bluuebunny/crossref_metadata_2025 huggingface dataset:
A108 ASSESSING THE RELATIONSHIP BETWEEN MENTAL HEALTH, QUALITY OF LIFE, AND ACCESSING CARE IN PREGNANT IBD PATIENTS
Authors: Srikanth V , Premjeyanth V , Perera S , O’Connor K , Krugliak N , Huang V
Published: February 2025

Background

Individuals with Inflammatory Bowel Disease (IBD) are at an increased risk of depression and anxiety, which are correlated with IBD disease activity and reduced quality of life. However, the impact of mental health on pregnant persons with IBD and the barriers to mental health care remain less clear.

Aims

To explore associations between mental health, quality of life, and barriers to addressing mental health concerns in pregnant persons with IBD.

Methods

We conducted an anonymous, cross-sectional survey of pregnant IBD patients. Data collected included demographics, IBD disease activity via modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD) and the Partial Mayo Score 6 (pMayo6) for ulcerative colitis (UC), mental health scores (PHQ-9 and GAD-7), and IBD-related quality of life using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We also explored patient perceptions of mental health stigma, barriers to accessing care, and comfort in discussing these concerns. Chi-square analysis and Fisher’s Exact Test were employed for categorical comparisons, and the Mann-Whitney U test was used to compare mental health scores with SIBDQ.

Results

Fifty-seven surveys were analyzed (52.6% CD, 47.4% UC). The mean age was 33.98 years (SD 3.734), and 22.7% had active disease (mHBI ≥ 5 or pMayo6 > 1). Elevated mental health scores (PHQ-9 and/or GAD-7 ≥ 5) were observed in 57.9% of participants, with 7% having high PHQ-9 scores, 12.3% having high GAD-7 scores, and 38.6% having both. The median SIBDQ score was 57 (IQR 12). A significant association was observed between lower SIBDQ scores and the presence of both an elevated PHQ-9 and GAD-7 score (p < 0.001), while neither score alone had a significant effect.

17.5% reported feeling stigmatized when discussing mental health, highlighting concerns of being perceived as weak, some in their role as maternal figures. A statistically significant association was observed between a clinical diagnosis of both depression and anxiety and feeling stigmatized. 12.3% reported cultural deterrents, noting language, negative cultural connotations, and lack of understanding within their communities. Ethnicity, education, and marital status did not significantly affect satisfaction with available supports, experiencing stigma or barriers to access. There was no significant association between Caucasian versus non-Caucasian patients’ preference for discussing these concerns with a physician (GP, IBD specialist, gastroenterologist, OBGYN, psychiatrist) or family/friends.

Conclusions

Pregnant IBD patients with both elevated PHQ-9 and GAD-7 scores may experience diminished quality of life, underscoring the need to address mental health concerns in disease management. Further research is needed to explore the influence of these factors on maternal-neonatal outcomes.

Funding Agencies

University of Toronto: UT GE-HEP NEW INVESTIGATOR PILOT AWARD
A116 PROMOTING ALCOHOL CESSATION IN THE INPATIENT GASTROENTEROLOGY WARD
Authors: Hussain M , Natt N , Almahanna Y , Hudson D
Published: February 2025

Background

Alcohol use disorder (AUD) is a significant global health issue, ranking as the third leading cause of death and disability, with a financial burden exceeding $16 billion annually for the Canadian healthcare system. A recent review of patient discharges from the inpatient Gastroenterology ward at University Hospital revealed that less than 8% of patients with AUD were discharged with anti-craving medications or addiction referrals, highlighting a gap in care coordination

Aims

Increase the prescription rate of anti-craving medications by 20% for patients admitted with alcohol-related conditions to the Gastroenterology ward within the next 6 months, to improve post-discharge care and addiction support

Methods

The project began by identifying key stakeholders and surveying 22 residents rotating through gastroenterology and 11 consultant physicians. Results revealed that 34.7% of residents and 36.4% of consultants were uncomfortable prescribing medications for alcohol use disorder. Root cause analysis identified several issues: limited knowledge of anticraving medications, lack of addiction resources, time constraints, and no standardized process for identifying high-risk alcohol use disorder patients.

Multiple Plan-Do-Study-Act (PDSA) cycles were implemented, targeting trainee education with handouts, early detection of high-risk patients using the AUDIT-C questionnaire at admission, and increasing referrals to addiction services and social work

Results

Between January and July 2024, a total of 57 patients with alcohol-related admissions were identified. During the intervention period, educational handouts for trainees and a Gastroenterology educational grand rounds presentation were implemented, demonstrating some success in increasing rates of anticraving medications. However, these results were not sustained, highlighting the need for a long-term solution. We are developing an EMR-based admission order set to standardize AUDIT-C completion, facilitating the identification of high-risk inpatients and automatic consultations with social work and addiction services through informatics principles

Conclusions

Although educational interventions temporarily increased rates of anticraving medications, the results were not sustainable. The project is ongoing and will transition to exploring EMR-based interventions

Comfort of Prescribing Anti-Craving Medication among GI staff

Funding Agencies

None
A135 INCREASED USE OF PSYCHIATRIC MEDICATION USE FOLLOWING DEVELOPMENT OF CELIAC DISEASE AUTOIMMUNITY
Authors: Goddard Q , King J A , Coward S , Williamson T , Kaplan G G
Published: February 2025

Background

Celiac disease (CeD) autoimmunity is characterized by new positivity for tissue transglutaminase antibodies (TTG) with or without pathologic confirmation. CeD autoimmunity is associated with an increased risk of psychiatric disorders. However, patterns in treatment for psychiatric conditions in relation to diagnosis of celiac autoimmunity remain unclear.

Aims

To determine trends in psychiatric medication use in individuals with CeD autoimmunity before and after TTG positivity.

Methods

A population-based cohort of individuals with incident CeD autoimmunity (n = 14,324; 9,180 females) between April 2015 and March 2023 in Alberta was linked to medication dispensation records. Individuals were classified as children (≤ 12), young adults (13–24), adults (25-64), or seniors (≥ 65) according to age at time of TTG positivity. Medications were categorized by anatomical therapeutic chemical codes: N06A (antidepressants), N05B (anxiolytics), and N05A (antipsychotics). Dispensation data was collected for up to five years before and after TTG positivity. The proportion of days covered (PDC) was calculated as the number of days a drug was prescribed over the follow-up period, per patient. McNemar’s test (for proportions) and Wilcoxon signed rank tests (for PDC) were used to compare medication use before vs after TTG positivity.

Results

Antidepressants were prescribed to 36% of the cohort, anxiolytics to 21%, and antipsychotics to 8% at least once during the study period. A significantly greater proportion of the cohort dispensed antidepressants (20% vs 26%) and antipsychotics (4% vs 6%, both p < 0.001) after TTG positivity, while a significantly lower proportion dispensed anxiolytics (12% vs 11%, p = 0.01) after TTG positivity. A greater proportion of all age categories and sexes dispensed antidepressants after TTG positivity, except for seniors (p = 0.84). The largest increase occurred in young adults, with 24% vs 36% dispensing antidepressants pre- vs post-TTG positivity. PDC significantly increased post-diagnosis for antidepressants (11% vs 35%), anxiolytics (2% vs 4%), and antipsychotics (6% vs 23%, all p < 0.001). For all drug classes, all age groups and sexes had a significantly higher PDC post-TTG, except for children (p = 0.20) and seniors (p = 0.38) with anxiolytics.

Conclusions

Psychiatric medication use is common in individuals with CeD autoimmunity, with increased use following TTG positivity. While the proportion of individuals on medication is only marginally greater following TTG positivity, we observe increased reliance (i.e., PDC) on medication following TTG positivity. These findings suggest enhanced monitoring for psychiatric comorbidities is warranted in this population.

Individual-level PDC by medication class, five years before and after TTG test.

Funding Agencies

CIHR
A148 NOD2 LIGAND AND PEPTIDOGLYCAN HYDROLASE GENE ABUNDANCES ARE ALTERED IN PRE-CROHN’S DISEASE
Authors: Ren M , de Sa O , LI Q , Bharali B , Mu K , Turpin W , Croitoru K ,   o.n behalf of the CCC-GEM Research Consortium, Philpott D
Published: February 2025

Background

Crohn’s disease (CD) is a chronic disorder of unknown etiology. Genome-wide association studies have revealed that NOD2 loss of function mutations are an important gene contributor to CD pathogenesis. NOD2 is a pattern recognition receptor that responds to phosphorylated muramyl-dipeptide (MDP), whose production from peptidoglycan (PGN) is dependent on the expression of specific microbial hydrolases in the lumen. While a variety of studies have shown that reductions in NOD2 ligand and corresponding hydrolases, particularly DL-endopeptidases, occur in active CD or as a consequence of inflammation, which may play a role in sustaining disease, the interplay between NOD2 ligands and PGN-hydrolases pre-disease is unknown.

Aims

We investigated whether stool NOD2 ligand concentration is altered in pre-CD individuals, and the associations of PGN-hydrolase abundances with NOD2 ligand and with other pre-disease biomarkers.

Methods

Fecal samples were collected from healthy first-degree relatives of CD patients who were followed prospectively as part of the CCC-GEM project nested case control cohort (n = 91 pre-CD, n = 242 matched controls, median time to diagnosis 3.2 years). Fecal calprotectin (FCP), urinary fractional excretion ratio of lactulose to mannitol (LMR), and C-reactive protein (CRP) from serum were measured. PGN-hydrolase gene abundances was assessed by shotgun sequencing of stool samples. NOD2 ligand abundance was measured by incubating diluted stool supernatant with human NOD2 reporter HEK293 cells overnight then measuring OD640. A database of PGN-hydrolase clusters was generated by sequentially clustering with MMseqs2 based on sequence identity, then with Foldseek based on the AlphaFold Protein Structure Database.

Results

NOD2 ligand concentration was significantly reduced in pre-CD compared to matched controls (p < 0.01). Although several PGN-hydrolase clusters were negatively associated with NOD2 ligand, the relative abundance of one DL-endopeptidase cluster expressed by the Firmicutes phylum was significantly positively associated with NOD2 ligand abundance (q < 0.05). A DD-carboxypeptidase cluster, an amidase cluster, and a muramidase cluster were each negatively associated with future diagnosis of CD (q < 0.05). While many clusters were positively and negatively associated with FCP and CRP, one DD-carboxypeptidase cluster was positively associated with LMR (gut barrier permeability, q < 0.05).

Conclusions

These results show that NOD2 ligand concentration and the PGN-hydrolases that produce it are altered in pre-CD stool, suggesting that this may contribute to disease onset, however further investigation is needed.

Funding Agencies

CCC, CIHRHelmsley Charitable Trust, Mount Sinai Hospital
A155 STOOL-BASED PROTEIN SIGNATURES FOR NON-INVASIVE ACCURATE DIAGNOSIS AND SUBTYPING OF INFLAMMATORY BOWEL DISEASE THROUGH HIGH-THROUGHPUT PROTEOMICS AND MACHINE LEARNING APPROACHES
Authors: Shajari E , gagne d , Malick M , Roy P , Delisle M , Brunet M , Boisvert F , Beaulieu J
Published: February 2025

Background

Accurate diagnosis of inflammatory bowel disease (IBD) is essential to distinguish it from other conditions with similar symptoms and to identify whether it’s ulcerative colitis (UC) or Crohn’s disease (CD), ensuring appropriate treatment and management. While colonoscopy and biopsy are the current gold standards, they are invasive, costly, and poorly accepted by asymptomatic patients. Fecal biomarkers like calprotectin are commonly used but lack the specificity and lack of ability to differentiate between CD and UC, highlighting the need for more precise, non-invasive diagnostic methods.

Aims

This study aims to develop a stool-based protein biomarker panel capable of accurately distinguishing IBD from IBD-mimicking conditions. It also seeks to classify the subtypes, CD and UC, by using high-throughput Data-Independent Acquisition mass spectrometry (DIA-MS) to identify precise biomarker signatures from complex stool samples, combined with advanced machine learning techniques for developing predictive model.

Methods

Stool samples were collected from 46 active-CD patients, 23 active-UC patients, and 53 patients with conditions presenting similar symptoms. Using DIA-MS, we analyzed the stool proteome, identifying and quantifying proteins. Data processing procedures were carefully optimized to establish a robust analytical pipeline. The samples were then split into training and testing groups. Feature selection algorithms were applied to the training group to identify proteins that significantly differed between the groups. Six machine learning algorithms (kNN, Naive Bayes, eXBoost, Random Forest, SVM, and glmnet) were subsequently evaluated to determine the best-performing classifier.

Results

Signature 1, consisting of 7 proteins for diagnosing true symptomatic IBD cases, and Signature 2, comprising 8 proteins for distinguishing between CD and UC, were developed using the best-performing classifier on the training dataset. Signature 1 achieved an AUC of 0.98, while Signature 2 reached an AUC of 0.96. For validation, the final predictive model was applied to a set of unseen samples. Impressively, the model demonstrated an AUC of 0.96 for both classifications, confirming its robustness and ability to generalize effectively to new samples.

Conclusions

In conclusion, this study illustrates the effectiveness of utilizing stool proteome obtained through DIA-MS in accurately diagnosing and subtyping active IBD. Further future validation on a larger cohort using targeted MRM mass spectrometry would be served to establish the clinical utility of this approach.

Funding Agencies

CCCFaculty of Medicine and Health Science of University of Sherbrooke
A161 HEMOPEXIN TREATMENT ALLEVIATES COLITIS SEVERITY IN THE ABSENCE OF IL-22RA1 SIGNALING IN MICE
Authors: Ajayi A S , Gerkins C , Cuisiniere T , McCartney C , Maumy T , Hajjar R , Oliero M , Fragoso G , Calve A , Santos M M
Published: February 2025

Background

Inflammatory bowel disease (IBD) is often defined by persistent intestinal epithelial inflammation, bleeding, and pain. It is one of the major risk factors for colorectal cancer (CRC). IBD’s pathogenesis is fundamentally characterized by the release of free luminal heme. Dietary heme induces intestinal dysbiosis and exacerbates colitis. Interleukin 22 (IL-22) is produced in the gut by immune cells, mainly innate lymphoid cell 3 (ILC3). It is known to induce a protective response mediated by hemopexin, a plasma heme scavenger produced in the liver that limits the availability of heme iron to microbes and suppresses bacterial growth.

Aims

To evaluate the protective role of IL-22 by the stimulation of hemopexin in a mouse model of acute colitis

Methods

To assess the effect of IL-22 on colitis, Il22ra1-/- and wild-type (Wt) mice on a C57BL/6 background were treated with 2.5% dextran sodium sulphate (DSS) in drinking water for 12 days to induce colitis, after which they were sacrificed. To reverse colitis severity with hemopexin, three groups of mice received 2.5% DSS in drinking water for 12 days. The treatment group (Il22ra1-/-) received an 15 mg/kg BW hemopexin injection intraperitoneally on day 7 of the DSS treatment, while the other two groups, Wt and Il22ra1-/-, received the vehicle (PBS).

Results

Il22ra1 -/- mice had significantly greater weight loss, higher disease activity index (DAI) score and shorter colon length on day 12 (endpoint) compared to the Wt mice. Significant increases in inflammatory markers such as lipocalin-2 (lcn-2), TNF-α and IL-6 were observed in Il22ra1-/- mice, contributing to their condition. Decreased fecal hemopexin and increased free luminal heme were observed in Il22ra1-/- mice compared to the Wt mice. Hemopexin administration reversed the disease severity by reducing DAI, inflammatory markers and increasing the colon length. Increased fecal hemopexin and reduced luminal heme were also observed in the Il22ra1-/- mice.

Conclusions

Hemopexin is present in the gut during colitis. The absence of Il-22ra1 enhances free luminal heme production, reduces hemopexin concentration in the gut, and aggravates colitis in mice. Hemopexin administration reduces free luminal heme in the gut, enhances hemopexin availability and alleviates colitis severity in mice.

Funding Agencies

CIHRUniversite de Montreal, CRCHUM, Institute du Cancer de Montreal
A166 SIMPLENESS: A QUALITATIVE DESCRIPTION STUDY EXPLORING PATIENT PERSPECTIVES ON THE BARRIERS AND FACILITATORS OF USING DIGITAL HEALTH TOOLS TO SELF-MANAGE INFLAMMATORY BOWEL DISEASE
Authors: Ajibulu L J , Chappell K , Seow C , Goodman K J , Wong K
Published: February 2025

Background

Inflammatory Bowel Disease (IBD) is a chronic condition that requires lifelong management and frequent interaction with healthcare providers. Digital health tools have the potential to enhance disease management by offering real-time data and improving care coordination. However, there is limited evidence on patient perspectives regarding the barriers and facilitators to using these tools effectively.

Aims

This study aimed to explore patient perspectives on the use of digital health tools for managing IBD, identifying key barriers and facilitators that influence their adoption and sustained use.

Methods

Using a qualitative description methodology, participants with a confirmed diagnosis of IBD were purposively recruited from multiple clinics in Alberta, Canada. Data was collected through virtual semi-structured interviews until thematic saturation was reached. Participants were introduced to “MyIBDToolkit,” a digital health tool in development, designed for seamless communication and data sharing between patients and providers, integrated into an electronic health record (EHR) patient portal to support self-management. Thematic analysis was used to identify key themes within the interviews.

Results

Thematic saturation was achieved with 18 interviews. Participants expressed varied views on self-management and digital disease management. Most were receptive to using digital health tools, highlighting benefits like enhanced monitoring and streamlined care. However, they noted concerns about sustainability, data entry burden, and privacy as significant barriers. Some participants were also skeptical about healthcare provider use of these tools.

Conclusions

While participants generally viewed digital health tools as beneficial for self-managing IBD, usability, engagement, and privacy challenges must be addressed for successful implementation. These findings underscore the importance of incorporating patient perspectives in developing and integrating digital health interventions for chronic disease management.

This graphical abstract highlights the key findings from semi-structured interviews with IBD patients, focusing on the potential benefits and challenges of digital health tools for disease management. The study identified improved care monitoring, streamlined care, and usability features as facilitators, while concerns about privacy, continued use, and adoption hindered engagement.

Funding Agencies

Alberta Innovates Partnership for Research and Innovation in the Health System 7 (PRIHS 7)
A172 GENETIC AND DIET-ASSOCIATED MUCUS IMPAIRMENTS INCREASE SUSCEPTIBILITY TO ULCERATIVE COLITIS PATHOBIONT-DRIVEN COLITIS.
Authors: Yang H , Kim W , ma c , Yu H , vallance B
Published: February 2025

Background

The Inflammatory Bowel Diseases (IBD), Crohn’s Disease (CD) and ulcerative colitis (UC) affect > 320,000 Canadians and are increasing in incidence. Ileal CD has been linked to the overgrowth of mucosal adherent-invasive Escherichia coli. Recent studies have also implicated the adherence of E. coli pathobionts to the colonic mucosa of UC patients. Using the representative UC E. coli pathobiont p19A, we recently demonstrated it aggravated chemical-induced colitis in susceptible mice, through the actions of the toxin alpha-hemolysin, and by adhering to the inflamed colonic mucosa via the adhesin FimH. It is less clear what host factors control susceptibility to UC pathobionts. I hypothesize that a key susceptibility factor is the glycosylated mucin Muc2, which forms the protective mucus layer that covers the colonic epithelium and is often impaired in UC patients.

Aims

To define the role of colonic mucus structure and function in determining susceptibility to the p19A pathobiont, and its ability to cause colitis in mice.

Methods

Susceptibility to p19A was tested in two mouse models of colonic mucus impairment. The first is a mouse strain deficient in core 1 derived O-glycans in their intestinal epithelial cells (IEC C1galt1-/-), resulting in reduced mucin glycosylation, and thus a thin and impaired mucus barrier. The second model involves feeding wildtype (WT) C57BL/6J mice a fiber-free (FF) diet, resulting in a significantly thinner colonic mucus layer. The mice were subsequently orally gavaged with p19A and their susceptibility determined by assaying p19A burdens, intestinal histopathology, inflammatory cytokine production.

Results

Following oral gavage of WT mice fed a normal diet, immunostaining identified p19A localizing within the colonic mucus layer, but it did not reach the epithelium or cause disease. In contrast, p19A regularly reached the colonic epithelial surface of mucus-impaired IEC C1galt1-/- mice (as compared to IEC C1galt1flox/flox mice) and in WT mice fed a fiber-free diet. This epithelial adherence was associated with increased p19A burdens, histopathology and production of inflammatory markers such as TNF-a and lipocalin 2. Notably, fiber-free diet-fed mice showed reduced SCFA levels in their feces and thinner mucus layer in their colon at baseline.

Conclusions

Our results indicate that UC E. coli pathobionts are able to reach the colonic epithelial surface and induce colitis in hosts suffering genetic or diet-based mucus dysfunction. This susceptibility highlights the important role played by intestinal mucus in protecting against IBD.

Funding Agencies

CCC, CIHR
A173 PATTERNS OF FISTULA DISEASE ACTIVITY IN PATIENTS WITH PERIANAL CROHN’S DISEASE
Authors: Huebener N , Sweet A , McCurdy J
Published: February 2025

Background

The disease course of perianal fistulizing Crohn’s disease (PFCD) is highly variable, from transient symptoms to chronic, progressive disease activity. The patterns of PFCD activity over time and their impact on long-term fistula outcomes is poorly understood.

Aims

To determine the patterns of PFCD activity within the first year of fistula diagnosis and their impact long-term outcomes.

Methods

We performed a retrospective, observational study between 2005-2023 at a single Canadian academic institution. We included adults >17 years with PFCD and a minimum of 2 clinical touchpoints within the first year after fistula diagnosis. PFCD was categorized into one of four patterns of disease activity: transient, minimally active, relapsing-remitting, and chronic persistent based on clinical symptoms within the first year after fistula diagnosis (Figure 1). Our primary outcome was major adverse fistula outcomes (MAFO), a composite of local surgery, hospitalization, and fecal diversion for PFCD. Secondary outcomes included individual components of MAFO and fistula remission at last follow-up. Time to event analyses were estimated by Kaplan Meir methods stratified by disease activity categories.

Results

101 patients met our study criteria. Mean age at PFCD diagnosis was 35 (SD=13) years, 46 (46%) patients were female, and 76 (78%) had complex fistula anatomy radiologically. A total of 44 (44%) patients underwent local surgical intervention at the time of diagnosis and 92 (91%) patients were treated with an advanced medical therapy. Patients were classified as having transient (n=35, 34%), minimally active (n=17, 17%), relapsing remitting (n=13, 13%) and chronic persistent (n=36, 36%) disease. After a mean follow-up of 114 months (SD=61.4), 65 (64%) of patients developed MAFO. At last follow-up 62 (61%) of patients were in remission. Table 1 shows long-term fistula outcomes stratified by each of the four disease activity categories. The proportion of patients with MAFO over time was lowest in the transient disease category. Fistula remission at last follow-up was highest in the transient disease category and lowest in the chronic persistent disease category.

Conclusions

Our study shows that PFCD can be categorized into 4 distinct disease activity categories within the first year of diagnosis and that these patterns may predict long-term fistula outcomes.

Table 1: PFCD outcomes according to clinical disease activity pattern

Figure 1: Patterns of PFCD Activity

Funding Agencies

None
A178 DISEASE COURSE AND MANAGEMENT OF CHILDREN WITH VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE
Authors: Kishore S B , Sethuraman A , Binomar H , Jacobson K
Published: February 2025

Background

Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed before 6 years of age, has a distinct phenotype with predominantly colonic involvement. However, there are limited studies describing the long-term outcome of children with VEO-IBD.

Aims

Our primary aim was to determine the long-term outcome in children with VEO-IBD and corticosteroid free clinical remission (CFCR) at one year post diagnosis and at last follow up. The secondary aim was to determine clinical response (CR) and biochemical remission (BR) at the same time points.

Methods

A retrospective cross-sectional chart review was conducted for all children with VEOIBD diagnosed between 1st January 2013 to 31st December 2022 with a minimum follow up of one year at British Columbia Children’s Hospital (BCCH). Patients were identified from the BCCH pediatric IBD database. Demographic and relevant clinical data including IBD medications and response were collected. Data points at 3 months, 6months, 1 year and then annually until 10 years from diagnosis were collected. Corticosteroid free clinical remission (CFCR) was defined as being off steroids for ≥ 3 months at yearly follow up. Biochemical remission (BR) was defined as fecal calprotectin <250ug/g. Clinical response (CR) was defined as a wPCDAI >17.5-point change or a PUCAI of a 20-point change from baseline.

Results

77 patients were identified, with 70 patients reviewed thus far. The mean age at diagnosis was 45.6 (±16.4 months). The median follow-up time was 60 months (interquartile range 36 to 84 months). Of the 38 (54%) patients on biologic therapy, the most common 1st, 2nd, 3rd and 4th line biologics were anti-TNF (25/26), vedolizumab (4/7), ustekinumab (4/4) and vedolizumab (1/1) respectively.

Conclusions

Children with VEOIBD who have milder disease and do not require biologic therapy achieved better rates of CFCR at 1 year follow up (83.3% compared to 52.7%) but comparable rates at last follow up (78.1% to 81.6%) to those with moderate to severe disease requiring biologic therapy.

Primary and secondary outcomes in VEOIBD patients

Funding Agencies

None
A180 THE IMPACT OF INTEGRATING PELVIC MRI AT DIAGNOSIS FOR EARLY DETECTION OF PERIANAL CROHN’S DISEASE IN PEDIATRICS
Authors: Antaya M , Hudson A , Lerner E , Nasser K , Carroll M , Migliarese Isaac D , Wine E , Perry T , Thompson A , Huynh H
Published: February 2025

Background

Perianal Crohn’s disease (CD) can be a severe, refractory manifestation of pediatric CD. It is underrecognized, particularly if asymptomatic, which has led to varied reported incidences (10-60%). Earlier detection by pelvic magnetic resonance imaging (pMR) may alter management and outcomes.

Aims

If performing pMR on newly diagnosed pediatric CD patients identifies asymptomatic perianal CD and leads to earlier biologic use, fewer hospitalizations, and less surgery.

Methods

New CD patients were prospectively enrolled into the Edmonton Pediatric Inflammatory Bowel Disease Clinic (EPIC) registry. This clinic has done baseline pMR since 2018. A retrospective review (2018-2023) collected pMR, perianal exam, symptoms, blood work, calprotectin, medications, and surgeries (perianal and intestinal). A blinded radiologist re-read pMRs using St. James and Parks criteria. Statistics included descriptive, Fisher’s exact test, multivariate logistic regression, and survival analysis.

Results

139 patients were included (63% male, median age 13 [IQR 11-16]). Ninety-six patients (69%) had no pMR perianal disease (pMR-), despite 13/96 (14%) having perianal symptoms and 26/96 (27%) with inflamed (n=6)/ non-inflamed (n=14) tags or fissures (n=6). Of the 43 (31%) with pMR+ perianal disease, 27/43 (63%) were asymptomatic (ASx) and 17/43 (40%) had a normal exam. pMR+/ASx patients with perianal exam findings included inflamed (n=4)/ non-inflamed (n=5) tags, fissures (n=1), and draining fistula (n=1). pMR+/Sx had higher Parks and St James scores compared to pMR+/ASx. Compared to pMR-, pMR+/ASx and pMR+/Sx patients had a relative risk of 1.40 [95% CI 1.16-1.71] and 1.72 [95% CI 1.72-1.73] of requiring a biologic at 6 months, and a relative risk of 1.39 [95% CI 1.23-1.62] and 1.45 [95% CI 1.45-1.46] of requiring a biologic at 1 year. pMR+/Sx patients had an increased probability of CD surgery (p<0.002) but not hospitalization (p>0.05). There were no differences between pMR+/ASx and pMR- patients in surgery or hospitalization (p>0.05). Time to surgery was shorter in pMR+/Sx (p<0.01), but not different between pMR+/ASx and pMR- (p>0.05).

Conclusions

The majority of patients with perianal CD identified on pMR had no perianal symptoms and had a normal exam. This early identification of subclinical perianal disease led to increased and earlier biologic use, which may explain the lack of increased hospitalization and surgical rates compared to those without pMR+ perianal disease. Baseline imaging was also helpful for demonstrating the absence of deeper perianal disease in several patients who did have perianal symptoms and tags/fissures.

Funding Agencies

NACTRC, Stollery Children’s Hospital Foundation through WCHRI
A202 PREOPERATIVE DIAGNOSIS OF JEJUNAL ADENOCARCINOMA ASSOCIATED WITH CROHN’S DISEASE DIAGNOSED, LOCALIZED AND SURVEILLED VIA DOUBLE BALLOON ENDOSCOPY: A CASE REPORT
Authors: Liu C S , Wong K , Kroeker K , Gozdzik M , Hoentjen F , Peerani F , Wasilenko S , Zepeda-Gomez S , Halloran B
Published: February 2025

Background

Small bowel carcinomas (SBC) are rare, accounting for only 1% to 5% of all gastrointestinal cancers. However, patients with Crohn’s disease face a significantly elevated risk of SBC. This case report outlines a rare case of preoperatively-diagnosed jejunal adenocarcinoma in a patient with long-standing Crohn’s disease with diagnosis and surveillance through double balloon endoscopy (DBE).

Aims

A 41-year-old female with a 30-year history of small bowel Crohn’s disease presents to the hospital with overt obscure GI bleeding. Throughout the course of her disease, she was thought to be in remission with Pentasa and 6-MP, though she had mild inflammation seen in the jejunal and neoterminal ileum visualized on magnetic resonance enterography (MRE). Subsequent oral DBE showed severe nodularity and friability throughout the jejunum with biopsies showing invasive moderately differentiated adenocarcinoma. Combined oral and rectal DBE was used to facilitate tattoo placement prior to open right hemicolectomy with jejunal resections, which was complicated by intraoperative bleed and anastomotic leak. Unusually, cross-sectional imaging with computer tomography (CT) and positron emission tomography (PET-CT) showed no GI tract enhancement or evidence of metastatic spread. Post-operatively, oral DBE found a saddle shaped deformity in the jejunum which had dysplasia on one biopsy. As a result of her complicated post-operative course, the patient is receiving regular surveillance with oral DBE every six months.

Methods

Balloon-assisted endoscopy (BAE) has the potential to allow for endoscopic and histopathologic examination of the entire gastrointestinal tract, which makes BAE an ideal modality for both diagnosis and surveillance in Crohn’s disease. In this particular case, DBE was able to detect a subtle jejunal lesion that was not identified on CT enterography or even a PET-CT scan, resulting in earlier detection of a small bowel adenocarcinoma that was curable with surgery.

Results

Currently, there is a gap in literature surrounding small bowel adenocarcinoma surveillance. This is further complicated by the lack of an established macroscopic appearance of SBC and the unknown prognostic significance of dysplasia on pathology in the context of small bowel inflammation. Further, many centres have limited access to BAE.

Conclusions

This case shows that it has an important, and underutilized role, in IBD management. It is currently the only methodology for visual assessment and biopsy of lesions in the mid gut. Small bowel endoscopy access should be increased in Canada with a focus on IBD patients. Development of high risk identifiers for possible small bowel carcinoma also need to be developed as part of ongoing guidelines.

Funding Agencies

None
A224 BARRIERS AND FACILITATORS TO IMPLEMENTATION OF A NURSE NAVIGATOR-LED, EVIDENCE-BASED, IBD FLARE PATHWAY; RESULTS FROM A NATIONAL MULTISTAKEHOLDER ENGAGEMENT PROCESS
Authors: Willett N , Heisler C , Marshall J , Stewart M , Jimenez L , Bennett A , Robar J , Currie B , Phalen-Kelly K , Jones J
Published: February 2025

Background

The clinical resources of many IBD programs are insufficient to meet population and care complexity needs for persons living with IBD. Implementation of evidence-based pathways via an existing provincial nurse navigator could improve access to evidence-based care for persons living with IBD. Stakeholder engagement is important when identifying barriers to implementation and adoption of evidence-based interventions. Groups interviews were performed as part of a national community advisory panel with nurses and gastroenterologists to better understand barriers and facilitators to implementation of evidence-based care guidelines for IBD flares.

Aims

To identify barriers and facilitators to implementation of evidence based IBD flare pathways in clinical practice through a nurse-led initiative.

Methods

Two semi-structured group interviews were performed as part of the national PACE CCC advisory panel in September 2022. Group interviews were via Zoom, each 1 hour in length. Interview script questions were guided by the COM-B implementation science framework. GI interviews was facilitated by a gastroenterologist (JM) and the nursing group interviews by a research assistant (CH). Results were derived from thematic analysis.

Results

A total of 16 IBD care providers participated. One group represented nurses (n=8), while the other included gastroenterologists (n=6) and members of Crohn’s and Colitis Canada (n=2). Thematic barriers to creating and implementing a flare pathway were identified as: Access to care issues, resources and staffing issues, COVID-19 impact, poor communication between specialists and community-based providers, variability of local resources (imaging, specialists, endoscopy), and cost of implementation. Facilitators included: Virtual care platforms, standardization of care, multidisciplinary teams, patient empowerment, leveraging digital health tools for customisation and implementation of the pathway (i.e., EMR templates). Intervention functions included: Empowering nurse navigators to manage flare assessments and improving access to diagnostic testing and resources by embedding pathways into electronic health records.

Conclusions

Nurses and Gastroenterologists shared invaluable insights into the status of IBD Care in Canada and ways to improve access to evidence-based, and equitable IBD care during a flare. Overall, evidence- based care pathways were viewed as being of importance and that implementation strategies should focus on leveraging digital health platforms, EMRs, and empower IBD nurses to facilitate IBD flare pathway implementation.

Funding Agencies

CCC
A226 THE EFFICACY OF MEDICAL THERAPY TO PREVENT SURGERY AND IMPROVE OUTCOMES AMONG PATIENTS WITH STRICTURING CROHN’S DISEASE: A SYSTEMATIC REVIEW
Authors: Alkhateeb Q , Saad A , Squirell E
Published: February 2025

Background

Despite the advancements in inflammatory bowel disease (IBD) management, the percentage of Crohn’s Disease (CD) patients presenting with obstructive symptoms due to small and large bowel strictures is estimated to be 25% and 10%, respectively. Treatment of CD has advanced over the past 20 years to include safer, more targeted options that carry less morbidity than surgical intervention. However, the efficacy of medical therapy once fibrosis has begun is theoretically reduced and, until recently, has had limited study.

Aims

The aim of this systematic review is to examine the efficacy of medical therapies, such as biologics (TNF inhibitors, interleukin inhibitors, anti-integrin therapy) and immunomodulators (thiopurines and methotrexate) to avoid the need for surgical intervention in stricturing Crohn’s disease.

Methods

We searched Medline, Embase, the Cochrane library, and Web of Science for experimental (i.e., randomized and non-randomized controlled trials), quasi-experimental (i.e., interrupted time series) and observational studies (i.e., cross-sectional surveys) examining the effect of medical therapies among adult and pediatric CD patients admitted for the management of strictures. Records were screened, in duplicate and independently, by their title and abstract and then full-text and relevant data were extracted using a standardized data extraction sheet. Efficacy data were pooled using meta-analyses, when applicable, or synthesized narratively.

Results

Our preliminary search yielded a total of 1059 unique records and 22 studies (3 RCTs, 19 cohort studies) were included in our analysis. Results from 8 cohort studies show that among 546 patients receiving TNF antagonists, 80% responded to treatment and did not require surgery at an average follow-up period of 4.1 years (95% CI 71% to 88%). Furthermore, one RCT and one cohort study found that Azathioprine in combination with anti-TNF therapy improved obstructive symptoms and reduced the odds of hospitalization and surgery by half.

Conclusions

Our review highlights systemic medical therapy, namely TNF antagonists, as a promising solution to prevent the need for surgery among patients with stricturing Crohn’s disease. More robust research is needed to confirm these findings and compare their efficacy.

Funding Agencies

None
A228 PSYCHOSOCIAL FACTORS IN ADULTHOOD AND RISK OF INFLAMMATORY BOWEL DISEASE
Authors: Lanoix C , Fantodji C , Jantchou P , Rousseau M
Published: February 2025

Background

Few studies have assessed the possible etiological role of psychosocial factors on inflammatory bowel disease (IBD). We have previously reported that some childhood psychosocial factors were associated with increased odds of IBD in adulthood.

Aims

The aim of this study was to estimate the associations between self-reported psychosocial factors first experienced in adulthood and occurrence of IBD later in life.

Methods

This matched case-control study was nested within a cohort of individuals born in Quebec in 1970-1974. Cases were identified with validated algorithms based on health services from 1983 to 2014; their date of diagnosis was based on their first health service (index date). Only cases diagnosed with Crohn’s disease (CD) (n = 1041) or ulcerative colitis (UC) (n = 511) at ≥18 years were included. Each case was individually matched with a control based on sex and birth year. Cases and controls completed a questionnaire documenting sociodemographic, lifestyle, and psychosocial factors up to the age corresponding to the index date. The psychosocial factors (n = 17) experienced in adulthood related to work (interruption, changes, problems), difficulties (academic, financial), judicial problems, marriage or union, divorce or separation (parents’/own), familial conflict, birth of a child, death (spouse or child/other loved one), depression, anxiety, accident, violence or abuse. Potential confounders were based on a priori knowledge. Conditional logistic regression was applied to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each psychosocial factor, for CD and UC separately. Multiple imputations were used to address missing data.

Results

Adjusting for potential confounders, the odds of CD were higher among those who had experienced changes in the workplace (OR: 1.58; 95% CI: 0.96-2.61), marriage (OR: 1.32; 95% CI: 1.06–1.64), divorce or separation (OR: 1.75; 95% CI: 1.19-2.58), death of spouse or child (OR: 3.21; 95% CI: 1.12-9.19), anxiety (OR: 2.17; 95% CI: 1.25-3.78), and accident (OR: 1.72; 95% CI: 1.09-2.73). The odds of UC were higher among those who had experienced problems at work (OR: 2.00; 95% CI: 1.03-3.87) and anxiety (OR: 1.75; 95% CI: 0.93 - 3.32) and lower among those exposed to changes in the workplace (OR: 0.48; 95% CI: 0.23-1.00). The other psychosocial factors were not associated with either CD or UC.

Conclusions

Several psychosocial factors, first experienced in adulthood, were associated with increased odds of CD or UC later in life, whereas only one, changes in the workplace was associated with decreased odds of UC. Further research should consider the self-reported subjective impact of these psychosocial factors.

Funding Agencies

CIHRCanada Foundation for Innovation & the Québec Ministry of Education, Leisure and Sports (#12532), Fonds de recherche du Québec-Santé (FRQS, #16227), Multiple Sclerosis Society of Canada (#2435), Institut de la statistique du Québec
A232 CAN WE ACCURATELY PREDICT SEVERE ACUTE PANCREATITIS IN CHILDREN? A RETROSPECTIVE REAL-LIFE COHORT OF HOSPITALIZED PATIENTS
Authors: Korman C , Elhaoua D , Blain S , Li T , Mohamed M , David A , Deslandres C , Halac U , Dirks M , Grzywacz K , Lallier M , Alvarez F , Jantchou P
Published: February 2025

Background

Severe acute pancreatitis (SAP) affects nearly a quarter of pediatric patients with acute pancreatitis (AP). However, previous studies suggested that severity scores used in adults have low sensitivity for predicting pediatric SAP. Uncertainty remains regarding the factors associated with SAP in children.

Aims

The primary aim was to validate SAP predictive scores in a Canadian pediatric population and identify associated predictive factors.

Methods

A retrospective observational cohort study was conducted in a tertiary hospital in Montreal, Canada (January 2014-December 2021). SAP was defined by intensive care unit (ICU) admission and/or complications including but not limited to fluid collection, necrosis, and pseudocyst. Firstly, multivariate logistic regression analyses were performed to evaluate the relationship between clinical and laboratory factors and the outcome (SAP). A predictive model was also developed based on age, co-existence of chronic disease (e.g., neoplasia, obesity), C-reactive protein (CRP) levels within 48 hours of admission, baseline urea levels, and sex. Secondly, receiver operator characteristic (ROC) curves were plotted for various published scores (Balthazar (n=55), DeBanto (n=118), Glasgow modified (n=38), Ranson (n=20)) and our model (n=122).

Results

Among 208 patients (51.0% male, median (interquartile range (IQR)) age [12.5 (7.1;15.3) years]), 76 (36.5%) developed SAP. Of these, 14 (6.7%) were admitted to the ICU, and 68 (32.7%) developed complications. The median (IQR) hospital duration was 5.0 (2.5;11.0) days. The ROC for Balthazar, DeBanto, Glasgow modified, Ranson, and our model showed an area under the curve of 0.63, 0.58, 0.59, 0.58, and 0.80, respectively. Balthazar demonstrated the highest specificity (100%). Ranson showed the highest sensitivity (50%). Our model demonstrated a specificity of 78% and a sensitivity of 58%. Each unit increase in CRP within 48 hours of admission and each unit increase in urea at admission were associated with a higher risk of SAP (ORCRP=1.02, 95% CI: 1.01-1.03; ORurea=1.32, 95% CI: 1.08-1.61) whereas each unit increase in lipase within 48 hours of admission (minimum 3.0 U/L; maximum 5745.0 U/L) were not predictive of SAP.

Conclusions

Existing scores display low predictive value for SAP. Our new model, which includes age, CRP and urea levels, sex, and the presence of co-existing conditions, demonstrates good predictive value for pediatric SAP and warrants external validation in larger pediatric cohorts.

Funding Agencies

None
A240 SOCIOECONOMIC STATUS AS A RISK FACTOR FOR ERCP OUTCOMES: A RETROSPECTIVE COHORT STUDY
Authors: Mahjoob M , Khalaf K , Mokhtar A , Na C , Tham D , Sabrie N , Chon J , Meleka M , Abal S , Chopra D , Malipatil S , Gupta S , Jugnundan S , Mhalawi W , Gimpaya N , Mosko J , Teshima C , May G , Grover S , Causada Calo N
Published: February 2025

Background

Endoscopic Retrograde Cholangiopancreatography (ERCP) has one of the highest adverse event rates among endoscopic procedures, close to 10%, including pancreatitis, bleeding, and perforation. To minimize complications and improve procedure success, understanding risk factors of adverse events is critical. Socioeconomic variables such as income, housing and education can influence health outcomes through access to resources, however, there is a literature gap regarding the effect of these variables on ERCP outcomes.

Aims

The purpose of this study is to investigate socioeconomic predictors of ERCP outcomes.

Methods

This study analyzed 6105 patients (51.4% female) who underwent ERCP at a tertiary care center between January 1, 2011 and December 31, 2020. Patient postal codes were translated to 2016 census division unique identifier codes which linked them to median monthly housing costs, household income, education levels, considered proxies for socioeconomic status. Multivariable logistic regression models were built to identify predictors of procedure success (achieving intended diagnostic or therapeutic goals) and adverse events (perforation, abdominal pain, pancreatitis, delayed/immediate bleeding). Data was analyzed using the “glm” package on R studio (Version 2023.06.1) and the adjusted P-value < 0.05 was considered for statistical significance.

Results

The multivariable logistic regression model demonstrated that better access to housing (OR:1.11 [1.01, 1.12], p=0.02) is associated with procedure success. Conversely, older age (OR: 0.86 [0.78, 0.93], p<0.01) and male sex (OR=0.81 [0.69, 0.95], p<0.0001) are associated with lower odds of procedure success. Higher housing costs (OR: 0.86 [0.75, 0.97], p=0.04) are associated with decreased adverse events, after adjusting for age and sex.

Conclusions

The findings of this study suggest socioeconomic differences may influence ERCP outcomes and should be further investigated in prospective studies.

Funding Agencies

None