bluuebunny/crossref_metadata_2025_split huggingface dataset:
787 Addiction Medicine Consultation Reduces Narcotic Use and ER Visits and Increases Smoking Cessation in IBD Patients: A Cross-Sectional Study
Authors: Kudaravalli Praneeth , Michailidis Lamprinos , Kindred Michael , Akanbi Olalekan , Tripathi Nishant , Yarra Pradeep , Perry Courtney , Mullins Selina , Abomhya Ahmed Abdelsatar , Barrett Terrence 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) patients are chronically prescribed narcotics for chronic relapsing abdominal pain. We previously reported that emergency room (ER) visits in IBD patients increase the risk for chronic opioid use (COU - defined as 90 days of opioid use in a 6-month period) (Pauley et al Infl Bowel Dis 2017). Here we examine if referral to addiction medicine therapy reduces opioid prescriptions as well as ER visits.

METHODS:
IBD patients seen in the University of Kentucky out-patient GI clinic between January 2013 and November 2018 with COU were identified. Referrals to addiction medicine were identified by ICD 9/10 billing codes. EMRs of all study patients were retrospectively examined to collect data. Paired samples t-test was performed for outcomes 1 yr before and after addiction medicine consultation. All the statistical analysis was performed using SPSS Version 25 software; an alpha level of .05 was used throughout.

RESULTS:
During the 6-yr period, 2296 IBD patients on narcotics were identified. Among those 77 patients received addiction medicine referral, 36 patients complied. Mean age of the study population was 43 yrs. ER visits were reduced by 0.53 ± 0.24 visits in the year after consultation (mean ± SEM, 95% CI: 0.007–1.09; P < 0.04). Opioid prescriptions after addiction medicine consultation were also reduced by 0.37 ± 0.38 (P = 0.31). Substance abuse and mental health illnesses such as smoking, alcohol, illicit drug use, mood disorders and anxiety was seen in 72.2%, 22.2%, 19.4%, 27.8% and 16.7% of patients, respectively. Mean number of addiction medicine visits for tobacco and opioid abuse disorders were 2.2 and 5.3 respectively. Smoking cessation was successful in 11.5% of patients at 1 yr. However, a substantial reduction in smoking was noted in 26.9% of patients.

CONCLUSION:
Substance abuse and chronic opioids are factors known to be associated with worse outcomes in IBD patients. Our study shows IBD patients referred to addiction medicine service had significantly lower ER visits and trended to have fewer numbers of opioid prescriptions. Addiction medicine referrals were also successful in reducing smoking use by 27% with 11% cessation. Results reported here encourage further testing in larger sample sizes and suggest the implementation of addiction medicine professionals in the care of IBD patients.
790 Does Inflammatory Bowel Disease Predispose Patients to an Increased Risk of Heparin-Induced Thrombocytopenia?
Authors: Aijazi Muaz , Ahuja Ashish , Williams George W. 
Published: October 2019

INTRODUCTION:
Heparin-induced thrombocytopenia (HIT) is a rare, but life-threatening, complication seen in approximately 5% of those exposure to heparin for more than 4 days. It is currently believed that the female sex, surgical patients, and those greater than age 40 are at increased risk for developing HIT.
1
Here, we explore the possibility of increased risk of HIT in patients who are known to have inflammatory bowel disease.

METHODS:
We used the National Inpatient Sample (NIS) from 2010 to 2012 to identify 14,121 patients with an ICD-9CM code for HIT. Patients with diagnosis codes for Crohn's disease or ulcerative colitis were classified as having IBD. Outcomes in patients with IBD were compared to those without immune mediated conditions using chi-square and student's t-test where appropriate.

RESULTS:
Of the 14,121 HIT patients identified, 103 had a pre-existing diagnosis of Crohn's disease and 56 had pre-existing ulcerative colitis. Having a prior diagnosis of Crohn's disease corresponded to an OR of 1.17 (P-value 0.115, 95% CI 0.96, 1.42) for subsequently developing HIT. Ulcerative colitis conferred an OR of 1.12 for developing HIT (P = 0.4, CI 0.86, 1.46). A statistically significant change was not demonstrated for either disease.

CONCLUSION:
Our study shows that having a diagnosis of IBD does not significantly increase risk of developing HIT. This is interesting considering IBD is considered as gastrointestinal immune disorders. Also of note, while they themselves are technically not considered autoimmune – it has been demonstrated in the literature that immune mediated diseases were significantly more frequent in patients with IBD.
2
Prospective research will be required to further elucidate a relationship between IBD and HIT.
791 Morbidity and Mortality of Influenza Virus in Inflammatory Bowel Disease
Authors: Maddika Srikanth , Then Eric O. , Aloreidi Khalil , John Febin , Are Vijay S. , Gayam Vijay , Culliford Andrea , Gaduputi Vinaya 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) is thought to occur secondary to inappropriate host immune responses, resulting in gastrointestinal inflammation. On that basis, many studies have established an association between IBD and opportunistic infections. No studies however have evaluated its association with influenza virus, a commonly seen pathogen.

METHODS:
We retrospectively analyzed patients hospitalized with the diagnosis of IBD, consisting of Crohns disease and Ulcerative Colitis, and patients with the diagnosis of influenza virus via ICD-9 codes in the year 2014 using the Nationwide Inpatient Sample (NIS) database. Our primary endpoint was to evaluate the morbidity and mortality associated with IBD and superimposed influenza virus. We looked at multiple variables including incidence, length of hospital stay (LOS), and mortality rate. Logistic regression models were developed using STATA software version 15.

RESULTS:
A total of 1,027,740 patients with IBD, 523,190 patients with influenza virus, and 358,400 patients with IBD and influenza virus were included in our study population. We found that patients with IBD were 111% more likely to have influenza virus than patients without IBD (OR: 112.772, CI: 108.778-116.808, P-value: 0.000). In addition, patients with IBD and influenza virus presented at a statistically significant younger age when compared to patients with IBD alone (56.31 years vs 58.47 years, P-value: 0.000). On the contrary, patients with IBD and influenza virus had statistically significant shorter LOS (4.4 days vs 4.7 days, P-value: 0.000) and lower mortality rate (1.5 vs 1.9, P-value: 0.004) than patients with influenza virus alone. Similarly patients with IBD and influenza presented at a later age than patients with influenza alone (56.31 years vs 55.99 years, P-value: 0.385), but these findings were not statistically significant.

CONCLUSION:
We conclude that IBD patients are more susceptible to develop infection with influenza virus than patients without IBD. Although this association is clear, the mortality rate and LOS were lower in IBD patients with influenza compared to patients with influenza virus alone. Limitations such as our retrospective study design, and sample size may explain this paradoxical finding. Conversely there may exist an age-related bias, in that older more frail patients with influenza virus are more likely to seek medical attention when compared to their younger counterparts.
792 Gastroenterologist-Led Management of Iron Deficiency Anemia—A Tertiary Care Experience
Authors: Dalal Robin , Coe Christopher , Meyers Matthew , Garrett Ailish , Duley Caroline , Wagnon Julianne , Annis Kim , Scoville Elizabeth , Beaulieu Dawn B. , Schwartz David A. , Horst Sara 
Published: October 2019

INTRODUCTION:
Iron deficiency anemia (IDA) is a common extra-intestinal complication of inflammatory bowel disease (IBD) which includes both Crohn's disease (CD) and Ulcerative Colitis (UC). The objective of this study was to evaluate the effects of gastroenterologist-led management of IDA in the IBD population.

METHODS:
A retrospective chart review was conducted at a single tertiary care inflammatory bowel disease center. All patients with proven IBD (CD or UC) and anemia (defined as hemoglobin (Hgb) < 12 for women and <13 for men) treated through the IBD center with standard regimens of intravenous iron (iron sucrose 200 × 5 doses, ferric carboxymaltose 750 mg × 2 doses, ferumoxytol 510 mg × 2 doses) were included. Statistical analysis was performed using paired t test, pearson chi-squared test, and Wilcoxon rank sum test.

RESULTS:
351 pts (249 pts with CD, 102 pts with UC) were evaluated. Median age was 33 (IQR 25, 46) and 62% were female. The majority of pts (79%, n = 251) had active endoscopic disease prior to treatment for IDA. 60% of pts were on biologic therapy and 27% were on corticosteroids. Hgb and iron increased significantly after iron treatment in both CD and UC as seen in Table 1. SIBDQ improved significantly in both CD and UC as seen in Figure 1. After iron treatment, 41.2% of pts had resolution of IDA. Male pts were more likely to remain anemic than female pts (P = 0.016 using pearson chi-squared test); age and IBD type (CD vs. UC) did not affect anemia persistence. 53% of pts were re-treated with iron infusions. 3% of pts required blood transfusions for IDA. Only 8% of pts required hematology referral.

CONCLUSION:
In a large cohort of pts with IBD, IDA improves after gastroenterologist-led treatment but persists in the majority of pts, especially male pts. Treatment of IDA improves pts quality of life. Over half of pts required re-treatment. Only a minority of pts required hematology referral for management of IDA.
793 Persisting Malnutrition After Medical Therapy in Children With Crohn's Disease Is Associated With Increased Rates of Surgery and Complicated Disease Behavior
Authors: Ahmed Shahzad , Iskandar Heba , Liu Zijun , Mondal Kajari , Markowitz James , Hyams Jeffrey , Denson Lee , Walters Thomas , Dubinsky Marla C. , Kugathasan Subra 
Published: October 2019

INTRODUCTION:
Although malnutrition in children diagnosed with Crohn's disease (CD) is common, the effect of malnutrition on clinical outcomes following diagnosis of CD has not been evaluated.

METHODS:
We used data from 948 CD subjects recruited from the RISK inception cohort to examine the impact of malnutrition on disease progression. Our primary exposures of interest were reported weight loss at diagnosis (reported as yes/no) as well as age specific body mass index (BMI) z-scores defined as the deviation of the value for an individual from the mean value of the reference population. Z-scores were stratified according 2015 guidelines of pediatric malnutrition to categorize the presence and severity of malnutrition over 3 years of follow-up. Our primary outcomes were development of complicated (stricturing or penetrating) disease, need for CD-related hospitalization, and surgery. Logistic regression models were used to define independent associations.

RESULTS:
Reported weight loss and malnutrition were present in 72.9% and 40.5% respectively of children diagnosed with Crohn's disease (Table 1). Following diagnosis at 6 months, BMI z-scores improved significantly such that only 13.2% remained malnourished and the rate of moderate/severe malnutrition declined from 17.6% to 2.2% (Figure 1). Failure to improve BMI z-score from 6 months was associated with increased risk of surgery (22% vs. 9%, P < 0.05) and B2/B2 phenotype (18% vs. 12%, P < 0.01) but not hospitalization (35% vs 28%, P > 0.05) at 3 years. The rate of overall malnutrition improved at 6 months but then remained stable until 3 years (range 13.9-15.9%, P > 0.05) and the association with increased rates of surgery and B2/B3 disease remained significant.

CONCLUSION:
Weight loss and malnutrition at diagnosis are common following diagnosis of CD in children. Failure to improve BMI z-score at 6 months and beyond correlates with increasing risk of surgery and complicated disease phenotype. We speculate that aggressive pharmacologic and nutritional management may improve/reverse the course in this narrow phenotype, and prospective studies are warranted to prove this concept.
796 Effect of Disease Location on Endoscopic and Radiographic Outcomes in Patients With Moderate to Severe Crohn's Disease Initiated on Vedolizumab
Authors: Kashani Amir , Pabla Baldeep S. , Eaddy Andre , Scoville Elizabeth , Dalal Robin , Beaulieu Dawn B. , Schwartz David A. , Horst Sara 
Published: October 2019

INTRODUCTION:
Vedolizumab (VDZ), an integrin antagonist, is approved to treat moderate to severe Crohn's disease (CD). We aimed to investigate how CD location effected the endoscopic and radiographic outcomes of VDZ.

METHODS:
This is a retrospective study from a tertiary care center, in patients (pts) with CD initiated on VDZ between July 2014 and January 2018. Pts had endoscopic or radiographic evaluation before (index examination) and >3 months after (follow-up examination) VZD initiation. Endoscopic remission/response was defined as resolution (remission) or significant improvement (response) of CD features with respect to the index examination. Endoscopic remission/response rate was compared between ileal and colonic disease. Improvement in radiographic features of small bowel (jejunum/ileum) CD was evaluated on magnetic resonance imaging or computed tomography scan.

RESULTS:
140 pts were evaluated with a median follow-up 18 months (range: 3-55) (Table 1). 90% of the pts (n = 126) had prior anti-TNFα failure. 128 pts had endoscopic evaluation with a median follow up 27 months (3-55) (Table 2). Endoscopic remission/response rates between pts with ileal CD (62% [47/76]) and pts with colonic CD (49% [34/69]) were not statistically different (P = 0.13). Endoscopic remission/response rates in pts with isolated ileal CD (n = 59) and isolated colonic CD (n = 52) were similar (59% vs. 46% respectively; P = 0.17). Among pts with both ileal and colonic disease (n = 17), endoscopic remission/response rates were similar in ileal and colonic CD (71% vs. 59% respectively; P = 0.47). Endoscopic remission/response rate in the ileal disease in pts with prior ileocolic resection (ICR; n = 38) was lower than in pts with an intact anatomy (n = 22) (55.3% vs. 77.3% respectively; P = 0.05). Follow-up imaging was available in 30 pts with radiographic evidence of small bowel CD (median follow up 13 months [3-28]). Radiographic improvement was observed in 26.7% of pts.

CONCLUSION:
In this cohort of pts with CD, majority anti-TNF experienced, a significant number of pts had improvement in endoscopic features of CD on VDZ, regardless of CD location. Ileal disease in pts with prior ICR appears to be less responsive to VDZ as compared to in pts with an intact anatomy. Radiographic features of small bowel CD showed a low rate of improvement on VDZ. Further understanding of the impact of VDZ on small bowel CD is warranted.
798 Predictors of Delayed Response to Tofacitinib: Results of the OCTAVE Open Study for Delayed Responders
Authors: Regueiro Miguel , Kinnucan Jami A. , Ungaro Ryan , Quirk Daniel , Su Chinyu , Lawendy Nervin , Fan Haiyun , Woodworth Deborah A. , Neurath Markus F. 
Published: October 2019

INTRODUCTION:
Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Tofacitinib efficacy and safety were shown in 3 Phase 3 trials in patients (pts) with UC.
1
Pts who received tofacitinib 10 mg twice daily (BID) for 8 weeks in OCTAVE Induction 1/2 (NCT01465763/NCT01458951) and did not achieve clinical response could receive tofacitinib 10 mg BID in a Phase 3, open-label, long-term extension (OLE) study (NCT01470612).
2
OLE data (up to 3 years) for pts achieving clinical response with an additional 8 weeks of tofacitinib (delayed responders) have been reported.
3

METHODS:
We evaluated potential predictors of delayed response (clinical response [≥3-point and ≥30% decrease from induction study baseline (BL) total Mayo score, and ≥1-point decrease in rectal bleeding subscore (RBS) or absolute RBS ≤1] after 16 weeks of 10 mg BID [8 weeks induction, 8 weeks in OLE]). Characteristics at OCTAVE Induction 1/2 BL and BL and Month 1 of the OLE study were evaluated in induction responders (clinical response to 8 weeks of 10 mg BID), delayed responders, or complete non-responders (non-response to 16 weeks of 10 mg BID).

RESULTS:
Characteristics at OCTAVE Induction 1/2 BL were generally similar between subgroups (Table 1). The proportion of pts with prior tumor necrosis factor inhibitor (TNFi) failure was numerically higher in complete non-responders vs delayed responders (Table 1). Induction study BL mean C-reactive protein was numerically higher in complete non-responders vs induction responders and delayed responders with a similar trend at OLE BL (Table 1). At OLE Month 1, stool frequency subscore (SFS) and RBS were numerically lower in delayed responders vs complete non-responders, and partial Mayo score (PMS) reduction from OLE BL was greater for delayed responders vs complete non-responders (Table 1).

CONCLUSION:
Numerically higher proportions of complete non-responders and delayed responders had prior TNFi failure vs induction responders. In pts with UC, early improvement at Month 1 during extended induction in SFS, RBS, and PMS may indicate likelihood of response to extended induction. The post-hoc data suggest tofacitinib 10 mg BID treatment beyond 8-week induction may be associated with clinical response in initial non-responders. Further evaluation with a larger sample size is needed.
801 Phenotypic Characteristics of Crohn’s Disease in Latin Americans Versus U.S. Hispanics: A Systematic Review With Meta-Analysis
Authors: Contreras Alberto , Satiya Jinendra , Zuckerman Marc J. , Alvarado Luis , Dwivedi Alok , Avalos Danny 
Published: October 2019

INTRODUCTION:
Latin America is experiencing a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Environmental and dietary changes may be contributing factors. In Latin America, Crohn’s disease (CD) is less common than ulcerative colitis (UC), but the predominant phenotype of CD is not established. Also, it is unknown whether there are regional differences in phenotype across Latin America. This systematic review aims to describe the phenotype of CD in Latin Americans as compared with U.S. Hispanics.

METHODS:
We conducted a systematic review with meta-analysis of population-based studies to compare the phenotype of CD across Latin America with U.S. Hispanics. Phenotype was defined according to the Montreal classification. A systematic search was conducted using MEDLINE and EMBASE. Inclusion criteria: (i) studies describing the phenotype of CD in Latin America and Hispanics in the U.S. (ii) age >18. Exclusion criteria: (i) prevalence or incidence studies not describing the phenotype. A random effects model was chosen “a priori” for analysis of pooled proportions.

RESULTS:
A total of 4,627 studies were screened. 34 studies from Latin America and 7 studies from the U.S met inclusion criteria. 2,877 Latin Americans and 233 U.S. Hispanics had the diagnosis of CD. The predominant phenotype in Latin America was ileo-colonic disease (L3) with a pooled proportion of 0.37 (95% CI 0.32-0.41, I2 82%), and for U.S. Hispanics, 0.46 (95% CI 0.31-0.61, I2 82.5%), P = 0.88. Inflammatory behavior (B1) was predominant for Latin America and U.S. Hispanics, 0.51 (95% CI 0.41-0.60, I2 94.3%) vs. 0.64 (95% CI 0.42-0.87, I2 91.7%), P = 0.24, respectively. Perianal involvement was similar between Latin Americans and U.S Hispanics with nearly one-third of patients showing this phenotype, P = 0.82. Phenotype across Latin America was similar except in Cuba, where ileal disease was present in nearly one-half of patients. Colonic CD (L2) was less frequently seen in Cuba, 0.15 (95% CI 0.10-0.21), P = 0.002. Disease behavior and perianal involvement were similar across Latin Americans, Table 1.

CONCLUSION:
The phenotype of Crohn's disease was similar between Latin Americans and U.S. Hispanics. This goes in line with current knowledge that ileo-colonic disease is the predominant disease location in Caucasians. Disease behavior and perianal involvement were similar between Latin Americans and U.S. Hispanics. In Latin America, the phenotype was homogeneous, except in Cuba where ileal disease was the predominant location.
804 Predictors of Colectomy in Patients Admitted With Inflammatory Bowel Disease: A Population-Based Study
Authors: Khoudari George , Singh Amandeep , Alkhadra Yasser , Baidoun Firas , Sarmini Muhammad Talal , Kirby Donald F. , Shen Bo , Regueiro Miguel 
Published: October 2019

INTRODUCTION:
In patients with inflammatory bowel disease (IBD), colectomy is common inpatient requiring hospitalization. Although risk factors for colectomy have been previously assessed in IBD patients, most of these studies were confined to referral hospitals. We aim to identify the factors associated with colectomy in a population-based cohort of hospitalized IBD patients.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, patients with the diagnosis of IBD were identified. Patients who underwent colectomy were then compared with patients who did not undergo colectomy. Multivariate logistic regression analysis was performed to identify predictors of colectomy in IBD patients.

RESULTS:
Out of 3,380,451 patients with IBD, 71,715 (2.1%) underwent a colectomy. There were more ulcerative colitis patients than Crohn’s disease, 52,534 and 19,980, respectively. Patients who underwent colectomy were younger (48.9 vs 50.4, P < 0.001), had more males (53% vs 43%, P < 0.001) and less African Americans (6.0% vs 10.1%, P < 0.001). In colectomy, patients had more clostridium difficile (C. diff) and cytomegalovirus (CMV) infections, primary sclerosing cholangitis, colon cancer, pulmonary circulation disorders, and coagulopathy (P < 0.001). On multivariate logistic regression, colon cancer had more than 5-times higher chances of colectomy (odd ratio [OR] 95% confidence interval {CI} 5.574 (5.364-5.792) (P ≤ 0.001). Risk of colectomy was higher in patients with C. diff infection, with coagulopathy, and CMV (OR [95% CI] 2.831 (2.748-2.915), 1.878 (1.813-1.946), and 1.537 (1.350-1.750), (P < 0.001 for all), respectively. Table 1 represents the patient's characteristics.

CONCLUSION:
In this large population cohort, IBD patients with an infection, specifically CMV and C. diff, or colon cancer had higher rates of colectomy. Patients with these risk factors should have an early consultation with surgery and evaluation for infections.