bluuebunny/crossref_metadata_2025_split huggingface dataset:
A108 ASSESSING THE RELATIONSHIP BETWEEN MENTAL HEALTH, QUALITY OF LIFE, AND ACCESSING CARE IN PREGNANT IBD PATIENTS
Authors: Srikanth V , Premjeyanth V , Perera S , O’Connor K , Krugliak N , Huang V 
Published: February 2025

Abstract

Background
Individuals with Inflammatory Bowel Disease (IBD) are at an increased risk of depression and anxiety, which are correlated with IBD disease activity and reduced quality of life. However, the impact of mental health on pregnant persons with IBD and the barriers to mental health care remain less clear.

Aims
To explore associations between mental health, quality of life, and barriers to addressing mental health concerns in pregnant persons with IBD.

Methods
We conducted an anonymous, cross-sectional survey of pregnant IBD patients. Data collected included demographics, IBD disease activity via modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD) and the Partial Mayo Score 6 (pMayo6) for ulcerative colitis (UC), mental health scores (PHQ-9 and GAD-7), and IBD-related quality of life using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We also explored patient perceptions of mental health stigma, barriers to accessing care, and comfort in discussing these concerns. Chi-square analysis and Fisher’s Exact Test were employed for categorical comparisons, and the Mann-Whitney U test was used to compare mental health scores with SIBDQ.

Results
Fifty-seven surveys were analyzed (52.6% CD, 47.4% UC). The mean age was 33.98 years (SD 3.734), and 22.7% had active disease (mHBI ≥ 5 or pMayo6 &gt; 1). Elevated mental health scores (PHQ-9 and/or GAD-7 ≥ 5) were observed in 57.9% of participants, with 7% having high PHQ-9 scores, 12.3% having high GAD-7 scores, and 38.6% having both. The median SIBDQ score was 57 (IQR 12). A significant association was observed between lower SIBDQ scores and the presence of both an elevated PHQ-9 and GAD-7 score (p &lt; 0.001), while neither score alone had a significant effect.
17.5% reported feeling stigmatized when discussing mental health, highlighting concerns of being perceived as weak, some in their role as maternal figures. A statistically significant association was observed between a clinical diagnosis of both depression and anxiety and feeling stigmatized. 12.3% reported cultural deterrents, noting language, negative cultural connotations, and lack of understanding within their communities. Ethnicity, education, and marital status did not significantly affect satisfaction with available supports, experiencing stigma or barriers to access. There was no significant association between Caucasian versus non-Caucasian patients’ preference for discussing these concerns with a physician (GP, IBD specialist, gastroenterologist, OBGYN, psychiatrist) or family/friends.

Conclusions
Pregnant IBD patients with both elevated PHQ-9 and GAD-7 scores may experience diminished quality of life, underscoring the need to address mental health concerns in disease management. Further research is needed to explore the influence of these factors on maternal-neonatal outcomes.

Funding Agencies
University of Toronto: UT GE-HEP NEW INVESTIGATOR PILOT AWARD
A116 PROMOTING ALCOHOL CESSATION IN THE INPATIENT GASTROENTEROLOGY WARD
Authors: Hussain M , Natt N , Almahanna Y , Hudson D 
Published: February 2025

Abstract

Background
Alcohol use disorder (AUD) is a significant global health issue, ranking as the third leading cause of death and disability, with a financial burden exceeding $16 billion annually for the Canadian healthcare system. A recent review of patient discharges from the inpatient Gastroenterology ward at University Hospital revealed that less than 8% of patients with AUD were discharged with anti-craving medications or addiction referrals, highlighting a gap in care coordination

Aims
Increase the prescription rate of anti-craving medications by 20% for patients admitted with alcohol-related conditions to the Gastroenterology ward within the next 6 months, to improve post-discharge care and addiction support

Methods
The project began by identifying key stakeholders and surveying 22 residents rotating through gastroenterology and 11 consultant physicians. Results revealed that 34.7% of residents and 36.4% of consultants were uncomfortable prescribing medications for alcohol use disorder. Root cause analysis identified several issues: limited knowledge of anticraving medications, lack of addiction resources, time constraints, and no standardized process for identifying high-risk alcohol use disorder patients.
Multiple Plan-Do-Study-Act (PDSA) cycles were implemented, targeting trainee education with handouts, early detection of high-risk patients using the AUDIT-C questionnaire at admission, and increasing referrals to addiction services and social work

Results
Between January and July 2024, a total of 57 patients with alcohol-related admissions were identified. During the intervention period, educational handouts for trainees and a Gastroenterology educational grand rounds presentation were implemented, demonstrating some success in increasing rates of anticraving medications. However, these results were not sustained, highlighting the need for a long-term solution. We are developing an EMR-based admission order set to standardize AUDIT-C completion, facilitating the identification of high-risk inpatients and automatic consultations with social work and addiction services through informatics principles

Conclusions
Although educational interventions temporarily increased rates of anticraving medications, the results were not sustainable. The project is ongoing and will transition to exploring EMR-based interventions
Comfort of Prescribing Anti-Craving Medication among GI staff

Funding Agencies
None
A135 INCREASED USE OF PSYCHIATRIC MEDICATION USE FOLLOWING DEVELOPMENT OF CELIAC DISEASE AUTOIMMUNITY
Authors: Goddard Q , King J A , Coward S , Williamson T , Kaplan G G 
Published: February 2025

Abstract

Background
Celiac disease (CeD) autoimmunity is characterized by new positivity for tissue transglutaminase antibodies (TTG) with or without pathologic confirmation. CeD autoimmunity is associated with an increased risk of psychiatric disorders. However, patterns in treatment for psychiatric conditions in relation to diagnosis of celiac autoimmunity remain unclear.

Aims
To determine trends in psychiatric medication use in individuals with CeD autoimmunity before and after TTG positivity.

Methods
A population-based cohort of individuals with incident CeD autoimmunity (n = 14,324; 9,180 females) between April 2015 and March 2023 in Alberta was linked to medication dispensation records. Individuals were classified as children (≤ 12), young adults (13–24), adults (25-64), or seniors (≥ 65) according to age at time of TTG positivity. Medications were categorized by anatomical therapeutic chemical codes: N06A (antidepressants), N05B (anxiolytics), and N05A (antipsychotics). Dispensation data was collected for up to five years before and after TTG positivity. The proportion of days covered (PDC) was calculated as the number of days a drug was prescribed over the follow-up period, per patient. McNemar’s test (for proportions) and Wilcoxon signed rank tests (for PDC) were used to compare medication use before vs after TTG positivity.

Results
Antidepressants were prescribed to 36% of the cohort, anxiolytics to 21%, and antipsychotics to 8% at least once during the study period. A significantly greater proportion of the cohort dispensed antidepressants (20% vs 26%) and antipsychotics (4% vs 6%, both p &lt; 0.001) after TTG positivity, while a significantly lower proportion dispensed anxiolytics (12% vs 11%, p = 0.01) after TTG positivity. A greater proportion of all age categories and sexes dispensed antidepressants after TTG positivity, except for seniors (p = 0.84). The largest increase occurred in young adults, with 24% vs 36% dispensing antidepressants pre- vs post-TTG positivity. PDC significantly increased post-diagnosis for antidepressants (11% vs 35%), anxiolytics (2% vs 4%), and antipsychotics (6% vs 23%, all p &lt; 0.001). For all drug classes, all age groups and sexes had a significantly higher PDC post-TTG, except for children (p = 0.20) and seniors (p = 0.38) with anxiolytics.

Conclusions
Psychiatric medication use is common in individuals with CeD autoimmunity, with increased use following TTG positivity. While the proportion of individuals on medication is only marginally greater following TTG positivity, we observe increased reliance (i.e., PDC) on medication following TTG positivity. These findings suggest enhanced monitoring for psychiatric comorbidities is warranted in this population.

Individual-level PDC by medication class, five years before and after TTG test.

Funding Agencies
CIHR
A148 NOD2 LIGAND AND PEPTIDOGLYCAN HYDROLASE GENE ABUNDANCES ARE ALTERED IN PRE-CROHN’S DISEASE
Authors: Ren M , de Sa O , LI Q , Bharali B , Mu K , Turpin W , Croitoru K ,   o.n behalf of the CCC-GEM Research Consortium, Philpott D 
Published: February 2025

Abstract

Background
Crohn’s disease (CD) is a chronic disorder of unknown etiology. Genome-wide association studies have revealed that NOD2 loss of function mutations are an important gene contributor to CD pathogenesis. NOD2 is a pattern recognition receptor that responds to phosphorylated muramyl-dipeptide (MDP), whose production from peptidoglycan (PGN) is dependent on the expression of specific microbial hydrolases in the lumen. While a variety of studies have shown that reductions in NOD2 ligand and corresponding hydrolases, particularly DL-endopeptidases, occur in active CD or as a consequence of inflammation, which may play a role in sustaining disease, the interplay between NOD2 ligands and PGN-hydrolases pre-disease is unknown.

Aims
We investigated whether stool NOD2 ligand concentration is altered in pre-CD individuals, and the associations of PGN-hydrolase abundances with NOD2 ligand and with other pre-disease biomarkers.

Methods
Fecal samples were collected from healthy first-degree relatives of CD patients who were followed prospectively as part of the CCC-GEM project nested case control cohort (n = 91 pre-CD, n = 242 matched controls, median time to diagnosis 3.2 years). Fecal calprotectin (FCP), urinary fractional excretion ratio of lactulose to mannitol (LMR), and C-reactive protein (CRP) from serum were measured. PGN-hydrolase gene abundances was assessed by shotgun sequencing of stool samples. NOD2 ligand abundance was measured by incubating diluted stool supernatant with human NOD2 reporter HEK293 cells overnight then measuring OD640. A database of PGN-hydrolase clusters was generated by sequentially clustering with MMseqs2 based on sequence identity, then with Foldseek based on the AlphaFold Protein Structure Database.

Results
NOD2 ligand concentration was significantly reduced in pre-CD compared to matched controls (p &lt; 0.01). Although several PGN-hydrolase clusters were negatively associated with NOD2 ligand, the relative abundance of one DL-endopeptidase cluster expressed by the Firmicutes phylum was significantly positively associated with NOD2 ligand abundance (q &lt; 0.05). A DD-carboxypeptidase cluster, an amidase cluster, and a muramidase cluster were each negatively associated with future diagnosis of CD (q &lt; 0.05). While many clusters were positively and negatively associated with FCP and CRP, one DD-carboxypeptidase cluster was positively associated with LMR (gut barrier permeability, q &lt; 0.05).

Conclusions
These results show that NOD2 ligand concentration and the PGN-hydrolases that produce it are altered in pre-CD stool, suggesting that this may contribute to disease onset, however further investigation is needed.

Funding Agencies
CCC, CIHRHelmsley Charitable Trust, Mount Sinai Hospital
A155 STOOL-BASED PROTEIN SIGNATURES FOR NON-INVASIVE ACCURATE DIAGNOSIS AND SUBTYPING OF INFLAMMATORY BOWEL DISEASE THROUGH HIGH-THROUGHPUT PROTEOMICS AND MACHINE LEARNING APPROACHES
Authors: Shajari E , gagne d , Malick M , Roy P , Delisle M , Brunet M , Boisvert F , Beaulieu J 
Published: February 2025

Abstract

Background
Accurate diagnosis of inflammatory bowel disease (IBD) is essential to distinguish it from other conditions with similar symptoms and to identify whether it’s ulcerative colitis (UC) or Crohn’s disease (CD), ensuring appropriate treatment and management. While colonoscopy and biopsy are the current gold standards, they are invasive, costly, and poorly accepted by asymptomatic patients. Fecal biomarkers like calprotectin are commonly used but lack the specificity and lack of ability to differentiate between CD and UC, highlighting the need for more precise, non-invasive diagnostic methods.

Aims
This study aims to develop a stool-based protein biomarker panel capable of accurately distinguishing IBD from IBD-mimicking conditions. It also seeks to classify the subtypes, CD and UC, by using high-throughput Data-Independent Acquisition mass spectrometry (DIA-MS) to identify precise biomarker signatures from complex stool samples, combined with advanced machine learning techniques for developing predictive model.

Methods
Stool samples were collected from 46 active-CD patients, 23 active-UC patients, and 53 patients with conditions presenting similar symptoms. Using DIA-MS, we analyzed the stool proteome, identifying and quantifying proteins. Data processing procedures were carefully optimized to establish a robust analytical pipeline. The samples were then split into training and testing groups. Feature selection algorithms were applied to the training group to identify proteins that significantly differed between the groups. Six machine learning algorithms (kNN, Naive Bayes, eXBoost, Random Forest, SVM, and glmnet) were subsequently evaluated to determine the best-performing classifier.

Results
Signature 1, consisting of 7 proteins for diagnosing true symptomatic IBD cases, and Signature 2, comprising 8 proteins for distinguishing between CD and UC, were developed using the best-performing classifier on the training dataset. Signature 1 achieved an AUC of 0.98, while Signature 2 reached an AUC of 0.96. For validation, the final predictive model was applied to a set of unseen samples. Impressively, the model demonstrated an AUC of 0.96 for both classifications, confirming its robustness and ability to generalize effectively to new samples.

Conclusions
In conclusion, this study illustrates the effectiveness of utilizing stool proteome obtained through DIA-MS in accurately diagnosing and subtyping active IBD. Further future validation on a larger cohort using targeted MRM mass spectrometry would be served to establish the clinical utility of this approach.

Funding Agencies
CCCFaculty of Medicine and Health Science of University of Sherbrooke
A161 HEMOPEXIN TREATMENT ALLEVIATES COLITIS SEVERITY IN THE ABSENCE OF IL-22RA1 SIGNALING IN MICE
Authors: Ajayi A S , Gerkins C , Cuisiniere T , McCartney C , Maumy T , Hajjar R , Oliero M , Fragoso G , Calve A , Santos M M 
Published: February 2025

Abstract

Background
Inflammatory bowel disease (IBD) is often defined by persistent intestinal epithelial inflammation, bleeding, and pain. It is one of the major risk factors for colorectal cancer (CRC). IBD’s pathogenesis is fundamentally characterized by the release of free luminal heme. Dietary heme induces intestinal dysbiosis and exacerbates colitis. Interleukin 22 (IL-22) is produced in the gut by immune cells, mainly innate lymphoid cell 3 (ILC3). It is known to induce a protective response mediated by hemopexin, a plasma heme scavenger produced in the liver that limits the availability of heme iron to microbes and suppresses bacterial growth.

Aims
To evaluate the protective role of IL-22 by the stimulation of hemopexin in a mouse model of acute colitis

Methods
To assess the effect of IL-22 on colitis, Il22ra1-/- and wild-type (Wt) mice on a C57BL/6 background were treated with 2.5% dextran sodium sulphate (DSS) in drinking water for 12 days to induce colitis, after which they were sacrificed. To reverse colitis severity with hemopexin, three groups of mice received 2.5% DSS in drinking water for 12 days. The treatment group (Il22ra1-/-) received an 15 mg/kg BW hemopexin injection intraperitoneally on day 7 of the DSS treatment, while the other two groups, Wt and Il22ra1-/-, received the vehicle (PBS).

Results
Il22ra1 -/- mice had significantly greater weight loss, higher disease activity index (DAI) score and shorter colon length on day 12 (endpoint) compared to the Wt mice. Significant increases in inflammatory markers such as lipocalin-2 (lcn-2), TNF-α and IL-6 were observed in Il22ra1-/- mice, contributing to their condition. Decreased fecal hemopexin and increased free luminal heme were observed in Il22ra1-/- mice compared to the Wt mice. Hemopexin administration reversed the disease severity by reducing DAI, inflammatory markers and increasing the colon length. Increased fecal hemopexin and reduced luminal heme were also observed in the Il22ra1-/- mice.

Conclusions
Hemopexin is present in the gut during colitis. The absence of Il-22ra1 enhances free luminal heme production, reduces hemopexin concentration in the gut, and aggravates colitis in mice. Hemopexin administration reduces free luminal heme in the gut, enhances hemopexin availability and alleviates colitis severity in mice.

Funding Agencies
CIHRUniversite de Montreal, CRCHUM, Institute du Cancer de Montreal
A166 SIMPLENESS: A QUALITATIVE DESCRIPTION STUDY EXPLORING PATIENT PERSPECTIVES ON THE BARRIERS AND FACILITATORS OF USING DIGITAL HEALTH TOOLS TO SELF-MANAGE INFLAMMATORY BOWEL DISEASE
Authors: Ajibulu L J , Chappell K , Seow C , Goodman K J , Wong K 
Published: February 2025

Abstract

Background
Inflammatory Bowel Disease (IBD) is a chronic condition that requires lifelong management and frequent interaction with healthcare providers. Digital health tools have the potential to enhance disease management by offering real-time data and improving care coordination. However, there is limited evidence on patient perspectives regarding the barriers and facilitators to using these tools effectively.

Aims
This study aimed to explore patient perspectives on the use of digital health tools for managing IBD, identifying key barriers and facilitators that influence their adoption and sustained use.

Methods
Using a qualitative description methodology, participants with a confirmed diagnosis of IBD were purposively recruited from multiple clinics in Alberta, Canada. Data was collected through virtual semi-structured interviews until thematic saturation was reached. Participants were introduced to “MyIBDToolkit,” a digital health tool in development, designed for seamless communication and data sharing between patients and providers, integrated into an electronic health record (EHR) patient portal to support self-management. Thematic analysis was used to identify key themes within the interviews.

Results
Thematic saturation was achieved with 18 interviews. Participants expressed varied views on self-management and digital disease management. Most were receptive to using digital health tools, highlighting benefits like enhanced monitoring and streamlined care. However, they noted concerns about sustainability, data entry burden, and privacy as significant barriers. Some participants were also skeptical about healthcare provider use of these tools.

Conclusions
While participants generally viewed digital health tools as beneficial for self-managing IBD, usability, engagement, and privacy challenges must be addressed for successful implementation. These findings underscore the importance of incorporating patient perspectives in developing and integrating digital health interventions for chronic disease management.

This graphical abstract highlights the key findings from semi-structured interviews with IBD patients, focusing on the potential benefits and challenges of digital health tools for disease management. The study identified improved care monitoring, streamlined care, and usability features as facilitators, while concerns about privacy, continued use, and adoption hindered engagement.

Funding Agencies
Alberta Innovates Partnership for Research and Innovation in the Health System 7 (PRIHS 7)
A172 GENETIC AND DIET-ASSOCIATED MUCUS IMPAIRMENTS INCREASE SUSCEPTIBILITY TO ULCERATIVE COLITIS PATHOBIONT-DRIVEN COLITIS.
Authors: Yang H , Kim W , ma c , Yu H , vallance B 
Published: February 2025

Abstract

Background
The Inflammatory Bowel Diseases (IBD), Crohn’s Disease (CD) and ulcerative colitis (UC) affect &gt; 320,000 Canadians and are increasing in incidence. Ileal CD has been linked to the overgrowth of mucosal adherent-invasive Escherichia coli. Recent studies have also implicated the adherence of E. coli pathobionts to the colonic mucosa of UC patients. Using the representative UC E. coli pathobiont p19A, we recently demonstrated it aggravated chemical-induced colitis in susceptible mice, through the actions of the toxin alpha-hemolysin, and by adhering to the inflamed colonic mucosa via the adhesin FimH. It is less clear what host factors control susceptibility to UC pathobionts. I hypothesize that a key susceptibility factor is the glycosylated mucin Muc2, which forms the protective mucus layer that covers the colonic epithelium and is often impaired in UC patients.

Aims
To define the role of colonic mucus structure and function in determining susceptibility to the p19A pathobiont, and its ability to cause colitis in mice.

Methods
Susceptibility to p19A was tested in two mouse models of colonic mucus impairment. The first is a mouse strain deficient in core 1 derived O-glycans in their intestinal epithelial cells (IEC C1galt1-/-), resulting in reduced mucin glycosylation, and thus a thin and impaired mucus barrier. The second model involves feeding wildtype (WT) C57BL/6J mice a fiber-free (FF) diet, resulting in a significantly thinner colonic mucus layer. The mice were subsequently orally gavaged with p19A and their susceptibility determined by assaying p19A burdens, intestinal histopathology, inflammatory cytokine production.

Results
Following oral gavage of WT mice fed a normal diet, immunostaining identified p19A localizing within the colonic mucus layer, but it did not reach the epithelium or cause disease. In contrast, p19A regularly reached the colonic epithelial surface of mucus-impaired IEC C1galt1-/- mice (as compared to IEC C1galt1flox/flox mice) and in WT mice fed a fiber-free diet. This epithelial adherence was associated with increased p19A burdens, histopathology and production of inflammatory markers such as TNF-a and lipocalin 2. Notably, fiber-free diet-fed mice showed reduced SCFA levels in their feces and thinner mucus layer in their colon at baseline.

Conclusions
Our results indicate that UC E. coli pathobionts are able to reach the colonic epithelial surface and induce colitis in hosts suffering genetic or diet-based mucus dysfunction. This susceptibility highlights the important role played by intestinal mucus in protecting against IBD.

Funding Agencies
CCC, CIHR