bluuebunny/crossref_metadata_2025_split huggingface dataset:
P239 Characteristics and outcomes of portal vein thrombosis in patients with Inflammatory Bowel Disease in Korea
Authors: Kim K J , Song S , Park J B , Bae J H , Baek J E , Kim G H , Kim M , Hong S W , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K , Yu C S , Yoon Y S , Lee J L , Kim M H , Park S H 
Published: January 2024

Abstract

Background
Portal vein thrombosis (PVT) is known to occur frequently in patients with inflammatory bowel disease (IBD), particularly when compounded by factors such as abdominal infection, IBD flares, or intra-abdominal surgery. However, PVT can lead to diverse complications, causing acute issues like intestinal ischemia or necrosis and long-term problems such as portal hypertension, varices, and ascites. Nevertheless, there is a significant shortage of research regarding the characteristics and prognosis of PVT in the context of IBD. Particularly, with the rising prevalence of IBD patients in Asia, the authors conducted an evaluation of clinical presentation and prognosis of PVT in IBD patients at a large tertiary hospital in South Korea.

Methods
This study is a retrospective study conducted at a single tertiary center in South Korea. It examined patients aged 18 and above diagnosed with inflammatory bowel disease (IBD) who had confirmed portal vein thrombosis (PVT) between June 1, 1989, and December 15, 2021. The study focused on investigating patient characteristics, PVT characteristics, treatment methods, and outcomes. The diagnosis and resolution of PVT were confirmed using enhanced CT imaging.

Results
A total of 78 patients met the inclusion criteria for this study. Only 21% (16/78) received oral anticoagulants, yet nearly all patients (96%; 75/78) achieved Complete Radiologic Resolution (CRR). When comparing baseline characteristics between the anticoagulation use group and the non-use group, a trend was observed with a higher utilization of anticoagulants in cases where the main portal vein was involved rather than only the left or right portal vein (p-value 0.006). However, when conducting multivariable analysis, no factors significantly influenced CRR, especially anticoagulant use and surgery status.

Conclusion
PVT concomitant with IBD demonstrated favorable outcomes regardless of anticoagulation use.
P250 Geriatric impairments associate with mortality and hospitalisations during follow-up in older IBD outpatients
Authors: Fons A , Asscher V , Stuyt R , Baven-Pronk M , van der Marel S , Jacobs R , van der Meulen-de Jong A , Mooijaart S , Kalisvaart K , Maljaars J 
Published: January 2024

Abstract

Background
We aimed evaluate the association between impairments found in a geriatric assessment and the risk for adverse outcomes in older patients with Inflammatory Bowel Disease (IBD).

Methods
In a prospective multicenter cohort study, a geriatric assessment was performed at baseline in 405 older (≥ 65 years) patients with IBD. Linear-and cox regression analyses were used to study the association between impairment in five geriatric domains measured in the geriatric assessment (somatic-, functional-, mental-, and social domain, physical capacity) and adverse outcomes occurring during 18 months of follow-up. Adverse outcomes were defined as all-cause-, acute-, and IBD-related hospitalisations and all-cause mortality. All analyses were adjusted for age, sex and biochemical disease activity (C-reactive protein ≥10 mg/L and/or fecal calprotectin ≥250 μg/g).

Results
Of 405 patients at baseline (median age: 70 years), 11 patients (2.7%) died and follow-up was conducted in 356 patients (87.9%). During 18 months, 136 all-cause hospitalizations occurred in 96 patients (23.7%), of which 103 (75.7%) were acute, occurring in 74 patients (18.3%). Forty-one hospitalizations (30.1%) in 28 patients (6.9%) were IBD-related. The number of impaired domains at baseline was independently associated with mortality (p=0.001, B=2.76), all-cause hospitalisation (p=0.016, B=1.28) and acute hospitalisation (p=0.02, B=1.3), but not with IBD-related hospitalisation (p=0.06, B=1.37). On domain level, mortality was associated with impaired mental- (p=0.002, B=8.9) and physical domains (p=0.006, B=9.5), all-cause hospitalisation with an impaired somatic domain (p=0.002, B=2.13), and acute hospitalisation with an impaired somatic domain (p=0.02, B=2.49).

Conclusion
Geriatric impairments in geriatric assessment are independently associated with adverse outcomes in older patients with IBD, including an increased risk of mortality, all-cause and acute hospitalizations. Therefore, this study provides the first prospective evidence for the predictive value of the geriatric assessment, enhancing risk stratification in older patients with IBD.
P259 Clinical characteristics and long-term disease course in patients with Crohn’s disease diagnosed by video capsule endoscopy; A retrospective multicentre matched case-control study
Authors: Bae J H , Park S H , Kim K O , Jang B I , Lee M R , Park J B , Baek J E , Hong S W , Hwang S W , Yang D H , Ye B D , Byeon J S , Myung S J , Yang S K , Kim E S , Park S H 
Published: January 2024

Abstract

Background
Video capsule endoscopy (VCE) is a non-invasive and accurate diagnostic modality that allows for direct visualization of the small intestinal mucosa in Crohn’s disease (CD). In rare cases, lesions not detected by other diagnostic modalities in patients suspected to have CD are solely identified through VCE. We aim to evaluate the clinical characteristics and long-term outcomes of these rare cases.

Methods
A retrospective multicentre matched case-control analysis was conducted in patients with CD across three hospitals in Korea, from January 2007 to April 2023. To perform a matched case-control study, we defined cases (VCE group) as patients with normal findings at colonoscopy and cross-sectional imaging, ultimately diagnosed with CD by VCE; the controls were patients with CD diagnosed with specific findings at endoscopy or cross-sectional imaging (non-VCE group). Controls were matched to cases with a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis. Clinical characteristics and outcomes between the two groups were compared.

Results
Of the 3,137 patients diagnosed with CD during the study period, 24 were diagnosed solely by VCE. When compared to 72 matched patients with CD, the mean duration from symptom onset to diagnosis did not significantly differ (27.2 months [SD 10.2] vs. 25.3 months [SD 8.9], p=0.394). There was a significant difference in the proportion of Montreal behaviour (p&lt;0.001). In the VCE group, non-stricturing and non-penetrating (B1) type and stricturing (B2) type accounted for 91.7 and 8.3%, respectively. However, there was no significant difference in the perianal fistula modifier (25% vs. 33.3%, p=0.446). Within the VCE group, 45.8% underwent the examination due to abdominal pain with diarrhoea, followed by 25.0% with perianal disease, and 20.8% with unexplained iron deficiency anaemia. Regarding capsule findings, the ileum was mostly involved (87.5%), while the jejunum and duodenum were affected in 70.8 and 16.7% of cases, respectively. Fifteen patients had two or three segments affected. The Median Lewis score was 838 [IQR 393–1803]. Concerning the cumulative incidence of clinical outcomes over 10 years, complicated behaviour, need for biologics, and CD-related hospitalization and surgery were all significantly lower in the VCE group than in the non-VCE group (p&lt;0.005).

Conclusion
Patients diagnosed with CD solely by VCE are rare. In this study, they exhibited different clinical characteristics and a more favourable long-term disease course compared to the general population of patients with CD. This included a lower incidence of complicated behaviour, reduced need for biologics, and CD-related hospitalization and surgery.
P262 Differences in the Management and Demographics of Adult Inflammatory Bowel Disease in Older-Onset and Younger-Onset
Authors: Kivrakoğlu F , Kilic V , Ergin M , Kucuk H , Yuksel I 
Published: January 2024

Abstract

Background
The goal of this study was to investigate differences in the management and demographic characteristics of older-onset and younger-onset adult patients with Ulcerative Colitis (UC) and Crohn’s Disease (CD).

Methods
We retrospectively compared the management and distinguishing characteristics of UC and CD patients who were older-onset (≥60 years) and younger-onset (18-60 years) between June 1993 and October 2023.

Results
A total of 1245 patients with 56 (4.5%) older-onset adults (Male 41, 73%) and 1189 (95.5%) younger-onset adults (Male 725, 58%) were admitted to the study. The median follow-up time was 11 years (Older-onset 6 and younger-onset 11 years) for both groups. Prevalence of UC 39 (69.6%) in the older-onset group was more common than that of younger-onset group 579 (48.7%), (p=0.002). There were no significant differences between the two disease onset groups in terms of UC extension, CD location, behavior, and perianal involvement. In younger-onset, active smokers 277 (23%) was more frequent than older-onsets 6 (10%) (p= 0.003). A family history of IBD in older onsets 2 (4%) was less common than younger-onsets 155 (13%) (p= 0.037). Prior major abdominal surgery was detected similar (Older-onset 20, 35.7% and younger-onset 464, 39%). At least one extraintestinal manifestation exist was less common in older-onsets 18 (32.1%) than younger-onsets 606 (51%) (p= 0.006). Baseline partial MAYO score 7 and CDAI 302 in older-onsets, and 297 in younger-onsets were similar in both groups.
Thiopurine usage 391 (32.9%) in younger-onsets was the most frequent than in older-onsets 9 (16.1%) (p=0.008). There was no difference in both groups in terms of other conventional medications. At least one biological experience was less common in older-onsets 15 (26.8%) than the younger-onsets group 586 (49.3%) (p=0.001). The two biological therapies that were used the most frequently were adalimumab (Older-onset; 6, 10.7% and younger-onset; 384, 32.8%) (p=0.001) and infliximab (Older-onset; 15, 26.8% and younger-onset; 586, 49.3%) (p=0.02).

Conclusion
Our study showed that the prevalence of UC in older-onsets was more common than younger-onsets. A family history, extraintestinal manifestation, thiopurine, and biological usage in older-onsets were less common than in younger-onsets. Major abdominal surgery was similar in both groups. Older-onset patients demonstrated significant differences in medication utilization, including less thiopurine and biological therapy compared with younger-onset groups, these utilization patterns may have long-term effects on disease outcomes. Further investigation is needed to optimize care pathways in the older-onset population.
P265 Factors affecting patient perception and acceptance of colonoscopy in patients with inflammatory bowel disease
Authors: Huang T Y , Liao C H , Chen Y J 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is characterized by chronic idiopathic inflammation of the gut. Colonoscopy is the mainstay procedure for managing and monitoring IBD patients. However, many patients with IBD do not comply with routine or surveillance colonoscopies, and the underlying reasons have not been determined for Asian patients with IBD. Therefore, this study analyzed IBD patients' perceptions of bowel preparation and colonoscopy procedures and attitudes toward examination intervals, using a questionnaire.

Methods
This cross-sectional study included 94 patients with IBD (41 with Crohn’s disease and 53 with ulcerative colitis) presenting at one medical center between July 2020 and May 2022. The patients’ perceptions of the four components associated with the colonoscopy procedure (embarrassment, pain, use of bowel-cleansing agents, and stress) were assessed via a questionnaire. Patients were asked to indicate the frequency at which they had scheduled a colonoscopy and the frequency at which they desired to undergo the procedure.

Results
“Bowel cleansing” and “pain” were most uncomfortable during the colonoscopy procedure. Younger age and younger age at diagnosis were associated with a greater burden of bowel preparation and painful sensations. Regarding examination intervals, male patients were more compliant with colonoscopies within shorter timeframes than female patients. Additionally, younger patients and those diagnosed at an earlier age tended to prefer longer examination intervals.

Conclusion
This study provides insights into the perception of colonoscopy in Taiwanese patients with IBD. Our findings would promote the adherence to colonoscopy and facilitate early detection of major complications in high-risk and long-term IBD patients.
P269 Harnessing Natural Language Processing for Structured Information Extraction from Radiology Reports in Crohn's Disease: A Nationwide Study From the epi-IIRN
Authors: Hazan L , Focht G , Gavrielov N , Reichart R , Friss C , Cytter Kuint R , Turner D , Freiman M 
Published: January 2024

Abstract

Background
Large-scale analyses of imaging in Crohn's disease (CD) hold promise for advancing research on the inflammatory burden in the bowel as well as developing predictive models of disease progression. However, the lack of structured human annotations in these datasets limits the ability use these for research. This study from epi-IIRN nationwide cohort, aims to develop and evaluate Natural Language Processing (NLP) algorithms for extracting structured information from unstructured radiology reports on CT and MR enterography.

Methods
We identified radiology reports of all patients diagnosed with inflammatory Bowel Disease (IBD) in the nationwide epi-IIRN cohort, which includes data from the four Israeli HMOs, covering 98% of the population. We developed an in-house NLP platform using a publicly available Hebrew pretrained BERT model. After annotating a small portion of the reports for validation, we fine-tuned the model on our dataset through a masked language task, followed by a few-shot approach based on the Next Sentence Prediction (NSP) pretraining objective for classification model fine-tuning. The platform extracts radiological indicators related to inflammation, stenosis, and location, including wall thickening, enhancement, lumen narrowing, and dilation in the following locations: jejunum, ileum, colon, sigmoid, and rectum. We validated our models using a 5-fold cross-validation experimental setup, employing accuracy, PPV, NPV, F1 score and Cohen’s kappa score as the evaluation metrics.

Results
We extracted 9,704 radiology reports (6,299 MRE, 2,405 CTE) of 7,062 IBD patients (5,972 were diagnosed with CD, and 1,076 with ulcerative colitis). The mean age on the first imaging study was 36.8±17.1 years and 52% were male. We selected 500 studies for being annotated for the radiological indicators. The most common label was wall thickening in the ileum (215 positive patients vs.285 negative) while the least common was lumen narrowing in the jejunum (1 positive patient vs. 499 negative). Table 1 summarizes the results and label distributions. The mean [95% CI] accuracy/PPV/NPV/F1/Cohen's kappa score averaged over all labels was 0.98 [0.95,1]/0.99 [0.96,1]/0.83 [0.56,1]/0.86 [0.6,1]/0.63 [0.16,1]. The labels with the highest F1/Cohen's kappa score were wall thickening, enhancement, and narrowing in the Ileum while the label with the lowest F1/Cohen's kappa score were dilation in the Colon and the Jejunum.

Conclusion
NLP methods can extract structured information from radiology reports with high accuracy. Few-shot approaches based on the Next Sentence Prediction can alleviate the need for large scale data annotation for training. NLP offers exciting possibilities for large-scale studies utilizing imaging data in CD.
P273 Defining the prognosis of children with Crohn Disease with the support of magnetic resonance enterography: a multi-center multi-reader study
Authors: Romanchuk A , Valle C , Ghirardi A , Bonaffini P A , Ippolito D , Sansotta N , Calia M , Zuin G , Sironi S , D’Antiga L , Norsa L 
Published: January 2024

Abstract

Background
Ileocolonoscopic assessment is the most accurate method for detecting intestinal inflammation in Crohn disease (CD), but it allows the assessment only of a limited tract of the small intestine and does not provide data on inflammation beyond the mucosa. The auxiliary use of magnetic resonance enterography (MRE) can overcome these limitations and allow to predict the course of CD. Paediatric Inflammatory Crohn's MRE Index (PICMI) is a multi-point index of intestinal inflammation (mucosal and transmural) in children with CD created on the basis of MRI. The aim of the present study is to assess whether this completely non-invasive index at diagnosis could predict the course of CD in children and to test the inter-reader agreement as surrogate of index reproducibility.

Methods
All children diagnosed with CD in two tertiary referral centres with a 1-year minimum follow-up were enrolled in the study. MRE at diagnosis was blindly evaluated by 3 expert radiologists and PICMI was calculated for all patients. Children’s disease was stratified according to PICMI at diagnosis into remission (&lt;10), mild (11-55), moderate (56-120) and severe (&gt;120). Inter-observer agreement among radiologist was calculated. Data at follow-up were collected at 6-8 weeks, 1 year, 3 years and 5 years after CD diagnosis. Association between PICMI at diagnosis and CD prognosis was evaluated.

Results
A total of 71 children (52 males) with proven CD were enrolled in the study and PICMI was calculated for 68. PICMI at diagnosis was stratified into remission 6 (8.8%), mild 29 (42.6%), moderate 24 (35.3%), severe 9 (13.2%). Inter-observer agreement was calculated with an intraclass correlation coefficient of 0.65 which indicates moderate reliability between the 3 raters. PICMI score at diagnosis significantly correlated with PCDAI (Paediatric Crohn's Disease Activity Index) at diagnosis (p: 0.036). Steroid-free remission at 1, 3 and 5 years was comparable between PICMI groups: remission + mild vs moderate + severe (p: 0.606). CRP and calprotectin negative steroid free remission at 1,3,5 was also comparable (p: 0.578). PICMI at diagnosis was associated with the probability of biologic introduction at 1 year: incidence rate ratio IRR: 2.17 (1.09-4.42); p=0.019, 3-year IRR: 2.12 (1.15-3.96); p=0.011, and 5 years: 2.21 (1.20-4.08); p=0.007 (figure 1).

Conclusion
PICMI score is a reliable and reproducible index to determine activity in children with Crohn’s disease. Children with more active disease at diagnosis according to PICMI have shown an increased need to progression to biologic treatment in order to gain a comparable rate of steroid free remission and inflammatory marker negativity if compared with children with lower PICMI scores.
P274 Renal failure in children with inflammatory bowel disease
Authors: Vuijk S , Klomberg R , Hellendoorn A , Kemos P , Aardoom M , Ruemmele F , Vrieling-Prince F , Croft N , de Ridder L 
Published: January 2024

Abstract

Background
Renal manifestations may occur in children with inflammatory bowel disease (IBD). The cause of renal manifestations is often unclear, but may occur as an extra-intestinal manifestation or due to IBD treatment. Renal complications can lead to acute renal failure, a severe complication and associated with a risk of developing chronic kidney disease (CKD). Current paediatric ECCO/ESPGHAN guidelines recommended to regular monitor renal function with calcineurin inhibitors. However, these recommendations are based on limited knowledge of renal manifestations in paediatric IBD. The aim of this study was to investigate the diagnosis and underlying causes of renal failure in children with IBD.

Methods
Cases of renal failure in children &lt;19 years with IBD were collected from the international, prospective PIBDSETQuality Safety Registry1. A monthly survey was sent to participating paediatric gastroenterologists throughout the world asking to report cases of renal failure within their clinical practice. Renal failure was defined as an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73m2 based on the Schwartz formula. Upon reporting a case of renal failure, a follow-up form was automatically sent to obtain more information about renal failure, IBD characteristics and outcomes (including CKD, defined as an eGFR &lt;60 for &gt;3 months).

Results
From November 2016 until August 2023, 220 gastroenterologists from 36 countries participated in the Safety Registry and 38 cases of renal failure were included. Characteristics at time of renal failure are reported in Table 1. Reported causes and diagnoses of renal failure are represented in Figure 1. Most frequently reported causes were IBD medication (n=12) and IBD itself (n=10). IBD medication included 5-ASA (n=5), tacrolimus (n=2) and one case of azathioprine or ibuprofen, vedolizumab, adalimumab, cyclosporine A and ciprofloxacin. Of the cases most likely caused by IBD itself, disease activity was remission (n=4), mild (n=2), moderate (n=3) or severe (n=1). In the majority of cases (n=26, 68%) creatinine was measured during routine follow-up, and not due to kidney-related symptoms. In 13/37 patients creatinine remained elevated after a median follow-up of 82 weeks [41-136 weeks]. Nine patients developed CKD, two patients required renal replacement therapy.

Conclusion
This is the first prospective study to report cases of renal failure in children with IBD. Renal failure can occur without symptoms, and may lead to CKD. Timely identification of cases of renal failure is important to adequately treat and monitor patients. We recommend to monitor creatinine in all children with IBD, independent of drug use, every 6 months.

References
1. Aardoom et al. BMJ Open. 2020