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Magnesium Citrate vs Polyethylene Glycol Electolyte Solution for Bowel Preparation: A Meta-Analysis of Randomized Controlled Trials
AGA Abstracts
preparations. The Begg's funnel plot indicated low probability of publication bias. Conclusions: SPMC before colonoscopy appears to be equally effective to PEG-ES bowel preparations but better tolerated
*Odds ratios for PWAG or CD (OR [95% CI]); adjusted by age, gender, and BMI. Su1094 A Systematic Review and Meta-Analysis of Non-Invasive Biomarkers for Assessing Disease Activity in Inflammatory Bowel Disease Mahmoud H. Mosli, Guangyong Zou, Sushil Kumar Garg, Sean Feagan, John K. MacDonald, William Sandborn, Nilesh Chande, Brian G. Feagan
Su1097 Acute Coronary Syndrome and Risk of Gastrointestinal Hemorrhage: When Is It Safe to Proceed? Joseph Yeh, Bechien U. Wu, Ngoc J. Ho
Background: Endoscopic disease activity in inflammatory bowel disease (IBD) is associated with poor outcomes. Endoscopic evaluation is the gold standard for the assessment of disease activity, but is invasive, expensive and potentially time consuming. Identification of noninvasive biomarkers of disease activity in IBD is a research priority. Methods: The primary objective was to evaluate the diagnostic accuracy of 3 non-invasive biomarkers (fecal calprotectin [FC], stool lactoferrin [SL] and C-reactive protein [CRP]) used for the evaluation of disease activity in IBD. MEDLINE, EMBASE, the Cochrane Library, the ISI Web of Knowledge and conference abstracts were searched from inception to November 2014 for relevant studies. Grey literature databases (e.g. SIGLE) were also searched to identify studies not indexed in traditional databases. All cohort and case-control studies that evaluated the diagnostic accuracy of FC, SL or CRP for assessment of disease activity in symptomatic patients with previously diagnosed IBD (ulcerative colitis and Crohn's disease) were included. True positive, true negative, false positive and false negative rates were extracted for each biomarker and used to construct 2X2 tables for each cutoff. Sensitivity, specificity and area under the curve (AUC) estimates for FC, SL and CRP were calculated for each study based on different cut-offs and pooled together into single estimates for each test. Receiver operator characteristics (ROC) curves were then used to identify the cut-off values for each biomarker that best predicted endoscopic disease activity. Results: Nineteen studies (2456 participants) met our inclusion criteria. Sensitivity, specificity, and AUC values for the 3 biomarkers are summarized in Table 1. The best cut-off values to detect endoscopically active disease in IBD determined by ROC analysis were 50 μg/g, 7.25 μg/mL and 10 mg/dL for FC, SL and CRP, respectively. Conclusions: FC and SL are highly accurate biomarkers that can be used to screen symptomatic IBD patients for endoscopic disease activity prior to colonoscopy. Table 1. Diagnostic Accuracy of Fecal Calprotectin, Stool Lactoferrin, and C-reactive Protein
Introduction: Gastrointestinal hemorrhage (GIB) has been shown to be a serious complication in acute coronary syndrome ACS) associated with high mortality.1 In this patient population, a history of gastrointestinal disease is an independent predictor of GIB.2,3 The aim of this study was to determine at what point the risk of hemorrhage from gastrointestinal disease becomes acceptable to proceed without prior endoscopic evaluation. Methods: We conducted a retrospective study using a community-based integrated health care system in Southern California from 2006 to 2011. Our database represented 15 hospitals and 202 medical offices. Study inclusion criteria included patients with a history of gastrointestinal disease prior to diagnosis of ACS. ACS was defined as ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction and unstable angina. Table 1 lists the ICD9 codes used to identify gastrointestinal disease and GIB in our analysis. Descriptive statistics were calculated for patients who developed GIB up to 1 year after the ACS diagnosis versus those who did not. Logistic regression models were constructed to examine the association between the time interval of gastrointestinal disease diagnosis prior to ACS and GIB, adjusting for age, gender, BMI, alcohol and smoking. Results: A total of 9652 patients satisfied the inclusion criteria of history of gastrointestinal disease and ACS. Of this group, 818 patients (9%) developed post-ACS GIB. The majority of post-ACS GIB (47.8%) occurred within one year of gastrointestinal disease diagnosis. Predicted probabilities for post-ACS GIB are displayed in Figure 1. The greatest risk of GIB (10-11%) occurred in patients with gastrointestinal disease history diagnosed within 1 year of ACS. The risk of GIB subsequently decreases as the interval increases between gastrointestinal disease and ACS diagnosis: 8% at 5 years, 5.8% at 10 years, 4.5% at 15 years. Conclusions: Our findings showed an inverse association between time interval of gastrointestinal disease diagnosis prior to ACS and risk of GIB: the longer the duration, the lower the risk. Although the risk and benefits for ACS patients should be weighed individually, those with a remote history of gastrointestinal disease over 10 years prior to ACS may have a low enough GIB risk to consider deferring endoscopic evaluation. References: 1. Abbas et al. Am J Cardiology 2005;96:173-6. 2. Shivaraju et al. Am Heart Journal 2011;162:1062-1068. 3. Bhala et al. BMJ 2011;343:d4264. 4. Nikolsky et al. J Am Coll Cardiol 2009;54(14):1293-302. Gastrointestinal disease and hemorrhage ICD-9 codes
Su1096 Picosulphate/Magnesium Citrate vs Polyethylene Glycol Electolyte Solution for Bowel Preparation: A Meta-Analysis of Randomized Controlled Trials Mohammad F. Madhoun, Hassaan Zia, Salman Nusrat, William M. Tierney Background: Polyethylene glycol electrolyte solution (PEG-ES) based bowel preparation for colonoscopy is very common. However, the large volume and the taste may reduce patient compliance, resulting into suboptimal bowel preparation. Recently, sodium picosulphate/ magnesium citrate (SPMC) has been evaluated in multiple randomized clinical trials (RCT's) as a lower volume and more palatable bowel preparation. Aims: The aims of this metaanalysis were to compare SPMC vs. PEG based products with regards (i) satisfactory bowel preparation, (ii) excellent bowel preparation, (iii) tolerability Methods: Studies were identified by searching ten medical databases including PubMed, Ovid MEDLINE and Cochrane Library Database for reports published between 1990 and 2014, using a reproducible search strategy. References from retrieved articles were also manually reviewed. Only fully published RCT's compared SPMC and PEG based products with regard to overall satisfactory bowel preparation were included. 2 reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted by both fixed-effects and randomeffects models; results are presented from the random effects model when heterogeneity was significant. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Heterogeneity was assessed by I-squared index (I2) statistics. Results: Nine studies (involving 2954 subjects; 1461 in SPMC arm and 1493 in PEG arm) met the inclusion criteria, with mean age ranging from 52.8 to 65 years. Four studies used low volume PEG based products (two used 2L of PEG plus bisacodyl; two used 2L of PEG plus ascorbic acid). SPMC demonstrated a similar rate of satisfactory bowel preparation and abdominal pain compared to PEG but much less nausea and vomiting. Furthermore, SPMC subjects were more willing to repeat bowel preparation compared to PEG-ES subjects (table). Only 2 studies reported the rate of excellent bowel preparation, an attempt was made to obtain this data directly from the authors of the other studies but was unsuccessful. Subgroup analysis revealed similar result for split dose SPMC vs. 4 L PEG-ES and for SPMC vs. low volume PEG
AGA Abstracts
S-406
preparations. The Begg's funnel plot indicated low probability of publication bias. Conclusions: SPMC before colonoscopy appears to be equally effective to PEG-ES bowel preparations but better tolerated
*Odds ratios for PWAG or CD (OR [95% CI]); adjusted by age, gender, and BMI. Su1094 A Systematic Review and Meta-Analysis of Non-Invasive Biomarkers for Assessing Disease Activity in Inflammatory Bowel Disease Mahmoud H. Mosli, Guangyong Zou, Sushil Kumar Garg, Sean Feagan, John K. MacDonald, William Sandborn, Nilesh Chande, Brian G. Feagan
Su1097 Acute Coronary Syndrome and Risk of Gastrointestinal Hemorrhage: When Is It Safe to Proceed? Joseph Yeh, Bechien U. Wu, Ngoc J. Ho
Background: Endoscopic disease activity in inflammatory bowel disease (IBD) is associated with poor outcomes. Endoscopic evaluation is the gold standard for the assessment of disease activity, but is invasive, expensive and potentially time consuming. Identification of noninvasive biomarkers of disease activity in IBD is a research priority. Methods: The primary objective was to evaluate the diagnostic accuracy of 3 non-invasive biomarkers (fecal calprotectin [FC], stool lactoferrin [SL] and C-reactive protein [CRP]) used for the evaluation of disease activity in IBD. MEDLINE, EMBASE, the Cochrane Library, the ISI Web of Knowledge and conference abstracts were searched from inception to November 2014 for relevant studies. Grey literature databases (e.g. SIGLE) were also searched to identify studies not indexed in traditional databases. All cohort and case-control studies that evaluated the diagnostic accuracy of FC, SL or CRP for assessment of disease activity in symptomatic patients with previously diagnosed IBD (ulcerative colitis and Crohn's disease) were included. True positive, true negative, false positive and false negative rates were extracted for each biomarker and used to construct 2X2 tables for each cutoff. Sensitivity, specificity and area under the curve (AUC) estimates for FC, SL and CRP were calculated for each study based on different cut-offs and pooled together into single estimates for each test. Receiver operator characteristics (ROC) curves were then used to identify the cut-off values for each biomarker that best predicted endoscopic disease activity. Results: Nineteen studies (2456 participants) met our inclusion criteria. Sensitivity, specificity, and AUC values for the 3 biomarkers are summarized in Table 1. The best cut-off values to detect endoscopically active disease in IBD determined by ROC analysis were 50 μg/g, 7.25 μg/mL and 10 mg/dL for FC, SL and CRP, respectively. Conclusions: FC and SL are highly accurate biomarkers that can be used to screen symptomatic IBD patients for endoscopic disease activity prior to colonoscopy. Table 1. Diagnostic Accuracy of Fecal Calprotectin, Stool Lactoferrin, and C-reactive Protein
Introduction: Gastrointestinal hemorrhage (GIB) has been shown to be a serious complication in acute coronary syndrome ACS) associated with high mortality.1 In this patient population, a history of gastrointestinal disease is an independent predictor of GIB.2,3 The aim of this study was to determine at what point the risk of hemorrhage from gastrointestinal disease becomes acceptable to proceed without prior endoscopic evaluation. Methods: We conducted a retrospective study using a community-based integrated health care system in Southern California from 2006 to 2011. Our database represented 15 hospitals and 202 medical offices. Study inclusion criteria included patients with a history of gastrointestinal disease prior to diagnosis of ACS. ACS was defined as ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction and unstable angina. Table 1 lists the ICD9 codes used to identify gastrointestinal disease and GIB in our analysis. Descriptive statistics were calculated for patients who developed GIB up to 1 year after the ACS diagnosis versus those who did not. Logistic regression models were constructed to examine the association between the time interval of gastrointestinal disease diagnosis prior to ACS and GIB, adjusting for age, gender, BMI, alcohol and smoking. Results: A total of 9652 patients satisfied the inclusion criteria of history of gastrointestinal disease and ACS. Of this group, 818 patients (9%) developed post-ACS GIB. The majority of post-ACS GIB (47.8%) occurred within one year of gastrointestinal disease diagnosis. Predicted probabilities for post-ACS GIB are displayed in Figure 1. The greatest risk of GIB (10-11%) occurred in patients with gastrointestinal disease history diagnosed within 1 year of ACS. The risk of GIB subsequently decreases as the interval increases between gastrointestinal disease and ACS diagnosis: 8% at 5 years, 5.8% at 10 years, 4.5% at 15 years. Conclusions: Our findings showed an inverse association between time interval of gastrointestinal disease diagnosis prior to ACS and risk of GIB: the longer the duration, the lower the risk. Although the risk and benefits for ACS patients should be weighed individually, those with a remote history of gastrointestinal disease over 10 years prior to ACS may have a low enough GIB risk to consider deferring endoscopic evaluation. References: 1. Abbas et al. Am J Cardiology 2005;96:173-6. 2. Shivaraju et al. Am Heart Journal 2011;162:1062-1068. 3. Bhala et al. BMJ 2011;343:d4264. 4. Nikolsky et al. J Am Coll Cardiol 2009;54(14):1293-302. Gastrointestinal disease and hemorrhage ICD-9 codes
Su1096 Picosulphate/Magnesium Citrate vs Polyethylene Glycol Electolyte Solution for Bowel Preparation: A Meta-Analysis of Randomized Controlled Trials Mohammad F. Madhoun, Hassaan Zia, Salman Nusrat, William M. Tierney Background: Polyethylene glycol electrolyte solution (PEG-ES) based bowel preparation for colonoscopy is very common. However, the large volume and the taste may reduce patient compliance, resulting into suboptimal bowel preparation. Recently, sodium picosulphate/ magnesium citrate (SPMC) has been evaluated in multiple randomized clinical trials (RCT's) as a lower volume and more palatable bowel preparation. Aims: The aims of this metaanalysis were to compare SPMC vs. PEG based products with regards (i) satisfactory bowel preparation, (ii) excellent bowel preparation, (iii) tolerability Methods: Studies were identified by searching ten medical databases including PubMed, Ovid MEDLINE and Cochrane Library Database for reports published between 1990 and 2014, using a reproducible search strategy. References from retrieved articles were also manually reviewed. Only fully published RCT's compared SPMC and PEG based products with regard to overall satisfactory bowel preparation were included. 2 reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted by both fixed-effects and randomeffects models; results are presented from the random effects model when heterogeneity was significant. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Heterogeneity was assessed by I-squared index (I2) statistics. Results: Nine studies (involving 2954 subjects; 1461 in SPMC arm and 1493 in PEG arm) met the inclusion criteria, with mean age ranging from 52.8 to 65 years. Four studies used low volume PEG based products (two used 2L of PEG plus bisacodyl; two used 2L of PEG plus ascorbic acid). SPMC demonstrated a similar rate of satisfactory bowel preparation and abdominal pain compared to PEG but much less nausea and vomiting. Furthermore, SPMC subjects were more willing to repeat bowel preparation compared to PEG-ES subjects (table). Only 2 studies reported the rate of excellent bowel preparation, an attempt was made to obtain this data directly from the authors of the other studies but was unsuccessful. Subgroup analysis revealed similar result for split dose SPMC vs. 4 L PEG-ES and for SPMC vs. low volume PEG
AGA Abstracts
S-406