bluuebunny/crossref_metadata_2025_split huggingface dataset:
P403 A new criterion, combining bowel wall thickness and submucosal index (SMI), is useful for estimating endoscopic improvement in Ulcerative Colitis
Authors: Komatsu H , Morikubo H , Kimura Y , Yonezawa H , Matsuura M , Miyoshi J , Hisamatsu T 
Published: January 2024

Abstract

Background
Endoscopic improvement (EI), Mayo endoscopic subscore of 0 or 1, is considered a therapeutic target in ulcerative colitis (UC) treatment. The potential to estimate EI non-invasively is an advantage of intestinal ultrasound (IUS). In a former study, we developed a new ultrasound parameter, the submucosal index (SMI), calculated as the ratio of the thickness of the submucosa to the thickness of the bowel wall (BWT), and reported that combining BWT and SMI could be a practical criterion for estimating EI without the assessment of bowel wall vascularity using color Doppler evaluation. In the present study, we validated the EI estimation ability of our B-mode-based UC criterion, Kyorin Ultrasound Criterion for UC (KUC-UC; BWT&lt;3.8mm and SMI&lt;50%), using an external cohort.

Methods
Patients who underwent IUS and CS at Kyorin University Hospital were included. The inclusion criteria were (1) both IUS and endoscopy (sigmoidoscopy or CS) for UC were performed between July 2021 and June 2022, (2) the interval between IUS and endoscopy was within 15 days, and (3) no change or addition of therapeutic agents between the two examinations. IUS findings including BWT, SMI, and modified Limberg score were evaluated. In the modified Limberg score, the threshold of normal BWT was less than 3 mm, while the original Limberg score employed less than 4 mm.

Results
The KUC-UC criterion defined as BWT &lt; 3.8 mm and SMI &lt; 50.0% is practical because it uses only B-mode findings and does not require complex calculations. We tested the ability of this criterion to estimate EI in UC. A total of 122 colon segments were evaluated by transabdominal IUS and CS. The criteria showed a sensitivity of 67.3%, specificity of 97.1%, PPV of 94.6%, and NPV of 80.0%. In the previous development cohort, the PPV and NPV of KUC-UC were 95.5% and 82.7%, respectively. Based on the above, this validation cohort is considered equivalent to the development cohort. BWT &lt; 3 mm and MUC have been reported as useful criteria for EI estimation. In the present cohort, BWT &lt;3mm showed a sensitivity of 67.3%, specificity of 91.4%, PPV of 85.4%, and NPV of 79.0%, and MUC demonstrated a sensitivity of 75.0%, specificity of 88.6%, PPV of 83.0%, and NPV of 82.0%. These results indicate that KUC-UC has a considerable potential to estimate EI as BWT &lt; 3 mm or MUC.

Conclusion
External validation showed that KUC-UC, using only B-mode findings without complicated calculations, is feasible, accurate sonographic criteria to estimate the EI of UC. The KUC-UC criterion could be one of the options for estimating EI in UC.
P407 Validation of a newly developed patient-reported experience measure for people with Inflammatory Bowel Disease
Authors: Totton N , Sheldon E , Ezaydi N , Bursnall M , Hind D , Wakeman R , Lobo A 
Published: January 2024

Abstract

Background
Patient-Reported Experience Measures (PREMs) assess a patient’s healthcare experiences and are important to improve the quality of healthcare. A PREM specific to inflammatory bowel disease (IBD) was co-produced with service users. This study aimed to validate the PREM.

Methods
The IBD PREM contains 38-items and comprises three domains: ‘the care team’, ‘what matters to me’, and ‘living with Crohn’s or Colitis’. Scores can be calculated for each domain and summated to give a total score.
Validation was completed on data collected from participants who completed the PREM every 3 months alongside the IBD-Control measure of disease activity at a single UK tertiary IBD service. The PREM was assessed for acceptability; reliability (internal consistency and repeatability); known groups validity; criterion validity and responsiveness. Face and content validity were completed before finalisation using ‘Think Aloud’ interviews.

Results
The dataset used for validation was extracted in September 2023 and contained responses from 287 participants (63% female, 89% White British, median age: 52) comprising 1,699 PREM responses between November 2021 and August 2023.
Acceptability was demonstrated with very low rates of missing data (four items with &gt;5% missing) and median submission duration of 4.8 minutes (IQR: 3.6 – 6.6). High Cronbach’s alpha scores (0.85, 0.97, 0.88 and 0.97 for each of the domains and total PREM score respectively) show internal consistency of the measure. However, the particularly high value on one domain and the total score suggest some overlapping items may remain. An intraclass corelation coefficient of 0.88 (95% CI: 0.85 to 0.91) suggests good repeat reliability over a two-week timeframe.
Good comprehension of the measure by service users satisfied face and content validity. Known groups validity was supported with lower score on ‘living with Crohn’s or Colitis’ domain the for those with an IBD Control score of less than 13 by 0.38 (95% CI: 0.23 to 0.54), p&lt;0.001). A low to moderate correlation of 0.37 (95% CI: 0.32 to 0.42) was found between the total PREM score and the IBD Control score, as expected.
Ceiling and floor effects had a maximum of 6% demonstrating potential responsiveness of the PREM. The change over a year detected by those that stated that had experienced a change was 0.53 (95% CI: 0.41 to 0.66, n=38) on a five-point scale.Conclusion
The co-produced PREM is an acceptable, valid, reliable, and responsive tool to measure experience of IBD care for quality improvement. Further work should assess the potential for item reduction as well as correlation to other related measures.
P422 Prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaire in Inflammatory Bowel Disease patients and its association with disease activity and quality of life
Authors: Chaemsupaphan T , Subdee N , Phaophu P , Salaemae M , Permpim P , Wannasewok K , Pimolsri C , Chotinaiwattarakul W , Limsrivilai J 
Published: January 2024

Abstract

Background
An association between active inflammatory bowel disease (IBD) and poor sleep quality has been proposed, however studies evaluating both subjective and objective assessment of disease activity and sleep quality are limited. Our study aimed to investigate the prevalence of poor sleep quality assessed by wrist actigraphy and sleep questionnaires in IBD patients and its association with disease activity and quality of life.

Methods
A prospective observational study was conducted in Siriraj Hospital, Mahidol University, Bangkok, Thailand from March 2021 to December 2022. Eligible IBD patients were categorized into remission, mild, and moderate-to-severe groups, based on standard clinical disease activity scores. Demographic data, inflammatory markers, inflammatory bowel disease questionnaire (IBDQ), sleep questionnaire (Pittsburgh Sleep Quality Index, PSQI), and seven-day sleep data from wrist actigraphy (Actiwatch®, CamNtech, Cambridge, United Kingdom) were obtained. The prevalence of sleep disorder and group comparison were analyzed.

Results
Eighty-four participants (40 Crohn’s disease, 44 UC), consisting of 60 remission, 16 mild, and 8 moderate-to-severe disease activity, were enrolled. Baseline demographic data were comparable between each group. Lower hemoglobin and albumin levels, and higher serum C-reactive protein, and fecal calprotectin levels were found in the more clinically active groups (table1). Fifty patients (60%) had poor sleep defined by PSQI &gt; 5 with a trend to be higher in the group with active symptoms (57% in remission, 63% in mild, and 75% in moderate-to-severe group, p=0.31). Using actigraphy, the group with moderate-to-severe symptoms tended to have longer sleep latency, more frequently awake after sleep, and poorer sleep efficiency than the other groups (Figure 1). Patients with more severe disease activity had poorer quality of life with a mean IBDQ of 190 in remission, 159 in mild, and 134 in moderate-to-severe group (p&lt;0.001).

Conclusion
Poor sleep quality is common among IBD patients, even those with clinical remission. Those with more severe symptoms had poorer sleep quality and worse quality of life. Sleep assessment and treatment should be integrated into IBD standard clinical care.
P432 Real-time automated assessment of histological disease activity in patients with ulcerative colitis using single wavelength endoscopy technology
Authors: Sinonquel P , Lenfant M , Eelbode T , Callaerts B , Watanabe H , Guedelha Sabino J P , Verstockt B , Maes F , De Hertogh G , Vermeire S , Bisschops R 
Published: January 2024

Abstract

Background
Assessment of mucosal healing as a key denominator in the treat-to-target strategy for managing ulcerative colitis remains challenging. To address this, objective evaluation of histological disease activity holds promise. Recent offline research shows encouraging results using a new deep-learning convolutional neural network based on single wavelength endoscopy technology (SWE-CAD) (Fujifilm Co, Japan). We aimed to validate the real-time performance of a new bedside prototype SWE-CAD model during standard colonoscopy.

Methods
A bedside module for real-time use was integrated in the endoscopy room to evaluate histological disease activity in patients with ulcerative colitis with Mayo Endoscopic Scoring (MES) ranging between 0 and 3. Imaging was performed in rectum and sigmoid following a standardized protocol based on white light and SWE (i.e. monochromatic light of 410nm). Biopsies were taken as reference at the center of the imaged region and were scored for the Geboes score (GBS). The SWE-CAD output was displayed on the separate monitor of the bedside module as a blue or red-colored indication, corresponding to histological remission or non-remission, respectively. Each region (2 in rectum and 2 in sigmoid) was simultaneously scored for MES by the endoscopist.

Results
In a total of 36 patients histological disease activity was automatically scored using the SWE-CAD. On a section level this CAD-system showed an accuracy of 96.4%, corresponding sensitivity was 99.3% and specificity was 85.5%.
When differentiating for disease activity as mild, moderate and severe, accuracy was 97.7%, 62.8% and 95.0%, respectively. On a per-patient level, overall diagnostic accuracy remained high with 94.4%, with only 2/36 underestimations when compared to GBS.

Conclusion
In this pilot trial, we successfully tested a novel CAD-system, utilizing SWE technology, for real-time assessment of histological disease activity in patients with UC. The system demonstrated exceptional clinical accuracy at 94.4% per-patient level, potentially aiding physicians in interpreting subtle endoscopic abnormalities, leading to cost-effective and individualized patient management.
P451 Specific Oral Manifestations in Patients with Crohn's Disease
Authors: Çagir Y , Durak M B , Simsek C , Yuksel I 
Published: January 2024

Abstract

Background
Extra-intestinal manifestations of Crohn's disease (CD), including arthropathic, mucocutaneous, ophthalmic and hepatobiliary disorders, have a prevalence ranging from 16.7% to 40%. Oral manifestations of CD are classified into specific manifestations directly related to intestinal inflammation and non-specific manifestations. The aim of this study was to determine the frequency and characteristics of specific oral manifestations in patients with CD.

Methods
We retrospectively evaluated 676 patients with CD who were followed up for at least 6 months between June 2013 and February 2023 at our tertiary care center. Specific oral lesions were clinically defined as cobblestoning, orofacial granulomatosis, lip/cheek swelling with fissuring, and pyostomatitis vegetans. Confirmation of specific lesions was made by experienced dentists for each case.

Results
Of the 676 CD patients (58.9% male, median age 38 years) followed for 6.83 years (IQR 3.45-11.76 years), 96 (14.2%) had oral lesions. Specific oral lesions were found in 8 patients (1.2%), while 88 (13.1%) had non-specific lesions. The specific lesions included cobblestoning (n=2), orofacial granulomatosis (n=3), glossitis with fissuring (n=2), and lip swelling with fissuring (n=2). Patients with specific lesions were predominantly male (75%) with a median age of 46.5 years (range 23-68 years). Disease location was ileal (25%), colonic (25%), and ileocolonic (50%), with perianal disease in 50%. Disease behavior was inflammatory in 7 and penetrating in 1 patient. Three patients were active smokers. Three patients had prior major abdominal surgery. Concurrent extraintestinal manifestations included peripheral arthritis/arthralgia (n=7), sacroiliitis (n=1), and uveitis (n=2). Immunomodulators were used in 7 patients and biologics in 5 patients. All specific lesions were associated with active disease (median CRP 35.5 mg/L, range 6-151 mg/L; median CDAI 313, range 227-480) and improved with immunomodulator or biologic therapy.

Conclusion
In this large cohort of CD patients, the frequency of specific oral manifestations was 1.2%. These lesions were associated with active disease and improved with immunosuppressive treatment, highlighting the need for close collaboration between gastroenterologists and dentists for early recognition and optimal management.
P452 Serum Amyloid A for Predicting Surgery and Disease Exacerbation in Patients with Newly Diagnosed Crohn’s Disease
Authors: Chen R , Chen Q , Chen M , Zhang S 
Published: January 2024

Abstract

Background
Crohn's disease (CD) is characterized by relapsing-remitting course with highly heterogenous prognosis, ranging from quiescent disease to complicated course with stricturing, penetrating or need of abdominal surgery. Identifying biomarkers that determine their disease course can enable implementing more aggressive preventive strategies. Serum amyloid A (SAA) has been demonstrated to involve in the pathogenesis of Crohn’s disease (CD); however, its prognostic value is still uncertain. This study was determined to explore the prognostic value of SAA for CD-related surgery and disease exacerbation in newly diagnosed CD.

Methods
We conducted a retrospective cohort study and recruited newly-diagnosed CD patients at the First Affiliated Hospital of Sun Yat-sen University. Level of SAA was detected at diagnosis. The primary outcome was CD-related surgery. The secondary outcome was disease exacerbation, defining as newly developed structuring or penetrating lesions. Association between variables and outcome was evaluated through Kaplan–Meier method and Cox proportional hazard regression analysis. For continuous variables, the optimal cutoff values were determined by using the survminer R package in the analysis of primary outcome. The prognostic model was developed by cox proportional-hazards model. Concordance-index (c-index) was used to assess the predictive ability of the prognostic model.

Results
During 2187.6 person-years (median age, 28 years, 72.4% male), 87 surgery and 153 disease exacerbation events were documented. After adjustment, a 14% higher risk for surgery (adjusted hazard ratio, aHR [95% confidence interval]: 1.14 [1.05–1.23]; p=0.001) and a 12% higher risk for disease exacerbation (1.12 [1.05–1.19]; p&lt;0.001) were observed with a 100-unit increase in SAA level. Patients with SAA levels ≥89.2 mg/L had aHRs of 2.08 [1.31–3.28] and 1.72 [1.22–2.41] for CD-related surgery and disease exacerbation, respectively. The association between SAA and outcomes was assessed as linear by the restricted cubic spline. Adding SAA into the model including known risk factors, including age at diagnosis ≥40 years, disease behavior, disease location, and initial biological treatment, led to significant improvement in its predictive ability for surgery (net reclassification index and integrated discrimination index, p&lt;0.001) and disease exacerbation (net reclassification index and integrated discrimination index, p&lt;0.001). Sensitivity analyses showed robust results.

Conclusion
Our study shows that higher serum SAA level at diagnosis was associated with poorer prognosis, including risk of surgery and disease exacerbation. And prognostic models based on SAA and known risk factors could better predict prognosis.
P455 Deploying machine learning algorithms to stratify patients with inflammatory bowel disease using routinely collected electronic health records
Authors: Mian H A , Radia C , Sarras K , Hayee B , Al-Agil M , Patel M , Kent A , Dubois P , Pavlidis P , Iniesta R 
Published: January 2024

Abstract

Background
Personalised medicine approaches are eagerly awaited to facilitate individualisation of medical care for patients with inflammatory bowel disease (IBD). Multiple approaches have already been explored in attempts to stratify patients into different prognostic trajectories. In this study we aimed to use machine learning algorithms to cluster patients based on their routinely collected electronic health records in an unsupervised approach.

Methods
We interrogated the rich electronic health records (EHR) of 619 patients with a diagnosis of IBD requiring an advanced therapy and attending the IBD service at King’s College Hospital (KCH), London, UK. Data for a seven year period (June 2016-May 2023) were included with variables that captured diagnosis, treatments, service utilisation and investigations. Ethical approval was provided following application to the KERRI committee (KCH committee for accessing anonymised HER). In a preliminary analysis, we employed a multi-step approach to analyse patient data, identify significant features through k-prototypes clustering and a combination of parametric and non-parametric statistical tests. We examined different cluster solutions up to six clusters.

Results
We included 38 quantitative and 32 qualitative variables for 350 patients with a diagnosis of CD and 269 with a diagnosis of UC. Missing data were addressed by imputation by k-NN, mode value and zero. In the context of the unsupervised learning approach, when k=3, key differentiating features included faecal calprotectin levels, body mass index, mean platelet volume, marital status, taking advanced therapy for less than 3 years, and service access (telephone or clinic appointments).

Conclusion
This first pass analysis suggests that patients who are relatively early in their journey with at least moderately active IBD take up more recourses of the IBD service. This associates also with their social circumstances. Further work will explore these interactions in more detail.
P469 Deep learning and minimally invasive endoscopy – panendoscopic detection of pleomorphic lesions
Authors: Mendes F , Mascarenhas M , Ribeiro T , Afonso J , Cardoso P , Martins M , Cardoso H , Andrade P , Mascarenhas Saraiva M , Ferreira J , Lopes S , Macedo G 
Published: January 2024

Abstract

Background
Capsule endoscopy is a minimally invasive exam capable of performing a panendoscopic evaluation of the gastrointestinal tract. Nevertheless, capsule endoscopy is a time-consuming exam, revealing suboptimal diagnostic yield when considering the upper gastrointestinal tract. Convolutional neural network are models based on the human visual cortex architecture, suitable for image analysis. However, there is still an absence of studies about their role in capsule panendoscopy.

Methods
Our group developed a deep Learning model for panendoscopic automatic detection of pleomorphic lesions (namely vascular lesions, protuberant lesions, hematic residues, ulcers and erosions). In order to develop the convolutional neural network, 355 110 images (6 977 oesophageal, 12 918 gastric, 258 443 enteric, 76 772 colonic) from eight different capsule endoscopy and colon capsule endoscopy devices were divided in a training and validation dataset in a patient split design. The model’s output was compared to three CE experts’ classification. The model performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the precision-recall curve.

Results
The panendoscopic convolutional neural network was composed by organ-specific neural networks. The binary oesophagus convolutional neural network had a diagnostic accuracy for pleomorphic lesions of 83.6%. The binary gastric network identified pleomorphic lesions with a 96.6% accuracy. The undenary small bowel convolutional neural network distinguished pleomorphic lesions with different potential with 97.6% accuracy. The trinary colonic model (detection and differentiation of normal mucosa, pleomorphic lesions and hematic residues) had 94.9% global accuracy.

Conclusion
Our group developed the first deep learning model for panendoscopic automatic detection of pleomorphic lesions in both small bowel and colon capsule endoscopy devices from multiple brands, solving a critical interoperability technological challenge. Deep learning-based tools may change the landscape of minimally invasive capsule panendoscopy.
P481 "I’ve been told to drop out of school because I need to focus on my health and that was just devastating to hear.": Experiences of Western Canadian young adults with inflammatory bowel disease transitioning from paediatric to adult care
Authors: Bihari A , Nahal I , Chappell K , Seow C H , Goodman K J , Wine E , Kroeker K I 
Published: January 2024

Abstract

Background
The incidence of patients diagnosed with inflammatory bowel disease (IBD) in childhood/adolescence is increasing worldwide; therefore, in the upcoming years, more patients will need to transition from paediatric to adult care. A smooth transition is essential to ensure continuity of care; however, transition is a difficult time for patients, when increasing responsibility for disease management needs to be balanced with full-time employment or schooling. This study explores the transition experience of young adults with IBD who have transitioned from paediatric to adult care.

Methods
We recruited young adults with IBD using purposive sampling from two IBD centres in Western Canada for participation in a semi-structured virtual interview. Eligibility required being transferred to adult care within the previous two years and being diagnosed with IBD at least one year before transferring. Interviews were audio recorded, transcribed verbatim, and then analysed with an inductive thematic analysis approach.

Results
We interviewed 16 young adults with IBD (Table 1). We grouped features of the transition experience described by participants into the following four major themes (Figure 1): 1) Anticipation and preparedness for adult care; 2) New and existing connections; 3) Skill development for disease management; 4) Comparison of adult care to paediatric care. In the first theme, participants described feeling unprepared for and nervous about adult care. In the second theme, participants described the structure of care and noted that adult care had less appointments and the adult care team took a less holistic approach to their IBD care. Subsequent themes focused on developing relationships with the new care team, the importance of existing social supports, and becoming responsible and independent in disease management.

Conclusion
The results outline four major themes that describe IBD patients’ transition experience. These themes provide insight into aspects of transition described by patients, which can be used to improve patient care. For example, participants characterized adult care as missing elements that were present in paediatric care, suggesting a potential need to prepare patients for care differences and support them through the care adjustments. Overall, this study provides valuable insights into patients’ transition experiences which can be used to inform the development of transition supports and improve patient-centred care.