bluuebunny/crossref_metadata_2025_split huggingface dataset:
P138 The use of video capsule endoscopy (vce) in patinets with a new diagnosis of Crohn's disease: the experience of one center
Authors: Nicolaou P , Theodoropoulou A , Psistakis A , Arna D , Velegraki M , Fragkaki M , Karmiris K , Vardas E , Paspatis G 
Published: January 2023

Abstract

Background
Crohn’s disease can involve any segment of the gastrointestinal tract, with terminal ileum being the most common affected part. The wireless or video capsule endoscopy (VCE) is a valuable diagnostic tool in detecting lesions in the small bowel beyond terminal ileum. The findings of the procedure in combination with other clinical, endoscopic and laboratory factors can determine the therapeutic plan.
Herein, we analyzed the findings of VCE in patients with suspicious or definite Crohn’s disease, and assessed its contribution to the therapeutic plan.

Methods
We evaluated these parameters in a retrospective analysis of 127 patients who underwent wireless capsule endoscopy in our department since June 2020.

Results
49/127 patients (51% male) were included in the study. The mean age was 40.24 years (SD ±14.30, IQR= 73–15). The majority of them (93.9 %) presented with a newly diagnosed Crohn’s disease or terminal ileitis. The VCE examination was performed to detect any other lesions in the small bowel. 6.1% had chronic diarrhea without endoscopic findings. 57.1% had findings of Crohn’s disease across the entire small bowel, 26.6% had sparse ulcers in the terminal ileum. In 12.2% multiple aphthous ulcers and edema were found in the terminal ileum and 4.1% had no findings. After VCE examination, initiation of treatment was considered in 57.1%. Magnetic enterography (MRE) was performed in 24.5% of the patients. VCE showed more extended lesions in the small bowel compared to MRE which showed non-specific terminal ileitis up to 15 cm in all patients.

Conclusion
In patients with mild terminal ileitis wireless capsule endoscopy reveals extended lesions in the small bowel leading to adjustments in the therapeutic plan. In patients with newly diagnosed or suspected Crohn’s disease, VCE can contribute to the assessment of the severity and location of the lesions as well as to the therapeutic plan.
P142 Evaluation of quantitative phase imaging for automated assessment of histopathological remission in patients with Ulcerative Colitis
Authors: Bokemeyer A , Buskermolen J , Ketelhut S , Tepasse P , Vollenberg R , Vieth M , Kemper B , Bettenworth D 
Published: January 2023

Abstract

Background
Ulcerative colitis (UC) is characterized by chronic intestinal inflammation. Histological remission has become an efficacy outcome in clinical trials and might have the potential to modify the course of UC. Quantitative phase imaging including digital holographic microscopy (DHM) can be used for objective and automated evaluation of tissue morphology and density. Our study aimed to evaluate DHM for quantifying histological inflammation in UC patients.

Methods
In a monocentric prospective study, UC patients undergoing colonoscopy were included. Disease activity was measured by the total Mayo Score. DHM was used to determine the refractive index (RI) in mucosal biopsy samples obtained during colonoscopy. RI values were correlated with histological disease activity as assessed by the Nancy histological index [NHI].

Results
In total, mucosal biopsy samples from 21 UC patients were included to the analysis. On average, UC patients had a moderate disease activity as reflected by a partial Mayo score of 3.1 (SEM ± 0.6), an endoscopic Mayo subscore of 1 (SEM ± 0.2) and a total Mayo score of 4.1 (SEM ± 0.8). The mean NHI was 1.3 (SEM ± 0.2) and the mean RI was 1.349 (SEM ± 0.0003).
RI values as determined by DHM correlated strongly with the histological disease activity as determined the NHI (p&lt;0,001 and R2=0.282). Similarly, a marked correlation was found using alternative histopathological indices (Geboes score, Riley index, Robarts histopathological index; all p&lt;0.001).

Conclusion
Our data demonstrate that DHM is appropriate to assess intestinal inflammation in UC patients and that it may be an alternative or supplemental tool to conventional histopathological assessment.
P147 Trends in choice of first line biologic therapy for patients with Inflammatory Bowel Disease. An observational cohort study
Authors: Fernando S , Abu-Rgeef R , Menon S , So K , Venugopal K , Picardo S 
Published: January 2023

Abstract

Background
Biologic therapies have revolutionised the management of Inflammatory Bowel Disease (IBD) with increasing utilisation over the last decade. The anti-Tumour Necrosis Factor-alpha (anti-TNF) agents (Infliximab (IFX) and Adalimumab (ADA)) as well as newer agents (Ustekinumab (UST) and Vedolizumab (VED)) all have well demonstrated safety and efficacy profiles in the management of IBD. The choice of an optimal first line biologic remains unclear due to lack of comparative randomised trials and real-world studies; however, certain patient and disease characteristics may influence this choice. The aims of this study were to explore temporal trends in choice of 1st-line biologic therapy and factors that influence this choice.

Methods
A retrospective observational cohort study of all patients with IBD that commenced induction and completed at least one maintenance dose of a biologic therapy between 1st January 2015 and 31st December 2021. Relevant patient and disease-specific factors were collected, including patient comorbidities (ischaemic heart disease, malignancy and opportunistic infections) at time of diagnosis, for each eligible patient. Factors affecting choice of biologic therapy were compared using ANOVA and c2 test.

Results
280 patients were included, with 50.7% being male and median age of IBD diagnosis of 29 years. There was a progressive increase in biologic use over time, with 15 patients commencing1st biologic therapy in 2015, rising to 58 patients in 2021. UST has overtaken IFX and ADA as first line choice for Crohn’s disease (CD) since its introduction in 2018 (Figure 1). IFX has remained preferred first line therapy for ulcerative colitis (UC) over VED and ADA, with stable trend in choice over time. Factors with significant differences in choice of first line biologic therapy included age (UST for older age of commencement), IBD subtype (higher proportion of patients commencing ADA had CD, whereas higher proportion of patients commencing VED had UC), disease location (VED was preferred for colonic over ileal CD), and malignancy (UST was preferred) (Table 1).

Conclusion
- There has been a steady rise in the number of patients commencing biologic therapies, with an average increase of 24% per year from 2015 to 2021.
- Ustekinumab has replaced anti-TNF therapy as the preferred first line biologic for Crohn’s disease; a trend likely secondary to the comparatively favourable safety profile of ustekinumab. Ustekinumab was preferred in older patients and those with history of malignancy.
- Infliximab remains the preferred first line therapy for ulcerative colitis with stable trends in choice.
- The presence of perianal disease was not a significant factor affecting choice.
P163 Is Peri-appendiceal Inflammation of Clinical Significance in Patients with Ulcerative Colitis?
Authors: Kim S J , Kim E J , Lee S M , Park H S , Noh Y K , Lee J 
Published: January 2023

Abstract

Background
Peri-appendiceal inflammation (PAI) is often found in patients with left-sided ulcerative colitis (UC) or proctitis. However, there is still no consensus on the clinical significance of PAI. This study aimed to identify the clinical significance of PAI in UC as a prognosis factor.

Methods
We retrospectively collected medical records and endoscopic results of patients with diagnosed left side UC or proctitis between January 2013 and December 2021. According to the presence of PAI, we divided the patients into PAI and non-PAI groups. Demographic features and clinical course of the two groups were collected and analyzed.

Results
A total of 107 patients (41 of left site UC, 56 of proctitis) were enrolled, of which 52 were in the PAI group and 55 were in the non-PAI group There was no difference in most of the demographic and clinical variables between the PAI and non-PAI groups. During the follow-up period of 51 months for the PAI group and 46 months for the non-PAI group, respectively, there was no difference in disease relapse rate (47.1% vs 49.1%, p=0.823), cumulative rate of disease relapse at 1, 3, and 5 years (10.7%, 26.2%, 34.8% vs 8.39%, 23.0%, 36.7%, p=0.823), rate of treatment escalation (59.6% vs 41.8%, p=0.066) and proximal disease extension (25% vs 25.5%, p=0.957) however, new occurrence of PAI during the follow-up period in the non-PAI group was associated with proximal disease extension (55.6% vs 19.6%, p=0.037) In this study, oral 5-aminosalicylate (ASA) was administered to most patients regardless of the extent of the disease. In patients with proctitis with PAI, oral 5-ASA did not affect relapse rate (37.1% vs 66.7%, p=0.550) and proximal disease extension rate (28.6% vs 33.3%, p=1.000).

Conclusion
PAI at diagnosis did not affect the course of the disease nor did oral 5-ASA in proctitis, however new occurrences of PAI during follow-up were associated with proximal disease extension.
P168 Development of predictive model for early detection of Inflammatory Bowel Disease in Korea
Authors: Lee C , Koh S J , Choi K , Lee H J , Im J P , Kim J S 
Published: January 2023

Abstract

Background
Diagnostic delay in inflammatory bowel disease (IBD) was frequent and may be associated with poor outcomes. The aim of this study was to develop a predictive model for early diagnosis of IBD.

Methods
From March 2020 to January 2022, a 15-item Red Flags questionnaire was administered to all patients who visited outpatient clinic with gastrointestinal symptoms suspected of IBD. All patients underwent additional diagnostic tests to confirm IBD. We estimated a model that could predict the early diagnosis of IBD using questionnaire and laboratory test results.

Results
A total of 186 patients were enrolled in this study and 114 (61.2%) patients were finally confirmed with IBD. The logistic regression identified 4-item independently associated with a diagnosis of IBD. 1) Perianal fistula/abscess or perianal lesions (apart from hemorrhoids) (OR, 2.6; p=0.044). 2) Chronic abdominal pain/discomfort (&gt;3 months) (OR, 0.3; p=0.013). 3) Rectal bleeding (OR, 7.4; p&lt;0.001). 4) First-degree relative with confirmed IBD (OR, 12.0; p=0.033). A receiver operating characteristic curve was used to evaluate predictability of the model for diagnosis of IBD and each area under the curve was as follows. 1) Questionnaire only : AUC 0.831 (95% confidence interval; 0.766-0.896), 2) Questionnaire and serum laboratory tests including blood cell counts, erythrocyte sedimentation rate and C-reactive protein : AUC 0.885 (95% C.I.; 0.834-0.936), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.895 (95% C.I.; 0.845-0.944). This model confirmed that the predictive value was particularly excellent for early diagnosis of Crohn's disease. 1) Questionnaire only : AUC 0.891 (95% C.I.; 0.818-0.964), 2) Questionnaire and serum laboratory tests : AUC 0.960 (95% C.I.; 0.914-1.000), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.975 (95% C.I.; 0.944-1.000).

Conclusion
The predictive model for early diagnosis of IBD has a high predictive value. The model allows for early detection of IBD from non-IBD patients.
P182 Modified Multiplier SES-CD (MM-SES-CD) and laboratorial Crohn’s disease activity parameters: is there any association?
Authors: Capela T , Ferreira A I , Macedo Silva V , Freitas M , Arieira C , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J 
Published: January 2023

Abstract

Background
Contrary to the Simple Endoscopic Score for Crohn’s Disease (SES-CD), Modified Multiplier SES-CD (MM-SES-CD) is a new endoscopic severity assessment tool that was able to predict one-year endoscopic remission in patients with Crohn’s Disease (CD) on active therapy. Unlike SES-CD, MM-SES-CD accounts for the number of segments affected and the different prognostic weight of individual SES-CD parameters according to disease location. Nevertheless, there is scarce information regarding its relationship with laboratorial parameters, namely C-reactive protein (CRP) and fecal calprotectin (FC). We aimed to analyze the association between MM-SES-CD and these laboratorial parameters.

Methods
Retrospective cohort-study including all ileocolonoscopies performed in adult CD patients between January 2020 and October 2022 with CRP (mg/dL) and FC (ug/g) collected within one month. Patients with previous intestinal surgery or inadequate bowel preparation were excluded. MM-SES-CD, ranging from 0 to 130.5, was calculated and different severity categories were defined as follows: remission (&lt;14), mild (≥14 to &lt;31), moderate (≥31 to &lt;45), and severe (≥45). MM-SES-CD values were correlated and compared, according to severity categories, with laboratorial biomarkers.

Results
A total of 272 ileocolonoscopies from 218 CD patients were included, most females (54.1%) with a mean age of 41 years old. Most patients were A2 (72.8%), L1 (51.1%) and B1 (73.9%), according to Montreal classification. Median MM-SES-CD, CRP and FC was 12.0, 2.9 and 222.0, respectively. Despite MM-SES-CD values correlated weakly with CRP (r=0.376, P&lt;0.001) and moderately with FC (r=0.531, P&lt;0.001), patients with endoscopic remission had significantly lower median CRP (2.9 vs 7.7, P&lt;0.001) and FC (128 vs 587, P&lt;0.001) than patients with active disease. Additionally, median CRP (2.9 vs 6.0 vs 16.0 vs 30.7, P&lt;0.001), and median FC (128 vs 531 vs 637 vs 877, P&lt;0.001) were significantly different between MM-SES-CD severity categories (remission vs mild vs moderate vs severe), respectively. CRP and FC optimal cut-offs for endoscopic remission were 8.5 mg/dL (Sensitivity 74.7%, Specificity 43.6%, negative predictive value (NPV) 77.4%, positive predictive value (PPV) 40.0%) and 471.5 ug/g (Sensitivity 62.6%, Specificity 87.3%, NPV 82.3%, PPV 71.3%), respectively.

Conclusion
To the best of our knowledge, this is the first study reporting an association between CRP and FC and increasing degrees of disease activity assessed by MM-SES-CD. A CRP &lt;8.5 mg/dL and a FC &lt;471.5 ug/g are suggested as cut-offs associated with endoscopic remission.
P183 Development of a new simple ultrasound activity score for intestinal Behçet's Disease
Authors: Yaguchi K , Kunisaki R , Sato S , Izumi M , Fukuno Y , Ebina T , Matsune Y , Hama T , Onishi M , Kobayashi K , Shibui S , Toritani K , Nishida D , Matsubayashi M , Nakamori Y , Nishio M , Umezawa S , Ogashiwa T , Sasaki T , Fujii A , Kimura H , Numata K , Maeda S 
Published: January 2023

Abstract

Background
Intestinal Behçet's disease (BD) is a relapsing-remitting disease typically associated with punched-out ulcers in the ileocecal region. Optimal monitoring of disease activity is necessary; however, ileocolonoscopy cannot be performed on a regular basis as it is invasive, resource-intensive and causes considerable patient discomfort. Furthermore, there are risks of intestinal bleeding and perforation caused by pretreatment laxatives and air insufflation during the examination. Hence, other follow-up examinations are required. Intestinal ultrasonography (IUS) is a minimally invasive imaging method, but there are no previous reports of comparisons between IUS and endoscopy for intestinal BD. This study aimed to evaluate the usefulness of IUS in assessing the activity of ileocecal ulcers in intestinal BD.

Methods
This retrospective single-centre study included patients with intestinal BD who underwent colonoscopy and IUS within 2 weeks, from 2007 to 2020. Correlations between the corresponding endoscopic activity using the Sakita–Miwa classification and six IUS variables (bowel wall thickness [BWT], vascularity, bowel wall stratification, intramural and extramural abscesses, fistulas and mesenteric lymphadenopathy) were assessed and used to select the variables that should be included in the new simple score. IUS findings were also compared with biomarker (C-reactive protein [CRP]) concentrations and clinical severity indices (Crohn’s disease activity index and disease activity index for intestinal BD [DAIBD]).

Results
Seventy-nine IUS examinations from 53 patients were included. Univariate analysis revealed that CRP and DAIBD and the IUS findings BWT, vascularity and bowel wall stratification and intramural and extramural abscesses differed significantly according to endoscopic ulcer activity. Multivariate analysis using a logistic regression model revealed that only BWT and vascularity were statistically different; therefore, a new simple score ([2*BWT] + [5*vascularity]) was constructed. Receiver operating characteristic curve analysis revealed an area under the curve of 0.91 for detecting endoscopic activity, which was superior to those of CRP (0.80; P=0.069), Crohn’s disease activity index (0.69; P=0.002) and DAIBD (0.67; P&lt;0.001).

Conclusion
A new simple ultrasound activity index for intestinal BD comprising BWT and vascularity was constructed and correlated well with endoscopic disease activity. This is the first report describing the usefulness of IUS for intestinal BD, and we believe the findings will have many implications in clinical practice.
P194 Characterization of Protein Disulfide Isomerases in adult and pediatric Crohn’s Disease and association with inflammation and fibrosis
Authors: Bequet E , Salée C , Bletard N , Vieujean S , Massot C , Fonzé F , Sarter H , Ley D , Colinet S , Delvenne P , Seghaye M C , Louis E , Meuwis M A ,   with the participation of EPIMAD group
Published: January 2023

Abstract

Background
Evolution of Crohn’s disease (CD) is often marked by fibrostenotic complications and available biotherapies cannot prevent or treat intestinal fibrosis. The pathophysiological mechanisms of intestinal fibrosis are multiple and poorly understood. The intestinal epithelium probably plays a key role. The endoplasmic reticulum stress (ERS) is involved in the pathophysiology of IBD and in fibrosis. Protein disulfide isomerases (PDIs) take part in the ER stress response, but their precise roles and associations with CD remain poorly characterized. We investigated the distribution of selected PDIs within the ileum and colon of adult and pediatric patients with inflammatory or stenosing CD.

Methods
Tissues from 72 pediatric and 47 adult CDs, and 26 pediatric and 48 adult patients without IBD were included from 4 tertiary hospitals. The degree of fibrosis and inflammatory infiltrate were evaluated. The distribution of 4 PDIs (AGR2, BiP, PDIA6, ERP44) within the tissues was studied by immunohistochemistry (IHC) using a semiquantitative scoring scale (0 to 4). Statistical tests used were ANOVA or Kruskal-Wallis (with post hoc test), T-Student and Mann-Whitney.

Results
The clinical characteristics of the patients included are described in Table 1. The PDIs provide an IHC signal which was mainly epithelial. The distribution of PDIs differed according to the segment studied (colon or ileum), the age of CD onset, location in the epithelium (surface, median crypt, or bottom of crypt), and the normal, inflammatory, and/or fibrotic features of the tissues. In the ileum of adult and pediatric CDs, the distribution of AGR2 was significantly higher in the epithelium adjacent to fibro-inflammatory tissues (p&lt;0.01). In pediatric cases, AGR2 increased significantly with the fibrosis grade within the surface epithelium of the ileum (Fig. 1). The distributions of the other PDIs (BiP, ERP44 and PDIA6) were rather influenced by the inflammatory infiltrates and varied in adult and pediatric CD. The distribution of BiP was significantly higher in tissues with acute and/or chronic inflammation and independent from fibrosis. In adults, the distribution of PDIA6 in the colonic epithelium was significantly higher in CD cases compared to non-CD cases.

Conclusion
Our results suggest that the studied PDIs may have different roles in the ERS response within the intestinal epithelium in adult and pediatric CD. These PDIs need to be functionally explored further to better understand their specific involvement in inflammation and fibrosis in CD. The increase of AGR2 in fibro-inflammatory tissues, not observed with other PDIs, suggests a specific link between AGR2 and intestinal fibrosis.
P202 Accuracy of blood-PCR for diagnosing CMV Colitis in patients with Inflammatory Bowel Disease
Authors: Serra-Ruiz X , Herrera-de Guise C , Esperalba J , Mayorga Ayala L , Céspedes Martínez E , Robles Alonso V , Casellas F , Pérez Martínez Z , Oller E , Borruel Sainz N 
Published: January 2023

Abstract

Background
Current guidelines in inflammatory bowel disease (IBD) advocate for endoscopic biopsies to confirm cytomegalovirus (CMV) colitis by means of immunohistochemistry (IHC) or tissue polymerase chain reaction (tPCR). Clinical usefulness of whole-blood PCR (bPCR) remains controversial. Our aim was to asses diagnostic accuracy of bPCR to predict CMV colitis.

Methods
We extracted data from all patients between 2017 and 2022 with ulcerative colitis (UC), Crohn’s disease (CD) or unclassified colitis presenting with a moderate-to-severe flare of IBD, and who were tested for CMV infection with both IHC and bPCR at the same time. IHC was considered reference standard and was used to evaluate diagnostic accuracy of bPCR.

Results
89 patients were included, of which 44 (49,4%) were women, and median age was 49 years (Figure 1). 48 (50,6%) had UC, 16 (19,1%) had CD, and 25 (29,2%) had unclassified colitis. 46 (51,7%) were receiving any IBD treatment by the time of enrolment, of which 34 (67,4%) were on corticosteroids. Among patients in the CMV colitis group we found a higher proportion of leucocyte counts in the normal concentration range (p=0,035) and higher endoscopic activity using the Mayo endoscopic score in CU (p=0,027).

Of the study subjects, 25 (28,2%) had CMV colitis; and bPCR was positive in 23 (25,8%). Diagnostic accuracy of bPCR was 75,3%, being sensitivity and specificity 52% and 84,4%, respectively. The positive predictive value and negative predictive value were 56,5% and 81,8%. Numerically, patients in the CMV colitis group showed higher concentrations of CMV DNA PCR without reaching statistical significance (6416,2 copies/mL vs. 2256 copies/mL, p=0,295).
The area under the receiver operating characteristic curve value was 0,646 (p=0,239). When setting a threshold of above 1336 copies/mL, sensitivity and specificity values were 40% and 92,2%, respectively, and the positive likelihood ratio (LR+) was 5,13 (Figure 2).

Conclusion
Although bPCR showed high specificity for diagnosing CMV colitis, the sensitivity values were low. In agreement with current guidelines, blood-based tests should not replace IHC or tPCR for detecting CMV reactivation in IBD. A threshold of above 1336 copies/mL showed a moderately high LR+, thus it should prompt consideration of early antiviral treatment.