Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a ubiquitous and high-risk procedure with variable performance across providers and centres. In this review, we aimed to summarize the evidence related to ERCP practice in 4 domains: indications and alternatives, quality indicators, training and credentialing, and facility standards. Methods We searched MEDLINE, Embase, Cochrane databases, and the grey literature (2000-2026) for ERCP quality standards published by professional societies or health agencies. Records were included if they included recommendations related to the 4 above-mentioned domains. Recommendations were described qualitatively. For quality indicators, we described benchmarks for performance, strength of recommendations, and quality of evidence when available. Results Fifty-seven reports were included from 4 continents. Eighteen unique indications were identified. Seventeen procedural quality indicators were identified. Priority indicators included appropriate indication (benchmark >90% of cases), cannulation success rate (≥85%-90%), management of common bile duct stones <1 cm (≥75%-90%) stent placement below the bifurcation (≥80%-95%), post-ERCP pancreatitis rate (≤6%-10%), and unplanned hospital visit within 30 days of ERCP (<15%). Training recommendations suggested minimum volumes of 100-300 supervised procedures and highlighted a shift towards competency-based assessment tools like The EUS and ERCP Skills Assessment Tool or Direct Observation of Procedural Skills. Facility standards focused on radiation safety, duodenoscope reprocessing/infection control, and mandatory photodocumentation. Conclusion There was substantial alignment among societies on several core ERCP quality metrics, yet variability remains in training and credentialing and facility standards. Significant gaps exist regarding maintenance of competence and ERCP assistant training. This evidence can support health authorities seeking to develop and implement ERCP quality improvement initiatives.
Abstract Background In Canada, Indigenous Peoples are screened less often for cancer compared to the non-Indigenous population, contributing to cancer-related mortality. Lack of culturally safe communication in the cancer screening process may contribute to this disparity. The purpose of this review was to synthesize the literature regarding culturally safe communication strategies that support Indigenous people’s participation in colorectal cancer screening. Methods A systematic search of the literature was conducted. Articles were eligible for inclusion if they were published between January 1, 2000 and December 31, 2025; were published in English, French, Spanish, or Oji-Cree; pertinent to Indigenous participants in settler colonial states; included Indigenous Peoples as the study population or a distinct sub-analysis; explicitly addressed the concepts of cultural safety, communication, and cancer screening. Protocols, abstracts, commentaries, editorials, newsletters, media papers, and articles without full text were excluded. Guided by the audience-channel-message evaluation framework and the consolidated criteria for strengthening reporting of health research involving Indigenous Peoples statement, the primary outcomes of culturally safe communication and Indigenous involvement in the research process were assessed. Findings In total, 35 articles met inclusion criteria—30 peer-reviewed articles and 5 grey literature reports. A variety of communication channels can be leveraged to provide culturally safe communication, including small media, in-person, and digital strategies. Alignment with cultural values and traditions facilitated cancer screening communication. Information was found to be most effective when shared from a trusted source with whom there are existing relationships.
Abstract Background Electronic consultation systems are increasingly used to improve access to specialists due to growing demand and prolonged wait times. Our Pediatric Gastroenterology Division in Edmonton launched an eReferral system in 2020, which allows healthcare providers to seek patient-related advice and directly refer to our subspecialty. Methods As a quality improvement project, we completed a retrospective chart review of paediatric gastroenterology eReferrals in Edmonton from 2022 to 2023. We aimed to understand patient outcomes, including emergency department visits, hospitalizations, and need for formal gastroenterology consultation and/or endoscopy. Results A total of 318 patients were referred through eReferral during the 2-year period. Most patients (263/318, 83%) were initially referred conventionally, via fax, or electronic medical record referral module, and were redirected by the triaging physician to seek eReferral advice. The remainder were self-initiated eReferral requests. In total, 11% (34/318) of eReferral patients visited the emergency department for the same gastroenterology concern after eReferral advice. Only 76/318(24%) of eReferral patients were seen by paediatric gastroenterology. About 26/76(34%) of these patients underwent endoscopy, and the majority of findings (21/26, 81%) were normal or non-specific without relevance to the patient’s symptoms or management. About 43/76(57%) of patients reviewed by gastroenterology were ultimately diagnosed with a disorder of gut–brain interaction (DGBI). Conclusions The eReferral system appears to be an effective tool in the management and care of paediatric patients with suspected DGBIs referred to our paediatric gastroenterology service. Most of these patients have disorders that do not require endoscopy or formal GI consultation. Timely e-advice to referring physicians can expedite enhanced care in the patient’s medical home.
Background Fecal microbiota, live (RBL) is a single-dose, broad consortium, microbiota-based product approved in the United States and Canada for preventing recurrent Clostridioides difficile (C. diff) infection in adults following standard-of-care (SOC) treatment.Methods PUNCH CD3-OLS was a phase 3, open-label, multicenter study evaluating safety and effectiveness of RBL in adults, including those with comorbidities, with recurrent C. diff infection. Participants were aged >= 18 years, had recurrent C. diff infection (>= 1 recurrence/>= 2 severe episodes; diagnostic method was site-specific), and received SOC antibiotics before rectal administration of RBL. The primary endpoint was treatment-emergent adverse events (TEAEs) through 6 months post-administration. Secondary endpoints included treatment success at 8 weeks and sustained clinical response at 6 months. This subgroup analysis examined outcomes among Canadian participants across 5 sites.Results Among 117 Canadian participants who received RBL, most were female and White, with a mean age of 61.3 years; 24.8% reported a first recurrence. The enrolling C. diff infection was diagnosed via polymerase chain reaction for 70.9% of participants. TEAEs, reported in 59.8% of participants, were mostly mild-to-moderate gastrointestinal events. Serious TEAEs occurred in 5.1% of participants within 8 weeks and 6.8% between 8 weeks and 6 months. Treatment success was achieved by 75.2% of participants at 8 weeks, among whom 90.9% maintained a sustained clinical response at 6 months.Conclusions Safety and effectiveness outcomes in Canadian participants were consistent with those observed in the PUNCH CD3 randomized controlled trial population, supporting the use of RBL for prevention of recurrent C. diff infection in Canada.ClinicalTrials.gov identifier NCT03931941. Antibiotics are often used to treat bacterial infections, but they can also harm helpful bacteria in the gut. This can upset the balance of bacteria, known as dysbiosis. When this happens, a bacterium called Clostridioides difficile (C. diff) can grow too much and release toxins that damage the colon. This can cause severe diarrhea and serious illness. Antibiotics used to treat C. diff infection can further disrupt gut bacteria and increase the chance that the infection comes back, known as recurrent C. diff infection. Microbiota-based products, such as RBL, are made from healthy gut bacteria and designed to help restore balance in the gut. These treatments have been shown to reduce the risk of recurrent C. diff infection. This study looked at the effectiveness and safety of RBL in adults in Canada with recurrent C. diff infection. Among Canadian participants who received RBL, 75.2% did not have a return of C. diff infection within 8 weeks. Of these, 90.9% remained free of C. diff infection for up to 6 months. The most common side effects were diarrhea and stomach pain. Overall, these results suggest that RBL was well tolerated and may help prevent recurrent C. diff infection among Canadian adults.
Abstract Objective Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Although many countries have developed CRC screening guidelines, how CRC screening guidelines are developed across countries remains unclear. This study examined guideline-development funding, stakeholders, and their conflicts of interest (COI), and compared CRC screening recommendations across Group of Seven (G7) countries. Methods We reviewed the most recent CRC screening guidelines issued by official research organizations or governmental bodies in G7 countries. We extracted information on responsible organizations, panel composition, recommendations, target ages, screening tests and intervals, supporting evidence, funding, and COI. Results While CRC screening recommendations showed some similarities across G7 countries, some differences were observed in starting age, screening modality, and implementation structure. Differences were also identified in funding, COI reporting and management, and stakeholder composition, including limited involvement of patient and public representatives. Conclusions Colorectal cancer screening guidelines among G7 countries varied despite shared international evidence. These differences likely reflect country-specific factors, including population characteristics, screening participation, health system capacity, and cultural context. Given that guideline development involves diverse stakeholders, ensuring transparency in the guideline-development process is essential.
Background Mirikizumab (MIR), a selective interleukin-23p19 inhibitor, has demonstrated efficacy in randomized trials for moderate-to-severe ulcerative colitis (UC). Real-world data remain limited. Here, we evaluated the effectiveness, durability, and safety of MIR in routine clinical practice.Methods We conducted a retrospective, multicentre cohort study of adults with UC initiating MIR at two tertiary centres in Canada. Clinical, biomarker, endoscopic, and safety outcomes were assessed at weeks 12, 28, and 52. The primary outcome was corticosteroid-free (CSF) clinical remission at week 12. Secondary outcomes included CSF clinical remission at weeks 28 and 52, CSF clinical response, mucosal healing, treatment persistence, extended induction, and serious adverse events. Predictors of extended induction were evaluated using logistic regression.Results Eighty-two patients were included; 94% were previously exposed to at least one advanced therapy. CSF clinical remission was achieved in 24% of patients at week 12, 35% at weeks 28, and 33% at week 52, with corresponding CSF clinical response rates of 45%, 53%, and 40%. Moreover, 40% of the cohort received extended induction. In the extended induction subgroup, CSF clinical remission was observed in 19% at week 28 and 22% at week 52, with CSF clinical response rates observed in 37% and 30%, respectively. Early CSF clinical response at week 12 was associated with treatment persistence. The incidence of serious adverse events was low, with no new safety signals.Conclusions In this multicentre real-world Canadian cohort of predominantly treatment-experienced patients with UC, MIR demonstrated clinically relevant effectiveness, acceptable durability, and a favourable safety profile over 1 year. Ulcerative colitis is a long-term disease that causes inflammation of the large bowel. It usually causes diarrhoea with blood. Many patients need stronger treatments when standard treatments do not work. Mirikizumab is a newer medication that targets bowel inflammation. Clinical trials have shown that it can work but less is known about how well it works in real-world practice. We studied 82 adults with ulcerative colitis treated with mirikizumab at two centres in Canada. Most patients had previously failed another strong therapy. We studied patient outcomes and safety over 1 year. At 12 weeks, roughly 1 in 4 patients were well on treatment without needing steroids. By 1 year, about 1 in 3 patients were well. Patients whose symptoms improved quickly were more likely to stay on treatment. Moreover, 40% needed a longer period of high dose treatment at the start. This was more common in patients who were on steroids at the start of treatment and in those who weighed more. Serious adverse events were uncommon. These findings suggest that mirikizumab is effective and generally safe for people with ulcerative colitis who have already tried other advanced treatments.
Background:A chart audit (pre-intervention, PRE) of endoscopic ultrasound (EUS)-fine needle biopsy (FNB) of solid masses identified a diagnostic yield of 75%. To improve diagnostic yield, a quality improvement intervention targeting tissue procurement and processing was developed and trialed (post-intervention, POST). Intervention:Increase needle passes to ≥3/mass, limit the personnel preparing cytology slides, and replace saline with formalin for cell block preparation. Methods:A POST chart audit was undertaken for solid mass EUS-FNB from January 2024-December 2024, with quarterly reviews. Only a definite diagnosis was used to calculate diagnostic yield. ResultsAbout:241 patients underwent 262 EUS-FNBs. Diagnostic yield was 81% in POST vs. 75% in PRE (p = ns). Single passes decreased to 14% in POST vs. 20% in PRE (p = ns), with similar diagnostic yield (57% vs. 56%, respectively). Number of ≥3 passes increased significantly (47% POST vs. 12% PRE, P < .0001). In POST, 86% of single passes were performed in the first half vs. 14% in the second (P = .012). Only 25% of ≥3 passes were performed in the first half vs. 75% in the second (P = .06). Diagnostic yield improved significantly between the first and second halves (72% vs. 90%, P < .0001). Replacing saline with formalin for cell block improved diagnostic yield (57% vs. 75%, P = .062). Limiting the personnel making slides from 25 nurses (PRE) to 3 endoscopists (POST) had no impact on diagnostic yield. Conclusions:Critical practice assessment, regular audit, and continued reinforcement led to a significant improvement in EUS-FNB diagnostic yield to 90% by increasing the number of needle passes to ≥3/mass.
Current inflammatory bowel disease (IBD) therapies neglect microbial drivers. Treatment failures lead to dose escalation and risk of adverse effects. Pathobiont bacteria, like adherent-invasive Escherichia coli (AIEC), have been postulated as a microbial driver in IBD, however, their targeting remains elusive for antibiotics are non-specific and disturb the background microbiome. Attention has shifted towards bacteriophages, yet their underlying mechanisms and adjunctive therapy capabilities, remain under-investigated. We assess whether and how phage, specific for a CD-associated bacterium, reduces colitis severity using gnotobiotic mouse models. In vitro kill curves and biofilm challenges identified lytic phage. Germ-free C57BL/6 mice were colonized with altered Schaedler-flora (ASF) and E. coli NRG857c (NRG). Mice were treated with phage (1x109 PFU/dose; daily or TIW) or vehicle (PBS) for 2 weeks (n = 6/group). Dextran sulfate sodium (2%; DSS) in drinking water induced colitis. Phage treatment was also tested in a spontaneous model of colitis using C57BL/6NTac-Il10em8Tac (IL-10-/-) mice, treated weekly. Mice were monitored daily for weight, stool consistency, and occult blood. Fecal bacterial load was determined, and the orientation of fimS was quantified using qPCR to assess virulence. Endpoint histological and immunohistochemistry analysis were performed to quantify colitis severity and NRG infiltration, respectively. Additional colonized C57BL/6 mice received a low-dose of budesonide (2ug/day) (n = 5) or vehicle (n = 5) until endpoint. Mice were monitored daily for disease activity and colon tissues were collected for histological analysis. HPLC was used to determine active budesonide levels. HER259 was identified as a lytic phage against NRG. In colonized mice, HER259 reduced clinical symptoms (p < 0.001, p < 0.001) and histological scores (p < 0.0001, p < 0.001) in induced and spontaneous colitis, respectively. A 1-log reduction in bacterial load was observed in HER259-treated mice. Reisolated NRG exhibited a reduced FimS ON/OFF ratio (p < 0.01). Immunohistochemistry revealed reduced infiltration of NRG into the lamina propria following HER259 treatment. HER259 treatment increased the efficacy of a sub-therapeutic dosing regimen of budesonide (p < 0.001), which was independent of microbial-based drug metabolism as determined by HPLC. We demonstrate that lytic phage targeting a CD-associated bacterium attenuates colitis in gnotobiotic mice. Intervention did not lead to bacterial eradication but instead modulated bacterial virulence mechanisms and enhanced responses to corticosteroid therapy. The data suggest alternative mechanisms should be considered when translating phage therapy to treat IBD in clinical trials. CIHR
Disease location varies among patients with inflammatory bowel disease (IBD), and may influence the efficacy of advanced therapies. Thus, it is important to understand recruitment pattens based on disease location and its impact of on outcomes in IBD clinical trials. We conducted a systematic review to evaluate the distribution of different disease locations and its effect on efficacy of advanced therapies among patients enrolled in IBD clinical trials. MEDLINE, Embase, and Cochrane CENTRAL (via OVID) were systematically searched for randomized, placebo-controlled induction trials (RCTs)in patients with IBD, published from 2000 to March 2025. We extracted baseline data on disease location or extent and assessed whether the studies included disease location in the eligibility criteria or considered it as a stratification factor in the randomization. Additionally, we collected data on efficacy outcomes by disease location, if reported. We identified 367 records and 215 underwent full text review. In total 139 RCTs met inclusion criteria. Among these 71 RCTs included patients with CD (n = 25616) and 68 UC (n = 22959). Among the CD studies, 24.8% (n = 6374) of patients had ileal disease, 36.0% (n = 9210) ileocolonic, 33.1% (n = 8467) colonic and 4.1% (n = 1056) had upper GI involvement. In 2 CD studies, exclusion of upper GI disease location was specified. Among UC studies, only 2.2% (n = 509) patients had proctitis, 49.9% (n = 11455) left sided colitis, and 37.2% (n = 8552) extensive/pancolitis. Although the majority of studies (n = 37) did not include patients with proctitis, only 31 explicitly listed proctitis as an exclusion criterion. No RCT stratified patients based on disease location in randomization; and 27 RCTs (CD:12, UC:15) reported outcomes based on disease locations. This systematic review provides valuable insights into the distribution of disease location and extent among patients participating with IBD clinical trials. Most CD trials included patients with ileocolonic disease location and patients with proctitis are generally excluded from UC trials. Additionally, disease location generally is not considered as a stratification factor in randomization. SRTP Schulich
Endoluminal vacuum (EndoVAC) therapy is a minimally invasive endoscopic approach for managing gastrointestinal (GI) leaks. Conventional systems often require oropharyngeal assembly under general anesthesia, adding airway manipulation, procedural complexity and patient discomfort. We describe a simplified, direct-transnasal EndoVAC technique performed under conscious sedation at a Canadian tertiary centre. To evaluate technical and clinical outcomes of a modified EndoVAC technique performed under conscious sedation. A retrospective single-centre review was conducted at Vancouver General Hospital including seven patients treated with a modified endoluminal vacuum (EndoVAC) therapy for gastrointestinal (GI) leaks. In this technique, non-adherent Telfa dressings were trimmed to defect size, wrapped around the distal port of a Salem Sump nasogastric tube, and secured with silk suture. The assembly was inserted transnasally under conscious sedation and advanced endoscopically to the defect, where continuous suction was applied. Technical success was defined as successful placement without general anesthesia or intraprocedural complications. Clinical success was defined as complete closure of the leak confirmed endoscopically or radiographically without surgical intervention. Six patients were treated using repeated exchanges of the modified EndoVAC configuration. The median age was 59 years (range 23–73); four (57%) were male. Indications included three foregut anastomotic leaks, one proximal sleeve leak, and two spontaneous esophageal perforations. Technical success was achieved in all cases (100%). The median number of exchanges was 4 (range 2–6), performed every 3–5 days. The median duration of therapy was 22 days (range 7–28). Clinical success was achieved in five patients (83%), including one who required adjunctive pigtail stenting due to poor tolerance. One patient (17%) required surgical intervention, due to pulmonary communication. Cases were performed under intravenous conscious sedation. There were no serious adverse events. This simplified, fully transnasal EndoVAC technique eliminates oropharyngeal manipulation and allows atraumatic placement under conscious sedation. It was safe, well tolerated, and achieved outcomes comparable to conventional systems. This approach may broaden the applicability of EndoVAC therapy to patients who are poor anesthetic candidates or in settings with limited access to general anesthesia. None
ESD has been established as a minimally invasive resection method for superficial neoplasms of the esophagus, stomach, and colorectum. However, the optimal technique for superficial non-ampullary duodenal lesions (SDLs) is uncertain because potential gains in resection quality with ESD may trade off against safety. This systematic review and meta-analysis aimed to evaluate the efficacy and adverse event rates of EMR versus ESD in adult patients with SDLs. We searched MEDLINE and Embase (via Ovid) to July 14, 2025, for experimental and observational comparative studies. Two reviewers independently screened/extracted data assessed risk of bias and graded the level of certainty (GRADE). Random-effects models yielded risk ratios (RRs) and 95% CIs. A prespecified subgroup analysis examined studies in which the EMR group reported mean/median lesion diameter ≥20 mm. Twenty-four retrospective cohort studies (5,515 lesions: EMR 3,709; ESD 1,806) were included. ESD improved en-bloc (RR 1.10, 95% CI 1.05–1.16) and R0 resection (RR 1.15, 95% CI 1.01–1.31); local recurrence did not differ (RR 0.62, 95% CI 0.28–1.39). Procedural risk was higher with ESD, including intraprocedural perforation (RR 9.34, 95% CI 6.03–14.45) and delayed perforation (RR 5.82, 95% CI 3.09–10.96); delayed bleeding and the need for surgery or endoscopic reintervention were also increased. In the ≥20 mm subgroup, differences diminished; only intraprocedural perforation remained higher with ESD (RR 3.76, 95% CI 1.04–13.58). Certainty of evidence (GRADE) was low for efficacy (en-bloc, R0) and local recurrence, high for perforations, delayed bleeding, and surgical intervention, moderate for endoscopic reintervention, and low for mortality. For SDLs, ESD achieves better resection quality but at greater procedural risk. EMR is a reasonable default first-line strategy for most benign polyps, reserving ESD for lesions where en bloc histology would alter management and where ESD can be completed in expert centers. Randomized trials, particularly lesion-stratified studies, are needed. None
Monitoring disease activity in inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is critical for guiding therapy and preventing irreversible mucosal damage. Colonoscopy, the current gold standard, is invasive and impractical for frequent follow-up, while fecal calprotectin lacks precision within its diagnostic “gray zone.” In this context, stool proteomics provides a non-invasive window into intestinal inflammation through direct measurement of molecular effectors. To establish a proof-of-concept study demonstrating that stool-derived peptides can be leveraged for accurate IBD activity classification (Active vs Remission) using an unbiased, reproducible nested cross-validation (NCV) machine-learning approach. A total of 170 stool samples from IBD patients were collected and profiled using SWATH-DIA mass spectrometry. Feature selection was performed within the training loops only (Boruta, LASSO, RRF) across repeated subsampling, retaining peptides consistently identified in ≥ 70 % of runs. Stable features were used to train four classifiers (GLMNet, SVM-Radial, SVM-Linear, Naïve Bayes) under inner 5-fold tuning. Outer test folds provided fully unseen evaluation, and misclassified cases were tracked to assess biological ambiguity. Feature selection yielded 8–12 stable peptides per fold, mapping to 9 unique proteins, several of which recurred across ≥60% of outer folds. Models showed high and stable performance across folds with AUC = 0.94–0.97 and Balanced Accuracy = 0.84–0.90. Specificity remained high (≥ 0.90), while sensitivity ranged 0.77–0.93, confirming reliable detection of both active and remission states. Inner-CV results highlighted GLMNet and SVM-Radial as consistently strong performers, whereas Naïve Bayes achieved slightly higher mean sensitivity. Only a few borderline samples were repeatedly misclassified, suggesting biological rather than algorithmic uncertainty. This work provides a proof of concept that stool-based peptidomic features can serve as reliable indicators of IBD activity when analyzed through robust, leakage-free machine-learning design. The study establishes a foundation for future translational studies aiming to refine and clinically implement stool peptide biomarkers as part of personalized, non-invasive IBD management. CCC, CIHR
Gastric cancer is the third deadliest cancer, often arising from chronic gastritis caused by Helicobacter pylori, which can lead to ulcers and excessive cell growth that may trigger tumor formation. This transition to gastric cancer is closely associated with metaplastic cell lineages in the epithelium, notably the appearance of proliferative mucus-producing cells at the base of the gastric glands, known as spasmolytic polypeptide/trefoil factor 2-expressing metaplasia (SPEM). Despite this understanding, the processes driving alterations in cell fate during chronic inflammation and their function in regeneration and tumorigenesis are poorly understood. A critical determinant of cell fate regulation in regenerating tissues is the Hippo pathway. Using an acute chemical injury model to initiate SPEM, based on administration of high-dose tamoxifen (HDT), our findings demonstrated that inactivation of the downstream Hippo effectors, Yap and Taz, in the murine gastric epithelium impaired SPEM resolution and triggered chronic gastritis. Thus, we hypothesize that the transcriptional activators Yap/Taz play an essential role in regulating epithelial-immune crosstalk during metaplasia and gastric cancer development. To address this hypothesis, we aim to dissect the direct immunomodulatory roles of these effectors by identifying epithelial-specific Yap/Taz responsive genes and functionally characterizing Yap/Taz-dependent immune responses. We also seek to investigate how Yap/Taz regulate epithelial cell fate during tissue repair, where their dysfunction may impair epithelial healing, further promote inflammation, and contribute to cancer development. Yap/Taz mutant mice were transcriptionally profiled to identify epithelial specific immunomodulatory signals as well as to uncover alterations in tissue regeneration pathways. Immune cell populations in the lamina propria of Yap/Taz-deficient mice were characterized by flow cytometry, and their functional roles during SPEM were further investigated using in vivo ablation experiments. Using a genetic cancer model with additional knockout of the tumor suppressor p53, we investigated whether the observed roles of Yap/Taz are implicated within a tumorigenic context. Our data revealed that Yap/Taz-deficient epithelium exhibits altered regulation in pathways related to chemotaxis and barrier integrity, which may underlie the associated inflammation. Further immune profiling demonstrated that loss of Yap/Taz resulted in chronic B cell and macrophage infiltration in corpus glands, supporting an immunomodulatory role for these effectors. Through this project, we aim to define biological and immunological responses that are controlled by Yap/Taz, providing important insights on immune-epithelial cell interactions important for tissue regeneration and tumorigenesis. CIHRFRQS
Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract with Crohn’s disease (CD) and ulcerative colitis (UC) as the two main phenotypes. IBD is often diagnosed during the reproductive years and presents to be a challenge due to the limited evidence of its impact during the peripartum period. Macronutrient intake during pregnancy is critical in women with IBD because chronic intestinal inflammation and malabsorption can impair maternal nutrient status and fetal growth. This study aims to compare the dietary patterns of women with and without IBD and their infant growth until 6 months (6M) postpartum. In total, 34 pregnant women with IBD and 12 pregnant women without IBD were recruited into our single-center prospective study at Mount Sinai Hospital, a tertiary care centre in Toronto with a high-risk pregnancy and IBD clinic. Participants completed a 3-day food intake diary at 3 months (3M) postpartum. Maternal nutrient intake and food group classification were assessed using ESHA Food Processor Nutrition Genesis. Infant growth measurements were compared to the World Health Organization’s standardized growth curve. Twenty-four women with IBD and 9 women without IBD completed the 3M dietary assessment. Women with IBD had lower consumption of protein compared to women without IBD (80.8 ± 21.4 g vs 89.0 ± 38.2 g, p = 0.414), less carbohydrate (271.4 ± 63.7 g vs 307.9 ± 111.3 g, p = 0.79), less fiber (19.7 ± 8.2 g vs 21.3 ± 7.1 g, p = 0.32), but more fats (95.7 ± 44.2 g vs 90.6 ± 29.4 g, p = 0.79) daily at 3M. Women with IBD’s diet consisted of 10% fewer vegetables at 1M (p = 0.10) and 3M (p = 0.15) postpartum. Infants born from women with IBD who met their recommended fat intake had lower weight-for-age (WFA) Z-scores compared to infants of women without IBD who met their fat intake at 3M (p = 0.48) and 6M (p = 0.47). There was no statistical difference in the WFA and length-for-age (LFA) Z-scores up to 6M. Women with IBD consumed more fats, but less protein, carbohydrates, and fiber than women without IBD. Infants born to women with IBD had a lower WFA and similar LFA Z-scores compared to infants of women without IBD. Future research will investigate the role of nutritional interventions and dietary counseling in optimizing pregnancy and infant outcomes in women with IBD. American College of Gastroenterology Resident Grant, University of Toronto’s Division of Gastroenterology Resident Grant, University of Toronto’s Department of Medicine Resident Grant, CAN-TAP-TALENT
Most patients with Crohn’s disease (CD) who undergo CD surgery are at high risk of malnutrition and postoperative morbidity and mortality. Preoperative nutritional assessment should be the standard of care as it can significantly reduce complication rates and improve outcomes. However, patients undergoing elective surgery for CD at The Ottawa Hospital (TOH) often do not receive routine nutritional assessments. These patients are often malnourished, but this is not recognized until it is too late. 1) Assess the current rates of formal nutrition assessment in patients undergoing elective CD surgery at TOH; 2) Determine what proportion of these patients develop post-operative complications. We performed retrospective chart reviews on patients who underwent elective or semi-elective CD surgery at TOH between June 2019 and October 2024. Patients were excluded if they had a diagnosis of ulcerative colitis or had a recent malignancy. Data collected included whether patients had a formal nutrition assessment and the timing in relation to their surgery. Outcome measures included 30-day post-operative complications (30-day infection, anastomotic leak or abscess formation, 90-day fistula development), 30-day follow-up surgery and 90-day readmission related to the surgery. 75 patients met inclusion criteria, 50.7% female with mean age 46. 70.7% of patients received a peri-operative nutrition assessment, with 41.3% assessed before surgery, 28% assessed at least 7 days before their surgery, and 29.3% only assessed after surgery. Of 42 patients who had malnutrition assessment documented, 88.1% had malnutrition and 35.7% were severely malnourished. 46.7% of patients had one or more of: post-operative complications, follow-up surgery or related re-admission. Of the patients who developed a complication, 29.4% had a nutrition assessment at least 7 days before surgery. Preoperative nutritional assessments and optimization can reduce the high risk of postoperative morbidity and mortality associated with elective CD surgery. Our study shows that current practices at TOH fall short of the expected standard of care. Despite a significant proportion of patients having evidence of malnutrition, less than half receive a nutrition assessment before surgery, and close to half develop post-operative complications. Our findings will help inform future intervention planning to standardize pre-surgical nutrition assessments for these patients. None
Densely O-glycosylated mucus is a crucial mediator of barrier function and protection from microbially induced colitis; however its therapeutic potential, particularly in a human-relevant context, is unclear. This is partly due to the difficulty in accessing large quantities of in vivo produced natural (primary) human MUC2, the major protein in mucus. Recent insights showing fecal association and encapsulation of microbial boli have enabled non-invasive access to primary human MUC2 for functional analysis. We tested the hypothesis that primary human fecal MUC2 can act as a prebiotic to restore homeostasis in a preclinical model of colitis induced by defective mucus within a humanized colonic ecosystem. A humanized colitogenic ecosystem was generated using TM-inducible epithelial-specific deletion of core 1 synthase (C1galt1f/f;VilCreERT2) to produce underglycosylated mucus with a human-like core 3 O-glycan profile, followed by colonization with human microbiota on a human-profile diet (Hu:TM-IEC C1galt1-/-). After colitis establishment (2 weeks post-TM), exogenous fecal MUC2 naturally enriched in core 3 O-glycans was administered. Clinical disease activity, histopathology, in situ mucus structure, 16S rRNA sequencing, and inflammatory gene expression (qPCR, ELISA) were assessed. Prior to induction, Hu-TM-IEC C1galt1-/- mice retained a robust mucus layer that was rapidly degraded post-TM, leading to spontaneous colitis and validating the model. Human MUC2 treatment reduced clinical disease activity by restoring body weight and decreasing diarrhea. Histology confirmed reduced hyperplasia and inflammatory infiltrates. RT-qPCR and ELISA showed decreased IL-6, IL-23a, and Ccl2 expression in colonic mucosa post-treatment. Mechanistically, MUC2 restored the endogenous proximal colon derived barrier layer, indicating protective effects in microbiota-adapted proximal regions. 16S profiling revealed increased representation of eubiotic-associated taxa and elevated anti-inflammatory short-chain fatty acids (acetic and propionic acid) in MUC2-treated mice. Primary human fecal MUC2 ameliorates colitis by restoring endogenous mucus barrier function and promoting eubiosis. This is the first demonstration of therapeutic application of exogenous human MUC2 in a humanized intestinal ecosystem. Weston Family Foundation
Gastric outlet obstruction (GOO) presents with nausea, vomiting, weight loss, early satiety, and abdominal distension due to impaired gastric emptying. While most gastric polyps are asymptomatic, larger polyps may prolapse through the pylorus and cause GOO in a “ball-valve” manner and may undergo malignant transformation. Current evidence is limited to case reports, case series, and reviews. This systematic review synthesizes primary data on presentation, diagnosis, management, and outcomes of GOO secondary to gastric polyps. To summarize the evidence on symptomatology, diagnostic approaches, and treatment of gastric polyp–related GOO. A PRISMA-based systematic review of MEDLINE, Embase, Scopus, and Web of Science was conducted. Descriptive statistics were used for demographics and treatment outcomes. Of 408 articles, 56 (52 case reports, 4 case series) published up to April 2025 were included. Median age at presentation was 47 years (range 2 days–89 years) with female predominance. Common symptoms included epigastric/abdominal pain, nausea, and vomiting. Polyps were usually in the antrum with a median size of 4 cm. Upper endoscopy was diagnostic in 91.8%, often revealing a pedunculated polyp prolapsing into the duodenum. CT was used in 34% as adjunct imaging. Endoscopic resection was performed in 24/61 cases (39.3%) and was curative in all. Surgical management was required in 27/61 (44.3%), especially for large or sessile lesions. Symptom resolution occurred in 58/61 cases (95%). In patients with weight loss, vomiting, and anemia, malignancy should first be suspected due to overlapping symptoms. GOO is a clinical diagnosis, and benign polypoidal causes should be considered once malignancy is rule out. Given malignant potential, polypectomy is first-line, with endoscopic or surgical approach based on polyp size and extent. Both methods show excellent outcomes and no procedure-related mortality. Hereditary polyposis syndromes should be considered in patients with personal or family history. Management should be individualized based on presentation, comorbidities, histology, and extent of polyposis. Further long-term studies are needed to assess recurrence after polypectomy. None
Nausea is a common symptom, yet understanding of its pathogenesis and optimal treatments remains elusive, due partly to limitations in the animal models of nausea. Because rats and mice are non-vomiting species, most animal studies have used other putative nausea-related behaviors. In rats, one such behavioral assay is conditioned taste reactivity (CTR), in which repeatedly pairing a novel taste with a nauseating stimulus yields characteristic aversion-associated movements of the mouth and forelimbs. Relatively few CTR studies have been conducted in mice, however, and none have investigated the effectiveness of nausea treatments. We sought to investigate whether clinical nausea is closely modeled by CTR in mice, as it is in rats. We prepared 8-12 month old C57B6 mice (n = 64) for CTR testing by implanting intraoral (IO) cannulas. On consecutive days, mice underwent habituation, 5 conditioning sessions, and final testing. During conditioning, 0.1% saccharin was infused IO, immediately followed by intraperitoneal (IP) injection of saline, cisplatin (0.5-2.5 mg/kg body weight), or lithium chloride, a common experimental nausea precipitant. Half the cisplatin- and lithium-treated mice were pre-treated with ondansetron 0.2 mg/kg IP 30 minutes before conditioning. In the testing session, behaviors during saccharin exposure were video recorded and manually scored. For comparison, we also conducted a separate experiment to investigate the effects of ondansetron and 2 other anti-nausea agents using conditioned flavor avoidance (CFA), another putative nausea-related assay focusing on the quantity of saccharin solution freely consumed by cisplatin-exposed mice (n = 15). In CTR testing, when compared to saline control, cisplatin conditioning at both doses increased the predominant aversive behavior, forelimb flailing (low-dose P = 0.042, high-dose P = 0.027, U test). Mice pre-treated with ondansetron exhibited intermediate levels of forelimb flailing, indicating partial blockade of the cisplatin effect (Fig 1). In CFA testing, all 3 anti-nausea agents, including ondansetron, were ineffective in reducing the effect of cisplatin conditioning. We showed, for the first time, that cisplatin elicits nausea-like behavior using the CTR assay in mice, and that pre-treatment with ondansetron mitigates this effect. These findings build confidence in the CTR experimental setup, which may be used to study novel nausea precipitants and treatments, as well as transgenic modifications that may elucidate relevant neural pathways. None
