bluuebunny/crossref_metadata_2025_split huggingface dataset:
A191 PERSISTENT BENEFIT OF DIETITIAN-LED GLUTEN-FREE DIET EDUCATION AT CD DIAGNOSIS ON DIETARY ADHERENCE IN CHILDREN AND ADULTS WITH TYPE 1 DIABETES AND CELIAC DISEASE
Authors: Marcon P , Clarke A , Pace K , McDonald C , Saibil F , Lochnan H A , Punthakee Z , Mahmud F 
Published: February 2022

Abstract

Background
Celiac disease (CD) is a common autoimmune comorbidity of type 1 diabetes (T1D) with a gluten-free diet (GFD) being the current gold standard treatment for this condition. Adherence to a GFD can be impacted by several factors including dietetic counselling, yet little is known about the impact of clinic-based interventions on long-term GFD adherence in this population.

Aims
To prospectively evaluate the impact of a dietitian-led GFD education intervention on adherence to a GFD in children and adults with T1D and CD over a 3-year period.

Methods
A cohort of N=62 pediatric and adult subjects who screened seropositive for CD as part of the CD-DIET clinical trial were followed over a 3-year period post-CD diagnosis and assessed on the basis of the GFD education regimen they received at initial CD diagnosis. This included 3 groups: 1) intensive dietitian training (IDT = 5 dietitian visits over 1 year while following GFD), 2) single dietitian training (SDT = 1 GFD training session after 1 year of following GCD) and 3) no dietitian training (NDT) at CD diagnosis. Annual visits included serologic testing of TTG-IgA titres, anthropometric assessments and the completion of questionnaires evaluating diet and adherence to a GFD. Data was analysed longitudinally using linear mixed effects and generalized estimating equations (GEE) regression modeling adjusting for the fixed effects of age, sex, duration of diabetes and time.

Results
At baseline, participants who received IDT (n=15), SDT (n=16) and NDT (n=31) represented 24.2%, 25.8%, and 50.0% of the cohort, respectively. Over the 3-year study period, participants in the IDT group had the greatest odds of self-reporting being a GFD, with odds 4.3 (95%CI: 1.1 to 16.4; P=0.033) and 9.5 (95%CI: 2.7 to 33.7; P&lt;0.001) greater than the SDT and NDT groups, respectively. The assessment of daily gluten intakes less than 10mg, as recommended for a GFD, revealed a lack of differences between the IDT and SDT groups. In contrast, the NDT group had significantly lower odds of meeting this threshold relative to those who received IDT (OR=0.2; 95%CI: 0.04 to 0.56; P=0.004). No longitudinal differences in TTG-IgA levels were seen between groups over the 3-year period.

Conclusions
In diabetes patients greater contact with a dietitian at CD diagnosis was associated with higher levels of GFD adherence over time, which was not reflected in follow-up Serologic evaluation. These findings highlight the importance of nutritional support in patients with both diabetes and celiac disease at the time of CD diagnosis. In addition, following TTG-IgA alone does not fully inform dietary compliance to a GFD.
Diet teaching stratification

Diet assignment

Funding Agencies
Juvenile Diabetes Research Foundation / PSI
A197 ACUTE ILEITIS IN ADULT PATIENT: A RETROSPECTIVE STUDY OF PATIENT OUTCOMES
Authors: Bachand M , Paradis A 
Published: February 2022

Abstract

Background
Rising availability of medical imaging exams in the emergency room potentially leads to an increase of ileitis findings by imaging in a context of gastrointestinal symptoms. However, it can be difficult to determine the clinical significance of this radiological finding in an acute consultation setting and to establish the relevant investigations.

Aims
The aim of this study is to describe the current management and the long-term outcome of patients with diagnostic of acute ileitis on imaging during an emergency consultation in our center, Centre Hospitalier Universitaire de Sherbrooke(CHUS).

Methods
We performed a retrospective study of all patients diagnosed with ileitis by abdominal ultrasound or computed tomography (CT scan) during a visit in our emergency department over the years 2010 and 2017. Patients with previous diagnosis of Crohn disease were excluded. Data collected were clinical, radiological and endoscopic at diagnostic and over at least 3 years following the initial visit.

Results
A total of 118 files were reviewed. The initial imaging modality was 43% ultrasound and 57% CT scan. 36% of patients had an ileocolonoscopy within one month of the initial visit. Of these, 60% demonstrated macroscopic endoscopic abnormalities. 51% of patients had follow-up imaging within 3 months of the initial consultation. 64% of these images demonstrated persistence of pathological changes in the ileal region. Only 48% had a stool culture at diagnosis. 72% of patients met a gastroenterologist and 45% saw a general surgeon. The most common cause of ileitis was an infectious origin at 44% predominantly with Yersinia enterocolitica and Campylobacter jejuni. 13% received a diagnostic of Crohn disease. 20% of ileitis remained undetermined. Among these, there was a case of Crohn’s disease which was eventually diagnosed 2 years later. The initial factors associated with a diagnosis of Crohn’s disease were family history of inflammatory bowel disease (OR 6.17 95% CI 1.67 to 22.781 p = 0.006), extra-digestive manifestations (OR 23.31 95% CI 2.255 to 240.92 p = 0.008), discontinuous impairment at initial imaging (OR 19.8 95% CI 4.284 to 91.52 p = 0.000), presence of stenosis at initial imaging (OR 14.429 95% CI 1.227 to 169.68 p = 0.034), the presence of abscess or collection on imaging (OR 11.54 95% CI 1.76 to 75.63 p = 0.011) and wall thickness in mm (1.22 95% CI 1.06 to 1.40 p = 0.005).

Conclusions
Our study shows that the majority of acute ileitis found on imaging are of infectious origin. A portion of acute ileitis corresponded to the initial presentation of Crohn’s disease. Thus, we believe that it is preferable to offer at least clinical follow-up to patients with acute ileitis on imaging and to consider additional investigation by imaging and / or colonoscopy when symptoms persist and this particularly in presence of factors associated with Crohn’s disease.

Funding Agencies
None
A201 A CASE OF SYPHILIS MASQUARADING AS CROHN’S DISEASE
Authors: Smith B C , Salh B 
Published: February 2022

Abstract

Background
It is important for gastroenterologists to keep syphilis on their differential. We present a case of rectal syphilis initially misdiagnosed as Crohn’s disease with commensal intestinal spirochetosis.

Aims
This case highlights how rectal syphilis can present with endoscopic and clinical findings consistent with refractory inflammatory bowel disease.

Methods
Case report and literature review.

Results
A 58 healthy male was referred for flexible sigmoidoscopy after having increased frequency of bowel movements, up to 10 per day, with mucous secretions at times mixed with blood and a 35lbs weight loss. He complained of urgency, tenesmus and intermittent incontinence. Endoscopy showed evidence of proctitis in the distal 10cm of the rectum with ulceration, edema and friability with biopsies showing moderately active colitis, compatible with ulcerative colitis.
5-ASA suppositories and subseqent oral prednisone had no effect. A colonoscopy 3 months later again showed proctitis and ulceration. Biopsies at this time showed moderately active proctitis with chronic architectural distortion and intestinal spirochetosis identified on Warthin-Starry stain in the right colon and rectum. Given the patient was immunocompetent he was diagnosed with inflammatory bowel disease and trialed on oral and rectal 5-ASA.
Four months later flexible sigmoidoscopy showed extensive distal rectal ulceration, biopsies positive for chronic proctitis and intestinal spirochetosis. Given no response to 5-ASA the patient was started on infliximab with a slight improvement but incomplete resolution of his symptoms. Repeat endoscopy showed continued rectal ulceration.
Incidentally, the patient had a same sex sexual encounter and subsequently tested positive for syphilis with positive T. pallidum EIA and an RPR of 1:8. He received benzathine penicillin G 2.4 million units intramuscularly.
After treatment with penicillin, the patient’s symptoms improved with no further hematochezia and decreased frequency. Flexible sigmoidoscopy showed normal mucosa with no evidence of ulceration indicating the initial proctitis and ulceration was secondary to infection by T. pallidum.

Conclusions
Syphilis, known as the “Great imitator,” is on the rise in Canada, with cases of infectious syphilis increasing more than 259.5% over the past decade. Rectal syphilis is often misdiagnosed as it can present with variable symptoms including puritis, tenesmus, urgency of defecation and anal discharge that may be purulent, mucoid or bloody. Endoscopic findings include non-specific proctitis, masses, ulceration and pseudotumors. Diagnosis is made with serology as pathology cannot differentiate between commensal intestinal spirochetosis and T. pallidum.
Given the diversity of presentations and rise in incidence, gastroenterologists need to ensure they take a thorough sexual history and keep syphilis on their differential when encountering this common clinical scenario.

Funding Agencies
None
A231 COLORECTAL CANCER PROVINCIAL SCREENING OPTIMIZATION USING GUT MICROBIOME AS BIOMARKER
Authors: Laforest-Lapointe I 
Published: February 2022

Abstract

Background
Colorectal cancer (CRC) is a disease easy to cure but quite difficult to detect. Because of that, the mortality rate of CRC is among the highest in the world. The current way to clinically detect CRC is by mean of immunochromatographic fecal occult blood test (iFOBT). If the test is positive, the patient undergoes a colonoscopy to confirm the presence and stage of CRC. However, iFOBT tests are affected by a high rate of false positives. In addition, colonoscopy preparation and intervention have major drawbacks on patients’ health. It is thus important to reduce the false negative rate of iFOBT.

Aims
In this study, we aim to find microbiome biomarkers that could reduce the rate of false positives, quantify microbiome composition as CRC worsens, and finally improve iFOBT accuracy by adding microbial biomarkers and CRC-related human genes to the detection for CRC.

Methods
To do that, 1048 fecal samples were collected with iFOBT kit (OC-Auto® FIT test Kit) then send to the CHUS (Centre Hospitalier de l’Université de Sherbrooke). Sex, age and health status (healthy with “no blood”; false positive: FP; adenoma, adenocarcinoma) were collected for 952 samples. Those samples come from healthy patient with “no blood” (no or below 175 ng/mL of blood in sample), FP patients (healthy but with a concentration above 175 ng/mL of blood), 387 patients with adenoma and 52 patients with adenocarcinoma. The community microbial DNA were extracted from samples by using QIAGEN QIAmp Fast DNA stool mini-kit. An amplification of the V4 region of the 16S rRNA gene were done by using the primers 515 F and 806R, then sequenced on a MiSeq platform.

Results
First, taxonomy was assigned to each ASV (Amplicon Sequence Variant) with Silva. Then ASVs were parsed through ten different machine learning algorithms to assess if the microbiome can increase the power of prediction (sensitivity and specificity) of CRC by comparing FP vs adenoma and FP vs adenocarcinoma by generating AUC-ROC (Area Under the Curve-Receiver Operating Characteristics) curves using only the sex, age and occult blood concentration, and then adding the ASVs community.
Preliminary results show that the power of prediction of CRC with only sex, age and occult blood concentration have an AUC-ROC curves varying between 0.53–61 when comparing FP vs adenoma, and an AUC-ROC curves varying between 0.56–0.74 when comparing FP vs adenocarcinoma. And when adding the community matrix, we see that the AUC-ROC curves comparing FP vs adenoma are varying between 0.48–0.68; and when comparing FP vs adenocarcinoma, the AUC-ROC curves are varying between 0.51–0.98.

Conclusions
In the future, we hope to explore the possibility of using this machine learning protocol to determine the stage of CRC disease and reduce the need for FP colonoscopies.

Funding Agencies
CIHRCanada Research Chair
A233 CHARACTERIZATION OF THE DUODENAL MICROBIOME IN PEDIATRIC CELIAC AND INFLAMMATORY BOWEL DISEASE PATIENTS
Authors: Manoogian J , Butcher J , Li J , Mack D R , Stintzi A 
Published: February 2022

Abstract

Background
Both Celiac disease (CE) and inflammatory bowel disease (IBD) are lifelong gastrointestinal tract (GIT) disorders. CE is an autoimmune disorder triggered by gluten consumption and can result in small intestine villus atrophy, crypt hyperplasia and epithelial permeability, while IBD is characterized by chronic, reoccurring inflammation and ulcers in the GIT. There is increasing evidence linking GIT microbes to both CE and IBD pathogenesis. Studies have also shown that CE patients are at increased risk of developing IBD, suggesting a possible link between these diseases. The duodenum can be affected in both CE and IBD, but it is understudied as compared to other GIT regions.

Aims
We thus aimed to characterize the duodenal microbiome of pediatric CE, IBD and control patients (n=76, 48 and 57 respectively) and hypothesized that the composition of microbes would vary between each diagnostic group.

Methods
We used mucosal luminal interface aspirates collected during upper endoscopy at the Children’s Hospital of Eastern Ontario. Metagenomic DNA was extracted from these samples and bacterial taxa was characterized by sequencing the V6 hypervariable region of the 16S rRNA gene.

Results
Control, CE, and IBD duodenal microbiotas showed no apparent differences in either α-diversity or β-diversity. However, we identified several significant differences between the relative abundances of specific taxa in these three patient groups. In particular, Atopobium parvulum was found to be enriched in Crohn’s disease samples when compared to non-IBD controls. There was also a trend for higher Bacteroides, Lactobacillus, Parabacteroides and Staphylococcus in CE patient MLI aspirates. These results are similar to what has been previously reported in CE patients. Finally, trends found in the duodenal MLI aspirates are more consistent with results previously found in the salivary microbiome in CD patients as opposed to studies of the large intestine.

Conclusions
This work provides unique insight into the microbial composition at the duodenum; a GIT region that has not been fully characterized in CE or IBD.

Funding Agencies
CIHRGenome Canada
A242 STOOL FROM IBS-D PATIENT WITH A HISTORY OF A DYSBIOTIC AND NON-DYSBIOTIC ONSET MODULATE NEURONAL EXCITABILITY VIA DIFFERENT MECHANISMS
Authors: Jiménez-Vargas N N , Guzman Rodriguez M , Yu Y , Neary E , Lomax A E , Reed D E , Vanner S 
Published: February 2022

Abstract

Background
We have shown that Irritable Bowel Syndrome diarrhea-predominant (IBS-D) patients with a history of a dysbiotic-like onset have distinct stool metabolomic profiles versus those with a non-dysbiotic-like onset. IBS stool supernatants can sensitize mouse colonic afferent nerves via both histamine and proteases. However, it is unknown if stool supernatants from the two IBS-D subgroups modulate the excitability of nociceptive neurons via different neuroactive mediators

Aims
To evaluate whether there are differences in neuroactive mediators within stool supernatants from subgroups of IBS-D patients that can modulate the excitability of nociceptive neurons.

Methods
Stool samples from healthy control (HC) (N=5) and IBS-D patients with a dysbiotic (N=7) or non-dysbiotic-like (N=7) onset, was homogenized with Krebs solution and filtered. Proteolytic activity was assessed using casein as a substrate with and without protease inhibitors. Histamine was quantified by ELISA. DRG neurons from C57BL/6 mice were incubated overnight or acutely (30 min) with stool supernatants. Some neurons were pre-incubated with PAR2 (GB83, 10 μM) or H1R (pyrilamine, 1μM) antagonists prior to supernatant incubation. Changes in neuronal excitability were assessed with perforated patch-clamp by measuring the rheobase (current that elicits an action potential).

Results
Proteolytic activity in dysbiotic-like (57.9 U/μg, p&lt;0.05) but not non-dysbiotic like (37.4 U/μg) stool supernatant was increased compared to HC (25.2 U/μg). Serine inhibitor decreased proteolytic activity of dysbiotic (46.6%, p&lt;0.05) and non-dysbiotic (34.2%, p&lt;0.01) supernatant whereas cysteine, aspartic and metalloproteases inhibitors had no effect. Histamine was increased 78% (p&lt;0.05) in IBS-D compared to HC. No differences in proteolytic activity and histamine concentration between IBS-D subtypes were found. In patch-clamp recordings, overnight incubation with dysbiotic (19%, p&lt;0.05) and non-dysbiotic (22%, p&lt; 0.01) stool supernatant decreased rheobase of DRG neurons compared to HC. No difference in rheobase was observed between IBS-D subtypes. GB83 blocked the overnight actions of supernatants from both subgroups, but pyrilamine had no effect. In contrast, following acute incubation, pyrilamine blocked the hyperexcitability evoked by dysbiotic like supernatant (60pA vs 48pA, p&lt;0.001) but had no effect on non-dysbiotic like supernatants.

Conclusions
Proteases in stool supernatants from IBS-D patients increase neuronal excitability but only those with a history of dysbiotic like onset acutely increase neuronal excitability through H1 receptors. These findings suggest that stool supernatants from subgroups of IBS-D may modulate nociceptor excitability via different mechanisms.

Funding Agencies
CIHRAmerican Neurogastroenterology and Motility Society
A253 IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON PHYSICAL ACTIVITY LEVELS IN CHILDREN AND ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE IN QUEBEC
Authors: Bouthot J , Dehbidi Assadzadeh L , Belmesk L , Madagh S , Geng S , Deslandres C , Jantchou P 
Published: February 2022

Abstract

Background
An average daily moderate-to-vigorous physical activity (MVPA) of at least 60 minutes was recommended by the Canadian Guidelines for children. Because of lockdown restrictions during the COVID-19 pandemic, maintaining physical activity levels (PAL) has been a challenge for youth.

Aims
The primary aim of this study was to compare MVPA levels in children with inflammatory bowel diseases (IBD) before and after this period. The secondary aims were to assess clinical factors that might influence any changes in MVPA patterns.

Methods
Patients with IBD, age ≥5 years, were enrolled in a prospective study on PAL starting June 2018 (self-reported questionnaires during outpatient visits). They were then surveyed online at the end of the second lockdown in July-August 2021. PAL were assessed with the Canadian Health Measure Survey Children-Physical Activity Questionnaire. The responses were converted into metabolic equivalents of tasks by using validated tables. Influence of clinical factors of IBD on changes in MVPA was assessed. A multivariate logistic regression was performed to investigate the association between several risk factors and PAL.

Results
We included 72 patients (38 males; mean (SD) age 17.0 (2.89) years, 48 (66.7%) diagnosed with Crohn’s disease, 19 (26.4%) with ulcerative colitis, and 5 (6.9%) with indeterminate colitis). At last follow-up, 90.3% were in clinical remission according to validated disease activity score. During summer 2021, 16.7% of patients reached the Canadian PAL target, compared to 38.9% before the pandemic. The median daily duration of MVPA in summer 2021 decreased from 37 (Interquartile range (IQR) = 3–82) to 21 (IQR=3–40) minutes. The proportion of sedentary patients increased by 1.4% (37.5% to 38.9%). The proportion of extremely active patients decreased by 16.7% (27.8% to 11.1%), while moderately active patients increased by 20.9% (8.3% to 29.2%). Age, gender, disease type and activity were not significantly associated with the PAL at baseline or at follow-up.

Conclusions
This study found a significant decrease in PAL and time spent doing MVPA in children with IBD in Quebec following the COVID-19 pandemic lockdown. While the recommended target was far from being met before the pandemic, the gap has widened further during the pandemic. We found no clinical factors associated with the PAL. The impact of low PAL on well-being, weight, disease activity and quality of life will be assessed during the follow-up of this cohort.

Funding Agencies
None
A254 PREVALENCE OF HELICOBACTER PYLORI INFECTION IN BARIATRIC SURGERY PATIENTS
Authors: Greenblatt M , Baillargeon D , Cote M , Nadeau M , Couture C , Hould F , Bouvet L , Tchernof A , Biertho L 
Published: February 2022

Abstract

Background
Helicobacter Pylori (HP) infection is the most common chronic infection in humans. Known risk factors include poor socioeconomic status and living conditions, especially at a young age. In Canada, the prevalence is estimated between 23% and 38%. The relationship between BMI and HP infection is controversial. Some data suggests that HP infection occurs less frequently in individuals who are overweight. Other authors endorse that obesity is a risk factor for HP infection, possibly explained by altered innate and adaptive immunity in these patients.

Aims
The objectives were to determine the prevalence of HP infection in patients undergoing bariatric surgery and assess the correlation between HP infection and various patient characteristics.

Methods
All patients who underwent bariatric surgery with a gastric resection in a single hospital between 01/2004 and 01/2019 were analyzed. When gastritis was present, HP immunohistochemical testing was performed. Characteristics of HP-positive (HP+) and HP-negative (HP-) patients were compared using Student’s t-test and χ 2 test.

Results
A total of 6388 specimens were reviewed (4365 women & 2023 men) with a mean age of 44.9±11.2 years and a mean BMI of 49.3±8.2 kg/m2. Histology-proven HP infection rate was 6.3% (n=405). There was no significant difference in sex, BMI and body weight between HP+ and HP- patients. HP+ patients were significantly older than HP– patients (47.4±9.8 vs 44.7±11.3 years, respectively, p&lt;0.0001). Logistic regressions identified age as a risk factor for HP infection in this population (OR 1.26, p&lt;0.0001, CI95% 1.14–1.40 for every 10-year increase).

Conclusions
The rate of histology-proven HP infection is low in patients with severe obesity who present for bariatric surgery and is directly associated with age. The benefits of routine preoperative testing in non-gastric-bypass surgery candidates should be questioned.
Characteristics of study participants

Funding Agencies
This study was performed with support from the Research Chair in Bariatric and Metabolic Surgery at Laval University (L. Biertho and A. Tchernof). MC is the recipient of a studentship from Diabète Québec.