bluuebunny/crossref_metadata_2025_split huggingface dataset:
1154 Discordance Between Self-Reported COI and CMS Open Payment Database Among Gastroenterology Guideline Authors
Authors: Shah Raj , Numan Laith , Chandar Apoorva K. , Maruggi Chiara , Alabdulwahhab Motib , Chauhan Mahak , Davitkov Perica , Falck-Ytter Yngve 
Published: October 2019

INTRODUCTION:
The 2011 IOM Standards of developing trustworthy guidelines emphasizes transparency and mitigating conflict of interest. This study aims to assess the transparency of reported conflict of interest in gastroenterology guidelines using the “Sunshine” CMS Open Payment Database for comparison.

METHODS:
Guidelines using GRADE methodology and guideline authors from American Association for the Study of Liver Disease, American College of Gastroenterology, American Gastroenterology Association, and American Society of Gastrointestinal Endoscopy societies from 2013 to October 15, 2018, were abstracted. We reviewed conflict of interest disclosure statements for each author on all guidelines, even if they had no conflict of interest. We analyzed the Sunshine data for each author for the year the guideline was published and the year prior.

RESULTS:
In guideline documents, 222/823 (26.6%) authors self-reported conflict of interest. Out of 823 authors, 510 (61.9%) of them were reviewed on the Sunshine database, and the remaining authors were not found on the database. 172 of the 510 (33.7%) self-reported at least one conflict of interest. However, 338 (66.2%) did not disclose any conflict of interest. Out of the 338, 325 (96.1%) and 220 (65%) authors did receive general payments in the same year the guideline was published and the year prior, respectively. Out of those who received payments, 213 (65.5%) and 147 (66.8 %) had general payment amounts above $500 in the same year the guideline was published and the year prior, respectively.

CONCLUSION:
There is a discordance between guideline self-disclosures and the sunshine database. Two-thirds of all guideline authors with CMS reported payments on the sunshine database do not seem to report conflict of interest on the guideline they published during the same time period. We encourage authors to frequently check this publically accessible database to ensure accuracy in its reporting. Additionally, authors and guideline societies should strive to increase conflict of interest reporting to allow for an even further transparent guideline development process.
1160 Female Authors Contributed to Less Than 20 Percent of the 100 Most Cited Articles in Gastroenterology and Hepatology - Will This Change?
Authors: Zafar Yousaf , Nasir Samar , Elkafrawy Ahmed A. , Saeed Lyla , Ullah Waqas 
Published: October 2019

INTRODUCTION:
The number of citations that an article has received can reflect its importance in a specialty. The purpose of this study was to analyze the characteristics of top-cited articles published in Gastroenterology and Hepatology Journals in the citation database-Scopus. The number of citations an article receives after its publication reflects its impact in the scientific community. The aim of this study was to identify and characterize the 100 top-cited articles published in gastroenterology journals over the past five decades.

METHODS:
The top-cited original research articles published in gastroenterology journals were identified using the database of Scopus 1970-2019. The 100 top-cited articles were selected and analyzed with regard to the number of citations, year of publication, publishing journal, authorship, Sex of the authors, country of origin, type of article, gastroenterology sub-specialty. Meta-analysis and Review articles were excluded.

RESULTS:
The 100 top-cited articles were published in eight gastroenterology journals, led by Gastroenterology (n = 48) and followed by the Hepatology (n = 27). These articles were published between 1970 and 2019 with a mean of 1324.31 citations per article (range, 879–4301). Forty-Eight articles were published between 2001-2010 alone. Of the total 45% originated from the United States followed by France with 10%. The most common sub-specialties of study were Hepatology (n = 52) and Colon (n = 31). 87% of first authors were male and 90% of last authors were male. 60% of all articles were clinical research.

CONCLUSION:
Our study presents the characteristic of the 100 top-cited articles published in gastroenterology journals. Close to half of the original articles were contributed from the USA. Women in gastroenterology contributed to less than 20% to the most cited as top authors.
1163 Physician Wellness Among Gastroenterologists: A Comparison of Gastroenterologists and Primary Care Providers
Authors: Nachnani Eesha , Nachnani Jagdish 
Published: October 2019

INTRODUCTION:
The Centers for Disease Control (CDC) makes multiple recommendations regarding nutrition, exercise and sleep which are in turn transmitted by doctors to patients. It recommends that adults should eat at least 1.5 to 2 cups of fruits and 2 to 3 cups of vegetables per day. In addition, it also recommends that adults should do at least 150 minutes of moderate aerobic physical activity or at least 75 minutes of vigorous aerobic activity throughout the week. There are also recommendations regarding adequate sleep, sodium intake and carbonated beverages.

METHODS:
A survey was conducted among gastroenterologists and primary care providers regarding their nutrition, sleep and exercise with physicians being asked to rank questions on a scale of 1 to 5 with one being not at all and 5 being all the time. For statistics, comparison was made with answers 3 or below with 4 and 5.

RESULTS:
Only 33% of the gastroenterologists were eating at least 1.5 to 2 cups of fruit and 2 to 3 cups of vegetables per day as compared to 75% of the primary care providers. Regarding exercise 100% of the gastroenterologists were doing the recommended guidelines of CDC of exercise as compared to 50% of the providers. 33% of the gastroenterologist were sleeping more than 7 hours a day on a regular basis as compared to 50% of the primary care providers. None of the gastroenterologists were consuming carbonated or sweetened beverages and only 33% of the gastroenterologists were meeting the CDC guidelines of consuming less than 2300 milligrams of sodium per day as compared to 50% of the primary care providers.

CONCLUSION:
Gastroenterologists were very cognizant and despite their busy lifestyles do take out time for exercise. In addition, gastroenterologists tend not to consume carbonated or sweetened beverages. However, they did not stick to the recommended guidelines regarding fruit and vegetable intake as well as the recommended hours for sleep per day as compared to primary care providers.
1170 The Socioeconomic Impact on Presentation and Clinical Course of Celiac Disease
Authors: Cao Christopher , Block Peter , Russell Madeline , Parikh Devayu , Robbins Justin , Kumar Priyanka , David Allison , DiMarino Anthony J. , Moleski Stephanie 
Published: October 2019

INTRODUCTION:
Treatment for Celiac Disease (CD) involves lifelong elimination of dietary gluten1. Compliance to a gluten-free diet (GFD) relies on purchasing gluten-free foods, which are commonly more expensive than their gluten-containing counterparts2. This study aimed to determine whether household income affects patients’ adherence to GFD and mucosal healing.

METHODS:
This is a single center retrospective chart review at an urban tertiary hospital. Any adult patient diagnosed with CD was included, with the exception of those without clear documentation of initial presentation. Outcomes included demographic information, socioeconomic data, GFD adherence, and pathologic and laboratory findings of CD. Using patient zip code, cohorts were stratified by US Census Bureau household income percentiles: low income (LI) (1st-50th percentile of US income), medium income (MI) (50th-70th percentile of US income) and high income (HI) (70th-99th percentile of US income).

RESULTS:
193 patients diagnosed between 1999 – 2017 were included and categorized into LI (n = 49), MI (n = 95) and HI (n = 49). LI presented at an older age (39.8 yr in LI; 39.5 yr in MI; 38.4 yr in HI) with a higher proportion of patients with Marsh 3A or greater classification (68.8% in LI; 68.0% in MI; 57.7% in HI). Non-adherence to GFD was noted to be highest in LI (16.3% in LI; 4.7% in MI, 0.0% in HI). Subsequently, LI was found prolonged mucosal healing (79.2 mo. in LI; 44.3 mo. in MI; 33.5 mo. in HI). HI had the lowest percentage of patients with Marsh 3A or greater classification on repeat encounters (25.7% in LI; 36.6% in MI; 14.3% in HI). Normalization of TTG IgA (69.2% in LI; 72.0% in MI; 84.6% in HI) and gliadin IgA (20.0% in LI; 75.0% in MI; 85.7% in HI) occurred more frequently in HI.

CONCLUSION:
Discussion: GFD remains a staple in the management of CD. Our study sought to evaluate the impact of socioeconomic status on GFD adherence, severity of CD, and mucosal healing. The LI group was noted to be less adherent with GFD, have more severe disease presentation, have longer time to mucosal healing, and have less normalization of TTG IgA and gliadin IgA. Future studies may focus on further determining the causation between socioeconomic status, GFD adherence and CD outcomes.
1183 Surgery Type Predicts Post-Operative Jejunal Polyp Detection in Patients With Familial Adenomatous Polyposis After Surgical Duodenectomy
Authors: Yoon Ji Yoon , Mehta Neal , Burke Carol A. , Augustin Toms , O'Malley Margaret , LaGuardia Lisa , Cruise Michael , Mankaney Gautam , Church James M. , Bhatt Amit , Kalady Matthew F. , Walsh R. Matthew 
Published: October 2019

INTRODUCTION:
In patients with familial adenomatous polyposis (FAP), advanced duodenal polyposis by Spigelman stage requires consideration of duodenal resection to prevent duodenal cancer. Pancreas-sparing duodenectomy (PSD) is preferred over pancreaticoduodenectmy (PD). Jejunal polyps occur 41 to 78% in post-duodenectomy patients, however, the differences by surgery type have not been evaluated.

METHODS:
We identified consecutive FAP patients following duodenal resection, including PD, PSD, or segmental duodenectomy (SD), at Cleveland Clinic, 08/1978 - 01/2018. Jejunal polyp-free survival (JPFS) time was calculated as time from surgery to detection of first lesion, or if no polyps, time to most recent endoscopy. Severity of jejunal polyposis was classified using the Spigelman score (henceforth, Neo-Spigelman). Kaplan-Meier curves were used to estimate JPFS by surgery type. Cox proportional hazards models adjusted for age, sex, race, and presence of pre-operative jejunal polyps were used.

RESULTS:
64 patients were identified (Table 1). Jejunal polyposis was detected after surgery in 38/64 patients (59.4%, Table 2). Surgery type (PSD vs PD vs SD) was a significant predictor of JPFS overall (Figure 1, P = 0.008). 5-year JPFS was 49.5% (CI 32.3–64.7%) for patients after PSD, 80.7% (CI 51.1–93.4%) after PD, and 66.7% (CI 19.5–90.4%) after SD. Comparison of PSD vs PD yielded a significant difference in JPFS (P = 0.006), as did comparison of PSD vs SD (P = 0.048). PD vs SD was not significant (P = 0.12). In comparison PD, adjusted analyses showed hazard ratio (HR) of polyp detection at 4.0 (CI 1.6 – 10.0) for PSD. HR estimate was not significant for SD (HR 2.6, CI 0.6 – 11.1). Surgery type had a significant association with Neo-Spigelman score (P < 0.037), with mean score at 4.5 ± 0.5 for PD, 5.5 ± 1.4 for PSD, and 6.3 ± 0.6 for SD. No association was found between surgery type and management of jejunal polyps (surveillance vs endoscopic resection vs surgery, P = 0.09).

CONCLUSION:
Jejunal polyposis occurs in the majority of FAP patients after surgical duodenectomy. We demonstrate differences in polyp-free survival by surgery type, with PSD demonstrating higher risk of jejunal polyposis in comparison to PD. Surgery type was also associated with severity of polyposis, with a tendency for higher Neo-Spigelman scores after PSD. The long-term outcomes of jejunal polyps in FAP patients requires further study, and the surgical determinants of their occurrence may merit consideration.
1187 Recurrence of Sporadic Non-Ampullary Duodenal Adenomas: A Single Center Retrospective Case Review
Authors: Phillips Brian , Lo David , Elliott John 
Published: October 2019

INTRODUCTION:
Duodenal adenomas, while uncommon, are known precursors of malignancy. Prevalence of sporadic duodenal adenomas in those undergoing endoscopy ranges from 0.3-4.6%. Newer studies, with small sample sizes, have shown success in endoscopic removal of duodenal polyps of varying sizes. There is limited data on the most appropriate resection method and surveillance period. The purpose of this study is to evaluate recurrence rate at a single center to better guide surveillance timeframes.

METHODS:
In this IRB-approved retrospective study, patients studied had biopsy confirmed sporadic duodenal adenomas found during 1/06-12/16, at Riverside Methodist Hospital. Provation was searched for “polyps” on upper GI endoscopy reports. Inclusion criteria: biopsy confirmed non-ampullary adenoma, age >21. Exclusion criteria: personal/family history of polyposis syndromes, life expectancy <10 years, ampullary adenomas, surgical resection.

RESULTS:
313 patients with “polyps,” 89 had non-ampullary duodenal adenomas. 26 patients were excluded, leaving 63 in our analysis. Average age 68 (+/-12 years), 57% female, 51% with smoking history. 52 patients had follow up; 13 of these 52 patients (25%) had recurrence. Average time to first recurrence was 636 days (95% CI: 352-920 days). 60: of adenomas were located in the 2nd part of the duodenum; 19% in the 1st and 3rd part each. Histology: 71% tubular, 21% tubulovillous, 5% villous, remainder with dysplasia. Average tubular adenoma size with recurrence was 12.1 mm (95% CI: 5.6-18.6), average tubular adenoma size without recurrence was 7.1 mm (95% CI: 4.7-9.4, P = 0.057). Data on recurrence of more advanced adenomas was limited due to sample size (P = 0.215). Majority of adenomas (37/63) were removed by cold forceps; 3/63 with piecemeal resection, remainder by single piece polypectomies. Resection technique did not have any significant impact on recurrence rate (P = 0.597). Only 3 patients had complications (2 minor bleeding; 1 embolization of gastroduodenal a.).

CONCLUSION:
While uncommon, duodenal adenomas warrant close follow up due to their malignant risk. For all polyp sizes, average time to first recurrence was close to 2 years. Sub-centimeter tubular adenomas tended not to recur, while larger initial size of tubular adenomas trended towards a higher likelihood of recurrence, thus for polyp size >10 mm we recommend repeat EGD in 1-2 years. Prospective studies are needed to help determine a standardized follow-up period and resection method.
1188 The Effects of Probiotics on Parenteral Nutrition-Related Complications: A Prescriber’s Dilemma
Authors: Alomari Mohammad , Al Momani Laith , Sarmini Muhammad Talal , Khazaaleh Shrouq , Almomani Shaden , Aasen Tyler , Young Mark 
Published: October 2019

INTRODUCTION:
Parenteral nutrition (PN) is a life-saving modality that carries risks for potentially life-threatening complications. The gut microbiome, which is often impaired in patients receiving PN, plays an integral role in intestinal wall integrity and immune function. Hence, restoration of a healthy microbiome may theoretically protect against various infections. Therefore, we aimed in our study to investigate the effect of probiotics on parenteral nutrition-related infectious complications.

METHODS:
We identified a cohort of patients with intestinal failure who received PN for >2 weeks at our center for human nutrition between January 2005 and August 2016. We excluded patients < 18 years of age, patients who used probiotics for < 30 days, and those who had long-term antibiotic use ( >30 days). Seventy-eight patient received probiotics, among them, 48% used it for small intestinal bacterial overgrowth (SIBO) treatment, 42% for SIBO prophylaxis in high-risk patients (history of recurrent SIBO, resection of the ileocecal valve, and surgically created blind loops), and 10% of the patients used non-prescription over-the-counter probiotics. Patients characteristics and other variables were determined by manual chart review.

RESULTS:
A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining received intravenous fluids (IVF). A total of 78 (27.7%) patients used probiotics. (Table 1) One hundred and six (37.6%) patients were diagnosed with SIBO, 31(11%) patients had at least one episode of catheter-related infection, and 88(31.2%) patients had at least one documented episode of sepsis. The prevalence of SIBO in patients who used prophylactic probiotic was 22 % vs. 30 % in patients who did not use probiotics, P = 0.5. Compared to non-users, the prevalence of sepsis and catheter-related infection among probiotics users were (26.9% vs. 32.8%; P = 0.33 and 7.7% vs. 12.3%; P = 0.27, respectively) (Figure 1)

CONCLUSION:
Although there was a non-significant trend toward less SIBO, sepsis and catheter-related infections among patients using probiotics, our findings don’t support the routine use of probiotics to prevent or treat PN-related complications. Interestingly, this study revealed-despite the lack of evidence- a quarter of our included patients received a medical prescription for probiotics to prevent or treat SIBO.
1189 Assessing Celiac Disease Biopsy Patterns at Indiana University: A Retrospective Review
Authors: Jansson-Knodell Claire L. , Kessler William R. 
Published: October 2019

INTRODUCTION:
The histologic abnormalities that are diagnostic of celiac disease (CD) can be patchy. As such, the ACG guidelines recommend that the sampling endoscopist obtain one or two biopsies from the bulb and at least four from the distal duodenum. Previous research has shown gaps in compliance with these recommendations. The aim of the project was to assess how often guideline-recommended biopsy protocol was followed at our institution in evaluating for both incident and prevalent cases of CD.

METHODS:
Clinical data were systematically abstracted from the electronic medical record of patients who underwent duodenal biopsy at our academic medical center between January 2009 and February 2019. Pathology and endoscopy reports were reviewed. Appropriate biopsy practice was defined as 5 or more specimens submitted for review. Categorical data were analyzed with the Chi-square test.

RESULTS:
The cohort of biopsied patients included 239 individuals (age range 17-87, median age 43 years old). Of the cohort, a majority were female (72.4%; 173 females, 66 males). Of the patients who presented for EGD with duodenal biopsies, 134 were presenting without a prior diagnosis for evaluation of CD (73.9% females) and 105 were prevalent cases of CD coming for assessment of intestinal healing (70.5% females). A total of 71 incident cases were identified (70.4% females) by 5 female and 15 male endoscopists. Mucosal healing with normal histology was only detected in 42.9% of prevalent individuals [Figure 1]. In the group being evaluated for possible CD 67.16% were biopsied appropriately versus 62.86% of the prevalent cases for follow up (P = 0.49). The number of biopsies obtained ranged from 1-15 (mean 5.68 +/- SD 2.18; median 5, IQR 3-7). Having a female endoscopist evaluate for new diagnosis of CD was associated with better adherence to established biopsy guidelines (OR 3.36, 95% CI 1.35-8.38, P = 0.0092) [Table 1].

CONCLUSION:
The results of this cohort-based study indicate that the majority of gastroenterologists at our institution follow guideline-driven biopsy protocol for CD in either suspected or prevalent patients. While these figures are better than historical research, we should strive for improved adherence. Of the patients that we followed with a biopsy-proven diagnosis of CD, we found a surprising number who had not achieved complete histologic healing, emphasizing the importance of follow up endoscopy and appropriate biopsy.
1190 Does Nonalcoholic Fatty Liver Disease Increase the Risk for Acute Ischemic Bowel Disease?
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Khoudari George , Al-Khadra Yasser , Alomari Mohammad , Dasarathy Srinivasan , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. It has been reported in the literature that NAFLD increases the risk for cardiovascular disease, but a possible association between NAFLD and acute ischemic bowel disease (AIBD) has not been studied. Our aim in this study is to evaluate if NAFLD is an independent risk factor for AIBD.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified patients who were diagnosed with NAFLD and AIBD using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of NAFLD. We then performed multivariate logistic regression analysis for the association between NAFLD and AIBD

RESULTS:
The total population was comprised of 101,137,143 patients, of which 365,701 (0.36%) were diagnosed with NAFLD and 133,201 (0.13%) were diagnosed with AIBD. Patients in the NAFLD group were older (53 vs 48), less likely to be females (57.7% vs 58.4%) and African American (9.3% vs 14.3%) (P < 0.0001 for all). In addition, NAFLD patients had more tobacco use (13.9% vs 9.5%), alcohol (7.1% vs 3.4%), obesity (26.2% vs 6.9%) and diabetes mellitus (DM) with or without complications (5.6% vs 3.2%) and (30.7% vs 14.1%) respectively. Furthermore, individuals in the NAFLD group had less comorbid chronic obstructive pulmonary disease (COPD) (9.5% vs 10.9%), congestive heart failure (CHF) (5.5% vs 6.5%), cardiovascular atherosclerosis (13.8% vs 17%) and atrial fibrillation (AFib) (5.8% vs 8.8%) (P < 0.0001 for all). Both groups had similar prevalence of major cardiovascular surgery (0.1%) (P > 0.05). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including: (age, gender, race, obesity, COPD, CHF, DM, tobacco use, cardiovascular atherosclerosis, AFib and a history of major cardiovascular surgery), NAFLD group had a statistically significant higher rate of AIBD (Odds Ratio [OR], 2.11, 95% confidence interval [CI], 2.02-2.20, P < 0.0001) compared with the non-NAFLD group.

CONCLUSION:
Based on our analysis, patients in the NAFLD group were twice more likely to have AIBD. To our knowledge, this the first study that evaluated the risk for AIBD in NAFLD patients. This finding adds to our understanding of NAFLD as multisystem disease and highlights the importance of controlling the risk factors associated with NAFLD.