bluuebunny/crossref_metadata_2025_split huggingface dataset:
A80 DEVELOPMENT OF COMPETENCY BASED MEDICAL EDUCATION CURRICULUM FOR INFLAMMATORY BOWEL DISEASE ADVANCED TRAINING PROGRAM IN CANADA
Authors: Yanofsky R P , Gallinger Z 
Published: March 2023

Abstract

Background
Inflammatory bowel disease (IBD) advanced training programs in Canada are heterogenous in their education, structure, and case exposure, resulting in differences in trainee experience. While competency based medical education (CBME) is becoming the primary educational framework in residency training, there is no CBME-based curriculum for IBD advanced training programs. Adopting a CBME framework for IBD fellowships may help standardize training to increase competence.

Purpose
The purpose of this study was to develop a CBME-based curriculum for IBD advanced training programs in Canada.

Method
Strategic groups consisting of 25 IBD experts were assigned to develop 15 entrustable professional activities (EPAs), which were then refined by experts in medical education and curriculum development. Acceptable EPAs were assessed using an electronically administered round-less Delphi panel. Panel members evaluated each EPA using a Likert scale, which asked participants to consider appropriateness of each EPA for an advanced IBD curriculum. A consensus strength greater than 70% was the acceptable threshold for inclusion into the final curriculum. Milestones were modelled after CanMED roles for each EPA.

Result(s)
Of the 15 initial EPAs, nine were recommended for the roundless Delphi panel by the selection committee: (1) identification, diagnosis, and treatment of new onset IBD; (2) assessment and treatment of outpatients with IBD; (3) the endoscopic evaluation of disease activity and the effective communication of endoscopic findings for patients with IBD; (4) provide effective inpatient management and coordinate transition to outpatient care for patients with IBD; (5) recognize and institute preventive health maintenance strategies in patients with IBD; (6) management and treatment of special populations with IBD; (7) identification, diagnosis, and treatment of the various extraintestinal manifestations of IBD; (8) Engage health care systems to improve the quality of care for patients with IBD; (9) engage in scholarly activities related to IBD. Eight of the nine EPAs achieved a consensus score greater than 70%, with the EPA, ‘engage in scholarly activities related to IBD’ failing to meet this cut-off. Associated milestones were developed for the eight final EPAs.

Image

Conclusion(s)
This study was the first attempt to develop a CBME-based IBD curriculum in Canada. With proper funding and guidance, we hope our model can be implemented across Canada in IBD advanced training programs. These methods may also help facilitate the development of CBME curricula for other advanced training programs.

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

Disclosure of Interest
None Declared
A81 OPTIMIZING THE INDICATIONS FOR BILIARY STENT PLACEMENT IN PATIENTS WITH CBD STONES: A QUALITY IMPROVEMENT INITIATIVE TO ENHANCE PATIENT CARE AND REDUCE HEALTHCARE RESOURCE UTILIZATION
Authors: Alzahrani I , Alhaidari S I S , Alhanaee M , Decanini A , Mohamed M , Zepeda-Gomez S , Mathura P , Zhang J , Sandha G 
Published: March 2023

Abstract

Background
A retrospective chart audit was performed to review biliary stent utilization from January 2020 to 2021 at the University of Alberta Hospital (UAH). Inappropriate stent usage was identified in 16% of patients with common bile duct (CBD) stones presenting for endoscopic retrograde cholangiopancreatography (ERCP). To improve this clinical practice, a quality improvement (QI) initiative was developed and completed.

Purpose
To reduce the number of inappropriately inserted biliary stents in patients with CBD stones.

Method
The results of the chart audit (pre-intervention) were shared with the ERCP group. The QI intervention was to align biliary stent insertion in accordance with published guidelines. A chart audit (post-intervention) was then performed on all ERCPs from July, 2021 to June, 2022. The indication for biliary stent insertion was assessed independently by two blinded reviewers.

Result(s)
A total of 661 patients (337 F) with mean age of 59±19 years (range 12-98 years) underwent 885 ERCPs during this post-intervention period. Of the 661 patients, 384 (58%) were referred for CBD stones. A total of 192 biliary stents (105 plastic, 85 metal) were placed during the first ERCP (192/661, 29%), as compared to the pre-intervention year (223/598, 37%, p=ns). However, only 13/192 stents (7%) were placed not in accordance with published guidelines (kappa=0.53), compared with 63/223 (28%) in the pre-intervention year (p&lt;0.0001). This accounts for a 75% reduction in overall unnecessary stent placement. This reduction was mainly seen in the CBD stone subgroup, where there was an 88% reduction in inappropriate biliary stent placement compared to the pre-intervention year (8/384, 2% vs. 61/376, 16%, p&lt;0.0001).

Image

Conclusion(s)
Education to align practice in accordance with published guidelines has demonstrated a significant improvement in biliary stent insertion during ERCP in patients with CBD stones. This has resulted in significantly fewer inappropriate stent placements, a reduction in unnecessary follow-up ERCPs, and an overall saving of healthcare resources.

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

Disclosure of Interest
None Declared
A82 PREVALENCE AND NON-INVASIVE SCREENING FOR CYSTIC FIBROSIS RELATED LIVER DISEASE IN A COHORT FOLLOWED AT A CYSTIC FIBROSIS REFERENCE CENTER
Authors: Coman D E , Vincent C , Lavoie A , Bilodeau M , Hercun J 
Published: March 2023

Abstract

Background
The reported prevalence of cystic fibrosis (CF) related liver disease (CFLD) varies widely based on diagnostic criteria but reaches up to 40% in some cohorts. Furthermore, its clinical impact is significant as hepatic involvement is the 3rd leading cause of mortality in CF patients and is associated with a lower life expectancy. Due to the heterogeneous clinical presentation of CFLD, clear diagnostic criteria and non-invasive assessment methods are lacking.

Purpose
This study aimed to measure the prevalence of CFLD in a cohort of patients followed at a tertiary CF center.

Method
The files of all patients followed at the CF clinic of the Centre hospitalier de l’Université de Montréal in 2021 were retrospectively reviewed. Imaging reports, histopathology, laboratory values and transient elastography results were assessed. The NIH criteria were used to define CFLD through either presence of one major criteria (abnormal imaging) or two minor criteria (persistently abnormal lab values, hepatosplenomegaly, or transient elastography ≥ 7 kPa).

Result(s)
358 patients were included in our study, 56% male with a median age of 36 years. While mean liver tests were within normal limits (ALT 24 U/L, AST 26 U/L, ALP 96 U/L, GGT 29 U/L), 182 patients (51%) had at least one episode of abnormal liver function tests (LFTs), and 85 patients (24%) had persistently abnormal LFTs. CFLD was present in 42 patients (12%), with 39 patients presenting major criteria and 3 patients presenting minor criteria. In addition, 67 patients (19%) had solely hepatic steatosis. Furthermore, clinically significant portal hypertension and esophageal varices were detected in 50% of patients with CFLD who underwent upper endoscopy (n=20). Median transient elastography value was 5.4 kPa (interquartile range 4.25 kPa) in the 51 patients with exam results, and 32% had values ≥ 7 kPa. Fibroscan values correlated well with the presence of major criteria, with an area under the curve (AUROC) of 0.80 (0.68-0.92, p=0.0007), while non-invasive serological markers did not perform as well (Fib4: AUROC 0.70 (0.59-0.81) and APRI: AUROC 0.69 (0.59-0.80)).

Conclusion(s)
The overall prevalence of CFLD, including hepatic steatosis, was 31% in this cohort. Prompt recognition is important in clinical care in order to prevent hepatic complications from cirrhosis and portal hypertension. The use of Fibroscan seems promising for detecting CFLD.

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

Disclosure of Interest
None Declared
A84 FACTORS ASSOCIATED WITH HIGH LEVELS OF TELEPHONE CARE SATISFACTION AMONG INDIVIDUALS WITH INFLAMMATORY BOWEL DISEASE
Authors: Foncham J N , Rohatinsky N , Fowler S , Peña-Sánchez J N 
Published: March 2023

Abstract

Background
Individuals with inflammatory bowel disease (IBD) require regular medical follow-up with gastroenterology care providers. Individuals in rural areas face barriers in assessing specialized IBD care. Virtual care (VC) may act as a solution. The coronavirus disease 2019 pandemic increased the use of VC, particularly telephone care (TC) appointments in Saskatchewan, Canada. There is limited evidence around the levels and factors associated with satisfaction with TC among individuals with IBD.

Purpose
This study aims to measure satisfaction with TC in individuals with IBD who live in Saskatchewan, Canada, and evaluate the factors associated with TC satisfaction.

Method
A cross-sectional study was conducted among individuals with IBD through an online survey between December 2021 and April 2022 in Saskatchewan. The Telephone Care Satisfaction Questionnaire for individuals with IBD (TCSQ-patient) was a 16-item questionnaire used to measure TC satisfaction on a scale from 1 (very dissatisfied) to 7 (very satisfied). The online survey also included the Quality of Care Through the Patient’s Eyes-IBD (QUOTE-IBD) questionnaire, Short Inflammatory bowel disease questionnaire (SIBDQ), and demographic questions. Factors associated with TC satisfaction were explored using linear regression models. A backward model building strategy was used, and 95% confidence intervals (95%CI) were reported.

Result(s)
In total, 87 individuals with IBD participated in the study. Among the study participants, 54 (64.3%) had Crohn's disease, 53 (61.6%) were female, 60 (69.8%) lived in urban centres, and 37 (43.5%) were between 41-59 years old. The mean satisfaction with TC was 5.70 (SD=0.94). In addition, the means of the QUOTE-IBD and SIBDQ were, respectively, 8.96 (SD=1.70) and 48.14 (SD=13.02). In the bivariate analysis, area of residence (rural vs. urban) and health related quality of life quality (SIBDQ&gt;50 vs SIBDQ&lt;50) were associated with satisfaction with TC, respectively, 0.47 (95%CI 0.02-0.91) and 0.48 (95%CI 0.08-0.88). Adjusting by gender, age group, type of disease, and health care provider managing IBD, we identified that the satisfaction with TC was 0.48 (95%CI 0.02-0.94) higher among individuals with IBD living in rural Saskatchewan in comparison to their urban counterparts.

Conclusion(s)
Individuals living with IBD in Saskatchewan reported high levels of satisfaction with TC. Rural residence is associated with higher levels of TC satisfaction. These results could help in the promotion of TC utilization and improve access to specialized IBD care, especially among those living in rural areas.

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

Please indicate your source of funding;
Saskatchewan Health Research Foundation (SHRF)

Disclosure of Interest
None Declared
A97 LARGE NON-PEDUNCULATED COLONIC POLYP (LNPCP) OUTCOMES REFERRED FOR ENDOSCOPIC RESECTION IN BRITISH COLUMBIA: A QUALITY ASSURANCE INITIATIVE
Authors: Tam L , Akhtar D , Hill E , Jiang S , Ghuman A , Xiong W , Shahidi N 
Published: March 2023

Abstract

Background
Endoscopic resection techniques have become the primary treatment strategy for the vast majority of large (≥ 20mm) non-pedunculated colonic polyps (LNPCPs). Despite this, surgery is still commonly performed with evidence suggesting an increasing trend over time. There is limited Canadian data confirming the effectiveness and safety of an endoscopic management strategy for LNPCPs.

Purpose
To investigate clinical outcomes of patients referred for endoscopic management of a LNPCP.

Method
Retrospective single-centre analysis of patients referred to a single endoscopist for the management of LNPCPs within a tertiary referral practice. LNPCPs were further subdivided into non-complicated (NC-LNPCP) or complicated (C-LNPCP) defined as those involving the ileocecal valve, appendiceal orifice, circumferential or previously attempted. Performance outcomes were evaluated by the frequencies of technical success (removal of all polypoid tissue during index procedure) and need for colorectal surgery. Safety was evaluated by the frequencies of clinically significant intraprocedural bleeding (CSIPB), clinically significant post-endoscopic resection bleeding (CSPEB), intra-procedural perforation and delayed perforation. Recurrence (either endoscopic or histologic) was evaluated at first surveillance colonoscopy (SC1). Continuous variables were summarized using median (IQR). Categorical variables were summarized as frequencies (%). To test for association between categorical variables, the Pearson χ2 or the Fisher exact test were used, where appropriate. For continuous variables, the Mann-Whitney U test was used. A probability (p) value of &lt;0.05 was considered statistically significant.

Result(s)
Between January 2021 to March 2022, 263 LNPCP were referred for endoscopic resection and 41 LNPCP were excluded (23 pedunculated, 14 optical evaluation suggestive of deeply invasive cancer, 4 other). 222 LNPCP (188 NC-LNPCP, 34 C-LNPCP) underwent endoscopic resection. Median size was 25mm (IQR 20-30mm) with the majority undergoing cold snare resection (115, 51.8%). Polyposis (Adenomatous or serrated) was present in 23 (12.6%) cases respectively. Technical success was 97.3%. Cancer was present in 5 (2%). Clinically significant bleeding (CSPEB) occurred in 2.7%, DMI IV in 1.8% and there were no delayed perforations. Recurrence occurred in 4 (3.5%) at SC1 and 11 (5%) required surgery due to technical failure, submucosal invasion on pathology and clinically significant bleeding.

Image

Conclusion(s)
Endoscopic resection as the primary treatment strategy for LNPCPs offers a safe and effective alternative to surgery in British Columbia.

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

Disclosure of Interest
None Declared
A138 SERRATED POLYPOSIS SYNDROME IN INFLAMMATORY BOWEL DISEASE: A SEQUELAE OF CHRONIC DISEASE ACTIVITY OR NEW WHO PHENOTYPE?
Authors: Jiang S X , Xiong W , Shahidi N 
Published: March 2023

Abstract

Background
Serrated polyposis syndrome (SPS) is a growing health concern with up to 1 in 125 universal screening program participants meeting diagnostic criteria. Conversely, SPS in inflammatory bowel disease (IBD) is rarely described in the literature, despite the predisposition for serrated epithelial change and serrated polyps in this population.

Purpose
To describe a case of World Health Organization (WHO) criterion I SPS in a patient with IBD, and discuss the existing literature on this rare occurrence.

Method
Case report and review of the literature.

Result(s)
Case Report
A 53-year-old female with ulcerative colitis (UC; Phenotype: Left-sided; Duration of disease: 40 years; Medical therapy: sulfasalazine) undergoing regular endoscopic surveillance was recently found to have multiple serrated-class lesions including 6 in the sigmoid colon ranging between 8-30mm in size; this included 3 sessile serrated lesions (SSLs) between 20-30mm removed by piecemeal cold snare resection without complication and 2 residual large SSLs for staged endoscopic resection. No endoscopic disease activity was appreciated (Mayo 0), with histopathology of the sigmoid colon and rectum demonstrating chronic inactive colitis.
Literature Review
From 2008 to 2021, there are eleven reported cases of SPS in IBD. Six patients had UC and most were in remission for several decades at the time of SPS diagnosis. Most SPS cases met WHO criteria and fit within described phenotypes. While the case above meets WHO criterion I for SPS, the presence of large distal lesions is atypical, raising the question of whether chronic disease activity contributed to the development of these serrated lesions, given the known predisposition for serrated epithelial change and serrated lesions in patients with colonic IBD.

Image

Conclusion(s)
SPS in patients with IBD is rare. Questions remain about the role of chronic disease activity contributing to the formation of serrated lesions, its clinical relevance, and optimal management strategy.

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

Disclosure of Interest
None Declared
A140 ECTOPIC SPLEEN PRESENTING AS A GASTRIC SUBMUCOSAL LESION
Authors: Balubaid I , Almudaires A , Sey M 
Published: March 2023

Abstract

Background
Accessory spleen is ectopic splenic tissue which can be either congenital or acquired. It is usually an asymptomatic incidental finding. In the context of known malignancy, accessory spleen can be mistaken for metastasis.

Purpose
Here, we share a case of ectopic spleen presenting as a gastric subepithelial lesion post splenectomy. Rare cases have been reported in the literature.

Method
Case Report and Literature Review

Result(s)
Case:
A middle age male with history of splenic rupture secondary to a motor vehicle accident and metastatic renal cancer was found to have a gastric subepithelial lesion on endoscopy. Endoscopic ultrasound (EUS) revealed a subepithelial mass coming off the submucosa or muscularis mucosa of the gastric wall with intact muscularis propria. EUS-guided core biopsy was performed and demonstrated splenic tissue

Conclusion(s)
Splenic tissue should be considered in the differential diagnosis when assessing gastric subepithelial tumors even in the context of previous trauma to the spleen. In addition, EUS-guided core biopsy may be required to rule out metastatic disease.

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

Disclosure of Interest
None Declared
ESOPHAGEAL, GASTRIC & DUODENAL DISORDERS
A199 BIOFILMS IN THE APPENDIX AND OTHER NON-INFLAMED SECTIONS OF THE COLON IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASES
Authors: Arjomand Fard N , Bording-Jorgensen M , Webb J , Veniamin S , Cheng C , Perry T , Wine E 
Published: March 2023

Abstract

Background
Biofilms, aggregated bacteria colonizing the extracellular polymeric substances matrix, are associated with the mucosa of inflammatory bowel diseases (IBD) patients with some studies showing a mean density of the mucosal biofilms 2-fold higher in IBD patients than in controls. The appendix, which is a highly immune organ, seems to be involved in IBD pathogenesis.

Purpose
In this study we aimed to evaluate biofilms in the appendix and other non-inflamed regions of the colon in pediatric IBD patients. We hypothesized that biofilms composed of pathobionts in these sections could drive inflammation in IBD patients.

Method
Tissues from the appendix, peri-appendicular region, cecum, and ascending colon (ASC), collected from the resected colons of 9 pediatric IBD patients and one pediatric non-IBD patient, preserved in methanol Carnoy’s solution were processed and paraffin embedded. Combined fluorescence in situ hybridization (FISH) for biofilms (probe: EUB338) and immunofluorescence (IF) mucin staining (MUC2) identified biofilms and their location. Biofilm formation capacity of culturable bacteria (identified through 16S DNA Sanger sequencing) from these sections was measured. Interleukin (IL)-8 (pro-inflammatory chemokine) and IL-10 (anti-inflammatory cytokine) expressions were assessed by tissue qPCR.

Result(s)
FISH demonstrated biofilms in these sections, in close proximity to epithelial cells. We used a biofilm formation assay to assess the ability of the identified bacteria from these sections to form biofilms, illustrating their potential to colonize and evade host defense and potential antibiotics. We found that Enterococcus avium has a significantly higher ability to form biofilms than the negative control. IL-8 and IL-10 both had the highest expression level in the appendix and peri-appendicular region and the lowest in the ASC among all the patients, suggesting an active immune response. Mechanistic experiments are in progress to investigate the type of bacteria involved in the biofilms and their effects on the gut barrier integrity.

Conclusion(s)
Biofilms adjacent to the epithelium, especially in the appendix and peri-appendix, could interact with or invade epithelial cells. The elevated chemokine transcript level in the appendix could reflect the recruitment of immune cells to this section following bacterial invasion, resulting in the activation of the immune system. Identifying the bacteria involved in the biofilms and clarifying their characteristics will aid us in developing novel microbe-altering treatment strategies or personalized medicine.

Disclosure of Interest
None Declared
A206 SYNERGISTIC EFFECTS OF HISTAMINE AND PROTEASES IN VISCERAL HYPERSENSITIVITY
Authors: Gilmour D A , Jimenez Vargas N , Omar A , Vanner S , Lomax A , Reed D 
Published: March 2023

Abstract

Background
Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain. Previous work has shown IBS fecal supernatants (FS) increase the excitability of nociceptive neurons compared to healthy volunteer FS. Altered production of intestinal mediators, including elevated histamine content and proteolytic activity, have been implicated in these effects. We hypothesized that the effects of histamine and proteases on neuronal excitability may be synergistic.

Purpose
1) Determine whether the excitatory effect of IBS patient FS can be abolished by histamine receptor antagonists and protease inhibitors. 2) Investigate whether the excitatory effects of histamine and proteases potentiate each other’s effects on visceral nociception

Method
Extracellular recordings were performed, measuring action potentials from mechanosensitive extrinsic afferent nerves innervating the mouse colon during colonic distensions to 60 mmHg. Colons were perfused (20 minutes) with histamine receptor antagonists (1 µM pyrilamine, 10 µM ranitidine, 30 nM clobenpropit, 1 µM JNJ7777120) or protease inhibitors (10 µM EDTA, 0.2 µM bestatin, 0.03 µM Pepstatin A, 0.03 µM E-64) prior to treatment with the IBS patient FS. Perforated patch clamp experiments were used to measure neuronal excitability from mouse dorsal root ganglion neurons by recording rheobase (minimum current required to elicit an action potential fire). This technique was used to examine the effect of subthreshold concentrations of histamine (1µM) and trypsin (5nM), as well as their simultaneous administration on the neurons.

Result(s)
Luminal administration of histamine antagonists or protease inhibitors blocked the excitatory effect of the IBS patient FS (two-way ANOVA P=0.44 for protease antagonists, two-way ANOVA P=0.37 for histamine antagonists). Patch clamp experiments revealed that a subthreshold concentration of either histamine (1µM) or trypsin (5nM) had no effect on neuronal rheobase, whereas the combination significantly decreased neuronal rheobase (one-way ANOVA with Tukey’s test, P=0.006).

Image

Conclusion(s)
These findings demonstrate that either histamine receptor antagonists or protease inhibitors inhibit the excitatory effect of IBS patient FS and suggest that a potentiating effect exists between the actions of histamine and proteases on nociceptive neurons.

Disclosure of Interest
None Declared