bluuebunny/crossref_metadata_2025_split huggingface dataset:
2834 Sex, Cancer Survivorship, and Colorectal Cancer Screening Among U.S. Adults: Analysis of a National Survey
Authors: Laiyemo Adeyinka , Kibreab Angesom , Scott Victor , Lee Edward , Brim Hassan , Jack Momodu , Mekasha Getachew , Howell Charles , Ashktorab Hassan , Aduli Farshad 
Published: October 2019

INTRODUCTION:
Men suffer higher burden from colorectal cancer (CRC) when compared to women. It is uncertain if this is due to poorer health services utilization or biological differences. It is well established that patients become more health conscious after a cancer diagnosis “as a wake-up call”. Aim: To determine uptake of CRC screening (with fecal occult blood test or endoscopy) among adult men and women in the United States and evaluate whether screening uptake differs by sex after a diagnosis of any cancer.

METHODS:
Methods: We used the 2013 Health Information National Trends Survey (HINTS) 4 cycle 3 conducted by the National Cancer Institute. A total of 1,829 respondents (weighted population size = 90,313,161) were 50 years and older. There were 732 (45.9%) men (weighted population size = 41,452,732) and 1,097 (54.1%) women (weighted population size = 48,860,429). There were 356 (14.7%) cancer survivors (weighted population size = 13,267,800) and 1,473 (85.3%) (weighted population size = 77,045,361) without any history of cancer. We evaluated whether survey respondents were ever screened for CRC (with fecal occult blood test or endoscopy) and compared CRC screening by cancer survivorship among men and women. All percentages were weighted.

RESULTS:
Overall, there were no sex differences in CRC screening rates among respondents (70.5% versus 75.2%; OR = 0.79; 95% CI: 0.58-1.07; P value = 0.13) regardless of cancer status. However, cancer survivors had increased CRC screening uptake (85.5% versus 70.5%: OR = 2.48; 95% CI: 1.46-4.22; P value = 0.001) regardless of sex in unadjusted analysis. Although there was an absolute 20.2% increase in CRC screening among men and an absolute 11.7% increase in CRC screening among women who have been diagnosed with a cancer, the differences were not statistically significant after adjustment for healthcare insurance status (Table 1).

CONCLUSION:
Conclusion: Increased efforts should be made to improve CRC prevention education and healthcare insurance coverage of US adults.
2836 Association of Body Mass Index (Bmi) and Sedative Use During Screening Colonoscopy
Authors: Atassi Hadi , Shine Amal , Liu Nanlong , Thomas Chandler , Furmanek Stephen , Liu David , McClain Craig 
Published: October 2019

INTRODUCTION:
Colonoscopy is a key tool for colorectal cancer screening, but like any procedure, it is not without risk. The procedure can be done with conscious sedation. Risks from sedation include hypotension or hypoxia, sometimes requiring hospitalization and even endotracheal intubation. Therefore, endoscopists aim to minimize the amount of sedation needed to keep a patient comfortable and still be able to complete the procedure. We sought to examine the relationship between a patient’s body mass index (BMI) and the amount of sedation used during colonoscopy.

METHODS:
Data was collected on 640 patients undergoing conscious sedation screening colonoscopies at Louisville Veterans Affairs Medical Center, and 501 were excluded based on specific exclusion criteria, including known colonic disorders (e.g., IBD history, pre-existing malignancies) and lack of documented sedative use. Of 139 patients included, median age was 62, 86% patients were male, and 72% were white. Data were gathered by retrospective chart review of patient’s BMI as well as dosage of Midazolam, Fentanyl, and Diphenhydramine used during colonoscopy. Multiple Regression Model was used for analysis with corresponding P-values calculated. Statistical significance was set at P < 0.05. The total number of polyps detected was controlled for, as this was thought to affect the duration of colonoscopy.

RESULTS:
Our study indicates that, although a higher BMI was hypothesized to be associated with increased sedative use, the association was not statistically significant for any of the three sedatives in this study. This is most likely due to the fact that there was little variability between the doses of each sedative and the small sample size.

CONCLUSION:
Data in literature is scarce regarding the association between BMI and sedation use for colonoscopy. Most society guidelines on sedation in obesity are based on expert opinion. Factors affecting sedation use include longer cecal intubation times due to difficult technique in patients with obesity, reluctance to use higher amounts of sedation in patients with obesity due to increased risk of airway compromise, and prior alcohol or drug use. Larger studies are needed to further explore these findings, which may have future clinical implications regarding the introduction of specific guidelines for sedative use in patients with obesity.
2837 Reliability of Fecal DNA Testing for Colorectal Cancer (CRC) Screening: A Retrospective Study
Authors: Mazumder Mohammed , Thorpe Candy , Horenstein Frances , Mazumder Jubaida , Thompson Darlene M. 
Published: October 2019

INTRODUCTION:
Colorectal Cancer (CRC) is the leading cause of death in the US. The gold standard for CRC screening is a Colonoscopy, which allows for diagnostic evaluation and endoscopic interventions-excision and Biopsy of polyp. In 2014 a Fecal DNA testing modality, (Cologuard; Exact Sciences), was approved by the FDA as an option for CRC screening. Fecal DNA testing is a combination of fecal immunochemical testing (FIT) and markers for abnormal DNA. The utilization of Fecal DNA testing has increased, and continues to rise due to its noninvasive technique. A diagnostic colonoscopy is recommended for all positive results.

METHODS:
The aim of this study is to determine the reliability of Fecal DNA testing in regards to CRC screening. This study took place in a community hospital in central Ohio, Between January 2017 and February 2019. 100 average risk individuals whom had a positive fecal DNA test were analyzed.

RESULTS:
100 patients had a positive Fecal DNA test. Among them 12 patients did not undergo colonoscopy. Our results are based on patients’ (100-12 = 88) findings who underwent a colonoscopy. 64 Patients were found to have adenomatous polyps (AP), High grade dysplasia or adenocarcinoma during examination (72.73%). Out of these 64 patients whom had positive findings, 61 were APs (95.31% of total positive endoscopic findings), and 3 were high-grade dysplasia or adenocarcinoma (4.69% of total positive endoscopic findings). 24 patients were found to have no adenomas (27.27% of patients with positive stool test).

CONCLUSION:
When comparing findings to statistics published by Exact Sciences, data is dissimilar. Exact sciences reports approximately 13% of tests are false positives, while our data revealed 27.27% false positive tests. Although there were a large number of patients with positive testing resulting in adenoma detection, the overall reliability of this testing strategy is difficult to determine due to the large number of false positive results. Further data is needed to evaluate if this testing technique is appropriate for CRC screening.
2850 Fecal Immunochemical Test in Asymptomatic People
Authors: Jurado da Silva Edson 
Published: October 2019

INTRODUCTION:
Occult blood is strategy for colorectal cancer screening. The aim of this study is to analyze the value of quantitative monoclonal antibodies against human Hemoglobin for colonoscopy screening.

METHODS:
One hundred asymptomatic adult patients, aged over 40 up to 77, with no risky group, have had one sample of stool specimens collected for qualitative immunochromatography with monoclonal antibodies against human hemoglobin, following several days later by complete colonoscopy. Chi-square was used to compare proportional data whereas Student t test to compare means. P < 0.05 was considered significant. This was a prospective stufy, All patients signed the informed consent The author has no finantial disclosures.

RESULTS:
A total of 100 patients being 36 men aged 67 ± 7 and women 64 aged 65,5 ± 8 P > 0.05, distributed by age in patients with colon neoplasia and positve occult blood in stools, 67 ± 6 N1 = 20, with negative occult blood in stools with neoplasia aged 68 ± 6 N2 = 11, with positive occult blood in stools without neoplasia 65,5 ± 9 N3 = 21 and negative occult blood in stools withou neoplasia 64,5 ± 8 N4 = 48 P > 0.05.Thirty-one (31%) of the patients had diagnosisof colon neoplasia, being 20 (64%) with positive occult blood in stools and 11 (35%) negative, P < 0.01. In the Group with positive occult blood in stools, two patients had diagnosis of adenocarcinoma, the others were adenomas. In the Group of negative occult blood in stools all were adenomas. We had 69 patients without neoplasia, of whom 21 (30.5%) had positive occult blood in stools and 48 (69%) negative, P < 0.01. In this Group without neoplasia, 12 (17%) had an abnormal colonoscopy, 5 (41.5%) with positive occult blood in stools and 7 (58%) negative P > 0.05. Abnormalities without neoplasia in patients with or withou occult blood in stools were angiodysplasia in ascending colon, shallow ulcer in ileocecal valve or ascending colon in NSAID user and uncomplicated diverticular disease.

CONCLUSION:
The age of the Group studied was similar, Adenocarcinoma only occurred in patients with positive blood in stools. Adenoma was present in positive and negative, although significantly more frequent in the positive ones. For bether conclusion, we need a greater number of asymptomatic people to be studied. The ideal test would be one that diagnoses cancer for treatment and adenoma for endoscopic prevention.
2859 Acetic Acid Chromoendoscopy in Barrett’s Esophagus Surveillance Is Superior to the Standardized Random Biopsy Protocol in Detecting Neoplasia: A Prospective Randomized Trial in a Community Setting
Authors: Castano Juan , Veeramachaneni Ravindra , Yamba Lana , Chacon Ingrid , Zamir Asif 
Published: October 2019

INTRODUCTION:
Barrett's esophagus (BE) is the most important precursor lesion and risk factor for development of esophageal adenocarcinoma (EAC) with annual risk of 0.12–0.5%. Surveillance endoscopy with random biopsies of Barrett’s tissue at established intervals is recommended. Targeted biopsies may eliminate the need for random biopsies. Those found with earlier neoplasia during surveillance have the best prognosis. Acetic acid chromoendoscopy (AAC) has been found to be useful in increasing the yield of neoplasia detection during BE surveillance. Use of AAC in a community setting has not been investigated.

METHODS:
A prospective randomized clinical trial was done including patients 18 years and older with confirmed diagnosis of BE in a community setting in a South Texas gastroenterology office. A total of 104 patients were required. Patients from two gastroenterologists were included. Patients were recruited from a BE Surveillance Program and were screened via medical chart reviews. Exclusion criteria included history of esophageal ulcerations, esophageal Candida, esophageal varices, history of dysplasia, and history of ablation therapy. Patients were randomized into two groups. The intervention arm had the esophageal mucosa sprayed with 10cc of 2.5% acetic acid solution before inspection and biopsy. The control group underwent random biopsies as per guidelines.

RESULTS:
A total of 61 patients were enrolled and 30 were excluded including 18 due to negative biopsies, 10 due to missed appointments, and 2 due to esophagitis. A total of 31 patients were randomized (Acetic Acid n = 20, Control n = 11) and of these 1 patient had EAC at the target site [Acetic Acid n = 1 (5%), Control n = 0 (0%)]. It was found that 78% of the sample were patients with short segment BE (SSBE). Results suggested that the study was under-powered. A total of 1176 (Acetic Acid n = 588, Control n = 588) patients would be required in order for the study to have sufficient power to be statistically significant. The sample sizes required were not feasible for a single community practice; therefore, the study was discontinued.

CONCLUSION:
Our study was halted due to lack of sample power required to prove the hypothesis. The prevalence of neoplasia in our community was low given the high percentage of enrolled patients with SSBE. In order to validate this cost-effective technique in a community setting in the United States, a randomized trial with a larger collective effort involving multiple community centers will be required.
2861 Importance of Barrett's Surveillance in the Senior Population
Authors: Sheikh Akber , Godil Aslam , Chang Andrew , Foliente Roy , Hill Kevin , Brichler Benjamin 
Published: October 2019

INTRODUCTION:
It is estimated that 5.6% of adults in the United States have Barrett’s esophagus (1). The annual cancer incidence in patients with Barrett’s esophagus is 0.1-0.4% per year, with it being higher among men, older patients, and patients with long segment Barrett’s mucosa. In patients with Barrett’s esophagus with low grade dysplasia (LGD), the annual incidence rates of esophageal adenocarcinoma (EAC) is 0.54% and of high-grade dysplasia (HGD) and/or EAC is 1.73%. Although the benefit of surveillance endoscopy remains unclear, current guidelines recommend surveillance endoscopy to detect dysplasia or EAC early enough to provide effective treatment. Currently there is no consensus on the age limit for Barrett’s surveillance, nor is there a recommended duration of surveillance. This may lead to endoscopic surveillance being performed without clear benefit. (2,3) Our aim was to assess the role of Barrett’s surveillance in detecting dysplasia and malignancy in all age groups; and evaluate the incidence and progression of Barrett's dysplasia to determine an age or duration limit to endoscopic surveillance.

METHODS:
A retrospective single center, longitudinal study was done by Sierra Nevada Gastroenterology Medical Associates, Inc., a community based gastroenterology group in Grass Valley, California. All outpatient upper endoscopies for Barrett’s screening and surveillance were included in the study. 300 electronic medical records were randomly selected and reviewed from Jan 2005 to Oct 2018. Data was collected on age, gender, race, ASA class, procedure findings, complications, pathology, and dysplasia status.

RESULTS:
See attached tables.

CONCLUSION:
In this study LGD was found in 10%, HGD in 0.3% and EAC in 0.3% of patients. In the subgroup of patients with LGD: 27% were detected in patients over 80 years old, 87% detected in patients with short Barrett's, 97% regressed to no dysplasia, and 3% progressed to HGD requiring ablation therapy. 16% of patients over 80 years old maintained or had dysplasia progress. Overall, 1 patient presented with EAC at index endoscopy. 91% of our study population had short Barrett's. There was no dysplasia before age 50 and dysplasia incidence increased with age. There were no endoscopy related complications. In patients over 80 years old, the incidence and progression of dysplasia remains significant. When evaluating endoscopy in this population, risks and benefits need to be considered, but age alone should not exclude a patient from surveillance.
2865 Acid Suppressants and Erosive Tooth Wear: An Analysis of National Health and Nutrition Examination Survey Data
Authors: Meek Reghan E. , Gumustop Derin R. , Rosenberg Jacob , Meek Patrick D. , Gumustop Bora 
Published: October 2019

INTRODUCTION:
Antacids and acid suppressants (i.e., proton pump inhibitors and histamine2-blockers) are commonly used by individuals with heartburn and gastroesophageal reflux disease (GERD). Frequent heartburn and breakthrough symptoms of GERD have been shown to contribute to dental complications. The aim of this study is to compare the likelihood of erosive tooth wear (ETW) among users of antacids or acid suppressants.

METHODS:
We used data from the National Health and Nutrition Examination Survey (NHANES, 2003-2004) to identify a nationally representative sample of adults (age ≥ 18) who underwent an oral health exam by trained dental examiners. Self-reports of use of antacids and prescribed acid suppressants were collected by trained personnel during a home interview and used to classify individuals into groups. Erosive tooth wear was defined in NHANES using Smith and Knight's Tooth Wear Index modified by Millward, et al., which rates the severity of ETW from 0 (sound tooth surface) to 3 (complete loss of enamel). Erosive tooth wear was evaluated for 40 tooth surfaces; 24 proximal (facial or incisal) and 16 distal (lingual or occlusal) surfaces. Erosions were categorized based on location and severity. We used weighted linear and logistic regression to compare means and estimate the prevalence of erosions for each group. Estimates were adjusted for age, sex, and race/ethnicity.

RESULTS:
NHANES ETW data were available for 4,414 adults; antacid users (n = 595), acid suppressant users (n = 386), and non-users (n = 3,433). The mean number of assessable tooth surfaces varied between groups (P > 0.001). Erosive tooth wear was more prevalent among those who reported the use of antacids or acid suppressants compared with non-users, however the difference was not statistically significant (P = 0.06). The percent of patients with ETW on at least one distal tooth surface was higher for antacid and acid suppressant users (P = 0.01). In addition, acid suppressant users had a higher prevalence of extensive tooth wear (P = 0.007).

CONCLUSION:
Individuals using antacids or acid suppressants (potentially for control of acid-reflux symptoms) are associated with a higher rate of dental complications, as suggested by the prevalence of erosions on distal tooth surfaces. In addition, extensive erosions were more common among users of acid suppressants than non-users. Emphasizing the importance of following recommendations from the American Dental Association for routine dental care may be particularly important for these individuals.
2871 Obstructive Sleep Apnea Could Be a Hidden Cause for Gastroesophageal Reflex
Authors: Al-Aboodi Yasir , Al-Chalabi Ahmed , Muhammad Ali , Sodeman Thomas , Nawras Ali 
Published: October 2019

INTRODUCTION:
Gastroesophageal reflex disease (GERD) and obstructive sleep apnea (OSA)are common conditions in the modern life. There have been stipulation that there might be association between GERD and OSA. In this study we tried to examined the association between them using a very large national data registry.

METHODS:
A binary logistic regression is performed to examine the association between OSA and GERD. The National Inpatient Sample (NIS) database for 2014 is used. Its the largest publicly available all payer data and it includes more than 7 millions inpatient admissions.The variables included in this study are identified using the international code for diseases version 9 (ICD9).

RESULTS:
5066557 with GERD diagnosis are included with mean age of 63 years (± 18). 40.8% are male and 59.2% are females. Majority of them are white (72.9%), (11.6%) black, Hispanic, (6.4%), Asians (1.4%), native Indians (0.5% and other (2.1%). Individuals with (OSA) are 2.4 more likely to have a diagnosis of GERD. (P < 0.000, CI (41-2.42), OR = 2.4). With control for known predisposing factors for GERD, patients with hiatal hernia has 5 times more likelihood to have GERD (P < 0.05; 95% CI (5.01-5.06), OR = 5.037). Scleroderma patients are 2.4 more likely to have GERD (P < 0.05; CI (2.29- 2.64; OR = 2.46). Obesity, smoking and alcohol abuse are 1.6 ,1.2 and 0.8 r are likely to have GERD respectively. (P < 0.05, 95% CI (1.59-160), OR = 1.60; P < 0.05, CI (1.24-1.250), OR = 1.253); P < 0.005, CI (81-0.830), OR = 0.824 respectively.

CONCLUSION:
Patients with obstructive sleep apnea are two times more likely to have GERD than people without OSA. . As our study design is cross sectional ,further Prorspective studies needed to confirm the association and or causation if any between GERD and OSA.
2887 Bowel Preparation Adequacy in a Direct Access Screening Program
Authors: Francis Gloria , French Brenda , Ahuja Amisha , Garrido Daniel , Daskalakis Constantine , Kastenberg David 
Published: October 2019

INTRODUCTION:
Direct access colonoscopy (DAC) pathways facilitate access to colon cancer screening. However, the absence of a pre-procedure office visit may increase the risk for inadequate colon cleansing, particularly in patients (pts) already at high risk for this. The aim of this pilot study was to establish non-inferiority of preparation (prep) adequacy for high-risk patients receiving high-dose (HD) purgative versus average-risk patients receiving standard-dose (SD) prep.

METHODS:
This was a retrospective single academic center study. HD assignment for DAC was based on any of the following criteria: chronic constipation (<3 BM/week), medications (narcotics, tricyclics, or calcium channel blockers), diabetes mellitus (DM) on medication, stroke, BMI >35, or prior inadequate prep. All pts received a PEG based prep. HD was defined as >2L PEG-ELS/vitamin C (MoviPrep®), >4L of PEG-ELS, or >2L PEG 3350-sports drink. Prep adequacy (BBPS of ≥2 per segment) was compared between the HD and SD groups, with a 12% relative margin of non-inferiority (relative risk = 0.88). Assuming an overall 85% adequacy rate, 140 patients per group would give the study 80% power. Secondary outcomes were comparison of inadequate prep risk factors between study groups.

RESULTS:
We identified 1,522 pts who received DAC over 11 months. 156 pts were excluded due to no electronic prep order or non-PEG prep use. These interim analyses are based on all 59 HD pts and a subset of 140 of the 1307 SD pts. The adequacy rates were 92% for HD (54/59) versus 99% for SD (139/140), failing to establish non-inferiority (P-value = 0.17). Predictably, HD pts were more likely than SD pts to have prior inadequate preparation (19% vs. 0%), to be obese (68% vs. 39%), to have chronic constipation (15% vs. 6%), to have DM on medication (32% vs. 16%), and to be using narcotics (10% vs. 5%) or tricyclics (5% vs. 1%).

CONCLUSION:
Despite miss-assignment of many pts high risk for inadequate prep to SD, we found high rates of adequate cleansing in all DAC pts. Improper prep assignment and retrospective design allowing examination of only electronic (and not telephone) orders likely contributed to fewer pts than expected in the HD arm. This interim analysis does not establish non-inferiority of the HD prep for pts high risk for prep failure. Future efforts will focus on analyzing and correcting the cause for pt miss-assignment and prospectively evaluating prep adequacy in these two groups.