bluuebunny/crossref_metadata_2025_split huggingface dataset:
P319 Genetic polymorphism of lactose intolerance in patients with Inflammatory Bowel Disease
Authors: Babayeva-Sadigova G , Guliyev F , Maxmudov U , Hasanov R , Musayev J , Asadova G , Ibrahimli H , Afandiyeva N , Hasanova A , Maharramova T 
Published: January 2024

Abstract

Background
Lactase deficiency is a disorder of lactose absorption in the body due to a deficiency of lactase, an enzyme that helps break down milk sugar. . The most common cause of primary lactase deficiency is due to a polymorphism in the MCM6 gene, which affects the function of the LCT lactase gene. Normal lactose digestibility is associated with the TT genotype, and when thymine is substituted for cytosine (allele C), a decrease in lactase levels in adulthood and impaired lactose digestibility to the point of complete inability to digest lactose should be expected. Understanding the prevalence of lactose intolerance in populations with inflammatory bowel disease may have important implications, preventing unnecessary restrictive diets and thereby helping to prevent future complications, including malnutrition and the occurrence of disorders of phosphorus-calcium metabolism.

Aim Of The Study
to investigate the prevalence of lactose intolerance and to evaluate the possibilities of correlation between genotype and lesion localization in IBD

Methods
Three single nucleotide polymorphisms of the LCT gene: LCT-13910 CC, LCT-13910 CT, LCT-13910 TT were analyzed in the group of patients with IBD (128 patients; UC-62 patients, CD 66 patients) and in the control group (45 patients with IBS).

Results
Baseline patient demographics and genetic analysis scores for lactase deficiency and variants of genetic polymorphism and association with localization of pathological process in IBD are presented in Table 1 and Figure 1.

Conclusion
Thus, the prevalence of LCT-13910 CC was 59.4% (congenital deficiency) and LCT-13910 CT was 31.3% (age-associated deficiency). In 9.4% of patients with IBD, no deficiency was genetically identified. In patients in the control group, LCT-13910 CC was detected in 15.5%, LCT-13910 CT in 42.4%, and LCT-13910 TT in 44.4%. LCT-13910 CC variant was predominant in CD patients with small intestinal lesions (n=41; 95.3% and 62.1%, respectively), in patients with left-sided ulcerative colitis (n=14; 51.8% and 22.6%, respectively) and total lesions in ulcerative colitis (n=12; 70.6% and 19.3%, respectively).Thus, the need for a lactose elimination diet is necessary in cases with small intestinal involvement in CD, and with total and left-sided course in UC.
P328 Ischemic Ulcers Do Not Significantly Impact The Endoscopic Recurrence Score In Crohn’s Disease: A Multicenter Comparative Study After Right-Side Resections For Crohn’s Disease And Colorectal Cancer
Authors: Luglio G , Castiglione F , Orlando A , Solina G , Fichera A , Imperatore N , Lamanda R , Di Girolamo E , Marone P , Delrio P , Tropeano F P , Calabrese G , Cricrì M , Calderone S , Toro B , De Palma G D , Rispo A 
Published: January 2024

Abstract

Background
Post-operative recurrence (POR) is common in patients with Crohn’s disease (CD) who have undergone surgery. Endoscopy, mainly based on Rutgeerts’ score, is crucial for the diagnosis of POR, showing also high prognostic value. More recently, several studies have suggested that the current endoscopic score system could be affected by the ischemic (not inflammatory) nature of some anastomotic ulcers, particularly at the level of the mucosal inverted stapled line, so overestimating the prevalence of the "real" anastomotic POR. However, these studies, based on the comparison between CD patients and subjects undergone right-side resection for colorectal cancer (CRC), included a very small population. Starting from these considerations, we performed a retrospective study aimed to directly compare the prevalence of anastomotic POR in CD with that of patients undergone right-side resection for CRC in a wide population.

Methods
A retrospective study was conducted at four Italian Institutions (2 with a high volume of IBD admissions; 2 with a high volume of CRC admissions). All patients performed endoscopy within 8 months from surgery. We selected all consecutive CD and CRC patients undergone a surgical resection with an anisoperistaltic stapled L-L anastomosis. The diagnosis of POR of CD was made in accordance with the modified Rutgeerts’ score (i0, i1, i2A, i2B, 3, 4). The global prevalence of POR (Rutgeerts’s score ≥2) was recorded. Furthermore, we directly compared the prevalence of the isolated anastomotic ulcers of CD (Rutgeerts i2A) to that detected in CRC patients.

Results
At the end of the study, we enrolled 221 CD patients and 72 CRC subjects. POR was recorded in 127 CD patients (57%). According to the endoscopic grade system, POR was scored as i0: 56 pts (25%), i1: 38 pts (17%); i2A: 42 pts (19%), i2B: 26 pts (12%), i3: 20 pts (9%), i4: 39 pts (18%). In the CRC group, endoscopy detected anastomotic ulcers in 2 out of 72 patients (3%); 1 case (1.4%) of CRC early recurrence was observed. When comparing the prevalence of isolated anastomotic ulcerations in CD (i2A) vs those in CRC patients, the prevalence of ulcerations was significantly higher in CD patients (19% vs 3%; p&lt;0.01; OR=6.3).

Conclusion
Our study confirms the high prevalence of early recurrence in CD patients, highlighting the role of early (within 6-8 months) post-operative endoscopy in CD setting. The prevalence of anastomotic (ischemic) ulcers in CRC patients is very low and, as a consequence, this issue should not represent a real diagnostic matter if shifted into the POR setting of CD. Prospective, multicentre and directly comparative studies are needed to confirm our results.
P334 The longitudinal analysis of fecal microbiota in response to ustekinumab treatment in patients with Crohn’s disease
Authors: Kim J , Kim M K , Yoon A R , Hong S W , Hwang S W , Park S H , Yang D H , Byeon J S , Myung S J , Yang S K , Ye B D 
Published: January 2024

Abstract

Background
Emerging evidence supports that treatment of Crohn’s disease (CD) can alter the intestinal microbiota, which can play a significant role in the pathogenesis and therapeutic outcomes of CD. Ustekinumab (UST) has also been reported to modify the intestinal microbiota during a short-term treatment period. However, the long-term impact of UST treatment on the intestinal microbiota has rarely been studied.

Methods
We prospectively enrolled patients with CD who were planning to start UST treatment and collected fecal samples before (baseline) and after UST administration at week 20 and week 52. Fecal bacterial taxonomic diversity and composition were analyzed through 16S ribosomal ribonucleic acid (rRNA) gene amplicon sequencing. The difference in the intestinal microbiota between clinical remitters and non-remitters defined by Crohn’s disease activity index (CDAI) was investigated, along with the longitudinal changes in the intestinal microbiota.

Results
A total of 124 fecal samples acquired from 43 patients were analyzed (median age 30 years, male 76.7%, median CDAI at baseline 183.2). Clinical remission was observed in 34.9% (n=15/43), 61.0% (n=25/41), and 60.0% (n=24/40) at baseline, week 20, and week 52, respectively. Shannon’s alpha diversity index increased significantly at week 20 and week 52 compared to baseline (both P&lt;0.001). Compared to non-remitters, a significant increase of Shannon’s alpha diversity index was also observed among remitters (P=0.044) across all time points, while no significant difference was noted at each time point. The beta diversity analysis based on the Bray-Curtis distance revealed a significant difference among remitters at week 20 (P=0.027), however, there were no significant differences at other time points. Compared to the baseline, the abundance of the Firmicutes phylum was higher at week 20 (P=0.048) and 52 (P=0.019). The Lactobacillus genus (P=0.042), and Lactobacillus gasseri group (P=0.016) were significantly less abundant in remitters, while the Lachnospiraceae family (P=0.017) was more abundant in remitters. At week 20, Bifidobacterium genus (P=0.027) and Bifidobacterium pseudolongum group (P=0.040) were significantly more abundant in remitter while the Lactobacillus genus was less abundant (P=0.009) in remitter (Figure 1).

Conclusion
The alteration of fecal microbiota after UST treatment may have the potential to serve as a biomarker for predicting clinical remission.

Financial Support
This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2021R1A2C2095096), the grant (2020IT0012) from the Asan Institute for Life Sciences, Seoul, Korea and the grant (CR 2017-4) from CELLTRION PHARM, Inc., Chungcheongbuk-do, Korea.
P336 Exploring Extracellular Matrix Markers in Ulcerative Colitis: Degradation and Formation Insights
Authors: Poulsen A , Riis L B , Pehrsson M , Sørensen L T , Krarup P M , Burisch J , Mortensen J H , Seidelin J B 
Published: January 2024

Abstract

Background
The gold standard for assessing disease activity in ulcerative colitis (UC) is endoscopy, which is uncomfortable for the patient, and only evaluates the superficial layers of the colon. Intestinal extracellular matrix (ECM) remodeling is highly dynamic during disease activity and blood spillover of ECM components might reflect transmural disease burden. The aim of this study was to evaluate baseline serum markers of ECM formation (PRO-C11, PRO-C22, and PRO-C7) and degradation (C7M) to assess disease activity and treatment response in UC.

Methods
Forty-nine UC patients with active disease and 50 healthy controls (HC) were included. All underwent endoscopy and blood sampling at inclusion. UC patients additionally had fecal calprotectin (FCP) measured at baseline and had treatment adjusted at the discretion of the attending physician. Subsequent follow up of UC patients included clinical activity score, FCP, and blood samples at 3 and 6 months as well as an endoscopy at 6 months. Ulcerative Colitis Endoscopic Index of Severity (UCEIS), total Mayo score (TMS), and disease extent (E1-E3) was registered. Response was defined as a reduction from severe to moderate or mild disease based on TMS. If no follow-up endoscopy was performed (n=9), partial Mayo was used. Spearman’s correlation and one-way-ANOVA with Turkey correlation and correction for multiple testing were applied for statistical analysis.

Results
All markers of ECM degradation and formation were elevated in patients with severely active UC measured by both UCEIS and TMS compared to HC (adjusted p&lt;0.0001 for each marker). CM7 and PRO-C22 differentiated moderate from severe UC by TMS (p&lt;0.0001) and UCEIS (p&lt;0.05) (Figure 1A-B). Baseline C7M, PRO-C7, and PRO-C11 correlated with CRP (Spearman’s: r=0.82, p&lt;0.0001; r=-0.45, p=0.0012; and r=-0.33, p=0.032, respectively). None of the markers correlated with FCP. Elevated C7M, PRO-C7, and PRO-C11 levels for E3 could differentiate E3 from E1 (Difference ng/ml: 3.89 (SE of diff: 1.47), 13.15 (4.55), 10.08 (4.09), respectively, all p&lt;0.05) (Figure 1C-E). Remission was achieved in 18/49 patients at 6 months. Both C7M and PRO-22 exhibited acceptable discriminative capabilities at baseline for 6-month TMS between remission and non-remission (AUC 0.72 (95% CI 0.58-0.87) p=0.01 and AUC 0.68 (95% CI 0.53-0.83) p=0.04, respectively) (Figure 1F-G).

Conclusion
This study demonstrates that ECM markers correlate with disease activity, disease extent, and predict future disease outcome in UC. ECM markers hold great promise as they provide a 'window' into transmural tissue remodeling and inflammatory and fibrotic burden, warranting further investigation.
P349 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: Descriptive Comparison of Experiences of Bowel Urgency among Patients with Ulcerative Colitis in Canada, Europe, and the US
Authors: Jairath V , Glass J , Braun M , Bessissow T , Gibble T , Atkinson C , Ellis H , Dewar T , Panaccione R 
Published: January 2024

Abstract

Background
Bowel urgency is a disruptive symptom affecting daily lives of patients with moderate-to-severe ulcerative colitis (UC). Previous analyses from the Communicating Needs and Features of IBD Experiences (CONFIDE) survey reported bowel urgency as a common and impactful symptom of UC in the United States (US) and Europe. This study used data from the CONFIDE survey to descriptively compare the prevalence and impact of bowel urgency in patients with UC across US, Europe, and Canada.

Methods
Online, quantitative, cross-sectional surveys were conducted among patients with UC in the US, Europe (France, Germany, Italy, Spain, UK), Japan, and Canada. Criteria based on previous treatment, steroid use, and/or hospitalization defined moderate-to-severe UC. Descriptive comparisons of data from US, Europe, and Canada are presented.

Results
Surveys were completed by 82 Canadian, 556 European, and 200 US patients with UC. Across geographies, most patients were receiving advanced therapies at the time of survey completion (Canada:73%, Europe:54%, US: 77%; Table). Similar to the findings in Europe and US, bowel urgency was among the top three most common symptoms currently (in the last month) experienced by Canadian patients (Canada:31%, Europe:30%, US:47%; Figure 1a). Due to fear/anticipation of bowel urgency-related accidents, 60% Canadian patients reported wearing diaper/pad/other protection, at least once a month in the past 3 months, similar to European (65%) and US (69%) patients. Among Canadian patients who ever experienced bowel urgency (n=46, 56%), most (78%) reported doing so at least once a month in past 3 months with similar frequencies observed among US and European patients; proportion of patients experiencing bowel urgency at least once a week was higher among US (79%) and European (71%) patients than Canadian patients (48%) (Table). Among patients receiving advanced therapies, similar patterns were observed (Table). Most patients in all three populations reported bowel urgency and bowel urgency-related accidents among the top five most common reasons for declining participation in work/school, social events, and sports/physical exercise (Figure 1b).

Conclusion
These descriptive analyses suggest that although the overall prevalence and burden of bowel urgency in Canada are similar to those in the US and Europe, a numerically lower proportion of Canadian patients with moderate-to-severe UC experienced bowel urgency at least once a week in past 3 months. Despite receiving advanced therapies, patients experience bowel urgency and related diaper/protection use across geographies. These findings highlight the clinical importance of evaluating and treating bowel urgency to improve the quality of life of patients with UC across geographies.
P356 Long-term outcome of UC patients in clinical remission with different level of mucosal activity: real world, retrospective, multicontinental study
Authors: Bacsur P , Wetwittayakhlang P , Resál T , Farkas B , Rutka M , Bessissow T , Afif W , Bálint A , Fábián A , Bor R , Szepes Z , Farkas K , Lakatos P L , Molnár T 
Published: January 2024

Abstract

Background
In contrast to the increasingly rigorous endpoints of clinical trials of ulcerative colitis (UC), Mayo endoscopic score (MES) ≤ 1 is mostly set as target during clinical follow-up, but long-term outcomes may differ according to different level of healing. Therefore, our study aimed to compare the long-term outcomes of UC patients in clinical remission with different MES and UCEIS scores in real-life condition.

Methods
UC patients in clinical remission (defined by pMayo&lt;2 with no rectal bleeding) who underwent colonoscopy between 2016-2020 were consecutively enrolled in this multicenter retrospective study. Mayo and UCEIS endoscopic scores were evaluated and clinical and demographic data were collected at baseline. Clinical flare, colectomy, hospitalization and treatment modifications were recorded during at least 3 year of follow-up. Primary outcome was the clinical flare, while secondary outcomes were hospitalization, colectomy, new biological initiation and biological dose escalation during follow-up. Outcomes were compared with Log-rank test and survival characteristics were plotted.

Results
In total, 156 UC patients were enrolled with a median age of 46.0 (IQR 35.5-58.0), while male/female ratio was 49.4 % (Table 1.). Near to half of the patients (44.9%) had MES&gt;0 endoscopic activity at baseline. Non zero baseline MES (Figure 1.; p = 0.002; MES 0 vs 1 p = 0.004) and UCEIS (p &lt; 0.001; UCEIS 0 vs. 1 p = 0.016) scores were associated with higher rate of clinical flare. Higher baseline MES (p = 0.042) and UCEIS (p = 0.008) scores were coupled with increased risk of hospitalization. Colectomy rates were low. Increased baseline UCEIS (p = 0.003), but not MES score was coupled with new biological treatment initiation, while only UCEIS score was associated with biological treatment intensification (&gt;4; p = 0.008).

Conclusion
Our study suggests differentiating between complete MH from MES 1 as long-term outcomes were more favorable in case of lower endoscopic scores. Consequently, targeting complete MH should be considered to achieve deep remission and disease clearance.
P357 Automated assessment of histological disease activity in Ulcerative Colitis using a deep learning algorithm
Authors: Kohli K , Khan A , Müller F , Cathomas G , Lugli A , Zlobec I , Mookhoek A 
Published: January 2024

Abstract

Background
Assessment of histological disease activity in patients with ulcerative colitis (UC) is becoming more important. Therefore, the DCA score was developed for use in clinical practice. Distribution (D), chronicity (C) and activity (A) are each scored on a three-point scale with distribution being dependent on the percentage of biopsy area affected by inflammatory changes. A major problem for implementation of any score is interobserver heterogeneity. To overcome this hurdle, we developed a deep learning algorithm to automatically compute the DCA score.

Methods
A retrospective cohort was created consisting of 117 adult patients with ulcerative colitis from which biopsies were taken during a colonoscopy performed in the setting of routine clinical evaluation (training set of 537 slides). From 75 cohort patients, an additional set of biopsies was available (test set of 299 slides). An expert gastrointestinal pathologist performed the DCA score. The model was trained on H&E-stained whole slide images scanned at 40x (0.243-μm pixel) resolution. Training was performed in a weakly supervised multiple-instance learning setup, using slide-level labels without region of interest annotations. The features from the convolutional neural network-based model trained at 2.5x, 5x, and 10x magnification were incorporated using a random forest classifier for final prediction. Model accuracy was evaluated using the test set.

Results
The algorithm differentiates between normal and inflamed with an accuracy of 90.9% (Table 1). Model performance from features aggregated across all magnification levels (i.e., 2.5x, 5x, and 10x) was superior to features from individual levels. This can be explained with the help of GradCam heatmaps (Figure 1), where we show that features learned at different magnification levels correspond to different aspects of histological changes in UC. The multiple instance approach did not appear to detect crypt abscesses, which may have resulted in a relatively poor performance in differentiating A1 from A2. The model accuracy for the 9-class DCA was 64.8%.

Conclusion
The algorithm first appears to assess architectural distortions at lower magnification and then the presence of cellular elements like neutrophils at higher magnification. This closely mirrors the approach of pathologists. The present model automates the scoring process and by supporting the daily diagnostic practice highlights the potential of deep learning technologies in assessment of histological disease activity in UC.
P361 Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet’s disease
Authors: Hyun H K , Park J , Park S J , Park J J , Kim T I , Kim W H , Lee J S , Lee H W , Kim B K , Park J Y , Kim D Y , Ahn S H , Kim S U , Cheon J H 
Published: January 2024

Abstract

Background
Behçet’s disease (BD) and nonalcoholic fatty liver disease (NAFLD) are chronic inflammatory diseases that share pathogenetic mechanisms. In this study, we investigated whether NAFLD influences the clinical outcomes in patients with intestinal BD.

Methods
Patients with intestinal BD and available hepatic steatosis index (HSI) and fibrosis-4 (FIB-4) scores were recruited between 2005 and 2022. An HSI of ≥30 and FIB-4 of ≥1.45 were used to diagnose hepatic steatosis and significant liver fibrosis, respectively. The primary outcomes were intestinal BD-related hospitalization, surgery, emergency room visits, or the first use of corticosteroids, immunomodulators, or biologic agents for intestinal BD.

Results
A total of 780 patients with BD were selected. The prevalence of hepatic steatosis and significant liver fibrosis were 72.3% and 8.8%, respectively. Multivariate analysis showed that younger age, prior smoking history, concomitant skin lesions, higher white blood cell count, and lower serum albumin levels were independently associated with an increased risk of clinical relapse (all p &lt;0.05), whereas hepatic steatosis and significant liver fibrosis were not (hazard ratio [HR] = 1.164, 95% confidence interval [CI] 0.923–1.468; p = 0.199 for hepatic steatosis; HR = 0.982, 95% CI 0.672–1.436; p = 0.927 for significant liver fibrosis).

Conclusion
Hepatic steatosis and liver fibrotic burden were not independently associated with clinical outcomes in patients with intestinal BD.
P389 Comparative Evaluation of ChatGPT and Human Specialists in the Application of ECCO Guidelines for the Management of Inflammatory Bowel Diseases and Malignancies: A Proof-of-Concept Study
Authors: Ghersin I , Weisshof R , Koifman E , Bar-Yoseph H , Ben-Hur D , Maza I , Waterman M , Gorelik Y 
Published: January 2024

Abstract

Background
Societal guidelines on colorectal dysplasia screening, surveillance and endoscopic management in inflammatory bowel diseases (IBD) are rather complex, and physician adherence to them is suboptimal.
We aimed to evaluate the use of ChatGPT, a large language model, in generating accurate guideline-based recommendations for colorectal dysplasia screening, surveillance and endoscopic management in IBD in line with European Crohn’s and Colitis Organization (ECCO) guidelines.

Methods
Thirty clinical scenarios in the form of free text regarding colorectal dysplasia in IBD were prepared and presented to ChatGPT and four gastroenterologists, two of them specializing in IBD and two with non-IBD specialties. Two additional IBD specialists subsequently assessed all responses provided by ChatGPT and the four gastroenterologists, judging their accuracy according to ECCO guidelines.

Results
ChatGPT provided accurate recommendations in 90% of cases (27/30), while among the four gastroenterologists the correct response rates were 28/30 (93%), 23/30 (77%), 26/30 (87%), and 25/30 (83%). The latter two represent the correct response rates of the IBD experts.
No statistically significant differences were observed between the accuracy of ChatGPT versus all gastroenterologists (p=0.44), or between the accuracy of ChatGPT versus the IBD experts and non-IBD expert gastroenterologists (p=0.71).

Conclusion
This study highlights the potential of language models in enhancing guideline adherence regarding colorectal dysplasia in IBD. Further investigation of additional resources and prospective evaluation in real-world settings are warranted.