bluuebunny/crossref_metadata_2025 huggingface dataset:
1137 C. difficile Infection (CDI) in Bariatric Patients: A Case Series and Brief Review
Authors: Schopis Michael , Advani Rashmi , Patel Sneha , Brandt Lawrence
Published: October 2019

INTRODUCTION:

Abdominal operations are known to be associated with a higher risk of CDI, although no current studies explore the association of post-operative CDI and patients who undergo bariatric surgery. We aimed to analyze the clinical characteristics and outcomes of morbidly obese patients who developed CDI after bariatric surgery.

METHODS:

This is a retrospective case series in which we describe 7 patients who underwent gastric bypass surgery from January 2012 to January 2016 and who developed CDI within 30 days after surgery.

RESULTS:

Mean patient age was 36.5 years. 100% of patients were female and mean body mass index (BMI) was 47.6kg/m2. 3 of 7 (42.8%) patients had controlled Type 2 Diabetes Mellitus (Table 1). All 7 patients had undergone laparoscopic Roux-en-Y gastric bypass. 4 of 7 (57.1%) patients were on proton pump inhibitors after gastric bypass. 3 of 7 (42.8%) patients developed non- C. difficile-related complications after their procedure, primarily intra-abdominal and abdominal wall abscesses that required antibiotics. None of the patients developed complications related to CDI and all patients had clinical resolution of symptoms on follow up within one month (Table 2).

CONCLUSION:

While numerous articles have characterized complications from bariatric surgery, many have not reported CDI as a potential complication. Given the ubiquity of studies demonstrating change in the intestinal microbiota population of obese patients, and the subsequent change of fecal microbiota after bariatric surgery, we believe further study into CDI after bariatric surgery is warranted. In this limited case series, all patients who developed CDI had undergone a laparoscopic Roux-en-Y gastric bypass. No major complications related to CDI were observed in this surgical cohort and clinical resolution was achieved by one month. We propose the need for larger, randomized control trials in future analysis of the association between various types of bariatric surgery, risk of post-operative CDI, and the impact on subsequent morbidity and mortality.
1140 Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis
Authors: Jacobs Chelsea , Banerjee Debdeep , Westerveld Donevan , Ayzengart Alexander L. , Draganov Peter V. , Yang Dennis
Published: October 2019

INTRODUCTION:

Bariatric surgery remains the most effective and durable treatment for obesity; yet, less than 2% of eligible candidates undergo surgery. Endoscopic sleeve gastroplasty (ESG) is a restrictive procedure that simulates the anatomical changes associated with laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric procedure. We performed a meta-analysis to compare clinical outcomes between ESG and LSG.

METHODS:

Comprehensive search of multiple databases (PubMed, EMBASE, Cochrane, Web of Science) since the inception of ESG (2013) to April 2019. Studies were included if they reported data needed for calculation of post-intervention percentage total body weight loss (%TBWL) and adverse events. Pooling was conducted by using either fixed or random-effects model depending on heterogeneity across studies.

RESULTS:

A total of 5822 studies were initially identified, of which 18 studies (1446 ESG and 2071 LSG patients) were included. The pooled mean %TBWL at 6 months was lower in the ESG group (14.3; 95% CI: 12.8-15.9) when compared to LSG (25.5; 95% CI:23.9-27.2) (P < 0.001). Similarly, the estimated mean %TBWL at 12 months was lower for ESG (15.7; 95% CI:13.5-17.9) versus LSG (29.5; 95% CI:27.3-31.7) (P < 0.001). The pooled rate for adverse events was significantly higher in patients who underwent LSG (7.8%; 95% CI: 4.3-12.1) compared to ESG (1.9%; 95% CI: 0.7-3.7) (P < 0.001).

CONCLUSION:

ESG achieves less weight loss at 6 and 12 months when compared to LSG, but LSG is associated with more adverse events. ESG is an acceptable minimally invasive approach for non-surgical candidates or for those seeking alternatives besides conventional bariatric surgery.
1141 12-Month Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis
Authors: Mohan Babu P. , Asokkumar Ravishankar , Khan Shahab R. , Kotagiri Rajesh , Sridharan Gurusaravanan Kutti , Chandan Saurabh , Ravikumar Naveen , Ponnada Suresh , Jayaraj Mahendran , Adler Douglas G.
Published: October 2019

INTRODUCTION:

Endoscopic sleeve gastroplasty (ESG) is a novel moderately-invasive technique in endo-bariatrics, with a theoretical potential to replace laparoscopic sleeve gastrectomy (LSG). We aimed at doing a meta-analysis to study its efficacy and safety.

METHODS:

We searched multiple databases from inception through March 2019 to identify studies that reported on ESG and LSG in the treatment of obesity. Our goals were to assess the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1-month, 6-month, and 12-month with ESG. The 12-month outcomes with LSG was used as a comparator group.

RESULTS:

7 studies each on ESG (1569 patients) and LSG(2179 patients) were analyzed. Baseline population characteristics were comparable between the groups, except for the mean range of BMI(33.3 to 38.9 in ESG-cohort and 37.4 to 48 in LSG-cohort). The pooled rates of %TWL at 1m, 6m, and 12m were 8.5 (7.7-9.3, I2 = 87.9), 15.4 (13.8-16.9, I2 = 94.7), and 17.5 (14.7-20.3, I2 = 94), respectively. The pooled rates of %EWL at 1m, 6m, and 12m were 30.1 (22.1-38.2, I2 = 96.6), 57.8 (48.6-66.9, I2 = 93.5), and 64.4 (50.3-78.5, I2 = 92.7), respectively. The pooled rates of BMI at 1m, 6m, and 12m were 32.6 (30.4-34.8, I2 = 97.5), 30.9 (29.1-32.6, I2 = 96.7), and 31.3 (27.5-34.9, I2 = 98), respectively. At 12-months, the pooled rates of %TWL, %EWL, and BMI with ESG were 17.5 (14.7-20.3, I2 = 94), 64.4 (50.3-78.5, I2 = 92.7), and 31.3 (27.5-34.9, I2 = 98), respectively; and with LSG were 30.3 (26.6-34.1, I2 = 97), 69.2 (59.7-78.8, I2 = 99), and 29.2 (26.6-31.9, I2 = 98.9), respectively. LSG demonstrated statistically superior %TWL when compared to ESG (P = 0.001), whereas %EWL and BMI at 12-months were comparable (P = 0.57 and 0.38, respectively). The pooled rate of all adverse events with ESG was 3.2% (2-5, I2 = 0) and with LSG was 11.8%(8.4-16.4, I2 = 80), with statistical significance, P = 0.001. The pooled rate of GERD with ESG was 0.5% (0.2-1.7, I2 = 7.3) and with LSG was 5.4%(3.1-9.3, I2 = 73), with statistical-significance, P = 0.001. The mean range of procedure time with ESG was 45 to 80 minutes and with LSG was 60 to 120 minutes. The hospital length of stay with ESG was 1-2 days and with LSG was a mean of 5 to 9 days.

CONCLUSION:

ESG appears to be an effective alternative option to LSG in the treatment of obesity. ESG has a faster procedure time, shorter hospital length of stay, and better safety profile. Overall, LSG resulted in superior total weight loss compared to ESG at 12-months.
1143 Prevalence of Eosinophilic Esophagitis Among Patients With Cystic Fibrosis: A Web-Based Survey
Authors: Kherallah Nizar , Maheshwari Anshu , Benson Jeffery , Kang Ian , Gupta Sandeep
Published: October 2019

INTRODUCTION:

Cystic Fibrosis (CF) is a multi-system disease including gastrointestinal (GI) manifestations such as growth failure, chronic/recurrent abdominal pain and gastroesophageal reflux disease. Eosinophilic Esophagitis (EoE) is an atopic condition characterized by infiltration of the esophageal mucosa by eosinophils and associated with symptoms of esophageal dysfunction such as dysphagia, vomiting and feeding difficulties. The prevalence of EoE in the general population is estimated at 0.5-1 in 2000. EoE prevalence in individuals with CF is not well determined.

OBJECTIVE:

To assess the prevalence of EoE in pediatric and adult CF patients, to explore the healthcare provider’s awareness of this disease, and to evaluate the availability of resources for reliable investigations and diagnosis.

METHODS:

We conducted a web-based survey of CF care centers in the United States. The survey was sent to 234 CF care center directors (CDs). Responses were gathered from May 7 to May 30, 2019. A combination of open- and closed-ended questions was used.

RESULTS:

The survey was completed by 8.1% (19/234) of the contacted CDs/designees (9 pediatric, 3 adult and 7 combined programs) (Table). 68% (13/19) of respondents had at least one suspected EoE case in the previous 24 months; a total of 18 confirmed EoE cases was reported out of total of 2395 patients with CF. All centers reported access to appropriate GI service with expertise in EoE. The prevalence of EoE among the CF patients was found to be 7/1000 (9/1295), 8.5/1000 (3/355), and 8/1000 (6/745) in the pediatric, adult and combined programs respectively. The total prevalence in all age groups was estimated at 7.5/1000.

CONCLUSION:

This study indicates high awareness of EoE among US CF care centers. Appropriate GI services with expertise in the diagnosis and management of EoE was available to all providers who responded to this survey. The prevalence of EoE among individuals with CF regardless of age is approximately 0.75% which is 7-14 times higher than that of the general population. There was no significant difference in the prevalence of EoE in pediatric versus adult CF populations. These results deserve more studies into the pathogenesis of EoE in CF, the reasons behind increased prevalence, and further characterization of CF patients with EoE.
1146 The Use of Liver Biopsy to Determine the Severity of Nonalcoholic Fatty Liver Disease in Children Across the United States
Authors: Ascher Bartlett Johanna M. , Gutierrez Sanchez Helena Luz , Kabbany Mohammad Nasser , Mittal Naveen , Shah Jay , Alkhouri Naim
Published: October 2019

INTRODUCTION:

Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease. Determining the severity of NAFLD using the presence of nonalcoholic steatohepatitis (NASH) and stage of liver fibrosis is important, yet liver biopsy remains the gold standard despite limitations to its use. This study surveyed pediatric gastroenterologists across the United States to determine which guidelines are used to determine the severity of NAFLD in children, which patients undergo liver biopsy, and how these guidelines compare to each other and to clinical practice.

METHODS:

140 pediatric gastroenterologists were surveyed electronically regarding current diagnostic practices for NAFLD. Responses were reviewed in Survey Monkey and compared to current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), American Association for the Study of Liver Diseases (AASLD) and European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines regarding liver biopsy for evaluation of NAFLD.

RESULTS:

140 surveys were distributed with 54 responses, a 38.6% response rate. Participants included pediatric gastroenterologists, hepatologists and transplant hepatologists. 96.2% reported familiarity with NASPGHAN guidelines, 22.6% with ESPGHAN and 39.6% with AASLD. 88.7% of responders desired a generalized consensus regarding proper diagnosis. Pediatric gastroenterologists referred obese patients with abnormal liver enzymes suspected to have NAFLD 22% of the time, pediatric hepatologists 27.2%, and transplant hepatologists 39.9% (one-way ANOVA with P-value of 0.324). 61.5% of responders reported using Fibroscan and 59.6% used MR elastography to assess severity of NAFLD and presence of liver fibrosis when not pursuing liver biopsy. 92.5% of responders believed the presence of autoimmune antibodies was important in deciding when to proceed to liver biopsy, as well as 88.7% using abnormal screening labs and 75.5% using imaging suggestive of liver fibrosis.

CONCLUSION:

Comparison between the criteria that providers believed warranted a liver biopsy versus those included in society guidelines differed. The presence of autoimmune antibodies, abnormal screening labs, and liver fibrosis suggested on imaging all appeared to be important factors regardless of current guidelines. Providers also seem to rely on Fibroscan and MR elastography over liver ultrasound despite the lack of validated cutoff values in children.
1154 Discordance Between Self-Reported COI and CMS Open Payment Database Among Gastroenterology Guideline Authors
Authors: Shah Raj , Numan Laith , Chandar Apoorva K. , Maruggi Chiara , Alabdulwahhab Motib , Chauhan Mahak , Davitkov Perica , Falck-Ytter Yngve
Published: October 2019

INTRODUCTION:

The 2011 IOM Standards of developing trustworthy guidelines emphasizes transparency and mitigating conflict of interest. This study aims to assess the transparency of reported conflict of interest in gastroenterology guidelines using the “Sunshine” CMS Open Payment Database for comparison.

METHODS:

Guidelines using GRADE methodology and guideline authors from American Association for the Study of Liver Disease, American College of Gastroenterology, American Gastroenterology Association, and American Society of Gastrointestinal Endoscopy societies from 2013 to October 15, 2018, were abstracted. We reviewed conflict of interest disclosure statements for each author on all guidelines, even if they had no conflict of interest. We analyzed the Sunshine data for each author for the year the guideline was published and the year prior.

RESULTS:

In guideline documents, 222/823 (26.6%) authors self-reported conflict of interest. Out of 823 authors, 510 (61.9%) of them were reviewed on the Sunshine database, and the remaining authors were not found on the database. 172 of the 510 (33.7%) self-reported at least one conflict of interest. However, 338 (66.2%) did not disclose any conflict of interest. Out of the 338, 325 (96.1%) and 220 (65%) authors did receive general payments in the same year the guideline was published and the year prior, respectively. Out of those who received payments, 213 (65.5%) and 147 (66.8 %) had general payment amounts above $500 in the same year the guideline was published and the year prior, respectively.

CONCLUSION:

There is a discordance between guideline self-disclosures and the sunshine database. Two-thirds of all guideline authors with CMS reported payments on the sunshine database do not seem to report conflict of interest on the guideline they published during the same time period. We encourage authors to frequently check this publically accessible database to ensure accuracy in its reporting. Additionally, authors and guideline societies should strive to increase conflict of interest reporting to allow for an even further transparent guideline development process.
1160 Female Authors Contributed to Less Than 20 Percent of the 100 Most Cited Articles in Gastroenterology and Hepatology - Will This Change?
Authors: Zafar Yousaf , Nasir Samar , Elkafrawy Ahmed A. , Saeed Lyla , Ullah Waqas
Published: October 2019

INTRODUCTION:

The number of citations that an article has received can reflect its importance in a specialty. The purpose of this study was to analyze the characteristics of top-cited articles published in Gastroenterology and Hepatology Journals in the citation database-Scopus. The number of citations an article receives after its publication reflects its impact in the scientific community. The aim of this study was to identify and characterize the 100 top-cited articles published in gastroenterology journals over the past five decades.

METHODS:

The top-cited original research articles published in gastroenterology journals were identified using the database of Scopus 1970-2019. The 100 top-cited articles were selected and analyzed with regard to the number of citations, year of publication, publishing journal, authorship, Sex of the authors, country of origin, type of article, gastroenterology sub-specialty. Meta-analysis and Review articles were excluded.

RESULTS:

The 100 top-cited articles were published in eight gastroenterology journals, led by Gastroenterology (n = 48) and followed by the Hepatology (n = 27). These articles were published between 1970 and 2019 with a mean of 1324.31 citations per article (range, 879–4301). Forty-Eight articles were published between 2001-2010 alone. Of the total 45% originated from the United States followed by France with 10%. The most common sub-specialties of study were Hepatology (n = 52) and Colon (n = 31). 87% of first authors were male and 90% of last authors were male. 60% of all articles were clinical research.

CONCLUSION:

Our study presents the characteristic of the 100 top-cited articles published in gastroenterology journals. Close to half of the original articles were contributed from the USA. Women in gastroenterology contributed to less than 20% to the most cited as top authors.
1163 Physician Wellness Among Gastroenterologists: A Comparison of Gastroenterologists and Primary Care Providers
Authors: Nachnani Eesha , Nachnani Jagdish
Published: October 2019

INTRODUCTION:

The Centers for Disease Control (CDC) makes multiple recommendations regarding nutrition, exercise and sleep which are in turn transmitted by doctors to patients. It recommends that adults should eat at least 1.5 to 2 cups of fruits and 2 to 3 cups of vegetables per day. In addition, it also recommends that adults should do at least 150 minutes of moderate aerobic physical activity or at least 75 minutes of vigorous aerobic activity throughout the week. There are also recommendations regarding adequate sleep, sodium intake and carbonated beverages.

METHODS:

A survey was conducted among gastroenterologists and primary care providers regarding their nutrition, sleep and exercise with physicians being asked to rank questions on a scale of 1 to 5 with one being not at all and 5 being all the time. For statistics, comparison was made with answers 3 or below with 4 and 5.

RESULTS:

Only 33% of the gastroenterologists were eating at least 1.5 to 2 cups of fruit and 2 to 3 cups of vegetables per day as compared to 75% of the primary care providers. Regarding exercise 100% of the gastroenterologists were doing the recommended guidelines of CDC of exercise as compared to 50% of the providers. 33% of the gastroenterologist were sleeping more than 7 hours a day on a regular basis as compared to 50% of the primary care providers. None of the gastroenterologists were consuming carbonated or sweetened beverages and only 33% of the gastroenterologists were meeting the CDC guidelines of consuming less than 2300 milligrams of sodium per day as compared to 50% of the primary care providers.

CONCLUSION:

Gastroenterologists were very cognizant and despite their busy lifestyles do take out time for exercise. In addition, gastroenterologists tend not to consume carbonated or sweetened beverages. However, they did not stick to the recommended guidelines regarding fruit and vegetable intake as well as the recommended hours for sleep per day as compared to primary care providers.
1170 The Socioeconomic Impact on Presentation and Clinical Course of Celiac Disease
Authors: Cao Christopher , Block Peter , Russell Madeline , Parikh Devayu , Robbins Justin , Kumar Priyanka , David Allison , DiMarino Anthony J. , Moleski Stephanie
Published: October 2019

INTRODUCTION:

Treatment for Celiac Disease (CD) involves lifelong elimination of dietary gluten1. Compliance to a gluten-free diet (GFD) relies on purchasing gluten-free foods, which are commonly more expensive than their gluten-containing counterparts2. This study aimed to determine whether household income affects patients’ adherence to GFD and mucosal healing.

METHODS:

This is a single center retrospective chart review at an urban tertiary hospital. Any adult patient diagnosed with CD was included, with the exception of those without clear documentation of initial presentation. Outcomes included demographic information, socioeconomic data, GFD adherence, and pathologic and laboratory findings of CD. Using patient zip code, cohorts were stratified by US Census Bureau household income percentiles: low income (LI) (1st-50th percentile of US income), medium income (MI) (50th-70th percentile of US income) and high income (HI) (70th-99th percentile of US income).

RESULTS:

193 patients diagnosed between 1999 – 2017 were included and categorized into LI (n = 49), MI (n = 95) and HI (n = 49). LI presented at an older age (39.8 yr in LI; 39.5 yr in MI; 38.4 yr in HI) with a higher proportion of patients with Marsh 3A or greater classification (68.8% in LI; 68.0% in MI; 57.7% in HI). Non-adherence to GFD was noted to be highest in LI (16.3% in LI; 4.7% in MI, 0.0% in HI). Subsequently, LI was found prolonged mucosal healing (79.2 mo. in LI; 44.3 mo. in MI; 33.5 mo. in HI). HI had the lowest percentage of patients with Marsh 3A or greater classification on repeat encounters (25.7% in LI; 36.6% in MI; 14.3% in HI). Normalization of TTG IgA (69.2% in LI; 72.0% in MI; 84.6% in HI) and gliadin IgA (20.0% in LI; 75.0% in MI; 85.7% in HI) occurred more frequently in HI.

CONCLUSION:

Discussion: GFD remains a staple in the management of CD. Our study sought to evaluate the impact of socioeconomic status on GFD adherence, severity of CD, and mucosal healing. The LI group was noted to be less adherent with GFD, have more severe disease presentation, have longer time to mucosal healing, and have less normalization of TTG IgA and gliadin IgA. Future studies may focus on further determining the causation between socioeconomic status, GFD adherence and CD outcomes.
1183 Surgery Type Predicts Post-Operative Jejunal Polyp Detection in Patients With Familial Adenomatous Polyposis After Surgical Duodenectomy
Authors: Yoon Ji Yoon , Mehta Neal , Burke Carol A. , Augustin Toms , O'Malley Margaret , LaGuardia Lisa , Cruise Michael , Mankaney Gautam , Church James M. , Bhatt Amit , Kalady Matthew F. , Walsh R. Matthew
Published: October 2019

INTRODUCTION:

In patients with familial adenomatous polyposis (FAP), advanced duodenal polyposis by Spigelman stage requires consideration of duodenal resection to prevent duodenal cancer. Pancreas-sparing duodenectomy (PSD) is preferred over pancreaticoduodenectmy (PD). Jejunal polyps occur 41 to 78% in post-duodenectomy patients, however, the differences by surgery type have not been evaluated.

METHODS:

We identified consecutive FAP patients following duodenal resection, including PD, PSD, or segmental duodenectomy (SD), at Cleveland Clinic, 08/1978 - 01/2018. Jejunal polyp-free survival (JPFS) time was calculated as time from surgery to detection of first lesion, or if no polyps, time to most recent endoscopy. Severity of jejunal polyposis was classified using the Spigelman score (henceforth, Neo-Spigelman). Kaplan-Meier curves were used to estimate JPFS by surgery type. Cox proportional hazards models adjusted for age, sex, race, and presence of pre-operative jejunal polyps were used.

RESULTS:

64 patients were identified (Table 1). Jejunal polyposis was detected after surgery in 38/64 patients (59.4%, Table 2). Surgery type (PSD vs PD vs SD) was a significant predictor of JPFS overall (Figure 1, P = 0.008). 5-year JPFS was 49.5% (CI 32.3–64.7%) for patients after PSD, 80.7% (CI 51.1–93.4%) after PD, and 66.7% (CI 19.5–90.4%) after SD. Comparison of PSD vs PD yielded a significant difference in JPFS (P = 0.006), as did comparison of PSD vs SD (P = 0.048). PD vs SD was not significant (P = 0.12). In comparison PD, adjusted analyses showed hazard ratio (HR) of polyp detection at 4.0 (CI 1.6 – 10.0) for PSD. HR estimate was not significant for SD (HR 2.6, CI 0.6 – 11.1). Surgery type had a significant association with Neo-Spigelman score (P < 0.037), with mean score at 4.5 ± 0.5 for PD, 5.5 ± 1.4 for PSD, and 6.3 ± 0.6 for SD. No association was found between surgery type and management of jejunal polyps (surveillance vs endoscopic resection vs surgery, P = 0.09).

CONCLUSION:

Jejunal polyposis occurs in the majority of FAP patients after surgical duodenectomy. We demonstrate differences in polyp-free survival by surgery type, with PSD demonstrating higher risk of jejunal polyposis in comparison to PD. Surgery type was also associated with severity of polyposis, with a tendency for higher Neo-Spigelman scores after PSD. The long-term outcomes of jejunal polyps in FAP patients requires further study, and the surgical determinants of their occurrence may merit consideration.
1187 Recurrence of Sporadic Non-Ampullary Duodenal Adenomas: A Single Center Retrospective Case Review
Authors: Phillips Brian , Lo David , Elliott John
Published: October 2019

INTRODUCTION:

Duodenal adenomas, while uncommon, are known precursors of malignancy. Prevalence of sporadic duodenal adenomas in those undergoing endoscopy ranges from 0.3-4.6%. Newer studies, with small sample sizes, have shown success in endoscopic removal of duodenal polyps of varying sizes. There is limited data on the most appropriate resection method and surveillance period. The purpose of this study is to evaluate recurrence rate at a single center to better guide surveillance timeframes.

METHODS:

In this IRB-approved retrospective study, patients studied had biopsy confirmed sporadic duodenal adenomas found during 1/06-12/16, at Riverside Methodist Hospital. Provation was searched for “polyps” on upper GI endoscopy reports. Inclusion criteria: biopsy confirmed non-ampullary adenoma, age >21. Exclusion criteria: personal/family history of polyposis syndromes, life expectancy <10 years, ampullary adenomas, surgical resection.

RESULTS:

313 patients with “polyps,” 89 had non-ampullary duodenal adenomas. 26 patients were excluded, leaving 63 in our analysis. Average age 68 (+/-12 years), 57% female, 51% with smoking history. 52 patients had follow up; 13 of these 52 patients (25%) had recurrence. Average time to first recurrence was 636 days (95% CI: 352-920 days). 60: of adenomas were located in the 2nd part of the duodenum; 19% in the 1st and 3rd part each. Histology: 71% tubular, 21% tubulovillous, 5% villous, remainder with dysplasia. Average tubular adenoma size with recurrence was 12.1 mm (95% CI: 5.6-18.6), average tubular adenoma size without recurrence was 7.1 mm (95% CI: 4.7-9.4, P = 0.057). Data on recurrence of more advanced adenomas was limited due to sample size (P = 0.215). Majority of adenomas (37/63) were removed by cold forceps; 3/63 with piecemeal resection, remainder by single piece polypectomies. Resection technique did not have any significant impact on recurrence rate (P = 0.597). Only 3 patients had complications (2 minor bleeding; 1 embolization of gastroduodenal a.).

CONCLUSION:

While uncommon, duodenal adenomas warrant close follow up due to their malignant risk. For all polyp sizes, average time to first recurrence was close to 2 years. Sub-centimeter tubular adenomas tended not to recur, while larger initial size of tubular adenomas trended towards a higher likelihood of recurrence, thus for polyp size >10 mm we recommend repeat EGD in 1-2 years. Prospective studies are needed to help determine a standardized follow-up period and resection method.
1188 The Effects of Probiotics on Parenteral Nutrition-Related Complications: A Prescriber’s Dilemma
Authors: Alomari Mohammad , Al Momani Laith , Sarmini Muhammad Talal , Khazaaleh Shrouq , Almomani Shaden , Aasen Tyler , Young Mark
Published: October 2019

INTRODUCTION:

Parenteral nutrition (PN) is a life-saving modality that carries risks for potentially life-threatening complications. The gut microbiome, which is often impaired in patients receiving PN, plays an integral role in intestinal wall integrity and immune function. Hence, restoration of a healthy microbiome may theoretically protect against various infections. Therefore, we aimed in our study to investigate the effect of probiotics on parenteral nutrition-related infectious complications.

METHODS:

We identified a cohort of patients with intestinal failure who received PN for >2 weeks at our center for human nutrition between January 2005 and August 2016. We excluded patients < 18 years of age, patients who used probiotics for < 30 days, and those who had long-term antibiotic use ( >30 days). Seventy-eight patient received probiotics, among them, 48% used it for small intestinal bacterial overgrowth (SIBO) treatment, 42% for SIBO prophylaxis in high-risk patients (history of recurrent SIBO, resection of the ileocecal valve, and surgically created blind loops), and 10% of the patients used non-prescription over-the-counter probiotics. Patients characteristics and other variables were determined by manual chart review.

RESULTS:

A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining received intravenous fluids (IVF). A total of 78 (27.7%) patients used probiotics. (Table 1) One hundred and six (37.6%) patients were diagnosed with SIBO, 31(11%) patients had at least one episode of catheter-related infection, and 88(31.2%) patients had at least one documented episode of sepsis. The prevalence of SIBO in patients who used prophylactic probiotic was 22 % vs. 30 % in patients who did not use probiotics, P = 0.5. Compared to non-users, the prevalence of sepsis and catheter-related infection among probiotics users were (26.9% vs. 32.8%; P = 0.33 and 7.7% vs. 12.3%; P = 0.27, respectively) (Figure 1)

CONCLUSION:

Although there was a non-significant trend toward less SIBO, sepsis and catheter-related infections among patients using probiotics, our findings don’t support the routine use of probiotics to prevent or treat PN-related complications. Interestingly, this study revealed-despite the lack of evidence- a quarter of our included patients received a medical prescription for probiotics to prevent or treat SIBO.
1189 Assessing Celiac Disease Biopsy Patterns at Indiana University: A Retrospective Review
Authors: Jansson-Knodell Claire L. , Kessler William R.
Published: October 2019

INTRODUCTION:

The histologic abnormalities that are diagnostic of celiac disease (CD) can be patchy. As such, the ACG guidelines recommend that the sampling endoscopist obtain one or two biopsies from the bulb and at least four from the distal duodenum. Previous research has shown gaps in compliance with these recommendations. The aim of the project was to assess how often guideline-recommended biopsy protocol was followed at our institution in evaluating for both incident and prevalent cases of CD.

METHODS:

Clinical data were systematically abstracted from the electronic medical record of patients who underwent duodenal biopsy at our academic medical center between January 2009 and February 2019. Pathology and endoscopy reports were reviewed. Appropriate biopsy practice was defined as 5 or more specimens submitted for review. Categorical data were analyzed with the Chi-square test.

RESULTS:

The cohort of biopsied patients included 239 individuals (age range 17-87, median age 43 years old). Of the cohort, a majority were female (72.4%; 173 females, 66 males). Of the patients who presented for EGD with duodenal biopsies, 134 were presenting without a prior diagnosis for evaluation of CD (73.9% females) and 105 were prevalent cases of CD coming for assessment of intestinal healing (70.5% females). A total of 71 incident cases were identified (70.4% females) by 5 female and 15 male endoscopists. Mucosal healing with normal histology was only detected in 42.9% of prevalent individuals [Figure 1]. In the group being evaluated for possible CD 67.16% were biopsied appropriately versus 62.86% of the prevalent cases for follow up (P = 0.49). The number of biopsies obtained ranged from 1-15 (mean 5.68 +/- SD 2.18; median 5, IQR 3-7). Having a female endoscopist evaluate for new diagnosis of CD was associated with better adherence to established biopsy guidelines (OR 3.36, 95% CI 1.35-8.38, P = 0.0092) [Table 1].

CONCLUSION:

The results of this cohort-based study indicate that the majority of gastroenterologists at our institution follow guideline-driven biopsy protocol for CD in either suspected or prevalent patients. While these figures are better than historical research, we should strive for improved adherence. Of the patients that we followed with a biopsy-proven diagnosis of CD, we found a surprising number who had not achieved complete histologic healing, emphasizing the importance of follow up endoscopy and appropriate biopsy.
1190 Does Nonalcoholic Fatty Liver Disease Increase the Risk for Acute Ischemic Bowel Disease?
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Khoudari George , Al-Khadra Yasser , Alomari Mohammad , Dasarathy Srinivasan , McCullough Arthur J.
Published: October 2019

INTRODUCTION:

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. It has been reported in the literature that NAFLD increases the risk for cardiovascular disease, but a possible association between NAFLD and acute ischemic bowel disease (AIBD) has not been studied. Our aim in this study is to evaluate if NAFLD is an independent risk factor for AIBD.

METHODS:

Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified patients who were diagnosed with NAFLD and AIBD using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of NAFLD. We then performed multivariate logistic regression analysis for the association between NAFLD and AIBD

RESULTS:

The total population was comprised of 101,137,143 patients, of which 365,701 (0.36%) were diagnosed with NAFLD and 133,201 (0.13%) were diagnosed with AIBD. Patients in the NAFLD group were older (53 vs 48), less likely to be females (57.7% vs 58.4%) and African American (9.3% vs 14.3%) (P < 0.0001 for all). In addition, NAFLD patients had more tobacco use (13.9% vs 9.5%), alcohol (7.1% vs 3.4%), obesity (26.2% vs 6.9%) and diabetes mellitus (DM) with or without complications (5.6% vs 3.2%) and (30.7% vs 14.1%) respectively. Furthermore, individuals in the NAFLD group had less comorbid chronic obstructive pulmonary disease (COPD) (9.5% vs 10.9%), congestive heart failure (CHF) (5.5% vs 6.5%), cardiovascular atherosclerosis (13.8% vs 17%) and atrial fibrillation (AFib) (5.8% vs 8.8%) (P < 0.0001 for all). Both groups had similar prevalence of major cardiovascular surgery (0.1%) (P > 0.05). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including: (age, gender, race, obesity, COPD, CHF, DM, tobacco use, cardiovascular atherosclerosis, AFib and a history of major cardiovascular surgery), NAFLD group had a statistically significant higher rate of AIBD (Odds Ratio [OR], 2.11, 95% confidence interval [CI], 2.02-2.20, P < 0.0001) compared with the non-NAFLD group.

CONCLUSION:

Based on our analysis, patients in the NAFLD group were twice more likely to have AIBD. To our knowledge, this the first study that evaluated the risk for AIBD in NAFLD patients. This finding adds to our understanding of NAFLD as multisystem disease and highlights the importance of controlling the risk factors associated with NAFLD.
1195 Clinical Manifestations of Strongyloides Infection on Hispanic Patients at the Veterans Affairs Caribbean Healthcare System
Authors: Cerra-Franco Javier A. , Rosa-Cortes Pedro , Estremera Rodolfo , Soto-Ramos Antonio , Saavedra Sonia , Toro-Lugo Doris
Published: October 2019

INTRODUCTION:

Strongyloidiasis is a soil-transmitted parasitic infection caused by an intestinal nematode classified as a neglected tropical disease by the World Health Organization. Although predominantly asymptomatic it can potentially turn into a life-threatening disease in immunocompromised host. Epidemiologic studies in the western hemisphere are scarce but even more is the description of the natural course of this disease. The objectives of this study were to identify the different clinical presentations and outcomes associated to Strongyloides stercolaris infection in the Hispanic population in our institution.

METHODS:

This is a single center, retrospective record review study involving patients diagnosed with S. stercolaris infection via serological studies, stool samples or organ biopsies from 2008 to 2014

RESULTS:

A total of 270 patients tested positive during the study period of which 210 (77.8%) were asymptomatic. Out of the patients who presented with symptoms, 25 had pulmonary manifestations, 21 gastrointestinal, 5 rash, 9 with more than one manifestation of which 5 presented with hyperinfection. The most common laboratory abnormalities were an elevated eosinophil count: 1.4 × 103/ul (normal: 0-0.1 × 103/ul) and eosinophil percent: 15.5% (normal: 0-7%). The other laboratory parameters were essentially unaffected. The mean age at diagnosis was 75.4 years old. The most common reasons for testing for S. stercoraliswere eosinophilia (n = 235), asthma (n = 21), diarrhea (n = 20), rash (n = 10) and others (n = 31).

CONCLUSION:

Evolving globalization trends have increased migratory rates around the globe. People from endemic countries can easily travel to places where S. stercoralis is not endemic. Natural disasters account for increased translocation of people from endemic to non-endemic areas. More recently, Hurricane María struck Puerto Rico and the Caribbean during September 2017. In its aftermath, nearly 400,000 Puerto Ricans left the island and established themselves in the continental United States, a crisis documented in multiple newspaper articles, columns and news outlets. The present study highlights the need to establish guidelines aimed towards increased screening of patients in communities with known increased migrant flow from endemic countries in order to timely diagnose and prevent the potentially fatal outcomes that may occur as a result of steroid or immunosuppressive therapy in patients with untreated strongyloidiasis.
1196 Three and Five-Year Outcomes for Teduglutide in Intestinal Failure
Authors: Puello Frances , Wall Elizabeth , Herlitz Jean , Lozano Scott , Reynolds Valerie , Widlicka Annie , McDonald Edwin K. , Semrad Carol , Micic Dejan
Published: October 2019

INTRODUCTION:

Intestinal failure (IF) results from a variety of causes leading to need for parenteral support (PS). Teduglutide was approved for adult patients requiring PS in December 2012. Teduglutide is a glucagon-like peptide 2 (GLP-2) analogue that aids in the growth of the intestinal villi and reduces gastric emptying, thereby promoting absorption of fluids, calories and electrolytes. Previous studies have shown that teduglutide has decreased PS use by >20% at 12 and 24 months. Long term efficacy data has not been studied. Our aim is to present 3 and 5 year patient outcomes on teduglutide.

METHODS:

Data was collected retrospectively from a single center including patients requiring PS that also received teduglutide between 3/1/13 and 5/1/19. Patient demographics including length of small intestine, presence/absence of an ileocecal valve and duration of PS was recorded. Outcomes of teduglutide therapy were recorded at 12, 24, 36, and 60 months with respect to PS volume, calories, days per week of PS use, and ability to stop PS. Response to teduglutide was defined as a > 20% reduction in PS compared to baseline volume. Data were analyzed using Fischer’s exact test for categorical variables and one-way ANOVA for comparison of means followed by Dunnett’s test.

RESULTS:

Patient demographic and IF etiology data is presented in Table 1. Eighteen patients were included in the final analysis. Indications for stopping teduglutide are listed in Table 2. Baseline and longitudinal PS requirements, weight trends and responders are shown in Table 3. Among individuals with follow-up, the number of responders was 11/16 (69%) at 12 months, 10/13 (77%) at 24 months, 7/10 (70%) at 36 months and 3/3 (100%) at 60 months. Among responders, the presence of a colon in continuity, ileocecal valve, or length of remaining small bowel did not affect TPN requirement (P > 0.05 for all comparisons). Ten out of 16 (63%) patients had a one or more day decrease in TPN frequency at 12 months, 9/13 (69%) at 24 months, 6/10 (60%) at 36 months, and 3/3 (100%) at 60 months. Change in PS volume and days of PS per week were significantly lower at 24 months and 60 months (Table 3).

CONCLUSION:

Previous studies have shown that teduglutide therapy decreases PS requirements in patients requiring PS over 12 and 24 months. We found that patients achieving reductions in PS requirements can successfully continue teduglutide therapy for up to 5 years with continued reductions in PS volume and days.
1198 Temporal Trends of Acute Myocardial Infarction-Related Hospitalizations in Celiac Disease Patients
Authors: Gupta Kamesh , Khan Ahmad , Gupta Manish , Barry Davis , Sohail Abdullah , Goyal Hemant
Published: October 2019

INTRODUCTION:

Celiac disease (CD) is a chronic autoimmune inflammatory disease of small bowel. There is availability of mixed data about influence of CD on the incidence of Acute Myocardial Infarction (AMI). Some studies have suggested that patients with CD have a worse atherosclerotic profile due to the underlying inflammatory state and restriction of whole grains in their diet. We aimed to evaluate temporal trends of incidence and mortality of CD + AMI hospitalizations in the largest nationally representative sample.

METHODS:

We reviewed Nationwide Inpatient Sample from 2005-2014 for adult AMI hospitalizations (includes ST elevation and Non ST elevation MI) as a principal diagnosis with CD as the secondary diagnosis by using validated ICD9-CM codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes.

RESULTS:

We identified a total of 61,80,485 AMI hospitalizations from 2005-2014 of which 3169 had a diagnosis for CD. The proportion of patients with CD in AMI hospitalizations increased from 0.015% in 2005 to % 0.076% in 2014 (Figure 1). CD + AMI hospitalizations were significant (P < 0.02) for being older (70.3 vs. 67.4 years), more female (51.9% vs. 39.5%); higher proportion of whites (93.8% vs. 76.6%; P < 0.01) and more prevalent in the Northeast (28.7% vs 19.5%) and West (21.0% vs 17.5%) United States. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, CD + AMI hospitalizations had lower odds-ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23-0.67; P < 0.01). Length of stay in the CD + AMI patients was shorter (4.53 vs 4.84 days, P < 0.01) but the mean hospitalization charges was higher ($64058 vs $60223, P < 0.01), as compared to non-CD AMI patients.

CONCLUSION:

The results of our study provide valuable epidemiological data about the occurrence of AMI in CD patients. We found that the number of AMIs in the CD patients has risen more than five-fold from 2005-2014. However, the odds of in-hospital mortality in these patients is lower than the patients without CD for unknown reasons. The results of our study add to the current literature that though the CD-related systemic inflammation is associated with an increasing number of AMI hospitalization but these patients have comparably favorable outcomes than controls.
1199 Post-Operative Ileus in the Post-Kidney Transplant Setting
Authors: Werlang Monia Elisa , Kesler Alex M. , Kroner Paul T.
Published: October 2019

INTRODUCTION:

Ileus is a known early complication following kidney transplant (KTx). There is limited data largely from case reports documenting the occurrence of ileus in KTx patients. Potential risk factors include post-operative setting, steroid withdrawal, or even peritoneal sclerosis in patients with a history of peritoneal dialysis (PD). The aim of this study is to assess inpatient prevalence and outcomes of ileus in the same admission as the KTx occurred.

METHODS:

Case-control study using the NIS 2012-2016. The ICD9-10CM procedural codes for KTx were used to identify all patients that underwent KTx during the same admission. None were excluded. Patients with associated ileus were identified using ICD9-10CM diagnostic codes. The primary outcome was determining the odds of ileus in post-KTx patients. Secondary outcomes were inpatient mortality, postoperative complications, resource utilization, length of hospital stay (LOS), total hospitalization charges and costs. Propensity score matching was used to create a matching population for gender, age and Charlson Comorbidity Index. Multivariate analysis were used to adjust for income in patients’ zip code, hospital region, location, size and teaching status.

RESULTS:

A total of 89,065 KTx patients were identified, of which 16,880 were propensity score matched for the selected covariates. The mean patient age was 50 years, and 40% were female. On multivariate analysis, the odds of ileus in the KTx cohort was 3.90 (P < 0.01) compared to patients who did not undergo KTx surgery. When patients that underwent KTx and developed ileus during the admission, they had greater adjusted odds of shock, TPN, AKI, multi-organ failure, post-op infection, Deep Vein Thrombosis, Pulmonary Embolism, and bleeding compared to patients with no KTx. In addition, those who developed ileus had greater hospitals costs, charges, and length of stay (LOS) (Table 1).

CONCLUSION:

Patients undergoing kidney transplant are more likely to develop ileus than patients who did not have kidney transplant surgery, confirming known reports documenting ileus in the early post-operative period. This cohort of patients who developed ileus following transplant have greater odds of post-operative complications, as well as increased morbidity, resource utilization and economic burden. Future studies should focus on elucidating the etiology of ileus following kidney transplant, as well as associated factors, and creating strategies to address it.