Extensive Colitis Research Articles

S1165 Efficacy and Safety of Etrasimod in Patients With Moderate to Severe Isolated Proctitis Relative to Those With More Extensive Colitis: Results From the Phase 3 ELEVATE UC 52 and ELEVATE UC 12 Trials

S1165 Efficacy and Safety of Etrasimod in Patients With Moderate to Severe Isolated Proctitis Relative to Those With More Extensive Colitis: Results From the Phase 3 ELEVATE UC 52 and ELEVATE UC 12 Trials

Intestinal Ultrasound for Inflammatory Bowel Diseased Patients Who Receive Biological Treatment

Abstract Background Crohn’s disease (CD) and ulcerative colitis (UC) are two forms of chronic inflammatory bowel diseases (IBDs) characterized by recurrent episodes of intestinal inflammation and a heterogeneous range of symptoms and clinical courses. In contrast to CD, UC is a mucosal and to some extent submucosal disease restricted to the colon. Depending on the involved colonic segment, UC can be divided into proctitis, left- sided colitis or extensive colitis. Aim of the Work Prospective evaluation of intestinal ultrasound (iUs) for disease monitoring of patients with ulcerative colitis (Uc) and crhons disease receiving biological treatment with following up the efficacy on intestinal wall. Newly diagnosed patients who will receive biologics and compare with colonoscopy Patients and Methods This was a cohort study in ultrasound unit of gastroenterology department at Ain shams university hospitals, the patients selected from the department of gastroenterology and gastroenterology outpatient clinic from May 2021 till January 2022 on 50 patients. Results When comparing baseline ultrasound results of inflammatory signs and colonoscopy we found non-significant results that support using intestinal ultrasound results as non-invasive tool for diagnosis of inflammatory bowel disease. and also doppler signs it showed significant results in some parts of the colon like terminal ilium, left side, transverse and sigmoid and that is very important in patient who have strictures in terminal ilium prevent terminal ilium intubation during colonoscopy. Also on comparing results of pathology and intestinal ultrasound we found the sensitivity of intestinal ultrasound is very high inflammatory signs 93.8% sensitivity and doppler signs 85.4% but specificity was 50% only that was because it depends on the operators vision and also on the machine used and the patient also he may be not fasting and distended that make the field very hard, also when comparing with ct enterography results and MR enterography it showed the same specificity and sensitivity that confirm our vision also. Conclusion For conclusion intestinal ultrasound one of the best modalities for diagnosis and follow up inflammatory bowel disease, especially in short term response, our finding give rise to not only the assumption of bowel wall thickness but also inflammatory markers, doppler signs, bowel lumen and fibrofatty nodules had significant difference at long term follow up Christian Maaser et al findings give rise to the assumption that monitoring BWT alone has the potential to predict therapeutic response. The additional monitoring of FC could add further value in monitoring patients with UC. Future prospective studies are necessary to determine the value of IUS in predicting short and long-term response and outcomes of therapies in UC

Anti-IFI16 Antibodies in Inflammatory Bowel Disease and Their Variation with Infliximab Therapy in Comparison to Other Modalities of Treatment

Abstract Background Amatory bowel diseases (IBDs) are remittent or progressive conditions that may affect the entire gastrointestinal tract and the colonic mucosa and are associated with an increased risk for colon cancer. Patients with mucosal lesions may not have clinical symptoms, or only present with mild symptoms. Objective measurements are required to assess and monitor IBD disease activity. Moreover responses to treatments must be closely monitored to determine effectiveness and avoid disease complications. Aim of the Work The aim of this study is to assess the utility of IFI16 antibodies as a predictor of infliximab-induced remission in IBD patients in comparison to other modalities of treatment. Patients and Methods A Comparative cross sectional study in internal medicine and gastroenterology outpatient clinic at Ain Shams University Hospital. With 60 IBD patients are included in this study divided into three groups. Results Patients with low levels of IgG antibodies against IFI16 at baseline had a higher probability of a clinical response or remission at the end of induction therapy with IFX (OR 1/4 0.143; 95% CI 0.027–0.761). The only statistically significant association found in patients with UC was that between anti-IFI16 IgG and extensive colitis (E3) (OR 1/4 7.255; 95% CI 2.452–21.463; P 1/4 0.0001) (data not shown). Conclusion Overall, the findings presented in this study deserve more investigation to verify the possibility of exploiting a patient’s reac- tivity against the IFI16 autoantigen as a predictive marker of response to IFX therapy. Anti-IFI16 IgG titers may be of great clinical relevance and provide guidance when tailoring therapeutic choices to individual patients.

The Underlying Changes in Serum Metabolic Profiles and Efficacy Prediction in Patients with Extensive Ulcerative Colitis Undergoing Fecal Microbiota Transplantation.

(1) Background: Fecal microbiota transplantation (FMT) is an effective treatment for ulcerative colitis (UC). Metabolomic techniques would assist physicians in clinical decision-making. (2) Methods: Patients with active UC undergoing FMT were enrolled in the study and monitored for 3 months. We explored short-term changes in the serum metabolic signatures of groups and the association between baseline serum metabolomic profiles and patient outcomes. (3) Results: Forty-four eligible patients were included in the analysis. Of them, 50.0% and 29.5% achieved clinical response and clinical remission, respectively, 3 months post-FMT. The top two significantly altered pathways in the response group were vitamin B6 metabolism and aminoacyl-tRNA biosynthesis. Both the remission and response groups exhibited an altered and enriched pathway for the biosynthesis of primary bile acid. We found a clear separation between the remission and non-remission groups at baseline, characterized by the higher levels of glycerophosphocholines, glycerophospholipids, and glycerophosphoethanolamines in the remission group. A random forest (RF) classifier was constructed with 20 metabolic markers selected by the Boruta method to predict clinical remission 3 months post-FMT, with an area under the curve of 0.963. (4) Conclusions: FMT effectively induced a response in patients with active UC, with metabolites partially improving post-FMT in the responsive group. A promising role of serum metabolites in the non-invasive prediction of FMT efficacy for UC demonstrated the value of metabolome-informed FMT in managing UC.

Sweet Syndrome Associated with Active Inflammatory Bowel Disease: A Case Series of a Rare Extra-intestinal Manifestation.

Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD. Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated. 25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47years (IQR 33-54years) and SS appeared at a median of 6.4years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%. Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies.

Propensity score analysis the clinical characteristics of active distal and extensive ulcerative colitis: a retrospective study.

Background and Objectives: Ulcerative Colitis (UC) subtypes defined by disease extent and shared pathophysiology are important. Analyzing the clinical characteristics of UC with different disease extent and optimizing clinical typing are conducive to the pathogenesis research, disease monitoring and precise treatment. Methods: 188 patients with active UC were divided into distal and extensive colitis. The clinical characteristics of the two groups were analyzed by propensity score. Spearman is used for correlation analysis, and receiver operating characteristic (ROC) curve was used to evaluate the ability of clinical indicators to predict Mayo endoscopic subscore (MES). Results: Compared with distal colitis, extensive colitis had more severe disease activity, younger age, higher utilization rate of corticosteroids and incidence of extra intestinal manifestations (EIMs), and clinical indicators were differentially expressed in the two groups. After using propensity score, the incidence of EIMs in the extensive colitis was still higher than that in distal colitis. Inflammation, coagulation and immune indicators like CRP, FC, IL-10, D-D and α1-MG are higher in extensive colitis, and metabolic indicators like LDL-C, HDL-C, TC, GSP and albumin are higher in distal colitis. The correlation between clinical indicators and MES is affected by disease extent. The area under curve (AUC) of CRP + D-D + α2-MG for predicting distal colitis MES3 was 0.85, and the AUC of IL-6+ GSP+ α1-MG predicted extensive colitis MES3 can reach 0.82. Conclusion: Differential clinical indicators can become potential markers for predicting disease progression and prognosis, and have significance for UC mechanism research and drug development. We can select biomarkers according to lesion site.

A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil.

Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical-epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil. This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021. Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years. More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.

A novel inflammatory marker for extensive ulcerative colitis; Endocan

Background & aimsUlcerative colitis (UC) is an inflammatory bowel disease characterized by mucosal inflammation. Endocan, a proteoglycan secreted by endothelial cells in response to inflammatory cytokines, has been reported to be overexpressed in inflammatory conditions. In this study, we aimed to evaluate the utility of endocan level in determining the extent and severity of disease in patients with ulcerative colitis and to determine whether it can be a candidate marker for noninvasive evaluation and monitoring since there is not enough data in the literature.Materials and methodsSixty-five people were included in the study, including thirty-five with ulcerative colitis and thirty in the control group. Patients with first diagnosed ulcerative colitis clinically, endoscopically, and histopathologically, without any treatment, and with normal liver and kidney tests were included in the study. Endoscopic scoring of all patients was performed according to the Mayo endoscopic scoring (MES) system. Blood samples for CRP (C-reactive protein) and endocan were taken from the patients simultaneously.ResultsThere was a significant statistical difference between all patients with ulcerative colitis and the control group in both endocan level and CRP level (p < 0.001). There was a statistically significant difference between endocan levels and CRP levels between the left-distal group and pancolitis (diffuse colitis) patients, but there was no statistical difference between age and MES.ConclusionSerum endocan level can be useful in determining the extent of ulcerative colitis and planning treatment.

IgE-Dependent Food Sensitisation and Its Role in Clinical and Laboratory Presentation of Paediatric Inflammatory Bowel Disease.

The rising prevalence of inflammatory bowel disease (IBD) and food allergies and their partially overlapping mechanisms such as microbiome diversity reduction raise questions about the role of allergies in IBD. While data on their comorbidity are available, analysis of IgE-sensitization's influence on the clinical presentation of IBD is lacking and is the aim of this study. Histories of 292 children with newly diagnosed IBD (173 cases of ulcerative colitis, 119 cases of Crohn's disease) were analyzed. Disease age of onset, activity, location, behaviour, and anthropometric and laboratory parameters were tested for its dependence on the presence of chosen IgE sensitization markers. A.o. Chi2, OR and phi coefficient were assessed. In Crohn's disease (CD), elevated total IgE (tIgE) correlated with weight loss, rectal bleeding, ASCA IgG positivity (φ = 0.19 for all) and negatively correlated with complicated disease behaviour (φ = -0.19). TIgE > 5 × reference range correlated with being underweight (φ = 0.2), ASCA IgG positivity (φ = 0.3), ASCA double (IgA and IgG) positivity (φ = 0.25) and elevated total IgG (φ = 0.18). The presence of specific IgEs (sIgE) correlated with extraintestinal manifestations of IBD (φ = 0.19): Egg white sIgE correlated with upper GI involvement (L4b) (φ = 0.26), severe growth impairment (φ = 0.23) and colonic mucosal eosinophilia (φ = 0.19). In ulcerative colitis, decreased IgA correlated with egg white sIgE (φ = 0.3), as well as the presence of any (φ = 0.25) or multiple sIgEs (φ = 0.2); the latter correlated also with elevated IgG (φ = 0.22), fever (φ = 0.18), abdominal pain (φ = 0.16) and being underweight (φ = 0.15). Cow's milk sIgE correlated positively with growth impairment (φ = 0.15) and elevated IgG (φ = 0.17) and negatively with extensive colitis (φ = -0.15). Pancolitis correlated negatively with sIgE presence (φ = -0.15). In summary, single moderate and numerous weak but interesting relationships were observed.

DEVELOPMENT OF AN OPTIMAL MACHINE LEARNING MODEL USING TREATMENT NAÏVE DIAGNOSTIC PATHOLOGY IMAGES TO PREDICT STEROID-FREE CLINICAL REMISSION AT ONE YEAR IN PEDIATRIC ULCERATIVE COLITIS

The majority of children with ulcerative colitis present with extensive colitis at diagnosis, but the response to therapy is heterogenous. Identifying the optimal window for biologic treatment and risk stratification of patients remains an unmet need.

Low Adherence is Associated with Chronic Active Disease in Ulcerative Colitis: A Retrospective Study from a Single Referral Center.

New therapeutic approaches for ulcerative colitis (UC) are now available, but there is still no robust evidence for predictors of poor outcomes. We aimed to evaluate the factors associated with a chronic active UC disease course. Data of all UC outpatients followed for at least 3 years after diagnosis between 2005 and 2018 were retrospectively collected. The primary aim was to identify risk factors for chronic active disease 3 years after diagnosis. Moreover, the following variables were investigated: proximal disease extension or disease regression, proctocolectomy, early use of biologics (BIO) or immunomodulators (IMM), hospitalization, colorectal cancer, and adherence. We defined adherence as both, taking the prescribed therapy and constancy in scheduled follow-up visits. A total of 345 UC patients followed for a median period of 82 months were included. Patients with extensive colitis at diagnosis had a higher rate of chronic active disease 3 years after diagnosis (p<0.012) together with a higher rate of surgery (p<0.001) at maximum follow-up. Patients with pancolitis showed significant disease regression over time (51%) without differences in treatment. The only factor associated with chronic active disease was non-adherence (p < 0.03; OR 0.49, 95% CI: 0.26-0.95). Adherent patients developed chronic active disease (p<0.025) less frequently but did receive more frequent IMM (p<0.045) or BIO (p<0.009) therapy. Patients diagnosed with pancolitis were more likely to have chronic active disease and to undergo colectomy. The only predictor for developing chronically active UC regardless of disease extension was the lack of adherence to therapy within the first 3 years after diagnosis, underlining the importance of tight control of UC patients and the need to timely identify potential risk factors for non-adherence.

Serrated polyps in patients with ulcerative colitis: Unique clinicopathological and biological characteristics.

Serrated polyps have recently been reported in patients with ulcerative colitis (UC); however, their prevalence and detailed characteristics remain unclear. The prevalence and clinicopathological and biological characteristics of serrated polyps in patients with UC were retrospectively examined in a single tertiary inflammatory bowel disease center in Japan from 2000 to 2020. Among 2035 patients with UC who underwent total colonoscopy, 252 neoplasms, including 36 serrated polyps (26 in colitis-affected segments, 10 in colitis-unaffected segments), were identified in 187 patients with UC. The proportion of serrated polyps was 1.8% (36/2035). Serrated polyps in colitis-affected segments were common with extensive colitis (88%), history of persistent active colitis (58%), and long UC duration (12.1 years). Serrated polyps in colitis-affected segments were more common in men (88%). Of the 26 serrated polyps in colitis-affected segments, 15, 6, and 5 were categorized as sessile serrated lesion-like dysplasia, traditional serrated adenoma-like dysplasia, and serrated dysplasia not otherwise specified, respectively. Sessile serrated lesion-like dysplasia was common in the proximal colon (67%) and with BRAF mutation (62%), whereas traditional serrated adenoma-like dysplasia and serrated dysplasia not otherwise specified were common in the distal colon (100% and 80%, respectively) and with KRAS mutations (100% and 75%, respectively). Serrated polyps comprised 14% of the neoplasias in patients with UC. Serrated polyps in colitis-affected segments were common in men with extensive and longstanding colitis, suggesting chronic inflammation in the development of serrated polyps in patients with UC.

The Incidence of Pouch Neoplasia Following Ileal Pouch-Anal Anastomosis in Patients With Inflammatory Bowel Disease.

Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure following proctocolectomy in patients with inflammatory bowel disease (IBD) who require colectomy. However, removal of the diseased colon does not eliminate the risk of pouch neoplasia. We aimed to assess the incidence of pouch neoplasia in IBD patients following IPAA. All patients at a large tertiary center with International Classification of Diseases-Ninth Revision/International Classification of Diseases-Tenth Revision codes for IBD who underwent IPAA and had subsequent pouchoscopy were identified using a clinical notes search from January 1981 to February 2020. Relevant demographic, clinical, endoscopic, and histologic data were abstracted. In total, 1319 patients were included (43.9% women). Most had ulcerative colitis (95.2%). Out of 1319 patients, 10 (0.8%) developed neoplasia following IPAA. Neoplasia of the pouch was seen in 4 cases with neoplasia of the cuff or rectum seen in 5 cases. One patient had neoplasia of the prepouch, pouch, and cuff. Types of neoplasia included low-grade dysplasia (n = 7), high-grade dysplasia (n = 1), colorectal cancer (n = 1), and mucosa-associated lymphoid tissue lymphoma (n = 1). Presence of extensive colitis, primary sclerosing cholangitis, backwash ileitis, and rectal dysplasia at the time of IPAA were significantly associated with increased risk of pouch neoplasia. The incidence of pouch neoplasia in IBD patients who have undergone IPAA is relatively low. Extensive colitis, primary sclerosing cholangitis, and backwash ileitis prior to IPAA and rectal dysplasia at the time of IPAA raise the risk of pouch neoplasia significantly. A limited surveillance program might be appropriate for patients with IPAA even with a history of colorectal neoplasia.

Prevalence and predictors of arthralgia after initiation of vedolizumab in patients with inflammatory bowel disease: a retrospective cohort study.

Vedolizumab is a mAb used for the treatment of moderate to severe ulcerative colitis and Crohn's disease. There is evidence that administration of vedolizumab has been associated with either new onset or reactivation of extra-intestinal manifestations, among which arthralgia is the most prominent. We aimed to study the incidence, characteristics and predictors for the occurrence of arthralgias in patients with inflammatory bowel disease (IBD) who receive vedolizumab. A retrospective cohort study was implemented in patients with IBD. The occurrence of new-onset and recurrent arthralgias were recorded. Multivariate Cox proportional-hazards models were used to identify factors associated with the endpoints of interest. A total of 115 vedolizumab-treated IBD patients (male = 50.4%; ulcerative colitis = 70.4%; median follow-up = 12.7 months) participated. New-onset arthralgia occurred in 20.9%, and recurrent in 46.7% (45 patients at risk). Among patients with ulcerative colitis, multivariate Cox's proportional-hazards models showed, that new onset arthralgia was significantly associated with extensive colitis (hazard ratio = 2.91; 95% confidence interval, 1.04-8.12). Of 15 patients with concomitant treatment of azathioprine, no one manifested new-onset arthralgia (X2P = 0.03; Fisher's exact test P = 0.038). No predictors were identified for recurrent arthralgia. Arthralgias is a common manifestation of vedolizumab treatment. Patients with extensive ulcerative colitis demonstrate a higher risk for new-onset arthralgia, whereas, concomitant treatment with azathioprine appears to be protective. These associations may be mediated by re-directed lymphocyte trafficking and may support concomitant immunomodulator administration in specific patient subpopulations who commence treatment with vedolizumab.

Incremental Detection Rate of Dysplasia and Sessile Serrated Polyps/Adenomas Using Narrow-Band Imaging and Dye Spray Chromoendoscopy in Addition to High-Definition Endoscopy in Patients with Long-Standing Extensive Ulcerative Colitis: Segmental Tandem Endoscopic Study.

High-definition (HD) endoscopy is recommended in surveillance colonoscopy for detecting dysplasia in patients with ulcerative colitis (UC). Dye-spray chromoendoscopy (DCE) and narrow-band imaging (NBI) are often used as adjunctive techniques of white-light endoscopy (WLE) in real-world practice. However, the incremental detection ability of DCE and NBI added to HD-WLE for dysplasia and serrated lesions has not yet been evaluated using tandem endoscopy in patients with long-standing extensive UC. We enrolled patients with extensive UC for >8 years who were in clinical remission (partial Mayo score < 2) at the Samsung Medical Center in Seoul, Republic of Korea. HD-WLE was performed first. Subsequently, HD-NBI and HD-DCE with indigo carmine were performed using the segmental tandem colonoscopy technique. A total of 40 patients were eligible, and data obtained from 33 patients were analyzed. The incremental detection rates (IDRs) for dysplasia and serrated lesions were calculated. HD-WLE detected three dysplasia and five sessile serrated adenomas/polyps (SSAs/Ps). HD-NBI and HD-DCE did not detect additional dysplasia (IDR = 0%; 95% confidence interval (CI): 0-56.2%). HD-NBI identified one missed SSA/P (IDR = 7.7%; 95% CI: 1.4-33.3%), and HD-DCE detected seven missed SSAs/Ps (IDR = 53.9%; 95% CI: 29.1-76.8%). Logistic regression found that HD-DCE increased the detection of SSAs/Ps compared to HD-WLE and/or HD-NBI (odds ratio (OR) = 3.16, 95% CI: 0.83-11.92, p = 0.08). DCE in addition to HD-WLE improved the detection of SSAs/Ps, but not dysplasia, in patients with long-standing extensive UC.

P315 The characteristics and severity of pediatric ulcerative proctitis

Abstract Background The diagnosis of ulcerative proctitis is rarer in childhood than in adulthood (4-29% vs. 44-60%). According to the literature, the prognosis of ulcerative colitis is favourable, however one third of the patients require biological therapy during follow-up, and the localization may extend in 20-25% in 5 years. Our aim was to compare the disease characteristics at diagnosis in children with ulcerative proctitis and with more extensive ulcerative colitis. Methods Retrospective, single centre analyses of patients with ulcerative colitis, diagnosed between 2010-2022 at the Heim Pál National Paediatric Institute, Budapest, Hungary. We compared the initial demographic, anthropometric data, and laboratory parameters of children with ulcerative proctitis (E1) and more extensive ulcerative colitis (E2-E4) according to the Paris classification. The analyses were performed with descriptive statistics and 2 samples t-tests. Results Between 2010-2022, of the 127 children were diagnosed with ulcerative colitis, 22 had proctitis (17.3%; 10 male; mean age: 15.0±1.9 year) and 105 had more extensive disease (82.7%; 53 boy; mean age: 12.2±3.8 year). The mean age was significantly higher in the proctitis group. The initial CRP, platelet count and faecal calprotectin (FCP) level was significantly lower (CRP [mg/l]: 1.2±1.4 vs. 12.0±21.5, p&amp;lt;0.001; thrombocyte [G/l]: 264.9±611.9 vs. 420.6±183.7, p&amp;lt;0.001; FCP [μg/mg]: 416.5±411.4 vs. 1054.5±316.6, p=0.001); while the haematocrit and albumin level was significantly higher (haematocrit [%]: 38.6±3.1 vs. 33.6±5.2, p&amp;lt;0.001; albumin [g/l]: 46.6±2.9 vs. 42.7±4.4, p&amp;lt;0.001) in the proctitis group compared to the other group. BMI z-score value at diagnosis was significantly higher in the proctitis group (0.45±1.4 vs. -0.12±1.2, p=0.02). The initial activity index (PUCAI) was significantly higher in the more extensive group (at diagnosis: 25.0±11.0 vs. 45.1±18.9, p&amp;lt;0.01). Conclusion Our results are in line with the literature, that the proportion of ulcerative proctitis is low in children. Based on our results, the manifestation of ulcerative proctitis presents in a milder form than more extensive colitis. Though it is important, that physicians should always consider the extension of the disease and need for treatment escalation to reach mucosal healing.

P829 The Burden of Colorectal Cancer in Patients with Ulcerative Colitis – Incidence and Risk factors from a Population-based Inception Cohort from Veszprem county, Western Hungary, from 1977–2020

Abstract Background Limited data are available on the incidence and risk of colorectal cancer (CRC) in ulcerative colitis (UC) from population-based studies in Eastern Europe. We aimed to identify the long-term incidence trends and predictors of CRC in a prospective population-based inception cohort from Veszprem, Western Hungary. Methods Patient inclusion for the inception cohort was between January 1,1977 and December 31,2018, and follow-up ended December 31,2020. The risk of CRC was estimated using standardized incidence ratios (SIRs). Age-and gender-specific CRC rates of the background population were derived from the National Cancer Registry. Results A total of 1,370 incident UC patients were included [male:51.2%, median age at diagnosis:37years). During a median follow-up of 17 years(IQR9-24), CRC was diagnosed in 41 UC patients(2.99%), equaling 1.76/1000 person-year(py).Median age at CRC diagnosis was 59(IQR:50.0-67.5) years. Overall SIR of CRC was 2.02(CI95%:10.1-12.1). SIRs were higher in extensive colitis (SIR:3.77, CI95%:2.41-5.91). The cumulative probability of CRC at 10-,20 and 30 years was 0.9% (95%CI0.6-1.2), 3.5%(95%CI2.8-4.2), and 6.5%(95%CI5.4-7.6), and there was no difference in the risk of CRC over different decades of UC diagnosis in a Kaplan Meier analysis(Log-rank=0.693). In multivariate analyses, co-existing PSC(HR4.19;95%CI1.72-10.20), colonic dysplasia(3.42;95%CI1.04-11.26), and extensive colitis (HR2.15;95%CI1.29-3.60) were identified as a significant predictor for CRC. Conclusion We report an increased CRC risk in UC patients with a standardized incidence ratio of approximately 2 folds, with a stable CRC risk over four decades. Disease extent, co-existing PSC and dysplasia were identified as predictors of CRC.

P170 Can histological activity of ulcerative colitis be predicted by assessment of the rectosigmoid colon?

Abstract Background Rectosigmoidoscopy is frequently used to assess disease activity in patients with ulcerative colitis (UC). Most recent guidelines suggest that the inflammatory activity of the whole colon can be inferred by endoscopic findings in the rectosigmoid colon. Nevertheless, whether the right colon can have endoscopic or histological activity when there is endoscopic and histological remission in the left colon, is yet to be completely determined. Aim To assess whether UC histological activity (HA) and improvement (HI) can be deduced by the findings in the rectosigmoid colon. Methods Retrospective single center cohort study. Consecutive patients with previously diagnosed UC undergoing endoscopic assessment, from January 2014 to September 2022, were included. Inclusion criteria were: a complete colonoscopy with adequate bowel preparation and biopsies made in all the four segments of the colon and in the rectum. Demographic, clinical, endoscopic (Mayo endoscopic subscore (MES)) and histological (Geboes score (GS)) data at the time of the colonoscopy was collected. Agreement and correlation between findings in the rectosigmoid and the whole colorectum were calculated with the kappa coefficient (k) and the Spearman correlation coefficient (r). Results Inclusion of 264 patients (49.2% male). Median age was 5015.7years. Smoking history in 33.5% of patients. Extension of UC was: proctitis in 13 (4.9%), left colitis in 109 (41.3%) and extensive colitis in 142 (53.8%) patients. MES was 0 in 139 (53.7%) patients, 1 in 52 (20.1%), 2 in 36 (13.9%) and 3 in 32 (12.3%). GS was 0 in 19 (7.3%), 1 in 124 (47.5%), 2 in 50 (19.1%), 3 in 40 (15.3%), 4 in 10 (3.8%) and 5 in 18 (6.9%). Regarding endoscopic activity, a very high correlation was found between MES of the whole colorectum and MES of the left colon (k=0.88, r=0.92). As far as HA (GS1.1) is concerned, HA in the whole colorectum was highly correlated with HA in the rectosigmoid colon (k=0.8, r=0.82), both in the whole cohort and in the subgroup of patients with extensive colitis (k=0.8, r=0.82). When assessing HI (GS&amp;lt;3.1) moderate coefficients (k=0.66, r=0.69) were found in the whole cohort. Patients with extensive colitis revealed similar agreement and correlation coefficients (k=0.69, r=0.71). Conclusion Endoscopic and histological activity in the rectosigmoid colon of patients with UC has a high correlation with activity in the whole colorectum. Therefore, UC activity can be inferred by analysis of the distal segments of disease. These findings reinforce that inflammatory activity in patients with UC can be assessed with rectosigmoidoscopy alone.

P158 Intestinal Ultrasound at IBD diagnosis predicts surgery – a Copenhagen IBD cohort study

Abstract Background The disease course of inflammatory bowel disease (IBD) is heterogeneous and unpredictable. Currently, we are unable to predict which patients will need IBD-related bowel resection in the first year after diagnosis. Intestinal Ultrasound (IUS) has been proven as a non-invasive modality for assessing disease activity in IBD. However, the evidence for IUS as a predictor of disease course is still limited. Here we present novel data on the predictive value of IUS performed at the time of IBD diagnosis. Methods Patients with new-onset IBD are currently being included in the ongoing multicentre prospective inception cohort study, the IBD Prognosis Study (May 2021 – April 2023). IUS is performed at the time of diagnosis and the patients are followed prospectively. Patients with proctitis are not assessed with IUS. The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) is calculated for the most inflamed segment with a high score indicating severe disease activity. IBUS-SAS (0-100) incorporates the bowel wall thickness (BWT), bowel wall stratification, colour Doppler signal, and inflammatory fat. Surgery was defined as an IBD-related bowel resection. Patients treated with corticosteroids for &amp;gt; 72 hours or with any IBD-treatment &amp;gt; two weeks prior to IUS were excluded from analysis. In this abstract, we report our preliminary results after including patients for 16 months. Results IBUS-SAS at diagnosis was available in 133 patients (out of 242 included). 68 patients were diagnosed with Crohn’s disease (CD) (ilieal: 22, colonic: 23, ileocolonic: 23) and 65 patients were diagnosed with ulcerative colitis (UC) or unclassified IBD (left-sided colitis: 20, extensive colitis: 45). Median follow-up was 226 days. During follow-up 10 patients underwent surgery (7.5%). These included 4 patients with UC (extensive colitis: 3, left-sided colitis: 1) and 6 patients with CD (ileal: 2, colonic: 2, ileocolonic: 2). Mean IBUS-SAS at diagnosis was 92.6 among patients who underwent surgery during follow-up vs. 48.8 for patients who did not undergo surgery (p&amp;lt;0.0001). Distribution of scores is shown in Figure 1. Mean BWT at diagnosis was 8.3 mm among patients who underwent surgery during follow-up vs. 5.0 mm for patients who did not undergo surgery (p&amp;lt;0.0001). In total, 12 patients had an IBUS-SAS &amp;gt; 90 at diagnosis and among these 7 (58.3%) were operated during follow-up. Figure 2 shows a Kaplan-Meier Curve of surgical free survival stratified by IBUS-SAS at diagnosis. Conclusion IUS activity at diagnosis of IBD seems to have the capability to predict short term risk of IBD-related surgery. Our results suggest IUS might be used at diagnosis to identify patients at high risk of IBD-related surgery.

P875 Disease course of Ulcerative Colitis during the first ten years following diagnosis in a prospective European population-based inception cohort – the Epi-IBD cohort

Abstract Background The Epi-IBD cohort is a prospective European population-based cohort of 1,390 patients diagnosed in 2010 and 2011 with inflammatory bowel disease (IBD) according to Copenhagen criteria in centres from Eastern and Western European countries. The study aims at describing differences in incidence, treatment strategies, disease course and prognosis of ulcerative colitis (UC) Eastern and Western Europe. Methods UC patients were followed prospectively from the time of diagnosis until December 31st, 2020, death, emigration or loss of follow-up. Clinical data on surgery, hospitalizations and medical treatment were captured throughout the follow-up period and entered in a validated web-database, www.epi-ibd.org. Associations between colectomy and covariates were analysed by multivariate Cox regression analyses. Results A total of 816 UC patients aged ≥15 years from 21 centres in 5 Eastern and 11 Western European countries were included. Overall, 51 (6%) patients underwent colectomy. A total of 190 (23%) patients were hospitalized at least once for their UC. Cancer was diagnosed in 28 (3%) patients, including 4 colorectal cancers. The use of medical therapy was comparable across Eastern and Western European centres (Table 1). During follow-up, 121 out of 776 (16%) patients with limited UC (proctitis or left-sided colitis) progressed to extensive colitis. The median time to progression was 21 (IQR: 8-48) months from diagnosis. No patients from Eastern Europe were exposed to biological therapy prior to change in disease extent, compared to 6 out of 98 patients (6%) from Western Europe. Multivariate Cox regression analysis showed no difference in risk of colectomy according to European region (Eastern vs. Western Europe, HR: 1.05, 95%CI: 0.48-2.29). Early intervention with biologicals (within 6 months) was associated with higher risk of colectomy (HR: 3.06, 95% CI: 1.23-7.58), and so was early introduction of immunomodulators (HR: 2.35, 95%CI: 1.16-4.76). Progression in disease extent to extensive colitis was significantly associated with higher risk of surgery (HR: 5.30, 95% CI: 2.36-11.90) and similarly extensive colitis at diagnosis compared to proctitis (HR: 3.48, 95% CI: 1.12-10.82). Conclusion After 10 years of follow up in this European multicentre study, only 6% percent had a colectomy performed. Despite the widespread use of immunomodulators and biologicals, 16% of patients with limited disease extent progressed to extensive colitis which was associated with higher risk of surgery. The need for early introduction of biological therapy and immunomodulators might predict risk of surgery.