bluuebunny/crossref_metadata_2025_split huggingface dataset:
975 Transjugular Intrahepatic Portosystemic Shunt Placement Is Equally Safe in Obese Patients
Authors: Fahad Hamna , Modaresi Jamak Esfeh , Sarmini Talal 
Published: October 2019

INTRODUCTION:
Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement is aimed at controlling complications of portal hypertension in patients with end stage liver disease. In spite of the current obesity epidemic and resultant comorbidities, there is no data in the literature if obesity increases the risk of complications for cirrhotic patients undergoing TIPS. We conducted this study to assess if obesity increases TIPS complications.

METHODS:
Patients were identified using the institutional TIPS registry. A manual, retrospective chart review was done to collect data. We divided patients based on BMI into 1) Underweight: (BMI < 20), 2) Normal Control (BMI: 20–24.99), 3) Overweight (BMI: 25–29.99), 4) Obese (BMI: 30–34.99) and 5) Morbidly obese: (BMI > 35). We then performed a multivariate logistic regression to assess for TIPS outcomes after adjusting for age, gender, cirrhosis etiology and TIPS indication. Outcomes of interest included vascular complications (such as hepatic and portal vein thrombosis); hematological complications (such as bleeding and hemolysis); ischemic liver injury; respiratory distress post procedure; need for revision within 6 months; incidence of TIPS stenosis; infections and incidence of hepatic encephalopathy post TIPS.

RESULTS:
329 patients underwent an elective TIPS procedure at our institute between 2013 and 2017. After excluding patients with missing data, 300 patients were identified and were divided based on BMI into five groups as mentioned above: Control (n = 92), underweight (n = 13), overweight (n = 89), obese (n = 55) and morbidly obese (n = 51). The mean age for each group was noted to be: (55.83, 53.69, 57.25, 58.45, and 56.20) respectively. The control group was noted to have more females compared to the underweight group (38.2% vs. 16.1%), but less females when compared to the rest of the groups: (38.2%, 50.9%, 60.8%). Using multivariate logistic regression there was no statistically significant increased risk for complications after TIPS in patients with increased BMI compared to the control group, P-value > 0.05. (Table 1. Comparison of post TIPS complications between all groups).

CONCLUSION:
BMI of patients with TIPS related complications is not significantly higher than those without complications. Obesity does not play a role in post TIPS complications.
977 Predictors of Response to Direct Acting Anti-Viral Therapy in Patients With Decompensated Hepatitis C Cirrhosis
Authors: Debnath Prasanta , Chandnani Sanjay , Rathi Pravin , Nair Sujit , Udgirkar Suhas 
Published: October 2019

INTRODUCTION:
The introduction of direct-acting antiviral (DAA)-based therapies for chronic hepatitis C virus (HCV) infection has revolutionized the approach to HCV treatment, resulting in highly efficacious and well-tolerated therapy for nearly all patients. Patients with a history of decompensated cirrhosis represent a unique subset of patients with a worse response to HCV therapy compared with those who have compensated cirrhosis or chronic HCV infection. Decompensated cirrhosis due to HCV is a difficult to treat population. At present, there is no gold standard predictors of response to Direct Acting Anti-virals (DAA). We conducted this study to look for factors responsible for improvement in state of decompensation post DAA therapy, i.e. attainment of Child-Turcotte-Pugh (CTP) class A from CTP class B or C.

METHODS:
Retrospective analysis was conducted for patients of decompensated HCV cirrhosis (48 patients of CTP class B and 14 patients of CTP class C). We collected demographic, clinical, treatment response, and laboratory data from patients, which included age, BMI, LFT, INR, GFR, MELD score, response to therapy (SVR12), presence of ascites, encephalopathy were noted for recruited decompensated HCV cirrhosis and tested their associations with patient outcomes at 24 weeks post-treatment. Patients were given Sofosbuvir combination treatment with Daclatasvir / Ledipasvir / Velpatasvir and/or Ribavirin according to genotype, for 12 weeks, where Ribavirin was used and rest 24 weeks.

RESULTS:
Total 62 patients of decompensated HCV cirrhosis patients recruited, with males 54%, Median age 48 years. 48 patients were CPT class B whereas 14 patients of CPT class C. Patients with MELD score < 10, 10–15 and >15 were 21 (33.8%), 28 (45.1%) and 13 (21.1%) in pre-treatment and 23 (37%), 30 (48.3%) and 9 (14.7%) in post-treatment period respectively. Post-treatment 34 patients (54.8%) turned into CTP class A, 25 (40.3%) and 3 (4.9%) remained in CTP class B & C. Factors associated with favorable prognosis were male sex, baseline albumin, bilirubin, MELD score, presence of ascites.

CONCLUSION:
This study showed that oral DAAs were able to reverse liver dysfunction in patients with decompensated HCV cirrhosis in more than half of our patient cohort and favoured use of treatment in such patients. The longer term benefits of therapy need to be ascertained though.
999 De-Livering an Assessment of Internet Information for Patients on Non-Alcoholic Fatty Liver Disease
Authors: Tabbara Nadeem , Clarke Lindsay , Baumgartner Scott , Szvarca Daniel , Basso Jessica , Dawit Lillian , Borum Marie 
Published: October 2019

INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disease in the United States. Given the potential for significant morbidity and mortality risk, individuals increasingly access online sources for self-education. This study evaluated the quality, readability, and content of readily accessible online resources on NAFLD using validated assessment tools.

METHODS:
A search of the terms “fatty liver” was executed using the Google search engine to obtain the first 100 websites. Websites that were non-accessible, included videos without transcripts, focused on veterinary topics or were duplicates were excluded. Websites were categorized by intended audience: patient versus professional. Quality was evaluated using the validated DISCERN instrument with DISCERN scores rated as Excellent 56-75, Good 36–55, Poor < 36. Readability was determined using the validated Flesch-Kincaid Grade Level Calculation. Statistical analysis was conducted using a two-tailed Fisher’s Exact Test and a Two-Sample T-test, with a P-value set at <0.05.

RESULTS:
100 websites were evaluated with 88 sites meeting inclusion criteria. 52 (59.1%) sites were intended for patients and 36 (40.9%) were for medical professionals. The average Flesch-Kincaid grade level was 12.7, with a significant difference (P = 0.009) between patient (11.9 grade level; range 6.3–18.6) and professional (13.8 grade level; range 7–19.7) websites. Professional sites were significantly (P = 0.0009) more likely to provide references (52.8%) than patient sources (17.3%). The mean DISCERN score was Good 47.7 with no significant difference in measured quality between patient (47.7; range 32–74) and professional (47.8; range 28–72) websites.

CONCLUSION:
Online NAFLD resources are readily available for patients and professionals. Based on the validated DISCERN tool, the quality of website information as rated as good. However, the patient reading level of medical information exceeded the NIH 6th grade reading level recommendation. Online sources targeted towards patients should be written in more patient-centered language. This study highlights the potential need for improvement in the current online medical information available to both patients and professionals regarding NAFLD and its spectrum of disorders. In addition, most websites disseminating medical information should be revised to include validated references and improve quality content.
1004 Does Hospital Teaching Status Influence Risk Factors and Incidence Rate for 30-day Readmission for Hepatic Encephalopathy?
Authors: Mehta Neal , Varghese Ron T. , Kamoga Roy , Khasawneh Khaled , Tharian Benjamin , Garg Shashank , Deneke Matthew G. , Inamdar Sumant 
Published: October 2019

INTRODUCTION:
Literature suggests that an index admission with Hepatic Encephalopathy (HE) is associated with all-cause readmission and increased mortality in patients with cirrhosis. Teaching hospitals may have higher readmission rates compared to non-teaching hospitals. We determined the 30-day all-cause readmission rate and risk factors for adults admitted with a principal diagnosis of HE in metropolitan teaching and non-teaching hospitals.

METHODS:
We utilized the Nationwide Readmission Database to identify admissions with a principal diagnosis of HE (ICD-9 572.2). Applicable admissions were all adults (age ≥ 18) from 01/01/2014 to 11/30/2014. Patients who died during index admission, those with missing covariates, or admission to non-metropolitan hospitals were excluded. All-causes including HE readmissions within 30-days of an index HE admission were analyzed. Statistical analysis was completed with Stata 15 (StataCorp, College Station, TX). Predictors for readmission were determined using a multivariate logistic regression model following sequential step-wise elimination of covariates including demographics, comorbidities, hospital characteristics, length of stay (LOS) for index admission, and the modified Elixhauser Comorbidity Index.

RESULTS:
A total of 19,047 patients met criteria for inclusion. There were 6,362 all-cause readmissions (33.40%) within 30-days of the index HE admission. The readmission rate for patients discharged from a teaching hospital and readmitted to any hospital was 33.65% with non-teaching hospitals at 32.95%. There was not a statistically significant difference (P = 0.32) between the readmission rate for patients discharged from teaching and non-teaching hospitals. There was no statistical difference in readmission for HE (P = 0.78). For non-teaching hospitals, discharge against medical advice, age between 35 and 65, and CKD were predictors for readmission. For teaching hospitals, females, age between 35 and 65, Medicaid insurance, LOS between 7 and 14 days, and CKD predicted readmission.

CONCLUSION:
Nearly 1 in 3 individuals admitted to a metropolitan hospital (non-teaching or teaching) with a principal diagnosis of HE was readmitted. While there was not a difference in the readmission rate, the risk factors for readmission at teaching and non-teaching hospitals were slightly different. Development of targeted interventions for sub-populations at high risk for readmission, may help to decrease healthcare cost, morbidity and mortality.
1086 Venous Thromboembolism Trends and Impact in Patients With Cirrhosis: Analysis of the National Inpatient Sample Database 2003-2014
Authors: Greenberg Ian , Quintero Luis Diaz , Tafur Alfonso 
Published: October 2019

INTRODUCTION:
Despite the decreased synthesis of coagulation factors and high bleeding risk in patients with cirrhosis, they are not free of venous thromboembolism (VTE) risk. The impact of VTE in patients with cirrhosis is not well understood, even less so the impact of acute VTE during hospitalization. This study set out to establish the impact of inpatient VTE occurrence in mortality, bleeding, length and cost of hospitalization in patients with cirrhosis.

METHODS:
We identified individuals ≥ 18 years old from the 2003-2014 National Inpatient Sample database with a diagnosis of cirrhosis using ICD-9-CM codes. Cirrhosis, acute deep vein thrombosis of extremities and acute pulmonary embolism diagnoses were allocated if present among the top 10 admission diagnoses. Demographics and inpatient outcomes of patients with VTE were compared to those without VTE. We used SPSS 25 to calculated odds ratios (OR) with confidence intervals (CI), and trend analysis.

RESULTS:
A total of 1,165,369 cirrhotic patients were included (weighted cases = 5,594,565). 11,049 (0.9%) VTE cases were diagnosed. Patients with VTE were older (61.9 vs 58.4 years, P < 0.0001), and less likely females (36.8% vs 39%, P < 0.0001). Patients with VTE were more likely to die during the hospitalization (OR 1.6 [CI 95% 1.5-1.71, P < 0.0001]), to have intracranial bleeding (OR 1.3 [CI 95% 1.03–1.64, P = 0.02]), retroperitoneal bleeding (OR 2.36 [CI 95% 1.68–3.3, P < 0.0001]), had longer inpatient stay (9.6 vs 6.0 days, P < 0.0001), and higher costs (72,434 vs 41,670 USD, P < 0.0001). There was an increasing trend of inpatient VTE per year (0.27% 2003 vs 1.16% 2014, P < 0.0001) but a decreasing trend in inpatient mortality per year in cirrhotic patients with VTE (17.6% 2003 vs 9.2% 2014, P = 0.0001).

CONCLUSION:
VTE occurrence is associated with increased inpatient mortality, intracranial bleed, retroperitoneal bleed, length and cost of hospitalization. More thorough VTE prophylaxis strategies may need to be implemented in patients with cirrhosis.
1126 Preoperative Endoscopic Findings in Veterans Undergoing Bariatric Surgery: Prevalence and Predictors of Barrett's Esophagus
Authors: Ozeki Katharine , Tran Sally , Cheung Ramsey , Eisenberg Dan 
Published: October 2019

INTRODUCTION:
The role of preoperative esophagogastroduodenoscopy (EGD) in patients seeking bariatric surgery remains unclear, as recommendations are based on data from a younger, largely female population. We aim to characterize and determine the frequency of EGD findings in a predominantly older, male Veteran population undergoing bariatric surgery.

METHODS:
This is a single-center retrospective analysis of Veterans who underwent Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy at a Veterans Affairs hospital between January 2008 and December 2017. All patients received a preoperative EGD. Data abstracted included demographics, comorbidities, preoperative laboratory values and EGD reports. Univariate and multivariate analyses using odds ratio (OR) were compared between those with a normal EGD and Barrett’s esophagus.

RESULTS:
Of the 260 Veterans included in our cohort, most were male (75%) aged 54.0 ± 9.0 years-old with a BMI of 44.9 ± 7.0 kg/m2 (Table 1). Most Veterans identified themselves as Caucasian (73.5%), followed by African American (9.2%), Hispanic (7.3%), Native American (1.2%), Asian (0.8%) and other (8.1%). The majority had hypertension (78.9%), previously smoked (63.9%), used a proton pump inhibitor (PPI) (53.1%) within 6 months of surgery, had gastroesophageal reflux disease (GERD) (49.2%) and diabetes (47.3%). One third of Veterans had a completely normal preoperative EGD. Common EGD findings included gastritis (35.8%), hiatal hernia (25.8%), esophagitis (20.8%), duodenitis (10.4%), Barrett’s esophagus (7.4%), H. pylori infection (4.6%) and gastric intestinal metaplasia (0.8%). On univariate analysis alone, male gender (OR 0.55, P = 0.041) and those with hypertension (OR 0.50, P = 0.025) were less likely associated with a normal EGD. On both univariate and multivariate analyses, those who recently used a PPI were also less likely to have a normal EGD (OR 0.38, P = 0.001; OR 0.030,P < 0.001, respectively). In contrast, on both univariate and multivariate analysis, increasing age (OR 1.08, P = 0.020; OR 1.08; P = 0.040, respectively), recent PPI use (OR 5.20, P = 0.010; OR 10.1, P = 0.002, respectively) and recent histamine receptor 2 blocker (H2B) use (OR 5.58, P = 0.007; OR 8.87 P = 0.014, respectively), were associated with Barrett’s esophagus (Table 3).

CONCLUSION:
Preoperative factors can be used to identify patients at risk for gastroesophageal pathology. Our data support preoperative EGD in select populations that include older males with recent PPI or H2B use.
1149 Endoscopic Signs Moderately Correlate With Histologic Changes in Children With Eosinophilic Esophagitis
Authors: Hiremath Girish , Tyree Regina N. , Correa Hernan , Acra Sari , Dellon Evan S. 
Published: October 2019

INTRODUCTION:
Management of children with eosinophilic esophagitis (EoE) could be simplified if the endoscopic signs strongly correlated with tissue level changes and served as a marker for mucosal healing. Accordingly, we tested the hypothesis that endoscopic signs would strongly correlate with histologic changes in children with EoE.

METHODS:
We consecutively enrolled 115 children with EoE (active EoE, defined as ≥ 15 eos/hpf, n = 62; inactive EoE, < 15 eos/hpf, n = 53) undergoing endoscopy with biopsies. Their demographic and clinical information was gathered. EoE relevant endoscopic signs (edema, rings, exudates, furrows, stricture) were recorded per the endoscopic reference scoring system (EREFS). Esophageal biopsies were assessed for both peak eos/hpf and the EoE Histology Scoring System (EoEHSS). Correlation between EREFS and peak eos/hpf or EoEHSS was evaluated using Spearman’s rho (r), and multiple linear regression analysis was used to adjust for confounders such as age, gender, ethnicity, duration of EoE, medication exposure, allergic co-morbidities, and disease status.

RESULTS:
The average age of our cohort was 9.4 ± 3.6 years, 77% were white and 73% were male. Overall correlation between EREFS and EoEHSS was marginally stronger [r = 0.60; P < 0.001] but not statistically significant when compared to peak eos/hpf [r = 0.55; P < 0.001]. In children with inactive EoE, the EREFS moderately correlated with eos/hpf [r = 0.44; P = 0.001] and EoEHSS [r = 0.46; P < 0.001]. However, in children with active EoE EREFS weakly correlated with EoEHSS [r = 0.32; P = 0.01] and did not significantly correlate with eos/hpf [r = 0.10; P = 0.41]. Regression analysis revealed that EREFS was positively associated with EoEHSS [ß = 1.66 (95% CI: 0.65-2.68); P = 0.002], and active EoE [0.60 (0.06-1.15); P = 0.02)], presence of dysphagia [0.75 (0.16-1.33); P = 0.01], and a history of eczema [-0.67 (-1.10- -0.24); P = 0.002] were other independent predictors. The association between EREFS and peak eos/hpf after adjusting for potential confounders did not attain statistical significance.

CONCLUSION:
Endoscopic signs only moderately correlate with histologic changes in children with EoE, particularly in children with inactive EoE. The variability in mucosal involvement and the severity and intensity of tissue level inflammatory alterations may explain the weak relationship in children with active EoE. As such, monitoring both endoscopic healing and histologic changes remains central to the management of children with EoE.
1161 Learning Styles and Burnout in Gastroenterology: Should Continuing Medical Education Be Changed to Accommodate all Learning Styles?
Authors: Bledsoe Adam C. , Stephenson Christopher , Mahapatra Saswati , Schleck Cathy , Mandrekar Jay , Collins C. Scott , Sanchez William , Ravi Karthik , Wittich Christopher , Raffals Laura E. 
Published: October 2019

INTRODUCTION:
Learning styles among gastroenterology providers have not been reported and may have implications in improving continuing medical education (CME). This study aims to 1) evaluate learning styles among gastroenterology providers participating in a board review course, 2) assess self-reported burnout, and 3) determine if demographic information, practice style, or burnout was associated with specific learning styles.

METHODS:
Participants at the 2018 Mayo GI and Hepatology Board Review Course had the opportunity to participate in an anonymous, survey-based study evaluating learning styles and burnout. Demographic and practice information, reason for participating in the course, questions regarding burnout and callousness, and the Kolb Learning Style Inventory (KLSI) (v3.1, Korn Ferry Hay Group, Boston, MA) were collected. Associations between demographic data, burnout, and learning styles were assessed using Fisher’s exact test.

RESULTS:
A total of 71 of 230 participants elected to participate and 47 completed the KLSI. Median age range was 41-50 years, 31 (43.7%) were female, and 60 (84.5%) had MD or DO degree. All regions of the United States were represented and 4 participants were from outside of the US. Reasons for participation included new certification (12.7%), recertification (45.1%), not passing prior board certification (4.2%), and general knowledge (38%). Burnout was noted by 27 (38%), callousness by 19 (26.8%), and both by 9 (12.7%). Kolb learning styles were diverging in 27.7%, assimilating in 31.9%, converging in 27.7%, and accommodating in 12.8%. There were no associations with demographics, practice type or reason for taking the course with specific learning styles; however, more frequent markers of burnout were associated with the accommodating learning style (50% burnout only, 33% callous only, and 16.7% reporting both; P = .03).

CONCLUSION:
All learning styles are represented at the studied board review course and are dispersed throughout ages, sex, geography, and practice style. This highlights the importance of a transition from lecture-based CME to more varied education modalities. Indices of self-reported burnout are seen frequently in this cohort, and seem to have increased association with the accommodating learning style. Future study with more participants is needed to further understand learning styles and burnout in gastroenterology providers, with the aim of improving CME.
1185 Predictors of Hospital Readmission Among Patients With Obscure Gastrointestinal Bleeding Following Inpatient Capsule Endoscopy
Authors: Levine Irving , Hong Soonwook , Bhakta Dimpal , McNeill Matthew B. , Gross Seth , Latorre Melissa 
Published: October 2019

INTRODUCTION:
Patients with obscure gastrointestinal bleeding (OGIB) often require frequent hospital admissions and endoscopic procedures to identify and treat bleeding. Capsule endoscopy (CE) provides a novel approach to evaluate OGIB. The role of inpatient CE in hospital readmissions has not been previously reported. We sought to identify patient and clinical factors associated with hospital readmission among patients with OGIB following inpatient CE.

METHODS:
We conducted a retrospective review of adult patients undergoing inpatient CE at a tertiary referral, academic medical center between 4/1/17 and 4/1/19 to evaluate for predictors of readmission. We reviewed patient demographics, medical history, medications, hospital course, results of CE, and 30-day readmission rates. Arteriovenous malformation (AVM) risk factors were defined as having comorbid cardiac valvular disease or advanced chronic kidney disease (stage 3-5). A positive CE was defined as having abnormal small bowel pathology or bleeding.

RESULTS:
86 patients were included. Overall, 64% were male with a median age of 69 years (Table 1). The main indication for inpatient CE was overt bleeding (59%). Complete CE was noted in 70 patients (81%), and positive CE in 48 patients (56%). Overall, 17 patients (19.8%) were readmitted within 30 days of index admission. Length of stay (LOS) on index admission was longer among those readmitted (Mean LOS 10 days vs 7.9 days, P = 0.07). Readmission was not related to age, gender, complete CE, positive CE or bleeding on CE. There was a trend for readmission among patients who had previously been admitted within 30 days (41% vs 22%, P = 0.1). There was a trend towards readmission for patients with diabetes mellitus (DM) and AVM risk factors. Medication use was not associated with readmission.

CONCLUSION:
Patient with OGIB have high rates of hospital admission. The use of inpatient CE can provide guidance on subsequent therapy in patients with OGIB, with the potential to decrease hospital admissions. We found high rates of 30-day hospital readmission among patients with OGIB after inpatient CE. No significant predictors of readmission were noted, though several factors, including increased LOS on index admission, DM, AVM risk factors, and recent admission trended towards readmission. Larger studies are necessary to fully elucidate predictors of readmission. To our knowledge, this is the first study to address the effect of inpatient CE and hospital readmissions.