bluuebunny/crossref_metadata_2025_split huggingface dataset:
P281 The role of transabdominal ultrasound in evaluating Ulcerative Colitis disease activity and predicting treatment response
Authors: Peng M , Pu T , Zhao Y 
Published: January 2024

Abstract

Background
As a non-invasive, accurate, and feasible examination, transabdominal ultrasound（TAUS） is of great value in disease monitoring of ulcerative colitis. The cut-off for disease activity of 3.0 or 4.0 mm is often debated， and studies lacked assessment of treatment response. This study aimed to assess the diagnostic accuracy of TAUS in detecting disease activity in adult patients with UC using endoscopy as the reference standard and evaluate TAUS for treatment response in a longitudinal cohort.

Methods
This study prospectively consecutive adult patients with an established diagnosis of UC in the First Affiliated Hospital of Zhengzhou University between June 2022 and September 2023. The patients with moderate-to-severe disease activity at baseline should have follow-up endoscopic assessment after induction, with available corresponding TAUS. The primary outcome of this study was the difference in BWT in the descending colon(DC) or sigmoid colon(SC) for patients with and without segmental endoscopic response after treatment. Endoscopic remission was defined as MES=0-1 or UCEIS=0-1, and Endoscopic response as a decrease of MES ≥1 or a reduction of UCEIS ≥2.

Results
A total of 315 colon segments in 80 patients were included. 171 (54.3%) colorectal segments had endoscopic remission and 144(45.7%) were in endoscopic activity. The TAUS parameters correlated with the Mayo endoscopic sub-score with significant differences between patients in endoscopic remission and patients in endoscopic activity. And we found 3.45mm(AUROC 0.833;95%CI 0.789-0.878， P＜0.001) to be the cutoff for endoscopic remission with 78% sensitivity and 75% specificity. The multivariable analysis identified BWT， the Colour Doppler Signal(CDS), and the wall layer stratification as independent predictors for endoscopic activity（ P＜0.001、=0.004、=0.001）. BWT in the DC or SC was significantly lower in patients with endoscopic response than those without after treatment. A 28% decrease in BWT from baseline predicted endoscopic response [AUROC 0.743;95%CI 0.589-0.896， P=0.015] with 58% sensitivity and 93% specificity. Multivariable analysis among all the ultrasound parameters considered normal wall layer stratification at baseline as the only independent predictor of endoscopic response at reassessment (odds ratio [OR]23.334, 95% CI 2.257-241.219; p = 0.008).

Conclusion
TAUS, importantly BWT, CDS, and wall layer stratification as the crucial parameters, is highly accurate in detecting disease activity and treatment response when evaluated against endoscopic outcomes. Normal intestinal wall stratification at baseline predicts long-term endoscopic response.
P284 Sex-specific aspects in IBD: a multidimensional view
Authors: Püschel L , Alaswad A , Liu Z , Zhou L , Bathon M , Seidler U , Lenzen H , Wedemeyer H , Li Y , Wiestler M 
Published: January 2024

Abstract

Background
Inflammatory bowel diseases (IBD), including Ulcerative colitis (UC) and Crohn's disease (CD), are chronic intestinal disorders characterised by varied intestinal symptoms and a negative impact on the patients` quality of life. Increasing evidence demonstrates sex differences regarding the prevalence, pathophysiology, clinical presentation and treatment outcome of IBD. While for some factors evidence is rather good, for others data are conflicting – thus a deeper understanding of sex related differences in IBD courses is still needed.

Methods
In this monocentric, cross-sectional study 221 IBD patients were stratified into 2 groups according to gender/biological sex (male [n=106]; female [n=113]). We evaluated patients personal and medical data including disease-specific quality of life (IBDQ) as well as clinical (HBI, PMS) and biochemical (CRP, fecal calprotectin) parameters of disease activity. Furthermore, we isolated and stimulated PBMCs with various pathogens to test ex vivo cytokine responses of this heterogeneous IBD cohort.

Results
Binary logistic regression analysis suggested an independent association of diagnostic delay (p= 0.039), IBD entity (p= 0.001), IBDQ (p= 0.001), and vitamin D3-25-OH serum level (p= 0.035) with disease activity for female IBD patients, while for male IBD patients an independent association was only suggested for IBD entity (p= 0.004) and IBDQ (p= 0.001) (figure 1). Next, we tested the association between the number of ADT (Advanced Therapies) taken during the overall course of the disease with both disease activity and diagnostic delay. We found a significant association between ADT and disease activity in both sexes (male-p = 0.015, female-p=0.037), but ADT was only significantly associated with diagnostic delay in female IBD patients (p=0.044) (figure 2). Regarding the frequency of therapies used in both sexes, we found that male patients are more frequently subscribed prednisolone (Mann-Whitney-U, p= 0.009) as well as 5-ASA (p= 0.004) (figure 3). Cytokine responses upon PBMC stimulations with various pathogens showed a significant trend in Interferon gamma levels in male CD patients (p&lt; 0.05) (figure 5A). A significant negative correlation between Interferon gamma levels and CD activity has only been found in male CD patients, but not in female CD patients (figure 5B).

Conclusion
In this analysis of a cross-sectional study, we are able to illustrate sex-specific aspects of not only clinical courses in IBD patients but also within specific immunological responses – highlighting the importance to closely take the IBD patients sex into consideration in the upcoming era of personalized medicine.
P287 Clinical aspects of late-age Onset Inflammatory Bowel Disease
Authors: Ferreira S , Parra R , Otoboni Aprile L R , Féres O , Joaquim Ribeiro da Rocha J , de Almeida Troncon L E 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is a clinical condition affecting mainly young and middle-aged adults. However, a significant proportion of new IBD cases is diagnosed in older individuals, as the incidence of IBD and our population mean age are increasing. Older patients with IBD comprise two groups: those with a new diagnosis of IBD (Late-age onset IBD) and patients with juvenile or adult-onset IBD who have reached an advanced age. Patients with late-age onset IBD represent a significant challenge due to the inherent characteristics of this population, such as polypharmacy, comorbidities, and fragility, as well as the scarcity of specific IBD studies in this age range. We aimed to evaluate clinical aspects and epidemiology of late-age onset IBD patients (&gt;60 years) as compared to patients with IBD diagnosed at earlier ages (&lt;60 years).

Methods
Retrospective analysis of data from 63 patients with late-age onset IBD and 128 younger patients followed in an IBD referral center. Groups of patients including both Crohn’s disease (CD) and ulcerative colitis (UC) were randomized in a 1:2 ratio based on sex, disease location and phenotype, and year of diagnosis, from January 2001 to December 2021. Medical records data comprised disease severity, medical treatments, clinical and endoscopy remission, surgical treatment, comorbidities, and deaths.

Results
A total of 63 old-age onset IBD (57.1% female, 90.5% Caucasians, mean age: 72.00 ± 6.44 years; 52.4% UC) were included. Significantly lower utilization of immunomodulator [CD (36.7% vs. 70.0%; p=0.0020) UC (15.2% vs. 45.6%; p =0.003] and biological agents [CD (50.0% vs. 75.0%; p=0.020) UC (12.1% vs. 33.8%; p =0.003] was observed in old-age onset IBD patients. Higher disease severity was observed in patients with CD diagnosed at younger ages (90.0% vs. 66.7%; p=0.006). Higher frequency of comorbidities (92.06% vs. 31.25%; p&lt;0.0001) and deaths (7.9 % vs. 0.7%; p=0.0015) were observed in old-age onset IBD patients. No significant differences were observed concerning clinical and endoscopy remission, use of corticosteroids and aminosalicylates and surgery (p&gt;0.05).

Conclusion
Despite lower IBD severity and lower utilization of immunomodulators and biologic agents, late-onset patients have substantial comorbidities and higher mortality. Further studies in this specific population are needed.
P292 Endoscopic findings in ileocolic anastomoses: Crohn's disease vs oncologic surgery
Authors: Rajão Saraiva M , Conceição D , Correia Gomes L , Lemos Garcia J , Currais P , Simões C , Maciel J , Limbert M , Rosa I , Claro I 
Published: January 2024

Abstract

Background
Endoscopic lesions of ileocolic anastomoses (ICA) are frequent findings in postoperative Crohn's Disease (CD) patients, associating with the risk of future recurrence by the modified Rutgeerts score (mRS). However, erosions and ulcers, mostly idiopathic, have also been described in colorectal cancer surgery anatomoses.

Methods
Primary aim: to evaluate the incidence of ICA lesions in CD and their impact on therapeutic choices. Secondary aim: to compare the endoscopic findings of ICAs in CD with those of patients operated for right colon adenocarcinoma (ICA-CRC). We performed a single-center retrospective study where we included all patients with CD submitted to ileocolic anastomoses and endoscopic reassessment up to 2 years after surgery (2010 to 2023). We randomly selected ICA-CRC patients with surveillance colonoscopy within the same interval.

Results
23 patients with CD; 48% male; age at date of surgery 18-65 years (median 41). Prior therapy: corticotherapy 14%; thiopurines 26%; anti-TNF 44%. Surgery: ileo-cecal resection 65%; right hemicolectomy 26%; previous anastomosis resection: 9%. Clavien Dindo ≥1: 9%. Surveillance colonoscopy: 4-24 months after surgery (mean 11); ICA assessed in 83%; Lesions in ICA-CD 60%: ulcers 46%; erosions 43%; stenosis 4%; mRS ≥2a: 30%; Therapeutic change: 60%. 66 with ICA-CRC; mean age 67years; adjuvant therapy 26%; cardiovascular risk factors 22%; Clavien Dindo ≥1: 22%; Surveillance colonoscopy (mean): 12 months after surgery; ICA lesions 4% (erosions). No patient with erosions had symptoms and no therapy was introduced. Comparing the two groups: CD patients were younger (p &lt;0.001), had fewer postoperative complications (p 0.01) and more often had ICA lesions (p &lt;0.001).

Conclusion
ICA lesions in CD, compared to ICA-CRC, were more frequent, despite the younger age of the patients and fewer postoperative complications, which favors CD recurrence. Erosions in ICA-CRC appear to have no clinical relevance.
P297 Differences in disease characteristics and treatment exposures between pediatric- and adult-onset Ulcerative Colitis
Authors: Granot M , Kopylov U , Nachum N , Krauthammer A , Abitbol C M , Ben Horin S , Weiss B , Haberman Y 
Published: January 2024

Abstract

Background
previous studies highlighted differences between pediatric-onset ulcerative colitis (pUC) and adult-onset UC (aUC), showing a more severe phenotype in pUC. However, most studies lacked prolonged follow-up, and some were conducted prior to the biologic era. We utilized a large cohort database to compare disease characteristics and treatment exposures between pUC and aUC.

Methods
Single-center IBD registry from the Sheba Medical Center was used and included aUC (age ≥ 18 years) and pUC (age ≥ 6 and &lt; 18 years) patients diagnosed between 2000 and 2022. Data were retrieved from the medical record to a computerized and periodically updating registry in a unified manner. Retrieved data included demographics, clinical disease characteristics and phenotype, and prescribed treatments during routine clinical follow-up. We used descriptive statistics, T-test, and chi-square test for between-group analyses.

Results
This study included 1332 UC patients, of them 682 were females (51.2%, Table 1). The cohort comprised 1058 aUC and 274 pUC patients. The median (IQR) age at diagnosis for pUC was 14.9 (12.5-16.8) years and 31.7 (23.6-48.9) years for aUC. Disease duration and the interval from diagnosis to last follow-up were similar between pUC and aUC, with a median (IQR) disease duration of 8.9 years (4.6-14.2) in pUC and 8.5 (4.5-14.1) in aUC, and a median interval from diagnosis to last follow-up of 7.3 years (3.5-12.3) in pUC and 7.3 years (3.4-13.0) in aUC. Significantly more pUC presented with pancolitis: 59.1% vs. 39.4% in aUC (p&lt;0.00001), (Table 1). During long-term follow-up, treatment exposures also varied significantly between pUC and aUC (Figure 1); 61.3% of pUC were treated with systemic steroids vs. only 42.4% in the aUC group. Thiopurines were used in 40.5% of pUC vs. only 16.7% of aUC, and biological therapy was used in 46.0% of pUC vs. 34.1% of aUC. Time to initiation of biologic treatment was shorter in pUC with a median (IQR) of 33.0 months (15.0-71.3) vs. 36.6 months (15.8-96.1) in aUC (p=0.04). Finally, the number of biologics lines used was also higher in pUC vs. aUC ((mean of 2.1±1.4 vs. 1.8±1.0, p=0.01). Limiting the comparison to only UC patients who presented with pancolitis included 163 pUC and 417 aUC. Within this more severe UC phenotype, exposure to steroids and thiopurines was still significantly higher in pUC vs. pUC, but exposure to a biologic was similar with 54.6% of pUC vs. 50.1% of aUC.

Conclusion
pUC presents with more pancolitis, considered a more severe form of UC. This more aggressive presentation at diagnosis likely leads to a higher rate of exposure to systemic steroids, thiopurines, and biologics during a median of ~7 years of follow-up.
P298 Adherence to diagnostic and treatment recommendations for the management of acute severe ulcerative colitis: a prospective and multinational study
Authors: Rodríguez-Lago I , Frasson M , Pinkney T , Blackwell S , Gecse K , Buskens C , Knowles C , Zmora O , Brookes M , Fiorino G , Nos P , Gallo G , Pata F , Verjee A , Leone S , Pellino G , Gisbert J P 
Published: January 2024

Abstract

Background
Acute severe ulcerative colitis (ASUC) is a serious, potentially life-threatening condition. Hospital admission and prompt medical therapy with intravenous steroids is crucial, but rescue medical therapy is frequently needed, and surgery is often required. Our aim was to assess the adherence to main diagnostic and management recommendations within the MASC multinational study.

Methods
MASC was a prospective, multinational cohort study, including all consecutive patients hospitalized for ASUC between February 2019-January 2020. The primary outcome was surgery during the first 90 days after admission. We used descriptive statistics to determine the proportion of patients fulfilling each diagnostic and treatment recommendation according to ECCO and AGA.

Results
A total of 823 patients from 123 centers in 32 countries in five continents were included (median age 39 years [IQR, 28-54], 56% male, 64% non-smokers; Table 1). Most cases (74%) had a previous diagnosis of ulcerative colitis, and around half (48%) with prior ASUC episodes. Upon admission, they were under 5-ASA therapy (60%), thiopurines (14%), or biologics (21%). They were mostly admitted to the Gastroenterology ward (74%). During the initial assessment, 112 patients (15%) did not have stool culture or C. difficile testing, and CMV was evaluated in 50% of cases. Endoscopic assessment was performed in 66% of patients, mainly by flexible rectosigmoidoscopy (74%).
Regarding treatment, 3.4% of patients received exclusive parenteral nutrition, 70% low molecular weight heparin, and 42% prophylactic antibiotics (Table 2). Steroids were started after a median of 0 days (IQR, 0-1), mostly with methylprednisolone or hydrocortisone (64%), 26% with other steroids, and 7% were managed without steroids. Infliximab was started in 159 patients (19%) after a median of 6 days (IQR, 4-8) after starting steroids, with 27% after &gt;7 days. Most of the patients (93%) had some type of tuberculosis screening done prior to infliximab. Twenty-eight patients (3.4%) started cyclosporine. Thirty-two patients (4%) received other rescue therapy different from infliximab or cyclosporin. Colectomy was performed in 25 patients (3%).

Conclusion
The diagnostic and medical management of ASUC remains heterogeneous and different from current recommendations. This context demands more evidence and consensus on the best management of ASUC.
P304 Endoscopic cuffitis is associated with severe inflammatory pouch phenotypes
Authors: Powers J , Westbrook K , Zemanek M , Dester E , Cohen B , Lashner B , Ivanov A , Hull T , Qazi T 
Published: January 2024

Abstract

Background
Ulcerative colitis (UC) patients who undergo ileal pouch-anal anastomosis (IPAA) without mucosectomy may develop inflammation of the rectal cuff (cuffitis). Studies have suggested that cuffitis is associated with clinical pouch inflammation (pouchitis), but it remains unclear if cuffitis is associated with specific endoscopic phenotypes of pre-pouch inflammation (ileitis), pouch body inflammation, and diffuse pouch inflammation. Therefore, this aim of this study is to identify if endoscopic cuffitis is a predictor of more severe pouch phenotypes, which may warrant earlier or more aggressive treatment.

Methods
In this cohort study, charts were reviewed of patients who underwent IPAA at a tertiary care center from 01/2010 to 12/2021. Inclusion criteria for this study were a diagnosis of UC and ≥18 years old at time of colectomy. Exclusion criteria were lack of endoscopic evaluations after the peri-operative period (defined as 6 months following ileostomy closure) and diagnoses other than UC requiring IPAA. Patients were divided into cohorts based on whether they had cuffitis identified on ≥1 endoscopy following IPAA, which was confirmed by two researchers. Outcomes for this study included pre-pouch ileitis, pouch body inflammation, and diffuse inflammation (inflammation of the pouch body, inlet, and pre-pouch ileum). A multivariate logistic regression was used to test for association between cuffitis and each outcome while controlling for potentially confounding variables suggested to be significant on univariate analyses.

Results
A total of 363 patients were included in this study with an overall median follow-up time of 2.4 (IQR 1.2-3.8) years after ileostomy closure. 149 (41.0%) patients had cuffitis on ≥1 endoscopy following IPAA. 65 (17.9%) patients developed pre-pouch ileitis (Table 1), which was significantly associated with cuffitis (aOR = 3.85; 95% CI 2.15-6.91; p &lt; 0.0001) and age (aOR = 0.98, 95% CI = 0.96-1.00, p = 0.0254). Pouch body inflammation occurred in 201 (55.4%) patients and was associated with cuffitis (aOR = 2.69, 95% CI = 1.69-4.29, p &lt; 0.0001), PSC (aOR = 6.60, 95% CI = 1.85-23.49, p = 0.0036), extraintestinal manifestations (EIMs) other than PSC (aOR = 2.35, 95% CI = 1.45-3.79, p = 0.0005), and age (aOR = 0.98, 95% CI = 0.97-1.00, p = 0.0359). Finally, diffuse inflammation occurred in 20 (5.5%) patients and was associated with cuffitis (aOR = 6.24, 95% CI = 2.04-19.08, p = 0.0013).

Conclusion
Endoscopic cuffitis is associated with the development of severe inflammatory pouch phenotypes. Future studies are needed to investigate whether treatment of cuffitis reduces this risk and whether the incidence of cuffitis is rising similar to pouchitis in the post-biologic era.
P313 Panenteric capsule endoscopy in the investigation and assessment of Crohn’s disease at a tertiary centre
Authors: Angadi N , Badat S , Villa M , Seward E , Willsmore J , Harrow P , Bloom S , McCartney S , Rahman F , Magee C , Parisi I 
Published: January 2024

Abstract

Background
Small bowel & colon capsule endoscopy have been established in their use to visualise the gastrointestinal (GI) tract. The Panenteric Crohn’s Capsule (PCC) is an evolution of these capsules enabling simultaneous assessment of both the small & large bowel with dual cameras for expanded mucosal coverage. This study investigates the use of PCC in patients suspected for inflammatory bowel disease (IBD), specifically Crohn's disease (CD), and in reassessing patients with established CD. The primary objective is to evaluate the impact of PCC results on patients’ management.

Methods
All consecutive patients who had PCC for suspected or established CD were included in the study. Those at risk of capsule retention (previous surgery, obstructive symptoms, stricturing disease) underwent a patency capsule, unless MR enterography was done within six months of PCC. Data was collected prospectively and included demographics, indication, procedural information such as completion rates, bowel cleansing & need for subsequent colonoscopy. PCC findings were recorded and the clinical outcome based on those was assessed at the subsequent clinic follow up.

Results
In this prospective single-centre study, 95 patients (average age 34 years, range 14-84) underwent PCC from November 2020 to May 2023, 61 were females (64%). 43 procedures were conducted remotely, 52 in-hospital, & 5 as inpatients. The primary indications were suspicion of IBD (n=54, 57%) and reassessment of established CD (n=41, 43%).
Among the 95 patients,68 (72%) had successful PCC procedures. 18% (17/95) required a subsequent colonoscopy, primarily for biopsy (7,7.4%). PCC findings revealed inflammation in 41 patients (43.2%), diverticular disease in 13 (13.7%), & polyps in 15 (15.8%). The data demonstrated a 51% change in management post-PCC, including treatment escalation (15.8%), treatment de-escalation due to IBD remission (10.5%), exclusion of IBD with redirection for other pathologies or IBS diagnoses (15.8%), new IBD diagnoses (5.3%), & discharged due to normal investigation without need of further investigation (3.2%).
Particularly in patients undergoing PCC for CD reassessment, 66% experienced a change in the treatment plan (14 escalated treatment, 7 de-escalated treatment due to remission, 3 achieved IBD treatment response & 3 treated for symptoms found to be caused by other pathologies).

Conclusion
PCC is a single, one-stop, non-invasive GI examination, ideal for suspected or established CD patients requiring pan-gut assessment. Despite suboptimal completion rates, PCC spared a colonoscopy in 82% of patients and resulted in change of management in over half of the patients and in 2/3 of those with established CD, suggesting a promising future role in diagnosing and monitoring CD.