Common Gastrointestinal Diagnosis Research Articles

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

PFKFB3 controls acinar IP3R-mediated Ca2+ overload to regulate acute pancreatitis severity.

Acute pancreatitis (AP) is among the most common hospital gastrointestinal diagnoses; understanding the mechanisms underlying the severity of AP is critical for development of new treatment options for this disease. Here, we evaluate the biological function of phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) in AP pathogenesis in 2 independent genetically engineered mouse models of AP. PFKFB3 was elevated in AP and severe AP (SAP), and KO of Pfkfb3 abrogated the severity of alcoholic SAP (FAEE-SAP). Using a combination of genetic, pharmacological, and molecular studies, we defined the interaction of PFKFB3 with inositol 1,4,5-trisphosphate receptor (IP3R) as a key event mediating this phenomenon. Further analysis demonstrated that the interaction between PFKFB3 and IP3R promotes FAEE-SAP severity by altering intracellular calcium homeostasis in acinar cells. Together, our results support a PFKFB3-driven mechanism controlling AP pathobiology and define this enzyme as a therapeutic target to ameliorate the severity of this condition.

Gut microbiome composition and metabolic activity in women with diverticulitis

The etiopathogenesis of diverticulitis, among the most common gastrointestinal diagnoses, remains largely unknown. By leveraging stool collected within a large prospective cohort, we performed shotgun metagenomic sequencing and untargeted metabolomics profiling among 121 women diagnosed with diverticulitis requiring antibiotics or hospitalizations (cases), matched to 121 women without diverticulitis (controls) according to age and race. Overall microbial community structure and metabolomic profiles differed in diverticulitis cases compared to controls, including enrichment of pro-inflammatory Ruminococcus gnavus, 1,7-dimethyluric acid, and histidine-related metabolites, and depletion of butyrate-producing bacteria and anti-inflammatory ceramides. Through integrated multi-omic analysis, we detected covarying microbial and metabolic features, such as Bilophila wadsworthia and bile acids, specific to diverticulitis. Additionally, we observed that microbial composition modulated the protective association between a prudent fiber-rich diet and diverticulitis. Our findings offer insights into the perturbations in inflammation-related microbial and metabolic signatures associated with diverticulitis, supporting the potential of microbial-based diagnostics and therapeutic targets.

Clinical and Demographic Characteristics of Young Patients Requiring Surgery for Diverticulitis

Introduction: Diverticulitis is a common gastrointestinal diagnosis. Diverticulitis is as increasing for all demographics, and the rise has been greatest for the younger subgroup. This study aimed to characterize the clinical and demographic features associated with patients ≤40 years needing surgery after their index episode of diverticulitis. Methods: Retrospective review of patients undergoing surgical intervention for index episode of diverticulitis from 2015 to 2021 at a single tertiary care center. Patients ≤40 years were compared with a control group consisting of patients >40 years old. Results: The analysis included 62 patients; 21 patients ≤40 years old (mean age 32.7 years) and 41 controls >40 years old (mean age 57.8 years); p = 0.001. Patients ≤ 40 years were more likely to be male (71.4% vs 34%, p = 0.005), Hispanic (66.7% vs 34.1%, p = 0.019), and obese (71.4% vs 29.3%, p = 0.017) with a greater mean BMI (32.9 kg/m2 vs 28.2 kg/m2, p = 0.002). The most likely indication for surgery in the ≤40 group was recurrent disease (38.1%), while the most common indication in the >40 group was development of a fistula (31.7%); p = 0.734. There was no difference in overall postoperative complication or readmission. Conclusion: We see an increasing proportion of advanced diverticulitis in the young population and our study demonstrates that the characteristics of this group differs from older patients. Further work to elucidate potential social, environmental, and biological etiologies of these findings is warranted.

Point of care ultrasound of the digestive tract (“Echoenterogram”)- Current evidence and the need for training

Background: Point-of-care ultrasound (PoCUS) is used in multiple fields of medicine to aid in diagnosis and treatment. However, gastroenterology focused PoCUS examinations (we named it “Echoenterogram”: a sound-based scanning of the digestive tract) are not routinely performed. Aims: The primary objective of this review is to highlight PoCUS examinations related to common gastroenterology (GI) pathologies, such as inflammatory bowel disease, non-alcoholic fatty liver disease, diverticulitis, small bowel obstruction, and assessment of gastric contents to help determine a nil per os status. Methods: We performed a search of the literature related to gastrointestinal PoCUS in PubMed, without publication type or study design limitations, and used snowballing to identify further papers from the reference lists of the identified papers. Two independent reviewers screened titles, followed by abstracts and full-text articles for eligibility. Results and Conclusions: We show that the PoCUS examination is a good diagnostic bedside tool for several common gastrointestinal diagnoses. In this comparison of GI PoCUS examinations to the current standard of care practices, we conclude that, with appropriate training of gastroenterologists, the echoenterogram can be incorporated into routine medical practice.

Overlap between irritable bowel syndrome and common gastrointestinal diagnoses: a retrospective cohort study of 29,553 outpatients in Germany

BackgroundIrritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients.MethodsUsing the Disease Analyzer database (IQVIA) featuring patients treated within 2010 and 2019 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS.Results65,569 patients with an initial diagnosis of IBS were included into the analysis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. Mean age was 48.8 (SD: 18.4) years, 65.0% were female. Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%). Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis.ConclusionOur data provide evidence for a high overlap between IBS and other GI diagnoses. Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases.

Population-based Trends in Healthcare Utilization and National Healthcare Spending on Pancreatitis in North America

It is estimated that the global incidence of pancreatitis has increased from ∼1.0 million new cases per year in 1990 to ∼1.6 million new cases annually in 2017.1 In the United States, pancreatitis is the third most common gastrointestinal diagnosis requiring hospitalization.2 With rising rates of alcohol consumption and obesity, the incidence of pancreatitis is anticipated to continue to increase. Furthermore, the management of pancreatitis is highly resource intensive and often requires hospitalization, close monitoring, and therapeutic interventions or surgery to manage either the underlying etiology or pancreatitis-related complications.

Proton pumps inhibitors in gastroesophageal reflux disease: what is the best regimen? A based evidence review

Objectives: Gastroesophageal reflux disease is one of the most common gastrointestinal diagnoses. This disorder causes many symptoms and may induce the development of Barret’s esophagus and esophageal adenocarcinoma. Proton pump inhibitors are the most used treatment and, usually, are prescribed for once-daily dosing before breakfast. However, many patients describe night-time symptoms, a period when an increase of basal gastric acid secretion occurs. Therefore, this evidence-based review was performed in order to understand which is the best regimen for proton pump inhibitor intake. Methods: The MeSH words ‘proton pump inhibitors’, ‘gastro-oesophageal reflux’, GERD, and pH were chosen to search for synopses, guidelines, meta-analysis, systematic reviews, and original papers, published after 2008 in the databases MEDLINE, National Guideline Clearinghouse, NHS Evidence, Canadian Medical Association, TRIP Database, The Cochrane Library, DARE and Bandolier in English, French, Spanish and Portuguese. A search in the Índex de Revistas Médicas Portuguesas with the words “inibidores das bombas de protões”, “refluxo gastroesofágico”, DRGE, and pH was also performed. The search retrieves 2,546 articles, from those, three were used in this review. Results: Three prospective studies that evaluate the effects of dosage and/or timing of proton pump inhibitors intake in gastric pH were obtained. These studies indicate that, in patients with predominant night-time symptoms, intake before dinner achieves better results than before breakfast. Additionally, doubling the dose reduces symptoms and the time of pH lower than four. Conclusion: Symptom timing and patient compliance are crucial when choosing the therapeutic regimen. The timing of proton pumps inhibitors intake should be associated with the symptom’s timing; C-level of recommendation.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis made in outpatient clinics, responsible for over 5 million annual outpatient visits and likely hundreds of thousands of inpatient stays for noncardiac chest pain. GERD’s current definition, based on international consensus, is a “condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.” Also defining GERD is the presence of erosive esophagitis on upper endoscopy (esophagogastroduodenoscopy [EGD]) with or without the presence of troublesome symptoms or the presence of troublesome symptoms without endoscopic evidence of erosive esophagitis (also known as nonerosive reflux disease). This review looks at GERD in detail, including its epidemiology and risk factors, genetics, pathogenesis and etiologic factors, clinical presentation and symptoms, differentials, diagnosis, and complications. Figures presented are an EGD image showing signs of erosive esophagitis, Barrett esophagus, and hiatal hernia and sample recordings from a 24-hour combined multichannel intraluminal impedance and pH testing. Tables list differential diagnoses for GERD, indications for performing EGD in patients with GERD symptoms, and a summary of GERD therapies. This review contains ­2 figures, 4 tables, and 74 references.

S1384 Acute Pancreatitis Secondary to Type B Aortic Dissection and Celiac Artery Hematoma

INTRODUCTION: Acute pancreatitis is one of the most common gastrointestinal diagnoses seen in inpatients, accounting for almost 280,000 hospital admissions annually. Cholelithiasis is the most common cause, followed by prolonged alcohol abuse. Hypertriglyceridemia, drugs, autoimmune disease, and infection each account for less than 5% of cases. Here we present a rare case of acute pancreatitis secondary to Type B aortic dissection. CASE DESCRIPTION/METHODS: A 61-year-old male presented with sudden onset right-sided and periumbilical abdominal pain with radiation to the epigastrium and mild chest pain. He had no pertinent medical history and no significant alcohol use history. On presentation, he was hypertensive and tachypneic. Physical examination revealed a diaphoretic male with diffuse abdominal tenderness. Laboratory work up showed a leukocytosis of 17.24 K/uL, lactate 4mmol/L, LDH 374 U/L, and lipase 383 U/L. CT angiography showed a prominent Stanford Type B aortic dissection with an intramural hematoma extending along the descending thoracic aorta through the upper abdominal aorta leading to occlusion of the celiac artery. His dissection was treated with esmolol drip with rapid correction of blood pressure to goal systolic blood pressure 100-120. Due to persistent leukocytosis, on hospital day 3 repeat CT imaging was performed revealing increasing irregular fluid scattered throughout the upper abdomen consistent with acute pancreatitis. Alternative etiologies were ruled out and this pancreatitis was presumed to be caused by vascular compromise in the setting of a type B aortic dissection and celiac artery hematoma. He showed gradual clinical improvement with medical management and was discharged home. DISCUSSION: Blood supply to the pancreas is provided by pancreatic branches of the splenic artery (from the celiac artery), and the superior and inferior pancreaticoduodenal arteries (from the superior mesenteric artery). The mechanism of pancreatitis caused by type B aortic dissection is organ ischemia, through occlusion of either the celiac artery or the superior mesenteric artery SMA. Most type B aortic dissections are managed conservatively with antihypertensives, but end organ ischemia can be an indication for surgical management. This presentation is exceedingly rare; we note only 6 similar cases in the literature. As our case demonstrates, acute pancreatitis as a complication of aortic dissection can be managed with standard conservative measures and does not necessitate surgical intervention.Figure 1.: Computed tomography angiogram shows a Stanford Type B Aortic Dissection (2 views).Figure 2.: Chest computed tomography imaging shows irregular fluid scattered throughout the upper abdomen representative of acute pancreatitis.Figure 3.: Computed tomography angiography reveals mild interval increase in peripancreatic fluid collections.

S0055 Trends of Gallstone-Associated Acute Pancreatitis Within a Large Health Management Organization

INTRODUCTION: Acute pancreatitis (AP) is the third most common gastrointestinal inpatient diagnosis, thereby accounting for significant patient and financial burden. Gallstone AP (GAP) is one of the most common causes of AP in the United States. Guidelines for diagnosis, and management of GAP recommend appropriate criteria for diagnosis, imaging as part of the workup and same-admission cholecystectomy. We characterized trends in diagnosis and adherence to treatment guidelines of patients presenting with GAP in a large healthcare system. METHODS: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health (a nine hospital system) between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with complete clinical information. We collected several variables pertaining to the management of GAP including but not limited to demographics, clinical symptoms, laboratory results, imaging, procedures, treatment and outcome variables. Statistical analysis was performed with PRISM (Ver 8.2.1, Graphpad). RESULTS: Out of 2,542 patients diagnosed with AP, 454 were attributed to GAP, of which 401 met Revised Atlanta Classification. The remaining 53 patients did not meet criteria but were labeled as GAP in the presence of gallstones on imaging. 95.8% of patients with GAP presented with pain and 82.4% had elevated lipase and those with prior history of choledocholithiasis were 4.37 times more likely to have GAP (P < 0.0001). About 97.6% of patient labeled with GAP got imaging during the admission but were no more likely to have evidence of gallstones on imaging (OR 1.10, P = 0.3650). Although patients with GAP are 2.48 times (P < 0.0001) more likely to have their etiological workup documented, it is still only documented 62.1% of the time. Despite the diagnosis of GAP, only 34.6% of patients (157/454) got cholecystectomy during the admission. CONCLUSION: The diagnosis of GAP may be erroneously made. In most cases of GAP, it could be the first and only presentation of gallstones. Despite the imaging study being positive for gallstones, appropriate workup for other causes of AP must be done, as a possible etiology can be missed. With the new guidelines focusing on early surgical management for GAP, these numbers could help drive improvements in quality of care in order to prevent recurrence.Table 1Table 2Table 3

CADM1 enhances intestinal barrier function in a rat model of mild inflammatory bowel disease by inhibiting the STAT3 signaling pathway.

Cell adhesion molecule 1 (CADM1) is frequently silenced in lung, prostate, liver, stomach, pancreatic and breast carcinomas and other forms of human carcinomas. However, it is unclear regarding the role of CADM1 in irritable bowel syndrome with diarrhoea (IBS-D) that is the most common gastrointestinal diagnosis and may contribute to impaired intestinal barrier function. The aim of the present study is to explore the potential mechanism of CADM1 in regulating intestinal barrier function in IBS-D. A rat model with IBS-D induced by the combination method of mother-infant separation, acetic acid and restraint stress was initially established. The defecation frequency, faecal water content (FWC), total intestinal permeability, sIgA, endotoxin, D-lactic acid and diamine oxidase (DAO) were then measured. Next, positive expression of CADM1 protein was detected in distal colonic tissue of rats by immunohistochemistry. The expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in distal colonic mucosa, CADM1, Janus kinase 1 (JAK1), STAT3, p-JAK1, p-STAT3, Claudin-1and Claudin-2 were evaluated using ELISA, RT-qPCR and western blot analysis. IBS-D rats exhibited low CADM1 expression and activated STAT3 signaling pathway. Overexpression of CADM1 in rats was shown to increase Claudin-1 expression, while decreasing expression of STAT3, Claudin-2, TNF-α and IL-6. In addition, silencing of CADM1 or inhibition of the STAT3 signaling pathway was demonstrated to improve the intestinal barrier function. Our study provides evidence that CADM1 can potentially improve intestinal barrier function in rats with IBS-D by inhibiting the STAT3 signaling pathway.

Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals.

Children with acute lymphoblastic leukemia (ALL) suffer from a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, environmental changes, and opioid use is a common issue for children newly diagnosed with leukemia. We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL hospitalized from October 2015 through September 2019. Our objective was to investigate the prevalence, risk factors, and treatment of constipation in hospitalized children with ALL. We identified 4647 unique patients with an ALL induction admission. Constipation was the most common gastrointestinal diagnosis with 1576 (33.9%; 95% confidence interval [CI]: 32.6%-35.3%) patients diagnosed during induction admission and 19.8% in post-induction admissions. The most commonly administered constipation medications were poly-ethyl glycol (n=3385, 89.6%), followed by senna (n=1240, 32.8%), lactulose (n=916, 24.2%), and docusate (n=914, 24.2%). Multivariate logistic regression revealed the following variables to be significantly associated with the presence of a constipation diagnosis: age<6 years at induction (compared with those ≥12 years; odds ratios [OR]=1.32 [95% CI: 1.13-1.55]; P=<0.001), female sex (OR=1.16 [95% CI: 1.02-1.31]; P=0.024), increased length of hospitalization (OR=1.03 [95% CI: 1.02-1.04]; P<0.0001), use of non-fentanyl opioids for one or two days (OR=1.28 [95% CI: 0.99-1.65]; P=0.056), and use of non-fentanyl opioids>2 days (OR=1.53 [95% CI: 1.19-1.95]; P<0.001). A large portion of hospitalized children with ALL experience constipation and required medications. Increased attention should be paid to constipation prophylaxis and treatment in ALL patients, particularly at the start of induction therapy.

Survivorship care engagement with American Indian and Alaska Native survivors of gastrointestinal (GI) cancers.

814 Background: American Indian and Alaska Native (AI/AN) survivors are at significant risk for GI cancers, and also represent an underserved medical population. Gastrointestinal cancers represent the third most commonly diagnosed cancers in the AI/AN population and are a leading cause of death. Survivorship resources tailored for the AI/AN population are sparse and patterns of survivorship care poorly understood. Methods: The OncoLife survivorship care plan has been through the OncoLink website since 2007. The tool is free and publically available. It asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. All research is IRB approved. Results: Over the past 12 years, the OncoLife tool has been utilized by &gt;85,000 persons, with survivors of GI cancer representing 10-12% of users each year. Most users are women (75%) and Caucasian (80%). American Indian and Alaska Native survivors represent &lt;1% of users since the launch of the tool. Of 519 AI/AN users, median age was 54 years, and 76% identified as female. Of plans created for AI/AN survivors, 13% were for survivors of GI cancers, with the most common GI diagnosis being colorectal cancer (74%), followed by pancreas (11%) and anal (6%). Most plans (73%) were created by HCP, with the remainder by survivors themselves; 20% of AI/ AN users completing plans requested information on smoking cessation as part of their care plan. Conclusions: American Indian and Alaska Native survivors represent a very small minority of survivors utilizing this free Internet-based tool, with most plans for this population being created by healthcare providers and not by survivors themselves. Future efforts should be directed at supporting this underserved population with survivorship information, particularly given high risk of morbidity and mortality related to GI cancers.

1433 A Case of Cocaine-Induced Pancreatitis

INTRODUCTION: Cocaine-induced pancreatitis is a rare and likely under-reported entity. Physicians must maintain a index suspicion when treating patients with cocaine use who present with abdominal pain especially if they are also on other concomitant medications that increase the risk of acute pancreatitis. CASE DESCRIPTION/METHODS: A 61-year-old male with cocaine abuse and heart failure with reduced ejection fraction (HFrEF) presented with 3 days of epigastric abdominal pain, nausea, and vomiting. His last intranasal use of cocaine was a few days prior to onset of symptoms. Lipase was 2300 (U/L) and computed tomography of the abdomen (CT) demonstrated an edematous and homogeneously enhancing pancreas with a small amount of peripancreatic fluid. Abdominal ultrasound was negative for cholelithiasis. Patient had a remote history of alcohol use but denied recent alcohol abuse. Toxicology was positive for cocaine on day of admission. An ethanol level was not obtained. Triglyceride, IgG4, and calcium levels were within normal limits. Notably, the patient was also hospitalized two months prior to present presentation for new onset left cerebellar stroke. Upon further evaluation, the patient was found to have a left ventricular ejection fraction of 30-35%, consistent with new diagnosis of HFrEF. The patient was started on metoprolol prior to discharge. Based on lack of other identifiable causative factors, patient's pancreatitis was attributed to concurrent cocaine and beta-blocker use. DISCUSSION: Pancreatitis is the most common gastrointestinal diagnosis resulting in admission, costing 2.6 billion dollars annually. The most common etiologies are gallstones and alcohol. Few cases of cocaine-induced pancreatitis have been reported in the literature. Cardiovascular and central nervous system (CNS) toxicities of cocaine such as acute coronary syndromes, chest pain, agitation, and strokes are well documented. Acute gastrointestinal complications of cocaine use are less common however usually include ischemic bowel and related perforation. There are only 5 reported cases of cocaine-induced pancreatitis. The mechanism of action of cocaine is inhibition of noradrenaline re-uptake, which produces vasoconstriction and thrombosis of mesenteric vessels. The pathophysiology of cocaine-induced pancreatitis is postulated to be related to vasoconstriction and thrombotic microangiopathy. In this patient, prior heavy alcohol may have led to underlying parenchymal disease and concomitant use of a beta-blocker were likely additive.

Overexpression of CCN1 in Het1A cells attenuates bile-induced esophageal metaplasia through suppressing non-canonical NFκB activation

GERD is the most common gastrointestinal diagnosis given during office visit. People who suffer from a long history of GERD eventually develop Barrett's esophagus, a premalignant intestinal metaplasia due to NFκB activation. Previous studies focused on the contribution of TNF-triggered canonical NFκB pathway to this event. In this study, we demonstrated in vitro that it was LTA, rather than TNF, initiated canonical NFκB activation at the beginning of acid/bile attacks, but later it switched to CD40-activated non-canonical pathway, which played a bigger part in esophageal metaplasia. CCN1 attenuated this cellular transformation by suppressing CD40 and its associated proteins involved in non-canonical signaling.

Clinical Outcomes of Acute Pancreatitis in Patients with Liver Cirrhosis - A Single-Center Experience

Introduction: Acute pancreatitis (AP) is a common gastrointestinal discharge diagnosis in the US, but outcomes in cirrhotic patients has not yet been studied. We aim to investigate these outcomes. Methods: Propensity score matching was used to match patients with and without cirrhosis on a 1:2 basis. The Cleveland Clinic acute pancreatitis registry database was used. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome (SIRS), length of hospital stay (LOS). Subgroup analysis of cirrhotic patients according to Child-Pugh and Model of End-stage Liver Disease (MELD) scores was performed. Multivariable logistic regression models were constructed using SAS software version 9.4 Results: 819 patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 6.1%. Cirrhosis patients were mostly males and younger (table 1). Mean Child-Pugh score was 8.2, mean MELD score was 16 (table 1). Etiology of AP was similar in both groups. Cirrhosis subjects had significantly higher inpatient mortality (7.5% vs. 1.3%, P=0.1), severe AP (17.5% vs. 7.5%), Shock (7.9% vs. 3%), ARDS (10% vs. 3.8%), ICU requirement (15% vs. 6.3%) although not statistically significant, the trend was present. Surprisingly, cirrhotics had lower prevalence of admission SIRS (22.5% vs. 32.5%), SIRS day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN and LOS (table 2). Finally, cirrhotic patients who had severe AP and/or required ICU and/or die in-hospital were mainly Child-C and had high MELD score (17-38) but they had low BISAP and Marshall scores (table 5). Conclusion: Limitations: Retrospective design. Small sample size due to low prevalence of cirrhosis. Strength: First study to analyze outcomes of cirrhosis in AP and compare according to Child-Pugh and MELD scores. Adjusted for age, gender, race, CCI. Conclusion: Acute pancreatitis patients with liver cirrhosis have higher inpatient mortality, possibly related to decompensated cirrhosis - as they appear to have lower prevalence of SIRS, low BISAP and Marshall scores as well as similar rates of pancreatic necrosis compared to non-cirrhotics. Importantly, cirrhotic patients who died were mostly Child-Pugh C and had very high MELD score.32_A Figure 1. Demographic and Baseline Characteristics32_B Figure 2. Outcomes: Characteristics of cirrhotic patients with severe pancreatitis, required ICU and/or died in the hospital32_C Figure 3. Outcomes of Cirrhotic patients: Child Pugh Class A vs. B/C

Obstructive Sleep Apnea a Risk Factor Pancreatitis Outcomes?

Introduction: Acute Pancreatitis is the most common inpatient gastrointestinal diagnosis in the US. It accounts for >250,000 admissions per year costing US Healthcare $2.6 billion annually. Gallstones and alcohol account for 2/3rd, however, there are many other causes of acute pancreatitis, but the exact pathogenesis has not been fully elucidated. Obstructive sleep apnea (OSA) is a common under diagnosed disorder and is associated with numerous conditions like hypertension, diabetes mellitus, metabolic syndrome and cancer including pancreatic ductal adenocarcinoma. Here we explore if OSA is a risk factor for inpatient pancreatitis outcomes. Methods: Data was obtained from the Nationwide Inpatient Sample (HCUP-NIS). Study variables were assessed using ICD-9 codes on adults aged 18 years and over admitted to a US hospital from 2012 to 2014 with a primary diagnosis of acute pancreatitis. Only patients with routine discharges following hospitalization were included in the study. Patients discharged to nursing facilities, palliative care, against medical advice and deaths were excluded. We examined the in-hospital length of stay among acute pancreatitis patients with OSA and compared with non-OSA patients. All the analysis was performed using SAS 9.4 software. Results: Of the 340,983 patients admitted for acute pancreatitis 12,463 had a diagnosis of OSA. Among those admitted with pancreatitis 65.8% were white, 16.7% black, 11.6% Hispanic, 2% Asian and 3.7% the rest. 49% of the admissions were female patients. The median length of stay for acute pancreatitis was 6.38 days (interquartile range [IQR] 3.0 to 7.0 days) for admissions with OSA and 5.87 days (IQR 2.0 to 7.0 days) for non-OSA patients. Conclusion: The observed differences in length of stay between OSA-associated and non-OSA associated acute pancreatitis supports our hypothesis that OSA can influence pancreatitis outcomes. Further studies looking at long-term sequela in terms of disease progression to chronic pancreatitis and cancer in OSA associated patients are needed.74_A Figure 1. No Caption available.74_B Figure 2. No Caption available.

Aging, Obesity, and the Incidence of Diverticulitis: A Population-Based Study

To understand why the population-based incidence of diverticulitis has increased over time, we studied temporal changes in age, body mass index (BMI), and diverticulitis in Olmsted County, Minnesota. We compared the BMIs of 2967 patients with diverticulitis and 9795 people without diverticulitis from January 1, 1980, through December 31, 2007. Because BMI is a surrogate for adipose tissue, computed tomographic estimations of abdominal fat content were compared between 381 diverticulitis cases and 381 age- and sex-matched controls. Between 1980 and 2007, the prevalence of obesity increased from 12% to 49% in the population and from 19% to 40% in patients with diverticulitis (P<.001 for both). Temporal trends in age, BMI, and the increased incidence of diverticulitis in people with normal BMI accounted for 48%, 47%, and 20%, respectively, of corresponding trends in diverticulitis. The secular decline in the proportion of people with normal BMI was partly offset by an increased incidence of diverticulitis in such people. In the case-control study, BMI was greater in cases than in controls (P=.001). However, after incorporating abdominal visceral (odds ratio [OR], 2.4; 95% CI, 1.6-3.7) and subcutaneous (OR, 2.9; 95% CI, 1.7-5.2) fat content (both associated with diverticulitis), BMI was associated with lower risk (OR, 0.8; 95% CI, 0.7-0.8) of diverticulitis. Aging, increasing obesity, and the increased incidence of diverticulitis in people with normal BMI account for the temporal increase in diverticulitis. Rather than BMI per se, increased abdominal visceral and subcutaneous fat are independently associated with diverticulitis. The incidence of diverticulitis, which is among the most common gastrointestinal diagnoses in hospitalized patients, has increased markedly since 2000. This study suggests that aging, increasing obesity, and the increased incidence of diverticulitis in people with normal BMI account for the temporal increase in diverticulitis.

Low Quality and Readability of Internet Dietary Information on Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diagnoses, and diet plays an important role in its management. Patients often