bluuebunny/crossref_metadata_2025_split huggingface dataset:
P390 Adiposity is negatively associated with a stenosing Crohn’s disease behaviour: a UK wide study in 8797 patients within the IBD Bioresource
Authors: Ndzo J , Trimble T , Yan K , Figueredo G , Vuyyuru S , Moran G 
Published: January 2024

Abstract

Background
Obesity has been implicated in the pathogenesis of fibrosis. With the rising incidence of Crohn`s Disease (CD) alongside an obesity pandemic, we hypothesise that adiposity may be associated with stenosing CD.

Methods
Using NIHR IBD Bioresource data, we retrospectively assessed the relationship between body mass index (BMI) and stenosing CD by logistic regression. BMI was the primary variable of interest; CD behaviour the dependent variable; stenosing CD the primary outcome. Confounders were adjusted for in a multivariate model. Statistical analyses were performed using SPSS 28.0.1.1.

Results
8,797 patients diagnosed between 1942 and 2020 were included. Mean overall BMI was 26.3kg/m2 (SD = 5.5). 52.7% had a BMI &gt;25kg/m2 (mean 30.2kg/m2, SD 4.5). Majority had inflammatory CD (62.9%) followed by stenosing (25.1%) and penetrating CD (12%). Stenosing and penetrating CD were more common in the &lt;25kg/m2 BMI group (50.7%, 50.3% respectively) p&lt;0.001. On univariate analysis, stenosing disease was positively associated with ileal disease location, disease duration, a surgical history, use of advanced therapies (infliximab, ustekinumab, vedolizumab, adalimumab) and azathioprine but negatively associated with BMI even after adjusting for confounders (OR 0.98, 95% CI [0.967-0.988]). On multivariate analyses, disease duration (OR 1.135, 95% CI [1.135-1.105-1.170]), ileal disease location (OR 3.69, 95% CI [3.22-4.24]), adalimumab (OR 1.47, 95% CI [1.30-1.66]) and ustekinumab (OR 1.512, 95% CI [1.14-2.01]) and azathioprine (OR 1.34, CI [1.189-1.529]) usage remained positively associated with stenosing CD (Table 1).

Conclusion
We observed a negative relationship between BMI and stenosing disease. This might reflect a change in eating behaviour due to persistent abdominal pain related to stenosing disease. Large longitudinal studies are needed to investigate this relationship further.
P392 Behaviour of Childhood-onset Inflammatory Bowel Disease through Adulthood
Authors: Zelinkova Z , Kadleckova B , Cierna I , Podmanicky D 
Published: January 2024

Abstract

Background
The incidence of childhood-onset inflammatory bowel disease (IBD) is rising but the data on the behaviour of the disease during the adulthood are scarce. Therefore, the aim of our study was to determine whether the long-term prognosis of childhood-onset IBD differs from adult onset IBD.

Methods
All IBD patients referred to a terciary IBD centre between April and October 2023 were identified. Previous surgical interventions, biologic use and disease course after transition to adult care were retrieved from medical records. Upper gastrointestinal tract localisation, multiple bowel segments involvement, perianal Crohn`s disease, stenosing and/or penetrating disease behaviour were considered as risk factors for complicated disease course. Differences between childhood- and adult-onset IBD in surgery rates, biologic use, time to surgery and time to biologic were analysed statistically.

Results
In total, 331 IBD patients were included. Childhood-onset IBD patients represented 21% of the cohort (70 out of 331). There were no differences between the two groups concerning the presence of complicated disease course risk factors (for both groups present in 67% of patients).
The proportion of operated patients was significantly higher in the childhood-onset group (63% vs. 45% in childhood- vs. adult-onset group, respectively; p=0,0087). The time to first surgery was significantly longer in the childhood- compared with adult-onset group (8,5 years vs. 4,4 years, respectively; p&lt;0,0001); mean age of first surgery in childhood-onset group was 23 years (range 9 to 39) with the majority (88%) of childhood-onset patients having been operated in their adult years.
Concerning biologics, there was significantly higher proportion of patients on biologics among childhood-onset patients (80% vs. 66% childhood- vs. adult-onset group, respectively; p=0.0205), which was also the case for multiple biologics use (51% vs. 26% childhood- vs. adult-onset group, respectively; p=0.0205). The time to the use of the first biologic was significantly longer among childhood-onset patients (7,5 years vs. 4,9 childhood- vs. adult-onset group, respectively; p=0.0113).
The majority of childhood-onset patients (70%) had ongoing disease activity in adulthood as defined by admission, corticoisteroid use, need for change of biologic or need for surgery.

Conclusion
Despite the similar risk for complicated disease course at diagnosis, there is higher rate of surgery and biologic use among childhood-onset inflammatory bowel disease patients as compared with adult-onset patients. In the majority of childhood-onset patients, first surgery and biologic use is delayed compared to adult-onset population which may contribute to the complicated disease course in their adult years.
P393 The frequency of COVID-19 infection and the impact of vaccination on the disease morbidity in Polish pediatric patients with Inflammatory Bowel Disease
Authors: Derda E , Szymanska E , Meglicka M , wiernicka A , Osiecki M , Kierkus J 
Published: January 2024

Abstract

Background
Little is known about morbidity of Covid-19 infection in pediatric patients with inflammatory bowel diseases (IBD). The aim of this study was to evaluate the frequency of SARS-CoV-2 infection in children with IBD.

Methods
A prospective, observational cohort study to evaluate morbidity of coronavirus disease 2019 (COVID-19) among pediatric patients with IBD. The questionnaire included information concerning numbers of vaccine doses, patients’ medication and disease activity. Disease flare was defined by worsening IBD symptoms and change in IBD medications.

Results
A total of 320 children with IBD, 169 with Crohn’s disease (CD)-52,8%, 150 with ulcerative colitis (UC) - 46,9%, 1 unclassified -0,3%, responded to the questionnaire concerning COVI-19 vaccination. Among the participants 114 (35,6%) patients have suffered from COVID19 (62 CD- 54,4%, 51 UC- 44,7%, 1 unclassified - 0,9%). In 79 cases (69,3%) COVID-19 course was mild, in 31 (27,2%) it was moderate, and 3 (2,6%) children had severe disease. There was no statistically significant difference in morbidity among patients with CD and UC. A total of 127 (39,7%) patients received at least 1 COVID-19 vaccine, and among them 22 (17,3%) children got COVID-19 infection after vaccination. 91 (47.2%) of unvaccinated patients got COVID 19 infection. Following SARS-CoV-2 disease, 22 (19.3%) patients reported exacerbation of IBD during or after COVID 19. In 82 (71.9%) patients COVID-19 infection had no effect on the course of their IBD. Among patients with exacerbation during/after SARS-CoV-2 disease, 3 (13.6%) were vaccinated and 19 (86.4%) of them were not vaccinated.

Conclusion
Based on the outcomes from our questionnaire concerning COVID-19 vaccination state on the large cohort of pediatric patients with IBD, we conclude that unvaccinated patients get sick more often than vaccinated ones, and there is no difference in the frequency of SARS-CoV-2 infection between children with CD and UC. Also, there is no statistically significant difference in the severity of COVID-19 infection between vaccinated and unvaccinated patients. Vaccination against COVID-19 has no effect on the exacerbation of IBD during/after infection.
P399 Impact of Body Mass Index on Clinical Outcomes in Intestinal Behçet’s disease
Authors: Park D , Ji J , Park S J , Park J J , Kim T , Park J , Cheon J 
Published: January 2024

Abstract

Background
The impact of underweight and obesity on clinical outcomes for intestinal Behçet’s disease (BD) is unknown. We aimed to identify the association between body mass index (BMI) and clinical outcomes in patients with intestinal BD.

Methods
We categorized 760 patients with intestinal BD according to the BMI at diagnosis into four groups (underweight, normal, overweight, obese) at Severance Hospital, Seoul, Korea between 1997 and 2021.We performed a Cox proportional hazard analysis to investigate the predictive capability of BMI for clinical outcomes such as biologics use, surgery, hospitalization and emergency room visit.

Results
Of the 760 patients, 130 patients were classified into underweight group (BMI&lt;18.5), 384 patients into normal group (BMI 18.5~22.9), 152 patients into overweight group (BMI 23~24.9), and 94 patients into obese group (BMI≥25). Patients with a higher BMI group showed significantly lower cumulative rates of biologics use (p trend = 0.001), surgery (p trend = 0.008), hospitalization (p trend = 0.002), and emergency room visits (p trend = 0.003) than those with a lower BMI group.
In a multivariate analysis, normal BMI group (HR: 0.667, 95% CI 0.483-0.992, p =0.014), overweight group (HR: 0.589, 95% CI 0.394-0.879,p=0.010), and obese group (HR: 0.515, 95% CI 0.321-0.828, p=0.006) were negatively associated with future hospitalization compared to underweight group. Overweight group (HR: 0.490, 95% CI 0.241-0.996, p =0.049) and obese group (HR: 0.312, 95% CI 0.116-0.840,p =0.021) were negatively associated with future biologics use compared to the underweight group.
Normal BMI group (HR: 0.706, 95% CI 0.484- 1.029, p=0.070) and obese group (HR : 0.556, 95% CI 0.303-1.020,p=0.058) were negatively associated with future surgery compared to the underweight group. Normal BMI group (HR: 0.711, 95% CI 0.513-0.985, p=0.041) and obese group (HR: 0.602, 95% CI 0.376-0.963, p=0.034) were negatively associated with future emergency room visit compared to the underweight group.

Conclusion
Underweight could affect poor outcomes in intestinal Behçet’s disease. Physicians should pay attention to the patients with underweight and make an effort to improve nutritional status.
P405 Intestinal ultrasound measures are highly correlated with small bowel Lewis score among patients with active Crohn’s disease
Authors: Ukashi O , Lahat A , Ungar B , Levy H , Eidler P , Eliakim R , Kopylov U , Carter D , Ben-Horin S , Albshesh A 
Published: January 2024

Abstract

Background
Small-bowel assessment is of prime importance among patients with Crohn’s disease (CD). While small-bowel capsule endoscopy (SBCE) evaluates the extent of mucosal inflammation, intestinal ultrasound (IUS) provides a complementary information with regards to transmural disease involvement. We aimed to examine the correlation between SBCE and IUS, among patients with active CD, as well as sensitivity to therapeutic response during follow-up.

Methods
Patients with active small-bowel CD, who have been started on biologics, were included. Patients were prospectively followed with fecal calprotectin (FC), SBCE and IUS at baseline and after 14 and 52 weeks. Lewis score (LS), Limberg score (LI) and terminal ileum bowel-wall thickness (TIBWT) were documented for each patient. Response to treatment was defined as a 25%-reduction compared to the baseline measure of FC, LS, LI and TIBWT, while FC&lt;150μg/mg, LS&lt;135, LI&lt;2 and TIBWT&lt;3 mm, were defined as biochemical, endoscopic and ultrasonographic remission, respectively (week 0→week 14/ week 14 →week 52). Baseline correlations were obtained using the Spearman's correlation. Comparison between correlations were assessed using the Fisher's Z-transformation. Fisher's exact-test was performed to evaluate the correlation between the examined response/remission outcomes.

Results
Seventy-one patients were included (median age: 26 (22-43) years, male-49%). The median time between SBCE and IUS procedures was 3 (0-25) days. Baseline LS was well correlated with both TIBWT (r=0.6, p&lt;0.001) and LI (r=0.6, p&lt;0.001). Ultrasonographic remission was significantly correlated with both biochemical remission (FC and TIBWT [p=0.012], FC and LI [p=0.024]) and endoscopic remission (LS and TIBWT [p=0.035], LS and LI [0.013]), [Figure 1]. The baseline correlation between FC and LS (r=0.490, p&lt;0.001) was numerically but not significantly higher than FC and BWT (r=0.386, p=0.002) or FC and LI (r=0.224, p=0.080) [p=0.500 and p=0.110, respectively]. No significant correlation was observed between FC and LS /TIBWT/LI response to treatment (p=0.347 p=0.261, p=0.864, respectively), while there was a trend regarding TIBWT and LS response to treatment correlation (p=0.052).

Conclusion
IUS measures are highly correlated with SBCE LS among patients with active CD, and provide an accurate and reliable assessment of disease activity during follow-up. Therefore, IUS may serve as a feasible and noninvasive tool in the monitoring and management of patients with CD.
P408 Complete endoscopic healing, the future therapeutic target in Crohn's disease? Results of a prospective multicenter study
Authors: Yzet C , Brazier F , Derval E , Vaneslander P , Dejour V , Pricope D , Diouf M , Fumery M 
Published: January 2024

Abstract

Background
The STRIDE II guidelines recognize endoscopic healing (EH), defined by an SES-CD score ≤2 or a CDEIS score &lt;3, as one of the main therapeutic targets in Crohn's disease (CD). Nevertheless, complete endoscopic healing could reduce the risk of long-term complications in CD. The aim of this study was to assess the risk of long-term complications in CD according to the degree of endoscopic healing achieved.

Methods
We conducted a prospective multicenter study that included all patients with CD undergoing colonoscopy for EH assessment or dysplasia screening between September 2019 and September 2022 in one university hospital, one general hospital and one private center. Two groups were compared: patients with complete EH (CDEIS = 0) and those with partial EH (CDEIS &lt;4). The primary endpoint was CD relapse, defined as the need for drug intensification and/or initiation of corticosteroid and/or CD-related hospitalization and/or development of a fistula (luminal or perianal) or abscess, and/or the need for bowel resection. Patients were followed up every 6 months for two years. Based on previously published data, 138 patients were expected to demonstrate a 13% difference with a two-sided alpha risk of 5% and a power of 80%.

Results
A total of 133 patients were included. The majority of patients were female (55%), non-smokers (63%), with a median disease duration of 10 (IQR, 4-19) years. Fifty-seven (43%) patients had ileocolonic location and 81 (61%) an inflammatory (B1) behavior. Patients had been on treatment for a median of 18.0 months (IQR 8.6-52) prior to colonoscopy, with no difference between the two groups. There was no significant difference between the two groups apart from BMI. Eighty-four (63%) patients had complete EH. After adjustment for BMI, the risk of relapse was significantly higher in the CDEIS&gt;0 group (23% vs. 41%, HR = 2.05; IC95% = [1.09 - 3.87]; p=0.027). After a median follow-up of 23.3 months, the number of drug intensification, hospitalizations, use of corticosteroids, occurrence of abscess, fistula, or bowel resection in the CDEIS 0 and CDEIS &gt; 0 and &lt;4 groups were 20% and 35% (p=0.065), 2.4 and 16% (p=0.005), 2.4% and 10% (p=0.10), 3.6% and 18% (p=0.009), 7.1% and 18% (p=0.048), 7.1% and 18% (p=0.048) respectively.

Conclusion
This prospective multicenter study confirms that complete endoscopic healing is associated with better long-term outcomes than partial endoscopic healing in patients with CD, as well as fewer surgeries and hospitalizations and an overall decreased risk of treatment failure.
P423 Incidence of Colorectal Cancer among Patients with Ulcerative Colitis in the Middle East: A Systematic Review and Meta-Analysis
Authors: Alshahrani A , Alshahrani Abdulaziz S , Albdrani Turki Ahmad A , Mukhtar Alamri Mariam S 
Published: January 2024

Abstract

Background
Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation of the colon. A well-documented long-term complication of UC is an increased risk of developing colorectal cancer (CRC). The Middle Eastern population, with its unique genetic and environmental factors, presents a distinctive context for the investigation of CRC risk in UC patients. This meta-analysis aims to systematically evaluate and synthesize the available data on the incidence of CRC among UC patients in the Middle East

Methods
A comprehensive literature search was conducted, identifying relevant studies from various databases and sources. A total of 12 studies met the inclusion criteria and were subjected to quantitative synthesis. The primary outcome measure was the incidence of CRC among UC patients in the Middle East. A random-effects model was used for data synthesis. Heterogeneity was assessed using the I^2 statistic.

Results
The meta-analysis included a total of 12 studies, comprising 13,881 UC patients in the Middle East. The overall estimated incidence of CRC in this population was 1.41% (95% confidence interval [CI]: 1.32% to 1.50%). Notably, there was substantial heterogeneity across the studies (I² = 100%).

Conclusion
This meta-analysis provides insights into the incidence of CRC among UC patients in the Middle East. The findings underscore the significance of recognizing and addressing the elevated risk of CRC in UC patients, particularly in the context of unique genetic and environmental factors in the Middle East. Further research is needed to refine risk assessment and optimize preventive strategies in this specific population. Ultimately, this study serves as a vital resource for clinicians and researchers seeking to combat the burden of CRC in Middle Eastern UC patients.
P441 Optimization of deep learning architectures for differentiating cytomegalovirus infection in severe ulcerative colitis
Authors: Choe A R , Jeong-Heon K , Ju Ran B , Yehyun P , Eun-Mi S , Rena L , Jin-Sung K , So-Hyun A , Sung-Ae J 
Published: January 2024

Abstract

Background
Cytomegalovirus (CMV) reactivation is common in patients with severe ulcerative colitis (UC). Patients with UC exacerbated by reactivated CMV experience worse prognoses than those without CMV reactivation. However, CMV is primarily diagnosed through biopsies, and it can take quite time to get results, making early diagnosis challenging. To address this, we have conducted research using deep learning to differentiate CMV from severe ulcerative colitis (UC), which has similar features, through endoscopic imaging, enabling early diagnosis of CMV.

Methods
This study leveraged endoscopic imaging to classify CMV and severe UC within a dataset comprising 86 cases from Ewha Womans University hospitals, deploying 7 convolutional neural networks. The training utilized a 4:1 ratio, enhanced by a 5-fold cross-validation, to counter the dataset's constraints. Networks underwent optimization for 10 epochs, a batch size of 10, sigmoid activation, and a learning rate of 1e-4. To improve the performance of the network, we employed augmentation techniques such as random rotations and flipping, and performed brightness standardization and resizing of resolution. Additionally, to distinguish lesions that are difficult to differentiate with RGB values, we converted the images to HSV values to separately process areas of reflected light and ulcerated regions.

Results
Among the total of 7 networks used in this study, Densenet121 showed the best performance with an accuracy of 0.8267 (Precision 0.7979). Densenet201 and MobileNetV2 also demonstrated the next best performances with accuracies of 0.7857 and 0.7143, respectively.The standardization and augmentation performed during the preprocessing process have been confirmed to improve the network's performance, and the network's robustness was verified through 5-fold cross-validation.

Conclusion
The research underscores the potential of deep learning models in differentiating CMV from severe UC through endoscopy images, indicating a promising direction for non-invasive diagnostics and timely treatment interventions.The results of the current study are based on data collected from two institutions, and thus, future research will involve multi-institutional studies to develop and test a more robust network with improved performance.
P457 Small bowel involvement proximal to the terminal ileum is a major risk factor for intestinal resection in patients with small bowel Crohn’s disease
Authors: Oh C K , Kim E H , Lee B I , Oh S N , Lee H H , Kim J S , Cho Y S , Lee K M , Kim S W , Choi H 
Published: January 2024

Abstract

Background
The current Montreal classification categorizes Crohn's disease (CD) with small bowel involvement into two groups: L1 and L3. The study aimed to investigate the significance of small bowel involvement proximal to the terminal ileum as a significant risk factor for intestinal resection.

Methods
We conducted a retrospective review of the medical records of Crohn's disease patients diagnosed between January 2001 and December 2020 at Seoul St. Mary's Hospital, St. Vincent Hospital, and Eunpyeong St. Mary's Hospital. The extent of small bowel involvement was independently assessed by two experienced gastrointestinal radiologists using conventional CT, CT enterography, or MR enterography at the time of diagnosis. The terminal ileum was defined as the distal ileal segment within 10 cm from the ileocecal valve and the jejunum was defined as the proximal 1/2 of the small intestine beyond the ligament of Treitz. Radiologic disease activity and fibrostenosis at the time of diagnosis were also scored as 0, 1, and 2 using Maglinte classification, respectively.

Results
Out of 617 CD patients, 346 were included in the study, while 271 were excluded due to radiologic noninvolvement of the small bowel, inadequate or missing radiologic data, initial diagnosis made at another institution, or diagnosis through surgery. Median age at diagnosis was 24 years (range 10-76) and 250 (72.3%) were male. The median follow-up duration was 53 months (4-201). During the follow-up period, 43 patients (12.4%) underwent intestinal resection. Small bowel involvement proximal to the terminal ileum was significantly associated with a higher cumulative risk of intestinal resection (15.4% vs. 3.5%, P=0.006). Neither jejunal involvement or colonic involvement (L3 vs. L1) showed a significant association with cumulative risk of intestinal resection (16.0% vs. 11.1%, P=0.222; 12.4% vs. 12.4%, P=0.773). Radiologic disease activity and fibrostenotic score at the time of diagnosis were significantly associated with the cumulative risk of intestinal resection, respectively (0% vs. 4.4% vs. 19.7%, P&lt;0.001; 8.5% vs. 16.7% vs. 28.2%, P&lt;0.001).

Conclusion
Small bowel involvement proximal to the terminal ileum was a major risk factor for requiring intestinal resection in patients with small bowel CD, while jejunal involvement was not. These findings suggest a need for subclassifying small bowel CD.