Sa1087 H. pylori Frequency in a Case Series of 119 Patients With Parasitic Diseases
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AGA Abstracts Mean percent anal relaxation of at least 4 trials of attempted evacuation in 54 consecutive patients, sorted by mean. Sa1086 Adalimumab or Infliximab for the Treatment of Inflammatory Bowel Disease Patients: Which Is More Effective? Maria Jesus Carrillo-Ramos, Calixto Duarte-Chang, Belen Maldonado-Perez, Rocio Beltran-Castaño, Luisa Castro-Laria, Federico Argüelles-Arias, Antonio Benitez-Roldan, Angel Caunedo-Alvarez, Francisco Pellicer-Bautista, Juan M Herrerias Background: Anti TNF-α antibodies, Adalimumab (ADA) and Infliximab (IFX), have demon- strated to be effective in inducing response and maintaining remission in patients with inflammatory bowel disease (IBD). Secondary loss of response is a frequent event occurring during biological therapy. About 20-50% of these patients present loss of response during the first year of therapy. The aim of this study was to compare the loss of response between IFX and ADA use in secondary non-responders IBD patients. Methods: An observational retrospective study that included 104 secondary non-responders of 375 IBD patients treated with Anti TNF-α antibodies during February 2000 and August 2013. The primary endpoint was to determine the mean duration in months of treatment when the loss of response was established between ADA and IFX. The loss of response was defined by two of the following: requirement of biological therapy dose intensification, switching between anti TNF-α anti- bodies, surgical intervention or steroid-free period less than three months. Results: Of 104 IBD patients, 23 were ulcerative colitis (UC) and 81 Crohn's disease (CD). 19% UC and 28% CD received ADA while 83% UC and 72% CD received IFX. The dose of ADA was 160mg followed by 80mg two weeks later and a maintenance dose of 40mg every two weeks. IFX dose was 5mg/kg at 0,2,6 weeks and a maintenance dose every 8 weeks. The mean disease duration was 13 ± 8 years (UC) and 13 ± 5 years (CD). In UC the mean duration of anti-TNF therapy was 16 ± 14 months for ADA and 11 ± 15 months for IFX (p = 0,58), whereas in CD, 16 ± 19 months and 23 ± 23 respectively (p = 0,21). According to disease location, IFX in UC pancolitis was associated with less mean duration of therapy than ADA (p = 0,01). Further, IFX in ileocolonic CD was associated with more mean duration of therapy than ADA (p = 0,05). More patients in the infliximab group required surgery in both UC and CD compared with ADA group, although was not signficant (p = 0,15 and 0,24 respectively). However, patients on IFX required less dose optimization in both UC and CD compared with patients on ADA, 0% vs 89% and 63% vs 72% respectively (p ∠ 0,01). Conclusions: In both UC and CD the loss of response between IFX and ADA, measured by the mean duration of therapy, showed no significant differences. However, by disease location, in UC patients with pancolitis, IFX presented earlier loss of response than ADA, while in ileocolonic CD, IFX presented later loss of response. In addition, in both UC and CD, ADA required more dose optimization tan IFX. Sa1087 H. pylori Frequency in a Case Series of 119 Patients With Parasitic Diseases Michael C. Payne, Rebecca Osgood, Alphonso Brown Purpose: Parasitic infections and H. Pylori are spread by exposure to contaminated water, food and soil.4 The rate of H. pylori coinfection in individuals with parasitic infections is not well described. Methods: Between 10/28/09 -11/11/13, 119 patients referred to a gastroenterologist at a Boston hospital practice for routine consultations were found to have evidence of parasites. The population was examined to evaluate the rate of coinfection with H. pylori. H. pylori stool antigen studies done by all practitioners at CHA were reviewed from 12/3/12 - 12/2/13. Results: 119 patients referred to the practice during the study interval were found to have parasites. Taken together 108 patients in the study population were tested for H pylori by biopsy, stool antigen or serology. Of these patients 38/108 (35.1%) had evidence a past or current infection of H. pylori. 985 patients evaluated by H. pylori stool antigen testing for all practitioners in the hospital system from 12/3/12-12/2/ 13 were also evaluated. 155/985 (15.7%) of the patients were found to be positive for H. pylori. Discussion: We have previously shown that serology and biopsy were the preferred manner of diagnosing Strongyloides and Schistosomiasis. O&P testing was not useful for diagnosing these infections in our population.1 35.1 % of the 108 patients tested for H. pylori were found to be positive. H. pylori like Schistosomiasis has been shown to be transmissible through contaminated water.3,4 It is logical to assume that water containing one pathogen may carry others. 4.2% of the 119 patients in the study population were diagnosed with 3 pathogens: an active H. pylori infection, a positive Schistosomiasis or Strongyloides antibody test and a parasitic infection other than Strongyloides and Schistoso- miasis. Conclusion: Systematic evaluation for parasites in asymptomatic, newly arrived immigrants and concerning individuals with a distant history of immigration or travel to at risk areas (especially those with eosinophilia) should be done as part of routine health care.1 H. pylori testing by either stool or biopsy should be part of such an evaluation. 1. Payne, M, Osgood, R, Brown, A. An unexpected epidemic: Schistosomiasis and Strongyloides infections detected in an academic urban community GI practice. A case series of 104 patients. The Global Journal of Gastroenterology & Hepatology 2013; Dec: In press. 2. Parsonnet J. The incidence of Helicobacter pylori infection. Aliment Pharmacol Ther 1995; 9 Suppl 2:45 3. Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther 1995; 9 Suppl 2:33 4. Bellack NR, Koehoorn MW, MacNab YC, Morshed MG. A conceptual model of water's role as a reservoir in Helicobacter pylori transmission: a review of the evidence. Epidemiol Infect 2006; 134:439 H. Pylori By Means of Diagnosis And Corelation to Parasite Diagnosis S-196 AGA Abstracts Sa1088 Providing Gastroenterology Care to Rural Patients Through Telemedicine Sandhya Shukla, Sumeet Munjal, Rositsa B. Dimova, Thomas Mahl Background and aims: Specialists usually cluster around urban centers making it burdensome or impossible for rural patients to receive access to appropriate care. We developed a telegastroenterology (TG) program to provide care to this underserved population. This study focuses on patient's satisfaction with this service. Methods: The VA Western New York (VAWNY) provides TG to 6 outlying VA facilities that do not offer gastroenterology services. The board-certified gastroenterologist is connected by a two-way television to these sites. The majority of the patient were seen at least once in person (usually the initial consultation) and were offered TG if it was unlikely that a physical examination would be required. All patients were mailed a survey assessing their experience with TG. In addition, we gathered demographic information from their medical records. Participants were advised that their participation in the survey is anonymous. Statistical analysis was performed using SAS (SAS Institute Inc., Cary, NC, USA). Results: 103 patients who were seen between Sept 2011 and Oct 2013 through TG were mailed the survey. The majority were white middle age men. The patients were equally divided as having a GI or liver problems. The mean distance from the patient's home to the VAWNY was 100 miles compared to 19 miles to the local VA telemedicine site. A total of 49 subjects answered the survey. The majority of them, 65.31% (32/49), stated that it is difficult or very difficult to travel to VAWNY and 81.63% (40/49) stated that it is easy/very easy to travel to the local telemedicine site usually taking less than 30 min. The overwhelming majority, 97.92% (47/48) of the subjects were satisfied with their telemedicine session(s). Furthermore, 95.83% (46/48) stated that, during the telemedicine session the physician provided medical care of the same quality they would expect from an in-person visit. Nearly all felt that they were able to communicate adequately, safely and comfortably with the provider. The vast majority, 91.67% (44/48) expressed that their telemedicine session was an easier, more convenient way to get their medical care and 87.23% (41/47) stated that they would prefer a telemedicine session for their next appoint- ment. Conclusions: Based on the opinions of VA patients from remote areas, we conclude that the medical care delivered through TG is an effective, convenient and preferred method of care. Moreover, the subjects from our population were comfortable with TG and very satisfied with the care they received. Thus, TG appears to be an effective method of delivering care to selected rural patients with GI and liver disorders. Sa1089 International Usage of an Online Clinical Decision Support System for Gastroenterology Timothy D. Imler Introduction: Clinical decision support systems (CDS) provide clinicians with information from disparate data to enhance health care decisions. Online CDS are playing an increasing role for decision making. Gastroenterology based CDS are disjointed and are of varying quality of evidence. It is unclear about the usage of these tools and their impact on care. Methods: From 2009-2013 a CDS that was specific to gastroenterology and hepatology was created with 25 gastroenterology and hepatology specific decision aides (16 hepatology, 2 GI bleeding, 2 IBD, 1 pancreas, and 4 others) from published literature. No advertising and no revenue was generated from this freely available resource. During the time period of 7/ 1/2013 - 9/29/2013, location, decision tool, and average time spent on page were tracked. Descriptive statistics and two sided t test were calculated to identify patterns of usage. Results: 9,419 unique accesses were logged over a 90 day period with 7,436 unique devices and 24,198 usages (265.91±102.3/day, 95% CI 244.6-287.2). A cyclical pattern of usage was noted following the work-week (313.1±79.8/day, 95% CI 293.0-333.2) versus the weekend (156.6±59.1/day, 95% CI 132.6-180.5) with P value < 0.0001. Two American holidays (4th of July and Labor Day) fell during the data collection period yielding 200.5±16.3 usages/day (95% CI 54.4-346.6) with a P Value of 0.05 in comparison to the work-week and 0.31 to the weekend. The average user logged 2.6±0.6 (95% CI 2.5-2.7) usages/access with an average duration of usage of 189.1±112.5 (95% CI 165.7-212.6) seconds. The top decision aide used was the Fibrosis 4 Score with 5,191 (21.5%), followed by MELD Na with 2,872 (11.9%), and NAFLD Fibrosis Score with 2,606 (10.7%). Table 1 shows the pattern of usage and supportive literature. The United States was the top country in usage with 4,589 (48.7%) unique accesses followed by the United Kingdom (665, 7.1%), and India (387, 4.1%). California (492, 10.7%), Indiana (414, 9.0%) and Texas (298, 6.5%) were the top three accessing states. Four of the top ten cities of usage were outside the United States (London, Seoul, Toronto, and Gurgaon). Figure 1A shows a heat map of the accesses by cities around the world. Figure 1B shows a heat map of accesses by cities within the United States. Conclusions: International usage of a free online CDS for gastroenterologists has yielded an 89% growth rate year over year. The usage reflects the world-wide desire for quick (189.1 seconds) access to CDS that are readily available and easy to use, particularly during the work-week. There is a need to further expand the currently available decision
Transcript of Sa1087 H. pylori Frequency in a Case Series of 119 Patients With Parasitic Diseases
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sMean percent anal relaxation of at least 4 trials of attempted evacuation in 54 consecutivepatients, sorted by mean.
Sa1086
Adalimumab or Infliximab for the Treatment of Inflammatory Bowel DiseasePatients: Which Is More Effective?Maria Jesus Carrillo-Ramos, Calixto Duarte-Chang, Belen Maldonado-Perez, RocioBeltran-Castaño, Luisa Castro-Laria, Federico Argüelles-Arias, Antonio Benitez-Roldan,Angel Caunedo-Alvarez, Francisco Pellicer-Bautista, Juan M Herrerias
Background: Anti TNF-α antibodies, Adalimumab (ADA) and Infliximab (IFX), have demon-strated to be effective in inducing response and maintaining remission in patients withinflammatory bowel disease (IBD). Secondary loss of response is a frequent event occurringduring biological therapy. About 20-50% of these patients present loss of response duringthe first year of therapy. The aim of this study was to compare the loss of response betweenIFX and ADA use in secondary non-responders IBD patients. Methods: An observationalretrospective study that included 104 secondary non-responders of 375 IBD patients treatedwith Anti TNF-α antibodies during February 2000 and August 2013. The primary endpointwas to determine the mean duration in months of treatment when the loss of response wasestablished between ADA and IFX. The loss of response was defined by two of the following:requirement of biological therapy dose intensification, switching between anti TNF-α anti-bodies, surgical intervention or steroid-free period less than three months. Results: Of 104IBD patients, 23 were ulcerative colitis (UC) and 81 Crohn's disease (CD). 19% UC and28% CD received ADA while 83% UC and 72% CD received IFX. The dose of ADA was160mg followed by 80mg two weeks later and a maintenance dose of 40mg every twoweeks. IFX dose was 5mg/kg at 0,2,6 weeks and a maintenance dose every 8 weeks. Themean disease duration was 13 ± 8 years (UC) and 13 ± 5 years (CD). In UC the meanduration of anti-TNF therapy was 16 ± 14 months for ADA and 11 ± 15 months for IFX(p = 0,58), whereas in CD, 16 ± 19 months and 23 ± 23 respectively (p = 0,21). Accordingto disease location, IFX in UC pancolitis was associated with less mean duration of therapythan ADA (p = 0,01). Further, IFX in ileocolonic CD was associated with more mean durationof therapy than ADA (p = 0,05). More patients in the infliximab group required surgery inboth UC and CD compared with ADA group, although was not signficant (p = 0,15 and0,24 respectively). However, patients on IFX required less dose optimization in both UCand CD compared with patients on ADA, 0% vs 89% and 63% vs 72% respectively (p ∠0,01). Conclusions: In both UC and CD the loss of response between IFX and ADA, measuredby the mean duration of therapy, showed no significant differences. However, by diseaselocation, in UC patients with pancolitis, IFX presented earlier loss of response than ADA,while in ileocolonic CD, IFX presented later loss of response. In addition, in both UC andCD, ADA required more dose optimization tan IFX.
Sa1087
H. pylori Frequency in a Case Series of 119 Patients With Parasitic DiseasesMichael C. Payne, Rebecca Osgood, Alphonso Brown
Purpose: Parasitic infections and H. Pylori are spread by exposure to contaminated water,food and soil.4 The rate of H. pylori coinfection in individuals with parasitic infectionsis not well described. Methods: Between 10/28/09 -11/11/13, 119 patients referred to agastroenterologist at a Boston hospital practice for routine consultations were found to haveevidence of parasites. The population was examined to evaluate the rate of coinfection withH. pylori. H. pylori stool antigen studies done by all practitioners at CHA were reviewedfrom 12/3/12 - 12/2/13. Results: 119 patients referred to the practice during the studyinterval were found to have parasites. Taken together 108 patients in the study populationwere tested for H pylori by biopsy, stool antigen or serology. Of these patients 38/108(35.1%) had evidence a past or current infection of H. pylori. 985 patients evaluated by H.pylori stool antigen testing for all practitioners in the hospital system from 12/3/12-12/2/13 were also evaluated. 155/985 (15.7%) of the patients were found to be positive for H.pylori. Discussion: We have previously shown that serology and biopsy were the preferredmanner of diagnosing Strongyloides and Schistosomiasis. O&P testing was not useful fordiagnosing these infections in our population.1 35.1 % of the 108 patients tested for H.pylori were found to be positive. H. pylori like Schistosomiasis has been shown to betransmissible through contaminated water.3,4 It is logical to assume that water containingone pathogen may carry others. 4.2% of the 119 patients in the study population werediagnosed with 3 pathogens: an active H. pylori infection, a positive Schistosomiasis orStrongyloides antibody test and a parasitic infection other than Strongyloides and Schistoso-miasis. Conclusion: Systematic evaluation for parasites in asymptomatic, newly arrivedimmigrants and concerning individuals with a distant history of immigration or travel to atrisk areas (especially those with eosinophilia) should be done as part of routine health care.1H. pylori testing by either stool or biopsy should be part of such an evaluation. 1. Payne,M, Osgood, R, Brown, A. An unexpected epidemic: Schistosomiasis and Strongyloidesinfections detected in an academic urban community GI practice. A case series of 104patients. The Global Journal of Gastroenterology & Hepatology 2013; Dec: In press. 2.Parsonnet J. The incidence of Helicobacter pylori infection. Aliment Pharmacol Ther 1995;9 Suppl 2:45 3. Pounder RE, Ng D. The prevalence of Helicobacter pylori infection indifferent countries. Aliment Pharmacol Ther 1995; 9 Suppl 2:33 4. Bellack NR, KoehoornMW, MacNab YC, Morshed MG. A conceptual model of water's role as a reservoir inHelicobacter pylori transmission: a review of the evidence. Epidemiol Infect 2006; 134:439H. Pylori By Means of Diagnosis And Corelation to Parasite Diagnosis
S-196AGA Abstracts
Sa1088
Providing Gastroenterology Care to Rural Patients Through TelemedicineSandhya Shukla, Sumeet Munjal, Rositsa B. Dimova, Thomas Mahl
Background and aims: Specialists usually cluster around urban centers making it burdensomeor impossible for rural patients to receive access to appropriate care. We developed atelegastroenterology (TG) program to provide care to this underserved population. Thisstudy focuses on patient's satisfaction with this service. Methods: The VA Western NewYork (VAWNY) provides TG to 6 outlying VA facilities that do not offer gastroenterologyservices. The board-certified gastroenterologist is connected by a two-way television to thesesites. The majority of the patient were seen at least once in person (usually the initialconsultation) and were offered TG if it was unlikely that a physical examination would berequired. All patients were mailed a survey assessing their experience with TG. In addition,we gathered demographic information from their medical records. Participants were advisedthat their participation in the survey is anonymous. Statistical analysis was performed usingSAS (SAS Institute Inc., Cary, NC, USA). Results: 103 patients who were seen between Sept2011 and Oct 2013 through TG were mailed the survey. The majority were white middleage men. The patients were equally divided as having a GI or liver problems. The meandistance from the patient's home to the VAWNY was 100 miles compared to 19 miles tothe local VA telemedicine site. A total of 49 subjects answered the survey. The majority ofthem, 65.31% (32/49), stated that it is difficult or very difficult to travel to VAWNY and81.63% (40/49) stated that it is easy/very easy to travel to the local telemedicine site usuallytaking less than 30 min. The overwhelming majority, 97.92% (47/48) of the subjects weresatisfied with their telemedicine session(s). Furthermore, 95.83% (46/48) stated that, duringthe telemedicine session the physician provided medical care of the same quality they wouldexpect from an in-person visit. Nearly all felt that they were able to communicate adequately,safely and comfortably with the provider. The vast majority, 91.67% (44/48) expressed thattheir telemedicine session was an easier, more convenient way to get their medical care and87.23% (41/47) stated that they would prefer a telemedicine session for their next appoint-ment. Conclusions: Based on the opinions of VA patients from remote areas, we concludethat the medical care delivered through TG is an effective, convenient and preferred methodof care. Moreover, the subjects from our population were comfortable with TG and verysatisfied with the care they received. Thus, TG appears to be an effective method of deliveringcare to selected rural patients with GI and liver disorders.
Sa1089
International Usage of an Online Clinical Decision Support System forGastroenterologyTimothy D. Imler
Introduction: Clinical decision support systems (CDS) provide clinicians with informationfrom disparate data to enhance health care decisions. Online CDS are playing an increasingrole for decision making. Gastroenterology based CDS are disjointed and are of varyingquality of evidence. It is unclear about the usage of these tools and their impact on care.Methods: From 2009-2013 a CDS that was specific to gastroenterology and hepatology wascreated with 25 gastroenterology and hepatology specific decision aides (16 hepatology, 2GI bleeding, 2 IBD, 1 pancreas, and 4 others) from published literature. No advertising andno revenue was generated from this freely available resource. During the time period of 7/1/2013 - 9/29/2013, location, decision tool, and average time spent on page were tracked.Descriptive statistics and two sided t test were calculated to identify patterns of usage.Results: 9,419 unique accesses were logged over a 90 day period with 7,436 unique devicesand 24,198 usages (265.91±102.3/day, 95% CI 244.6-287.2). A cyclical pattern of usagewas noted following the work-week (313.1±79.8/day, 95% CI 293.0-333.2) versus theweekend (156.6±59.1/day, 95% CI 132.6-180.5) with P value < 0.0001. Two Americanholidays (4th of July and Labor Day) fell during the data collection period yielding 200.5±16.3usages/day (95% CI 54.4-346.6) with a P Value of 0.05 in comparison to the work-weekand 0.31 to the weekend. The average user logged 2.6±0.6 (95% CI 2.5-2.7) usages/accesswith an average duration of usage of 189.1±112.5 (95% CI 165.7-212.6) seconds. The topdecision aide used was the Fibrosis 4 Score with 5,191 (21.5%), followed by MELD Nawith 2,872 (11.9%), and NAFLD Fibrosis Score with 2,606 (10.7%). Table 1 shows thepattern of usage and supportive literature. The United States was the top country in usagewith 4,589 (48.7%) unique accesses followed by the United Kingdom (665, 7.1%), andIndia (387, 4.1%). California (492, 10.7%), Indiana (414, 9.0%) and Texas (298, 6.5%)were the top three accessing states. Four of the top ten cities of usage were outside theUnited States (London, Seoul, Toronto, and Gurgaon). Figure 1A shows a heat map of theaccesses by cities around the world. Figure 1B shows a heat map of accesses by cities withinthe United States. Conclusions: International usage of a free online CDS for gastroenterologistshas yielded an 89% growth rate year over year. The usage reflects the world-wide desirefor quick (189.1 seconds) access to CDS that are readily available and easy to use, particularlyduring the work-week. There is a need to further expand the currently available decision
