bluuebunny/crossref_metadata_2025 huggingface dataset:
P0447 Accurate, rapid and economical diagnosis of chronic enteropathy associated with SLCO2A1 gene and the analysis of its clinical pathological features
Authors: Liu R , Ye L
Published: January 2025

Background

Chronic enteropathy associated with the SLCO2A1 gene (CEAS) is a rare intestinal disease caused by loss of protein function due to mutations in the SLCO2A1 gene. Currently, the clinical features of this disease are poorly understood, and diagnosis of lesions in the small intestine is challenging with limited methods, relying heavily on costly genetic sequencing. Therefore, this study aims to elucidate the clinical characteristics of Chinese CEAS patients and explore the diagnostic value of immunohistochemistry of biopsy tissues from duodenum, terminal ileum or colon site.

Methods

A retrospective analysis was conducted on 10 cases of CEAS admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2015 to May 2024. Data including demographic information, clinical manifestations, laboratory and imaging results, pathological findings, genetic testing, and immunohistochemistry (IHC) results were analyzed.

Results

Of the 10 patients, 4 were male and 6 were female, the average age at onset was 25 years (IQR 17-36), and the average age at diagnosis was 41 years (IQR 39-44), with an interval of about 16 years from onset to diagnosis. Two patients had concurrent primary hypertrophic osteoarthropathy (PHO), both of whom were male. All patients had small intestine involvement, with the most common endoscopic findings being multiple strictures and superficial ulcers of the small intestine. Pathological findings indicated nonspecific chronic inflammation limited to the mucosa and submucosa.

Five patients underwent surgical treatment, all involving partial small bowel resection. Genetic sequencing results indicated SLCO2A1 gene mutations in all 10 patients, with 7 patients having homozygous mutations and 3 having heterozygous mutations. Immunohistochemistry for SLCO2A1 protein on pathological specimens from the affected small intestine showed loss of SLCO2A1 expression in 9 patients and markedly reduced expression in 1 patient, with focal loss in specific vascular regions. Further immunohistochemistry of non-affected sites, including the descending duodenum and terminal ileum, also showed decreased or absent SLCO2A1 expression, consistent with findings in the affected areas.

Conclusion

CEAS is characterized by multiple small intestinal strictures, with a minority of patients also presenting with hypertrophic osteoarthropathy, which is more common in males. Immunosuppressants and biologics generally show poor efficacy. Historically, CEAS has been difficult to diagnose with a prolonged time to diagnosis, and genetic testing is costly and time-consuming. Immunohistochemical analysis of SLCO2A1 protein, regardless of whether the tissue is from affected or non-affected areas, can aid in early diagnosis.
P0452 Complicated and Extra-Complicated Crohn’s Disease Course: a Prospective Inception Real-World Cohort
Authors: Sharar Fischler T , Goren I , Ollech J E , Banai-Eran H , Avni-Biron I , Snir Y , Broitman Y , Freidenberg A , Pauker M H , Dotan I , Yanai H
Published: January 2025

Background

Crohn’s disease (CD) is a heterogeneous condition with a potentially complicated course. We aimed to evaluate the rates of a complicated disease course within a real-world prospective inception cohort of patients with newly diagnosed CD (ndCD).

Methods

A prospective, observational, longitudinal cohort study involving consecutive adults with ndCD was conducted at a tertiary referral center. Patients were managed at the discretion of their treating physician. Key outcomes were defined as ‘complicated disease course’ (any CD-related hospitalization, any CD-related surgery, steroid dependency, or ≥2 biologics) and ‘extra-complicated disease course’ (recurrent or >5-days hospitalization, multiple perianal procedures, CD-related intestinal resection, or ≥3 biologics) over time. The Chi-square Automatic Interaction Detector (CHAID) technique was used to identify cutoffs of clinical indices and blood count values at diagnosis associated with a complicated disease course at one year post-diagnosis. Kaplan-Meier survival analysis was used to assess complication rates over time, and multivariable Cox regression analysis was used to identify risk factors.

Results

A total of 192 patients with ndCD with a median age of 26 years (IQR: 21-36) were included, of whom 45.8% were female. Phenotypes included 18.8% with stricturing (B2), 9.9% with penetrating (B3), and 19.3% with perianal (P) disease. The median follow-up period was 3.9 years (IQR: 1.5-5). The cumulative rates of complicated and extra-complicated disease courses were 24.2% and 12.9% at one year, 35.9% and 18.9% at three years, and 51.3% and 26.6% at five years post-diagnosis, respectively. Patients with progressive phenotypes (B2, B3, or P) at diagnosis had a significantly elevated risk for both complicated (HR 3.362, 95% CI: 1.992-5.673) and extra-complicated disease course (HR 6.724, 95% CI: 3.36-14.418). Baseline laboratory values contributing to risk stratification included a platelet count above 370x103/uL (HR 2.64, 95% CI: 1.583-4.401 for complicated course; HR 4.105, 95% CI: 2.043-8.247 for extra-complicated course) and lymphocyte count above 1.2x103/uL (HR 1.800, 95% CI: 1.034-3.133 for extra-complicated course).

Conclusion

Nearly half of patients with ndCD experience a complicated disease course within five years, with progressive phenotypes at diagnosis significantly increasing the risk. Elevated platelet and lymphocyte count at diagnosis may further identify individuals at a higher risk for adverse outcomes (‘extra-complicated course’).
P0453 Intestinal Ultrasound Correlates with Patient-Reported IBD Disability in Ulcerative Colitis: A Step Towards Integrated Monitoring
Authors: Eggermont E , Lenfant M , Fierens L , Vermeire S , Ferrante M , Sabino J , Verstockt B
Published: January 2025

Background

Non-invasive imaging methods, particularly intestinal ultrasound (IUS), are increasingly pivotal in guiding management in ulcerative colitis (UC). While long-term treatment goals focus on reducing IBD-related disability, the link between ultrasonographic findings and patient-reported outcome measures (PROMs), such as IBD-related disability, remains unclear.

Methods

Data on IBD-related disability (using the IBD disk) were prospectively gathered through a digital questionnaire from patients with UC undergoing routine IUS, and performed within maximal one week of each other. Patients with isolated proctitis were excluded. Bowel wall thickness (BWT) was averaged from two independent measurements >1 cm apart, alongside colour Doppler assessments, all blinded to IBD disk data. The Milan Ultrasound Criteria (MUC) score was calculated, with relevant ultrasound activity defined as MUC >6.2 (worst affected segment).1 A high IBD-related burden was defined as an IBD disk score >40. Correlation analysis was performed using Spearman’s rank coefficient.

Results

Thirty-one paired assessments (median interval: 0.0 [IQR 0.0–3.0] days) were conducted on unique UC patients (38.7% female, median age 32.6 [28.0–45.9] years, median disease duration 1.3 [0.3–6.6] years, 71.0% left-sided colitis). Ultrasound activity (MUC >6.2) was present in 51.6% of patients, while 29.0% reported a high IBD-related disability. Total IBD disk scores correlated significantly with maximal BWT (r=0.41, p=0.02), modified Limberg Doppler signal (r=0.35, p=0.05), and MUC scores (r=0.44, p=0.01). Patients without MUC-defined inflammation showed significantly lower IBD-related disability (median IBD disk score: 41.0 [26.0–52.0]) compared to those with inflammation (72.0 [58.0–78.0], p=0.001) (Figure 1A). Individual IBD disk components—abdominal pain, body image, education/work impact, emotions, energy, interpersonal interactions, defecation regulation, sexual function, and sleep—differed significantly between patients with and without ultrasonographic inflammation (Table 1). Quartile analysis revealed that normal ultrasonographic findings were most likely in patients with the lowest IBD disk scores (Q1 vs Q2–Q4: 87.5% vs 53.3%, p=0.02) (Figure 1B). Receiver Operating Characteristic (ROC) analysis suggested a stricter MUC cutoff of 5.3, achieving 71.0% [48.1–93.8%] accuracy in estimating IBD-related disability with a negative predictive value of 88.2%.

Conclusion

In patients with UC, IUS findings correlate with IBD-related disability and warrant further exploration as potential endpoint and/or treatment target. However, these metrics seem complementary rather than fully interchangeable.

References

1.Allocca M et al. J Crohns Colitis 2023.
P0463 Co-infection of Clostridium innocuum Worsens Outcomes in Inflammatory Bowel Disease Patients with Clostridioides difficile Infection
Authors: Ching Reigh H , Le P H , Chiu C H , Chiu C T , Su M Y , Kuo C J , Chang M L
Published: January 2025

Background

Clostridioides difficile infection (CDI) is known to trigger acute flare-ups and worsen clinical outcomes in patients with inflammatory bowel disease (IBD). Increasing evidence suggests that co-infection with Clostridium innocuum (CI), which is resistant to vancomycin, also contributes to negative outcomes. However, CI is often overlooked or misdiagnosed. No previous study has specifically examined the impact of CI co-infection in IBD patients with CDI. This study aims to address this gap.

Methods

This retrospective cohort study included 142 IBD inpatients at Linkou Chang Gung Memorial Hospital, Linkou, between January 2000 and May 2021, of whom 79 were diagnosed with CDI based on stool toxin A/B tests. Patients were classified into two groups: 50 with CDI alone and 29 with co-infection of CDI and CI, based on stool culture results. Clinical manifestations, outcomes, and between-group differences were analyzed using the Mann-Whitney U test, while independent risk factors were evaluated through multivariable analysis.

Results

Among the 79 IBD patients included, 50 had CDI and 29 had CDI with CI co-infection. In the co-infection group, the most common symptoms were bloody stool (69%) and diarrhea (65.5%) (Table 1). Clinically, the co-infection group experienced a higher rate of biological therapy failure (1 vs. 0, p = 0.050) and took longer to achieve clinical remission (6.5 vs. 2 months, p = 0.002) and steroid-free remission (11 vs. 6 months, p = 0.016). Multivariable analysis identified biologic use as the only independent predictor of CDI/CI co-infection (OR 5.375, 95% CI 1.822–15.857, p = 0.002).

Conclusion

Co-infection with Clostridioides difficile and Clostridium innocuum is associated with poorer outcomes in IBD patients, including prolonged time to remission and increased risk of biological therapy failure. Early recognition of CI, even in IBD patients with CDI, is crucial for improving clinical management and outcomes.

References

1.Yu S, Ge X, Xu H, Tan B, Tian B, Shi Y, Dai Y, Li Y, Hu S, Qian J. Gut microbiome and mycobiome in inflammatory bowel disease patients with Clostridioides difficile infection. Front Cell Infect Microbiol. 2023;13:1129043. doi:10.3389/fcimb.2023.1129043.

2.Wu HY, Kuo CJ, Chou CH, Ho MW, Chen CL, Hsu TS, Chen YC, Chiang-Ni C, Chen YM, Chiu CH, Lai CH. Clostridium innocuum, an emerging pathogen that induces lipid raft-mediated cytotoxicity. Virulence. 2023;14(1):2265048. doi: 10.1080/21505594.2023.2265048.

3.Bai M, Guo H, Zheng XY. Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management. Therap Adv Gastroenterol. 2023;16:17562848231207280. doi:10.1177/17562848231207280.

4.Le PH, Chiu CT, Yeh PJ, Pan YB, Chiu CH. Clostridium innocuum infection in hospitalised patients with inflammatory bowel disease. J Infect. 2022;84(3):337-342. doi: 10.1016/j.jinf.2021.12.031.
P0465 Chromoendoscopy for Dysplasia Detection in High-Risk IBD Patients: A Decade of Experience at a Tertiary Care Centre
Authors: Weisshof R , Postnikov M , Gorelik Y , Ben-Hur D , Waterman M , Koifman E
Published: January 2025

Background

Ulcerative colitis (UC) and colonic Crohn’s disease (CD), carries an increased risk of colorectal cancer, necessitating effective surveillance strategies. Dye spraying and electronic virtual chromoendoscopy techniques enhance mucosal visualisation and aid in dysplasia detection. We aim to presents the effectiveness and characteristics of chromoendoscopy (CE) in a tertiary care center.

Methods

We conducted a retrospective cohort study of inflammatory bowel disease (IBD) patients who underwent CE at our center between 2014 and 2024, following recommended guidelines. Dysplasia detection rates were documented, and associated risk factors were analysed. Advanced dysplasia was defined as villous pathology features, lesion ≥ 10mm, high-grade dysplasia, or malignancy.

Results

A total of 139 patients (50% female; median age at procedure: 51.6 years [IQR 40.6–62.8]; median duration from diagnosis: 17.5 years [IQR 12.2–25.5]) underwent a median of 2 endoscopies (IQR 1–4) with a median Boston bowel preparation score of 8 (IQR 7–9). Among these patients, 75% had UC and 70.8% were non-smokers. Dysplasia was detected in 13 patients (9.4%) at the first surveillance. Overall, the dysplasia detection rate was 17.4% per procedure (64/367) and 14.4% per patient (20/139). Advanced dysplasia was identified in 13 procedures (3.5%). Univariate analysis revealed significant associations between dysplasia detection and male sex (67.4% vs. 44.2%; p = 0.03), age at diagnosis (35 years [IQR 28.5–41.3] vs. 29.2 years [IQR 19.6–37.6]; p = 0.03), age at procedure (62.7 years [IQR 53.2–67.1] vs. 50.4 years [IQR 43.2–62.3]; p = 0.025), and prior dysplasia at first surveillance (25.7% vs. 2.9%; p < 0.001). No correlations were identified with family history of colorectal cancer, treatment history, primary sclerosing cholangitis, or smoking status. Multivariate analysis identified age at procedure as the only significant risk factor (OR: 1.07, 95% CI: 1.02–1.12). Over the past decade, a notable shift was observed from dye chromoendoscopy (usage declined from 74% to 36%) to electronic chromoendoscopy (usage increased from 8.3% to 67.6%). Dysplasia detection rates remained steady over time (figure 1).

Conclusion

Routine chromoendoscopy surveillance in high-risk colitis patients yields high dysplasia detection rates. Our findings reaffirm the association of some of the known risk factors with increased dysplasia detection and highlight the growing preference for electronic CE in endoscopic surveillance. These results further reinforce the value of chromoendoscopy in targeted and effective surveillance strategies.
P0466 Impact of the COVID-19 Pandemic on Clinical Presentation and Management of Inflammatory Bowel Disease: A Multicentre Study in the West Midlands, UK
Authors: Rafique H , Ismail A , Umar N , Hasaan S , Rahania K , Saeed M H , Harvey P , De Silva S
Published: January 2025

Background

The COVID-19 pandemic disrupted healthcare systems globally, exacerbating disease severity and delaying management of chronic conditions like inflammatory bowel disease (IBD). This multicentre study investigates the pandemic’s impact on clinical presentation, treatment patterns, and outcomes of ulcerative colitis (UC) and Crohn’s disease (CD) patients at two UK district hospitals.

Methods

A retrospective study was conducted between July 2017–June 2022 at two district hospitals, comparing pre- and post-COVID outcomes in UC and CD patients. Factors analyzed included disease extent, inflammatory markers, treatment patterns, diagnostic investigations, and patient outcomes, such as emergency surgery.

Results

Among 602 IBD patients (52.2% UC, 47.8% CD), the median age was 41 years (IQR 29), and 51.3% were male. Post-COVID, UC patients presented with more severe disease: UC E3 (Extensive Colitis) increased from 24.0% to 32.8% (p=0.01), while UC E1 (Proctitis) decreased from 18.4% to 7.4% (p=0.004). Median hospital stays rose from 4 to 6 days (p=0.03), with inflammatory markers showing significant increases—median CRP levels rose from 25 to 35 mg/L (p=0.016), and faecal calprotectin levels increased from 600 to 1800 µg/g (p<0.0001). Treatment patterns shifted, with reduced 5-ASA (77.6% to 59.3%, p=0.001) and immunosuppressant use (19.2% to 9.0%, p=0.004) but increased biologic therapy (27.2% to 31.7%, p=0.001).

In CD, disease localization shifted significantly: terminal ileum involvement (CD L1) rose from 30.6% to 46.8% (p=0.001), while ileocolonic disease (CD L3) decreased from 45.9% to 31.1% (p=0.01). Imaging utilization nearly doubled, with CT/MRI use increasing from 36.7% to 71.6% (p<0.001). Post-COVID CD patients were younger, with median age decreasing from 42 to 39 years (p=0.05). Untreated cases in the younger cohort of age <43 years rose from 64% to 84% (p=0.004). Emergency surgery rates in both UC and CD and ITU admission rates remained unchanged pre- and post-COVID.

Conclusion

Post-COVID, UC patients presented with more extensive colitis, higher inflammatory markers, and longer hospital stays. CD patients showed shifts in disease localization, increased imaging use, and a younger, less-treated demographic. Delayed access to care likely fostered disease progression, compounded by pandemic-related psychological stress and immune dysregulation. Strengthening healthcare systems with robust referral pathways and timely IBD treatment is essential to mitigate impacts of any future systemic disruptions.
P0470 Albumin as a prognostic marker in IBD : Insights from a Tertiary Care Hepato-Gastroenterology Center Experience
Authors: Adamou Mainassra F , Koulali H , Hassini A , Essadi B , Douhri I , Elmqddem O , Zazour A , Zahi I , Kharrasse G
Published: January 2025

Background

Chronic inflammatory bowel diseases (IBD) are persistent conditions characterized by alternating phases of flare-ups and remissions, ranging from mild exacerbations to severe cases, such as those in ulcerative colitis (UC), which may require colectomy and significantly affect patients’ functional and vital outcomes. Over time, several predictive markers, particularly in Crohn’s disease (CD), have been identified at diagnosis. This raises an essential question: could hypoalbuminemia be considered a prognostic factor in the clinical course of IBD?

Methods

This retrospective descriptive and analytical study spanned 5 years and 2 months (January 2018 to March 2023) and included all IBD patients monitored in our department. Data analysis was conducted using SPSS, with chi-square tests and multivariate logistic regression employed to evaluate relationships

Results

302 IBD patients were analyzed, with a mean age of 40.7 years and a female predominance ( sex ratio = 0.7).165 had Crohn’s disease (CD), and 143 had ulcerative colitis (UC), categorized as pancolitis (61 cases), UC E2 (46 cases), and UC E1 (30 cases). In the CD cohort, 30% (50 patients) underwent ileocecal resection. Smoking and alcoholism were reported in 14.9% and 6.6% of cases, respectively, while NSAID and PPI use were noted in 11.5% and 3.3%. Additionally, 8.6% reported phytotherapy use. Hypoalbuminemia was defined as serum albumin ≤35 mg/L, with 32% (97 patients) meeting this criterion. Patients with hypoalbuminemia were treatment-naïve and had serum albumin levels assessed at diagnosis, with follow-up for at least one year.

Key findings included

• Steroid Use: 78.35% of hypoalbuminemic patients required at least two courses of corticosteroids, compared to 12.68% with normal albumin levels (P=0.003).

• Thiopurines and Anti-TNF: Thiopurines were used in 81% of hypoalbuminemic patients vs. 45.8% (P=0.001), and anti-TNF therapy in 42.2% vs. 16.58% (P=0.006).

• Colectomy: Rates were higher in hypoalbuminemic patients (17.52%) compared to those with normal albumin (0.4%, P=0.009).

• Anemia: Observed in 92.78% of hypoalbuminemic cases vs. 18.53% with normal albumin levels (P=0.001).

Notably, only 7.2% of hypoalbuminemic patients were treated with combined oral and rectal 5-ASA, achieving sustained clinical and endoscopic remission over three years.

Conclusion

In conclusion, our study highlights hypoalbuminemia as a critical prognostic marker in the progression of IBD. Assessing albumin levels at diagnosis, particularly in UC, provides valuable insight for identifying patients at higher risk of severe disease, guiding the need for intensified treatment and closer follow-up. This reinforces the importance of early, comprehensive evaluation in optimizing IBD management strategies
P0471 Prevalence and risk factors for gallstone and renal stone formation in patients with intestinal Behçet’s disease
Authors: Park J , Jae Hee C
Published: January 2025

Background

The association between inflammatory bowel disease (IBD) and gallstone and renal stone formation has been established. However, few studies have investigated this association in patients with intestinal Behçet’s disease (BD).We aimed to examine the prevalence of gallstones and renal stones in patients with intestinal BD and identify potential risk factors.

Methods

We analyzed gallstone and renal stone occurrences in 553 patients diagnosed with intestinal BD who had undergonecross-sectional imaging examinations between March 2005 and April 2021 at the IBD Center, Severance Hospital,Seoul, South Korea. Logistic regression models were used to identify risk factors for gallstone and renal stone formation.

Results

Of 553 patients over a mean 12.1-year duration, 141 (25.4%) patients had gallstones and 35 (6.3%) had renal stones. In multivariate logistic regression analysis, disease duration > 19 years (OR 2.91, 95% CI 1.56–5.44, p < 0.001), prior intestinal BD-related surgery (OR 2.29, 95% CI 1.42–3.68, p < 0.001), and disease activity index for intestinal BD scores ≥ 75(OR 2.23, 95% CI 1.12–4.45, p = 0.022) were associated with increased gallstone occurrence. A positive correlation was observed between renal stones, disease duration > 19 years (OR 5.61, 95% CI 1.98–15.90, p = 0.001) and frequent hospitalization(> 3 times) (OR 3.29, 95% CI 1.52–7.13, p = 0.002). No significant correlation was observed between gallstone and renal stone occurrence.

Conclusion

These findings contribute to greater understanding concerning gallstone and renal stone prevalence and associated risk factors in patients with intestinal BD.

References

1.Sakane T, Takeno M, Suzuki N, Inaba G. Behçet’s disease. NEngl J Med 1999;341:1284-1291.

2.Kaklamani VG, Kaklamanis PG. Treatment of Behçet’s disease--an update. Semin Arthritis Rheum 2001;30:299-312.

3.Kim DH, Cheon JH. Intestinal Behçet’s disease: a true inflammatorybowel disease or merely an intestinal complication ofsystemic vasculitis? Yonsei Med J 2016;57:22-32.

4.Suzuki Y, Hagiwara T, Kobayashi M, Morita K, Shimamoto T,Hibi T. Long-term safety and effectiveness of adalimumab in462 patients with intestinal Behçet’s disease: results from alarge real-world observational study. Intest Res 2021;19:301-312.

5.Song EM, Yang SK. Natural history of inflammatory boweldisease: a comparison between the East and the West. IntestRes 2022;20:418-430.
P0473 Establishment of a prediction model for endoscopic activity of Ulcerative Colitis based on Intestinal ultrasound combined with biochemical indicators
Authors: Zhao Y , Pei J , Li Y , Pu T , Wen H
Published: January 2025

Background

Intestinal ultrasound (IUS) is becoming a standard evaluation tool for ulcerative colitis (UC). Since the limited diagnostic efficacy of individual ultrasound parameters, we aimed to develop and validate a predictive model for endoscopic disease activity in ulcerative colitis based on transabdominal intestinal ultrasound in combination with biochemical indices, to improve the non-invasive standard of UC synthetically

Methods

This study enrolled 101 consecutive adult UC patients in the First Affiliated Hospital of Zhengzhou University from June 2022 to August 2024. Classified by Mayo endoscopic score (MES) as remission (MES = 0), mild (MES = 1), moderate (MES = 2), and severe (MES = 3). The 101 patients were split into a training set (n = 81) and a test set (n = 20), with 10% of the training set as the validation set. The neural network model was built using an MLP multi-layer perceptron (Fig. 1), and the prediction performance of the model was evaluated using accuracy, precision, recall, and AUC.

Results

1. The ultrasound indicators selected for correlation analysis with MES score including bowel wall thickness (BWT), Limberg blood flow signal, blood flow velocity, resistance index, and mesenteric hypertrophy were statistically significant (p<0.05).

2. The laboratory indicators selected for correlation analysis with the MES score including WBC, PLT count, hemoglobin, CRP, PCT, ESR, and ALB were statistically significant (p<0.05).

3. Seven biochemical indices and five IUS indices that had strong correlations were selected as inputs to construct an MLP network. In the test set, the combined US-bio model was used to predict the states of remission (MES = 1), mild (MES = 2), moderate (MES = 3), and severe (MES = 4), and the AUC values were 94.7%, 93.3%, 73.3%, and 94.9% respectively. When predicting the overall disease activity, the combined model predicted the disease activity of UC patients, with an AUC of 89.1%, an accuracy of 53.2%, and a recall of 52.2% (Table 1).

Conclusion

The indicators of IUS and laboratory biochemical are significantly related to the disease activity of UC patients. The neural network prediction model established based on IUS indicators combined with biochemical indicators can effectively predict the disease activity of UC patients.
P0475 Differential characteristics and predictors of time to colectomy in ulcerative colitis: stratified by medical refractory disease vs. colitis-associated neoplasia
Authors: Kim J , Hebert-milette I , Conner J , Borowski K , Stempak J , Lee S H , Silverberg M S
Published: January 2025

Background

Colectomy rates for ulcerative colitis (UC) have likely decreased in recent decades due to advancements in therapy, but surgery remains crucial for managing medically refractory disease or UC-associated neoplasia. This study aimed to evaluate the differential characteristics and predictors of early colectomy in UC patients undergoing colectomy for medical refractoriness versus UC-associated neoplasia.

Methods

We retrospectively reviewed the medical records of 569 UC patients who underwent colectomy at Mount Sinai Hospital, Toronto, between January 2010 to June 2023. Patients with pathologically confirmed UC and surgery due to medical refractoriness (MR) or UC-associated neoplasia were included. We analyzed the clinical characteristics and their impact on time to colectomy from diagnosis using Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models.

Results

Among the 394 patients who met the criteria, 57.1% were male, 94.7% had extensive colitis. The median ages at UC diagnosis and colectomy were 25 years (IQR 19–36) and 36 years (IQR 26-49), respectively. Of these, 288 patients (73.1%) underwent colectomy for MR, and 106 patients (26.9%) for UC-associated neoplasia. The median age at colectomy differed between the MR and neoplasia groups (33 years [IQR 24-44] vs 47 years [IQR 35-55], P < 0.001), as did the median UC duration (4 year [IQR 2-8] vs 16 years [IQR 9-21], P < 0.001). The proportion of patients with primary sclerosing cholangitis was higher in the neoplasia group (2.4% vs 20.5%, P < 0.001). The use of systemic steroids (67.7% vs 15.1%, P < 0.001) and biologics or small molecules (68.8% vs 43.4%, P < 0.001) prior to surgery was higher in the MR group. In the MR group, male sex (HR 1.30, 95% CI 1.02-1.66, P = 0.036), never smoking (HR 1.42, 95% CI 1.02-1.98, P = 0.039), and diagnosis age > 40 year (HR 1.58, 95% CI, 1.15-2.16, P = 0.005) were associated with a shorter time to colectomy. In contrast, in the neoplasia group, age at diagnosis > 40 years (HR 0.39, 95% CI 0.25–0.63, P < 0.001) was linked to a longer time to colectomy.

Conclusion

Significant differences in clinical characteristics were identified between UC patients undergoing colectomy for MR compared with UC-associated neoplasia. Late-onset UC, diagnosed after the age of 40, may be linked to a shorter time to colectomy for medically refractory disease while it seems to have a lower likelihood of early colectomy for neoplasia.
P0478 Peripheral blood cytokines in patients with paediatric-onset Inflammatory Bowel Disease – a systematic review and meta-analysis
Authors: Jansson S , Ehrström A , Rask C U , Burisch J , Benros M E , Seidelin J , Malham M , Wewer V
Published: January 2025

Background

Cytokines play a central role in the aetiology, disease severity and treatment of adult-onset inflammatory bowel disease (IBD)1. However, despite the aggressive phenotype reported in paediatric-onset IBD, little is known about the cytokine levels in paediatric-onset IBD. This systematic review and meta-analysis aimed to summarize findings of cytokine levels in peripheral blood in patients with paediatric-onset IBD compared to healthy controls.

Methods

This systematic review followed the PRISMA guidelines2 and was registered at Prospero [CRD42024579684]. A literature search was performed on the 1st of August 2024 in PubMed, EMBASE, Web of Science and Scopus. We included studies that reported levels of cytokines in plasma or serum, in patients with paediatric-onset IBD and healthy controls. To ensure a complete overview, we did not exclude studies based on patients’ treatment status. Pooled effect sizes of mean values were calculated using Hedges’ g for any cytokine reported by two or more studies. The Newcastle-Ottawa scale was used for quality assessment.

Results

The literature search revealed 10,110 papers (4,582 duplicates), and 5,528 articles were independently screened by two authors. Twenty-one articles met the inclusion criteria including a total of 950 patients with paediatric-onset IBD, and 481 healthy controls. Studies reported on 57 different cytokines. Meta-analysis was performed for interleukin-6 (IL-6) (12 studies, of which 7 provided mean values) and tumour necrosis factor-α (TNF-α) (7 studies, of which 2 provided mean values). Mean values of other cytokines were not provided by two or more studies, and meta-analysis could therefore not be performed. Pooled effect sizes showed increased levels of IL-6 (standardized mean difference: 1.99, 95% confidence interval: 1.15-3.26). However, the heterogeneity between studies was high (Figure 1). Levels of TNF-α did not differ between patients and controls (standardized mean difference: 0.36 95% confidence interval: -0.08-0.79). Overall, the included studies had moderate-good quality.

Conclusion

IL-6 was increased in the peripheral blood of patients with paediatric-onset IBD. Data on other cytokines were scarce.

References

1)Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014;14(5):329-342. doi:10.1038/nri3661

2)Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Published 2021 Mar 29. doi:10.1136/bmj.n71
P0479 The impact of inflammatory bowel disease on sexuality of male and female patients
Authors: Szymanska E , Kisielewska L , kotkowicz-szczur M , Kisielewski R , Jaroslaw K
Published: January 2025

Background

Inflammatory bowel disease (IBD) is a chronic condition that globally affects the health of individuals who suffer from it, deteriorating their quality of life (QoL), which includes one’s sexual functioning. The aim of this study was to assess the influence of intestinal disease on sexuality of male and female with IBD.

Methods: Patients and Methods

A prospective survey study on male and female individuals with IBD using an anonymous questionnaire including 60 inquiries concerning patients ‘intimate relationship and sexual functioning was performed. The following statistical tests were used: chi-square test of independence, Spearman’s rank correlation coefficient, Wilcoxon and U Mann-Whitneyatests. The significance level of p = 0.05 was assumed as statistically significant.

Results

The survey included 110 respondents with IBD (41% with Crohn’s disease and 57% with ulcerative colitis) - 52 women (47%) and 58 men (53%). Most of them were aged between 31 and 40 (45%).

Statistically significant differences were found in the assessment of satisfaction with sex after IBD diagnosis between the groups - female vs male (p = 0.041). Women gave different ratings on a 5-point scale, most often 1 (23%), 4 (23%) and 5 (27%), while men most often gave 4 (49%) and 5 (26%). Despite the disease, men were more likely than women not to give up sexual activity: 53% vs 43%, respectively (p = 0.011). While women were more likely than men to be afraid that after being diagnosed with IBD they would be less attractive to their partner: 31% vs 10%, respectively (p = 0.002). Nearly 31% of women after diagnosis of IBD did not have orgasm or achieved it less frequently than before the diagnosis, which was less common in men (4%). The difference was statistically significant (p = 0.002). Men more often than women did not change their erotic perception of the partner after IBD diagnosis: 71% vs 39%. The difference was statistically significant (p = 0.001). Women (70%) were more likely than man (28%) to expect a gastroenterologist to inform about sexuality and fertility in IBD. The difference was statistically significant (p < 0.001).

Conclusion

According to our survey IBD has more negative impact on sexuality of female patients. After the diagnosis women were less satisfied with sex, felt less attractive to their partner and more often resigned from sexual intercourse because of the disease. However, women were more interested in information about sexuality and fertility in IBD than men.
P0481 Real-World Analysis of Disease Progression in Ulcerative Colitis: A Comparative Study Across Diagnostic Eras at a Tertiary IBD Center
Authors: Valdivia Krag C , Mirabent C , González Castilla M L , Benítez J M , Marín Pedrosa S , Soto P , Iglesias-Flores E , Gros B
Published: January 2025

Background

Ulcerative colitis (UC) is a chronic condition characterized by a relapsing-remitting course, leading to cumulative systemic damage and disease progression. This progression may include extension of colitis, new extraintestinal manifestations (EIMs), dysplasia/colorectal cancer (CRC), and the need for colectomy. This study aimed to compare disease progression based on the time of diagnosis, to assess the impact of new therapeutic options.

Methods

Retrospective study at Reina Sofía University Hospital, analyzing all UC patients diagnosed within the past 10 years (2014-2023, cohort B) and a matched cohort diagnosed prior to 2014 (cohort A). Disease progression was defined as the first occurrence of new EIMs, new dysplasia/CRC, need for colectomy, or progression of UC extension. Kaplan-Meier analysis was used to calculate time to progression events.

Results

Of 643 patients identified, 72 were excluded, leaving 571 for analysis. Among them, 194 (34%) were diagnosed before 2014 and 377(66%) within the last decade (2014-2023). Median age at diagnosis was 39.5 years (IQR 27.3–54.2), and 304 (53.2%) were male. Initial disease extent was: proctitis 147(25.7%), left-sided colitis 203 (35.6%) and pancolitis 191 (33.5%). At diagnosis, 40 (7%) had EIMs.

During a median follow-up of 7.1 years (3.7–13.3), 223(39.1%) patients experienced disease progression, including extension of colitis in 57(10%) cases, new EIMs in 114 (20%), colectomy in 46 (8.1%), and dysplasia/CRC in 56(9.8%). Patients diagnosed within the last decade showed a shorter time to progression compared to those diagnosed prior to 2014 (log-rank test, p<0.0001). This trend was also observed for new EIMs (p=0.01), dysplasia/CRC (p<0.0001), and disease extension (p=0.014) (Figure 1B-E). However, no significant difference was found in time to colectomy between groups (p=0.31) (Figure 1F).

First maintenance therapy was mesalazine in 366(97.9%) of patients diagnosed within the last decade compared to those diagnosed previously 178(96.7%). Corticosteroids were used at some point in 379(69.4%), median number of corticosteroid courses of 2(1-4). Advanced therapy during follow-up was prescribed in 94(24.9%) of patients diagnosed in the last decade compared to 66(34%) of those diagnosed previously, p=0.022. However, time to advanced therapy prescription was significantly shorter in patients with recent diagnosis (log-rank test p=0.014) (Figure 1A)

Conclusion

A substantial proportion of patients with UC experienced disease progression within a follow-up period of less than 10 years. Despite the availability and earlier use of advanced therapeutic options, disease progression was observed to occur sooner in patients diagnosed within the last decade, compared to those diagnosed before 2014.
P0482 Diagnostic yield of Small Bowel Capsule endoscopy and Double Balloon Enteroscopy for Small bowel Crohn’s disease
Authors: Sheehan T , Clarke M , Deane C , Kelly O , Hall B
Published: January 2025

Background

Small Bowel Capsule Endoscopy (SBCE) a valuable tool in visualizing the small bowel (SB) SBCE paired with Double Balloon Enteroscopy (DBE) can obtain histology to investigate Crohn’s disease (CD). Diagnostic yield was assessed using SBCE & DBE.

Methods

A retrospective analysis of patients referred to SBCE service with suspected CD. PillCam SB3 was used in this study with one reporting gastroenterologist. Previous colonoscopy, histology, faecal calprotectin (FC) & MR enterography (MRE) analysed. Linear regression statistical analysis performed.

Results

94 patients (50% female, median age = 44). No prior diagnosis of CD. 99% completed study rate.

Pre-referral, 46 had Colonoscopy, 26 elevated FC (median = 160) & 8 had abnormal MRE. Abnormal MRE findings: mural thickening of SB, strictures and terminal ileitis. Raised FC was not statistically significant for a SBCE finding in keeping with CD p = 0.357 however, an abnormal MRE was p=0.034.

64.8% of SBCE had an abnormal report, 35.1% had findings in keeping with CD i.e. 54% of abnormal findings on SBCE were indicative of CD. Further investigations: repeat SBCE (10.7%), repeat ileocolonoscopy (1.96%) RDBE (16.6%) & ADBE (10.7%). Repeat SBCE was performed to assess healing. No further diagnosis of CD made with DBE.

Conclusion

SBCE and DBE are useful adjunct diagnostic tools rather than the primary investigations. A positive yield on SBCE did not correlate to diagnosis of CD. FC did not show significant correlation to a positive diagnosis. MRE showed to be significant precursor to SBCE. Similar research including intestinal ultrasound should be conducted.
P0485 Seroproteomic index of endoscopic activity associates with endoscopic outcomes in a longitudinal cohort of adults ulcerative colitis
Authors: Boland B , Zablan K , Penrose H , Neill J , Le H , Ho J , Dervieux T
Published: January 2025

Background

A seroproteomic index of endoscopic activity (serum index) is validated in adult CD but its performance in Ulcerative Colitis (UC) is lacking. We prospectively evaluated the serum index in an observational cohort of adult UC undergoing longitudinal endoscopic assessments.

Methods

UC underwent Montreal classification, were consented and followed longitudinally for their outcomes (clinical and endoscopic) at a single center. Serum specimens were collected at the time of assessments. The UC endoscopic index score (UCEIS) was calculated, with scores above 4 points indicating endoscopic active disease. Clinical symptoms were measured using the partial Mayo score with score < 2 points indicating clinical remission. The serum index which is a composite of CRP-HS plus 12 other proteins in an algorithm that associates with endoscopic outcomes in CD was applied unmodified in UC. The index ranges from 0 to 100 points where higher index are associated with higher likelihood of endoscopic active disease. All sera were processed by an accredited clinical laboratory. Receiver operating characteristic curves (ROC with area under the curve [AUC]) and logistic regression were employed to evaluate the index in distinguishing endoscopic outcomes. Nonlinear mixed effect models were used to correlate the longitudinal changes in UCEIS (>1 endoscopic assessment).

Results

A total of 231 patients with UC (mean age 41 years, n=115 females) were enrolled, and 294 serum samples with an UCEIS score were collected. Average partial Mayo score was 2.5±2.7 points [SD] with 50% assessments in clinical remission. Average UCEIS was 2.2±2.3 points (22% [n=66] with UCEIS>4 points). Average CRP, and serum index was 5.2±8.1 mg/L, and 38±19 points, respectively. Comparison in distinguishing UCEIS>4 points yielded significantly higher AUC with serum index (AUC=0.797±0.034) than with CRP (AUC=0.714±0.035) (p=0.047). In subjects with more than one endoscopic assessment (n=49/112 endoscopies), the change in partial Mayo scores, CRP and serum index associated with the changes in the UCEIS (Table).

At optimal cutoff, serum index above 42 points yielded 73% sensitivity and 78% specificity in identifying moderate to severe endoscopic disease (OR= 9.0 95%CI: 5.0-17.2) (p<0.001) (PPV=52%, NPV=89% with 25% pretest probability). In multivariate analysis, endoscopic active disease associated with the absence of clinical remission (aOR=0.05 (95%CI: 0.01,0.16) with each point increase in serum index yielding 1.05 (95%CI: 1.03,1.07) fold higher likelihood of endoscopic active disease (Figure).

Conclusion

We have validated the performance of a seroproteomic index of endoscopic activity in adults with UC demonstrating its potential as a non-invasive biomarker.
P0487 Understanding the learning curve of intestinal ultrasound in IBD: a comparative study between novice, regular and expert
Authors: Bove L , Meyer J , Collins M , Frampas E , Bourreille A , Le Berre C
Published: January 2025

Background

Intestinal ultrasound (IUS) has emerged as a valuable tool for monitoring inflammatory bowel disease (IBD), but its reliability depends on the technical skills of the operator. This study aimed to assess the IUS learning curve of a complete novice and a gastroenterologist with formal general ultrasound training and regular IUS experience, using an expert radiologist as the gold standard.

Methods

This was a single-center, prospective study conducted between April 2023 and January 2024, which consecutively included patients with IBD (Crohn’s disease [CD], ulcerative colitis [UC]). Three IUS scans were performed successively and in a standardized manner by the three operators in each included patient. Each operator assessed disease activity using quantitative and semi-quantitative scales, and ultrasound activity scores based on bowel wall thickness and stratification, Doppler signal intensity according to the Limberg score, and appearance of mesenteric fat. Inter-operator agreement was calculated using the intraclass correlation coefficient (ICC).

Results

A total of 50 patients were included (76.6% CD; 23.4% UC), of whom 31.9% had active disease and 23.4% a history of IBD-related surgery. Mean BMI (standard deviation [SD]) was 24.2 (4.2) kg/m². Mean examination time was 4’12’’ for the expert radiologist (gold standard), 3’45’’ for the experienced gastroenterologist, and 5’17’’ for the novice (p<0.001). Regarding quantitative assessment of IUS activity (visual analog scale), the experienced gastroenterologist had good agreement with the radiologist throughout the study (ICC ranging from 0.61 at the start of the study to 0.79 at the end; overall ICC = 0.71 [95% CI 0.54-0.83]), while the novice maintained poor agreement, with no learning curve (ICC increasing from 0.21 to 0.33; overall ICC = 0.33 [0.05-0.55]). Similar results were obtained with the other activity measurements. The ileocolonic location of CD and surgical history significantly impaired novice performance. Excluding surgical patients enabled a learning curve to be obtained for the novice, with poor initial agreement (ICC 0.21) then moderate to good agreement at the end of the study (ICC 0.59).

Conclusion

A formal general ultrasound training and 200 IUS examinations of experience allowed good agreement with an expert radiologist in IBD patients. The novice failed to go beyond poor agreement throughout the study, although a faster learning curve was observed in patients without history of IBD surgery. These findings highlight the difficulty of the technical performance of IUS rather than its interpretation. Comprehensive training beforehand and between 50 and 200 examinations of experience are necessary before embarking on IUS.
P0489 The impact of inflammatory bowel disease and disease activity on patients’ sexuality
Authors: Szymanska E , Kisielewska L , Kotkowicz-Szczur M , Kisielewski R , Kierkus J
Published: January 2025

Background

Sexuality is an integral part of general health and wellbeing. Chronic diseases, such as inflammatory bowel disease (IBD), have an impact on patients’ sexual functioning. The aim of this study was to assess the influence of intestinal disease and its activity on sexuality of individuals with IBD.

Methods: Patients and Methods

A prospective survey study on male and female individuals with IBD using an anonymous questionnaire including 60 inquiries concerning patients ‘intimate relationship and sexual functioning was performed. The following statistical tests were used: chi-square test of independence, Spearman’s rank correlation coefficient, Wilcoxon and U Mann-Whitneyatests. The significance level of p = 0.05 was assumed as statistically significant.

Results

The survey involved 110 respondents with IBD (41% with Crohn’s disease and 57% with ulcerative colitis) - 52 women (47%) and 58 men (53%). Most of them were aged between 31 and 40 (45%).

Before being diagnosed with IBD, the respondents rated their satisfaction with sex on an average of 4.1 on a 5-point scale; after the diagnosis, the rating was lower and amounted to 3.6. In 34% of respondents, the assessment of satisfaction with sex after diagnosis decreased, in 24% it increased, and in 42% it did not change. The difference between the assessments before and after diagnosis was statistically significant (p = 0.007).

Statistically significant correlations were found between IBD clinical activity and the impact of the disease on the sexual desire (p < 0.001), the need for sex after diagnosis (p < 0.001), satisfaction with sex after diagnosis (p = 0.003), and the average number of intercourse (p = 0.004), average duration of intercourse after diagnosis (p = 0.001), feeling guilty in the sexual sphere due to the disease (p = 0.006), assessment of one’s attractiveness since diagnosis (p = 0.032), and change in the partner’s erotic perception after diagnosis ( p < 0.001). Respondents with disease exacerbation were less willing to engage in sexual activity, had less need for intercourse, rated their satisfaction with sex lower, had fewer intercourse, and their duration was shorter. They more often felt sexual guilt due to the disease and assessed their current attractiveness worse.

Conclusion

Inflammatory bowel disease has negative impact on patents’ sexuality and disease activity strongly affects their sexual functioning. The exacerbation of IBD causes in patients decrease in sexual needs, worse sexual experience and lower assessment of one’s attractiveness.