bluuebunny/crossref_metadata_2025_split huggingface dataset:
2895 Recurrent Bleeding in Patients With LVADs: Endoscopic Yield and Impact of Endoscopic Intervention
Authors: Palchaudhuri Sonali , Dhawan Ishita , Siddique Shazia M. , Mehta Shivan , Coniglio Mary , Fisher Laurel 
Published: October 2019

INTRODUCTION:
Patients with LVADs are at increased risk for gastrointestinal bleeds (GIBs) because of chronic anticoagulation and high flow states. A prior retrospective study at our institution confirmed that 22% of patients with LVADs had a GIB after implantation, consistent with prior literature. There are no evidence-based guidelines regarding the role of repeat endoscopic procedures for recurrent GIB, resulting in varying practice patterns among Cardiology and GI teams. It is unknown how often repeat inpatient endoscopic examinations during hospitalizations result in intervention or reduction in future GIB episodes. We sought to assess the proportion of endoscopic intervention and impact on recurrent GIB.

METHODS:
We conducted a retrospective cohort study of all patients at one academic institution who underwent LVAD implantation between March 2016 through February 2018. For each patient, we assessed post implant hospital encounters for GIBs through May 2019. The primary outcome was the odds ratio for a future GIB based on the occurrence of endoscopic intervention versus none (endoscopy with no intervention or no procedure). Secondary outcomes included endoscopic intervention based on overt versus occult GIB.

RESULTS:
The cohort included 105 patients who had LVADs implanted during the stated time. 34 patients (32%) presented for GIBs during the study period, with a total of 71 encounters. A third or higher encounter occurred in 26% of patients (9/34) and accounted for 27% (19/71) of encounters. 79% of all encounters (56/71) included at least one invasive endoscopic evaluation; an endoscopic intervention was performed in 41% (23/56). The odds ratio for future GIB after endoscopic intervention during the first GIB (34/71) was 0.2 (95% CI 0.04-0.97, P = 0.046) but was not statistically significant if the intervention was during a recurrent GIB (37/71) (0.33, 95% CI 0.08 - 1.41, P = 0.14). The odds ratio of performing an intervention during endoscopic procedure for overt versus occult GIB was 3.4 (95% CI 0.98-11.7231, P = 0.053), trending towards significant.

CONCLUSION:
Patients with LVADs who have recurrent GIBs experience repeat admissions and endoscopic procedures. In our cohort, endoscopic interventions for repeat GIB did not have an impact on future episodes of GIB. Our data suggest that the endoscopic yield is likely lower with occult GIB.There is a clinical need to identify characteristics of LVAD patients at risk and to develop guidelines for the management of patients with recurrent GIB.
2908 Clinical Factors Associated With Vitamin D Deficiency in Patients With Ulcerative Colitis
Authors: Choi Jongwook , Cho Byungha , Kim Seongmin , Kwon Hyeonwoo , Lee Jun Su , Park JiSook , Ji Jung Woong , Kim DaeHyun , Kim Hyoung Woo , Kim Ki Bae , Han Joung-Ho , Chae Hee Bok , Park Seon Mee , Youn Sei Jin , Yoon Soon Man 
Published: October 2019

INTRODUCTION:
Vitamin D has known to play a role in the development and the course of Crohn's disease and ulcerative colitis (UC). However, little is known about the clinical factors associated with vitamin D status in patients with UC. Therefore, we aimed to identify the clinical characteristics associated with vitamin D status and also evaluate the patients' quality of life (QOL) according to vitamin D status in UC patients.

METHODS:
We enrolled 81 patients with UC and measured serum 25-OH vitamin D levels. We investigated patients' clinical characteristics, disease activity, laboratory findings such as CRP, albumin, and fecal calprotectin. In addition, we evaluated patients'' QOL using IBD-specific questionnaire according to vitamin D status.

RESULTS:
The median age at vitamin D measurement was 46.4 ± 1.8 years (range: 19-82, M/F: 48/33) and the median vitamin D level was 18.6 ± 0.9 ng/mL. Among 81 patients, 75 patients (92.6%) revealed vitamin D deficiency (<30 ng/mL). Fecal calprotectin level had negative correlation with vitamin D level (r = −0.324, P < 0.028). However, there was no correlation with CRP, albumin, and disease activity according to vitamin D level. In addition, the patients’ QOL was not associated with vitamin D level. The patients with vitamin D deficiency showed higher fecal calprotectin level than patients with normal level (P = 0.038). However, there were no significant differences of CRP, history of steroid use, smoking status, and disease activity according to vitamin D status.

CONCLUSION:
Vitamin D deficiency was pretty common in UC patients. Fecal calprotectin levels were inversely correlated with vitamin D levels. However, there was no association between vitamin D status and disease activity or patients' QOL in UC patients.
2912 Higher Induction Propofol Dosing Decreases Induction Time for Sedation of Inflammatory Bowel Disease Patients Undergoing Elective Endoscopic Procedures
Authors: Zhang Daniel S. , Stana Roman , Abraham Bincy 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) patients undergo frequent endoscopic procedures. As a result, they may be exposed to anesthesia and its associated risks.1–2 Prior studies have indicated that IBD patients may require higher sedation needs.3–5 We conducted a retrospective study comparing the induction sedation dose and time by an anesthesiologist experienced with IBD patients (IBD-e) compared to anesthesiologists not experienced with IBD patients (IBD-ne).

METHODS:
Patients 18 and older with documented IBD and an American Society of Anesthesiologists (ASA) score of 2 or less undergoing an elective endoscopic procedure using total intravenous anesthesia (TIVA) were included in the study. These anesthesiologists were either experienced or inexperienced with sedating IBD patients. Exclusion criteria included pregnancy, recipient of any sedative other than propofol, or inpatient status. Age, body mass index (BMI), relevant comorbidities, medications, and validated disease activity scores were recorded. Any adverse events were recorded. The primary outcome was the time required to achieve adequate sedation (seconds) as determined by the level of consciousness by the anesthesiologist. Secondary outcome was the induction dose of propofol per kilogram patient weight (mg/kg) required to achieve sedation. The sample size needed for the primary outcome of sedation time with 80% power and an alpha 0.05 was 144 total patients.

RESULTS:
A total of 180 IBD patients were analyzed, with 108 patients in the IBD-e group and 72 in the IBD-ne group. Baseline characteristics including were similar between the groups (Table 1). Specific IBD scores of endoscopic disease activity were also similar between the two groups (Table 2). Sedation time was significantly reduced in the IBD-e group 38.9 ± 2.1 sec when compared to the IBD-ne group 94.2 ± 10.7 sec (P < 0.05). The induction dosage of propofol was significantly higher in the IBD-e group 3.42 ± 0.39 mg/kg than the IBD-ne group 2.09 ± 0.21 mg/kg (P < 0.05) (Table 3). No significant adverse events were reported in either group.

CONCLUSION:
We have shown that higher induction propofol decreases induction time for sedation of IBD patients undergoing elective endoscopic procedures regardless of age, gender, BMI or endoscopic disease activity. Understanding these findings, anesthesiologists may achieve more efficient sedation in IBD patients. Further studies are needed to validate our findings.
2930 Does Triple Antibiotic Therapy Reduce Faecal Calprotectin Levels and Gastrointestinal Symptoms in Patients With Ulcerative Colitis? A Retrospective Study
Authors: Hesari Niloufar Roshan , Gunaratne Anoja W. , Clancy Annabel , Benstock Simon , Tu Jeffrey , Borody Thomas 
Published: October 2019

INTRODUCTION:
Ulcerative colitis (UC) is characterised by inflammation in the colon and the rectum. The primary symptoms include abdominal pain, diarrhoea, fever, weight loss and anaemia. Fusobacterium varium (F. varium) is present in the colonic mucosa of approximately 80% of patients with UC. Butyric acid, a derivative of F. varium culture supernatants has shown to cause UC-like lesions in mice. F. varium shows susceptibility to a combination of antibiotics whose efficacy in inhibiting inflammation was investigated in this study. Aims To assess the efficacy of triple antibiotic therapy in reducing faecal calprotectin in patients with UC at 6 and 12 weeks.

METHODS:
A retrospective analysis of patients with UC, who were treated with triple antibiotic therapy between July 2014 and December 2018 was conducted. Patients were treated with three antibiotics tinidazole, rifaximin and nitazoxanide for 12 weeks. Gastrointestinal symptoms and faecal calprotectin were recorded pre-treatment and at 6 and 12 weeks on the treatment. Elevated faecal calprotectin in the stool indicates intestinal inflammation (Normal range ≤ 50 µg/g). Wilcoxon matched-pairs signed rank test was used to compare the differences between data sets, and a P value < 0.05 was considered statistically significant.

RESULTS:
A total of N = 63 patients (32 M, average age 42 years) with UC treated with the antibiotics were identified. Baseline calprotectin was available for 22 patients, follow-up values at 6 weeks in 8 patients and in 15 patients at 12 weeks of treatment. A significant reduction in faecal calprotectin was observed at 12 weeks on the treatment (median: 64 µg/g) (P = 0.003) but not at 6 weeks (P = 0.382) compared to baseline (median: 252.5 µg/g) (Figure 1). Baseline symptoms were reported for 57 patients, of which 31 patients at 6 weeks and 39 patients reported symptoms at 12 weeks. Diarrhoea and blood in the stool resolved significantly at 6 and 12 weeks on the treatment (P ≤ 0.006) (Figure 2). No changes were seen in constipation, pain, nausea, vomiting, mucus in the stool or weight loss at 6 or 12 week on the treatment versus pre-treatment (P ≥ 0.077).

CONCLUSION:
A significant improvement in gastrointestinal symptoms and a fall in faecal calprotectin were observed in patients with UC who were treated with a triple antibiotic regimen. Future prospective studies are required to evaluate the efficacy of this therapy in inducing endoscopic remission.
2939 Outcomes of Patients With Large Colonic Polyps Referred to a Tertiary Center for Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection
Authors: Lamm Vladimir , Olaiya Babatunde , Lou Hui , Chen Huimin , Xia Liang , Vachaparambil Cicily , Kapil Neil , Xu Jennifer , Yu Michael , Cai Qiang 
Published: October 2019

INTRODUCTION:
Large colonic polyps (>2 cm), flat or sessile, are difficult to remove by endoscopy. These difficult polyps are usually referred to experienced advanced endoscopists for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). There is no data regarding outcomes of referred polypectomies to a tertiary care center for endoscopic management. We aimed to examine outcomes of patients referred to a tertiary center for EMR and ESD and thereby provide feedback to referring physicians.

METHODS:
A retrospective study of patients with difficult polyps referred to an experienced advanced endoscopist at a large academic center for EMR and ESD between February 2016-August 2018 was completed. 141 referred patients were enrolled. Charts were reviewed for outcomes including: procedure setting, procedure type, need for surgical consult, duration, complete removal, complications, antibiotic use, hospital days, pathology, and repeat colonoscopy findings.

RESULTS:
The average size of referred polyps was 3.39 cm, with most being flat or sessile. Procedures were largely performed in the surgical ambulatory center. EMR constituted the majority of procedures, followed by ESD, and snare cautery polypectomy. Complete removal with first session colonoscopy was originally noted with 87% of polyps. For this group, mean procedure time was 47 minutes with a complication rate of 8.9%, consisting mainly of hematochezia. Of this subset of patients, 46.4% had a repeat colonoscopy/pathology at time of study with majority of findings unremarkable. When accounting for residual polyps on repeat colonoscopy, 62.4% of patients had complete removal at first colonoscopy. Overall, 7.8% required a surgical consult. Most patients did not require hospitalization after procedure or antibiotics. Comparative analysis revealed no significant difference between different techniques.

CONCLUSION:
Most polypectomies referred to an experienced advanced endoscopist for EMR and ESD can be performed in an outpatient ambulatory surgical center. Most of the polyps were removed by EMR. ESD was performed in a small percentage of patients. Currently there are no guide lines regarding what kind of polyps should be referred. The majority of referred difficult polyps were completed removed at the first colonoscopy within a relatively short procedure time. At least a portion of those polyps should be able to be resected at the index colonoscopy, without referral, to reduce health care cost and patient inconvenience.
2946 Does Non-Alcoholic Fatty Liver Disease Increase the Risk of Cholangiocarcinoma? A Single Center Retrospective Review
Authors: Martinez-Tapia Ana , Bahirwani Janak , Folterman Christopher , Chaput Kimberly J. , Duarte-Chavez Rodrigo , Martins Noel B. 
Published: October 2019

INTRODUCTION:
Cholangiocarcinoma is a highly aggressive cancer of the bile duct epithelium, usually diagnosed at an advanced stage. Limited research has shown evolving risk factors and pathogenesis of cholangiocarcinoma. Studies have revealed a link between Non-Alcoholic Fatty Liver Disease (NAFLD) and cholangiocarcinoma, mainly intrahepatic cholangiocarcinoma. The major risk factors for NAFLD- include obesity, impaired fasting glucose, dyslipidemia, and metabolic syndrome. In this study, we aim to determine a possible association between NAFLD and cholangiocarcinoma.

METHODS:
The electronic medical records were retrospectively reviewed for adults with NAFLD, Intrahepatic cholangiocarcinoma (ICC) and Extrahepatic cholangiocarcinoma (ECC) by ICD code, imaging, or pathological report. Exclusion criteria were; alcoholic liver disease, primary sclerosing cholangitis, hepatitis B & C, HIV infection, and inflammatory bowel disease between March 2012-2019. Analysis was conducted on possible risk factors such as NAFLD, metabolic syndrome and subsequent risks; diabetes mellitus, BMI, dyslipidemia, hypertension (HTN), and coronary artery disease.

RESULTS:
A total of 59 patients with diagnosis of cholangiocarcinoma was collected and classified into ICC (N = 48) and ECC (N = 10) with mean age of 72 years. Gender distribution was 54% females and 46% males, in ICC and 40% females vs 60% males in ECC, respectifully. 18% of patients with ICC had NAFLD in comparison with 0% in the ECC class. Fisher exact test showed 37.5% of patients with ICC had metabolic syndrome vs 30% of patients with ECC, but this was statistically not significant. Each individual risk factor for metabolic syndrome was further analyzed and among these 81% of patients with ICC had HTN and was statistically significant vs 50% of ECC cases had HTN.

CONCLUSION:
Our cohort did not demonstrate an association between NAFLD and cholangiocarcinoma. Our sample size was low and ICC had more representation than ECC. Diagnoses of NAFLD was obtained mainly by imaging and pathology results rather than ICD codes, but underrepresented in our study in comparison to the general population, likely from undercoding. There was no association between gender, age, metabolic syndrome or its risk factors, except HTN, which was prevalent in the ICC group with statistical significance. This finding was not seen in prior studies. This could likely represent more prevalence of HTN overall in the cohort, however more research is helpful in determining this possible association.
2967 Post Prandial Lipemia: A Potential Diagnostic Modality for NAFLD
Authors: Nath Gautam 
Published: October 2019

INTRODUCTION:
Clinically, NAFLD encompasses a broad spectrum of hepatic derangements ranging from fat accumulation (steatosis) to severe inflammation and fibrosis (NASH, nonalcoholic steatohepatitis) that can lead to cirrhosis and subsequently to hepatocellular carcinoma. NAFLD is now more common than alcoholic liver disease owing to the rapid rise in the prevalence of obesity, and NAFLD is the most common cause of abnormal liver function tests.

METHODS:
Twenty consecutive Patients with age range 30-60 yrs attending our OPD during the years 2014-2016 with ultrasonographically proven hepatic steatosis and satisfying following criteria were selected: Alcohol intake less than 20 g/day, absence of autoimmune hepatitis (on the basis of clinical findings, raised globulin, AST/ALT ratio), absence of viral hepatitis (on the basis of serology for viral markers of HBV, HCV), absence of history of intake of any hepatotoxic drug.

RESULTS:
Considering the fasting lipid profile, difference was observed between the groups in serum TG (177.15 ± 16.18 VS 128.3 ± 22.4), total cholesterol (221.45 ± 31.26 vs 179.35 ± 26.59) and HDL (42.2 ± 6.13 vs 49.8 ± 4.39). The difference found was statistically significant (P < 0.001). Summing up for the cases, a higher value was recorded for alkaline phosphatise which was statistically not significant. The postprandial lipemic response of the subjects were estimated using serum triglyceride (TG) level measurement considering the same being the most dynamic parameter considering fat challenge. The serial estimations of TG at 2 hourly interval have also shown a significant difference in serum TG levels between cases and control groups with (P < 0.001). In order to calculate the magnitude of lipaemia, the Area under the curve (AUC) was calculated for the two groups using trapezoid rule, which showed a statistically significant (P < 0.001) between the two groups (1814.20 ± 166.46 vs 1341.25 ± 153.36).

CONCLUSION:
We have observed that all subjects from the case group have had a TG surge of greater than 240 mg% as opposed to the healthy controls, this difference could possibly serve as a useful tool provided a standardized diet challenge is implemented prior to test.
2993 Interaction Between Internet Browsing Habit and Dyspepsia Syndrome in Adolescents
Authors: Bayupurnama Putut , Sofia Noor Asyiqah , Cahyani Angelin Utami 
Published: October 2019

INTRODUCTION:
There were many patients, including adolescents, with dyspepsia symptoms in our daily clinical practice have been interacting with internet search engine to find medical information which induced or worsened their dyspeptic symptoms. Aim of the study is to know the pattern of internet browsing habit and dyspepsia syndrome in adolescents

METHODS:
Grade 12 level students of senior high schools in Yogyakarta, Indonesia were included in the study with stratified random sampling. Students with confirmed organic dyspepsia diagnosis were excluded. We use two simple questions to reveal the students internet browsing habit, question no 1:“Did you ever browse information about diseases in the internet?” (answer choice: a. never; b. once; c. more than once); question no 2.: “Did you ever browse information about your medical complaint in the internet?” (answer choice: a. never; b. once; c. more than once). We used validated Gastrointestinal Symptom score (GIS) to reveal the students dyspepsia symptoms. Data were analyzed with chi-square test and anova.

RESULTS:
There were 665 (477 girls and 188 boys) senior high school students (age range: 16-20 years old) included in this study. Based on question no 1 (Table 1) the result showed significantly different (P < 0.001) between students with and without the dyspepsia syndrome, and the question no 2 (Table 2) also showed similar result (P = 0.002). The anova between GIS and question no 1 showed significantly different (P < 0.001) and the similar result was also found between GIS and question no 2 (P < 0.001).

CONCLUSION:
Many patients with dyspepsia symptoms who came to our private and hospital clinics have been interacting with the internet search engine to find medical information about their symptoms including fake medical information that may influenced their psychogenic pain perception. This study showed that the internet browsing habit may influenced the development of dyspepsia syndrome in adolescents and further study is needed to find the cause and effect relationship.
3035 Pancreatico-Vesical Fistula
Authors: Ghosh Sudeshna , Patel Saumil , Hira Priya , Aswani Yashant 
Published: October 2019

INTRODUCTION:
Acute pancreatitis is an important cause of acute abdomen. It involves peripancreatic tissues or even remote organs or organ systems due to the enzyme rich fluid of pseudocyst. Here we report a case where acute pancreatitis resulted in a fluid collection that tracked down to the pelvis and spontaneously drained into the urinary bladder via a pancreatico-vesical fistula.

CASE DESCRIPTION/METHODS:
A 28-year-old male, chronic alcoholic, developed epigastric pain for last 4 days which radiated to the back with raised serum lipase and amylase levels. He was started on conservative therapy for acute pancreatitis and took discharge against medical advice but returned again 3 weeks later with severe pain in epigastrium as well as left flank, which is boring. Abdominal tenderness and muscle guarding were elicited. Diminished bowel sounds. CT abdomen: a bulky pancreas with non-enhancing areas, peripancreatic stranding, and acute fluid collections involving the body and tail of the pancreas extending along the renal fascia toward the pelvis and resting on the left superolateral wall of the urinary bladder. The epigastric pain gradually improved with complaints of burning micturition 2 days after without pyelonephritis signs. The urine had brownish tinge, turbid, foul smelling and microscopy revealed no bacteria/casts. An abdominal sonogram: normal kidneys but thickened UB wall with thick mobile echoes lying on left superolateral UB. Urine lipase and amylase were 499 U/Lit and 350 IU/Lit. CT cystography: contrast leakage from the left superolateral UB wall into the perivesical with fluid-fluid level seen in the UB suggestive of contrast –debris level means pancreatic-vesical fistula. Stenting of the pancreatic duct and percutaneous drainage of the fluid collection are done with regression of urinary symptoms and urinary amylase. 12 days after a repeat cystogram showed spontaneous healing of the fistula. The patient was followed up for 5 months with free of symptoms.

DISCUSSION:
Inappropriate activation of pancreatic proenzymes causes acute pancreatitis. It digests the pancreatic parenchyma, the peripancreatic tissues, leads to arterial pseudoaneurysms, fat necrosis and bowel perforation. Pseudocyst can communicate with the pleura, peritoneum, and gut or to the skin surface. Pancreatic fistulas to the urinary tract are rare and such fistulas usually communicate with the left kidney. Urinary amylase levels can thus be monitored.