P476 Disease recurrence patterns in patients undergoing bowel resections for Crohn’s disease
Bibliographic record
Abstract
Abstract Background Despite numerous advances in the medical management of IBD, it is estimated that 70–90% of patients with Crohn’s disease require surgical intervention with a significant proportion requiring repeat surgery. There is evidence to suggest that biologic agents may reduce the incidence of disease recurrence and may delay progression to further surgery. We aim to compare disease progression in biologic-naïve patients with patients on established biologic therapy Methods A retrospective single-centre UK study including patients who underwent primary Ileo-caecal resections for Crohn’s disease between 01/01/2014 to 31/12/2019. Patients were classified according to the Montreal classification. Electronic case records used to obtain patient data. Disease recurrence was defined as active disease on radiological imaging or endoscopic visualisation up until 01/11/2021. Prophylactic treatment included medical therapy initiated postoperatively prior to disease recurrence. Results In total, 88 patients, with a median follow-up of 54 months (IQR: 1–104 months), were included (Table 1). Of these, 69 patients had been started on medical therapy prior to surgery and 21 had Biologic treatment. Nearly half of the patients (36/88) underwent emergency resections (Table 2). Postoperative prophylaxis was given to 28 patients (31.8%), of which 8 were given Biologics. Patients who were smokers were more likely to be offered post-operative prophylaxis (55.56% vs 22.9%). 58 patients (65.9%) developed disease recurrence and 9 patients (15.5%) required further resections. Use of biologic therapy preoperatively was associated with an increased risk of requiring further resections (20.8% vs 6.8% with alternative agents; OR: 3.684, p-value: 0.030). Biologics were continued postoperatively in 5/21 patients and none of these required further resections. Discontinuation of biologics postoperatively was associated with a higher risk of recurrence (68.75%) and further bowel resection (25%). Prophylactic use of biologics had an overall net preventive effect on disease recurrence compared to alternative agents (62.5% vs 89%; OR: 0.417). Conclusion Preoperative biologic therapy can be a marker of more severe disease at presentation and may indicate need for repeat resection. In addition, patients on biologic therapy preoperatively have significantly worse outcomes if this is discontinued in the postoperative period.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".