bluuebunny/crossref_metadata_2025_split huggingface dataset:
2888 Hospitalization for Colonoscopy Preparation and Its Effects on Prep Quality
Authors: El-Halawany Hani , Khan Shahryar , Elkafrawy Ahmed A. , Choudhry Iqra , Poonia Jasmin , Abuamr Khalil 
Published: October 2019

INTRODUCTION:
Colonoscopy is the most commonly used method for colon cancer screening. The quality of prep greatly affects the examination. Risk factors for inadequate prep include prior inadequate prep, male gender, prior surgery, diabetes, low health literacy and cognitive delay. Studies have shown improvement in colonoscopy prep using split-dosing however despite this, inadequate prep continues to be a problem. One solution at our institution is to hospitalize selected patients with prior failed outpatient colonoscopy prep in an attempt to improve the prep quality.

METHODS:
We retrospectively identified all patients who were hospitalized for colonoscopy prep from 2016 to 2018. Patients who did not have documentation of prep quality were excluded. Data including age, gender, indication for procedure and presence of risk factors was gathered. The prior prep quality and prep quality after admission was documented.

RESULTS:
122 patients were included in the study. “Screening” was the most common indication for the procedure. Most of the patients had at least one risk factor for inadequate prep. 90 patients had improvement in their prep quality.

CONCLUSION:
Bowel prep continues to be inadequate in up to 25% of examinations. Several patient related risk factors for inadequate prep have been identified in previous studies. Patients who have risk factors for slow bowel transit such as immobility, CVA and chronic use of narcotics can also be factors in colon prep. We believe the improvement in bowel prep in our study is related to adherence to dietary restrictions, accurate laxative consumption, and improved assessment of stool clearance. Our study also showed a significant number of improved bowel prep quality in patients who had risk factors for poor prep. The cost of hospitalization was not evaluated in our study. We believe that an adequate bowel would result in a longer time-interval for subsequent colonoscopies and reduced overall cost. Our study is limited given its retrospective design and small number of patients. In addition, given that our software does not allow use of the Boston Bowel Prep Scale, the results may be difficult to generalize to other populations. Repeat studies would be needed to assess cost effectiveness. Quality of bowel prep continues to be a barrier to high quality colonoscopy. This study shows that hospitalized bowel prep may help improve prep quality in a select group of patients in the underserved population and with known risk factors.
2889 Upper and Lower Gastrointestinal Endoscopy and Concomitant Anesthesia in a Central Canadian Province: A Population-Based Study
Authors: Singh Harminder , Derksen Shelley , Sirski Monica , McCulloch Scott , Lix Lisa 
Published: October 2019

INTRODUCTION:
There are limited data on upper and lower gastrointestinal endoscopy (GIE) and concomitant anesthesia in universal health care systems, despite their increasing use. All Canadian provinces advocate for fecal occult blood test based colorectal cancer screening, which theoretically should lead to less lower GIE use. We evaluated the time trends and variations in use of upper and lower GIE and concomitant anesthesia in the province of Manitoba between April 1, 1984 and March 31, 2017.

METHODS:
Physicians claims reimbursement data from the provincial health ministry were used to ascertain upper, lower GIE and anesthesia use. Provincial population in each year was determined from the registrants’ database. Hospitalization discharge database was used to identify procedures performed in hospitals. Generalized linear models with generalized estimating equations were used to test the linear trend over time and differences amongst age groups, health regions, income quintiles. Logistic regression analysis with generalized estimating equations was used to assess predictors of anesthesia use.

RESULTS:
410, 685 individuals had at least one procedure between 1984-2017. Although approximately half of the procedures were performed outside the recommended CRC screening age group of 50-74 years (38% among those less than 50 years), the rate of increase stabilized among the > 75 years group over the last 5 years of the study (Figure 1). There were marked regional differences in the last ten years, with the slowest increase in the largest urban region (Figure 2). There were much more marked variation in anesthesia use, ranging from 1% in the largest region to 80% in a rural region (Figure 3).

CONCLUSION:
There are marked variations in GIE use and concomitant anesthesia use in a universal health care system. The potential good news is that the rate of GIE use is no longer increasing among the older individuals. We have identified several endoscopist factors which could lead to targeted information dissemination, individual provider review and feedback and continuing medical education initiatives.
2891 Designing the GI Cloud
Authors: Shergill Annie , Narasimhan V. Lakshmi , Garg Deepti , Sala Amruth K. 
Published: October 2019

INTRODUCTION:
Gastroenterology is a field of medicine that has its roots deeply embedded in the technological revolution of the 21st century. It emerges as a specialty dominated by ever-evolving imaging and diagnostic modalities that have surpassed archaic means of diagnosing and treating various GI disorders. This article highlights advancement in Cloud computing technology that has the potential to change the way healthcare professionals in GI work in the inpatient and outpatient setting. Cloud based technology for storing, retrieving and manipulating patient specific data is set to transcend from being used in government or corporate organizations to outpatient and inpatient GI services.

METHODS:
A comprehensive review of cloud computing and its application to facilitate a cohesive method of functioning that ties one end of the expanding patient database and procedural reporting to the other end of effective reproduction and recall of this data.

RESULTS:
An emerging challenge in the field of GI today is the need to accommodate an enlarging patient database, while concurrently balancing a myriad of quality determining factors, such as information security, privacy, reliability and interoperability of data. Considering this, Cloud based technology emerges as the single most vied advancement to address this issue. The Cloud environment refers to the practice of using a network of remote servers hosted on the internet to store, manage and process data, rather than a local server or a personal computer. Cloud computing can transform the way information technology is consumed and managed, resulting in improved cost efficiencies, accelerated innovation and the ability to scale applications on demand.

CONCLUSION:
Groundbreaking advancements always stem from the absolute need to bring about a change in the existing methodology. There is a void emerging from the disparity between increasing volume of patient specific data and a concomitant lack of infrastructure to handle the same. There is also an increasing need to introduce automated features that facilitate patient specific data storage, search, retrieval and processing. Hence, the quest to pursue cloud based technology as the mainstay of data handling and processing in GI. In a dynamic field like GI, brand new concepts are crucial to challenge those that already exist and alternative techniques and modalities are vital. Therefore, Cloud computing offers an efficient solution to several data processing problems and issues encountered in GI.
2894 The Gastrointestinal Phenotype of Cowden’s Syndrome and Effects of Surveillance
Authors: Khare Anshika , Burke Carol A. , Leach Brandie , O'Malley Margaret , LaGuardia Lisa , Eng Charis , Mankaney Gautam 
Published: October 2019

INTRODUCTION:
Cowden’s syndrome is an autosomal dominant hamartoma syndrome characterized by germline mutations in the phosphatase and tensin (PTEN) homolog gene, the protein product of which negatively regulates the PI3K-AKT-mTOR pathway. Clinically, individuals develop multiple hamartomas in body tissues, including the stomach and colon, and have a high risk of developing cancer. To mitigate the risks, individuals undergo upper and lower endoscopic surveillance. The effectiveness of endoscopic surveillance and polypectomy remains unknown.

METHODS:
17 individuals who met relaxed international Cowden consortium criteria and had undergone at least two upper or lower endoscopies were included. We describe polyp number, size, location, pathology, and interventions over the surveillance period.

RESULTS:
The average age was 69 (43-88). 6 were males and 11 females. Average number of upper and lower endoscopies was 2 (1-8) and 5 (2-14), respectively. The average interval between upper and lower endoscopies was noted to be 2.64 years (standard deviation = 1.53) and 3.03 years (standard deviation = 2.14). One patient developed a cancerous polyp that was identified on the second colonoscopy. The polyp was located in the transverse colon and removed via snare polypectomy. Pathology showed invasive adenocarcinoma. Patient underwent colectomy with ileocolic anastomosis without chemotherapy. 68.5% of upper and lower endoscopies had an intervention performed including polypectomy with cold biopsy forceps (n = 40), cold snare (n = 7), hot biopsy forceps (n = 16), and hot snare (n = 33). Polyp pathologies in the stomach and upper intestine included hamartomas (n = 4), hyperplastic (n = 6), adenomas (n = 2), and fundic gland polyps (n = 6). Polyp pathologies in the colon included hamartomas (n = 14), hyperplastic (n = 40), ganglioneuromas (n = 2), adenomas (n = 81), inflammatory (n = 4), and sessile serrated (n = 7). 3 patients had more than one upper endoscopy, 2 of whom had a decrease in polyp size while 1 had no change. In the colon, the sizes of the polyps decreased over time in 11 of the 17 patients, 4 did not change, and 2 had an increase in size.

CONCLUSION:
We show that the overall size of polyps decrease in both the stomach and colon with endoscopic surveillance. One patient had a malignant polyp treated with endoscopic polypectomy.
2897 Prognostic Factors for Identifying Etiology of Subacute Drops of Hemoglobin in Hospitalized Patients Without Overt Gastrointestinal Bleeding
Authors: Raman Daya 
Published: October 2019

INTRODUCTION:
Studies have shown hospitalized patients have a decrease in hemoglobin (Hb) concentration with no overt blood loss. GI consultation and endoscopy are routinely requested for a decrease in Hb. In this study, we retrospectively reviewed hospitalized patients who had a subacute drop in hemoglobin without evidence of GI bleeding. Our aim was to identify prognostic factors that could be predictive of endoscopic findings.

METHODS:
Electronic health records were obtained to identify patients admitted to our hospital from October 2016 to May 2018 that had undergone an endoscopic procedure during their hospitalization. Next, we excluded those with an admitting diagnosis of a gastrointestinal bleed (hemorrhage, melena via ICD10 code). We then manually identified those with a subacute drop in Hb, defined as a drop in Hb ≥ 3 from baseline admission. This resulted in a cohort of 113 patients. Hb changes for each patient were examined and the maximum drop in Hb was categorized into four groups: minimal drop was defined as 3-3.5 mg/dL, moderate drop was 3.6–5.5 mg/dL, high drop 5.6-7.5 mg/dL and very high drop >7.5 mg/dl. Endoscopic procedure outcomes for each patient were analyzed and grouped into either category “bleed” or “no bleed”. “Bleed” was categorized as an ulcer, frank bleeding, varices and/or neoplasm which are lesions that can be the cause of drop in Hb. Normal endoscopy, gastritis, duodenitis, and/or polyps were categorized as “no bleed” which are unlikely the cause in drop in Hb.

RESULTS:
Sixty-two patients (56%) belonged to the "no-bleed group" and fifty-one patients (44%) to the “bleed” group. Patients with minimal Hb drop were found to be predominantly in the “no-bleed” group, 85% compared to 15% for the “bleed” group. There were equal numbers of "bleed" and "no bleed” patients in both the moderate and high Hb drop groups. For very high Hb drop >7.5, the number of patients in the "bleed" group were greater than "non-bleed" group, 71% vs 29%. Comorbidities such as HTN, Type 2 Diabetes, CAD, Liver disease, CVA, GERD, and Kidney disease were also considered in association with a subacute drop in Hb and outcomes of bleed vs. no bleed. Using multivariate modeling, patients with Diabetes or those receiving packed RBCs were found to have a statistically significant predictor of "bleed", P-value 0.047 and 0.044, respectively.

CONCLUSION:
For the majority of patients, the primary reason for a subacute drop in hemoglobin is multifactorial and cannot be unambiguously attributed to GI bleed.
2899 Description of Outcomes in Inflammatory Bowel Disease Patients With Granuloma on Histology: A Single-Center Experience
Authors: Wehbe Hisham , Hosni Mohammad N. , Binion David , Hashash Jana G. 
Published: October 2019

INTRODUCTION:
It has been suggested that the presence of granulomas on surgical pathology of patients with Crohn’s disease (CD) is associated with a more aggressive disease phenotype. We sought to investigate the outcomes of patients who had granulomas present on their surgical specimens.

METHODS:
This was a retrospective chart review that identified all inflammatory bowel disease patients who had the word ‘granuloma’ listed on their pathology report, whether from an endoscopic procedure (EGD or colonoscopy) or surgical resection specimen. We search reports from 1997 to 2019. All patients who had an intestinal granuloma were identified. Demographic, clinical, and histologic information was obtained from the medical records of these patients.

RESULTS:
A total of 41 CD patients were found to have a granuloma on their surgical specimen; 8 were found on a surgical resection specimen while 33 were found on endoscopic biopsies. Of the 41 patients, 53.7% were males, 41.7% were smokers, and the average age at diagnosis of these patients was 32 ± 15 years. The most common site for granuloma detection was the ileum accounting for 23 cases (56%). A total of 13 patients had granulomas present in more than one site/location (31.7%). The median C-reactive protein within 2 weeks of colonoscopy for patients with granuloma was 16.5mg/L; IQR 2.9-58 (normal < 2.5mg/L), median erythrocyte sedimentation rate was 25mm/hr; IQR 15-45 (normal 17.5mm/hr), and median hemoglobin of these patients was 12g/dL; IQR 10.3-13.6 (normal 12.5g/dL). Of the 41 CD patients with granulomas, 42.5% were on a biologic agent, 41% on an immunomodulatory, and 20% had received a steroid at any time for their disease. A total of 9 patients (24.3%) had stricturing disease, 15.2% had a history of an intra-abdominal abscess, and 13.9% had a history of peri-anal disease. A total of 32.5% of granuloma CD patients had an intestinal resection and 34% had a CD related hospitalization.

CONCLUSION:
As part of this study, we are hoping to match (age and gender) our CD patients with granulomas to CD patients who were not found to have granulomas on their surgical specimens and to compare the outcomes amongst these groups. Based on our descriptive data of the granuloma patients, we suspect that these patients will a more aggressive disease course.
2904 Influenza and Pneumococcal Vaccination in Patients With Inflammatory Bowel Disease: Findings From a Large Safety Net Hospital
Authors: Ajose Taiwo A. , Kagbokue Suaka , Gboluaje Temitayo , Abe Temidayo , Ajose Afolarin , Chineke Iloabueke , Simien Melvin , Richter Seth 
Published: October 2019

INTRODUCTION:
Inflammatory Bowel Disease (IBD) inherently predisposes to infections due to a lack of appropriate innate and adaptive immune responses to infectious agents. Immunomodulators and biological therapies further increase the risk of infections in IBD patients by dampening the immune response of an already dysregulated intestinal immunity. Many of these infections are preventable with vaccinations. Advisory committee on immunization practices recommends pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23) and annual influenza vaccine for all IBD patients. Despite these recommendations, vaccination rates continue to be suboptimal. We present our findings on the vaccination rate at a large safety net hospital.

METHODS:
We hypothesized that vaccination rate are low at most outpatient centers. In order to test this, we retrieved electronic medical records (EMR) from one of the outpatient departments of a large safety net hospital between November 2017 and March 2018. Patients with a diagnosis of IBD were identified and EMR were reviewed. Data regarding influenza vaccine, PCV13, PPSV23, immunosuppressive medications and comorbidities were obtained. Microsoft Excel and SPSS software version 21 were used for data management and analyses. Two-sided P-value < 0.05 was considered statistically significant.

RESULTS:
181 patients were included in the study, 51.9% female and 48.1% male. Majority were African American (86.7%). The mean age was 45 years with 56.9% of patients being ≤49 years, 38.7% were between 50-69 years and 4.4% were over 70 years. 59.1% of patients were on immunosuppressive therapy. Overall, only 54.1% received an annual influenza vaccine. 24.9%, received PPSV23 alone, 4.4% received PCV13 alone and 13.8% patients received both P13 and PPSV23. Patients within the ages of 50-69 years were more likely to receive influenza vaccine (r = 0.358, P < 0.001). 43.1% of our patient populations were uninsured and 53.5% were unemployed.

CONCLUSION:
Our study revealed suboptimal implementation of national recommendation on influenza and pneumococcal vaccination among IBD patients at the selected institution, consistent with previous studies. We also found that older age predicts vaccination uptake. We propose that continuous education on the vaccination guidelines should be consistently provided to physicians involved in the care of IBD patients. Incorporating reminder alerts and patient education materials on vaccination guidelines in the EMR might improve its uptake and rate.
2907 Knowledge and Perception of Gastroenterologists Regarding Medical Marijuana Use in Patients With Inflammatory Bowel Disease
Authors: Santiago Artemio , Torres Esther 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease is a chronic debilitating condition whose cause is still not completely understood. Goals of therapy include relief of symptoms, mucosal healing, decrease in need for hospitalization and surgery and improved quality of life. Giventhe varying results achieved with conventional medical therapy, patients are turning to a variety of complementary and alternative options for relief, cannabis products being one of the most common. In 2014, Puerto Rico (PR) legalized medicinal marijuana including Crohn's and ulcerative colitis as indications. We questioned whether the gastroenterology community was prepared to confidently and correctly answer the questions brought by their patients. The purpose of this study was to collect data regarding Puerto Rican gastroenterologists' knowledge, comfort and perceptions regarding medical cannabis use in patients with IBD.

METHODS:
An anonymous 20 question online survey was distributed among gastroenterologists and trainees who are members of the Puerto Rican Gastroenterology Association. The protocol was approved by the MSC IRB.

RESULTS:
Forty-five responses (25% response rate) were received and analyzed. Participants were mostly males (69%) between the ages of 25-45 (63%) and mainly have private practices (56%) in the metropolitan area (60%). 71% of physicians see less than 15 patients with IBD in one month. Most of the participants (85%) feel informed regarding IBD practice guidelines, and uninformed (51%) regarding their knowledge of the endocannabinoid system. 20% of participants are aware of the requirements to obtain medical marijuana in PR and only 42% know the approved indication. 75% of physicians think that cannabis should be a therapeutic option for IBD patients, however only 40% would recommend it to their patients. 46% of participants reported that their patients have used cannabis for IBD, and pain (80%) is the most common reason. 86% of gastroenterologists cite medical literature as the leading factor in their decision to recommend its use or not and 100% of them would be interested in receiving more information regarding this topic.

CONCLUSION:
Puerto Rican gastroenterologists are misinformed regarding medical cannabis use in patients with IBD. Although the study sample is small, it highlights the need for education in our community to improve patient care. Strategies to address this concern are needed and would be well received by physicians.
2915 Acute Pancreatitis and Celiac Disease—Is There an Association?
Authors: Wadhwa Vaibhav , Gupta Kapil , Gonzalez Adalberto , Singh Harjinder , Garg Sushil , Bilal Mohammad , Lara Luis 
Published: October 2019

INTRODUCTION:
The association of Acute Pancreatitis and Celiac Disease (CD) has been sparingly reported in the literature. CD is known to affect approximately 1% of the western population. A Swedish national database study reported a 3-fold increased risk of developing pancreatitis in patients with CD. The exact mechanism of this is unknown but it could be related to untreated celiac disease affecting the major papilla causing stenosis or exocrine pancreatic insufficiency that has been reported previously. The aim of this study was to look at the association between acute pancreatitis and celiac disease. We also looked whether there was any association between chronic pancreatitis and celiac disease.

METHODS:
We performed a retrospective cross-sectional cohort study using the 2013 National Inpatient Sample (NIS) database. We included all patients who were hospitalized with either acute pancreatitis (ICD Code 577.0) or Chronic Pancreatitis (577.1). Patients who had diagnoses of both acute and chronic pancreatitis were considered to have acute on chronic pancreatitis and combined with the chronic pancreatitis group. We then analyzed both groups for presence or absence of celiac disease. Continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. All analyses were performed using SAS Survey Procedures (version 9.4, The SAS Institute, Cary, NC).

RESULTS:
We analyzed more than 35 million hospitalizations in 2013 out of which 378,715 had a primary discharge diagnosis of acute pancreatitis and 155,130 had a primary discharge diagnosis of chronic pancreatitis. The mean age in the acute pancreatitis group was 53.3 yrs and in chronic pancreatitis group was 51.7 yrs. There were more males in chronic pancreatitis group (55.1%) than females (44.9%). There was significantly higher prevalence of acute pancreatitis in CD (2.3%) than non-CD patients (1.2%) (Figure 1, P = 0.001). Similarly, there was higher prevalence of chronic pancreatitis (1.2%) than the control group (0.43%) (Figure 1, P < 0.001).

CONCLUSION:
There is a higher prevalence of acute pancreatitis in patients with CD. Patients were also found to have much higher prevalence of chronic pancreatitis in CD. This could be related to recurrent acute pancreatitis episodes in CD patients. Further studies are needed to validate these findings.