bluuebunny/crossref_metadata_2025_split huggingface dataset:
P443 Transmural Remission Associates with a Lower Risk of Phenotype Progression in Crohn’s Disease
Authors: Fernandes S R , Rodrigues I , Saraiva S , Bernardo S , Rita Gonçalves A , Moura Santos P , Valente A , Correia L , Cortez-Pinto H , Magro F 
Published: January 2024

Abstract

Background
Patients with Crohn’s disease (CD) are at risk of progressing from inflammatory to stricturing and penetrating phenotypes. The influence of the type of remission on phenotype progression has not been adequately evaluated.

Methods
Retrospective cohort study including surgically naïve CD patients with inflammatory or stricturing phenotype evaluated concomitantly by magnetic resonance enterography and colonoscopy. The degree of remission was correlated with the risk of progressing to stricturing and penetrating phenotypes.

Results
381 CD patients were included, 21.8% with transmural remission, 21.3% with isolated endoscopic remission, 10.5% with isolated radiologic remission, and 46.5% without remission. Patients with transmural remission presented the lowest rates of phenotype progression (1.2%), with a significant difference compared to isolated endoscopic remission (18.3%, P≤ 0.001), isolated radiologic remission (17.5%, P=0.002), and no remission (36.9%, P≤0.001). In multivariate regression analysis, transmural remission (OR 0.023 95%CI 0.003-0.171, P&lt;0.001), isolated radiologic remission (OR 0.342 95%CI 0.141-0.826, P=0.017), and isolated endoscopic remission (OR 0.441 95%CI 0.220-0.881, P=0.020) resulted in lower rates of phenotype progression compared to no remission.

Conclusion
The degree of intestinal remission correlates with the risk of phenotype progression. Patients with transmural remission are at the lowest risk of progressing to stricturing and penetrating phenotypes.
Figure 1 presents the Kaplan-Meier estimates of remaining free of penetrating complication (upper curve) and free of stricturing and/or penetrating complication (lower curve) after the baseline assessment in patients with no remission (A), isolated endoscopic remission (B), isolated radiologic remission (C), and transmural remission (D). B1, non-stricturing non-penetrating phenotype; B2, stricturing phenotype; B3, penetrating phenotype.
P444 Active perianal Crohn’s disease negatively impacts patients’ quality of life, psychosocial wellbeing and is associated with barriers related to social determinants of health
Authors: Shenoy S , Debroff J , Lacoste J , Giselbrecht E , Keefer L , Wong S Y 
Published: January 2024

Abstract

Background
Perianal fistulizing Crohn’s Disease (PFCD) is associated with poor quality of life (QoL) and increased healthcare utilization. However, the effect of PFCD on patients’ lives remain incompletely understood. We conducted a survey-based study of patients with PFCD to examine the impact of perianal fistula disease activity on QOL, psychosocial wellbeing, and barriers related to SDOH.

Methods
Patients aged 18 years and above with a diagnosis of PFCD were included between July and November 2023 at Mount Sinai Hospital. Patient data, including demographics and clinical data, were obtained from patients and chart review. Perianal disease classifications were assessed through chart review. Crohn’s anal fistula quality of life (CAFQOL) scale, PROMIS scale for anxiety and depression, Internalised stigma for mental illness (ISMI), Everyday discrimination scale, health first screening tool for SDOH and the Cantril ladder of life scale were administered to patients. Patients with active PFCD, defined as perianal pain and/or drainage, were compared to patients with inactive PFCD, defined as lack of perianal pain or drainage. Descriptive statistical analysis was performed using SPSS

Results
A total of 50 patients were included in the study, of whom 39 had active disease and 11 inactive disease (Table 1). Annual household income was lower among patients with active PFCD (p=0.017). Disease characteristics such as Montreal classification, HBI and perianal disease classification, presence of proctitis, surgical history were similar across both groups. Overall, patients with active PFCD compared to inactive PFCD had higher CAFQOL scores (mean active:inactive;1.82:0.44, p&lt;0.001). Patients with active PFCD also had higher rates of depression and anxiety (mean 2.06:1.23, p=0.020). Internalised stigma was higher among patients with active PFCD. There was no difference in discrimination faced as a consequence of PFCD. 20.5% and 12.8% patients with active PFCD reported facing social isolation and food insecurity respectively. By the Cantril ladder, patients with active PFCD had lower current life satisfaction compared to inactive PFCD (mean 6.03:7.60, p=0.024). However, there was no difference in their outlook on life satisfaction in 5 years.

Conclusion
In our cohort, perianal disease activity alone results in significantly worse quality of life and negatively impacts psychosocial wellbeing. Patients with active PFCD are at risk for barriers related to SDOH which are known to have implications on health equity.
P446 Influence of seasonal vitamin D deficit in clinical course of inflammatory bowel disease patients
Authors: Baz-Lopez A , Baston-Rey I , Martí-Marqués E , Calvino-Suarez C , Santos-Blanco E , Ferreiro-Iglesias R , Blanco-Hortas A , Lopez-Roses L , Dominguez-Munoz J E , Barreiro-de Acosta M 
Published: January 2024

Abstract

Background
Vitamin D deficiency is common in healthy subjects and it is even more prevalent in inflammatory bowel disease (IBD). Vitamin D (VitD) may influence disease behavior. Whether a deficient vitamin D status facilitates flares or flares consume vitamin D is still a burning question. Data on seasonal variations of VitD levels in IBD are scarce. The aim of this study was to evaluate VitD deficit in IBD patients compared with general population and the influence of seasonal variation in their evolution.

Methods
A prospective two center study was performed. Patients with Crohn disease (CD) or ulcerative colitis (UC) and no comorbilities that may have influenced VitD were consecutively included from two IBD centers with geographical proximity (less than 100 kms) in order to have comparable solar radiation. Clinical and biochemical characteristics of patients were recorded. Patients were followed for two consecutive seasons, VitD was measured twice: during winter and during summer. VitD levels from general population were also available. Both hospitals share the same methodology for VitD testing. VitD levels were defined as normal (&gt;30 ng/ml), insufficient (20-30 ng/ml), or deficient (&lt;20 ng/ml). Data were analyzed and Mann-Whitney U test was applied using R to compare subsets of patients.

Results
199 patients with IBD were consecutively included (38.7% CD, 61.3% UC). 165 (83%) patients have consecutive determinations of VitD (both in summer and winter). Mean age was 47.1, being 54.8% males and 45.2% females. Median value of VitD in winter was 14 ng/ml, and 21 ng/ml in summer. Lab tests in our center for general population in winter presented a median value was 21.2 ng/ml in winter and 24 ng/ml in summer (Figure 1). According values of our laboratory in winter, just 31% of the general population presented VitD values &gt; 30 ng/ml in summer and 26.7% do so in winter. For our cohort of patients with IBD, the results are more pronounced: only 3.8% presented normal values in winter and 23.2% in summer (Table 1). The average variation in VitD values has been 9.26 ng/ml between the two seasons. No statistically significant relationship was found between the factors analyzed (BMI, location, calprotectin levels or disease duration) and VitD levels, neither in summer nor in winter. Most patients remained in remission despite having low VitD levels (82,8% in winter and 80,3% in summer).

Conclusion
VitD deficit was frequent in summer and in winter in IBD and more prevalent than in general population. Despite frequent deficit only a small percentage of patients presented disease activity. No relationship was observed between VitD deficit and patients characteristics or calprotectin levels.
P450 Influence of radon levels at home in the clinical course of inflammatory bowel disease incident patients
Authors: Mauriz Barreiro M V , Ruano-Raviña A , Ferreiro-Iglesias R , Baston-Rey I , Calvino-Suarez C , Nieto-García L , Porto-Silva S , Martinez-Seara X , Peón-González J , Dominguez-Munoz J E , Barreiro-de Acosta M 
Published: January 2024

Abstract

Background
Inflammatory Bowel Diseases (IBD) are a group of pathologies of unknown etiology associated with some environmental factors, only partially identified. The role of indoor radon, a radioactive gas, has not been formally studied and it might play a role on the evolution of the disease. The aim of this study is to analyze if residential radon exposure is associated with the evolution and development of flares or hospitalizations of IBD new diagnosed patients in a radon-prone area.

Methods
An observational prospective study was developed between June 2020 and September 2023, including incident cases with IBD that had been living at least 5 years in the same dwelling, those with a change of address in the last 5 years prior to diagnosis were excluded. All patients were followed-up through one year to assess the evolution of the disease. Hospitalizations related with the disease during the period, and number and severity of flares (measured by Partial Mayo Score and Harvey- Bradshaw) were collected. Radon levels were measured over three months in the participants’ home. Each individual was provided with a residential radon meter (a RSKS trace detector), given and read by the Galician Radon Laboratory, a certified radon laboratory. Radon concentrations were categorized into three groups, 0-99 Bq/m3, 100-299 Bq/m3 and &gt;299 Bq/m3. Results are expressed as Odds Ratios with their 95%CI obtained through logistic regression.

Results
136 patients with IBD (78 ulcerative colitis, 52 Crohn’s disease and 6 unclassified colitis) were included and prospectively followed, with a median age of 52 years old (IQR 40 – 59). 50% were females. There were no statistically significant differences in radon levels, taking levels of 0-99 Bq/m3 as reference, between patients hospitalized compared with non-hospitalized (OR 0.8 95%CI 0.3-2.1 for 100-299 Bq/m3, OR 1.7 95%CI 0.6-5.0 for &gt;299 Bq/m3) nor in patients with a flare compared with patients without flares during the follow-up year (OR 0.4 95%CI 0.0-4.5 for 100-299 Bq/m3, OR 5.4 95%CI 0.8-34.3 for &gt;299 Bq/m3). Radon levels were not associated with the number of flares either (OR 0.6 95%CI 0.3-1.7 for 100-299 Bq/m3, OR 1.5 95%CI 0.5-4.5 for &gt;299 Bq/m3). Results are shown in table 1. Stratifying by type of IBD, results do not vary. For Crohn’s disease, OR for flare are 2.5 (95%CI 0.4-16.1) and 4.1 (95%CI 0.6-27.9), and for hospitalization 1 and 6.5 (OR95% (0.2-205-2). For ulcerative colitis, OR for flare are 0.6 (95%CI 0.2-1.8) and 1.8 (95%CI 0.4-7.8) and for hospitalization 0.9 (95%CI 0.1-17.1) and 9.3 (95%CI 0.6-134.0).

Conclusion
Indoor radon concentration seems to be not associated with an initial worst evolution of IBD patients in terms of hospitalizations or flares.
P467 Towards AI-Augmented Clinical Decision Making: An Examination of ChatGPT's Utility in Acute Ulcerative Colitis Presentations
Authors: Levartovsky A , Ben-Horin S , Kopylov U , Klang E , Barash Y 
Published: January 2024

Abstract

Background
ChatGPT is a large language model based chatbot created by OpenAI. Since its release, ChatGPT has gained widespread attention among the healthcare community regarding its potential utility as a medical practice tool. In addition, ChatGPT can be adapted to serve as a clinical-decision support tool. In this study we explored the potential of ChatGPT as a decision support tool for acute Ulcerative Colitis (UC) presentations in the setting of the emergency department (ED).

Methods
Our investigation centered around 20 distinct acute UC presentations to the ED, accumulated over two years. Case summaries - embodying crucial data points such as symptoms, vital signs, and laboratory results - were processed by ChatGPT. For each case, we asked ChatGPT to assess disease severity based on the TrueLove and Witts classification, substituting erythrocyte sedimentation rate ≥30 with C-Reactive protein ≥12. Furthermore, it was to recommend hospitalization or outpatient care for each case based on the disease severity. The answers were compared with assessments made by our department's gastroenterologists and the actual decision made by the physician in the ED.

Results
Overall, ChatGPT categorized 12, 7 and 1 patient with severe, moderate and mild disease, respectively. For each case, ChatGPT supplied a detailed answer depicting severity of every variable of the criteria and an overall severity classification (table 1). Compared to our gastroenterologists’ assessments, ChatGPT graded 16/20 (80%) of the patients with the same severity. A high degree of reliability was found between the two assessments as the average measure intra-class correlation coefficient of absolute agreement was 0.839 (95% confidence interval 0.588-0.937, F= 5.95, p&lt;0.001). Inconsistencies in four cases stemmed primarily from inaccurate cut-off values for systemic variables. Following severity assessment, ChatGPT leaned towards hospitalization for 16 out of 18 (88.9%) patients. For two moderate UC cases, however, it could not provide a decisive recommendation. Comparatively, only 12 out of the 20 patients were hospitalized in actual clinical practice.

Conclusion
In this unique study, findings suggest that Chat-GPT, has potential as a clinical decision-support tool in assessing UC severity and recommending suitable settings for further treatment. While this concept warrants further investigation and validation, its ability to evaluate a clinical scenario based on established criteria could greatly benefit the field of Inflammatory bowel disease and gastroenterology.
P476 Correlation between fecal calprotectin and inflammation on ultrasound in fibrostenotic Crohn’s Disease
Authors: Gulhati V , Rosentreter R , Motamedi M , Macci A , Ingram R , Kaplan G , Ma C , Seow C , Novak K , Panaccione R , Lu C 
Published: January 2024

Abstract

Background
Fibrostenotic Crohn’s Disease (CD) is a challenging phenotype particularly due to the absence of intestinal anti-fibrotic therapies. Differentiating between strictures that are predominantly fibrotic versus inflammatory remains a diagnostic dilemma. The ability to make this differentiation is critical to inform therapeutic decisions. Fecal calprotectin (FC) is a stool marker reflective of intestinal inflammation. Very few studies have evaluated the relationship of FC concentration in ileal CD strictures and parameters of inflammation on intestinal ultrasound (IUS). Strictures on imaging are defined as 1) increased bowel wall thickness (BWT), 2) narrowed luminal apposition, and 3) pre-stenotic dilation (PSD). BWT and hyperemia (color Doppler signal (CDS)) are the most sensitive markers for CD inflammation on IUS. It is predicted that FC will match CDS in ileal strictures, similar to non-stricture phenotypes. We aim to correlate FC levels with IUS inflammation of ileal CD strictures.

Methods
We performed a retrospective cohort pilot study exploring the relationship between FC levels and IUS inflammatory parameters in ileal strictures. FC levels were obtained ≤ 60 days of index IUS in fibrostenotic ileal CD patients. Individuals who underwent medication changes or experienced a clinical flare during this period were excluded. Inflammation was measured as BWT and CDS using a modified Limberg (ML) score. Pearson correlation for continuous variables, Spearman rank correlation and a Kruskal-Wallis test for FC and Limberg scale were completed.

Results
A total of 25 fecal samples were obtained from 17 patients with ileal strictures (47% male, median age 59 years (range 18-76)) were assessed. Median FC concentrations was 204.9 ug/g, IQR: 250.4. Median ileal stricture BWT was 7.0 mm (range 3.0–10.0). 40% (10/25) had ML1 (short chains in bowel), 32% (8/25) ML2 (long chains in bowel), and 28% (7/25) ML3 (long chains and perienteric fat). There was no correlation between FC and BWT (r=0.02, p=0.92), nor FC with ML scores (r=0.20, p=0.25). In those with ML1, median FC was 232.4, while those with ML2 or 3, had a FC of 155.6 and 469.7, respectively. FC values were significantly different between the ML scores, p&lt;0.0001.

Conclusion
FC levels were not correlated with inflammatory parameters as seen on IUS in ileal CD. This unexpected finding may be due to ML2 scores having lower FC than anticipated, and small sample size. Other imaging factors such as loss of wall stratification need to be taken into account, and are perhaps more reflective of inflammation than BWT and CDS. This study provides the initial data to assess accuracy of FC and hyperemia of ileal CD strictures on IUS compared to histologic measures of inflammation on resected specimens.
P484 Intestinal Ultrasound Can Detect Active Inflammation In Inflammatory Bowel Disease Patients Despite Combined Clinical And Biomarker Remission
Authors: Saleh A , Abraham B 
Published: January 2024

Abstract

Background
Intestinal ultrasound (IUS) has only recently been implemented in the USA for inflammatory bowel disease (IBD) monitoring. Colonoscopy is considered the gold standard for evaluation of inflammation but may not be feasible for every assessment due to cost, time, and accessibility. Clinical activity scores and biomarkers are used instead as adjunct measures of disease. Since IUS incurs low cost and time with easy accessibility, our study aimed to demonstrate the utility of incorporating IUS into IBD practice by evaluating the sensitivity and specificity of these adjunct measures of inflammation and the impact of decisions made based on IUS.

Methods
This retrospective cohort analysis evaluated patients with IBD at our institution who underwent IUS from July 2020 to May 2021. The patients were reviewed for repeat IUS visits until July 2022. Patients received IUS regardless of clinical or biomarker remission, and/or if they were able to receive a colonoscopy. Clinical remission was defined as UCAI ≤ 5 and partial Mayo ≤ 2 or HBI ≤ 5. Biomarker remission was defined as ESR ≤ 40 mm/hour; CRP ≤ 8 mg/L; FCP ≤ 125 mg/mg; and fecal lactoferrin ≤ 30 mcg/mL. Combined remission was defined as both clinical and biomarker remission. The sensitivity and specificity of these groups was evaluated based on IUS. Treatment plans were decided based on IUS findings. Patients with normal IUS maintained therapy while those with positive findings required a change/escalation of therapy. These patients had repeat IUS to ensure the changes resulted in reduction of inflammation.

Results
In 148 total patients receiving IUS, 62% (N=92) had active disease. Clinical remission (figure 1) was 41% sensitive and 75% specific while biomarker remission was 49% sensitive and 58% specific to IUS findings. When combined (clinical + biomarker remission), sensitivity increased to 62% and specificity decreased to 52% (figure 2). There was a total of 39 repeat ultrasounds. Inflammation was improved at repeat IUS, measured by a decrease in overall bowel wall thickness in 77% (30/39) patients for a mean of 0.121 cm. Vascular flow improved in 79% (15/19) of patients with abnormal Doppler at initial IUS by a mean of 0.65, and mural stratification improved in 80% (20/25) of patients with mural disruption at initial IUS.

Conclusion
Our study showed that even when combining biomarker results and clinical scores, the sensitivity for detecting inflammation was 62%. Additionally, as demonstrated by the improvement in inflammation at IUS follow up, clinical decisions based on IUS results effectively reduced inflammation in IBD patients. As such, IUS is necessary in the management of IBD to effectively identify and treat patients with masked inflammation.
P490 Prevalence and clinical features of chronic nonbacterial osteomyelitis in a nationwide cohort of children with inflammatory bowel diseases
Authors: Scarallo L , Knafeltz D , Marrani E , Alvisi P , Arrigo S , Bramuzzo M , Felici E , Romano C , Simonini G , Lionetti P 
Published: January 2024

Abstract

Background
Among musculoskeletal extraintestinal manifestations (EIM), the association between IBD and a rare autoinflammatory condition, chronic nonbacterial osteomyelitis (CNO), has been reported. The primary objective of our study was to report the clinical characteristics and the disease course of a cohort of patient with concurrent diagnosis of CNO and IBD. The secondary outcome was to define the prevalence of CNO in a nationwide cohort of patients with IBD.

Methods
This is a retrospective, multicenter study based on the Italian Society of Gastroenterology, Hepatology, and Pediatric Nutrition (SIGENP) IBD National Registry. The diagnosis of CNO was defined as the presence of uni- or multifocal bone inflammatory lesions with suggestive radiological or histopathological characteristics, having excluded infectious, oncological, or other inflammatory conditions. All patients under 18 years of age with a combined diagnosis of IBD and CNO identified in the registry were included.

Results
18 patients with a combined diagnosis of CNO and IBD out of 4229 patients with IBD were identified, with an overall prevalence of 0.4%. 15 (83.3%) patients were male. Median age at IBD diagnosis was 10.1 years (IQR: 6.16 years), whereas median age at CNO diagnosis was 11.7 years (IQR: 6.31 years). The most frequently reported IBD phenotype was CD (13 patients, 72.2%), followed by IBD-U (3 patients, 16.7%) and UC (2 patients, 11.1%). The diagnosis of concurrent CNO was more common in patients affected by CD than in those affected by either UC or IBD-U (13/1843, 0.7% vs 5/2886, 0.2%, p=0.01). Similarly, the occurrence of CNO was more frequent in male gender when compared to female one (15/2312, 0.6% vs 3/1917, 0.1%, p=0.01). All the patients had multifocal bone involvement; 2 (11.1%) developed subsequently dermatological manifestations consistent with SAPHO syndrome. In 8 patients (44.4%) IBD onset preceded CNO diagnosis, in 6 (33.3%) IBD onset followed CNO diagnosis, whereas in the remaining 4 patients (22.2%) the diagnosis of IBD and CNO was concomitant. Table 1. summarizes therapeutic approach to both conditions in each of the patient identified in our case series. At the end of follow-up, 14 (77.8%) patients had achieved IBD clinical and biochemical remission. Ten (55.6%) patients achieved clinical and radiological remission of bone lesions, 6 (32.3%) had achieved clinical remission but showed persistence of bone lesions at magnetic resonance imaging (MRI), 2 (11.1%) had persistence of both clinical and radiological activity.

Conclusion
Our findings support the hypothesis that CNO disease spectrum can be considered a rare extraintestinal manifestation of IBD, with a low but still non-negligible prevalence.