P494 Multicentre cohort study to evaluate the need for re-intervention following multimodal treatment in Crohn's disease with perianal fistula
Bibliographic record
Abstract
Background: Treatment paradigms for Crohn's disease with perianal fistula (CD-PAF) are still evolving. We aimed to study the impact of multidisciplinary multimodality treatment approach in patients with CD-PAF on the recurrence rates of fistula and the need for re-interventions. We also aimed to study the predictive factors for the need for re-intervention Methods: This was a multinational multicentre (11 centres) retrospective cohort study with data collected in CD patients with CD-PAF from 2010 to 2015.Multidisciplinary multimodality approach was defined as using a combination of medical treatments (antibiotics, immunomodulators, and biologics) along with surgical approach (examination under anaesthesia (EUA) +/− Seton drainage) at diagnosis. Univariate was analysis done for variables impacting fistula recurrence and re-intervention a logistic regression adjusting for age to identify significant predictors of re-intervention. Results: 253 adult onset CD-PAF patients were included (161 M, 92 F). 53% had complex fistula. 70% of the patients had EUA at presentation with 136 patients (53.8%) needing a median of 1 Seton insertion (range 1–6.84% of the patients had anti TNF therapy. There was significant difference in fistula healing rates between simpleand complex fistulae (complete healing 60% vs 41%, p=0.015.52% of patients who received multimodality treatment had complete fistula healing. 27% of simple fistula and 40.3% of the complex patients had recurrent fistula needing re-intervention. There was a significant difference in the need for re-intervention based on fistula healing with 22% of those with complete healing needing repeat surgery compared to 49% with partial healing and 71% in those with no healing (p≤0.001. Only 26% of the 141 patients having multidisciplinary multimodal treatment needed surgical re-intervention when compared to 59% without this (p≤0.001. Univariate analysis showed complex (p=0.008), absence of multidisciplinary approach (p≤0.001, EUA (p=0.005), combined immunosuppression (p=0.032, presence of proctitis (p≤0.001) as factors impacting need for re-intervention but there was no impact of age, gender, smoking status, mode of presentation, Montreal class, presence of anal stenosis and thiopurine use alone. On logistic regression, absence of multi-disciplinary approach (OR 2.8,95% CI: 1.4–5.6)and presence of proctitis (OR2.2, 95% CI: 1.2, 3.9) were predictors for re-intervention. Conclusions: This large multicentre cohort study describes outcomes in CD-PAF patients receiving multidisciplinary multimodality treatment approach. In this cohort, complete fistula healing rates were higher and the recurrence rates lower than previously reported. Presence of proctitis and lack of multidisciplinary approach are predictors for recurrence and re-intervention for CD-PAF.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".