Predictive Factors That May Differentiate “Suspected” Crohnʼs Disease From “Definitive” Crohnʼs Disease - A Prospective Cohort Study
Notice bibliographique
Résumé
Purpose: Crohn's disease (CD) involving the small bowel can be difficult to diagnose and there is no single gold standard test that allows for a definitive diagnosis. A diagnosis of CD is usually based on a constellation of findings including history, physical exam, laboratory, endoscopy, radiology and pathology. There is little data on those specific factors that may be predictive of the diagnosis of CD. The aim of this study is to determine those factors most predictive of a definitive diagnosis of CD in a prospective cohort of patients with suspected CD. Methods: Persons aged 10-65 years who presented with suspected CD were enrolled. Suspected CD included altered bowel habits and/or abdominal pain for more than 6 weeks and/or extra-intestinal manifestations plus elevated ESR or CRP, anemia, hypoalbuminemia, positive serology or an abnormal WBC scan. Data was collected regarding the presence or absence of weight loss, fevers, abdominal pain, anemia, change in bowel habits, vomiting, rectal bleeding, inflammatory markers, and serology. All patients were evaluated with capsule endoscopy and ileocolonoscopy to make a diagnosis of CD. Logistic regression was performed to evaluate factor(s) that might be associated with a definitive diagnosis of CD diagnosed by capsule endoscopy compared to those without CD. A subgroup analysis was performed among patients diagnosed by ileocolonoscopy. Results: 80 subjects (mean age 28 yrs) with suspected CD were enrolled. 20 subjects were eventually diagnosed with definitive CD by capsule endoscopy. The factors described above were then compared between the cohort with definitive CD (n=20) and those without CD (n=60). Weight loss and the combination of abdominal pain/anemia were significant predictors of definitive CD. The odds ratio for CD was 4.03 (95% CI 1.25-12.98; p = 0.02) for those persons presenting with weight loss and 3.46 (1.06 - 11.32; p = 0.04) for combined abdominal pain/anemia. No differences were found in the other measures evaluated. In the subset of 13 patients diagnosed by ileocolonoscopy, anemia (p=0.029), weight loss (p=0.043) and abdominal pain/anemia (p=0.003) were associated with the diagnosis of CD. Conclusion: The definitive diagnosis of CD remains challenging. In a cohort of subjects with CD diagnosed by capsule endoscopy and/or ileocolonoscopy, weight loss and combined abdominal pain/anemia appear to be predictive of a definitive diagnosis of CD. A larger study is warranted to validate these data. Disclosure: Jonathan A. Leighton - Research: Given Imaging, Consultant:Intromedic, Olympus, Given Imaging,; Stanley A. Cohen - Research Support: Given Imaging, Consultant: Given Imaging, Speaker's Bureau: Given Imgaging, Prometheus; Ervin Toth-Research Support: Given Imaging, Speaker's Bureau: Given Imaging, Olympus; David R. Cave-Research Support: Given Imaging, Consultant: Intromedic, Olympus, Given Imaging; Douglas C. Wolf-Research Support: Given Imaging; Gerard E. Mullin-Research Support: Given Imaging; Scott Ketover-Research Support: Given Imaging; Peter E. Legnani-Research Support:Given Imaging; Ernest G. Seidman-Research Support: Given Imaging, Prometheus Laboratories, Speaker's Bureau: Given Imaging, Prometheus Laboratories, Advirosry Committee: Given Imaging, Prometheus Laboratories; Rami Eliakim-Research Support: Given Imaging; Gary R. Lichtenstein-Consultant: Prometheus Laboratories, Research Support: Prometheus Laboratories; Michael D. Crowell-Research Support: Given Imaging; Ian M. Gralnek-Research Support:Given Imaging, Consultant: Given Imaging. This research was supported by an industry grant from Given Imaging.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».