bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0341 Variation in healthcare utilisation amongst IBD care centres in Australia and New Zealand, Crohn’s Colitis Care Data Insight’s Program
Authors: Su W K , Wilson W , Wark G , Walker G , Su H , Forbes A , Kim A , Giles E , Lawrance I , Dutt S , Brett L , Begun J , Lynch K , Andrews J M , Connor S J 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is a global health issue with Australia (AUS) and New Zealand (NZ) having amongst the highest prevalence rates worldwide. Due to a paucity of externally visible data on how care is delivered within individual sites, little is known about utilisation of various care inputs and the presence and/or magnitude of any variation in this amongst centres. We therefore examined the use of various documented care inputs amongst 11 Australasian IBD centres over a 12-month period.

Methods
Crohn’s Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record (EMR) used in Australasia. Deidentified data prospectively entered by clinicians and consumers during routine clinical practice from September 2023 to September 2024 were retrospectively analysed. Centres with over 100 people with IBD with an assessment during the last 14-month period were included.

Results
A total of 7119 eligible people with IBD from 11 centres were included; of those, 55.9% (n=3982) had Crohn’s Disease, 41.3% (n=2938) had Ulcerative Colitis, and 2.8% (n=199) had IBD-Unclassified. There was an even gender distribution with 49.3% (n=3508) male, 48.0% (n=3420) female; 2.8% (n=199) did not have gender documented. Most resided in AUS (71.9%, n=5120) and 28.1% (n=1999) in NZ. Their median age was 42 years (IQR 31 – 57), and the median disease duration was 10.8 years (IQR 5.2 – 19.2). The number of eligible people with IBD included per centre ranged from 165 to 1421 (median 729, IQR 350 – 805).
A total of 10,910 clinical assessments (in-person and telehealth) were conducted and documented in CCCare; with centre variation from 1.0 per person (pp) to 2.4 pp (p&lt;0.001). Nine centres documented Helpline contacts which varied from 0.0 pp to 7.8 pp (p&lt; 0.001). The number of endoscopies performed varied from 0.2 pp to 0.5 pp (p&lt;0.001) and the number of radiological investigations performed varied from 0.0 pp to 0.8 pp (p&lt;0.001). Admission rates across the sites were similar, ranging from 0.0 pp to - 0.1 pp (p=0.88).

Conclusion
There was significant variation in healthcare utilisation across 11 IBD centres in AUS and NZ. Despite large variation in rates of radiology and endoscopy, admission rates did not differ, suggesting that, at least in the short term, greater use of these resources did not improve outcomes at cohort level. Further analyses are required to understand this variability, which may include specific patient needs, site-specific practices, or differences in access to healthcare services and resources. A tool like CCCare, is key to enabling health services research across centres and will support us with data to develop evidence-based IBD care guidelines to achieve equitable, cost-effective care.
P0345 Tailoring Crohn’s disease surveillance in clinical remission: new insights from the Lewis score
Authors: Ferreira A I , Lima Capela T , Xavier S , Arieira C , Rosa B , Cotter J 
Published: January 2025

Abstract

Background
Optimal thresholds for Lewis score in the surveillance of patients with known Crohn’s disease (CD) in clinical remission remain uncertain. The aim of this study was to evaluate predictive factors of clinical exacerbation in patients with small bowel inflammatory-type CD in clinical remission, focusing on the yield of the Lewis score.

Methods
Retrospective, unicentric cohort study including adult patients with known small bowel inflammatory-type, non-stricturing and non-penetrating CD, in clinical remission, who were submitted to small bowel capsule endoscopy for evaluation of mucosal healing. Clinical exacerbation was defined as the need for corticosteroid administration, biological/immunomodulator treatment initiation, intensification or switch, intestinal surgery, or CD-related hospitalization, with a minimum follow-up time of 24 months.

Results
A total of 63 patients were included, and clinical exacerbation occurred in 18 patients (28.6%), with 8 patients requiring oral corticosteroid administration (12.7%), 12 needing biological/immunomodulator treatment initiation or switch (19.0%), and 2 needing both (3.2%). An age ≤33 years and a Lewis score &gt;225 were found to be independent predictive factors of clinical exacerbation (OR 7.145, p=0.028 and OR 12.585, p=0.005, respectively). Patients who were not in biochemical remission were 14 times more likely to have a clinical exacerbation during follow-up (83.3% vs 42.2%, p=0.003). Furthermore, patients who were not in biochemical remission and who had a Lewis score &gt;225 were 16 times more likely to have a clinical exacerbation (66.7% vs 13.3%, p&lt;0.001). Patients with a Lewis score &gt;225 had an overall risk for clinical exacerbation of 59.1%, compared to 12.2% in those with a Lewis score ≤225 (p&lt;0.001). Additionally, patients with a Lewis score &gt;225 had a shorter period of time free from clinical exacerbation (32±5 vs 80±5 months, χ2=22.414, p&lt;0.001) (figure 1).

Conclusion
Clinical exacerbation occurred in almost one third of patients with small bowel inflammatory-type CD in clinical remission. An age ≤33 years and a Lewis score &gt;225 were independent predictive factors of clinical exacerbation. The absence of biochemical remission was also associated with clinical exacerbation. A Lewis score &gt;225 was the best threshold to predict clinical exacerbation and shorter period of time free from clinical exacerbation. Therefore, in small bowel CD patients with a Lewis score &lt;225, a wait and watch therapeutic strategy can be applied, since the risk of clinical exacerbation for a minimum 24-month follow-up period is low. However, those with a Lewis score &gt;225 should be considered for therapeutic intensification, especially if younger, in order to prevent clinical exacerbation in the long term.
P0348 Ultrasound enterography with a novel ultrasound contrast agent for Crohn’s Disease
Authors: Gjengstoe A J , Volkmann H L V , Aziz A , Dimcevski G , Gilja O H , Nylund K 
Published: January 2025

Abstract

Background
Gastrointestinal ultrasound (GIUS) is a method with both high sensitivity and specificity for evaluating disease activity in patients with Crohn’s disease. However, detecting and classifying stenosis and ulcerations can be challenging with GIUS. Developing an ultrasound method for detecting and categorising these findings would be of significant benefit to these patients. GIUS using an oral ultrasound contrast agent containing microbubbles is a new method with the potential to improve the intestinal ultrasound examination in patients with Crohn’s disease. The goal of this study is to investigate if intestinal ultrasound with oral contrast containing Sonazoid microbubbles in a PEG solution is a feasible and safe method in patients with Crohn’s disease.

Methods
24 patients with Crohn’s disease in the terminal ileum (TI) was examined with ileocolonoscopy and intestinal ultrasound with oral contrast in a phase 2, single centre prospective cross-sectional drug trial. The ultrasound examination was done using Logiq E10 in contrast hybrid mode after ingestion of 1ml Sonazoid mixed with 500ml of PEG. The quality of the examination was graded 0-3 based on the amount of contrast in the lumen. In grade 3 the terminal ileum filled completely with contrast, and this was considered a successful examination. The contrast grade and transit time to TI after ingestion was documented along with symptoms, side effects and disease activity using "Mobile Health Index for Crohn’s Disease" before and after the study visit (1).

Results
All the included patients completed the ultrasound examination. The examination had a feasibility of 96 % as 23/24 patients achieved contrast effect grade 3 in TI with a clear separation of the intestinal wall and lumen. Average time from ingestion to grade 3 contrast effect in the TI was 20.8 min. Average duration of contrast effect grade 3 in the TI was 50.4 min. 50% of the patients had self-limiting diarrhea after the examination, however using paired samples T test there was no significant difference in average disease activity measured by MHICD before and after the examination (p=0.685). 96% of the patients agreed or completely agreed to undergo the examination again.

Conclusion
All except one patient achieved successful grade 3 contrast effect in the terminal ileum with a clear separation of the lumen and intestinal wall. Half of the patients had self-limiting diarrhea, but there was no increase in Crohn’s disease activity after the contrast examination. According to our study, ultrasound with oral contrast consisting of 1ml Sonazoid and 500ml PEG is a feasible and safe method to examine patients with Crohn’s disease.

References
1. Van Deen WK et. Al. Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1742-1750.e7. doi: 10.1016/j.cgh.2015.10.035.
P0350 Asia Pacific Association of Gastroenterology consensus statements on histopathological evaluation of Inflammatory Bowel Diseases
Authors: Leong R , Chaemsupaphan T , Lin H , Lim W C , Ooi C J , Chetwood J D , Mao R , Wu H Y , Wei S C , Makharia G , Ahuja V , Banerjee R , Limsrivilai J , Aniwan S , Pisespongsa P , Hilmi I , Raja Ali R A , Leung W K , Ng S , Ye B D , Kobayashi T , Matsuoka K , Chau C , Sanpavat A , Shun C T , Puspanathan P , Gearry R B , Danese S , Ma C , Pudipeddi A , Paramsothy S 
Published: January 2025

Abstract

Background
Mucosal histological activity is increasingly valued as a treatment endpoint in inflammatory bowel diseases (IBD). In the Asia Pacific region, however, the utility and acceptability of IBD histology as a treatment endpoint is uncertain due to the heterogeneity of IBD prevalence, resourcing, and level of knowledge among practitioners. There is an opportunity to engage clinicians to harmonise histology reporting and collaborate with pathologists in this field. To this end, we developed statements to determine their consensus through anonymous voting on histological features, processing, reporting, and relevance to treatment outcomes in ulcerative colitis and Crohn’s disease.

Methods
Representatives of the Asia Pacific Association of Gastroenterology, in collaboration with pathologists, voted anonymously in accordance with modified Delphi methodology on statements relevant to IBD and histology. Domains of interest were histological features of ulcerative colitis and Crohn’s disease, relevance to clinical management, and the potential utility of artificial intelligence in grading histological disease severity. Level of evidence and recommendation grade were included in accordance with the NHMRC guidelines of Australia.

Results
Consensus was reached on 37 statements concerning definitions, pathology processing and reporting, scoring system, and relevance to clinical outcomes (Figure). There was uncertainty on escalating treatment when histological remission is not achieved, preventing consensus on this statement. Knowledge gaps were identified over the role of artificial intelligence.

Conclusion
These consensus statements provide recommendations, with specific relevance to the Asia Pacific region, on the role of histology in IBD ways to harmonise its use. The consensus statements will promote understanding and applicability in research and in the routine management of IBD.
P0351 Differential Cutoff Values of Fecal Calprotectin Based on Disease Extent of Ulcerative Colitis
Authors: Lee J , Kim S J , Lee M H 
Published: January 2025

Abstract

Background
Fecal calprotectin (FC) is a well-established biomarker for bowel inflammation in ulcerative colitis (UC). However, its utility across different disease extents remains poorly defined. This study investigates the correlation between FC levels and endoscopic severity according to disease extent in UC, aiming to establish specific cutoff values for each disease extent

Methods
From January 2013 to December 2020, UC patients slated for colonoscopy at our institution were recruited. Fecal samples were collected pre-procedure for FC analysis. Demographic and clinical data were recorded, categorizing patients by UC extent. Disease activity was evaluated using the Partial Mayo Score and Mayo Endoscopic Subscore (MES).

Results
We performed 404 colonoscopies on 165 UC patients. Analysis demonstrated varying correlations between FC and MES, particularly showing diminished correlation in patients with proctitis (E1/E2/E3 correlations: 0.298/0.533/0.574; p-values: 0.010/0.001/0.001). Cutoff values for FC varied with disease extent: 77 for proctitis (AUC: 0.752; Sensitivity: 64%; Specificity: 84%), 164 for left-sided colitis (AUC: 0.821; Sensitivity: 83%; Specificity: 100%), and 222 for pancolitis (AUC: 0.870; Sensitivity: 86%; Specificity: 83%). FC was superior to C-reactive protein in discriminating remission across all extents.

Conclusion
FC levels correlate with UC disease extent, suggesting that differential cutoff values should be utilized to enhance diagnostic accuracy. Specifically, lower correlations in proctitis highlight the need for adjusted diagnostic thresholds, underlining FC’s varied utility in managing UC.

References
1.Lichtenstein GR, Rutgeerts P. Importance of mucosal healing in ulcerative colitis. Infamm Bowel Dis. 2010;16:338–46.
2.Lee J. [Fecal Calprotectin in Inflammatory Bowel Disease]. Korean J Gastroenterol. 2016 May 25;67(5):233-7.
3.Walsh A, Kormilitzin A, Hinds C, et al. Defning faecal calprotectin thresholds as a surrogate for endoscopic and histological disease activity in ulcerative colitis—a prospective analysis. J Crohn’s Colitis. 2019;13:424–30.
4.Mosli MH, Zou G, Garg SK, et al. C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2015 Jun;110(6):802-19
5.Sonoyama H, Kawashima K, Ishihara S, et al. Capabilities of fecal calprotectin and blood biomarkers as surrogate endoscopic markers according to ulcerative colitis disease type. J Clin Biochem Nutr. 2019 May;64(3):265-270
P0352 Fecal calprotectin and pseudopolyps in Ulcerative Colitis: Is there a relationship?
Authors: Crespo A , Pèlach A , Vidal M , Calafat M , Llaó J , Domènech E , Mañosa M 
Published: January 2025

Abstract

Background
Fecal calprotectin (FC) is the main biomarker of inflammatory bowel disease (IBD). Pseudopolyps are lesions that arise after repeated episodes of inflammation following healing processes. The impact of the presence of pseudopolyps on FC levels in patients with ulcerative colitis (UC) is not established.
The aim of the study was to analyze FC levels in relation to the presence of pseudopolyps and to investigate the association between these and the risk of relapse.

Methods
Retrospective study of patients with UC followed up at the IBD unit of a tertiary hospital. We selected adult patients in clinical and endoscopic remission (Mayo endoscopic score 0-1), with a quality screening colonoscopy between 2015 and 2024. Demographic, clinical, analytical and endoscopic variables were analyzed.

Results
The study included 147 patients with UC, of whom 51 (35%) presented pseudopolyps. Patients with pseudopolyps had a significant proportion of extensive UC, hospitalizations due to UC, and use of immunomodulators and biological drugs. The median FC levels pericolonoscopy were 32 µg/g (IQR 15-53) in those with pseudopolyps and 28 µg/g (IQR 20-42) in those without (P = 0.464). There were also no differences in CF levels according to the use of NSAIDs (P = 0.722) or PPIs (P = 0.945). The median follow-up was 23 months (IQR 13-45). The presence of pseudopolyps was not associated with a greater risk of clinical relapse during follow-up (P = 0.425), neither the time to relapse (P = 0.937). In contrast, the condition of ex-smoker or non-smoker (P = 0.003) and extensive UC (P = 0.007) were associated with relapse.

Conclusion
In patients in clinical and endoscopic remission, the presence of pseudopolyps is not associated with higher levels of fecal calprotectin neither an increased risk of clinical relapse in the medium term.
P0353 Correlation between qUality of life and point of cAre intestinaL ultrasound In patients wiTh inflammatorY bowel disease (CUALITY)
Authors: Parra Izquierdo L V , Ernest Suarez K , Argollo M , Frías-Ordoñez J , Orduz G , Puentes Manosalva F , Cubillos S , Verstockt B 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) impairs patients’ quality of life, and hence, there is increased awareness of patient-reported outcomes (PRO). Intestinal ultrasound (IUS) is becoming increasingly important as a noninvasive patient monitoring strategy. However, no data exist on the concordance between PRO and IUS findings. Therefore, we investigated the association between PRO, assessed by the IBD Questionnaire-32 (IBDQ-32), and IUS parameters.

Methods
This prospective study recruited patients with IBD who underwent IUS assessment, while subsequently, an IBDQ-32 was recorded. The IUS parameters captured were bowel wall thickening (BWT), colour doppler sign using the modified Limberg score and color wall flow (CWF) absent or present, also, presence of lymphadenopathies, and mesenteric fat hypertrophy. We performed uni- and bivariate analysis. A p-value &lt;0.05 was considered significant.

Results
A total of 55 patients were included [37 with ulcerative colitis (UC); 18 with Crohn’s disease (CD)]. In UC, we observed a significant association between IBDQ-32 and BWT (P=0.049), CWF (P=0.02) (Figure 2). and mesenteric fat hypertrophy (P=0.040) respectively. Exploring the dimensions of the IBDQ-32, there was a statistically significant association between the dimension of gastrointestinal symptoms (P= 0.002) and systemic symptoms (P=0.003) with CWF, as well a with BWT respectively (P= 0.013). No association between IUS features and emotional and social dimensions was observed. The validated MUC score (cutoff 6.2) associated significantly with IBDQ-32 (P=0.010) (Figure 1). No associations were observed in patients with CD.

Conclusion
The quality of life assessed by IBDQ-32 is associated with intestinal ultrasound parameters that reflect disease activity in UC.
P0359 Characteristics and long-term outcomes of biopsy proven serrated epithelial change in patients with inflammatory bowel disease: a retrospective analysis
Authors: Vaitiekunas L , Kakkadasam Ramaswamy P , Pillai S , Willis T , Mohsen W 
Published: January 2025

Abstract

Background
Serrated epithelial change (SEC) is an increasingly recognised histologic finding in patients with inflammatory bowel disease (IBD) and may be associated with an increased risk of synchronous or metachronous colorectal dysplasia.1,2 The aims of this study were to characterise the clinical and histologic features of IBD patients with SEC and determine the incidence of dysplasia.

Methods
We performed a retrospective, observational, single-centre study at a tertiary referral hospital. IBD patients with SEC were identified by searching the pathology database for ‘serrated’, ‘epithelial’ and ‘change’ in pathology reports. The first colonic biopsy showing SEC between 2015 to 2023, was designated as the index SEC. SEC was defined as colonic mucosa with goblet cell-rich epithelium, disorganised crypt architecture and irregular serrations without distortion of basal aspects of crypts or features of dysplasia. Patients without follow-up colonoscopy or flexible sigmoidoscopy were excluded (see Figure 1). Clinical and histological data were extracted from electronic medical records and endoscopy reports.

Results
The cohort included 26 IBD patients (16 with Crohn’s Disease and 10 with ulcerative colitis), consisting of 14 males (53.8%) with a median age of 58 years at the time of the index SEC diagnosis. See Table 1 for patient characteristics. A total of 30 specimens with SEC were identified among the 26 patients, and all patients had at least one follow-up colonoscopy or flexible sigmoidoscopy. The mean disease duration was 15 years, and the median follow-up time was 24.5 months. SEC was detected on high-definition white light endoscopy in 61.5% of cases. SEC was primarily located in the cecum (30%), rectum (23.3%) and transverse colon (16.7%), detected on nodular or polypoid mucosa (60%), and exhibited multifocal distribution (19.2%). In patients with SEC, endoscopic and histologic inflammation was demonstrated in 50% and 46.2% of cases, respectively. One case (3.8%) of low-grade dysplasia in the caecum was observed in a patient with Crohn’s disease.

Conclusion
SEC was predominantly found as polypoid or nodular lesions proximal to the splenic flexure and associated with endoscopic and histologic inflammation. Larger, prospective, multi-centre studies are necessary to clarify the clinical implications of SEC in IBD, its potential role in carcinogenesis and dysplasia surveillance strategies.

References
1.Johnson DH, Khanna S, Smyrk TC, et al. Detection rate and outcome of colonic serrated epithelial changes in patients with ulcerative colitis or Crohn’s colitis. Alimentary Pharmacology & Therapeutics. 2014;39(12):1408-1417. doi:10.1111/apt.12774
2 Parian A, Koh J, Limketkai BN, et al. Association between serrated epithelial changes and colorectal dysplasia in inflammatory bowel disease. Gastrointestinal Endoscopy. 2015;84(1):87-95.e1. doi:10.1016/j.gie.2015.12.010