P0519Enhanced diagnostic performance of intestinal ultrasound in elderly patients with Ulcerative Colitis

Abstract Background Intestinal ultrasound (IUS) is a non-invasive tool for diagnosis and monitoring in inflammatory bowel disease (IBD). Current IUS transmural healing definitions emphasize on normalization of bowel wall thickness (BWT). As BWT varies with weight and age1, it is unclear if the 3 mm cut-off for normal BWT applies to all populations, particularly in the elderly who may present structural changes with aging. This study aims to determine the role of BWT and other IUS parameters in predicting endoscopic remission in an elderly ulcerative colitis (UC) cohort. Methods A multicenter, prospective cohort of elderly (³60 years) UC patients who underwent colonoscopy and IUS within ≤60 days was recruited. Patients with proctitis or previous UC surgery were excluded. Endoscopic and IUS segmental data (sigmoid, descending, transverse, and ascending) were collected (Mayo endoscopic subscore MES, BWT, inflammatory fat iFat, color Doppler CDS using the modified Limberg scale, and echostratification ES). Endoscopic remission (MES ≤1) was considered gold standard. IUS remission was defined as BWT 3.0 mm (average of 2 cross-sectional and 2 longitudinal measurements) without CDS, iFat, or ES loss. Two logistic regression models were developed: Model 1 (BWT only) and Model 2 (BWT, CDS, iFat, and ES). Model performance was assessed with odds ratios, -2 log-likelihood, Nagelkerke R2, and classification accuracy. ROC analyses evaluated model discrimination (AUC) and optimal probability thresholds (Youden’s index). Results 34 elderly UC patients (41.2% females) were included (Table 1A). Out of 99 colonic segments, endoscopic activity was identified in 24 (24.2%). The colonic segments with endoscopic remission and endoscopic activity had a median BWT (range) of 3.1 mm (0.7-5.1) and 4.0 mm (2.4-8.0), respectively. iFat was absent in most segments (69.7%), and extensive ES loss was observed in 6.1%. Model 1 showed moderate discrimination (AUC 0.88) with a sensitivity (Sn) of 74.7% and specificity (Sp) of 83.3%. Model 2 demonstrated excellent discrimination (AUC 0.96) with a higher Sn of 94.7% and a Sp of 83.3% (Figure 1). Only CDS remained independently associated with remission (OR: 0.19, p = 0.041) (Table 1B). Conclusion BWT alone showed moderate ability to detect endoscopic remission in elderly UC; this may be influenced by potential age-related changes in the bowel wall. Combining additional IUS parameters, particularly CDS, appears to improve accuracy in these patients, suggesting the need for a more comprehensive assessment. These findings need validation in larger cohorts. Reference: 1. Nylund K, Hausken T, Ødegaard S, Eide GE, Gilja OH. Gastrointestinal Wall Thickness Measured with Transabdominal Ultrasonography and Its Relationship to Demographic Factors in Healthy Subjects. Ultraschall Med - Eur J Ultrasound. 2012;33(7):E225-E232. doi:10.1055/s-0031-1299329 Conflict of interest: Dr. Ernest-Suárez, Kenneth: Consulting/Advisory Board fees: Abbvie, AstraZeneca, Johnson & Johnson, Pfizer, Ferring, Sandoz, SatisfAI, Takeda Speaker fees: Abbvie, AstraZeneca, Bayer, Johnson & Johnson, Ferring, Sandoz Calvo-Marin, Javier: Consulting/Advisory Board fees: Adium, AstraZeneca, NovoNordisk Speaker fees: Adium, AstraZeneca, Bayer, NovoNordisk, Viatris Umaña-Solis, Elizabeth: Speaker Fees: Johnson & Johnson Parra Izquierdo, Leidy Viviana: None Orillac, Valeria: No conflict of interest Rettally, Carlos: No conflict of interest Cabral, Julia: Speaker fees: Abbvie, Johnson & Johnson Nuñez, Paulina: Speaker Fees: Abbvie, Ferring Johnson & Johnson, Takeda St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda. Novak, Kerri L.: Research Grants: Helmsley Trust, Pfizer, Janssen Adboard, consulting fees: Abbvie, Janssen, Pfizer, Pendopharm, Takeda, Elli Lilly, Celltrion, Bristal Myers Non financial support (ultrasound machine) McKesson Pharmcy. Pfizer, Celltrion Gozdzik, Michal: Speaker Fees: Pfizer, Janssen Consultancy/Advisory Board Fees: Abbvie, Takeda, Celltrion, Ferring Educational grant: Pfizer Hoentjen, Frank: Frank Hoentjen has served on advisory boards or as speaker for Abbvie, CCRN, Janssen, Takeda, Pfizer, Celltrion, Teva, Amgen and Pendopharm, and has received independent research funding from Celltrion, Janssen, Abbvie, and Takeda. Lu, Cathy: Advisory board - Abbvie, JnJ, Takeda, Ferring, Merck, Celltrion, Pfizer Research Funding - Abbvie, JnJ