bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARING MAGNETIC RESONANCE ENTEROGRAPHY AND ENDOSCOPY FINDINGS TO QUANTATATIVE MAGENTIC RESONANCE IMAGING IN PEDIATRIC CROHN’S DISEASE
Authors: McSorley Brianna , Plunk Matthew , Challa Sai Alekha , Pan Amy , Menys Alex , Noe Joshua 
Published: January 2024

Abstract

BACKGROUND
In pediatric Crohn’s disease, endoscopy has remained the gold standard for diagnosis; however, Magnetic Resonance Enterography (MRE) is able to show inflammation of the bowel that a gastroenterologist cannot reach with endoscopy. For a standard MRE, a patient needs to ingest oral contrast, receive intravenous (IV) contrast and a spasmolytic agent, and hold his/her breath during portions of the study, which can be challenging in younger children. As shown in previous studies, quantitative Magnetic Resonance Imaging (MRI) can evaluate bowel motility in children with Crohn’s disease, showing that as motility decreases in the bowel, inflammation increases. A motility score obtained from GIQuant software (Motilent, UK) may allow existing MRE protocols to be shortened and can be done with free-breathing techniques and without IV contrast and the spasmolytic agent.

AIM
Our primary aim is to demonstrate that quantitative MRI, which uses the cine image to develop a motility score from GIQuant software, is as effective as standard MRE in assessing inflammation of the bowel. We secondarily hypothesize that the motility score will inversely correlate to the Endoscopic Biopsy Acute Histologic Inflammatory Score (eAIS), the Crohn’s Disease Endoscopic Index of Severity (CDEIS) score, and the MR Index of Activity (MaRIA) score.

METHODS
This was a retrospective study of 50 pediatric patients from Children’s Wisconsin with ileal and/ or cecal Crohn’s disease who underwent endoscopy and MRE within 7 days of each other without exposure to therapy. Cine images were used from patients’ previously obtained MREs to obtain a motility score using GIQuant. A cine image and GIQuant map example is shown in Figure 1. The relationships between motility score and MaRIA, eAIS, and CDEIS were then calculated by Spearman’s rank correlation coefficient (ρ).

RESULTS
MaRIA and motility scores inversely correlated (ρ = -0.66, p &lt;.0001), which is seen in Figure 2. MaRIA positively correlated with CDEIS (ρ = 0.30, p= 0.03) and eAIS (ρ = 0.26, p = 0.07). The motility score showed a non-significant negative correlation with CDEIS (ρ = -0.17, p = 0.24) and eAIS (ρ = -0.23, p =0.11).

CONCLUSION
Quantitative MRI is as effective as standard MRE in identifying inflammation of the bowel in Crohn’s disease. The cine image is obtained much faster than standard MRE and without the use of intravenous contrast, spasmolytic agent, and breath-holding techniques, which is crucial for children who are too young to cooperate with current MRE protocols.

Figure 1 MRE cine image with the Region of Interest in the terminal ileum identified via the polygon and the resulting Motility Map produced by GIQuant

Figure 2 MaRIA and Motility scores of each patient in our cohort
SOCIOECONOMIC DISPARITIES IN HOSPITALIZATION AND OUTCOMES OF EOSINOPHILIC COLITIS: A FIVE-YEAR NATIONAL ANALYSIS
Authors: Karki Bibek , Kandel Pujan , Belbase Samjhana , Ghimire Calvin , McDonald Philip , Elbedawi Mamoon 
Published: January 2024

Abstract

BACKGROUND
Eosinophilic colitis (EoC) is a rare gastrointestinal inflammation of the colon due to an altered hypersensitivity reaction characterized by eosinophilic infiltration into the colonic wall. Patients usually present with abdominal pain, diarrhea, and weight loss.

METHODS
We used the National Inpatient Sample (NIS) database to conduct a retrospective study of hospitalized adult patients with eosinophilic colitis using the validated ICD-10 diagnosis codes between January 1, 2016, and December 31, 2020.

RESULTS
We identified 4353 cases of eosinophilic colitis using the NIS database. There were 748, 776, 889, 934, and 1,006 eosinophilic colitis cases diagnosed in 2016, 2017, 2018, 2019, and 2020 respectively. Males were more likely to be hospitalized due to eosinophilic colitis than females (51.8% vs. 48.2%). Moreover, there was a significantly higher prevalence of eosinophilic colitis among the white population, with 81.7% in Whites, 8.1% in Blacks, 6.3% in Hispanics, and 1.3% in Asians. 26.5% of those patients had Medicare, 15.7% had Medicaid, and 50.6% had private/HMO insurance. About 20.7% of patients had a median household income of $45,999 or less, 23.6% had $46,000-58,999, and 55.6% had $59,000 or more. Based on hospital location, 30.3% of the cases were in the South, 27.5% in the Midwest, 23.4% in the West, and 18.8% in the Northeast. The majority of patients admitted for eosinophilic colitis were recorded in urban teaching hospitals (77.8%) compared to 17.6% in urban nonteaching hospitals and 4.6% in rural areas. Only 16.5% of the patients with eosinophilic colitis had a Charlson Comorbidity Index of 3 or higher.

CONCLUSION
Based on the national inpatient sample over 5 years, males and whites are more likely to be hospitalized with eosinophilic. The report suggests that eosinophilic colitis is common among patients with high median household income and has a better prognosis.
UNIQUE MONOCYTE EXPRESSION SIGNATURE IN A STXBP2 MUTATION CAUSING INFANTILE ONSET VEO-IBD AND HLH
Authors: Baccarella Alyssa , Dawany Noor , Conrad Maire , Heimall Jennifer , Bunin Nancy , Gaddipati Shreya , Cohen Maya , Pickering Oliver , Borodyanskaya Yelizaveta , Sullivan Kathleen , Kelsen Judith 
Published: January 2024

Abstract
Mutations in syntaxin-binding-protein-2 (STXBP2) can result in NK cell dysfunction leading to a hyperinflammatory state including familial HLH and infantile onset inflammatory bowel disease (IBD). While the function of STXBP2 in NK cells and cytotoxic T cells has been well described, it is highly expressed in monocytes with unclear relevance. We report the case of an infant who presented with severe infantile onset diarrhea with an identified pathogenic mutation in STXBP2. We sought to utilize scRNA-Seq to study the impact of STXBP2 deficiency on monocyte transcription, with the goal of generating insight into the pathogenesis of disease.
METHODS: Trio whole exome sequencing was performed. PBMCs were collected from the described patient (case), and two control groups: 3 patients with VEO-IBD, and 3 age matched healthy controls. Single cell RNA-Seq was performed using the 10x platform and data analysis was done using Seurat in R.
RESULTS: A male infant presented at 1 week of age with diarrhea and metabolic acidosis. Endoscopic evaluation at 4 weeks of age showed histologic findings of colitis and marked epithelial cell changes, including cell rounding. WES identified a homozygous pathogenic mutation in STXBP2. Due to significant risk of HLH, he underwent evaluation for stem cell transplant. However, in the interim he developed severe HLH requiring ICU level care. He recovered following aggressive treatment and underwent HSCT at 4 months of age and retransplant for graft failure at 11 months of age. He is currently in endoscopic remission off therapy.
We analyzed PBMCs from the case patient using single cell RNA-Seq, as compared to patients with VEO-IBD and age-matched controls. STXBP2 expression was most enriched in monocyte populations and reduced in the case patient compared to controls. 231 and 187 genes were differentially expressed in the case monocytes as compared to both controls. The case patient had a paucity of non-classical monocytes. Within the classical monocytes, differentially expressed genes showed enrichment of host defense, cytokine processes, and apoptotic processes. Within the intermediate monocytes, differentially expressed genes showed enrichment of chemotaxis pathways, antigen presentation and T cell activation processes.
CONCLUSIONS: Mutations in STXBP2 are a life-threatening cause of fHLH and infantile onset IBD. We report a case of infantile onset IBD due to a homozygous mutation in STXBP2 with resolution of disease post HSCT. Transcriptional analysis of PBMCs from this patient reveals a paucity of non-classical monocytes in the peripheral blood, and differential regulation of genes implicated in host defenses, antigen presentation, chemotaxis and apoptosis. These results may suggest the role of monocyte function in pathogenesis of STXBP2 and in other forms of IBD.
COST PER REMISSION FOR MIRIKIZUMAB VS USTEKINUMAB IN THE MAINTENANCE PHASE FOR MODERATELY-TO-SEVERELY ACTIVE ULCERATIVE COLITIS TREATMENT FROM THE UNITED STATES COMMERCIAL PAYER PERSPECTIVE
Authors: Gulati Ankit , Kane Sunanda , Mittal Neha , Creveling Thomas , Bires Nicholas , Fisher Deborah , Chanan Neha , Koushik Amit Kumar , Upadhyay Navneet 
Published: January 2024

Abstract

BACKGROUND
In phase 3 studies, mirikizumab (MIRI), an IL-23p19 antibody, demonstrated efficacy vs placebo in adult patients with moderately-to-severely active ulcerative colitis (UC). It is being developed for the United States Food and Drug Administration approval for the treatment of UC. Ustekinumab (USTE), an IL-12/23p40 antibody, is currently the most utilized second line treatment in UC patients. Physicians may prescribe MIRI in a similar placement to USTE, and payers may compare them when making formulary decisions for IL-23 inhibitors. Given the need for continued maintenance therapy to manage UC, it is of interest to evaluate the relative cost-efficiency of MIRI vs USTE. We estimated and compared the cost of MIRI vs USTE for achieving remission in one additional patient during the maintenance phase in biologic/Janus kinase inhibitor (JAKi)-experienced patients with UC.

METHODS
This study used a network meta-analysis (NMA) of published randomized controlled trials of maintenance phase therapy to derive the number needed to treat (NNT) for achieving clinical remission among those who responded to induction therapy. In NMA, clinical remission was defined as a total Mayo score of ≤2 points, with no individual sub-score &gt;1. An Excel-based analytic model was developed to estimate cost per additional patient achieving clinical remission at the end of maintenance trial period. The model included the cost of maintenance therapy from a US commercial payer perspective and the NNT of achieving clinical remission for MIRI and USTE in the biologic/JAKi-experienced population. Wholesale Acquisition Cost (WAC) of USTE was taken from Micromedex Redbook. A scenario with USTE biosimilar was also considered where NNT was considered the same as USTE, but the WAC was considered 50% lower than the current WAC of USTE.

RESULTS
The costs per biologic/JAKi-experienced patient achieving clinical remission during the maintenance phase were $501,472 and $1,027,799 for MIRI and USTE. The lower cost per remission for MIRI in maintenance was the result of both lower relative NNT and lower anticipated WAC of MIRI compared to USTE. The scenario also resulted in a comparable cost per remission for MIRI vs a USTE biosimilar.

CONCLUSION
MIRI is projected to have a lower cost per remission during maintenance therapy compared to USTE. Given the need for long-term treatment for this chronic condition, MIRI appears to be a cost-efficient treatment option based on its lower NNT and anticipated acquisition cost in the maintenance phase.
DEVELOPING A SCORING SYSTEM TO PREDICT CHRONIC OPIOID USE AMONG ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Balbale Salva , Huang Lynn , Raval Mehul 
Published: January 2024

Abstract

BACKGROUND
Chronic, or long-term, opioid use is associated with higher risk of addiction and death as well as poor inflammatory bowel disease (IBD) outcomes. Recent data estimate that up to 20% of adolescents and young adults (AYA) with IBD may be chronic opioid users. Models to predict chronic opioid use among AYA with IBD may support identification, clinical management, and follow-up of patients at high risk of opioid dependence. We aimed to develop a clinical predictive model based on administrative data for chronic opioid use among AYA with IBD.

METHODS
We performed a retrospective analysis of AYA patients between 15-29 years treated at a tertiary academic center for IBD management from 3/2018-12/2021. Univariate regression was performed to identify individual predictors of chronic opioid use. Multivariate regression was performed using variables with p-values &lt;0.15 in univariate regression. Variables significant after adjustment were included in a simple scoring system. Point estimates for chronic opioid use risk probabilities were derived using the percentage of chronic opioid users in our analytic cohort assigned that prognostic score. 95% confidence intervals were estimated using a bootstrapping technique with 1000 replications.

RESULTS
Our final cohort included 575 unique AYA patients with IBD. Patients were, on average, 23 years old (IQR 20-26) and 69% of the cohort was female. 41% had a diagnosis of Crohn’s disease, 25% with ulcerative colitis and 64% with indeterminate colitis. Patients’ mean age at index IBD diagnosis was approximately 22 years and over half (56%) had undergone prior IBD surgery. Following adjustment, eleven factors were associated with the highest odds of chronic opioid use, including: public insurance coverage, non-digestive or non-gastrointestinal (GI) surgery, outpatient prescription receipt for weaker opioids (i.e. codeine/tramadol), and concurrent depression and post-traumatic stress disorder (PTSD) diagnoses (Figure 1). Prognostic scores ranged from 1-9 (mean: 5, SD=2.7). Patients were stratified into three risk categories by prognostic score (1-4; 5-7; 8-9) with associated risk scores of 52.1% (95% CI: 48.9-55.2%), 68.6% (66.5-71.1%), 86.2% (76.6%-94.4%), respectively (Figure 2).

CONCLUSIONS
We developed a practical scoring system to stratify AYA with IBD by chronic opioid use risk. Future directions include understanding the relationship between these risk factors and their influence on chronic use. Risk factors most associated with chronic opioid use among AYA with IBD included: public insurance coverage, undergoing a non-digestive surgical procedure, and having concurrent diagnoses of depression and PTSD. Findings will directly inform targeted opioid reduction initiatives for this vulnerable population.

Figure 1 Final risk factors associated with development of prognostic score.

Figure 2 Percent of chronic opioid users by prognostic score.
DIFFERENCE IN HEALTHCARE OUTCOMES BETWEEN PUBLIC AND PRIVATE PAYERS FOR PATIENTS ADMITTED WITH CROHN'S DISEASE
Authors: Salazar Miguel , Flocco Gianina , Al-Smadi Khaled , Hammami Bader , Saffouri George 
Published: January 2024

Abstract

BACKGROUND
In countries where health coverage is not universal, there is ample evidence of disparities in healthcare, often associated with insurance. Crohn’s disease (CD) is a complex chronic disease with potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to primary payers and CD remains lacking.

METHODS
We queried the National Inpatient Sample (NIS)from 2016-2019 using ICD10-CM/PCS codes to identify hospital discharges with a diagnosis of CD. Patients were subsequently stratified based on insurance (Medicare, Medicaid, Private, and No insurance). Observations were categorized into two groups, private and public (Medicare and Medicaid) insurance. Patients without insurance were excluded from the study. In-hospital mortality, total hospital cost, length of stay, and in-hospital complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders.

RESULTS
A total of 135,075 discharges with diagnosis of CD were identified with a primary payer insurance, of which 70,275(52.1%) had private insurance and 64,800 (47.9%) public. Patients with private insurance were more likely to be white (68.9% vs 78.4%; P&lt;0.01), have lower Charlson score (46.1% vs 59.1%; P&lt;0.01), belong to the higher income bracket (16.7% vs 29.6%; P&lt;0.01), be admitted to a teaching institution (74.2% vs 79.4%; P&lt;0.01), and be in an urban setting (92.2% vs 95.5%; P&lt;0.01). Patients with private insurance were less likely to require parenteral nutrition (5.9% vs 5.3%; P=0.04), have severe malnutrition (8.8% vs 6.4%; P&lt;0.01), abuse EtOH (1.7% vs 0.8%; P&lt;0.01), use tobacco (1.4% vs 1.1%; P&lt;0.01), use cannabis (4.2% vs 2.3%; P&lt;0.01), have iron deficiency anemia (13.4% vs 11.6%; P&lt;0.01), and die during hospitalization (0.4% vs 0.1%; P&lt;0.01).
On multivariate analysis, there was lower mortality in patients with a private primary payer [0.28; (P&lt;0.01)], shorter LOS (5.8 vs 4.9 days mean days; P&lt;0.01), and lower healthcare charges [ -3,903 US$; (P&lt;0.01)]. Overall, those with private insurance had lower in-hospital complications such as respiratory failure [aOR 0.75; (P=0.05)], endotracheal intubation [aOR 0.50; (P&lt;0.01)], prolonged mechanical ventilation [aOR 0.36;(P&lt;0.01)], hemodialysis [aOR 0.34; (P&lt;0.01)], acute kidney injury [aOR 0.72; (P&lt;0.01)], and venous thromboembolism [aOR 0.54; (P&lt;0.01)]. However, they had higher rates of surgical interventions including small bowel resection [aOR 1.57; (P&lt;0.01)], large bowel resection [aOR 1.58; (P&lt;0.01)], laparoscopic surgery [aOR 2.44; (P&lt;0.01)], and to require conversion to open surgery [aOR 1.55; (P&lt;0.01)].

CONCLUSIONS
Our findings suggest that primary public payers were independently associated with higher morbidity and mortality in patients admitted with CD.
REVOLUTIONIZING IBD MANAGEMENT: HOW DO CHATGPT & GOOGLE BARD STAND UP IN OFFERING COMPREHENSIVE MANAGEMENT SOLUTIONS?
Authors: Mohan Raj Mohan Ram , Natt Dilman , Joy Melvin , Magam Sai Reshma , Magam Sai Greeshma , Desai Jiten , Jiyani Rucha , Mustacchia Paul 
Published: January 2024

Abstract

INTRODUCTION
Artificial Intelligence (AI) has notably transformed the realm of healthcare, especially in diagnosing and treating Inflammatory Bowel Disease (IBD) and other digestive disorders. Essential AI tools, such as ChatGPT and Google Bard, can interpret endoscopic imagery, analyze diverse samples, simplify administrative duties, and assist in assessing medical images and the automation of devices. By individualizing treatments and forecasting adverse reactions, these AI applications have notably enhanced the management of digestive diseases. Integrating such AI technologies empowers patients to make knowledgeable choices by evaluating customized treatment alternatives.

METHODS
The study's objective was to evaluate the precision of two widely used Chat Bots, Chat GPT and Google BARD, in responding to queries related to medical management. Each bot was tasked with answering a series of questions, and the responses were scored on a 1-10 Likert scale, with 1 denoting high accuracy. To uphold impartial judgment, two unbiased assessors reviewed each bot's replies. The purpose of this research was to illuminate the competencies of these chatbots by systematically analyzing their performance in aspects of accuracy and dependability. Employing two evaluators and utilizing the Likert scale approach helped mitigate potential biases, corroborating the findings.

RESULTS
Our study compared the proficiency of Chat GPT and Google BARD in medical management. Chat GPT demonstrated superior performance, achieving 71% in accuracy as opposed to Google BARD’s 39% (p = 0.032) and 58% versus 29% in the reliability of medical information (p = 0.021). This research underscores the pivotal importance of accuracy and reliability in the creation of IBD chatbots. While Chat GPT showed commendable results, signifying its promise as a trustworthy resource, it also highlighted the imperative need for ongoing research and advancement in this domain.

DISCUSSION
AI has significantly reshaped healthcare, particularly aiding in the diagnosis and management of IBD. ChatGPT and Google Bard are key AI tools that analyze medical images, assess samples, and optimize tasks. Our research evaluated the precision and dependability of these chatbots in the sphere of medical management. ChatGPT surpassed Google Bard, securing 71% in accuracy and 58% in reliability of information. While ChatGPT showcases substantial potential as a reliable AI instrument in IBD management, the results also accentuate the continual necessity for exploration and advancement in this area.
RACIAL AND GENDER DISPARITIES IN THE DEVELOPMENT OF CROHN’S DISEASE COMPLICATIONS: A RETROSPECTIVE ANALYSIS
Authors: Iqbal Humzah , Haddadin Rakahn , Haidary Hasib , Zhang Patrick , Prajapati Devang 
Published: January 2024

Abstract

BACKGROUND
Crohn’s disease (CD) is a chronic systemic inflammatory disease that most commonly affects the gastrointestinal tract (GI) and is characterized by transmural inflammation. Complications of CD include fistulization, abscess formation, and GI bleed. CD predominantly affects patients with European ancestry, however Black and Hispanic patients have been noted to have phenotypic differences in disease presentation. Gender may also play a role in CD, with some studies suggesting that men develop more severe disease.

METHODS
Patients with a diagnosis of CD were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of CD complications which included fistula, abscess, and bleed. Patients with complications were further stratified based on the specific complication. Data were collected regarding age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between gender, race, and the development of fistula, abscess, or bleed among patients hospitalized with CD was analyzed using multivariate regression analysis.

RESULTS
A total of 178,279 patients with a diagnosis of CD were included in the study. Of these, 23,889 (13.4%) developed a complication of CD including fistula, abscess, or bleed. Female patients with CD had a statistically significant lower odds of developing a CD complication (aOR 0.79, P &lt; 0.001). Higher odds of developing a complication of CD were seen in Black patients (aOR 1.47, P &lt; 0.001) and Hispanic patients (aOR 1.29, P &lt; 0.001). Black patients with CD had increased odds of developing fistula (aOR 1.35, P &lt; 0.001), abscess (aOR 1.26, P = 0.004), and bleed (aOR 1.60, P &lt; 0.001). Hispanic patients with CD had higher odds of developing a bleed (1.46, P &lt; 0.001).

CONCLUSION
CD is a complex inflammatory process that is influenced by both genetic and environmental factors. Complications of CD such as fistulization, abscesses, and GI bleed are commonly seen. Our study found that women are at lower risk of developing these complications compared to men. Despite CD being primarily seen in White patients, our study found that Black and Hispanic patients are more likely to develop complications of CD. Further studies are needed to elucidate the socioeconomic and genetic factors that are responsible for these findings.

Inclusion process for the study.