bluuebunny/crossref_metadata_2025_split huggingface dataset:
2924 Risk of Malignancy Due to Radiation Exposure in Patients With IBD
Authors: Zafar Yousaf , Zamir Harris , Jakhar Ishaan , Elkafrawy Ahmed A. , Asif Samia , Sahil Suman , Cheng An-Lin 
Published: October 2019

INTRODUCTION:
Diagnostic imaging is routinely used in the management of IBD and in most cases, comes at the cost of repeated radiation exposure to the patient. We aim to show correlation between increased rates of cancer in patients with IBD and increased levels of radiation exposure. It is our purpose to demonstrate that efforts should be made to assessment and monitor total radiation exposure in patients with IBD.

METHODS:
We used a case-control design to compare patients with cancer diagnosis cases vs No cancer diagnosis controls. Cases were a composite of 74-cancer diagnosis. Cases were obtained from Cerner Healthfacts database, including 67 hospitals, using ICD9/10 codes for cancer after radiation exposure due to CT scans identified by CPT codes (74175, 74174, 74150, 74176, 74160, 74178, 74177, and 74170) in IBD patients, while controls were randomly selected from the remaining IBD patients with CT scans. Using sociodemographic and other medical diagnoses within the database, we screened candidate variables for a multivariable regression analysis for being a case and included all variables in the regression with P < 0.10 on univariate analysis.

RESULTS:
Between 01/01/2010 and 12/31/2016, we identified 132 patients with cancer out of 2,768 IBD patients who had radiation exposure (4.8%). Table 1 shows indication for the cancer. Combined with 2,636 controls, our study population had an average age of 48.0 (IQR: 34-62), 86.3% were white, and 59.3% were female. The two variables with P < 0.10 on univariable comparisons were included in the final model. After adjusting for confounders, older patients, and those on higher radiation doses had increased odds for developing cancer (Table 2). Steroid use and Immunomodulatory therapy, while significant on univariable analysis, were no longer significant risk factors after adjusting for confounders.

CONCLUSION:
Diagnostic imaging is a vital tool used to determine disease severity, extent, and response to treatment in IBD. As the disease tends to relapse and remit, repeat diagnostic imaging is a continuous part of disease management resulting in cumulative exposure to ionizing radiation over the lifetime of a patient. Patients with IBD have an increased risk of developing colorectal and small intestinal cancers than the general population irrespective of their exposure to radiation. Our data shows that additionally, the increased burden of radiation exposure increases the rates of cancer in these patients.
2926 The Reiationship of Bone Marrow Suppression and Remission by Immunomodulators in the Patients With Crohn's Disease
Authors: Cho Byungha , Kim Hyoung Woo , Kim Ki Bae , Han Joung-Ho , Chae Hee Bok , Park Seon Mee , Youn Sei Jin , Yoon Soon Man , Choi Jongwook , Kwon Hyeonwoo , Kim Seongmin , Lee Jun Su 
Published: October 2019

INTRODUCTION:
Immunomodulator including azathioprine and 6-mercaptopurine has been widely used in the patients with Crohn's disease. Most common adverse event of immunomodulator has been known as bone marrow suppression such as leukopenia. We aim to evaluate the relationship of bone marrow suppression and the remission by immunomodulator in the patients with Crohn's disease.

METHODS:
We investigated 160 patients with Crohn's disease undertaken immunomodulator and analyzed the relationship of bone marrow suppression and the maintenance of remission and relapse rate by immunomodulator.

RESULTS:
Among the 160 patients (male:female, 122:38, age of 33 ± 12 years (range, 17-69)), 37 patients (23.1%) developed bone marrow suppression. Initial dose of azathioprine was 43 ± 18 mg (25-150 mg, 0.8 ± 0.3 mg/kg) and 81 ± 33 mg (25-175 mg, 1.3 ± 0.6 mg/kg) during maintenance. Only 2 patients were taken 6-mercaptopurine because of nausea with azathioprine. 5-aminosalicylic acid was most frequently co-administered drug with immunomodulator in patients who developed bone marrow suppression. The maintenance of remission and relapse rate showed no significant difference depending on bone marrow suppression during immunomodulator.

CONCLUSION:
The rate of bone marrow suppression by immunomodulator was relatively high. However, bone marrow suppression did not seem to be related to the maintenance of remission and relapse rate by immunomodulator in the patients with Crohn's disease.
2929 Correlation of Body Mass Index (BMI) and C-Reactive Protein (CRP) With Inflammatory Bowel Disease Progression in an Urban, Afro-Caribbean Population
Authors: Gupta Nikita , DeRoche Ketisha , Arroyo-Mercado Fray , Likhtshteyn Michelle , Chokshi Tanuj , Veluvolu Rajesh , Grossman Evan 
Published: October 2019

INTRODUCTION:
Inflammatory Bowel Disease (IBD) is associated with changes in body composition of patients. Recent studies have shown that the prevalence of obesity is rising in patients with IBD, where 15-40% of adults are obese and 20-40% are considered overweight. One prospective study analyzed body composition in IBD patients overtime and noted that despite an overall increase in adiposity, the total muscle mass was decreased. Low lean muscle mass has an association with poor response to therapy, surgical outcomes and the quality of life in IBD patients. Low C-reactive protein (CRP) levels after initiation of anti-TNF therapy have been associated with mucosal healing on surveillance colonoscopies and clinical disease remission. The aim of this study is to analyze the association between BMI and CRP with progression of IBD, using anti- TNF use as a surrogate marker for disease severity.

METHODS:
Medical records at Kings County Medical Center in Brooklyn, New York were queried for patients with the ICD 9 and 10 code diagnoses for Crohn's disease (CD) and Ulcerative Colitis (UC) from 2015 to 2018. Biographical, laboratory and endoscopic data, including BMI and CRP, was collected and analyzed.

RESULTS:
148 patients with IBD were analyzed from 2015-2018; where 57.2% had UC and 42.8% had CD. Mean age of patients was 47.4 years, and 53.4% of patients were females. The average BMI prior to initiation of therapy was 27.6 kg/m2. The average years diagnosed with IBD was 11.1 years. Of the total patients, 37 were on biologic therapy. In the BMI group, the odds ratio was 0.905 indicating that patients with a lower BMI had more severe disease. The P value was 0.068, not significant but trended towards significance. In the CRP group, the odds Ratio was 1.020, which signified that patients with higher CRP values had more severe disease, with a P value of 0.046.

CONCLUSION:
The results of our small retrospective study suggest that a lower BMI and higher CRP are independent predictors of severe disease. Our study demonstrated that severe IBD, as measured by anti-TNF use, is associated with high CRP levels. We believe that low BMI and high CRP measurements may be used in conjunction with endoscopic findings and clinical presentation to escalate therapy early preventing worsening of disease. Further studies can be done to also incorporate endoscopic scoring system on surveillance colonoscopies to confirm the correlation between lower BMI and higher CRP with severity of disease.
2932 Histological Diagnosis of Pancreatic Serous Cystadenomas Using a 22G Core Biopsy Needle: A Case Series
Authors: Schwartz Michael , Esteban Marcus Juan , Jakate Shriram , Singh Ajaypal 
Published: October 2019

INTRODUCTION:
Pancreatic Serous Cystadenoma or Pancreatic Cystic Serous Neoplasm (SCN) are a type of benign pancreatic tumor that account for 1-2% of all pancreatic masses. They are most often benign, with very rare malignant potential. SCN's will often have a cystic or honeycomb appearance on CT scan. In the past, the mainstay of diagnosing SCN has been via endoscopy ultrasound (EUS) with fine needle aspiration (FNA) to assess fluid for CEA levels and also for cytological analysis. However fluid can be difficult to obtain and often there is not enough cellularity for cytology. In this case series of 7 patients we performed fine needle biopsy (FNB) of the cell walls of pancreatic cysts as a technique for histological review.

METHODS:
We retrospectively reviewed medical records of patients who underwent EUS for FNA for fluid sampling of pancreatic cysts but due to microcystic nature a decision was made to proceed with FNB to obtain tissue for histology. FNB was done using 22 G FNB needle with slow stylet pull technique. The tissue was placed in formalin for histological analysis by an expert GI pathologist.

RESULTS:
A total of seven patients were evaluated. The mean age was 75 years old and 5 of the patients were female. All patients had one cyst that was sampled. The location of the cyst was on the head in 1 of the patients and body or tail of the other 6 patients. The mean cyst size was 31.1 mm (range 14-40 mm). There were no post procedure complications. All seven samples were adequate for histological analysis. Six out of the seven biopsy samples were consistent with serous cystadenomas. One samples showed benign pancreatic acinar tissue and stroma without malignancy.

CONCLUSION:
Management of pancreatic SCNs can be challenging as no follow up is recommended if the diagnosis is confirmed but lots of times a definite diagnosis cannot be made based on endosonographic and CT/MRI findings. These patients can be potentially subject to repeat imaging for surveillance. Here we show that pursuing FNB instead of FNA for microcystic lesions can yield enough tissue for histological diagnosis of SCNs and can alter management and avoid further imaging.
2948 Does Thrombocytopenia in Cirrhotic Patients Improve After Transjugular Intrahepatic Portosystemic Shunt?
Authors: Benrajab Karim , Ali Saad Emhmed , Frandah Wesam , Ismail Bahaaeldeen 
Published: October 2019

INTRODUCTION:
Thrombocytopenia (TP) is commonly encountered in cirrhotic patients, likely secondary to splenic congestion from portal hypertension. The few available studies showed inconsistent effect of Transjugular Intrahepatic Portosystemic Shunt (TIPS) on thrombocytopenia and were limited mostly by short term (≤3 months) follow up after TIPS which can underestimate the effect. Moreover, the majority of studies did not examine the predictors of improved thrombocytopenia, so it is not clear which patients would benefit from the procedure. In this study, we assess the effect of TIPS on TP up to 6 months after TIPS.

METHODS:
We conducted a retrospective study including adults with cirrhosis who underwent TIPS at Tertiary referral center between January 2016 and June 2018. Only patients with average platelet count <150 k/ul in the 3 months before TIPS were included. Charts were manually reviewed to collect baseline and outcome variables. The shunt patency was ensured using Doppler ultrasound in 3-6 months after TIPS. Primary outcome was the percentage of patients with improved TP after TIPS. This was defined based on the difference between average count in the 3 months before TIPS and the average count in the 3-6 months after. Secondary outcome was to determine the predictors of improved TP on a multivariate logistic regression model.

RESULTS:
Forty-one patients were included. Table 1 shows the demographic and clinical characteristics of the patients. 22 patients (54%) had an improved TP after TIPS (median absolute rise 15.04 [0.25, 133.67], median percent increase 14.59% [0.40, 122.26] (Figure 1). The majority of patients (13/22) had mild improvement by <20 k/ul. The improved TP group had more variceal bleed as an indication for TIPS, lower pre-TIPS average platelet count, and a lower pre-TIPS portosystemic pressure gradient (PSPG). The predictors of improved TP were TIPS for variceal bleeding rather than refractory ascites; OR 31 [2.3-432], lower mean platelets count before TIPS, OR 0.96 [0.93-0.99] and lower change in PSPG; OR 0.55 [0.32-0.95].

CONCLUSION:
Our result is in agreement with previous studies that showed improvement in TP in a subset of patients following TIPS. However, the improvement was modest in most patients. Predictors of improvement in our cohort were lower pre-TIPS average platelet count, lower pre-TIPS PSPG, and variceal bleeding as an indication for TIPS placement. More studies are demanded to validate the role of TIPS in the management of TP.
2960 National Variation in Approach to HCV in Patients Listed for Liver Transplant
Authors: Durney Philip A. , Dhanekula Raja Koteswar , Shah Ashesh , Fenkel Jonathan 
Published: October 2019

INTRODUCTION:
Due to recent progress in the treatment of hepatitis C virus (HCV), many providers specializing in transplant medicine face the difficult clinical decision of whether to treat HCV in patients before or after liver transplantation (LT). Eradicating HCV in the pre-LT population has a powerful impact on both the LT waitlist and on the types of donors offered to recipients. Concurrently, increasing availability of organs from high-risk donors is occurring, largely due to the US overdose epidemic. We sought to better understand how some of these clinical and social dynamics impact decisions at US transplant centers.

METHODS:
We surveyed all medical and surgical transplant directors from adult US. LT centers via an online survey in 2017. The survey queried directors about their program's specific approach to waitlisted patients with HCV pre-LT. The survey posed broad questions about patient demographics as well as more specific questions relating to the frequency with which Public Health Service-increased risk (PHS-IR) and HCV+ donors are offered, the degree to which PHS-IR and HCV+ offers are declined due to a lack of waitlisted patients with HCV, and the existence of any cutoffs for transplantation.

RESULTS:
28 respondents (17% response rate), representing programs in 10/11 UNOS regions, answered the survey. Respondents were primarily from university-affiliated LT programs (92.3%) and represented variably-sized programs (LT volume ≤50 in 46.4%, 51-100 in 35.7%, >100 in 17.9%). 93% of programs reported seeing >10% are PHS-IR offers, and 19% of programs reported >30% PHS-IR offers. 39.3% of programs reported >10% offers are from HCV+ donors. 50% of programs reported turning down offers for HCV+ organs due to lack of available HCV+ recipients on the waitlist. A minority of programs (14.3%) continue to use donor age cutoffs for HCV+ recipients and many programs do not attempt to treat chronic HCV in non-HCC patients with CPT-B (42.3%) and CPT-C (77.8%) cirrhosis.

CONCLUSION:
Significant heterogeneity in US LT centers' approach to HCV patients on the waitlist exists. There is a trend to leave the sickest HCV+ patients untreated, though organs may be discarded due to lack of available HCV+ recipients in some parts of the country. As utilization of HCV+ organs into HCV- recipients begins to increase in the US, consideration for a separate allocation strategy for these organs may be warranted.
2961 Characteristics and Outcomes of Patients Hospitalized With Autoimmune Hepatitis in the United States: Nationwide Analysis in 2016
Authors: Tunio Nahel A. , Tashtish Nour , Sclair Seth , Cohen Stanley Martin 
Published: October 2019

INTRODUCTION:
Autoimmune hepatitis (AIH) is a rare inflammatory disorder of the liver, and is associated with liver cirrhosis or hepatic failure. There is scarce contemporary data on epidemiology and outcomes of AIH in the United States. We used a large database to describe the epidemiology of AIH in the hospitalized patient in the USA.

METHODS:
We used the 2016 National Inpatient Sample Database, to identify all hospitalized patients who were discharged with a primary or secondary diagnosis of AIH (ICD10 K75.4) in 2016. We analyzed the demographics, causes of admission, liver transplantation rates, inpatient mortality and hospital charges.

RESULTS:
A total of 21,850 (SE 534) patients were admitted with AIH (2405, SE 68 with primary diagnosis of AIH). The mean age of the patient cohort was 55.8 (SE 0.4) years, 12755 (58.4%) were Caucasians, 3530 (16.2%) were African Americans and 16815 (76.9%) were females. Primary causes of admission were AIH (2405, 11%), sepsis (1885, 8.6%), liver cirrhosis (910, 4.2%), acute kidney injury (495, 2.3%), and gastrointestinal bleeding (375, 1.7%). Overall, 330 (1.5%) underwent liver transplantation and 825 (3.8%) died during hospitalization. Mean hospitalization charges were $63,444 (SE 2122), and length of stay was 5.74 days (SE 0.11).

CONCLUSION:
In the NIS database, we described the demographics of patients admitted with a diagnosis of AIH. Hospital admissions for AIH are associated with high cost and mortality. Moreover, liver transplantation is utilized in a small percentage of AIH admissions.
2968 Juxta-Papillary Duodenal Diverticulum (JPDD) Are Associated With Pyogenic Liver Abscesses
Authors: Bhandari Priyanka , Shankar Uday , Panchal Ankur , Bansal Raghav , Walfish Aaron , Baum Joel A. , Weeks David , Aron Joshua , Ahmed Moiz 
Published: October 2019

INTRODUCTION:
Juxta-papillary duodenal diverticulum (JPDD) has been implicated by association as a potential risk factor for ascending cholangitis. Putative mechanisms include periampullary colonization of pathogenic bacteria and mechanical obstruction. The relationship of JPDD to liver abscess has not been described. We hypothesize that JPDD is associated with pyogenic liver abscess (PLA).

METHODS:
We conducted an IRB approved retrospective chart review from 2008 to 2018 to identify 66 cases of pyogenic liver abscess. Inclusion criteria for the diagnosis of liver abscess included CT imaging and either culture or confirmed resolution after antibiotic therapy. A similar number of age and sex matched controls were identified who had abdominal CT scan performed for another reason. All cases and controls were reviewed by a single expert radiologist to identify the presence of JPDD. Chi square statistic was used to test our hypothesis.

RESULTS:
8 out of 66 cases of PLA had JPDD compared to only 2 out of 66 controls. Chi square testing was statistically significant for association between JPDD and PLA (Chi Square statistic = 3.89; P = 0.048).

CONCLUSION:
JPDD has statistically significant association with PLA. This may suggest a role of JPDD in etiology of “idiopathic” liver abscesses by either mechanical effect or by increased colonization by the pathogenic bacteria.
2972 Treatment of Chronic Hepatitis C With SOF/LDV Leads to a Significant Decrease of Fasting Glycaemia in Cirrhotic and IFG/T2DM Patients but Treatment With 3D Combo Only in IFG/T2DM Patients
Authors: Drazilova Sylvia , Janicko Martin , Skladany Lubomir , Oltman Marian , Kristian Pavol , Jarcuska Peter 
Published: October 2019

INTRODUCTION:
Chronic hepatitis C is a systemic disease and type 2 diabetes mellitus (T2DM) belongs to more common extrahepatic. The aim of our study was to compare the effect of sofosbuvir/ledipasvir (SOF/LDV) vs 3D combo treatment on the fasting glycemia (FG) in all chronic hepatitis C (CHC) patients, in cirrhotics and in patients with impaired fasting glucose (IFG) or T2DM.

METHODS:
We performed a longitudinal retrospective observational study focused on the patients undergoing SOF/LDV or 3D combo treatment of chronic hepatitis C. Data about FG, history of diabetes, hepatitis C virus, treatment, and stage of fibrosis were obtained at baseline (before treatment start), at the end of treatment (ET).

RESULTS:
We included 344 patients; 65% treated by 3D combo; 47% had liver cirrhosis and 49% had IFG or T2DM. FG decreased significantly by SOF/LDV treatment (baseline vs ET) in all CHC patients (6.33 ± 2.51 mmol/L vs 5.79 ± 1.78 mmol/L; P = 0.001); in cirrhotics (6.71 ± 2.97 mmol/L vs 5.89 ± 1.78 mmol/L; P = 0.008) and in IFG/T2DM patients (7.49 ± 2.91 mmol/L vs 6.38 ± 2.13 mmol/L; P = 0.0001). FG decreased significantly in 3D combo patients only in IFG/T2DM group (7.36 ± 2.22 mmol/L vs 6.67 ± 2.19 mmol/L; P = 0.008); but not in all CHC patients (6.09 ± 2.01 mmol/L vs 5.96 ± 1.83 mmol/L; NS) and not in cirrhotics (6.70 ± 2.50 mmol/L vs 6.25 ± 2.32 mmol/L; NS).

CONCLUSION:
Both SOF/LDV and 3D combo led to a significant decrease of FG in IFG/T2DM patients, but only SOF/LDV treatment resulted in a FG decrease in cirrhotics.
2974 PCSK9 Inhibitors Do Not Worsen Liver Function Tests in Patients With Hepatic Steatosis
Authors: Zafar Yousaf , Saeed Lyla , Suddaby Stephanie , Ullah Waqas , Cheng An-Lin 
Published: October 2019

INTRODUCTION:
Hepatic Steatosis is associated with cardiovascular disease independently of classic risk factors. Hepatocytes secrete proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) which in turn inhibits the uptake of low-density lipo-proteins by targeting the receptor for degradation and possibly lipogenesis. Anti-PCSK9 drugs reduce LDL-cholesterol but it is unclear how it affects the liver function in patients with underlying steatosis. AIM: To evaluate the efficacy and safety of PCSK9 inhibitors in patients with Fatty Liver disease.

METHODS:
A retrospective chart review study was done from September 2015 to January 2018 to include patients currently prescribed PCSK9 inhibitors who had an ICD code of hepatic steatosis or fatty liver disease. Blood AST (aspartate aminotransferase), ALT (alanine aminotransferase), Triglycerides, Cholesterol and HBA1c were charted of patients who were started on this medication and were followed after interval of 12 months while on the medication. This was compared to a control of patients who were not on PCSK9 but did have underlying diagnosis of fatty liver disease.

RESULTS:
A total of 37 patients on PCSK9 were identified having the ICD 9 and 10 code for fatty liver disease. A random control of 73 patients with the same ICD9/10 code were identified. The mean age of all the patients was 63 (32-90 years), 36% male and 64% female. The mean ALT in the study group after 12 months of PCSK9 therapy was 51 which was not statistically different from the control group (P = 0.05). The average AST value was 43 in the group that was studied and was not statistically significant (P = 0.09). Mean Triglyceride value was 180 (P = 0.87) and mean cholesterol was 143 (P < 0.01). This shows that the drug does significantly reduce the cholesterol values.

CONCLUSION:
PCSK9 may not have a detrimental effect on the liver profile as observed in our study. There was no significant difference in the liver function test after initiation of the drug. These drugs may serve as alternative agents for those who have experienced or are at risk of hepatic injury.