bluuebunny/crossref_metadata_2025 huggingface dataset:
2822 Twelve-Month Durability of Microbiota-Based Drug RBX2660 for Preventing Clostridioides difficile Infection (CDI) Is Not Associated With Patient Demographics: Sub-Population Analysis of a Phase 2 Open-Label Study
Authors: Ray Arnab , Mische Sarah , Blount Ken , Bancke Lindy , Su Xin , Harvey Adam , Gerding Dale
Published: October 2019

INTRODUCTION:

Recurrent Clostridioides difficile infection (rCDI) is an urgent public health threat that is associated with significant mortality and substantial medical cost. Microbiota therapy is gaining acceptance to prevent rCDI in multi-recurrent individuals. Two Phase 2 clinical studies have reported the efficacy of RBX2660, a standardized, stabilized microbiota-based drug, in preventing rCDI. To address the suggestion of demographic differences on treatment outcome, we investigated two key demographic stratifications (age and gender) of rCDI subjects enrolled in the Phase 2 open-label study and their associations with outcomes through 12 months post-RBX2660 treatment.

METHODS:

Data were drawn from a multi-center, open-label Phase 2 study (NCT02589847) in which subjects with multi-recurrent CDI received <2 doses of RBX2660 delivered via enema 7 days apart; this analysis includes data to 12 months after completion of dosing, with ongoing follow-up through 24 months. Efficacy was defined as absence of CDI recurrence through 56 days after the last dose; and durability is defined as a continued lack of reported CDI occurrence. Subjects were censored from subsequent time intervals if they experienced a new CDI occurrence. Fisher’s exact test was performed comparing the proportion of treatment subjects who were recurrence-free by subgroup: age, >65 years vs. <65 years; sex, male vs. female.

RESULTS:

This study included 149 RBX2660-treated participants in the USA and Canada. Eight-week efficacy for RBX2660 in preventing rCDI (76.5%; 114/149) was higher than CDI-free rates in the historical control group (51.8%, 57/110; P < 0.0001). Of the 114 RBX2660 subjects who achieved treatment success through 8-weeks, 109 subjects had 6-month follow-up data. Of those, three experienced a new CDI episode through 6 months. Between 6 and 12 months, two additional subjects experienced a CDI occurrence. The overall durability through 12 months is 91.7%, as four of the 109 subjects didn’t complete 12-month follow-up and were conservatively assessed as failures. Age and gender did not have a statistically significant impact on efficacy outcome (Table 1). The safety profile through 12 months is consistent with previous reports for RBX2660.

CONCLUSION:

RBX2660, a microbiota-based drug, was efficacious for preventing rCDI, with clinical durability to at least 12-months after treatment. Importantly, durability was not dependent on age or gender. Twenty-four month follow-up of efficacy and safety are ongoing.
2826 Trends of Sepsis Mortality in Colon Cancer Patients
Authors: Aijazi Muaz , Ahuja Ashish , Masood Jamil , Bhatti Waqas , Williams George W.
Published: October 2019

INTRODUCTION:

Investigations have revealed that 1 in 6 severe sepsis patients have underlying neoplastic disease. Cancer patients have been shown to be nearly 10 times more likely to acquire sepsis than the noncancer US population. Moreover, this patient population was also shown to have a 30% higher risk of mortality compared with other severe sepsis patients (1, 2). We utilize a national database - Surveillance, Epidemiology, and End Results (SEER) - to analyze and elucidate trends in sepsis mortality over the years in patients diagnosed with colon cancer.

METHODS:

Incidence data was derived from the 9 original registries of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer. 10% of US population was accounted for under the 9 original SEER registries. (3) Cancer incidences were collected from 1985 to December 31, 2014. Septicemia was chosen as the end point for our patient population. SEER data of death events occurring from 1/1/1985-12/31/2014 were used in change point analysis. We fitted the two-piece linear trend line with jump located at each year in 1990 to 2010. Root-mean-square error (RMSE) was obtained for each trend line. Year of jump was determined by choosing the trend line with smallest RMSE.

RESULTS:

In 1985 to 2014, a total of 185,582 deaths were recorded in patients diagnosed with primary colon malignancies. Septicemia was listed as the cause of death for 1,517 of these patients. When assessing temporal changes in sepsis mortality, a statistically significant change in trend was seen in the year 1999 across the colon cancer cohort (+0.39%, P < 0.001).

CONCLUSION:

There was a statistically significant increase in the ratio of sepsis deaths to total deaths in patients with colon cancer in 1999. It is difficult to declare at this point one single reason for this trend, however the authors believe it could in large part be attributed to earlier diagnosis of colon cancer, and thus an apparent prolonged duration of life. Interestingly, in 1998, Medicare began to cover colon cancer screening via fecal occult blood testing (FOBT) and sigmoidoscopy. In mid-2001, universal coverage was advanced to screening colonoscopy. 1) Martin GS et al. The Epidemiology of Sepsis in the United States from 1979 through 2000. The New England Journal of Medicine. 2003;348(16):1546-54. 2) Danai PA et al. The Epidemiology of Sepsis in Patients With Malignancy. Chest. 2006;129(6):1432-40.
2827 Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection in Patients With Multiple Comorbidities: A Case Series From a Tertiary Care Community Hospital
Authors: Subramanian Charumathi Raghu , Talluri Swapna , Khan Safi U. , Georgetson Michael J. , Preetika Sinh
Published: October 2019

INTRODUCTION:

Cure rates of Clostridium difficile infection (CDI) with Fecal Microbioata Transplant (FMT) have been promising. However, there is debate regarding success of FMT in patients with co-morbidities. In this case series, we describe a tertiary care center’s experience with FMT for recurrent CDI in patients with varied clinical background including those with co-morbidities and IBD.

METHODS:

CDI was defined as diarrhea (≥3 loose stools in 24 hours) and stool test positive for C. difficile toxins by PCR. Early FMT failure was defined as diarrhea and positive stool test within 8 weeks, and recurrence/late FMT failure was defined as that after 8 weeks. Adults >18 years of age with 3 or more recurrences of CDI were included in the study. There were no specific exclusion criteria. Electronic chart review was done to collect data on patients who underwent FMT from January 2015 to August 2017. Charts were analyzed in November 2018 with a median follow up of 25.4 months (IQR 10.4). The study was approved by Institutional Review Board (IRB). Descriptive analyses like frequencies and measures of central tendencies were used for continuous variables. Due to low sample size, further statistical analysis could not be performed.

RESULTS:

20 patients underwent FMT (Table 1). The primary success rate at our institution was 90% (Figure 1) and overall recurrence rate was 100%. 6 patients (43%) had FMT failure (early and late). 2 patients (10%), both of whom were immunosuppressed, had early FMT failure. 4 (20%) patients had late FMT failure or recurrence of CDI and had successful resolution either with repeat FMT or antibiotic treatment . None of the 20 patients reported side effects from FMT. All-cause mortality was noted in 2 (10%) patients unrelated to FMT. Charlson comorbidity index was not associated with failure of FMT.

CONCLUSION:

50% FMT failure patients were immunosuppressed compared to 21% in the primary success group. Immunosuppression was due to medications in all patients. 33% of FMT failure patients had IBD (vs 7% in the FMT cure group), all of them had sustained cure after repeat treatments. Mean age of FMT failure patients was lower than those in the primary cure group (59 vs 64), while the subgroup of patients with early failure were older (65.5). PPI use was higher in late failure patients (75% vs 64%), but overall there was no difference between patients with failure and cure. Our case series reiterates the safety and efficacy of FMT for recurrent CDI in patients with comorbidities.
2833 Too Open for Business? Audit of Our “Open Access” Colonoscopy Program
Authors: Piech Gregory , Bhuta Rajiv , Reichenbach Zachary , Toro Butros , Gotfried Jonathan
Published: October 2019

INTRODUCTION:

Open access colonoscopy programs are designed to decrease barriers to colorectal cancer (CRC) screening and streamline processes for patients and providers. Appropriate pre-procedure selection and patient education around bowel preparation are essential to successfully complete screening. We performed an audit of the current open access program at our urban, tertiary care university hospital in an effort to determine utilization of our program and quality of procedures for participating patients.

METHODS:

We performed a prospective analysis of the first, consecutive 100 patients enrolled for open access colonoscopy from February – May 2019. Patients answered standard screening questions about medical history to determine eligibility for open access CRC screening. To account for all patients, the electronic health record was modified for schedulers to designate patients as 'open access' at the time of scheduling. Patients were followed over the subsequent three months to determine show rate, reasons for incomplete procedure, quality of screening examination and findings on colonoscopy.

RESULTS:

A total of 98/100 patients were included for analysis (excluded two patients inadvertently designated as screening colonoscopy). The average screening age was 56 (range 45 - 73) with the majority females (62%). The overall show rate for scheduled procedure was 74/98 (75.5%). Of the 24 patients who did not show for scheduled procedure, 12.5% required pre-procedure cardiology clearance, 12.5% did not have appropriate in-network insurance, 12.5% did not complete bowel preparation, 8.3% cancelled for personal reasons and 54.2% did not show and could not be reached for follow up. There was no statistically significant difference between no-show rate depending on the PCP's affiliation: health system [14] vs. outside referral [10]). For those completing colonoscopy, 14.9% (11/74) had poor prep, 10.8% (8/74) had fair/adequate prep and 74% (55/74) had good/excellent prep. The most commonly prescribed bowel regimens were 4L PEG (53%) and 2L PEG + Vit C (22%).

CONCLUSION:

Despite a majority of patients completing colonoscopy for CRC screening, a significant group of patients did not complete screening through our open access system. By performing an audit, several barriers were identified that can be modified in future quality improvement projects to maximize open access success and completion rates.
2842 Do Socioeconomic Factors Really Have an Impact on Early Detection of Hepatocellular Carcinoma and Colorectal Cancer?
Authors: Zafar Yousaf , Kaur Anahat , Khan Ghazal , Asif Samia , Saeed Lyla , Simon Stephen , Shrestha Anuj
Published: October 2019

INTRODUCTION:

Improving surveillance in Hepatocellular Carcinoma (HCC) and Colorectal Cancer (CRC) is an important topic in the field of Gastroenterology and Oncology due to significant benefit associated with early detection and better outcomes. Multiple studies have been undertaken to assess association between socioeconomic status of the population and its impact on HCC/CRC screening and survival after diagnosis. Most of these studies used self-reporting surveys and faced limitations due to reporting bias. We aimed to assess the relevance of socioeconomic factors in diagnosis of HCC and CRC in Jackson County, Kansas City, Missouri by means of a census-based survey.

METHODS:

We retrospectively studied 190 HCC and 690 CRC cases at our institution using a census-based analysis, which consisted of geocoding home addresses of patients and then attaching block level census variables for household occupancy, education level and household income. Survival was assessed using time of last contact at our facility. Statistical analysis was performed using Cox proportional hazard model and ordinal logistic regression.

RESULTS:

We did not find a statistically significant association between socioeconomic factors and adherence to surveillance guidelines for HCC and CRC leading to improved overall survival. Variables that were analyzed included high school education or better (P = 0.5), four-person households with one or more workers (P = 0.08) and income less than 25 thousand dollars (P = 0.58). Study results were risk adjusted for age, race and gender. Separate ordinal logistic regression analysis was done to also adjust for stage at time of eventual cancer diagnosis, no statistically significant result was obtained.

CONCLUSION:

Our study showed no association between socioeconomic variables and participation in HCC or CRC surveillance. The study is limited by a relatively small sample size confined to local patients seen at our institution. Multicenter census-based surveys and meta-analyses need to be conducted to determine whether socioeconomic factors really have an appreciable impact on early screening and detection of HCC and CRC.
2846 Colorectal Cancer Screening in Individuals Ages 45-49 Years: Point Sensitivity of the Multi-Target Stool DNA Test
Authors: Domanico MIchael , Statz Sandra , Weiser Emily , Swartz Rebecca , Berger Barry M. , Limburg Paul
Published: October 2019

INTRODUCTION:

Colorectal cancer (CRC) incidence and mortality rates in the ≥55 year old population is decreasing, while CRC incidence and mortality is increasing in those < 55 years old (SEER Cancer Stat Facts: Colorectal Cancer. NCI, Bethseda, MD). Recently, the American Cancer Society revised its CRC screening guidelines to recommend screening initiation at age 45 years for average-risk individuals (American Cancer Society, 2018). To date, most endorsed CRC screening tests have not been rigorously studied in younger age groups. In this study, we examined the point sensitivity of the multi-target stool DNA (mt-sDNA) test in patients ages 45-49 years. The mt-sDNA test is currently FDA-approved to qualitatively detect biomarkers associated with colorectal neoplasia in individuals 50 years and older and at average risk for CRC, and data do not suggest age-related changes in sensitivity of the mt-sDNA test (Imperiale et al, 2014, NEJM).

METHODS:

Clinical listings of Exact Sciences-sponsored studies were queried to identify archived stool samples previously collected from individuals ages 45-49 years, with confirmed diagnoses of CRC or advanced adenomas (AA; defined as ≥1 cm, or ≥25% villous morphology or high-grade dysplasia of any size). Historical information regarding CRC risk was limited. Stool samples were collected at least 7 days after the screening colonoscopy, prior to lesion excision and any pre-surgical prep or neoadjuvant treatment. Samples were analyzed per the mt-sDNA test label instructions. Mt-sDNA test sensitivity for advanced colorectal neoplasia (CRC + AA), CRC, and AA were the primary study study endpoints.

RESULTS:

Archived stool was available from 13 individuals with CRC and 6 with AA. Mt-sDNA test sensitivity for advanced neoplasia (CRC + AA), CRC, and AA were 89% (17/19 samples), 92% (12/13 samples), and 83% (5/6 samples), respectively.

CONCLUSION:

This small study using archived stool samples from individuals ages 45-49 years without complete risk status information found that mt-sDNA test sensitivity was similar to previously reported data for individuals ages 50 years and older (Imperiale et al, 2014, NEJM), providing initial demonstration of test sensitivity in this younger population. Larger studies are needed to confirm and more broadly evaluate mt-sDNA performance characteristics in an average risk screening population in this age group.
2847 Outside the Scope a Better FIT for Some Patients
Authors: Ghiya Ronak , Lin Harris , Calderon Joanattan
Published: October 2019

INTRODUCTION:

Colorectal cancer is the 3rd most common cancer in American adults and is the 2nd most common cause of cancer death. Colorectal cancer screening (CRCS) is unique because it not only detects but also prevents cancer from ever developing, something no other cancer screening accomplishes. Despite this advantage, in 2015 the national average for CRCS compliance was only 63%, below the National Colorectal Cancer Roundtable (NCCR) goal of 80%. The reason for the low rate of CRCS is multifactorial including the fear of having a colonoscopy. At the Baylor Scott & White Primary Care Clinic in Round Rock, TX, CRCS compliance in 2019 was 54% for commercial insurance and 73% for Medicare patients. Our goal was to increase our CRCS compliance and provide better preventative care for our patients.

METHODS:

We reviewed the charts of 200 randomly selected patients who were considered non-compliant with CRCS between September 2017 to September 2018. Non-compliance was defined as a patient who was eligible for CRCS in this one-year time frame but failed to have CRCS. This helped identify causes for why CRCS was not performed. In our review, 0% of these patients were offered alternative methods of CRCS besides colonoscopy. This information led us to educate attending and resident physicians with oral presentations on the availability of alternative testing modalities for CRCS. In addition, one of these modalities, fecal immunochemical test (FIT) kits, were placed in patient rooms in our primary care clinic. Providers were asked to offer patients a colonoscopy for CRCS, and if a patient refused, to then offer FIT testing.

RESULTS:

Among noncompliant patients, no modalities aside from colonoscopy were mentioned by providers for CRCS to non-compliant patients. With the implementation of FIT kits, patients were more inclined to undergo CRCS. From January to March 2019, there was a 12% CRCS compliance rate. After our intervention in April 2019, CRCS compliance was 18% in April 2019, with the entire 6% increase in compliance coming from FIT test kits.

CONCLUSION:

Despite its benefit, CRCS remains below compliance goals set by NCCR. By having FIT kits placed in all the clinic rooms, it was more convenient for patients to have CRCS. There will be continued education on the benefits and modalities of CRCS to more health care providers. We plan to implement this project at other Baylor Scott & White Primary Care Clinics in the region.
2855 To Determine the Clinical Profile of Patients With Esophageal Cancers
Authors: Adnan Muhammad , Nasar Aida
Published: October 2019

INTRODUCTION:

Cancer of the esophagus ranks twelfth among the major cancers in the number of new cases diagnosed and seventh in the number of cancer death. Its high mortality rate makes it a major concern. Numerous approaches have been described for resection of esophagus. Combined modality therapy including radiotherapy and chemotherapy has raised hope for improvement of survival with promising preliminary data.Finally, for palliation of dysphagia in those patients with advanced disease,various newer therapeutic options have been introduced like endoscopic stenting and laser ablation. Thus this study elaborates view of current literature pertaining to the disease and concludes by comparing the results of the present study with the former national and international scenario.

METHODS:

The one year cross sectional study was conducted at tertiary care hospital. All the patients either gender who were diagnosed as esophageal cancer were included in the study. These patients were allowed to undergo necessary investigations and treatment while the subjects excluded from study were patients who were lost to follow up and the non cooperative patients who not interested to participate in the study while the frequency / percentages (%) and means ± SD computed for study variables.

RESULTS:

During one year study period total fifty patients with esophageal carcinoma were explored and studied. the frequency for male and female population was 32 (64%) and 18 (36%) with mean ± sd for age of male and female individuals was 54.47 ± 5.87 and 51.75 ± 7.72 respectively. Gender male 32 (64%) and female 18 (36%), type of lesion exophytic 05 (10%), infiltrative 10 (20%), ulcerative 35 (70%), location upper third 05 (10%), middle third 30 (60%) and lower third 15 (30%). Histological type squamous cell carcinoma 36 (72%) and adenocarcinoma 14 (28%).

CONCLUSION:

Carcinoma esophagus is one of the most common gastrointestinal tract malignancies. It was the second most common gastrointestinal cancer in our hospital, second only to carcinoma stomach, constituting 6.2% of all malignancies. Squamous cell carcinomas accounts for the vast majority of cancers arising in high- incidence areas throughout the world.Seventy two percent of our patients had squamous cell cancer while twenty eight percent had adenocarcinoma. This reflects the difference in epidemiology and the fact that adenocarcinoma is not rising in incidence in less well- developed nations like ours compared to the West.
2856 The Epidemiology of Barrett’s Esophagus in Chronic Kidney Disease in the U.S.: A Population-Based Study
Authors: Alkhayyat Motasem , Saleh Mohannad Abou , Sanghi Vedha , Rouphael Carol , Mansoor Emad , Thota Prashanthi N. , Chak Amitabh
Published: October 2019

INTRODUCTION:

Background and Aims: Patients with chronic kidney disease (CKD) frequently suffer from gastroesophageal reflux disease (GERD) and have increased risk of various cancers including esophageal cancer. There is limited data in the literature regarding the epidemiology of Barrett’s esophagus (BE) in patients with CKD and if there is any association between both conditions. Using a large database, we sought to describe the epidemiology of BE in CKD.

METHODS:

Methods: We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems. We identified a cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) diagnosis of BE without a diagnosis of CKD from 2014-2019. This was used as the control group. Similarly, we identified a cohort of patients with SNOMED-CT diagnosis of new BE after at least one year of CKD diagnosis. We performed analyses to describe age-, gender-, and race-based distributions and evaluate underlying associations.

RESULTS:

Of the 36,893,970 individuals in the database (2014-2019), 1,298,830 had the diagnosis of CKD (3.5%) and 179,610 (0.49%) had the diagnosis of BE. Amongst CKD patients, 7,030 (0.54%) individuals had a new diagnosis of BE after at least one year of being diagnosed with CKD. When compared to individuals without a history of CKD, CKD patients were more likely to develop BE [OR: 1.29; 95% CI 1.26-1.33, P < 0.0001]. The prevalence rates of BE in patients with CKD is increasing in the past 5 years as illustrated in Figure 1. Individuals with CKD and BE were more likely to be males vs females, elderly (age >65) vs young adults (age< 65), and African American vs Caucasian. They were also more likely to be smokers, with history of metabolic syndrome, obesity, obstructive sleep apnea, and with diagnosis of GERD when compared to individuals without CKD (Table 1).

Limitations:

Endoscopic and histological data are not available. This database is at risk of confounding bias.

CONCLUSION:

Conclusions: In this large database, there is 30% higher prevalence of BE in CKD patients compared to those without CKD. This may be due to increased utilization of health care by CKD patients or an unknown confounding factor or a true association. Given the aforementioned limitations, this association needs to be confirmed in further studies.
2857 Acute Esophageal Necrosis: A Systematic Review of the Literature
Authors: Zafar Yousaf , Gondi Keerthi , Maitra Neil , Altom Keaton , Luke Alex
Published: October 2019

INTRODUCTION:

Acute Esophageal Necrosis (AEN) is a condition characterized by necrosis of the esophageal with black-appearing mucosa, commonly terminating at the gastroesophageal junction. This study aimed to identify the clinical characteristics of AEN.

METHODS:

We conducted a systematic review of the literature to identify all published cases of AEN between 1980 and 2019. All available cases were analyzed for clinical characteristics and outcomes.

RESULTS:

271 cases of AEN were identified. The majority of patients were male (72.3%) and of old age (62.9 years). The most common coexisting comorbidities were hypertension, diabetes mellitus, coronary artery disease, and alcohol abuse. AEN commonly presented alongside acute kidney injury, diabetic ketoacidosis, and sepsis. Reported etiologies of AEN included ischemia (32.5%), DKA (8.1%) alcohol use (5.9%), and medications (3.3%). Endoscopy revealed AEN most commonly occurs in the distal esophagus with circumferential involvement. Most patients were treated with medical management (60.9%). Mortality rate was 35.1%. Common complications included perforation, mediastinitis, and superinfection.

CONCLUSION:

AEN is a rare condition with severe morbidity and mortality. Acid suppressive therapy and supportive care is sufficient in the majority of patients. Perforation predicts a poor prognosis.
2866 Association of Metabolic Syndrome in Patients With Barrett’s Esophagus With High-Grade Dysplasia Compared to Low-Grade Dysplasia
Authors: Baldwin Nicholas , Nunley Benjamin , Spencer Chad , Peter Shajan
Published: October 2019

INTRODUCTION:

Barrett’s esophagus (BE) is a premalignant condition with potential to progress to esophageal adenocarcinoma. In the general population, the incidence and prevalence are increasing based on recent data. Newer studies, including a recent meta analysis, report an association of metabolic syndrome (MS) with an increased risk of BE.

METHODS:

Single-center, retrospective cohort study of patients who had both MS and BE with biopsy-proven HGD vs. LGD during a 5-year period. Descriptive statistics were used to summarize clinical categorical variables into frequencies and percentages. The chi-squared test was performed to make the statistical comparisons of categorical and continuous variables, respectively.

RESULTS:

308 patients with MS were included in the study, 125 had BE with HGD and 183 had BE with LGD. The proportion of metabolic syndrome in HGD patients was not significantly higher than LGD patients (27.2% vs. 25.7%, P = 0.77). Based on our results, HGD patients were 8.1% more likely to experience metabolic syndrome than LGD patients, although the result was not significant (OR 1.081; 95% CI 0.646 – 1.809).

CONCLUSION:

While there is an association of metabolic syndrome resulting in an increased risk for BE based on recent studies, our results show that there is not a stronger association of MS in patients with HGD compared to LGD.
2867 Barrett's Esophagus Screening: A Survey of Primary Care Physicians to Assess Knowledge Gaps
Authors: David Allison , Vitolo Melissa , Elden Andrew C. , Tarassoff Christopher , Altshuler Marc , Ziring Barry , Infantolino Anthony , Tofani Christina
Published: October 2019

INTRODUCTION:

Barrett’s esophagus (BE) is a condition in which metaplastic columnar epithelium with goblet cells replaces the stratified squamous epithelium normally found in the distal esophagus. It is a precursor for esophageal adenocarcinoma (EAC), however screening for BE remains a controversial topic and any guidelines that exist may not be well known among primary care physicians (PCPs). The transformation from nondysplastic BE to EAC has a slow rate of progression, giving screening for BE the potential to identify patients earlier via endoscopic visualization and confirmatory biopsy. A prior study found that less than 5% of patients undergoing resection for EAC had a prior diagnosis of BE, 1 indicating potential missed opportunities for screening of appropriate patients. Newer data recommends selective screening via stratification of patients based on risk factors. PCPs are often a patients first line of contact within the healthcare system; therefore, they should have an thorough understanding of the risk factors for BE and be comfortable in identifying appropriate patients to refer for screening.

METHODS:

We conducted a survey of PCPs (n = 63) at a large urban university hospital. The survey consisted of eight questions regarding risk factors, screening recommendations and physician comfort in identifying appropriate patients for BE screening.

RESULTS:

Collectively, PCPs scored 60%, suggesting a significant lack of knowledge regarding BE, with only 13% of participants answering all questions correctly. In regards to identifying risk factors, only 25% answered correctly. 41% of respondents indicated they are comfortable identifying appropriate patients for screening. Comfortability was assessed on a scale of 1-5, with 1 being not comfortable at all. The average response was 3.02, reflecting neutrality in physician comfort.

CONCLUSION:

Our survey found that knowledge of risk factors among PCPs may be inadequate. Additionally, PCPs acknowledge they are not comfortable identifying appropriate patients for screening. This may stem from not being familiar with known risk factors or not being up to date with screening guidelines. Those in practice longer said they are more comfortable, however were not more knowledgeable in risk factors and screening guidelines, indicating that increased education is necessary throughout a physician's career. 1. Dulai, Gareth S., et al. "Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review." Gastroenterology (2002): 26-33.
2873 The Demographic, Clinical, and Endoscopic Features of Patients With Eosinophilic Esophagitis (EOE) in a Rural Gastroenterology Solo Practice in Central Maine
Authors: Henry Winoah A.
Published: October 2019

INTRODUCTION:

Eosinophilic esophagitis (EoE) is a chronic, food-triggered, immune-mediated disorder of the esophagus. The average age of adult diagnosis is 30 years and the M:F ratio is 3:1. Rural patients may be at higher risk of EoE and may present with heartburn rather than dysphagia. This study aimed to characterize the demographic, clinical, and endoscopic features of adult rural EoE patients.

METHODS:

This was a retrospective, descriptive analysis of data obtained between 2013 and 2018. Adults ≥ 18 years with ≥ 15 eos/HPF regardless of PPI-response were included. The reported incidence of EoE is 7.2/100,000 and the expected sample size was 22. Statistical analysis of demographics, clinical history, and endoscopy data was conducted.

RESULTS:

During the study period there were 51 cases and the mean age at diagnosis was 45 years. There was no significant difference between the mean age at diagnosis in males and females, 44 vs 45 years. The M:F ratio was 1.8:1. The average BMI was 31.3, 80% were overweight or obese, and 57% were obese. There was no significant difference between the BMI of males and females. The frequency of tobacco use was 41% and cannabis use was 14%. Half (49%) had other atopic conditions, 16% had a family history of atopy, and 2% had a family history of EoE. Fifty-two percent were PPI-responsive and 53% were responsive to PPI or H2-blocker. While 51% of patients presented with dysphagia, females more often presented with dysphagia when compared to males (61% vs 45%; P = 0.0002). Food impaction on presentation was rare and no female patient presented with food impaction (0% vs 9%). Compared to males, more females had rings (72% vs 55%; P < 0.0001) but significantly more males had fibrotic strictures (36% vs 33%; P = 0.04).

CONCLUSION:

EoE is common in this rural solo GI practice and the incidence was higher than predicted. EoE is more common in males but rural females may be impacted more than urban females. Obesity and tobacco exposure are prevalent features in this population. In contrast to previous study, most rural EoE patients present with dysphagia and not heartburn and dysphagia is more prevalent in females than males. Rings are the most common endoscopic feature however rings are more prevalent in females whereas strictures are more prevalent in males. Rings are likely associated with the symptom of dysphagia but not with the presence of fibrotic strictures. EoE diagnosis is delayed by 15 years in this rural environment emphasizing the need for increased awareness.
2874 Gastrointestinal (GI) and Hepatobiliary Conditions Among Medical Students: A Single Center Study
Authors: Ahmed Monjur , Papadopoulos Konstantinos
Published: October 2019

INTRODUCTION:

Medical students go through many stressful situations and suffer from various GI and hepatobiliary conditions. The purpose of the study was to assess the prevalence of GI and hepatobiliary conditions among medical students, the variability among gender and race, and what effect it had on their daily life.

METHODS:

A survey questionnaire link via surveymonkey.com was emailed to every medical student at Sidney Kimmel Medical College. The survey was completely voluntary and anonymous.

RESULTS:

246 students answered the survey and 67 of had a GI and/or hepatobiliary conditions. 42.6% were female and 57.4% were male. 50% were aged between 21-25, 50% between 26-30, and family history of GI and hepatobiliary conditions was positive in 52.2%. Among the different ethnicities, 82.0% identified as Caucasians, 13.4% as Asians, 4.5% as African Americans, and 1.4% as Middle-Eastern. The different GI and hepatobiliary conditions reported were as follows: gastroesophageal reflux disease (GERD) – 40.2%, irritable bowel syndrome (IBS) – 38.8%, ulcerative colitis – 5.9%, lactose intolerance - 4.4%, 2.9% (2 cases) had eosinophilic esophagitis, Crohn’s disease, liver hemangioma, and esophageal spasm, and 1.4% (1 response) had: peptic ulcer disease. Regarding treatment, 45.50% were not taking any medication, 44.1% were taking medication, 7.30% took both medication and psychotherapy, and 2.90% psychiatric ttreatment. The gastrointestinal and hepatobiliary conditions affected their daily life mildly (rated 1-3) in 64.7%, moderately (rated 4-7) in 26.4%, and severely (rated 8-10) in 8.8%.

CONCLUSION:

A significant number of medical students suffered from gastrointestinal disorders, most had the illness for over 5 years, and greater than half were taking medications. The disorders were more common in males than in females and greater than half had a positive family history. In addition, 35.2% mentioned that the condition had a moderate-to-severe effect on their daily life. GERD was the most common disorder followed by IBS which were both prevalent in almost one-third of the students with a GI condition. Overall, these findings are significant for the effect on the daily life of these medical students and the possible long-term effects on their morbidity and mental health. This study gives further evidence of the importance of stress reduction and renewed focus on student wellness in stressful academic environments.
2890 Too Fast or Too Slow: Do Sedation Protocols Improve Outcomes?
Authors: Walker Caroline , Smallfield George B. , Kaspar Matthew
Published: October 2019

INTRODUCTION:

Moderate sedation improves patient tolerance and satisfaction of colonoscopy, but few guidelines exist regarding optimal sedation. While sedation has not been shown to increase ADR, it can decrease pain and discomfort and increase the likelihood that patients may return for repeat exams. Typically ordered by the endoscopist, variation in sedation practices may alter time to discharge, overall risk, cost, and time to complete. This study sought to determine if adherence to a sedation protocol decreased procedure time and overall medication dose without altering time to discharge.

METHODS:

A retrospective chart review based on a database of 3,382 screening colonoscopies at a tertiary care center. Of these, 152 included necessary data. Adherence to dosing protocol was defined as 2-3 minutes between each induction dose. Induction doses were doses given prior to scope-in time. The outcomes of total fentanyl, versed, maintenance fentanyl, maintenance versed, procedure duration and recovery time were collected. Patient sex, scope vintage, and if at least one lesion found during the procedure were summarized by frequencies and percentages. Two-sample t-tests were used to compare outcomes between the adherence groups. Linear mixed effects models were performed to determine if there were differences in the means of the 6 outcomes while adjusting for sex, scope vintage and presence of a polyp. The endoscopist was included as a random effect. A model with recovery time as an outcome was run after excluding 4 recovery time outliers.

RESULTS:

Of the 152 analyzed, 42.1% adhered to dosing protocol, while 57.9% did not. Two sample t-tests did not show a difference for any of the outcomes between groups adhering to protocol and those not. The linear mixed models adjusting for sex, scope vintage, presence of a polyp removed during procedure, and performing MD as a random effect did not show a difference in means for any of the outcomes between groups. 4 colonoscopies were outliers for recovery time. An additional mixed model was performed after excluding these outliers also failed to show significance between the two groups.

CONCLUSION:

Adjusted and unadjusted analysis show that adherence to the proposed dosing protocol does not impact total dose, procedure duration, or recovery time. Lack of quality measures for moderate sedation makes choosing and monitoring outcomes difficult. Our data no not show better outcomes with a conscious sedation protocol compared to endoscopist driven conscious sedation.
2892 Adenoma Detection With Endocuff at a Veterans Affairs Medical Center: Encouraging Results From a Single Endoscopist Consecutive Series
Authors: Chung Jae , Nassar Yousef , Long Mary , Thompson Douglas , Malecki Elise
Published: October 2019

INTRODUCTION:

Improving adenoma detection rate should improve the colorectal cancer prevention that can be expected from screening and surveillance colonoscopies.

METHODS:

To address this goal, one endoscopist at the Albany Veterans Affairs Medical Center employed the Endocuff device (AEC120 or AEC130, Arc Medical, Leeds, UK), which attaches to the end of the colonoscope and has flexible projections that splay open the colonic lumen on withdrawal. Consecutive charts of all outpatients undergoing screening and surveillance colonoscopies were prospectively reviewed starting three months prior to institutional availability of the Endocuff and continued three months after. 91 cases were done with the Endocuff and 143 without. 21 cases were done without the Endocuff after institutional availability due to exhaustion of the supply, endoscopist failure to request the device, or fellow preference, and these are included in the analysis in the “without Endocuff” group.

RESULTS:

After excluding cases aborted for poor prep, 91 cases with and 135 cases without the Endocuff remained. The groups were not different with respect to sex, age, body mass index or hemoglobin A1c. Similar proportions of patients in each group had IBD, diverticulosis, family history of colorectal cancer, personal history of colorectal cancer or partial colectomy. The groups were also similar in quality of preparation, fellow participation, withdrawal time or sedative used for the procedure. Adenomas were detected in 47 of 91 (51.6%) patients in whom the Endocuff was used, with a total of 104 adenomas, vs. 61 of 135 (42.7%) patients in whom it was not, with a total of 143 adenomas. As the Endocuff provides a good view of the distal rectum on direct endoscopy, retroflexion in the rectum was not routinely performed with this device but was done without the device if there was suspicion for a distal rectal lesion. Even without retroflexed views, one rectal adenocarcinoma and one anal squamous cell carcinoma were detected in patients undergoing colonoscopy with the Endocuff. No cancers were detected in the patients in whom the Endocuff was not used but retroflexion in the rectum was performed. Results did not reach the P < 0.05 level of significance with Pearson’s chi-squared test.

CONCLUSION:

High baseline rate of adenomas and small sample size were limitations of this study. These preliminary results show a trend toward increased adenoma detection with the Endocuff device in our patient population, and the trial is ongoing.
2893 Epidemiology of Sub-Epithelial Gastrointestinal Lesions and Factors Influencing Their Tissue Yield by EUS Guided Sampling in a Predominantly African-American and Hispanic Population at a Tertiary Care County Hospital
Authors: Mathew Madhu , Mbachi Chimezie , Desai Parth M. , Salazar Miguel , Vohra Ishaan , Wang Yuchen , Gandhi Seema , Attar Bashar M.
Published: October 2019

INTRODUCTION:

Gastrointestinal subepithelial lesions are generally found incidentally during endoscopy or abdominal imaging, with an approximate prevalence of 0.4%. Our study aims at obtaining the Epidemiology of Sub-Epithelial Gastrointestinal lesions and factors influencing their Tissue yield by Endoscopic Ultrasound guided sampling in a predominantly African- American and Hispanic population.

METHODS:

In this retrospective observational study, we included the patients from a busy tertiary care County hospital, who underwent EUS from Jan 2010 through Jan 2018 for Sub-Epithelial Gastrointestinal lesions or found to have and SEL on EUS. Data was collected on basic demographic factors, EUS indications, finding, Histopathology and mode of final diagnosis. After collecting the data, we performed analysis with STATA 14.0 College Station, Texas. with Univariate and Multivariate Logistic Regression analysis for tissue sampling yield.

RESULTS:

84 patients were included in our study of which 53% women 31% men. 18.6% of our population was uninsured and 41.4% were of African American ethnicity. Out of all the lesions majority were Gastric nodules [54.9%], 21.4% esophageal, 14.3% duodenal, 7.1 rectosigmoid and 1.2% periampullary. Of the total patients, 52.5% had some form of a tissue sampling [FNA, FNB, Forceps biopsy or EMR] and 47.6% had no biopsy. Of all the lesions seen in EUS, 41.7% were less than 1 cm nodules and 4.8% nodules measured >4cm. Echogenicity and the layer of lesion were also assessed. Univariate and Multivariate Logistic Regression to analyze the tissue sampling yield based on the above variables which showed that none of the variables had a statistically significant correlation to the tissue sampling yield, thus inferring that the yield may likely be dependent on the sampling method and the operator.

CONCLUSION:

Subepithelial lesions are those located beneath the epithelium and originate from any layer of the gastrointestinal wall.EUS is the best imaging modality to assess gastrointestinal subepithelial lesions and can be used for EUS guided tissue sampling, in addition to diagnostic sonological imaging of the nodule. It helps to distinguish extrinsic lesions from intramural ones based on the originating layer, echogenicity and tissue acquisition to reach an accurate diagnosis. In clinical practice, cytological and immunocytochemical results determine the final diagnosis. In contrary to other literature available, our study was done in a predominantly African American and Hispanic population.
2896 30-Day Outcomes, Trends of Admission and Readmission of Gastrointestinal Bleeding for Last Decade
Authors: Kirshan Ravi Shri Jai , Yang Tsujung , Ravi Priyanika , Ahuja Satish Kumar , Essrani Rajesh , Lal Darshan , Chand Raja , Ahuja Keerat Rai , Kumar Ravi
Published: October 2019

INTRODUCTION:

Gastrointestinal (GI) bleeding is one of the major medical problems causing about 300000 hospitalizations in the United States. We report the trend of the number of patients who were admitted & readmitted for GI bleeding in a tertiary care setting of Northern Pennsylvania.

METHODS:

Patients admitted with Gastrointestinal bleeding were extracted using ICD 10 codes K92.0, K92.1 and K92.2. Essential baseline characteristics including age, race, Primary Diagnosis, Readmission Diagnosis, Patients on bleeding medications, atrial fibrillation, Deep Vein Thrombosis, Pulmonary embolism, Metallic Heart Valve, History of CVA, 30-day mortality, causes of readmissions were identified by reviewing the electronic medical record of individual patients. Statistical analysis was performed using SPSS version 25.

RESULTS:

Total of 1296 patients was admitted in the last decade from 2009-2018 with the diagnosis of Gastrointestinal bleeding. Mean age of patients was 70.31 ± 15.38(Mean ± SD), the majority were Males (50.2%) and Caucasians (97.1%). Patients had following associated co-morbidities such as Deep venous thrombosis (9.0%), Pulmonary Embolism (5.8%), Atrial Fibrillation (33.4%), Metallic Heart Valve(5.8%) and History of Stroke/TIA (16.4%). Patients' mean hemoglobin at the time of admission was 10.1 ± 1.72(Mean ± SD) mg/dl. Median Length of stay was 4 days (IQ Range 2-6), 30 days Readmission rate was 19.4% and overall 30-day mortality was 6%. Among readmitted patients, 38.1% of patients were readmitted due to GI causes and 61.9% were readmitted due to Non-GI causes. The rate of readmission was observed to be increasing from 2009-2018 but was not statistically significant from (13.3% vs. 17.9% linear by linear P-value 0.717).

CONCLUSION:

This study showed that the number of admissions with a diagnosis of Gastrointestinal bleeding in the tertiary care setting of Northern Pennsylvania increased from 2009 to 2018 but the rate of readmission was not significantly affected.
2900 Additional Training in Nutrition Helps Recruit More Patients for Nutritional Therapy in Inflammatory Bowel Disease (IBD)
Authors: Greene Jessica , Warman Anmol , Edwards Jade , Vidyarthi Gitanjali
Published: October 2019

INTRODUCTION:

IBD is growing at an alarming rate from than 1 per100,000 in 1960s to 4.1 in 1980s in the western world. This sharp increase is unlikely to be explained by genetic factors alone and an environmental factor is strongly incriminated. Diet has been proposed by some as a plausible culprit with significant effect on the course of IBD. Western diet which is high in refined sugar and processed food has been associated with altered immune response and thought to contribute to the pathogenesis of inflammatory bowel disease. Food rich in fruits and vegetables have a lower incidence of IBD. In this regard elemental diet has been studies extensively However there appears to be a taste fatigue leading to poor tolerance and there is lack of data for its long-term effectiveness. Another diet which has shown promise, is specific carbohydrate diet (SCD) and has the potential for better tolerance. Patient unwillingness and lack of familiarity with this diet by providers has been reported as causes for limited use. Here we are reporting patient willingness to participate when provider training is present.

METHODS:

We have a gastroenterologist at our Institution who is also Board Certified in Nutrition by American Society of Enteral Nutrition (A.S.P.E.N.). Provider knowledge in SCD increased with giving National talks and attending nutrition conferences. This led to creation of an inner core group team by training of registered dietician (RD). Via a grant, books were obtained for patient distribution and hundreds of recipes. Patients who were seen in clinic or inpatients were offered SCD when provider felt it was appropriate. Inclusion criteria was presence of IBD. Exclusion criteria was stable disease, fulminant colitis. Treatment was offered with one-on-one session with a RD and a second meeting the next day if patient had any questions. Patients were given books, recipes. A telephone call was planned in 2 weeks and a follow-up.

RESULTS:

Eight patients were offered SCD of which 7 patients agreed to participate. When this result was compared prior to training of the inner core team no patient was offered this.

CONCLUSION/DISCUSSION:

Our numbers are small and out study has just started but it does reveal that when a team trained in Nutrition is involved more patient participation is seen as several patients want to avoid side-effects of expensive and toxic medications. Our goal is to check patient compliance, its impact on the course of disease.