National Gastroenterology Research Articles

OP14 The United European Gastroenterology green paper—climate change and gastroenterology

Abstract Background The 2024 Lancet Countdown highlights the urgent need for aligned structural and sustained changes to avoid the most severe global health impacts. According to the latest Emissions Gap Report from 2024 by the UN Environment Programme, the continuation of current policies would lead to 3.1°C of global warming. Climate change exacerbates extreme weather, food insecurity, and disease prevalence, thereby affecting human health, medical practice, and healthcare stability. Physicians increasingly encounter these effects in daily patient care, with alterations in the gut microbiome, air pollution, heatwaves, and shifts in infectious disease patterns affecting gastrointestinal and hepatic health. Methods The United European Gastroenterology (UEG) conducted a comprehensive literature review to assess the climate change associated health hazards and outcomes in gastroenterology as well as the environmental impact of gastroenterology practices. Additionally, the review aimed to identify research gaps and barriers to the implementation of eco-friendly practices in gastroenterology. Results Climate change and healthcare exist in a bidirectional feedback loop: healthcare: emissions, waste and resource consumption from the healthcare sector amplify climate change, which subsequently increases the incidence of GI and liver diseases, heat-related illnesses, zoonoses, vector-borne diseases, and malnutrition. The healthcare sector contributes to 4.4% of global carbon emissions, with gastroenterology procedures, particularly endoscopy as the third highest generator with 3.09 kg of waste per day per bed. The "5 Rs of Greener Gastroenterology" framework—reduce, reuse, recycle, rethink, and research—offer a pathway towards reducing the environmental footprint of gastroenterology. These include minimizing unnecessary procedures, advocating for the Planetary Health Diet, and integrating eco-friendly practices such as telemedicine, digitalization, and sustainability-focused education and research. Promoting roles such as "eco-gastroenterologists," "eco-endoscopists", “eco-intensivist” and "eco-surgeons" is essential to advancing sustainable healthcare on both personal and institutional levels. Conclusion The United European Gastroenterology Green Paper aims to raise awareness and outline key principles that the GI workforce can adopt to tackle the climate crisis together. To facilitate adoption and transformation into clinical practice, UEG has developed a toolkit for stakeholders to promote such concepts and provide possible solutions at any structural level. This is a call to joint action between national und specialist gastroenterology societies.

Switching from Dose-Intensified intravenous to SubCutaneoUS infliximab in Inflammatory Bowel Disease (DISCUS-IBD): protocol for a multicentre randomised controlled trial

IntroductionA substantial proportion of patients with inflammatory bowel disease (IBD) on intravenous infliximab require dose intensification. Accessing additional intravenous infliximab is labour-intensive and expensive, depending on insurance and pharmaceutical reimbursement....

Proceedings of the 40th National Gastroenterology Week and 11th Congress of Gastrointestinal Surgery.

Proceedings of the 40th National Gastroenterology Week and 11th Congress of Gastrointestinal Surgery.

Determining efficacy of dynamic multimedia bowel preparation instructions versus standard instructions on adenoma detection and patient reported measures (DIGICLEAN trial): a study protocol for a multicentre, colonoscopist-blinded, randomised controlled trial

IntroductionColonoscopy plays important roles in bowel cancer screening and treatment. Poor bowel preparation occurs in 20–25% of colonoscopies. This negatively impacts adenoma and sessile serrated lesion detection rates, procedural time,...

Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

The coronavirus disease-2019 pandemic profoundly disrupted preventative health care services including cancer screening. As the largest provider of cirrhosis care in the United States, the Department of Veterans Affairs (VA) National Gastroenterology and Hepatology Program aimed to assess factors associated with hepatocellular carcinoma (HCC) stage at diagnosis, treatment, and survival. Veterans with a new diagnosis of HCC in 2021 were identified from electronic health records (N= 2306). Structured medical record extraction was performed by expert reviewers in a 10% random subsample of Veterans with new HCC diagnoses. Factors associated with stage at diagnosis, receipt of treatment, and survival were assessed using multivariable models. Among 199 patients with confirmed HCC, the average age was 71 years and most (72%) had underlying cirrhosis. More than half (54%) were at an early stage (T1 or T2) at diagnosis. Less-advanced liver disease, number of imaging tests adequate for HCC screening, HCC diagnosis in the VA, and receipt of VA primary care were associated significantly with early stage diagnosis. HCC-directed treatments were administered to 145 (73%) patients after a median of 37 days (interquartile range, 19-54 d) from diagnosis, including 70 (35%) patients who received potentially curative treatments. Factors associated with potentially curative (vs no) treatments included HCC screening, early stage at diagnosis, and better performance status. Having fewer comorbidities and better performance status were associated significantly with noncurative (vs no) treatment. Early stage diagnosis, diagnosis in the VA system, and receipt of curative treatment were associated significantly with survival. These results highlight the importance of HCC screening and engagement in care for HCC diagnosis, treatment, and survival while demonstrating the feasibility of developing a national quality improvement agenda for HCC screening, diagnosis, and treatment.

Recommendations on TNFα inhibitor biosimilar use in clinical practice: a comparison of European gastroenterology IBD guidance

ABSTRACT Background Professional associations publish guidance advising gastroenterologists on prescribing biosimilars; however, guidelines differ between countries and change over time. This study aimed to map the presence and content of guidance from European gastroenterology associations on TNFα inhibitor biosimilar use and its development over time. Research design and methods Guidelines on biosimilar prescribing from national gastroenterology associations in the European Economic Area (EEA) partnered with the European Crohn’s and Colitis Organization (ECCO) were collected. Treatment guidelines and biosimilar position papers from 2010 to 2022 were included. Data were extracted using a template. Results 26 of 30 EEA countries have an ECCO-partnered gastroenterology association, of which 14 (53.8%) had national guidelines addressing biosimilars, four (15.4%) followed ECCO’s position, and three (11.6%) had treatment guidelines without mentioning biosimilars. From five countries (19.2%) no guidelines were retrieved. Among 18 countries with guidance, 14 (77.8%) associations endorsed initiating biological treatment with biosimilars, and 13 (72.2%) endorsed transitioning from originator to biosimilar. Nine associations published multiple guidelines over time addressing biosimilars; overall, their positions became more encouraging. Conclusions The majority of gastroenterology associations endorsed biosimilar use. The lack of (up-to-date) guidelines for some associations indicates an area of improvement to support biosimilar use in clinical practice.

Enteral Nutrition Prescription in Children and Adults with Inflammatory Bowel Diseases: Gaps in Current Gastroenterology Practice in Saudi Arabia.

Background: Evidence for the effectiveness of enteral nutrition (EN) for the management of patients with inflammatory bowel disease (IBD) is well-established. However, there is considerable global variation in EN practices. This study aimed to characterize the practices and perceptions of gastroenterologists regarding the use of EN in patients with IBD in one of the largest countries in the Gulf region. Methods: A cross-sectional study was conducted on pediatric and adult gastroenterologists working in Saudi Arabia who are involved in IBD management. A self-administered web-based survey was distributed via social media platforms and mailing lists of national gastroenterology societies. Results: A total of 80 gastroenterologists completed the survey. However, only 55 reported that they were currently practicing EN in any form. EN was mostly indicated by gastroenterologists who “sometimes” recommend EN for: the prevention and correction of undernutrition (50.9%), preoperative optimization (50.9%), and the induction of remission in patients with active and long-standing CD (36.4%), at initial diagnosis (34.5%), during the management of complications (61.8%), and after failing to respond to pharmacological therapy (58.2%). Exclusive enteral nutrition (EEN) is regularly recommended by 14.5% of gastroenterologists. The prescription of EEN was significantly associated with the pediatric profession (p < 0.01), IBD specialty (p < 0.05), level of nutrition education during training (p < 0.01), and previous training in a unit with regular EN use (p < 0.01). The most reported barriers to using EN were patients’ lack of acceptance (73.8%) and poor adherence (65%). A lack of dietitian support and a lack of standardized protocols were also reported as barriers by many physicians. Pediatric gastroenterologists were more likely to use at least one assessment method to evaluate EN success. Conclusion: EN practices differ between gastroenterologists working in Saudi Arabia. Future EN protocols should be optimized to support both children and adults with IBD. Gastroenterology training programs should offer nutrition support-focused training to help physicians better utilize EN.

@MondayNightIBD and the Expanding Gastroenterology Twitterverse: A Study on Continuing Medical Education on #GITwitter.

@MondayNightIBD provides weekly continuing medical education (CME) activities focused on inflammatory bowel diseases to clinicians on Twitter. Given its novelty, we assessed whether @MondayNightIBD improves learner knowledge and leads to practice change. We also examined whether inflammatory bowel disease topics addressed in @MondayNightIBD are aligned with entrustable professional activities (EPA) set forth by national gastroenterology societies. @MondayNightIBD CME sessions from February 2020 (date the handle was accredited to provide CME) to May 2021 were analyzed. Preactivity and postactivity knowledge was assessed for average score improvement using the Student t test and Cohen d effect size. Postactivity surveys examined for learners' perceptions of whether activities met educational goals and affected willingness to change clinical practice using descriptive percentages. In addition, activities from April 2019 (date of @MondayNightIBD inception) to May 2021 were assessed for whether they address EPA set forth by national gastroenterology societies. Learners' knowledge improved after @MondayNightIBD activities with average preactivity correct answers of 58% to a postactivity average of 79% ( P < 0.001). Greater than 95% of learners found that activities met learning objectives and enhanced knowledge. A total of 92% of learners were committed to practice change because of their @MondayNightIBD participation. Finally, 78% of EPA set forth by a national gastroenterology society have been covered by @MondayNightIBD since its inception. @MondayNightIBD is a Twitter-based CME activities platform for gastroenterologists and other clinicians that is embraced by learners, improves knowledge, and encourages practice change. Topics covered during @MondayNightIBD are aligned with EPA set forth by national gastroenterology societies. @MondayNightIBD is a successful model of social media medical education and a novel approach to effectively provide evidence-based CME.

Interventions to improve the quality of screening-related colonoscopy: protocol for a systematic review and network meta-analysis of randomised controlled trials

IntroductionColonoscopy quality can vary depending on endoscopist-related factors. Quality indicators, such as adenoma detection rate (ADR), have been adopted to reduce variations in care. Several interventions aim to improve ADR,...

S1525 The File Drawer Effect in the Gastroenterology and Hepatology Literature

Introduction: The File Drawer Effect, or the tendency for studies with statistically significant results to be published and those with unequivocal or negative findings to remain unpublished or less known, can have a significant impact on the scientific literature available in a field. We sought to examine the proportion of studies with statistically significant results published in the gastroenterology and hepatology literature. Methods: We reviewed all original articles published in 2012 and 2017 in 4 national gastroenterology and hepatology journals (Gut, Journal of Crohn’s and Colitis, Hepatology, and Clinical Gastroenterology and Hepatology). Our primary study outcome was the proportion of studies with a statistically significant finding. The number of times the study was cited according to Google Scholar was recorded and used as a measure of a study’s impact. The type of study (clinical or basic) was also recorded. Results: In total, 1,414 articles were reviewed and 3 were excluded due to unclear study results. Of the studies included, 97.31% (1,373) had at least one positive study result and 2.69% (28) had all negative study results. The proportion of articles with positive findings in 2012 (96.9%) was lower, though not significantly, from the proportion of articles with positive findings in 2017 (97.8%) (P < .38). The proportion of clinical science articles with positive findings (99.3%) was significantly greater than the proportion of basic research articles with positive findings (95.9%) (P < .01). The difference between the median number of times a study was cited and whether the study had a positive or negative result was not found to be statistically significant (P = .26). Conclusion: An overwhelming majority of studies published in the selected journals were found to be positive, and this proportion increased slightly between 2012 and 2017. While a study’s impact did not significantly differ between those with statistically significant and insignificant results, this could not be adequately examined due to the low sample size of negative studies (only 28) and subsequent lack of statistical power. The low representation of studies without statistically significant results, especially in clinical research, highlights a possible publication bias that is prevalent across the specialty’s literature. This bias can potentially drive poor clinical practice, and steps should be considered to further study this effect.

S1304 Female Representation in the Gastroenterology and Hepatology Literature

Introduction: Despite making up greater than 50% of medical students, women continue to be underrepresented in the fields of gastroenterology and hepatology. According to a 2017 survey by the Association of American Medical Colleges, only 17% of attending gastroenterologists were women. This underrepresentation is present in both the clinical and research environments. We conducted a literature review to determine trends in female author representation in the gastroenterology and hepatology literature. Methods: We reviewed all original articles published during 2012 and 2017 in four national gastroenterology and hepatology journals (Gut, Journal of Crohn’s and Colitis, Hepatology, and Clinical Gastroenterology and Hepatology). The sex of the authors were recorded. Results: In total over the two years, 1,414 articles were reviewed. Author sex could not be determined for 8 first authors, 9 supplemental authors, and 6 senior authors. Of the studies for which sex of the first author could be determined, 39.5% (556) had a female first author and 60.5% (850) had a male first author. 87% (1,227) of studies had at least one female supplemental author, while 12.7% (178) had only male supplemental authors. 21.5% (302) of studies had a female senior author and 78.6% (1,106) had a male senior author. The increase in percentage of female authors from 2012 to 2017 was significant for articles with at least one female supplemental author (83.1% to 91.8%, p=0.001) and for articles with female senior authors (18.8% to 24.3%, p=0.016). There was a statistically insignificant increase in percentage of female first authors (38.0% to 41.3%, p=.231). Conclusion: Male first and senior authors outnumbered female authors in the examined literature, though the difference decreased in the examined years. The higher percentage of female first authors compared to senior authors is likely related to the near equal representation of females in student and trainee roles, which the first author is more likely to be. The lower proportion of female senior authors may be attributed to the limited female representation in research faculty positions. As women continue to gain representation in senior roles, further research may measure how female authorship continues to change over time.

P467 Therapeutic drug monitoring of biologics in Inflammatory Bowel Disease: Nordic survey on implementation and barriers in clinical practice

Abstract Background Therapeutic drug monitoring (TDM) is a useful tool to optimise biologic treatments of patients with inflammatory bowel disease (IBD). Albeit broadly recommended by gastrointestinal societies, it is, however, currently unknown how TDM has been adopted and is being used in everyday clinical practice. The aim of the study was to investigate how TDM has been taken up by physicians including barriers for implementation. Methods A web-based survey on TDM was distributed to all gastroenterology consultants in the Nordic countries via national gastroenterology- and IBD societies. Results Out of 377 physicians responding, 297 handled IBD patients on biologic therapies and were thus eligible for inclusion (NO 118 (40%), DK 86 (29%), SE 50 (17%), FI 33 (11%), IS 10 (3%)). The vast majority were consultant gastroenterologists (n=252, 85%), 152 (51%) were employed at university hospitals, 136 (46%) at community hospitals, and 9 (3%) in private practice. Overall, 257 (87%) used TDM during biologic therapies; 231 (90%) used reactive TDM and 163 (63%) proactive TDM. Common indications were to improve efficacy (70%), aid treatment decisions (62%), improve safety (36%), and improve cost-effectiveness (32%). Notably, Danish physicians used TDM to a significantly lesser extent than all others (58% vs 98%; odds ratio (OR) 0.03 [95%CI 0.01- 0.09], p&amp;lt;0.001); in particular outside the capital region (OR 0.15 [0.05–0.46], p=0.001). Reactive TDM was applied both at primary (74%) and secondary treatment failure (99%) and predominantly for TNF-inhibitors (90–98%) (vedolizumab 63%, ustekinumab 46%). Proactive TDM was used by 80% during maintenance therapy and 56% during induction, and mostly for TNF-inhibitors (79–97%) (vedolizumab 70%, ustekinumab 54%). Proactive TDM was more commonly used in NO, SE, and FI (p&amp;lt;0.001), and by physicians managing &amp;gt;10 IBD patients per week (OR 2.71 [1.34–5.48], p=0.005), but was not associated with employment at university hospital, size of hospital catchment area, or seniority. Main barriers to the use of TDM were lack of guidelines (51%), long response time from the laboratory (49%), lack of knowledge regarding how to use and interpret test results (42%), costs (38%), and currently available evidence (31%). Among physicians using TDM, only 66% reported awareness of TDM guidelines or recommendations. Conclusion TDM, and in particular reactive TDM of TNF-inhibitors, has been broadly adopted into clinical practice in the Nordic countries to improve efficacy and assist treatment decisions. Across the Nordic countries, IBD physicians call for improved test response times and, notably, TDM guidelines detailing indications for TDM and interpretation of test results.

Impact of the COVID-19 Pandemic on Gastroenterology Department Activity: The Gastroenterologist’s Perspective Nationwide and the Real Impact in a Portuguese Center

Background: Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists’ perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic. Methods: For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020. Results: Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019. Conclusion: The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents’ education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.

Safety and protection in endoscopic services during phase II of COVID-19 pandemic: a national survey.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic requires appropriate measures for containing infection spreading. Endoscopic procedures are considered at increased risk of infection transmission. We evaluated organizational aspects and personal behaviours in Italian Endoscopic Units during phase II of the pandemic.MethodsA questionnaire on organizational aspects and use of personal protective equipment (PPE) were e-mailed to gastroenterologists working in Endoscopic Units. Data were analysed accordingly to the National Health Institute and Gastroenterology Societies recommendations.ResultsData of 117 centres were collected, and different shortcomings emerged. Specific protocols for containing infection and training programs for operators were lacking in 20 and 30% of centres, respectively, and telephone triage 24–72 h before the endoscopy was not implemented in 25% of hospitals. In 30% of centres, the slot time for endoscopies and between examinations was not prolonged. PPE, masks, shirts and gloves were universally adopted, although with some differences. In 20% of centres, a FFPE-FFP3 mask was not adopted during endoscopic examinations. Postendoscopy patient tracking/contact was completed in only one-third of centres.ConclusionsOur survey provides information on organizational and medical behaviours during COVID-19 phase II in Italy, which could be useful for adopting appropriate measures for containing COVID-19 spread during phase II.

Ergonomic Injuries in Endoscopists and Their Risk Factors.

Background/AimsProlonged repetitive strain caused by the continuous performance of complex endoscopic procedures enhances the risk of ergonomic injuries among health-care providers (HCPs), specifically endoscopists. This study aimed to assess the risk factors of ergonomic injuries among endoscopists and non-endoscopists. MethodsThis cross-sectional study was conducted at the Gastroenterology Department of Liaquat National Hospital, Karachi, Pakistan. A total of 92 HCPs were enrolled, of whom 61 were involved in endoscopic procedures and 31 were non-endoscopists. Data were collected through a self-administered questionnaire during national gastroenterology conferences and analyzed using SPSS version 22 (IBM Corp. Chicago, IL, USA). ResultsOf the total study population, 95.08% of endoscopists were observed to have ergonomic injuries, whereas only 54.83% of non-endoscopists had ergonomic injuries (p<0.00). The most common injury associated with musculoskeletal (MSK) pain sites was back (41%), leg (23%), and hand (19.7%) pain among endoscopists. Of 28 endoscopists performing ≥20 procedures/week, 26 had MSK injury. However, 95.08% of endoscopists had developed MSK injury irrespective of working hours (>5 or <5 hr/wk). ConclusionsEndoscopists are at high risk of developing ergonomic injuries, representing the negative potential of the endoscopy-associated workload. To overcome these issues, an appropriate strategic framework needs to be designed to avoid occupational compromises.

Australia IBD Microbiome (AIM) Study: protocol for a multicentre longitudinal prospective cohort study

IntroductionCrohn’s disease and ulcerative colitis are common chronic idiopathic inflammatory bowel diseases (IBD), which cause considerable morbidity. Although the precise mechanisms of disease remain unclear, evidence implicates a strong multidirectional...

Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Eder P, Łodyga M, Dobrowolska A, Reguła J, Rydzewska G. Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(1):2-4. doi:10.5114/pg.2021.103666. APA Eder, P., Łodyga, M., Dobrowolska, A., Reguła, J., & Rydzewska, G. (2021). Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(1), 2-4. https://doi.org/10.5114/pg.2021.103666 Chicago Eder, Piotr, Michał Łodyga, Agnieszka Dobrowolska, Jarosław Reguła, and Grażyna Rydzewska. 2021. "Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases". Gastroenterology Review/Przegląd Gastroenterologiczny 16 (1): 2-4. doi:10.5114/pg.2021.103666. Harvard Eder, P., Łodyga, M., Dobrowolska, A., Reguła, J., and Rydzewska, G. (2021). Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(1), pp.2-4. https://doi.org/10.5114/pg.2021.103666 MLA Eder, Piotr et al. "Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 16, no. 1, 2021, pp. 2-4. doi:10.5114/pg.2021.103666. Vancouver Eder P, Łodyga M, Dobrowolska A, Reguła J, Rydzewska G. Position statement of the Polish Society of Gastroenterology and the National Gastroenterology Consultant on vaccination against COVID-19 among patients with inflammatory bowel diseases. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(1):2-4. doi:10.5114/pg.2021.103666.

Abstract 14229: Hepatobiliary Markers in Minority Heart Failure Patients; Echocardiography and Clinical Outcomes

Introduction: AHA sponsored guidelines and studies have focused on cardiac disease and particular heart failure (HF) profiles among minorities like African, Hispanic, and Asian Americans. Previous studies on liver function tests (LFT) in HF patients, like aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase (ALP), and bilirubin (Bili), have underrepresented minority groups in study cohorts. We investigated the relationship between LFT levels with echocardiographic (ECHO) findings and readmission outcomes among minority patients at the Heart Health Center (HHC) of NYC Health + Hospitals, Kings County, in Brooklyn, New York. Hypothesis: In minority HF patients, LFT levels are associated with ECHO parameters, and LFT abnormalities are associated with increased risk of admission. Methods: Retrospective review was performed of patients in the HF clinic at the HHC, and during acute HF exacerbation admission from November 2017 - November 2018, with hospitalization monitored through November 2019. Baseline and admission LFT levels were obtained. While abnormal AST, ALP, and Bili levels were classified by the hospital’s laboratory range, abnormal ALT levels were classified based on national gastroenterology guidelines. Regression analysis was used to examine the relationship between LFT levels during acute HF exacerbation and ECHO parameters. Odds ratio (OR) and confidence interval (CI) were used for analysis of readmission outcomes. Results: Among 586 HF patients, there was an increased risk of hospitalization with baseline elevations in AST (OR 2.30, CI 1.24 - 4.25, p = 0.008) and ALP (OR 1.99, CI 1.10 - 3.64, p = 0.023). In those hospitalized with acute HF (n = 147), Bili was positively correlated with mitral valve (MV) EA ratio (r = 0.28, p = 0.002) and tricuspid regurgitation max velocity (r = 0.21, p = 0.004). ALT positively correlated with mean MV e’ velocity (r = 0.23, p = 0.009) and negatively correlated with aortic valve (AV) mean velocity (r = -0.24, p = 0.001). Conclusions: Understanding the association of ECHO findings and risk of hospitalization in minority patients with baseline and acute HF LFT levels has crucial implications for the identification of high risk patients and for the development of patient centered HF care strategies.

Burnout and work-related stressors in gastroenterology: a protocol for a multinational observational study in the ASEAN region

BackgroundClinician burnout is an important occupational hazard that may be exacerbated by the novel COVID-19 pandemic. Within Southeast Asia, burnout in gastroenterology is understudied. The primary objective of this study...

Assessment of Liver Fibrosis In Non-Alcoholic Fatty Liver Disease Using Real-Time Elastography

Background: Non-alcoholic fatty liver disease (NAFLD) become a challenge as it`s prevalence, difficulty to diagnose and complex pathogenesis representing about 20% of common liver disorders Patients with NAFLD are at higher risk for adverse outcomes such as cirrhosis, HCC and liver-related mortality. Aim and objectives : We aim to assess the applicability and performance of real-time elastography for the diagnosis of liver fibrosis.Methods: One hundred and thirty subjects attended damanhour medical national institute hepatology and gastroenterology outpatient clinic were divided into two groups; Group (I): Hundred cases having NAFLD by ultrasound, Group (II): thirty healthy subjects as control.Results: Fibrosis stages in NAFLD patients significantly higher than in the control group diagnosed by real time elastrography (P = 0.001). There was an agreement between Realtime Elastrography and FIB-4 index and NAFLD fibrosis score 93% and 86% respectively and diagnostic performance of real time elastrography in advanced liver fibrosis ≥F3 was assessed in comparing with FIB-4 index show sensitivity 90%, specifity 93.3%, PPV 60%, NPV 98.8%, accuracy 93%, AUC0.917, 95%CI 0.81-1.0 and (p = 0.001). Conclusion : Real time elastography may be useful in diagnosis of fibrosis in non-alcoholic fatty liver disease.