bluuebunny/crossref_metadata_2025_split huggingface dataset:
A202 INVESTIGATION OF THE DIRECT EFFECT OF HEMIN-HEMOPEXIN AND HAPTOGLOBIN STIMULATION IN INFLAMMATORY BOWEL DISEASE
Authors: Ajayi A S , Hajjar R , Oliero M , Cuisiniere T , Gerkins C , Fragoso G , Calve A , Vennin-Rendos H , Santos M M 
Published: March 2023

Abstract

Background
Inflammatory bowel disease (IBD) is a global health issue defined by persistent intestinal epithelial inflammation resulting in bleeding, and it is one of the major risk factors of colorectal cancer (CRC). Hemin is an activator of heme-oxygenase and has anti-inflammatory, cytoprotective, and antiapoptotic properties by stimulating hemopexin and haptoglobin production. Hemopexin and haptoglobin are scavenging proteins with high affinity for hemin and hemoglobin, and are activated by interleukin (IL)-22.

Purpose
To evaluate the protective role of hemin through the stimulation of hemopexin and haptoglobin in experimental acute colitis.

Method
Mice were preconditioned with hemin by intraperitoneal injection with 5mg/kg body weight of hemin for three days while control mice were treated with PBS. Colitis was induced by giving 2.5-3% dextran sulfate sodium (DSS) in drinking water for 12 days. The disease activity index (DAI) was determined by daily monitoring of body weight, fecal bleeding and stool consistency. At the end of the experiment, liver, feces, serum and colon samples were harvested for the evaluation of fecal levels of hemopexin, fecal haptoglobin, IL-22, IL-22BP, IL-6 and TNF-α. Fecal microbiota composition will be determined using 16S rRNA sequencing.

Result(s)
We found that hemin treatment resulted in the presence of hemopexin and haptoglobin in fecal samples, where they may exert a protective role and influence the growth of pathobionts able to acquire iron using heme and hemoglobin as sources.

Conclusion(s)
The findings from this study will contribute to the understanding of the possible protective role of hemopexin and haptoglobin in ulcerative colitis.

Please acknowledge all funding agencies by checking the applicable boxes below
CIHR

Disclosure of Interest
None Declared
A209 ASSESSMENT OF OUTCOMES OF PATIENTS ADMITTED WITH ACUTE, SEVERE ULCERATIVE COLITIS ON ESTABLISHED BIOLOGIC THERAPY: A SINGLE CENTRE RETROSPECTIVE ANALYSIS
Authors: Sabrie N , Jogendran M , Jogendran R , Targownik L 
Published: March 2023

Abstract

Background
Acute, severe, ulcerative colitis (ASUC) is associated with a high morbidity and mortality. Current guidelines recommend the initiation of high dose intravenous steroids, followed by anti-TNF therapy if a satisfactory therapeutic response is not rapidly achieved. However, guidelines are agnostic on how to manage patients who are admitted for ASUC despite being on established biologic therapy. Furthermore, short-term clinical outcomes in this population are not well characterized.

Purpose
The aim of this study is to assess the differences in short-term clinical outcomes in patients admitted with ASUC who are on established biologic therapy compared to those not on established biologic therapy.

Method
We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until December 2021. Patients were included if they were deemed to have a severe flare, defined as having 6 or more loose bowel movements per day with at least one of the following features: temperature of 38.0 Celsius, tachycardia, anemia, or elevated inflammatory markers. Included subjects were considered to be on established biologic therapy if they had a biologic within 56 days prior to admission, all other admitted subjects were included as controls. Our primary outcome was the difference in hospital length of stay (HLOS). We also contrasted duration of intravenous steroids, rates of surgical consultation, rates of in-hospital colectomy, and readmission rates within 90 days of discharge.

Result(s)
130 charts were included in our study, 53 of which were patients on established biologic therapy, and 77 of which were patients not on established biologic therapy. The HLOS between the two groups was not significantly different, (7.23 days [established biologic therapy] vs.7.47 days [not on biologic therapy], p value = 0.77). Patients on established biologic therapy were more likely to receive an inpatient surgical consultation (33.96% vs 7.79%, p-value &lt;0.001). However, rates of colectomy prior to discharge were not statistically different (1.89% vs 0%, p-value = 0.23). Patients on established biologic therapy were significantly more likely to be readmitted within 90 days of discharge (30.19% vs 12.99%, p-value = 0.016).

Image

Conclusion(s)
Although there were no differences in HLOS and colectomy rates between the 2 groups, patients with ASUC on established biologic therapy were more likely to be readmitted within 3 months of discharge. Further work is required to define optimal medical management of persons admitted with ASUC who are failing biologic therapies.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared
A212 THE IMPACT OF COMBINED MEDICAL AND SURGICAL TREATMENT FOR PERIANAL CROHN’S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Fung M , Farbod Y , Kankouni H , McCurdy J 
Published: March 2023

Abstract

Background
Multidisciplinary care involving surgical drainage via examinations under anesthesia (EUA) and anti-tumor necrosis factor (TNF) therapy is recommended for perianal Crohn’s disease (PCD). However, the impact of this combined modality approach is not well-established.

Purpose
To determine the impact of combined modality (surgical and anti-TNF) vs. single modality (either surgical or anti-TNF) therapy on fistula healing in perianal Crohn’s disease.

Method
MEDLINE, EMBASE, and Cochrane databases were searched systematically from inception through September 15, 2022 independently in duplicate. We included studies that reported on fistula outcomes after treatment with combined modality vs. single modality therapy for PCD. Surgery was defined as EUA ± seton or closure procedure. Weighted summary estimates with 95% CI were estimated by random effects models. Study quality was determined using an adapted version of the Newcastle-Ottawa scale.

Result(s)
Thirteen studies met inclusion criteria. The total population included 1279 patients: 685 patients treated with single modality therapy with either surgical or anti-TNF therapy and 594 patients treated with combined modality therapy. Patients treated with combined modality therapy were more likely to achieve fistula healing compared to single modality therapy (65.4% vs. 57.7%; OR 1.68; 95% CI 1.03-2.73, p = 0.04) (Figure 1a). In a subgroup analysis, the rates of fistula healing were higher with combined modality therapy than with surgical therapy alone (OR 2.34; 95% CI 0.85-6.46, p = 0.10) but not anti-TNF therapy alone (OR 1.19; 95% CI 0.78-1.81, p = 0.43), although neither comparison was statistically significant (Figures 1b and c). The majority of studies were rated low-quality due to risk of bias from uncontrolled confounding variables.

Image

Conclusion(s)
Limited high-quality evidence suggests that fistula healing occurs more frequently in patients treated with combined modality therapy. However, the benefit of a combined modality approach appears to be driven mainly by anti-TNF therapy. Further prospective randomized trials are needed to confirm these findings.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared
A221 EFFECT OF PROXIMITY TO A SPECIALTY TERTIARY CENTRE ON OUTCOMES IN INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED RETROSPECTIVE COHORT STUDY
Authors: Mikail M , Alkhateeb Q , Pope V , Khanna R 
Published: March 2023

Abstract

Background
The etiology of inflammatory bowel disease (IBD) is unknown; however, developed nations such as Canada ranking amongst the highest worldwide. With many diseases patients in urban and rural areas have different access to care and resources.

Purpose
To describe the differences in outpatient healthcare utilization, use of biologic agents and complication of IBD based on proximity to a tertiary health care centre.

Method
A retrospective cohort study was conducted comparing IBD patients seen in IBD clinics at affiliated with Western University in London, Canada between August 2019 – December 2019. IBD patients were compared on their use of outpatient healthcare utilization, biologic agents and IBD complications based on their proximity to a tertiary care centre (&gt;100 km and &lt;100 km). Patients residing &gt;100 km from a tertiary centre were termed “rural” while &lt;100 km from a tertiary centre were termed “urban.” Retrospective chart review occurred over a six-month period between January to June 2021.

Result(s)
A total of 481 were reviewed. Of those, 97 (UC, n=29; CD, n=68) and 95 (UC, n=30; CD, n=65) met inclusion for the urban and rural groups respectively. Patient demographics were similar between the two groups except IBD disease location with pancolitis seen more commonly in urban patients compared to ileocolonic in rural patients (urban, n=39; rural, n=34). IBD patients in both groups had similar number of appointments (urban, n=20.1 ± 13.8; rural, n=17.5 ± 12.1) and endoscopic procedures (urban, n= 4.9 ± 3.1; rural, n= 4.7 ± 3.2) with their gastroenterologists. More urban patients were managed with no therapy for their IBD (urban, n=16; rural, n=5). A higher rate of rural patients were managed with biologics (urban, n=56; rural, n=66) and combination therapy (urban, n=16; rural, n=27). The most common related IBD-related complications were IBD flares (urban, n=55; rural, n=60), intestinal strictures (urban, n=25; rural, n=34), intestinal obstructions (urban, n=10; rural, n=23) and rectal/genitourinary fistulas (urban, n=6; rural, n=21). Similar numbers of intra-abdominal surgery were seen between both groups with partial bowel resection (urban, n=13; rural, n=12) and right hemicolectomy (urban, n=10; rural, n=18) as the predominant surgery in urban and rural patients, respectively.

Conclusion(s)
This study demonstrated outpatient healthcare utilization when attending specialty gastroenterology appointments and outpatient endoscopies were numerically similar in rural and urban patients. IBD patient residing further from a tertiary care centre were numerically more likely to be managed with biologics and combination therapy. However the dataset is small and generalizations cannot be made.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared
A222 EFFECT OF CLINICAL FACTORS ON IBD TREATMENT RESPONSE: FINDINGS FROM A NOVEL SINGLE CENTER PATIENT REGISTRY
Authors: Lavalle C , Khanna R , Asfaha S 
Published: March 2023

Abstract

Background
Inflammatory bowel disease (IBD), comprising both Crohn’s disease as well as ulcerative colitis, has shown heterogenous response to therapy. Over the past decades, targeted biologic therapies have become the mainstay of treatment. Even with the rapid pace of progress in this field, roughly a third of patients do not show an initial response to these treatments. The ability to accurately predict treatment response to therapy would both improve patient safety and satisfaction as well as decrease costs from ineffective therapies.

Purpose
The primary aim of this project is to identify clinical factors predictive of disease response to induction biologic therapy in inflammatory bowel disease through the creation of a novel single center patient registry.

Method
Initially, a single center tissue biopsy registry of IBD patients receiving colonoscopy was created. Retrospective clinical data was subsequently collected on patients identified to have initiated or changed biologic therapy after entry into the registry. Clinical data regarding age, sex, comorbidities, lifestyle factors, time since initial diagnosis, extra intestinal manifestations, serum markers, prior IBD treatments, planned treatment, clinical response, as well as endoscopic response were collected. A Pilot study of the first 30 patients identified was undertaken. Individual clinical factors were compared between patients with a documented clinical response to biologic therapy and non-responders at the group level as well as by biologic therapy initiated.

Result(s)
No statistically significant differences in collected clinical data parameters were observed between treatment responders and non responders in aggregate as well as when sub selected by individual biologic therapy initiated, bio-naive status, and steroid dependence.

Conclusion(s)
This project has demonstrated that clinical factors alone do not adequately predict disease response in inflammatory bowel disease. Future work will expand this data registry to further clinical factors and continue patient enrolment. Next steps also include the addition of tissue level data, in particular tissue level RNA data. It is hoped that these parameters, either individually or in combination, will provide a robust and accessible predictor of response to biologic therapy in inflammatory bowel disease.

Please acknowledge all funding agencies by checking the applicable boxes below
Other

Please indicate your source of funding below:
Western University Department of Medicine

Disclosure of Interest
None Declared
A243 THROMBOELASTOGRAPHY-GUIDED COAGULOPATHY CORRECTION IN CIRRHOTIC PATIENTS DECREASES BLOOD PRODUCT TRANSFUSION: A SYSTEMATIC REVIEW AND ANALYSIS
Authors: Komeylian H , Ching C , Zhu J 
Published: March 2023

Abstract

Background
Patients with cirrhosis are a risk factor for coagulopathy and bleeding complications. Thromboelastography (TEG) guided therapy is available to rapidly assess and guide blood product transfusion in this population.

Purpose
This study aims to determine if TEG-guided therapy is able to decrease the administration of blood products and reduce adverse events such as bleeding and mortality compared to standard coagulation testing (SCT).

Method
We performed a systematic review and meta-analysis of literature in PubMed, EMBASE, and The Cochrane Library and pooled six randomized-controlled trials comparing thromboelastography versus standard coagulation testing in patients with cirrhosis. A total of six studies were pooled (n= 386). Primary outcomes were mean platelet transfusion units and fresh frozen plasma (FFP) transfusion units. Secondary outcomes were mortality and bleeding events.

Result(s)
Compared to SCT, there was a significant standard mean decrease in platelet (P&lt;0.00001) and FFP (P&lt;0.00001) administration compared to TEG perioperatively prior to a liver transplant. However, there was no significant difference in the pooled odds ratio between TEG and SCT in patients receiving both platelets and FFP (OR 1.40 [95% Cl 0.61-3.23, P=0.42]). Recurrent variceal bleeding was significantly reduced in the TEG group compared to SCT for platelet transfusion (OR 0.05 [95% Cl 0.01-0.20, P&lt;0.0001]) or FFP transfusions (OR 0.18 [95% Cl 0.05-0.63, P=0.007]). With regards to the 5-day, 28-day, 42-day, and 90-day mortality, there was no significant difference between the pooled odds ratio between the TEG and SCT groups (OR 0.69 [95% Cl 0.47-1.02, P=0.06]). The 24-hour, 48-hour, 5-day, and 42-day rebleeding rates were significantly lower in TEG versus SCT groups (OR 0.50 [95% Cl 0.29-0.85, P = 0.01)].

Conclusion(s)
The use of TEG-guided therapy favors a reduction in platelet and FFP transfusion compared to SCT in patients with cirrhosis. Additionally, TEG-guided therapy is able to improve patient care by reducing the rebleeding rate of patients with cirrhosis compared to SCT. However, this same effect was not seen for mortality.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared
A244 SIMILAR RISK OF INCIDENT HEPATOCELLULAR CARCINOMA IN IMMIGRANTS/REFUGEES WITH HEPATITIS B CIRRHOSIS REGARDLESS OF THEIR REGION OF ORIGIN
Authors: Wang P , Djerboua M , Flemming J 
Published: March 2023

Abstract

Background
In Canada, over 75% of new immigrants/refugees come from HBV-endemic areas. Whether the risk of hepatocellular carcinoma (HCC) in immigrants/refugees with HBV cirrhosis is associated with their region of origin has not been reported.

Purpose
The aim of our study was to describe the epidemiology of HCC in foreign-born individuals with HBV cirrhosis stratified by region of origin.

Method
Population-based retrospective cohort study using administrative healthcare data in Ontario, Canada. Recent immigrants/refugees with HBV (sAg+ or DNA+) and cirrhosis from 2000–2017 were identified and stratified by World Bank region of origin by linkage to the Immigration, Refugees and Citizenship Canada Permanent Resident Database. Individuals were followed until HCC, death, liver transplant, or end of study (2020). The 1-, 5-, and 10-year cumulative incidences (CI) of HCC were calculated. Using adjusted competing risks regression, the subdistribution hazard ratios (sHR) for HCC were calculated with region of origin as the main exposure where death/LT were competing events.

Result(s)
4,438 immigrants/refugees were included (64% male, median age 47 years [IQR 37–56], 72% Asia/Pacific, 9% South Asia, 6% Sub-Saharan Africa, 3% Latin America/Caribbean, 7% Europe/Central Asia, 3% Middle East/North Africa) with 430 (10%) developing incident HCC over a median of 7.9 years (IQR 4.5-11.7). Age at HCC diagnosis was lowest in those from Sub-Saharan Africa (53 years IQR [44-58]). Overall, the annual incidence of HCC was 1.14/100 person-years. The CI of HCC at 1-, 5-, and 10 years was highest in those from Latin American/Caribbean (6.8%, 10.3%, and 13.1%), East Asia/Pacific (4.5%, 7.7%, 10.3%) and South Asia (4.0%, 7.2%, 10.3%). After adjusted competing risk regression (Table), decompensated cirrhosis (sHR 2.5; 95% CI 1.7–3.5), male sex (sHR 2.2; 95% CI 1.7–2.7), and age (sHR 1.05, 95% CI 1.04–1.06) were independently associated with HCC, while region of origin was not.

Conclusion(s)
Among immigrants/refugees with HBV cirrhosis, HCC is associated with male sex, older age, and decompensated cirrhosis but not with their region of origin. Efforts ensuring timely detection and evaluation of HBV in immigrants/refugees with a goal to prevent development of decompensated cirrhosis and provide early detection of HCC should be aggressively pursued regardless of their region of origin.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared
A251 NON-ALCOHOLIC FATTY LIVER DISEASE AT A CANADIAN TERTIARY CARE CENTRE: RISK FACTORS AND SEVERITY OF DISEASE
Authors: Klemm N K , Zhu K , Jaffer A , Ramji A , Mohajerani A 
Published: March 2023

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide with an increasing prevalence of 25-40%. Although the prevalence increases to 57.5-74% in obese patients, lean individuals also develop NAFLD. Patients are commonly asymptomatic and the diagnosis is often incidental or when progressed to cirrhosis. Once fibrosis has developed, the risk of cardiovascular and liver-related death increases exponentially. The increasing prevalence of NAFLD presents significant healthcare and economic consequences.
The severity of NAFLD and its risk factors have been studied in various countries, which guide decisions on screening and management. Similar studies have not been performed in Canada.
Purpose: To determine the severity of NAFLD in a tertiary care centre and associated risk factors.

Method
Retrospective review of patients with NAFLD diagnosed on ultrasound, or fibroscan from January 1, 2019 to December 31, 2021. Patients were 18 years or older and were excluded if they had co-existent liver disease, significant alcohol use or CAP &lt;238. CAP and fibrosis scores were determined using transient elastography. Chi-square and multivariate analysis were performed for statistical analysis.
Result(s): A total of 583 patients were included in the study; 312 (53.5%) were male and the mean age was 54.04 years. The majority of cases, 317 (56.8%), were diagnosed by ultrasound or CT scan and only 30 (5%) patients had a known family history of NAFLD. Lean-NAFLD (L-NAFLD) was present in 83 (15.2%) patients, overweight NAFLD (OW-NAFLD) 220 (40.2%), obese-NAFLD (OB-NAFLD) 206 (37.7%) and morbidly obese-NAFLD (MB-NAFLD) 38 (6.9%).
The prevalence of T2DM was 28.6%, dyslipidemia 37.4%, hypertension 35.5%, coronary artery disease 6.2% and obstructive sleep apnea 6.7%. Risk factors for Stage 3 steatosis (CAP&gt;290) included BMI&gt;30 (2.84) and type 2 diabetes (OR 2.45), but not dyslipidemia, hypertension, age or gender. Type 2 diabetes, dyslipidemia, hypertension, BMI, gender and age were not significantly predictive of moderate steatosis (CAP 260-289).
The proportion of patients with transient elastography scores of F2, F3, and F4 were 16.0%, 7.7%, and 11.0%, respectively. F2 and F3 scores were associated with T2DM (OR 1.94), BMI &gt; 30 (OR 1.83, p&lt;0.05) and age &gt;60 (OR 1.90, p&lt;0.05), but not dyslipidemia or hypertension. F4 scores were significantly associated with age &gt; 60 (OR 1.89), T2DM (OR 2.60), dyslipidemia (OR 1.79), hypertension (OR 1.86) and BMI&gt;30 (OR 2.54).

Conclusion(s)
Diabetes and BMI were associated with severe steatosis and fibrosis. Dyslipidemia and hypertension were only associated with advanced fibrosis. Our study demonstrates challenges in identification of early NAFLD given that metabolic syndrome factors were not associated with mild to moderate steatosis.

Please acknowledge all funding agencies by checking the applicable boxes below
None

Disclosure of Interest
None Declared