bluuebunny/crossref_metadata_2025_split huggingface dataset:
P372 Barriers and facilitators of the transition from paediatric to adult care in inflammatory bowel disease: A Western Canadian perspective
Authors: Bihari A , Wine E , Seow C H , Goodman K J , Kroeker K 
Published: January 2024

Abstract

Background
Patients diagnosed with inflammatory bowel disease (IBD) in childhood/adolescence face additional challenges compared to those diagnosed in adulthood, including more extensive disease and higher risk of complications. The need to undergo transition from paediatric to adult care is associated with an increase in health care utilization and a decrease in adherence to medical appointments and medications. An effective transition may reduce these negative impacts, but there remains a need to engage the stakeholders involved in transition to identify ways to improve the transition process. This study aims to describe the perspectives of key stakeholders - patients, parents, and health care providers - on barriers and facilitators of a successful transition from paediatric to adult care.

Methods
We conducted a qualitative description study informed by naturalistic inquiry. Patients, parents, and providers from Western Canada were recruited using purposive and snowball sampling for a virtual semi-structured interview. Interviews were recorded, transcribed, and then analyzed by latent content analysis.

Results
We interviewed 17 patients, 13 parents, and 15 providers. Preparedness as a facilitator was the only theme to emerge across all groups. Groups described preparedness as knowing disease history (patients & providers), expectations of adult care (providers), and having a peer support program (parents). A supportive adult care team was identified as a facilitator by patients (n=10) and parents (n=4) who described an adult care team as one with open lines of communication, and one that is welcoming and caring. Additional facilitator themes included patient characteristics (i.e., patients who were mature, organized, and independent), and supportive parents and home environment, where a patient’s self-confidence and ability to advocate for themselves was encouraged. A barrier theme of patient factors was characterized by providers (n=8) and parents (n=4) as patients in denial of their IBD or who had mental health comorbidities. In the theme of hovering parents and family factors, providers (n=12) described parents who were reluctant to transfer disease responsibility to their child, and families with economic and/or personal challenges. Additional barrier themes included the need to navigate a new health care system and travel to clinic.

Conclusion
The results suggest a uniform agreement is necessary amongst stakeholders to ensure the development of resources aimed at preparing patients. Our study found differences in how stakeholder groups characterize the barriers and facilitators of transition. Future research should engage multiple stakeholder groups in designing transition interventions and supports for patients with IBD.
P379 PD-1-positive cells contribute to the diagnosis of Inflammatory Bowel Disease and can aid in predicting response to vedolizumab
Authors: Kim M K , Jo S I , Kim S Y , Lim H , Kang H S , Moon S , Ye B D , Soh J S , Hwang S W 
Published: January 2024

Abstract

Background
Differentiating inflammatory bowel disease (IBD) from other inflammatory diseases is often challenging. Programmed cell death protein-1 (PD-1) is expressed in T cells and is an indicator of their exhaustion. The role of PD-1 expression in diagnosing IBD and predicting the response of biologic agents remains inconclusive.

Methods
In this study, endoscopic biopsy samples of 19 patients diagnosed with IBD and other inflammatory diseases were analysed using multiplexed immunohistochemistry . Other inflammatory diseases comprised five patients with intestinal tuberculosis, and five with intestinal Behçet’s disease. Additionally, a separate prospectively maintained "vedolizumab (VDZ) cohort", established in 12 ulcerative colitis(UC) patients who underwent endoscopic biopsy before VDZ administration was analysed to predict response to VDZ.

Results
In the immunohistochemistry analysis, the cell density of T cell subsets, including helper T cell (Th), cytotoxic T cell (Tc), regulatory T cell (Treg), PD-1+ cell, PD-1+ Th, PD-1+ Tc, and PD-1+ Treg was investigated and compared between IBD and other inflammatory disease. Cell densities of PD-1+ cells (p=0.028), PD-1+ Th (p=0.008), and PD-1+ Treg (p=0.024) were higher in IBD compared with other inflammatory disease.(Figure 1) In addition, the proportion of PD-1+ cells in Th and Treg was higher in the IBD group than in the other inflammatory disease group (median 7% vs. 3%, p=0.008; median 6% vs. 2%, p=0.004, respectively). Comparing within IBD, the cell density of Treg was higher in Crohn’s disease(CD) than in UC (p=0.042), whilst the cell density of Tc was higher in CD than in UC with marginal statistical significance (p=0.066). In the VDZ cohort, patients with a 14-week steroid-free clinical response had higher levels of PD-1+ cells (p=0.026), PD-1+ Th (p=0.026), and PD-1+ Treg (p=0.041) than the no response group.(Table 1)

Conclusion
We explored the relationship between PD-1 expression and IBD using multiplexed immunohistochemistry. We compared IBD and other inflammatory disease in their expression of various immune cells including PD-1+ cells, and found IBD had higher PD-1 expression, as well as higher PD-1+ Th and PD-1+ Treg compared with other inflammatory diseases. In addition, VDZ-responsive patients had higher PD-1 expression. Our study confirmed the difference in PD-1 expression in IBD and other inflammatory diseases and revealed that PD-1 expression could be a predictive marker for VDZ responsiveness.
P396 Bowel ultrasound training in European and Mediterranean Countries: results of a survey
Authors: Costantino A , Af Björkesten C , Vaiano M L , Banai H , Schreiner P , Zignani N , Penagini R 
Published: January 2024

Abstract

Background
Bowel ultrasound (US) is a cost-effective, non-invasive, accurate, and readily available tool for the diagnosis and monitoring of patients with inflammatory bowel disease (IBD). Moreover, it can be an accurate tool in the hands of gastroenterologists for the initial assessment of patients with chronic and acute intestinal disorders -such as abdominal pain and diarrhoea- to rule in and out organic causes.
Currently, it is not known how many European residents in gastroenterology or internal medicine who care for IBD patients have the opportunity to have a bowel US training. Tha aims of our study were to investigate the bowel US training in Europe and the perception of utility of this diagnostic technique.

Methods
The participants of the survey were residents from different Countries who voluntarily chose to take part in one of the two first editions of the bowel US course, one of the optional courses held during the UEG Summer School in Prague (2022 and 2023).
Participants answered an initial test in a digital anonymous questionnaire.

Results
Among the 135 participants in the course, 104 (77%) answered all the questions. Respondents were from 28 European and Mediterranean area Countries.
The majority of respondents (60.6%) were residents in their 3rd and 4th year of specialization (men 58.7%). Among the respondents, 61 (58.7%) stated they had a general abdominal US training period during their residency (62.5% of them reporting &lt;100 exams performed). (Figure 1) It was not offered any bowel US training to 76% of residents. (Figure 2) Among the respondents, the Italian residents showed the highest probability to have a bowel US training (7/13, 53,8%). At a Likert scale, 96.2% stated that bowel US is important for their future profession (Figure 3) and 93.3% stated it is important for treatment decision in gastroenterology. (Figure 4)

Conclusion
Our survey reveals, despite the possible limits given by the response and selection bias, that in Europe bowel US training is deficient and heterogeneous.
Only one every four participants received a bowel US training during their residency, despite bowel US knowledge is considered a necessary skill by approximately 95% of young gastroenterologists who participated in the course. Since less than 2/3 have a US period during their residency (often insufficient), it is likely that most residents interested in bowel US are forced to acquire this skill attending other specific courses during or after their residency.
Solutions may be represented by the implementation of specific courses or with the institution of minimum bowel US training level during the residency.
P400 Experience with the use of intestinal ultrasound and application of the Milan Ultrasound Criteria in Colombian patients with ulcerative colitis
Authors: Parra Izquierdo L V , Vargas M , Frías-Ordoñez J , Ibañez E , Rios S , Orduz G , Florez-Sarmiento C 
Published: January 2024

Abstract

Background
Intestinal ultrasound (IUS) has been reported to be accurate in the diagnosis of ulcerative colitis (UC) and can also be applied to determine the extent of the disease, its severity and location of inflammation, also, is fast, effective, non-invasive, relatively inexpensive, and can be performed in health care centres of varying complexity. The aim of this study is to assess the validity and reproducibility of IUS in patients with UC, and evaluate the Milan Ultrasound Criteria (MUC) as a predictor of activity in UC.

Methods
analytical observational study in adults and paediatric patients with UC with different degrees of activity, and with a need for colonoscopy. Clinical, biochemical, endoscopic, and ultrasonographic variables were collected. Logistic regression analysis was performed. The presence of endoscopically active disease was the outcome (or dependent variable). All IUS parameters described were independent variables. Univariate analysis was used to identify candidate predictors. A significance level of 0.05 was used in all tests.

Results
Thirty-six subjects were included, predominantly male, 75% (27/36) were in endoscopic remission (Mayo score 0 -1), while 25% (9/36) had endoscopic activity (Mayo endoscopic score &gt; 2). Median Colonic wall thickening (CWT) in patients in endoscopic remission (Mayo score 0-1) was 2.4 (IQR 2-2.8) mm compared to 3.1 (IQR 2.15-4.2) mm in patients with endoscopically active disease (Mayo score 2) with no statistically significant difference p=0.148. Colonic wall flow at power doppler (CWF) was present in 22.2 % (6/27) of patients in endoscopic remission compared to 44.4 % (4/9) of patients showing endoscopic activity (p=0.148). Endoscopic activity (p = 0.264). Loss of elasticity and peristalsis was present in 11.1% (3/27) patients in remission compared to 66.6% (6/9) in patients with activity (p=0.003). As for mesenteric fat hypertrophy, it was found in 44.4% (4/9) of patients with activity compared to 14.8% (4/27) in remission (p=0.098). Enlarged mesenteric nodes were found in 22.2% (2/9) patients with activity compared to 14.8% (4/27) in remission (p=0.615). Free fluid was present in 22.2% (2/9) of patients with activity compared to 7.4% (2/27) in remission (p=0.315). The mean value of the MUC score was 4.025 (observer 1 mean 3.85 with S: 77% and E: 70%, observer 2 mean 3.99, with S: 66% and E: 77%). The degree of interobserver agreement was 0.957.

Conclusion
IUS is a useful and effective tool in the evaluation of disease activity in patients with UC, with a MUC measurement of 4.025 suggesting an adequate diagnostic performance of this score, being the best cut-off point to discriminate between activity versus remission.
P419 Proximal Crohn’s disease location is associated with a more benign course of perianal Crohn’s disease (the PERIAPROX study)
Authors: Romero-Mascarell C , Giordano A , Riestra S , Martín-Arranz M D , Ricart E , Gisbert J P , Brunet-Mas E , Rivas Rivas C , Calafat M , Fernández Salgado E , Guardiola J , Gomollón F , Sierra Moros E , Hernández Camba A , Iglesias E , De Prado Á , Martinez-Montiel P , Mesonero F , Varela P , de Castro L , Madero Velázquez L , Lázaro Pérez-Calle J , Esteve M , Rodríguez-Lago I , Bermejo F , Lorente R , Sicilia B , Castro-Poceiro J , Gordillo J , Huguet J M , Ponferrada A , Sierra M , Bujanda L , Marín-Jiménez I , Pascual I , Vera I , Sesé E , Vega P , Domènech E , Garcia-Planella E 
Published: January 2024

Abstract

Background
Proximal Crohn’s disease (CD) location (L4 according to the Montreal Classification) is associated with a more severe course with higher risk of abdominal surgery. However, little is known about the relation with perianal disease. The aim of our study was to investigate the impact of L4 disease location on perianal disease incidence and clinical course.

Methods
A case-control study was conducted in the prospectively maintained ENEIDA database for all CD with and without L4 location between January 2005 and March 2023. Demographic data, disease characteristics, perianal disease diagnosis and evolution according to biologic therapy and surgery requirement were collected. Demographic data, CD characteristics, perianal disease diagnosis and course were analyzed. Cox proportional hazards and Kaplan-Meier methods were used for the analysis of perianal incidence, and biologic and surgery requirement.

Results
A cohort of 14022 CD patients were included in the analysis. The mean follow-up duration was 6.4 years (SD 4.9). L4 location showed a lower prevalence of perianal disease (18.0 vs 19.9%, p=0.018), with lower rate of fistulas (60.9 vs 66.1%, p=0.021) and perianal abscesses (33.5 vs 39.4%, p=0.013). Perianal disease and L4 were associated with male sex (OR 1.29, p&lt;0.001), younger age (43 vs 44), and the structuring phenotype (OR 2.14, p&lt;0.001). L4 location was associated with a lower incidence of perianal disease (HR 0.891, p=0.041), while proctitis was associated with a higher risk (HR=2.161, p&lt;0.001). L4 location was also associated with a lower requirement for biologics (HR 0.712, p=0.023), along with advanced age (HR 0.988, p&lt;0.001). Proctitis (HR 1.292) and a history of perianal surgery (3.373) were associated with a higher requirement for biologics. At univariate analysis, L4 location was associated with a lower requirement of surgery (HR 0.833), however at multivariate analysis this finding was not confirmed (p=0.525). Instead, a history of active smoking (HR 1.419), the use of biologics (HR 2.262), and CD penetrating pattern (HR 1.277) were associated with a higher requirement for perianal surgery.

Conclusion
L4 location is associated with a lower incidence of perianal disease and a more benign course with lower requirement for biologics and surgery.
P428 Nutritional, Muscular status and micronutrient deficiencies in patients with Inflammatory Bowel Disease
Authors: Han J , Song H J , Kim H U , Kang M S , Kang K S 
Published: January 2024

Abstract

Background
Malnutrition and micronutrient deficiencies are common in inflammatory bowel disease (IBD). Nutrient deficiencies increase the morbidity and complications of IBD. The aim of this study was to evaluate the nutritional and muscular status and identify micronutrient deficiencies of patients with IBD receiving treatment.

Methods
A total of 105 patients with IBD were enrolled prospectively in the department of gastroenterology and pediatrics from June 2019 to October 2021. To obtain objective data, iron, ferritin, phosphate, folate, Mg, 25-OH vitamin D, vitamin B12, and Zinc were measured in the patient's serum. In addition, body composition analysis was performed using bioelectrical impedance analysis to gain information regarding muscular status.

Results
There were 51 patients with ulcerative colitis (UC), 54 with Crohn's disease (CD), and the gender ratio (M:F) was 54:51. The average age was 37±18 years, which was significantly lower in patients with CD than UC (28.6±15.9 vs. 45.3±16.3, p&lt;0.001). The mean body mass index (BMI) was 22.0 ± 3.7 kg/m2, lower in patients with CD than UC (21.2 ± 3.8 kg/m2, vs. 22.0 ± 3.3 kg/m2, p=0.030). The disease activity of the patients was 64.8% in remission, with 17.1% mild, 15.2% moderate, and 2.9% severe. In the UC and CD patient groups, skeletal muscle index(SMI) and adjusted skeletal muscle mass were lower in patients with CD compared to UC.(SMI : 35.8±5.5 vs. 32.8±4.7 %, p&lt;0.004, adjusted skeletal muscle : 8.2±1.9 vs. 7.0±1.5 kg/m2, p&lt;0.001) However, there was no difference of SMI and adjusted skeletal muscle according to disease activity in both UC and CD patients (Table 1). Iron was lower in patients with CD compared to UC (63.3 ± 42.5 vs. 82.8 ± 44.0 ug/dL, p=0.024). Ferritin, phosphorus, folic acid, vitamin B12, and zinc were also within normal limits. Magnesium was lower in patients with CD compared to UC (2.08 ± 0.15 vs. 2.15 ± 0.19, p=0.036 mg/dL). Vitamin D levels showed insufficient vitamin D in patients with UC and vitamin D deficiency (below 20 ng/mL) in patients with CD (20.1 ± 10.6 vs. 19.0 ± 9.9 ng/mL, p = 0.567) (Table 2).

Conclusion
Nutritional status of patients with IBD is favorable, and the lack of trace elements, specifically iron, magnesium, and vitamin D, and reduced skeletal muscle mass were observed to be prominent in patients with CD compared to UC.
P445 Wireless capsule endoscopy reading support for Crohn’s disease patients using deep neural networks with an active learning method
Authors: Rouveyre R , Subileau-Langlois T , Gomez T , Mouchère H , Bourreille A , Leberre C 
Published: January 2024

Abstract

Background
Artificial intelligence (AI) systems, in particular neural networks (NN), have been developed to detect lesions in wireless capsule endoscopy (WCE) in patients with Crohn’s disease (CD) in order to ease their reading. Despite acceptable performance on individual images, these tools do not analyze entire videos and require a large amount of labeled data. Active learning (AL) methods have already been used, proving their ability to limit labeling cost without reducing NN performance. The aim of this study was to evaluate several AL models in order to train an AI system able to differentiate normal and pathological entire videos with a limited labeled dataset.

Methods
Firstly, 76 WCEs of CD patients were used to automate the detection of the first and last image of the small bowel. They were identified by an expert and then used for training, validation and test of a NN. The model associated with the Viterbi algorithm predicted boundaries location and was compared with expert annotations.
Secondly, 4286 images from the Crohn-IPI database¹ were used to train another NN to classify pathological or normal images. An image was considered pathological if it contained erythema, oedema, ulceration or stenosis. Four AL models with several selection criteria² were tested on a limited labeled dataset and their classification performance (normal/pathological image) was evaluated.
Finally, 42 WCEs were used to assess performance of a pre-trained AL model to predict the normal or pathological nature of entire videos.

Results
Overall, the model detected the pylorus compared with experts with a median deviation (IQR) of 3 images (66.5) and the last ileal image with a median deviation of 98 images (336). A history of ileocolic resection non-significantly impaired the last ileal image location, with a median difference of 203 images (812, p=0.59).
None of the four AL models showed superiority in classifying pathological or normal image, with a sensitivity of 60% and a specificity of 98%.
Finally, the AL pre-trained NN assessed the pathological/normal status of entire videos with a sensitivity of 83% and a specificity of 50%.

Conclusion
Our study suggests the feasibility and efficiency of NN to identify the first and last image of the small bowel on CD patients WCE. Performances of the four AL models were similar but remained sufficient given the small amount of labeled data used. Prediction of the pathological/normal status of entire videos by AI systems seems feasible, but requires optimization to obtain acceptable results for current practice.
1. De Maissin A et al. Multi-expert annotation of Crohn's disease(...) neural network, Endosc IntOpen(2021)
2. Wang K et al. Cost-Effective Active Learning for Deep Image Classification, IEEE (...) Technology(2017)
P454 Systemic free thiols associate with clinical and biochemical disease activity in Inflammatory Bowel Disease: a prospective diagnostic validation study
Authors: Geertsema S , Holstein H J , Bulthuis M L C , Faber K N , van Goor H , Dijkstra G , Bourgonje A R 
Published: January 2024

Abstract

Background
In the pathophysiology of inflammatory bowel diseases (IBD), oxidative stress plays an important role. Lower levels of plasma free thiols (FT) reflect a higher oxidative stress burden and correlate with IBD disease activity. However, their clinical significance as biomarker for disease activity remains unclear. This study aimed to prospectively validate the utility of plasma FT levels as biomarker for clinical, biochemical, and endoscopic disease activity in patients with IBD.

Methods
In an ongoing prospective diagnostic trial aiming to include 100 IBD patients, we conducted an interim analysis of plasma FT levels in 52 patients with IBD (24 Crohn's disease [CD], 21 ulcerative colitis [UC], and 7 patients with undetermined IBD). Clinical disease activity was quantified by the Harvey-Bradshaw Index (HBI) for CD and Simple Clinical Colitis Activity Index (SCCAI) for UC. Biochemical disease activity was determined by measuring blood C-reactive protein [CRP] and faecal calprotectin [fCal]). Endoscopic disease activity was quantified with the Mayo endoscopic subscore for UC and the Simple Endoscopic Score (SES-CD) for CD. Plasma FT levels were assessed for correlations with disease activity parameters using linear and logistic regressions models. Discriminative capacity of biomarkers was evaluated through calculating receiver operating characteristics (ROC) statistics.

Results
Plasma FT levels were significantly negatively correlated in clinical parameters, like HBI (r = -0.53, p &lt; 0.05) (Fig. 1A). Other inflammatory biomarkers, like CRP, were also negatively correlated with plasma FT levels and were reduced in patients with active IBD (r = -0.43, p &lt; 0.05) (Fig. 1B). Plasma FT levels accurately discriminated between CD patients with clinically quiescent (HBI &lt; 5) and active disease (HBI ≥ 5) (AUC = 0.80, p = 0.02, Fig. 1C), better than fCal (AUC = 0.55, p = 0.83). Plasma FT were not significantly different for biochemically quiescent (CRP &lt; 5 mg/l) and active (CRP ≥ 5mg/l) disease (AUC = 0.69, p = 0.20, Fig. 1D). Both Mayo and SES-CD scores, after adjusting for confounders, also exhibited a trend towards negative association with plasma FT levels (Fig. 1E).
Figure 1

Conclusion
Further completion of the trial will reveal whether systemic FT levels will reflect endoscopically observed disease activity, and this interim analysis shows strong correlations FT levels and parameters of clinically and biochemically active disease. Measuring systemic FTs in IBD may be a promising, minimally invasive strategy to monitor IBD disease activity.

Funding
None