bluuebunny/crossref_metadata_2025_split huggingface dataset:
A38 EVALUATING GLYCOCAGED DEXAMETHASONE IN SHIP-DEFICIENT MICE
Authors: Luzentales-Simpson M , Jung H , Menzies S , Ma W , Wang C , Brumer H , Sly L M 
Published: February 2022

Abstract

Background
Corticosteroids systemically reduce immune system activity thereby limiting inflammation in the GI tract. Corticosteroid use is limited by deleterious systemic effects including immunosuppression and adverse effects on growth and development (Giles et al., 2018). The metabolism of dietary polysaccharides, such as plant cell wall xyloglucan, by gut symbionts has been demonstrated to be mediated by niche members of the human gut microbiota (Larsbrink et al., 2014). By caging corticosteroids like dexamethasone (DEX) with xyloglucans to be released by microbiota at the site of disease, there is potential to increase efficacy and limit adverse effects.
Mice deficient in Src homology 2 domain-containing inositol polyphosphate 5’-phosphatase (SHIP-/-) develop spontaneous CD-like ileal inflammation (Ngoh et al., 2016). We have used SHIP-/- mice to compare the efficacy of DEX versus caged DEX to reduce intestinal inflammation.

Aims
Caged DEX will reduce CD-like ileal inflammation in SHIP-/- mice at a lower dose than uncaged DEX because it is released and acts at the site of inflammation.
To assess this hypothesis we propose 3 aims:
Measure decaging activity along the GI tract of SHIP-/- mice ex vivo
Determine the minimum effective dose of DEX required to reduce ileal inflammation in SHIP-/- mice
Determine if equimolar and lower concentrations of caged DEX can reduce ileal inflammation in SHIP-/- mice

Methods
Intestinal contents and feces were harvested from SHIP-/- mice. Decaging activity was measured ex vivo, using caged resorufin (a fluorescent reporter).
SHIP-/- mice were orally gavaged with dexamethasone (or vehicle), or the molar equivalent of caged dexamethasone from 6–8 weeks of age. At 8 weeks of age, gross and histopathology were assessed and IL-1β concentrations were measured in full-thickness tissue homogenates.

Results
SHIP-/- mice demonstrated decaging activity in the cecal, colon, and fecal contents assayed. DEX treatment (3 or 1 mg/kg) of SHIP-/- mice eliminated CD-like gross pathology and histopathology, and reduced IL-1β concentrations in full-thickness ileal tissue homogenates from SHIP-/- mice compared to untreated or vehicle-treated mice. DEX did not have any harmful effects on the intestines of SHIP+/+ mice. 1 or 0.3 mg/kg molar equivalent of caged DEX (3-fold lower concentrations) eliminated CD-like gross pathology in SHIP-/- mice compared to treatment with vehicle control. Additionally, the mean IL-1β concentration in tissue homogenates of mice treated with the molar equivalent of 1 mg/kg caged DEX was reduced

Conclusions
SHIP-/- mice express decaging activity are effectively treated by DEX, and caged DEX shows similar efficacy at reducing SHIP-/- ileal pathology at lower concentrations than uncaged DEX. In future experiments, we will examine caged DEX at a lower concentration, and in 2nd mouse model of intestinal inflammation.

Funding Agencies
GlycoNet
A40 IDENTIFYING NOVEL ROLES FOR TLR2 SIGNALING IN THE INTESTINAL EPITHELIUM USING ORGANOIDS
Authors: Chen Y , Allaire J M , Han X , Yang H , Crowley S M , Vallance B 
Published: February 2022

Abstract

Background
Inflammatory bowel disease (IBD) is thought to result from an imbalance between protective and damaging immune responses to the resident microbiota and other luminal antigens. Increasing evidence suggests that toll-like-receptor (TLR)-mediated innate immune dysfunction contributes to the pathogenesis of IBD. Among the receptors in the TLR family, TLR2 and its signalling pathway appears to play an important protective role in the gastrointestinal (GI) tract. Notably, our group previously discovered that Tlr2 expression by nonhematopoietic cells played an important protective role in the Citrobacter rodentium model of infectious colitis.

Aims
To determine if intestinal epithelial cells (IECs) control Tlr2 dependent tissue protective responses, we sought to characterize the role of Tlr2 signalling in intestinal organoids. In addition, to better define the role of Tlr2 during C. rodentium infection, we developed a novel in vitro model of C. rodentium infection using organoid-derived monolayers.

Methods
Organoids were derived from the colonic tissue of wild type (C57BL/6J) and Tlr2 deficient (-/-) mice and then stimulated with Tlr2 agonists, and their responses were evaluated by qPCR, ELISA, Western blot and immunostaining. In addition, 2D monolayers were grown from organoids, and infected with C. rodentium to explore whether Tlr2 signaling regulates other protective IEC functions such as barrier proteins and cell death in response to noxious stimuli.

Results
Stimulation of WT, but not Tlr2-/- mouse orgnaoids led to increased transcription of chemokine and cytokine genes Ccl20, Mcp-1, Cxcl1 and Tnf-α. This was accompanied by increased protein secretion through a NF-κB and p38 MAP kinase dependent mechanism. Interestingly, organoids derived from the distal colon displayed stronger Tlr2 responses than organoids from the proximal colon. During C. rodentium infection of monolayers, Tlr2 signaling had no effect on the distribution of tight junction proteins such as ZO-1 or Claudin3, however, Tlr2 did regulate levels of IEC apoptosis upon C. rodentium infection.

Conclusions
Our study demonstrates that colonic organoids express functional Tlr2, which upon stimulation, leads to pro-inflammatory responses as well as control over cell death. Our novel C. rodentium infection model enables us to further study the role of IEC in promoting host defense during bacterial infection. Futher work will examine how interactions with Tlr2 dependent cytokines (ie. IL-6, IL-22) impact IEC responses to C. rodentium.

Funding Agencies
CCC, CIHRCH.I.L.D
A54 DIETARY COMPONENTS ARE ASSOCIATED WITH FECAL CALPROTECTIN IN ULCERATIVE COLITIS
Authors: Chiu E , Taylor L , Ingram R , Panaccione R , Ghosh S , Ramay H , McCoy K , Reimer R , Raman M 
Published: February 2022

Abstract

Background
Ulcerative colitis (UC) is thought to arise from dysregulated immune responses due to intestinal dysbiosis and altered epithelial barrier function. Dietary components may affect the gut microbiome and contribute to either inflammation or its resolution. The relationship between diet and disease activity in UC warrants further investigation.

Aims
This prospective cohort study explored the relationship between dietary components, and markers of disease activity: fecal calprotectin (FCP) and partial Mayo score (PMS) in patients with UC.

Methods
40 participants were recruited from University of Calgary IBD clinics. Study staff obtained two 24-hour diet recalls using the validated automated self administered (ASA)-24 and captured PMS at baseline (T1) and follow-up at week 12 (T2). FCP samples were collected at T1 and T2. Diet variables included adjusted macro/micronutrients (n=44), food groups (n=36) and the validated Canadian healthy eating index-2009 (CHEI) where higher scores reflect healthier intake. CHEI captures intake of dark green and orange foods (DGO) and moderation scoring (MOD) of saturated fats (SF), sodium and added sugars. Higher CHEI scores result from increased intake of DGO and lower intake of SF, sodium and added sugars (higher MOD score). Associations with outcome variables were examined at T1 and T2 individually and across both timepoints (BT). Mixed effect logistic regression models identified relationships between dietary variables, FCP and PMS. Models were adjusted for age, sex, BMI, medications, probiotics, and for repeated measures in both timepoint analyses.

Results
A positive association was identified between FCP as a continuous variable and SF (T1:Coef=0.22, p_adj=0.02) and a negative association identified between FCP with citrus/melon/berries (BT:Coef=-1.01, p_adj =0.04), total sugars (BT:Coef=-0.06, p_adj=0.025) and HEI (BT:Coef=-0.13, p_adj =0.06 and T1 coef=-0.18, p_adj =7.0 e-5). FCP increased as SF (-0.30,p_adj=0.01), DGO (-0.60, p_adj=0.02), and MOD (-0.21, p_adj=0.02) scores decreased. The presence of inflammation (as a binary variable, FCP &gt;250) was negatively associated with higher fiber intake (BT: Odds Ratio (OR)= 0.016, CI(0.001,0.40) p_adj=0.08). For PMS as a continuous variable, HEI had a negative association with PMS (T2: -0.05, p_adj=0.06). With PMS as a discrete score (remission=PMS&lt;2) there was no significant association with any diet components.

Conclusions
This study suggests that a healthier diet, both in overall pattern and specific dietary components, was associated with lower FCP and PMS. Our findings related to SF, citrus/melons/berries, and DGO parallel the IOIBD dietary guidelines. Future research should explore through controlled intervention studies whether modifying dietary patterns and components independently reduces disease activity.

Funding Agencies
Crohn’s and Colitis Foundation
A67 ABC, EASY AS 123, SIMPLE AS GLUTEN-FREE? KNOWLEDGE AND ADHERENCE IN ADOLESCENTS WITH CELIAC DISEASE
Authors: Pohoreski K , Gidrewicz D 
Published: February 2022

Abstract

Background
Research shows that adolescents with celiac disease (CeD) are at great risk for non-adherence to the gluten-free diet (GFD), and that knowledge of the GFD may play a role in adherence.

Aims
The primary objective of this study was to examine the relationship between patient knowledge and adherence to the GFD in a local population of adolescents with CeD. Secondary objectives were to identify information sources used to learn about the GFD, and compare adolescent and parent knowledge of the GFD.

Methods
Adolescents with CeD (12–17 years) were recruited at pediatric gastroenterology clinics in Calgary, Alberta. Preliminary data was collected October 2020 to August 2021. Both the adolescent and a parent were asked to complete a 5 minute online survey received via email. Survey measures included a validated adherence scale (Biagi score) and a unique knowledge assessment (GFD-Q), adapted from a previously published questionnaire. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying 3/3 gluten-containing foods, at least 4/7 of gluten-free foods, and at least 4/7 foods that may contain gluten. Respondents submitted demographic and clinical information, as well as reviewed information sources used to learn about the GFD.

Results
Initial data were reviewed for 25 participant pairs (adolescent with respective parent), with a planned sample size of 40 participant pairs. Most adolescents (96%) reported adherence to the GFD (Biagi score of 3 or 4). Eleven (44%) adolescents had sufficient knowledge of the GFD. About 90% of adolescents correctly identified which foods to question, however, 20% did not correctly identify a gluten-containing food (namely malt), and 36% did not identify most gluten-free foods (such as maltodextrin and balsamic vinegar). Parents scored higher on the GFD-Q with 17/25 (68%) demonstrating sufficient knowledge. Interestingly, of the 11 adolescents with sufficient knowledge, 10/11 (91%) respective parents also had sufficient knowledge. Most adolescents and parents identified the gastroenterologist, another individual with CeD, and Google as helpful information sources. Adolescents also indicated their parents were a helpful information source.

Conclusions
While the study is still enrolling to reach sample size, we acknowledge that most adolescents in our study report being adherent to the GFD. However, their reported knowledge is variable, especially in knowing which foods are safe to eat. Thus, education should also focus as much on which foods to avoid, as well as safe foods to consume. Parent knowledge of the GFD may have a role in adolescent knowledge. At study completion, descriptive statistics will be used to examine participant characteristics and identify trends to assist in the development of future health education for adolescents with CeD.

Funding Agencies
Canadian Celiac Association - James A.Campbell Research Fund
A80 CANADIAN NEUROGASTROENTEROLOGY NETWORK (CNN) SURVEY ON PH/MOTILITY TESTING IN CANADA
Authors: Reed D E , Beyak M J , Rodrigues D , Vanner S , Paterson W G 
Published: February 2022

Abstract

Background
Anecdotal reports suggest that access to pH/motility testing is problematic in Canada, but to date there is little data documenting this.

Aims
To assess the volume and accessibility of motility lab testing in Canada.

Methods
The CNN developed a questionnaire directed at the scope, volume and accessibility of pH/motility testing in Canadian labs. Fifty-three labs were identified using lists provided by companies that supply pH/motility recording equipment in Canada. Of these, 12 labs were excluded (10 had incorrect or absent contact information, 1 had recently closed and 1 had just opened). Questionnaires were sent in early 2020 to the remaining 41 labs, and respondents were asked to use data from their last fiscal year pre-pandemic.

Results
26 completed questionnaires were returned (i.e., 63% response rate, but representing ~ 51% of active labs): 23 adult units (7 community, 15 academic and 1 private) and 3 academic pediatric units. Of the adult units, 6 performed studies in children &lt;12 yrs old. All 3 pediatric units provided both esophageal and anorectal high-resolution manometry (HRM) and pH/Impedance recording, with wait times of &lt; 3 months. All 23 adult labs provided esophageal HRM, but just 50% performed anorectal manometry and only 3 anorectal manometry with biofeedback. Ambulatory pH/Impedance was performed in all but 1 adult unit. 15 of 23 adult centres reported access to colon transit studies and only one performed colonic manometry. No units performed antroduodenal manometry. Five units offered Bravo wireless pH recording and 4 performed ENDOFLIP. In adult units, the median number of procedures per year were as follows: esophageal HRMs - 278 (range: 50–1140); pH/impedance - 225 (range: 40–634); anorectal manometry - 90 (range: 10–450). Corresponding median wait times in months were as follows: esophageal HRM - 4 (range: 0.5–14); pH/Impedance - 4.5 (range: 0.5–14); anorectal manometry - 4.6 (range: 2–9). Only 6 of the 23 adult units met recommended wait time targets of &lt;2 months. Testing was performed by a nurse in ~ 80% of centres, while testing was done by technicians in 2 units and physicians in 3 units. 8 units accepted referrals from primary care physicians, whereas the remainder only accepted specialist referrals. 50% screened referrals for appropriateness and restricted access accordingly.

Conclusions
The scope of motility and pH testing across Canada is variable, with lower GI testing lacking in many regions. Wait times vary significantly across labs and the majority of centres exceed recommended limits of 2 months. The reasons underlying the identified limitations to pH/motility testing access warrant further study.

Funding Agencies
None
A84 SECURE ELECTRONIC DOCUMENT SIGNING UPTAKE IN BIOLOGIC PRESCRIBING FOR IMMUNE MEDIATED DISEASES
Authors: Sharma S , Jones J , Stewart M 
Published: February 2022

Abstract

Background
The COVID-19 pandemic drastically impacted workflows in gastroenterology practice. Physicians managing immune-mediated diseases (IMDs) must complete special authorization (SA) and prescription renewal (Rx) forms for patients on biologic therapy. This adds significant administrative burden potentially leading to delays in therapy initiation and care continuity. Historically, document completion has largely been paper-based, with forms faxed between patient support programs (PSPs) and physician offices. Disruption of normal office processes during the pandemic necessitated the movement of existing paper-based workflows online. The use of secure electronic document signing (SEDS) platforms has allowed physicians to receive and complete documents digitally.

Aims
To evaluate the impact of SEDS-based biologic documentation on clinical practice. Objectives were 1) to determine if the use of SEDS platforms increased timeliness of document returns compared to traditional workflows 2) assess whether SEDS usage is acceptable and sustainable and 3) assess MD satisfaction with SEDS platforms.

Methods
This was a retrospective audit of SEDS and paper-based biologic document workflows from a single PSP (Abbvie Care). Outcomes of interest were the number of documents completed monthly using SEDS, new monthly users, and the number of active monthly users between April 1, 2020-March 31, 2021. Time (days) to SEDS completion (vs. paper process) was determined by reviewing timepoint data for SA and Rx documents from May 2019-January 2020 (‘pre- SEDS’) and for SEDS documents from May 2020-January 2021(‘SEDS’). The return time (RT) was defined as the time between date sent to a physician’s office by the PSP to the date returned to the PSP. Documents in the pre-SEDS cohort with a RT exceeding 30 days were excluded

Results
In totality, 5573 SA and Rx documents were completed by 383 physicians using the SEDS platform from April 2020-March 2021. A mean of 14.6 (sd 21.8) documents were signed per physician. The number of monthly electronic documents processed increased from 104 in April 2020 to 800 in March 2021. Active monthly users increased from 24 in April 2020 to 213 in March 2021 (31 new users monthly). A total of 19,387 paper documents were processed during the ‘pre-SEDS’ period and 3,317 electronic documents processed in the ‘SEDS’ period. The mean RT in the ‘pre-SEDS’ period was 8.03 days (Sd 8.2) and the ‘SEDS’ period was 1.11 days (sd 2.6).

Conclusions
This data demonstrates acceptability, appropriateness, and improved processing efficiency of a SEDS platform improving timeliness of patient care. Next steps in this research include surveying physicians to understand the work-flow impact of SEDS, functionality, long-term sustainability, satisfaction and impacts on disease related outcomes.

Funding Agencies
None
A88 UNDERSTANDING NURSE PERCEPTIONS OF CARING FOR PATIENTS WITH ALCOHOL USE DISORDER: A CROSS-SECTIONAL STUDY
Authors: Hyde A , Johnson E , Bray C , Meier T , Carbonneau M , Spiers J , Tandon P 
Published: February 2022

Abstract

Background
Alcohol Use Disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. AUD increases morbidity and mortality and has a substantial impact on daily functioning including quality of life, relationships and employment. AUD is particularly detrimental in patients who already have liver damage like cirrhosis. The management of AUD includes screening, brief intervention and referral to treatment for psychological and pharmacotherapy based treatment. People with AUD have frequent interactions with the healthcare system. These interactions represent opportunities to engage patients with therapy. As front-line workers who have maximal contact with patients, nurses practicing in acute care are in an ideal position to initiate AUD related discussion with patients. Prior to the design of an educational intervention to increase nursing engagement with AUD screening and brief intervention, there is a need to understand baseline knowledge, attitudes and perceptions in this group.

Aims
The aim of the present study was to explore the knowledge, attitudes and perceptions of nurses caring for patients with cirrhosis and AUD.

Methods
We conducted a cross-sectional survey using the Survey of Attitudes and Perceptions (SAP). The SAP is derived from a validated tool to assess attitudes and perceptions towards patients with AUD. Anonymous surveys were distributed on inpatient medicine units across 5 geographic zones in Alberta between September 2019-March 2020. Data were analyzed using descriptive and inferential statistics.

Results
A total of 93 nurses from 7 inpatient medicine units across Alberta participated in the study. The majority of participants were Registered Nurses (74.9%), who practiced in an urban setting (69%), and had worked in their role for an average of 9.9 years. Few (22.6%) participants reported any prior structured education on caring for patients with AUD, with the majority reporting limited knowledge of alcohol and effects of alcohol consumption. Though most reported that caring for patients with AUD was part of their professional role, only 15.7% felt motivated to work with this group of patients. Responses to individual questions or sub-domains of the survey did not significantly differ by length or time in professional role, or practice setting.

Conclusions
Our results indicate that nurses have limited knowledge on caring for patients with AUD. Given the importance of AUD in the development and progression of cirrhosis as well as the frequency of hospitalizations for patients with cirrhosis, increasing nurse knowledge of AUD is crucial to improving the quality of care for these patients. The results of this study will be used to inform the development of an educational intervention to increase nursing knowledge of caring for patients with cirrhosis and AUD.

Funding Agencies
Alberta Innovates
A92 EDUCATIONAL INTERVENTIONS TO IMPROVE ERGONOMIC PERFORMANCE IN GASTROINTESTINAL ENDOSCOPY: A SYSTEMATIC REVIEW
Authors: Bansal R , Scaffidi M , Gimpaya N , Fecso A , Khan R , Li J , Torabi N , Shergill A , Grover S 
Published: February 2022

Abstract

Background
Physicians in procedural specialties, such as gastrointestinal endoscopy, are at a high risk of musculoskeletal injuries (MSPI) which can affect physician wellness and productivity. Training in ergonomic principles for endoscopy may help reduce and prevent the incidence of MSPI.

Aims
The aim of this systematic review was to identify educational interventions using ergonomic strategies that target the reduction of MSPI and/or pain from GI endoscopy.

Methods
We conducted a systematic search following PRESS guidelines in MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews for articles published from inception to December 16, 2020. Studies were included if they investigated educational interventions aimed at changing knowledge and/or behaviours related to ergonomics in gastrointestinal endoscopy. After screening and full-text review, we extracted data on the study design, participants, type of training and assessment of primary outcomes. We evaluated study quality with the Medical Education Research Study Quality Instrument (MERSQI). A qualitative synthesis of the data was conducted.

Results
Of the initial 575 records identified in the search, 5 met inclusion criteria for qualitative synthesis. We found that most studies (n=4, 90%) were single armed interventional studies that were conducted in simulated and/or clinical settings. The most common types of intervention were didactic sessions and/or videos (n=4, 80%). Other interventions included individualized feedback (n=2, 40%), checklists (n=2, 40%), and simulated training (n=1, 20%). Two (40%) studies used both standardized assessment studies and formal statistical analyses to assess primary outcomes. All included studies reported a benefit of their interventions on their respective dimensions assessed for ergonomics. The mean MERSQI score was 9.7.

Conclusions
There is emerging literature demonstrating the effectiveness of interventions to improve ergonomic performance in gastrointestinal endoscopy, which is likely to reduce MSPI among endoscopists. Further higher quality research in this field is required to make robust recommendations.

Study flow diagram

Funding Agencies
None