bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0232 Increasing awareness of joint symptoms in Inflammatory Bowel Disease clinic using recognised clinical joint pain scoring symptoms may aid early diagnosis of spondyloarthropathy
Authors: Kerr H , Clarke M , Connaughton R , Elsiddig M , Hall B , Farrell R , Smyth C , Kelly O 
Published: January 2025

Abstract

Background
Axial spondyloarthropathy(axSpA) is under-recognised and underdiagnosed in lnflammatory Bowel Disease (IBD) patients. The aim of our study is to assess the prevalence of subclinical axSpA in our IBD patient cohort, assess risk factors and improve patient health through early recognition and referral.

Methods
A prospective observational study assessing presence of clinical symptoms suggestive of spondyloarthropathy was performed. Patients with established IBD and no previous history of joint pain or documented rheumatological disease attending a specialist IBD clinic were screened over a 6 month period from January to July 2024. All patients reporting lower back pain were assessed with a screening questionnaire using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. BASDAI score ≥ 4 suggests moderate activity of axial spondyloarthropathy. Radiographic imaging of the sacroiliac joints were performed. BASDAI scores were correlated with CRP and calprotectin levels. Other demographic factors were also recorded from patient records.

Results
590 patient visits for IBD were recorded from January to July 2024. 320 patients were screened for the study. 34 (10.6%) patients reported symptoms suggestive of axial spondyloarthropathy when questioned. The mean age was 45 years of age (19-82). 55.9% of patients were female. 14.7% of patients had symptoms of other extra-intestinal manifestations (EIMs). 50% of patients had Ulcerative colitis, 44% of patients had Crohn’s disease and 6% had IBD-U. Mean CRP level was 2.36 (0.5–7). Mean calprotectin was 151 (13-1100). 21/34 (62%) of patients had a BASDAI score suggestive of moderately active clinical symptoms of arthropathy. Mean BASDAI score was 4.97. 2/21 (9.5%) of those with BASDAI ≥ 4 had radiographic evidence of sacroiliitis. Of those patients with radiographic axSpA, the mean BASDAI was 5.1. Patients with radiographic axSpA were referred to the rheumatology outpatient service. 84% females screened had BASDAI ≥ 4 compared to 40 % males (Fisher exact test, p=0.015). There was no correlation noted between reporting of joint symptoms and age, CRP or calprotectin nor did it correlate with disease type or behaviour.

Conclusion
The use of rheumatological screening tests in the IBD clinic could contribute to the early diagnosis of axial spondyloarthropathy in IBD patients. Raising awareness of musculoskeletal manifestations of IBD could improve diagnosis, early involvement of the multidisciplinary team and improve disease burden.
P0236 Diaphragmatic ultrasound investigation to discriminate sarcopenic index in a population of patients with ibd
Authors: Palmisano C M , Dell'Aquila P , Cormio S , Borraccino A V , Squeo F , Savino F , Novielli D , Forastiere D , Principi M R D 
Published: January 2025

Abstract

Background
Sarcopenia is prevalent in patients with inflammatory bowel disease (IBD) and impacts surgical and therapeutic outcomes.The use of different muscles for the study of sarcopenia is described in the literature. The ultrasound study of the diaphragm is a rapid, reproducible, non-invasive with a rapid learning curve.The aim of this work was to evaluated whether the ultrasound diameter of the diaphragm muscle (DM) correlated with the clinical SARC-F score in patients with IBD, in order to use DM measurement as a tool in the diagnosis of sarcopenia in this population.

Methods
Consecutive IBD patients were enrolled.All patients underwent ultrasound of the diaphragm muscle.The diameters during exhalation and during inspiration were assessed, then from these two values it was possible to extrapolate the diaphragm thickness fraction.We calculated the diaphragm-to-height ratio in the US as the average diaphragm thickness fraction divided by the patient's height (mm/m).As previous studies have shown, a cut-off of 1 cm above which one speaks of a normal diaphragmatic excursion has been considered. All patients underwent a clinical questionnaire to calculate the SARC-F score. A SARC-F value≥4 was significant of sarcopenia.

Results
A total of 353 IBD patients (170 CD and 183 UC), 54,55% male, with a mean age of 44.78 years were enrolled.The diaphragm index had a mean value of 0.70cm/m (±.024cm/m). The Pearson test showed a significant negative correlation between the sarcopenia score SARC-F and the diaphragm index (r: -0.42; p-value ˂ 0.05).Of the 353 patients enrolled, 98 had a diaphragmatic excursion of less than 1 cm.Of these, when subjected to the SARC-F score, 57 patients (16.19%) showed positive results with a score above 4, while the remainder had a score of 3, just below the cut-off. These were patients who all had a diaphragmatic excursion index of less than 1 cm. The mean sarcopenia score was 1.51 (±2.02), with a median of 1 (IQR: 0 – 2). Cohen’s Kappa statistics used using the fifth percentile as a threshold, it yielded a significant 80.80% agreement rate (expected: 80.35; Kappa: 0.55; p-value ˂ 0.05).

Conclusion
The study shows a significant correlation between the diaphragmatic index and the SARC-F clinical score,suggesting how reliable the use of diaphragmatic ultrasound is for the study of sarcopenia in patients with IBD. This research could take significant implications for disease management in IBD patients and underscores the importance of further investigations to validate these findings in larger cohorts.
P0243 Evaluation of liver fibrosis and steatohepatitis associated with metabolic dysfunction (MASH) in patients with inflammatory bowel disease (IBD) and steatotic liver disease associated with metabolic dysfunction (MASLD)
Authors: Oliveira E C S D , Lopes M A , Beraldo R F , Castelhano N S , Baima J P , Herrerias G S P , Quaglio A E V , Di Stasi L C , Barbosa W F , Silva G F , Sassaki L Y 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is associated with a systemic inflammatory state and dysbiosis, which may increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This occurs through intestinal bacterial translocation and the increased entry of lipopolysaccharides, free fatty acids, and other toxins into the liver via the portal circulation. One significant complication of MASLD is metabolic dysfunction-associated steatohepatitis (MASH), which can progress to cirrhosis. This study aimed to evaluate the prevalence of MASLD in IBD patients and assess the frequency of complications, such as MASH and liver fibrosis.

Methods
The presence of MASLD was based on the presence of NAFLD associated with the metabolic criterion in outpatients with IBD. The presence of NAFLD was confirmed using liver ultrasound. Noninvasive estimate of liver fibrosis (FIB-4) Index and NAFLD Fibrosis Score (NFS) were used as indirect scores of liver fibrosis. Patients with scores greater than NFS &gt; 0.675 and/or FIB-4 &gt; 2.67; and patients with indeterminate or discordant scores were indicated for liver biopsy to quantify liver fibrosis and evaluate MASH. Liver elastography was not performed due to unavailability in our center.

Results
A total of 179 patients underwent liver ultrasound, with 72 (40.2%) diagnosed with MASLD, including 33 with Crohn’s disease (CD) and 39 with ulcerative colitis (UC). Regarding disease activity, 36.11% were clinically active and 50% were endoscopically active. Biological therapy was used by 54.2% of patients. The degree of steatosis was mild (41.67%), moderate (44.4%) and intense (13.89%). According to the FIB-4 Index, patients were classified as low risk of fibrosis (72.22%), intermediate risk (26.32%) and high risk (1.39%). According to the NFS, the risks for fibrosis were low (53.52%), undetermined (38.08%) and high (8.45%). Sixteen (22.22%) patients underwent liver biopsy, and the presence of fibrosis was observed in 11 (68.75%) patients. The histological stage of fibrosis was F1 (n=6, 54.5%), F2 (n=3, 27,3%), F3 (n=1, 9.1%) and F4 (n=1, 9.1%) according to Kleiner's classification. 4 patients (25%) met criteria for MASH.

Conclusion
A high prevalence of MASLD was observed in patients with IBD. Among patients with MASLD, we must be aware of the risk of liver fibrosis and MASH. Routine monitoring of liver function and fibrosis, including liver biopsy or elastography when appropriate, is crucial for early detection and management of complications. Due to the lack of routine elastography in our center in Brazil, liver biopsy remains essential for accurate assessment in those patients.
P0244 Serum IgLC Levels in Ulcerative Colitis: Limited Utility as Biomarkers for Disease Activity
Authors: Oh J E , Park J J , Choi S , Park J , Park S J , Kim T I , Cheon J H 
Published: January 2025

Abstract

Background
Immunoglobulin free light chains (IgLC), which are surplus light chains produced by plasma cells that fail to bind to heavy chains, have been reported to be elevated in Crohn's disease. However, the presence and clinical significance of serum IgLC levels in ulcerative colitis (UC) remains unclear. We investigated serum IgLC levels and their association with disease activity in UC patients.

Methods
In this prospective study, we enrolled consecutive UC patients (n=25) and assessed disease activity using the partial Mayo score. Serum IgLC kappa and lambda levels were measured using immunoturbidimetric assay. Inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also evaluated. Disease extent was classified as proctitis, left-sided colitis, or pancolitis.

Results
Mean serum IgLC lambda levels were significantly higher in active UC compared to remission (29.8 ± 20.2 mg/L vs. 14.4 ± 3.0 mg/L, P = 0.044). However, IgLC kappa levels showed no significant difference between the two groups (36.0 ± 37.6 mg/L vs. 22.5 ± 7.4 mg/L, P = 0.330). In correlation analysis, CRP and ESR demonstrated strong correlations with disease activity (r = 0.573 and r = 0.517, respectively), while IgLC lambda showed only weak correlation (r = 0.315, P = 0.125). Subgroup analysis by disease extent revealed different patterns: while no biomarkers correlated with disease activity in proctitis, CRP alone showed significant correlation in left-sided colitis (r = 0.718) and pancolitis (r = 0.693), with ESR and IgLC lambda showing no significant associations.

Conclusion
Despite elevated serum IgLC lambda levels in active UC, its correlation with clinical disease activity was limited. These findings suggest that B-cell activity markers may not serve as reliable biomarkers for UC disease activity assessment.
P0246 Predicting Operative Recurrence in Crohn's Disease Using a Nomogram Incorporating Histopathological Factors
Authors: Zhang C , Zhang Y , Xiong S , Zhang P , Cao Q , Ye Z , Qiu Y 
Published: January 2025

Abstract

Background
Crohn's disease (CD) poses a substantial risk of disability and often necessitates recurrent surgical interventions. To date, no association between histologic activity and relapse in CD were found.

Methods
Data were retrieved from a prospective inflammatory bowel disease registry. Two blinded pathologists graded the inflammation and fibrosis of archived specimens from primary ileal or ileocolonic resections based on an established histopathological score. Factors associated with earlier operative recurrence were identified using a multivariate logistic regression model. A nomogram was constructed to predict reoperation, with model performance assessed using receiver-operating characteristic (ROC) curves and decision curve analysis (DCA).

Results
Among the 133 patients (68.4% male), the median time to reoperation was 31.9 months (IQR, 14.1-65.7 months). Fourteen reoperations were detected, 4 for abscess/fistula/perforation and 10 for stricture/stenosis. Fifty-four patients experienced endoscopic recurrence within a median time of 10.7 months (IQR, 4.53-18.9 months). Factors associated with reoperation included disease behavior (stricturing, OR 12.1, 95% CI 1.8-80.9; penetrating, OR 9.9, 95% CI 1.4-67.9) and the degree of intestinal fibrosis in the resected specimens (OR 12.1, 95%CI 1.2-126.6). A nomogram, incorporating fibrosis scores, smoking status, disease behavior, and perianal lesions, was established. Both ROC curve and DCA analysis indicated that the nomogram provided increased benefits for predicting reoperation.

Conclusion
The established nomogram, integrating fibrosis grading from resected specimens, serves as a practical tool for predicting reoperation in CD patients. This nomogram enables the identification of high-risk patients, facilitating proactive postoperative interventions to mitigate operative recurrence.
P0247 Clinical and Colonoscopic Features of Colitis in HIV-Positive Patients Mimicking Inflammatory Bowel Disease Over the Past 12 Years
Authors: Kim Prof. Dr. W J , Choi Y S , Kim J K , Paik N 
Published: January 2025

Abstract

Background
Not only the incidence of inflammatory bowel disease(IBD) but also that of HIV-positive colitis is increasing as individual freedom is emphasized, making the diagnosis of IBD more challenging nowadays.

Methods
We reviewed the data of 75 HIV-positive patient at Daehang Hospital, Seoul, from January 2012 to October 2024. Ten patients were filtered from retrospective medical records analysis who were suspected to have IBD before the HIV-positive diagnosis.

Results
Among the 10 patients suspected to have IBD, all were men with a median age of 27, ranging from 22 to 62. Symptom complaints started 2 week ago(2 men), 1 month ago(6 men), 2months ago(1 man), 6month ago(1 man). Initial diagnoses from personal history were ulcerative colitis(5 men), Crohn’s disease(3 men), irritable bowel syndrome(1 man), infectious colitis(1 man). Anal sex history could be obtained from 5 patients. Colonoscopy revealed rectal ulcers(4 men), whole colon ulcers or erosions(4 men), left colon erythema, edema (1 man), and anal abscess(1 man). One patient was found to have amebiasis from cecum tissue.

Conclusion
HIV-positive colitis is very rare but now increasing, necessitating differential diagnosis. Initial suspicion through careful history taking and close observation of colonic mucosal lesions could reduce the misdiagnosis of IBD. Further large-scale cases are needed to identify the characteristics of HIV-positive colitis to exclude the diagnosis of IBD.
P0248 Insomnia as a determinant of poor IBD disease course
Authors: Weintraub Y , Tauman R , Shouval D S , Shamir R , Kwapisz L , Rosenberg S , Dunietz G L 
Published: January 2025

Abstract

Background
Insomnia is one of the most common sleep disorders, affecting up to 30% of the adult population worldwide. Sleep disorders can have a marked impact on immune functions and inflammation, including in patients with inflammatory bowel diseases (IBD) in both active and inactive disease states. Whether insomnia preceding IBD flares affects clinical outcomes is unknown. We examined the association between insomnia and IBD-related outcomes in adults diagnosed with of Crohn’s disease (CD) or ulcerative colitis (UC).

Methods
A retrospective, real-world, cohort study utilizing the Lynx MD’s electronic medical record dataset, provided by a US-based community gastroenterology practice. Deidentified patient charts were analyzed to identify patients with a confirmed diagnosis of IBD (either CD or UC). Eligibility criteria included: ≥3 diagnoses of IBD, ≥1 diagnoses of IBD and: histopathologic diagnosis of IBD; or IBD related surgery; or ≥ 3 months of treatment with standard accepted therapies for IBD; and ≥3 years of follow-up. IBD-related events of hospitalization and/or surgery were recorded. The cohort was classified into two groups based on insomnia diagnosis, prior to IBD related hospitalizations or surgeries. We implemented Cox Proportional Regression models to estimate Hazard Ratios for the IBD-related outcomes.

Results
Among 20,011 patients with IBD, 10,775 (54%) were women, at a mean age of 48.2 ± 18.2 years old, 11,842 (59%) were diagnosed with UC and 8,169 (41%) with CD. Over 3,100 patients (16%) were diagnosed with insomnia prior to the first IBD related hospitalization or surgery.
In an unadjusted model, insomnia was significantly associated with IBD-related hospitalizations - hazard ratio (HR) of 1.43 (95% CI 1.28, 1.59) and IBD related surgeries - HR of 1.42 (95% CI 1.12, 1.81). After adjustment for age, sex, race, body mass index, anxiety and type of IBD (CD vs. UC), IBD-affected patients with insomnia had a higher HR of hospitalization and surgery: HR of 1.35 (95% CI 1.2,1.51) and 1.29 (95% CI 1.01,1.66), respectively, compared to those without insomnia.

Conclusion
In a large real-life dataset of patients with IBD, we found higher rates of IBD-related hospitalizations and surgeries among patients with comorbid insomnia, suggesting that insomnia may be associated with a more severe course of IBD.
P0249 The Impact of Obesity on the Persistence of Advanced Therapies in Inflammatory Bowel Disease
Authors: Hsu W C , Lin S H , Chiu H Y , Kuo C J , Chen C M , Su M Y , Wu R C , Chiu C T , Chang C W , Huang T Y , Pan Y B , Le P H 
Published: January 2025

Abstract

Background
Obesity has emerged as a factor influencing outcomes in inflammatory bowel disease (IBD), yet its effect on the persistence of advanced biologic therapies, especially in Asian populations, remains unclear. This study evaluates obesity’s impact on clinical outcomes and treatment persistence among Taiwanese IBD patients on advanced biologic therapies.

Methods
This retrospective cohort study was conducted at Chang Gung Memorial Hospital, Taiwan, involving IBD patients on advanced biologics between April 2017 and October 2024. Patients were categorized by BMI into obesity (≥27 kg/m²) and control (&lt;27 kg/m²) groups. Outcomes included one-year therapy persistence, infections, IBD-related hospitalizations, surgeries, and flare-ups, with persistence compared across biologic agents.

Results
Among 555 IBD patients, 68 were obese. Obese patients had distinct characteristics: higher male prevalence (86.8% vs. 65.3%), smoking rates (20.6% vs. 7.8%), and comorbidities such as hypertension (30.6% vs. 13.6%) and cardiovascular disease (11.8% vs. 2.5%). Lab results indicated elevated white blood cells, hemoglobin, albumin, and triglycerides, and lower HDL cholesterol in the obesity group. While overall one-year persistence rates were similar, Ustekinumab showed a lower persistence in obese patients.

Conclusion
Obesity in Asian IBD patients is linked to specific clinical traits and comorbidities. Although obesity did not affect overall therapy persistence, Ustekinumab’s lower persistence among obese patients suggests the need for tailored treatments. Future studies should explore optimal therapies for obese IBD patients.
P0251 Inter-rater disagreements in applying the Montreal classification for Crohn’s disease: The Five-Nations Survey Study
Authors: Ukashi O , Amiot A , Laharie D , Menchén L , Gutierrez A , Fernandes S , Pessarelli T , Correia F , Gonzalez-Muñoza C , López-Cardona J , Barreiro-de Acosta M , Yanai H , Armuzzi A , Magro F , Kopylov U 
Published: January 2025

Abstract

Background
The Montreal classification has been widely used in Crohn’s disease (CD) since 2005 to categorize patients by the age of onset (A), disease location (L), behavior (B), and upper gastrointestinal tract and perianal involvement. With evolving management paradigms in CD, we aimed to assess the performance of gastroenterologists in applying the Montreal classification.

Methods
An online survey was conducted among participants in an international educational conference on inflammatory bowel diseases (IBD). Participants classified 20 theoretical CD cases using the Montreal classification. Agreement rates with the IBD board (three expert gastroenterologists whose consensus rating was considered the gold standard) were calculated for gastroenterologist specialists and fellows/specialists with ≤2 years of clinical experience. A majority vote&lt;75% among participants was considered a notable disagreement. The same cases were classified using three large language models (LLMs), ChatGPT-4, Claude-3, and Gemini-1.5, and assessed for agreement with the board and gastroenterologists. Fleiss Kappa was used to assess within-group agreement.

Results
Thirty-eight participants from five countries completed the survey. In defining the Montreal classification as a whole, specialists (21/38 [55%]) had a higher agreement rate with the board compared to fellows/young specialists (17/38 [45%]) [58% vs. 49%, p=0.012] and to LLMs (58% vs. 18%, p&lt;0.001). Disease behavior classification was the most challenging, with 76% agreement among specialists and fellows/young specialists and 48% among LLMs compared to the IBD board. Regarding disease behavior within-group agreement was moderate (specialists: k=0.522, fellows/young specialists: k=0.532, LLMs: k=0.577; p&lt;0.001 for all). Notable points of disagreement included: defining disease behavior concerning obstructive symptoms, assessing disease extent via video capsule endoscopy, and evaluating treatment-related reversibility of the disease phenotype.

Conclusion
There is significant inter-rater disagreement in applying the Montreal classification, particularly for disease behavior in CD. Improved education or revisions to phenotype criteria may be needed to enhance consensus on the Montreal classification.