bluuebunny/crossref_metadata_2025_split huggingface dataset:
1203 Low Viscosity Soluble Dietary Fibre for Gastroparesis Sufferers
Authors: Suresh Harsha , Zhou Jerry , Ho Vincent 
Published: October 2019

INTRODUCTION:
Gastroparesis is a chronic idiopathic disorder which affects 125,000 people in Australia. The symptoms of gastroparesis can range from mild to very severe. Current management of gastroparesis involves enteral strategies such as prescription drugs, feeding tubes using jejunostomy and gastric electric simulation (GES). Medical practitioners currently recommend that gastroparesis sufferers take little to no fibre in their diet regardless of the severity of their symptoms but low-viscosity soluble fibres have been proposed as a solution for dietary fibre intake in mild to moderate gastroparesis sufferers.

METHODS:
The rheological properties of ten soluble dietary fibres were studied under normal and simulated gastric conditions. A clinical trial involving two soluble fibres (test fibres), one partially-soluble fibre (positive control) and no fibre (negative control) was approved under the UID H12254 at Western Sydney University, AUS. The clinical trial is used to study blood glucose absorption, symptoms and mouth-to-caecum emptying times of eligible patients after consumption of soluble dietary fibres under controlled conditions. The polysaccharide chain length and monosaccharide unit composition in these dietary fibres will be analysed using Q-ToF-MS.

RESULTS:
The rheological stress σ (Pa) at the visco-elastic relaxation modulus Gc under normal and simulated gastric conditions was characterised for 10 different fibres. There was a significant reduction in the rheological stress from normal to gastric conditions for three low-stress soluble fibres. Two of those three low-stress fibres and one medium-stress fibre were selected for the clinical trial. Preliminary results of the clinical trial (6 patients) indicate that most patients find the low-stress fibres more palatable than the medium-stress fibre based on the Gastroparesis Cardinal symptom Index (GCSI). No significant differences in postprandial blood glucose absorption over 3 hours were observed for both the low-stress and medium-stress fibres. The low-stress fibres also show no significant delay in gastric emptying up to 3 hours compared to the negative control using hydrogen breath test analysis.

CONCLUSION:
The preliminary results of the rheology and the clinical trial indicate that soluble fibres could be incorporated into the diet of a gastroparesis patient. We hope to summarize the rheological, chemical and clinical data about these fibres and provide the relevant information to dieticians and gastroenterologists.
1205 The Prevalence of Carcinoid Tumors of the Stomach in the USA: A Population-Based Study
Authors: Saleh Mohannad Abou , Sarmini Muhammad Talal , Rouphael Carol , Mansoor Emad , Chak Amitabh , Vargo John , Bhatt Amit 
Published: October 2019

INTRODUCTION:
Most carcinoid tumors occur in the GI tract. Epidemiologic studies evaluating gastric carcinoid (GC) tumors were limited by small sample size. Our aim was to obtain an epidemiologic survey of GC tumors using population-based data in order to identify the prevalence and underlying associations.

METHODS:
A commercial database (Explorys Inc, Cleveland, OH), an aggregate of electronic medical records from 26 major integrated US healthcare systems. was used. We identified all patients aged 18 and older who were diagnosed with gastric carcinoid tumors between 1996 and 2018 based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT) and evaluated the prevalence of GC tumors. We also performed analyses to describe age-, race-, and gender-based distributions and to identify associations. Annual inpatient admissions trend was reviewed using the National Inpatient Sample (NIS) database 2008-20014 where all patients with GC were identified.

RESULTS:
Of the 62,881,700 individuals in the database, 1,590 were identified to have GC tumors with prevalence of 2.53/100,000. Individuals with GC tumors were more likely to be females [OR: 1.43; 95% CI 1.30 to 1.59, P < 0.0001], elderly (age >65) [OR: 4.26; 95% CI 3.56 to 4.70, P < 0.0001], Caucasians [OR: 2.18; 95% CI 1.95 to 2.44, P < 0.0001], smokers [OR: 3.01; 95% CI 2.61 to 3.47, P < 0.0001], with history of alcohol use [OR: 3.01; 95% CI 2.69 to 3.36, P < 0.0001], diabetes mellitus (DM) [OR: 9.76; 95% CI 8.84 to 10.78, P < 0.0001], pernicious anemia [OR: 122.00; 95% CI 104.03 to 141.99, P < 0.0001], obesity [OR: 6.38; 95% CI 5.74 to 7.10, P < 0.0001], family history of cancer [OR: 8.86; 95% CI 7.82 to 10.05, P < 0.0001], and multiple endocrine neoplasia type 1 [OR: 900.01; 95% CI 576.22 to 1405.75, P < 0.0001] (Figure 1). Prevalence in the past 5 years is on the rise in the Explorys database (Figure 2). Of the study group, 40 (3%) had total gastrectomy, 140 (9%) had subtotal gastrectomy, and 190 (12%) had surgical excision of the tumor. Using NIS database, we identified total of 53,281,476 inpatient admissions between 2008 and 20014 of which 1,334 were diagnosed with GC. The trend analysis showed that the number of annual inpatient admissions with GC is also gradually increasing as shown in Figure 3 (P < 0.001).

CONCLUSION:
This is the largest epidemiological study evaluating the prevalence of GC tumors. We estimated the prevalence rate of GC tumors to be 2.53/100,000. The overall prevalence is rising with increase in the annual admissions as well.
1208 Contemporary Prevalence and Predictors of Helicobacter pylori Infection in a U.S. Population
Authors: Peng Frederick B. , Nguyen Theresa H. , Emelogu Ikenna , Mallepally Niharika , Liu Yan , Thrift Aaron P. , El-Serag Hashem B. , Tan Mimi C. 
Published: October 2019

INTRODUCTION:
The prevalence of Helicobacter pylori has been declining overall, but there is no current screening strategy in the U.S. to identify patients with H. pylori. We identified the prevalence and predictors of H. pylori infection among patients undergoing upper endoscopy with gastric biopsies in the Harris County Hospital System.

METHODS:
We identified consecutive patients undergoing upper endoscopy with gastric biopsies for any indication from two hospitals in the Harris County Hospital System in Houston, TX during 1/2015-12/2016. We abstracted sociodemographic, laboratory, endoscopic, and histopathologic data from the medical record to evaluate previous as well as active H. pylori infection seen on gastric biopsy. We determined the overall and race/ethnic specific prevalence of H. pylori infection. We evaluated associations between demographic, lifestyle, and endoscopic features with H. pylori infection in logistic regression models, reported as odds ratios (OR) and 95% confidence intervals (CI).

RESULTS:
Of 943 patients who underwent gastric biopsies, 376 were men (39.9%) with mean age 53.0 years (SD 11.6 years). Most were Hispanics (51.1%) or blacks (26.0%) with a small proportion of whites (11.1%). The overall prevalence of H. pylori infection was 52.8% (n = 498), which was highest among Hispanics (60.2%), blacks (51.0%), and Asians (52.3%) compared to whites (21.9%). Of 943 patients, 486 (51.5%) were previously screened for H. pylori infection, and 301 (31.9%) had tested positive. Predictors of H. pylori included male sex (adjOR 1.53, 95% CI 1.10-2.13), race (vs. white, black adjOR 3.76, 95% CI 2.19-6.45; Hispanic adjOR 5.31, 95% CI 3.14-9.00; Asian adjOR 3.96, 95% CI 1.93-8.11), and proton pump inhibitor use (adjOR 1.50, 95% CI 1.10-2.05). Gastric polyps identified on endoscopy were associated with the absence of H. pylori (OR 0.57, 95% CI 0.37-0.88). There were no significant associations with age, family history of gastric cancer, smoking, alcohol use, or endoscopy indication.

CONCLUSION:
In this contemporary U.S. cohort of patients undergoing endoscopy with gastric biopsies, the overall prevalence of H. pylori infection is very high (52.8%). Black, Hispanic, and Asian race were associated with high H. pylori infection, and men were at higher risk of developing this infection. These findings call for developing a H. pylori screening strategy in certain high risk U.S. populations.
1211 Socio-Demographic Disparities in Gastric Cancer: A Population-Based Study
Authors: Rana Navpreet , Gosain Rohit , Lemini Riccardo , Groman Adrienne , Mukherjee Sarbajit 
Published: October 2019

INTRODUCTION:
Gastric cancer is one of the leading causes of cancer-related mortality worldwide, with a global burden of 5.7% new cases each year and 8.2% of cancer-related deaths. Area of residence has been found to affect survival in different cancers but their impact on gastric cancer remains largely unknown. The purpose of this study is to address the potential disparities between the rural and urban populations affected by gastric cancer.

METHODS:
We conducted a retrospective study, analyzing different socio-demographic factors associated with populations affected by gastric cancer between 1973 and 2015. Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to evaluate disease-specific survival (DSS) and overall survival (OS). Different socio-demographic factors including location of residence, that is urban area (UA) or rural area (RA), gender, race, insurance status and marital status were included in the analyses.

RESULTS:
A total of 68,959 [RA, N = 6,841; UA, N = 60,282] patients were included in the study. The incidence of gastric cancer was noted to have a steady decline during the studied time period, in both RA and UA. Majority of the study population was non-Hispanic white (N = 42,806, 62%) and male (N = 46,504, 67%). Univariate and multivariate analysis showed that RA had the worst DSS (univariate - HR = 1.15, P < 0.001; multivariate - HR = 1.13, P < 0.001) and OS (univariate - HR = 1.13, P < 0.001; multivariate HR = 1.11; P < 0.001) compared to UA. Similarly, DSS and OS was poor in uninsured and single patient population compared to insured patients and married couples respectively. Multivariate analysis further showed female patients had better DSS (HR = 0.91, P < 0.001) and OS (HR = 0.88, P < 0.001) in comparison to their male counterparts.

CONCLUSION:
This study identifies socio-demographic disparities in gastric cancer. Access to healthcare, variations in patient care, environmental and lifestyle factors as well as genomic differences are all potential factors that affect the OS. This is consistent with the available literature in gastric cancer, including studies demonstrating survival differences in different populations undergoing surgical treatment in the United States. Based on the above data, it is imperative for future health policy initiatives to address these disparities in an effort to improve OS.
1213 Barriers in Completion of H. pylori Eradication Testing in Predominantly Underserved Hispanic Resident Clinic: A Quality Improvement Project
Authors: Nagirimadugu Ankita , Rozenshteyn Frederick , Young Ari 
Published: October 2019

INTRODUCTION:
We present a quality improvement study at a resident clinic serving predominantly underserved Hispanic/Latino patients to assess physician and patient adherence to completing H. Pylori stool test of cure, and provide sustainable interventions to increase rates of eradication.

METHODS:
A database of patients who had confirmed H. Pylori via stool testing from July 9, 2015–June 30, 2017 was created and reviewed retrospectively. The primary endpoint was to determine the rate of eradication confirmation and observe barriers in providing the standard of care. Secondary outcomes include delay in collection and treatment. Data analysis was completed with the student's T-Test and Z-Test.

RESULTS:
A total of 102 patients with confirmed H. Pylori were included in this study. Patient population was predominantly identified as Hispanic (72 patients), and English was the primary language in 59 (57.8%) patients. Average delay in collection of primary stool samples to make the diagnosis of H. Pylori was 7.14 days. Men vs. women average delay in completion of initial H. Pylori testing was noted to be 10 days vs. 4.9 days with a T-Score of 1.01 (P = 0.312). Hispanic vs. non-Hispanic patients average delay in completion of initial H. Pylori testing was noted to be 8.8 days vs. 3.5 days with a T-Score of 1.40 (P = 0.165). Standard of care treatment was prescribed for 90 (89.2%) patients. Primary care physicians ordered confirmation of eradication for 78 (76.4%) patients, and 63 (61.7%) patients successfully completed eradication testing. Men vs. women in completion of eradication testing were noted to be 61% vs. 79% with a Z-Score of -2.19 (P = 0.02). Completion rate of stool eradication testing amongst patients was found to be 79.5%.

CONCLUSION:
Key findings include 24% of patients were not ordered eradication testing likely secondary to high physician turnover. 20% of our patients that were ordered eradication testing did not complete it, due to improvement in initial symptoms and the cumbersome stool testing process. We plan to improve compliance by offering same day urea breath testing on site, which is a simpler, less time-consuming test for patients. Community outreach, H. pylori education pamphlets in Spanish and English, reminder phone calls, and standardized physician templates for H. pylori testing are also being considered and implemented at our clinic to improve the overall rate of successfully treating H. pylori infection.
1217 Gastroparesis Dietary Recommendations in Patients With Gastroparesis-Like Symptoms Are Only Effective in Normal Colon Transit Documented by Wireless Motility Capsule Methodology
Authors: Moshiree Baha , Hasler William , Lee Allen , Parkman Henry , McCallum Richard , Rao Satish , Nguyen Linda A. , Sarosiek Irene , Schulman Michael , Wo John M. , Kuo Braden 
Published: October 2019

INTRODUCTION:
We previously reported a positive impact of gastroparesis diet recommendations on overall and individual symptoms in patients with suspected gastroparesis who show gastric emptying delays. In contrast, those with non-delayed gastric emptying showed only minimal benefits on this diet. The impact of gastroparesis diet recommendations in patients with delayed colon transit (DCT) based on Wireless Motility Capsule (WMC) testing has not been assessed. We hypothesized that patients with normal colon transit (NCT) presenting with upper GI symptoms respond to a gastroparesis diet while those with DCT do not respond.

METHODS:
Patients with suspected gastroparesis at 10 tertiary centers underwent concurrent WMC testing and gastric emptying scintigraphy. Several treatment recommendations, including a gastroparesis diet (low fat, low fiber and low residue diet with small-sized but frequent meals) were recommended for 31 patients with NCT and 15 with DCT. For this analysis, overall GCSI, and individual symptom scores from PAGI-SYM surveys (0 = none, 5 = very severe) at baseline and 6- month follow-up on the gastroparesis diet were related to the presence or absence of DCT defined as colon transit exceeding 59 hours by WMC.

RESULTS:
Gastroparesis diet recommendations were associated with overall GCSI and PAGI-SYM score reductions from 2.6 ± 1.1 to 2.1 ± 1.1 (P = 0.004) and 2.5 ± 1.1 to 1.9 ± 1.2 (P = 0.0004), respectively, in patients with NCT. Individual symptoms of bloating, fullness and diarrhea also improved with NCT (P < 0.02 for all) (Table 1). Constipation and lower abdominal pain scores did not differ pre- and post- gastroparesis diet recommendations. In patients with DCT, only constipation improved over 6 months (P = 0.04). This finding may be explained by increased use of laxatives in this group after DCT was found on WMC testing.

CONCLUSION:
This is the first study to show a differential impact of gastroparesis diet recommendations in patients with suspected gastroparesis based on colon transit findings by wireless motility capsules. A positive impact of the gastroparesis diet with long-term benefits on overall and individual symptoms up to 6 months in patients with suspected gastroparesis and normal colonic transit was seen. In contrast, patients with delayed colon transit had lesser benefits from gastroparesis diets. Whole gut transit testing with WMC may differentiate responders and non-responders to the gastroparesis diet based on colonic transit times.
1221 Trends in Incidence, Survival, and Mortality of Gastric Cancer in the United States: A Surveillance, Epidemiology, and End Results (SEER) Database Study 1975-2016
Authors: Asif Samia , Saeed Lyla , Zafar Yousaf 
Published: October 2019

INTRODUCTION:
Using Surveillance, Epidemiology, and End Results (SEER) data, we examined epidemiological associations between patient characteristics and the incidence and survival in gastric cancer in the US.

METHODS:
Patients diagnosed with stomach cancer between 1975-2016 were identified in SEER registries. We incorporated SEER 9 and 18 registries to calculate incidence, race/ethnicity and disease characteristics. Cox regression was used to estimate survival from SEER follow up data.

RESULTS:
Males (M) had higher incidence rates (IR) than females (F): 10.0/105 vs 5.3/105. Observed IR have been decreasing on average 1.5%/year over last 10 years. IR increases with age; for any age group, it is higher for: M than F; black M than white M and black F than white F. IR are highest in ages 65 years and above compared to ages below 65 (36.7/105 vs 3.1/105) and highest in Asian-Pacific Islander (API) populations, Blacks (B), Hispanics (H), American Indian/Alaskan Native, non-Hispanic white (NHW) and Whites (W) in decreasing order. For each ethnicity, IR is higher in M than F. In 2016, W constituted 69.2% of prevalent cases, while B, H and API constituted 12.6, 11.3 and 7.1% respectively. Mortality rates (MR) decreased from 8.51/105 to 3.02/105 between 1975-2016. MR increases with age for both M and F; between 2012-16 it is highest in B (5.5/105), API (5.3/105), H (5.1/105), American Indian/Alaskan Native (3.4/105), W (2.7/105) and NHW (2.4/105) in decreasing order. 5-year survival improved from 15% in 1975-77 to 32% in 2009-2015. For F, 5-year survival is 36%, higher in BF than WF (39.5% vs 35%). In M, 5-year survival is 30%, lower for BM compared to WM (27%vs 29%). Adenocarcinoma comprised 80% of all cases reported; others included epidermoid and squamous cell carcinoma and sarcoma/soft tissue tumors (0.8, 0.8 and 0.2% respectively). Rest were documented as other specific or unspecified tumors. Distant disease comprised (36%) of reported cases, compared to localized (26%), regional (26%) and unknown/un-staged (10%) disease. 5-year survival rates were highest for localized (69%) compared to regional (31%), distant (5%) and unknown/un-staged (23.0%) disease.

CONCLUSION:
Epidemiological trends show improved 5-year survival in gastric cancer among all ethnicities. Advance age and distant disease portend poor outcome. Since black women have better outcome than black men, we postulate that the disease pathogenesis varies by gender and races without considering confounding factors.
1222 Co-Prescription of Ondansetron With Other QT-Prolonging Drugs: Data From a Large Community-Based Hospital System
Authors: Varghese Elsa , Ehrenpreis Eli , Ehrenpreis Jamie 
Published: October 2019

INTRODUCTION:
The Food and Drug Administration (FDA) has warned about the co-prescription of ondansetron with other QT-prolonging medications. Electronic medical records (EMR) with built-in warning systems for drug-drug interactions (DDIs) are designed to improve patient safety. However, overriding of warnings are common. Response to warnings for potentially life-threatening DDIs such as QT-prolongation has not been fully investigated. We studied outpatient co-prescription of ondansetron with other QT-prolonging medications in a large community-based health practice.

METHODS:
Data for all outpatient prescriptions for oral ondansetron from January 1 to March 31st, 2016 at NorthShore University HealthSystem was reviewed. A de-identified dataset was developed that included all outpatient prescriptions for oral ondansetron in patients receiving another QT-prolonging drug. Duplicate orders were removed. Interaction warnings, including the severity of the interactions are generated at the time of order placement. Prescriber response to DDI warnings and further analysis of the co-prescribed QT-prolonging drugs was performed. Demographic information was also studied.

RESULTS:
11,935 cases of inpatient and outpatient co-prescriptions of ondansetron with and one or more QT-prolonging drug occurred during the study period. After filtering, there were 884 outpatient ondansetron and QT-prolonging co-prescription orders in 723 patients. All warnings were “severe interactions”. Only 93 (10.5%) prescriptions in outpatients were canceled, while 791 (89.5%) of the prescription orders were overridden. The most common classes of QT-prolonging medications taken by patients with overridden orders for ondansetron were selective serotonin reuptake inhibitors (SSRIs) (33%), macrolide antibiotics (29%), fluoroquinolone antibiotics (13%), and serotonin antagonist reuptake inhibitors (SARIs) (11%) (See Table 1). The most commonly co-prescribed QT prolonging drugs are listed in Table 2. Twelve patients receiving QT-prolonging antiarrhythmic agents had completed orders for ondansetron. 617 (78%) of overridden prescriptions occurred in women.

CONCLUSION:
Warnings for ondansetron co-prescription with other QT-prolonging drugs are usually ignored. Co-prescription of ondansetron with other QT-prolonging drugs is more common in female patients. This is of particular concern because women are more likely to develop serious arrhythmias related to ondansetron-induced QT-prolongation.