S1179 Course of IBD Extra-Intestinal Manifestations Following Ostomy Construction
Bibliographic record
Abstract
Introduction: Up to 50% of patients with inflammatory bowel disease (IBD) develop extra-intestinal manifestations (EIMs), which can negatively impact quality of life and increase complexity of care. Despite high rates of ostomy construction in this population, the course of EIMs following ostomy creation has been largely neglected in the literature. In this study, we assessed the course of 5 key EIMs after ostomy creation: peripheral arthritis, axial arthritis, uveitis, pyoderma gangrenosum (PG), and erythema nodosum (EN). Methods: We performed a retrospective analysis of patients with IBD who underwent ostomy construction between October 1970 to October 2023. Patients with other coexisting autoimmune disorders (psoriatic arthritis, rheumatoid arthritis, lupus, sarcoidosis, or primary sclerosing cholangitis) were excluded to avoid possible confounding factors. Data regarding demographics, IBD phenotype and disease activity status, indications for surgery, and EIM course were collected. Statistical analyses included Pearson’s chi-square test, Fisher’s exact test, Wilcoxon rank-sum test, and McNemar’s test. Results: The study included 62 patients (median age 45.5 years, 74.2% female, 45 (72.6%) Crohn’s disease). We observed a statistically significant increase in the proportion of patients with PG post-ostomy construction (P =0.002) and conversely a statistically significant decrease in proportion of patients with EN post-ostomy construction (P =0.003). However, there was no significant difference in the proportion of patients with uveitis, axial arthritis, or peripheral arthritis. There was also no statistically significant difference in EIM course when compared by IBD type (Crohn’s disease vs ulcerative colitis) or disease activity assessed by imaging and/or endoscopy. Conclusion: This retrospective study identified statistically significant changes in prevalence of skin manifestations post-ostomy construction but not of joint or ocular manifestations. There was not enough evidence to conclude that disease activity status post-ostomy construction influenced overall EIM rates. Ongoing research in larger cohorts is needed to better understand the course of EIMs after ostomy creation (see Figure 1, Table 1).Figure 1.: Pre- and post-ostomy pyoderma gangrenosum and erythema nodosum. Table 1. - Patients’ demographic, ostomy creation, EIM and inflammation characteristics CD UC P-value Inactive Disease on imaging Active Disease on imaging P-value Inactive Disease on ileoscopy Active Disease on ileoscopy P-value N=45 (72.6%) N=17 (27.4%) N=15 N=30 N=13 N=12 Patients’ demographic and ostomy creation characteristic: Median Age [25th,75th] 44.0 [40.0;54.0] 55.0 [42.0;67.0] 0.065 Sex: 0.750 Female 34 (75.6%) 12 (70.6%) Male 11 (24.4%) 5 (29.4%) Tobacco History: 0.297 Never 27 (60.0%) 11 (64.7%) Former (quit >2 weeks) 12 (26.7%) 6 (35.3%) Active 6 (13.3%) 0 (0.00%) Montreal location (CD):Terminal ileum (L1) 2 (4.44%) Colon only (L2) 2 (4.44%) Ileocolonic (L3) 39 (86.7%) Upper GI (L4) 2 (4.44%) CD phenotype:Inflammatory 40 (88.9%) Stricturing 22 (48.9%) Penetrating 35 (77.8%) UC Phenotype: Extensive 10 (58.8%) Left sided 7 (41.2%) Surgery Indication:Refractory to medication 19 (42.2%) 10 (58.8%) 0.377 Stricturing complication 2 (4.44%) 1 (5.88%) 1.000 Penetrating complication 20 (44.4%) 2 (11.8%) 0.036 Perianal disease 5 (11.1%) 0 (0.00%) 0.310 Patient preference 1 (2.22%) 0 (0.00%) 1.000 Failed pouch 0 (0.00%) 2 (11.8%) 0.072 Other 1 (2.22%) 0 (0.00%) 1.000 Pre- and post-ostomy EIM: Peripheral arthritis (pre) 14 (31.1%) 5 (29.4%) 1.000 Peripheral arthritis (post) 8 (17.8%) 2 (11.8%) 0.713 2 (13.3%) 8 (26.7%) 0.456 3 (23.1%) 6 (50.0%) 0.226 Axial arthritis (pre) 5 (11.1%) 1 (5.88%) 1.000 Axial arthritis (post) 3 (6.67%) 1 (5.88%) 1.000 2 (13.3%) 2 (6.67%) 0.591 0 (0.00%) 2 (16.7%) 0.220 Uveitis (pre) 0 (0.00%) 1 (5.88%) 0.274 Uveitis (post) 1 (2.22%) 0 (0.00%) 1.000 0 (0.00%) 1 (3.33%) 1.000 1 (7.69%) 0 (0.00%) 1.000 Pyoderma gangrenosum (pre) 10 (22.2%) 3 (17.6%) 1.000 Pyoderma gangrenosum (post) 23 (51.1%) 9 (52.9%) 1.000 7 (46.7%) 22 (73.3%) 0.152 7 (53.8%) 9 (75.0%) 0.411 Erythema Nodosum (pre) 13 (28.9%) 1 (5.88%) 0.087 Erythema Nodosum (post) 1 (2.22%) 1 (5.88%) 0.476 1 (6.67%) 1 (3.33%) 1.000 0 (0.00%) 0 (0.00%) . EIM present (pre) 30 (66.7%) 10 (58.8%) 0.781 EIM present (post) 26 (57.8%) 10 (58.8%) 1.000 8 (53.3%) 25 (83.3%) 0.070 8 (61.5%) 10 (83.3%) 0.378 Data were described using median with interquartile range [25th,75th], and frequency with percentage (%). EIM = Extra-Intestinal Manifestation; CD = Crohn’s Disease; UC = Ulcerative Colitis.
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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 | 0.001 |
| 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 | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".