bluuebunny/crossref_metadata_2025_split huggingface dataset:
2900 Additional Training in Nutrition Helps Recruit More Patients for Nutritional Therapy in Inflammatory Bowel Disease (IBD)
Authors: Greene Jessica , Warman Anmol , Edwards Jade , Vidyarthi Gitanjali 
Published: October 2019

INTRODUCTION:
IBD is growing at an alarming rate from than 1 per100,000 in 1960s to 4.1 in 1980s in the western world. This sharp increase is unlikely to be explained by genetic factors alone and an environmental factor is strongly incriminated. Diet has been proposed by some as a plausible culprit with significant effect on the course of IBD. Western diet which is high in refined sugar and processed food has been associated with altered immune response and thought to contribute to the pathogenesis of inflammatory bowel disease. Food rich in fruits and vegetables have a lower incidence of IBD. In this regard elemental diet has been studies extensively However there appears to be a taste fatigue leading to poor tolerance and there is lack of data for its long-term effectiveness. Another diet which has shown promise, is specific carbohydrate diet (SCD) and has the potential for better tolerance. Patient unwillingness and lack of familiarity with this diet by providers has been reported as causes for limited use. Here we are reporting patient willingness to participate when provider training is present.

METHODS:
We have a gastroenterologist at our Institution who is also Board Certified in Nutrition by American Society of Enteral Nutrition (A.S.P.E.N.). Provider knowledge in SCD increased with giving National talks and attending nutrition conferences. This led to creation of an inner core group team by training of registered dietician (RD). Via a grant, books were obtained for patient distribution and hundreds of recipes. Patients who were seen in clinic or inpatients were offered SCD when provider felt it was appropriate. Inclusion criteria was presence of IBD. Exclusion criteria was stable disease, fulminant colitis. Treatment was offered with one-on-one session with a RD and a second meeting the next day if patient had any questions. Patients were given books, recipes. A telephone call was planned in 2 weeks and a follow-up.

RESULTS:
Eight patients were offered SCD of which 7 patients agreed to participate. When this result was compared prior to training of the inner core team no patient was offered this.

CONCLUSION/DISCUSSION:
Our numbers are small and out study has just started but it does reveal that when a team trained in Nutrition is involved more patient participation is seen as several patients want to avoid side-effects of expensive and toxic medications. Our goal is to check patient compliance, its impact on the course of disease.
2901 Variation in Standard IBD Financial Charges Across Major U.S. Medical Systems
Authors: Beard Jonathan , Click Benjamin 
Published: October 2019

INTRODUCTION:
Inflammatory bowel diseases (IBD) are costly chronic illnesses with routine services both inpatient and outpatient, preventative care, and costly biologic pharmaceuticals. Recent mandates require US hospitals to publish healthcare system financial charges. As many as 10-15% of IBD patients are uninsured and as such, are accountable for the entirety of their healthcare charges. We aimed to assess the variability in healthcare charges for standard tests and procedures routinely utilized in IBD care.

METHODS:
Financial charges from 25 geographically diverse healthcare systems were obtained and queried. Serum studies included metabolic, nutritional, inflammation, and infectious screening studies Stool studies included infectious testings and fecal calprotectin. Imaging studies included CT and MRI abdomen; endoscopy included EGD and colonoscopy with biopsy. Lab studies were divided into Basic (e.g., CBC, CMP, CRP) and Extended categories (e.g., EBV serology) to express differing views on the routine testing extent. Diagnosis-related groups for commonly billed encounters for IBD patients (DRG 329-331) were also examined.

RESULTS:
Most centers reported data on all serum, stool, and imaging studies queried; however, reporting on colonoscopy with biopsy (n = 14/25) and DRG charges (range 8-14) was inconsistent. There was significant variability in the charges for routine laboratory, imaging, and endoscopic evaluation across the healthcare systems (Figure 1). The median sum charge for Basic labs was $2,105 (IQR $1,576-3,522), Extended labs $4,596 (IQR $3,877-7,341), and rose to $9,671 (IQR $7677-12,051) and $13,085 (IQR $10,481-15,511) with the addition of CT plus colonoscopy, respectively. DRGs for inflammatory bowel disease demonstrated less variability (Figure 2). Median charge for IBD without complication or comorbidity was $64,268 (IQR $52,296-76,377), with complication/comorbidity $96,588 (IQR $71,962-109,674, and rose to $181,675 (IQR $133,962-235,744) with a major complication or comorbidity. The most inexpensive healthcare system averaged charges 65% below than the median, and the most costly averaged 232% higher.

CONCLUSION:
There is significant variability across healthcare systems in financial charges for commonly ordered tests and procedures in IBD patients that can reach staggering sums. Uniformity and transparency in healthcare pricing structures is desperately needed to ease the financial burden, particularly for uninsured populations.
2906 Significantly Increased Mucosal Eosinophils in Patients With Post-IBD IBS-D May Have a New Avenue
Authors: Tozlu Mukaddes , Beketaev Ilimbek , Younes Mamoun , Dar Wasim A. , Ju Changqing , Ertan Atilla 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) patients in remission who present with irritable bowel syndrome with diarrhea (IBS-D) like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD-IBS-D. This syndrome was first reported by Isgar et al. who documented IBS-type symptoms in 33% of their patients with chronic ulcerative colitis (CUC) in remission in 1983. In their meta-analysis of 13 studies incorporating 1703 patients, Halpin and Ford in 2012 calculated a pooled prevalence for IBS symptoms among IBD subjects in remission of 35%. The post-IBD IBS-D represents a source of considerable stress, incurs morbidity and impairs quality of life of these patients. The etiology of this syndrome is unknown and may be multifactorial such as environmental, psychological and genetic components and possibly by gut microbiome.

METHODS:
We conducted a retrospective, single-center electronic medical record review of patients with history of IBD and IBS-D like symptoms. The demographic characteristics, type of IBD, colonoscopy and biopsy findings with GI-hypoallergenic diet and budesonide treatment were analyzed.

RESULTS:
We have found significantly increased mucosal eosinophils (>30-50 HPF in both side of the colon examined) in our patients with post- IBD IBS-D syndrome. In this study, 15 patients with CUC and 20 Crohn's disease (CD) patients with this syndrome were investigated and showed no clinical, serological, mucosal or microscopic IBD activity. These patients had non-bloody diarrhea (3-20x daily), lower abdominal cramps (90%), mild weight loss (4-6 lbs), and fecal incontinence (25%) who were placed on the GI-hypoallergenic diet and budesonide therapy. Sixty-seven percent of these 35 patients with post- IBD IBS-D responded well clinically to this management. Increased mucosal eosinophils in these patients may have eosinophilic colopathy that may be related to intestinal permeability disarray. The epithelium in these IBD patients who are in remission may have the production of pro-inflammatory cytokines by the eosinophils, especially IL-23 and IL-33.

CONCLUSION:
In summary, this is an exciting new findings that significantly increased mucosal eosinophils in our patients with post-IBD IBS-D may have a new avenue, eosinophilic colopathy. Interestingly, these patients have responded to the GI-hypoallergenic diet and budesonide therapy. Obviously, we need more patients in the near future with a longer follow-up and we hope that the other investigators may confirm our findings.
2911 Older Onset Inflammatory Bowel Disease: Are Patients Well Informed?
Authors: Crooks Benjamin J. , McLaughlin John , Limdi Jimmy K. 
Published: October 2019

INTRODUCTION:
In an aging population, 25-35% of those with inflammatory bowel disease (IBD) are over 60 years old. A third of these are diagnosed with IBD at or over the age of 60 (“older-onset” IBD). Patient-education is an important outcome modifier in chronic disease, yet, virtually no studies exist exploring disease related knowledge in older-onset IBD. We report a British experience aimed at understanding patient knowledge of disease using the validated Crohn's and Colitis Knowledge (CCKNOW) questionnaire in patients with older-onset IBD.
1

METHODS:
A prospective, questionnaire-based study is being conducted in the UK. Two-hundred patients with older-onset IBD will complete the 24-item CCKNOW questionnaire along with a questionnaire regarding patient demographics and disease specifics. We present an interim analysis of the first 29 patient responses.

RESULTS:
The mean age of respondents was 73.5 years (55% male, 93% Caucasian). 69% had ulcerative colitis and 31% had Crohn's disease. Mean disease duration was 6.2 years. The highest educational qualification recorded was as high-school (3%), post-secondary (3%), university degree (10%) and other professional qualification/diploma (28%), none (17%) and unspecified (39%). The mean total CCKNOW score was 5.7 with a median of 5 (range 0-21). Areas with the poorest scores were those relating to “pregnancy and fertility” (10% correct responses), “IBD related complications” (17%) and “Anatomy and physiology” (18%). Subgroups with the most correct responses were “IBD related symptoms” (55%) and “IBD diagnosis” (34%). There was no difference in CCKNOW scores between CD and UC (P = 0.71) and duration of disease has no relationship with total score (P = 0.67).

CONCLUSION:
Discussion Our initial data suggest that the IBD specific knowledge of patients with “older-onset” IBD is poor but comparable to other patient cohorts.
2
Given the impact patient knowledge has been shown to have on chronic disease outcomes, it is imperative that we can match patients' information needs to healthcare delivery and IBD information resources. A larger dataset will be presented at conference proceedings.
2913 Health-Related Quality of Life in Patients With Inflammatory Bowel Disease at the University Hospital of the West Indies
Authors: Smith Natalie M. , Dawkins Yvonne M. , Lee Michael G. , Arthurs Milton , Ferguson Trevor 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) is a chronic condition that can significantly affect health-related quality of life (HRQoL). The aim of this study is to determine the HRQoL of patients with IBD seen at the Gastroenterology clinic at the University Hospital of the West Indies (UHWI).

METHODS:
A cross sectional study was conducted, which included seventy patients with IBD (CD 25, UC 44 and one patient with Indeterminate colitis). Data analyses were restricted to 69 patients who had CD or UC. All the patients completed the validated Inflammatory Bowel Disease Questionnaire (IBDQ) and a questionnaire with demographic data. Disease activity was measured using Crohn's Disease Activity Index (CDAI) for CD and Truelove and Witts severity index for UC. Data analysis was conducted using Stata 14 statistical software.

RESULTS:
Mean age was 44.3 ± 16.2 years, 56.5% females, mean disease duration 12.0 ± 11.0 years and mean age at diagnosis of IBD was 31.5 ± 13.4 years. Patients with CD had more frequent hospital admissions (3.9 ± 3.7 vs 0.9 ± 1.8; P value 0.001) and surgeries (0.75 ± 0.8 vs 0.1 ± 0.4; P value 0.001) compared to those with UC. The mean total IBDQ score was 179.6 ± 34.4 (CD was 175.0 ± 37.1 and 182.1 ± 33.0 for patients with UC). Patients with higher IBDQ scores were more likely to be male gender (OR 1.93, 95% CI 0.69–5.39, P value 0.207), married (OR 2.25, 95% CI 0.60-7.31, P value 0.177), educated to secondary school level (OR 2.05, 95% CI 0.46-9.06, P value 0.343), employed in the private sector (OR 3.00, 95% CI 0.83-10.90, P value 0.095) and on no medications (OR 3.24, 95% CI 0.27–0.80, P value 0.006). Higher IBDQ score was associated with fewer hospital admissions (OR 0.90, 95% CI 0.73-1.10, P value 0.287). The best score was seen in the systemic domain. The lowest score was seen in emotional domain for both diseases. Overall male patients had a better score for all domains.

CONCLUSION:
The HRQoL for patients with IBD at the UHWI was comparable to those in other studies. Patients with UC and male gender appeared to have better quality of life, but comparisons were limited by small sample size.
2914 Difference in Presentation and Treatment Response of Inflammatory Bowel Disease in the Asian Population
Authors: Shinn Brianna , Asif Bilal , Cao Christopher , Nahar Ritu , Dhanekula Raja Koteswar , Kistler Charles , Ahmed Monjur 
Published: October 2019

INTRODUCTION:
The prevalence of Inflammatory Bowel Disease (IBD) has historically been lower in Asian populations compared to the Western World, although the incidence of this disease has rapidly increased in Asian nations over the past two decades. This is thought to be secondary to environmental factors – including westernization of society, increased industrialization and urbanization - although past research shows that the genetics of this disease also differ between patient populations. Such differences may impact how Asian patients with IBD clinically present, optimal diagnosis, and management. We aimed to assess ethnic differences in the treatment response of IBD amongst the Asian population within the Jefferson Hospital Network by evaluating laboratory values, endoscopic response and clinical response.

METHODS:
This was a single center retrospective chart review of patients of Asian descent diagnosed with IBD using applicable ICD-10 codes. Patient's charts were queried for demographic data, laboratory studies, CT abdomen/pelvis reports, colonoscopy reports and subsequent histopathology biopsy data.

RESULTS:
We identified 18 patients (53% female, 32% inpatient) of Asian descent who had ICD 9/10 codes for inflammatory bowel disease (ICD-10: K51.90 or ICD-9: 560.89) between 2015 and 2017 in the Jefferson Hospital network; the average age of diagnosis was 36.2 years. 83% (n = 15) of these Asian patients were ultimately diagnosed with ulcerative colitis through colonoscopy and subsequent histopathologic analysis, the remaining had Crohn's Disease (16%, n = 3). 37% (n = 7) of our population were initiated on biologic agents, including Remicade, Humira, or Infliximab; 57% (n = 4) of these patients had a “good” response, defined as no recurrence of activity and no further change in therapy. Of the original 18, 61% (n = 11) were initiated on 5-aminosalicylic acid (5-ASA) agents, and 36% (n = 4) of these had a “good” response, defined as above. Only 2 (11%) patients in our cohort had need for surgery eventually.

CONCLUSION:
Majority of the Asian patients with IBD had ulcerative colitis. The management of IBD in Asian Americans was distinct from management of non-Asian groups. Majority of patients were started on 5-ASA. Response to 5-ASA and biologic agents was significant. Further studies are warranted to evaluate appropriate management for this specific population, particularly to evaluate response to different biologic therapies.
2919 Meta-Analysis: Retreatment of Inflammatory Bowel Disease Patients Who Previously Achieved Deep Remission With Anti-TNFa and Subsequently Stopped Therapy Electively
Authors: Alipour Omeed , Gulati Alakh , Shao Ling , Zhang Bing 
Published: October 2019

INTRODUCTION:
Deep remission (DR) is an emerging therapeutic target in inflammatory bowel disease (IBD). Although there is no consensus definition, many consider DR as clinical remission with mucosal healing with or without additional criteria. Anti-TNFα demonstrate increased success in achieving DR, which lead to longer periods of remission and improved outcomes. However, 30-50% patients in DR relapse within one and two years after anti-TNFα withdrawal. Furthermore, despite the availability of biosimilars, the decision to withdrawal anti-TNFα agents is greatly influenced by cost and limited access in certain countries. This meta-analysis assesses the response to retreatment with anti-TNFα in patients who previously achieved DR with anti-TNFα but subsequently stopped therapy and relapsed.

METHODS:
Search terms (“inflammatory bowel diseases” OR “IBD” OR “crohn*” OR “ulcerative colitis” OR “UC” OR “colitis”) AND (“mucosal healing” OR “deep remission” OR “complete remission” OR “full remission” OR “endoscopic remission”) produced 7,514 articles from Pubmed and EMBASE on Oct 1, 2018. Inclusion criteria were adult IBD patients in DR after treatment with anti-TNFα, defined as clinical remission and mucosal healing, who were followed until clinical or endoscopic relapse and subsequently restarted on anti-TNFα. Exclusion criteria were studies including children, patients on steroid maintenance, and non-English publications. Two authors independently reviewed publications for inclusion; a third author served as tie-breaker. Statistics was performed using OpenMetaAnalyst.

RESULTS:
Five publications with 73 cases were included. Retreatment with anti-TNFa successfully induced clinical remission in 94.4% (68/73; I2 = 0, P = 0.685) of all patients. No significant difference existed among ulcerative colitis (19/21) and Crohn's disease (49/52) patients. However, eight patients required either dose escalation of their prior anti-TNFα therapy, or were switched to another anti-TNFα agent.

CONCLUSION:
Literature reports deep remission to be more durable with improved outcome compared to clinical remission. Incorporation of anti-TNFα agents into treatment logarithm increase the likelihood of achieving DR. However, patients' preferences, medication cost, and healthcare policies may lead to treatment termination. This meta-analysis demonstrates that cessation of anti-TNFα is a viable option for patients with DR, as retreatment leads to clinical remission in an overwhelming majority of these patients.
2922 Epidemiology of Indeterminate Colitis in the United States Between 2014 and 2019: A Population-Based National Study
Authors: Mansoor Emad , Jin-Dominguez Fangyuan , Cheema Tayyab , Saleh Mohannad Abou , Regueiro Miguel , Katz Jeffry , Cooper Gregory S. 
Published: October 2019

INTRODUCTION:
It is estimated that Indeterminate Colitis (IC) accounts for 5-15% of new diagnosis of Inflammatory Bowel Disease (IBD). However, the epidemiology of IC in the United States (US) has not been studied extensively and is subject to debate. We sought to describe the epidemiology of IC in the US between 2014 and 201 9 utilizing a large population based database.

METHODS:
We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to 2019. We identified an aggregated patient cohort of eligible patients with “Indeterminate colitis” between June 2014 and 2019, based on Systemized Nomenclature Of Medicine – Clinical Terms. We calculated the prevalence of IC overall and among different patient groups and compared prevalence of IC with Crohn's disease (CD) and Ulcerative Colitis (UC).

RESULTS:
Of the 36,733,720 individuals active in the database from June 2014-2019, we identified 8,070 individuals with a diagnosis of IC with an overall prevalence rate of 22/100,000. Compared to IC, there were 165,930 individuals with CD and 139,810 individuals with UC with overall prevalence rates of 451/100,000 and 381/100,000 respectively (Figure 1). The prevalence of IC was increased in females at 27/100,000 [OR: 1.74, 95% CI: 1.66-1.83, P < 0.0001] compared to males at 16/100,000; elderly (aged >65 years) at 42/100,000 [OR: 2.61, 95% CI: 2.49-2.72, P < 0.0001] compared to non-elderly (aged <65 years) at 16/100,000 and Caucasians at 29/100,000 [OR: 3.22, 95% CI: 2.90-3.58, P < 0.0001] compared to African-Americans at 9/100,000 (Figure 2).

CONCLUSION:
This is one of the first large studies to date that has described the epidemiology of IC in the US. We found that the estimated prevalence of IC is low at 22/100,000. IC is more likely to be diagnosed in elderly, females and Caucasians.
2923 A Prospective Longitudinal Study of Proton Pump Inhibitors Effect on Inflammatory Bowel Disease Flares and Activity
Authors: Xu Anthony , Mallepally Niharika , Shapiro Jordan , Hou Jason 
Published: October 2019

INTRODUCTION:
Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications in the United States. Some recent studies have suggested that PPIs may have a negative effect on the gut microbiome. Dysbiosis of the gut microbiome has been linked with inflammatory bowel disease (IBD). We hypothesized that PPI use is associated with increased IBD flares and activity. This study was aimed to assess the effect of PPIs on IBD flares and activity.

METHODS:
We conducted a prospective longitudinal study of Veterans from the IBD clinic at the Michael E. DeBakey VA Medical Center from 2014 to 2018. Our eligibility criteria included patients who were at least 18 years of age, who were diagnosed with Crohn's Disease (CD) or Ulcerative Colitis (UC), and who had at least 1 clinic visit. IBD flare was defined by patient self-report of IBD flare between clinical encounters. IBD activity was quantified using the partial Mayo Score (pMayo) for UC, and the Harvey Bradshaw Index (HBI) for CD. Remission was defined by pMayo <2 for UC and HBI <5 for CD. Exposure of PPI was confirmed by chart review. Associations of PPI use with IBD flare and activity were assessed using T-tests and Chi-squared tests.

RESULTS:
A total of 132 patients were included in the analysis of which 74 had CD and 58 had UC. 40 patients were PPI users, and IBD flares occurred in 60 patients. No significant association between PPI usage and IBD flares were observed: 42.5% of PPI users developed flares compared to 46.7% of non-PPI users who developed flares, P-value = 0.658. In patients with CD, PPI use was associated with non-remission status (RR 2.53; 95% CI 1.04-6.15). In UC patients, PPI use was not associated with non- remission status (RR 1.10; 95% CI 0.67-1.79). 13 CD patients on PPIs discontinued the PPI between encounters, which was associated with a statistically significant decrease in HBI (3.62- >2.54, P-value = 0.005). Among UC patients who discontinued PPIs, there was a non-significant trend towards decreased pMayo (2.26- >1.59, P-value = 0.069).

CONCLUSION:
Amongst CD patients, PPI use was not associated with interval flare however, it was associated with non-remission status. Cessation of PPIs was associated with a statistically significant decrease in HBI in CD patients. In UC patients, no significant association between PPI use and flare or activity were observed. Decreasing unnecessary PPI use in patients with CD may decrease disease severity.