bluuebunny/crossref_metadata_2025_split huggingface dataset:
P155 Natural history of anal stricture in pediatric-onset Crohn’s disease: a two-decades population-based study
Authors: Mortreux P , Leroyer A , Ley D , Dupont-Lucas C , Bertrand V , Wils P , Coevoet H , Paupard T , Gower-Rousseau C , Siproudhis L , Guillon N , Sarter H , Savoye G , Turck D , Fumery M 
Published: January 2023

Abstract

Background
The natural history of anal stricture complicating pediatric-onset Crohn’s disease (CD) is poorly known. The aims of this study were: to determine in a population-based study the risk of anal stricture in pediatric-onset CD; to identify risk factors for anal stricture; and to evaluate the natural history of anal stricture at the population level.

Methods
All patients with a diagnosis of CD made before the age of 17 years between 1988 and 2011 in a population-based registry were followed retrospectively until 2013. A specific collection of additional data was performed in patients with anal stricture at diagnosis or during follow-up. Variables collected included: proctological examination, diagnostic management and treatment. Multivariate Cox models were used to identify factors associated with anal stricture.

Results
Among the 1,007 included CD patients (females, 451 (44.8%); median age at diagnosis 14.4 years (IQR, 12.0-16.1), median follow-up 8.8 years (IQR, 4.6-14.2)), only one (0.1%) had anal stricture at diagnosis while 26 (2.6%) presented anal stricture during follow-up. Cumulative incidence of anal stricture at 5 and 10 years after diagnosis was 0.6% (CI95%, 0.1-1.1) and 1.4% (CI95%, 0.5-2.3), respectively. Among the 27 patients with anal stricture, 25 (92.6%) had already at least one episode of anal ulceration or fistulizing perianal CD (pCD). In multivariable analysis, the presence of extra-intestinal manifestations (Hazard Ratio (HR) 2.2, CI95% 1.0-4.8, p=0.027), colonic location (L1 vs L3 HR 0.0 (-); L2 vs L3 HR 1.2, CI95% 0.6-2.7, p=0.006) and history of fistulizing pCD (HR 9.9, CI95% 4.3-22.8, p&lt;0.0001) were significantly associated with anal stricture. Eleven (41%) patients needed at least one dilation. After a median follow-up of 16.9 years (IQR, 11.5-20.2), healing of anal stricture was observed only once. One patient (3.7%) presented an anal cancer 7 years after the diagnosis of anal stricture. Nine (33.3%) patients needed a stoma. Among them, 8 already had a fistulizing pCD and 4 needed an abdominoperineal amputation. Anal stricture was significantly associated with an increased risk of stoma (HR 5.8, CI95% 2.3-14.3), p=0.0002).

Conclusion
Anal stricture is a rare event in pediatric onset CD, occurring in 1.5% of patients over a 10 year-period after diagnosis. However, anal stricture had a negative impact on disease prognosis with a five-fold increase of the risk of stoma.
P159 Development of a core set of quality of care measurements for patients with inflammatory bowel disease in Belgium
Authors: Fierens L , Bossuyt P , Baert F , Baert D , Lavaerts M , Weltens C , Ferrante M 
Published: January 2023

Abstract

Background
Uniform and standardized quality indicator (QI) measurement allows to assess quality of care (QoC) and set up quality improvement initiatives. To date there is no uniform measurement of QoC in IBD centres in Belgium. We therefore aimed to adapt existing standards of QoC to practical local needs, and to define a core set of quality measurements (QM) through a multi-stakeholder consensus.

Methods
A Core Team (4 IBD expert clinicians, 3 researchers) prepared and coordinated the Delphi process (Figure). Through a literature review, 221 existing QIs for IBD were identified. Second, an importance rating scale exercise was performed, leading to 58 QIs that were reformulated into practical QMs. Next, a variety of experts from different centres in Flanders were invited to rate the importance of these 58 QMs on a 10-point Likert scale. In between two consecutive online voting rounds, expert and patient (n=93) perspectives were provided. Furthermore, participants could also suggest items that were missing in the pre-selected list. A consensus threshold of ≥80% of the participants scoring the item 7, 8, 9 or 10 in voting round 2 was applied as the cut-off criterion for an item to be directly included in the final set of QMs. Newly suggested items and items that did not reach the cut-off criterion were discussed and reconsidered for inclusion in the final set during a closing consensus meeting. In order to come to a workable selection of items, participants to the consensus meeting were requested to estimate the potential for improvement of each of the selected QMs.

Results
In total 40 stakeholders of which 29 IBD clinicians, 7 IBD nurses, 2 paediatricians, 1 abdominal surgeon and 1 chief medical officer from 24 different Flemish centres participated in both Delphi voting rounds. Of this group, 21 IBD clinicians, 3 IBD nurses and 2 paediatricians also participated in the virtual consensus meeting. In total, 50 items reached the cut-off criterion for direct inclusion in the final QM set, the other 8 items and also 3 new items were discussed and re-voted during the consensus meeting of which 8 additionally reached the cut-off criterion to include in the final set. Based on the estimated improvement potential, 19 of these 58 QMs were prioritized and agreed to measure in clinical practice (Table).

Conclusion
We defined a core set of 58 QMs for IBD based on multi-stakeholder consensus. In the next phase of this project, a more condensed subset of 19 QMs with potential for improvement will be measured in IBD centres across Belgium, allowing QoC assessment, benchmarking and quality improvement initiatives.
P169 Copy number variation of alpha defensin 1-3 is a predictive marker of therapeutic response in ulcerative colitis
Authors: Kanmura S , Tanaka A , Maeda N , Kuwazuru K , Komaki F , Sameshima Y , Komaki Y , Ido A 
Published: January 2023

Abstract

Background
Alpha-defensin 1-3 (DEFA1A3) is an antimicrobial peptide found in phagocytic cells such as neutrophils, functioning as an effector factor in innate immunity. Reports suggest that copy number variation (CNV) of the DEFA1A3 gene is associated with the severity of ulcerative colitis (UC). However, the impact of DEFA1A3 on the pathogenesis of UC, and treatment response has not been fully investigated. Therefore, we aimed to evaluate the relationship between DEFA1A3-CNV and UC treatment response.

Methods
This was a retrospective and two medical centers study. The study included UC patients with DEFA1A3-CNV measurements, who attended our department and related facilities between 2020 and 2022. Clinical background and white blood cell count and serological marker were collected from the medical records of included patients. DEFA1A3-CNV was measured using droplet digital PCR after DNA extraction from peripheral blood mononuclear cells. Mayo score was used to determine the response to treatment and severity of UC.

Results
In total, 197 UC patients were included in the study. The median DEFA1A3 copy number was 7.36, and there was a significant correlation between DEFA1A3 copy number and Mayo score. The high DEFA1A3 copy number group had a significantly higher severity of UC during the observation period, compared with the low copy number group. In the analysis of the relationship between prednisolone/immunosuppressive therapy and DEFA1A3-CNV, the DEFA1A3 copy number was significantly higher in the non-remission group than in the remission group following prednisolone treatment. However, there was no correlation between other immunosuppressive therapies and DEFA1A3 copy number.

Conclusion
DEFA1A3 copy number is a predictive marker of disease severity and prednisolone treatment response.
P172 Metabolic disorders with non-alcoholic fatty liver disease in people with inflammatory bowel disease
Authors: Walker C , Stapleton E , Dempsey M , Carroll A , Connaughton R , Breslin N , McNamara D , O'Donnell S , Ryan B , O'Connor A 
Published: January 2023

Abstract

Background
Globally rising rates of obesity and consequent metabolic diseases have been reflected in the inflammatory bowel disease (IBD) population. Non-alcohol fatty liver disease (NAFLD) is a common liver disorder associated with obesity, that occurs more frequently in people with IBD.

Methods
A prospective single-centre cohort study. In total, we recruited 203 patients from our IBD service in a tertiary academic hospital. 7 participants were excluded due to later diagnosed non-NAFLD liver disease. Following informed consent, participants underwent a fibroscan for liver stiffness (LSM) and controlled attenuation parameter (CAP) measurement, and blood tests for HbA1c and fasting lipids.
Basic demographics, past medical history, exercise measured on the Godin-Shepard Leisure Time Physical Activity Questionnaire, physical functioning on SF-36 Questionnaire, blood pressure, CAP and LSM were recorded. T-test and Fishers exact test were used to test for statistical significance as appropriate.

Results
Of the 196 IBD patients included, 34.7% (n=68/196) had a healthy BMI, 34.7% (n=68/196) were overweight (BMI≥25-29.9), and 30.6% (n=60/196) were obese (BMI≥30). Overall, 16.3% (n=32) had a CAP score &gt;294dB/m consistent with NAFLD, and 2.55% (n=5) had a LSM &gt;8.1kPa consistent with fibrosis.
When compared to those without NAFLD, those with NAFLD had higher BMIs, 26.9 vs 32.3 p&lt;0.05. They also had a much higher incidence of diabetes 28.1% vs 0% p=0.0001, higher overall rates of abnormal HbA1C (≥6%), 21.9% (n=7/32) vs 6.4% (n=10/156) p=0.0121, and higher rates of abnormal HbA1c without a diagnosis of diabetes 13% (n=3/23) vs 6.45% (n=10/155) p=0.4043. Additionally, they had non-significant higher mean systolic blood pressure and higher rates of diagnosed hypertension.
Compared to those without NAFLD, the NAFLD cohort had higher rates of diagnosed hypercholesterolaemia 34.4% (n=11/32) vs 15.3% (n25/163) p=0.022 and there were higher rates of elevated total cholesterol (&gt;5mmol/L) in those not previously diagnosed with hypercholesterolaemia, 42.9% (n=9/21) vs 31.8% (n=47/148) p=0.3292.
Participants with NAFLD also had lower exercise scores 17 vs 24.9 p=0.03543, and lower scores for physical functioning 71.9 vs 83.2 p=0.00676.
Of particular note, they had more than double the 10-year risk of myocardial infarction or death determined by the Framingham risk scores for hard coronary heart disease, 2.48% vs 5.75%, p=0.00012.

Conclusion
Our study shows that people with concurrent NAFLD and IBD have a significant cardiovascular risk profile. With increased awareness of this, metabolic syndrome conditions should be screened for and treatment initiated where appropriate, to decrease cardiovascular related mortality in this cohort.
P196 Major variance in scoring of endoscopic recurrence after ileocolic resection for Crohns Disease – a systematic review and meta-analysis
Authors: Van Der Does De Willebois E , Bellato V , van Dieren S , Duijvestein M , Buskens C , Vignali A , Bemelman W 
Published: January 2023

Abstract

Background
Adequate scoring of endoscopic recurrence in Crohn’s disease patients is of utmost importance, as it is used to diagnose recurrent disease, to predict disease outcomes, to (re-)initiate or change therapy and to monitor its effect. This study aims to assess the variance in endoscopic recurrence in patients after ileocolic resection for Crohn's disease using the most common classification systems, the Rutgeerts (RS) and modified Rutgeerts (mRS) classification.

Methods
A systematic literature search using MEDLINE, Embase and the Cochrane Library was performed. All RCTs and cohort studies describing endoscopic recurrence after an ileocolic resection for Crohn's disease were included. Main outcome was the range of endoscopic recurrence rates within twelve months postoperatively, defined as RS≥i2 and/or mRS≥i2b. A proportional meta-analysis was performed.

Results
Seventy-six studies comprising 7751 patients were included. The weighted mean of the endoscopic recurrence rates, defined as either RS≥i2 and/or mRS≥i2b, was 43.99% (95 per cent CI 43.56 – 44.43), ranging from 5.0% – 93.0%, fig 1. For studies reporting endoscopic recurrence defined as ≥i2 and for studies reporting recurrence defined as ≥i2b the weighted means were 44.0% (range 5.0% – 93.0%) and 41.1% (range 19.8% – 62.9%) respectively. Within studies reporting both RS and mRS the weighted means for endoscopic recurrence were 61.3% (range 39.1% – 84.7%) and 40.6% (range 19.8% – 62.0%) respectively.

Conclusion
This study demonstrates a major variance in scoring endoscopic recurrence after ileocolic resection for Crohn's disease, with the greatest variance when using the original Rutgeerts classification. This suggests a high likelihood of inadequate diagnosis of disease recurrence, with major implications for quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.
P197 A biomarker of early mucosal destruction: Neutrophil-mediated type IV collagen degradation is elevated in patients with Crohn’s Disease and Ulcerative Colitis
Authors: Sorokina Alexdóttir M , Pehrsson M , Karsdal M A , Godskesen L E , Krag A , Kjeldsen J , Mortensen J H 
Published: January 2023

Abstract

Background
Inflammatory bowel disease (IBD) is characterized by chronic inflammation due to an uncontrolled immune response orchestrated through, i.e. neutrophils. The basement membrane acts as a front-line defense promoting tissue integrity, where the α-3 chain of type IV collagen is solely expressed on the outermost layer of the mucosa. Detection of subclinical ulceration is crucial since early-stage IBD presents a unique window of opportunity for intervention, as the disease might become a self-sustaining process once deep inflammation becomes established. We therefore, wanted to develop a biomarker reflecting early tissue injury, aiding in the implementation of prompt treatment.

Methods
A competitive enzyme-linked immunosorbent assay quantifying a human neutrophil elastase (HNE) degraded fragment of type IV collagen α-3 chain was developed (C4A3-HNE). Dilution- and spiking recovery, inter- and intra-variability, and interference were evaluated. Acceptance criteria for technical validation were a recovery of 100% ±25 and an inter-intra variability of &lt;15%. Commercial serum samples were purchased from ProteoGenex. Biological relevance was validated in an observational study from Odense University Hospital (OUH) and healthy controls. Groups were compared using Kruskal Wallis (Dunn‘s corrected).

Results
The technical validation of the C4A3-HNE assay demonstrated acceptable results for recovery, variation, and interference (table 1). Biological relevance was assessed in commercial IBD samples and healthy donors. C4A3-HNE was elevated in both CD and UC compared to healthy (p=0.001 and &lt;0.0001)(AUC [95% CI]: 0.820 [0.669-0.971]; 0.875 [0.775-1.000]). The results were validated in a cohort of IBD patients (both p&lt;0.0001)(fig.1). For UC, analysis showed that compared to patients in endoscopic remission, C4A3-HNE is elevated in patients with mild endoscopic activity, decreasing dose-dependently for moderate and severe disease. Fecal calprotectin and CRP levels were also lower in IBD patients with high levels of C4A3-HNE (fig.2). With a cut-off value of 54.1 ng/ml, C4A3-HNE could significantly discriminate between mild and severe endoscopic disease (table 2).

Conclusion
Our study demonstrates the biological and possible clinical relevance of the novel C4A3-HNE biomarker. The biomarker is elevated in patients with IBD compared with healthy, and high levels may reflect early mucosal damage in patients with UC. Furthermore, inflammatory markers were lower in IBD patients with high levels of C4A3-HNE, pointing towards high levels being indicative of early disease. C4A3-HNE may provide early detection of mucosal damage; however, further studies are required to assess the clinical validity of this biomarker.
P198 Sonographic features of colonic pseudopolyposis in inflammatory bowel diseases
Authors: Silva Mendes S , Lepore F , Hussey M , Cataletti G , Maconi G 
Published: January 2023

Abstract

Background
Colonic pseudopolyps are a frequent finding in inflammatory bowel disease (IBD). Yet there are no published data describing the characteristics of pseudopolyposis in intestinal ultrasound (IUS). This study aimed at identifying the key features of pseudopolyposis in IUS.

Methods
This case-control study included 8 patients with ulcerative colitis or Crohn’s colitis with extensive left colon pseudopolyposis and 24 matched IBD patients without pseudopolyps at colonoscopy. Luminal (diameters, thickening, stratification, margins, and vascularity) and intraluminal (vascular signals at color Doppler), and extraluminal (mesenteric fat) parameters of the left colon were compared. Anonymized still images and videos of these patients were blindly reviewed to estimate the accuracy in detecting this condition.

Results
Among the IUS parameters assessed, the anteroposterior diameter ≥ 12 mm and the presence of luminal vascular signals were significantly correlated with pseudopolyposis (table 1). The detection of both these findings were able to detect extensive pseudopolyposis with a sensitivity of 62.5% a specificity of 96.8%, a positive predictive value of 83.3% and negative predictive value of 88.46%, and an overall accuracy of 87.5% (table 2).

Conclusion
This is the first study describing the IUS features of pseudopolyposis in IBD. The potential use of IUS to assess pseudopolyposis might have an impact on IUS monitoring and surveillance of IBD patients with condition.
P206 Artificial Intelligence reproduces central reading for automated scoring of colonoscopies from multiple clinical trials in Ulcerative Colitis
Authors: Gutierrez Becker B , Arús-Pous J , Yao H , Luscher J , Richmond D , Fisher E , Bojic D , Bigorgne A , Prunotto M 
Published: January 2023

Abstract

Background
Using Artificial Intelligence (AI) for the automated scoring of colonoscopy videos with Mayo Clinic Endoscopic Subscore (MCES) has been successful in several models [1]. However, no study to date has evaluated the performance of such algorithms on a new cohort obtained from a separate clinical trial. In this study, we aimed to build an AI scoring algorithm able to reproduce central reading from three Phase III clinical trials in Ulcerative Colitis (UC).

Methods
As a training dataset, still frames were automatically extracted from sigmoidoscopy videos of two Etrolizumab clinical trials: Hickory NCT02100696 [2] and Laurel NCT02165215 [3]. A quality control AI algorithm [4] was applied and the resulting dataset (N=1897 videos) was paired with central reading MCES for each colon section. The training was achieved on a multiclass MCES scoring algorithm [4] with the challenging task of assigning a multiclass score (MCES between 0 - 3) instead of a binary score (MCES &lt;=1 or not). The performance was assessed on 2,292 videos from independent cohorts (Hibiscus I NCT02163759, Hibiscus II NCT02171429 [5], Gardenia NCT02136069 [6]). Videos were pre-processed in an identical manner as those from the training dataset (N= 637, 636 and 1019 videos for Hibiscus I, Hibiscus II and Gardenia, respectively). This dataset constitutes the largest cohort to date for the evaluation of a MCES scoring algorithm.

Results
The Area Under the Receiver Operator Characteristic curve (AUROC) was evaluated independently for each trial. Table 1 summarizes AUROC values per MCES for each clinical trial. The resulting mean AUROC values were 0.79 for Hibiscus I and 0.77 for both Hibiscus II and Gardenia. The average Cohen’s kappa between the automatic measurements and the central readings is 0.40, in contrast to 0.41 between central and local readers.

Conclusion
Our automated MCES scoring algorithm efficiently reproduces central reading in three independent clinical trials cohorts. In addition, algorithm evaluation was performed on data from independent trials, different from the ones used for the development of the algorithm. This is the first study evaluating, on such an extended cohort, the use of AI based automated MCES scoring in UC.
References:
1. Stafford,et al. Inflamm. Bowel Dis 28(10), 1573-1583.
2. Peyrin-Biroule et al. Lancet Gastroenterol. Hepatol. 7.2 (2022): 128-140.
3. Vermeire et al. Lancet Gastroenterol. Hepatol. 7.1 (2022): 28-37.
4. Gutierrez et al. Ther Adv Gastro Endoscopy 14 (2021).
5. Rubin, et al. Lancet Gastroenterol. Hepatol. 7.1 (2022): 17-27.
6. Danese et al. Lancet Gastroenterol. Hepatol. 7.2 (2022): 118-127.
P208 Validation of the IBD-Disk in a Portuguese cohort of patients with inflammatory bowel disease
Authors: Garrido I , Lopes S , Dias C , Macedo G 
Published: January 2023

Abstract

Background
Inflammatory Bowel Disease-Disability Index (IBD-DI) is a validated tool that was developed for assessing disability and to help clinicians to guide different therapeutic decisions. However, due to its complexity, it is difficult to apply in daily practice. The IBD-Disk is a new shortened adaptation of the IBD-DI, designed to give an immediate representation of disability. However, further investigation is required to validate this tool in clinical practice. The objective of this study was to evaluate the IBD-Disk for its capacity to assess disability in a Portuguese cohort of patients with IBD.

Methods
In this single-center, cross-sectional observational study, patients with IBD were consecutively recruited between February 2021 to February 2022 from our outpatient department. Both IBD-Disk and IBD-DI were delivered and filled out simultaneously by all included patients. Sociodemographic and clinical data were also collected.

Results
A total of 258 patients were included, the majority female (51.9%), with a median age of 41 years old (IQR 32-52). There were 184 (71.3%) individuals with Crohn′s disease and 74 (28.7%) with ulcerative colitis (Table 1). The median total score of IBD-Disk was 29.6±24.4 and that of IBD-DI was 23.8±11.2. The item on the IBD-Disk with the highest score was “energy” (4.33±3.5) and the lowest scoring item was interpersonal interactions (1.98±2.8). A significant positive correlation between total scores of IBD-Disk and IBD-DI was identified (r=0.722, p&lt;0.001), with a high Pearson correlation. Regarding the validity per item, there was also a good correlation between both scores. Including all 10 items in the IBD-Disk scale, a value of 0.918 was observed for Cronbach’s alpha, demonstrating a very good homogeneity of IBD-Disk items. Performing the one-at-a-time removal procedure, Cronbach’s alpha varied between 0.905 and 0.915, confirming that all items contribute to the construct. All items showed an item-total correlation coefficient &gt;0.4. Table 2 shows the univariate analysis of clinical factors associated with the IBD-Disk score. Hemoglobin level (p=0.973), serum albumin (p=0.998) and fecal calprotectin (p=0.183) were not associated with the IBD-Disk score. In multivariate analysis, a significant impact of the female sex (β=11.760 [6.117; 17.404], p&lt;0.001), biological therapy (β=9.042 [1.546; 16.539], p=0.018) and perianal surgery (β=12.091 [2.862; 21.320], p=0.010) on the IBD-Disk total score was observed.

Conclusion
IBD-Disk is a valid and reliable tool for quantifying disability for both Crohn’s disease and ulcerative colitis in clinical practice. It should allow gastroenterologists to rapidly assess a patient’s disability at a given time.