A127 CROHN’S DISEASE DIAGNOSIS AFTER PROCTOCOLECTOMY AND ILEAL POUCH-ANAL ANASTOMOSIS FOR ULCERATIVE COLITIS: THERAPEUTIC APPROACH
Bibliographic record
Abstract
New onset Crohn’s disease (CD) occurs in about 10% of patients having undergone total proctocolectomy and ileal pouch-anal anastomosis (IPAA) for the treatment of their ulcerative colitis (UC). Our objective was to review the treatment of CD developed in our patients with IPAA. We reviewed files of 302 patients with an IPAA performed between 1985 and 2014 at the CHUM-Hôpital Saint Luc in Montreal. In patients with a minimal follow-up of 5 years postoperatively, 35 cases of CD were diagnosed. Patients were classified as having a diagnosis of CD through intestinal inflammation (proximal to the ileal pouch) (19 patients), fistulising (perineal) disease (11 patients), or a combination of both (5 patients). CD was diagnosed on average 88 months postoperatively (ranging from 2 to 244 months). Disease was controlled in 3 of 15 patients who received 5-ASA (20 %), in 7 of 19 patients treated with immunomodulators (37%), in 13 out of 17 patients receiving biologic TNF-inhibitors (76%). Surgical treatment was performed in 13 patients (7 patients needed pouch removal). Surgery was done in 9 out of 11 of cases with fistulising disease (82%); with pouch removal in 36% of cases, whereas in only 2 of the 19 patients in the intestinal inflammation group (11%). Pouch removal enabled discontinuation of medical therapy in 5 cases whereas the remaining 2 patients required long term therapy with TNF-inhibitors. Therapeutic options for new onset CD of the ileal pouch are identical to the options available for treatment of typical CD. The approach can be tailored depending on the mode of presentation. Removal of the pouch enabled discontinuation of pharmacological therapy in a certain number of cases. None
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".