P98 Disease involution is common among paediatric Crohn’s disease patients: a study from the biologic era
Bibliographic record
Abstract
Introduction Paediatric Crohn’s disease (PCD) often presents with a pan-enteric phenotype at diagnosis. However, its long-term evolution in to adulthood, especially since the advent of biological therapy, is not well characterised. Only few studies have assessed this change, with conflicting results and limited by short follow-up times. Our study aimed to evaluate how the PCD phenotype evolves through childhood into adult life. Methods We performed a single-centre retrospective study of PCD patients diagnosed ≤16 years of age, transitioned to an adult gastroenterology unit with a minimum follow up of 2 years. Disease location and behaviour was characterised using Paris and Montreal classification at diagnosis and follow-up respectively. We assessed for evidence of disease extension or involution as well as variables associated with complicated disease behaviour and surgery. Comparison of frequencies was performed using Pearson’s chi-square test. Hazard ratios from Cox proportional hazards models were used to quantify risk of surgery and complicated disease behaviour. Results 132 patients were included, transitioning to adult care between 2002 and 2016. The median age at diagnosis was 13 (IQR 11–14) and median follow up 11 years. At diagnosis, 27 (20.4%) patients had complicated disease behaviour compared to 46 (34.9%) at follow up (p=0.0018). 83 (62.9%) patients had a ‘pan-enteric’ phenotype at diagnosis, however only 55 (66.3%) retained this phenotype at follow-up (p=0.0002). Disease extension was noted in 18.9% of patients and involution in 35.6% of patients, with upper GI disease noted in only 15.9% of patients at follow-up (p=0.0001). There was a high exposure to both thiopurines (91.7%) and biologics (63.6%), with a median time to starting treatment of 0 (IQR 0–1) and 5 (IQR 2–7) years for thiopurines and anti-TNF therapy respectively. The rate of exposure to biological therapy was similar in patients with disease involution (32/47, 68.1%) and disease extension (21/25, 84%). The cumulative probability (95% CI) of surgery was 0.05 (0.02, 0.11) at 1 year, 0.17 (0.11, 0.24) at 3 years and 0.22 (0.15, 0.30) at 5 years respectively. Overall, 56 (42.4%) patients had surgery at the end of follow-up. Neither disease location nor behaviour were associated with need for surgery. Conclusions Changes in both disease location and behaviour were seen in our PCD cohort as they progressed to adult life. A significant proportion had disease involution, likely related to a high rate of exposure to biological therapy.
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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) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".