Medical Biology Research Articles

Interaction of Valine with Biometal Chlorides in an Aqueous Environment at 25°C

Research in medical biology and pharmacology can expand understanding of the interactions of biometals with amino acids, which are key components of biological systems. This may lead to the development of new complexes that can be used in medicine, for example, to develop new drugs with antimicrobial activity or to maintain metabolic balance in the body. Research purpose:obtaining complex compounds of biometals, cobalt chloride, nickel chloride and manganese chloride with the amino acid valine, as well as the study of their physicochemical and biological properties. For the analysis, the Kjeldahl method was used to determine the nitrogen content. The composition of the formed crystals was analyzed by IR spectroscopy. The structure and shape of cobalt, nickel and manganese crystals were determined using a microscope. The identity of the obtained compounds was confirmed by IR spectroscopy and microscopic analyses. We can conclude that valine in the complex is coordinated to metal ions through the oxygen atoms of the carboxyl and nitrogen groups of the amine groups.

Efectividad y seguridad de los fármacos biológicos y las moléculas pequeñas en la hidradenitis supurativa: experiencia en un centro terciario y propuesta de un algoritmo terapéutico

IntroductionHidradenitis suppurativa is an occasionally devastating inflammatory skin disease. Currently, adalimumab is the only approved biological or small molecule medication for its treatment. ObjectivesTo evaluate the efficacy and safety of biological or small molecule drugs other than adalimumab, with the ultimate goal of proposing a standardized therapeutic algorithm. MethodsA retrospective study was conducted with all biological or small molecule drugs other than adalimumab in a tertiary hospital. Objective and subjective measurements were recorded through an analysis before (prior to the introduction of the medication) vs. after (withdrawal of the medication or end of the study period). ResultsBetter response rates than adalimumab were found in most of the objective response items (Hurley, IHS4, HSSI, modified Sartorius) and subjective response items (DLQI, pain, itching, sexual relationships, therapeutic satisfaction) with infliximab leading, followed by ustekinumab, brodalumab, and secukinumab.

Perianal disease: Updates and controversies in closing the gaps

Perianal complications are common and morbid in children with Crohn’s disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation and management. We focus on updates such as the increasing frequency of biologic medications and MRI for evaluation. We also highlight controversies on the timing and approaches to surgical techniques. Finally, perianal disease requires the coordination of multidisciplinary care with nursing, radiology, gastroenterology, and surgery to optimize outcomes – both medical and patient-centered.

المراقبة الدوائية العلاجية للإنفلاكسيماب في المرضى العراقيين المصابين بمرض كرون

Background: Inflammatory bowel disease (IBD) is a collection of chronic, recurrent inflammatory illnesses of the gastrointestinal system, including Crohn's disease (CD). Infliximab is one of the biological medications used to treat CD. Therapeutic drug monitoring has evolved as a treatment in IBD, aiming to optimize benefit while meeting more demanding, objective end criteria. Objective: To determine the achievement of target trough level (TL), develop anti-drug antibodies (ADAs) to infliximab, assess response to therapy, and study TL relations with different variables. Methods: The present study was cross-sectional and conducted from May 2022 to November 2022. It included 40 CD patients allotted into 2 groups: group 1 patients achieved the TL target, and group 2 patients did not achieve the TL target. Results: Twenty-two patients achieved target TL, while 18 patients did not. Dose escalation is recommended for 11 patients, switching therapy for 15 patients, and continuing the same dosage regimen for 14 patients. In addition, erythrocyte sedimentation rate, C-reactive protein, serum calprotectin and ADAs were significantly lower in patients who achieved target infliximab TL. Only serum calprotectin can be used to predict the achievement of the target TL of infliximab. Conclusions: Therapeutic drug monitoring of infliximab to determine the TL and ADAs can help to explain why some patients do not respond to this drug. Serum calprotectin may be used as a novel marker to predict the TL and response to infliximab.

Impact of pharmacist-driven referral to increase specialty pharmacy prescription capture.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To assess the impact of a clinical pharmacy specialist (CPS) embedded within a rheumatology clinic at a large academic medical center on the prescription capture rate at the health-system specialty pharmacy. Initially low prescription capture rates for the health-system specialty pharmacy led to the integration of a CPS in the main campus rheumatology clinic. Benchmarking was completed by assessing the prior prescription capture rate using electronic medical record analytics and Loopback Analytics (a database of prescription capture for the health-system specialty pharmacy). The existing workflows for both the rheumatology clinic and specialty pharmacy were observed with regard to biologic medication ordering and processing. Strategies for an updated workflow for biologic ordering with the incorporation of an embedded CPS in the rheumatology clinic were designed. This new workflow was established with key stakeholders, including the CPS, rheumatology providers, clinic staff, and pharmacy technicians. Once the workflow was established, all parties were educated and updated, including rheumatology providers, nursing staff, and specialty pharmacy staff. Prescription capture rate was monitored on a monthly basis. Prescription capture increased from 13.16% before pharmacist implementation (October to December 2021) to 35.42% after pharmacist implementation (October to December 2022) (P = 0.019). During the same periods, the revenue generated increased from $43,222.89 to $135,198.70 (P = 0.224) and the proportion of prescriptions initially sent to the health-system specialty pharmacy compared to other specialty pharmacies increased from 37% to 79% (P < 0.001) with CPS implementation. Expansion and implementation of pharmacy services by integrating a CPS in a rheumatology ambulatory clinic increased prescription capture and pharmacy revenue while optimizing patient care. We hope to expand similar CPS services to other clinics within the health system.

Assessing the Efficacy of Active Learning to Support Student Performance Across Undergraduate Programmes in Biomedical Science.

Introduction: Active learning is a useful tool to enhance student engagement and support learning in diverse educational situations. We aimed to assess the efficacy of an active learning approach within a large interprofessional first year Medical Cell Biology module taken by six healthcare programmes across the School of Biomedical Sciences at Ulster University, United Kingdom. Materials and methods: An active learning approach was developed for weekly formative assessment using Smartwork to design a weekly interactive multiple-choice quiz to reinforce key concepts specifically for each lecture. We tracked and assessed student performance in the module overall and in each element of course work and exam for 2years prior to and following the introduction of an active learning strategy to engage and support learning for students from all academic backgrounds and abilities. Results: Full engagement with active learning was significantly associated with an increased overall module performance as well as a significantly increased performance in each element of class test (No engagement vs. Full engagement, p < 0.001), exam (No Engagement vs. Full engagement, p < 0.05) and coursework (No engagement vs. Full engagement, p < 0.001) within this overall total (No Engagement vs. Full engagement, p < 0.01). Partial engagement with active learning was associated significantly improved class test (No engagement vs. partially engaged, p < 0.001) and coursework (No engagement vs. partially engaged, p < 0.05) performance. While a trend toward increased performance in exam and overall module mark was observed, these were not significant. Discussion: Active learning is a useful tool to support student learning across a range of healthcare programmes taken by students with differing backgrounds and academic abilities in an interprofessional and widening participation setting. Student engagement in active learning was highlighted as a key contributory factor to enhanced student performance in all aspects of assessment.

Biologic immunomodulatory medications and autoimmune cytopenias: A cross-sectional analysis of a national surveillance database

Biologic immunomodulatory medications and autoimmune cytopenias: A cross-sectional analysis of a national surveillance database

Development of an integrated and project-based laboratory course in upper-level biochemistry and molecular biology.

An integrated and projected-based laboratory course was described, integrating interconnected knowledge points and biochemistry and molecular biology techniques on a research project-based system. The program, which served as an essential extension of theoretical courses to practice, was conducted with a sophomore of basic medical science who had completed the course in medical biochemistry and molecular biology. This course engaged students in learning "genetic manipulation" and "recombinant DNA technology" to understand the target gene's role in disease mechanics, thus altering evaluation and treatment for clinical disease. Students could master applied and advanced techniques, such as cell culture, transfection, inducing exogenous fusion protein expression, purifying protein and its concentration assay, quantitative polymerase chain reaction, and western bot analysis. This laboratory exercise links laboratory practices with the methods of current basic research. Students need to complete the experimental design report and laboratory report, which could be advantageous for improving their ability to write lab summaries and scientific papers in the future. The reliability and validity analyses were conducted on the questionnaire, and we examined students' satisfaction with the course and their gains from the course. The student feedback was generally positive, indicating that the exercise helped consolidate theoretical knowledge, increase scientific research enthusiasm, and provide a powerful tool to be a better person and make informed decisions.

Unraveling Atopic Dermatitis: Insights into Pathophysiology, Therapeutic Advances, and Future Perspectives.

Atopic dermatitis (AD) is an inflammatory skin condition that frequently develops before the onset of allergic rhinitis or asthma. More than 10% of children are affected by this serious skin condition, which is painful for the sufferers. Recent research has connected the environment, genetics, the skin barrier, drugs, psychological factors, and the immune system to the onset and severity of AD. The causes and consequences of AD and its cellular and molecular origins are reviewed in this paper. The exploration of interleukins and their influence on the immunological pathway in AD has been facilitated by using relevant biomarkers in clinical trials. This approach enables the identification of novel therapeutic modalities, fostering the potential for targeted translational research within the realm of personalized medicine. This review focuses on AD's pathophysiology and the ever-changing therapeutic landscape. Beyond the plethora of biologic medications in various stages of approval or development, a range of non-biologic targeted therapies, specifically small molecules, have emerged. These include Janus kinase (JAK) inhibitors like Baricitinib, Upadacitinib, and Abrocitinib, thus expanding the spectrum of therapeutic options. This review also addresses the latest clinical efficacy data and elucidates the scientific rationale behind each targeted treatment for atopic dermatitis.

Verification of the analytical performance of the serum CA 125 assay on the Abbott Alinity ci®: Experience of the biochemistry laboratory of the Mohammed VI university hospital of Oujda

The aim of our work was to evaluate the analytical performance of CA 125 determination by a two-step immunoassay using microparticle chemiluminescence immunoassay (CMIA) technology, in accordance with the Scope A criteria of the guide of the verification/validation of medical biology methods. We evaluated the repeatability and the intermediate precision of the CA 125 assay.The results obtained are very satisfactory for the three levels (low, medium and high), both for intermediate fidelity, with coefficients of variation (CV) of 2.68%, 1.62% and 2.11% respectively, and for repeatability, with coefficients of variation of CV1 = 2.17%, CV2 = 2.04%, and CV3 = 1.38% respectively. The results obtained made it possible to verify the method's performance and compare it with the analytical objectives set in order to meet the regulatory and normative requirements set by the supplier and learned societies. The achieved results facilitated the verification of the method's performance and its comparison with the analytical objectives established, aligning with regulatory and normative requirements outlined by the supplier and relevant professional learned societies.

Prescribing Practices and Barriers of Biologics for Chronic Rhinosinusitis Amongst Otolaryngologists.

Biologics for chronic rhinosinusitis with nasal polyposis (CRSwNP) are an evolving therapeutic option, but there are limited data on physician experiences in prescribing them. The goal of this study was to gain a better understanding of these experiences including prescribing practices, patient factors which guide prescriber decision, and physician and patient-reported issues which might limit cost-effectiveness of these therapies. A survey was distributed to attending otolaryngologists using the Canadian Society of Otolaryngology (CSOHNS) email distribution and eSurvey program. Responses were tabulated for the entire cohort and compared between rhinologists and non-rhinologists where appropriate. Frequencies and proportions were expressed as a percentage of total respondents. Fisher's exact test was used for statistical analysis between groups. Seventy-nine total survey responses were recorded representing a response rate of 43%. Significantly more rhinologists reported prescribing biologic medications on their own (100% vs. 50%; p < 0.001) and a higher proportion (1 to 10% vs. <1%) of their patients were on biologics compared with non-rhinologists (p = 0.023). Rhinologists were more likely to consider poor response to medical therapies, need for rescue steroids, and comorbid type 2 conditions in their decision to pursue biologics than non-rhinologists, but they also experienced poorer assistance from patient support programs and less availability to medications. Rhinologists are more comfortable with prescribing and managing biologics for CRSwNP compared with non-rhinologist colleagues. Clinicians prescribing biologic medications for CRSwNP should be familiar with guidelines, indications, and potential adverse events. N/A Laryngoscope, 2024.

Synthesis of current data on typhoid fever

Typhoid fever is an infectious disease that affects millions of people around the world. It is most often encountered in developing countries where hygiene conditions are poor. Mortality is estimated between 1 and 4% in children over 5 years old and in adults. The sources of contamination are varied with several phases contributing to the penetration of the responsible germ into the human body. For adequate management of the infection, the medical biology laboratory remains essential for the isolation and identification of the germ responsible for the disease through increasingly specific examinations. This work aims to make a bibliographical synthesis on the responsible germ, its physiopathology as well as the different laboratory techniques for isolating the bacterium of the genus Salmonella. To do this, a literature review was carried out in scientific databases with keywords for this purpose.

Use of Efficiency Frontiers to Align Prices and Clinical Benefits of Biologic Therapies for Plaque Psoriasis.

The US lacks a systematic approach for aligning drug prices with clinical benefit, and traditional cost-effectiveness analysis (CEA) faces political obstacles. The efficiency frontier (EF) method offers policymakers an alternative approach. To assess how the EF approach could align prices and clinical benefits of biologic medications for plaque psoriasis and estimate price reductions in the US vs 4 peer countries: Australia, Canada, France, and Germany. This health economic evaluation used the EF approach to compare the prices and clinical benefits of 11 biologics and 2 biosimilars for plaque psoriasis in the US, Australia, Canada, France, and Germany. Data were collected from February to March 2023 and analyzed from March to June 2023. EFs were constructed based on each biologic's efficacy, measured using the Psoriasis Area and Severity Index (PASI) 90 response rate, and annual treatment cost as of January 2023; US costs were net of estimated manufacturer rebates. Prices based on the EF were compared with traditional CEA-based prices calculated by the Institute for Clinical and Economic Review at a threshold of $150 000 per quality-adjusted life-year gained. Among 13 biologics, PASI 90 response rates ranged from 17.9% (etanercept) to 71.6% (risankizumab); US net annual treatment costs ranged from $1664 (infliximab-dyyb) to $79 277 (risankizumab). The median (IQR) net annual treatment cost was higher in the US ($34 965 [$20 493-$48 942]) than prerebate costs in Australia ($9179 [$6691-$12 688]), Canada ($15 556 [$13 017-$16 112]), France ($9478 [$6637-$11 678]), and Germany ($13 829 [$13 231-$15 837]). The US EF included infliximab-dyyb (PASI 90: 57.4%; annual cost: $1664), ixekizumab (PASI 90: 70.8%; annual cost: $33 004), and risankizumab (PASI 90: 71.6%; annual cost: $79 277). US prices for psoriasis biologics would need to be reduced by a median (IQR) of 71% (31%-95%) to align with those estimated using the EF; the same approach would yield smaller price reductions in Canada (41% [6%-57%]), Australia (36% [0%-65%]), France (19% [0%-67%]), and Germany (11% [8%-26%]). Except for risankizumab, the EF-based prices were lower than the prices based on traditional CEA. This economic evaluation showed that for plaque psoriasis biologics, using an EF approach to negotiate prices could lead to substantial price reductions and better align prices with clinical benefits. US policymakers might consider using EFs to achieve prices commensurate with comparative clinical benefits, particularly for drug classes with multiple therapeutic alternatives for which differences can be adequately summarized by a single outcome measurement.

Réforme du troisième cycle des études médicales en France

The reform of the third cycle of medical studies was implemented in 2017. Its main objective was the professionalization of training allowing young doctors to establish themselves as specialized medical doctors upon obtaining their specialized studies diploma (DES) which is the only diploma. The number of DES increased from 30 to 44: 13 DES in surgical specialties, 30 DES in medical specialties, and the DES in Medical Biology. The DES are divided into three phases: a one-year base phase which takes place in services that recruit frequent pathologies in the specialty and can guarantee close supervision, a 2 to 3-year in-depth phase which corresponds to the former intern status, and a consolidation phase of one to two years. The student's competencies are evaluated at the end of each phase. At the end of the in-depth phase, the student must have defended his thesis to move on to the consolidation phase and obtain the title of Junior Doctor. The choice of internships is made according to the ranking for the foundation and in-depth phases and according to a matching procedure by mutual consent for the consolidation phase. The options and specialized transversal training (FST) are training courses which allow the acquisition of skills complementary to those acquired within the framework of the DES. These are named options when they are specific to a DES, and FST when they are shared between several DES (26 different FST). A postgraduate student can only follow one option or FST. Since November 2023, it has been possible to follow training to obtain a second DES, from three years of practice after obtaining the first DES. The second DES replaces the first. It is also possible to obtain a new option or FST while retaining its original DES.

Electrochemical Acetylcholinesterase Sensors for Anti-Alzheimer's Disease Drug Determination.

Neurodegenerative diseases and Alzheimer's disease (AD), as one of the most common causes of dementia, result in progressive losses of cholinergic neurons and a reduction in the presynaptic markers of the cholinergic system. These consequences can be compensated by the inhibition of acetylcholinesterase (AChE) followed by a decrease in the rate of acetylcholine hydrolysis. For this reason, anticholinesterase drugs with reversible inhibition effects are applied for the administration of neurodegenerative diseases. Their overdosage, variation in efficiency and recommendation of an individual daily dose require simple and reliable measurement devices capable of the assessment of the drug concentration in biological fluids and medications. In this review, the performance of electrochemical biosensors utilizing immobilized cholinesterases is considered to show their advantages and drawbacks in the determination of anticholinesterase drugs. In addition, common drugs applied in treating neurodegenerative diseases are briefly characterized. The immobilization of enzymes, nature of the signal recorded and its dependence on the transducer modification are considered and the analytical characteristics of appropriate biosensors are summarized for donepezil, huperzine A, rivastigmine, eserine and galantamine as common anti-dementia drugs. Finally, the prospects for the application of AChE-based biosensors in clinical practice are discussed.

Longitudinal Measurements of Blood Biomarkers in Patients with Crohn's Disease or Ulcerative Colitis Treated with Infliximab: Only the Latest Values in the Induction Period Predict Treatment Failure.

Background: Few studies have incorporated longitudinal assessments or used combinations of blood biomarkers as predictors of loss of response to biologic therapy for patients with Crohn's disease (CD) or ulcerative colitis (UC). Methods: This is a population-based cohort study comprising Danish patients with CD or UC from 2008 to 2018. We used logistic regression to analyze whether levels and changes in levels of C-reactive protein (CRP), serum albumin, and hemoglobin, routinely measured during a 14-week infliximab induction period, predicted a change to another biologic medication or cessation of biologic therapy. Results: During the induction period, 2883 (1626 CD, 1257 UC) patients had 12,730, 12,040, and 13,538 specimens with CRP, serum albumin, and hemoglobin, respectively. In all, 284 patients (9.9%) switched to another biologic medication, and 139 (4.8%) ceased biologic therapy in the follow-up period. Only the most recent CRP and hemoglobin levels predicted the efficacy of infliximab treatment at approximately 14 weeks, a time point when the clinician often determines whether to continue treatment. Conclusion: Measurement of blood biomarkers prior to the clinical assessment does not predict the effectiveness of infliximab.

Seroprevalence of Rubella in Pregnant Women at the Military Hospital Oued Eddahab Agadir, Morocco

Rubella is an epidemic rash that is generally benign, but dangerous for pregnant women in the early stages of pregnancy, due to the teratogenic power of the virus. It causes spontaneous abortion, fetal death, premature delivery and congenital malformations known as congenital rubella syndrome (CRS). The aim of this study was to determine the rubella immune status in all pregnant women consulting or being tested at the Medical Biology Department of the Oued Eddahab Military Hospital in Agadir. An 18-month retrospective cross-sectionnal study was conducted from January 1, 2022 to June 30, 2023 to assess the IgG seroprevalence of rubella in 1393 pregnant women aged 19 to 43 years old of any gestationnal age using the Architect i1000SR Analyzer. Of the 1393 pregnant women tested, 1184 (85%) were seropositive. Despite of the vaccination recommandations after their anterior pregnancy, 07% of multiparous remained seronegativ. Preventive measures against congenital rubella must be reinforced and vaccination awareness campaigns, particularly for unimmunized multiparous women, remain essential.

Vaccination recommendations for adults receiving biologics and oral therapies for psoriasis and psoriatic arthritis: Delphi consensus from the medical board of the National Psoriasis Foundation

For psoriatic patients who need to receive nonlive or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving nonlive or live vaccines. Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. Key recommendations include continuing most oral and biologic therapies without modification for patients receiving nonlive vaccines; consider interruption of methotrexate for nonlive vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of livevaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4weeks after live vaccination. Studies regarding infection rates after vaccination are lacking. Interruption of antipsoriatic oral and biologic therapies is generally not necessary for patients receiving nonlive vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases.

Investigation of the effect of belinostat on MCF-7 breast cancer stem cells via the Wnt, Notch, and Hedgehog signaling pathway.

To evaluate belinostat's (PXD101) activity on MCF-7 breast cancer stem cells (CSCs) via Wnt, Notch, and Hedgehog. This research study was carried out at the Department of Medical Biology, Necmettin Erbakan University, Konya, Turkey, from June 2017 to July 2019. The effect of PXD101 on MCF-7 cell viability was determined by cell proliferation kit (XTT). Following belinostat treatment, CD44+/CD24- MCF-7 CSCs were isolated by FACS. Ribonucleic acid isolation and copy-deoxyribonucleic acid synthesis were carried out using HEK-293 cells, MCF-7 cells, and MCF-7 CSCs. Expression changes of metastasis-related genes, Wnt, Hedgehog, Notch, and stem cell markers were analysed by quantitative polymerase chain reaction. The IC50 in MCF-7 cancer cells was 5 μM for 48 hours. The FACS analysis indicated that 2% of the MCF-7 cancer cells were CSCs. Following belinostat treatment, the MCF-7 cell count decreased by 44%, and the MCF-7 CD44+/CD24- CSC count decreased by 66%. Belinostat treatment reduced the expression of metastasis, Wnt, Notch, Hedgehog, and stem cell marker genes. Belinostat has a potential effect on the differentiation and self-renewal of breast CSCs.

EPISODE OF CARE MODEL PROVIDES A MORE ACCURATE ESTIMATE OF COSTS FOR PATIENTS WITH IBD COMPARED TO THE TRADITIONAL CALENDAR YEAR MODEL

Abstract INTRODUCTION Inflammatory bowel diseases (IBD) are gastrointestinal (GI) conditions characterized by chronic inflammation of the digestive tract, which are associated with significant costs. Traditionally, research has focused on the overall costs of a disease per calendar year, however examining the cost of a specific illness-related index event and the surrounding episode of care may provide a more representative estimate of the costs of care and identify opportunities for targeted value-based interventions. METHODS We conducted a cohort study using data from IBM Watson, a claims-based database covering millions of commercially insured individuals. We identified adult patients aged 18 to 65 years with encounters associated with a primary or secondary diagnosis of IBD from 01/01/2018 to 12/31/2019 based on ICD-10 codes. We defined an episode of care as 360 days of continuous care (90 days prior to the index event to 270 days after such event) around an emergency room (ER) visit, gastroenterologist visit, and non-gastroenterologist GI visit (which could include a visit to a PCP, rheumatologist, dietician, and other services attributable to IBD symptoms). Measures of cost and utilization were calculated as a per member mean over 360 days. RESULTS 105,496 IBD patients with 1 year of continuous enrollment between 01/01/2019 to 12/31/2019 (calendar year cohort) and 81,774 patients with 2 years of continuous enrollment between 1/1/2018-12/31/2019 (episode of care cohort) were identified. Among IBD patients identified in the episode of care cohort, 13,164 (16.1%) patients had an IBD-related ER visit, 42,001 (51.4%) patients had a gastroenterologist visit, and 28,699 (35.1%) patients had a non-gastroenterologist GI visit. The mean per member calendar year total cost and GI-related costs were $40,842 and $31,051 respectively, compared to $68,0565 and $54,060 for an ER episode, $42,915 and $34,870 for gastroenterologist visit episode, and $48,556 and $38,120 for a non-gastroenterologist GI visit episode. Per member GI inpatient admissions (0.84), GI ER visits (1.98), GI-tests (5.90), and GI-imaging (0.91) were highest in the ER episode of care. Per member gastroenterologist visits (2.20), GI-related medication administration services (1.22) and biologic medication (1.41) were highest in the gastroenterologist episode of care. Per member non-gastroenterologist GI visits (4.50), and non-biologic GI medications (8.26) were highest in the non-gastroenterologist GI visits episode of care (Table 1 and 2). CONCLUSION This study found large variations in costs and utilization when looking at IBD- specific episodes of care. This episode-centered approach provides insights for developing targeted strategies to identify and intervene at the critical moments when patients seek advanced care, which may lead to patient-centered and cost-efficient healthcare delivery.