bluuebunny/crossref_metadata_2025 huggingface dataset:
P349 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: Descriptive Comparison of Experiences of Bowel Urgency among Patients with Ulcerative Colitis in Canada, Europe, and the US
Authors: Jairath V , Glass J , Braun M , Bessissow T , Gibble T , Atkinson C , Ellis H , Dewar T , Panaccione R
Published: January 2024

Background

Bowel urgency is a disruptive symptom affecting daily lives of patients with moderate-to-severe ulcerative colitis (UC). Previous analyses from the Communicating Needs and Features of IBD Experiences (CONFIDE) survey reported bowel urgency as a common and impactful symptom of UC in the United States (US) and Europe. This study used data from the CONFIDE survey to descriptively compare the prevalence and impact of bowel urgency in patients with UC across US, Europe, and Canada.

Methods

Online, quantitative, cross-sectional surveys were conducted among patients with UC in the US, Europe (France, Germany, Italy, Spain, UK), Japan, and Canada. Criteria based on previous treatment, steroid use, and/or hospitalization defined moderate-to-severe UC. Descriptive comparisons of data from US, Europe, and Canada are presented.

Results

Surveys were completed by 82 Canadian, 556 European, and 200 US patients with UC. Across geographies, most patients were receiving advanced therapies at the time of survey completion (Canada:73%, Europe:54%, US: 77%; Table). Similar to the findings in Europe and US, bowel urgency was among the top three most common symptoms currently (in the last month) experienced by Canadian patients (Canada:31%, Europe:30%, US:47%; Figure 1a). Due to fear/anticipation of bowel urgency-related accidents, 60% Canadian patients reported wearing diaper/pad/other protection, at least once a month in the past 3 months, similar to European (65%) and US (69%) patients. Among Canadian patients who ever experienced bowel urgency (n=46, 56%), most (78%) reported doing so at least once a month in past 3 months with similar frequencies observed among US and European patients; proportion of patients experiencing bowel urgency at least once a week was higher among US (79%) and European (71%) patients than Canadian patients (48%) (Table). Among patients receiving advanced therapies, similar patterns were observed (Table). Most patients in all three populations reported bowel urgency and bowel urgency-related accidents among the top five most common reasons for declining participation in work/school, social events, and sports/physical exercise (Figure 1b).

Conclusion

These descriptive analyses suggest that although the overall prevalence and burden of bowel urgency in Canada are similar to those in the US and Europe, a numerically lower proportion of Canadian patients with moderate-to-severe UC experienced bowel urgency at least once a week in past 3 months. Despite receiving advanced therapies, patients experience bowel urgency and related diaper/protection use across geographies. These findings highlight the clinical importance of evaluating and treating bowel urgency to improve the quality of life of patients with UC across geographies.
P356 Long-term outcome of UC patients in clinical remission with different level of mucosal activity: real world, retrospective, multicontinental study
Authors: Bacsur P , Wetwittayakhlang P , Resál T , Farkas B , Rutka M , Bessissow T , Afif W , Bálint A , Fábián A , Bor R , Szepes Z , Farkas K , Lakatos P L , Molnár T
Published: January 2024

Background

In contrast to the increasingly rigorous endpoints of clinical trials of ulcerative colitis (UC), Mayo endoscopic score (MES) ≤ 1 is mostly set as target during clinical follow-up, but long-term outcomes may differ according to different level of healing. Therefore, our study aimed to compare the long-term outcomes of UC patients in clinical remission with different MES and UCEIS scores in real-life condition.

Methods

UC patients in clinical remission (defined by pMayo<2 with no rectal bleeding) who underwent colonoscopy between 2016-2020 were consecutively enrolled in this multicenter retrospective study. Mayo and UCEIS endoscopic scores were evaluated and clinical and demographic data were collected at baseline. Clinical flare, colectomy, hospitalization and treatment modifications were recorded during at least 3 year of follow-up. Primary outcome was the clinical flare, while secondary outcomes were hospitalization, colectomy, new biological initiation and biological dose escalation during follow-up. Outcomes were compared with Log-rank test and survival characteristics were plotted.

Results

In total, 156 UC patients were enrolled with a median age of 46.0 (IQR 35.5-58.0), while male/female ratio was 49.4 % (Table 1.). Near to half of the patients (44.9%) had MES>0 endoscopic activity at baseline. Non zero baseline MES (Figure 1.; p = 0.002; MES 0 vs 1 p = 0.004) and UCEIS (p < 0.001; UCEIS 0 vs. 1 p = 0.016) scores were associated with higher rate of clinical flare. Higher baseline MES (p = 0.042) and UCEIS (p = 0.008) scores were coupled with increased risk of hospitalization. Colectomy rates were low. Increased baseline UCEIS (p = 0.003), but not MES score was coupled with new biological treatment initiation, while only UCEIS score was associated with biological treatment intensification (>4; p = 0.008).

Conclusion

Our study suggests differentiating between complete MH from MES 1 as long-term outcomes were more favorable in case of lower endoscopic scores. Consequently, targeting complete MH should be considered to achieve deep remission and disease clearance.
P357 Automated assessment of histological disease activity in Ulcerative Colitis using a deep learning algorithm
Authors: Kohli K , Khan A , Müller F , Cathomas G , Lugli A , Zlobec I , Mookhoek A
Published: January 2024

Background

Assessment of histological disease activity in patients with ulcerative colitis (UC) is becoming more important. Therefore, the DCA score was developed for use in clinical practice. Distribution (D), chronicity (C) and activity (A) are each scored on a three-point scale with distribution being dependent on the percentage of biopsy area affected by inflammatory changes. A major problem for implementation of any score is interobserver heterogeneity. To overcome this hurdle, we developed a deep learning algorithm to automatically compute the DCA score.

Methods

A retrospective cohort was created consisting of 117 adult patients with ulcerative colitis from which biopsies were taken during a colonoscopy performed in the setting of routine clinical evaluation (training set of 537 slides). From 75 cohort patients, an additional set of biopsies was available (test set of 299 slides). An expert gastrointestinal pathologist performed the DCA score. The model was trained on H&E-stained whole slide images scanned at 40x (0.243-μm pixel) resolution. Training was performed in a weakly supervised multiple-instance learning setup, using slide-level labels without region of interest annotations. The features from the convolutional neural network-based model trained at 2.5x, 5x, and 10x magnification were incorporated using a random forest classifier for final prediction. Model accuracy was evaluated using the test set.

Results

The algorithm differentiates between normal and inflamed with an accuracy of 90.9% (Table 1). Model performance from features aggregated across all magnification levels (i.e., 2.5x, 5x, and 10x) was superior to features from individual levels. This can be explained with the help of GradCam heatmaps (Figure 1), where we show that features learned at different magnification levels correspond to different aspects of histological changes in UC. The multiple instance approach did not appear to detect crypt abscesses, which may have resulted in a relatively poor performance in differentiating A1 from A2. The model accuracy for the 9-class DCA was 64.8%.

Conclusion

The algorithm first appears to assess architectural distortions at lower magnification and then the presence of cellular elements like neutrophils at higher magnification. This closely mirrors the approach of pathologists. The present model automates the scoring process and by supporting the daily diagnostic practice highlights the potential of deep learning technologies in assessment of histological disease activity in UC.
P361 Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet’s disease
Authors: Hyun H K , Park J , Park S J , Park J J , Kim T I , Kim W H , Lee J S , Lee H W , Kim B K , Park J Y , Kim D Y , Ahn S H , Kim S U , Cheon J H
Published: January 2024

Background

Behçet’s disease (BD) and nonalcoholic fatty liver disease (NAFLD) are chronic inflammatory diseases that share pathogenetic mechanisms. In this study, we investigated whether NAFLD influences the clinical outcomes in patients with intestinal BD.

Methods

Patients with intestinal BD and available hepatic steatosis index (HSI) and fibrosis-4 (FIB-4) scores were recruited between 2005 and 2022. An HSI of ≥30 and FIB-4 of ≥1.45 were used to diagnose hepatic steatosis and significant liver fibrosis, respectively. The primary outcomes were intestinal BD-related hospitalization, surgery, emergency room visits, or the first use of corticosteroids, immunomodulators, or biologic agents for intestinal BD.

Results

A total of 780 patients with BD were selected. The prevalence of hepatic steatosis and significant liver fibrosis were 72.3% and 8.8%, respectively. Multivariate analysis showed that younger age, prior smoking history, concomitant skin lesions, higher white blood cell count, and lower serum albumin levels were independently associated with an increased risk of clinical relapse (all p <0.05), whereas hepatic steatosis and significant liver fibrosis were not (hazard ratio [HR] = 1.164, 95% confidence interval [CI] 0.923–1.468; p = 0.199 for hepatic steatosis; HR = 0.982, 95% CI 0.672–1.436; p = 0.927 for significant liver fibrosis).

Conclusion

Hepatic steatosis and liver fibrotic burden were not independently associated with clinical outcomes in patients with intestinal BD.
P389 Comparative Evaluation of ChatGPT and Human Specialists in the Application of ECCO Guidelines for the Management of Inflammatory Bowel Diseases and Malignancies: A Proof-of-Concept Study
Authors: Ghersin I , Weisshof R , Koifman E , Bar-Yoseph H , Ben-Hur D , Maza I , Waterman M , Gorelik Y
Published: January 2024

Background

Societal guidelines on colorectal dysplasia screening, surveillance and endoscopic management in inflammatory bowel diseases (IBD) are rather complex, and physician adherence to them is suboptimal.

We aimed to evaluate the use of ChatGPT, a large language model, in generating accurate guideline-based recommendations for colorectal dysplasia screening, surveillance and endoscopic management in IBD in line with European Crohn’s and Colitis Organization (ECCO) guidelines.

Methods

Thirty clinical scenarios in the form of free text regarding colorectal dysplasia in IBD were prepared and presented to ChatGPT and four gastroenterologists, two of them specializing in IBD and two with non-IBD specialties. Two additional IBD specialists subsequently assessed all responses provided by ChatGPT and the four gastroenterologists, judging their accuracy according to ECCO guidelines.

Results

ChatGPT provided accurate recommendations in 90% of cases (27/30), while among the four gastroenterologists the correct response rates were 28/30 (93%), 23/30 (77%), 26/30 (87%), and 25/30 (83%). The latter two represent the correct response rates of the IBD experts.

No statistically significant differences were observed between the accuracy of ChatGPT versus all gastroenterologists (p=0.44), or between the accuracy of ChatGPT versus the IBD experts and non-IBD expert gastroenterologists (p=0.71).

Conclusion

This study highlights the potential of language models in enhancing guideline adherence regarding colorectal dysplasia in IBD. Further investigation of additional resources and prospective evaluation in real-world settings are warranted.
P390 Adiposity is negatively associated with a stenosing Crohn’s disease behaviour: a UK wide study in 8797 patients within the IBD Bioresource
Authors: Ndzo J , Trimble T , Yan K , Figueredo G , Vuyyuru S , Moran G
Published: January 2024

Background

Obesity has been implicated in the pathogenesis of fibrosis. With the rising incidence of Crohn`s Disease (CD) alongside an obesity pandemic, we hypothesise that adiposity may be associated with stenosing CD.

Methods

Using NIHR IBD Bioresource data, we retrospectively assessed the relationship between body mass index (BMI) and stenosing CD by logistic regression. BMI was the primary variable of interest; CD behaviour the dependent variable; stenosing CD the primary outcome. Confounders were adjusted for in a multivariate model. Statistical analyses were performed using SPSS 28.0.1.1.

Results

8,797 patients diagnosed between 1942 and 2020 were included. Mean overall BMI was 26.3kg/m2 (SD = 5.5). 52.7% had a BMI >25kg/m2 (mean 30.2kg/m2, SD 4.5). Majority had inflammatory CD (62.9%) followed by stenosing (25.1%) and penetrating CD (12%). Stenosing and penetrating CD were more common in the <25kg/m2 BMI group (50.7%, 50.3% respectively) p<0.001. On univariate analysis, stenosing disease was positively associated with ileal disease location, disease duration, a surgical history, use of advanced therapies (infliximab, ustekinumab, vedolizumab, adalimumab) and azathioprine but negatively associated with BMI even after adjusting for confounders (OR 0.98, 95% CI [0.967-0.988]). On multivariate analyses, disease duration (OR 1.135, 95% CI [1.135-1.105-1.170]), ileal disease location (OR 3.69, 95% CI [3.22-4.24]), adalimumab (OR 1.47, 95% CI [1.30-1.66]) and ustekinumab (OR 1.512, 95% CI [1.14-2.01]) and azathioprine (OR 1.34, CI [1.189-1.529]) usage remained positively associated with stenosing CD (Table 1).

Conclusion

We observed a negative relationship between BMI and stenosing disease. This might reflect a change in eating behaviour due to persistent abdominal pain related to stenosing disease. Large longitudinal studies are needed to investigate this relationship further.
P392 Behaviour of Childhood-onset Inflammatory Bowel Disease through Adulthood
Authors: Zelinkova Z , Kadleckova B , Cierna I , Podmanicky D
Published: January 2024

Background

The incidence of childhood-onset inflammatory bowel disease (IBD) is rising but the data on the behaviour of the disease during the adulthood are scarce. Therefore, the aim of our study was to determine whether the long-term prognosis of childhood-onset IBD differs from adult onset IBD.

Methods

All IBD patients referred to a terciary IBD centre between April and October 2023 were identified. Previous surgical interventions, biologic use and disease course after transition to adult care were retrieved from medical records. Upper gastrointestinal tract localisation, multiple bowel segments involvement, perianal Crohn`s disease, stenosing and/or penetrating disease behaviour were considered as risk factors for complicated disease course. Differences between childhood- and adult-onset IBD in surgery rates, biologic use, time to surgery and time to biologic were analysed statistically.

Results

In total, 331 IBD patients were included. Childhood-onset IBD patients represented 21% of the cohort (70 out of 331). There were no differences between the two groups concerning the presence of complicated disease course risk factors (for both groups present in 67% of patients).

The proportion of operated patients was significantly higher in the childhood-onset group (63% vs. 45% in childhood- vs. adult-onset group, respectively; p=0,0087). The time to first surgery was significantly longer in the childhood- compared with adult-onset group (8,5 years vs. 4,4 years, respectively; p<0,0001); mean age of first surgery in childhood-onset group was 23 years (range 9 to 39) with the majority (88%) of childhood-onset patients having been operated in their adult years.

Concerning biologics, there was significantly higher proportion of patients on biologics among childhood-onset patients (80% vs. 66% childhood- vs. adult-onset group, respectively; p=0.0205), which was also the case for multiple biologics use (51% vs. 26% childhood- vs. adult-onset group, respectively; p=0.0205). The time to the use of the first biologic was significantly longer among childhood-onset patients (7,5 years vs. 4,9 childhood- vs. adult-onset group, respectively; p=0.0113).

The majority of childhood-onset patients (70%) had ongoing disease activity in adulthood as defined by admission, corticoisteroid use, need for change of biologic or need for surgery.

Conclusion

Despite the similar risk for complicated disease course at diagnosis, there is higher rate of surgery and biologic use among childhood-onset inflammatory bowel disease patients as compared with adult-onset patients. In the majority of childhood-onset patients, first surgery and biologic use is delayed compared to adult-onset population which may contribute to the complicated disease course in their adult years.
P393 The frequency of COVID-19 infection and the impact of vaccination on the disease morbidity in Polish pediatric patients with Inflammatory Bowel Disease
Authors: Derda E , Szymanska E , Meglicka M , wiernicka A , Osiecki M , Kierkus J
Published: January 2024

Background

Little is known about morbidity of Covid-19 infection in pediatric patients with inflammatory bowel diseases (IBD). The aim of this study was to evaluate the frequency of SARS-CoV-2 infection in children with IBD.

Methods

A prospective, observational cohort study to evaluate morbidity of coronavirus disease 2019 (COVID-19) among pediatric patients with IBD. The questionnaire included information concerning numbers of vaccine doses, patients’ medication and disease activity. Disease flare was defined by worsening IBD symptoms and change in IBD medications.

Results

A total of 320 children with IBD, 169 with Crohn’s disease (CD)-52,8%, 150 with ulcerative colitis (UC) - 46,9%, 1 unclassified -0,3%, responded to the questionnaire concerning COVI-19 vaccination. Among the participants 114 (35,6%) patients have suffered from COVID19 (62 CD- 54,4%, 51 UC- 44,7%, 1 unclassified - 0,9%). In 79 cases (69,3%) COVID-19 course was mild, in 31 (27,2%) it was moderate, and 3 (2,6%) children had severe disease. There was no statistically significant difference in morbidity among patients with CD and UC. A total of 127 (39,7%) patients received at least 1 COVID-19 vaccine, and among them 22 (17,3%) children got COVID-19 infection after vaccination. 91 (47.2%) of unvaccinated patients got COVID 19 infection. Following SARS-CoV-2 disease, 22 (19.3%) patients reported exacerbation of IBD during or after COVID 19. In 82 (71.9%) patients COVID-19 infection had no effect on the course of their IBD. Among patients with exacerbation during/after SARS-CoV-2 disease, 3 (13.6%) were vaccinated and 19 (86.4%) of them were not vaccinated.

Conclusion

Based on the outcomes from our questionnaire concerning COVID-19 vaccination state on the large cohort of pediatric patients with IBD, we conclude that unvaccinated patients get sick more often than vaccinated ones, and there is no difference in the frequency of SARS-CoV-2 infection between children with CD and UC. Also, there is no statistically significant difference in the severity of COVID-19 infection between vaccinated and unvaccinated patients. Vaccination against COVID-19 has no effect on the exacerbation of IBD during/after infection.
P399 Impact of Body Mass Index on Clinical Outcomes in Intestinal Behçet’s disease
Authors: Park D , Ji J , Park S J , Park J J , Kim T , Park J , Cheon J
Published: January 2024

Background

The impact of underweight and obesity on clinical outcomes for intestinal Behçet’s disease (BD) is unknown. We aimed to identify the association between body mass index (BMI) and clinical outcomes in patients with intestinal BD.

Methods

We categorized 760 patients with intestinal BD according to the BMI at diagnosis into four groups (underweight, normal, overweight, obese) at Severance Hospital, Seoul, Korea between 1997 and 2021.We performed a Cox proportional hazard analysis to investigate the predictive capability of BMI for clinical outcomes such as biologics use, surgery, hospitalization and emergency room visit.

Results

Of the 760 patients, 130 patients were classified into underweight group (BMI<18.5), 384 patients into normal group (BMI 18.5~22.9), 152 patients into overweight group (BMI 23~24.9), and 94 patients into obese group (BMI≥25). Patients with a higher BMI group showed significantly lower cumulative rates of biologics use (p trend = 0.001), surgery (p trend = 0.008), hospitalization (p trend = 0.002), and emergency room visits (p trend = 0.003) than those with a lower BMI group.

In a multivariate analysis, normal BMI group (HR: 0.667, 95% CI 0.483-0.992, p =0.014), overweight group (HR: 0.589, 95% CI 0.394-0.879,p=0.010), and obese group (HR: 0.515, 95% CI 0.321-0.828, p=0.006) were negatively associated with future hospitalization compared to underweight group. Overweight group (HR: 0.490, 95% CI 0.241-0.996, p =0.049) and obese group (HR: 0.312, 95% CI 0.116-0.840,p =0.021) were negatively associated with future biologics use compared to the underweight group.

Normal BMI group (HR: 0.706, 95% CI 0.484- 1.029, p=0.070) and obese group (HR : 0.556, 95% CI 0.303-1.020,p=0.058) were negatively associated with future surgery compared to the underweight group. Normal BMI group (HR: 0.711, 95% CI 0.513-0.985, p=0.041) and obese group (HR: 0.602, 95% CI 0.376-0.963, p=0.034) were negatively associated with future emergency room visit compared to the underweight group.

Conclusion

Underweight could affect poor outcomes in intestinal Behçet’s disease. Physicians should pay attention to the patients with underweight and make an effort to improve nutritional status.
P405 Intestinal ultrasound measures are highly correlated with small bowel Lewis score among patients with active Crohn’s disease
Authors: Ukashi O , Lahat A , Ungar B , Levy H , Eidler P , Eliakim R , Kopylov U , Carter D , Ben-Horin S , Albshesh A
Published: January 2024

Background

Small-bowel assessment is of prime importance among patients with Crohn’s disease (CD). While small-bowel capsule endoscopy (SBCE) evaluates the extent of mucosal inflammation, intestinal ultrasound (IUS) provides a complementary information with regards to transmural disease involvement. We aimed to examine the correlation between SBCE and IUS, among patients with active CD, as well as sensitivity to therapeutic response during follow-up.

Methods

Patients with active small-bowel CD, who have been started on biologics, were included. Patients were prospectively followed with fecal calprotectin (FC), SBCE and IUS at baseline and after 14 and 52 weeks. Lewis score (LS), Limberg score (LI) and terminal ileum bowel-wall thickness (TIBWT) were documented for each patient. Response to treatment was defined as a 25%-reduction compared to the baseline measure of FC, LS, LI and TIBWT, while FC<150μg/mg, LS<135, LI<2 and TIBWT<3 mm, were defined as biochemical, endoscopic and ultrasonographic remission, respectively (week 0→week 14/ week 14 →week 52). Baseline correlations were obtained using the Spearman's correlation. Comparison between correlations were assessed using the Fisher's Z-transformation. Fisher's exact-test was performed to evaluate the correlation between the examined response/remission outcomes.

Results

Seventy-one patients were included (median age: 26 (22-43) years, male-49%). The median time between SBCE and IUS procedures was 3 (0-25) days. Baseline LS was well correlated with both TIBWT (r=0.6, p<0.001) and LI (r=0.6, p<0.001). Ultrasonographic remission was significantly correlated with both biochemical remission (FC and TIBWT [p=0.012], FC and LI [p=0.024]) and endoscopic remission (LS and TIBWT [p=0.035], LS and LI [0.013]), [Figure 1]. The baseline correlation between FC and LS (r=0.490, p<0.001) was numerically but not significantly higher than FC and BWT (r=0.386, p=0.002) or FC and LI (r=0.224, p=0.080) [p=0.500 and p=0.110, respectively]. No significant correlation was observed between FC and LS /TIBWT/LI response to treatment (p=0.347 p=0.261, p=0.864, respectively), while there was a trend regarding TIBWT and LS response to treatment correlation (p=0.052).

Conclusion

IUS measures are highly correlated with SBCE LS among patients with active CD, and provide an accurate and reliable assessment of disease activity during follow-up. Therefore, IUS may serve as a feasible and noninvasive tool in the monitoring and management of patients with CD.
P408 Complete endoscopic healing, the future therapeutic target in Crohn's disease? Results of a prospective multicenter study
Authors: Yzet C , Brazier F , Derval E , Vaneslander P , Dejour V , Pricope D , Diouf M , Fumery M
Published: January 2024

Background

The STRIDE II guidelines recognize endoscopic healing (EH), defined by an SES-CD score ≤2 or a CDEIS score <3, as one of the main therapeutic targets in Crohn's disease (CD). Nevertheless, complete endoscopic healing could reduce the risk of long-term complications in CD. The aim of this study was to assess the risk of long-term complications in CD according to the degree of endoscopic healing achieved.

Methods

We conducted a prospective multicenter study that included all patients with CD undergoing colonoscopy for EH assessment or dysplasia screening between September 2019 and September 2022 in one university hospital, one general hospital and one private center. Two groups were compared: patients with complete EH (CDEIS = 0) and those with partial EH (CDEIS <4). The primary endpoint was CD relapse, defined as the need for drug intensification and/or initiation of corticosteroid and/or CD-related hospitalization and/or development of a fistula (luminal or perianal) or abscess, and/or the need for bowel resection. Patients were followed up every 6 months for two years. Based on previously published data, 138 patients were expected to demonstrate a 13% difference with a two-sided alpha risk of 5% and a power of 80%.

Results

A total of 133 patients were included. The majority of patients were female (55%), non-smokers (63%), with a median disease duration of 10 (IQR, 4-19) years. Fifty-seven (43%) patients had ileocolonic location and 81 (61%) an inflammatory (B1) behavior. Patients had been on treatment for a median of 18.0 months (IQR 8.6-52) prior to colonoscopy, with no difference between the two groups. There was no significant difference between the two groups apart from BMI. Eighty-four (63%) patients had complete EH. After adjustment for BMI, the risk of relapse was significantly higher in the CDEIS>0 group (23% vs. 41%, HR = 2.05; IC95% = [1.09 - 3.87]; p=0.027). After a median follow-up of 23.3 months, the number of drug intensification, hospitalizations, use of corticosteroids, occurrence of abscess, fistula, or bowel resection in the CDEIS 0 and CDEIS > 0 and <4 groups were 20% and 35% (p=0.065), 2.4 and 16% (p=0.005), 2.4% and 10% (p=0.10), 3.6% and 18% (p=0.009), 7.1% and 18% (p=0.048), 7.1% and 18% (p=0.048) respectively.

Conclusion

This prospective multicenter study confirms that complete endoscopic healing is associated with better long-term outcomes than partial endoscopic healing in patients with CD, as well as fewer surgeries and hospitalizations and an overall decreased risk of treatment failure.
P423 Incidence of Colorectal Cancer among Patients with Ulcerative Colitis in the Middle East: A Systematic Review and Meta-Analysis
Authors: Alshahrani A , Alshahrani Abdulaziz S , Albdrani Turki Ahmad A , Mukhtar Alamri Mariam S
Published: January 2024

Background

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation of the colon. A well-documented long-term complication of UC is an increased risk of developing colorectal cancer (CRC). The Middle Eastern population, with its unique genetic and environmental factors, presents a distinctive context for the investigation of CRC risk in UC patients. This meta-analysis aims to systematically evaluate and synthesize the available data on the incidence of CRC among UC patients in the Middle East

Methods

A comprehensive literature search was conducted, identifying relevant studies from various databases and sources. A total of 12 studies met the inclusion criteria and were subjected to quantitative synthesis. The primary outcome measure was the incidence of CRC among UC patients in the Middle East. A random-effects model was used for data synthesis. Heterogeneity was assessed using the I^2 statistic.

Results

The meta-analysis included a total of 12 studies, comprising 13,881 UC patients in the Middle East. The overall estimated incidence of CRC in this population was 1.41% (95% confidence interval [CI]: 1.32% to 1.50%). Notably, there was substantial heterogeneity across the studies (I² = 100%).

Conclusion

This meta-analysis provides insights into the incidence of CRC among UC patients in the Middle East. The findings underscore the significance of recognizing and addressing the elevated risk of CRC in UC patients, particularly in the context of unique genetic and environmental factors in the Middle East. Further research is needed to refine risk assessment and optimize preventive strategies in this specific population. Ultimately, this study serves as a vital resource for clinicians and researchers seeking to combat the burden of CRC in Middle Eastern UC patients.
P441 Optimization of deep learning architectures for differentiating cytomegalovirus infection in severe ulcerative colitis
Authors: Choe A R , Jeong-Heon K , Ju Ran B , Yehyun P , Eun-Mi S , Rena L , Jin-Sung K , So-Hyun A , Sung-Ae J
Published: January 2024

Background

Cytomegalovirus (CMV) reactivation is common in patients with severe ulcerative colitis (UC). Patients with UC exacerbated by reactivated CMV experience worse prognoses than those without CMV reactivation. However, CMV is primarily diagnosed through biopsies, and it can take quite time to get results, making early diagnosis challenging. To address this, we have conducted research using deep learning to differentiate CMV from severe ulcerative colitis (UC), which has similar features, through endoscopic imaging, enabling early diagnosis of CMV.

Methods

This study leveraged endoscopic imaging to classify CMV and severe UC within a dataset comprising 86 cases from Ewha Womans University hospitals, deploying 7 convolutional neural networks. The training utilized a 4:1 ratio, enhanced by a 5-fold cross-validation, to counter the dataset's constraints. Networks underwent optimization for 10 epochs, a batch size of 10, sigmoid activation, and a learning rate of 1e-4. To improve the performance of the network, we employed augmentation techniques such as random rotations and flipping, and performed brightness standardization and resizing of resolution. Additionally, to distinguish lesions that are difficult to differentiate with RGB values, we converted the images to HSV values to separately process areas of reflected light and ulcerated regions.

Results

Among the total of 7 networks used in this study, Densenet121 showed the best performance with an accuracy of 0.8267 (Precision 0.7979). Densenet201 and MobileNetV2 also demonstrated the next best performances with accuracies of 0.7857 and 0.7143, respectively.The standardization and augmentation performed during the preprocessing process have been confirmed to improve the network's performance, and the network's robustness was verified through 5-fold cross-validation.

Conclusion

The research underscores the potential of deep learning models in differentiating CMV from severe UC through endoscopy images, indicating a promising direction for non-invasive diagnostics and timely treatment interventions.The results of the current study are based on data collected from two institutions, and thus, future research will involve multi-institutional studies to develop and test a more robust network with improved performance.
P457 Small bowel involvement proximal to the terminal ileum is a major risk factor for intestinal resection in patients with small bowel Crohn’s disease
Authors: Oh C K , Kim E H , Lee B I , Oh S N , Lee H H , Kim J S , Cho Y S , Lee K M , Kim S W , Choi H
Published: January 2024

Background

The current Montreal classification categorizes Crohn's disease (CD) with small bowel involvement into two groups: L1 and L3. The study aimed to investigate the significance of small bowel involvement proximal to the terminal ileum as a significant risk factor for intestinal resection.

Methods

We conducted a retrospective review of the medical records of Crohn's disease patients diagnosed between January 2001 and December 2020 at Seoul St. Mary's Hospital, St. Vincent Hospital, and Eunpyeong St. Mary's Hospital. The extent of small bowel involvement was independently assessed by two experienced gastrointestinal radiologists using conventional CT, CT enterography, or MR enterography at the time of diagnosis. The terminal ileum was defined as the distal ileal segment within 10 cm from the ileocecal valve and the jejunum was defined as the proximal 1/2 of the small intestine beyond the ligament of Treitz. Radiologic disease activity and fibrostenosis at the time of diagnosis were also scored as 0, 1, and 2 using Maglinte classification, respectively.

Results

Out of 617 CD patients, 346 were included in the study, while 271 were excluded due to radiologic noninvolvement of the small bowel, inadequate or missing radiologic data, initial diagnosis made at another institution, or diagnosis through surgery. Median age at diagnosis was 24 years (range 10-76) and 250 (72.3%) were male. The median follow-up duration was 53 months (4-201). During the follow-up period, 43 patients (12.4%) underwent intestinal resection. Small bowel involvement proximal to the terminal ileum was significantly associated with a higher cumulative risk of intestinal resection (15.4% vs. 3.5%, P=0.006). Neither jejunal involvement or colonic involvement (L3 vs. L1) showed a significant association with cumulative risk of intestinal resection (16.0% vs. 11.1%, P=0.222; 12.4% vs. 12.4%, P=0.773). Radiologic disease activity and fibrostenotic score at the time of diagnosis were significantly associated with the cumulative risk of intestinal resection, respectively (0% vs. 4.4% vs. 19.7%, P<0.001; 8.5% vs. 16.7% vs. 28.2%, P<0.001).

Conclusion

Small bowel involvement proximal to the terminal ileum was a major risk factor for requiring intestinal resection in patients with small bowel CD, while jejunal involvement was not. These findings suggest a need for subclassifying small bowel CD.
P468 Relevance of anti-drug antibodies in context of supra-therapeutic anti-TNF concentrations
Authors: Kim J , Walshe M , Borowski K , Milgrom R , Stempak J , Lee S H , Croitoru K , Silverberg M S
Published: January 2024

Background

The low serum concentration of anti-tumor necrosis factor-alpha (anti-TNFα) agents and the presence of anti-drug antibodies are related to poor therapeutic outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the prognosis of patients having both antidrug antibodies and supratherapeutic drug concentrations.

Methods

IBD patients on maintenance infliximab (IFX) or adalimumab (ADA) therapy were prospectively recruited. Serum drug concentrations and antidrug antibodies were measured (Anser, Prometheus). The drug concentrations were classified as subtherapeutic (IFX: <3 µg/mL; ADA: <5 µg/mL), therapeutic (IFX: 3-8 µg/mL; ADA 5-10 µg/mL), and supratherapeutic (IFX > 8 µg/mL; ADA > 10 µg/mL) concentrations regardless of the timing of blood sample collection. We analysed the relationship between i) drug concentrations and ii) the presence and absence of anti-drug antibodies with use of systemic corticosteroids and anti-TNF discontinuation.

Results

Of 172 patients (122 CD [70.9%], 44 UC [25.6%], 3 IBD-U [1.7%], and 3 IBD-pouch [1.7%]), the median age was 32.3 years (range, 24.8-42.5), and the median duration of IBD was 9.7 years (range 5.3-15.6). IFX and ADA were used in 81 (47.1%) and 91 (52.9%) patients, respectively, and concurrent usage of immunomodulators and systemic corticosteroids was observed in 39 (22.7%) and 23 (13.4%) patients, respectively. Supratherapeutic, therapeutic, and subtherapeutic concentrations were observed in 74 (43.0%), 32 (18.6%), and 66 (38.4%), respectively. The patients with antidrug antibodies (n = 79, 45.9%) showed a higher frequency of having subtherapeutic drug concentrations (68.4% vs 12.9%, P < 0.001) compared to those without antibodies, and the presence of antibodies was an independent predictor of discontinuation of anti-TNFα agents (hazard ratio 3.50, 95% confidence interval 1.88-6.51, P < 0.001, Fig. 1A). In subgroup analysis, patients with antidrug antibodies and supratherapeutic drug concentration exhibited a tendency to have improved drug persistence compared to those with subtherapeutic drug concentration, albeit insignificantly (P = 0.099, Fig. 1B). However, the persistence in this group was still poorer than that observed in patients without antibodies (P = 0.003). Finally, neither anti-TNFα concentrations nor the presence of antidrug antibodies were associated with the need for additional systemic corticosteroid use within 6 months.

Conclusion

The presence of antidrug antibodies can predict the discontinuation of anti-TNFα agents despite supratherapeutic drug levels. While supratherapeutic drug concentration may improve the treatment persistence of anti-TNFα agents in patients with anti-drug antibodies, it does not last as long as in those without antibodies.
P474 IBD-Disk : Towards validating the classical Arabic version of the questionnaire ?
Authors: Elleuch N , Kallel H , Limam R , Dahmeni W , Hammami A , Braham A , Ben Slama A , Jaziri H , Ksiaa M
Published: January 2024

Background

The IBD-Disk is a validated 10-question, self-administered visual questionnaire used to assess the inflammatory bowel disease (IBD) related disability. It has been translated into several languages and validated in different populations since its emergence. The aim of our study is to explore the internal consistency and item reliability of the IBD-Disk in its classical Arabic version, and to analyze the strength of correlation between each item and the sum of the scale.

Methods

We conducted a monocentric cross-sectional study including IBD patients. All individuals completed the IBD-Disk questionnaire in classical Arabic. The internal consistency of the IBD-Disk was assessed using Cronbach's alpha between item combinations. A value > 0.70 was considered acceptable, > 0.80 good, and > 0.90 excellent. Cronbach's corrected correlation was assessed using Pearson's correlation coefficient.

Results

We included 166 patients, 53.6% were men and 69.3% had Crohn's disease. Median age was 38 years [30 - 48]. The mean total score was 36.4 ± 21.0. The "Energy", "Emotions" and "Education & work" items had the highest scores (4.9 ± 2.9, 4.7 ± 3.1, and 4.4 ± 3.2 respectively). Including the 10 items of the IBD-Disk scale, a value of 0.913 95% CI [0.893-0.932] was observed for Cronbach's alpha, demonstrating good reliability between the different sub-scores. By performing the removal procedure one by one, Cronbach's alpha varied between 0.902 and 0.915, confirming that all items contribute to the construct. In addition, all items showed a Cronbach corrected correlation between each item and the rest of the scale r > 0.4, p<0.001. Energy showed the highest correlation (r=0.751), and joint pain the lowest (r=0.506) (Table 1). Also, Cronbach's alpha was positive for every pair of IBD-Disk items at the start of the study. The item pairs that showed the best correlation were [Abdominal pain - Regulating defecation], [Energy - Regulating defecation] and [Energy - Sleep]. In contrast, the item pairs that were least interconnected were [Abdominal pain - Joint pain], [Interpersonal interaction - Joint pain] and [Body image - Joint pain] (Table 2).

Conclusion

Our work has demonstrated excellent item homogeneity in the classical Arabic version of the IBD-Disk, and a good correlation between each item and the remaining total score. However, a prospective measurement of the intra-class correlation coefficient of the classical Arabic version will be necessary to assess its reproducibility over time.
P489 Systematic review and meta-analysis of the accuracy of computer-aided diagnosis in identifying endoscopic remission in Ulcerative Colitis
Authors: Gautham A , Kader R
Published: January 2024

Background

Endoscopic remission (ER), the absence of active inflammation during endoscopy, is a key therapeutic target in Ulcerative Colitis (UC). ER is assessed during colonoscopy using standardised scoring systems. However, there remains significant inter-operator variability in assessing ER, for which the application of computer-aided diagnosis (CADx) could be a potential solution. A previous systematic review and meta-analysis on this topic was limited to literature up to June 2022 and did not assess the methodological quality of studies or heterogeneity amongst results. We aimed to update this review.

Methods

Searches were performed on six electronic databases and relevant reference lists up to May 2023. Data was extracted and screened independently by two reviewers. Methodological assessment was performed using the QUADAS-2 tool. An ‘image selection’ domain was added to the tool given the importance of endoscopic image quality in training and testing data on CADx’s accuracy. Meta-analysis was performed using a bivariate model. Heterogeneity was assessed through visual inspection of forest plots and receiver-operating characteristic curves, subgroup analyses and meta-regression. The overall quality of evidence was assessed using GRADE methodology.

Results

17 studies (16 full-text articles and one abstract) were identified. 15 studies adopted a cross-sectional design. All studies used expert endoscopists scoring of ER as the reference standard. The Mayo Endoscopic Score was the most commonly used scoring system (13/17). CADx assessed ER in real-time in one study, but was applied to images and videos obtained from previous endoscopic procedures in all other studies. Inception-v3 was the most common CADx system used (6/17). ‘Patient selection’ was the domain of greatest concern due to a considerable number of studies using images from the same public database and under-reporting participant characteristics. All studies had a low risk of bias (ROB) in the ‘image selection’ domain. One study was deemed overall high ROB, and two were deemed overall unclear ROB. Sensitivity analysis was performed by removing these studies and the abstract, and pooled estimates were obtained from the remaining 13 studies. CADx had a pooled sensitivity of 90.3% and specificity of 94.6% for diagnosing ER. The overall quality of evidence was moderate due to the failure of a significant proportion of studies to report sufficient participant characteristics.

Conclusion

There is moderate quality evidence that CADx has high sensitivity and specificity for diagnosing ER in pre-clinical studies. Further evaluation is required in randomised controlled trials to evaluate its efficacy in real-time and human-computer interactions.
P495 Comparative characteristics of joint damage and entheses of the upper and lower extremities in patients with inflammatory bowel diseases
Authors: Gainullina G , Kirillova E , Odintsova A , Abdulganieva D
Published: January 2024

Background

The aim of study was to compare the incidence of joint damage and entheses of the upper and lower extremities in patients with inflammatory bowel diseases (IBD).

Methods

95 IBD pts were prospectively enrolled into the study: 55 pts with ulcerative colitis and 40 - with Crohn's disease. The average age of pts was 32 (26; 37) years. The average duration of the disease was 48 (12; 96) months. Using ultrasound, each pt was examined 14 joints and 68 enthesis of the upper and lower extremities. The vascularization was detected in the power Doppler mode. The presence of synovitis was established by detecting the proliferation of the synovial membrane and/or effusion in the joint cavity. Inflammatory (enthesis hypoechogenicity, enthesis thickening, presence of vascularity) changes in enthesis were also performed by ultrasound imaging.

Results

According to the results of ultrasound of the joints, synovites were detected in 41 pts (43%), including synovites with vascularization in 29 pts (31%). Synovites were most often detected in the ankle joints - in 28 pts (29%). Synovites with vascularization were most often detected in the elbow joints - in 11 pts (12%), in the wrist joints - in 11 pts (12%), in the knee joints - in 10 pts (11%). When comparing the incidence of lesions of the joints of the upper and lower extremities, it was found that synovites were more often observed in the joints of the lower extremities - in 42 pts (44%) than in the upper extremities - in 33 pts (35%). However, differences did not reach statistical significance (p=0.23).

Enthesites were found in 72 pts (76%), including vascularized enthesites in 35 pts (37%). The most common enthesites were pes anserinus enthesitis in 42 pts (44%) and medial collateral ligament of the knee joint in 37 pts (39%). The most common enthesitis with vascularization was medial collateral ligament of the knee joint - in 24 pts (25%). Comparing the incidence of enthesis lesions of the upper and lower extremities, it was found that enthesites and enthesites with vascularization were significantly more often observed in the lower extremities (p=0.00, p=0.0001, respectively).

Conclusion

Pts with IBD had a higher incidence of lower extremity joint involvement, although the differences did not reach statistical significance. Entheses were significantly more often affected in the lower extremities.