bluuebunny/crossref_metadata_2025_split huggingface dataset:
P137 Lesions of Cytomegalovirus and Epstein Barr virus of the proximal gastrointestinal tract in patients with Inflammatory Bowel Disease after COVID-19
Authors: Babayeva-Sadigova G , Makhmudov U , Quliyev F , Asadova G , Mirzazade O , Samadova T , Hasanova A 
Published: January 2022

Abstract

Background
The problem of opportunistic infections in IBD remains one of the most pressing issues in the diagnosis and treatment of this pathology. Particular attention among opportunistic infections in IBD is given to cytomegalovirus infection(CMV), the Epstein-Barr virus(EBV). Aim: To assess the frequency of detection of CMV and EBV in biopsies taken from the mucous membranes of the proximal gastrointestinal tract (GIT) in patients with IBD who underwent COVID-19.

Methods
72 patients with CD(40 w/32 m) and 69 patients with UC(39 m/30 w) who underwent COVID-19, in whom CMV and EBV were not previously detected, were examined. The age of the patients was from 18 to 62 years(39.4±2.7). All patients(p.) underwent a standard endoscopic examination(EE), disease activity was assessed in accordance with the ECCO regulations; the determination of CMV and EBV was carried out by PCR in biopsies of mucous membranes from the proximal GIT.

Results
EE in 27 p.with CD revealed deeper and more widespread ulcerative lesions of the gastric mucosa(CMV+11 p.40.7%/15.3%;EBV+12 p.44.4%/16.7 %;CMV and EBV+4 p.14.8%/5.5%), in 16 p.similar changes were detected in the esophagus(CMV+7 p.43.7%/9.7%,EBV+6 p.37.5%/8.3%;CMV and EBV+3 p.18.7%/4.2%),in 49 p.in the duodenal region(CMV+17 p.34.7%/23.6 %,EBV+23 p.46.9%/31.9%;CMV and EBV+9 p.18.4%/12.5%).
EE with UC revealed deeper and more widespread ulcerative lesions of the gastric mucosa in 29 p. (CMV+12 p.41.4%/17.4%;EBV+13 p.44.8%/18.8%; CMV and EBV+4 p.3.8%/5.8%),in 19 p. similar changes were detected in the esophagus(CMV+9 p.47.7%/13.1%,EBV+6 p.31.6%/8.7%;CMV and EBV+4 p.21.1%/5.8%),in 44 p. in the duodenal region(CMV+17 p.38.6%/24.6%,EBV+23 p. 52.3%/33.3%;CMV and EBV+4 p.9.1%/5.8%).
Thus, in patients with CD, when determining CMV in biopsy materials by PCR,an isolated positive result(48.6%) was obtained in 35 cases,for EBV(isolated)-41 cases(56.9%), in 16 pat. a combined lesion of CMV and EBV was revealed(22.2%); the localization of lesions was dominated by the duodenal region(68.1%),the stomach (37.5%)and the esophagus(22.2%). In patients with UC, when determining CMV in biopsy materials by PCR,an isolated positive result(55.1%) was obtained in 38 cases,for EBV(isolated)-42 cases(60.7%),in 12 pat. a combined damage to CMV and EBV(17.4%); the localization of lesions was dominated by the duodenal region(63.8%),the stomach(42%) and the esophagus(27.5%).
The clinical and endoscopic picture indicates a more severe course of IBD in the presence of herpes viruses detected by PCR examination of biopsies taken from the mucous membranes of the proximal GIT.

Conclusion
The findings allow us to recommend the need for more thorough inspection during endoscopy in patients with IBD who have undergone COVID-19.
P145 Ultrasonographic parameters associated with mucosal healing 1 year after infliximab therapy in Crohn’s Disease: a multicentric and prospective study
Authors: Nascimento C , Frias Gomes C , Morão B , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J , Pereira F , Caldeira A , Rosa C , Macedo G , Macedo C , Ferreira M , Cravo M , Glória L , Torres J , Palmela C 
Published: January 2022

Abstract

Background
Bowel wall thickness (BWT) is an accurate ultrasonographic parameter to assess disease activity in Crohn’s disease (CD). The IBUS-SAS score includes BWT, doppler sign, loss of stratification and inflammatory fat (i-fat) and allows a reproducible assessment of inflammation in CD using intestinal ultrasound (IUS). Our aim: to assess clinical, laboratorial and ultrasonographic predictors of mucosal healing (MH) at 1 year of infliximab (IFX) therapy.

Methods
Prospective multicentric cohort study including patients with active CD starting IFX. Harvey-Bradshaw index, C-reactive protein (CRP), fecal calprotectin (FC) and IUS were performed at week 0, 14, 30 and 54. IUS remission was defined as BWT normalization (≤3mm) in the most affected segment. Ileocolonoscopy was performed at W0 and W54. MH was defined as SES-CD &lt;3 with no ulcers.

Results
We included 28 patients with CD (61% male; mean age of 34±12y). Clinical, laboratory and sonographic parameters are shown in Table 1. At week 54, 89% were in clinical remission, 79% had normalization of CRP and FC, 50% had IUS remission and 39% had MH. MH at W54 was associated with lower BWT at W14 (3.7 vs 5.2mm, p=0.049), lower Limberg score at W14 (1 vs 2, p=0.006), lower levels of i-fat at W14 (18 vs 72%, p=0.006) and lower IBUS-SAS score at W0, W14 and W30 (47 vs 71, p=0.002; 26 vs 58, p=0.001; 25 vs 50 p=0.046). We found a fair to good correlation between SES-CD W54 and BWT at W14 (r=0.45, p=0.015), Limberg score at W14 (r=0.4, p=0.037), IBUS-SAS at W0 and W14 (r=0.49, p=0.008; r=0.58, p=0.001). The area under the curve of IBUS-SAS for MH was 0.86 at W0 and W14 and 0.69 at W30. Best IBUS-SAS cut-off value was 27.6 at W14.

Conclusion
Lower values of BWT, Limberg score and i-fat after induction (W14) were associated with MH at 1 year of therapy. IBUS-SAS score at W14 had the highest AUC to predict MH at 1 year. Early IUS monitoring can be a helpful tool to predict response to therapy in CD patients at 1 year.
P148 Subclinical inflammatory bowel disease precedes the diagnosis and leads to an increase on healthcare resources utilization: multicentric case-control study in the Basque Country
Authors: Rodríguez-Lago I , Aguirre U , Ramírez de la Piscina P , Muñagorri A , Zapata E , Higuera R , Montalvo I , Iriarte A , Fernández-Calderón M , Arreba P , Carrascosa J , Cabriada J L , Barreiro-de Acosta M 
Published: January 2022

Abstract

Background
The inflammatory process associated to ulcerative colitis (UC) and Crohn’s disease (CD) starts before the onset of symptoms and the diagnosis, but this period has not yet been well defined. Our aim was to determine if patients with an incidental diagnosis of UC or CD have an increase in healthcare utilization in the years preceding the symptomatic onset of the disease.

Methods
All asymptomatic patients with a diagnosis of UC or CD during the colorectal cancer screening program between October 2010-January 2021 were included in this multicentric retrospective case-control study. Cases were matched 1:3 with controls adjusted by sex, age and date, excluding subjects with any visit to Gastroenterology. The main outcomes were the number of outpatient or Emergency Rooms visits, admissions, radiological examinations (US, CT, MRI), sick-leaves, and drug prescriptions (antibiotics, systemic steroids) up to 5 years before the diagnosis. Descriptive statistics were used, with chi-square tests and a multivariable hurdle or negative binomial regression model, adjusted by smoking habits and Charlson index.

Results
A total of 124 patients were included (87 UC, 30 CD, 7 IBD-U; median 56 years (IQR, 53–62); 56% male), compared with 372 controls. Baseline characteristics including comorbidities were balanced between both cohorts. Patients demonstrated an increase in the number of visits to Primary Care physician during both 3 and 5 years before the diagnosis, but there were no differences in the remaining outcomes including hospital admissions, Emergency Room or outpatients visits, and sick-leaves (Figure 1 and 2). Systemic steroids were more frequently prescribed to patients in the preceding 3 to 5 years before diagnosis. Patients underwent US and/or CT scan less frequently in the preceding 5-year period.

Conclusion
Patients with IBD show an increased need of medical assistance in the years prior to the diagnosis, even during the presymptomatic phase of the disease. Tools focused on early identification of IBD may start on Primary Care facilities, but certain factors as steroids may alter the development of symptoms and the full spectrum of the disease.
P151 Rationalizing colonoscopy utilization for Inflammatory bowel disease diagnosis: time to reset the Calprotectin threshold to &gt;600?
Authors: Desoki R , Abdellah Ahmed M , Taylor K , Woodward J , Corbett G , Parkes M 
Published: January 2022

Abstract

Background
Faecal calprotectin (FC) measurement is used to stratify risk of IBD in primary care. Typically the normal range for FC is 0–50 ug/g, and in established practice FC&gt;200 mandates gastroenterology referral for further investigations, including colonoscopy. The optimal FC threshold for referral is, however, debated: most people with FC&gt;200 do not have IBD and some with IBD have FC&lt;200.
We aimed to assess FC at different thresholds, and whether the threshold might be safely raised (hence reducing the numbers referred for colonoscopy) by combining FC with other easily ascertained parameters without significantly impacting IBD diagnostic yield.

Methods
We included all patients aged 18–45 in whom FC testing was requested in primary care in 2018 and 2019, regardless of FC result, and who subsequently underwent colonoscopy at Cambridge University Hospitals (CUH). We excluded patients with a prior IBD diagnosis. Based on the retrospective review of findings at colonoscopy and case notes, we classified the final diagnosis as one of (1) normal (2) IBD/subtype (3) non-IBD intestinal inflammation (e.g. infection, microscopic colitis, NSAID enteropathy) and (4) cancer.

Results
852 patients were included, 60% female, median age 33. The FC ranged from 10 to &gt;600. 98/189 with FC&gt;600 had IBD, compared to 17/166 with FC 200–600 and 15/497 with FC&lt;200 (Figure 1). Only 52% with small bowel CD had FC&gt;600 (Figure 2).
74% of colonoscopies showed no inflammation. 10.5% of these patients had FC &gt;600 and 18.6% had FC 200–600.
Of the 32/130 (24.6%) patients with newly diagnosed IBD who had FC&lt;600, 24 reported rectal bleeding, 13 had raised CRP &gt;6, and 6 had a family history (FH) of IBD (table 1). Only one patient with FC &lt;600 subsequently diagnosed with IBD had none of these parameters. Sensitivity and specificity data are provided in table 2. For patients with intermediate FC the UK advice is to repeat the test. In our cohort 168 patients had an initial FC of &lt;600 and had a repeat. In this group the subsequent FC was &lt;50 in 88. 6 cases of IBD were identified in those in whom the repeat FC was &gt;50 but &lt;600, but all had one or more of rectal bleeding, raised CRP or FH of IBD.
12/852 were found to have colorectal cancer, however, 8 of them had been referred to CUH on the ‘suspected cancer’ pathway. Of the 4 referred on the ‘suspected IBD’ pathway, only 1 had FC &gt;600 – others were in the 50–600 range.

Conclusion
Based on our observations, using an FC threshold of &gt;600, or 50–600 with one or more of rectal bleeding, raised CRP or FH of IBD, would substantially reduce the number of colonoscopies undertaken and have a minimal impact on diagnosis of IBD. Repeat testing following a modestly elevated FC had no further utility. These data require independent validation.
P156 A multicentric study on the development and application of a deep learning algorithm for automatic detection of ulcers and erosions in the novel PillCam™ Crohn’s capsule
Authors: Ribeiro T , Mascarenhas M , Afonso J , Cardoso H , Andrade A P , Lopes S , Mascarenhas Saraiva M , Ferreira J , Macedo G 
Published: January 2022

Abstract

Background
Crohn’s disease has the potential to involve all segments of the gastrointestinal tract, requiring frequent and judicious clinical and endoscopic surveillance. Capsule endoscopy (CE) has revolutionized the management of these patients, playing a role in diagnosis, classification, and assessment of response to treatment. In 2017, PillCam™ Crohn’s Capsule (PCC) was introduced to provide a panenteric assessment to this panenteric disease. However, reviewing each PCC exam is time-consuming and prone to errors as it implies examining thousands of images while significant lesions may only be represented in a small number of frames. Recently, the development of artificial intelligence (AI) algorithms for automatic interpretation of endoscopic images has generated a large interest. The performance of these tools, particularly convolutional neural networks have shown potential to overcome some of the main drawbacks of CE. This multicentric study aims to assess the performance of a deep learning algorithm for the automatic detection of small intestinal and colonic ulcers and erosions in PCC images.

Methods
We included a total of 59 PCC exams from two centres (ManopH Gastroenterology Clinic and Centro Hospitalar Universitário de São João) performed between 2017 and 2021. A total of 78415 frames were extracted. This pool of images was constituted by 14124 images depicting ulcers and erosions and 64291 with normal enteric and colonic mucosa. For the automatic identification of these findings, this image pool was split into training and validation datasets in a patient-based manner. Therefore, images from the same patient were restricted to a single dataset. A CNN model with transfer learning was developed using tensorflow and keras tools.

Results
The neural architecture of our CNN was optimized for the detection of enteric and colonic ulcers and erosions. An example of the output provided by the CNN is shown in Figure 1.

The deep learning model had a sensitivity of 86.7%, a specificity of 98.6%, a positive predictive value of 92.3% and a negative predictive value of 97.4%. The overall accuracy of our network was 96.6% (Figure 2).

At a threshold value of 50%, our CNN had an area under the curve of 0.98 for the detection of ulcers and erosions (Figure 3).

Conclusion
In this multicentric study, our group has developed a CNN and assessed its performance in a patient-based design, which provides significant robustness to our results. Patient-split analyses are the first step towards real-life application of AI solutions which, allied to the high-performance results of our model, may significantly improve the diagnostic yield of this panendoscopic tool.
P177 Validation of UC Intestinal Ultrasound (UC-IUS) Index for children with Ulcerative Colitis
Authors: Huynh Dr H , Ma H , Isaac D , Novak K , Almeida P , Kim J , Kuc A , Carroll M , Wine E 
Published: January 2022

Abstract

Background
Transabdominal bowel ultrasound (TABUS) is an ideal tool to assess transmural inflammation in children with Ulcerative Colitis (UC). The UC intestinal US (UC-IUS) Index was developed and validated using endoscopy with strong correlation between UC-IUS Index and Mayo subscore (ρ 0.830; p&lt;0.001). Our aim was to determine how bowel wall thickness (BWT) and UC-IUS Index performed in children at diagnosis in comparison to endoscopy using the Mayo score.

Methods
Subjects (0–18 years old) with suspected inflammatory bowel disease (IBD) were prospectively enrolled. Baseline TABUS (excluding rectum due to poorly seen) done prior to endoscopy. Pediatric Ulcerative Colitis disease Activity Index (PUCAI) and Mayo were calculated, albumin, C-reactive protein (CRP) and fecal calprotectin (FCP) collected. The UC-IUS Index was calculated for each segment – sigmoid (SC), descending (DC), transverse (TC) and ascending (AC) [bowel wall thickness (BWT) (mm): &gt; 2 =1, &gt;3 =2 and &gt;4 =3; doppler: spots=1 and stretches =2, abnormal haustrations = 1 and fat wrapping =1]. Spearman’s rank (rho) and Pearson’s correlation (r) assess for a correlation. Receiver operating characteristic [ROC] analysis performed for BWT to determine sensitivity and specificity of BWT cut-offs in the UC-IUS.

Results
Of the 75 subjects recruited for suspected IBD, 26 had UC with mean age 15 years (SD 3.33) and 5 had normal US. Twenty three have extensive pancolitis. Mean PUCAI score: 60 (SD 23.28), CRP 22.62 (SD 39.5) mg/l, albumin 35.6 (SD 6.96) g/l and fecal calprotectin of 2223 (SD 1757) mg/kg. ROC curves generated using a total of 122 colonic segments. BWT of 2 mm discriminates between active and inactive:Mayo 0 and Mayo1-3 [sensitivity 84.9%; specificity 86.2%; an area under the curve [AUC] 0.900]; a cut-off of 3mm discriminates between Mayo 1 from Mayo 2–3 [sensitivity of 61.3%; specificity 90.5%; AUC 0.858]; a cut of 4mm discriminates Mayo 3 (sensitivity 64.7%; specificity 85.7 %; AUC 0.876). BWT and UC-IUS scores of all colonic segments correlated highly positively with the Mayo score of corresponding segments (rho=0.684, r=0.660, p&lt;0.001) and (rho=0.750, r=0.722, P&lt;0.001) respectively. The UC-IUS Index correlates poorly with CRP, ESR, and Fecal Calprotectin - r = 0.262, 0.346 and 0.100 respectively; p&gt;0.05.

Conclusion
BWT and UC-IUS Index correlated highly positively with the Mayo subscore in children with UC. UC-IUS has a better correlation than BWT. BWT cut-off of 2mm discriminate between normal and mild Mayo is optimal. Cut-offs of 3 mm and 4 mm for moderate and severe Mayo may be too high in children with lower sensitivity. A larger cohort of children with UC will need to be studied to determine optimal BWT cut-off for moderate and severe disease.
P181 IBD patients with early clinical and sonographic improvements achieve better long-term outcomes than patients with clinical improvements alone – one-year interim results of the TRUST BEYOND study
Authors: Kucharzik T , Helwig U , Seibold F , Biedermann L , Högenauer C , Fischer I , Kolterer S , Rath S , Hammer L , Maaser C 
Published: January 2022

Abstract

Background
In the treat-to-target era, frequent and objective monitoring of disease activity in IBD patients is emphasized [1]. Over the past years, intestinal ultrasound (IUS) has become a useful modality to monitor and assess disease activity and response to therapy. (Trans)mural response and healing examined by IUS have emerged as outcome measures of growing interest and potential therapeutic goals in the IBD community [2–4]. However, the predictive value of a composite clinical/IUS improvement for the long-term outcome remains elusive.

Methods
TRUST BEYOND is an ongoing, prospective, observational, multi-centre study in patients with active CD or UC initiating a biologic- or Januskinase-inhibitor (JAKi)-therapy at baseline. The aim of this study is to assess the predictive value of IUS parameters evaluated at week 12 for the long-term outcome after 52 weeks (assessed by clinical+ sonographic endpoints). For this interim analysis, 89 IBD patients (39 CD, 50 UC) with a documented visit at week 52 until September were included. The predictive value of (trans)mural response (TR; reduction of ≥ 25% in bowel wall thickness, BWT) and clinical remission at W12 was evaluated for the outcome at W52.

Results
Eighty-nine IBD patients in clinical flare with increased BWT were included into this analysis. Patients were predominantly female (53.9%,n=48) with a median age of 34.3 years (29.0–51.5) and a median disease duration of 7.18 years (2.31–13.47). Following the induction of advanced therapy, the rate of IBD patients with a (trans)mural response increased from 67.4% (n=60) at W12 to 73.0% (n=65) at W52. Likewise, the proportion of IBD patients demonstrating a (trans)mural healing rose from 32.6% (n=29) at W12 to 41.6% (n=37) at W52. Of note, 53.5% (n=38) of IBD patients who achieved the composite endpoint “clinical remission and (trans)mural response” at W12 were in clinical remission at W52 while only 23.9% of patients who were only in clinical remission at W12 sustained clinical remission until W52 (p=0.007). Moreover, patients achieving both early clinical remission and (trans)mural response had better sonographic outcomes at W52.
Fig 1: W52 outcomes of patients with either clinical remission and (trans)mural response or only clinical remission at W12.

Conclusion
IBD patients who reached the composite endpoint clinical remission and (trans)mural response at week 12 had better outcomes after 1 year compared to patients in early clinical remission only. Our results strongly suggest that it is worth treating patients to composite clinical and sonographic endpoints.

Reference
1. Turner D et al. Gastroenterol. 2021; 2 Kucharzik T et al. Clin Gastroenterol Hepatol. 2017; 3 Maaser C et al. Gut 2020; 4 Wilkens R et al. Therap Adv Gastroenterol 2021
P197 Anogenital Crohn’s disease and granulomatosis: A systematic review of epidemiology, clinical manifestations, and treatment
Authors: Honap S , Meade S , Spencer A , Pavlidis P , Luber R , Calonje E , Rashid E , Bunker C , Lewis F , Irving P 
Published: January 2022

Abstract

Background
Metastatic Crohn’s disease (CD) is an extra-intestinal manifestation (EIM) characterised by ulceration, swelling or inflammatory lesions that are non-contiguous with the gut; genital involvement is rare. We conducted a systematic review of ACD and granulomatosis to provide a synthesis of epidemiology, clinical features, and treatment outcomes in adults and children.

Methods
A systematic literature search was conducted via MEDLINE, EMBASE and the Cochrane database from inception to 1st December 2020 to identify studies of ACD presentation and/or treatment outcomes. Investigators extracted, analysed, and reported study data in accordance with PRISMA. Clinical response was defined as a reduction in symptoms, genital swelling or partial healing of ulcers and fissures. Remission was defined as complete resolution of symptoms and examination findings.

Results
Of 9,381 screened studies, 185 articles, (comprising 410 cases; 273 female (F), 137 male (M)), were included (figure 1). The median age at diagnosis was 29 (F) and 16 (M) and up to 50% did not have a prior CD diagnosis. Luminal CD was subsequently diagnosed in 80% of cases including 45–80% patients without gastrointestinal symptoms (time to CD diagnosis from ACD presentation [range] –43 to 11 years). The predominant clinical features across both sexes were, oedema (79%), ulcers/fissures (47%), and hypertrophic, exophytic lesions (nodules and plaques) (23%) (table 1). Adults and children present similarly. Most patients, 81% (331/410), underwent genital biopsy (106 (M), 225 (F)). Granulomas were noted in 71% (234/331) cases and an inflammatory cell infiltrate was documented in 191/331 (58%). Systemic antibiotics, corticosteroids, thiopurines and anti-TNF therapy were the most frequently prescribed agents with the highest response and remission rates (table 2). At final follow-up, where reported, non-response, response, and remission rates were 37/304 (12%), 267/304 (88%) and 114/304 (38%), respectively. Oedema was associated with a poor response to topical corticosteroids vs. those with ulcers or fissures without oedema (p=0.03). Greater response rates to anti-TNF therapy were seen in patients prescribed concomitant immunomodulation (24/25, 96% vs 67/90, 74%, p=0.02).

Conclusion
To our knowledge this is the first systematic review of ACD in adult and paediatric males and females. ACD and granulomatosis are rare EIMs of CD that are under-recognised, leading to treatment delay, and significant morbidity. There is a wide heterogeneity in presentation and some of the treatments used in luminal and perianal CD appear to be effective. Further studies with longer follow up are required to define optimal treatment strategies.