bluuebunny/crossref_metadata_2025_split huggingface dataset:
115 Bone Health in Chronic Pancreatitis: A Pilot Study
Authors: Manickavasagan Hanisha , Shah Zarine , Hart Phil , Lara Luis , Hinton Alice , Lu Andrew , Yadav Dhiraj , Conwell Darwin 
Published: October 2019

INTRODUCTION:
Metabolic bone disease is associated with increased morbidity, mortality, and resultant health care costs. Chronic pancreatitis (CP) has multiple overlapping risk factors and complications (smoking, vitamin D malabsorption, fat maldigestion, alcohol abuse, and chronic inflammation) that promote an imbalance in bone mineralization and remodeling. This, in turn, leads to an increased risk of osteoporosis and fragility fractures. In this pilot study, we sought to assess the distribution of bone mineral density (BMD) and the clinical factors associated with reduced BMD in CP.

METHODS:
We selected patients with a definitive diagnosis of CP (according to the American Pancreatic Association guidelines) who were enrolled into The Ohio State Wexner Medical Center Pancreas Disease Biobank. Demographic and clinical details were abstracted, including age, sex, race, BMI, smoking, and alcohol history, and compared to BMD assessed by DEXA scans.

RESULTS:
Sixty-four patients with definite CP were identified. A total of 32 (50%) had bone mineral density screening with DEXA scans completed. Of those with BMD assessment, 59.3% (19/32) had a Z-score < −1.5. The overall mean of the lowest DEXA Z-score for the CP cohort was −1.39. Of the CP patients with metabolic bone disease, the majority were older than 50 years of age (68%), and there was an equal distribution of males (59%) to females (60%). The mean Z-score was lower for females than males, although this did not reach statistical significance (−1.9 versus −1.3 respectively; P = 0.25). There was no association with bone disease and race, smoking and alcohol.

CONCLUSION:
Despite the increased risk of metabolic bone disease, only 50% of patients with CP had screening DEXA scans. Of these, metabolic bone disease was seen in up to 60% of CP patients. Older patients and female-gender had similar bone mineral density trends in CP as expected in the general population. A larger sample size of CP patients is needed to evaluate the true impact and predictors of metabolic bone disease in CP.
117 Gender and Racial Disparities in the Annual Percent Change of Incidence and Mortality Rates of Pancreatic Cancer
Authors: Bhagat Vicky , Kahaleh Michel 
Published: October 2019

INTRODUCTION:
In the United States, pancreatic cancer is the fourth leading cause of cancer death for both men and women. The purpose of this study is to investigate the impact of gender, and race/ethnicity on the annual percent change of incidence and mortality rates of pancreatic cancer from 2000–2016 using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS:
Patients diagnosed with pancreatic cancer from 2000–2016 were identified from the SEER Registry. We retrospectively evaluated gender-specific, and race/ethnicity variations in age-adjusted annual percent changes in incidence rates and mortality rates for people above the age above 20. We used ethnic groups consisting of White, Non-Hispanic White, Black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic.

RESULTS:
Based on the SEER 21 areas data sets, the age-adjusted incidence rates of pancreatic cancer increased from 2000–2014 but remained stable from 2014–2016. The annual percent of change in incidence for both males and females from 2000–2014 was 0.9 and was −1.4 from 2014–2016. Females had an annual percent change of incidence of 0.7 from 2000 to 2016. For males, the annual percent change was 1.2 from 2000–2009 but the annual percent change from 2009–2016 was 0.2. Females had an upward trend of annual percent change of incidence rates during this period. The annual percent change of incidence by race/ethnicity can be seen in Table 1. The annual percent change in mortality rates was analyzed during 2000–2016. Females had an annual percent change of 0.2 and males had an annual percent change of 0.3. The trend of mortality rates was upward for males and females. The annual percent change of mortality rate by race/ethnicity can be seen in Table 2.

CONCLUSION:
The poor outcome and silent nature of pancreatic cancer necessitates the need to understand the trends associated with disease. Females had an upward trend in the annual percent change of incidence rates of pancreatic cancer from 2000–2016. There is also upward trend for annual percent change of incidence rates for Asians, Hispanics, and Non Hispanic Whites. The trend of annual percent change of mortality rates was increasing for both males and females during 2000–2016. The trend was increasing for both Non-Hispanic White and White Americans. This may support interventions to inform certain race/ethnic populations about the importance of screening for pancreatic cancer in high-risk populations.
118 Effects of Gallstones or Cholecystectomy on Gastrointestinal Cancer Risk and Prognosis: A Population-Based Cohort Study
Authors: Kwon Hyeonwoo , Kim Seongmin , Lee Jun Su , Cho Byungha , Choi Jongwook , Park Seon Mee 
Published: October 2019

INTRODUCTION:
It is debatable whether the gallstones or cholecystectomy increases gastrointestinal cancer (GIC) risk. We evaluated GIC risk and prognosis in gallstone patients treated with or without cholecystectomy and compared them with controls.

METHODS:
We identified gallstone patients (n = 480,688; follow-up: 12 years) and 1:10 age- and sex-matched healthy controls from Korean National Health Insurance data (2002–2016). Incidence and mortality rate of gastric cancer (GC), colon cancer (CC), rectal cancer (RC), hepatocellular carcinoma (HCC), bile duct cancer (BDC), and pancreatic cancer (PC) were compared. Possible risk factors such as sex, age, metabolic syndrome-related parameters (hypertension, obesity, hyperlipidemia, and hyperglycemia), liver enzyme levels, and smoking and drinking habits were adjusted.

RESULTS:
Compared to controls, gallstone patients without cholecystectomy revealed 0.78-, 0.95-, and 0.80-fold lower incidences of GC (88.87 per 105 person-year), CC (54.65), and RC (30.57) and 4.23-, 4.87-, and 1.60-fold higher incidences of HCC (107.69), BDC (33.85), and PC (22.29), respectively. Cholecystectomy was performed in 132,901 gallstone patients (27.6%); 87.5% of them were diagnosed with acute cholecystitis or cholangitis. Compared to gallstones without cholecystectomy, the incidences of gallstone patients treated with cholecystectomy revealed decreased in HCC (38.43) and BDC (13.90), increased in GC (107.32) and CC (59.58), and unchanged in RC (29.91) and PC (21.22). All GIC patients who underwent cholecystectomy had higher survival rates than controls.

CONCLUSION:
Risks of HCC, BDC, and PC were higher in gallstone patients, which decreased or unchanged after cholecystectomy. Gallstones or cholecystectomy had minimal effects on the incidences of GC, CC, and RC.
119 Kinetics of Stool Polymerase Chain Reaction in Clostridioides difficile Infection and Its Utility in Predicting Recurrence
Authors: Saha Srishti , Pardi Ryan , Patel Robin , Pardi Darrell , Khanna Sahil 
Published: October 2019

INTRODUCTION:
Testing strategies for Clostridioides difficile infection (CDI) remain a clinical conundrum with stool polymerase chain reaction (PCR) being highly sensitive; this high sensitivity may mean that PCR would remain positive for several weeks after CDI resolution. We studied the kinetics of PCR testing positivity in CDI, and whether a positive test during or after treatment predicts recurrence.

METHODS:
Adults with watery diarrhea and positive C. difficile PCR from 10/2009 to 5/2017 were included. Treatment was given per standard of care. Five serial stool samples collected within 60 days after treatment initiation and additionally clinically indicated samples were included. Recurrent CDI was defined as typical CDI symptoms after interim symptom resolution with positive stool PCR within 56 days of treatment. A positive stool test in the absence of symptoms was considered colonization and treatment was not offered. Descriptive statistics and Fisher's test were used, as appropriate. Kaplan-Meier survival curves for time to first negative PCR from treatment initiation, and log-rank test to compare treatments [metronidazole (MET) vs vancomycin (VAN)] were used. P < 0.05 was considered statistically significant.

RESULTS:
Fifty patients, median age 51 (range 20–86) years, 66% female, were included. Initial treatment was MET in 50% (25), VAN in 44% (22), both MET and VAN in 4% (2) and fidaxomicin in 2% (1). Median treatment duration was 14 (range 8–60) days. Overall, 82% (41) patients submitted ≥3 samples at variable times. Median time to first negative PCR was 9 days (95% CI, 7–14 days) after treatment initiation (Figure 1). This was similar in MET and VAN treated patients (P = 0.5; Figure 2). CDI recurred in 28% (14) of patients. Overall, 13 patients (33%) had ≥1 positive PCR(s) during and 45% (19) had ≥1 positive PCR(s) after treatment. Patients with positive vs negative PCR(s) during treatment trended towards a higher risk of recurrence [OR 3.9 (95% CI, 0.9–16.1), P = 0.054]. Patients with positive PCR(s) after treatment completion also had a non-significant trend towards a higher risk of recurrence [OR 2.8 (95% CI, 0.7–11.5), P = 0.15].

CONCLUSION:
Median time to first negative PCR in CDI was 9 days from treatment initiation. Positive PCR during or after treatment did not predict recurrence, though the positive odds ratio indicates the need for a larger study. Patients with CDI should not routinely undergo repeat testing to predict recurrence.
121 Opioid Use Are Independently Associated With Rectal Hyposensitivity and Dyssynergic Defecation in Chronic Constipation
Authors: Lodhia Nayna , Horton Laura , Goldin Alison , Chan Walter W. 
Published: October 2019

INTRODUCTION:
The role of defecation dysfunction (DD) and rectal sensitivity in opioid related chronic constipation (CC) is unknown. The purpose of this study is to evaluate the relationship between opioid use and rectal sensation, defecatory function, and balloon expulsion on physiology testing.

METHODS:
This was a retrospective cohort study of consecutive adult patients who underwent high-resolution anorectal manometry (HRAM) at a tertiary care center for CC. Baseline patient clinical characteristics and HRAM findings were reviewed. Rectal hyposensitivity was defined by increased rectal sensation volume for first sensation, urge, and maximal tolerance. DD was defined by impaired anal sphincter relaxation (<20% decrease from resting pressure) during strain maneuver with or without weak push, defined as inadequate rectal contraction pressure (<40 mmHg increase from baseline). Successful balloon expulsion was defined by evacuation of 50 mL balloon within 2 minutes. Statistical analyses were performed using Fisher exact or student t-test for univariate analyses and logistical or general linear regression for multivariate analyses.

RESULTS:
317 patients (mean age 50.3 years; 86.8% female) were included. Patients with recent opioid use (<3 months of HRAM) had significantly increased volume for first rectal sensation (70.4 mL vs 61.5, P = 0.043), urge sensation (120.4 vs 104.5, P = 0.04), and maximal tolerance (170.2 mL vs 149.6, P = 0.0083) when compared to those without recent opioid use. No significant difference in rectal sensation was found in patients with a distant history of opioid use (>3 months) (Figure 1). Patients with recent opioid use also had increased risk of DD (63.4% vs 44.9%, P = 0.029), but no difference in failed balloon expulsion (75.9% vs 74.8%, P = 0.90). On multivariate analyses after controlling for potential confounders including history of irritable bowel syndrome (IBS), age, sex and history of abdominal or pelvic surgeries, recent opioid use (<3 months), but not distant use (>3 months), remained independently associated with increased volume for urge sensation (β-coefficient 14.3, P = 0.03) and maximal tolerance (β-coefficient 22.8, P = 0.006), and higher risk for DD (OR 1.67, P = 0.04) (Table 1).

CONCLUSION:
Recent opioid use was an independent risk factor for rectal hyposensitivity and DD on HRAM in patients with CC, but that effect may decrease with discontinuation of use. Anorectal physiology testing may be considered in patients on opioids with CC.
122 Multidisciplinary Quality Improvement Initiative to Reduce Bowel Complications in Post-Operative Orthopedic Patients
Authors: Latorre Melissa , Meneses Michelle , Arbuah Nancy , Adenikinju Abidemi , Wasterlain Amy , Swensen Stephanie 
Published: October 2019

INTRODUCTION:
Gastrointestinal (GI) complications in patients undergoing orthopedic surgery are common but underreported. Prolonged immobility and the use of post-operative narcotics can increase the risk of GI complications which include: constipation, ileus, bowel obstruction, stercoral colitis, perforation, and death. In 2017 we observed an increase in GI complications among patients undergoing orthopedic surgery at our orthopedic hospital. This prompted a multidisciplinary quality improvement (QI) initiative to reduce GI complications among patients admitted after joint or spine surgery.

METHODS:
Following a surge of GI complications at our university-affiliated tertiary referral orthopedic satellite hospital in early 2018 we created a multidisciplinary QI program. The first component was a didactic lecture delivered by a GI attending to the orthopedic trainees, attendings, physician extenders, nurses and staff. The 1 hour lecture discussed an effective GI history, exam and reviewed the symptoms and treatment of common GI conditions affecting post-operative patients. The second component was the development of a post-operative constipation and bowel assessment algorithm focused on early identification, escalation and treatment of GI conditions (Figure 1). The third component was a redesign of the electronic medical record post-operative constipation order sets in order to facilitate implementation of the aforementioned bowel algorithm. This new order set changed laxative orders from “as needed” to standing with an option to be held for diarrhea. These QI initiatives were implemented on a rolling basis from 1/31/2018 to 5/31/2018. Cases of ileus, obstruction and perforation were determined based on coding for admitted orthopedic patients.

RESULTS:
The proportion of patients admitted with each diagnosis was compared from the first quarter (1/1 to 3/31) of 2018 to 2019 corresponding to 6 months after the implementation of all QI components (Figure 2). We achieved a 71% reduction in overall bowel complications (P < 0.05). The greatest reduction was achieved in post-operative ileus by 81% (P < 0.05). Following the QI initiative there was only 1 perforation corresponding to a 50% reduction.

CONCLUSION:
We created a multidisciplinary QI program that successfully reduced GI complications in patients hospitalized following orthopedic surgery. The greatest impact was in the reduction of post-operative ileus and serious adverse events such as perforation.
124 Investigating the Impact of Ambient Lighting on Adenoma Detection Rate and Eye Fatigue During Screening Colonoscopy
Authors: Hoff Ryan T. , Mazulis Andrew , Doniparthi Meghana , Munis Assad , Rivelli Anne , Lakha Asif , Ehrenpreis Eli 
Published: October 2019

INTRODUCTION:
Previous studies indicate that adenoma detection rate (ADR) decreases as the number of consecutive hours performing procedures increases. Differences in adaptation between a bright screen and a dimly lit room may contribute to eye strain and eye strain related symptoms occur in most video display users. Increasing ambient light may improve symptoms of eye strain, but ambient light effects have yet to be explored in the field of gastroenterology. We aim to determine if the use of ambient lighting, between 75–150 lux, during screening colonoscopy will maintain ADRs and decrease symptoms of eye strain.

METHODS:
A single center study comparing screening colonoscopies in a dimly lit room to use of ambient lighting by 9 gastroenterologists was performed. Retrospective data was collected over a 6-month period performed in procedure rooms with no lighting. Prospective data was then collected on colonoscopies with ambient lighting during the same 6 calendar months the following year. A survey on eye fatigue was completed by all gastroenterologists before and after the use of ambient lighting. Satisfaction surveys were completed by gastroenterologists, anesthesiologists, nurses and technicians.

RESULTS:
There were 498 low light and 611 ambient light cases. 172 adenomas (ADR = 34.5%) were detected with low light and 220 adenomas were detected with ambient light (ADR = 36.0%) (P = 0.611). For low light cases, ADR was 37.5% for 1st cases of the day and 31.9% for last cases of the day (P = 0.545) (Table 1). For ambient light cases, the ADR was 34.1% for 1st cases of the day and 36.9% for last cases of the day (P = 0.266). Overall difference in ADR between 1st and last cases using ambient lighting (+2.80%) versus no lighting (−5.60%), was statistically significant (P = 0.010) (Table 2). 41% of respondents agreed or strongly agreed fewer symptoms of eyes strain occurred with ambient light and 54% of respondents felt that ambient light improved detection of changes in patient status.

CONCLUSION:
Our data suggests that performing screening colonoscopies with ambient light may improve the differential change in ADR that occurs from the beginning to the end of the day, as compared with lights off. This improvement in ADR may be related to improved symptoms of eye strain, and further investigation is warranted.
126 Association Between Sessile Serrated Adenoma and Extra-colonic Malignancies
Authors: Fathallah Jihan , Al-Jumayli Mohammed , Jahandar Donya R. , Hejazi Reza , Young Chase 
Published: October 2019

INTRODUCTION:
Sessile serrated adenomas (SSAs) are precursors for 20% of microsatellite unstable colon cancers with the CpG island methylator phenotype. They are the result of a BRAF mutation and promoter hypermethylation of tumor suppressor genes or mismatch repair genes. Eighty percent of SSA harbor BRAF V600E mutation with some having KRAS mutation. BRAF V600E mutation can lead to different kinds of malignancies. Therefore, we conducted a retrospective study to assess the association between SSAs and extra-colonic malignancies.

METHODS:
We performed a retrospective study of patients diagnosed with SSA on colonoscopies done in Kansas University Medical Center from 2016 to 2018. The diagnosis of SSA was confirmed by histologic exam interpreted by pathologists. The group of SSA patients was compared to patients diagnosed with non-SSA polyp (control group). The electronic records were reviewed for data extraction regarding demographics and extracolonic malignancies.

RESULTS:
400 patients were diagnosed with SSA from 2016 to 2018 compared to 372 patients with tubular/villous adenomas. The majority of patients in SSA and non-SSA groups were Caucasians (92% and 84.5% respectively). Mean age in group of SSA was higher than control group (age 65 ± 11 vs 55 age ± 10). Underlying morbidity i.e., obese/overweight (43.75% vs 24.5%), and HTN (51.25% vs 21%) were more common in SSA group. The two groups demographics are shown in Table 1. 60% of patients with SSA, including 6.25% of patients with skin cancer and 5.5% of those with breast cancer, had family history of cancer in first degree relative. Only 2.75% of patients with SSA had history of different organ transplant. Thirteen extra-colonic malignancies were identified (Table 2). Patients with SSA had significantly higher rates of skin cancers including, non melanoma skin cancer (12%) and breast cancer (8.25%) compared to non-SSA patients (6.2%, and 3%, P-values < 0.05 respectively).

CONCLUSION:
To our knowledge this is the largest study of the association between SSA and extra-colonic malignancies. We found a significant association between breast and skin cancer with SSA. This could be potentially explained by presence of BRAF V600E mutation in SSA which is a precursor for different types of tumors especially melanomas. We suggest prospective studies are needed to determine whether patients with SSA should have more expanded and different cancer screening tests. Until then we emphasize the importance of skin exams and screening mammograms for patients with SSA.
129 Association Between Colitis and Immune Checkpoint Inhibitor Use: Analysis of the FDA Adverse Event Reporting System (FAERS)
Authors: Tunio Nahel A. , Cooper Gregory S. 
Published: October 2019

INTRODUCTION:
Immune checkpoint inhibitors (ICI) are increasingly being used for management of malignancies, but they are associated with serious immune-related adverse events (irAE) due to overactivation of the immune system. Gastrointestinal tract is commonly affected by the ICI and have been frequently reported in literature. The purpose of this study is to evaluate the epidemiology of colitis associated with ICI use reported to the FDA.

METHODS:
We used the Food and Drug Administration Adverse Event Reporting System (FAERS), a database that contains adverse events reports, medication error reports and product quality complains reported to the FDA. It is a voluntary post-marketing pharmacosurveillance database maintained by the FDA. We identified all adverse events (AEs) associated with 5 FDA-approved ICIs (Nivolumab, Ipilimumab, Pembrolizumab, Atezolizumb, Durvalumab) between April 2011 and December 2018. We investigated the number of colitis cases associated with these ICI reported to the FDA.

RESULTS:
We identified 53,899 adverse events related to ICI that were reported to FDA, out of which 1908 (3.54%) were reported as colitis. The highest number of colitis was reported to be associated with Ipilimumab 1278 (53.9%), followed by Nivolumab 784 (33.1%). Given that these ICI were approved during different years ranging from 2011–2017, we identified total number of colitis cases in the year 2018 and determined that 12.01% of colitis-deaths were associated with Nivolumab, followed by Ipilimumab (7.48%). The number of colitis cases reported increased from 236 in 2011–2013, to 665 in 2014–2016, and 1007 in 2017–2018 (Figure 2). Moreover, of the total 1908 colitis cases, 1849 cases were noted to be serious cases out of which 336 (17.6%) died due to colitis.

CONCLUSION:
In the FAERS database we described the prevalence of colitis as an immune related adverse event associated with the use of immune checkpoint inhibitors. Colitis accounted for 3.5% of the total adverse events reported with ICI between 2011 and 2018. Moreover, our study showed high mortality rate (17.6% of the cases) associated with ICI-Colitis.