bluuebunny/crossref_metadata_2025_split huggingface dataset:
P255 Association of penetrating disease and hypoalbuminemia with Crohn's disease anastomotic recurrence in the biological era: results of a long-term experience from a tertiary IBD center
Authors: Cardelli S , Gerti D , Calini G , Amato A , Sissa L , Serafini L , Rizzello F , Gionchetti P , Poggioli G , Rottoli M 
Published: January 2024

Abstract

Background
Crohn's disease (CD) anastomotic recurrence remains a clinical challenge with significant consequences. Its relationship with perioperative factors is controversial. This study investigates factors associated with surgical and endoscopic recurrence in a large historical cohort during the biological era.

Methods
Retrospective series of consecutive patients who underwent primary ileocecal resection for CD and the subsequent follow-up at our institute between 2004 and 2021. Follow-up or surgery for recurrence carried out in other centres were exclusion criteria. Primary outcome: identifying the variables associated with the surgical recurrence defined the need for surgery for the recurrence of disease at the site of the previous anastomosis. Secondary outcome: identifying the variables associated with the endoscopic recurrence, according to Rutgeert's score. Univariate comparisons and multivariable Cox regression survival analyses were performed accordingly.

Results
Out of 417 patients followed in our centre with a median follow-up time of 85 months (IQR 47-114), 170 presented with an endoscopic recurrence after a median time of 46 months (IQR 13-79). Surgical recurrence was observed in 65 patients at a median time of 85 months (IQR 47-114). The five-year surgical and endoscopic recurrence-free survival rates were 92.7% and 68%, respectively, while the 10-year surgical and endoscopic recurrence-free survival rates were 78% and 47%, respectively (Figure 1).
At the multivariate Cox regression, the risk of endoscopic recurrence was significantly associated with male gender (HR 1.47, 95%CI 1.03–2.09, p=0.03) and current smoking (HR 1.47,95%CI 1.03–2.09, p=0.03). Penetrating disease behavior was significantly associated with a lower risk of both endoscopic (HR 0.71, 95%CI 0.5–0.99, p=0.04) and surgical recurrence (HR 0.44, 95%CI 0.25–0.8, p=0.007), as well as the albumin levels at the time of primary surgery (HR for endoscopic recurrence: 0.7, 95%CI 0.52 –0.92, p=0.01; HR for surgical recurrence 0.6, 95%CI 0.36–0.96, p=0.03) (Table 1).

Conclusion
The role of penetrating disease as a risk factor for recurrence should be reassessed in the biological era. Hypoalbuminemia could represent a useful indicator in the stratification of patients at high risk of recurrence.
P257 Clinical characteristics and outcome of Hirschsprung's disease-associated inflammatory bowel disease: experience from 33 years of practice in a single institution
Authors: Gang S , Kwon H , Park J , Kim D Y 
Published: January 2024

Abstract

Background
Hirschsprung-associated Inflammatory Bowel Disease (H-IBD) is a very rare condition, occurring in approximately 2% of individuals with Hirschsprung's disease. The etiology remains unclear. In a recent study by Wang et al., nine genes were identified as consistently overexpressed in patients with both Crohn's disease and Hirschsprung's disease. Notably, all of them possess proinflammatory properties (IL1B, IL10, CXCL10, ICAM1, EGR1, FCGR3A, S100A12, S100A9, and FPR1). This suggests that chronic inflammation in HD patients may be involved in the progression to IBD. However, due to its low prevalence, there is currently a lack of knowledge about its course and response to treatment. In this study, we aimed to describe our initial experience with H-IBD by analyzing 378 patients operated on for HD at our institution.

Methods
We retrospectively reviewed all patients who underwent operation for HD from January 1989 to December 2021 in a single institution. Of 378 patients, 13 patients were suspected of H-IBD. The diagnosis of H-IBD was based on the criteria described in Sutthatarn et al. We analyzed patient characteristics and outcome.

Results
Of the 13 patients, 8 (61.5%) were boys. All patients had a final diagnosis of total colonic aganglonosis (TCA, long segment HD). One patient was accompanied by an imperforate anus and this patient got colonic segmental resection. Duhamel was performed in 4 patients, endorectal pull-through in 5 patients, and Swenson in 1 patient. Seven patients underwent a re-do pull-through operation. H-IBD was diagnosed by bloody stools in 4 patients, diarrhea in 5 patients, repeated Hirschsprung-associated enterocolitis (HAEC) in 3 patients and iron-deficiency anemia in 1 patient. Seven patients started treatment, and all but one with recurrent flare-ups improved. Immunologics were used in 2 patients, and the remaining patients were maintained with steroids, mesalazine, and antibiotics. Additional surgeries for H-IBD were not performed in all patients.

Conclusion
In our experience, H-IBD was diagnosed in 13 of the 46 children operated on with TCA. (28.3%) Progression to H-IBD should be suspected in patients with recurrent postoperative HAECs and poor response to antibiotic therapy. In addition, in patients older than 5 years of age who require stoma formation due to diarrhea or hematochezia, it may be helpful to screen for the possibility of H-IBD and initiate appropriate therapy.
P261 Co-infection of Clostridioides Difficile Aggravates Poor Outcomes in Inflammatory Bowel Disease with Cytomegalovirus Colitis
Authors: Hsieh C R , Le P H , Yeh P J , Chiu C T , Chiu C H 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) prognosis is adversely affected by both Cytomegalovirus (CMV) colitis and Clostridioides Difficile (CD) infection. This is the first study in Asia to investigate the clinical impact and risk factors associated with their co-infection in IBD patients.

Methods
We conducted a retrospective cohort study at Linkou Chang Gung Memorial Hospital from January 2000 to May 2021, involving 53 IBD patients diagnosed with CMV colitis through colonic CMV immunohistochemistry staining. Based on stool toxin A/B tests, patients were divided into two groups: CMV only and CMV+CD co-infection. We compared baseline characteristics, clinical manifestations, risk factors, and outcomes between these groups. Logistic regression was used to analyze independent risk factors, and Kaplan-Meier methods evaluated cumulative incidence of remission rates.

Results
The study included 53 patients (37 in the CMV group and 16 in the Co-infection group). Diarrhea (93.8%) and abdominal pain (87.5%) were more prevalent in the co-infection group. Compared to the CMV group, the co-infection group had higher hospitalization times (2.5 vs. 1, p=0.005), more frequent CMV recurrences (1 vs. 0, p&lt;0.001), and longer durations to achieve clinical (5 vs. 1 months, p&lt;0.001), steroid-free (10 vs. 4 months, p=0.001), endoscopic (17.5 vs. 8.3 months, p=0.011), and histological remission (18 vs. 11 months, p=0.021) (Table 1-1). Kaplan-Meier analysis also indicated similar trends in Figure 1. The use of biologics was identified as an independent risk factor for co-infection (Odds Ratio 13.33, Confidence Interval 1.52-117.15, P=0.02) (Table 1-2).

Conclusion
Co-infection with CMV and CD in IBD patients leads to significantly worse outcomes. Early identification and aggressive treatment of co-infection in high-risk patients are vital for improving their prognosis.
P267 Prospective validation of the IBD - Distribution, Chronicity, Activity (DCA) histological score for Ulcerative Colitis and correlation with UCEIS and MES
Authors: Egong D , Hanly M , McGrath E , Cotter M B , Cullen G , Sheridan J , Doherty G , Sheahan K 
Published: January 2024

Abstract

Background
Histological assessment is not currently recognised as an independent parameter to guide personalised treatment for patients with ulcerative colitis (UC). The development of the Inflammatory Bowel Disease – Distribution, Chronicity, Activity (IBD-DCA) score allows a pragmatic approach to quantitatively evaluate mucosal injury and healing in UC, compared with other pre-existing histological scores (Lang-Schwarz et al., J Crohns Colitis, 2021). This scoring system facilitates a template-based reporting to produce consistent reports with information representing UC severity. Each domain of the IBD-DCA is scored as one of 0 (normal), 1 (mild), or 2 (moderate to severe) based on the presence of established histological UC findings (Figure 1). This project aims to prospectively validate the IBD-DCA score for routine clinical deployment and correlate with endoscopic scores – UC Endoscopic Index of Severity (UCEIS) and Mayo Endoscopic Score (MES).

Methods
Colonoscopic biopsies from patients with a previously confirmed diagnosis of UC attending one of four hospitals in a single healthcare group from August 2022 to January 2023 were reported using the IBD-DCA histological score, and the corresponding, clinician-reported UCEIS and MES scores were recorded. The histopathology reports were assessed based on the completeness of information in their respective D, C, and A domains. The proportion of reports with information fully represented by the IBD-DCA reporting template and the distribution of biopsy sites were described. The correlation between IBD-DCA with UCEIS and MES was quantified via Kendall’s tau (τ) using the R statistical package v4.3.2.

Results
Of the 151 cases reported, 70 (46.4%) patients were female and 81 (53.6%) were male. 12 patients (7.9%) had full colonic biopsies, while the remaining cases were assessed with selective biopsies. Rectal biopsy was most often performed (83.4%). The IBD-DCA components were reported for every biopsied sites in 133 (88.1%) cases. Notable correlations included UCEIS vascular pattern with histological chronicity (τ = 0.3891), UCEIS erosions/ulceration with histological activity (τ = 0.3252), and histological activity with the total UCEIS score (τ = 0.3450). MES showed the strongest correlation with histological disease distribution (τ = 0.3450)(Table 1). All p-values &lt; 0.001.

Conclusion
These data show encouraging uptake of this simple histological reporting template in UC in daily routine use. The findings suggest that the IBD-DCA score may be a useful addition in the clinical management in patients with UC.
P277 Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn’s disease
Authors: Bak M , Hammoudi N , Allez M , Silverberg M , Schellekens I , Erler N , Dijkstra G , Romberg-Camps M , de Boer N , Jansen S , van der Marel S , Horjus C , Goetgebuer R , van Dop W , Hoekstra J , Bodelier A , Molendijk I , Derikx L , van Schaik F , West R , Duijvestein M , van der Woude J , van Ruler O , de Vries A 
Published: January 2024

Abstract

Background
The modified Rutgeerts’ score (mRS) is widely used for the assessment of endoscopic postoperative recurrence (ePOR) in Crohn’s disease (CD) after ileocolic resection to guide therapeutic decisions. To improve the validity and prognostic value of this endoscopic assessment, two new scores have been proposed. This study assessed the interobserver agreement of the current (mRS) and new endoscopic scores for ePOR in CD.

Methods
Sixteen academic and non-academic IBD specialists assessed endoscopic videos (n=71) of postoperative CD patients (n=66) retrieved from nine Dutch centers. Each video was assessed for the degree of inflammation by four gastroenterologists using the mRS, REMIND score (separate score of anastomosis and neoterminal ileum) and anatomic score (separate score of lesions at the anastomotic line, ileal body, ileal inlet, neoterminal ileum, colonic and/or ileal blind loop). Interobserver agreement was assessed using Fleiss’ weighted kappa.

Results
Fleiss’ weighted kappa for the mRS was 0.67 (95% confidence interval [CI] 0.59–0.74). The weighted kappa for the REMIND score was 0.73 (95% CI 0.65–0.80) for lesions in the neoterminal ileum and 0.46 (95% CI 0.35–0.58) for anastomotic lesions. In the anatomic score, the weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, colonic and ileal blind loop was 0.61 (95% CI 0.49–0.73), 0.63 (95% CI 0.54–0.72), 0.61 (95% CI 0.49–0.74), 0.83 (95% CI 0.62–1.00) and 0.68 (95% CI 0.46–0.89), and 0.44 (95% CI 0.32–0.55) for lesions at the anastomotic line.

Conclusion
The interobserver agreement of the mRS is substantial. Similarly, the interobserver agreement is substantial for lesions in the neoterminal ileum according to both the REMIND and anatomic score, whereas only moderate for anastomotic lesions. Since therapeutic decisions in clinical practice are based on these assessments and these scores are used as outcome measure in clinical studies, further improvement of agreement is essential.
P285 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: European and US Patient and Health Care Professional Perspectives on the Broad Impact of Bowel Urgency in Ulcerative colitis
Authors: Travis S , Potts Bleakman A , Panni T , Schreiber S , Dubinsky M , Panaccione R , Hibi T , Kayhan C , Hunter Gibble T , Flynn E , Atkinson C , Rubin D T 
Published: January 2024

Abstract

Background
Bowel urgency (BU) affects quality of life and psychosocial function of patients with moderate-to-severe ulcerative colitis (UC). This study used data from the Communicating Needs and Features of IBD Experiences (CONFIDE) survey to explore the patient and health care professional (HCP) perceptions on the broad impact of BU on patients’ emotions and daily lives.

Methods
Online, quantitative, cross-sectional surveys were conducted among patients with moderate-to-severe UC and HCPs in Europe (France, Germany, Italy, Spain, UK), the United States (US) and Japan. Data from Europe and US are presented here. A 7-point scale was used to rate the emotional impact of BU (Patients: 1=does not make me feel like this at all, 7=makes me feel like this a great deal; HCPs: 1=patients do not experience at all, 7=patients experience a great deal) and interference of BU with 12 different aspects of patients’ daily lives (Patients: 1=does not interfere, 7=interferes a great deal; HCPs: 1=no impact on patients and 7=impacts patients a great deal).

Results
Surveys were completed by 556 patients and 503 HCPs in Europe and 200 patients and 200 HCPs in the US. Among patients experiencing BU in the past month (Europe:30%, US:47%), most reported emotional impacts due to BU (mean rating [MR]≥4.1), as did the HCPs (MR≥5.2). In Europe, patients felt embarrassed when having to run to the bathroom due to BU (MR=5.0); HCPs reported that patients felt anxious/nervous due to BU as well as panic and embarrassment when having to run to bathroom due to BU (MR=5.8 each; Figure). In the US, similar to patients (MR=4.8), HCPs (MR=5.8) perceived their patients felt anxious/nervous due to BU.
Impacts of BU on daily life were reported by patients (MR≥4.2) and HCPs (MR≥4.6). In Europe, patients reported a high impact on spontaneous activities (MR=5.1); HCPs reported a high impact on patients’ ability to travel (MR=5.8; Table). In the US, patients reported a high impact of BU on the choice (variety) and quantity of food/drinks (MR=5.2 each); HCPs perceived a high impact on patients’ spontaneous activities and ability to travel (MR=5.7 each). While most HCPs (Europe:58%, US:54%) ranked BU among top five most impactful symptoms, it was not among the top three most impactful symptoms on treatment decisions.

Conclusion
In both Europe and US, BU affected patients emotionally and limited their ability to travel and make spontaneous plans. Despite the broad impact of BU from both HCP and patient perspectives, with HCPs perceiving (numerically) a higher impact than patients, it was not among the top three most impactful symptoms on HCPs’ treatment decisions. Increased awareness of BU among HCPs is needed when making treatment decisions for patients with UC.
P288 Fecal leukocyte esterase level can predict endoscopic activity for Inflammatory Bowel Disease patients
Authors: Weng M T , Tsai F P , Tung C C , Wu H Y , Chen Z C , Wei S C 
Published: January 2024

Abstract

Background
The urine leukocyte esterase (LE) strip is widely employed to detect leukocyte presence in human body fluids due to its simplicity, speed, and cost-effectiveness. Our previous study demonstrated that fecal LE (FLE) correlated with fecal calprotectin (FC) which serves as a surrogate marker reflecting disease activity in inflammatory bowel disease (IBD) patients. This study aims to assess the correlation between FLE and endoscopy severity.

Methods
This prospective study included IBD patients at National Taiwan University Hospital from December 2021 to November 2023. FLE and FC in the same stool sample, which was collected within one month of endoscopy, were analyzed. The correlation between FLC, FC, and endoscopic severity scores was assessed using the Pearson method. Active disease in ulcerative colitis (UC) and Crohn's disease (CD) patients was defined as Mayo endoscopic score (MES) ≥ 2 and simple Endoscopic Score for Crohn's Disease (SESCD) ≥ 8, respectively. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and the Area Under the Receiver Operating Characteristic curve (AUROC) were analyzed by using SPSS.

Results
A total of 177 IBD patients (93 with UC, 84 with CD) were included. The correlation between FLE and FC levels was moderately positive (r=0.305, p&lt;0.001). The correlation between FLE and endoscopic severity in UC and CD patients was 0.442 (p&lt;0.001) and 0.293 (p=0.007), respectively. Among UC patients, the area under the receiver operating characteristic curve (AUROC) for predicting MES ≥ 2 by FLE and FC was 0.717 and 0.787 (p=0.241), with an optimal cutoff of 2+ for FLE and 42.5 mg/kg for FC, respectively. At this cutoff point, FLE demonstrated a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for predicting MES ≥ 2 as 52.3%, 81.6%, 71.8%, and 65.6%, respectively. For CD patients, the AUROC for predicting SESCD ≥ 8 by FLE and FC was 0.761 and 0.869 (p=0.203), with an optimal cutoff of 2+ for FLE and 225 mg/kg for FC, respectively. FLE exhibited a sensitivity, specificity, PPV, and NPV of 81.8%, 64.4%, 74.3%, and 95.9% for predicting SESCD ≥8 respectively, at this cutoff.

Conclusion
Our results demonstrated that FLE can predict endoscopic activity, which is a cheaper and widely available monitoring tool, might be an alternative choice to FC for IBD monitoring.
P289 Bowel Stiffness Assessed by Shear-wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients with Crohn’s Disease
Authors: He J , Chen Y , Chen M , Xie X , Mao R 
Published: January 2024

Abstract

Background
There is a lack of reliable predictors of disease behavior progression in patients with Crohn’s disease (CD). Real-time shear-wave elastography (SWE), a novel method for evaluating tissue stiffness, is reportedly helpful in determining the prognosis of liver cirrhosis or breast cancer. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression.

Methods
We retrospectively collected data from CD patients with the non-stenotic non-penetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound with SWE measurement at baseline and were followed up. The endpoint was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. A multivariate Cox regression model was used to explore the association between baseline SWE and subsequent outcome. We also established a multivariate nomogram to predict the risk of disease behavior progression and evaluated its performance with receiver operating characteristic curve and decision curve analysis.

Results
A total of 130 CD patients with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE ≥12.75 kPa was the only independent predictor of disease behavior progression (HR 1.08, 95% CI 1.03-1.12, P=0.001, Fig 1A). A restricted cubic spline with multiple covariates adjusted showed an approximately linear positive correlation between SWE and the risk of disease behavior progression, with a cut-off of 12.75 kPa (Fig 1B).
We further established a multivariate nomogram incorporating SWE and other clinical characteristics to predict the risk of disease behavior progression quantitatively (Fig 1C). Compared to the model composed solely of SWE, the multivariate nomogram showed a higher but less significant performance (0.738 vs. 0.792, p=0.169, Fig 1D). However, the decision curve analysis showed that the model outperformed the single indicator of SWE in predicting endpoint events, especially those occured after 12 months of baseline (Fig 1E).

Conclusion
Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. CD patients with SWE ≥12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases, which warrants timely intervention.
P290 Evaluation of response to chronic and acute stress in patients with Crohn’s disease
Authors: Laoudi E , Papalouka D , Gkizis M , Kokkotis G , Chatzinicolaou M L , Mantzou A , Lyrakos G , Vlachogiannakos I , Papakonstantinou I , Bamias G 
Published: January 2024

Abstract

Background
Impaired response to stress in patients with chronic inflammatory disease, such as rheumatoid arthritis, is associated with decreased cortisol secretion. The aim of this study was the evaluation of response to chronic and acute stress in patients with Crohn’s Disease (CD).

Methods
Data was collected from patients who underwent surgery due to complications of Crohn’s (n=26)(CD group) or due to other indications (n=31) (control group). Patients on corticosteroid treatment during last 3 months and other immunological comorbidities were excluded. Cortisol concentration of the hair (proximal 3cm to the sculp) was measured as an indicative marker of stress taking place the last 3 months (chronic stress). Cortisol concentration in the saliva was measured at day 2 post surgery in a daily fluctuation manner (6 measurements in 24h), as an indicative marker of response to acute stress. The chemiluminescence method was used for cortisol measurements. Cortisol concentrations were correlated with DASS 21 questionnaire (validated Greek version),consisting of 21 questions which correspond to separate measurment scales for stress, anxiety or depression. SPSS was used for statistical analysis.

Results
Hair samples were measured from 17 CD patients and 20 controls. CD patients had significant lower concentrations of hair cortisol (median = 6.375 pgF/mg, IQR = 4.821 - 9.949) compared to control group (median = 9.643 pgF/mg, IQR = 6.602-14.637) (Mann-Whitney U-test P = 0.034). Saliva samples were measured from 21 CD patients and 27 controls. In regards to the post surgical cortisol fluctuation (acute stress), there was no significant difference between the two groups. No significant difference was observed between cortisol concentrations, and questionnaires results.

Conclusion
In CD, as in other immunological diseases, hypothalamic-pituitary–adrenal axis appears to be affected, leading in decreased response to chronic stress. This observation may have important implications for the pathophysiology, prognosis and treatment of CD.