bluuebunny/crossref_metadata_2025_split huggingface dataset:
P355 Motility in small bowel strictures in Crohn’s Disease measured with cine-MRI
Authors: Beek K , de Jonge C S , van Rijn K , de Voogd F A E , Buskens C J , D'Haens G , Gecse K B , Stoker J 
Published: January 2023

Abstract

Background
Strictures develop in over half of Crohn’s Disease (CD) patients and can lead to complaints of bowel obstruction, requiring treatment. A study showed that strictures and pre-stricture small bowel (SB) have lower motility measured with cine-MRI, compared to normal bowel in CD. However, stricture motility has not been correlated with disease duration or Harvey Bradshaw Index (HBI). Investigating this correlation can provide insight in the physiologic behavior of a stricture in relation to the extent of bowel damage (disease duration) and clinical complaints (HBI). This could possibly support the clinician in treatment decisions. Our aim is to investigate correlations between stricture motility measured with cine-MRI and disease duration and HBI, respectively.

Methods
At a tertiary center CD patients (≥18yrs) with SB strictures were included. Patients fasted 4 hours, after which they drank 1600 mL (2.5%-mannitol-solution) in 60 minutes prior to 3T MRI. All underwent coronal dynamic 2D bFFE scans of the most stenotic SB and the pre-stenotic dilation if present, during a 20-second expiration breath-hold. Bowel motility was assessed with a validated displacement mapping technique (GIQuant, Entrolytics, Motilent, UK). Strictures (wall thickening &gt;3mm and ≥50% luminal reduction) and pre-stenotic dilations (luminal diameter &gt;3cm) were delineated on a reference image and motility was quantified on a motility map within these regions of interest (ROI), producing a single, numerical motility score (Arbitrary Units=AU). Stricture and pre-stenotic dilation motility scores are presented in medians [IQR]. Correlation was tested between stricture motility, disease duration and HBI by means of spearman’s rank correlation test.

Results
Twenty-two patients (55% male, age 37yrs [IQR 25-55], disease duration 7yrs[IQR 4-12]) were included. SB stricture motility was 57AU[IQR 48-71]. Pre-stenotic dilation motility (n=6) was 131AU[IQR 88-340]. Disease duration and stricture motility showed no correlation(r=0.2, p=0.4). HBI and stricture motility were inversely correlated(r=-0.6, p&lt;0.01).

Conclusion
We found an inverse correlation between SB stricture motility and HBI. No correlation was found between SB stricture motility and disease duration. The inverse correlation between HBI and stricture motility suggests that lower motility is associated with poorer clinical condition. This finding can possibly lead to earlier endoscopic or surgical intervention, since it indicates lower motility is associated with poorer clinical condition. Interestingly, we also measured higher pre-stenotic dilation motility compared to stricture motility, presumably a physiological response of the pre-stenotic dilation to the distal stricture and ongoing proximal peristalsis.
P360 Role of intestinal ultrasound scores in the diagnosis of post-operative recurrence in Crohn's disease
Authors: Amor Costa C , Suárez Ferrer C , Poza Cordón J , Yebra Carmona J , Rueda García J L , Sánchez Azofra M , Martín Arranz E , González Díaz I , Amiama Roig C , Martín Arranz M D 
Published: January 2023

Abstract

Background
Ileocolonoscopy is the gold standard to evaluate post-operative recurrence (POR) in Crohn's disease (CD) patients. Rutgeerts endoscopic score remains the gold standard in the evaluation of post-operative recurrence in CD.
Intestinal ultrasound (IUS) is proposed as a non-invasive alternative to ileocolonoscopy for the diagnosis of POR, with a sensitivity of 94% and specificity of 84%. There are several IUS scores that evaluate CD disease activity such as SUS-CD (validated), IBUS-SAS and Simple US Score, which have not yet been studied in the diagnosis of POR. The aim of this study is to assess whether these ultrasound scores correlate with endoscopy in the diagnosis of PR.

Methods
A retrospective study was performed. Patients with CD who had undergone ileocecal resection, with both an ileocolonoscopy and intestinal ultrasound performed for the detection of POR were included. The time between tests was less than 6 months and there was no therapeutic change between tests.
Endoscopic POR was evaluated with Rutgeers score (RS), considering POR RS ≥i2b. In IUS, were used: Simple US Score, SUS-CD and IBUS-SAS.

Results
Forty-five patients were included (female 48,89%, male 51,11%). The Montreal classification was: L1 n=22 (48,89%), L2=1 (2,22%), L3 n=22 (48,89%), B1 n=3 (6,67%), B2 24 (54,4%) and B3 n=18 (40%).
24 patients (53%) had no endoscopic POR, 6 (6%) had RS i2b and 15 (33.33%) had severe POR. The mean wall thickness measured by IUS was 4.39 mm (SD +/- 1.92) and 26 patients (57.77%) had hyperemia (Limberg score &gt;1). The mean values for IUS scores were: Simple US Score 5.79 (SD +/- 2.81), SUS-CD 2.35 (SD +/- 1.62) and IBUS-SAS 34.04 (SD +/- 24.21). For the Simple US Score an area under the ROC curve (AUC) of 80.65% (95% CI 67.7 - 93.6) was obtained, with a score ≥5.4. The sensitivity (S) was 95.24% and specificity (E) 66.67%. IBUS-SAS presented an AUC of 87% (95% CI 76.98 - 97.02), a result ≥28 granted a S 90.48% and E 70.83%. The SUS-CD index had an AUC of 79% (95% CI 76.98 - 97.92), a result ≥3 presented S 90.48% and E 62.5%.

Conclusion
In our experience, IUS scores (IBUS-SAS, SUS-CD and Simple US Score) show a high sensitivity in the diagnosis of POR.
P363 Depression and anxiety in Clostridioides difficile infection compared with inflammatory bowel disease during the Covid-19 pandemic
Authors: Țurcan S , Platon V , Negru I 
Published: January 2023

Abstract

Background
Numerous studies and their meta-analysis have shown a high prevalence of anxiety and depression in patients with inflammatory bowel disease (IBD): up to a third of patients with anxiety symptoms and a quarter with depression symptoms. These rates increase even more with high disease activity: up to half of patients with anxiety criteria and up to a third with depression symptoms.
Data on the frequency and severity of depression and anxiety in patients with Clostridioides difficile infection (CDI) are not so numerous and unambiguous. During the Covid-19 pandemic, the frequency of depression and anxiety increased among healthy individuals and, even more so, among patients with intestinal diseases.
The aim of the study was to evaluate the degree of anxiety and depression in patients with IBD and those with CDI during the Covid-19 pandemic.

Methods
Thirty patients with IBD and 30 patients with CDI were included in the study. IBD was confirmed by endoscopy and histology. CDI was confirmed by enzyme analysis for glutamate dehydrogenase and toxins A and B in the feces of patients with nosocomial infection.
Hamilton scale (17 items) was used in order to assess the depression grade. This scale divides patients into four groups: no depression, mild, moderate and severe depression. Anxiety was diagnosed by the Spielberger scale (40 items) which includes analysis of State anxiety (SA) and Trait anxiety (TA).

Results
Depression was determined in 56.7% of patients in the IBD group: 46.7% had mild depression, and 10% moderate depression. In the CDI group depression was diagnosed significantly more frequently – 86.7% of cases: mild grade in 76.6% and moderate in 10%, predominantly among women.
SA was identified in 46.7% of patients in IBD group, and severe SA in 10.0%. In CDI group the frequency and grade of SA were similar: 40.0% and 13.3% respectively.
The of TA was extremely high in both groups: 93.3% in the IBD group, of which 50.0% with severe TA, and 96.7% in the CDI group, of which 40.0% with severe TA.

Conclusion
The results of the study confirm the presence of anxiety and depression in an extremely large number of patients with IBD and CDI during the Covid-19 pandemic. The frequency of anxiety and depression in this study is significantly higher than previously reported. Patients with IBD and CDI should be monitored for early diagnosis and adequate treatment of depression and anxiety.
P375 Izencitinib induction treatment in patients with moderately-to-severely-active Crohn’s Disease: A phase 2 double-blind, randomized, placebo-controlled study
Authors: Schreiber S , Reinisch W , Nguyen D , Guerin T , Kierkus J , Rozpondek P , Bourdet D , Abhyankar B , Peyrin-Biroulet L 
Published: January 2023

Abstract

Background
The unmet need in Crohn’s disease (CD) exists for new medications with an optimized risk-benefit ratio with avoidance of systemic side effects. This Phase 2 study evaluated the efficacy and safety of the oral, once-daily, gut-selective pan-Janus kinase inhibitor izencitinib as an induction therapy for CD.

Methods
This trial was a multicentre, randomized, double-blind, Phase 2 study of adults with moderately-to-severely active CD (≥220 and ≤ 450 CDAI with SES-CD score of ≥6 [or ≥4 if isolated ileal disease]) who were corticosteroid-dependent or had demonstrated failure to aminosalicylates, corticosteroids, immunosuppressive agents, and/or biologic therapies. Patients were randomised 2:3:3 to receive placebo or izencitinib, 80, or 200 mg once daily for 12 weeks.
The primary endpoint was change in CDAI score from baseline to week 12 and was analysed using a mixed-model repeated measures analysis. Change from baseline in SES-CD was analysed with an analysis of covariance model and binary endpoints were analyzed using a stratified Cochran-Mantel-Haenszel chi-square test.

Results
159 and 145 patients were included in the safety and modified ITT populations, respectively.
At week 12, the LS mean change in CDAI was -105.6 (SE: 12.7) and -117.9 (12.4) points for patients randomized to izencitinib 80 and 200 mg, respectively, vs -104.86 (SE: 15.496) for those randomized to placebo. There were no improvements observed in change from baseline in SES-CD. There were non-significant numerical improvements in clinical and endoscopic response between placebo and the highest dose 200mg. No improvements were observed in CDAI-based clinical remission or PRO2 (SF/AP)-based remission at any dose of izencitinib relative to placebo.
As expected, plasma izencitinib exposure was low. Serious adverse events (AEs; n = 13) were well balanced among the treatment groups and not considered related to study treatment; no deaths were observed.
Exacerbation of Crohn’s Disease, headache, rash, abdominal pain and nausea were the most common treatment-emergent AEs observed with izencitinib treatment. No clinically important changes in laboratory values, electrocardiography parameters, or vital signs were noted in patients treated with izencitinib compared with placebo, and no drug-related AEs of special interest were observed.

Conclusion
In patients with moderately-to-severely active Crohn’s Disease, izencitinib treatment for 12 weeks did not demonstrate a statistically significant reduction in CDAI or endoscopic severity. Izencitinib at both doses was well tolerated without a new safety signal.
P382 Serum Ustekinumab Concentrations are Associated with Improved Outcomes with the Magnetic Resonance Index of Activity for Crohn’s Disease
Authors: Chen K , Chen J , Smith E , Mathani P , Longman R , Lukin D , Scherl E , Battat R 
Published: January 2023

Abstract

Background
Controversy exists for ustekinumab concentrations needed in Crohn’s disease (CD). No data exist comparing ustekinumab concentrations and validated radiologic outcomes. We characterized these relationships and clarified concentrations needed.

Methods
CD patients on maintenance (&gt; 16 weeks) ustekinumab with both ustekinumab concentrations and simplified magnetic resonance index of activity (sMaRIA) scoring were included. Ustekinumab concentrations were compared between those with and without (1) radiologic remission (sMaRIA &lt; 2), (2) severe radiologic inflammation (sMaRIA &lt; 3) and (3) fecal calprotectin (FCP) biomarker remission (FCP &lt; 50μg/g). Area under the receiver-operating characteristic (AUROC) curve determined optimal ustekinumab concentrations. Outcomes were compared between patients above and below identified ustekinumab thresholds.

Results
Thirty-eight paired ustekinumab concentrations and magnetic resonance enterography imaging results were included. Ustekinumab concentrations were higher with radiologic remission (11.4μg/mL vs. 6.4μg/mL, P=.005) and had good diagnostic accuracy for radiologic remission (AUROC 0.76, 95% CI 0.60 – 0.91) and for absence of severe inflammation (AUROC 0.71, 95% CI 0.55 – 0.88, optimal concentration 8.4μg/mL). With ustekinumab ≥8.4μg/mL, higher proportions had radiologic remission (63.2% vs. 21.1%, P=.01) and absence of severe inflammation (78.9% vs. 36.8%, P=.01) compared to patients with lower concentrations. Ustekinumab concentrations had good diagnostic accuracy (AUROC 0.73, 95% CI 0.52 – 0.94) for FCP biomarker remission (optimal concentration: 6.1μg/mL). Patients with ustekinumab concentrations ≥6.1μg/mL had higher proportions with biomarker remission (72.2% vs. 12.5% P&lt;.01) compared to those with lower concentrations.

Conclusion
Ustekinumab concentrations are associated with radiologic and biomarker outcomes in CD. These data validate the need for higher ustekinumab concentrations.
P398 Disease clearance: a potential target for management of patients with Ulcerative Colitis
Authors: Andronic A M , Toader E 
Published: January 2023

Abstract

Background
Disease clearance defined by the absence of symptoms and intestinal inflammation at endoscopic and histological examination, is proposed as a target in the evaluation of the ulcerative colitis (UC) course. The purpose of this study was to evaluate disease remission on the UC evolution according to disease clearance concept.

Methods
Between January 2020 - March 2022, 79 patients with UC were evaluated clinically, laboratory testing, endoscopically and histologically. Patients positive for COVID and CDI were not included in the study. Disease remission, in accordance with the concept of disease clearance it is defined as clinical (partial Mayo score ≤2), endoscopic (endoscopic Mayo score ≤1) and histological (Nancy Index) remission. Disease clearance was measured at inclusion in the study and during follow-up after 12 months. Results were compared in patients who did or did not achieve disease clearance.

Results
The patients were divided into 2 groups according to disease clearence: group 1: 35 out of 79 patients with UC evaluated, were considered with disease clearance at the initial moment of the evaluation. Group 1 did not present complications and did not require surgical interventions during the follow-up period, compared to group 2: non-disease clearence patients, 44 out of 79 patients (0.0% vs. 31.8%, p=0.03, OR=23.1). During follow-up, 38.6% patients (N=17 pts, Incidence Rate=0.3864) from group 2 obtained clinical remission, of which 15.9% patients obtained endoscopic remission, 6.81% patients obtained histological remission (p=0.025) and 27.2% patients were under biological therapy. A total of 27 patients from both groups required hospitalization, significantly shorter for patients with initial values ​​of fecal calprotectin below 200 μg/mg, and without endoscopic and/or histological activity (8.57% vs. 54.54%, p=0.002, OR=0.57, RR=0.224). 51.8% patients presented severe forms of disease with surgical and non-surgical complications (35.7% vs. 64.2%, p=0.91, OR=1.07). Surgical complications include toxic megacolon (N=2 pts, 14.2%), colonic perforation (N=1 pts, 7.1%), gastrointestinal hemorrhage (N=1 pts, 7.1%) and stricture with bowel obstruction (N=1 pts, 7.1%). Non-surgical complications include gastrointestinal hemorrhage (N=6 pts, 42.8%), venous thrombosis (N=1 pts, 7.1%) and colorectal cancer (N=2 pts, 14.2%). No deaths were reported.

Conclusion
According to the concept of disease clearance, our data indicate that UC patients in clinical, endoscopic and histological remission present a significantly lower risk of hospitalization, complications and surgical intervention.
P409 Using antidepressants for refractory symptoms of Inflammatory Bowel Disease: a prospective service evaluation
Authors: Moulton C , Avery P , Hart A 
Published: January 2023

Abstract

Background
One third of patents with inflammatory bowel disease (IBD) have refractory gastrointestinal symptoms, such as pain and diarrhoea, even after exhaustion of medical therapies. A further 40% have persistent fatigue. Although antidepressants can improve such symptoms, their role in treatment-refractory IBD has not been studied.

Methods
We evaluated a Consultant Psychiatrist clinic for patients with refractory IBD symptoms. Patients were reviewed remotely over 3-6-month follow-up. For pain, we used duloxetine or venlafaxine first-line. For nausea and insomnia-driven fatigue, we used mirtazapine first-line. For refractory fatigue or diarrhoea, we used bupropion, reboxetine or vortioxetine. Ineffective medications were changed after 6-8 weeks. Antidepressants were combined and augmented with antipsychotic if required. The primary outcome was change in the self-report IBD Control Questionnaire, scored from 0 (poor) to 16 (good). Secondary outcomes were changes in depression (PHQ-9), anxiety (GAD-7), IBD Fatigue Scale and average daily bowel frequency. Data were presented as mean (SD) if parametric and median [interquartile range] if skewed. Changes over time were measured using 2-tailed paired t-tests (parametric) or Wilcoxon signed rank tests (skewed data).

Results
Of 62 patients with IBD offered antidepressants, 80.1% started treatment. Mean age was 41.8 years and mean IBD duration 16.6 years. Of these, 88% had Crohn’s disease, 70% were refractory to multiple biologics, 62% had previous bowel resection and 14% had intestinal failure. At baseline, 92% had severe fatigue (IBD-Fatigue &gt;10), 52% had diarrhoea/high stoma output, 50% had pain and 18% nausea/vomiting. At baseline, 86% met ICD-10 criteria for moderate/severe depression and/or generalised anxiety disorder, and 26% had existing treatment-resistant depression.
At follow-up, IBD Control score improved from 1.5 [0-4] to 5 [1.5-8] (p&lt;0.001), as did depression (mean 24% reduction, p&lt;0.001), anxiety (mean 28% reduction, p&lt;0.001) and fatigue (mean 18% reduction, p=0.01). Although 27% of patients responded to first-line antidepressants, the rest required changes in treatment, combination therapy or augmentation. Ultimately, 51.5% were prescribed bupropion, reboxetine or vortioxetine, collectively in whom median bowel frequency fell from 6/day to 4/day (p&lt;0.001). Only 8% could not tolerate antidepressants.

Conclusion
Even in very difficult-to-treat IBD, antidepressants can improve IBD control, depression, anxiety and fatigue. However, specialist- or combination antidepressants are often required in this specific group. Clinical services should consider expansion of psychiatry provision to improve IBD outcomes. Trials of antidepressants for patients with refractory IBD symptoms are needed.
P411 Early ultrasound assessment predicts therapy response: an easy tool for clinical decision making
Authors: Calabrese PhD E , Castiglione F , De Cristofaro E , Rispo A , Capacchione C , Testa A , Guarino A D , Caiazzo A , Monteleone G , Zorzi F 
Published: January 2023

Abstract

Background
Intestinal ultrasound (IUS) is an effective and easy-to-use tool in monitoring Crohn’s disease (CD) lesions during different biological therapies. Aim of our study was to evaluate whether lesion improvement during biological therapy could predict transmural healing.

Methods
We performed a prospective study enrolling CD patients (pts) with indication to biological therapies. IUS and doppler US parameters at baseline, at 3 and 12 months were: bowel wall thickening (BWT), lesion length, echopattern, complications, blood flow according to Limberg’ score. Transmural healing (TH) was defined as normalization of all parameters; IUS responders were defined as pts with improvement of BWT associated with decreased lesion length, Limberg’ score improvement, and no worsening of the other parameters. Delta (Δ) signified the difference between IUS parameters at baseline and at 3 months. Changes in parameters and in Δ values at baseline and after 3 months were analyzed using Mann Whitney test; the area under (a ROC) curve was calculated. Differences between combination of parameters were tested by Chi-square test.

Results
One hundred and fifteen CD pts were enrolled (63.5% males; median age 37 years; median disease duration 96 months). Forty-nine per cent of pts had L1, 9% had L2, 42% had L3 according to the Montreal criteria. TH rate at 12 months was 20% and IUS responder rate was 43%. At baseline, no statistical differences in terms of BWT were observed between pts achieving TH vs no TH. Similarly, no differences were observed in pts defined as IUS responders vs non responders. Patients achieving TH at 12 months had a higher ΔBWT than patient without TH (p=0.0004). On ROC curve, ΔBWT improvement of 1.25 mm showed sensitivity and specificity of 73% and 61%, respectively, in predicting pts who achieved TH. Similarly, IUS responder group at 12 months had a higher ΔBWT than patients IUS non-responder group (p&lt;0.0001). On ROC curve, ΔBWT improvement of 1.25 mm showed sensitivity and specificity of 83% and 57%, respectively, in predicting IUS responders. A combination of a ΔBWT (≥1 mm) and Limberg’ score improvement (1 point) was associated with a higher risk of TH at 12 months (p=0.0007; OR 5.1; 95% CI, 1.8-12.8). A combination of a ΔBWT (≥1 mm) and Limberg’ score improvement (1 point) was associated with a higher risk of IUS responders at 12 months (p&lt;0.0001; OR 15.7; 95% CI, 4.5-52).

Conclusion
An early ΔBWT, and a combination of a ΔBWT and Limberg’ score improvement showed high diagnostic accuracy in predicting pts who achieved TH and IUS responder at 12 months. This information may help clinical decision making in terms of prompt optimization or switching/swapping therapies in CD.