bluuebunny/crossref_metadata_2025_split huggingface dataset:
P161 Simplified Endoscopic Mucosal Assessment for Crohn’s Disease (SEMA-CD): External Application and Prognostic Value Definition
Authors: Macedo Silva V , Ferreira A I , Lima Capela T , Arieira C , Cúrdia Gonçalves T , Boal Carvalho P , Dias de Castro F , Moreira M J , Cotter J 
Published: January 2023

Abstract

Background
In 2022, the Simplified Endoscopic Mucosal Assessment for Crohn’s Disease (SEMA-CD) was created and internally validated, aiming to simplify endoscopic activity assessment in ileocolonoscopies for CD. This score was shown to be easier and faster to apply than previously used Simple Endoscopic Score for CD (SES-CD). In our investigation, we aimed to apply this score on a European population and to assess if its prognostic value was the same as SES-CD.

Methods
Longitudinal study of consecutive CD patients undergoing ileocolonoscopy for assessment of endoscopic activity. Patients with previous ileocecal resection were excluded. CD endoscopic activity was classified according to both SES-CD and SEMA-CD.
A minimum follow-up period of 12 months was required. Treatment escalation, hospitalization and bowel resection were assessed during the follow-up period.

Results
The initial sample included 265 patients, with 61 being excluded for having previous ileocecal surgery. Final sample included 204 patients, 113 (54.9%) female, with a mean age of 43±14 years.
SEMA-CD had a nearly-perfect correlation with SES-CD (r=0.998; p&lt;0.001). SEMA-CD performed similarly to SES-CD in predicting treatment escalation (AUC=0.905 vs AUC=0.908), bowel resection (AUC=0.517 vs AUC=0.516), and hospitalization (AUC=0.605 vs AUC=0.610) (p&gt;0.05). Optimal SEMA-CD cut-off predicting treatment escalation during the subsequent year was a SEMA-CD ≥2 (sensitivity 88%; specificity 86%).

Conclusion
In our sample, SEMA-CD perfectly correlated with SES-CD, having similar performances in predicting treatment escalation, surgery and hospitalization in CD patients. We first defined a SEMA-CD ≥2 as a possible guide to treatment escalation. Our study confirms SEMA-CD as a potentially helpful tool in CD patients’ follow-up.
P164 Dysplasia detection rates in a surveillance program real-world data from a tertiary referral center for inflammatory bowel diseases
Authors: Snir Y , Ollech J E , Peleg N , Avni-Biron I , Eran-Banai H , Broitman Y , Sharar-Fischler T , Goren I , Zohar L , Dotan I , Yanai H 
Published: January 2023

Abstract

Background
Patients with inflammatory bowel diseases (IBD) with an increased risk of developing colorectal carcinoma should undergo periodic surveillance colonoscopies. There is no quality metric for dysplasia detection rate (DDR) in IBD surveillance. We evaluated DDR in a dedicated surveillance program at a tertiary IBD referral center.

Methods
This cross-sectional study assessed DDR among consecutive patients with quiescent colitis enrolled in our surveillance program. Patients underwent high-definition colonoscopy with dye chromoendoscopy (DCE). A single specialized operator performed the procedures. Advanced dysplasia (AD) was defined as low-grade dysplasia ≥ 10mm, high-grade dysplasia, or colorectal cancer. We evaluated risk factors for dysplasia detection.

Results
Overall, 119 patients [female: 39.5%; median age: 54 years (IQR 43-66); median disease duration: 20 years (IQR 14-29)] underwent 151 procedures that revealed 206 lesions, of which 40 were dysplastic, and seven were considered AD. Per-procedure and per-lesion DDR were: 20.5%, and 19.4%, respectively. Per-procedure AD detection rate (ADDR) was 4.6%. Per-procedure dysplasia detection was associated with increased age at diagnosis at the index colonoscopy and past dysplasia or indefinite dysplasia, however, on multivariable analysis, only past dysplasia or indefinite dysplasia maintained a significant association (AdjOR 4.84, 95% CI 1.52-15.45, p=0.008). A Kudo pit pattern of II-V had a sensitivity of 92.5% for per-lesion dysplasia detection but a false positive rate of 64.8% (p&lt;0.001).

Conclusion
DDR in a dedicated surveillance program in a real-world setting reached 20%. DDR should be considered a quality measure while surveying high-risk patients with IBD.
P165 Vitamin D deficiency is associated with poor sleep quality in patients with Crohn’s disease
Authors: Walker C , Stacey W , Ramkalawan K M , Kafienah Y , Connaughton R , Breslin N , McNamara D , O'Donnell S , Ryan B , O'Connor A 
Published: January 2023

Abstract

Background
Sleep disturbances affect 40-50% of patients with Crohn’s Disease and are associated with disease flares. Symptoms, treatment side effects and pro-inflammatory status have been shown to have an effect on sleep quality and duration. Vitamin D deficiency affects between 18% and 70% of inflammatory bowel disease (IBD) patients and is independently associated with lower Health Related Quality of Life and greater disease activity. Our primary aim was to assess for a correlation between sleep quality and Vitamin D deficiency in people with IBD. Our secondary aim was to assess the impact of these factors on quality of life.

Methods
54 patients with Crohn’s Disease were invited to attend for Vitamin D testing and complete a survey. Vitamin D deficiency was defined as a serum Vitamin D less than 30 nmol/L. The survey included general demographic information, inflammatory bowel disease information, Pittsburgh Sleep Quality Index (PSQI), disease activity score (Harvey Bradshaw Index), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). One-way ANOVA tests and unpaired t-tests were used to calculate the statistical significance.

Results
· Median age 42.5 years. 50% female (n=27) and 50% male (n=27).
· Mean duration of IBD was 17 years
· 46% of patients were in clinical remission per HBI, 13% had mild activity, 37% moderate activity and 4% severe disease.
· The mean global PSQI score was 7.7, with 61% (n=33) of participants having a global PSQI score &gt;5, indicating poor sleep quality.
· 24% of patients (n=15) had Vitamin D deficiency
· Mean PSQI of patients with Vitamin D deficiency was 10.5 compared to 6.7 in those without (P= 0.008).

Conclusion
Vitamin D deficiency is associated with poorer sleep quality in IBD, which in turn impacts quality of life in patients with IBD. IBD patients presenting with fatigue and sleep difficulties should be assessed for Vitamin D levels and treated where deficient.
P167 Ileocecal valve that cannot be intubated during colonoscopy in patients with Crohn’s disease: Is this a sign of poor prognosis?
Authors: Durak M B , Simsek C , Inan B , Yuksel I 
Published: January 2023

Abstract

Background
In Crohn's disease (CD) the inability to intubate ileocecal valve during colonoscopy may be correlated with disease prognosis. We aimed to compare the long-term outcomes of CD patients with or without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter.

Methods
Data were retrospectively collected in CD with isolated ileal involvement between January 1993 and July 2022. Patients who underwent ileal resection were excluded. Basal characteristics as well as long-term clinical outcomes including steroid dependence, CD-related hospitalization, biological treatment and abdominal surgery were compared between the two groups of patients with intubated and non-intubated ileocecal valve during colonoscopy.

Results
A total of 155 CD patients were included. Median age at disease onset was 35 years and 63.9% was male. Out of 155, 97 (62.5%) were in intubated and 58 (37.5%) were in non-intubated group. The median follow-up of cohort was 3.81 years (1.44-7.63). Non-intubated group was older at diagnosis (39.0 vs 30.5 age; p=0.002) while other baseline characteristics such as sex, smoking status, family history of IBD, disease duration, perianal disease, upper gastrointestinal and extraintestinal involvements were similar. At baseline, serum hemoglobin (12.3 vs. 13.3 mg/dL; p=0.029), albumin (4.1 vs. 4.3 g/dL; p=0.001), CRP (14 vs. 7.8 mg/L; p=0.005) and CDAI score (301 vs. 208; p&lt;0.001) were all statistically significantly higher in the non-intubated group than in the intubated group.
Non-intubated group had more frequent stenosing (41.4% vs. 10.1%) and penetrating (29.3% vs. 5.2%; p&lt;0.001) disease course. On the other hand, intubated group had more inflammatory disease behavior (84.5% vs. 29.3%; p&lt;0.001). Budesonide (37 vs. 13; p=0.043) and methotrexate use (32 vs. 9; p=0.017) was more common the intubated group, while 5-ASA, steroid, and thiopurine use was similar. Non-intubated group had higher rates of steroid dependence (67.2% vs. 46.4%; p=0.012), biologic treatment (89.7% vs. 58.8%; p&lt;0.001), CD-related hospitalization (81% vs. 24.7%; p&lt;0.001), and major abdominal surgery (58.6% vs. 15.5%; p&lt;0.001).
In logistic regression analysis, positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), whereas negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior.

Conclusion
In CD patients with isolated ileal involvement, the inability to intubate the ileocecal valve during colonoscopy may indicate a poor prognosis.
P170 Can histological activity of ulcerative colitis be predicted by assessment of the rectosigmoid colon?
Authors: Temido M J , Gama J , Caetano Oliveira R , Silva A , Lopes S , Mendes S , Ferreira M , Ferreira M , Narra Figueiredo P , Portela F 
Published: January 2023

Abstract

Background
Rectosigmoidoscopy is frequently used to assess disease activity in patients with ulcerative colitis (UC). Most recent guidelines suggest that the inflammatory activity of the whole colon can be inferred by endoscopic findings in the rectosigmoid colon. Nevertheless, whether the right colon can have endoscopic or histological activity when there is endoscopic and histological remission in the left colon, is yet to be completely determined.

Aim
To assess whether UC histological activity (HA) and improvement (HI) can be deduced by the findings in the rectosigmoid colon.

Methods
Retrospective single center cohort study. Consecutive patients with previously diagnosed UC undergoing endoscopic assessment, from January 2014 to September 2022, were included. Inclusion criteria were: a complete colonoscopy with adequate bowel preparation and biopsies made in all the four segments of the colon and in the rectum. Demographic, clinical, endoscopic (Mayo endoscopic subscore (MES)) and histological (Geboes score (GS)) data at the time of the colonoscopy was collected. Agreement and correlation between findings in the rectosigmoid and the whole colorectum were calculated with the kappa coefficient (k) and the Spearman correlation coefficient (r).

Results
Inclusion of 264 patients (49.2% male). Median age was 5015.7years. Smoking history in 33.5% of patients. Extension of UC was: proctitis in 13 (4.9%), left colitis in 109 (41.3%) and extensive colitis in 142 (53.8%) patients. MES was 0 in 139 (53.7%) patients, 1 in 52 (20.1%), 2 in 36 (13.9%) and 3 in 32 (12.3%). GS was 0 in 19 (7.3%), 1 in 124 (47.5%), 2 in 50 (19.1%), 3 in 40 (15.3%), 4 in 10 (3.8%) and 5 in 18 (6.9%). Regarding endoscopic activity, a very high correlation was found between MES of the whole colorectum and MES of the left colon (k=0.88, r=0.92). As far as HA (GS1.1) is concerned, HA in the whole colorectum was highly correlated with HA in the rectosigmoid colon (k=0.8, r=0.82), both in the whole cohort and in the subgroup of patients with extensive colitis (k=0.8, r=0.82). When assessing HI (GS&lt;3.1) moderate coefficients (k=0.66, r=0.69) were found in the whole cohort. Patients with extensive colitis revealed similar agreement and correlation coefficients (k=0.69, r=0.71).

Conclusion
Endoscopic and histological activity in the rectosigmoid colon of patients with UC has a high correlation with activity in the whole colorectum. Therefore, UC activity can be inferred by analysis of the distal segments of disease. These findings reinforce that inflammatory activity in patients with UC can be assessed with rectosigmoidoscopy alone.
P171 Subfertility in young patients with Crohn′s disease. A case-control study.
Authors: Gutiérrez Casbas A , Bernal L , Zapater P , Herreros B , Rodríguez A , Muñoz R , Madero L , Orts B , Belen O , Sempere L , Torregrosa M E , Moreno-Pérez O , Francés R 
Published: January 2023

Abstract

Background
Inflammatory bowel disease (IBD) commonly affects women and men during the reproductive years.The effect of the disease burden on fertility in these patients is a common concern for them. ECCO guidelines establish that active disease is associated with decreased fertility in women but studies regarding this topic are of low quality and outdated.

Aims
to investigate the effect of CD on fertility, studying ovarian reserve in women as well as global Sertoli cell function in men, - To compare these results of CD patients with the healthy control group. (HC) - To assess the related factors to subfertility in women and males with CD.

Methods
This was a cross-sectional, prospective and case-control study, including CD patients, aged 18-40 years-old, and HC matched by gender and age (ratio 2:1). Morning baseline IB was measured in men using ELISA. Serum anti-Müllerian hormone (AMH) was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected.Subfertility was defined as IB &lt; 89pg/mL, AMH &lt;1.66 ug/L in 0-24 years old group; &lt;1.18 ug/L in 25-29 years old group; &lt;0.67 ug/L in 30-34 years old group; &lt;0.77 ug/L in 35-39 years old group; and &lt;0.01 ug/L in 40-44 years old group. AMH &lt;2 ug/L in women under 40 was considered low.

Results
A total of 163 individuals were included: 83 men (58 CD, median 28 years old, RIQ 24-36; 25 HC, median 31 years old, RIQ 26-37) and 80 women (50 CD, median 26 years old, RIQ 21-36; 30 HC, median 28, RIQ 26-32). Sedentary lifestyle was more frequent in women with CD vs HC (46% vs 3,3%, p&lt;0,001). 24% of women with CD and 8% of males had clinical activity (IHB &gt;4). Low AMH (&lt;2ug/L) in women older than 30 was more frequent in CD vs HC: 95% (18/19) vs 44% (4/9) p=0.001, with an OR of presenting AMH &lt; 2 ug/L of 3.28 (IC 95%, 1.6-6.4) for women with CD &gt;30 years old. The average AMH serum level was similar between women with CD and HC [1.83 (1.04-3.34) vs. 2.74 (1.05-4.12) g/L, p=0.4]. Abnormal AMH rate by age rank was not different between groups in global population (11/50, 22% EC vs. 7/30, 23% in CS, p=0.9,). IB levels were significantly lower in men with CD vs HC [169 (140-217) vs 232 ug/L (178-274) p=0.001]. IB &lt;89 pg/mL was not detected in any control vs 6% (n=3) in CD. In multivariate analysis, only AMH was associated with lower levels of IB in CD men, no association with clinical activity or treatments in CD was found.

Conclusion
Women with CD and &gt;30 years old have a higher risk than general population of presenting low AMH (&lt;2).These data could be helpful at council of women with CD that desire to have progeny. IB concentration was lower in men with CD compared to HC.
P173 Patency capsule: A novel independent predictor for long-term outcomes among patients with quiescent Crohn’s disease
Authors: Ukashi O , Kopylov U , Ungar B , Haj-Natour O , Selinger L , Neuman S , Yanai H , Dotan I , Yablecovitch D , Lahat A , Eliakim R , Ben-Horin S 
Published: January 2023

Abstract

Background
Patency capsule (PC) is a recommended procedure to rule-out small-bowel stenosis before video capsule endoscopy (VCE).We examined future clinical outcomes among patients with failed-PC versus patients in whom PC had passed (passed-PC).

Methods
A Post-hoc analysis of two prospective cohort studies of adult patients with quiescent small-bowel CD that underwent PC between 2013-2020. The primary composite-outcome was the need for intestinal-surgery or endoscopic-dilation during follow-up in patients with or without failed-PC.

Results
A total of 191 patients were included (47-failed PC, 144-passed PC, median follow-up 34.12 months). Patients with a failed-PC had higher rates of the primary composite-outcome (21.3% vs. 1.4%, Hazard ratio [HR] 20.4, 95% confidence interval [CI] 4.4-94.1, p&lt;0.001) and also secondary outcomes including intestinal-surgery (14.9% vs. 0.70%, p&lt;0.001), endoscopic-dilation (14.9% vs. 0.70%, p&lt;0.001), admissions (23.3% vs. 5.7%, p&lt;0.001) and clinical-flares (43.9% vs. 27.5%, p=0.005) during follow-up compared with controls. Failed-PC was the only statistically significant factor for surgery and/or endoscopic-dilation, regardless of a B2/B3 phenotype at baseline. In sensitivity-analyses restricted only to patients with stricturing phenotype (n=74), failed-PC still predicted worse long-term composite-outcome (HR 23.1 95% CI 2.3-228.0, p=0.007). Of the 191 patients ingesting a PC, only one patient with a failed-PC had 48 hours of self-limiting mild symptoms

Conclusion
Clinically-stable CD patients with failed-PC have worse long-term clinical outcomes than those without, independently of CD phenotype. Standalone PC may serve as a novel, safe and affordable prognostic examination to stratify patients with CD for future risk of poor outcomes and potentially guide pre-emptive management decisions.
P177 C-reactive protein/albumin ratio: a novel biomarker for monitoring of the disease activity in Ulcerative Colitis patients
Authors: Tomasic V , Biscanin A , Ćaćić P , Palac L , Dorosulic Z , Kralj D , Babic F , Ogresta D , Hrabar D 
Published: January 2023

Abstract

Background
Fecal calprotectin (FC) is a reliable laboratory test for non-invasive assessment of disease activity in ulcerative colitis (UC) patients; it's high cost, absence of widespread availability and low patient adherence limits it's use as a potential surrogate for endoscopy. The association of higher C-reactive protein (CRP) and low albumin levels, both obtained from patient's sera, with disease acitivity in UC, is well established. C-reactive protein/albumin ratio (CAR) is suggested as a biomarker for evaluating disease activity in various inflammatory conditions. We aimed to evaluate association between CAR, FC, CRP and serum albumin values with disease activity in UC patients.

Methods
A single center, noninterventional retrospective chart review of adult UC patients treated with biologics at a tertiary center was performed. Routine clinical (stool frequency score – SFS, and rectal bleeding score – RBS), biochemical (CRP, serum albumin, FC), and endoscopic (Mayo Endoscopic Subscore – MES) findings were assessed prior to initiating biologics. Active UC was defined as SFS 2/3 + RBS 2/3 + MES 2/3. Differences between continuous variables were calculated using independent sample t-tests and Mann–Whitney U test. Sperman’s correlation and ROC curve analysis were carried out. The Z statistic was used to compare correlation coefficients and AUC.

Results
Total of 82 patients (52.2% females, mean age 40.3 ± 15.3 years, smokers 16.9%) with dominantly extensive UC (57.3%) were analysed. The CAR (0.175 vs 0.025; p=0.02) and FC (1363.5 vs 65.5; p=0.01) levels were significantly higher in active vs inactive UC patients. Positive correlation was observed between CAR (rs = 0.354, p = 0.01), FC (rs = 0.448, p = 0.001) and CRP (rs = 0.316, p = 0.005) with active UC. Although serum albumin (r's = - 0.093, p = 0.532) negatively correlated with disease activity it didn't reach statistical significance. There was no statistically significant difference between CAR and FC correlation coefficients. The area under the curve (AUC) for the diagnosis of active UC was 0.896 (SE: 0.058; 95% CI 0.73 - 0,983, p=0.015) and 0.994 (SE: 0.009; 95% CI 0.98 - 1, p=0.001) for CAR and FC, respectively. Although AUC for FC was higher compared to CAR it didn’t reach statistical significance (p = 0.1).
The cut-off value associated with the active UC for CAR was 0.06 (sensitivity 77,2%, specificity 100%), and 120 mcg/g for FC (sensitivity 97.6%, specificity 100%).

Conclusion
There is good correlation between CAR and clinical as well as endoscopic disease activity in patients with UC, comparable to FC. CAR could be offered as a cheap and practical biomarker for detection of active UC disease.
P178 Evaluation of the Ulcerative Colitis Intestinal Ultrasound (UC-IUS) Index in Pediatric patients with newly diagnosed ulcerative colitis
Authors: Hudson A , Ma H , Lo C , Kim J , Kuc A , Novak K , Carroll M , Wine E , Isaac D , Huynh Dr H 
Published: January 2023

Abstract

Background
Transabdominal bowel ultrasound (TABUS) is a non-invasive tool that can be used to assess bowel inflammation in ulcerative colitis (UC). It is particularly attractive for use in children, given the need for general anesthesia when undergoing endoscopic assessment of bowel inflammation. A standardized TABUS scoring system in UC has only been developed in adults (the UC Intestinal Ultrasound (UC-IUS) Index). Our aim was to evaluate the UC-IUS Index in Pediatric patients.

Methods
Pediatric patients (&lt;18 years old) with suspected UC were prospectively enrolled. TABUS was performed for the right side colon, transverse, descending, and sigmoid colons. UC-IUS Index scores were calculated: bowel wall thickness (BWT) (&gt;2mm=1, &gt;3mm=2, &gt;4mm=3), Doppler signal (spots=1, stretches=2), haustrations (abnormal=1), and fat wrapping (present=1). Mayo endoscopic subscore (for each segment), Pediatric Ulcerative Colitis Activity Index (PUCAI), and inflammatory biomarkers were collected. Non-parametric tests were used to correlate UC-IUS and BWT with Mayo endoscopic subscores. Receiver operating characteristic (ROC) analyses evaluated the UC-IUS Index BWT cut-offs.

Results
Fifty-two patients (56% male) were included (Table 1). Data for 206 colonic segments were analyzed (2 segments missing due to 1 incomplete colonoscopy). Total UC-IUS scores significantly correlated with CRP (rho=0.61), albumin (rho=-0.49), PUCAI (rho=0.54), FCP (rho=0.41). UC-IUS Index scores and mean BWT for each segment showed significant moderate correlations with Mayo sub-scores of that segment (rho=0.60 and rho=0.58, respectively) (p&lt;0.001) (Fig 1). These correlations were strong in the right colon (rho=0.77, rho=0.69), and moderate in the transverse (rho=0.52, rho=0.56), descending (rho=0.43, rho=0.50), and sigmoid (rho=0.50, rho=0.46) colons (p&lt;0.01). The adult UC-IUS 2mm cut-off (Mayo 0 vs. Mayo 1-3) performed similarly in our Pediatric patients (sensitivity 80%, specificity 96%, area under the curve (AUC) 0.92). The 3mm (Mayo 0-1 vs. Mayo 2-3) and 4mm (Mayo 0-2 vs. Mayo 3) cut-offs had lower sensitivity (sensitivity 44%, specificity 98%, AUC 0.87; sensitivity 59%, specificity 92%, AUC 0.80) (Fig 2). Thinner BWT cut-offs performed better: 2.5mm (sensitivity 65%; specificity 89%) and 3.5mm (sensitivity 71%; specificity 86%).

Fig 1:

Fig 2:

Conclusion
In Pediatric patients with newly diagnosed UC, TABUS was a useful tool, with the UC-IUS and BWT correlating well with their endoscopic, clinical, and biochemical disease activity. Compared to the adult UC-IUS Index, Pediatric patients need a thinner BWT cut-off to better discriminate between mild vs. moderate/severe disease (2.5mm instead of 3mm) and mild/moderate vs. severe disease (3.5mm instead of 4mm).