bluuebunny/crossref_metadata_2025_split huggingface dataset:
P205 Impact of histologic disease activity on long-term outcomes in patients with ileal pouch-anal anastomosis for ulcerative colitis
Authors: Gabbiadini R , Spaggiari P , Dal Buono A , Iuzzolino M , Furfaro F , D'Amico F , Repici A , Spinelli A , Armuzzi A 
Published: January 2023

Abstract

Background
Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can incur in several complications like pouchitis leading to the need of immunosuppressive therapy, hospitalization and pouch failure. Unlike non-operated UC patients, therapeutic goals are an unmet need in UC-IPAA patients and the impact of the histologic activity on the development of complications is unknown. The aim of the study was to assess the association between histology and the risk of long-term negative outcomes in UC subjects with IPAA.

Methods
This is a single-center, retrospective study which included UC adult patients with IPAA undergoing at least one pouchscopy with biopsies in the pouch body after ileostomy closure. Pouch biopsies were blindly reviewed by a gastrointestinal pathologist with expertise in IBD. Histologic disease remission was defined as a Pouchitis Disease Activity Index (PDAI) histology subscore £ 1. Negative outcomes were: IPAA related complications (acute or chronic pouchitis, hospitalization, pouch failure) and escalation of medical therapy (start of immunosuppressive or biologics). Both descriptive and inferential statistical analyses carried out

Results
A total of 66 patients were included (male n=37; 56,1%) of whom 40,9% (n=27) had histological activity at the baseline pouchscopy. The characteristics of the study population are represented in table 1. The median time of follow up was 38,5 months (range 12-151). During the study period, 27 patients (40,9%) developed acute pouchitis and 10 patients (15,2%) chronic pouchitis. Thirty-nine subjects (59,1%) required antibiotic therapy while 8 subjects required systemic steroids (12,1%). Furthermore, 15 patients (22,7%) started immunomodulatory therapy with either azathioprine or biologic agents. Six patients (9,1%) needed pouch-related hospitalization and 1 patients (1,5%) experienced pouch failure. Chronic pouchitis and the need of immunosuppressive/biology therapy was observed more frequently in patients with pouch histologic activity (29,6% vs. 5,1%, and 40,7% vs. 10,3%, respectively) (P&lt;0.05). After adjusting for risk factors for pouchitis, the presence of histologic activity remained an independent risk factor for developing acute pouchitis (OR 4.10, 95% CI 1.39-12.04; P= 0.010), chronic pouchitis (OR 8.51, 95% CI 1.51-47.80, P=0.015) and the need for immunosuppressive or biologic therapy (OR 6.98, 95% CI 1.69-28.80; P=0.007).

Conclusion
Histologic activity was associated with an increased risk of developing both acute and chronic pouchitis and with the need for immunosuppressive/biologic therapy. Future research will clarify whether histologic remission might be considered as a therapeutic target for UC-IPAA patients developing pouchitis.
P216 Oral Budesonide and low serum albumin levels at surgery are associated with a higher risk of postoperative intra-abdominal septic complications after primary ileocecal resection for Crohn’s disease: a retrospective analysis of 853 consecutive patients treated in a tertiary centre.
Authors: Dajti G , Cardelli S , Rizzello F , Gionchetti P , Poggioli G , Rottoli M 
Published: January 2023

Abstract

Background
Patients undergoing ileocecal resection for Crohn’s disease (CD) are at high risk of postoperative intra-abdominal septic complications (IASC). The associated risk factors are still debated. The aim of the study was to identify the variables associated with IASC in patients treated for primary CD of the terminal ileum.

Methods
Retrospective single-centre study including consecutive patients undergoing ileocecal resection for CD between 2004-2021 and managed before surgery in a multidisciplinary IBD unit.

Outcomes
to identify the variables associated with IASC (primary aim) and severe complications, classified as Clavien-Dindo grade 3 and higher (secondary aim).
The potential independent predictors of each outcome were evaluated using logistic regression. To reduce overfitting, all models were built including only the variables that were significant at univariate analyses, except for age, gender and history of cardiovascular diseases, that were included a priori. Standard diagnostic procedures were adopted to check all models validity: influential observation analysis (Dbeta, change in Pearson chi-square), Hosmer-Lemeshow test for the goodness of fit and C statistic (area under the Receiving Operator Curve).

Results
A total of 853 patients were included. Overall sample characteristics are shown in Table 1.

Table 2 and Table 3 reported the comparison according to the primary (IASC) and secondary (severe complications) outcomes, respectively.

Table 4 showed the multivariate analyses of the potential predictors of IASC and severe complications.

The onset of IASC was associated with lower serum albumin level (OR 1.81, 95% CI 1.15-2.94, p=0.011) and the use of oral budesonide at time of surgery (OR 2.07, 95% CI 1.12-3.83, p= 0.021). The risk of severe complications was associated with a history of cardiovascular disease (OR 2.91, 95% CI 1.08-7.84, p=0.03) and lower serum albumin level (OR 1.58, 95% CI 1.02-2.50, p=0.04).

Conclusion
The present study analysed a large population of patients affected by CD of the terminal ileum who were treated homogeneously before surgery in a multidisciplinary setting and confirmed the significant impact of preoperative nutritional status on the risk of severe postoperative complications and IASC. The latter, however, was also associated with the use of oral budesonide at the time of surgery. This finding has not been previously reported in the literature. Based on the present evidence, oral budesonide should be discontinued or tapered to the lowest dose before surgery.
P224 Diagnostic delay in inflammatory bowel disease is not associated with difficult access to healthcare facilities: a clinical study on incidental cases
Authors: Cantoro L , Monterubbianesi R , Camastra C , Falasco G , Pantanella P , Cosintino R , Faggiani R , Fiorino G 
Published: January 2023

Abstract

Background
Diagnostic delay is a challenge in inflammatory bowel disease (IBD), more in Crohn’s disease (CD) than in ulcerative colitis (UC). Whether difficult access to healthcare facilities may be a cause of diagnostic delay is debated. Restrictions due to SARS-COV2 pandemic have impacted on the prompt access to hospitals and clinics during 2020. We aimed to investigate if those limitations impacted on diagnosis, presence of IBD-related complications, and the number of hospitalization and surgeries by the first 12 months after diagnosis.

Methods
We retrospectively analysed all consecutive patients who had access to our tertiary referral centre in Rome, Italy in the period between January 1st, 2019 and December 31st, 2021. We split all patients in three study groups: those who had diagnosis of IBD in 2019 (normal setting, control group), 2020 (severe restrictions for access to our clinic), and 2021 (intermediate restrictions). Delay from symptoms to diagnosis, presence of IBD-related complications at diagnosis, need for hospitalization and/or surgery at diagnosis, and hospitalization and surgery rates in the first 12 months since diagnosis were collected and analysed. Statistically significant differences were set as per p value &lt;0.05.

Results
Overall, 6,125 patients accessed to our department in 2019, 4,594 in 2020, and 6,063 in 2021. In the entire period, 89 patients were diagnosed with IBD (17 CD and 14 UC in 2019, 12 and 10 in 2020, and 17 and 19 in 2021). Baseline characteristics are listed in Table 1. Median delay between symptoms and diagnosis did not statistically differ among the 3 groups (7 months in 2020, and 2 months in 2021, compared to controls, p=0.07 and p=0.24 respectively), and among CD and UC patients (p=0.30). No differences were found in hospitalisation at diagnosis (p=0.90 for 2020, and p=0.66 for 2021 compared to controls), and in the rates of IBD-related hospitalization and surgery in the following 12 months since diagnosis (p=0.41 for 2020, 0.81 for 2021 compared to controls). No significant associations were found between CD and UC patients, and no significant association was found between sex, age, type of disease, and localisation of the disease at diagnosis and 12-month outcomes.

Conclusion
Although on a small population, difficulties in accessing to hospital did not impact on diagnostic delay and further disease course in IBD patients. Further investigation on factors associated with diagnostic delay is needed.
P228 Machine learning models utilizing simple laboratory tests may assess endoscopic activity in ulcerative colitis
Authors: Kempinski R , Kraszewski S , Nizioł P , Neubauer K 
Published: January 2023

Abstract

Background
Together with the implementation of innovative therapies for inflammatory bowel disease, mucosal healing (MH) became the novel therapeutic goal. Currently, a golden standard for evaluation of the colonic mucosa is an invasive and expensive colonoscopy. We propose here a machine learning (ML) based model as a noninvasive tool trained on biochemical patient data. Employed random forest technique used aggregation and randomization of predictors constituted of biochemical tests to accomplish a high degree of predictive accuracy reaching 95%. SHapley Additive exPlanations (SHAP) known from cooperative game theory were used to boost the interpretability of ML model based on additive feature importance across all possible predictors in the feature space.

Methods
The study group consisted of 252 ulcerative colitis patients hospitalized in theDepartment of Gastroenterology and Hepatology, Wroclaw Medical University. Routine laboratory test results and colonoscopy reports with the Mayo scores were collected. The data were processed with different ML classifiers. The most performant model was the random forest classifier. Then the SHAP model for the importance of consecutive clinical data was calculated.

Results
We found a set of particular biochemical predictors. Total protein, C-reactive protein, creatinine, and fecal calprotectin had the most significant impact on the prediction of endoscopic Mayo score, as shown in Figure 1.

Conclusion
Novel numerical models may predict the endoscopic activity of ulcerative colitis based on simple biochemical tests.
P237 Superior predictive value of intestinal ultrasound over endoscopic severity for colectomy risk in patients with ulcerative colitis
Authors: Piazza N , Noviello D , Filippi E , Conforti F , Furfaro F , Fraquelli M , Fiorino G , Danese S , Allocca M , Caprioli F 
Published: January 2023

Abstract

Background
Up to 15% of patients with ulcerative colitis (UC) do not respond to medical therapies and ultimately require colectomy for disease control. Baseline endoscopic severity and failure to achieve endoscopic healing, as defined by a Mayo Endoscopic Subscore (MES) ≤ 1, following therapy have been associated with an increased risk of colectomy. Intestinal ultrasound severity, as defined by a Milan ultrasound criteria (MUC) score &gt; 6.2, has been associated with an increased risk of colectomy. The aim of this study is to evaluate and compare MES and MUC in predicting the need for colectomy in patients with UC.

Methods
This is a double-center prospective observational cohort study. All consecutive adult UC patients between January 2016 and January 2020 requiring colonoscopy received intestinal ultrasound within 20 ± 12 days in a blinded fashion. Colectomies were evaluated during the follow-up. Univariable and multivariable Cox regression analyses were used to identify variables independently associated with colectomy risk. ROC analysis was used to compare baseline MES and MUC scores' performances in predicting colectomy.

Results
A total of 141 patients were enrolled (Table 1). Overall 13 patients underwent colectomy during 256.41 person-years of observation time. At baseline, patients requiring colectomy had increased mean values of MUC as compared to patients not undergoing surgery (6.84 ± 2.49 vs 10 ± 1.9, p &lt;0.001). At univariate analysis, MES (HR: 3.15, 95% CI:1.18 – 8.37, p = 0.02) and MUC (HR: 1.48, 95% CI:1.19 – 1.76, p &lt;0.001) were associated with colectomy risk. At multivariable analysis, MUC but not MES was associated with colectomy risk (HR: 1.46, 95% CI: 1.06 – 2.02, p 0.02). As compared with MES, MUC score demonstrated a higher AUROC (0.83, 95% CI: 0.75 – 0.92 vs 0.71 95% CI: 0.62 – 0.80) and better performance for assessing the need for colectomy (p = 0.02) (Figure 1). The optimal MUC score cutoff for predicting colectomy, as assessed by the Youden index, was 7.72, with a sensitivity and specificity of 1 and 0.6, respectively.

Conclusion
Ultrasound severity, as assessed by the MUC score, is superior to endoscopic severity in predicting the need for colectomy in patients with UC. A baseline MUC score of &lt; 7.72 may rule out colectomy risk in UC patients.
P250 The impact of Primary Sclerosing Cholangitis (PSC) on fecal calprotectin assessment in individuals with Inflammatory Bowel Disease (IBD)
Authors: Arar A , Scott F , Click B , Fennimore B , Ahmed W , Oonk A , Gerich M 
Published: January 2023

Abstract

Background
Fecal calprotectin (FCP) is recommended as a non-invasive biomarker in ulcerative colitis (UC); however, the accuracy of FCP in individuals with concurrent primary sclerosing cholangitis (PSC) is less understood due to biliary fluid calprotectin excretion in PSC. We aimed to determine the relationship of endoscopic disease activity to FCP levels in individuals with PSC and colitis (PSC-IBD) compared to individuals with UC alone.

Methods
Individuals with PSC-IBD and UC controls who underwent colonoscopy at a large tertiary academic medical center. Controls with similar UC extent were selected in a 2:1 ratio. Mayo endoscopic scores (MES) were derived from the endoscopic database. If no prospective score was recorded, images were reviewed by two investigators with adjudicated discrepancies. Disease characteristics, baseline demographics, FCP (within 6 months of endoscopy), and C-reactive protein (CRP) were derived from the electronic medical record. Exclusion criteria included Crohn's disease or non-IBD colitis, infectious colitis, treatment change between endoscopy and FCP measurement, and colonic resection. Mean FCPs and standard deviations (SDs) were calculated, stratified by PSC status and MES. Multivariable linear regression was employed to assess the association of PSC on FCP adjusting for MES, age, alkaline phosphatase (ALP), and disease location.

Results
264 colonoscopies for 197 patients (mean age 48, 61% males, 97% extensive disease) were identified with corresponding FCP from 2013 to 2022. Compared to UC controls, there were more males in the PSC-IBD cohort; MES did not differ significantly between the two groups (Table 1). There was no significant difference in mean FCP in PSC-IBD compared to UC controls (314.7 vs 284.5, p=0.56). Mean FCP increased with increasing MES (Table 2). There was no significant difference in mean FCP between those with PSC and those without when stratified by MES (Table 3). In multivariable linear regression, left-sided disease extent, MES, and ALP were independently associated with increasing FCP (Table 4).

Conclusion
In this cohort, a diagnosis of PSC was not associated with significant differences in FCP for IBD patients when stratified by MES. These data suggest that FCP remains a reliable marker of colitis activity in IBD patients with and without PSC. Further research is required to understand the role of PSC activity in modulating FCP concentrations.
P257 Is colorectal screening in IBD fit for purpose?
Authors: Saeidinejad M , Dawson H E , Newbury C M , Searle H , Gordon J N 
Published: January 2023

Abstract

Background
Patients with IBD are at increased risk of CRC with it recommended that patients with longstanding colitis undergo regular surveillance endoscopy. However, there is conflicting evidence for the quality and effectiveness of IBD surveillance programmes. We undertook an audit of the effectiveness of our surveillance programme against national standards alongside a case-note review of cases of CRC arising in patients with IBD diagnosed over the same period.

Methods
Sequential colonoscopies for IBD surveillance at Hampshire Hospitals Foundation Trust from 01/01/2019 to 31/12/2020 were reviewed retrospectively. The quality of the surveillance endoscopy programme was assessed against the BSG and SCENIC guidelines. Patients with CRC and IBD were identified using the International Classification of Diseases coding system over the same period with subsequent case-note review of identified cases.

Results
250 colonoscopies were reviewed with 6 excluded (3 inadequate bowel preparation, 3 severe active disease) leaving 244 for analysis. 203 (83.2%) were adherent to the guidelines. Non-compliance was either due to lack of dye-spray or inadequate number of biopsies (35 had 3-10 biopsies, 6 no biopsies). Overall, 2421 random biopsies were taken along with 90 targeted biopsies and/or polypectomies. 1 adenocarcinoma (0.45%), 1 HGD (sporadic polyp), 1 LGD, and 1 indefinite lesion were detected along with 19 sporadic polyps. During the same period 9 patients were diagnosed with CRC that were not in the surveillance programme. 3 had a diagnosis of probable pre-existing IBD made at the time of diagnosis of cancer (2 UC, 1 CD), 2 had a historical diagnosis of UC but were not known to secondary care, 1 was not under surveillance due to age (85), 2 had ileocaecal CD with CRC in unaffected segment of large bowel, and 1 had colitis &lt;8 yrs.

Conclusion
Our audit showed that the quality of the surveillance endoscopy had improved since our previous audit (2016) with the majority of cases now undertaken with dye-spray, and less cases undertaken by non-specialist endoscopists. Though there remains room for improvement with 16.8% non-complaint primarily due to inadequate biopsies, it was reassuring that 83.2% of procedures were performed in adherence with current guidance. Despite this only 1/10 (10%) of cases of CRC in patients with IBD were picked up through surveillance with 9/10 (90%) diagnosed in patients with IBD outside the programme. These results suggest that targeting resources at improving the surveillance programme further is likely to have a limited impact on reducing CRC in patients with IBD and that research is needed to identify and address why the majority of IBD patients that develop CRC are not reached by current surveillance strategies.
P309 Accuracy of PanMayo endoscopic score in predicting long-term disease outcomes in ulcerative colitis– a promising scoring system
Authors: Bacsur P , Wetwittayakhlang P , Resál T , Rutka M , Bessissow T , Atif W , Bálint A , Fábián A , Bor R , Szepes Z , Farkas K , Lakatos P L , Molnár T 
Published: January 2023

Abstract

Background
Ulcerative colitis (UC) is a systemic immune-mediated disease that affects the colon continuously. Colonoscopy plays a crucial role in management of UC that helps to assess mucosal healing objectively along the colon. Different scoring systems are available to assess severity, however most of them does not take into consideration of disease extent. Extension modified (PanMayo) Mayo endoscopic subscore (MES) system has been shown to correlate with UCEIS and Riley scores and calprotectin. Our study aimed to assess the predictive power and accuracy of PanMayo score compared to MES, UCEIS and Dublin to predict mid- and long-term disease outcomes.

Methods
This is retrospective, two-center study. UC patients, who underwent colonoscopy due to any reason between 2016 and 2018, were consecutively enrolled. PanMayo, MES, UCEIS and Dublin scores and additionally the Nancy histology score (where available) were recorded with clinical and demographical data at baseline. Disease flare, need for change in therapy (incl. initiation of biologicals, need for systemic steroids), hospitalisations and colectomy were tracked amongst patients with clinical remission (pMayo&lt;2) during an at least 3-years follow-up to assess predictive value of score systems. Log-rank, Cox regression analysis and Chi2 tests were used to analyse outcomes and Kaplan Meier curves were plotted.

Results
A total of 250 UC patients (male ratio: 0.45, median age 45 (IQR) 22.3 years) were enrolled with 156 (male ratio 0.49; mean age 46 IQR 20.8 years, Table 1.) of UC patients having baseline clinical remission. PanMayo, MES, and Dublin scores were positively associated with risk of disease flare (Figure 1.; p=0.002, p&lt;0.01, p=0.003). Increasing MES score was coupled with risk of relapse (MES0=26.7%, MES1=53.1% and MES2-3=47.6%; p=0.008). PanMayo score (above 12 points), but not MES or UCEIS, was associated with the need of new biological (Figure 2.; 66.7% vs. 21.7%; p&lt;0.001) and treatment escalation (33.3 vs. 11.5%; p=0.018), similar trend was found for the Dublin score for need for new biologicals. There was a strong trend for PanMayo to predict need for hospital admission (p=0.06). All scores were strongly associated with need for systemic corticosteroids. Colectomy rates were low. Nancy score showed only a trend to predict risk of clinical flare and need for corticosteroids.

Conclusion
Our study suggests that combined endoscopic assessment of the extent and severity may be more accurate in predicting disease outcomes in UC in clinical remission. PanMayo scores may be an alternative of the existing scoring system and was associated more granularly with disease outcomes. In addition, outcomes were different in patients with initial MES 0 and 1 scores.