bluuebunny/crossref_metadata_2025_split huggingface dataset:
A127 ENDOSCOPIC MUCOSAL RESECTION FOR DYSPLASTIC AND NEOPLASTIC BARRETT’S ESOPHAGUS: FINDINGS FROM A FOREGUT NEOPLASIA MULTIDISCIPLINARY DATABASE
Authors: Wilson H A , Blakely P , Dang J , Sun W , McLean R , Karmali S , Wong C 
Published: February 2022

Abstract

Background
Previously, Barrett’s esophagus with high grade dysplasia (HGD) or neoplasia was treated with esophagectomy, which is associated with a high postoperative morbidity and mortality rate. Recent guidelines support the use of endoscopic mucosal resection (EMR) for T1a esophageal adenocarcinoma (EAC) and potentially T1b EAC; however, data on long term outcomes of endoscopic treatment is lacking. We created a combined prospective and retrospective multidisciplinary database to monitor outcomes of patients with Barrett’s esophagus undergoing endoscopic treatment.

Aims
Our primary aim was to compare outcomes of EMR and esophagectomy in patients presenting with BE and HGD, and/or early EAC.

Methods
A collaboration of gastroenterologists, general surgeons and thoracic surgeons from the University of Alberta, Edmonton, Alberta, provided input on the development of the database. All patients referred to the Northern Alberta Endoscopic Ablation Program from 2009–2021 who received at least one endoscopic treatment were included. A sub-analysis of all patients with pathologic confirmation of HGD, and/or early EAC was conducted to compare outcomes of EMR and esophagectomy.

Results
A total of 212 patients have been entered into the database. The most common findings were HGD, low grade dysplasia (LGD), and adenocarcinoma, respectively. All patients (n=48) who had at least LGD reached complete eradication of dysplasia (CE-D) and 95.8% reached complete eradication of intestinal metaplasia (CE-IM). Of those patients that reached CE-D, 8.3% developed recurrence of dysplasia (n=4). In the sub-analysis, 74 patients (76.3%) received endoscopic therapy while 23 patients (23.7%) received endoscopic therapy then ultimately an esophagectomy. There were significantly more T1b lesions in the esophagectomy group compared to the EMR group ( p&lt;0.0001). Of all the patients in the EMR group, only 5.4% (n=4) had treatment related complications. Of patients receiving an esophagectomy, 60.9% (n=14) experienced treatment related complications. The mean length of stay for patients in the EMR group was 1.03 +/- 0.2 days, compared to 16.5 +/- 11.8 days for esophagectomy ( p&lt;0.0001).

Conclusions
EMR provides definitive and durable treatment for BE lesions classified as T1b or less severe, with fewer complications and a shorter length of hospital stay than esophagectomy.

Funding Agencies
Alberta Innovates Health Solutions
A133 EVALUATION OF DYSPHAGIA IN AN ACADEMIC CENTRE
Authors: Reed D E , Al-Zubide S , Beyak M J , Paterson W G 
Published: February 2022

Abstract

Background
Dysphagia is a common referral to gastroenterology with both benign and malignant etiologies. There is a lack of studies regarding its clinical assessment, complications and outcomes in Canada.

Aims
To evaluate the assessment and outcomes of secondary and tertiary level dysphagia referrals in adult patients.

Methods
We conducted a retrospective analysis of 98 consecutive adult patients who were initially referred for dysphagia to the Division of Gastroenterology at the Kingston Health Sciences Centre in 2015. Chart reviews were performed to assess demographics, characteristics of dysphagia, time for clinical assessment and outcomes.

Results
Of the referred patients, 19 did not present for their clinic appointment. The majority of patients (60%) were &gt;60 yrs old with an equal distribution of male and female patients. In the assessed patients, reflux was the most common etiology (55.5%) followed by oropharyngeal causes (13.5%) and motility disorders (12%). Only 3 patients of the cohort were diagnosed with esophageal cancer, 2 of whom had metastasis at the time of presentation. Time from referral to clinical assessment was &lt;4 weeks in just 30% and &gt;12 weeks in 55%. For the patients diagnosed with malignancy, 2 were assessed within of 2 weeks while the third patient was assessed and endoscoped at 12 weeks. In patients sent for endoscopy, 28% had an endoscopy &lt;4 weeks after assessment while 47% had endoscopy &gt; 12 weeks after assessment. Manometry was performed in 18% of the patients assessed. Information was available on the course of the dysphagia in 65 patients. Dysphagia had resolved or improved in 83%, remained unchanged in 14% and worsened in 3%.

Conclusions
Reflux-related dysphagia was by far the most common cause of dysphagia in this referral cohort. Wait times for clinical assessment greatly exceeded current CAG recommendations in the majority. Given current resource constraints, this highlights the need for improved referral information and patient care pathways in the management of patients referred with dysphagia.

Funding Agencies
None
A142 IMPACT OF HLADQA1*05G&gt;A GENETIC-SCREENING FOR OPTIMAL ANTI-TNF THERAPY IN INFLAMMATORY BOWEL DISEASE: A PRELIMINARY REPORT
Authors: Wilson A , Chande N , Ponich T , Gregor J C , Khanna R , McIntosh K , Sey M , Beaton M D , Kim R B 
Published: February 2022

Abstract

Background
Genetic variation in the human leukocyte antigen ( HLA) gene is strongly associated with the formation of anti-drug antibodies to tumor necrosis factor-alpha antagonists (anti-TNF) in inflammatory bowel disease (IBD). It is also associated anti-TNF loss of response and treatment discontinuation.

Aims
We aimed to evaluate the utility of preemptive HLADQA1*05G&gt;A screening to reduce the incidence of treatment-related adverse events in an IBD population by lessening the need for combination therapy in those who do not carry the risk allele. We also assessed for the occurrence of anti-TNF anti-drug antibody (ADA) formation, anti-TNF loss of response, treatment discontinuation compared to an unscreened population.

Methods
A non-randomized open label study is ongoing in IBD patients being considered for anti-TNF therapy. Participants received either pre-treatment HLADQA1*05G&gt;A screening (prospective-screening group, n=25/110 recruited), with the addition of one of azathioprine or methotrexate to anti-TNF therapy (combination therapy) if identified as a high risk variant carrier (G/A or A/A) or received combination therapy without undergoing prospective HLADQA1*05A&gt;G screening (control group, n=25/110 recruited). All participants will be followed for up to 1 year and observed for the occurrence of any adverse drug events, formation of anti-TNF drug antibodies (ADA), anti-TNF loss of response and anti-TNF discontinuation.

Results
To date, the prevalence of HLADQA1*05 G/A and A/A was 20% in the prospective-screening group and thus 20% (n=5/25) received combination therapy and 80% (n=20) received anti-TNF monotherapy. All participants in the control group (n=25/25) received combination therapy. Considering all groups, 78% (n=39/50) received infliximab, while 22% (n=11/50) received adalimumab. To date, the median follow-up period is 5 (IQR=4) months. Fewer adverse drug events have been reported in the prospective-screening group versus the control group (16.7% vs 33.3%, odds ratio 0.40, 95%CI=0.12–1.56, p=0.18). Anti-TNF ADA formation and treatment discontinuation were similar between groups (prospective-screening, 0% versus control, 4.2%). A higher proportion of controls experienced anti-TNF loss of response (16.7% vs 8.3%, p=0.38).

Conclusions
Preemptive HLADQA1*05G&gt;A screening appears to reduce the need for combination therapy when using anti-TNF agents in an IBD population. Fewer drug-related adverse events are reported to date in the screened cohort without a concomitant increase in deleterious outcomes such as ADA formation or anti-TNF discontinuation. Completion of this study will help define whether or not HLADQA1*05G&gt;A-screening is a clinically-actionable and relevant tool for guiding the application of combination therapy in IBD.

Funding Agencies
Lawson Health Research Institute
A148 IMPACT OF EXAMINATION UNDER ANESTHESIA PRIOR TO ANTI-TUMOR NECROSIS FACTOR THERAPY ON FISTULA HEALING FOR PERIANAL CROHN’S DISEASE PATIENTS: A COMPARATIVE COHORT STUDY
Authors: Fung M , Chan M , Chin Koon Siw K , Sabri E , McCurdy J 
Published: February 2022

Abstract

Background
Current guidelines recommend a combined approach consisting of an examination under anesthesia (EUA) and anti-TNF therapy for perianal Crohn’s Disease (PCD). However, the impact of this approach on fistula healing and long-term outcomes is unknown.

Aims
To assess the effect of EUA on fistula healing and long term outcomes in patients with perianal Crohn’s disese who are treated with anti-TNF therapy.

Methods
We performed a retrospective, single-center, comparative cohort study between 2009 and 2019. We compared patients with PCD who received EUA prior to anti-TNF therapy (combined therapy) to anti-TNF therapy alone. Our primary outcome was fistula closure by clinical assessment. Secondary outcomes included subsequent local surgery and fecal diversion. Logistic regression and multivariable cox-proportional hazard models adjusted for abscesses, concomitant immunomodulators, and time to anti-TNF initiation were performed.

Results
A total of 155 patients underwent 188 distinct anti-TNF starts: 66 (35%) after an EUA. Patients who underwent an EUA prior to anti-TNF therapy were more likely to have an abscess (50% vs. 15%; p &lt; 0.001) and concomitant immunomodulator usage (64% vs. 50%; p = 0.07). Otherwise, there were no differences between cohorts in age, smoking status, disease duration, and location of luminal disease. There were no significant differences in fistula closure at 3, 6, or 12 months between cohorts overall (Table 1). The results remained consistent in sensitivity analyses that excluded patients with abscesses and prior biologic treatment failure. The results were also similar when defining the combined therapy group as those with setons. After a median follow-up of 4.6 years (IQR, 5.95) patients who underwent an EUA prior to anti-TNF therapy were more likely to require a subsequent EUA (aHR 2.2; 95% CI, 1.3–3.6) (Figure 1) but not fecal diversion (aHR 1.3; 95% CI, 0.45–3.9).

Conclusions
In this single center study, combined therapy (EUA prior to anti-TNF therapy) was not associated with improved clinical outcomes compared with anti-TNF therapy alone. These findings suggest that EUA may not be necessary in every patient with PCD prior to initiation of anti-TNF therapy. Future prospective studies that control for fistula complexity are warranted.
Table 1: Unadjusted rates of fistula closure after anti-TNF therapy comparing patients with and without an exam under anesthesia

Funding Agencies
University of Ottawa Department of Medicine
A161 MUCOSAL TRANSCRIPTOMICS IN NON-INFLAMED ILEUM OF CROHN’S DISEASE PATIENTS SHOWS DIFFERENTIALLY EXPRESSED GENE PROFILE COMPARED TO ILEUM OF HEALTHY CONTROLS
Authors: Martinez-Lozano H , Nayeri S , Borowski K , Olivera Sendra P A , Leibovitzh H , Hernandez-Rocha C , Lee S , Stempak J , Silverberg M S 
Published: February 2022

Abstract

Background
The terminal ileum is the most susceptible location to develop Crohn’s disease (CD) and therefore is a valuable tissue to investigate biological mechanisms underlying chronic inflammation. Gene expression is highly affected by the level of inflammation, however, data on ileal transcriptomic profile in the absence of active inflammation is limited.

Aims
To investigate the ileal mucosal transcriptomic profile of CD patients in endoscopic and histologic remission compared to healthy controls (HC).

Methods
Ileal biopsies were collected during colonoscopy from patients with CD and HC. Biopsies were classified as non-inflamed based on endoscopic appearance and histologic criteria. Endo-histologic remission (EHR) was defined as simple endoscopic score &lt; 3 and absence of active histologic inflammation. We included CD patients with EHR and HC for the analysis of this study. CD phenotype was divided into isolated colonic CD (cCD) that included Montreal L2 and ileal predominant CD (iCD) that included Montreal L1 and L3. Total RNA was extracted from samples, sequenced using a HiSeq 2500 instrument (Illumina, San Diego, CA, USA) and differential expression analysis was performed in EdgeR. Genes that were differentially expressed at the average of 2-fold-change (FC) in mean expression and False Discovery Rate (FDR) &lt; 0.05 were considered significant.

Results
Ileal samples from 14 CD patients in EHR and 29 HC were included in the analysis. CD patients were significantly younger (median age 28.5 years, interquartile range (IQR)=24–40) compared with HC (median age 56 years, IQR=51–64). There were no differences in gender distribution (42.9% males in CD and 55.2% males in HC). We found 101 differentially expressed genes in CD patients compared to HC (99 genes were up-regulated and two were down-regulated). Dual oxidase 2 (DUOX2) and complement C6 were respectively the most significant up-regulated (logFC=4.45, FDR=1.3e-8) and down-regulated (logFC=-2.73, FDR=0.0006) genes in non-inflamed ileum CD group when compared with HC. In a subgroup analysis comparing ileal samples of CD patients with cCD (n=8) versus iCD phenotype (n=6), no differentially expressed genes were identified.

Conclusions
The mucosal transcriptomic profile of patients with inactive endoscopic and histologic ileal CD shows significant differentially expressed gene profile compared to ileal mucosa of HC. The clinical relevance of these findings should be further investigated.

Funding Agencies
IBD Genetics Consortium
A180 CLINICAL OUTCOMES OF COVID-19 AND IMPACT ON DISEASE COURSE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Wetwittayakhlang P , Albader F , Golovics P , Drügg Hahn G , Bessissow T , Bitton A , Afif W , Wild G , Lakatos P L 
Published: February 2022

Abstract

Background
The impact of COVID-19 has been of great concern in patients with IBD worldwide, including an increased risk of severe outcomes and/or flare of IBD.

Aims
This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD.

Methods
A consecutive cohort of IBD patients diagnosed with COVID was obtained between March 2020 - April 2021.

Results
A total of 3,516 IBD cohort patients were included. 82 patients (2.3%) were diagnosed with COVID infection (median age 39.0, 77% with Crohn’s disease). The prevalence of COVID-19 in IBD was significantly lower compared to the general population in Canada and Quebec (3.5% vs. 4.3%, p&lt;0.001). Severe COVID occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID infection was reported in 8 patients (9.8%) within 3 months. Age ≥55 years (OR 11.1, 95%CI:1.8–68.0), systemic corticosteroid use (OR:4.6, 95%CI:0.7–30.1), active IBD (OR:3.8, 95%CI:0.7–20.8) and comorbidity (OR:4.9, 95%CI:0.8–28.6) were associated with severe COVID. After initial infection, 61% received vaccinations.

Conclusions
The prevalence of COVID-19 among patients with IBD was lower than the general population. Severe COVID and flare of IBD were relatively rare. Older age, comorbidities, active IBD, and corticosteroid, but not biological therapy were associated with severe COVID.
Outcome of COVID-19 in IBD patients, disease course of IBD, and vaccination after COVID infection

Funding Agencies
None
A187 RISK FACTORS OF CLINICAL RELAPSES IN PEDIATRIC LUMINAL CROHN’S DISEASE, A RETROSPECTIVE COHORT STUDY
Authors: Sassine S , Djani L , Cambron-Asselin C , Savoie-Robichaud M , Lin Y , Fadela Zekhnine S , Qaddouri M , Grzywacz K , Groleau V , Dirks M , Drouin É , Halac U , Marchand V , Girard C , Courbette O , Patey N , Dal Soglio D , Deslandres C , Jantchou P 
Published: February 2022

Abstract

Background
Few risk factors are associated with the risk of relapses of Crohn’s disease in children.

Aims
The aims of this retrospective cohort study were to describe the rate of relapses in children with Crohn’s disease, its evolution over the past decade and to determine risk factors associated with relapse.

Methods
Patients under 18 years old and diagnosed between 2009 and 2019 were included. Patients clinical, endoscopic, histological, and laboratory characteristics, as well as their treatments, where collected from their medical records and the prospective CHU Sainte-Justine inflammatory bowel disease registry. Survival analyses and Cox regression models were used to assess the impact of those risk factors on relapse.

Results
639 patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of patients diagnosed between 2009 and 2014 experienced a relapse compared to 49.1% of patients diagnosed between 2015 and 2019 (p&lt;0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio (aHR)= 1.51, p=0.0009), high PCDAI (aHR= 1.02, p=0.04) and SES-CD (aHR= 1.03, p=0.03) scores at diagnosis, upper digestive tract involvement (aHR= 1.59, p=0.0003), exposure to oral 5-ASA (aHR= 1.91, p=0.0003), use of immunomodulatory agents compared to TNF-alpha inhibitors (methotrexate aHR= 1.91, p=0.0006; thiopurines aHR= 2.06, p&lt;0.0001), presence of granulomas (aHR= 1.27, p=0.04) and increased eosinophils on intestinal biopsies (aHR= 1.34, p=0.02), high levels of C-reactive protein (aHR= 1.01, p&lt;0.0001) and fecal calprotectin (aHR=1.09, p&lt;0.0001) during clinical remission and low serum infliximab levels during maintenance (aHR for mean serum infliximab level under 7ug/mL = 2.48, p=0.005).

Conclusions
Relapse risk was significantly associated with baseline clinical, endoscopic, histological and laboratory data and treatment strategies. These results could help better select treatment options for pediatric Crohn’s disease at induction and maintenance.

Kaplan-Meier curve representing patients time to relapse according to the mean infliximab level in post-induction.

Funding Agencies
NoneFonds Recherche Santé Québec / Fondation du CHU Sainte-Justine
A189 INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS POST RENAL TRANSPLANT:A CASE SERIES
Authors: Sethuraman A , Guttman O , Barker C , Skinn A 
Published: February 2022

Abstract

Background
Diarrhea in renal transplant recipients may be due to infection, medication induced colitis and post-transplant lymphoproliferative disease. Uncommonly a subset of these children develop denovo inflammatory bowel disease (IBD), despite being already immunosuppressed. Paucity of literature in the pediatric population has been noted.

Aims
To describe the clinical presentation, investigations and response to treatment in a cohort of children diagnosed with IBD post renal transplant

Methods
Patients diagnosed with IBD post renal transplant between January 1 - October 1, 2021 at BC Children’s Hospital were identified. Medical history, symptoms at presentation, histological characteristics, results of investigations and response to treatment were reviewed

Results
Data of 3 children were collected. Ages of the children were 11, 16 and 17 years (2 female). All patients had bloody diarrhea, abdominal pain and weight loss for 1 to 2 months. IBD diagnosis was made 8, 7 and 4 years respectively post renal transplant. All children were on maintenance immunosuppression with prednisone, MMF and tacrolimus. Bacterial, viral and parasitic causes were ruled out by relevant studies. All patients had negative anti-tissue transglutaminase.
Patient 1 (transplanted for renal dysplasia) was diagnosed with Crohn disease involving the antrum, ileum, and colon with rectal sparing. Fecal calprotectin (FC) was 1742 ug/g, CRP elevated at 56mg/L. Histology showed focally active chronic gastritis and changes in ileum with cryptitis and crypt dropout. The colon had features of moderate chronic active colitis with focal severe ulceration in the rectum. The patient achieved clinical remission on treatment with methylprednisolone, then started on vedolizumab in context of rising BK virus titre.
Patient 2 (transplanted for focal segmental glomerulosclerosis) was diagnosed with indeterminate colitis involving the IC valve and scattered colonic ulcers. FC was 674 ug/g and CRP and ESR were normal. Histology showed normal ileum, moderate active chronic changes in colon and rectal sparing. Clinical remission was achieved with oral mesalamine.
Patient 3 (transplanted for Bardet-Biedl syndrome) was diagnosed with indeterminate colitis with a colonoscopy that showed patchy colonic erythema and normal ileum. FC was 966 ug/g, and CRP and ESR were normal. Histology showed patchy chronic active colitis and mild active ileitis. Clinical remission was achieved with oral and rectal mesalamine.

Conclusions
Denovo IBD occurs in children post renal transplant and must be considered in the differential for ongoing diarrhea in these patients. It can be a challenge to distinguish between IBD and other causes of diarrhea. The patients in this series entered clinical remission in a short period of time. Further exploration of the pathogenesis of IBD in these immunosuppressed patients would be valuable

Funding Agencies
None
A195 GEOEPIDEMIOLOGICAL CHANGES DUE TO ALTERATIONS IN DIAGNOSTIC ROME CRITERIA FOR IRRITABLE BOWEL SYNDROME
Authors: Szilagyi A , Xue X 
Published: February 2022

Abstract

Background
Irritable bowel syndrome (IBS) is a positive diagnosis based on consensus opinions. The Rome (R) criteria, have gone through 4 rounds. R4 restricted diagnosis of IBS over R3, reducing global prevalence. Previously, there were no correlations of world distributions of IBS and Inflammatory Bowel Disease [IBD](Lovell). There are also epidemiological studies showing relationships between IBD and national wealth.

Aims
We reevaluate relationships among different R criteria and latitude(Lat), lactose digestion status (LNP), human development index(HDI), gross domestic product/capita(GDP/c), Crohn’s disease (CD and ulcerative colitis (UC) incidence(i) and prevalence(p).

Methods
Literature on world prevalence of national IBS (Oka,Sperber), IBD rates (Ng), and GDP (Lopez Ruiz) (4) were sought on PubMed and Google Scholar.National HDI(08 or 2016) were available on the internet (http://hdr.undp.org/en/data). National lactase distributions and latitudes were quoted (Szilagyi). Target dates were for the year 2008±8yrs. After log transformation of IBD incidence, Pearson’s correlations were carried out.(strong at; r ≥0.7, moderate ≥0.5, weak ≤ 0.49, negligible ≤ 0.3). (significance was p&lt;0.05).

Results
Correlations of HDI08 and HDI16 was 0.98. Comparisons of R2 and a composite based on Manning, R 1 and 2 (Lovell) was r = 0.96 (N21 countries), Correlation of R 3 and 4 were r = 0.85 (N17). Correlations of R2 and R3 or R4 were negligible (r = -0.2 (n15) and -0.12 (N22). Correlations of R2 and both economic metrics were weak but significant (r = 0.42 – r = 0.49, p &lt; 0.03 - &lt; 0.001). However, correlations of metrics with R3 were non significant and negligible with R4. Comparisons of R2 with LNP or Lat were negligible, but those of R3 or R4 with Lat were significant. Comparisons of R3 with CDp showed a strong correlation while R4 showed a weak but significant correlation with UCi. R2 had negligible correlations with IBD.

Conclusions
Although, these results are based on limited data variations in R criteria have changed relations with IBS prevalence.Earlier R criteria showed increased IBS in poorer nations. The recent R3 and R4 criteria are independent of national economy, but show more relations with increasing latitudes. Consequences of the change include R3 and 4 reflecting western society symptoms perhaps linking it more with IBD.It is unclear if this new relationship incorporates an irritable inflammatory bowel syndrome (Gajula).The generalizability therefore of the new R4 criteria may still be limited.
Table: Rome criteria compared to variables.
Statistical significance * &lt; 0.03, ** ≤ 0.05

Funding Agencies
None