bluuebunny/crossref_metadata_2025_split huggingface dataset:
575 No-show Endoscopy Appointments: An Analysis of Patient Characteristics
Authors: George Nayana , Syeda Hafsa Bareen , Goel Akshay , Perisetti Abhilash , Khan Salman Ali , Thandassery Ragesh , Garg Shashank , Inamdar Sumant , Tharian Benjamin 
Published: October 2019

INTRODUCTION:
Patient no-show for scheduled endoscopy is a widespread health-problem. We reviewed patients who did not show up for the procedure to identify key characteristics of this population.

METHODS:
All patients scheduled for endoscopy in a 6 month period and did not show up were included. Demographics and appointment waiting times were obtained through review of medical charts. Descriptive statistics were used to define study population.

RESULTS:
495 patients did not show up during study period. Mean age was 55+/- 12.5 years. 59.8% were females. No significant racial difference. Majority were unemployed or disabled. Patients with waiting times less than 4 weeks were fewer (13.13%) compared to those with wait 4 to 12 weeks (23.23%), 12 to 24 weeks (24.04%) and more than 24 weeks (39.6%). Longer waiting time for endoscopy was associated with higher no-show rates.

CONCLUSION:
Among patients who did not show up, most patients did not have a partner and were unemployed or disabled, were current or former smokers. Long wait times to endoscopy appointment was the major modifiable risk factor identified. Further studies are needed to identify factors that predict no-show. This will help design interventions to reduce no-show rates and improve health care delivery.
655 Tumor Necrosis Factor Antagonists Are Superior to Ustekinumab and Vedolizumab for the Prevention of Postoperative Recurrence in Adult Crohn's Disease
Authors: Nakamura Takahiro , Main Michael , Chang Shannon , Click Benjamin , Hudesman David , Axelrad Jordan 
Published: October 2019

INTRODUCTION:
Relapse of Crohn's disease (CD) is common after surgical resection. Prior data have demonstrated that postoperative tumor necrosis factor antagonists (anti-TNF) may reduce recurrence, although little is known about the efficacy of other biologic therapies. The aim of this study was to compare biologics for preventing postoperative objective recurrence in adult CD patients.

METHODS:
We performed a retrospective chart review of CD patients who underwent intestinal resection from 2012 to 2018. Demographics, IBD history, pre- and postoperative course were obtained from the electronic medical record. The primary outcome was postoperative recurrence during follow up, defined as a composite of endoscopic (Rutgeerts grade > i2), biochemical (increase in CRP >5 mg/dL), or radiographic (presence of active inflammation) disease recurrence stratified by postoperative biologic exposure, including anti-TNF, vedolizumab (VDZ), ustekinumab (UST), and no therapy. Student's t-test, Pearson's chi-squared, logistic and Cox regression analyses were used to detect differences in the composite and components of the outcome among these groups.

RESULTS:
123 patients were included. CD recurrence occurred in 36.6% of patients (13.0% biochemically, 24.4% endoscopically, 16.3% radiographically) at a median of 6.9 months (IQR 3.3-14.1) from surgery (Table 1). The number of patients in the anti-TNF, VDZ, UST, and no therapy groups were 57 (46.7%), 6 (4.9%), 13 (10.7%), and 46 (37.7%), respectively. Biologic therapy was initiated after ileostomy reversal within 3 months for 55 patients (72.4%), between 3-6 months for 11 patients (14.5%), and between 6-12 months for 10 patients (13.2%). Adjusting for prior resection and anti-TNF exposure, any biologic initiation within 6 months of surgery was superior to initiation after 6 months for preventing postoperative endoscopic recurrence (OR 0.24, 0.06-0.92), but not for the composite outcome. There were statistically significant differences among biologics for recurrence (Figure 1). Adjusting for prior resection and anti-TNF exposure, less patients relapsed under anti-TNF exposure compared to UST (HR 3.46, 1.45-8.23) for the composite outcome, and compared to UST (HR 3.95, 1.43-10.9) and VDZ (HR 4.42, 1.02-19.1) for endoscopic recurrence (Figure 2).

CONCLUSION:
Among CD patients, initiation of biologics within 6 months and anti-TNF agents were superior in preventing postoperative recurrence compared to other management strategies.
685 Red Cell Distribution Width as a Differentiating Marker for Patients With Inflammatory Bowel Disease
Authors: Navabi Seyedehsan , Gorrepati Venkata Subhash , Yoo Esther , Pattison Zachary , Groff Andrew , Akhtar Nabeel , Stuart August , Tinsley Andrew , Williams Emmanuelle D. , Coates Matthew , Clarke Kofi 
Published: October 2019

INTRODUCTION:
Anemia is a common systemic manifestation in patient with Inflammatory Bowel Disease (IBD). It can be caused by malabsorption and/or chronic blood loss and is more prominent in Crohn's disease (CD) compared to ulcerative colitis (UC), likely due to the distribution of lesions in entire gastrointestinal tract. Red Cell Distribution Width (RDW) is a reliable index of anisocytosis and has the highest sensitivity for iron deficiency in patients with anemia. We postulated that RDW could be used additional differentiating test for IBD patients.

METHODS:
The database consists of various demographic variables, nutritional and inflammatory markers, medication use, anatomic demarcation and endoscopic disease severity information. High RDW was defined as RDW >14.2 after analysis of receiver operator curves (ROC). Categorical variables were compared using chi-square test and continuous variables using t-test. Univariate logistic regression was used to explore the relationship between high RDW, type of IBD, endoscopic disease severity, and anatomic location. Analysis was performed using SAS University edition v9.4.

RESULTS:
Six hundred seventy-one IBD patients (214 UC, 431 CD, and 25 indeterminate colitis) were included n this study. Among patients with CD or UC, 347 (53.7%) were female. 261 patients had high RDW (67 UC vs. 89 CD) and 410 patients had normal RDW (147 UC vs. 243 CD). After adjusting for demographic variables, ultivariate analysis suggests that RDW is a significant differentiating factor for diagnosis of IBD with odds of having CD 1.69 times greater if RDW > 14.2 {OR CD vs. UC = 1.67 (95% CI: 1.17-2.38), P = 0.002)}. There was no significant correlation noted between RDW and endoscopic severity or location of the disease in both CD and UC patients. However, there was a near significant trend noted in RDW and disease extent in UC (proctitis 16% vs. left sided colitis 25% vs. pancolitis 38%, P = 0.056). There were no differences in RDW in relation to gender, ethnicity or smoking status.

CONCLUSION:
RDW can be used as an additional, simple, inexpensive differentiating tool in IBD patients. Patients with CD have higher odds of having abnormal RDW compared to patients with UC. Given the simplicity and inexpensiveness of RDW, these findings support utilization of this test as an additional method for differentiating IBD disease subtypes, even by healthcare providers without extensive background in IBD management.
724 Does Zinc Deficiency in IBD Predispose Patients to Repeat C. difficile Infection?
Authors: Hunold Thomas , Dickson Zachary , Baray Merwise , Hays R. Ann 
Published: October 2019

INTRODUCTION:

Clostridiodes difficile infection (CDI) is the most common hospital-acquired infection in the United States. CDI is more common in patients with inflammatory bowel disease with a greater risk in ulcerative colitis patients compared to Crohn's disease patients. Recent literature revealed an association between decreased zinc levels and CDI via the activation of Th17 cells through the STAT3 pathway. We aimed to investigate the relationship of Zinc levels with the risk of recurrent CDI in IBD patients.

METHODS:
We performed an IRB retrospective cohort study of patients aged 18-75 with a history of IBD and a positive Clostridium Difficile PCR between January 1, 2012 and December 31, 2016 at a tertiary care center. A second CDI diagnosis within 3 months of the first was defined as recurrent CDI (rCDI). A second diagnosis after 3 months, but within 3 years of the first diagnosis was defined as reinfection. All charts were reviewed for zinc level testing at the time of any CDI. The primary outcome was zinc level at the time of primary diagnosis. This was also broken down by type of IBD. Descriptive statistics were calculated for the primary and secondary outcomes using SAS 9.4 (SAS Institute, Cary, NC).

RESULTS:
Of 121 patients with IBD and a positive C. difficile PCR, 23 patients had a zinc level tested. The average Zinc level among patients with only one CDI episode was 0.66, while it was 0.62 for rCDI and 0.62 for CDI reinfection. Of the 23 patients with a zinc level, 12 had Crohn's disease and 11 had Ulcerative Colitis. Only three Crohn's patients had one C difficile infection, four had rCDI, and six had C. difficile reinfection with average zinc levels of 0.66, 0.64, and 0.54 respectively. No ulcerative colitis patients only had a primary infection. The six UC patients with rCDI had an average zinc level of 0.64, while those with C. difficilereinfection had an average level of 0.72.

CONCLUSION:
While the sample size of this study was small, there is a trend for patients with Crohn's disease to have lower zinc levels if they have CDI reinfection compared to primary and rCDI. This could be explained by a sustained increase in the activation of Th17 cells via the STAT3 pathway in Crohn's patients with lower zinc levels. However, the patients with ulcerative colitis in this study did not have a tendency to have lower zinc levels suggesting that a different mechanism may be at play. Further investigation of this relationship in a larger study is required.
731 De novo Inflammatory Bowel Disease After Secukinumab Use: A Population Based Analysis
Authors: Mohy-ud-din Nabeeha , Carleton Neil , El-Hachem Sandra , Baki Heitham Abdul , Syed Aslam , Dulai Parambir , Kochhar Gursimran 
Published: October 2019

INTRODUCTION:
Secukinumab is a human monoclonal antibody and an inhibitor of IL-17A. It is indicated for treatment of Psoriatic Arthritis, Psoriasis and Ankylosing Spondylitis. There have been a few case reports documenting new or worsening IBD in patients being treated with secukinumab. However, large patient cohorts reporting this relationship are lacking. The aim of this study is to analyze if the use of secukinumab leads to increased risk of development of IBD.

METHODS:
A retrospective study was performed using a HIPPA-enabled web platform called Explorys (IBM, New York). Explorys contains de-identified data from approximately 62 million electronic health records. Data was obtained using the search criteria of “Secukinumab” and “Inflammatory Bowel Disease.” A temporal relationship was established between secukinumab use and development of de-novo IBD. Demographics and management data were collected and compared using odds ratio with 95% confidence intervals.

RESULTS:
Sixty-two million electronic health records were analyzed. Of them, 2870 patients were noted to use secukinumab. Rates of de-novo IBD after secukinumab use were higher than the prevalence of IBD in the general population [3.2% vs 0.74%, RR-4.2 (95% CI 3.45-5.18)]. Patients with de-novo IBD after secukinumab use were younger [age < 65-78% vs 65%, OR 1.92 (1.17-3.15)] and more obese [BMI >30- 22% vs 7%, OR 3.91 (2.38-6.43)]. Additionally, they had higher proportion of patients with use of immunomodulators [67% vs 10%, OR 17.81 (11.49, 27.61)].

CONCLUSION:
The risk of developing de-novo IBD in patients with secukinumab use is higher compared to the general population. These patients were younger, more obese and more likely to use immunomodulators.
799 Hospital Length of Stay and Mortality in Patients With Inflammatory Bowel Disease and Atrial Fibrillation
Authors: Panchal Dayna , Khawaja Umar Sharif , Motlaghazadeh Yasaman , Nasir Umair M. , Choi Catherine 
Published: October 2019

INTRODUCTION:
Proinflammatory markers such as interleukin (IL)-6 have been closely associated with various pathological processes, such as oxidative stress, apoptosis, and fibrosis that promote formation of atrial fibrillation (AF). These markers are characteristically elevated in inflammatory bowel disease (IBD). It has been shown that AF has a higher prevalence in IBD. It is important to analyze the effect of comorbid AF and IBD on hospital length of stay and mortality.

METHODS:
The National Inpatient Sample (NIS) database, representing roughly 20% of all inpatient admissions, was used to identify patients with a primary or secondary diagnosis of Crohn's disease and Ulcerative Colitis from 2012 to 2014. The sample was analyzed to assess for LOS, Charlson comorbidity index (CCI), length of stay (LOS) and inpatient mortality among patients with or without history of AF. The sample was weight to calculate national rates. Categorical variables were analyzed via Chi square test and continuous variables via T-test. Multivariable logistic regression analysis was used to assess the primary outcome of inpatient hospital mortality, with the analysis adjusted for age, sex, race and CCI.

RESULTS:
A total of 249045 patients from the 2012-2014 NIS database were admitted for IBD; of those 3.9% had history of AF. The average LOS was 4.7 days, rate of and mortality during hospitalization was 0.2%. AF was associated with older patients (mean age 70 vs. 43.5 years, P < 0.001) and higher CCI (3.9 vs. 1.2, P < 0.001) when compared to non AF patients. AF was also associated with increased hospital LOS (5 days vs. 4.4 days, P < 0.05) as well as higher mortality rates (0.9% vs. 0.1%, P < 0.001) when compared to non AF patients. After adjusting for possible confounders including age, sex, race and Charlson comorbidity index, the mortality rate was significantly higher in the AF group (odds ratio 1.8, P < 0.001, 95% CI 1.5-2.4).

CONCLUSION:
Our study found that hospitalized patients with comorbid IBD and AF had higher mortality rates as well as increased hospital LOS. IBD leads to a chronic inflammatory state promoting systemic inflammation. It has been proposed that this pro-inflammatory state leads to the development of AF in IBD patients. Given the higher incidence of AF in IBD patients compared to the standard population, and the increased mortality and hospital LOS associated with the two conditions, further studies should be done to explore the cause of mortality and any intervention that could improve outcomes.
889 Enhancing Radiation Safety During Fluoroscopy Procedures in Endoscopy Units
Authors: Chatterjee Ritodhi , Chu Jinna , Varghese Vilu , Smith Jason , Robbins Richard , Cole Rhonda , Velez Eugenia , Jarbrink-Sehgal Maria , Hair Clark , Ketwaroo Gyanprakash Avinash 
Published: October 2019

INTRODUCTION:
Fluoroscopy is an imaging technique often used in gastroenterology for endoscopic retrograde cholangiopancreatography (ERCP) procedures, subjecting the endoscopist and staff to radiation. Many studies have proposed best practices around behavior, choices, and equipment that attenuate radiation exposure. Gastrointestinal society guidelines also recommend measuring and documenting fluoroscopy time as an important quality metric for ERCP. Our goal was to ensure adequate safety precautions and reporting are adhered to by gastroenterology (GI) staff during fluoroscopy.

METHODS:
We performed baseline assessments of adherence to radiation safety protocols for fluoroscopy, interviewed interventional radiologists, and reviewed the medical literature to guide development of our intervention. We created an educational presentation on radiation safety and equipment handling with survey administration before and after. The first 4 questions used a Likert scale (1 = poor, 5 = excellent) to assess knowledge of and adherence to various aspects of radiation safety, while the latter 4 were multiple-choice questions regarding content. Second, we designated a radiation safety officer (RSO) to assess yearly reports. Lastly, we created a template with fluoroscopy time and dose recording. All interventions were delivered from 10/1/18 – 10/11/18. We reviewed post-ERCP notes to assess adherence.

RESULTS:
17 individuals responded to pre- and post-intervention surveys (Table 1). Before the intervention, the first four questions had an average rating of 4.1 (SD of 0.70) and last four questions had an average correct response of 48% (SD of 20%); after the intervention, the average increased to 4.6 (SD of 0.17) and 93% (SD of 11%). We reviewed post-ERCP notes from 8/1/18 – 9/30/18 (n = 11) and found recording of the fluoroscopy time and radiation dose at baseline was 3%. After intervention, review of all post-ERCP notes from 10/1/18 – 5/31/19 (n = 94) showed recording to range from 86% - 100%.

CONCLUSION:
Initial audits showed a lack in radiation safety knowledge resulting in poor adherence to radiation safety protocols and documentation among GI staff at our tertiary care center. Interventions on education and facilitating documentation with templates can improve the quality of ERCPs and safe radiation practices dramatically.
1019 Performance of Lab-Based Scoring Tests for the Assessment of Hepatic Fibrosis Compared to the Liver Biopsy Among Patients With Non-Alcoholic Fatty Liver Disease
Authors: Miller Alexander , Li Na , Hinton Alice , Mumtaz Khalid 
Published: October 2019

INTRODUCTION:
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. Hepatic fibrosis is the most important predictor for its prognosis. Various lab-based scoring tests have been developed as non-invasive measures to assess for hepatic fibrosis. The aim of this study was to examine the performance of these tests compared to the liver biopsy.

METHODS:
This is a retrospective study that included 354 biopsy-proven NAFLD patients. The sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic (AUROC) curve of aspartate aminotransferase to platelet ratio (APRI), Fibrosis-4 (FIB-4), and NAFLD fibrosis score (NFS) were compared to histological fibrosis between groups without (F0-2) and with advanced hepatic fibrosis (F3-4).

RESULTS:
The mean age of our study population was 50 ± 13 years. The mean BMI was 33.92 ± 8.51 kg/m2. The majority were whites (87.29%) and females (57.63%). The overall mean prevalence of F0-2 fibrosis and F3-4 were 73.7% and 26.3%, respectively. Patients with NFS ≤0.675 were less likely to have advanced hepatic fibrosis (P = 0.011) compared to those who had NFS >0.675. With NFS ≤0.675 and >0.675, the sensitivity and specificity for advanced hepatic fibrosis were 37.6% and 76.2%, and the AUROC was 0.56. The sensitivities and specificities of NFS, APRI and FIB-4 for detecting advanced histological fibrosis are shown in the Table 1.

CONCLUSION:
This is the largest study comparing various lab-based scoring tests with the liver biopsy. The performance of lab-based scoring tests is overall not satisfactory. Therefore, new tests or a combination of these tests with other modality such as elastography is warranted to reliably assess the stages of hepatic fibrosis.
1088 Achievement of SVR With Ledipasvir/Sofosbuvir in Patients With Hepatitis C and Moderate Chronic Kidney Disease May Lead to Improved Glomerular Filtration Rate
Authors: Obineme Chuma G. , Miller Lesley S. 
Published: October 2019

INTRODUCTION:
Ledipasvir/Sofosbuvir (LDV/SOF) was approved for the therapy of hepatitis C virus (HCV) in 2014 and has become one of the most widely used direct-acting antiviral (DAA) therapies for HCV. There has been conflicting data in regards to the nephrotoxicity of LDV/SOF. Case reports and small studies have suggested a drug-induced intrinsic renal injury from treatment with LDV/SOF.

METHODS:
We assessed the renal function of patients who underwent 12-weeks of therapy with LDV/SOF in a safety-net hospital liver clinic. This was a single-center retrospective study and included all patients who achieved (sustained virologic response) SVR and were initiated on therapy from July 1st, 2015 to December 31st, 2015. Those who failed to achieve SVR or had combination therapies with non-DAA medications (i.e. ribavarin) were excluded. Charts were reviewed for demographics, baseline renal function and renal function at 12 weeks of therapy.

RESULTS:
A total of 88 patients were treated with 12 weeks of LDV/SOF therapy and completed renal function assessment at the start and at 12 weeks of therapy. Within the study group, the mean age was 57.2 years, 60 (68.2%) were men, 75 (85.2%) were African American, 34 (38.6%) had cirrhosis, and 45 (51.1%) had chronic kidney disease. Patients were followed for confirmation of SVR at 12 weeks. There was no significant difference between patients’ baseline creatinine and repeat creatinine after 12 weeks of LDV/SOF therapy (P = 0.835). Even in sub-group analysis where 51.1% of patients had chronic kidney disease, 38.6% had cirrhosis and 35.2% had type 2 diabetes no significant differences in creatinine were seen (P = 0.210, P = 0.388, P = 0.884 respectively). There were 2 (2.3%) patients who developed acute kidney injury (an increase of creatinine by 0.3mg/dL) during the course of therapy. 6 (6.8%) patients had clinical improvement in renal function (defined by decrease in creatinine of 0.3mg/dL). Patients who showed clinical improvement in renal function with HCV therapy had significantly lower baseline estimated glomerular filtration rate in comparison to the total study group (eGFR 76 vs 90 ml/min/1.73m2, P < .0001).

CONCLUSION:
In patients with HCV who underwent 12-week therapy with LDV/SOF and achieved SVR there were no significant differences in renal function after therapy. Patients with moderate chronic kidney disease (stages II and III) treated with LDV/SOF may preferentially show improvements in renal function if they achieve SVR.