bluuebunny/crossref_metadata_2025_split huggingface dataset:
P234 Differentiation of histopathological features between sporadic and colitis-associated colorectal cancer in a nationwide large cohort.
Authors: Uchino M , Ikeuchi H , Noiguchi T , Okabayashi K , Futami K , Tanaka S , Ohge H , Watanabe K , Itabashi M , Okamoto K , Okita Y , Mzushima T , Mizuuchi Y , Yamada K , Shimada Y , Sato Y , Kimura H , Takahashi K , Hida K , Kinugasa Y , Okuda J , Daito K , Koyama F , Ueno H , Yamamoto T , Hanai T , Kobayashi H , Kono T , Ajioka Y , Sugihara K , Ishihara S ,   Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum
Published: January 2023

Abstract

Background
Colitis-associated colorectal cancer (CAC) can develop in patients with inflammatory bowel disease, and histological features differ between CAC and sporadic colorectal cancer (CRC). Moreover, advanced CAC has a poorer prognosis than sporadic CRC. Therefore, we compared histopathological findings distinct from cancer stage between CAC and sporadic CRC to evaluate the features of CAC.

Methods
We reviewed the clinical and histopathological data collected from 43 institutions, including surgery and gastroenterology departments, in the Japanese Society for Cancer of the Colon and Rectum between 1983 and 2020. Patient characteristics were compared between ulcerative colitis (UC), Crohn’s disease (CD), and sporadic CRC. Comparisons were performed by using all collected data or propensity score-matched data.

Results
A total of 1,077 patients with UC-CAC, 297 with CD-CAC, and 136,927 with sporadic CRC were included in all collected data. Although the prevalence of well or moderately differentiated adenocarcinoma (G1:well differentiated and G2:moderately differentiated) decreased according to tumor progression in all diseases (p&lt;0.01, figure1), the prevalence of G3,G4, including signet ring cell carcinoma, mucinous carcinoma, poorly differentiated adenocarcinoma, neuroendocrine carcinoma and squamous cell carcinoma, was significantly higher in CAC than in sporadic CRC. Based on propensity score-matched data for 982 patients with UC and 268 with CD, the prevalence of histopathological findings other than G1 and G2 was also significantly higher in CAC (figure2,3). At pT4, mucinous carcinoma occurred at a significantly higher rate in patients with CD (45/86 (52.3%)) than in those with sporadic CRC (13/88 (14.8%)) (p&lt;0.01).

Conclusion
Malignant potential is higher in CAC than in sporadic CRC according to tumor progression, which may lead to the poor prognosis of CAC.
P235 Patients with inflammatory ileal pouch anal anastomosis (IPAA) disorders are characterized by a distinct breath volatile organic compounds (VOC) metabolome profile
Authors: Qazi T , Ottichilo R , Grove D , Rayan C , Cohen B , Bhat S , Regueiro M , Dweik R , Rieder F 
Published: January 2023

Abstract

Background
Following creation of an IPAA in patients with ulcerative colitis (UC), more than 60% of subjects develop inflammatory complications. The current objective assessment for inflammation of the pouch is limited to surrogate stool and blood biomarkers or endoscopy. The development of non-invasive and accurate biomarkers for the assessment of IPAA inflammation is an area of unmet need. Measurement of exhaled breath volatile organic metabolome compounds (VOCs) has shown promise as a biomarker for the diagnosis and monitoring of inflammatory disorders. We here aimed to characterize the pattern of VOCs in the exhaled breath of patients with an IPAA and assess whether VOC analysis is able to discriminate patients with endoscopically active IPAA inflammation from patients without IPAA inflammation.

Methods
This is a cross-sectional study of patients with an IPAA created for the management of UC. Exhaled breath samples were collected at time of endoscopic evaluation of the pouch and 97 VOC metabolites assessed via selective ion flow tube mass spectrometry (SIFT-MS). The IPAA cohort was dichotomized using the endoscopic pouch disease activity index (PDAI) into endoscopic PDAI of &gt;= 4 (severe inflammation), or endoscopic PDAI score &lt;= 1 (mild or no inflammation). Principle component analysis (PCA) was conducted to reveal the VOCs with the strongest discriminatory capability and principle component regression (PCR) was performed to assess the association of exhaled breath VOC analysis in differentiating the groups.

Results
Exhaled breath metabolome analysis was performed on 10 subjects with PDAI &gt;=4 and 7 subjects with PDAI &lt;=1. Demographics are provided in Table 1. PCA indicated robust discrimination of the two groups based on breath VOCs (Figure 1). 10 out of 97 VOCs were up-regulated in the PDAI &gt;=4 group compared to control, including ammonia and hydrogen sulfide. Isopropenyltoluene, tetrachloroethylene, and 3-pentanone provided the highest contribution to differentiate between the cohorts (Figure 2). Receiver operative curve (ROC) analysis of the PCR model indicated an area under the curve (AUC) of 0.81 (0.61-99), suggesting a strong association of breath VOCs with inflammation of the pouch (Figure 1).

Conclusion
VOC exhaled breath metabolome analysis shows a strong ability to discriminate patients with severe endoscopic pouch inflammation from patients with minimal to no endoscopic inflammation. The differences in reported VOCs point toward metabolic differences in bacterial fermentation, lipid and carbohydrate metabolism, and an increase in reactive oxygen species in patients with endoscopic pouch inflammation. Validation studies addressing the role of VOC analysis for non-invasive disease assessment patients with IPAA are ongoing.
P238 The ‘Malnutrition Universal Screening Tool’ (MUST) is less effective than an IBD specific Malnutrition Inflammation Risk Tool (MIRT) in identifying malnutrition risk with hospital admissions and surgical complication
Authors: xia Q , Mujiri S , Syme G , Mehta S 
Published: January 2023

Abstract

Background
IBD is associated with altered body composition and micronutrient deficiencies. None of the existing validated nutritional screening tools can correctly identify nutritional deficiencies in IBD. MUST is a widely used malnutrition screening tool in the UK. However, it failed to present relevance to clinical outcomes, while a newly developed IBD-specific tool, MIRT, showed significant correlations in CD patients.

Methods
Two single-centred retrospective projects were conducted in IBD tertiary centre at Royal London Hospital. Study A focused on IBD inpatients during the year 2021 with hospital stays ≥7 days 69 patients (43 males and 26 females), while study B examined 49 who underwent IBD-related surgery admitted between October 2019 and March 2022. They share the same defining criteria in MUST and MIRT. Hospital length of stay (LoS) and Clavien-dindo grade (CDG) were used to assess the clinical outcomes in surgical patients (study B).

Results
Study A: There were significant differences between MIRT and MUST in identifying the risk of malnutrition (Chi-square statistics =1.817, df =1, p =0.178). Fisher’s exact test P=0.239. and accepted alternative hypothesis. MIRT identified a significantly higher proportion of patients with the risk of malnutrition in comparison to MUST (strengths of relationship k=0.165 [95% CI] p =0.178). An independent sample t-test was undertaken to determine the association between malnutrition -MUST ≥2 and LoS. It was found that there was no difference between the means of the two groups and the LoS. t (32) =-0.002 p=0.998 P&gt;0.05. Similarities have been found with MIRT≥3 score and association with LoS t (67) = -0.158 p=0.875 p&gt;0.05Study B: The MUST did not significantly correlate with CDG or LoS (ρ =0.145, P =0.322; ρ = 0.033, P =0.823); however, the MIRT score did (ρ = 0.339, P =0.017; ρ =0.399, P = 0.005). The MIRT is thus a better NST than MUST in correlating with surgical outcomes within the IBD patient population. A higher MIRT score of ≥3 was significantly associated with both CDG (P =0.009) and hospital LoS (P =0.003), while a higher MIRT score ≥2 was not significantly associated with either (P =0.272; P =0.095) shown in Table 1

Conclusion
MIRT identifies a higher proportion of malnutrition in IBD patients 1 week from admission, but there is no direct correlation with complications and LoS. However, the opposite is the case in surgical patients where MIRT is a better pre-indicator for longer stays and complications. Having a disease-specific tool that correctly identifies the risk of malnutrition and predicts disease clinical outcomes in the IBD inpatient setting will improve the quality of healthcare and also will reduce healthcare costs. Further studies are needed ideally prospectively.
P239 Incidence of Long COVID and impact of medications on the risk of developing Long COVID in a nationwide cohort of Inflammatory Bowel Disease patients
Authors: Khan N , Mahmud N , Patel M , Sundararajan R , Reinisch W 
Published: January 2023

Abstract

Background
With the ongoing SARS-CoV-2 pandemic there is concern for development of Long COVID in patients with immune-mediated diseases treated with immunosuppressive agents. We aimed to determine the incidence of Long COVID among Inflammatory Bowel Disease (IBD) patients and to identify associated risk factors. Our study also aimed at studying the differences in risk of Long COVID among different IBD medication exposures.

Methods
We conducted a retrospective cohort study utilizing a nationwide cohort of patients with IBD in the Veteran Affairs Healthcare System (VAHS). Patients diagnosed with SARS-COV-2 between March 10th, 2020, and January 24th, 2021, were included. All charts were reviewed to determine recent IBD hospitalization, hospitalization for SARS-CoV-2 infection, and stability of IBD control pre and post infection. COVID-19 hospitalizations were also reviewed for intensive care unit requirement (ICU). COVID-19 treatments including remdesivir, monoclonal antibody infusions, and corticosteroids were also ascertained. Primary outcome was development of Long COVID. Cox regression analysis was used to identify variables associated with Long COVID.

Results
A total of 677 patients with SARS-CoV-2 infection were included, of which 49 (7.3%) were diagnosed with Long COVID (Table 1). No significant differences in IBD medication class between patients with and without Long COVID diagnoses were noted. In multivariable regression analysis, COVID-19 hospitalization (HR 3.56, 95% CI 1.80-7.09, p&lt;0.001), ICU requirement (HR 2.20, 95% CI 1.18-4.08, p=0.01), and COPD (HR 2.41, 95% CI 1.03-5.64, p=0.04) were significantly associated with Long COVID (Table 2). Adjusted survival curves showed that relative to patients who were not hospitalized, patients hospitalized in the ICU had an 8.61-fold increased hazard of Long COVID (HR 8.61, 95% CI 3.98-18.65, p&lt;0.001) (Figure 1).

Conclusion
Hospitalization and ICU care for COVID-19, as well as pre-existing COPD, were associated with increased risk of developing Long COVID, suggesting that severity of infection with a vulnerable substrate are key drivers of risk. Medications used in the treatment of IBD did not impact the risk of Long COVID. These findings should help reassure and inform IBD patients about the risk of Long COVID.
P251 Level of Interleukin-17 in Inflammatory Bowel Disease and Its relation to disease activity.
Authors: Menesy A , Hammad M , Aref S , Abozeid F 
Published: January 2023

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the gastrointestinal tract (GIT).It causes progressive structural and functional damage to the GIT epithelium. Chronic inflammation in IBD is characterized by an imbalance in the production of T helper -1 (Th1),Th2 andTh17 cytokines.This imbalance is important in chronic inflammatory process, since the formation of defective immune response to pathogenic agents promotes the recurrence of the disease.Whether interleukin-17A (IL-17A) has pathogenic and/or protective roles in the gut mucosa is controversial.The aim of this study was to detect serum IL-17 levels in IBD patients and its relation to disease activity.

Methods
This was a single center cross-sectional study, conducted at hepatology & gastroenterology unit, Mansoura specialized Medical Hospital, Egypt.Patients who were aged 18-65 years and diagnosed either UC or CD based on previous colonoscopy were included.55 patients were UC, 24 patients were CD,21 patients were control.Patients who were excluded were &lt;15 y, with history of GIT malignancy or any comorbidities affecting kidney,liver ,etc.All population were subjected to routine history, physical examination& laboratory investigations including serum IL-17 by ELISA besides CBC,CRP,ESR,Stool analysis, fecal calprotectin.

Results
Table (1): Correlation between laboratory findings and IL-17 among studied cases
We found that serum IL-17 level was increased significantly among UC ;median (min-max)= 72(21-502), in CD 54.5(25-260) versus control19(14-35) ng/l, P&lt;0.001.However, it was not correlated to the disease activity either Mayo score of UC or CDAI of CD.
It showed significant correlation to the extent of inflammation in UC affecting the colon (either proctosigmoiditis or left sided colitis or pan colitis), also to the type of CD (either inflammatory or stricturing or fistulizing) by P&lt;0.05.
It was not correlated significantly with any of the IBD activity markers (either CRP, ESR,or fecal calprotectin).Yet there was only negative significant correlation with Hb level (r =-0.28, p=0.005).
AUC was significantly differentiating between IBD and control group =0.993 with the best-detected cut off point from curve is 32 yielding sensitivity of 97.5% and specificity of 95.2%, while for discriminating activity of IBD by IL-17 ;AUC of UC and CD =0.56 & 0.65, with sensitivity 52.6% & 61.5% and specificity 58.3% &63.6 % respectively.

Conclusion
IL-17 increases in colonic inflammation significantly more than in control group, however its increase is not correlated to IBD activity.
P252 Solid organ transplant (with the exception of liver) in patients with inflammatory bowel disease: An ECCO CONFER Multicentre Case Series
Authors: Ribaldone D G , Vieujean S , Julsgaard M , Zingone F , Savarino E , Cañete F , Aratari A , Imperatore N , Ramos L , Plaza R , Pugliese D , Barberio B , Drobne D , Chaparro M 
Published: January 2023

Abstract

Background
There are limited data available on the course of IBD in patients with solid organ transplantation.
The aim of this ECCO CONFER study was to evaluate the trend of IBD before and after solid organ transplantation but liver.

Methods
This was a retrospective observational multicentre study that collected cases through the CONFER project. Patients with an established IBD diagnosis who underwent a solid organ transplantation (with the exception of liver) were eligible candidates.

Results
33 patients with solid organ transplantation (67% male; 55% CD) were collected from 12 referral centres in five different countries.
Mean age was 53 ± 16 years. 34 organs were transplanted in 33 patients. Most of the patients underwent kidney transplantation (n=27, 82%). 4 (12%) received a heart and 1 (3%) underwent lung transplantation; 1 (3%) underwent a combined heart and kidney transplant.
The mean duration of IBD was 18.4 ± 14.7 months. Clinical characteristics are summarized in Table 1.

The median follow-up after transplantation was 4.3 years (IQR 3.25 – 10.7).
7/33 patients (21.2%) experienced organ rejection, with 1 kidney retransplant.
Regarding immunosuppressive therapy, 29/33 patients (88%) were treated with tacrolimus, 25 (76%) with systemic steroids, 22 (67%) with mycophenolate mofetil, 11 (33%) with everolimus, 6 with cyclosporine (18%), 3 (9%) with thiopurines. Regarding biologics, 1 patient was treated with infliximab, 2 with adalimumab, 2 with vedolizumab, 1 with ustekinumab.
Defining a severe IBD course the need for biologic therapy or bowel resection or hospitalization, 4 patients (11.7%) had a severe disease course after transplantation versus 3 patients (9.3%) in the first 51 months of disease before transplantation (p = 0.26). Univariate analysis is reported in Table 2.

1 case of low-grade dysplasia was found 10 years after the transplantation. 1 case of colorectal cancer was found in a patient affected by CD five years after kidney transplantation. The other cases of tumours after transplantation are reported in Table 3.

The first serious infectious episode after transplantation is shown in Table 4: 17 of 33 patients (51.5%) reported at least 1 episode of serious infection.

In total 29 different serious infectious episodes after transplantation were recorded, compared to 28 episodes in the pre-transplantation period.
At the last follow-up visit, 6/33 (18.2%) patients had died: 1 due to cholangiocarcinoma, 1 amyloidosis, 1 heart failure, 1 myocardial infection (2 not available).

Conclusion
Solid organ transplantation appears to have a satisfactory course for both the transplanted organ and IBD, in terms of organ survival and IBD severity; furthermore, the use of biologics in these patients does not appear to be linked to a worse outcome.
P262 Development and validation of a score predicting non-response to intravenous corticosteroids in patients with Acute Severe Ulcerative Colitis on day 3 of admission
Authors: Subhaharan D , Ramaswamy P K , Willmann L , Moattar H , Bhullar M , Ishaq N , Dorrington A , Shukla D , McIvor C , Edwards J , Mohsen W 
Published: January 2023

Abstract

Background
Colectomy rates in acute severe ulcerative colitis (ASUC) patients have declined over the last 25 years. Objective predictors of non-response to IV corticosteroids (IVCS) in ASUC can further improve outcomes. Our aim was to develop and validate predictors of IVCS non-response in ASUC patients in the biologic era.

Methods
Consecutive patients with ASUC satisfying Truelove and Witts’ criteria hospitalised at two tertiary IBD centres in Australia between 2013-2020 were included. Primary outcome was steroid non-response requiring medical or surgical rescue therapy. UCEIS was scored on flexible sigmoidoscopy performed within 24-48 hours of admission. Development cohort comprised 112 episodes of ASUC between 2013 and 2017, and the validation cohort comprised 114 episodes of ASUC between 2018-2020.

Results
In the development cohort, 52 (46.4%) episodes were steroid non-responders and 18 (16%) episodes underwent colectomy during the same admission. On multi-variable analysis, predictors of non-response to IVCS were UCEIS score [OR 2.45 (1.65-3.63, p &lt;0.001)] and serum albumin day 3 after admission [OR 0.83 (0.76-0.90), p &lt;0.001]. A score was developed allocating 1 point to each variable (UCEIS ≥ 7 and day 3 serum albumin ≤ 25 mg/L) For predicting steroid non-response, the score had OR 6.31 (3.11- 12.79), p &lt;0.001, AUROC 0.763 (0.676-0.849), score of 2 points had a sensitivity of 26%, specificity 100%, PPV 100, NPV 59.5%; for same admission colectomy OR 20.58 (6.16-68.6), p &lt;0.001, AUROC 0.905 (0.846-0.964). In the validation cohort, 52 (45.6%) episodes were steroid non-responders and 7 (6.1%) episodes underwent colectomy during the same admission. For predicting steroid non-response, the score had OR 4.26 (2.07-8.76), p &lt;0.001, AUROC 0.684 (0.593-0.776), score of 2 points had sensitivity 13%, specificity 100%, PPV 100%, NPV 57%; for same admission colectomy OR 5.42 (2.44-12.05), p &lt;0.001, AUROC 0.83 (0.753-0.907).

Conclusion
In the biologic era, UCEIS score and serum albumin on day 3 of admission are predictors of steroid non-response in patients with ASUC. We have developed and validated a score comprising UCEIS ≥ 7 and day 3 serum albumin ≤ 25mg/L. A score of 2 has a specificity of 100% and PPV 100% for predicting non-response to IVCS.
P264 Machine learning can accurately predict development of Inflammatory Bowel Disease
Authors: Dyer E , Kliper E , Zamstein N , Hodik G , Kariv R , Cohen N A 
Published: January 2023

Abstract

Background
Prediction of inflammatory bowel disease (IBD) development is the subject of intense study. We have previously shown that significant changes occur in routine laboratory tests in the 5 years preceding IBD diagnosis. Using routinely collected laboratory results, we developed machine learning models to predict development of IBD.

Methods
We extracted data from the electronic medical records of Maccabi Health Services and included patients with IBD ≥ 16 years of age with a minimum of 5 years follow up and an age and sex matched healthy cohort. The outcome measured was entry into the IBD registry. The study population was split into training and validation cohorts and using laboratory values in the 5 years prior to IBD diagnosis as features, we assessed the performance of supervised learning models and performed interpretability analysis with unsupervised dimensionality reduction.

Results
5643 patients with IBD and 17199 healthy people were included in this study. 3039 (53.8%) had Crohn’s disease (CD), 2322 (41.1%) ulcerative colitis (UC) and 282 (5%) indeterminate colitis. The mean age of the IBD and healthy cohorts at study inclusion was 39.3 ± 16.5 and 38.5 ± 15.6 years, respectively. Weighted nearest neighbour imputation was used to correct for data missingness. Unsupervised Uniform Manifold Approximation Projection dimensionality reduction correctly separated the cohort into healthy and IBD clusters (Figure 1A). Furthermore, this algorithm identified two distinct groups correlating to CD or UC diagnosis (Figure 1B). Supervised learning models, namely neural net (AUC 0.95), linear support vector machine (SVM) (AUC 0.93), radial basis function SVM (AUC 0.85) and logistic regression (AUC 0.93) models, accurately predicted IBD diagnosis (Figure 2). These models were repeated without C-reactive protein and the predictive value was not significantly changed. Moreover, we excluded data in the 2 years preceding IBD diagnosis to determine whether model performance was reduced and the predictive value remained the same. Interestingly, using only data from 3-5 years preceding IBD diagnosis, the model could better distinguish between CD and UC (Figure 3).

Conclusion
In this study, machine learning models could accurately predict a diagnosis of IBD using laboratory data from the 5 years preceding IBD diagnosis. Prospective studies are needed to test these models in a real world setting.