bluuebunny/crossref_metadata_2025_split huggingface dataset:
473 The Prevalence and Burden of Rome IV Functional Colorectal Disorders in Ulcerative Colitis
Authors: Nigam Gaurav B. , Limdi Jimmy K. , Hamdy Shaheen , Vasant Dipesh H. 
Published: October 2019

INTRODUCTION:
Despite advances in Ulcerative Colitis (UC) therapies, many patients suffer refractory symptoms in the absence of active inflammation. For this group, treatment remains challenging, with a paucity of therapeutic options. In this prospective, ongoing study, we aim to determine the prevalence and burden of functional colorectal disorders inpatients with quiescent UC.

METHODS:
In a cross-sectional study, consecutive patients with UC attending Inflammatory Bowel Disease (IBD) clinicscompleted a series of validated questionnaires; including Hospital Anxiety and Depression Scale (HADS), the Rome IV diagnostic questionnaire for functional gastrointestinal disorders (FGIDs), an IBD-QoL score and the IBD-control questionnaire. Participants were asked to return a Fecal Calprotectin (FCP) within 2 weeks of completing questionnaires. Quiescent UC was defined as IBD-control 8 score ≥13 and IBD-control-VAS ≥85, and/or FCP levels ≤250 (where available, FCP was used in preference to IBD-control to classify UC activity). Based on Rome IV diagnosis and UC disease activity (active or quiescent), patients were divided into groups and data compared using non-parametric tests.

RESULTS:
Overall, n = 97 UC patients (n = 50 males, mean age 48 (range 18-82)) participated. 41/97, (42%) UC patients met the Rome IV diagnostic criteria for ≥1 FGIDs (irritable bowel syndrome n = 26, functional constipation n=6 and faecal incontinence (FI) n = 22). Disease activity data (IBD-control and/or FCP) were available for all patients, and based on these 61/97, 63% had quiescent UC. Within the quiescent UC group, 25/61 (41%) met the Rome IV diagnostic criteria for ≥1 FGIDs (irritable bowel syndrome n = 14, functional constipation n = 3 and FI n = 13). In the active UC group, those with co-existing FGIDs, compared to those without FGIDs, had significantly worse median QoL scores (P = 0.02), higher HADS-depression (P = 0.005) and HADS-anxiety (P = 0.05). By contrast, in those with quiescent UC, those with an FGID did not have different median HADS scores (depression P = 0.15, anxiety P = 0.62) or IBD-QoL scores (P = 0.20), compared those without FGIDs.

CONCLUSION:
This study is one of the first to use Rome IV criteria in UC and confirms that the prevalence of FGIDs is high. Patients with active disease and overlapping functional symptoms appear to have worse QoL and more psychological distress compared to those with quiescent disease. Clinicians should be vigilant to this functional overlap and treat both functional and inflammatory driven symptoms.
476 Pelvic Floor Dysfunction Is Associated With Reduced Urinary Flow Rate in Younger Men
Authors: White Bradley , Linder Brian , Klingele Christopher , Szarka Lawrence , Prichard David O. 
Published: October 2019

INTRODUCTION:
In younger men, in whom organic prostate disease is uncommon, the etiology of lower urinary tract symptoms (LUTS) is frequently unclear. Studies suggest that in this young cohort voiding phase dysfunction is more common than storage phase dysfunction or normal urodynamics. Abnormal pelvic floor muscle relaxation, which can result in constipation, could potentially result in voiding dysfunction also. To date, no studies have investigated the relationship between posterior pelvic floor dysfunction and LUTS in young men.

METHODS:
Men who had undergone both anorectal manometry and uroflowmetry (i.e. had lower gastrointestinal and urinary symptoms) between October 2012 and September 2018 were identified. Patients >40 years old were excluded to reduce the likelihood of prostate disease. Clinical data was extracted from the electronic health records. Descriptive and comparative analyses were performed.

RESULTS:
Of 47 identified patients, 13 were excluded due to a history of neurogenic bowel/bladder, urethral/anal surgery or significant neurological disease. The mean age and standard deviation (SD) of the 34 men analyzed was 30 ± 6 years. Twenty patients demonstrated an abnormal balloon expulsion test (BET). The median (and interquartile range [IQR]) number of LUTS was 1.5 (1-2). An abnormal BET was not associated with symptoms of nocturia, hesitancy, incomplete emptying or the total number of LUTS (2 vs 1, P = 0.6). An abnormal balloon expulsion test was associated with a lower maximum urinary flow rate (Qmax, 14 vs 29 mls/sec, P < 0.001) but not flow duration (34 vs. 27 seconds, P = 0.2), residual urine volume (55 vs. 43 mls, P = 0.7) or urine volume (300 vs. 301 mls, P = 0.5). No correlation was seen between anal pressures at rest or during simulated evacuation and maximum urinary flow rate. No correlation was found between functional constipation and Qmax, LUTS or abnormal uroflow. No relationship between rectal sensory thresholds and urinary symptoms was identified.

CONCLUSION:
In this study of young men undergoing both anorectal manometry and uroflow, pelvic floor dysfunction was not associated with specific LUTS but was associated with a clinically significant reduction in maximum urinary flow rate. However an objective diagnosis of functional constipation was not associated with urologic abnormalities. Further studies will be needed to prospectively characterize this cohort and to identify whether PFD-associated LUTS and reduced flow respond to biofeedback therapy.
478 Assessing the Relation Between Irritable Bowel Syndrome and Nonalcoholic Liver Disease
Authors: Sarmini Muhammad Talal , Asfari Mohammad Maysara , Alomari Mohammad , Al-Khadra Yasser , Khoudari George , Dasarathy Srinivasan , McCullough Arthur J. 
Published: October 2019

INTRODUCTION:
Irritable bowel syndrome (IBS) and nonalcoholic fatty liver disease (NAFLD) are both very common gastroenterological disorders. There are recent reports in the literature linking these disorders together, but to date there are no large studies to highlight this relation. We aimed in this study to investigate whether IBS is an independent risk factor for NAFLD.

METHODS:
Using data from the National Inpatient Sample (NIS) database between 2003 and 2014, we identified patients who were diagnosed with IBS using appropriate ICD 9 coding. The control group was the patients who did not have a diagnosis of IBS. We then performed multivariate logistic regression analysis for the association between IBS and NAFLD.

RESULTS:
The total population was comprised of 84,456,866 patients, of which 637,942 (0.75%) were diagnosed with IBS. IBS patients were older (58 vs 57), more likely to female (82.7% vs 60.1%) and less likely to be African American (8.9% vs 14.8%) (P < 0.001 for all). In addition, IBS patients had less diabetes mellitus (DM) with or without complications (2.6% vs 3.8) and (13.7% vs 17%) respectively (P < 0.001). On the other hand, individuals in the IBS group had more obesity (11% vs 8.2%), hypertension (HTN) (47.6% vs 43.6%), hyperlipidemia (HLD) (20.6% vs 16%) (HLD) and hypothyroidism (16.5% vs 9.2%) (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential cofounding factors including (age, race, gender,obesity, HTN, HLD, DM and hypothyroidism), individuals in the IBS group had a statistically significant higher rate of NAFLD (Odds Ratio [OR], 3.204, 95% confidence interval [CI], 3.130 -3.279, P < 0.001) compared with the non-IBS group.

CONCLUSION:
In our study patients with IBS were three times more likely to have NAFLD. This finding supports the recent reports that suggest that the changes in gut microbiota, impaired intestinal permeability and impaired intestinal motility in IBS may also play an important role in NAFLD development.
484 Whole Genome Sequencing Analysis of Gastroparesis
Authors: Smieszek Sandra P. , Carlin Jesse L. , Birznieks Gunther , Polymeropoulos Mihael H. 
Published: October 2019

INTRODUCTION:
Gastroparesis is a disorder characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction of the stomach, resulting in the cardinal symptoms of early satiety, postprandial fullness, nausea, vomiting, belching and bloating. To ascertain the genetic risk factors for gastroparesis we conducted the first to date whole genome sequencing (WGS) study of gastroparesis cohort.

METHODS:
We investigated the frequency and effect of rare loss-of-function (LOF) variants in patients with idiopathic and diabetic gastroparesis enrolled in a clinical study, VLY686-2301. The dataset consisted of 119 WGS samples.

RESULTS:
Among rare LOF variants, we report an increased frequency of a frameshift mutation within Motilin Receptor (MLNR) gene, variant rs562138828. Motilin is a 22 amino acid peptide hormone expressed throughout the gastrointestinal (GI) tract. The protein encoded by this gene is a motilin receptor which is a member of the G-protein coupled receptor 1 family. We have shown an increased frequency of a frameshift mutation with MAF 0.01 as compared 0.0009 AF in GNOMAD (P-value = 0.01) with Odds Ratio of 21.9. We detect 4/119 gastroparesis patients carry the variant of interest that results in p.Leu202ArgfsTer105. Noteworthy is the fact that the 4 cases were equally split among idiopathic and diabetic, so this possible Gastroparesis risk factor appears to be agnostic as to condition. The finding may be of direct relevance to treatment as individuals with the identified mutation may respond differently to gastroparesis treatments especially those targeting MLNR. Among other rare LOF, we identified a case of CHD7 discussed in literature in gastro-related context and a case of CFTR duodenal stenosis pathogenic variant. The CFTR variant has been seen in pancreatitis and is likely causative of Cystic Fibrosis Gut which is characterized by increased mucous viscosity and development of intestinal inflammation, dysbiosis, and dysmotility.

CONCLUSION:
Whole genome sequencing of gastroparesis patient samples showed enrichment for rare variants in the MTLR in cases compared with controls. The identified LOF variants within the region can serve as a risk factor for disease as well as inform treatments, especially given the knowledge of different response to treatment.
489 Opioid and Neuromodulator Prescription Patterns Among U.S. Gastroenterologists
Authors: LeBrett Wendi G. , Chen Frank W. , Yang Liu , Chang Lin 
Published: October 2019

INTRODUCTION:
The opioid epidemic has garnered significant national attention and is responsible for $78.5 billion in annual economic costs. Best practices encourage the use of alternatives to opioids such as neuromodulators to treat pain. This study characterizes opioid and neuromodulator prescription patterns among US gastroenterologists.

METHODS:
Medicare Part D Prescriber Data from 15,172 gastroenterologists between 2013 and 2017 were analyzed to calculate prescription metrics for opioids and neuromodulators. Neuromodulators include tricyclic antidepressants (TCAs), SSRIs, SNRIs and antispasmodics. Linear temporal trends were assessed using a Cochran-Armitage test. Multivariable logistic regression was used to examine the association between provider characteristics and >10 opioid prescriptions or >10 neuromodulator prescriptions annually.

RESULTS:
59% of gastroenterologists prescribed opioids at least once in 2017. However only 15% wrote more than 10 opioid prescriptions. In comparison, 57% of gastroenterologists wrote more than 10 neuromodulator prescriptions. During the 5-year study period, the trend of gastroenterologists who prescribed at least one opioid (P < 0.001) or >10 opioids (P < 0.001) decreased, while the overall trend of those who prescribed >10 neuromodulators (P < 0.001) increased, predominantly due to antispasmodics and TCAs. Among gastroenterologists who prescribed more than 10 opioids, there was a decrease from 2013 to 2017 in opioid prescriptions, opioid prescriptions per physician, % of patients prescribed opioids, and opioid prescriber rates compared to all prescriptions written. Female gastroenterologists were associated with decreased odds of prescribing opioids (OR 0.45, 95% CI 0.39–0.53), while practice in the South (OR 1.65, 95% CI 1.48–1.83) increased odds. Patient populations with higher percentages of female, whites and patients who received Medicare low-income subsidies were also associated with opioid prescriptions. Similar features of physicians were associated with neuromodulator prescriptions.

CONCLUSION:
The most recent opioid epidemic began in 2013. Since then, opioid prescriptions by gastroenterologists have decreased while neuromodulator prescriptions have increased for Medicare patients. Gastroenterologists are more likely to prescribe neuromodulators than opioids, both of which are used to treat abdominal pain. Compared to family medicine physicians (6%) and surgical subspecialties (37%), gastroenterologists (3%) had lower opioid prescription rates.
492 The Combination of a Tricyclic Antidepressant and Diaphragmatic Breathing Is an Effective Treatment for Rumination Syndrome
Authors: Robles Alejandro , Romero Yehudi A. , Tatro Eric , Quezada Hugo , McCallum Richard 
Published: October 2019

INTRODUCTION:
Rumination syndrome (RS) is a functional gastrointestinal disorder that is characterized by effortless postprandial regurgitation, usually preceded by belching, and accompanied by epigastric abdominal wall pain and gastric visceral hypersensitivity. Almost invariably, the onset of symptoms is preceded by a psychologically stressful situation, and anxiety is often an accompanying complaint. In this background of gastric visceral hypersensitivity, anxiety, and psychological stress, we investigated the effectiveness of combining a tricyclic antidepressant (TCA) with the more standard approach of diaphragmatic breathing/relaxation techniques (DB/RT) for the treatment of RS, as well as highlight the clinical aspects of this entity.

METHODS:
Patients referred to an academic motility center for vomiting of unknown origin were prospectively identified. Those who fulfilled the Rome IV criteria for RS received hands-on instructions/coaching on diaphragmatic breathing techniques, were given relaxing auditory media, started on a TCA, and completed a follow-up symptoms questionnaire after undergoing a minimum of three months of this therapy.

RESULTS:
A total of 44 patients, 35 women; mean age 40.4 [range 20-71] were identified and completed the treatment protocol. Mean time from onset of symptoms to diagnosis was 36.0 months [range 6-180], weight loss ranged from 1.4 – 39.5 kg., six required a jejunostomy feeding tube (J-tube), and one was receiving total parenteral nutrition (TPN). 65.9% had a history of anxiety and/or depression, and 65.9% reported the onset of symptoms were chronologically related to an inciting event/psychological stressor. Moreover, half of the patients were taking opioid medications for abdominal wall pain at the time of initial evaluation (Table 1). After a mean follow-up period of 8.8 months, 90.9% of patients reported improvement in their symptoms, with a mean subjective improvement from baseline of 68.9%, and specifically, 45.5% of patients reported ≥80% improvement. Weight increased or stabilized in 80.6% of those initially reporting weight loss, all six patients with a J-tube were weaned off, and the patient on TPN was transitioned to a J-tube. Additionally, 81.8% of patients initially taking opioid medications were successfully tapered off by the time of follow-up (Table 2).

CONCLUSION:
The combination of a TCA with DB/RT is an effective treatment modality for the management of RS as it addresses the underlying factors identified in this entity.
495 A Prospective Study of Gender and Quality of Life in Patients With Irritable Bowel Syndrome
Authors: Haroon Mustafa , Canakis Andrew , Cabral Howard , Weber Horst C. 
Published: October 2019

INTRODUCTION:
Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder characterized by abdominal pain and change in bowel habits. IBS represents a significant public health problem because of its substantial reduction of quality of life (QoL) and increased healthcare cost. There is a significant paucity of data regarding gender-based QoL measures. Therefore, we report here results of a prospective study on gender based QoL measures in outpatients with IBS conducted at a single tertiary care center.

METHODS:
We prospectively enrolled adult outpatients with IBS (N = 72) and non-IBS patients (N = 181) based on a validated Rome III criteria questionnaire. Electronic medical records were reviewed, and demographic data were collected. Validated IBS-specific QoL (IBSQoL 34-item instrument) and general QoL (Veterans RAND-12, VR-12) questionnaires were completed by the study sample. Statistical analyses of data were performed using Chi-square, Fisher's exact, and two-samples t-test.

RESULTS:
The proportion of female IBS patients (N=44; 61%) was not different (P = 0.35; Table 1) from female non-IBS patients (N = 99; 55%). Other demographics, including BMI, marital status, smoking and insurance status were also comparable between these 2 groups, but IBS patients were younger (45 vs 51 yrs; P = 0.01, Table 1). Female and male subgroup analysis within both the IBS and non-IBS samples showed all similar demographic characteristics (age, BMI, smoking, marital and insurance status; data not shown). QoL in IBS subjects was highly significantly reduced as compared with non-IBS subjects both using the VR-12 and the IBSQoL instruments (Tables 2 and 3 and data not shown). In IBS patients, QoL (by VR-12) was significantly lower in males (P = 0.02) as compared to females in MCS (P = 0.02), but not in PCS (P = 0.07; Table 2). Male IBS patients scored significantly lower in the IBSQoL instrument than females in 2 of 8 domains (dysphoria and interference) and in the overall score whereas no gender differences were noted within the non-IBS sample (Table 3). The greatest IBSQoL reduction occurred in the food avoidance domain without gender disparity.

CONCLUSION:
IBS patients suffer from substantial impairment of QoL. This gender-based study is the first to demonstrate lower QoL scores in male IBS patients as compared to females in specific domains of validated general QoL and IBS-specific QoL instruments. Gender disparities demonstrated in this study were not associated with differences in age, BMI, and other demographics.
501 Prevalence of Cannabinoid Use in Patients With Gastrointestinal Symptoms
Authors: Bushyhead Daniel W. , Kalra Gorav , Strate Lisa L. 
Published: October 2019

INTRODUCTION:
Cannabinoids are compounds derived from the Cannabis sativa plant. These include the psychoactive delta-9-tetrahydrocannabinol (Δ9-THC), although non-psychoactive compounds such as cannabidiol also exist. Given the prevalence of cannabinoid receptors in the enteric nervous system, use of cannabinoids may contribute to the pathophysiology or treatment of gastrointestinal motility and functional disorders. However, little is known about the prevalence of cannabinoid use in patients referred to out-patient gastroenterologists. The aim of this study was to determine the prevalence of cannabinoid use, and its relation to specific gastrointestinal symptoms, in patients seen in gastroenterology clinic.

METHODS:
An optional survey was administered to patients attending gastroenterology clinic at a county hospital in a state where both recreational and medical cannabis use are legal. The study period was January to May of 2019. The survey queried subjects on type of cannabinoid product used, frequency of use, whether cannabinoids were used for treatment of gastrointestinal symptoms, and efficacy. Diagnosis was recorded following review of the electronic medical record. Patients who were unable to consent or those who did not demonstrate proficiency with written English were excluded. Data were analyzed with descriptive statistics using Excel (Version 16.23). Institutional Review Board approval was obtained.

RESULTS:
A total of 60 subjects completed the survey. Forty-nine (82%) respondents were female, and median age was 43-years-old. Twenty-nine (48%) subjects reported use of cannabinoids within the past year; the most common substances were marijuana (90%) or marijuana and cannabidiol (48%). The most common diagnosis for these subjects was chronic abdominal pain (see Figure 1). Thirty-one percent of patients reported using cannabinoids more than once daily. Twenty-eight percent of subjects reported use of cannabinoids to alleviate gastrointestinal symptoms, with a median improvement of 6 on a scale of 0-10 (0 representing no relief, 10 representing full relief). The most common reported symptom for this subset of patients was abdominal pain (see Figure 2).

CONCLUSION:
Use of cannabinoids, including both marijuana and cannabidiol products, was common in subjects with gastrointestinal symptoms referred to a gastroenterology clinic in a state where use is legal. More than half of subjects using cannabinoids did so for relief of a wide variety of gastrointestinal symptoms.
504 Golden-Finger: Digital Rectal Exam Predicts Dyssynergic Defecation but Not Type of Dyssynergy Pattern on ARM
Authors: Mahoro Giselle , Jarava David , Desai Nisa , Corning Brooke , Copland Andrew , Frye Jeanetta 
Published: October 2019

INTRODUCTION:
Functional defecation disorders are a common cause of chronic constipation and the diagnosis include an abnormality in two or more of the following tests: balloon expulsion test (BET), anorectal manometry (ARM) or uncoordinated defecation on electromyography. Additionally, there have been four types of anorectal manometry dyssynergy patterns identified. Rao et al have shown that digital rectal examination (DRE) performed by a single expert gastroenterologist can accurately detect patients with dyssynergia. We conducted a study evaluating whether DRE performed by gastroenterology specialists could predict the presence and type of dyssynergia in patients with chronic constipation.

METHODS:
Patients with chronic constipation as defined by Rome IV criteria were evaluated by GI specialty providers at a single tertiary care hospital. After performing a DRE, each provider documented a prediction regarding the type of dyssynergy pattern that would be identified on ARM as well as whether the patient would pass the balloon during BET. An abnormal BET was defined as failure to pass the balloon in less than 60 seconds. Patients subsequently underwent ARM and BET and results of predicted and measured values on ARM and BET were compared.

RESULTS:
21 patients were referred to undergo ARM and BET. 19 patients met the inclusion criteria. 16 displayed a dyssynergy pattern on ARM. Of the 16 patients, 11 were also identified to have features of dyssynergia on DRE with a detection rate of 69% (Table 1). One patient was noted to have features of dyssynergia on DRE but had normal ARM. Two patients had normal DRE with normal ARM. 11 of the 16 patients with dyssynergia on ARM had abnormal BET. Of the 11 patients with abnormal BET, 7 were predicted to have abnormal BET based on DRE (64% detection rate). DRE predicted the correct type of dyssynergia (type 1-4) in 31% of patients (Table 2).

CONCLUSION:
Studies have shown that DRE can predict dyssynergia when performed by a single expert gastroenterologist with a detection rate of 73%. Our analysis suggests that DRE can be used to predict dyssynergia on ARM and outcomes of BET even when multiple providers perform the exam. However, DRE is not a good predictor of the type of dyssynergia. Further studies are needed to evaluate the differences in detection rates between types of dyssynergia classified by ARM, and to assess whether there is a difference in detection rates between trainees and attendings.