bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0367 A Clustering approach to discriminate slow and rapid biologics switchers in difficult-to-treat Crohn’s Disease patients
Authors: Vuckovic C , Cremer A , Minsart C , Amininejad L , Bottieau J , Franchimont D , Liefferinckx C 
Published: January 2025

Abstract

Background
CD patients exhibit highly variable responses to biologics. While some patients achieve sustained remission with only one biologic over the course of their disease, other will require the sequencing of multiple biologics (“difficult-to-treat” patients) for optimal disease control. The aim of this study was to delineate the profile of treatment regimen of the biological exposed CD patients with luminal disease.

Methods
Among CD patients diagnosed between 1999 and 2019 with B1 phenotype at diagnosis, 203 patients who maintained this phenotype at maximum follow-up (FU, median 11y [8–15]) were selected, based on inclusion criteria. All events were recorded from date of diagnosis to maximum FU, from disease characteristics to treatment adaptations. A temporal clustering approach using k-means was applied to determine biologics treatment regimen profiles. Patient profiles were compared using the Dynamic Time Warping (DTW) similarity measure, considering 3 successive cumulative biologic exposures (for primary/secondary non response only). Clusters number was chosen to balance maximizing silhouette score while ensuring sufficient individuals per cluster. Cumulative biologic exposures were summarized as cluster profiles, represented by their corresponding barycenters computed with soft-DTW distance. Clustering approach was performed using Python (tslearn).

Results
The 203 patients were clustered in 5 distinct profiles, based on their cumulative biologics exposure in the first 10 years after CD diagnosis (Figure 1). Patients in Cluster 1 were not exposed to biologics (n=55). Patients in Cluster 2 were treated late with one biologic (n=51) while patients in Cluster 3 were treated early with one biologic (n=53). Patients from Cluster 4 (n=23) and Cluster 5 (n=21) were both treated early with multiple biologics. Patients from Cluster 2 were exposed to biologics later after CD diagnosis than patients from Cluster 3 to 5 (Median 5.7y [3.6–6.9] vs 0.7y [0.2-1.8], p&lt;0.0001), as also shown by their lower biological exposure compared to those of Cluster 3 to 5 (median 48% [37-58] vs 80% [60-89], p&lt;0.0001). Most interestingly, patients from Cluster 5 required faster biologics changes compared to patients from Cluster 4 (Figure 2). In Cluster 5 (rapid switchers), patients were exposed earlier compared to patients in Cluster 4 (Slow Switchers) to the first (p&lt;0.005), second (P&lt;0.005) and third biologic (p=0.01), introducing the concept of rapid and slow biologic switchers among CD patients.

Conclusion
This clustering approach highlights the highly variable pattern of response to biologics in luminal CD patients. Furthermore, this study discriminatessingle and multiple biologics-exposed patients, in whom we identified slow and rapid biologic switchers.
P0373 CLINICAL RECURRENCE AFTER ILEOCOLIC RESECTION FOR CROHN’S DISEASE: Interest of the REMIND group’s endoscopic score
Authors: Amal J , Abdelwahab N , Sonia B , myriam A , zeineb B , nessrine H , bochra B , taieb J , rym E , Med Hedi D 
Published: January 2025

Abstract

Background
The Rutgeerts score is the most commonly used score for assessing endoscopic recurrence after ileocolic resection in Crohn’s disease. However, a significant drawback of this score is that it combines lesions localized to the anastomosis with those in the neo-terminal ileum in the same category, assigning them equal prognostic significance. The aim of this study was to evaluate the performance of the REMIND score in predicting postoperative recurrence of Crohn’s disease and compare its performance with the Rutgeerts score.

Methods
We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. The REMIND score was derived from endoscopic details documented in the colonoscopy reports. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-abdominal collection or occlusion, or subsequent surgery Postoperative. Statistical analysis was performed using SPSS.25 for Windows.

Results
Eighty patients were included, with a mean age of 35.7 years, and a gender ratio H/F=2,2. Median follow-up was 5 years from surgery. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p&lt;0,001 and not significantly different between patients without anastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p&lt;0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49).

Conclusion
In contrast to the Rutgeerts and A(x) scores, the I(x) score seems to exhibit superior performance in predicting postoperative recurrence. Therefore, the use of a score describing separately ileal and anastomotic lesions might be more appropriate to define postoperative endoscopic recurrence.

References
Hammoudi N, Auzolle C, Tran Minh ML, Boschetti G, Bezault M, Buisson A, et al. Postoperative endoscopic recurrence on the neoterminal ileum but not on the anastomosis is mainly driving long-term outcomes in crohn’s disease. Am J Gastroenterol. 2020 Jul;115(7):1084-93.
P0378 Normalization or reduction of at least 50% in faecal calprotectin levels after 3 months of treatment predicts clinical and endoscopic remission at 1 year in patients with ulcerative colitis: results of the prospective MIROIR study
Authors: Buisson A , Coban D , Bazoge M , Dodel M , Pereira B 
Published: January 2025

Abstract

Background
The STRIDE-2 consensus considers the improvement of faecal calprotectin (Fcal) (biochemical response) as an intermediate goal in ulcerative colitis (UC). However, no consensual definition of biochemical response is currently available.
MIROIR study evaluated the performance of Fcal levels three months after initiating treatment to predict clinical and endoscopic remission at 12 months in UC.

Methods
In this prospective longitudinal prediction study, any adult UC patient with partial Mayo score (&gt;2) and endoscopic Mayo score (MES) ≥2, requiring starting therapy for UC was included. Patients with acute severe colitis or prior colectomy were excluded.
Clinical and biological data, including Fcal levels, were collected, at baseline, month 3 (M3), M6, M9, and M12. Endoscopic and histological (Nancy index) evaluations were performed at inclusion, 3 months, and 12 months. Physicians were blinded from Fcal levels.
The primary endpoint was Fcal level at 3 months, while the primary dependent variable was therapeutic success defined as clinical remission (total Mayo score ≤ 2 with endoscopic Mayo score (MES) = 0 or 1) at M12, without dose escalation or treatment discontinuation due to failure.

Results
Among 62 included patients, the mean age at inclusion was 43.9 ± 14.4 years, with 55.5% being male. UC extent was proctitis (E1) in 13.7%, left-sided colitis (E2) in 39.2%, and pancolitis (E3) in 47.1%. At baseline, endoscopic activity was Mayo 2 and Mayo 3 in 46.3% and 53.7%, respectively. and median ffcal level was 665 µg/g [296-1800].
Initiated therapies were 5-ASA (13.0%), corticosteroids (13.0%), immunosuppressants (5.5%), anti-TNF agents (26.4%), vedolizumab (22.6%), ustekinumab (35.8%), and tofacitinib (3.7%).
At M3, 10 patients (18.5%) achieved endoscopic remission (MES 0), 23 (42.6%) showed endoscopic improvement (MES 0 or 1), while 10 (18.5%) and 13 (24.1%) still had endoscopic activity, MES 2 or 3, respectively.
The median Fcal level at M3 correlated with MES at M3: 27 [14-142], 115 [20-460], 665 [135-1830], 755 [472-1340] (p = 0.0006) for MES 0, 1, 2 and 3, respectively, and with endoscopic activity (MES ≥2) at M3 (90 [18-192] vs. 679 [428-1830], p = 0.0001) with a substantial effect size (1.32 [0.72-1.91]).
Fcal level &lt;150 µg/g at M3 was the best threshold to predict therapeutic success at M12. A decrease of at least 50% in Fcal level at M3 was the best threshold for predicting therapeutic success at M12, with high negative predictive value: 92.3%[74.9% - 99.1%].

Conclusion
Our study demonstrates that normalization or reduction of at least 50% in Fcal level after 3 months of treatment predicts therapeutic success at 1 year in ulcerative colitis. This could therefore be proposed as a definition of biochemical response.
P0381 Correlation Between Rectal Endoscopic and Histological Involvement and the Prevalence and Severity of Ano-Perineal Lesions in Inflammatory Bowel Disease
Authors: Elommal H , Koulali H , Elmqaddem O , Zazour A , ismaili Z , Kharrasse G 
Published: January 2025

Abstract

Background
Rectal involvement in inflammatory bowel disease (IBD), assessed through endoscopic and histological findings, may correlate with the development and severity of ano-perineal lesions (APLs) such as fistulae, abscesses, fissures, and thrombosed hemorrhoids. This study aimed to evaluate the relationship between rectal inflammation, histological abnormalities, and the prevalence and severity of APLs in IBD patients.

Methods
A retrospective analysis was conducted on IBD patients with documented rectal endoscopic and histological findings. Endoscopic involvement was categorized based on ulceration, erythema, and mucosal friability. Histological abnormalities were defined as crypt abscesses, epithelial damage, or infiltration of inflammatory cells. The prevalence and severity of APLs were assessed using clinical and imaging data. Correlations were analyzed using multivariate logistic regression.

Results
• Prevalence of rectal involvement: Rectal endoscopic abnormalities were present in 72% of patients, while histological abnormalities were detected in 65%.
• Association with APLs: Patients with rectal endoscopic involvement had a higher prevalence of APLs (68%) compared to those without (32%, p &lt; 0.01). Histological abnormalities also strongly correlated with APL prevalence (OR: 2.4, p &lt; 0.01).
• Severity correlation: Severe APLs, characterized by complex fistulae or abscesses, were more frequent in patients with severe rectal endoscopic (45%) and histological abnormalities (40%). Combined endoscopic and histological involvement further increased the odds of severe APLs (OR: 3.2, p &lt; 0.01).
• Subtype associations: Fistula openings and abscesses were the most common lesions in patients with combined rectal abnormalities, highlighting a direct link with rectal inflammation.

Conclusion
Rectal endoscopic and histological abnormalities are strongly associated with the prevalence and severity of ano-perineal lesions in IBD. The combined presence of these abnormalities significantly increases the risk of complex lesions, emphasizing the importance of systematic rectal evaluation in IBD patients. These findings underscore the role of rectal inflammation as a critical factor in the pathogenesis of APLs and guide early therapeutic strategies.
P0383 Factors associated with steatotic liver disease associated with metabolic dysfunction (MASLD) in patients with Inflammatory Bowel Disease (IBD)
Authors: Oliveira E C S D , Lopes M A , Beraldo R F , Castelhano N S , Baima J P , Herrerias G S P , Quaglio A E V , Di Stasi L C , Barbosa W F , Silva G F , Sassaki L Y 
Published: January 2025

Abstract

Background
IBD is characterized by a systemic inflammatory state. The dysbiosis found in these patients may lead to a possible increased risk of MASLD through intestinal bacterial translocation, and increased entry of lipopolysaccharides, free fatty acids and other toxins directly to the liver via the portal vein. The objective of this study is to evaluate the prevalence of MASLD in patients with IBD and the factors associated with this condition.

Methods
The presence of MASLD was based on the presence of hepatic steatosis associated with at least 1 metabolic criterion, and the exclusion of other liver disease in outpatients with IBD. Patients with BMI &lt; 18.0 or BMI &gt; 40 kg/m2, alcohol use or prednisone use &gt; 20 mg/d were excluded.

Results
A total of 179 IBD patients were included: 95 with ulcerative colitis (UC) (53.1%) and 84 with Crohn’s disease (CD) (46.9%). The mean age was 45.1±14.4 years, 65.4% were female, and the mean disease duration was 10.9±7.8 years. Clinical activity was observed in 40. 45% and endoscopic activity in 49.70%. Biological therapy was used by 35.8% of UC patients and 71.4% of CD patients. In total, 72 (40.22%) patients had MASLD; 4 (2.23%) had MASH and 9 (5.02%) had liver fibrosis. Patients with MASLD were significantly older (48.3±12.6 vs. 43.0±15.2 years, p=0.0148) and had a higher prevalence of comorbidities, including diabetes (20.8% vs. 6.5%, p=0.0043), hypertension (30.6% vs. 12.2%, p=0.0023), dyslipidemia (25.0% vs. 7.5%, p=0.0011), and insulin resistance (61.4% vs. 19.4%, p&lt;0.0001). MASLD patients also had higher BMI (29.1±3.6 vs. 24.5±4.0, p&lt;0.0001), elevated blood glucose (100.1±23.8 vs. 87.3±17.9, p&lt;0.0001), and triglycerides (186.9±107.5 vs. 117.6±59.9, p&lt;0.0001), along with lower HDL-cholesterol (51.0±16.6 vs. 57.0±15.3, p=0.0098). Laboratory parameters including hematocrit (p=0.0035), hemoglobin (p=0.003), creatinine (p=0.017), CRP (p=0.0444), AST (p=0.0033), ALT (p&lt;0.0001), gamma-GT (p&lt;0.0001), and ferritin (p=0.0003) were also elevated in MASLD patients. There was no difference in disease characteristics such as extent of the inflammatory process, clinical (p=0.6131) or endoscopic activity (p=0.3877) or use of medications (p&gt;0.05) between the groups.

Conclusion
We found a high prevalence of MASLD in patients with IBD, with a strong association to metabolic risk factors rather than disease activity. Therefore, early identification and management of metabolic syndrome and MASLD are critical to preventing liver disease progression and related complications in IBD patients.
P0384 Applying ChatGPT to Improve Inflammatory Bowel Disease Diagnosis and Evaluation
Authors: Ozturk O , Coskun O , Yavuz C , Tenlik I , Yuksel I 
Published: January 2025

Abstract

Background
Chat Generative Pre-Trained Transformer-v4 (ChatGPT-v4) is an unquestionable asset to healthcare professionals. This paper will outline a number of ways in which ChatGPT-v4 can be used to improve the accuracy of its diagnosis and treatment strategies for ulcerative colitis (UC) and Crohn’s disease (CD), in line with the ECCO guidelines.

Methods
This 102-item questionnaire was designed to assess the accuracy, consistenacy, and inclusiveness of responses to questions about the diagnosis and treatment of UC and CD. The questionnaire was created in the form of true/false and multiple-choice questions and was based on clinical scenarios reflecting real-life situations and the ECCO guidelines. After that, ChatGPT-v4 was shown it, and its reactions were assessed.
The responses were evaluated using a Likert scale. The queries were posed to the artificial intelligence at 15-day intervals.

Results
In 47 responses (92%), ChatGPT adhered to the established guidelines, with deviations observed in 4 instances (8%). Of the 4 responses previously identified as non-compliant, 3 demonstrated no change or improvement following a 15-day reassessment period.
The mean values for the accuracy scores were found to differ, with 5.45 for the first set and 5.56 for the second (p = 0.606). The completeness scores showed a similar trend, with the mean value differing by 0.10, with 2.33 for the first set and 2.43 for the second (p = 0.280). The standard deviation trends for the two sets were also comparable.
The analysis revealed a significant enhancement in accuracy from the initial to the fifteenth day of assessment (5.49 and 5.56, respectively). A comparable increase was observed in completeness scores, rising from 2.15 to 2.37 between the initial and fifteenth day assessments. The imaging results indicated that more accurate responses were given to questions pertaining to it, although the difference was not statistically significant (p = 0.31).
In the context of multiple-choice questions, the performance of the AI model demonstrated enhanced stability and consistency (p = 0.606). The majority of answers were initially correct (90% of the total). Four out of five incorrect answers evolved into correct answers, one incorrect answer persisted, and two correct answers changed to incorrect answers.

Conclusion
ChatGPT-v4 has demonstrated potential for development as a clinical support tool in the management of inflammatory bowel diseases, including UC and CD. However, performance differed between binary and multiple-choice questions.
P0385 Delayed Diagnosis in Inflammatory Bowel Disease in Turkish Population
Authors: Acehan M F , Yilmaz V , Koç Ö , Güvenir S T , Er R E , Soykan A İ , Toruner M 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory condition characterized by relapsing episodes. These diseases typically present with diarrhea, abdominal pain, and bloody stools. However, the diagnosis of IBD may be delayed due to the higher prevalence of other clinical syndromes that can present with similar symptoms, lack of using diagnostic tools or depending on patient dependent reasons. This diagnostic delay can exceed six month or even much more in some patients. In this study, we aimed to examine the impact of demographic characteristics on diagnostic delay in IBD patients.

Methods
Patients diagnosed with UC and CD were retrospectively reviewed. Demographic data were collected, including gender, age group, educational status, marital status, parental status (whether the patient had children), geographical region (Central Anatolia vs. other regions), settlement type (urban vs. rural), and year of diagnosis. The time interval between symptom onset and diagnosis was also recorded. Variables associated with diagnostic delay were then identified. Diagnostic delay was defined as the duration between symptom onset and diagnosis exceeding six months.

Results
A total of 326 IBD patients were included in the study, with 138 (42.3%) and 188 (57.7%) patients assigned to the UC and CD groups, respectively. Of these, 185 (56.7%) were male. The majority of patients were in the age groups of 26–35 years (113, 34.7%) and 36–45 years (103, 31.6%) (Table 1) . Diagnosis dates ranged from 1992 to 2024, with 154 (47.2%) patients diagnosed before 2014 and 172 (52.8%) diagnosed in 2014 or later. The interval between symptom onset and diagnosis exceeded six months (defined as diagnostic delay) in 159 (48.8%) patients. The frequency of diagnostic delay was significantly lower in UC compared to CD (19.0% vs. 63.3%, p &lt; 0.001). Across the entire IBD cohort, no variables were significantly associated with diagnostic delay. However, when UC and CD were analyzed separately, diagnostic delay in UC significantly decreased in patients diagnosed in 2014 or later compared to those diagnosed before 2014 (36.0% vs. 20.6%, p = 0.048) (Figure 1). In CD, a reverse trend was observed, but the difference was not statistically significant (59.5% vs. 66.1%, p = 0.357).

Conclusion
The frequency of diagnostic delay in IBD patients was significantly lower in UC compared to CD. While diagnostic delay in UC significantly decreased in patients diagnosed in 2014 or later, an opposite trend was observed in CD, although the difference was not statistically significant.
P0386 Prevalence and Impact of Anorectal Disorders in IBD: Insights from a Romanian Tertiary Gastroenterology Center
Authors: Costache R E , Dimitriu A , Marinescu A , Saizu I A , Gheorghe L , Gheorghe C 
Published: January 2025

Abstract

Background
Anorectal motility disorders profoundly affect the quality of life in patients with quiescent inflammatory bowel disease (IBD). Although faecal incontinence (FI) has a reported prevalence of up to 74%, its true extent is likely underestimated due to the stigma surrounding the condition. Fear of FI and challenges in accessing toilets remain significant concerns. This study evaluates the prevalence of these issues in Romanian tertiary care patients using the validated questionnaire International Consultation on Incontinence Questionnaire for Bowel Incontinence – IBD (ICIQ-IBD).

Methods
We surveyed 65 IBD patients aged over 18, admitted to our center, who were in remission but had previously experienced moderate to severe disease. Using the ICIQ-IBD questionnaire, we collected data on faecal incontinence, soiling, anal dyskinesia, their impact on quality of life, and demographic information. The analysis was conducted using Excel and Minitab.

Results
Of the 65 patients included in the study, 69% were male, with a median age of 40.82 ± 12.10 years. The majority were diagnosed with Crohn’s disease (65% CD, 35% UC). During remission, 22% of patients reported the need to rush to the toilet “always” or “most of the time,” compared to 40% during relapse, with a significant difference between disease phases (p = 0.02) but no differences based on gender or diagnosis. In relapse, 68% of patients had less than one minute to reach a toilet, compared to 32% in remission (p = 0.00). Soiling was reported by 49% of patients during active disease and 25% in remission (p = 0.004). Difficulty controlling liquid stools affected 62% of patients in relapse and 55% in remission, with no significant difference between disease states (p = 0.417). Emotional impact was reported by 72% of patients in relapse and 15% in remission, highlighting the psychosocial burden of bowel dysfunction in IBD.

Conclusion
Anorectal disorders significantly affect IBD patients’ quality of life, even during remission. Key symptoms, such as soiling and urgency, were more prevalent during relapse and strongly linked to emotional distress. These findings underscore the need for targeted management of anorectal symptoms in IBD care.

References
Norton, Christine et al. “Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life.” Journal of Crohn’s & colitis vol. 7,8 (2013): e302-11. doi:10.1016/j.crohns.2012.11.004
Dibley, Lesley et al. “Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD.” European journal of gastroenterology & hepatology vol. 28,2 (2016): 233-9. doi:10.1097/MEG.0000000000000513