bluuebunny/crossref_metadata_2025_split huggingface dataset:
P412 Faecal Calprotectin as a predictor of endoscopic and histologic remission in patients with Ulcerative Colitis
Authors: Drügg Hahn G , Flores C , Afif W , Wild G , Bitton A , Lakatos P L , Bessissow T 
Published: January 2024

Abstract

Background
Faecal calprotectin (FCP) is a reliable surrogate marker for disease activity in ulcerative colitis (UC). However, there are no consensus cut-off values for histoendoscopic remission. The aim of the study is to correlate FCP with Mayo Endoscopic Score (MES) and histological disease activity (Geboes score) of UC patients in clinical remission.

Methods
We performed a prospective study including adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission (partial Mayo score ≤2) or disease relapse, undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FCP was collected. MES was documented during colonoscopy. Biopsies were taken throughout the colon and histological activity was assessed using Geboes score (GS) by a blinded expert gastrointestinal pathologist.

Results
The study included 253 patients, of which 117 (46%) were male with a mean age of 38.2 years (standard deviation [SD] ± 24.8). 46% of the patients had pancolitis at the time of colonoscopy. 5-aminosalicylate were used by 68.4% of patients while 20.9% were on immunomodulators, 19% on biologics and 0.4% on small molecules as treatment. Regarding endoscopic correlation, it showed that an FCP ≥ 200 μg/g predicts MES &gt; 1 despite clinical remission, yielding sensitivity of 59% and specificity of 74%. A FCP ≥ 123 predicts MES &gt; 0 despite clinical remission (58% sensitivity and 70% specificity), also aiding to differentiate MES 0 from MES 1 (61% sensitivity and 70% specificity). As to histologic correlation, a FCP ≥ 80 μg/g identified histological disease activity using Geboes criteria (GS score &gt; 3.1) in patients with clinical remission, yielding 64.7% sensitivity, 58.7% specificity and 77% positive predictive value (Figure 1). When using a GS score threshold of &gt; 2, a cut-off value of FCP ≥ 50 μg/g, appears to be the most clinically relevant to identify patients in clinical remission who continue to have active histologic inflammation, with an 49.6% sensitivity, 41.6% specificity and 40% positive predict value. Results are summarized in Table 1.

Conclusion
FCP correlates very well with endoscopic and histologic disease activity and can be used as a surrogate marker for disease activity. Our study prospectively demonstrated the optimal cut-off values helping to discriminate endoscopic healing and histologic remission.
P415 The influence of bowel urgency on the quality of life in individuals with ulcerative colitis
Authors: Karakan T , Dede A , Özgül S , Karataş A , Cindoruk M 
Published: January 2024

Abstract

Background
Ulcerative colitis (UC) is a persistent inflammatory condition marked by periods of relapse and remission, significantly impacting overall quality of life (QoL). Among the various symptoms influencing this quality, bowel urgency (BU) stands out as particularly distressing. BU manifests with profound negative implications on physical health, psychological well-being, and social aspects. Furthermore, bowel urgency (BU) is often omitted from the majority of disease activity scoring systems and is not consistently considered as a treatment outcome. Our objective was to explore the impact of BU on specific subgroups of QoL measures and its correlation with the partial Mayo score.

Methods
During this cross-sectional study, patients were categorized based on both BU and the concurrent partial Mayo score. The patients completed the Whoqol Bref questionnaire for assessing their QoL. Long-term outcomes, such as steroid use, hospitalization and colectomy, were evaluated at the 6-month follow-up.

Results
The study included 154 patients diagnosed with UC. When comparing BU with the partial Mayo score in terms of QoL, significant differences were found in the physical health domain (p&lt;0.001), psychology domain (p&lt;0.001), social relationship domain (p&lt;0.014), and environmental domain (p&lt;0.001). Among patients in remission according to the partial Mayo score (25/117, 21.3%), a notable proportion experienced bowel urgency (BU). BU was identified as a predictor for both steroid requirement (OR: 4.7; 95% CI [2.3-9.7], p&lt;0.001) and hospitalization (OR: 4.7; 95% CI [2.3-9.7], p&lt;0.001) during the six-month follow-up period. None of the patients required surgical intervention. Notably, even among patients in remission according to the partial Mayo score (25/117, 21.3%), bowel urgency (BU) persisted.

Conclusion
We noted that the existence of BU significantly impairs the quality of life for individuals with UC. Moreover, it is associated with an increased probability of future steroid use and hospitalization. Notably, some patients still experienced BU even while in remission. Further investigations are necessary to elucidate the mechanisms contributing to the persistence of these symptoms in these individuals.
P417 1 year follow-up of pediatric ulcerative colitis using intestinal ultrasound
Authors: Thornton S , Isaac D , Hudson A , Mckay D , Kuc A , Carroll M , Wine E , Huynh Dr H 
Published: January 2024

Abstract

Background
Intestinal ultrasound (IUS) is an emerging tool that offers a non-invasive method for monitoring inflammatory bowel disease in pediatric patients, with increasing popularity worldwide. Assessment of IUS for monitoring pediatric Ulcerative Colitis (UC) has been limited to small samples of patients with no long-term follow up. Our aim is to utilize intestinal ultrasound assessments obtained at routine time points to determine changes in IUS parameters within 12 months of study enrollment in newly diagnosed children with UC, and their relationship to biochemical markers, clinical assessments, and endoscopic findings.

Methods
Pediatric patients with suspected ulcerative colitis were prospectively enrolled through the Edmonton Pediatric IBD Clinic. Participants underwent IUS, clinical assessments, bloodwork for biomarkers, and fecal calprotectin (FCP) testing at baseline, 1-, 3-, 6-, and 12-month visits, as well as endoscopy at baseline and 6-12 months. In each IUS assessment, the bowel wall thickness (BWT), presence of hyperemia, abnormal haustrations, and fat wrapping was determined in 4 bowel segments (right, transverse, descending, and sigmoid colon). The Pediatric Ulcerative Colitis Activity Index (PUCAI) scores and Ulcerative Colitis Intestinal Ultrasound Scores (UC-IUS) were calculated at each visit.

Results
42 patients (55% male) were included. Median UC-IUS total scores and BWT alone improved in all bowel segments over the study period. For the most affected bowel segment for all patients, median percent reduction of BWT was 39.6%, 34.2%, 33.7%, and 42.5%, at the 1-, 3-, 6-, and 12-month assessment respectively. The biggest decrease in UC-IUS scores and BWT occurred with the initiation of therapy between baseline and 1-month. UC-IUS scores significantly correlated with endoscopy at 12-months, clinical assessments at all time points, and biochemical markers of disease at all time points over the 12-month study period (p&lt;0.05). BWT measurement alone also had significant correlation with endoscopy at 12 months; clinical assessment at 1-, 3-, and 6-months; and with biochemical markers at every time point (p&lt;0.05). Patients with inflammatory bowel markers (indicated by elevated FCP (&gt;250)) at 12-months were found to have significantly thicker BWT and UC-IUS scores at 3- and 6-months.

Conclusion
BWT and UC-IUS performed well in pediatric patients with newly-diagnosed UC, with UC-IUS scores and BWT measurements alone correlating significantly with endoscopic, clinical, and biochemical disease activity over the 12-month study period. BWT alone performed similarly to total UC-IUS scores. This data suggests that IUS can offer a non-invasive method to monitor long-term pediatric UC disease severity.
P418 Lipopolysaccharide-Binding Protein (LBP) in Crohn's Disease (CD) Patients: A Promising Non-Invasive Biomarker Monitoring Disease Activity
Authors: Minsart C , Toris L , Husson C , Franchimont D , Liefferinckx C 
Published: January 2024

Abstract

Background
Current biomarkers of inflammatory bowel disease (IBD) monitoring (serum C-reactive protein (CRP) and faecal calprotectin (FC)) have limitations in terms of specificity (SP) and sensitivity (SE), especially for Crohn’s disease (CD) patients. Lipopolysaccharide-binding protein (LBP) is a soluble acute-phase protein and is thought to partly reflect intestinal permeability by binding to bacterial lipopolysaccharides. The search for new biomarkers to monitor disease activity would improve the management of IBD patients.

Methods
This is a retrospective study including 69 IBD patients (43 CD and 26 ulcerative colitis (UC)) and 21 healthy controls (HC). Serum LBP levels were measured by enzyme-linked immunosorbent assay. Clinical, biological and endoscopic parameters were analysed for IBD patients. Statistical tests, including nonparametric tests and receiver operating characteristic (ROC) curve analysis, were used to evaluate the diagnostic accuracy of LBP.

Results
Demographics and baseline data of the overall cohort is presented in Table 1. IBD patients displayed a significantly higher LBP median (29.6 µg/mL [19.8-38.8] in CD and 22.8 [13.7-38.8] in UC) than HC (5.5 [4.4-6.5], P &lt; 0.001) with no overlapping distributions, a finding supported by an AUC of 0.997 and 0.989, respectively for CD and UC patients (Figures 1A).
In CD patients, LBP levels gradually increased with endoscopic severity, demonstrating a 1.7-fold rise in active patients compared to remitter patients (P=0.02) (Figure 1B). LBP levels were higher in Montreal B1 compared to B2 and B3 CD patients (P &lt; 0.001) (Figure 1C). Overall, a robust correlation was observed between LBP and CRP (ρ=0.75, P &lt; 0.001). The correlation increased upon the exclusion of cases with normal CRP levels but active endoscopic disease (ρ=0.79, P &lt; 0.001). In those endoscopically active patients with normal CRP, LBP level was higher than in remitter patients (34.3 [29.4-37.6] vs 19.1 [10-24.7], P=0.01) with a discriminative cut-off of 25 µg/mL (SE of 100%, SP of 89%).
Likewise, LBP level exhibited a positive correlation with FC (ρ=0.42, P &lt; 0.01) which was further strengthened after excluding cases where FC measurements did not align with endoscopic activity (ρ=0.53, P &lt; 0.01). The median LBP for those patients was 25.6 [18.5-31.5], reflecting again the interest of LBP measurement to evaluate CD activity when FC lacks sensibility.

Conclusion
Our study suggests that LBP might be a promising non-invasive biomarker for monitoring disease activity, especially in CD patients. Furthermore, in clinical situations where current biomarkers (CRP and FC) lack sensitivity for assessing disease activity, LBP could be discriminative and help filling the gap for reliable therapeutic decisions.
P420 Natural history of intra-abdominal inflammatory masses (phlegmons) in Crohn’s disease
Authors: Djalal A , Sehgal P , Shenoy S , Benson C , Rajauria P , Agrawal M , Colombel J F , Lewis J , Ungaro R 
Published: January 2024

Abstract

Background
Intra-abdominal inflammatory masses (phlegmons) are a feature of penetrating Crohn’s disease (CD). However, there are few data on the natural history and outcomes of inflammatory masses in CD. We aimed to describe clinical outcomes and predictors of surgery in individuals with CD and intra-abdominal inflammatory masses (IAIM).

Methods
We conducted a multi-center retrospective cohort study. Patients with a diagnosis of CD or inflammatory bowel disease unclassified (IBD-U) and a finding of phlegmon, phlegmonous change or inflammatory mass on cross-sectional imaging with IV contrast (MR or CT) at two tertiary care centers were included between July 2006 and April 2023. Data collected included demographics, clinical characteristics, Montreal CD classification, treatments at the time of and after IAIM diagnosis, and size and location of the IAIM. Primary outcome was surgery defined as any CD-related resection or surgical drainage. Bivariate comparisons between patients who did or did not undergo surgery were performed. Multivariable logistic regression was performed with backward selection of variables to identify those associated with surgery.

Results
A total of 100 patients were included, and comparison between those who did or did not undergo surgery is given in Table 1. Most were white (80%), 44% were women, and 12% were current smokers. A majority had ileocolonic disease location (77%) and 50% were on a biologic at time of diagnosis. Mean size of IAIM was 3.4 cm and the majority (72%) were located adjacent to small bowel. Radiologic evidence of intra-abdominal fistula was seen in 40%, and 30% of patients had a stricture adjacent to the IAIM.
A large proportion required hospitalization (75%) and received intravenous antibiotics (64%); 13% progressed to an abscess, and the mean (SD) time to abscess was 108 (119.4) days. The majority (65%) underwent surgery, with a mean (SD) time to surgery of 59 (97.8) days. Seven patients developed sepsis, all of whom subsequently required surgery. On multivariable analysis, patients were more likely to require surgery if there was a concomitant stricture (aOR = 3.12, 95% CI 1.01 – 11.9) and less likely to require surgery if treated with steroids (aOR = 0.15, 95% CI 0.03 – 0.61). Antibiotic use was not associated with surgery (aOR 1.22, 95% CI 0.53 – 2.81) nor was IAIM size.

Conclusion
In this large retrospective cohort, most intra-abdominal inflammatory masses required surgery, particularly if there was a concomitant stricture. Patients treated with steroids were less likely to require surgery though this may be confounded by severity of disease.
P427 Inflammatory bowel disease after liver transplantation: a retrospective cohort study from Latin America
Authors: Penna F G C E , Bayma L R , Azzi L L M , Faria A A D , Campos J F , Ferrari M D L D A , Daguer F B R , Azevedo M F C D , Carlos A D S , Cançado E L R , Terrabuio D R B , Damião A O M C , Barros L L 
Published: January 2024

Abstract

Background
The management of inflammatory bowel disease (IBD) in the setting of liver transplantation (LT) is a significant challenge. Previous data have described conflicting results on the incidence of relapses, risk of colectomy and post-transplant prognosis. In addition, there is no guidelines to recommend specific immunosuppressive regimens in this scenario. Our aim is to describe the IBD course in a cohort of liver transplanted patients in Latin America.

Methods
Medical records from two quaternary centers were reviewed using informatics tools to identify patients with Crohn’s Disease (CD) and Ulcerative Colitis (UC), associated with LT, from January 2010 and July 2023. Data on demographics, IBD phenotype, immunosuppressive therapy and infections were extracted.

Results
Among 1,683 patients that underwent LT, 45 had concomitant IBD diagnosis. Most for them (55%) were diagnosed with IBD prior to the LT. The median age at IBD diagnosis was 45 years and 57% were male. The majority had UC (80%). The causes of LT were primary sclerosing cholangitis in 24 (53.3%) patients, overlapping with autoimmune hepatitis (AIH) in 15 (33.3%), isolated AIH in 9 (20%), AIH with or without primary biliary cholangitis (PBC) in 4 (8.8%), viral hepatitis in 3 (6,6%) and other causes in 2 (4.4%) patients. Regarding immunosuppression, 19 (42.2%) patients were treated with tacrolimus, 10 (22.2%) with tacrolimus and mycophenolate mofetil, 8 (17.7%) with tacrolimus and azathioprine, 3 (6.6%) tacrolimus and everolimus, 3 (6.6%) with mycophenolate mofetil and cyclosporine, 2 (4.4%) patients with cyclosporine monotherapy. Before LT, 13 (28.8%) patients were treated with aminosalicylates and/or thiopurines, while 2 (4.4%) of them were on biologics. After LT, 20 (44.4%) patients required biological therapy, 11 (24.4%) were treated with anti-TNF (infliximab and adalimumab), 5 (11.1%) with vedolizumab, 3 (6.6%) with ustekinumab and 1 with tofacitinib. Seven (15.5%) patients required total colectomy for refractory disease, 75% after LT. Sixteen (35.5%) patients developed serious infections and the most frequent were cholangitis and cytomegalovirus (68.7%). Two patients developed adverse events, such as infliximab-induced autoimmune hepatitis and thrombocytopenic purpura related to the tacrolimus. Eight (17.7%) patients had malignancies, 3 of them related to the baseline conditions such as hepatocellular, gallbladder carcinoma, colorectal cancer, while 4 patients died during the follow-up.

Conclusion
In our experience, IBD patients undergoing LT exhibited an aggressive disease course and required concomitant biological therapy, despite the ongoing immunosuppressive regimens.
P429 Explainable AI identified metabolome and diet interactions in the blood and faceal samples
Authors: Acharjee A , Onwuka S , Bravo L , Gkoutos G 
Published: January 2024

Abstract

Background
Background: Inflammatory Bowel Disease (IBD) represents a multifaceted condition that can be characterised by the interplay of four primary elements: immunity, genetics, microbiome and environmental factors. Among these, the relationship between nutrition and the metabolome is pivotal and a number of machine learning based approaches have been developed in an effort to gain a better understanding of this relationship. Nevertheless, to date, these approaches suffer from interpretability, thereby restricting their practical applicability within clinical settings.Hence, in this study, we leverage two publicly available datasets, the UK Biobank (UKB) and the Human Microbiome Project Phase II IBD Multi’Omics Database (HMP2), to perform metabolomics-based IBD disease predictions. We apply explainable an AI (XAI) based framework to understand these predictions and explore the diet-metabolite relationships in IBD and non-IBD individuals.

Methods
4,137 plasma samples (2,099 IBD, 2,038 non-IBD) from UKB and 546 fecal samples (411 IBD, 135 non-IBD) from HMP2 with complete dietary data were used in the analysis. Random forest classification, optimized by grid search and estimator retraining was then trained to predict disease with Shapley Additive exPlanations (SHAP) included downstream to generate further insight on the model’s predictions. Finally, diet-metabolite associations were examined using Spearman-based correlations.

Results
From the plasma dataset, inflammatory markers, HDL and LDL cholesterols and omega 3 fatty acids were identified in relationship with IBD diagnosis. Within the feces samples, the discriminatory metabolites identified included B vitamins, phospholipids, urobilin, and taurine, and these latter provided a better predictive power than the plasma derived biomarkers (AUC: fecal 0.90.(95% CI: 0.84-0.96), plasma 0.66 (95% CI: 0.61-0.71). Regarding diet contribution, fish, fruit, vegetables, and processed foods exhibited a strong correlation with metabolites in both datasets, with correlations in fecal samples exhibiting a stong difference between IBD and non-IBD patients.

Conclusion
While this study has certain limitations, these results suggest that, compared to healthy individuals, IBD patients are characterised by a distinct gut profile primarily influenced by diet. It also suggests that disease, or health, influences how the gut responds to food intake. Future studies should confirm these findings using XAI and analysing both gut and blood matrices in same individuals along with their dietary intake for personalized IBD therapy development.
P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype
Authors: Avellaneda N L , Pellino G , Maroli A , Tottrup A , Bislenghi G , Colpaert J , D'Hoore A , Giorgi L , Juachon P , Harsløf S , de Buck Van Overstraeten A , Olivera P , Gomez J , Holubar S , Lincango Naranjo E , Steele S , Merchea A , Shacker A , Marti Gallostra M , Kraft M , Kotze P G , Yuki Maruyana B , Wexner S , Garoufalia Z , Zhihui C , Hahnloser D , Rrupa D , Buskens C , Haanappel A , Warusavitarne J , Williams K , Christensen P , Spinelli A 
Published: January 2024

Abstract

Background
Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease.

Methods
A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study.

Results
2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: &lt; 0.001), and low albumin (11.3 vs. 2.6%, p: &lt; 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: &lt; 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030).

Conclusion
Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.