bluuebunny/crossref_metadata_2025_split huggingface dataset:
185 Evaluating Dynamics of Bile Acid Metabolism to Predict Recurrence of Clostridioides difficile Infection
Authors: Allegretti Jessica R. , Mullish Benjamin , Nativ Lotem , Marcus Jenna , Marchesi Julian , McDonald Julie A.K. , Pechlivanis Alexandros , Kennedy Kevin , Gerber Georg , Bry Lynn 
Published: October 2019

INTRODUCTION:
Recurrent Clostridioides difficile infection (CDI) is a major public health problem. The ability of commensal gut microbiota to metabolize primary into secondary bile acids plays a role in protection against this infection. Current clinical prediction tools for CDI recurrence do not incorporate biomarkers predictive of protective microbiota functionalities. We investigated metabolomic predictors of C. difficile recurrence.

METHODS:
We conducted a prospective longitudinal study of patients experiencing a first CDI episode. Patients testing positive with either enzyme immunoassay (EIA) toxin or polymerase chain reaction (PCR), and being treated for CDI, were eligible for inclusion. Serial stool samples were collected at diagnosis through week-8 post-completion of anti-CDI therapy if no recurrence, or until the point of recurrence (defined as diarrhea with positive C. difficile EIA toxin stool test). Liquid chromatography-mass spectrometry was performed to profile fecal bile acids. The week 1 post-antibiotic time point was chosen to assess for potential predictors. We derived a univariate logistic regression model predicting recurrence and computed the AUC (c-statistic) on discriminatory ability. The Youden index was calculated as the value that maximizes sensitivity and specificity.

RESULTS:
29 first episode CDI patients were enrolled. 10 patients recurred (34.5%) during 8-weeks of follow-up. Average time to recurrence was 1.9 weeks. Two clinical factors were assessed a-priori for recurrence: use of metronidazole vs vancomycin (OR: 3.56, 95% CI 0.61–20.81, P = 0.15) and diagnosis with EIA vs PCR (OR 8.75, 95% CI 1.53–50.1, P = 0.01). At week 1, significantly more of the secondary bile acids lithocholic acid (LCA) and isolithocholic acid were found in non-recurrers vs recurrers (relative abundance per mg of stool: 20395.0 vs 4542.5, P = 0.037 and 4318.0 vs 1122.7, P = 0.031 respectively) (Table 1). As these are co-linear, we proceeded with LCA alone. With Youden index 17025, sensitivity was 80% and specificity was 57.9%, and the overall AUC resulted in a c-statistic of 0.753 (Figure 1a). However, when clinical risk factors were combined with LCA, sensitivity became 90% and specificity was 79%, with c-statistic of 0.91 (Figure 1b).

CONCLUSION:
The secondary bile acid, LCA, a known inhibitor of C. difficile's vegetative growth, predicted eventual recurrence of CDI with moderate accuracy; however, the model improved significantly with the addition of simple clinical variables.
186 Anaerobic Versus Aerobically Prepared Fecal Microbiota Transplantation Capsules: A Pilot Comparative Cohort Analysis Using a Novel Sequencing Approach
Authors: Mendolia Gina M. , Bi Haixin S. , Kassam Zain , Chu Nathaniel , Smith Mark , Alm Eric , Allegretti Jessica R. 
Published: October 2019

INTRODUCTION:
Fecal microbiota transplantation (FMT) capsules have emerged as a therapeutic option for recurrent C.difficile infection (rCDI). Standard FMT capsules are prepared under aerobic conditions; however, anaerobic processing limits oxygen's impact on healthy anaerobic microbes, may enhance microbial community viability, improve engraftment, and may in turn increase efficacy. Thus, we compared the engraftment profiles of FMT capsules prepared by aerobic (AER) versus an anaerobic process (ANA) in rCDI patients. We applied a novel DNA-sequencing method (PMA-seq) to differentiate living and dead microbes.

METHODS:
We conducted a prospective cohort study of rCDI patients (3 or more confirmed episodes within 1 year) eligible for standard of care FMT. Subjects were enrolled sequentially to receive either a single administration of 30 capsules of standard AER or ANA. 3 healthy donors were use and stool donation was split; half prepared under anaerobic and half under aerobic conditions. This technique was used to address donor and stool specific confounding effects. All measures were taken to manage oxygen exposure, otherwise the split stool samples were treated identically. ANA preparations occurred inside an anaerobic chamber. Patients were assessed, and stool samples collected at 72 hours, 10 days, 4 weeks and 8 weeks post-FMT. Gut microbial communities were profiled via shotgun metagenomic and 16S sequencing. Additionally, PMA-seq, a novel species-specific live-dead assay was conducted. Pre and post treatment microbiome engraftment outcomes were analyzed. Assessment for clinical cure was done at week 8 [testing via (GDH/EIA)].

RESULTS:
A total of 10 recurrent CDI patients were enrolled (5 AER and 5 ANA). Relevant characteristics were similar between the AER [mean age: 73 (SD = 15.9), mean recurrence 3.4] and ANA groups [mean age: 67.1 years (SD = 18.7), mean recurrence 3.0]. Overall, gut microbial community outcomes from ANA and AER, including alpha diversity, beta diversity and relative abundances, did not vary substantially by 16S, shotgun metagenomic sequencing or PMA-seq (Figures 1 and 2). Clinical cure at week 8 for AER and ANA was 100% (5/5 in each group). Both formulations were safe and well-tolerated.

CONCLUSION:
To our knowledge, this is the first study to compare aerobically versus anaerobically prepared FMT capsules, including assessment of live and dead specific-microbial profiles. This pilot study suggested there were no significant differences in engraftment profiles in rCDI.
187 Poor Bowel Prep Leads to Low Yield for Inpatient Colonoscopies and Significantly Increases Overall Healthcare Cost: It Is High Time to Reevaluate Bowel Prep Options
Authors: Ramireddy Srinivas , Manisundaram Krish , Patil Prithvi , Badillo Ricardo , Davee Tomas , Thosani Nirav 
Published: October 2019

INTRODUCTION:
There have been multiple studies reporting inadequate bowel preparation based on standardized scales like Boston bowel preparation scale (BBPS) for inpatients compared to outpatient colonoscopies. Most of these inpatient procedures might be incomplete or inadequate due to bowel prep and they might be repeated the next day putting additional burden on both the patient and hospital financial system or repeated as outpatient. Aim of this study to evaluate retrospectively the efficacy of bowel prep on inpatient colonoscopy and indirectly assess healthcare delivery cost at our institution.

METHODS:
Prospectively collected data for all inpatient colonoscopies done at our center between January 2018 to August 2018 was retrospectively evaluated. All patient's scheduled for inpatient colonoscopy was given split dose bowel preparation according to standard guidelines. Our database included daily endoscopy and floor nurse documentation regarding completeness of bowel prep, procedure cancellation or rescheduling related to poor bowel prep and colonoscopy procedure detail including Boston Bowel Prep Score for each completed procedure. Adequate bowel preparation is consider composite BBPS 7 or above and BBPS 6 or less was considered inadequate bowel prep.

RESULTS:
A total of 246 (n = 246) patients were scheduled for inpatient colonoscopy from January 2018 to August 2018. Of the total patients about 136 (55.5%) patients were male and 110 (44.5%) patients were female with average age of 60.6 ± 16.15 years (Range 18–91 years). Of the total number of patients (200) who completed their procedures, a total of 114 (57.0%) patients had a total score (BBPS Right + BBPS Transverse + BBPS Left) of 7 and above and the rest 86 (43%) patients had a BBPS score of less than 7. For all these patients, a repeat colonoscopy at short interval (within 6 months–1 year) was recommended. Average cost of additional inpatient hospitalization day at our institution is at least 600$. Indirect cost with loss of overall productivity was estimated to be additional 1000$. This each inpatient colonoscopy with poor bowel prep added at least 1600$ in direct and indirect healthcare cost, not counting indirect cost incurred by patient and family members related to loss of productivity.

CONCLUSION:
While colonoscopy remains valuable diagnostic and therapeutic tool, current bowel prep options for inpatient colonoscopy are not sufficient. Alternative means of bowel prep options needs to evaluated in inpatient setting.
190 Anti-Depressant Use Does Not Predict Development of Microscopic Colitis: A Retrospective Case-Controlled Study
Authors: Shenoy Abhishek , Redd Walker D. , Hunold Thomas , Hays R. Ann 
Published: October 2019

INTRODUCTION:
Microscopic Colitis (MC) is a chronic inflammatory disease of the colon that presents with chronic, non-bloody, watery diarrhea and is diagnosed with colonoscopy (CSPY). Literature is mixed on the association of Anti-Depressant (AD) use and their association with MC. We investigated the association of AD's with MC among patients with clinically significant diarrhea.

METHODS:
We performed a retrospective case-control study of all patients with clinically significant chronic diarrhea whom underwent CSPY to rule out MC from 1/2012–12/2016 at the University of Virginia Hospital. 127 patients diagnosed with MC were propensity score matched to 127 patients with normal biopsies based on age and gender. Patients were excluded if they were <18 years old, inpatients, or had FMT. The primary outcome was history of AD use. The secondary outcome was use of NSAIDs or PPI's. OR was calculated for the primary outcome and binomial logistic regression modeling was used to control for other medication use. Statistical analysis and propensity score matching were performed in R using the MatchIt Package.

RESULTS:
55/127 patients with MC and 45/127 patients with normal biopsies used AD's (OR 1.4; 95% CI (0.65–3.04). No differences were observed among the case and control groups with respect to age, gender, celiac disease, or PPI use. No statistical difference was seen in the lymphocytic (LC) vs. collagenous colitis (CC) subtypes among MC patients with AD use. More patients with AD use had LC than CC but this difference was not clinically or statistically significant. Logistic regression revealed that only NSAID use was a predictor of the development of MC (P < 0.001). Anti-depressant use was not a predictor of MC development. Neither combination of AD and NSAID (P = 0.7385) nor AD and PPI use (P = 0.6892) together was predictive of development of MC.

CONCLUSION:
In this study, a history of AD did not predict a pathologic diagnosis of MC in an at risk population. It remains unclear if PPI's or AD's are associated with the development of MC suggesting that MC development may be iatrogenic. Despite studies on the gut-brain axis and gut microbiota dysbiosis associated with AD's, our series showed no association between AD use and MC. Further studies may prove beneficial in relating the development of MC with long-term AD use and their influence on the microbiome, Based on our data, the diagnosis of MC does not warrant discontinuing AD's especially since depression itself may lead to worsened clinical stability of MC.
192 The Latest Trend and Disparities in Clostridium difficile Colitis Related Hospitalizations in the United States
Authors: Chkhikvadze Tamta , Gigauri Nino , Gogokhia Lasha , Shi Junxin , Kwak Ye Eun 
Published: October 2019

INTRODUCTION:
Enterocolitis due to Clostridium Difficile infection (CDI) has been a leading and drastically rising cause of nosocomial infection worldwide. We aimed to examine the trends, demographics and hospital resource utilization of CDI hospitalizations in the United States using the largest available national administrative database.

METHODS:
We analyzed National Inpatient Sample (NIS) database from 2005 to 2016. We extracted patient discharge data using ICD-9 (008.45) and ICD-10 (A04.7) primary diagnoses codes for enterocolitis due to CDI from 2005 to 2014 and 2016, respectively. Combined ICD-9 and ICD-10 diagnoses codes were used for year 2015 due to coding transition. Trend in hospitalization due to enterocolitis from CDI was the primary outcome. Secondary outcomes included inpatient mortality, mean hospital charges, hospital length of stay (LOS) and demographic disparities. Type of hospitals and discharge places for CDI were also analyzed.

RESULTS:
Total of 257,613 CDI enterocolitis admissions were identified from 2005–2016, which is estimated to 1,255,271 hospitalizations nationally. Increasing trends in CDI admissions were noted from 73,611 in 2005 to 106,245 in 2016 (Figure 1). In-hospital mortality demonstrated decreasing trend from 4% in 2005 to 1.3% in 2016. Female represented majority of CDI admissions throughout the entire examined years (65% female vs. 35% male). There was significant racial disparity in CDI admissions, with 77.3% white, 10.5% black, 8.3% Hispanic, 1.3% Asian/Pacific Islander and 2.6% Native American origin. Admissions to teaching hospitals due to CDI showed increasing trend from 37% in 2005 to 60% in 2016, whereas admissions to non-teaching hospitals decreased from 63% in 2005 to 40% in 2016. Mean charges have increased by 8.4% from $34,887 to $37,832 (Table 1), while mean LOS has decreased by 1.6 days, corresponding to −22% change from 2005 to 2016 (Table 2). Most patients were discharged home (59%), while others were discharged to home health care (16%), long-term care facilities (22%) or short term care facilities (1%).

CONCLUSION:
CDI related admissions and mean hospital charges have been increased nationally from 2005 to 2016, despite the decrease in length of stay and in-hospital mortality. Significant racial disparities in CDI admissions persisted throughout the decade. Further research investigating preventive measures to decrease hospitalization and cost as well as to improve racial disparities and resource utilization for CDI is needed.
193 Decreased Levels of High-Molecular-Weight Adiponectin Is Associated With Colorectal Neoplasia in Japan
Authors: Inoue Nagamu , Bessho Rieko , Yoshida Toshifumi , Kashiwagi Kazuhiro , Hirose Hiroshi , Sugino Yoshinori , Iwao Yasushi 
Published: October 2019

INTRODUCTION:
In Japan, the incidence and mortality rate of colorectal cancer (CRC) has been increased and CRC is considered to be one of obesity-related malignancies. Adiponectin is an adipocyte-specific adipokine, which possesses pleiotropic properties on various disease including atherosclerotic diseases, cardiovascular diseases, inflammatory diseases and tumors. In addition, recent studies have demonstrated that high-molecular-weight (HMW) form of adiponectin is active form of this adipokine. The objective of the present study was to investigate whether HMW adiponectin was a risk factor for colorectal neoplasia (CRN; adenomatous polyp ≥5 mm in size and cancer) using comprehensive health checkup data.

METHODS:
We conducted a retrospective analysis in clinical practice at a single center. Among 10138 subjects who took comprehensive health checkup at our hospital between in August 2012 and December 2016, 315 subjects who underwent screening both colonoscopy and optional metabolic syndrome course were enrolled. HMW adiponectin was measured using commercially available ELISA kit. We evaluated demographic characteristics, anthropometric measurements, visceral fat area (VFA) measured by CT, hematological metabolic parameters, degree of liver fat evaluated by ultrasonography, and current smoking and drinking habits as variables. Association between variables and CRN was evaluated by univariate analysis using t-test, χ2 test, Mann-Whitney test, and then by multivariate analysis using multiple logistic regression model. A P value <0.05 was considered statistically significant.

RESULTS:
Of 315 subjects (men: 228, women: 87) analyzed, 97 subjects were diagnosed as MetS (30.8%) and 33 subjects had CRN (10.5%). Subjects with MetS had more CRN (12 subjects, 12.4%) compared with those without MetS (21 subjects, 9.6%) (n.s.). Univariate analysis identified significant association of sex, age, VFA, systolic blood pressure, current smoking habits, drinking habits and ≥10 kg weight gain compared with the body weight at the age of twenty with CRN prevalence. Moreover, HMW adiponectin level was inversely corelated with CRN prevalence (P = 0.003). Logistic regression analysis revealed that age, systolic blood pressure, current smoking, and HMW adiponectin level were independent factors associated with CRN prevalence (Table 1).

CONCLUSION:
The present study demonstrated that decreased levels of HMW adiponectin is a risk factor for colorectal neoplasia in Japan.
195 Adequacy Rates of Magnesium Citrate Bowel Preparation in a Large Retrospective Cohort
Authors: Alsamman Mohd Amer , Leung Stephanie , Moustafa Abdelmoniem , Baird Grayson , Shah Samir A. 
Published: October 2019

INTRODUCTION:
Magnesium Citrate (MC) is not FDA approved as a colonoscopy preparation, but has been used widely in Europe. Advantages include low cost and small volume Few studies have evaluated MC as a bowel preparation. A large prospective trial by Gu, where MC (n = 53) had better tolerability and bowel cleansing compared to GoLYTELY but was statistically insignificant likely due to small sample size. Arora found PEG to be superior to MC We evaluated bowel preparations used in an endoscopy center of a Gastroenterology practice. Sample size is the largest for any similar studies (n = 19173).

METHODS:
Electronic Medical Records were queried for colonoscopies between 2010–2016. Bowel prep used, indication for colonoscopy (screening vs other) and preparation adequacy were all documented prospectively but queried for analysis retrospectively. Cases where the prep type was not recorded were excluded. Adequacy was based on numeric grade (0 = excellent, 1 = good, 2 = fair, and 3 = poor), where 0–2 were considered adequate and 3 not. An adequate prep resulted in following guidelines for next interval colonoscopy. Adequacy rates were calculated and compared. Data were analyzed using SAS software.

RESULTS:
A total of 19,173 cases (MC 2 bottles plus 2 Dulcolax (n = 9315), MC 3 bottles (n = 4682), Golytely 4 L (n = 137), Golytely 2 L (n = 72), Miralax (n = 193), Moviprep (n = 153), Nulytely 4 L (n = 145), Halflytely (n = 104), Osmoprep (n = 42), Suprep (n = 208), Combo prep which was a combination of GoLytely or Nulytely with MC (n = 3960), miscellaneous (n = 162)). We divided all into two major groups (Screening colonoscopies and non-screening colonoscopies) and looked at adequacy rate of each preparation used (Table 1). We compared MC 2 bottles and 3 to the rest of the major groups (Table 2).

CONCLUSION:
Our study included a large number of MC (n = 13,997), and we observed an excellent adequacy rate for both 2 bottles and 3 bottles, for both screening and non-screening colonoscopies (all > 90%). This is the largest study evaluating MC as a bowel preparation. Two bottles with Dulcolax were better than 3 bottles, which could be due to better tolerability, combination with Dulcolax or other. We failed to detect a difference between screening and non-screening groups. MC demonstrated better results than GoLYTELY, nonetheless, the sample size for the later was smaller. In conclusion; MC as bowel preparation is an adequate, well tolerated, and inexpensive. In a large retrospective analysis, it compares favorably to other preparations.
198 Incorporating Sacral Nerve Evaluation for Fecal Incontinence Into a Gastroenterology Practice: Initial Experience and Outcomes
Authors: Stone Christian D. , Williams Mary-Jane O. 
Published: October 2019

INTRODUCTION:
Fecal incontinence (FI) is a common yet underappreciated condition for which many gastroenterologists (GE) lack training to address in their patients. A potential therapy for FI is sacral nerve evaluation (SNE), a 1-week trial procedure in which electrodes are placed temporarily to stimulate the sacral nerve. A successful SNE trial may then prompt permanent surgical implant of sacral electrodes to provide long term control of FI. Despite encountering many FI patients, GE have been slow to adopt SNE in the management for FI. The goal of this study was to document the experience of introducing the SNE procedure into a GE practice, with a focus on measuring the initial success rate of SNE, and identifying factors that impact patient selection and transition to permanent implant.

METHODS:
SNE was introduced to a single GE practice beginning in October 2017 and the study period ended in April 2019. Patient demographics and clinical data were collected and post-SNE outcomes were assessed. The primary outcome was SNE success defined as ≥ 50% decrease in FI events during the 7-day SNE trial. Factors associated with SNE success were evaluated.

RESULTS:
SNE was performed on 42 patients [31 (76%) female; mean age 62 years (range 27–80)] during the study period with a median follow up time of 49 weeks. In intent-to-treat analysis, SNE success was achieved in 71% (30/42). Of these, 11 (37%) proceeded to permanent implant with 75–100% improvement in FI. Factors associated with SNE success included female gender (OR 2.0), age ≥ 65 (OR 2.4), and absence of complicating diagnoses (OR 4.1; Crohn's, colitis, prior anal surgery). The most common reason for not proceeding to permanent implant was FI improvement from reduction in diarrhea, followed by personal opposition to implant, unrelated new-onset medical condition, and socioeconomic barriers. Only one SNE complication (rash) was reported.

CONCLUSION:
SNE introduced into a GE practice achieved favorable initial success in improving FI and is a safe, viable procedural modality that can ecpand therapeutic options. Older, traditional FI patients were associated with better SNE results. The transition from successful SNE to permanent implant is reduced by multiple disparate factors, some of which could be addressed with more intensive follow up.