bluuebunny/crossref_metadata_2025_split huggingface dataset:
A173 PATTERNS OF FISTULA DISEASE ACTIVITY IN PATIENTS WITH PERIANAL CROHN’S DISEASE
Authors: Huebener N , Sweet A , McCurdy J 
Published: February 2025

Abstract

Background
The disease course of perianal fistulizing Crohn’s disease (PFCD) is highly variable, from transient symptoms to chronic, progressive disease activity. The patterns of PFCD activity over time and their impact on long-term fistula outcomes is poorly understood.

Aims
To determine the patterns of PFCD activity within the first year of fistula diagnosis and their impact long-term outcomes.

Methods
We performed a retrospective, observational study between 2005-2023 at a single Canadian academic institution. We included adults &gt;17 years with PFCD and a minimum of 2 clinical touchpoints within the first year after fistula diagnosis. PFCD was categorized into one of four patterns of disease activity: transient, minimally active, relapsing-remitting, and chronic persistent based on clinical symptoms within the first year after fistula diagnosis (Figure 1). Our primary outcome was major adverse fistula outcomes (MAFO), a composite of local surgery, hospitalization, and fecal diversion for PFCD. Secondary outcomes included individual components of MAFO and fistula remission at last follow-up. Time to event analyses were estimated by Kaplan Meir methods stratified by disease activity categories.

Results
101 patients met our study criteria. Mean age at PFCD diagnosis was 35 (SD=13) years, 46 (46%) patients were female, and 76 (78%) had complex fistula anatomy radiologically. A total of 44 (44%) patients underwent local surgical intervention at the time of diagnosis and 92 (91%) patients were treated with an advanced medical therapy. Patients were classified as having transient (n=35, 34%), minimally active (n=17, 17%), relapsing remitting (n=13, 13%) and chronic persistent (n=36, 36%) disease. After a mean follow-up of 114 months (SD=61.4), 65 (64%) of patients developed MAFO. At last follow-up 62 (61%) of patients were in remission. Table 1 shows long-term fistula outcomes stratified by each of the four disease activity categories. The proportion of patients with MAFO over time was lowest in the transient disease category. Fistula remission at last follow-up was highest in the transient disease category and lowest in the chronic persistent disease category.

Conclusions
Our study shows that PFCD can be categorized into 4 distinct disease activity categories within the first year of diagnosis and that these patterns may predict long-term fistula outcomes.
Table 1: PFCD outcomes according to clinical disease activity pattern

Figure 1: Patterns of PFCD Activity

Funding Agencies
None
A178 DISEASE COURSE AND MANAGEMENT OF CHILDREN WITH VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE
Authors: Kishore S B , Sethuraman A , Binomar H , Jacobson K 
Published: February 2025

Abstract

Background
Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed before 6 years of age, has a distinct phenotype with predominantly colonic involvement. However, there are limited studies describing the long-term outcome of children with VEO-IBD.

Aims
Our primary aim was to determine the long-term outcome in children with VEO-IBD and corticosteroid free clinical remission (CFCR) at one year post diagnosis and at last follow up. The secondary aim was to determine clinical response (CR) and biochemical remission (BR) at the same time points.

Methods
A retrospective cross-sectional chart review was conducted for all children with VEOIBD diagnosed between 1st January 2013 to 31st December 2022 with a minimum follow up of one year at British Columbia Children’s Hospital (BCCH). Patients were identified from the BCCH pediatric IBD database. Demographic and relevant clinical data including IBD medications and response were collected. Data points at 3 months, 6months, 1 year and then annually until 10 years from diagnosis were collected. Corticosteroid free clinical remission (CFCR) was defined as being off steroids for ≥ 3 months at yearly follow up. Biochemical remission (BR) was defined as fecal calprotectin &lt;250ug/g. Clinical response (CR) was defined as a wPCDAI &gt;17.5-point change or a PUCAI of a 20-point change from baseline.

Results
77 patients were identified, with 70 patients reviewed thus far. The mean age at diagnosis was 45.6 (±16.4 months). The median follow-up time was 60 months (interquartile range 36 to 84 months). Of the 38 (54%) patients on biologic therapy, the most common 1st, 2nd, 3rd and 4th line biologics were anti-TNF (25/26), vedolizumab (4/7), ustekinumab (4/4) and vedolizumab (1/1) respectively.

Conclusions
Children with VEOIBD who have milder disease and do not require biologic therapy achieved better rates of CFCR at 1 year follow up (83.3% compared to 52.7%) but comparable rates at last follow up (78.1% to 81.6%) to those with moderate to severe disease requiring biologic therapy.

Primary and secondary outcomes in VEOIBD patients

Funding Agencies
None
A180 THE IMPACT OF INTEGRATING PELVIC MRI AT DIAGNOSIS FOR EARLY DETECTION OF PERIANAL CROHN’S DISEASE IN PEDIATRICS
Authors: Antaya M , Hudson A , Lerner E , Nasser K , Carroll M , Migliarese Isaac D , Wine E , Perry T , Thompson A , Huynh H 
Published: February 2025

Abstract

Background
Perianal Crohn’s disease (CD) can be a severe, refractory manifestation of pediatric CD. It is underrecognized, particularly if asymptomatic, which has led to varied reported incidences (10-60%). Earlier detection by pelvic magnetic resonance imaging (pMR) may alter management and outcomes.

Aims
If performing pMR on newly diagnosed pediatric CD patients identifies asymptomatic perianal CD and leads to earlier biologic use, fewer hospitalizations, and less surgery.

Methods
New CD patients were prospectively enrolled into the Edmonton Pediatric Inflammatory Bowel Disease Clinic (EPIC) registry. This clinic has done baseline pMR since 2018. A retrospective review (2018-2023) collected pMR, perianal exam, symptoms, blood work, calprotectin, medications, and surgeries (perianal and intestinal). A blinded radiologist re-read pMRs using St. James and Parks criteria. Statistics included descriptive, Fisher’s exact test, multivariate logistic regression, and survival analysis.

Results
139 patients were included (63% male, median age 13 [IQR 11-16]). Ninety-six patients (69%) had no pMR perianal disease (pMR-), despite 13/96 (14%) having perianal symptoms and 26/96 (27%) with inflamed (n=6)/ non-inflamed (n=14) tags or fissures (n=6). Of the 43 (31%) with pMR+ perianal disease, 27/43 (63%) were asymptomatic (ASx) and 17/43 (40%) had a normal exam. pMR+/ASx patients with perianal exam findings included inflamed (n=4)/ non-inflamed (n=5) tags, fissures (n=1), and draining fistula (n=1). pMR+/Sx had higher Parks and St James scores compared to pMR+/ASx. Compared to pMR-, pMR+/ASx and pMR+/Sx patients had a relative risk of 1.40 [95% CI 1.16-1.71] and 1.72 [95% CI 1.72-1.73] of requiring a biologic at 6 months, and a relative risk of 1.39 [95% CI 1.23-1.62] and 1.45 [95% CI 1.45-1.46] of requiring a biologic at 1 year. pMR+/Sx patients had an increased probability of CD surgery (p&lt;0.002) but not hospitalization (p&gt;0.05). There were no differences between pMR+/ASx and pMR- patients in surgery or hospitalization (p&gt;0.05). Time to surgery was shorter in pMR+/Sx (p&lt;0.01), but not different between pMR+/ASx and pMR- (p&gt;0.05).

Conclusions
The majority of patients with perianal CD identified on pMR had no perianal symptoms and had a normal exam. This early identification of subclinical perianal disease led to increased and earlier biologic use, which may explain the lack of increased hospitalization and surgical rates compared to those without pMR+ perianal disease. Baseline imaging was also helpful for demonstrating the absence of deeper perianal disease in several patients who did have perianal symptoms and tags/fissures.

Funding Agencies
NACTRC, Stollery Children’s Hospital Foundation through WCHRI
A202 PREOPERATIVE DIAGNOSIS OF JEJUNAL ADENOCARCINOMA ASSOCIATED WITH CROHN’S DISEASE DIAGNOSED, LOCALIZED AND SURVEILLED VIA DOUBLE BALLOON ENDOSCOPY: A CASE REPORT
Authors: Liu C S , Wong K , Kroeker K , Gozdzik M , Hoentjen F , Peerani F , Wasilenko S , Zepeda-Gomez S , Halloran B 
Published: February 2025

Abstract

Background
Small bowel carcinomas (SBC) are rare, accounting for only 1% to 5% of all gastrointestinal cancers. However, patients with Crohn’s disease face a significantly elevated risk of SBC. This case report outlines a rare case of preoperatively-diagnosed jejunal adenocarcinoma in a patient with long-standing Crohn’s disease with diagnosis and surveillance through double balloon endoscopy (DBE).

Aims
A 41-year-old female with a 30-year history of small bowel Crohn’s disease presents to the hospital with overt obscure GI bleeding. Throughout the course of her disease, she was thought to be in remission with Pentasa and 6-MP, though she had mild inflammation seen in the jejunal and neoterminal ileum visualized on magnetic resonance enterography (MRE). Subsequent oral DBE showed severe nodularity and friability throughout the jejunum with biopsies showing invasive moderately differentiated adenocarcinoma. Combined oral and rectal DBE was used to facilitate tattoo placement prior to open right hemicolectomy with jejunal resections, which was complicated by intraoperative bleed and anastomotic leak. Unusually, cross-sectional imaging with computer tomography (CT) and positron emission tomography (PET-CT) showed no GI tract enhancement or evidence of metastatic spread. Post-operatively, oral DBE found a saddle shaped deformity in the jejunum which had dysplasia on one biopsy. As a result of her complicated post-operative course, the patient is receiving regular surveillance with oral DBE every six months.

Methods
Balloon-assisted endoscopy (BAE) has the potential to allow for endoscopic and histopathologic examination of the entire gastrointestinal tract, which makes BAE an ideal modality for both diagnosis and surveillance in Crohn’s disease. In this particular case, DBE was able to detect a subtle jejunal lesion that was not identified on CT enterography or even a PET-CT scan, resulting in earlier detection of a small bowel adenocarcinoma that was curable with surgery.

Results
Currently, there is a gap in literature surrounding small bowel adenocarcinoma surveillance. This is further complicated by the lack of an established macroscopic appearance of SBC and the unknown prognostic significance of dysplasia on pathology in the context of small bowel inflammation. Further, many centres have limited access to BAE.

Conclusions
This case shows that it has an important, and underutilized role, in IBD management. It is currently the only methodology for visual assessment and biopsy of lesions in the mid gut. Small bowel endoscopy access should be increased in Canada with a focus on IBD patients. Development of high risk identifiers for possible small bowel carcinoma also need to be developed as part of ongoing guidelines.

Funding Agencies
None
A224 BARRIERS AND FACILITATORS TO IMPLEMENTATION OF A NURSE NAVIGATOR-LED, EVIDENCE-BASED, IBD FLARE PATHWAY; RESULTS FROM A NATIONAL MULTISTAKEHOLDER ENGAGEMENT PROCESS
Authors: Willett N , Heisler C , Marshall J , Stewart M , Jimenez L , Bennett A , Robar J , Currie B , Phalen-Kelly K , Jones J 
Published: February 2025

Abstract

Background
The clinical resources of many IBD programs are insufficient to meet population and care complexity needs for persons living with IBD. Implementation of evidence-based pathways via an existing provincial nurse navigator could improve access to evidence-based care for persons living with IBD. Stakeholder engagement is important when identifying barriers to implementation and adoption of evidence-based interventions. Groups interviews were performed as part of a national community advisory panel with nurses and gastroenterologists to better understand barriers and facilitators to implementation of evidence-based care guidelines for IBD flares.

Aims
To identify barriers and facilitators to implementation of evidence based IBD flare pathways in clinical practice through a nurse-led initiative.

Methods
Two semi-structured group interviews were performed as part of the national PACE CCC advisory panel in September 2022. Group interviews were via Zoom, each 1 hour in length. Interview script questions were guided by the COM-B implementation science framework. GI interviews was facilitated by a gastroenterologist (JM) and the nursing group interviews by a research assistant (CH). Results were derived from thematic analysis.

Results
A total of 16 IBD care providers participated. One group represented nurses (n=8), while the other included gastroenterologists (n=6) and members of Crohn’s and Colitis Canada (n=2). Thematic barriers to creating and implementing a flare pathway were identified as: Access to care issues, resources and staffing issues, COVID-19 impact, poor communication between specialists and community-based providers, variability of local resources (imaging, specialists, endoscopy), and cost of implementation. Facilitators included: Virtual care platforms, standardization of care, multidisciplinary teams, patient empowerment, leveraging digital health tools for customisation and implementation of the pathway (i.e., EMR templates). Intervention functions included: Empowering nurse navigators to manage flare assessments and improving access to diagnostic testing and resources by embedding pathways into electronic health records.

Conclusions
Nurses and Gastroenterologists shared invaluable insights into the status of IBD Care in Canada and ways to improve access to evidence-based, and equitable IBD care during a flare. Overall, evidence- based care pathways were viewed as being of importance and that implementation strategies should focus on leveraging digital health platforms, EMRs, and empower IBD nurses to facilitate IBD flare pathway implementation.

Funding Agencies
CCC
A226 THE EFFICACY OF MEDICAL THERAPY TO PREVENT SURGERY AND IMPROVE OUTCOMES AMONG PATIENTS WITH STRICTURING CROHN’S DISEASE: A SYSTEMATIC REVIEW
Authors: Alkhateeb Q , Saad A , Squirell E 
Published: February 2025

Abstract

Background
Despite the advancements in inflammatory bowel disease (IBD) management, the percentage of Crohn’s Disease (CD) patients presenting with obstructive symptoms due to small and large bowel strictures is estimated to be 25% and 10%, respectively. Treatment of CD has advanced over the past 20 years to include safer, more targeted options that carry less morbidity than surgical intervention. However, the efficacy of medical therapy once fibrosis has begun is theoretically reduced and, until recently, has had limited study.

Aims
The aim of this systematic review is to examine the efficacy of medical therapies, such as biologics (TNF inhibitors, interleukin inhibitors, anti-integrin therapy) and immunomodulators (thiopurines and methotrexate) to avoid the need for surgical intervention in stricturing Crohn’s disease.

Methods
We searched Medline, Embase, the Cochrane library, and Web of Science for experimental (i.e., randomized and non-randomized controlled trials), quasi-experimental (i.e., interrupted time series) and observational studies (i.e., cross-sectional surveys) examining the effect of medical therapies among adult and pediatric CD patients admitted for the management of strictures. Records were screened, in duplicate and independently, by their title and abstract and then full-text and relevant data were extracted using a standardized data extraction sheet. Efficacy data were pooled using meta-analyses, when applicable, or synthesized narratively.

Results
Our preliminary search yielded a total of 1059 unique records and 22 studies (3 RCTs, 19 cohort studies) were included in our analysis. Results from 8 cohort studies show that among 546 patients receiving TNF antagonists, 80% responded to treatment and did not require surgery at an average follow-up period of 4.1 years (95% CI 71% to 88%). Furthermore, one RCT and one cohort study found that Azathioprine in combination with anti-TNF therapy improved obstructive symptoms and reduced the odds of hospitalization and surgery by half.

Conclusions
Our review highlights systemic medical therapy, namely TNF antagonists, as a promising solution to prevent the need for surgery among patients with stricturing Crohn’s disease. More robust research is needed to confirm these findings and compare their efficacy.

Funding Agencies
None
A228 PSYCHOSOCIAL FACTORS IN ADULTHOOD AND RISK OF INFLAMMATORY BOWEL DISEASE
Authors: Lanoix C , Fantodji C , Jantchou P , Rousseau M 
Published: February 2025

Abstract

Background
Few studies have assessed the possible etiological role of psychosocial factors on inflammatory bowel disease (IBD). We have previously reported that some childhood psychosocial factors were associated with increased odds of IBD in adulthood.

Aims
The aim of this study was to estimate the associations between self-reported psychosocial factors first experienced in adulthood and occurrence of IBD later in life.

Methods
This matched case-control study was nested within a cohort of individuals born in Quebec in 1970-1974. Cases were identified with validated algorithms based on health services from 1983 to 2014; their date of diagnosis was based on their first health service (index date). Only cases diagnosed with Crohn’s disease (CD) (n = 1041) or ulcerative colitis (UC) (n = 511) at ≥18 years were included. Each case was individually matched with a control based on sex and birth year. Cases and controls completed a questionnaire documenting sociodemographic, lifestyle, and psychosocial factors up to the age corresponding to the index date. The psychosocial factors (n = 17) experienced in adulthood related to work (interruption, changes, problems), difficulties (academic, financial), judicial problems, marriage or union, divorce or separation (parents’/own), familial conflict, birth of a child, death (spouse or child/other loved one), depression, anxiety, accident, violence or abuse. Potential confounders were based on a priori knowledge. Conditional logistic regression was applied to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each psychosocial factor, for CD and UC separately. Multiple imputations were used to address missing data.

Results
Adjusting for potential confounders, the odds of CD were higher among those who had experienced changes in the workplace (OR: 1.58; 95% CI: 0.96-2.61), marriage (OR: 1.32; 95% CI: 1.06–1.64), divorce or separation (OR: 1.75; 95% CI: 1.19-2.58), death of spouse or child (OR: 3.21; 95% CI: 1.12-9.19), anxiety (OR: 2.17; 95% CI: 1.25-3.78), and accident (OR: 1.72; 95% CI: 1.09-2.73). The odds of UC were higher among those who had experienced problems at work (OR: 2.00; 95% CI: 1.03-3.87) and anxiety (OR: 1.75; 95% CI: 0.93 - 3.32) and lower among those exposed to changes in the workplace (OR: 0.48; 95% CI: 0.23-1.00). The other psychosocial factors were not associated with either CD or UC.

Conclusions
Several psychosocial factors, first experienced in adulthood, were associated with increased odds of CD or UC later in life, whereas only one, changes in the workplace was associated with decreased odds of UC. Further research should consider the self-reported subjective impact of these psychosocial factors.

Funding Agencies
CIHRCanada Foundation for Innovation & the Québec Ministry of Education, Leisure and Sports (#12532), Fonds de recherche du Québec-Santé (FRQS, #16227), Multiple Sclerosis Society of Canada (#2435), Institut de la statistique du Québec
A232 CAN WE ACCURATELY PREDICT SEVERE ACUTE PANCREATITIS IN CHILDREN? A RETROSPECTIVE REAL-LIFE COHORT OF HOSPITALIZED PATIENTS
Authors: Korman C , Elhaoua D , Blain S , Li T , Mohamed M , David A , Deslandres C , Halac U , Dirks M , Grzywacz K , Lallier M , Alvarez F , Jantchou P 
Published: February 2025

Abstract

Background
Severe acute pancreatitis (SAP) affects nearly a quarter of pediatric patients with acute pancreatitis (AP). However, previous studies suggested that severity scores used in adults have low sensitivity for predicting pediatric SAP. Uncertainty remains regarding the factors associated with SAP in children.

Aims
The primary aim was to validate SAP predictive scores in a Canadian pediatric population and identify associated predictive factors.

Methods
A retrospective observational cohort study was conducted in a tertiary hospital in Montreal, Canada (January 2014-December 2021). SAP was defined by intensive care unit (ICU) admission and/or complications including but not limited to fluid collection, necrosis, and pseudocyst. Firstly, multivariate logistic regression analyses were performed to evaluate the relationship between clinical and laboratory factors and the outcome (SAP). A predictive model was also developed based on age, co-existence of chronic disease (e.g., neoplasia, obesity), C-reactive protein (CRP) levels within 48 hours of admission, baseline urea levels, and sex. Secondly, receiver operator characteristic (ROC) curves were plotted for various published scores (Balthazar (n=55), DeBanto (n=118), Glasgow modified (n=38), Ranson (n=20)) and our model (n=122).

Results
Among 208 patients (51.0% male, median (interquartile range (IQR)) age [12.5 (7.1;15.3) years]), 76 (36.5%) developed SAP. Of these, 14 (6.7%) were admitted to the ICU, and 68 (32.7%) developed complications. The median (IQR) hospital duration was 5.0 (2.5;11.0) days. The ROC for Balthazar, DeBanto, Glasgow modified, Ranson, and our model showed an area under the curve of 0.63, 0.58, 0.59, 0.58, and 0.80, respectively. Balthazar demonstrated the highest specificity (100%). Ranson showed the highest sensitivity (50%). Our model demonstrated a specificity of 78% and a sensitivity of 58%. Each unit increase in CRP within 48 hours of admission and each unit increase in urea at admission were associated with a higher risk of SAP (ORCRP=1.02, 95% CI: 1.01-1.03; ORurea=1.32, 95% CI: 1.08-1.61) whereas each unit increase in lipase within 48 hours of admission (minimum 3.0 U/L; maximum 5745.0 U/L) were not predictive of SAP.

Conclusions
Existing scores display low predictive value for SAP. Our new model, which includes age, CRP and urea levels, sex, and the presence of co-existing conditions, demonstrates good predictive value for pediatric SAP and warrants external validation in larger pediatric cohorts.

Funding Agencies
None