Predictive Factors That May Differentiate “Suspected” Crohnʼs Disease From “Definitive” Crohnʼs Disease - A Prospective Cohort Study
Bibliographic record
Abstract
Purpose: Crohn's disease (CD) involving the small bowel can be difficult to diagnose and there is no single gold standard test that allows for a definitive diagnosis. A diagnosis of CD is usually based on a constellation of findings including history, physical exam, laboratory, endoscopy, radiology and pathology. There is little data on those specific factors that may be predictive of the diagnosis of CD. The aim of this study is to determine those factors most predictive of a definitive diagnosis of CD in a prospective cohort of patients with suspected CD. Methods: Persons aged 10-65 years who presented with suspected CD were enrolled. Suspected CD included altered bowel habits and/or abdominal pain for more than 6 weeks and/or extra-intestinal manifestations plus elevated ESR or CRP, anemia, hypoalbuminemia, positive serology or an abnormal WBC scan. Data was collected regarding the presence or absence of weight loss, fevers, abdominal pain, anemia, change in bowel habits, vomiting, rectal bleeding, inflammatory markers, and serology. All patients were evaluated with capsule endoscopy and ileocolonoscopy to make a diagnosis of CD. Logistic regression was performed to evaluate factor(s) that might be associated with a definitive diagnosis of CD diagnosed by capsule endoscopy compared to those without CD. A subgroup analysis was performed among patients diagnosed by ileocolonoscopy. Results: 80 subjects (mean age 28 yrs) with suspected CD were enrolled. 20 subjects were eventually diagnosed with definitive CD by capsule endoscopy. The factors described above were then compared between the cohort with definitive CD (n=20) and those without CD (n=60). Weight loss and the combination of abdominal pain/anemia were significant predictors of definitive CD. The odds ratio for CD was 4.03 (95% CI 1.25-12.98; p = 0.02) for those persons presenting with weight loss and 3.46 (1.06 - 11.32; p = 0.04) for combined abdominal pain/anemia. No differences were found in the other measures evaluated. In the subset of 13 patients diagnosed by ileocolonoscopy, anemia (p=0.029), weight loss (p=0.043) and abdominal pain/anemia (p=0.003) were associated with the diagnosis of CD. Conclusion: The definitive diagnosis of CD remains challenging. In a cohort of subjects with CD diagnosed by capsule endoscopy and/or ileocolonoscopy, weight loss and combined abdominal pain/anemia appear to be predictive of a definitive diagnosis of CD. A larger study is warranted to validate these data. Disclosure: Jonathan A. Leighton - Research: Given Imaging, Consultant:Intromedic, Olympus, Given Imaging,; Stanley A. Cohen - Research Support: Given Imaging, Consultant: Given Imaging, Speaker's Bureau: Given Imgaging, Prometheus; Ervin Toth-Research Support: Given Imaging, Speaker's Bureau: Given Imaging, Olympus; David R. Cave-Research Support: Given Imaging, Consultant: Intromedic, Olympus, Given Imaging; Douglas C. Wolf-Research Support: Given Imaging; Gerard E. Mullin-Research Support: Given Imaging; Scott Ketover-Research Support: Given Imaging; Peter E. Legnani-Research Support:Given Imaging; Ernest G. Seidman-Research Support: Given Imaging, Prometheus Laboratories, Speaker's Bureau: Given Imaging, Prometheus Laboratories, Advirosry Committee: Given Imaging, Prometheus Laboratories; Rami Eliakim-Research Support: Given Imaging; Gary R. Lichtenstein-Consultant: Prometheus Laboratories, Research Support: Prometheus Laboratories; Michael D. Crowell-Research Support: Given Imaging; Ian M. Gralnek-Research Support:Given Imaging, Consultant: Given Imaging. This research was supported by an industry grant from Given Imaging.
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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 | 0.003 |
| 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".