Gastroenterology Research Articles

P624 Investigating the symptom burden among European patients with moderate-to-severe Crohn’s disease using a real-world survey

Abstract Background Despite treatment, patients with Crohn’s disease (CD) experience symptoms that affect their health-related quality of life (HRQoL). Understanding how CD affects HRQoL reveals valuable insight into disease impact. We aimed to examine the disease burden in patients with moderate-to-severe CD in remission vs not in remission using real-world, gastroenterologist (GE)- and patient-reported data. Methods Data were drawn from the Adelphi Inflammatory Bowel Disease (IBD) Disease Specific Programme,1 a point-in-time survey conducted in France, Germany, Italy and Spain from October 2020 to March 2021. GEs collected data from the next 5–8 consecutive patients (≥18 years old, not involved in clinical trials) with a CD diagnosis who they saw in clinical practice. GEs reported patient demographics, clinical characteristics (including remission status) and treatment history. Patients completed questionnaires on their treatment satisfaction, symptoms and HRQoL (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and EQ-5D scores). Scores were compared among patients in remission vs not in remission using propensity score matching (PSM). Results Overall, 133 GEs reported on 538 patients with CD (Table 1). Overall, 66.0% of patients were employed, and of those not working, 24.3% were not working due to CD. Most patients (70.9%) had received ≥2 lines of treatment and 43.3% of patients were receiving a tumour necrosis factor (TNF) inhibitor. Of 427 patients from whom complete data were available and were therefore included in PSM analyses, 70.0% (n=299) were in remission. Although patients in remission were generally less likely than those not in remission to experience CD symptoms, they were still moderately likely to experience symptoms such as fatigue/tiredness and abdominal pain (Figure 1). Similarly, whilst patients in remission had better mean SIBDQ and EQ-5D scores than those not in remission, their scores still indicated diminished HRQoL (Figure 2). Of patients for whom symptom data were provided, 39.2% were either not satisfied with their current treatment or believed that better disease control could be achieved. A higher proportion of patients who were dissatisfied with their treatment reported residual symptoms than those who were satisfied, especially abdominal pain, non-bloody diarrhoea and fatigue/tiredness (Figure 3). Characteristics of patients in remission with mucosal healing were similar regardless of whether remission was confirmed by endoscopy. Conclusion A substantial proportion of patients with CD, even those in remission, experience high symptom burden and diminished HRQoL despite treatment. There is a need for therapies that provide more comprehensive disease control. 1. Anderson P et al. Curr Med Res Opin 2008:24;3063–72.

INCORPORATION OF RISK ASSESSMENT TOOL IMPACTS PATIENT AND GASTROENTEROLOGIST CONFIDENCE AND TREATMENT DECISION MAKING IN BIONAIVE CROHN’S DISEASE

Abstract BACKGROUND Clinical guidelines recommend the incorporation of risk stratification assessments when making decisions about Crohn’s disease (CD) treatment. We aimed to evaluate if patient and gastroenterologist (GI) decision making and confidence about starting or changing therapy were impacted by reviewing a CD risk stratification assessment. METHODS We conducted a multicenter, prospective study evaluating the impact of a risk stratification tool on decision making by GIs and biologic naïve adult CD patients considering starting or changing therapy. Medical records were reviewed by a GI at the organizing site to determine risk according to the American Gastroenterological Association (AGA) Crohn’s Disease Care Pathway risk assessment tool. Patients with any risk factors for rapid disease progression (age<30 at diagnosis, deep ulcers, extensive anatomic involvement, perianal disease, prior CD surgery, and/or stricturing/penetrating behavior) were considered moderate-high risk. Patients and treating GIs were then provided a report with their risk assessment conveyed in both written and visual (“risk gauge”) format. Participants were surveyed at baseline and at 7 days after viewing the risk stratification assessment and were unaware which risk assessment tool was used to determine risk. The primary outcome was behavioral change defined as any modification in treatment plan or increase in patient or GI self-assessed confidence in need for treatment change (on 5-point Likert scale) from baseline to day 7. RESULTS 47 patient-GI pairs were enrolled across 14 sites. Among CD patients, mean age was 40.2 years, 59% were men, 70% were white, 80% had inflammatory (B1) disease behavior, 74% had no prior CD-related hospitalizations, and 82% no prior CD-related surgeries. 64% of patients were deemed moderate-high risk and 36% low risk by AGA criteria. In comparison, 40% of patients self-assessed their risk as moderate-high at baseline. The most common moderate-high risk factors were age<30 (45%) and stricturing/penetrating behavior (20%). At baseline, 49% of GI risk assessments of their patients were discordant with AGA risk stratification (e.g. moderate-high risk by AGA evaluated as low risk). Behavioral change was observed in 52% of participants at day 7 and was similar whether patient was low or moderate-high risk. At day 7, patient confidence increased in 21%, GI confidence increased in 23%, and treatment recommendation was changed in 36% of cases. Among patients assessed as low risk disease, confidence that patient would benefit from treatment change decreased in 47% of GIs and 59% of CD patients at day 7. CONCLUSION Incorporation of a simple risk stratification assessment when considering treatment change in CD can assist in patient and GI decision making. Low risk assessments are associated with lower confidence in decision making.

TREATMENT PREFERENCES IN CROHN’S DISEASE PERIANAL FISTULA: PERSPECTIVES OF HEALTHCARE PROFESSIONALS

Abstract INTRODUCTION Crohn’s perianal fistulas (CPFs) are a common complication of Crohn’s disease and treated with both medical and surgical interventions. This study aimed to characterize the experience and satisfaction of healthcare professionals (HCPs) with current CPF treatments and assess HCP preferences for future CPF treatment attributes. METHODS A US observational study recruited gastroenterologists (GEs) and surgeons who managed at least three patients with CPF in the past 12 months and spent ≥ 70% of their professional time treating patients. Using a web-enabled questionnaire, HCP satisfaction with CPF treatments and attitudes towards CPF care were rated using a 1–9 scale (1 = not at all satisfied/strongly disagree, 9 = extremely satisfied/strongly agree). A discrete choice experiment (DCE) evaluated HCP preferences for future treatment attributes. Data were analyzed using descriptive statistics and hierarchical Bayesian modeling for DCE. RESULTS In total, 137 HCPs were recruited (GEs, n = 77; surgeons, n = 60) with a mean (standard deviation [SD]) of 15.6 (7.8) years in active clinical practice. The mean (SD) number of patients with CPF per HCP was 29.4 (16.7), and 41% of patients had moderate disease severity. Overall, HCPs reported moderate satisfaction with current CPF treatment (medication or surgical) attributes (Table). HCP satisfaction scores for each CPF medication and surgical procedure were low to moderate (mean range [SD]: 3.4 [2.1]–6.7 [1.5]; 4.2 [2.2]–5.7 [1.6], respectively) with biologics rated highest for medications (4.7 [2.2]–6.7 [1.5]), and short- or long-term seton placement highest for surgical procedures (mean [SD]: 5.7 [1.6] and 5.5 [1.7], respectively). HCP attitudes towards current CPF interventions (mean score [SD]) revealed a need for better treatments (7.4 [1.5]), a concern for CPF recurrence despite treatment (7.2 [1.4]), that current treatments may not reduce risk of fecal incontinence (FI) (6.8 [1.4]), and that setons are a good short- but not long-term solution for CPF (6.5 [1.8]). Achieving fistula closure was the most important treatment goal for HCPs (57%), with improvement in quality of life (mean score [SD]: 7.7 [1.3]), low chance of symptom recurrence (7.5 [1.4]), minimal risk of FI (7.5 [1.4]) and sustained efficacy post treatment (7.5 [1.5]) the main attributes influencing treatment decisions. The DCE identified symptom control and/or fistula closure and low FI rates as the most important future CPF treatment attributes (Figure). CONCLUSIONS HCPs were unsatisfied with current CPF treatments, highlighting a need for better treatments. From an HCP’s perspective, future CPF therapies should control symptoms, promote fistula closure, and low rates of FI.

Prescribing Patterns of Proton Pump Inhibitors in Germany: A Retrospective Study Including 472 146 Patients.

The aims of this study were to analyze proton pump inhibitor (PPI) users in Germany, defining and classifying them in terms of treatment appropriateness, and to analyze the PPI prescription practices of healthcare providers. The updated DGVS (Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten) gastroesophageal reflux disease (GERD) treatment guideline (published March 2023) for mild heartburn symptoms recommends carrying out a probatory treatment of mild symptoms via other medication such as antacids, alginates, and H2 blockers before escalating to PPI treatments, if the patient profile allows. This retrospective cross-sectional study was based on data from the IQVIA™ Disease Analyzer database (DA) and included adult patients (18 years or older) in 1006 general and 39 gastroenterological practices in Germany who received at least 1 PPI prescription or alginate between September 2019 and September 2021 (hereinafter referred to as the index period). Analyses included indications associated with PPI prescription, co-diagnoses, co-therapies of PPI patients, duration of PPI therapy, dosages of PPI prescriptions, and proportions of practices prescribing PPIs and alginates. A total of 472 146 patients taking PPIs and 9101 patients taking alginates were available for analysis. Very few patients (4.5%) of the total cohort were treated in complete adherence to treatment guidelines. Conditions such as gastritis and duodenitis (47.2%) and reflux diseases (38.4%) were more frequently associated with PPI prescriptions. The average PPI treatment period lasted 141 days, and 36.6% of patients were treated for >6 months. High doses were prescribed relatively often (ie, 42.8% of esomeprazole prescriptions were 40 mg, 59.1% of lansoprazole prescriptions 30 mg, 28.6% of omeprazole prescriptions 40 mg). With each practice prescribing PPIs to at least 10% of their patients; 72% of general practitioners (GPs) and 8% of GENTS (Gastroenterologists) prescribed alginates. This study highlights that discrepancies exist between clinical guidelines and real-life prescribing practices of PPIs in Germany. Particular attention should be given to the incidence of patients being prescribed high-dose or long-duration PPI with mild indications. These findings are particularly apt considering the publication (March 2023) of new guidelines on the "management of gastroesophageal reflux disease and eosinophilic esophagitis," by the DGVS.

Innovations and New Technologies in Gastrointestinal Surgery

Introduction. Innovations in surgery have advanced significantly in the last decade. The new technologies in minimally invasive surgery, including robotics, advanced endoscopy, and the progress in artificial intelligence and machine learning are impacting gastrointestinal surgery and medicine. These technologies have been available since 1956, and in the early 1970’s, they were implemented for first time with the Mycin system, which was developed to detect infectious diseases in blood. Objective. To describe the experiences of new technology innovations in surgery, in terms of novel interventions, development of devices, and the process of adopting these technologies in the clinical practice. Methodology. Personal reflections about the process of adopting new technologies in surgery and its future implications, documented from my perspective as an academic surgeon. Results and discussion. This article summarizes the most relevant advances in the field of gastrointestinal surgery during the last decade. Conclusions. Adopting a culture of innovation in surgery involves knowledge of the process, technical resources available to support initiatives, access to mentors or tutors, and support services.

S874 Evaluation of Quality-of-Care Indicators Among Patients With Crohn’s Disease and Ulcerative Colitis in the United States: 2019–2020

Introduction: Crohn’s disease (CD) and ulcerative colitis (UC) can be difficult to manage and, due to a lack of meaningful quality measures, patient (pt) care may vary by provider. To understand where gaps in care may exist for these pts, this study assessed specific healthcare resource utilization (HRU) and medication metrics that may be potential quality of care (QOC) indicators. Methods: Using a large commercial US claims database (2019–2020), pts with CD or UC were identified. Potential QOC indicators were selected based on clinical guidelines and recommendations from measures of quality organizations and included CD or UC prevalence; gastroenterologist (GE) and IBD-related non-GE outpatient visits; IBD-related emergency department visits or hospitalizations; excessive steroid use (prednisone equivalent ≥10 mg/day for ≥60 consecutive days or a single prescription of ≥600 mg prednisone); excessive steroid users on corticosteroid (CS)-sparing therapy; excessive steroid users with central dual-energy X-ray absorptiometry (DEXA) or osteoporosis pharmacologic treatment; use of targeted immunomodulators (TIMs) and oral mesalamine (CD only); imaging assessments; and assessment of inflammatory biomarkers. National percentages of pts achieving each metric are reported. Results: In total, 41,555 CD and 52,507 UC pts were identified in 2019, resulting in a 0.3% and 0.4% prevalence, respectively (Table). Over a third of CD pts (39.8%) and almost half of UC pts (45.5%) did not visit a GE in 2019. Around 10% CD pts, and up to 6.4% of UC pts, had IBD-related ED visits or hospitalizations. 17.1% CD and 14.5% UC pts were excessive steroid users, yet < 9% CD and UC pts, received DEXA scans and/or bone treatments. A third of excessive steroid users with CD (34.5%), and over half (53.0%) of those with UC, did not receive CS-sparing therapy. The rate of TIM use was over two times higher in CD vs UC pts (CD: 44.3%; UC: 18.9%). Despite evidence that mesalamine is ineffective in CD, 18.7% of pts with CD were prescribed it. Inflammatory biomarker level testing rates were < 50% in both CD and UC. Similar outcomes were reported in 2020, with lower HRU, possibly due to COVID-19. Conclusion: This analysis of QOC indicators highlights various areas for improvement that may provide better treatment outcomes and reduce HRU for pts with CD and UC. Future research is needed to assess outcomes in pts that are not being routinely monitored. Table 1. - Proportion of CD and UC patients achieving potential QOC metrics by year Indicator 2019 2020 CDN=41,555a UCN=52,507a CDN=39,025a UCN=47,940a Diagnosis Rate 0.3% 0.4% 0.3% 0.4% GE Outpatient Visits 60.2% 54.5% 57.5% 52.9% IBD-Related Non-GE Outpatient Visit 38.5% 43.8% 41.3% 45.6% IBD-related ED Visits 11.2% 4.7% 9.9% 4.5% IBD-related Hospitalizations 10.3% 6.4% 9.1% 5.9% Excessive Steroid Useb Corticosteroid-Sparing Therapyc,d DEXA or Bone Treatmentc,e,f 17.1%65.5%8.9% 14.5%47.0%7.9% 15.8%66.9%8.0% 14.5%49.4%6.9% Targeted Immunomodulator Use 44.3% 18.9% 48.4% 22.2% Oral Mesalamineg 18.7% N/A 17.0% N/A Imagingh 59.4% 64.2% 54.0% 58.0% Inflammatory Biomarkersi 49.8% 35.8% 49.9% 36.9% a) Sample size shown is based on continuous eligibility in medical benefit. Denominator for medication use outcomes focused on patients fully enrolled in both medical and pharmacy benefit, and thus were a subset of the larger population. b) Excessive steroid use was defined as doses ≥10 mg/day prednisone equivalent for ≥60 consecutive days or a single prescription of ≥600 mg prednisone. c) In excessive steroid users only. d) Treatments included thiopurine, methotrexate, or TIMs. e) All indicators were within the respective calendar year except DEXA/bone treatments that occurred during the prior calendar year. f) Defined as prescription osteoporosis treatment, excluding vitamin and mineral supplements. g) In patients with CD only. h) Including endoscopy, CT scan, MRI, or ultrasound. i) Including fecal calprotectin and c-reactive protein. CD, Crohn’s disease; CT, computed tomography; DEXA, dual-energy X-ray absorptiometry; ED, emergency department; GE, gastroenterologist; IBD, inflammatory bowel disease; TIM, targeted immunomodulator; UC, ulcerative colitis.

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

S904 Burden of Bowel Urgency Across Specific Treatment Groups Among Crohn’s Disease Patients: Real World Global Study Analyses

Introduction: Bowel urgency (BU) is a sudden and immediate need to have a bowel movement, a common symptom in Crohn’s disease (CD) patients. The pathophysiology /mechanism of BU in CD is very complex. BU may persist despite treatment for CD and when disease is considered inactive1-2. This study explored differences in disease burden among CD patients with BU based on their treatment pathway. Methods: Data were extracted from the Adelphi Disease Specific Programme for CD3, a point-in-time survey of gastroenterologists (GIs) and patients from Jan 2020-Mar 2021 in Germany, France, Spain, Italy, UK and US. GIs provided patient demographics, clinical characteristics and treatment history. The same patients were invited to complete the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), EQ-5D and Work Productivity and Activity Impairment (WPAI) questionnaire. Three patient subgroups were identified: never received targeted therapy (biologics and JAK inhibitors) (TT-naïve), receiving first TT currently (1L TT) and receiving TT with prior TT use (TT-exp). Within these groups, patients currently experiencing BU, reported by physicians, with current treatment duration >3 months, were included. ANOVA, chi-square and/or Kruskal-Wallis tests were used to compare across groups. Results: Of the CD patients in the TT-naïve (n=643), 1L TT (n=994) and TT-exp (n=404) groups, 17%, 13% and 15% experienced BU, respectively (Table). 9% of the TT-naïve group were flaring vs. 15% 1L TT and 29% TT-exp patients (p=0.0024). Steroid use was higher in the TT-naïve group (45%) vs. 15% 1L TT and 12% TT-exp (p< 0.0001). The patient reported outcome measures indicated substantial and similar quality of life impairment across all patients with BU (Table). Conclusion: This study confirmed that a substantial proportion of patients with CD across all three groups still experience BU despite receiving treatment. Since BU is known to negatively impact patients’ quality of life, there is a therapeutic need to address this symptom. Table 1. - Patients with CD on treatment for >3 months with presence of bowel urgency by treatment groups – physician reported data TT-naïveN=110 1L TTN=126 TT-expN=60 p-value Age, mean (SD) 37.8 (13.1) 40.0 (13.0) 44.7 (14.1) 0.0059* Sex, male, n (%) 62 (56.4) 59 (46.8) 30 (50.0) 0.3381 BMI, mean (SD) 23.4 (2.9) 24.0 (3.9) 23.9 (3.5) 0.2910 Smoking status N=103 N=117 N=59 0.5772 Current smoker, n (%) 28 (27.2) 22 (18.8) 14 (23.7) Ex-smoker, n (%) 30 (29.1) 44 (37.6) 20 (33.9) Never smoked, n (%) 45 (43.7) 51 (43.6) 25 (42.4) Flare status: Currently flaring, n (%) N=1039 (8.7) N=11517 (14.8) N=5817 (29.3) 0.0024* Current treatment: Steroids, n (%) N=11050 (45.4) N=12619 (15.1) N=607 (11.7) < 0.0001* SIBDQ1: Total score, mean (SD) N=5349.0 (8.5) N=3747.9 (14.7) N=3045.4 (11.9) 0.3873 EQ-5D: VAS2, mean (SD) N=5576.3 (13.6) N=3971.6 (21.0) N=3071.8 (13.6) 0.2893 WPAI: Activity impairment, mean % (SD) N=5327.2 (16.2) N=3831.1 (27.0) N=2729.3 (20.0) 0.6839 WPAI: Absenteeism3, mean % (SD) N=291.1 (4.1) N=1911.7 (31.4) N=173.9 (6.7) 0.1247 WPAI: Presenteeism3, mean % (SD) N=3824.5 (15.0) N=2119.0 (14.1) N=1825.0 (14.7) 0.3332 WPAI: Overall work impairment3, mean % (SD) N=2926.4 (17.5) N=1722.0 (15.6) N=1727.9 (16.2) 0.5582 SD – standard deviation; BMI – body mass index; SIBDQ – Short Inflammatory Bowel Disease Questionnaire; VAS – Visual analogue scale; WPAI – Work Productivity and Activity Impairment.1Scores range from 10 – 70, with higher scores indicating better health related quality of life.2Scores range from 0 – 100, with higher scores indicating better health related quality of life.3Includes working patients only with known data.*statistical significance of α= 0.05.

S1460 Endoscopic Reversal of Roux-en-Y Gastric Bypass Prevents Worsening of Nutritional Outcomes in Patients With Severe Malnutrition

Introduction: Roux-en-Y gastric bypass (RYGB) can precipitate protein-caloric malnutrition and micronutrient deficiencies. Sonographically guided endoscopic reversal (ER) via deployment of a stent from the gastric pouch to the remnant stomach is emerging as a novel option for increasing intestinal transit time and increasing absorptive surface area. In this investigation, short-term nutritional outcomes after endoscopic reversal for malnutrition were assessed. Methods: Patients (age ≥ 18) who underwent ER of RYGB for malnutrition from a single academic health center in Minneapolis over a 7-year period (2015-2021) were reviewed. Nutrition status (assessed by a registered dietitian (RD) or a gastroenterologist (GI)), mode of nutrition (per oral (PO), tube feed (TF), or total parenteral nutrition (TPN)), weight and body-mass index (BMI) were obtained pre-procedurally, at 6 months, and at one year post-procedurally. Results: Seventeen patients underwent ER for severe protein caloric malnutrition or dependence on TF / TPN. In this cohort, at the time of the ER procedure, median age was 49 [IQR 46, 58] years and median BMI was 25.2 [IQR 21.18, 29.03] kg/m2, 70% of patients were female, and 82% were White, and 96% had health insurance. Weight and BMI were not significantly different at 6-month or at one year follow-up (P >0.05; Figure demonstrates individual weight trends). At 6 months post-ER, 2 patients were no longer malnourished by RD/GI assessment and only on PO nutrition; 3 patients previously on TPN were liberated from TPN. A panel of laboratory values including markers of protein calorie malnutrition (e.g. albumin), renal function (e.g. creatinine and GFR) and micronutrients (e.g. Vitamin B12) were not significantly different at 6-month or at one year follow-up (P >0.05; Table). In all patients, access to the remnant was maintained throughout the study period and no complications were noted after the procedure. Conclusion: ER is a nuanced, advanced technique useful for when remnant access is desired in RYGB patients, and is safe in experienced hands. Despite small sample size, this investigation revealed that ER of RYGB may prevent worsening weight loss, and worsening macro and micro-nutrient deficiencies; though improvement in weight and nutritional parameters was not observed. As ER affords patients a potential alternative to revisional bariatric surgery, further studies are warranted to examine longer-term nutritional and medical outcomes.Figure 1.: Individual weight trends before RYGB Endoscopic Reversal and at 6 months and 1 year following RYGB Endoscopic Reversal Table 1. - Pre-procedure Post-procedure at 6 months Post-procedure at 1 year Malnutrition Status by dietitian or gastroenterologist assessment (n, %) N=17 N=17 N=9 Severe Malnutrition or on TF / TPN 17 (100%) 15 (88%) 8 (89%) Moderate 0 0 0 Non-severe 0 0 0 Not malnourished 0 2 (12%) 1 (11%) Nutrition Route N=17 N=17 N=9 Oral intake (PO) 6 6 2 Tube feeding (TF) 3 6 3 Total parenteral nutrition (TPN) 8 5 4 Weight / Body Mass Index, median (IQR) N=17 N=15 N=9 Weight (Kg) 64.8 (54.3, 78.1) 68.4 (57.9, 83.6) 67.8 (63.0, 71.1) BMI (Kg/m2) 25.2 (21.2, 29.0) 25.1 (23.1, 30.3) 23.2 (20.5, 24.9) Nutritional Laboratory Values, median (IQR) N * N * ** Albumin (g/dL) 2.6 (2.3, 3.1) 2.4 (1.92, 3.05) x Prealbumin (mg/dL) 14 (10, 15) 14 (8, 16) x Hemoglobin (g/dL) 9.4 (8.8, 11.5) 10.6 (8.8, 12.4) x Creatinine (mg/dL) 0.88 (0.62, 0.99) 0.72 (0.66, 1.06) x Glomerular filtration rate (mL/min) 86 (61, 90) 84 (52, 90) x Iron (ug/dL) 59 (29, 71) 34.5 (19, 49.3) x Ferritin (ng/mL) 113 (27.8, 409) 39 (28.5, 114) x Vitamin B12 (pg/mL) 893 (554, 1405) 1271 (731, 1422) x Folate (ng/mL) 6.6 (5.4, 21.4) 10.6 (6.5, 11.8) x Vitamin D (ug/L) 14 (13, 39) 24.5 (14.5, 27.8) x Zinc (ug/dL) 56 (55, 71) 56.5 (48, 62) x *Various different sample size based on lab availabilities.**1 Year nutritional laboratory values not assessed.

Physicians perceive that ostomates have decreased quality of life but not overall health: An international survey of physicians.

The aim of this work was to evaluate physicians' perceptions of ostomates' quality of life (QoL) and comfort of care among an international sample of physicians caring for ostomates. This was a cross-sectional survey study. We conducted a survey of primary care physicians (PCP), gastroenterologists (GI), and general surgeons (GS) from three continents using the SERMO online physician platform. We piloted the survey for content, clarity and domain development using a pilot sample of physicians from each speciality before use. We summarized responses to questions related to physician comfort of ostomate care with descriptive statistics. We conducted multiple logistic regression with the primary outcome of physician perception of ostomate QoL. A total of 617 physicians (PCP 264, GI 176, GS 177) completed the survey representing North America, Europe and Australia similarly. The average age was 46 years and 21% were women. Ninety per cent of physicians care for an ostomate at least once per month. Eighty eight per cent had access to enterostomal nurses. Eighty two per cent of physicians believed that ostomates have decreased QoL. Forty seven per cent believed that ostomates have decreased overall health. Almost half of respondents answered incorrectly to a 'bogus question' citing fake clinical evidence supporting a negative impact of ostomies on social relationships. Increased physician comfort in ostomy care (OR 1.30, p= 0.04) and US-based physicians (OR 1.75, p= 0.01) were associated with increased odds of answering that ostomates have no decreased QoL. Among a diverse international sample, most physicians believe that ostomates have decreased QoL but not overall health. Physician implicit bias, physician comfort and geographical variability account for these findings. Targeted efforts to increase physician comfort in ostomate care and establish universal best practices is needed.

Ginger polysaccharides relieve ulcerative colitis via maintaining intestinal barrier integrity and gut microbiota modulation

Ulcerative colitis (UC) is an autoimmune disease afflicting an increasing number of patients and increasing demands towards the development of efficacious and safe drugs. Recently, with increasing interest in alternative medicines, natural resources have become a hotspot for drug discovery against UC. In addition to being consumed as a food and spice, ginger is also widely used as a well-recognized gastrointestinal herbal medicine. With a long history in the treatment of digestive disorders, the potential of ginger in alleviating UC has been documented in several experimental models and clinical trials. However, as a major active constituent of ginger, ginger polysaccharides (GP) and its effect on UC has yet to be reported. In this study, GP was firstly separated and characterized. In a dextran sulfate sodium (DSS)-induced colitis mouse model, GP alleviated UC symptoms by inhibiting pro-inflammatory cytokines levels to regulate intestinal inflammation, repairing the intestinal barrier as indicated by occludin-1 and ZO-1, as well as regulating gut microbiota. Taking these results together, we believe GP could be an innovative option in developing functional foods or therapeutic agents for UC management.

CoMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectivesReports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. MethodsAll consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. ResultsComplete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. ConclusionsThe results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality.Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).

Patient journey in erosive oesophagitis: real-world perspectives from US physicians and patients

ObjectiveManagement of erosive oesophagitis (EE) remains suboptimal, with many patients experiencing incomplete healing, ongoing symptoms, and relapse despite proton pump inhibitor (PPI) treatment. The Study of Acid-Related Disorders investigated patient...

Review of drug recalls and quality of pharmaceutical products in Nepal

ObjectivesTo evaluate the pattern of substandard and falsified pharmaceutical products recall in Nepal.SettingWe analysed drug recall notices issued by the Department of Drug Administration (DDA), Nepal, and systematically reviewed peer-reviewed...

Iron surveillance and management in gastrointestinal oncology patients: A national survey of physician practice.

e13644 Background: In 2018, there were an estimated 4.8 million new cases of gastrointestinal (GI) cancers worldwide and 3.4 million related deaths. Iron deficiency (ID) is a frequent complication of GI malignancy that eventually manifests as iron deficiency anemia (IDA). Early recognition and treatment of ID/IDA in GI oncology patients is an important aspect of care. Traditional serum ferritin monitoring and oral iron supplementation hold limited diagnostic and therapeutic value in this population as it may be falsely elevated and confounded by poor absorption and blood loss, respectively. Therefore, we conducted a survey of Canadian physicians to assess disparities in IDA surveillance and management practices in GI cancer patients. Methods: From February 2020 to September 2021, a 20-question electronic survey was sent to Canadian medical oncologists (MO), surgical oncologists (SO), and gastroenterologists (GE). The survey collected information on four domains: demographics, screening practices, treatment practices, and knowledge of the latest guidelines of ID/IDA. Analysis was conducted using descriptive statistics. Results: A total of 108 (55 GE, 19 SO, and 34 MO) of the 872 (12.4%) invited physicians completed the survey. A greater proportion of GE (70.9% compared to 36.8% of SO, and 26.5% of MO) measured baseline iron parameters. Of these, a slight trend of iron parameters were being measured mainly at initial consult (61.5% of GE, 85.7% of SO, and 44.4% of MO), with little continuing surveillance throughout treatment course. Most physicians who measured iron parameters relied on ferritin mainly (82.1% of GE, 100% of SO), while MO were evenly distributed in their evaluation of ferritin (88.9%), serum iron (100%), total iron binding capacity (100%) and iron saturation (88.9%). The majority supplemented iron if ID/IDA was identified prior to systemic/surgical oncologic treatment (94.2% of GE, 85.7% SO, and 66.7% of MO). Of these, parenteral iron was the preferred modality for SO (85.7%), while oral iron was preferred among GE (82.8%) and MO (55.6%). The majority of physicians (81.3%) were not aware of the ASH/ASCO guidelines regarding the use of erythropoiesis stimulating agents in conjunction with parenteral iron supplementation for treatment anemia in this setting (92% of GE, 66.7% of SO, and 80.9% of MO). Conclusions: Results from this Canadian survey suggests a disparity in practice pattern for IDA management between different specialties caring for GI oncology patients. Moreover, there appears to be a gap in knowledge and thus a gap in care surrounding evidence-based IDA management principles which may be contributing to poor clinical outcomes. Focused knowledge translation and exchange efforts are required to improve treatment of ID/IDA in patients with GI cancer nationally.

P-42 Iron surveillance and management in gastrointestinal oncology patients: A national survey of physician practice

In 2018, there were an estimated 4.8 million new cases of gastrointestinal (GI) cancers worldwide and 3.4 million related deaths. Iron deficiency (ID) is a frequent complication of GI malignancy that eventually manifests as iron deficiency anemia (IDA). Early recognition and treatment ofID/IDA in GI oncology patients is an important aspect of care. Traditional serum ferritin monitoring and oral iron supplementation hold limited diagnostic and therapeutic value in this population as it may be falsely elevated and confounded by poor absorption and blood loss, respectively. Therefore, we conducted a survey ofCanadian physicians to assess disparities in IDA surveillance and management practices in GI cancer patients. From February 2020 to September 2021, a 20-question electronic survey was sent to Canadian medical oncologists (MO), surgical oncologists (SO), and gastroenterologists (GE). The survey collected information on four domains: demographics, screening practices, treatment practices, and knowledge of the latest guidelines of ID/IDA. Analysis was conducted using descriptive statistics. A total of 108 (55 GE, 19 SO, and 34 MO) of the 872 (12.4%) invited physicians completed the survey. A greater proportion of GE (70.9% compared to 36.8% of SO, and 26.5% of MO) measured baseline iron parameters. Of these, a slight trend of iron parameters were being measured mainly at initial consult (61.5%of GE, 85.7% of SO, and 44.4% of MO), with little continuing surveillance throughout treatment course. Most physicians who measured iron parameters relied on ferritin mainly (82.1% of GE, 100% of SO), while MO were evenly distributed in their evaluation of ferritin (88.9%), serum iron (100%), total iron binding capacity (100%) and iron saturation (88.9%). The majority supplemented iron if ID/IDA was identified prior to systemic/surgical oncologic treatment (94.2% of GE, 85.7% SO, and 66.7% of MO). Of these, parenteral iron was the preferred modality for SO (85.7%), while oral iron was preferred among GE (82.8%) and MO (55.6%). The majority of physicians (81.3%) were not aware of the ASH/ASCO guidelines regarding the use of erythropoiesis stimulating agents in conjunction with parenteral iron supplementation for treatment anemia in this setting (92% of GE,66.7% of SO, and 80.9% of MO). Results from this Canadian survey suggests a disparity in practice pattern for IDA management between different specialties caring for GI oncology patients. Moreover, there appears to be a gap in knowledge and thus a gap in care surrounding evidence-based IDA management principles which may be contributing to poor clinical outcomes. Focused knowledge translation and exchange efforts are required to improve treatment of ID/IDA in patients with GI cancer nationally.

Impact of the COVID-19 Pandemic on Gastroenterology Training in India

Abstract Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected the healthcare system. The residents who are at the frontline of this pandemic have suffered the most. The extent of the training loss due to the COVID-19 pandemic on gastroenterology (GE) training is not studied in India. Methods We designed a 36-question based google survey and distributed it to the GE residents all across India, via email. All the responses collected were analyzed using appropriate statistical methods. Results A total of 140 responses were received. No significant decrease in teaching sessions/ classes was reported. Most of the residents (83.5%) reported inability to complete the target thesis enrolment. The number of patients seen by the residents in outpatient department, patients managed in wards and endoscopic procedures done by residents have decreased significantly (p-valve &lt;0.001 for all). An overwhelming 89.9% (n = 125) of the GE residents were posted for COVID-19 duties. Almost half (50.4%) of them were COVID-19 positive. Conclusion The COVID-19 pandemic has affected the training of GE residents in India immensely and an extension period of 3 months may be offered to them.

American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter?

BackgroundAmerican Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates. MethodsWe identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression. ResultsIn states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27–1.37 times higher than in states below this threshold (p < 0.036). ConclusionsGI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.

Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology.

Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs. The purpose of this study was to review and compare outcomes of PEG tubes placed by ACS and GI. Retrospective chart review of patients who received a PEG placed by ACS or GI at the bedside in any ICU from December 2016 to September 2019. Charts were reviewed for the following outcomes: Success rates of placing PEG, duration of procedure, major complications, and death. Secondary outcomes included discharge disposition, and rates of comfort measures only after PEG. In 2017, 75% of PEGs were placed by GI and 25% surgery. In 2018, 47% were placed by GI and 53% by surgery. In 2019, 33% were placed by GI and 67% by surgery. There was no significant difference in success rates between surgery (146/156 93.6%) and GI (173/185 93.5%) (p 0.97). On average, GI performed the procedure faster than surgery [Median 10 (7-16) min vs 16 (13-21) mins, respectively, p < 0.001]. There were no significant differences between groups in any of the PEG outcomes or complications investigated. Bedside PEG tube placement appears to be a safe procedure in the ICU population. GI and Surgery had nearly identical success rates in placing PEGs. GI performed the procedure faster than surgery. There were no significant differences in the reviewed patient outcomes or complications between PEGs placed by ACS or GI. Of note, when a complication occurred, ACS PEG patients typically were managed in the OR while GI tended to re-PEG patients highlighting a potential difference in management that should be further investigated.

Factors Associated With Clinician Recommendations for Colorectal Cancer Screening Among Average-Risk Patients: Data From a National Survey.

IntroductionColorectal cancer (CRC) screening among average-risk patients is underused in the US. Clinician recommendation is strongly associated with CRC screening completion. To inform interventions that improve CRC screening uptake among average-risk patients, we examined clinicians’ routine recommendations of 7 guideline-recommended screening methods and factors associated with these recommendations.MethodsWe conducted an online survey in November and December 2019 among a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a panel of US clinicians. Clinicians reported whether they routinely recommend each screening method, screening method intervals, and patient age at which they stop recommending screening. We also measured the influence of various factors on screening recommendations.ResultsNearly all 814 PCCs (99%) and all 159 GIs (100%) reported that they routinely recommend colonoscopy for average-risk patients, followed by stool-based tests (more than two-thirds of PCCs and GIs). Recommendation of other visualization-based methods was less frequent (PCCs, 26%–35%; GIs, 30%–41%). A sizable proportion of clinicians reported guideline-discordant screening intervals and age to stop screening. Guidelines and clinical evidence were most frequently reported as very influential to clinician recommendations. Factors associated with routine recommendation of each screening method included clinician-perceived effectiveness of the method, clinician familiarity with the method, Medicare coverage, clinical capacity, and patient adherence.ConclusionClinician education is needed to improve knowledge, familiarity, and experience with guideline-recommended screening methods with the goal of effectively engaging patients in informed decision making for CRC screening.