bluuebunny/crossref_metadata_2025 huggingface dataset:
P0384 Applying ChatGPT to Improve Inflammatory Bowel Disease Diagnosis and Evaluation
Authors: Ozturk O , Coskun O , Yavuz C , Tenlik I , Yuksel I
Published: January 2025

Background

Chat Generative Pre-Trained Transformer-v4 (ChatGPT-v4) is an unquestionable asset to healthcare professionals. This paper will outline a number of ways in which ChatGPT-v4 can be used to improve the accuracy of its diagnosis and treatment strategies for ulcerative colitis (UC) and Crohn’s disease (CD), in line with the ECCO guidelines.

Methods

This 102-item questionnaire was designed to assess the accuracy, consistenacy, and inclusiveness of responses to questions about the diagnosis and treatment of UC and CD. The questionnaire was created in the form of true/false and multiple-choice questions and was based on clinical scenarios reflecting real-life situations and the ECCO guidelines. After that, ChatGPT-v4 was shown it, and its reactions were assessed.

The responses were evaluated using a Likert scale. The queries were posed to the artificial intelligence at 15-day intervals.

Results

In 47 responses (92%), ChatGPT adhered to the established guidelines, with deviations observed in 4 instances (8%). Of the 4 responses previously identified as non-compliant, 3 demonstrated no change or improvement following a 15-day reassessment period.

The mean values for the accuracy scores were found to differ, with 5.45 for the first set and 5.56 for the second (p = 0.606). The completeness scores showed a similar trend, with the mean value differing by 0.10, with 2.33 for the first set and 2.43 for the second (p = 0.280). The standard deviation trends for the two sets were also comparable.

The analysis revealed a significant enhancement in accuracy from the initial to the fifteenth day of assessment (5.49 and 5.56, respectively). A comparable increase was observed in completeness scores, rising from 2.15 to 2.37 between the initial and fifteenth day assessments. The imaging results indicated that more accurate responses were given to questions pertaining to it, although the difference was not statistically significant (p = 0.31).

In the context of multiple-choice questions, the performance of the AI model demonstrated enhanced stability and consistency (p = 0.606). The majority of answers were initially correct (90% of the total). Four out of five incorrect answers evolved into correct answers, one incorrect answer persisted, and two correct answers changed to incorrect answers.

Conclusion

ChatGPT-v4 has demonstrated potential for development as a clinical support tool in the management of inflammatory bowel diseases, including UC and CD. However, performance differed between binary and multiple-choice questions.
P0385 Delayed Diagnosis in Inflammatory Bowel Disease in Turkish Population
Authors: Acehan M F , Yilmaz V , Koç Ö , Güvenir S T , Er R E , Soykan A İ , Toruner M
Published: January 2025

Background

Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory condition characterized by relapsing episodes. These diseases typically present with diarrhea, abdominal pain, and bloody stools. However, the diagnosis of IBD may be delayed due to the higher prevalence of other clinical syndromes that can present with similar symptoms, lack of using diagnostic tools or depending on patient dependent reasons. This diagnostic delay can exceed six month or even much more in some patients. In this study, we aimed to examine the impact of demographic characteristics on diagnostic delay in IBD patients.

Methods

Patients diagnosed with UC and CD were retrospectively reviewed. Demographic data were collected, including gender, age group, educational status, marital status, parental status (whether the patient had children), geographical region (Central Anatolia vs. other regions), settlement type (urban vs. rural), and year of diagnosis. The time interval between symptom onset and diagnosis was also recorded. Variables associated with diagnostic delay were then identified. Diagnostic delay was defined as the duration between symptom onset and diagnosis exceeding six months.

Results

A total of 326 IBD patients were included in the study, with 138 (42.3%) and 188 (57.7%) patients assigned to the UC and CD groups, respectively. Of these, 185 (56.7%) were male. The majority of patients were in the age groups of 26–35 years (113, 34.7%) and 36–45 years (103, 31.6%) (Table 1) . Diagnosis dates ranged from 1992 to 2024, with 154 (47.2%) patients diagnosed before 2014 and 172 (52.8%) diagnosed in 2014 or later. The interval between symptom onset and diagnosis exceeded six months (defined as diagnostic delay) in 159 (48.8%) patients. The frequency of diagnostic delay was significantly lower in UC compared to CD (19.0% vs. 63.3%, p < 0.001). Across the entire IBD cohort, no variables were significantly associated with diagnostic delay. However, when UC and CD were analyzed separately, diagnostic delay in UC significantly decreased in patients diagnosed in 2014 or later compared to those diagnosed before 2014 (36.0% vs. 20.6%, p = 0.048) (Figure 1). In CD, a reverse trend was observed, but the difference was not statistically significant (59.5% vs. 66.1%, p = 0.357).

Conclusion

The frequency of diagnostic delay in IBD patients was significantly lower in UC compared to CD. While diagnostic delay in UC significantly decreased in patients diagnosed in 2014 or later, an opposite trend was observed in CD, although the difference was not statistically significant.
P0386 Prevalence and Impact of Anorectal Disorders in IBD: Insights from a Romanian Tertiary Gastroenterology Center
Authors: Costache R E , Dimitriu A , Marinescu A , Saizu I A , Gheorghe L , Gheorghe C
Published: January 2025

Background

Anorectal motility disorders profoundly affect the quality of life in patients with quiescent inflammatory bowel disease (IBD). Although faecal incontinence (FI) has a reported prevalence of up to 74%, its true extent is likely underestimated due to the stigma surrounding the condition. Fear of FI and challenges in accessing toilets remain significant concerns. This study evaluates the prevalence of these issues in Romanian tertiary care patients using the validated questionnaire International Consultation on Incontinence Questionnaire for Bowel Incontinence – IBD (ICIQ-IBD).

Methods

We surveyed 65 IBD patients aged over 18, admitted to our center, who were in remission but had previously experienced moderate to severe disease. Using the ICIQ-IBD questionnaire, we collected data on faecal incontinence, soiling, anal dyskinesia, their impact on quality of life, and demographic information. The analysis was conducted using Excel and Minitab.

Results

Of the 65 patients included in the study, 69% were male, with a median age of 40.82 ± 12.10 years. The majority were diagnosed with Crohn’s disease (65% CD, 35% UC). During remission, 22% of patients reported the need to rush to the toilet “always” or “most of the time,” compared to 40% during relapse, with a significant difference between disease phases (p = 0.02) but no differences based on gender or diagnosis. In relapse, 68% of patients had less than one minute to reach a toilet, compared to 32% in remission (p = 0.00). Soiling was reported by 49% of patients during active disease and 25% in remission (p = 0.004). Difficulty controlling liquid stools affected 62% of patients in relapse and 55% in remission, with no significant difference between disease states (p = 0.417). Emotional impact was reported by 72% of patients in relapse and 15% in remission, highlighting the psychosocial burden of bowel dysfunction in IBD.

Conclusion

Anorectal disorders significantly affect IBD patients’ quality of life, even during remission. Key symptoms, such as soiling and urgency, were more prevalent during relapse and strongly linked to emotional distress. These findings underscore the need for targeted management of anorectal symptoms in IBD care.

References

Norton, Christine et al. “Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life.” Journal of Crohn’s & colitis vol. 7,8 (2013): e302-11. doi:10.1016/j.crohns.2012.11.004

Dibley, Lesley et al. “Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD.” European journal of gastroenterology & hepatology vol. 28,2 (2016): 233-9. doi:10.1097/MEG.0000000000000513
P0390 Development, internal, and external validation of a novel endoscopic activity score for evaluation of Crohn’s disease (EASE-CD)
Authors: Ma C , Khanna R , Maguire B R , Zou G , Bressler B , Hindryckx P , Mosli M , Sparrow M P , Hart A L , Leong R W , Rubin D T , Rémillard J , Shackelton L M , D’Haens G R , Danese S , Peyrin-Biroulet L , Sands B E , Panaccione R , Feagan B G , Jairath V
Published: January 2025

Background

Endoscopy is essential for measuring luminal disease activity in Crohn’s disease (CD). Current endoscopic indices for evaluating CD activity are limited: they are only modestly correlated with disease activity, contain items that are ambiguously defined and have poor inter-observer reliability, and lack validated definitions for clinically relevant change. We aimed to develop and internally and externally validate a reliable and responsive endoscopic CD activity index.

Methods

In this multi-part study, candidate endoscopic items for index development with face validity derived from a prior RAND/UCLA appropriateness exercise were assessed by blinded central readers using ileocolonoscopy videos from the phase 3b adalimumab EXTEND (NCT00348283) and phase 2 risankizumab (NCT02031276) trials. Acceptable item-level operating properties for further consideration as covariables in regression for model building included at least moderate inter-rater reliability (intraclass correlation coefficient [ICC]≥0.41), and medium responsiveness defined as the probability of a patient receiving active treatment having a better endoscopy score than a patient receiving placebo or win probability (WinP) ≥0.56. Model development and internal validation with bootstrapping utilised data from 112 paired baseline and post-treatment videos from the adalimumab trial. External model validation utilised data from 108 video pairs from the risankizumab trial.

Results

The Endoscopic Activity Score for Evaluating CD (EASE-CD) is comprised of ulcer size, presence of deep ulcer(s), and percentage of ulcerated surface with each item evaluated and averaged across visualised bowel segments (Table 1). Total scores range from 0-100 (higher scores indicate greater endoscopic activity). EASE-CD demonstrated almost perfect inter-rater reliability (ICC 0.820 [95% CI: 0.662-0.906]) and a large degree of responsiveness (WinP 0.769 [95% CI: 0.658-0.851]). A 10-point reduction in EASE-CD had 87.8% specificity and 60.9% sensitivity for endoscopic response defined by the Simple Endoscopic Score for CD (SES-CD)/CD Endoscopic Index of Severity (CDEIS). Ulcer-free endoscopic remission results in EASE-CD=0.

Conclusion

EASE-CD is a novel, validated, continuous measure of endoscopic CD activity constructed using modern principles of index development, that is reliable, responsive to treatment, and linearly correlated with disease activity. EASE-CD does not include “narrowing” (which cannot be reliably evaluated between observers) or “affected area” (which is ambiguous in meaning, poorly reliable, and not independently associated with disease activity). EASE-CD is based only on ulcer-related items, the hallmark lesion in CD.
P0392 Prospective endoscopy of pan-enteric mucosal, transmural and biochemical dynamics in the first year of biological treatment in Crohn’s disease - a prospective MILESTONE study
Authors: Ukashi O , Lahat A , Ungar B , Levy H , Zlotnik A , Ben-Horin S , Eliakim R , Kopylov U
Published: January 2025

Background

Crohn’s disease (CD) complications affect 25% of patients at diagnosis and may progress to over 70% within ten years, often evolving into more complex forms. Controlling inflammation is essential to prevent disease progression, with biologics playing a central role. Video capsule endoscopy (VCE) and intestinal ultrasound (IUS) have proven effective in monitoring CD and predicting future complications. However, prospective data on pan-enteric mucosal inflammation and transmural healing in CD remain limited.

Methods

This prospective observational study included patients with CD who started on first-line biologics. Patients were followed at baseline, 14 weeks, and 52 weeks with assessments including CD Activity Index (CDAI), C-reactive protein (CRP), fecal calprotectin (FCP), pan-enteric VCE after confirming small-bowel patency via patency capsule (PC) ingestion, and IUS. The primary outcome was the continuation of biologic therapy after one year. Biochemical, endoscopic, and ultrasonographic remission were defined as follows: FCP<150 µg/g, Lewis score (LS)<135 or Eliakim score (ES)<4, and terminal ileum-bowel wall thickness (TI-BWT)<3 mm.

Results

Seventy-eight patients were screened, with 59 enrolled (median age: 30 [23-43] years; male: 31/59 [52%]; B2/3 disease phenotype: 12/59 [20.3%]), and 19 excluded (Figure, A). The patients started vedolizumab (21/59, 35%), infliximab (11/59, 19%), adalimumab (24/59, 41%) and ustekinumab (3/59, 5%). Eight patients were dropped out before the 14-week time point (Figure, A). At 52 weeks, 34/59 (58%) patients continued their biologics. Among patients with abnormal baseline biochemical, endoscopic, and ultrasonographic measures, 11/42 (26.2%) achieved biochemical normalization, 7/52 (13.5%) achieved small-bowel mucosal healing (MH), 6/38 (15.8%) achieved pan-enteric MH, and 8/28 (28.6%) achieved transmural healing at 14 weeks (Figure, B). Seventeen patients discontinued the study between the 14-week and 52-week time points (Figure, A). At 52 weeks, 17/42 (40.5%) of patients achieved biochemical normalization, 9/52 (17.3%) achieved small-bowel MH, 12/38 (31.6%) achieved pan-enteric MH, and 10/28 (35.7%) achieved transmural healing (Figure, B).All median study indices significantly improved during follow-up: CDAI: 103→64→63 (p=0.08); CRP (mg/dL): 6.6→5.0→4.1 (p=0.016); FCP (μg/g): 678→190→101 (p=0.009); LS: 750→225→225 (p<0.001); ES: 11→4→2 (p<0.001); TI-BWT (mm): 3.8→ 3.3→2.3 (p<0.001) (Figure, C).

Conclusion

First-line biologics significantly improve pan-enteric MH rates, along with clinical, biochemical, and ultrasonographic indices, in patients with CD over one year, with more than half of patients remaining on therapy during this period.
P0398 Point of Care Intestinal ultrasound – is it the key to reducing the carbon footprint of IBD Care?
Authors: Nwaezeigwe M , Hanley M , Lakshman K , Sheridan J , Cullen G , Doherty G
Published: January 2025

Background

Sustainability of IBD care has been identified as a key priority for the coming years by ECCO as part of the REACH strategy.

Additionally, the Irish Health Service Climate Action Strategy aims to achieve net-zero emissions by 2050 and provide healthcare that is environmentally and socially sustainable.

The STRIDE II consensus discusses new treatment goals in the care of IBD such as endoscopic healing which would require more frequent monitoring. However this poses an environmental burden as one MRI generates approximately 20kg CO2e, 3 times more than a CT scan (7kg CO2e), and 20 times more than an ultrasound (1kg CO2e) and 1 colonoscopy is estimated to generate between 28-55kg CO2e. Decontamination of the endoscope generate a further 11.19 kg CO2e.

Point of Care Intestinal ultrasound (POC-IUS) offers a low carbon alternative compared to CT, MRI and endoscopy for disease assessment and monitoring.

Aim

To calculate the potential reduction in Greenhouse Gas (GHG) emissions from the use of POC-IUS for disease monitoring.

Methods

A retrospective analysis of all POC-IUS performed over a 12mth period was conducted.

We focused on the impact of utilising IUS in the IBD clinic instead of interval MRE or colonoscopy to assess disease activity.

The immediate carbon emissions saved as a result of utilising IUS alone was calculated.

The long term reduction of carbon emissions over a three year period from using IUS as an alternative tool for disease monitoring was also calculated.

Data on patient travel, investigations and associated emissions were collected from the patient health record and calculated on ecotree.green.

Results

259 patients were identified who underwent IUS, 92% had Crohns disease.

20% (n=52) of patients had active disease which was followed up by POC-IUS alone. Mean F.Calpro was 495.

Consequently, 14 fewer colonoscopies and 43 fewer MRE were performed over the 12mth period due to the immediate assessment offered by IUS corresponding to at least 5460km reduction in travel to and from appointments with an overall reduction in GHG emission of 1,485kg CO2e. Overall, the use of POC-IUS instead of MRE and/or colonoscopy led to an estimated reduction in GHG of 3269kg CO2e.

Projecting these results over an interval period where IUS is used as the only primary monitoring tool to assess disease activity showed potential carbon emission savings of 36,531kg C02e.This is equivalent to 15 Round-Trip Flights from New York to London.

Conclusion

The findings emphasise the role IUS delivered within the IBD clinic might play in reducing the carbon footprint of IBD care.

POC-IUS is a low carbon alternative and is a tool in providing a lean care system which are two key principles of delivering a sustainable clinical practice.
P0403 The relationship between liver stiffness and disease duration in Crohn’s Disease: A prospective cohort study of hepatic manifestations in inflammatory bowel disease
Authors: Moon W , Park H J , Seo K I , Park J H
Published: January 2025

Background

Intestinal mucosal injury is known to contribute to liver disease, and abnormal liver profiles are frequently observed in inflammatory bowel disease (IBD) patients. This study aimed to investigate the hepatic manifestations of IBD in Korea.

Methods

A prospective cohort to evaluate hepatic abnormalities in IBD was established at Kosin University Gospel Hospital in 2018. From December 2018 to September 2024, patients diagnosed with IBD were consecutively enrolled and underwent abdominal ultrasonography and transient elastography-controlled attenuation parameter (TE-CAP), and laboratory tests including liver function tests, lipid profiles, and fecal calprotectin.

Results

A total of 383 patients were enrolled, including 218 with ulcerative colitis (UC) and 165 with Crohn’s disease (CD). The mean age was 45.8 (±15.2) years for UC patients and 37.6 (±16.3) years for CD patients. Among the participants, 250 were male, and 133 were female. The mean BMI was 23.1 (±3.49) for UC patients and 22.0 (±4.11) for CD patients. HBsAg was positive in 14 (3.7%) patients, Anti-HBc IgG in 76 (19.8%) patients, Anti-HCV Ab in 6 (1.6%) patients. The proportion of patients with a disease duration more than one year was 123 (56.4%) for UC and 90 (54.5%) for CD. The mean CAP (dB/m) score was 220.0 (±54.5) [UC 230.5 (±52.6), CD 209.4 (±53.5)]. The mean E (kPa) value was 4.71 (±1.94) [UC 4.70 (±1.98), CD 4.65 (±1.80)]. Mean fecal calprotectin levels was 1146.6 (±17.27.7) in UC and 1075.8 (±1720.6) in CD. (Table 1) In total population, CAP score was significantly associated with BMI (r=0.616, P<0.001), triglyceride (TG) (r=0.273, P<0.001). In UC patients, CAP score was significantly associated with BMI (r=0.527, P<0.001) and TG (r=0.285, P<0.001). In CD patients, CAP score was significantly associated with BMI (r=0.660, P<0.001), albumin (r=0.400, P<0.001), total cholesterol (r=0.288, P<0.001), TG (r=0.271, P<0.001) and inversely with fecal calprotectin (r=－0.329, P<0.001). The E value was significantly associated with total bilirubin (r=0.348, P<0.001), ALT (r=0.495, P<0.001) and disease duration (r=0.333, P<0.001). In CD patients with a disease duration of more than one year (n=75), E value was observed to increase gradually as the disease period lengthened (r=0.496, P<0.001). (Figure 1)

Conclusion

In CD patients, liver stiffness is associated with a longer disease duration. In both UC and CD patients, abnormal lipid profiles are related to the development of fatty liver.
P0405 Evaluation of penetrating Crohn’s disease: course of complicated disease and risk factors associated with progression to penetrating complications
Authors: Pekmezci A , Bakkaloglu O K , Atay K , Erzin Y , Celik A F , Hatemi I
Published: January 2025

Background

This study aimed to identify the risk factors for developing penetrating Crohn’s disease (CD) and to evaluate clinical course of patients with penetrating CD at the time of diagnosis and those who subsequently evolved to penetrating CD during follow-up.

Methods

CD patients with penetrating complications followed between 1986 and 2022 were retrospectively evaluated. Patients who developed penetrating CD were compared to a control group of who did not. Also, patients developing penetrating CD on follow-up were compared to patients presenting with penetrating CD at the time of diagnosis.

Results

From a cohort of 1,404 CD patients, penetrating complications were identified in 312 (22.2%). A total of 198 patients were excluded due to insufficient data and 114 patients with penetrating CD were included in the analyses. Among them, 36 (31.6%) had penetrating complications at diagnosis and 78 (68.4%) developed penetrating complications during follow-up. The patients who developed penetrating complications during follow-up were compared with a control group (n:78) of CD patients who did not develop any penetrating complications. In-between these groups; The age at the diagnosis in the penetrating group was 25.5±9.03 years and was lower than in the control (33.0 ± 11.41); The need for steroids was higher and the rate of hospitalizations was more common in the penetrating group (p=0.022 and 0.002, respectively). The proportion of patients who underwent biologic treatment (78.2%) and was unresponsive to biologics (26.4%) were higher in the penetrating group. The frequency of endoscopic remission was higher in the control group (44.9% vs. 33.3%; p=0.03). Additionally, cross-sectional imaging revealed significantly more frequent instances of regressed disease in the control group (54.8% vs. 23.8%; p=0.006). Further, clinical follow-up of patients with penetrating CD were evaluated. Patients who presented with penetrating CD and those who developed penetrating complications subsequently during follow-up had similar rates of surgical intervention and resection related to penetrating CD (28.3% vs. 71.7%; 50.0% vs. 51.3%; respectively). The presence of an obstructive area before the development of penetrating complications was less common in the group with penetrating disease at diagnosis compared to the group who developed penetrating disease at follow-up (13.9% vs 61.5%, p<0.001).

Conclusion

Age, treatment response and previous active clinic are identified risk factors for developing penetrating disease in initially non-penetrating CD. The clinical course of patients with penetrating disease at diagnosis and those who developed penetrating disease at the follow-up seems similar.
P0410 Clinical outcomes of endoscopically confirmed immune checkpoint inhibitor-induced colitis: A multicentre retrospective study
Authors: Ibraheim H , D’arienzo P , Dean N J , Aboulela M , Anderson K , Manickavasagar T , Vadera S , Symington J , Mullings S , Olsson-brown A , Young K , Powell N
Published: January 2025

Background

Immune checkpoint inhibitors (CPIs) have transformed cancer outcomes, but frequently trigger CPI-induced colitis (CPI-c) leading to significant morbidity and prolonged immunosuppression. This study characterises CPI-c patients (pts) using robust definitions. Additionally, the impact of macroscopic inflammation (endoscopic and histological evidence) compared to microscopic inflammation (histological only) on clinical outcomes remains unclear.

Methods

Retrospective outcome data were obtained from consecutive CPI-c pts from 2 U.K centres. Pts with diarrhoea and histological ± endoscopic colonic inflammation were included. Factors associated with macroscopic inflammation were analysed using Chi squared tests and multivariable logistic regression.

Results

Of 161 pts (55% male, median age 64), cancers included melanoma (50%), renal (18%), lung (16%) and others (16%). CPI therapies included anti-PD-1/L1 monotherapy (41%), dual anti-CTLA-4/PD-1 (47%) and chemoimmunotherapy (6%). Toxicity onset was earlier with dual anti-PD-(L)1/CTLA-4 therapy vs. anti PD-(L)1 monotherapy (47 vs.150 days, p < 0.001). The average bowel frequency was 8x/day (range 2-20); 115 (71%) had nocturnal symptoms; 28 (17%) had bloody stool and 63% required hospitalisation.

89 pts (54%) were corticosteroid (cs) refractory, requiring biologics (infliximab (IFX), 73; vedolizumab, 13). 41/73 (56%) responded to IFX, and 5/13 (38%) to vedolizumab. Three underwent colectomy for refractory colitis.

Macroscopic inflammation occurred in 78%, while 22% had microscopic inflammation. Time to endoscopy did not differ between groups. Among macroscopic cases, 91 (70%) had mild (Mayo 1), while 30% had moderate or severe inflammation (Mayo 2-3). CTCAE grade did not correlate with endoscopic severity.

In the regression analysis, male sex (OR 3.25 p<0.01) and dual anti-CTLA-4/PD-1 (OR 2.63 p<0.01) predicted macroscopic inflammation. Age, cancer, CTCAE grade, duration of diarrhoea, concurrent CMV colitis, number of cs tapers, duration of cs therapy, hospitalisation and recurrence of colitis were not predictive.

Macroscopic inflammation correlated with higher faecal calprotectin (FC) levels (889 vs 414, p=0.02) and biologic escalation (52.7% vs 30.6%, p<0.05).

30% received CPI re-challenge, with colitis relapse in 13/45 (29%). No relapses exceeded initial CTCAE or endoscopic severity.

Conclusion

This study represents one of the largest real-world cohorts of robustly defined CPI-c pts. Pts with macroscopic inflammation have a more aggressive clinical course, marked by higher FC levels and greater need for biologic escalation, emphasising the need for heightened monitoring in this group. Reassuringly, CPI re-challenge did not lead to more severe colitis relapses than the initial episode.
P0413 Clinical features of pediatric ulcerative colitis with atypical endoscopic findings
Authors: Miyazaki H , Agawa M , Nakamura H , Ito Y , Okamoto N , Ku Y , Watanabe D , Hoshi N , Ueda C , Kondo A , Horinouchi T , Ooi M , Kodama Y
Published: January 2025

Background

Atypical endoscopic features are not uncommon in newly diagnosed pediatric ulcerative colitis (UC) compared to adults. However, the clinical meaning of these atypical endoscopic features at diagnosis are obscure. We aimed to clarify the clinical characteristics of pediatric patients with UC who do not exhibit typical endoscopic findings.

Methods

This is a retrospective study of the newly diagnosed pediatric patients with UC. The inclusion criteria are as follows: (1) aged 15 years or younger at the time of diagnosis, (2) diagnosis of UC according to the criteria set by the Japanese Ministry of Health, Labour and Welfare, and (3) attendance at Kobe University Hospital (Kobe, Japan) between April 2018 to January 2024. Endoscopic activity was assessed using the Mayo Endoscopic Subscore. Patients were categorized into two groups based on the endoscopic findings at diagnosis. The “typical group” was defined as patients who showed endoscopic inflammatory activity starting in the rectum and expanding proximally in a continuous manner. All other patients were classified as the “atypical group”. We compared the background characteristics and the clinical course between the two groups.

Results

Thirty-three patients were included in this study. Sixteen patients (48.5%) were male, and the median age at diagnosis was 13 years. The median Pediatric Ulcerative Colitis Activity Index (PUCAI) score was 40, while the median serum level of albumin, hemoglobin, and CRP were 3.8 g/dL, 11.9 g/dL, and 1.0 mg/L, respectively. At the time of diagnosis, 2 patients had proctitis, 3 had left-sided colitis, 27 had pancolitis, and 1 had right-sided colitis. Endoscopic activity was mild in 4 patients (12.1%), and moderate in 29 (87.9%).

Of the 33 patients, 21 (63.6%) were classified into the typical group and 12 (36.4%) into the atypical group based on colonoscopy at diagnosis. There was no difference between the two groups in terms of baseline characteristics such as sex, age at diagnosis, duration of symptoms before diagnosis, endoscopic activity, and the extent of the disease. The median albumin level was lower in the typical group than in the atypical group (p=0.006).

Kaplan-Meier analysis showed that patients in the atypical group were more likely to maintain a biologic-free condition than those in the typical group (p=0.028). Patients in the atypical group were also likely to remain in a steroid-free condition compared with those in the typical group, although not statistically significant.

Conclusion

Pediatric patients with UC who have typical endoscopic findings of a continuous lesion extending from the rectum at diagnosis may have a poor prognosis and require advanced therapy compared to those with atypical endoscopic findings.
P0418 The implementation of IBD-dedicated multidisciplinary healthcare pathway improves patients’ satisfaction and reduces disability in patients with IBD
Authors: Buisson A , Banana Hamadidi A , Dumas V , Dodel M , Coban D , Bazoge M , Rivière C , Heux J , Pereira B
Published: January 2025

Background

The management of patients with Inflammatory Bowel Diseases (IBD) has recently evolved highlighting the need for holistic approach.

We evaluated patients’ satisfaction after the implementation of an IBD-dedicated multidisciplinary healthcare pathway (IBD-MHP) compared to the previous organization and assessed its impact on medical follow-up and disability in patients with IBD.

Methods

In this prospective study, we enrolled consecutively all adult IBD patients seen in the IBD-MHP during 8 weeks. A questionnaire was specifically developed for this study. Patients’ satisfaction was assessed using a numerical scale from 0 to 10 (10 = perfect satisfaction).

The previous organization followed a traditional model of medical consultations and additional examinations. The IBD-MHP was organized with dedicated reception by a secretary, completion of IBD-Disk to assess functional disability, a consultation with one of two IBD nurses (including blood tests, pre-analytical faecal calprotectin testing, and therapeutic education program), optional consultation with a psychologist, followed by a medical consultation. Additional examinations (e.g., sigmoidoscopy, ultrasound, MRI) were performed the same day just before the care pathway within or near the IBD unit.

Results

Among 388 patients, 276 patients (57.6% female, mean age 43.8 ± 15.0 years, 58.3% with Crohn’s disease) completed the questionnaires.

Overall satisfaction was significantly higher with the new organization (IBD-MHP) compared to the previous (8.7 ± 1.5 vs. 7.6 ± 1.8, p <0.0001; effect size (ES) = 0.69). Patients’ satisfaction were improved regarding the attention paid by the team to the indirect consequences of the disease (8.8 ± 1.6 vs. 7.2 ± 2.1, p <0.0001; ES = 0.87), time spent at the IBD unit during each visit (7.6 ± 2.0 vs. 6.7 ± 2.2, p <0.0001; ES = 0.50), punctuality of healthcare professionals (7.7 ± 1.8 vs. 6.8 ± 2.0, p <0.0001; ES = 0.45), coordination of examinations (8.4 ± 1.8 vs. 7.4 ± 2.1, p <0.0001; ES = 0.60), knowledge about their disease (8.5 ± 1.7 vs. 8.1 ± 1.8, p <0.0001; ES = 0.23), and interaction with medical staff (8.5 ± 1.8 vs. 7.0 ± 2.2, p <0.0001; ES = 0.81).

IBD-MHP led to a slight increase of treatment adherence (71.3% vs. 75.2%, p < 0.05), a modest decrease in active smoking (18.8% vs. 17.0%, p <0.001 and an overall improvement in disability (IBD-Disk) (32.60 ± 21.59 vs. 30.50 ± 23.92; p <0.001).

Conclusion

The implementation of IBD-MHP, replacing the traditional consultation model, led to improved patients’ satisfaction and reduced patients’ disability, meeting the objectives of holistic approach. This type of organization should be promoted in IBD unit.
P0431 Multiparametric Assessment of IBD, SpA and IBD-SpA patients to explore disease biomarkers and response predictors
Authors: Parisio L , Privitera G , Varca S , Perniola S , Alivernini S , Tolusso B , Petito V , Masi L , Napolitano D , Schiavoni E , Turchini L , Amatucci V , Scaldaferri F , Gasbarrini A , Armuzzi A , Gremese E , Guidi L , Pugliese D
Published: January 2025

Background

Immune-mediated inflammatory diseases (IMID) can coexist within the same patient and their pathogenesis could overlap. Inflammatory bowel disease (IBD) [Crohn’s disease (CD) and ulcerative colitis (UC)], and spondylarthritis (SpA), often associate, but disease biomarkers are not fully characterized. This project aims to investigate a possible molecular signature of disease and predictor markers of response

Methods

We performed an observational prospective study, enrolling consecutive IMID patients (pts) starting a target therapy. We principally focused on 3 cohorts: IBD, SpA and IBD-SpA. At baseline, we performed a test for serum cytokines and also collected intestinal biopsies, to stain for immune cell markers. Clinical intestinal and articular response (CR) was assessed at 4, 12 and 24 months. CR was defined using clinical scores: Patient Reported Ouctome-2 (PRO-2) for UC and CD, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) for SpA

Results

We enrolled 134 pts (59 IBD, 75 SpA). All the SpA pts were seronegative with prevalent peripheric articular involvement. In the IBD cohort, 48% of the pts were naïve to advanced therapies, while the remaining part had been exposed to biologics. 34% pts were on concomitant steroid therapy at baseline. At baseline, we found lower serum levels of IL-6, IL-12/23, IL-7, IL-10, IL-33, IL-35 and IL-37 in IBD pts compared to SpA pts and that levels presented a direct or inverse correlation with the clinical scores (figure). In the IBD-SpA group, compared to the IBD group, we found higher levels of IL-6(p=0.001), sTREM1(p=0.027), IL10(p=0.002) and IL-37(p=0.016). According to PRO-2, 70% of pts were in steroid-free clinical remission at 12 months, and 81.8% at 24 months. Considering CR at 12 months, statistically significant differences were found in the groups of responders versus no responders. In the IBD cohort we found that 100% of responders, had low levels of IL-8(<8.6 pg/mL) and low CD117 cell count in intestinal tissue at baseline; besides, 80% of responders had high CD20 count in intestinal tissue at baseline. Kaplan-Meier curves for achieving CR at 24 months, in the entire cohort of pts, showed no statistically significant differences stratifying pts on demographic characteristics and type of disease

Conclusion

In IBD pts, we found results which could suggest a different systemic inflammation signature between IBD and SpA pts and the presence of possible biomarkers which, if confirmed, could help the physician in the early and non-invasive identification of the disease phenotype at diagnosis and response to therapies
P0432 CMV infection in IBD patients with disease flare in the era of advanced therapies and outpatient setting
Authors: Pipek B , Zelinková Z
Published: January 2025

Background

The infection with cytomegalovirus (CMV) has typically been reported to be associated with poor clinical outcomes in inflammatory bowel disease patients with severe, steroid-refractory ulcerative colitis.Data on prevalence, clinical picture and evolution of CMV infection in IBD outpatient setting, including patients with Crohn’s disease colitis are limited.

Methods

All IBD patients who underwent colonoscopy or flexible recto/sigmoidoscopy for clinical suspicion of disease flare were identified in the electronic medical record system of two IBD referral centra.Patients with histopathological hallmarks of CMV infections and/or positivity of immunohistochemical staining for CMV were identified and further analyzed. Basic demographics,laboratory findings,medications and CMV infection treatment were noted.

Results

In total, 226 endoscopic and histologic findings were reviewed, of which, eight were tested positive for CMV infections. Seven out of these eight patients had typical histopathological morphology with inclusion bodies and teste positive for CMV immunohistochemistry, one patient had only CMV immunohistochemical staining positive. There were four patients with colonic Crohn’s disease and four with ulcerative colitis, median age 42 years (range 25-72 years); median duration of the disease was 10 years (range 1-20 years). All patients had symptoms of colonic disease activity, two patients had fever. Median CRP was 27,5 mg/L (range 3-240), all patients had normal leucocytes and thrombocytes count and no liver tests abnormalities.None of the patients had systemic corticosteroids at the time of CMV diagnosis, one patient was using topical budesonide and one budesonide-MMX; three patients were treated with infliximab for several years; two had vedolizumab; one ustekinumab and two patients had no treatment and were about to start their first line biologic.All patients were treated with virostatic treatment with valganciclovir or ganciclovir.All patients had their biologic treatment interrupted for the time of antivirotic treatment. One of the patients who needed i.v. treatment had no improvement upon antivirotic treatment with persistent CMV viremia and underwent colectomy with rapid resolution of symptoms afterwards. The remaining seven patients achieved clinical response with antivirotic treatment and subsequent biologic therapy.

Conclusion

CMV infection in IBD patients with active colonic disease is rare but when present, it can lead to systemic manifestation of the infection. In contrast to the thus far reported typical picture of infection complicating severe ulcerative colitis, it can occurs in both, Crohn’s disease and ulcerative colitis patients with moderate disease activity and without extensive immune suppressive treatment.

References

Maresca, R et al. Cytomegalovirus Infection: An Underrated Target in Inflammatory Bowel Disease Treatment. J. Clin. Med. 2024, 13, 136
P0436 The rare case of Littoral Cell Angioma concomitant with Crohn’s Disease: our centre’s experience
Authors: Emma E P , Mariatti M , Palleschi C V , Perna F , Ficari F , Scaringi S , Milla M
Published: January 2025

Background

Littoral Cell Angioma (LCA) is a rare splenic vascular tumor, first described in 1991. Although it is usually benign and clinically non-specific, the outcome is not predictable, and some cases with malignant behavior have been described.The pathogenesis of this lesion remains unknown, although a correlation with important immune disorders such as Crohn’s disease (CD) is established. The aim of the report is to present the experience of our center. We report the 5th described case of LCA in a patient affected by CD.

Methods

We describe the case of a 32-year-old patient diagnosed with CD stenosing dijuno-ileal and colic associated with splenomegaly (Dec 2011). He was treated with Adalimumab (Feb-Sep 2012, discontinued due to ineffectiveness), Infliximab (Oct 2012-Dec 2014, discontinued due to healing mucosa) and AZA since Dec 2013.

For subsequent finding of splenic parenchymal lesions of difficult clinical-instrumental definition, in Jan 2023 splenectomy, digiunal resection (20cm) and digiuno-digiunal.

Michelassi strictureplasty (30cm) were performed.

Results

Histological examination showed CD in a severe phase of activity with reactive lymphadenitis. In the splenic parenchyma there were circumscribed and demarcated areas consisting of blood exudates and an exudative/productive inflammatory infiltrate with histiocytic elements. Immunohistochemistry: CAM5.2-, CK7-, CDX-2-, CD68-PMG1+, CD1a-, CD207-. In light of the clinical- instrumental picture, histological preparations and immunohistochemical investigations, the morphological and immunophenotypical findings were compatible with splenic LCA.

Conclusion

LCA is often associated with immune diseases. Its diagnosis should be evoked in case of splenomegaly contextual toCD. The tumor may be related to the natural history of CD, and splenomegaly may be present at the time of diagnosis.

The entero-RM to establish the degree of CD activity could represent an opportunity in the study of the prevalence and natural history of thisrare splenic neoplasia.
P0441 Vitamin D seasonal fluctuation is more prominent in inflammatory bowel disease patients undergoing advanced therapies
Authors: Baz-Lopez A , Baston-Rey I , Marti-Marques E , Calviño-Suarez C , Santos-Blanco E , Ferreiro-Iglesias R , Blanco-Hortas A , Lopez-Roses L , Dominguez-Muñoz J E , Barreiro-de Acosta M
Published: January 2025

Background

The influence of Vitamin D (vitD) has been investigated in inflammatory bowel disease (IBD) patients to see how might affect disease activity. VitD is expected to be lower in winter and higher in summer due to sun exposure. The effect of VitD in IBD patients is thought to be similar to that in healthy subjects. The aim of the study was to evaluate fluctuation of vitD in IBD patients undergoing different treatments during two consecutive seasons.

Methods

IBD patients (both ulcerative colitis (UC) and Crohn’s disease (CD)) were recruited from two IBD units in Northern Spain and followed-up for at least 6 months. Patients who were being treated with supplement vitD or oral steroids were excluded. Patients with comorbidities that could interfere with vit D, such as advanced kidney disease, were also excluded. Clinical data regarding IBD activity and vitD was collected during two separate seasons (summer from June to September and winter from December to March). For this evaluation we assumed the vitD fluctuation (using mean values) in the general population to be normal. Frequency of vitD fluctuation in IBD patients undergoing advanced therapies and standard treatment were compared with that of the general population using Chi-Square test.

Results

We followed-up 199 IBD patients (both UC and Crohn’s disease) for at least 6 months. Most patients were in clinical and biochemical remission (77% in winter and 76% in summer had fecal calprotectin <150 microg/g). IBD patients undergoing advanced therapies n=90 (biologics and antiJaks) were compared to IBD patients undergoing standard treatments n=104 regarding vitD fluctuation. Usind data from the general population we established a normal fluctuation of 2.8 ng/ml of vitD from season to season in our cohort (that is we expected at least a 2.8 ng/ml increase from winter to summer and a less than 2.8 ng/ml decrease from summer to winter). VitD fluctuation comparable to the general population was observed in 24% of patients undergoing advanced therapies, which is less frequent than in those undergoing standard treatment (48%). This result was statistically significant (p= 0.0067)

Conclusion

The difference in seasonal fluctuation of vitD was significantly more prominent in IBD patients undergoing advanced therapies than in those undergoing standard treatment. Patients undergoing standard treatment had a similar VitD fluctuation to that of the general population.
P0443 Prognosis of primary sclerosing cholangitis (PSC) in Hungary is independent of coexisting inflammatory bowel disease (IBD) and prognostic ability of the currently used PSC risk scores are limited
Authors: Vén P , Lénárt Á , Tornai D , Tóth B , Vitális Z , Tornai I , Tornai T , Altorjay I , Papp M
Published: January 2025

Background

Primary sclerosing cholangitis (PSC) is a rare, chronic disorder of the intra- and extrahepatic biliary tree characterized by cholestasis, periductal inflammation and fibrosis. Currently, there is very limited epidemiological data from the Central-Eastern European region. We assessed disease characteristics and natural history of PSC in a bicentre Hungarian cohort and compared its outcome with respect to co-existing inflammatory bowel disease (IBD).

Methods

Imaging, laboratory and clinical data including presence of IBD, variant syndrome, disease course and outcome were prospectively collected in two large Hungarian Clinical Centre Patients were followed on a yearly basis. Median diseases follow-up (FUP) time was 8.82 (IQR: 5.2-13.5) years. A wide range of clinical scoring systems were applied. Poor disease outcome was defined as orthotopic liver transplantation (LT) and/or liver-related death during the FUP.

Results

Of 135 patients (57.8% males; median age at diagnosis: 31 [IQR: 20-47] yrs) with confirmed PSC, 73 (54.1%) had coexisting IBD. Nineteen patients already had cirrhosis at diagnosis and 31 more developed it during the FUP. A total of 21 (15.6%) patients died of which 85.7% were liver-related deaths. Twenty-five patients (18.5%) underwent liver transplantation (LT). Twenty-three (17%) patients developed malignancy (9 cholangiocarcinoma, 3 hepatocellular carcinoma, 6 colorectal carcinoma and 6 non-gastrointestinal malignancy) during the FUP. Patients with IBD were younger and had higher Mayo and Amsterdam-Oxford scores at diagnosis compared to those without, however there was no difference in disease outcomes in these groups (p=0.133). Clinical scores at diagnosis had moderate prognostic ability for poor disease outcome (AUROC [95%CI], Mayo score: 0.637 [0.521-0.753]; p=0.018; Amsterdam-Oxford: 0.687 [0.576-0.798]; p=0.002; p<0.001; UK-long: 0.695 [0.588-0.803]; p<0.001), except UK-short PSC risk score (0.745 [0.643-0.847]). Persistent alkaline phosphatase (ALP) increase, despite ursodeoxycholic acid (UDCA) treatment, especially within the first two years of diagnosis had good prognostic ability (AUROC [95%C], at diagnosis: 0.656 [0.556-0.757], p= 0.006; after one year: 0.724 [0.602-0.847], p<0.001; after two years: 0.746 [0.617-0.875], p<0.001).

Conclusion

Prognosis of PSC is independent of coexisting IBD in our large Hungarian prospective PSC cohort. Prognostic ability of the currently used PSC risk scores is limited. The UK-short PSC risk score and early ALP response to UDCA treatment showed to have the best accuracy.