bluuebunny/crossref_metadata_2025_split huggingface dataset:
P317 Diagnostic accuracy of plasma calprotectin and serum calprotectin in patients with suspected Crohn’s disease
Authors: Rasmussen M H , Brodersen J B , Brasen C L , Madsen J S , Knudsen T , Kjeldsen J , Jensen M D 
Published: January 2024

Abstract

Background
Faecal calprotectin is a sensitive marker for chronic inflammatory bowel disease (IBD), and it correlates with the endoscopic disease activity. However, patient reluctance and handling in the laboratory are limitations for the clinical use, and there is a need for new reliable blood-based biomarkers. Prior studies indicate, that serum calprotectin (SCal) and plasma calprotectin (PCal) can be used as biomarkers for IBD, and SCal correlates better with disease activity in Crohn’s disease (CD) than in ulcerative colitis. The aim of this study was to investigate the diagnostic accuracy of SCal and PCal in patients examined for CD.

Methods
Patients with clinically suspected CD were enrolled in a prospective, blinded, multicentre study examining non-invasive modalities for diagnosing CD (ClinicalTrials.gov identifier NCT03134586). Patients had a standardized work-up including ileocolonoscopy, pan-enteric capsule endoscopy and blood samples within a 2-week period. EDTA plasma was prepared less than 2 hours of sampling by centrifugation at 3000 g for 15 minutes. Samples were stored in a biobank at − 80°C until further analysis. A routine C-reactive protein (CRP) was measured on the same day. SCal and PCal were analysed in batches using the calprotectin assay product nr.1201 from Gentian (Moss, Norway) on the Cobas platform (Roche, Basel, Switzerland). Analyses were performed in an ISO 15189 accredited laboratory.

Results
126 patients were enrolled in the study: 69 % women and 31 % men with a median age of 27.5 years (Table 1). A total of 57 (45%) patients were diagnosed with CD based on the result of ileocolonoscopy and pan-enteric capsule endoscopy. Patients with CD had a mean PCal of 0.50 mg/L (95% confidence interval (CI) 0.38-0.62) compared to 0.35 mg/L (CI 0.27-0.44) in non-CD patients (P = 0.03). The mean SCal was 1.45 mg/L (CI 1.20-1.69) and 1.06 mg/L (CI 0.90-1.22) in patients with and without CD, respectively (P = 0.01). Receiver operating characteristics curves showed an AUC of 0.63 (CI 0.53-0.73) for SCal and 0.61 (CI 0.51-0.71) for PCal, which was inferior to CRP (0.76, CI 0.68-0.85, P &lt; 0.02) (Figure 1). In patients diagnosed with CD, SCal and PCal had a moderate correlation with CRP (rs = 0.47 and 0.55, respectively, P &lt; 0.001), and SCal had a weak correlation with the Simple Endoscopic Score for CD (rs = 0.29, P = 0.04) and the Crohn’s Disease Activity Index (rs = 0.36, P = 0.03).

Conclusion
Levels of PCal and SCal are increased in patients with CD reflecting the systemic inflammatory response in this disease. However, SCal and PCal are insufficient biomarkers in patients with clinically suspected CD, and they are both inferior to CRP.
P320 Impact of Enterography on the Outcomes of Endoscopic Balloon Dilation for Ileocolonic Anastomotic Strictures in Crohn's Disease
Authors: Goncalves J , Lima Capela T , Cúrdia Gonçalves T , Magalhães J , Rosa B , Cotter J 
Published: January 2024

Abstract

Background
Ileocolonic anastomotic stricture (ICAS) is a common complication following surgery for complicated Crohn's Disease (CD). Endoscopic balloon dilation (EBD) has emerged as a non-invasive therapeutic modality for symptom relief and delaying surgical interventions. However, the impact of enterography, utilizing magnetic resonance imaging (MRI) or computed tomography (CT), in characterizing ICAS and its influence on short- and long-term EBD outcomes remain unclear.

Methods
This retrospective study included patients who underwent EBD for ICAS. Demographic and clinical data were collected, encompassing short-term outcomes (procedure complications and symptom improvement) and long-term outcomes (need for surgery, hospitalization, or repeat dilation).

Results
A total of 15 patients with ICAS were included in the study, with 46.7% being females, and a mean age of 41.2±15.6 years at the time of EBD. Six patients (40%) had undergone enterography six months prior to EBD. The median balloon diameter used for dilation was 15mm (range: 10mm to 17mm) and during the procedure, significant mucosal inflammation of the anastomosis (Rutgeerts Score ≥2) was observed in seven patients (46.7%). EBD was successful in 12 patients (80%) without any immediate complications. In the 12-month post-procedure period, one patient experienced hospital admission due to intestinal occlusion, one patient required abdominal surgery, and another patient underwent two additional EBD procedures. We did not observe a trend for an increased occurrence of complications in patients submitted to EBD without prior recent enterography, in the 12 months following the procedure or thereafter.

Conclusion
In this small but homogeneous cohort, our findings suggest that recent enterography does not significantly improve ICAS EBD outcomes. Therefore, our data suggest that performing enterography should not delay EBD in symptomatic CD patients with ICAS.
P329 Sarcopenia is a risk factor of post-operative recurrence of Crohn’s disease
Authors: Ceccarelli L , Rosi E M , Scandiffio R , Neri C M , Fe' P , Fornaroli G , Comparato C , Berti G , Baiano Svizzero G , Mumolo M G , D'Ischia R , de Bortoli N , Bellini M , Franceschi M , Costa F 
Published: January 2024

Abstract

Background
Sarcopenia is defined as reduction in skeletal muscle mass and muscle strength; it was found in up to 50% of patients with Crohn's disease (CD) in several studies.In CD patients sarcopenia is a risk factor for surgery, post-operative complications and worse surgical outcomes; furthermore, it is a negative prognostic factor for endoscopic remission in patients treated with biologics.The aim of our study was to evaluate the impact of sarcopenia on endoscopic recurrence at 6-12 months follow-up in CD patients after ileo-colic resection.

Methods
CD patients undergoing primary elective ileo-colic resection surgery between 2013 and 2023 were enrolled. Patients with previous intestinal surgery, pre-operative complications (abscess, perforation) and immunosuppressive or biologic therapy after surgery were excluded. Sarcopenia was defined as the sex- and height-adjusted Total Psoas Area Index (TPAI) lower than 5.4 cm2/m2 (men) and 3.56 cm2/m2 (women), calculated at the level of the third lumbar vertebra on MRI scans performed within 3 months before surgery. Already known risk factors for post-surgical disease recurrence were considered. Uni- and multi-variate analyses were performed to evaluate if sarcopenia before surgery could influence endoscopic recurrence (Rutgeers score ≥ i2) of disease 6-12 months after surgery.

Results
Seventy-two CD patients were included. Endoscopic recurrence (at 6-12 months follow-up colonscopy) was found in 22% of patients and it was associated with the presence of pre-operative sarcopenia (1.4% vs 15.3%;p&lt;0.001) and surgical complications (2.78% vs 6.94%;p=0.024), while it was not associated with comorbidies, familiarity, smoke, extension of resection or pre-operative therapy, PCR and albumin. Sarcopenia was identify as predictor of endoscopic recurrence (OR=25;p=0.005) as well as surgical complications after resection (OR=99.7;p=0.032). Neither medical or surgical complications showed statistically significant correlation with the presence of pre-operative sarcopenia (p=0.819).

Conclusion
Sarcopenia in CD patients before surgery seems to be an independent prognostic factor for endoscopic recurrence. Perioperative interventions to improve sarcopenia may have positive impact on surgical outcomes and disease recurrence.
P352 Comparison of Radiation Dose, Image Quality, and Diagnostic Performance between Hybrid Iterative Reconstruction and Deep Learning Reconstruction for CT Enterography of IBD
Authors: He W , Xu P , Xu R L , Li X H 
Published: January 2024

Abstract

Background
CT enterography (CTE) is recommended as one of the preferred methods for patients with inflammatory bowel disease (IBD), especially in primary hospitals that lack MRI equipment. However, the potential risk of radiation derived from using CTE during the life-long follow-up is an important issue for these patients. This study aimed to compare the radiation dose, image quality, and diagnostic performance of CTE for IBD using hybrid iterative reconstruction (HIR) and deep learning reconstruction (DLR).

Methods
We prospectively collected data on low dose CTE reconstructed by HIR and DLR in patients with IBD between February 2023 and September 2023, and retrospectively enrolled IBD patients who underwent conventional dose CTE reconstructed by HIR between June 2019 and June 2022 as controls. The CTE examinations were performed within 2 weeks of bowel histologic evaluation (the reference standard of bowel inflammation). The objective and subjective image quality and the image features were evaluated by two IBD radiologists. The radiation dose, image quality, and diagnostic performance was compared between the two dose protocols.

Results
The preliminary study included 36 patients in the low dose group with HIR and DLR and 40 patients in the conventional dose group with HIR. There were no significant differences in demographic data of patients between the two groups (all P&gt;0.05). The sensitivity, specificity, and diagnostic accuracy for detecting active inflammation were 71.4% (43.3%), 83.3% (80.0%), and 75.0% (52.5%) for the low dose group with DLR (HIR), respectively, and 84.4%, 62.5%, and 80% for the conventional dose HIR group. Low dose group with DLR resulted in significantly increased objective and subjective image quality and diagnostic confidence for active inflammation compared to low dose group with HIR (all P&lt;0.05), with no inferiority to conventional dose group with HIR (all P&gt;0.05). The dichotomous inter-reader reliability (k) for the entire group was 0.88. Low dose group resulted in a significant reduction in radiation exposure (mean [± SD], 2.20 ± 0.29 mSv) compared to conventional dose group (4.85 ± 1.96 mSv; P&lt;0.001).

Conclusion
Low dose CTE with DLR significantly improved image quality compared to low dose CTE with HIR, and maintained similarly high diagnostic performance as conventional dose CTE with HIR. Importantly, the low dose CTE with DLR significantly reduced the radiation dose, improving the safety of CTE application in the life-long follow-up of patients with IBD.
P363 Multimodal dynamic ultrasound approach as predictor of response in patients with Crohn’s disease treated with ustekinumab
Authors: Mignini I , Maresca R , Esposto G , Ainora M E , Liguori A , Cintoni M , Galasso L , Laterza L , Lopetuso L R , Garcovich M , Riccardi L , Gasbarrini A , Scaldaferri F , Zocco M A 
Published: January 2024

Abstract

Background
Early prediction of the response to biological drugs in Inflammatory Bowel Diseases (IBD) is of utmost importance to allow prompt optimization of therapeutic strategies. Ustekinumab (UST) is nowadays a milestone in the treatment of Crohn’s disease (CD), but potential markers predicting its long-term efficacy are still lacking. Multimodal ultrasound (US), encompassing B-mode US, color-Doppler and contrast-enhanced US (CEUS), is a promising non-invasive technique, providing complementary information to endoscopy, due to its ability to both assess transmural healing and quantify changes in bowel microvascularization over time. The main objective of this study was to evaluate the role of multimodal US in predicting endoscopic response to UST in patients with CD. The secondary aim was to develop an US score that allows an early detection of treatment response.

Methods
We conducted a prospective monocentric study in the IBD outpatient clinic of Policlinico Agostino Gemelli in Rome, enrolling consecutive patients with moderate to severe ileal CD, who were scheduled to begin UST therapy as per clinical practice. Demographic, clinical and laboratory data were collected. Clinical activity was defined according to Harvey-Bradshaw Index. A complete US evaluation including B mode, Doppler, dynamic CEUS and elastography was perfomed at the time of induction (T0) and after 8 (T1), 16 (T2), 24 (T3) and 48 (T4) weeks of therapy. Each US parameter and their variations from baseline were correlated with endoscopic response (SES-CD reduction of at least 50% from baseline) and mucosal healing (SES-CD &lt; 3) after 1 year.

Results
A total of 52 patients were included, 29 (55.8%) of which reached endoscopic response at T4. Median values of US parameters at the various time points were significantly different in the group who achieved endoscopic response from non reponders’ group (Figure 1). The univariate analysis showed that the percentage changes between T3 and T0 of bowel wall thickness, Limberg score (LS), mean signal intensity, rise time, wash-in rate (WiR), C reactive protein and Harvey-Bradshaw Index were associated with long-term therapeutic outcome (table 1). At the multivariate logistic regression analysis, three independent predictors of endoscopic response were selected: male sex, ∆%LS, and ∆%WiR. Based on the above parameters, we developed an US score that showed a good performance in predicting 1 year-endoscopic response (area under the curve: 0.91).

Conclusion
Multimodal ultrasound provides early predictors of the long-term therapeutic outcome in patients with CD treated with UST.
P365 Incidental terminal ileitis in asymptomatic patients. Is it Crohn’s disease?
Authors: Tsafaridou M , Theodoraki E , Foteinogiannopoulou K , Koutroubakis I 
Published: January 2024

Abstract

Background
Inflammation of the terminal ileum is a common finding during colonoscopy, even in patients without symptoms as an accidental finding. Nevertheless, there are no guidelines or wide consensus about the indications for treatment or follow-up, since the clinical importance and natural history of this entity has not yet been fully investigated.

Methods
This was a retrospective cohort study, where the electronic database of the Gastroenterology Department of University Hospital of Heraklion, Greece was searched through using the term "inflammation of terminal ileum" and "ulcers of terminal ileum", through the years 2012-2023. All cases with terminal ileitis as an accidental finding in asymptomatic patients, where colonoscopies performed for miscellaneous reasons (e.g. screening colonoscopy, follow-up colonoscopy after polypectomy) were identified. Patients with symptoms, or known Crohn’s Disease (CD) were excluded. Patients’ demographics, endoscopic and clinical follow-up data, as well as treatment and final diagnosis of CD were registered. Possible risk factors for terminal ileitis [smoking, use non-steroidal anti-inflammatory drugs (NSAIDs)] were also recorded. Univariate and multivariate analysis of the data was performed with SpSS v22 software.

Results
In a total of 465 cases with terminal ileitis 205 had known CD, 153 underwent colonoscopy for symptoms whereas 107 patients (62 females) underwent colonoscopy with no associated symptoms and constituted the study population. Among these 107 patients [median age 50, interquartile range (IQR) 39-64years, median BMI 25kg/m2, IQR 23.2-27.1kg/m2, median follow-up 4years) 27 (25%) patients were current smokers, 32 (30%) ex-smokers and 22 (20%) reported recent use of NSAIDS (Table 1).
During follow-up, 88 (82%) patients had a new colonoscopy with persistence of terminal ileitis in 66 (62%) of them, 68 (64%) developed symptoms, 37 (35%) were diagnosed with CD,39 (36%) received treatment, and 18 (17%) required hospitalization.
In the group of the patients that required treatment, only 8 (7.4% of the study population) eventually required systemic immunosuppression (corticosteroids, thiopurines, biologic agents.
In multivariate analysis, there was no statistically significant correlation between the persistent terminal ileitis on follow-up colonoscopy and BMI, the use of NSAIDs, or ex-smoking. Nevertheless, there was a significant correlation between active smoking and the persistence of terminal ileitis (p=.005).

Conclusion
Most of the patients with incidental, asymptomatic terminal ileitis remain asymptomatic and don’t require treatment. Close monitoring is required since diagnosis of Crohn’s disease is established in one third of them.
P373 Primary sclerosing cholangitis associated with inflammatory bowel disease: clinical characteristics of patients from reference centers in Brazil
Authors: da Silva B C , Chebli J M F , Ferreira S D C , Chebli L A , Evangelista R K A , Ribeiro T C D R , Alencar S R , Borges M D M , Lima G A S , Rzetelna H , Freire C C F , Parente J M L 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are closely associated pathological entities that, when present in combination, create a phenotypically different disease, referred to as PSC-IBD. The occurrence of PSC complicating IBD seems to vary depending on the studied population. The aim of this study was to describe the clinical profile of patients with PSC-IBD in reference centers in Brazil.

Methods
Descriptive cross-sectional study in 7 tertiary centers. Patients with PSC and IBD were identified. Data were collected from patients' charts. The following variables were studied: age, age at diagnosis of IBD and PSC, type of IBD, Montreal classification, medications used, occurrence of colorectal cancer and dysplasia, colectomy and liver complications. The study was approved by the ethics and research committee.

Results
Ninety-three patients were included. The mean age of the patients was 43,8 years (range 17 to 73). 63 patients were male (67.7%). UC was more frequent 74.2% (N=69). The mean age at diagnosis of IBD and PSC was 31.4 years (range 6 to 67) and 35.6 years (range 8 to 72), respectively. The diagnosis of PSC preceded that of IBD in only 15 (16.1%) cases. Among patients with UC, the majority (61/69) had extensive colitis (88.4%), and 47.8% (33/69) had already used at least one biological therapy. Only 9 (13%) patients with UC required colectomy. Regarding CD, colon involvement occurred in 21 (87.5%) patients and 20 (83.3%) needed to use at least one biologic. Just 3 CD patients (12.5%) had isolated disease in the small intestine. In our study, liver cirrhosis occurred in 20 (21,5%) cases of the studied population, and 13 (14%) patients required liver transplantation. Fourteen (15,1%) IBD patients had dysplasia or colorectal cancer (CRC). Use of biological therapy was more frequent in patients with CD than in those with UC (83.3% vs 47.8%; p=0.002). There was a trend towards a higher occurrence of CRC in the UC population (p=0.08).

Conclusion
In our studied PSC-IBD population, UC was more common than CD. Furthermore, we observed that in this subgroup of IBD with PSC, UC presented a more severe phenotype, with a superior occurrence of extensive colitis and need for biological therapy. In CD, most patients have colonic involvement. Interestingly, we observed a greater need to use at least one biologic in CD patients (p=0.002), as well as the need to use multiple biologics compared to UC patients (p=0.009). Additionally, there was a trend towards greater occurrence of CRC in UC patients. The rates of occurrence of dysplasia and liver cirrhosis in our casuistic emphasize the demand for more intensive follow-up in patients with IBD and PSC.
P380 Integrated fecal metagenome and serum metabolome analysis revealed gut microbiome associated serum metabolites as diagnostic biomarkers for inflammatory bowel disease
Authors: Liu J , Huang L , Guo X , Dai X , Cao Q 
Published: January 2024

Abstract

Background
Gut microbiomes are altered among patients with IBD. Certain microbiome species were used as biomarkers for IBD diagnosis, yet with limited sensitivity and specificity, especially when used for the classification of UC and CD. Gut microbiome reprogramming was accompanied with metabolic shift. Previous studies discovered that gut microbiome-associated serum metabolites (GMSM) were disease-specific biomarkers with high sensitivity. The aim of this study is to explore how gut microbiome reprogramming is reflected in serum metabolome shift in IBD, and the potential of GMSM for IBD diagnosis and classification of UC and CD.

Methods
Shotgun metagenomic of stool and ultraperformance liquid chromatography-mass spectrometry based untargeted metabolomic profiling of serum samples from a discovery cohort of IBD and healthy individuals were performed. Spearman correlation analysis was used to identify GMSM that were differentially abundant among IBD and healthy individuals. Candidate GMSM for model construction were selected using LASSO and logistic regression. The selected GMSM panel was then transferred to multiple reaction monitoring based targeted detection. Diagnostic model for IBD and classification model for UC and CD were developed based on the GMSM panel using a training cohort, and then validated using an independent cohort consisting of patients with IBD, healthy individuals and patients with colorectal adenoma or non-adenoma polyps.

Results
Metagenome sequencing of fecal samples from 77 patients with IBD and 74 healthy individuals revealed significant shifts in gut microbiome, such as decrease in F. prausnitzii. Untargeted metabolomic profiling of serum from 76 patients with IBD and 28 healthy individuals revealed 724 differentially abundant metabolites, of which 151 metabolites were found to be significantly associated with gut microbiomes detected from the fecal samples (figure).
Candidate GMSM for model construction were established using the method described and the ultimate panel consisted of 17 metabolites, including 10 GMSM for diagnostic model for IBD and 7 GMSM for classification model for UC and CD. Eventually, the diagnostic model for IBD achieved an area under curve (AUC) of 0.98 in the training cohort, and 0.92 in the validation cohort. The classification model for UC and CD achieved AUC of 0.94 in the training cohort, and 0.9 in the validation cohort. In addition, the diagnostic model for IBD also effectively distinguished IBD from patients with colorectal adenoma or non-adenoma polyps (table).

Conclusion
Based on GMSM, we developed diagnostic and classification models for IBD with high specificity and sensitivity, providing an accurate and non-invasive approach for IBD diagnosis and classification of UC and CD.