bluuebunny/crossref_metadata_2025 huggingface dataset:
A52 SEX DIFFERENCES IN POST-INFLAMMATORY VISCERAL PAIN IN A MOUSE MODEL OF INFLAMMATORY BOWEL DISEASE (IBD)
Authors: Arzamendi M , Shute A , Chan R , Defaye M , Altier C , Sharkey K A , Geuking M B , Nasser Y
Published: March 2023

Background

Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the gastrointestinal tract. Despite achieving endoscopic remission, up to 50% of IBD patients continue to experience chronic abdominal pain, with female patients displaying an increased prevalence. The reason underlying these differences in pain perception is unknown, but the influence of sex hormones represents an important biological source for variability in pain sensitivity. To date, few studies have examined sex differences in chronic visceral pain in IBD.

Purpose

Examine sex-specific differences in post-inflammatory chronic visceral pain in IBD.

Method

We used the post-inflammatory DSS mouse model of chronic visceral pain. Ovariectomy was performed to study the effects of estrogen deficiency; sham surgery was performed as a control. Male, cycling female and ovariectomized female mice were given 2.5% DSS for five days and allowed to recover for 5 weeks. Somatic pain was evaluated using the hot plate and von Frey hair tests. Visceral pain was evaluated using the visceral motor reflex (VMR) to colorectal distension five weeks after DSS treatment. Visceral and somatic pain testing in cycling females was performed in diestrus.

Result(s)

Male, cycling female and ovariectomized female mice given DSS initially lost weight when compared to controls (p<0.0001). Cycling females displayed significantly decreased colitis severity when compared to males [Disease Activity Index at Day 12: 1.41 ± 0.41 cycling females, n=12; 4.41 ± 0.31 males, n=12; p<0.001] but increased severity compared to ovariectomized females [Disease Activity Index at Day 12: 2.0 ± 0.41 ovariectomized females, n=13; 4.77 ± 0.6 cycling females, n=13, p=0.0005]. Increased visceral hypersensitivity was seen in post-inflammatory cycling females compared to post-inflammatory males [VMR at 60mmHg, post-inflammatory cycling females 0.10 ± 0.016, n=10; post-inflammatory males 0.07 ± 0.007, n=10; p=0.032] and post-inflammatory ovariectomized females [VMR at 60mmHg, post-inflammatory sham females 0.072 ± 0.005, n=8; post-inflammatory ovariectomized females 0.047 ± 0.005, n=8; p=0.019]. Thermal hyperalgesia and mechanical allodynia were similar across all groups.

Conclusion(s)

These data suggest that estrogen plays an important role in the severity of colitis severity and post-inflammatory visceral pain. Understanding sex-specific differences in post-inflammatory visceral pain in IBD may allow us to define novel therapeutic approaches for IBD patients.

Disclosure of Interest

None Declared
A59 GLOBAL PROTEOMIC PROFILING OF HUMAN COLONOID MONOLAYERS UNDERGOING IN VITRO CHRONIC DAMAGE
Authors: Sandilya S , Steiner T , Lange P , Rees W
Published: March 2023

Background

An in vitro damage model has been established in our lab using human colonoids grown as 2D monolayers. Upon being subjected to repeated rounds of air-liquid interface (ALI) growth and injury by submergence, these colonoid monolayers lost their barrier integrity and regrowth potential. Changes in mRNA expression and DNA methylation in genes from this human model of injury were similar to those that occur in Inflammatory Bowel Disease (IBD) and colon cancer. Significant morphological changes were observed in these monolayers after they were subjected to subsequent rounds of submergence injury, compared to when they were differentiated in ALI.

Purpose

Submergence injury is predicted to be involved in unfolded protein response (UPR) activation which can specifically alter translation. Hence proteomics studies will help undertand these changes.

Method

To determine if these changes are mirrored in the proteomes of damaged colonoids, we employed a Single-Plot, Solid-Phase-enhanced Sample Preparation (SP3) technology for Mass Spectrometry (MS) based proteomics analysis to characterize these monolayers at baseline, once they were differentiated in ALI, after one and five rounds of injury after differentiation in ALI, and after stimulation with the Toll-like receptor 5 (TLR5) agonist FliC. Hierarchical clustering, enrichment analysis, volcano plot analysis after pre-processing and normalization of the proteomics data set revealed differentially expressed proteins across various groups of monolayers.

Result(s)

Preliminary proteomic data analysis revealed changes in the profile of proteins involved in cellular differentiation, mitochondrial proteins, hypoxia upregulated proteins, those responsible for the maintenance and reorganization of the cytoskeletal structure and Golgi structure. These changes in protein profile may account for the significant morphological changes observed in these monolayers when subjected to submergence injury. Some outliers in monolayers subjected to microbial stimulation included proteins involved in regulation of extracellular matrix dependent motility and components of Adaptor Protein Complexes. Further studies are needed to ascertain if these account for the protective effect of FliC on these monolayers.

Conclusion(s)

This study suggests that the submergence injury to these healthy human derived colonoid monolayers leads to changes in their protein profile which mirror those seen in case of acute and chronic inflammation like IBD and colon cancer. It corroborates with the findings of gene expression and epigenetic analyses using the in vitro model established in our lab.

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CCC

Disclosure of Interest

None Declared
A74 URGENCY FOR BOWEL MOVEMENTS IS A HIGHLY DISCRIMINATORY SYMPTOM FOR ACTIVE DISEASE IN PERSONS WITH IBD (THE MANITOBA LIVING WITH IBD STUDY)
Authors: Kulyk A , Shafer L A , Graff L A , Stone J , Witges K , Targownik L E , Bernstein C
Published: March 2023

Background

The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity.

Purpose

We aimed to assess the prevalence of symptoms, and examine which symptoms are most associated with disease activity as measured by a symptom index and objective measure of inflammation.

Method

The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly Inflammatory Bowel Disease Symptom Inventory (IBDSI) surveys. Relative risks (RR) (with 95% confidence interval (CI)), positive and negative predictive values (PPV, NPV), and area under receiver operator curve (AUC) were reported for each symptom to predict active disease defined as: (1) active IBDSI, (2) self-reported flare, and (3) elevated fecal calprotectin (FCAL) (>250µg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn’s disease (CD) and ulcerative colitis (UC)).

Result(s)

In total, 69.2% of participants were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all 3 disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). Absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV, RR and AUC across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR in men = 3.5, 95% CI 1.2-9.9, RR in women = 1.8, 95% CI 1.2-2.7, AUC in men = 0.73, 95% CI 0.59-0.84, AUC in women = 0.65, 95% CI 0.56-0.72), as did blood in stool in females with UC (RR = 1.8, 95% CI 1.2-2.7). In men with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of elevated FCAL in females with CD.

Conclusion(s)

Fatigue was the most prevalent symptom irrespective of disease activity. Urgency stood out as being consistently associated with disease activity, irrespective of the disease measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD.

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None

Disclosure of Interest

None Declared
A92 FEMALE AUTHORSHIP IN GASTROENTEROLOGY RANDOMIZED CONTROL TRIALS: 2011 - 2021
Authors: Liu C S , Lin Z X , Kroeker K
Published: March 2023

Background

Although tremendous strides have been made in the participation of women in medicine, female continues to be underrepresented in leadership positions and higher-level academic medicine. An important factor in determining career advancement in academic medicine is the quality and quantity of an individual’s scholarly publications. To date, no study has looked at female authorship in gastroenterology (GI) randomized control trials (RCTs), which remains the gold standard for evaluating intervention effectiveness.

Purpose

The primary outcome is to assess female authorship in gastroenterology randomized control trials from 2011 to 2021, and the secondary outcome is to assess female authorship within GI subspecialty RCT publications.

Method

In this observational study, the gender of the first and last author of gastroenterology RCTs from January 1, 2011 to December 31, 2021 was assessed. Python (v3.8.12) was used to extract publication data from PubMed. A validated algorithm, genderize.io, was used to determine gender. Author first names that cannot be determined by the algorithm were manually searched on publicly-available profiles.

Result(s)

A total of 5690 original gastroenterology RCTs were included from January 1, 2011 to December 31, 2021. The gender of the first and senior authors of the papers was determined for 5668 (99.6%) first authors and 5656 (99.4%) senior authors. Overall, 1937 (34.1%) of the first authors and 1138 (20.0%) of senior authors were female.

There was an increase in the proportion of female first authors over the past decade, from 25.4% in 2011 to 37.8% in 2021 (p<0.05). For senior authors, there was a more gradual increase in female authorship from 14.2% in 2011 to 21.6% in 2021 (p<0.05). (Figure 1)

Within GI subspecialties, 612 RCTs were included for inflammatory bowel disease, 1143 RCTs were included for hepatology, and 1856 RCTs were included for therapeutic endoscopy from January 1, 2011 to December 31, 2021. Further analysis will be performed to determine the gender trend for GI subspecialties.

Image

Conclusion(s)

Female authorship in gastroenterology RCTs has increased from 2011 to 2021, although the rate of senior authorship has increased to a slower extent compared to first authors. Across all years, female authorship in gastroenterology RCTs has been lower than males.

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None

Disclosure of Interest

None Declared
A112 MEASURING COLORECTAL POLYP SIZE USING A NOVEL VIRTUAL SCALE FUNCTION DURING ENDOSCOPIES: A CLINICAL PILOT STUDY
Authors: Djinbachian R , Zarandi-Nowroozi M , Taghiakbari M , von Renteln D
Published: March 2023

Background

Although accurate polyp size measurement is essential for adequately managing patients, we still rely on the endoscopists' subjective visual estimation of polyp size in routine practice.

Purpose

We therefore conducted a clinical pilot study to evaluate relative accuracy of measuring colorectal polyp size during live colonoscopies using a novel virtual scale endoscope (VSE) that superimposes a virtual linear or circular ruler onto objects in the endoscopist's field of view.

Method

We conducted a pilot phase 1 study to evaluate the relative accuracy of VSE for polyp size measurement. We measured polyp size from fresh polypectomy specimens before formalin fixation using a digital vernier caliper. These reference measurements were compared to visual size estimations and VSE measurements obtained during live colonoscopies. The primary outcome was the relative accuracy of visual size estimation versus size estimation using VSE. The secondary outcome was the percentage of measurements that fall within 25% of true polyp size.

Result(s)

43 patients (mean age: 63.3 years; 44.2% male) undergoing screening, surveillance, or diagnostic colonoscopies were included in the pilot study. Colonoscopies were performed by two endoscopists, including one trainee and one staff gastroenterologist. Visual, VSE, and reference size measurements was performed for 17 polyps. VSE during live colonoscopies had a higher relative accuracy of polyp size measurements when compared with visual polyp size estimation 84.3% (95% confidence interval (CI) 77.22% to 91.41%) vs 69.3% (95%CI 61.13% to 77.39%) (p=0.005). The percentage of size measurements that were within 25% of sizes as measured by caliper were 41.2% for visual polyp size estimation and 88.2% for VSE (p=0.02).

Conclusion(s)

We found that a novel endoscope equipped with a virtual scale allowed for significantly higher accuracy in polyp size measurement. A prospective randomized controlled trial is currently underway to validate these results.

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Other

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Fujifilm

Disclosure of Interest

R. Djinbachian: None Declared, M. Zarandi-Nowroozi: None Declared, M. Taghiakbari: None Declared, D. von Renteln Grant / Research support from: Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, Fujifilm, and Pentax., Consultant of: Boston Scientific and Pendopharm,
A116 OPTIMIZING CROHN’S DISEASE ENDOSCOPIC SCORING OPERATING CHARACTERISTICS TO ASSIST WITH THE ADVENT OF ARTIFICIAL INTELLIGENCE
Authors: Galts C , Narula N , Wong E , Reinisch W
Published: March 2023

Background

To date, no studies have used Artificial Intelligence (AI) to produce standard endoscopic scores for Crohn’s Disease (CD). These scores are essential to clinical practice and have a major cost in clinical trials.

Purpose

We aimed to re-examine the components of the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and Modified Multiplier (MM-SES-CD) to see if scoring of individual colonic segments could be combined while maintaining predictive value accuracy, thus simplifying scoring for AI.

Method

Data from 279 participants in the UNITI and EXTEND trials as well as an infliximab biosimilar trial (NCT02096861) were used in this retrospective study. The primary outcome was endoscopic remission (ER-1) of the colon, defined as absence of ulcers. Secondary outcomes included alternative definitions of colonic endoscopic remission including SES-CD score of 0 (ER-2), SES-CD <3 (ER-3), and SES-CD reduction by 50% or greater from baseline (colonic endoscopic response).

Result(s)

The mean baseline SES-CD score was 13.7 (SD 7.7) and the mean MM-SES-CD score was 22.8 (SD 12.4). Among all possible colonic segment combinations, the combination of Right + Rectum + worst of Left or Transverse performed best for prediction of one-year ER-1, with fair accuracy (AUC 0.71, 95% CI 0.65-0.78, p < 0.0001). Accuracy of prediction of one-year ER-2 was poor (AUC 0.68, 95% CI 0.62-0.75, p < 0.0001), ER-3 was fair (AUC 0.71, 95% CI 0.65-0.77, p < 0.0001), and prediction of endoscopic response was poor (AUC 0.64, 95% CI 0.56-0.72, p > 0.01). These results were very similar to conventional scoring (without combining any “worst of” segments) with all of the colonic MM-SES-CD scores, with AUCs of 0.70, 0.69, 0.71, and 0.61 for the respective outcomes. Assessing only for the presence of ulcers was as accurate as the full assessment and exclusion of scoring stenosis had minimal impact on scores.

Image

Conclusion(s)

By combining assessment of colonic segments accuracy was maintained compared with currently used endoscopic scoring. Assessing for features other than ulceration had no significant impact on overall scores. By combining colonic segments and limiting assessment to ulceration, it may be simpler to develop AI algorithms reliably scoring endoscopic severity of CD for clinical practice and trials.

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None

Disclosure of Interest

None Declared
A120 ENDOSCOPIC CLOSURE TECHNIQUES FOLLOWING ACUTE IATROGENIC PERFORATION -- AN UPDATED SYSTEMATIC REVIEW
Authors: Buttar J , Enns R , Lam E , Shahidi N
Published: March 2023

Background

Iatrogenic perforation is arguably the most feared adverse event associated with endoscopy. Current American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastroenterology Endoscopy (ESGE) guidelines recommend endoscopic closure as the first-line treatment strategy. Historically, this has been achieved using through-the-scope clips (TTSC). Given the emergence of alternative endoscopic closure techniques including over-the-scope clips (OTSC) and endoscopic suturing, we sought to provide an updated review of the literature.

Purpose

To review endoscopic closure techniques following iatrogenic perforation during screening or therapeutic endoscopy.

Method

Based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, an electronic search of MEDLINE and EMBASE from June 1st, 1946 – Oct 10th, 2022 was performed. Inclusion criteria was limited to English full-text original citations, with case reports, and cohorts with < 3 patients excluded. Our primary objective was to assess complete defect closure after attempted endoscopic treatment. Outcomes were stratified by modality (TTSC, OTSC, endoscopic suturing) and chronologically based on a previous well received systematic review.

Result(s)

A total of 2549 citations were identified in our electronic search, of which 34 were included representing 830 perforations. Overall, successful endoscopic closure was achieved in 763 cases (91.9%). When stratified by endoscopic closure techniques, range estimates for successful endoscopic closure was 71% – 100%, 57% - 100%, and 100% for TTSC, OTSC and endoscopic suturing respectively. When stratifying chronologically, an improvement in TTSC closure was identified.

Conclusion(s)

Endoscopic defect closure, including TTSC, OTSC and endoscopic suturing, are effective in the management of iatrogenic perforations with increasing TTSC performance over time. It remains the primary treatment strategy for iatrogenic perforation.

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None

Disclosure of Interest

None Declared
A122 MINIMALLY INVASIVE ENDOSCOPIC RESECTION TECHNIQUES FOR ANORECTAL JUNCTION NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Arif A A , Donaldson K , Qian H , Lam E , Shahidi N
Published: March 2023

Background

The management of neoplastic lesions at the anorectal junction remains debated. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) have emerged as the primary endoscopic modalities of choice.

Purpose

We sought to compare the performance of ESD and EMR in resection of anorectal neoplasia.

Method

Two authors independently searched MEDLINE, EMBASE and Cochrane Libraries (Jan 2000 – Aug 2021) for citations evaluating the performance of endoscopic resection techniques (ESD, EMR) for lesions involving the anorectal junction (defined as within 20mm of the dentate line). The frequencies and 95% confidence intervals (95% CI) of technical success (complete removal of all neoplastic tissue at index procedure), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, recurrence and referral to surgery were assessed using random-effects modelling.

Result(s)

We included 11 studies (total 563 patients: 414 ESD, 149 EMR) of which nine were ESD and two were EMR studies. Technical success was achieved in 97.2% overall (95% CI 94.8%-98.5%, ESD 97.5% and EMR range 93.9%-98.0%). Clinically significant post-endoscopic resection bleeding occurred in 4.3% (95% CI 1.6%-11.1%, ESD 3.0% and EMR range 8.2%-11.0%). Delayed perforation was not identified. Recurrence at first screening colonoscopy occurred in 4.8% (95% CI 1.9%-11.7%, ESD 3.0% and EMR range 15.4%-18.4%). Referral to surgery for any reason occurred in 5.9% (95% CI 4.3%-8.0%, ESD 6.9%, EMR range 2.0%-3.0%).

Conclusion(s)

ESD and EMR demonstrate high frequencies of technical success but may have different rates of adverse events and recurrence. More studies investigating lesions at the anorectal junction should be conducted including head-to-head analyses between ESD and EMR for low-risk anorectal junction neoplasia.

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None

Disclosure of Interest

None Declared
A125 TANDEM STUDY DESIGN IS LESS LIKELY TO DEMONSTRATE IMPROVED ADENOMA DETECTION RATE THAN PARALLEL STUDY DESIGN IN THE ASSESSMENT OF ARTIFICIAL INTELLIGENCE-ASSISTED COLONOSCOPY
Authors: Lee M C , Jeyalingam T , Parker C H , Liu L W
Published: March 2023

Background

Randomized controlled trials have reported that artificial intelligence (AI) improves adenoma detection rate (ADR). Different methodologies, namely parallel and tandem study designs, have been employed to evaluate the efficacy of AI-assisted colonoscopy in randomized controlled trials. In systematic reviews and meta-analyses, a pooled effect that includes both study designs have been reported. However, it is unclear whether there are inconsistencies in the reported results of these two designs.

Purpose

To determine if there are differences in ADR using AI-aided technologies during colonoscopy between parallel and tandem study designs

Method

A systematic search of Ovid MEDLINE (1946 to October 2022) and EMBASE (1947 to October 2022) for randomized controlled trials comparing AI-assisted colonoscopy with routine high-definition colonoscopy in polyp detection was conducted. Reference lists of systematic reviews were searched for additional studies. The publications were divided based on trial design: parallel vs. tandem. Analysis was conducted using Review Manager 5.4.1 using a random effects model.

Result(s)

The search identified 540 articles. After screening the title and abstract for relevance, 19 randomized controlled trials involving a total of 14 657 patients were included for full-text review. Fourteen were parallel studies (14 136 patients) and 5 were tandem studies (521 patients). ADR was reported in 17 studies, and there was overall improvement in ADR with AI-assisted colonoscopy (risk ratio [RR] 1.33, 95% CI 1.22-1.44; p<.0001). Based on a separate pooled analyses of 13 parallel studies and 4 tandem studies, ADR significantly improved with AI assistance compared to routine colonoscopy, regardless of study design (RR 1.35, 95% CI 1.24-1.47 and p<.0001; RR 1.15, 95% CI 1.03-1.28; p=0.02, respectively). A significant increase in ADR with AI assistance were found in 84.6% (11/13) of parallel design studies, but in only 25% (1/4) of tandem studies.

Image

Conclusion(s)

AI assistance during colonoscopy significantly increased ADR in both parallel and tandem studies; however, improvement in ADR was less likely to be seen in tandem compared to parallel studies. It remains unclear why this difference exists, but some hypotheses include smaller sample sizes in the tandem studies, significant heterogeneity in the tandem design, and differences in operator bias depending on study design. Better understanding the differences in these study designs will inform future studies of new endoscopic technologies.

Disclosure of Interest

None Declared
A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW
Authors: Sabrie N , Seleq S , Homsi H , Khan R , Gimpaya N , Bansal R , Scaffidi M , Lightfoot D , Grover S
Published: March 2023

Background

Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy.

Purpose

To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally.

Method

We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form.

Result(s)

From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained.

Image

Conclusion(s)

There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy.

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None

Disclosure of Interest

None Declared
A197 INVESTIGATING THE PROTON-PUMP INHIBITOR USE PRECEDING AND POST AN INFLAMMATORY BOWEL DISEASE DIAGNOSIS
Authors: Singh N , Nugent Z , Singh H , Shaffer S , Bernstein C
Published: March 2023

Background

Proton-pump inhibitors (PPI) have an impact on gut microbiome. The use of PPI has increased since the late 1980s and between 2007-2017, there were nearly 59 million PPIs dispensed annually in France.1 Considering that inflammatory bowel disease (IBD) affects persons of all races, a disease trigger for IBD may be a factor that can directly alter the intestinal immune response, or indirectly through changes in the gut microbiome. This raises the possibility that the advent use of PPI may be associated with the worldwide rise in IBD.

Purpose

We investigated whether increased use of PPI was associated with a diagnosis of IBD.

Method

The University of Manitoba IBD Epidemiology Database includes all Manitobans diagnosed with IBD between 1984 to 2018 with age, sex and geography-matched controls and comprehensive prescription drug data from April 1995. Subjects were considered to be users if they received 2 prescriptions of PPI. We assessed PPI prescriptions pre-diagnosis and for 3-years post-diagnosis of IBD. The absolute and relative rates were calculated and compared for PPI use pre- and post-IBD diagnosis.

Result(s)

A retrospective analysis was completed by analyzing 5920 subjects that were diagnosed with IBD after April 1996. Rates of PPI use in controls increased gradually from 1.5 to 6.5% over 15-years. Persons with IBD have a higher rate of PPI use peaking up to 17% within 1-year of IBD diagnosis with a rate ratio (RR) of 3.1 [95% CI 2.9 – 3.3]. Furthermore, persons with Crohn’s disease (CD) [RR= 4.2; 95% CI 3.7 – 4.6] were more likely to have been PPI users pre-diagnosis than persons with ulcerative colitis [RR= 2.4; 95% CI 2.2 – 2.7]. Important predictors of increased PPI use were older age, year of data collection and CD diagnosis.

Conclusion(s)

This retrospective analysis showed an increase in PPI use over the past 20-years among all Manitobans. Persons with IBD have higher PPI use within 1-year of their IBD diagnosis. It is possible that persons with IBD have an increase in acid peptic diseases or alternatively, the use of a PPI alters the gut microbiome increasing the risk for IBD diagnosis, or that some IBD symptoms are treated with PPI whether warranted or not. Future studies are needed to delineate whether the indication for ongoing PPI use is appropriate.

References:

1Lassalle M, Le Tri T, Bardou M, et al. Use of proton pump inhibitors in adults in France: a nationwide drug utilization study. Eur J Clin Pharmacol. 2020;76(3):449-457.

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None

Disclosure of Interest

None Declared
A211 CAN AN EXPERIMENTAL MOUSE MODEL BE USED TO CHARACTERIZE BEHAVIOURAL COMORBIDITIES ASSOCIATED WITH INFLAMMATORY BOWEL DISEASES?
Authors: Josephson J , Barnett J , Chiang H , Gibson D
Published: March 2023

Background

Inflammatory Bowel Diseases (IBD) are increasing globally with westernized countries experiencing a dramatic increase in cases of ulcerative colitis and Crohn’s disease. The corresponding rise in the comorbidities of anxiety and depression are linked to inflammation and microbiome dysbiosis; impacting the gut-brain axis (GBA). Another facet of the GBA are the tryptophan metabolites serotonin (5HT) and kynurenine (Kyn). 5HT and Kyn are metabolites implicated in anxious behaviours and memory deficiencies with dysbiosis influencing metabolite production. In inflammatory conditions, upregulation of Kyn impacts brain homeostasis as Kyn has both positive and negative brain metabolites. As disease outcomes are tied to the severity of depression/anxiety, characterization of the behavioural and tryptophan metabolite profile of an IBD model can allow us to develop better IBD therapies.

Purpose

To characterize the anxiety and memory phenotype with corresponding assessment of tryptophan metabolites 5HT and Kyn across tissues of interest in an spontaneous colitis model.

Method

Mucin 2 knockout mice (Muc2-/-) lack the protective mucin 2 layer in the distal colon, allowing for direct contact between the gut contents and the gut epithelial layer. Over time this contact results in the development of spontaneous colitis. Muc2-/- n=12 per sex were compared to C57Bl/6 mice for behaviour and tryptophan metabolites across brain, colon and serum. Open Field Test and Light/Dark tests were used to assess anxiety levels, Novel Object and Radial Arm maze were performed to assess memory deficits. Mice underwent one anxiety and one memory test and were euthanized following their last maze. Enzyme-linked immunosorbent assay (ELISA) assessment of 5HT and Kyn were performed on brain, colon and serum samples. T-tests were performed and graphs created using PRISM (v9.4.1).

Result(s)

Muc2-/- mice had decreased anxiety (p=0.0113) compared to C57Bl/6 wild type mice in the light/dark maze. Muc2-/- displayed no significant differences in novel object preferences or the number of memory errors in novel object recognition test and radial arm maze respectively. Serum kynurenine was found to be significantly elevated (p=0.0444) in Muc2-/- mice. The sex factor has to be mentioned here in the results not in the conclusions.

Conclusion(s)

IBD is increasing globally and problems with mental health is often comorbid. Within our model we were able to show that behavioural and biochemical differences do exist between our Muc2-/-and wild-type mice with depressed anxiety responses and heightened serum kynurenine, however the implications of these findings require further investigation. Understanding how inflammation is driving behavioural alterations can provide pathways to ameliorate the behavioural comorbidities in IBD patients suffering from anxiety of memory deficits.

Disclosure of Interest

None Declared
A234 PARASITIC INFECTION MIMICKING CROHN'S DISEASE: AN UNUSUAL PRESENTATION OF LOWER GASTROINTESTINAL SCHISTOSOMIASIS
Authors: Vantomme E , Jin J
Published: March 2023

Background

Chronic intestinal schistosomiasis (CIS) is a disease caused in humans by infection with one of seven schistosome species. These species are predominantly found in Africa, South America, and East Asia. Symptoms of CIS include abdominal pain, anorexia, weight loss and diarrhea. In cases of large parasitic burden, overt gastrointestinal bleeding can occur. To our knowledge there are only three other cases of CIS mimicking Crohn's Disease that have been published in the literature. In each of these cases, this was associated with ileal disease, perianal fistulas, or both.

Purpose

We present the first case of CIS in North America that mimicked Crohn's Disease on imaging with no associated ileal or visible perianal disease.

Method

Case report of a patient presenting to a tertiary care hospital in Edmonton, Alberta.

Result(s)

A 47 year old man who recently immigrated from Eritrea presented to the emergency department in June 2020 with red blood per rectum. Digital rectum exam revealed small external hemorrhoids. He was discharged with a plan for outpatient abdominal CT scan and colonoscopy. He presented again to the emegency department in January 2021 where he complained of back pain exacerbated by bowel movements productive for small, hard stool. He also began seeing white discharge mixed with his stool. His back pain, white discharge, and blood-streaked bowel movements persisted for over a year, and he developed perianal pain that was exacerbated by valsalva. A CT scan of the abdomen/pelvis revealed extensive soft tissue swelling in the anorectal region, extraluminal gas, and a 15mm fluid collection adjacent to the coccyx. A diagnosis of fistulizing Crohn's Disease was suspected. A digital rectal exam and colonoscopy were performed September 19, 2022 which revealed small hemorrhoids but otherwise endoscopically normal colonic and ileal mucosa. Biopsies from the rectum revealed eosinophilic granulomas associated with parasitic ova; a diagnosis of schistosomiasis was made.

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Conclusion(s)

CIS is a rare diagnosis in North America. It is unusual for this disease entity to present is a mimic of fistulizing Crohn's Disease. This case report reminds the clinician that a high index of suspicion in patients presenting from endemic regions is required to make this diagnosis.

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A236 ENDOSCOPIC MANAGEMENT OF RARE JEJUNAL SOLITARY PEUTZ-JEGHERS-TYPE POLYP IN AN ELDERLY PATIENT WITHOUT A POLYPOSIS SYNDROME: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Alenezi T , Bessissow T , Marcus V
Published: March 2023

Background

Solitary Peutz-Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered as a different entity from Peutz-Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP are susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction.

Purpose

We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy

Method

An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels, who presented with 1-week history of melena, generalized fatigue and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, double balloon enteroscopy detected a 4 cm polyp with stalk in the proximal jejunum. Endoscopic polypectomy was performed and the whole polyp was removed. Histopathological examination was consistent with Peutz-Jeghers polyp. The oropharyngeal and skin examination was negative for mucocutaneous hyperpigmented macules and the genetic analysis was negative for STK11 mutation. Follow up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient’s symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months.

Result(s)

To our knowledge this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP.

Conclusion(s)

Conclusion

Solitary Peutz-Jeghers hamartomas are a rare occurrence but should be part of the differential diagnosis for abdominal pain from intussusception, or small bowel bleeding even in elderly patient. Balloon assisted enteroscopy is a valuable technique for the management of solitary small bowel lesions.

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None

Disclosure of Interest

None Declared

LIVER AND BILIARY DISEASE
A263 MODULATION OF THE GUT MICROBIOTA TO PREVENT LOCAL ANASTOMOTIC TUMORS AND DISTANT METASTASIS IN COLORECTAL CANCER SURGERY
Authors: Hajjar R , Ajayi A S , Oliero M , Fragoso G , Alaoui A A , Cuisiniere T , Gerkins C , Calvé A , Vennin Rendos H , Richard C , Santos M M
Published: March 2023

Background

Colorectal cancer (CRC) recurrence is a leading cause of mortality worldwide. It has been suggested that poor anastomotic healing and leakage (AL) after surgery allows cancer cells to implant at the anastomotic site thereby increasing the risk of local cancer recurrence and metastatic spread in the peritoneum and to extraintestinal organs. We have previously showed that inulin, a well-known prebiotic, improves anastomotic healing and strengthens the gut barrier.

Purpose

The objective of the this study was to investigate the relationship between the promotion of postoperative intestinal healing using inulin and local and distant cancer recurrence.

Method

A 10-years' retrospective review of AL and non-AL cases after CRC surgery was performed in our institution. The effect of dietary supplementation with inulin on the occurrence of local anastomotic tumors was assessed in a mouse model inoculated with tumor cells directly in the gut lumen after colonic surgery. We also investigated in mice whether inulin may prevent metastatic spread and growth of tumor cells in the liver by transplanting CRC cells surgically into the spleen.

Result(s)

Patients experiencing AL displayed significantly lower overall survival and more cancer recurrence and progression compared to non-AL patients. Poor anastomotic healing in mice led to larger anastomotic tumors and peritoneal cancer dissemination. Inulin supplementation significantly inhibited local tumor implantation at the anastomotic site, and metastatic spread to the peritoneum and liver. Inulin increased the production of beneficial short-chain fatty acids, reinforced the gut barrier function and alleviated systemic inflammation in mice.

Conclusion(s)

Anastomotic leak was associated with worse oncological outcomes in patients and mice. Inulin was shown to reinforce the gut barrier, decrease the implantation of cancer cells at the anastomosis, and to prevent tumor dissemination and progression of liver metastasis. This paves the way toward future clinical trials in which such supplementation may be used to promote better oncological outcomes.

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CIHR, Other

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CRS, FRQS

Disclosure of Interest

None Declared
A278 SEX DIFFERENCES IN THE EFFECT OF THE MICROBIOTA FROM IRRITABLE BOWEL SYNDROME PATIENTS ON ABDOMINAL PAIN
Authors: Bennett A , Baker C , Guzman-Rodriguez M , Jimenez-Vargas N , Vanner S , Reed D , Lomax A
Published: March 2023

Background

Irritable bowel syndrome (IBS) is a chronic abdominal pain disorder that affects women twice as often as men. The gut microbiota has been implicated as a key player in the modulation of abdominal pain in IBS. Given this, we hypothesised that the production of pro-nociceptive mediators within the gut lumen are increased in females, and this contributes to the female predominance of IBS.

Purpose

Compare the effects of FS from male and female IBS patients on abdominal pain pathways and identify the impact of female mouse estrous cycle on abdominal pain.

Method

Fecal supernatants (FS) were perfused through murine colonic preparations while performing extracellular colonic afferent nerve recordings to measure changes in action potential frequency in response to colonic distension. Phase of estrous cycle in female mice was determined through vaginal swabs. FS from male and female IBS patients reporting low, moderate, and high levels of abdominal pain were used.

Result(s)

FS from female IBS patients (N=6) increased afferent nerve discharge (p < 0.05) whereas FS from male IBS patients has no effect (N=4). However, single unit analysis of nociceptive axons revealed that male IBS FS increased nociceptor activity in female mice taken during the proestrus/estrus stage (p < 0.05), but not female mice taken during the metestrus/diestrus stage or male mice. Further investigation found that IBS FS from female patients with high abdominal pain (N=6), but not patients with moderate (N=5) or low pain (N=3), increased visceral afferent nerve discharge by 70%. Single unit analysis of nociceptive axons showed that their activation was increased by almost 50% following FS perfusion from high abdominal pain patients only (p < 0.05). Histamine concentrations and proteolytic activity are increased in FS from female IBS patients with high abdominal pain compared to male IBS patients.

Conclusion(s)

This work suggests that luminal mediators that impact abdominal pain are increased in female IBS patients compared to male IBS patients, and females appear to be more sensitive to their pro-nociceptive effects. Together, these sex differences may contribute to the female predominance of IBS.

Disclosure of Interest

None Declared
A281 GASTROPARESIS AND FUNCTIONAL GASTROPARESIS IN YOUNG CANADIAN WOMEN: A DETAILED PRACTICE REVIEW IN LONDON, ONTARIO
Authors: Han Y , McIntosh K S , Rahman A N
Published: March 2023

Background

Gastroparesis is a chronic clinical syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction causing symptoms such as nausea, vomiting, and abdominal pain. This condition is heterogenous in its severity and the resulting impact on individuals who experience this diagnosis. Patients with severe gastroparesis symptoms can require extensive pharmacologic and nutritional therapies.

Purpose

We hope to identify young women (age<50) experiencing gastroparesis in local gastroenterology clinics to describe a group of patients requiring extensive therapeutic support suggestive of a severe subset of this condition.

Method

Mutual patients with a diagnosis of gastroparesis between a London motility clinic and nutrition clinic were identified. Key patient characteristics including current age, age at diagnosis, current BMI, gastric emptying scan results, the number of prokinetic/anti-constipation/anti-emetic medications ever used, the presence of opioid use, the use of outpatient IV access/IV fluids, the placement of a feeding tube, and the use of total parental nutrition were recorded through a retrospective chart review. Descriptive analyses were performed on the recorded data.

Result(s)

A total of 26 patient charts were reviewed and 11 patients meeting inclusion criteria were included in the analysis. The mean age was 32.7y, the mean age at gastroparesis diagnosis was 28.5y, and the mean body mass index was 22.9kg/m2. Eighty-two percent of these patients have had a gastric emptying scan to confirm their diagnosis, and 36% of them have experienced multiple scans. The mean gastric emptying half-time was 231 minutes and the mean retained gastric content at 4 hours post-ingestion was 39.5%. The mean number of motility medications ever used was 2.2, the mean number of anti-constipation medications ever used was 2.1, and the mean number of anti-emetic medications ever used was 1.5. Fifty-five percent were prescribed opioid medications. The majority of patients identified required advanced nutritional strategies including 45% requiring outpatient IV access and IV fluid hydration, 55% ever using TPN, and 73% ever using a feeding tube.

Conclusion(s)

We are encountering an increasing number of gastroparesis patients who require intensive therapy and resource allocation. These patients outline the need for further health resources and integration of care from practitioners across multiple disciplines for optimal management.

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None

Disclosure of Interest

None Declared
A289 EXPLORING THE LIVED EXPERIENCES OF ADULT USING HOME ENTERAL NUTRITION AND THEIR CAREGIVERS: A QUALITATIVE SYSTEMATIC REVIEW
Authors: Sandhu R , Elliott T , Engbers J , Edwards T , Hussain W , Johnson C , Pawliw T , Kassam R
Published: March 2023

Background

Home enteral nutrition allows individuals to receive food and water through a tube at home when they are unable to meet their needs by mouth. To date, systematic literature reviews to date have focused on specific insertion methods, coordinated community care models, and prophylactic vs. reactive use. Few qualitative systematic reviews exist and those that do have only explored the lived experiences of sub-populations of adults using home enteral nutrition, such as those with head and neck cancers. Given healthcare services often serve adult home enteral nutrition populations with various underlying conditions, a synthesis describing the lived experiences of all adult using home enteral nutrition and caregivers is needed.

Purpose

To conduct a meta-aggregation systematic review to evaluate lived experiences of home enteral nutrition in adult users and their caregivers.

Method

A systematic search of Medline, PsychINFO, EmBase and CINAHL was conducted September 2021. Only studies with a full-text and published in English were included. Study quality was assessed using the Johanna Briggs Institute meta-aggregation methodology. Details of the study design, participants, and experiences were recorded, and themes across all studies collatedCollated themes were reviewed with a team of healthcare providers, home enteral nutrition users and a caregiver to ensure trustworthiness.

Result(s)

A total of 38 studies representing 702 participants were included. Using the meta-aggregative approach, three different synthesized findings were identified: (1) positive experiences, (2) negative experiences, and (3) facilitators and coping mechanisms. While, overall, the findings reported more negative experiences than positive experiences, users and caregivers who had developed coping mechanisms or had access to supportive services tended to share more positive experiences with home enteral nutrition. In contrast, those with few to no supports or coping mechanisms reported greater dissatisfaction and negative experiences.

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Conclusion(s)

Home enteral nutrition impacts the lived experience of users and their caregivers. While more negative than positive experiences were reported by adults and their caregivers using home enteral nutrition, overall, they still view home enteral nutrition as a positive intervention if they are adequate supported or developed adequate coping mechanisms. It is imperative that healthcare providers working with adults using home enteral nutrition explore and understand their patients’ and caregivers’ needs, in order to ensure community programs are designed to provide the necessary supports to maximize users experiences.

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None

Disclosure of Interest

None Declared

PANCREATIC DISORDERS