bluuebunny/crossref_metadata_2025_split huggingface dataset:
408 WATS Brushings Are More Sensitive for Detecting Intestinal Metaplasia in Barrett’s Esophagus Than Concurrent Forceps Biopsies: Results From a National Registry
Authors: Cotton Cary , Chaletsky David , Moloney Brian , Malik Zubair , Trindade Arvind , Gordon Stuart , Yachimski Patrick , Khan Abraham , Schnoll-Sussman Felice , Shafa Shervin , Smith Michael S. , Shaheen Nicholas J. 
Published: October 2019

INTRODUCTION:
Forceps biopsies (FB) are used to sample the esophageal mucosa for intestinal metaplasia (IM) to diagnose BE, confirm eradication of BE, and detect recurrence after treatment. FB are limited by their focal field of sampling. Wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis (WATS3D, CDx Diagnostics, Suffern, NY) samples a wider area of mucosa, but its sensitivity in routine clinical settings is incompletely understood. Our aim was to determine the sensitivity of WATS compared to FB for IM in patients undergoing surveillance of non-dysplastic BE (NDBE).

METHODS:
The WATS Registry is an ongoing multicenter U.S. study enrolling subjects undergoing WATS as part of usual care at 13 sites. Patients are aged 18 to 80 and are enrolled in one of three categories: screening endoscopy for gastroesophageal reflux symptoms without a history of BE, surveillance endoscopy for already-diagnosed BE without prior endoscopic eradication therapy, or surveillance endoscopy for BE following eradication therapy. We analyzed all endoscopy visits where subjects underwent both WATS and FB for surveillance of prevalent, treatment naïve NDBE with not less than 1 cm of columnar mucosa. Given that all these subjects previously had both endoscopic and histologic evidence of BE, FB or WATS not demonstrating IM was assumed to represent sampling error. We calculated the sensitivity of WATS and FB for IM, manifest by goblet cell metaplasia, with 95% asymptotic confidence limits.

RESULTS:
This analysis included 454 endoscopies of patients with a previous diagnosis of BE, presenting for surveillance and undergoing both FB and WATS. We observed a higher (p = 0.005) overall sensitivity of WATS (63.0% (95% CL 58.6 – 67.4%) than FB (53.7% (95% CL 49.2 – 58.3%)) of diagnosing IM (Figure). In addition to the patients with IM on FB, greater than 1/3 more subjects (36%, 87/244) had IM on WATS. The sensitivity of WATS for IM was similar across demographic groups (Table). Sensitivity of both FB and WATS increased with the length of BE being sampled.

CONCLUSION:
WATS has higher sensitivity for detecting IM compared to concurrent FB in patients with a previous history of BE. The addition of WATS to FB in these patients results in an overall additional 36% detection of IM. Given the included patients had previously demonstrated IM in visible segments of columnar epithelium in the esophagus, the incremental yield of WATS likely represents sampling error by FB.
409 Risk Factors of Readmission to Hospital for Eosinophilic Esophagitis in United States: A National Readmission Database Analysis
Authors: Eke Ransome , Leonov Andrey 
Published: October 2019

INTRODUCTION:
Eosinophilic esophagitis (EoE), once considered a rare entity, is becoming a commonly encountered gastroenterological condition. In addition to increased clinical recognition of EoE, rising EoE related hospitalization in the United States have been reported. Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database, we aimed to identify factors associated with readmissions in population with EoE.

METHODS:
We performed a retrospective cohort study using 2012-2014 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes, we identified patients with discharge diagnoses of EoE (530.13) and ascertained other related comorbidities (asthma (493.XX) and esophageal reflux (530.81)) during index admission. We evaluated patients with EoE related hospitalization, from January 2012 to November 2014, and analyzed readmissions over 90 days after discharge. Logistic regression analyses were used to examine the factors associated with risk of 90-day readmission.

RESULTS:
Among 6,877 hospitalizations of EoE patients, 407 (3%) were readmitted within 90 days of the index hospitalization resulting in average annual excess charge of roughly $4 million. The common reasons for readmission were foreign body in the esophagus (6%) and dysphagia (7%). Ninety-eight of readmitted EoE cases were ages 19 years or above, and common comorbidities associated with readmissions were GERD (25%) and asthma (26%). In multivariable analysis of patients with EoE, female compared to males (OR 1.94, 95%CI: 1.16–3.24) and having co-morbid asthma compared to no-asthma comorbidity (OR 1.39, 95%CI: 1.25–3.14) were associated with a significant increase in odds of readmission. There was no significant difference in risk of readmission by the type of insurance.

CONCLUSION:
In a national sample of inpatients with EoE, the risk of 90-day readmission was significantly associated with female and having asthma co-morbidity. These factors may represent targets for interventions to prevent frequent hospital readmission in this population.
410 Barrett’s Esophagus and Obstructive Sleep Apnea: Is There a Link?
Authors: Radadiya Dhruvil K. , Devani Kalpit H. , Charilaou Paris , Patel Pranav D. , Young Mark , Reddy Chakradhar 
Published: October 2019

INTRODUCTION:
Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma. While some studies suggest relationship between obstructive sleep apnea (OSA) and GERD. Studies linking BE to obstructive sleep apnea (OSA) remains limited. Here, we hypothesized that OSA is independently associated with presence of Barrett’s esophagus.

METHODS:
We used the Nationwide Inpatient Sample (NIS) database from the year 2016 for this study. We identified patient with obstructive sleep apnea and Barrett’s esophagus using ICD-10-CM codes. Patients less than 18 years old were excluded from the study. Clinical factors associated with Barrett’s esophagus (age >50, white race, GERD, male gender, hiatal hernia, obesity and smoking) were also extracted from the database. We performed multivariate logistic regression to control for confounding factors associated with BE. All statistical analyses were performed using SAS 9.4.

RESULTS:
Out of 6,028,636 patients, 6.4% patients had OSA in year 2016. Prevalence of Barrett’s esophagus in OSA was 0.75%. We divided patients in two groups based on diagnosis of OSA. The mean age of the OSA population was 63.2 year, 40.8% were male, and 72% were white. Proportion of patients with age more than 50 year was high in OSA group (84.7%). Smoking and hiatal hernia were equally distributed among two groups. OSA group had higher prevalence of GERD, obesity and BE as shown in Table 1. Age more than 50, male gender, and white race were associated with almost 2-fold increase likelihood of having BE as shown in table 2. Patients with hiatal hernia are 7 times more likely to have BE (OR: 7.4, P < 0.0001). For unclear reason, obesity was associated with marginally lower risk of BE (OR: 0.935, P < 0.0001). Patients with OSA had 30% more chance of having BE compared to patient without OSA (OR: 1.293, 95% CI: 1.270 – 1.317, P < 0.0001). AUC (Area Under Curve) for this model was 0.81.

CONCLUSION:
OSA is an independently associated with higher likelihood of Barrett’s esophagus even after adjusting for potential confounders. Further studies can be pursued to reinforce the finding so that OSA can be included as a factor for screening for BE.
414 The Association Between Cigarette Smoking and Gastroesophageal Reflux Disease in Japan: Analysis of Symptoms and Endoscopic Findings
Authors: Ihara Sozaburo , Sakitani Kosuke , Fujiwara Hiroaki 
Published: October 2019

INTRODUCTION:
Cigarette smoking is regarded as a weak or moderate risk factor of gastroesophageal reflux disease (GERD), and smoking cessation may reduce GERD symptoms. However, the evidence for these associations is limited. This study aimed to investigate the effects of cigarette smoking or smoking cessation on the development of GERD by using endoscopic findings and the Gastrointestinal Symptom Rating Scale (GSRS).

METHODS:
The subjects were 848 patients who received upper endoscopy and answered the GSRS questionnaire as health checkup at our hospital in Japan. The patients were divided into three groups; non-smoking, smoking-cessation, and current-smoking group (322, 371 and 155 patients, respectively). Endoscopic findings of GERD were graded by the Los Angeles classification, and grade B or more were defined as severe GERD. The GSRS questionnaire is an interview-based seven-graded rating scale including the questions on heart burn and acid regurgitation. The prevalence of patients with positive GSRS scores (i.e. 2 or more) was compared between three groups. Data were analyzed statistically using the Kruskal-Wallis, Mann-Whitney U, or chi-square test.

RESULTS:
The overall prevalence of endoscopic GERD and positive GSRS scores on heart burn and acid regurgitation was 19.2, 14.5, and 19.7%, respectively. The prevalence of patients with severe endoscopic GERD in smoking group was significantly higher than that in non-smoking group (OR: 4.64; 95% CI: 1.47-14.67; P = 0.007). In contrast, the prevalence of patients with positive GSRS scores on heart burn in smoking group was significantly lower than that in non-smoking group (OR: 0.46; 95% CI: 0.26-0.80; P = 0.006). As for smoking cessation, there was no significant difference in the prevalence of patients with severe endoscopic GERD between smoking-cessation and current-smoking group (OR: 0.37; 95% CI: 0.11-1.18; P = 0.149). Also, there was no significant difference in positive GSRS scores between smoking-cessation and current-smoking group (heart burn; P = 0.077, and acid regurgitation; P = 0.871).

CONCLUSION:
Cigarette smoking increases risk of developing endoscopic GERD severity, while not developing GERD symptoms. Upper endoscopy may be useful for Japanese using cigarette even if they have no GERD symptoms. Although smoking cessation is not associated with improvement of endoscopic GERD severity in this study, prospective studies should be performed to evaluate the effects of smoking cessation on GERD.
415 External Validation of the Progression in Barrett’s Score in a Prospective Multicenter BE Cohort
Authors: Codipilly Don C. , Kennedy Kevin , Plevak Matthew , Dierkhising Ross , Lansing Ramona , Johnson Michele , Parasa Sravanthi , Sharma Prateek , Iyer Prasad 
Published: October 2019

INTRODUCTION:
Endoscopic surveillance guidelines in Barrett’s esophagus (BE) to detect progression to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) are based solely on dysplasia grade. Given low rates of progression, identification of predictors (and scores) of progression may help to focus surveillance or intervention in those at higher risk. We aimed to assess predictors of progression and externally validate the Progression in Barrett’s (PIB) score in an independent multicenter prospective BE and EAC cohort.

METHODS:
The EA and Barrett’s esophagus (EABE) registry is a prospective cohort of patients recruited from three medical centers. Progressors were defined as those with the development of HGD or EAC more than 12 months after initial diagnosis. Demographic and clinical variables were abstracted. The annual incidence rate and predictors of progression were assessed using univariate and multivariable Cox proportional hazards analysis. The ability of the PIB score (incorporating weighted scores for male gender, smoking (ever versus never), BE length and confirmed LGD) to risk stratify the cohort into low (0-10 points), intermediate (11-20 points) and high risk (> 20 points) groups was assessed.

RESULTS:
429 patients were included. 84% were men, with a mean (SD) age of 61.5 (9.9) years. 65% were ever smokers and most (76.7%), had NDBE at diagnosis. Mean (SD) maximal BE segment length was 5.9 (3.2) cm. Eighty-two patients (19.1%) progressed to HGD (n = 65) or EAC (n = 17) over a median (IQR) follow up of 7.5 (3.7, 12.5) years. Annual incidence rates of progression to EAC and EAC/HGD were 0.5% and 2.0% respectively. Univariate and multivariable predictors of progression are displayed in Table 1. The PIB score divided patients into three groups (Table 2) with progressively increasing rates of progression. The risk in the high risk group was three fold higher than the low risk group (P = 0.024). The risk in the intermediate group was twofold higher but not statistically significantly higher (P = 0.13). The PIB score had a c-statistic score of 0.76 in the original cohort. In this cohort the c-statistic value was lower at 0.64, suggesting moderate performance.

CONCLUSION:
Male sex and BE length predicted progression in this independent multicenter cohort. The PIB score was also able to risk-stratify patients in this validation cohort with the high risk cohort being 3x more likely to progress compared to the low risk cohort.
420 Assessing the Prevalence of Gastroesophageal Reflux in Gastroparesis: Putting the G Back in GERD
Authors: Bensinger Andrew , Clayton Steven 
Published: October 2019

INTRODUCTION:
Patients with gastroparesis experience a wide range of symptoms from early satiety to frequent emesis and severe abdominal pain. However, few studies have evaluated concomitant underlying esophageal pathology or frequency of gastroesophageal reflux episodes in patients diagnosed with gastroparesis. Prolonged gastric emptying may lead to increased intra-gastric pressure and volume of gastric contents that may result in increased frequency of distal esophageal reflux events. The aim of this study was to assess for significant differences in total duration of distal esophagus acid exposure and number of gastroesophageal reflux events as detected by impedance pH testing between gastroparesis and control cohorts.

METHODS:
A retrospective analysis of 84 patient charts who underwent both 4-hour gastric emptying studies and 24-hour ambulatory pH testing was performed. Patients with gastroparesis, as documented by abnormal 4-hour gastric emptying studies, were compared with age and gender matched controls. Patients taking PPI during testing were excluded from the study. Percent of total distal esophageal time pH < 4 (nl < 4%) and impedance values (nl< 53) were compared between the gastroparesis and control groups. Continuous variables were analyzed using independent 2-tailed t-test, while categorical values were evaluated using a chi squared analysis.

RESULTS:
Forty-two gastroparesis patients (9 men and 33 women, median age 46 years old, range 19-81 years old) underwent 24-hour ambulatory pH monitoring while off of PPI. When comparing total mean impedance events during pH testing, the gastroparesis cohort experienced significantly more episodes of distal esophageal reflux events, 61.27 ± 11.34 vs 45.81 ± 7.72 (P = 0.028), respectively. Mean percent total distal time for esophageal pH < 4.0 was higher for the gastroparesis group when compared to controls, 4.79 ± 1.48% vs 3.31 ± 1.15% (P = 0.125), respectively.

CONCLUSION:
This pilot study demonstrates that patients meeting criteria for gastroparesis by gastric emptying study have significantly higher number of reflux episodes than those with normal gastric emptying. Trends toward a higher percentage of total distal esophageal acidity exposure time and a higher proportion of the gastroparesis group meeting diagnostic criteria for GERD were also seen. In the future, expanding sample sizes to better investigate these preliminary trends will be beneficial to better understand the association of GERD and gastroparesis.
426 Prevalence of Gastroparesis in Achalasia: A U.S. Population-Based Study
Authors: Lal Pooja , Saleh Mohannad Abou , Mansoor Emad , Cooper Gregory S. 
Published: October 2019

INTRODUCTION:
Patients with achalasia often present with symptoms including bloating, early satiety and abdominal discomfort suggesting there might be an underlying concomitant gastric motility dysfunction. Moreover, treatments such as botulinum toxin injection are efficacious in both achalasia and gastroparesis. There are a lack of studies in the literature examining the association between achalasia and gastroparesis. We hypothesized that patients with achalasia would have a higher prevalence of gastric motility dysfunction, contributing, in part to the upper GI symptoms. The aim of this study was to compare the prevalence of gastroparesis in achalasia to the general population using a large population based commercial database.

METHODS:
The database used was Explorys Inc. (Cleveland, OH, USA) which contains electronic health records from 26 major integrated US healthcare systems. We identified patients with achalasia who were diagnosed with gastroparesis in the last 5 years based on Systemized Nomenclature of Medicine – Clinical Terms and compared it to patients with gastroparesis in the general population without achalasia.

RESULTS:
Of the 36,825,640 active patients within the last 5 years in the database, we identified 19,630 (0.05%) patients who had a diagnosis of achalasia and 104,140 (0.28%) patients with gastroparesis out of which only 600 (0.57%) were related to diabetes mellitus. A total of 990 cases of gastroparesis were observed in patients with achalasia, and 103,150 cases of gastroparesis in patients without achalasia. The overall Relative Risk (RR) of developing gastroparesis in patients with achalasia was 17.96 (95% CI 16.90 to 19.10; P < 0.0001) compared to general population without achalasia. Patients aged 18-64 (RR 20.50, 95% CI 18.94 to 22.39, P < 0.0001) and those aged ≥ 65 (RR 10.24, 95% CI 9.38 to 11.19, P < 0.0001) both had an increased risk of developing gastroparesis. Gender-based and race-based relative risk are shown in Table 1.

CONCLUSION:
Gastroparesis has a higher prevalence among people with achalasia compared to general population, with a relative risk of nearly 18. This increase in risk is seen across all age-groups. The findings of this analysis prove that there might be an underlying pathophysiological relationship between the esophageal and gastric motility disorders.
431 Late Stage Diagnosis of Esophageal Adenocarcinoma in Veterans: Could Screening Be Made More Effective?
Authors: Sharma Anamay , Blum Andrew , Chak Amitabh , Faulx Ashley 
Published: October 2019

INTRODUCTION:
The prognosis of EAC is very poor largely due to presentation at late stage, ineffective systemic therapy and high morbidity and mortality associated with surgical treatment. The detection and surveillance of Barrett’s Esophagus (BE) is the only strategy for prevention and early detection of EAC. ACG guidelines recommend endoscopic screening of men with chronic GERD and risk factors for developing Barrett’s Esophagus. A recent study from the Michael E. DeBakey VA Medical Center demonstrated that only ∼25% of patient diagnosed with EAC had had prior upper endoscopy. This study aimed to determine what proportion of veterans present with late stage EAC and evaluate whether there was an opportunity to perform endoscopic screening prior to diagnosis.

METHODS:
This was a retrospective chart review, done at the Louis Stokes Cleveland VA Medical Center. Patients with diagnosis of esophageal adenocarcinoma from 2007 to 2017 were included. Data were gathered for age, gender, race, history and duration of GERD, prior upper endoscopy, prior Barrett’s diagnosis, stage at diagnosis, smoking behavior, family history etc. A simple descriptive analysis of all variables were performed.

RESULTS:
A total of 113 patients met inclusion criteria. Of these, 111 (98.2%) were men, and 107 (94.7%) were Caucasians. Total 52 (46%) patients presented as stage 4. Of these 52 patients, 20 had history of chronic GERD and 17 had PCP visit at least 1 year before diagnosis. Total fifty three (46%) patients had a documented history of chronic GERD. 43 of 53 patients (81%) had at least one visit to PCP office within 1 year of cancer diagnosis. Based on ACG guidelines 42 (97.6 %) of these 43 patients met criteria for screening for Barrett’s Esophagus, however only 16 of these 42 (38%) had prior upper endoscopy. 14 of these were diagnosed with Barrett’s esophagus.

CONCLUSION:
These results suggest that majority of patients with GERD symptoms had regular visit to outpatient clinic (81%), and there was missed opportunity to screen them. Better awareness among primary care physicians is needed to increase screening rate for Barrett’s Esophagus
433 Incidence, Admission Rates, and Economic Burden of Adult Emergency Visits for Esophageal Cancer: Data From the National Emergency Department Sample, 2006 to 2014
Authors: Singh Dhruv P. , Kandlakunta Harika , Garg Sushil 
Published: October 2019

INTRODUCTION:
Esophageal cancer accounts for 1% of cancers diagnosed in the United States and the seventh most common cause of cancer-related mortality among men in the United States, with a 5-year survival rate of 19%. With an estimated $1.5 billion in direct medical costs in 2010, we look at ED utilization by this group of patients and analyze the economic burden and trends in ED visits and inpatient admissions over a 9-year period

METHODS:
The Nationwide Emergency Department Sample (NEDS; 2006-2014) was interrogated to identify patients with a primary diagnosis of esophageal cancer (ICD-9 CM code). The yearly incidence of ED visits, rates of hospitalization, length of stay (LOS), and total charges associated with ED or subsequent inpatient stays were assessed. As secondary analysis, survey logistic regression model was used to determine predictors of hospitalization.

RESULTS:
A total of 46,431 esophageal cancer-related ED visits were identified during this time period. Overall, early readmission visits increased overall from 6,295 in 2006 to a peak of 6,837 in 2014. The mean ED charges per visit, adjusted to inflation increased significantly from $1,401 in 2006 to $3,168 in 2014, while the mean total charges incurred by patients who were admitted to the hospital also increased from $41,009 in 2006 to $61,809 in 2014. Hospitalization rates decreased from 83.5% in 2006 to 78.8% in 2014 but in-hospital deaths decreased from 11.4% in 2006 to 8.7% in 2014. The average LOS in the hospitals decreased from 7.8 to 7.2 days.

CONCLUSION:
Increasing ED visits and charges associated with esophageal cancer are concerning. While hospitalization rates are slightly decreased during this 9-year period, there is an alarming uptrend in mortality rates which needs to be explored further. The results of our study suggest that further exploring factors that are associated with the recent upsurge in mortality may lead to the development of interventions that will significantly reduce in-hospital deaths.