Active Colitis Research Articles

Evaluation of Tryptophan and Its Metabolites in Predicting Disease Activation in Inflammatory Bowel Disease

Background and Aim: Inflammatory bowel disease (IBD), which comprises ulcerative colitis (UC) and Crohn’s disease (CD), is characterized by chronic inflammation and fluctuating disease activity. This study aimed to evaluate serum tryptophan (TRP) and its metabolites as potential biomarkers for predicting disease activation in comparison to fecal calprotectin (FC). Methods: This prospective study included 115 patients (77 with UC and 38 with CD). Disease activity was assessed based on clinical and endoscopic findings. Serum TRP levels and their metabolites were measured using liquid chromatography–tandem mass spectrometry (LC-MS/MS), whereas FC levels were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results: Serum TRP levels ≤ 11,328.41 ng/mL predicted disease activation with 72.1% sensitivity and 62.7% specificity, whereas FC levels ≥ 89.60 µg/g showed 84.2% sensitivity and 67.6% specificity. The TRP-to-C-reactive protein (CRP) ratio (TRP/CRP) demonstrated superior diagnostic accuracy, with an area under the curve (AUC) of 0.847. Conclusions: The TRP/CRP ratio is a novel and comprehensive approach for predicting disease activation in IBD patients. Although FC remains the gold standard, TRP and its metabolites provide valuable complementary insights. Further research is required to validate these findings in larger cohorts.

The influence of stress, coping mechanisms and psychological symptoms on inflammatory bowel disease activity: A retrospective case-control analysis.

Psychological stress is widely recognized as a key factor that can initiate or aggravate symptoms in patients with inflammatory bowel disease (IBD). This research was aimed at examining the influence of stressors, coping mechanisms and psychological symptoms on disease activity in patients with Crohn's disease (CD) and ulcerative colitis (UC). A retrospective case-control research was performed with 138 patients diagnosed with IBD (76 with CD and 62 with UC). The participants were categorized into case groups (active disease: 31 CD, 38 UC) and control groups (inactive disease: 31 CD, 38 UC), with matching on demographic and clinical characteristics. Each participant completed several assessments such as the Simple Clinical Colitis Activity Index (SCCAI), the Harvey-Bradshaw index (HBI), the Life Distress Inventory (LDI), the Symptom Checklist (SCL-25) and the Coping Inventory for Stressful Situations (CISS-21). Participants experiencing active disease reported higher levels of life stress, with mean scores of 65.42 ± 8.88 in CD and 65.42 ± 8.88 in UC, in comparison with 45.97 ± 13.23 and 41.79 ± 13.49, respectively, in those with inactive disease. Additionally, psychological symptoms were more prevalent in both CD group (57.00 ± 12.71 vs. 47.39 ± 14.65) and the UC group (57.80 ± 9.82 vs. 40.05 ± 11.23) with active disease. Patients with active disease were more likely to employ coping strategies centered on avoidance, emotional responses and tasks than those without disease activity. Logistic regression analysis identified life stress (p < 0.001, 95% CI = [1.06-1.18], B = 1.24) and emotion-focused coping strategies (p < 0.001, 95% CI = [1.26-1.88], B = 1.54) as notable predictors of disease activity, whereas task-focused coping emerged as a protective factor (p < 0.029, 95% CI = [1.68-1.98], B = 1.81). This research underscores the critical role of managing stress and adopting effective coping mechanisms in reducing the likelihood of disease flare-ups in IBD subjects. Healthcare providers should prioritize integrating these approaches into treatment protocols for IBD management.

Assessment of activity and severity of inflammatory bowel disease in cross-sectional imaging techniques: a systematic review.

Cross-sectional imaging techniques, including intestinal ultrasonography (IUS), computed tomography enterography (CTE), magnetic resonance enterography (MRE), are increasingly used for evaluation of inflammatory bowel diseases (IBD). We aimed to systematically review literature evidence on the assessment of disease activity, and/or severity through cross-sectional imaging in IBD patients, and to offer guidance on their most effective utilization. We performed a systematic review of PubMed, EMBASE, and Scopus to identify citations pertaining the assessment of disease activity, and/or severity at cross-sectional imaging techniques compared to a reference standard (i.e., other radiological techniques, endoscopy, histopathology, and surgery) in IBD patients published until December 2023. Overall, 179 papers published between 1990 and 2023 were included, with a total of 10988 IBD patients (9304 CD [84.7%], 1206 UC [11.0%], 38 IBD-U [0.3%], 440 unspecified [4.0%]). 39/179 studies investigated IUS, 22/179 CTE, 101/179 MRE, in the remaining papers two techniques were addressed together. In 81.6% of the papers, endoscopy (with or without histopathology) was used as a reference standard. All studies included evaluated disease activity, while just over half (100/179, 55.8%) also evaluated disease severity of the addressed cross-sectional methodology. Pooled sensitivity, specificity, and overall accuracy of IUS, MRE, and CTE compared to the reference standard were 60-99%, 60-100%, and 70-99%, respectively. All cross-sectional imaging techniques demonstrated moderate-to-good accuracy in assessing disease activity, and severity of IBD. This finding highlights the potential, especially for MRE and IUS to be widely utilized in managing IBD in both clinical practice and clinical trials.

An online mindfulness-based intervention for adults with Inflammatory Bowel Disease & psychological distress: A feasibility randomized controlled trial of the Mind4IBD program

ObjectiveThe bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapies, such as mindfulness-based interventions (MBI), for improving biopsychosocial outcomes. Therefore, the aim is to examine the feasibility, acceptability, and preliminary efficacy of an online-delivered, self-directed MBI, adapted to individuals with IBD and psychological distress, in comparison to wait-list control (WLC). Methods50 adults with IBD were randomized to WLC (N = 25) or intervention (N = 25) groups. The intervention (MIND4IBD program) consisted of six, weekly, 15-min videos (with guided meditations). Feasibility was examined through recruitment and retention rates, while acceptability was examined through intervention satisfaction ratings and qualitative feedback. Preliminary efficacy was examined using linear mixed models for group differences in outcomes between baseline and post-intervention. ResultsPrimary Outcomes. The retention rate for the WLC group was 92 %, while the retention rate for the intervention group was 48 %. However, 16 % of participants allocated to the intervention group never began the intervention, therefore this resulted in a retention rate of 71 % of participants who began the intervention. Acceptability was high with an average intervention satisfaction rating of 83/100. Secondary Outcomes. When compared with the WLC, the MIND4IBD program improved total mindfulness levels (b = 0.29, 95 %CI [0.11,0.47], p = 0.004) with a large effect size (β = 0.54, b = 0.19, 95 %CI [0.04,0.34], p = 0.014). Themes based on participants' intervention feedback included: 1) beginning of journey with mindfulness, 2) the beneficial impact of mindfulness, 3) why adapting the intervention to IBD is important, 4) views on program delivery, and 5) mixed reactions to AI generated presenters. ConclusionMIND4IBD is feasible and acceptable for individuals with IBD and psychological distress. Participants' total mindfulness levels increased significantly in the intervention group compared to WLC. Most participants provided positive intervention feedback. These findings warrant a full-scale RCT to determine MIND4IBD's efficacy for IBD.

Long-term safety and sustained efficacy of bimekizumab in patients with ankylosing spondylitis (radiographic axial spondyloarthritis): 5-year results from BE AGILE (phase 2b) and its open-label extension

ObjectiveAssess long-term safety, tolerability and efficacy of bimekizumab in ankylosing spondylitis (radiographic axial spondyloarthritis (r-axSpA)).MethodsPatients with active r-axSpA completing the dose-ranging 48-week randomised controlled trial could enrol in the open-label...

The ability of C-reactive protein-albumin ratio to predict disease activity in ulcerative colitis.

Ulcerative colitis (UC) is an incurable disease represented by relapse and remission. Noninvasive biomarkers are required to predict disease activation. This study aimed to identify noninvasive biomarkers, such as the c-reactive protein-albumin (CRP/ALB) ratio, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR), that might forecast disease activation in UC. This retrospective study included 443 participants: 192 patients with active UC, 166 in remission, and 85healthy controls. Mayo Endoscopic Subscore was employed to assess endoscopic disease activity. Serum CRP, erythrocyte sedimentation rate (ESR), ALB levels, and complete blood count characteristics were documented. Three ratios of inflammation-related indicators were identified as CRP/ALB, PLR, and NLR. A positive correlation was found between ESR, CRP, neutrophil count, platelet count, levels of CRP/ALB, PLR, NLR, and endoscopic activity. The CRP/ALB ratio demonstrated more efficacy than the NLR and PLR in differentiating the UC patients from the controls (p = 0.007, p = 0.003, respectively) and the active group from the remission group (p < 0.001, p < 0.001, respectively). Regression analysis revealed that the CRP/ALB was significantly able to distinguish active UC from the remission group and the controls (p < 0.001, p < 0.001, respectively). The CRP/ALB ratio could be useful as an independent predictive biomarker for disease activity in UC.

Fecal Calprotectin Correlates with Disease Extent but Remains a Reliable Marker of Mucosal Healing in Ulcerative Colitis.

Fecal calprotectin (FC) is a marker of mucosal inflammatory activity in ulcerative colitis (UC). FC levels may also be influenced by the extent of disease. We aimed to examine the relationships between FC, mucosal activity, and disease extent, and to assess how disease extent affects the diagnostic accuracy of FC. We conducted a single-center observational study of patients with UC. Mucosal inflammatory activity was rated by the Mayo Endoscopic Score (MES) and Nancy Histological Index (NHI). The endoscopic and histological extents of disease were categorized by the Montreal classification and colorectal distribution of histologically active inflammation (NHI ≥ 2), respectively. FC was measured by EliA Calprotectin Enzyme fluoroimmunoassay (Phadia). A total of 518 visits by 254 patients were analyzed. In endoscopically active UC (MES ≥ 2), FC levels were significantly lower in proctitis (440 [IQR: 175-1350] mg/kg) as compared to left-sided colitis (840 [IQR: 298-2011] mg/kg, p = 0.048) or pancolitis (1690 [IQR: 723-2582] mg/kg, p = 0.00005). In MES ≤ 1, FC levels were significantly higher in pancolitis (85 [IQR: 43-350] mg/kg) as compared to proctitis (24 [IQR: 15-116] mg/kg, p = 0.00032) or left-sided colitis (40 [IQR: 15-160] mg/kg, p = 0.012). However, FC remained a reliable marker of mucosal healing across all disease extents, with AUC ranging from 0.878 to 0.915, and no significant differences between the extent categories (DeLong´s test, p ≥ 0.2919). FC showed a significant association with disease extent yet remained a reliable surrogate marker for mucosal healing across all disease extents.

The Role of Environmental Factors Prior to Diagnosis on the Activity and Severity of Inflammatory Bowel Diseases-Results From the Prospective Population-Based Copenhagen Inflammatory Bowel Disease Inception Cohort.

The influence of environmental factors on the severity of early inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is unclear. Herein, we aimed to investigate the role of environmental factors in the initial phenotype, activity, and severity of IBD. Copenhagen IBD Inception Cohort is a prospective population-based cohort of patients with newly diagnosed IBD between May 2021 and May 2023. Data on environmental factors were captured at IBD diagnosis using International Organisation of IBD (IOIBD) and HeartDiet questionnaires. Environmental factors' influence on outcome was analyzed and odds ratios (aOR) were adjusted for age, gender, and disease characteristics (adjusted OR, aOR [95% confidence interval]). In total, 208 and 128 patients with incident UC and CD, respectively, were included. Active smoking was associated with increased risk of CD-related hospitalization (aOR=2.84 [1.03; 7.88]) and stricturing phenotype (aOR=5.28 [1.76; 15.85]) but lower risk of severe UC course (aOR=0.28 [0.08; 0.95]). Further, previous smoking was not associated with negative effects in patients with CD in terms of early need for biologics, surgery, or hospitalization. In terms of diets, daily consumption of fruits (aOR=0.27 [0.07; 0.99]) or vegetables (aOR=0.27 [0.09; 0.80]) was inversely associated with stricturing CD, whereas whole meal bread was associated with reduced risk of severe CD activity (aOR=0.40 [0.16; 0.98]). This prospective population-based study highlighted several environmental factors associated with the initial severity and activity of IBD, emphasizing their pivotal role in the initial disease burden and giving guidance to personalized patient counseling.

The Relationship Between Inflammatory Bowel Disease Activity and Sleep Efficiency in Adult Patients: A Systematic Review

Background and Objectives: Patients with Inflammatory Bowel Disease frequently report disturbances in sleep. Few studies have utilized objective investigations like wrist actigraphy or polysomnography to explore sleep patterns in patients with IBD. To address this, we conducted a systematic review and meta-analysis to determine how disease activity impacts sleep efficiency among IBD patients. Methods: We conducted a search of Medline, the Cochrane Library, the National Library of Medicine Clinical Trial Database, and EMBASE for relevant studies from the date of establishment to July 2023. Sleep efficiency data in active and quiescent Crohn’s disease was summarised using a fixed-effects model. Results: Of the 780 articles identified in the initial search, 7 eligible studies were selected. Separate data regarding UC was lacking. There were 5 suitable studies eligible for meta-analysis, comprising 219 participants (107 and 112 patients with active and quiescent Crohn’s Disease, respectively). In this meta-analysis, the 95% CI of four out of five studies included unity, but the pooled analysis revealed greater sleep efficiency in those with remission Crohn’s disease in comparison to active Crohn’s (pooled mean difference [MD], -3.64; 95% Confidence Interval [CI], -5.56, -1.73, p= 0.0002). The degree of heterogeneity between studies was minimal (I2 = 0%, p = 0.59). Conclusion: We have demonstrated that worse sleep efficiency is associated with active CD compared to quiescent disease, but there is insufficient data regarding UC. Additional research, applying objective measures to evaluate sleep efficiency is necessary for a better understanding of the relationship between sleep quality and disease activity in IBD.

Utility of Serum-Based Markers to Predict Severity, Histological Activity, and Rehospitalisation in Ulcerative Colitis

Introduction: Inflammatory Bowel Disease (IBD) comprises ulcerative colitis (UC) and Crohn’s disease (CD). Serum-based non-invasive biomarkers are suggested for endoscopic and histological healing in clinical practice. Aims: The aim of this study was to investigate the utility of serum-based markers to predict severity, histological activity, and rehospitalization in ulcerative colitis. Materials and Methods: This was a cross-sectional study that was performed in a tertiary care center from October 2022 to March 2023. Diagnosis of ulcerative colitis on the basis of clinical history, imaging findings, flexible sigmoidoscopy/colonoscopy findings, and histopathology reports and agreed to participate were included. All the data, including blood parameters, were analysed. Results: C Reactive Protein (CRP)/albumin (AUC 0.821; 95% CI: 0.732 to 0.891, cut off point of &gt;2.57), (AUC 0.875; 95% CI: 0.794 to 0.933, cut off point of &gt;4.13) was the best predictor for correctly predicting endoscopic severity (UCEIS) and active histological inflammation and also a good predictor of re-hospitalization in the last 6 months (AUC 0.814; 95% CI: 0.724 to 0.885, cut off point of &gt;6.34) as compared to red cell distribution width (RDW)/albumin (AUC 0.598; 95% CI: 0.495 to 0.695), (AUC 0.537; 95% CI: 0.434 to 0.637), which was non-significant. RDW/Albumin (AUC 0.793; 95% CI: 0.701 to 0.868) also predicts 6-month rehospitalization significantly but less as compared to CRP/Albumin. Conclusion: In ulcerative colitis, the CRP/ALB ratio was a strong predictor of endoscopic severity, histologic disease activity, and rehospitalization in 6 months. It can be used to predict treatment response and as an indirect biomarker for mucosal healing.

Effects of inflammatory bowel diseases on sexual function in women.

Inflammatory bowel disease (IBD) is a chronic disease that includes Crohn's disease and ulcerative colitis. Studies found that 40-60% of women diagnosed with IBD have sexual dysfunction (SD). To determine SD and associated factors in women with IBD. Female patients diagnosed with IBD in the Gastroenterology Department who volunteered and healthy volunteers who were examined by a general practitioner were included in the study as the control group. After appropriate training was provided by the researcher, patients and volunteers were asked to fill out the Clinical and Sociodemographic Questionnaire, Hospital Anxiety Depression Scale and Female Sexual Function Index. There were 255 patients in the patient group and 240 patients in the control group. The mean ages of the patient and control groups were 40 ± 12 and 38 ± 11years, respectively. Mean disease duration in IBD patients was 9 ± 5.6years. The SD rate in the patient group (63.5%) was higher than in the control group (23.8%) (p < 0.01). The prevalence of SD was significantly lower in mildly active IBD patients than in moderate and severe IBD patients (p < 0.05). Active disease (OR: 3.82), active perianal disease (OR: 2.15), and severe depression (OR: 3.19) were predictive factors for SD in univariate logistic regression analysis. Previous abdominal surgery was found to be predictive for SD in multivariate analysis (OR: 5.13). The prevalence of SD was high in female IBD patients and its prevalence increased as disease activity increased. History of abdominal surgery in IBD was found to be associated with SD.

P0400 Automated real-time detection of intestinal tract and inflammatory bowel disease in intestinal ultrasound with the vision transformer (ViT)

Abstract Background Intestinal ultrasound is a powerful tool for diagnosing and monitoring inflammatory bowel disease (IBD). Although access to training is improving, the detection and interpretation of ultrasound images in IBD remains complex. The aim of this study was to develop and validate an artificial intelligence module to automatically detect the intestinal tract and active IBD in order to simplify the use of ultrasound in IBD. Methods Vision Transformers (ViTs), recently introduced as a competitive alternative to Convolutional Neural Networks (CNNs), were used to automate the real time detection and segmentation of the normal and inflamed intestinal tract. ViTs were chosen for their ability to better capture global relationships in images, which is particularly useful for recognizing complex patterns in medical images. The ViT model was trained on a dataset consisting of 17,488 intestinal ultrasound images from 46 patients, including 11,396 images of active IBD and 6,092 inactive IBD evaluated by two gastroenterologists. Results The sensitivity, specificity and accuracy for the detection of inactive and active IBD calculated from two intestinal ultrasound loop containing a total of 617 images of inactive IBD and 339 images of active IBD were 95%, 94% and 95% respectively. Some limitations were identified, notably a decrease in sensitivity in the detection of minor anomalies, in areas of low contrast and during variations in scale. These points suggest that the model could benefit from further refinement of its spatial processing capabilities, particularly in complex clinical situations. Conclusion We have developed a model based on the pre-trained Vision Transformer (ViT) architecture that is able to detect the active and inactive IBD. This approach could eventually make it easier for inexperienced operators to use intestinal ultrasound to detect and monitor IBD. Further in-depth tests on a larger set of images and videos are under way to validate the model’s performance.

P0263 Comparative analysis of the faecal biomarker potential of Plasminogen activator inhibitor type 1 (PAI-1) to the Calprotectin in Inflammatory Bowel Diseases

Abstract Background Inflammatory Bowel Diseases (IBD) require lifelong treatment and patient monitoring. Current predictors of relapse and therapeutic success have limitations, mostly invasive, time-consuming, and expensive. The faecal biomarker can help in disease activity and therapeutic response monitoring by simple and non-invasive way. Faecal Calprotectin (FC) is the gold-standard, but it has many disadvantages. We previously described that the correlation between the faecal Plasminogen activator inhibitor type 1 (PAI-1) (FP) level and the endoscopic activity and therapeutic response promote that it could be used as a novel non-invasive faecal biomarker in IBD diagnosis.1 To observe the exact faecal biomarker potential, we aimed to define the FP level of IBD patients and subjects with other gastrointestinal (GI) diseases and compare it with the FC. Methods Faecal samples were collected from 84 patients with IBD (CD-active: 12, CD-inactive: 10, UC-active: 9, UC-inactive: 10) and other GI diseases [colorectal cancer (CRC): 10, diverticulosis [DIV]: 9, irritable bowel syndrome [IBS]: 5, Polyp: 10) and 9 healthy subjects. ELISA method was applied to define FP level and it was validated for stool samples by us. In our previous study, 0.68 ng/g PAI-1 level was defined as the cut-off value. For FC observation diagnostic FC ELISA kit (Orgentec) was used. FC cut-off value was 50 mg/g. ROC analysis was applied to define Youden-index, specificity, and sensitivity of the measured values. Results FP level was significantly higher in patients with active IBD compared to inactive IBD and healthy subjects. No significant differences were observed between CD-active and UC-active groups. In addition, FP concentrations were significantly increased in active IBD patients compared to inactive IBD, CRC, DIV, IBS, Polyp, and healthy subjects. However, FC showed the same pattern as FP, except at the inactive IBD and DIV. In these groups, there were no significant differences compared to the active IBD subjects. ROC analysis defined high specificity (88.9%) and moderate sensitivity (47.6%) values (TP: 10, FP: 7, FN: 11, TN: 56, PPV: 0.588, NPV: 0.836) at the FP measurements. Nevertheless, at FC levels 34.9% specificity and 95.2% sensitivity were measured (TP: 20, FP: 41, FN: 1, TN: 22, PPV: 0.328, NPV: 0.957). Calculated Youden-index was higher at the FP (0.37) compared to the FC (0.3). Conclusion Our results suggest that the FP level selectively increased in the active IBD and discriminated more specifically from the other GI diseases compared to the FC. However, the sensitivity was lower, but it could be improved by the increasing patient numbers. Thus, the FP level could be useful in the diagnosis of IBD independently or combined with FC.

P1247 An argument for screening? Disordered eating patterns are highly prevalent in Inflammatory Bowel Disease (IBD)

Abstract Background The complex relationship between body image perception, disordered eating behaviours, and quality of life (QoL) has been poorly examined in patients with IBD. Although individuals with chronic gastrointestinal conditions are at an increased risk for disordered eating behaviours, the prevalence and risk factors associated with these attitudes remain underexplored in IBD. Therefore, this study aimed to investigate the relationship between IBD activity, body image perception, and disordered eating behaviours to determine clinical features that impact patient QoL. Methods An online questionnaire was administered through a tertiary centre IBD clinic in South Australia. Disordered eating behaviours were assessed via the validated Eating Disorder Examination-Questionnaire (EDE-Q7). Clinically significant eating disorder attitude is defined as EDE-Q7 score &amp;gt;3.5. Univariate and multivariate logistic regression analyses were performed to correlate clinically significant disordered eating behaviours with patient sex, disease activity, and the presence of clinical depression or anxiety. Results In a cohort of 210 respondents, clinically significant disordered eating behaviours were observed in 33.2% of respondents. Higher global EDE-Q7 scores were significantly associated with female sex (P&amp;lt;0.0001), active IBD (P=0.0169), and clinical depression (P&amp;lt;0.0001) and anxiety (P&amp;lt;0.0001). High global dietary restraint, shape/weight overevaluation, and body dissatisfaction subscores were significantly associated with female sex (P=0.0063; P=0.0001; P&amp;lt;0.0001), patients with clinical depression (P=0.0142; P&amp;lt;0.0001; P&amp;lt;0.0001), and patients with clinical anxiety (P=0.0003; P&amp;lt;0.0001; P&amp;lt;0.0001). IBD activity and Crohn’s disease were significantly associated with high global shape/weight overevaluation subscores (P=0.0216; P=0.0175) and body dissatisfaction subscores (P=0.0063;P=0.0117). Furthermore, clinically significant disordered eating behaviours were significantly associated with IBD activity (OR, 2.2; 95% CI, 1.3-4.0; P=0.007), clinical anxiety (OR, 7.7; 95% CI, 4.0-14.7; P&amp;lt;0.0001) and clinical depression (OR, 4.6; 95% CI, 2.4-8.7; P&amp;lt;0.0001). Multivariate regression analysis showed that the odds of high global EDE-Q7 scores are significantly increased by clinical anxiety (OR, 8.9; 95% CI, 4.3-18.4; P&amp;lt;0.0001). Conclusion This study demonstrates that disordered eating behaviours are highly prevalent in patients with IBD. Collectively, these findings provide important insight into the eating and body image behaviours that impact the QoL of patients with IBD.

Structural equation modeling of the impact of disease activity on inflammatory bowel disease control: the mediating roles of self-efficacy and self-management behaviors

BackgroundMaintaining effective disease control in patients with inflammatory bowel disease (IBD) is both a significant goal and challenge. Drawing on the Common-Sense Model of Self-Regulation (CSM) and related research, this study investigates how IBD activity status influences disease control through both direct and indirect pathways.MethodsA cross-sectional survey was conducted among 310 IBD patients who attended a tertiary general hospital, the leader of the IBD Alliance Group in Chongqing City, between March and August 2024. Structural equation modeling (SEM) was utilized to assess the role and magnitude of various influencing factor pathways. Relying on AMOS26 software, the path effects and magnitude of various factors in the disease control process were analyzed using structural equation modeling (SEM) to test hypothetical models.ResultsA total of 306 valid questionnaires were collected, with a mean IBD-control score of 12.14 ± 3.665. There was a negative link between disease activity and IBD-control (P < 0.01) and a positive correlation between chronic illness management self-efficacy, IBD self-management behavior, and IBD-control (P < 0.01). Path analysis showed that IBD activity negatively predicted IBD control (β = -0.715, P = 0.01). Chronic disease management self-efficacy partially mediated this relationship (β = -0.071, P = 0.012). A significant chain-mediated pathway was identified, where IBD activity affected IBD control via self-efficacy guided by self-management behavior (β = -0.025, P = 0.007). However, the pathway where IBD activity influenced control through self-efficacy and subsequently self-management behavior showed only marginal significance (P = 0.074).ConclusionEffective self-management behaviors improve IBD control. High disease activity may reduce chronic disease management self-efficacy, impairing IBD control. Positive feedback loops involving self-management behaviors and enhanced self-efficacy are crucial for better disease control, as patients who perceive positive outcomes are more motivated to maintain these behaviors.

P0070 Distinct Serum Proteome Alterations Following Vedolizumab and Ustekinumab Therapy in IBD Patients

Abstract Background Inflammatory bowel disease (IBD) is a chronic intestinal disorder characterized by relapse and remission. Dysregulated cytokine networks and excessive immune activation drive intestinal inflammation. Therapies targeting cytokines (e.g., TNF, IL-12/23) and immune cell trafficking (e.g., integrin inhibitors) have been effective. However, the impact of anti-integrin (vedolizumab) and anti-IL-12/23 (ustekinumab) therapies on systemic inflammation is poorly understood. This study compares serum proteome profiles of patients treated with vedolizumab or ustekinumab to elucidate their distinct effects on inflammatory pathways. Methods This study included patients with Crohn’s disease (CD), ulcerative colitis (UC), and age- and sex-matched healthy donors (HD), who received either ustekinumab or vedolizumab treatment. The ustekinumab cohort comprised 23 CD and 10 UC patients, while the vedolizumab cohort included 7 CD and 27 UC patients. Serum samples were collected from ustekinumab-treated patients at baseline (week 0) and 8 weeks post-treatment, and from vedolizumab-treated patients at baseline (week 0) and 6 weeks post-treatment. Additionally, serum samples were collected from 32 healthy donors. Proteomic analysis was performed using the Olink Inflammation Panel, measuring 92 inflammation-related proteins. Differential protein expression analysis was conducted to compare baseline and post-treatment samples within each cohort. Results Serum proteomic analysis using the Olink Inflammation panel revealed significant alterations in the levels of 15 proteins in IBD patients compared to healthy controls. Pro-inflammatory markers, including 4E-BP1, SIRT2 and TNF were significantly upregulated, indicating immune activation in IBD. Conversely, anti-inflammatory regulators, such as LIF-R and SCF, were significantly downregulated. Ustekinumab treatment led to upregulation of IL-12B and downregulation of 4E-BP1, SIRT2. Notably, IL-12B was upregulated in both CD and UC, while 4E-BP1 and SIRT2 were downregulated in CD (week 8 vs week 0). Conversely, vedolizumab treatment induced robust proteomic changes over time. Between week 0 and week 6, majority of proteins showed significant differential expression, more than the differences observed between IBD and HD groups. Conclusion Serum proteomic profiles of IBD patients differ from healthy donors. Ustekinumab induced minimal serum changes, indicating a limited systemic effect, while vedolizumab led to substantial proteomic shifts, suggesting broader modulation of inflammation. These distinct effects highlight the differing mechanisms of ustekinumab and vedolizumab on systemic inflammation in IBD, prompting further investigation to optimize therapeutic strategies.

P0472 Artificial intelligence-enabled histology is comparable in performance to pathologists in assessing histological remission in inflammatory bowel disease: a systematic review, meta-analysis and meta-regression

Abstract Background Achieving histological remission is a desirable treatment target in inflammatory bowel disease (IBD)1, yet its assessment is challenged by high inter- and intra-observer variability, reliance on experts, and lack of standardisation2. Artificial intelligence (AI) holds promise in addressing these issues3. This systematic review, meta-analysis, and meta-regression evaluated the AI’s performance in assessing histological remission and compared it with that of pathologists. Methods We searched Medline/PubMed and Scopus databases from inception to September 2024. We included studies on AI models assessing histological activity in IBD, with or without comparison to pathologists. Pooled performance metrics were calculated: sensitivity, specificity, positive and negative predictive value (PPV &amp; NPV), observed agreement, and F1 score. A pairwise meta-analysis compared AI and pathologists, while sub-meta-analysis and meta-regression evaluated heterogeneity and factors influencing AI performance. Results From 432 studies retrieved, fourteen met the inclusion criteria. AI models exhibited strong performance with a pooled 0.85 sensitivity (95% CI 0.81-0.89), 0.88 specificity (0.85-0.91), 0.88 PPV (0.86-0.91), 0.83 NPV (0.76-0.89), 0.86 observed agreement (0.83-0.89), and 0.85 F1 score (0.82-0.88). AI demonstrated no significant differences when compared to pathologists’ PPV, observed agreement, and F1 score, but significantly lower sensitivity (OR 0.50, 95% CI 0.28-0.87; p=0.01) despite considerable heterogeneity (I2=0-74.6%). AI models for the adult population were linked to reduced heterogeneity and enhanced AI performance at meta-regression. Conclusion AI shows significant potential for assessing histological remission in IBD and performs comparably to pathologists. Future research should focus on standardised, large-scale studies to minimise heterogeneity and support widespread AI implementation in clinical practice.

P0079 Serum calprotectin [cpa9-hne], a biomarker of neutrophil activity, is associated with histological inflammation and fibrosis burden

Abstract Background Infiltration of neutrophils into the intestinal tissue is a crucial component of the inflammatory response in Crohn‘s disease (CD). CPa9-HNE, a calprotectin fragment released by human neutrophil elastase during NETosis, has been shown to strongly correlate with endoscopic disease activity in inflammatory bowel disease (IBD) and serves as an indicator for pharmacodynamic response. Furthermore, emerging data suggests that neutrophil extracellular traps (NETs) significantly contribute to the pathogenesis of fibrosis. For the first time, we investigated the association of CPa9-HNE with histological grading of both inflammation and fibrosis. Methods The cohort included 62 patients with stenotic Crohn‘s disease. Inclusion criterion was the presence of stenotic disease requiring bowel resection, as confirmed by radiographic assessment. Upon surgery, the resected specimens were collected and histologically graded according to transmural fibrosis burden, and inflammation (D'Haens score). Serum was drawn at baseline (before resection). CPa9-HNE was measured, reflecting a human neutrophil elastase-derived fragment of calprotectin. Spearman’s rank correlation was applied. Results CPa9-HNE showed an overall positive correlation to the D'Haens score (ρ=0.279, p&amp;lt;0.005). Significant positive correlation was observed between CPa9-HNE and the presence of neutrophils, both in the epithelium and the lamina propria (ρ=0.309, ρ=0.349, p&amp;lt;0.005 both), as well as with epithelial damage (ρ=0.262, p&amp;lt;0.005). We also observed a positive correlation between CPa9-HNE and transmural fibrosis burden, specifically fibrosis in the submucosa (ρ=0.294, p&amp;lt;0.005) Conclusion This study showed that CPa9-HNE, a biomarker of neutrophil activity, correlated with the presence of neutrophils in the intestinal tissue, as well as epithelial damage. Interestingly, CPa9-HNE also showed association to submucosal fibrosis, emphasizing the importance of considering neutrophil activity when targeting the fibro-inflammatory axis. These findings highlight the potential use of CPa9-HNE as a complementary tool for histological grading of inflammation and fibrosis burden, and could be used to further explore the role of neutrophil extracellular traps in intestinal fibrosis.

P0363 Explore the application value of serum GOLM1 in the diagnosis of Inflammatory Bowel Disease

Abstract Background Current biomarkers used to monitor the disease activity of inflammatory bowel disease (IBD) have several limitations in specificity and sensitivity, and there is an urgent need to identify novel biomarkers. Previously, Golgi membrane protein 1 (GOLM1) has been proven to protect against colitis by modulating the equilibrium of Notch signaling pathway. Therefore, we aimed to explore the possible value of serum GOLM1 in the clinical diagnosis and disease activity assessment of IBD. Methods Collected clinical data, including serum GOLM1 and inflammatory markers (ESR, CRP, and Interleukin-6 [IL-6]), from 60 IBD patients (30 UC and 30 CD) and 30 control subjects (patients with colon polyps) at the First Affiliated Hospital of Zhengzhou University between August 2023 and August 2024. Mayo score and Crohn’s Disease Activity Index (CDAI) were used to evaluate the clinical disease activity of UC and CD, respectively. In UC, endoscopic disease activity was determined by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and in CD, it was measured by the Endoscopic Score for Crohn’s Disease (SES-CD). The level of serum GOLM1 was compared between IBD and the control subjects, as well as among different subgroups of IBD patients. Analysed the correlations between serum GOLM1 level and inflammatory markers, and between serum GOLM1 level and disease activity indices. Results 1. Serum GOLM1 levels were all elevated in IBD patients (p &amp;lt; 0.001), UC patients (p &amp;lt; 0.001), and CD patients (p = 0.050) compared with the control patients, and this trend was more pronounced in UC (Figure 1). Serum GOLM1 levels did not differentiate between UC and CD. Also, there was no significant difference in serum GOLM1 levels between remissive and active IBD patients, whether assessed clinically or endoscopically. 2. The level of serum GOLM1 was positively correlated with ESR (r = 0.491, p &amp;lt; 0.001), CRP (r = 0.397, p = 0.002) and IL-6 (r = 0.493, p &amp;lt; 0.001) in IBD patients. The same trend was also observed in UC. Serum GOLM1 level was also positively correlated with UCEIS in endoscopically active UC patients (UCEIS ≥ 1) (r = 0.489, p = 0.048), but not with Mayo score in clinically active UC patients (Mayo ≥ 3) (Figure 2). In CD, serum GOLM1 level was only positively correlated with ESR (r = 0.437, p = 0.016) and IL-6 (r = 0.377, p = 0.040). In endoscopically active CD patients (SES-CD ≥ 3), serum GOLM1 level was not associated with SES-CD. Similarly, no association was found between serum GOLM1 level and CDAI in clinically active CD patients (CDAI ≥ 150). Conclusion This study revealed a significant increase in the serum GOLM1 level in IBD, especially in UC. GOLM1 may be involved in the inflammatory process of IBD and may serve as a potential biomarker of IBD.

P0380 Mild Hyperemia in the Absence of Bowel Wall Thickening on Intestinal Ultrasound is Associated with Biochemical Disease Activity and Worse Disease Outcomes in Patients with Crohn’s Disease and Ulcerative Colitis

Abstract Background Bowel wall thickness (BWT) and hyperemia measured by intestinal ultrasound (IUS) predict endoscopic disease activity in Inflammatory Bowel Disease (IBD). The clinical significance of mild hyperemia (mLim1) without BWT is unknown. We previously described the short-term predictive value of mLim1 without BWT. Here we compare biochemical disease activity and longer-term outcomes in IBD pts with mLim1 to those with normal IUS. Methods We reviewed index IUS exams of pts with IBD at the University of Chicago from 7/18/2022 to 5/7/2024 and included pts with normal BWT (≤3.0mm) + mLim1 and compared them to pts with normal BWT + no hyperemia (mLim0). We excluded pts with mLim2 or 3, BWT&amp;gt;3mm anywhere on index IUS or pts with mLim1 at surgical anastomoses only. Clinical Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI)) and biochemical disease activity (faecal calprotectin (FCP) or C-reactive protein (CRP)) were assessed at the time of index IUS. Clinical remission was defined as HBI of &amp;lt;5 or SCCAI of ≤2, FCP&amp;lt;150 μg/g, CRP&amp;lt;5 mg/L. Primary analysis was poor disease outcome (PDO) within 12 mo of follow-up, defined as: IBD medication change/escalation, prescription of corticosteroids, IBD-related surgery, or IBD-related hospitalization. Results 45 pts with mLim1 (38 Crohn’s disease (CD), 7 Ulcerative colitis (UC)) and 61 pts with mLim0 (52 CD, 9 UC) at index IUS were included (Table 1). At baseline IUS, mLim1 pts had elevated median FCP but normal median HBI/SCCAI, while mLim0 pts had normal median FCP and HBI/SCCAI (Table 1). Of mLim1 CD pts, 14/38 (36.8%) had a PDO within 3 months (mo), 18/38 (47.4%) within 6 mo, and 18/30 (60%) within 12 mo, with median time to PDO of 37 d (IQR 28.5-112.5). Of the mLim0 CD pts, 5/52 (9.6%) had a PDO within 3 mo, 9/46 (19.6%) within 6 mo, and 14/45 (31.1%) within 12 mo, with median time to PDO of 91 d (IQR 93-184). Rates of PDO between mLim1 and mLim0 in CD pts at 12 mo were statistically significant (stat sig), p = 0.013. Of the mLim1 UC pts, 3/7 (42.9%) had a PDO within 3 mo and 2/3 (66.7%) had a PDO within 12 mo, with a median time to PDO of 139 d (IQR 93-184). Of the mLim0 UC pts, one had a PDO at 3 mo with no further events noted at 6 mo (0/8) or 12 mo (0/4). Rates of PDO between mLim1 and mLim0 in UC pts at 12 mo were not stat sig, (p = 0.270). Conclusion Mild hyperemia without BWT is associated with biochemical disease activity in both CD and UC and predicts PDO in CD. Although PDO in UC was numerically higher in mLim1 compared to mLim0, this was not stat sig likely due to small cohort size. These findings support the consideration of treatment adjustments when this isolated parameter is identified and inform future IUS treat-to-target strategies.