Journal of the Canadian Association of Gastroenterology最新文献

{"title":"A19 THE IMPACT OF FOOD INSECURITY ON ADHERENCE TO A GLUTEN-FREE DIET IN THE ADULT CELIAC DISEASE POPULATION ATTENDING A DEDICATED CELIAC CLINIC","authors":"R. Leong, S. Tandon, M. Khaouli, J. Blom, R. Daca, Eduardo Verdu, D. Armstrong, M. Pinto-Sanchez","doi":"10.1093/jcag/gwad061.019","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.019","url":null,"abstract":"Abstract Background A strict gluten-free diet (GFD) is currently the only treatment for celiac disease (CeD), but a GFD can be inconvenient and expensive. CeD patients who are food insecure (FI) face threats to GFD adherence, overall health, and quality of life. Aims To evaluate the prevalence of FI in patients with CeD attending a dedicated Adult Celiac Disease Clinic (ACDC) at an academic hospital and to examine the relationship between FI and GFD adherence, quality of life and various gastrointestinal symptoms. Methods Patients were invited to participate in the CeD registry when they attended the ACDC; those who agreed to participate then provided verbal and signed consent. Patients had the option to complete the CeD registry forms in the clinic on an iPad or at home using a card with a QR code and a unique ID to access the online CeD registry. The CeD registry uses REDCap (v. 11.1, 2021, US) and includes six validated questionnaires (Celiac Diet Adherence Test (CDAT), Celiac Disease Quality of Life Questionnaire (CD QoL), Celiac Symptom Index (CSI), Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale (HADS), and Household Food Security Survey Module (HFSSM)). Continuous data are expressed as mean (SD), and categorical data as proportions of patients. The chi-squared test with Fisher correction and t-test were used to assess differences between groups. Results A total of 653 patients attended the ACDC from November 2, 2022, to September 20, 2023, and 411 patients were invited to participate in this study. Of them, 204 completed the CeD registry. Food insecurity was identified in 16% of CeD patients, of whom 11 (5%) were marginally FI, 16 (8%) were moderately FI, and 7 (3%) were severely FI. Compared to CeD patients who are food secure, a greater proportion of FI CeD patients reported nonadherence to GFD (26/34 vs 70/170; p<0.001), reduced QoL (32/34 vs 98/170; p<0.001), greater anxiety (27/34 vs 84/170; p=0.001) and greater depression (13/34 vs 26/170; p=0.004) compared with normal values. CeD patients with FI also reported lower QoL [61.0(14.9) vs 49.6(16.7); p=0.001] and increased gastrointestinal symptoms [GSRS 37.7(14.7) vs 29.0(12.8); p=0.001] compared with food secure CeD patients. Conclusions Food insecurity is common in patients with CeD and is associated with significantly worse adherence to treatment, symptom control, and quality of life. There is an important need for programs and societal measures to abolish food insecurity and ensure adequate access to treatment for patients with CeD. Funding Agencies TRIANGLE Summer Studentship","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"55 6","pages":"10 - 11"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838270","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":"A96 A QUALITY ASSESSMENT STUDY TO DETERMINE IF TISSUE ACQUISTION AND SPECIMEN HANDLING IMPACT THE DIAGNOSTIC YIELD OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION OF SOLID MASS","authors":"S Khan, P. Mathura, L. Puttangunta, S. Girgis, J Zhang, J. Nilsson, S. Wesilenko","doi":"10.1093/jcag/gwad061.096","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.096","url":null,"abstract":"Abstract Background Endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy (FNAB) of solid mass lesions has a sensitivity and specificity between 50-100%. Tissue acquisition and specimen handling are factors that may contribute to this variability. At our institution, 3 endoscopists perform EUS. The aspirated material obtained is expressed onto slides for cytology (prepared by a nurse) and solid tissue fragments transferred into formalin. At the discretion of the endoscopist, aspirated material is collected in saline for cell block preparation. Aims To assess the impact of tissue collection and specimen handling on diagnostic yield of EUS-FNAB of solid mass lesions. Methods A chart audit was completed for all patients undergoing EUS-FNAB of solid mass lesions between January 1, 2022 and December 31, 2022. Descriptive statistics were completed. A definite diagnosis was considered when calculating the diagnostic yield. Results A total of 184 patients (100 M, 84 F), mean age 64±13 years (range 14-89 years), underwent 200 EUS-FNABs by 3 endoscopists. Pancreatic masses were the most common indication in 118/200 (59%) cases. A 22-gauge FNAB needle was used in 189/200 (95%) cases. A total of 285 needle passes were performed in 149 cases (mean 1.9/case). In the remaining 51 cases (26%), the number of needle passes was not specified. Tissue samples were transported in formalin in 190 cases, on cytology slides in 170 cases, and in saline for cell block preparation in 41 cases. Overall, a definite diagnosis was achieved in 149/200 cases (75%). Stratifying for needle passes, a definite diagnosis was achieved in 22/39 (56%), 71/85 (84%), 20/24 (83%), and 1/1 (100%) cases that had 1, 2, 3, and 4 needle passes. Of the 51 cases with unspecified needle passes, a definite diagnosis was achieved in 35 cases (69%). The diagnostic yield obtained with saline for cell block was similar to that obtained with formalin and cytology slides (30/41 [73%] vs. 144/190 [76%] and 132/170 [78%]). Conclusions Increasing the minimum number of needles passes for tissue acquisition to 3 per case may increase the diagnostic yield of EUS-FNAB. Documenting the number of needles passes in the endoscopy report is an important quality indicator. Cytology slides and tissue in formalin should be considered standard of care but aspirated material should continue to be used for cell block preparation. However, there is some concern that saline as a transport medium may de-vitalize the aspirated material, so it should be replaced with formalin to preserve tissue integrity. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"55 5","pages":"68 - 69"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838271","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":"A98 EFFECT OF A PROLONGED MULTIVITMAIN SHORTAGE ON HOME PARENTERAL NUTRITION PATIENTS: SINGLE CENTRE EXPERIENCE","authors":"N. C. Lam, C Wang, K. Schwenger, C. Arca-Juico, K. Chin, A. Macgillivray, C. Yuen, I. Pang, J. Allard","doi":"10.1093/jcag/gwad061.098","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.098","url":null,"abstract":"Abstract Background Multivitamin shortages in home parenteral nutrition (HPN) are scarce but have a significant impact on patient morbidity. Recently, Ontario, Canada experienced a HPN intravenous multivitamin shortage that lasted over 3 months. As per the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines, patients were instructed to use an over-the-counter multivitamin supplement during the shortage. However, due to the nature of HPN patients, the risk for malnutrition related complications remains high, specifically thiamine deficiency. Aims This study aims to assess the relationship between the multivitamin shortage and thiamine deficiency. We conducted an analysis before and after the intravenous multivitamin shortage in HPN patients and compared anthropometric, biochemical and clinical outcomes in those who followed the oral multivitamin recommendation versus those who did not. Methods This retrospective descriptive study included HPN patients in a single-centre program in Toronto, Canada who required HPN ≥ 5 days/week. These patients were followed throughout the multivitamin shortage which lasted from February - June 2023. Patients were categorized into two groups: those who consumed an oral multivitamin and those who did not. Clinical and biochemical data were collected pre and post-multivitamin shortage. Data was collected on compliance with taking oral multivitamins. The primary outcome was the presence of any adverse clinical outcome related to a micronutrient deficiency. Results Twenty-five HPN patients were included. 56% (n=14) of patients were compliant with oral multivitamin usage and met the ASPEN recommendations for supplementation. Compliant patients were significantly older and were on significantly longer duration of HPN. Two patients were diagnosed with WE and had brief hospitalizations. Both patients experienced complete resolution of their symptoms after treatment with high-dose thiamine. Hence, compliance with oral multivitamins did not correlate to developing WE. The median time from the shortage to the development of WE was 2 months. Though not statistically significant, those who developed WE were more likely to be female, utilized a venting gastrostomy tube, and utilized HPN for longer. Conclusions Complications related to micronutrient deficiency are rare in the HPN population but shortages in intravenous multivitamins can increase the risk of conditions such as WE. In our study, compliance with oral multivitamins did not guarantee protection from developing adverse outcomes, likely due to limitations in absorption due to altered gastrointestinal anatomy. A regimented protocol for screening should be implemented in HPN patients, especially during long shortages of key HPN components like multivitamins. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"67 ","pages":"71 - 71"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838358","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":"A273 A PILOT PROSPECITVE, MULTI-CENTRE, RANDOMIZED CONTROLLED TRIAL COMPARING FECAL MICROBIOTA TRANSPLANTATION (FMT) TO PLACEBO AT INDUCING REMISSION IN MILD TO MODERATE CROHN'S DISEASE","authors":"K Wong, D. Kao, H. Jijon, R. Franz, N. Narula, F. Peerani, C. Turbide, K. Kroeker, P. Moayyedi, K. Madsen","doi":"10.1093/jcag/gwad061.273","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.273","url":null,"abstract":"Abstract Background FMT has shown promise at inducing remission in ulcerative colitis. The effect of FMT on inducing remission in Crohn’s disease however remains unknown. Aims To evaluate the efficacy of FMT at inducing remission in mild-to-moderate Crohn’s disease Methods This double-blind, randomized, trial conducted at 3 Canadian academic centers (Edmonton, Hamilton and Calgary) randomized. Adult patients with mild-to-moderate Crohn’s disease with modified Harvey Bradshaw Index (mHBI) score of ampersand:003E5 and at least one objective measure of inflammation (CRP ≥ 8mg/L or fecal calprotectin (FCP) ≥ 250 ug/g) on stable dosing of concomitant therapy were assigned to FMT or placebo. First assigned treatment was by colonoscopy followed by 20 [DK1] capsules weekly for 7 weeks. Endoscopic severity (SES-CD) was assessed at baseline during colonoscopic delivery of assigned treatment and at week 8 by a blinded central reader using video recording. The primary endpoint was the proportion of patients in both clinical (mHBI ampersand:003C 5) and endoscopic remission (SES-CD ≤ 5) at week 8. Responders (reduction of HBI ≥ 3 or HBI ≤ 5 and reduction of CRP or FCP by ≥ 10%) in FMT group were eligible to continue with open-label FMT capsule every 2 weeks. Non-responders in the placebo group were permitted to restart the trial at week 0 with open-label FMT. Secondary outcomes included patient reported outcomes and safety outcomes. Results Between July 2017 to Jun 2021, 28 were randomized (16 to FMT and 12 to placebo). The study team voluntarily suspended the trial twice due to Health Canada safety warnings regarding potential transmission of multi-drug resistant organisms and SARS-CoV-2 through FMT. At week 8, 0% (0/16) of patients in the FMT group versus 8.3% (1/12) in the placebo group reached the primary endpoint of combined clinical and endoscopic remission. Of the 50% (8/16) in the FMT group who achieved a clinical response and continued on open-label FMT every 2 weeks, 12.5% (1/8) achieved the primary endpoint. Of the 7 non-responders in the placebo group who restarted the trial at week 0 and received open-label FMT, 28.6% (2/7) achieved primary endpoint at week 8 on open-label FMT. No death or hospitalization were observed. The study was terminated early at the recommendation of the Data Safety Monitoring Board. Conclusions FMT was not effective at inducing remission in Crohn’s disease using the FMT regimen in this study. However, this study was limited by a small sample size and recruitment barrier during the COVID pandemic. Future studies may consider other strategies to potentially enhance treatment response, including antibiotic pre-treatment, optimized donor-recipient pairing, and concomitant anti-inflammatory diet. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"41 4","pages":"220 - 220"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838370","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":"A214 AGE, SEX AND POSITION INFLUENCE UPPER ESOPHAGEAL SPHINCTER PRESSURES","authors":"K. Pokraka, M. Woo, D. Randall","doi":"10.1093/jcag/gwad061.214","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.214","url":null,"abstract":"Abstract Background Upper esophageal sphincter (UES) function may be evaluated using high resolution manometry (HRM) to measure manometric parameters specific to the UES. The UES parameters are not well established however there is evidence suggesting a relationship between the UES parameters and esophageal motility disorders as well as UES parameters and symptoms including dysphagia, globus sensation and reflux. The Esophageal Symptom Questionnaire (ESQ-30) is a validated tool in the assessment of esophageal symptoms and measures the frequency and severity of dysphagia, reflux and globus through three separate sub-scales (ESQ-D, ESQ-R, ESQ-G respectively). Aims We aimed to identify the relationship between UES manometric variables and patient demographic variables (age, sex) as well as patient symptoms including broad categories of globus sensation, dysphagia and reflux. Methods Retrospective analysis of consecutive reports from HRM studies performed between October 2021 – March 2023 who provided consent for inclusion in the motility databank and completed ESQ-30 questionnaires. All values expressed as median (IQR: 25-75-centile). Values were compared with the non-parametric Mann-Whitney U test. Relationships between manometric diagnosis, UES pressures and symptomatology were explored. Results 681 patients underwent esophageal manometry and completed the ESQ-30 questionnaire. These patients were 442 (65%) female (mean age 54.6 +/- 14.8 years). Over the study period, 318 patients underwent esophageal HRM in the upright position and were diagnosed according to CCv3 and 361 patients underwent HRM in the supine position and were diagnosed by CCv4 manometric criteria. UES mean basal pressure was significantly higher in females than males (64.6 [42.3-89.1] vs 68.4 [48.4-96.1], p = .015) as well as in the supine position (77.5 [55.9-101.0] vs. 56.0 [38.7-80.3]. UES mean basal pressure was negatively correlated with age (R2 -.28 p ampersand:003C .001). In terms of esophageal symptomatology, dysphagia scores (ESQ-D) were negatively correlated with UES mean basal pressure (R2 -.15, p ampersand:003C .001). Conclusions Age, sex and position may influence UES manometric pressures. The finding of higher UES pressures in the supine position may reflect a mechanism for decreasing proximal reflux. The decreased UES basal pressure with age is possibly related to changes in the integrity of the neuromuscular system. Having a better understanding of the poorly understood normal UES dynamics and how this changes in motility disorders may allow us to more specifically target areas for treatment. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"41 1","pages":"169 - 170"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838397","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":"A263 IRONING OUT THE DETAILS: CROHN’S DISEASE PATIENT DERIVED MACROPHAGES ARE MORE SUSCEPTIBLE TO FERROPTOSIS","authors":"J A Sousa, B. E. Callejas Pina, Y. Munazza, A Wang, M. Raman, D. McKay","doi":"10.1093/jcag/gwad061.263","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.263","url":null,"abstract":"Abstract Background Death of intestinal epithelial cells is ubiquitous in Crohn’s disease (CD) but the death of immune cells such as macrophages is less explored. We have found that monocyte derived macrophages from patients with active CD are more susceptible to H2O2-induced cytotoxicity but the form of regulated cell death these cells undergo remains to be elucidated. Selenium (Se)—a common micronutrient deficiency in patients with CD—is used in the synthesis of selenoproteins that have antioxidant properties (e.g., glutathione peroxidases (GPx)) and are highly expressed in macrophages. Whether Se deficiency plays a role in the increased cytotoxicity also remains to be elucidated. Aims To determine the form of cell death of macrophages in response to H2O2-induced cytotoxicity and whether selenium deficiency plays a role in the increased susceptibility to H2O2-induced cytotoxicity. Methods Blood collected from healthy volunteers and patients with active CD was analyzed for serum GPx activity. Monocytes isolated by plastic adherence were treated with M-CSF (10ng/ml, 7d) to derive macrophages. Macrophages were treated with H2O2 (500μm, 2h) and lactate dehydrogenase release was measured. GPX1, SLC7A11 and PTGS2 mRNA expression were determined by qPCR. The presence of cleaved caspase 3 was determined by immunoblotting and IL-1β by ELISA. Lipid peroxidation a marker of ferroptosis was assessed by staining macrophages with Bodipy C-11 (± liproxstatin-1, an inhibitor of ferroptosis). Results CD macrophages were two times more susceptible to H2O2-evoked cell death. In response to H2O2 macrophages did not express cleaved caspase 3 or IL-1β, but there was an induction of ferroptosis markers (SLC7A11 and PTGS2). Moreover, lipid peroxidation was induced and could be blocked with liproxstatin-1. Dietary Se intake did not differ between groups but serum GPx activity was greater in patients with CD compared to control. In contrast, GPX1 mRNA expression and GPx1 protein expression were decreased in CD macrophages compared to healthy controls. Conclusions Macrophages derived from patients with CD are inherently more sensitive to ferroptosis potentially through reduced GPx1 expression. Future studies warrant testing if GPx1 prevents ferroptotic macrophage cell death and if it holds therapeutic relevance in CD pathophysiology. Funding Agencies Helmsley Charitable Trust, Crohn's and Colitis Foundation of America","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"13 5","pages":"211 - 212"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838416","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":"A86 INFORMING MODERN CARE FOR CANADIAN IBD PATIENTS: A PROSPECTIVE RANDOMIZED TRIAL ON APPOINTMENT TYPES","authors":"C. Galts, B. Siempelkamp, K. Cade, L. Wilson, D. Loomes","doi":"10.1093/jcag/gwad061.086","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.086","url":null,"abstract":"Abstract Background There is now significant data supporting virtual care (telehealth or telephone) as a means to provide care to IBD patients with equivalent outcomes to in-person care. Many studies assessing virtual care lack a control group and suffer from recall bias. Further, there is a lack of understanding individual patient appointment style preferences and the reasons for these preferences. Aims We aimed to determine patient’s preferred appointment styles and to inform these preferences by assessing demographic factors and other appointment related factors (e.g. cost, time required, communication, privacy etc). We hypothesize that this information may help to inform decisions regarding choosing the optimal appointment for patients. Methods In this single centre randomized trial we assigned IBD patients to in-person, telehealth (with video), or telephone appointments in a sequential manner. To minimize recall bias, surveys were completed after each appointment style. All participants had demographic data collected and survey data was compiled using UBC redcap. Standard regression analyses and T-scores were used for assessment of statistical significance. Results After exclusion of surveys with incomplete data, a total of 81 surveys were included, 27 in-person, 28 telephone, and 26 telehealth. The overall scores (out of ten) were 9.1 ±1.0, 7.8 ±2.1, and 8.0 ±2.6 for in-person, telephone and telehealth appointments respectively. With exclusion of telehealth appointments which suffered technical difficulties (n=6) the overall score improved and range was comparable to in-person appointments (8.9 ±1.2). In-person appointments were associated with a higher cost and longer time commitment but had the highest scores across all appointment features (e.g. perceived privacy, physician engagement etc.). Among patients who would have preferred an in-person appointment optimal communication (80.0%) and interaction with care provider (83.3%) were prioritized. Conversely, among participants who would have preferred telehealth appointments, time savings (71.4%) and cost savings (42.9%) were prioritized. Age, gender, number of dependents, and perceived privacy were not associated with any appointment style preference. Conclusions This study concludes that all appointment styles have certain benefits and drawbacks that individual patients may variably prioritize. In-person appointments had a higher cost and time requirement but still remained the highest rated appointment style. As virtual care continues to be part of the standard of care for patients with IBD, we suggest that providers individualize the style of patient appointment to their patients and the expected nature of that encounter. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"54 5","pages":"60 - 61"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838507","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":"A82 A SURVEY-BASED ASSESSMENT OF RADIATION PROTECTION ATTITUDES AND PRACTICES IN ADVANCED THERAPEUTIC ENDOSCOPY TRAINING CURRICULUMS","authors":"K. Chin Koon Siw, C. Sypkes, M. Gozdzik, H. Dhaliwal, A. Kundra","doi":"10.1093/jcag/gwad061.082","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.082","url":null,"abstract":"Abstract Background Fluoroscopy-assisted endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) expose patients and physicians to the risks of ionizing radiation, including infertility, cataracts, skin hypersensitivity, hair loss and cancer. Radiation exposure from these procedures can have lasting adverse effects on the health and productivity of gastroenterologists. With attention to “as low as reasonably achievable” (ALARA) principles, recent efforts to minimize radiation use have emphasized the importance of formal radiation protection education, including during advanced therapeutic endoscopy (ATE) training. However, teaching of basic protective measures in radiation safety during ATE training remains often overlooked. Aims We aimed to learn how radiation safety training is delivered in ATE programs across Canada and the US. Identifying the existing training standards and knowledge will help us understand the current gaps in training curriculums and inform future curricular development. Methods Our study was reviewed by the Ottawa Health Science Network Research Ethics Board in September 2023. Surveys were designed and distributed with the REDCap software and sent to ATE trainees (current and recent graduates within the last 3 years) in Canada and Program Directors (PDs) of accredited ATE programs across Canada and the US. Results The survey was completed by 12 trainees and 4 PDs. These are preliminary results and further survey responses are being collected. The majority of trainees (75%) believed it would be very important for their program’s curriculum to include dedicated radiation safety teaching, but most trainees (83.3%) received no such training. Familiarity in optimizing modifiable fluoroscopy parameters to minimize radiation exposure (collimation, gain, magnification, frame rate modification or pulsed fluoroscopy) was variable among trainees (36.4%-81.8%). Seventy-five percent of trainees were unaware of the annual limit for radiation exposure and only 25% believed they were operating within a safe level. Most trainees (90.9%) felt they were given inadequate training to optimally reduce their risk of radiation exposure and 90.9% expressed a desire for further radiation safety training. Despite these findings, only 50% of PDs believed it would be beneficial to offer dedicated radiation safety training as part of their program’s curriculum. Among PDs, 75% did not feel their trainees had the knowledge required to reduce their risk of radiation exposure and all (100%) felt that dedicated training would be useful. Conclusions These findings indicate a need for more robust radiation safety training. Further studies are needed to understand the most effective way to deliver comprehensive radiation safety training to ATE trainees. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"63 ","pages":"57 - 58"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838539","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":"A68 PERCEPTIONS OF ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE REGARDING A BIOPSYCHOSOCIAL TRANSITION INTERVENTION: A QUALITATIVE STUDY","authors":"B. Allemang, M. Browne, M. Barwick, N. Bollegala, N. Fu, K Lee, A. Miatello, I. Nistor, E. Dekker, S. J. Anthony, E. I. Benchimol","doi":"10.1093/jcag/gwad061.068","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.068","url":null,"abstract":"Abstract Background The transition from the pediatric to adult care healthcare system for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) is complex. This group requires support to prepare for and adapt to adult care due to the manifestation of the disease, expectations for self-management, and simultaneous life transitions. To address this need, a multi-site randomized controlled trial (RCT) is being conducted to evaluate the impact of a multimodal transition intervention on functional, clinical, and psychosocial outcomes for AYAs with IBD. An embedded qualitative study explored participants’ perspectives of the intervention's acceptability and appropriateness to support the translation of findings into practice. Aims Using in-depth individual qualitative interviews with a purposive sample of AYAs in both the intervention and control arms of the RCT, this qualitative study aimed to understand AYAs’ experiences preparing for and undergoing service transitions, developing self-management skills, and engaging with the intervention. Methods Semi-structured interviews were held via videoconference with 21 AYAs aged 16-18 years participating in the RCT (intervention arm n=11; control arm n=10) in Toronto, Canada. Purposive sampling was used to recruit AYAs with diverse demographic and clinical characteristics at different stages of the healthcare transition. Interviews were audio-recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis. Results The analysis yielded four overarching themes related to 1) individual, familial, and system-level factors promoting transition readiness, 2) areas of strength and areas for growth regarding self-management skill development, 3) perceptions of the multimodal transition intervention, including barriers and facilitators to engagement, and 4) recommendations for future transition care, including refinement of the intervention. Findings to date indicate the criticality of considering AYAs’ support systems, learning styles, and communication preferences when designing and implementing transition interventions. The qualitative data analysis is ongoing, and the full results will be presented. Conclusions The perspectives of AYAs with IBD can inform the development and refinement of clinical interventions, ensuring they are tailored to recipients’ unique needs and preferences and promote engagement and skill development during pediatric-adult transitions. Funding Agencies CCCThe Leona M. and Harry B. Helmsley Charitable Trust","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"18 ","pages":"46 - 46"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838646","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":"A150 DEVELOPMENT OF MIMETIC MATRICES AS INSTRUCTIVE ORGANOIDS MICROENVIRONMENT FOR THE STUDY OF COLONIC DISEASES","authors":"V. Bat, C Jones, F. Boudreau, N. Faucheux, N. Perreault","doi":"10.1093/jcag/gwad061.150","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.150","url":null,"abstract":"Abstract Background The functional complexity of the colonic epithelium is dependent on its interaction with the microenvironment involving gradients of soluble factors, extracellular matrix (ECM) proteins and stiffness. The influence of dynamic changes in the ECM has been observed in tumours, with variations in protein expression and rigidity. Their biomolecular impacts on epithelial cell behaviour are less studied due to the structural complexity of the matrix. Organoids offers a novel approach for the study of ECM biodynamics, as they require a matrix (Matrigel) to develop. Previous work showed that it is possible to grow organoids in hydrogels other than Matrigel. To evaluate the effect of matrix composition alteration on cancer initiation, we developed biofunctionalized composite hydrogels that mimic the ECM changes (chemical and physical) observed in the BmpR1a-deficient telocytes Foxl1 + (Bmpr1a△Foxl1+) mouse model of colorectal cancer (CRC) initiation. Aims The development of mimetic matrices, in association with organoids, would enable us to uncover the impact of matrix deregulation on colonic cells behaviour in pathogenesis process. Methods These hydrogels were made of alginate and 8-arm polyethylene glycol- vinyl sulfone (PEG) macromers bearing cysteine residues (CYS) and peptides. Four peptides derived from fibronectin, laminin 111, collagen I and collagen IV were used to mimic the ECM changes in the Bmpr1a△Foxl1+ colon. The grafting of CYS on alginate or peptides on PEG macromers was first characterized by thiol quantification assays. The non-grafted peptides were also analysed by uHPLC. Stiffness of the hydrogels was then determined by dynamic mechanical analysis. Finally, normal mouse organoids were seeded on hydrogels and evaluated for survival by live/dead labeling and proliferation by Alamar blue assays. Matrigel was used as a control. Results Chemical characterization revealed that CYS were grafted onto the alginate chain at around 190 μmol/g alginate. The PEG macromers were functionalized with four peptides at concentration varying from 0.25 to 1.5 mM. Rigidity of the hydrogels depends on the concentration of alginate used where lower concentration leads to soft matrix (0.5 kPa, homeostasis) and high concentration produced a stiff matrix (4 kPa, diseased). Organoids seeded in these mimetic composite hydrogels survived and proliferated in comparison to alginate alone. Conclusions Our results indicate that we can develop mimetic composite hydrogels where colon organoids can survive and thrive. This is a breakthrough model for defining the roles of ECM mechanical and biochemical stimuli in epithelial behaviour during the initiation and development of CRC. Funding Agencies CIHR","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"149 ","pages":"115 - 116"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838703","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}