bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0657 Quality of ileocolic resection in Crohn’s disease- A systemic review and meta-analysis
Authors: Lingam G , De Burlet K , Shakir T , Khattab M , Yiu A , Giannarou S , Francis N , Sahnan K 
Published: January 2025

Abstract

Background
The terminal ileum is the most common site affected by Crohn’s disease and the area most commonly requiring surgical management. Post operatively, there is large heterogeneity between patient outcomes; with a proportion requiring no further medical or surgical management, whilst others will require life-long management with repeated operations. The reason for this remains unclear.
Surgical key performance indicators for an ileocolic resection can include: recurrence, rate of anastomotic leak, post-operative complications (Clavien Dindo (CD) &gt;3), length of stay, re-admission rate and mortality.
The aim of this study was to evaluate the effects of mode of surgery, the extent of mesenteric excision and the type of anastomosis on the rate of recurrence.

Methods
A systematic review was conducted following a priori protocol. Covidence software was used to exclude duplicates, screen studies and extract data. Extracted data was analysed. The primary outcome was recurrence rate and the mode of detection. Secondary outcomes were; anastomotic leak, post-operative complications (CD &gt;3), length of stay, readmission rate, mortality and duration of follow up. Combined overall effect size was calculated using SPSS software. The revised Cochrane risk of bias tool and the Newcastle-Ottawa scale were used to assess risk of bias.

Results
A total of 24 studies were included. Four (three randomised controlled trials (RCTs)) in the mode of surgery group, four in the extent of mesenteric resection group and sixteen (two RCTs) in the type of anastomosis group. In all four studies included in the mode of surgery group, laparoscopic surgery was associated with a shorter length of stay. No difference was observed in the other outcomes, including rate of recurrence. There was no significant correlation between extended versus limited mesenteric excision and the rate of recurrence (p0.307, OR 0.61 (CI95% -.056, 1.77)). Four studies compared Kono-S anastomosis versus non-Kono-S anastomosis. Kono-S anastomosis was associated with a significantly lower recurrence rate (p=0.002, OR 0.62 (CI95% 0.24, 1.01)). There was significant heterogeneity between these studies (p&lt;0.001).

Conclusion
To date there is no convincing evidence that the mode of surgery, the extent of the mesenteric excision or the type of anastomosis have any significant effect on reducing the occurrence of Crohn’s recurrence at the anastomosis.

References
N/A
P0660 Comparative Accuracy and Reliability of Handheld versus Cart-Based Ultrasound in assessing Inflammatory Bowel Disease Activity
Authors: Khaing M M , Fernandes R G , An Y K , Baraty B , Bryant R V , Ghaly S , Smith R L , Srinivasan A , Hay K , Begun J 
Published: January 2025

Abstract

Background
Bowel wall thickness (BWT) and vascularity are key parameters for assessing inflammatory bowel disease (IBD) activity. Handheld ultrasound devices (HHUS) provide a portable and affordable alternative for incorporating intestinal ultrasound (IUS) into IBD management. However, their diagnostic accuracy and reliability compared to cart-based ultrasound (CBUS) remain uncertain. This study assesses the diagnostic accuracy, reproducibility, and practitioner confidence with HHUS in comparison to CBUS for assessing BWT and vascularity.

Methods
In this prospective, comparative study, 12 patients with IBD, with body mass index (BMI) &lt;23 kg/m², were assessed. Each patient underwent ultrasound scanning of 2–3 pre-specified bowel segments using five devices: one CBUS device (Samsung™) and four HHUS devices (Clarius™ L15 HD3, GE™ Vscan Air CL, Mindray™ TE Air, and Philips™ Lumify L12-4). Linear probes were used for all devices except Mindray™, which employs a phased array probe optimised for cardiac imaging. Scans were conducted by two to three gastroenterologists accredited by the Gastroenterology Network of Intestinal Ultrasound (GENIUS), who were blinded to each other’s findings to reduce bias. BWT and Doppler vascularity, as well as other standard IUS parameters, were assessed for each segment. Diagnostic accuracy and inter-/intra-expert agreement were analysed using statistical models.

Results
Among the 12 patients (42% male; median age: 26 years, IQR: 23–36) with CD (n=6) and UC (n=6), a total of 29 bowel segments were assessed with all devices (Table 1). BWT measurements showed high concordance across devices for active segments (mean BWT: 4.3–4.6 mm, p=0.73). However, significant discrepancies were noted in inactive segments (p&lt;0.001), particularly with the Mindray™ device showing larger deviations from the CBUS measurements. Intraclass Correlation Coefficients (ICC) for intra-expert BWT measurements were good to excellent across devices (ICC 0.79–0.97), while inter-expert agreement was good for all devices (ICC 0.70–0.77) except for Mindray™ (ICC 0.36) (Figure 1B). Significant confidence was noted for BWT, vascularity, stratification, mesenteric fat, and inflamed bowel length across devices, highlighting consistent measurement reliability for these parameters (Table 1).

Conclusion
The majority of HHUS devices used in this study demonstrate high diagnostic accuracy and reproducibility in assessing IBD activity and are comparable to CBUS for identifying and assessing active disease. This study supports the integration of HHUS into IBD management as a portable and accessible tool while highlighting the importance of recognising device-specific limitations when selecting devices for clinical practice.
P0661 Effectiveness of upadacitinib for induction of remission in moderate-to-severe ulcerative colitis: real-world clinical outcomes appear independent of prior tofacitinib exposure
Authors: Elosua Gonzalez A , Zabalza L , Vicuña M , Rubio S , Nantes Ó , Rodriguez C 
Published: January 2025

Abstract

Background
Upadacitinib (UPA), a selective JAK1 inhibitor, has shown efficacy in clinical trials for moderate-to-severe ulcerative colitis (UC), but real-world data remain limited, particularly on outcomes related to prior exposure to other JAK inhibitors, such as tofacitinib (TOFA). This study evaluates real-world outcomes of UPA induction therapy in UC, focusing on clinical remission and differences by prior TOFA exposure.

Methods
This retrospective, observational study was conducted at a tertiary care centre in Spain, including adult patients with moderate-to-severe UC who initiated UPA in routine clinical practice. Data were retrospectively collected from electronic records, capturing baseline characteristics, TOFA exposure, disease duration, and concomitant treatments. The primary outcome was clinical remission at end of induction, assessed via the Physician Global Assessment (PGA) based on symptoms and laboratory data. Secondary outcomes included changes in faecal biomarkers, adverse events, treatment discontinuation, and maintenance dosing.

Results
Twenty-six patients were included, with a mean age of 50.5 years, 61.5% female, and a median disease duration of 10 years. All patients had prior exposure to advanced therapies, with 53.8% treated with at least three different lines of therapy. TOFA-exposed patients had a higher rate of pancolitis (84.6% vs. 30.8%; p=0.013), though endoscopic severity was similar between groups. All patients began with 45 mg UPA once daily; 23% had concomitant treatments, including vedolizumab (n=1), apheresis (n=3), and prednisone tapering (n=2).
Following induction, 65.4% achieved clinical remission and 88.5% at least a partial response based on PGA. Among TOFA-naïve patients, 76.9% achieved remission and 100% partial response, compared to 53.8% and 76.9%, respectively, in TOFA-exposed patients (p=0.9). Faecal calprotectin levels decreased, with reductions of 96.7% in TOFA-naïve patients (from median 4002 µg/g to 132 µg/g) and 97.9% in TOFA-exposed patients (from 3556 µg/g to 76 µg/g).
Extended induction was needed in 38.4% of patients, with no difference based on prior TOFA exposure (46.2% vs. 30.8%, p=0.6). Discontinuation during induction occurred in 23%, due to lack of effectiveness in 50%, adverse events in 33%, and transition to vedolizumab monotherapy in 17%. Post-induction, 88.4% continued on 30 mg as maintenance, consistent across both groups.

Conclusion
UPA induction therapy shows promise in achieving clinical remission in moderate-to-severe UC, with comparable outcomes independent of prior TOFA exposure. Our data suggests UPA may be a valuable option in real-world, treatment-experienced UC populations. Further studies could help clarify its role in complex cases and refine treatment strategies
P0663 Efficacy and safety of risankizumab therapy in Chinese patients with moderately to severely active crohn’s disease
Authors: Gao X , Cao Q , Ran Z H , Chen Y X , Chen Y , Wen Z H , Liu D L , Ding J , Zhong J , Liu F , Sha W H , An P , Wang B M , Hu L X 
Published: January 2025

Abstract

Background
Risankizumab (RZB) is an interleukin 23p19 inhibitor approved for adults with moderately to severely active CD. In phase 3 trials, greater proportions of patients with CD achieved clinical remission and endoscopic response with RZB therapy vs placebo (PBO). This post hoc subanalysis evaluates the efficacy and safety of RZB therapy in Chinese patients from the induction and maintenance studies.

Methods
ADVANCE and MOTIVATE were randomized, double-blind, PBO-controlled, phase 3 induction studies. Patients with intolerance/inadequate response to biologic and/or conventional therapy were randomized to receive intravenous (IV) RZB (600 or 1200 mg) or PBO at weeks 0, 4, and 8. Clinical responders to IV RZB could enter the phase 3, randomized, double-blind, PBO-controlled maintenance withdrawal study (FORTIFY). Patients were rerandomized to receive subcutaneous (SC) RZB (180 or 360 mg) or PBO (withdrawal) every 8 weeks for 52 weeks. Stool frequency (SF)/abdominal pain score (APS) clinical remission (average daily SF ≤2.8 plus average daily APS ≤1, and both not worse than induction baseline) and endoscopic response (&gt;50% decrease in Simple Endoscopic Score for Crohn’s Disease [SES-CD] from baseline [or ≥2-point reduction from baseline for patients with isolated ileal disease and a baseline SES-CD of 4]) were evaluated.

Results
This analysis evaluated 75 Chinese patients in the induction studies. Demographic and baseline disease characteristics were generally similar across treatment groups (Table 1).At week 12 of induction, a numerically greater proportion of patients treated with RZB compared with PBO achieved, with percentages of 56.7% and 53.3% for the RZB 600 mg group, 64.7% and 44.1% for the RZB 1200 mg group, and 27.3% and 18.2% for the PBO group, respectively (Figure 1).
Among the 50 patients who entered the maintenance study, a numerically greater proportion of patients treated with RZB compared with PBO achieved SF/APS clinical remission and endoscopic response at week 52. with percentages of 73.3% and 66.7% for the RZB 180 mg group, 83.3% and 72.2% for the RZB 360 mg group, and 64.7% and 41.2% for the PBO group, respectively.
Similarly, at both week 12 and week 52, patients in the RZB groups achieved numerically greater proportions of Crohn’s Disease Activity Index (CDAI )clinical remission, CDAI clinical response, and endoscopic remission compared to the PBO group.RZB IV and SC doses were well-tolerated in the Chinese patients.

Conclusion
Consistent with global population results, Chinese patients with moderately to severely active CD treated with RZB achieved clinical and endoscopic outcomes at higher rates than did patients receiving PBO, with a tolerable safety profile.

References
1. D’Haens G, et al. Lancet. 2022;399:2015–30. 2.Ferrante M, et al. Lancet. 2022;399:2031–46.
P0668 Is there a “Weekend Effect” on clinical outcomes in acute severe ulcerative colitis? A single centre retrospective analysis
Authors: Mohamedrashed M , Yogakanthi S , xu C , Bartlett R , Chew M , Nedumannil L , Lucas S , Chauhan A , Lewis D , Kashkooli S , Garg M 
Published: January 2025

Abstract

Background
Acute severe ulcerative colitis (ASUC) represents a medical emergency that requires hospitalisation, close monitoring and intensive medical therapy. The “weekend effect” refers to the observed phenomenon of poorer patient outcomes when admitted over the weekend compared to weekdays. This study aimed to examine this phenomenon in patients admitted with ASUC.

Methods
Patients admitted with ASUC between January 2016 to October 2024 were identified retrospectively. Patient characteristics and clinical outcomes were accessed from the electronic medical records (EMR). Outcomes analysed included length of hospitalisation, time to first endoscopic assessment, requirement for rescue therapy, time to rescue therapy, rate of colectomy, and 12-month readmission rate. Weekday admissions were defined as Monday-Thursday, with weekend admissions Friday-Sunday.

Results
141 patients (56% male; median age 34 [IQR 25-49] y) fulfilling Truelove and Witts’ criteria were included in this study. 105 (74.5%) were admitted on weekdays, and 36 (25.5%) on weekends. Baseline characteristics of both groups are outlined in Table 1.
The median length of initial hospitalisation was 138 (IQR 95-174) hours in patients admitted on weekdays compared with 167 (IQR 129-263) hours in those admitted on weekends (p = 0.02). The time to first endoscopic assessment was 30 vs 62 (p = 0.05) hours in those admitted on weekdays vs weekends, respectively. Rescue therapy with infliximab was required in 60 (57.1%) vs 24 (66.6%) patients (p = 1.0), respectively. The median time for infliximab therapy was 82 (IQR: 52.5-116) hours in the weekday vs 99 (IQR: 75-149) hours in the weekend group (p = 0.02). On multivariate analysis, weekend admission, as well as baseline characteristics and intervention timings, did not significantly predict length of stay. There was no statistically significant difference in the requirement for colectomy (6 vs 1 patients, p = 0.68).
Twelve-month all-cause readmission rates were similar for both weekday and weekend admission groups (33/105 [31.4%] vs 12/36 [33.3%], p = 0.83), including both UC-related (weekday 17/105 [16.1%] vs. weekend 8/36 [22.2%], p = 0.66), and non-UC-related (weekday 16/105 [15.2%] vs. weekend 4/36 [11.1%], p = 0.18).

Conclusion
Patients admitted to hospital with ASUC on weekdays had a significantly shorter length of stay, time to endoscopy assessment, and time to rescue infliximab therapy. No significant differences in other outcomes were noted. Improved access to endoscopic assessment and infliximab rescue therapy may reduce length of stay, improving resource utilisation.
P0669 Safety of intravenous and subcutaneous guselkumab induction administration: Results from the GALAXI and GRAVITI studies in participants with Crohn’s Disease
Authors: Danese S , Sands B E , Afzali A , Hisamatsu T , Armuzzi A , Wolf D , Duvall G , Van Rampelbergh R , Olurinde M , Terry N A , Yee J , Li H , Rosas Ballina M , D’Haens G , Rubin D T , Panaccione R 
Published: January 2025

Abstract

Background
Guselkumab (GUS) is a dual-acting IL-23 inhibitor that potently neutralizes IL-23 and binds to CD64, a receptor on cells that produce IL-23. Induction with both intravenous (IV) and subcutaneous (SC) GUS was effective in phase 2/3 clinical trials of participants (pts) with moderately to severely active Crohn’s disease (CD). To characterize the safety of GUS IV and SC induction regimens, we evaluated safety data from clinical trials of GUS in CD.

Methods
We evaluated data from phase 2/3 CD studies with IV induction (GUS 200mg IV q4w in GALAXI 1, 2, and 3) and SC induction (GUS 400mg SCq4w in GRAVITI) to assess rates of safety events (proportions of pts with ≥1 event) during the induction period (Week 0-12).

Results
During the induction period, rates were not higher in either the IV or the SC groups than the respective placebo (PBO) groups for adverse events (AEs), serious AEs, or AEs leading to discontinuation (Table 1). Serious infections occurred in 1 pt in the GUS IV group and 1 pt in the GUS SC group; neither led to discontinuation of study treatment. No serious infections were reported in PBO-treated pts in either group.
Of the 1376 GUS SC injections during the induction period in GRAVITI, 6 (0.4%) were associated with injection site reactions, which included pruritus, erythema, and swelling. Injection site reactions beyond the induction period with GUS SC in GALAXI and GRAVITI remained low (≤1%) and were comparable regardless of induction administration route.
No cases of active tuberculosis, anaphylaxis, serum sickness reactions, major adverse cardiovascular events, or venous thromboembolism were reported during the induction period. In the IV induction group, 1 opportunistic infection (esophageal candidiasis) was reported in a PBO-treated pt and 2 were reported in GUS-treated pts (cytomegalovirus infection and esophageal candidiasis). In the SC induction group, 1 opportunistic infection of esophageal candidiasis was reported in a PBO-treated pt and 0 were reported in GUS-treated pts. One malignancy (basal cell carcinoma) not leading to discontinuation was reported in a pt in the GUS 400 mg SC group. One death was attributed to a non-suicidal (not self-inflicted) gunshot wound in a pt treated with GUS SC.
Clinically significant hepatic disorders were reported in 2 pts in the GUS 200mg IV group (1 SAE and 1 AE that led to discontinuation) and 1 pt in the GUS 400mg SC group (1 AE that led to discontinuation) during the induction period. All cases were confounded by additional diagnoses or concomitant medications.

Conclusion
Both IV and SC induction demonstrated comparable safety results consistent with the well-characterized GUS safety profile. No new safety concerns were identified.
P0675 Ultrasonographic assessment of response in hospitalized patients with acute severe ulcerative colitis
Authors: Arora U , Kandasamy D , Verma M , Madan D , Singh M , Narang H , Goyal M , Mubunnu M , Panwar R , Dash N R , Goyal A , Sharma R , Ahuja V , Kedia S 
Published: January 2025

Abstract

Background
Patients admitted with acute severe ulcerative colitis (ASUC) respond to medical therapy in upto two-third cases but monitoring and early detection of non-response is of prime importance to prevent colectomy or mortality, through use of rescue medical therapy. This study evaluates the utility of ultrasonography (USG) in prognostication and decision-making for ASUC patients undergoing standardized treatment protocols. USG offers a non-invasive approach to assess bowel wall thickening and vascularity, pivotal indicators of disease activity.

Methods
In this prospective study, 45 ASUC patients undergoing intravenous steroid therapy were enrolled, with additional randomization to receive tofacitinib or placebo. USG evaluations of bowel wall thickness (defined as ≥3 mm) and vascularity were conducted at baseline and on day 5, with data available for 41 patients. Clinical responses were assessed using the Lichtiger index. Correlations between USG findings, clinical outcomes, and biochemical markers such as CRP and albumin were analyzed.

Results
Baseline USG revealed bowel wall thickening in the sigmoid colon in 82.9% (34/41) of patients and in the descending colon in 70% (28/41). (Figure 1)
Responders showed a significant reduction in bowel wall thickness in the sigmoid and descending colon (p &lt; 0.05), whereas non-responders exhibited no changes. (Figure 2)
There was a moderate correlation between bowel wall thickening across different segments (Spearman’s rho = 0.3–0.5, p &lt; 0.05), but no significant correlation with CRP, albumin, or endoscopic severity. Doppler findings indicated similar rates of increased vascularity (Limberg grade ≥3) in both responders and non-responders at baseline and follow-up. Ancillary findings, such as pericolic fat thickening and free fluid, were associated with poor clinical outcomes, highlighting their prognostic value. Notably, baseline USG identified skip lesions in two patients, later confirmed to have Crohn’s colitis instead of ASUC. The sample size was limited as the trial is ongoing, and the treatment groups (tofacitinib vs. placebo) remain blinded.

Conclusion
Serial ultrasonography of the left colon provides valuable, non-invasive insights into treatment response in ASUC, correlating well with reductions in clinical activity and bowel wall thickness among responder. Presence of pericolic fat thickening and ascites correlates with poor outcomes, while doppler assessment does not contribute to the assessment. Importantly, baseline USG may aid in differentiating ASUC from Crohn’s colitis in patients with index presentation as acute severe colitis.
P0679 Therapeutic Drug Monitoring of the Infliximab (anti-TNF) Level with Bedside Kit in Inflammatory Bowel Disease
Authors: Gur M B , Bakkaloglu O K , Eskazan T , Akpinar A , Hatemi A İ , Erzin Y Z , Celik A F 
Published: January 2025

Abstract

Background
Approximately half (10-40%) of the Inflammatory Bowel Disease (IBD) patients using Infliximab (IFX) develop secondary loss of response due to drug levels falling below the therapeutic range. This study aims to identify drug levels, influencing factors and parameters that may be useful in predicting target drug levels.

Methods
The pre-infusion drug levels and associated laboratory parameters were evaluated in IBD patients on maintenance dose of IFX (5-15 mg/kg every 4-8 weeks) between Nov2021 - Oct2024. Drug levels were measured using a bedside kit capable of quantitatively detecting values between 0.4-20 µg/ml.

Results
In total, 931 single pre-infusion measurements from 415 different patients, and dual measurements at weeks 4 and 8 from 116 patients were separately evaluated. 82% of the patients in the single measurement group, and 84% in the double measurement group had Crohn’s disease(CD), rest having Ulcerative Colitis. The most used doses in the single measurement group were 5 mg/8 weeks and 10 mg/4 weeks (Table 1). In the single measurement group, median albumin was 4.4 (IQR: 0.5), and median CRP was 3.1 (IQR: 6.4). Drug levels were below 5 µg/ml in 33% of measurements. CRP showed a significant difference according to drug level groups (Table 2), while no such difference was observed for albumin. In the measurable IFX range (0.4-20 µg/ml), correlation analysis revealed a weak negative correlation between CRP and drug levels (r: -0.09, p: 0.03). Regression analysis showed that lower CRP, higher drug dose, and CD diagnosis were independently associated with achieving &gt;5 µg/ml drug levels. In the dual measurement group: The median CRP levels of patients at weeks 4 and 8 were 2.1 (5.1) and 2.6 (6.2), respectively (p&gt;0.05). Among patients with IFX levels &gt;20 µg/ml at week 4, 79% maintained levels &gt;5 µg/ml at week 8, while this rate dropped to 71% for those with levels &gt;10 µg/ml. Only 67% of patients with levels &gt;5 µg/ml at week 4 maintained a level of &gt;5 µg/ml at week 8 (all p-values &lt;0.001).

Conclusion
As drug levels increase, significant reductions in CRP levels are observed. Therefore, low CRP levels may predict the likelihood of achieving the therapeutic range. Dose adjustment should be considered in cases with high CRP levels. Achieving a high drug level (&gt;20 µg/ml) at 4th week is an important indicator of achieving at least an acceptable drug level (&gt;5 µg/ml) at the end of treatment. (8th week).