Gastroenterology Clinic Research Articles

Parent satisfaction survey in a pediatric ambulatory care clinic utilizing an interprofessional education model

BackgroundInterprofessional education (IPE) is a required component of health professional education in order to produce effective collaborators prior to entering the work force. Little data focus on the use of IPE clinics to assess patient or caregiver satisfaction with or perceptions of interprofessional care in pediatric ambulatory care. PurposeTo determine caregiver satisfaction in a student-led, IPE pediatric gastroenterology (GI) clinic. MethodCaregivers completed an optional survey to assess satisfaction with and perception of IPE care. DiscussionAnalysis included 160 survey responses. The responses were overwhelmingly positive with 100% of caregivers ‘Very happy/satisfied’ with the care of their child and 87% of respondents preferred team-based care to seeing a sole provider. Caregivers perceived the care received to be thorough, time-saving, and valuable. ConclusionsCaregivers are mostly satisfied with a pediatric IPE clinic. More studies are required to assess IPE effects on patient outcomes and caregiver satisfaction in the pediatric ambulatory care setting.

Prevalence of Malnutrition among Pediatric Celiac Disease

Purpose: Celiac Disease (CD) is an autoimmune systemic disorder triggered by gluten in genetically susceptible individuals, which can lead to chronic malabsorption. Considering the changes in the manifestations of CD.The present study was designed to determine the nutritional status and prevalence of malnutrition of celiac disease in children and to investigate the nutritional markers, anthropometric parameters such as body mass index (BMI), meal patterns ,and routine laboratory in celiac disease children
 Methodology: This cross-sectional study aimed to evaluate the children with CD who had referred to Pediatric gastroenterology Clinic between 2021 and 2022. Totally, 40 children were eligible, and their weight, height, and Body Mass Index (BMI) were extracted by interview. The anthropometric indices were presented based on the criteria of the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO). Biochemical tests were obtained during the study period from medical files of the studied patients. Data were analyzed using descriptive statistics. The Chi-Square test was applied to examine the study data.
 Findings: Data shows that 52% of CD children were well-nourished while the remaining 45%, 3%had moderate -to-severe malnutrition. Regarding the height for age and weight for age 20% of the participants had short stature, 80% were normal stature, in addition ,40% of the patients had sever wasting for age and 43% had normal weight for age. Based on the CDC’s criteria 20%,65%, 10%, and 20% low BMI, normal BMI, overweight, and obese for age respectively. In addition, results show that most of CD children had normal hemoglobin level with low level of vitamin D. Regarding to meals pattern of CD children result revealed that the most kind of food daily intake was milk and white bread while there was not daily consumed of ice cream and whole wheat bread.
 Conclusion: To sum up, the results clearly indicated that growth failure and low height, weight, and BMI were less prevalent among the studied group of children with CD. Early diagnosis of celiac disease is very important to prevent long-term complications, early initiation of nutritional intervention and treatment is important. Currently, the only effective treatment is a lifelong gluten-free diet.

Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery.

Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. The mean age was found as 56.16 ± 15.75years in Group 1 and 57.71 ± 15.95years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum.

A Comparison of the Effects of COVID-19 on Irritable Bowel Syndrome and Inflammatory Bowel Disease Patients While Working at Home and in the Office: A Retrospective Study.

Background Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have a strong relationship with psychological stress. Studies have shown increased stress levels in patients with IBS and IBD during the SARS-CoV-2 (COVID-19) pandemic. The current literature on the impact ofwork environment on IBD and IBS symptoms is limited, particularly during the current pandemic. Objective This study aims to analyze how the pandemic impacted patients with IBS and IBD in the setting of staying home versus working outside the home. Methods After Institutional Review Board (IRB) approval, a retrospective review of 245 patients with IBS and IBD who followed with our gastroenterology clinic in the past year was performed. Patients were asked about symptoms including, but not limited to, worsening diarrhea, constipation, and abdominal pain. Pearson's chi-squared test was used for analysis. Results Of the 245 patients in our study, 67 had IBS, 166 had IBD, and 12 had both. The male-to-female ratio was 1:1.4. A total of 136 (55.5%) patients worked from home during the pandemic, while 109 (44.5%)patients worked outside. Eighty-three patients working from home reported no change in symptoms, 35 reported worsening symptoms, and18 reported an improvement in symptoms. Sixty-eight patients working outside the home reported no change in symptoms, 26 reported worsening symptoms, and 15 reported improvements. Working outside the home had a statistically significant relationship with COVID-19 infection. Thirty patients were infected, of which 22 (73.3%) worked outside the home (p=0.01). Overall, 203(82.8%) patients received the vaccine, and only 14 of these patients reported worsening gastrointestinal (GI) symptoms one week after receiving the vaccine. Comparable results were seen after dividing the data into cohorts of IBS and IBD patients. Of the patients with IBD staying at home,15.9% had depression (p=0.01). Conclusion Most patients had symptoms at baseline. There was no statistically significant correlation between change in symptoms and work settings. Patients were less likely to be infected with COVID-19 while staying home. Our patient population showed a high vaccination rate of 82.9% as compared to the national average of 59.2% (source: Centers for Disease Control and Prevention (CDC)). Only 5.7% of the patients reported new or worsening gastrointestinalsymptoms in the week following vaccination. The limitations of the study included its retrospective design and poor correlation in general between symptoms and disease activity in IBD patients.

Leveraging Natural Language Processing to Extract Features of Colorectal Polyps From Pathology Reports for Epidemiologic Study.

Histopathologic features are critical for studying risk factors of colorectal polyps, but remain deeply embedded within unstructured pathology reports, requiring costly and time-consuming manual abstraction for research. In this study, we developed and evaluated a natural language processing (NLP) pipeline to automatically extract histopathologic features of colorectal polyps from pathology reports, with an emphasis on individual polyp size. These data were then linked with structured electronic health record (EHR) data, creating an analysis-ready epidemiologic data set. We obtained 24,584 pathology reports from colonoscopies performed at the University of Utah's Gastroenterology Clinic. Two investigators annotated 350 reports to determine inter-rater agreement, develop an annotation scheme, and create a reference standard for performance evaluation. The pipeline was then developed, and performance was compared against the reference for extracting polyp location, histology, size, shape, dysplasia, and the number of polyps. Finally, the pipeline was applied to 24,225 unseen reports and NLP-extracted data were linked with structured EHR data. Across all features, our pipeline achieved a precision of 98.9%, a recall of 98.0%, and an F1-score of 98.4%. In patients with polyps, the pipeline correctly extracted 95.6% of sizes, 97.2% of polyp locations, 97.8% of histology, 98.3% of shapes, and 98.3% of dysplasia levels. When applied to unseen data, the pipeline classified 12,889 patients as having polyps, 4,907 patients without polyps, and extracted the features of 28,387 polyps. Tubular adenomas were the most common subtype (55.9%), 8.1% of polyps were advanced adenomas, and the mean polyp size was 0.57 (±0.4) cm. Our pipeline extracted histopathologic features of colorectal polyps from colonoscopy pathology reports, most notably individual polyp sizes, with considerable accuracy. This study demonstrates the utility of NLP for extracting polyp features and linking these data with EHR data to create an epidemiologic data set to study colorectal polyp risk factors and outcomes.

Does amyloid β precursor protein gene expression have a role in diagnosis of biliary atresia?

Biliary atresia (BA) is an important cause of surgical jaundice. Although the precise etiology is unknown, β-amyloid (Aβ) has been observed around the bile ducts in BA livers. It is unclear whether Aβ plays a role in the pathogenesis of this disease. This study aims to assess the amyloid β precursor protein (APP) gene expression in infants with BA in comparison with other causes of neonatal cholestasis. This could help explore the role of Aβ in the pathogenesis and diagnosis of BA. A prospective study was conducted at the outpatient clinic of Paediatric Hepatology, Gastroenterology, and Nutrition Department, National Liver Institute, Menoufia University, Shebin El Kom, Menoufia, Egypt during the period March 2022 to December 2022. Clinical data were gathered and laboratory and radiological investigations were conducted including β precursor protein gene expression measured in liver biopsies of the three groups using quantitative real-time PCR (qPCR). Gene expression of APP was considerably higher in the BA group (p = 0.0001) compared to neonatal cholestasis (NC) patients. Gamma glutamyl transferase (GGT) and APP had a positive correlation (p = 0.001). No significant association was found between APP and fibrosis. APP was noticeably higher in BA than NC other than BA. Also, APP in BA was higher (statistically significant, p = 0.0001) than the control. There was no statistically significant difference among NC, BA, and control groups regarding APP (p = 0.07). Both males and females did not show significant differences as regards APP (p = 0.851). Age did not have a statistically significant correlation with APP (p = 0.532). Also, there were no correlations between APP and alkaline phosphatase (ALP), aspartate transaminase (AST), or total bilirubin (TB) (p > 0.05). We concluded that the development and identification of BA may depend on the liver expression of serum APP. Surgeons may be able to carry out early intraoperative cholangiography for BA confirmation if the combination of APP with GGT and other hepatic function parameters exhibits a high predictive potential as a diagnostic test for BA. To evaluate this hypothesis, more research with sizable sample numbers is necessary.

Outcomes of endoscopic papillary large balloon dilatation in comparison to mechanical lithotripsy for large common bile duct stone

Background: The management of common bile duct stone (CBDS) has changed drastically over the past two decades, as open surgery has been supplanted by per-oral endoscopic procedures. Currently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the standard worldwide. After performing an endoscopic biliary sphincterotomy (EBST), endoscopic therapy entails CBDS extraction using conventional procedures. Lithotripsy is an endoscopic procedure used to remove CBDS that are too large to be extracted using conventional techniques.Aim: The aim of the present work is to compare the results of endoscopic large balloon dilatation and mechanical lithotripsy for large CBDS.Subjects and Methods: This prospective cohort study was conducted on 60 cases undergoing endoscopic retrograde cholangial pancreatography for large CBDS who were referred to out-case's clinic and in-case's wards of Gastroenterology, Hepatology and Endoscopy unit of Internal Medicine Department at Tanta University Hospitals December 2019 to February 2021. Cases were divided into two equal groups. Group I included cases undergoing endoscopic papillary large balloon dilatation (EPLBD) and Group II included cases undergoing mechanical lithotripsy (ML).Results: Success of CBDS extraction, Hb, PLT, TLC, albumin, PA, ALT, AST, creatinine and urea and CBDS parameters (diameter, CBDS size, CBDS number) after ERCP were insignificantly different between both groups. Total serum bilirubin, direct serum bilirubin and, Alkaline phosphatase after ERCP were significantly lower in EPLBD. However, Amylase and lipase were significantly higher in EPLBD.Conclusion: Despite that the endoscopic large balloon dilatation caused significantly higher pancreatitis, it showed lower TSB, DSB and ALP. However, both techniques showed no difference regarding the success of CBDS extraction and laboratory investigations.

Клиническое наблюдение наследственного панкреатита у 4 сибсов вследствие мутации в гене PRSS1

Hereditary pancreatitis in children remains a challenging problem in clinical genetics, gastroenterology, and surgery. Genetic causes account for more than 50% of all cases of acute recurrent pancreatitis and 75% of chronic pancreatitis in children. The development of chronic pancreatitis is commonly caused by mutations in the CFTR, PRSS1, SPINK1, CTRC, and CPA1 genes. This article presents a clinical case of hereditary pancreatitis with an autosomal dominant inheritance in 4 siblings, in whom a pathogenic variant in the PRSS1 gene was detected during molecular genetic testing. Key words: hereditary pancreatitis, pathogenic variant, PRSS1 gene, children, siblings

SURGICAL INTERVENTION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY BOWEL DISEASE AND PERIANAL DISEASE

Aim: The aim of the study was to investigate the incidence of IBD in gastrointestinal surgery patients and record the disease’s characteristics and treatment. Materials and Methods: A search was carried out in the archives of the gastroenterology clinics of the University General Hospital of Ioannina and the General Hospital of Ioannina “G. Hatzikosta” in Greece. All cases of operated patients from 1980 to 2018 were examined. The duration of the study was 4 months. Data were analyzed with the SPSS program, v.28. Results: The total sample consisted of 1464 patients (n=1464). Most of them (915-62.5%) came from the University General Hospital of Ioannina, while the rest (549-37.5%) came from the GHI hospital “G. Hatzikosta”. The mean age of the patients was 47 years (M=47.26, SD=17.34, Min=<1 month, Max=95 years). From the total sample, 58 patients (4%) suffered from IBD; most were men (42-72.41%). Their mean age was approximately 50 years (M=49.63, SD=16.48, Min=25 years, Max=77 years, range=52 years) and most belonged to the age groups of 31-40 years (11 patients- 19.6%) and 21-30 years and 61-70 years (10 patients-17.9%). The perianal disease was present in 43.1% (25 patients). The most frequent type of operation was fistula resection, ligation, curettage-biopsy (24.1%) and opening-drainage (22.4%-13 patients) and the most frequent type of anesthesia was general anesthesia (93.1%-54 patients). Conclusions: This long-term study of the patients’ data followed up over time showed that the possibility of surgery in patients with IBD is mitigated through systematic monitoring and multifaceted therapeutic treatment.The perianal disease which appeared more often in men shows that it can be diagnosed early and at an early stage and with the new minimally invasive techniques the patient with IBD can be treated with a better quality of life.

Evaluation of patients via colonoscopy who underwent positron emission tomography/computerized tomography due to colon involvement.

Fluorodeoxyglucose is not a tumor-specific agent and it can also be involved in benign conditions, which may cause diagnostic confusion. This research aims to elucidate the colonoscopic findings of patients who underwent colonoscopy due to colon involvement in positron emission tomography/computerized tomography. A total of 71 patients who underwent colonoscopy due to colonic involvement in positron emission tomography/computerized tomography at SBU Keçiören Training and Research Hospital Gastroenterology Clinic Endoscopy Unit have been analyzed retrospectively. Demographic characteristics of the patients, areas of involvement in positron emission tomography/computerized tomography, and severity have been obtained from the hospital database. The gastrointestinal involvement area of 22.5% (n=16) of the patients was ascending colon, 15.5% (n=11) was sigmoid, 15.5% (n=11) was rectum, 12.7% (n=9) was stomach, 11.3% (n=8) was transverse colon, 8.5% (n=6) was anal canal, 5.6% (n=4) was esophagus, and 5.6% (n=4) was descending colon. The endoscopic findings of 19.7% (n=14) patients were normal, whereas 29.6% (n=21) had polyps, 9.9% (n=7) had cancer, 2.8% (n=2) had an ulcer, 15.5% (n=11) had gastritis, 14.1% (n=10) had hemorrhoids, and 7% (n=5) had colitis. Fluorodeoxyglucose-positron emission tomography can detect unexpected distant metastases with high sensitivity because it allows whole-body imaging. Curative resection significantly contributes to the choice of treatment modality in the pre-operative period of colorectal cancer patients with planned surgery.

DIAGNÓSTICO DE REFLUXO GASTROESOFÁGICO E DOENÇA DE REFLUXO GASTROESOFÁGICO: PANORAMA CLÍNICO E EPIDEMIOLÓGICO DE CRIANÇAS ATENDIDAS EM AMBULATÓRIO ESPECIALIZADO

Objective: Verify the prevalence of gastroesophageal reflux disease (GERD) among infants diagnosed with gastroesophageal reflux (GER) treated at a pediatric gastroenterology clinic, describing the clinicalepidemiological profile of the studied population. Methods: This is an epidemiological, retrospective, crosssectional study, based on the review of medical records of patients. Sociodemographic, clinical, epidemiological variables were recorded, such as age, sex, symptoms presented, type of nutrition, pediatricians prescription and medications used. Results: There were studied 93 children diagnosed with GERD, whose prevalence of GERD was 45.2%. In GER and GERD groups, the most prevalent clinicalepidemiological profile was of boys (58.8% and 52.4%), aged over 6 months (54.9% and 61.9%). The onset of symptoms occurred at 3.0 months (IIQ [0.0-5.0 months]) in children with GER and at 2.0 months (IIQ [0.0-3.0 months]) in those with GERD. There was a higher prevalence of regurgitation (92.2%) and irritability (33.3%) among children with GER; and regurgitation (95.2%), cough and hiccups (28.6%, each) in those with GERD. Regarding drug treatment, there was a higher prevalence of the use of acid inhibitors (66.7%). Conclusion: A high prevalence of GERD was demonstrated, with regurgitation, cough and hiccups as the main symptoms. Infants on exclusive breastfeeding had a lower frequency of GER and GERD. Among the most used drugs, acid inhibitors were the most prescribed.

Effectiveness of management program of chronic functional constipation in children who are attending the Pediatric Gastroenterology Clinic at Elbeheira Specialized Children's Hospital

Effectiveness of management program of chronic functional constipation in children who are attending the Pediatric Gastroenterology Clinic at Elbeheira Specialized Children's Hospital

Correlation of Dyspepsia with the type of First Meal of the Day; Breakfast or Brunch: A Cross-Sectional Study from Karachi Pakistan

Background: Breakfast skipping is traditionally viewed as a bad habit. The customary choice for those who skip breakfast is brunch. Changes in gastrointestinal function are correlated with a range of dietary factors. Objective: To evaluate the correlation of the type of first meal of the day with dyspepsia among patients visiting gastroenterology clinics with dyspeptic symptoms. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, Liaquat National Hospital from August 2021 to April 2022. Short-Form Leeds Dyspepsia Questionnaire was used to identify the presence of dyspepsia (SF-LDQ). Breakfast was defined as the meal consumed in the morning and any beverages or food taken in the morning before 11:00 a.m. regularly in a week. Data were analyzed using the statistical package SPSS version 21. Results: A total sample of 390 patients were analyzed in this study with median age and duration of symptoms 35 (IQR=26-42) years 12 (IQR=8-24) months respectively. The frequency of breakfast skipping was 15.6%. The frequency of dyspeptic symptoms including indigestion, heartburn, regurgitation, and nausea was significantly higher among patients taking brunch as the first meal of the day than those who were having breakfast regularly. The frequency of dyspepsia was 75.1%. On univariate and multivariable analysis, the practice of consuming breakfast regularly was found to be associated with a lower risk of dyspepsia than those who were consuming brunch as the first meal of the day. Conclusion: The current study analyzed that type of first meal was significantly associated with dyspepsia. The frequency of dyspeptic symptoms was significantly higher among patients taking brunch at least once a week than patients who were regularly consuming breakfast.

Diagnóstico de refluxo gastroesofágico e doença de refluxo gastroesofágico: panorama clínico e epidemiológico de crianças atendidas em ambulatório especializado

OBJECTIVE: Verify the prevalence of gastroesophageal reflux disease (GERD) among infants diagnosed with gastroesophageal reflux (GER) treated at a pediatric gastroenterology clinic, describing the clinical-epidemiological profile of the studied population. METHODS: This is an epidemiological, retrospective, cross-sectional study, based on the review of medical records of patients. Sociodemographic, clinical, epidemiological variables were recorded, such as age, sex, symptoms presented, type of nutrition, pediatricians prescription and medications used. RESULTS: There were studied 93 children diagnosed with GERD, whose prevalence of GERD was 45.2%. In GER and GERD groups, the most prevalent clinical-epidemiological profile was of boys (58.8% and 52.4%), aged over 6 months (54.9% and 61.9%). The onset of symptoms occurred at 3.0 months (IIQ [0.0-5.0 months]) in children with GER and at 2.0 months (IIQ [0.0-3.0 months]) in those with GERD. There was a higher prevalence of regurgitation (92.2%) and irritability (33.3%) among children with GER; and regurgitation (95.2%), cough and hiccups (28.6%, each) in those with GERD. Regarding drug treatment, there was a higher prevalence of the use of acid inhibitors (66.7%). CONCLUSION: A high prevalence of GERD was demonstrated, with regurgitation, cough and hiccups as the main symptoms. Infants on exclusive breastfeeding had a lower frequency of GER and GERD. Among the most used drugs, acid inhibitors were the most prescribed.

Telehealth for Pediatric Disorders of Gut-Brain Interaction During the COVID-19 Pandemic.

A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with a disorder of gut-brain interaction including functional abdominal pain and irritable bowel syndrome. Cognitive behavioral therapy (CBT) was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 22 youth (mean age = 14.36 years) who received CBT via telehealth between February and September of 2021, after completing an initial evaluation between February and July of 2021. Patients completed reliable and valid self-report measures of functional disability and pain during treatment. A unique CBT model was employed with an initial focus on psychoeducation and function regardless of level of severity of functional impairment. Consistent with study hypotheses, nonparametric statistical analyses demonstrated statistically significant reductions in functional disability and pain following implementation of the CBT model via telehealth. Contrary to predictions, there was no relation found between severity of functional impairment and duration of treatment.

Regional Swedish study found that one in seven coeliac patients experienced loss of follow up during childhood.

To examine the clinical follow up of paediatric coeliac disease and the rate of loss of follow up during childhood, for which data are scarce. In a cohort of coeliac children diagnosed in 2013-2018 in Gothenburg, Sweden, we retrospectively explored the follow-up practice of paediatric coeliac disease until June 2021. We used medical records from hospital-based paediatric gastroenterology and general paediatric outpatient clinics, laboratory records, and questionnaires. Loss of follow up was defined no coeliac disease-related follow up or tissue transglutaminase test over the past 2 years of study enrolment. We included 162 children (58% girls) aged 7.8-18.2 years (average 12.7). Most participants (76%) were followed at general paediatric outpatient clinics rather than hospital-based clinics. After 2.3-8.8 (average 5.3) years since diagnosis, 23 patients (14%; 95% confidence interval, 9%-21%) had been lost to follow up. Patients with loss of follow up were more often boys (61% versus 39%, p=0.08), with a somewhat longer average disease duration of 5.8 versus 5.2 years (p=0.11). There were no between-group differences in socio-economic characteristics and patient-reported experience measures of coeliac disease care. One in seven coeliac patients may experience loss of follow up during childhood.

Development of a brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut-brain interaction: Initial feasibility, acceptability, and clinical outcomes.

Avoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with disorders of gut-brain interaction (DGBI), but treatments for this population (DGBI + ARFID) have yet to be evaluated. We aimed to identify initial feasibility, acceptability, and clinical effects of an exposure-based cognitive-behavioral treatment (CBT) for adults with DGBI + ARFID. Patients (N=14) received CBT as part of routine care in an outpatient gastroenterology clinic. A two-part investigation of the CBT included a retrospective evaluation of patients who were offered a flexible (8-10) session length and an observational prospective study of patients who were offered eight sessions. Feasibility benchmarks were ≥75% completion of sessions, quantitative measures (for treatment completers), and qualitative interviews. Acceptability was assessed with a benchmark of ≥70% patients reporting a posttreatment satisfaction scores ≥3 on 1-4 scale and with posttreatment qualitative interviews. Mixed model analysis explored signals of improvement in clinical outcomes. All feasibility and acceptability benchmarks were achieved (and qualitative feedback revealed high satisfaction with the treatment and outcomes). There were improvements in clinical outcomes across treatment (all p's < .0001) with large effects for ARFID fear (-52%; Hedge's g=1.5; 95% CI=0.6, 2.5) and gastrointestinal-specific anxiety (-42%; Hedge's g=1.0; 95% CI=0.5, 16). Among those who needed to gain weight (n=10), 94%-103% of expected weight gain goals were achieved. Initial development and testing of a brief 8-session CBT protocol for DGBI + ARFID showed high feasibility, acceptability, and promising clinical improvements. Findings will inform an NIH Stage 1B randomized control trial. While cognitive-behavioral treatments (CBTs) for ARFID have been created in outpatient feeding and eating disorder clinics, they have yet to be developed and refined for other clinic settings or populations. In line with the recommendations for behavioral treatment development, we conducted a two-part investigation of an exposure-based CBT for a patient population with high rates of ARFID-adults with disorders of gut-brain interaction (also known as functional gastrointestinal disorders). We found patients had high satisfaction with treatment and there were promising improvements for both gastrointestinal and ARFID outcomes. The refined treatment includes eight sessions delivered by a behavioral health care provider and the findings reported in this article will be studied next in an NIH Stage 1B randomized controlled trial.

Helicobacter pylori Standard Triple Therapy Outcomes in Iranian Population: A Retrospective Population-based Study in Mashhad, Northeast of Iran

Background: Helicobacter pylori infection is one of the most prevalent infections in many areas of the world, which is treated with different combinations of medications. Objectives: This study aimed to investigate the response rate and outcomes of H. pylori-infected Iranian patients treated with triple therapy. Methods: The current study examined the records of patients with dyspepsia referred to Imam Reza hospital's gastroenterology clinic in Mashhad, Iran, diagnosed with H. pylori from 2017 to 2019. The patients received the triple therapy for H. pylori and were divided into responsive and non-responsive groups. Results: Out of the 750 patients, 477 were included in the study. The response rate to H. pylori standard triple therapy was 79% after 14 days of treatment. Patients aged 30 - 39 years had the highest rate of treatment response. There was no significant relationship between the response rate to treatment and smoking (P = 0.74), alcohol consumption (P = 0.91), opium addiction (P = 0.89), history of aspirin (P = 0.46) or nonsteroidal anti-inflammatory drugs (NSAIDs) use (P = 0.66), diabetes (P = 0.18), renal failure (P = 0.054), and family history of GI malignancies (P = 0.51). Furthermore, patients with gastric ulcer (P = 0.43), duodenal ulcer (P = 0.66), and gastric precancerous lesions (P = 0.93) showed no significant difference in response to treatment. Conclusions: The H. pylori triple therapy regimen can be an effective medication strategy for H. pylori infection in the Iranian population.

Patterns of Functional Gastrointestinal Disorders Among Children in Makkah City: A Single Institutional Experience.

Background Functional gastrointestinal disorders (FGIDs) are syndromes identified based on a group of symptoms defined according to the criteria of the Rome Foundation. The most commonly observed disorders among the pediatric population are functional abdominal pain disorders and functional constipation. This study aims to identify the patterns of FGIDs among children in Makkah, Saudi Arabia. Methods A retrospective cohort study was conducted at pediatric gastroenterology clinics from 2015 to 2019 in a tertiary centre in Makkah, Saudi Arabia. The FGID outcomes were compared with the patient's gender, age, and other characteristics using Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) software to analyze the data. Results One hundred and fifty-two participants met the inclusion criteria, with a mean age of 5.49 ± 3.27 and an average weight of 20.68 ± 12.15 kg. Male patients account for 59.2% of the total population. The prevalence of abdominal pain was 17.84%, while constipation was 50.93%. There was a statistically significant association between abdominal pain and independent variables such as family history (p=0.004) and age, particularly in older children (5-12 years; p=0.001). A statistically significant correlation was found between constipation with gender (p=0.032) and family history (p<0.001). Conclusion The prevalence of functional constipation and abdominal pain increased with age among children in Makkah City, with constipation being significantly more prevalent than functional abdominal pain. There is a significant relationship between age and family history with abdominal pain, whereas gender and family history are associated with a greater likelihood of constipation.

Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care

Telehealth in ophthalmology has traditionally focused on preventive disease screening with limited use in outpatient evaluation. The unique conditions of the COVID-19 pandemic afforded the opportunity to evaluate different implementations of teleophthalmology at scale, providing insight into expanding teleophthalmology care. To compare telehealth use in ophthalmology with other specialties and assess the feasibility of augmenting ophthalmic telehealth encounters with asynchronous testing during the COVID-19 pandemic. This quality improvement study evaluated retrospective, longitudinal, observational data from the first 18 months of the COVID-19 pandemic (January 1, 2020, through July 31, 2021) for 881 080 patients receiving care from outpatient primary care, cardiology, neurology, gastroenterology, surgery, neurosurgery, urology, orthopedic surgery, otolaryngology, obstetrics/gynecology, and ophthalmology clinics of the University of California, San Francisco. Asynchronous testing was evaluated for teleophthalmology encounters. A hybrid care model wherein ophthalmic testing data were acquired asynchronously and used to augment telehealth encounters. Telehealth as a percentage of total volume of ambulatory care and use of asynchronous testing for ophthalmic conditions. The volume of in-person outpatient visits dropped by 83.3% (39 488 of 47 390) across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic, and the initial use of telehealth increased for these specialties before stabilizing over the 18-month study period. In ophthalmology, telehealth use peaked at 488 of 1575 encounters (31.0%) early in the pandemic and returned to mostly in-person visits as COVID-19 restrictions lifted. Elective use of telehealth was highest in gastroenterology, urology, neurology, and neurosurgery and lowest in ophthalmology. Asynchronous testing was combined with 126 teleophthalmology encounters, resulting in change of clinical management for 32 patients (25.4%) and no change for 91 (72.2%). Telehealth increased across various specialties during the COVID-19 pandemic. Combining teleophthalmic visits with asynchronous testing suggested that this approach is feasible for subspecialty-level evaluation. Additional study is needed to evaluate whether asynchronous testing outside the same institution could provide an effective and lasting approach for expanding the reach of ophthalmic telehealth.