Abdominal Pain Research Articles

Placebo-Controlled Trials in the Management of Crohn’s Disease: An Umbrella Review of Meta-Analyses

Introduction: Crohn’s disease is a chronic inflammatory bowel disease characterized by abdominal pain, diarrhea, and other symptoms. It can lead to significant complications and impact patients’ quality of life. Therefore, effective management strategies are essential for improving outcomes. Methods: To assess the efficacy of the treatments for Crohn’s disease, this umbrella review systematically addresses systematic reviews and meta-analyses on Crohn’s disease management published between 2013 and 2023. The quality of the included studies was assessed using the National Institutes of Health’s quality assessment tool. Results: Sixteen studies were included, evaluating various interventions for the induction and maintenance of remission. These included biologic agents (anti-TNF agents, anti-IL-12/23p40 antibodies, and integrin receptor antagonists), antimetabolites, and corticosteroids. Conclusions: The findings suggest that biologic agents may be promising options for both the induction and maintenance of remission in Crohn’s disease. Antimetabolites and corticosteroids may be effective in certain cases, but their efficacy and safety profiles require further investigation. The included studies varied in quality and sample size. More research is needed to confirm the findings and establish optimal treatment strategies. Moreover, while biologic agents show promise, the optimal management of Crohn’s disease requires further research. A personalized approach considering patient factors and disease characteristics is crucial for optimizing outcomes.

Misses and Near Misses in Paediatric Appendicitis: An Eight-Year, Single-Centre Retrospective Review.

Diagnostic error can result in the appendectomy of a normal appendix, commonly known as negative appendectomy (NA). Missed appendicitis (MA) is related to a poor outcome. The aim of this study was to determine whether there are factors in presentation associated with NA or MA. This is a single-centre, retrospective chart review of histology-confirmed appendicitis over an eight-year period. We defined MA as appendicitis diagnosed within the week of a paediatric emergency department discharge for a similar presentation. Negative appendectomy was defined as a histologic examination of the appendix that lacked signs of inflammation. A total of 845 children had appendicitis on pathologic examination. NA included 69 children, and MA 29 children. Inflammatory markers were lower for children with NA than for children with appendicitis, and children with NA were less likely to undergo CT. Almost half of the children with MA were discharged without laboratory evaluation, and almost three quarters were discharged without imaging evaluation. Half of the children with MA returned with complicated appendicitis. Increased rates of laboratory and/or imaging evaluations in patients with abdominal pain or non-classic gastroenteritis, along with observation or early follow-up, may decrease MA. More frequent use of ultrasound and MRI may keep the NA rate to a minimum.

P-127. Safety and Efficacy of Fecal Microbiota Spores, Live-brpk (Formerly SER-109) in Patients with Recurrent Clostridioides difficile Infection (CDI): Subgroup Analysis by Number of Prior CDI Recurrences from an Integrated Analysis of Phase 3 Trials

Abstract Background Patients experiencing ≥1 recurrence of CDI are at elevated risk for subsequent recurrences and complications versus those with an initial CDI episode. Treatment selection for recurrent CDI (rCDI) is influenced by the number of recurrences a patient has experienced. Fecal microbiota spores, live-brpk (VOWST™; formerly SER-109, hereafter referred to as VOS for Vowst Oral Spores) is an oral microbiota-based therapeutic to prevent rCDI in adults with rCDI after antibacterial treatment for rCDI, thought to work by enabling rapid restoration of the microbiome. We report results from an integrated analysis of two Phase 3 trials to further describe safety/efficacy of VOS in patients, stratified by number of prior CDI recurrences. Methods The randomized, controlled ECOSPOR III trial enrolled 182 patients with ≥2 CDI recurrences, and the open-label, single-arm ECOSPOR IV trial enrolled 263 patients with ≥1 CDI recurrence. VOS was given as 4 capsules over 3 consecutive days after completing antibiotic treatment. Treatment-emergent adverse events (TEAEs) were collected through Week 8 after VOS; serious TEAEs/AEs of special interest were collected through Week 24. Efficacy endpoint included rCDI (toxin-positive diarrhea requiring treatment) through Week 8. Results A total of 77 patients had 1, 150 patients had 2, and 121 patients had ≥3 prior CDI recurrences; incidence of TEAEs was 44%, 70%, and 67%, respectively (Table 1). No serious TEAEs, TEAEs of special interest, or TEAEs leading to study withdrawal were considered related to VOS by investigators. TEAEs in ≥15% of patients with 1, 2, or ≥3 prior CDI recurrences were flatulence (6%; 29%; 29%), abdominal pain (6%; 27%; 16%), fatigue (1%; 26%; 20%), abdominal distension (3%; 22%; 20%), and diarrhea (27%; 21%; 23%). On-study recurrence rate through Week 8 in the overall population was 9.5% (95% CI: 6.6%–13.0%); in those with 1 or multiple (≥2) CDI recurrences, rates (95% CI) were 6.5% (2.1%–14.5%) and 10.3% (7.0%–14.6%), respectively. Conclusion This integrated analysis confirms VOS was well tolerated and rCDI rates were low/consistent in patients, regardless of the number of CDI recurrences. Results suggest VOS may be considered in patients with rCDI, regardless of the number of prior CDI recurrences. Disclosures Matthew Sims, MD, PhD, Adaptive Phage Therapeutics: Grant/Research Support|Applied Biocode: Advisor/Consultant|Applied Biocode: Grant/Research Support|Astra Zeneca: Grant/Research Support|Biotest AG: Grant/Research Support|ContraFect: Grant/Research Support|Janssen: Grant/Research Support|Leonard-Meron Biosciences: Grant/Research Support|Novozyme: Grant/Research Support|OpGen: Advisor/Consultant|OpGen: Grant/Research Support|Pfizer: Grant/Research Support|Prenosis: Advisor/Consultant|Prenosis: Grant/Research Support|QIAGEN: Grant/Research Support|Seres: Advisor/Consultant|Seres: Grant/Research Support|Summit Therapeutics: Grant/Research Support|Venatorx: Advisor/Consultant Colleen S. Kraft, MD, MSc, Ferring: Advisor/Consultant|Seres: Advisor/Consultant Lisa von Moltke, MD, Cara Therapeutics: Board Member|Cara Therapeutics: Stocks/Bonds (Public Company)|Seres Therapeutics: Employee|Seres Therapeutics: Stocks/Bonds (Public Company) Brooke Hasson, PhD, Seres Therapeutics: employee|Seres Therapeutics: Stocks/Bonds (Public Company) Maximilian von Eynatten, MD, Nestlé Health Science: Employment Darrell Pardi, MD, AMT, Inc: Grant/Research Support|Boehringer Ingelheim: Grant/Research Support|Exe GI: Grant/Research Support|Immunic: Advisor/Consultant|Lilly: Advisor/Consultant|Rise Therapeutics: Advisor/Consultant|Rise Therapeutics: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Seres Therapeutics: Expert Testimony|Vedanta: Advisor/Consultant|Vedanta: Grant/Research Support

P-1303. Moving Research into Action: The Use of Hospital Admission Data as a Measure of Ukrainian Child Migrants’ and War Refugees’ Health Needs in the First 100 Days of the War

Abstract Background Since the start of the war in Ukraine on February 24th, 2022, Poland has been one of the countries with the largest arrival of migrant and war refugees from Ukraine. As the presence of Ukrainian migrant and war refugee children has increased in Poland, studies of their health condition and the use of health services have become of key importance in fulfilling their unmet health needs. Methods Data on the hospitalization of Ukrainian pediatric patients in Polish hospitals come from the Nationwide General Hospital Morbidity Study (NGHMS). The analyses were based on the diagnoses and conditions most responsible for the patient’s stay in hospital and coded in accordance with ICD-10. Results According to the NGHMS, during the first 100 days of war 2,544 Ukrainian children and adolescents under 18 years of age were admitted to Polish hospitals. The most frequently reported hospital events among the Ukrainian migrant children were infectious and parasitic diseases (A00-B99) – 24.1%, mainly viral and other specified intestinal infections (A08; 49.3%), other gastroenteritis and colitis of infectious and unspecified origin (A09; 36.2%). Symptoms, signs and abnormal clinical and lab findings (R00-R99 – 17.8%) were the second most frequently reported cause of hospitalization, the majority of which were related to digestive system symptoms - mostly nausea and vomiting and abdominal pain, as well as fever of unknown origin. Diseases of the respiratory system (J00-J99) ranked as the third leading cause of pediatric hospitalization (12.2%), with a predominance of acute bronchitis (J20) and influenza due to identified seasonal influenza virus (J10). 88 Ukrainian children were admitted to hospital due to COVID-19. One third of analyzed hospitalizations (33.1%) had a principal diagnosis of vaccine-preventable disease (VPD). Conclusion Our findings suggest a greater focus on preventive healthcare and public health interventions, especially in the area of VPD. As vaccination should be considered a health equity intervention, the tailored vaccination program SAY YES TO VACCINATION in collaboration with UNICEF (SBC Office) has been implemented to increase mothers’ vaccination literacy and address gaps in vaccination coverage among Ukrainian children in Poland. Disclosures All Authors: No reported disclosures

Changes in hormone receptor when breast cancer metastasizes to the colon: case report and literature review

The metastasis of breast cancer to the colon is a rare occurrence, especially in the presence of changes in estrogen and progesterone receptors. To date, literature has only reported two cases of invasive ductal carcinoma and two cases of invasive lobular carcinoma metastasizing to the colon with concurrent changes in hormone receptors. This report describes a 65-year-old woman with a history of left breast cancer, who presented with symptoms of bloody stools and abdominal pain. CT and colonoscopy results revealed a malignant tumor in the ascending colon, and the patient underwent surgery. Pathological results post-surgery indicated changes in hormone receptors, differing from the previous breast cancer pathology, ultimately leading to the diagnosis of breast cancer metastasis to the colon. The patient was found to have liver metastasis 14 months after right hemicolectomy, and systemic metastases in various locations were discovered at the 19-month mark.

P-153. Malaria in a military hospital in Bogotá, Colombia, 2023 – 2024

Abstract Background In Colombia malaria is an endemic mosquito-borne disease. Although military personnel are recognized as a high-risk group for malaria, little is known about on features of this parasitic disease in Colombian military members. Methods We recorded data on demographic, clinical, laboratory and treatment of patients with confirmed malaria diagnosis (positive thick blood smear or Rapid Diagnostic Test), attended in a reference military hospital, located in Bogotá, Colombia, from February 2023 to April 2024. Cases of severe malaria and recurrence were classified following the last WHO guidelines. Dengue and malaria coinfection were defined as a confirmed malaria case with positive dengue NS1 antigen. Results During the study period, 97 patients were attended; all of them males, in active military service, and the median age was 25 years. Most (70%) consulted between November 2023 and April 2024 (Figure 1), and the main Colombian departments where the infections were acquired were Chocó (29%), Córdoba (22%) and Nariño (12%) (Figure 2). Plasmodium vivax was the main etiology (79%), follow by P. falciparum (17%), mixed infections (3%) and Plasmodium sp. (1%); four patients had coinfection with dengue. Most (51%) were attended at the emergency department, 39% at general ward, and 10% required intensive care unit. Recurrences were diagnosed in 36%, and the remaining as new infections. Among clinical features, the main symptoms were fever (88%), headache (75%) and chills (64%); and the main signs were jaundice (25%), abdominal pain (21%) and mild dehydration (12%) (Table 1). The median days of fever at hospital admission was five. Severe malaria was diagnosed in 8 patients. Among laboratory findings, thrombocytopenia was the most frequent (77%), follow by hyperbilirubinemia (71%). Hepatosplenomegaly was the most finding at the abdominal ultrasound (49%) (Table 2). Regarding treatment, 92% of P. vivax cases received chloroquine-primaquine; 69% of P. falciparum cases received artemether-lumefantrine and single dose primaquine; mixed infections cases received artemether-lumefantrine and primaquine; and all severe malaria received intravenous artesunate. No deaths were recorded. Conclusion Malaria remains a potential health threat to Colombian military personnel. Disclosures All Authors: No reported disclosures

P-1206. Dengue Epidemic Outbreak 2023-2024: is it here for good? Experience in a Tertiary Care Pediatric Hospital in Buenos Aires, Argentina

Abstract Background Between epidemiological weeks (EW) 1 and 13 of 2024, the Region of the Americas reported 4,820,955 suspected dengue cases, triple the count from 2023. Argentina ranked second with 379,341 cases, a fourfold increase from the previous season. Our aim is to describe the behavior of dengue in a pediatric population during 2023 and 2024 and compare the characteristics of the latest two dengue outbreaks in Argentina. Methods Two cross-sectional studies were conducted in a children’s hospital in Buenos Aires City. Clinical, epidemiological, laboratory, and follow-up data were recorded for patients < 18 years with confirmed dengue, according to PAHO definitions. The first season period included from March to May 2023 (EW 11 to 20) and the second from January to April 2024 (EW 2 to 15). Results A total of 1145 suspected cases were attended. 565 (49%) patients with confirmed dengue were included. Median age: 11 years (IQR 9-14), 308 (54%) being male. Most common symptoms: fever (100%), median duration of 4 days (IQR 3-5); headache/retro-orbital pain (88%); myalgias (75%). 188 patients (33%) exhibited warning signs, the most common: mucosal bleeding, persistent vomiting and severe abdominal pain. 396 patients had leukopenia (71%) and 346 had elevated liver enzymes (62%). Thrombocytopenia (< 100,000/mm3) was found in 131 patients (24%). Significant differences were observed when comparing warning signs: more mucosal bleeding in 2024 (p< 0,001), and more abdominal pain in 2023 (p=0,023). Regarding diagnosis, 495 (88%) patients were confirmed by detectable RT-qPCR, serotype 2 predominated (57%) and was significantly most frequent in 2023 (p< 0,001). 70 (12%) patients had positive NS1 antigen enzyme immunoassay. 86 patients (15%) required hospitalization. 5 cases (0,8%) of severe dengue. No deaths occurred. Conclusion Timely and precise diagnosis, along with proper categorization of severity criteria, are crucial during dengue infection. One third of patients had warning signs. Despite serotype 2 being the most common during the 2023 outbreak, which is often linked with severe dengue, the hospitalization rate was the same in both periods. The new quadrivalent vaccine available could be an important tool to decrease the number of patients in our region. Disclosures All Authors: No reported disclosures

P-131. Study of Enteric Parasitic Infections to Delineate Low Grade Inflammation in Patients with Functional Dyspepsia

Abstract Background Growing evidence of chronic low-grade intestinal inflammation in post-infectious functional gastrointestinal disorders (FGID), including functional dyspepsia (FD), have been observed. Present study aimed to investigate the role of enteric parasitic infestations along with Helicobacter pylori and associated inflammatory cellular components among FD patients. Methods Prospective observational study included 183 adult patients with symptoms of FD consistent with the ROME IV criteria. All these patients were subjected to clinical evaluation, routine blood tests, and stool sample analyses for parasitological examination. Upper gastrointestinal endoscopic biopsy samples were examined for the presence of H. pylori and to extrapolate cellular components of low-grade inflammation. Results Among the 183 individuals, (85/183) 46.4% and (98/183) 53.6% belonged to the subtype post-prandial distress syndrome (PPDS) and epigastric pain syndrome (EPS) respectively. 46/183 (25.14%) of the stool samples tested positive for parasites, most common being Blastocystis species. The distribution of Blastocytis cells were 14/85 (16.47%) for PPDS and 16 (16.32%) for EPS patients. Histopathological analysis revealed significantly elevated duodenal mast cells and their degranulation among 85.24% and 76.5% FD patients respectively whereas, duodenal eosinophilia, duodenal eosinophil degranulation, and duodenal intra-epithelial lymphocytosis were observed in 3.28%, 15.3%, 1.7% respectively. Patients of the EPS subtype with intestinal parasitosis had elevated duodenal mast cell count, albeit statistically non-significant (p value = 0.078). There was no significant correlation between intestinal parasitosis or H. pylori with any of the clinical parameters examined, other than intestinal parasitosis with anemia (PPDS, p-value < 0.02). Conclusion Presence of duodenal mast cells along with the presence of Blastocystis cells in some of the FD patients suggests their potential involvement in symptom generation, albeit lack of experimental studies. Our findings also give impetus to further understand the complex interplay between elevated duodenal mast cell count and mast cell degranulation with FD symptoms. Disclosures All Authors: No reported disclosures

P-96. Efficacy and Safety of Lactobacillus reuteri Supplementation Combined with Triple Therapy for Eradicating Helicobacter pylori: An Updated Meta-Analysis of Randomized Controlled Trials

Abstract Background The efficacy of Helicobacter pylori (H. pylori) triple therapy is declining over time. Lactobacillus reuteri (L. reuteri) is a probiotic that has shown promising results for eradicating H. pylori and decreasing adverse events. We aim to assess the efficacy of adding L. reuteri to the standard triple therapy for H. pylori eradication. Methods We systematically searched PubMed, Embase, Cochrane Central, Web of Science (WOS), and Scopus databases from inception until May 2nd, 2024. We included any randomized controlled trial comparing individuals receiving viable L. reuteri or a placebo preceding, during, or after the standard triple therapy for H. pylori eradication. We used Review Manager 5.4 for all statistical analyses. Results Seven randomized controlled trials with a total of 518 patients were included in the meta-analysis. We found that patients who received L. reuteri added to their triple therapy showed a higher eradication rate than those with triple therapy alone (HR: 1.16, 95% CI [1.03, 1.31], p = 0.01). The pooled results showed that the addition of L. reuteri to the triple therapy resulted in a significantly lower risk of taste distortion (RR: 0.59, 95% CI [0.39, 0.90], p = 0.01), diarrhea (HR: 0.44, 95% CI [0.28, 0.71], p = 0.0007), and constipation (HR: 0.52, 95% CI [0.31, 0.87], p = 0.01). There was no difference between both groups in experiencing epigastric pain (HR: 0.62, 95% CI [0.29, 1.33], p = 0.22), or nausea/vomiting (HR: 0.61, 95% CI [0.16, 2.40], p = 0.48). Conclusion In contrast to a previous meta-analysis, L. reutri supplementation improved the H. pylori eradication rate. Adding L. reuteri to the triple therapy decreased diarrhea, constipation, and taste distortion compared to the standard triple therapy alone. To reinforce our conclusions, further clinical trials with larger sample sizes are required. Disclosures All Authors: No reported disclosures

Euodiae Fructus: a review of botany, application, processing, phytochemistry, quality control, pharmacology, and toxicology

Euodiae Fructus (EF) is the dried and nearly ripe fruit of Euodia rutaecarpa, first recorded in Shen Nong’s Herbal Classic. EF is a versatile Traditional Chinese Medicine (TCM) known for the effects of dispelling colds and alleviating pain, suppressing adverse qi to relieve vomiting, and boosting yang to mitigate diarrhea. However, it should be noted that EF possesses mild toxicity. In TCM prescriptions, EF is employed to treat various ailments, including abdominal pain, diarrhea, chronic non-atrophic gastritis, irritable bowel syndrome, and primary dysmenorrhea. This review collected the literature published before September 2024 on EF. An exhaustive analysis of EF literature was conducted utilizing multiple sources, namely classic TCM books and various scientific databases like Web of Science, PubMed, Elsevier, ACS, ResearchGate, Google Scholar, and Chinese National Knowledge Infrastructure. So far, more than 300 metabolites have been extracted and identified from EF, exhibiting various pharmacological effects, such as cardiovascular protection, gastrointestinal protection, neuroprotection, anti-inflammation, analgesia, anti-tumor, glucose and lipid metabolism regulation, etc. It also exhibits diverse toxicological properties and poses specific toxic risks to the liver, heart, and kidney. Nonetheless, research is scarce regarding the toxicology of EF, especially on its cardiotoxicity and nephrotoxicity. Further in-depth research is necessary to explore the mechanisms underlying EF’s pharmacological and toxicological mechanisms and to develop strategies for quality control and toxicity mitigation. The toxicity of EF can be reduced by processing, but this aspect is rarely discussed, and the quality control needs to be further standardized. Evodiamine, rutaecarpine, and limonin are the effective metabolites of EF and are also one of the causes of EF toxicity. The pharmacological effects of evodiamine and rutaecarpine have been intensely studied, but there are few studies on limonin and other metabolites of EF. Therefore, this paper focuses on the botanical characteristics, traditional applications, processing methods, phytochemistry, quality control, pharmacology, and toxicology of EF. We hope this paper provides a theoretical basis for the future high-value and high-connotation development of EF.

P-756. Primary Mycobacterium Infections presenting in patients of Rheumatic diseases - A Case Series

Abstract Background We present a study about patients with rheumatic diseases who were diagnosed for mycobacterium infections in their follow-up visit. The role of side effects of immunosuppressants have been established. However, their association with mycobacteria in endemic countries like India is yet to be understood well. ABDOMINAL CT - CASE 1 (TUBERCULAR PERITONITIS) Moderate to gross ascites with thickened enhancing parietal peritoneum, significant with caking and abdominal lymphadenopathy hence pointing towards Tubercular Peritonitis. Methods Consent was obtained from the patients to use their data for a case series. Relevant data related to the cases was collected, and organised. HRCT THORX - CASE 3 (PULMONARY TB) HRCT THORAX shows multiple, discrete, randomly distributed nodules in both the lungs, multiple enlarged lymph nodes in left axilla and in left anterior chest wall, some of which are confluent in nature and two calcifications in one of the lymph node. Results First case is about a 54 yr-old male patient, known case of Ankylosing spondylitis treated with 9 doses of Anti-TNF alpha drug Adalimumab presented with severe abdominal pain, fever with chills, vomiting & diarrhea for which he underwent abdominal CT-scan which revealed thickened enhancing parietal peritoneum, significant with caking and abdominal lymphadenopathy hence pointing towards Tubercular Peritonitis. Second case is about Non-Tuberculous Mycobacteria(NTM) or atypical mycobacteria diagnosed in a patient with Ankylosing Spondylitis who had negative tests for primary TB. Third case about a 28 year-old female, known case of bilateral iridocyclitis and recurrent multiple medium-vessel vasculitic/throm2botic occlusions treated with mycophenolate-mofetil and cyclosporine-A, was started on adalimumab. Later she presented with fever for which pulmonary workup was done which revealed positive TB. Fourth case is of a patient having symptoms similar to Rheumatoid arthritis but not responsive to treatment which led to extensive workup and mycobacterium leprae was found as a culprit. Fifth case is of a 16 year-old male, known case of GPA who was refractory to cyclophosphamide was started on rituximab, after which he presented with complaints of fever with chills and rigors, and breathlessness on exertion which was followed by the diagnosis of miliary tuberculosis. TB patients were given Anti-tubercular therapy(ATT) and Leprosy patient was given Multi-drug therapy(MDT) and all are now improving. Leonine Facies - Case 4 Conclusion • Our study shows that immunosuppressants can be considered to have even increased risk of primary mycobacterium infection. • Leprosy can present with similar manifestations of RA (Rheumatoid Arthritis) so signs of suspicion need to be kept in mind and screening should be done in such cases. Leprosy mimicking RA - Case 4 Disclosures All Authors: No reported disclosures

P-132. Retrospective Comparison of Short and Prolonged Treatment Strategies for Patients with Neutropenic Enterocolitis

Abstract Background Neutropenic enterocolitis (NE) is a severe necrotizing condition affecting the small and/or large intestines in neutropenic patients. With a lack of high-quality studies looking at antimicrobial duration and outcomes for patients with NE, this study aims to evaluate the impact of short versus prolonged antimicrobial treatment durations on clinical outcomes in patients with NE. Methods This was a single-center, retrospective, cohort study conducted at a tertiary care academic medical center in New Jersey. Medical records of adult patients with hematologic malignancies admitted between January 2015 to September 2023, with diagnosis of NE and receipt of treatment with broad-spectrum antimicrobials, were reviewed. This study compared patients who received short versus prolonged antimicrobial treatment courses for NE. Patients in the short treatment group included those who received broad antimicrobials for NE treatment, that were stopped or switched to prophylaxis while the patient’s absolute neutrophil count (ANC) was less than 0.5 x 103/uL. The prolonged treatment group included patients who received broad antimicrobials at least until ANC was over 0.5 x 103/uL. The primary endpoint was the time to clinical improvement of symptoms between the two groups. Secondary endpoints included hospital length of stay (LOS), intensive care unit (ICU) admission, incidence of NE complications, and 30-day mortality. Results A total of 17 patients were included, with 5 (21.7%) patients who underwent hematopoietic stem cell transplantation. Time to clinical improvement, defined as improvement in symptoms (including resolution of abdominal pain, abdominal distension and/or cramps, diarrhea, nausea, vomiting, lower GI bleed), and 30-day mortality were similar in both treatment groups. However, hospital LOS, ICU admission, and incidence of NE complications were higher in the prolonged treatment group. Conclusion Between short and prolonged treatment groups in patients with NE, time to clinical improvement was similar. Larger, randomized controlled trials are needed in this patient population to assess the appropriate duration of therapy for patients with NE. Disclosures Navaneeth Narayanan, PharmD, MPH, BCIDP, Astellas: Honoraria|Beckman Coulter: Honoraria|Merck: Grant/Research Support|Shionogi: Grant/Research Support Pinki Bhatt, MD, Sanofi: Grant/Research Support

P-159. Epidemiological and Clinical Characteristics of Dengue Fever in Patients Admitted at a Universitary Hospital

Abstract Background Dengue is the fastest spreading mosquito-borne viral infection, which affects people living in the tropical and subtropical countries and cause severe clinical symptoms and possibly death. We aimed to determine the epidemiological and clinical characteristics of patients with dengue fever and to find mortality predictors. Methods We conducted a retrospective observational study between November 2023 and April 2024 in five hospitals of Misiones, Argentina. Dengue virus infection was confirmed by a positive non-structural protein 1 test, IgM capture ELISA or RT-PCR. Clinical and laboratory patient details were collected by an electronic case report form. Results A total of 289 patients were documented. Overall mean age was 50 years (15-88). Over half (56%) of the patients were female. Common comorbidities: hypertension (36%), age >60 years (31%) and diabetes mellitus (18%). Signs and symptoms at hospital admission: fever (82%), asthenia (47%) and myalgias (33%). Most frequent warning signs at admission were abdominal pain 29%, vomiting 23% and drowsiness 22%. Frequent hematological and biochemical abnormalities: Hto >30% (83%), leukopenia < 4000 cells/mm3 (48%), thrombocytopenia severe and very severe (25%), ALT or AST >200 iu (16%) and creatinine >2 mg/dl (16%). Complications at any time during patient hospitalization: renal failure 15%, diarrhea 9% and acute respiratory distress syndrome (ARDS) 9%. Patients who required admission to the ICU 15%. Dengue classification: without warning signs 27%, with warning signs 61% and severe dengue 12%. Mortality associated with dengue 7%. Admission to ICU (aHR: 5.81 95% [CI 2.29-14.7]), ARDS (aHR: 5.44 [95% CI 2.25-13.17]) and platelet transfusion (aHR: 10.46 [95% CI 3.92-27.89]) were independently associated with increased mortality. Conclusion Our fatality rate was similar to the reported in other studies. Early recognition of warning signs and hematological monitoring is essential in order to detect patients at risk and offer them adequate early treatment. Disclosures Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria

DRUG–ASSOCIATED NEPHROTIC SYNDROME IN A CHILD WITH WILSON–KONOVALOV DISEASE

Wilson's disease (WD) (synonyms: Wilson–Konovalov disease, hepatolenticular degeneration, hepatocerebral dystrophy) is a rare, severe, hereditary multisystem disorder that manifests itself primarily in liver, neurological, and psychiatric disorders due to excessive copper deposition in organs and tissues. The long latent course and polymorphism of clinical symptoms make diagnostics difficult. WD manifests itself in childhood, adolescence, and later in life. WD diagnostics is based on a combination of clinical symptoms, laboratory test data (determination of ceruloplasmin levels in the blood, copper excretion in the urine), and molecular genetic testing. Complex treatment of WD primarily involves adherence to a copper–eliminating diet. A mandatory condition for the effectiveness of treatment of patients with WD is lifelong chelation therapy. The drug of choice in all age groups is D–penicillamine (a penicillin derivative), which has a significant number of side effects. Adverse reactions against the background of D–penicillamine therapy develop in about 30% of cases. These include changes in the nervous system (loss of taste, pyridoxine–deficiency polyneuritis), respiratory system (interstitial pneumonitis, diffuse fibrosing alveolitis, Goodpasture's syndrome), digestive system (decreased appetite, nausea, vomiting, diarrhea, aphthous stomatitis, glossitis, intrahepatic cholestasis, pancreatitis), kidneys (nephritis, nephrotic syndrome, hematuria). The purpose of this publication is to describe the case history of a 6–year–old girl with Wilson's disease. The peculiarity of the clinical case we present is the latent course of the disease in a 6–year–old girl, which was suspected when cytolysis syndrome was detected in connection with an examination for episodic abdominal pain. Further examination showed a decrease in the ceruloplasmin level, initially borderline values of copper excretion with urine and questionable values in the penicillamine test. Molecular genetic testing was important for establishing the diagnosis, which confirmed the diagnosis. Prescribed chelation therapy with D–penicillamine led to the normalization of cytolysis syndrome indices, but caused serious adverse events in the form of nephrotic syndrome formation, which required replacing D–penicillamine with trientine and prescribing glucocorticoids. Against the background of treatment correction, stable clinical and laboratory remission of nephrotic syndrome was achieved with satisfactory renal and liver function indices and no cytolysis manifestations.

Diagnostic Approach to Patients with Hepatic Abscess: A Case Report

Hepatic abscess is a severe infection characterized by pus accumulation within the liver, often caused by bacterial or amoebic pathogens. This case report discusses the diagnostic challenges and management of bilateral hepatic abscesses in a resource-limited setting. A 43-year-old male presented with right upper quadrant abdominal pain, jaundice, and systemic symptoms. Diagnostic investigations, including ultrasonography and contrast-enhanced CT scan, revealed abscesses in the right and left hepatic lobes. Laboratory findings showed leukocytosis, hypoalbuminemia, and elevated liver enzymes. The patient was treated with empiric antibiotics and underwent laparotomy for abscess drainage, yielding 1700 cc of pus. Postoperative recovery was uneventful, with significant clinical improvement. This study highlights the importance of a combined medical and surgical approach in managing complex hepatic abscess cases, particularly in settings with limited diagnostic resources. The findings emphasize early diagnosis, multidisciplinary care, and tailored treatment strategies to improve outcomes for patients with hepatic abscesses, especially in underserved regions.

Case report: Spontaneous renal hemorrhage in anti-neutrophil cytoplasmic antibody-associated vasculitis

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic necrotizing vasculitis that predominantly affects small vessels. In this report, we present a typical case of granulomatosis with polyangiitis (GPA) complicated by spontaneous renal hemorrhage (SRH), a rare but potentially severe condition. The patient developed SRH during immunosuppressive therapy but recovered following conservative treatment. We then conducted a systematic literature review on SRH in the context of AAV, and analyzed clinical features, management strategies, and patient prognosis. A total of 15 patients were enrolled for statistical analysis, comprising the one case reported in the current study and 14 from the literature. Of these patients, nine presented with GPA and six showed microscopic polyangiitis (MPA), with a sex distribution of 3:2 males to females. The average patient age was 54.5 years, and ranged from 25 to 82 years. Acute flank pain was the most common clinical manifestation, and was occasionally accompanied by anemia and shock. Treatment varied for the different patients. Eight patients received glucocorticoid and immunosuppressive agents that included rituximab, cyclophosphamide, and azathioprine; five patients underwent transcatheter arterial embolization (TAE); and one patient underwent nephrectomy. Our findings indicate that SRH typically occurs early in the course of AAV and correlates with disease activity, with renal aneurysm rupture as the primary cause. More than half of the patients respond well to corticosteroids and immunosuppressants. Timely TAE is essential for patients showing persistent deterioration despite conservative management.

Gastrointestinal complications of hepatic glycogen storage disease: a national survey questionnaire study in China

BackgroundHepatic glycogen storage diseases (GSD) are inborn errors of metabolism with abnormal storage or utilization of glycogen, a complex disease with significant genetic heterogeneity and similar clinical manifestations. This study aimed to describe the gastrointestinal symptoms and endoscopic features of hepatic GSD, including types Ia, Ib, III, VI, and IX, to provide evidence for etiology and treatment.MethodsA national cohort survey questionnaire was distributed to patients diagnosed with GSD type Ia, Ib, III, VI, and IX through genetic testing or their parents in mainland China in May 2022. Expert gastroendoscopists performed endoscopic examinations and evaluations in 10 hospitals. Descriptive statistics were used for analysis.ResultsA total of 315 patients with hepatic GSD were included in the study, including 191 males and 124 females, the median age at diagnosis was 1.42 years (range = 0.08–36.08 years), with a median age of 5.42 years at the time of investigation (range = 0.58–38.08 years). 95% of patients relied on uncooked corn starch (UCCS) for blood glucose maintenance, and the median age of initiation was 18.5 months (range = 4-360 months). The common characteristics of these GSDs were hypoglycemia, lactic acidosis, anemia, liver enlargement, hyperlipidemia, hyperuricemia, and weakness. More than 60% of patients reported gastrointestinal symptom including anorexia, nausea/vomiting, abdominal pain, abdominal bloating, diarrhea, and mucus or bloody stool. The incidence of gastrointestinal symptoms in patients with GSD type Ia, Ib, III, VI and IX were 68%, 68%, 48%, 59% and 48%, respectively. A total of 48 GSD patients underwent gastroenteroscopy, 54% (26/48, 24 patients with type Ib, 1 patient with type Ia and 1 with III) were diagnosed with GSD-associated inflammatory bowel disease (IBD), the endoscopic images showed mucosal edema, erythema, erosions, single or scattered multiple large, deep, round ulcers and strictures, without linear ulcers and cobblestone mucosal lesions.ConclusionPatients with GSD type Ia, Ib, III, VI and IX had different degrees of gastrointestinal complications, among which patients with type Ia, Ib and III were the most prominent, and the proportion of GSD-Ib patients had a higher proportion of GSD-associated IBD.

Prevalence of colorectal malignant and pre-malignant diseases in faecal immunochemical test positive individuals: an observational study

Background: Colorectal cancer (CRC) is a challenging clinical entity worldwide. Adenomatous polyps are considered precursors to cancer. For early detection of polyps or ulcers, different screening investigations like colonoscopy, faecal immunochemical test (FIT), gFOBT, CT colonography etc. are used. Despite colonoscopy is being a highly accurate and gold standard therapeutic, it is not easily available in remote areas. The FIT, one of several tests available for CRC screening, is currently used in many countries and well accepted to all patients. Methods: To find out the prevalence of colorectal malignant and pre-malignant diseases in FIT positive individuals. This prospective cross-sectional observational study was done in the department of colorectal surgery, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka. A total 140 patients were selected according to the inclusion and exclusion criteria. FIT was done who matched. Colonoscopy was done in the FIT positive individuals. Results: The study patients were aged ≥45 years, with a mean age of 51.73±7.97 years. The most common clinical finding was abdominal pain (n=117), followed mucous discharge (n=56) and changes in bowel habit (n=47). Colonoscopy revealed that 50% of the patients had polyps, 10.71% had nonspecific ulcers, 2.86% had growths, and 12.14% had haemorrhoids. Histopathology showed that 61.43% of the polyps were hyperplastic polyps, and 63.16% of the ulcers were non-specific colitis. Most of the patients had single polyps in colonoscopy. Sensitivity, specificity and PPV of FIT is 85.7%, 97.5% and 66.4% respectively. Conclusions: The consistent evidence linking FIT positivity to the presence of colorectal malignant and pre-malignant diseases reinforces its efficacy as a frontline screening tool.

Acute appendicitis and secondary peritonitis in a patient with end-stage renal failure and a dormant peritoneal dialysis catheter

Peritoneal dialysis (PD) is a common renal replacement therapy for patients with end-stage renal disease (ESRD). Despite its benefits, PD-related peritonitis remains a severe complication, often associated with significant morbidity and mortality. Although most cases of PD-related peritonitis are due to touch contamination, intra-abdominal infections, such as appendicitis, are less common but can result in severe outcomes. We present a case of severe peritonitis secondary to perforated appendicitis in a patient with a dormant PD catheter. A 41-year-old male with ESRD, previously on PD, presented with a 36-hour history of fever, chills, nausea, and abdominal pain. Despite transitioning to hemodialysis, the patient had retained his PD catheter, which had not been used for months. On admission, the patient was septic with evidence of peritonitis. Blood cultures were positive for Escherichia coli, while PD catheter cultures were negative. An abdominal CT scan revealed a gangrenous perforated appendix. The patient underwent an emergency laparoscopic appendectomy and PD catheter removal, resulting in significant clinical improvement. Perforated appendicitis in ESRD patients with a PD catheter can result in severe peritonitis with life-threatening complications, including sepsis and cardiac events. This case underscores the importance of maintaining a high index of suspicion for intra-abdominal causes of peritonitis in PD patients, even when the PD catheter is dormant. Timely diagnosis, empiric antibiotic therapy, and prompt surgical management are essential to reduce mortality in these patients.

Pregnancy problems: a case report

Appendicitis is a common surgical cause of abdominal pain. Investigation and diagnosis of the cause of right lower quadrant abdominal pain is more complex in women who are pregnant. A 27 year old, 34 week pregnant female presented with migratory RIF pain. Inflammatory markers were mildly elevated. There was a strong patient preference to avoid unnecessary. In this case we demonstrate the importance of keeping a broad differential diagnosis despite imaging findings. With a higher index of suspicion in this case surgery could potentially have been avoided. This could have avoided potential morbidity and additional psychosocial stress during the patient’s pregnancy. As such the limitations of diagnostic certainty with imaging especially less common modalities such as MRI should be appreciated.