bluuebunny/crossref_metadata_2025_split huggingface dataset:
P321 Increased modified DUBLIN scores are associated with serious ulcerative colitis and treatment failure
Authors: Xie C , Su J , Liu L , Lin Y , Hu Y , Shi H 
Published: January 2023

Abstract

Background
Grading of endoscopic lesions is important for determining the severity of ulcerative colitis and developing treatment strategies, but the commonly used methods are not sufficient.This study aimed to investigate whether new endoscopic scoring systems incorporating lesions and disease extent are associated with clinical disease severity and maintainable remission.

Methods
This was a retrospective study. One hundred and ten patients with ulcerative colitis were included and eighty seven completed 12 months follow-up.Colonoscopy was performed within 1week before blood samples were taken. DUBLIN (Degree of ulcerative colitis burden of luminal inflammation) scores were calculated as the product of MES (Mayo endoscopic score) by disease extent and UCEIS (ulcerative colitis endoscopic index of severity) was used to replace MES when calculating modified DUBLIN scores.

Results
DUBLIN and modified DUBLIN scores were increased in the moderate and severe groups significantly (p&lt;0.05). Both of increased scores contributed to the detection of serious diseases, and the clinical cut-off values of DUBLIN and modified DUBLIN were 3(AUC=0.809, p=0.001) and 7(AUC=0.815, p=0.001). They were with high sensitivity, but the specificity of DUBLIN was lower. Both scores were correlated to partial Mayo scores, CPR and ESR positively, and they were correlated to the albumin negatively (p&lt;0.05). Higher modified DUBLIN scores (&gt;7) were associated with an increase risk of treatment failure (HR=4.96, 95% CI 1.17-21.00, p=0.03), but there were no association between DUBLIN scores and long term remission (p&gt;0.05).

Conclusion
Increased DUBLIN and modified DUBLIN scores were conducive to screening serious disease, but only modified DUBLIN scores had the potential to assist in making an upgraded therapeutic schedule.
P323 The Rate of and Risk of Dysplasia in Long Standing Ulcerative Colitis Patients Among Middle-Eastern Population
Authors: Altuwaijiri M , Alharbi O , Alruthia Y , Aljebreen A , Almadi M , Almalki Y , Alrashed A W , Alzahran S A , Almuhaya H , Alhowaish N , Alshehri K F , Alrushud S S , Alanazi W S , Azzam N 
Published: January 2023

Abstract

Background
Patients with long-standing Ulcerative Colitis (UC) are at high risk of getting colorectal cancer (CRC). Therefore, surveillance colonoscopy is recommended to minimize that risk.

Aim
To examine the rate of dysplasia alongside the clinical, biochemical and endoscopic variables associated with dysplasia among patients with long-standing UC in a university-affiliated tertiary care center.

Methods
This was a retrospective medical chart review was conducted. UC patients with a disease history of ≥ 8 years or had primary sclerosing cholangitis (PSC) and underwent colonoscopy surveillance between 2010 and 2021 were included. Patients’ endoscopic and histopathological characteristics as well as their adherence to annual surveillance colonoscopy were assessed.

Results
Two-hundred and sixty patients were included with a mean age and duration of illness of 45 years and 15 years, respectively. Most of the patients were females (55%) and did not adhere to the annual surveillance (56%). About 59% of the patients were in remission, and 48% of them had pancolitis, 35% had left-sided UC, and 17% had proctitis. The percentage of treated patients with monoclonal antibody (mAb) among those who adhered to the annual surveillance colonoscopy was twice that among those who did not adhere to the annual surveillance colonoscopy (34% vs. 17%). The odds of detecting dysplasia among those who adhered to regular annual colonoscopy was 78% lower in comparison to their counterparts who did not adhere to the annual colonoscopy (OR= 0.153, 95% CI= 0.026 – 0.90, p-value=0.0379) controlling for the presence of PSC, disease duration, history of colectomy, and baseline albumin level. On the other hand, patients with longer disease duration had higher odds of dysplasia detection in comparison to their counterparts with shorter disease duration (OR= 1.136, 95% CI= 1.038 – 1.243, p-value=0.0055).
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Conclusion
Adherence to the annual colonoscopy among high-risk UC patients was associated with lower rates of dysplasia detection. However, the rates of dysplasia detection among patients with poor adherence to the annual colonoscopy were lower that the ones reported in the literature. Future studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
P343 Eosinophilic inflammation as an indicator of the activity of the course of Inflammatory Bowel Diseases
Authors: Babayeva-Sadigova G , Asadova G , Quliyev F , Makhmudov U , Ismayilova K , Samedova T , Hasanova A , Mirzazada O , Mahammadaliyeva M , Abdulzada C , Musayev C , Iskenderov N ,   IBD
Published: January 2023

Abstract

Background
Eosinophils have been identified as cells that promote immune cell infiltration in inflammatory bowel diseases (IBD). Activation of eosinophils causes degranulation, which can lead to tissue damage due to the release of toxic oxygen radicals, including eosinophilic cationic protein (ECP). The potential role of eosinophils in inflammation and fibrosis in patients with IBD remains relevant.

Purpose of the study
to study the effect of changes in the level of eosinophilic cationic protein on the activity of the course of inflammatory bowel diseases.

Methods
The study was conducted from January 2016 to April 2022, among 400 patients with IBD (MC 12 patients, women 8, men 4; UC 150 patients, women 71, men 79; CD 238 patients, women 120, men 118). Patients underwent endoscopy with biopsy sampling for pathomorphological examination, as well as laboratory blood tests (general blood count, h/s CRP, homocysteine, vitamin D, ANCA-parameters, α-THF and IL-1β, IL-4, IL -8, IL-10, IL-18, total protein, albumin, iron, ferritin, eosinophilic cationic protein (ECP), İgE; urinalysis and urinary albumin; fecal analysis and fecal calprotectin and lactoferrin.

Results
In 250 patients (62.5%) with a poor response to basic therapy, a study was conducted on ECP and in 69 cases (27.6%) the result was positive, the number of positive endoscopic manifestations was 190 (76%), the number of patients with a positive pathological conclusion for the presence of eosinophils in the biopsy material (more than 30-35 eosinophils per field of view) - 95 (38%), the number of patients with concomitant allergic diseases - 14 (5.6% / 20.2%). The level of EPC fluctuated within 29-228 ng/mL (N&lt;24 ng/mL). Indicators for the studied parameters are presented in Table 1.
Table 1. Changes in activity in some laboratory, endoscopic and pathological parameters

During the follow-up in the group of patients with elevated levels of eosinophilic cationic protein for 6-24 months, some changes occurred: new cases of fibrosis appeared in patients with CD, as well as cases of non-response to basic therapy and, as an outcome, cases of surgical interventions in patients with ulcerative colitis (Diagram 1).
Diagram 1. Outcome of patients with elevated EPC levels

Conclusion
The increase in the level of ECP in the study group of patients was 27.6% and correlated with higher rates both in laboratory and in endoscopic and morphological activity of IBD. The study of the increase in ECP is of interest in the context of the “non-response” marker to basic therapy in IBD and in the search for new targets for treatment.
P346 Influence of diagnostic delay on ulcerative colitis characteristics at disease onset
Authors: Ramírez C , Barreiro-de Acosta M , Cabriada J L , Rodríguez-Lago I 
Published: January 2023

Abstract

Background
Diagnostic delay (DD) is defined as the time between the onset of the first symptoms and the definitive diagnosis of IBD. It is highly heterogeneous and it has a negative impact on the disease course. Our objective was to describe the main clinical and histological characteristics at diagnosis of UC according to the DD and its influence on clinical course.

Methods
A retrospective study compiled information from consecutive patients diagnosed with UC between January 2015 and December 2019 and included in the ENEIDA registry in our hospital. Patient and disease characteristics at diagnosis such as age, DD, disease extent, partial Mayo Score (PMS), extraintestinal manifestations (EIM), fecal calprotectin (FC), and histological characteristics at diagnosis were compiled. The role of DD was evaluated as both quantitative and dichotomous variable using Spearman correlation, chi-square and Mann-Whitney tests.

Results
A total of 146 patients (53% male; 47% former smokers; median age 46 years [IQR, 34-56]; 27% E2 and 35% E3; median FC of 289 mg/kg (IQR, 105-586) with a median DD of 2 months (IQR, 1 -4) were included. The median PMS at diagnosis was 2 points (IQR, 2-5), with higher scores in patients with shorter DD (≤2 months, median 3 points [IQR, 2-5] vs &gt;2 months, median 2 points [IQR, 2-4]; p=0.002). Among them, 7% of patients presented at least one EIM, reported more frequently in patients with a DD &gt;2 months (1.4% with DD≤2 vs 13.4% with DD&gt;2 months; p=0.007; Figure A). During follow-up, 9% developed proximal disease extension.
The most frequent histological findings were cryptic abscesses (71%), with a predominantly chronic infiltrate with basal plasmacytosis (97%), epithelial irregularity (83%), decreased mucosecretion (46%), erosions (21%), and ulceration (12%). The presence of eosinophils was more frequent as DD increases (5.6% if DD≤2 vs 18% if DD&gt;2 months; p=0.029; Figure B), whereas the degree of chronic infiltration is more severe in patients with shorter DD (94% if DD≤2 vs 82% if DD&gt;2 months; p=0.029; Figure C).

Conclusion
DD in UC influences the severity of clinical disease activity and the rate of EIM at diagnosis. In addition, eosinophils are more frequent as DD increases, while the degree of chronic infiltrate was more pronounced in patients with shorter disease duration.
P351 Validation of anterior thigh ultrasound for screening of sarcopenia and elevated body fat in Inflammatory Bowel Disease
Authors: Mc Gettigan N , Saeidi R , Hanley M , Clarke M , O'Toole A , Morrin M , Boland K 
Published: January 2023

Abstract

Background
Sarcopenia (low muscle mass, strength and function) and visceral obesity are associated with adverse outcomes in inflammatory bowel disease (IBD). US measurement of thigh muscle thickness as a biomarker of muscle loss in IBD has not been validated to date. Our aim is to validate anterior thigh US for measurement of total muscle thickness (TMT) and fat thickness (FT) in IBD patients and to identify muscle thickness values associated with sarcopenia using bioelectrical impedance analysis (BIA).

Methods
A prospective study of muscle function and mass was carried out using handgrip strength testing, sit-to-stand test, B-mode US and bioelectrical impedance analysis (BIA) (SECA mBCA 525) in IBD patients attending outpatients in our centre. Sarcopenia was confirmed by ASM/H2. Stata was used for statistical analysis, p ≤ 0.05 denoted statistical significance.

Results
A total of 52 patients were included, 42% (n=22) were females with a mean age of 45.5 years. CD patients accounted for 75% (n=39). Mean BMI of females was 29.64 (SD 5.88) vs males 26.2 (SD 3.8), p=0.014. Sarcopenia was diagnosed in 16 patients (31%), 10/16 were female with a significantly lower TMT vs non-sarcopenic females (mean 3.56cm vs 4.32cm, p=0.05). ASM/H2 was lower in sarcopenic patients (mean 4.67 kg/h2 vs 8.97 kg/h2, p&lt;0.001). Handgrip strength was lower in sarcopenic patients (mean 24.4 vs 32.1 kg, p=0.25), sit-to-stand did not differ significantly (mean 18.84 vs 13.13sec, p=0.027). Physical activity levels were insignificantly lower in the sarcopenia group (mean PAL 1.78 vs 1.85, p=0.089). TMT strongly correlated with ASM/H2 (r=0.385,p=0.005), skeletal muscle mass (mm) (r=0.368, p0.008), right leg MM (r=0.404, p0.003), handgrip strength (0.29, 0.035) and BMI (r=0.39, 0.005). FT strongly correlated with body fat (kg) (r=0.699, p&lt;0.001), body fat % (r=0.76, p&lt;0.001), body fat index (r=0.67, p&lt;0.001), waist circumference (r=0.35,p0.01) and BMI (r=0.68, p&lt;0.001). Of the sarcopenic patients, 62.5% had high body fat (n=10) which trended toward but did not reach statistical significance (p=0.08). Visceral fat was high overall with higher levels in men (3.6L vs 2.0L, p=0.009), it did not correlate with SF (r=-0.074, p=0.6). Finally, the intra-rater reliability for TMT and SF were both excellent (r=0.97, p&lt;0.001 and 0.979 p&lt;0.001 respectively).

Conclusion
Sarcopenia is prevalent in IBD patients. Anterior thigh US correlates with BIA and can be used as a screening tool for early loss of muscle mass in IBD patients in addition to screening for high visceral adiposity. The presence of increased visceral adiposity was high, which may have deleterious outcomes for CD patients, given its association with transmural inflammation and post-operative recurrence.
P354 Application of the clinical decision support tool to predict treatment outcomes in Crohn’s Disease patients treated with vedolizumab subcutaneous formulation
Authors: Dulai P , Lindner D , Agboton C , Alric H , Bamias G , Peyrin-Biroulet L 
Published: January 2023

Abstract

Background
There is a need to identify Crohn’s Disease (CD) patients who will obtain most clinical benefit from treatment with vedolizumab (VDZ), an anti-α4β7 integrin inhibitor for the treatment of ulcerative colitis and Crohn’s Disease (CD). Previously, a clinical decision support tool (CDST) has been developed and validated to guide treatment decisions in CD patients (pts) treated with intravenous VDZ.1 In this study, we aimed to test the ability of the CDST to predict clinical outcomes in CD pts receiving maintenance treatment with the subcutaneous (SC) formulation of VDZ.

Methods
Pts with moderate to severe CD receiving maintenance treatment with VDZ SC in the VISIBLE 2 study were categorized using the CDST into low (≤13 points), intermediate (&gt;13 and ≤19 points) and high response probability groups (&gt;19 points) based on the scoring system detailed in Table 1. Clinical outcomes evaluated included clinical remission: CD Activity Index (CDAI) ≤ 150 at Week 6, 14, 30, and 52, and enhanced clinical response: decrease from baseline in CDAI score ≥ 100 points at Week 52. All outcomes were evaluated as observed.

Results
There were 275 pts who completed induction treatment with VDZ 300 mg IV and continued into maintenance treatment with VDZ 108 mg SC until Week 52. Using the CDST, at baseline, 14 pts (5.1%) had a low, 98 (35.6%) had an intermediate, and 163 (59.3%) had a high probability of treatment response with VDZ. Due to the low number of pts in the low probability group, the low and intermediate groups were combined. At Week 6, 99 pts (61.1%) in the high probability group had achieved clinical remission vs 38 pts (33.9%) in the low/intermediate probability group (Fig 1). Rates of clinical remission in the high probability group continued to exceed those of the low/intermediate group through until Week 52 when 89 pts (86.4%) in the high probability group were in clinical remission vs 43 pts (79.6%) in the low/intermediate probability group (Fig 1). In the high probability group, 97 pts (94.2%) had an enhanced clinical response at Week 52 compared with 46 pts (85.2%) in the low/intermediate group.

Conclusion
Compared with the low/intermediate group, pts categorized by the CDST as having the highest probability of treatment response to VDZ achieved clinical remission sooner, as early as Week 6. These findings provide further confirmation of the CDST as a means of identifying pts with CD likely to benefit from treatment with VDZ in either IV or SC formulations.
References:
1. Dulai PS et al. (2018) Gastroenterology 155:687-695.e10.
P356 CRAB Score, An Indian Insight into in hospital and long-term Colectomy following Acute Severe Ulcerative Colitis (ASUC)
Authors: Varghese J 
Published: January 2023

Abstract

Background
Oxford and Swedish index were developed to predict in hospital colectomy in ASUC and not for long-term prediction say one to two years. Oxford index, Swedish index and other predictors of Colectomy are based on western Data. In hospital colectomy rates were also rapidly decreasing during the last two decades with the advent of rescue therapy like infliximab and cyclosporine but the colectomy rate within one or two years of ASUC is not significantly reduced. Study by Alice et al had shown that with advent of infliximab and cyclosporine rescue therapy oxford index no longer predicts in-hospital colectomy rates also in addition to its shortcoming in predicting long-term colectomy rates. Our study Aims to find out the predictors of in hospital and long-term colectomy in an Indian cohort of ASUC patients.

Methods
Prospective observational study conducted in department of Medical Gastroenterology medical college Trivandrum over a period of 5 years (2015-2020). ASUC is defined by Truelove Witts criteria Patients with ASUC were followed up for a period of 24 months to look for progression to colectomy.

Results
Total 81 patients were taken up for the study (47 males and 34 females). 15 patients progress to colectomy during the follow up period of 24 months (11 patients had colectomy done during the same hospital admission and 4 patients during the follow up period of 24 months). Among the variables analysed Albumin, CRP and Hb were significant in predicting colectomy in 24 months. On regression analysis CRP and Albumin were independent predictors of 24-month colectomy and coefficient of Beta was multiplied to albumin and CRP and total score was obtained and termed it as CRAB (CRP + Albumin) score (CRAB score = CRP*0.2 – Albumin*0.26). This score was plotted to AUROC and the score has AUROC of 0.923 and at a Score of &gt;0.4 has sensitivity of 82 and specificity of 92% 24-month chance for colectomy following ASUC. The score was validated in a validation cohort of 31 patients and in validation cohort also at &gt;0.4 the score has sensitivity of 83 and specificity of 96% in predicting colectomy. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.

Conclusion
CRAB score is a simple prognostic score that can predict 24-month colectomy in ASUC patients with high sensitivity and specificity. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.
P357 Intestinal ultrasound as a promising non-invasive monitoring tool in patients with Ulcerative Colitis
Authors: Morão B , Nascimento C , Revés J , Abreu B , Bravo A C , Saraiva S , Glória L , Torres J , Palmela C , Frias Gomes C 
Published: January 2023

Abstract

Background
Intestinal ultrasound (IUS) is an established non-invasive tool for monitoring disease activity in Crohn’s disease, however its value in ulcerative colitis (UC) is still less clear. Our goal was to correlate IUS features with well-established disease targets in UC.

Methods
Prospective study including patients with left-sided (E2) or extensive (E3) UC. Simple Clinical Colitis Activity Index (SCCAI), patient reported outcomes (PRO-2), C-reactive protein (CRP), fecal calprotectin (FCal) and endoscopic activity (Mayo endoscopic subscore - sMayo) were evaluated. IUS features included bowel wall thickness (BWT) and color Doppler flow (CDF), assessed by modified Limberg score. The most affected segment was selected for analysis. Clinical remission was defined by SCAAI ≤ 2, endoscopic remission by sMayo of 0 and IUS remission by BWT ≤ 3 mm and CDF=0.

Results
17 UC patients (59% males, median age 44 (20-68) years, 53% E3) were included and evaluated in 46 different time-points, with concomitant endoscopic assessment in 31 cases. Overall, 55% were in clinical remission, 30% in endoscopic remission and 22% in IUS remission. The sigmoid colon was the most affect segment by IUS (46%) and endoscopy (39%). Median BWT in the most affected segment was 4.28 (3.08-6.25) mm and 83% had a Limberg score ≥ 1. Median CRP was 0.41 (0.06-18.55) mg/dL and FCal 80 (3-8000) ug/g. There was a moderate agreement between IUS and endoscopy regarding the most affected segment (k=0.43, p&lt;0.001). BWT showed a strong correlation with sMayo and CRP and a moderate correlation with FCal, SCCAI and PRO-2. CDF showed no significant correlations with clinical, biochemical and endoscopic features (Table 1). Patients with IUS remission presented higher rates of endoscopic remission (78% vs 10%, p&lt;0.001) and lower sMayo scores (0 vs 2, p&lt;0.001), together with lower FCal (21 vs 133 ug/g, p=0.01) and CRP levels (0.08 vs 0.54, p&lt;0.01).

Conclusion
IUS features showed a significant correlation with endoscopic activity, clinical activity and biomarkers. IUS remission was associated with endoscopic remission and lower biomarker activity, suggesting that IUS is an accurate method to evaluate UC patients both with active disease and in remission.
P373 An Unusual Occurrence of Right-sided Colonic Neuroendocrine Carcinoma in Ulcerative Colitis – A case report
Authors: Alessa S , Aldraiweesh S , Albogami F 
Published: January 2023

Abstract

Background
It's estimated that inflammatory bowel disease (IBD) accounts for 1-2% of all colorectal cancer (CRC) cases. However, the mere presence of IBD increases the risk by 2 folds compared with the general population. It's been established that the most prevalent epithelial colonic malignancy linked to IBD is adenocarcinoma. Neuroendocrine neoplasms arising in the large intestines are extremely rare (rate &lt;1%), even less common in association with IBD.(1)
Herein, we report a 49 years-old male with a longstanding history of ulcerative pancolitis, who was found to have a metastatic right-sided colorectal neuroendocrine carcinoma (NEC).

Methods
Case Presentation
A 49-years-old male patient, with a 13-years history of ulcerative pancolitis underwent a colonoscopy. It revealed a large ulcerated mass extending from the ileocecal valve into the proximal ascending colon highly suspicious for malignancy. Biopsy showed a large cell poorly differentiated NEC in the ascending colon. Tumor cells were positive for Synaptophysin and cytokeratin AE1/3, and a high Ki67. Serum Chromogranin A (CgA) and urine 5-hydroxyindoleacetic acid were high. Imaging was evident for a short segment circumferential wall thickening at the ascending colon and hepatic metastasis. The patient was planned to receive chemotherapy, but died before treatment.

Results
Discussion
Risk of CRC increments linearly approximately 7 years following diagnosis of IBD. After 30 years of colitis, the incidence is estimated to be around 18%. NECs in particular are not frequently encountered in association with IBD, much less right-sided.(1) Colonic NECs are usually aggressive with a Ki67 typically greater than 20%, often present with metastasis with absence of a characteristic hormonal secretion picture.(2, 3)
The incidence of NECs in association with Ulcerative Colitis (UC) is twice more frequent in males, with a mean age of 49.36, and development after a median of 15 years of UC first diagnosis. Majority of NECs were found in the left side of the colon, in the contrary to our patient. Prognosis was dismal in most cases, as most demonstrated a higher malignant potential compared to adenocarcinomas.(3)
Early diagnosis of gastrointestinal NECs poses a challenge since it lacks a specific clinical presentation. Serum CgA level correlates with the tumor burden and overall survival. Additionally, studies demonstrating the role of endoscopic surveillance in colonic NECs early detection is scarce.(1,4)

Conclusion
Thorough understanding of the condition and its risk factors is crucial for a timely diagnosis, which maximizes the likelihood of a favorable prognosis. By reporting this case, we emphasize the importance of considering NEC as a differential diagnosis of CRC in IBD, particularly in UC patients.