S1179 Course of IBD Extra-Intestinal Manifestations Following Ostomy Construction
Notice bibliographique
Résumé
Introduction: Up to 50% of patients with inflammatory bowel disease (IBD) develop extra-intestinal manifestations (EIMs), which can negatively impact quality of life and increase complexity of care. Despite high rates of ostomy construction in this population, the course of EIMs following ostomy creation has been largely neglected in the literature. In this study, we assessed the course of 5 key EIMs after ostomy creation: peripheral arthritis, axial arthritis, uveitis, pyoderma gangrenosum (PG), and erythema nodosum (EN). Methods: We performed a retrospective analysis of patients with IBD who underwent ostomy construction between October 1970 to October 2023. Patients with other coexisting autoimmune disorders (psoriatic arthritis, rheumatoid arthritis, lupus, sarcoidosis, or primary sclerosing cholangitis) were excluded to avoid possible confounding factors. Data regarding demographics, IBD phenotype and disease activity status, indications for surgery, and EIM course were collected. Statistical analyses included Pearson’s chi-square test, Fisher’s exact test, Wilcoxon rank-sum test, and McNemar’s test. Results: The study included 62 patients (median age 45.5 years, 74.2% female, 45 (72.6%) Crohn’s disease). We observed a statistically significant increase in the proportion of patients with PG post-ostomy construction (P =0.002) and conversely a statistically significant decrease in proportion of patients with EN post-ostomy construction (P =0.003). However, there was no significant difference in the proportion of patients with uveitis, axial arthritis, or peripheral arthritis. There was also no statistically significant difference in EIM course when compared by IBD type (Crohn’s disease vs ulcerative colitis) or disease activity assessed by imaging and/or endoscopy. Conclusion: This retrospective study identified statistically significant changes in prevalence of skin manifestations post-ostomy construction but not of joint or ocular manifestations. There was not enough evidence to conclude that disease activity status post-ostomy construction influenced overall EIM rates. Ongoing research in larger cohorts is needed to better understand the course of EIMs after ostomy creation (see Figure 1, Table 1).Figure 1.: Pre- and post-ostomy pyoderma gangrenosum and erythema nodosum. Table 1. - Patients’ demographic, ostomy creation, EIM and inflammation characteristics CD UC P-value Inactive Disease on imaging Active Disease on imaging P-value Inactive Disease on ileoscopy Active Disease on ileoscopy P-value N=45 (72.6%) N=17 (27.4%) N=15 N=30 N=13 N=12 Patients’ demographic and ostomy creation characteristic: Median Age [25th,75th] 44.0 [40.0;54.0] 55.0 [42.0;67.0] 0.065 Sex: 0.750 Female 34 (75.6%) 12 (70.6%) Male 11 (24.4%) 5 (29.4%) Tobacco History: 0.297 Never 27 (60.0%) 11 (64.7%) Former (quit >2 weeks) 12 (26.7%) 6 (35.3%) Active 6 (13.3%) 0 (0.00%) Montreal location (CD):Terminal ileum (L1) 2 (4.44%) Colon only (L2) 2 (4.44%) Ileocolonic (L3) 39 (86.7%) Upper GI (L4) 2 (4.44%) CD phenotype:Inflammatory 40 (88.9%) Stricturing 22 (48.9%) Penetrating 35 (77.8%) UC Phenotype: Extensive 10 (58.8%) Left sided 7 (41.2%) Surgery Indication:Refractory to medication 19 (42.2%) 10 (58.8%) 0.377 Stricturing complication 2 (4.44%) 1 (5.88%) 1.000 Penetrating complication 20 (44.4%) 2 (11.8%) 0.036 Perianal disease 5 (11.1%) 0 (0.00%) 0.310 Patient preference 1 (2.22%) 0 (0.00%) 1.000 Failed pouch 0 (0.00%) 2 (11.8%) 0.072 Other 1 (2.22%) 0 (0.00%) 1.000 Pre- and post-ostomy EIM: Peripheral arthritis (pre) 14 (31.1%) 5 (29.4%) 1.000 Peripheral arthritis (post) 8 (17.8%) 2 (11.8%) 0.713 2 (13.3%) 8 (26.7%) 0.456 3 (23.1%) 6 (50.0%) 0.226 Axial arthritis (pre) 5 (11.1%) 1 (5.88%) 1.000 Axial arthritis (post) 3 (6.67%) 1 (5.88%) 1.000 2 (13.3%) 2 (6.67%) 0.591 0 (0.00%) 2 (16.7%) 0.220 Uveitis (pre) 0 (0.00%) 1 (5.88%) 0.274 Uveitis (post) 1 (2.22%) 0 (0.00%) 1.000 0 (0.00%) 1 (3.33%) 1.000 1 (7.69%) 0 (0.00%) 1.000 Pyoderma gangrenosum (pre) 10 (22.2%) 3 (17.6%) 1.000 Pyoderma gangrenosum (post) 23 (51.1%) 9 (52.9%) 1.000 7 (46.7%) 22 (73.3%) 0.152 7 (53.8%) 9 (75.0%) 0.411 Erythema Nodosum (pre) 13 (28.9%) 1 (5.88%) 0.087 Erythema Nodosum (post) 1 (2.22%) 1 (5.88%) 0.476 1 (6.67%) 1 (3.33%) 1.000 0 (0.00%) 0 (0.00%) . EIM present (pre) 30 (66.7%) 10 (58.8%) 0.781 EIM present (post) 26 (57.8%) 10 (58.8%) 1.000 8 (53.3%) 25 (83.3%) 0.070 8 (61.5%) 10 (83.3%) 0.378 Data were described using median with interquartile range [25th,75th], and frequency with percentage (%). EIM = Extra-Intestinal Manifestation; CD = Crohn’s Disease; UC = Ulcerative Colitis.
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 | 0,000 | 0,001 |
| 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 | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».