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Risk Factors of Renal Dysfunction Caused by Tacrolimus Therapy for Intractable Ulcerative Colitis
Mo1884
Background: SIBO is increasingly being diagnosed in clinical practice in patients with a variety of gastrointestinal symptoms such as flatulence, bloating and diarrhea. There are various risk factors for the development of SIBO including altered small bowel anatomy (gastric resection, Biliroth II surgery, Roux- en-Y anastomosis, jejunoileal bypass surgery, surgically created blind loop, fistula between proximal and distal bowel, small bowel stricture, resection of ileocecal valve), altered small bowel motility (due to diabetic autonomic neuropathy, cirrhosis of liver, acute necrotizing pancreatitis or chronic pancreatitis, scleroderma, polymyositis, intestinal pseudoobstruction, celiac disease, irritable bowel syndrome), small bowel diverticulosis, chronic renal failure, immunodeficiency states, hypochlorhydria, recurrent antibiotics, chronic alcoholics, diabetes mellitus and old age. There are also a subset of patients without previously defined symptoms that develop SIBO. Purpose: To define what risk factors may predispose patients to developing SIBO and to find out whether symptomatic patients with risk factors have greater chance of developing SIBO than symptomatic patients without any risk factor for SIBO. Methods: Retrospective study with review of electronic medical records from Thomas Jefferson University Hospital and Methodist Hospital in Philadelphia from July 1, 2015 to June 30, 2016. All symptomatic patients (gas, bloating, diarrhea, constipation, abdominal pain, belching, halitosis) above the age of 18, irrespective of sex and race who had lactulose breath test during that period were included in our study. Patients with repeat breath tests after treatment were excluded from the study. The study data was analyzed in Microsoft Excel. Result: 434 patients underwent a lactulose breath test. The number of positive tests was 344 (79.26%) and total negative test was 90 (20.74%). 232 patients had previously defined risk factors (RF) were some of them had multiple risk factors) and out of them 182 (78.45%) had a positive test (Table 1). Patients without risk factors were 202 and out of them 162 (80%) had positive test. Demographics of these two groups are shown in Table 2. To compare the breath test results between the two groups, Z test was done and Z score was found to be -0.4485 (P value 0.32636) indicating that there was no significant difference between the results. Conclusion: Although there are known risk factors for the development of SIBO, symptomatic patients can have SIBO even without any risk factor. About 50% of the patients with risk factors had IBS. The next common risk factors were diabetes mellitus, old age >75 years and Celiac disease. Irrespective of the risk factors, SIBO should be ruled out if the patients are symptomatic. Risk Factor with Positive Test breakdown
Mo1882 REBLEEDING RATE AND RELATED RISK FACTORS FOR NON-STEROIDAL ANTI-INFLAMMATORY DRUG-INDUCED ENTEROPATHY Seong Ran Jeon, Junseok Park, Jin-Oh Kim, Hyun Gun Kim, Tae Hee Lee, Jun-Hyung Cho, Bong Min Ko, Joon Seong Lee, Moon Sung Lee Background/Aims: Limited reports have been published about rebleeding after non-steroidal anti-inflammatory drugs (NSAIDs)-induced enteropathy-associated bleeding. The aim of this study was to evaluate the rebleeding rate and related risk factors in patients with NSAIDsinduced small bowel bleeding. Methods: Among 402 patients with obscure gastrointestinal bleeding who had been evaluated with capsule endoscopy, fifty-one were diagnosed with NSAIDs-induced enteropathy. We retrospectively reviewed the medical records and analyzed patients' clinical characteristics. Modified Charlson comorbidity index score was used for evaluating the patients' underlying comorbidities. For patients who were taking additional drugs, an odds ratio (OR) was calculated taking this additional drug use into account. The OR was then used as the drug-related rebleeding risk score. Results: The rebleeding rate in patients with NSAIDs-induced enteropathy was 19.6% with a median interval of 16 months. Significant differences between patients with and without rebleeding were found according to age (71.2±18.6 years vs. 59.4±15.5 years, p=0.043) and discontinuation of NSAIDs after the first bleeding episode (85.3% vs. 20.0%, p=0.027). There were no differences in underlying comorbidities, drug-related rebleeding risk scores, or therapeutic use of proton pump inhibitors (p=0.354, p=0.205, and p>0.999, respectively). In multivariate analysis, an age of over 70 years (OR: 2.613, 95% CI: 1.995-93.19, p=0.021) and the continuous use of NSAIDs after the first bleeding episode (OR: 2.272, 95% CI: 1.184-79.384, p=0.034) were independent rebleeding related risk factors. Conclusions: Up to one fifth of patients with NSAIDs- induced enteropathy showed rebleeding within two years. Careful long-term follow-up should be offered in elderly patients with NSAIDs-induced enteropathy who need to continue NSAID treatment.
Mo1883 RISK FACTORS OF RENAL DYSFUNCTION CAUSED BY TACROLIMUS THERAPY FOR INTRACTABLE ULCERATIVE COLITIS Takashi Mikami, Kazuki Kakimoto, Azusa Hara, Yujiro Henmi, Yutaka Naka, Yuki Hirata, Yoshimasa Hirata, Toshihiko Okada, Sadaharu Nouda, Ken Kawakami, Kazuhide Higuchi Background: Tacrolimus (Tac), a calcineurin inhibitor, shows excellent efficacy for inducing remission in ulcerative colitis (UC) patients. To achieve remission induction, high blood trough levels of Tac need to be maintained; however, high trough levels lead to renal dysfunction as a complication. In the present study, we retrospectively analyzed the effect of Tac therapy on renal function and examined associated risk factors. Methods: The study included 72 patients who received continuous Tac therapy for one month or more for UC at our hospital between January 2011 and May 2016. Tac therapy was initiated at a dose of 0.1 mg/kg/day; subsequently, after the blood trough levels were maintained at 10 - 15 ng/ml (high trough period) for 3 weeks, they were set at 5 - 10 ng/ml (maintenance trough period). Renal dysfunction was defined as a 1.5-fold increase in the Creatinine (Cr) level and a decrease of at least 25% in estimated glomerular filtration rate (eGFR). The patients who exhibited renal dysfunction during the high trough period with trough level ≥ 10 ng/ ml were assigned to group A, those who exhibited renal dysfunction during the maintenance trough period were assigned to group B, and those who showed no renal dysfunction were assigned to group C. The patient age, gender, disease duration, Lichtiger's CAI, laboratory findings, combined therapy, and presence or absence of an underlying disease were compared between each group. Furthermore, in groups A and B, the incidence of renal impairment, the duration of Tac therapy until the onset of renal dysfunction, and the mean trough level for the week immediately prior to the observation of renal dysfunction were examined. Finally, risk factors for renal dysfunction were examined. Results: In all UC patients, the mean age was 44.8 ± 18.3 years, and the mean Cr was 0.73 ± 0.24. Renal dysfunction was observed in 47.2% (34 patients), including 40.2% (29 patients) in group A, and 7% (5 patients) in group B. There was no difference in the background factors between the three groups. The period when renal dysfunction was observed was 13.7 days after Tac therapy in group A, and 101.6 days in group B. The mean trough levels for the week immediately prior to the observation of renal dysfunction were 16.4 ng/ml in group A and 7.1 ng/ml in group B. The patients aged 65 years and older who exhibited renal dysfunction accounted for 63.7% (7/11 patients), and those aged younger than 65 years accounted for 44.3% (27/ 61 patients), and thus a trend was observed in which the patients aged 65 years and older were prone to renal dysfunction. Conclusion: In Tac therapy for UC, there was a high rate of renal dysfunction at 47.2%, with onset particularly common in the high trough period. Furthermore, elderly individuals were prone to renal dysfunction, and hence we believe that Tac therapy should be administered with caution.
Table 2
Mo1885 USE OF INFLIXIMAB IN THE TREATMENT OF NIVOLUMAB-INDUCED REFRACTORY COLITIS IN PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER Ravi K. Prakash, Elham Abboud, Bruce Gershenhorn, Digant Gupta, Pankaj G. Vashi Introduction: Nivolumab is used as a second-line treatment in patients with advanced nonsmall cell lung cancer (NSCLC) who have progressed after platinum-based chemotherapy. Diarrhea is the most common gastrointestinal adverse event of nivolumab for which cessation of immune therapy and steroids are the mainstay of treatment. We describe three complex
S-809
AGA Abstracts
AGA Abstracts
SMALL BOWEL BACTERIAL OVERGROWTH (SIBO) IN INDIVIDUALS WITHOUT AND WITH RISK FACTORS C. Andrew Kistler, Beverly Ng, Monjur Ahmed
Background: SIBO is increasingly being diagnosed in clinical practice in patients with a variety of gastrointestinal symptoms such as flatulence, bloating and diarrhea. There are various risk factors for the development of SIBO including altered small bowel anatomy (gastric resection, Biliroth II surgery, Roux- en-Y anastomosis, jejunoileal bypass surgery, surgically created blind loop, fistula between proximal and distal bowel, small bowel stricture, resection of ileocecal valve), altered small bowel motility (due to diabetic autonomic neuropathy, cirrhosis of liver, acute necrotizing pancreatitis or chronic pancreatitis, scleroderma, polymyositis, intestinal pseudoobstruction, celiac disease, irritable bowel syndrome), small bowel diverticulosis, chronic renal failure, immunodeficiency states, hypochlorhydria, recurrent antibiotics, chronic alcoholics, diabetes mellitus and old age. There are also a subset of patients without previously defined symptoms that develop SIBO. Purpose: To define what risk factors may predispose patients to developing SIBO and to find out whether symptomatic patients with risk factors have greater chance of developing SIBO than symptomatic patients without any risk factor for SIBO. Methods: Retrospective study with review of electronic medical records from Thomas Jefferson University Hospital and Methodist Hospital in Philadelphia from July 1, 2015 to June 30, 2016. All symptomatic patients (gas, bloating, diarrhea, constipation, abdominal pain, belching, halitosis) above the age of 18, irrespective of sex and race who had lactulose breath test during that period were included in our study. Patients with repeat breath tests after treatment were excluded from the study. The study data was analyzed in Microsoft Excel. Result: 434 patients underwent a lactulose breath test. The number of positive tests was 344 (79.26%) and total negative test was 90 (20.74%). 232 patients had previously defined risk factors (RF) were some of them had multiple risk factors) and out of them 182 (78.45%) had a positive test (Table 1). Patients without risk factors were 202 and out of them 162 (80%) had positive test. Demographics of these two groups are shown in Table 2. To compare the breath test results between the two groups, Z test was done and Z score was found to be -0.4485 (P value 0.32636) indicating that there was no significant difference between the results. Conclusion: Although there are known risk factors for the development of SIBO, symptomatic patients can have SIBO even without any risk factor. About 50% of the patients with risk factors had IBS. The next common risk factors were diabetes mellitus, old age >75 years and Celiac disease. Irrespective of the risk factors, SIBO should be ruled out if the patients are symptomatic. Risk Factor with Positive Test breakdown
Mo1882 REBLEEDING RATE AND RELATED RISK FACTORS FOR NON-STEROIDAL ANTI-INFLAMMATORY DRUG-INDUCED ENTEROPATHY Seong Ran Jeon, Junseok Park, Jin-Oh Kim, Hyun Gun Kim, Tae Hee Lee, Jun-Hyung Cho, Bong Min Ko, Joon Seong Lee, Moon Sung Lee Background/Aims: Limited reports have been published about rebleeding after non-steroidal anti-inflammatory drugs (NSAIDs)-induced enteropathy-associated bleeding. The aim of this study was to evaluate the rebleeding rate and related risk factors in patients with NSAIDsinduced small bowel bleeding. Methods: Among 402 patients with obscure gastrointestinal bleeding who had been evaluated with capsule endoscopy, fifty-one were diagnosed with NSAIDs-induced enteropathy. We retrospectively reviewed the medical records and analyzed patients' clinical characteristics. Modified Charlson comorbidity index score was used for evaluating the patients' underlying comorbidities. For patients who were taking additional drugs, an odds ratio (OR) was calculated taking this additional drug use into account. The OR was then used as the drug-related rebleeding risk score. Results: The rebleeding rate in patients with NSAIDs-induced enteropathy was 19.6% with a median interval of 16 months. Significant differences between patients with and without rebleeding were found according to age (71.2±18.6 years vs. 59.4±15.5 years, p=0.043) and discontinuation of NSAIDs after the first bleeding episode (85.3% vs. 20.0%, p=0.027). There were no differences in underlying comorbidities, drug-related rebleeding risk scores, or therapeutic use of proton pump inhibitors (p=0.354, p=0.205, and p>0.999, respectively). In multivariate analysis, an age of over 70 years (OR: 2.613, 95% CI: 1.995-93.19, p=0.021) and the continuous use of NSAIDs after the first bleeding episode (OR: 2.272, 95% CI: 1.184-79.384, p=0.034) were independent rebleeding related risk factors. Conclusions: Up to one fifth of patients with NSAIDs- induced enteropathy showed rebleeding within two years. Careful long-term follow-up should be offered in elderly patients with NSAIDs-induced enteropathy who need to continue NSAID treatment.
Mo1883 RISK FACTORS OF RENAL DYSFUNCTION CAUSED BY TACROLIMUS THERAPY FOR INTRACTABLE ULCERATIVE COLITIS Takashi Mikami, Kazuki Kakimoto, Azusa Hara, Yujiro Henmi, Yutaka Naka, Yuki Hirata, Yoshimasa Hirata, Toshihiko Okada, Sadaharu Nouda, Ken Kawakami, Kazuhide Higuchi Background: Tacrolimus (Tac), a calcineurin inhibitor, shows excellent efficacy for inducing remission in ulcerative colitis (UC) patients. To achieve remission induction, high blood trough levels of Tac need to be maintained; however, high trough levels lead to renal dysfunction as a complication. In the present study, we retrospectively analyzed the effect of Tac therapy on renal function and examined associated risk factors. Methods: The study included 72 patients who received continuous Tac therapy for one month or more for UC at our hospital between January 2011 and May 2016. Tac therapy was initiated at a dose of 0.1 mg/kg/day; subsequently, after the blood trough levels were maintained at 10 - 15 ng/ml (high trough period) for 3 weeks, they were set at 5 - 10 ng/ml (maintenance trough period). Renal dysfunction was defined as a 1.5-fold increase in the Creatinine (Cr) level and a decrease of at least 25% in estimated glomerular filtration rate (eGFR). The patients who exhibited renal dysfunction during the high trough period with trough level ≥ 10 ng/ ml were assigned to group A, those who exhibited renal dysfunction during the maintenance trough period were assigned to group B, and those who showed no renal dysfunction were assigned to group C. The patient age, gender, disease duration, Lichtiger's CAI, laboratory findings, combined therapy, and presence or absence of an underlying disease were compared between each group. Furthermore, in groups A and B, the incidence of renal impairment, the duration of Tac therapy until the onset of renal dysfunction, and the mean trough level for the week immediately prior to the observation of renal dysfunction were examined. Finally, risk factors for renal dysfunction were examined. Results: In all UC patients, the mean age was 44.8 ± 18.3 years, and the mean Cr was 0.73 ± 0.24. Renal dysfunction was observed in 47.2% (34 patients), including 40.2% (29 patients) in group A, and 7% (5 patients) in group B. There was no difference in the background factors between the three groups. The period when renal dysfunction was observed was 13.7 days after Tac therapy in group A, and 101.6 days in group B. The mean trough levels for the week immediately prior to the observation of renal dysfunction were 16.4 ng/ml in group A and 7.1 ng/ml in group B. The patients aged 65 years and older who exhibited renal dysfunction accounted for 63.7% (7/11 patients), and those aged younger than 65 years accounted for 44.3% (27/ 61 patients), and thus a trend was observed in which the patients aged 65 years and older were prone to renal dysfunction. Conclusion: In Tac therapy for UC, there was a high rate of renal dysfunction at 47.2%, with onset particularly common in the high trough period. Furthermore, elderly individuals were prone to renal dysfunction, and hence we believe that Tac therapy should be administered with caution.
Table 2
Mo1885 USE OF INFLIXIMAB IN THE TREATMENT OF NIVOLUMAB-INDUCED REFRACTORY COLITIS IN PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER Ravi K. Prakash, Elham Abboud, Bruce Gershenhorn, Digant Gupta, Pankaj G. Vashi Introduction: Nivolumab is used as a second-line treatment in patients with advanced nonsmall cell lung cancer (NSCLC) who have progressed after platinum-based chemotherapy. Diarrhea is the most common gastrointestinal adverse event of nivolumab for which cessation of immune therapy and steroids are the mainstay of treatment. We describe three complex
S-809
AGA Abstracts
AGA Abstracts
SMALL BOWEL BACTERIAL OVERGROWTH (SIBO) IN INDIVIDUALS WITHOUT AND WITH RISK FACTORS C. Andrew Kistler, Beverly Ng, Monjur Ahmed