bluuebunny/crossref_metadata_2025_split huggingface dataset:
2864 Utility of HRM for Improving Diagnosis and Detection of Esophageal Disorders in a Community Clinic
Authors: Tran Victoria , Litynski James , Tadros Micheal 
Published: October 2019

INTRODUCTION:
High resolution manometry (HRM) has improved the ability to diagnosis esophageal motility disorders. HRM has the potential to provide diagnostic clarity to patients who suffer from dysphagia, gastroesophageal reflux disease, unexplained chest pain, and other non-specific symptoms. The purpose of this study is to explore the diagnostic yield of HRM in classifying esophageal dysmotility, specifically in a community clinic setting rather than the tertiary care center. High diagnostic accuracy better serves patients. Ultimately, community-based HRM prevents overload at large hospitals and improves access to care for patients.

METHODS:
We reviewed motility studies performed for the past 18 months at a satellite office built to serve the community. We reviewed the indications and diagnostic yield of HRM.

RESULTS:
From the cohort of 90 patients, the most common indication was esophageal dysphagia (45.5%). Refractory heartburn made up 32.3% of indications; unexplained chest pain made up 12.2%. Preoperative and postoperative assessments made up 7.7% and 2.2%, respectively. 3 patients were unable to finish the study. 87 were able to complete it. Diagnosis was based on the Chicago Classification version 3.0. Of those who completed the study, 44.8% were classified as normal; 29.8% of cases were EGJ outflow obstruction; 6.8% of cases classified as achalasia; distal spasm was not found in any patients; 3.4% of patients classified as hypercontractile esophagus; 4.6% of cases had absent contractility; 8% had ineffective motility; 1.1% had fragmented peristalsis; post-Nissen assessment was done for 1 patient.

CONCLUSION:
In our study population, HRM had a high diagnostic yield with its ability to identify esophageal dysmotility by narrowing down the pathogenesis of symptoms like dysphagia, heartburn, and chest pain.. For most patients in this cohort, HRM was well-tolerated. With careful patient selection, HRM has a high diagnostic yield. Because of the clinic location, we were able to assist patients in the rural community and minimize delay in care delivery. Furthermore, community-based HRM has the potential to reduce patient load at larger hospitals. By providing this resource in the community, providers in small-scale clinics improve patient access to care. Gyawali CP, Roman S, Bredenoord AJ, et al. Classification of esophageal motor findings in gastroesophageal reflux disease: Conclusions from an international consensus group. Neurogastroenterol Motil. 2017;29:e13104.
2869 Retrospective Study of Patients With Esophageal Squamous Cell Carcinoma in an Urban Safety Net County Hospital
Authors: Ayyala Divya , Park Caron , Ma Yanling , Idos Gregory , Shaker Anisa 
Published: October 2019

INTRODUCTION:
Esophageal squamous cell carcinoma (ESCC) accounts for 90% of esophageal cancers worldwide but is less common in the developed world. Our aim was to report patient and tumor characteristics of individuals diagnosed with ESCC within the underserved Los Angeles County population.

METHODS:
Review of the hospital pathology database identified 65 cases of patients ages 18-80 with a pathologic diagnosis of ESCC from 2003-2015. A retrospective chart review of electronic health records was conducted excluding patients of unknown ethnicity leaving 61 patients. Patients were characterized by gender, age, alcohol and tobacco use, and family history. Endoscopy and pathology reports were reviewed to confirm tumor location, length, and pathological staging. Frequency counts and percentages were reported for categorical characteristics. A chi-square test or Fisher’s Exact test was performed to assess if characteristic variables differed by ethnicity.

RESULTS:
Patients identified with ESCC in our cohort were predominantly Hispanic (59%, n = 36) and 41% were non-Hispanic (n = 10 Asian, n = 10 African Americans, and n = 5 Caucasian). ESCC was more commonly diagnosed in males vs. females in Hispanics and non-Hispanics (83.3% and 80% vs 16.7% and 20%, P = 0.75). Age of diagnosis was between the ages of 18-60 years in nearly 56% and greater than 60 years in 44% of Hispanics and non-Hispanics (P = 0.97). Most Hispanics and non-Hispanics had exposure to alcohol (74.1% and 85%, P = 0.48) or tobacco (53.9% and 68.2%, P = .31). Most Hispanic and non-Hispanics did not have a family history of cancer (72% and 80%, P = 0.73). Tumor location was most often proximal in Hispanic and non-Hispanics (66.7% and 83.3%, P = 0.16) and of similar length (P = 0.29). Most tumors in both Hispanic and non-Hispanic patients were moderately/poorly differentiated (82.9% and 91.3%, P = 0.46). Hispanics were less likely to present with metastatic ESCC as compared to non-Hispanic patients (42.3% vs. 75%, P = 0.03).

CONCLUSION:
ESCC in both groups within the Los Angeles County population were diagnosed most often in the proximal esophagus of males with history of exposure to alcohol and/or tobacco. Despite similar patient and tumor characteristics, ESCC in Hispanics was less often metastatic at the time of diagnosis compared to non-Hispanics. Despite the small numbers, our study is one of the few to include a large cohort of Hispanics and support further investigation of factors in different ethnicities that may be protective against advanced disease.
2870 Flexible Endoscopic Diverticultomy: Development of a Community-Based Referral Program and Ways to Improve Efficiency and Outcomes
Authors: Sharma Neil , Krishnakurup Jay , Rumancik Brad , Kota Sharwani , Gopakumar Harishankar , Kanuru Reshi , Zelt Christina , Gupta Saurabh , Grabowski Michael 
Published: October 2019

INTRODUCTION:
Until recently Flexible endoscopic diverticulotomy (FED) has not gained momentum among GI endoscopists in USA due to a variety of reasons including new skill set, referral patterns, procedural risks and complexity. Thus far it has been limited to select university hospitals, restricting its availability. We present a case series of FED performed in our community hospital system.

METHODS:
Retrospective review was performed from the start of the FED program over 3 months in 2018. We established a new multi-disciplinary Advanced GERD & Esophageal Services (PAGES) program through which patients were reviewed and selected. All were performed by a single interventional ESD (endoscopic submucosal dissection) trained endoscopist.

RESULTS:
Mean age 69yrs; mean Eckardt score (EDS) 5. Prominent symptoms were dysphagia and weight loss. Diagnosis was established by imaging or EGD. ESD knives were used. Clips were placed on the diverticular base. The thickness and length of the cricopharyngeal bar varied from 0.7- 3 cm (mean: 1.8) and 3- 5 cm (mean: 3.6) respectively. Total operative time depended on the length of the septum, thickness, the type of knife used and varied from 25-168 min (mean:62). The transition from other ESD knives to scissor type knives reduced our operative time by 50% (168 down to 40min) (Table 1). Patients were discharged home 6 hrs post-procedure. A routine predischarge esophagogram was obtained to document complete excision of cricopharyngeal bar. One case of intraoperative bleeding was controlled using a coagrasper. No blood transfusions or second endoscopic procedures were required to control bleeding. One patient was readmitted within 24 hrs of discharge for control of N/V. The success of the procedure was measured using 4 week post-operative EDS. Three of five patients achieved complete symptom resolution at week 1. Two patients had occasional dysphagia (EDS:1) and regurgitation (EDS:1) respectively. All were symptom free at the end of week 4 (EDS: 0 -1) (Table 2).

CONCLUSION:
Transoral FED gives the gastroenterologists the opportunity to be the forerunners in managing ZD. The vast majority of these patients present to GI physicians with a complaint of dysphagia. The development of the multi-disciplinary program to identify and triage patients, scissor type ESD knife, and a fellowship trained advanced endoscopist are the recipe to success for a tertiary community program.
2872 Efficacy of Robotic Dor Fundoplication on Severe Nocturnal Gastroesophageal Reflux Disease in Patients With Scleroderma
Authors: Loganathan Priyadarshini , Davis Brian , McCallum Richard 
Published: October 2019

INTRODUCTION:
Scleroderma is a systemic disease and its effect on the GI tract is atrophy and replacement fibrosis of the smooth muscles. The esophagus is invariably involved and approximately eighty percent of patients with scleroderma develop both gastroesophageal reflux disease (GERD) and dysphagia. The nocturnal GERD can lead to regurgitation and aspiration which further worsens the pulmonary fibrosis from scleroderma. Performing the standard fundoplication would worsen their dysphagia. Aim- Our goal was to investigate whether a Dor fundoplication (a 270-degree anterior wrap) can reduce nocturnal heartburn and regurgitation without worsening of the dysphagia in patients with scleroderma and severe GERD.

METHODS:
5 scleroderma patients with drug refractory severe GERD underwent Dor fundoplication procedure (Figure 1) with a median follow up of 18 months. All had undergone a preoperative high-resolution manometry documenting very impaired esophageal motility. Patients were interviewed post operatively and were assessed for nocturnal and diurnal GERD symptoms and treatment response, status of dysphagia and adverse effects of surgery.

RESULTS:
All 5 patients were female with average age 50 years (range 36-65). 4 of the 5 patients (80%) reported 90% improvement in both diurnal and nocturnal GERD symptoms since surgery, they no longer suffered from nocturnal reflux, heart burn or regurgitation and that they are able to sleep well at night without requiring any more pillows or wedges. 50% of patients reported decrease in their proton pump inhibitor dosage after surgery compared to before surgery. There was no surgical complication reported and specifically no worsening of dysphagia. 100% of the patients were able to belch, burp better effectively after surgery. 4 out of 5 patients reported that they would strongly recommend this surgery to another scleroderma patient suffering from drug refractory GERD symptoms. In one patient, there was no change in symptoms after the surgery but no worsening of dysphagia.

CONCLUSION:
Robotic Dor fundoplication is very effective in drug refractory GERD secondary to scleroderma dominated by nocturnal regurgitation. This procedure resulted in significant symptom reduction in 80% of our patient group which in turn improved their quality of life and nocturnal sleep without affecting dysphagia.
2879 Evaluating the Pattern of Probiotic Use by Patients and Gastroenterology Providers
Authors: Park Sa Ra , Kim Margaret , Lee Daniel , Wynter Javelle , Copland Andrew , Frye Jeanetta 
Published: October 2019

INTRODUCTION:
Probiotic use for management of GI conditions is becoming more popular, as it is perceived to be a natural and low-risk therapeutic option. Despite their increasing use, how patients choose to use probiotics or how GI providers make recommendations has not been well-studied. This survey aims to characterize the pattern of probiotic use by patients and GI providers.

METHODS:
Surveys were distributed to patients seen at a GI clinic at a single tertiary medical center. Surveys were also distributed to GI providers who attended a regional postgraduate course. Survey questions included basic demographics, indication for probiotic use, subjective clinical response to probiotics, side effects, brand of probiotics, and factors that influenced choice of probiotics.

RESULTS:
76 patient surveys and 58 provider responses were collected. Patients used probiotics for general digestive health (22%), IBS (17%), and GERD (16%), while providers recommended probiotics for IBS (81%), Clostridioides difficile infection (64%), and IBD (45%). For symptoms, patients used probiotics to treat abdominal pain (38%) and bloating (26%), while providers recommended it for bloating (76%) and diarrhea (71%). 45% of patients reported improvement of GI symptoms, whereas 21% reported no improvement. Side effects were uncommon, but bloating and diarrhea were most frequently reported. Providers recommended specific brands and bacterial strains, while patients took a wide variety of brands without knowing specific strains. Most patients (82%) chose to take probiotics without their provider’s recommendations. Patients’ selection of probiotics was driven by cost, variety of strain, and number of colonies forming units. 91% of providers felt the need for more specific guidelines on probiotic use.

CONCLUSION:
This study shows that patients and their gastroenterologists have vastly different probiotic “prescribing” patterns. Despite a relative lack of evidence for many conditions, probiotics were frequently utilized. Patients use probiotics for different symptoms and conditions than physicians and have remarkably different factors that influence selection of a probiotic. Providers should proactively discuss current evidence on probiotic use and help patients identify key features and differences between probiotic products.
2880 Prevalence of Irritable Bowel Syndrome Among Medical Students of Puerto Rico
Authors: Velasco-Corrada Paloma , Amill Reinaldo Ramirez , Torres Esther 
Published: October 2019

INTRODUCTION:
Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and altered bowel habits. A high prevalence has been reported in medical students around the globe. Data in the population of Puerto Rico (PR) is sparse. This study aimed to investigate the prevalence of IBS and associated risk factors in medical students in PR.

METHODS:
A cross sectional study was conducted in a sample of medical students from first to fourth year currently enrolled at the University of Puerto Rico School of Medicine. Participants completed a self-administered, anonymous questionnaire that contained questions about general socio-demographic data, lifestyle habits, degree of subjective psychological stress and the Rome III criteria: IBS Module. Students were grouped as preclinical (first and second year) and clerkship (third and fourth year) for comparison. Results were analyzed using Chi-square (X 2) test and Fisher's exact test. A P value < 0.05 was considered statistically significant. Statistical analysis was performed using STATA software v. 11.1.

RESULTS:
314 medical students (137 preclinical and 177 clerkship students) were included for analysis. The mean age was 24.8 ± 3.25; 48.1% were females. The prevalence of IBS was 36.3% (33.1% for females and 39.3% males; P = 0.291). Among the IBS subjects, 78 (24.8%) were classified as IBS-M (mixed). Family history of IBS, psychological stress and cigarette smoking were significantly associated to IBS (P < 0.05). There was no significant difference in the presence of IBS between preclinical and clerkship students (45 of 137 [32.85%] versus 69 of 177 [38.98%]; P = 0.262). No statistically significant relationship was found between IBS and age, gender, BMI, eating habits, exercise frequency, and caffeine consumption.

CONCLUSION:
This is the first study to describe the prevalence of IBS in medical students in PR. A higher prevalence of IBS was found as compared to that reported for medical students in other countries. Moreover, when comparing to the general population of North America and other Hispanic groups in both Central and South America, the prevalence rate of IBS in our students was higher. Additional studies aimed at estimating the impact of IBS on quality of life and academic performance of the medical students are essential. Studies focusing on determining the prevalence of IBS in the general population of PR as well as identifying other associated factors are also needed.
2881 Can Eluxadoline Be Useful in Managing Patients With Functional Diarrhea?
Authors: Vizuete John A. , Randall Charles W. , Martinez Nicholas 
Published: October 2019

INTRODUCTION:
Eluxadoline is an FDA approved medication for use in patients with irritable bowel syndrome with diarrhea (IBS-d). It is a peripheral mu-opioid receptor agonist resulting in a reduction in colonic motility while antagonizing central delta receptors that modify pain and thus targets the two key components of IBS-d. Functional diarrhea (FD) is similar to IBS-d, but there is no pain with FD and there are currently no FDA approved medications for its treatment. This caseseries examines the efficacy of eluxadoline in managing FD.

METHODS:
Electronic medical records at a private gastroenterology clinic were reviewed from May 2015-present. Patients must have undergone diagnostic evaluation including stool elastase, lactoferrin, breath testing, celiac serology, and both upper and lower endoscopy with biopsies. Detailed clinical histories and medication reconciliation were also performed to exclude other causes for diarrhea. Patients found to have other FGIDs, IBD, bowel obstruction, malabsorption, or cholecystectomy were excluded. Patients must also have failed or demonstrated intolerance to OTC anti-diarrheals, dietary changes and supplemental fiber, and anticholinergics or tricyclics. Eligible patients were treated for 6 months with open label eluxadoline and clinical follow up was required. All patients began 100 mg bid, but were allowed to reduce the dose to 75 mg bid if constipation or abdominal discomfort occurred. There were 2 primary endpoints: Improvement in Bristol Stool Scale (BSS) and decrease in daily stool frequency by 30%.

RESULTS:
Eleven patients with FD were identified by Rome IV criteria and were included in the series. All completed 6 months of therapy with eluxadoline. Patients had a mean BSS of 6.2 (range 6-7) and mean daily stool frequency of 4.8 (range 3-10) at baseline. Eight patients (73%) satisfied both clinical endpoints with an average reduction in stool frequency to 2.8 (range: every other day to 4 per day). The mean BSS decreased from 6.2 to 4.2, with a range of 2-5. 2 patients developed constipation but responded to the lower dose. The remaining 3 patients (27%) showed moderate clinical improvement but did not meet one or both of the primary endpoints.

CONCLUSION:
1. Eluxadoline may be an effective tool in managing FD where conventional therapy has failed. 2. The length of the trial demonstrated durability. 3. This open label case series should stimulate interest into funding a blinded placebo controlled trial.
2882 Analysis of Risk Factors for Poor Bowel Preparation in Hospitalized Patients
Authors: Dickson Zachary , Park Sa Ra , Tung William , Douglas Scott R. , Haug Rebecca , Shenoy Abhishek , Milner Paul , Desai Nisa , Earasi Athidi , Wynter Emmett , Hunold Thomas , Powell Steven 
Published: October 2019

INTRODUCTION:
Poor bowel preparation for colonoscopy is associated with reduced diagnostic yield, increased risk of perforation, and longer length of hospitalization. Prior studies have demonstrated inpatient status as a risk factor for poor bowel preparation. Research at our institution has identified risk factors that are associated with poor bowel preparation, but this study consisted primarily of an outpatient population. The aim of this study is to investigate the impact of known risk factors on bowel preparation quality in an inpatient population.

METHODS:
A retrospective chart review was performed for all patients undergoing inpatient colonoscopies from July 2017 - April 2019 at a single academic medical center. ICU patients were excluded. The indication for colonoscopy, amount of bowel preparation (4L vs >4L of polyethylene glycol), and documented quality of the bowel preparation (adequate vs poor) were reviewed. Previously identified risk factors for poor bowel preparation including gender, type 2 diabetes (T2DM) with end-organ damage, COPD, neurologic disease (stroke, dementia, Parkinson’s disease), TCA use, opioid use, and laxative use were recorded. Association of risk factors with poor bowel preparation was analyzed using chi-square tests.

RESULTS:
306 patients underwent inpatient colonoscopy. 42 patients (13.7%) had poor bowel preparation. 31.7% (n = 13) of patients with at least 3 risk factors had poor bowel preparation while only 11.5% (n = 29) of patients with two or less risk factors had poor bowel preparation (P = 0.01). This statistically significant relationship was upheld when controlled for standard colonoscopy preparation (P = 0.03). Among the 42 patients with poor bowel preparation, 54.7% (n = 23) were male, 38% (n = 16) had active opioid use, 26% (n = 11) had T2DM with end-organ dysfunction, 26% (n = 11) had active laxative use, 14.2% (n = 6) had neurological disease, 11.9% (n = 5) had COPD, and 2.3% (n = 1) had active TCA use.

CONCLUSION:
To date, there is not a nationally accepted risk stratification system for identifying patients at high risk for poor bowel preparation in the inpatient setting. This study shows that patients with at least 3 risk factors were associated with a higher incidence of poor bowel preparation in hospitalized patients. Recognition of these risk factors and individualized bowel preparation could lead to a reduction in the incidence of poorly visualized colonoscopies in the inpatient setting.
2883 How Well Are We Prepped? Synopsis of Quality of Bowel Prep at a Community Hospital
Authors: Khuttan Akhilesh K. , Tripathi Shalini , Ale Shirisha , Charilaou Paris , Yegneswaran Balaji 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is the third most common cause of cancer death in the United States in women, and the second leading cause of death in men. Colonoscopy involves visual inspection of colonic mucosa for detection of pre-cancerous lesion and possible intervention to prevent CRC. The success of the procedure is closely linked to adequacy of bowel preparation. However, up to 20-25% of preparation are inadequate for colonoscopies. Poor bowel prep can lead to inadequate mucosal surveillance, with failure to detect a pre-cancerous lesion, requiring rescheduling which further increases health care cost and patient dissatisfaction. In our study, we have analyzed quality outpatient colonoscopies.

METHODS:
Retrospective analysis of bowel preparation in outpatient colonoscopy during the period of 03/01/2019 to 03/29/2019. Data was collected from medical records and included date of procedure, indication, physician performing the procedure, findings, quality of bowel preparation.

RESULTS:
Total 99 charts were reviewed. Mean age was 60.35 years; Male to Female ratio was 9:10. Among the indication of colonoscopy 32.3% were for diagnostic study and 67.7% were screening and follow-up studies. 70.7% of bowel prep were reported as qualitative scoring (The American Society for Gastrointestinal Endoscopy and American College of Gastroenterology Taskforce), 25.2% had quantitative scoring of Boston Bowel Preparation Score (BBPS) and 4% had no scoring. Among qualitative scoring 12.8% were excellent, 57.1% were good, 4.3% were adequate, 15.7% were fair, 1% were suboptimal or satisfactory preparations. Of quantitative scoring almost all preparations were more than or equal to 6, among these 36% had BBPS score of 9. In 60.6% cases where polyps were detected, 33.3% cases had qualitative assessment of good preparation with only 1% being excellent preparation and 6.7% had BBPS of 6 and 9 respectively. Polyp detection was noted in 11.7% of fair preparations.

CONCLUSION:
Highest percentage of polyp detection was observed in good bowel prep or BBPS of 6. Variation in scoring method qualitative versus quantitative was observed, which remains an area of endoscopist preference.