S1143 End Ostomy in Crohn's Disease: Insights From the Cleveland Clinic Inflammatory Bowel Disease Ostomy Research Registry
Bibliographic record
Abstract
Introduction: Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), often requires surgical intervention. Permanent end ostomy (EO) is needed in 8% of UC and over 10% of CD patients, significantly impacting quality of life and clinical management. Previous studies on IBD patients with EO have been limited by small sample sizes, heterogeneous data, and short follow-up. This study aims to provide detailed descriptive data on CD patients who underwent EO from the Cleveland Clinic IBD Ostomy Research Registry. Methods: This is a retrospective single institution study using the first ever comprehensive registry comprising IBD patients with EO created at age 18 or older with at least 6 months of follow up after EO. Data was collected on various demographic, clinical, and surgical variables and analysis was made using R Studio. Results: 125 patients (77 CD, 48 UC) were included. In the CD cohort, 75 (97.4%) patients had an end- ileostomy, while 2 (2.6%) had an end-colostomy. The mean time from ostomy surgery to the last follow- up was 8.23 (±10.7). The mean age at diagnosis was 28.4 (±16.9) years, and the mean age at ostomy surgery was 41.4 (±15.5) years. The median time from diagnosis to surgery was 13.0 (±10.5) years. Patients were predominantly female (59.7%) and white (90.9%). A family history of IBD was reported by 28 (36.4%) patients. Half of the patients (50%) were never smokers. Regarding disease characteristics, 39 (54.2%) patients had a history of prior bowel surgery, with an average of 2.90 (±1.75) surgeries per patient. The pattern of disease was predominantly ileocolonic in 43 (55.8%) patients and penetrating in 46 (59.7%) patients. Extra-intestinal manifestations were present in 40.3% of patients, most commonly peripheral arthritis (20.8%). Pre-ostomy medication use was reported by 75 (97.4%) patients, with infliximab and azathioprine/6-mercaptopurine use each reported in 41 (53.2%) patients. Fifty (64.9%) patients reported a history of pre-ostomy oral corticosteroid use. Conclusion: Preliminary analysis of the ongoing Cleveland Clinic IBD Ostomy Research Registry offers valuable insights that could inform future clinical practice and research. This study provides a detailed demographic and clinical profile of CD patients with history of EO, highlighting the significant disease burden and surgical history in this population (see Table 1). Table 1. - Demographic and clinical characteristics of Crohn’s disease patients in the Cleveland Clinic Inflammatory Bowel Disease Ostomy Research Registry Variable Population Characteristics Patients (n=77, percent) Age (years) Age at diagnosis 28.4 (±16.9) Age at ostomy surgery 41.4 (±15.5) Time from diagnosis to surgery 13.0 (±10.5) Time from ostomy surgery to last follow-up 8.23 (±10.7) Sex Female 46 (59.7%) Male 31 (40.3%) Race/Ethnicity white 70 (90.9%) Black or African American 2 (2.6%) Hispanic or Latino 1 (1.3%) American Indian or Alaska Native 1 (1.3%) Multiracial/Multicultural 3 (3.9%) Family History of IBD Family History of CD 19 (24.7%) Family History of UC 9 (11.7%) Tobacco History Never 38 (50.0%) Former (quit >2 weeks) 28 (36.8%) Active 10 (13.2%) Weight Body Mass Index (BMI) 27.0 (±7.11) Disease Location and Behavior History of Perianal Involvement 55 (72.4%) History of Prior Bowel Surgery 39 (54.2%) Number of Bowel Surgeries 2.90 (±1.75) Extra-Intestinal Manifestations History of Extra-Intestinal Manifestations 31 (40.3%) Peripheral arthritis (arthritis of extremities) 16 (20.8%) Axial arthritis (arthritis of spine) 5 (6.49%) Uveitis 3 (3.90%) Pyoderma gangrenosum 5 (6.49%) Erythema Nodosum 6 (7.79%) Primary Sclerosing Cholangitis 1 (1.30%) Medications Pre-ostomy Medications 75 (97.4%) Montreal Classification Terminal ileum (L1) 5 (6.49%) Colon only (L2) 30 (39.0%) Ileocolonic (L3) 43 (55.8%) Upper GI (L4) 3 (3.90%) CD Location Jejunum/proximal ileum 8 (10.4%) Terminal ileum 44 (57.1%) Colon 71 (92.2%) Rectum 43 (55.8%) CD Behavior Inflammatory 32 (41.6%) Stricturing 28 (36.4%) Penetrating 46 (59.7%)
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".