bluuebunny/crossref_metadata_2025_split huggingface dataset:
A193 MICROBIOTA CHARACTERIZATION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE BASED ON SELF-REPORTED FOOD INTOLERANCES
Authors: Dang R , Boron D , Linton J , Marshall J , Narula N , Caminero A 
Published: February 2025

Abstract

Background
Approximately, 20% of the world’s population experiences adverse reactions to different food items. Patients with inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) commonly exhibit more food intolerances. The dietary triggers and mechanistic pathways involved in food intolerances are unknown. As IBD patients present an altered intestinal microbiota, we hypothesized that IBD-related adverse reactions are associated with defective microbial metabolism.

Aims
We aim to 1) understand dietary triggers and patterns of adverse reactions to foods in IBD and 2) characterize the intestinal microbiota of IBD patients based on food intolerance.

Methods
127 participants (85 IBD and 42 healthy controls) were recruited from the Gastroenterology clinic and recruitment posters at McMaster University between August 2021 to September 2023. Inclusion criteria for IBD included a confirmed diagnosis of CD or UC and between 18 to 75 years old. All participants completed questionnaires related to food intolerances, symptoms, demographics, and provided a stool sample for 16S rRNA Illumina sequencing to determine microbial composition.

Results
86% of IBD patients reported at least 1 food intolerance compared to 33% of controls. The mean number of food intolerances reported in patients with CD was 3.5 (SD=1.90), UC was 3.2 (SD=1.80), and controls was 1.3 (SD=0.83). Among IBD participants who reported a food intolerance, the common reactions were reported to dairy (72% CD and 73% UC), wheat (44% CD and 37% UC), and peanuts/tree nuts (28% CD and 30% UC). Regarding microbiota analysis, IBD patients had an altered fecal microbiota with lower alpha diversity (Shannon index) compared to healthy controls (p&lt;0.0001). Alpha diversity was lower in IBD patients who reported 2 or more food intolerances compared to those who had none or 1. Also, specific adverse reactions such as dairy intolerance is associated with low alpha diversity in UC patients. IBD patients who reported a food intolerance had a higher abundance of Bacteroidota (p&lt;0.05) compared to IBD with no food intolerance.

Conclusions
Overall, IBD patients reported a high number of intolerances to foods including dairy, wheat, peanuts/tree nuts, and caffeine. IBD patients have a lower alpha diversity measure compared to controls, which was more pronounced in patients experiencing several food intolerances. Further research to understand these offending foods in intestinal inflammation could help guide dietary interventions for IBD patients.

Funding Agencies
CCC
A195 MALNUTRITION IMPAIRS WOUND HEALING DURING DSS COLITIS AND AN IN-VITRO EPITHELIAL MIGRATION ASSAY
Authors: Littlejohn P , Yang H , Wang K , Kobor M , vallance B 
Published: February 2025

Abstract

Background
Malnutrition is a major public health burden. Caused by insufficient intake of food/nutrients, malnutrition often stems from poverty and lack of access to food. Malnutrition is also a common complication of many gastrointestinal diseases, including inflammatory bowel disease (IBD). Reportedly, more than half of all IBD patients suffer from micronutrient or macronutrient malnutrition, resulting from malabsorption, low nutrient intake, and excessive bleeding or diarrhea. Nutritional deficiencies can alter the course of IBD, prolong hospitalizations, alter treatment response, and delay wound healing. Notably, epithelial wound healing is critical in IBD, but efficient re-epithelization rely on nutrients such as zinc and vitamin A. I thus hypothesize that malnutrition will impair intestinal epithelial wound repair, in vivo and in vitro.

Aims
We tested how malnutrition affects wound healing following epithelial damage caused by dextran sulphate sodium (DSS)-induced colitis and in a 2D monolayer gap closure assay.

Methods
We used our previously published mouse model of multiple micronutrient deficiencies (MND) and induced colitis using dextran sodium sulfate (DSS). Weanling three-week-old male C57BL/6N mice were fed a diet deficient in (zinc, vitamin A, B12, folate and iron) or a control diet for 4 weeks. At 3 weeks, we induced colitis by administering 2.5% DSS in drinking water for 4 days, plus 3 days of water recovery. We investigated epithelial damage, wound repair and molecular responses through histological and gene expression profiling. We also generated 3D colonoids from non-colitic malnourished mice, converted them to a 2D monolayer and subjected them to a wound migration assay cultured using an established malnourished media containing standard nutrients, and 50% of normal levels.

Results
We found that while DSS induced tissue damage both in our control and MND mice, those on the MND diet exhibited impaired tissue repair with decreased re-epithelization over the wounded area compared to controls. Organoids cultured in the 50% malnourished media showed diminished growth, being smaller and less dense compared to standard media. Notably, epithelial migration towards gap closure in the 2D monolayer was delayed by 75% compared to standard media.

Conclusions
Our work demonstrates that malnutrition impairs intestinal wound repair mechanisms. We also demonstrate an effective organoid model for examining the effects of malnutrition in vitro. We propose that efforts to address underlying malnutrition may improve wound healing leading to better outcomes for patients with IBD.

Funding Agencies
CIHRTRIANGLE/Crohn’s and Colitis Canada, BC Children’s Hospital Research Foundation
A196 MATERNAL AND NEONATAL OUTCOMES IN PREGNANT WOMEN WITH IBD TREATED WITH USTEKINUMAB OR RISANKIZUMAB: A CASE SERIES
Authors: Li K , Nabavian H , Eisen S , O’Connor K , Srikanth V , Huang V 
Published: February 2025

Abstract

Background
Biologics are an important therapy for patients with moderate to severe IBD. These include Ustekinumab (UST) – anti-IL-12/23, and the newer biologic Risankizumab (RIS) – anti-IL23. For UST, the PIANO registry and some cohort studies found no significant difference in maternal/neonatal outcomes compared to controls. However, the EPI-MERES registry found an increase in likelihood of small for gestational age births, and one study reported a slower initial postnatal growth rate for in-utero exposed infants. RIS currently has limited evidence in pregnancy.

Aims
We present a case series of maternal and neonatal outcomes of UST and RIS treated pregnant patients with IBD.

Methods
We conducted a single-centre case series including patients treated with UST and RIS at any point during pregnancy enrolled between Jan 1, 2017 and Jul 31, 2024. Data was collected on maternal outcomes including live birth, miscarriage, delivery method, and pregnancy-related complications. Neonatal outcomes included preterm birth, small for gestational age (SGA), large for gestational age (LGA), congenital anomalies, NICU admission, APGAR scores, and neonatal infection.

Results
There were 23 UST patients – 21 (91.3%) had live births and 2 (8.7%) had miscarriages. Of the 21 that delivered, there were 12 (57.1%) vaginal deliveries, 8 (38.1%) elective c-sections, and 1 (4.8%) emergency c-section due to placental insufficiency. One patient had gestational diabetes, 1 had pre-eclampsia, but there were no preterm premature rupture of membranes or intrauterine growth restrictions (IUGR). Of the 21 neonates, 3 (14.3%) were preterm, 1 (4.8%) was SGA, 3 (14.3%) were LGA, and 1 unknown. There were no congenital anomalies. Five (23.8%) infants were admitted to the NICU after birth and 1 (4.8%) was reported to have a postnatal infection within 3 months. Of the 12 infants with known APGAR scores, 10 had scores ≥7 at 1 minute, and 2 were &lt;7. At 5 minutes, all scores were ≥7.
Of the 2 RIS patients, 1 was exposed to RIS throughout the entire pregnancy and the other was given a dose during the 1st and 3rd trimester only. Both pregnancies resulted in live births with 1 vaginal delivery and 1 elective c-section. One neonate was LGA. One had an APGAR score of 8 at 1 minute and 9 at 5 minutes. The other infant scored 9 at 1 minute and the score at 5 minutes was not documented. There were no preterm births, congenital anomalies, or pregnancy-related complications.

Conclusions
In our case series of UST and RIS exposed pregnancies, there were no significant adverse maternal or neonatal outcomes. Further data is necessary to better characterize the safety of both medications.

Funding Agencies
None
A198 BIO-EXPERIENCED ULCERATIVE COLITIS PATIENTS REQUIRING ADMISSION HAVE A TWO-FOLD RISK OF COLECTOMY AS COMPARED TO BIO-NAÏVE PATIENTS
Authors: Panteluk A , Chappell K , Gozdzik M , Kroeker K 
Published: February 2025

Abstract

Background
Admission rates for patients with ulcerative colitis (UC) are decreasing, however patients admitted with a UC flare are at increased risk of colectomy. In recent years, numerous advanced therapies have emerged to treat flares and maintain remission. Many patients are now “bio-experienced”, defined as prior/current exposure to at least one advanced therapy. In flare management, colectomy is reserved for patients with severe or refractory disease, or to manage complications such as toxic megacolon or perforation. It is not known if a patient’s bio-exposure status (i.e. bio-experienced or bio-naive) affects their risk of requiring a colectomy when they are hospitalized for a UC flare. Such information is important to clinicians when choosing to initiate therapy, determining the timing of therapy escalation and allowing patients to understand their risk to make informed treatment decisions.

Aims
To assess the relative risk of 90-day colectomy in bio-experienced versus bio-naïve patients admitted to hospital with UC flare as well as secondary outcomes such as time to first advanced therapy in hospital and length of stay (LOS).

Methods
This is a single centre retrospective cohort study that included patients admitted with a diagnosis of UC flare to a major tertiary hospital in Edmonton, AB from Nov 2019 to Apr 2024. The cohort was designated as bio-naïve, having never received advanced therapies or bio-experienced, having received at least one advanced therapy prior to admission. Administrative data extraction and chart review was used to obtain the primary and secondary outcomes. Relative risk of colectomy was calculated between groups and a 95% confidence interval generated for this. The secondary outcomes were analyzed using an unpaired t-test with the significance level of p&lt;0.05. For LOS with colectomy, given significant variance, median and IQR were reported instead.

Results
In total, there were 216 admissions; 87 patients were bio-experienced and 129 were bio-naïve at the time of admission. Twenty-six patients underwent colectomy within 90 days. Of the patients who were bio-experienced, 18.39% underwent colectomy compared to 7.75% in the bio-naïve group. The relative risk of 90-day colectomy in the bio-experienced compared to bio-naïve patients was 2.37 (1.13-4.98 95% CI).
Secondary outcomes showed similar average length of stay, however bio-experienced patients were placed on advanced therapy sooner and those requiring colectomy had shortened LOS, compared to bio-naïve patients (Figure 1). Chart review for other secondary outcomes (eg. prior therapies, disease duration) is underway.

Conclusions
In this retrospective cohort study, we demonstrated that the relative risk of colectomy for UC patients admitted with flare is 2.3 fold higher in bio-experienced compared to bio-naïve patients.

Figure 1

Funding Agencies
None
A205 IMPACT OF THE PANDEMIC ON BUDESONIDE MMX DISPENSING AND TREATMENT FAILURE IN ULCERATIVE COLITIS
Authors: Coward S , Martins K , Klarenbach S , Kroeker K , Ma C , Panaccione R , Richer L , Seow C , Targownik L , Kaplan G G 
Published: February 2025

Abstract

Background
Budesonide MMX is a locally acting corticosteroid with reduced side effects compared to prednisone. During the pandemic, budesonide MMX may have been preferred due to its favourable side effect profile.

Aims
To analyze rates of budesonide MMX dispensing and treatment failure before / during the pandemic.

Methods
We analyzed population-based administrative healthcare data from Alberta to identify people dispensed budesonide MMX who met three criteria: 1. incident cases of ulcerative colitis (UC) after January 1, 2018; 2. ≥18 years old; 3. not concurrently on prednisone. We defined failure of budesonide MMX as subsequent prednisone dispensing within 30 days. We calculated rates of budesonide MMX dispensing per 1000 incident UC cases. We calculated average monthly percentage change (AMPC) in dispensing and failure rates with 95% confidence intervals (CI) by Poisson or negative binomial models. An interaction term tested differences between pre-pandemic rates (prior to April 2020) and pandemic rates (April 2020 to March 2023). We used Cox proportional hazard models to compare budesonide MMX failure before vs during the pandemic, with hazard ratios (HR) and 95%CIs—a sensitivity analysis was done to extend the follow-up time to 90 days.

Results
Overall, 320 incident UC cases were dispensed budesonide MMX with 30-days follow-up. Of those, 14.06% (95%CI: 10.25, 17.87) received prednisone within 30 days. Mean time to failure was 17 days. There was a significant difference in the AMPC in dispensing rates was observed pre-pandemic vs during the pandemic (p=0.037) (Table 1). After the pandemic onset, budesonide MMX dispensing significantly decreased (AAPC: −2.43%; 95%CI: −3.77, −1.08). For the 30 days, the HR for budesonide MMX failure was 1.92 (95%CI: 0.95, 3.88). When the follow-up was extended to 90 days the HR was significant at 1.68 (95%CI: 1.05, 2.71), suggesting a significantly increased hazard of budesonide MMX failure during the pandemic compared to pre-pandemic.

Conclusions
Budesonide MMX dispensing was stable pre-pandemic but significantly decreased during. The pandemic may have been associated with an increased failure rate of budesonide MMX—particularly within 90 days—as more patients required prednisone to manage their UC.
Analysis of Rates per 1000 Individuals with Incident UC

Funding Agencies
Ferring Pharmaceuticals
A211 CLINICAL CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASE IN JORDANIAN CHILDREN: A RETROSPECTIVE STUDY
Authors: Altamimi E , Alsmadi A S , Almomani H H , Alshurman M A 
Published: February 2025

Abstract

Background
Inflammatory Bowel Disease (IBD) is a chronic condition characterized by inflammation of the gastrointestinal tract. While IBD is increasingly recognized in pediatric populations worldwide, there is limited data on its characteristics in Jordanian children.

Aims
This study aims to describe the clinical presentation and management outcomes of IBD in children from a tertiery center in North Jordan.

Methods
A retrospective analysis was conducted on pediatric patients (aged 0-18 years) diagnosed with IBD between July 2017 and July 2024 at King Abdullah University Hospital in North Jordan. Data on demographic information, clinical symptoms, diagnostic procedures, treatment regimens, and follow-up outcomes were collected from medical records.

Results
Over the study period, 31 patients were diagnosed with IBD, with 58% being female. Among these, 51.6% were classified as Crohn’s disease, 29.0% as ulcerative colitis, and 19.4% as indeterminate colitis. The mean age at diagnosis was 8.7 years. The most common presenting symptoms were diarrhea (67.6%), abdominal pain (58.0%), weight loss (32.2%), and fatigue/malaise (32.2%).
Anemia was observed in 17 patients (54.8%). Intravenous iron therapy was required in 3 patients (9.7%), while 2 patients (6.5%) needed multiple blood transfusions. Escalation of initial therapy was necessary for 15 patients (48.4%). Biologic therapy (Anti-TNF agents) was used in 8 patients (25.8%), all of whom initially responded. However, 3 patients (37.5%) were switched to a second anti-TNF agent after secondary loss of response. Two patients (25.0%) developed psoriatic lesions, although none experienced serious infections. Notably, one patient (12.5%) required concomitant anti-tuberculosis treatment due to a latent tuberculosis diagnosis prior to initiating biologics.
One patient (3.2%) developed pancreatitis requiring hospitalization. This same patient also experienced dural venous thrombosis, necessitating prolonged anticoagulant therapy. None of the patients in this cohort underwent surgical intervention.

Conclusions
IBD in Jordanian children presents with clinical features similar to those reported in other regions, although environmental or genetic factors may lead to some variations in disease patterns, and treatments` response. Further studies are needed to optimize management protocols for pediatric IBD in Jordan.

Funding Agencies
None
A216 THE COST-EFFECTIVENESS OF FERRIC DERISOMALTOSE VERSUS FERRIC CARBOXYMALTOSE IN THE TREATMENT OF IRON DEFICIENCY ANAEMIA IN CANADA
Authors: Pollock R F , Bernstein C N , Shaffer S 
Published: February 2025

Abstract

Background
In Canada, approximately 0.8% of people have inflammatory bowel disease (IBD), which is estimated to rise by 2.4% annually over the next decade. Iron deficiency anaemia (IDA) is common in people with IBD, who can experience high levels of fatigue that may be alleviated by iron treatment. Intravenous (IV) iron is recommended for people who are intolerant or unresponsive to oral iron or those who require iron rapidly. Ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) are high-dose, rapid-infusion iron formulations approved for treatment of IDA in people with IBD.

Aims
To evaluate the cost-utility of FDI versus FCM when treating IDA in patients with IBD in Canada.

Methods
A published model was adapted to evaluate the cost-utility of FDI versus FCM in Canada. Joint distributions of bodyweight and haemoglobin were used alongside the product monographs (PMs) to model iron need. Iron supply models for FCM and FDI were developed based on posological information in the PMs. Disease-related quality of life (QoL) was modelled using SF-36 data from the PHOSPHARE-IBD randomized trial and a diminishing marginal utility model was used to estimate the effect of iron infusions on QoL. Costs were obtained from Canadian sources aligned with a previous CDA-AMC appraisal of FDI. Price parity between FCM and FDI was assumed, and indirect costs arising from attending IV iron infusions were captured. Analyses were run over 10 years, costs were expressed in 2023 Canadian dollars ($), and future costs and effects were discounted at 1.5% per annum. Scenario analyses were performed incorporating fracture incidence based on recent data showing elevated fracture risk after administration of FCM versus FDI.

Results
Relative to FCM, FDI was associated with an additional 0.147 QALYs over 10 years, driven primarily by differences in disease-related QoL (Table). Costs were lower with FDI than FCM ($7,630 versus $9,236), corresponding to a saving of $1,606 per patient over 10 years driven by a reduced number of infusions required to correct iron need with FDI (11.13 versus 14.21 with FCM), and no requirement to monitor phosphate after FDI (Figure). FDI was therefore the dominant intervention. In the fracture scenario analysis, fracture risk was similar before and after treatment with FDI, but was higher with FCM, accompanied by additional costs of $3,086 versus FDI over 10 years ($4,285 versus $1,199).

Conclusions
In people with IBD and IDA requiring IV iron, FDI dominated FCM, reducing costs while improving QoL.
Contributors to QoL over 10 years

Direct cost drivers in the base case analysis and indirect costs in the societal analysis

Funding Agencies
Pharmacosmos A/S
A218 INFLAMMATORY PHENOTYPE AS A PREDICTOR OF TREATMENT RESPONSE IN ULCERATIVE COLITIS
Authors: AlDarwish A , Wilson A 
Published: February 2025

Abstract

Background
A variety of immune pathways contribute to the propagation of inflammation in ulcerative colitis (UC). Both, Th1- and Th2-associated cytokines and cells, have been implicated in the pathogenesis of the disease. Eosinophils, which are elicited by Th2 immune response, are increasingly recognized to have a pivotal role in the pathogenesis of UC, however, the exact link between eosinophils and UC disease outcomes and treatment responses over time is still incompletely defined.

Aims
We aim to evaluate the association between pre-treatment peripheral eosinophil counts and treatment response in patients with ulcerative colitis.

Methods
In this retrospective cohort study, data from 150 treatment naïve adult patients who were diagnosed with ulcerative colitis between 2005 and 2020 were reviewed. White blood count differential was collected at diagnosis and following exposure to one or more of the following treatments: corticosteroids, TNFa antagonists, or vedolizumab. Patients were stratified into two cohorts for analysis: “high-eosinophil” cohort (&gt;=0.2x109cells/L) and “low-eosinophil” cohort (&lt;0.2x109cells/L). The partial and endoscopic Mayo scores were evaluated at baseline and following treatment. Patients’ data were collected until their last gastroenterology follow-up or until surgical intervention. Demogoraphic data were summarized using descriptive statistics. Fisher’s Exact test was used to evaluate the association between eosinophil count and drug response as well as other outcomes.

Results
A total of 150 patients were included. 92 patients (63.3%) were included in the high-eosinophil cohort, while 58 patients (38.6%) were included in the low-eosinophil cohort. The median duration of follow-up was 78 months (IQR42.5) and 74 months (IQR45) in the high-eosinophil group and low-eosinophil group, respectively. Between the high-eosinophil group and low eosinophil group, there was no statistically significant difference in terms of steroid response (71.3%, 78.6% respectively, p=0.330), achieving steroid-free remission with TNFa antagonist (76%, 72.2% respectively, p=0.662), achieving steroid-free remission with vedolizumab (54.1%, 65.2% respectively, p=0.394), or disease refractoriness requiring more than 2 drug changes (15.4%, 8.8% respectively, p = 0.106).

Conclusions
This study did not show a correlation between baseline eosinophil count and response to therapy - corticosteroids, TNFa antagonist, and vedolizumab. Larger prospective studies are warranted to assess disease outcomes and treatment response to eosinophil-targeted therapy.

Funding Agencies
None