bluuebunny/crossref_metadata_2025_split huggingface dataset:
A60 ANXIETY AND DEPRESSION ARE ASSOCIATED WITH POOR ADHERENCE TO THE GLUTEN-FREE DIET, GREATER SYMPTOMS SEVERITY, AND REDUCED QUALITY OF LIFE IN TREATED CELIAC DISEASE PATIENTS
Authors: Echagüe F J , Verma A K , Leong R , Aman A , Blom J , Noejovich V , Daca R , Armstrong D , Pinto-Sanchez M 
Published: February 2025

Abstract

Background
Studies have reported an association between celiac disease (CeD) and anxiety and depression. However, how this impacts symptoms and disease management is unknown.

Aims
To assess 1) the prevalence of anxiety and depression in adult patients with celiac disease and 2) the association of anxiety and depression with CeD outcomes including symptoms, disease activity, treatment adherence and quality of life.

Methods
Consecutive patients attending the adult Celiac Disease Clinic at a tertiary care hospital were enrolled in the Celiac Registry. Participants completed the gluten-free diet (GFD) adherence (CDAT), Quality of Life (CD-QoL), Celiac Symptom (CSI), and Anxiety and Depression Scale (HADS) questionnaires. Anxiety or depression were defined based on a HADS score ≥ 7 for each subscale. CDAT &lt;13 was considered good adherence to the GFD. CSI score ≤30 was considered a low CeD-symptom burden. Continuous variables were expressed as median (IQR) and categorical variables as percentages.

Results
From October 2020 to October 2024, 673 CeD patients, [38 (31) years] were enrolled in the study. Of these, 251 (37%) met the criteria for anxiety and 109 (16%) for depression. Anxiety and depression were associated with lower adherence to a gluten-free diet (anxiety OR=0.7, p&lt;0.001; depression OR=0.5, p&lt;0.001), reduced QoL (anxiety OR=1.07, p&lt;0.001; depression OR=1.03, p&lt;0.001) and increased celiac-related symptoms (anxiety OR=0.56, p&lt;0.001; depression OR=0.2, p&lt;0.001). A non-significant trend of increasing weight was observed in CeD patients with anxiety and depression. Regression analysis showed QoL, diet adherence, and weight changes were predictors for an increased risk of anxiety and depression in CeD patients.

Conclusions
Anxiety and depression are common in CeD patients, and they are associated with poor adherence to a GFD, symptom control, and worse quality of life. Addressing mental health in CeD is crucial for the management of celiac disease and has the potential to improve celiac outcomes.
Funding Agencies:
A68 CROSSING PATHS: THE OVERLAP BETWEEN INTESTINAL TB AND CROHN’S DISEASE, A CASE REPORT
Authors: Denier D , O’Donnell J , Griffiths A , Walters T 
Published: February 2025

Abstract

Background
We report the case of a 17-year-old female, who initially presented with a 3-week history of abdominal pain to a hospital in India, an area endemic for tuberculosis (TB). An abdominal CT scan and endoscopy showed circumferential narrowing involving the cecum and terminal ileum (TI). A tuberculin skin test was positive, while PCR from biopsies was negative. The differential diagnosis was Intestinal TB versus Ileocecal Crohn’s disease (CD). Empirical TB treatment was started, resulting in rapid symptom improvement. She presented to our hospital after immigration with increasing abdominal pain, vomiting and findings of a short, narrowed segment of TI on ultrasound. The patient developed two subsequent episodes of complete bowel obstruction, prompting urgent IC resection. At operation there was a stricture at the level of the cecum, the TI was noted to be thickened with proximal dilatation. Pathology showed inconclusive results with acute and chronic inflammation, possibly inflammatory bowel disease (IBD) or infectious etiology. Repeat quantiferon test was positive with high titre.

Aims
Abdominal TB can uncommonly cause intestinal stricturing during the active phase of disease. The potential for a very similar presentation to CD makes differentiation challenging. In this case report we discuss the background and potential approaches to stricturing intestinal disease in patients from a TB endemic area and the implications for post-operative management.

Methods
Case report with literature review

Results
Gastrointestinal TB can occur as a primary infection or in the context of active pulmonary disease. TB PCR is highly specific but with low sensitivity and Quantiferon Test may be negative in patients with extra pulmonary manifestations. Differentiating between intestinal TB and CD is challenging. In TB endemic areas, the standard approach is to treat for intestinal TB first, only considering CD if symptoms persist; a markedly different approach than practiced in Canada.
Our patient primarily presented with intestinal obstruction showing initial improvement after anti-TB treatment, followed by rapid evolution of fibrostenosis. Confirmation of TB diagnosis was complicated by limited evaluation prior to anti-TB therapy and inconclusive test results subsequently. Although surgical resection was inevitable in this case, post-operative medical management becomes problematic in the absence of a confirmed diagnosis where the choices include ongoing anti-TB therapy versus the initiation of CD post-operative prophylaxis with anti-TNF therapy.

Conclusions
Clinicians should be aware that intestinal TB can cause intestinal stenosis, especially in the IC region. Diagnostic clarity should be top priority, in order to provide the best possible long-term outcomes.

Funding Agencies
None
A70 EXPLORING THE ROLE OF MICROBIAL PHOSPHOLIPIDS IN VISCERAL HYPERSENSITIVITY AND ALTERED EMOTIONAL BEHAVIOUR INDUCED BY INFLAMMATORY BOWEL DISEASE (IBD)-ASSOCIATED MICROBIOTA
Authors: Vicentini F A , Hall-Bruce M , Pujo J , Rueda G H , Nardelli A , Jiang A , De Palma G , Verdu E , Collins S , Bercik P 
Published: February 2025

Abstract

Background
IBD is characterized by relapsing episodes of inflammation in the gastrointestinal tract. Abdominal pain is common in IBD and often persists without overt inflammation. Moreover, patients with IBD often develop anxiety and depression, further impairing their quality of life. Recently, gut microbiota emerged as a tentative pathophysiological factor in pain and mood disorders. However, little is known about the specific mechanisms by which microbiota modulate pain and mental health in IBD.

Aims
We hypothesized that bacteria contribute to visceral hypersensitivity and behavioural abnormalities in IBD via modulation of bioactive phospholipids, focusing on lysophosphatidylcholine (LPC) and its metabolite lysophosphatidic acid (LPA), which were previously linked to chronic pain, anxiety and depression.

Methods
Fecal samples from healthy controls (HC n=15) and IBD patients (n=35; Crohn’s Disease (CD) n=18, Ulcerative Colitis (UC) n=17) were collected to assess the levels of LPC and LPA via mass-spectrometry. Samples from selected donors (HC n=5, CD n=6, UC n=5) were used to colonize germ-free C57BL/6 mice (n=115) of both sexes. After 3 weeks, the light preference and tail suspension tests were performed to assess anxiety- and depression-like behaviour. Visceral sensitivity was assessed by visceromotor responses to colorectal distension (100-300 μL). Gut inflammation was evaluated by histology. Microbiota composition was assessed via 16S rRNA gene sequencing.

Results
Fecal concentrations of LPC and LPA were higher in patients with IBD, mainly in those with chronic abdominal pain. Mice colonized with IBD microbiota displayed a reduced preference for the light compartment and increased immobility, suggestive of anxiety- and depression-like behaviour, respectively. Mice with IBD microbiota had higher visceromotor responses to colorectal distension. Interestingly, we observed increased responses to non-noxious stimuli (100 μL), suggestive of visceral allodynia. Microbiota profiles differed between mice colonized with IBD or HC microbiota. Also, mice with increased visceral sensitivity had lower abundance of Bacteroidales taxa, which contains genes related to the catabolism of LPC and LPA. Histology analysis did not show signs of overt inflammation in the jejunum, ileum, or colon.

Conclusions
Microbiota from patients with IBD negatively affect the gut-brain axis by inducing changes in anxiety- and depression-like behaviour and triggering visceral hypersensitivity. Bacterial production of LPC and LPA may be responsible for these deleterious effects.

Funding Agencies
CCC, CIHRCrohn’s & Colitis Foundation
A75 EARLY-LIFE IRON SUPPLEMENTATION SHAPES GUT MICROBIOTA AND MODULATES RECOVERY FROM GUT DYSBIOSIS
Authors: Maumy T , Santos M M 
Published: February 2025

Abstract

Background
Iron is an essential micronutrient, but its supplementation carries significant risks to intestinal health. Excess free iron in the gut fosters pathogenic bacterial growth, disrupting the microbiota and increasing susceptibility to future intestinal stresses. Early life represents a critical window for microbiota establishment, yet little is known about the long-term effects of iron supplementation during this period. This raises concerns about how early iron exposure may impact the gut’s resilience to future stressors, such as gut dysbiosis, especially given the prevalence of intestinal stress and the widespread availability of over-the-counter iron supplements.

Aims
Our study aims to investigate how early-life iron excess influences the gut microbiota and its capacity to recover from two distinct dysbiosis models:
1- Colitis-induced dysbiosis via dextran sulfate sodium (DSS)
2- Antibiotic-induced dysbiosis via a metronidazole and ciprofloxacin cocktail.
We hypothesize that early exposure to excess iron impairs microbiota recovery compared to exposure during adult life.

Methods
Using C57BL/6 mice, we compared the outcomes of iron-sufficient and iron-excess diets initiated at weaning and continued into adulthood. After a 5 week exposure and an iron-sufficient period of two weeks, dysbiosis was induced, followed by an 8-week recovery phase, with frequent stool sampling for 16S rRNA sequencing to track gut microbiota composition. A bioinformatic pipeline was developed to analyze microbiota recovery and the influence of iron exposure. Parallel experiments on adult mice were conducted to explore the role of age in recovery outcomes.

Results
Preliminary data indicate that the colitis model was effective, with disease severity scores confirming a stronger inflammatory response in mice exposed to excess iron during early life. Young mice in the iron-excess group showed heightened susceptibility to DSS-induced colitis compared to their iron-sufficient counterparts. Our bioinformatics workflow has been optimized for other datasets, showing reduced computational time while maintaining analytical precision.

Conclusions
These findings suggest that early-life iron excess impairs gut resilience, potentially predisposing individuals to heightened responses to gut stresses like colitis or antibiotic exposure. Ongoing 16S analysis will further delineate recovery patterns, providing critical insights into how iron supplementation during infancy may influence long-term intestinal health and informing future dietary recommendations for young infants.

Funding Agencies
Institut du Cancer de Montreal, Centre de recherche du CHUM, University of Montreal
A76 MODULATING THE PREOPERATIVE GUT MICROBIOTA USING DIETARY FIBER TO IMPROVE COLORECTAL CANCER SURGICAL OUTCOMES
Authors: McCartney C , Fragoso G , Calve A , Gerkins C , Cuisiniere T , Ajayi A S , Alaoui A , Hajjar R , Taleb N , Richard C , Santos M M 
Published: February 2025

Abstract

Background
Anastomotic leak (AL) is a postoperative complication that occurs in up to 20% of patients undergoing surgery for colorectal cancer (CRC). It is characterized by the poor healing of the intestinal reconnection and is associated with increased mortality, morbidity, and cancer recurrence. The gut microbiota plays a key role in anastomotic healing, potentially mediated by the production of beneficial short-chain fatty acids (SCFA). Supplementation with the dietary fiber inulin was shown to increase SCFA as well as improve microscopic and macroscopic anastomotic healing in a mouse surgical model. However, when considering clinical applications, differences in baseline microbiota composition and patient ability to respond to a dietary fiber must be taken into account.

Aims
In order to differentiate between responders and non-responders prior to surgery, we tested patient responses to different fibers in a mouse fecal microbiota transplantation (FMT) model. Our overall objective is to identify microbial or systemic markers that could predict patient response to different fibers, allowing for personalized dietary interventions.

Methods
Wild-type C57BL/6 mice received FMT from a human donor. Following a 2 week engraftment period, mice received supplementation with one of four dietary fibers for 2 weeks, after which fecal samples were collected for SCFA analysis using HPLC-MS.

Results
The microbiota response to each dietary fiber was estimated based on increased fecal SCFA levels at endpoint for each FMT donor.

Conclusions
Our FMT mouse model is able to detect increased SCFA levels in response to dietary fiber supplementation. Future validation will include measuring post-operative intestinal healing parameters in a mouse surgical model and comparing these results with an ongoing clinical trial. By lowering the risk of AL, we aim to decrease treatment burden for CRC patients and improve their quality of life post treatment.

Funding Agencies
CIHRFRQS
A77 THE INFLUENCE OF IRON SUPPLEMENTATION IN EARLY LIFE ON COLORECTAL CANCER PROGRESSION
Authors: Gerkins C , Cuisiniere T , Maumy T , McCartney C , Fragoso G , Calve A , Santos M M 
Published: February 2025

Abstract

Background
During the first years of life, the immune system develops simultaneously with the gut microbiota, and it has been previously shown that perturbations to gut microbiota development can lead to altered immune phenotypes later in life. One factor that may influence the gut microbiota in early life, and therefore immune development, is iron supplementation.

Aims
We aim to evaluate how iron supplementation in early life affects immune system development and therefore cancer progression in adulthood.

Methods
BALB/c mice were given either an iron sufficient or an iron excess diet beginning at weaning until adulthood at 8 weeks of age. All mice were then placed on the iron sufficient diet for two weeks prior to beginning the experimental model in order to establish the effect of iron only during the early life period. Mice were then injected subcutaneously with the murine colon carcinoma cell line CT-26.

Results
Mice that recieved iron supplementation in early life had significantly higher levels of iron in both the liver and spleen, indicating that this diet was successful in increasing iron levels. Furthermore, mice given iron supplementation had significantly more sebaceous glands per mm ear tissue than mice given the iron sufficient diet. Sebaceous glands are structures in the skin important for coordination of the innate immune response and regulation of the skin microbiota. We next measured several cytokines by ELISA. Mice supplemented with iron had significantly lower levels of interleukin (IL)-4, IL-10, and interferon (IFN)-γ.

Conclusions
Considering that mice given the iron excess diet had significantly altered skin immune structures and significantly decreased basal cytokine levels in ear tissue, we conclude that iron supplementation in early life modulates immune system development. Next, we will evaluate how iron supplementation in early life affects colorectal cancer development and progression.

Funding Agencies
CIHRFRQS, NSERC
A89 PREVALENCE AND OUTCOMES OF SERRATED POLYPOSIS SYNDROME IN TERTIARY GASTROENTEROLOGY PRACTICES: A RETROSPECTIVE ANALYSIS
Authors: Jiang S X , Zarrin A , Taylor E , Tavakoli P , Bell S , Walia A , Pang S , Rui Xuan Yu M , Motomura D , Lam E , Enns R , Telford J , Xiong W , Shahidi N 
Published: February 2025

Abstract

Background
While serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC), incident CRC can be mitigated through programmatic endoscopic surveillance. Diagnosing SPS remains challenging due to physician awareness and the logistics of cumulative polyp tracking. There is a lack of data on SPS prevalence and outcomes outside of established cohorts.

Aims
To evaluate the prevalence and outcomes of SPS within tertiary gastroenterology practices.

Methods
Using a validated histopathology database, all patients with at least 1 sessile serrated lesion (SSL) removed by 1 of 11 gastroenterologists in a tertiary centre between 2013-2023 were considered for evaluation. All patients were subsequently screened for SPS based on the 2019 World Health Organization (WHO) criteria. Patients meeting SPS criteria underwent full chart review for demographic, procedural, and clinical outcomes. Analysis was based on serrated class lesions (SCLs), which included sessile serrated lesions, hyperplastic polyps, and traditional serrated adenomas.

Results
A total of 6117 patients had at least 1 SSL of which 178 (3%) met SPS criteria (110 WHO I, 10 WHO II, 58 WHO I/II). Median age at first colonoscopy was 62 years (IQR 54-71 years) and 115 (65%) were female. Diagnostic criteria were achieved over a median of 3 years (IQR 1-9 years) and a median of 3 colonoscopies (IQR 2-4 colonoscopies). On index colonoscopy, patients eventually meeting SPS criteria had a median of 3 SCLs (IQR 2-6 SCLs) with median largest lesion size of 11mm (IQR 5-18mm) whereas patients without SPS had a median of 1 SCL (IQR 1-2 SCLs) with median largest lesion size of 5mm (IQR 4-8mm) (p&lt;0.001). SPS was diagnosed by the gastroenterologist in only 132 (74%) patients. SPS was managed by endoscopy and surgery in 157 (88%) and 21 (12%) respectively. Reasons for surgery included polyp burden (9, 5%), endoscopic adverse event (1, 0.5%) and CRC (11, 6%). CRC was diagnosed either before or concurrent to SPS diagnosis in 7 (63.6%).

Conclusions
In patients with at least 1 SSL, the prevalence of SPS was 3% and the diagnosis was recognized in 74% by the primary gastroenterologist. Increased awareness of SPS criteria alongside consideration for modified surveillance intervals based on index SCL size and number may improve patient outcomes.

Funding Agencies
None
A94 ASSOCIATION OF BOWEL URGENCY WITH OTHER DISEASE ACTIVITY MEASURES IN ULCERATIVE COLITIS
Authors: Gill P , Finch H , Stein L , Ma C 
Published: February 2025

Abstract

Background
The presence of bowel urgency and fecal incontinence negatively impacts quality of life in patients with ulcerative colitis (UC).

Aims
We aimed to characterize the assessment of urgency and incontinence in routine clinical care.

Methods
We conducted a retrospective cohort study of prevalent cases of UC evaluated in the University of Calgary IBD Clinic from December 2022 to May 2023, with at least 12 months of follow-up to May 2024. Data on the evaluation of bowel urgency was collected, as were other patient-, disease-, and outcome-related parameters. We aimed to evaluate (1) the proportion of clinic visits where bowel urgency was assessed and documented; (2) the methods for evaluating urgency; (3) the correlation between bowel urgency and other patient-reported outcome measures (including stool frequency and rectal bleeding); and (4) the correlation between bowel urgency and endoscopic appearance.

Results
A total of 274 patients with UC who attended 435 clinic visits were included in this analysis (126 [46.0%] male, mean age at diagnosis 33.2 years [SD 15.5], 104 [40.3%] pancolitis. At the index visit, bowel urgency was evaluated in 160/274 visits (58.4%) and was present in 24.4% (39/160). Most cases were evaluated using the presence/absence of bowel urgency, rather than using a Likert or ordinal scale. In 416 follow-up visits, bowel urgency was assessed in 231 (55.5%) of visits and was present in 75 cases (33.0%). There were moderate-to-strong correlations between bowel urgency and stool frequency (Spearman correlation coefficient 0.54, p&lt;0.001) and rectal bleeding (0.53, p&lt;0.001), but only weak correlation with endoscopic evaluation (Spearman 0.20, p=0.08). Among 136 patients with normal or near normal stool frequency, 16.2% (22/136) had persistent bowel urgency. Among 59 patients with normal or near normal endoscopy, 20.3% (12/59) had persistent bowel urgency.

Conclusions
Bowel urgency remains inconsistently evaluated in clinical care, representing an important area for quality improvement. Although bowel urgency was significantly associated with other patient-reported outcome measures, approximately 1 in 5 patients will have persistent bowel urgency despite minimal endoscopic activity.

Funding Agencies
None
A104 ADENOMATOUS POLYPOSIS WITHIN TERTIARY GASTROENTEROLOGY PRACTICES: A RETROSPECTIVE STUDY
Authors: Jiang S X , Tavakoli P , Rui Xuan Yu M , Ten-Pow M , Flegg D , Taylor E , Walia A , Pang S , Motomura D , Lam E , Enns R , Telford J , Xiong W , Shahidi N 
Published: February 2025

Abstract

Background
Adenomatous polyposis (AP) is defined as ≥ 10 cumulative colorectal adenomas. Despite its clinical relevance, its prevalence, genetic implications, and optimal management remains unknown.

Aims
Evaluate the prevalence and outcomes of AP within a tertiary gastroenterology referral center.

Methods
Patients with at least 1 adenomatous colorectal polyp removed by 1 of 11 gastroenterologists at a tertiary referral center between 2013-2023 were screened for AP using a validated histopathology database. Patients with a known adenomatous polyposis syndrome and/or previous colorectal surgery prior to referral were excluded from analysis. All patients with AP (defined as ≥ 10 adenomatous colorectal polyps) underwent full chart review. Data were extracted for demographic and clinical outcomes.

Results
Of 10,603 patients with at least 1 colorectal adenoma, 330 (3.1%) were diagnosed with AP. AP patients were diagnosed over a median of 5 years (IQR 1-9 years) and a median of 3 colonoscopies (IQR 2-4 colonoscopies). The frequencies of an advanced adenoma and colorectal cancer (CRC) were 236 (71.5%) and 23 (7.0%), respectively. 78.2% of CRC diagnosed before or concurrent to AP diagnosis. Genetic analysis was completed in 22 (6.8%) patients, with a deleterious mutation found in 10 (45.4%). 276 (83.6%) patients were managed endoscopically with 24 (7.3%) referred to surgery and 30 (9.1%) discharged due to age. 300 (90.9%) patients had 10-20 adenomas and 30 (9.1%) patients had &gt; 20 adenomas. Patients with &gt; 20 adenomas were more commonly referred to surgery (6, 20% vs. 18, 6%; p = 0.014). There was no difference in the frequency of CRC between groups (21, 7.0% in 10-20 adenomas and 2, 6.7% in &gt;20 adenomas; p=0.195).

Conclusions
In patients with ≥ 1 colorectal adenoma, the prevalence of AP was 3.1%, with an overall CRC risk of 7.0%. The majority of patients can be successfully managed endoscopically with further evidence needed to delineate appropriate surveillance interval recommendations.

Funding Agencies
CAG