determined by two pathologists blinded for endoscopic scores. The included patients were divided into endoscopic improvement with histologic activity [EIHA] (MES ≤1, GS ≥2B.1) and histo-endoscopic mucosal remission [HEMR] (MES ≤1, GS <2B.1). We distinguished a subpopulation within the HEMR group that we labelled as histo-endoscopic mucosal normalization [HEMN] (MES ≤1, GS ≤0.1).

As comparators, 50 healthy individuals [HV] and 50 UC patients with active disease (MES 2-3, independent, matched by treatment) [AD] were included. Normalised RNA counts were analysed by principal component analysis [PCA] and differential expression analysis. Genes with a |log2 FC|>1 and a FDR <0.05 were considered as differentially expressed [DEG], and were selected for pathway analysis (R 4.3.2, DEseq2; QIAGEN IPA).

Results

In this study cohort 172 patients were included (Table). PCA analysis showed clustering patterns for each study group (Figure). In particular, separation along the PC1 axis tended to follow the different degrees of histo-endoscopic activity. Interestingly, besides inflammatory and tissue remodeling markers (e.g., DUOX2, MMP 3, CHI3L1) for PC1 and epithelial and metabolic markers (e.g., SLC9A3, LPIN3) for PC2, the gene with the highest variance for both PC1 and PC2 was Aquaporin-8 (AQP8). This gene encodes for a water transporter at the apical surface of the colon, and its mucosal expression level indeed follows a spectrum of histo-endoscopic activity (Figure).

Differential expression analyses identified 1261 DEG in HEMN, 1684 DEG in HEMR (not HEMN), 2178 DEG in EIHA, all compared to HV. A total of 1014 overlapping DEG were identified for all these comparisons, being enriched for pathways related to inflammation, metabolic epithelial functions (lipid metabolism, bile acid regulation) and wound healing.

Conclusion

UC patients with histo-endoscopic remission have a mucosal transcriptional profile which significantly differs from that of healthy individuals, even in UC patients whose biopsies appear normal upon histological evaluation. The histo-endoscopic spectrum of the mucosal transcriptome in UC is nicely illustrated by the gene expression of Aquaporin-8 (AQP8).
P358 Impact of end-ileostomy versus ileal pouch-anal anastomosis on graft-survival following liver transplantation for primary sclerosing cholangitis
Authors: Schabl L , Maspero M , Holubar S , Hull T
Published: January 2024

Background

IBD-PSC patients may require both liver transplantation and ileoanal pouch (IPAA) construction. Recently, concerns have been raised regarding an increased rates of hepatic artery thrombosis, biliary strictures, and graft loss in individuals who underwent IPAA after liver transplantation compared to those who underwent end-ileostomy (EI). We hypothesized that graft survival was not negatively affected by IPAA compared with EI.

Methods

A prospectively maintained database from a large tertiary center was searched for patients meeting the inclusion criteria for liver transplantation, primary sclerosing cholangitis, ulcerative colitis, and total colectomy with IPAA or EI. Univariate analysis and Kaplan-Meier survival curves were calculated.

Results

Between January 1990 and December 2023, 55 patients met inclusion criteria. Of these, 46 (83.6%) underwent IPAA, and 9 (16.4%) underwent EI. The average age at colectomy (41.7 vs. 45.7 years; p=0.44), sex distribution (female: 26.1% vs. 22.2%, p=1), and MELD score before transplantation (20.3 vs. 14; p=0.06) were comparable between patients with IPAA and EI patients. The rates of re-transplantation (21.7% vs. 22.2%; p=1), hepatic artery thrombosis (8.7% vs. 0; p=1), episodes of acute rejection (32.6% vs. 44.4%; p=0.7), chronic rejection (4.3% vs. 11.1%; p=0.42), recurrence of primary sclerosing cholangitis (23.9% vs. 22.2%; p=1), and biliary complications (21.7% vs. 33.3%; p=0.43) were similar between the IPAA and EI groups, respectively. None of the EI patients developed parastomal varices. Survival analyses for time to re-transplantation (p=0.97), overall survival (p=0.3), and time to graft loss or mortality (p=0.73) were similar.

Conclusion

In contrast to a previous study, we observed similar rates of liver transplant graft loss, biliary complications, and recurrent PSC after IPAA compared to those after end-ileostomy. IPAA may be associated with an increased rate of hepatic artery thrombosis.
P359 Persistence of severe fatigue in adults with Crohn's disease in remission
Authors: Sartain S , McDonnell M , Dingwall M , Westoby C , Katarachia V , Davis C , Heinson A , Wootton S , Cummings F
Published: January 2024

Background

Fatigue is a frequent manifestation in patients with Inflammatory Bowel Disease (IBD), including those in remission. The persistence of fatigue over time in inactive disease is not well known. We aimed to determine the prevalence and continuation of severe fatigue at baseline and at 12 months follow-up in a cohort of patients with Crohn’s disease (CD) in remission.

Methods

Adult patients with CD in remission, defined by age ≥18 years, HBI <5 and faecal calprotectin <250mcg/g, were recruited to the INTICO2 observational study. Baseline assessment included SF36, FACIT-F and IBD Control patient-reported outcome measures. After 12 months in routine care, participants were invited to repeat FACIT-F. Severe fatigue was defined as scoring FACIT-F <30. Baseline data was analysed for factors associated with the persistence of severe fatigue at 12 months.

Results

A total of 198 patients were studied at baseline, of which 141 completed both baseline and 12-month assessments. The correlation between FACIT-F scores at baseline and 12 months was r = 0.79 (p < 0.001). Twenty-five (17.7%) patients were severely fatigued at both baseline and 12-month follow-up, and 99 (72.1%) were not severely fatigued at either time. Of the 34 patients severely fatigued at baseline, 9 (26.5%) were not severely fatigued at 12 months. From the 107 patients who were not severely fatigued at baseline, 12 (7.5%) became severely fatigued at 12 months. Participants with ongoing severe fatigue at baseline and 12 months had significantly worse SF36 Mental Health scores, 64 v 80 (p <0.001), and more night waking due to IBD, 32.0% v 7.1% (p = 0.011), at baseline assessment than those not severely fatigued at either assessment, see Table 1. Eight patients had a clinical disease flare during the 12-month follow-up period.

Conclusion

Most patients in this cohort in remission continued to have similar fatigue severity at 12-month follow-up. A higher proportion of severely fatigued patients at baseline improved at 12 months than non-severely fatigued patients at baseline developing severe fatigue at 12 months. Factors at baseline associated with persistent severe fatigue were worse mental health and poor sleep secondary to IBD. These may represent areas where intervention could improve reported fatigue levels in remission.
P367 Are patients with Inflammatory Bowel Disease and two or more associated Immune-Mediated Inflammatory Diseases different from those with no or one associated disease?
Authors: De Francisco Garcia R M , Pérez-Martínez I , Castaño-García A , Carballo-Folgoso L , Flórez-Díez P , García-Pérez C , Fernánez-González E , González-Sánchez H , Chiminazzo V , Queiro R , Alonso-Castro S , Santos-Juanes J , Gueimonde M , Riestra S
Published: January 2024

Background

It is well known that immune-mediated inflammatory diseases (IMIDs) are frequently diagnosed in patients with inflammatory bowel disease (IBD). However, few studies have taken into account whether the number of associated IMIDs influences IBD. Our aim was to evaluate the clinical, demographic, and drug needs of patients with IBD based on the number of other IMIDs they present.

Methods

Cross-sectional study that included patients treated at the IBD Unit of the Central University Hospital of Asturias (Spain) between August 2020 and December 2021. Demographic data and disease characteristics were collected and IMID diagnosis was confirmed in the medical records of each patient. Patients were split into three groups: non-IMID, 1-IMID, and two or more associated IMIDs. Hospitalizations, drugs and surgery requirement were analyzed. The comparison between groups was carried out using the Kruskal-Wallis test, and Pearson's Chi-square test or Fisher's exact test. When there was a significant difference between any of the groups, a post-hoc test was performed with p-value correction following the Benjamini and Hochberg method.

Results

A total of 1,620 patients were included in the analysis. 1,067 (66%) had no IMID, 394 (24%) had one IMID, and 159 (9.8%) had two or more IMIDs. Overall, the most frequent IMIDs were spondylarthritis (14%), psoriasis (7.5%), erythema nodosum (4.3%), intrinsic asthma (2.8%), and uveitis (2.5%). The presence of an IMID was associated with older age, longer duration of IBD, female sex, and Crohn's disease (Table 1). The use of steroids, immunomodulators, and biologics, as well as the need for hospitalizations, was higher in patients with several IMIDs. When we analyzed the groups of patients with one and with two or more IMIDs, the only significant differences were a longer duration of disease, a greater prevalence of Crohn's disease, and a higher use of steroids, immunomodulators, and biologics among patients with two or more IMIDs. The percentage of patients with joint (spondylarthritis, psoriasic arthritis, juvenile idiopathic arthritis), cutaneous (psoriasis, hidradenitis suppurative, erythema nodosum, pyoderma gangrenosum) and ocular (uveitis and episcleritis) IMIDs and intrinsic asthma was higher in the group with two or more IMIDs than in the group with one IMID.

Conclusion

10% of patients with IBD have two or more associated IMIDs. The duration of IBD and the need to use steroids, immunomodulators and biologics is greater than in patients with one IMID.
P370 Quality of life in inflammatory bowel diseases – is the flare all that matters?
Authors: Topala M , Ionescu V , Iacob R , Gheorghe C
Published: January 2024

Background

Burden in inflammatory bowel diseases (IBD) is high and affects both physical and psychological status. Short inflammatory bowel disease questionnaire (SIBDQ) is a self-administered health-related quality of life questionnaire that evaluates social, bowel, emotional and systemic dimension. Our aim is to evaluate the impact of IBD status on patients’ daily life.

Methods

We analysed 82 patients diagnosed with Crohn’s disease or ulcerative colitis or that were admitted between March 2021 and April 2022 in Fundeni Clinical Institute, Bucharest. SIBDQ consists of ten questions, with score ranging from 10 (poor) to 70 (optimal). Patients completed SIBDQ and we assessed disease status and determined biological and clinical markers.

Results

51% of patients were diagnosed with Crohn’s Disease. 79% were in clinical remission. The mean age was 39.53±12.9 years old and 52.4% were men. Mean illness duration was 8.03±7.18 years. Mean SIBDQ score was 50.25±14.51, with significantly higher scores in the remission subgroup (55.26±10.30 vs. 31.11±12.24, p<0.001) and it correlated with faecal calprotectin level (ρ=-0,502) and C-reactive protein level (ρ=- 0,531), without regard to disease type or sex. There were no correlations between SIBDQ score and Crohn’s disease or ulcerative colitis phenotype, duration since diagnosis, presence of extraintestinal manifestations or history of abdominal surgery related to IBD.

Conclusion

Patients with IBD flares have low quality of life and SIBDQ scores correlate with markers of disease severity, comparable to previously-published literature. Patients in clinical remission presented with higher SIBDQ scores, independently of IBD phenotype or previous surgery. Acute flares of IBD have a major impact on daily life, additional psychological and social support is needed in order to improve management.
P381 Intestinal ultrasound in newly diagnosed Ulcerative Colitis predicts the need for colectomy
Authors: Madsen G R , Attauabi M , Wilkens R , Ilvemark J F K F , Theede K , Bjerrum J W , Bendtsen F , Seidelin J B , Boysen T , Burisch J
Published: January 2024

Background

Upon diagnosis of ulcerative colitis (UC), it remains challenging to predict who will have a severe disease course, ultimately necessitating colectomy. Predictive tools capable of risk-stratifying patients and individualize treatment are warranted. The aim of this study was to assess whether Intestinal ultrasound (IUS), performed at the onset of UC, could help predict the need for colectomy within the first year of diagnosis.

Methods

In a Danish prospective inception cohort, all new-onset adult patients with UC (including unclassified IBD) with left-sided or extensive colitis underwent IUS near the diagnostic endoscopy. The assessment included the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and the bowel wall thickness (BWT) of the most inflamed segment. Besides IUS, we recorded age, gender, smoking, BMI, the Mayo endoscopic score (MES), the Simple Clinical Colitis Activity Index (SCCAI), and biomarkers hemoglobin (hgb), C-reactive protein (CRP), albumin and fecal calprotectin.

Results

During inclusion (May 2021 – April 2023), we included 193 UC patients with Montreal classification E2 or E3. In total, 12/193 (6%) underwent colectomy within the first year or during follow-up (min. 6 months). Baseline characteristics are presented in Table 1.

Univariable analyses identified high MES, CRP, SCCAI, IBUS-SAS, and BWT, along with low Hgb and albumin, as significantly associated with an increased colectomy risk. Multivariable analysis with stepwise reduction identified only SCCAI (OR: 2.0, CI 1.2–3.3, p<0.005) and BWT (OR: 1.6, CI 1.1–2.3, p=0.01) as independent predictors. Through ROC analysis, BWT presented the highest accuracy (AUC: 0.89), and the optimal cut-off by Youden Index for colectomy prediction was > 6.1 mm. Combining all the significant non-IUS predictors, CRP, MES, SCCAI, hgb, and albumin yielded an AUC of 0.88. The highest accuracy was found by combining SCCAI and BWT, with an AUC of 0.94. Kaplan-Meier curve for colectomy-free survival is presented in Figure 1.

Among patients with BWT>6.1mm, 18/21 (86%) started systemic steroids within the first week, compared to 43/125 (34%) of patients with BWT ≤ 6.1, p=0.007. Among patients with BWT > 6.1mm, 11/21 (52%) started biologics within the first 31 days, compared to 5/125 (4%) of patients with BWT≤6.1mm, p<0.001.

Despite more aggressive treatment, 8/21 (38%) with BWT>6.1mm had a colectomy compared to 2/125 (2%) with BWT≤6.1mm.Conclusion

IUS at UC onset, specifically BWT, is a robust predictor of colectomy risk within the first year of diagnosis. Combining clinical symptom scores with IUS enhances predictive accuracy. It can accurately identify patients at an increased risk of colectomy, guiding early treatment decisions for improved patient outcomes.
P387 Short and long-term outcomes of surgery for inflammatory (uncomplicated) ileocecal Crohn’s disease: multicentric retrospective analysis of 211 patients
Authors: Avellaneda N L , Maroli A , Tottrup A , Buskens C , Kotze P G , Pellino G , Dige A , Haase A M , Haanappel A , Giorgi L , Carvello M , Yuki Maruyama B , Christensen P , Spinelli A
Published: January 2024

Background

Surgical management for patients with inflammatory ileocecal Crohn’s disease (CD) could be a reasonable alternative to second-line medical treatment.

Methods

A retrospective analysis of patients intervened for primary ileocecal CD with uncomplicated (inflammatory) phenotype at four referral hospitals during 2012-2021 was performed. The objective was to assess short and long-term outcomes of patients operated on for inflammatory, ileocecal CD.

Patients operated on due to inflammatory ileocecal CD (last 50 cm of the terminal ileum and cecum), were considered eligible to participate in this study. Operations performed during a 9-year period (2012-2021) were considered for the study. Patients who were operated for CD for advanced structural bowel damage (fibrotic strictures or penetrating phenotype), those who had had previous abdominal CD-related procedures, and patients who had disease activity in other anatomical regions at the time of surgery, were excluded from the study.

Results

211 patients were included. 43% of patients underwent surgery more than 5 years after diagnosis, and 49% had been exposed to at least one biologic agent preoperatively. 89% were operated by laparoscopy, with 1.6% conversion rate. The mean length of stay for patients was 5 days, with only 24 patients (11%) requiring a prolonged hospitalization. The complication rate was 23.7% (50 patients), but most complications were minor (Clavien-Dindo < IIIa), with only 11 patients (5%) presenting with major complications. Leak rate for patients who received a primary anastomosis was 2.9%. The median length of the resected bowel was 25 cm (7-92) and three patients (1.43%) received a stoma. Median follow-up was 36 (17-70) months. The endoscopic recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 56%, 52%, 45%, 38%, and 33%, respectively. The clinical recurrence-free survival proportion at 24, 48, 72, 96, and 120 months was 83%, 79%, 76%, 74%, and 74%, respectively. In multivariate analysis, previous biological treatment (HR=2.01; p=0.001) was associated with a higher risk of overall recurrence.

Conclusion

In this study, surgery in patients with primary inflammatory ileocecal CD is associated with good postoperative outcomes, low postoperative morbidity with reasonable recurrence rates. Further studies need to validate the present results.
P403 A new criterion, combining bowel wall thickness and submucosal index (SMI), is useful for estimating endoscopic improvement in Ulcerative Colitis
Authors: Komatsu H , Morikubo H , Kimura Y , Yonezawa H , Matsuura M , Miyoshi J , Hisamatsu T
Published: January 2024

Background

Endoscopic improvement (EI), Mayo endoscopic subscore of 0 or 1, is considered a therapeutic target in ulcerative colitis (UC) treatment. The potential to estimate EI non-invasively is an advantage of intestinal ultrasound (IUS). In a former study, we developed a new ultrasound parameter, the submucosal index (SMI), calculated as the ratio of the thickness of the submucosa to the thickness of the bowel wall (BWT), and reported that combining BWT and SMI could be a practical criterion for estimating EI without the assessment of bowel wall vascularity using color Doppler evaluation. In the present study, we validated the EI estimation ability of our B-mode-based UC criterion, Kyorin Ultrasound Criterion for UC (KUC-UC; BWT<3.8mm and SMI<50%), using an external cohort.

Methods

Patients who underwent IUS and CS at Kyorin University Hospital were included. The inclusion criteria were (1) both IUS and endoscopy (sigmoidoscopy or CS) for UC were performed between July 2021 and June 2022, (2) the interval between IUS and endoscopy was within 15 days, and (3) no change or addition of therapeutic agents between the two examinations. IUS findings including BWT, SMI, and modified Limberg score were evaluated. In the modified Limberg score, the threshold of normal BWT was less than 3 mm, while the original Limberg score employed less than 4 mm.

Results

The KUC-UC criterion defined as BWT < 3.8 mm and SMI < 50.0% is practical because it uses only B-mode findings and does not require complex calculations. We tested the ability of this criterion to estimate EI in UC. A total of 122 colon segments were evaluated by transabdominal IUS and CS. The criteria showed a sensitivity of 67.3%, specificity of 97.1%, PPV of 94.6%, and NPV of 80.0%. In the previous development cohort, the PPV and NPV of KUC-UC were 95.5% and 82.7%, respectively. Based on the above, this validation cohort is considered equivalent to the development cohort. BWT < 3 mm and MUC have been reported as useful criteria for EI estimation. In the present cohort, BWT <3mm showed a sensitivity of 67.3%, specificity of 91.4%, PPV of 85.4%, and NPV of 79.0%, and MUC demonstrated a sensitivity of 75.0%, specificity of 88.6%, PPV of 83.0%, and NPV of 82.0%. These results indicate that KUC-UC has a considerable potential to estimate EI as BWT < 3 mm or MUC.

Conclusion

External validation showed that KUC-UC, using only B-mode findings without complicated calculations, is feasible, accurate sonographic criteria to estimate the EI of UC. The KUC-UC criterion could be one of the options for estimating EI in UC.
P407 Validation of a newly developed patient-reported experience measure for people with Inflammatory Bowel Disease
Authors: Totton N , Sheldon E , Ezaydi N , Bursnall M , Hind D , Wakeman R , Lobo A
Published: January 2024

Background

Patient-Reported Experience Measures (PREMs) assess a patient’s healthcare experiences and are important to improve the quality of healthcare. A PREM specific to inflammatory bowel disease (IBD) was co-produced with service users. This study aimed to validate the PREM.

Methods

The IBD PREM contains 38-items and comprises three domains: ‘the care team’, ‘what matters to me’, and ‘living with Crohn’s or Colitis’. Scores can be calculated for each domain and summated to give a total score.

Validation was completed on data collected from participants who completed the PREM every 3 months alongside the IBD-Control measure of disease activity at a single UK tertiary IBD service. The PREM was assessed for acceptability; reliability (internal consistency and repeatability); known groups validity; criterion validity and responsiveness. Face and content validity were completed before finalisation using ‘Think Aloud’ interviews.

Results

The dataset used for validation was extracted in September 2023 and contained responses from 287 participants (63% female, 89% White British, median age: 52) comprising 1,699 PREM responses between November 2021 and August 2023.

Acceptability was demonstrated with very low rates of missing data (four items with >5% missing) and median submission duration of 4.8 minutes (IQR: 3.6 – 6.6). High Cronbach’s alpha scores (0.85, 0.97, 0.88 and 0.97 for each of the domains and total PREM score respectively) show internal consistency of the measure. However, the particularly high value on one domain and the total score suggest some overlapping items may remain. An intraclass corelation coefficient of 0.88 (95% CI: 0.85 to 0.91) suggests good repeat reliability over a two-week timeframe.

Good comprehension of the measure by service users satisfied face and content validity. Known groups validity was supported with lower score on ‘living with Crohn’s or Colitis’ domain the for those with an IBD Control score of less than 13 by 0.38 (95% CI: 0.23 to 0.54), p<0.001). A low to moderate correlation of 0.37 (95% CI: 0.32 to 0.42) was found between the total PREM score and the IBD Control score, as expected.

Ceiling and floor effects had a maximum of 6% demonstrating potential responsiveness of the PREM. The change over a year detected by those that stated that had experienced a change was 0.53 (95% CI: 0.41 to 0.66, n=38) on a five-point scale.Conclusion

The co-produced PREM is an acceptable, valid, reliable, and responsive tool to measure experience of IBD care for quality improvement. Further work should assess the potential for item reduction as well as correlation to other related measures.
P422 Prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaire in Inflammatory Bowel Disease patients and its association with disease activity and quality of life
Authors: Chaemsupaphan T , Subdee N , Phaophu P , Salaemae M , Permpim P , Wannasewok K , Pimolsri C , Chotinaiwattarakul W , Limsrivilai J
Published: January 2024

Background

An association between active inflammatory bowel disease (IBD) and poor sleep quality has been proposed, however studies evaluating both subjective and objective assessment of disease activity and sleep quality are limited. Our study aimed to investigate the prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaires in IBD patients and its association with disease activity and quality of life.

Methods

A prospective observational study was conducted in Siriraj Hospital, Mahidol University, Bangkok, Thailand from March 2021 to December 2022. Eligible IBD patients were categorized into remission, mild, and moderate-to-severe groups, based on standard clinical disease activity scores. Demographic data, inflammatory markers, inflammatory bowel disease questionnaire (IBDQ), sleep questionnaire (Pittsburgh Sleep Quality Index, PSQI), and seven-day sleep data from wrist actigraphy (Actiwatch®, CamNtech, Cambridge, United Kingdom) were obtained. The prevalence of sleep disorder and group comparison were analyzed.

Results

Eighty-four participants (40 Crohn’s disease, 44 UC), consisting of 60 remission, 16 mild, and 8 moderate-to-severe disease activity, were enrolled. Baseline demographic data were comparable between each group. Lower hemoglobin and albumin levels, and higher serum C-reactive protein, and fecal calprotectin levels were found in the more clinically active groups (table1). Fifty patients (60%) had poor sleep defined by PSQI > 5 with a trend to be higher in the group with active symptoms (57% in remission, 63% in mild, and 75% in moderate-to-severe group, p=0.31). Using actigraphy, the group with moderate-to-severe symptoms tended to have longer sleep latency, more frequently awake after sleep, and poorer sleep efficiency than the other groups (Figure 1). Patients with more severe disease activity had poorer quality of life with a mean IBDQ of 190 in remission, 159 in mild, and 134 in moderate-to-severe group (p<0.001).

Conclusion

Poor sleep quality is common among IBD patients, even those with clinical remission. Those with more severe symptoms had poorer sleep quality and worse quality of life. Sleep assessment and treatment should be integrated into IBD standard clinical care.
P432 Real-time automated assessment of histological disease activity in patients with ulcerative colitis using single wavelength endoscopy technology
Authors: Sinonquel P , Lenfant M , Eelbode T , Callaerts B , Watanabe H , Guedelha Sabino J P , Verstockt B , Maes F , De Hertogh G , Vermeire S , Bisschops R
Published: January 2024

Background

Assessment of mucosal healing as a key denominator in the treat-to-target strategy for managing ulcerative colitis remains challenging. To address this, objective evaluation of histological disease activity holds promise. Recent offline research shows encouraging results using a new deep-learning convolutional neural network based on single wavelength endoscopy technology (SWE-CAD) (Fujifilm Co, Japan). We aimed to validate the real-time performance of a new bedside prototype SWE-CAD model during standard colonoscopy.

Methods

A bedside module for real-time use was integrated in the endoscopy room to evaluate histological disease activity in patients with ulcerative colitis with Mayo Endoscopic Scoring (MES) ranging between 0 and 3. Imaging was performed in rectum and sigmoid following a standardized protocol based on white light and SWE (i.e. monochromatic light of 410nm). Biopsies were taken as reference at the center of the imaged region and were scored for the Geboes score (GBS). The SWE-CAD output was displayed on the separate monitor of the bedside module as a blue or red-colored indication, corresponding to histological remission or non-remission, respectively. Each region (2 in rectum and 2 in sigmoid) was simultaneously scored for MES by the endoscopist.

Results

In a total of 36 patients histological disease activity was automatically scored using the SWE-CAD. On a section level this CAD-system showed an accuracy of 96.4%, corresponding sensitivity was 99.3% and specificity was 85.5%.

When differentiating for disease activity as mild, moderate and severe, accuracy was 97.7%, 62.8% and 95.0%, respectively. On a per-patient level, overall diagnostic accuracy remained high with 94.4%, with only 2/36 underestimations when compared to GBS.

Conclusion

In this pilot trial, we successfully tested a novel CAD-system, utilizing SWE technology, for real-time assessment of histological disease activity in patients with UC. The system demonstrated exceptional clinical accuracy at 94.4% per-patient level, potentially aiding physicians in interpreting subtle endoscopic abnormalities, leading to cost-effective and individualized patient management.
P451 Specific Oral Manifestations in Patients with Crohn's Disease
Authors: Çagir Y , Durak M B , Simsek C , Yuksel I
Published: January 2024

Background

Extra-intestinal manifestations of Crohn's disease (CD), including arthropathic, mucocutaneous, ophthalmic and hepatobiliary disorders, have a prevalence ranging from 16.7% to 40%. Oral manifestations of CD are classified into specific manifestations directly related to intestinal inflammation and non-specific manifestations. The aim of this study was to determine the frequency and characteristics of specific oral manifestations in patients with CD.

Methods

We retrospectively evaluated 676 patients with CD who were followed up for at least 6 months between June 2013 and February 2023 at our tertiary care center. Specific oral lesions were clinically defined as cobblestoning, orofacial granulomatosis, lip/cheek swelling with fissuring, and pyostomatitis vegetans. Confirmation of specific lesions was made by experienced dentists for each case.

Results

Of the 676 CD patients (58.9% male, median age 38 years) followed for 6.83 years (IQR 3.45-11.76 years), 96 (14.2%) had oral lesions. Specific oral lesions were found in 8 patients (1.2%), while 88 (13.1%) had non-specific lesions. The specific lesions included cobblestoning (n=2), orofacial granulomatosis (n=3), glossitis with fissuring (n=2), and lip swelling with fissuring (n=2). Patients with specific lesions were predominantly male (75%) with a median age of 46.5 years (range 23-68 years). Disease location was ileal (25%), colonic (25%), and ileocolonic (50%), with perianal disease in 50%. Disease behavior was inflammatory in 7 and penetrating in 1 patient. Three patients were active smokers. Three patients had prior major abdominal surgery. Concurrent extraintestinal manifestations included peripheral arthritis/arthralgia (n=7), sacroiliitis (n=1), and uveitis (n=2). Immunomodulators were used in 7 patients and biologics in 5 patients. All specific lesions were associated with active disease (median CRP 35.5 mg/L, range 6-151 mg/L; median CDAI 313, range 227-480) and improved with immunomodulator or biologic therapy.

Conclusion

In this large cohort of CD patients, the frequency of specific oral manifestations was 1.2%. These lesions were associated with active disease and improved with immunosuppressive treatment, highlighting the need for close collaboration between gastroenterologists and dentists for early recognition and optimal management.
P452 Serum Amyloid A for Predicting Surgery and Disease Exacerbation in Patients with Newly Diagnosed Crohn’s Disease
Authors: Chen R , Chen Q , Chen M , Zhang S
Published: January 2024

Background

Crohn's disease (CD) is characterized by relapsing-remitting course with highly heterogenous prognosis, ranging from quiescent disease to complicated course with stricturing, penetrating or need of abdominal surgery. Identifying biomarkers that determine their disease course can enable implementing more aggressive preventive strategies. Serum amyloid A (SAA) has been demonstrated to involve in the pathogenesis of Crohn’s disease (CD); however, its prognostic value is still uncertain. This study was determined to explore the prognostic value of SAA for CD-related surgery and disease exacerbation in newly diagnosed CD.

Methods

We conducted a retrospective cohort study and recruited newly-diagnosed CD patients at the First Affiliated Hospital of Sun Yat-sen University. Level of SAA was detected at diagnosis. The primary outcome was CD-related surgery. The secondary outcome was disease exacerbation, defining as newly developed structuring or penetrating lesions. Association between variables and outcome was evaluated through Kaplan–Meier method and Cox proportional hazard regression analysis. For continuous variables, the optimal cutoff values were determined by using the survminer R package in the analysis of primary outcome. The prognostic model was developed by cox proportional-hazards model. Concordance-index (c-index) was used to assess the predictive ability of the prognostic model.

Results

During 2187.6 person-years (median age, 28 years, 72.4% male), 87 surgery and 153 disease exacerbation events were documented. After adjustment, a 14% higher risk for surgery (adjusted hazard ratio, aHR [95% confidence interval]: 1.14 [1.05–1.23]; p=0.001) and a 12% higher risk for disease exacerbation (1.12 [1.05–1.19]; p<0.001) were observed with a 100-unit increase in SAA level. Patients with SAA levels ≥89.2 mg/L had aHRs of 2.08 [1.31–3.28] and 1.72 [1.22–2.41] for CD-related surgery and disease exacerbation, respectively. The association between SAA and outcomes was assessed as linear by the restricted cubic spline. Adding SAA into the model including known risk factors, including age at diagnosis ≥40 years, disease behavior, disease location, and initial biological treatment, led to significant improvement in its predictive ability for surgery (net reclassification index and integrated discrimination index, p<0.001) and disease exacerbation (net reclassification index and integrated discrimination index, p<0.001). Sensitivity analyses showed robust results.

Conclusion

Our study shows that higher serum SAA level at diagnosis was associated with poorer prognosis, including risk of surgery and disease exacerbation. And prognostic models based on SAA and known risk factors could better predict prognosis.
P455 Deploying machine learning algorithms to stratify patients with inflammatory bowel disease using routinely collected electronic health records
Authors: Mian H A , Radia C , Sarras K , Hayee B , Al-Agil M , Patel M , Kent A , Dubois P , Pavlidis P , Iniesta R
Published: January 2024

Background

Personalised medicine approaches are eagerly awaited to facilitate individualisation of medical care for patients with inflammatory bowel disease (IBD). Multiple approaches have already been explored in attempts to stratify patients into different prognostic trajectories. In this study we aimed to use machine learning algorithms to cluster patients based on their routinely collected electronic health records in an unsupervised approach.

Methods

We interrogated the rich electronic health records (EHR) of 619 patients with a diagnosis of IBD requiring an advanced therapy and attending the IBD service at King’s College Hospital (KCH), London, UK. Data for a seven year period (June 2016-May 2023) were included with variables that captured diagnosis, treatments, service utilisation and investigations. Ethical approval was provided following application to the KERRI committee (KCH committee for accessing anonymised HER). In a preliminary analysis, we employed a multi-step approach to analyse patient data, identify significant features through k-prototypes clustering and a combination of parametric and non-parametric statistical tests. We examined different cluster solutions up to six clusters.

Results

We included 38 quantitative and 32 qualitative variables for 350 patients with a diagnosis of CD and 269 with a diagnosis of UC. Missing data were addressed by imputation by k-NN, mode value and zero. In the context of the unsupervised learning approach, when k=3, key differentiating features included faecal calprotectin levels, body mass index, mean platelet volume, marital status, taking advanced therapy for less than 3 years, and service access (telephone or clinic appointments).

Conclusion

This first pass analysis suggests that patients who are relatively early in their journey with at least moderately active IBD take up more recourses of the IBD service. This associates also with their social circumstances. Further work will explore these interactions in more detail.
P469 Deep learning and minimally invasive endoscopy – panendoscopic detection of pleomorphic lesions
Authors: Mendes F , Mascarenhas M , Ribeiro T , Afonso J , Cardoso P , Martins M , Cardoso H , Andrade P , Mascarenhas Saraiva M , Ferreira J , Lopes S , Macedo G
Published: January 2024

Background

Capsule endoscopy is a minimally invasive exam capable of performing a panendoscopic evaluation of the gastrointestinal tract. Nevertheless, capsule endoscopy is a time-consuming exam, revealing suboptimal diagnostic yield when considering the upper gastrointestinal tract. Convolutional neural network are models based on the human visual cortex architecture, suitable for image analysis. However, there is still an absence of studies about their role in capsule panendoscopy.

Methods

Our group developed a deep Learning model for panendoscopic automatic detection of pleomorphic lesions (namely vascular lesions, protuberant lesions, hematic residues, ulcers and erosions). In order to develop the convolutional neural network, 355 110 images (6 977 oesophageal, 12 918 gastric, 258 443 enteric, 76 772 colonic) from eight different capsule endoscopy and colon capsule endoscopy devices were divided in a training and validation dataset in a patient split design. The model’s output was compared to three CE experts’ classification. The model performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the precision-recall curve.

Results

The panendoscopic convolutional neural network was composed by organ-specific neural networks. The binary oesophagus convolutional neural network had a diagnostic accuracy for pleomorphic lesions of 83.6%. The binary gastric network identified pleomorphic lesions with a 96.6% accuracy. The undenary small bowel convolutional neural network distinguished pleomorphic lesions with different potential with 97.6% accuracy. The trinary colonic model (detection and differentiation of normal mucosa, pleomorphic lesions and hematic residues) had 94.9% global accuracy.

Conclusion

Our group developed the first deep learning model for panendoscopic automatic detection of pleomorphic lesions in both small bowel and colon capsule endoscopy devices from multiple brands, solving a critical interoperability technological challenge. Deep learning-based tools may change the landscape of minimally invasive capsule panendoscopy.
P481 "I’ve been told to drop out of school because I need to focus on my health and that was just devastating to hear.": Experiences of Western Canadian young adults with inflammatory bowel disease transitioning from paediatric to adult care
Authors: Bihari A , Nahal I , Chappell K , Seow C H , Goodman K J , Wine E , Kroeker K I
Published: January 2024

Background

The incidence of patients diagnosed with inflammatory bowel disease (IBD) in childhood/adolescence is increasing worldwide; therefore, in the upcoming years, more patients will need to transition from paediatric to adult care. A smooth transition is essential to ensure continuity of care; however, transition is a difficult time for patients, when increasing responsibility for disease management needs to be balanced with full-time employment or schooling. This study explores the transition experience of young adults with IBD who have transitioned from paediatric to adult care.

Methods

We recruited young adults with IBD using purposive sampling from two IBD centres in Western Canada for participation in a semi-structured virtual interview. Eligibility required being transferred to adult care within the previous two years and being diagnosed with IBD at least one year before transferring. Interviews were audio recorded, transcribed verbatim, and then analysed with an inductive thematic analysis approach.

Results

We interviewed 16 young adults with IBD (Table 1). We grouped features of the transition experience described by participants into the following four major themes (Figure 1): 1) Anticipation and preparedness for adult care; 2) New and existing connections; 3) Skill development for disease management; 4) Comparison of adult care to paediatric care. In the first theme, participants described feeling unprepared for and nervous about adult care. In the second theme, participants described the structure of care and noted that adult care had less appointments and the adult care team took a less holistic approach to their IBD care. Subsequent themes focused on developing relationships with the new care team, the importance of existing social supports, and becoming responsible and independent in disease management.

Conclusion

The results outline four major themes that describe IBD patients’ transition experience. These themes provide insight into aspects of transition described by patients, which can be used to improve patient care. For example, participants characterized adult care as missing elements that were present in paediatric care, suggesting a potential need to prepare patients for care differences and support them through the care adjustments. Overall, this study provides valuable insights into patients’ transition experiences which can be used to inform the development of transition supports and improve patient-centred care.