bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0380 Mild Hyperemia in the Absence of Bowel Wall Thickening on Intestinal Ultrasound is Associated with Biochemical Disease Activity and Worse Disease Outcomes in Patients with Crohn’s Disease and Ulcerative Colitis
Authors: Krugliak Cleveland N , Bhondwe K , Duty C , Fear E , George T , Ayoub Q N , McDonald B , Kellar A , Rubin D T 
Published: January 2025

Abstract

Background
Bowel wall thickness (BWT) and hyperemia measured by intestinal ultrasound (IUS) predict endoscopic disease activity in Inflammatory Bowel Disease (IBD). The clinical significance of mild hyperemia (mLim1) without BWT is unknown. We previously described the short-term predictive value of mLim1 without BWT. Here we compare biochemical disease activity and longer-term outcomes in IBD pts with mLim1 to those with normal IUS.

Methods
We reviewed index IUS exams of pts with IBD at the University of Chicago from 7/18/2022 to 5/7/2024 and included pts with normal BWT (≤3.0mm) + mLim1 and compared them to pts with normal BWT + no hyperemia (mLim0). We excluded pts with mLim2 or 3, BWT&gt;3mm anywhere on index IUS or pts with mLim1 at surgical anastomoses only. Clinical Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI)) and biochemical disease activity (faecal calprotectin (FCP) or C-reactive protein (CRP)) were assessed at the time of index IUS. Clinical remission was defined as HBI of &lt;5 or SCCAI of ≤2, FCP&lt;150 μg/g, CRP&lt;5 mg/L. Primary analysis was poor disease outcome (PDO) within 12 mo of follow-up, defined as: IBD medication change/escalation, prescription of corticosteroids, IBD-related surgery, or IBD-related hospitalization.

Results
45 pts with mLim1 (38 Crohn’s disease (CD), 7 Ulcerative colitis (UC)) and 61 pts with mLim0 (52 CD, 9 UC) at index IUS were included (Table 1). At baseline IUS, mLim1 pts had elevated median FCP but normal median HBI/SCCAI, while mLim0 pts had normal median FCP and HBI/SCCAI (Table 1). Of mLim1 CD pts, 14/38 (36.8%) had a PDO within 3 months (mo), 18/38 (47.4%) within 6 mo, and 18/30 (60%) within 12 mo, with median time to PDO of 37 d (IQR 28.5-112.5). Of the mLim0 CD pts, 5/52 (9.6%) had a PDO within 3 mo, 9/46 (19.6%) within 6 mo, and 14/45 (31.1%) within 12 mo, with median time to PDO of 91 d (IQR 93-184). Rates of PDO between mLim1 and mLim0 in CD pts at 12 mo were statistically significant (stat sig), p = 0.013. Of the mLim1 UC pts, 3/7 (42.9%) had a PDO within 3 mo and 2/3 (66.7%) had a PDO within 12 mo, with a median time to PDO of 139 d (IQR 93-184). Of the mLim0 UC pts, one had a PDO at 3 mo with no further events noted at 6 mo (0/8) or 12 mo (0/4). Rates of PDO between mLim1 and mLim0 in UC pts at 12 mo were not stat sig, (p = 0.270).

Conclusion
Mild hyperemia without BWT is associated with biochemical disease activity in both CD and UC and predicts PDO in CD. Although PDO in UC was numerically higher in mLim1 compared to mLim0, this was not stat sig likely due to small cohort size. These findings support the consideration of treatment adjustments when this isolated parameter is identified and inform future IUS treat-to-target strategies.
P0382 Identifying atypical disease phenotypes in paediatric Ulcerative Colitis: Insights from the real world PIBD-SETQuality cohort
Authors: Camman A , Klomberg R , Peters P , Christos T , Koletzko S , Russell R , Nedelkopoulou N , Croft N , de Ridder L 
Published: January 2025

Abstract

Background
The heterogeneity of paediatric ulcerative colitis (P-UC) can complicate diagnosis and prompt start of optimal induction treatment, which is crucial for adequate disease control. Recognizing and understanding atypical disease patterns in P-UC will decrease misclassification and contribute to the development of standardized classification tools. This study aims to provide insight in the real world prevalence of atypical phenotypes in newly diagnosed P-UC patients.

Methods
Data were collected from the Paediatric Inflammatory Bowel Diseases Network for Safety, Efficacy, Treatment and Quality improvement of care (PIBD-SETQuality) cohort, a multicenter, international, prospective, observational study including therapy naive children &lt;19 years old with IBD. Patients diagnosed with UC between January 1st 2017 and June 14th 2024 were enrolled. Diagnostic criteria and macroscopical atypical disease were based on the validated PIBD-classes algorithm by revised Porto Criteria1. The Mann-Whitney U test and Chi-square tests were used to compare, respectively, numerical and categorical data between patient groups.

Results
Baseline data of 197 P-UC patients were included. At diagnosis, 68% of the patients presented with pancolitis. Atypical disease occurred in 35.0% (69/197) of the patients of which relative rectal sparing was most common (Table 1). Aspecific upper gastrointestinal inflammation occurred in 10.6% (17/161) of the patients, of whom 6 also exhibited atypical disease phenotypes. Approximately 1 out of 10 patients with atypical disease presented with multiple atypical phenotypes. Patients with atypical disease did not show significant differences compared to patients without atypical disease in time to diagnosis (107 days vs. 104 days, P=0.19), absolute PUCAI score (40 [IQR 30-55] vs. 35 [IQR 25-58.75], p=0.10), initial induction therapy and need for treatment intensification during induction therapy (8 vs. 4 patients, p=0.22).

Conclusion
Atypical disease presentations are common in P-UC in this real world cohort, as is the presence of combined atypical disease features. Recognition of atypical disease features in P-UC, and understanding their impact on disease course, are crucial for prompt start of optimal tailored therapy. In this cohort, the presence of atypical disease did not result in a diagnostic delay or treatment intensification during induction period.

References
1.Birimberg-Schwartz L, Zucker DM, Akriv A, et al. Pediatric IBD Porto Group of ESPGHAN. Development and validation of diagnostic criteria for IBD subtypes including IBD-unclassified in children: a multicentre study from the Pediatric IBD Porto Group of ESPGHAN. J Crohns Colitis. 2017;11(9):1078-1084. doi:10.1093/ecco-jcc/jjx053.
P0388 Can intestinal ultrasound guide us in the treatment of inflammatory bowel disease?
Authors: Tejerizo García L , Prieto Vicente V , Piñero Pérez M C , Fernandez Pordomingo A , Dominguez Gómez R , Gómez Hidalgo R , Velasco Guardado A , Garcia-Alvarado M , Muñoz Nuñez F 
Published: January 2025

Abstract

Background
Intestinal Ultrasonography (IUS) is a useful method for monitoring inflammatory bowel disease. The role of Shear Wave Elastography (SWE) and the relationship with other parameters indicating activity are not yet well understood.

Methods
The aim was to describe the ultrasound characteristics observed in a cohort of patients with Crohn’s disease (CD) and the changes in therapeutic attitude derived from the results of this imaging test.
To evaluate the usefulness of SWE in patients with intestinal strictures to detect fibrosis in comparison with analytical and ultrasound parameters of inflammatory activity.
We conducted a single-center, retrospective, observational study of a baseline study including IUS examinations performed in CD patients between May 2022 and February 2023.

Results
We included 63 IUS in CD patients (60.9% male; mean age 43 ± 17 years). The mean HBI-score was 2.77 (± 2.6). A change in therapeutic approach was made in 32.8% of cases following IUS.
Stricture was found in 22 IUS (34.9%), with a mean length of 5.6 ± 2.59 cm. Fat wrapping was observed in 40.9% of cases, and loss of wall stratification in 9.1%. Median SWE of the stricture was 9.05. Calprotectin is directly related to the Limberg scale (p&lt;0.001) and indirectly with the SWE value (p&lt;0.05). Inverse correlation between Limberg scale and SWE value (p&lt;0.05) was observed.

Conclusion
intestinal ultrasonography facilitates a proactive monitoring in CD because immediate changes in therapeutic approach can be made. The combination of the Limberg scale and the SWE value allow the definition of intestinal strictures. Comparative studies are needed to clarify the usefulness in predicting the degree of fibrosis.
P0389 Cardiovascular risk assessment and ultrasound-assisted reclassification in patients with Inflammatory Bowel Disease (IBD): a single-centre study
Authors: Blando G , Viola A , Patanè L , Toscano A , Costantino G , Squadrito G , Mandraffino G , Fries W 
Published: January 2025

Abstract

Background
Patients with inflammatory bowel disease (IBD) have an increased cardiovascular risk (CVR) and cardiovascular disease (CVD) is the leading cause of mortality in IBD patients. A more in-depth screening of patients has become important with the EMA warning for JAK-inhibitors. The current CV risk stratification algorithms are based on traditional risk factors not considering subclinical atherosclerosis. This study aimed to stratify the CVR of IBD patients according to the European Society of Cardiology (ESC 2021/23) and European Society of Atherosclerosis (EAS), together with the evaluation of the presence of previously subclinical atherosclerosis by carotid ultrasound.

Methods
Demographic and disease-related data were collected from consecutive IBD patients aged over 40 years, including systolic blood pressure, body mass index (BMI), lipid panel, and cardiovascular comorbidities. Asymptomatic atherosclerotic disease was assessed by carotid ultrasound in order to measure the carotid intima-media thickness (cIMT) and to detect the presence of plaques. CVR was stratified based on the latest guidelines on dyslipidemias (EAS/ESC 2019), cardiovascular prevention (ESC 2021), and the management of cardiovascular disease in patients with diabetes (ESC 2023). Moreover, additional IBD-related parameters potentially associated with an increased CVR were investigated, such as disease activity, current therapies, duration of disease, and extraintestinal manifestations.

Results
A total of 120 IBD patients were included (UC: 67 patients, CD: 53 patients) Baseline characteristics are presented in Table 1. Patients with UC had significantly higher mean values of total cholesterol (C-TOT) and low-density lipoprotein cholesterol (C-LDL) (p&lt;0.001 and p=0.001 respectively). At baseline, 48% of patients were classified as having intermediate CVR, 34% as high risk, and 18% as very high risk (Table 2). Following carotid ultrasonography, subclinical atherosclerosis was diagnosed in 48.3% of patients. Based on these findings, CVR re-stratification was performed in 21% of patients resulting in 71% of patients with high and very high risk, compared to 50% at baseline. Additional risk factors for an increased CVR identified by multivariate regression analysis were having active disease (p=0.047) and concomitant spondiloathropathies (p=0.03).

Conclusion
Our study demonstrates that carotid ultrasound contributed to re-classify the CVR in patients who were previously considered to be in lower risk categories confirming that the use of traditional risk scores underestimates CVR in IBD patients. Having active intestinal disease and concomitant spondiloarthritis increases further the CV risk.
P0393 Radiological healing in perianal fistulising Crohn’s disease: MRI predictors and disease course
Authors: Delmotte V , Gillard R , Louis E , Defraigne-Peigneur E , Meunier P , Reenaers Dr C 
Published: January 2025

Abstract

Background
Perianal fistulising Crohn’s disease (CD) is a disabling condition affecting up to 30% of patients. Studies suggest that greater fibrosis in the fistula tract is linked to improved clinical outcomes. This study aims to describe the natural history of perianal fistulising CD, including MRI parameters, and to identify clinical and radiological predictors of relapse and radiological healing

Methods
Pelvic MRIs for perianal fistula performed at CHU Liège, Belgium, from 2018 to 2023 were collected. MRI protocols used 1.5T [Siemens Aera/Sola] or 3T [Siemens Vida] machines, with sequences including T2 TSE, T2 TSE FS, and T1 TSE FS before and after gadolinium injection. The MAGNIFI-CD and modified Van Assche (VA) indices were assessed for each patient. Two blinded radiologists evaluated fistula tract fibrosis. For patients with perianal flare, only the first MRI was analysed (MRI 1). For others, the first and last MRI (MRI 2) within the study period were assessed. Perianal flare was defined as abscess drainage or stoma creation for active perianal CD, and radiological healing as ≥80% fistula fibrosis or a MAGNIFI-CD score of 0.

Results
A total of 102 pelvic MRIs from 84 patients were included. The median patient age was 39 years (31–51), with 40% female. The median duration of perianal CD was 52 months (2–144); 26% had a seton at MRI 1, 7% had a stoma, and 41% were on anti-TNF therapy. During follow-up, 22% required abscess drainage. No clinical factors were associated with perianal flare. Univariate analysis identified several MRI 1 radiologic predictors of flare: fibrosis percentage (OR=0.72, p=0.033), VA hyperintensity T2 (OR=3.22, p=0.028), VA rectal involvement (OR=1.75, p=0.040), VA inflammatory mass (OR=1.42, p=0.022), VA T1 post-contrast hyperintensity (OR=3.68, p=0.045), MAGNIFI-CD score (OR=1.13, p=0.022), MAGNIFI T1 post-contrast hyperintensity (OR=1.77, p=0.031), and MAGNIFI inflammatory mass (OR=1.40, p=0.033). In multivariate analysis, only MAGNIFI T1 post-contrast hyperintensity remained significant (OR=1.77, p=0.031). Radiological healing was achieved in 30% at MRI 1 (25/84) and 44% at MRI 2 (8/18). No factors at MRI 1 predicted healing at MRI 2, though T1 post-contrast hyperintensity at MRI 1 showed a trend towards predicting lack of healing (OR=0.11, p=0.071).

Conclusion
One-fifth of patients experienced perianal flare during follow-up. Clinical and therapeutic factors did not predict outcomes; only persistent MRI inflammation and low fistula fibrosis were linked to future abscess drainage. Specific MRI features may serve as therapeutic targets in perianal CD management, pending validation in a prospective cohort.
P0400 Automated real-time detection of intestinal tract and inflammatory bowel disease in intestinal ultrasound with the vision transformer (ViT)
Authors: Delaire J , Mohtaram N , Yzet C , Brazier F , Chaidron C , Fumery M 
Published: January 2025

Abstract

Background
Intestinal ultrasound is a powerful tool for diagnosing and monitoring inflammatory bowel disease (IBD). Although access to training is improving, the detection and interpretation of ultrasound images in IBD remains complex. The aim of this study was to develop and validate an artificial intelligence module to automatically detect the intestinal tract and active IBD in order to simplify the use of ultrasound in IBD.

Methods
Vision Transformers (ViTs), recently introduced as a competitive alternative to Convolutional Neural Networks (CNNs), were used to automate the real time detection and segmentation of the normal and inflamed intestinal tract. ViTs were chosen for their ability to better capture global relationships in images, which is particularly useful for recognizing complex patterns in medical images. The ViT model was trained on a dataset consisting of 17,488 intestinal ultrasound images from 46 patients, including 11,396 images of active IBD and 6,092 inactive IBD evaluated by two gastroenterologists.

Results
The sensitivity, specificity and accuracy for the detection of inactive and active IBD calculated from two intestinal ultrasound loop containing a total of 617 images of inactive IBD and 339 images of active IBD were 95%, 94% and 95% respectively. Some limitations were identified, notably a decrease in sensitivity in the detection of minor anomalies, in areas of low contrast and during variations in scale. These points suggest that the model could benefit from further refinement of its spatial processing capabilities, particularly in complex clinical situations.

Conclusion
We have developed a model based on the pre-trained Vision Transformer (ViT) architecture that is able to detect the active and inactive IBD. This approach could eventually make it easier for inexperienced operators to use intestinal ultrasound to detect and monitor IBD. Further in-depth tests on a larger set of images and videos are under way to validate the model’s performance.
P0401 The IBD-disk accurately assesses disability and psychological burden at IBD diagnosis and predicts adverse outcomes in both UC and Crohn’s disease during the first year of treatment
Authors: Rimmer P , Stoica V , Ibrahim M , Javed A , Hazel K , Owusu M , Regan-Komito D , Cooney R , Iqbal A J , Chapple I , Harvey P , Iqbal T 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is linked with increased prevalence of mental health diseases (MHD), particularly anxiety and depression. How this influences treatment outcomes is poorly studied at IBD diagnosis. The IBD disk is a patient-reported outcome measure that quantifies disease-associated disability. We aimed to determine if the disk can be used pre-diagnosis to screen for mental health symptoms and predict treatment outcomes.

Methods
Patients with suspected IBD were seen in a rapid-access clinic. An IBD disk was completed upon review, pre-diagnosis. A subgroup simultaneously completed the Hospital Anxiety and Depression scale (HADS). Repeat disks were completed after diagnosis, with 12-month outcomes collected prospectively.

Results
188 patients completed a baseline disk (97 Crohn’s disease [CD], 91 Ulcerative colitis [UC]), 95 completed a simultaneous HADS and 82 completed a repeat disk. Both a pre-existing MHD diagnosis (CD 22%, UC 11%, X2 p=0.049) and an active anti-depressant prescription (CD 16%, UC 7%, X2 p=0.035) were more common at CD diagnosis than UC. The ‘Emotions’ domain correlated with HADS depression (rs=0.607 p&lt;.001), anxiety (rs=0.586 p&lt;.001) and reliably identified HADS defined moderate-severe depression (Area under the curve 0.873). A score ≥7 identified all patients meeting this HADS threshold (Sensitivity 100%, specificity 60.5%, Youden’s index 0.601). This is shown in Figure 1.
Whilst the IBD Disk did not outperform traditional disease severity indices, elevated baseline disk scores in UC predicted the subsequent need for advanced therapies (p=0.019), persistent active disease at 12 months (p=0.023) and need for inpatient treatment (p&lt;.001). In CD, elevated disk scores predicted need for advanced therapies (p=0.014), persistent active disease (p=0.015) and showed a weak association with the need for surgical resection within 12 months (p=0.064). These results are summarised in Table 1.
After diagnosis and treatment, ongoing disability and psychological symptoms were driven by disease activity. In both UC and CD, the ‘Emotions’ domain fell significantly in those in remission at first follow-up (CD p&lt;.001; UC p=0.008) but was unchanged when the disease remained active (CD p=0.71; UC p=0.72).

Conclusion
The IBD disk reliably screens for symptoms of depression and anxiety and identifies risk of adverse treatment outcomes at IBD presentation. Its use in the outpatient setting can support holistic disease assessment and identify those who are most likely to benefit from additional psychological support. Moreover, particularly in UC patients, elevated baseline IBD disk scores should prompt the consideration of treatment escalation early in the disease course.
P0404 Ileal Thickening in a TB-endemic Country : Crohn’s or Tuberculosis? Serial Intestinal Ultrasound Holds the Answer
Authors: Kulkarni A , Joshi H , Giri S 
Published: January 2025

Abstract

Background
In countries like India, which are endemic for Tuberculosis (TB), every symptomatic ileal thickening may not implicate a straightforward diagnosis of Crohn’s disease. In fact, most of these symptomatic findings are attributable to TB, and anti-tuberculosis therapy (ATT) leads to symptomatic as well as endoscopic improvement. In patients with Crohn’s Disease (CD), on the other hand, ATT leads to a deceptive symptomatic improvement; however, multiple studies from India found that it is not accompanied by endoscopic improvement, and if this is not picked up, there are higher chances of the patient later developing structuring CD. A colonoscopy at the end of two months of empirical ATT is the current protocol in India, to differentiate between TB and CD. This is resource-intensive for the patients as well as healthcare facilities. We explored the role of Intestinal Ultrasound (IUS) in differentiating ileo-cecal TB and CD.

Methods
All adult patients presenting to our centre with a symptomatic ileal or ileo-cecal thickening were subjected to IUS in addition to the standard of care evaluation (Inflammatory markers such as CRP and ESR, CT or MR Enterography, Ileo-colonoscopy with biopsy). After the evaluation, these patients were administered empirical ATT for two months, followed by a repeat IUS. The baseline ileal wall thickness, vascularity were noted. The patients received their diagnosis (TB or CD) based on the presence of endoscopic response at the end of the two-month ATT course.

Results
The mean ileal wall thickness, as measured in the baseline IUS, before ATT, was 2.9 mm for patients with ileo-cecal TB compared to 4.2 mm for CD (p &lt; 0.0001). At baseline, the mean Limberg Score in patients with TB was 1 compared to 2.7 in those with CD (p &lt; 0.0001). At the end of two months after the ATT course, the average decline in the wall thickness was 0.6 mm for TB compared to 0.09 mm for CD (p &lt; 0.0001). This also correlated with persistent endoscopic findings after ATT, signifying presence of CD. The average Limberg score calculated at the end of the ATT for two months was 0.38 for TB compared to 2.7 for CD (p &lt; 0.0001).

Conclusion
The higher baseline wall thickness and prominent vascularity is a significant predictor of CD in patients with ileo-cecal thickening. A lack of decline in the wall thickness and vascularity with ATT correlates with the lack of endoscopic response, and thus is able to differentiate between TB and CD.