S1002 The Impact of Endoscopic Healing on Disease-Related Outcomes in Patients with Ulcerative Proctitis
Notice bibliographique
Résumé
Introduction: The role of endoscopic healing (EH) in ulcerative proctitis (UP) is unclear. The long-term treatment goal in ulcerative colitis (UC) is achieving symptomatic resolution and EH, which has been associated with a reduced risk of colectomy. UP is a limited form of UC involving only the rectum and, unlike extensive/left-sided UC, has not been associated with elevated colorectal cancer risk. Therefore, achieving EH as compared to clinical remission in UP represents an uncertain therapeutic target. Methods: This study assessed the impact of EH on outcomes in UP patients. This was a single-center, retrospective cohort study including patients aged ≥ 18 with a UP diagnosis based on clinical/endoscopic criteria. Patients had ≥2 endoscopies, with the first showing active disease (Mayo endoscopy score [(MES) of 1, 2, or 3]) and ≥1 month to the follow-up scope. EH was defined as an MES of 0 or 1 at the second scope. Descriptive statistics were used for baseline characteristics. The relationship of EH to IBD-related outcomes was assessed using univariate analysis (Pearson's Chi-squared test; Fisher's exact test; Welch Two Sample t-test) and those independently associated with EH were identified using logistic regression analysis (odds ratio, 95% confidence interval). Results: Among 200 UP patients, 109 patients (54.5%) achieved EH. The median time from baseline to follow-up was 15 months (IQR: 6, 31). EH was associated with fewer IBD-related ED visits (EH: 8.3%, no EH: 21%) or hospitalizations (5.5% vs 18%) and fewer GI visits per follow-up year (mean: 1.47 [SD: 1.40], vs 2.96 [2.52]) after the follow-up scope. Patients with EH were less likely to have iron deficiency anemia (IDA; 23% vs 41%), iron infusion (10% vs 25%), C. difficile infection (0.9% vs 6.6%), or to initiate a new biologic after relapse (15% vs 33%). Patients with EH had a greater time to clinical relapse (650 days [730] vs 270 days [416]) (P=0.008). Patients with EH had reduced odds of an IBD-related ED visit (OR: 0.32, 95% CI: 0.13, 0.73) or hospitalization (0.26 [0.09, 0.67]), and 64% lower odds of biologic initiation after relapse (0.36 [0.13, 0.95]), adjusting for index MES score (Table 1). Conclusion: UP patients with EH had less IBD-related healthcare utilization, fewer IBD-related complications, and were less likely to escalate to biologics after relapse than patients without EH. Using a treatment target of EH may be desirable in UP given its potential utility in preventing disease-related complications and improving long-term outcomes. Table 1 - Characteristic Overall, N=2001 Mucosal healing, N=1091 No mucosal healing, N=911 P-value2 IBD complication 0.4 Multiple complications 60 (30%) 31 (28%) 29 (32%) No complications 67 (34%) 41 (38%) 26 (29%) Clinical relapse (n=167) 98 (59%) 47 (53%) 51 (65%) 0.14 Dysplasia 5 (2.5%) 3 (2.8%) 2 (2.2%) >0.99 CRC 0 (0%) 0 (0%) 0 (0%) Colectomy 8 (4.0%) 2 (1.8%) 6 (6.6%) 0.14 IBD-related ED visit 28 (14%) 9 (8.3%) 19 (21%) 0.01 IBD-related hospitalization 22 (11%) 6 (5.5%) 16 (18%) 0.007 Recent ESR (mm/h)3 (n=101) 0.13 Mean (SD) 12 (11) 10 (11) 13 (11) Range 0, 52 0, 51 1, 52 Recent CRP (mg/dL)3 (n=94) 0.28 Mean (SD) 2.54 (17.94) 0.51 (0.52) 4.11 (23.86) Range 0.01, 174.30 0.01, 2.89 0.01, 174.39 Recent calprotectin (mcg/g)3 (n=38) 0.24 Mean (SD) 275 (408) 196 (369) 355 (440) Range 4, 1250 4, 1250 11, 1144 GI Visits per follow-up year < 0 .001 Mean (SD) 2.17 (2.13) 1.47 (1.40) 2.96 (2.52) Range 0.10, 10.84 0.10, 6.28 0.16, 10.84 IDA 62 (31%) 25 (23%) 37 (41%) 0.007 Iron infusion 34 (17%) 11 (10%) 23 (25%) 0.004 C. Difficile infection 7 (3.5%) 1 (0.9%) 6 (6.6%) 0.048 Extra-intestinal manifestations, after 2nd scope 84 (42%) 48 (44%) 36 (40%) 0.52 Extra-intestinal manifestations, after 2nd scope - type 0.49 Multiple sites 10 (5.0%) 5 (4.6%) 5 (5.5%) No sites 116 (58%) 61 (56%) 55 (60%) Arthritis/arthralgias 69 (34%) 39 (36%) 30 (33%) 0.68 Uveitis 5 (2.5%) 1 (0.9%) 4 (4.4%) 0.18 Rash 10 (5.0%) 7 (6.4%) 3 (3.3%) 0.35 PSC 0 (0%) 0 (0%) 0 (0%) Oral ulcers 11 (5.5%) 6 (5.5) 5 (5.5) >0.99 Biologic initiation after relapse (n=98) 24 (24%) 7 (15%) 17 (33%) 0.034 Biologic initiation after relapse - type (n=24) 0.75 Anti-TNF 9 (38%) 4 (57%) 5 (29%) Clinical Trial 1 (4.2%) 0 (0%) 1 (5.9%) JAK inhibitor 1 (4.2%) 0 (0%) 1 (5.9%) Anti-IL-12/23 3 (12%) 0 (0%) 3 (18%) Anti-integrin 10 (42%) 3 (43%) 7 (41%) 1n (%) 2 Pearson's Chi-squared Test; Welch 2 Sample t-Test; Fisher's Exact Test 3 'Recent' was Defined as Within 3 Months Before or After the Time of the Second Scope CRC: colorectal cancer ED: emergency department IBD: inflammatory bowel disease GI: gastroenterology IDA: iron deficiency anemia EIMs: extra-intestinal manifestations.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
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 ».