bluuebunny/crossref_metadata_2025_split huggingface dataset:
2875 The Prevalence of Irritable Bowel Syndrome in Patients With Obstructive Sleep Apnea: A Meta-Analysis and Systematic Review
Authors: Al Momani Laith , Alomari Mohammad , Patel Ankit , El Kurdi Bara , Aasen Tyler , Young Mark 
Published: October 2019

INTRODUCTION:
Irritable bowel syndrome (IBS) is a common disease that affects between 10-15% of the population globally. A growing body of research is attempting to further understand the underlying pathophysiology of IBS and its association with other extra-intestinal manifestations with reports suggestive of sleep disturbances and obstructive sleep apnea (OSA) being implicated. This study aims to explore the available literature for the prevalence of IBS in OSA patients.

METHODS:
A systematic review was conducted in PudMed, MEDLINE, EMBASE, and Cochrane databases from inception through June 2019 to identify the studies that explored the prevalence of IBS in OSA patients. We included studies that presented event rates with a 95% confidence interval (CI) or presented the data sufficient to calculate the event rate with a 95% CI. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird and a pooled prevalence was calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques.

RESULTS:
Four studies with a total of 792 patients with OSA were included in this study. The mean age was 52.94 years and 557 (73.09%) patients were men. The pooled event rate of IBS in OSA patients was 23.90% (95% CI: 20.8%-27.3%) (Figure 1). The pooled event rates of IBS in male and female patients with OSA were 26.4% (95% CI: 22.5%-30.8%) and 19.8% (95% CI: 14.6% - 26.2%) respectively (Figures 2 and 3).

CONCLUSION:
These results suggest a higher prevalence of IBS in OSA patients compared to the general population. Further research might be needed to evaluate the prevalence of OSA in IBS patients and whether the treatment of OSA would affect the IBS disease course in these patients. Furthermore, health care providers should also screen patients with OSA for gastrointestinal symptoms.
2917 Rates of Hospitalization Related to Fractures Are Decreasing in Patients With Primary Biliary Cholangitis: Insights From the Nationwide Inpatient Sample
Authors: Shah Ishani , Bhurwal Abhishek , Mehta Harsh , Uppal Surabhi , Reddymasu Savio 
Published: October 2019

INTRODUCTION:
Primary Biliary Cholangitis (PBC) is associated with reduced bone density (20-50%) and increased predisposition of developing fractures. Clinical practice guidelines advocate for measures such as calcium and vitamin D supplementation and use of bisphosphonates to prevent development of fractures in this patient population. The purpose of this study was to trend rates of hospitalizations related to fractures in PBC. We also examined fracture-associated morbidity and mortality among patients with PBC.

METHODS:
All adults hospitalized with PBC during the years 2010 to 2014, were identified using the Nationwide Inpatient Sample (NIS). Within this group, temporal analysis of PBC patients with a co-diagnosis of hip, vertebral or wrist fractures (study group) was performed with regards to total number of inpatient admissions, inpatient mortality, length of stay, and total charges associated with hospitalization.

RESULTS:
During the five-year study period, there were 308,753 hospitalizations for PBC. Trends for fracture-related hospitalizations over this period are shown in Figure 1. There has been a significant (P = 0.002) reduction in fracture related admissions in patients with PBC during this study period. Compared with PBC-controls, PBC-fracture patients were older (mean age 73.62 years vs 65.24 years; P < 0.001), more likely to be female (51.92% vs 47.62%; P = 0.24), predominantly White (83.72% vs 69.62%; P = 0.003) and had a higher prevalence of osteoporosis (15.73% vs 4.09%; P < 0.001). Length of stay (10.85 days vs 7.36 days; P < 0.001) was higher in the PBC-fracture group compared to PBC-control group; however, no significant variations in mortality were identified between the two groups (6.6% vs 4.82%; P = 0.26). Total hospitalization charges among the PBC-fracture patients were higher than the control group ($98,444 vs $72,964; P = 0.004) (Table 1).

CONCLUSION:
There has been a steady decline in rate of fracture related hospitalizations in patients with PBC. However, patients with PBC who have fractures have adverse utilization of health care resources compared to their cohort admitted for reasons other than for fracture. Increased adoption of guidelines with regards to bone health in patients with PBC hopefully will lead to continued reduction in rate of fracture related hospitalizations in PBC.
2927 A Prospective Longitudinal Study of Acetaminophen/NSAIDs Effect on Inflammatory Bowel Disease Flares and Activity
Authors: Xu Anthony , Mallepally Niharika , Shapiro Jordan , Hou Jason 
Published: October 2019

INTRODUCTION:
It is well established that non-steroidal anti-inflammatory drug (NSAID) users are more likely to have intestinal inflammation/damage. There have been several conflicting studies about the effect of acetaminophen and NSAIDs on inflammatory bowel disease (IBD). We hypothesized that acetaminophen/NSAID use is associated with increased IBD flares and activity. This study was aimed to assess the effect of acetaminophen/NSAIDs on IBD flares and activity.

METHODS:
We conducted a prospective longitudinal study of Veterans from the IBD clinic at the Michael E. DeBakey VA Medical Center from 2014 to 2018. Our eligibility criteria included patients who were at least 18 years of age, who were diagnosed with Crohn's Disease (CD) or Ulcerative Colitis (UC), and who had at least 1 clinic visit. IBD flare was defined by patient self-report of IBD flare between clinical encounters. IBD activity was quantified using the partial Mayo Score (pMayo) for UC, and the Harvey Bradshaw Index (HBI) for CD. Remission was defined by pMayo <2 for UC and HBI <5 for CD. Acetaminophen/NSAID exposure was assessed via surveys during clinical encounters. Associations of Acetaminophen/NSAID use with IBD flare and activity were assessed using T-tests and Chi-squared tests.

RESULTS:
A total of 132 patients were included in the analysis of which 74 had CD and 58 had UC. 43 patients were acetaminophen users, 43 patients were NSAID users, and IBD flares occurred in 60 patients. No significant associations between Acetaminophen/NSAID usage and IBD flares were observed: Acetaminophen/NSAID users who developed a flare was 41.9% and 55.8% respectively while 54.5% non-users developed a flare. UC patients using acetaminophen/NSAIDs were associated with significant increases in pMayo compared with UC patients not using acetaminophen/NSAIDs (acetaminophen: 1.71- >2.91, P-value = 0.003; NSAIDs: 1.81- >2.60, P-value = 0.034). In patients with UC, acetaminophen use was associated with non-remission status (RR 1.96; 95% CI 1.29-2.97).

CONCLUSION:
Amongst UC patients, acetaminophen/NSAID usage was not associated with interval flare however was associated with increased disease activity and non-remission status. In CD patients, no significant associations between Acetaminophen/NSAID use with flare or activity were observed. Counseling patients on decreasing acetaminophen/NSAID usage may decrease disease severity in patients with UC.
2938 Finding the Needle in the Haystack: A Retrospective Review on the Diagnostic Accuracy of EUS-FNA Needles for Pancreatic Cancer
Authors: Renelus Benjamin D. , Jamorabo Daniel S. , Gurm Hashroop , Bhesania Siddharth , Arya Mukul 
Published: October 2019

INTRODUCTION:
Pancreatic cancer is an aggressive malignancy with a dismal five year survival <7%. Early diagnosis and resection can increase this to 15%-25%. Extensive investigation has yet to identify clear diagnostic superiority among needle sizes for EUS-guided FNA. As a result, this topic remains an area of debate heavily based upon institutional practice. The aim of this study is to compare the diagnostic utility of 22G and 25G needles for confirming the presence of pancreatic cancer.

METHODS:
We performed a retrospective review of index pancreatic cancer cases dating from 2010-2017 at our university-affiliated institution. We used Chi-squared testing to compare the diagnostic yield of 22G and 25G needles for EUS-FNA pancreatic tissue sampling.

RESULTS:
We identified 81 pathology confirmed pancreatic cancer cases which underwent EUS-FNA for initial sampling. EUS-FNA with 22G needle provided significantly higher diagnostic yield than did 25G needles (93% vs 50%; P = 0.006). There were no complications or adverse events including blood loss, for both groups.

CONCLUSION:
EUS-FNA with 22G needles provided superior diagnostic yield for pancreatic cancer when compared to 25G needles. This is likely due to the endoscopist familiarity with the needle or former's ability to obtain more tissue for analysis given its wider diameter. Interestingly, there were no differences in adverse events between the two needle sizes. Twenty-two gauge needles may be more helpful in pancreatic cancer diagnosis via EUS-FNA.
2940 Favorable Rates of Post-ERCP Pancreatitis With Endoscopic Sphincterotomy With Delayed Sphincteroplasty Approach
Authors: Malik Fahad , Kim Marina , Mukul Arya , Muhammad Wafa 
Published: October 2019

INTRODUCTION:
There are multiple modalities for the management of large bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP). Large bile duct stones, defined as size greater than 15 mm, are a subset of multiple clinical situations associated with difficult bile duct stone extraction. The successful extraction of common bile duct stones typically requires either a sphincterotomy or papillary balloon dilation. Multiple prior studies have shown that endoscopic papillary balloon dilation (EPBD) has less success in stone clearance with more frequent requirement for lithotripsy in addition to carrying a higher risk of post-ERCP pancreatitis. We report the technique of delayed sphincteroplasty to be effective and safe in the management of large bile duct stones.

METHODS:
A retrospective analysis from 2012 to 2018 was obtained from our endoscopy software of all patients who underwent a two-step ERCP with balloon dilation and analyzed in terms of patient demographics, stone size, success of stone extraction, number or procedures required for duct clearance and procedure-related complications. Patients with bile duct strictures, periampullary malignancy or coagulopathy were excluded.

RESULTS:
Seventy five patients had ERCP performed with balloon sphincterotomy at least 30 days after initial ERCP. Twenty seven of them were men. Age ranged from 26 to 101 with an average age of 73. 37.3% of the patients were Caucasian, 33.3% African American, 6.6% Asian, 5.3% Hispanic and 17.3% unknown. The average common bile duct size on imaging prior to ERCP was 14.2 mm. The initial ERCP was performed within an average of 4 days of admission. Total bilirubin was 3.9 on average. Most common indication was proven bile duct stone on imaging, 60.8%. 84% of patients had a plastic stent placed during initial ERCP. 13% had more than 5 stones. Balloon was dilated to an average of 14.6 mm. 97% (73/75) had no immediate complications post procedure. Three patients needed additional lithotripsy.

CONCLUSION:
We present our center's experience with the management of large bile duct stones with the technique using endoscopic sphincterotomy with stent placement for initial drainage and a delayed sphincteroplasty reported decreased rates of post-ERCP pancreatitis and encouraging success rates for stone extraction.
2941 Endoscopic Ultrasound-Guided Gastroenterostomy for the Management of Gastric Outlet Obstruction: A Systematic Review and Meta-Analysis
Authors: Iqbal Umair , Khara Harshit S. , Hu Yirui , Kumar Vikas , Tufail Kashif , Confer Bradley , Diehl David L. 
Published: October 2019

INTRODUCTION:
Gastric outlet syndrome (GOO) is characterized by epigastric pain and postprandial vomiting secondary to mechanical obstruction. Management of GOO is usually focused on alleviating the symptoms of obstruction and can be achieved by surgical gastrojejunostomy or enteral stenting. Recent studies have shown success with endoscopic ultrasound guided gastroenterostomy (EUS-GE) in the management of GOO but data is limited. We therefore conducted a meta-analysis to evaluate the safety and efficacy of EUS-GE in the management of GOO.

METHODS:
A comprehensive literature review was conducted by searching the several databases from inception to January 2019 to identify all studies that evaluate the efficacy and safety of EUS-GE in GOO. Our primary outcome was to evaluate technical success and clinical success. Technical success was defined as successful EUS guided deployment luminal apposing stent (LAMS). Clinical success was defined as ability to tolerate oral intake after the procedure. Secondary outcomes were to evaluate need for reintervention and adverse events of the procedure.

RESULTS:
Twelve studies including 285 patients were included in the meta-analysis. Among 12 included studies 3 were case series, 1 prospective and 8 retrospective cohort studies. 7 of the included studies were good quality studies while 5 were of fair quality. EUS-GE was performed in 202 patients with GOO secondary to malignancy while 83 patients had benign etiologies of GOO. Technical success was achieved in 266 patients out 308 patients who underwent EUS-GE with a pooled technical success of 92% [95% CI: 88%-95%]. Clinical success was achieved in 249 patients with a pooled clinical success rate of 90% [95% CI: 85%-94%]. Adverse events occurred in 28 patients with a pooled incidence of 12% [95% CI: 9%-17%]. Recurrence of GOO symptoms and need for unplanned re-intervention was needed in 16 patients with a pooled incidence of 9% [95% CI: 6%-13%]. There was no statistical heterogeneity existed among the included studies (I2 = 0%, P > 0.05). Egger's test indicated no publication bias as the symmetry existed in the funnel plot (P > 0.05).

CONCLUSION:
EUS-GE is safe and efficacious treatment modality for the management of benign and malignant GOO. EUS-GE is also comparable to enteral stenting and may be associated with fewer adverse effects and need for re-intervention compared to enteral stenting. Larger prospective trials are needed to compare the efficacy of EUS-GE with endoscopic duodenal stenting and SGJ in GOO.
2947 Systematic Review and Meta-Analysis of the Association Between H. pylori and Non-Alcoholic Fatty Liver Disease
Authors: Kamal Faisal , Khan Muhammad Ali , Shrestha Shreesh , Tariq Raseen , Reddy Yala , Marella Hemnishil K. , Howden Colin W. 
Published: October 2019

INTRODUCTION:
Metabolic syndrome is a risk factor for non-alcoholic fatty liver disease (NAFLD). H. pylori infection has been reported to be associated with the development of metabolic syndrome. Studies evaluating a possible association between H. pylori and NAFLD have reported conflicting results. We conducted a systematic review and meta-analysis to evaluate the possible association between H. pylori and NAFLD.

METHODS:
We searched several databases including Pubmed, Scopus and Web of Science from inception to November 1, 2018 to identify studies evaluating any association between H. pylori and NAFLD. We also searched for abstracts evaluating this association from major conferences including AASLD, DDW and EASL in the past 5 years. Studies reporting odds ratios (ORs) or hazard ratios (HRs) were included. ORs and HRs were pooled using a random effects model; summary data are reported as pooled OR with 95% confidence interval (CI). Heterogeneity was assessed by I2 statistic. To examine for any directionality, studies evaluating the risk of developing NAFLD in H. pylori-infected subjects and studies evaluating the risk of H. pyloriinfection in subjects with NAFLD were also analyzed separately. Sensitivity analysis was done to explore reasons for any heterogeneity.

RESULTS:
15 studies (13 publications and 2 abstracts) were included. Meta-analysis of all studies showed a weak positive association but with substantial heterogeneity (OR 1.21; 95% CI 1.11 to 1.32; I2 = 68%) (Figure 1). Sensitivity analysis excluding two studies reporting extreme effect estimate also showed a weak positive association (OR 1.17; 95% 1.10 to 1.24) although heterogeneity was lower (I2 = 43%). Considering the possible directionality of any association (Figure 2), analysis of studies evaluating the risk of NAFLD in H. pylori-infected subjects showed a weak positive association (OR 1.18; 95% CI 1.09 to 1.26; I2 = 49%). Analysis of studies evaluating the risk of H. pylori in subjects with NAFLD showed a similarly weak positive association (OR 1.39; 95% CI 1.04 to 1.86; I2 = 81%).

CONCLUSION:

H. pylori infection and NAFLD are weakly associated bi-directionally. This is likely to be due to confounding and may be influenced by sociodemographic and ethnic differences among populations in the different studies and/or by shared environmental risk factors.
2952 Liver Transplant in Patients With Budd-Chiari Syndrome: A National Study
Authors: Ghavimi Shima , Hashemipour Reza , Panchal Dayna , Nasir Umair M. , Javidialsaadi Atefeh , Pyrsopoulos Nikolaos T. 
Published: October 2019

INTRODUCTION:
Budd-Chiari syndrome (BCS) involves obstruction of hepatic venous outflow tracts at various levels from small hepatic veins to the inferior vena cava and is the result of thrombosis or its fibrous sequelae. The clinical presentation and clinical manifestations are so varied that it should be suspected in any patient with acute or chronic liver dysfunction. Liver transplantation (LT) may be indicated as a rescue treatment or for fulminant cases with promising results. Living donor liver transplantation (LDLT) can also be used for patients with BCS if deceased donor livers are scarce. The Aim of this study is to assess the mortality rate and review the safety of liver transplant in patients with Budd-Chiari Syndrome.

METHODS:
The National Inpatient Sample (NIS) is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected and reviewed data records of new liver transplant patients from the NIS database from the year 2009 to 2014. IBM Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis.

RESULTS:
A total of 5,592 patients were discharged between 2009-2014 with a new liver transplant. Of these patients, there were 37 patients (0.66%) with BCS. The overall mortality rate for a new liver transplant was substantially higher for BCS patients (10.8%) when compared to non-BCS patients (4.0%) with an odds ratio (OR) of 2.92 (CI 1.03-8.32). However, liver transplant complications were not significantly higher in BCS patients (27.0%) when compared with non-BCS patients (15.3%) with OR of 2.06 (CI 0.99-4.26). The mean length of stay was higher in BCS patients at 32 days as compared to non-BCS patients at 20 days (P = 0.001). Results of the statistical analysis are presented in Tables 1 and 2.

CONCLUSION:
LT can be indicated as a rescue treatment or for fulminant cases with promising results. LDLT can also be used for patients with BCS, but it involves a difficult procedure particularly regarding venous outflow reconstruction. Our research indicates that liver transplant is riskier in patients with BCS and we encourage more research to be done regarding BCS patients regarding liver transplantation. Limitations of the study are that the NIS is an administrative database which predisposes to errors from coding inaccuracies as well as the inability to distinguish temporal relationships between variables. Future prospective studies can expand on these conclusions.
2971 Correlation Between Markers of Hepatic Inflammation and Novel Magnetic Resonance Elastography Measurements
Authors: Zhou Kali , Ohliger Michael 
Published: October 2019

INTRODUCTION:
Non-invasive tools to stage liver fibrosis exist, but a method to evaluate necroinflammation is lacking. A component of MR elastography (MRE) stiffness measurements, termed loss modulus, has shown potential in estimating hepatic inflammation in animal models. We aimed to correlate histologic and laboratory markers of inflammation with this novel MRE marker in patients with chronic liver disease undergoing liver biopsy.

METHODS:
In this prospective, cross-sectional, pilot study, adults over 18 years with a liver biopsy performed for clinical indications were recruited to participate. Those with contraindications to MRI, decompensated cirrhosis or liver cancer were excluded. All participants underwent a 30-minute MRE using a 3T-MRI scanner. MRE measurements (stiffness, storage and loss modulus) were obtained at 30-Hz and 60-Hz. Results were interpreted by a single radiologist following established protocols and blinded to histologic data. Correlation between serum alanine aminotransferase (ALT) and MRE measurements was determined.

RESULTS:
Eleven participants completed the MRE scan: 64% were male with a median age of 53 years (IQR 32-61). Indication for liver biopsy was fibrosis staging in 4 (36%), elevated liver enzymes in 3 (27%) and evaluation for non-alcoholic steatohepatitis in 4 (36%). The median time from liver biopsy to MRE was 93 days (34-139). Median ALT was 42 U/L (26-85). Adequate MRE results were obtained on 9 of 11 participants. Four (44%), 2 (22%) and 3 (33%) had F0, F0-1, and F1 fibrosis on histology, respectively. Two (22%) had grade 0-1 inflammation and 7 (88%) had grade 1 inflammation. At 60-Hz, median stiffness was 1.85 kPa (1.66-2.30) and loss modulus was 0.23 (0.19-0.28). At 30-Hz, median stiffness was 1.21 kPa (1.03-1.24) and loss modulus was 0.11 (0.06-0.14). Measurements by fibrosis stage and inflammation grade are presented in the Table. There was very weak correlation between ALT and stiffness at both 60-Hz and 30-Hz (r = 0.05 and 0.16, respectively) (see Figure 1). Correlation was moderate between ALT and loss modulus at 60-Hz (r = 0.39) and strong between ALT and loss modulus at 30-Hz (r = 0.62).

CONCLUSION:
In this small cohort of patients with minimal liver fibrosis and mild inflammation on histology, ALT correlated better with MRE measurements of loss modulus compared to stiffness, particularly at 30-Hz, suggesting that loss modulus may approximate hepatic inflammation. Larger studies are needed to validate and optimize the diagnostic performance of this novel tool.