bluuebunny/crossref_metadata_2025_split huggingface dataset:
A160 A CASE OF BREAST CANCER METASTASIS MASQUERADING AS SIGNET RING CELL ADENOCARCINOMA OF THE STOMACH
Authors: Stephenson E , Zeman-Pocrnich C , Sey M 
Published: February 2024

Abstract

Background
Gastric cancer has a poor prognosis, particularly at advanced stages. Endoscopic submucosal dissection (ESD) can be used to treat selected early-stage gastric cancers. This case study explores the challenge of diagnosing and managing patients when metastatic lesions mimic primary gastric cancer, as seen in this case of breast cancer metastasis resembling signet ring cell adenocarcinoma of the stomach.

Aims
The aim of this case report is to describe an unusual case of breast cancer metastasis to the stomach identified unexpectedly on random gastric biopsies, initially diagnosed as a primary gastric signet ring cell adenocarcinoma.

Methods
Clinical and pathological records of the described patient were reviewed retrospectively. Furthermore, a review of the relevant literature was also performed.

Results
A 68 year-old-woman underwent gastroscopy for nausea and vomiting. Her past medical history was remarkable for bilateral mastectomies ten years ago for invasive lobular carcinoma, with metastatic bone disease diagnosed by imaging five years prior. She had been well controlled on letrozole taken intermittently due to side effects. At endoscopy, while the stomach appeared grossly normal, random biopsies done for Helicobacter pylori identified a single focus of signet ring cell adenocarcinoma. Subsequent chromoendoscopy identified an area of subtle mucosal abnormality for which the patient declined surgery and was instead managed by ESD which surprisingly yielded no dysplasia. A follow up gastroscopy with random biopsies also failed to identify any areas of dysplasia, but random biopsies on a subsequent gastroscopy again identified a minute focus of adenocarcinoma with signet ring cell morphology. Given the unusual presentation of apparent signet ring cell adenocarcinoma in two distinct areas in the stomach without any visible endoscopic abnormality an in-depth pathological analysis was conducted. By immunohistochemistry the tumor cells stained positive for Estrogen Receptor, GATA3, and CK7 and negative for antibodies targeting CK20 and CDX2, which supported an interpretation of minute multifocal breast cancer metastases to the stomach from hematogenous spread.

Conclusions
In this case, repeated endoscopic investigations and immunohistochemical staining revealed minute multifocal breast cancer metastases to the stomach. Conventional tumor staging methods often cannot identify microscopic metastases, potentially impacting disease progression and patient care. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis allowed for the correct diagnosis in this patient.

Funding Agencies
None
A165 MALIGNANT TUMORS OF THE SMALL BOWEL DIAGNOSED BY DOUBLE BALLOON ENTEROSCOPY: A FIFTEEN-YEAR EXPERIENCE OF A MEDICAL CENTER IN MID-TAIWAN
Authors: Wu Y , Chou J 
Published: February 2024

Abstract

Background
The malignant tumors of the small bowel are relatively rare, and their pre-operative diagnosis is usually difficult

Aims
This study was aimed to investigate the clinical characteristics of patients with malignant small bowel tumors who underwent double balloon enteroscopy. Secondary end points were to evaluate the usefulness and safety of double balloon enteroscopy for the diagnosis of patients with suspected small bowel tumors derived from other previous procedures.

Methods
From January 2008 to June 2023, we retrospectively analyzed consecutive patients who underwent double balloon enteroscopy at a medical center in mid-Taiwan over a 15-year period (Figure 1).

Results
Double balloon enteroscopy were performed in 1001 patients. Small bowel tumors were diagnosed in 141 patients (141/1001; 14.1%), of which 76 patients (53.9%) (43 males, a mean age of 61.89 years) had malignant tumors : 37 had gastrointestinal stromal tumors (49.4%), 16 had adenocarcinoma (20.8%), 10 had metastatic cancer (13.1%), 7 had lymphoma (9.2%), 3 had angiosarcoma (3.9%), 2 had carcinoid (2.6%), and 1 had desmoid tumor (1.3%) (Figure 2).
The indications for double-balloon enteroscopy in patients with malignant small bowel tumors were obscure gastrointestinal bleeding (68.4%). The concordance rate of diagnoses based on double balloon enteroscopy with diagnoses based on small bowel barium study, computed tomography, and capsule endoscopy among patients with small bowel tumors was 54.1%, 65.9% , and 76.9%, respectively. (Figure 3, 4) .
Therapeutic plans were changed to surgery in 67.1 % of patients with malignant small bowel tumors.
Additionally, treatment was added on chemotherapy in 25.6% of patients with malignant small bowel tumors after the results of double-balloon enteroscopy.

Conclusions
Approximately 14.1% of patients who underwent double balloon enteroscopy had small bowel tumors, 53.9% of small bowel tumors are malignant. The most common indication for double balloon enteroscopy in patients with malignant small bowel tumors was obscure gastrointestinal bleeding. Double balloon enteroscopy is a very useful modality in diagnosing malignant small bowel tumors and has an important impact on therapeutic plans and clinical results.

Figure 1. The Prevalence Rate of Small Bowel Tumor
Figure 2. Malignant tumor
Figure 3. Location Distribution of Small Bowel Tumors
Figure 4. The clinical manifestations of Malignancy Tumors

Funding Agencies
None
Intestinal Disorders
A168 RATES OF CLOSTRIDIOIDES DIFFICILE INFECTIONS REQUIRING HOSPITALIZATION DURING THE COVID-19 PANDEMIC
Authors: Besney J , Buhler K , Kaplan G G , Lu C , Seow C , Novak K , Panaccione R , Ma C 
Published: February 2024

Abstract

Background
Clostridium difficile infection (CDI) is the most common cause of nosocomial infectious diarrhea and is associated with a substantial burden of morbidity and mortality. Most cases of CDI are acquired through health care setting contacts, where appropriate infection prevention and control (IPC) measures such as contact isolation and proper hand hygiene have been demonstrated to prevent horizontal transmission.

Aims
We aimed to evaluate whether there was a reduction in CDI-related hospitalizations during the COVID-19 pandemic when an increased emphasis was placed on maintaining IPC measures.

Methods
We analyzed data from the National Inpatient Sample (NIS) between January 2018 and November 2020. The NIS is the largest publicly available administrative health database in the United States, capturing ampersand:003E7 million hospital admissions annually. All analyses were weighted for the complex survey design of the NIS. Temporal trends in monthly admissions for patients with CDI defined using International Classification of Disease 10th revision codes and excluding patients with established CDI carrier status were evaluated using joinpoint regression. Changes over time were expressed as monthly percent change (MPC). To establish whether temporal changes were related to a reduction in CDI or whether these were more generalized effects due to the pandemic, we compared these temporal trends to rates of hospitalizations for inflammatory bowel disease (IBD) and stroke.

Results
A total of 1,501,415 CDI admissions were identified. The mean age was 64.6 years and 54.2% of patient’s were female. 4.5% of admissions for CDI were associated with in-hospital mortality. Trends in hospitalization are summarized in Figure 1. Compared to the pre-pandemic period (January 2018-December 2019) CDI-related hospitalizations decreased by 9.1%/month [95% CI: -19.2%, +2.0%] (p=0.12) in early 2020 (January-March 2020). This reduction was not sustained: hospitalizations subsequently increased by +8.0% [95% CI: -4.0%, +21.6%] (p=0.19) in mid-2020 (April-June 2020) and were stable after July 2020 (MPC -0.9% [95% CI: -3.5%, +1.7%], p=0.48). Similar patterns were observed for both IBD and stroke-related hospitalizations. Total hospitalizations per month for CDI were similar by June 2020 as compared to the year preceding the pandemic.

Conclusions
Although an initial decrease in the rates of CDI hospitalizations were seen early in the pandemic (January-March 2020), this pattern was similarly seen for other chronic and acute conditions, and this has not been sustained long-term.

Figure 1. Rates of CDI admissions (2018-2020)

Funding Agencies
None
A173 WHAT HAS CHANGED IN THE DIAGNOSIS OF CELIAC DISEASE IN CANADIANS OVER THE PAST 25 YEARS? RESULTS FROM THE STATE OF CELIAC IN CANADA SURVEY 2022
Authors: King J A , McAulay C , Secord M , Pinto-Sanchez M , Turner J , Gidrewicz D , Case S , Duerksen D 
Published: February 2024

Abstract

Background
Prior surveys of Canadians with celiac disease (CD) have demonstrated several challenges on the path to diagnosis. It has been over a decade since findings from the most recent survey were published.

Aims
To compare the experiences of Canadian individuals prior to CD diagnosis across time.

Methods
The State of Celiac Disease in Canada Survey is an online, nationwide survey distributed by Celiac Canada in December 2022. Over 75 questions were included, covering diagnostic pathways, presenting symptoms, and involvement of health care professionals (HCPs). Analysis was restricted to those who responded to having CD, dermatitis herpetiformis, or gluten ataxia, as well as provided the time since their diagnosis.

Results
A total of 6052 participants were included: 1210 (20.0%) were diagnosed in the last two years, 1113 (18.4%) two to five years ago, 1136 (18.8%) five to 10 years ago, 1040 (17.2%) 10 to 15 years ago, 960 (15.9%) 15 to 25 years ago, and 593 (9.8%) more than 25 years ago. Diarrhea was reported in over 70% of respondents diagnosed over 25 years ago, compared to approximately 50% diagnosed in the last five years (Figure 1A). Conversely, 31% of individuals diagnosed over 25 years ago experienced brain fog compared to 57% of those diagnosed in the last two years. Approximately 25% of respondents diagnosed at least 15 years ago experienced symptoms for more than 20 years prior, compared to 15% of those diagnosed in the last two years (Table 1). There were no clear differences in the proportion of respondents who saw a family physician before diagnosis, but there was a drop in those consulting a gastroenterologist (60% diagnosed more than 25 years ago versus 43% diagnosed in the last five years, Figure 1B).

Conclusions
Over time, there has been a shift in the clinical presentation of celiac disease, which may reflect improved detection of cases without gastrointestinal symptoms. Delays in diagnosis remain a concern but have also improved over time. The phenomenon of fewer patients consulting with gastroenterologists requires further investigation to understand the cause and impact on accurate diagnosis.
Delays in diagnosis across time since diagnosis
Note: 496 respondents did not report time from symptoms to diagnosis

Symptoms experienced (A) and healthcare professionals consulted (B) prior to diagnosis

Funding Agencies
Celiac Canada (FKA Canadian Celiac Association)
A176 RESTORATION OF IMPAIRED MICROBIOTA-MEDIATED ARYL HYDROCARBON RECEPTOR SIGNALING IN PATIENTS WITH CELIAC DISEASE BY ORAL TRYPTOPHAN SUPPLEMENTATION: AN EXPLORATORY STUDY
Authors: Kirtikar U , Rueda G H , Szeto J , Galipeau H , Constante M , Wang X , Pinto-Sanchez M , Armstrong D , Bercik P , Verdu E 
Published: February 2024

Abstract

Background
Celiac disease (CeD) is an autoimmune condition driven by gluten in individuals expressing celiac-specific genes (HLA-DQ2 and/or DQ8). A strict gluten-free diet (GFD) is currently the only treatment. 30-40% of celiac patients exhibit persistent symptoms despite following a GFD ampersand:003E1 year and are considered non-responsive. Tryptophan is an essential amino acid metabolized by gut microbiota to produce indoles that activate aryl hydrocarbon receptor (AhR), contributing to intestinal barrier homeostasis. Our previous study showed CeD patients have altered tryptophan metabolism and limited AhR activation, only partially improving with a GFD. In healthy volunteers, oral tryptophan supplementation improved AhR activation in the small intestine, thus, indicating its feasibility as adjuvant to the GFD in non-responsive CeD.

Aims
The study aims were to: 1) determine whether tryptophan supplementation improves celiac specific symptoms in non-responders; and 2) if tryptophan supplementation modifies gut microbiota composition, intestinal indole production and AhR activity.

Methods
The study is a double-blind, randomized, placebo-controlled trial with the aim to recruit 50 adults from the McMaster University Celiac Clinic. At visit 1, consented participants are randomized 1:1 to L-tryptophan (3g/day) or placebo and receive intervention capsules to be taken for 3 weeks after Visit 2. At Visits 2 and 3, participants complete dietary and symptom questionnaires, provide blood, stool, and urine samples, and undergo endoscopy. The primary outcome, improvement in symptoms, is assessed using the Celiac Symptoms Index (CSI); general GI symptoms by Gastrointestinal Symptoms Rating Scale (GSRS); mood symptoms by Hospital Anxiety and Depression Scale (HADS); quality of life by Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life questionnaire (PAGI-QoL).

Results
To- date we have recruited 10 participants. We will present blinded results from participants that have completed the study at the time of presentation based on responses to questionnaires pre, and post tryptophan/placebo intervention. At the time of analysis of this abstract, 5 participants had completed the study showing reduced CSI scores post intervention. The GSRS was also significantly reduced post intervention however, no change was observed in HADS and PAGI-QoL.

Conclusions
As all these results are currently blinded, we cannot attribute the symptom improvement to either tryptophan or the placebo effect. After unblinding the data, we will analyze the data to determine the extent of symptom reduction in relation to tryptophan metabolites (from urine, stool and duodenal aspirates) and AhR activation (from duodenal biopsy samples).

Funding Agencies
Weston Family Foundation
A177 AUTOIMMUNE ENTEROPATHY – AN UNCOMMON CAUSE OF MALNUTRITION
Authors: Minhas G S , Bukhari A , Tse F 
Published: February 2024

Abstract

Background
Autoimmune Enteropathy is a rare condition characterized by clinical symptoms of intractable diarrhea, vomiting, and weight loss that often results in malnutrition. It is associated with other autoimmune conditions from primary sclerosing cholangitis to type 1 diabetes and autoimmune thyroid disease. The epidemiology of AIE in adults is not well described. It is detailed more in the pediatric population, particularly early in life, the incidence is estimated at less than 1 in 100,000 infants.

Aims
Aims: To review a case of malnutrition secondary to Autoimmune enteropathy seen at our centre, and review the limited literature for treatment.

Methods
We did a case report presentation on an inpatient seen at our Tertiary care center in Hamilton, Ontario
We reviewed the limited literature regarding treatment of autoimmune enteropathy in adults and modelled our treatment based on this.

Results
We describe the case of a 63-year-old male in Ontario, Canada whereby he was initially diagnosed with ulcerative colitis, but did not respond to therapy – with the final diagnosis being autoimmune enteropathy. He was first consulted to Gastroenterology with colonoscopy consistent with mayo III disease, and biopsies showing chronic active colitis. He did not improve despite 5-ASA compounds, oral steroids, and trials of IV steroids. He underwent multiple admissions for chronic watery diarrhea, and subsequent treatment with IV steroids. He was started on an Infliximab biosimilar with little to no clinical response, and subsequently referral to our centre for evaluation of worsening malnutrition. Our patient’s symptoms mirrored much of what was initially described in the literature in 1985 with significant unremitting diarrhea, and dependence on TPN due to malabsorption. He underwent an EGD which demonstrated villous blunting, and apoptotic bodies – reviewed by a GI-specialized pathologist who found it was consistent with autoimmune enteropathy. His serology testing revealed a weakly positive TTG, HLA testing was completed showed a HLA DQ2 positivity and a gluten free diet was reccomended. His symptoms improved drastically from 10-12 bowels movements daily, to 1-2 daily within two weeks of treatment.
The limited literature surrounding treatment of autoimmune enteropathy was reviewed and the patient was started on oral budesonide in a tapering dose with significant clinical improvement as described in a retrospective case-control study in 2017.

Conclusions
Autoimmune enteropathy is a rare cause of malnutrition in adult patients. It is often associated with other autoimmune conditions, withsmall bowel histology showing villous atrophy, villous blunting, apoptotic bodies, and a relatively low amount of lymphocytic infiltration. The literature on treatment is limited, our patient responded to initial treatment of gluten removal for underlying celiac disease combined with oral budesonide.

Funding Agencies
None
A179 UNDERSTANDING THE NEED FOR A ZINC DIET TO TREAT ZINC DEFICIENCY IN PATIENTS WITH CELIAC DISEASE
Authors: Tandon S , Graham K , Russell L , Morgan J , Armstrong D , Pinto-Sanchez M 
Published: February 2024

Abstract

Background
Nutritional deficiencies in celiac disease (CeD) are caused by delayed intestinal healing and a nutrient-lacking gluten-free diet (GFD). At our specialized adult celiac clinic, zinc (Zn) was the most common deficiency present in patients and is clinically treated through Zn supplementation. However, Zn supplements in excess may cause inhibition of other minerals, and gastrointestinal side effects. Alternatively, a Zn diet may be a sustainable option to treat zinc deficiency, however patient preference regarding this treatment method is unknown.

Aims
To understand patient preference of zinc supplementation compared to a zinc diet to treat Zn deficiency in CeD. We also aim to determine the tolerability and effectiveness of Zn supplements to reduce gastrointestinal and extraintestinal symptoms in the CeD population.

Methods
This observational prospective pragmatic study was conducted from March 2022-September 2023. Eligible participants had bloodwork indicating plasma Zn levels ampersand:003C 9.4 μ/mol . All participants were prescribed 25 mg per day of Zn gluconate supplements throughout the study. Patients were provided a RedCap link where they completed questionnaires at Visit 1 and at their next clinic appointment in 3-6 months (Visit 2). These surveys included; Celiac Symptom Index (CSI) Questionnaire 2) Extraintestinal Symptoms Visual Analogue Scale (ES-VAS) and 3) Patient Perception Survey (PPS). Continuous data are expressed as Mean (SD), and categorical data is reported as frequencies (%). The Wilcoxon test was used to assess changes in symptoms.

Results
A total of 42 participants completed the Visit 1 survey, of which 17 participants had their follow up clinic appointment (Visit 2). Out of these 17 participants, 15 were female (88.2%) and the mean age was 33.7 years (+/- 10.6). The mean CSI score at Visit 1 was 35.3 (+/- 10.3) and 33.7 (+/- 13.0) at Visit 2, indicating moderate disease symptoms (p=0.552). The most common extraintestinal symptoms was anxiety (ES-VAS: 5.7), foggy mind (ES-VAS: 4.1), fatigue (ES-VAS: 4.1) and depression (ES-VAS: 3.5). There were no significant changes in extraintestinal symptoms between clinic visits. Out of 42 participants, 15 (35.7%) prefer to treat their Zn deficiency through diet, 26 (59.5%) through supplement, and 1 (2.4%) of participants had no preference. Additionally, 35 (85.4%) participants indicated that they were “likely” to comply to a Zn-diet treatment.

Conclusions
CeD patients did not experience improvement in gastrointestinal or extraintestinal symptoms on Zn supplementation. However, a portion of CeD patients prefer to treat and are likely to comply with a Zn diet to treat their deficiency. Based on this knowledge, further studies should investigate the efficacy of a Zn diet compared to supplements CeD patients.

Funding Agencies
CIHR
A182 EXPLORING THE LINK BETWEEN SPECIFIC MICROBIAL STRAINS AND ANXIETY AND DEPRESSION IN PATIENTS WITH ULCERATIVE COLITIS
Authors: Chiew B A , Haskey N , Lewis A , Nadeem H , Gold S L , Taylor L M , McCoy K , Ohland C , McGregor K , Raman M 
Published: February 2024

Abstract

Background
Anxiety and/or depression (A/D) have been identified as significant co-morbidities of ulcerative colitis (UC), and even considered as extraintestinal manifestations, with emerging evidence to support the role for gut microbial dysbiosis in the natural history for both UC and A/D. However, there is a paucity of knowledge regarding the specific attributes of the gut bacteriome in individuals with UC with concomitant A/D.

Aims
To explore the connection between the gut bacteriome and A/D in a cohort of patients with UC.

Methods
This cross-sectional study included 29 participants diagnosed with UC either in remission or with mild to severe disease. To test for depression and anxiety, participants completed the Patient Health Questionnaire-8 (PHQ-8) and General Anxiety Disorder-7 (GAD-7) respectively. Participants provided a stool sample for microbiome analysis and the fecal bacteriome was assessed using metagenomic shotgun sequencing.

Results
Among the 29 patients, 55% were female (n=16) and 45% were male (n=13), 34.5 % (n=10) had a Partial Mayo Score over 5 indicating moderate-severe disease activity (median 3, IQR 1-6). Mean age was 38.3 years (± 12.2 years). Sixty-nine percent were on 5-ASA, 42.9% on steroids, 31.0% on Anti-TNF, and 20.7% on immunomodulators. Mean FCP was 976.4 μg/g (± 1589.2). Forty-four percent (n=12) screened positive for anxiety with a median GAD-7 score of 5.0 (IQR: 1-8), while 26% screened positive for depression with a median PHQ-8 of 3 (IQR: 3-10). Principal Coordinate Analysis (PCoA) reveals distinct clustering between UC patients with or without A/D (Figure 1). Regarding the microbial analyses, the log fold change of Firmicutes bacterium CAG:424, Holdemanella biformis, Blautia hansenii, Bifidobacterium pullorum, Anaerostipes caccae, and Ruminococcus gnavus exhibited positive associations with both A/D, whereas Roseburia sp. CAG:303, Prevotella copri, and Bacteroides stercoris demonstrated negative associations. Uniquely, Faecalicoccus pleomorphus and Lachnospira pectinoschiza showed negative associations only with the PHQ-8.

Conclusions
Our research affirms the presence of anxiety and depression in a cohort of UC patients. The severity of A/D measured by the GAD-7 and PHQ-8 were linked to the levels of specific fecal microbes. We introduce several novel species that warrant further examination in UC patients with and without A/D. As this was an exploratory study, the findings need replication in a larger sample size.

PCoA results reveal distinct bacterial clustering patterns between individuals with minimal anxiety/depression (absence) versus those with mild/moderate/severe anxiety and depression as measured by GAD-7 and PHQ-8.

Funding Agencies
None