50 Predicting Inflammation in Crohn's Disease Small Bowel Strictures
Bibliographic record
Abstract
Background: Managing fibrostenotic Crohn’s Disease (CD) remains a challenge due to the absence of intestinal anti-fibrotic therapies. Additionally, there remains a diagnostic dilemma in differentiating strictures that are predominantly fibrotic versus inflammatory versus mixed. Differentiating these different types of strictures is paramount in aiding therapeutic decision-making. Strictures on intestinal ultrasound (IUS) are defined by bowel wall thickening (BWT), luminal narrowing, and pre-stenotic dilation (PSD). BWT and hyperemia on color Doppler signal (CDS) are the most sensitive markers of Crohn’s inflammation on IUS. Although elevated fecal calprotectin (FC) and increased BWT on IUS has been consistently shown to reflect inflamed non-stricturing CD, persistent high BWT, with low CDS and FC may indicate fibrosis rather than active inflammation. The IBUS-SAS score is a validated IUS score to predict inflammation in IBD using BWT, inflammatory fat, CDS and bowel wall stratification. It is hypothesized that FC will correlate with CDS and not BWT in ileal strictures. Thus, FC with CDS on IUS, and not classically BWT, may be complementary in providing a robust, inexpensive and accessible marker of stricture inflammation. Methods: We conducted a retrospective cohort study assessing the relationship between FC and IUS parameters in fibrostenotic ileal CD. FC levels within 60 days of index IUS were analyzed, excluding patients with medication changes or clinical flares. Inflammation was measured by BWT and CDS using the Modified Limberg Score (MLS). FC was correlated with MLS using Kendall’s Tau, and with the IBUS-SAS score using Spearman correlation. Results: A total of 104 fecal samples were obtained from 104 patients with ileal strictures (50% male). The median FC concentrations was 247.5 ug/g, IQR: 372.3. Median ileal stricture BWT was 6.5 mm (range 2.3–12.0). 35% (37/104) had an MLS of 0 (no colour doppler flow) 31% (32/104) MLS 1 (short chains in bowel), 23% (24/104) MLS 2 (long chains in bowel), and 11% (11/104) MLS 3 (long chains and perienteric fat). There was a statistically significant positive correlation between FC and MLS (τ = 0.24, P < 0.001), but not with BWT (ρ = 0.141, P = 0.15). Median BWT for strictures were 6.0 mm (ML0), 6.5 mm (ML1), 6.9 mm (ML2) and 8.0 mm (ML3). FC was not correlated to BWT (P = 0.69). FC was significantly correlated with IBUS-SAS score (ρ = 0.200, P = 0.04). Conclusions: FC and MLS were positively correlated, indicating utility in predicting stricture inflammation. Unlike non-stricturing CD, FC did not correlate with BWT, suggesting BWT is unreliable for active inflammation in strictures. Future work should compare FC, CDS, and BWT with histologic gold standards.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 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) | 0.002 | 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".