bluuebunny/crossref_metadata_2025_split huggingface dataset:
METHODS TO DERIVE A MODIFIED MAYO SCORE FROM ELECTRONIC HEALTH RECORDS DATA
Authors: Swenson Anna , Burke Kristin , Womack Katherine , Quinn Meaghan , Curhan Gary 
Published: January 2023

Abstract

BACKGROUND
The modified Mayo Score (MMS), which consists of stool frequency, rectal bleeding, and endoscopic subscores, is the most commonly used method for measuring disease activity in Ulcerative Colitis (UC) patients. It is a standard outcome measure in clinical trials, and is recommended as a clinical trial endpoint by the US Food and Drug Administration. Each component has a score from 0-3; the total MMS ranges from 0 to 9. MMS is infrequently recorded in routine care, in part because it requires an endoscopic assessment. Real world data, including electronic health record (EHR) databases, are useful for studying longitudinal disease and treatment outcomes, but most EHR databases do not include Mayo scores. Building off the methods described by Rudrapatna et al., 2021, we calculated a derived MMS using data elements available in EHRs.

METHODS
Data were derived from the OM1 PremiOM UC Dataset (OM1, Boston, MA), a multisource real-world database with linked healthcare claims and EHR data on US patients with UC (2013-present). Each of the three subscores was extracted from clinical notes and endoscopy reports, either by automated natural language processing methods or by abstraction by a trained medical abstractor. Rectal bleeding and stool frequency scores occurring within 4 months before or up to 1 month after the endoscopic score were combined to calculate a MMS. Multiple MMSs could be calculated for each patient, but each component score could contribute to only one MMS.

RESULTS
Among 12,849 UC patients, only 38 had a full Mayo score recorded in their notes, and 1 had a modified Mayo recorded. After applying the above algorithm, we were able to calculate a derived MMS for 739 patients. 220 patients had &gt; 1 score available. Figure 1 shows the distribution of derived MMSs. Patients with a MMS were younger and more likely to be Asian, more likely to be treated with biologic therapies and less likely to be treated with mesalamine compared with those who could not have a MMS calculated (Table 1).

CONCLUSIONS
A derived MMS can be calculated from data that may be recorded in the medical record. Further work to validate these measures against a gold standard should be considered, but was not feasible in the OM1 dataset due to the paucity of observed Mayo scores in EHR data. Increased emphasis on standardized collection of relevant information in EHR systems would further improve the availability of derived MMSs. The population for which a MMS can be derived may have more severe disease and more frequent interactions with the healthcare system as evidenced by higher proportion of patients prescribed biologic therapies. MMSs can be derived and used to describe UC patients and could potentially be used to study longitudinal changes in patient disease status and treatment effectiveness in settings where observed scores are not available.
INCIDENTAL DYSPLASIA DURING TOTAL PROCTOCOLECTOMY WITH ILEOANAL POUCH: IS IT ASSOCIATED WITH WORSE OUTCOMES?
Authors: Maspero Marianna , Otero Ana , Lavryk Olga , Holubar Stefan , Lipman Jeremy , Gorgun Emre , Liska David , Kessler Hermann , Valente Michael , Steele Scott , Hull Tracy 
Published: January 2023

Abstract

BACKGROUND
Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or non-endoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term oncological outcomes and pouch survival, however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery. We hypothesized incidental colorectal dysplasia is associated with worse oncologic outcomes compared to dysplasia diagnosed preoperatively.

METHODS
Using our prospectively collected pouch registry, we identified patients who had a) preoperative dysplasia or b) dysplasia found only after colectomy. Patients with cancer preoperatively or after colectomy were excluded. Included patients were divided into three groups: ONLYPRE (+preoperative biopsy, negative final pathology), PREFINAL (+preoperative biopsy and final pathology), and ONLYFINAL (negative preoperative biopsy, +final pathology. Long-term pouch survival in the three groups was assessed with survival analysis.

RESULTS
In total, 517 patients were included: ONLYPRE = 125 (24%), PREFINAL = 254 (49%), ONLYFINAL = 137 (26%). Overall, the median age at IPAA was 46 (IQR 36 - 62) and 33% were female. The preoperative diagnosis was ulcerative colitis in 91% cases. No demographic differences were observed between the groups. In patients with a positive preoperative biopsy, the concordance between preoperative biopsy and final pathology was 49% (Figure 1a). After a median follow-up of 12 years (IQR 3 – 21), there were no differences in overall, disease-free or pouch survival between groups (Figure 1b, c, d). Cancer/dysplasia developed in 11 patients: 3 (2%) in the ONLYPRE, 5 (2%) in the PREPOST, and 3 (2%) in the ONLYPOST group (Table 1). Oncologically, one required redo pouch (ONLYPRE group), while 4 required pouch excision: 1 (1%) In ONLYPRE, 1 (0.5%) in the PREPOST, and 2 (2%) in the ONLYPOST group (p = 0.24). Only one cancer-related death occurred in the entire cohort (ONLYPRE group). Disease-free survival at 10 years was 98% for ONLYPRE, 98% for PREPOST, and 98% for ONLYPOST (p = 0.968). Pouch survival at 10 years was 96% for ONLYPRE, 99% for PREPOST, and 97% for ONLYPOST (p = 0.236).

CONCLUSION
An ileoanal pouch in the setting of IBD-associated dysplasia, regardless of when it is diagnosed, confers exceptionally good long-term outcomes. The incidental finding of dysplasia during proctocolectomy does not seem to be associated with worsened outcomes compared to preoperatively diagnosed dysplasia.
INCORPORATION OF RISK ASSESSMENT TOOL IMPACTS PATIENT AND GASTROENTEROLOGIST CONFIDENCE AND TREATMENT DECISION MAKING IN BIONAIVE CROHN’S DISEASE
Authors: Ungaro Ryan , Patel Anish , Rui Shumin , Jimenez Darwin , Helmus Drew , Gorbenko Ksenia , Dubinsky Marla , Keefer Laurie 
Published: January 2023

Abstract

BACKGROUND
Clinical guidelines recommend the incorporation of risk stratification assessments when making decisions about Crohn’s disease (CD) treatment. We aimed to evaluate if patient and gastroenterologist (GI) decision making and confidence about starting or changing therapy were impacted by reviewing a CD risk stratification assessment.

METHODS
We conducted a multicenter, prospective study evaluating the impact of a risk stratification tool on decision making by GIs and biologic naïve adult CD patients considering starting or changing therapy. Medical records were reviewed by a GI at the organizing site to determine risk according to the American Gastroenterological Association (AGA) Crohn’s Disease Care Pathway risk assessment tool. Patients with any risk factors for rapid disease progression (age&lt;30 at diagnosis, deep ulcers, extensive anatomic involvement, perianal disease, prior CD surgery, and/or stricturing/penetrating behavior) were considered moderate-high risk. Patients and treating GIs were then provided a report with their risk assessment conveyed in both written and visual (“risk gauge”) format. Participants were surveyed at baseline and at 7 days after viewing the risk stratification assessment and were unaware which risk assessment tool was used to determine risk. The primary outcome was behavioral change defined as any modification in treatment plan or increase in patient or GI self-assessed confidence in need for treatment change (on 5-point Likert scale) from baseline to day 7.

RESULTS
47 patient-GI pairs were enrolled across 14 sites. Among CD patients, mean age was 40.2 years, 59% were men, 70% were white, 80% had inflammatory (B1) disease behavior, 74% had no prior CD-related hospitalizations, and 82% no prior CD-related surgeries. 64% of patients were deemed moderate-high risk and 36% low risk by AGA criteria. In comparison, 40% of patients self-assessed their risk as moderate-high at baseline. The most common moderate-high risk factors were age&lt;30 (45%) and stricturing/penetrating behavior (20%). At baseline, 49% of GI risk assessments of their patients were discordant with AGA risk stratification (e.g. moderate-high risk by AGA evaluated as low risk). Behavioral change was observed in 52% of participants at day 7 and was similar whether patient was low or moderate-high risk. At day 7, patient confidence increased in 21%, GI confidence increased in 23%, and treatment recommendation was changed in 36% of cases. Among patients assessed as low risk disease, confidence that patient would benefit from treatment change decreased in 47% of GIs and 59% of CD patients at day 7.

CONCLUSION
Incorporation of a simple risk stratification assessment when considering treatment change in CD can assist in patient and GI decision making. Low risk assessments are associated with lower confidence in decision making.
INFLAMMATORY BOWEL DISEASE AND ASSOCIATED CARDIOVASCULAR DISEASE OUTCOMES: A SYSTEMATIC REVIEW
Authors: Naz Sidra , Butey Swatika , Jaiswal Vikash , Dagar Mehak , Huang Helen , Ea Chia Jia , Endurance Evbayekha O , Raj Nishchita , Patel Srushti , Maroo Dipansha , Mukherjee Dattatreya , Hanif Muhammad 
Published: January 2023

Abstract

BACKGROUND
There is limited and conflicting data available regarding the Cardiovascular disease outcomes associated with Inflammatory Bowel Disease (IBD)

OBJECTIVE
We aim to perform a systematic review to evaluate the cardiovascular outcomes and mortality associated with IBD patients.

METHODS
A systematic literature search has been performed on PubMed, Embase, Cochrane, and Scopus from inception till May 2022 without any language restrictions.

RESULTS
A total of 2,029,941 patients were included into the analysis from 16 studies. The mean age of the patients was 45.6 years. More females were found compared with males (57% vs 43%). The most common risk factors for Cardiovascular disease (CVD) included smoking (24.19%) and alcohol (4.60%). The most common co-morbidities included hypertension (30%), diabetes mellitus (14.41%), dyslipidemia (18.42%), previous CVD (22%), and renal disease (10%). Among outcomes All-cause mortality among IBD patients was 1.66%; Ulcerative Colitis (UC): 15.92%; and Crohn’s disease (CD): 0.30%. Myocardial Infarction (MI) among IBD patients were 1.47%, among UC: 30.96%; and among CD: 34.14%. Cardiovascular Death (CVD) events among IBD patients were 1.95%. Heart failure events among IBD patients were 5.49%, while Stroke events among IBD Patients were 0.95%; among UC: 2.63%; and CD: 2.41% respectively.

CONCLUSION
There was a possible association between IBD patients and adverse cardiovascular outcomes especially in young and females. Though there remains a lack of concrete treatment algorithms and assessment parameters that better characterize IBD risk factors, nutritional modifications and physical activity should be at the fore-front of CVD prevention in IBD.
MOOD DISORDERS AND OUTCOMES OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A 2016-2019 NATIONWIDE ANALYSIS
Authors: Kilani Yassine , Aldiabat Mohammad , Bhatija Rinku Rani , Kamal Syeda Ashna Fatima , Arshad Iqra , Sohail Haris , Favour Markson 
Published: January 2023

Abstract

INTRODUCTION
Several risk factors have been associated with inflammatory bowel diseases (IBD), including genetic, environmental, gut microbiota and immune dysregulation. Psychiatric disorders have been linked to IBD. However, the question of whether psychiatric conditions affect the severity of patients with IBD remains unanswered. We aimed to investigate the relationship between mood disorders and IBD outcomes.

METHODS
This is a retrospective longitudinal study of patients admitted with a primary diagnosis of IBD. Data was retrieved from the Nationwide Inpatient Sample (NIS) databases of the years 2016 to 2019 using ICD-10-CM codes for IBD. Multivariate logistic regression analysis was applied to estimate the effect of mood disorders on the outcomes of IBD (mortality, complications and hospital utilization), while adjusting for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for IBD with and without a secondary diagnosis of mood disorder (table 1). We used Stata® Version 17.0 Software (Statacorp, Texas, USA) for analysis. The p-value was set at p &lt; 0.05.

RESULTS
A total of 374745 adults with a primary diagnosis of IBD were identified; less than one fifth (21%) had a documented mood disorder. A significantly higher proportion of females (66%, p-value=0.000) and Whites (81%, p-value=0.000) were noted in the mood disorder group. Having a mood disorder was associated with no statistically significant change in mortality (Odds ratio (OR) = 0.86, p = 0.461), anemia (OR = 0.99; p = 0.891), gastrointestinal bleed (OR = 0.99; p = 0.910), inflammatory polyps (OR = 0.79; p = 0.452), toxic megacolon (OR = 0.79; p = 0.664), colorectal cancer (OR = 0.70; p = 0.133), primary sclerosing cholangitis (OR = 1.34; p = 0.228), and pyoderma gangrenosum (OR = 1.01; p = 0.945) (figure 1). A statistically but non clinically significant reduction in the risk of intestinal abscess (OR= 0.81; p = 0.024), stenosis (OR= 0.68; p = 0.000), and fistula (OR= 0.84; p =0.012), was noted in patients with mood disorder. However, an increased hospital utilization was noted in patients with mood disorder (length of stay: 0.59 days, p-value = 0.000; total healthcare cost: 3372 US Dollars, p-value = 0.000).

DISCUSSION
IBD patients demonstrate a higher prevalence of mood disorders when compared to the general population, especially in females and Whites. Our study showed that the presence of mood disorder concurrently with IBD does not significantly affect the outcomes of IBD in terms of mortality, or morbidity. A multidisciplinary approach of patients with IBD including diagnosis and management of the underlying psychiatric disorders could help optimize the hospital utilization of patients with IBD.
MORTALITY AND MORBIDITY DIFFERENCE IN GERIATRICS PATIENTS HOSPITALIZED FOR INFLAMMATORY BOWEL DISEASE: POPULATION-BASED AGE-STRATIFIED RETROSPECTIVE STUDY
Authors: Aldiabat Mohammad , Aljabiri Yazan , Kilani Yassine , Al-bashabsheh Abdel-qader 
Published: January 2023

Abstract

BACKGROUND
Given the increase in prevalence of Inflammatory Bowel Disease (IBD) worldwide and the increase in general population life expectancy, it is expected to for IBD to be more prevalent disorder among elderly patients. However, the mortality and outcomes of geriatric patients hospitalized for management of IBD remain understudied.

METHODS
Using ICD-10 codes, the National Inpatient Sample database of the years 2016 to 2019 was screened for to geriatric (≥ 65 years old) and non-geriatric adult (18-65 years old) population who were hospitalized with a primary diagnosis of IBD (Crohn’s Disease and Ulcerative Colitis). Multivariate logistic regression analysis was performed to compare the mortality and hospital complications risks of elderly patients (Study group) hospitalized for IBD to that of younger group (Controls). Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was &lt;0.05.

RESULTS
Among 953,094 adults’ patients who were hospitalized in US with a primary diagnosis of IBD from 2016 - 2019, 370,424 (38.9%) were ≥ 65 years old. Age-stratified patients baseline characteristics are listed in Table 1. In term of mortality, Geriatric patients were found to have a 2.50-fold increase in risk of mortality (OR 2.50, 95% CI 2.29– 2.72, p&lt;0.001) when compared to younger adults. In term of in-hospital outcomes (Figure 1), Geriatrics patients had a higher risk of sepsis (OR 1.21, 95% CI 1.16– 1.26, p&lt; 0.001), septic shock (OR 1.44, 95% CI 1.34– 1.54, p&lt; 0.001), acute kidney injury (OR 1.43, 95% CI 1.38– 1.48, p&lt; 0.001), acute coronary syndrome (OR 1.52, 95% CI 1.36 – 1.70, p&lt;0.001), in-hospital cardiac arrest (OR 1.29, 95% CI 1.09 – 1.53, p= 0.003), UTIs (OR 1.93, 95% CI 1.86 – 2.01, p&lt; 0.001), pneumonia (OR 1.36, 95% CI 1.30 – 1.43, p&lt; 0.001), acute respiratory failure (OR 1.41, 95% CI 1.34 – 1.48, p&lt;0.001) and mechanical ventilation (OR 1.13, 95% CI 1.05 – 1.23, p=0.001) when comparted to non-Geriatrics patients. Interestingly, Geriatrics/IBD patients had no significant difference in length of stay (Coefficient 0.09 days, 95% CI -0.009 –0.172, p&lt;0.028) and cost of care (Coefficient 403$, 95% CI -937 – 1745, p=0.55) when compared to younger subjects.

CONCLUSION
Elderly patients hospitalized for management of IBD have higher rates of mortality, sepsis, septic shock, acute kidney injury, acute coronary syndrome, in-hospital cardiac arrest, UTIs, pneumonia, acute respiratory failure and mechanical ventilation, with no significant difference in healthcare resources utilization compared to younger subjects. These results are likely related to the higher comorbidities and the benefits/risk balance of undergoing invasive therapeutic measures in this friable age group.
OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS
Authors: Kilani Yassine , Aldiabat Mohammad , Kamal Syeda Ashna Fatima , Arshad Iqra , Sohail Haris , Favour Markson 
Published: January 2023

Abstract

INTRODUCTION
Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD.

METHODS
This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p &lt; 0.05 for statistical significance.

RESULTS
A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population.

DISCUSSION
The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .
PENTOSAN POLYSULFATE-ASSOCIATED DYSPLASIA IN INFLAMMATORY BOWEL DISEASE: A CASE SERIES
Authors: Anderson Jenna , Frost Spencer , Keyashian Kian , Modiano Nir 
Published: January 2023

Abstract

BACKGROUND
Pentosan polysulfate is used for symptomatic management of interstitial cystitis. At one institution we incidentally noted six patients who were on this agent and had a diagnosis of inflammatory bowel disease (IBD). Three of these patients stopped the drug and all three had clinical and/or endoscopic improvement. Three of the six patients developed multifocal dysplasia. This observation led us to evaluate the hypothesis that pentosan polysulfate is associated with dysplasia in patients with IBD.

METHODS
We searched the electronic medical records at two tertiary care centers to identify patients using pentosan polysulfate who had a diagnosis of Crohn’s disease or ulcerative colitis.

RESULTS
Thirty patients who met the search criteria were identified. Of these, 10 (33.3%) had colonic dysplasia: 8 (80%) with low-grade dysplasia and 2 (20%) with both low- and high-grade dysplasia. Of the patients with dysplasia, 6 (60%) required colectomy for endoscopically unresectable dysplasia. Following physician consultation, three patients (10%) discontinued the drug and subsequently demonstrated clinical benefit and/or achieved endoscopic healing.

CONCLUSIONS
Inflammatory bowel disease patients at two institutions who had taken pentosan polysulfate had high rates of colonic dysplasia leading to surgery. Patients in this cohort who stopped this agent showed improvement in their colitis. These findings raise questions about whether pentosan polysulfate may play a causal role in both the development of colitis and the observed high rate of dysplasia. If larger studies validate these findings, this would indicate a readily identifiable subset of patients who are at high risk of developing colitis-associated malignancy.