bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0286 Assessment of clinical predictive factors for the development of short bowel syndrome in a cohort of patients with Crohn’s disease
Authors: Parisio L , Becherucci G , Pizzoferrato M , Del Gaudio A , Covello C , Di Vincenzo F , Iaccarino J , Petito V , Masi L , Turchini L , Amatucci V , Profeta F , Foscarini E , Coppola G , Puca P , Laterza L , Lopetuso L R , Pugliese D , Chieppa M , Mocci G , Covino M , Cammarota G , Gasbarrini A , Scaldaferri F , Papa A 
Published: January 2025

Abstract

Background
Short bowel syndrome(SBS)is a severe clinical condition occuring when,following multiple intestinal resections,the remaining small bowel in continuity is ≤200cm.SBS is associated with intestinal failure(IF)when the intestinal absorptive function is compromised,requiring intravenous nutritional or electrolyte supplementation.Crohn’s disease(CD)is one of adults’ most frequent causes of SBS.The aim of this study was to identify clinical predictive factors of SBS in CD pts

Methods
We performed a prospective study, enrolling consecutive CD outpatients (pts).Statistical univariate comparison for primary outcome was assessed for continuous variables by the Mann-Whitney U test and the Kruskal-Wallis ANOVA test.Categorical variables were compared using the chi-square test.We also assessed a multivariate logistic regression model to identify independent predictors of SBS

Results
We enrolled 169 CD pts(47.3% male,mean age 43.5 years[±14.1]).45.5% of them were smokers;extraintestinal manifestations(EIMs)were present in 45.5% of pts, and 67.5% of pts had bowel resections(26.6% of them with more than one surgical intervention).Median disease duration and median time between diagnosis and the first resection were 9y(IQR 4-17)and 6.5y(IQR 1-13),respectively.At baseline,101 pts were on anti-TNF therapy,and considering the course of the disease,overall,20.1% of the pts were exposed to ≥3 biologics.10% of pts had SBS and 5.3% IF.In univariate analysis,comparing patients with and without SBS,the following variables were statistically different:disease duration(p=0.000),upper gastrointestinal disease location(p=0.001),ileocolonic location(p=0.008),stenosing behavior(p=0.040),perianal disease(p=0.000)and time elapsing from CD diagnosis to start biological therapy(0.002).At multivariate analysis,disease duration(p=0.000),perianal disease(p=0.05)and time elapsing from CD diagnosis to start biological therapy(p=0.016)resulted independently associated with the development of SBS

Conclusion
Our data identify the clinical features that would allow the gastroenterologists to predict the risk of developing SBS in a cohort of CD pts.Further studies would be needed to confirm our findings.Funded by:2.1 “Rafforzamento e potenziamento della ricerca biomedica del SSN”,finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project “Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets”code:PNRR-MAD-2022-12376791
P0287 Mild Crohn´s Disease is associated with a low, but not negligible, rate of progression, over a 5-year follow-up period
Authors: Bárbara A , Bravo C , Abrantes D , Abreu B , Reves J , Palmela C , Gomes C , Torres J 
Published: January 2025

Abstract

Background
Currently, most studies aim to identify predictive factors for complicated phenotype in Crohn’s disease (CD). However, it is equally important to identify factors associated with a mild disease course, thereby avoiding unnecessary exposure of patients to the potential risks of medication.

Methods
This was a retrospective cohort study of incident CD cases between February 2015 and August 2023. Mild CD was defined as: 1) absence or minimal symptoms at diagnosis, 2) absence of deep ulcers on colonoscopy, 3) absence of complications (strictures, fistula, perianal disease), and/or 4) no need for surgery within three months of diagnosis. A composite outcome was defined by the need of steroids, therapeutic escalation, surgery, progression to fistulizing/penetrating disease, or perianal disease. Survival analysis was performed.

Results
We included 40 patients (55% male; median age of 44 years, IQR [34-56]), with a median follow-up of 63 months, IQR [35–111]. According to Montreal classification the majority were A2 (55%) with terminal ileum involvement (L1 72.5%, of which 80% had &lt;10 cm of ileal involvement, L2 20%, L3 7.5%). At diagnosis, 55% started on 5-ASA, 35% oral budesonide, and 10% did not receive any treatment. The composite outcome occurred in 22.5% of cases (9/40), with a median time until the event of 30 months IQR [6.5-70]: perianal disease in 0.03% (1/40), development of stricturing phenotype in 0.03% (1/40), need for steroids in 17.5% (7/40) and need to escalate therapy also in 17.5% (7/40) patients.
Characteristics at baseline were not different between those who developed the composite outcome. Shorter ideal disease showed a trend toward a lower rate of disease progression (16%vs 23%, p=0.09) (table 1). In a multivariate cox regression, none of these variables were independent predictors of the need of corticotherapy, escalation of therapy or the development of the composite outcome.

Conclusion
Only a minority of patients with mild CD had disease progression, which was generally indolent. No factors associated with worse outcomes were identified in our cohort. Mild CD appears to represent a distinct phenotype that warrants further investigation to better characterize its disease course.
P0288 Translation and validation of the IBD-Disk as a tool for assessing the degree of disability in a cohort of Spanish-speaking patients with inflammatory bowel disease. TRAVIDI study.
Authors: González Muñoza C , Giordano A , Gely C , Gordillo Ábalos J , Bertoletti F , Roig C , Garcia Planella E 
Published: January 2025

Abstract

Background
Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), impact patients’ quality of life, affecting them during both active periods and remission. Recently, tools have been designed to align therapeutic goals between patients and healthcare professionals, known as Patient-Reported Outcome Measures (PROMs). The Inflammatory Bowel Disease Disability Index (IBD-DI) measures disability in IBD patients, but its complexity limits its use. Alternatively, a simplified self-administered version, the IBD-Disk (IBDD), has been developed and validated in various languages, though not yet in Spanish. This study aims to translate and validate the Spanish version of the IBDD

Methods
This prospective study involved the translation and validation of the IBDD in a cohort of patients at a tertiary referral centre for IBD in Catalonia. Two phases were carried out: Phase 1 involved forward translation into Spanish, resolution of discrepancies by a bilingual expert (English and Spanish), and back translation into English to produce a final synthesised document tested internally with a group of 10 patients (not included in the final analysis) following the World Health Organization protocol. Phase 2 consisted of a prospective validation (at week 0 and week 24 ± 4 weeks) of the Spanish version of the IBDD, comparing it with the IBD-DI in IBD patients. Sociodemographic, clinical, and laboratory data were collected during both visits.

Results
A total of 102 patients were included (52 CD and 50 UC). The Spanish version of the IBD-Disk demonstrated high internal consistency (alpha 0.925, 95% CI: 0.902–0.945) and good test-retest reliability (intraclass correlation coefficient of 0.957). The correlation between the total IBDD and IBD-DI scores was excellent (R = 0.912; p &lt; 0.001), confirming good concurrent validity. Seventy-two patients completed the questionnaire at week 24, showing good correlation with clinical evolution (measured by the Walmsley and Harvey-Bradshaw indices) and the IBDD.

Conclusion
The Spanish version of the IBD-Disk is a valid and reliable tool for assessing disability in Spanish-speaking IBD patients.
P0294 Functional outcomes after primary ileocecal resection for Crohn’s disease
Authors: Grellier N , Kirchgesner J , Chafai N , Nion-Larmurier I , Debove C , Bourrier A , landman C , Mclellan P , Sokol H , Beaugerie L , Lefèvre J H , Seksik P 
Published: January 2025

Abstract

Background
Ileocecal resection (ICR) is a common procedure in Crohn’s disease (CD). Increasing evidence suggests ICR may be considered a first-line treatment for localized ileal CD to maintain long-term remission, rather than starting biologics. However, removal of the ileocecal valve affects bowel transit and disabling symptoms may arise. The aim of our study was to prospectively assess the impact of primary ICR on daily digestive symptoms in CD patients.

Methods
We included patients who underwent primary ICR at Saint-Antoine Hospital between January 2017 and December 2022. Patients were assessed after a morphological evaluation (endoscopy or MRI) performed between 5 months and 1 year post-ICR. Digestive symptoms were prospectively and systematically collected using a dedicated database. The primary endpoint was the prevalence of a composite outcome, defined as at least 4 soft or liquid stools per day and/or a fecal urgency with inability to delay defecation for more than 15 minutes, and/or moderate to severe daily abdominal pain. Secondary endpoints included other digestive symptoms. Multiple logistic regression analysis was performed to assess predictive factors for the primary outcome.

Results
One hundred nine patients were included. Indications for ICR were fistulizing disease (n=61, 56%) and stenosis (n=41, 37.6%). Only 7 patients (6.4%) had surgery for uncomplicated inflammatory disease. Thirty-five patients (32.1%) had morphological recurrence, defined as i2b, i3, i4 score, deep ulcers, stenosis, or fistulas on MRI. The primary endpoint was met by 24 patients (22%), with 21.1% having at least 3 liquid stools per day. Diarrhea (soft to liquid stools daily) was observed in 56.9%, fecal urgency in 22.9%, and abdominal pain in 32.1% (Figure 1). The primary endpoint prevalence was 17.6% in patients without morphological recurrence and 31.4% in those with recurrence (p=0.17) (Table 1). Multivariate analysis showed that age &gt;40 years at surgery (OR=3.58 [95%CI 1.06-12.8] p=0.04), disease duration &gt;2 years (OR=5.67 [95%CI 1.69-23.0] p=0.008), sepsis (fever &gt;38.3°C within 7 days before surgery) (OR=8.06 [95%CI 1.68-44.2] p=0.01), and small bowel resection length &gt;40 cm (OR=9.50 [95%CI 2.35-45.8] p=0.003) were associated with poorer digestive quality of life as defined by the primary composite endpoint.

Conclusion
The prevalence of digestive symptoms after primary ICR for CD is notable, regardless of disease recurrence. Advanced age, long disease duration, sepsis at surgery, and resection length were associated with disabling digestive symptoms. These results suggest that ICR leads to frequent and disabling digestive symptoms for many patients, which should be considered when proposing ICR.
P0296 Comparison of clinical characteristics of Montreal classification group A3 patients with Crohn’s disease in Korea: Results from the Prospective and Retrospective CONNECT Study
Authors: Yoon J , Kim Y S , Ye B D , Cheon J H , Im J P , Joo Sung K 
Published: January 2025

Abstract

Background
The CONNECT study, a nationwide multicenter cohort study of Crohn’s disease (CD) in Korea, was designed to investigate the clinical characteristics and long-term prognosis of CD patients. Starting in 2009, the study enrolled patients in both a prospective cohort (patients diagnosed since 2009) and a retrospective cohort (patients diagnosed before 2009). Recent trends show an increase in elderly-onset CD (EOCD) in Korea, alongside cases in younger individuals; however, research focusing specifically on EOCD patients remains limited. This study aims to evaluate the clinical characteristics and long-term outcomes of EOCD patients using data from this nationwide, multicenter cohort in Korea.

Methods
We analyzed data both the prospective and retrospective CONNECT cohorts, which included 2,399 CD patients diagnosed between 1982 and 2019 (retrospective cohort of 1,224 patients, prospective cohort of 1,175 patients). Of these, 244 patients were identified as having Montreal classification A3 at diagnosis. Fifty-six EOCD patients (diagnosed at age 60 or older) were compared with 188 adult-onset CD patients (diagnosed at age 40-59) in aspects of baseline characteristics, medication use, and bowel resection rates.

Results
EOCD patients had a higher proportion of females (55.4%) compared to the adult-onset CD group (31.5%). Ileal involvement was the most common location of disease at diagnosis in EOCD patients (51.8%). Previous use of anti-tuberculosis medication was more frequent in EOCD patients than in the adult-onset CD group (29.6% vs. 16.3%, p = 0.047). Although there were no significant differences in disease behavior at diagnosis or ever use of medication between the groups, EOCD patients showed a significantly lower risk of bowel resection (p = 0.008).

Conclusion
EOCD patients in Korea appear to present with distinct clinical features and have a more favorable prognosis, as evidenced by a reduced need for bowel resection compared with adult-onset CD patients. Further research is essential to better understand the unique needs of EOCD patients, including the development of tailored therapeutic guidelines that address the complexities associated with aging and the management of CD.
P0297 Development of Red Flags Index for Crohn’s Disease in the Korean population
Authors: Kim O , Kim S H , Lee H J , Im J P , Kim B G , Kim J S , Koh S J ,   Gastroenterology
Published: January 2025

Abstract

Background
The prevalence of Crohn’s disease (CD) is gradually increasing in South Korea, leading to various complications and negatively impacting quality of life, highlighting the need for early and non-invasive diagnosis. In 2015, the International Organization for Inflammatory Bowel Disease (IO-IBD) developed the Red Flags index for early detection of CD, but it requires validation or improvement for the Korean population. The aim of this study is to develop a Red Flags index tailored to the Korean population.

Methods
A total of 126 CD patients receiving treatment at Seoul National University Hospital were recruited for the study. These patients were compared with two control groups: Group A (111), consisting of individuals with non-CD conditions, such as irritable bowel syndrome, and Group B (60), comprising high-risk individuals who had not yet been diagnosed with CD but were either first- degree relatives of IBD patients, ASCA-positive or had spondyloarthritis. Patients answered 15 questions selected from the IO-IBD study. Chi-square test and multiple logistic regression were used consecutively to select items for the Red Flags index. To evaluate the diagnostic value of the Red flags index as a tool, ROC analysis was performed. Additionally, fecal calprotectin levels were measured in the study participants and diagnostic accuracy of combining fecal calprotectin with the Red flag index was analyzed.

Results
The Red flags index was developed for non-CD subjects and high-risk subjects, respectively. When comparing the area under the curve (AUC), the index constructed from high-risk subjects (Control Group B) showed a larger AUC of 0.909. Notably, the AUC increased when the Red Flag index was used in combination with fecal calprotectin, indicating improved diagnostic accuracy with the combined approach.

Conclusion
We developed the Red Flags index for the Korean population, designed to predict the diagnosis of CD in patients presenting with gastrointestinal symptoms. This index offers a simple, effective tool for the early CD detection.

References
1.Allocca M, Fiorino G, Bonifacio C, et al. Validation of the Red Flags Index for Early Diagnosis of Crohn’s Disease: A Prospective Observational IG-IBD Study Among General Practitioners. J Crohns Colitis. 2020;14(4):512-518.
2.Peyrin-Biroulet L, Sandborn W, Sands BE, et al. Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn’s Disease: An IOIBD Initiative. J Crohns Colitis. 2015;9(8):601-606.
3.Furfaro F, Biamonte E, Vero V, et al. The Earlier You Find, the Better You Treat: Red Flags for Early Diagnosis of Inflammatory Bowel Disease. Diagnostics (Basel). 2023;13(20):3183.
4.Kim JW, Cho YE, Kim JH, et al. Clinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn’s disease and its relationship to the disease clinical course. Dig Liver Dis. 2007;39(7):610-616.
P0298 Revolutionizing Diagnostics: Evaluating ChatGPT-4’s Performance in Ulcerative Colitis Endoscopic Assessment
Authors: Levartovsky A , Albshesh A , Grinman A , Shachar E , Lahat A , Eliakim R , Kopylov U 
Published: January 2025

Abstract

Background
The Mayo Endoscopic Subscore (MES) is a widely utilized measure for assessing endoscopic disease activity in ulcerative colitis (UC). This assessment has a key role in clinical practice as endoscopic remission is a long-term therapeutic objective. Artificial intelligence has emerged as a promising tool for enhancing diagnostic precision and addressing inter-observer variability among endoscopists. This study aims to evaluate the diagnostic accuracy of ChatGPT-4, a multimodal large language model (LLM), in identifying and grading endoscopic images of UC patients using the MES as a reference standard, without prior configuration or fine-tuning.

Methods
Real-world endoscopic images of UC patients were obtained for severity assessment and reviewed by an expert consensus board. Each image was classified by severity grade (0-3) based on the MES. Only images that were uniformly graded by the consensus board were subsequently provided to three IBD specialists and ChatGPT-4 in three separate sessions. Severity gradings of the IBD specialists and ChatGPT-4 were compared with assessments made by the expert consensus board.

Results
Fifty endoscopic images were initially evaluated by the expert consensus board. Of those, 30 images (60%) were graded with complete agreement of MES among the experts. Compared to the consensus board, ChatGPT4’s MES gradings were accurate in 26/30 (86.7%), 21/30 (70%) and 24/30 (80%) with a mean accuracy rate of 78.9%. The IBD specialists gradings were accurate in 24/30 (80%), 24/30 (80%) and 25/30 (83.3%) with a mean accuracy rate of 81.1% (figure 1). There was no statistically significant difference in mean accuracy rates between the two groups (p = 0.71).

Conclusion
ChatGPT-4 has the potential of assessing mucosal inflammation severity from endoscopic images of UC patients, without prior configuration or fine-tuning. Performance rates were comparable to IBD specialists. Further research and validation are warranted to explore the broader applications of LLMs and their integration into diagnostic workflows.
P0313 Bowel wall thickness is not inferior to intestinal ultrasound scores in detecting endoscopic activity in Ulcerative Colitis
Authors: Elkot A , Maher M , Omran E , Eldesoky A E 
Published: January 2025

Abstract

Background
Several intestinal ultrasound (IUS) scores have been proposed to assess disease activity in ulcerative colitis (UC) combining different intestinal ultrasound parameters. However, it is not known if these scores are superior to solely measuring bowel wall thickness (BWT), the IUS parameter most strongly correlated with disease activity and showing a near perfect inter-rater agreement. This study aimed to compare the performance of BWT and 2 validated IUS scores, Milan US criteria (MUC), and the IUS-UC index in identifying active endoscopic disease.

Methods
Consecutive UC patients (Age ≥ 18 y) scheduled for colonoscopy or sigmoidoscopy in a single center underwent IUS within 3 weeks of the procedure, with disease activity graded using the Mayo endoscopic subscore (MES). IUS parameters assessed included BWT, color doppler signal (CDS), haustral pattern (HP), wall layer stratification (WLS), and fat wrapping. Correlations between MES and all IUS parameters, IUS-UC index, and MUC were assessed using Spearman’s rank correlation coefficient. The area under the receiver-operating characteristic (ROC) curves for detecting endoscopic activity (MES ≥ 1) for BWT, IUS-UC index, and MUC were compared.

Results
A total of 57 UC patients (undergoing 60 examinations) were enrolled (median age 34.8 years, 34.3% male). Twenty-five percent of patients were in clinical remission, defined by simple clinical colitis activity index SCCAI &lt; 3. In comparison, 16.3% of patients had endoscopic remission (MES 0), and 33.3% had MES ≤1. The median interval between IUS and colonoscopy was 5 days. The median (IQR) BWT was 1.4mm (1.3-1.7) for MES 0, 2.1mm (1.7-2.7) for MES 1, 3.5mm (2.8-4.3) for MES 2, and 4.4mm for MES 3 (3.9-5.4). BWT, abnormal HP, CDS, IUS-UC index, and MUC showed strong correlation with endoscopic activity. The Pearson correlation coefficients were 0.834, 0.820, 0.757, 0.876, and 0.882, respectively, with all p values &lt;.001. Fat wrapping showed moderate correlation (r = 0.666, p&lt;.001), while loss of WLS showed a weak correlation (r = 0.391, p&lt;.001). There was no significant statistical difference in the area under the receiver-operating characteristic curve for BWT, IUS-UC index, and MUC in differentiating endoscopic remission from endoscopic activity (MES≥1) (figure 1). The optimal cutoff values are presented in Table 1.

Conclusion
IUS-index and MUC are both sensitive and specific in detecting even mild endoscopic activity, however they didn’t show superiority over using BWT as a single parameter. Our study suggests that BWT alone is as effective as more complex IUS scores in detecting active endoscopic disease in UC. BWT may be used as a practical primary IUS parameter for the routine assessment of UC activity.