bluuebunny/crossref_metadata_2025 huggingface dataset:
473 The Prevalence and Burden of Rome IV Functional Colorectal Disorders in Ulcerative Colitis
Authors: Nigam Gaurav B. , Limdi Jimmy K. , Hamdy Shaheen , Vasant Dipesh H.
Published: October 2019

INTRODUCTION:

Despite advances in Ulcerative Colitis (UC) therapies, many patients suffer refractory symptoms in the absence of active inflammation. For this group, treatment remains challenging, with a paucity of therapeutic options. In this prospective, ongoing study, we aim to determine the prevalence and burden of functional colorectal disorders inpatients with quiescent UC.

METHODS:

In a cross-sectional study, consecutive patients with UC attending Inflammatory Bowel Disease (IBD) clinicscompleted a series of validated questionnaires; including Hospital Anxiety and Depression Scale (HADS), the Rome IV diagnostic questionnaire for functional gastrointestinal disorders (FGIDs), an IBD-QoL score and the IBD-control questionnaire. Participants were asked to return a Fecal Calprotectin (FCP) within 2 weeks of completing questionnaires. Quiescent UC was defined as IBD-control 8 score ≥13 and IBD-control-VAS ≥85, and/or FCP levels ≤250 (where available, FCP was used in preference to IBD-control to classify UC activity). Based on Rome IV diagnosis and UC disease activity (active or quiescent), patients were divided into groups and data compared using non-parametric tests.

RESULTS:

Overall, n = 97 UC patients (n = 50 males, mean age 48 (range 18-82)) participated. 41/97, (42%) UC patients met the Rome IV diagnostic criteria for ≥1 FGIDs (irritable bowel syndrome n = 26, functional constipation n=6 and faecal incontinence (FI) n = 22). Disease activity data (IBD-control and/or FCP) were available for all patients, and based on these 61/97, 63% had quiescent UC. Within the quiescent UC group, 25/61 (41%) met the Rome IV diagnostic criteria for ≥1 FGIDs (irritable bowel syndrome n = 14, functional constipation n = 3 and FI n = 13). In the active UC group, those with co-existing FGIDs, compared to those without FGIDs, had significantly worse median QoL scores (P = 0.02), higher HADS-depression (P = 0.005) and HADS-anxiety (P = 0.05). By contrast, in those with quiescent UC, those with an FGID did not have different median HADS scores (depression P = 0.15, anxiety P = 0.62) or IBD-QoL scores (P = 0.20), compared those without FGIDs.

CONCLUSION:

This study is one of the first to use Rome IV criteria in UC and confirms that the prevalence of FGIDs is high. Patients with active disease and overlapping functional symptoms appear to have worse QoL and more psychological distress compared to those with quiescent disease. Clinicians should be vigilant to this functional overlap and treat both functional and inflammatory driven symptoms.
476 Pelvic Floor Dysfunction Is Associated With Reduced Urinary Flow Rate in Younger Men
Authors: White Bradley , Linder Brian , Klingele Christopher , Szarka Lawrence , Prichard David O.
Published: October 2019

INTRODUCTION:

In younger men, in whom organic prostate disease is uncommon, the etiology of lower urinary tract symptoms (LUTS) is frequently unclear. Studies suggest that in this young cohort voiding phase dysfunction is more common than storage phase dysfunction or normal urodynamics. Abnormal pelvic floor muscle relaxation, which can result in constipation, could potentially result in voiding dysfunction also. To date, no studies have investigated the relationship between posterior pelvic floor dysfunction and LUTS in young men.

METHODS:

Men who had undergone both anorectal manometry and uroflowmetry (i.e. had lower gastrointestinal and urinary symptoms) between October 2012 and September 2018 were identified. Patients >40 years old were excluded to reduce the likelihood of prostate disease. Clinical data was extracted from the electronic health records. Descriptive and comparative analyses were performed.

RESULTS:

Of 47 identified patients, 13 were excluded due to a history of neurogenic bowel/bladder, urethral/anal surgery or significant neurological disease. The mean age and standard deviation (SD) of the 34 men analyzed was 30 ± 6 years. Twenty patients demonstrated an abnormal balloon expulsion test (BET). The median (and interquartile range [IQR]) number of LUTS was 1.5 (1-2). An abnormal BET was not associated with symptoms of nocturia, hesitancy, incomplete emptying or the total number of LUTS (2 vs 1, P = 0.6). An abnormal balloon expulsion test was associated with a lower maximum urinary flow rate (Qmax, 14 vs 29 mls/sec, P < 0.001) but not flow duration (34 vs. 27 seconds, P = 0.2), residual urine volume (55 vs. 43 mls, P = 0.7) or urine volume (300 vs. 301 mls, P = 0.5). No correlation was seen between anal pressures at rest or during simulated evacuation and maximum urinary flow rate. No correlation was found between functional constipation and Qmax, LUTS or abnormal uroflow. No relationship between rectal sensory thresholds and urinary symptoms was identified.

CONCLUSION:

In this study of young men undergoing both anorectal manometry and uroflow, pelvic floor dysfunction was not associated with specific LUTS but was associated with a clinically significant reduction in maximum urinary flow rate. However an objective diagnosis of functional constipation was not associated with urologic abnormalities. Further studies will be needed to prospectively characterize this cohort and to identify whether PFD-associated LUTS and reduced flow respond to biofeedback therapy.
478 Assessing the Relation Between Irritable Bowel Syndrome and Nonalcoholic Liver Disease
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Alomari Mohammad , Al-Khadra Yasser , Khoudari George , Dasarathy Srinivasan , McCullough Arthur J.
Published: October 2019

INTRODUCTION:

Irritable bowel syndrome (IBS) and nonalcoholic fatty liver disease (NAFLD) are both very common gastroenterological disorders. There are recent reports in the literature linking these disorders together, but to date there are no large studies to highlight this relation. We aimed in this study to investigate whether IBS is an independent risk factor for NAFLD.

METHODS:

Using data from the National Inpatient Sample (NIS) database between 2003 and 2014, we identified patients who were diagnosed with IBS using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of IBS. We then performed multivariate logistic regression analysis for the association between IBS and NAFLD.

RESULTS:

The total population was comprised of 84,456,866 patients, of which 637,942 (0.75%) were diagnosed with IBS. IBS patients were older (58 vs 57), more likely to female (82.7% vs 60.1%) and less likely to be African American (8.9% vs 14.8%) (P < 0.001 for all). In addition, IBS patients had less diabetes mellitus (DM) with or without complications (2.6% vs 3.8) and (13.7% vs 17%) respectively (P < 0.001). On the other hand, individuals in the IBS group had more obesity (11% vs 8.2%), hypertension (HTN) (47.6% vs 43.6%), hyperlipidemia (HLD) (20.6% vs 16%) (HLD) and hypothyroidism (16.5% vs 9.2%) (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including (age, race, gender,obesity, HTN, HLD, DM and hypothyroidism), individuals in the IBS group had a statistically significant higher rate of NAFLD (Odds Ratio [OR], 3.204, 95% confidence interval [CI], 3.130 -3.279, P < 0.001) compared with the non-IBS group.

CONCLUSION:

In our study patients with IBS were three times more likely to have NAFLD. This finding supports the recent reports that suggest that the changes in gut microbiota, impaired intestinal permeability and impaired intestinal motility in IBS may also play an important role in NAFLD development.
484 Whole Genome Sequencing Analysis of Gastroparesis
Authors: Smieszek Sandra P. , Carlin Jesse L. , Birznieks Gunther , Polymeropoulos Mihael H.
Published: October 2019

INTRODUCTION:

Gastroparesis is a disorder characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction of the stomach, resulting in the cardinal symptoms of early satiety, postprandial fullness, nausea, vomiting, belching and bloating. To ascertain the genetic risk factors for gastroparesis we conducted the first to date whole genome sequencing (WGS) study of gastroparesis cohort.

METHODS:

We investigated the frequency and effect of rare loss-of-function (LOF) variants in patients with idiopathic and diabetic gastroparesis enrolled in a clinical study, VLY686-2301. The dataset consisted of 119 WGS samples.

RESULTS:

Among rare LOF variants, we report an increased frequency of a frameshift mutation within Motilin Receptor (MLNR) gene, variant rs562138828. Motilin is a 22 amino acid peptide hormone expressed throughout the gastrointestinal (GI) tract. The protein encoded by this gene is a motilin receptor which is a member of the G-protein coupled receptor 1 family. We have shown an increased frequency of a frameshift mutation with MAF 0.01 as compared 0.0009 AF in GNOMAD (P-value = 0.01) with Odds Ratio of 21.9. We detect 4/119 gastroparesis patients carry the variant of interest that results in p.Leu202ArgfsTer105. Noteworthy is the fact that the 4 cases were equally split among idiopathic and diabetic, so this possible Gastroparesis risk factor appears to be agnostic as to condition. The finding may be of direct relevance to treatment as individuals with the identified mutation may respond differently to gastroparesis treatments especially those targeting MLNR. Among other rare LOF, we identified a case of CHD7 discussed in literature in gastro-related context and a case of CFTR duodenal stenosis pathogenic variant. The CFTR variant has been seen in pancreatitis and is likely causative of Cystic Fibrosis Gut which is characterized by increased mucous viscosity and development of intestinal inflammation, dysbiosis, and dysmotility.

CONCLUSION:

Whole genome sequencing of gastroparesis patient samples showed enrichment for rare variants in the MTLR in cases compared with controls. The identified LOF variants within the region can serve as a risk factor for disease as well as inform treatments, especially given the knowledge of different response to treatment.
489 Opioid and Neuromodulator Prescription Patterns Among U.S. Gastroenterologists
Authors: LeBrett Wendi G. , Chen Frank W. , Yang Liu , Chang Lin
Published: October 2019

INTRODUCTION:

The opioid epidemic has garnered significant national attention and is responsible for $78.5 billion in annual economic costs. Best practices encourage the use of alternatives to opioids such as neuromodulators to treat pain. This study characterizes opioid and neuromodulator prescription patterns among US gastroenterologists.

METHODS:

Medicare Part D Prescriber Data from 15,172 gastroenterologists between 2013 and 2017 were analyzed to calculate prescription metrics for opioids and neuromodulators. Neuromodulators include tricyclic antidepressants (TCAs), SSRIs, SNRIs and antispasmodics. Linear temporal trends were assessed using a Cochran-Armitage test. Multivariable logistic regression was used to examine the association between provider characteristics and >10 opioid prescriptions or >10 neuromodulator prescriptions annually.

RESULTS:

59% of gastroenterologists prescribed opioids at least once in 2017. However only 15% wrote more than 10 opioid prescriptions. In comparison, 57% of gastroenterologists wrote more than 10 neuromodulator prescriptions. During the 5-year study period, the trend of gastroenterologists who prescribed at least one opioid (P < 0.001) or >10 opioids (P < 0.001) decreased, while the overall trend of those who prescribed >10 neuromodulators (P < 0.001) increased, predominantly due to antispasmodics and TCAs. Among gastroenterologists who prescribed more than 10 opioids, there was a decrease from 2013 to 2017 in opioid prescriptions, opioid prescriptions per physician, % of patients prescribed opioids, and opioid prescriber rates compared to all prescriptions written. Female gastroenterologists were associated with decreased odds of prescribing opioids (OR 0.45, 95% CI 0.39–0.53), while practice in the South (OR 1.65, 95% CI 1.48–1.83) increased odds. Patient populations with higher percentages of female, whites and patients who received Medicare low-income subsidies were also associated with opioid prescriptions. Similar features of physicians were associated with neuromodulator prescriptions.

CONCLUSION:

The most recent opioid epidemic began in 2013. Since then, opioid prescriptions by gastroenterologists have decreased while neuromodulator prescriptions have increased for Medicare patients. Gastroenterologists are more likely to prescribe neuromodulators than opioids, both of which are used to treat abdominal pain. Compared to family medicine physicians (6%) and surgical subspecialties (37%), gastroenterologists (3%) had lower opioid prescription rates.
492 The Combination of a Tricyclic Antidepressant and Diaphragmatic Breathing Is an Effective Treatment for Rumination Syndrome
Authors: Robles Alejandro , Romero Yehudi A. , Tatro Eric , Quezada Hugo , McCallum Richard
Published: October 2019

INTRODUCTION:

Rumination syndrome (RS) is a functional gastrointestinal disorder that is characterized by effortless postprandial regurgitation, usually preceded by belching, and accompanied by epigastric abdominal wall pain and gastric visceral hypersensitivity. Almost invariably, the onset of symptoms is preceded by a psychologically stressful situation, and anxiety is often an accompanying complaint. In this background of gastric visceral hypersensitivity, anxiety, and psychological stress, we investigated the effectiveness of combining a tricyclic antidepressant (TCA) with the more standard approach of diaphragmatic breathing/relaxation techniques (DB/RT) for the treatment of RS, as well as highlight the clinical aspects of this entity.

METHODS:

Patients referred to an academic motility center for vomiting of unknown origin were prospectively identified. Those who fulfilled the Rome IV criteria for RS received hands-on instructions/coaching on diaphragmatic breathing techniques, were given relaxing auditory media, started on a TCA, and completed a follow-up symptoms questionnaire after undergoing a minimum of three months of this therapy.

RESULTS:

A total of 44 patients, 35 women; mean age 40.4 [range 20-71] were identified and completed the treatment protocol. Mean time from onset of symptoms to diagnosis was 36.0 months [range 6-180], weight loss ranged from 1.4 – 39.5 kg., six required a jejunostomy feeding tube (J-tube), and one was receiving total parenteral nutrition (TPN). 65.9% had a history of anxiety and/or depression, and 65.9% reported the onset of symptoms were chronologically related to an inciting event/psychological stressor. Moreover, half of the patients were taking opioid medications for abdominal wall pain at the time of initial evaluation (Table 1). After a mean follow-up period of 8.8 months, 90.9% of patients reported improvement in their symptoms, with a mean subjective improvement from baseline of 68.9%, and specifically, 45.5% of patients reported ≥80% improvement. Weight increased or stabilized in 80.6% of those initially reporting weight loss, all six patients with a J-tube were weaned off, and the patient on TPN was transitioned to a J-tube. Additionally, 81.8% of patients initially taking opioid medications were successfully tapered off by the time of follow-up (Table 2).

CONCLUSION:

The combination of a TCA with DB/RT is an effective treatment modality for the management of RS as it addresses the underlying factors identified in this entity.
495 A Prospective Study of Gender and Quality of Life in Patients With Irritable Bowel Syndrome
Authors: Haroon Mustafa , Canakis Andrew , Cabral Howard , Weber Horst C.
Published: October 2019

INTRODUCTION:

Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder characterized by abdominal pain and change in bowel habits. IBS represents a significant public health problem because of its substantial reduction of quality of life (QoL) and increased healthcare cost. There is a significant paucity of data regarding gender-based QoL measures. Therefore, we report here results of a prospective study on gender based QoL measures in outpatients with IBS conducted at a single tertiary care center.

METHODS:

We prospectively enrolled adult outpatients with IBS (N = 72) and non-IBS patients (N = 181) based on a validated Rome III criteria questionnaire. Electronic medical records were reviewed, and demographic data were collected. Validated IBS-specific QoL (IBSQoL 34-item instrument) and general QoL (Veterans RAND-12, VR-12) questionnaires were completed by the study sample. Statistical analyses of data were performed using Chi-square, Fisher's exact, and two-samples t-test.

RESULTS:

The proportion of female IBS patients (N=44; 61%) was not different (P = 0.35; Table 1) from female non-IBS patients (N = 99; 55%). Other demographics, including BMI, marital status, smoking and insurance status were also comparable between these 2 groups, but IBS patients were younger (45 vs 51 yrs; P = 0.01, Table 1). Female and male subgroup analysis within both the IBS and non-IBS samples showed all similar demographic characteristics (age, BMI, smoking, marital and insurance status; data not shown). QoL in IBS subjects was highly significantly reduced as compared with non-IBS subjects both using the VR-12 and the IBSQoL instruments (Tables 2 and 3 and data not shown). In IBS patients, QoL (by VR-12) was significantly lower in males (P = 0.02) as compared to females in MCS (P = 0.02), but not in PCS (P = 0.07; Table 2). Male IBS patients scored significantly lower in the IBSQoL instrument than females in 2 of 8 domains (dysphoria and interference) and in the overall score whereas no gender differences were noted within the non-IBS sample (Table 3). The greatest IBSQoL reduction occurred in the food avoidance domain without gender disparity.

CONCLUSION:

IBS patients suffer from substantial impairment of QoL. This gender-based study is the first to demonstrate lower QoL scores in male IBS patients as compared to females in specific domains of validated general QoL and IBS-specific QoL instruments. Gender disparities demonstrated in this study were not associated with differences in age, BMI, and other demographics.
501 Prevalence of Cannabinoid Use in Patients With Gastrointestinal Symptoms
Authors: Bushyhead Daniel W. , Kalra Gorav , Strate Lisa L.
Published: October 2019

INTRODUCTION:

Cannabinoids are compounds derived from the Cannabis sativa plant. These include the psychoactive delta-9-tetrahydrocannabinol (Δ9-THC), although non-psychoactive compounds such as cannabidiol also exist. Given the prevalence of cannabinoid receptors in the enteric nervous system, use of cannabinoids may contribute to the pathophysiology or treatment of gastrointestinal motility and functional disorders. However, little is known about the prevalence of cannabinoid use in patients referred to out-patient gastroenterologists. The aim of this study was to determine the prevalence of cannabinoid use, and its relation to specific gastrointestinal symptoms, in patients seen in gastroenterology clinic.

METHODS:

An optional survey was administered to patients attending gastroenterology clinic at a county hospital in a state where both recreational and medical cannabis use are legal. The study period was January to May of 2019. The survey queried subjects on type of cannabinoid product used, frequency of use, whether cannabinoids were used for treatment of gastrointestinal symptoms, and efficacy. Diagnosis was recorded following review of the electronic medical record. Patients who were unable to consent or those who did not demonstrate proficiency with written English were excluded. Data were analyzed with descriptive statistics using Excel (Version 16.23). Institutional Review Board approval was obtained.

RESULTS:

A total of 60 subjects completed the survey. Forty-nine (82%) respondents were female, and median age was 43-years-old. Twenty-nine (48%) subjects reported use of cannabinoids within the past year; the most common substances were marijuana (90%) or marijuana and cannabidiol (48%). The most common diagnosis for these subjects was chronic abdominal pain (see Figure 1). Thirty-one percent of patients reported using cannabinoids more than once daily. Twenty-eight percent of subjects reported use of cannabinoids to alleviate gastrointestinal symptoms, with a median improvement of 6 on a scale of 0-10 (0 representing no relief, 10 representing full relief). The most common reported symptom for this subset of patients was abdominal pain (see Figure 2).

CONCLUSION:

Use of cannabinoids, including both marijuana and cannabidiol products, was common in subjects with gastrointestinal symptoms referred to a gastroenterology clinic in a state where use is legal. More than half of subjects using cannabinoids did so for relief of a wide variety of gastrointestinal symptoms.
504 Golden-Finger: Digital Rectal Exam Predicts Dyssynergic Defecation but Not Type of Dyssynergy Pattern on ARM
Authors: Mahoro Giselle , Jarava David , Desai Nisa , Corning Brooke , Copland Andrew , Frye Jeanetta
Published: October 2019

INTRODUCTION:

Functional defecation disorders are a common cause of chronic constipation and the diagnosis include an abnormality in two or more of the following tests: balloon expulsion test (BET), anorectal manometry (ARM) or uncoordinated defecation on electromyography. Additionally, there have been four types of anorectal manometry dyssynergy patterns identified. Rao et al have shown that digital rectal examination (DRE) performed by a single expert gastroenterologist can accurately detect patients with dyssynergia. We conducted a study evaluating whether DRE performed by gastroenterology specialists could predict the presence and type of dyssynergia in patients with chronic constipation.

METHODS:

Patients with chronic constipation as defined by Rome IV criteria were evaluated by GI specialty providers at a single tertiary care hospital. After performing a DRE, each provider documented a prediction regarding the type of dyssynergy pattern that would be identified on ARM as well as whether the patient would pass the balloon during BET. An abnormal BET was defined as failure to pass the balloon in less than 60 seconds. Patients subsequently underwent ARM and BET and results of predicted and measured values on ARM and BET were compared.

RESULTS:

21 patients were referred to undergo ARM and BET. 19 patients met the inclusion criteria. 16 displayed a dyssynergy pattern on ARM. Of the 16 patients, 11 were also identified to have features of dyssynergia on DRE with a detection rate of 69% (Table 1). One patient was noted to have features of dyssynergia on DRE but had normal ARM. Two patients had normal DRE with normal ARM. 11 of the 16 patients with dyssynergia on ARM had abnormal BET. Of the 11 patients with abnormal BET, 7 were predicted to have abnormal BET based on DRE (64% detection rate). DRE predicted the correct type of dyssynergia (type 1-4) in 31% of patients (Table 2).

CONCLUSION:

Studies have shown that DRE can predict dyssynergia when performed by a single expert gastroenterologist with a detection rate of 73%. Our analysis suggests that DRE can be used to predict dyssynergia on ARM and outcomes of BET even when multiple providers perform the exam. However, DRE is not a good predictor of the type of dyssynergia. Further studies are needed to evaluate the differences in detection rates between types of dyssynergia classified by ARM, and to assess whether there is a difference in detection rates between trainees and attendings.
507 The Functional Gastrointestinal Disorders Population-Based Prevalence and Relationship to Dietary Factors in Latino Populations in the Resource Limited Setting of Rural Central America
Authors: Norwood Dalton A. , Dominguez Lucia , Paredes Andrea A. , Montalvan Eleazar E. , Dougherty Michael K. , Dominguez Ricardo L. , Morgan Douglas
Published: October 2019

INTRODUCTION:

The prevalence of the Functional Gastrointestinal Disorders (FGIDs) in Latino populations in resource-limited settings such as rural Central America is largely uninvestigated. The relationship of the FGIDs and dietary habits is unknown in this environment.

METHODS:

With population-based sampling, we administered the Rome IV questionnaire and a validated dietary questionnaire to a cross-section of the general adult population of rural Western Honduras. We estimated the prevalence of specific FGIDs and used logistic regression with Bonferroni adjustment to evaluate the relationship of each FGID diagnosis with particular dietary habits.

RESULTS:

We interviewed 815 subjects, of whom 151 fulfilled Rome IV criteria for an FGID (18.5% 95% CI 15.9-21.4%). The mean age was 40.6 years, of whom 58.7% were female. Gastroduodenal FGIDs were noted in 10.1%, with epigastric pain syndrome (EPS) more common than post-prandial distress syndrome (PDS), 8.5% versus 1.6%. Among the bowel disorders, functional abdominal bloating (FAB) was most prevalent (6.2%; 95% CI, 4.6-8.1), followed by irritable bowel syndrome (IBS, 3.5%, 95% CI 2.5-5.1; IBS-U 1.6%, IBS-C 1.2%, IBS-D 0.5%), functional diarrhea (FD, 3.4%) and functional constipation (FC, 1.1%). In multivariable logistic regression analysis, the diagnosis of any FGID was inversely associated with consumption of beans (OR 0.41, 95% CI 0.27-0.63, adjusted P = 0.009), driven by negative associations with IBS and FD. Overall vegetable consumption was associated with a lower prevalence of FD (OR 0.12, 95% CI 0.043-0.35, adjusted P = 0.018) and any diarrheal disorder (OR 0.11, 95% CI 0.42-0.31, adjusted P = 0.004). There was a trend toward association with all FGIDs for subjects who consumed greater than the mean daily intake of 4.6 corn tortillas per day, OR 1.74 (95% CI 1.22-2.50, adjusted P-value NS).

CONCLUSION:

FGIDs are prevalent in the resource-limited setting of rural Central America, with an altered distribution of specific FGIDs (common FAB, versus less common PDS, IBS, FC) compared with other global populations and urban Latin America populations. In this setting, with locally grown foods and limited diet variability, local dietary influences such as vegetable, bean, and tortilla intake may be important factors in specific FGIDs.
508 Relationship of Patient Factors to High Resolution Anorectal Manometry Findings in Chronic Constipation
Authors: Tanner Samuel , Vachhani Herit , Jehangir Asad , Malik Zubair , Parkman Henry
Published: October 2019

INTRODUCTION:

High resolution anorectal manometry (HRARM) is used to evaluate patients with chronic constipation by assessing anorectal sensory and motor dysfunction. Despite the growth of HRARM, there is still little known about the patient factors that are associated with manometric diagnoses of dyssynergic defecation (DD) and its subtypes Type I – IV. The aims of this study are: 1) to characterize the abnormalities on HRARM in patients with chronic constipation seen at our center; and 2) to correlate patient factors (demographics and symptoms) to abnormalities identified on HRARM.

METHODS:

HRARM of consecutive patients being evaluated for chronic constipation between July 2018 and February 2019 were included. Patients completed a questionnaire describing symptoms related to their bowel movements. HRARM was performed using ManoScanTMand analyzed using ManoViewTM software (Medtronic, Shoreview, MN). Results are expressed as mean±SD or percentages. Metrics were compared using ANOVA or chi square tests, as appropriate.

RESULTS:

Of 170 patients included in the study, 63 had Type 1 DD, 24 had Type 2 DD, 16 had Type 3 DD, 17 had Type 4 DD, and 50 patients had a non-dyssynergic defecation pattern (Figure 1). Demographics: Patients with Type 3 DD were younger (P = 0.02) and had a higher BMI (P = 0.07), while patients with Type 1 DD were older (P = 0.02) (Table 1). Additionally, patients with Type 1 or Type 2 DD were more likely to be men (P = 0.02); a majority (29 of 36, 81%) of men had either Type 1 or Type 2 DD. Symptoms: Patients with Type 1 DD less frequently had 2 or less bowel movements per week (P = 0.02). Several other symptoms trended towards a difference such as improvement of abdominal discomfort with bowel movement (P = 0.15) and blockage sensation (P = 0.13). Manometric profile: Patients with Type 2 and Type 4 DD had lower intrarectal pressure compared to Type 1 DD, Type 3 DD, and non-DD patients (P < 0.001).

CONCLUSION:

Type 1 dyssynergic defecation is the most common form of anorectal dysfunction seen in patients with chronic constipation. Age and sex distribution differed between the dyssynergic defecation subtypes and normal HRARM populations. However, the symptom profile between these groups is largely the same. Thus, HRARM remains an important tool in differentiating dyssynergic defecation from other causes of chronic constipation.
512 Prevalence of Naturopath and Herbalist Consultation in Patients With Gastrointestinal Symptoms
Authors: Bushyhead Daniel W. , Kalra Gorav , Strate Lisa L.
Published: October 2019

INTRODUCTION:

Complementary and alternative medicine are commonly used by patients with gastrointestinal symptoms often in conjunction with a naturopath or herbalist provider. It is unknown how often patients seen in gastroenterology clinic also consult with a naturopath or herbalist provider, what diagnoses patients are subsequently given, and how this affects management of their gastrointestinal symptoms. The purpose of this study was to determine the prevalence of naturopath and herbalist co-management, and details of this alternative medical care, in patients seen in gastroenterology clinic.

METHODS:

An optional survey was administered to patients attending gastroenterology clinic at a county hospital. The study period was January to May of 2019. The survey queried subjects on consultation with a naturopath or herbalist, which symptoms prompted this consultation, and what diagnoses and management recommendations were subsequently received. Patients unable to consent or those who did not demonstrate proficiency with written English language were excluded. Data were analyzed with descriptive statistics using Excel (Version 16.23). Institutional Review Board approval was obtained.

RESULTS:

A total of 60 subjects completed the survey. Forty-nine (82%) respondents were female, and median age was 43-years-old. Twelve (20%) subjects reported consultation with a naturopath or herbalist in the past year for gastrointestinal symptoms. The majority of these subjects were female (92%). The most common symptoms prompting referral were abdominal pain, nausea and constipation, but numerous other symptoms were also reported (see Figure 1). The most common diagnoses given to subjects were irritable bowel syndrome, food allergies, leaky gut and small intestinal bacterial overgrowth (25% for each diagnosis). Seven (58%) subjects reported receipt of herbal medications following consultation.

CONCLUSION:

One-fifth of subjects referred to gastroenterology clinic had also consulted with a naturopath or herbalist. A wide variety of gastrointestinal symptoms prompted these consultations, and more than half of subjects received treatment with herbal medications.
523 Is Sore Throat an Under-Reported and Under-Estimated Quality Indicator of Endoscopic Procedures? Results From a Large Prospective Cohort
Authors: Kim Katherine , Gaddam Srinivas , Verula John , Lai Ellis , Dollentas Ashley , Hill Bee , Francis Sarah , Chess Shara , Lo Simon
Published: October 2019

INTRODUCTION:

Patients can develop of sore throat after upper endoscopy procedures (UGI) (oral endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), double balloon enteroscopy (DBE) and gastroscopy (EGD)) but there is limited data on incidence and its risk factors. Aim: From a large prospective cohort of patients undergoing endoscopy 1) to evaluate for incidence of sore throat and 2) to identify independent risk factors for sore throat.

METHODS:

Data was collected prospectively on consecutive outpatient endoscopy procedures performed at Cedars-Sinai Medical Center from Oct 2018 - Feb 2019. Patients were given pre- and immediate post-procedure surveys evaluating for sore throat (pain scale from 1-10). Intraprocedural information was collected by a procedure nurse. Fisher's exact test and Mann-Whitney U test were utilized for univariate analysis; significant variables (P < 0.05) were entered into a multivariate logistic regression model.

RESULTS:

Data was collected on 715 patients. Patients undergoing lower GI procedures alone (n = 226, 31.6%) were excluded; the rate of sore throat in these patients was lower than patients undergoing UGI procedures (1.3% vs. 19.2%, P < 0.01). Patients with pre-procedure sore throat were excluded (17, 2.4%). In total, 472 patients (mean age = 61 years, females = 53%) met inclusion criteria and were included in the analysis (Table 1). 85 patients (18%) experienced post-procedure sore throat. 9.4% and 29.4% of them reported throat soreness as severe (level ≥ 8/10) or moderate (level 5-7/10) respectively. On univariate analysis, female gender (OR 1.8), oral EUS (OR 1.8), oral DBE (OR 5.3), fellow involvement (OR 2.3), throat suctioning (OR 2.1), general anesthesia (OR 3.9) and use of an oral airway (OR 4.1) and prolonged procedure (>30 minutes, OR 1.9) were risk factors for sore throat (all P < 0.05) (Table 2). On the multivariate analysis (all P < 0.05), the independent risk-factors to post-procedure sore throat were oral DBE (OR 5.2), oral airway (OR 4.8), general anesthesia (OR 2.7), fellow involvement (OR 2.5), oral EUS (OR 2.4), and female gender (OR 2.0) (Table 3).

CONCLUSION:

Throat soreness after endoscopic procedures is common (18%), with 39% rated by patients as either moderate or severe. Two endoscopy types, 2 anesthesia maneuvers, female gender and fellow involvement were all risk factors. Future studies are warranted to further characterize this under-reported and under-estimated quality indicator.
525 Impact of Water Exchange, Cap and Endocuff on Adenoma Detection Rate: An Indirect Comparison With Air Insufflation as the Common Comparator
Authors: Shao Paul , Bui Aileen , Jia Hui , Leung Felix
Published: October 2019

INTRODUCTION:

Adenoma detection rate (ADR) is an important quality indicator for colonoscopy. Interval cancer (IC) is associated with low ADR. Every 1% increase in ADR is associated with a 3% and 5% reduction of the risk of IC and fatal IC, respectively. Water exchange (WE) colonoscopy is considered the best insertion method for improving ADR when compared with water immersion and air insufflation (AI). Attachment devices such as cap and Endocuff also improve ADR. We assessed the effectiveness of improving ADR between WE, cap and Endocuff colonoscopy by indirect comparison with AI as the common comparator.

METHODS:

A literature search was done to identify all relevant RCTs comparing WE, cap and Endocuff with AI colonoscopy published since 2000 as full text in English and including ADR among the outcomes. EMBASE, Medline, SCOPUS, and Cochrane Library were searched systematically for all RCTs that included the following terms in their titles, abstracts, or keyword lists: colonoscopy, and water exchange, cap, or Endocuff. Two investigators screened the articles manually and separately. The results were compared; and a discussion was held with a third investigator to resolve any discrepancies.

RESULTS:

A total of 1,453 articles resulted from initial keywords search. 37 articles were identified based on titles and abstracts alone. After thorough review of full texts, and discussion between the investigators, 21 RCTs were included in the analysis. A total of 16,572 subjects underwent AI, WE, cap (CC) or Endocuff (EC) colonoscopy. ADR of WE, CC, and EC were compared to AI. Table 1 shows that there is a significant difference in ADR between AI and WE (24.2%, 30.8%, P = 0.0001). ADR in AI and EC were significantly different (41.7%, 48.0%, P = 0.0001). No significant difference in ADR exists between AI and CC, (36.8%, 36.6%, P = 0.92). ADR as a percentage change of AI in WE, EC and CC were 27.4%, 15.1% and -0.42%, respectively. We found that WE and EC significantly improved ADR while CC does not significantly change ADR. Compared to EC and CC, WE has a higher percentage increase in ADR. This greater increase in ADR by WE may be related to the low ADR in the AI group.

CONCLUSION:

The impact of the study method in enhancing overall ADR is more prominent with the WE method, especially in patient cohort with lower ADR.
527 TissueCypher™ Barrett's Esophagus Assay for Risk Stratification of Barrett's Esophagus Patients With “Low Grade Crypt Dysplasia” on WATS3D® Brush
Authors: Amer Kamal , Amer Rami , Tofani Christina , Infantolino Anthony
Published: October 2019

INTRODUCTION:

Barrett's Esophagus (BE) and progression into esophageal adenocarcinoma (EA) is a major cause of cancer-related morbidity and mortality in the United States. Surveillance of patients with non-dysplastic BE has encountered a subset of specimens termed low grade crypt dysplasia (BE-LGCD) through use of Wide Area Trans-Epithelial Sampling (WATS) brush. The natural history of BE-LGCD is not currently known. To better characterize the risk of progression from LGCD to EA, we utilized a TissueCypher BE analysis (a validated BE risk progression tool) to produce a comprehensive risk prediction for development of high-grade dysplasia (HGD) or EA in patients with BE.

METHODS:

We sampled 17 patients with a history of BE made via Esophagogastroduodenoscopy (EGD) biopsy with WATS brush samples displaying “LGCD” between July 01,2017 to July 01, 2018. Pathology slides collected via standard of care screening EGDs were sent to an affiliate laboratory for the TissueCypher BE analysis. TissueCypher categorized the risk of progression as either low (Risk score 0-< 5.5), Intermediate (5.5-< 6.4), and High (Risk score > 6.4) based on protein-based biomarkers. TissueCypher analysis generated an in-depth score analysis for risk of progression to EA. We used measures of central tendency to identify the risk of progression and studied identified risks of BE (BMI, smoking, age, gender, family history, GERD). We also used Regression Analysis and Kendall Tests to determine significance of these variables as well as their dependence on elevated risk.

RESULTS:

Of the 17 samples included, 5.8% represented female patients. The Mean age was 64.2 years. Mean risk of progression was overall low (Risk Score of 4.95, SD of 1.30). 100% of samples collected were from Caucasian patients. Increased segment length of BE, increased BMI, history of GERD or tobacco use, and family history of BE or EA did not correlate with increased risk of progression [Table 1]. BMI, smoking history, BE segment length, GERD history, as well as family history were not statistically dependent variables [Table 2].

CONCLUSION:

Our data implies that BE-LGCD is not associated with increased risk of progression to EA. It mostly affects Caucasian males. Smoking, high BMI, segment length, history of GERD, and family history were not associated with increased risk of progression towards EA. Limitations to this study include a small sample size vs non-representative sample population. Future studies could identify progression of these patients.
529 The Effect of Sedation Modality on Outcomes in Emergent Endoscopic Intervention
Authors: Cha Ming Han , Razik Roshan , Khalid Saher , Sandooja Rashi , Khanzada Huda J.
Published: October 2019

INTRODUCTION:

Foreign body ingestion and food bolus impaction (FBI) are common indications for emergent endoscopic intervention. The choice of sedation used is often dictated by physician experience. There is paucity of data examining the efficacy and safety of general anesthesia versus conscious sedation in this population. This study aims to investigate the outcomes and complication rates of emergent endoscopic extrication of foreign body/food bolus performed under conscious sedation (CS) compared to general anesthesia (GA).

METHODS:

Using ICD-9 and ICD-10 codes, we conducted a single-center retrospective chart review of all patients presenting with acute FBI between 2013 and 2018. Data on demographics, comorbidities, endoscopic details and sedation practices were collected. Complications recognized during the procedure were considered early whereas patients presenting with a procedure-related complication within two weeks of the index event were considered delayed complications. Chi-square analysis was used to compare groups based on sedation type. Results were considered statistically significant at P < 0.05.

RESULTS:

Among the 223 encounters analyzed, 133 encounters (59.6%) were performed under general anesthesia or monitored anesthesia care, with the rest (40.4%) under conscious sedation. The median age of the subjects was 52 years old, with 70.5% being male. A total of 27 subjects (12.1%) had severe comorbidities and 21.9% had psychiatric disorders. The majority of the encounters (73.7%) were food bolus impaction with the rest being foreign body ingestion (26.3%). The most commonly observed early complications were mucosal laceration (8.5%) and bleeding (4.0%). The most common delayed complication was abdominal pain (1.3%). Five patients could not adequately be sedated with CS and had to be converted to GA. Chi-square analysis revealed no statistically significant difference in the complication rate between patients sedated under GA (18.1%) vs CS (14.4%), P = 0.48.

CONCLUSION:

For patients who present with foreign body ingestion or food bolus impaction and undergo emergent endoscopic treatment, there is no significant difference in complication rates between general anesthesia and conscious sedation. This finding may potentially lead to lower procedure-related costs and length of hospital stay.
534 Patient Experience With NER1006 as a Bowel Preparation for Colonoscopy: A Prospective, Multicenter U.S. Survey
Authors: Cash Brooks D. , Moncrief Mary Beth
Published: October 2019

INTRODUCTION:

NER1006 is a 1L PEG bowel prep approved in the US in 2018 for colonoscopy in adults. An online survey assessed real-world ease of use and treatment satisfaction in US adults who received NER1006 as a bowel prep.

METHODS:

Patients were recruited from community GI practices throughout the US and provided with a kit number to enroll online. Within 2 weeks post-colonoscopy, an online survey was to be completed by each patient. Survey questions included evaluation of patient history of colonoscopy and prior bowel prep(s) prescribed, experience during administration of NER1006, and patient satisfaction with the bowel prep process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 “very difficult” to 9 “very easy”); importance of volume requirement and importance of clear liquid choice (range, 1 “not important at all” to 9 “very important”); and patient satisfaction (range, 1 “not satisfied at all” to 9 “very satisfied”). Data were deidentified and summarized using descriptive statistics.

RESULTS:

1630 patients were enrolled (707 health care providers); 1606 patients had a colonoscopy and 1598 completed the survey from Sept 2018 through Feb 2019. Of the 1606 patients, 62.5% were female and 34.9% were male (2.6% not reported); mean age was 54.4 y (range, 18-89 y). While data were unknown for 8 of the 1606 patients, most (74.7%) did not report a family history of colon cancer, this was not the first colonoscopy for 62.6%, and 64.8% were undergoing colonoscopy for routine screening. A majority of the 1598 patients (76.1%) reported that NER1006 was very easy to prepare and take/administer (Table 1), and 89.9% of patients were very or moderately satisfied with NER1006 overall (Figure 1). Most (97.6%) patients consumed all/most of the prep. Also, 84.7% of 1005 patients with previous bowel prep use stated that their experience with NER1006 was much better/better (65.3%) or about the same (19.4%) compared with bowel preps they had previously used (Table 1).

CONCLUSION:

In this first real-world, multicenter survey, patient experience with NER1006 as a bowel prep for colonoscopy was favorable and adherence was high. The majority of patients were very/moderately satisfied with the overall experience and found it much better/better than other bowel preps used. Funding: Salix Pharmaceuticals. BD Cash participated in study, enrolled 3 patients, and reviewed content for scientific accuracy. Patients were compensated for their time for completing survey.
538 The Association of Cecal Withdrawal Time With Adenoma Detection Rate (ADR) and Sessile Serrated Adenoma/Polyp Detection Rate (SDR) in Average Risk Screening Colonoscopies
Authors: Hassan Seemeen , Ahmed Zaheer , Chhabra Rajiv , Ghanimeh Mouhanna Abu , Sadeddin Esmat , Yousef Osama
Published: October 2019

INTRODUCTION:

The ASGE, ACG & AGA in the Multi Society Task Force of Colorectal Cancer recommended quality benchmarks in 2017 to enhance the quality of screening colonoscopies. Cecal withdrawal time of ≥6 minutes (m) was recommended to achieve an adenoma detection rate (ADR) of ≥25%. The primary objective was to assess the relationship between withdrawal time & ADR in the USA using a large national database. The secondary objective was to assess the polyp detection rate (PDR) & sessile serrated adenoma/polyp detection rate (SDR).

METHODS:

The Clinical Outcomes Research Initiative (CORI) V4 database was queried for screening colonoscopies from 2009 to 2014. PDR, ADR & SDR were measured for each minute of withdrawal time. The detection rates were defined as the number of procedures bearing at least one lesion of interest (polyp for PDR, or adenoma for ADR or sessile serrated adenoma/polyp for SDR) divided by the total number of colonoscopies meeting the inclusion criteria. Inclusion criteria was age ≥18 years, average risk screening colonoscopies, performance years 2009 to 2014, successful cecal intubation, documentation of withdrawal time & post polypectomy pathology submission to CORI at a rate of ≥90%. SAS 9.4 was used.

RESULTS:

23242 colonoscopies met the inclusion criteria. PDR increased with longer cecal withdrawal times in a linear fashion (Figure 1). The rise in PDR was very similar in pattern to the rise in ADR. The ratio of PDR to ADR decreased as the withdrawal time increased (2.7 at 6 m, 1.8 at 10 m, 1.5 at 13 m & 1.2 at 22 m). ADR increased with longer withdrawal times in a linear fashion (Figure 2). ADR was 8.1% at 6 m, 25.4% at 10 m & 42.1% at 13 m. The ADR continued to rise in association with longer withdrawal times reliably reaching 75.5% at 26 m. ADR continued to rise beyond 26 m but it was less reliable due to the number of procedures being < 100 per withdrawal minute beyond 26 m. SDR increased with longer withdrawal times in an exponential fashion (Figure 3). It was 0.6% at 6 m, 1.3% at 10 m, 2.6% at 13 m & 9.0% at 22 m. It seemed to reach a plateau after 22 m & SDR was less reliable past that point due to <100 procedures per withdrawal minute.

CONCLUSION:

PDR & ADR are likely to be higher with longer withdrawal times in a linear fashion. SDR is likely to be higher with longer withdrawal times in an exponential fashion until 22 m after which it tends to plateau. The optimal withdrawal time for reaching the benchmark of ADR ≥25% may be as high as 10 m when assessed at a national level.