bluuebunny/crossref_metadata_2025_split huggingface dataset:
A204 THE EARLY POST-DISCHARGE PERIOD IS A VULNERABLE PERIOD FOR VENOUS THROMBOEMBOLISM IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.
Authors: Seeraj A A , McCurdy J , Siegal D , Kuenzig E , Ghasemi R , Tennakoon G 
Published: February 2025

Abstract

Background
Patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolism (VTE). The temporal relationship between VTE and hospitalization is poorly understood.

Aims
To determine the proportion of VTE events that are associated with hospitalization in patients with IBD.

Methods
We performed a retrospective cohort study of individuals with Crohn’s disease or Ulcerative Colitis (UC) who developed a VTE between January 1, 2009 and December 31, 2024 at a Canadian academic institution, the Ottawa Hospital. Patients with IBD and VTE events were identified by ICD-10 codes and confirmed with chart review. VTE events were categorized as ambulatory or hospital-associated (within the hospital admission or 90 days of discharge). To account for diagnostic delay at the time of hospitalization, VTE events within 48 hours of admission were categorized as ambulatory events. We determined demographics, comorbidities, medication exposure, anticoagulation and IBD disease activity at the time of VTE diagnosis. Differences between cohorts was determined using Chi-squared or Fisher’s exact test where appropriate.

Results
We identified 275 IBD patients with a VTE event: mean age (SD) was 55 (15.8),132 (48%) female,168 (62%) CD and 103 (38%) UC. The types of VTE included: 49% pulmonary embolism (PE) ± deep vein thrombosis (DVT), 24% DVT alone, 13% portal vein thrombosis and 14 % other VTE (splenic vein, hepatic vein, superior mesenteric vein, cerebral venous sinus). A total of 150 (55%) VTE events were categorized as hospital associated (33 patients (22%) during hospitalization and 117 patients (78%) within 90 days after hospital discharge). 30% of patients in the ambulatory category and 71% of patients in the hospital-associated category (94% during hospitalization and 30% after hospital discharge) were receiving anticoagulation (prophylaxis or therapeutic) prior to the VTE diagnosis. Patients in the hospital-associated category were significantly more likely to have a current malignancy (p=0.01), a severe flare of UC (p=0.008) and receive corticosteroids (p=0.002). There were no differences between cohorts in age, sex, comorbidities, smoking status and anti-TNF exposure.

Conclusions
Our study demonstrates that a large percentage of VTE events in patients with IBD are hospital-associated with the majority occurring early after hospital discharge. Importantly, only a minority of patients received VTE prophylaxis during this period, suggesting the post-discharge period is a vulnerable time for patients with IBD.

Funding Agencies
None
A212 ROLE OF UPADACITINIB AND IUS IN PEDIATRIC PATIENTS WITH REFRACTORY ACUTE SEVERE COLITIS: SINGLE-CENTER CASE SERIES
Authors: Alrwili R , Prowse K , Zachos M , Sharma R 
Published: February 2025

Abstract

Background
Inflammatory Bowel Disease (IBD) refractory to first-line agents is challenging in pediatrics due to limited therapeutic options, especially in Acute Severe Colitis (ASC). Upadacitinib (UPA) is a selective Janus-Kinase (JAK) inhibitor approved for use in adults. Its use in pediatrics for refractory moderate to severe colitis is off label, but its oral route of administration and quick onset of action make it a promising therapy. Intestinal Ultrasound (IUS) in this context may be a useful tool for monitoring treatment response.

Aims
To describe the efficacy of UPA as a second-line agent for pediatric ASC and report IUS findings to demonstrate its use in monitoring IBD.

Methods
Single-center chart and literature review of pediatric patients with IBD on UPA.

Results
Case 1: A 12-year-old female with pancolonic Ulcerative Colitis (UC) since age 9 maintained on Infliximab (IFX). Despite adequate IFX levels, re-induction and steroids, she had a Pediatric Ulcerative Colitis Activity Index (PUCAI) of 50, elevated C-Reactive Protein (CRP) and fecal calprotectin (FC) leading to repeat admissions. Intravenous (IV) steroids, followed by UPA 45mg for 8 weeks, led to rapid clinical response by Day 4. At discharge, PUCAI was 5 and CRP &lt;5. On Day 20 of UPA, IUS showed normal bowel wall thickness (BWT) and Modified Limberg (ML) score of 0. At 6 months, she remains in steroid-free remission with a normal FC.
Case 2: A 16-year-old female presented with a Pediatric Crohn’s Disease Activity Index (PCDAI) of 45 and was diagnosed with Crohn’s colitis with perianal fistula. Due to inadequate response to 6 days of IV steroids, she received IFX. Despite robust IFX levels, IUS showed pancolonic inflammation with increased BWT of 4.6 mm and ML score of 1-2. [1] She was readmitted with severe anemia and elevated CRP. Concurrent C. jejuni infection was treated without symptom resolution. Given severe colitis despite IFX and steroids, UPA 45mg for 12 weeks was started with clinical response and discharge by Day 4; PCDAI of 20. At 1 month, she remains asymptomatic on a steroid taper with a normal hemoglobin. Repeat IUS and FC is pending.
Case 3: A 15-year-old male with IBD favouring UC since age 14, who initially did well on steroids and IFX was re-admitted with a PUCAI of 65 and elevated FC while weaning steroids. Repeat endoscopy showed Mayo 2 colitis to hepatic flexure correlating to increased BWT of 3.5 mm and ML score of 2 on IUS. Despite appropriate IFX levels, due to steroid dependence at discharge (PUCAI 25), UPA 45mg for 8 weeks was started as an outpatient. By Day 21 his PUCAI was 0, with normal FC. At 2 months, IUS showed normal BWT and ML Score 0 with steroid-free remission.

Conclusions
These cases demonstrate the efficacy of UPA in refractory pediatric ASC with rapid clinical response, normalization of biochemical tests and IUS findings.

Funding Agencies
None
A214 CONSTRUCTION AND VALIDATION OF A FRAILTY INDEX FOR THE INFLAMMATORY BOWEL DISEASE POPULATION
Authors: Willett N , Stewart S , Jones J , Theou O , Rockwood K 
Published: February 2025

Abstract

Background
Frailty can be defined as a state of vulnerability to adverse health events, resulting from a reduction in physiological processes that are protective for health. Measuring frailty in populations with chronic immune-mediated disease, such as Inflammatory Bowel Disease (IBD), is becoming increasingly important. A Frailty Index (FI) operates within the Deficits Accumulation model and is a valid and accepted method of measuring frailty. Much of the work done in the field of frailty and IBD describes the association of frailty with post-operative complications and mortality. These studies have used various methods to determine a patient’s degree of frailty such as use of ICD codes and claims-based scoring.

Aims: Aims
To develop an FI for the IBD patient population using an accumulation of deficits approach.

Methods
A standardized method for constructing an FI using data from the SPOR IMAGINE IBD cohort was applied to a pan-Canadian, observational prospective study. Seventy-seven deficits were selected to be incorporated into the index, most from psychological or gastrointestinal variables. Construct and content validity of the index was assessed. The index was trichotomized based on established cut points and was then compared to patient demographics in the baseline cohort.

Results
An IBD Frailty Index (FI) was created using a validated 10 step process with baseline data from 2714 participants in the SPOR IMAGINE cohort. The IBD FI is made up of 77 items, and is primarily composed of physical, functional and psychological health deficits. The IBD FI showed a right skew, which is characteristic of most FIs. In this distribution the upper limit (99th percentile) of FI score is 0.529 displaying a submaximal limit, and the mean FI score was higher in women (0.19) (95% CI: 0.13, 0.15] compared to men (0.14), which are characteristic to valid FI tools. The mean age of our cohort was 45.8 years (SD: 15), mean FI score was 0.17 (SD: 0.12) (lower than in other immune mediated diseases), and 30.6% of our sample was categorized as frail (FI score &gt;0.21). Surprisingly the IBD FI scores were not positively associated with age, though they were associated with IBD symptom severity (R=0.767).

Conclusions
Frailty is an important health measure that provides a holistic picture of an individual’s health. We operationalized the accumulation of deficits approach to frailty and created a frailty measurement tool for the IBD population using variables from a wide variety of health domains. Future research projects using the IBD FI should investigate the scores’ predictive abilities for mortality and should explore the differences in frailty between patients diagnosed in middle of life (first epidemiological peak) versus later in life.

Funding Agencies
None
A215 INJECTION SITE PAIN AND ADHERENCE IN PATIENTS SWITCHING FROM REFERENCE ADALIMUMAB TO AVT02 – INTERIM RESULTS OF THE EASE PAIN TRIAL.
Authors: Shahrokh D K , Afif W , Steinhart A , Narula N 
Published: February 2025

Abstract

Background
AVT02, a biosimilar to reference product (RP) adalimumab, was first approved in Canada in 2022. AVT02 is formulated at high concentration and with citrate-free excipients. The EASE PAIN trial is a Phase IV study in Canada evaluating the impact of switching from RP, or an alternative adalimumab biosimilar, to AVT02.

Aims
The primary objective was to examine the impact of switching on injection site pain across patients in Canada. Secondary objectives included describing the impact of switching on injection site reaction including burning sensation and soreness, treatment adherence, and patient-reported quality of life.

Methods
The study enrolled patients with gastrointestinal conditions (Crohn’s disease [CD], ulcerative colitis [UC]), rheumatological conditions (rheumatoid arthritis [RA], ankylosing spondylitis [AS], psoriatic arthritis [PsA]), or dermatological conditions (hidradenitis suppurativa [HS], psoriasis [PsO]). Participants were eligible if their treating physician had decided to switch them from low-concentration RP or alternative adalimumab biosimilar to AVT02. The study assesses injection site pain measured via Visual Analog Scale (VAS), adherence, and quality of life (based on EQ-5D-5L) for participants up to Day 180 after switching. The study is currently ongoing (331 Patients enrolled in the Study; 287 included in the interim analysis)

Results
The intention-to-treat (ITT) population comprised 287 participants. Following the first administration of AVT02, injection site VAS pain score decreased by an average of -18.8 ± 25.51 across the whole population. Supporting this, there was reduction in overall injection site reactions (49.1%), burning sensation (79.4%), and soreness (84.8%) between baseline (RP administration) and follow-up (AVT02 administration). Adherence rate was 95.5% overall. The ITT population maintained high quality of life score (EQ-5D-5L score of &gt;81 on a scale of 1-100) after switching from RP to AVT02.

Conclusions
The results of this study demonstrate that switching from RP or alternative biosimilar adalimumab to AVT02 leads to decreased injection site pain across all indications, and maintenance of high adherence rates and high quality of life among patients.

Funding Agencies
None
A233 CANADIAN EXPERIENCE OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE: A CASE SERIES
Authors: Jiang S X , Thilakanathan C , Winter R , Byrne M F , Jain A , Motomura D , Gan S , Trasolini R 
Published: February 2025

Abstract

Background
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging treatment for acute cholecystitis in patients who are poor surgical candidates. There is a lack of EUS-GBD data in the Canadian setting, which may differ from its global counterparts in pattern of healthcare availability, aging population, and use of conscious sedation.

Aims
To describe outcomes following EUS-GBD in the Canadian setting.

Methods
The case series included patients undergoing EUS-GBD by an interventional gastrointestinal endoscopist in a tertiary academic centre in Canada. Data included were clinicodemographic information, procedural details, and clinical outcomes.

Results
From September 2023 to September 2024, a total of 18 patients underwent EUS-GBD. Median age was 85 (IQR 75-88) years, 6 (33%) were female, and 17 (94%) were American Society of Anesthesiologists Physical Status (ASA) classification III. Indication included 15 cases of acute calculous cholecystitis and 3 (17%) cases of salvage treatment for malignant biliary obstruction without alternative access. Placement was transduodenal in 10 (56%) and transgastric in 8 (44%). A coaxial double pigtail was placed in 15 cases (83%). Conscious sedation was used for 15 cases (83%), with 1 case using deep sedation with propofol and 2 with general anesthesia. All cases were technically successful followed by improvement of symptoms and biochemistry. There were no intra-procedural complications, but 3 post-procedural complications were noted. One patient had recurrent cholecystitis after 1 month due to stent occlusion despite coaxial pigtail placement, which was managed endoscopically with symptom resolution. Another patient had a buried stent, which was managed with placement of a second lumen-apposing metal stent within the first stent. A third patient had pain post-procedure suspected due to stent expansion, which self-resolved within 2 weeks. No rescue percutaneous or surgical interventions were required following EUS-GBD. No patients underwent subsequent cholecystectomy. Four patients died from underlying systemic disease, including 3 patients who underwent EUS-GBD for malignant obstruction with no recurrent cholecystitis up to time of death at 15-150 days post-procedure.

Conclusions
In an elderly population and using primarily conscious sedation, EUS-GBD was safe and effective in patients with high surgical risk, underscoring the suitability of this technique for a Canadian setting.

A. Gallbladder with debris/sludge on EUS. B. Distal flange of lumen apposing metal stent (LAMS) deployed within gallbladder lumen. C. Proximal flange deployed in duodenum. D. Coaxial double pigtail placed within LAMS.

Funding Agencies
None
A234 ELEVATED DIRECT BILIRUBIN DOES NOT PREDICT ELEVATED CONJUGATED BILIRUBIN IN NEONATES
Authors: Samaraweera P , Brill H 
Published: February 2025

Abstract

Background
Neonatal cholestasis guidelines consider direct and conjugated bilirubin to be equivalent because the delta bilirubin component of direct bilirubin is assumed to be negligible. Since 2015 William Osler Health System automatically measures conjugated bilirubin if the direct bilirubin is 20 µmol/L or greater in patients under 3 months old. This afforded us the opportunity to assess if direct bilirubin accurately reflects conjugated bilirubin.

Aims
To determine if direct bilirubin reliably reflects conjugated bilirubin levels in neonates and confirms the appropriateness of further investigation of neonatal cholestasis

Methods
Patient data from 2015 to 2024 was retrospectively collected and analyzed, focusing on neonates three months or younger with direct bilirubin levels of 20 µmol/L or higher. Both Direct and Conjugated bilirubin were measured using different assays. Main outcome measure was the difference between direct and conjugated bilirubin measurements.

Results
Results: 121 subjects were identified. Average direct bilirubin (32.0µmol/L) and average conjugated bilirubin (8.9µmol/L) are significantly different (p=0.008). A direct bilirubin below 22 µmol/L almost never results in a conjugated bilirubin above 2 µmol/L. Moreover, for a conjugated bilirubin of 17 or higher (the guideline trigger for neonatal cholestasis investigations), the lowest direct bilirubin measured was 34.

Conclusions
Direct Bilirubin is not an analogous proxy for conjugated bilirubin. Future guidelines should be modified to require confirming cholestasis with a conjugated bilirubin if direct bilirubin is the default tes

Funding Agencies
None
A237 INCIDENCE, RISK FACTORS, AND OUTCOMES OF POST-ERCP CHOLANGITIS: AN INTERNATIONAL MULTICENTER PROSPECTIVE STUDY
Authors: Gupta M , Fazal M , Hammal J , Ficaccio S , Khan R , Forbes N 
Published: February 2025

Abstract

Background
Cholangitis is a well-described adverse event (AE) following endoscopic retrograde cholangiopancreatography (ERCP) that is associated with significant morbidity and mortality. Despite this, contemporary characterization of this AE using high-quality prospective data is incomplete.

Aims
In this study we describe post-ERCP cholangitis incidence, risk factors, and outcomes in a large, international multicenter population of patients undergoing ERCP.

Methods
We analyzed prospective data from nine centers in Canada, USA, and Europe between 2018-2024 with 30-day follow-up. The primary outcome was post-ERCP cholangitis, defined as (1) temperature &lt;36.0°C or &gt;38.0°C or white blood cells &lt;4 x109/L or &gt;10x109/L, (2) accompanying rise in bilirubin or transaminases to &gt;1.5 times the upper limit of normal or any increase compared to pre-procedure, and (3) emergency department visit or hospital admission and/or prolongation of existing admission. Multivariable logistic regression was performed to identify risk factors, with results presented as odds ratios (OR) with associated 95% confidence intervals. Outcomes following cholangitis were also described.

Results
Post-ERCP cholangitis occurred following 134 (1.7%) of 8,119 ERCPs (mean onset of symptoms 2.0 days). Repeat ERCP was required in 53.7% of these cases. Mortality attributed to cholangitis occurred in 8.2% of incident cases. Male sex (OR 1.48, 1.02-2.19), longer procedural time (OR 1.01, 1.00-1.02 per additional minute) and presence of a biliary stricture (OR 3.24, 1.98-5.30) were all independent risk factors for post-ERCP cholangitis, while placement of a biliary stent (OR 0.59, 0.36-0.95), and biliary sphincterotomy (OR 0.59 0.39-0.87) were both protective against post-ERCP cholangitis.

Conclusions
Post-ERCP cholangitis is common and associated with high mortality rates. Adequate pre-procedural counseling and early recognition is advised, especially in patients at increased risk.

Funding Agencies
None
A238 A MULTIDISCIPLINARY APPROACH FOR PANCREATICOBILIARY CANCER WITH EMPHASIS ON TIME TO CARE ACCESS: AN OVERVIEW OF THE EDMONTON PANCREATICOBILIARY INFLAMMATION AND CANCER (EPIC) PROGRAM
Authors: Ashrafinia N , Timmermans M , Buchanan G , Perryman S , Kwan A , Bereznicki E , Mathura P , Sandha G 
Published: February 2025

Abstract

Background
Persistent challenges in pancreaticobiliary (PB) cancer management continue to have a significant impact on patients. Prolonged access to care, for diagnosis and treatment, prompted the launch of a multidisciplinary approach in 07/2023 to provide timely access to patient-centred points of care, and to improve overall quality of life (QOL).

Aims
To evaluate the outcomes of the multidisciplinary EPIC program, with a focus on access to care timelines established in a collaborative care pathway developed for this program.

Methods
All consecutive patients with suspected PB cancer presenting to the University of Alberta Hospital between 07/2023 and 08/2024 were referred to the EPIC program. Referrals were triaged by gastroenterology, pancreaticobiliary surgery, and the EPIC nurse navigator (NN) into resectable, partially resectable, and unresectable cases. Endoscopic intervention for biopsy and/or stent placement was scheduled as necessary, and referral to the local cancer cantre when indicated. Appropriate referrals were made to palliative and dietary services. The NN ensured timely referral and scheduling in accordance with the care pathway timelines and served as the primary point of contact for patients throughout their journey. Data was entered into the REDCap database. Descriptive statistics were performed.

Results
A total of 254 patients (152 male, 102 female) with a median age of 68±11 years were referred. Presenting symptoms were abdominal/back pain (72%), weight loss (47%), jaundice (36%), nausea/vomiting (18%), pruritus (9%), coincidental finding (6%), new-onset diabetes (6%), and fever (1%). The site of cancer was pancreas (81%), bile duct (13%), ampulla (2%), and others 3%. The median times to access are shown in the table and figure. The 6- and 12-month survival for resectable pancreatic cancer was 93% and 82%, respectively, whereas for unresectable pancreatic cancer was 44% and 37%, respectively.

Conclusions
A NN-led, patient-centred care model is crucial for timely access to care in PB cancer. Improved coordination of care and overall improvement in patient QOL were demonstrated with the initiation of this program.
TIME TO CARE ACCESS IN DAYS, median ± SD

Funding Agencies
None
A245 THE ROLE OF FODMAP-MICROBIOTA INTERACTIONS IN IBS-RELATED VISCERAL PAIN
Authors: Ables S E , Bennett A S , Vanner S J , Lomax A E , Reed D E 
Published: February 2025

Abstract

Background
Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits. IBS is more common in females. Furthermore, food and stress are two common triggers of abdominal pain in IBS patients. A low FODMAP diet (LFD) reduces abdominal pain in a subgroup of IBS patients, although the mechanism behind this is unclear. We hypothesize that a LFD improves abdominal pain by altering neuroactive gut luminal mediators.

Aims
1. Explore the effect of a LFD on IBS symptoms and gut luminal mediator-induced neuronal activity.
2. Investigate whether stress alters IBS symptoms and luminal mediator-induced neuronal activity.
3. Examine sex differences in dorsal root ganglion (DRG) neuron sensitivity to luminal mediators.

Methods
Six female IBS patients followed a LFD for six weeks. Participants donated stool samples and completed the IBS Symptom Severity Scale (IBS-SSS) and the Depression, Anxiety, and Stress Scale (DASS-21) questionnaires. Male and female C57Bl6 mouse DRG neurons were incubated with IBS patient and healthy control (HC) fecal supernatant (FS). Capsaicin-induced Ca2+ influx was quantified to measure neuronal activity. N refers to number of mice.

Results
Overall, IBS FS collected prior to the LFD caused a 17% increase in neuronal activity compared to HC FS (N=32 mice, p&lt;0.05). This finding was sex dependent, as only DRG neurons from female mice exhibited an IBS FS-induced increase in neuronal activity (N=18, p&lt;0.005). There was no difference in neuronal activity caused by IBS FS versus HC FS in neurons from male mice (N=16, p&gt;0.05). FS collected from patients after a LFD did not alter neuronal activity compared to FS collected before the LFD (N=32, p&gt;0.05). However, when solely analyzing neurons from female mice, LFD FS-induced neuronal activity was lower than IBS FS-treated neuronal activity (N=16, p&lt;0.05).
Four IBS patients reported a clinically significant improvement in symptoms (&gt;50-point reduction in IBS-SSS scores) during the LFD. Of these, two had a &gt;50% reduction in IBS-SSS scores and their LFD FS reduced neuronal activity compared to their IBS FS (N=10, p&lt;0.05). The two others had modest symptom improvement on the LFD; their LFD FS had similar effect on neuronal activity compared to their IBS FS (N=11, p&gt;0.05). Additionally, in two IBS patients, periods of severe stress (DASS-21 stress sub-scale score &gt;26) corresponded to high IBS-SSS scores; FS from these time points increased neuronal activity (N=10, p&lt;0.05).

Conclusions
In a subgroup of IBS patients, a LFD improves symptoms and reduces the excitatory effects of luminal mediators on sensory neuronal activation. Stress appears to increase the excitatory effects of luminal mediators and exacerbates IBS symptoms. Finally, neurons from female mice may be more sensitive to pro-nociceptive luminal mediators, potentially contributing to abdominal pain in female IBS patients.

Funding Agencies
CIHR