bluuebunny/crossref_metadata_2025 huggingface dataset:
P0268 Patient-reported outcomes in a Greek cross-sectional survey of inflammatory bowel disease patients treated with biologic therapy
Authors: Tzanetakos C , Vakouftsi V , Mavridoglou G , Gourzoulidis G
Published: January 2025

Background

Patient reported-outcomes [PROs] are a major therapeutic goal in inflammatory bowel disease [IBD]. The study objective was to investigate the burden of IBD and unmet medical need in patients who receive biologic therapy in Greece.

Methods

Between October 2023 and January 2024, adult patients who were members of Hellenic Society of Crohn’s disease’s (CD) and Ulcerative Colitis’ (UC) patients (HELLESCC) filled out a structured self-questionnaire. The survey questionnaire included sociodemographic characteristics, smoking habits, history of comorbidities, disease activity, disease characteristics, IBD medications, and PROs (Short Inflammatory Bowel Disease Questionnaire [SIBDQ], Work Productivity and Activity Impairment-Specific Health Problem [WPAI-SHP], Patient Health Questionnaire-9 [PHQ-9], treatment satisfaction and treatment adherence).

Results

Datasets were obtained from 287 IBD patients (median age 42 years, proportion of females 57.8%, median BMI 26, proportion of current smokers 35.2%, median age at diagnosis and disease duration 30 and 10 years, respectively). According to disease activity scores, 42.9% were in remission, 26.8% had mild disease, and 30.3% had moderate/severe disease. Around 76% of patients reported moderately [SIBDQ 45–59: 31.8%] to severely [SIBDQ <45: 44.5%] impaired quality of life (QoL) (30% of them were in remission). One-fifth reported work productivity loss and 30% reported activity impairment (severe work and activity impairment [>50%] in 30.2% and 42.9% of patients respectively). Around half of patients reported moderate to severe depressive symptoms [PHQ-9≥10: 48.1%]. The 39.1% of patients were “not at all”, “little” or “quite” satisfied by their biologic treatment, with the main reason of dissatisfaction being the “fatigue is increasing”. Nine out of ten patients (89.1%) reported that they follow their biologic treatment regularly. Statistically significant relationships were found between PROs but not between disease types [CD or UC] or therapeutic classes (tumor necrosis factor-α antagonists, anti-integrin agents, and interleukin-12/23 antagonists).

Conclusion

Despite the use of biologic therapies, the disease burden is very high in IBD, with poor QoL as well as increased work impairment, depression, and disease activity in Greek patients. Marked treatment dissatisfaction was reported by four out of ten patients.
P0271 Overweight is associated with low mediterranean diet adherence and increased disability in patients with Inflammatory Bowel Disease
Authors: Nardone O M , Leo C , Calabrese G , Guarino A D , Ciotola N , Caldiero A , Bonacci L , Petolicchio M , Testa A , Rispo A , Castiglione F
Published: January 2025

Background

The prevalence of obesity in inflammatory bowel disease (IBD) has risen, with 15–40% of adults classified as obese and an additional 20–40% as overweight1. Poor dietary habits and sedentary lifestyles contribute to overweight and sarcopenia, potentially worsening IBD-related disability. This study aimed to evaluate the relationships between nutritional status, adherence to the Mediterranean diet, sarcopenia and disability in IBD patients.

Methods

This cross-sectional study included consecutive IBD patients attending an outpatient clinic or infusion unit between 2023-2024. Bioelectrical impedance analysis (BIA) was used to estimate the fat-free mass index (FFMI), a recognized measure of skeletal muscle mass. Physical function was assessed via gait speed (time to walk 6 meters), and handgrip strength (HGS) measured using a Jamar dynamometer. Sarcopenia was diagnosed based on FFMI, HGS, and walking speed. Disability was evaluated using the IBD-Disk questionnaire, with scores ≥40 indicating moderate-to-severe disability. Adherence to the Mediterranean diet was assessed using the Medi-Lite score, with scores <9 reflecting low adherence. Demographic, clinical, and disease-related data were collected

Results

A total of 95 IBD patients (58% with Crohn’s disease, CD), 57.8% female, with a median age of 42 years (IQR 26-58) were included. Clinical activity ,measured with the Harvey-Bradshaw index (HBI) had a median score of 6 (IQR 4–7) for CD, while the median pMayo score for ulcerative colitis (UC) was 4 (IQR 2–6).

The median BMI was 23.60 (IQR 21-27). Overweight prevalence was 43.2% (41/95). Low adherence to the Mediterranean diet was significantly more frequent in overweight patients compared to non-overweight patients (p<0.001). Overweight was also associated with increased age (p < 0.001). Sarcopenia prevalence was 7% (7/95) and was more common in non-overweight patients than in overweight patients (p = 0.002). The median BMI among sarcopenic patients was 20.6 (18.5–25.3). The mean IBD-Disk score was 41 ± 23.2, with 46.3% of patients reporting moderate-to-severe disability. Overweight patients were more likely to experience moderate-to-severe disability compared to non-overweight patients [27 (65.9%) vs. 23 (42.6%), p = 0.02]. No significant association was found between sarcopenia and moderate-to-severe disability (p = 0.44).

Conclusion

Overweight is associated with low adherence to the Mediterranean diet and increased disability in IBD patients. Targeted interventions to improve adherence to the Mediterranean diet and manage overweight could potentially reduce disability in IBD patients.

References

1.Singh S et al, Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes, Nat Rev Gastroenterol Hepatol. 2017 February ; 14(2): 110–121
P0273 Advances in understanding and managing perianal Crohn’s disease: Insights from the new classification system and results from a single-center series.
Authors: Mesonero Gismero F , García de la Filia I , López Cardona J , Fernández C , Abadía P , Ocaña J , Ballestero A , Tobaruela E , García-Pérez J C , Die Trill J , López-Sanroman A
Published: January 2025

Background

A new classification for perianal disease has been published to assist clinicians in identifying and treating this phenotype (1). However, no studies have evaluated its use in real-world settings. We analyzed the distribution and appropriateness of perianal fistula management in a single center.

Methods

This was a retrospective and unicentric study. Crohn´s disease patients with perianal fistulizing phenotype were included. Non fistulizing perianal disease, recto-vaginal fistulae, ileoanal pouch-related fistula or patients without follow-up were excluded. Fistulas were identified according to the new classification system. Baseline characteristics, the applied treatment, and the probability of progression were analyzed. Therapeutic success and management errors were based on consensus recommendations. Descriptive statistics were applied.

Results

Over 1068 patients diagnosed with Crohn´s disease a total of 267 patients presented perianal disease (25%). Finally, 184 patients were included (the majority of excluded patients were due to non fistulating perianal disease or rectovaginal fistulae). Basal characteristics are shown in Table 1. Perianal fistulae distribution according to new classification is presented in Figure 1. Thirty six patients (20%) changed fistulae class after a median time of 44 months (range 20-265): class 2b (11 patients, 31%), class 2c (16 patients, 44%), class 3 (7 patients, 20%). No patients presented class 4 fistulae during period evaluation.

The treatment employed was: seton plus biological therapy (41%), biological therapy plus reparative surgery (22%), seton replacement alone (10%), biological therapy alone (4%), proctectomy (3%) and defunctioning ostomy (3%). No treatment was administered to 17% of cases. In 44% of cases, there were management errors according to established recommendations. These were: no reparative surgery (40%), no biological therapy use (35%), no defunctioning ostomy (15%). It was significantly higher in the case of type 2a class (37 vs 7%, p 0.001). Despite this findings, 78% of cases achieved the therapeutic goal according to new recommendations.

Conclusion

Class 2 perianal fistulae are the most common and where management errors may occur. However, the majority of patients achieve the therapeutic goal.

References

1.Geldof J, Iqbal N, LeBlanc JF, Anandabaskaran S, Sawyer R, Buskens C, Bemelman W, Gecse K, Lundby L, Lightner AL, Danese S, Spinelli A, Carvello M, Faiz O, Warusavitarne J, Lung P, De Looze D, D’Hoore A, Vermeire S, Hart A, Tozer P. Classifying perianal fistulising Crohn’s disease: an expert consensus to guide decision-making in daily practice and clinical trials. Lancet Gastroenterol Hepatol. 2022 Jun;7(6):576-584.
P0274 Progression from Segmental Colitis Associated with Diverticulosis to Ulcerative Colitis
Authors: Asumu L M , Mayorga Ayala L F , Herrera De Guise C M , Serra-Ruiz X , Céspedes Martínez E , Robles Alonso V , Lastiri Gonzalez E , Borruel Sainz N
Published: January 2025

Background

Despite the high prevalence of diverticulosis in the population, segmental colitis associated with diverticulosis (SCAD) is uncommon. Due to its overlap with characteristics typical of inflammatory bowel diseases, especially Ulcerative Colitis (UC), a possible link in its pathogenesis has been postulated, with some cases of disease progression from one to the other described. We present a series of SCAD cases that progressed to UC

Methods

We describe SCAD cases followed at our IBD Unit at Hospital Universitari Vall d’Hebron that were subsequently diagnosed with UC between 2016 and 2024. Demographic and clinical data from all patients were collected and analyzed.

Results

We identified 5 cases, 3 female and 2 male, with a median age of 73±3 years, initially diagnosed with SCAD. All patients had significant inflammatory involvement in the peridiverticular mucosa at the sigmoid and descending colon. Four patients presented with luminal substenosis and inflammatory pseudopolyps. Histopathology revealed chronic active nonspecific cryptodestructive colitis with a marked mixed lymphoplasmacytic infiltrate. The remaining colon and rectum were preserved in all cases. Treatments for SCAD included mesalamine and antibiotics for 3 patients, oral corticosteroids for 1, and sigmoidectomy for 1 due to refractory disease. Progression to UC occurred in a median of 63 weeks after SCAD diagnosis, with all colonoscopies showing distal progression of inflammation with rectal involvement, and biopsies compatible with UC. Four patients required therapy escalation to biological agents, and only one remained on oral mesalamine with adequate control. One patient underwent a left hemicolectomy due to refractoriness.

Conclusion

Our study showed that progression from SCAD to UC can be aggressive, with most patients in our series requiring biological therapy. It is important to recognize the potential evolution of SCAD into UC for an effective diagnosis and management of these patients.
P0275 The Impact of Sarcopenia on Clinical Outcomes in Pediatric Crohn’s Disease
Authors: D’Arcangelo G , De Mitri D , Busato L , Verrino A , Bottino L , Maccioni F , Aloi M
Published: January 2025

Background

Sarcopenia, the age-related progressive loss of muscle mass and strength, affects up to 50% of adults with Crohn’s Disease (CD) and is related to major clinical outcomes. However, data on children is scarce. We investigated whether sarcopenia at the diagnosis impacts the outcomes of children with CD.

Methods

Retrospective, single-center, case-control study of newly diagnosed children with CD undergoing magnetic resonance (MR) within one month from the diagnosis, from 2011 to 2022. Sarcopenia was assessed by measuring total psoas muscle area (tPMA) at L3-L4 level on the MR and defined as z-score values ≤2 standard deviations. Sarcopenic and nonsarcopenic children were compared for the risk of disease flares, IBD-related hospitalization, complications, need for step-up treatment, and courses of steroids over a 2-year follow-up.

Results

Seventy-eight children were included (mean age 11.7 years, 41% females), 46 (59%) sarcopenic and 32 (41%) nonsarcopenic. Sarcopenic children presented at the diagnosis with higher serum levels of total cholesterol (140 ± 28 mg/dL vs. 105.6 ± 27 mg/dL, p=0.009) as well as LDL and HDL cholesterol (77 ± 26 vs. 57.7 ± 24. 4 mg/dL, p=0.03 and 42.8 ± 9.2 vs 36 ± 8 mg/dL, p=0.02, respectively). The risk of clinical relapse was higher in sarcopenic vs nonsarcopenic patients at 6 [21.7% vs. 0%, OR 8.6 (95% CI 1.2-96.2), p=0.004] and 12 months [34.7% vs. 6.6%, OR 7.4 (95% 1.6-34.4), p=0.005]. Additionally, the risk of steroid use was higher in sarcopenic vs. nonsarcopenic children at 12 months [34.7% vs. 13.3%, OR 3.4 (95% CI 1.1-10.3), p=0.06]. Kaplan Meier analysis showed lower survival free from relapses in sarcopenic vs nonsarcopenic patients [Log Rank p=0.004, HR 2.8 (95%CI 1.3-5.7)]. Multivariate logistic regression analysis identified sarcopenia as an independent predictor of relapse risk [OR (95%CI)142 (2.1-470), p=0.051].

Conclusion

The presence of sarcopenia at the diagnosis seems to increase the risk of unfavorable outcomes, specifically clinical relapses in the first year of diagnosis. An altered lipid profile may indicate an increased risk of reduced muscle mass children, highlighting the need for targeted nutritional and therapeutic interventions
P0284 A Comparison of the Milan Ultrasound Criteria with the Ulcerative Colitis Intestinal Ultrasound Index to Assess Disease Activity in Patients with Ulcerative Colitis
Authors: Yuksel I , Cagir Y , Durak M B , Atay A , Ozturk O , Ergul M , Oktay M E , Acun K , Kilic Z M Y
Published: January 2025

Background

Intestinal ultrasound (IUS) scoring systems have been developed to detect disease activity in patients with ulcerative colitis (UC). Nevertheless, further and comparing studies IUS scores to evaluate disease activity in UC patients are needed. We aimed to compare 2 existing validated scores, the Milan Ultrasound Criteria (MUC) and Ulcerative Colitis Intestinal Ultrasound (UC-IUS) index, for evaluating disease activity in patients with UC.

Methods

An observational cross-sectional study was performed in adult UC patients between November 2019 and June 2024. All UC patients underwent IUS before a day colonoscopy, and endoscopic Mayo score ≥2 was accepted as an active disease.

Results

Total 62 adult patients with UC (median age: 39 years) were included in the study, 39 (62.9%) patients were male, the median age was 39 years and the median duration of the disease was 6.32 (IQR, 2.63-12.32) years. Extensive location was the most prevalent extension 39 (62.9%) among all patients.

The median MUC was 8.42 (IQR, 6.34-10.96) and the median UC-IUS index was 5 (IQR, 4-6.25) for all UC patients. In patients with endoscopically remission group (endoscopic Mayo score <2), which include 14 (22.6%) patients, the median MUC was 5.76 (IQR, 3.61-6.8) and the median UC-IUS index was 3 (IQR, 2-4). Nevertheless, in endoscopically active group, the median MUC was 9.14 (IQR, 7.6-11.63) and the median UC-IUS index was 6 (IQR, 4-7), MUC and UC-IUS index were higher in endoscopic active group than in remission group (p< 0.001). Furthermore, the clinically active group (partial Mayo score ≥5) had greater MUC and UC-IUS index than the clinically remission group (p< 0.005 and p< 0.001, respectively).

The cut-off value for MUC to predict endoscopic activity (endoscopic Mayo score ≥2) was 7.46 (AUC: 0.906, 95% CI: 0.830-0.983, sensitivity: 81%, specificity: 86%, p < 0.001), and the cut-off value for UC-IUS index to expect endoscopic activity was 4.5 (AUC: 0.846, 95% CI: 0.739-0.953, sensitivity: 71%, specificity: 86%, p < 0.001).

Conclusion

In this study, we found that MUC and UC-IUS index demonstrates a strong correlation with the endoscopically active UC patients. The most accurate cut-off value for MUC was 7.6 and the most accurate cut-off value for UC-IUS index was 4.5 in UC patients with endoscopically active group.
P0289 Correlation between endoscopic scores and Nancy histological Index in ulcerative colitis: A real-world, single-center prospective study
Authors: Stratigakis L , Lakiotaki D , Lekakis V , Sakellariou S , Stofas A , Driva T , Karatzas P , Papatheodoridis G , Koutsoumpas A
Published: January 2025

Background

The Nancy Histological Index (NI) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are established tools for evaluating disease activity in ulcerative colitis (UC). This study aims to evaluate the correlation between UCEIS and NI scores in various clinical scenarios, including endoscopies performed during clinical flares (Group A), to assess mucosal healing post-treatment (Group B), at initial disease diagnosis (Group C) and during surveillance (Group D).

Methods

This prospective single-center study was conducted between June 2022 and October 2024, involving 179 patients with confirmed UC, as part of a pilot phase of implementing NI in our Histology Lab. Patients underwent colonoscopy or flexible sigmoidoscopy during which UCEIS and Mayo Endoscopic Score (MES) were independently assessed by two experienced endoscopists in the most affected colon segment. Biopsies from the same segment were scored for histological activity using the NI by two blinded to the endoscopic score pathologists. Statistical analyses were performed with SPSS version 29.0.1.1. Correlations between UCEIS/MES and NI scores were analyzed using Spearman’s correlation coefficient. The correlation coefficients between UCEIS/NI and MES/NI for each group were compared using the Z-test. All test were two-tailed, with p-values less than 0.05 considered statistically significant.

Results

Data from 179 patients (median age:54 years) were collected. Flares accounted for 62% of endoscopy indications, followed by surveillance (26.3%), mucosal healing (8.9%) and diagnosis (2.8%). Correlation coefficient between UCEIS (0-8) and NI (0-4) for all UC patients was rs=0.77 (95%CI:0.70-0.82; p<0.001), while correlation coefficient between MES (0-4) and NI was rs=0.71 (95%CI:0.63-0.78; p<0.001). Across different clinical settings, the correlation coefficients between UCEIS and NI were as follows: Group A: rs=0.54 (95% CI:0.39-0.66; p<0.001), group B: rs=0,84 (95%CI:0.58-0.94; p<0.001), group C: rs=0.75 (95%CI:-0.42-0.98; p=0.14) and group D: rs=0.74 (95%CI:0.57-0.85; p<0.001). The corresponding correlation coefficients between MES and NI were: Group A: rs=0.45 (95%CI:0.28-0.59; p<0.001), Group B: rs=0,80 (95%CI:0,49-0.93; p<0.001), Group C: rs=0.18 (95%CI:-0.84-0.98; p=0.76) and Group D: rs=0.72 (95%CI:0.54-0.84; p<0.001). The correlation coefficients between UCEIS/NI and MES/NI showed no significant differences across any group.

Conclusion

This study highlights a strong correlation between UCEIS or MES and NI scores across various clinical settings, reinforcing their complementary role in evaluating UC severity. These findings support the integration of histological and endoscopic indices for more comprehensive disease activity assessment.
P0290 Predicting disease remission in Ulcerative Colitis patients - early results from the PRESAGER study
Authors: Nordestgaard R L M , Lo B , Bergstrøm R , Adzioski I , Nielsen H S , Hawwa I M , Holme S K , Tiftikci B , Majchrzak K , Vind I , Bendtsen F , Burisch J
Published: January 2025

Background

The disease course of Ulcerative Colitis (UC) remains unpredictable. While some patients experience years of remission, others experience frequent flares, hospitalization, and surgery. The PRESAGER study aims to develop decision models to predict UC disease activity. In this preliminary analysis, we created a logistic regression model to identify predictors of remission.

Methods

UC patients with disease activity (Mayo endoscopic score [MES] ≥ 1) were recruited into the study. Demographic data, disease history, IBD Disability Index (IBD-DI), biopsies, and blood samples were collected at inclusion. Eight weeks later, patients were followed up with IBD-DI, blood samples, and an optional sigmoidoscopy. Medications taken before inclusion and during the follow-up period were recorded. Symptomatic or endoscopic remission was noted depending on if patients opted for follow-up endoscopy.

Using multivariate logistic regression, we examined the association between inclusion data and disease remission. Stepwise model selection by Akiake information criterion (AIC) was used to create a logistic regression model with the most relevant predictors. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs) and p-values. AI was used for writing inspiration and help with R coding, and no work was copied directly from an AI source.

Results

As of September 2024, 250 patients were included in the study. 182 (73%) patients had completed eight-week follow-up with IBD-DI and blood samples, and 72 (29%) patients had completed the eight-week follow-up sigmoidoscopy.

At inclusion, left-sided colitis and moderate disease activity were most common. When looking at medications taken within 14 days of inclusion, 66% of patients used mesalazine suppositories and 61% used oral mesalazine or sulfasalazine (Figure 1). Other treatments included mesalazine foam/enemas (30%), oral corticosteroids (26%), immunomodulators (18%), and biologics (14%).

A multivariate logistic regression model showed that older age and higher IBD-DI scores significantly reduced the likelihood of remission, whereas a longer disease duration was linked to a greater likelihood (Table 1). Surprisingly, calprotectin levels above 500 was associated with increased likelihood of remission compared to levels below 250. Additionally, patients with moderate disease activity had a greater likelihood of remission than those with mild activity, likely due to the increased use of corticosteroids and biologics in these cases.

Conclusion

Older age and higher disability scores significantly reduced the likelihood of remission for UC patients, while longer disease duration, moderate disease activity, and high calprotectin increased the likelihood.
P0295 Histological healing reduces the risk of relapse in ulcerative colitis: results of a prospective study
Authors: Yzet C , Robert C , Brazier F , Meudjo E , Moreau C , Chatelain D , Fumery M
Published: January 2025

Background

The STRIDE II guidelines recognize endoscopic mucosal healing (MH), defined by a UCEIS score ≤1 or a Mayo endoscopic subscore = 0 (MES), as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.

Methods

We conducted a prospective study including all consecutive UC patients in clinical remission and endoscopic MH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).

Results

A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5-19.0]) and 66 (82%) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy. Mayo=0 and HH were observed in 49 (65%) and 55 (79%) patients, respectively. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17%) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no significant difference in the risk of relapse between MES 1 and MES 0 patients (13.6% vs. 30.7% respectively p = 0.27). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7% versus 20.1% respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0% versus 27.4% respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, only absence of HH was associated with disease relapse (HR = 6.1, 95% CI = [1.6 - 23.1], p = 0.01). The degree of correlation between rectal biopsies and whole-colon biopsies was almost perfect (к 0.84 (%-agree 93.1, p < 0.001)) for HH assessment.

Conclusion

In this prospective study, histological healing was associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing. Rectal biopsies were effective in identifying HH.
P0299 Luminal phenotype of Crohn’s disease: the effectiveness of ultrasound compression elastography in the early diagnosis of disease recurrence.
Authors: Iakovlev A A , Palenyi A , Nelasov N , Tarasova G , Volkov A
Published: January 2025

Background

In recent decades, the problem of early diagnosis of Crohn’s disease remains relevant. A traditional diagnostic method is ileocolonoscopy, which has a number of contraindications and complications due to its invasiveness. Ultrasound examination of the intestine is actively used for non-invasive diagnosis of tumor processes, as well as stenosis of the colon. Research data on the diagnostic value of various ultrasound signs of compression elastography in the luminal form of Crohn’s disease are contradictory. In this work, we assessed the parameters of compression elastography (CE) in patients with a luminal Crohn’s disease with endoscopic and clinical and laboratory markers of active of inflammation.

Methods

The study included 24 patients with endoscopically verified Crohn’s disease of the colon (mean age 38.7 years (95% CI 35.4–52.1)) - group 1 and 18 without endoscopic verification, but with clinical and laboratory markers of active inflammation (mean age 42.4 years (95% CI 38.7–55.4)) - group 2. All patients underwent ultrasound with CE (scanner Phillips IU 22 convex (9-4 MHz) and linear (5-12 MHz) sensors. Signs were examined: thickening of the colon wall (3 mm or more), color Doppler mapping indicators (type 0, type 1 and - 2), CE indicators (type 1B (green mapping - soft-elastic type), type 2BA (soft-elastic type with mosaic color pattern), type 1A (predominantly blue-hard type).

Results

When conducting ROC analysis, it was found that there was a significant increase in blood flow in the mesentery and intestinal wall, predominantly type 1A (predominantly blue-hard type) (color Doppler mapping), a sign of a “rigid wall” of the colon CE and its thickening of more than 3 mm (diagnostic efficiency 87.9%, 98.3%, 96.5%, P<.0001) are reliable markers of the luminal form of Crohn’s disease (Fig. 1).

Conclusion

Luminal phenotype of Crohn’s disease: the effectiveness of ultrasound compression elastography in early diagnosis of relapse of the disease.
P0301 The Prevalence and Association Between Immune-Mediated Inflammatory Disorders and Inflammatory Bowel Disease
Authors: Mosli M , Osman B , Ruckn A , Alsharif A , Alghamdi J , Aldeen R , Rehal A , Alsiyoufi S , Saadah O , Alsahafi M
Published: January 2025

Background

Inflammatory bowel disease ([IBD]), comprising ulcerative colitis ([UC]) and Crohn’s disease ([CD]), represents chronic immune-mediated inflammatory disorders ([IMIDs])[1]. We aimed to ascertain the predictive factors and prevalence of IMIDs in patients with IBD.

Methods

The study was a single-center retrospective study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia , included adult patients with confirmed inflammatory bowel disease (IBD), regardless of age, nationality, and sex, who followed up at the hospital between 2017 and 2022. The King Abdulaziz University (KAU) Inflammatory Bowel Disease Information System (IBDIS) registry was utilized to identify eligible patients.

Results

One hundred and seventy-two patients were randomly selected. This cohort had a mean age of 37.33 years; 55.8% were women, 87 (50.6%) had IMIDs other than IBD, 57% had CD, and 43% had UC. Patients with IMIDs showed shorter IBD duration [(10.06 (6.60) vs. 12.23 (5.23) years]) than those without IMIDs ([P < .05]). IMID prevalence was lower among patients with CD exhibiting EIMs ([P < .05]) than patients with UC with erythema nodosum [(EN]) or aphthous stomatitis ([P < .05]). The male sex was a positive IMID predictor ([Odds Ratio [OR]: 2.57, 95% confidence interval (CI) = 1.08- 6.08, P = .031]), while EN ([OR: 4.75, 95% CI = 1.28 - 6.01, P = .001]) or pyoderma gangrenosum ([OR: 7.44, 95% CI = 1.46 - 17.95, P = .016]) were protective against IMID.

Conclusion

Our Retrospective study shows a substantial risk of patients with inflammatory bowel disease (IBD) developing associated immune-mediated inflammatory diseases (IMIDs).In the study cohort, 50% of individuals with IBD had comorbid IMIDs, with type1 diabetes mellitus (DM) and primary sclerosing cholangitis (PSC) being the most common.Several predictors were identified for the emergence of IMIDs, including male sex, shorter disease duration, specific laboratory findings, and the presence of complications.

Our findings emphasize the importance of recognizing multiple IMID predictors in the clinical management of IBD.

References

1.Centers for Disease Control and Prevention. Inflammatory bowel disease (IBD). 2023. Available from: https://www.cdc.gov/ibd/index.htm. Accessed November 20, 2023.
P0302 Outcomes of colectomy-IPAA for UC, is De Novo-CD on the rise?
Authors: Bakkaloglu O K , Tukek B , Atay K , Hatemi I , Celik A F , Erzin Y
Published: January 2025

Background

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical option for refractory ulcerative colitis (UC), dysplasia, or malignancy. De novo Crohn’s Disease (CD) is a recognized postoperative complication that can occur in UC patients after IPAA. Pouchitis, a common complication marked by nonspecific pouch inflammation, typically responds to antibiotics but can progress to proximal or penetrating transmural inflammation, later defined as de novo-CD.

Methods

This retrospective study analyzed UC patients who underwent proctocolectomy-IPAA between 2000 and 2022, focusing on the frequency of pouchitis and de novo-CD and associated risk factors.

Results

Among 1197 UC patients, 82 (6.8%) underwent proctocolectomy-IPAA. Of these, 65.9% (n=54) were male, with a mean UC diagnosis age of 35±12 years and a median disease duration of 49 (IQR: 112) months before surgery. Median follow-up was 83 (IQR: 86.5) months. Chronic inflammation was the primary indication for surgery, while malignancy accounted for 15.9%. Anti-TNF therapy was used in 37.8% of patients before colectomy, with a median duration of 9 (IQR: 9) months.

De novo-CD developed in 32.9% of patients, with 48% presenting with fistulizing disease. The median time to de novo-CD diagnosis was 35 (IQR: 63) months, with fistulizing disease diagnosed slightly earlier at 31 (IQR: 52) months. One-third of de novo-CD cases were initially misdiagnosed as pouchitis. Pouchitis occurred in 52% (n=43) of patients, with a median onset of 18 (IQR: 27) months. Overall, 62% of patients required treatment for pouchitis or de novo-CD, with antibiotics being the most common therapy (52%, median 2 courses). Biological therapies, primarily used in de novo-CD cases, were utilized in 24% of patients.

Patients with isolated pouchitis showed no significant differences in age at diagnosis, disease duration, gender, colectomy indication, or prior UC treatments compared to those without pouchitis. Pouchitis was more frequent in left-sided UC and less common in pancolitis. Emergency colectomy was associated with higher pouchitis rates. De novo-CD was more common in patients undergoing colectomy for malignancy and in surgeries performed in last decade.

Conclusion

De novo-CD develops in ~33% of UC patients after IPAA, typically within 2.5 years, with earlier onset in fistulizing disease. A third of cases initially mimic pouchitis. Pouchitis is more frequent in left-sided UC and less so in pancolitis. Shorter disease-free survival for de novo-CD in recent years may reflect evolving disease patterns.
P0303 Evaluation of the Terminal Ileum on Computed Tomography of Patients with Non-Traumatic Acute Abdominal Pain in the Emergency Department
Authors: Ergul M , Durak M B , Ozturk O , Cagir Y , Yuksel I
Published: January 2025

Background

Crohn’s Disease (CD) may be overlooked in patients presenting to the emergency department with acute abdominal pain. We aimed to determine the frequency of CD and increased terminal ileum wall thickness on abdominal computed tomography (CT) in patients presenting to the emergency department with non-traumatic acute abdominal pain.

Methods

A cross-sectional observational study was conducted among patients who had presented to the emergency department with non-traumatic acute abdominal pain and underwent CT between September 2023 and September 2024. Before CT, patients with known diseases such as CD, vasculitis, tuberculosis, and lymphoma were excluded from the study. A colonoscopy was performed on patients with terminal ileum wall thickness on CT examination.

Results

A total of 1014 patients were admitted to the emergency department with non-traumatic acute abdominal pain, 10 (1%) of whom were determined to increase terminal ileum wall thickness. The median age was 41.2, and 7 (70%) patients were female. Median terminal ileum wall thickness was measured as 6.04 mm. 9 (90%) had limited terminal ileum, 6 (60%) had a length of wall thickness more than > 5cm, 7 (70%) had stenosis and 5 (50%) had pre-stenotic dilatation on CT. Colonoscopy revealed aphthous ulcers in the terminal ileum in 6 patients, longitudinal deep ulcers in 2 patients, and 2 patients with intact terminal ileum mucosa.

3 (0.3%) of the patients with terminal ileum wall thickness were diagnosed CD after colonoscopic examination. One patient had ileocolonic involvement with stricturing behavior, while the other two had isolated ileal involvement with inflammatory behavior. 2 patients were managed with medical treatment and the other patient with ileal resection. The remaining 5 patients with terminal ileal aphthous ulcers had a history of antibiotic, nonsteroidal anti-inflammatory drug use, or gastroenteritis within the last 3 months.

Conclusion

In this study, CD was detected in 3 (0.3%) patients who has previously undiagnosed, presented non-traumatic acute abdominal pain with terminal ileum wall thickness on CT. Terminal ileitis is a rare reason in patients presenting acute abdominal pain. However, CD should be kept in mind among differential diagnosis.
P0309 Machine learning for predicting Crohn’s disease from routine blood tests years before diagnosis: results from the epi-IIRN
Authors: Lev Zion R , Dolev A , Yuval Bar-Asher S , Ben-Tov A , Ledderman N , Matz E , Dotan I , Turner D , Lerner B
Published: January 2025

Background

Various biomarkers may help predict inflammatory bowel disease (IBD) in advance of diagnosis, but these are mostly not routinely tested and thus are more challenging for screening. In this nationwide study, we used the epi-IIRN validated cohort to explore the utility of routine blood tests as markers for predicting IBD occurrence.

Methods

We used the epi-IIRN cohort to collect results of all blood tests performed up to 15 years before diagnosis, from all IBD patients diagnosed between 2005-2020 and insured by Israeli health maintenance organizations (HMOs); each patient was individually matched to two non-IBD controls. Means were compared using Welch’s t-test with false discovery rate correction to account for multiple comparisons. We then used machine learning to build a model using the 15 most statistically significant blood tests to predict Crohn’s disease.

Results

46,223 individuals were included – 8,630 with Crohn’s disease (CD) (43% males, mean age at diagnosis 38±19 years) and 6,791 with ulcerative colitis (UC) (41% males, mean age at diagnosis 42±10 years) with their 2:1 matched controls. For adults with CD, 29 tests showed differences between cases and controls earlier than 1 year pre-diagnosis, including 3 with consistent differences >10 years pre-diagnosis (white blood cell, neutrophil and platelet counts). In children, 17 blood tests showed consistent differences earlier than 1 year pre-diagnosis. No test showed significant differences between UC cases and controls.

The machine-learning model had an area under the curve (AUC) for predicting future CD 1 year pre-diagnosis of 0.70 in adults and 0.68 in children.

Conclusion

We were able to detect significant changes in routinely collected blood tests long before CD diagnosis and to predict future CD using a machine learning model. This opens the possibility of detecting early signals of future CD in patients undergoing routine blood tests, which may be used for developing screening and prediction models for prevention strategies.
P0310 Intestinal Ultrasound parameters correlate with endoscopic findings in patients with post-operative Crohn’s disease.
Authors: Laoudi E , Chatzinikolaou M L , Kokkotis G , Koutsounas I , Gizis M , Chalakatevaki K , Kitsou V , Bamias G
Published: January 2025

Background

In patients with Crohn’s disease (CD) and ileocecal resection, colonoscopy remains the gold-standard for detecting post-operative recurrence (POR). Intestinal ultrasound (IUS) is non-invasive, patient-friendly, with high accuracy for the detection of bowel inflammation. The aim of the present study was to investigate the correlation between post-operative endoscopic findings and those of IUS in patients with CD.

Methods

We analyzed data from CD patients with ileocecal resection who underwent colonoscopy and IUS for follow up. Post-operative endoscopic recurrence (ER) was defined as Rutgeert’s score (RS)≥i2b. The following IUS parameters were analyzed: bowel wall thickness (BWT), bowel wall stratification (BWS), modified Limberg score for the assessment of bowel wall hyperemia (BWH) and neo-terminal ileum peristalsis. Linear and binary logistic regressions were used to identify associations between RS and IUS parameters. SPSS-23 was used for the statistical analysis with a threshold of P=0.05 for statistical significance.

Results

In total, 44 patients [29 male, median age (SD): 40 (14.7) years] underwent IUS 42 [2-126] months following ileocecal resection. Thirty-eight (86%) patients were on treatment [infliximab 10 (23%), adalimumab 9 (21%), ustekinumab 11 (25%), vedolizumab 4 (9%), ozanimod 1 (2%) azathioprine 1 (2%), methotrexate 1 (2%)] and 7 (16%) patients were on no treatment. Endoscopic recurrence was detected in 52% of patients. Higher RS was associated with increased BWT, absence of peristalsis in the neo-TI and loss of BWS (P=0.007, P=0.001 and P=0.028 respectively). In multivariate analysis a higher RS was independently associated with the absence of peristalsis in the neo-terminal ileum (P=0.019). A tendency for a positive correlation between RS and ΒWT (P = 0.071) was also observed. RS≥i2b was significantly correlated with loss of BWS (P=0.045), absence of peristalsis (P=0.027) and a tendency was observed with BWT(P=0.081). RS≥i3 was significantly correlated with absence of peristalsis in the neo-TI (P= 0.001), BWT>3mm (P= 0.041), while a tendency was observed with modified Limberg score≥2 (P= 0.082).

Conclusion

IUS parameters correlate with RS in patients with post-operative CD. IUS may be a valuable monitoring tool for the assessment of POR in CD. Larger prospective studies are needed to determine cut-off values of sonographic parameters that may accurately predict post-operative recurrence of CD.
P0320 The consistency of ultrasound and colonoscopy of every colonic segment in patients with Ulcerative Colitis
Authors: Zhang Y , Yang H
Published: January 2025

Background

Many studies have indicated the consistency of ultrasound and colonoscopy in patients with ulcerative colitis (UC). However, their relationship in every colonic segment has not been shown.

Methods

The sigmoid, descending, transverse, and ascending colon of 111 UC patients were evaluated by ultrasound and colonoscopy. Regarding ultrasound, four parameters were evaluated: bowel wall thickness, colour Doppler signal, wall layer stratification, and Milan score. For colonoscopy, the Mayo endoscopic score (MES) was used. Their association was assessed if ultrasound and endoscopic evaluations are close in time (defined as within 8 weeks).

Results

One hundred and sixty-six matched pairs of ultrasound and colonoscopy were assessed. The bowel wall thickness and the Milan score were significantly associated with MES regardless of colonic segments. The higher the MES was, the thicker the bowel wall thickness was. A similar trend was also shown for the Milan score. The colour Doppler signal is increasingly abundant with higher MES in the descending, transverse, and ascending colon. Besides, the patients with loss of wall layer stratification in the sigmoid and descending colon had a higher MES.

Conclusion

The bowel wall thickness and Milan score are consistent with the MES for all colonic segments. However, the consistency of the colour Doppler signal and bowel wall stratification is different for four bowel segments. The consistency of the ultrasound colour Doppler signal and MES is good in the descending, transverse, and ascending colon, but not in the sigmoid colon. The consistency of the wall layer stratification and MES is good in the descending and sigmoid colon but not in the transverse and ascending colon.
P0323 Serum leucine-rich α2-glycoprotein (LRG) and Monocyte chemoattractant protein-1 (MCP-1) as Novel Biomarkers for Predicting Vedolizumab Response in Ulcerative Colitis Patients
Authors: Yoshihara T , Shinzaki S , Naka T , Iijima H , Hayashi Y , Inoue T , Tsujii Y , Uema R , Otake-Kasamoto Y , Tani M , Amano T , Tashiro T , Asakura A , Sakakibara Y , Yamada T , Hiyama S , Nishida T , Ishiguro K , Baba Y , Takehara T
Published: January 2025

Background

Close monitoring of disease activity is essential for the therapeutic management of inflammatory bowel disease. A minimally invasive and reliable serum biomarker is desirable, but its reliability and validity have not yet been fully evaluated. The purpose of this study (UMIN000043185) was to investigate the utility of leucine-rich α-2-glycoprotein (LRG) in the management of vedolizumab therapy in patients with ulcerative colitis (UC), and to identify mucosal signatures and surrogate biomarkers by using serum cytokine and mucosal transcriptome analysis.

Methods

Serum LRG, C-reactive protein (CRP), serum Mucosal Vascular Addressin Cell Adhesion Molecule 1(MadCAM1), serum vedolizumab levels, 19 serum cytokines, and fecal calprotectin (fCal) were measured over 54 weeks (week 0, 2, 6, 14, 30, and 54) (n=21). Clinical remission (Mayo score <= 2, all subscore < = 1) and mucosal healing (Mayo endoscopic subscore <= 1) at week 14 were compared between the clinical remission (CR) group (n=11) and non-clinical remission (non-CR) group (n=10), and between the mucosal healing (MH) group (n=14) and non-mucosal healing (non-MH) group (n=7). Differentially expressed gene (DEG) extraction was performed by stratifying data at week 0 and comparing two groups: CR (n=10) and non-CR (n=3), and complete MH (Mayo endoscopic subscore = 0) (n=8) and non-complete MH (n=6) at week 14.

Results

Serum LRG concentrations were significantly lower in CR group compared to the non-CR group at week 0 (19.0 vs. 29.0 ug/mL, p=0.027) and week 6 (13.4 vs. 19.6 ug/mL, p=0.034) and significantly lower in MH group compared to the non-MH group at week 6 (13.7 vs. 21.6 ug/mL, p=0.033). In contrast, there were no significant differences in serum CRP and fecal calprotectin levels at any time point for either CR or MH. Serum MCP-1 levels showed significant differences between CR and non-CR at week 0 (609.0 vs 403.4 pg/mL, p=0.0018), between MH and non-MH at week 0 (587.2 vs 358.9 pg/mL, p<0. 001), week 6 (606.9 vs 451.6 pg/mL, p=0.015). DEGs extracted from colon tissue included LRG1 and LRG-related cytokines, MCP-1, reflecting the effect of vedolizumab treatment.

Conclusion

Both serum LRG (lower in CR/ MH group) and serum MCP-1 (higher in CR/MH group) were suggested to be promising predictive biomarkers of vedolizumab treatment response in patients with UC. Further studies are needed to assess their reliability and validity as indicators of treatment effectiveness.
P0332 Optimization and assessment of colonoscopy preparation in Inflammatory Bowel Disease: a comprehensive single-center analysis with focus on disease-specific factors
Authors: Saidani R , Cherif D , Hassine H , Yacoub H , Debbabi H , Kchir H , Maamouri N
Published: January 2025

Background

Colonoscopy remains a cornerstone in inflammatory bowel disease (IBD) management, yet comprehensive data on preparation quality and tolerability in this specific population remains limited. We aimed to evaluate bowel preparation efficacy, tolerability, and colonoscopy outcomes in IBD patients while analyzing disease-specific influencing factors.

Methods

We conducted a prospective single-center study of 78 IBD patients (45 ulcerative colitis [UC] and 33 Crohn’s disease [CD]) undergoing routine colonoscopy surveillance. All patients received a split-dose 4L polyethylene glycol preparation. We collected comprehensive data including clinical parameters, Boston Bowel Preparation Scale (BBPS) scores, sedation requirements, and procedure tolerability using Visual Analogue Scale (VAS, 0-100mm). Disease activity was assessed using standardized endoscopic scores.

Results

Mean age was 47.2 ± 14.5 years for UC and 43.8 ± 13.9 years for CD patients. Adequate bowel preparation (BBPS ≥6) was achieved in 85.7% (67/78) of patients, with a mean total BBPS score of 6.3 ± 1.4. Female patients showed slightly higher preparation quality scores compared to males (BBPS 6.5 ± 1.3 vs 6.1 ± 1.4, p=0.12), though this difference was not statistically significant. Complete colonoscopy was successfully performed in 93.6% (73/78) of cases. No significant differences in BBPS scores were observed between UC and CD patients (6.4 ± 1.5 vs 6.2 ± 1.3, p=0.62), or between patients with active disease versus those in remission (6.3 ± 1.4 vs 6.2 ± 1.5, p=0.85). Preparation tolerability was rated as good or excellent (VAS ≥70) in 76.9% (60/78) of patients, with similar ratings between genders (females: 77.8%, males: 75.9%, p=0.83). Notably, 32.1% (25/78) of IBD patients required increased sedation compared to standard doses, with a higher proportion in CD patients (42.4%, 14/33) compared to UC patients (24.4%, 11/45, p=0.047), and in female patients (37.2%, 16/43) compared to males (25.7%, 9/35, p=0.038). Disease-related factors including disease duration, location, and previous surgery did not significantly impact preparation quality.

Conclusion

Our study demonstrates that high-quality bowel preparation can be achieved in IBD patients regardless of gender and disease characteristics, with good tolerability rates. However, increased sedation requirements, particularly in CD patients and females, should be anticipated. These findings support the implementation of standardized preparation protocols in IBD patients while emphasizing the need for personalized sedation strategies based on both disease and demographic factors.