S1242 Examining the Relationship Between Transmural Response on MRE and Subjective Wellness Assessments in Small Bowel Crohn’s Disease
Bibliographic record
Abstract
Introduction: In Crohn’s disease (CD), treatment goals have advanced over time with an objective of deep remission: absence of symptoms along with mucosal healing (MH) observed on ileocolonoscopy. In patients with small bowel CD, magnetic resonance enterography (MRE) has been used in place of ileocolonoscopy with a goal of assessing transmural response (TR). While TR may be a useful target in evaluating inflammation, it is not known whether this correlates with improvement in disease symptoms. We sought to determine if degree of inflammation on MRE is associated with subjective wellness measures. Methods: We analyzed a cohort of 83 patients ages 18-80 with small bowel CD seen in Washington University IBD clinics. Initial visits took place from 2018 to 2021 with Week 0 Inflammatory Bowel Disease Disability Index (IBD-DI) and EQ-5D questionnaires completed at that time. This was repeated for those with visits at Week 52. Subjects also had a week 0 MRE which was completed within 1 year prior to initial clinic visit with week 52 MRE done within 1 month of week 52 visit. Each MRE was assessed by a specialized GI radiologist and scored using the simplified Magnetic Resonance Index of Activity (sMaRIA). Difference between Week 0 and 52 questionnaire scores was compared directly with associated sMaRIA values. Change in questionnaire scores was also assessed in connection with mucosal healing (MH) and mucosal response (MR) defined per sMaRIA guidelines as a global sMaRIA < 5 and decrease in sMaRIA ≥ 50% respectively. Results: At Week 0, mean IBD-DI, EQ-5D visual analogue scale, and sMaRIA values were -8.08, 75.80, and 1.87. At Week 52, mean IBD-DI, EQ-5D, and sMaRIA were -5.24, 77.90, and 1.49. IBD-DI and EQ-5D scores did not show significant association with global sMaRIA (P =0.06, P =0.42). Neither change in IBD-DI nor EQ-5D were associated with progression of sMaRIA scores from Week 0 to Week 52 by multivariate regression models (P =0.79, P =0.95) adjusting for gender, BMI, race, and Montreal disease classification. Change in IBD-DI and EQ-5D scores was not associated with development of MH (P =0.94, P =0.71) or MR (P =0.66, P =0.45) by week 52. Conclusion: In our analysis, there was no significant connection between IBD-DI and/or EQ-5D questionnaire scores and inflammation or healing on MRE. This highlights a potential need for improved patient-reported wellness surveys to reflect true disease activity. Further study is warranted to determine possible utility of IBD-DI and EQ-5D in CD management (see Figure 1, Table 1).Figure 1.: Questionnaire scores and sMaRIA as a function of time. Table 1. - Baseline characteristics of study participants (n=83) Demographic Category Number of Subjects (%) Gender Male 42 (50.6) Female 41 (49.4%) Age 18-40 47 (56.6%) 40-60 31 (37.3%) 60-80 5 (6.0%) Race White 73 (88.0%) Black/African American 7 (8.4%) Native Hawaiian or Pacific Islander 2 (2.4%) More than one race 1 (1.2%) BMI < 18 3 (3.6%) 18-25 34 (41.0%) 25-30 23 (27.7%) 30-40 18 (21.7%) 40+ 5 (6.0%) Baseline Biologic Infliximab 13 (15.7%) Adalimumab 2 (2.4%) Vedolizumab 22 (26.5%) Ustekinumab 46 (55.4%) Montreal Classification A1 (age ≤16) 8 (9.6%) A2 (age 17-40) 62 (74.7%) A3 (age >40) 13 (15.7%) L1 (ileal disease) 25 (30.1%) L2 (colonic disease) 0 (0.0%) L3 (ileocolonic disease) 58 (69.9%) L4 (isolated upper disease) 0 (0.0%) B1 (nonstricturing, nonpenetrating) 35 (42.2%) B2 (stricturing) 26 (31.3%) B3 (penetrating) 22 (26.5%) p (perianal involvement) 15 (18.1%)
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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 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".