bluuebunny/crossref_metadata_2025_split huggingface dataset:
P263 Raman spectroscopy analysis of saliva combined with an artificial neural network algorithm could discriminate between Ulcerative Colitis and Crohn’s disease
Authors: Buchan E , Majumder S , Nardone O , N Shivaji U , Abdawn Z , Hejmadi R , Iacucci M , Goldberg Oppenheimer P 
Published: January 2023

Abstract

Background
Early and accurate detection of inflammatory bowel disease (IBD) is crucial for proper intervention.The IBD diagnostic process can be both time-consuming and invasive and lacks a gold standard in disease differentiation. Saliva analysis has gained interest as a potential non-invasive source of disease biomarkers due to its positive correlation with blood-based constituents (e.g. interleukins) at a molecular level. We systematically studied the molecular fingerprint of saliva and tissue biopsy, including how they compare as well as changes associated with disease state-IBD vs non-IBD and Ulcerative colitis (UC) vs Crohn’s disease (CD).

Methods
After obtaining informed consent Saliva and colon biopsies were collected from patients undergoing endoscopy as a standard of care procedure at University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK. The samples were correlated with their tissue pathology markers and findings of the endoscopic evaluation. By combining Raman spectroscopy and an artificial neural network algorithm, Self-Optimising Kohonen Index Network (SKiNET), we have developed a non-destructive molecular profiling tool that assesses both salivary and colonic biopsy changes, which helps to determine the diseased state of the sample source. The collected Raman spectra were analysed using SKiNET as a decision support tool to identify spectral markers and discriminate between healthy and IBD disease classes [1].

Results
This pilot study characterised the spectral signatures of 101 saliva samples (healthy = 50, UC = 27 and CD =24) and 44 tissue biopsy samples (healthy = 12, UC = 17 and CD = 15). The algorithm reached 87.5% sensitivity and 89% specificity when classifying saliva and 83.9% sensitivity and 84.6% specificity when classifying tissue biopsy. When comparing the spectral fingerprints of saliva to tissue biopsy, the UC spectra are of similar forms with comparable intensities at each of the primary peaks; 1003 cm1(phenylalanine), 1440 cm-1 (Lipids) and 1656 cm-1 (Amide I). In contrast, CD saliva and tissue biopsy indicate significant variance throughout the Raman spectral fingerprint region, with intensity changes observed at each of the primary peaks and the presence of additional shoulder peaks associated with proteins and lipids. In identifying markers of disease IL-4, IL-8 and IL-10 were identified as having important and designatory Raman bands which could serve in the discrimination of IBD in individuals.

Conclusion
This unique combination of Raman spectroscopy and advanced machine learning represents significant progress towards improved, non-invasive and rapid classification of IBD.This technique also lays the foundation for future applications in disease diagnosis, monitoring and therapeutics.
P270 A global consensus on the definitions, diagnosis and management of fibrostenosing small bowel Crohn’s disease
Authors: Bettenworth D , Baker M E , Bemelmann W , Bruining D , D’Haens G , D’Hoore A , Dignass A , Dotan I , Feagan B G , Feakins R , Fleshner P , Fletcher J G , Gordon I , Ha C , Gaylyn H , Jairath V , Lu C , Lyu R , Ng S C , Panes J , Rogler G , Mao R , Rimola J , Sandborn W J , Siegmund B , Silverberg M S , Taylor S , Verstockt B , Rieder F 
Published: January 2023

Abstract

Background
Small bowel fibrostenotic strictures are common in patients with Crohn’s disease (CD). No global consensus recommendations on definitions, diagnosis and clinical management are available.

Methods
Several systematic reviews followed by a RAND/University of California Los Angeles appropriateness study on the definitions, diagnosis and clinical management of fibrostenosing CD in clinical practice were performed. A panel of 28 global experts and a patient representative were convened. They assessed a total of 152 candidate items. The items were subsequently evaluated for appropriateness.

Results
No accurate predictive biomarkers are available for naïve or anastomotic fibrostenosing strictures. Accurate diagnosis of fibrostenosing CD requires cross-sectional imaging which should evaluate bowel wall thickness, luminal narrowing and prestenotic dilatation. A potential inflammatory component should be assessed. Abdominal cross-sectional imaging was considered necessary prior to any treatment decision. The panel proposed an approach to medical, endoscopic, and surgical therapies (Figure 1 and Table 1). Technical characteristics for endoscopic balloon dilation and follow up strategies after successful dilation therapy were identified. Appropriateness, types and performance of different surgical approaches in various settings were evaluated.

Conclusion
This global consensus provides clinical guidance for the diagnostic and therapeutic management of patients with fibrostenotic CD.
P271 Variability in histologic activity of paired same-segment biopsies in Crohn’s disease dictates multiple biopsies needed to accurately evaluate histological status
Authors: Lenfant M , Vermeire S , Sabino J , Ferrante M , Verstockt B , De Hertogh G 
Published: January 2023

Abstract

Background
At present, the significance of histologic remission in Crohn’s disease [CD] is unclear. One of the main reasons is the heterogeneous distribution of the lesions. This contrasts with ulcerative colitis, where histologic scoring systems have been applied with success on limited numbers of biopsies. We assessed the variability of histologic activity in paired same-segment biopsies from CD patients.

Methods
All CD patients undergoing ileocolonoscopy between January 2020 and July 2022 at our tertiary referral center were eligible for inclusion. Clinical data were retrospectively collected from medical records. Endoscopies were video-recorded and the Simple Endoscopic Score for Crohn’s Disease [SES-CD] was used to evaluate endoscopic activity. Paired biopsies were taken within the most affected area per segment, in accordance with ECCO guidelines.
The Global Histology Activity Score (GHAS), the Geboes Score [GS], the Robart’s Histopathology Index [RHI] and the Nancy Histological Index [NHI] were determined for each biopsy by an experienced IBD pathologist [GDH] blinded to the endoscopic scores. The cut-off values for histologic remission were set at GHAS ≤4, GS &lt;2B.1, RHI ≤3 and NI ≤1 (absence of neutrophils for RHI and NI).
Variability was assessed by intraclass correlation coefficient [ICC] and Kappa statistics. Association between histologic and endoscopic scores was studied with Spearman’s rank correlation coefficient.

Results
A total of 151 biopsy pairs from 128 patients were analysed. Patient characteristics are summarised in Table 1. Endoscopic activity was observed in 79% of segments. In patients with endoscopic remission, histologic activity (presence of neutrophils) was found in 29% of cases. There was a moderate association between the endoscopic and histologic assessment, with correlation levels ranging from 0.48 to 0.52 [p&lt;0.001].
Histologic indices showed fair agreement between paired biopsies [Table 2]. Looking at the predefined cut-offs, moderate variability across the different histological scores was seen [Table 3]. When comparing biopsies from segments with endoscopic activity and those without, overall higher variability in active segments and substantial agreement in paired biopsies from inactive segments was observed [Table 4].

Conclusion
The patchy nature of microscopic inflammation in CD is reflected in the histologic scores of paired same-segment biopsies, with only moderate agreement across histologic scoring indices, although lower variability was seen in biopsies from endoscopic inactive segments. Endoscopic activity only moderately reflects histological status. Multiple biopsies per segment are therefore needed for accurate histological evaluation, the optimal number necessary remains to be explored.
P280 Quality of life in military patients with Inflammatory Bowel Disease
Authors: Ben Safta N , Medhioub A , Mohamed G , Boughoula K , Ben Slimane B , Ben Abdallah H , Bouali R , Bizid S , Abdelli M N 
Published: January 2023

Abstract

Background
Inflammatory Bowel Disease (IBD), represented by Crohn's disease (CD) and Ulcerative Colitis (UC), are chronic conditions that can impair quality of life (HRQOL). Active military personnel are particularly at risk, given the strain of their work and military missions. The aim of our study was to evaluate the HRQOL of active military patients with IBD and to search for factors related to its alteration.

Methods
This was a prospective cross-sectional study, over a period of 5 months [February 2022 - June 2022], including male military patients that were still serving. The HRQOL of these patients was assessed by the IBD-Disk, which is a visual scale that consists of 10 items (Abdominal pain, diarrhea, social behavior, education and work, sleep, energy, emotions, body image, sexual activity, joint pain). It is validated for the assessment of HRQOL in IBD patients. Each dimension is scored from 0 to 10, with a total score of 0 to 100. The higher the score, the more impaired the HRQOL. The overall IBD-Disk score was considered impaired if it was higher than 40.

Results
We included 30 patients. The most represented age range was from 31 to 40 years. Ten patients were smokers. Twenty-four patients had CD and 6 had UC. The majority of CD was isolated ileal (n=16) with an upper gastrointestinal tract involvement in one patient and anoperineal manifestations in 5 patients. UC was distal in 3 patients and extensive in the other 3. Nine patients had extra-intestinal involvement, principally rheumatological (n=8). The mean overall IBD-Disk score was 21.6 [6 - 66]. We noted that CD was associated with the alteration of the dimensions related to urgent stools (p=0.001), social life (0.002) and sleep (p=0.004). The presence of anoperineal lesions during CD was associated with impairment of the social (p=0.002) and energy (p=0.006) dimensions. The presence of extra-intestinal manifestations was associated with elevated social dimension score (p=0.002). Azathioprine treatment was associated with impaired sleep dimension (p=0.048). Patients with a disease that had been evolving for more than 5 years had an alteration in the dimension related to urgent stools (diarrhea) (p=0.036), energy (p=0.048) as well as the dimension of sexual life (p=0.042). History of hospitalization for IBD was associated with impaired body image (p=0.030). History of surgical resection was associated with impaired energy (p=0.029), sexuality (p=0.015) and overall quality of life (p=0.02).

Conclusion
In our active military patients, HRQOL was not impaired overall, but several factors, related to severe forms, were associated with lower HRQOL.
P284 Assessing Patient Experience in an Inflammatory Bowel Disease service. Can we measure an effect from socioeconomic deprivation – experience from the AWARE-IBD programme?
Authors: Sheldon E , Roman S , Bursnall M , Hawkins R , Lobo A , Hind D , Randall K , Wakeman R , Ainley R 
Published: January 2023

Abstract

Background
There is increasing international attention on delivery of services for people with Inflammatory bowel diseases (IBD). Experience of care is defined and measured as ‘what’ happened, ‘how’ and ‘how often’ and is an important facet of service provision. Socioeconomic deprivation may be associated with poor disease-related outcomes and sub-optimal utilisation of services but its effect on experience of care in people with inflammatory bowel disease has not been reported.

Methods
An invitation to participate in a research study nested within the AWARE-IBD quality improvement programme was sent to 4082 patients attending the IBD service at a single UK teaching centre in October 2021. A second invitation was sent in May 2022 followed by telephone recruitment targeted to those from the most deprived deciles based on the index of multiple deprivation (IMD), a measure of relative deprivation for small areas in England (‘lower-layer super areas’, approximately 1500 residents). Participants returned an IBD specific patient reported experience measure (PREM) via a web application comprising 38 items across 3 domains: ‘My Care Team’, “What matters to me’, ‘Living with Crohn’s or Colitis’. Each item was scored 1 (poorest experience) to 5 (best experience). Median scores for individual items and by domain was compared in the following demographic groups: IMD decile IMD (1 = most deprived; 10 = least deprived), age, gender, disease type (ulcerative colitis or Crohn’s disease).

Results
PREM responses were received from 249/4,082 (6%) patients. Patients from the most deprived decile were underrepresented in respondents compared to the invited cohort (Decile 1 22/249 (9%) vs 667/4,063(16%) p=0.002) and patients from the least deprived decile were over-represented; Decile 10: 38/249 (15%) vs 379/4063(9%) p=0.002). Respondents were otherwise broadly comparable to the invited cohort in terms of age, gender and disease type. Experience of care for respondents for individual PREM items or by domain did not differ according between IMD deciles (Figure 1), age, gender or disease type.

Conclusion
Measuring experience of care is an important part of IBD service quality improvement. No effect from socioeconomic deprivation was demonstrated. This finding conflicts with the literature on links between socioeconomic factors and quality of care and results across a service should be interpreted with caution. Experience of those at greatest risk is difficult to elicit with survey based experience measurement. Instead, tailored engagement exercises are required including qualitative and ethnographic approaches to better understand the impact of deprivation on experience.
P285 Correlation between the endoscopic scoring system SES-CD for Crohn’s disease with histological and clinical outcomes
Authors: Gibbons E , Afridi I , Sheehan T , Smyth C , Farrell R , Hall B , Kelly O B 
Published: January 2023

Abstract

Background
There is a growing body of literature demonstrating that persistent histological activity, despite endoscopic remission, may be associated with increased risk of relapse in IBD. Much of this research has focused on outcomes in UC. The primary aim of this study was to examine the correlation of the endoscopic scoring system, SES-CD with histological outcomes and their association with flare/hospitalisation in the ensuing twelve months.

Methods
We selected 82 random colonoscopies performed for Crohn’s surveillance/assessment between 2017-2019. Adult patients with a complete colonoscopy were included. All reports were reviewed and blindly scored by 2 expert endoscopists using SES-CD scoring system. Histology was classified as normal, mild, moderate and severe by an experienced gastrointestinal histopathologist. Clinical/ IBD demographics, flare episodes and hospitalisations were recorded. Correlation between endoscopic and histologic activity was tested. Comparisons were made between patients with histologic and endoscopic remission, those in endoscopic remission with histologic activity and those with both endoscopic and histologic activity.

Results
82 patients with Crohn’s disease (median age 44; M:F 38:44) were included. A wide range of SES-CD scoring was noted (median score 3), with 47.5% in remission (0-2), 30.5% mild activity (3-6), 18% moderate activity (7-15) and 3.5% severe disease activity scoring &gt; 16. Patient groups were similar, p=ns for demographic variables. 29/82 (35%) were in both endoscopic and histologic remission, 10/82 (12%) were in endoscopic remission with persistent histologic activity, and 33/82 (40.2%) had both endoscopic and histologic activity. Histologic activity was independently associated with steroid use/ flare within six months (Z= -2.6, p=0.0075) as was endoscopic activity (Z=-2.76, p=0.0058). Chi analysis of the three groups showed significant differences in the groups, 8.2 p- 0.016 for change in treatment, 9.5 p= 0.008 for steroid use/ flare. 2 way analysis, however, of histologic activity versus deep remission is p=ns, though a trend is apparent.

Conclusion
There is now a growing body of evidence that histological remission is an important endpoint. The extent that histologic remission affects outcomes is unclear to date. In a recent 2021 meta-analysis only one study focused on outcomes in Crohn’s was included. Further studies are required incorporating greater numbers of patients and robust histologic scoring systems.
P287 Clinical characteristics and outcomes of ileal pouch–anal anastomosis (IPAA) inflammation in a Latin American (LA) IBD reference Center (I.
Authors: Sambuelli A , Gil A , Rohwain M J , Candel I , Huernos S , Tirado P , Negreira S , Balaban E 
Published: January 2023

Abstract

Background
Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) can be associated with a wide spectrum of complications, ranging from a frequently mild acute pouchitis (AP) to Chronic pouch inflammation (CPI, either antibiotic dependent or refractory, CADP and CARP respectively) and Crohn's disease like pouch inflammation (CDLPI). The pathogenesis, still largely unknown, probably is multifactorial, and environment may play a role.
We aimed to describe clinical characteristics and outcomes of IPAA inflammation in a Latin American (LA) IBD reference Center. Our main focus is CDLPI, because, despite of UC is reported more frequent in LA, epidemiology is changing, and notably, colon location (within CD) reach the half of the CD casuistic in our hospital, as well as other Argentina locations (Cordoba) and Uruguay, a neighbor Country. Probably, this epidemiological feature could impact in our patient′s evolution.

Methods
Our hospital has a Coloproctology Team pioneer of IPAA surgery in Argentine and as Clinical IBD Service, we performed a revision in our electronic data base (included from 1990 to current date, and detected 437 pts. with IPAA. Criteria were; modified PDAI (for disease activity), for CPI and CDLPI we adopted that of Shen B, Clin. Gastrienterol hepatol 200, 6:145-58.

Results
Results
We compare 46 CDLPI with 24 CPI pts. (CADP and CARP) and 24 AP. A total of 55 M, 39 F, were evaluated for demographic data and disease complications. Mean age ±SD at complication: CDLPI 33.8±13.8, CPI 34.2±11.2, AP 40.1±13.7, (NS for gender and Age). Median time (IQR) up to each one of 3 complications: 1.6 (4.19), 2.09 (7.17) and 1.34 (2.67), respectively (NS, Median test). Follow–up time was similar: 20.11 (10.9), 13.7 (12.2), 13.9 (15.6), respectively. CDLPI presented inflammatory pattern in: 37 (80.4%), stricturing in 6 (13.04%), fistulizing in 16 (34.8%) Perianal complication: 43.5%.
Pre-pouch ileitis in CDLP: 26 (56 5%) vs. CPI 1(4.2%), in AP 0% (p.00000), prepouch strictures (13.04% vs. 0%), significant different, as well as prepouch fistulas (17.4%), with suboclusion in 29% Pouch vaginal fistulas and pouch-cutaneous in 1/5 of patients. Cuffitis in 19%. The original IBD was more severe and extensive p &lt;0.02 in the mentioned subgroup.
As regard treatment, IMM treatment in CDLP: was required in 70% vs. 26% in CPI and biologics en 2/3 0.00016, 11% ≥2 biologics. Pouch failure (diversion and resection) was observed in 30% and 13% respectively.

Conclusion
We are a LA center with high CD prevalence. The complications of surgery must be taken into account. IPAA revolutionized UC surgery, but close monitoring, and new research are required with the future hope of acting proactively.
P288 Application of a new classification of Fistulizing Perianal Crohn’s Disease (FPCD) in clinical practice: evaluating the correlation between clinician and patient’s assessments and FPCD patient′s quality of life
Authors: Rodrigues C , Valério F , Casimiro C , Soares C , Ventura S , Domingues Â , Silva A , Cancela E , Ministro P 
Published: January 2023

Abstract

Background
FPCD remains a challenging condition with negative impact on quality of life. Recently, a novel classification was proposed intending to optimize and standardize the management of these patients (Geldof J, et al. Lancet Gastroenterol Hepatol. 2022 Jun;7(6):576-584). We aimed to characterize and classify a population of patients with FPCD according to this recent classification, evaluate the agreement between patient and clinician perspectives regarding disease treatment goals and correlate the new classification with patient’s quality of life.

Methods
Cross-sectional study which consecutively included FPCD’ adult patients (diagnosis &gt; 6 months) followed at a gastroenterology consultation, from September to November 11, 2022. A Portuguese translated diagram of the new classification was presented to included patients, which had to select the class that most faithfully represents the current moment of their disease status. Subsequently, the IBDQ-32 questionnaire was completed. A separate form completed by a senior gastroenterologist include all the demographic and clinical data of each patient and the respective blindly chosen class.

Results
23 patients (mean age of 34.4 ± 13.8 years, 60.7% woman) with FPCD were included. Disease location (Montreal Classification) was L1 in 9/23 patients, L2 in 5/23 patients and L3 in 9/23 patients. Two patients had also upper gastrointestinal tract involvement (L4). Crohn’s disease duration was 8.87 ± 8.176 years and fistula duration 4.26 ± 3.063 years (table 1). Therapy data including surgery is shown in Table 2. Most patients had a transphincteric (13/23) and complex fistula (20/23). Mean PDAI was 6±2.6 and HBI 2.2±1.65. Class 2a (repair) was the most frequently chosen by patients and clinician (62.5% and 58.3% respectively) (table 3). Mean IBDQ32 score was 97.6 ± 16.9 (table 4). A slight agreement between patient and clinician regarding the new classification system was found (Cohen’s Kappa of 0.176), and a negative correlation between the class chosen by the patient and the respective IBDQ-32 score (Kendalls’ Tau correlation coefficient -0.359, p = 0.033 (p&lt;0,05)).

Conclusion
The low level of concordance between patient and clinician (with the limitation of a small sample size) draws attention to a gap in the treatment decision-making process of FPCD patients. A turning point in the management of these patients may occur with a progressive implementation of this classification into clinical practice after its validation, as it may allow for a shared discussion and greater patient responsibility in therapeutic decisions. The significant disease burden carried by these patients is underscored by the progressive lower IBDQ32 scores associated with higher class in this new system classification.