bluuebunny/crossref_metadata_2025_split huggingface dataset:
201 Efficacy of Fecal Microbiota Transplantation for Acute Graft Versus Host Disease in the Gut: A Systematic Review and Meta-Analysis
Authors: Tariq Raseen , Furqan Fateeha , Pardi Darrell , Khanna Sahil 
Published: October 2019

INTRODUCTION:
Graft versus Host disease (GVHD) is a major cause of mortality and morbidity in allogenic hematopoietic stem cell transplant recipients (HSCT). Gut microbiome dysbiosis secondary to conditioning regimens (which include antibiotics) in HSCT, appears to play a significant role in gut GVHD development through its interaction with the immune system. Fecal Microbiota Transplantation (FMT) has been explored for the treatment of gut GVHD owing to its ability to restore the gut microbiome. We performed a systemic review and meta-analysis to review the efficacy and safety of FMT for gut GVHD.

METHODS:
A systematic search of Medline, Embase, and Web of Science was performed from January 2000 through May 2019. Articles included for meta-analysis were observational studies which included patients with steroid-dependent or resistant gut GVHD after HSCT who underwent one or more FMTs. The main outcomes were pooled proportions of patients achieving response defined as a decrease in gastrointestinal symptoms including stool volume and frequency or reduction of steroid or immunosuppressant dose. Partial response was defined as a decrease of gastrointestinal symptoms followed by recurrence of symptoms.

RESULTS:
Five studies (4 prospective single arm pilot studies and 1 retrospective case series) including 37 patients were included with follow up ranging from 1–13 months. Three studies used naso-duodenal route, one used oral capsules and one used colonoscopy for FMT. Median number of FMTs per study was 2 (range, 1–6). Unrelated donors were used in 4 studies. A total of 23/37 patients achieved complete response with a pooled proportion of 61.0% (95% confidence interval [CI] 46–76.0), with no heterogeneity (I2 = 0%). Partial response was seen in 3 patients. Hence, the overall response rate was 74.0% (95% CI 49–93, I2 53%). FMT was generally well tolerated. No treatment-related mortality was reported by any study. Serious adverse events were reported in 3 patients (hypoxia in one patient and bacteremia in two patients) but were not directly attributed to FMT.

CONCLUSION:
FMT is a promising modality for management of gut GVHD and appears to be safe as a salvage therapy based on the current limited data. Ongoing placebo-controlled prospective clinical trials will help to further establish its safety and efficacy.
233  Managing Fecal Immunochemical Test (FIT) at Population Health Level in an Urban Safety Net Hospital
Authors: Elangovan Abbinaya , Greco Peter J. , Davis Katherine R. , Kaelber David C. , Sandhu Dalbir S. 
Published: October 2019

INTRODUCTION:
Annual fecal immunochemical test (FIT) is a non-invasive screening method recommended for individuals at average risk of colorectal cancer (CRC). Lack of FIT orders is perceived as a barrier to complete CRC screening. We aimed to evaluate bulk ordering FIT as a population health level methodology in improving CRC screening rates.

METHODS:
Individuals 50–75 years old, who visited a primary care provider (PCP) in the MetroHealth System within the preceding 2 years were reviewed between 10/2018 and 04/2019. Individuals at average-risk of CRC who neither completed FIT in the preceding 11 months nor were assigned to the colonoscopy screening track were identified via querying of the electronic health record (EHR). Bulk orders were placed on eligible individuals once a month, using PCP as the authorizing provider or residency program director for residents. Individuals were informed of the order via the most appropriate channel: personal health record message (MyChart), email, or secure text message mediated by third-party texting services (Clintell). An automated daily process canceled any obsolete bulk FIT orders when patients turned 76 years old, switched to colonoscopy track, or had another FIT order resulted. FIT orders were released when the patient visited the clinic or requested the kit to be mailed. Individuals with a positive FIT were contacted by designated staff to schedule a follow-up colonoscopy. FIT numbers at each step of the bulk order method were compared to regular orders in usual care (FIT orders placed by a provider during an outpatient visit) to analyze differences in outcome.

RESULTS:
From 10/2018 to 04/2019, 27,212 bulk orders and 13,756 regular orders were placed. Only 8.5% of bulk orders were released compared to regular orders (91.6%) but the released orders were completed at similar rates in either group. Among those with a positive FIT, a significantly higher number had a follow-up colonoscopy within 120 days in the bulk order (67.8%) compared to usual care (53.2%), P = 0.04. 33.9% of positive bulk FIT detected an adenoma compared to 29.5% of positive routine care FIT, P = 0.50.

CONCLUSION:
Managing FIT at population health level provides a time-efficient way to identify patients due for CRC screening in an urban safety-net hospital. Bulk ordering bypasses the need for a PCP encounter for order placement. Bulk ordering FIT has shown better follow up rates compared to the traditional method and may ultimately improve CRC detection.
305 Clinical Significance of Pseudopolyps for Patients With Inflammatory Bowel Disease
Authors: Lewis Ayanna E. , Kirchgesner Julien , Dray Xavier , Svrcek Magali , Beaugerie Laurent 
Published: October 2019

INTRODUCTION:
Postinflammatory polyps (PIPs), often referred to as “pseudopolyps,” have previously been associated with an increased risk for colorectal neoplasia (CRN) in inflammatory bowel disease (IBD) patients. This has resulted in some IBD patients with PIPs receiving a more aggressive colorectal cancer (CRC) surveillance strategy. However, newer studies have questioned whether the presence of PIPs increases overall risk for CRN. Recently, a multi-centered retrospective study did not find any association between the presence of PIPs in patients with IBD undergoing CRC surveillance and the development of CRN. We also suspected that PIPs did not confer any increased risk of CRN and speculated that this may in fact be explained by the degree of inflammation in the associated colonic segments. Our study sought to better understand the relationship between the presence of PIPs, colonic inflammation and subsequent risk for development of CRN.

METHODS:
We performed a retrospective analysis of patients entered from 1/1/1996 to 9/1/2018 in the MICISTA IBD registry at Saint Antoine Hospital in France. Patients were included if they had PIPs on at least one colonoscopy. Those with a questionable IBD diagnosis or without a colon were excluded. Endoscopy reports were divided into 4 segments for analysis. Each segment was then graded according to the number of PIPs identified per segment and the degree of endoscopic inflammation. The corresponding pathology reports were then also reviewed by segment for histological IBD activity using the Nancy histological index. Patients were also compared to a historical cohort of IBD patients without PIPs. Logistical regression was used to identify factors associated with detection of neoplasia in segments with and without PIPs.

RESULTS:
471 IBD patients were identified with a total of 607 endoscopies containing PIPs. 40 patients were found to have CRN. Preliminary analysis did not show any clear association between the presence of PIPs and the subsequent development of colorectal neoplasia.

CONCLUSION:
PIPs continue to pose a clinical dilemma for risk stratifying patients with IBD. Newer studies appear to upend the old knowledge that PIPs mandate a more aggressive approach to CRC surveillance. We suspect, with carefully performed endoscopy, these IBD patients may not require colonoscopies any more frequently than those without PIPs. This less intensive management strategy may lead to significant health cost-savings as well as improved quality of life for patients.
330 Increased Risk of Colorectal Cancer in Individuals With Hypothyroidism and Hyperthyroidism: Results From a Population-Based National Study
Authors: Mansoor Emad , Chouhan Vijit , Saleh Mohannad Abou , Sheriff Zaahid M. , Cooper Gregory S. 
Published: October 2019

INTRODUCTION:
Prior epidemiologic studies have linked thyroid dysfunction and cancer, however, a few studies have looked at the association with CRC. These prior studies have shown conflicting results and have been limited by small sample size. We sought to describe the prevalence of CRC in individuals with hypothyroidism (hypoT) and hyperthyroidism (hyperT) in the United States (US) between 2014 and 2019 utilizing a large population based database.

METHODS:
We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 2014 to 2019. We identified an aggregated patient cohort of eligible patients with “hypothyroidism”, “hyperthyroidism” and first-ever diagnosis of “Primary malignant neoplasm of cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum” aged ≥18 years, at least 1 day after a diagnosis of hypoT or hyperT between June 2014 and 2019, based on Systemized Nomenclature Of Medicine – Clinical Terms, individuals with family history of CRC were excluded from analysis. We calculated the prevalence of CRC in hypoT, hyperT and individuals without thyroid dysfunction.

RESULTS:
Of the 30,132,930 individuals active in the database from 2014-2019, we identified 2,377,510 and 317,490 individuals with hypoT and hyperT with overall prevalence rates of 7.8% and 1.1% respectively. The prevalence of CRC in hypoT, hyperT and individuals without thyroid dysfunction was 0.5%, 0.5% and 0.3% respectively (Figure 1). The risk of CRC was higher in hypoT [OR: 1.71, P < 0.0001] and hyperT [OR: 1.57, P < 0.0001] compared to individuals without thyroid dysfunction. Within hyperT, risk of CRC was higher in males at 0.67% [OR: 1.46, P < 0.0001] compared to females at 0.45% and elderly (aged >65 years) at 0.97 % [OR: 4.40, P < 0.0001] compared to adults (aged 18-65 years) at 0.22%. Within hypoT, risk of CRC was higher in males at 0.72% [OR: 1.46, P < 0.0001] compared to females at 0.49% and elderly at 0.88 % [OR: 3.89, P < 0.0001] compared to adults at 0.23%. There were no differences in prevalence of CRC between Caucasians and African-Americans in hypoT or hyperT (Figure 2).

CONCLUSION:
This is one of the first large studies to date that has described the epidemiology of CRC in hypoT and hyperT in the US in individuals aged ≥18 years. We found that the risk of CRC is increased overall in hypoT and hyperT and is particularly high in males and elderly.
356 Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE): A Novel Procedure for the Management of Gastroesophageal Reflux Disease in Altered Anatomy Patients
Authors: Sowa Piotr , Fortinsky Kyle , Chin Mathew , Samarasena Jason , Chang Kenneth J. 
Published: October 2019

INTRODUCTION:
Gastroesophageal reflux disease (GERD) is caused by reflux of gastric contents into the esophagus. For patients with esophageal or gastric surgery there are limited options for endoscopic or surgical therapy for GERD. There has recently been introduced an endoscopic suturing platform that allows for full thickness suturing. We created a technique called Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE) to anatomically correct the GEJ in patients where other surgical or endoscopic options may not be possible.

METHODS:
This is a single-center prospective observational study. The standardized procedure involved APC ablation below the GE junction to improve tissue apposition prior to suturing. Three sutures were placed along the lesser curvature of the cardia immediately below the EGJ. This creates a tightening and tissue bulge that acts as a barrier to reflux. The primary outcome evaluated was 30% improvement in reflux disease questionnaire (RDQ) and GERD Health Related Quality of Life Questionnaire. The secondary outcomes evaluated were reduction in PPI use, procedure tolerance and safety.

RESULTS:
10 patients with a mean age of 63 years with altered anatomy: Fundoplication (N = 5), Billroth II (N = 1), Roux-en-Y (N = 3), and Sleeve gastrectomy (N = 1) underwent MASE procedure. The RDQ and HRQL questionnaires were recorded for each patient before and after MASE. Mean follow-up time was 113 days. Primary outcome of 30% improvement in RDQ and GERD HRQL were achieved for all patients (Figure 1). There was a 90 % reduction in PPI use in the study group; 6 patients (66%) were able to discontinue PPI use, and 2 patients (22%) reduced their dose. The most common side effect was self-limited post-procedure epigastric pain (9%).

CONCLUSION:
The MASE procedure represents a novel endoscopic treatment option for management of GERD in patients with altered anatomy. Altered anatomy patients have limited treatment options once they fail standard PPI therapy. The MASE procedure can reduce GERD symptoms in this difficult to treat patient population and reduce reliance of daily anti-secretory medication use. Further studies need to be performed to determine longevity of this procedure.
361 WATS3D vs. Traditional Forceps Biopsy in Screening of Barrett’s Esophagus: A Community Hospital Experience
Authors: Srinivasan Sachin , Agha Yasmine Hussein , Hyder Jeffrey , Wuthnow Chelsea , Kilgore William , Tofteland Nathan , Salyers William 
Published: October 2019

INTRODUCTION:
Barrett’s esophagus (BE) is a pre-malignant condition of the esophagus currently diagnosed using systematic 4-quadrant cold forceps biopsies during endoscopy. Demonstration of intestinal metaplasia on histopathology and the degree of dysplasia is the cornerstone of BE diagnosis and management. This current method of biopsy is fraught with errors due to the randomness of sampling and experience of the operator. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique to collect esophageal samples and improve detection of BE. We compared WATS3D with traditional biopsy as a screening tool in BE.

METHODS:
We reviewed the charts of adult patients that underwent BE screening by 3 of our gastroenterologists involved in the study with WATS3D and traditional cold forceps biopsy (FB) over the last year across community hospitals in Wichita, KS. The biopsy specimens were processed and analyzed by in-house pathologists while the WATS3D specimen were sent to CDX technology labs, NY. WATS3D specimens were obtained after FB in all instances.

RESULTS:
A total of 108 patients were identified to have undergone both WATS3D and FB at the same time for BE screening. FB detected 62 cases (57.4%) while WATS3D detected 83 (76%) cases of BE. This attributed to an absolute increase in 21 cases (18.6%) of incident BE detection by WATS3D. The number needed to test (to detect an additional patient with BE) with WATS3D was 5. We divided the sample into 4 groups – WATS3D+FB+, WATS3D+FB-, WATS3D-FB+, WATS3D-FB- to compare the agreement across the 4 groups (Table 1). Overall agreement by kappa statistic was 0.74 (good). There were 62 and 23 cases that were identified as positive and negative respectively by both methods. The pathologist read both cases of FB+ that was WATS3D- as intestinal metaplasia with no dysplasia. Of the 21 cases that were FB-, WATS3D identified 15 cases of goblet cell metaplasia, 4 cases of crypt dysplasia, 1 case of low-grade dysplasia and 1 case of adenocarcinoma. There were no immediate complications reported among the patients studied.

CONCLUSION:
WATS3D identified 20 cases of BE missed by FB, including 1 case of low-grade dysplasia and 1 case of adenocarcinoma. It is possible that the cases missed by WATS3D were due to the presence of an island of BE that was removed during FB. Overall, with no added increase in complications, WATS3D improved incident detection of BE compared to FB alone.
481 Motility Abnormalities Identified by Wireless Motility Capsule in Postural Orthostatic Tachycardia Syndrome
Authors: Zikos Thomas A. , Zhou Wendy , Clarke John O. , Nguyen Linda A. , Neshatian Leila 
Published: October 2019

INTRODUCTION:
Gastrointestinal symptoms are common in patients with postural tachycardia syndrome (POTS). Previous studies have reported a wide range of abnormalities, particularly delayed gastric emptying in POTS. Wireless motility capsule (WMC) is a minimally invasive test that allows the evaluation of gastrointestinal physiology. We aimed to investigate the diagnostic yield of WMC in patients with POTS.

METHODS:
We conducted a retrospective review of all patients at our institution with both formal WMC testing (SmartpillTM) and autonomic testing for evaluation of gastrointestinal and neurological symptoms respectively. Patient demographics and results of respective testing were extracted. We compared transit abnormalities and contraction patterns between patients meeting diagnostic criteria for POTS and those without POTS. Transit abnormality percentages were compared using chi2 testing, and contraction pattern parameters were compared using 2-sample t-testing.

RESULTS:
A total of 27 women with both WMC and autonomic testing were studied. The mean age was 39.6 (range 18-68). Fourteen patients had POTS, while the other 13 had either mild or no autonomic abnormalities. Patients with POTS were more likely to have delayed small bowel transit (42.9% vs 7.69%, P = 0.037), but no differences were seen in gastric or colonic transit delays (Table 1). Additionally, POTS patients were more likely to exhibit a hypocontractile pattern throughout the gastrointestinal tract compared to non-POTS patients. Specifically, maximal gastric pressure, and small bowel peak amplitude and motility index were significantly lower in POTS patients. There was a trend towards lower colonic maximum pressure, contraction/min and peak amplitude in POTS patients that did not reach significance (Table 1).

CONCLUSION:
Our data shows that gastrointestinal motility abnormalities, as observed in WMC, are more common in patients with POTS. Patients with POTS were more likely to have delayed small bowel transit, as well as hypocontractile gastrointestinal patterns, particularly in the small bowel, compared to non-POTS patients. WMC offers a unique opportunity to evaluate patients with autonomic dysfunction and POTS. Further prospective evaluation and higher sample sizes are needed.
491 Wireless Motility Capsule Testing Results in New Diagnostic Information in 38% of Patients With Suspected GI Dysmotility: A 6-Year Review
Authors: Irshad Quratulain , Abu-Sbeih Hamzah , Stroehlein John , Shafi Mehnaz A. 
Published: October 2019

INTRODUCTION:
GI motility disturbances often present with upper and lower GI symptoms or a combination of both. Wireless Motility Capsule (WMC) is a standardized pH based test that can measure regional and whole gut actual transit times. Aims: 1. Determine the prevalence of transit time abnormalities in patients with GI dysmotility symptoms. 2. Correlate regional transit abnormality with clinical symptoms. 3. Assess change in patients' diagnosis based on WMC testing.

METHODS:
A prospective study of patients with suspected GI dysmotility who underwent WMC testing between 2012 and 2018. Patients were placed into three groups: 1) Upper GI symptoms: nausea, vomiting, bloating, and abdominal pain. 2) Lower GI symptoms: constipation and diarrhea. 3) Both upper and lower GI symptoms. Assessments of gastric emptying time (GET), small bowel transit time (SBTT), and colonic transit time (CTT) were recorded in each group and the diagnostic yield was evaluated.

RESULTS:
72 patients were evaluated with WMC. 59 patients had complete study data and were included in the analysis. Mean age was 46 ± 14 years. 62 (86 %) were female. 21 (29%) had a h/o cancer. 22 (31%) were diabetic. 43/59 (73%) patients had an abnormal WMC result (Table 1). In patients with upper GI symptoms (n = 31), 15 (48%) had delayed GET (Table 2). New diagnostic information was obtained in 14/31 (45%). Of the 13 patients with lower GI symptoms, only 3 (23%) had a prolonged CTT. No patients had isolated abnormality of GET or SBTT. New diagnostic information was obtained in 5/13 (38%). In the group with overlapping upper and lower GI symptoms, only 2 (13%) had multiregional dysmotility. 8/15 (53%) patients had normal transit studies. This resulted in 5 patients (33%) with new diagnostic information.

CONCLUSION:
GI symptoms are not an accurate predictor of disease localization. Only15 (48%) of the patients with upper GI symptoms had gastroparesis, and 3 (23%) of the patients with lower GI symptoms had slow transit constipation. WMC study resulted in new diagnostic information in 45% of patients with upper GI symptoms, 38% of patients with lower GI symptoms and 33 % of patients with pan GI symptoms, including the presence of isolated and whole gut dysmotility that was not suspected based on the patient's presentation. Therefore patients with suspected GI dysmotility should undergo tests of the entire GI tract, as reported symptoms are poor indicators of the affected gut region.
493 Epidemiology and Healthcare Resource Utilization Associated With Adults Hospitalized With Short Bowel Syndrome
Authors: Siddiqui Mohamed Tausif , Singh Amandeep , Bilal Mohammad , Kirby Donald F. 
Published: October 2019

INTRODUCTION:
Multiple intestinal surgeries or massive resection often lead to short bowel syndrome (SBS) which is associated with frequent hospitalizations and has high morbidly and resource utilization. But, data on these outcomes are lacking. We aimed to assess the trends of SBS-related hospitalizations, mortality and costs associated with these hospitalizations.

METHODS:
We used United States' Nationwide In-patient Sample (NIS) Database for 10 years beginning from 2005 to 2014. SBS does not have a unique International Classification of Diseases 9th Clinical Modification (ICD-9-CM) Code, therefore, we used a previously described methodology which identified SBS via combination of two diagnostic ICD-9 codes. Any hospital discharge with the presence of ICD9: “579.3: Other and unspecified postsurgical non-absorption” and ICD9: “99.15: Parenteral infusion of concentrated nutrition substances” was labeled in our study as an SBS case. We excluded the cases with missing information of in-hospital mortality (N = 40).

RESULTS:
A total of 53,040 hospitalizations associated with SBS were included in the final analysis. Our study population consisted of 65% females and 78% were Caucasians. Ages 51-56 and >65 were the most prevalent age groups (37% and 30%, respectively) and Medicare the major payer in the study populations (Table 1). Overall, SBS-related hospitalizations have increased from 4037 in 2005 to 6265 in 2014. But, all cause in-hospital mortality has decreased from 40/1000 hospitalizations in 2005 to 29/1000 hospitalizations in 2014. Most common concurrent diagnoses were protein-calorie malnutrition (N = 13063, 24.6%), hypertension (N = 11450, 21.5%), hypokalemia (N = 11334 21.3%), acute kidney injury (N = 10611, 20.01%) and dehydration (N = 9649, 18.1%). A total 15,761 (29.7%) patients received packed red cell transfusion. Mean length of stay for SBS-related hospitalization was 14.7 days and average hospital cost was US$ 31,921.

CONCLUSION:
Our results suggests that SBS-hospitalizations have increased by 54% in the last decade but in-hospital mortality associated with SBS has decreased by 27.5%. Further studies are required to assess the causes related to increased hospitalizations and improved mortality outcomes.