bluuebunny/crossref_metadata_2025_split huggingface dataset:
P461 Deep learning model for endoscopic differential diagnosis between intestinal lymphoma and Crohn's disease: a multicenter study
Authors: Gu Y , Zhao L , Zhang Y , Zou D 
Published: January 2024

Abstract

Background
Primary and secondary intestinal lymphoma (IL) are a relatively rare cancer, while easily misdiagnosed due to the unclear aetiology and unspecific clinical symptoms. Moreover, the endoscopic features of IL vary depending on pathological types, making it difficult to distinguish from Crohn's disease (CD). This study aims to develop deep learning models based on endoscopic images, facilitating the differential diagnosis of IL and CD.

Methods
We retrospectively recruited 271 patients with IL and 232 patients with CD from 6 tertiary centres in China. With out-of-focus or poor-bowel-prepared images excluded, we used 1739 IL and 1649 CD images for internal and external validation to build deep learning models. For internal validation, we used five-fold cross-validation with 1517 IL images and 1428 CD images from 5 centres randomly assigned without any patient overlap. 222 IL and 221 CD images from the 6th centre were used for independent external validation to measure the generalization ability of models. Further, we compared the performance of models with that of clinical physicians consisting of 2 junior physicians and 2 endoscopy specialists with more than ten years of clinical experience. We evaluated models using metrics such as accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) and used the kappa statistic to measure the inter-rater reliability between models and clinical physicians.

Results
We developed multiple convolutional neural network models, including ResNet18, ResNet34, ResNet50, VGG16, VGG19, DenseNet121, Inception v3, and Xception. The top 3 models in the internal validation were Inception v3, Xception, and DenseNet121. Inception v3 showed the best performance (accuracy: 83.1%; AUC: 0.910), while Xception performed better on average (average accuracy: 76.8%; average AUC: 0.834). In the external validation, the top 3 models were Inception v3, DenseNet121, and VGG19. Inception v3 achieved the highest accuracy of 81.9%, while DenseNet121 had the best AUC of 0.903. Compared with clinical physicians, Inception v3 performed better than junior physicians (average accuracy: 67.2%) and showed good agreement with the best endoscopy specialist (kappa: 0.604, p&lt;0.05).

Conclusion
Convolutional neural network models using endoscopic images were able to differentiate PIL from CD, with better-diagnosing performance than junior physicians, good agreement with specialists, and good generation ability, which were expected to assist clinical physicians lacking experience to differentiate PIL and CD more precisely under endoscope.
P471 Tight control strategy improves combined histologic and endoscopic remission in ulcerative colitis
Authors: Rodrigues I , Fernandes S , Botto I , Saraiva S , Bernardo S , Gonçalves A R , Moura Santos P , Valente A , Araújo Correia L 
Published: January 2024

Abstract

Background
Increasing evidence suggests that combined histological and endoscopic remission associates with less adverse outcomes (hospitalization and corticosteroid therapy) and predicts a quiescent course of ulcerative colitis (UC). However, few patients can achieve this target with the drugs currently available. A tight control strategy with a proactive treatment escalation based on biomarkers may improve these results.

Methods
Retrospective, single-center cohort study including consecutive patients with UC with severe endoscopic disease (Mayo endoscopic subscore=3) and subsequent endoscopic, histologic and faecal calprotectin (FCP) evaluation. Data concerning demographic, disease phenotype, laboratory findings and treatment were collected. We defined tight control strategy as therapeutic escalation in &gt;50% of cases where FCP≥250ug/g. Therapeutic escalation was defined as the start, switch or dose increment/interval shortening of biologic therapies/small molecules. Endoscopic remission was defined as a Mayo endoscopic subscore ≤1. Histologic remission was defined as the absence of ulcers, erosions and neutrophils in the lamina propria.

Results
One hundred and seven patients were included, 56.0% male and 63.6% with extensive UC. Thirty-four patients (31.8%) were included in the tight control group. During follow up, 52 patients (48.6%) achieved endoscopic remission, 29 (27.1%) histological remission and 27 (25.1%) combined remission. Patients in the tight control group achieved combined remission more frequently (38.2 vs 19.2%, P=0.05). On multivariate analysis including age at diagnosis, duration and extension of disease and therapy received, a tight control strategy was independently related to a higher probability of combined remission: OR 2.768 IC95% 1.056-7.255, P=0.038.

Conclusion
A tight control strategy based on FCP was associated with higher combined histological and endoscopic remission in UC.
P473 Comparison of clinical performance of fecal calprotectin of laboratory methods with lateral flow based POC and home tests
Authors: Reinhard C , Pénager R , Ueberschlag M E , Kräuchi S , Trapani-Vondran D , Kupchak P , Schuster T 
Published: January 2024

Abstract

Background
To confirm an IBD diagnosis and manage IBD patients, endoscopy is the gold standard to assess mucosal inflammation. Fecal calprotectin (fCAL) is a reliable biomarker of intestinal inflammation that highly correlates with endoscopic and histological findings. Fecal calprotectin testing is recommended in most IBD guidelines for diagnosis and disease course evaluation. Different assay technologies exist that need to measure fecal calprotectin comparably. These range from classic enzyme linked immunosorbent assays (ELISA), particle enhance turbidimetric immuno assays (PETIA), and rapid lateral flow assays (LFIA). LFIA[AL1] [RC2] s can be read by conventional tabletop readers or by everyday smartphone applications using the phone’s camera to acquire an image, detect the test cassette and calculate a quantitative result. As there is no international standard to date, fecal calprotectin assay manufacturers rely on their own internal calprotectin standardization. This study compared four different assays measuring the same clinical samples.

Methods
The 128 raw stool samples that were analyzed in this study were obtained from patients that presented with signs and symptoms suggesting intestinal inflammation and underwent endoscopic evaluation to establish or exclude an IBD diagnosis. Samples were extracted with the BÜHLMANN CALEX® Cap stool extraction device. Each extract was then measured on the BÜHLMANN fCAL® ELISA, fCAL® turbo (PETIA), Quantum Blue® fCAL extended lateral flow assay and smartphone based IBDoc® fCAL home test. For the home test, two phones, iPhone 11 and Samsung Galaxy S7, were used to measure the lateral flow test cassettes. Each sample was measured one time on each assay and Receiver Operating Characteristic (ROC) curve analysis was performed and total agreement between each method was calculated.

Results
ROC curves were generated to assess the ability of each assay to differentiate between IBS and IBD with area under the curve (AUC) values ranging from 0.827 (Samsung Galaxy S7 to 0.835 (fCAL turbo). There was no significant difference between the methods. Commonly used cut-offs in the assessment of IBD patients are 100 and 250 µg/g, respectively. Positive and negative percent agreement (PPA/NPA) between the smartphone-based home test and the laboratory assays was calculated. The PPA was above 90% for all methods while the NPA was above 88% for all methods.

Conclusion
The results presented here show that the four BÜHLMANN assays measure fecal calprotectin extremely comparably and show an excellent clinical performance. This allows for the use of the methods interchangeably, depending on the needs of the patients and their care team.
P485 Do intestinal ultrasound scores have a role in the diagnosis of post-operative recurrence?
Authors: Amor Costa C , Suarez Ferrer C , Poza Cordon J , Rueda Garcia J L , Sanchez Azofra M , Martin-Arranz E , Yebra Carmona J , Spigarelli Rabago I , Amiama Roig C , Gonzalez Diaz I , Garcia Ramirez L , Martin-Arranz M D 
Published: January 2024

Abstract

Background
Ileocolonoscopy and Rutgeerts endoscopic score remains the gold standard to evaluate post-operative recurrence (POR) in Crohn's disease (CD) patients. Intestinal ultrasound (IUS) is proposed as a non-invasive alternative to ileocolonoscopy for the diagnosis of POR, with a sensitivity of 94% and specificity of 84%. There are several IUS scores that evaluate CD disease activity such as SUS-CD (validated), IBUS-SAS and Simple US Score, which have not yet been studied in the diagnosis of POR. The aim of this study is to assess whether IUS parameters and ultrasound scores correlate with endoscopy in the diagnosis of POR.

Methods
A unicentric retrospective study was performed. There were included patients with CD with both an ileocolonoscopy and intestinal ultrasound performed for the detection of POR, the time between tests was less than 6 months and there was no therapeutic change between tests. Endoscopic POR was evaluated with Rutgeers score (RS), considering POR RS ≥i2b. In IUS, were used: Simple US Score, SUS-CD and IBUS-SAS.

Results
103 patients were included, baseline characteristics are in Table 1. 30 patients (29.1%) had no endoscopic POR, 22 (21.4%) had RS i2a, 12 (11.6%) RS i2b and 39 (37.9%) had severe POR (RS i3-i4). The mean wall thickness measured by IUS in patients without endoscopic POR was 2.7 mm (SD +/- 1.3) versus 5.0 (SD +/- 1.7) in patients with RS ≥i2b (p 0.001). Hyperemia (Limberg &gt;1) was present in 60 patients (82.2%) with RS ≥i2a vs in 4 patients (13.3%) without endoscopic POR (p 0.001). Both hyperemia and wall thickness had a sensitivity of 89.0% and specificity of 76.7% in the diagnosis of POR.
The mean values for IUS scores were: Simple US Score 5.5 (SD +/- 3.1), SUS-CD 2.1 (SD +/- 1.8) and IBUS-SAS 32.9 (SD +/- 26.3). There were positive correlation for IUS scores (Simple US Score r 0.68, SUS-CD r 0.68 and IBUS-SAS r 0.67) with RS (p &lt;0.0001). For the Simple US Score an area under the ROC curve (AUC) of 84.13% (95% CI 76.81 – 91.45) was obtained, with a score ≥3, the sensitivity (S) was 82.19% and specificity (E) 80.0%. IBUS-SAS presented an AUC of 84.93% (95% CI 77.98 - 91.87), a result ≥15 granted a S 82.19% and E 80.0%. The SUS-CD index had an AUC of 83.38% (95% CI 75.55 - 91.20), a result ≥1 presented S 82.19% and E 80.0%.

Conclusion
In our experience, IUS scores (IBUS-SAS, SUS-CD and Simple US Score) show a high sensitivity and specificity in the diagnosis of POR. The three scores had AUC greater than 80%, IBUS-SAS showed slightly higher AUC results.
P529 Assessing patient-perceived burden of disease in Crohn’s disease: a novel scoring approach in a real-world Australasian cohort
Authors: Pipicella J L , Gu B , Palmer L , Connor S J , Wilson W , Andrews J M 
Published: January 2024

Abstract

Background
The prevalence and burden of inflammatory bowel diseases (IBD) including Crohn’s disease (CD) are rising globally. We present a novel score to evaluate the patient-perceived burden of disease (PPBoD) in CD, and explored it in a large real-world Australasian cohort.

Methods
The Crohn’s Colitis Care (CCCare) Clinical Registry was interrogated in October 2023. Adults with CD across 17 IBD centres with an outpatient encounter in the last 14 months were included. A novel PPBoD score was designed for CD, which included patient-reported components from the Harvey-Bradshaw index (abdominal pain and patient-rated general wellbeing) as well as nocturnal bowel actions, defecation urgency and stool frequency. The PPBoD score was calculated as detailed in figure 1. A total score of 0 was defined as no PPBoD, 1-2 as mild, 3-4 as moderate and ≥ 5 as significant PPBoD. Correlations amongst PPBoD and demographics, disease and treatment factors were explored.

Results
A total of 3461 people with CD were assessed in the last 14 months and 3233 (93.4%) had adequate data to calculate PPBoD. Of these, 80.0% had either no or mild PPBoD (table 1). While gender varied significantly between PPBoD categories, age and BMI did not. People with lower PPBoD were more likely to be receiving advanced therapies and had lower rates of steroid use than those with higher PPBoD. There were no significant differences in the use of immunomodulators and/or aminosalicylates across PPBoD categories. The cohort was geographically dispersed across Australia (n = 2414, 74.7%) and New Zealand (n = 819, 25.3%). There was significantly higher PPBoD in New Zealand compared to Australia but notably people in New Zealand were less likely to be receiving advanced therapies (p &lt; 0.001). In the subset of 1074 people (33.2%) with a recent faecal calprotectin, those with no PPBoD were more likely to have biochemical remission (faecal calprotectin &lt; 100 μg/g). Data were available to assess endoscopic and radiological remission in 1049 people (32.4%); those with no PPBoD were more likely to be in remission. Less than 1% of people with no PPBoD had any days out of role due to CD, whereas those with higher PPBoD had more days out of role (Table 1).

Conclusion
We present a novel consumer-focused score to quantify PPBoD in CD. Within this geographically dispersed cohort, the majority had either no or mild PPBoD. Advanced therapy use appeared to be protective against high PPBoD. Further studies are required to validate this novel score to assess PPBoD in CD.
P542 Clinical decision support tool guided selective intensive induction strategy of ustekinumab in patients with Crohn’s disease: real-world evidence
Authors: Li Q , Tang J , Shi L , Lv X , Chen W , Guo Q , Li M , Gao X , Chao K 
Published: January 2024

Abstract

Background
Clinical decision support tool (CDST) of ustekinumab (UST) can predict the possibility of drug response1. However, the potential benefits of initial intensification induction therapy (IIT) to improve clinical outcomes for different responders has not been explored2. We aimed to evaluate the effectiveness and safety of the strategy of initial IIT for Crohn’s disease patients who exhibit varying responses based on UST-CDST.

Methods
This is a multicenter retrospective study included active Crohn’s disease patients who were low, intermediate and high probability responders according to UST-CDST (Figure 1). IIT was defined as intensive induction by 2 or 3 initial doses of a weight-based intravenous UST. The patients treated with standard therapy (ST) were identified as controls. The primary endpoint was corticosteroid-free clinical remission (CFCR) at week 24. The secondary endpoint was clinical remission, clinical response, endoscopic remission, endoscopic response, and CRP normalization at week 24. Propensity-matched analyses were applied to ensure comparability.

Results
A total of 296 patients were included, with 69 patients receiving IIT and 227 patients receiving ST. At week 24, in low-intermediate probability responders, IIT group was associated with higher rates of CFCR (72.3% vs 43.0%, OR 3.47 [95%CI 2.15-5.68], clinical remission (77.3% vs 47.1%, OR 3.82 [95%CI 2.33-6.37]), clinical response (78.1% vs 60.1%, OR 2.37 [95%CI 1.43-3.97]), endoscopic remission (50.6% vs 22.4%, OR 3.55 [95%CI 1.65-7.92]) and endoscopic response (83.1% vs 44.1%, OR 6.23 [95%CI 2.75-15.26]). CRP normalization were comparable. In high probability responders, all end points did not demonstrate statistically significant differences (Table 1). The cut-off UST trough concentration for predicting corticosteroid-free clinical remission was determined to be 1.43µg/mL, with an area under the curve (AUC) of 0.612, a sensitivity of 55.0%, and a specificity of 70.0%. No serious adverse events occurred.

Conclusion
Initial dose intensification induction in low-intermediate responders based on UST-CDST was superior to the ST in both clinical and endoscopic remission at week 24, which provide a novel strategy for stratifying patients at baseline.
1. Park J, Chun J, Yoon H, Cheon JH. Feasibility of a Clinical Decision Support Tool for Ustekinumab to Predict Clinical Remission and Relapse in Patients With Crohn's Disease: A Multicenter Observational Study. Inflamm Bowel Dis. 2023;29(4):548-554.
2. Ren H, Kang J, Wang J, et al. Efficacy of Ustekinumab Optimization by 2 Initial Intravenous Doses in Adult Patients With Severe Crohn's Disease [published online ahead of print, 2023 Aug 24]. Inflamm Bowel Dis. 2023; izad184.
P562 Safety and persistence oh the first JAK inhibitor Tofacitinib in patients with ulcerative colitis
Authors: González Chávez J , Santos Fagundo A , Ceballos Santos D , Calzado Gómez G , González Pérez Y , Morales León V , Otazo Pérez S M , Hernandez Camba A 
Published: January 2024

Abstract

Background
A drug safety warning was published in 2021 about the risks associated with tofacitinib, which were found in the Oral-Surveillance study. The European Medicines Agency (EMA) and the Spanish Agency for Medicines and Medical Products (AEMPS) have recommended, due to this warning, some precautions in the prescriptions: It should not be used in patients older than 65 years of age, people who are current or past smokers, or individuals with cardiovascular or malignancy risk factors unless there are no suitable treatment alternatives. The aim fo this study was to assess the safety and treatment persistence of tofacitinib in clinical practice in three Spanish third-level hospitals.

Methods
Retrospective observational multicenter study of patients with Ulcerative Colitis (UC) treated with tofacitinib from January 2019 to October 2023. Sex, age, line of treatment, persistence, adverse events, discontinuations and risk factors associated with the warning were evaluated. Information was collected from the hospital’s information systems.

Results
A total of 56 patients, 53% women, mean age 55 (18-72) years old. Tofacitinib was the first line treatment in 2% of the patients after loss of response to the conventional treatment, second line for 57%, third line for 30% and fourth line for 11% after biological drugs (infliximab, adalimumab, vedolizumab and ustekinumab). 52% of patients needed maintenance with the higher doses (10mg dose) after induction due to the lack of response with the 5 mg dose, with an average of 52 weeks. The mean persistence was 18 months (1-56), with 19,6% discontinuations due to primary failure and secondary failure. It must be noted that one patient, who received tofacitinib for three years, underwent appendicular neoplasia and finally died due to liver metastases. There was not discontinuation due to other adverse events, which were: 3,6% herpes zoster, 46,4% increased total cholesterol level &gt;200 mg/dl (compared with the initial measurement), of which 19% received statins.There were 27 (48%) patients with risk factors associated with the safety warning: 37% cardiovascular risk, 3,7% older than 65 years, 11,1% previous malignancy, 18,5% current or past smokers and 29,6% had several of these risks.

Conclusion
In this multicenter real-world treatment-refractory UC population cohort, tofacitinib was well tolerated in the long term, even in the patients with risk factors related to the warning.
P588 Evolution and management of inflammatory joint pathology with non-anti-TNF therapies in inflammatory bowel disease
Authors: Gonzalez Diaz I , Suarez Ferrer C , Plasencia Rodriguez C , Gutierrez M , Rueda Garcia J L , Martin-Arranz E , Poza Cordon J , Sanchez-Azofra M , Amor Costa C , Amiama Roig C , Martin-Arranz M D 
Published: January 2024

Abstract

Background
The role of ustekinumab (UST) and vedolizumab (VDZ) in articular extra-intestinal manifestations of IBD remains unclear and most existing studies are retrospective. The aim of this study is to analyze the incidence of new onset or worsening of a preexisting IBD-associated arthropathy in patients treated with UST and VDZ.

Methods
An observational prospective study in a tertiary care University hospital was conducted. IBD patients undergoing treatment with VDZ or UST with previous spondyloarthritis (SpA) or new onset arthropathy were included. Articular manifestations were evaluated by a rheumathologist within 72 hours. IBD and rheumatological related variables were assessed at baseline and after 6 months, including demographics, clinical, biochemical, endoscopic and ultrasound data.

Results
201 patients were on treatment with UST and VDZ. Of these, 80 were referred to rheumatology for previous SpA or symptoms onset. 56 (70%) with VDZ and 24 (30%) with UST. 24 (30%) of them were classified as SpA: 22 (92%) had a previous diagnosis and 2 (8%) debuted during treatment with VDZ or UST. The remaining 56 (70%) were diagnosed with other rheumatological pathologies. Type of arthritis was: peripheral arthritis, 11 (46.4%); axial, 7 (29%) and mixed, 6 (25%).
Most patients had received 1 or 2 biological therapies (73%), 90% of them were anti-TNF experienced. 48% of patients received UST or VDZ in monotherapy, without disease-modifying antirheumatic drugs (DMARDs).
The most frequent type of arthritis in patients with previous SpA was peripheral (50% peripheral only and 18% mixed). Joint activity remained stable or even improved in these patients. Only 2 (9%) had axial disease flare-up, one with UST and one with VDZ. Both patients had moderate intestinal activity (C-reactive protein; CRP &gt; 2.5 mg/dl and faecal calprotectin; FC &gt; 600 ug/g). Treatment was not discontinued in any case.SpA debuted in 2 patients with mixed arthritis on treatment with VDZ. Both patients also had poor IBD control (CRP &gt; 3.5 mg/dl and CF &gt; 600 ug/g). A change of biologic therapy was performed in addition to adjusting treatment with concomitant DMARDs.

Conclusion
In our experience, treatment with UST and VDZ did not worsen joint pathology in patients with SpA. Most of them remained stable or improved. Patients with joint flare-ups also had poor control of bowel activity, which could be the main cause of worsening SpA.