bluuebunny/crossref_metadata_2025_split huggingface dataset:
P289 Hyperoxaluria in patients after ileocolic resection
Authors: Navrátil V , Pipek B , Krivinka J , Gregar J , Kunovsky L , Falt P 
Published: January 2023

Abstract

Background
Oxaluria is one of the risk factors for developing urolithiasis and oxalate nephropathy, which may lead to renal failure. Patients with Crohn's disease (CD) who underwent an ileocolic (IC) resection are at increased risk. The aim of the study is to determine the incidence of hyperoxaluria in these patients in comparison to CD patients with IC involvement without the resection.

Methods
Patients with CD of age over 18 years after IC resection were included into the study and patients with IC involvement without resection were included as a control group. Exclusion criteria were concomitant citrate treatment, severe chronic kidney disease (G4-5 KDIGO with GFR &lt;30ml/min/1,73 m2) and patients with more than two intestinal resections, with colectomy or with short bowel syndrome. Patients filled out a questionnaire form, a blood sample and fresh urine sample were taken, abdominal ultrasonography for assessment of kidneys and gallbladder was performed and finally, patients collected urine for 24 hours for examination of oxaluria and citraturia. Oxaluria over 0,6 mmol/24 hours and citraturia under 1,6 mmol/24 hours were considered significantly pathological.

Results
40 patients were included in the study until now. There were 45% after IC resection, 57.5% were female (77.8% in the resection group and 40.9% in the control group), mean age was 41,5 years +/-13,1. 7 patients were receiving corticosteroid treatment, 26 had immunosuppressants and 4 patients had biologics. Hyperoxaluria has been detected in 27.5% (of all patients), in 22% in the resection group and in 31.8% in the control group (p=0,34). Hypocitraturia has been found in 32.5%, in 38.9% in the resection group and 27.3% in the control group (p=0,41). No patient with urolithiasis and one with cholecystolithiasis was detected with ultrasonography and one patient had urolithiasis in medical history.

Conclusion
Hyperoxaluria was detected in 27.5% of patients and there was no significant difference between the groups with and without IC resection. Hypocitraturia was detected in 32.5% with nonsignificant predominance in the resection group. Recruitment of patients is still going on, as now we can't determine the role of routine testing for hyperoxaluria and hypocitraturia in daily practice.
P290 Development of an artificial intelligence model using stool pictures for predicting endoscopic mucosal inflammation in patients with Ulcerative Colitis; KASID multicenter study
Authors: Kim E S , Lee J W , Kim S K , Lee H S , Lee Y J , Kim J , Kim K O , Jang B I , Kim E Y , Jung Y J , Park S K , Park D I , Woo D , Jeong S ,   IBD Research Group of KASID
Published: January 2023

Abstract

Background
Disease monitoring through objective measures including fecal calprotectin and endoscopy is crucial for the management of ulcerative colitis (UC). The role of stool pictures taken by smart phones in the disease monitoring of UC is not known. We aimed to develop artificial intelligence (AI) model using stool pictures for predicting endoscopic mucosal inflammation in patients with UC.

Methods
This was a prospective multicenter study conducted in 6 tertiary referral hospitals. Patients scheduled to undergo endoscopy for monitoring of mucosal inflammation were included in the study. They were asked to send their stool photos taken at the toilet using smartphones within ± 5 days from the day of endoscopy. Endoscopic activity was assessed with Ulcerative Colitis Endoscopic Index of Severity (UCEIS). 80% and 20% of total data were randomly selected as training and validation set, respectively and this process repeated 4 times on different iterations for cross-validation. Accuracy of AI model for predicting endoscopic healing was compared with that of fecal calprotectin (Fcal).

Results
A total of 2463 stool pictures from 293 patients with UC were collected (mean age, year, 44±15.2; female, 108 (36.9%)). Endoscopic healing was found in 165 patients (56.3%). In validation set, the mean area under the receiver operating characteristic (AUROC) for predicting endoscopic activity using AI model was 0.78±0.02 (p=0.001) which was not statistically different from the AUROC of Fcal (0.81±0.08, p=0.01; AI model vs. Fcal p&gt;0.05). When we excluded rectal sparing cases (20, 6.8%), the mean AUROC of AI model increased to 0.85±0.05 (p=0.0007). Accuracy, sensitivity and specificity of AI model for predicting endoscopic activity in all patients and without rectal sparing cases were 0.739, 0.643, and 0.826, and 0.798, 0.711, and 0.872, respectively.

Conclusion
Stool photos of UC patients with deep learning technology demonstrated similar accuracy to Fcal in speculating endoscopic activity with better accuracy in patients without rectal sparing. The potential of simple stool pictures as a possible monitoring tool for UC activity is hopefully presented in this study.
P293 Correlation between clinical measures to capture disease burden and prediction of the initial course of Crohn’s disease - findings from a Copenhagen IBD Inception Cohort Study (IBD Prognosis Study)
Authors: Attauabi M , Madsen G R , Bendtsen F , Bjerrum J T , Wilkens R , Theede K , Ilvemark J F K F , Boysen T , Seidelin J B , Burisch J 
Published: January 2023

Abstract

Background
The initial disease burden of Crohn’s disease (CD) is dissimilar across patients; however, the ability to capture and predict the disease burden at diagnosis is scarcely investigated. The aim of the current study was to describe the initial disease burden of Crohn’s disease.

Methods
IBD Prognosis Study is an ongoing prospective population-based inception cohort of newly diagnosed patients with CD between May 1st, 2021, and November 1st, 2022, according to the Copenhagen IBD Criteria.1 We defined an indolent disease presentation as no need for CD-related surgery, hospitalization, nor initiation of steroid, immunomodulatory, or biologic therapies within the first 30 days after diagnosis, while a complicated course was defined as the opposite.

Results
The study included 134 patients with adult-onset CD, of whom approximately one-third (44/134, 33%) had an early indolent course, with 26 patients (19%) not requiring any medication (Tables 1-2). In demographic factor adjusted analyses, a colonic phenotype (adjusted odds ratio (aOR) =4.5 (95% confidence interval (CI) 1.6-15) and a low symptom load measured with Harvey-Bradshaw Index (HBI) &lt;5 (aOR = 3.1 (CI 1.0-10) were independently associated with an indolent course. In contrast, a C-reactive protein (CRP) level higher than 10 mg/L was the only parameter associated with a complicated onset of CD (aOR = 4.7 (CI 2.1-12)). Pearson’s correlation analyses demonstrated a significant, moderate correlation between fecal (F-) calprotectin, CRP, and endoscopic lesions, measured with Simple Endoscopic Score for CD (SES-CD) (Table 3). HBI and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) exhibited a significant but weak correlation with CRP. In a sensitivity analysis allowing exposure to anti-inflammatory therapy for only up to seven days, the platelet count, F-calprotectin, and bowel wall thickness measured in IBUS-SAS demonstrated a significant and moderate correlation with SES-CD. The total IBUS-SAS and CRP showed a significant but weak correlation, and other measures included in the IBUS-SAS did not yield significant correlations.

Conclusion
Preliminary data from the ongoing population-based cohort indicate that one-third of patients with newly diagnosed CD have an early indolent course. This study identified colonic disease location and CRP levels to be associated with the early course, while platelet count, bowel wall thickness, and CRP were correlated with endoscopic lesions at the onset of CD.
References:
1. Attauabi M et al. Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. doi:10.1136/bmjopen-2021-055779
P294 Assessment of Fatigue and Associated Factors in Patients with Inflammatory Bowel Disease: A Questionnaire-based Study
Authors: Kang S B , Jung S H , Kim T O 
Published: January 2023

Abstract

Background
Although fatigue is common in patients with inflammatory bowel disease (IBD), it often goes unrecognized and untreated. We investigated the degree of fatigue, and associated factors, in patients with IBD.

Methods
A multicenter study involving 147 IBD patients was conducted at five academic hospitals from August 2019 to December 2021. Demographic, clinical, and laboratory data were collected. Disease activity was assessed by the Mayo score or Crohn’s Disease Activity Index, as appropriate. Fatigue was evaluated using the validated Korean version of the Multidimensional Fatigue Inventory (MFI-K). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale.

Results
Among 97 ulcerative colitis and 50 Crohn’s disease patients, the mean total MFI-K score was 59.0 ± 5.5. Age, sex, body mass index, disease duration, anemia, hypoalbuminemia, and use of steroids did not affect the total MFI-K score. The anxiety and depression scores did not correlate with the fatigue score. Moderate and high disease activity significantly increased the MFI-K general and physical fatigue subscale scores compared to remission and mild disease activity (17.6 ± 1.7 vs. 16.7 ± 2.0, P = 0.009), while the use of biologics significantly decreased the total MFI-K score (57.3 ± 5.0 vs. 59.5 ± 5.5, P = 0.031). Multiple linear regression showed that fatigue was significantly increased by a history of surgery for IBD and decreased by the use of biologics.

Conclusion
The degree of fatigue in patients with IBD is high, and disease activity is the most important contributing factor.
P300 Overweight and obesity in Inflammatory Bowel disease: epidemiology, disease course and treatment outcomes
Authors: Khemiri W , Ben Mustapha N , Ben Safta N , Serghini M , Laabidi S , Fekih M , Labidi A , Boubaker J 
Published: January 2023

Abstract

Background
The incidence of Inflammatory Bowel Disease (IBD) is increasing in parallel with overweight and obesity. Contrary to conventional belief, a considerable number of IBD patients are at least overweighted. This may contribute to the development of IBD. The objectives of our study were to estimate the prevalence of overweight and obesity in IBD and to compare the epidemiological, evolutive and therapeutic profiles in these patients with those of a BMI (Body Mass index) of less than 25 kg/m².

Methods
We conducted a retrospective, descriptive and comparative study including patients hospitalized for IBD over a 9-year period [January 2011-January 2020]. Patients with less than 2 years of follow-up were excluded. Patients with a BMI of less than 25kg/m² represented group 1 and patients with a BMI ≥ 25kg/m² represented group 2.

Results
We included 225 men and 227 women. We enrolled 341 patients diagnosed with Crohn’s disease (CD) and 111 patients with ulcerative colitis (UC). BMI was less than 18.5kg/m², between 18.5 and 25kg/m², between 25 and 30kg/m² and ≥30kg/m² in 27.1%, 48.3%, 19.1% and 5.5% of the patients respectively, resulting in 340 patients in group 1 and 112 patients in group 2. The mean age at diagnosis was 36.15 ± 12.74 years. It was significantly lower in group 1 (32.24 years vs 40.06 years, p&lt;0.001). Smoking was noted in 34.1% of patients and 15.9% were alcohol users, the difference in these habits was not significant between the two groups. Diabetes and hypertension were significantly higher in group 2 (p&lt;0.001 and p=0.002 respectively). The percentage of patients followed up for UC was higher in group 2 (31.8% vs 20.54%, p=0.04). For CD, patients with upper GI tract involvement were more numerous in group 1, without a significant difference between the two groups (16.22% vs. 7.8%, p=0.068). The mean level of albumin was lower than normal in both groups (31.57g/L in group 1 and 34.02g/L in group 2) with a significantly lower level in group 1 (p=0.002). The use of surgical treatment was significantly higher in group 1 (p=0.003). However, there was no significant difference between the two groups in the use of corticosteroid, immunosuppressive agents, anti-TNFα therapy and the responses to these different treatments. The maximum duration of hospitalization was statistically longer in group 1 compared to group 2 (20.95 days vs. 15.32 days, p=0.003). The ratio of years of follow-up to years of active disease was significantly higher in group 2 (5.8 vs. 4.7, p=0.014), reflecting a better disease course in group 2.

Conclusion
In our series, one fifth of the patients were either overweighted or obese. IBD in these patients was, overall, less severe.
P301 Outcomes following colectomy for patients with Ulcerative Colitis, ten years of data from a tertiary referral centre
Authors: Gallagher A , Sheridan J , Doherty G , Mulcahy H , Cullen G 
Published: January 2023

Abstract

Background
Patients who undergo subtotal colectomy for Ulcerative Colitis (UC) have a persistent risk of colorectal cancer (CRC) in the retained rectum and this increases overtime. There are currently no guidelines for rectal surveillance in this group. We aimed to assess the outcome following colectomy for patients with UC over a ten year period.

Methods
We conducted a retrospective analysis of patients with UC who underwent colorectal surgery in a tertiary referral centre. The Hospital In-Patient Enquiry system and the St Vincent's Hospital IBD Database were used to identify patients. Patients with colorectal cancer were excluded.

Results
In a six year period one-hundred and seventy six bowel surgeries were carried out for patients with Inflammatory Bowel Disease. Sixty five of these procedures were performed on patients with UC, eight of which would subsequently be re-diagnosed with Crohn’s Disease.
73.6% (n=42) had a completion proctectomy within ten years, 12% (n=7) were lost to follow up and 5% (n=3) died from non-gastrointestinal disorders. 8.7% (n=5) retained their rectum after ten years.
For patients who had a completion proctectomy the median time to surgery was two years. Most of these patients did not have surveillance within the twenty four month time frame. Patients who had a completion proctectomy between three and ten years underwent surveillance endoscopy on average two occasions.
All patients in the retained rectum group had surveillance proctoscopy with a median frequency of 2.4 years. The risk of further surgery was a factor for two patients due to obesity and decompensated liver disease. A third patient had an ileorectal anastamosis abroad and continues to have active rectal disease.
Dysplasia was found in the rectum of the fourth patient thirteen years post colectomy. The final patient refused surgery but agreed to endoscopic surveillance. A rectal adenocarcinoma was diagnosed ten years post-operation.

Conclusion
Despite the absence of guidelines for completion proctectomy and/or surveillance of the retained rectal stump, three quarters of our UC patients had undergone completion proctectomy within ten years. A small but significant number of patients have a residual rectal stump after ten years, they require CRC surveillance and clear guidelines on this are needed.
P303 Ultrasound is effective to identify mucosal healing in Crohn’s disease patients : results of a cross-sectional study
Authors: Yzet C , Brazier F , Hautefeuille V , Decrombecque C , Sarba R , aygalenq P , Venezia F , Buisson A , Pichois R , Michaud A , Fumery M 
Published: January 2023

Abstract

Background
Endoscopy is still the gold-standard to assess disease activity in Crohn’s disease (CD). Its invasiveness, acceptability and cost limit its use in the era of tight control and treat-to-target. Fecal calprotectin and intestinal ultrasound (IUS) are non-invasive alternatives to colonoscopy to assess disease activity. The objective of this study was to evaluate the performance of IUS and fecal calprotectin to assess mucosal healing in CD.

Methods
All consecutive CD patients who underwent colonoscopy for mucosal healing assessment and IUS and/or calprotectin within 4 weeks between September 2019 and April 2022 were included in a prospective cohort. Bowel wall thickness (BWT) and color doppler signal (CDS) were assessed on each segment. Endoscopic mucosal healing was defined by a CDEIS score &lt; 3.

Results
A total of 153 patients were included, of whom 122 had endoscopic mucosal healing. Eighty-two (53.6%) were female, the median age and disease duration were respectively 36 years (IQR, 28-46) and 10 years (IQR, 4-19). Respectively 56 (56/120, 46.7%) and 93 (93/120, 77.5%) patients presented a BWT &lt; 3 mm and an absence of CDS. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of BWT &lt; 3 mm to predict endoscopic mucosal healing were 56%, 88%, 95% and 36% (patients misclassified as endoscopic mucosal healing 2.5%). The association of an absent of CDS with a normal BWT did not modify the performances. For a calprotectin &lt; 250 µg/g , The Se, Sp, PPV and NPV were respectively 91%, 63%, 90% and 67% for (patients misclassified 8%). The association of a calprotectin &lt; 250 µg/g, with a BWT &lt; 3 mm and the absence of CDS increased the specificity and the PPV (Se 58%, Sp 95%, PPV 97%, VPN 43%, patients misclassified 1%).

Conclusion
Ultrasound is an efficient non-invasive tool to identify patients with Crohn’s disease who have achieved endoscopic mucosal healing.
P306 Serum tryptophan metabolites as a biomarker for disease severity in patients with IBD
Authors: Karakan T , Karatas A , Cindoruk M , Gulbahar O 
Published: January 2023

Abstract

Background
The levels of tryptophan (TRP) metabolites such as kynurenine (KYN), kynurenic acid (KYNA), quinaldic acid, 3-hydrocynynene, anthranilic acid, picolinic acid (PA) and xanthurenic were determined systematically in inflammatory bowel disease (IBD). Previous studies found a negative correlation with TRP levels and IBD disease activity. However, there is no data about serum levels of TRP metabolites and their correlation with severity of IBD. We aimed to determine the correlation between the levels of TRP, its metabolites and the clinical, laboratory, and endoscopic findings of the disease activation including fecal calprotectin.

Methods
A total of 115 patients, 77 (66.4%) with UC and 38 (33.6%) with CD, were included. Forty three % (n=49) of the patients were female. 57 % (n=66) were male. The mean age of females and males were 42.07±13.39 and 44.23± 10.04 years, respectively. Patients were categorized according to their disease activity: Sixty-five (57%) of the patients were in remission and 50 (43%) were active. The predictive value of the disease activity was evaluated by the levels of serum tryptophan, its metabolites and the fecal calprotectin levels.

Results
At a cut-off value of ≤11328.41 ng/ml of tryptophan, the sensitivity to predict disease activation is 76.9% and the specificity is 71.7%. On the other hand, at a cut-off value of ≥89.60 µg/g of fecal calprotectin, the sensitivity of detecting disease activation was 88.1% and the specificity was 80.0%. Calprotectin, sedimentation, CRP, KYN/TRP values were found to be significantly higher in patients in the active period than in patients in remission (p&lt;0.001, p&lt;0.001, p&lt;0.007 respectively). KYNA, TRP, and PA values were found to be statistically significantly lower in patients in the active phase compared to those in remission (p=0.01, p&lt;0.001, p=0.022 respectively).

Conclusion
Serum TRP levels were lower in increased disease activity. Quinolinic acid levels did not differ between active patients and patients in remission. Quinolinic acid, which is the metabolite of TRP degradation, was increased with active disease. However, fecal calprotectin still had superior predictive value for IBD disease activity. Further studies are needed to assess the TRP pathway for the disease severity and disease course in IBD.
P307 High frequency of Deep Infiltrating Endometriosis in patients with Inflammatory Bowel Disease: a nested case-control study
Authors: Neri B , Russo C , Mossa M , Martire F G , Aikaterini S , Mancone R , Calabrese E , Rizzo G , Exacoustos C , Biancone L 
Published: January 2023

Abstract

Background
Inflammatory Bowel Disease (IBD) and endometriosis are chronic inflammatory diseases occurring in young women, sharing some clinical manifestations. We aimed to investigate, in a multidisciplinary approach, symptoms, type and site of pelvic endometriosis in IBD patients versus non-IBD Controls with endometriosis.

Methods
In a prospective nested, case-control study, all female premenopausal IBD patients showing symptoms compatible with endometriosis were enrolled. Patients were referred to dedicated gynecologists for assessing pelvic endometriosis by transvaginal sonography (TVS). Each IBD patient with endometriosis (Cases) was retrospectively matched for age (±5 years) and body mass index (±1) with 4 patients with endometriosis at TVS, but no-IBD (Controls). Data were expressed as median [range], the Mann-Whitney or Student-t and χ2 tests were used for comparisons.

Results
Endometriosis was diagnosed in 25 (71%) out of 35 IBD patients with compatible symptoms including 12 (52.6%) Crohn’s Disease and 13 (47.4%) Ulcerative Colitis patients. Dyspareunia and dyschezia were significantly more frequent in Cases vs Controls (25 [73.7%] vs 26 [45.6%]; p=0.03). At TVS, deep infiltrating endometriosis (DIE) and posterior adenomyosis were significantly more frequent in Cases vs Controls (25 [100%] vs 80 [80%]; p=0.03 and (19 [76%] vs 48 [48%]; p=0.02).

Conclusion
Endometriosis was detected in two/thirds of IBD patients with compatible symptoms. The frequency of DIE and posterior adenomyosis was higher in IBD than in Controls. A diagnosis of endometriosis, often mimicking IBD activity, should be considered in subgroups of female patients with IBD.