bluuebunny/crossref_metadata_2025_split huggingface dataset:
P468 Relevance of anti-drug antibodies in context of supra-therapeutic anti-TNF concentrations
Authors: Kim J , Walshe M , Borowski K , Milgrom R , Stempak J , Lee S H , Croitoru K , Silverberg M S 
Published: January 2024

Abstract

Background
The low serum concentration of anti-tumor necrosis factor-alpha (anti-TNFα) agents and the presence of anti-drug antibodies are related to poor therapeutic outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the prognosis of patients having both antidrug antibodies and supratherapeutic drug concentrations.

Methods
IBD patients on maintenance infliximab (IFX) or adalimumab (ADA) therapy were prospectively recruited. Serum drug concentrations and antidrug antibodies were measured (Anser, Prometheus). The drug concentrations were classified as subtherapeutic (IFX: &lt;3 µg/mL; ADA: &lt;5 µg/mL), therapeutic (IFX: 3-8 µg/mL; ADA 5-10 µg/mL), and supratherapeutic (IFX &gt; 8 µg/mL; ADA &gt; 10 µg/mL) concentrations regardless of the timing of blood sample collection. We analysed the relationship between i) drug concentrations and ii) the presence and absence of anti-drug antibodies with use of systemic corticosteroids and anti-TNF discontinuation.

Results
Of 172 patients (122 CD [70.9%], 44 UC [25.6%], 3 IBD-U [1.7%], and 3 IBD-pouch [1.7%]), the median age was 32.3 years (range, 24.8-42.5), and the median duration of IBD was 9.7 years (range 5.3-15.6). IFX and ADA were used in 81 (47.1%) and 91 (52.9%) patients, respectively, and concurrent usage of immunomodulators and systemic corticosteroids was observed in 39 (22.7%) and 23 (13.4%) patients, respectively. Supratherapeutic, therapeutic, and subtherapeutic concentrations were observed in 74 (43.0%), 32 (18.6%), and 66 (38.4%), respectively. The patients with antidrug antibodies (n = 79, 45.9%) showed a higher frequency of having subtherapeutic drug concentrations (68.4% vs 12.9%, P &lt; 0.001) compared to those without antibodies, and the presence of antibodies was an independent predictor of discontinuation of anti-TNFα agents (hazard ratio 3.50, 95% confidence interval 1.88-6.51, P &lt; 0.001, Fig. 1A). In subgroup analysis, patients with antidrug antibodies and supratherapeutic drug concentration exhibited a tendency to have improved drug persistence compared to those with subtherapeutic drug concentration, albeit insignificantly (P = 0.099, Fig. 1B). However, the persistence in this group was still poorer than that observed in patients without antibodies (P = 0.003). Finally, neither anti-TNFα concentrations nor the presence of antidrug antibodies were associated with the need for additional systemic corticosteroid use within 6 months.

Conclusion
The presence of antidrug antibodies can predict the discontinuation of anti-TNFα agents despite supratherapeutic drug levels. While supratherapeutic drug concentration may improve the treatment persistence of anti-TNFα agents in patients with anti-drug antibodies, it does not last as long as in those without antibodies.
P474 IBD-Disk : Towards validating the classical Arabic version of the questionnaire ?
Authors: Elleuch N , Kallel H , Limam R , Dahmeni W , Hammami A , Braham A , Ben Slama A , Jaziri H , Ksiaa M 
Published: January 2024

Abstract

Background
The IBD-Disk is a validated 10-question, self-administered visual questionnaire used to assess the inflammatory bowel disease (IBD) related disability. It has been translated into several languages and validated in different populations since its emergence. The aim of our study is to explore the internal consistency and item reliability of the IBD-Disk in its classical Arabic version, and to analyze the strength of correlation between each item and the sum of the scale.

Methods
We conducted a monocentric cross-sectional study including IBD patients. All individuals completed the IBD-Disk questionnaire in classical Arabic. The internal consistency of the IBD-Disk was assessed using Cronbach's alpha between item combinations. A value &gt; 0.70 was considered acceptable, &gt; 0.80 good, and &gt; 0.90 excellent. Cronbach's corrected correlation was assessed using Pearson's correlation coefficient.

Results
We included 166 patients, 53.6% were men and 69.3% had Crohn's disease. Median age was 38 years [30 - 48]. The mean total score was 36.4 ± 21.0. The "Energy", "Emotions" and "Education & work" items had the highest scores (4.9 ± 2.9, 4.7 ± 3.1, and 4.4 ± 3.2 respectively). Including the 10 items of the IBD-Disk scale, a value of 0.913 95% CI [0.893-0.932] was observed for Cronbach's alpha, demonstrating good reliability between the different sub-scores. By performing the removal procedure one by one, Cronbach's alpha varied between 0.902 and 0.915, confirming that all items contribute to the construct. In addition, all items showed a Cronbach corrected correlation between each item and the rest of the scale r &gt; 0.4, p&lt;0.001. Energy showed the highest correlation (r=0.751), and joint pain the lowest (r=0.506) (Table 1). Also, Cronbach's alpha was positive for every pair of IBD-Disk items at the start of the study. The item pairs that showed the best correlation were [Abdominal pain - Regulating defecation], [Energy - Regulating defecation] and [Energy - Sleep]. In contrast, the item pairs that were least interconnected were [Abdominal pain - Joint pain], [Interpersonal interaction - Joint pain] and [Body image - Joint pain] (Table 2).

Conclusion
Our work has demonstrated excellent item homogeneity in the classical Arabic version of the IBD-Disk, and a good correlation between each item and the remaining total score. However, a prospective measurement of the intra-class correlation coefficient of the classical Arabic version will be necessary to assess its reproducibility over time.
P489 Systematic review and meta-analysis of the accuracy of computer-aided diagnosis in identifying endoscopic remission in Ulcerative Colitis
Authors: Gautham A , Kader R 
Published: January 2024

Abstract

Background
Endoscopic remission (ER), the absence of active inflammation during endoscopy, is a key therapeutic target in Ulcerative Colitis (UC). ER is assessed during colonoscopy using standardised scoring systems. However, there remains significant inter-operator variability in assessing ER, for which the application of computer-aided diagnosis (CADx) could be a potential solution. A previous systematic review and meta-analysis on this topic was limited to literature up to June 2022 and did not assess the methodological quality of studies or heterogeneity amongst results. We aimed to update this review.

Methods
Searches were performed on six electronic databases and relevant reference lists up to May 2023. Data was extracted and screened independently by two reviewers. Methodological assessment was performed using the QUADAS-2 tool. An ‘image selection’ domain was added to the tool given the importance of endoscopic image quality in training and testing data on CADx’s accuracy. Meta-analysis was performed using a bivariate model. Heterogeneity was assessed through visual inspection of forest plots and receiver-operating characteristic curves, subgroup analyses and meta-regression. The overall quality of evidence was assessed using GRADE methodology.

Results
17 studies (16 full-text articles and one abstract) were identified. 15 studies adopted a cross-sectional design. All studies used expert endoscopists scoring of ER as the reference standard. The Mayo Endoscopic Score was the most commonly used scoring system (13/17). CADx assessed ER in real-time in one study, but was applied to images and videos obtained from previous endoscopic procedures in all other studies. Inception-v3 was the most common CADx system used (6/17). ‘Patient selection’ was the domain of greatest concern due to a considerable number of studies using images from the same public database and under-reporting participant characteristics. All studies had a low risk of bias (ROB) in the ‘image selection’ domain. One study was deemed overall high ROB, and two were deemed overall unclear ROB. Sensitivity analysis was performed by removing these studies and the abstract, and pooled estimates were obtained from the remaining 13 studies. CADx had a pooled sensitivity of 90.3% and specificity of 94.6% for diagnosing ER. The overall quality of evidence was moderate due to the failure of a significant proportion of studies to report sufficient participant characteristics.

Conclusion
There is moderate quality evidence that CADx has high sensitivity and specificity for diagnosing ER in pre-clinical studies. Further evaluation is required in randomised controlled trials to evaluate its efficacy in real-time and human-computer interactions.
P495 Comparative characteristics of joint damage and entheses of the upper and lower extremities in patients with inflammatory bowel diseases
Authors: Gainullina G , Kirillova E , Odintsova A , Abdulganieva D 
Published: January 2024

Abstract

Background
The aim of study was to compare the incidence of joint damage and entheses of the upper and lower extremities in patients with inflammatory bowel diseases (IBD).

Methods
95 IBD pts were prospectively enrolled into the study: 55 pts with ulcerative colitis and 40 - with Crohn's disease. The average age of pts was 32 (26; 37) years. The average duration of the disease was 48 (12; 96) months. Using ultrasound, each pt was examined 14 joints and 68 enthesis of the upper and lower extremities. The vascularization was detected in the power Doppler mode. The presence of synovitis was established by detecting the proliferation of the synovial membrane and/or effusion in the joint cavity. Inflammatory (enthesis hypoechogenicity, enthesis thickening, presence of vascularity) changes in enthesis were also performed by ultrasound imaging.

Results
According to the results of ultrasound of the joints, synovites were detected in 41 pts (43%), including synovites with vascularization in 29 pts (31%). Synovites were most often detected in the ankle joints - in 28 pts (29%). Synovites with vascularization were most often detected in the elbow joints - in 11 pts (12%), in the wrist joints - in 11 pts (12%), in the knee joints - in 10 pts (11%). When comparing the incidence of lesions of the joints of the upper and lower extremities, it was found that synovites were more often observed in the joints of the lower extremities - in 42 pts (44%) than in the upper extremities - in 33 pts (35%). However, differences did not reach statistical significance (p=0.23).
Enthesites were found in 72 pts (76%), including vascularized enthesites in 35 pts (37%). The most common enthesites were pes anserinus enthesitis in 42 pts (44%) and medial collateral ligament of the knee joint in 37 pts (39%). The most common enthesitis with vascularization was medial collateral ligament of the knee joint - in 24 pts (25%). Comparing the incidence of enthesis lesions of the upper and lower extremities, it was found that enthesites and enthesites with vascularization were significantly more often observed in the lower extremities (p=0.00, p=0.0001, respectively).

Conclusion
Pts with IBD had a higher incidence of lower extremity joint involvement, although the differences did not reach statistical significance. Entheses were significantly more often affected in the lower extremities.
P499 Anorectal Motility Disorders In Inflammatory Bowel Disease Patients
Authors: Costache R E , Dimitriu A , Gheorghe C 
Published: January 2024

Abstract

Background
In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients.

Methods
We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol

Results
We studied 30 patients (18 patients with Ulcerative Colitis and 12 patients with Crohn’s Disease, 18 females and 12 males, mean age 40 (±12.85) years. Only 33% (10 patients) had rectal active involvement. Symptoms were reported by 87% (26) patients: anal incontinence (85%), difficult evacuation (35%) and urgency (46%); rectal inflammation was not correlated with the presence of symptoms in our study group (p=0.28). Perianal surgical interventions didn’t represent a risk factor for fecal incontinence (p=0.18), or for dyssinergic defecation (p=0.1). Modified manometric parameters were found in 23 patients (79%). Low resting pressures were registered in 48% of patients; 55% of them presented low squeeze pressures; during push maneuvers, 34% of patients had insufficient rectal propulsive force, presenting low rectal pressures and 59% of them lacked anal canal relaxation. We performed sensibility testing on 18 patients: 9 patients presented criteria for hypersensitivity, hence reduced rectal compliance; 7 patients presented rectal hyposensitivity, while only 2 patients had normal rectal sensation. Recto-anal inhibitory reflex (RAIR) was present only in 28% of the patients, reflecting the dysfunction of the enteric neural system.

Conclusion
Patients with inflammatory bowel disease (IBD) have significantly higher rates of functional anorectal disease. Therefore, pelvic floor investigation is an essential tool in the investigation and management of IBD patients with ongoing symptoms not thought to be related to an IBD flare.
P526 Handsewn versus Stapled Ileocolic Anastomosis for Crohn's: Comparable Outcomes Despite More Severe Disease Profile in the Handsewn Group
Authors: Alipouriani A , Uchino T , Erozkan K , Lipman J , Hull T , Steele S R , Holubar S 
Published: January 2024

Abstract

Background
Stapled anastomosis is the most common anastomotic method after ileocolic resection for Crohn's disease, whereas handsewn end-to-end (HS-ETE) anastomosis is less frequently performed. The optimal technique for ileocolic anastomosis in Crohn's patients remains controversial. Some studies have suggested potential benefits of HS-ETE over SSTS, including lower recurrence rates, whereas others have found no difference. We aimed to compare short-term postoperative outcomes and long-term recurrence-free survival between the HS-ETE and SSTS groups at our center.

Methods
This retrospective study included consecutive patients who underwent ileocolic resection for Crohn's disease between 2012-2022 with either HS-ETE or SSTS anastomosis. The primary outcomes were perianastomotic recurrence and need for surgical/endoscopic intervention. Cox regression and Kaplan-Meier curves were used to compare recurrence-free survival.

Results
A total of 764 patients were included: 162 (21%) with HS-ETE and 602 (79%) with SSTS anastomosis. The median age of the HS-ETE and SSTS groups was 39 and 38 years, respectively. Males comprised 43% of the HS-ETE group and 51% of the SSTS group. The median BMI was 24 kg/m2 in both groups. The HS-ETE group had a longer median disease duration (10 vs. 7 years, p=0.02) and a higher rate of previous abdominal surgery (35% vs. 22%, p=0.01) than the SSTS group did. The ileocolonic location (78% vs. 66%, p=0.03) and perforating disease (45% vs. 35%, p=0.04) were also more common in the HS-ETE group. The median operative time (207 min vs. 147 min, p&lt;0.001) and estimated blood loss (150 mL vs. 75 mL, p&lt;0.001) were greater in the HS-ETE group. There were no differences in 30-day outcomes between the groups. Perianastomotic recurrence rates were similar between the HS-ETE and SSTS groups (29.6% vs. 28.9%, p=0.93). The 5-year recurrence-free survival rates were also comparable (HS-ETE, 56.4% vs. SSTS, 59%; p=0.94). Also, we found that the risk of requiring surgical or endoscopic intervention for recurrence between HS-ETE and SSTS was comparable (HS-ETE, 65.2% vs. SSTS, 74.2%; p=0.273)

Conclusion
Although the HS-ETE group had worse baseline disease characteristics, including longer disease duration, higher previous surgery rates, and more aggressive disease location and behavior, HETE and SSTS anastomosis after ileocolic resection for Crohn’s disease yielded comparable perioperative and long-term outcomes in our patient cohort.
P532 The enhanced recovery after surgery protocol take its place in inflammatory bowel disease surgery
Authors: Barugola G , Bertocchi E , Masini G , Geccherle A , Variola A , Todeschini A 
Published: January 2024

Abstract

Background
The enhanced recovery after surgery (ERAS) protocol is an evidence-based standardised multimodal programme formulated to reduce surgical stress and optimise recovery after surgery. The ERAS represents the best care practice for patients undergoing colorectal surgery. To ensure high compliance with active ERAS elements, patients must be educated to actively participate in the perioperative care pathway. ERAS protocols were originally designed to treat patients with colorectal cancer (CRC), only few studies have assessed this protocol in IBD patients. The aim of this study was to investigate the adherence to ERAS in IBD patients.

Methods
This retrospective study enrolled adult patients who underwent elective colorectal surgery and the ERAS protocol at our institute between May 2020 and December 2022. The patients were divided into IBD and non-IBD group. Data on medical history were collected from electronic health records. Preoperative, intraoperative, and postoperative data were collected for each patient using a self-reported mobile application (iColon). Adherence was calculated for at least 75% of active ERAS items. Chi-square test was used to compare categorical variables.

Results
619 patients, 492 non-IBD and 127 IBD, were enrolled. The overall adherence to ERAS protocol items was similar between the two groups (84% vs 82%, p 0.2). Adherence was evaluated during the three ERAS phases in the groups: preoperative (92% vs 90%, p 0.11), hospitalization (63% vs 62%, p 0.8), post-discharge period (96% vs 93%, p 0.2). Moreover, focusing on the preoperative ERAS items adherence, there were significant difference between non-IBD and IBD group in nutritional optimization (84% vs 67%, p &lt;0.001) but no difference were reported in the patient’s pre-habilitation adherence (74 % vs 71%, p 0.4).

Conclusion
The feasibility of ERAS protocol was good in colorectal surgery as well as in IBD surgery. We need to focus on a tailored nutritional optimization in order to improve adherence and compliance among IBD patient.
P536 Outcome of colorectal cancer surveillance in paediatric inflammatory bowel disease: Time for new guidelines?
Authors: Vermeer E , Palsma C J , Gorter R R , de Boer N K , de Jonge R , Roelofs J J , de Meij T G J 
Published: January 2024

Abstract

Background
Paediatric inflammatory bowel disease (IBD) patients have an increased risk of colorectal cancer (CRC). Current guidelines advise to conduct CRC surveillance colonoscopy eight years following IBD diagnosis, or more often in case other risk factors for CRC are present, such as previous findings of colorectal dysplasia, or a concomitant primary sclerosing cholangitis (PSC) diagnosis. However, these guidelines are based on adult data and with no regard to the patient’s age, while frequent endoscopies impose a significant burden on children. In this study, we aimed to estimate the risk of dysplasia and CRC in paediatric IBD patients before the ages of 18 and 27 years.

Methods
Using the Dutch Nationwide Pathology Databank (PALGA), we examined the incidence and prevalence of dysplasia and CRC in patients up to 27 years in all Dutch paediatric IBD patients diagnosed between 1991 and 2023. Additionally, we assessed the influence of PSC diagnosis on CRC risk.

Results
Out of the 7,873 patients with biopsy-proven paediatric IBD, 24 developed dysplasia (0.34%) and two (0.025%) developed CRC before the age of 18 years. Out of the 3,425 patients from this cohort currently aged over 26 years, eleven (0.3%) developed CRC between 17 and 27 years. Overall, 120 patients (1.5%) were diagnosed with concomitant PSC, seven (5.8%) of which developed dysplasia and two (1.6%) of which developed CRC before the age of 27 years. The median time between IBD diagnosis and CRC diagnosis was 9.5 years in this cohort. Overall, CRC incidence before the age of 27 years decreased between 1991 and 2023. Additional clinical data on IBD localisation, severity of the disease, and concomitant diagnoses could not reliably be obtained from this database.

Conclusion
In this retrospective study, we found low prevalence of dysplasia and CRC in paediatric IBD patients, both before the age of 18 years and before the age of 27 years. PSC prevalence was low in this cohort, since only biopsy-proven PSC was included. However, we showed that PSC significantly increased the risk of CRC in paediatric IBD patients. Based on our findings it could be proposed to initiate CRC surveillance beyond the age of 18 years by experienced adult gastroenterologists, except in case of a concomitant PSC diagnosis.