Gastroenterology Clinic Research Articles

S53 Barriers to Coordinating Proactive Therapeutic Drug Monitoring: A Qualitative, Descriptive Study at a Pediatric Gastroenterology Clinic With a Rural Catchment

S53 Barriers to Coordinating Proactive Therapeutic Drug Monitoring: A Qualitative, Descriptive Study at a Pediatric Gastroenterology Clinic With a Rural Catchment

Chronic ischemia in Left anterior descending artery territory presenting as intractable hiccups: An unusual symptom of coronary artery disease.

Classical symptoms of ischemic heart disease include exertional chest pain associated diaphoresis, palpitations or shortness of breath. Yet, it can also present unusually with symptoms ranging from epigastric discomfort, fatigue and vomiting. A 48 years old male presented to the hospital with severe retrosternal chest pain for 6 hours duration. ECG showed acute anterior wall STEMI. Primary PCI to LAD was performed successfully. He had been complaining of intractable hiccups for the past one year for which he had been seen in gastroenterology clinics multiple times with no relief in hiccups. After we performed primary PCI to LAD, he had complete resolution of hiccups. He is still under regular follow up with us for the past 4 months with no active complaints of hiccups. This case conclude that Intractable hiccups can be the only symptomatic manifestation of coronary artery disease (CAD) in some patients. Therefore, a high suspicion of CAD should be kept in mind especially in patients with risk factors for CAD.

Chest Pain in Young Patients (5-15 Years) Referred to Pediatric Cardiology Outpatient Clinic

Background: Chest pain is the communal complaint among pediatric age groups. Chest pain due to heart disease is rare in children and adolescents, with an incidence of less than 6%. History and physical examination may be sufficient to identify the most important etiologies. Aim: The aim of the study is to review various causes of chest pain in young patients admitted to a pediatric cardiology clinic. Method: We retrospectively analyzed the clinical data of our patients visited to emergency or outpatient clinics in our hospital with chest pain from March 2022 to October 2022. A total of 56 patients (36 females and 20 males), aged 5-15 years were included in this study. Follow-up of the patients was carried out by calling all relatives of the patient and asking about the child's condition and chest pain. Clinical history and physical examination were performed. Results: A total of 56 patients between the ages of 5 and 15 were enrolled in the study, with a mean age of 11.78 ± 2.95 years. Six cases (10.7%) were identified to have a cardiac cause. 16 individuals (28.6%) had a respiratory cause identified. 3(5.4%) of patients referred to a gastroenterology clinic with gastrointestinal causes. The diagnosis of idiopathic chest pain was made in 6 individuals (10.7%) after a negative history, physical examination, and testing. Conclusion: Chest pain in children is usually mild. However, thorough physical examination and detailed history should be performed to detect any signs of disease. Keywords: Chest pain, Pediatric patients, Echocardiography.

Patient-Centered Access to IBD Care: A Qualitative Study.

Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with IBD with a focus on accessing health care. Using a qualitative descriptive approach, patients diagnosed with IBD (≥18 years of age) were purposively sampled from rural and urban gastroenterology clinics and communities across Canada. Co-facilitated by a researcher and patient research partner, 14 focus groups were recorded, transcribed, and coded for themes. Thematic analysis was used to ascertain the congruence or discordance of IBD specialty care access experiences. A total of 63 individuals participated in the study. The majority of participants were female (41/63, 65%) and from urban/suburban regions (33/63, 52%), with a mean age of 48.39 (range 16-77 years). The analysis generated three main themes: (1) need for patient to be partner, (2) adapting IBD care access to individual context, and (3) patient-defined care priorities should guide access to IBD care. The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the impact of these factors on accessing care. Using a patient-centered exploration of barriers and facilitators, IBD specialty care access in Canada can be better understood and improved on provincial and national levels.

Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study.

ObjectiveThe National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon...

Special Considerations for the Management of Disorders of Gut-Brain Interaction in Older Adults.

The world's population is aging rapidly, with 40% of patients seen in US gastroenterology (GI) clinics being 60years or older. Many gastrointestinal problems are more common or unique to the older adult because of progressive damage to the structure and function of the GI tract. Until recently, the epidemiology of disorders of gut-brain interaction (such as irritable bowel syndrome and functional dyspepsia) was not well-characterized. Forty percent of persons worldwide have disorders of gut-brain interaction (DGBI), with varying global patterns of incidence in older adults. There are multiple first-line approaches to managing DGBI which can also be combined including pharmacologic (e.g., neuromodulators) and nonpharmacologic approaches including dietary therapies and brain-gut behavioral therapies. However, there are considerations clinicians must account for when offering each approach related to unique biopsychosocial factors in the older adult population. In this review, we aim to critically review recent literature on the pathophysiology, epidemiology, and special considerations for diagnosing and managing DGBI in the older adult population. There have been many advances in the management of DGBI over the past decades. Given the increase in the number of older adults in the USA and worldwide, there is an urgent need for evidence-based guidance to help providers guide comprehensive care for specifically our aging patient population with respect to DGBI.

Inflammatory bowel disease type influences development of elevated liver enzymes.

Up to a third of patients with inflammatory bowel disease (IBD) have elevated liver enzymes (ELE). We evaluated the incidence, predictors, and outcomes associated with ELE in a diverse and vulnerable IBD cohort. We retrospectively evaluated 336 IBD patients receiving care at the San Francisco safety net gastroenterology clinics between June 1996 and December 2019. Baseline characteristics were captured at first visit, then patients were followed until last clinic activity or death. Testing and etiology, pattern of ELE defined as transient (<1month) or persistent (≥1month), were assessed. Multivariate modeling evaluated predictors of ELE at baseline, new ELE at follow-up, and pattern of ELE. Baseline median age was 40.3 years, 62% male, 46% White (13% Black, 19% Asian, and 18% Latino), and 59% had ulcerative colitis (UC). Among those without known liver disease (n= 14), 51.6% (166 of 322; 52 at baseline, 114 during follow-up) had ELE. In multivariate logistic regression, 5-aminosalicylic acid use (odds ratio [OR] 2.2, 95% confidence interval [CI]: 1.07-4.4, P= 0.03) and higher body mass index (OR 1.08, 95% CI: 1.02-1.14, P= 0.01) were associated with baseline ELE. In multivariate Cox regression, UC (vs. Crohn's disease [CD]) had a 34% lower risk of developing new ELE during follow-up (hazard ratio [HR] 0.66, 95% CI: 0.46-0.95, P= 0.02). Mortality rate was higher for patients with ELE (0% normal vs 2.3% transient ELE vs 6.5% persistent ELE, P< 0.001). ELE is prevalent in IBD, especially in CD, and associated with higher rates of mortality. Identification and management of ELE particularly when persistent are important to IBD outcomes.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Jocelyn A. SilvesterJocelyn A. SilvesterDr Jocelyn A. Silvester, MD PhD, is Assistant Professor of Pediatrics at Harvard Medical School, USA, and Director of Research for the Celiac Disease Program at Children's Hospital (BCH) in Boston, Massachusetts, USA. She also maintains a general pediatrics practice in Northern Manitoba and Nunavut through the Ongomiizwin Health Services JA Hildes Northern Medical Unit. Dr Silvester completed her PhD in Biology at the University of Cambridge in England, UK, where she studied mitochondrial ATP synthase under the supervision of Professor Sir John E. Walker. She earned her medical degree from Dalhousie University in Canada and completed her residency in general pediatrics at the University of Manitoba, Canada. She came to the United States for pediatric gastroenterology fellowship training at Boston Children's Hospital. Dr Silvester is co-Chair of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Celiac Disease Special Interest Group and serves on the American Gastroenterological Association Council for section for basic and clinical intestinal disorders. Her research interests include the diagnosis and management of celiac disease with a particular interest in what happens after the diagnosis of celiac disease is made. She is co-Investigator on the Manitoba Celiac Disease Cohort Study, involved in clinical trials for alternative therapies to a gluten-free diet and is leading a consortium of pediatric celiac centers across the United States to develop tools to improve follow-up care. Tilak U. ShahTilak U. ShahDr Shah is an Associate Professor of Medicine at Virginia Commonwealth University (VCU) Health Science Center, USA, as well as Director of Endoscopy and Interventional Endoscopy at the Central Virginia VA Healthcare system in Richmond, VA, USA. He serves as Associate GI Fellowship Program Director at VCU, and is a member of the Development and Therapeutics section of VCU Massey Cancer Center. Dr Shah graduated from the University of North Carolina (UNC) at Chapel Hill, USA, in 1997, and UNC School of Medicine in 2006. He completed internal medicine residency and fellowship training in gastroenterology at Duke University Medical Center, USA. Dr Shah also obtained a master's degree in clinical research from the Duke-NIH Clinical Research Training Program, and underwent formal training in Advanced Endoscopy at Emory University Medical Center, USA. He joined the medical faculty at Virginia Commonwealth University in 2014. Dr Shah has served on American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), and Veterans Administration (VA) Committees. He has served as a reviewer for several journals including American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, World Journal of Gastroenterology, and Cochrane Database of Systematic reviews, and is section editor for Current Opinion in Gastroenterology. Dr Shah's research interests involve endoscopic approaches to diagnose and treat esophageal and colorectal neoplasia, including advanced imaging, artificial intelligence, endoscopic resection, and cryotherapy. Dr Shah is the recipient of research awards from the ASGE and McGuire Research Institute, and is site investigator for VA Co-Operative and Merit studies. He is an author on over 30 original papers, and has authored two board preparation textbooks, “NMS Medicine Casebook,” and “Acing the Pancreaticobiliary Questions on the GI Boards.”

Varicella-zoster virus infection and autonomic dysfunction.

Autonomic dysfunction has been occasionally described in varicella-zoster virus (VZV) infection, while few systematic reviews are available. We systematically review autonomic dysfunction due to VZV infection. This study followed the PRISMA guideline, and three databases were researched and included cross-sectional studies in full-length publications in the English language using appropriate search keywords. A total of 102 articles were identified initially; finally 45 studies were used for review, comprising pupillomotor dysfunction in 4, sudomotor dysfunction in 2, cardiovascular dysfunction in 2, gastrointestinal dysfunction in 14, and urogenital dysfunction in 23. They can be summarized as (1) VZV infection rarely produces orthostatic hypotension, which involves diffuse sympathetic dysfunction by polyneuropathy. (2) In contrast, VZV infection produces dysfunction of the bladder and the bowel, which involves segmental parasympathetic or sympathetic dysfunction by dorsal root ganglionopathy. Awareness of VZV-related autonomic dysfunction is important, because such patients may first visit a gastroenterology or urology clinic. Close collaboration among neurologists, dermatologists, gastroenterologists, and urologists is important to start early antiviral agents and maximize bowel and bladder care in such patients.

Endosonografia a elastografia v diagnostike neuroendokrinných nádorov pankreasu

Summary: Introduction: The group of neuroendocrine tumors derived from pancreatic cells is called pancreatic neuroendocrine tumors (PNETs). The combination of EUS and elastography (EG) expands diagnostic and imaging capabilities. Aim: The aim of our work was to determine the representative images of B-mode for PNET, evaluation of a typical EG image of PNETs, use of strain ratio (SR) and “strain histogram” (SH) in differential diagnosis of PNETs, determination of SR and SH cut off value for PNETs and comparison of standardized measurements with literature. Methods: Patients examined at the Internal Gastroenterology Clinic were included in the cohort. A total of 31 patients were examined. The group included 25 patients (8 men, 17 women). The mean age in group was 52.76 years (14–74). Non-invasive examination by endoscopic ultrasonography was performed on all patients. After locating the lesion by ultrasound, the first recording was made after freezing the image in B-mode and performing size measurement. Subsequently, a Strain elastography measurement was performed. In the monitored group we recorded an average size of 12.75 mm. Results: The characteristics of the image in B-mode were as follows for PNETs 68% hypoechogenic, 12% hyperechogenic, 12% isoechogenic and 8% mixed echogenicity. 80% of PNETs in B-mode were sharply demarcated and 20% with blurred borders. The accuracy of the value assignment typical of pancreatic malignancies using elastography was 96% for PNET in 5-degree classification system and 88% for a 4-degree classification, for SR cut off &gt;3.2 with a sensitivity of 80% and SH cut off &lt;50 100%. Discussion: Given the average tumor sizes observed in our study, EUS provides high sensitivity in PNET diagnostics and allows diagnostics at a time when minimally invasive removal is still possible. In addition to the typical picture of hypoechogenicity and the less frequently described pictures of hyperechogenicity and isoechogenicity for PNET, we also observed mixed echogenicity. The elastographic qualitative strain image evaluated by the four- and five- -degree classification proved to be reliable in distinguishing PNET from benign tumors. In quantitative elastography, the values of SR are between malignant and benign deposits of the pancreas, one of the reasons for such values may be the diversity of this group of diseases with different mitotic activity – grade of the tumor. Conclusion: Consistency of the results published by us, shows the applicability of this method in deciding on a definitive diagnosis if tumor histology is not and cannot be available. Key words: neuroendocrine tumor – pancreas – ultrasonography – elastography

Clinical Implications of the Gastroesophageal Reflux Disease Questionnaire and Reflux Symptom Index in Patients With Suspected Laryngopharyngeal Reflux Symptoms.

Background/AimsTo evaluate the usefulness of gastroesophageal reflux disease questionnaire (GerdQ) and reflux symptom index (RSI) for diagnosis of gastroesophageal reflux disease (GERD) in patients with suspected laryngopharyngeal reflux (LPR) symptoms (cough, hoarseness, globus, and throat pain).MethodsA total of 98 patients with LPR symptoms were incorporated from either gastroenterology or otorhinolaryngology clinic. Patient’s laryngoscopic findings were graded by reflux finding score (RFS), and RFS ≥ 7 was considered as positive LPR. Erosive esophagitis on endoscopy or abnormal results on ambulatory impedance-pH monitoring were used as diagnostic criteria for GERD. Esophageal motor function was evaluated using high-resolution esophageal manometry.ResultsNinety-three (94.9%) of the 98 subjects were diagnosed as LPR by RFS, but only 15 (15.3%) had GERD. For GerdQ, the cutoff value of 9 showed the highest area under curve (AUC) to diagnose GERD by receiver operating curve analysis (AUC = 0.565); the sensitivity, specificity, positive predictive value, and negative predictive value were unsatisfactory (50.0%, 70.7%, 22.6%, and 89.2%, respectively.) RSI also showed poor performance in diagnosing GERD; the cutoff value of 25 showed the highest yield (AUC = 0.581); the sensitivity, specificity, positive predictive value, and negative predictive value were 42.9%, 79.3%, 26.1%, and 89.0%, respectively. Ineffective esophageal motility was frequently observed (69 of 98, 70.4%), but there was no difference in esophageal motility parameters between GERD and non-GERD patients.ConclusionsIn patients with LPR symptoms, significant discrepancies are observed between laryngoscopic diagnosis and GERD. In this population, neither GerdQ nor RSI is useful in diagnosing GERD.

Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

One third of adults experience laryngeal symptoms such as throat clearing and chronic cough and 50-80% of adults seeking care of these symptoms are told that laryngopharyngeal reflux (LPR) is the etiology. LPR results from retrograde flow of gastroduodenal contents to the larynx and pharynx; however, treatment of presumed LPR remains challenging with limited evidence-based guidance. This article summarizes the @GIJournal Twitter discussion of Yadlapati et al, “Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation,” originally published in Clinical Gastroenterology and Hepatology. In this study of 302 patients with chronic laryngeal symptoms referred for reflux evaluation, five distinct phenotypic groups were described, and reflux was only present in two of the proposed phenotypes. LPR and GERD with hiatal hernia (group A); mild LPR/GERD (group B); no LPR/no GERD (group C); reflex cough (group D); and mixed/possible obstructive esophagogastric junction (EGJ) (group E). Phenotypic differences can inform targeted clinical trials design and improve outcomes.

Using the Charlson comorbidity index as a prognostic factor of lower gastrointestinal system bleeding: the experience of a tertiary center

Introduction: Lesions in the gastroinestinal (GI) tract that are distal to the Treitz ligament are what cause the lower gastrointestinal bleeding (LGB) system. The purpose of this study was to investigate and compare the Charlson Comorbidity Index (CCI), mortality rates, length of hospital stays, need for intensive care, need for blood products, and surgical rates in patients with acute LGB. Material and Method: Retrospective research was done on patients who had lower GI bleeding and had been seen in our gastroenterology clinic between 2015 and 2021. We looked into the impact of CCI on patients' follow-up after LGB. Results: The mean age of the 210 patients who had lower GI bleeding was 67.70±13.67 years. For all of the patients, the median CCI value was 4.00. (2.00-5.00). While 16 study participants (group 1) passed away, 194 participants (group 2) were released from the hospital. The variance in the median CCI values between the two groups was statistically significant (p&amp;gt;0.001). The results of a multivariate logistic regression analysis revealed that CCI was a reliable predictor of mortality (p&amp;gt;0.001). Conclusion: It was found that CCI was an accurate predictor of mortality. CCI ought to be regarded as a crucial factor in the treatment of patients who are bleeding from their lower gastrointestinal tract.

An Unusual Cause of Diarrhea in Young Adulthood

Question: A 31-year-old woman presented to the gastroenterology clinic for a second opinion regarding chronic intermittent abdominal pain and alternating diarrhea and constipation for more than 10 years. She occasionally noticed a greasy film on the toilet water, but there was no blood in the stool, rectal pain, or weight loss. She had undergone computed tomographic (CT) imaging about 10 years before presentation for similar symptoms (Figure), and recently underwent esophagogastroduodenoscopy and colonoscopy with normal duodenal and colon biopsies, respectively.

Questionnaire-Based Study of 81 Patients in Poland to Evaluate the Course of Inflammatory Bowel Disease and the Effects of the COVID-19 Pandemic on Quality of Life and Mental State from February to June 2021.

BACKGROUND The COVID-19 pandemic affected many people worldwide, including those with chronic diseases. Our objective was to analyze its influence on medical care and the course of inflammatory bowel disease (IBD) in Poland. MATERIAL AND METHODS In 2021, 81 patients in Poland with IBD completed an original anonymous questionnaire about the impact of the COVID-19 pandemic on the course of their disease and mental status. The printed questionnaire was distributed to IBD patients treated at the Gastroenterology Outpatient Clinic of the University Clinical Hospital in Białystok, and an online questionnaire was sent to patients via social media. Statistical analysis was performed using the chi-squared test, with a significance level of P<0.05. RESULTS The study group consisted of 46 women and 35 men with a mean age of 32.42 years. Fifty-nine patients had ulcerative colitis and 22 had Crohn disease. Patients reported significant deterioration in medication availability (50.62%) and restricted access to gastroenterology outpatient clinics (51.90%) (P<0.05). Of patients who contracted COVID-19, 89.47% did not require hospitalization, 32.10% (26/81) were asymptomatic, mild, or moderate, despite immunosuppressive biological treatment (27.16%, 22/81), or steroids (18.52%, 15/81). Over 50% of respondents stated the pandemic negatively affected their mental state and 30% of them associated that with worsening IBD. CONCLUSIONS During the pandemic, respondents were mainly concerned with difficulties in accessing the gastroenterology clinic and limited drug availability. The pandemic negatively affected patients' mental state. In cases of COVID-19 disease, patients with IBD were mostly asymptomatic and did not require hospitalization, despite therapy affecting the immune system.

Association between Dietary Habits and Helicobacter pylori Infection among Bahraini Adults.

Helicobacter pylori (H. Pylori) infection is the main bacterial cause of several gastrointestinal disorders. This study aims to estimate the prevalence of H. pylori infection in a population of Bahraini adults seeking care in gastroenterology clinics in a tertiary care hospital in the Kingdom of Bahrain and examine the association between dietary habits and other factors with H. pylori infection. The study is a hospital-based retrospective, cross-sectional analytical study that included 200 participants. H. pylori infection prevalence among the studied group was 55.5%, and it was significantly higher among participants with a high school education or less (44.1%). Among dietary habits, the mean of frequency of green tea, coffee and honey intake was significantly lower among the H. pylori infected participants compared to their non-infected counterparts. H. pylori infection was significantly higher among participants with vitamin D deficiency (63.6%) compared to participants with normal vitamin D (30%) (p = 0.001) and each unit decrease in serum vitamin D was associated with an increased risk of infection by 1.1 times (OR = 1.1; 95% CI: 1.05, 1.18; p < 0.001). The study revealed that high educational levels, consumption of honey, green tea, and coffee, as well as normal serum vitamin D level, were independent protectors against H. pylori infection. Additional studies are needed to estimate the prevalence and predisposing factors of H. pylori infection in the general population.

Emotional, Behavioral and Social Problems in Children with Fecal Incontinence by Child Behavior Checklist (CBCL): A Cross-sectional Study

Background: Fecal incontinence (FI) is a stressful condition for children and their parents that may affect the patient’s psychological well-being. Evaluating the patients’ psychological status may help physicians manage the disease effectively. Objectives: This study aimed to assess the emotional and behavioral disturbances in children with FI who were referred to the pediatric gastroenterology clinic in Mofid Children’s Hospital from April 2021 to 2022. Methods: This cross-sectional study included children (over four years old) with chronic constipation and fecal incontinence. The diagnosis of chronic constipation and FI were made according to Rome-IV criteria. The Child Behavior Checklist (CBCL) evaluated patients’ emotional, behavioral, and social problems. Results: One hundred one patients with a mean age of 7.96 years were enrolled in the study; 67.32% were males. According to CBCL, 12% (12 patients) indicated emotional and behavioral problems, with CBCL scores in the clinical or at-risk range. We detected anxious/depressed problems in five (4.95%), withdrawn/depressed problems in eight (7.92%), somatic complaints in seven (6.93%), social problems in eight (7.92%), thought problems in nine (8.91%), attention problems in seven (6.93%), rule-breaking behavior in two (1.98%), and aggressive behavior in nine (8.91%) patients. The risk of internalizing and externalizing disorders was reported in four (3.96%) and five (4.95%) patients. Also, eight (7.92%) and seven (6.93%) patients had clinical symptoms of internalizing and externalizing disorders, respectively. There was no significant relationship between patients’ age and gender with the CBCL scores in any subscales. However, there was a significant difference in the total score among the age groups (P = 0.04). Conclusions: The relatively high prevalence of emotional, behavioral, and social problems in our study corroborates the importance of psychological screening of children with FI during the treatment process.

Assessment of telemedicine versus in-person care in managing abdominal pain in children during the COVID-19 pandemic

Objectives The COVID-19 pandemic has led to a dramatic increase in telemedicine care delivery. This raises the question of whether the visit type affects the care provided to patients in the pediatric gastroenterology clinic. The aim of this study is to assess whether diagnostic, treatment, and outcome measures differ between telemedicine and in-person visits in patients seen in pediatric gastroenterology clinics for the chief complaint of abdominal pain. Methods We conducted a retrospective analysis of patients aged 0–22 who underwent their initial pediatric gastroenterology clinic visit, for abdominal pain, between March and September 2020 (n = 1769). The patients were divided into two groups: in-person or telemedicine. Clinical outcome measures were compared from the initial gastroenterology visit and followed for a total of 3 months. Results There was an increase number of images (M = 0.52 vs. 0.36, p < 0.001), labs (M = 4.87 vs. 4.05; p = 0.001), medications (M = 2.24 vs. 1.67; p < 0.001), and referrals (M = 0.70 vs. 0.54; p < 0.001) performed per visit in the in-person group. Electronic communications (3.97 vs. 5.12 p <0.003) was less frequent after in-person visits. There was no difference in number of procedures (M = 0.128 vs. 0.122, p = 0.718), emergency room visits (M = 0.037 vs. 0.017 p = 0.61), follow-up visits (M = 1.21 vs. 1.21 p = 0.922), or telephone encounters (M = 1.21 vs. 1.12 p = 0.35) between the two groups. Conclusion Telemedicine utilizes less resources while having comparable outcome measurements in children with a chief complaint of abdominal pain.

Interprofessional Collaboration Between a Clinical Pharmacist and Specialty Physicians to Treat Hepatitis C in an Interdisciplinary Medical Practice Setting.

Objective: Describes the activities of a clinical pharmacist in a gastroenterology (GI) clinic providing services to hepatitis C virus (HCV) patients, with a focus on practice management activities and tools. Practice Description: Located inside a GI specialty clinic in Fort Worth, Texas, the pharmacist provides comprehensive medication management under a collaborative practice agreement (CPA). Once referred by the GI physician, the pharmacist has face-to-face patient visits, develops the care plan, orders medications, and follows patients through sustained virologic response and the development of a hepatocellular carcinoma surveillance plan. Practice Innovation: The role of pharmacists in the management of HCV is important to understand. This article details a pharmacist-led clinic in an open GI medical practice. Evaluation: A retrospective chart review study was conducted to assess outcomes related to the integration of the clinical pharmacist. Methods: Completed by the study team, this study included manual chart reviews of patients with the ambulatory care pharmacist-driven HCV practice to pull data and information that were then tabulated using Qualtrics. Results: A total of 95 charts were surveyed, 78 records were created, and 49 patients were started on direct-acting antiviral (DAA) treatment by the pharmacist. Patients required multiple pharmacist communication actions. The minimum duration of the pharmacist service was 6 months and could extend more than 9 months depending on the time it took to get the patient started on medication. Pharmacist integration into the practice resulted in improved intake for the GI clinic, improved interprofessional interaction, and increased utilization of newer treatment modalities for HCV which feature cure rates up to 99% with limited side effects. Conclusion: Clinical pharmacists are well positioned to help navigate patients through the complexities of the medication use system, medication access, drug interactions and adverse effects, promote medication adherence, and allow patients to start and complete therapy.

S1521 Sex, Race, and Geographic Disparities Are Prevalent Among Authors and Patients in Prospective Studies Published in Major U.S. Gastroenterology Journals Over the Past Decade

Introduction: Our team investigated geographic and sex representation among authors in addition to sex and racial representation among patients in prospective cohort and randomized-controlled trials published in the major United States-based (US) gastroenterology and hepatology journals from 2010-2021. Methods: Our librarians retrieved articles published in the American Journal of Gastroenterology (AJG), Gastroenterology, Clinical Gastroenterology and Hepatology (CGH), Hepatology, and Gastrointestinal Endoscopy (GIE) from 1/1/2010 through 12/31/2021 through PubMed, Scopus, and Web of Science. We randomly selected 2,749 articles and excluded all retrospective studies, meta-analyses, cross-sectional studies, translational work, and case series (Figure 1, Table 1). We then excluded 707 RCTs and PCs that were missing patient demographic data (eg, sex, race, etc). Categorical variables were compared using chi-square analysis while t-testing was used for numerical variables. All analysis was done using R. Results: We analyzed 244 RCTs and PCs and found US and Canada-based institutions represented 192/244 of lead authors (78.7%, P < 0.01), while the South comprised 71/192 (38.6%, P = 0.22) of the US-based authors. There were no papers from Africa or South America, and just 12 combined (4.9%) from East or South Asia, and North America apart from the US/Canada. Male lead authors (166/244; 68%) comprised the majority in both RCTs (2.8:1, P = 0.03) and PCs (1.5:1, P = 0.03), and in multi-center studies (3:1, P = 0.02) and single center studies (1.3:1, P = 0.02). Lead authorship was not significantly associated with journal editorial board membership. There were 1,401,292 patients, including 885,255 women (63.2%) and 308,010 non-White (21.9%) patients. The mean number of female to male patients was equivalent in 3 of the 5 journals and just above 2:1 in the other 2 journals (AJG, Gastroenterology). The ratio of White patients was significantly higher than that of non-White patients across all 5 journals (4.7:1 in AJG, 3.9:1 in Gastroenterology, 3.1:1 in GIE, 2.2:1 in Hepatology, and 1.6:1 in CGH; P = 0.04) for RCTs and PCs, whether single-center (2.5:1) or multi-center (5.4:1). Conclusion: There are geographic and sex-based disparities among lead authors, and race-based disparities among patients, particularly in multi-center studies and RCTs, which tend to be the most prestigious in clinical research. Further investigation and effort is needed to help address underrepresentation in these areas.Figure 1.: Flow Chart for Article Selection. Table 1. - Baseline Characteristics for Lead Authors and Study Types Variable Number (Percent); n=244 Journal American Journal of Gastroenterology 38 (15.6) Clinical Gastroenterology and Hepatology 72 (29.5) Gastroenterology 69 (28.3) Gastrointestinal Endoscopy 23 (9.4) Hepatology 42 (17.2) Study Type Prospective Cohort 104 (42.6) Randomized-Controlled Trial 140 (57.4) Number of Sites Single-Center 95 (38.9) Multi-Center 149 (61.1) US Geographic Region Midwest 43 (23.4) Northeast 41 (22.3) South 71 (38.6) West 29 (15.8) World Geographic Region East and South Asia 7 (2.9) Europe 30 (12.3) Middle East 3 (1.2) North America (NOT US/Canada) 2 (0.8) Oceania 10 (4.1) US/Canada 192 (78.7) Lead Author Sex Female 78 (32) Male 166 (68) Lead Author on Editorial Board? No 215 (90.3) Yes 23 (9.7) Article's Main Focus Endoscopic Technique 28 (15.1) Liver Disease 101 (51) Pancreatico-Biliary or Gallbladder Disease 20 (10.8) Inflammatory Bowel Disease 24 (13) GI-Based Cancer 24 (13.3) Motility 11 (6.2) Functional GI Disease 27 (14.6) Other GI Issue Not Otherwise Specified 37 (19.2)