bluuebunny/crossref_metadata_2025_split huggingface dataset:
A45 EXPLORING COST AND VALIDITY OF NOVEL COMMERCIAL AND NON-COMMERCIAL (SELF-ASSEMBLED) SIMULATORS IN GASTROINTESTINAL ENDOSCOPY TRAINING: A SCOPING REVIEW
Authors: Zhao A Y , Gimpaya N , Lisondra J , Wiggin A , Almneni A , Tran W , Grover S 
Published: February 2025

Abstract

Background
Simulation-based training improves trainee learning curves and minimizes patient risk. However, not all endoscopic procedures have commercially available simulation models. Further, costs and location may limit trainee access to commercial simulators. This has driven the design and development of non-commercial, self-assembled simulators by educators, training programs, and learners.

Aims
To perform a scoping review to explore reporting of validity, assembly time and cost of novel simulators developed in the last 5 years.

Methods
A search on MEDLINE, PubMed, and ProQuest from January 2019 to September 2024 identified articles that developed or used simulators for gastrointestinal (GI) endoscopy procedures and techniques. A five-year date limit was implemented to account for advancement in simulation technology over this time frame. Two independent reviewers screened the articles. Included articles were designated as non-commercial simulators if they are open-access, not for purchase, and intended for self-assembly; or commercial simulators if they did not meet these points. Data on cost, assembly time, and method of validity testing were recorded. Costs were converted to USD using a consumer price index calculator (2024). The primary outcome was the type of validity testing as reported in the articles. Other outcomes are the differences between cost and assembly time.

Results
28 articles were included. Figure 1 summarizes each study, the characteristics and the specific skills simulated for each simulator, and the methods used for validity testing. 19 articles were on non-commercial simulators (18 mechanical, 1 Virtual Reality (VR)) and 9 were on commercial simulators (7 mechanical and 2 VR). Validity testing was conducted in 12 of the 19 non-commercial simulator studies (9 instances of face validity, 10 content, and 11 construct), and in 8 of the 9 commercial simulator articles (3 instances of face validity, 2 content, and 2 construct). The single study on a non-commercial VR simulator did not report cost. Costs ranged from $28-$1035, for non-commercial mechanical simulators, $247-$12,995 for commercial mechanical simulators, and $62,087-$136,591 for commercial VR simulators. Only four articles on mechanical simulators reported assembly time, which ranged from 1-8 hours, with additional set-up ranges of 10-20 minutes.

Conclusions
This scoping review explored the validity testing, cost, preparation time and types of validity used in newly-developed commercial and non-commercial simulators. Future iterations of this study will expand the search strategy, assess the quality of studies, evaluate and compare the validity testing performed between commercial and non-commercial simulators.

Included articles.

Funding Agencies
None
A62 UNCOVERING MICROBIAL DETERMINANTS OF IBS FLARE-UPS: COHORT-LEVEL VS PATIENT-SPECIFIC APPROACHES
Authors: Mohan V , pinto-sanchez M , Nardelli A , Borojevic R , Magee M , Shanmuganathan M , Kroezen Z , De Palma G , Moayyedi P , Britz Mckibbin P , Collins S , Bercik P 
Published: February 2025

Abstract

Background
Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder with a global prevalence of 3.8% (5.8% in Canada, using Rome IV criteria), with the gut microbiota implicated in its pathophysiology. Despite extensive research in the last decade, the microbial mechanisms underlying symptom flares remain unclear. We showed in the previous analysis of our longitudinal study that the strongest factors responsible for separating IBS flare-ups from asymptomatic periods were stool appearance (Bristol stool scale) and somatization, followed by pain scores. Although there were no significant differences in alpha microbial diversity, beta diversity changes associated to symptom flares occurred in 25% of patients.

Aims
Explore cohort-level versus personalized analyses in identifying microbial and metabolic predictors of flares in IBS patients.

Methods
Twenty-eight IBS patients (IBS-D n=20; IBS-C n=8) and 10 healthy controls (HC) were followed for 25 weeks, with weekly symptom assessment (Birmingham IBS, HAD, STAI questionnaires) and stool sample collected (950 samples), analyzed by 16S rRNA sequencing and metabolomics profiling. Discriminatory taxa and metabolites among groups and within individuals were identified using sparse PLS-DA and mixed-effect models.

Results
The integrated stool microbiome-metabolome analysis revealed 6 taxa and 8 metabolites in IBS-D, and 10 taxa and 18 metabolites in IBS-C cohort, that differed from HC (adjusted p&lt;0.05). However, when comparing asymptomatic and flare-up timepoints within IBS cohorts, these microbial taxa and metabolites lost significance. Variance partitioning from mixed models indicated that individuals accounted for a larger share of the variance than cohort-level differences. Consequently, we performed time-course individual analysis in several patients, which identified about 40 bacterial taxa and 33 metabolites being altered during flare-up timepoints among both IBS-D and IBS-C patients. Furthermore, alterations in specific metabolic pathways were more prominent in individuals than in cohort comparisons.

Conclusions
Our results suggest that personalized analysis is essential for better understanding of symptom dynamics within individual patients. Group-level differences may highlight general alterations in microbiome that make IBS patients more susceptible to the effects of transient taxa and metabolites identified in individual analyses, which might then contribute to symptom flares in that individual. While these microbial and metabolic predictors still require further investigation, they emphasize the complexity of IBS pathophysiology and the need for a hybrid approach to improve biomarker discovery.

Funding Agencies
CIHR
A64 VALIDATION OF THE MODIFIED MULTIPLIER OF SES-CD (MM-SES-CD) TO PREDICT ENDOSCOPIC REMISSION IN CROHN’S DISEASE: A POST HOC ANALYSIS OF THE SEAVUE TRIAL
Authors: Anvari S , Ahuja D , Wong E , Dubai P , Marshall J , Jairath V , Reinisch W , Narula N 
Published: February 2025

Abstract

Background
The modified multiplier of the SES-CD (MM-SES-CD) has been shown to have prognostic value for predicting endoscopic healing (EH) in patients with Crohn’s disease.

Aims
The purpose of this analysis was to validate baseline categories of endoscopic disease severity using the MM-SES-CD and determine their prognostic value for predicting one-year EH.

Methods
Participants in the SEAVUE trial (n = 386) were categorized based on baseline endoscopic disease severity using MM-SES-CD cut-offs into mild (≥22.5 to &lt; 31), moderate (≥ 31 to &lt; 45) and severe (≥45) disease. The primary outcome was achievement of endoscopic healing (EH) based on MM-SES-CD score (&lt; 22.5) at one year. Secondary outcomes included achieving clinical remission based on patient-reported outcomes and normalization of fecal calprotectin in patients with raised baseline levels at one year.

Results
MM-SES-CD &lt; 22.5 at one year was achieved in 62.0% of patients with baseline mild endoscopic disease, 48.6% with moderate disease and 33.8% with severe disease (p &lt;0.001). Similarly, a trend was observed for patient-reported outcome (PRO-2) clinical remission, which was achieved in 78.9% of patients with baseline mild endoscopic disease, 72.9% of those with moderate and 66.2% of those with severe disease (p=0.09). Likelihood of fecal calprotectin (FCP) normalization was significantly associated with baseline endoscopic disease severity (p=0.008).

Conclusions
Baseline MM-SES-CD-based cutoffs for endoscopic disease severity demonstrate prognostic value for achieving one-year EH, PRO2 remission, and FCP normalization. These findings suggest that the MM-SES-CD can be used both to measure baseline endoscopic disease severity and predicts post-maintenance outcomes in patients with CD.

Figure 1: Percentage of patients in MM-SES-CD remission (&lt;22.5) at week 52 stratified by baseline MM-SES-CD categories (Mild ≥ 22.5 to &lt; 31, moderate ≥ 31 to &lt; 45, severe ≥ 45)
Funding Agencies:
A69 UVB SKIN EXPOSURE MODULATES INTESTINAL METABOLISM AND HOST DEFENSE
Authors: Jimenez Sanchez M C , Yang H , Sham H , Dutz J , vallance B 
Published: February 2025

Abstract

Background
Gastrointestinal (GI) diseases are rising in Western societies, alongside environmental changes like reduced exposure to ultraviolet (UV) B light. UVB light affects the skin through vitamin D (vitD) and Aryl hydrocarbon receptor (Ahr) signaling, but its potential influence on distant sites, like the gut, is not well studied, despite GI and skin diseases often co-occurring (O’Neill et al, 2016). Patients not only suffer from GI symptoms but also may experience various mood disorders such as anxiety and depression (Graff et al, 2009). We aimed to explore how UVB skin exposure influences gut health, microbiota and its metabolic by-products, and hypothesize that UVB may also affect the gut-brain axis, influencing mood and cognition.

Aims
Test the (1) effect of UVB light using vitD deficient (-) and sufficient (+) diets on the metabolomic profile and gut microbiome, and (2) the impact of vitD levels and UVB on susceptibility to Citrobacter rodentium infection.

Methods
Female C57BL/6J mice were fed either vitD (+) or (-) diets. They were anaesthetized, and then 8 cm2 of their dorsal skin was shaved and exposed to UVB. Mice were euthanized to collect serum, cecal content, and stool (FI-ToF metabolomics analysis and 16S sequencing). Ingenuity Pathway Analysis (IPA) was used to predict the impact of metabolic changes.
Mice were infected by oral gavage using 2x108 colony-forming units of WT C. rodentium, monitored daily and euthanized on day 10 post-infection. Samples (cecum, colon, and stool) were collected for CFU, histology, immunostaining, and qPCR analysis.

Results
In vitD (-) fed mice, UVB skin exposure raised vitD levels to match those on vitD (+) diets. Untargeted metabolomics detected ~1,630 stool metabolites at baseline, and following one UVB exposure, 266 metabolites changed in the vitD (-) group, 297 in the vitD (+), with 47 overlapping. After 6 exposures, 449 metabolites changed in the vitD (-) group, 138 in the vit D (+), with 61 overlapping. Pathway analysis revealed significant alterations in purine, tryptophan, and alanine-aspartate-glutamate metabolism. IPA determined that changes in these pathways in the vitD (-) group were associated with mood disorders and colorectal tumor inhibition. 16S microbiome analysis showed changes in the Bacteroidota phylum. Finally, vitD (-) group showed increased susceptibility to C. rodentium infection, while UVB light skin exposure reduced intestinal pathology in the vitD (-) group, suggesting a protective role of UVB light against intestinal infection.

Conclusions
The study demonstrates that UVB exposure significantly alters the GI metabolome and microbiome, with a greater impact in vitD (-) mice. These findings highlight the complex interplay between UVB exposure, vitD status, and host metabolism and immunity.

Funding Agencies
NSERC
A78 INTESTINAL AND PANCREATIC HNF4A ACTING TOGETHER TO MANAGE BLOOD GLUCOSE LEVELS
Authors: Rodriguez Rodriguez N , de Castro A , Jones C , Pupo D , Boudreau F 
Published: February 2025

Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST
Please acknowledge all funding agencies listed below
Funding Agencies: Bourses d’excellence de l’Université de Sherbrooke
A79 EAT, SLEEP, WORK, REPEAT! WEARABLES AND APPS TO TRACK IBD PATIENTS’ SYMPTOMS, DIET, SLEEP, AND PHYSICAL ACTIVITY
Authors: Miranda P M , Fernando I , Armstrong D 
Published: February 2025

Abstract

Background
Lifestyle factors like diet, physical activity, and sleep patterns are known to influence symptoms and progression in Inflammatory Bowel Disease (IBD). However, accurately determining temporal relationships between these factors and symptoms has been hampered by a lack of reliable data collection methods. New technologies, such as wearables and smartphone apps, offer real-time, remote monitoring and allow for better understanding of their relationship with IBD symptoms.

Aims
To assess the feasibility of using remote monitoring tools (wearables and mobile apps) to explore the temporal relationships between symptoms, diet, and sleep in IBD patients.

Methods
Adult IBD patients participated in a 3-month pilot study (Track-IBD), during which they wore a fitness monitor (Oura Ring) and tracked their diet and symptoms in real-time using Keenoa (diet tracking) and Zamplo (symptom tracking) smartphone apps.

Results
Fifteen IBD patients (9 - Crohn’s disease, 6 - ulcerative colitis; 8 female; 12 Caucasian; mean age 41.2 years) were enrolled. The usage rates were 69.8% for Zamplo, 77.0% for Keenoa, and 77.0% for the Oura Ring. The most commonly reported symptoms were abdominal pain, diarrhea, and fatigue, which together accounted for 67% of all recorded symptoms. Symptoms were predominantly reported in the afternoon (30.1%) and late-night (49.2%), while morning and early-night periods saw fewer reports (20.7%). Most symptoms occurred within 5 hours of a meal, with peaks in meal-to-symptom latency (MTSL) at 0.5–1 hour and 4–5 hours post-meal, demonstrating an association between meal timing and symptoms. No correlation was found between MTSL and the nature of the symptoms (upper, lower, or extra-intestinal) or macronutrient intake. Wearable data analysis revealed decreased sleep quality and increased average heart rate on symptomatic days (p&lt;0.04). Most participants found the apps easy to use (Oura: 100%, Zamplo: 93%, Keenoa: 73%) and helpful in managing their IBD (Oura: 100%, Zamplo: 87%, Keenoa: 60%).

Conclusions
The Track-IBD study demonstrates high adherence to monitoring diet, symptoms, and physiological measures by IBD patients over 3 months. It also shows the feasibility of combining multiple tracking technologies to assess lifestyle patterns, physiological parameters, and symptoms in real-time. Preliminary analyses identified relationships between symptoms, diet and sleep quality, highlighting the potential to identify lifestyle triggers of disease and symptom flares and provide personalized therapeutic advice to IBD patients.

Funding Agencies
Balsam Foundation
A87 LEVERAGING DIGITAL HEALTH: SYMPTOM TRACKING IN PEDIATRIC IBD USING A SMARTPHONE APP FOR ENHANCED PATIENT-REPORTED OUTCOMES
Authors: L’Heureux-Hubert É , Mah T , Fleur-Aimé M , Louis P , Vaccarino C , Khouna H , Martin R , Kubinski R , Chapuy L , Cuccia L , Deslandres C , Jantchou P 
Published: February 2025

Abstract

Background
Patient-reported outcome measures (PROMs) are essential for managing chronic diseases, as they provide valuable insights into patients’ perspectives on their condition’s impact and help tailor treatments accordingly. However, collecting this information from pediatric patients with inflammatory bowel disease (IBD) presents several challenges, such as the reluctance of patients to discuss sensitive topics such as bowel movements, defecation, and rectal bleeding. Additionally, the subjective nature of physicians’ evaluations compared to the experiences of patients affect the symptom assessment. An IBD app could help teenagers to routinely assess the clinical symptoms.

Aims
The objectives of the study were twofold: first, to describe the trajectory of symptoms as self-reported by patients through a digital application, and second, to compare these symptoms with those evaluated by physicians during medical visits.

Methods
We conducted a prospective study involving teenagers with IBD aged 15-18 years old. All participants had a smartphone and an understanding of English. They received an app (Injoy Gut Health tracking by Phyla Technologies Inc.) that allowed for the collection of symptoms at home, which they were asked to use daily. At inclusion, participants completed the IBD Control questionnaire. Additionally, we collected information on disease status such as the physician global assessment (PGA).

Results
We included 25 children (60% female) with a median age at diagnosis of 14.5 years (interquartile range (IQR): 13.2-14.5) for IBD (64% Crohn’s disease) for a median of 3.6 years (IQR: 2.7-5.4). Most participants (84%) were in complete remission and 16% had mild active disease, according to the PGA. The teenagers completed the app survey for a median of 122 (IQR: 44-200) days.
Participants reported gastrointestinal symptoms during daily data collection: 48% experienced rectal pain, 64% experienced nausea, 96% experienced gas, 76% experienced bloating and 80% experienced abdominal pain. Finally, 28% noted blood in their stools representing a median of 7.8% (IQR 8.88-11.9) of their stools. The PROMs filled at baseline depicted a spectrum of disease activity. The median IBD-control-8 subscore was 12 (IQR: 10-15).
The PROMs and the data self-collected daily at home were not in agreement with the PGA. Indeed, symptom data showed that participants experienced a median of 7 (IQR: 4-8) symptoms while 92% (23) of patients reported more than two symptoms.

Conclusions
These results highlight the importance of incorporating PROMs for more precise and personalized management of IBD in children. The use of an app for at-home daily data collection proved to be a valuable tool in capturing real-time symptomatology.

Funding Agencies:
A88 PATIENT-CENTRIC VALIDATION OF A PROVINCE-WIDE COLONOSCOPY REFERRAL SHEET DETERMINING WAIT-TIME PROCEDURAL ALLOCATION
Authors: Barkun A , Aprikian S , Hansen-Barkun C , Kim D , Milky G , Beauchesne-Blanchet J , Martel M , Menard C , von Renteln D 
Published: February 2025

Abstract

Background
The widespread use of a standardized, validated province-wide colonoscopy referral form (PCRF), regrouping mutually exclusive indications into suggested priority wait time categories has allowed for a more comprehensive, patient-centric assessment of routine colonoscopy practice

Aims
To better characterize colonoscopic finding yields based on specific clinical indications (PCRF) determined by patient symptoms’ questionnaire-generated indications rather than referring physician-based indications. We also attempt further validation of the PCRF.

Methods
Prospective cohort of consecutive adult patients from two hospitals. Information collected from PCRF (therefore referring physician assessment) but also additional symptoms from a patient questionnaire. The primary outcome was the colonoscopy findings. Descriptive and inferential statistics and multivariable regression analyze predictive modeling of different indications and symptoms.

Results
Overall, 5979 patients (mean age 59.2±14.2years, 49.8% female, mean BMI 26.7±5.2) were included from June 2022 to February 2024. Duration between colonoscopy referral and colonoscopy (days) was 266.7 ± 405.9 (median=138 days). Excluding diverticulosis and non-bleeding hemorrhoids, 41.3% of patients had clinically significant lesions and 0.9% adenocarcinomas. The main indication according to patients was surveillance of polyps (IN13 - 35.7%), surveillance for significant family history (IN21 - 21.2%), IBD surveillance (IN15 - 11.7%). Based on additional questions of the patient questionnaire that did not correspond to any indication on the PCRF, 70.0% had no additional symptoms while 13.3% experienced abdominal pains, and 11.1% cramping, with 4.8% reporting weight loss. Between-group comparisons for adenocarcinoma and clinically significant lesions are described in figure 1. Models with the best fit for predicting adenocarcinoma were associated with the combinations of age&gt;40, and presence of IN2, IN5, IN6 and IN17 with OR=7.74 (4.45; 13.46) (or OR=6.46 (2.78; 15.14) for age&gt;60). Clinically significant lesions were associated with the combinations of age&gt;60, IN5, IN17 and IN13 with OR=2.05 (1.83; 2.90).

Conclusions
This exercise has allowed further validation of recently adopted provincial changes in PCRF priorities attributed to some indications. Addition of symptoms not captured in PCRF indications did not improve prediction using existing indications in multivariable modelling. The use of multiple PCRF indication in allocating waiting priorities rather than choosing the sole perceived most urgent one (which is how the PCRF is used) now requires prospective validation.

Funding Agencies
CPAC and MSSS
A95 APPROACH AND OUTCOMES OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING: ANALYSIS OF 50 CASES IN A TERTIARY CARE CENTRE
Authors: Labib K A , Zepeda-Gomez S , aldaihani a , Fazal M , Hashmi A 
Published: February 2025

Abstract

Background
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a significant cause of morbidity and mortality worldwide. NVUGIB refers to bleeding occurring above the ligament of Treitz, excluding variceal causes. Despite improvements in management, the incidence and mortality of NVUGIB remain high. Key challenges include determining optimal treatment strategies and predicting patient outcomes.

Aims
To analyze clinical presentation, management strategies, endoscopic findings, treatment and outcomes of NVUGIB patients.

Methods
A retrospective review was conducted at the University of Alberta Hospital on 50 patients diagnosed with NVUGIB who underwent endoscopy within 48 hours of presentation. We analyzed clinical presentation, management strategies, endoscopic findings, treatment and outcomes to assess their impact on patient care.

Results
Of the 50 patients, 54% were male, and melena was the most frequent presenting symptom (56%). Sixty-two percent of patients received intravenous proton pump inhibitors (IV PPI) during initial management, while 42% were on NSAIDs without concurrent PPI therapy. Peptic ulcer disease was the leading cause of bleeding (90%), followed by vascular lesions (6%) and Mallory-Weiss tears (4%). Among ulcers, 66.7% were classified as Forrest III. Nine patients (18%) underwent urgent endoscopy within 6-12 hours, while 30% had early endoscopy (12-24 hours), and 52% had late endoscopy (after 24 hours). High-risk lesions (Forrest Ia, Ib, IIa) were identified in 32% of patients. The early endoscopy group had the highest rate of high-risk lesions (53%), compared to the urgent group (33%) and the late group (19%). Patients with high-risk lesions experienced significantly longer hospital stays, averaging 7.8 days compared to 4.9 days for those without high-risk findings (p &lt; 0.005). Re-bleeding occurred in 16% of patients after initial endoscopy. Six patients received successful repeat endoscopic therapy, while two required embolization for bleeding duodenal ulcers. No further episodes of bleeding occurred in the re-bleeding group, and one patient died within 30 days of presentation, the cause was unrelated to bleeding.

Conclusions
Peptic ulcer disease remains the most common cause of NVUGIB, with NSAID use as a key risk factor. Timely endoscopy and appropriate initial management are critical for optimizing outcomes. High-risk lesions are found in approximately 30% of patients and are associated with longer hospital stays. Physicians should be aware of embolization as a rescue therapy for patients who experience re-bleeding.

Funding Agencies
None