bluuebunny/crossref_metadata_2025_split huggingface dataset:
P0326 Environmental factors, genetic predisposition and subclinical inflammation in the development of perinuclear-antineutrophil cytoplasmic antibody (P-ANCA)-positive ulcerative colitis: A European twin study
Authors: Bergemalm D , Amcoff K , Pierik M J , Colombel J F , Vermeire S , Bodin L , Halfvarson J 
Published: January 2025

Abstract

Background
Perinuclear-antineutrophil cytoplasmic antibodies (P-ANCAs) have been identified in familial ulcerative colitis (UC), but the precise mechanism underlying their expression remains elusive. We assessed the role of genetic predisposition, environmental factors and systemic subclinical inflammation in the development of P-ANCA in a twin cohort with UC.

Methods
A total of 48 twin pairs (Leuven, Belgium n=4, Maastricht, The Netherlands n=6 and Örebro, Sweden n=38) with UC were included. Among these, 18 were monozygotic (3 concordant and 15 discordant for UC) and 30 were dizygotic (1 concordant and 29 discordant for UC). P-ANCA was detected through standardised ELISA, an indirect immunofluorescence assay and DNase treatment. In addition to high sensitivity C-reactive protein (hs-CRP), 92 inflammatory protein markers were measured in serum by proximity extension assay (Olink proteomics).

Results
P-ANCA was present in 16/52 (31%) of UC twins vs. 4/44 (9%) healthy twin siblings (p=0.01). No agreement in the presence of P-ANCA or their levels was observed between twin siblings in monozygotic pairs discordant for UC [intraclass correlation coefficient (ICC)=0.09] or dizygotic pairs (ICC=-0.20). Female sex was associated with an increased likelihood of P-ANCA (odds ratio, OR 5.49; 95% confidence interval, CI 1.47-20.57) and higher ANCA levels (ratio of geometric means 1.80; 95% CI 1.12-2.88). Active smoking was associated with lower concentrations of ANCA (ratio of geometric means 0.33; 95% CI 0.15-0.75) and potentially reduced the likelihood of P-ANCA (OR 0.23; 95% CI 0.02-2.21) in twins with UC but not in their healthy siblings. In twin siblings without UC, significant correlations between ANCA levels and hs-CRP, CDCP1, IL17A, CXCL9 and IL5 (correlation coefficients 0.36-0.41, p-values &lt;0.05) were observed.

Conclusion
Female sex and tobacco smoking outweighed genetics regarding the generation and levels of P-ANCA and ANCA antibodies. The correlations between ANCA levels and inflammatory markers in healthy twin siblings suggest that P-ANCA may result from subclinical inflammation in these healthy siblings.
P0327 Histologic remission predicts endoscopic remission in patients with ulcerative colitis
Authors: Aouroud H , Lairani F E , Aouroud M , Nacir O , Ait Errami A , Oubaha S , Samlani Z , Krati K 
Published: January 2025

Abstract

Background
In 2015, the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) committee proposed a treat-to-target (T2T) approach and recommended that the therapeutic target in UC should be both clinical and patient-reported outcomes (PRO) as well as the histological remission is also considered to be a treatment target. The aim of this study was to evaluate whether histologic activity can predict the maintenance of endoscopic remission in UC pa- tients with Mayo endoscopic subscore (MES) 0 or 1

Methods
This was a retrospective study conducted over a period of 18 months (January 2023 to June 2024) at a our tertiary hospital center. Patients diagnosed with UC who had been in clinical remission (n=56) for at least 6 months were evaluated for endoscopic remission. Those in endoscopic remission (Mayo score ≤1;23/56, 41%) were subjected to multiple biopsies from the rectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria: Patients were divided into two groups based on their histologic activity: histologic remission and active.

Results
Over 23 patients in endoscopic remission the majority had E1 (proctitis) disease (45.6%) followed by E2 (39.1%) and E3 disease (pancolitis) (15.2%) at baseline. Histological remission was noted in 47% of the patients, while 52% still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (86.6%), cryptitis (93.3%), and crypt abscesses (8/15, 53.3%). On follow-up, after 1 year, 79.1% of the patients who had been in histological remission remained clinically asymptomatic, while 20% had relapsed. Among the histologically active patients, 36.6% remained in clinical remission, while 63.3% had relapsed.

Conclusion
The patients who achieve histologic remission are more likely to maintain endoscopic remission compared to those with histologic activity.
P0328 Faecal calprotectin and MRI are complementary tools for assessing treatment efficacy and predicting the risk of bowel damage progression in Crohn’s disease: results of the IZNOGOUD study
Authors: Buisson A , Guilmoteau T , Allimant C , Pereira B 
Published: January 2025

Abstract

Background
Faecal calprotectin (Fcal) and magnetic resonance imaging (MRI) could be used as non-invasive tools to monitor mucosal and transmural healing, respectively, in Crohn’s disease (CD).
We assessed the agreement between Fcal and MRI in detecting active CD and to explore the complementarity of these tools in predicting long-term CD outcomes.

Methods
Using pooled data from two prospective studies, we included patients with CD who underwent both MRI and Fcal testing within 7 days. MRI was performed without bowel cleansing or enema but with 0.5–1L of PEG for bowel distension. MRI included a segmental assessment of jejunum, non-terminal ileum, terminal ileum (last 30 cm), right colon, transverse colon, left colon/sigmoid colon, and rectum.
Transmural healing on MRI was defined as a C-score &lt;0.5 in all segments.
Patients were classified into four groups: transmural healing (both normal), MRI healing (Fcal &gt;100 μg/g but normal MRI), biochemical healing (Fcal &lt;100 μg/g but abnormal MRI), and no healing (both Fcal and MRI abnormal).
The endpoints were the time to bowel damage progression and the time to relapse-related drug discontinuation.
Survival analyses were performed using the log-rank test (univariate) and Cox models (multivariate). Results were expressed as hazard ratios (HR) with 95% confidence intervals.

Results
Among the 112 patients included, 6.2% (7/112), 11.6% (13/112), 18.8% (21/112), and 63.4% (71/112) achieved transmural healing, MRI healing, biochemical healing, and no healing, respectively.
No significant differences were observed between the four groups. At baseline, 42% (47/112) of patients were symptomatic according to PRO-2.
The agreement between IUS and Fcal for detecting active CD was low (69.6%, κ coefficient = 0.10±0.09).
A total of 57 patients experienced progression of bowel damage during follow-up. Transmural healing, MRI healing (HR = 0.13[0.04-0.43]), or biochemical healing (HR = 0.24 [0.07-0.77]) were associated with a reduced risk of bowel damage progression compared to no healing (p &lt;0.0001), with a non-significant trend favoring transmural healing over MRI or biochemical healing (Figure 1).
Of the 94 patients who discontinued treatment due to relapse during follow-up, transmural healing was associated with a lower risk of treatment discontinuation compared to biochemical healing (HR = 0.29[0.02-0.45], p = 0.003), MRI healing (HR = 0.45[0.02-0.60], p = 0.001), or no healing (HR = 0.11[0.018-0.04], p = 0.002).

Conclusion
Transmural healing, as assessed by two non-invasive tools, MRI and fecal calprotectin, appears to be associated with a reduced risk of bowel damage progression in patients with Crohn’s disease, suggesting an interesting complementarity of these tools in daily clinical practice.
P0329 Clostridium difficile infection associates with the need for biologics: a retrospective long-term analysis in a cohort of 102 ibd patients
Authors: Spagnuolo R , Scarlata G G M , Morano D , Imoletti F , Suraci E , Marasco R , Imeneo M G , Pavia G , Pantanella M , Calabretta M V , Marascio N , Quirino A , Trecarichi E M , Russo A , Abenavoli L , Matera G , Luzza F 
Published: January 2025

Abstract

Background
Gastrointestinal Infections (GIs) pose a significant challenge in patients with inflammatory bowel diseases (IBD), complicating its management and triggering IBD relapses. The overlap in clinical symptoms makes complex differentiating GIs from IBD flares, impacting therapeutic decisions. This study aims at evaluating the long-term impact of GIs in IBD patients.

Methods
From January 2020 to September 2024, 102 IBD patients (mean age 45±16 yrs; 78 ulcerative colitis, UC and 24 Crohn’s disease, CD) experiencing a clinical relapse according to ECCO guidelines, were retrospectively evaluated. GIs were established via stool immunochromatography and multiplex molecular assay. Demographic, clinical and laboratory findings along with the treatment were noticed at the time of flare, 6 and 12 months later. Statistical analysis was performed by Mann-Witney and chi-square test as appropriate (p&lt;0.05).

Results
Nineteen patients tested GIs positive (GIs+): 14 out of 78 (18%) UC and 5 out of 24 CD (21%) patients. Clostridium difficile infection (CDI) was found in 11 patients while non-CDI enteric pathogens (EP+) in the remaining 8 patients. All CDI patients received a first-line antibiotic treatment while no treatment was offered to EP+ patients. By stratifying for GIs at the flare time, there were no differences between GIs+ and GIs- patients with regard to age (45±16 vs46±17 yrs, p=ns), disease duration (11±9 vs 12±10 yrs, p=ns), disease activity score (Mayo score 5±2 vs 5±2, p=ns and Harvey Bradshaw index 8±4 vs 8±4, p=ns) and inflammation biomarkers (C-reactive protein 21±41 vs 22±42 mg/dl, p=ns and fecal calprotectin 1446±1751 vs 1452±1714 mcg/gr, p=ns). At 12 months after flare, the number of patients being treated with biologics increased only in GIs+ IBD patients, from 3 out 19 (16%) to 10 out 19 (53%) (Figure 1). All the 7 IBD patients who have got biologics were CDI+.

Conclusion
This study confirms that distinguishing a disease flare from the presence of superimposed GIs remains challenging. Notably, only in patients with CDI there was an increased use of biologics later after the flare onset. This suggest that CDI may serve as a marker of a more aggressive disease course in IBD patients.
P0331 Insights from the Polish Registry of Microscopic Colitis. The Overlapping Symptoms of Microscopic Colitis and Irritable Bowel Syndrome
Authors: Bielski A , Marlicz W , Małecka-Wojciesko E , Reguła J , Mróz A , Zwolińska-Wcisło M , Waśko-Czopnik D , Eder P , Daniluk J , Rosołowski M , Rydzewska G 
Published: January 2025

Abstract

Background
Microscopic colitis (MC) is a chronic inflammatory bowel disease (IBD), characterized by chronic watery diarrhea without blood, fecal urgency and distninct histological features. Symptoms of MC resemble those of irritable bowel syndrome (IBS), which can delay accurate diagnosis and effective treatment. The potential overlap in symptoms may impede to select effective management strategies.

Methods
The purpose of establishing the Polish Registry of Microscopic Colitis was to understand the clinical characteristics of patients and to improve diagnosis and treatment effectiveness. We present retrospective and prospective data from the cohort of 213 patients, collected across 9 reference gastroenterology centers in Poland.

Results
The median age at MC diagnosis was 56 years. MC occurred 3.5 times more frequently in women. On average, patients waited about 3 years for a proper diagnosis after the onset of symptoms. The lymphocytic subtype was diagnosed much more frequently than the collagenous subtype (68.4% vs 23.3%). Predominant symptoms at the diagnosis of MC were watery diarrhea (88.7%) and fecal urgency (68.1%). Patients also reported symptoms more typical of IBS: abdominal pain (59.2%), bloating (60.1%) and incomplete evacuation (40.8%). Notably, one-third of the patients met the Rome IV criteria for IBS during medical interviews (figure 1). Nearly half of the patients had COVID-19 diagnosis confirmed by an authorised test.
The most effective treatment was budesonide MMX, with a 93.2% improvement rate. 54% of patients using rifaximin and almost 40% of patients using probiotics reported improvement in intestinal symptoms, although these are not recommended therapies in MC. The effectiveness of various treatments is presented in table 1. Five patients with severe MC were successfully treated with biologics (three with adalimumab and two with vedolizumab). Unfortunately, one patient lost response to adalimumab after 8 months treatment and one patient showed no improvement with adalimumab.

Conclusion
The similarity of the symptoms of MC and IBS delays an accurate diagnosis. The results from the Polish Microscopic Colitis Registry emphasize a potential overlap of symptoms between MC and IBS. One possible reason for the frequent occurrence of IBS symptoms among patients with MC may be COVID-19 pandemic. The overlap in symptoms, necessitate a comprehensive clinical evaluation to select appropriate treatment and avoid unnecessary escalation of immunosuppressive therapy.
The much more frequent diagnosis of the lymphocytic subtype than the collagenous subtype indicates the need for discussion with pathologists about the potential underdiagnosis of collagenous colitis in Poland.
P0335 Development of an entrustable professional activity for intestinal ultrasound in North America
Authors: Aronskyy I , Spencer E , Yen E , Chugh R , Winter M , Jacobs J , Wahbeh G , Debruyn J 
Published: January 2025

Abstract

Background
Intestinal ultrasound (IUS) has emerged as an effective tool to evaluate and monitor inflammatory bowel disease (IBD) with rapidly expanding use worldwide. Concurrently, entrustable professional activities (EPAs) have become an essential and foundational element of competency-based medical education. Together, this arose a need to define and standardize IUS-specific tasks required to achieve competency in clinical practice. The Intestinal Ultrasound Group of the United States and Canada (iUSCAN) aimed to develop an EPA to inform current and future IBD specialists and training programs on the skills and responsibilities necessary to effectively achieve competency in IUS among IBD specialists.

Methods
The iUSCAN Education Committee established a multi-step process for EPA development (Figure 1). Step 1: A comprehensive literature review was conducted to identify the key competencies required for performing and interpreting IUS across various IBD presentations. Step 2: A focus group, organized by the iUSCAN Education Committee and consisting of adult and pediatric gastroenterologists with extensive IUS experience (each with &gt;300 IUS scans), was formed to refine these competencies. Using a modified nominal group technique, the focus group evaluated, critiqued, and iteratively refined the identified competencies. This process resulted in the initial selection of 28 essential components necessary for performing consistent, high-quality IUS examinations and interpretations. Step 3: The revised competencies were then circulated for further feedback, adjustments, and expansion. Step 4: Finally, the committee utilized the Knowledge, Skills, and Attitudes framework to finalize this EPA into 34 associated milestones. The iUSCAN Education Committee, Executive Committee, and Steering Committee Chairs reviewed and approved the final version of the EPA.

Results
The Knowledge, Skills, and Attitudes components of an EPA on performing and interpreting IUS are shown in Table 1.

Conclusion
We present the development of an EPA that defines the competencies necessary to effectively perform, interpret, and integrate IUS into the care of patients with IBD. This IUS EPA is designed to serve as a lasting framework for foundational IUS competencies performed by IBD specialists. As IUS continues to advance with innovative and specialized techniques, this EPA will require further updates to incorporate new modalities and skillsets into standard competencies.
P0336 From inflammation to depression: key biomarkers for Inflammatory Bowel Disease-related Major Depressive Disorder
Authors: Hu C , Guo H 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic, inflammatory, and autoimmune disorder[1], and its incidence of comorbid with major depressive disorder (MDD) is significantly higher than the general population[2]. However, many patients lack proper recognition and necessary psychological health treatments. We aimed to identify potential biomarkers and mechanisms involved in the development of IBD comorbid with MDD (IBD-MDD).

Methods
We utilized IBD and MDD-related datasets from the GEO database for differential gene expression analysis, protein-protein interaction (PPI) and pathway enrichment analysis, random forest algorithm, LASSO regression analysis, and construction of a disease prediction model. We assessed the accuracy of the model using ROC curve, explored potential mechanisms through immune infiltration analysis, and validated candidate biomarkers using peripheral blood samples from patients in our center’s cohort.

Results
We identified 484 IBD-related secreted proteins and 142 key module genes associated with MDD. PPI analysis revealed two crucial modules primarily involved in inflammation and immune regulation. We identified four diagnostic genes (HGF, SPARC, ADAM12, and MMP8) from the 21 shared genes between IBD-related secreted proteins and MDD key module genes, constructed a nomogram model and confirmed its accuracy using ROC curve from an external independent dataset. Immune infiltration analysis revealed significant associations between the four diagnostic genes, and cellular immune dysregulation in MDD.
Finally, we validated the expression patterns of the four diagnostic genes in our cohort.The results showed that the serum levels of HGF and MMP8 were significantly elevated in IBD patients with comorbid MDD, SPARC and ADAM12 showed an increasing trend (Figure 1A). Meanwhile, we developed a predictive model for IBD-related MDD based on our cohort (Figure 1B). The calibration curve suggests that the predictive probability of the nomogram model is nearly the same as that of the ideal model (Figure 1C). ROC curve analysis of the efficacy of the joint predictive model based on the 4 diagnostic markers showed that the AUC value was 0.87, indicating that the nomogram have strong diagnostic value for IBD-related MDD (Figure 1D).

Conclusion
Our study discovered four candidate biomarkers for IBD-MDD, providing new insights for the diagnosis and therapeutic intervention of serum-based IBD comorbid with MDD.

References
[1] Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011; 474:307-317.
[2] Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res. 2016; 87:70-80.
P0338 Early identification of pediatric inflammatory bowel disease based on machine learning with non-invasive data
Authors: Wu H , Sun Y H , Tang Z F , Qin X J , Wang Y H , Huang Y 
Published: January 2025

Abstract

Background
Early identification of pediatric inflammatory bowel disease (IBD) can improve long-term prognosis, yet significant diagnostic delays persist. This study aims to develop an effective early identification tool using machine learning with non-invasive testing.

Methods
This retrospective study collected data from 314 pediatric patients (109 with IBD and 205 without IBD) hospitalized in Fudan University Children’s Hospital, to serve as the training dataset. We developed machine learning classifiers using support vector machine, artificial neural network, extreme gradient boosting, decision tree, random forest, k-nearest neighbors, logistic model, and gradient boosting machine methods, incorporating easily obtainable clinical examination tools. Participant data included age, sex, and three groups of features across different dimensions: IBD symptoms (diarrhea lasting ≥1 month; blood in stool for ≥1 week; recurrent perianal abscesses or fistulas; delayed growth; abdominal pain lasting ≥1 month; &gt;10% weight loss; first-degree family history; arthritis, uveitis, erythema nodosum without definitive rheumatologic diagnosis; recurrent aphthous ulcers; unexplained fever), inflammatory biomarkers (elevated fecal calprotectin; elevated serum inflammatory markers; anemia; hypoalbuminemia; ANCA positivity), and transabdominal bowel ultrasound parameters (Limberg level &gt;1 indicating bowel wall thickening with vascularity; mesenteric fat wrapping; bowel wall stratification disorder or loss; lymphadenopathy). We evaluated the performance of each feature group and their combinations, optimized hyperparameters, internal validation, and performed sequential validation with 66 prospectively recruited pediatric patients from the same center. The final model was selected based on optimal and stable performance in both the development and external validation cohorts, with Shapley values used to interpret feature importance.

Results
The support vector machine outperformed other algorithms, achieving an area under the curve of 0.95 in both internal and external validation datasets. The five most important features based on Shapley values were Limberg level &gt;1, elevated ESR, elevated fecal calprotectin, recurrent perianal disease, and elevated CRP. Additionally, combining all three feature dimensions outperformed any single or paired combination. The probability of IBD classification showed moderate correlation with clinical, endoscopic, and histologic scores .

Conclusion
The machine learning model based on non-invasive data has the potential to become a low-cost and time-efficient tool for early identification of IBD. Ultrasound examination plays a significant role in distinguishing children with IBD from those without.