Introduction

Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC), and this is assumed to be due to chronic inflammation of the colorectal mucosa.

Aims & Methods

To identify risk factors for the development of dysplasia or CRC in patients with UC. Retrospective observational cohort study. Clinical data and colonoscopy findings were collected from medical records. A 1:2 Propensity Score Matching (PSM) was performed to balance covariates adjusting for disease extension, age, gender, smoking habit and disease duration. An Andersen-Gill model was used to account for multiple colonoscopies per patient and time-varying risk of dysplasia or CRC, allowing for recurrent events and intra-individual correlation.

Results

A total of 571 UC patients were identified, median age at diagnosis was 39.5 (27.3-54.2), and 304 (53.2%) were men. At diagnosis, 147 (25.7%) had proctitis, 203 (35.6%) left side colitis and 191 (33.5%) extensive colitis. During a median follow-up of 7.1 years (IQR 3.7– 13.3), 51 patients (9.8%) developed dysplasia/CRC. This was more frequent in males (72.9% vs. 27.1%, p=0.004) and in older patients [48.1 years (36.7–60.2) vs. 38.5 years (26.5–53.8), p=0.004].
After PSM adjustment, 123 patients were included, 41 of whom had dysplasia/CRC, with a total of 381 colonoscopies over a follow-up period of 14.6 years (IQR 8.0–22.4). Macroscopic inflammatory activity was present in 283 (74.3%) colonoscopies and microscopic involvement in 5 (1.3%). Older age at diagnosis (aHR 1.03, 95% CI 1.04–1.10, p<0.001) and higher degree of macroscopic inflammation (aHR 1.44, 95% CI 1.02–2.03, p=0.041) were associated with an increased risk of dysplasia/CRC development; advance therapy, family history of CRC, disease extension and microscopic inflammation were not associated with an increased risk.

Table 1. Baseline characteristics of the complete cohort and after Propensity Matching Score.

	Complete cohort				PMS
	N = 571	No dysplasia/CRC	Dysplasia/CRC	p	N = 123	No dysplasia/CRC	Dysplasia/CRC	p
		515 (90.2%)	56 (9.8%)			82 (66.6%)	41 (33.3%)
Male, n (%)	304 (53.2)	262 (59.4)	42 (75)	0.123	88 (71.5)	59 (67)	29 (33)	0.88
Age at diagnosis median (IQR), years	39.5 (27.3-54.2)	36.2 (25.9-49.5)	41.6 (28.5-56.2)	<0.0001	48.3 (35.6-59.0)	41.6 (28.5-56.2)	36.2 (25.9-49.5)	0.372
Disease extension, n (%) -Proctitis (E1) -Left side (E2) -Pancolitis (E3)	147 (25.7) 203 (35.6) 191 (33.5)	127 (24.1) 182 (35.3) 178 (34.6)	20 (35.7) 21 (37.5) 13 (23.2)	0.808	38 (30.9) 46 (37.4) 39 (31.7)	26 (31.7) 31 (37.8) 25 (30.5)	12 (29.3) 15 (36.6) 14 (34.1)	0.914
Mayo endoscopic score at diagnosis, n (%) -Mild (Mayo 1) -Moderate (Mayo 2) -Severe (Mayo 3)	83 (14.3) 279 (47.9) 108 (18.6)	68 (13.2) 256 (49.7) 96 (18.6)	15 (26.8) 23 (41.1) 11 (19.6)	0.106	24 (23.3) 53 (51.45) 26 (25.2)	16 (19,5) 35 (42,6) 16 (19,5)	8 (19.5) 18 (43.9) 10 (24.4)	0.797
Smokers, n (%) -Yes -Ex-smokers	66 (11.6) 86 (15.1)	57 (11.1) 77 (15)	9 (16.1) 9 (16.1)	0,004	20 (16.3) 103 (83.7)	13 (15.9) 69 (84.1)	7 (9.8) 34 (82.9)	0.863
EIMs at diagnosis, n (%)	40 (7)	38 (7.4)	2 (3.6)	0.887	11 (8.9)	10 (12.2)	1 (2.4)	0.074
Advanced therapy, n (%)	152 (26.8)	142 (27.7)	10 (17.9)	0.113	36 (29.3)	25 (30.5)	11 (26.9)	0.674

Conclusion

Older age at diagnosis and the presence of macroscopic involvement on successive colonoscopies are associated with an increased risk of developing dysplasia or CRC in patients with UC.

Disclosure

Beatriz Gros has worked as an advisor for Abbvie, Pfizer, Alphasigma and Roche and has served as an speaker for Abbvie, Pfizer, Alphasigma, Roche, Janssen, Takeda and Gilead.

Introduction

Aim: To report on the efficacy and safety of elective switching from intravenously (IV) to subcutaneously (SC) administered Vedolizumab in Inflammatory Bowel Disease (IBD) patients in clinical remission.

Aims & Methods

Retrospective analysis of IBD patients in clinical remission who were receiving Vedolizumab IV for treatment of their disease in a single tertiary center and were switched to SC, based on their physician’s choice. The primary endpoint was disease deterioration during the follow-up period, according to the disease specific composite measures. In CD, clinical remission was defined as Crohn's Disease Activity Index (CDAI) <150 and in UC as Simple Clinical Colitis Activity Index (SCCAI) <2.

Results

Between December 2023 and February 2025, 86 patients (Crohn’s disease = 17, Ulcerative colitis = 69) were consulted in order to switch from IV to SC vedolizumab administration. Five patients (5,8%) did not want to change and therefore, 81 patients (94,2%) were finally switched. All patients were in clinical remission. After a mean (SD) follow up period of 8 (4) months, 9 patients (11,1%) experienced worsening of their disease, and were either switched back to IV VDZ (n=4, 4,9%) or to another agent (n=5, 6,2%). The remaining 72 patients (88,8%) showed favorable response, none of them requested an unscheduled visit, or developed an adverse event (clinical or laboratory) or needed escalation of treatment.

Conclusion

Elective switching from IV to SC Vedolizumab seems to be an effective and safe approach in real-world every day clinical practice in IBD patients in clinical remission.

Introduction

Intestinal ultrasound (IUS) is increasingly used as a point-of-care tool for patients with ulcerative colitis (UC). Non-invasive monitoring is essential for managing disease progression and therapeutic intervention in pediatric UC patients. The Milan Ultrasound criteria (MUC), ulcerative colitis intestinal ultrasound score (UC-IUS), and Civitelli score show promise as real-time disease activity assessment tools, potentially reducing the need for invasive procedures like endoscopy.

Aims & Methods

A prospective cohort of 34 pediatric UC patients underwent IUS and colonoscopy to assess disease activity using MUC, UCIUS, and Civitelli scores. Assessments were conducted within a 7-day interval, with no therapeutic changes between procedures. Diagnostic accuracy was determined using receiver operating characteristic (ROC) curves, with endoscopy as the reference
standard, and histological parameters assessed in a subset of patients using the Nancy Index.

Results

The study included 34 pediatric UC patients (median age: 14.7 years; 65% male) with varied disease severities and durations (median duration: 12.6 months; median PUCAI: 30; median fecal calprotectin: 1041 μg/g). Bowel wall thickness (BWT) correlated significantly with all IUS scores; however, no correlation was observed between BWT and baseline Mayo endoscopic disease activity. The area under the curve (AUC) was 0.528 (CI:0.348–0.704) for MUC, 0.602 (CI: 0.418–0.768) for UC-IUS, and 0.572 (CI: 0.388–0.742) for the Civitelli score, indicating moderate diagnostic accuracy. While differences among scores were not statistically significant, UC-IUS demonstrated the highest accuracy. In 16 patients with available Nancy Index data, the AUC values were 0.500 for MUC, 0.579 for Civitelli, and 0.563 for UC-IUS, further supporting moderate accuracy (Table 1).

Score	AUC (vs Endoscopic Findings)	AUC (vs Histological Parameters)
MUC	0. 528	0.500
UC-IUS	0.602	0.563
Civitelli	0.572	0.579

Table 1. Ultrasound characteristics and disease activity scores for the pediatric patients with UC.

Conclusion

Both MUC, Civitelli, and UC-IUS scores provide moderate diagnostic accuracy in assessing pediatric UC, though potentially less effective than in adult populations. UC-IUS, with its emphasis on vascularization, haustration and wall thickness, may offer enhanced sensitivity in pediatric patients. Lowering the cut-off for bowel wall thickness may improve accuracy in children, given their thinner, yet highly vascularized bowel walls, particularly in early disease stages.

References

1. van Wassenaer EA, van Rijn RR, Zwetsloot SLM, et al. Intestinal Ultrasound to Assess Ulcerative Colitis Disease Activity in Children: External Validation and Comparison of 2 Intestinal Ultrasound Activity Indices. Inflamm Bowel Dis. 2023;29:1217-1222.
2. Allocca M, Dell'Avalle C, Craviotto V, et al. Predictive value of Milan ultrasound criteria in ulcerative colitis: A prospective observational cohort study. United European Gastroenterol J. 2022;10:190-197

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) recommends colorectal cancer (CRC) screening for individuals at average risk, aged 50-75 years. However, recent trends indicate an increasing incidence of colorectal neoplasms among younger individuals.

Aims & Methods

The primary aim of this cross-sectional study is to record the prevalence of polyps, adenomas, and advanced neoplasia (high-grade dysplasia and CRC) in individuals up to 49 years old, and secondarily to identify predictors of neoplasia and high-grade dysplasia. The data were collected retrospectively through the hospital’s electronic database. All serial colonoscopies, with cecum intubation, from 1/1/2018 until 31/12/2024 were included. Endoscopies in patients with diagnosed familial polyposis syndromes, inflammatory bowel disease and those with poor bowel preparation were excluded. Patients’ demographics, CRC family history and the recorded polyps' size, location, Paris classification, and pathology reports were collected. SPSS 23 (IBM, Armonk, NY, USA) was used for the statistical analysis.

Results

Table. Polyps, adenomas and advanced adenomas by age groups
	<25 (n=36)	25-29 (n=31)	30-34 (n=61)	35-39 (n=76)	40-44 (n=146)	45-49 (n=218)	Total (n=568)	P
Polyps, n (%)	0 (0)	2 (6.5)	6 (9.8)	20 (26.3)	52 (35.6)	86 (39.4)	166 (29.2)	<0.001
Adenoma, n (%)	0 (0)	1 (3.2)	2 (3.3)	9 (11.8)	21 (14.4)	36 (16.5)	68 (12.1)	0.006
Advanced adenoma, n (%)	0 (0)	1 (3.2)	0 (0)	3 (3.9)	4 (2.8)	12 (5.6)	20 (3.5)	0.266

A total of 568 colonoscopies were included, involving 306 male patients (53.8%), with a median age of 42 years (IQR: 36-46). Of these, 71 patients (12.5%) had a family history of CRC. At least one polyp was identified in 166 patients (29.2%), with adenomas observed in 68 patients (12.1%) and advanced neoplasia in 20 patients (3.5%), including 3 patients (0.5%) diagnosed with CRC (Table). Advanced adenomas were more frequently detected in colonoscopies performed due to visible blood in stools (8.5%) and as follow-up after diverticulitis (7.1%). In multivariate analysis, in which age, family history of CRC, and bowel preparation quality were included as variables, the presence of adenomas and advanced adenomas was significantly associated with age (adenoma OR = 1.08; 95% CI: 1.04-1.13 and advanced adenoma OR = 1.08; 95% CI: 1.00-1.18).
In total 271 polyps were identified. Ninety-four were adenomas of which 74 had low-grade dysplasia and 20 high-grade dysplasia or cancer. Sixteen of 177 not-adenomatous polyps were found to be serrated and 2 of those had low-grade dysplasia. “Large” polyps [≥10mm] had a higher probability of being adenomas (71.4%) compared to “small” [5-9mm] (26.2%) and “diminutive” [<5mm] (24.4%), Chi square P<0.001. Regarding the Paris classification Ip and Isp presented a higher probability to be adenomas (87.5% and 86.4% respectively) in contrast to Is and 0-IIa (35.6% and 12.2% respectively), Chi square P<0.001.
The resected adenomas were also categorized according to the type of reported dysplasia to identify predictors of high-grade dysplasia. High-grade dysplasia was present in 42.5% of large polyps compared to 4.5% of small and 6.2% of diminutive (Chi square P<0.001). High-grade dysplasia was also present in a higher frequency in polyps resected from the “left” colon (26.2%) compared to the “right” (10.3%) and in 0-IIa (66.7%) and Ip (38.1%) compared to Isp (21.1%) and Is (12.5%) polyps according to the Paris classification, but not in a statistically significant degree (Chi square P<0.010).

Conclusion

Despite the relatively small sample size of our study, initiation of screening at a younger age should be considered to be lowered, since adenoma and advanced adenoma were identified in 15% and 4.3% of individuals aged 35-49.

Disclosure

GB: Advisor/lecturer for Janssen, Pfizer, Takeda, Abbvie, MSD, Mylan, Genesis Pharma, Adacyte Therapeutics, Amgen, Ferring, Cooper; Funding (Grants/Honoraria): Pfizer, Takeda, Abbvie, Aenorasis; Research/Clinical Trials: Abbvie, Takeda.

Introduction

Crohn ‘s disease (CD) is characterized by chronic inflammation in the gut, where severe complications such as fibrotic strictures require surgical resection. Stricture development involves excessive extracellular matrix (ECM) deposition due to continuous activation of intestinal myofibroblasts, that further contribute to intestinal fibrogenesis. Emerging data suggests that stricture-related intestinal myofibroblasts overexpress a serine protease called fibroblast activation protein (FAP). Furthermore, type III collagen deposition is increased during fibrosis in all layers of the intestinal tract, and studies have shown elevated collagen degradation in serum from patients with CD. The present study aimed at evaluating the potential of FAP-cleaved type III collagen [C3F] as a serum marker for intestinal fibrosis in CD.

Aims & Methods

The cohort consisted of 49 patients with luminal CD and 62 patients with stenotic CD. Clinical assessment was conducted for all patients at baseline and 12 months post study initiation. For the luminal phenotype, endoscopy was performed at both time points. For the stenotic group, radiographical assessment was done prior to surgery and endoscopy was performed at 12 months. C3F was measured in serum at all timepoints for baseline, post-operative day (POD), 1, 3, 6 and 12 months. To compare C3F levels at baseline for luminal vs stenotic phenotype, Mann-Whitney U-test was conducted. For the stenotic group, mixed-effect analysis, with a Dunnett’s multiple comparison applying Bonferroni Correction, was conducted to compare C3F levels for baseline vs POD and Spearman’s rank correlation was applied.

Results

C3F baseline levels were significantly higher in patients with stenotic CD compared to luminal CD (Table 1). In the stenotic group, C3F was significantly increased in patients at POD compared to baseline (Table 1). In the luminal group, C3F was significantly elevated in patients at 12 months compared to baseline. Furthermore, C3F showed a positive correlation with C-reactive protein (CRP) (ρ=0.350, p=0.006) and a significant negative correlation with disease duration (ρ= -0.257, p=0.048) for patients with the stenotic CD phenotype (Table 1).


Table 1. C3F levels are elevated in the stenotic CD vs the luminal CD group, with increased levels at POD compared to baseline for the stenotic phenotype. Spearman’s rank correlation, depicting the relationship between C3F and routine blood demographics, as well as demographics. Significant findings (p<0.05) are highlighted in bold.

Biomarker	Timepoints						P-values
C3F	Baseline	POD	1 month	3 months	6 months	12 months	Baseline vs. POD	Baseline vs. 12 months	Stenotic vs Luminal at Baseline
Stenotic, median [IQR]	28.01 [22.21, 37.97]	34.17 [24.27, 41.24]	23.26 [20.14, 35.17]	25.76 [21.36, 36.83]	26.62 [20.99, 37.23]	31.79 [22.04, 41.07]	0.006	0.346	0.022
Luminal, median [IQR]	20.51 [15.53, 31.22]	-	25.20 [20.37, 36.75]	25.14 [20.61, 35.03]	25.46 [18.38, 30.23]	26.43 [19.86, 38.20]	-	0.016
Spearman's correlation	Markers and Demographics
C3F	Hemoglobin	Platelets	CRP	Fecal calprotectin	Length of specimen	BMI	Age at inclusion	Disease duration
Rho	-0.146	0.072	0.350	0.149	0.004	-0.088	-0.019	-0.257
p-value	0.264	0.588	0.006	0.336	0.974	0.506	0.885	0.048

Conclusion

C3F was elevated in patients with stenotic CD, with even higher levels after the surgical resection. The data suggests that C3F reflects fibroblast activity during fibrostenosis and tissue remodeling following surgery. The positive correlation with CRP supports the association with inflammation leading to collagen deposition and fibrosis. Interestingly, C3F shows negative correlation with disease duration suggesting that C3F could reflect fibrosis at early stages of stenotic CD. These findings highlight the potential use of C3F as a novel biomarker for intestinal fibrosis in CD.

Disclosure

TTK, MSA, MP are employed at Nordic Bioscience. ACBJ, JHM and MAK are employees and stock owners at Nordic Bioscience.

Introduction

Recurrence of Crohn’s disease (CD) lesions after surgery remains high. Identifying patients at high risk of recurrence who may benefit from prophylactic therapy would be relevant. However, data on specific preoperative risk factors remain scarce, while onset and severity of Post Operative Recurrence (POR) are assessed with the Rutgeerts score (RS)(1). Still, the value of early endoscopic lesions, and RSi2, to predict the later course of the disease and the risk of late (from 1 to 10 years) POR in any individual patient is unclear. Non-invasive Small Intestine Contrast Ultrasonography (SICUS) assesses intramural extension of CD lesions, their progression, and is as effective as RS in detecting early POR lesions (2).

Aims & Methods

1. To develop a risk score based on pre-operative clinical predictors to estimate POR likelihood;
2. to identify predictors of severity of mucosal lesion according to RS;
3. to assess the overtime progression of transmural lesion.
Prospective cohort study (1998-2022). CD patients were evaluated at ileo-colonic surgery and every 6-12 months thereafter. Sex, age at diagnosis/surgery, active smoking, CD behaviour (B)/location (L), perianal disease (PD), length of resected bowel, steroids, immunosuppressants/biologics therapy use, and CD duration before surgery were analysed using multivariable proportional hazards regression. Cumulative POR rates and risk score were calculated with Poisson models, taking for each predictor the integer part of the Poisson model parameter.

Results

Over a median follow-up of 7.6 years (IQR 4.1–12), 78 patients (32 F; median age 30 years; 60% smokers) were analysed. CD characteristics: B1 8%; B2 67%; B3 25%; L1 63%; L3 36%; PD 22%; immunosuppressive/biologics 17%; median CD duration pre-surgery 4.7 years; median resected bowel length 28 cm. Cumulative POR rates were 51.8% (IQR,41%-63.4%), 65.2% (54.4%-75.7%), 69% (58.6%-79%), 75.9% (65.8% -84.8%), 78.9% (69.0%-87.3%), at 1, 2, 3, 4, and 5 years. POR risk factors included active smoking, age ≥35 years at surgery, and marginally B1 (Table). Predictors of RS were PD (HR=3.39; 95% CI 1.12-10.26; p=0.03 and CD duration ≥5 years pre-surgery (3.45; 1.15–10.32; p=0.03). The estimated cumulative probability of POR increased with higher risk scores (from 1 to 3) being 22%, 58%, 83% and, respectively, 43%, 80% and 100% at 1 and 4 years. Lesion length at POR varied by RS (median, IQR): RSi1 (32%): 0.5 cm (0.5-0.5), RSi2 (35%): 4 cm (0.5-7), RSi3 (15%): 15 cm (8.5-21.5), RSi4 (5%): 16 cm (9.5-23.5). Lesions remained stable in patients with RSi1 and RSi3 (45%) but fluctuated in those with RSi2 and RSi4 (31% increased, 24% decreased).

		Univariate analysis				Multivariate analysis				Cumulative Risk Score
Variable		HR	95% CI		p	HR	95% CI		p	contribution
Age at surgery (years)	≥35 vs. <35	1.84	1.10	3.10	0.02	1.82	1.07	3.07	0.03	0.60
Sex	Female vs. Male	1.24	0.74	2.08	0.42	1.59	0.90	2.79	0.11	0.46
Active smoking	Yes vs. No	1.50	0.88	2.55	0.14	1.99	1.06	3.75	0.03	0.69
Disease behaviour	B2 vs. B1	2.28	0.81	6.44	0.12	2.53	0.89	7.19	0.08	0.93
	B3 vs. B1	2.01	0.66	6.09	0.22	3.01	0.94	9.61	0.06	1.10
Disease duration (years)	≥5 vs. <5	1.18	0.71	1.98	0.52	NI	NI	NI	NI	NI
Length of resection (cm)	≤ 25 vs. >25	1.15	0.69	1.92	0.60	NI	NI	NI	NI	NI
PD	Yes vs. No	1.10	0.63	1.92	0.74	NI	NI	NI	NI	NI

HR:hazard ratio;CI: confidence interval;*time dependent covariates; NI:not included in the final model selected through a backward selection (p<0.2)

Conclusion

The present score based on preoperative factors predicts the risk of postoperative recurrence. Patients with preoperative higher risk scores or RSi2 at recurrence would require early and close monitoring due to significant transmural lesion progression.

References

1.Rutgeerts R et al. 1990; 2. Pallotta N et al. 2010.

Disclosure

Nothing to disclosure

Introduction

The Mayo Endoscopic Subscore (MES) is widely used in clinical trials and daily practice to assess disease activity and response to treatment in UC.

Aims & Methods

The objective of this study was to identify any nuances in patients with MES > 1 treated with non-TNF biologics and targeted oral therapies. The Ipsos UC Therapy Monitor, a multi-centre online medical chart review study of patients with UC, was conducted between July and September 2024 among gastroenterologists practicing across hospital and private practices in the UK, France, Germany, Italy, and Spain. Physicians were screened for practice duration and patient volume. Charts of patients prescribed advanced therapy were included in the analysis.

Results

205 sampled physicians collectively reported 820 UC patients. Of the reported patients with MES > 1, 62 were treated with non-TNF biologics and 62 were treated with novel oral therapies. Among the patients treated with non-TNF biologics, a higher proportion were female vs those receiving oral therapy (48% vs 31%); they were also older in age (mean years: 43 vs 38).
The patients treated with non-TNF biologics had a higher prevalence of comorbidities, including depression/anxiety (24% vs 19%), cardiovascular disease (8% vs 0%), and dyslipidemia/hyperlipidemia/hypercholesterolemia (11% vs 7%), compared to those treated with novel oral therapy.
Mean CRP levels were higher in the oral therapy group (10.2 mg/L vs 9.1 mg/L), while mean Mayo scores were slightly lower (4.7 vs 5.2). Fecal calprotectin levels were elevated in patients treated with non-TNF biologics vs oral therapy group (441 µg/g vs 503 µg/g).
When analysing reasons for prescribing selected advanced therapy between the two patient groups, a greater proportion of patients treated with non-TNF biologics had safety reasons specified more frequently by the sampled physicians.

Table 1: % of reported UC patients receiving advanced therapy for specific cited reasons

% reported UC patients - cited reasons	Patients treated with non-TNF biologics	Patients treated with novel oral therapies
Low incidence of side effects	53%	13%
Good safety profile	61%	16%
Rapid symptomatic profile	19%	60%

Conclusion

This study highlights key differences in patient characteristics and treatment considerations among UC patients with MES > 1 treated with non-TNF biologics compared to those treated with targeted oral therapies. Patients on non-TNF biologics tend to be older, more often female, and have a higher prevalence of comorbidities. Physicians prescribing non-TNF biologics prioritize safety, while those prescribing oral therapies focus on rapid symptom control. These findings highlight the importance of considering patient characteristics and treatment goals when selecting advanced therapies for UC patients with MES > 1. Further investigation using comparator cohort is warranted.