bluuebunny/crossref_metadata_2025_split huggingface dataset:
1224 Exploring the Possibility of Gastroesophageal Reflux Disease as a Screening Factor for Helicobacter pylori in Patients From Endemic Regions
Authors: Ahmed Ahmed , Rotundo Laura , Silva Alejandro , Feurdean Mirela , Atkin Suzanne 
Published: October 2019

INTRODUCTION:
Helicobacter pylori (HP) is a common gastric infection with the highest prevalence in Asia, Africa, Central, and South America as well as in U.S. immigrants from these areas. Current American College of Gastroenterology (ACG) guidelines recommend screening for HP in cases such as patients with active or prior peptic ulcer disease (PUD). However, screening is not recommended for patients who exhibit only symptoms of gastroesophageal reflux disease (GERD) irrespective of regional origin. The goal of this study was to determine if patients from endemic regions with GERD should be screened for HP.

METHODS:
This is a retrospective chart review of all patients who presented to an internal medicine ambulatory care clinic in 2017 with symptoms of GERD and/or PUD for whom orders were placed for HP testing via stool antigen or endoscopic biopsy. GERD symptoms were defined as reflux or heartburn and PUD as any symptom of dyspepsia. Patients were stratified by symptoms: GERD, PUD, or both. Exclusion criteria were as follows: tests ordered but never collected, orders for confirmation of cure for prior infection, multiple tests ordered for the same patient over the study period, tested patients with no symptoms, and patients with symptoms related to a non-H. pylori preexisting disorder. Enrolled patients were further stratified by region of origin.

RESULTS:
122 patients that met the selection criteria were included in this study. 43% (52/122) of all patients were positive for HP. Of those that were positive, 92% (48/52) came from an endemic area (83% from South or Central America) and of these 75% (36/48) had PUD symptoms, 25% (12/48) had GERD only, and 52% (25/48) had both GERD and PUD symptoms. Of HP positive patients from non-endemic areas, all had GERD symptoms (4/4), with 1 having GERD only. Of patients that had GERD symptoms only, 25% (12/48) tested positive for HP and were from endemic areas.

CONCLUSION:
In our study, 25% of patients from endemic regions with solely GERD symptoms tested positive for HP, suggesting that recommendations for screening should include this population. Our data collection was small and skewed towards patients originating from endemic regions of South and Central America, and the results may not be applicable to other endemic regions, such as Asia and Africa. Further studies are needed to establish appropriate screening recommendations that are applicable to other endemic areas, so that the diagnosis of HP is not missed.
1225 Gastric Adenocarcinoma Incidence and Incidence-Based Mortality: A Population-Based Study of 62,863 Cases From the Surveillance, Epidemiology and End Results (SEER) Program Over Last Four Decades
Authors: Afifi Ahmed , Elmehrath Ahmed , Hashim Mahmoud , Abdelwadoud Moaz , Ismail Bahaaeldeen 
Published: October 2019

INTRODUCTION:
Gastric cancer (GC) is the third deadliest cancer worldwide therefore tracking its morbidity and mortality trends is necessary to identify the most susceptible population groups, and develop targeted clinical management strategies.

METHODS:
We searched the SEER 9 databases to investigate the incidence and incidence-based mortality (IBM) rates of gastric adenocarcinoma (GAC) from 1973 to 2015 according to patients' gender, age, race, state of residence, and GAC stage. We analyzed the annual percent change (APC) of the incidence and IBM of GAC via Joinpoint® regression software.

RESULTS:
We analyzed 62,863 GAC cases. GAC incidence and IBM rates decreased by 1.66% and 1.53% (P < 0.001) annually, respectively (Table 1). Incidence rates were highest among males, African Americans, and patients aged 65 years or more, whereas the IBM rates were the highest among males, American Indians, Alaska Natives, Asians and Pacific Islanders and patients aged 65 years or older. GAC incidence in stomach cardia increased by 0.66% annually, while GAC incidence in the antrum and lesser curvature decreased by 1.77% and 3.04% annually, respectively. Likewise, GAC IBM in stomach cardia increased by 0.52%, while GAC IBM in antrum and lesser curvature decreased by 1.4% and 2.2% annually, respectively. Geographically, the incidence and IBM rates of GAC decreased in all states over the study period. Notably, Hawaii (HI) had the highest incidence and IBM rates (Table 2). Also, we found that cardia GAC was the most prevalent sub-type in all states except HI, where antrum GAC was the highest.

CONCLUSION:
Despite an overall decrease in GAC incidence and IBM, there is an increase in cardia GAC, which may be secondary to rise in obesity and alcohol consumption along with decrease in H. pylori prevalence. The incidence rate of GAC is higher in HI, Michigan and Connecticut, which is in concordance with the published data from State Cancer Profiles between 2011-2015. We could not evaluate the underlying risk factor for each state due to study's nature; however, the higher incidence rates in HI may be attributed to genetic environmental interactions, as supported by migrant studies. In conclusion, we were able to outline trends in incidence and IBM of GAC in USA over last four decades, which suggest a need for tailoring treatment and preventive strategies to fit each state population.
1228 Cardiac Safety and Clinical Efficacy of High Dose Domperidone for Long-Term Treatment of Gastroparesis
Authors: Woods Kevin , Sarosiek Irene , Espino Karina , Ramirez Marisol , Siddiqui Tariq , McCallum Richard 
Published: October 2019

INTRODUCTION:
Domperidone (D), a dopamine 2 receptor antagonist, is an effective anti-emetic that acts at the chemoreceptor trigger zone and only minimally crosses the blood brain barrier while also exerting prokinetic effects on the stomach and proximal small bowel. D is not approved in the USA. Recommended dosing worldwide is 30 mg/day and due to scattered reports of cardio toxicity ECG monitoring is recommended. Our goal was to explore the cardiac safety and clinical efficacy of long-term use of D, titrated as high as 120 mg/day, in patients not responding or unable to tolerate other therapies for gastroparesis (GP).

METHODS:
From our database we identified 19 patients without preexisting cardiac diagnoses, 85% F, mean age 47 (range 27-74), 50% white, 42% Hispanic, who received a high dose D per FDA/IND approved protocol. Baseline GP symptoms were assessed and then monitored for changes during treatment using a physician administered IRB-approved questionnaire which recorded the GP symptoms of nausea, vomiting, early satiety and abdominal pain, which were graded for severity (0-absent to 4-extremely severe) and compared to baseline values. Patients had to be improved symptomatically by ≥50% to be considered responders. Adverse cardiac events were recorded, and follow up ECGs (average 2 repeat ECGs per patient (range 1-7) focused on prolonged QTc intervals (>450 ms in M, >470 ms in F).

RESULTS:
The mean duration of D therapy was 31 months (range 3-96) median time of 17 months. The average dose of D was 80 mg/day (range of 40-120), while 3 (15%) of GP patients recieved 120 mg/day. No patients had serious cardiac adverse events. Two (F) patients had prolonged QTc of 491 ms and 482 ms requiring discontinuation of D and 4 reported heart palpitations or chest pain unrelated to prolonged QTc, and continued the medication. 78% of patients met criteria for treatment response with overall mean symptoms improvement of 71% (range 30-100) compared to pre-D scores. Vomiting was the most improved symptom.

CONCLUSION:
Long-term treatment with high doses of D resulted in significant improvement of GP symptoms in patients previously refractory to other medical therapies. There were no adverse cardiac events reported, and only asymptomatic QTc prolongation was recorded in 11% of patients. These data emphasize both the safety and efficacy of high dose D in the treatment of symptomatic GP.
1229 Resident Education in the Placement and Confirmation of Feeding Tubes
Authors: Oruganti Poornima , Nakshabandi Ahmad , Palmer Lena 
Published: October 2019

INTRODUCTION:
Nasogastric feeding tube (FT) placement is often done by trainees without uniform education. Serious complications can occur if FT are improperly inserted. This study assesses trainee education in FT insertion to identify knowledge-gaps and a need for standardized training.

METHODS:
A 16- item, web-based E-questionnaire was distributed to 149 Internal Medicine, Medicine-Pediatrics, Family Medicine, Obstetrics and Gynecology, General Surgery and Neurology residents at a university medical center and a community-based teaching hospital near Chicago, IL. Results were collected and analyzed through the web-based platform. The study was exempted from institutional review.

RESULTS:
One hundred seventeen residents responded (78.5% response rate). Most were Internal Medicine residents (66.1%) in postgraduate year 1 (37.8%). 76.1% of survey respondents received training in residency and 59.8% in medical school. The majority of survey respondents (94.9%) learned by bedside demonstration. The second most common training method was simulator training, but this was reported by only 29.9%. Most survey respondents felt they had adequate training (74.1%); however, only 50% felt very confident in their ability. Most residents reported requirements between 0 and <10 supervised placements before being certified by their institution. Almost a third (32.8%) of respondents were unaware of the requirements for certification, and surprisingly 23.3% reported that none were required. Most indicated that residents or fellows placed the majority of FT at their institutions. Almost all respondents (96.6%) were able to correctly identify abdominal Xray as the gold standard to confirm correct FT placement. Though 47% stated they were responsible for certifying proper positioning of FT, only 62.6% of responders reported they received instruction in Xray interpretation, and only 36.8% were able to correctly answer a question regarding radiographic landmarks of properly-placed tubes.

CONCLUSION:
Our study is the first to survey American medical residents regarding their knowledge, training, and comfort in placing FT. While the data indicate residents generally feel they receive adequate training, only half reported being very confident in this skill, and training in Xray interpretation was inadequate. This suggests a role for standardized training in placement and confirmation of FT to improve patient safety and resident education.
1230 Helicobacter pylori Eradication and Its Association With Metachronous Gastric Cancer Recurrence and Pre-Neoplastic Lesions: A Systematic Review and Meta-Analysis
Authors: Khan Muhammad Y. , Aslam Aysha , Mihali Albana B. , Rawala Muhammad Shabbir , Dirweesh Ahmed , Khan Salman , Siddiqui Ali 
Published: October 2019

INTRODUCTION:
Gastric cancer is the 4th leading cause of cancer deaths worldwide displaying global variation in incidence. Helicobacter pylori (H Pylori) is known risk factor for gastric cancer. The magnitude of benefit of H pylori eradication in preventing GC recurrence is unclear. We performed a systematic review (SR) and meta-analysis (MA) of available randomized clinical trials (RCTs) to investigate the impact of H Pylori eradication on GC recurrence and precancerous lesions.

METHODS:
A planned literature search of Medline, PubMed and Google Scholar databases was carried out from inception to 10 February 2019. Ten (RCTs) included for analysis had H Pylori eradication as intervention arm compared to placebo. Statistical analysis was performed using statistical software RevMan, version 5.3. Random effects model and Mantel-Haenszel method for the statistical analysis was used for dichotomous data to calculate the odds ratio (OR). Two sided P values of less than 0.05 was considered statistically significant.

RESULTS:
10 RCTs with total of 7,098 patients were included for final comparison. There were 3548 subjects in H Pylori group and 3550 in the placebo arm. The primary outcome was development of metachronous GC after endoscopic mucosal resection (EMR) in patients with early stage GC. H pylori group showed significant reduction in incidence of metachronous GC compared to placebo OR = 0.47, 95% confidence interval (CI) = 0.33– 0.67, P < 0.0001, I2 = 0%]. Incidence of GC in high risk patients without GC at baseline showed no difference between two groups OR = 0.67, 95% CI = 0.42–1.07, P = 0.09, I2 = 0%). H Pylori eradication group showed statistically significant improvement in AG and IM from baseline compared to placebo group with OR = 2.10, 95% CI = 1.19–3.71, P = 0.01, I2 = 87% and OR = 2.08, 95% CI = 1.28–3.36, P = 0.003, I2 = 30% respectively. RCTs with mean duration of follow up >5 years for GC incidence showed statistically significant reduction in GC incidence in H Pylori eradication group OR = 0.55, 95% CI = 0.40-0.76, P = 0.0003, I2 = 0%.

CONCLUSION:
Our meta-analysis showed the beneficial role of H Pylori eradication in decreasing GC recurrence for patients with early GC post EMR. H Pylori group also showed improvement in AG and IM grades compared to placebo. There was no difference in GC incidence in asymptomatic patients without GC at baseline between the two groups. More studies are needed from the North America, Europe and other non-Asian countries to better understand the differences in geographical regions.
1231 Racial and Ethnic Differences in Mortality in Gastric Cancer and Esophageal Adenocarcinoma in the United States
Authors: Laszkowska Monika , Tramontano Angela , Kim Judith , Camargo M. Constanza , Neugut Alfred , Abrams Julian , Hur Chin 
Published: October 2019

INTRODUCTION:
Studies have shown that the incidence of non-cardia gastric cancer (GC) has been declining in recent years, while the rate of cardia GC has been increasing, paralleling the trends of esophageal adenocarcinoma (EAC). Mortality trends in these malignancies have not been well studied, particularly for non-cardia GC. The aim of our study was to examine differences in incidence-based mortality in cardia and non-cardia GC, as well as EAC for comparison, in a representative cohort of the US population.

METHODS:
A total of 19,025 individuals with non-cardia GC, 14,268 with cardia GC, and 18,015 with EAC were identified in the Surveillance, Epidemiology, and End Results database. Age-adjusted incidence-based mortality rates and corresponding annual percent change (APC) were calculated between 2004-2016 to assess trends. Mortality analyses were stratified by race/ethnicity, age, and stage of disease at diagnosis.

RESULTS:
The age-adjusted incidence-based mortality rate (per 100,000 population) for non-cardia GC was 2.50, for cardia GC was 1.85, and for EAC was 2.31. Mortality in non-cardia GC was higher in blacks, Hispanics, and Asians/Pacific Islanders than non-Hispanic whites (P-value < 0.01 for each group). These differences remained statistically significant across all age groups and stages of disease (P-value < 0.01). From 2004-2016, mortality rates have not changed significantly over time for any racial/ethnic group. Interestingly, incidence-based mortality in EAC and cardia GC was higher in non-Hispanic whites than blacks, Hispanics, and Asians/Pacific Islanders (P-value < 0.01 for each group). These differences remained statistically significant across all age groups and stages of disease (P-value < 0.05). From 2004-2016 mortality has been rising in whites for EAC (APC = 3.86, P-value < 0.05) and cardia GC (APC = 3.90, P-value < 0.05), and in Hispanics for cardia GC (APC = 2.23, P-value < 0.05).

CONCLUSION:
Incidence-based mortality is higher in blacks, Hispanics, and Asians/Pacific Islanders in non-cardia GC, and higher in non-Hispanic whites in EAC and cardia GC. These differences persist when adjusting for age and stage of disease at diagnosis. Further research is needed to better understand the underlying causes of these differences in order to improve outcomes.
1233 Disaggregation of Gastric Cancer Risk Between Asian American Subgroups
Authors: Huang Robert , Hwang Joo Ha , Palaniappan Latha 
Published: October 2019

INTRODUCTION:
Within the United States (US), 26,000 new cases of gastric cancer (GC) and over 10,000 related deaths occur annually. Within the US, Asians and Pacific Islanders (API) in aggregate are known to be at increased risk for GC. There is limited data regarding GC risk between API subgroups. While screening of the general American population is not cost-effective, improved understanding of GC risk by disaggregated API subgroups may allow for targeted and cost-effective endoscopic screening.

METHODS:
All incident cases of GC diagnosed in the years 2011-2014 were identified from the Surveillance, Epidemiology, and End Results Program registries incorporating California (CA) and Hawaii (HI). From these incidence registries, API subgroup of patients were identified: Korean (CA and HI), Japanese (CA and HI), Chinese (CA and HI), Vietnamese (CA only), Filipino (CA and HI), and Indian (CA only). API subgroup population estimates were obtained from the American Community Survey (ACS). The age-adjusted incidence rates per 100,000 population and 95% confidence intervals (CIs) were generated for each subgroup, and among non-Hispanic whites (NHWs) for reference.

RESULTS:
2,132 incident API GCs, and 3,984 incident NHW GCs were identified. Significant differences in GC incidence exist between API subgroups. In CA, Koreans (23.4 per 100,000, 95% CI 15.8 to 31.0) and Japanese (21.4, CI 16.1 to 26.7) demonstrated high incidence, Chinese (11.0, CI 10.4 to 11.6) and Vietnamese (10.3, CI 7.8 to 12.8) demonstrated intermediate incidence, and Filipinos (4.6, CI 3.4 to 5.8) and Indians (3.7, CI 2.9 to 4.5) demonstrated low incidence (Figure 1). The incidence among NHWs in CA was 6.6 (CI 6.0 to 7.2). In HI, Koreans (16.3, CI 11.4 to 21.2) and Japanese (16.0, CI 12.5 to 19.5) demonstrated high incidence, while Filipino (5.0, CI 3.4 to 6.6) and Chinese (4.8, CI 2.1 to 7.5) demonstrated low incidence (Figure 2). The incidence among NHWs in HI was 4.7 (CI 3.1 to 6.3).

CONCLUSION:
Substantial heterogeneity in risk for GC exist between API subgroups. Koreans and Japanese are at highest risk, with incidence nearly five-fold higher than Filipinos and Indians. This suggests that the higher GC-risk in APIs in aggregate are driven by certain subgroups. This may hold implications for screening for GC. There is a lower incidence of GC in HI compared to CA, even within API subgroups. These differences may represent cohort effects from generational migration, or regional dietary and environmental differences.
1234 Variability in Gastric Cancer Survival by Disaggregated Asian American Subgroups
Authors: Huang Robert , Palaniappan Latha , Hwang Joo Ha 
Published: October 2019

INTRODUCTION:
Within the United States (US), 26,000 new cases of gastric cancer (GC) and over 10,000 related deaths occur annually. Asians and Pacific Islanders (API) in the U.S. are known to be at increased risk for GC. Due to differences in H. pylori prevalence, smoking habits, dietary patterns, and other genetic and environmental factors, the behavior of GC may vary between API subgroups. There exists little data regarding survivorship from GC between API subgroups.

METHODS:
All incident cases of GC diagnosed in between 2004-2014 were identified from the Surveillance, Epidemiology, and End Results Program registries. From the incidence registries, the records of Koreans, Japanese, Chinese, Vietnamese, Filipino, and Indians patients were extracted and compared with non-Hispanic white (NHW) patients as a reference. Differences between subgroups in all-cause mortality following diagnosis was evaluated utilizing Kaplan-Meier statistics and the log-rank test. The proportion of GCs diagnosed at a local stage (as defined by National Cancer Institute summary stage) were compared between subgroups. A proportional hazards regression model was used to compare subgroups, and adjust for differences in age and stage of diagnosis.

RESULTS:
There exist substantial differences in all-cause survival between API subgroups (Figure 1, P < 0.001). Koreans demonstrated better overall survival than other subgroups, while NHW demonstrated worst overall survival. Koreans had the highest percentage of GCs diagnosed at local stage (37.8%), while Filipinos had the lowest percentage (18.9%, Figure 2). In univariate proportional hazards regression (Figure 3), all API subgroups except Filipinos demonstrated superior survival compared to NHW. In multivariable regression adjusted for age, gender, and stage of diagnosis, all API subgroups except Filipinos continued to demonstrate superior survival compared to NHW.

CONCLUSION:
API subgroups seem to exhibit better overall survival following GC diagnosis compared to NHWs. Korean Americans appears to have the best overall survival. Part of this difference may be explained by a higher proportion of cancers diagnosed at a Local stage in Koreans. However, even after adjustment for stage of diagnosis API subgroups continued to demonstrate better survival compared to NHWs, suggesting possible underlying biological differences as well.
1238 Tradipitant Complete Responder Analysis in Gastroparesis Patients
Authors: Carlin Jesse L. , Lieberman Verna R. , Dahal Arya , Keefe Madison S. , Xiao Changfu , Birznieks Gunther , Polymeropoulos Mihael H. 
Published: October 2019

INTRODUCTION:
A Phase II multicenter, randomized, double-blind, placebo-controlled trial with gastroparesis subjects demonstrating delayed gastric emptying and moderate to severe nausea were randomized to receive oral 85 mg tradipitant bid or placebo (1:1) for four weeks. Of the 152 patients enrolled, 60% of patients had idiopathic and 40% had diabetic gastroparesis.

METHODS:
The primary outcome was change in average nausea score from baseline, measured using the 5-point Gastroparesis Core Symptom Daily Diary (GCSDD). Overall gastroparesis symptoms were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM).

RESULTS:
A statistically significant and clinically meaningful improvement in nausea and overall gastroparesis symptoms was observed in patients on tradipitant. Subjects receiving tradipitant had a significant decrease in their average nausea score compared to placebo with LS mean difference (95% CI) of -0.53 (-0.92, -0.13, P = 0.0099) as well as a significant increase in nausea free days (28.8% increase on tradipitant compared to 15.0% increase on placebo, P = 0.0160). A complete nausea response as defined by a nausea severity score ≤1 at week 4 was found to occur in 33% of patients on tradipitant compared to 12% of patients on placebo (P = 0.0013). A clinically meaningful response in overall gastroparesis defined as a 1-point or more improvement on the GCSI total score was observed in 46.6% of patients on tradipitant compared to 23.5% of patients on placebo (P = 0.0053).

CONCLUSION:
Tradipitant treatment resulted in statistically and clinically meaningful improvements in nausea and overall gastroparesis symptoms. Tradipitant was well tolerated with comparable rates of adverse events between tradipitant and placebo groups. These robust efficacy results suggest tradipitant has the potential to become a first line pharmacological treatment for gastroparesis.