P420 Natural history of intra-abdominal inflammatory masses (phlegmons) in Crohn’s disease
Bibliographic record
Abstract
Abstract Background Intra-abdominal inflammatory masses (phlegmons) are a feature of penetrating Crohn’s disease (CD). However, there are few data on the natural history and outcomes of inflammatory masses in CD. We aimed to describe clinical outcomes and predictors of surgery in individuals with CD and intra-abdominal inflammatory masses (IAIM). Methods We conducted a multi-center retrospective cohort study. Patients with a diagnosis of CD or inflammatory bowel disease unclassified (IBD-U) and a finding of phlegmon, phlegmonous change or inflammatory mass on cross-sectional imaging with IV contrast (MR or CT) at two tertiary care centers were included between July 2006 and April 2023. Data collected included demographics, clinical characteristics, Montreal CD classification, treatments at the time of and after IAIM diagnosis, and size and location of the IAIM. Primary outcome was surgery defined as any CD-related resection or surgical drainage. Bivariate comparisons between patients who did or did not undergo surgery were performed. Multivariable logistic regression was performed with backward selection of variables to identify those associated with surgery. Results A total of 100 patients were included, and comparison between those who did or did not undergo surgery is given in Table 1. Most were white (80%), 44% were women, and 12% were current smokers. A majority had ileocolonic disease location (77%) and 50% were on a biologic at time of diagnosis. Mean size of IAIM was 3.4 cm and the majority (72%) were located adjacent to small bowel. Radiologic evidence of intra-abdominal fistula was seen in 40%, and 30% of patients had a stricture adjacent to the IAIM. A large proportion required hospitalization (75%) and received intravenous antibiotics (64%); 13% progressed to an abscess, and the mean (SD) time to abscess was 108 (119.4) days. The majority (65%) underwent surgery, with a mean (SD) time to surgery of 59 (97.8) days. Seven patients developed sepsis, all of whom subsequently required surgery. On multivariable analysis, patients were more likely to require surgery if there was a concomitant stricture (aOR = 3.12, 95% CI 1.01 – 11.9) and less likely to require surgery if treated with steroids (aOR = 0.15, 95% CI 0.03 – 0.61). Antibiotic use was not associated with surgery (aOR 1.22, 95% CI 0.53 – 2.81) nor was IAIM size. Conclusion In this large retrospective cohort, most intra-abdominal inflammatory masses required surgery, particularly if there was a concomitant stricture. Patients treated with steroids were less likely to require surgery though this may be confounded by severity of disease.
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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 | 0.000 |
| 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 | 0.001 |
| 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".