bluuebunny/crossref_metadata_2025_split huggingface dataset:
P438 Histological scores are poor predictors of short-term response to therapy in acute severe ulcerative colitis
Authors: Jena A , Mishra S , Sekar A , Prasad K K , Sachan A , Singh A K , Shah J , Mandavdhare H S , Singh H , Dutta U , Sharma V 
Published: January 2024

Abstract

Background
Although all patients with acute severe ulcerative colitis (ASUC) undergo sigmoidoscopy and biopsy, the predictive value of various histological scores is unclear. We studied the association between histological scoring and the need for second-line rescue therapy and whether these scores predict the response to therapy in ASUC.

Methods
All consecutive patients of ASUC (as per Truelove and Witts criteria) admitted from 1st April 2019 to 31st January 2021 in North India were included. All patients, who underwent sigmoidoscopy and biopsy, underwent histological assessment by two independent pathologists [Simplified Geboes score (SGS), Robarts Histopathology Index (RHI) and Nancy histological index (NHI)]. The primary outcomes were to study the association between histological scores and the need for second-line rescue therapy in index admission and the accuracy of each score in predicting the need for second-line rescue therapy or colectomy at day 28. The secondary outcomes included an association between histological scores and endoscopic Mayo scores with response to corticosteroids on day three as per Oxford criteria.

Results
Eighty-two cases of ASUC (Mean age: 36 years, males 47.5%) were analyzed. Sixteen patients required second-line drug therapy and eight patients required colectomy in index admission. There was no significant association between the need for second-line therapy or colectomy and the baseline histological scores [NHI (p=0.61), SGS (p=0.116) and RHI (p=0.109)]. All three histopathological scores performed poorly to predict the need for second-line treatment or colectomy within 28 days of admission. No significant correlation was found between endoscopic Mayo score and histological scores. There was no significant association between the degree of inflammation on baseline histology and response to steroids (NHI (p=0.796), SGS (p=0.57) and RHI (p=0.941)]. There was a strong positive correlation among the three histological scores in patients of ASUC.

Conclusion
All three scores (SGS, RHI and NHI) performed poorly in predicting the need for second-line treatment or colectomy within 28 days of admission. There is a need for dedicated histopathology scores in the setting of acute severe ulcerative colitis.
P439 Mild Crohn’s disease is characterized by a unique serum metabolomic signature
Authors: Bourgonje A R , Ibing S , Argmann C , Sands B E , Dubinsky M , Jacobsen H A , Larsen L , Jess T , Suarez-Farinas M , Mehandru S , Colombel J F , Ungaro R C 
Published: January 2024

Abstract

Background
Approximately 20-30% of patients with Crohn's disease (CD) experience a mild disease course following initial diagnosis. Balancing the effectiveness and safety of medical treatments is crucial in the management of mild CD. However, the main clinical challenge currently lies in identifying patients likely to maintain this mild disease course, underscoring the urgent need for biomarkers of mild CD. In this study, we therefore aimed to identify potential circulating biomarkers for patients with mild CD leveraging a metabolomics approach.

Methods
Patients with mild CD were retrospectively identified from participants of the Mount Sinai Crohn's and Colitis Registry (MSSCR). Baseline screenings in MSSCR included assessments of the use of biologicals and immunomodulators, history of IBD-related surgeries, and the presence of disease complications (including stricturing, penetrating, and perianal CD). Mild CD was defined as the absence of all these variables at baseline as well as after a 5-year follow-up period. Untargeted serum metabolomic profiling was performed to measure the circulating metabolome of these patients. Multivariable logistic regression analyses, adjusting for age, sex, measurement batch, and smoking behavior, were conducted to identify metabolites associated with mild CD.

Results
In total, 114 patients with CD were characterized in which 1,456 different metabolites were profiled, with 32 patients (28.1%) meeting the criteria for mild CD. The remaining 82 patients (71.9%) partially met criteria for mild CD; these were all biologic-naïve and did not undergo IBD-related surgeries. Multivariable logistic regression revealed 45 distinct metabolites that were significantly associated with the mild CD group (nominal P&lt;0.05). Sphingomyelin compounds and ceramides exhibited the most prominent associations with mild CD (odds ratios [OR] all &gt;2.0), while tryptophan, pantothenate, and salicylate metabolites were also linked to mild CD. Conversely, primary and secondary bile acid metabolites and amino acid derivatives from lysine-, tyrosine-, and proline metabolism were all inversely associated with mild CD.

Conclusion
Mild CD is associated with distinct alterations in metabolic pathways compared to patients with moderate-to-severe CD. Future research should focus on longitudinal assessments of these metabolites for disease monitoring and determining optimal therapeutic strategies for this clinical subgroup.
P440 Myenteric plexitis and active inflammation at surgical margins are high-risk predictors for postoperative clinical recurrence of Crohn’s disease
Authors: Okano S , Abe K , Sonoda A , Iwamoto S , Sako M , Okamoto K , Yamana T , Fukata M 
Published: January 2024

Abstract

Background
Preventing postoperative recurrence is an important issue for clinical management of Crohn’s disease (CD). Identification of practical risk factors and an effective prophylactic treatment strategy has been desired for the prevention of postoperative recurrence. Although some of the clinical risk factors have been applied to select candidates for prophylactic treatments, these attempts have not fully prevented postoperative recurrence. In this study, we investigate the histological features at resected margins which predicted postoperative recurrence, and whether the initiation of prophylactic treatments could prevent postoperative recurrence in these cases.

Methods
We retrospectively reviewed the clinical recurrence rate in CD patients who underwent intestinal resection between January 2019 and December 2021. Clinical recurrence was defined by combination of serological, radiographic, and endoscopic findings or treatment escalation. To assess the histological risk factors for postoperative recurrence, resection margins of the surgical specimens were evaluated for the presence of myenteric plexitis, granulomas, and active inflammation. Each histological feature was evaluated from Grade 0 to 3. We also examined the ability of prophylactic treatments to prevent postoperative recurrence stratified with histological findings related to clinical recurrence rates.

Results
Of the 141 patients included in this study, 61.9% had plexitis (grade 3:Inflammatory cells at myenteric plexus, 10&gt;HPF) at the proximal margin and 13.5% had active inflammation (grade 3: erosion or ulcer) at the distal margin. Log rank test identified the presence of plexitis (Grade3) (HR:1.84, 95%CI [1.05-3.22], p=0.029) at the proximal margin and active inflammation (Grade3) at the distal margin (HR:1.29, 95%CI [1.05-1.58], p=0.012) as possible risks of clinical recurrence (Figure). Multivariate analysis confirmed that the presence of plexitis (Grade3) at the proximal margin (HR 1.82, 95% CI 1.04-3.21, P=0.038) and active inflammation (Grade 3) at the distal margin (HR 2.31, 95% CI 1.18-4.46, P=0.013) were associated with postoperative clinical recurrence. Prophylactic use of immunomodulators (IM) and biologics did not show a significant reduction of clinical recurrence compared to treatment without IM and/or biologics in patient with histological risk factors (Table).

Conclusion
Our results indicate that the presence of plexitis in the proximal margin and active inflammation in the distal margin of the resected intestine are risk factors for postoperative recurrence. In these cases, initiation of prophylactic treatments with biologics and/or IM may not prevent the clinical recurrence.
P442 Renal lithogenic risk in patients with Inflammatory Bowel Diseases correlates with microbiota composition, urinary profile and dietary intake
Authors: Mignini I , Blasi V , Masucci L , De Maio F , Agrillo C , Monzo F R , Laterza L , Scaldaferri F , Napolitano D , Schiavoni E , D' Amato D , De Ninno G , Baroni S , Mele M C , Grassi F , Cintoni M , Garcovich M , Riccardi L , Gasbarrini A , Ferraro P M , Papa A 
Published: January 2024

Abstract

Background
Nephrolithiasis (NL) is a common extra-intestinal complication of inflammatory bowel diseases (IBD), often related to enteric hyperoxaluria. Growing evidence highlights the association between NL and gut microbiota, but no data are available on the urinary microbiota in IBD patients. Our study aims to analyse the relationship between diet, urinary lithogenic profile, and gut and urinary microbiota in patients with IBD.

Methods
We prospectively enrolled consecutive adult patients with IBD. All patients underwent abdominal ultrasound, blood tests and 24h-urine collection for lithogenic profile analysis. Moreover, a nutritional evaluation was performed, and all patients underwent bioimpedance measurement. Urinary and gut microbiota were analysed through 16S rRNA sequencing.

Results
60 patients were enrolled: 32 with Crohn’s disease (CD) and 28 with ulcerative colitis (UC). NL was more frequent in CD than in UC (28% vs 14%). In patients with NL, gut microbiota analysis showed a lower relative abundance of Agathobacter (p&lt;0.05) and a reduction in alpha diversity (p&lt;0.05) [figure 1]. No statistically significant difference was found in urinary microbiota composition comparing patients with the presence or absence of NL. Protein (g/die) and phosphorus (mg/die) dietary intake were significantly associated with oxaluria (mg/L) (p=0.032 and p=0.007, respectively). At the same time, protein and calcium (mg/day) intake were significantly associated with NL (p= 0.018 and p= 0.023, respectively). Oxaluria and calcium oxalate relative saturation ratio (RSRCaOx) were significantly higher in CD compared to UC [Table 1].

Conclusion
Patients with IBD and NL have distinctive gut microbiota features. CD patients showed a higher prevalence of NL and oxaluria levels than UC. In addition, NL occurrence and oxaluria correlated with some nutritional parameters. Further studies are needed to identify patients with IBD at greater risk of NL by connecting the parameters of the gut microbiota, urinary profile and dietary intake to act on modifiable factors aiming to reduce this risk.
P458 Diagnostic accuracy of patency capsule and cross-sectional imaging for capsule endoscopy retention: A systematic review and meta-analysis
Authors: Kim Y E , Kim P H , Yoon H M , Lee J S , Jung A Y , Cho Y A , Oh S H , Kim K M 
Published: January 2024

Abstract

Background
Although small bowel capsule endoscopy (SBCE) has been widely used to evaluate small bowel lesions including Crohn’s disease, there is a risk of capsule retention that can cause obstructive symptoms potentially necessitating surgical treatment. We conducted a systematic review and meta-analysis to evaluate the accuracy of patency capsule (PC) and cross-sectional imaging (CSI) for predicting capsule retention.

Methods
MEDLINE/PubMed, EMBASE, Web of science, and the Cochrane library databases were searched for articles that invested the diagnostic accuracy of PC or CSI for predicting capsule retention up to August 15, 2023. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. Considering that SBCE was generally not performed when capsule retention was suspected on PC, the false-negative rates of PC and CSI were separately analyzed and compared using a single-proportion meta-analysis based on random-effects modeling. Quality assessment of the selected studies was performed using the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results
A total of 22 peer-reviewed articles, including 17 articles for PC (covering 2,234 patients) and 7 articles for CSI (covering 302 patients) were included in this systematic review. The pooled sensitivity and specificity for predicting capsule retention with CSI were 64% [95% confidence interval (CI), 31%–87%] and 85% [95% CI, 62%–95%], respectively. The pooled sensitivity and specificity for predicting capsule retention with PC were 75% [95% CI, 43%–92%] and 94% [95% CI, 90%–96%], respectively (Figure 1, Table 1). Although there was no statistically significant difference in prediction accuracy between PC and CSI on the bivariate random-effects model (P=0.14), the pooled false-negative rate was significantly lower in the PC compared to CSI (2.5% [95% CI, 1.4%–4.7%] vs. 11.0% [95% CI, 5.2%–21.8%]; P=0.003) (Table 1).

Conclusion
Cross-sectional imaging showed good specificity, but showed moderate sensitivity in predicting capsule retention. In contrast, patency capsule showed good sensitivity and excellent specificity, with a significantly lower false-negative rate compared to cross-sectional imaging. Therefore, in patients with clinically suspicious small bowel stenosis, the patency capsule is a more reliable modality for predicting capsule retention.
P459 The prevalence and characteristics of inflammatory bowel disease-related ocular involvement in children
Authors: Ben-Tov A , Achler T , Patalon T , Gazit S , Yanai H , Shulman S , Assa A 
Published: January 2024

Abstract

Background
Ocular manifestations (OM) in patients with inflammatory bowel disease (IBD) are uncommon, particularly in children. We aimed to explore the prevalence, characteristics and risk factors of IBD associated OM in a large epidemiologic cohort-based study.

Methods
A cross-sectional study was performed using the Maccabi Healthcare Services (MHS) database. The eligible population included all patients diagnosed with IBD as children (&lt;18 years) between January 2005 and July 2023. An additional analysis was conducted on patients diagnosed with ocular disease during childhood (&lt;18 years) and IBD during childhood or adulthood.

Results
Out of 2,567 children with IBD (males 55%, Crohn’s disease 64%), 78 (3%) were diagnosed with OM at any time during disease course. In 54 patients (69%), the OM occurred after IBD diagnosis with a median time of 2.6 (0.47-7) years between the two events, whereas in 24 patients (31%) OM preceded IBD diagnosis with a median time of 2.1 (0.6-5.7) years. OM was significantly associated with Crohn’s disease, compared with ulcerative colitis (78.2% vs. 63.6% in the entire cohort; p=0.03). The presence of OM was associated with increased usage of systemic corticosteroids (p&lt;0.001), biologic agents (p=0.04) and longer duration since IBD diagnosis (p=0.04). There were 55 patients with OM during childhood who were ever diagnosed with IBD. In this population OM was also associated with increased usage of systemic corticosteroids (p&lt;0.001) and increased hospitalization rate per year (p=0.048). The annual prevalence of OM increased gradually from 10/1000 patients in 2005 to 22/1000 patients in 2022 (p=0.55).

Conclusion
Ocular involvement in children with IBD is rare and more common in patients with Crohn’s disease with a stable prevalence rate. It is associated with a longer duration of disease, greater usage of systemic corticosteroids and biologic agents and with a higher rate of hospitalizations, potentially representing a more severe disease course.
P478 Fatigue, physical fitness, and physical activity in patients with inflammatory bowel disease
Authors: Demers K , Bongers B C , Jonkers D M A E , Pierik M J , Stassen L P S 
Published: January 2024

Abstract

Background
Fatigue is a common and debilitating symptom in patients with Inflammatory Bowel Disease (IBD) with a great impact on quality of life and work productivity. A better comprehension of the contributing factors to fatigue could potentially pave the way for more targeted and effective strategies for managing fatigue in IBD. Fatigue may be associated with lower levels of physical activity and reduced physical fitness. Yet, the interaction between these factors in IBD, measured with validated tests, is not fully understood. Therefore, this study aimed to investigate the association between fatigue and physical fitness and physical activity in patients with IBD.

Methods
Adult patients with IBD in remission or with mild-to-moderate clinical disease activity with an ASA Physical Status &lt;III were eligible for inclusion. Fatigue was defined as a Checklist Individual Strength-fatigue subscale score ≥35. Patient and clinical characteristics were collected, including age, sex, body mass index, comorbidities, disease duration, disease location and behavior, clinical and biochemical disease activity, smoking status, previous intestinal resection, and medication use. Cardiorespiratory fitness was measured using cardiopulmonary exercise testing to assess the oxygen uptake at peak exercise (VO2peak). Muscular strength (peak torque at 60°/s) and endurance (fatigue rate as percentage decline in peak torque over 30 repetitions at 180°/s) of the knee extensor and flexor muscles were assessed using an isokinetic dynamometer. Objective physical activity data were collected continuously for seven consecutive days utilizing the MOX accelerometer, with activities categorized into sedentary, standing, light (LPA), moderate (MPA), and vigorous physical activity (VPA) levels.

Results
In total, 50 patients were included, with 17 being classified as fatigued. Fatigued patients had significantly higher BMIs, a higher frequency of clinical disease activity, and a higher prevalence of smoking (Table 1). They also exhibited significantly lower VO2peak (mean [±SD] 28.1 [±7.9] vs. 36.0 [±9.8] mL·kg-1·min-1, p=0.007) and higher knee extensor fatigue rate (mean [±SD] 39.0% [±8.8] vs. 31.1% [±10.4], p=0.010) compared to non-fatigued patients. There was no statistical significant difference in physical activity between fatigued and non-fatigued patients.

Conclusion
Although physical activity did not differ between patients with and without fatigue, fatigued patients exhibited lower cardiorespiratory fitness and knee extensor muscular endurance. A larger population is needed to further investigate the influence of patient and disease characteristics on this relationship to work towards more targeted and effective strategies for managing fatigue in patients with IBD.
P483 Fatigue and brain morphology in active and remitted Crohn’s Disease
Authors: Thomann A , Schmitgen M , Szabo K , Ebert M , Reindl W , Wolf C 
Published: January 2024

Abstract

Background
Extraintestinal symptoms like fatigue and psychosocial impairments are highly prevalent in IBD, especially during active phases of the disease. They not only significantly impair patients’ quality of life, but can also alter the disease course. Disturbances of brain-gut-interactions may contribute to these symptoms. The aim of this study was to examine associations between brain structure, inflammatory biomarkers and symptoms of fatigue, depression and anxiety in persons with Crohn’s Disease (CD) in different disease states.

Methods
We prospectively enrolled n=109 participants (n=67 persons with CD, n=42 healthy controls). All participants underwent cranial magnetic resonance imaging at 3Tesla, provided stool samples for analysis of faecal calprotectin and completed questionnaires to assess symptoms of fatigue, depression and anxiety. We analysed differences in grey matter volume (GMV) between patients and controls and associations between regional GMV alterations, neuropsychiatric symptoms and faecal calprotectin.

Results
Symptoms of fatigue, depression and anxiety were increased in patients with CD compared to controls, with the highest scores in active CD (Table 1). Patients exhibited regionally reduced GMV in cortical and subcortical sensorimotor regions, occipitotemporal and medial frontal areas. GMV in some of these regions showed a significant negative association with fatigue, but not with depression or anxiety (Fig. 1a). Subgroup analyses revealed symptom-GMV-associations for fatigue in remitted (Fig. 1b), but not in active CD (Fig. 1c), while fatigue was positively associated with fCal in active (Fig. 1c), but not remitted disease (Fig. 1b).

Conclusion
Our findings support disturbances of brain-gut-interactions in the development extraintestinal symptoms in CD, which may be particularly relevant for fatigue during remitted disease. Reduced GMV in the precentral gyrus and other sensorimotor areas could reflect key contributions to fatigue pathophysiology in CD. A sensorimotor model of fatigue in CD could also pave the way for novel treatment approaches, such as targeted noninvasive brain stimulation. Moreover, differences in gut-brain-disturbances between active and remitted disease with regard to fatigue may indicate the need for differential therapeutic approaches dependent on the disease state.
P486 Chronic kidney disease in inflammatory bowel disease: systematic review and meta-analysis
Authors: Innocenti T , Zadora W , Meijers B , Verstockt B 
Published: January 2024

Abstract

Background
Chronic kidney disease (CKD) is defined by a reduction in kidney function (estimated glomerular filtration rate &lt; 60 mL/min/1.73m2) and/or damage markers that are present for at least three months, regardless of the underlying aetiology. Case reports and cohort studies suggest that inflammatory bowel disease (IBD) is associated with CKD. The extent and magnitude of a potential association between IBD and CKD is currently unknown.

Methods
A comprehensive search was conducted in EMBASE, MEDLINE, Web of Science, the Cochrane database, and SCOPUS. Two separate reviewers were involved in the process of article selection and evaluation. In studies where a comparison between an IBD population and a non-IBD control population was available, odds ratios were calculated to quantify the association. To derive an overall estimate of the effect, the Mantel–Haenszel test was employed, utilising a random effect model. This systematic review was registered with PROSPERO (ID RD42023381927).

Results
Fifty-four articles were included in the review [Table].
Eight articles compared an IBD population with a healthy control population (102.230 total patients with IBD and 762.432 total non-IBD controls) and were included in the meta-analysis, although with high heterogeneity (I2 88%). An increased risk of CKD in the IBD population was observed, with an overall odds ratio of 1.59 (95% CI 1.31-1.93) [Figure].
Importantly, this effect was independent of 5-aminosalicylic acid use. Data on other therapies was sparse, except for known nephrotoxic medication like tacrolimus and cyclosporine. Interestingly, several studies reported a decreasing relative risk with increasing age, potentially reflecting an increased baseline risk in this ageing population.

Conclusion
The existing evidence on CKD in IBD was systematically reviewed, including all human epidemiological studies. An increased CKD prevalence in IBD was found, independent of medication. Hence, we suggest regular measurements of kidney function by determination of baseline serum creatinine for all patients with IBD, irrespective of the therapeutic regimen. For patients having a normal baseline function, we would recommend annual follow-up. A more systematic research approach regarding CKD and IBD is warranted.