P177 Small intestinal mucosal healing assessed by video capsule endoscopy in Crohn’s disease patient treated with adalimumab: The SIMCHA study—interim results
Bibliographic record
Abstract
Video capsule endoscopy (VCE) has been established as the most sensitive modality in evaluating small bowel (SB) Crohn’s disease (CD). Endoscopic mucosal healing is recognised as a key treatment target in IBD. However, studies have generally employed ileocolonoscopy. The aim of this study was to investigate SB mucosal healing of CD after 6 months of adalimumab therapy using VCE. Prospective single-centre study in consecutive adult CD patients (>17 years) with moderate-to-severe SB involvement, defined by a baseline VCE examination at diagnosis with a Lewis score > 790 (normal <135, mild disease 135–790) in at least one tertile. Exclusion criteria included the use of drugs known to induce SB lesions such as NSAIDs for a minimum of 1 month. Patients were also excluded if there was a history suggestive of obstructive symptoms, known strictures or a failed patency capsule examination. Patients were all treated with adalimumab monotherapy for 24 weeks prior to undertaking a second VCE. Primary endpoint was the Lewis score on repeat VCE at 24 weeks. Mucosal healing was defined as a repeat Lewis score <350, whereas partial response was defined as a >50% decrease in repeat Lewis score. Secondary outcomes included clinical index of remission (Harvey–Bradshaw Index <5) and faecal calprotectin. Interim results are available for the first 14 consenting patients (8 males, 6 females) recruited (2012–2018). Mean baseline Lewis score was 1940 (range 475–6340). Mean Lewis score on second VCE was 331 (range 112–2734; p = 0.0005 vs. baseline). Complete mucosal healing was observed in 7 (50%) cases, and partial response in 5 others. The mean decrease in Lewis score was 1632 (range 363–5189), representing a mean reduction of 80.2%. Baseline VCE demonstrated one or more ulcerated SB strictures in three cases; two had non-ulcerated strictures at Week 24 that were traversed. No capsule retention or other adverse events were observed. The HBI was elevated (>4) in 10 cases prior to starting therapy. Repeat HBI was consistent with clinical remission (HBI < 4) in all cases at Week 24. Mean faecal calprotectin decreased from 409 (range 62–1676) to 135 (range 30–329), but the difference did not achieve significance (p = 0.1). Adalimumab led to significant improvement of small intestinal mucosal Crohn’s disease, with 50% achieving mucosal healing. Our preliminary data suggest that VCE is a safe and effective method to diagnose and monitor SB mucosal healing in CD.
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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 | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".