S1242 Examining the Relationship Between Transmural Response on MRE and Subjective Wellness Assessments in Small Bowel Crohn’s Disease
Notice bibliographique
Résumé
Introduction: In Crohn’s disease (CD), treatment goals have advanced over time with an objective of deep remission: absence of symptoms along with mucosal healing (MH) observed on ileocolonoscopy. In patients with small bowel CD, magnetic resonance enterography (MRE) has been used in place of ileocolonoscopy with a goal of assessing transmural response (TR). While TR may be a useful target in evaluating inflammation, it is not known whether this correlates with improvement in disease symptoms. We sought to determine if degree of inflammation on MRE is associated with subjective wellness measures. Methods: We analyzed a cohort of 83 patients ages 18-80 with small bowel CD seen in Washington University IBD clinics. Initial visits took place from 2018 to 2021 with Week 0 Inflammatory Bowel Disease Disability Index (IBD-DI) and EQ-5D questionnaires completed at that time. This was repeated for those with visits at Week 52. Subjects also had a week 0 MRE which was completed within 1 year prior to initial clinic visit with week 52 MRE done within 1 month of week 52 visit. Each MRE was assessed by a specialized GI radiologist and scored using the simplified Magnetic Resonance Index of Activity (sMaRIA). Difference between Week 0 and 52 questionnaire scores was compared directly with associated sMaRIA values. Change in questionnaire scores was also assessed in connection with mucosal healing (MH) and mucosal response (MR) defined per sMaRIA guidelines as a global sMaRIA < 5 and decrease in sMaRIA ≥ 50% respectively. Results: At Week 0, mean IBD-DI, EQ-5D visual analogue scale, and sMaRIA values were -8.08, 75.80, and 1.87. At Week 52, mean IBD-DI, EQ-5D, and sMaRIA were -5.24, 77.90, and 1.49. IBD-DI and EQ-5D scores did not show significant association with global sMaRIA (P =0.06, P =0.42). Neither change in IBD-DI nor EQ-5D were associated with progression of sMaRIA scores from Week 0 to Week 52 by multivariate regression models (P =0.79, P =0.95) adjusting for gender, BMI, race, and Montreal disease classification. Change in IBD-DI and EQ-5D scores was not associated with development of MH (P =0.94, P =0.71) or MR (P =0.66, P =0.45) by week 52. Conclusion: In our analysis, there was no significant connection between IBD-DI and/or EQ-5D questionnaire scores and inflammation or healing on MRE. This highlights a potential need for improved patient-reported wellness surveys to reflect true disease activity. Further study is warranted to determine possible utility of IBD-DI and EQ-5D in CD management (see Figure 1, Table 1).Figure 1.: Questionnaire scores and sMaRIA as a function of time. Table 1. - Baseline characteristics of study participants (n=83) Demographic Category Number of Subjects (%) Gender Male 42 (50.6) Female 41 (49.4%) Age 18-40 47 (56.6%) 40-60 31 (37.3%) 60-80 5 (6.0%) Race White 73 (88.0%) Black/African American 7 (8.4%) Native Hawaiian or Pacific Islander 2 (2.4%) More than one race 1 (1.2%) BMI < 18 3 (3.6%) 18-25 34 (41.0%) 25-30 23 (27.7%) 30-40 18 (21.7%) 40+ 5 (6.0%) Baseline Biologic Infliximab 13 (15.7%) Adalimumab 2 (2.4%) Vedolizumab 22 (26.5%) Ustekinumab 46 (55.4%) Montreal Classification A1 (age ≤16) 8 (9.6%) A2 (age 17-40) 62 (74.7%) A3 (age >40) 13 (15.7%) L1 (ileal disease) 25 (30.1%) L2 (colonic disease) 0 (0.0%) L3 (ileocolonic disease) 58 (69.9%) L4 (isolated upper disease) 0 (0.0%) B1 (nonstricturing, nonpenetrating) 35 (42.2%) B2 (stricturing) 26 (31.3%) B3 (penetrating) 22 (26.5%) p (perianal involvement) 15 (18.1%)
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 | 0,003 |
| 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 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 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 ».