bluuebunny/crossref_metadata_2025_split huggingface dataset:
P048 Intestinal inflammation and microbiome diversity are conserved more in consecutive pregnancies among women with inflammatory bowel disease compared to healthy controls
Authors: Agrawal M , Tarassishin L , Rendon A , Hillenbrand C , Debebe A , White S , Eisele C , Hawkins K , Kim E S , Thjømøe A , Mørk E , Chen C L , Kornbluth A , George J , Legnani P , Maser E , Stone J , Dubinsky M , Sabino J , Torres J , Colombel J F , Peter I , Hu J 
Published: May 2021

Abstract

Background
There are increasing data on changes in intestinal inflammation and microbiome diversity during pregnancy in women with inflammatory bowel disease (IBD) with implications towards individual and offspring immune function. However, differences in intestinal inflammation, as measured by fecal calprotectin (FC) and microbial a-diversity, in consecutive pregnancies are not known.

Methods
We prospectively enrolled a cohort of women, 37 with IBD and 39 without IBD, during two consecutive pregnancies, and their offspring. We collected serial stool samples and clinical data, and measured FC and bacterial abundance during each trimester of each pregnancy. We further performed correlation analysis between FC in consecutive pregnancies and between microbial a-diversity in consecutive pregnancies among women with and without IBD.

Results
Compared to healthy controls, IBD pregnancies had significantly lower gestational age at birth and higher frequency of Cesarean section. Mode of delivery, the status of Group B Streptococcus (GBS) infection and GBS infection prophylaxis were significantly associated with the pregnancy order in both IBD and controls (Table). Furthermore, we observed strong correlations of FC (r=0.56, p-value=0.093) and microbial alpha-diversity assessed as operational taxonomic unit (OTU) richness (r=0.88, p=0.0087) between paired consecutive pregnancies in women with IBD, but not in those without IBD (Figure). There were no differences in microbial alpha-diversity using the Shannon and Simpson indices when comparing consecutive pregnancies of women with and without IBD.

Conclusion
In this study, we demonstrate that intestinal inflammation and microbiome diversity are more conserved in consecutive pregnancies of women with IBD compared to healthy controls. These findings may have implications towards understanding the impact of pregnancy on host-microbiome interactions in IBD as well as the potential impact on offspring health.
P069 Artificial intelligence (AI)-filtered Videos for Accelerated Scoring of Colonoscopy Videos in Ulcerative Colitis Clinical Trials
Authors: Gutierrez Becker B , Giuffrida E , Mangia M , Arcadu F , Whitehill V , Guaraglia D , Schwartz M , Sabouni R , Prunotto M , Oh Y , Daperno M 
Published: May 2021

Abstract

Background
Endoscopic assessment is a critical procedure to assess the improvement of mucosa and response to therapy, and therefore a pivotal component of clinical trial endpoints for IBD. Central scoring of endoscopic videos is challenging and time consuming. We evaluated the feasibility of using an Artificial Intelligence (AI) algorithm to automatically produce filtered videos where the non-readable portions of the video are removed, with the aim of accelerating the scoring of endoscopic videos.

Methods
The AI algorithm was based on a Convolutional Neural Network trained to perform a binary classification task. This task consisted of assigning the frames in a colonoscopy video to one of two classes: “readable” or “unreadable.” The algorithm was trained using annotations performed by two data scientists (BG, FA). The criteria to consider a frame “readable” were: i) the colon walls were within the field of view; ii) contrast and sharpness of the frame were sufficient to visually inspect the mucosa, and iii) no presence of artifacts completely obstructing the visibility of the mucosa. The frames were extracted randomly from 351 colonoscopy videos of the etrolizumab EUCALYPTUS (NCT01336465) Phase II ulcerative colitis clinical trial.
Evaluation of the performance of the AI algorithm was performed on colonoscopy videos obtained as part of the etrolizumab HICKORY (NCT02100696) and LAUREL (NCT02165215) Phase III ulcerative colitis clinical trials. Each video was filtered using the AI algorithm, resulting in a shorter video where the sections considered unreadable by the AI algorithm were removed.
Each of three annotators (EG, MM and MD) was randomly assigned an equal number of AI-filtered videos and raw videos. The gastroenterologist was tasked to score temporal segments of the video according to the Mayo Clinic Endoscopic Subscore (MCES). Annotations were performed by means of an online annotation platform (Virgo Surgical Video Solutions, Inc).

Results
We measured the time it took the annotators to score raw and AI-filtered videos. We observed a statistically significant reduction (Mann Whitney U test p-value=0.039) in the median time spent by the annotators scoring raw videos (10.59∓ 0.94 minutes) with respect to the time spent scoring AI-filtered videos (9.51 ∓ 0.92 minutes), with a substantial intra-rater agreement when evaluating highlight and raw videos (Cohen’s kappa 0.92 and 0.55 for experienced and junior gastroenterologists respectively).

Conclusion
Our analysis shows that AI can be used reliably as an assisting tool to automatically remove non-readable time segments from full colonoscopy videos. The use of our proposed algorithm can lead to reduced annotation times in the task of centrally reading colonoscopy videos.
P088 Neurotuberculosis in a patient with Ulcerative Colitis using adalimumab for a long period in Brazil
Authors: Facanali M , Bortolozzo Graciolli Facanali C , Rodrigues Boarini L , Vaz Safatle Ribeiro A , Sobrado C W 
Published: May 2021

Abstract

Background
Immunobiological antibodies to tumor necrosis factor alpha (TNFα), act by decreasing the proinflammatory cytokine TNFα. In this context, patients using these biologicals may develop an immunocompromised state (1). TNFα is important in the activation, differentiation and recruitment of different immune cells, with an important role in the formation and maintenance of granulomas, in response to intracellular organisms (2), such as tuberculosis (TB), whose reports occur, on average, 12 weeks after onset of the biological (1). Neurotuberculosis (NT) is the most severe form of TB (3), being responsible for 5 to 7% of cases of extra-pulmonary involvement (4,5). Its diagnosis being based on suspicious symptoms, biochemical analysis of the cerebrospinal fluid (CSF) and confirmed by the detection of the TB bacillus in the CSF. TB in the central nervous system (CNS) is usually due to the spread of pulmonary infection, and rarely occurs in isolation as in this case we are reporting.

Methods
This study aims to report a case of NT was described in patient with Ulcerative Colitis (UC), 4 years after the start of therapy with biological, and discuss clinical aspects, diagnosis, management and prognosis.

Results
34-year-old woman with UC since the age of 20, using adalimumab for 4 years, presented with progressive headache for 20 days, associated with daily afternoon fever (38⁰C). She denied any contact or familiar with TB. Analysis of CSF revealed TB culture positive. On brain MRI, there were small cortical lesions in the left frontal lobe and two larger lesions, with post-contrast enhancement, in the left temporal lobe and in the right frontal lobe, both measuring about 10 mm (Figure 1). She was in sustained deep remission with adalimumab for 4 years (Figure 2). She has had a chest X-ray and a tuberculin test every year, all of which are negative for TB. The initial management was discontinuing adalimumab, treatment with rifampicin, isoniazid, ethambutol, pyrazinamide and prednisone. The patient showed clinical and neurological improvement. Currently, 12 months after the diagnosis, she is asymptomatic and without neurological sequelae.

Conclusion
The reported case assumes importance because this patient has isolated TB in the CNSDigitar texto without pulmonary involvement who has UC and was using adalimumab. Screening tests for TB can ignore latent infection, especially in patients undergoing immunosuppression (anti-TNF, steroids and HIV). The possibility of TB should always be considered in the presence of fever of unknown origin in patients on anti-TNFα therapy, even for a long period. Early recognition, suspension and appropriate treatment are important steps towards therapeutic success, avoiding neurological sequelae and mortality.
P099 Evaluation of endoscopic mayo score with an artificial intelligence algorithm
Authors: Kani H T , Ergenc I , Polat G , Ozen Alahdab Y , Temizel A , Atug O 
Published: May 2021

Abstract

Background
Multi-layered convolutional neural networks are artificial intelligence (AI) algorithms that allow to process specific datasets. Endoscopic mayo score (EMS) is an endoscopic scoring tool for ulcerative colitis (UC) that is widely using for evaluating the disease activity to make a further treatment plan. EMS is an endoscopist-depended subjective tool that varies according to the physician’s experience. In this study, our aim was to create a high accuracy EMS diagnostic algorithm to minimize endoscopist-depended inconsistency and standardize the patient care.

Methods
We collected the endoscopic images of UC patients between December 2011 and July 2019 from electronic database of our gastroenterology institute. Images with insufficient bowel cleaning, artifact, retroflection images, terminal ileum images and pouch patients were excluded. Two blinded gastroenterologists evaluated and tagged the images according to the EMS. Images with a disagreement were excluded for a further evaluation. AI algorithm was performed with Python by using PyTorch library. The dataset was divided into two (85% was used for training and %15 was used for test). ResNet18 model was also used for training.

Results
A total of 19690 images of 572 patients from 1053 colonoscopies were identified for the study. The mean procedure number was 1.8 per patient and the mean image number was 18.7 for per colonoscopy. Four thousand and six hundred images without any disagreement between two gastroenterologists were included to the analysis. Two thousand eight hundred and thirteen (61.65%) images were tagged as EMS 0, 956 (20.66%) were tagged as EMS 1, 406 (8.77%) were tagged as EMS 2 and 413 (8.92%) were tagged as EMS 3. Accuracy was found 73.16% with a sensitivity of 773.2% and specifity of 92.9% in assessment of all EMS groups (Image 1). Also, the accuracy of severe mucosal disease diagnosis (EMS 0 and 1 vs EMS 2 and 3) was 96.3% with a sensitivity of 98.2% and specifity of 86.5% (Image 2) with a perfect reproductivity (к: 1.00). The performance of the remission diagnosis (EMS 0 vs EMS 1,2 and 3) was done with a 92% accuracy.

Conclusion
This is an ongoing study and the preliminary results of our EMS diagnosis algorithm was promising with a high accuracy. The accuracy and sensitivity would be improved by including more images and improving the algorithm. The use of AI in daily IBD practice can eliminate the subjectivity according to the endoscopist in diagnosis and assessing the disease severity for treatment decision.
P115 Chronic pouchitis and Crohn’s disease of the pouch after ileal pouch-anal anastomosis: incidence and risk factors
Authors: Bresteau C , Amiot A , Kirchgesner J , de’Angelis N , Lefevre J H , Bouhnik Y , Panis Y , Beaugerie L , Allez M , Brouquet A , Carbonnel F , Meyer A 
Published: May 2021

Abstract

Background
Restorative proctocolectomy with ileal-pouch anal-anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) or with inflammatory bowel diseases unclassified (IBDU) who had failed medical treatment or with colon dysplasia. The aim of our study was to assess the incidence and risk factors of chronic pouchitis (CP) and Crohn’s disease of the pouch (CDP).

Methods
We conducted a retrospective study among five tertiary referral hospitals. All patients older than 15 years of age with UC or IBDU who underwent IPAA between January, 2011 and December, 2019, were included. Patients with no ileostomy closure or with a follow-up of less than 2 months after ileostomy closure were excluded. The main outcome was the occurrence of CP or CDP. Patients’ demographic, clinical and endoscopic characteristics were collected from medical records at the time of surgery. We looked for risk factors with multivariable and a least absolute shrinkage and selection operator (LASSO) Cox models.

Results
247 patients were included. The median follow-up was 3.1 years (IQR: 1.1–5.7). The incidence rate of CDP was 7.9% (95%CI: 3.9–11.8) two years after IPAA and 18.3% (95%CI: 11.0–25.0), five years after IPAA. The incidence rate of CP was 7.6% (95%CI: 3.8–11.3) two years after IPAA and 19.5% (95%CI: 12.2–26.2), five years after IPAA. The incidence rate of either CP or CDP was 15.6% (95%CI: 10.2–20.7) two years after IPAA and 35.3% (95%CI: 26.2–43.2), five years after IPAA. In multivariable analysis, diagnosis of IBDU (HR 3.18; 95%CI: 1.77–5.70; p&lt;0.001), age of less than 35 years at surgery (HR 2.03; 95%CI: 1.20–3.43; p=0.008) and extra-intestinal manifestations other than articular and primary sclerosing cholangitis (HR 4.37; 95%CI: 2.12–9.02; p&lt;0.001) were associated with higher incidence of either CP or CDP. The LASSO analysis identified these three prognostic factors and also articular manifestations. In patients with two or more prognostic factors, the 5-year cumulative incidence of CP or CDP, was 65.2% (95%CI: 41.8–79.2). It was 18.6% (95%CI: 7.1–28.6) in patients with none.

Conclusion
Five years after IPAA, approximately one-third of patients had either CP or CDP. Risk factors were IBDU, an age of less than 35 years at surgery, articular manifestations and other extra-intestinal manifestations, excluding primary sclerosing cholangitis. These results suggest that high-risk patients might benefit from scheduled endoscopies of the pouch and/or postoperative medical therapy to limit pouch damages.
P118 External validation of model predicting early-onset surgery in Crohn’s Disease patients
Authors: Yao J , Hu B , Wang H , Zhi M 
Published: May 2021

Abstract

Background
Screening Crohn’s disease (CD) patients with high risk of early-onset surgery is crucial in launching therapeutic strategies. We have already identified disease behavior, smoking, body mass index, C-reactive protein level at diagnosis, previous perianal or intestinal surgery, maximum bowel wall thickness, use of biologics, and exclusive enteral nutrition as independent significant factors associated with 1-year surgery surgeries risk and further established a prognostic model (Fig.1,World J Gastroenterol. 2020;26(5):524–534). We aimed to validate this model using external cohort.

Methods
This retrospective study was conducted from Jan, 1, 2017, to Dec, 31, 2019 in three tertiary referral centers including Sixth Affiliated Hospital of Sun Yat-Sen University, Second Affiliated Hospital of Zhejiang University, and Second Affiliated Hospital of Military Medical University. Data of patients with a confirmed diagnosis of CD were collected through hospital electronic system. The published model was validated with calibration using the Hosmer-Lemeshow goodness-of-fit test, and discrimination was assessed using areas under the curve (AUC).

Results
A total of 756 patients were enrolled in our study with 101 (13.4%) excluded for the sake of incomplete data and loss of follow-up. Of the enrolled patients, 74.8% were male (n = 490) at the mean age of 28.4 ± 11.0 years, with the mean follow-up period of 21.8 ± 8.1 months. An ideal predictive ability of this model was confirmed by receiver operating characteristic curves and AUC as high as 94.5%. Besides, acceptable sensitivity of 69.5% and excellent specificity of 97.0% supported further clinical promotion and application of this model.

Conclusion
This model owns ideal ability to predict 1-year surgery risk in CD patients, which definitely help clinical decision-making and acid therapeutic strategies launching.
P119 There is minimal agreement on the recognition of deep ulcers as seen on endoscopy in patients with Inflammatory Bowel Disease: a national survey
Authors: Chavannes M , Hart L , Afif W , Lakatos P , Bitton A , Bressler B , Bessissow T 
Published: May 2021

Abstract

Background
Deep ulcers have been described as a marker of severe disease phenotype in patients with IBD and play a role in choice or escalation of therapy. However, there is no agreed upon characterization of deep ulcers in the literature. We therefore assessed Canadian gastroenterologists’ ability to identify the presence of deep ulcers on endoscopic images.

Methods
We present a post-hoc analysis of a cross-sectional questionnaire from gastroenterologists across Canada (March-October 2017). Three IBD experts independently rated 20 ileocolonoscopy images of single bowel segments. They described the images by selecting descriptors from a list developed a priori. Images described by all 3 experts as having “deep ulcers” were retained for analysis (5 images). Survey participants similarly applied descriptors from the same list to each endoscopy image. We examined the percent agreement between the gastroenterologists and the experts. The percent agreement for each question was summarized using median and IQR. Difference in median scores in physician subgroups was determined using the Mann-Whitney U test. We also assessed the inter-observer agreement on the presence of deep ulcers amongst gastroenterologists using Fleiss Kappa.

Results
131 gastroenterologists participated in the study. The majority (55.7%) were between 36–50 years old. 48% were in practice for less than 10 years. 59.5% practiced in an academic setting. 9.9% of responders were pediatric gastroenterologists. The median agreement between the gastroenterologists and the experts was 30.5% (30.5–76.3), indicating an under-recognition of deep ulcers. As a group, inter-observer agreement on the presence of deep ulcers was minimal (k = 0.39, CI: 0.16–0.65). Inter-observer agreement was lower in the academic setting than the community setting (k= 0.39 vs k= 0.49 respectively) and was fairly similar in those with more experience compared to those with less experience (k= 0.40 for less than 10 years in practice, vs k= 0.36 for those with greater than 10 years in practice). Compared to the experts’ responses, there was no significant difference if the physician practiced in an academic vs community setting (49.24% correct identification vs 54.52%, p = 0.6004) or if the physician had less than 10 years’ experience vs greater than 10 years’ experience (48.26% vs 53.44%, p =0.2948).

Conclusion
Deep ulcers have been described as a critical indicator of disease severity in patients with IBD. However, our study shows that there is poor agreement between physicians in identifying this important feature. This indicates the need for a standardized definition of deep ulcers to prevent undertreatment of patients who require escalated therapy.
P143 Depression and anxiety symptoms among patients with early inflammatory bowel disease during and after COVID-19 lockdown
Authors: Sempere Robles L , Bernabeu P , Cameo J , Gutiérrez A , García G , García M F , Aguas M , Zapater P , Ruiz-Cantero M T , van-der Hofstadt C 
Published: May 2021

Abstract

Background
Patients with inflammatory bowel disease (IBD) are vulnerable to some psychological disorders. Here we describe the psychological impact of a COVID-19 pandemic lockdown in patients with IBD.

Methods
This multicenter prospective cohort study included 145 patients recently diagnosed with IBD. Data on clinical and demographic characteristics, anxiety and depression (Hospital Anxiety and Depression Scale), and IBD activity (the Modified Harvey Bradshaw Index for CD and Simple Clinical Colitis Activity Index for CU) were collected in two telephone surveys, during and after the first COVID-19 lockdown in Spain. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results
During lockdown, 33.1% and 24.1% scored high on the anxiety and depression scales, respectively. Independent factors related to anxiety (all values ORs; 95% CIs) during lockdown were female sex (2; 1.2–5.4) and IBD activity (4.3; 1.8–10.4). Factors related to depression were comorbidity (3.3; 1.1–9.8), IBD activity (6; 1.9–18.1), use of biologics (2.9; 1.1–7.6), and living alone or with one person (3.1; 1.2–8.2). After lockdown, anxiety and depression symptoms showed significant improvement, with 24.8% and 15.2% having high scores for anxiety and depression, respectively. Factors related to post-lockdown anxiety were female sex (2.5; 1.01–6.3), Crohn’s disease (3.3; 1.3–8.5), and active IBD (4.1; 1.2–13.7). Factors associated with depression were previous history of mood and/or anxiety disorders (6.3; 1.6–24.9), active IBD (7.5; 2.1–26.8), and steroid use (6.4; 1.4–29).

Conclusion
Lockdown during the COVID-19 pandemic had a significant psychological impact in patients with IBD. Disease activity was related to the presence of anxiety and depression symptoms during and after lockdown.
P158 Diagnostic yield of different imaging modalities (VCE, MRE and SBUS) in paediatric Inflammatory Bowel Disease patients
Authors: Kurteva E , Rendo G , Ahmad T , Watson T , Jones K , Gaynor E , Kiparissi F 
Published: May 2021

Abstract

Background
Wireless Video Capsule Endoscopy (VCE), Magnetic resonance enterography (MRE) and Small Bowel ultrasound (SBUS) are well-established diagnostic tools, used in the evaluation of small bowel disease in paediatric inflammatory bowel disease (IBD) patients.The aim of this study was to compare VCE findings with those of MRE and SBUS and evaluate discrepancies between them.

Methods
VCE examinations were conducted in histologically confirmed paediatric IBD patients in a period of 19 months (March 2018 – November 2019) in a tertiary center. The VCE findings were retrospectively compared to relevant findings on MRE and SBUS, collected from electronic data records.

Results
34 patients were included in the study (16 males,18 females) with an age range at the moment of diagnostic assessment between 4–17 years (median 12 years). 21 patients were diagnosed with Crohn disease (CD), 9 patients with Ulcerative Colitis (UC) and 4 patients with IBD Unclassified (IBD-U). 8/34 (23.5%) patients were found to have all three diagnostic investigations, 21/34 (61.8%) had MRE and 21/34 (61.8%) had SBUS. Concordance between the three modalities were seen in 5/8 (62.5%) patients. Of these, 3/5 (60%) had no small bowel disease identified on VCE, MRE and SBUS, while in 2/5 patients (40%) the same distribution of small bowel disease was identified using all three diagnostic modalities. When comparing VCE to MRE, differing distributions of disease were seen in 10/21 patients (47.6%). 6/10 (60%) had terminal ileitis, 2/10 (20%) had ceacal disease and 3/10 (30%) jejunal disease noted on MRE, but with no disease identified on VCE. 1/10 patient (10%) had a normal MRE but duodenal and proximal jejunal ulceration was reported on VCE. VCE and SBUS had a higher concordance (71.4%) in identifying disease distribution. In 6/21 patients (28.5%) there was a discrepancy in the findings reported on SBUS when compared to VCE.Of these, 4/6 (66.7%) had a normal SBUS but small bowel disease (jejunal and ileal disease) on VCE.1/6 patient (16.7%) had caecal inflammation and 1/6 (16.7%) had active terminal ileitis on SBUS, which was not reported on their VCE.

Conclusion
The identification of small bowel disease is essential in the diagnosis and subsequent management of paediatric IBD. VCE, MRE and SBUS are established modalities to detect intestinal disease. This study demonstrates that performing all three diagnostic modalities may have important practical significance and increase diagnostic yield in detecting small bowel inflammatory bowel disease.