bluuebunny/crossref_metadata_2025_split huggingface dataset:
A206 DUPILUMAB TREATMENT REDUCES THE FREQUENCY OF DYSPHAGIA DAYS AND ACTIONS TO RELIEVE DYSPHAGIA IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS (EOE): RESULTS FROM THE PHASE 3 LIBERTY EOE TREET STUDY
Authors: Dellon E , Hirano I , Chehade M , Fugere N , Sun X , Pela T , Durrani S , Jacob-Nara J A , Radwan A , Tilton S T , McCann E 
Published: February 2024

Abstract

Background
Dysphagia is the predominant symptom of EoE in adolescents and adults.

Aims
To assess change in number of days with dysphagia, number of days with action taken to relieve dysphagia, and change in pain associated with dysphagia in patients receiving dupilumab 300 mg once weekly (qw) vs placebo in LIBERTY EoE TREET.

Methods
Dysphagia Symptom Questionnaire (DSQ) score (range 0–84) was calculated from daily responses over 14 days for Q2 (frequency) and Q3 (severity); Q4 (pain) was separately assessed (range 0–56). Higher scores indicate a worse outcome. Inclusion criteria required patients to have a baseline DSQ score ≥10. Number of days with dysphagia (Q2), action taken to relieve dysphagia (Q3), and pain (Q4) were analyzed at baseline and Week (W) 24 for the placebo-controlled study parts (A and B). P-values are nominal.

Results
81 patients enrolled in Part A (dupilumab/placebo: n=42/39) and 159 in Part B (n=80/79). Mean number of days with dysphagia was similar with dupilumab vs placebo at baseline, but lower in the dupilumab group at W24 (Figure). Mean [SD] change from baseline (dupilumab vs placebo) was –6.5 [3.78] vs –3.9 [4.61], Pampersand:003C0.05 in Part A, and –7.8 [4.24] vs –4.7 [4.02], Pampersand:003C0.0001 in Part B. Mean [SD] number of days with any action taken to relieve dysphagia was similar in the dupilumab vs placebo group at baseline (Part A: 7.3 [3.76] vs 8.2 [3.82]; Part B: 9.5 [3.53] vs 8.7 [3.85]) but lower (numerically) in the dupilumab group at W24 (Part A: 3.6 [3.73] vs 5.7 [4.78]; Part B: 3.0 [3.84] vs 5.3 [4.69]). At W24, numerically fewer days with more severe dysphagia (need to cough/gag, vomit, or seek medical attention to relieve dysphagia) occurred with dupilumab vs placebo. Baseline DSQ pain score was similar in dupilumab vs placebo groups. Least squares mean [95% CI] change from baseline at W24 in DSQ pain score was −10.1 [–12.2, –7.9] vs −4.4 [–6.8, –2.0] for dupilumab vs placebo in Part A (difference vs placebo: −5.7 [95% CI −8.67, –2.72]; P=0.0002), and −10.0 [–11.7, –8.1] vs −6.5 [–8.3, –4.6] in Part B (difference vs placebo: −3.5 [95% CI −5.90, −1.03]; P=0.0053).

Conclusions
At W24, patients in the dupilumab 300 mg qw group experienced fewer days with dysphagia, fewer days with any action taken for dysphagia relief, and less pain associated with dysphagia vs placebo.

Funding Agencies
Research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.
A207 SLING-FIBER PRESERVATION DURING POEM IS AN INDEPENDENT FACTOR IN REDUCING POST-POEM GERD SYMPTOMS: A CANADIAN SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Fujiyoshi Y , Fujiyoshi M , Khalaf K , May G , Teshima C 
Published: February 2024

Abstract

Background
Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM procedure. Preservation of the sling-fiber during POEM was reported to reduce post-POEM GERD in Japan, but there are no reports of this technique in a western population.

Aims
The aim is to investigate the association of sling-fiber preservation during POEM and post-POEM GERD symptoms at our institution, which is a large therapeutic endoscopy referral center in Canada.

Methods
This is a retrospective, single-center study of patients who underwent POEM from October 2017 to January 2023 at our center. The initial cohort of patients were treated by conventional POEM until June 2021, after which a second cohort underwent POEM with sling-fiber preservation, as the techniques advanced. The primary outcome was the rate of positive GERD symptoms after POEM. The secondary outcomes were clinical success rate, adverse events rate, use of PPI at follow-up. Multivariate regression was performed to identify factors that reduce post-POEM GERD symptoms.

Results
148 POEM cases (52.5±15.6y/o, female:61(43%)) were included in this study. There was no significant difference in patient characteristics between the groups. The mean procedure time (108.6±34.5 vs 109.1±45.7 min, P=0.93) and rate of adverse events (20% vs 18%, P=0.85) were similar between the traditional and modified groups. In the sling fiber preservation group, gastric myotomy length was significantly longer (2.2±0.7 vs 1.6±0.8 cm, Pampersand:003C0.05) yet the GERD symptom rate at follow-up was significantly lower (22% vs 42%, Pampersand:003C0.05), although PPI use was similar (52% vs 48%, P=0.73). The clinical success rate was similar between groups (88% vs 84%, P=0.6). Regression analysis indicated that, after adjusting for other risk factors of post-POEM GERD, sling-fiber preservation during POEM had an odds ratio of 0.24 (95%CI:0.07-0.85, Pampersand:003C0.05) for post-POEM GERD symptoms.

Conclusions
Sling-fiber preservation during POEM effectively reduces post-POEM GERD symptoms, despite a longer gastric myotomy length. It stands as a independent factor in reducing post-POEM GERD symptoms. Hence, sling-fiber preservation may be a beneficial solution for reducing post-POEM GERD symptoms in Western populations.
Outcomes of conventional POEM and sling-fiber preservation POEM
POEM; Peroral endoscopic myotomy, SD; standard deviation, GERD; gastroesophageal reflux disease, PPI; proton pump inhibitor

Funding Agencies
None
A210 ESOPHAGEAL SQUAMOUS PAPILLOMATOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Gilhotra R , Zarrin A , Jiang S X , Xiong W , Shahidi N 
Published: February 2024

Abstract

Background
Squamous papillomatosis is a rare benign epithelial finding, generally found incidentally in the distal esophagus. The pathophysiology is not well understood but felt to be secondary to reflux and chemical irritation leading to leukoplakia and verrucous hyperplasia of the epithelium and papilloma formation.

Aims
To present a case of esophageal squamous papillomatosis after endoscopic submucosal dissection (ESD) and radiofrequency ablation (RFA) of Barrett’s esophagus (BE) and early esophageal cancer.

Methods
Case report and review of the literature

Results
A 78-year-old male with C3M3 BE and previous band mucosectomy for nodular dysplasia was referred for ESD of an early esophageal cancer. ESD was successfully performed, with histopathology identifying a low-risk well-differentiated intramucosal adenocarcinoma without lymphovascular invasion and negative margins. Radiofrequency ablation was performed 3-months post-resection for residual BE. Subsequent surveillance gastroscopy 6 months post-resection identified extensive fleshy pink granulation tissue at the ESD scar, histopathology revealing SP. This was confirmed on subsequent repeat gastroscopy and biopsy. Compliance with double dose proton pump inhibitor therapy was confirmed.

Conclusions
To our knowledge, this is the first reported case of SP developing post-ESD and RFA; further expanding our knowledge of potential Barrett’s endotherapy-related adverse events.

Funding Agencies
None
A212 SYMPTOMS IN PATIENTS WITH NORMAL ESOPHAGEAL MOTILITY MAY DIFFER BASED ON AGE AND SEX
Authors: Kim D R , Woo M 
Published: February 2024

Abstract

Background
High resolution esophageal manometry (HREM) is used to diagnose esophageal motility disorders. While esophageal symptoms including dysphagia are common and seen in up to 20% of adults, a minority of symptomatic patients have esophageal dysmotility, when defined by the Chicago Classification v4 (CCv4). The generation of esophageal symptoms in a patient with normal esophageal motor function is complex, but may relate to visceral hypersensitivity, inappropriate pain perception or unidentified contraction abnormalities. The Esophageal Symptom Questionnaire (ESQ-30) is a validated tool in the assessment of esophageal symptoms and measures the frequency and severity of dysphagia, reflux and globus through three separate sub-scales (ESQ-D, ESQ-R, ESQ-G respectively).

Aims
To determine age and sex in esophageal symptoms (as measured by ESQ-30 sub-scales) in a population of symptomatic patients with normal esophageal motility.

Methods
Retrospective analysis of consecutive reports from HRM studies performed between October 2021 – March 2023 who provided consent for inclusion in the motility databank and completed ESQ-30 questionnaires. All values expressed as median (IQR: 25-75-centile). Spearman’s bivariate correlations were performed between ESQ-D, ESQ-R, ESQ-G and manometric variables (IRP, DCI, % failed, and % weak) as well as demographic variables (age). Group means were compared with the non-parametric Mann-Whitney U test.

Results
Within the study period, 681 patients underwent HREM and had complete ESQ-30 questionnaires. Of these patients, 151 female and 73 male participants (mean age 51.8 +/- 15.2 years) had normal esophageal motility by CCv4. ESQ-D and ESQ-R scores were significantly higher in women in comparison to men. ESQ-D was 10 in women and 5 in men (p=.021), and ESQ-R was 28 in women and 19 in men (p=.029). There was a weak negative correlation between age and reflux symptoms (R2 -.139, p = 0.038). There was no significant difference in manometric parameters between males and females (p ampersand:003E .05 for all comparisons). Dysphagia and globus weakly negatively correlated with median IRP (R2 -.156, p = .019 and R2 -.139, p = .038 for dysphagia and globus respectively).

Conclusions
In a population of symptomatic patients with normal esophageal motility, symptom profile differed based on age and sex. Women had higher dysphagia and reflux symptoms compared to men, while older patients had lower reflux symptoms. These findings suggest that esophageal sensitivity may vary with age and sex in patients with normal esophageal motility.
The finding of higher dysphagia and globus symptoms in patients with lower median IRP (integrated relaxation pressure) is an unexpected finding and may reflect reflux effect. Further studies to assess for the impact of GERD (using 24h pH-metry/MII) on patients with normal esophageal motor function are warranted.

Funding Agencies
None
A213 DUPILUMAB EFFICACY IN EOSINOPHILIC ESOPHAGITIS PERSISTS FOR HISTOLOGIC, SYMPTOMATIC, AND ENDOSCOPIC OUTCOMES REGARDLESS OF CONCOMITANT HIGH-DOSE PROTON PUMP INHIBITOR USE
Authors: Rothenberg M , Dellon E , Bredenoord A J , Martire E , Sun X , Laws E , Mortensen E , Maloney J , Glotfelty L , Shabbir A 
Published: February 2024

Abstract

Background
Proton-pump inhibitor (PPI) therapy is the most commonly used first-line therapy for eosinophilic esophagitis (EoE) but data informing long-term outcomes are limited.

Aims
This pre-specified analysis of data from the phase 3 LIBERTY EoE TREET (NCT03633617) study assessed the efficacy of weekly dupilumab vs placebo in patients (pts) with and without concomitant PPI use.

Methods
Pts with peak intraepithelial eosinophil (eos) count ≥15 eos/high-power field (hpf) after ≥8 weeks’ high-dose PPI were randomized to dupilumab or placebo. Pts on high-dose PPIs at screening remained on a high-dose regimen during the treatment period; switching of PPI types was permitted but new initiation of PPIs was prohibited. Endpoints at Week 24 were: proportion of pts achieving ≤6 eos/hpf, absolute change from baseline in Dysphagia Symptom Questionnaire (DSQ) score, % change in peak eos count, absolute change in Endoscopic Reference Score (EREFS) and Histologic Scoring System (HSS) grade/stage scores.

Results
In Parts A and B, respectively, 61.9% and 71.3% of pts in the dupilumab group and 64.1% and 72.2% in the placebo group were using PPIs at randomization. For pts treated with dupilumab vs placebo in Parts A and B, respectively, ≤6 eos/hpf was achieved by 69.2% (95% confidence interval [CI] 48.2–85.7) vs 8.0% (95% CI 1.0–26.0) and 59.6% (95% CI 45.8–72.4) vs 7.0% (95% CI 2.0–17.0) of pts using PPIs, and by 43.8% (95% CI 19.8–70.1) vs 0% (95% CI 0–23.2) and 56.5% (95% CI 34.5–76.8) vs 4.5% (95% CI 0.1–22.8) of pts not using PPIs. Least squares mean change from baseline in DSQ score for dupilumab vs placebo was –18.5 vs –12.9 and –21.8 vs –14.0 for pts using PPIs in Parts A and B, respectively, and –27.8 vs –3.8 and –28.4 vs –13.3 for those not using PPIs (Figure 1). Dupilumab improved outcomes vs placebo for secondary endpoints, with comparable results in pts with and without concomitant PPI use. Absolute change from baseline in EREFS score is shown in Figure 1. Dupilumab was generally well tolerated.

Conclusions
Dupilumab improved histologic, symptomatic, and endoscopic aspects of EoE in adults and adolescents, up to 24 weeks, regardless of concomitant high-dose PPI use.

Figure 1. Effect of dupilumab 300 mg qw versus placebo on primary endpoints (A) proportion of patients with peak esophageal intraepithelial eosinophil count of ≤6 eos/hpf (B) absolute change from baseline in DSQ total score at Week 24 (C) absolute change from baseline in EREFS total score at Week 24, by concomitant PPI use
CI, confidence interval; DSQ, Dysphagia Symptom Questionnaire; EREFS, endoscopic reference score; eos, eosinophils; hpf, high-power field; LS, least squares; PPI, proton pump inhibitor; pt, patient; qw, once weekly; SE, standard error.

Funding Agencies
Research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.
A215 DEFINING THE MODERN GLOBAL INCIDENCE AND PREVALENCE OF EOSINOPHILIC ESOPHAGITIS IN POPULATION-BASED STUDIES
Authors: Ray C M , Buhler K , Ma C 
Published: February 2024

Abstract

Background
Eosinophilic esophagitis (EoE) is an immune-mediated condition that results in esophageal dysfunction. Previous research demonstrated a marked increase in both incidence and prevalence of EoE globally, associated with a concomitant increase in type 2 inflammatory diseases. A previous meta-analysis suggested that the pooled prevalence of EoE was 34.4 cases/100,000 population and the incidence was 6.6 cases/100,000 person-years, but this analysis included only studies conducted to 2018.

Aims
To assess the current global incidence and prevalence of EoE, through systematic review and meta-analysis of population-based studies.

Methods
Electronic databases (Medline and Embase) were searched to February 22, 2023. Abstracts were screened, and full texts were reviewed for inclusion in meta-analysis. Original population-based studies published after 2018 that reported the incidence or prevalence of EoE in adults or children were included. Meta-analysis of incidence and prevalence rates, reported per 100,000 person-years or per 100,000 population, respectively, were pooled using a random-effects model. Heterogeneity was quantified using the I2 statistic.

Results
A total of 1916 unique reports were identified, and abstracts were reviewed. 129 full texts were read, and 21 reports met inclusion criteria for population based, incidence and prevalence studies. The pooled global incidence of EoE was 8.43 cases per 100,000 person-years [95% CI: 6.52, 10.34] (I2=99%) (Figure 1). The incidence was similar in adult and pediatric subgroups. The pooled global prevalence of EoE was 68.0 cases per 100,000 population [95% CI: 37.5, 123.4] (I2=99%).

Conclusions
The incidence and prevalence of EoE in recent studies is higher than that previously published. The prevalence of EoE is anticipated to compound, given that this is a disease typically diagnosed in young patients without an associated increased risk of mortality.

Funding Agencies
None
A216 MODERATE TO SEVERE ACUTE UPPER GASTROINTESTINAL BLEEDING IN RURAL NORTHERN ONTARIO: AN EPIDEMIOLOGICAL ANALYSIS OF AETIOLOGIES, GEOGRAPHIC LIMITATIONS, AND OUTCOMES
Authors: Saunders M , Savage D , Zezos P 
Published: February 2024

Abstract

Background
Hospitalizations for upper gastrointestinal bleeds (UGIBs) are resource-demanding as they often require blood transfusion, endoscopy, and intensive care unit admission. Referral centers that provide higher levels of care to remote regions treat illnesses, including UGIB, in much later stages of disease and of higher severity. The Thunder Bay Regional Health Sciences Center (TBRHSC) is a referral center servicing over 250,000 people over a geographically expansive region of Northern Ontario. Despite known barriers to accessing care, little data is currently available to guide our understanding of UGIB aetiologies, severity, and outcomes among patients living remotely in Canada.

Aims
This retrospective study aimed to evaluate epidemiological data among patients with UGIB at TBRHSC.

Methods
Of 441 patients with a discharge diagnosis of gastrointestinal hemorrhage from 2016–2022, inclusion criteria were met for 333. Patients under 18 y or with lower GIB were excluded. Patients were classified as regional if their primary address was outside the District of Thunder Bay.

Results
Patients were highly comorbid (median CCI = 5) and presented with a median (IQR) GBS of 9 (6) and Clinical Rockall Score of 3 (1). Of those who received inpatient endoscopy (n=248), findings included erosive gastritis (21%), gastric ulcer (14%), esophagitis (12%), duodenal ulcer (8%), AVM (7%), and variceal (6%). No definite lesion was observed in 62 patients (22%). The median (IQR) Complete Rockall Score was 4 (2) with major stigmata of recent hemorrhage found in 20%. There was a high prevalence (19%) of cirrhosis, of which 83% had a history of liver decompensation. In 49% of cirrhotic patients, culprit lesions did not include portal hypertensive gastropathy or variceal bleeding. Regional patients accounted for 14% of the population and travelled an average of 424 km to seek care at TBRHSC. Regional patients were younger and required more ICU admissions (p=0.01). ICU admission primarily due to UGIB was 5.4% and all-cause thirty-day mortality was 3.3%. Oral anti-coagulation use prevalence was 43.2% and was associated with a longer length of stay (pampersand:003C0.0001), higher proportion of all-cause 30-day mortality (pampersand:003C0.005). Forty-eight patients did not receive endoscopy due to bleeding stability, palliation, and preference.

Conclusions
Patients with UGIB at TBRHSC are a highly multimorbid population with a significantly burden of anticoagulant use, cirrhosis, and variceal bleeding. Comparative analysis with metropolitan centers will expand our understanding for providing UGIB care in Northern Ontario.

Funding Agencies
NOAMA
A217 EVALUATING PREDICTIVE SCORING AND OUTCOMES OF PATIENTS DISCHARGED HOME FROM THE EMERGENCY DEPARTMENT WITH UPPER GASTROINTESTINGAL BLEEDING
Authors: Saunders M , Jones M , Lawlor C , Savage D , Zezos P 
Published: February 2024

Abstract

Background
Upper gastrointestinal bleed (UGIB) is a common emergency department (ED) presentation. The Glasgow-Blatchford Bleeding Score (GBS) is a validated tool for predicting UGIBs requiring admission for endoscopic evaluation. Utilization of GBS in Northern Ontario EDs may help risk stratify UGIB to decrease return to care.

Aims
This study aimed to evaluate factors and outcomes of patients discharged from the ED with suspected UGIB.

Methods
A total of 1,139 charts were identified with an ICD-10 ED diagnosis of gastrointestinal hemorrhage from 2016-2022. Of these, 92 charts met inclusion criteria. Patients admitted to hospital from the index ED visit, who were below the age of 18 years at the time of presentation, or with clinically suspected lower gastrointestinal hemorrhage were excluded. Patient were further grouped by place of residence if their primary address was within Thunder Bay city limits or not.

Results
There were 48 males (52%) with a median age of 58.7 (IQR 32.2) at presentation with UGIB to ED. The median (IQR) Charlson Comorbidity Index (CCI) and GBS were 3 (5) and 3 (6), respectively. The odds ratio for returning to the ED and being admitted for UGIB within sixty days was 4.07 times greater for patients from the region compared to Thunder Bay residents (95% CI 1.28–12.97). GBS was found to be significantly greater (p=0.048, Mann-Whitney U-Test) among seven patients who underwent emergent endoscopy from the ED and were discharged home. In univariate K-M survival analysis, the mean survival time to hospital admission at sixty days was 45 days among those with a presenting GBS score of ampersand:003E3, compared to 57 days when GBS was 3 or less (pampersand:003C0.005, log rank Mantel-Cox). After adjustment for age, sex, place of residence, and CCI, there was a 17% increase in the expected hazard for hospital admission at sixty days for each point increase in GBS (95% CI 1.03–1.34). Similarly, the expected hazard for follow-up hospital admission was 2.95 times higher (95% CI 1.11–7.85) in patients living outside Thunder Bay travelling to seek care. There were no statistically significant hazards identified between age, sex, or CCI and hospital admission (Cox proportional hazards model, p=0.001). Of patients admitted to hospital within sixty days of ED discharge (n=17), the median length of stay was five days with 56% requiring blood transfusion and 83% receiving endoscopy.

Conclusions
Higher GBS scores and residence outside of Thunder Bay increase the likelihood of revisit and admission to hospital for UGIB following ED discharge. Future research will aim to compare outcomes among larger urban centers.

Funding Agencies
NOAMA
A220 MORTALITY IN PATIENTS WITH ULCERATIVE COLITIS UNDERGOING COLECTOMY (2016-2020)
Authors: Ahmed N S , Krawchuk S , buhler k , Stukalin I , Besney J , Shaheen A , Seow C , Novak K , Ingram R , Lu C , Kaplan G G , Panaccione R , Ma C 
Published: February 2024

Abstract

Background
Despite an expanding armamentarium of medical treatment options, the 10-year cumulative risk of colectomy for patients with ulcerative colitis (UC) remains 5-10%. Surgery for UC is associated with a substantial burden of mortality. A previous meta-analysis of population-based studies found that postoperative mortality was 0.7% of patients undergoing elective surgery and 5.3% of patients undergoing emergent colectomy.

Aims
Given improvements in managing acutely ill patients with UC, we aimed to evaluate contemporary rates of postoperative mortality following colectomy.

Methods
We analyzed data in the National Inpatient Sample (NIS) for 2016-2020. The NIS is an all-payer administrative health database, capturing information from ampersand:003E7 million inpatient admissions at ampersand:003E1000 hospitals across the United States annually. All analyses were weighted to account for the complex stratified survey design. Adult patients (≥18 yrs) with a primary diagnosis of UC undergoing colectomy were identified with ICD-10 coding. Rates of in-hospital postoperative mortality were calculated, and predictors of mortality were evaluated in survey-adjusted logistic regression.

Results
A total of 8570 hospitalizations for patients with UC undergoing colectomy were included. Mean age at colectomy was 44.5 years and 47% of patients were female. Emergency colectomy was performed in 38.2% [95% CI: 35.9%, 40.7%] of patients, and was attempted laparoscopically in 55.9% [53.1%, 58.7%]. Overall mortality from 2016-2020 was 1.2% [0.8%, 1.9%], but was 0.2% [0.1%, 0.8%] for elective surgery and 2.9% [1.9%, 4.5%] for emergent surgery. Stratified rates of mortality are summarized in Table 1. In multivariable analysis, age was not an independent predictor of mortality but laparoscopic surgery (adjusted odds ratio 0.24 [0.06-0.98], p=0.047) and elective resection (aOR 0.16 [0.04-0.68], p=0.01) were associated with a lower risk of postoperative death.

Conclusions
Approximately 1 in 100 patients undergoing colectomy for UC will die postoperatively. This risk is highest in comorbid patients undergoing open laparotomy or emergency colectomy. The risk of mortality in both emergent and elective settings is lower than previously reported.
Table 1. Stratified risks of mortality after colectomy for ulcerative colitis

Funding Agencies
None