- Email: [email protected]
Trends in Incidence and Survival of Esophageal Cancer in Korea: A Population-Based Epidemiologic Study
AGA Abstracts
Tu1707
eosinophilic esophagitis (EoE), achalasia and esophageal cancer were also identified using the ICD-9 and DRG24. The association between IBD and esophageal disorders was calculated using multivariate logistic regression. RESULTS: The study population included a total of 6,145,845 inpatients from NIS; 71,027 in the IBD group and 6,074,818 in the control group. Mean age was 57 ± 20.6 years (range 18-90 years) with 59.4 % females. IBD patients had higher prevalence of Barrett's esophagus [OR: 1.44 (95% CI: 1.29 - 1.61, P< 0.001)]. After controlling for GERD, age and gender, IBD was also associated with higher EoE [OR: 2.53 (95% CI: 1.6 - 4, P<0.001)]. Prevalence of achalasia was similar between the IBD and the control groups [OR: 1.01 (95% CI: 0.72-1.44, P: 0.25)]. CONCLUSIONS: Inflammatory bowel disease is associated with higher prevalence of esophageal disorders such as Barrett's esophagus and eosinophilic esophagitis IBD & Esophageal Disorders
AUTOIMMUNE GASTRITIS IN JAPAN: A STUDY OF 200 PATIENTS AT MULTICENTER STUDY Shuichi Terao, Takahisa Furuta, Tomoari Kamada, Yasuhiko Maruyama, Jyoji Syunto, Rika Aoki, Masanori Ito, Noriaki Manabe, Yuichi Sato, Kazuhiko Oho, Kazuhiko Inoue, Akiko Shiotani, Ken Haruma OBJECTIVES: Autoimmune gastritis (AIG) is thought an uncommon disease in Japan, because pernicious anemia (PA) and gastric type I NET associated with AIG are less common in Japan compared to the western countries. However, the prevalence of atrophic gastritis induced by H. pylori infection is common in Japan. The aims of this study is to clarify the incidence of AIG and to study the clinical characteristics of Japanese AIG patients. PATIENTS AND METHODS: A total of 200 Japanese patients with AIG, from January 2010 to October 2016, were reviewed in 10 institutes in Japan. 43 of 200 patients were prospectively diagnosed as having AIG at healthcare check endoscopy among consecutive 8716 subjects, from April 1 2015 to July 31 2016. Definition of AIG as follows; 1: corpus predominantly severe atrophic gastritis, 2: presence of anti-parietal cell antibody, 3: hypergastrinemia (>350 pg/ ml). RESULTS: From the result of healthcare endoscopy for the asymptomatic 8716 subjects, 43 AIG patients (mean age 64.2yrs, 35 females) were diagnosed and the estimated incidence of AIG in Japan was 0.49% (0.14% in male and 0.9% in female). Other 157 patients were collected from the endoscopic examination in clinical practice and the total of 200 AIG patients were analyzed in this study. Of the 200 AIG patients, the mean age was 65.9±10.9yrs (range 36-89yrs, 135 females). PA was present in only 27 patients (13.5%) and 45 patients had autoimmune disease (28 Hashimoto' disease, 4 NASH, 3 primary biliary cirrhosis, 5 rheumatoid arthritis, 1 autoimmune hepatitis, 4 others). Gastric NET was diagnosed in 24 patients (12%) and adenocarcinoma in 8 (4%). H. pylori infection was positive in 7.8% (13/ 167). The mean serum gastrin level was 2625 pg/ml (range 358-8485) and endocrine micronests of corpus mucosa were detected in 72 (72/123, 58.5%). CONCLUSIONS: AIG is more frequent than expected in Japan and significantly a female predominant, rarely accompanied with (PA). The prevalence of gastric NET was 12% and that of gastric cancer was 4% among 200 AIG patients. This is the first report describing the actual incidence and the characteristics of AIG in Japan.
Tu1710 INCREASING FREQUENCY OF HOSPITALIZATIONS AMONG YOUNG PATIENTS FOR COMPLICATED DIVERTICULITIS: NATIONAL TRENDS AND IN-HOSPITAL OUTCOMES Douglas L. Nguyen, Matthew L. Bechtold, M. Mazen Jamal
Tu1708 THE NUMBER AND LOCATION OF LESIONS DETERMINE THE CLINICAL FEATURES OF SMALL BOWEL BLEEDING DUE TO VASCULAR ECTASIA Juan S. Lasa, Angel D. Peralta, Guillermo Dima, Ignacio Fanjul, Pablo A. Olivera, Gustavo Cernadas, Luis O. Soifer, Rafael Moore
Introduction: There are increasing reports that young patients have a more complicated presentation of diverticulitis compared to older patients. However, limited information are available for trends of hospitalizations across age groups for complicated diverticulitis and need for surgery. The aim of this study is to better define the frequency of complicated diverticulitis across all age groups and their in-hospital outcomes. Methods: We analyzed the National Inpatient Sample (NIS) 1988 to 2011 to determine the frequency of complicated diverticulitis requiring hospitalization using ICD-9 codes and define in-hospital outcomes and length of hospitalization. Results: From 1988 to 2011 using NIS sample, a total of 1,171,181 patients were admitted to a U.S. hospital for complicated diverticulitis. The ageadjusted frequency of hospitalizations has increased nearly 2-fold from 37.24 per 100,000 to 68.34 per 100,000 patients in 2011 (p<0.001). Of all the hospitalizations, there were approximately 2-fold increase in frequency of hospitalizations among patients ages 18-30 (0.92% in 1988 to 1.92% in 2011) and ages 31-59 (20.15% in 1988 to 40.6% in 2011). However, there was nearly a 1.5-fold decline in frequency of hospitalizations for ages over 60 years old (78.93% in 1988 to 57.47% in 2011). Overall, the mean age-adjusted mortality rate has declined significantly from 87.35 per 100,000 to 36.68 per 100,000 patients. Compared to patients >60 years old, younger patients had a significantly higher rate for intestinal perforation, abscess, stricture, intestinal fistula, and need for surgery (p <0.001). However, patients >60 years old had a significantly higher rate of diverticular bleeding compared to younger patients (p< 0.001). The overall length of hospitalization has decreased from 10.2 days in 1988 to 6.1 days in 2011. Conclusion: There were a 2-fold increase of rates of hospitalization among patients less than 60 years old. Younger patients has a higher rate of intestinal perforation, abscess, stricture, development of intestinal fistula, and need for surgery at time of hospitalization, compared to older patients. Older patients who presents with diverticulitis has a higher rates of diverticular management. Given improvement in medical care and early management of complications related to diverticulitis, the length of hospitalization and mortality rates have decreased significantly in the last two decades.
BACKGROUND: Small bowel bleeding is one of the most common causes of obscure gastrointestinal bleeding. This type of bleeding can be overt or occult, which usually manifests as iron-deficiency anemia. Vascular ectasia are a frequent cause of small bowel bleeding. The endoscopic variables which determine the type of clinical presentation are not well known. AIM: To determine features that may be associated with the type of obscure gastrointestinal bleeding due to vascular ectasia and with its magnitude. MATERIALS AND METHODS: Capsule endoscopy database of our Department was reviewed to identify those patients with a diagnosis of obscure gastrointestinal bleeding. Among those subjects, patients with at least one small bowel vascular ectasia were included for analysis. The following variables were retrieved: gender, age, clinical presentation (overt or occult), proximal and/or distal location of vascular ectasia. A proximal location lesion was defined as any lesion located within the first two thirds of the small bowel transit time. Also, the difference between basal hemoglobin and the hemoglobin value when capsule endoscopy was performed (∆Hb) was estimated as a surrogate of the magnitude of the bleeding. A univariate analysis was performed to estimate the variables associated with the type of clinical presentation; a multivariate analysis followi ∆Hb) using a logistic regression model was furtherly performed. We also identified variables significantly associated with a more severe bleeding, according to the ∆Hb value. RESULTS: Overall, 98 studies performed between Januray 2014 and July 2016 were reviewed; 81.65% were done on patients with obscure gastrointestinal bleeding: 53 of them had a diagnosis of small bowel vascular ectasia. Among these, 41.5% had overt gastrointestinal bleeding, 58.49% were male and median age was 65 years (23-90); 45.28% had more than one ectasia and the most common location was proximal (52.83%).Univariate analysis showed that age less than 60 [OR 4.72 (1.02-18.6)] and proximal location of vascular ectasia [OR 6.18 (1.56-24.4)] were significantly associated with overt bleeding presentation. On multivariate analysis, only proximal location was significantly associated with overt bleeding presentation [OR 4.35 (1.20-16.4)]. Additionally, proximal location (p 0.01) as well as more than one vascular ectasia (p 0.03) were significantly associated with a larger ∆Hb. CONCLUSION: Proximal location of small bowel vascular ectasia was associated with a clinically evident presentation of occult gastrointestinal bleeding, and with a more severe bleeding - along with the presence of more than one lesion.
Tu1711 TRENDS IN INCIDENCE AND SURVIVAL OF ESOPHAGEAL CANCER IN KOREA: A POPULATION-BASED EPIDEMIOLOGIC STUDY Aesun Shin, Hye-Kyung Jung, Young-Joo Won, Hyun-Joo Kong, Kyu-Won Jung, ChangMo Oh, Sun Young Yi, Chung Hyun Tae
Tu1709
Background/Aim: The diagnostic and therapeutic modalities of esophageal cancer have been recently improved in Asia, and its prognosis is expected to change. We aimed to provide a first-time population-based report on the epidemiology of esophageal cancer with trends in Korea. Methods: Cancer incidence data from 1999-2013 were obtained from the Korea Central Cancer Registry (KCCR), which covered the entire population under the PopulationBased Cancer Registry Program. Age-standardized incidence rates per million, and annual percent changes (APCs) were calculated according to subsites and histologic types. Fiveyear relative survival rates were estimated for cases diagnosed between 1993 and 2013 and followed up to 2014. Results: The Age-standardized incidence rates decreased from 8.2 per 100,000 populations in 1999 to 7.1 in 2013 with annual percent change (APC) of -2.6% in men. Similar decrease (APC of -2.2%) was observed for women. The proportion of squamous cell carcinoma was 83.9% and adenocarcinoma 3.5% and the incidence of both cancers decreased. The detection rate of localized and regional cancer showed a tendency to increase more than the detection of distant cancer. Five-year relative survival of squamous cell carcinoma was improved from 12.1% between 1993 and 1995 to 34.6% between 2009
THE ASSOCIATION BETWEEN INFLAMMATORY BOWEL DISEASE AND ESOPHAGEAL DISORDERS Mohammad Maysara Asfari, Tarek Sawas, Madhusudhan R. Sanaka BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving all or parts of the digestive system. IBD is known to be associated with other gastrointestinal disorders such as colon cancer, primary sclerosing cholangitis and ampullary cancer. The association between IBD and other esophageal disorders is not well known. Hence the aim of our study was to study the association between IBD and esophageal disorders from a large national database. METHODS: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) database during the year 2012. We identified adult patients age 18-90 years who were admitted to the hospital with Crohn's disease or ulcerative colitis using the International Classification of Diseases ICD-9 codes and Diagnosis Related Group, Version 24 (DRG24). The control group was adult individuals whose hospital discharge records did not contain IBD. Esophageal disorders including Barrett's esophagus,
AGA Abstracts
S-948
*Education level was classified as low (middle school graduates or less), middle (high school graduates or university dropouts), or high (university graduates or graduates of a postgraduate course). **Household income was classified as low (less than US $ 3,000), medium (US $ 3,000 to 10,000), or high (more than US $ 10,000).
Tu1712
Tu1713
TIME TREND IN THE PREVALENCE OF HELICOBACTER PYLORI INFECTION IN KOREA OVER 18 YEARS AND THE ASSOCIATION WITH METABOLIC SYNDROME Seon Hee Lim, Nayoung Kim, Joo Sung Kim, Jeong Yoon Yim, Changhyun Lee
OUTCOME OF FECAL MICROBIOTA TRANSPLANTATION FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION ON QUALITY OF LIFE Christine Lee, Peter T. Kim, Emma Smith Background: Fecal microbiota transplantation (FMT) has established itself as a promising treatment for recurrent Clostridium difficile infection (CDI). Despite the clinical efficacy, there is limited information regarding the impact of FMT on health-related quality of life. Using the RAND 36-Item Short Form Health Survey (RAND-36), patients who received FMT for CDI were monitored longitudinally for the following eight health scales: Physical Functioning; Role Limitations (Physical); Role Limitations (Emotional); Energy or Fatigue; Emotional Well-being; Social Functioning; Pain; and, General Health. Methods: A randomized double-blind clinical trial was completed at Canadian academic medical centers from July 2012 to September 2014 with the primary objective of comparing the efficacy of fresh versus frozen fecal microbiota transplantation. The RAND-36 instrument was administered to patients within the modified intention-to-treat population (n = 219), all of whom had recurrent and/or refractory CDI. The surveys were collected at four time points starting at baseline (pre-FMT), at Day 10, Week 5 and Week 10-12 post-FMT. Owing to the longitudinal nature of the data, we were severely challenged with missing observations, some with greater than 50% for the latter surveys. We therefore used multivariate imputation by chained equations with predictive mean matching to generate complete data sets. Following a strict protocol for various imputation diagnostics, we computed the eight health scales for each data set according to the RAND guidelines. Results: Significant improvement of health status from baseline was observed over time in all eight health parameters. In seven of the eight health scales, significant improvement was achieved as early as Day 10 post-treatment. The effect of FMT on Pain improvement appeared later at up to Week 5 (Figure 1). We believe this is likely attributable to the opportunistic nature of recurrent CDI which predominantly affects the elderly populations and those with co-morbidities, and may require a longer transition time for improvement of pain. These results were consistent for all scenarios included within the sensitivity analysis and with the current evidence that a large majority of patients experience resolution of Clostridium difficile-related diarrhea within days following successful FMT. Conclusion: Fecal microbiota transplantation can positively influence the multidimensional health profile of patients with recurrent and/or refractory CDI within 10 days following successful FMT. Table 1: Summary table of mean dimension scores, from 0 to 100, and their standard errors over time.
Backgrounds and Aims: The aim of this study was to evaluate the time trend of seropositivity of Helicobacter pylori (H. pylori) over the period of 18 years in an asymptomatic Korean population, and investigate the association with metabolic profile including presence of metabolic syndrome. Methods: This cross-sectional study surveyed anti-HP IgG antibodies with anthropometric and metabolic data in 17,152 health check-up subjects (aged 17-97) in 2016. Seropositivity in asymptomatic subjects without H. pylori eradication was compared between the years 1998, 2005, 2011, and 2016. Results: After exclusion of subjects with a history of HP eradication therapy and gastric symptoms, the seroprevalence of HP was 44.9% in 14,830 subjects. This was significantly lower than the seroprevalence of 54.4% in 2011, 59.6% in 2005 and that of 66.9% in 1998, and this decrease of seropositivity of H. pylori became widespread across all ages and in both sexes. Clinical risk factors of HP infection were lower HDL-cholesterol level [ <40 mg/dl in men, <50mg/dl in women] (OR = 1.40; 95% CI = 1.19-1.63), male gender (OR 1.36 95% CI 1.14-1.62), presence of metabolic syndrome (OR1.22, 95% CI 1.02-1.46), older age (OR 1.03, 95% CI 1.02-1.04), and low education on multivariate logistic analysis. Conclusion: A downward trend of H. pylori seroprevalence has been observed continuously, over 18 years in Korea. In addition, the relationship between H. pylori infection and low HDL-cholesterol and presence of metabolic syndrome needs more investigation regarding underlying pathogenesis. Table 1. Time trend of the seropositivity of H. pylori Ig G in Korea
yr, years old Table 2. Risk factors of Seropositivity of H. pylori Ig G
Figure 1. Pooled mean dimension scores and their associated standard error over time. Followup times marked with a star differ significantly from baseline at the 1% level of significance.
Tu1714 PROCEDURAL-RELATED AND PATIENT-RELATED FACTORS INFLUENCE CLOSTRIDIUM DIFFICILE RECURRENCE AFTER FECAL MICROBIOTA TRANSPLANT Aaron H. Mendelson, Samara Rifkin, Jessica Shay, Mohammed A. Razvi, Linda A. Lee Background: Fecal microbiota transplant (FMT) is effective therapy for Clostridum difficile infections (CDI) that have failed antibiotic therapy. Less is known about factors that influence the success or failure of FMT. Objective: To identify factors associated with success or failure of FMT therapy for CDI. Methods: Retrospective study of patients with antibioticrefractory CDI treated with FMT at a single center from 1/2013-8/2016. Early FMT failure was defined as recurrent or ongoing diarrhea along with a positive nucleic acid PCR for C. difficile toxin B gene ≤90 days after FMT. Late CDI recurrence was defined as persistence
S-949
AGA Abstracts
AGA Abstracts
and 2013. Improvement of survival was observed for localized cancer (49.5% in 2006 ~ 2008 and 58.8% in 2009 ~ 2013) and regional stages (25.3% and 29.2%, respectively). Conclusion: Over the past 15 years, the incidence of esophageal cancer has decreased in Korea and the survival has increased by early detection with advancement of therapeutic outcome.
Tu1707
eosinophilic esophagitis (EoE), achalasia and esophageal cancer were also identified using the ICD-9 and DRG24. The association between IBD and esophageal disorders was calculated using multivariate logistic regression. RESULTS: The study population included a total of 6,145,845 inpatients from NIS; 71,027 in the IBD group and 6,074,818 in the control group. Mean age was 57 ± 20.6 years (range 18-90 years) with 59.4 % females. IBD patients had higher prevalence of Barrett's esophagus [OR: 1.44 (95% CI: 1.29 - 1.61, P< 0.001)]. After controlling for GERD, age and gender, IBD was also associated with higher EoE [OR: 2.53 (95% CI: 1.6 - 4, P<0.001)]. Prevalence of achalasia was similar between the IBD and the control groups [OR: 1.01 (95% CI: 0.72-1.44, P: 0.25)]. CONCLUSIONS: Inflammatory bowel disease is associated with higher prevalence of esophageal disorders such as Barrett's esophagus and eosinophilic esophagitis IBD & Esophageal Disorders
AUTOIMMUNE GASTRITIS IN JAPAN: A STUDY OF 200 PATIENTS AT MULTICENTER STUDY Shuichi Terao, Takahisa Furuta, Tomoari Kamada, Yasuhiko Maruyama, Jyoji Syunto, Rika Aoki, Masanori Ito, Noriaki Manabe, Yuichi Sato, Kazuhiko Oho, Kazuhiko Inoue, Akiko Shiotani, Ken Haruma OBJECTIVES: Autoimmune gastritis (AIG) is thought an uncommon disease in Japan, because pernicious anemia (PA) and gastric type I NET associated with AIG are less common in Japan compared to the western countries. However, the prevalence of atrophic gastritis induced by H. pylori infection is common in Japan. The aims of this study is to clarify the incidence of AIG and to study the clinical characteristics of Japanese AIG patients. PATIENTS AND METHODS: A total of 200 Japanese patients with AIG, from January 2010 to October 2016, were reviewed in 10 institutes in Japan. 43 of 200 patients were prospectively diagnosed as having AIG at healthcare check endoscopy among consecutive 8716 subjects, from April 1 2015 to July 31 2016. Definition of AIG as follows; 1: corpus predominantly severe atrophic gastritis, 2: presence of anti-parietal cell antibody, 3: hypergastrinemia (>350 pg/ ml). RESULTS: From the result of healthcare endoscopy for the asymptomatic 8716 subjects, 43 AIG patients (mean age 64.2yrs, 35 females) were diagnosed and the estimated incidence of AIG in Japan was 0.49% (0.14% in male and 0.9% in female). Other 157 patients were collected from the endoscopic examination in clinical practice and the total of 200 AIG patients were analyzed in this study. Of the 200 AIG patients, the mean age was 65.9±10.9yrs (range 36-89yrs, 135 females). PA was present in only 27 patients (13.5%) and 45 patients had autoimmune disease (28 Hashimoto' disease, 4 NASH, 3 primary biliary cirrhosis, 5 rheumatoid arthritis, 1 autoimmune hepatitis, 4 others). Gastric NET was diagnosed in 24 patients (12%) and adenocarcinoma in 8 (4%). H. pylori infection was positive in 7.8% (13/ 167). The mean serum gastrin level was 2625 pg/ml (range 358-8485) and endocrine micronests of corpus mucosa were detected in 72 (72/123, 58.5%). CONCLUSIONS: AIG is more frequent than expected in Japan and significantly a female predominant, rarely accompanied with (PA). The prevalence of gastric NET was 12% and that of gastric cancer was 4% among 200 AIG patients. This is the first report describing the actual incidence and the characteristics of AIG in Japan.
Tu1710 INCREASING FREQUENCY OF HOSPITALIZATIONS AMONG YOUNG PATIENTS FOR COMPLICATED DIVERTICULITIS: NATIONAL TRENDS AND IN-HOSPITAL OUTCOMES Douglas L. Nguyen, Matthew L. Bechtold, M. Mazen Jamal
Tu1708 THE NUMBER AND LOCATION OF LESIONS DETERMINE THE CLINICAL FEATURES OF SMALL BOWEL BLEEDING DUE TO VASCULAR ECTASIA Juan S. Lasa, Angel D. Peralta, Guillermo Dima, Ignacio Fanjul, Pablo A. Olivera, Gustavo Cernadas, Luis O. Soifer, Rafael Moore
Introduction: There are increasing reports that young patients have a more complicated presentation of diverticulitis compared to older patients. However, limited information are available for trends of hospitalizations across age groups for complicated diverticulitis and need for surgery. The aim of this study is to better define the frequency of complicated diverticulitis across all age groups and their in-hospital outcomes. Methods: We analyzed the National Inpatient Sample (NIS) 1988 to 2011 to determine the frequency of complicated diverticulitis requiring hospitalization using ICD-9 codes and define in-hospital outcomes and length of hospitalization. Results: From 1988 to 2011 using NIS sample, a total of 1,171,181 patients were admitted to a U.S. hospital for complicated diverticulitis. The ageadjusted frequency of hospitalizations has increased nearly 2-fold from 37.24 per 100,000 to 68.34 per 100,000 patients in 2011 (p<0.001). Of all the hospitalizations, there were approximately 2-fold increase in frequency of hospitalizations among patients ages 18-30 (0.92% in 1988 to 1.92% in 2011) and ages 31-59 (20.15% in 1988 to 40.6% in 2011). However, there was nearly a 1.5-fold decline in frequency of hospitalizations for ages over 60 years old (78.93% in 1988 to 57.47% in 2011). Overall, the mean age-adjusted mortality rate has declined significantly from 87.35 per 100,000 to 36.68 per 100,000 patients. Compared to patients >60 years old, younger patients had a significantly higher rate for intestinal perforation, abscess, stricture, intestinal fistula, and need for surgery (p <0.001). However, patients >60 years old had a significantly higher rate of diverticular bleeding compared to younger patients (p< 0.001). The overall length of hospitalization has decreased from 10.2 days in 1988 to 6.1 days in 2011. Conclusion: There were a 2-fold increase of rates of hospitalization among patients less than 60 years old. Younger patients has a higher rate of intestinal perforation, abscess, stricture, development of intestinal fistula, and need for surgery at time of hospitalization, compared to older patients. Older patients who presents with diverticulitis has a higher rates of diverticular management. Given improvement in medical care and early management of complications related to diverticulitis, the length of hospitalization and mortality rates have decreased significantly in the last two decades.
BACKGROUND: Small bowel bleeding is one of the most common causes of obscure gastrointestinal bleeding. This type of bleeding can be overt or occult, which usually manifests as iron-deficiency anemia. Vascular ectasia are a frequent cause of small bowel bleeding. The endoscopic variables which determine the type of clinical presentation are not well known. AIM: To determine features that may be associated with the type of obscure gastrointestinal bleeding due to vascular ectasia and with its magnitude. MATERIALS AND METHODS: Capsule endoscopy database of our Department was reviewed to identify those patients with a diagnosis of obscure gastrointestinal bleeding. Among those subjects, patients with at least one small bowel vascular ectasia were included for analysis. The following variables were retrieved: gender, age, clinical presentation (overt or occult), proximal and/or distal location of vascular ectasia. A proximal location lesion was defined as any lesion located within the first two thirds of the small bowel transit time. Also, the difference between basal hemoglobin and the hemoglobin value when capsule endoscopy was performed (∆Hb) was estimated as a surrogate of the magnitude of the bleeding. A univariate analysis was performed to estimate the variables associated with the type of clinical presentation; a multivariate analysis followi ∆Hb) using a logistic regression model was furtherly performed. We also identified variables significantly associated with a more severe bleeding, according to the ∆Hb value. RESULTS: Overall, 98 studies performed between Januray 2014 and July 2016 were reviewed; 81.65% were done on patients with obscure gastrointestinal bleeding: 53 of them had a diagnosis of small bowel vascular ectasia. Among these, 41.5% had overt gastrointestinal bleeding, 58.49% were male and median age was 65 years (23-90); 45.28% had more than one ectasia and the most common location was proximal (52.83%).Univariate analysis showed that age less than 60 [OR 4.72 (1.02-18.6)] and proximal location of vascular ectasia [OR 6.18 (1.56-24.4)] were significantly associated with overt bleeding presentation. On multivariate analysis, only proximal location was significantly associated with overt bleeding presentation [OR 4.35 (1.20-16.4)]. Additionally, proximal location (p 0.01) as well as more than one vascular ectasia (p 0.03) were significantly associated with a larger ∆Hb. CONCLUSION: Proximal location of small bowel vascular ectasia was associated with a clinically evident presentation of occult gastrointestinal bleeding, and with a more severe bleeding - along with the presence of more than one lesion.
Tu1711 TRENDS IN INCIDENCE AND SURVIVAL OF ESOPHAGEAL CANCER IN KOREA: A POPULATION-BASED EPIDEMIOLOGIC STUDY Aesun Shin, Hye-Kyung Jung, Young-Joo Won, Hyun-Joo Kong, Kyu-Won Jung, ChangMo Oh, Sun Young Yi, Chung Hyun Tae
Tu1709
Background/Aim: The diagnostic and therapeutic modalities of esophageal cancer have been recently improved in Asia, and its prognosis is expected to change. We aimed to provide a first-time population-based report on the epidemiology of esophageal cancer with trends in Korea. Methods: Cancer incidence data from 1999-2013 were obtained from the Korea Central Cancer Registry (KCCR), which covered the entire population under the PopulationBased Cancer Registry Program. Age-standardized incidence rates per million, and annual percent changes (APCs) were calculated according to subsites and histologic types. Fiveyear relative survival rates were estimated for cases diagnosed between 1993 and 2013 and followed up to 2014. Results: The Age-standardized incidence rates decreased from 8.2 per 100,000 populations in 1999 to 7.1 in 2013 with annual percent change (APC) of -2.6% in men. Similar decrease (APC of -2.2%) was observed for women. The proportion of squamous cell carcinoma was 83.9% and adenocarcinoma 3.5% and the incidence of both cancers decreased. The detection rate of localized and regional cancer showed a tendency to increase more than the detection of distant cancer. Five-year relative survival of squamous cell carcinoma was improved from 12.1% between 1993 and 1995 to 34.6% between 2009
THE ASSOCIATION BETWEEN INFLAMMATORY BOWEL DISEASE AND ESOPHAGEAL DISORDERS Mohammad Maysara Asfari, Tarek Sawas, Madhusudhan R. Sanaka BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving all or parts of the digestive system. IBD is known to be associated with other gastrointestinal disorders such as colon cancer, primary sclerosing cholangitis and ampullary cancer. The association between IBD and other esophageal disorders is not well known. Hence the aim of our study was to study the association between IBD and esophageal disorders from a large national database. METHODS: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) database during the year 2012. We identified adult patients age 18-90 years who were admitted to the hospital with Crohn's disease or ulcerative colitis using the International Classification of Diseases ICD-9 codes and Diagnosis Related Group, Version 24 (DRG24). The control group was adult individuals whose hospital discharge records did not contain IBD. Esophageal disorders including Barrett's esophagus,
AGA Abstracts
S-948
*Education level was classified as low (middle school graduates or less), middle (high school graduates or university dropouts), or high (university graduates or graduates of a postgraduate course). **Household income was classified as low (less than US $ 3,000), medium (US $ 3,000 to 10,000), or high (more than US $ 10,000).
Tu1712
Tu1713
TIME TREND IN THE PREVALENCE OF HELICOBACTER PYLORI INFECTION IN KOREA OVER 18 YEARS AND THE ASSOCIATION WITH METABOLIC SYNDROME Seon Hee Lim, Nayoung Kim, Joo Sung Kim, Jeong Yoon Yim, Changhyun Lee
OUTCOME OF FECAL MICROBIOTA TRANSPLANTATION FOR RECURRENT CLOSTRIDIUM DIFFICILE INFECTION ON QUALITY OF LIFE Christine Lee, Peter T. Kim, Emma Smith Background: Fecal microbiota transplantation (FMT) has established itself as a promising treatment for recurrent Clostridium difficile infection (CDI). Despite the clinical efficacy, there is limited information regarding the impact of FMT on health-related quality of life. Using the RAND 36-Item Short Form Health Survey (RAND-36), patients who received FMT for CDI were monitored longitudinally for the following eight health scales: Physical Functioning; Role Limitations (Physical); Role Limitations (Emotional); Energy or Fatigue; Emotional Well-being; Social Functioning; Pain; and, General Health. Methods: A randomized double-blind clinical trial was completed at Canadian academic medical centers from July 2012 to September 2014 with the primary objective of comparing the efficacy of fresh versus frozen fecal microbiota transplantation. The RAND-36 instrument was administered to patients within the modified intention-to-treat population (n = 219), all of whom had recurrent and/or refractory CDI. The surveys were collected at four time points starting at baseline (pre-FMT), at Day 10, Week 5 and Week 10-12 post-FMT. Owing to the longitudinal nature of the data, we were severely challenged with missing observations, some with greater than 50% for the latter surveys. We therefore used multivariate imputation by chained equations with predictive mean matching to generate complete data sets. Following a strict protocol for various imputation diagnostics, we computed the eight health scales for each data set according to the RAND guidelines. Results: Significant improvement of health status from baseline was observed over time in all eight health parameters. In seven of the eight health scales, significant improvement was achieved as early as Day 10 post-treatment. The effect of FMT on Pain improvement appeared later at up to Week 5 (Figure 1). We believe this is likely attributable to the opportunistic nature of recurrent CDI which predominantly affects the elderly populations and those with co-morbidities, and may require a longer transition time for improvement of pain. These results were consistent for all scenarios included within the sensitivity analysis and with the current evidence that a large majority of patients experience resolution of Clostridium difficile-related diarrhea within days following successful FMT. Conclusion: Fecal microbiota transplantation can positively influence the multidimensional health profile of patients with recurrent and/or refractory CDI within 10 days following successful FMT. Table 1: Summary table of mean dimension scores, from 0 to 100, and their standard errors over time.
Backgrounds and Aims: The aim of this study was to evaluate the time trend of seropositivity of Helicobacter pylori (H. pylori) over the period of 18 years in an asymptomatic Korean population, and investigate the association with metabolic profile including presence of metabolic syndrome. Methods: This cross-sectional study surveyed anti-HP IgG antibodies with anthropometric and metabolic data in 17,152 health check-up subjects (aged 17-97) in 2016. Seropositivity in asymptomatic subjects without H. pylori eradication was compared between the years 1998, 2005, 2011, and 2016. Results: After exclusion of subjects with a history of HP eradication therapy and gastric symptoms, the seroprevalence of HP was 44.9% in 14,830 subjects. This was significantly lower than the seroprevalence of 54.4% in 2011, 59.6% in 2005 and that of 66.9% in 1998, and this decrease of seropositivity of H. pylori became widespread across all ages and in both sexes. Clinical risk factors of HP infection were lower HDL-cholesterol level [ <40 mg/dl in men, <50mg/dl in women] (OR = 1.40; 95% CI = 1.19-1.63), male gender (OR 1.36 95% CI 1.14-1.62), presence of metabolic syndrome (OR1.22, 95% CI 1.02-1.46), older age (OR 1.03, 95% CI 1.02-1.04), and low education on multivariate logistic analysis. Conclusion: A downward trend of H. pylori seroprevalence has been observed continuously, over 18 years in Korea. In addition, the relationship between H. pylori infection and low HDL-cholesterol and presence of metabolic syndrome needs more investigation regarding underlying pathogenesis. Table 1. Time trend of the seropositivity of H. pylori Ig G in Korea
yr, years old Table 2. Risk factors of Seropositivity of H. pylori Ig G
Figure 1. Pooled mean dimension scores and their associated standard error over time. Followup times marked with a star differ significantly from baseline at the 1% level of significance.
Tu1714 PROCEDURAL-RELATED AND PATIENT-RELATED FACTORS INFLUENCE CLOSTRIDIUM DIFFICILE RECURRENCE AFTER FECAL MICROBIOTA TRANSPLANT Aaron H. Mendelson, Samara Rifkin, Jessica Shay, Mohammed A. Razvi, Linda A. Lee Background: Fecal microbiota transplant (FMT) is effective therapy for Clostridum difficile infections (CDI) that have failed antibiotic therapy. Less is known about factors that influence the success or failure of FMT. Objective: To identify factors associated with success or failure of FMT therapy for CDI. Methods: Retrospective study of patients with antibioticrefractory CDI treated with FMT at a single center from 1/2013-8/2016. Early FMT failure was defined as recurrent or ongoing diarrhea along with a positive nucleic acid PCR for C. difficile toxin B gene ≤90 days after FMT. Late CDI recurrence was defined as persistence
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AGA Abstracts
AGA Abstracts
and 2013. Improvement of survival was observed for localized cancer (49.5% in 2006 ~ 2008 and 58.8% in 2009 ~ 2013) and regional stages (25.3% and 29.2%, respectively). Conclusion: Over the past 15 years, the incidence of esophageal cancer has decreased in Korea and the survival has increased by early detection with advancement of therapeutic outcome.