bluuebunny/crossref_metadata_2025_split huggingface dataset:
P333 Early intestinal ultrasound remission is associated with endoscopic healing after one year of infliximab therapy in Crohn’s disease: a multicentre prospective study
Authors: Revés J , Morão B , Nascimento C , Frias-Gomes C , Cúrdia Gonçalves T , Freitas M , Castro F , Moreira M J , Cotter J , Pereira F , Caldeira A , Sousa R , Coelho R , Macedo G , Glória L , Torres J , Palmela C 
Published: January 2023

Abstract

Background
Endoscopic healing (EH) is currently the consensual long-term treatment target to achieve in Crohn’s disease (CD). However, optimization of therapy based on an endoscopic response implies a delay as endoscopy is an invasive procedure and cannot be used longitudinally, stressing the need for non-invasive predictors of EH. We aimed to assess the predictive role of biomarkers and intestinal ultrasound (IUS) parameters after induction therapy to predict EH one year after infliximab (IFX) therapy.

Methods
Prospective multicentre cohort study including patients with active CD starting IFX. Harvey-Bradshaw index (HBI), C-reactive protein (CRP), faecal calprotectin (FC), and IUS were performed at week (W) 0, 14, 30, and 54. Ileocolonoscopy was performed at W0 and W54. Clinical remission (CR) was defined as HBI&lt;5 and laboratory remission (LR) as CRP &lt;0.5mg/dL and FC &lt;150ug/g. Transmural healing (TH) was defined as the normalization of bowel wall thickness (BWT≤3mm), doppler sign (≤1), wall stratification, and inflammatory fat in the most affected segment. The IBUS-SAS (International Bowel Ultrasound Segmental Activity Score) was used to assess disease activity and includes BWT, doppler sign, loss of stratification, and inflammatory fat. EH was defined as total SES-CD &lt;3.

Results
We included 52 patients with CD (54% male; mean age 35±14y). Baseline characteristics are available in Table 1. At W14, 89% were in CR, 46% had LR and 19% had TH. After 1 year of IFX therapy, 90% were in CR, 62% had LR, 43% had TH and 37% had EH. At W14, patients with EH had lower BWT (3.3 vs 4.6mm, p=0.01), lower IBUS-SAS (15 vs 61, p&lt;0.01), and lower FC (44 vs 239ug/g, p&lt;0.01). At W14, both TH (OR 11.3, 95%CI 2.1-61.4, p&lt;0.01) and FC remission (OR 7.4, 95%CI 1.8-30.7, p&lt;0.01) were significant predictors for EH. In a multivariate analysis including significant baseline characteristics and early non-invasive monitoring targets at W14 (table 2), TH was an independent predictor of EH (OR 8.6, 95%CI 1.2-61.7, p=0.03). Even after adjusting for the baseline ultrasonographic severity according to the IBUS-SAS, TH at W14 remained a significant predictor of EH (OR 6.5, 95%CI 1.02-40.9, p=0.047). Using a ROC curves analysis, the IBUS-SAS at W14 was the best predictor for EH, with an AUC of 0.81 and the best cut-off value of 32.2 (Table 3).

Conclusion
Early assessment of ultrasonographic remission at week 14 can help predict EH after one year of therapy and offers an opportunity for early therapy optimization. TH at week 14 assessed by IUS was an independent predictor for EH after one year of therapy. Our results support the use of early IUS monitoring to predict response to therapy in CD patients.
P336 Endoscopic scores as predictors of treatment failure in Ulcerative Colitis
Authors: Ferreira A I , Lima Capela T , Xavier S , Arieira C , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J 
Published: January 2023

Abstract

Background
The endoscopic Mayo score (MS) is the most frequent score used for the evaluation of inflammatory activity in Ulcerative Colitis (UC), varying from 0 to 3 points. Recently the DUBLIN score (DS) emerged, which varies from 0 to 9 points and results from the product of the MS and the disease extent, according to Montreal classification, E1-E3. In this study we aimed to evaluate and compare the predictive ability of MS and DS for long term treatment failure.

Methods
A retrospective and unicentric study was conducted, including patients with left-sided or extensive UC, asymptomatic and without the need for steroid therapy or therapy changes in the 6 months prior to undergoing total colonoscopy with calculation of MS and DS. Treatment failure was evaluated, defined by the need for therapy changes and/or hospitalization because of disease exacerbation, over a follow-up period of a minimum of 24 months and a maximum of 84 months.

Results
A total of 204 patients were included, 104 (51%) females and with a mean age at diagnosis of 36.4±12.7 years. In the initial evaluation, 48 (23.5%) were being treated with anti-TNFα medication. The mean values of MS were 1.0±1.1 points and of DS were 2.2±2.6 points. During follow-up, 32 (15.7%) patients experienced treatment failure and patients initially treated with anti-TNFα medication had 2.3 times higher risk of treatment failure (p=0.042). MS values (AUC 0.809; p&lt;0.001; with sensitivity of 0.938 and specificity of 0.529 for values equal or superior to 1) and DS values (AUC 0.789; p&lt;0.001; with sensitivity of 0.844 and specificity of 0.581 for values equal or superior to 2) had good discriminative abilities in predicting treatment failure. There were no statistically significant differences in the discriminative ability between both scores (p=0.340).

Conclusion
MS and DS had good discriminative abilities in predicting treatment failure. However, the integration of the disease extent in the DS as a complement of MS in the evaluation of UC was not associated with a higher predictive ability of long term treatment failure.
P337 Developing Preliminary MRI-based Classifier for Perianal Fistulizing Crohn’s Disease by Using Deep Convolutional Neural Networks
Authors: Zhang H , Li L , Deng K , Li W , Ren D 
Published: January 2023

Abstract

Background
Early diagnosis and management of perianal fistulizing Crohn’s disease (PFCD) is critical. But there is still lack of single reliable diagnostic modality to differentiate between early PFCD and cryptoglandular anal fistula (CAF). This study aimed to evaluate the feasibility and efficacy of deep convolutional neural networks (DCNNs) for distinguishing PFCD from CAF based on pelvic magnetic resonance imaging (MRI).

Methods
The MRIs from 400 patients primarily diagnosed with PFCD or CAF (two hundred respectively) were retrospectively collected as datasets and used in this study. All patients had no fistula associated surgical histories. The datasets were split into training (80%), validation (10%), and test(10%). Four different DCNNs, MobileNetV2, VGG11, ResNet18 and ResNet34, were trained to classify the patients with fistula MRIs as PFCD or as CAF. Both untrained and pretrained networks were used. Pretrained networks were obtained from the Pytorch Models, an open-access repository of pretrained models for use with Pytorch. The protocol was shown in Figure 1 and was approved by the institutional review board (2022ZSLYEC-421).On the test dataset, receiver operating characteristic curves and areas under the curve (AUCs) were used to assess model performances and were compared with the performances of radiologists. Comparisons between AUCs were made by using the Delong method. Accuracy, sensitivity, and specificity were determined from the optimal threshold by the Youden index.
Figure 1.

Results
Compared with CAF, the PFCD dataset contained more high fistulas (59.5% vs. 44.5%，P=0.003), more fistulas involved in the deep anterior space (15.5% vs. 3.0%，P&lt;0.001), and less abscess formation (32.5% vs. 59.5%，P&lt;0.001). Other fistula characteristics including ramification formation, supra- or infralevator extension, were not statistically different. The performances of the pretrained models were better than that of the untrained models (Figure 2). The AUC of 4 pretrained DCNN classifiers were MobileNetV2 [AUC: 0.943，95%CI（0.820~0.991）], VGG11 [AUC: 0.935, 95%CI（0.810~0.988）], ResNet 18 [AUC: 0.920, 95%CI（0.789~0.982）], ResNet 34[AUC: 0.929, 95%CI（0.801~0.986）] respectively. The performances of 4 pretrained DCNN classifiers were equivalent to that of senior radiologist, and were superior to that of junior radiologist (Figure 2, 3, 4).
Figure 2.

Figure 3.

Figure 4.

Conclusion
Deep learning with DCNN in classifying PFCD or CAF on perianal MRI is feasible. Transfer learning may further improve the performance of the DCNN model. A larger sample size dataset to train the former DCCNs is conducting in our constitution and the external validation will be added in the future.
P348 Disease trajectories in ulcerative colitis: Early identification of patients with endoscopic remission at Week 52
Authors: Schreiber S W , Danese S , Dirk L , Agboton C , Colombel J F 
Published: January 2023

Abstract

Background
Clinical understanding of different disease courses in response to targeted therapies in ulcerative colitis (UC) is lacking. Symptom load over time can help to define different trajectories leading to outcome measures at week 52. This post hoc analysis from the GEMINI 1 study of vedolizumab (VDZ) vs placebo for the treatment of moderately to severely active UC1 aimed to define different clinical patterns of response that led to Week 52 endoscopic remission based on daily collection of symptom data: rectal bleeding (RB) and stool frequency (SF).

Methods
RB and SF data, each scored 0 to 3, were extracted from the diary cards of patients who were treated with VDZ up to Week 50, had clinical outcome assessed at Week 52 and had sufficient diary data. From the daily scores, six different daily symptom score rules comprising RB alone or various combinations of RB and SF (Table 1) were derived. Each of the six symptom score rules was then accrued over the time to derive cumulative symptom scores (area under the curve [AUC]). The AUCs at Weeks 6, 10, 14 and 22 for each rule were evaluated for sensitivity and specificity to predict endoscopic remission at Week 52, which was defined as Mayo endoscopic subscore of ≤1 point.

Results
Of the 895 pts included in the GEMINI 1 study, 217 pts were treated with VDZ, had sufficient RB and SF data and Week 52 outcome data. Of these, 157 (72.4%) achieved endoscopic remission at Week 52. Rule 4, with a score of 0 if both RB=0 and SF≤1 or 1 if not, was consistently better at predicting response at Week 52, i.e., had largest area under the receiver-operator characteristic (ROC) curve (Week 10 and Week 14 shown in Table 2). Area under ROC curve for Rule 4 was 0.7317 (0.6578, 0.8057) and 0.7534 (0.6810, 0.8258) at Week 10 and Week 14, respectively (Fig 1). Rule 4 had better predictive performance than the use of RB Mayo score (RB1) alone or the simple dichotomization (RB2, 0 if RB≤1, 1 if RB &gt;1) [Table 2]. AUCs for Rule 4 differed between pts with vs without endoscopic remission at Week 52, with differences evident as early as Week 10: median AUC=41 for pts with endoscopic remission vs 70 for pts without (Fig 2).

Conclusion
The daily collection of RB and SF symptoms during the first weeks of therapy with VDZ identifies patients with a high likelihood for endoscopic emission at Week 52. Early clinical symptom change is a simple method for tight monitoring of patients with UC. The identification of preferential responder populations in which marked reduction of suffering are combined with hard endpoints could help in establishing treatment optimization algorithms for targeted therapies.
References:
1. Feagan BG et al. (2013) N Engl J Med 369:699–710
P349 Faecal Calprotectin in Ulcerative Colitis - Associations with Mucosal Inflammatory Activity and Disease Extent
Authors: Steinsbø Ø , Aasprong O G , Karlsen L N , Aabakken L , Grimstad T 
Published: January 2023

Abstract

Background
In ulcerative colitis (UC), faecal calprotectin (FC) correlates with endoscopic severity and disease extent, and low levels are associated with histological remission [1, 2]. The effect of mucosal inflammatory activity versus disease extent on the FC levels, remains poorly understood.
We aimed to compare FC levels in patients grouped by endoscopic and histologic scores of the inflammatory activity. We also grouped patients according to active disease extent based on endoscopic or histological evaluations.

Methods
This was a post hoc analysis of patients diagnosed with UC or with confirmed UC at Stavanger University Hospital, Norway, from 2012 to 2020. Visits were performed at diagnosis, and after 3 and 11 months. FC was analysed in samples collected from 4 weeks before until 3 days after visits (EliA Calprotectin or EliA Calprotectin 2, Thermo Scientific). At each visit, colonoscopy was performed, and biopsies were collected from three colorectal segments (rectum, left colon, right colon).
Mucosal inflammatory activity was scored endoscopically by Mayo Endoscopic Score (MES 0 – 3) and histologically by Nancy Histological Index (NHI 0 – 4). The highest value of the segmental NHI scores were reported.
Disease extent was defined by Montreal classification. Distribution of acute inflammation was defined by the number of colorectal segments with NHI ≥ 2 (presence of neutrophilic infiltrates).

Results
In total 554 visits of 249 patients were analysed. FC levels increased significantly for every stepwise increase in MES, and median FC was 30-fold (range 19-49) higher in MES 3 than in MES 0 subgroups. The largest difference was observed between MES 1 and MES 2 (Figure 1a).
FC levels also increased significantly for every stepwise increase in NHI, except between NHI 3 and NHI 4. Median FC level was 54-fold higher in NHI 4 group compared with the NHI 0 group, and the largest difference was observed between NHI 1 and NHI 2 (Figure 1b).

Disease extent showed little effect on FC, and significant difference was only observed between proctitis and pancolitis with 3-fold (range 1.6 – 4.5) higher levels in the latter groups (Figure 2a).
Median FC level was 3-fold higher in patients with acute inflammation in all 3 segments compared to patients with acute inflammation in only 1 colorectal segment (Figure 2b).

Conclusion
FC increased significantly by increasing mucosal inflammatory activity, whereas disease extent showed a modest effect on the FC levels. FC is an accurate and useful biomarker of both endoscopic and histological inflammatory activity in patients with ulcerative colitis.
References:
1. Kawashima K. et al, BMC Gasteroenterology 2016
2. Magro F. et al, Gut 2019
P362 Systematic review: Oncological outcomes of patients with Inflammatory Bowel Disease undergoing segmental colonic resections for colorectal cancer and dysplasia
Authors: Shamsiddinova A , Deputy M , Worley G , Rao C , Dean H , Thomas-Gibson S , Faiz O 
Published: January 2023

Abstract

Background
Current international guidelines recommend that patients with inflammatory bowel disease (IBD) diagnosed with high grade dysplasia (HGD), or colorectal cancer undergo a proctocolectomy, and that proctocolectomy is considered within a shared decision-making framework with the patient in cases of low grade (LGD) or indeterminate (IND) dysplasia. However, segmental colectomy (surgical resection leaving remaining colon or rectum) is considered by some as a valid alternative, with less physiological stress, stoma avoidance and thus acceptability to patients. This systematic review aims to assess oncological and post-operative outcomes in studies reporting on segmental colectomy or proctocolectomy for patients with IBD and colonic or rectal dysplasia and cancer.

Methods
This systematic review was prospectively registered with PROSPERO (CRD42021292891) and carried out in line with the PRISMA guidelines. Studies published between 1990 and 2022 reporting on oncological and surgical outcomes of adult patients undergoing segmental resection and/or proctocolectomy that included at least three cases of neoplasia were included. Descriptive statistics were used in the context of significant heterogeneity. A meta-analysis was performed for outcomes with at least three results.

Results
The search returned 2178 results, and after screening 12 studies were included in the final analysis. A total 12,701 patients were included reporting on outcomes of 10,386 segmental resections and 2,315 proctocolectomies. The pooled incidence of missed synchronous cancers (i.e. identified in remaining colon or rectum within 6 months of surgery) in the segmental resection group was 1.4%, and dysplasia 0.5%; metachronous cancer recurrence was 1.4% (1.1% in subtotal colectomy, 11.8% in any other segmental resection), and dysplasia recurrence 5.3% (4.7% in subtotal colectomy, 7.5% in any other segmental). Average time to recurrence for metachronous cancer was 6.5 years. Recurrence of metastatic cancer was 0.2% for proctocolectomy, and 0.1% for segmental resection (OR 1.28, 95% CI 0.19 - 8.65, p =ns).

Conclusion
Segmental colectomy does not disadvantage against metastatic cancer recurrence. The incidence of missed synchronous lesions is low. There is increased metachronous cancer risk, however this is mitigated by subtotal colectomy. These results may help to counsel patients regarding the risks and benefits of segmental resection for IBD-related dysplasia and cancer. The risk of metachronous cancer after segmental resection reiterates the need for enhanced high quality post-operative surveillance. The paucity of data in this field is also demonstrated here by the high inter-study heterogeneity, highlighting the need for prospective studies.
P368 The presence of extra-intestinal manifestations is associated with poor prognosis in acute severe ulcerative colitis: A KASID multicenter study
Authors: Kim D H , Kim E S , Kim H S , Park S H , Kim S J , Kim K O , Lee Y J , Song E M , Kim D S , Lee J ,   IBD Research Group in Korean Association for the Study of the Intestinal Diseases (KASID)
Published: January 2023

Abstract

Background
Many patients with inflammatory bowel disease experience extra-intestinal manifestations (EIM)s. The presence of EIMs is related to disease activity. Acute severe ulcerative colitis (ASUC) is associated with a high inflammatory burden. However, there are insufficient studies on the relation between the presence of EIMs and the prognosis of exacerbation of ulcerative colitis. This study was conducted to elucidate the correlation between EIMs and ASUC.

Methods
We retrospectively included patients who were hospitalized at four tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the underlying disease, disease activity, EIMs, colectomy, treatment method, and readmission due to ulcerative colitis aggravation were checked.

Results
A total of 145 patients (mean age 44.4 years, 68 women) were investigated. The initial partial Mayo score, the Mayo endoscopy sub-score, and the ulcerative colitis endoscopic severity index were 7.6±0.8%, 2.7±0.5, and 6.0±1.4%, respectively.
EIMs were expressed in a total of 10.3% (15/145) of patients. The most common type of EIMs was the peripheral articular type (46.7%) followed by skin lesions (20%) and axial articular disease (13.3%). The group with EIMs was younger and had a higher proportion of women than the group without EIMs (39.4 versus 45 years, p=0.03), and had a longer duration of disease (5.8 versus 3.5 years, p=0.02). The Mayo endoscopic sub-score (2.9 vs. 2.7, p&lt;0.01) and partial endoscopic score (7.9 vs. 7.6, p&lt;0.01) were also higher in the EIMs group. The length of hospital stay was also longer in the EIMs group (25.5 days vs. 13.8 days, p&lt;0.01).
The response rate to initial treatment was lower in the EIMs group (71.4% vs. 95.5%, p&lt;0.01), and more rescue therapy (28.6% vs. 4.5%, p&lt;0.01) was performed. The rate of colectomy on admission was also higher in the group with EIMs (13.3% vs. 0.8%, p&lt;0.01). Patients with EIMs showed a high tendency to visit the hospital for re-exacerbation of ulcerative colitis after discharge (p=0.07, HR 2.10 CI: 0.93 – 4.76).

Conclusion
EIMs were expressed in a total of 10.3% of patients with ASUC. The presence of EIMs suggested a poor prognosis in ASUC.
P369 Do teenager and adult onset Crohn′s disease patients have different outcomes? A Portuguese cohort study
Authors: Cerqueira R , Correia M , Veloso R , Manso M C 
Published: January 2023

Abstract

Background
Crohn’s disease (CD) is a chronic illness that, according to the age of onset, has disease heterogeneity. Comparing with CD adult-onset (AO), the teenager-onset (TO) may lead to a deeper health impact: late pubertal development and psychosocial problems. There is paucity of data comparing TO with AO in the biologics era.
The aim of this single center study was to compare disease characteristics, the use rate and predictive risk factors at diagnosis for CD biologic therapy (anti-TNF) and the rate of CD related surgery

Methods
Observational study designed as an analysis of a historical cohort: 298 CD patients followed up to 21 years (2000-2021), 49 TO (&lt;20 years-old) and 249 AO (≥20 years-old). Median follow-up was 9 years in TO and 10 years in AO cohort (p=0.792).
The data collected included sex, and at diagnosis, age, smoking habits, CD location, CD behaviour, presence of perianal disease and extra intestinal manifestations. The independent effect of significant variables (p&lt;0.05) was assessed using multivariate logistics regression analysis. The cumulative use rate of biologic therapy and CD related surgery were estimated using Kaplan-Meier plots.

Results
The TO cohort comprised 49 (16.4%) and the AO 249 (83.6%) CD patients. Upper digestive tract involvement and inflammatory behaviour at diagnosis were significantly higher in the TO cohort (p&lt;0.001). Biologic therapy rate was significantly higher in TO than in AO (63.3% vs 43.8%, OR=2.21(95%CI:1.17-4.15), although the time span from diagnosis to the fist biologic use is independent of group (Log-Rank(Mantel-Cox);p=0.812). On multivariate analysis, predictive risk factors at diagnosis for biologic therapy in AO cohort were non-inflammatory phenotype, OR=2.75(95%CI:1.58-4.81), steroid therapy, OR=3.64(95%CI:2.05-6.47) and perianal disease, OR=14.49(95%CI:5.50-38.17); no significant predictive risk factors were identified in the TO cohort. Regarding CD related surgery, there was no significant different rates between the two age groups (18.4% in teens vs 26.1% in adults, OR=0.66(95%CI:0.31-1.45); p=0.300) and the time span from diagnosis to surgery was also independent of group (Log Rank(Mantel-Cox);p=0.204).

Conclusion
Compared with AO, TO CD has different characteristics and, «per se», is a higher risk for biologics drugs treatment.
However, TO CD is not associated with higher risk of surgery.