S1207 Clinical Decision Making in Mimickers of IBD: Practice Management From IBD Live
Bibliographic record
Abstract
Introduction: Since 2009, a group of inflammatory bowel disease (IBD) specialists have been utilizing “IBD Live,” a weekly live video conference with a global audience of 150-200 participants, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed as IBD, a substantial number were mimics for which IBD was not the ultimate diagnosis. We have prospectively categorized all IBD Live cases and identified “IBD mimics” with consequent clinical management implications. Methods: Cases have been recorded and archived since May 2018. 371 total cases from May 2018 through February 2023 were reviewed spanning 186 hours. IBD mimics were defined as those cases with features of IBD that ultimately resulted in a non-IBD diagnosis. IBD mimics were analysed and categorized by original suspected diagnosis, diagnostic workup, and the evaluation that led to the correct diagnosis. Results: 306 of the 371 cases discussed were IBD including 193 Crohn’s disease (CD), 107 ulcerative colitis (UC) and 6 IBD-unclassified (IBD-U). 65 (17.5%) cases (Table 1) were mimics with a presumed initial diagnosis of IBD. The evaluations that ultimately resulted in the correct diagnosis included: additional endoscopic biopsies (n=13, 21%), surgical exploration/pathology (n=10, 16.5%), biopsies from outside the GI tract (n=10, 16.5%), genetic and other laboratory testing (n=8, 13%), deeper analysis of patient history, including medication review, family, social, and sexual history (n=8, 13%), imaging (n=5, 8%), balloon enteroscopy (n=5, 8%), and capsule endoscopy (n=2, 3%). We further delineated the diagnostic testing into three categories that ultimately yielded a correct diagnosis: 1) procurement of additional tissue for evaluation, 2) different radiographic or endoscopic evaluation from the original work-up, especially inspection of the small bowel, and 3) more thorough history-taking. Conclusion: In a 5-year period at IBD Live, 17.5% of cases were found to be IBD mimics, many of which originally received advanced therapies for presumed CD or UC. The diverse presentation of IBD cases and the complexity of both assessment and diagnosis necessitates significant consideration of IBD mimics at all times. The substantial differences and often conflicting treatment approaches to IBD vs IBD mimics will directly impact the quality and cost of patient care. Table 1. - IBD mimics presented at IBD live, 2018-2023 Category Mimic N = Diagnosis Systemic diseases CD 21 Vasculitis (7), CVID (2), Sweets (1), EGPA (1), CHAI (1), BADAS (1), Behcet’s (1), eosinophilic esophagitis (1), carcinoid (1), histoplasmosis (1), sarcoidosis (1), amyloidosis (1), PIK3cd (1), adrenal insufficiency (1) Ileal disorders CD 16 BCL (4), IMHMV (2), SCAD (2), follicular lymphoma (1), T-cell lymphoma (1), Kaposi’s sarcoma (1), Meckel’s diverticulum (1), appendiceal carcinoid (1), tropical sprue (1), collagenous sprue (1), autoimmune enteropathy (1) Medication induced UC/CD 8 Immune checkpoint inhibitor (Pembrolizumab [1], Ipilimumab + Nivolumab [2]), chemotherapy (Encorafenib + Binimetinib [1]), Olmesartan (1), Mycophenolate (1), mu-opioid receptor agonist (Kratom [1]), GABA-mimetic (Phenibut [1]) Colonic inflammation UC 5 Ischemic colitis (1), pouchitis (1), diversion colitis (1), CMV colitis (1), STI proctitis (1) Polyposis disorders UC 2 Cronkhite Canada syndrome (1), juvenile polyposis syndrome (1) Obstruction CD 2 Abdominal actinomyces (1), cecal volvulus (1) Peri-anal disease CD 1 Cryptoglandular abscess (1) No diagnosis made UC/CD 11 Unclear at time of IBD Live (9), presumed C-MUSE (1), presumed congenital tailgut cyst (1) Abbreviations: BADAS – bowel-associated dermatosis-arthritis syndrome; BCL – B-cell lymphoma; CHAI – CTLA4 haploinsufficiency with autoimmune infiltrates; C-MUSE – cryptogenic multifocal ulcerous stenosing enteritis; CMV – cytomegalovirus; CVID – common variable immunodeficiency; EGPA – eosinophilic granulomatosis with polyangiitis; IMHMV - idiopathic myointimal hyperplasia of mesenteric veins; SCAD – segmental colitis associated with diverticulitis; STI – sexually transmitted infection; TB – tuberculosis.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.005 |
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".