bluuebunny/crossref_metadata_2025_split huggingface dataset:
P717 Evaluating the performance of Large Language Models in responding to patients' health queries: A comparative analysis with medical experts
Authors: Yan Z , Lu S , Xu D , Yang Y , Wang H , Mao J , Fan Y , Chen Y , Tseng H C 
Published: January 2024

Abstract

Background
Patients with chronic diseases exhibit a heightened interest in seeking health information, and access to high-quality information can positively impact clinical outcomes. While previous research on static internet text/video information has highlighted concerns about low-barrier creation leading to low-quality content, it remains uncertain whether similar issues persist in responses generated by Large Language Models (LLMs). Assessing the ability of LLMs in responding to medical queries provides valuable insights for their application in healthcare settings.

Methods
In alignment with open science principles, we utilized real patient queries from the China Crohn's and Colitis Foundation (CCCF) series "Questions and Answers on Ulcerative Colitis and Crohn's Disease." The dataset comprised questions posed by patients and corresponding answers from medical professionals, collected from outpatient visits and online social media. In September 2023, 263 patient questions were sequentially input into ChatGPT-3.5 (August 3, 2023 version), and the resulting responses were compiled alongside the original medical professional responses, forming 263 modules. Three Inflammatory Bowel Disease (IBD) specialist physicians and three IBD patients were invited to assess each module. Evaluators were instructed to: 1) choose their preferred response version, and 2) provide a multidimensional Likert 5-point subjective assessment using a crowdsourcing strategy. Additionally, the CRIE 3.0 team conducted an automated objective analysis of Simplified Chinese readability.

Results
Mann-Whitney U tests on text readability levels (median: 7th grade for both medical professionals and ChatGPT responses; Q1: 6th grade; Q3: 8th grade) revealed no significant difference (p=0.87), suggesting ChatGPT's performance align well with recommended literacy levels for popular science publications and is comparable to the average education level in China.

Conclusion
Cautiously interpreting our findings, ChatGPT's preliminary performance appears comparable to specialized IBD physicians, indicating its potential utility in patient community Q&A. Integrating ChatGPT or similar LLMs into the drafting or refinement stages of health texts is feasible. However, due to the presence of AI hallucinations and the consensus in most experimental conclusions, direct use of large language models for patient Q&A services is not recommended. Recognizing the variability in health information understanding between medical professionals and patients can enhance patient education efforts.
P718 Observational real-world evidence on the efficacy and safety of Janus Kinase inhibitors (JAKi) in the treatment of moderate to severe Active Ulcerative Colitis (UC)
Authors: Al-Zarrad D , Yeung K , Arebi N , Dyall L , Kamperidis N 
Published: January 2024

Abstract

Background
Janus kinase inhibitors (JAKi) are the first orally administered treatment for Ulcerative Colitis (UC). The JAK family comprises of four intracellular tyrosine kinases inhibitors (JAK1, JAK2, JAK3 and Tyrosine Kinase 2). Inhibition of the JAK kinases lead to dampening of the inflammatory cytokines which drive Inflammatory Bowel Disease (IBD).
Tofacitinib was the first generation pan-JAKi. This was followed by second generation JAKi: Filgotinib and Upadacinib which preferentially inhibit JAK1.
We report on the real-world evidence on the efficacy and safety of JAKi in the treatment of UC in a tertiary IBD treatment centre.

Methods
Patients attending the IBD clinic at weeks 8-12 of initiation of therapy were included. Baseline demographics, disease activity and previous therapies were recorded. Clinical response was measured using the SCCAI and biochemical response was measured using calprotectin and CRP.
We defined clinical response as ≥3 points reduction from baseline SCCAI, and clinical remission as SCCAI Score of &lt;2.5, and / or biochemical remission as a CRP of less than 5 mg/L and a calprotectin level of &lt; 250 mg/g. We also assessed treatment persistence, and the reasons for treatment cessation.

Results
The UC populations are shown in Table 1. 52 patients were included and an additional 24 patients who discontinued therapy early on were assessed to review secondary outcomes. Table 1 summarises the comparative outcomes of the JAKi. 81% and 63% of patients achieved clinical and biochemical remission respectively. Overall, 31% discontinued treatment due to lack of efficacy or adverse events. 60% of patients reported adverse events (AEs), 25 % of patients discontinued treatment due to AEs and 84% of patients continued treatment despite reporting AEs. The most common AEs were hypercholesteremia and cold and flu like symptoms and the most common AEs related with treatment discontinuation were recurrent infection or persistent deranged liver functions contributed to patients’ history of primary sclerosing cholangitis. No Serious Adverse Events were reported. 60% of patients on tofacitinib developed side effects and persisted with therapy, which included hypercholesteremia (67%), shingles (11%), flu like symptom (11%) and hair loss (11%). 53% had side effects with Filgotinib; hypercholesteremia (25%), cold like symptoms (25%), chest infection (13%), shingles (13%), acne (13%). 68% developed side effects with Upadacitinib; reports of acne (20%), cold and flu (33%), shingles and mood swings (7%) and high cholesterol (67%).

Conclusion
In this real-world cohort of UC patients, JAKi was effective in inducing remission and had an acceptable safety profile. The observed safety profile was as expected compared to clinical data results.
P719 Vitamin and micronutrient excess in patients with Crohn’s disease under oral ambulatory exclusive enteral nutrition
Authors: Oliveira R , Mendes B , Cunha Neves J , Amorim E , Roseira J , Tavares de Sousa H 
Published: January 2024

Abstract

Background
Exclusive enteral nutrition (EEN) is recommended for preoperative nutritional optimization (PNO) in adult Crohn's disease (CD) patients. However, during ambulatory oral EEN, a lack of routine monitoring for vitamins may occur, with a potential risk of hypervitaminosis-related toxicity, which remains unexplored. This study aims to assess the serum levels of vitamins and micronutrients in CD patients undergoing EEN and to examine its potential impact.

Methods
Complicated phenotype CD patients followed at a University Tertiary Hospital who were started on oral EEN June 2021 - June 2023 were prospectively included. EEN composition was determined and modified by an IBD nutritionist according to patients’ nutritional status and needs and laboratory values. Compliance was monitored daily, both for in- and outpatients. Patients’ weight and serum values (albumin, C-reactive protein [CRP], iron, folic acid, and vitamins B1, B6, B12, A, D, E and K) were monitored weekly.

Results
Nine patients (median age 29 years, 55.6% female) received a median of 24 (IQR 14.5-25.0) days of EEN, for PNO of symptomatic stricturing (7, 77.8%) or abdominal penetrating disease (2, 22.2%). All patients were discharged while on EEN, which was maintained until elective surgery (4, 44.4%) or the planned start of advanced medical therapy (5, 55.6%), with EEN successfully avoiding emergent surgeries. Patients were started on a combination of hypercaloric-hyperproteic and hypercaloric-normoproteic ready-to-drink concentrated polymeric formulas, providing 30 kcal/kg/d and 1.2-1.5g/kg/d of protein. EEN daily volume ranged from 1000 to 1400mL. Compliance was 100%, requiring flavour adjustments for tolerance. Table 1 illustrates changes over time in patients' weight and serum levels of interest. Resolution of anaemia and hypoalbuminemia was achieved, while weight was maintained . Hypervitaminosis cases were remarkably detected: 5 (55.6%) for vitamin B1, 4 (44.4%) for A, 2 (22.2%) for E, and 3 (33.3%) for K, with increasing trends over time. However, no symptoms related to hypervitaminosis were reported.

Conclusion
Our study on PNO EEN in CD uncovered a gap in routine monitoring for essential vitamins during EEN. While achieving significant clinical improvement, our findings revealed subtle and asymptomatic cases of hypervitaminosis in short-term EEN courses. These results underscore that vitamin monitoring is advisable during EEN, especially in prolonged EEN protocols due to possible hypervitaminosis-related toxicity.
P724 Long-term outcomes of exclusive enteral nutrition in the peri-operative period for Crohn’s disease: A seven year follow-up study
Authors: Ragatha R , Estridge P , Shams O , Bethune R 
Published: January 2024

Abstract

Background
Exclusive enteral nutrition (EEN) is a recommended first-line treatment for Crohn’s disease flares in the paediatric population. Its use has yet to translate widely to the adult population. There is growing evidence for the use of EEN in the pre-operative setting to downstage the disease process and improve short term surgical outcomes. Little is known in this context regarding the long term effects of pre-operative EEN. Our study reports on follow up data for a cohort of patients who underwent surgery following pre-optimisation with EEN compared to those who did not. We assessed long term complications, disease recurrence and disease control as our key outcomes.

Methods
We carried out a seven year follow up study of the patients included in a retrospective, matched cohort trial conducted in a single, tertiary care, inflammatory bowel disease centre, in the UK. Patients pre- optimised with EEN prior to surgery were compared to a matched control cohort.

Results
Median follow up period was seven and six years for EEN and control groups respectively. Patients in the EEN group were more likely to be on maintenance medical therapy compared to control (73.47% vs 46.67%, p=0.005), however, admission rates and clinical recurrence rates were similar between groups (32.65% vs 24.66%, p=0.33 and 71.43% vs 65.58%, p=0.42). There was a moderate difference in complication rates beyond six months in favour of the EEN group (5.55% vs 17.80%, p=0.08). EEN patients were more likely to need further surgery however, this observation was not sustained when surgery for peri-anal disease was excluded (22.45% vs 13.69%, p=0.21)

Conclusion
Pre-optimising patients with EEN prior to Crohn’s disease surgery may improve short term surgical outcomes, it is unlikely to improve long term disease outcomes, based on results from this study.
P726 A phase 2 study investigating the efficacy and safety of dupilumab versus placebo in adults with moderately to severely active ulcerative colitis with an eosinophilic phenotype
Authors: Gottlieb E , Binion D , Feagan B , Laws E , Nivens C , Maloney J , Abdulai R , Radin A , Glotfelty L 
Published: January 2024

Abstract

Background
Ulcerative colitis (UC) is a heterogeneous, chronic inflammatory disease, with many different drivers of pathogenesis, characterised by inflammation of the colon mucosa, relapsing–remitting disease course and variable response to therapy. Around 30–55% of patients with UC are refractory to treatment during the induction phase, despite the availability of molecular targeted agents. Recent studies have investigated a potential link between eosinophilia and increased disease activity, poorer clinical outcomes and response to therapy.
Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin (IL)-4 and IL-13, key and central drivers of type 2 inflammation in multiple diseases. It is approved for treatment of atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyps, eosinophilic oesophagitis and prurigo nodularis. The phase 2 LIBERTY-UC SUCCEED (NCT05731128) study is designed to investigate the efficacy and safety of dupilumab versus placebo in adults with moderately to severely active UC with an eosinophilic phenotype.

Methods
Approximately 100 patients will be randomised 1:1 to receive dupilumab or placebo treatment for 52 weeks. Key inclusion criteria include age ≥18 years, moderately to severely active UC (modified Mayo score 5–9), biomarker enrichment, and inadequate/non-response, loss of response, or intolerance to standard biologic therapy and/or oral corticosteroids, ASA compounds, immunomodulators or small molecules. Key exclusion criteria include severe extensive colitis (defined by current hospitalisation, requirement for surgery for UC within 12 weeks of screening), prior medical history of eosinophilic colitis, or presence of intestinal failure. Participants who qualify will have the opportunity to receive open-label dupilumab.

Results
The primary endpoint is proportion of patients in clinical remission at Week 24, defined as a modified Mayo score of ≤2 with a stool frequency score ≤1, a rectal bleeding score = 0 and a Mayo endoscopic subscore ≤1 with absence of friability. Higher scores indicate greater disease severity. Secondary endpoints include the proportion of patients achieving clinical response by modified Mayo score at Week 8, 24 and 52, and incidence of treatment-emergent or serious adverse events.

Conclusion
The phase 2 LIBERTY-UC SUCCEED study will evaluate the efficacy and safety of dupilumab therapy in adults with moderately to severely active UC with an eosinophilic phenotype. This will aid in addressing the need for precision medicine approaches to treat UC.
P730 Edema index as a more sensitive indicator of nutritional status with Crohn’s disease
Authors: Peng Y , Liu X 
Published: January 2024

Abstract

Background
Crohn's disease (CD) often presents with malnutrition due to the impaired mucosal barrier accelerating the loss of protein. The edema index can indicate protein consumption. This study aims to confirm whether the edema index could be a nutritional assessment for CD patients.

Methods
The study was conducted at Xiangya Hospital Central South University between May 2023 and July 2023, including CD patients and the control group. In both groups, bioelectrical impedance analysis was performed, and the edema index defined as extracelluar water/total body water (ECW/TBW) was calculated. The demographic data and body composition parameters were collected through the medical system. The control group consisted of healthy adults, strictly matched for gender, age, and BMI in a 1:1 case-control manner. Univariate analysis and multivariate analysis were used to compare the differences in nutrition-related indicators between both groups.

Results
A total of 128 subjects were included in the final cohort with 50% each of CD patients and healthy individuals. There were no significant differences in gender, age, BMI. Fat free mass, muscle mass, basal metabolic rate (BMR), and visceral fat rating were similar in both groups (P &gt; 0.05). Compared to the control group, CD patients had significantly lower fat mass (9.26 ± 5.38 vs.16.63 ± 10.67, P = 0.006), bone mass (2.16 ± 0.41 vs. 2.52 ± 0.57, P = 0.019), but a higher level of edema index (41.07 ± 2.38 vs. 38.53 ± 5.62, P = 0.015). Multivariate logistic regression analysis revealed that edema index was an independent factor to malnutrition in CD patients (OR: 1.665, 95% CI: 1.158-2.395, P = 0.006).

Conclusion
A higher edema index in CD patients demonstrates their worse nutritional status compared to healthy subjects. The edema index may serve as a more sensitive and noninvasive indicator to assess nutritional status in CD patients.
P733 Long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel diseases treated with intensified doses: the REMSWITCH-LT study
Authors: Buisson A , Nachury M , Bazoge M , Yzet C , Wils P , Dodel M , Coban D , Pereira B , Fumery M 
Published: January 2024

Abstract

Background
We recently demonstrated that switching from intravenous to subcutaneous infliximab is safe and well-accepted at short-term in IBD patients including those with intensified IV regimen. However, the long-term risk of relapse in these patients remains unknown.
We assessed the long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel diseases (IBDs) treated with or without intensified intravenous regimen.

Methods
In this prospective multicenter observational study, IBD patients in clinical remission (partial Mayo score ≤ 2 or Harvey-Bradshaw index ≤ 4) were switched to a unique dose of subcutaneous infliximab (120 mg every other week). Pharmacological and biological data were collected at baseline, 6 months and at last follow-up (median follow-up : 18 [15-20] months). Relapse was defined as clinical relapse or fecal calprotectin increase ≥ 150 mg/g compared with baseline.

Results
Among 184 eligible patients, 72.3% (n = 133/184) agreed to switch. At M6, a relapse occurred in 10.2% (n = 6/59), 7.3% (n = 3/41), 16.7% (n=3/18), and 66.7% (n=10/15) (P &lt; .001) of patients receiving 5 mg/kg every 8 wks, 10 mg/kg every 8 wks, 10 mg/kg every 6 wks, and 10 mg/kg every 4 wks, respectively. At 18 months, the rate of relapse was 13.6% (n=8/59), 17.7% (n=7/41), 33.3% (n=6/18), and 86.7% (n=13/15) (P &lt; .001) of patients receiving 5 mg/kg every 8 wks, 10 mg/kg every 8 wks, 10 mg/kg every 6 wks, and 10 mg/kg every 4 wks, respectively.
Dose escalation led to recapture clinical remission in 82.1% (23/28) of the patients, including 83.3% (15/18) and 80.0% (8/10) in those receiving 240 mg every other week or 120 mg every week, respectively.
Infliximab serum levels increased after the switch (P &lt; .0001) except for patients receiving 10 mg/kg every 4 wks. In multivariable analysis, 10 mg/kg every 4 wks regimen (OR= 61.0; [6.0-600.1], p &lt;0.001) and 10 mg/kg every 6 wks regimen (OR=4.7; [1.1-20.2], p = 0.039) had a higher risk of relapse at 18 months as well as reduced (58.3%) or stable (52.6%) infliximab serum levels between baseline and visit 1 compared with increased serum levels (19.7%) (P = 0.006 and P = 0.008, respectively).
Patients’ acceptability (10-point scale) was improved by the switch (6.9 ± 1.6 for IV vs 8.6 ± 1.4 at V1 after the switch; P &lt; .0001) and did not decrease over time during SC maintenance regimen 8.8 ± 1.3 at 6 months and 8.8 ± 1.3 at 18 months. No severe adverse event was reported.

Conclusion
Switching from IV to SC infliximab 120mg eow is safe and well-accepted leading to a low long-term risk of relapse in IBD patients. Tight monitoring and escalated dose should be recommended for patients receiving 10mg/kg/6 weeks and 4 weeks, respectively.
P736 Class 4 Fistulizing Perineal Disease after Proctectomy for Crohn’s Disease: A Multicentre Study
Authors: Khan A , Khan I , Ward T , Cohen B , Valente M , Holubar S 
Published: January 2024

Abstract

Background
The TOpCLASS International Consortium recently described a paradigm shifting classification scheme for perianal Crohn’s disease, based on the desired patient goals of care. Class 4 perineal fistulizing disease is a CD that persists after proctectomy, and there are limited data defining this entity. We sought to determine the rates of clinical perineal fistulizing disease after proctectomy and to secondarily define the risk factors for recurrence.

Methods
Adult patients with CD who underwent perineal resection with proctectomy or proctocolectomy at three hospitals within our institution’s health network between 2009 and 2021 were retrospectively reviewed. The exclusion criteria included a preoperative diagnosis of ulcerative colitis or indeterminate colitis, and patients who underwent restorative proctectomy. Extracted data included baseline demographic data, preoperative medical treatment for CD, proctectomy indication, clinical recurrence of perineal disease, and resolution of perineal disease.

Results
A total of 405 patients with Crohn’s disease were included, including 190 (46.9%) who underwent proctectomy and 215 (53.1%) who underwent proctocolectomy. The median age was 44 years (IQR 33-58) and 58.8% of the patients were female. Within three months prior to surgery, 36% were exposed to biologic therapy, 29.1% to immunomodulators, and 11.4% to corticosteroids. During a median follow-up of 4 years, clinical recurrence of fistulizing perineal CD occurred in 62 (15.3%) patients, including five patients with perineal-vaginal fistulas and one with adenocarcinoma in the fistula tract. The median time to the development of perineal disease was 6.5 months (IQR 3-23 months). Factors associated with perineal disease included younger age (38 vs. 46 years; p &lt;0.01), female sex (71% female vs. 56.6% female; p=0.03), preoperative corticosteroid use (19.4% vs. 9.9%; p=0.031), and the presence of perianal CD, regardless of the indication for proctectomy (85.4% vs 60.1%; p&lt;0.01). After treatment for class 4 disease, perineal symptom resolution was observed in 40 (62.9%) patients. There were 79 (19.5%) patients underwent examination under anesthesia (EUA) for perineal disease, with a median of 2 EUA’s (range 1-21). Preoperative biological therapy was not associated with recurrent perineal disease (p= 0.29).

Conclusion
Perineal CD after proctectomy is common and frequently requires multiple surgical interventions. Younger age, female sex, preoperative corticosteroid use, and the presence of perianal disease may benefit from a more intensive postoperative review and consideration of the continuation or early initiation of prophylactic post-proctectomy CD medical management with biologics.
P737 Poor body image is associated with significant depression, anxiety and self-harm in people with inflammatory bowel disease
Authors: Barnes A , Prosser R , Mountifield R 
Published: January 2024

Abstract

Background
Body image dissatisfaction is common in inflammatory bowel disease (IBD) and is associated with worse quality of life in this population. In other populations body image dissatisfaction has been associated with psychological distress. We aimed to investigate the relationship between body image and depression, anxiety, and self-harm in an IBD population.

Methods
IBD patients at a tertiary IBD referral centre were sent a pre-clinic survey to be undertaken once a year. This survey included a validated measure of body image dissatisfaction – the body image scale (BIS) – with a BIS &gt;= 10 indicating Body Image Dissatisfaction. Demographic data and measures of depression (Patient health questionnaire 9 (PHQ9), and anxiety (Generalised anxiety disorder-7 (GAD7)) were also obtained.

Results
There was 146 responses to the questionnaire, majority female (64%), median age 42 years interquartile range (29-58), 57% Crohn’s disease. A BIS over &gt;= 10 was seen in 35.3%, with mean (SD) BIS score 8.5 (7.5). Consistent with previous literature BIS score was higher in females (11.3 (1.2) v 3.4 (3.5), p&lt;0.001). BIS score was higher in obesity (11.0 v 7.2, p=0.049), however correlation with weight was poor (-0.044), and overall body weight was not higher in BIS&gt;=10 (77.5 (2.8) v 82.1 (4.8) p=0.37), and similarly no difference seen in BMI (30.0 (1.5) v 28.3 (1.2) p=0.41).
BIS score and depression score (PHQ9) correlation was strong (ro=0.56), and similarly for anxiety severity score (ro=0.57). More frequent self-harm was associated with worse body image dissatisfaction (Figure 1 oneway ANOVA). Self-harm or suicidal ideation more than half the days was associated with a BIS score over 10 (p=0.012 Chi2, Odds ratio 4.16 for self-harm given BIS over 10).

Conclusion
Body image dissatisfaction is associated with self-harm, depression and anxiety, In addition to its known relationship with lower quality of life. Consideration should be given to developing body image targeting interventions in IBD populations and future research should consider interventional trials in this area.