bluuebunny/crossref_metadata_2025_split huggingface dataset:
1142 Regional Variation in the Intestinal Microbiome of Pediatric Patients With Crohn’s Disease
Authors: Shah Rajesh , Hoffman Kristi , Kellermayer Richard 
Published: October 2019

INTRODUCTION:
Numerous studies have described microbiome alterations in patients with Crohn’s disease (CD), but no studies have examined the influence of geography on these changes. Therefore, the aim of this study was to examine the effect of geography on microbiome composition in pediatric patients with CD and to develop a machine learning model to differentiate patients from healthy controls.

METHODS:
We performed a cross sectional study of pediatric patients with newly diagnosed CD from the RISK cohort. The RISK cohort was a multicenter study that enrolled patients with CD throughout the United States. Ileal, rectal and stool samples were analyzed using 16S rDNA sequencing prior to initiation of therapy. Age at diagnosis, sex, ethnicity, disease phenotype and center were reviewed. Centers were grouped into 3 regions based on geography (Northeast, South and West). Patients were compared by regions using richness, alpha and beta diversity and taxonomy. A random forest model was trained in the Northeast and tested in the South and West to discriminate patients from controls using the R package randomForest.

RESULTS:
We included 227 patients with CD and 165 controls. The mean ages were 12.2 and 12.1 for patients and controls, respectively. 58.6% of patients were male and 78.9% were Caucasian. 182 patients were in the Northeast region, 33 in the South and 12 in the West. No significant differences were found between richness or alpha and beta diversity between patients from biopsies. However, unweighted and weighted PCoA plots of stool samples revealed significant differences. In the South, patients had an increase in Fusobacteria and Bacteroidetes with a decrease in Actinobacteria and Firmicutes. This corresponded to an increase in the genera Bacteroidesand Fusobacteriumwith a decrease in Bifidobacteriumand Lactobacillus. The random forest models performed well in the Northeast and South, with decreased performance in the West. In the models, ileum and rectum shared OTUs discriminating CD, which included Lachnospiraceae, Clostridiaceae and Blautia. Additionally, ileal biopsies and stool samples shared OTUs for Erysipelotrichaceae and Haemophilus.

CONCLUSION:
The stool microbiome of pediatric patients with CD varies slightly between geographic regions. A random forest model effectively discriminates patients from healthy controls. Within North America, regional variation does not seem to significantly influence microbiome composition in pediatric patients with CD.
1147 Long-Term Efficacy of Vedolizumab in Pediatric Inflammatory Bowel Disease
Authors: Sarles Harry E. , Whitney Annette E. , Kuten Samantha A. , Van Anglen Lucinda J. 
Published: October 2019

INTRODUCTION:
Pediatric patients (pts) with inflammatory bowel disease (IBD) who have failed anti-TNF therapy have limited treatment options. Vedolizumab (VDZ) has proven to be safe and effective for adults with refractory IBD. While short-term data (≤30 weeks) of VDZ in pediatric IBD pts are promising, long-term outcomes have not been reported.

METHODS:
We performed a retrospective study of IBD pts ≤18 years who received VDZ for at least 12 months. Data collection included demographics, disease characteristics, therapy, and adverse events (AEs). Disease activity scores were assessed at baseline, 14 weeks, 6, 12, and 24 months using the short pediatric Crohn’s disease (CD) activity index (shPCDAI) and pediatric ulcerative colitis (UC) activity index (PUCAI). Clinical remission was defined by shPCDAI score less than 15 or PUCAI score less than 10.

RESULTS:
A total of 29 pediatric IBD pts treated with VDZ since drug approval in 2014 were identified. Baseline demographics were as follows: mean age 14 ± 3.2 years, male 17 (59%), CD 16 (55%), UC 13 (45%). All were previously treated with an anti-TNF agent. Median VDZ treatment duration was 21.3 months (IQR 13.8-39.1). VDZ was discontinued in 5 pts for primary non-response (< 6 months) and in 5 pts for secondary non-response (12-24 months). Efficacy data is presented for 24 pts treated with VDZ for 1 year and 14 pts for 2 years. Significant reductions in shPCDAI and PUCAI scores compared to baseline were observed at all time points, as shown in Figure 1. Clinical remission was achieved at 1 year in 8 of 13 (62%) CD pts and 5 of 11 (45%) UC pts. Remission was sustained at 2 years in 8 of 9 (89%) CD pts and 3 of 5 (60%) UC pts [Figure 2]. The most commonly reported AEs were headache and fatigue; no drug discontinuations occurred due to AEs. There was one IBD-related ED visit and three IBD-related hospitalizations, with two resulting in surgery.

CONCLUSION:
Our data suggest that VDZ is effective in achieving clinical remission in pediatric IBD pts with prior anti-TNF failure, with minimal safety concerns. We observed early and sustained remission rates in both UC and CD pts, with CD pts experiencing higher rates than previously reported in literature. Additional studies are warranted to determine the role of VDZ in the treatment of pediatric IBD.
1155 Temporal Trends of Discordant Recommendations in Gastroenterology Guidelines Over the Last 5 Years
Authors: Numan Laith , Shah Raj , Chauhan Mahak , Chandar Apoorva K. , Maruggi Chiara , Alabdulwahhab Motib , Davitkov Perica , Falck-Ytter Yngve , Sultan Shahnaz 
Published: October 2019

INTRODUCTION:
Within the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework, recommendations are accompanied by a strength of recommendation (strong/conditional) along with an assessment of the certainty of evidence (high/moderate/low/very low). Strong recommendations based on lower certainty evidence are termed “discordant recommendations.” While generally not considered appropriate, within GRADE there are 5 situations in which such recommendations may be warranted: Strong recommendations FOR an intervention can be made when there is 1) only low/very low certainty of benefit but you have a life-threatening problem, 2) low/very low certainty of equivalence in benefit of two interventions but one is associated with less harm. Strong recommendations AGAINST the intervention can be made when there is 1) low/very low certainty of harm but the harm is catastrophic and 2) high certainty of similar benefits of two alternatives but one is less harmful, and 3)low/very low certainty of benefit but one is more harmful. We strived to assess the prevalence of GRADE recommendations and temporal trends of discordant recommendations (DR).

METHODS:
Guidelines produced by AASLD, ACG, AGA, and ASGE from 2013 to October 15, 2018 that used GRADE, were reviewed. Across all guidelines, we identified the prevalence of and temporal trends of DRs.

RESULTS:
A total of 87 guidelines were identified and of these 78 (89.6%) were based on the GRADE framework. Across these 78 guidelines a total of 1,443 recommendation statements were generated. The number of DRs that did not fit the 5 paradigmatic scenarios above by year were as follows: 2013 = 12.7 % (45/353), 2014 = 15.9 % (50/313), 2015 = 19.5 % (60/307), 2016 = 29.3% (54/184), 2017 = 17.9% (32/178), 2018 = 17.5% (19/108) [Figure 1].

CONCLUSION:
Discordant recommendations are discouraged because when either the benefits or harms of an intervention are uncertain, one cannot be confident that an intervention does more good than harm. Over the last 5 years, the number of DRs in gastroenterology guidelines increased until 2016 and then started to downtrend. Further investigations should explore the etiology of why discordant recommendations are made as they may contribute to patients receiving suboptimal care.
1162 Choosing Wisely: The Evidence Behind Gastroenterology Recommendations
Authors: Thakur Kshitij , Pekez Marijeta 
Published: October 2019

INTRODUCTION:
Choosing wisely initiative of the ABIM foundation seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. We live in a society where medical bills are the number one cause of bankruptcy and social determinants of health play a crucial role in the care we provide to our patient. The Choosing wisely recommendations promote conversations between clinicians and patients by helping choose care that is evidenced bases, free from harm and truly necessary.

METHODS:
Our aim was to review the evidence supporting the recommendations related to gastroenterology. We listed all the gastroenterology (GI) related recommendations from different societies by using the topic area filter as “Gastroenterology” in the Choosing wisely website. We got a list of 26 recommendations from 11 different societies and extracted all the references cited by these recommendations. We excluded 2 specific recommendations related to use of PEG tubes due to duplication. All recommendations were categorized by the highest level of evidence strength cited.

RESULTS:
Among all GI recommendations, 70.9% cited Clinical practice guidelines, while 29.1% cited primary research (16.6% systematic review and 12.6%observational studies). None of the recommendations cited case series, review articles or other lower quality data as their highest evidence.

CONCLUSION:
These findings suggest that all GI related Choosing wisely recommendations are from high quality evidence. These recommendations should be used in daily practice to help with decision making. These recommendations also provides a valuable resource to educate trainees about evidence based medicine.
1166 Female Authorship of Major Gastroenterology Society Guidelines and Technical Reviews
Authors: Bushyhead Daniel W. , Strate Lisa L. 
Published: October 2019

INTRODUCTION:
Authorship in gastroenterology society guidelines and technical reviews may aid academic advancement. Challenges facing women in academic gastroenterology have gained recent attention, and there may be a disparity in authorship of these documents. The purpose of this study was to analyze the proportion of female authors of major gastroenterology society guidelines and technical reviews in comparison to males.

METHODS:
American Association for the Study of Liver Disease (AASLD), American College of Gastroenterology (ACG), and American Gastroenterological Association (AGA) guidelines and technical reviews were identified from online materials. Documents were included from 2007 to 2018. The sex of each author, and the total number of guideline authors were abstracted. The number of female authors was compared to the total number of authors. We also examined the proportion of guidelines and technical reviews with female first authors. The time period was broken into three equal periods: 2007-2010, 2011-2014 and 2015-2018. Data were analyzed with descriptive statistics using Excel (Version 16.23). The Cochrane-Armitage trend test was used to compare the proportion of female authors between time periods.

RESULTS:
Eighty-three guidelines and technical reviews from 2007 to 2018 were identified. A total of 425 authors were identified after combining author totals of each guideline and technical review while excluding duplicates. Eighty-eight (21%) of authors were women. The total percentage of guideline and technical review authors who were women varied according to each society and over time but remained persistently below that of men (see Figure 1). The proportion of female authors of AASLD guidelines increased from 21% in 2007-2010 to 34% in 2015-2018 (P = 0.042). Female authorship was stable across time for ACG guidelines (20%, 16%, 18%; P = 0.713). For AGA guideline and technical reviews, female authorship declined from 24% in 2011-2014 to 13% in 2015-2018 (P = 0.045). The majority of first authors of guidelines and technical reviews for each society were male (see Figure 2).

CONCLUSION:
There were significant disparities in female authorship of guidelines and technical reviews by the AASLD, ACG and AGA. There was a statistically significant increase in female authorship over the past ten years only for AASLD guidelines. Addressing disparities in guideline and technical review authorship may promote academic advancement for female gastroenterologists.
1173 Patients Taking Proton Pump Inhibitors Are More Likely to Respond to Endoscopic Dilation of Benign Duodenal Stenosis, Regardless of the Etiology
Authors: Chittajallu Vibhu , Simons-Linares Roberto , Bhatt Amit , Stevens Tyler , Vargo John , Chahal Prabhleen 
Published: October 2019

INTRODUCTION:
Benign duodenal stenosis (BDS) is usually managed by endoscopic balloon dilation (EBD), but there is very limited literature on this practice outcomes. We sought to investigate the etiological spectrum, response to EBD and predictors for successful EBD.

METHODS:
We performed a cohort study of a prospectively maintained database of benign duodenal stenosis at a tertiary referral center between 2013 and 2018. Pyloric stenosis patients were excluded. All patients that underwent EBD were analyzed. Dilation was performed using through the scope balloons. Technical and clinical success of initial and repeat EBD were compared among the BDS etiologies, location within the duodenum, and number of stenotic tracts. Logistic regression models were performed using SAS software.

RESULTS:
A total of 276 patients were analyzed, of whom 87 patients underwent EBD for BDS. Most common etiology was peptic ulcer disease (PUD) 42 (45%) (Table 1). Upon initial EBD, technical success was 96.5% and clinical success was 74.4%. Upon repeat EBD, technical success was 98.1% and clinical success was 78.7%. When comparing PUD vs. All others, initial clinical success was 77.8% vs. 71.4% (P = 0.52), and on repeat EBD clinical success was 72.0% vs. 86.4% (P = 0.23). When comparing Crohn’s disease vs. All others, initial EBD clinical success was 72.2% vs. 75.0% (P = 0.81), and repeat EBD clinical success was 91.7% vs. 74.3% (P = 0.20). When comparing location of the stenosis in the 1st portion of the duodenum vs. distal duodenum, initial EBD clinical success was 70.0% vs. 82.1% (P = 0.24), and repeat EBD clinical success was 75.0% vs. 78.7% (P = 0.36). When comparing single vs. multiple strictures, initial EBD clinical success was 73.0% vs. 100.0% (P = 0.57), and repeat EBD clinical success was 77.3% vs. 100.0% (P = 0.99) (Table 2). 15 patients underwent planned/prophylactic EBD, but this did not impact the outcomes. Males were more likely to have distal duodenum stenosis when compared to females (63.6% vs. 36.4%, P = 0.007). African American had a lower likelihood of clinical success (aOR 0.083, P = 0.004), and usage of PPI increased likelihood of clinical success (aOR 3.65, P = 0.04) (Table 3).

CONCLUSION:
EBD has very high technical and clinical success rates in BDS. Males tend to have more distal duodenal involvement; African Americans ethnicity are less likely to respond to EBD and importantly, PPI usage was an independent predictor for EBD clinical success regardless of etiology.
1179 Characterization of the Bacterial Makeup and Quantitative Distribution in Patients With Suspected Small Intestine Bacterial Overgrowth (SIBO): A Meta-Analysis
Authors: Jones Mitchell L. , Lee Shaoying N. , Allan Nick , Singh Sharat , Wahl Chris , Chuang Emil , Kelly Colleen , Styli Jack 
Published: October 2019

INTRODUCTION:
Small Intestinal Bacterial Overgrowth (SIBO) is associated with abnormally high bacterial counts in the small intestine and clinical features such as diarrhea, constipation, abdominal pain, distension and bloating. A meta-analysis of studies of endoscopic samples from patients with suspected SIBO was performed to estimate the distribution of bacterial colony forming units (CFU) and identify the bacterial populations in these patients.

METHODS:
A literature search was performed to find studies of the jejunum or duodenum culture aspirates from patients with suspected SIBO using keywords: SIBO (or SBBO), culture aspirate and CFU. A total of 10 studies met the inclusion criteria. The CFU distribution was estimated using a log-spline smoothing technique in the statistical package R. Top bacterial population identified in aspirates of these patients was reviewed.

RESULTS:
The studies used in the meta-analysis including the number and type of subjects, the region where the culture aspirate sample was taken, and the type of CFU data presented was summarized in Table 1. A histogram of the estimated CFU distribution using the first five papers with actual CFU counts was shown in Figure 1. The spike at zero showed that approximately 26% of patients had sterile cultures. Sensitivity analyses using the first seven papers and all ten papers yielded similar estimated distributions to Figure 1, particularly in terms of the proportion of subjects with CFU counts between 104 and 106. The proportion of subjects in the tails of the distributions (sterile samples or CFU counts >1010) had larger variations between the three fitted distributions presumably due to differences in counting methodologies. The top bacterial species cultured and identified from jejunal aspirates was summarized in Table 2.

CONCLUSION:
Using a standard diagnostic threshold >105 CFU, only 24% of patients with suspected SIBO would test positive; while lowering the threshold to >104 CFU increases the positive call rate to 33%. As expected, bacterial culture identification was unable to clearly distinguish a single contributing organism. Limitations to this work are substantial and include variability in sampling regions, contamination, difficulty culturing and counting bacteria, lack of standardization in procedures and reproducibility. Given these limitations, there is consensus that novel tools are needed for evaluating patients with suspected SIBO.
1197 Prevalence of Celiac Disease in Patients Presenting With Short Stature: A Systematic Review and Meta-Analysis
Authors: Singh Achintya D. , Singh Prashant , Farooqui Naba , Strand Tor , Ahuja Vineet , Makharia Govind 
Published: October 2019

INTRODUCTION:
Short stature is a common extra-intestinal manifestation of celiac disease (CeD). The proportion of patients with short stature having CeD varies. We conducted a systematic review and meta-analysis to assess the prevalence of CeD in patients with presenting with short stature.

METHODS:
We searched Medline and EMBASE databases for the keywords 'celiac disease, coeliac disease, celiac, tissue transglutaminase antibody, anti-endomysial antibody, short stature and growth retardation'. All studies published from 1991 to February 2019 were included. Patients without any prior evaluation for short stature were classified as all-cause short stature, while previously evaluated patients, where no cause was found for short stature, were classified as having idiopathic short stature. Diagnosis of CeD was based on the European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data. Risk of bias was assessed across each study using a validated tool developed for prevalence studies by Hoy et al (1).

RESULTS:
Seventeen studies including 3959 patients (1729 with all-cause short stature and 2230 with idiopathic short stature) were included. The pooled seroprevalence of CeD based on positive anti-tissue transglutaminase antibody, anti-endomysial antibody and antigliadin antibody was 11.5% (95% CI 2.34, 20.7; I2 = 47%) and 12.7% (95% CI 8.2, 17.3; I2 = 93.3%) for all-cause and idiopathic short stature (Figure 1), respectively. The pooled prevalence of biopsy-proven CeD was 7.2% (95% CI 4.44, 9.9; I2 = 77.7%) and 9.6 (95% CI 6.8,12.4) for all-cause (Figure 2) and idiopathic short stature (Figure 3), respectively. There was an overall moderate risk of selection bias and significant heterogeneity in the present studies. Statistical heterogeneity was partially due to differences in the diagnostic strategy (biopsy in seropositive individuals vs biopsy in all suspected patients), study design (retrospective vs prospective studies). Age, sample size did not influence the results on meta-regression analysis.

CONCLUSION:
Approximately 1 in 14 patients with all-cause short stature and 1 in 10 patients with idiopathic short stature have biopsy-confirmed CeD. Therefore, all patients with short stature should be evaluated for CeD.
1210 Implementation of Stress Ulcer Prophylaxis Appropriate Use Criteria in a Community Hospital
Authors: Beattie Michael , Pawlaczyk Barbara , Anderson Tara , Tauscher Samantha 
Published: October 2019

INTRODUCTION:
Upper gastrointestinal stress ulcer formation is a potential risk for critically ill hospitalized patients. Due to this, SUP is an important preventative measure for at risk patients. Stress ulcer medications such as PPIs and H2 blockers do come with potential side effects.1,2 A widely accepted guideline was written by the American Society of Health System Pharmacists which along with similar variations continue to be used today.3,4 One such guideline has been implemented within the Ascension Health System (Figure 1). Despite guidelines, inappropriate administration continues to be a common problem. Studies show rates of inappropriate administration anywhere from 20 to 70 percent.5–9 A discrepancy in knowledge from providers leads to inappropriate prescribing of SUP medications. Administration of these laminated cards will improve appropriate administration of the medications.

METHODS:
Laminated cards were dispersed to fit on ID badges of IM and FP residents which following the Ascension SUP guidelines. Data was collected on all patients admitted under the core faculty of an IM or FP attending between 7/1/18–9/30/18 and 11/1/18–1/31/19. 10/1/19-10/31/19 constituted the run-in period. Patients were excluded if they had active diagnoses of GERD, PUD, H. Pylori. Eligible patients' charts were reviewed at random by using an online number generator. The A&P section of the H&P note was reviewed to determine if SUP was was appropriately administered, appropriately held, inappropriately administered, or inappropriately held. Any discrepancies were reviewed by the principal investigator. A t-test was performed to determine if statistical significance was achieved.

RESULTS:
There were 124 and 115 patients in the pre and post-intervention period respectively. There was an overall improvement of 5.64% (P = 0.21) after distribution of cards (Figure 1). Inappropriately given SUP use improved by 5.01% (P = 0.22). Inappropriately held SUP use improved by 0.61% (P = 0.78).

CONCLUSION:
Administration of cards improved appropriate prescribing. The cards provided a resource to aid in enhancing knowledge and on-the-go decision making. The availability of implementing these guidelines or similar such protocols using EMR may be more effective in reaching a wider audience of physicians and provide a consistent effect on prescribing habits.