bluuebunny/crossref_metadata_2025_split huggingface dataset:
1195 Clinical Manifestations of Strongyloides Infection on Hispanic Patients at the Veterans Affairs Caribbean Healthcare System
Authors: Cerra-Franco Javier A. , Rosa-Cortes Pedro , Estremera Rodolfo , Soto-Ramos Antonio , Saavedra Sonia , Toro-Lugo Doris 
Published: October 2019

INTRODUCTION:
Strongyloidiasis is a soil-transmitted parasitic infection caused by an intestinal nematode classified as a neglected tropical disease by the World Health Organization. Although predominantly asymptomatic it can potentially turn into a life-threatening disease in immunocompromised host. Epidemiologic studies in the western hemisphere are scarce but even more is the description of the natural course of this disease. The objectives of this study were to identify the different clinical presentations and outcomes associated to Strongyloides stercolaris infection in the Hispanic population in our institution.

METHODS:
This is a single center, retrospective record review study involving patients diagnosed with S. stercolaris infection via serological studies, stool samples or organ biopsies from 2008 to 2014

RESULTS:
A total of 270 patients tested positive during the study period of which 210 (77.8%) were asymptomatic. Out of the patients who presented with symptoms, 25 had pulmonary manifestations, 21 gastrointestinal, 5 rash, 9 with more than one manifestation of which 5 presented with hyperinfection. The most common laboratory abnormalities were an elevated eosinophil count: 1.4 × 103/ul (normal: 0-0.1 × 103/ul) and eosinophil percent: 15.5% (normal: 0-7%). The other laboratory parameters were essentially unaffected. The mean age at diagnosis was 75.4 years old. The most common reasons for testing for S. stercoraliswere eosinophilia (n = 235), asthma (n = 21), diarrhea (n = 20), rash (n = 10) and others (n = 31).

CONCLUSION:
Evolving globalization trends have increased migratory rates around the globe. People from endemic countries can easily travel to places where S. stercoralis is not endemic. Natural disasters account for increased translocation of people from endemic to non-endemic areas. More recently, Hurricane María struck Puerto Rico and the Caribbean during September 2017. In its aftermath, nearly 400,000 Puerto Ricans left the island and established themselves in the continental United States, a crisis documented in multiple newspaper articles, columns and news outlets. The present study highlights the need to establish guidelines aimed towards increased screening of patients in communities with known increased migrant flow from endemic countries in order to timely diagnose and prevent the potentially fatal outcomes that may occur as a result of steroid or immunosuppressive therapy in patients with untreated strongyloidiasis.
1196 Three and Five-Year Outcomes for Teduglutide in Intestinal Failure
Authors: Puello Frances , Wall Elizabeth , Herlitz Jean , Lozano Scott , Reynolds Valerie , Widlicka Annie , McDonald Edwin K. , Semrad Carol , Micic Dejan 
Published: October 2019

INTRODUCTION:
Intestinal failure (IF) results from a variety of causes leading to need for parenteral support (PS). Teduglutide was approved for adult patients requiring PS in December 2012. Teduglutide is a glucagon-like peptide 2 (GLP-2) analogue that aids in the growth of the intestinal villi and reduces gastric emptying, thereby promoting absorption of fluids, calories and electrolytes. Previous studies have shown that teduglutide has decreased PS use by >20% at 12 and 24 months. Long term efficacy data has not been studied. Our aim is to present 3 and 5 year patient outcomes on teduglutide.

METHODS:
Data was collected retrospectively from a single center including patients requiring PS that also received teduglutide between 3/1/13 and 5/1/19. Patient demographics including length of small intestine, presence/absence of an ileocecal valve and duration of PS was recorded. Outcomes of teduglutide therapy were recorded at 12, 24, 36, and 60 months with respect to PS volume, calories, days per week of PS use, and ability to stop PS. Response to teduglutide was defined as a > 20% reduction in PS compared to baseline volume. Data were analyzed using Fischer’s exact test for categorical variables and one-way ANOVA for comparison of means followed by Dunnett’s test.

RESULTS:
Patient demographic and IF etiology data is presented in Table 1. Eighteen patients were included in the final analysis. Indications for stopping teduglutide are listed in Table 2. Baseline and longitudinal PS requirements, weight trends and responders are shown in Table 3. Among individuals with follow-up, the number of responders was 11/16 (69%) at 12 months, 10/13 (77%) at 24 months, 7/10 (70%) at 36 months and 3/3 (100%) at 60 months. Among responders, the presence of a colon in continuity, ileocecal valve, or length of remaining small bowel did not affect TPN requirement (P > 0.05 for all comparisons). Ten out of 16 (63%) patients had a one or more day decrease in TPN frequency at 12 months, 9/13 (69%) at 24 months, 6/10 (60%) at 36 months, and 3/3 (100%) at 60 months. Change in PS volume and days of PS per week were significantly lower at 24 months and 60 months (Table 3).

CONCLUSION:
Previous studies have shown that teduglutide therapy decreases PS requirements in patients requiring PS over 12 and 24 months. We found that patients achieving reductions in PS requirements can successfully continue teduglutide therapy for up to 5 years with continued reductions in PS volume and days.
1198 Temporal Trends of Acute Myocardial Infarction-Related Hospitalizations in Celiac Disease Patients
Authors: Gupta Kamesh , Khan Ahmad , Gupta Manish , Barry Davis , Sohail Abdullah , Goyal Hemant 
Published: October 2019

INTRODUCTION:
Celiac disease (CD) is a chronic autoimmune inflammatory disease of small bowel. There is availability of mixed data about influence of CD on the incidence of Acute Myocardial Infarction (AMI). Some studies have suggested that patients with CD have a worse atherosclerotic profile due to the underlying inflammatory state and restriction of whole grains in their diet. We aimed to evaluate temporal trends of incidence and mortality of CD + AMI hospitalizations in the largest nationally representative sample.

METHODS:
We reviewed Nationwide Inpatient Sample from 2005-2014 for adult AMI hospitalizations (includes ST elevation and Non ST elevation MI) as a principal diagnosis with CD as the secondary diagnosis by using validated ICD9-CM codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes.

RESULTS:
We identified a total of 61,80,485 AMI hospitalizations from 2005-2014 of which 3169 had a diagnosis for CD. The proportion of patients with CD in AMI hospitalizations increased from 0.015% in 2005 to % 0.076% in 2014 (Figure 1). CD + AMI hospitalizations were significant (P < 0.02) for being older (70.3 vs. 67.4 years), more female (51.9% vs. 39.5%); higher proportion of whites (93.8% vs. 76.6%; P < 0.01) and more prevalent in the Northeast (28.7% vs 19.5%) and West (21.0% vs 17.5%) United States. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, CD + AMI hospitalizations had lower odds-ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23-0.67; P < 0.01). Length of stay in the CD + AMI patients was shorter (4.53 vs 4.84 days, P < 0.01) but the mean hospitalization charges was higher ($64058 vs $60223, P < 0.01), as compared to non-CD AMI patients.

CONCLUSION:
The results of our study provide valuable epidemiological data about the occurrence of AMI in CD patients. We found that the number of AMIs in the CD patients has risen more than five-fold from 2005-2014. However, the odds of in-hospital mortality in these patients is lower than the patients without CD for unknown reasons. The results of our study add to the current literature that though the CD-related systemic inflammation is associated with an increasing number of AMI hospitalization but these patients have comparably favorable outcomes than controls.
1199 Post-Operative Ileus in the Post-Kidney Transplant Setting
Authors: Werlang Monia Elisa , Kesler Alex M. , Kroner Paul T. 
Published: October 2019

INTRODUCTION:
Ileus is a known early complication following kidney transplant (KTx). There is limited data largely from case reports documenting the occurrence of ileus in KTx patients. Potential risk factors include post-operative setting, steroid withdrawal, or even peritoneal sclerosis in patients with a history of peritoneal dialysis (PD). The aim of this study is to assess inpatient prevalence and outcomes of ileus in the same admission as the KTx occurred.

METHODS:
Case-control study using the NIS 2012-2016. The ICD9-10CM procedural codes for KTx were used to identify all patients that underwent KTx during the same admission. None were excluded. Patients with associated ileus were identified using ICD9-10CM diagnostic codes. The primary outcome was determining the odds of ileus in post-KTx patients. Secondary outcomes were inpatient mortality, postoperative complications, resource utilization, length of hospital stay (LOS), total hospitalization charges and costs. Propensity score matching was used to create a matching population for gender, age and Charlson Comorbidity Index. Multivariate analysis were used to adjust for income in patients’ zip code, hospital region, location, size and teaching status.

RESULTS:
A total of 89,065 KTx patients were identified, of which 16,880 were propensity score matched for the selected covariates. The mean patient age was 50 years, and 40% were female. On multivariate analysis, the odds of ileus in the KTx cohort was 3.90 (P < 0.01) compared to patients who did not undergo KTx surgery. When patients that underwent KTx and developed ileus during the admission, they had greater adjusted odds of shock, TPN, AKI, multi-organ failure, post-op infection, Deep Vein Thrombosis, Pulmonary Embolism, and bleeding compared to patients with no KTx. In addition, those who developed ileus had greater hospitals costs, charges, and length of stay (LOS) (Table 1).

CONCLUSION:
Patients undergoing kidney transplant are more likely to develop ileus than patients who did not have kidney transplant surgery, confirming known reports documenting ileus in the early post-operative period. This cohort of patients who developed ileus following transplant have greater odds of post-operative complications, as well as increased morbidity, resource utilization and economic burden. Future studies should focus on elucidating the etiology of ileus following kidney transplant, as well as associated factors, and creating strategies to address it.
1200 Rifabutin (RHB-105) Based Triple Therapy for Helicobacter pylori (HP) Infection Eradication: Results of Pivotal Phase 3 Multi-Center Study (ERADICATE Hp2)
Authors: Graham David Y. , Canaan Yamil , Maher James , Weiner Gregory , Kalfus Ira N. 
Published: October 2019

INTRODUCTION:

H. pylori causes considerable morbidity and mortality worldwide, and antimicrobial resistance has led to unacceptably low eradication rates for previously effective therapies. The WHO has categorized H. pylori as a pathogen for “High Priority” therapeutic development. A prior clinical study (NCT01980095) of RHB-105 showed an eradication rate of 89.4% in the mITT (received at least 1 dose of therapy and post treatment test of cure) population.

METHODS:
Phase 3, double-blind, active comparator study (NCT03198507) assessed HP eradication with 4 capsules RHB-105 (an ‘all-in-one’ fixed dose oral capsule providing rifabutin 50 mg, amoxicillin 1000 mg, omeprazole 40 mg) vs high dose PPI-amoxicillin dual therapy (amoxicillin 1000 mg, omeprazole 40 mg) Q8H for 14 days.Dyspeptic, treatment naïve subjects with confirmed HP infection, 13C UBT (urea breath test) and endoscopy (CLO test, pathology, or culture), had 13C UBT primary end point assessed at least 4 weeks post-therapy. Subjects who failed HP eradication were assessed for development of resistance and offered physician-directed standard of care.

RESULTS:
In 455 subjects randomized 1:1, the ITT eradication rate of RHB-105 (83.8%) was superior to that of active comparator (57.7%), P < 0.0001. A pre-specified PK population assessing efficacy in subjects with positive drug levels at day 13 similarly demonstrated superiority of RHB-105 over active comparator 90.3% vs. 64.7%, P < 0.0001. No rifabutin resistance was noted pre or post treatment. RHB-105 efficacy was unaffected by clarithromycin or metronidazole resistance. Drug compliance was similar in both groups (>95%). Comparable AEs were noted between arms with no drug related SAEs reported. AEs seen with RHB-105 (>1% over comparator) were diarrhea (10.1% vs 7.9%) and rash (1.3% vs 0.0%). Physician directed standard of care (primarily clarithromycin or metronidazole based) eradication rate was 53% in patients who failed double blinded therapy.

CONCLUSION/DISCUSSION:
RHB-105, an all-in-one rifabutin triple therapy, was safe, effective, well-tolerated in H. pylori eradication, and not affected by clarithromycin or metronidazole resistance. The efficacy for RHB-105 was substantially greater due to rifabutin and the difference was statistically significant and clinically meaningful. RHB-105 may be a new best in class, first line empiric treatment for H. pylori infection, with the potential to serve an unmet need in an environment of increasing antibiotic resistance.
1212 H. pylori Breath Testing in an Academic Medical Center: Utilization and Treatment Outcomes
Authors: Monk Ian , Benjaram Sindhuri , Sahni Neha , Naylor Paul , May Elizabeth , Ehrinpreis Murray N. 
Published: October 2019

INTRODUCTION:

Helicobacter pylori is a major cause of stomach and duodenal ulcers According to the 2017 American College of Gastroenterology (ACG) Clinical Guidelines, only patients with active or past Peptic Ulcer Disease (PUD), low-grade MALT lymphoma, or history of endoscopically resected early gastric cancer should be tested for H. pyloriinfection. The breath test should be performed at least 4 weeks after stopping antibiotics and at least 2 weeks after stopping PPIs. The objective of this study was to determine whether the guidelines for the use of the breath test in an internal medicine physician practice were being followed.

METHODS:
We evaluated all 2016 patients in an academic Internal Medicine practice who had a BreathTek® Urea Breath Test for H. pylori in 2016. Patient files were reviewed through 2018 with respect to treatment and outcomes.

RESULTS:
An H. pylori breath test was performed in 257 patients (191 African-American (AA); 74%) and 66 non-AA). It was most likely used for diagnostic purposes (217/257 = 84%) and more likely to be ordered by a non-gastroenterologist (non-GI) (94% vs 69%; P < 0.001). Only 2 tests were for PUD; the majority were for Acid Reflux/Dyspepsia/GERD (48%), Abdominal Discomfort (33%), or Nausea/Vomiting/Recurrence of symptoms (12%). Of the 68 patients on a PPI, the gastroenterologists (GI) were more likely to comply with the guidelines of waiting to perform the test 2 weeks later as compared to the non-GI (48% vs 23%; P < 0.05). Of the 84 patients who were positive for H. pylori and were treated, 55 were cured with treatment, 22 were lost to follow up, and 7 were not cured with treatment (89% cure per protocol). The primary treatment was triple therapy (n = 77) with Clarithromycin/Amoxicillin (Metronidazole)/PPI. Seven patients were treated with quadruple therapy (triple plus bismuth). The percent of cured patients was similar between AA (87%) and non-AA (95%). Retreatment was successful in the 3 patients who received it.

CONCLUSION:
The majority of breath tests were for gastric/esophageal discomfort and did not meet the recommended criteria for the test. Significant numbers of providers in this study did not wait the recommended 2 weeks following PPI usage when ordering a breath test for H. pylori. Patients responded well to treatment with antibiotic and PPI therapy regardless of race. Thus, these studies suggest that educational interventions might be useful to increase compliance with the guidelines.
1214 Quadruple Therapy Is Superior to Triple Therapy in the Treatment of Clarithromycin Exposed Helicobacter pylori
Authors: Ramai Daryl , Aamar Ali , Goldstein Robyn , Solow Marissa , Madedor Ogenetaga , Tsipotis Evangelos , Reddy Madhavi 
Published: October 2019

INTRODUCTION:
Resistance of Helicobacter Pylori to antibiotics has reached alarming levels around the world, which has a great effect on efficacy of treatment. Little is known about its resistance pattern and optimal treatment within Brooklyn, New York. The objective of this study was to investigate whether triple or quadruple therapy is more effective in the treatment of H. Pylori, and whether prior clarithromycin exposure affects primary clinical outcomes.

METHODS:
A total of 598 patients were identified by retrospective chart review from January 2015 to January 2018 that satisfied our inclusion criteria; 272 of those patients were selected based on selection criteria. Patients were excluded from the study if they were less than 18 years of age, or were treated for recurrent H. Pylori infection. Descriptive statistics was used to compare continuous and categorical variables.

RESULTS:
Of the 272 patients identified, the median age was 50 ± 16 years. The majority (36%) of patients were Asian. Approximately 20.5% of patients were active smokers or had a history of smoking. 84% (n = 229) patients did not have prior clarithromycin exposure, while only 16% (n = 43) were exposed. 65% (n = 176) patients used triple therapy, while 35% (n = 96) used quadruple therapy for H. Pylori treatment. 79% (n = 214) patients had no recurrence, while 21% (n = 58) patients experienced treatment failure. Overall, triple therapy was associated with higher rates of treatment failure when compared to quadruple therapy (22% triple therapy vs 20% quadruple therapy). When prior clarithromycin exposure taken into account, treatment failure increased to about 28%. This effect was higher in patients treated with triple therapy than quadruple (28% vs 27%, respectively). However, due to small sample sizes, significance was not observed.

CONCLUSION:
Quadruple therapy appears to be more effective at treating H. Pylori overall and in the setting of prior clarithromycin exposure. While these findings may guide clinical decision making, larger head to head studies are needed to validate these findings.
1218 The Relationship Between Gastric Food Residue and the Rate of Gastric Emptying
Authors: Bi Danse , Camilleri Michael , Prichard David O. , League John 
Published: October 2019

INTRODUCTION:
Gastric food residue (GFR) identified during gastrointestinal (GI) endoscopy is assumed to reflect delayed gastric emptying (GE [i.e., gastroparesis]). The aims of this study aims were to determine i) the prevalence of GFR during upper GI endoscopy (EGD) and, ii) the relationship between GFR and GE, structural abnormalities and diseases associated with gastroparesis.

METHODS:
Electronic health records were used to identify patients who had undergone both EGD and gastric emptying scintigraphy (GES) between October 2013 and September 2018. The test meal included radiolabeled scrambled eggs (320 kcal, 30% fat). Data were collected via the Advanced Cohort Explorer (ACE) application available at Mayo Clinic. The presence of GFR, structural or physiological factors associated with delayed GE was determined. Descriptive and comparative analyses were performed.

RESULTS:
In the 5 year period, the prevalence of GFR during upper GI endoscopy was 3.2% per patient and 2.5% per procedure (37% or patients had undergone >1 procedure). Of 3169 patients who underwent both EGD and GES available for review, 230 (7.3%) had GFR. Type 1 diabetes mellitus (DM, 22% vs 7%, P < 0.001) and type 2 DM (13% vs 7%, P < 0.05), but not systemic sclerosis (P = 0.1), were associated with GFR. Relative to patients with no GFR, patients with GFR had reduced GE at 2 and 4 hours (35% vs 46%, P < 0.001 and 67% vs 81%, P < 0.001 respectively) and were more likely to have structural abnormalities in the stomach or small bowel (e.g., surgery/stenosis, 14% GFR vs. 5%, P < 0.001) or have predisposing medical conditions (e.g. DM, systemic sclerosis, 20% GFR vs. 8%, P < 0.001). GE rates for patients with these conditions are shown in Table 1. Among those with no structural abnormalities or medical conditions associated with delayed GE, GE at 2 hours and 4 hours was significantly reduced in patient with GFR compared to those without GFR (37% vs 46%, and 69% vs 81%, both P < 0.001 respectively). The proportion of patients with delayed GE at 2 and 4 hours was greater in patients with GFR than without (42% vs 22% and 35% vs. 54%, both P < 0.001).

CONCLUSION:
GFR is encountered in 3% of all EGDs. In a cohort undergoing endoscopy and GES, ∼20% of patients with type 1 DM demonstrated GFR. The presence of GFR during endoscopy is associated with retarded GE. However, almost 50% of patients with GFR will have normal GE; therefore the presence of GFR at EGD does not accurately reflect gastric retention of digestible solids.
1219 Usefulness of Blood Flow Rate of Subepithelial Microvessels in Gastric Mucosa Using Magnifying Endoscopy in the Stomach
Authors: Ueyama Hiroya , Matsumoto Kenshi , Murakami Takashi , Yao Takashi , Nagahara Akihito 
Published: October 2019

INTRODUCTION:
Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G) is used for qualitative diagnosis based on irregular microvascular architecture and micro-surface structure, but it is a static diagnostic algorithm using still images. On the other hand, magnifying endoscopy (ME) visualizes subepithelial microvascular red blood cell (RBC) flow in real time, but there has been no study focusing on the usefulness of microvascular blood flow in the diagnosis of early gastric cancer. We therefore evaluated microvascular blood flow using ME in the diagnosis of early gastric cancer.

METHODS:
Patients with early gastric cancer (EGC, n = 5) or patchy redness (PR, n = 5) underwent ME with blue light imaging (M-BLI, EG-L600ZW7, Fujifilm) at our hospital. A scale in 1-mm increments was visualized at 100× (3 frames) to 135× (4 frames) magnifications prior to examination, and gastric subepithelial microvascular blood flow in lesions and background mucosa videoed using M-BLI. Images were split into 30 frames/sec, and the mean blood flow rate was calculated by the mean movement distance of one tagging RBC. The blood flow rates in EGC, PR and background mucosa were compared between them. The ratio of blood flow rate (inside lesion/background mucosa) was compared between EGC and PR.

RESULTS:
EGC characteristics were as follows: mean age, 74.6 ± 7.8 years; male/female ratio, 2:3; previous history (hypertension: 1); Helicobacter pylori infection (current: 3, eradicated: 2); location (M: 4, L: 1); macroscopic type (IIa: 3, IIc: 2); histology (well- [n = 4] and moderately differentiated [n = 1] adenocarcinoma); and invasion depth (all M). PR characteristics were as follows: mean age, 68.2 ± 10 years; male/female ratio, 4:1; previous history (hypertension: 3); H. pylori infection (eradicated: 5); location (M: 2, L: 4). The mean blood flow rate was significantly slower in EGC (1881.4 μm/s; range 1406–2344) vs. PR (4162.6 μm/s; 3281–4688) or background mucosa (4265.7 μm/s; 3750–5156) (P < 0.01). The ratio of blood flow rate (inside lesion/background mucosa) was significantly lower in EGC (0.46; 0.38–0.50) than in PR (0.94; 0.88–1.10; P < 0.01).

CONCLUSION:
Early gastric cancer was associated with a significantly slower gastric subepithelial microvascular flow rate compared to patchy redness and background mucosa. Gastric subepithelial microvascular flow using magnifying endoscopy in real time may enable physiological diagnosis of early gastric cancer.