bluuebunny/crossref_metadata_2025_split huggingface dataset:
A235 INFLAMMATORY BOWEL DISEASE AND PREECLAMPSIA: A PHYSICIAN SURVEY
Authors: Hanna Y , Tandon P , Huang V 
Published: February 2024

Abstract

Background
Preeclampsia is a disorder of pregnancy recognized as the second cause of maternal mortality worldwide. The association between IBD and preeclampsia remains unclear, but the significant comorbid profile, and lack of treatment aside from urgent delivery, make primary prevention a priority.
Aspirin was shown to halve preeclampsia rates and is recommended for primary prevention for women at risk. Despite high-quality evidence supporting Aspirin use and its well tolerated side effect profile, studies in non-IBD patients have demonstrated a knowledge-to-practice gap.

Aims
While there are no studies reported in women with IBD, prescribing rates may be even lower in this population, given that it may be incorrectly perceived to increase the risk of an IBD flare. Understanding physician perceptions could allow for a targeted educational approach to increase patient and physician awareness of the indications for Aspirin prophylaxis and its safety profile.

Methods
This is a cross-sectional survey study assessing physician perceptions and Aspirin prescribing patterns for preeclampsia prevention conducted from Mount Sinai Hospital. Demographic information, information on perceptions of preeclampsia risk in pregnant women with IBD, and on the perceived clinical benefit and risk of Aspirin prescribing were collected.

Results
A total of 38 Canadian healthcare professionals (HCPs) (15 Gastroenterologists, 14 Obstetricians, 5 General Practitioners, 2 General Internists, 1 nurse practitioner, and 1 midwife) were surveyed. Most HCPs were practicing for over 10 years (71%). In total, 68% of HCPs were comfortable with pregnancy-specific management of IBD. Most HCPs correctly identified all comorbidities associated with a high risk of preeclampsia including a history of preeclampsia (95%), renal disease (87%), and autoimmune disease (68%). A total of 55% of HCPs believed that pregnant patients with IBD were at increased risk of placental related diseases, and 56% agreed that these patients were at increased risk of preeclampsia specifically. Thirty-five percent of HCPs believed that IBD in remission, in the absence of other risk factors, was an indication for Aspirin prophylaxis. More so, 45% believed that IBD, with poor disease control, was an indication.
Only 8% of HCPs believed that Aspirin, when used for preeclampsia prevention, was associated with an IBD flare. In patients whom Aspirin prophylaxis was indicated, 77% agreed with its use, even in patients in whom disease control was poor. Finally, 63% agreed that the Aspirin dose should be 162 mg daily, and more than half (58%) agreed that the prescriber should be the patient’s obstetrician.

Conclusions
Most HCPs agreed that IBD was a risk factor for preeclampsia and that Aspirin prophylaxis was effective and safe for primary prevention. High quality studies are needed to evaluate risk of preeclampsia in IBD, especially in patients with active disease.

Funding Agencies
CAG
A236 THE EFFECTIVENESS AND SAFETY OF DUAL ADVANCED THERAPIES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A CASE-SERIES
Authors: Howarth N C , Wilson A , Boyd T , Rohekar S , Basharat P 
Published: February 2024

Abstract

Background
Patients with inflammatory bowel disease (IBD) refractory to medical therapy and patients with IBD and concurrent extra-intestinal manifestations (EIMs) pose a challenge within gastroenterology. The small number of approved agents for IBD limits therapeutic options for this population. Utilizing a combination of newer biologic therapies with favourable safety profiles may provide a safe and efficacious option for treating patients with refractory disease or patients with well-controlled IBD but uncontrolled EIMs.

Aims
The aim of our study was to assess the safety and efficacy of dual advanced therapies for patients with IBD.

Methods
Patients at London Health Sciences Centre and St. Joseph’s Healthcare Centre on dual advanced therapies for inflammatory bowel disease were retrospectively assessed for a minimum period of 12 months. Major bacterial infection, adverse events, endoscopic, histologic, and clinical remission of IBD, and remission of EIMs of IBD were assessed.

Results
Five patients with Crohn’s disease receiving dual advanced therapies were identified. Stricturing Crohn’s disease was the predominant phenotype in 80% of the patients. One patient had perianal fistulizing disease. Dual therapy was initiated for concurrent management of EIMs in 80% of patients (enteropathic arthritis in 2 patients, spondyloarthritis in 2 patients, rheumatoid arthritis in 1 patient) and for refractory IBD in one patient. The majority of patients were on a combination of a tumour-necrosis-factor inhibitor and vedolizumab. Other advanced therapies included JAK inhibitors and ustekinumab. The patients were predominantly female (80%) and age at diagnosis was ampersand:003C50 years old in 80% of patients. No adverse events or major bacterial infections were observed during dual therapy. At the end of follow-up, all 5 patients were in clinical remission of their IBD and 4 patients demonstrated endoscopic remission. Only 60% of patients had remission of their EIMs within the follow-up period.

Conclusions
Our findings suggest that dual advanced therapies are safe and may represent a long-term treatment option for complicated patients with IBD.

Funding Agencies
None
A237 ROTAVIRUS VACCINE SAFETY IN INFANTS EXPOSED TO BIOLOGICS IN UTERO IN AN INFLAMMATORY BOWEL DISEASE POPULATION: A PROSPECTIVE COHORT STUDY
Authors: Jeyakumar Y , Mohmand Z , O'Connor K , Piche-Renaud P , Morris S , Huang V 
Published: February 2024

Abstract

Background
Biologics, the mainstay of therapy in patients with moderate-to-severe inflammatory bowel disease (IBD), undergo placental transfer during the second trimester of pregnancy and may remain detectable in the blood of exposed infants for up to 12 months. Due to concerns regarding the risk of immunosuppression and adverse events following immunization with live attenuated vaccines in infants exposed to biologics in utero, current guidelines recommend avoiding live vaccines in the first 6 to 12 months of life.

Aims
This study investigates whether the live rotavirus vaccine can safely be administered in infants exposed to biologics in utero.

Methods
We conducted a single-centre prospective cohort study, which included infants exposed to biologics in utero and born to mothers with IBD between October 1, 2020 and June 30, 2022. Infants were included in the study if they were assessed by Paediatric specialists at the Special Immunization Clinic (SIC) at SickKids Hospital (Toronto, Ontario). Mothers were followed by Gastroenterologists at the Special Pregnancy IBD Clinic at Mount Sinai Hospital (Toronto, Ontario). Data were collected on biologic agent exposure history, infant immune function testing, SIC recommendations for rotavirus vaccination, rotavirus vaccine series completion, and adverse events after immunization. Adverse events following immunization included fevers, vomiting, diarrhea, and/or intussusception within 42 days following immunization.

Results
22 infants were included in the study. Of the 22 infants, 5 (22.7%) were exposed to infliximab in utero, 10 (45.5%) were exposed to adalimumab, 3 (13.6%) were exposed to vedolizumab, and 3 (13.6%) were exposed to ustekinumab. Of the 22 infants, 18 (81.8%) were recommended to receive the rotavirus vaccine by the SIC. 1 (0.05%) was not recommended to receive the vaccine due to neutropenia and low CD54 count on lymphocyte testing. The recommendation given to 3 infants is unknown. Of the 18 infants who were recommended to receive the vaccine, 16 (88.9%) received the vaccine and had no adverse events following immunization. 1 (6%) infant did not receive the rotavirus vaccine despite it being recommended due to parental choice. The rotavirus vaccination status and response in 1 infant recommended to receive the vaccine, is unknown.

Conclusions
Administration of the rotavirus vaccine in biologic-exposed infants did not result in adverse events in our study cohort. Although guidelines currently advise against live vaccinations in infants exposed to biologics in utero, specialist assessment of infant immune function can help encourage safe live vaccination uptake.

Funding Agencies
None
A238 BEST APPROACH TO SURVEILLANCE COLONOSCOPY FOR COLORECTAL CANCER IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS AND INFLAMMATORY BOWEL DISEASE
Authors: Khan R , Dhalwi G , Ricciuto A 
Published: February 2024

Abstract

Background
Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease and it has been recognized as a risk factor for hepatobiliary and colorectal carcinoma (CRC). Inflammatory bowel disease (IBD) is associated with a 6-fold increased risk of CRC as compared to the general population but with co-existing PSC, this risk rises to 30-fold and hence CRC surveillance is critical in these patients.

Aims
We performed a systematic review of the literature on surveillance colonoscopy for CRC in patients with PSC-IBD, with the aim of identifying the most effective approach.

Methods
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID 472215. The search was executed in the databases Medline, EMBASE, Cochrane, Web of science, Scopus and Google Scholar databases from 1947 to May 2023. Observational or randomized controlled studies were included if patients had PSC-IBD (paediatric or adult) undergoing surveillance colonoscopy. There was no restriction for language. We used a modified version of the Newcastle–Ottawa Quality Assessment Scale to assess the risk of bias. Neoplasia was defined as the presence of low-grade dysplasia, high grade dysplasia or colorectal carcinoma.

Results
Amongst 2900 studies identified, 7 studies met the inclusion criteria with a total number of 379 PSC-IBD patients and 1884 IBD patients (all adult). The median frequency of surveillance colonoscopy was every 0-2 years. The most common endoscopic presentation of dysplasia in PSC-IBD was a normal appearing mucosa or subtle abnormalities such as mild inflammation. Three studies performed random and targeted biopsies and only one study did quadruple random biopsy (every 10 cm of the colon). Two studies used chromoendoscopy and high-definition endoscopy whereas another two studies used white light colonoscopy. Studies varied in terms of the number of biopsies taken and timing for the frequency and initiation of surveillance. Outcomes included intensive surveillance, resection, and colectomy. Our meta-analysis of 2 studies that reported the prevalence of colorectal dysplasia in PSC-IBD patients revealed a pooled prevalence of 21% (95% CI 1.4%-28%, I2 = 0%, Pampersand:003C0.597, shown in Figure 1)

Conclusions
Colorectal dysplasia is prevalent in patients with PSC-IBD and is associated with worse disease outcomes. As a result, PSC-IBD patients should be screened annually from the diagnosis of PSC. However, there is variation in practice, and no clear consensus on the best approach to perform screening colonoscopy in this population. Literature comparing various approaches is very sparse. Additional high-quality studies on this subject are needed to guide practice, particularly in paediatrics where data are non-existent.

Figure 1: Forest plot for meta-analysis of CRC dysplasia prevalence in PSC-IBD

Funding Agencies
None
A239 MOTIVATIONS BEHIND CAM USE IN PATIENTS WITH CROHN'S DISEASE AND ULCERATIVE COLITIS
Authors: Klemm N K , Trasolini R , Bressler B , Rosenfeld G , Leung Y 
Published: February 2024

Abstract

Background
Complementary and alternative medicine (CAM) use is common in IBD patients and impacts compliance with conventional treatment. Gastroenterologists should understand the motivational factors of CAM use—factors that push patients away from standard therapy or pull towards CAM. Our study describes the motivations behind CAM use for IBD and evaluates differences between CD and UC patients.

Aims
To compare the motivations behind CAM use between CD and UC patients.

Methods
Retrospective cohort survey of patients over 18 years old with IBD, evaluated by gastroenterologists at a tertiary care referral centre from January 1 to December 31, 2019. Only patients that reported CAM use were included. Chi-square and independent t-tests were performed and p-value ampersand:003C0.05 was significant.

Results
Of the 230 completed surveys, 193 reported CAM use (CD:57.5% & UC:42.5%). Demographics, disease duration and hospitalizations were similar, but CD patients had lower SIBDQ scores (CD:48.1 & UC:53.5 pampersand:003C0.001).
Both groups were largely influenced by their social network to use CAM (CD:33% & UC:31.3%) and did not feel well informed of CAM (87.4%). CD and UC patients had similar push and pull factors. Push factors included lack of improvement (39%) and side effects (20%) with conventional treatment. Pull factors included the desire for a holistic approach (21%) and to improve mood (35%). Most patients hoped fatigue 62.7%, diarrhea 61.7% and abdominal pain 58.0% would improve with CAM.

Conclusions
Despite differences in QoL, push and pull motivations for CAM use do not differ between CD and UC patients. Most users do not feel well informed of CAM and ongoing dialogue is important for patient-centred care.
Table 1: Characteristics of CAM use

Funding Agencies
None
A240 THE PROTECTIVE EFFECT OF HYMENOLEPIS DIMINUTA INFECTION IN EXPERIMENTAL COLITIS CAN BE INDEPENDENT OF IL-4RΑ SIGNALING
Authors: Kraemer Rocha L , Li S , Rajeev S , Wang A , McKay D 
Published: February 2024

Abstract

Background
Helminth parasites are potent inducers of Th2 immunity, characterized by the production of IL-4, IL-5, IL-13 and IL-10, and mobilization of regulatory cells. This orchestrated immune response establishes an immunomodulatory and/or immunosuppressive environment that may be protective against colitis and other inflammatory diseases. Earlier studies reveal that infection with the tapeworm parasite Hymenolepis diminuta ameliorates chemical-induced colitis in immunocompetent mice, and highlighted participation of the anti-inflammatory cytokine IL-10 in the mechanisms of protection. Moreover, the IL-4ra/STAT6 signaling pathway plays a pivotal role in promoting the Th2 immune response that is crucial for parasite expulsion: IL-4ra KO mice cannot expel the worm. However, the need for activation of IL-4rasignaling in the suppression of colitis by H. diminuta infection is unknown.

Aims
To determine if the inhibition of DNBS-induced colitis evoked by infection with H. diminuta requires IL-4ra signaling.

Methods
IL-4ra KO mice (n=4-8/group) were orally infected with 5 viable cysticercoids of H. diminuta and 8 days post-infection (dpi) were treated with 2.5 mg of dinitrobenzene sulfonic acid (DNBS). Subsequently, mice were assessed 72h post-DNBS. Disease was assessed by macroscopic disease activity score, colon length, weight loss, MPO activity of the colon, and leucocyte profile by blood count. Production of IL-10 by concanavalin-A (con-A; 48h)-stimulated splenocytes was measured by ELISA.

Results
An increase in blood eosinophilia in H. diminuta infected mice indicated a successful infection. DNBS treatment induced acute colitis in IL-4ra KO mice, and surprisingly prior infection with H. diminuta resulted in significantly less severe colitis, as evidenced by reduction in macroscopic disease activity score, prevention of weight loss, reduced MPO colon levels and maintenance of regular colon length. However, splenocytes from H. diminuta-infected IL-4ra KO mice did not show increased IL-10 production evoked by con-A compared to cells from non-infected mice.

Conclusions
These results indicate that the protection against DNBS-induced colitis by prior infection with H. diminuta can occur in the absence of IL-4ra signalling. This suggests redundancy in the anti-colitic effect of infection with this helminth parasite, such that absence of IL4ra is compensated for via another, yet to be determined, mechanism. We speculate that this may be via participation of type 2 innate lymphoid cell activity, mobilization of regulatory T cells or innate immunity: all possibilities that need to be rigorously tested.

Funding Agencies
CIHRBeverly Phillips Rising Star and Cumming School of Medicine (U. Calgary) Fellowships
A243 BONE MINERAL DENSITY AND DIETARY BONE NUTRIENTS DIFFER IN PATIENTS WITH CROHN'S DISEASE STRICTURES
Authors: Macci A , Basit J , Klassen R , Rosentreter R E , Bindra K , Lethebe B , Boyd S , Billington E , Raman M , Burt L , Lu C 
Published: February 2024

Abstract

Background
Crohn’s disease (CD) phenotypes include inflammatory (non-stricture) and stricture behaviours. Strictures are bowel narrowing’s that may lead to obstructions and subsequent dietary restrictions to prevent blockages. Bone mineral density (BMD) in CD is affected by many factors including corticosteroid use, CD itself, but also dietary changes. Clinical gold standard for measuring BMD is by dual x-ray absorptiometry (DXA) scans. High-resolution peripheral quantitative computed tomography (HR-pQCT), a more precise imaging modality assesses volumetric BMD, bone geometry and bone microarchitecture. We aim to compare dietary intake, and bone quality in both stricture and non-stricture CD.

Aims
To identify nutritional patterns, bone quality differences and deficiencies between two subtypes of CD; including energy intake, dietary components and/or micronutrients

Methods
Individuals (≥55 years old) with ileal CD strictures (fixed, angulated bowel or thickened bowel with pre-stenotic dilation on diagnostic imaging), or inflammatory CD were prospectively recruited. Patients with short gut, celiac disease, dysphagia history were excluded. All patients completed DXA hip and spine scans and HR-pQCT radius and tibia scans. Dietary assessment questionnaires (Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), and Diet History Questionnaire III for food frequency over the past year were completed.

Results
56 (27 inflammatory (48% female, mean age 64.2, BMI 28.7, 16 years CD duration) and 29 strictures (45% female, mean age 65.9, BMI 27.3, 25 years CD duration, 15 (51.7%) prior bowel resection) were included. 31/56 (55.4%) patients were on biologics and 11 (19.5%) had past corticosteroid exposure. DXA-based BMD for stricture versus non-stricture CD patients was not significantly different at the hip or spine. However, HR-pQCT-based radial total BMD (p=0.03), cortical thickness (p=0.01) and cortical area (p=0.04) were lower in stricture than non-stricture patients.11 (7 stricture, 4 inflammatory) patients with past steroids consumed more dairy (p=0.01), vitamin D (p = 0.04), and calcium (p=0.03) than other CD patients. Stricture patients had significantly less consumption of vitamin K (p=0.001), vegetables (p=0.02), calcium (p=0.03), and dairy (p=0.03).

Conclusions
Patients with CD strictures have lower BMD and cortical bone quality at the radius than those without strictures. Patients with CD strictures also consume significantly less vitamin K, calcium, and dairy, all vital dietary components to prevent OP, compared to non-stricture patients. Overall, the skeletal fracture risk is likely much greater in CD patients with strictures than without, due to greater inherent bone fragility, and less consumption of key nutrition building blocks of bones.

Funding Agencies
Koopmans Memorial Research Fund
A244 DEVELOPING AND ASSESSING THE EFFECTIVENESS OF A REMOTE MONITORING PROTOCOL FOR ULCERATIVE COLITIS PATIENTS - ULCERATIVE COLITIS CLINICAL OUTREACH (UCCO)
Authors: MacKay S A , Hagerman C , Parsons D , Dieleman L , Hoentjen F , Kroeker K , Peerani F , Wong K , Halloran B 
Published: February 2024

Abstract

Background
Ulcerative colitis (UC) is a chronic inflammatory bowel disease which requires regular gastroenterologist monitoring. Outpatient monitoring programs to date have focused on clinical scores alone, leaving patients with asymptomatic inflammation susceptible to undertreatment despite increased risk of flares and colorectal cancer. The University of Alberta IBD Unit developed and piloted an outreach and remote monitoring protocol for UC patients including clinical and biochemical variables. We assessed the effectiveness of this protocol at improving UC care.

Aims
This study aimed to develop a clinical outreach and remote patient monitoring protocol for UC patients and assess the impact this protocol had on disease management.

Methods
Biologic naïve adult UC patients who had not been reviewed by their gastroenterologist in at least six months were contacted by phone and mailed monitoring kits with Partial Mayo, Sutherland Index, and medication adherence questionnaires and a requisition for blood work and fecal calprotectin (FCP). Results were compiled and sent to each patient’s gastroenterologist. Participating gastroenterologists completed a survey about the perceived utility of the protocol and intended UC management changes.

Results
85 patients completed the protocol. 86.4% of physician surveys rated the protocol as helpful to clinicians. UC management was changed in 55.6% of cases, with 82.2% of changes being management escalations. Six patients had active flares and 17 patients with asymptomatic inflammation were identified. Endoscopy was completed for 23 patients, with active disease observed in 78.2% of cases. Six patients started biologic therapies based on the protocol and endoscopic findings. UC management escalations were significantly predicted by FCP and Sutherland Index scores on logistic regression analysis.

Conclusions
This protocol had a meaningful impact on UC management and identified patients with active disease in both the presence and absence of clinical remission. Remote outpatient monitoring in UC should include collection of both FCP and clinical scores every six months to improve UC management.

Funding Agencies
None