bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0431 Multiparametric Assessment of IBD, SpA and IBD-SpA patients to explore disease biomarkers and response predictors
Authors: Parisio L , Privitera G , Varca S , Perniola S , Alivernini S , Tolusso B , Petito V , Masi L , Napolitano D , Schiavoni E , Turchini L , Amatucci V , Scaldaferri F , Gasbarrini A , Armuzzi A , Gremese E , Guidi L , Pugliese D 
Published: January 2025

Abstract

Background
Immune-mediated inflammatory diseases (IMID) can coexist within the same patient and their pathogenesis could overlap. Inflammatory bowel disease (IBD) [Crohn’s disease (CD) and ulcerative colitis (UC)], and spondylarthritis (SpA), often associate, but disease biomarkers are not fully characterized. This project aims to investigate a possible molecular signature of disease and predictor markers of response

Methods
We performed an observational prospective study, enrolling consecutive IMID patients (pts) starting a target therapy. We principally focused on 3 cohorts: IBD, SpA and IBD-SpA. At baseline, we performed a test for serum cytokines and also collected intestinal biopsies, to stain for immune cell markers. Clinical intestinal and articular response (CR) was assessed at 4, 12 and 24 months. CR was defined using clinical scores: Patient Reported Ouctome-2 (PRO-2) for UC and CD, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) for SpA

Results
We enrolled 134 pts (59 IBD, 75 SpA). All the SpA pts were seronegative with prevalent peripheric articular involvement. In the IBD cohort, 48% of the pts were naïve to advanced therapies, while the remaining part had been exposed to biologics. 34% pts were on concomitant steroid therapy at baseline. At baseline, we found lower serum levels of IL-6, IL-12/23, IL-7, IL-10, IL-33, IL-35 and IL-37 in IBD pts compared to SpA pts and that levels presented a direct or inverse correlation with the clinical scores (figure). In the IBD-SpA group, compared to the IBD group, we found higher levels of IL-6(p=0.001), sTREM1(p=0.027), IL10(p=0.002) and IL-37(p=0.016). According to PRO-2, 70% of pts were in steroid-free clinical remission at 12 months, and 81.8% at 24 months. Considering CR at 12 months, statistically significant differences were found in the groups of responders versus no responders. In the IBD cohort we found that 100% of responders, had low levels of IL-8(&lt;8.6 pg/mL) and low CD117 cell count in intestinal tissue at baseline; besides, 80% of responders had high CD20 count in intestinal tissue at baseline. Kaplan-Meier curves for achieving CR at 24 months, in the entire cohort of pts, showed no statistically significant differences stratifying pts on demographic characteristics and type of disease

Conclusion
In IBD pts, we found results which could suggest a different systemic inflammation signature between IBD and SpA pts and the presence of possible biomarkers which, if confirmed, could help the physician in the early and non-invasive identification of the disease phenotype at diagnosis and response to therapies
P0432 CMV infection in IBD patients with disease flare in the era of advanced therapies and outpatient setting
Authors: Pipek B , Zelinková Z 
Published: January 2025

Abstract

Background
The infection with cytomegalovirus (CMV) has typically been reported to be associated with poor clinical outcomes in inflammatory bowel disease patients with severe, steroid-refractory ulcerative colitis.Data on prevalence, clinical picture and evolution of CMV infection in IBD outpatient setting, including patients with Crohn’s disease colitis are limited.

Methods
All IBD patients who underwent colonoscopy or flexible recto/sigmoidoscopy for clinical suspicion of disease flare were identified in the electronic medical record system of two IBD referral centra.Patients with histopathological hallmarks of CMV infections and/or positivity of immunohistochemical staining for CMV were identified and further analyzed. Basic demographics,laboratory findings,medications and CMV infection treatment were noted.

Results
In total, 226 endoscopic and histologic findings were reviewed, of which, eight were tested positive for CMV infections. Seven out of these eight patients had typical histopathological morphology with inclusion bodies and teste positive for CMV immunohistochemistry, one patient had only CMV immunohistochemical staining positive. There were four patients with colonic Crohn’s disease and four with ulcerative colitis, median age 42 years (range 25-72 years); median duration of the disease was 10 years (range 1-20 years). All patients had symptoms of colonic disease activity, two patients had fever. Median CRP was 27,5 mg/L (range 3-240), all patients had normal leucocytes and thrombocytes count and no liver tests abnormalities.None of the patients had systemic corticosteroids at the time of CMV diagnosis, one patient was using topical budesonide and one budesonide-MMX; three patients were treated with infliximab for several years; two had vedolizumab; one ustekinumab and two patients had no treatment and were about to start their first line biologic.All patients were treated with virostatic treatment with valganciclovir or ganciclovir.All patients had their biologic treatment interrupted for the time of antivirotic treatment. One of the patients who needed i.v. treatment had no improvement upon antivirotic treatment with persistent CMV viremia and underwent colectomy with rapid resolution of symptoms afterwards. The remaining seven patients achieved clinical response with antivirotic treatment and subsequent biologic therapy.

Conclusion
CMV infection in IBD patients with active colonic disease is rare but when present, it can lead to systemic manifestation of the infection. In contrast to the thus far reported typical picture of infection complicating severe ulcerative colitis, it can occurs in both, Crohn’s disease and ulcerative colitis patients with moderate disease activity and without extensive immune suppressive treatment.

References
Maresca, R et al. Cytomegalovirus Infection: An Underrated Target in Inflammatory Bowel Disease Treatment. J. Clin. Med. 2024, 13, 136
P0436 The rare case of Littoral Cell Angioma concomitant with Crohn’s Disease: our centre’s experience
Authors: Emma E P , Mariatti M , Palleschi C V , Perna F , Ficari F , Scaringi S , Milla M 
Published: January 2025

Abstract

Background
Littoral Cell Angioma (LCA) is a rare splenic vascular tumor, first described in 1991. Although it is usually benign and clinically non-specific, the outcome is not predictable, and some cases with malignant behavior have been described.The pathogenesis of this lesion remains unknown, although a correlation with important immune disorders such as Crohn’s disease (CD) is established. The aim of the report is to present the experience of our center. We report the 5th described case of LCA in a patient affected by CD.

Methods
We describe the case of a 32-year-old patient diagnosed with CD stenosing dijuno-ileal and colic associated with splenomegaly (Dec 2011). He was treated with Adalimumab (Feb-Sep 2012, discontinued due to ineffectiveness), Infliximab (Oct 2012-Dec 2014, discontinued due to healing mucosa) and AZA since Dec 2013.
For subsequent finding of splenic parenchymal lesions of difficult clinical-instrumental definition, in Jan 2023 splenectomy, digiunal resection (20cm) and digiuno-digiunal.
Michelassi strictureplasty (30cm) were performed.

Results
Histological examination showed CD in a severe phase of activity with reactive lymphadenitis. In the splenic parenchyma there were circumscribed and demarcated areas consisting of blood exudates and an exudative/productive inflammatory infiltrate with histiocytic elements. Immunohistochemistry: CAM5.2-, CK7-, CDX-2-, CD68-PMG1+, CD1a-, CD207-. In light of the clinical- instrumental picture, histological preparations and immunohistochemical investigations, the morphological and immunophenotypical findings were compatible with splenic LCA.

Conclusion
LCA is often associated with immune diseases. Its diagnosis should be evoked in case of splenomegaly contextual toCD. The tumor may be related to the natural history of CD, and splenomegaly may be present at the time of diagnosis.
The entero-RM to establish the degree of CD activity could represent an opportunity in the study of the prevalence and natural history of thisrare splenic neoplasia.
P0441 Vitamin D seasonal fluctuation is more prominent in inflammatory bowel disease patients undergoing advanced therapies
Authors: Baz-Lopez A , Baston-Rey I , Marti-Marques E , Calviño-Suarez C , Santos-Blanco E , Ferreiro-Iglesias R , Blanco-Hortas A , Lopez-Roses L , Dominguez-Muñoz J E , Barreiro-de Acosta M 
Published: January 2025

Abstract

Background
The influence of Vitamin D (vitD) has been investigated in inflammatory bowel disease (IBD) patients to see how might affect disease activity. VitD is expected to be lower in winter and higher in summer due to sun exposure. The effect of VitD in IBD patients is thought to be similar to that in healthy subjects. The aim of the study was to evaluate fluctuation of vitD in IBD patients undergoing different treatments during two consecutive seasons.

Methods
IBD patients (both ulcerative colitis (UC) and Crohn’s disease (CD)) were recruited from two IBD units in Northern Spain and followed-up for at least 6 months. Patients who were being treated with supplement vitD or oral steroids were excluded. Patients with comorbidities that could interfere with vit D, such as advanced kidney disease, were also excluded. Clinical data regarding IBD activity and vitD was collected during two separate seasons (summer from June to September and winter from December to March). For this evaluation we assumed the vitD fluctuation (using mean values) in the general population to be normal. Frequency of vitD fluctuation in IBD patients undergoing advanced therapies and standard treatment were compared with that of the general population using Chi-Square test.

Results
We followed-up 199 IBD patients (both UC and Crohn’s disease) for at least 6 months. Most patients were in clinical and biochemical remission (77% in winter and 76% in summer had fecal calprotectin &lt;150 microg/g). IBD patients undergoing advanced therapies n=90 (biologics and antiJaks) were compared to IBD patients undergoing standard treatments n=104 regarding vitD fluctuation. Usind data from the general population we established a normal fluctuation of 2.8 ng/ml of vitD from season to season in our cohort (that is we expected at least a 2.8 ng/ml increase from winter to summer and a less than 2.8 ng/ml decrease from summer to winter). VitD fluctuation comparable to the general population was observed in 24% of patients undergoing advanced therapies, which is less frequent than in those undergoing standard treatment (48%). This result was statistically significant (p= 0.0067)

Conclusion
The difference in seasonal fluctuation of vitD was significantly more prominent in IBD patients undergoing advanced therapies than in those undergoing standard treatment. Patients undergoing standard treatment had a similar VitD fluctuation to that of the general population.
P0443 Prognosis of primary sclerosing cholangitis (PSC) in Hungary is independent of coexisting inflammatory bowel disease (IBD) and prognostic ability of the currently used PSC risk scores are limited
Authors: Vén P , Lénárt Á , Tornai D , Tóth B , Vitális Z , Tornai I , Tornai T , Altorjay I , Papp M 
Published: January 2025

Abstract

Background
Primary sclerosing cholangitis (PSC) is a rare, chronic disorder of the intra- and extrahepatic biliary tree characterized by cholestasis, periductal inflammation and fibrosis. Currently, there is very limited epidemiological data from the Central-Eastern European region. We assessed disease characteristics and natural history of PSC in a bicentre Hungarian cohort and compared its outcome with respect to co-existing inflammatory bowel disease (IBD).

Methods
Imaging, laboratory and clinical data including presence of IBD, variant syndrome, disease course and outcome were prospectively collected in two large Hungarian Clinical Centre Patients were followed on a yearly basis. Median diseases follow-up (FUP) time was 8.82 (IQR: 5.2-13.5) years. A wide range of clinical scoring systems were applied. Poor disease outcome was defined as orthotopic liver transplantation (LT) and/or liver-related death during the FUP.

Results
Of 135 patients (57.8% males; median age at diagnosis: 31 [IQR: 20-47] yrs) with confirmed PSC, 73 (54.1%) had coexisting IBD. Nineteen patients already had cirrhosis at diagnosis and 31 more developed it during the FUP. A total of 21 (15.6%) patients died of which 85.7% were liver-related deaths. Twenty-five patients (18.5%) underwent liver transplantation (LT). Twenty-three (17%) patients developed malignancy (9 cholangiocarcinoma, 3 hepatocellular carcinoma, 6 colorectal carcinoma and 6 non-gastrointestinal malignancy) during the FUP. Patients with IBD were younger and had higher Mayo and Amsterdam-Oxford scores at diagnosis compared to those without, however there was no difference in disease outcomes in these groups (p=0.133). Clinical scores at diagnosis had moderate prognostic ability for poor disease outcome (AUROC [95%CI], Mayo score: 0.637 [0.521-0.753]; p=0.018; Amsterdam-Oxford: 0.687 [0.576-0.798]; p=0.002; p&lt;0.001; UK-long: 0.695 [0.588-0.803]; p&lt;0.001), except UK-short PSC risk score (0.745 [0.643-0.847]). Persistent alkaline phosphatase (ALP) increase, despite ursodeoxycholic acid (UDCA) treatment, especially within the first two years of diagnosis had good prognostic ability (AUROC [95%C], at diagnosis: 0.656 [0.556-0.757], p= 0.006; after one year: 0.724 [0.602-0.847], p&lt;0.001; after two years: 0.746 [0.617-0.875], p&lt;0.001).

Conclusion
Prognosis of PSC is independent of coexisting IBD in our large Hungarian prospective PSC cohort. Prognostic ability of the currently used PSC risk scores is limited. The UK-short PSC risk score and early ALP response to UDCA treatment showed to have the best accuracy.
P0447 Accurate, rapid and economical diagnosis of chronic enteropathy associated with SLCO2A1 gene and the analysis of its clinical pathological features
Authors: Liu R , Ye L 
Published: January 2025

Abstract

Background
Chronic enteropathy associated with the SLCO2A1 gene (CEAS) is a rare intestinal disease caused by loss of protein function due to mutations in the SLCO2A1 gene. Currently, the clinical features of this disease are poorly understood, and diagnosis of lesions in the small intestine is challenging with limited methods, relying heavily on costly genetic sequencing. Therefore, this study aims to elucidate the clinical characteristics of Chinese CEAS patients and explore the diagnostic value of immunohistochemistry of biopsy tissues from duodenum, terminal ileum or colon site.

Methods
A retrospective analysis was conducted on 10 cases of CEAS admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2015 to May 2024. Data including demographic information, clinical manifestations, laboratory and imaging results, pathological findings, genetic testing, and immunohistochemistry (IHC) results were analyzed.

Results
Of the 10 patients, 4 were male and 6 were female, the average age at onset was 25 years (IQR 17-36), and the average age at diagnosis was 41 years (IQR 39-44), with an interval of about 16 years from onset to diagnosis. Two patients had concurrent primary hypertrophic osteoarthropathy (PHO), both of whom were male. All patients had small intestine involvement, with the most common endoscopic findings being multiple strictures and superficial ulcers of the small intestine. Pathological findings indicated nonspecific chronic inflammation limited to the mucosa and submucosa.
Five patients underwent surgical treatment, all involving partial small bowel resection. Genetic sequencing results indicated SLCO2A1 gene mutations in all 10 patients, with 7 patients having homozygous mutations and 3 having heterozygous mutations. Immunohistochemistry for SLCO2A1 protein on pathological specimens from the affected small intestine showed loss of SLCO2A1 expression in 9 patients and markedly reduced expression in 1 patient, with focal loss in specific vascular regions. Further immunohistochemistry of non-affected sites, including the descending duodenum and terminal ileum, also showed decreased or absent SLCO2A1 expression, consistent with findings in the affected areas.

Conclusion
CEAS is characterized by multiple small intestinal strictures, with a minority of patients also presenting with hypertrophic osteoarthropathy, which is more common in males. Immunosuppressants and biologics generally show poor efficacy. Historically, CEAS has been difficult to diagnose with a prolonged time to diagnosis, and genetic testing is costly and time-consuming. Immunohistochemical analysis of SLCO2A1 protein, regardless of whether the tissue is from affected or non-affected areas, can aid in early diagnosis.
P0452 Complicated and Extra-Complicated Crohn’s Disease Course: a Prospective Inception Real-World Cohort
Authors: Sharar Fischler T , Goren I , Ollech J E , Banai-Eran H , Avni-Biron I , Snir Y , Broitman Y , Freidenberg A , Pauker M H , Dotan I , Yanai H 
Published: January 2025

Abstract

Background
Crohn’s disease (CD) is a heterogeneous condition with a potentially complicated course. We aimed to evaluate the rates of a complicated disease course within a real-world prospective inception cohort of patients with newly diagnosed CD (ndCD).

Methods
A prospective, observational, longitudinal cohort study involving consecutive adults with ndCD was conducted at a tertiary referral center. Patients were managed at the discretion of their treating physician. Key outcomes were defined as ‘complicated disease course’ (any CD-related hospitalization, any CD-related surgery, steroid dependency, or ≥2 biologics) and ‘extra-complicated disease course’ (recurrent or &gt;5-days hospitalization, multiple perianal procedures, CD-related intestinal resection, or ≥3 biologics) over time. The Chi-square Automatic Interaction Detector (CHAID) technique was used to identify cutoffs of clinical indices and blood count values at diagnosis associated with a complicated disease course at one year post-diagnosis. Kaplan-Meier survival analysis was used to assess complication rates over time, and multivariable Cox regression analysis was used to identify risk factors.

Results
A total of 192 patients with ndCD with a median age of 26 years (IQR: 21-36) were included, of whom 45.8% were female. Phenotypes included 18.8% with stricturing (B2), 9.9% with penetrating (B3), and 19.3% with perianal (P) disease. The median follow-up period was 3.9 years (IQR: 1.5-5). The cumulative rates of complicated and extra-complicated disease courses were 24.2% and 12.9% at one year, 35.9% and 18.9% at three years, and 51.3% and 26.6% at five years post-diagnosis, respectively. Patients with progressive phenotypes (B2, B3, or P) at diagnosis had a significantly elevated risk for both complicated (HR 3.362, 95% CI: 1.992-5.673) and extra-complicated disease course (HR 6.724, 95% CI: 3.36-14.418). Baseline laboratory values contributing to risk stratification included a platelet count above 370x103/uL (HR 2.64, 95% CI: 1.583-4.401 for complicated course; HR 4.105, 95% CI: 2.043-8.247 for extra-complicated course) and lymphocyte count above 1.2x103/uL (HR 1.800, 95% CI: 1.034-3.133 for extra-complicated course).

Conclusion
Nearly half of patients with ndCD experience a complicated disease course within five years, with progressive phenotypes at diagnosis significantly increasing the risk. Elevated platelet and lymphocyte count at diagnosis may further identify individuals at a higher risk for adverse outcomes (‘extra-complicated course’).
P0453 Intestinal Ultrasound Correlates with Patient-Reported IBD Disability in Ulcerative Colitis: A Step Towards Integrated Monitoring
Authors: Eggermont E , Lenfant M , Fierens L , Vermeire S , Ferrante M , Sabino J , Verstockt B 
Published: January 2025

Abstract

Background
Non-invasive imaging methods, particularly intestinal ultrasound (IUS), are increasingly pivotal in guiding management in ulcerative colitis (UC). While long-term treatment goals focus on reducing IBD-related disability, the link between ultrasonographic findings and patient-reported outcome measures (PROMs), such as IBD-related disability, remains unclear.

Methods
Data on IBD-related disability (using the IBD disk) were prospectively gathered through a digital questionnaire from patients with UC undergoing routine IUS, and performed within maximal one week of each other. Patients with isolated proctitis were excluded. Bowel wall thickness (BWT) was averaged from two independent measurements &gt;1 cm apart, alongside colour Doppler assessments, all blinded to IBD disk data. The Milan Ultrasound Criteria (MUC) score was calculated, with relevant ultrasound activity defined as MUC &gt;6.2 (worst affected segment).1 A high IBD-related burden was defined as an IBD disk score &gt;40. Correlation analysis was performed using Spearman’s rank coefficient.

Results
Thirty-one paired assessments (median interval: 0.0 [IQR 0.0–3.0] days) were conducted on unique UC patients (38.7% female, median age 32.6 [28.0–45.9] years, median disease duration 1.3 [0.3–6.6] years, 71.0% left-sided colitis). Ultrasound activity (MUC &gt;6.2) was present in 51.6% of patients, while 29.0% reported a high IBD-related disability. Total IBD disk scores correlated significantly with maximal BWT (r=0.41, p=0.02), modified Limberg Doppler signal (r=0.35, p=0.05), and MUC scores (r=0.44, p=0.01). Patients without MUC-defined inflammation showed significantly lower IBD-related disability (median IBD disk score: 41.0 [26.0–52.0]) compared to those with inflammation (72.0 [58.0–78.0], p=0.001) (Figure 1A). Individual IBD disk components—abdominal pain, body image, education/work impact, emotions, energy, interpersonal interactions, defecation regulation, sexual function, and sleep—differed significantly between patients with and without ultrasonographic inflammation (Table 1). Quartile analysis revealed that normal ultrasonographic findings were most likely in patients with the lowest IBD disk scores (Q1 vs Q2–Q4: 87.5% vs 53.3%, p=0.02) (Figure 1B). Receiver Operating Characteristic (ROC) analysis suggested a stricter MUC cutoff of 5.3, achieving 71.0% [48.1–93.8%] accuracy in estimating IBD-related disability with a negative predictive value of 88.2%.

Conclusion
In patients with UC, IUS findings correlate with IBD-related disability and warrant further exploration as potential endpoint and/or treatment target. However, these metrics seem complementary rather than fully interchangeable.

References
1.Allocca M et al. J Crohns Colitis 2023.