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Su1353 Outcomes of Patients With Microscopic Colitis Treated With Bismuth Subsalicylate
improvement of diarrhea at 8 weeks +/- 2 weeks with BSS. Patients with less than 6 weeks of treatment were excluded. Recurrence was defined if diarrhea recurred without an alternative etiology after complete resolution on treatment with BSS. Data were analyzed using JMP version 9.0.1. Results: 64 patients with MC were treated with BSS. Median age was 70 yrs (range, 31-86); 59 (92%) were female; 33 (52%) had LC and 31 (48%) had CC. Median duration of BSS therapy was 8 weeks (range, 6-51 weeks). Median duration of follow-up from initiation of treatment with BSS was 24 months. The daily dose of BSS was 6 tablets in 11 patients (17%), 8 tablets in 13 patients (20%), and 9 tablets in 40 patients (63%). Overall, 33 (52%) had complete response, 18 (28%) had partial response, and 13 (20%) had no response. One complete responder was lost to follow-up. Of the 32 remaining complete responders, 23 (72%) recurred. The median time to recurrence was 4.9 weeks after stopping BSS. There was evidence for a dose-response, with 9 tablets per day being associated with a higher rate of complete response and treatment with 8 tablets per day with partial response (Table 1, p=0.006). Recurrence did not vary based on dose (p=0.54). Response varied by baseline severity of diarrhea (Table 2, p=0.04). Moreover, response rates varied by MC subtype, with LC much more likely to have a complete response than CC (70% vs 32%, p=0.001). Conclusion: Patients with MC treated with bismuth subsalicylate had a high clinical response rate but also had a high risk of recurrence. A dose of 9 tablets per day was superior to lower doses. Patients with mild diarrhea had a better response than patients with severe diarrhea, and patients with LC were much more likely to have a complete response than CC. However, to determine the true benefit of BSS, prospective placebocontrolled studies stratified by disease severity and subtype are needed. Response Based on Daily Dose in Number of Tablets
Detection of Clostridium difficile-Infected Stool by Electronic-Nose Analysis of Fecal Headspace Volatile Organic Compounds Daniel K. Chan, Marlys Anderson, David T. Lynch, Cadman L. Leggett, Lori S. Lutzke, Magdalen A. Clemens, Kenneth K. Wang Introduction Electronic-noses (e-noses) have the ability of converting smells to digital signatures. By interacting with volatile organic compounds (VOC's) emitted by metabolic end-products of disease, e-noses create distinct patterns of aggregate VOC's to generate unique signatures that can be used to identify disease. The detection of Clostridium difficile (C. diff) by VOC's is prototypic as it has been successfully identified by scent using canines. We seek to pilot a novel portable e-nose device to profile fecal headspace to diagnose C. diff infection. Methods We are prospectively enrolling patients undergoing stool testing by C. diff PCR for infectious diarrhea for fecal headspace analysis using the Aetholab e-nose (eNose Company, Zutphen, NL). Stool specimens were obtained from the clinical microbiology lab of our institution within 7 days of ambient collection and aliquots of 10-ml of homogenized stool were transferred to disposable analysis bottles. The e-nose circulates fecal headspace gas within each analysis bottle to allow interaction with its respective sensor array. Each sensor array comprises of three metal-oxide sensors that undergo reversible redox reactions with VOC's at an electrochemical interface. Electrical resistance changes are measured by applying a 32-point thermal cycle to the sensor array generating a digital signature (Figure 1). This process has been shown to interact with a wide range of VOC's. Combined data from the 3 sensors in 7 combinations (A, B, C, AB, AC, AC, ABC) is permuted across 3 scaling factors generating a total of 21 data sets per analysis. These are then compressed through a multi-way analysis to reduce the large amount of data to avoid spurious associations. Finally each sample's compressed dataset is introduced into an artificial neural network (ANN) using a supervised approach. The 5 best models generated using a leave-one-out approach are used to obtain the reported results. Results Separation was observed using all 20 C. diff-PCR positive and 53 C. diff-PCR negative stools. The ROC curve for this model is shown in Figure 2 with an AUC = 0.85. This demonstrated 80% sensitivity, 85% specificity with 84% accuracy. The positive predictive value was 0.67 and the negative predictive value 0.92. Matthews correlation coefficient was 0.64. Conclusion Through the use of a pattern-recognition e-nose device it is possible to distinguish C. diffinfected stools. This is the first time that this type of device has been used for this diagnosis, and also the first time this e-nose has been applied for fecal headspace analysis of infectious disease. This indicates that C. diff testing can translate into a point-of-care evaluation.
Response Based on Baseline Diarrhea Severity
Su1354 Endoscopic Findings and Predictive Factors for Operation in Intestinal Behcet's Disease Kazuki Kakimoto, Takuya Inoue, Mitsuyuki Murano, Naoki Yorifuji, Munetaka Iguchi, Kaori Fujiwara, Yuichi Kojima, Ken Narabayashi, Toshihiko Okada, Sadaharu Nouda, Ken Kawakami, Yosuke Abe, Toshihisa Takeuchi, Daisuke Masuda, Kazuhide Higuchi
Figure 1: A representative depiction of composite e-nose signal outputs: A1,B1,C1 are respective outputs from the three-sensor array. The axes are denoted by: X-axis: Thermal Cycle, Y-axis: Time, Z-axis: Resistance
Backgrounds and Aims: Behçet disease (BD) is a chronic and intractable multisystemic inflammatory disorder of unknown cause. Intestinal BD is a specific subtype of BD, characterized by oval punched-out ulcers in the ileocecal region. Similar to inflammatory bowel disease, intestinal BD exhibits a fluctuating disease course with repeated episodes of relapse and remission. Intestinal BD is often refractory to medical therapy and surgeries are required due to massive bleeding and gastrointestinal perforation. In this study, we assessed the clinical presentation, clinical course, endoscopic findings, and therapeutic outcomes for intestinal BD. And we assessed whether the need of surgery can be predicted from the endoscopic features based on the examination of endoscopic images and legion localization of BD. Methods: The relationships of clinical features, endoscopic images, and lesion localization with surgery were examined. Intestinal lesions were classified into the following 5 groups: type I (punched-out ulcers in the ileocecal region), type II (punched-out ulcers in the ileocecal region and multiple small ulcers in the surrounding area), type III (multiple small ulcers in the ileocecal region), type IV (multiple small ulcers in areas other than the ileocecal region), and type V (others). Results: There were 27 cases of intestinal BD, and 77.8% (21/27) of cases had punched-out ulcers in the ileocecal region. Cases with lesions in the areas other than the ileocecal region were 37.0% (10/27). When examined based on the above-mentioned intestinal-lesion classification, intestinal BD had 7 cases with type I, 13 cases with type II, 2 cases with type III, 3 cases with type IV and 2 cases with type V. High percentage 25.9% (7/27) of intestinal BD required a surgery during the course. Type II (Odds ratio 6.50, 95%CI:1.05-40.14) in intestinal BD was considered a surgery predictor. Conclusions: This indicated that it is possible to predict the need for surgery based on endoscopic features of intestinal BD.
Figure 2: ROC curve from model using all stool samples (AUC=0.85) Su1355 Su1353
Perception of Lactose Intolerance Impairs Health Related Quality of Life Francesc Casellas, Anna Aparici, María José Pérez Panzano, Purificacion Rodriguez
Outcomes of Patients With Microscopic Colitis Treated With Bismuth Subsalicylate Nicole M. Gentile, Sahil Khanna, Edward V. Loftus, William J. Tremaine, Patricia P. Kammer, Darrell S. Pardi
Changes in health impacts patient's well-being, which is perceived as an impaired health related quality of life (HRQOL). It is debated whether adult lactose malabsorption is a normal situation or a pathological condition. In any case, the symptoms that people attribute to lactose intolerance or malabsorption have great relevance as they are associated with a lower consumption of calcium/vitamin D and a lower bone density. In addition, it is not known if malabsorption or intolerance to dairy products is associated with a loss of HRQOL. OBJECTIVE: To determine the HRQOL depending on the perception of tolerance to lactose and on the objective determination of the absorption of lactose. METHODS: Prospective, observational, cross-sectional study in a cohort of patients referred to assess the absorption of lactose. After signing the informed consent, patients completed a validated questionnaire to determine the perception of symptoms of intolerance during their regular consumption of dairy products at home and a visual analogue scale as a generic measure of quality of
Background: Microscopic Colitis (MC) is a common cause of chronic diarrhea. Treatment options include bismuth subsalicylate (BSS), although data on its use and subsequent outcomes are limited. Aim: To evaluate clinical response and recurrence rates of patients with MC treated with BSS. Methods: Patients with collagenous colitis (CC) or lymphocytic colitis (LC) treated at our institution from 12/31/01 to 12/31/2011 were identified by searching the electronic medical record for the terms "microscopic colitis", "LC", or "CC", and "bismuth subsalicylate" or "Pepto-Bismol." MC was defined by the presence of diarrhea, normal endoscopic examination and histopathological evidence of MC. Complete response was defined as resolution of diarrhea, whereas partial response was defined as at least 50%
S-483
AGA Abstracts
AGA Abstracts
Su1352
Detection of Clostridium difficile-Infected Stool by Electronic-Nose Analysis of Fecal Headspace Volatile Organic Compounds Daniel K. Chan, Marlys Anderson, David T. Lynch, Cadman L. Leggett, Lori S. Lutzke, Magdalen A. Clemens, Kenneth K. Wang Introduction Electronic-noses (e-noses) have the ability of converting smells to digital signatures. By interacting with volatile organic compounds (VOC's) emitted by metabolic end-products of disease, e-noses create distinct patterns of aggregate VOC's to generate unique signatures that can be used to identify disease. The detection of Clostridium difficile (C. diff) by VOC's is prototypic as it has been successfully identified by scent using canines. We seek to pilot a novel portable e-nose device to profile fecal headspace to diagnose C. diff infection. Methods We are prospectively enrolling patients undergoing stool testing by C. diff PCR for infectious diarrhea for fecal headspace analysis using the Aetholab e-nose (eNose Company, Zutphen, NL). Stool specimens were obtained from the clinical microbiology lab of our institution within 7 days of ambient collection and aliquots of 10-ml of homogenized stool were transferred to disposable analysis bottles. The e-nose circulates fecal headspace gas within each analysis bottle to allow interaction with its respective sensor array. Each sensor array comprises of three metal-oxide sensors that undergo reversible redox reactions with VOC's at an electrochemical interface. Electrical resistance changes are measured by applying a 32-point thermal cycle to the sensor array generating a digital signature (Figure 1). This process has been shown to interact with a wide range of VOC's. Combined data from the 3 sensors in 7 combinations (A, B, C, AB, AC, AC, ABC) is permuted across 3 scaling factors generating a total of 21 data sets per analysis. These are then compressed through a multi-way analysis to reduce the large amount of data to avoid spurious associations. Finally each sample's compressed dataset is introduced into an artificial neural network (ANN) using a supervised approach. The 5 best models generated using a leave-one-out approach are used to obtain the reported results. Results Separation was observed using all 20 C. diff-PCR positive and 53 C. diff-PCR negative stools. The ROC curve for this model is shown in Figure 2 with an AUC = 0.85. This demonstrated 80% sensitivity, 85% specificity with 84% accuracy. The positive predictive value was 0.67 and the negative predictive value 0.92. Matthews correlation coefficient was 0.64. Conclusion Through the use of a pattern-recognition e-nose device it is possible to distinguish C. diffinfected stools. This is the first time that this type of device has been used for this diagnosis, and also the first time this e-nose has been applied for fecal headspace analysis of infectious disease. This indicates that C. diff testing can translate into a point-of-care evaluation.
Response Based on Baseline Diarrhea Severity
Su1354 Endoscopic Findings and Predictive Factors for Operation in Intestinal Behcet's Disease Kazuki Kakimoto, Takuya Inoue, Mitsuyuki Murano, Naoki Yorifuji, Munetaka Iguchi, Kaori Fujiwara, Yuichi Kojima, Ken Narabayashi, Toshihiko Okada, Sadaharu Nouda, Ken Kawakami, Yosuke Abe, Toshihisa Takeuchi, Daisuke Masuda, Kazuhide Higuchi
Figure 1: A representative depiction of composite e-nose signal outputs: A1,B1,C1 are respective outputs from the three-sensor array. The axes are denoted by: X-axis: Thermal Cycle, Y-axis: Time, Z-axis: Resistance
Backgrounds and Aims: Behçet disease (BD) is a chronic and intractable multisystemic inflammatory disorder of unknown cause. Intestinal BD is a specific subtype of BD, characterized by oval punched-out ulcers in the ileocecal region. Similar to inflammatory bowel disease, intestinal BD exhibits a fluctuating disease course with repeated episodes of relapse and remission. Intestinal BD is often refractory to medical therapy and surgeries are required due to massive bleeding and gastrointestinal perforation. In this study, we assessed the clinical presentation, clinical course, endoscopic findings, and therapeutic outcomes for intestinal BD. And we assessed whether the need of surgery can be predicted from the endoscopic features based on the examination of endoscopic images and legion localization of BD. Methods: The relationships of clinical features, endoscopic images, and lesion localization with surgery were examined. Intestinal lesions were classified into the following 5 groups: type I (punched-out ulcers in the ileocecal region), type II (punched-out ulcers in the ileocecal region and multiple small ulcers in the surrounding area), type III (multiple small ulcers in the ileocecal region), type IV (multiple small ulcers in areas other than the ileocecal region), and type V (others). Results: There were 27 cases of intestinal BD, and 77.8% (21/27) of cases had punched-out ulcers in the ileocecal region. Cases with lesions in the areas other than the ileocecal region were 37.0% (10/27). When examined based on the above-mentioned intestinal-lesion classification, intestinal BD had 7 cases with type I, 13 cases with type II, 2 cases with type III, 3 cases with type IV and 2 cases with type V. High percentage 25.9% (7/27) of intestinal BD required a surgery during the course. Type II (Odds ratio 6.50, 95%CI:1.05-40.14) in intestinal BD was considered a surgery predictor. Conclusions: This indicated that it is possible to predict the need for surgery based on endoscopic features of intestinal BD.
Figure 2: ROC curve from model using all stool samples (AUC=0.85) Su1355 Su1353
Perception of Lactose Intolerance Impairs Health Related Quality of Life Francesc Casellas, Anna Aparici, María José Pérez Panzano, Purificacion Rodriguez
Outcomes of Patients With Microscopic Colitis Treated With Bismuth Subsalicylate Nicole M. Gentile, Sahil Khanna, Edward V. Loftus, William J. Tremaine, Patricia P. Kammer, Darrell S. Pardi
Changes in health impacts patient's well-being, which is perceived as an impaired health related quality of life (HRQOL). It is debated whether adult lactose malabsorption is a normal situation or a pathological condition. In any case, the symptoms that people attribute to lactose intolerance or malabsorption have great relevance as they are associated with a lower consumption of calcium/vitamin D and a lower bone density. In addition, it is not known if malabsorption or intolerance to dairy products is associated with a loss of HRQOL. OBJECTIVE: To determine the HRQOL depending on the perception of tolerance to lactose and on the objective determination of the absorption of lactose. METHODS: Prospective, observational, cross-sectional study in a cohort of patients referred to assess the absorption of lactose. After signing the informed consent, patients completed a validated questionnaire to determine the perception of symptoms of intolerance during their regular consumption of dairy products at home and a visual analogue scale as a generic measure of quality of
Background: Microscopic Colitis (MC) is a common cause of chronic diarrhea. Treatment options include bismuth subsalicylate (BSS), although data on its use and subsequent outcomes are limited. Aim: To evaluate clinical response and recurrence rates of patients with MC treated with BSS. Methods: Patients with collagenous colitis (CC) or lymphocytic colitis (LC) treated at our institution from 12/31/01 to 12/31/2011 were identified by searching the electronic medical record for the terms "microscopic colitis", "LC", or "CC", and "bismuth subsalicylate" or "Pepto-Bismol." MC was defined by the presence of diarrhea, normal endoscopic examination and histopathological evidence of MC. Complete response was defined as resolution of diarrhea, whereas partial response was defined as at least 50%
S-483
AGA Abstracts
AGA Abstracts
Su1352