bluuebunny/crossref_metadata_2025 huggingface dataset:
P0490 Diagnosis and treatement of latent tuberculosis infection in patients with chronic Inflammatory Bowel Disease candidates for anti-TNFα therapy in a tuberculosis endemic country
Authors: Mouslim I , jioua C , touibi A , ouahid S , nejjari F , berrag S , Tarik A , Mouna T
Published: January 2025

Background

The increasing use of anti-TNFα agents in the management of IBD raises concerns about the increased risk of latent TB reactivation, justifying the need for effective screening recommendations.

Our study focuses on IBD patients candidates for anti-TNF therapy aiming to determine the prevalence of latent TB infection, examine factors influencing QantiFERON® outcomes, and describe therapeutic modalities for latent TB in this population.

Methods

This was a descriptive retrospective study of 87 patients followed up in the gastroenterology department of the Mohammed V Military Training Hospital in Rabat for IBD who were candidates for anti-TNF alpha biotherapy between 2021 and 2024.

Results

The prevalence of latent tuberculosis TBL identified in patients with chronic inflammatory bowel disease candidates for anti-TNFα therapy in our study was 24.1%, detected by the Quantiferon Gold IT® test. Factors influencing the results of the test found mainly include the various risk factors for tuberculosis in our context of intermediate endemicity, and the use of immunosuppressants, which is associated with a negative test. As the intradermal tuberculin test could not be carried out in Morocco due to a stock shortage, the comparison of the performance of the two tests was not possible. Despite an initially negative Quantiferon Gold IT® test, 4 cases of active tuberculosis were recorded after initiation of anti-TNF treatment.

Conclusion

The IGRA Quantiferon Gold IT® test is considered a valuable tool for detecting latent tuberculosis in IBD patients who are candidates for anti-TNF treatment. However, its use and interpretation in an endemic country and in vaccinated subjects should be the subject of larger-scale studies aimed at proposing appropriate recommendations based on the risk of latent tuberculosis.
P0495 Impact of the HLA DQA1*05 allele on the efficacy of vedolizumab treatment in inflammatory bowel disease
Authors: Castro Torres S , Ramiro cuenca L , Rodríguez-Moranta F , Rodríguez-Alonso L , Ruiz-Cerulla A , Sánchez-Pastor E , Antón-Güell S , Guardiola Capon J
Published: January 2025

Background

Patients with inflammatory bowel disease (IBD) carrying the HLA-DQA1*05 allele have a higher risk of developing immunogenicity and loss of response to anti-TNFs. On the other hand, this association has not been observed with ustekinumab, a fact that could help individualize treatment (J. Guardiola ECCO 2024). We do not have data for vedolizumab.

Methods: Objective

To evaluate the relationship between the HLA-QA1*05 allele and the loss of response and the persistence of treatment with vedolizumab.

Methods

Design: Unicentric retrospective cohort study from a tertiary hospital.

Population

IBD patients who have completed induction with vedolizumab.

Loss of response

need for intensification, change of treatment, hospitalization or surgery.

Analysis

univariate (Kaplan Meyer) and multivariate (Cox Regression) analyses.

Results

We included 67 patients with IBD (24 Crohn’s disease and 43 ulcerative colitis) with an average follow-up of 29±21 months. Both cohorts were comparable in relation to baseline characteristics. 44% were carriers of the risk allele. 74% had previous exposure to biologicals. Mean basal and postinduction calprotectin were 866±1103 and 295±1228, respectively. 28 (46%) of the patients lost response during follow-up. During this period 29%, 25%, 7% and 42% required hospitalization, treatment with corticosteroids, surgery or intensification respectively.

We found no differences in relation to clinical or biological remission rates at 6 and 12 months, nor differences in discontinuation rates in relation to the status of carriers of the risk allele. The mean duration free of loss of response was 28 months (95% CI: 9-46) in individuals not carrying the HLA-DQA1*05 allele and 13 months (95% CI: 9-16) in those carriers, without significant differences between both groups (Log Rank p=0.517) (Figure 1).

In multivariate analysis, after adjusting for treatment with prior biologics, obesity and type of IBD, the presence of the HLA-DQA1*05 allele was not associated with loss of response to vedolizumab or persistence of the treatment.

Conclusion

The presence of the HLA-DQA1*05 allele is not associated with loss of response or persistence of vedolizumab treatment.
P0499 A multicenter study utilizes multi-scale clinical data from Crohn’s disease patients to develop large-scale language-human interaction models for predicting the progression of intestinal diseases
Authors: Li Z , Zhang R , Wang Y , Wang X , Mao R , Feng S T , Li X
Published: January 2025

Background

The hospital admission records of patient with Crohn’s disease (CD) contain extensive textual content that provides a valuable resource for gaining a thorough understanding of the disease development and progression. The medical application of large language model (LLM) has been extensively researched. We aim to employ LLMs to analyze multi-scale clinical data from patients with CD and predict their gastrointestinal outcomes.

Methods

By analyzing the clinical data and relevant literature, we established a comprehensive database incorporating intestinal disease related factors while selecting three highly representative LLMs (ChatGPT-4omini, ChatGPT-4o, and Gemini-Pro) through prompt engineering of original LLMs with chain-of-thought, knowledge-guided prompting, and self question. Nine combined models were then developed and their performances to predict the intestinal disease were compared. The comprehensiveness, accuracy, conciseness, and readability of logicality reports generated by different LLMs were evaluated.

Results

The clinical data of 649 patients from six clinical centers were retrospectively collected. Following two rounds of evaluation by ten experts in CD diagnosis and treatment, a total of 117 disease related factors out of 199 were selected to construct the LLM prompt. The ChatGPT-4o’s level-3 model demonstrated superior predictive performance in predicting intestinal outcomes for patients within center-1 as training set, achieving an accuracy of 0.844, sensitivity of 1.000, and specificity with 0.783 (ChatGPT4o-mini: 0.688, 1.000, 0.665; Gemini-pro: 0.758, 1.000, 0.708). For patients from other five medical centers as testing set, the accuracy reached a value at 0.835 (sensitivity: 1.000, specificity: 0.768). However, the readability tests indicate that Gemini-pro offers a better comprehensiveness than others.

Conclusion

The ChatGPT-4o human-computer interaction model based on multi-scale clinical data of CD patients can accurately predict the progression of intestinal diseases, providing accurate and effective basis for precise management of Crohn’s disease in clinical practice. The Gemini-pro offers a more comprehensible method for non-clinical-experts to under their condition of intestinal disease.
P0504 The Impact of Disease Activity and Medications on Pregnancy and Fetal Outcomes in Women With Inflammatory Bowel Disease: A Cohort Study From the IBD-ME Group
Authors: Azzam King Saud University N , Almadi M , Alfarhan H , Altuwaijiri M , Aljebreen A , Alharbi O , Abaalkhail M , Jaran M , Altamimi A , Al Theneyan A , Al Turki N , Alharbi L , AL Ghamdi J , Al Dakhil A , Mosli M ,   IBD-ME Group
Published: January 2025

Background

Women with Inflammatory bowel disease (IBD) and their children may face a higher risk of adverse outcomes during and after pregnancy. The primary aim was to examine the association between IBD and adverse pregnancy outcomes: preterm birth, small for gestational age, birth weight, congenital anomalies, and stillbirth. The secondary aim was to assess the impact of maternal IBD and medications used on children’s outcomes: adverse reactions to vaccinations and development of IBD in the offspring up until seven years of age.

Methods

We performed a multicenter retrospective study in Saudi Arabia and Kuwait. Three participating hospitals enrolled women with IBD who gave birth between 2016 and 2023. Information regarding disease characteristics, medication use, pregnancy outcomes, and long-term health outcomes of children until age fourteen was collected.

Results

This study analyzed data from 167 patients with a median age of 37.0 years (IQR: 33.0 to 44.0). Crohn’s disease was the most common type of IBD (51.2%), followed by ulcerative colitis (46.3%). Of note, 42.7% of the women were on mesalamine, while 25.1% of the study population were on both anti-TNF agents and Azathioprine. The most frequent pregnancy outcome was low birth weight (22.5%), and 8.2% of the offsprings were diagnosed with IBD. A history of having six or more pregnancies significantly predicted IBD in an offspring (OR = 4.02, 95% CI, 1.19 to 14.8, p < 0.01). In contrast, disease control before pregnancy significantly reduced the risk of adverse infant outcomes (OR = 0.10, 95% CI, 0.01 to 0.61, p < 0.01). None of the IBD medications predicted poor pregnancy outcomes.

Conclusion

Infants of women with active IBD have an increased risk of prematurity and being small for gestational age. Number of pregnancies was a significant predictor for IBD in an offspring. Controlling disease activity at conception is essential to improve both pregnancy and fetal outcomes.
P0511 Establishing a gastroenterologist-led intestinal ultrasound service in the United Kingdom: outcomes, correlation and patient satisfaction
Authors: Hazel K , De Silva S
Published: January 2025

Background

Intestinal ultrasound (IUS) has been used a tool for assessing IBD in Europe over the preceding decades. Its use globally is increasing. Russells Hall Hospital has one of the first gastroenterologist-led services in the UK. IUS is a non-invasive tool for assessing IBD and potentially reduces the requirement for endoscopy and imaging. It reduces the requirement for multiple patient visits; giving a point-of-care assessment of IBD activity, gastroenterologist review and a management plan in one session. A study by a tertiary UK centre showed projected annual savings of almost £500,000 with the implementation of radiologist-led IUS in their centre.

Methods

To validate our accuracy of diagnosis at IUS, the first 50 patients assessed were offered IUS in addition to endoscopy and/or MRE. This data was collated and our accuracy assessed. We also provided patients with questionnaires, outlining their experience and satisfaction with IUS.

Results

45 patients underwent assessment with IUS and either endoscopy or MRE. 28 (62.2%) were male, with an average age of 44 years. 17 patients had UC (37.8%) and 28 CD (62.2%). The median time to assessment with a second modality was 10 days (0-367 days). 86.7% of patients had IUS first. 18 patients had flexible sigmoidoscopy, 17 colonoscopy and 9 MRE. We showed a correlation of 86.7% between IUS and second modality. Notably, accuracy improved with time as the first 4 of 6 patients without correlation were within the first three months of IUS implementation. Notably, four patients with normal IUS had very mild disease activity at endoscopy with isolated ileal/neo-TI disease (Rutgeert’s i2a) or small aphthae in the left colon. Of patients with an abnormal IUS and normal subsequent assessment, one had a full course of prednisolone between IUS and MRE. From a patient satisfaction perspective, 40 patients completed surveys, with an equal gender split. 85.7% of patients had a CD diagnosis. 64.3% of patients were not aware of IUS prior to their visit. 92.9% found IUS “very easy”. 85.7%, 78.6%, 92.9% and 100% found it “very easy” compared to blood tests, stool tests, MRE and endoscopy, respectively. All patients would have a repeat IUS and 85.7% were extremely satisfied with having an IUS to assess their IBD.

Conclusion

Gastroenterologist-led IUS is a non-invasive and accurate modality for assessing IBD in the UK population. With increasing experience, we improved our accuracy, in keeping with published data and can offer patients IUS as a single modality for monitoring their IBD, potentially offering cost savings for our trust. Overall, patients were extremely satisfied with the service and found it much easier than routine methods of monitoring IBD.
P0512 Predict the risk of acute severe ulcerative colitis based on machine learning algorithm: A multicenter cohort study
Authors: Qiu Y , Rao M , Peng S , Zhang C , Gao X , Cao Q , Ng S C , Chen M
Published: January 2025

Background

Severe ulcerative colitis (UC) is associated with with increasing risk of admission and colectomy. Till now, there are limited number of studies on the predictive models for severe UC especially in Asian population. In this study, we aimed to develop and validate a predictive model for severe UC Chinese patients using machine learning algorithm.

Methods

Patients diagnosed with mild-to-moderate UC were included retrospectively at four tertiary hospitals in China from 2013 to 2016. The primary outcome was severe UC requring admissions within 3 years after diagnosis. The machine learning algorithm were applied to develop and validate a predictive model for severe UC. The model performance was then compared to the well-established one for europeans patients - the Oxford’s model.

Results

Altogether 437 patients with mild-to-moderate UC were included. A total of 67(15.3%) of patients with mild to moderate UC developed severe UC requring hospitalization or surgery within 3 years. The predictive model selected 11 features, including age, gender, disease extent, CRP, ESR, hemoglobin, WBC, platelet, ALB and history of intravenous corticosteroids, immunosuppressor and/or biological agent. The area under receiver operating characteristic curve (AUC) of multilayer perception (MLP) in the internal validation dataset was 0.883. The AUC of MLP model in external validation dataset was 0.897, which was better than both the Oxford’s model (AUC=0.661, P＜0.012) and the model based on Cox’s regression analysis (AUC=0.764, P＜0.001).

Conclusion

The MLP predictive model had excellent discrimination for severe UC patients, which outperformed both the Oxford’s model and the model based on logistic regression analysis.
P0514 Assessing the relationship between physician perspective and subjective disabilities in IBD patients: a comparative study using IBD-Disk and IBD-Q
Authors: Galletti G , Pasta A , Calabrese F , Saturni A , Furnari M , Marabotto E , Giannini E G , Bodini G
Published: January 2025

Background

Inflammatory Bowel Diseases (IBD) are chronic conditions that often affect young patients throughout their lives. Treating patients with IBD, it is essential not only to achieve deep remission (clinical, biochemical, and mucosal) but also to completely restore the patient’s quality of life. Addressing and reducing the cumulative burden of disease, enabling a return to a “normal life,” and preventing disability have become major therapeutic goals in the management of patients with IBD management. Recently, a brief and patient-friendly questionnaire, the IBD-Disk, has been proposed as a tool for monitoring disability in IBD outpatients.

This study aims to assess the relationship between gastrointestinal symptoms, biochemical parameters, and subjective disabilities in patients affected by IBD.

Methods

In this prospective study, we enrolled consecutive patients with IBD who completed the IBD-Disk during an in-person visit. We also recorded demographic data, clinical features, disease activity, biochemical data, and ongoing treatments. Clinical activity was evaluated using the partial Mayo score (p-Mayo) for Ulcerative Colitis (UC) and the Harvey-Bradshaw index (HBI) for Crohn’s disease (CD). The IBD-Q was also administered at the time of evaluation and a cut-off of 170 was considered to define symptomatic remission.

Results

We included 95 patients with IBD (49 males, 51.6%), median age of 52.9 years (IQR 37-61), with 45 (47.4%) having CD and 50 (52.6%) having UC. 76 patients (80 %) of patients were on conventional therapy, and 12.6% were receiving concomitant steroids. At the time of evaluation, 29 (30.5%) patients had clinically active disease, and 31 (32.6%) had biochemically active disease. An inverse linear correlation was found between the IBD-Disk and IBD-Q (r² = 0.66, p<0.001). Patients with clinically active disease had significantly higher IBD-Disk scores (40, IQR 24-60 vs. 26, IQR 10-51, p=0.016) and lower IBD-Q (148, IQR 140-176 vs. 180, IQR 159-200) compared to those in clinical remission. The AUROC for clinical remission for IBD-Disk and IBD-Q were 0.650 (95% CI 0.54-0.76) and 0.755 (95% CI 0.65-0.85), respectively. Among patients in remission, 39.3% had an IBD-Q score below 170, while the median IBD-Disk value was 26 (IQR 10-51). The majority of patients preferred completing the IBD-Disk (71, 74.7%).

Conclusion

Both the IBD-Disk and IBD-Q are associated with objective disease activity, with the IBD-Q demonstrating slightly superior performance. However, most patients preferred the IBD-Disk. Despite achieving satisfying clinical endpoint, doctors often fail to perceive patient’s quality of life.
P0515 The Role of Immunohistochemistry Staining in Diagnosing Cytomegalovirus Disease in the Gastrointestinal Tract
Authors: Chiu C H , Yeh P J , Wu R C , Le P H
Published: January 2025

Background

Accurate diagnosis of invasive cytomegalovirus (CMV) diseases in the gastrointestinal (GI) tract is essential, yet studies evaluating the diagnostic accuracy of Hematoxylin and eosin (H&E) staining and the necessity of immunohistochemistry (IHC) staining in different GI tract locations are limited.

Methods

We analyzed GI tract specimens with both H&E and IHC staining from a pathology database. Patients were divided into two groups: those with suspected CMV infection (HEs) and those without evidence of CMV infection (HEn). Using IHC staining as the gold standard, we calculated the sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of H&E staining.

Results

Among 1,448 specimens, the SE/SP (%) of H&E staining for the entire GI tract, esophagus, stomach, small intestine, and colon were as follows: 76.1%/82.1%, 76.1%/70%, 85.5%/71.7%, 60%/94.2%, and 75%/87%, respectively. The corresponding PPV/NPV (%) were 58%/91.3%, 39.3%/92%, 51.2%/93.5%, 69.2%/91.5%, and 68%/90.4%.

Conclusion

For patients with high clinical suspicion of CMV infection, IHC staining is essential for accurate diagnosis across various GI tract sites.
P0516 Chronic Rhinosinusitis and Inflammatory Bowel Disease: discovering the gut-lung axis- preliminary results from a single-center pilot study
Authors: Maresca R , Del Gaudio A , Iaccarino J , Murgiano M , Sessa G , Frasca P , Mignini I , Baglivo I , Pugliese D , Rigante M , Zavarella M A , Colantuono S , Laterza L , Papa A , Gasbarrini A , Caruso C , Scaldaferri F
Published: January 2025

Background

Inflammatory Bowel Diseases (IBD) are multifactorial and debilitating diseases that significantly impact patients’ quality of life. As it is known, they involve an altered immune system. For this reason, patients with IBD have an increased risk of developing other chronic immune disorders, including chronic rhinosinusitis (CRS). The coexistence of these two conditions can undoubtedly affect patients’ life and disease history. This study aims to define the prevalence of CRS in IBD patients and assess how it affects their quality of life.

Methods

We conducted a prospective, observational, monocentric pilot study. in which we enrolled consecutive IBD under biological therapy. We collected clinical, demographic, and disease history data. Four questionnaires were administered to the patients: the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), EuroQol 5 Dimension 5 Level (EQ-5D-5L), the Short-Form- 36 (SF-36), and the SNOT-22 questionnaire to identify subjective symptoms of CRS. According to the SNOT-22 score, patients were divided into two groups: patients without/mild CRS (group 1, SNOT-22 <30 points) and patients with moderate/severe CRS (group 2, SNOT-22>30 points).

Results

We enrolled 50 IBD patients, of which 48% were affected by ulcerative colitis (UC) and 52% were affected by Crohn’s Disease (CD). Among them, 42% (n=21) of patients were naive to biological therapy, while 48% had failed at least two lines of biological therapy. We observed no statistically significant differences in the mean values of the score of SNOT-22 between naive and multi-failure patients (30.1 and 28.5, respectively, p=0.76). Dividing patients based on the SNOT-22 score, 42% were part of group 1 (absent or mild CRS), and 58% were part of group 2 (moderate/severe CRS).CD patients of group 2 had a significantly higher disease activity, defined according to the Harvey-Bradshaw Index (HBI), compared to group 1 (mean value of 2.3 vs 0.48, p=0.008).We did not observe statistically significant differences in Full Mayo Score between group 1 and group 2 UC patients. The median VAS EQ-5D-5L was compared between Groups 1 and 2 showing a lower score in patients with moderate/severe CRS (66.6 vs. 81.3, p = 0.0019).

Conclusion

CRS is frequent in IBD patients. Those with both conditions have reduced quality of life, more severe symptoms, and worse disease characteristics than those without CRS. Level of some cytokines can induce alterations of gastrointestinal motility in gastrointestinal disorders, due to increased intestinal barrier damage. However, our findings are preliminary, and further studies, clinical evaluations, and specialized laboratory investigations are needed to better understand the gut-lung axis.
P0521 Accuracy of a non-invasive approach in monitoring pediatric inflammatory bowel disease: interim-analysis of a prospective multicenter italian study
Authors: D’Arcangelo G , Gravina A , Colucci A , Raso T , Casertano M , Cenni S , Strisciuglio C , Maccioni F , Oliva S
Published: January 2025

Background

Ileocolonoscopy is the gold standard for diagnosing and monitoring pediatric IBD. However, it has limitations, including high costs, invasiveness, and the inability to visualize the small bowel (SB) and assess transmural involvement. Magnetic resonance enterography (MRE), while not the gold standard, is recognized as a key tool for evaluating the SB. Its limitations include high costs, the requirement for oral contrast—which reduces patient tolerance—and longer procedure times. To provide less invasive monitoring, especially in children, non-invasive methods such as capsule endoscopy (CE) and ultrasound (US) have been developed. We aimed to evaluate the accuracy of these non-invasive techniques (US and CE) in monitoring pediatric IBD.

Methods

This study represents an interim analysis of the prospective multicenter protocol GR-2019-12370621. Consecutive children with IBD were enrolled. At baseline, 6 and 12 months, UC children underwent ileocolonoscopy (IC), CE and US, while CD children underwent IC and EGD, MRE, CE and US. For the terminal ileum in CD and the colon in UC and CD, IC was the gold- standard. For the SB (jejunum, proximal and mid-ileum) MRE was the comparator to assess the presence of active disease. EGD served as the gold standard for duodenum. Sensitivity (Se), specificity (Sp), negative and positive predictive value (NPV and PPV) and accuracy of CE and US were determined for CD and UC in an ITT analysis.

Results

Thirty-one patients (16 CD and 15 UC) were enrolled as of the retrieval date (04/10/2024). For UC, 31 IC, 31 CE and 30 US procedures were performed. In CD, a total of 40 endoscopies, 30 CEs, 12 US procedures, and 36 MREs were available. In UC, CE showed a Se of 85%, Sp 100%, NPV of 87%, PPV of 100%, and an accuracy of 92.8%. The Se, SP, NPV, PPV and accuracy of US were 63%, 100%, 70%, 100% and 80%, respectively. The combination of CE and US increased accuracy up to 93.1% (Table 1).For CD: the combined accuracy of CE and US was 100% for the terminal ileum, 80% for the jejunum, 69% for the proximal ileum, and 75% for the mid ileum. The accuracy of CE for the colon in CD was 82.1% (Table 2).

Conclusion

Non-invasive monitoring achieves an accuracy of 93% compared to endoscopy in UC. For CD, it demonstrates excellent accuracy for the terminal ileum (100%) and fair accuracy for the colon (82.1%) compared to the invasive counterpart. However, reduced accuracy in the small intestine, ranging from 69% to 80%, may be influenced by the lack of a definitive gold standard for this segment. The low PPV of the CE, particularly for jejunum and proximal ileum, could be explained by the detection of mucosal lesion not visible by the comparator (MRE).
P0526 Association of plasma IgA with bowel wall thickness and disease activity in IBD patients assessed by intestinal ultrasound
Authors: Chen Y L , Tsai T
Published: January 2025

Background

IgA, the primary immunoglobulin secreted by gut B cells, plays a key role in defending against pathogen invasion. Elevated plasma IgA levels have been observed in inflammatory bowel disease (IBD) patients, particularly those undergoing biologic therapy. However, direct evidence linking plasma IgA levels to bowel wall inflammation is lacking. This study investigates the relationship between plasma IgA levels and intestinal inflammation, using parameters from intestinal ultrasound (IUS).

Methods

We enrolled 30 IBD patients (20 with ulcerative colitis (UC) and 10 with Crohn’s disease (CD)) for IUS evaluation starting in July 2023. Ultrasound scores were based on the Milan ultrasound criteria (MUC) for UC and the bowel ultrasound score (BUSS) for CD. Plasma levels of ESR, CRP, albumin, IgA, partial Mayo score, and CDAI were collected at baseline, during treatment, and after 52 weeks of advanced therapy (Adalimumab, Vedolizumab, or Tofacitinib). IUS findings and plasma IgA levels were analyzed for correlations with clinical parameters using the Student’s t-test and linear regression.

Results

IUS findings were closely correlated with disease activity. In UC, the MUC score was positively correlated with CRP (P < 0.0001, R² = 0.4888), partial Mayo score (P = 0.0002, R² = 0.3652), and negatively with albumin levels (P = 0.0002, R² = 0.3747). In CD, the BUSS score showed a positive correlation with CDAI (P = 0.0394, R² = 0.2694). Plasma IgA levels were significantly associated with bowel wall thickness (BWT) in both UC and CD (P = 0.0041, R² = 0.1759) (Figure 1). Notably, when BWT exceeded 3.5 mm, plasma IgA levels increased significantly (P = 0.0021) (Figure 2). Interestingly, in CD, plasma IgA was strongly correlated with the BUSS score (P = 0.0001, R² = 0.6585), while no such relationship was observed between MUC score and plasma IgA in UC.

Conclusion

Plasma IgA levels are positively correlated with bowel wall thickness in both UC and CD patients, particularly when BWT exceeds 3.5 mm. In CD patients, IgA levels also show a strong correlation with the BUSS score, highlighting IgA as a potential biomarker for bowel wall inflammation. These findings suggest that plasma IgA could serve as a biomarker of disease activity, particularly in CD, and could aid in monitoring therapeutic response and disease progression in IBD. Further research is warranted to validate these results and explore the potential for IgA-targeted therapies.

References

1.B Lee, J Hsu, T Tsai, A241 Correlation between plasma IgA level and biological therapy in inflammatory bowel disease, Journal of the Canadian Association of Gastroenterology, 2024;doi.org/10.1093/jcag/gwad061.241

Figure 1

Figure 2
P0527 Bowel Ultrasound Scan (BUS) in Pediatric Acute Severe Colitis (ASC): a multicenter prospective study on behalf of the IBD Porto group
Authors: Scarallo L , Alvisi P , Aloi M , Bramuzzo M , Broekaert I , De Laffolie J , Kierkus J , Matar M , Pranzetti A , Renzo S , Velasco Rodríguez-Belvís M , Strisciuglio C , Tasciotti L , Lionetti P ,   IBD Porto Group
Published: January 2025

Background

Acute severe colitis (ASC) is a potentially life-threatening event. Optimal timing for second-line treatment in children is mainly based on the clinical score Pediatric Ulcerative Colitis Activity Index (PUCAI) score. The aim of our study was to evaluate the potential role of bowel ultrasound scan (BUS) in predicting short-term treatment outcomes in pediatric ASC.

Methods

This was a prospective longitudinal study, conducted across ten European centers between March 2020 and March 2024. Biologic-naïve children with Ulcerative Colitis hospitalized for ASC, either at diagnosis or at disease relapse, were included. Each patient underwent two BUS, the first one within the first 48 hours of from IVCS intravenous corticosteroids administration and the second one within 5-7 days from treatment initiation. Key metrics assessed included colonic wall thickness (CWT), colonic wall stratification (CWS) and colonic wall blood flow via power Doppler. All the above-mentioned ultrasound parameters were recorded in 4 different segments of the bowel: ascending, transverse, descending, and sigmoid colon. Furthermore, Milan ultrasound criteria (MUC) score was also calculated for each colonic quadrant. Clinical, laboratory, and treatment data were gathered during hospitalization and at 2-, 4-, and 8-weeks follow-up.

Results

59 patients (61% males, median age at ASC: 14.2 years) were included. Almost 60% of patients had pancolitis, 22 (37.3%) experienced ASC at disease onset. Table 1. summarizes patients’ characteristics at ASC. 38 (64.4%) patients failed to respond intravenous corticosteroids (IVCS) and required second-line therapy with infliximab (IFX). Patients who required step-up treatment with IFX had higher colonic wall thickness (CWT) and more frequently an increased vascularization (Limberg score > 2) (p=0.041 and p=0.005, respectively). Furthermore, patients who failed to respond to IVCS and required escalation to IFX had a higher MUC score at firs BUS (p=0.042). Ten patients (16.9%) failed to respond to medical treatment and required short-term colectomy (within 8 weeks of follow-up). Patients who required colectomy had a higher CWT both at first and at second BUS (p=0.033 and p=0.004, respectively). Moreover, patients who responded to medical therapy had higher DeltaCWT (difference between worse CWT at first and at second BUS) compared to those who required surgery (p=0.0018).

Conclusion

BUS may serve as an effective noninvasive tool to predict first-line therapy failure and the need for colectomy in patients with ASC. Its implementation in clinical practice may enable physician to support clinical evaluation and tailor treatment escalation upon patient’s individual characteristics.
P0541 Placebo rates in randomised clinical trials of Ulcerative Colitis: An individual patient data meta-analysis
Authors: Solitano V , Hogan M , Singh S , Danese S , Peyrin-Biroulet L , Vuyyuru S , MacDonald J K , Zou G , Yuan Y , Sands B E , Panaccione R , Feagan B G , Hanzel J , Sedano R , Dulai P , Narula N , Ma C , Jairath V
Published: January 2025

Background

Information on placebo rates is important for designing clinical trials. We aimed to assess placebo rates and associated factors using individual patient data from multiple randomised clinical trials in ulcerative colitis.

Methods

We conducted a meta-analysis of individual participant-level data from nine randomised trials using Vivli and Yale University Open Data Access data-sharing platforms. Phase 2 and 3 placebo-controlled randomised clinical trials of advanced biologic therapies in adults with moderate-to-severe active ulcerative colitis published since 2010 were included. Pooled placebo rates and 95% CIs were estimated using one-stage and two-stage meta-analytical approach. Significant patient-level factors (P<0.05) associated with placebo rates were identified using regression analyses. The pre-specified primary outcomes were placebo clinical response and remission.

Results

Outcome data were available for 1,703 patients from nine studies (three induction-only, one maintenance-only, and five including both phases). For induction trials, overall placebo response and remission rates were 33% (95% CI 29-38%) and 9% (95% CI 7-11%), respectively (Figure). Overall placebo response and remission rates in maintenance trials were 28% (95% CI 17%-41%) and 14% (95% CI 9-20%), respectively (Figure). A lower body mass index reduced odds of placebo response and remission, while higher baseline albumin levels and left-sided UC (compared to extensive) increased the odds of these outcomes. A one-point increase in the Mayo Clinic Score and adapted Mayo Clinic Score was associated with a 26% and 27% reduction in the odds of clinical remission. For induction trials, prior exposure to biologics or tumour necrosis factor antagonist therapy was associated with lower odds of both response and remission. Multi-centre trials have lower placebo effect than single-centre trials.

Conclusion

These results will enable future trials that include placebo to incorporate design elements that enable reduction of placebo rates as well as a precise benchmark for expected rates in clinical trials that do not include placebo.
P0544 Long-term evaluation of quality of life in inflammatory bowel diseases: results from a prospective cohort study
Authors: Marinica A , State R M , Miron M , Mateescu R B
Published: January 2025

Background

Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and Ulcerative Colitis (UC) have a negative impact on patients’ well-being and quality of life. Dysfunctions usually affect daily activities, performance in school, ability to work, and social life. The Short Inflammatory Bowel Disease Questionnaire (SIBDQ), frequently used to apraise Health-related Quality of Life (HRQoL) among IBD patients, measures social, systemic, bowel and emotional status (score 10–70, poor to good HRQoL)[1]. Our aim was to observe the impact of IBD on the patients’ quality of life over time.

Methods

We conducted a retrospective descriptive observational cohort study, followed prospectively at the Colentina Clinic Hospital Bucharest. The 10 questions of the SIBDQ questionnaire were divided into 4 subdomains (social, emotional, bowel and systemic). The SIBDQ was administered to patients at each study visit, scheduled every 12 months or more frequent, in case of unscheduled visits (disease flare).

Results

We included in the final analysis 219 patients, 88 (40%) with CD and 131(60%) diagnosed with UC. The 128 (58%) male and 91 (42%) female patients were followed for a median duration of 24 months. Overall SIBDQ scores improved at follow up visits (median SIBDQ 49 at baseline vs. mean 54 after 12 months of surveillance, p<0.05, Chi-square test). SIBDQ differs significantly according to both clinical and endoscopic activity (SIBDQ score 57 vs 43 for clinical remission/activity and 54 vs 50 for mucosal healing/endoscopic activity, p<0.05, Chi-square test). All subdomains of QoL were equally affected at the baseline visit and median scores improved during the first 24 months of follow-up: social (10 vs 11 points), emotional (15 vs 16 points) , bowel (13 vs 15 points) and systemic (10 vs 11 points). At the univariate analysis, we detected in the systemic (p=0.046) and social (p= 0.032) subcategories a significant association between the screening visit and the 48 months visit).

Conclusion

SIBDQ is a reliable tool for QoL assesement in IBD patients, correlated with clinical and endoscopic activity. In our cohort, long-term follow-up significantly improved QoL and patients achieved SIBDQ scores indicative of a good quality of life, in all subdomains (social, emotional, bowel and systemic).

References

[1]Jowett SL, Seal CJ, Barton JR, Welfare MR. The short inflammatory bowel disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis. Am J Gastroenterol. 2001;96(10):2921-2928. doi:10.1111/j.1572-0241.2001.04682.x
P0555 Quantitative Assessment of Colon Motility in Ulcerative Colitis using Magnetic Resonance Enterography: Correlation with Endoscopic Disease Activity
Authors: Sarikhani M , Naim I , Torabi A , Amouei M , Vahedi H , Sima A R , Kolahdoozan S , Menys A , Radmard A R
Published: January 2025

Background

Changes in small bowel motility have been quantified by magnetic resonance enterography (MRE) in Crohn’s disease to assess disease activity, but there is no data about colon motility changes in ulcerative colitis (UC). The aim of this study was to examine the correlation between colon motility (bowel wall motion) and endoscopic and laboratory features of activity in patients with UC.

Methods

This prospective study included 33 adults with known UC (mean age 38 [SD: 12.9] years, 51% female) and 30 controls (mean age 46 [SD: 15.2] years, 73% female). Two board-certified radiologists, blinded to clinical and endoscopic information, assessed motility scores for each colonic segment from dynamic cine MRE sequences using FDA-approved software with higher GIQuant scores indicating greater motility. Mayo endoscopic scores (MES) were determined by two experienced gastroenterologists in a consensus for each segment. Colonoscopy and laboratory tests were performed within 14 days of MREs. We used a mixed-effects linear model to evaluate the correlation between MES and motility scores across the five segments per patient.

Results

UC group consisted of 12 (36%) and 21 (64%) patients with left-sided colitis and pancolitis, respectively. The median value of GIQuant score for all colonic segments was significantly lower in UC patients (1184, IQR 693 to 1675) than controls (1245, IQR 851 to 1693) (p= 0.006). There was a decreasing trend of motility from ascending colon to rectum in controls with the similar pattern in UC patients except for lower motility of sigmoid than rectum. Per segment analysis of UC cases revealed a weak negative correlation between GIQuant and MES only in sigmoid (r= -0.2, p= 0.01). The mixed-effects model in per patient analysis identified a significant negative association between MES and GIQuant, indicating that each one-score increase in MES corresponds to a 144.3-point reduction in GIQuant between the less and more-involved colonic segment (β = -144.30, SE = 33.19, p < 0.001, 95% CI: -209.34 to -79.25). No significant correlation was found between the median GIQaunt score of all involved colonic segments and fecal calprotectin or serum CRP levels.

Conclusion

Higher endoscopic UC activity in each colonic segment is associated with lower motility compared to the less involved segments in each patient. Given the significant between-patient variability, colon motility should be assessed individually. MRE-based colon motility scores may provide an objective, transmural and physiological impression to complement endoscopy which may aid personalized assessment of UC activity.
P0556 A novel switching of artificial intelligence to generate simultaneously multimodal images to assess inflammation and predict outcomes in Ulcerative Colitis
Authors: Iacucci M , Zammarchi I , Santacroce G , Kolawole B B , Chaudhari U , Del Amor R , Meseguer P , Naranjo V , Puga-Tejada M , Capobianco I , Ditonno I , Buda A , Hayes B , Crotty R , Bisschops R , Ghosh S , Grisan E ,   PICaSSO group
Published: January 2025

Background

Virtual Chromoendoscopy (VCE) is pivotal for assessing activity and predicting outcomes in Ulcerative Colitis (UC), though inter- and intra-observer variability and the need for expertise persist. Artificial intelligence (AI) has the potential to offer standardised VCE-based assessment. This study introduces a novel AI model to detect, generate and transition between various endoscopic modalities, enhancing AI-driven inflammation assessment and outcome prediction in UC.

Methods

Endoscopic videos in high-definition white-light (HD-WLE), iScan2, iScan3 and NBI modalities from UC patients of the international PICaSSO iScan and Narrow-Band Imaging (NBI) cohort (302 and 54 patients, respectively) were used to develop a neural network (NN) able to identify the acquisition modality of each frame and for inter-modality image switching. 2535 frames were switched to different endoscopic modalities and used to train a deep-learning model for inflammation assessment using single and multimodal inputs on 169 videos of the iScan cohort. Subsequently, the model was tested on a subset of the iScan and NBI cohort (72 and 51 videos, 1080 and 765 frames, respectively). The model performance in predicting endoscopic and histological activity and outcomes and the agreement with experts were evaluated.

Results

Table 1 details the diagnostic performance of the AI model for the prediction of endoscopic and histological remission. The AI model efficiently classified and converted images across modalities (92% NN classifier accuracy). It showed excellent performance in predicting endoscopic and histological remission, with the multimodal assessment outperforming the unimodal one in both iScan cohorts (accuracy 91.67 [95% CI 82.74-96.88] and 88.89 [80.4-97.73]; AUROC 0.96 and 0.90 by Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Paddington International Virtual Chromoendoscopy (PICaSSO) score, respectively) and NBI cohort (accuracy 84.62 [95% CI 65.13-95.64] and 88.46 [69.85-97.55]; AUROC 0.92 by UCEIS and PICaSSO score, respectively). Moreover, it showed a remarkable ability to predict clinical outcomes in the iScan and NBI cohort (HR 3.18 [0.98-10.35] and 1.7 [0.7-4.11] by endoscopy; 5.75 [1.77-18-71] and 3.9 [1.15-13.28] by histology, respectively). Finally, the agreement with the assessment performed by endoscopists and pathologists was good.

Conclusion

Our multimodal "AI-switching" model innovatively detects, generates, and transitions between different endoscopic enhancement modalities and platforms, refining inflammation assessment, outcome prediction, and precise UC management by integrating model-derived images.
P0569 Inflammatory Bowel Disease nursing helpline trends in a large real-world Australasian cohort: Crohn's Colitis Cure (CCC) data insights program
Authors: Chan P , Su W K , Wilson W , Cabaero A , Antoniades S , Forbes A , Arnold K , Grafton R , Andrews J , Connor S
Published: January 2025

Background

The chronic nature of Inflammatory Bowel Disease (IBD) necessitates ongoing engagement between the healthcare team and patients with IBD. Dedicated nurse led helplines have been demonstrated to improve access to care, reduce healthcare costs and utilisation, and improves satisfaction. IBD nurses and helplines may not be widely available subject to resourcing. We analysed real world IBD-helpline usage across 10 Australasian sites to determine current trends.

Methods

Crohn’s Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record used increasingly in Australasia. The inclusion of a helpline augments the service through enabling encounter related documentation. De-identified data is made available from an associated, clinical quality registry (CQR). Helpline-associated data prospectively entered from September 2023 to September 2024 were analysed.

Results

In our cohort (n=7,493), 55.8% (n=4,181) had Crohn’s Disease (CD), 41.4% (n=3,101) had Ulcerative colitis (UC) and 2.8% (n=211) had IBD-Unclassified (IBDU). The median age was 42 years (IQR 31–56) and the cohort was evenly distributed in gender (49.0%, n=3,670 male). All patients resided in either Australia (73.1%, n=5,478) or New Zealand (23.6%, n=1,477). Three-quarters (75.2%) lived in metropolitan regions compared to regional/rural areas (24.8%). A total of 10,673 helpline encounters were documented, 75.5% (n=8,078) by email and 24.5%, (n=2,622) by phone. Email remained the predominant modality of communication across all age groups except those under 16. Those receiving advanced therapy (biologic or novel small molecule) formed 60% (n=3876) of the cohort but comprised 81.9% of the helpline utilisation likely reflecting increased complexity associated with their care. The most common reasons for helpline encounters related to administrative tasks (33.3%), medication-related issues (24.0%), and investigations/results (14.3%). Clinical concern and care only formed 14.3% of helpline contact encounters. This was consistent across most age groups, however a greater proportion of encounters were related to clinical concern or care in those under 18 (>30%) and over 80 (>20%).

Conclusion

IBD helplines play an essential role in augmenting the routine care provided to people with IBD, however it is limited by resource allocation, along with the burden of non-clinical and administrative tasks. Digital delivery of the IBD nursing helpline is utilised preferentially across all demographics in our cohort and signals an opportunity for innovative digital solutions to streamline care, reduce administrative burden, and improve overall patient care and satisfaction.

Figure 1. Helpline encounter reasons by age groups.
P0574 Correlations Between Inflammatory Biomarkers and Hematological Parameters in Assessing Disease Activity in IBD
Authors: Andronic A M , Andronic C , Toader E
Published: January 2025

Background

Monitoring ulcerative colitis (UC) and Crohn's disease (CD) involves assessing inflammatory and hematological biomarkers to evaluate disease activity, treatment response, and the impact of inflammation on overall health. The aim of this study was to assess if hematological and inflammatory biomarkers along with clinical parameters correlate with IBD inflammatory activity and severity.

Methods

The study retrospectively analyzed 100 IBD patients, of which 72 patients with UC and 38 patients with CD. Age, hematological parameters (hemoglobin, iron and ferritin), inflammatory biomarkers (CRP, fibrinogen and fecal calprotectin) and clinical scores such as Truelove and Witts for UC and UCDAI for CD were analyzed. Pearson's correlation coefficient demonstrated relationships between hematological and inflammatory biomarkers, while the Kruskal-Wallis test evaluated associations between these biomarkers and clinical scores.

Results

The mean age was 44.02 years, with UC patients averaging 43.03 years and CD patients 49.3 years, reflecting a slightly older demographic for CD. Age was negatively correlated with iron (-0.93) and positively with ferritin (0.88), indicating that older individuals have less iron deposits. Hemoglobin levels (mean 11.81 g/dL) were reduced across both diseases and exhibited significant negative correlations with CRP (-0.93) and fecal calprotectin (-0.91). Systemic (CRP) and intestinal (fecal calprotectin) inflammation can diminish hemoglobin levels in IBD patients, causing inflammatory anemia. Iron levels were lowest in CD (61.78 µg/dL) and correlated negatively with CRP (-0.93) and ferritin (-0.99) during active systemic inflammation, while ferritin levels (107.89 ng/mL) were elevated, particularly in active inflammation in CD group. Intestinal inflammation impacts iron status (-0.40), while ferritin and CRP are positively correlated (0.96), showing that systemic inflammation enhances iron storage. Fecal calprotectin emerged as a particularly sensitive marker of intestinal inflammation, showing the highest levels in UC patients (517.18 µg/g) and significant correlations with clinical activity scores (p = 0.02) for both Truelove-Witts and UCDAI. Hemoglobin was the only parameter that showed a weak trend of correlation with clinical scores (p=0.06), without statistical significance.

Conclusion

Hematological and inflammatory biomarkers along with clinical parameters correlate with IBD inflammatory activity and severity of the inflammatory process. The results highlight the effectiveness of biomarker evaluation in the personalized management of patients, enabling the adaptation, configuration, or establishment of monitoring schedules and therapeutic optimization based on the inflammatory profile.