bluuebunny/crossref_metadata_2025_split huggingface dataset:
A50 PRODUCTION OF A PANCREATIC AND INTESTINAL HEPATOCYTE NUCLEAR FACTOR 4A DOUBLE KNOCKOUT MOUSE MODEL TO UNRAVEL NEW MECHANISMS CONTROLLING METABOLISM
Authors: Rodriguez Rodriguez N , Di Castro A , Jones C , Pupo Gómez D , Boudreau F 
Published: February 2024

Abstract

Background
Hepatocyte nuclear factor (HNF) 4A is a transcription factor mainly found within endodermal organs, including the intestine and pancreas. HNF4A controls the expression of genes associated with glucose transit, glycolytic enzymes, lipid and drug metabolism, and incretin production from intestinal enteroendocrine cells. Mutations within this are linked to various diseases, including maturity-onset diabetes of the young and increased risk of Type 2 diabetes mellitus. However, it remains unclear whether intestinal and pancreatic HNF4A is functionally involved in glucose metabolism. This could be partly due to the lack of suitable experimental model that allow recreating phenotypes associated with hnf4a lost in two key organs involved in controlling body glucose levels.

Aims
To generate a conditionally mutant mouse line that does not express HNF4A in the intestine or the pancreas and to investigate how glucose metabolism is affected in these mice.

Methods
Conditional deletion in each organ was achieved by mating VillinCre or InsCreER with Hnf4αloxP/loxP C57BL/6 mice, respectively. The mutant mouse line was then generated by crossing mice Hnf4αloxP/loxP+VillinCre and Hnf4αloxP/loxP+InsCreER. PCR was performed to confirm all genotypes. Male and female mice around 2-3 months were distributed in four groups, including controls, Hnf4α-deleted intestine only, Hnf4α-deleted pancreas only, and Hnf4α-deleted in both organs. HNF4A expression was measured by qPCR, immunoblot and immunofluorescence. Glucose metabolism tests, including oral glucose tolerance (2g/kg) and insulin tolerance (0.75 International Units/kg) were performed. The blood glucose levels were measured after overnight fasting at 15, 30, 60, and 120 min.

Results
The body weight of four groups of mice remained comparable over experimental time. HNF4A expression was not detected from double mutant mice’s gut epithelial or pancreatic β cells. The oral glucose challenge showed a difference among the group of experimental mice as compared to the control group. After 15 min, blood glucose values of double mutant mice remained higher than control mice, for which glucose clearance was less efficient in the mutants. Insulin tolerance tests demonstrated that double mutant mice behave differently than control mice, suggesting a defect in insulin response.

Conclusions
These promising preliminary results allow us to obtain and characterize a novel murine model to study glucose metabolic syndrome that could be related to hnf4a gene deletion in both the gut and pancreas. Further studies are needed to establish a mechanism by which the HNF4A transcription factor could interplay between the intestine and the pancreas during whole-body glucose metabolism.

Funding Agencies
CIHRBourses d’excellence de l'Université de Sherbrooke
A69 EXPANDED ROLE OF THE DIETITIAN IN THE CLINICAL MANAGEMENT OF PATIENTS WITH CELIAC DISEASE
Authors: Asaria I , Blom J , Morgan J , Khaouli M , Armstrong D , Pinto-Sanchez M 
Published: February 2024

Abstract

Background
The only available treatment for Celiac Disease (CeD) is adhering to a strict gluten-free diet (GFD). However, a GFD has been associated with multiple nutrient imbalance and deficiencies, which are often under-recognized and remain untreated.

Aims
To identify the reasons for referral to a registered dietitian (RD) and RD-recommended dietary interventions for patients with CeD attending a specialised Adult Celiac Disease Clinic.

Methods
We conducted a retrospective chart review using nutrition assessment forms completed by the RD between November 2021 and May 2022. CeD diagnosis was performed through specific serology (anti-tissue transglutaminase IgA and anti-deamidated gliadin peptide IgG) and confirmed by duodenal biopsies demonstrating villous atrophy. We collected data on demographics, diagnosis date, nutritional status (BMI), micronutrients measured in serum, gastrointestinal (GI) symptoms, reason for consult, and the recommendations made by the RD. Data was collected in RedCap (v. 11.1, 2021, US) and expressed as both a proportion and Median (IQR).

Results
A total of 136 visits from 102 patients were included in the analysis. Of them, 77 were female (75.5%) with a mean age of 40.3 yrs (+/- 16.0). The median year of CeD diagnosis was 4 (IQR= 6) from 2002-2022. Patients reported various symptoms including bloating (50.9%), abdominal pain (34.3%), and constipation (23.5%). 56% of patients were overweight or obese (BMI ampersand:003E25), and 4.9% were undernourished (BMIampersand:003C18). The most common nutrient deficiencies were ferritin below 30 ng/mL (58.8%), zinc below 9.4 µmol/L (23.5%), and suboptimal levels of vitamin D (38.2%). The most common reasons for referral to the RD were to assess GFD adherence (44.1%), dietary management of GI symptoms (30.4%) and nutritional optimization (24.5%). We identified 18 different interventions recommended by the RD, the most common being how to prevent gluten cross-contamination (58.8%), tips for dining out (43.1%), GF diet education (32.4%), and increasing fibre intake (30.4%). The most common reasons for follow up visits (n=34) included dietary management of GI symptoms (60.9%) and GFD adherence (43.5%).

Conclusions
Patients with CeD face multiple nutritional challenges associated with following a GFD, and a number of GI symptoms. Although the GFD is the only available treatment, this review identifies the need for multiple individualized dietary interventions, which require and encourage the inclusion of a specialized RD to ensure personalized, effective care and support in the management of CeD.

Funding Agencies
None
A71 IMPACT OF THE COVID-19 PANDEMIC ON WAIT TIMES, AND CLINICALLY RELEVANT FINDINGS AT COLONOSCOPY
Authors: Barkun A , Ravanbakhsh K , Kim D , Milky G , Stanowski P , Geraci O , Martel M , Menard C , von Renteln D 
Published: February 2024

Abstract

Background
The widespread use of a standardized and validated province-wide colonoscopy referral form (PCRF), regrouping mutually exclusive indications into suggested priority wait times categories (P1 to P5), has allowed for a more comprehensive description of routine colonoscopy practice.

Aims
To better understand the impact of COVID-19 on the routine practice of colonoscopy.

Methods
This is a multicenter retrospective cohort study of consecutive adult patients referred with PCRF data available from two Quebec tertiary hospitals. Patient and procedural characteristics were recorded. The primary outcomes were the diagnostic rates of colorectal cancers (CRC) and clinically significant lesions (CSF), defined as endoscopic findings affecting subsequent patient management, excluding hemorrhoids and diverticulosis. The secondary outcome was procedural wait times. We compared endpoints contrasting colonoscopy findings pre-COVID (before March 15th, 2020) to intra-COVID (after April 15th, 2020).

Results
7,476 pre-COVID and 7,181 Intra-COVID patients (mean age 59.2 ± 14.0 years, 50.9% female) were included from 2018 to 2022. There were no clinically relevant between-group differences in patient characteristics. CRC detection remained similar (0.9% pre- vs 0.8% intra-COVID, p=0.69), while CSF were diagnosed more frequently intra-COVID (41,2% vs 39.7%, p=0.02).
There were higher rates of indications performed for urgent and semi-elective priorities (P2, P3) intra-COVID (2.9% vs 1.3%, pampersand:003C0.01, and 50.5% vs 47.9%, pampersand:003C0.01). Corresponding intra- vs pre-COVID differences in indications (all Pampersand:003C0.01) included a clinical suspicion of active inflammatory bowel disease (6.4% vs 5.2%), a high index of suspicion for cancer based on imaging, endoscopy or clinical exam (2.9% vs 1.3%), suspicion of occult colorectal cancer (1.4% vs 0.9%), and doing a repeat endoscopy because of a prior inadequate bowel preparation (1.3% vs 0.8%). In contradistinction, more elective colonoscopies had been performed pre-COVID (P4: 15.5% vs 8.6%, pampersand:003C0.01, and P5: 5.2% vs 3.8%, pampersand:003C0.01. COVID Colonoscopy wait times grew significantly longer intra- vs pre-COVID (176.3 ± 252.4 days vs 78.6 ± 110.2 days, pampersand:003C0.01).

Conclusions
We witnessed significant changes in indications and referral priorities distributions for colonoscopy pre- vs intra-COVID, amidst longer wait times. These practice modifications did not alter CRC diagnostic yields, but resulted in greater proportions of CSF detection

Funding Agencies
CPAC and MSSS
A77 COMPLICATIONS OF DUODENAL DIVERTICULA: A SYSTEMATIC REVIEW ON CLINICAL PRESENTATION AND MANAGEMENT OF ENTEROLITH ILEUS SECONDARY TO DUODENAL DIVERTICULA FORMATION
Authors: Miranda C J , Carlson A M , Hossein-Javaheri N , Aijaz A , Ali M H , Ismail M 
Published: February 2024

Abstract

Background
Duodenal diverticula (DD) are relatively common findings in the gastrointestinal (GI) tract with their presence noted in up to 20% of the population. Rarely, however, these diverticula predispose to enterolith formation which can lead to small bowel obstruction, a phenomenon termed “enterolith ileus”. Both surgical and non-surgical approaches have been espoused in tackling this complication but definitive literature on optimal management is lacking and is limited to scattered case reports and case series. With this phenomenon carrying significant morbidity and mortality, we have conducted a comprehensive review of all available case reports to summarize our understanding of this condition.

Aims
To investigate the prevalance and clinical presentation of enterolith ileus secondary to duodenal diverticula and their optimal management whether that be medical or surgical.

Methods
A comprehensive search of PubMed, OVID, CINAHL, and Cochrane databases up to February 2023 was conducted to identify all studies reporting clinical information on enterolith formation in DD leading to small bowel obstruction. Each article was qualitatively assessed, and relevant data were extracted from selected studies to determine clinical courses and optimal management.

Results
Our literature review identified 17 case reports of enterolith ileus secondary to DD. The mean age of the patients was 72 years (SD 11.43), with 59% of them being female. Three patients had previously undergone Roux-en-Y gastric bypass, while one patient had undergone a distal gastrectomy. The most common symptoms reported were abdominal pain, nausea, and vomiting (88%), followed by abdominal distension (47%). Dilated bowel loops was the most common finding on X-rays, while CT scans revealed signs of small bowel obstruction and DD with an endoluminal mass in most of the cases. Upper GI series was performed in five cases, revealing multiple duodenal diverticula. Despite initial conservative management, 16 out of 17 patients eventually required surgical intervention. Enteroliths were extracted via enterotomy in 14 out of 17 cases, while surgical resection of the bowel was performed in three cases due to suspicion of tumor or perforation.

Conclusions
Our findings highlight the importance of prompt diagnosis and management of DD leading to enterolith ileus, particularly in elderly patients and those with a history of gastric surgery. Surgical intervention is almost always required and therefore early recognition and intervention can help minimize the risk of morbidity and mortality associated with this condition.

Funding Agencies
None
A78 VALIDITY EVIDENCE FOR OBSERVATIONAL EUS COMPETENCY ASSESSMENT: A SYSTEMATIC REVIEW
Authors: Ceccacci A , Hothi H , Khan R , Gimpaya N , Chan B , Forbes N , James P D , Mosko J , Yeung E , Walsh C M , Grover S C 
Published: February 2024

Abstract

Background
Endoscopic ultrasound (EUS) encompasses a range of diagnostic and therapeutic procedures that require technical, cognitive, and non-technical skills. The implementation of competency-based frameworks in endoscopic education has emphasized trainee assessment based on predefined milestones, rather than procedure volume. Observational assessment tools with strong validity evidence are needed to achieve this goal.

Aims
To systematically identify and evaluate observational competency assessment tools employed in EUS using an established validity framework. The secondary aim is to evaluate the educational utility of assessment tools.

Methods
We searched three databases (MEDLINE, EMBASE, and Evidence-Based Medicine Reviews) and the grey literature from inception to May 2023. Messick’s unified framework was used to evaluate validity evidence based on content, response process, internal structure, relations to other variables, and consequences. Each domain was scored from 0 to 3 with a maximum score of 15 points. Educational utility was evaluated using the Accreditation Council for Graduate Medical Education Standards considering ease of use, ease of interpretation, resources required, and educational impact. Study quality was assessed using the Medical Education Research Quality Instrument.

Results
Our search identified 2081 records. We screened 44 full texts and included 5 observational EUS assessment tools from 10 studies. All 5 tools are formative assessments, with 4 employed in clinical settings and one in a simulated setting. All tools use Likert rating scales and are rater-based, with 2 having additional self-assessment components. Validity evidence scores ranged from 3 to 13, with the EUS Assessment Tool (EUSAT), Global Assessment of Performance and Skills in EUS (GAPS-EUS), and The EUS and ERCP Skills Assessment Tool (TEESAT) scoring highest, with 10, 11, and 13 points, respectively. Overall educational utility was high across studies given ease of tool use. The TEESAT had the strongest educational impact considering its influence on credentialing and competence thresholds. Study quality was high overall, with scores ranging from 9.5 to 12 (maximum 13.5 points). Inter-rater agreement for validity evidence and educational utility scoring was substantial (k=0.73, raw agreement 80%) and almost perfect (k=0.92, raw agreement 96%), respectively.

Conclusions
The EUSAT, GAPS-EUS, and TEESAT demonstrate the strongest validity evidence for observational competency assessment of EUS and are easy to implement in educational settings. Future work should investigate barriers to implementation and evaluate utility of these tools for summative assessment.

EUS Observational Competency Assessment Tool Validity Evidence Scores

Funding Agencies
None
A79 PATIENT AND PHYSICIAN PERSPECTIVES ON IMPLEMENTION OF BEDSIDE INTESTINAL ULTRASOUND FOR THE ASSESSMENT OF INFLAMMATORY BOWEL DISEASE
Authors: Chan R , Stewart M , Jones J 
Published: February 2024

Abstract

Background
New tools for evaluating Inflammatory Bowel Disease (IBD) activity and complications are needed to deliver timely disease management and improve patient outcomes. Point of care (POC) intestinal ultrasound (IUS) is safe, inexpensive, and less invasive compared to standard endoscopy and imaging.

Aims
To evaluate the implementation of POC IUS within an ambulatory IBD clinic at the QEII Health Sciences Center.

Methods
This was a retrospective evaluation of a cohort of patients who had undergone IUS within the Nova Scotia Collaborative Inflammatory Bowel Diseases Clinic (NSCIBD) between January 18, 2023 and August 13, 2023. Medical records were reviewed retrospectively. Patient demographics, disease-related characteristics, perceived impact of IUS on need for endoscopy, perceived impact of IUS on IBD management, and clinical utility of IUS were collected. Surveys were administered prospectively to referring care providers and patients following IUS. Patient surveys assessed IUS satisfaction, acceptance of other methods to assess IBD activity, whether IUS improved knowledge of illness, and impact on quality of life (QoL).

Results
One physician completed 107 IUS exams on 92 patients at the NSCIBD clinic over a nine-month period. Of 92 patients, 47 (51%) were male and 78 (85%) had Crohn’s disease. 53 patients provided an email and consented to survey participation. 34 responses were submitted (64%). There were 97 responses (91%) from 12 referring gastroenterology specialist clinicians.
Ninety-three percent of responses show IUS reports were very helpful (60%) or somewhat helpful (33%). More than a third (37%) of IUS exams were reported to delay or prevent the need for endoscopic evaluation, and 34% were reported to prompt a therapeutic change.
Of available tools, IUS had the highest proportion of patients who felt it was completely acceptable (77%), compared to colonoscopy (41%), stool sampling (50%), blood tests (71%), and computed tomography/magnetic resonance imaging (47%). Most (89%) indicated IUS caused either no discomfort (68%) or little discomfort (21%), with no patient reporting a lot of discomfort. Some patients (41%) reported that IUS improved their understanding of their illness, and 38% believe it improved their QoL.

Conclusions
POC IUS offers an accurate, less invasive option for monitoring IBD activity compared to traditional investigations. There is limited data on implementation of, and patient and clinician perspectives regarding use of IUS and its clinical implications. Even early in implementation, POC IUS has clear benefits. This study suggests that IUS is highly acceptable to patients for investigating/monitoring their illness. Treating clinicians find significant value in IUS and report that it can prevent the need for endoscopic evaluation and prompt changes in therapeutic management.

Funding Agencies
None
A81 GASTROINTESTINAL (GI) FEATURES OF HYPERMOBILE EHLERS-DANLOS SYNDROME (HEDS) AND HYPERMOBILITY SPECTRUM DISORDER (HSD): A SCOPING REVIEW
Authors: Chang N , Borovsky D , Yuan Y , Armstrong D 
Published: February 2024

Abstract

Background
Ehlers-Danlos syndromes (EDS) are a varied group of hereditable connective tissue disorders (HCTD) typified by skin, joint and vascular features, along with less well-recognized features of chronic pain, immunological dysfunction and chronic GI symptoms.
The latest EDS classification (2017) lists 13 EDS types and 19 genetic factors but there is no identified genetic basis for hEDS, the most common type and the most-commonly associated with GI symptoms. There is a need for robust data on the prevalence of GI symptoms and diagnoses in hEDS and HSD.

Aims
To investigate the extent of evidence on GI symptom prevalence and methods used to establish GI diagnoses in patients with hEDS and HSD.

Methods
Following the JBI (Joanna Briggs Institute) guide for scoping reviews, a systematic search of Ovid Medline, Embase and Cochrane Library retrieved scoping and systematic reviews, published in English (1974 – Sept 2023), reporting GI symptom prevalence, assessment and complications in EDS or HSD. Abstracts of identified papers were reviewed by NC & DB and discrepancies resolved by YY & DA. As a scoping review, it required no statistical comparisons.

Results
Duplicate screening of 410 abstracts yielded 10 papers that met inclusion criteria: 1 scoping and 9 systematic reviews. Four systematic reviews reported GI surgical issues related to vascular EDS; none was evaluated further. Two papers reported, specifically, on GI symptoms in patients with postural tachycardia syndrome or eating disorders, some of whom had hEDS or HSD and two papers reported on multiple GI and non-GI symptoms associated with fibromyalgia or functional somatic symptoms. The final 2 papers reported on multiple GI and non-GI symptoms in patients with HSD or multiple EDS types, limited in the latter case to papers published after the latest EDS classification (2017). In general, GI symptoms were characterised as IBS-like symptoms (Rome III or Rome IV) or as typical GI symptoms but without using a validated symptom questionnaire.

Conclusions
There are few data on GI symptom prevalence in hEDS or HSD and no standardised methods for identifying or characterizing GI symptoms or function in hEDS. The evaluation of GI function and symptoms in EDS is hampered by the absence of a definitive genetic or diagnostic test for hEDS or HSD and by changes in EDS classification over the last 50 years.
There is a need for targeted systematic reviews of the prevalence of various GI symptoms in hEDS individuals and of relevant diagnostic methods, to guide further research into the causes of GI dysfunction in hEDS or HSD.

Funding Agencies
None
A85 PERCEIVED FOOD INTOLERANCES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE COMPARED TO HEALTHY CONTROLS
Authors: Dang R , Boron D , Linton J , Mundra P , Narula N , Caminero A 
Published: February 2024

Abstract

Background
Inflammatory bowel disease (IBD) patients commonly exhibit food intolerance. However, the precise dietary triggers and mechanistic pathways responsible for food intolerances are unknown. The characterization of the main offending foods in intestinal inflammation could guide targeted dietary interventions in IBD management.

Aims
To examine self-reported food intolerances in IBD participants compared to healthy controls.

Methods
IBD participants (18-75 years old with a confirmed ulcerative colitis (UC) or Crohn’s disease (CD) diagnosis) were recruited from the Gastroenterology clinic at McMaster University from August 2021 to September 2023. Healthy controls (18-75 years old with medical condition) were recruited through recruitment posters at McMaster University. Participants completed questionnaires pertaining to self-reported food intolerances, gastrointestinal rating symptoms, demographic information, and past medical conditions.

Results
A total of 80 IBD participants (48 CD and 32 UC) and 26 controls completed the questionnaires. We found that IBD participants (88% CD and 90% UC) reported at least one food intolerance compared to controls (30%). The mean number of food intolerances IBD participants reported was 3 (SD=1.78). The most common adverse reactions were reported to dairy (60% CD and 63% UC), wheat (37% CD and 40% UC), peanuts/tree nuts (27% CD and 25% UC), caffeine (27% CD and 25% UC) and fiber (22% CD and 28% UC). The rates of intolerances to all of the food groups were higher than reported by controls. The most common symptoms include discomfort (75% CD and 50% UC), bloating (66% CD and 62% UC), diarrhea (62% CD and 56% UC) and pain (56% CD and 37% UC) when consuming offending foods. About half of IBD participants had these symptoms before their diagnosis and 30% reported worsening of intolerances after their IBD diagnosis.

Conclusions
Our current findings reveal that IBD participants commonly report food intolerances that are associated with symptomatology. Common offending foods include dairy, wheat, peanuts/tree nuts and caffeine. IBD participants commonly experience discomfort, bloating and diarrhea when eating offending foods, which can persist after diagnosis. Ongoing studies will provide insights into the relationship between stool bacterial composition and food intolerance symptoms.

Funding Agencies
CCC