bluuebunny/crossref_metadata_2025_split huggingface dataset:
A67 EVALUATING ACCESS TO IBD CARE ACROSS CANADA: PROCEEDINGS FROM THE 2017 IBD ACCESS SUBMMIT
Authors: MacDonald S , Heisler C , Mathias H , Mirza R , Jones J 
Published: February 2020

Abstract

Background
Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated disease, with Canada demonstrating the highest incidence and prevalence rates in the world. Patients with IBD often require lifelong treatment and, therefore, lifelong interactions with the healthcare system. Access to care can have a direct impact on patient health-related outcomes. Although acknowledged as a problem, the complexity of accessing IBD specialty care in Canada has not been reviewed. This lack of understanding presents a barrier in evaluating and implementing changes in IBD specialty care.

Aims
To identify key barriers and facilitators for and to develop a national working strategy to address limitations in access to IBD specialty care by exploring the perceptions and experiences of key stakeholders (pediatric and adult gastroenterologists, IBD patients, researchers, and policy makers).

Methods
The IBD Summit was held in Toronto, Ontario in November 2017, sponsored by SPOR-CIHR catalyst funding and in partnership with Crohn’s & Colitis Canada. Perceptions and experiences of key stakeholders were gathered during two audio-recorded stakeholder dialogues held during the Summit. The audio recordings were transcribed and coded to compare and contrast between key stakeholders to determine potential differences in access to IBD care. Five final themes are highlighted in this report.

Results
A total of 21 key stakeholders attended, including pediatric and adult gastroenterologists, patients, researchers, and policy makers. Five key themes of importance relating to access to IBD care arose from The IBD Summit:(1) Integrated Models of Care, (2) IT Enhanced Care, (3) Health System Process, (4) Communication and Advocacy, and (5) Community Supports. The IBD Summit identified similar perceptions and experiences, highlighting common barriers and facilitators that transcend provincial borders. Shared perceptions included a need for common medical records and overall improved IT-enhanced care for managing IBD; improved centralized triage systems; increased comprehensive care support for patients and primary care physicians; and increased community supports for patients and providers.

Conclusions
Highlights from the IBD Summit present several clinically relevant and actionable suggestions for improved access to IBD speciality care across Canada. The suggestions provided by key stakeholders highlight the need for a system-level redesign in order to improve access to enhanced models of care. Improvements in access to IBD specialty care can only occur through partnerships between those working within the healthcare system and those within the community. Future research will involve pursuing deeper insight into the experience of patient and provider stakeholders as they navigate the healthcare system in order to access and provide care.

Funding Agencies
CIHRNova Scotia Health Authority Research Fund
A76 INCOMPLETE RESECTION OF 1-20MM COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Djinbachian R , Iratni R , Durand M , Marques P , von Renteln D 
Published: February 2020

Abstract

Background
Colonoscopy has been used as a screening or surveillance tool for colorectal cancer (CRC), however, a minority of patients develop post-colonoscopy interval CRC. Incomplete resection of colorectal polyps is thought to be a major cause of post-colonoscopy interval CRC.

Aims
We were interested in studying the incomplete resection rate (IRR) of colorectal polyps and factors associated with incomplete resection in a systematic review and meta-analysis.

Methods
We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, EBM Reviews, and CINAHL of all studies reporting on IRR of polyps 1-20mm published until March 2019. Exclusion criteria were: Inclusion of IBD cohorts; referrals for difficult polypectomy; polyp size &gt;20mm; endoscopic submucosal dissection; conference abstracts; non-english language. Primary outcome was histologic IRR for polypectomies. Secondary outcomes included IRR for all studies; IRR for polyps 1-10mm and 10-20mm; IRR with or without submucosal injection; IRR based on assessment method of completeness; IRR for different polypectomy methods.

Results
6148 records were identified through initial search and 37 studies with a total of 11962 polyps were included in our quantitative analysis. Histologic IRR for polypectomies (snare and forceps) was 10.54% (95%CI 8.56–12.53). IRR for all included studies was 9.05% (95%CI 7.54–10.56). IRR was lower for polyps 1-10mm than polyps 10-20mm; 8.85% (95%CI 7.27–10.44) vs 18.08% (95%CI 10.30–25.87). IRR was statistically significantly lower when only evaluated using imaging enhanced endoscopy (IEE) (0.69%; 95%CI 0.02–1.35) compared to post polypectomy margin biopsies (7.19%; 95%CI 5.39–8.99). Histologic IRR for snare polypectomy (8.79%; 95%CI 6.96–10.62) was lower than histologic IRR for forceps polypectomy (17.75; 95%CI 10.49–25.01).

Conclusions
Incomplete resection of 1-20mm colorectal polyps occurs in a significant proportion of polypectomies. Incomplete resection occurs more frequently in larger (10-20mm) polyps. Visual inspection with IEE after polypectomy underestimates IRR in comparison to post polypectomy biopsies. Snare polypectomy had lower IRR when compared with forceps.

Funding Agencies
None
A79 CLINICAL VALIDATION OF THE SIMPLE CLASSIFICATION FOR OPTICAL DIAGNOSIS OF DIMINUTIVE AND SMALL COLORECTAL POLYPS
Authors: Alaoui A , Oumedjbeur K , Djinbachian R , Marchand E , Marques P , Hammar C , Pohl H , Bouin M , Deslandres E , Bouchard S , von Renteln D 
Published: February 2020

Abstract

Background
Image enhanced endoscopy (IEE) allows for real-time optical diagnosis of colorectal polyps in order to replace histopathology. A novel classification system (SIMPLE classification) has recently been developed for optical diagnosis when using the novel Pentax Optivista IEE platform.

Aims
The aim of this study was to evaluate the SIMPLE classification for optical polyp diagnosis in a prospective clinical study.

Methods
Patients undergoing screening, diagnostic or surveillance colonoscopies were enrolled in the study. All colorectal polyps 1-10mm found underwent optical polyp diagnosis using the SIMPLE classification with either iScan or Optivista for image-enhanced endoscopy (IEE). Polyps were resected as per standard care and sent for histopathology analysis. Optical diagnosis and surveillance intervals were calculated based on SIMPLE criteria and compared to pathology-based results as reference. Primary outcome was the agreement of the surveillance intervals based on the SIMPLE classification with pathology-based surveillance intervals for 1-5mm colorectal polyps. Secondary outcomes included negative predictive value (NPV) for rectosigmoid adenoma, percentage of pathology avoided, percentage of post-colonoscopy immediate recommendations, and surveillance interval agreement, rectosigmoid NPV for 1-10mm polyps.

Results
399 patients (mean age: 62.4, 55.6% female) with 278 diminutive and 364 small polyps were evaluated in the study cohort. For ≤5mm polyps, agreement with pathology-based surveillance intervals was 93.5% [95% CI 91.1–95.9] (shorter: 4.5% [95% CI 2.5–6.5]; longer: 1.8% [95% CI 0.5–3.0]). NPV for rectosigmoid adenomatous polyps (including SSA) was 85.5% [95% CI 77.6–93.4]. Using Optical diagnosis and the SIMPLE classification, pathology analysis could be avoided in 61.5% [95% CI 56.9–66.2] of polyps and post-colonoscopy immediate surveillance interval recommendation could be given in 70.9% [95% CI 66.5–75.4] of patients. For ≤10mm polyps, agreement with pathology-based surveillance intervals was 92.2% [95% CI 89.6–94.9] (shorter: 5.5% [95% CI 3.3–7.8]; longer: 2.3% [95% CI 0.8–3.7]). NPV for rectosigmoid adenomatous polyps (including SSA) was 83.7% [95% CI 75.9–91.5].

Conclusions
The first clinical validation study using the SIMPLE classification in combination with Optivista or iScan IEE showed a high (≥90%) surveillance interval agreement compared to pathology. More than 60% of pathology could be avoided, and most patients could be given immediate surveillance intervals when using IEE in combination with the SIMPLE classification.

Funding Agencies
NonePentax
A85 COLON CANCER SCREENING IN PATIENTS ASSESSED FOR LUNG TRANSPLANTATION
Authors: Sanders D , Telford J J , Levy R 
Published: February 2020

Abstract

Background
Colorectal Cancer (CRC) mortality is significantly higher after a lung transplant (1). CRC screening for average risk patients in British Columbia is done with Fecal Immunochemical Testing (FIT) every two years (2), however colonoscopy is currently the standard modality in patients undergoing lung transplant assessments in British Columbia. The yield of using FITs or Fecal Occult Blood Testing (FOBT) and colonoscopy in screening for lung transplant assessments in Canada is unknown.

Aims
To review the colon cancer screening results for all lung transplants done in British Columbia from 2013 to 2018.

Methods
This is a retrospective chart review of the 222 lung transplants done from January 2013 to December 2019.

Results
220 patients were transplanted during this time period. 2 patients were re-transplanted. 136 of the 220 lung transplant patients were male (62%). The most common indication for transplantation was interstitial lung disease (44%), followed by chronic obstructive pulmonary disease (30%), cystic fibrosis (7%), and pulmonary hypertension (4%). Colonoscopies were performed in 127 of the 220 patients. Computed tomography (CT) colonography was performed in 15 of the 220 patients, and a FOBT or FIT was performed in 200 of the 220 patients. No colon cancers were found by colonoscopy or CT colonography (0/142). Of the colonoscopies performed, 38 % (49/127) had adenomatous or serrated polyps removed. Of these 36% (18/49) had high risk pathology. The positive predictive value of a FIT/FOBT positive for a polyp was 51.4 % (CI 37.6–65.1%).

Conclusions
The value of non-invasive screening modalities in pre-lung transplant patients are modest. Program screening should be tailored to the lung transplant candidate’s risk of CRC and the risk of an invasive procedure with a known complication rate.

Funding Agencies
None
A117 A CASE OF ADULT AUTOIMMUNE ENTEROPATHY AND PRIMARY SCLEROSING CHOLANGITIS
Authors: Lei Y , Azhari H , Raman M 
Published: February 2020

Abstract

Background
Autoimmune enteropathy (AIE) is a rare, immune-mediated condition causing severe diarrhea and mucosal damage. The diagnostic criteria are chronic diarrhea with malabsorption, blunting of the small bowel villi, specific histologic changes, and the exclusion of other causes of villous atrophy. Anti-enterocyte and anti-goblet cell antibodies are supportive of the diagnosis, but not specific or sensitive enough to make the diagnosis. It has several clinical and histologic phenotypes and affects children more than adults. To our knowledge, there are only 2 published cases of AIE with concurrent primary sclerosing cholangitis (PSC).

Aims
To review the literature for adult AIE, any previous cases of concurrent PSC, and present a case of both conditions.

Methods
We searched PubMed for “autoimmune enteropathy psc”, “autoimmune enteropathy”, “autoimmune enteropathy case report”, “autoimmune enteropathy adult” and collected all the relevant articles. Relevant clinical features of demographics, IBD status, liver diseases, immune conditions, antibody status, and treatment agents were summarized.

Results
A 31-year-old man presented with a 20-year history of diarrhea and 11kg weight loss over 3 months. He had gout, no regular medications, and relevant no family history. All initial investigations were normal. Repeat endoscopy showed increased intra-epithelial lymphocytes (IEL) in the colon consistent with lymphocytic colitis. He was given budesonide with moderate improvement. He then developed biliary stasis, and was found to have early PSC. Repeat colonoscopy for ongoing diarrhea showed increased colonic IEL. Ulcerative colitis (UC) was suspected, and he was given oral 5-ASA and prednisone, with subsequent switch to vedolizumab. He then relapsed, requiring IV fluids, total parenteral nutrition (TPN), and IV steroids. Repeat endoscopy showed persistent colonic IEL, and villous blunting in the terminal ileum and duodenum. Celiac disease, IBD, combined variable immunodeficiency (CVID), and enteric infections were excluded. In this context, AIE was considered. He improved with IV steroids, and was switched to infliximab. Despite initial improvement, he had worsening diarrhea and malnutrition. After dose escalation of infliximab, and further IV steroids and TPN, he was started on a trial of ustekinumab. We found 35 articles that reported on 100 adult cases of AIE. There were two previous adult cases of concurrent PSC. We found 7 cases where TNF-alpha inhibitors were used, one case where vedolizumab was used, and no cases using ustekinumab. Details are in Table 1.

Conclusions
AIE is a rare condition causing chronic diarrhea and gut mucosal damage reported only in case reports and series. There have only been 2 other reported cases of concurrent PSC with AIE in adults. This is the first reported case of ustekinumab being tried to control symptoms.

Funding Agencies
None
A123 GASTROINTESTINAL SYMPTOMS AND DISORDERS OF GUT BRAIN INTERACTION ARE COMMON IN PATIENTS WITH EHLERS-DANLOS SYNDROME (EDS) IN TERTIARY REFERRAL CENTER
Authors: Abu-Farhaneh E , Tse Y , Parker C H , Liu L W 
Published: February 2020

Abstract

Background
Ehlers Danlos Syndrome (EDS) is a group of rare connective tissue disorders. Gastrointestinal (GI) symptoms such as abdominal pain, nausea, vomiting, bloating and altered bowel habits are common in patients with EDS. Specifically, disorders of gut brain interaction (DGBI) appear to be more common in this patient population. The University Health Network (UHN) has the first and only multi-disciplinary clinic, including specialized gastroenterology services, in Canada for the management of EDS.

Aims
The aim of this study is to describe the GI symptoms and DGBI that are present in our cohort of EDS patients.

Methods
A retrospective chart review of all EDS who were seen in the gastroenterologist clinic of the GoodHope EDS clinic at UHN were reviewed from November 1, 2017 to September 26, 2019. Demographic information including age, sex and EDS subtype were collected. GI symptoms that were collected include constipation, diarrhea, fecal incontinence, nausea, vomiting, bloating, abdominal pain, early satiety, heart burn, dysphagia and regurgitation. A physician made diagnosis of irritable bowel syndrome (IBS) was recorded. Descriptive statistics were performed.

Results
The charts of 79 EDS patients were reviewed; 4 were excluded due to missing data. 75 patients were included in the final analysis. 93.3% of patients were female with a mean age of 36.4 +/- 12.5 years. Of these 75 patients, 43 (57.3%) had EDS-hypermobile subtype, 13 (17.3%) EDS-classic, 3 (4%) EDS-vascular, 3 (4%) unknown EDS subtype and 13 (17.3%) were categorized as having a hypermobile spectrum disorder. The most common GI symptoms observed in this patient group included abdominal pain in 85.5%, bloating in 64.4%, heartburn in 61.8%, constipation in 57.9%, nausea in 50%, diarrhea 43.4%, dysphagia in 43.4%, regurgitation in 34.2%, early satiety in 32.89%, vomiting in 30.2%,and fecal incontinence in 13.1%. It was also observed that 50.7% (n=38) had a physician made diagnosis of IBS. Of these patients with IBS, 16 (42.1%) had IBS constipation, 12 (31.5%) had IBS mixed, and 10 (26.3%) had IBS diarrhea.

Conclusions
Our study demonstrated that GI symptoms are common in patients with EDS. In our cohort, abdominal pain is the most commonly reported GI symptom, though other various GI symptoms are also reported in high numbers. DGBI are also common, with IBS being much more common than what has been reported in the general population. Further studies are needed to better understand the pathophysiology and impact of these GI symptoms and DGBI in patients with EDS.

Funding Agencies
UNH Foundation Goodhope Fund
A131 MALNUTRITION FOLLOWING IMPLEMENTATION OF A STRICT LOW FODMAP DIET FOR IBS
Authors: Woodman K , Bercik P 
Published: February 2020

Abstract

Background
Low fermentable oligosaccharides, disaccharides, monosaccharides and polysaccharides, polyols (FODMAP) diet is an elimination diet recommended for the symptom management of irritable bowel syndrome (IBS). It involves reducing the amount of unabsorbed and fermentable carbohydrates in attempt to decrease osmotic overload and gas production. This diet may be deficient in calcium and carbohydrates and alter the gut microbiota, however, its long-term nutritional implications are unknown. Thus, the 2019 CAG Guidelines for management of IBS suggest its short-term use with dietician supervision. To our knowledge, no previous cases of malnutrition secondary to a low FODMAP diet have been reported.

Aims
We report of case of severe weight loss and laboratory evidence of malnutrition following a low FODMAP diet in a patient with IBS.

Methods
Data was obtained by chart review, patient interview and review of relevant literature.

Results
A 40-year-old otherwise healthy female presented to the outpatient gastroenterology clinic for assessment of IBS in fall of 2018. At that time, she had been moderately restricting FODMAPs for several months to reduce abdominal pain and bloating. After her initial clinic visit, she followed a strict low FODMAP diet for 1 month, followed by slow and gradual re-introduction of high FODMAP containing foods. This was self-implemented without the supervision of a dietician, using on-line resources. From fall of 2018 to early 2019, she lost 12 percent of her body weight secondary to dietary restriction. While there was some improvement in bloating and pain, she developed significant fatigue.
Blood work prior to implementation of low FODMAPs diet was normal, including INR of 1.2, albumin of 45 g/L, neutrophil count 2.2 x 10E9/L, and alkaline phosphatase 31 U/L (30–110 U/L). In spring of 2019, 5 months after starting a low FODMAP diet, her INR was elevated at 1.4, neutrophils low at 1.6 x 10^9/L, alkaline phosphatase low at 32 U/L (35 U/L – 120 U/L), with normal albumin of 45 g/L. After consulting a hematology specialist, she was advised to resume adequate dietary intake.
She slowly returned to her baseline diet, but excluded lactose, beans, fruit, eggs, nuts and oats. While she restored her body weight by Fall 2019, her gut symptoms returned, although had improved overall. Her lab work showed normal neutrophils of 2.7 x 10^9/L, INR 1.3, with unchanged albumin at 45g/L.

Conclusions
While these are indirect markers of nutritional adequacy, the timeline and associated weight loss are highly suggestive of dietary inadequacy secondary to FODMAP restriction. Serum albumin remained normal as FODMAP restriction does not affect dietary protein intake. This case exemplifies the danger of initiating extreme dietary restriction in self-management manner and stresses the need of dietician supervision of such a restrictive diet.

Funding Agencies
None
A139 CANADIAN GASTROENTEROLOGY CAREER PATHWAY EXPERIENCES: A GENDER DIVIDE UNDER EXAMINATION
Authors: Jawaid N , Boctor M , Lomonaco J , Bollegala N 
Published: February 2020

Abstract

Background
The number of Canadian gastroenterologists has been on the rise in the last 20 years but female representation has stayed disproportionately low (30%). Gastroenterology has remained a male dominated subspecialty despite research showing as early as 1990’s that systemic gender-based barriers exist.

Aims
To determine whether GI career profiles differ between male and female gastroenterologists and understand barriers to career advancement related to gender in order to help shape future interventions to counteract these issues.

Methods
A 51-question survey was disseminated to gastroenterologists practicing in Canada. Using provincial College of Physicians and Surgeons websites, an electronic survey was sent to GIs with email addresses and a paper copy to those with fax numbers. The Canadian Association of Gastroenterology sent our survey link in their September 2019 membership email. The survey included questions pertaining to personal, professional, financial and practice characteristics of participants. Data was analyzed using SAS statistical program, and descriptive analysis with 95% confidence intervals was used to compare proportions of men and women. Nonparametric tests were used for continuous data. Qualitative thematic analysis was applied for short answer responses.

Results
Total 98 responses received (14.7% response rate) with 35% female respondents. Majority had adult, urban practices (86%) but males reported significantly more endoscopy time (42% v. 30%) vs. females who spent more time on research (23% v. 10%). Men were more likely to be married and have children than females. Women were more likely to not only have to choose between their marriage and their career, but more chose marriage compared to men specifically taking time off for maternity or childcare needs. Men were more likely to leave childcare predominantly to their spouse whereas women were more likely to share responsibility of childcare with spouse and hired help. Even after adjusting for age, males earned a significantly higher income than females (&gt;$100,000 difference). 40% of men reported a salary over $600,000, compared to only 4% of women. Several gender-based biases were cited by females during their staff GI career: receiving less recognition for their work, challenging relationships with senior colleagues and support staff, inferior promotion opportunity, more difficulty publishing research and having their competency challenged by peers.

Conclusions
This survey shows that there are still many differences in the Canadian GI career pathway experience based on gender. Female GIs are disproportionately negatively affected in their clinical and academic practices, renumeration and work-life balance. Understanding these disparities is the first step towards remedying gender inequality in GI workplace culture.

Funding Agencies
None