bluuebunny/crossref_metadata_2025_split huggingface dataset:
507 The Functional Gastrointestinal Disorders Population-Based Prevalence and Relationship to Dietary Factors in Latino Populations in the Resource Limited Setting of Rural Central America
Authors: Norwood Dalton A. , Dominguez Lucia , Paredes Andrea A. , Montalvan Eleazar E. , Dougherty Michael K. , Dominguez Ricardo L. , Morgan Douglas 
Published: October 2019

INTRODUCTION:
The prevalence of the Functional Gastrointestinal Disorders (FGIDs) in Latino populations in resource-limited settings such as rural Central America is largely uninvestigated. The relationship of the FGIDs and dietary habits is unknown in this environment.

METHODS:
With population-based sampling, we administered the Rome IV questionnaire and a validated dietary questionnaire to a cross-section of the general adult population of rural Western Honduras. We estimated the prevalence of specific FGIDs and used logistic regression with Bonferroni adjustment to evaluate the relationship of each FGID diagnosis with particular dietary habits.

RESULTS:
We interviewed 815 subjects, of whom 151 fulfilled Rome IV criteria for an FGID (18.5% 95% CI 15.9-21.4%). The mean age was 40.6 years, of whom 58.7% were female. Gastroduodenal FGIDs were noted in 10.1%, with epigastric pain syndrome (EPS) more common than post-prandial distress syndrome (PDS), 8.5% versus 1.6%. Among the bowel disorders, functional abdominal bloating (FAB) was most prevalent (6.2%; 95% CI, 4.6-8.1), followed by irritable bowel syndrome (IBS, 3.5%, 95% CI 2.5-5.1; IBS-U 1.6%, IBS-C 1.2%, IBS-D 0.5%), functional diarrhea (FD, 3.4%) and functional constipation (FC, 1.1%). In multivariable logistic regression analysis, the diagnosis of any FGID was inversely associated with consumption of beans (OR 0.41, 95% CI 0.27-0.63, adjusted P = 0.009), driven by negative associations with IBS and FD. Overall vegetable consumption was associated with a lower prevalence of FD (OR 0.12, 95% CI 0.043-0.35, adjusted P = 0.018) and any diarrheal disorder (OR 0.11, 95% CI 0.42-0.31, adjusted P = 0.004). There was a trend toward association with all FGIDs for subjects who consumed greater than the mean daily intake of 4.6 corn tortillas per day, OR 1.74 (95% CI 1.22-2.50, adjusted P-value NS).

CONCLUSION:
FGIDs are prevalent in the resource-limited setting of rural Central America, with an altered distribution of specific FGIDs (common FAB, versus less common PDS, IBS, FC) compared with other global populations and urban Latin America populations. In this setting, with locally grown foods and limited diet variability, local dietary influences such as vegetable, bean, and tortilla intake may be important factors in specific FGIDs.
508 Relationship of Patient Factors to High Resolution Anorectal Manometry Findings in Chronic Constipation
Authors: Tanner Samuel , Vachhani Herit , Jehangir Asad , Malik Zubair , Parkman Henry 
Published: October 2019

INTRODUCTION:
High resolution anorectal manometry (HRARM) is used to evaluate patients with chronic constipation by assessing anorectal sensory and motor dysfunction. Despite the growth of HRARM, there is still little known about the patient factors that are associated with manometric diagnoses of dyssynergic defecation (DD) and its subtypes Type I – IV. The aims of this study are: 1) to characterize the abnormalities on HRARM in patients with chronic constipation seen at our center; and 2) to correlate patient factors (demographics and symptoms) to abnormalities identified on HRARM.

METHODS:
HRARM of consecutive patients being evaluated for chronic constipation between July 2018 and February 2019 were included. Patients completed a questionnaire describing symptoms related to their bowel movements. HRARM was performed using ManoScanTMand analyzed using ManoViewTM software (Medtronic, Shoreview, MN). Results are expressed as mean±SD or percentages. Metrics were compared using ANOVA or chi square tests, as appropriate.

RESULTS:
Of 170 patients included in the study, 63 had Type 1 DD, 24 had Type 2 DD, 16 had Type 3 DD, 17 had Type 4 DD, and 50 patients had a non-dyssynergic defecation pattern (Figure 1). Demographics: Patients with Type 3 DD were younger (P = 0.02) and had a higher BMI (P = 0.07), while patients with Type 1 DD were older (P = 0.02) (Table 1). Additionally, patients with Type 1 or Type 2 DD were more likely to be men (P = 0.02); a majority (29 of 36, 81%) of men had either Type 1 or Type 2 DD. Symptoms: Patients with Type 1 DD less frequently had 2 or less bowel movements per week (P = 0.02). Several other symptoms trended towards a difference such as improvement of abdominal discomfort with bowel movement (P = 0.15) and blockage sensation (P = 0.13). Manometric profile: Patients with Type 2 and Type 4 DD had lower intrarectal pressure compared to Type 1 DD, Type 3 DD, and non-DD patients (P < 0.001).

CONCLUSION:
Type 1 dyssynergic defecation is the most common form of anorectal dysfunction seen in patients with chronic constipation. Age and sex distribution differed between the dyssynergic defecation subtypes and normal HRARM populations. However, the symptom profile between these groups is largely the same. Thus, HRARM remains an important tool in differentiating dyssynergic defecation from other causes of chronic constipation.
512 Prevalence of Naturopath and Herbalist Consultation in Patients With Gastrointestinal Symptoms
Authors: Bushyhead Daniel W. , Kalra Gorav , Strate Lisa L. 
Published: October 2019

INTRODUCTION:
Complementary and alternative medicine are commonly used by patients with gastrointestinal symptoms often in conjunction with a naturopath or herbalist provider. It is unknown how often patients seen in gastroenterology clinic also consult with a naturopath or herbalist provider, what diagnoses patients are subsequently given, and how this affects management of their gastrointestinal symptoms. The purpose of this study was to determine the prevalence of naturopath and herbalist co-management, and details of this alternative medical care, in patients seen in gastroenterology clinic.

METHODS:
An optional survey was administered to patients attending gastroenterology clinic at a county hospital. The study period was January to May of 2019. The survey queried subjects on consultation with a naturopath or herbalist, which symptoms prompted this consultation, and what diagnoses and management recommendations were subsequently received. Patients unable to consent or those who did not demonstrate proficiency with written English language 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. Twelve (20%) subjects reported consultation with a naturopath or herbalist in the past year for gastrointestinal symptoms. The majority of these subjects were female (92%). The most common symptoms prompting referral were abdominal pain, nausea and constipation, but numerous other symptoms were also reported (see Figure 1). The most common diagnoses given to subjects were irritable bowel syndrome, food allergies, leaky gut and small intestinal bacterial overgrowth (25% for each diagnosis). Seven (58%) subjects reported receipt of herbal medications following consultation.

CONCLUSION:
One-fifth of subjects referred to gastroenterology clinic had also consulted with a naturopath or herbalist. A wide variety of gastrointestinal symptoms prompted these consultations, and more than half of subjects received treatment with herbal medications.
523 Is Sore Throat an Under-Reported and Under-Estimated Quality Indicator of Endoscopic Procedures? Results From a Large Prospective Cohort
Authors: Kim Katherine , Gaddam Srinivas , Verula John , Lai Ellis , Dollentas Ashley , Hill Bee , Francis Sarah , Chess Shara , Lo Simon 
Published: October 2019

INTRODUCTION:
Patients can develop of sore throat after upper endoscopy procedures (UGI) (oral endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), double balloon enteroscopy (DBE) and gastroscopy (EGD)) but there is limited data on incidence and its risk factors. Aim: From a large prospective cohort of patients undergoing endoscopy 1) to evaluate for incidence of sore throat and 2) to identify independent risk factors for sore throat.

METHODS:
Data was collected prospectively on consecutive outpatient endoscopy procedures performed at Cedars-Sinai Medical Center from Oct 2018 - Feb 2019. Patients were given pre- and immediate post-procedure surveys evaluating for sore throat (pain scale from 1-10). Intraprocedural information was collected by a procedure nurse. Fisher's exact test and Mann-Whitney U test were utilized for univariate analysis; significant variables (P < 0.05) were entered into a multivariate logistic regression model.

RESULTS:
Data was collected on 715 patients. Patients undergoing lower GI procedures alone (n = 226, 31.6%) were excluded; the rate of sore throat in these patients was lower than patients undergoing UGI procedures (1.3% vs. 19.2%, P < 0.01). Patients with pre-procedure sore throat were excluded (17, 2.4%). In total, 472 patients (mean age = 61 years, females = 53%) met inclusion criteria and were included in the analysis (Table 1). 85 patients (18%) experienced post-procedure sore throat. 9.4% and 29.4% of them reported throat soreness as severe (level ≥ 8/10) or moderate (level 5-7/10) respectively. On univariate analysis, female gender (OR 1.8), oral EUS (OR 1.8), oral DBE (OR 5.3), fellow involvement (OR 2.3), throat suctioning (OR 2.1), general anesthesia (OR 3.9) and use of an oral airway (OR 4.1) and prolonged procedure (>30 minutes, OR 1.9) were risk factors for sore throat (all P < 0.05) (Table 2). On the multivariate analysis (all P < 0.05), the independent risk-factors to post-procedure sore throat were oral DBE (OR 5.2), oral airway (OR 4.8), general anesthesia (OR 2.7), fellow involvement (OR 2.5), oral EUS (OR 2.4), and female gender (OR 2.0) (Table 3).

CONCLUSION:
Throat soreness after endoscopic procedures is common (18%), with 39% rated by patients as either moderate or severe. Two endoscopy types, 2 anesthesia maneuvers, female gender and fellow involvement were all risk factors. Future studies are warranted to further characterize this under-reported and under-estimated quality indicator.
525 Impact of Water Exchange, Cap and Endocuff on Adenoma Detection Rate: An Indirect Comparison With Air Insufflation as the Common Comparator
Authors: Shao Paul , Bui Aileen , Jia Hui , Leung Felix 
Published: October 2019

INTRODUCTION:
Adenoma detection rate (ADR) is an important quality indicator for colonoscopy. Interval cancer (IC) is associated with low ADR. Every 1% increase in ADR is associated with a 3% and 5% reduction of the risk of IC and fatal IC, respectively. Water exchange (WE) colonoscopy is considered the best insertion method for improving ADR when compared with water immersion and air insufflation (AI). Attachment devices such as cap and Endocuff also improve ADR. We assessed the effectiveness of improving ADR between WE, cap and Endocuff colonoscopy by indirect comparison with AI as the common comparator.

METHODS:
A literature search was done to identify all relevant RCTs comparing WE, cap and Endocuff with AI colonoscopy published since 2000 as full text in English and including ADR among the outcomes. EMBASE, Medline, SCOPUS, and Cochrane Library were searched systematically for all RCTs that included the following terms in their titles, abstracts, or keyword lists: colonoscopy, and water exchange, cap, or Endocuff. Two investigators screened the articles manually and separately. The results were compared; and a discussion was held with a third investigator to resolve any discrepancies.

RESULTS:
A total of 1,453 articles resulted from initial keywords search. 37 articles were identified based on titles and abstracts alone. After thorough review of full texts, and discussion between the investigators, 21 RCTs were included in the analysis. A total of 16,572 subjects underwent AI, WE, cap (CC) or Endocuff (EC) colonoscopy. ADR of WE, CC, and EC were compared to AI. Table 1 shows that there is a significant difference in ADR between AI and WE (24.2%, 30.8%, P = 0.0001). ADR in AI and EC were significantly different (41.7%, 48.0%, P = 0.0001). No significant difference in ADR exists between AI and CC, (36.8%, 36.6%, P = 0.92). ADR as a percentage change of AI in WE, EC and CC were 27.4%, 15.1% and -0.42%, respectively. We found that WE and EC significantly improved ADR while CC does not significantly change ADR. Compared to EC and CC, WE has a higher percentage increase in ADR. This greater increase in ADR by WE may be related to the low ADR in the AI group.

CONCLUSION:
The impact of the study method in enhancing overall ADR is more prominent with the WE method, especially in patient cohort with lower ADR.
527 TissueCypher™ Barrett's Esophagus Assay for Risk Stratification of Barrett's Esophagus Patients With “Low Grade Crypt Dysplasia” on WATS3D® Brush
Authors: Amer Kamal , Amer Rami , Tofani Christina , Infantolino Anthony 
Published: October 2019

INTRODUCTION:
Barrett's Esophagus (BE) and progression into esophageal adenocarcinoma (EA) is a major cause of cancer-related morbidity and mortality in the United States. Surveillance of patients with non-dysplastic BE has encountered a subset of specimens termed low grade crypt dysplasia (BE-LGCD) through use of Wide Area Trans-Epithelial Sampling (WATS) brush. The natural history of BE-LGCD is not currently known. To better characterize the risk of progression from LGCD to EA, we utilized a TissueCypher BE analysis (a validated BE risk progression tool) to produce a comprehensive risk prediction for development of high-grade dysplasia (HGD) or EA in patients with BE.

METHODS:
We sampled 17 patients with a history of BE made via Esophagogastroduodenoscopy (EGD) biopsy with WATS brush samples displaying “LGCD” between July 01,2017 to July 01, 2018. Pathology slides collected via standard of care screening EGDs were sent to an affiliate laboratory for the TissueCypher BE analysis. TissueCypher categorized the risk of progression as either low (Risk score 0-< 5.5), Intermediate (5.5-< 6.4), and High (Risk score > 6.4) based on protein-based biomarkers. TissueCypher analysis generated an in-depth score analysis for risk of progression to EA. We used measures of central tendency to identify the risk of progression and studied identified risks of BE (BMI, smoking, age, gender, family history, GERD). We also used Regression Analysis and Kendall Tests to determine significance of these variables as well as their dependence on elevated risk.

RESULTS:
Of the 17 samples included, 5.8% represented female patients. The Mean age was 64.2 years. Mean risk of progression was overall low (Risk Score of 4.95, SD of 1.30). 100% of samples collected were from Caucasian patients. Increased segment length of BE, increased BMI, history of GERD or tobacco use, and family history of BE or EA did not correlate with increased risk of progression [Table 1]. BMI, smoking history, BE segment length, GERD history, as well as family history were not statistically dependent variables [Table 2].

CONCLUSION:
Our data implies that BE-LGCD is not associated with increased risk of progression to EA. It mostly affects Caucasian males. Smoking, high BMI, segment length, history of GERD, and family history were not associated with increased risk of progression towards EA. Limitations to this study include a small sample size vs non-representative sample population. Future studies could identify progression of these patients.
529 The Effect of Sedation Modality on Outcomes in Emergent Endoscopic Intervention
Authors: Cha Ming Han , Razik Roshan , Khalid Saher , Sandooja Rashi , Khanzada Huda J. 
Published: October 2019

INTRODUCTION:
Foreign body ingestion and food bolus impaction (FBI) are common indications for emergent endoscopic intervention. The choice of sedation used is often dictated by physician experience. There is paucity of data examining the efficacy and safety of general anesthesia versus conscious sedation in this population. This study aims to investigate the outcomes and complication rates of emergent endoscopic extrication of foreign body/food bolus performed under conscious sedation (CS) compared to general anesthesia (GA).

METHODS:
Using ICD-9 and ICD-10 codes, we conducted a single-center retrospective chart review of all patients presenting with acute FBI between 2013 and 2018. Data on demographics, comorbidities, endoscopic details and sedation practices were collected. Complications recognized during the procedure were considered early whereas patients presenting with a procedure-related complication within two weeks of the index event were considered delayed complications. Chi-square analysis was used to compare groups based on sedation type. Results were considered statistically significant at P < 0.05.

RESULTS:
Among the 223 encounters analyzed, 133 encounters (59.6%) were performed under general anesthesia or monitored anesthesia care, with the rest (40.4%) under conscious sedation. The median age of the subjects was 52 years old, with 70.5% being male. A total of 27 subjects (12.1%) had severe comorbidities and 21.9% had psychiatric disorders. The majority of the encounters (73.7%) were food bolus impaction with the rest being foreign body ingestion (26.3%). The most commonly observed early complications were mucosal laceration (8.5%) and bleeding (4.0%). The most common delayed complication was abdominal pain (1.3%). Five patients could not adequately be sedated with CS and had to be converted to GA. Chi-square analysis revealed no statistically significant difference in the complication rate between patients sedated under GA (18.1%) vs CS (14.4%), P = 0.48.

CONCLUSION:
For patients who present with foreign body ingestion or food bolus impaction and undergo emergent endoscopic treatment, there is no significant difference in complication rates between general anesthesia and conscious sedation. This finding may potentially lead to lower procedure-related costs and length of hospital stay.
534 Patient Experience With NER1006 as a Bowel Preparation for Colonoscopy: A Prospective, Multicenter U.S. Survey
Authors: Cash Brooks D. , Moncrief Mary Beth 
Published: October 2019

INTRODUCTION:
NER1006 is a 1L PEG bowel prep approved in the US in 2018 for colonoscopy in adults. An online survey assessed real-world ease of use and treatment satisfaction in US adults who received NER1006 as a bowel prep.

METHODS:
Patients were recruited from community GI practices throughout the US and provided with a kit number to enroll online. Within 2 weeks post-colonoscopy, an online survey was to be completed by each patient. Survey questions included evaluation of patient history of colonoscopy and prior bowel prep(s) prescribed, experience during administration of NER1006, and patient satisfaction with the bowel prep process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 “very difficult” to 9 “very easy”); importance of volume requirement and importance of clear liquid choice (range, 1 “not important at all” to 9 “very important”); and patient satisfaction (range, 1 “not satisfied at all” to 9 “very satisfied”). Data were deidentified and summarized using descriptive statistics.

RESULTS:
1630 patients were enrolled (707 health care providers); 1606 patients had a colonoscopy and 1598 completed the survey from Sept 2018 through Feb 2019. Of the 1606 patients, 62.5% were female and 34.9% were male (2.6% not reported); mean age was 54.4 y (range, 18-89 y). While data were unknown for 8 of the 1606 patients, most (74.7%) did not report a family history of colon cancer, this was not the first colonoscopy for 62.6%, and 64.8% were undergoing colonoscopy for routine screening. A majority of the 1598 patients (76.1%) reported that NER1006 was very easy to prepare and take/administer (Table 1), and 89.9% of patients were very or moderately satisfied with NER1006 overall (Figure 1). Most (97.6%) patients consumed all/most of the prep. Also, 84.7% of 1005 patients with previous bowel prep use stated that their experience with NER1006 was much better/better (65.3%) or about the same (19.4%) compared with bowel preps they had previously used (Table 1).

CONCLUSION:
In this first real-world, multicenter survey, patient experience with NER1006 as a bowel prep for colonoscopy was favorable and adherence was high. The majority of patients were very/moderately satisfied with the overall experience and found it much better/better than other bowel preps used. Funding: Salix Pharmaceuticals. BD Cash participated in study, enrolled 3 patients, and reviewed content for scientific accuracy. Patients were compensated for their time for completing survey.
538 The Association of Cecal Withdrawal Time With Adenoma Detection Rate (ADR) and Sessile Serrated Adenoma/Polyp Detection Rate (SDR) in Average Risk Screening Colonoscopies
Authors: Hassan Seemeen , Ahmed Zaheer , Chhabra Rajiv , Ghanimeh Mouhanna Abu , Sadeddin Esmat , Yousef Osama 
Published: October 2019

INTRODUCTION:
The ASGE, ACG & AGA in the Multi Society Task Force of Colorectal Cancer recommended quality benchmarks in 2017 to enhance the quality of screening colonoscopies. Cecal withdrawal time of ≥6 minutes (m) was recommended to achieve an adenoma detection rate (ADR) of ≥25%. The primary objective was to assess the relationship between withdrawal time & ADR in the USA using a large national database. The secondary objective was to assess the polyp detection rate (PDR) & sessile serrated adenoma/polyp detection rate (SDR).

METHODS:
The Clinical Outcomes Research Initiative (CORI) V4 database was queried for screening colonoscopies from 2009 to 2014. PDR, ADR & SDR were measured for each minute of withdrawal time. The detection rates were defined as the number of procedures bearing at least one lesion of interest (polyp for PDR, or adenoma for ADR or sessile serrated adenoma/polyp for SDR) divided by the total number of colonoscopies meeting the inclusion criteria. Inclusion criteria was age ≥18 years, average risk screening colonoscopies, performance years 2009 to 2014, successful cecal intubation, documentation of withdrawal time & post polypectomy pathology submission to CORI at a rate of ≥90%. SAS 9.4 was used.

RESULTS:
23242 colonoscopies met the inclusion criteria. PDR increased with longer cecal withdrawal times in a linear fashion (Figure 1). The rise in PDR was very similar in pattern to the rise in ADR. The ratio of PDR to ADR decreased as the withdrawal time increased (2.7 at 6 m, 1.8 at 10 m, 1.5 at 13 m & 1.2 at 22 m). ADR increased with longer withdrawal times in a linear fashion (Figure 2). ADR was 8.1% at 6 m, 25.4% at 10 m & 42.1% at 13 m. The ADR continued to rise in association with longer withdrawal times reliably reaching 75.5% at 26 m. ADR continued to rise beyond 26 m but it was less reliable due to the number of procedures being < 100 per withdrawal minute beyond 26 m. SDR increased with longer withdrawal times in an exponential fashion (Figure 3). It was 0.6% at 6 m, 1.3% at 10 m, 2.6% at 13 m & 9.0% at 22 m. It seemed to reach a plateau after 22 m & SDR was less reliable past that point due to <100 procedures per withdrawal minute.

CONCLUSION:
PDR & ADR are likely to be higher with longer withdrawal times in a linear fashion. SDR is likely to be higher with longer withdrawal times in an exponential fashion until 22 m after which it tends to plateau. The optimal withdrawal time for reaching the benchmark of ADR ≥25% may be as high as 10 m when assessed at a national level.