bluuebunny/crossref_metadata_2025_split huggingface dataset:
752 Should Gastroenterologists Screen Immunosuppressed IBD Patients for HIV?
Authors: Naik Katrina , Borum Marie , Khan Ali , Boortalary Tina , Imasuen Esosa 
Published: October 2019

INTRODUCTION:
HIV screening is recommended in all patients aged 15-75 years once in their lifetime and more frequently if at higher risk, including those taking immunosuppressive therapy. Gastroenterologists are uniquely positioned to improve screening rates since they prescribe immunosuppressive therapy to inflammatory bowel disease (IBD) patients. This study evaluated the frequency of HIV screening among IBD patients on immunosuppressive therapy at a university medical center.

METHODS:
A retrospective chart review of all IBD patients at an urban academic medical center seen during a 5-year period was performed. Patient gender, age, race/ethnicity, disease type, medication regimen, HIV screening and ordering physician specialty were obtained. Exclusion criteria were a previous HIV diagnosis or not receiving immunosuppressive treatment. A confidential database was created using Microsoft Excel with statistical analysis set at <0.05. This study was approved by IRB.

RESULTS:
Medical records of 392 IBD patients were reviewed. Of the 226 patients on immunosuppressant therapy, 97 (42.9%) males and 129 (57.1%) females were a mean age of 43.3 years. 58 (25.7%) had Crohn's Disease, 161 (71.2%) had ulcerative colitis and 8 (3.5%) had indeterminate colitis. 93 (41.2%) were screened for HIV. Three (0.004%) were HIV positive. African Americans were screened significantly more than non-African Americans (61.5%, 31.3%; P = 0.0001). There were no significant differences in HIV screening by gender (37.1% M, 44.2% F; P = 0.339); age (40.3% < 45 years, 42.4% ≥45 years; P = 0.784); or IBD type (51.7% CD, 37.9% UC; P = 0.0870). Primary care doctors screened for significantly more (51.6%) than obstetricians/gynecologists (22.6%; P = 0.0001) or other specialty physicians (9.7%; P = 0.0001) (Figure 1).

CONCLUSION:
Chronic colonic inflammation may contribute to CD4 lymphocyte depletion and negatively impact HIV outcome. While there are few HIV-infected patients in this study, HIV vulnerability may vary in other immunosuppressed populations. While this study is limited by size, single-institution design and focus on immunosuppressed IBD patients, it offers a foundation for future research and preventive health care efforts. It is important that all at-risk populations be screened for HIV with a focus on eliminating racial disparity. Gastroenterologists have the potential to significantly improve HIV testing for at-risk populations. Increased efforts are needed to heighten all physicians' awareness of HIV testing recommendations.
764 Long-Term Efficacy and Safety of Etrasimod for Ulcerative Colitis: Results From the Open-Label Extension of the OASIS Study
Authors: Chiorean Michael , Vermeire Séverine , Panés Julian , Peyrin-Biroulet Laurent , Zhang Jinkun , Sands Bruce E. , Lazin Krisztina , Cabell Chris H. , Naik Snehal U. , Klassen Preston , Sandborn William J. 
Published: October 2019

INTRODUCTION:
Etrasimod, a once-daily, oral, selective, sphingosine-1-phosphate receptor modulator, was previously tested in the 12-week (wk) phase 2, randomized, placebo-controlled, double-blind (DB) OASIS study (NCT02447302) in adults with moderate–to–severe ulcerative colitis (UC). This open-label extension (OLE) study (NCT02536404) evaluated safety/efficacy of etrasimod for an additional 34 wk in OASIS completers.

METHODS:
All patients completing the DB study could enroll in the OLE and receive etrasimod 2 mg QD for a subsequent 34 wk. Efficacy was summarized in the modified intent-to-treat (mITT) population evaluable cohort, which included patients with required assessments who received etrasimod 2 mg throughout the OLE. The treat-through (TT) group received etrasimod 2 mg in both the DB and OLE studies. Endpoints were clinical remission (endoscopic score ≤1 [with absence of friability], rectal bleeding [RB] = 0, and stool frequency [SF] score ≤1 with ≥1 point decrease from DB baseline), clinical response (clinical remission or decrease in modified Mayo Clinic score [endoscopy findings, RB, or SF] of ≥2 points and ≥30% decrease from DB baseline, with either a RB decrease of ≥1 or RB score of ≤1), and endoscopic improvement (subscore ≤1). All statistics are descriptive. End of treatment (EOT) was the last observation for each patient.

RESULTS:
118 patients (84% of DB completers) entered the OLE; 112 patients received etrasimod 2 mg at any point in the OLE (safety population), of whom 105 received etrasimod 2 mg throughout the OLE (evaluable cohort), and 92 completed the OLE. At EOT, 70% of patients had a clinical response, increased from 40% at wk 12 (Table 1). Most patients with clinical response, clinical remission, or endoscopic improvement at wk 12 maintained that status at EOT (Table 2). Median lymphocyte reduction from DB baseline was 44.6% at wk 12 with etrasimod 2 mg and 42.9% at EOT in the TT group. In the safety population, 60% experienced ≥1 TEAE (mostly mild or moderate) and 9% stopped study drug due to a TEAE. Of 14 serious TEAEs in 7 patients, only 1 was considered treatment-related (worsening UC). Effects on heart rate and atrioventricular (AV) conduction were minimal; no patients withdrew due to bradycardia or AV block.

CONCLUSION:
Etrasimod 2 mg showed sustained clinical response, clinical remission, and endoscopic improvement at the end of the OLE. Etrasimod had a favourable long-term safety profile, with most AEs of mild to moderate severity; no new safety findings were reported.
765 Low Skeletal Muscle Index Is an Independent Risk Factor for Inflammatory Bowel Disease Surgical Complications
Authors: Berger Matthew , Micic Dejan , Sakuraba Atsushi 
Published: October 2019

INTRODUCTION:
Pre-operative assessment is necessary to determine if patients with inflammatory bowel disease (IBD) will benefit from nutrition support. The relationship between skeletal muscle area and the prognosis of patients who undergo surgery for IBD remains undetermined. This study aims to evaluate the skeletal muscle index (SMI) area as a predictive marker for surgical outcomes in patients with IBD.

METHODS:
Data were collected retrospectively for consecutive surgeries for IBD complications between March 2014 and April 2016. The primary outcome of interest was infectious and non-infectious post-operative complications. The SMI was measured using the cross-sectional computed tomography images at the mid-L3 level using ImageJ. Sarcopenia was defined using previously validated SMI categories adjusted for sex and BMI. Data were analyzed using Wilcoxon rank-sum test for continuous variables and Fischer's exact test for categorical variables. Multivariate logistic regression was performed to identify independent factors predictive of postoperative complications.

RESULTS:
439 patients were included in the final analysis. 92 (20.1%) patient had cross-sectional imaging available for sarcopenia evaluation. 178 (40.5%) experienced post-operative complications. In univariate analysis, Crohn's disease, SMI, Nutrition Risk Index, albumin, CRP, and BUN were associated with increased risk of 30-day postoperative complications (Table 1). In multivariate analysis, only sarcopenia as defined by Martin et al. (OR = 5.6; CI: 1.7-18.3) was significantly predictive of postoperative complications. In subgroup analysis, sarcopenia was found to be predictive of infectious postoperative complications (57.1% versus 22%, P = 0.001).

CONCLUSION:
Skeletal muscle index utilizing previously defined categorical variables is a readily available and significant independent risk factor for 30-day postoperative complications in IBD with a strong association with infectious complications. Further interventional studies are required to define our abilities to mitigate post-operative complications based on these findings.
766 Predictors and Trends in Hospitalized Patients With Inflammatory Bowel Disease and Colorectal Cancer That Develop Venous Thromboembolism: A Retrospective Review
Authors: Palacios Pedro , Attar Bashar M. , Mbachi Chimezie , Chukwujindu Ezekiel , Paintsil Isaac , Nwaichi Chineme , Vohra Ishaan , Majeed Muhammad , Wang Yuchen , Gandhi Seema 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) is an idiopathic inflammatory process affecting the gastrointestinal tract. Patients with IBD have been shown in several studies to be at higher risk of venous thromboembolism (VTE) and colorectal cancer (CRC) compared to the general population. IBD and CRC have different prothrombotic properties; it is unknown how the interaction of these prothrombotic properties in patients with both IBD and CRC predicts the development of VTE in hospitalized patients necessitating the current study.

METHODS:
The national inpatient sample (NIS) from 2005-2014 was queried for all patients with a co-diagnosis of IBD and CRC who were hospitalized with a diagnosis of VTE as one of the top three discharge diagnosis using ICD9 codes 4534.X, 4533.X, 4511.X, 4518.X, 4151.X, 4538.X and 4151.X. The main outcome was the predictors of VTE. While secondary outcomes were trend in prevalence, length of stay, total charge and in-patient mortality among patients with VTE. All analysis was done using STATAv14.

RESULTS:
7,585 adults with a co-diagnosis of IBD and CRC were included, among which 197 (2.5%) were coded to have VTE as one of their top three diagnoses. Multivariate logistic regression showed that black race patients (10.6% vs 5.2%; aOR 2.33 [1.40-3.89], P = 0.001), patients with metastasis (27.9% vs 16.7%; aOR 1.67 [1.17-2.40], P = 0.005) and with pulmonary circulation disorders (27.4% vs 1.2%) aOR 28.52 [18.8-43.1], P = < 0.001) had more odds of having VTE while patients with uncomplicated diabetes (8.1% vs 15.5%; aOR 0.47 [0.26-0.84], P = 0.012) had less odds of having VTE. Obesity and anemia were significantly associated with VTE in univariate logistic regression analysis but lost its significance on multivariate logistic regression analysis. VTE was also associated with more length of stay (8.41 vs 6.87 days, P = 0.005) and more total charges ($64,388 vs $50,874, P = 0.009). There was no significant trend in the prevalence of VTE neither was VTE associated with a higher odds of mortality.

CONCLUSION:
VTE was more common in patients with metastatic cancer and pulmonary circulation disorders compared to patients with localized disease while obesity and anemia lost significance after multivariate logistic regression analysis. Patients with IBD and CRC might have peculiar procoagulant properties different from patients with only IBD or CRC and might require tailored strategies to stratify these population into a different category so as to develop more directed VTE prophylaxis regimen.
769 Association Between Vitamin D Deficiency and Inflammatory Bowel Disease (IBD)
Authors: Baidoun Firas , Sarmini Muhammad Talal , Alkhadra Yasser , Khoudari George , Shen Bo 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) with its two major forms, ulcerative colitis (UC) and Crohn disease (CD), has an increasing incidence rate worldwide. Vitamin D deficiency is a common disorder and it has been more prevalent in the last twodecades. multiple studies have shown a link between vitamin Dlevel and IBD severity raising the question of vitamin Ddeficiency role as a risk factor for IBD. The goal of this study is to investigate the association between vitamin D deficiency and IBD using a large inpatient data base.

METHODS:
By using the data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified the patients with vitamin D deficiency and IBD diagnosis using the International Classification of Diseases 9th version codes (ICD-9). The control group was the patients without vitamin D deficiency using the ICD-9 codes. We did multivariate logistic regression analysis to calculate the association between vitamin Ddeficiency and IBD.

RESULTS:
The study had total 101,137,145 patients. The vitamin Ddeficiency group had 339,418 patients (0.34%). We noticed that patients with vitamin D deficiency were older with mean age (63 vs 48), had more African American patients (17% vs 14%) and more female patients (67% vs 58%) (P < 0.001 for all). The vitamin D deficiency group had more patients with obesity (16% vs 7%) and more tobacco use (11% vs 10%) (P < 0.001 for all) (Figure 1). Using univariate analysis, we found patients with vitamin Ddeficiency had higher rate of IBD compared with patients without vitamin D deficiency (Odds Ratio [OR], 2.539, 95% confidence interval [CI], 2.474-2.605, P < 0.001), then we used multivariate logistic regression analysis, and after adjusting for potential cofounding factors, patients with vitamin D deficiency had a statistically significant higher rate of IBD (Odds Ratio [OR], 2.35, 95% confidence interval [CI], 2.285-2.417, P < 0.001) compared with patients without vitamin D deficiency (Figure 2).

CONCLUSION:
Based on our study we found that patients with vitamin D deficiency have two times higher risk of having IBD compared to patients without vitamin D deficiency. This raise the importance of screening for vitamin D deficiency in IBD patients. Further studies are needed to assess the role of vitamin D supplement in IBD course and outcome.
778 Association Between Serum Albumin Levels and the Rate of Active Crohn's Disease in Patients Seen at a Tertiary Care IBD Center
Authors: Harris Patrick , Matin Tasnia , Zhang Nan , Talha Malik 
Published: October 2019

INTRODUCTION:
Crohn's Disease (CD) is a chronic inflammatory condition, primarily of the gastrointestinal tract with an increasing incidence and prevalence worldwide. In clinical practice, gastroenterologists are often faced with challenges in evaluating disease activity, severity, and prognosis to guide appropriate management of CD. We studied the association between serum albumin level and the rate of active clinical disease in CD patients seen at a tertiary care Inflammatory Bowel Disease (IBD) referral center.

METHODS:
We designed a retrospective cohort study using adult patients (>18 years) with CD followed for at least one year at University of Alabama at Birmingham (UAB) IBD center by a single trained IBD specialist between 2014-2018. Serum albumin levels were divided into: low mean serum albumin (≤3.2 mg/dL) vs. appropriate mean serum albumin (>3.2 mg/dL). Clinical disease activity was measured using the Harvey-Bradshaw index (HBI). Active disease was defined as HBI score of 8 or higher. Poisson Regression Models (GPR) for Rate Data were used to estimate partially adjusted and fully adjusted incidence rate ratios (IRR) of active clinical disease among CD patients. We also examined IRRs for serum albumin level as a continuous variable.

RESULTS:
In this single IBD practice at UAB, 269 patients with CD had albumin drawn at initial visit and serially at each subsequent visit. Poisson regression model adjusted for age, gender, race, duration of disease, steroid use, smoking and Crohns location demonstrated that CD patients with a low mean serum albumin during clinical observation were approximately 1.5 times more likely to have active clinical disease during observation (IRR 1.49, 95% CI 1.04-2.15, P = 0.032) compared to those with a serum albumin level of >3.2 mg/dL. The adjusted model with serum albumin as a continuous variable demonstrated that with every unit (0.1 mg/dL) reduction in mean serum albumin, there was 30% higher likelihood of active Crohns in clinic (IRR 1.30, 95% CI 1.02-1.66, P = 0.037).

CONCLUSION:
Lower mean serum albumin during clinical observation is associated with a higher likelihood of active clinical disease among CD patients. Whether interventions designed to correct or increase serum albumin stores/levels in these patients would be beneficial remains to be examined.
779 Dietary Practices and Beliefs of British South Asian Patients With Inflammatory Bowel Disease: A Prospective Study From the United Kingdom
Authors: Crooks Benjamin J. , McLaughlin John , Limdi Jimmy K. 
Published: October 2019

INTRODUCTION:
The increasing incidence of inflammatory bowel disease (IBD) in developing countries and immigrant populations appears to outpace that which genetic influences alone could instigate and implicates “westernisation” and diet in the aetiopathogenesis of IBD.
1
Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian patients with IBD and the information resources which guide these beliefs.

METHODS:
A prospective, cross-sectional, questionnaire-based study is being conducted in the UK. Two-hundred South Asian patients with IBD will complete a questionnaire regarding demographics and dietary practices. Here we provide an interim analysis of the data collected from the first 27 patients.

RESULTS:
Mean patient age was 36.1 years (59% male). 56% had UC and 44% Crohn's. 62% identified themselves as Pakistani, 19% as Indian and 19% as Bangladeshi. 74% of patients were born in the UK to parents born outside of the UK, the remaining 26% were born outside of the UK. Mean disease duration was 10.2 years. 48% considered diet to be an initiating factor in their IBD, based on their own experience (100%) and internet resources (31%). 63% of patients felt that diet had triggered a relapse of their disease, the most commonly reported foods being spicy (65%), fatty foods (53%), milk products (35%) and red meat (35%). 81% of patients avoided certain foods in an attempt to prevent an IBD “flare.” Most frequently avoided foods were spicy foods (91%), fatty foods (86%), coffee and carbonated drinks (55%) and red meat (50%). Just over a third of patients reported being able to find specific dietary advice for IBD, most commonly on the internet. Around half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD.

CONCLUSION:
Dietary restriction may be highly prevalent amongst the British South Asian community with IBD with a high proportion reporting diet as an initiating factor and trigger for IBD. Studies on immigrant populations may hold valuable clues for IBD pathogenesis or related symptoms. A larger dataset will be presented at conference proceedings.
780 Dietary Practices and Beliefs of Patients With Older Onset Inflammatory Bowel Disease: A Prospective Study From the United Kingdom
Authors: Crooks Benjamin J. , McLaughlin John , Limdi Jimmy K. 
Published: October 2019

INTRODUCTION:
In an aging population, 25-35% of those with inflammatory bowel disease (IBD) are over 60 years old. A third of these are diagnosed with IBD at or over the age of 60, so-called “older-onset” IBD [1]. Despite epidemiological associations implicating diet in IBD aetiology, virtually no studies exist exploring perceptions and beliefs of patients with older-onset IBD.

METHODS:
A prospective, cross-sectional, questionnaire-based study is being conducted in the UK. Two-hundred patients with older-onset IBD will complete a questionnaire regarding demographics and dietary practices. Here we provide an interim analysis of the data collected from the first 29 patients.

RESULTS:
Mean patient age was 73.5 years, 55% were male, 93% Caucasian, 69% had ulcerative colitis and 31% had Crohn's disease. Mean disease duration was 6.2 years. 24% of patients felt diet was an initiating factor in their IBD and this was based on their own experience (86%) or advice from a gastroenterologist (57%) or dietician (43%) in the majority of cases. Just under a quarter of patients believed that diet could trigger a relapse of their disease with 43% of these identifying both milk products and raw fruit and vegetables as the most common causes. 60% of patients avoided certain foods to prevent relapse. The most commonly avoided foods were spicy (82%) and fatty foods (65%), carbonated drinks (53%), red meat (47%) and alcohol (41%). Over 50% reported being able to find specific advice regarding dietary recommendations in IBD, and three-quarters of these used the internet to obtain this advice. A fifth of patients avoided eating the same menu as their family at least some of the time to prevent relapse of their IBD and 30% of patients avoided eating out. 17% had tried a specific exclusionary diet to help manage their disease.

CONCLUSION:
Despite a low proportion implicating diet in the initiation of IBD or its relapse, a significant number continue to restrict their diet. This, along with co-existing frailty, comorbidities and polypharmacy, may put this group of patients at increased risk of nutritional deficiency and its associated complications, underpinning the need for understanding the dietary practices and perceptions in this vulnerable group. A larger dataset will be presented at conference proceedings.
783 Nonalcoholic Fatty Liver Disease in a South Asian Crohn's Disease Population: External Validation of the St. Louis Steatosis Index
Authors: Tirath Ankita , McHenry Scott , Ganesh Girish , Ciorba Matthew A. , Sharma Mithun , Banerjee Rupa , Deepak Parakkal 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease affecting one-quarter of the world population. NAFLD is also an extra-intestinal manifestation of Crohn's Disease (CD), where it is associated with higher morbidity and mortality. We aimed to (1) characterize risk factors for NAFLD in South Asian CD pts, and (2) externally validate a clinical prediction score for NAFLD in CD, the St. Louis Steatosis Index (SLSI).

METHODS:
We prospectively enrolled CD pts from 2/1/2019-5/31/2019 at the Asian Institute of Gastroenterology, a tertiary referral center for Inflammatory Bowel Disease (IBD) in India. Exclusion criteria included an alternative etiology of liver disease (e.g., chronic viral hepatitis). Controlled attenuation parameter (CAP) with transient elastography was measured using FibroScan® (Echosens, Waltham, MA) to quantitate hepatic steatosis and fibrosis. The outcome of NAFLD was defined as CAP ≥ 240 dB/m with the secondary outcome of hepatic fibrosis defined as ≥7 kPa. The SLSI operating characteristics were compared at re-calibrated low risk (<10%) and high risk (>40%) thresholds. The discrimination was compared to the Hepatic Steatosis Index (HSI) by both the C-statistic and net reclassification improvement (NRI) for the primary outcome and to both the HSI and the NAFLD fibrosis score (NFS) for the secondary outcome.

RESULTS:
100 pts (63% male, median age 35 years) were enrolled with 42 (42%) demonstrating NAFLD and 6 (6%) demonstrating hepatic fibrosis. Univariate risk factors for NAFLD are shown (Table 1). Older age, male gender, elevated BMI, and presence of hypertension were significantly associated with a diagnosis of NAFLD. A low-risk SLSI was 71% sensitive and a high-risk SLSI was 93% specific for a diagnosis of NAFLD. SLSI showed fair discrimination for NAFLD but this was not different from the HSI (C statistic 0.747 vs 0.722; NRI +0.02). For the diagnosis of hepatic fibrosis, a low-risk SLSI was 83% sensitive and a high-risk score was 90% specific. The SLSI showed fair discrimination (0.767) that was superior to both the HSI (C statistic 0.587, NRI +0.47) and the NFS (C statistic 0.688, NR +0.23).

CONCLUSION:
NAFLD was common among this South Asian cohort with CD despite few traditional risk factors. The SLSI has fair discrimination for both NAFLD and the more clinically relevant subgroup with hepatic fibrosis. Further steps include exploring alternate mechanisms for this finding and devising more sensitive CD-specific screening tools for NAFLD.