bluuebunny/crossref_metadata_2025 huggingface dataset:
A89 EXPLORING THE ENDOSCOPY SEDATION EXPERIENCES OF INDIVIDUALS WITH PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE (IBD) AFTER THE TRANSITION TO ADULT CARE: A PILOT STUDY
Authors: Bollegala N , Ramkissoon A , Mohmand Z
Published: March 2023

Background

Different sedation practices are utilized in pediatric and adult endoscopy settings. While pediatric endoscopies are performed under deep sedation, adult endoscopies are often performed under conscious sedation.

Purpose

This study sought to explore the experiences of patients with pediatric-onset IBD that have undergone transfer to adult care and to identify gaps in endoscopy sedation practices that may inform a larger and more comprehensive evaluation of this topic.

Method

A pilot study was performed at Women's College Hospital involving patients aged 18 to 25 years old with a diagnosis of pediatric-onset IBD that received endoscopies in both the pediatric and adult setting. Patients were recruited between June 1 and October 1, 2022. A 36-item questionnaire was distributed assessing sedation methods used in pediatric and adult settings, anxiety, pain, satisfaction during endoscopy and perceptions of transition of care preparation as it pertained to endoscopy. This study was reviewed by institutional authorities at WCH and was deemed not to require REB approval.

Result(s)

Twelve patients participated in the pilot survey study (7 Ulcerative colitis, 5 Crohn’s disease) with a mean age of 22. Of those, 100% were female and 66% did not have any comorbid conditions. The mean age of diagnosis was 12.8 years, with respondents spending an average of 67.3 months in pediatric care prior to transition. In pediatric care, the mean number of endoscopies received was 2.3 with a majority performed under deep sedation (83%). Respondents reported being very satisfied with their sedation experience (58%) and experiencing no pain (67%), however mild to severe anxiety was reported (58%). In adult care, mean endoscopies received was 2.1, with conscious sedation (50%) performed more often than deep (42%) or no sedation (8%). More respondents reported satisfaction with deep sedation (100%) than conscious sedation (67%). During conscious sedation, respondents experienced more pain (50% vs. 20%), moderate discomfort (33% vs. 0%), and were more anxious (83% vs. 60%) than in deep sedation. Factors that contributed to anxiety included fear of endoscopy and insufficient sedation. Of those who received deep sedation in the adult setting, 60% reported that the sedation method utilized impacted their future willingness for endoscopy. Lack of communication regarding sedation method, poor experiences with conscious sedation, and the desire to choose the sedation method appropriate for them were areas for improvement.

Conclusion(s)

This pilot study demonstrated that IBD patients transferred to adult care receive varying endoscopy sedation methods and experience differential levels of satisfaction favouring deep sedation. This is an important signal that requires larger study.

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None

Disclosure of Interest

None Declared
A90 IMPLEMENTATION OF NATIONAL GUIDELINES ON THE MANAGEMENT OF VACCINE PREVENTABLE ILLNESS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: PERCEIVED BARRIERS AND INTERVENTION FUNCTIONS AMONGST GASTROENTEROLOGISTS
Authors: Zhou F , Robar J , Stewart M , Jones J
Published: March 2023

Background

Vaccination uptake amongst patients with IBD remains suboptimal. Studies evaluating effectiveness of interventions designed to improve vaccine uptake have not assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI).

Purpose

The aim of this study was to identify barriers and facilitators for evidence-based management of VPI in IBD.

Method

A semi-structured interview was conducted with gastroenterologists. Interview questions were developed and guided by the COM-B and TDF evidence-based implementation science frameworks. A brief intake questionnaire was administered to collect participant demographic and clinical practice information. Gastroenterologists were recruited through direct local contact via email by the investigators. Sixty minute interviews were recorded and transcribed for data analysis. Using thematic analysis, codes from the study data will be generated to identify themes. The data will be categorized into the coding scheme and themes created using an inductive coding approach.

Result(s)

As of October 2022, 5 interviews were conducted. Mean participant age was 47.8 years, with 60% identifying practice in an urban/academic setting compared to a rural/community setting (20%). Preliminary major themes included 1) assessing vaccination status and recommending appropriate vaccines are the responsibility of the gastroenterologist 2) gastroenterologists need more support to administer vaccines in clinical practice 3) barriers to implementation of VPI guidelines include lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines and 4) intervention themes include use of clinical decision support tools embedded into the workflow of healthcare providers, need for support from allied healthcare providers, increased need for third party support, and more education/CME relating to management of VPI in clinical practice. Specific knowledge gaps include 1) uncertainty relating to what vaccines are covered financially 2) lack of knowledge of risk factors for specific VPI such as pneumococcus and meningococcus and 3) how to administer live vaccines in patients already on immunosuppressants.

Conclusion(s)

Preliminary qualitative themes suggest that although gastroenterologists acknowledge the importance of managing VPI in patients with IBD, perceived resource, policy, and educational barriers exist. The qualitative data from this study will be used to design and implement customized, evidence-based implementation strategies for managing VPI that are sensitive to the local environment.

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None

Disclosure of Interest

None Declared
A95 ASSESSMENT OF BIRTH COHORT SCREENING OF CHRONIC HEPATITIS C IN COLORECTAL CANCER SCREENING PATIENTS IN BRITISH COLUMBIA
Authors: Kaviani R , Chou F Y , He C B , Marquez V
Published: March 2023

Background

Birth cohort screening of chronic hepatitis C (CHC) is recommended in British Columbia since 2018 for baby boomers born between 1945 to 1964, with an estimated provincial prevalence of 2.31%. Though there remained a gap in care following anti-hepatitis C positivity, resulting in reflexive ribonucleic acid (RNA) testing provincially. Dual screening of CHC in patients referred to colorectal (CRC) screening programs can provide an opportunity to link patients with healthcare professionals to ensure appropriate follow-up.

Purpose

We aimed to assess the uptake of CHC screening amongst CRC screening patients after the release of British Columbia’s birth cohort guidelines, both pre and post-COVID-19 pandemic.

Method

A retrospective review of patients referred to a CRC screening program in Vancouver from October 1st to December 31st, 2019, and December 1st – 31st, 2021, was performed. Collected data included demographics, liver disease history, and co-infection rates with hepatitis B (HBV) or human immunodeficiency virus (HIV). Dates of first-time hepatitis C antibody, RNA and viral load testing were gathered. Descriptive statistics were used to identify the proportion of screening and prevalence of CHC.

Result(s)

A total of 553 patients were referred for colonoscopy to the CRC screening program, of whom 458 (82.8%) patients were born between 1945 to 1964, and 273 (n=49%) were female. Among the 250 (45.2%) patients screened for CHC, 4 (0.72%) had positive anti-hepatitis C, all of whom were baby boomers. In 2019, 44% (n=183) of patients were screened for CHC; 78.7% (n=144) were screened before colonoscopy referral. In 2020, 48.6% (n=67) of patients were screened for CHC; 100% of cases were screened before colonoscopy referral.

Conclusion(s)

Birth cohort screening of CHC is underutilized in British Columbia. Dual screening of CHC at the time of referral to CRC screening provides a practical approach to linking patients to healthcare.

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None

Disclosure of Interest

None Declared
A103 DESIGNING QUALITATIVE RESEARCH FOR UNDERSTANDING THE EXPERIENCES OF TRANGENDER AND GENDER DIVERSE PERSONS WITH GASTROINTESTINAL DISEASE OR SEEKING GASTROINTESTINAL CARE
Authors: Kariyawasam N , Newman K , Streed C G , Rizkalla L , Vélez C , Targownik L
Published: March 2023

Background

Transgender and gender diverse (TGD) people make up approximately 1% of the population, with 2.1% of Generation Z adults (born 1997-2003) identifying as TGD. As a marginalized population, TGD people have been shown to have poorer access to health care services and report worse health-related outcomes. While the health care disparities faced by TGD people need to be addressed by Medicine broadly, TGD people may face unique barriers in gastrointestinal (GI) care. To date, there has been no systematic assessment of the GI health care needs of TGD people. With the aging of Generation Z, GI care providers will increasingly be responsible for the care of TGD people, and it is important to understand their needs and experiences to ensure they receive appropriate and sensitive care.

Purpose

Recognizing the absence of literature on the issues faced by TGD people with GI disease or seeking care for GI issues, we plan to use qualitative research methodology to aggregate and analyze narrative experiences of TGD people of diverse backgrounds, identities and experiences. Our research will focus on TGD people’s interactions with GI care providers, and on the experience of being a TGD person with GI disease or having sought evaluation of GI symptoms.

Method

We will use a qualitative approach to gain a broad understanding of the experiences and perceptions of TGD people with: 1) established GI diseases, in particular IBD and DGBIs (disorders of gut-brain interaction), and 2) GI symptoms or concerns requiring GI investigations. We will use snowball sampling to reach out to TGD people in Canada and the US, with the aim of achieving diverse representation across gender identity, surgical status, age, race/ethnicity, and socioeconomic status. Participants will sit for semi-structured interviews to elicit narratives about their beliefs and experiences while living with GI disease and/or seeking care for GI issues. Interview transcripts will be subjected to objective and researcher-guided thematic analysis to identify commonalities and disparities in experiences and points-of-view.

Result(s)

Our proposed presentation will highlight our process in designing and initiating this project. We believe our methods and approach to this work is an important discussion and will help shape next steps in this field. We may also present some of the early results of our semi-structured interviews.

Conclusion(s)

This work will provide a foundation to guide further research into the process and outcomes of care for TGD people with GI disease and undergoing GI evaluations and will provide a framework to develop best practices for GI care providers pertaining to the care of TGD people.

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None

Disclosure of Interest

None Declared
A107 VISCERAL ADIPOSE TISSUE VOLUME DIFFERENTIATES BETWEEN FIBROSTENOTIC AND INFLAMMATORY CROHN’S DISEASE
Authors: Rosentreter R , Cheng E , Shen H , Ma C , Bhayana D , Panaccione R , Raman M , Medellin A , Lu C
Published: March 2023

Background

Creeping fat, a form of visceral adipose tissue (VAT) that wraps the intestinal wall, influences the formation of Crohn’s disease (CD) strictures. The degree of fat wrapping from intestinal stricture resections is correlated with the extent of chronic inflammation, fibrosis, stricture formation, and response to biologic therapy. VAT and subcutaneous adipose tissue (SAT) ratios from CTE (computed tomography) scans are elevated in CD strictures. However, the definition of strictures in these studies has been poorly defined and not included current well-recognized criteria: 1) bowel wall thickness (BWT), 2) narrowed luminal diameter, and 3) pre-stenotic dilation. (PSD).

Purpose

The objective of this pilot study was to assess the relationship of 2D and 3D VAT:SAT ratios with CT stricture parameters in patients with terminal ileal (TI) CD strictures.

Method

2D VAT:SAT ratios from CT’s of CD patients with TI strictures defined as increased BWT, narrowed luminal diameter (< 50% relative to normal adjacent distended loop), and PSD greater than the stricture diameter were retrospectively obtained from a database and chart review. CT’s from fibrostenotic CD patients were sex and BMI matched to patients with only TI inflammatory behaviour. Patient demographics, medication, smoking, and surgical history were also obtained. Analyses were adjusted for age, sex, and BMI covariates. Unpaired t-tests and multi-variable logistic regression analyses were conducted.

Result(s)

Twenty-eight patients with stricturing CD had a significantly greater mean VAT:SAT volume ratio than 29 non-stricturing CD (41.5 cm3 vs 34.2 cm3, p=0.03). Thirty-six percent (10/28) of CD stricture patients had prior ileocolic resection with a mean disease duration of 13.5 years (range 0-48). The median ileal BWT (7.0 mm, range 4.0-13.0 mm) for the stricturing group was significantly greater than those with inflammatory behaviour (BWT 2.0 mm, p<0.0001). The median luminal diameter and PSD for the stricture group was 2.0 mm (range 0 - 14.0 mm), and 3.0 cm (range 1.0 - 7.3 cm), respectively.

Image

Conclusion(s)

Fibrostenotic TI CD patients have increased VAT:SAT ratios in comparison to those with only inflammatory behaviour. These pilot VAT:SAT results provide an initial foundation for further studies to assess its predictive role in responsiveness of medical or surgical therapies in stricturing CD.

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None

Disclosure of Interest

None Declared
A123 COMPARING SIZE MEASUREMENT OF SIMULATED COLORECTAL POLYPS WHEN USING A NOVEL VIRTUAL SCALE ENDOSCOPE, ENDOSCOPIC RULER OR FORCEPS: A BLINDED RANDOMIZED TRIAL
Authors: Djinbachian R , Taghiakbari M , Haumesser C , Zarandi-Nowroozi M , Abou-Khalil M , Sidani S , Liu J , Panzini B , von Renteln D
Published: March 2023

Background

Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (forceps or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies.

Purpose

Our aim was to evaluate the performance of VSE when compared to ER and forceps-based measurement.

Method

We conducted a randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and forceps. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5, 10, and 20mm thresholds.

Result(s)

A total of 360 measurements were performed. The relative accuracy of biopsy forceps, ER, and VSE was 78.9% (95%CI=76.2-81.5), 78.4% (95%CI=76.0-80.8), and 82.7% (95%CI=80.8-84.8). VSE had significantly higher accuracy compared to biopsy forceps (p=0.02) and ER (p=0.006). VSE misclassified a lower percentage of polyps >5mm as ≤5mm (9.4%) compared to forceps (15.7%) and ER (20.9%). VSE misclassified a lower percentage of ≥20mm polyps as <20mm (8.3%) compared with forceps (66.7%) and ER (75.0%). 25.6%, 25.5%, and 22.5% of polyps ≥10mm were misclassified as <10mm with ER, forceps, and VSE, respectively.

Conclusion(s)

VSE had significantly higher relative accuracy in measuring polyps compared to ER or forceps assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds.

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None

Disclosure of Interest

R. Djinbachian: None Declared, M. Taghiakbari: None Declared, C. Haumesser: None Declared, M. Zarandi-Nowroozi: None Declared, M. Abou-Khalil: None Declared, S. Sidani: None Declared, J. Liu: None Declared, B. Panzini: 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,
A132 A CASE OF COLONIC MALAKOPLAKIA PRESENTING AS A LARGE CECAL MASS : NOT EVERY POLYP HAS TO LOOK LIKE A NAIL
Authors: Jiang S X , Xiong W , Shahidi N
Published: March 2023

Background

Malakoplakia is a rare inflammatory condition, commonly affecting the genitourinary system of immunocompromised patients. Gastrointestinal malakoplakia has been reported in the literature, with previous endoscopic findings mimicking mass lesions.

Purpose

To describe a case of colonic malakoplakia after referral for endoscopic management of a large non-pedunculated colorectal polyp.

Method

Case report and review of the literature.

Result(s)

Case Report

An 80-year-old male with chronic kidney disease and remote renal transplant on immunosuppressive therapy (mycophenolate mofetil, tacrolimus, prednisone) was referred for endoscopic resection for a large non-pedunculated colorectal polyp in the cecum. Original presenting symptoms included chronic diarrhea, iron deficiency anemia, and fecal immunochemical test (FIT) positivity. A repeat colonoscopy demonstrated a 40mm Paris 0-IIA plaque-like lesion in the cecum with optical features not in keeping with adenomatous or serrated histopathology. Biopsies were performed with histopathology demonstrating normal colonic mucosa with confluent sheets of histiocytes with concentrically layered cytoplasmic inclusions, in keeping with malakoplakia.

Literature review

Malakoplakia, Greek for “soft plaque”, is a rare inflammatory condition characterized by impaired dysfunction in macrophages leading to the accumulation of incompletely degraded bacteria in phagolysosomes. Histologically, this appears as concentrically layered cytoplasmic inclusions, comprising the pathognomonic Michaelis-Gutmann bodies. Many bacterial organisms have been implicated in the development of malakoplakia, with E. coli being the most common; specifically in immunocompromised patients, whether from immunosuppressive medications, immunodeficiency syndromes, or clinical conditions precluding effective immune function. Malakoplakia commonly presents as a mass-like lesion and has been found in all organs, most commonly in the genitourinary system. Diagnosis is made by biopsy and allows for appropriate treatment, which is most commonly a reduction in immunosuppressive therapy and antibiotic therapy.

Image

Conclusion(s)

Malakoplakia is rare but should be considered when a lesion with atypical optical evaluation features is found in immunocompromised individuals or those with recurrent infections.

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None

Disclosure of Interest

None Declared
A178 ELUCIDATING THE ROLE OF THE LEUCINE-RICH REPEAT KINASE 2 G2019S MUTATION IN CROHN’S DISEASE PATHOGENESIS USING A CITROBACTER RODENTIUM INFECTIOUS COLITIS MODEL
Authors: Samman B , Yadav J , Bayer G , Foerster E G , Chen L , Rocha J D B , Girardin S E , Philpott D J
Published: March 2023

Background

Associations have been found linking certain LRRK2 kinase domain gain-of-function variants, such as G2019S, to the development of Crohn’s disease and Parkinson’s disease, yet their exact roles in pathogenesis remains elusive. LRRK2 is most robustly expressed in circulating and tissue-resident immune cells, such as neutrophils, lymphocytes, and macrophages. Myeloid cells deficient in LRRK2 exhibit defective antimicrobial responses, such as reduced production of reactive oxygen species in response to microbial stimuli and reduced bactericidal activity in response to infection. As an enteric colitis-inducing extracellular pathogen, Citrobacter rodentium can help us better understand the consequences of LRRK2 kinase hyperactivity on intestinal inflammation by correlating pathogen burden with key host response parameters over the course of infection.

Purpose

To investigate the effects of the Crohn’s and Parkinson’s disease-associated Lrrk2 G2019S hyper-kinase mutation on pathogen burden and colonic inflammation in the context of C. rodentium-induced infectious colitis.

Method

Wild-type and Lrrk2 G2019S mutant mice (7-8 weeks old) were fasted for 4 hours then infected with 1 x 108 CFU of C. rodentium in a 3% NaHCO3 solution by oral gavage. Body weight, faecal pathogen burden, and faecal lipocalin-2 (Lcn2) concentrations were measured at 2, 4, 7, 9, 10, 12, and 14 days post-infection (DPI). Systemic pathogen burden (as measured in the mesenteric lymph nodes and spleen), colon length, colonic inflammatory gene expression, and histopathological scoring were assessed at 7, 10, and 14 DPI.

Result(s)

While G2019S mice exhibited marginally higher C. rodentium loads at certain timepoints, no significant differences were found in overall pathogen burden or pathogen clearance rates between genotypes over the first 14 days of infection. Faecal pathogen load peaked at 7-9 DPI in both WT and G2019S mice, which correlated with detectable levels of C. rodentium in the mesenteric lymph nodes and spleens of some mice at 7 DPI. Lcn2 secretion and the expression of inflammatory and antimicrobial genes of interest were induced robustly over the course of infection. They peaked and ebbed at timepoints correlating well with pathogen burden; however, no significant differences were observed between WT and G2019S mutant mice at the various timepoints assessed.

Conclusion(s)

Mice expressing the G2019S Lrrk2 mutation exhibit neither defective pathogen control nor deleterious hyperinflammation – compared to WT mice – when infected with C. rodentium. Further research will aim to investigate the role of this Lrrk2 variant in additional models of intestinal inflammation.

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CCC, CIHR

Disclosure of Interest

None Declared
A204 COST-EFFECTIVENESS OF THERAPIES AFTER FAILURE OF CONVENTIONAL THERAPY FOR PATIENTS WITH MODERATE-TO-SEVERE ULCERATIVE COLITIS IN THE CANADIAN HEALTHCARE SYSTEM
Authors: Hagerman C , Kroeker K I , Dieleman L , Peerani F , Baumgart D C , Wong K , Halloran B
Published: March 2023

Background

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon which requires ongoing medical therapy. The therapeutic options for moderate-to-severe UC include biologics and small molecules, which are effective but come with a significant cost. As such, their exact positioning in the therapeutic algorithm remains unclear.

Purpose

The aim of our study was to assess and compare the cost-effectiveness of infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib for the management of moderate-to-severe UC from the perspective of the Canadian public healthcare system.

Method

A Markov model was constructed to simulate the disease course of UC patients after initiating each available therapy. Drug costs were obtained from the Alberta Health Drug Benefit List and the remaining costs were determined from the CIHI Patient Cost Estimator. Transition probabilities were obtained from a review of the literature, and loss of response and complication rates were obtained from randomized controlled trials. Our main analysis used a time horizon of 5 years, and time horizons of 1- and 10-years were also assessed in our sensitivity analysis. Probabilistic sensitivity analysis was performed to characterize uncertainty related to all parameters.

Result(s)

Infliximab costs $26,611 per quality-adjusted life year (QALY) using a 5-year time horizon. Adalimumab costs $20,783 per QALY. Vedolizumab costs $40,553 per QALY. Golimumab costs $34,316 per QALY. Ustekinumab costs $26,366 per QALY. Lastly, tofacitinib costs $25,572 per QALY. At a willingness-to-pay threshold of $50,000 per QALY, sensitivity analysis revealed that infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib had a 36%, 12%, 1%, 1%, 44% and 6% probability of being cost-effective, respectively.

Conclusion(s)

Our economic model concluded that adalimumab is the most cost-effective first-line therapy for UC patients who have failed conventional therapy.

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None

Disclosure of Interest

None Declared
A219 BIOLOGIC USE DURING PREGNANCY IN WOMEN WITH INFLAMMATORY BOWEL DISEASE AND ASSOCIATED NEONATAL OUTCOMES: A RETROSPECTIVE CHART REVIEW
Authors: Jeyakumar Y , O'Connor K , Huang V
Published: March 2023

Background

Biologics are the mainstay of therapy for patients with advanced inflammatory bowel disease (IBD). Most biologics readily undergo placental transfer during the second trimester and remain detectable in infant serum for up to 12 months. Therefore, most clinical guidelines currently recommend avoiding live vaccines in the first 6 to 12 months for exposed infants. In Canada, the rotavirus vaccine is the only live vaccine administered before 6 months. Emerging evidence is suggesting that the vaccine may safely be given to infants with normal immune function, even if serum biologic level is detectable. Specialist assessment of infant immune function may help guide decision-making about rotavirus vaccine administration, but there remains a large gap in our knowledge of the impact of biologic exposure on the immune function of infants, necessitating further study.

Purpose

In this single-centre retrospective chart review, we aim to study the clinical outcomes, immune function, and rotavirus vaccine recommendations for infants exposed to biologics in utero during their first year of life.

Method

The study included mothers seen at the Pregnancy IBD Clinic at Mount Sinai Hospital in Toronto, ON, who were offered a referral to the Special Immunization Clinic (SIC) at The Hospital for Sick Children due to biologic exposure in utero. Data was collected on the recommendations made by paediatric specialists at SIC, based on complete blood count, lymphocyte phenotyping, and T-cell receptor excision analysis. Data was obtained on adverse neonatal outcomes in the first year of life, including prematurity, congenital malformations, and infections based on post-partum surveys completed by mothers and follow-up letters from SIC.

Result(s)

43 patients were referred to and seen by paediatric specialists at SIC between 2 to 12 months of age. 18 infants (42%) were exposed to Adalimumab in utero, 16 (37%) to Infliximab, 5 (12%) to Vedolizumab, and 4 (9%) to Ustekinumab. The rotavirus vaccine was recommended to 34 infants (81%) and not recommended to 3 (7%) for reasons including gastrointestinal illness, neutropenia, and low lymphocyte counts. Recommendation is pending for 6 infants (14%). Two infants (5%) had premature births. Four infants (9%) were admitted to the NICU for reasons including respiratory distress, and prematurity (9%). One infant (2%) had a congenital malformation, specifically bilateral sensorineural hearing loss. Six infants (14%) had upper respiratory tract infections, none of which required hospital admission or antibiotics.

Conclusion(s)

This study is currently in progress. Further data is required to assess whether biologic exposure in utero has a significant impact on neonatal immune function, especially beyond the first year of life, and whether there is a significant difference in vaccine recommendations and response based on the type of biologic received.

Disclosure of Interest

None Declared
A226 EFFECT OF PHYSICAL ACTIVITY AMONG INDIVIDUALS WITH QUIESCENT OR MILDLY ACTIVE INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW
Authors: Oketola B , Akinrolie O , Webber S , Singh H , Askin N , Rabbani R , Abou-Setta A
Published: March 2023

Background

Individuals with quiescent inflammatory bowel diseases (IBD) can continue to have several symptoms. Physical activity (PA) can improve immunological response and psychological health.

Purpose

We performed a systematic review of trials investigating the safety and efficacy of PA as an adjunct therapy to manage persistent symptoms in quiescent or mildly active IBD.

Method

We searched for randomised controlled trials (RCTs) and nonrandomised non-controlled trials (non-RCTs) in eight databases, trial registries and conference proceedings, published in English between 2011 and 2021. We focused on trials in adults (>18 years) using any form of PA as an adjunct therapy to medical therapy. Outcomes of interest were health-related quality of life, fatigue, joint pain, abdominal pain, stress, anxiety, and depression.

Result(s)

From 10,862 retrieved citations, we identified seven RCTs and one non-RCT that met our inclusion criteria. All trials deemed PA safe for individuals with quiescent or mildly active IBD. Clinical heterogeneity was noted among the trials for all outcomes. Six RCTs utilized parallel-group design while one utilized a cross-over design. Seven trials provided partially or fully supervised PA interventions, and one provided no supervision. All trials used different types of PA, which varied between running, resistance training, yoga, and aerobic exercises. The trials used different parameters to measure PA intensity including Peak Power Output, Resistance Intensity Scale for Exercise, percentage of maximum heart rate, ability to talk while running. Heterogeneity was noted in the duration and frequency of PA.

Conclusion(s)

Even though PA is safe for individuals with quiescent or mildly active IBD, heterogeneity in available trials make it difficult to ascertain precise estimates of treatment effect. This also presents a challenge when determining the specific modes of PA that are beneficial for individuals with quiescent or mildly active IBD. This highlights the need for standardization of the definitions of parameters involved in PA in IBD research.

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CAG

Disclosure of Interest

None Declared
A230 A MISSENSE MUTATION IN GOBLET CELL PROTEIN FCGBP ALTERS THE GLYCOMIC PROFILE AND FUNCTION OF THE COLONIC MUCUS BARRIER
Authors: Gorman H , Moreau F , Zandberg W , Bergstrom K , Chadee K
Published: March 2023

Background

MUC2 mucin, produced by colonic goblet cells, forms a mucus bilayer that provides a physical barrier between potential pathogens in the lumen and the underlying epithelial cells. Mucus is thus the first line of innate host defense in the gastrointestinal (GI) tract. Many GI diseases including inflammatory bowel disease and colon cancer affect the glycosylation of mucus. Goblet cells produce a variety of proteins that are associated with the mucus layer. Of these proteins, FCGBP is of significant interest due to its structural similarities to MUC2 mucin with unknown functions. In this study, we investigated how a missense mutation in FCGBP altered the glycosylation of goblet cell MUC2 and affected its barrier functions.

Purpose

Hypothesis: A missense mutation in FCGBP results an impaired mucus layer by the altering glycomic profiles of goblet cell mucins. Specific aims:

1) To determine mechanistically how FCGBP impeded the structural integrity of the mucus layer

2) To quantify MUC2 glycoprotein modifications in the altered mucus layer

Method

To investigate whether FCGBP impaired mucus barrier functions, two cell types were investigated: wildtype LS174T (WT) MUC2 mucus-producing goblet cells and LS174T cells with a missense mutation in FCGBP (FCGBP MS). To determine if FCGBP MS led to loss in barrier function in the mucus layer, the penetration of 0.2, 1, and 2 μm fluorescent beads (to mimic bacteria) through the mucus layer were quantified. To determine if the differences in penetrability were caused by differences in MUC2 glycosylation in the goblet cell lines, sensitive glycomic analyses were performed by high-performance liquid chromatography-mass spectrometry (HPLC-MS) and capillary electrophoresis with laser-induced fluorescence detection (CE-LIF). Both intact cells and isolated MUC2 mucin granules were analyzed. To determine if differences in the glycomic profiles was caused by differences in glycotransferases, RT-PCR was performed on over 30 human glycosyltransferases.

Result(s)

FCGBP MS cells exhibited significant loss in MUC2 mucus barrier function as quantified by fluorescent beads penetration through the mucus layer in a temporal manner. FCGBP MS cells exhibited an altered glycomic profile with a notable increase in sialylated glycans as quantified by HPLC-MS. The increase in sialylated glycans was associated with a significant increase in sialyl-transferase expression in FCGBP MS cells.

Conclusion(s)

These data demonstrate that a single missense mutation in FCGBP altered the penetrability of the mucus layer associated with an increase in sialylated proteins, a signature hallmark of numerous colonic diseases. FCGBP was critical in providing structural integrity of the mucus layer and maintenance of goblet cell glycosylation profiles.

Please acknowledge all funding agencies by checking the applicable boxes below

CIHR

Disclosure of Interest

None Declared
A246 BALLOON-OCCLUDED RETROGRADE TRANSVENOUS OBLITERATION FOR PRIMARY PROPHYLAXIS OF GASTRIC VARICEAL BLEEDING: A SYSTEMATIC REVIEW
Authors: Howarth N C , Little D , Mujoomdar A , Cool D , Hocking D , Teriaky A , Qumosani K , Khan Q , Robert S , Brahmania M , Peck D
Published: March 2023

Background

Gastric variceal (GV) bleeding is an infrequent but serioous complication of cirrhosis that is associated with high mortality. Balloon-occluded retrograde transvenous obliteration (BRTO) is an effective treatment to prevent rebleeding from GV. The role of BRTO for primary prophylaxis of GV bleeding has not been established.

Purpose

The aim of the current study is to establish the efficacy and safety of BRTO for primary prophylaxis of GV bleeding.

Method

We searched EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception to November 2021. Randomized controlled trials and observational studies involving adults with cirrhosis related GV that had never bled and were treated with BRTO were included. Studies without clinical outcomes or those not reporting primary prophylaxis outcomes separately were excluded. Risk of bias was assessed using the Newcastle-Ottawa scale.

Result(s)

We identified 791 unique citations with 9 eligible studies after a full-text review. A total of 577 patients were included from 9 observational studies (1 prospective, 8 retrospective). Technical success after the first procedure ranged from 82.4-100% (7 studies) and GV eradication on follow-up endoscopy ranged from 88.2-100% (4 studies). GV bleeding occurred in 0-7.3% of patients with follow-up ranging from 15.8-66.2 months (9 studies). Eight studies were considered at high risk of bias due to the lack of a control group or poor comparability between the cohorts.

Conclusion(s)

BRTO appears to be effective for primary prophylaxis of GV bleeding. Further controlled studies are needed before BRTO can be routinely performed for primary prevention of gastric variceal bleeding.

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None

Disclosure of Interest

None Declared
A257 ASSOCIATION OF DIETITIAN CONSULTATION WITH INFECTION RATES IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS
Authors: Yau M T K , Tsien C , Bielawska B
Published: March 2023

Background

Patients with alcoholic hepatitis have significant morbidity and mortality, frequently infection related. They are often malnourished from increased nutritional demands. Studies show conflicting results on whether nutritional therapy reduces infections.

Purpose

To examine if dietitian consultation is associated with lower infection rates in patients with alcoholic hepatitis.

Method

Retrospective chart review of adults aged 18-75 admitted to The Ottawa Hospital for severe alcoholic hepatitis between January 1, 2016 and December 31, 2018. Patients with co-existing liver diseases were excluded. Descriptive statistics compared those with and without dietitian consultation during admission. The primary exposure was dietitian consultation over 48 hours before infection. The primary outcome was infection over 48 hours after admission.

Result(s)

64 patients were assessed (mean age 52.3+/-10.9 years; mean Maddrey Discriminant Function 53.6+/-33.2). Those with dietitian consultation (N=17, 26.6%) had greater Charlson (p=0.016) and Model for End Stage Liver Disease (p=0.048) scores, with no difference in steroid use (p=0.60). Among 53 patients without infection on admission, 10 had infection in hospital, of whom 4 had dietitian consultation before infection. Dietitian consultation was associated with increased infection risk (OR 6.5, 95%CI=1.3-33.2).

Conclusion(s)

Only the sickest patients received dietitian consultation, which likely explains the observed increased infection risk. Given high malnutrition rates in this population, our results suggest a significant care gap.

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None

Disclosure of Interest

None Declared
A270 THE PREBIOTIC, INULIN, IMPACTS TUMORIGENESIS PROMOTION BY COLIBACTIN-PRODUCING
Authors: Oliero M , Hajjar R , Cuisiniere T , Fragoso G , Calvé A , Santos M M
Published: March 2023

Background

The prebiotic inulin has previously shown both protective and tumor-promoting effects in colorectal cancer. These discrepancies may be due to polyketide synthase-positive (pks+) Escherichia coli promoting carcinogenesis through the production of colibactin, a genotoxin that induces double-strand DNA breaks (DSBs).

Purpose

In this study we investigated the impact of inulin on the genotoxicity of colibactin-producing bacteria.

Method

E. coli strains Nissle (EcN), and NC101 (EcNC101) were grown in medium supplemented with inulin. Colibactin expression was assessed by luciferase reporter gene expression and Caco2 cells were used to assess colibactin-induced genotoxicity by γ-H2AX immunofluorescence analysis. ApcMin/+ mice received 2% dextran sodium sulfate (DSS) followed by oral gavage with EcNC101 and were fed a diet supplemented with 10% cellulose (control diet) or 10% inulin for four weeks.

Result(s)

Inulin enhanced EcNC101-induced expression of colibactin and DSB levels in Caco2 cells. Inulin supplementation in ApcMin/+ mice led to enhanced EcNC101 colonization and tumor progression.

Conclusion(s)

The presence of colibactin producing E. coli in the gut influences the outcome of inulin supplementation in CRC progression. Further studies are needed to investigate the interaction between dietary supplements and cancer-promoting bacteria.

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CIHR, Other

Please indicate your source of funding;

NSERC, Institut du cancer de montréal

Disclosure of Interest

None Declared
A271 THE MODULATION OF INTESTINAL INFLAMMATION BY PARABACTEROIDES GOLDSTEINII IN EXPERIMENTAL MURINE COLITIS
Authors: Gerkins C , Oliero M , Hajjar R , Vennin Rendos H , Fragoso G , Calvé A , Diop K , Routy B , Santos M M
Published: March 2023

Background

Inflammatory bowel diseases (IBDs), comprised mainly of Crohn’s disease and ulcerative colitis, are characterized by chronic and relapsing intestinal inflammation. Though the etiology of IBDs is not entirely understood, it is thought that an imbalance of the gut microbiota is one contributing factor, making it a potential target for the treatment of IBDs.

Purpose

This study aims to examine how the potential probiotic Parabacteroides goldsteinii modulates intestinal inflammation in the context of experimental colitis.

Method

Wild type C57BL/6 mice were divided into three groups. One group was given phosphate-buffered saline (PBS) via oral gavage without any further treatment. The second group was treated with 1% dextran sodium sulfate (DSS) for twelve days induce colitis and given PBS every three days. Finally, the third group was also treated with 1% DSS for twelve days and given P. goldsteinii via oral gavage every three days. Weight loss, stool consistency, and intestinal bleeding were monitored and were used to calculate the Disease Activity Index (DAI) daily. Postmortem, colon length was measured, and inflammation score was evaluated on hematoxylin and eosin-stained samples of the colon and spleen. Finally, inflammatory cytokine levels were measured in the colon tissue and the serum by multiplex assay.

Result(s)

Colonization was confirmed at day three after gavage by real-time PCR. Preliminary results show that DSS-treated mice lost significantly more weight by day twelve than mice colonized with P. goldsteinii. Additionally, on days eight and twelve, mice colonized with P. goldsteinii had significantly lower DAI scores than mice that received only PBS. Finally, mice colonized with P. goldsteinii had significantly longer colons than those that received only PBS.

Conclusion(s)

The preliminary data indicates that mice colonized with P. goldsteinii had less severe symptoms of colitis than mice only given PBS. This suggests that P. goldsteinii may attenuate inflammation in mice treated with DSS.

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CIHR

Disclosure of Interest

None Declared
A275 MECHANOSENSITIVE KCA2 + 1.1 CHANNEL MEDIATES INTRALUMINAL DISTENSION-INDUCED CALCIUM INFLUX IN ENTERIC NEURONS
Authors: Wongkrasant P , CAVIN J -B , Balemba O , MacNaughton W , Sharkey K
Published: March 2023

Background

The enteric nervous system (ENS) is the extensive neural network within the wall of the gastrointestinal (GI) tract that is essential for the control of gut function. However, the mechanisms whereby the ENS responds to the mechanical forces associated with distension are not well understood, and this has implications for gut function in health and disease.

Purpose

This study aims to determine the mechanisms underlying the responsiveness of enteric neural circuits in the myenteric plexus to intraluminal distension.

Method

Intact segments of the colon from mice expressing a genetically encoded fluorescent calcium reporter specifically in enteric neurons (Wnt-1-GCaMP6 mice) or cholinergic neurons (Chat-GCaMP6 mice) were bathed and luminally perfused with Krebs solution in a custom-designed chamber (35-37°C, 95% O2 ,5% CO2, pH 7.4). Intracellular Ca2+ fluorescence in enteric neurons was visualized by live-cell confocal microscopy and was analyzed using Imaris™ software. Intraluminal distension was accomplished either by increasing luminal perfusion pressure or using colonic preparations containing natural fecal pellets. The degree of intraluminal distension produced by perfusion was defined by the relative distance between identified neurons in preparation and is expressed as a percentage increase in the distance between them. Distension was studied over a range from 0-75%. The degree of distension produced by a fecal pellet in the distal colon is approximately 75%.

Result(s)

Intraluminal distension significantly increased intracellular Ca2+ fluorescence in most (>85%) of neurons of the myenteric plexus. When the colon was distended, the response to depolarization by KCl, a general cell depolarization activator, and DMPP, a nicotinic receptor agonist in Wnt1-cre GCaMP6 mice and Chat GCaMP6 mice, respectively was substantially inhibited. To identify how distention induced an increase in intracellular Ca2+ fluorescence and inhibited depolarization, pharmacological inhibitors of mechanosensitive ion channels were used. The nonspecific mechanosensitive channel inhibitor, gadolinium (50 mM) and the Kca1.1 channel inhibitor, paxilline (10 mM), both significantly reduced the luminal distension-induced increase in intracellular Ca2+ fluorescence. The effect of luminal distension-inhibited cell depolarization by KCl recovered in the presence of paxilline. This was not observed in the Ca2+ responses evoked by DMPP, suggesting that other mechanisms may play a role in the inhibition of neuronal responses in cholinergic enteric neurons.

Conclusion(s)

The majority of neurons of the colonic myenteric plexus are mechanosensitive and show an increase in intracellular Ca2+ when the gut is distended. Myenteric neurons do not respond to nicotinic receptor activation when the gut is distended through a mechanism that is dependent on the activity of Kca1.1 channel.

Supported by CIHR

Disclosure of Interest

None Declared
Volatiles produced by symbiotic yeasts improve trap catches of Carpophilus davidsoni (Coleoptera: Nitidulidae): an important pest of stone fruits in Australia
Authors: Baig Farrukh , Farnier Kevin , Ishtiaq Muhammad , Cunningham John Paul
Published: March 2023

Carpophilus davidsoni (Dobson) is an important pest of Australian stone fruit. Current management practices for this beetle include the use of a trap that contains an attractant lure comprised of aggregation pheromones and a ‘co-attractant’ mixture of volatiles from fruit juice fermented using Baker’s yeast, Saccharomyces cerevisiae (Hansen). We explored whether volatiles from yeasts Pichia kluyveri (Bedford) and Hanseniaspora guilliermondii (Pijper), which are closely associated with C. davidsoni in nature, might improve the effectiveness of the co-attractant. Field trials using live yeast cultures revealed that P. kluyveri trapped higher numbers of C. davidsoni compared to H. guilliermondii, and comparative GC-MS of volatile emissions of the two yeasts led to the selection of isoamyl acetate and 2-phenylethyl acetate for further investigation. In subsequent field trials, trap catches of C. davidsoni were significantly increased when 2-phenylethyl acetate was added to the co-attractant, compared to when isoamyl acetate was added, or both isoamyl acetate and 2-phenylethyl acetate. We also tested different concentrations of ethyl acetate in the co-attractant (the only ester in the original lure) and found contrasting results in cage bioassays and field trails. Our study demonstrates how exploring volatile emissions from microbes that are ecologically associated with insect pests can result in more potent lures for use in integrated pest management strategies. Results from laboratory bioassays screening volatile compounds should be treated with caution when making inferences regarding attraction under field conditions.