bluuebunny/crossref_metadata_2025_split huggingface dataset:
178 Short and Long-Term Outcomes of Patients With Severe Complicated Clostridioides (Clostridium) difficile Infection Treated With Fecal Microbiota Transplant
Authors: Park Sa Ra , Wang Patty , Hays R. Ann 
Published: October 2019

INTRODUCTION:
Severe complicated Clostridioides difficile infection (SC-CDI) has mortality rates of 20–80%. Standard treatment for SC-CDI refractory to antibiotic therapy includes colectomy with end ileostomy and more recently diverting loop ileostomy, which have mortality rates of 19–57%. Fecal microbiota transplantation (FMT) is a well-established treatment for recurrent CDI, but its use for SC-CDI has not been well-studied. Here, we present short-term and long-term outcomes of patients who underwent FMT for SC-CDI.

METHODS:
An IRB-approved retrospective cohort study was conducted on patients with SC-CDI who received FMT at a single academic center between 2015–2018. SC-CDI was defined by the 2013 American College of Gastroenterology guidelines. Two patients who underwent both surgery and FMT were excluded. We obtained: WBC count, heart rate (HR), pressor requirement pre-FMT then 24, 48, and 72 hours (h) after FMT, mortality, cause of death, re-admission rate, and re-admission diagnoses.

RESULTS:
Total 8 patients were identified. Regarding short-term outcomes of FMT, we observed that patients showed clinical improvement within 72 h of FMT. We found that WBC count was significantly decreased at 72 h compared to pre-FMT (9.6 vs 12.9, P = 0.025). Heart rate (HR) was also significantly decreased at 72 h post-FMT (91.6 vs 79.6, P = 0.022). One patient was on vasopressor pre-FMT (norepinephrine 16 mcg/min), and it was discontinued by 72 h post-FMT. Regarding long-term outcomes, 1 patient died 564 days after FMT due to chronic leg infection. All other patients were alive at the time of chart review. All patients had survived at least 1-year post-FMT, 6 for 2-years post-FMT, 5 for 3-years post-FMT, and 3 for 4-year post-FMT. No patient had post-procedural complication from FMT. Average number of FMTs that patients received was 3. Within 1 year of FMT, 3 patients had recurrent admission due to CDI. There were no admissions for CDI beyond 1-year post-FMT.

CONCLUSION:
Our study showed that patients with SC-CDI had significant clinical improvement within 72 h of FMT. Their long-term survival up to 4 years after FMT was unexpectedly high. FMT is a promising modality for treatment of SC-CDI. Prospective studies are needed to identify the appropriate clinical setting for this promising treatment in patients with SC-CDI (e.g., adjuvant or neoadjuvant to surgery, replacement of surgery, or patients without acute abdomen but refractory to antibiotic therapy).
182 A Comparison of the Mucosal Defects and Healing by Hot Snare Polypectomy (HSP) vs. Cold Snare Polypectomy (CSP) for Endoscopic Removal of Colorectal Polyps
Authors: Fukushima Hirofumi , Sakamoto Naoto , Murakami Takashi , Ueyama Hiroya , Matsumoto Kenshi , Shibuya Tomoyoshi , Nagahara Akihito 
Published: October 2019

INTRODUCTION:
Screening colonoscopy with polypectomy of small polyp substantially reduces colorectal cancer incidence and mortality. CSP and HSP are two major methods for polypectomy. The basic difference of CSP and HSP is the use of a high frequency generator of HSP. HSP may damage deeper vessels with increased risk of delayed healing, thereby post-polypectomy bleeding and even perforation. For this reason, CSP is usually considered safer, in recent years, CSP has increasingly been used for the removal of colorectal polyps. On the other hand, CSP is concerned associate with a rate of incomplete resection. So far few studies have confirmed endoscopically the early condition after treatment. In this study, through a randomized controlled study, we evaluated to compare mucosal defects and healing one week after treatment, from polypectomy using CSP vs. HSP.

METHODS:
The 52 patients has tumor size under 10 mm were randomly divided into two groups using opaque envelopes: CP (n = 27) and HP (n = 25). We compared the mean tumor size, ulcer diameter one week after endoscopic treatment, exposed blood vessels, residual recurrence and contingencies for CSP and HSP. Pathological diagnosis of complete resection was defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps.

RESULTS:
The overall the mean tumor size did not differ between the two groups (CSP vs. HSP: 5.44 mm vs. 5.32 mm). Ulcer base diameter one week after treatment is CSP group had a smaller compared to the HSP group (2.7 mm vs. 4.84 mm; P < 0.001). And the CSP group had a lower exposed blood vessels compared to the HSP group (7.4% vs. 36.0%; P < 0.05). Delayed perforation or bleeding was not recognized in any patient during the one weeks after treatment. One case of residual recurrence was admitted to CSP group.

CONCLUSION:
Our study findings show that although there is no difference tumor diameter between the two techniques, the size of ulcer diameter one weeks after treatment, resection time and the rate of post-polypectomy bleeding is lower with CSP. However remnant recurrence was observed only in CSP. In clinically, CSP can be safely used as one of the effectively techniques for the resection colorectal polyps, but It is important to make an accurate endoscopic diagnosis and exclude cancer before treatment.
183 Epidemiology of Diverticulitis and Prevalence of First-Ever Colorectal Cancer Post-Diverticulitis in Adults in the United States Between 2014 and 2019: A Population-Based National Study
Authors: Jin-Dominguez Fangyuan , Mansoor Emad , Saleh Mohannad Abou , Isenberg Gerard , Wong Richard C. , Cooper Gregory S. 
Published: October 2019

INTRODUCTION:
Prior studies show the incidence of colorectal cancer (CRC) after an episode of diverticulitis ranges from 0 to 7.4%. We sought to describe the prevalence of first-ever diverticulitis in the US between 2014 and 2019 and evaluated the prevalence of first-ever CRC post diverticulitis in the US between January 2014 and 2019 utilizing a large population based database.

METHODS:
We queried a commercial database (Explorys Inc, OH), an aggregate of EHR data from 26 major integrated healthcare systems in the US from 1999 to 2019. We identified an aggregated patient cohort with a diagnosis of “diverticulitis of large intestine” from 2014 to 2019 followed by “first-ever primary malignant neoplasm of cecum, ascending colon, transverse colon, descending colon, sigmoid colon and/or rectum,” at least 1 day after and within 6 months of diverticulitis, aged >18 years, based on Systemized Nomenclature of Medicine—Clinical Terms. We excluded patients with IBD, family and personal history of CRC. We calculated the prevalence of diverticulitis and CRC post diverticulitis overall and among different patient groups.

RESULTS:
Of the 31,441,890 individuals active in the database from 2014–2019, we identified 785,740 individuals with first-ever diverticulitis with an overall prevalence of 2.5%. The prevalence in male was 2.6%, females 2.4%, adults (age 18–65 years) 1.5%, senior (>65 years) 5.5%, Caucasian 3.3%, African-American 2.3% and Asian 1.3% (Figure 1). Furthermore, 4,390 out of 785,740 individuals were diagnosed with CRC (first-ever) post diverticulitis with prevalence of 0.56% (Figure 2). In contrast, the prevalence of CRC without history of diverticulitis was 0.3%. Odds ratio (OR) of CRC post diverticulitis was 1.9 compared to individuals without diverticulitis (P < 0.0001). The risk of CRC post diverticulitis was higher in female (OR 2.04, P < 0.0001) vs male; African Americans (OR 2.16, P < 0.0001) vs Caucasians and Asians; adults (OR 2.36, P < 0.0001) than seniors (Figure 3).

CONCLUSION:
This is one of the largest population-based national studies that describes the epidemiology of diverticulitis and first-ever CRC post diverticulitis from 2014 to 2019. Prevalence of diverticulitis is higher in male, seniors, and Caucasians. Post diverticulitis, patients are twice as likely to be diagnosed with CRC. The risk of post diverticulitis CRC is higher in female, adults and African-Americans. Given the high burden of CRC, we advocate for screening for CRC after first occurrence of diverticulitis among adults.
199 Clinical and Molecular Characteristics of Early-Onset Colorectal Cancer Across Various Ethnicities
Authors: Dayah Rawan , Bilal Mohammad , Tun Nattpron , Abu-Shami Tewfeek , Booth Adam , Singh Shailendra , Parupudi Sreeram , Guturu Praveen 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is the third most common cancer in the United States. Guidelines from the American Cancer Society recommend CRC screening at 45 years of age in average-risk patient populations. Previous studies have shown an increase in incidence of CRC in African Americans (AAs) less than 50 years of age. We aimed to examine the disease characteristics of patients with early-onset CRC (EOCRC) across different races.

METHODS:
A retrospective cross-sectional study was performed using our electronic pathology database. All patients diagnosed with CRC between January 2012 and September 2018 were included. Data regarding patient demographics, co-morbid conditions and patient presentation was noted. In addition to information regarding the location, staging and molecular features of CRC.

RESULTS:
A total of 627 patients with CRC were identified. Out of these, 117 (18.6%) were younger than 50 years of age (EOCRC). Table 1 compares the baseline characteristics of patients across different races. The mean age of onset of CRC was significantly lower in Hispanics compared to Caucasians [56.6 years vs 61.6 years, P value = 0.0002] and AAs [56.6 years vs 60.2 years, P value = 0.01]. The clinical and molecular features of CRC across different racial groups are summarized in Table 2. The proportion of patients with early-onset CRC was higher in Hispanics as compared to Caucasians (27.9% vs 16.0%, P value = 0.004) and AAs (27.9% vs 16.9%, P = 0.03). On a multivariate analysis after adjusting for confounders, the proportion of Hispanics with early-onset CRC was significantly higher as compared to Caucasians [OR: 2.2, (95% CI 1.3–3.7), P value = 0.003]. Hispanics were less likely to harbor BRAF mutation as compared to Caucasians (5.1% vs 13.1%, P-value: 0.05), while Hispanics were more likely to have mutations in MSH-6 (100% vs 91.3%, P-value: 0.01) and MSH-2 (100% vs 94.2%, P-value = 0.05) as compared to AAs.

CONCLUSION:
Our study shows that proportion of patients with early-onset CRC is higher in Hispanics as compared to Caucasians and AAs. In addition, there are unique molecular features specific to CRC across various racial groups. Our findings raise concerns that there might be knowledge gaps regarding early-onset CRC amongst minority populations. Further large multi-center studies are needed to better understand the unique clinical and molecular characteristics in early-onset CRC in minority populations.
213 Outcomes of Fecal Microbiota Transplants in High Risk Elderly Populations
Authors: Luo Yuying , Tixier Emily , Grinspan Ari 
Published: October 2019

INTRODUCTION:
Recurrent Clostridioides difficile infection (CDI) in the elderly is associated with significant morbidity and mortality. Fecal microbiota transplant (FMT) is a safe and effective option for treating CDI; however, this is less clear for high risk elderly populations such as patients with severe or fulminant CDI, inflammatory bowel disease (IBD) and immunocompromised patients.

METHODS:
This is a retrospective study following patients 65 years of age or older who received at least one FMT between 2014 and 2019 at one high-volume academic center. Baseline patient characteristics were compared using Fisher's exact test or independent sample t-tests. Outcome measures included recurrence rates (early defined as <12 weeks, late defined as >12 weeks), adverse events, and subgroup analysis of high risk populations.

RESULTS:
75 patients (72% female) were included with a mean age of 76.4 ± 8.3 years and Charlson Comorbidity Index score of 5.4 ± 2.4. 20 out of 75 patients (26.7%) developed recurrent CDI with 18 patients (90%) recurring <12 weeks and 2 patients (10%) recurring >12 weeks from FMT. Use of antibiotics post-FMT was the only significant predictor associated with recurrence (P = 0.02) amongst analysis of pre- and post-FMT characteristics. Our cohort included 46 high risk patients: 15 immunocompromised, 8 IBD and 23 severe or fulminant. CDI recurrence occurred in 13 (28.3%) patients of this cohort including 4 out of 15 immunocompromised, 3 out of 8 IBD and 6 out of 23 severe or fulminant patients. The adjusted recurrence rate was 33.3% accounting for two patients with fulminant CDI who required colectomy and five patients who died from CDI-related complications. Serious adverse events were recorded in 16 patients (21.3%) across our entire cohort including 12 readmissions for recurrent CDI, three episodes of post-procedural hypotension, and one perforation during FMT.

CONCLUSION:
Overall, FMT is a safe and effective treatment modality for CDI in high-risk elderly populations including those with severe or fulminant CDI. Our cohort contained a significant portion of high-risk patients (61.3%) which likely accounts for our higher recurrence rate compared to that which is reported in literature. The majority of adverse events related to readmissions for CDI. Further studies of high risk populations is warranted.
214 12-Month Post Marketing Safety Surveillance Data of Chewable Inulin Fiber
Authors: Lacy Brian E. , Epstein Michael S. , Corsino Patrick 
Published: October 2019

INTRODUCTION:
Most Americans consume only half of the daily fiber recommended by the National Academy of Medicine, which is 25 grams per day of fiber for women and 38 grams per day for men. Fiber has been shown to promote bowel regularity, lower cholesterol, control blood sugar, and maintain body weight. To fill the “fiber gap” many patients use fiber supplements. There is a perception that fiber supplementation can lead to bloating and excess gas production, among other adverse events. This study aimed to examine whether or not a pattern of adverse events was associated with chewable inulin fiber (CIF).

METHODS:
A call-in number for reporting adverse events (AEs) was provided on bottles of a specific brand of CIF. An independent call center with pharmacovigilance-trained health care personnel in accordance with the FDA and global regulatory guidelines on properly reporting AEs was retained to receive and record customer AEs. The AEs for this study were collected and processed from January 1, 2018 to December 31, 2018.

RESULTS:
An estimated 809,259 individual patients consumed CIF during the surveillance. An analysis of the data showed that there were no serious AEs reported. Additionally, the self-reporting rate of non-serious AEs was low, with only 23 non-serious events reported by 21 individuals; a rate of 2.8 per 100,000 users. The top reported, non-serious AEs were flatulence, diarrhea, and constipation; however, the rates for these were extremely low (4.9, 3.7, and 1.2 per million, respectively). Two events were reported that were classified as musculoskeletal and connective tissue disorders; however, these were considered to not be related, having no basis for biological plausibility.

CONCLUSION:
12 months of monitoring real-world use of CIF in a population of over 800,000 patients demonstrates an extremely low rate of self-reported AEs. Contrary to conventional thinking, the rate of flatulence was remarkably low (4.9 per million users), and can most likely be considered statistical background noise. These data, combined with previous RCTs, indicates that CIF is a safe and effective option for fiber supplementation.
216 Determinants of Hospital Admission in Patients With Community-Acquired Clostridium difficile Infection (CA-CDI)
Authors: Deshmukh Farah , Levy Victor , Merrell Nancy 
Published: October 2019

INTRODUCTION:
Community-acquired Clostridium difficile infection (CA-CDI) is defined as Clostridium difficile infection (CDI) in patients who have not been in inpatient setting within 90 days of being tested positive for Clostridium difficile. The incidence of CA-CDI has been increasing in young individuals with no co-morbidities or recent antibiotic exposure. Recent research shows that up to 40% patients with CA-CDI need hospitalization, however, the risk factors associated with hospitalization of patients who test positive for CDI in outpatient setting has not been studied. The goal of this study is to look at patients diagnosed with CDI initially as outpatients and analyze the risk factors associated with hospitalization in these patients.

METHODS:
This study was approved by the Institutional Review Board. This is a retrospective chart review of 524 patients (189 males, 335 females, mean age 60 years) who were seen in the outpatient department from 2015 to 2018 and were tested for CDI. Inclusion criteria was patients over the age of 18 with positive C. difficile by nucleic acid amplification tests (NAATs). Exclusion criteria was prior diagnosis of C. difficile. For patients with positive C. difficile, the two outcomes selected were hospital admission within 2 weeks, and those remaining outpatients. The variables extracted from the electronic medical record included demographics, medications and co-morbidities. Utilizing a machine-learning algorithm, a Bayesian probabilistic predictive tool was constructed that evaluated a series of variables and their association with potential outcomes.

RESULTS:
Of the 524 patients that tested positive, 105 patients required admission within two weeks of diagnosis. The incidence of hospitalization among males and females was not significantly different. There was significant association between use of acid suppression medications (pantoprazole and famotidine) and risk of hospitalization for C. difficile (P-value <0.0001 and 0.002 for pantoprazole and famotidine, respectively). There was no association seen between co-morbidities such as coronary or carotid artery disease, peripheral vascular disease, diabetes mellitus and the risk of hospitalization.

CONCLUSION:
Although PPIs have been associated with increased risk of developing CDI, our study shows that acid suppression medications may also increase the risk of hospitalization for CDI. Providers should consider the risk versus benefit of continued use of acid suppression medications in patients with CDI.
217 Post Colonoscopy Diverticulitis: How Common Is It?
Authors: Shah Hardikkumar , Botros Youssef , Bhesania Siddharth , Baddoura Walid 
Published: October 2019

INTRODUCTION:
Acute Diverticulitis (AD) is a common cause of hospitalization. Colonoscopy is a commonly performed outpatient procedure. There is limited data exist regarding post colonoscopy AD. There are few single center studies which discuss about post colonoscopy AD but larger studies are lacking. Our aim is to evaluate incidence, demographic factors, clinical factors and mortality associated with post colonoscopy AD in nationwide patient population.

METHODS:
We used Nationwide Readmissions Database (NRD) of year 2014 to find patients admitted with AD. From that sample, we found patients who had underwent colonoscopy between one and four days prior to admission. AD patients with and without prior colonoscopy were compared by univariate and multivariate analysis. Chi-square or fisher's exact test was done for categorical variables while t test was used for continuous outcome. Multivariate logistic regression was done to compare in hospital mortality between two groups.

RESULTS:
There are total 235847 weighted admissions in year 2014 with AD out of which 797 (0.3%) patients had underwent colonoscopy between one and four days prior to admission. Univariate analysis showed that patients who are male and with age above 65 were significantly more associated with post colonoscopy AD. It also showed that patients with post colonoscopy AD had significantly higher mortality and total hospitalization charges (Table 1). In Multivariate analysis, patients with liver disease (Odds Ratio 1.5, P 0.02), kidney disease or electrolytes abnormalities (Odds Ratio 3.9, P < 0.0001), age more than 65 (Odds Ratio 22, P < 0.0001), and those who had recent weight loss (Odds Ratio 3.8, P < 0.001) had higher in hospital mortality while obese patients (Odds Ratio 0.7, P 0.008) had significantly lower in hospital mortality.

CONCLUSION:
Incidence of AD between 1 to 4 days after colonoscopy is 0.3% (3/1000) which is more commonly seen in elderly patients. Although a rare complication, possibility of AD post procedure should be kept in mind mainly for patients who already had history of AD in the past as second episode of AD can increase their morbidity and mortality significantly. Also risk stratification becomes extremely important in high risk patients such as those who are more than 65 years of age, patients with liver and kidney diseases as they will have higher in hospital mortality and higher total hospitalization charges.
220 Gender Differences of Acute Diverticulitis Hospitalizations in the United States
Authors: Persaud Alana , Panchal Dayna 
Published: October 2019

INTRODUCTION:
The incidence of diverticulosis has been increasing and various factors including diet, race, and genetics may influence the severity of subsequent diverticulitis. However, it is recently seen that gut microbiota can also play a role in diverticular disease. Indeed, sex-specific microbiota have been documented in humans. Other works have demonstrated post-surgical complications and surgical outcomes that are greatly influenced by gender. This study sought to examine the different outcome measures of diverticulitis hospitalization, based on gender.

METHODS:
The National Inpatient Sample is an inpatient database consisting of approximately 20% of all admissions to non-federal hospitals in the United States. We collected data in all patients with a primary diagnosis of acute diverticulitis in 2014, which was then stratified by gender. Cases were identified using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Primary outcomes were mortality, cost of admission, and length of stay. Multivariate logistic regression was used to adjust for demographics, hospital characteristics, and co-morbidities.

RESULTS:
There were 220,390 patients included; 127,840 females (58%) and 92,550 males (42%). Caucasians comprised 77% of both cohorts and mean age was greater in women (64 years old vs. 56 years old, P < 0.00). The mortality was greater in women (590 deaths vs. 350 deaths), which mirrored the increased length of stay in females (4.77 days vs. 4.61 days, P < 0.00). Interestingly, there is an increased cost of hospitalization in males ($38,385 vs. $39, 445, P < 0.058). Logistic regression showed no association between women and increased mortality or length of stay. However, hospitalization was associated with greater economic burden in males.

CONCLUSION:
Diverticulitis hospitalization has been increasing over time and is a substantial source of morbidity and mortality in the United States. This analysis revealed that the female cohort develops diverticulitis to a greater extent. Despite this, mortality and length of stay are not significantly affected by gender. However, the financial impact of treatment is considerably more among males. A plausible explanation may reside in the treatment modality utilized (surgery versus prolonged antibiotic course). Furthermore, colon microbiota may also play a role in the outcome measures demonstrated above, but prospective studies are needed to further elucidate this relationship.