bluuebunny/crossref_metadata_2025 huggingface dataset:
A95 OUTCOMES OF ERCP UNDER CONSCIOUS SEDATION COMPARED TO GENERAL ANESTHESIA: A PRE-POST RETROSPECTIVE COHORT REVIEW
Authors: Greaves G E , Yee B , Harding K G , Nguyen V C , Parker B , Perren J , Richardson W , Bak A W , Perini R , Jowhari F , Tai T
Published: February 2022

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure used to address pathologies of the pancreatic and biliary systems. ERCP performed under conscious sedation (CS) is the current standard of care but is limited by patient movement and agitation, especially in the context of lengthy or technically complex cases. Recent literature suggests that general anesthesia (GA) may optimize patient comfort and safety while reducing complications such as pancreatitis, perforation, and mortality. In October 2017, Kelowna General Hospital (KGH) transitioned the standard anesthesia modality for ERCP from CS to GA.

Aims

To investigate differences in complications and patient outcomes for ERCP performed under CS (n=1334) before the practice change compared to GA (n=899) after the practice change.

Methods

Our study is a pre-post retrospective chart review of 2,233 patients who underwent ERCP between 2015 and 2020 at KGH. Demographic, clinical, procedural and outcome data were extracted from patient charts, and the data in CS and GA groups were compared using univariate statistical analysis.

Results

Preliminary results show rates of post-ERCP pancreatitis (6% vs. 4%; p=0.018) and rates of procedure failure (8% vs. 3%; p<0.001) were statistically significant and higher under CS before the practice change compared to under GA afterwards, respectively. The 30-day mortality rates, ICU transfer rates, return rates post-discharge, and rates of cholangitis were similar.

Our study showed improvements in several patient safety outcomes, including lower procedure failure rates and lower post-ERCP pancreatitis rates with ERCP performed under GA compared to CS.

Conclusions

Performing ERCP under GA rather than under CS is a valuable practice change that should be considered by ERCP-related programs across all health authorities due to its potential to optimize both patient comfort and safety significantly. The reduction in complication rates may have implications for net cost savings in the long term.

Funding Agencies

Kelowna General Hospital Foundation, Interior Health
A98 FECAL LEUKOCYTE ESTERASE: AN ALTERNATIVE BIOMARKER TO FECAL CALPROTECTIN IN INFLAMMATORY BOWEL DISEASE
Authors: Klemm N K , Trasolini R , Zhu K , Wong S , Salh B
Published: February 2022

Background

Fecal calprotectin (FC) is a non-invasive biomarker used in inflammatory bowel disease (IBD) management and risk stratification of non-specific gastrointestinal symptoms. Leukocyte esterase is an inexpensive and widely available point-of-care inflammatory marker present on urinalysis test strips.

Aims

We aim to assess the diagnostic accuracy of fecal leukocyte esterase (FLE) relative to FC and endoscopy and demonstrate its use as an alternative biomarker for IBD.

Methods

In this prospective cohort study, 70 patients who had FC ordered as part of standard clinical care also received FLE testing. FLE levels were compared to various FC cut-off values, endoscopy and pathology findings as gold standard.

Results

As the FC cut-off increased from 50 to 500 μg/g, FLE sensitivity increased from 67% to 95% while the specificity decreased from 86% to 76%. The area under the receiver operating characteristic (AUROC) increased from 0.79 to 0.90. An FLE of ≥1+ had the best test characteristics. Amongst patients who underwent endoscopic evaluation, FLE demonstrated an identical sensitivity (75%) and specificity (86%) to FC in predicting endoscopic inflammation. AUROC was 0.80 for FLE and 0.85 for FC with an optimal cut-off of ≥2+ and 301 μg/g, respectively. When used to distinguish between active IBD and no/inactive IBD patients, FLE had a sensitivity of 84% and specificity of 90%, comparable to the 84% and 83%, respectively, of FC. AUROC was 0.88 for FLE and 0.91 for FC with an optimal cut-off of ≥2+ and 145 μg/g, respectively

Conclusions

FLE demonstrates adequate correlation and comparable accuracy to FC in predicting endoscopic inflammation and distinguishing between patients with active versus inactive IBD.

Funding Agencies

None
A106 THE EPIDEMIOLOGY OF COMPLEX COLONIC POLYPS: A POPULATION BASED STUDY OF THE SOUTHWEST ONTARIO COLONOSCOPY COHORT
Authors: Almudaires A , Alqahtani S , Siebring V , Mcdonald C , Lee S , Sey M , Yan B
Published: February 2022

Background

Complex polyps are well recognized amongst endoscopists, but its definition varies in the literature and from one endoscopist to another. Despite its clinical importance, the epidemiology of complex polyps is poorly understood.

Aims

To assess the epidemiology of complex polyps on a population level, and in FIT positive individuals.

Methods

The Southwest Ontario Colonoscopy cohort is a prospective database consisting of all adult patients undergoing colonoscopy at 21 hospitals in Southwest Ontario. Data is collected through a mandatory quality assurance form completed by the endoscopist after each procedure. All outpatient adult colonoscopies for any indication were included. Incomplete colonoscopies, repeat procedures, and poor preparation colonoscopies were excluded. A manual review of the colonoscopy report was completed in cases where the description of the complex polyps was missing. The primary outcomes were the prevalence of complex polyps in the cohort, and in FIT positive patients. Secondary outcomes include endoscopic description of the complex polyp, rates of attempted and complete resection, and identification of possible associations between patient and endoscopist factors with complex polyp detection and removal. A multivariate logistic regression model was generated to assess for factors associated with complex polyp detection.

Results

From February 2019 to December 2020, 43389 colonoscopies were included, of which 1459 were for FIT positive patients. 2294 patients had a complex polyp, with a prevalence of 5.3% [95% CI 0.051–0.055], while the prevalence was 17.1% [95% CI 0.152–0.191] in the FIT positive cohort. Compared to average-risk patients undergoing colonoscopy for colon cancer screening, the odds ratio (OR) of detecting a complex polyp in individuals with positive FIT was 4.12 [95% CI 3.42–4.98, p<0.0001]. Among complex polyps,1324 (57.7%) were described as large (>2cm) and 1290 (56%) described as sessile. Of 2294 patients with complex polyps,1992 (86.8%) [95% CI 0.855–0.882] underwent a removal attempt, with successful complete removal as determined by the endoscopist achieved in 1905 patients (95.6%) [95% CI 0.947–0.965]. Compared to gastroenterologists, general surgeons and internists were less likely to detect a complex polyp, OR 0.67 [95% CI 0.61–0.73, p <0.0001] and 0.36 [95% CI 0.20–0.67, p=0.0011] respectively. Trainee involvement was associated with higher rate of complex polyp detection, OR 1.20 [95% CI 1.07–1.35, p=0.0022]. Females were less likely to have a complex polyp compared to males, OR 0.71 [95% CI 0.65–0.77, p<0.0001].

Conclusions

Complex polyps are more prevalent than previously reported in the literature, with a high prevalence among the FIT positive population compared to other indications of colonoscopy.

Funding Agencies

None
A160 MOLECULAR ANALYSIS OF THE INJURY-REPAIR RESPONSE IN ULCERATIVE COLITIS REVEALS HETEROGENEITY IN DISEASE ACTIVIT
Authors: Madill-Thomsen K , Venner J , Pon S , Kroeker K , Peerani F , Dieleman L A , Wong K , Baugmart D C , Halloran P , Halloran B
Published: February 2022

Background

Ulcerative colitis (UC) is a chronic inflammatory condition affecting the colonic epithelium. We used an established microarray-based system to analyze a set of 128 UC biopsies (113 patients), assessing gene expression associated with the colon’s response to injury in UC.

Aims

Our aim was to describe the burden of injury in UC biopsies and to explore molecular heterogeneity across disease activity, as assessed by the endoscopic Mayo score.

Methods

128 UC colon biopsies were collected at the University of Alberta Hospital (Edmonton, AB) and Cedars-Sinai Hospital (Los Angeles, CA) during standard of care colonoscopy and processed using Affymetrix microarrays. Principal component analysis (PCA) and archetypal analysis (AA) visualized relationships between biopsies and previously annotated injury-associated transcript sets. AA assigned each biopsy to one of three groups, and scores to each biopsy relating it to all three groups.

Results

Spearman correlations (Table 1A) were highest between the endoscopic Mayo score and the injury-repair-associated transcripts (IRRAT, 0.64, P=4.7x10-16), immunoglobulin transcripts highly associated with chronic injury and fibrosis (IGT, 0.63, P=3.0x10-15), endothelial transcripts (ENDAT, 0.61, P=1.8x10-14), and parenchymal dedifferentiation i.e. epithelial solute carrier loss (CT2, -0.60, P=6.5x10-14).

PCA separated injury from no injury in PC1 (Figure 1A). T cell transcripts (QCATs), interferon-gamma inducible transcripts (GRITs) and targets of biologics (IL12, TNFA, ITGA4/B7) separated from injury transcripts in PC2.

We assigned three AA groups and visualized biopsies in PCA (Figure 1B, colored by AA membership). Group 1 (grey, N=44) biopsies had little parenchymal dedifferentiation and low expression of injury-associated transcripts. Groups 2 (red, N=44) and 3 (blue, N=40) had increased expression of injury-associated transcript sets and dedifferentiation compared to Group 1 (Table 1). Although Group 3 was endoscopically similar to Group 1 (P>0.05), Group 3 showed elevated injury-associated transcript set expression (e.g. IRRAT) and increased parenchymal dedifferentiation (CT2).

Conclusions

Assessment of UC biopsies using AA and previously annotated injury-associated gene sets reveals two groups of biopsies that are endoscopically similar though one group has increased molecular abnormalities, thus revealing heterogeneity unrelated to the Mayo score. A molecular system based around PCA and AA could enhance and refine UC disease assessment by allowing for quantitation and qualification of injury in biopsies obtained at endoscopy i.e. a level of resolution beyond conventional endoscopic scoring.

Funding Agencies

None
A165 VEDOLIZUMAB IS AN OPTION TO TREAT MICROSCOPIC COLITIS IN PATIENTS DEPENDENT ON ORAL STEROIDS OR HAVE FAILED A BIOLOGIC: A MULTICENTRE CANADIAN CASE SERIES
Authors: Kulyk A , Muthiah K
Published: February 2022

Background

Microscopic colitis (MC) is an inflammatory bowel condition demonstrating normal mucosa on endoscopy, with evidence of inflammation and lymphocytosis on pathologic analysis of biopsies. The pathophysiology for this disease is largely unknown, and evidence for its management in cases refractory to oral steroids or after failing a biologic is sparse. Vedolizumab, an integrin receptor antagonist, has been used in a handful of persons with MC with limited literature.

Aims

Review literature on the use of Vedolizumab in treatment of MC. Present 7 cases of MC where Vedoluzimab was used to manage patients refractory to therapy (either steroid dependent, or failing biologic therapy).

Methods

Patients with MC managed with Vedolizumab were identified by soliciting practicing Gastroenterologists within Winnipeg at 3 health centres. A chart review was conducted to obtain pertinent information including patient demographics, symptoms, and medications previously trialed.

Results

Review of literature revealed 3 case reports, and 4 case series reporting on the use of Vedolizumab in MC. We identified 7 cases; 6 female, and a mean age at diagnosis of 50.7. Histologies included 3 lymphocytic, 2 collagenous, 1 developed from lymphocytic to collagenous over time, and 1 with evidence of both. 4 patients were on a biologic prior to initiating Vedolizumab with a mean duration of therapy of 24.25 months. Indications for initiating Vedolizumab included: 3 with steroid dependency, 3 Infliximab failures, and 1 with Adalimumab-associated hepatotoxicity. Mean disease duration prior to initiating Vedolizumab was 112.7 months. Number of stools pre-Vedolizumab were: 1–3 = 0, 4–6 = 2, 7–9 = 2, >/=10 = 3, compared to >6 months post-Vedolizumab: 1–3 = 5, 4–6 = 1, 7–9 = 1, >/=10 = 0. Symptoms pre-Vedolizumab compared to >6 months post-Vedolizumab included: 4 with urgency pre-Vedolizumab versus 1, 3 had incontinence versus 0, and 4 had nocturnal symptoms versus 0. Use of alternative medications included anti-diarrheals, oral 5-aminosalicylic acid, and immunomodulators. On average, patients tried 7.6 different treatments prior to starting Vedolizumab. 1 case is considered to have failed Vedolizumab due to increasing symptoms.

Conclusions

This multicentre case series is the first in Canada to assess patient characteristics and symptoms before and after Vedolizumab induction in persons with MC who are either steroid dependent or have failed a biologic. Our results demonstrate an overall improvement in symptoms when assessed >6 months after induction therapy. This review was limited in not having a symptom inventory/severity index completed at each clinic visit, resulting in a number of difficult-to-compare and incomplete data points.

Funding Agencies

None
A168 UTILITY OF FOLLOW-UP PANCOLONIC DYE SPRAY CHROMOENDOSCOPY FOR THE DETECTION AND TREATMENT OF DYSPLASTIC LESIONS IDENTIFIED DURING HIGH-DEFINITION WHITE-LIGHT ENDOSCOPY IN PATIENTS WITH COLONIC INFLAMMATORY BOWEL DISEASE
Authors: Dziegielewski C , Gupta S , McCurdy J , Sy R , Saloojee N , Murthy S
Published: February 2022

Background

Patients with inflammatory bowel disease (IBD) involving the colorectum are at higher risk for the development of flat and poorly delineated dysplastic lesions. Pancolonic dye spray chromoendoscopy (DCE) can represent an adjunct to white light endoscopy (WLE) that enhances detection and delineation of such lesions.

Aims

We evaluated the utility of follow-up DCE for lesion detection and treatment in patients with IBD who had visible (polypoid or flat lesions) or invisible (identified in non-targeted biopsies) dysplasia detected during high-definition (HD)-WLE.

Methods

We retrospectively studied patients with colonic IBD from The Ottawa Hospital who underwent DCE by a trained endoscopist, as follow-up for dysplasia detected during HD-WLE, over a 7-year time period (2013–2020). We collected demographic and disease-specific variables.

Results

Twenty-four patients were included (mean age 56.7±13.8 years, 50.0% male, 70.8% ulcerative colitis, mean disease duration 18.0±11.0 years, 70.8% moderate or severe disease activity historically, and 41.7% remote history of dysplasia). Seventeen (70.8%) patients were referred following detection of invisible dysplasia; the remainder (29.2%) were referred for surveillance of poorly defined visible dysplastic lesions. For those referred following detection of invisible dysplasia, DCE identified visible dysplasia at the same site in 8/17 (47.1%) patients, at a different site in 6/17 (35.3%) patients, and no dysplasia in 3/17 (17.6%) patients. DCE identified 1.39±1.50 new visible dysplastic lesions per patient that were not identified on index HD-WLE. DCE upgraded the highest grade of dysplasia and diagnosed colorectal cancer in 2/24 (8.3%) patients, which was missed on index HD-WLE. Endoscopic resection was successful in 23/34 (76.7%) dysplastic lesions identified on DCE. However, DCE was unable to facilitate lesion resection in three patients due to advanced lesion characteristics. Follow-up data was available for 17/24 (70.8%) patients (mean 0.88±0.58 years). Of these patients, 7/17 (41.2%) developed subsequent dysplasia, including 4/17 (23.5%) at a site of prior invisible dysplasia, 2/17 (11.8%) at sites of prior visible dysplasia, and 1/17 (5.88%) at a different site. One of these patients developed high-grade dysplasia requiring resection.

Conclusions

In this study, DCE is a valuable tool for dysplasia detection and treatment in persons with colonic IBD who have ill-defined dysplasia identified during HD-WLE. Given some patients developed dysplasia following DCE in our cohort, it is important to maintain close follow-up and obtain biopsies around sites of prior invisible and visible dysplasia. Further studies are required to validate our findings.

Funding Agencies

None
A169 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE
Authors: Dang F , Habashi P , Gallinger Z , Nguyen G C
Published: February 2022

Background

Hospital readmission rates are high in the inflammatory bowel disease (IBD) population, with 20% of patients readmitted within the same year. Discharge processes are not routinely standardized and deficiencies in transition of care puts patients at an increased risk of recurrent illness and healthcare costs. In addition, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism.

Aims

We hypothesize that standardized follow-up by an IBD practice nurse and electronic health outcome monitoring reduces the risk of hospital readmission compared to current approaches of hospital discharge alone.

Methods

This pilot study uses a prospective parallel randomized control design and includes patients admitted with an IBD flare who were discharged without surgical intervention. Patients randomized to the control arm were discharged with usual standard of care (i.e. discharge summary and/or follow-up). In addition to standard of care, those in the intervention group received organized telephone or email follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. These patients also received bi-weekly corespondence from an electronic survey tool, NoviSurvey, to determine clinical disease severity and medication adherence. Based on patient interactions and survey responses, the IBD nurse may arrange for expedited ambulatory visit or readmission for high-risk patients.

Results

At present, 41 patients have been enrolled into our study, 4 of which were excluded due to surgical management. 19 patients were randomized to the intervention and 17 to the control group. In the intervention group, the 30-day cumulative rate of readmission [0/19 (0%) vs. 4/17 (24%), p = 0.040] as well as the proportion of patients who failed to taper steroids [0/18 (0%) vs. 5/15 (33%), p = 0.013] was significantly lower when compared to the control group. There were no occurrences of deep vein thrombosis within 30 days post-discharge in either group.

Conclusions

These findings in our pilot study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates and better medication adherence, warranting a large clinical trial to confirm findings.

Patient Demographics and Clinical Outcomes Between Intervention and Control Groups

Funding Agencies

CAG, CCC
A183 SUCCINATE IN THE RELATIONSHIP BETWEEN INFLAMMATORY BOWEL DISEASE AND OBESITY IN SUCCINATE RECEPTOR DEFICIENT MICE
Authors: Arsenault A M , Nettleton J E , Otley M O , Sinal C , Connors J M , Stadnyk A
Published: February 2022

Background

The incidence of Inflammatory Bowel Disease (IBD) among the obese pediatric populations is increasing. Succinate has been identified as a possible metabolite linking the two diseases. Succinate receptor 1 (SUCNR1) gene knockout (KO) mice are less susceptible to dextran sulfate sodium (DSS)-induced colitis.

Aims

To determine whether succinate plays a role in mice becoming obese and colitis in obesity, and whether an obese-inducing diet would change the gut microbiota. We hypothesized that SUCNR1-KO mice would not become obese and would experience less colonic inflammation despite the diet.

Methods

C57BL/6 (WT) were bred with SUCNR1-KO mice (generously provided by Amgen), and the heterozygous (HZ) F1 offspring bred to obtain F2. Two of 3 F2 litters included SUCNR1-KO mice, which were caged by sex but not genotype. These F2 mice began a high-fat/high-sugar (obese, Dytes) diet at 5 wks of age for 5 wks. Weights were recorded and stool collected. All mice then had 3% DSS replace their water, for 5 days. Mice were observed for diarrhea and occult blood. After the DSS, facility water was returned for 1 day prior to postmortem analyses. Mice were scanned using dual-energy X-ray absorptiometry (DEXA) for measures of fat, lean and fat mass, and bone density. Their colons were resected and fixed for histopathology. Stool was banked frozen until processed for sequencing using 16S Ribosomal primers.

Results

Three F2 litters were comprised of ratios of HZ:WT:SUCNR1-KO of 14:7:2. SUCNR1-KO mice (n=2 female) had a greater increase in weight compared to other genotypes during the obesity-induction phase. Weight loss during the DSS phase was similar across all genotypes. All mice had blood in their stool. DEXA measures did not differ between genotypes. All genotypes of mice had inflamed colons.

Conclusions

SUCNR1-KO mice are not resistant to obesity, nor from colitis when consuming the obese diet, outcomes that do not support our hypothesis. It remains to be determined whether the diet alters the microbiome resulting in SUCNR1-KO mice being suscueptible to colitis. Microbial sequencing is underway.

Funding Agencies

IWK Health Project Grant
A191 PERSISTENT BENEFIT OF DIETITIAN-LED GLUTEN-FREE DIET EDUCATION AT CD DIAGNOSIS ON DIETARY ADHERENCE IN CHILDREN AND ADULTS WITH TYPE 1 DIABETES AND CELIAC DISEASE
Authors: Marcon P , Clarke A , Pace K , McDonald C , Saibil F , Lochnan H A , Punthakee Z , Mahmud F
Published: February 2022

Background

Celiac disease (CD) is a common autoimmune comorbidity of type 1 diabetes (T1D) with a gluten-free diet (GFD) being the current gold standard treatment for this condition. Adherence to a GFD can be impacted by several factors including dietetic counselling, yet little is known about the impact of clinic-based interventions on long-term GFD adherence in this population.

Aims

To prospectively evaluate the impact of a dietitian-led GFD education intervention on adherence to a GFD in children and adults with T1D and CD over a 3-year period.

Methods

A cohort of N=62 pediatric and adult subjects who screened seropositive for CD as part of the CD-DIET clinical trial were followed over a 3-year period post-CD diagnosis and assessed on the basis of the GFD education regimen they received at initial CD diagnosis. This included 3 groups: 1) intensive dietitian training (IDT = 5 dietitian visits over 1 year while following GFD), 2) single dietitian training (SDT = 1 GFD training session after 1 year of following GCD) and 3) no dietitian training (NDT) at CD diagnosis. Annual visits included serologic testing of TTG-IgA titres, anthropometric assessments and the completion of questionnaires evaluating diet and adherence to a GFD. Data was analysed longitudinally using linear mixed effects and generalized estimating equations (GEE) regression modeling adjusting for the fixed effects of age, sex, duration of diabetes and time.

Results

At baseline, participants who received IDT (n=15), SDT (n=16) and NDT (n=31) represented 24.2%, 25.8%, and 50.0% of the cohort, respectively. Over the 3-year study period, participants in the IDT group had the greatest odds of self-reporting being a GFD, with odds 4.3 (95%CI: 1.1 to 16.4; P=0.033) and 9.5 (95%CI: 2.7 to 33.7; P<0.001) greater than the SDT and NDT groups, respectively. The assessment of daily gluten intakes less than 10mg, as recommended for a GFD, revealed a lack of differences between the IDT and SDT groups. In contrast, the NDT group had significantly lower odds of meeting this threshold relative to those who received IDT (OR=0.2; 95%CI: 0.04 to 0.56; P=0.004). No longitudinal differences in TTG-IgA levels were seen between groups over the 3-year period.

Conclusions

In diabetes patients greater contact with a dietitian at CD diagnosis was associated with higher levels of GFD adherence over time, which was not reflected in follow-up Serologic evaluation. These findings highlight the importance of nutritional support in patients with both diabetes and celiac disease at the time of CD diagnosis. In addition, following TTG-IgA alone does not fully inform dietary compliance to a GFD.

Diet teaching stratification

Diet assignment

Funding Agencies

Juvenile Diabetes Research Foundation / PSI
A197 ACUTE ILEITIS IN ADULT PATIENT: A RETROSPECTIVE STUDY OF PATIENT OUTCOMES
Authors: Bachand M , Paradis A
Published: February 2022

Background

Rising availability of medical imaging exams in the emergency room potentially leads to an increase of ileitis findings by imaging in a context of gastrointestinal symptoms. However, it can be difficult to determine the clinical significance of this radiological finding in an acute consultation setting and to establish the relevant investigations.

Aims

The aim of this study is to describe the current management and the long-term outcome of patients with diagnostic of acute ileitis on imaging during an emergency consultation in our center, Centre Hospitalier Universitaire de Sherbrooke(CHUS).

Methods

We performed a retrospective study of all patients diagnosed with ileitis by abdominal ultrasound or computed tomography (CT scan) during a visit in our emergency department over the years 2010 and 2017. Patients with previous diagnosis of Crohn disease were excluded. Data collected were clinical, radiological and endoscopic at diagnostic and over at least 3 years following the initial visit.

Results

A total of 118 files were reviewed. The initial imaging modality was 43% ultrasound and 57% CT scan. 36% of patients had an ileocolonoscopy within one month of the initial visit. Of these, 60% demonstrated macroscopic endoscopic abnormalities. 51% of patients had follow-up imaging within 3 months of the initial consultation. 64% of these images demonstrated persistence of pathological changes in the ileal region. Only 48% had a stool culture at diagnosis. 72% of patients met a gastroenterologist and 45% saw a general surgeon. The most common cause of ileitis was an infectious origin at 44% predominantly with Yersinia enterocolitica and Campylobacter jejuni. 13% received a diagnostic of Crohn disease. 20% of ileitis remained undetermined. Among these, there was a case of Crohn’s disease which was eventually diagnosed 2 years later. The initial factors associated with a diagnosis of Crohn’s disease were family history of inflammatory bowel disease (OR 6.17 95% CI 1.67 to 22.781 p = 0.006), extra-digestive manifestations (OR 23.31 95% CI 2.255 to 240.92 p = 0.008), discontinuous impairment at initial imaging (OR 19.8 95% CI 4.284 to 91.52 p = 0.000), presence of stenosis at initial imaging (OR 14.429 95% CI 1.227 to 169.68 p = 0.034), the presence of abscess or collection on imaging (OR 11.54 95% CI 1.76 to 75.63 p = 0.011) and wall thickness in mm (1.22 95% CI 1.06 to 1.40 p = 0.005).

Conclusions

Our study shows that the majority of acute ileitis found on imaging are of infectious origin. A portion of acute ileitis corresponded to the initial presentation of Crohn’s disease. Thus, we believe that it is preferable to offer at least clinical follow-up to patients with acute ileitis on imaging and to consider additional investigation by imaging and / or colonoscopy when symptoms persist and this particularly in presence of factors associated with Crohn’s disease.

Funding Agencies

None
A201 A CASE OF SYPHILIS MASQUARADING AS CROHN’S DISEASE
Authors: Smith B C , Salh B
Published: February 2022

Background

It is important for gastroenterologists to keep syphilis on their differential. We present a case of rectal syphilis initially misdiagnosed as Crohn’s disease with commensal intestinal spirochetosis.

Aims

This case highlights how rectal syphilis can present with endoscopic and clinical findings consistent with refractory inflammatory bowel disease.

Methods

Case report and literature review.

Results

A 58 healthy male was referred for flexible sigmoidoscopy after having increased frequency of bowel movements, up to 10 per day, with mucous secretions at times mixed with blood and a 35lbs weight loss. He complained of urgency, tenesmus and intermittent incontinence. Endoscopy showed evidence of proctitis in the distal 10cm of the rectum with ulceration, edema and friability with biopsies showing moderately active colitis, compatible with ulcerative colitis.

5-ASA suppositories and subseqent oral prednisone had no effect. A colonoscopy 3 months later again showed proctitis and ulceration. Biopsies at this time showed moderately active proctitis with chronic architectural distortion and intestinal spirochetosis identified on Warthin-Starry stain in the right colon and rectum. Given the patient was immunocompetent he was diagnosed with inflammatory bowel disease and trialed on oral and rectal 5-ASA.

Four months later flexible sigmoidoscopy showed extensive distal rectal ulceration, biopsies positive for chronic proctitis and intestinal spirochetosis. Given no response to 5-ASA the patient was started on infliximab with a slight improvement but incomplete resolution of his symptoms. Repeat endoscopy showed continued rectal ulceration.

Incidentally, the patient had a same sex sexual encounter and subsequently tested positive for syphilis with positive T. pallidum EIA and an RPR of 1:8. He received benzathine penicillin G 2.4 million units intramuscularly.

After treatment with penicillin, the patient’s symptoms improved with no further hematochezia and decreased frequency. Flexible sigmoidoscopy showed normal mucosa with no evidence of ulceration indicating the initial proctitis and ulceration was secondary to infection by T. pallidum.

Conclusions

Syphilis, known as the “Great imitator,” is on the rise in Canada, with cases of infectious syphilis increasing more than 259.5% over the past decade. Rectal syphilis is often misdiagnosed as it can present with variable symptoms including puritis, tenesmus, urgency of defecation and anal discharge that may be purulent, mucoid or bloody. Endoscopic findings include non-specific proctitis, masses, ulceration and pseudotumors. Diagnosis is made with serology as pathology cannot differentiate between commensal intestinal spirochetosis and T. pallidum.

Given the diversity of presentations and rise in incidence, gastroenterologists need to ensure they take a thorough sexual history and keep syphilis on their differential when encountering this common clinical scenario.

Funding Agencies

None
A231 COLORECTAL CANCER PROVINCIAL SCREENING OPTIMIZATION USING GUT MICROBIOME AS BIOMARKER
Authors: Laforest-Lapointe I
Published: February 2022

Background

Colorectal cancer (CRC) is a disease easy to cure but quite difficult to detect. Because of that, the mortality rate of CRC is among the highest in the world. The current way to clinically detect CRC is by mean of immunochromatographic fecal occult blood test (iFOBT). If the test is positive, the patient undergoes a colonoscopy to confirm the presence and stage of CRC. However, iFOBT tests are affected by a high rate of false positives. In addition, colonoscopy preparation and intervention have major drawbacks on patients’ health. It is thus important to reduce the false negative rate of iFOBT.

Aims

In this study, we aim to find microbiome biomarkers that could reduce the rate of false positives, quantify microbiome composition as CRC worsens, and finally improve iFOBT accuracy by adding microbial biomarkers and CRC-related human genes to the detection for CRC.

Methods

To do that, 1048 fecal samples were collected with iFOBT kit (OC-Auto® FIT test Kit) then send to the CHUS (Centre Hospitalier de l’Université de Sherbrooke). Sex, age and health status (healthy with “no blood”; false positive: FP; adenoma, adenocarcinoma) were collected for 952 samples. Those samples come from healthy patient with “no blood” (no or below 175 ng/mL of blood in sample), FP patients (healthy but with a concentration above 175 ng/mL of blood), 387 patients with adenoma and 52 patients with adenocarcinoma. The community microbial DNA were extracted from samples by using QIAGEN QIAmp Fast DNA stool mini-kit. An amplification of the V4 region of the 16S rRNA gene were done by using the primers 515 F and 806R, then sequenced on a MiSeq platform.

Results

First, taxonomy was assigned to each ASV (Amplicon Sequence Variant) with Silva. Then ASVs were parsed through ten different machine learning algorithms to assess if the microbiome can increase the power of prediction (sensitivity and specificity) of CRC by comparing FP vs adenoma and FP vs adenocarcinoma by generating AUC-ROC (Area Under the Curve-Receiver Operating Characteristics) curves using only the sex, age and occult blood concentration, and then adding the ASVs community.

Preliminary results show that the power of prediction of CRC with only sex, age and occult blood concentration have an AUC-ROC curves varying between 0.53–61 when comparing FP vs adenoma, and an AUC-ROC curves varying between 0.56–0.74 when comparing FP vs adenocarcinoma. And when adding the community matrix, we see that the AUC-ROC curves comparing FP vs adenoma are varying between 0.48–0.68; and when comparing FP vs adenocarcinoma, the AUC-ROC curves are varying between 0.51–0.98.

Conclusions

In the future, we hope to explore the possibility of using this machine learning protocol to determine the stage of CRC disease and reduce the need for FP colonoscopies.

Funding Agencies

CIHRCanada Research Chair
A233 CHARACTERIZATION OF THE DUODENAL MICROBIOME IN PEDIATRIC CELIAC AND INFLAMMATORY BOWEL DISEASE PATIENTS
Authors: Manoogian J , Butcher J , Li J , Mack D R , Stintzi A
Published: February 2022

Background

Both Celiac disease (CE) and inflammatory bowel disease (IBD) are lifelong gastrointestinal tract (GIT) disorders. CE is an autoimmune disorder triggered by gluten consumption and can result in small intestine villus atrophy, crypt hyperplasia and epithelial permeability, while IBD is characterized by chronic, reoccurring inflammation and ulcers in the GIT. There is increasing evidence linking GIT microbes to both CE and IBD pathogenesis. Studies have also shown that CE patients are at increased risk of developing IBD, suggesting a possible link between these diseases. The duodenum can be affected in both CE and IBD, but it is understudied as compared to other GIT regions.

Aims

We thus aimed to characterize the duodenal microbiome of pediatric CE, IBD and control patients (n=76, 48 and 57 respectively) and hypothesized that the composition of microbes would vary between each diagnostic group.

Methods

We used mucosal luminal interface aspirates collected during upper endoscopy at the Children’s Hospital of Eastern Ontario. Metagenomic DNA was extracted from these samples and bacterial taxa was characterized by sequencing the V6 hypervariable region of the 16S rRNA gene.

Results

Control, CE, and IBD duodenal microbiotas showed no apparent differences in either α-diversity or β-diversity. However, we identified several significant differences between the relative abundances of specific taxa in these three patient groups. In particular, Atopobium parvulum was found to be enriched in Crohn’s disease samples when compared to non-IBD controls. There was also a trend for higher Bacteroides, Lactobacillus, Parabacteroides and Staphylococcus in CE patient MLI aspirates. These results are similar to what has been previously reported in CE patients. Finally, trends found in the duodenal MLI aspirates are more consistent with results previously found in the salivary microbiome in CD patients as opposed to studies of the large intestine.

Conclusions

This work provides unique insight into the microbial composition at the duodenum; a GIT region that has not been fully characterized in CE or IBD.

Funding Agencies

CIHRGenome Canada
A242 STOOL FROM IBS-D PATIENT WITH A HISTORY OF A DYSBIOTIC AND NON-DYSBIOTIC ONSET MODULATE NEURONAL EXCITABILITY VIA DIFFERENT MECHANISMS
Authors: Jiménez-Vargas N N , Guzman Rodriguez M , Yu Y , Neary E , Lomax A E , Reed D E , Vanner S
Published: February 2022

Background

We have shown that Irritable Bowel Syndrome diarrhea-predominant (IBS-D) patients with a history of a dysbiotic-like onset have distinct stool metabolomic profiles versus those with a non-dysbiotic-like onset. IBS stool supernatants can sensitize mouse colonic afferent nerves via both histamine and proteases. However, it is unknown if stool supernatants from the two IBS-D subgroups modulate the excitability of nociceptive neurons via different neuroactive mediators

Aims

To evaluate whether there are differences in neuroactive mediators within stool supernatants from subgroups of IBS-D patients that can modulate the excitability of nociceptive neurons.

Methods

Stool samples from healthy control (HC) (N=5) and IBS-D patients with a dysbiotic (N=7) or non-dysbiotic-like (N=7) onset, was homogenized with Krebs solution and filtered. Proteolytic activity was assessed using casein as a substrate with and without protease inhibitors. Histamine was quantified by ELISA. DRG neurons from C57BL/6 mice were incubated overnight or acutely (30 min) with stool supernatants. Some neurons were pre-incubated with PAR2 (GB83, 10 μM) or H1R (pyrilamine, 1μM) antagonists prior to supernatant incubation. Changes in neuronal excitability were assessed with perforated patch-clamp by measuring the rheobase (current that elicits an action potential).

Results

Proteolytic activity in dysbiotic-like (57.9 U/μg, p<0.05) but not non-dysbiotic like (37.4 U/μg) stool supernatant was increased compared to HC (25.2 U/μg). Serine inhibitor decreased proteolytic activity of dysbiotic (46.6%, p<0.05) and non-dysbiotic (34.2%, p<0.01) supernatant whereas cysteine, aspartic and metalloproteases inhibitors had no effect. Histamine was increased 78% (p<0.05) in IBS-D compared to HC. No differences in proteolytic activity and histamine concentration between IBS-D subtypes were found. In patch-clamp recordings, overnight incubation with dysbiotic (19%, p<0.05) and non-dysbiotic (22%, p< 0.01) stool supernatant decreased rheobase of DRG neurons compared to HC. No difference in rheobase was observed between IBS-D subtypes. GB83 blocked the overnight actions of supernatants from both subgroups, but pyrilamine had no effect. In contrast, following acute incubation, pyrilamine blocked the hyperexcitability evoked by dysbiotic like supernatant (60pA vs 48pA, p<0.001) but had no effect on non-dysbiotic like supernatants.

Conclusions

Proteases in stool supernatants from IBS-D patients increase neuronal excitability but only those with a history of dysbiotic like onset acutely increase neuronal excitability through H1 receptors. These findings suggest that stool supernatants from subgroups of IBS-D may modulate nociceptor excitability via different mechanisms.

Funding Agencies

CIHRAmerican Neurogastroenterology and Motility Society
A253 IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON PHYSICAL ACTIVITY LEVELS IN CHILDREN AND ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE IN QUEBEC
Authors: Bouthot J , Dehbidi Assadzadeh L , Belmesk L , Madagh S , Geng S , Deslandres C , Jantchou P
Published: February 2022

Background

An average daily moderate-to-vigorous physical activity (MVPA) of at least 60 minutes was recommended by the Canadian Guidelines for children. Because of lockdown restrictions during the COVID-19 pandemic, maintaining physical activity levels (PAL) has been a challenge for youth.

Aims

The primary aim of this study was to compare MVPA levels in children with inflammatory bowel diseases (IBD) before and after this period. The secondary aims were to assess clinical factors that might influence any changes in MVPA patterns.

Methods

Patients with IBD, age ≥5 years, were enrolled in a prospective study on PAL starting June 2018 (self-reported questionnaires during outpatient visits). They were then surveyed online at the end of the second lockdown in July-August 2021. PAL were assessed with the Canadian Health Measure Survey Children-Physical Activity Questionnaire. The responses were converted into metabolic equivalents of tasks by using validated tables. Influence of clinical factors of IBD on changes in MVPA was assessed. A multivariate logistic regression was performed to investigate the association between several risk factors and PAL.

Results

We included 72 patients (38 males; mean (SD) age 17.0 (2.89) years, 48 (66.7%) diagnosed with Crohn’s disease, 19 (26.4%) with ulcerative colitis, and 5 (6.9%) with indeterminate colitis). At last follow-up, 90.3% were in clinical remission according to validated disease activity score. During summer 2021, 16.7% of patients reached the Canadian PAL target, compared to 38.9% before the pandemic. The median daily duration of MVPA in summer 2021 decreased from 37 (Interquartile range (IQR) = 3–82) to 21 (IQR=3–40) minutes. The proportion of sedentary patients increased by 1.4% (37.5% to 38.9%). The proportion of extremely active patients decreased by 16.7% (27.8% to 11.1%), while moderately active patients increased by 20.9% (8.3% to 29.2%). Age, gender, disease type and activity were not significantly associated with the PAL at baseline or at follow-up.

Conclusions

This study found a significant decrease in PAL and time spent doing MVPA in children with IBD in Quebec following the COVID-19 pandemic lockdown. While the recommended target was far from being met before the pandemic, the gap has widened further during the pandemic. We found no clinical factors associated with the PAL. The impact of low PAL on well-being, weight, disease activity and quality of life will be assessed during the follow-up of this cohort.

Funding Agencies

None
A254 PREVALENCE OF HELICOBACTER PYLORI INFECTION IN BARIATRIC SURGERY PATIENTS
Authors: Greenblatt M , Baillargeon D , Cote M , Nadeau M , Couture C , Hould F , Bouvet L , Tchernof A , Biertho L
Published: February 2022

Background

Helicobacter Pylori (HP) infection is the most common chronic infection in humans. Known risk factors include poor socioeconomic status and living conditions, especially at a young age. In Canada, the prevalence is estimated between 23% and 38%. The relationship between BMI and HP infection is controversial. Some data suggests that HP infection occurs less frequently in individuals who are overweight. Other authors endorse that obesity is a risk factor for HP infection, possibly explained by altered innate and adaptive immunity in these patients.

Aims

The objectives were to determine the prevalence of HP infection in patients undergoing bariatric surgery and assess the correlation between HP infection and various patient characteristics.

Methods

All patients who underwent bariatric surgery with a gastric resection in a single hospital between 01/2004 and 01/2019 were analyzed. When gastritis was present, HP immunohistochemical testing was performed. Characteristics of HP-positive (HP+) and HP-negative (HP-) patients were compared using Student’s t-test and χ 2 test.

Results

A total of 6388 specimens were reviewed (4365 women & 2023 men) with a mean age of 44.9±11.2 years and a mean BMI of 49.3±8.2 kg/m2. Histology-proven HP infection rate was 6.3% (n=405). There was no significant difference in sex, BMI and body weight between HP+ and HP- patients. HP+ patients were significantly older than HP– patients (47.4±9.8 vs 44.7±11.3 years, respectively, p<0.0001). Logistic regressions identified age as a risk factor for HP infection in this population (OR 1.26, p<0.0001, CI95% 1.14–1.40 for every 10-year increase).

Conclusions

The rate of histology-proven HP infection is low in patients with severe obesity who present for bariatric surgery and is directly associated with age. The benefits of routine preoperative testing in non-gastric-bypass surgery candidates should be questioned.

Characteristics of study participants

Funding Agencies

This study was performed with support from the Research Chair in Bariatric and Metabolic Surgery at Laval University (L. Biertho and A. Tchernof). MC is the recipient of a studentship from Diabète Québec.
A259 ASSESSING SYSTEM BASED QUALITY MEASURES IN THE CARE OF ACUTE PANCREATITIS AT A TERTIARY CARE HOSPITAL
Authors: Saad Mohammed A , Almeshal F , Rai M , Hookey L
Published: February 2022

Background

Acute pancreatitis (AP) is an acute condition associated with significant morbidity and mortality. There has been a >75% increase in incidence since 1990 associated with annual Canadian healthcare costs greater than $200 million. Despite established guidelines for clinical management and quality indicators at the individual patient level, system-based performance measures are novel. Thus, hospital-based quality measures have recently been released by the American Gastroenterology Association (AGA) and are yet to be evaluated in a clinical setting.

Aims

To assess rates of compliance to the AGA quality and performance measures in the care of acute pancreatitis.

Methods

Retrospective chart review identified adult patients admitted with AP from June 2019 to May 2020 at Kingston Health Sciences Centre to review clinical profile. Data was collected, assessed, and stratified based on compliance with AGA performance measures of (1) cholecystectomy on index presentation of gallstone pancreatitis (GP), (2) initiation of early oral feeding within 24 hours, and (3) inappropriate parenteral nutrition (PN) use. Additional data collected included length of stay (LOS), presence of complications, and etiology of AP to assess for trends in associations. Descriptive and bivariate analysis was conducted.

Results

There were 130 admissions of AP during the study period, of which the most common aetiologies were GP (52.3%) and alcohol (16.9%). Unknown/idiopathic AP had an incidence rate of 22.3%. The most likely etiology of having a prior presentation of AP was unknown/idiopathic AP (34.5%), closely followed by alcoholic AP (32%). The incidence of complications was 13.1% and median LOS was 4 days. 63% of eligible GP patients underwent cholecystectomy on index admission, whereas 20% proceeded with cholecystectomy at a later date. 88% of admissions had a diet ordered within 24 hours of admission. The median LOS was 4 days in the early feeding group, in contrast to 7.5 days in admissions which did not have diet ordered within 24 hours. A total of 3 patients received parenteral nutrition, however only one of these patients was eligible for enteral feeding.

Conclusions

This study demonstrates that increasing cholecystectomy rates during index admission is an area to improve upon. Early diet orders were associated with a shorter hospital LOS; however additional evidence of direct correlation is required. Further studies are warranted to identify system level factors affecting quality of care as well as the development of targeted interventions in AP.

Funding Agencies

None
Impact of Bemisia tabaci MEAM1 (Hemiptera: Aleyrodidae) on Soybean Yield and Quality Under Field Conditions
Authors: Schutze Inana X , Naranjo Steve E , Yamamoto Pedro T
Published: February 2022

Bemisia tabaci MEAM1 (Hemiptera: Aleyrodidae) is a key insect pest in soybean fields in Brazil but data are lacking on the relationship between pest abundance and crop yield and quality. Controlled infestation studies were conducted on caged soybean plants in the field over a two year period at two sites in Brazil. Differences in temperature in the two years affected population growth of B. tabaci, reaching 413 nymphs per leaflet in the first year, and 179 the second year even when the average temperature was 3ºC higher. Higher temperatures promoted a shorter lifecycle and nearly one more generation. Yield was affected with losses up to 500 kg/ha in 2017/2018 and 1,147 kg/ha in 2018/2019. A decrease in the weight of a thousand grains of 18 and 33 g was observed in the first and second year, respectively. No significant differences were observed in grain germination, but estimated losses in protein content were up to 440 kg/ha at the highest infestation level. Pest density and yield data were used to estimate economic injury levels (EILs). EILs ranged from 2.5 to 25.67 nymphs per leaflet and 0.17–1.79 adults per leaflet over a range of control costs, soybean production values, and control efficacies. These results should provide data useful toward development of pest management decision making tools.