bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0222 Predicting corticosteroid failure in Acute Severe Ulcerative Colitis at admission using the ADMIT-ASC score
Authors: Chan P , Ajmera R , Thin L 
Published: January 2025

Abstract

Background
The treatment paradigm for Acute Severe Ulcerative Colitis (ASUC) continues to evolve in the era of biologics and small molecules, with corticosteroids forming the initial foundation of treatment. A significant proportion of patients fail to improve on corticosteroid therapy alone1 and are at subsequent risk of colectomy, requiring treatment escalation. We applied the recently developed ADMIT-ASC2 model to an Australian cohort of ASUC patients to further validate its role in predicting steroid failure.

Methods
158 admissions (147 patients) that met the modified Truelove and Witts’ criteria for ASUC between 2016-2023 at a Western Australian tertiary hospital were retrospectively analysed. The previously described ADMIT-ASC model was applied to our cohort: CRP ≥100mg/L (1 point), albumin ≤25g/L (1 point), UCEIS ≥4 (1 point) or ≥7 (2 points). Baseline patient data including demographic, disease characteristics, and prior treatment information were collected. Steroid-failure was defined as requiring a lack of clinical improvement (defined by the Oxford Criteria) necessitating medical rescue therapy or surgery.

Results
In our cohort, 158 admissions for ASUC were analysed and 46 (29%) patients were new diagnoses of ulcerative colitis at the time of admission. Of those, 99 patients (62.7%) received medical rescue therapy (95% infliximab, 4% tofacitinib, 1% cyclosporine). Twenty-two (13.9%) patients underwent a colectomy within 30 days and an additional 12 (7.6%) required colectomy within 12 months of discharge. The ADMIT-ASC score was applied to our cohort. A score of ≥3 yielded a 94.1% positive predictive value for steroid failure (OR 9.56). A score of 0 predicted steroid response in 100% of the cohort. The baseline characteristics of the steroid responsive and non-steroid responsive groups are shown in Table 1.

Conclusion
The ADMIT-ASC score provides a simple scoring system available from initial endoscopic and biochemical evaluation. Increased utilisation of this validated tool potentially allows for day 1 prediction of patients at high risk of steroid failure to prompt earlier treatment escalation to advanced therapies.

References
[1]Adams, A., Gupta, V., Mohsen, W., Chapman, T. P., Subhaharan, D., Ramaswamy, P. K., ... & Satsangi, J. (2023). Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut, 72(3), 433-442.Chicago
[2]Ho, G. T., Mowat, C., Goddard, C. J. R., Fennell, J. M., Shah, N. B., Prescott, R. J., & Satsangi, J. (2004). Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery. Alimentary pharmacology & therapeutics, 19(10), 1079-1087.
P0223 In Vitro Fertilization in Women with Inflammatory Bowel Disease – Clinical Characteristics and Outcomes
Authors: Ashkenazi A , Ron Y , Skornick-Rapaport A , Leibovitzh H , Thurm T , Hirsch A , Maharshak N , Cohen N A 
Published: January 2025

Abstract

Background
Inflammatory Bowel Disease (IBD) most commonly affects women of reproductive age. While considered effective, there are limited data concerning IBD and pregnancy-related outcomes in patients receiving in vitro fertilization (IVF). This study compares the characteristics and outcomes of pregnant women with IBD who conceived spontaneously with those who required IVF.

Methods
This retrospective study included pregnant women with IBD who visited the IBD Mom Clinic at the Tel Aviv Sourasky Medical Center (TLVMC). The cohort consists of two groups - women who conceived spontaneously (IBD-spon) or through IVF therapy (IBD-IVF). Demographics, clinical characteristics, as well as pregnancy and IBD-related outcomes were collected from electronic medical records.

Results
A total of 269 IBD pregnancies from September 2017 to December 2023 were reviewed; 53 women (19.7%) conceived via IVF. Among the IBD-IVF group, there was a lower rate of Crohn’s disease (54.7% vs 67%, P=0.02), similar rate of ulcerative colitis (35.8% vs 31%, p=0.347) and lower rate of patients with pouch (9.4% vs 1.9%, p=0.005). Disease duration was longer in IBD-IVF (10.5 ± 6.9 vs. 8.3 ± 6.0 years, p&lt;0.05) and the IBD-IVF group was significantly older (mean 34.5 ± 5.4 years vs. 31.6 ± 4.4 years, p&lt;0.001) and independently associated with a 10% increase in IVF conception likelihood per additional year of age (OR=1.10, p&lt;0.001). Patients with CD who received IVF had higher rates of peri-anal involvement compared to those who conceived spontaneously (37.9% vs. 19.5% p&lt;0.05). Table 1 summarizes these findings.
First-trimester fecal calprotectin levels were elevated in the IBD-IVF group (684.1 ± 1003.5 vs. 373.8 ± 529.6 μg/g, p&lt;0.001). Despite that, no significant differences in IBD exacerbations, advanced therapy adjustments, or hospitalizations were observed. Adverse pregnancy outcomes were more frequent in the IBD-IVF group. These includes lower mean fetal weight (2999.7 ± 493 vs. 3185.6 ± 524.6 g, p=0.05), spontaneous abortions (9.4% vs. 1.9%, p=0.03), and pregnancy losses before 20 weeks (7.5% vs. 1.5%, p=0.03), as detailed in Table 2.

Conclusion
In this study, significantly higher rates of adverse pregnancy outcomes were observed in patients conceiving through IVF. Older age was independently associated with IVF conception. No increased adverse IBD-related outcomes were observed. These data suggest that the complications in the IVF group, are more related to underlying maternal risk factors and emphasize the importance of close monitoring and follow-up in this population.
P0233 Prevalence and characteristics of short bowel syndrome in Crohn's disease: a retrospective observational single centre study
Authors: Laffusa A , Viganò C , Pirola L , Hu W , Mulinacci G , Gallo C , Savino A , Fichera M , Sampietro G M , Invernizzi P , Massironi S 
Published: January 2025

Abstract

Background
Despite a wide range of treatment options for Crohn’s Disease (CD), over half of patients require bowel resection within five years of diagnosis, with one-third needing additional surgery. Even with conservative surgical techniques, these patients remain at risk of Short Bowel Syndrome (SBS), defined as a residual small bowel length of less than 200 cm, potentially leading to intestinal failure (IF), characterized by reduced absorption of macronutrients, water or electrolytes. The prevalence and risk factors for SBS in CD patients remain unclear. Available retrospective studies report an SBS prevalence in operated CD patients ranging from 3.3% to 5.9 %. Our study aimed at describing the prevalence and characteristics of SBS, IF and Intestinal Functional Deficiency (IFD), defined as the need of any chronic enteral supplementation of macro and/or micronutrients, in a cohort of CD patients.

Methods
We conducted a retrospective observational cohort study, including all adult patients with CD referred to the Gastroenterology Department at IRCCS San Gerardo dei Tintori (Monza - Italy) between September 2014 and April 2022. Data were collected through the Electronic Medical Records.

Results
456 CD patients were included with a mean age of 52 years (±18 SD). 221 (48.5%) patients underwent bowel surgery with a median resection length of 63 cm (IQR 60.75); the ileocecal valve was preserved in 49 (22.1%) patients. Four patients (1.8% of operated CD patients) developed SBS, after two to four surgeries over a median follow-up of 18 (IQR 15) years. Of these, three presented with type 2 SBS (jejuno-colonic anastomosis) and one with type 1 SBS (jejunostomy). Three patients had ileocolonic disease and one ileal disease, upper disease was present in three. Two SBS patients had stricturing disease, and the remaining two a penetrating phenotype. Perianal involvement was present in two patients. Only one patient (0.5%) developed permanent IF. On the other hand, 110 (49.7%) of operated patients presented post-surgical IFD: 109 (99.1%) received vitamins, 7 (6.4%) proteo-caloric, and 3 (2.7%) electrolytes supplements. These patients had a higher median age (62 vs 51.5 years, p=0.001), longer small bowel resections (60 vs 20 cm, p&lt;0.0001) and more frequent ileocecal valve resections (91.8% vs 63.9%, p&lt;0.0001) than patients without deficiency.

Conclusion
SBS and IF are rare conditions in CD patients following surgical bowel resection, prevalence is lower than previously reported. Whereas IFD affects about half of resected CD patients, highlighting the importance of prevention, early diagnosis and treatment of nutritional deficit.
P0234 Predicting factors for long-term outcomes of intestinal Behçet's disease in Japan
Authors: Murakami K , Ihara S , Fujishiro M 
Published: January 2025

Abstract

Background
This study aimed to investigate long-term prognosis and predictive factors for relapse in patients with intestinal Behçet's disease (BD) who initiated conventional therapy (5-ASA, oral steroids, and azathioprine) in Japan.

Methods
Sixty-three patients with intestinal BD treated at Tokyo University Hospital in Japan from 2005 to 2024 were included. Patients who required anti-TNFα agents were classified as the Advanced Therapy (AT) group, while those controlled with conventional therapy were classified as the Conventional Therapy (CT) group. Cumulative relapse rates and risk factors for relapse were analyzed by Kaplan-Meier method and Cox proportional hazards Regression.

Results
The median follow-up was 93 months (range, 4-231), with 28 patients (44%) in the AT group and 35 patients (56%) in the CT group. At the time of diagnosis of intestinal BD, there were no significant differences between the two groups in terms of sex, age, and BD subtypes. The cumulative relapse rates at 1, 3, 5, and 10 years were 22.6%, 35.9%, 40.0%, and 50.8%, respectively. Univariate and multivariate analyses identified concomitant use of PPIs (HR: 2.65, 95% CI: 1.06-6.58, p=0.036), the presence of bloody stool (HR: 2.40, 95% CI: 1.05-5.46, p=0.037), CRP ≥ 4 mg/dL (HR: 2.56, 95% CI: 1.04-6.31, p=0.042), and maximum ulcer size ≥ 3 cm (HR: 2.68, 95% CI: 1.05-6.84, p=0.039) as independent risk factors for transitioning to AT. A predictive model incorporating these factors demonstrated good diagnostic ability (AUC = 0.847).

Conclusion
PPI use, bloody stool, high CRP, and large ulcer size were considered risk factors for resistance to conventional therapy and the need for anti-TNFα agents in patients with intestinal BD.
P0239 Sexual quality of life and patient-healthcare communication in Inflammatory Bowel Disease: a comprehensive single-center analysis
Authors: Saidani R , Cherif D , Hassine H , Yacoub H , Debbabi H , Kchir H , Maamouri N 
Published: January 2025

Abstract

Background
Sexual health concerns significantly impact quality of life in inflammatory bowel disease (IBD), yet remain insufficiently addressed in clinical practice. We aimed to assess sexual quality of life (SQoL) in IBD patients compared to healthy controls while exploring patient-healthcare communication patterns.

Methods
We conducted a prospective single-center study of 78 IBD patients (45 with Crohn's disease [CD] and 33 with ulcerative colitis [UC]) and 49 healthy controls. Participants completed a comprehensive assessment including sociodemographic data and validated instruments: Short IBD Questionnaire (SIBDQ), Sexual QoL Questionnaire-Male/Female (SQoL-M/F), Nine-item Patient Health Questionnaire (PHQ-9), and specific questions about sexual health communication with healthcare providers. Disease characteristics and surgical history were also collected.

Results
The cohort included 43 females (55.1%) and 35 males (44.9%), with a mean age of 46.3 ± 13.8 years. IBD patients reported significantly lower SQoL scores compared to controls (males: 77.29 vs 83.83, p&lt;0.001; females: 70.40 vs 81.63, p&lt;0.001). A majority of patients (76.9%, 60/78) reported specific sexual health concerns.
Physical symptoms affecting sexual life included pain during intercourse (34.6%), fatigue (42.3%), and incontinence concerns (29.5%). Psychological impacts were more prevalent, with fear of symptom occurrence during intimacy (51.3%) and decreased sexual drive (47.4%) being the most common concerns. Perianal disease (present in 23.1%, 18/78) significantly impacted male SQoL scores (70.2 vs 79.8, p=0.003) but not female scores.
Depression symptoms (PHQ-9 ≥10) were present in 35.9% of patients and strongly correlated with reduced SQoL (r=-0.62, p&lt;0.001). While 82.1% of patients desired healthcare provider-initiated discussions about sexual health, only 15.4% had raised these concerns themselves, citing embarrassment (56.4%) and perceived time constraints (41.0%) as main barriers.
In multivariate analysis, independent predictors of reduced SQoL in males included age (β=-0.31, p=0.02), depression (β=-2.101, 95% CI: -2.505 to -1.696, p&lt;0.001), and perianal disease (β=-0.28, p=0.03). In females, depression remained the sole independent predictor (β=-1.973, 95% CI: -2.313 to -1.632, p&lt;0.001).

Conclusion
IBD patients experience significantly impaired sexual quality of life compared to healthy controls, with distinct gender-specific patterns in predictive factors. Despite high prevalence of sexual health concerns, there remains a substantial communication gap between patients and healthcare providers. These findings emphasize the need for routine screening of sexual health issues and proactive healthcare provider-initiated discussions as integral components of IBD care.
P0241 The DETECTION Study: DETection by Endoscopy of Colitis in Screening ImplementaTION
Authors: Lloyd A , Hanly M , Nolan B , Doran R , McCarville L , Macmathuna P , Coffey H , Adetona O , Rajan M , Dokic D , Manj J , Morahan F , Lucey M , Walsh N , Musial O , Sugrue K , Twomey R , O'Sullivan C , O'Brien L , Gleeson S , Sheehan D , McDonald C , Moran C , Buckley M , Iacucci M , McDermott E , Cullen G , Horgan G , Mulcahy H , Buckley M , Sheridan J , Egan L , Kevans D , McCarthy J , Leydan J , O'Toole A , Macnamara D , Slattery E , Boland K , Doherty G 
Published: January 2025

Abstract

Background
The National Bowel Screening Program (Bowelscreen), a nationwide initiative program, aims to provide direct access to those aged 55-74 (currently 59-69) for colonoscopy assessment deemed high risk for colorectal cancer via positive faecal immunochemical test (FIT). Inflammatory Bowel Disease (IBD) follows a bimodal distribution of onset with European studies reporting 10-15% diagnosis after age 60. Limited published research exists on IBD incidence in Ireland via FIT-based population screening and associated outcomes. We aim to dtermine incidence rates/severity of incident IBD cases found via FIT-based colorectal screening programme and hRetrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopyow often screening colonoscopy is performed for patients with known IBD and positive FIT.

Methods
Retrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopy.

Results
203/8070 (2.52%) of index screening colonoscopies analysed reported endoscopic diagnosis of colitis. 105/8070 (1.3%) satisfied diagnostic criteria for classic IBD (65.7% UC; 34.2% Crohn’s), of which the majority were new diagnosis (73.3%). 32% cases of segmental colitis associated with diverticulosis (SCAD) were identified. 21% cases of NSAID induced colitis were identified. UC Colitis distribution: 18.8% pancolitis, 38.4% proctitis and 42.8% left-sided. Crohn’s distribution: 8.3% small bowel solely; 89% colonic and 2.7% mixed. 48% reported symptoms at endoscopy. Median FCP following diagnostic colonoscopy was 216.5μg/g. 10% of newly diagnosed IBD patients required biologic escalation.

Conclusion
Incidental diagnosis of colitis occurs in 3% of FIT-positive screening participants in a population based screening programme with new diagnoses of IBD including UC, Crohn’s and SCAD requiring treatment. This is a novel, unintended benefit to FIT-based population screening.
P0245 Analysis of quality measurements of colonoscopy at different levels of care in IBD
Authors: Bacsur P , Farkas B , Ivány E , Fábián A , Bor R , Szepes Z , Farkas K , Molnár T 
Published: January 2025

Abstract

Background
High-quality endoscopy in IBD is associated with better clinical outcomes, while quality measurement supports effective quality control. The European Society of Gastrointestinal Endoscopy recommends using nine performance measures, depending on the indication for endoscopic examination in IBD. Our study aimed to compare colonoscopy quality between tertiary and secondary referral centers for IBD patients, based on endoscopic reports.

Methods
In this cross-sectional study, colonoscopy reports of IBD patients were analyzed. At our tertiary center, we consecutively enrolled patients over 18 years old with established IBD between July and October 2024, using their available colonoscopy reports. The secondary care group included patients referred to our tertiary center, with the last existing report from secondary care used for analysis, while the tertiary care group consisted of our patients whose most recent report was similarly used. Nine key performance measures (indication, bowel preparation, photo documentation, ileal intubation, biopsy, endoscopic activity score, high-definition and chromoendoscopy use, and neoplasia detection) were evaluated based on colonoscopy reports. Patients were stratified by procedure indication (diagnostic, activity assessment, or surveillance) as well. Descriptive statistics, Welch’s, and Fisher’s exact tests were used to compare groups, with p-values &lt;0.05 considered significant.

Results
Overall, 207 colonoscopy reports were assessed, of which 68/207 were performed at secondary care level. A total of 78/207 patients were diagnosed with Crohn’s disease, while unclassified diagnoses were noted only at secondary centers. Activity control (88% vs. 38%, p&lt;0.001) and surveillance (8% vs. 0%, p=0.02) examinations were more common at the tertiary level. Bowel preparation was better at tertiary centers (Boston Bowel Preparation Scale [BBPS] 8.3±2.3 vs. 7.2±1.2; p=0.003), and use of BBPS was more frequent at higher levels of care (p&lt;0.001). Disease activity scores were more commonly used at the tertiary level during activity control examinations (51.2% vs. 19.2%, p=0.004), while ileal intubation was also more frequent at the tertiary level (53% vs. 28%; p&lt;0.001). Procedure and withdrawal times did not differ between levels in diagnostic or activity control examinations. Neoplasia detection was low, and biopsy rates were similar.

Conclusion
Quality indicator targets were met in neither secondary nor tertiary centers; however, wider investigation is needed to verify these results. Broad education can help to improve the quality of colonoscopy in IBD care.
P0252 Mild Crohn’s disease is associated with altered sphingolipid metabolism and reduced neutrophilic inflammation
Authors: Bourgonje A R , Ibing S , Argmann C , Sands B E , Dubinsky M C , Jacobsen H A , Larsen L , Jess T , Rajauria P , Shapiro J M , Shah S A , Ananthakrishnan A N , Suarez-Fariñas M , Renard B Y , Colombel J F , Ungaro R C 
Published: January 2025

Abstract

Background
Around 20-30% of patients with Crohn's disease (CD) experience a mild disease course. However, identifying patients likely to maintain a mild course is challenging. This study aimed to identify molecular features of mild CD by exploring biological datasets from two large patient cohorts.

Methods
Patients with mild CD were analysed from two longitudinal cohorts: the Mount Sinai Crohn's and Colitis Registry (MSSCR) observational cohort and the Ocean State Crohn’s and Colitis Registry (OSCCAR) inception cohort. Baseline assessments in both cohorts included biological/immunomodulator use, history of IBD-related surgeries, and complications (stricturing, penetrating, and perianal CD). Mild CD was defined by the absence of these variables at baseline and after five years of follow-up (Fig. 1A). The remaining patients were mild at baseline but progressed during follow-up. Patients with mild CD and those who progressed after being mild at baseline were evaluated for potential molecular biomarkers including circulating metabolites (metabolomics), immune cell profiles (multiparametric flow cytometry), serum proteomics, and intestinal transcriptomics.

Results
In total, 100 (MSSCR) and 152 (OSCCAR) patients were characterized, with 55 (55.0%) and 74 (48.7%) classified as mild CD, respectively. Intestinal transcriptomic analysis revealed downregulation of genes associated with neutrophilic inflammation and innate immunity, including SAA, DUOXA2, FCGR3B, LCN2, S100A8, and AQP9 (Fig. 1B). Flow cytometry showed lower frequencies of neutrophils (CD16+), lower neutrophil-to-lymphocyte ratios (NLR), and higher counts of NK and total B cells in mild CD (Fig. 1C). Metabolomic analysis identified ceramide- and sphingomyelin compounds (particularly acyl-CoA chain lengths C14-16 and C22-26) as positively associated with mild CD (odds ratios [OR] &gt;2.0), whereas primary and secondary bile acids and amino acid derivatives from lysine, tyrosine, and proline metabolism were inversely associated (Fig. 1D). Proteomic analysis in OSCCAR demonstrated associations between C-X-C motif chemokine ligand 9 (CXCL9), macrophage colony stimulating factor (CSF-1), and TGF-β1 latency-associated peptide (LAP-TGF-β), and an inverse association for Delta and Notch-like epidermal growth factor-related receptor (DNER) with mild CD (adjusted P&lt;0.05) (Fig. 1E).

Conclusion
This study provides multi-omics-based biomarker signatures of mild CD, which primarily relate to altered ceramide- and sphingomyelin metabolites and lower systemic neutrophilic inflammation. Future studies focusing on the biological significance and potential clinical impact on disease monitoring and therapeutic strategies are warranted.