bluuebunny/crossref_metadata_2025_split huggingface dataset:
784 A Population-Based Analysis of Obesity, Metabolic Syndrome, and Cardiovascular Outcomes Among Patients With Inflammatory Bowel Disease in the National Health and Nutrition Examination Survey 2009-2010
Authors: Tirath Ankita , McHenry Scott , Rhea Lee , Salter Amber , Deepak Parakkal 
Published: October 2019

INTRODUCTION:
Prior studies have reported high prevalence of obesity and metabolic syndrome in inflammatory bowel disease (IBD) pts, increasing the risk for stroke and coronary artery disease (CAD). Here, we compare the prevalence of obesity, metabolic syndrome and cardiovascular outcomes in IBD compared to non-IBD controls in a large, nationally representative United States (US) population, controlling for traditional risk factors and dietary habits.

METHODS:
IBD pts were identified in the National Health and Nutrition Examination Survey (NHANES) 2009-2010. This population-based survey combines data from pt interviews, physical exam, and lab tests. For analysis, obesity was defined as BMI ≥ 30 and metabolic syndrome by waist circumference, presence of diabetes, hypertension, and hyperlipidemia. IBD pts were propensity matched in a 1:5 ratio to non-IBD controls on age, gender, race, 26-item dietary screener questionnaire (DSQ), smoking, and alcohol usage. Cardiovascular outcomes analyzed included CAD, congestive heart failure (CHF), angina/angina pectoris, myocardial infarction (MI), and stroke with 1:5 propensity matching done on age, gender, race, BMI, body composition, presence of metabolic syndrome, DSQ items, smoking, and alcohol use. Raw data was extrapolated to the US population using provided sample weights and analyses performed using SAS 9.4.

RESULTS:
A total of 62 IBD pts were identified; 3 were excluded due to missing data. Baseline characteristics of the IBD (median age 54, 63% female, 46% white) and the propensity matched non-IBD group can be seen in Table 1. The prevalence of obesity in the IBD cohort was 34% compared to 41% in the non-IBD cohort, and when extrapolated to the U.S. population was not significant (P = 0.13). Similarly, the prevalence of metabolic syndrome in IBD compared to non-IBD, 43% to 45%, was not significant when extrapolated to the US population (P = 0.52). Comparing IBD to non-IBD controls (Table 2), there was no significant difference in prevalence of CAD (7.1% VS 4.4%, P = 0.45) or angina (3.6% vs 2.95, P = 0.97) while there was trend towards significance for stroke (8.9% vs 3.6%, P = 0.0599).

CONCLUSION:
Our findings suggest that when controlled for traditional risk factors and dietary habits, the prevalence of obesity, metabolic syndrome and cardiovascular disease in a nationally representative survey of self-reported IBD population in the US is similar to the non-IBD population.
788 The Natural History and Treatment Outcomes of Concomitant Eosinophilic Esophagitis (EoE) and Inflammatory Bowel Disease (IBD)
Authors: Urquhart Siri A. , Quinn Kevin P. , Ravi Karthik , Loftus Edward V. 
Published: October 2019

INTRODUCTION:
Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are distinct chronic inflammatory conditions involving the gastrointestinal tract. The presence of eosinophilic infiltration in gastrointestinal mucosa has been observed as a histopathological feature of IBD, being described in both Crohn's disease (CD) and ulcerative colitis (UC). The natural history of patients with coexisting EoE and IBD has not been extensively studied. Our aim was to determine clinical characteristics and treatment outcomes in patients with concomitant IBD and EoE.

METHODS:
A retrospective cohort study was performed of all EoE patients who also had a diagnosis of IBD from January 2000 to December 2018. Patients were identified using ICD-9 and ICD-10 diagnostic codes. Confirmation of EoE and IBD diagnoses were required for inclusion in the study. Pertinent demographic and clinical data were extracted from the electronic medical record. Treatment outcomes and frequencies of disease-related complications were determined.

RESULTS:
Sixty-nine patients met inclusion criteria (68.1% male) with a median follow-up of 6 years. Forty-one patients had a diagnosis of CD (59.4%), 26 UC (37.7%), and 2 indeterminate colitis (IC) (2.9%). Forty-eight patients were diagnosed with IBD prior to EoE (69.6%). The most common treatments for EoE were proton pump inhibitors (78.3%) and topical steroids (59.4%) with 51.9% and 63.4% demonstrating clinical improvement, respectively (Table 1). The most common treatments for IBD were oral 5-aminosalicyclic acid (5-ASA) (69.6%), oral corticosteroids (66.7%), azathioprine (44.9%), and adalimumab (43.5%), with 37.5%, 43.5%, 35.5%, and 50% demonstrating clinical improvement, respectively (Table 2). Fifteen patients with CD (36.5%), 7 with UC (26.9%) and 1 with IC (50%) required surgical intervention for IBD. Eighteen patients with CD (43.9%), 8 with UC (30.8%), and 1 with IC (50%) required hospitalization for IBD (Table 3).

CONCLUSION:
Recent literature has shown an association between IBD and EoE. In our cohort, IBD is the more frequent initial diagnosis. As such, it is important to be vigilant for signs suggestive of EoE in patients with IBD and evaluate accordingly. It seems most patients with IBD and EoE respond to conventional treatment modalities used for each diagnosis. However, about 40% of patients with CD and EoE required hospitalization and/or surgical intervention, possibly suggesting a more severe phenotype in this specific subset of patients.
789 The Association Between Inflammatory Bowel Disease and Lactose Intolerance
Authors: Asfari Mohammad Maysara , Sarmini Muhammad Talal , Kendrick Katherine , Sridhar Subbaramiah , Sifuentes Humberto 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) is a complex condition precipitated by genetic susceptibility and disturbed microbiome. The role of dairy foods in IBD has been controversial. Therefore, we aimed to investigate the association between lactose intolerance (LI) and IBD.

METHODS:
Data on hospital admissions of all IBD adult patients were extracted from the National Inpatient Sample (NIS) database between 2004 and 2014. Comorbidities and outcomes of interest were defined by querying all diagnostic and procedural fields for the corresponding ICD-9 codes. Patients who were diagnosed with IBD were defined (study group). The control group were the patients who did not have a diagnosis of IBD. LI diagnosis was identified in both study and control groups using the ICD-9 codes. Univariable and multivariate logistic regression was performed to study the association between IBD and LI.

RESULTS:
The total population was comprised of 71,342,237 patients, of which 598,129 (0.83%) were diagnosed with IBD. IBD patients were younger (52 vs 57) with fewer female (57.5% vs 60.1%) and African American patients (10% vs 14.3%) (P < 0.0001 for all). In addition, the IBD patients had more tobacco use (14% vs 12%). After adjusting for the potential cofounding factors including age, race, gender, obesity and tobacco use, the IBD group had a statistically significant higher rate of LI (Odds Ratio [OR], 2.71, 95% confidence interval [CI], 2,55-2.88, P < 0.0001) compared to non-IBD group. The findings were similar on further stratification of IBD into Crohn's disease compared to the control group (OR: 2.7, 95% CI: 2.50–2.92, P < 0.0001) and ulcerative colitis compared to the control group (OR: 2.71, 95% CI: 2.46–2.98, P < 0.0001).

CONCLUSION:
IBD patients have a 2.7 times higher risk of suffering from lactose intolerance. Screening for lactose intolerance in this population warranted to avoid confusing symptomatology with inflammatory bowel disease activity.
794 Admission Risk Factors as Predictors of In-Hospital Colectomy in Acute Severe Ulcerative Colitis
Authors: Dwadasi Sujaata , Goens Donald , Paknikar Raghavendra , Zafer Maryam , Rubin David T. , Micic Dejan 
Published: October 2019

INTRODUCTION:
Ulcerative colitis is an immune-mediated disorder characterized by chronic inflammation of the gastrointestinal tract. In the setting of hospitalization and presentation with acute severe ulcerative colitis (ASUC), the risk of colectomy approaches 30-40%. In an effort to improve medical therapies, identifying early predictors for colectomy has the potential to reduce the risk of surgery in ASUC.

METHODS:
We designed a retrospective study including all patients >18 years of age with an admission for ASUC at the University of Chicago Medical Center between the 1/1/2013 and 4/1/2018. Cases of were identified using the ICD-9 code 556.X and ICD-10 code K51.X and separately reviewed based on clinical, radiographic, histologic and endoscopic information. Additional electronic variables of interest were extracted from the electronic data warehouse. Data were analyzed using Wilcoxon rank-sum test for continuous variables and Fischer's exact test for categorical variables. Multivariate logistic regression was performed to identify independent factors predictive of inpatient colectomy.

RESULTS:
We identified 260 unique patient encounters admitted for ASUC, of which 59 (22.7%) underwent inpatient colectomy. Risk factors for inpatient colectomy are demonstrated in Table 1. Among individuals requiring colectomy in univariate analysis, a prior history of DVT/PE, prior admission for intravenous steroids or recent hospitalization were predictive of colectomy. Presenting endoscopic Mayo score, number of prior biologic therapy exposures, and laboratory values suggestive of active inflammation were predictive of colectomy. In a final multivariate model, risk factors of inpatient colectomy included: number of prior biologic exposure (OR: 2.27, 95% CI 1.5-3.4), transfer from an outside hospital (OR: 5.03, 95% CI 1.97-12.86) and platelet count on admission (OR: 1.01, 95% CI 1-1.01).

CONCLUSION:
Early identification of potentially medically refractory disease has the potential to reduce need for colectomy in ASUC. Number of prior exposures to biologic therapies, transfer from an outside institution and platelet count are independently associated with risk of colectomy. Additional studies are required to improve the medical therapies offered to high-risk patients in order to reduce colectomy risk.
797 High Thiopurine Methyltransferase Activity Does Not Affect Concentration of Azathioprine Metabolite 6-Thioguanine Nucleotide in Inflammatory Bowel Disease
Authors: Jonason David , Sievers Tyson , Abraham James M. , Vaughn Byron 
Published: October 2019

INTRODUCTION:
Azathioprine (AZA) is commonly used to treat inflammatory bowel disease (IBD). Thiopurine methyltransferase (TPMT) converts AZA to key active metabolite 6-thioguanine nucleotide (6-TGN). Low TPMT activity is associated with high 6-TGN and side effects. Conversely, low 6-TGN is associated with lack of clinical response and has been associated with high TPMT activity but has not been examined in an IBD population. The aim of this study was to identify the independent effect of normal to high TPMT activity on 6-TGN concentrations in an IBD population.

METHODS:
We performed a retrospective chart review of patients aged >18 with IBD treated with AZA and with documented TPMT activity and 6-TGN levels from 2010 to 2017. To account for different assays, TPMT activity was normalized against the established low-normal TPMT activity, with low activity defined as less than 1 and high activity defined as above the 75th quantile of TPMT activity in the cohort. Those with low TPMT were excluded. Linear regression was used to determine the effect of TPMT activity on 6-TGN accounting for potential confounders. Further assessment of the interaction between dose and TPMT activity on 6-TGN was measured through the Average Causal Mediation Effects (ACME). Statistics performed in R v3.6.0 using mediation package. This study was IRB approved.

RESULTS:
Dosing of AZA in mg/kg, TPMT activity, and 6-TGN concentration were documented in 63 patients, of which 10 had low TPMT activity and were subsequently excluded, leaving 53 patients for analysis. Overall 37% of the cohort had a therapeutic 6-TGN level of >240 pmol/8 × 108 RBC. No patient under 1mg/kg achieved a therapeutic 6-TGN level, whereas 50% of patients taking 2.5 mg/kg did. The median 6-TGN in the normal TPMT range was 191.5 (IQR: 78.8, 296.3) versus 201 (IQR: 45, 312) in the high group (P = 0.57). There was a weak positive correlation between dosing (mg/kg) and 6-TGN (R2 = 0.08), while no correlation was seen between TPMT and 6-TGN (R2 = 0.0). Linear regression to assess the effect of TPMT activity and dose on 6-TGN concentrations including potential confounders of sex, age, smoking status only identified dose (mg/kg) to have a significant effect on 6-TGN concentration (Table 1).

CONCLUSION:
There was no effect on 6-TGN as TPMT activity increased, although 6-TGN was positively affected by dose. Despite normal TPMT activity, therapeutic 6-TGN concentrations were only found in 50% of those dosed at 2.5 mg/kg.
802 Risk Factors for 90-Day Readmission Among Hospitalized Patients With Ulcerative Colitis
Authors: Goens Donald , Dwadasi Sujaata , Paknikar Raghavendra , Zafer Maryam , Rubin David T. , Micic Dejan 
Published: October 2019

INTRODUCTION:
The hospitalization of a patient with an ulcerative colitis (UC) flare reflects a severe disease state and is a significant contributor to the overall costs of care. Thus, understanding which factors influence the likelihood of readmission among patients hospitalized for UC is critical to providing high quality, low cost care. This study aims to evaluate which factors for patients admitted with UC are associated with an increased risk for 90-day readmission.

METHODS:
We designed a retrospective study including all patients 18 years or older with an admission for ulcerative colitis at the University of Chicago Medical Center between 1/1/2013 and 4/1/2018. Cases of ulcerative colitis were identified using the ICD-9 code 556.X and ICD-10 code K51.X and separately reviewed based on clinical, radiographic, histologic and endoscopic information. Data was analyzed using a Wilcoxon rank-sum test for continuous variables and Fischer’s exact test for categorical variables. Multivariate logistic regression was performed to identify independent risk factors for 90-day readmission.

RESULTS:
1,455 admissions were reviewed. 1,046 were excluded for age < 18 (n = 102), diagnosis of Crohn’s disease (n = 42), colitis other than UC (n = 13), history of colectomy (n = 245), admissions unrelated to a UC flare (n = 430), planned surgical procedures (n = 199) and other (i.e. duplicate records, leaving against medical advice; n = 19). An additional 149 were removed for being rehospitalizations (n = 103), absence of 90 day follow up (n = 42). Of the 260 patients remaining, 48 patients (18%) were re-admitted to the hospital within 90 days. Factors associated with re-admission on univariate analysis included: history of parenteral nutrition use prior to colectomy (17.1% vs 6.2%, P = 0.036), use of steroids as an outpatient prior to admission (77.1% vs 57.1%, P = 0.013), and mean units of blood transfused during hospitalization (0.46 vs 0.25, P = 0.006). After controlling for factors in univariate analysis, only outpatient steroid use prior to admission was associated with increased risk of 90-day readmission (OR 3.52; 95% CI 1.32-9.33) (Table 1).

CONCLUSION:
Of the factors studied, only steroid use prior to admission was an independent risk factor for readmission. Additional factors related to readmission risk throughout the hospitalization to include laboratory and vital sign trends may offer additional insights into the risk of readmission.
803 The Majority of Patients With Inflammatory Bowel Disease Are Interested in Drug Discontinuation Despite Risks
Authors: Harrison Nicole , McCarthy John , Singla Manish 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) is a chronic autoimmune condition affecting the gastrointestinal tract. Advances in immunosuppression have led to high rates of remission; discontinuation of immunosuppression is associated with a 50% risk of relapse within 2 years. The aim of this study is to determine whether patients would be interested in drug discontinuation despite this risk of relapse.

METHODS:
This is a retrospective study of patients in our IBD clinic in clinical remission for greater than a year with no signs of ongoing inflammation that were counseled on immunosuppression discontinuation and the risks therein. We examined the electronic health record for their age, duration of disease, disease phenotype and severity, duration of therapy, and disease characteristics (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fecal calprotectin, endoscopy) at time of discussion. All patients were counseled by one of two IBD specialists of a 50% risk of flare within 2 years with a 80-90% chance of recapture with the same agent that was discontinued. Decisions about which patients to offer discontinuation were at the discretion of the provider. Patients who self-elected to discontinue drugs were excluded from the study.

RESULTS:
40 patients were counseled on drug discontinuation. Average age was 50.0 ± 15.0 years. Patients had an average of 15.5 ± 9.9 years of disease, and 6.1 ± 5.0 years of the therapy that was discussed for discontinuation. 39 patients (98%) wanted to discontinue drugs. 20 discontinued 6-mercaptopurine, 8 patients discontinued methotrexate, 4 patients discontinued azathioprine, 3 patients discontinued adalimumab, and 3 patients discontinued infliximab. At time of discontinuation, patients had a mean ESR of 19.3 ± 13.0 mm/hr, and a mean CRP 0.30 ± 0.54 mg/dL. After a mean 29.0 ± 16.8 months of follow up, four patients had clinically flared and were placed back on immunosuppression. The remaining 36 patients had a follow up mean ESR 20.1 ± 14.8 mm/hr and CRP 0.27 ± 0.32 mg/dL.

CONCLUSION:
Patients with IBD are overwhelmingly interested in drug discontinuation, with >95% of patients offered discontinuation choosing to do it. In carefully selected patients, discontinuation is safe and well tolerated, with 90% of patients in biomarker and clinical remission more than 2 years after drug discontinuation.
808 Clinical Course of Patients With Concomitant Eosinophilic Esophagitis and Inflammatory Bowel Disease
Authors: Leung David , Nhu Quan M. , Konijeti Gauree G. 
Published: October 2019

INTRODUCTION:
An overlap between eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD), both immune-mediated diseases of the gastrointestinal tract, is gaining recognition. However, the natural history and clinical implications of concurrent EoE and IBD remain to be characterized. We describe an institutional experience of patients with concurrent EoE and IBD.

METHODS:
We conducted a retrospective single-center case series of patients with diagnoses of EoE and either Crohn’s disease (CD) or ulcerative colitis (UC) seen between 01/01/2008 and 12/01/2018. Clinical data were analyzed for demographics, diagnostic findings, medical treatments, and disease outcomes.

RESULTS:
In our cohort, the prevalence (per 100,000 patients) of EoE, CD, and UC was 58.9, 111.4, 159.5, respectively. We identified 7 patients with both IBD (4 CD, 3 UC) and EoE. All were Caucasian, with median age 52 (SD 15.9), and 86% male. Median age at diagnosis of IBD was 25.5 (SD 17.4), and EoE was 50 (SD 15.9). Diagnosis of IBD preceded EoE in 6/7 patients, by an average of 14.3 years (range, 2-30 years). At the time of EoE diagnosis, IBD therapies included no therapy (29%), mesalamine (29%), ustekinumab (14%), or adalimumab/6-mercaptopurine (14%). EoE was treated with proton-pump inhibitor (PPI) in 4 patients (43%), elimination diet in 2 (29%), and/or swallowed fluticasone in 1 (14%). EoE complications, identified at time of EoE diagnosis, included 2/7 (29%) requiring esophageal stricture dilation. No further EoE complications developed following EoE treatment. CD complications preceded diagnosis of EoE, with 2 patients with perianal fistula, one with both ileal stricture and perianal fistula. No UC-associated or additional CD complications were identified after EoE diagnosis. Co-existing immune-mediated conditions included allergic rhinitis (43%), primary sclerosing cholangitis (14%), and rheumatoid arthritis (14%).

CONCLUSION:
In our cohort, diagnosis of IBD preceded EoE diagnosis by more than one decade, with EoE median age at diagnosis occurring later in IBD than that reported in non-IBD patients. Majority of disease-related complications in either IBD or EoE appear unrelated to concomitant diagnosis or treatment. Further studies are needed to examine immune-mediated pathways resulting in these concomitant diagnoses
811 Ustekinumab for Concomitant Crohn’s Disease and Psoriasis
Authors: Rehman Saif U. , Farooq Umer , Amin Muhammad K. , Ahmed Zahoor , Bakhat Khush , Riaz Asma , Gondal Amlish B. 
Published: October 2019

INTRODUCTION:
Ustekinumab (CNTO 1275), approved for Crohn’s disease (CD) and psoriasis, acts by preventing the immune responses involved in the pathogenesis of CD and psoriasis. It is an IgG1 monoclonal antibody that blocks the activation of IL-12 and IL-23 by binding to their P40 subunits. The scope of this systematic review was to review the clinical effectiveness of Ustekinumab in the treatment of patients who have a concomitant diagnosis of CD and psoriasis.

METHODS:
A systematic literature search was conducted using MeSh terms on MEDLINE per PRISMA reporting guidelines. Following the PICO framework, research articles with patients having a concomitant diagnosis of Crohn’s disease and psoriasis, treated with Ustekinumab were included. Psoriatic subjects with CD were included, regardless of whether their psoriasis was primary or anti-TNF therapy induced. Study designs included were retrospective cohorts, prospective cohorts, clinical trials, case reports and case series due to the anticipated paucity of literature on the study topic. Studies on non-human subjects and not in English were excluded.

RESULTS:
Of the 45 studies identified by systematic searches, 8 studies (n = 206) met the inclusion criteria (Figure 1). Seventy five percent patients had concurrent CD and treatment induced psoriasis whereas the rest had concurrent CD and primary psoriasis. Inductions doses of Ustekinumab ranged from 45 mg to 90 mg subcutaneously; maintenance doses were 45 to 90 mg after every 12 weeks, subcutaneously. In this patient population with concomitant CD and psoriasis (Table 1), Ustekinumab was reported to be efficacious for treatment of CD, reducing Crohn’s disease activity index (CDAI) and Harvey Bradshaw index scores, while demonstrating improvement in clinical symptoms and ileocolonoscopy findings. Similarly, improvement in psoriasis was reported by reductions in psoriasis area and severity index (PASI) and clinical assessments of disease severity.

CONCLUSION:
Ustekinumab appears to be novel drug for the treatment of concurrent Crohn’s disease and psoriasis. However, the published literature is limited by its retrospective nature and the extremely limited availability of epidemiologic data for patients with concurrent Crohn’s and psoriasis. Considering the shared immuno-pathogenetic mechanisms governing CD and psoriasis, further investigation is needed on studying the efficacy and adverse effects of ustekinumab.