bluuebunny/crossref_metadata_2025_split huggingface dataset:
A36 INVESTIGATING TYPE 1 REGULATORY T CELLS AS A THERAPY FOR INFLAMMATORY BOWEL DISEASE USING A MOUSE MODEL OF ACUTE INTESTINAL EPITHELIAL DAMAGE
Authors: Poloni C , Sze A , Wang X , Lim S , Steiner T 
Published: March 2023

Abstract

Background
Inflammatory bowel disease (IBD) affects an estimated 270,000 people in Canada and is rapidly increasing in prevalence. All patients have relapsing disease, and a subset of individuals do not respond to current treatments. Further, there are no approved treatment options in Canada that reverse IBD-induced intestinal fibrosis. We have previously shown type 1 regulatory cells (Tr1s) are capable of suppressing inflammatory macrophages, promote barrier function of human intestinal epithelial cells, and induce differentiation of mucin-producing goblet cells. We hypothesize that Tr1 cells can prevent inflammatory damage and fibrosis in an mouse model of acute gut damage.

Purpose
We hypothesize that Tr1 cells can prevent inflammatory damage and fibrosis in an mouse model of gut damage. Here we evalute the therapeutic potential of Tr1 cells in an model of acute intestinal epithelial damage.

Method
Tr1 cells were isolated and expanded from CD4+ CD44high FOXP3- cells. Their phenotype was characterized by flow cytometry and cytokine secretion was measured via ELISA. WT B6 mice were given 2% DSS in H2O for 7 days, followed by H2O alone for 7 days. Prior to DSS treatment, mice were sub-lethally irradiated to facilitate engraftment, and given I.P. injections of PBS or 0.5 – 2 x 106 Tr1 cells. Mice weights and health scores were recorded daily. At the endpoint, blood, spleen, and mesenteric lymph nodes were analyzed for Tr1 cell engraftment (or lack thereof) for each mouse. Complete white blood counts were performed for each mouse. Additionally, proximal, medial, and distal portions of the ileum were processed for histologic scoring.

Result(s)
Tr1 cells isolated from CD4+ CD44high FOXP3- cells produce high levels of IL-10 following stimulation (&gt;35,000 pg/ml/1 x 105 cells). Additionally, these cells express high levels of Tr1 markers CD49b and Lag-3. Optimization experiments indicated no significant differences between mice irradiated and given DSS and mice only given DSS (no irradiation). Our results suggest no significant differences in inflammatory cell infiltrate scores between control and Tr1 treated mice. However, gut architecture scores appeared to improve with increasing Tr1 doses. Further, weight change improved with Tr1 treatment, as compared to PBS controls. Interestingly, Tr1 treatment appeared to decrease total eosinophil and neutrophil counts from peripheral blood.

Conclusion(s)
Our initial findings indicate Tr1 adoptive transfer prior to acute damage via DSS improves gut damage and weight loss.

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CIHR

Disclosure of Interest
None Declared
A44 A 1000 PATIENT CANADIAN NETWORK FOR AUTOIMMUNE LIVER DISEASE EVALUATION OF CLINICAL AND DEMOGRAPHIC PATTERNS OF AUTOIMMUNE HEPATITIS
Authors: Plagiannakos C G , Montano-Loza A J , Lytvyak E , Pallotta J , Mason A L , Qumosani K M , Worobetz L , Flemming J A , Hercun J , Vincent C , Cheung A , Chen T , Grbic D , Swain M G , Gulamhusein A , Hansen B E , Hirschfield G M 
Published: March 2023

Abstract

Background
We sought to understand how the demographics of autoimmune hepatitis (AIH) have changed over time in Canada.

Purpose
Using a large multi-centre Canadian cohort of patients with AIH, we describe the trends in patient and disease characteristics at presentation across 30 years of clinical practice.

Method
Patients from the Canadian Network for Autoimmune Liver Disease with a confirmed diagnosis of AIH (simplified score ≥6) were included for analysis. Patients were grouped into five cohorts according to the year of diagnosis (i.e., &lt;2000, 2000-2004, 2005-2009, 2010-2014, ≥2015). Patient demographics and baseline clinical and biochemistry features of disease activity were investigated using Chi-square tests and Kruskal-Wallis tests adjusted for multiple comparisons. Logistic and linear regression models with estimated means were utilized to further investigate relationships with time and to adjust for confounding.

Result(s)
1016 patients followed across 10 Canadian health centres with AIH were diagnosed between November 1965 and December 2021. Overall, 76.4% (n=776) of patients were female, and the median age at diagnosis was 46 years (IQR 28.2 - 58.3). Cirrhosis at presentation was seen in 20.6% of patients (n=209). The median age at diagnosis increased significantly from 31.8 years [IQR 17.9 - 46.8] pre-2000 to 54 years [IQR 9.0 - 95.2] after 2014 (p&lt;0.001; Figure 1a). This effect of time persisted after adjusting for sex and cirrhosis status at diagnosis. Female sex and the presence of cirrhosis at diagnosis were factors independently associated with older age at presentation (p&lt;0.0001).
The proportion of patients that presented with cirrhosis at diagnosis increased significantly over calendar time, from 13.7% (n=23) pre-2000 to 30.8% (n=69) after 2014 (p=0.003; Figure 1b). Male sex was independently associated with an increased odds of having cirrhosis at presentation (OR= 1.46, CI 1.02 - 2.07) and higher baseline ALT levels compared to females (p=0.036). The proportion of patients that identified as non-white ethnicity increased significantly from 15.2% (n= 24) pre-2000, to 32% (n= 86) after 2014 (p&lt;0.001, Figure 1b). This effect of time on ethnicity was most pronounced after the year 2010 (OR= 2.32, CI 1.39 - 3.98) and persisted after adjusting for sex. There was no significant pattern of change in sex over calendar time.

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Conclusion(s)
In Canada, patients with AIH at presentation are now older, have more advanced disease, and are more ethnically diverse than when compared to 30 years ago.

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Other

Please indicate your source of funding;
industry

Disclosure of Interest
None Declared
A65 VISCERAL FAT INDICES: DO THEY HELP DIFFERENTIATE CROHN’S DISEASE AND INTESTINAL TUBERCULOSIS IN CHILDREN?
Authors: Srivastava A , Seetharaman J , Yadav R R , Singh S , Mishra P , Sarma M S , Poddar U 
Published: March 2023

Abstract

Background
Crohn’s disease (CD) and Intestinal tuberculosis (ITB) mimic each other and are often difficult to differentiate. A correct and prompt diagnosis is essential for a good outcome. Mesenteric fat hypertrophy is a feature of CD and studies in adults have shown higher visceral fat in CD than ITB. There is no published data in children.

Purpose
This study evaluated the utility of visceral fat indices in differentiating CD and ITB in children.

Method
Symptomatic children diagnosed to have CD or ITB based on standard recommended criteria were enrolled. The clinical and laboratory details were noted. Abdominal fat was measured on Computed Tomography in supine position at the level of L4 vertebrae. Visceral fat (VF) and subcutaneous fat (SF) area was measured separately by an experienced radiologist, blinded to the diagnosis. Sum of VF and SF was taken as total fat (TF). VF/SF and VF/TF ratio was calculated.

Result(s)
34 children [14 boys, median age 14.0 (inter quartile range 10.8-17.0)] years were recruited, of which 12 (29%) had CD [7 boys, age 13.0 (IQR 9.25-16.5) years] and 22 (71%) had ITB [7 boys, age-14.5 (IQR 11-17) years]. Visceral fat area (VF) was significantly higher in CD compared to ITB (table 1). However, there was no significant difference in the SF (2199.5 (1537.6-3881.6) vs 2176.5 (671.0-6651.5) mm2; p=0.958) and TF (3096.1 (2108.2-5373.5) vs 4518.2 (2677.6-8456.3) mm2; p=0.245) in ITB and CD respectively. The ratio of VF/SF and VF/TF was significantly higher in CD as compared to ITB for all cases (table1). When comparing CD and ITB in boys and girls separately the same trend was observed but the difference was statistically significant only for boys. On ROC analysis, VF:SF ratio of 0.609 predicted CD with the sensitivity of 75% and specificity of 86.4% (area under curve [AUC]-0.795, 95% CI 0.636-0.955; p=0.005). VF:TF ratio of 0.379 had similar sensitivity of 75% and specificity of 86.4% (AUC-0.795, 95% CI 0.636-0.955; p=0.005). The VF area of 1485.26 mm2 had a sensitivity of 83.3% and specificity of 72.7% for CD (AUC-0.758, 95% CI 0.590-0.925; p=0.01).

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Conclusion(s)
The VF/SF ratio is a simple, non-invasive, objective parameter to differentiate CD and ITB in children with a good sensitivity and specificity.

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None

Disclosure of Interest
None Declared
A73 EFFECT OF FECAL IMMUNOCHEMICAL TEST CUT-OFF LEVELS ON ADENOMA DETECTION RATE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Zarandi-Nowroozi M , Taghiakbari M , Barkun A , Pohl H , Nauche B , Chagnon M , von Renteln D 
Published: March 2023

Abstract

Background
Adenoma detection rate (ADR) is higher after a positive fecal immunochemical test (FIT) compared to direct screening colonoscopy.

Purpose
This meta-analysis evaluated how ADR, the rates of advanced adenoma detection (AADR), colorectal cancer detection (CDR), and sessile serrated lesion detection (SSLDR) are affected by different FIT positivity thresholds.

Method
We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews databases for studies reporting ADR, AADR, CDR, and SSLDR according to different FIT cut-off values in asymptomatic average-risk individuals aged 50 to 74 years old. Data were stratified according to sex, age, time to colonoscopy, publication year, continent, and FIT kit type. Study quality, heterogeneity, and publication bias were assessed.

Result(s)
Overall, 4280 articles were retrieved and fifty-seven studies were included (332,281 FIT-positive colonoscopies; mean cecal intubation 96.2%; mean age 60.7 years; male 52.1%). Mean ADR was 55.9% (95% CI 53.2% – 58.6%), while mean AADR, CDR, and SSLDR were 27.2% (95% CI 24.3% – 30.1%), 5.4% (95% CI 4.7% – 6.1%), and 3.0% (95% CI 1.7% – 4.6%), respectively. For each 20 μg Hb/g increase in FIT cut-off level, ADR increased by 2.87% (95% CI 1.70% – 4.05%, p &lt; 0.01), AADR increased by 3.90% (95% CI 2.76% – 5.05%, p &lt; 0.01) and CDR by 1.46% (95% CI 0.66% – 2.24%, p &lt; 0.01). Many detection rates were greater amongst males and Europeans.

Conclusion(s)
ADRs in FIT-positive colonoscopies are influenced by the adopted FIT positivity threshold, and identified targets, importantly, proved to be higher than most current societal recommendations.

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None

Disclosure of Interest
None Declared
A89 EXPLORING THE ENDOSCOPY SEDATION EXPERIENCES OF INDIVIDUALS WITH PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE (IBD) AFTER THE TRANSITION TO ADULT CARE: A PILOT STUDY
Authors: Bollegala N , Ramkissoon A , Mohmand Z 
Published: March 2023

Abstract

Background
Different sedation practices are utilized in pediatric and adult endoscopy settings. While pediatric endoscopies are performed under deep sedation, adult endoscopies are often performed under conscious sedation.

Purpose
This study sought to explore the experiences of patients with pediatric-onset IBD that have undergone transfer to adult care and to identify gaps in endoscopy sedation practices that may inform a larger and more comprehensive evaluation of this topic.

Method
A pilot study was performed at Women's College Hospital involving patients aged 18 to 25 years old with a diagnosis of pediatric-onset IBD that received endoscopies in both the pediatric and adult setting. Patients were recruited between June 1 and October 1, 2022. A 36-item questionnaire was distributed assessing sedation methods used in pediatric and adult settings, anxiety, pain, satisfaction during endoscopy and perceptions of transition of care preparation as it pertained to endoscopy. This study was reviewed by institutional authorities at WCH and was deemed not to require REB approval.

Result(s)
Twelve patients participated in the pilot survey study (7 Ulcerative colitis, 5 Crohn’s disease) with a mean age of 22. Of those, 100% were female and 66% did not have any comorbid conditions. The mean age of diagnosis was 12.8 years, with respondents spending an average of 67.3 months in pediatric care prior to transition. In pediatric care, the mean number of endoscopies received was 2.3 with a majority performed under deep sedation (83%). Respondents reported being very satisfied with their sedation experience (58%) and experiencing no pain (67%), however mild to severe anxiety was reported (58%). In adult care, mean endoscopies received was 2.1, with conscious sedation (50%) performed more often than deep (42%) or no sedation (8%). More respondents reported satisfaction with deep sedation (100%) than conscious sedation (67%). During conscious sedation, respondents experienced more pain (50% vs. 20%), moderate discomfort (33% vs. 0%), and were more anxious (83% vs. 60%) than in deep sedation. Factors that contributed to anxiety included fear of endoscopy and insufficient sedation. Of those who received deep sedation in the adult setting, 60% reported that the sedation method utilized impacted their future willingness for endoscopy. Lack of communication regarding sedation method, poor experiences with conscious sedation, and the desire to choose the sedation method appropriate for them were areas for improvement.

Conclusion(s)
This pilot study demonstrated that IBD patients transferred to adult care receive varying endoscopy sedation methods and experience differential levels of satisfaction favouring deep sedation. This is an important signal that requires larger study.

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None

Disclosure of Interest
None Declared
A90 IMPLEMENTATION OF NATIONAL GUIDELINES ON THE MANAGEMENT OF VACCINE PREVENTABLE ILLNESS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: PERCEIVED BARRIERS AND INTERVENTION FUNCTIONS AMONGST GASTROENTEROLOGISTS
Authors: Zhou F , Robar J , Stewart M , Jones J 
Published: March 2023

Abstract

Background
Vaccination uptake amongst patients with IBD remains suboptimal. Studies evaluating effectiveness of interventions designed to improve vaccine uptake have not assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI).

Purpose
The aim of this study was to identify barriers and facilitators for evidence-based management of VPI in IBD.

Method
A semi-structured interview was conducted with gastroenterologists. Interview questions were developed and guided by the COM-B and TDF evidence-based implementation science frameworks. A brief intake questionnaire was administered to collect participant demographic and clinical practice information. Gastroenterologists were recruited through direct local contact via email by the investigators. Sixty minute interviews were recorded and transcribed for data analysis. Using thematic analysis, codes from the study data will be generated to identify themes. The data will be categorized into the coding scheme and themes created using an inductive coding approach.

Result(s)
As of October 2022, 5 interviews were conducted. Mean participant age was 47.8 years, with 60% identifying practice in an urban/academic setting compared to a rural/community setting (20%). Preliminary major themes included 1) assessing vaccination status and recommending appropriate vaccines are the responsibility of the gastroenterologist 2) gastroenterologists need more support to administer vaccines in clinical practice 3) barriers to implementation of VPI guidelines include lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines and 4) intervention themes include use of clinical decision support tools embedded into the workflow of healthcare providers, need for support from allied healthcare providers, increased need for third party support, and more education/CME relating to management of VPI in clinical practice. Specific knowledge gaps include 1) uncertainty relating to what vaccines are covered financially 2) lack of knowledge of risk factors for specific VPI such as pneumococcus and meningococcus and 3) how to administer live vaccines in patients already on immunosuppressants.

Conclusion(s)
Preliminary qualitative themes suggest that although gastroenterologists acknowledge the importance of managing VPI in patients with IBD, perceived resource, policy, and educational barriers exist. The qualitative data from this study will be used to design and implement customized, evidence-based implementation strategies for managing VPI that are sensitive to the local environment.

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None

Disclosure of Interest
None Declared
A95 ASSESSMENT OF BIRTH COHORT SCREENING OF CHRONIC HEPATITIS C IN COLORECTAL CANCER SCREENING PATIENTS IN BRITISH COLUMBIA
Authors: Kaviani R , Chou F Y , He C B , Marquez V 
Published: March 2023

Abstract

Background
Birth cohort screening of chronic hepatitis C (CHC) is recommended in British Columbia since 2018 for baby boomers born between 1945 to 1964, with an estimated provincial prevalence of 2.31%. Though there remained a gap in care following anti-hepatitis C positivity, resulting in reflexive ribonucleic acid (RNA) testing provincially. Dual screening of CHC in patients referred to colorectal (CRC) screening programs can provide an opportunity to link patients with healthcare professionals to ensure appropriate follow-up.

Purpose
We aimed to assess the uptake of CHC screening amongst CRC screening patients after the release of British Columbia’s birth cohort guidelines, both pre and post-COVID-19 pandemic.

Method
A retrospective review of patients referred to a CRC screening program in Vancouver from October 1st to December 31st, 2019, and December 1st – 31st, 2021, was performed. Collected data included demographics, liver disease history, and co-infection rates with hepatitis B (HBV) or human immunodeficiency virus (HIV). Dates of first-time hepatitis C antibody, RNA and viral load testing were gathered. Descriptive statistics were used to identify the proportion of screening and prevalence of CHC.

Result(s)
A total of 553 patients were referred for colonoscopy to the CRC screening program, of whom 458 (82.8%) patients were born between 1945 to 1964, and 273 (n=49%) were female. Among the 250 (45.2%) patients screened for CHC, 4 (0.72%) had positive anti-hepatitis C, all of whom were baby boomers. In 2019, 44% (n=183) of patients were screened for CHC; 78.7% (n=144) were screened before colonoscopy referral. In 2020, 48.6% (n=67) of patients were screened for CHC; 100% of cases were screened before colonoscopy referral.

Conclusion(s)
Birth cohort screening of CHC is underutilized in British Columbia. Dual screening of CHC at the time of referral to CRC screening provides a practical approach to linking patients to healthcare.

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None

Disclosure of Interest
None Declared
A103 DESIGNING QUALITATIVE RESEARCH FOR UNDERSTANDING THE EXPERIENCES OF TRANGENDER AND GENDER DIVERSE PERSONS WITH GASTROINTESTINAL DISEASE OR SEEKING GASTROINTESTINAL CARE
Authors: Kariyawasam N , Newman K , Streed C G , Rizkalla L , Vélez C , Targownik L 
Published: March 2023

Abstract

Background
Transgender and gender diverse (TGD) people make up approximately 1% of the population, with 2.1% of Generation Z adults (born 1997-2003) identifying as TGD. As a marginalized population, TGD people have been shown to have poorer access to health care services and report worse health-related outcomes. While the health care disparities faced by TGD people need to be addressed by Medicine broadly, TGD people may face unique barriers in gastrointestinal (GI) care. To date, there has been no systematic assessment of the GI health care needs of TGD people. With the aging of Generation Z, GI care providers will increasingly be responsible for the care of TGD people, and it is important to understand their needs and experiences to ensure they receive appropriate and sensitive care.

Purpose
Recognizing the absence of literature on the issues faced by TGD people with GI disease or seeking care for GI issues, we plan to use qualitative research methodology to aggregate and analyze narrative experiences of TGD people of diverse backgrounds, identities and experiences. Our research will focus on TGD people’s interactions with GI care providers, and on the experience of being a TGD person with GI disease or having sought evaluation of GI symptoms.

Method
We will use a qualitative approach to gain a broad understanding of the experiences and perceptions of TGD people with: 1) established GI diseases, in particular IBD and DGBIs (disorders of gut-brain interaction), and 2) GI symptoms or concerns requiring GI investigations. We will use snowball sampling to reach out to TGD people in Canada and the US, with the aim of achieving diverse representation across gender identity, surgical status, age, race/ethnicity, and socioeconomic status. Participants will sit for semi-structured interviews to elicit narratives about their beliefs and experiences while living with GI disease and/or seeking care for GI issues. Interview transcripts will be subjected to objective and researcher-guided thematic analysis to identify commonalities and disparities in experiences and points-of-view.

Result(s)
Our proposed presentation will highlight our process in designing and initiating this project. We believe our methods and approach to this work is an important discussion and will help shape next steps in this field. We may also present some of the early results of our semi-structured interviews.

Conclusion(s)
This work will provide a foundation to guide further research into the process and outcomes of care for TGD people with GI disease and undergoing GI evaluations and will provide a framework to develop best practices for GI care providers pertaining to the care of TGD people.

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None

Disclosure of Interest
None Declared