Journal of the Canadian Association of Gastroenterology最新文献

{"title":"A91 PYOGENIC LIVER ABSCESSES DUE TO FUSOBACTERIUM NUCLEATUM ARE ASSOCIATED WITH SEVERE INFLAMMATORY RESPONSE AND ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"N. Hossein-Javaheri, M. Cloutier, C. Dennis, M. Ramesh, I. Singh, A. Aijaz, H. Gohil, C. J. Miranda","doi":"10.1093/jcag/gwad061.091","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.091","url":null,"abstract":"Abstract Background Pyogenic liver abscesses (PLAs) are uncommon entities with potentially devastating consequences requiring early diagnosis and treatment. Fusobacterium nucleatum is an anaerobic, gram-negative bacterium that is a rare cause of liver abscesses. F. nucleatum initiates a severe pro-inflammatory cascade that promotes abscess formation through the gut-liver axis especially when the gastrointestinal (GI) barrier is compromised. Aims In this study, we explore the characteristics of PLAs due to F.nucleatum, including the duration and mode of therapy. This may inform clinical decisions when treating persons with suspected F.nucleatum PLAs and improve mortality. Methods A systematic literature search was conducted in MEDLINE, PubMed, and the Cochrane Library, from 1977 to September 2023. We included full-text abstracts and articles written in English that reported patients with F.nucleatum PLA aged ampersand:003E18. Demographics, history of GI diseases, pertinent laboratory markers, abscess characteristics, and the approaches taken to treat the abscess were collected. Pooled data were assessed qualitatively and reported as mean±SEM when appropriate. Results We included 32 studies. The mean patient age was 52±20 years with 71% being male. In total, 47% of patients had a recent history of GI disease: sigmoid diverticulosis (n=6), colonic adenomas (n=5), duodenitis (n=2), appendicitis (n=1) and ulcerative colitis (n=1). On presentation, only 53% (n=17) reported abdominal pain. Labs were significant for leukocytosis at 22±2 K/µL, C-reactive protein 199±37 mg/L, aspartate transferase (AST) 128±24 U/L, alanine aminotransferase (ALT) 116±16 U/L, Alkaline phosphatase (ALP) 275±35 IU/L, and bilirubin 11±3 mg/dL suggestive of severe inflammatory response and cholestatic liver injury. The average abscess size was approximately 10.2±0.7 cm, 28% of which had loculations (n=9) requiring multiple drainages (n=7) or laparoscopy (n=2). The initial antibiotic of choice was piperacillin/tazobactam (Zosyn) (n=12), ceftriaxone + metronidazole (n=7), Ampicillin/Sulbactam (Unasyn) (n=5), followed by Meropenem, Metronidazole, and Ciprofloxacin. The estimated length of stay was 23±4 days with a need for long-term antibiotic therapy (54±10 days) upon discharge. The majority of patients were discharged on Metronidazole (n=11), or Amoxicillin/Clavulanic acid (Augmentin) (n=6). With appropriate source control, the estimated survival was 91% (n=29). Conclusions Our findings suggest that PLAs due to F.nucleatum are associated with large abscesses, a severe inflammatory response, cholestatic liver injury, and prolonged hospitalization. Multiple drainages with targeted gram-negative coverage may be required for adequate source control and favorable outcomes. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"146 1","pages":"64 - 65"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139837899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A38 EXPLORING HOW BOWEL PREPARATION CAN AFFECT INFLAMMATORY BOWEL DISEASE VIA THE GUT MICROBIOTA","authors":"C. Clayton, K Ng, C. Tropini","doi":"10.1093/jcag/gwad061.038","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.038","url":null,"abstract":"Abstract Background Inflammatory bowel disease (IBD) is a debilitating disorder that targets the gastrointestinal (GI) tract. Although its causes remain unknown, recent studies have identified changes to the gut microbiota associated with IBD. While most gut bacteria are essential for GI health, pathobionts are bacteria that are prevalent in IBD patients and that can act as pathogens and induce inflammation. IBD patients undergo routine endoscopies which require the administration of laxative-based bowel prep to clear out the luminal contents of the GI for the endoscope. It has been found that after bowel prep some IBD patients experience inflammatory flareups. IBD patients may experience adverse reactions following bowel prep, including increased inflammation, emergency room visits, and medication adjustments. Importantly, bowel prep perturbs the gut microbiota, depleting beneficial microorganisms, while allowing pathobiont strains to thrive, which could be the cause for worsened symptoms post-bowel prep in some patients. Aims We hypothesize that the altered intestinal microenvironment during bowel prep causes commensal bacteria depletion and favours osmotolerant pathogenic species that lead to increased inflammation in two systems: 1) in a model disease-causing microorganism, Salmonella enterica 2) in an IBD microbiota. Methods To investigate pathogen expansion after bowel prep a Salmonella mouse model was established. Microbiota changes were determined by 16S rRNA sequencing and spot plating. Changes to the gut environment and the mechanism for pathogen colonization were characterized using Salmonella mutants and confocal imaging. To identify changes to the IBD microbiota, a humanized mouse model was established, and microbiota changes were investigated as done in the Salmonella model. IBD-associated pathobiont growth was also characterized in in vitro conditions that were identified in our in vivo model. Results We have demonstrated that bowel prep increases GI osmolality and leads to increased Salmonella colonization in the gut and systemic organs following bowel prep unlike mice treated with vehicle, supporting our hypothesis. We then explored the effects of bowel prep in a humanized mouse model of IBD, which showed increased translocation of bacteria from the gut to internal organs post-prep. Additionally, IBD-associated pathobionts were able to grow much greater than commensal strains highlighting that IBD pathobionts can persist in the gut after bowel prep. Conclusions Our study highlights that bowel prep disrupts the gut microbiota and the intestinal environment allowing for pathogen colonization and bacterial translocation. Therefore, bacterial translocation could provide mechanistic insight for inflammatory flareups following bowel prep. Ultimately, our research underscores the importance of the gut environment in facilitating pathobiont exacerbation of IBD. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"76 ","pages":"21 - 22"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A126 IMPACT OF TIME OF DAY ON PROCEDURAL OUTCOMES IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS FROM A TERTIARY REFERRAL CENTER","authors":"M. Deeb, N. Sabrie, K. Khalaf, N. Calo, J. Mosko, N. Forbes, S. Grover","doi":"10.1093/jcag/gwad061.126","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.126","url":null,"abstract":"Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an established diagnostic and therapeutic tool for hepatobiliary disease. Given its technical demands, it remains one of the highest-risk endoscopic procedures. Addressing modifiable factors, such as operator fatigue, may mitigate procedural risk. In colonoscopy, there is conflicting data on whether procedure time of day, as a surrogate of operator fatigue, affects outcomes, with some literature demonstrating decreased procedure completion and polyp detection rates in the afternoon. There is a paucity of data evaluating this potential relationship in ERCP. Aims To evaluate the impact of procedure time of day on procedural success and short-term adverse outcomes in patients undergoing ERCP. Methods A retrospective review of ERCP's performed on adult patients at our tertiary referral center from January 1, 2011 to December 31, 2020 was performed. The primary outcome was the procedural success rate, defined as successful navigation to the papilla, selective duct cannulation and cholangiography, and realization of the intended therapeutic goals. Secondary outcomes included procedure duration, rate of deep ductal cannulation, rate of sphincterotomy, and short-term (30-day) adverse events (immediate bleeding, delayed bleeding, pancreatitis, perforation). Statistical analysis was conducted using R. Categorical variables were compared using the Chi-square test of independence or Fisher’s exact test. Continuous variables were compared using T-tests or the Mann-Whitney-U test. Results A total of 5755 ERCP’s were performed between 8 AM – 6 PM; 2863 were performed before 12PM (AM group) and 2892 after 12PM (PM group). Baseline characteristics were similar between the two cohorts, with the exception of hypertension (33.7% AM vs 30.1% PM; p=0.003), and anticoagulation (20.3% AM vs 18.3% PM; p=0.05). In both groups, the most common ERCP indication was choledocholithiasis. The primary operators in both cohorts were clinical fellows. There was no difference in procedural success rate (87.0 % AM vs 86.7% PM; p = 0.72), procedure duration (33.6 minutes AM vs 32.9 minutes PM; p = 0.29), rates of deep cannulation (82.6% AM vs 83.0% PM; p = 0.81) and sphincterotomies (63.2% vs 62.7%; p = 0.68). Rate of adverse events were similar, with slightly higher rates of immediate bleeding in the AM group (5.0% AM vs 3.8% PM; p = 0.03). Results were similar in a subgroup analysis of patients with altered anatomy. Conclusions In this large retrospective review of ERCPs performed at a tertiary referral center, the procedure time of day did not impact procedural success rate. There were slightly higher rates of immediate bleeding in the AM group, though this may be explained by higher rates of anticoagulation in that group. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"25 ","pages":"95 - 96"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A240 THE PROTECTIVE EFFECT OF HYMENOLEPIS DIMINUTA INFECTION IN EXPERIMENTAL COLITIS CAN BE INDEPENDENT OF IL-4RΑ SIGNALING","authors":"L. Kraemer Rocha, S Li, S. Rajeev, A Wang, D. McKay","doi":"10.1093/jcag/gwad061.240","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.240","url":null,"abstract":"Abstract Background Helminth parasites are potent inducers of Th2 immunity, characterized by the production of IL-4, IL-5, IL-13 and IL-10, and mobilization of regulatory cells. This orchestrated immune response establishes an immunomodulatory and/or immunosuppressive environment that may be protective against colitis and other inflammatory diseases. Earlier studies reveal that infection with the tapeworm parasite Hymenolepis diminuta ameliorates chemical-induced colitis in immunocompetent mice, and highlighted participation of the anti-inflammatory cytokine IL-10 in the mechanisms of protection. Moreover, the IL-4ra/STAT6 signaling pathway plays a pivotal role in promoting the Th2 immune response that is crucial for parasite expulsion: IL-4ra KO mice cannot expel the worm. However, the need for activation of IL-4rasignaling in the suppression of colitis by H. diminuta infection is unknown. Aims To determine if the inhibition of DNBS-induced colitis evoked by infection with H. diminuta requires IL-4ra signaling. Methods IL-4ra KO mice (n=4-8/group) were orally infected with 5 viable cysticercoids of H. diminuta and 8 days post-infection (dpi) were treated with 2.5 mg of dinitrobenzene sulfonic acid (DNBS). Subsequently, mice were assessed 72h post-DNBS. Disease was assessed by macroscopic disease activity score, colon length, weight loss, MPO activity of the colon, and leucocyte profile by blood count. Production of IL-10 by concanavalin-A (con-A; 48h)-stimulated splenocytes was measured by ELISA. Results An increase in blood eosinophilia in H. diminuta infected mice indicated a successful infection. DNBS treatment induced acute colitis in IL-4ra KO mice, and surprisingly prior infection with H. diminuta resulted in significantly less severe colitis, as evidenced by reduction in macroscopic disease activity score, prevention of weight loss, reduced MPO colon levels and maintenance of regular colon length. However, splenocytes from H. diminuta-infected IL-4ra KO mice did not show increased IL-10 production evoked by con-A compared to cells from non-infected mice. Conclusions These results indicate that the protection against DNBS-induced colitis by prior infection with H. diminuta can occur in the absence of IL-4ra signalling. This suggests redundancy in the anti-colitic effect of infection with this helminth parasite, such that absence of IL4ra is compensated for via another, yet to be determined, mechanism. We speculate that this may be via participation of type 2 innate lymphoid cell activity, mobilization of regulatory T cells or innate immunity: all possibilities that need to be rigorously tested. Funding Agencies CIHRBeverly Phillips Rising Star and Cumming School of Medicine (U. Calgary) Fellowships","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"44 3","pages":"193 - 194"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A75 PEDIATRIC ABDOMINAL PAIN PRESENTING TO A HOSPITAL-BASED GI CLINIC: EVOLUTION AND DISPOSITION","authors":"H. Brill, R Patel","doi":"10.1093/jcag/gwad061.075","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.075","url":null,"abstract":"Abstract Background Abdominal pain accounts for 50% of pediatric gastroenterology consultations. While data exists on the possible etiologies of abdominal pain, there is a paucity of data on the natural evolution of abdominal pain while under the care of a Pediatric Gastroenterologist. Given limited access to Pediatric Gastroenterologists and long waiting times for initial consultation for abdominal pain, understanding what interventions ameliorate pain may help Gastroenterologists advise referring physicians while the patient awaits a consultation. Aims Primary outcome measure was the percentage of patients who reported at least a 75% subjective improvement of pain over baseline consultation. Methods A retrospective chart review between April 2014 and Dec 31, 2022 was taken in a hospital based GI clinic. Subjects referred for assessment of abdominal pain were identified, along with subjects referred for reflux and dysphagia as a comparator group. Subsequent visits were abstracted to identify diagnosis disposition and assess which interventions were tried and to what extent they succeeded. Patient loss to follow up were also measured. Results were summarized using descriptive statistics, and regression modeling will be attempted to identify predictors of response. Results 393 subjects were referred for abdominal pain and 286 for GERD and dysphagia. 439 (64.7%) reported at least 75% improvement in symptoms. 242 (35.6%) underwent endoscopy, 263 (38.7%) used Proton Pump Inhibitors, and 38 (8.54%) used Polyethylene Glycol-3350. Carbohydrate eliminations of various types were used in 13.5 - 27% of subjects with pain. 193 subjects (28.5%) were ultimately lost to follow up though some did report improvement in symptoms. Only 45 (6.6%) remained in active care by the end of the study while only 13 (1.93%) were transitioned to an Adult Gastroenterologist at 18 years old. Conclusions Pediatric Abdominal Pain is primarily a transitory population in the Pediatric GI clinic, with a large number responding to successive interventions. There is also a sizable minority who are lost to follow up. Future studies should attempt to identify the reasons for loss to follow up and ultimate disposition. Funding Agencies William Osler Health System Summer Student Research Program","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"54 ","pages":"51 - 52"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A293 PREVALENCE OF METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE AND ITS IMPACT ON ADVERSE OUTCOMES IN PRIMARY BILIARY CHOLANGITIS PATIENTS","authors":"R. Kaviani, Y. Wong, D. Shreekumar, A. Mason, A. Montano Loza, E. Lytvyak","doi":"10.1093/jcag/gwad061.293","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.293","url":null,"abstract":"Abstract Background Metabolic associated steatotic liver disease (MASLD) is highly prevalent among Canadians, thus making coexistence with other liver diseases inevitable. Primary biliary cholangitis (PBC) is the most common autoimmune liver disease diagnosed in one out of 1,000 women above 40. The impact of concomitant MASLD on liver outcomes in patients with PBC is unclear. Aims We aimed to determine the prevalence of MASLD among patients with PBC and the association between concomitant liver disease and adverse liver outcomes. Methods PBC patients diagnosed between 1984 and 2023 and followed up at the University of Alberta with vibration-controlled transient elastography data available were included. MASLD was diagnosed if the Controlled Attenuation Parameter ≥288 dB/min with at least one cardio-metabolic criteria, based on elevated body mass index, blood pressure, and abnormal glycemic and lipid tests. Proportions were compared using chi-square, medians – Mann-Whitney test. We utilized a Cox hazards regression model to calculate hazard ratios and determine associations between MASLD and the development of cirrhosis or decompensation, need for liver transplant, or death. Results A total of 115 patients (87.0% females, age at diagnosis 52.3±11.5 years) followed over a median duration of 11.0 [range 0.1-39.7] years) were included. The prevalence of MASLD (33.0% [n=38]) was higher in females than males (35.0%[n=35] vs. 20.0%[n=3]; p=0.249). The prevalence of cirrhosis at diagnosis was twice as high among PBC patients with MASLD than those without (26.3%[n=10] vs. 13.0%[n=10]; p=0.076). No difference was observed in the frequency of decompensation at diagnosis (8.8%[n=3] vs. 6.3%[n=4]; p=0.638). Cirrhosis frequency (50.0% vs. 50.6%; p=0.948) and decompensation (38.2% vs.37.1%; p=0.912) over the course of the disease were similar between PBC patients with and without MASLD. There was no association between MASLD and development of cirrhosis (HR0.51, 95%CI 0.23-1.13; p=0.095), decompensation (HR0.81, 95%CI 0.37-1.76; p=0.596), liver transplantation (HR0.72, 95%CI 0.19-2.72; p=0.628), or death (HR0.69, 95%CI 0.22-2.16; p=0.519). PBC patients with MASLD have comparable event-free (median 10.7 [3.1-30.8] vs. 10.7 [0.1-23.3] years; p=0.684) and overall survival (median 11.3 [3.2-39.7 vs. 10.7 [0.1-23.3] years; p=0.456). Conclusions Every third patient with PBC had MASLD, which tended to be more prevalent among females. We did not observe any significant differences in the development of adverse liver outcomes between patients with PBC and concurrent MASLD in comparison to those without. Studies with larger sample sizes are necessary to further explore the potential impact of MASLD on liver outcomes. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"33 3","pages":"237 - 238"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A194 EARLY LIFE WESTERN-TYPE DIET ACCELERATES THE ONSET OF MURINE IL-10 KO COLITIS","authors":"M. Ren, A. Luchak, C. Dang, D. Philpott, K. Croitoru","doi":"10.1093/jcag/gwad061.194","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.194","url":null,"abstract":"Abstract Background Early life is a critical time for gut microbiome and immune development, including the establishment of proper host-microbe interactions. While exposures to western world environmental factors are associated with inflammatory bowel disease (IBD) susceptibility, the link between environment in early life and later disease onset is unclear. One of the most important western world environmental factors is diet, which can distinctly alter the gut microbiome. We believe an early life western-type diet (WD) can affect disease progression in a murine IL-10 KO colitis model through dysregulated T-cell responses against the microbiome. Aims We aimed to characterize how an early life WD given to IL-10 KO mice would affect colitis development and the gut microbiome. Methods IL-10 KO mice were housed in specific pathogen free conditions and fed normal chow (NC) or WD ad libitum, either between days 10 to 35 (early WD, eWD) or days 35 to 60 (adolescent WD, aWD). Stool was collected from mice at days 35, 56, and 84 for lipocalin-2 (LCN-2) and 16S rDNA sequencing. Mice were sacrificed at day 84, assessing mesenteric lymph node weight, gene expression, colon damage by histopathology, and colon lamina propria leukocyte (LPL) phenotype and cytokine expression by flow cytometry. Results Compared to NC and aWD, the eWD fed IL-10 KO mice displayed increased fecal LCN-2 at days 56 and 84, indicating greater inflammation. At sacrifice, eWD fed mice had larger mesenteric lymph nodes and more significant colon damage by histopathological scoring. Colon LPL preparations showed that eWD fed IL-10 KO mice had higher proportions and absolute numbers of effector and regulatory T-cells. Additionally, higher proportions and absolute numbers of those T-cells were IFNγ+, IL-17A+, and IL-22+. qPCR of distal colon tissue revealed increased gene expression of innate and type 3 proinflammatory cytokines such as Il1b, Tnfα, and Il23, while showing no change in Il6 and Il4. Taxa positively associated with WD were able to establish a persistent niche in eWD fed mice but not in aWD fed mice. An increase in only one specific taxon was associated with eWD at all timepoints while also most strongly correlating with inflammatory markers. Conclusions This data suggests that eWD feeding during gut microbiome and immune development is uniquely capable of increasing long-term susceptibility to intestinal inflammation in IL-10 KO mice. This appears to be associated with persistent colonization of potentially more inflammatory taxa. This work provides insight into the potential role of early life environmental risk factors, i.e. WD, in the later development of IBD. Funding Agencies CAG, CIHRUniversity of Toronto, Taconic Biosciences","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"68 ","pages":"152 - 153"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A242 EPIDEMIOLOGICAL ASPECTS, RISK FACTORS, AND CUMULATIVE PREVALENCE OF EXTRAINTESTINAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASE: RESULTS FROM A 7,150 PATIENTS’ COHORT IN A TERTIARY CARE CENTER","authors":"E. Lytvyak, A. Montano Loza, B. Halloran, F. Hoentjen, A. Mason, F. Peerani, K Wong, R. Fedorak, L. Dieleman","doi":"10.1093/jcag/gwad061.242","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.242","url":null,"abstract":"Abstract Background Canada is among the countries with a high burden of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Extraintestinal manifestations (EIMs) incorporate a spectrum of systemic IBD-accompanying conditions that are associated with a poorer quality of life, higher disease activity, and increased need for IBD-related surgery and treatment escalation. Aims We aimed to establish the all-time and cumulative prevalence of EIMs in a large cohort of IBD patients and assess the risk factors associated with EIMs in IBD. Methods We conducted a retrospective cohort study of 7,150 IBD patients followed at the Division of Gastroenterology, University of Alberta, diagnosed between 1954–2022, with 159,026 person-years follow-up. Data were obtained via manual chart review, from electronic medical records and administrative reporting systems. The EIMs included ophthalmological, musculoskeletal, urogenital, hepatobiliary, dermatological, and pulmonary. Univariate and multivariate logistic regression models and cumulative prevalence curves with the Kaplan-Meier analysis were used. Results Data of 3,910 CD and 3,240 UC patients (50.3% females, median age 48.0 (range 17-98 y.o.)) were analyzed. Over one-third of IBD patients (34.0%) had at least one EIM. The EIMs prevalence did not differ significantly between CD and UC (34.8% vs. 33.0%; p=0.112). In CD patients, the most common EIM was scleritis/episcleritis (10.9%), followed by nephrolithiasis (10.1%) and axial spondyloarthritis (7.3%). The UC patients most frequently had scleritis/episcleritis (10.3%), primary sclerosing cholangitis (8.4%) and nephrolithiasis (7.8%). In CD patients, age at diagnosis ≥40 y.o. (OR 1.77, 95%CI 1.33-2.37), disease duration ≥20 years (OR 2.28, 95%CI 1.62-3.21) and C-reactive protein≥8.0 mg/L (OR 1.46, 95%CI 1.01-2.12) were independent risk factors for EIMs (Fig.1a). Among UC patients, the following EIM risk factors were identified: disease duration ≥20 years (OR 1.63, 95%CI 1.19-2.22), obesity (OR 1.40, 95%CI 1.04-1.89), vitamin B12 deficiency (OR 1.64, 95%CI 1.12-2.40), and need for IBD surgery (OR 1.63, 95%CI 1.13-2.34) (Fig.1b). Cumulative probability of EIMs in CD vs. UC was 8% vs. 12%, at 10 years, 27% vs. 38% at 20 years, and 51% vs. 59% at 30 years since diagnosis (Log-rank, pampersand:003C0.001) (Fig.1c). Conclusions Over one-third of IBD patients have at least one EIM and their pattern and cumulative prevalence varies substantially between CD and UC. It is important to be aware of the EIMs’ risk factors to recognize them early and provide adequate management aiming to decrease morbidity and mortality and improve the quality of life of IBD patients. Fig. 1a. Associations between demographic, phenotypic and clinical IBD features and EIMs among CD patients - results of the multivariate logistic regression analysis. Fig. 1b. Associations between demographic, phenotypic and clinical IBD features and EIMs among UC patients ","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"39 ","pages":"194 - 195"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A259 METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE IS ASSOCIATED WITH MULTI-ORGAN COMORBIDITIES AND FIBROSIS PROGRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD)","authors":"D. Kablawi, S. Sasson, F. Aljohani, C. S. Palumbo, A. Bitton, W. Afif, P. L Lakatos, G. Wild, T. Bessissow, G. Sebastiani","doi":"10.1093/jcag/gwad061.259","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.259","url":null,"abstract":"Abstract Background Patients with IBD are at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) due to chronic inflammation, hepatotoxic drugs, alteration of gut microbiota. MASLD, formerly known as non-alcoholic fatty liver disease, provides a positive rather than negative diagnosis, appropriately assigns a metabolic basis for hepatic steatosis (HS), avoids any potentially stigmatizing term, and excludes alcohol abuse. MASLD carries higher risk of both liver fibrosis progression and extra-hepatic involvement, including cardiovascular disease , extra-hepatic cancer, hypothyroidism, chronic kidney disease (CKD). Data on the effect of MASLD on fibrosis progression and multi-organ co-morbidities are lacking in this population. Aims We aimed to determine if MASLD and liver fibrosis carry a higher risk of extra-hepatic co-morbidities in IBD. Methods We prospectively included consecutive IBD patients who underwent liver stiffness measurement (LSM) with controlled attenuation parameter (CAP) by Fibroscan at a single centre. MASLD was defined as any grade HS without alcohol abuse and viral hepatitis. HS progression was defined as any grade HS (CAPampersand:003E270 dB/m), or transition to severe HS (CAPampersand:003E330 dB/m) with CAPampersand:003E270 but ampersand:003C330 dB/m at baseline. Fibrosis progression was defined as significant liver fibrosis (LSM≥8 kPa), or transition to cirrhosis (LSM≥13 kPa) with LSMampersand:003E8 but ampersand:003C13 kPa at baseline. We estimated incidence rates of HS and fibrosis progression by dividing participants with the outcome by number of person-years (PY) of follow-up. Covariate adjustments for HS progression were evaluated by multivariable Cox regression models and predictors of extra-hepatic conditions by multivariable logistic regression analysis. Results 430 patients were included with mean age 43 years, BMI 25 Kg/m2, IBD duration 14 years, CRP 5.2, ALT 22; females 45%, ulcerative colitis (UC) 31.8%, T2DM 4.7%. Patients with MASLD had higher proportion of CV events (12% vs. 6%), CKD (8% vs. 3%) and hypothyroidism (12% vs. 6%) vs. those without. After adjusting for age, male sex and Crohn’s IBD subtype, MASLD remained an independent predictor of extra-hepatic comorbidities (aOR 1.79, 95% CI 1.15–2.78; p=0.01) with T2DM (aOR 3.53, 95% CI 1.68-7.42; p=0.001). Patients were followed for 26 months (SD 16.4). Rate of HS progression was 16.2 per 100 PY (95% CI, 11.5-22.8) and liver fibrosis progression was 6.12 per 100 PY (95% CI 3.48-10.44). In multivariable analysis, after adjusting for IBD duration and BMI,UC was associated with faster progression of HS (aHR 2.21, 95% CI 1.02-4.91). Conclusions MASLD is associated with extra-hepatic diseases in patients with IBD and can progress to liver fibrosis and cirrhosis. Figure 1. Evolution of NAFLD and associated liver fibrosis in patients with IBD. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 5","pages":"208 - 209"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A298 HIGH MORTALITY NOTED AMONG PATIENTS ADMITTED WITH ALCOHOL ASSOCIATED HEPATITIS: A DESCRIPTIVE STUDY","authors":"G. Malhi, C. McChesney, D. Hudson, E. Stephenson, Y. Almahanna, J. Arab","doi":"10.1093/jcag/gwad061.298","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.298","url":null,"abstract":"Abstract Background Alcohol associated hepatitis is a syndrome related to alcohol use disorder characterized by jaundice, malaise, decompensated liver disease, and coagulopathy. This is associated with bacterial infections, the development of chronic liver failure, and high short-term mortality. However, the rates at which these events occur is less understood, with a broad range of estimates reported. Aims To understand the demographic profile of those admitted with alcohol associated hepatitis assess its impact on resource utilization, complications in hospital, and mortality. Methods This study examined a subset of individuals with alcohol associated hepatitis who were admitted to the GI and Medicine Wards between 2010 and 2023. Results 70 encounters were identified and interpreted. The average age at admission was 48.3 ± 11.4 years old. 62.8% were male and 22% reported cannabis use. 54% had a previous reported history of alcohol use disorder. The average MELD-Na score at the time of admission was 25.9 ± 7.7. The Median length of stay was 8.5 days (IQR 4.5,15). 63% were provided steroids in hospital and 33.3% developed infectious complications. 36.3% of patients had a GI bleed reported during admission. 4% of patients underwent a transplantation during follow-up. Approximately 44.3% experienced mortality with a 30-day mortality rate found to be 28.6%. Conclusions Alcohol associated hepatitis patients are prone to developing infections and bleeding during admission. This diagnosis also carries a high mortality rate, particularly within the first 30 days. Further studies examining the global impact of alcohol associated hepatitis should be considered. Table 1: Baseline Demographics Parameter Number (%) Total 70 (100) Sex Male 44 (62.9) Female 26 (37.1) Age Mean 48.3 ± 11.4 Range 23-72 Previously Diagnosed Cirrhosis Yes 27 (38.6) No 43 (61.4) Marijuana Use Yes 16 (22.9) No 54 (77.1) Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"909 ","pages":"242 - 243"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}