bluuebunny/crossref_metadata_2025_split huggingface dataset:
P277 Predicting disease relevant features in Crohn’s Disease and Ulcerative Colitis from Haematoxylin & Eosin stained whole slide images using self-supervised deep learning
Authors: Mokhtari R , Hamidinekoo A , Lewis A , Sutton D , Angermann B , Gehrmann U , Lundin P , Khachapuridze N , Adissu H , Marks D , Cairns J , Burlutskiy N 
Published: January 2023

Abstract

Background
Histopathological endpoints are evolving as a treatment target in Inflammatory Bowel Disease (IBD). Use of histology to screen entrants could add value in IBD clinical trials; for example, by refining eligibility criteria to ensure studies recruit patients with definitive active inflammation at the microscopic level. Several histopathological indices have been developed, but the relative complexity of available scores hinders the development of an AI algorithm without large-scale labour-intensive annotation by a pathologist. We aimed to develop computer vision tools to assist decoding the complex clinical disease features at the histological level for both Crohn’s Disease (CD) and Ulcerative Colitis (UC). This will inform understanding of disease pathology and patient stratification to support clinical trial development strategies.

Methods
A total of 1397 clinically annotated Haematoxylin & Eosin (H&E) images were included from 418 CD and 218 UC patients enrolled in a multicentred longitudinal Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. We developed an image quality control (QC) algorithm to automatically identify image and tissue processing/staining artefacts negatively impacting analysis (e.g., out-of-focus, tissue folds, overstained regions) and excluded these regions (Fig. 1). Next, a self-supervised learning (SSL) deep learning computer vison model was developed and trained to predict disease relevant features including disease diagnosis and lesional macroscopic appearance (inflammation, erosions and ulcers). Finally, to better understand the model’s predictions, we generated heatmap overlays on the tissue that show regions which the model considers to be most predictive (Fig. 2) and shared these with pathologists for qualitative evaluation.

Results
We find that the SSL model performs well on different downstream classification tasks such as UC vs CD (area under curve (AUC) = 0.79) and normal vs lesional tissue (AUC = 0.76). Specialist pathologist collaboration further confirmed that the heatmap overlays identified clinically relevant tissue features, including inflammatory cell infiltrates (Fig. 2).

Conclusion
These encouraging results support further exploration of this deep-learning algorithm to distinguish disease specific characteristics in this set of images from CD and UC patients. Further work is ongoing to validate the heatmap approach on endoscopic scores, we also plan to validate our model on IBD clinical trial datasets.
P295 Hocus Pocus: The Role Of Hand-Held Ultrasonography In Predicting Disease Extension And Endoscopic Activity In Ulcerative Colitis
Authors: Rispo A , Calabrese G , Testa A , Patturelli M , Imperatore N , Nardone O M , Guarino A D , Cantisani N M , Toro B , Castiglione F 
Published: January 2023

Abstract

Background
Ulcerative colitis (UC) diagnosis and monitoring still require ileo-colonoscopy (IC) as the reference standard. Bowel sonography (BS) has recently emerged as a non-invasive assessment tool, and Milan Ultrasound Criteria (MUC) score has been validated to estimate and predict UC disease activity. Recently, hand-held BS (HHBS) has been used effectively in several clinical settings (e.g. cardiology, orthopedy, gynaecology), while data about its use in UC are still limited. We aimed to evaluate the diagnostic accuracy of HHBS compared to conventional bowel sonography (BS) in predicting UC extension and activity compared to endoscopy.

Methods
From November 2021 to September 2022, we prospectively enrolled consecutive UC patients afferent to our third-level IBD Unit for IC evaluation. Patients underwent IC, HHBS, and BS, and the operators were blinded by the other procedure results. Endoscopy was considered the reference standard for UC extension. Cohen’s k test was applied after MUC dichotomization to test the concordance between BS-MUC and HHBS-MUC following Allocca et al. (MUC &gt;6.2: yes/no).

Results
At the end of the study, 86 patients with UC were examined. No significant difference was recorded between BS and HHBS in terms of UC at the per-segment extension (p: N.S.) (table 1), and both procedures were comparable regarding colonic wall thickness (CWT) and colonic wall pattern (CWP) assessment (figure 1 and 2). Regarding the prediction of endoscopic activity, BS and HHBS displayed excellent agreement when applying the MUC score system (k = 0.86, p&lt;0.01) (figure 3).

Conclusion
Hand-held bowel sonography and BS are comparable in defining UC extension and MUC evaluation in the UC setting. HHBS could be reliable for detecting disease activity and estimating its extension, providing close monitoring of the treat-to-target paradigm. It also represents a non-invasive, easily practicable investigation during a physical examination, allowing immediate medical decisions with significant time and cost advantages.
P297 The Toronto IBD Global Endoscopic Reporting (TIGER) Score and its Ability to Predict Outcomes Regarding Steroid and Biologic Use in Ulcerative Colitis and Crohn’s Disease Patients – A Construct Validation Study
Authors: Zittan E , Levy M , Saban L , Vered S , Steinhart A H , Milgrom R , Gralnek I M , Silverberg M S , Zelber-Sagi S 
Published: January 2023

Abstract

Background
The recently developed TIGER endoscopy score was established to reliably describe disease severity as it can be utilized for both Ulcerative Colitis (UC) and Crohn’s disease (CD) patients.1The aim of this prospective study was to assess the TIGER score’s ability to predict UC and CD patient outcomes including biologic and steroid use.

Methods
A cohort of 78 patients with UC (n=40) and CD (n=38) were included in a 52-week multiple visit prospective study. Each visit included patient interviews using the IBD disk questionnaire, blood draws for C-reactive protein (CRP), and fecal calprotectin (FC). Endoscopy assessment was performed at baseline. Administration of steroids, immunomodulators (IMN), biologics, and dose escalations were recorded. Baseline total TIGER scores were dichotomized as &lt;100 points (remission-mild endoscopic activity) or ≥100 points (moderate-severe endoscopic activity) as a predictor of therapeutic outcomes.

Results
At baseline, compared to patients with TIGER scores &lt;100, UC patients with TIGER scores ≥100 had significantly higher CRP (p&lt;0.0005), FC (p&lt;0.0001), and IBD disk (p&lt;0.0001). In CD patients, at baseline, compared to patients with TIGER scores &lt;100, patients with TIGER scores ≥100 had significantly higher CRP (p&lt;0.0006), FC ( p&lt;0.006), and IBD disk ( p&lt;0.0001). At 52-weeks, compared to patients with baseline TIGER scores &lt;100, UC and CD patients with baseline TIGER scores ≥100 had a significantly increased likelihood of requiring steroids as therapy (p&lt;0.0001). Specifically, 7.1% and 0% of UC and CD patients with baseline TIGER scores &lt;100 required steroids compared to 73.1% and 48.3% of UC and CD patients with baseline TIGER scores ≥100, respectively. Moreover, at 52-weeks, compared to patients with baseline TIGER scores &lt;100, UC and CD patients with baseline TIGER scores &gt;100 both had a significantly increased likelihood of being prescribed or having to subsequently escalate biologic therapy (p&lt;0.0001). More specifically, 7.1% and 11.1% of UC and CD patients with baseline TIGER scores &lt;100 required biologic therapy compared to 92.3% and 100% of UC and CD patients with baseline TIGER scores ≥100, respectively.

Conclusion
The TIGER endoscopy score demonstrates significant association with CRP, FC and IBD disk in UC and CD patients. Moreover, the TIGER endoscopy score can be utilized as a measure to predict the likelihood of UC and CD patients with moderate-to-severe disease burden requiring certain therapeutic interventions. These data suggest that the TIGER score reflects disease burden and the subsequent need for pharmacologic intervention in both UC and CD patients.
1. Zittan E, et al. J Crohns Colitis 2022;16:544-553.
P299 Disability in newly diagnosed patients with Crohn′s Disease: initial results from the prospective CROCO (Crohn′s Disease Cohort) Study
Authors: Tinoco da Silva Torres J , Ellul P , Vieujean S , Ordas I , Burisch J , Mocanu I , Duricova D , Rodríguez-Lago I , Buisson A , Goldis A , Hernandez V , Arebi N , Kaimakliotis I , Nachury M , Fumery M , Allocca M , Pedersen N , Barberio B , Shaji S , Guedes A , Ribeiro R , Ungaro R , Lambert J , Colombel J F 
Published: January 2023

Abstract

Background
CD is classically seen as a progressive disease leading to bowel damage and disability. Disability has been proposed by the Spirit-IOIBD consensus1 as an endpoint in disease modification trials. However, there is a paucity of data regarding disability in CD patients at diagnosis.

Methods
The “Crohn′s Disease Cohort Study” (CROCO) is an ongoing prospective cohort aiming to study the longitudinal evolution of bowel damage and disability following diagnosis of CD. All patients are included within 12 months following CD diagnosis and will be followed over 5 years with serial assessments of bowel damage and disability. At recruitment patients completed an IBD disability score questionnaire (DS),2 comprising several domains: mobility, self-care, major daily life activities, gastrointestinal-related problems, mental health and interaction with the environment. We here describe the baseline DS and its association with disease features, disease activity score (Harvey-Bradshaw Index), and biomarkers of disease activity, on the first patients recruited into CROCO.

Results
Ninety-four patients were recruited, of which 66 filled at least 80% of the questions in the DS questionnaire; of those 55% were male and median age at diagnosis was 30.6 [IQR 24.2;38.8]. The baseline visit occurred at a median time of 6 months [IQR 2.6;9.2] after CD diagnosis. Ileal involvement (L1/L3) was reported in 82% of patients; 68% had B1 phenotype, and 26% presented extra-intestinal manifestations. Overall, 32% of patients had been hospitalised, and 6% had a history of CD-related surgery. Regarding medication [from diagnosis to baseline], 55% received steroids, 56% immunosuppressants, and 65% Anti-TNF therapy. The median DS was 79 [IQR 67;108.2] (range: 49;198); only 2 patients (3%) patients presented DS&gt;162 (the central value of the DS), indicating no or mild disability. No correlations were found between clinical or analytical biomarkers of disease activity at the time of recruitment (Table 1). Associations between disease features and DS are displayed in Table 2. A history of CD-related hospitalisation was associated with a significantly higher DS (103 [IQR 79;157] versus 76.5 [65.5;97], p=0.013). No other associations were observed.

Conclusion
In a cohort of newly diagnosed CD patients, disability was mostly mild and independent of disease activity, disease location or behaviour; around 1/3 required hospitalisation within the first year of diagnosis, which was associated with increased disability. These data add to the growing concept that newly diagnosed disease represents a window of opportunity for intervention.
P315 The characteristics and severity of pediatric ulcerative proctitis
Authors: Müller K , Dohos D , Imrei M , Gombos E , Szentannay J , Szabó A , Oberfrank M , Karoliny A 
Published: January 2023

Abstract

Background
The diagnosis of ulcerative proctitis is rarer in childhood than in adulthood (4-29% vs. 44-60%). According to the literature, the prognosis of ulcerative colitis is favourable, however one third of the patients require biological therapy during follow-up, and the localization may extend in 20-25% in 5 years. Our aim was to compare the disease characteristics at diagnosis in children with ulcerative proctitis and with more extensive ulcerative colitis.

Methods
Retrospective, single centre analyses of patients with ulcerative colitis, diagnosed between 2010-2022 at the Heim Pál National Paediatric Institute, Budapest, Hungary. We compared the initial demographic, anthropometric data, and laboratory parameters of children with ulcerative proctitis (E1) and more extensive ulcerative colitis (E2-E4) according to the Paris classification. The analyses were performed with descriptive statistics and 2 samples t-tests.

Results
Between 2010-2022, of the 127 children were diagnosed with ulcerative colitis, 22 had proctitis (17.3%; 10 male; mean age: 15.0±1.9 year) and 105 had more extensive disease (82.7%; 53 boy; mean age: 12.2±3.8 year). The mean age was significantly higher in the proctitis group. The initial CRP, platelet count and faecal calprotectin (FCP) level was significantly lower (CRP [mg/l]: 1.2±1.4 vs. 12.0±21.5, p&lt;0.001; thrombocyte [G/l]: 264.9±611.9 vs. 420.6±183.7, p&lt;0.001; FCP [μg/mg]: 416.5±411.4 vs. 1054.5±316.6, p=0.001); while the haematocrit and albumin level was significantly higher (haematocrit [%]: 38.6±3.1 vs. 33.6±5.2, p&lt;0.001; albumin [g/l]: 46.6±2.9 vs. 42.7±4.4, p&lt;0.001) in the proctitis group compared to the other group. BMI z-score value at diagnosis was significantly higher in the proctitis group (0.45±1.4 vs. -0.12±1.2, p=0.02). The initial activity index (PUCAI) was significantly higher in the more extensive group (at diagnosis: 25.0±11.0 vs. 45.1±18.9, p&lt;0.01).

Conclusion
Our results are in line with the literature, that the proportion of ulcerative proctitis is low in children. Based on our results, the manifestation of ulcerative proctitis presents in a milder form than more extensive colitis. Though it is important, that physicians should always consider the extension of the disease and need for treatment escalation to reach mucosal healing.
P319 Characteristics of filgotinib-treated patients with Ulcerative Colitis who achieve sustained corticosteroid-free remission: Post hoc analysis of the phase 2b/3 SELECTION study
Authors: Kobayashi T , Dignass A , Roblin X , Fujitani Y , Oortwijn A , Jamoul C , Hibi T 
Published: January 2023

Abstract

Background
Filgotinib (FIL) is a once-daily, oral, Janus kinase 1 preferential inhibitor approved for the treatment of ulcerative colitis (UC) in Europe and Japan. The efficacy and safety of FIL in patients with moderately to severely active UC was evaluated in the phase 2b/3 randomized, double-blind, placebo (PBO)-controlled SELECTION study (NCT02914522).1 This post hoc analysis aimed to identify characteristics of FIL-treated patients that were associated with achieving corticosteroid (CS)-free remission.

Methods
Adults aged 18–75 years were randomized 2:2:1 to induction FIL 100 mg, FIL 200 mg or PBO once daily for 11 weeks in induction study A (biologic-naive) and B (biologic-experienced). At week 10, patients in clinical remission or with a Mayo Clinic Score (MCS) response were re-randomized 2:1 to continue their FIL regimen or PBO for 47 weeks in the maintenance study. This analysis included only data from patients receiving CSs at baseline. Using univariate logistic regression, we analysed characteristics associated with achieving clinical remission at week 58 without using CSs for UC over a continuous period of ≥6 months (CS-free remission). P values &lt;0.05 were considered statistically significant.

Results
At baseline, 81, 37, 92 and 47 patients were receiving CSs in the maintenance FIL 100 mg (n=172), PBO-to-match (PTM) FIL 100 mg (n=89), FIL 200 mg (n=199) and PTM FIL 200 mg (n=98) groups, respectively. The rates of CS-free remission in the FIL 100 mg, PTM FIL 100 mg, FIL 200 mg and PTM FIL 200 mg groups were 13.6%, 5.4%, 27.2% and 6.4%, respectively. Age, body mass index, history of pancolitis, duration of UC, faecal calprotectin and C-reactive protein levels, MCS and concomitant use of systemic CSs, immunomodulators and aminosalicylates had no significant effect on CS-free remission in the FIL 200 mg group. Mean baseline Robarts Histopathology Index (RHI) (odds ratio [OR]=0.949, p=0.023) was significantly associated with 6-month CS-free remission in the FIL 200 mg group. A baseline Mayo endoscopic subscore (MES) of 2 (vs 3) was associated with significantly increased odds of 6-month CS-free remission in the FIL 200 mg and FIL 100 mg groups (Table). Being male, a former (vs current) smoker or biologic-experienced was associated with significantly reduced odds of 6-month CS-free remission in the FIL 200 mg group.

Conclusion
Most baseline characteristics analysed had no statistically significant effect on 6-month CS-free remission under FIL 200 mg treatment. Low baseline MES and RHI, female sex, being a current (vs former) smoker and biologic-naive may predict higher likelihood of sustained CS-free remission in patients receiving FIL 200 mg.
P326 PREFAB-study: PRediction tool for Early identification of patients at risk of Crohn's disease in perianal Fistulas and ABscesses: interim analysis of a prospective pilot study at a non-academic, IBD-expert centre in the Netherlands
Authors: Munster L , de Groof E J , van Dieren S , Mundt M W , D’Haens G R A M , Bemelman W A , Buskens C J , van der Bilt J D W 
Published: January 2023

Abstract

Background
Perianal abscesses (PAA) and perianal fistulas (PAF) are life impairing conditions associated with Crohn’s disease (CD). A retrospective study at Flevohospital showed a reduced median delay in diagnosis of CD from 33 months (IQR 23-64) in the period 2007-2016 to 3 months (IQR 0-5) in the period 2017-2021, with &lt;20% of patients diagnosed &lt;1 year after the first perianal surgical procedure in 2007-2016 versus 79% in 2017-2021. This study also showed CD in up to 10% of patients with PAA/PAF, which was reason to continue data collection in a larger prospective pilot study to identify risk factors for CD in patients presenting with PAA/PAF.

Methods
All consecutive patients ≥16 years presenting with PAA/PAF were included. Patients were prospectively screened for risk factors/red flags from a ‘perianal Red Flag Index Questionnaire’ (pRFI) (identified from previous literature searches/expert opinion) and fecal calprotectin (FC-)samples were taken in all patients. Colonoscopy was performed in case of ≥5 positive answers in the pRFI and/or FC-values ≥150mcg/g.

Results
Sixty-nine patients were included (72,5% male) with median age of 41 years (IQR 30,5-54,6). Thirty-five patients (50,7%) presented with PAA, whereas 34 patients presented with PAF (49,3%). Thirty-one patients (44,9%) had recurrent PAA/PAF. Additional colonoscopy was performed in 11 patients, in whom 5 patients (7,2%) eventually were diagnosed with CD with a median delay of 44 months (IQR 7,5-87,5, still 5 patients in diagnostic work-up). Median FC-values were 552mcg/g (IQR 198,5-4585) in patients with confirmed CD and 31,5mcg/g (IQR 10-102,75) in patients without CD (p=0,002). Risk factors associated with CD were a younger age, presence of PAF (compared to PAA only), higher number of previous perianal interventions, multiple internal fistula openings, fissures and proctitis (p&lt;0,05 in all).

Conclusion
This pilot study reveals several risk factors associated with CD in patients presenting with PAA/PAF and forms the basis for development of a clinical decision tool that incorporates both the pRFI questionnaire and selected FC-measurement to early identify patients at risk of CD when presenting with perianal disease. This clinical decision tool will be subject of a larger prospective multicentre study to reduce diagnostic/treatment delay, thereby improving outcomes in patients with Crohn’s fistulas.
P331 Risk Factors and Prediction Model for Fecal Incontinence in Patients with Crohn’s Disease: A Multicenter Study
Authors: Wang C , Yang F , Qiao L , Chen Q , Chen H , Li Y , Zhang X , Liao X , Cao L , Xu H , Xiang Y , Wang X , Yang B ,   Department of Colorectal Surgery Affiliated Hospital of Nanjing University of Chinese Medicine Jiangsu Province Hospital of Chinese Medicine Nanjing China
Published: January 2023

Abstract

Background
Fecal incontinence (FI) is a common complaint that seriously affects the quality of life in patients with Crohn’s disease (CD). We aimed to identify risk factors related to FI and construct a risk prediction model for FI in patients with CD.

Methods
Four hundred and sixty-one patients diagnosed with CD between June 2016 and April 2021 in Jiangsu Province Hospital of Chinese Medicine were retrospectively enrolled in this study and randomly divided into the development (n=368) and internal validation cohort (n=93). FI-related risk factors were selected from the development cohort using the random forest procedure and included in a logistic regression model from which the prediction model was elaborated. The discrimination, calibration and clinical benefit of the model were evaluated by examining the area under the receiver operating characteristic curves, calibration curves and decision curve analysis in internal validation and external validation (using 225 patients from four tertiary hospitals), respectively.

Results
Four independent variables were selected and included in the logistic regression model: body mass index, history of non-fistulizing perianal lesions surgery, the number of loose stools in the last week and perianal disease activity index. A nomogram was developed to facilitate risk score calculation. The model showed good discrimination ability with AUC was 0.798 and 0.780 in the internal and external cohorts, respectively. The calibration curves demonstrated good agreement with the model using the Hosmer-Lemeshow test in both cohorts (internal validation, P = 0.562; external validation, P = 0.383). DCA confirmed the clinical validity of the predictive model.

Conclusion
This study recognized four risk factors related to the prevalence of FI and developed a new model to effectively predict risk scores of FI in CD patients, helping to provide early risk stratification and timely intervention.