Journal of the Canadian Association of Gastroenterology最新文献

{"title":"A162 DEFINING INNATE IMMUNE CELL MECHANISMS UPON HELICOBACTER PYLORI MEDIATED TUMORIGENESIS","authors":"T. Supreme, T Kim","doi":"10.1093/jcag/gwad061.162","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.162","url":null,"abstract":"Abstract Aims Hypothesis: H. pylori interacts with eosinophils to inhibit degranulation, alter eosinophil gene expression and promote gastric tumorigenesis Aim 1: Elucidate the mechanisms underlying the interactions between eosinophils and H. pylori. Aim 2: Determine the role of eosinophils during H. pylori mediated gastric tumorigenesis. Methods Histological and immunofluorescent staining. Hemotoxilin and eosin staining is important to analyze gastric gland structure and parietal cell loss. Immunofluorescent staining is used to detect and localize specific antigens present in cells and cell membranes. Gastric organoids: Gastric organoids are an important tool for modelling dissease. Gastric organoids generated from adult stem cells from gastric glands depend on growth factors that mimic tissue regeneration. Bone marrow derived eosinophils: Bone marrow progenitor cells isolated from murine femur and tibia are easily converted into maturer eosinophils with the addition of cytokine interleukin-5. Results Addition of mouse derived eosinophils to gastric organoids significantly increases number of organoids. To understand the relationship between eosinophils and gastric epithelial cell (GEC) growth, I designed a co-culture experiment that involved incubating mature eosinophils with gastric glands in an extracellular matrix. These findings revealed a significant increase in the number of gastric organoids per well when eosinophils were present compared to the gastric organoids without eosinophils. This observation supports the hypothesis that eosinophils may play a crucial role in promoting gastric tumorigenesis. Exposure of mouse derived eosinophils to H. pylori significantly increases gastric organoid proliferation. To explore the impact of stimulating eosinophils prior to incubation with GECs I incubated the eosinophils with H. pylori. As expected, there was a significant increase in the number of organoids per well with the addition of uninfected eosinophils. Interestingly, when H. pylori incubated eosinophils were added to the gastric glands, there was a significant increase in the number of gastric organoids per well compared to uninfected eosinophils. Conclusions My preliminary findings have indicated that eosinophils can promote gastric epithelial stem cell proliferation. These results led me to ask how treatment of eosinophils with H. pylori subsequently impacts gastric organoid growth and gastric stem cell proliferation. Interestingly, I found H. pylori treated eosinophils increase growth and gastric stem cell proliferation. These results support my hypothesis as increased proliferation is considered a hallmark of tumorigenesis. There little known about resident and inflammatory GI eosinophils and the role of eosinophils during tumorigenesis in unknown. A better understanding of the role eosinophils play can uncover novel mechanisms to be targeted for therapeutic intervention. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"787 ","pages":"125 - 126"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838800","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":"A148 OSTEOSARCOMA GASTROINTESTINAL METASTASIS: A RARE ENTITY IN ADULTS","authors":"B. Alabdulkarim, F. Habal","doi":"10.1093/jcag/gwad061.148","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.148","url":null,"abstract":"Abstract Background Osteosarcoma is highly aggressive and is the most common primary bone malignancy for both children and adults with a bimodal age distribution. The first peak coincides with pubertal growth spurt and the second is in the seventh and eighth decade of life. They frequently metastasize to the lungs. Metastasis to the gastrointestinal tract is extremely rare and to our knowledge, there have only been 15 cases reported in the literature since 1987, of those only three in the second peak. Aims Describe a case of 61-year-old female with periampullary metastatic osteosarcoma. Describe the demographics of osteosarcoma patients who develop gastrointestinal metastasis. Methods Search Pubmed using the terms: (\"Osteosarcoma\"[MeSH Terms] OR \"Osteosarcoma\"[Title/Abstract]) AND (\"Gastrointestinal Tract\"[MeSH Terms] OR \"Gastrointestinal Tract\"[Title/Abstract] AND \"Case Reports\"[Publication Type]. 113 articles were identified and screened by title. 15 articles were further screened by abstract or full text. 7 articles were identified. the remainder 7 articles were located by screening the references of the previously identified articles. Results A 61-year-old woman with a medical history significant for metastatic Osteosarcoma was referred to Gastroenterology clinic July 2023 for anemia investigation. Her Osteosarcoma was first diagnosed in the left femur in 2009. She was known for extensive bilateral lung metastasis, subcutaneous metastatic deposits, and distant bone metastasis. She had undergone over 37 surgeries and multiple sessions of radiotherapy. Aside from neoadjuvant and adjuvant chemotherapy for the primary tumor and the first occurrence of lung metastasis, she refused to undergo further cycles of chemotherapy. She had a 60 mg/dl hemoglobin drop from a previous one in December 2023 and intermittent melena. On gastroscopy, she was found to have a 2 cm bleeding mass in the periampullary area. The pathology report of the biopsies was consistent with metastatic osteosarcoma. It showed fragments of ampullary mucosa incorporating a malignant spindle cell neoplasm with a fascicular growth pattern, including scattered osteoclast-like giant cells, morphologically consistent with the known history of metastatic osteosarcoma. Of the 15 cases published, 9 were in patients 27 years old and younger, 3 were in patients 50 and older, and 3 were only available as titles. 50% of cases presented with intussusception while the rest had anemia or melena. The site of metastasis was the jejunum in the majority of patients (58%). Other sites included the ileum, stomach, colon, and esophagus. Only one other patient had periampullary metastasis. All patients had lung metastasis. Conclusions Gastrointestinal metastasis of osteosarcoma remains a rare occurrence. Our case report describes the second case reported in the literature of periampullary metastasis and the first case reported in older patients Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"201 ","pages":"114 - 114"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838819","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":"A226 NEUTROPHIL-TO-LYMPHOCYTE RATIO AT DIAGNOSIS PREDICTS COLONOSCOPIC ACTIVITY IN PEDIATRIC INFLAMMATORY BOWEL DISEASES (PIBD)","authors":"B. Aziz, R. Belaghi, H. Huynh, K. Jacobson, D. Mack, C. Deslandres, A. Otley, J. deBruyn, W. El-Matary, E. Crowley, M. Sherlock, N Ahmed, A. Griffiths, T. Walters, E. Wine","doi":"10.1093/jcag/gwad061.226","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.226","url":null,"abstract":"Abstract Background Neutrophil-to-lymphocyte ratio (NLR) has been recently identified as a potential biomarker for several autoimmune conditions. NLR predicts disease activity in adults with inflammatory bowel diseases (IBD) but had not been studied in pediatric IBD. Aims Investigate the link between NLR and baseline colonoscopic disease activity in UC and CD, the need for surgery or admission, and one-year therapy response in children. Methods Pediatric IBD patients were prospectively enrolled into the CIDsCaNN database [Canada-wide inception cohort for pediatric patients with IBD]. The cohort included patients diagnosed between 2003–2022 based on ileocolonoscopy, histopathology, and established diagnostic criteria. Patients were excluded if they had other conditions affecting NLR, such as neoplasms and autoimmune diseases. Endoscopic disease activity was assessed using the Mayo endoscopic score (MES; dichotomized as low (0, 1) or high activity (2, 3)) in UC and SES-CD score (as continuous variable) in CD. Logistic regression was used to test the link between predictors and binary outcomes. Simple linear regression was used to analyze the relationship between continuous variables. Results 576 UC and 1076 CD patients ampersand:003C18 years old were included. In UC, baseline NLR was significantly associated with baseline MES in univariate and multivariable logistic regression (multivariable OR= 1.5, 95% CI= 1.1–1.99, p= 0.019; Table). Patients with high-activity MES have significantly higher neutrophils (p= 0.0003), but lymphocytes wasn't different between the two groups. In CD, NLR was significantly correlated with SES-CD score in univariate and multivariable simple linear regression (multivariable coefficient= 1.4, 95% CI= 0.7–2.2, pampersand:003C0.0001; Fig1). Additionally, NLR predicted biologic-free remission in the CD cohort only in univariate analysis. NLR did not predict other the need for admission or surgery either in UC or CD. Conclusions Pediatric IBD patients with higher baseline NLR had a higher endoscopic disease activity. This establishes the significance of NLR as a non-invasive biomarker to help direct clinical decision making. This association suggests a role for neutrophils, as innate immunity cells in the acute stage of inflammation. Multivariable logistic regression of the relation between baseline labs in pediatric UC and Mayo endoscopic score Variables OR Standard error p value 95% CI NLR 1.45 0.23 0.02 1.06 - 1.99 Albumin 0.91 0.03 0.002 0.85 - 0.96 Year of diagnosis 1.10 0.14 0.48 0.85 - 1.41 Extra intestinal manifestations 0.61 0.28 0.28 0.25 - 1.49 Scatter plot demonstrating the relationship between baseline NLR and baseline SES-CD score Funding Agencies C.H.I.L.D.","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"135 3","pages":"180 - 181"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838875","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":"A58 UTILIZATION OF HYPOXIA-TOLERANT ORGANISMS AS A MODEL IN THE STUDY OF ISCHEMIC-REPERFUSION INJURY IN TRANSPLANT HEPATOLOGY","authors":"N. Hossein-Javaheri, L. Buck","doi":"10.1093/jcag/gwad061.058","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.058","url":null,"abstract":"Abstract Background Ischemic-reperfusion injury (IRI) is a barrier to successful liver transplantation. This complex process is initiated by an episode of hypoxia and decreased adenosine triphosphate (ATP) production. Mammalian hepatocytes are susceptible to prolonged hypoxia and may experience irreversible damage with ATP depletion. Yet, facultative anaerobes have developed physiological hepatoprotective strategies to tolerate hypoxic stress. The painted turtle (Chrysemys picta belli) and the common goldfish (Carassius auratus) are able to survive under severe hypoxia for weeks to months. Aims Introducing hypoxia-tolerant organisms as a suitable animal model for studying IRI in transplant hepatology. Methods A comprehensive search of PubMed, OVID, CINAHL, and Cochrane databases up to May 2023 was conducted to identify all studies reporting experimental evidence and hepatoprotective pathways in hypoxia-tolerant organisms (HTOs). Each article was qualitatively assessed. The primary focus was on cell death, intracellular ion gradient, mitochondrial function, and reactive oxygen species (ROS) with hypoxia and IRI. Results HTOs have increased glycogen storage with a greater ATP yield from anaerobic metabolism (glycolysis). Approximately 15-30% of liver mass in HTOs is composed of glycogen which is massive compared to 5-6% in mammals. Turtle isolated hepatocytes can tolerate 10 hours of anoxia by reducing cellular metabolic demand by 90% through decreased protein synthesis and ion channel activity. Goldfish hepatocytes can tolerate 6 hours of anoxia via similar strategies. In mammals, mitochondria undergo depolarization, Ca2+ efflux, cellular swelling, and apoptosis with anoxia. Yet, a depolarized mitochondrial membrane potential is regulated to provide cellular protection in HTOs. The ability to preserve mitochondrial function and electrochemical gradients with oxygen lack is an important contributor to cellular survival. Even in mammalian hepatocytes, if the mitochondrial integrity is maintained, cells are better able to tolerate ischemic insults. Finally, formation of radicals with reperfusion leads to hepatocyte apoptosis and necrosis in the mammalian model. Meanwhile, regulated ROS levels in turtles and goldfish cells, prevent cell death and IRI. Conclusions IRI is of significant interest in transplant hepatology. Although extremely valuable, the traditional mammalian models are vulnerable to hypoxia. Meanwhile, HTOs have undergone years of adaptation with thousands of genes dedicated to hypoxia tolerance. Utilizing these organisms can provide a broader understanding of IRI and avoid irreversible tissue damage in transplant hepatology. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"592 ","pages":"38 - 38"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839022","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":"A200 EXPOSURE TO CANNABIS SMOKE IN UTERO AFFECTS THE DEVELOPMENT OF THE ENDOCANNABINOID SYSTEM IN THE GASTROINTESTINAL TRACT","authors":"E. Ratcliffe, M. Sunil, T. Podinić, J. Kasinska, J. Hirota, S. Raha","doi":"10.1093/jcag/gwad061.200","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.200","url":null,"abstract":"Abstract Background Recreational use of cannabis has been legalized in Canada since 2018. Increasing numbers of women are using cannabis while pregnant, with reported rates ampersand:003E10%. There is a disconnect with societal perceptions, with up to one third of women believing that cannabis is safe for use in pregnancy, but with preclinical and clinical studies demonstrating negative neurodevelopmental outcomes. A key component of gut-brain axis regulation is found in the endocannabinoid system (ECS), of which receptors, ligands and enzymes are extensively distributed throughout the gastrointestinal (GI) tract and are actively involved in GI motility and sensation. Aims We tested the hypothesis that exposure to cannabis smoke in utero could influence the expression of ECS components in the developing GI tract. Methods We developed a “real world” cannabis smoke inhalation model in which CD-1 pregnant mouse dams were exposed daily to a delta-9-tetrahydrocannabinol (THC)-dominant strain of cannabis in a smoking chamber unit, from embryonic days 6 (E6) to E18. Control mice were placed in a restraining cage and exposed to room air for the equivalent time-period. Dams were sacrificed at E18, fetuses removed and the fetal GI tract (from stomach to distal colon) collected for RNA extraction. Key components of the ECS were investigated by developing a NanoString Custom CodeSet, including receptors (cannabinoid receptors 1 and 2; CB1 and CB2, transient receptor potential vanilloid type 1; TRVP1, GPR55) and enzymes (diacylglycerol lipase; DAGL, fatty acid amide hydrolase; FAAH, monoacylglycerol lipase; MAGL, N-acylphosphatidyletanolamine phospholipase D; NAPE-PLD). Samples (n=per litter; 7 cannabis-exposed and 8 control) were processed in the Farncombe Metagenomics Facility and NanoString data analyzed using nSolver Analysis Software. Results We found a significant increase in the expression of ECS receptors in the cannabis-exposed compared to control GI tract at E18, including CB2 (pampersand:003C0.05), TRPV1 (pampersand:003C0.05) and GPR55 (pampersand:003C0.0005). Interestingly, no significant change in mRNA expression was detected for CB1. We also found a significant increase in mRNA encoding the full panel of ECS enzymes, including DAGL (pampersand:003C0.005), FAAH (pampersand:003C0.05), MAGL (pampersand:003C0.05) and NAPE-PLD (pampersand:003C0.005) in cannabis-exposed compared to control GI tract. Conclusions In conclusion, we have found a significant increase in mRNA expression in a panel of key ECS receptors and enzymes in the GI tract at a point of maximal exposure to cannabis in utero. Future research will be needed to further characterize potential impacts on postnatal GI development and function. Funding Agencies CIHRThe Azrieli Foundation","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"503 4","pages":"157 - 158"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839060","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":"A290 ILLICIT SUBSTANCE USE AND ITS IMPACT ON ALCOHOL-ASSOCIATED HEPATITIS IN LATIN AMERICA","authors":"A H Islam, L. A. Diaz, F. Idalsoaga, G. Ayares, J. Arnold, B. Alcayaga, K. Maldonado, J. Arab","doi":"10.1093/jcag/gwad061.290","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.290","url":null,"abstract":"Abstract Background Concomitant substance use is frequent among patients with alcohol use disorder (AUD), but its impact on alcohol-associated hepatitis (AH) is unknown. Aims To assess the prevalence and impact of substance use in patients hospitalized for AH in a multinational cohort in Latin America. Methods Multicenter prospective cohort study including patients with AH between 2015-2022. We recorded sociodemographic and clinical information, including data on alcohol and drug use. We assessed the impact of substance consumption using competing-risk models. Results We included 405 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 49.6±12.2 years, 345 (85.4%) were men, 210 (57.5%) had a previous diagnosis of cirrhosis, and the median MELD at diagnosis was 25 [20–31] points. Around 74% of patients fulfilled ACLF criteria (ACLF-1: 11.1%, ACLF-2: 11.6%, ACLF-3: 49.6%). A total of 82 (20.3%) reported active substance use, while 22 (5.4%) were former substance users. The most common drugs used at admission were marijuana (11.1%), cocaine (10.4%), methamphetamine (4.4%), and heroin (0.5%). Out of the total, 35.7% died, and only 2.5% underwent liver transplantation during follow-up. Active substance use was higher in younger patients (users 44.4±16.1 years vs. non-users 51.0±10.6 years; pampersand:003C0.001) and in men compared to women (22.0% vs 10.2%, p=0.036). In a competing-risk model adjusted by age, sex, history of cirrhosis, MELD, and ACLF grade, active substance use was independently associated with mortality (subdistribution Hazard Ratio [sHR] 1.53, 95%CI:1.01–2.32; p=0.043). Also, active cocaine (sHR 1.69, 95%CI:1.07–2.70; p=0.025) and marijuana use (sHR 1.83, 95%CI:1.11–3.04; p=0.018) were independently associated with mortality in adjusted competing-risk analyses. Conclusions Active drug use is common in AH patients. Marijuana and cocaine were the most frequent substances and were independently associated with increased mortality. Substance use should be screened in patients with AUD, and integrated management with addiction specialists and psychiatrists could impact survival in AH. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"406 5","pages":"235 - 235"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839442","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":"A78 VALIDITY EVIDENCE FOR OBSERVATIONAL EUS COMPETENCY ASSESSMENT: A SYSTEMATIC REVIEW","authors":"A. Ceccacci, H. Hothi, R Khan, N. Gimpaya, B Chan, N. Forbes, P D James, J. Mosko, E. Yeung, C M Walsh, S. Grover","doi":"10.1093/jcag/gwad061.078","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.078","url":null,"abstract":"Abstract Background Endoscopic ultrasound (EUS) encompasses a range of diagnostic and therapeutic procedures that require technical, cognitive, and non-technical skills. The implementation of competency-based frameworks in endoscopic education has emphasized trainee assessment based on predefined milestones, rather than procedure volume. Observational assessment tools with strong validity evidence are needed to achieve this goal. Aims To systematically identify and evaluate observational competency assessment tools employed in EUS using an established validity framework. The secondary aim is to evaluate the educational utility of assessment tools. Methods We searched three databases (MEDLINE, EMBASE, and Evidence-Based Medicine Reviews) and the grey literature from inception to May 2023. Messick’s unified framework was used to evaluate validity evidence based on content, response process, internal structure, relations to other variables, and consequences. Each domain was scored from 0 to 3 with a maximum score of 15 points. Educational utility was evaluated using the Accreditation Council for Graduate Medical Education Standards considering ease of use, ease of interpretation, resources required, and educational impact. Study quality was assessed using the Medical Education Research Quality Instrument. Results Our search identified 2081 records. We screened 44 full texts and included 5 observational EUS assessment tools from 10 studies. All 5 tools are formative assessments, with 4 employed in clinical settings and one in a simulated setting. All tools use Likert rating scales and are rater-based, with 2 having additional self-assessment components. Validity evidence scores ranged from 3 to 13, with the EUS Assessment Tool (EUSAT), Global Assessment of Performance and Skills in EUS (GAPS-EUS), and The EUS and ERCP Skills Assessment Tool (TEESAT) scoring highest, with 10, 11, and 13 points, respectively. Overall educational utility was high across studies given ease of tool use. The TEESAT had the strongest educational impact considering its influence on credentialing and competence thresholds. Study quality was high overall, with scores ranging from 9.5 to 12 (maximum 13.5 points). Inter-rater agreement for validity evidence and educational utility scoring was substantial (k=0.73, raw agreement 80%) and almost perfect (k=0.92, raw agreement 96%), respectively. Conclusions The EUSAT, GAPS-EUS, and TEESAT demonstrate the strongest validity evidence for observational competency assessment of EUS and are easy to implement in educational settings. Future work should investigate barriers to implementation and evaluate utility of these tools for summative assessment. EUS Observational Competency Assessment Tool Validity Evidence Scores Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"41 6","pages":"54 - 54"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836456","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":"A233 PHENOTYPE OF MUSCULOSKELETAL MANIFESTATIONS IN A CANADIAN INCEPTION COHORT OF PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE","authors":"E. Dzongowski, N. Suthar, T. Walters, A. Griffiths, W. El-Matary, E. I. Benchimol, J. deBruyn, R Berard, E. Crowley","doi":"10.1093/jcag/gwad061.233","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.233","url":null,"abstract":"Abstract Background Musculoskeletal (MSK) manifestations, including arthritis and arthralgia, are among the most common extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD), reported in 20-30% of adult patients [1]. However, there is a paucity of data regarding MSK EIMs in the pediatric IBD population. A recent systematic review [2] found only 13 studies with limited results, due to heterogenous study design and data reporting methods. As such, little is known regarding frequency of MSK EIMs, their phenotype, or factors associated with their development. Aims The purpose of this study was to determine the frequency of MSK EIMs in a contemporary cohort of Canadian pIBD patients and describe the phenotype of MSK EIMs in this population. Methods This was a prospective longitudinal cohort study with data from the inception cohort of CIDsCaNN (Canadian Children IBD Network) comprising patients aged 2-17 from 12 Canadian pediatric centres, from 2014 to 2021. MSK EIM frequency was calculated for the cohort, and for subgroups by age, sex, and IBD type. MSK-EIM phenotype was described from case report forms with specific MSK features reported. Variables were compared with Pearson Chi-square or Fisher’s exact test. For patients without MSK EIM at IBD diagnosis, a Cox regression survival analysis was used for time to MSK development, with right censoring for patients who never reported MSK EIMs. Results 1,330 pIBD patients were included, with 761 males (57.2%) and 569 females (42.8%). There were 824 CD (62.0%), 382 UC (28.7%), and 124 IBD-U patients (9.3%). 81 patients (6.1%) reported MSK EIMs, with 63 CD (7.6%), 10 UC (2.6%), and 8 IBD-U (6.4%). CD patients were more likely to have MSK EIMs (7.6% vs 3.6% UC/IBD-U, p=0.002). 47 patients (58.0%) had MSK EIMs at or before diagnosis while 34 had them ampersand:003E4 weeks after diagnosis. There was no difference in overall frequency between sex or age groups, or time to MSK EIM development by age or ethnicity. Females were more likely to develop MSK EIMs, with odds increasing by 4.68 for each year after diagnosis (p=0.047). 59 (74.7%) MSK patients were seen by a rheumatologist. Peripheral MSK disease was in 51 patients (63%), axial disease only in 37. Peripheral and axial MSK symptoms followed the course of bowel disease in 40.3% and 28.1% of patients respectively, which were not significantly different. Conclusions MSK EIMs affect 6.1% of a contemporary cohort of Canadian pIBD patients.This is less than reported in literature, likely due to physician-reported nature of our data. Our next step is to compare pIBD patients with MSK EIMs to a matched group without, for bowel disease-related outcomes and response to medications. Funding Agencies Cassie and Friends Care and Research Network (CREW) funding.","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"63 5","pages":"186 - 187"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836521","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":"A106 COLONOSCOPY TEACHING: A SURVEY OF CANADIAN GASTROENTEROLOGY RESIDENTS","authors":"G Park, H. Komeylian, A. Kohansal, M Stewart","doi":"10.1093/jcag/gwad061.106","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.106","url":null,"abstract":"Abstract Background With the advancement in equipment and techniques, colonoscopy training continues to evolve. Programs such as the Skills Enhancement for Endoscopy (SEE) curriculum developed by the Canadian Association of Gastroenterology teach techniques such as loop reduction, patient turning, and water immersion aimed at improving adenoma detection, cecal intubation, and patient comfort. While there is vast literature focused on assessing learners’ endoscopic competencies, there is limited data pertaining to the training of specific colonoscopy techniques. Aims To assess various colonoscopy techniques used to train gastroenterology residents in Canada. Methods A survey of gastroenterology trainees was developed to assess specific aspects of their experience with colonoscopy education. This included questions on the frequency of position changes, use of pediatrics colonoscopes, water immersion, loops reduction, and SEE program initiatives. The survey was advertised at the 2023 Gastroenterology Residents-In-Training Course with a link to the survey e-mailed to all attendees. This survey has been re-distributed to the current gastroenterology resident cohort and therefore this abstract’s results are interim data pending further survey responses. Results At the time of survey administration, there were 69 gastroenterology residents registered in Canada. Responses were received from 21(30%) residents; 5 in post graduate year (PGY) 4 and 16 in PGY5. One quarter (24%) of residents reported that colonoscopy teaching methods were uniform amongst faculty members and one third (33%) reported that more than half of their preceptors mentioned SEE program initiatives. Thirty-eight percent of residents reported that more than half of their preceptors suggested position change on insertion when the scope is advancing well on insertion. Majority of residents (90%) reported that water immersion during colonoscope insertion was recommended by most preceptors. Most residents (76%) reported that position change to help with loop reduction was suggested by more than half of their preceptors. Fifty-seven percent of residents reported that more than half of their preceptors commented on type of loop formation and reduction techniques. Once the cecum is reached, a minority of residents (29%) reported that more than half of preceptors recommended position change specifically to improve cecal visualization. Conclusions Certain colonoscopy techniques such as turning patients, water immersion, and loop reduction can assist with adenoma detection rates and patient comfort. However, there exists considerable variability in colonoscopy techniques taught to Canadian gastroenterology residents. Increased standardization among colonoscopy technique education may benefit gastroenterology trainees. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"266 ","pages":"78 - 78"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836544","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":"A251 GUT-SPECIFIC DOWNREGULATION OF INTERFERON-LAMBDA RESPONSES OCCURS IN INFLAMMATORY BOWEL DISEASES","authors":"O. Ogungbola, R. Mahmood, J. Ouyang, V. Vu, N Nguyen, X Liu, K. Bittorf, S. Lamb, W. El-Matary, C. Bernstein, E. Wine, L. D. Tyrrell, H. Armstrong, D. Santer","doi":"10.1093/jcag/gwad061.251","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.251","url":null,"abstract":"Abstract Background Inflammatory bowel diseases (IBD) affect 1:140 Canadians, resulting in significant inflammation and gut damage. Unlike type I and II interferons (IFNs), the most recently discovered IFNs, interferon-lambdas (IFN-λs), uniquely downregulate gut inflammation and promote gut healing in mouse models. However, it remains unknown if the important anti-inflammatory IFN-λ signaling pathways induced downstream of the IFN-λR1/IL-10RB heterodimeric receptor are altered in IBD. Aims To compare intestinal and peripheral IFN-λR levels and responses in people with active or remission IBD and those without IBD. We hypothesized that intestinal IFN-λR1 levels and downstream activities are decreased in people living with IBD, which could contribute to IBD pathology (gut inflammation and mucosal damage). Methods During routine colonoscopy, uninflamed biopsy samples were obtained from the terminal ileum and sigmoid colon. IFN-λR1 levels were quantified in intestinal biopsy and blood samples from persons with or without IBD (n=12 adults and n=12 pediatric) by immunohistochemistry and flow cytometry. Fresh intestinal biopsies were also cultured ex vivo for 24 hr in media +/- IFN-λ3 and gene expression was quantified by RT-qPCR. Results In IBD gut tissues, a significant decrease in IFN-λR1+ cells was more prominent in IBD patients with active disease (pampersand:003C0.01, 30-50% reduction). The decrease was more prominent in IBD patients with active disease. Consequently, there was a significantly lower IFN-λ-driven upregulation of genes such as IFIT1 and MX1 in IBD as compared to non-IBD tissues (pampersand:003C0.05, 4-7-fold reduction). Interestingly, IFN-λR1 levels were not decreased in peripheral blood immune cells, indicating the dysregulation of IFN-λR responses is likely gut-specific. Conclusions Our findings demonstrate that people living with IBD have dysregulated IFN-λ responses in the gut which could lead to the lower induction of key anti-inflammatory pathways. This work supports the further study of mechanisms regulating the IFN-λ system to develop strategies to restore and promote IFN-λ responses as a novel potential future IBD therapy. Funding Agencies University of Manitoba, Weston Family Foundation, The Children's Hospital Research Institute of Manitoba.","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"684 ","pages":"202 - 202"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836983","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}