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Tu1087 Gastric Acid Suppression and Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis
AGA Abstracts
assessing the risk of CRC in patients with chronic liver diseases. The primary outcome was the risk of CRC. Only studies that reported standardized incidence ratio (SIR) were included for analysis. Results: Fifteen studies, including 36,628 patients that reported the incidence of CRC in liver diseases were identified. Among the 4 studies that included hepatitis and cirrhotic patients due to alcoholic liver disease, viral hepatitis, primary biliary cirrhosis, or autoimmune hepatitis, the pooled SIR was 2.06 (95% confidence interval (CI) = 1.46-2.90). Moderate heterogeneity was seen ( I2 = 49.18), and meta-regression showed that older age was associated with a higher risk of CRC. Two studies reported an increased risk of CRC in primary sclerosing cholangitis (SIR 7.09, 95% CI = 2.27-22.15). Among the 9 studies that included post-transplant patients, the pooled SIR was 2.02 (95% CI = 1.37-2.97). Moderate heterogeneity was seen ( I2 = 57.83), and meta-regression showed a correlation between the proportion of autoimmune related liver diseases and the risk of CRC. Conclusion: In the present systematic review and meta-analysis, patients with chronic liver diseases, regardless of the cause or history of transplant, had an increased risk of CRC, which warrants more intensive surveillance in this population.
Tu1088 An Epidemiological Study on Incidence of Hospitalization and In-hospital Mortality of Peptic Ulcer Bleeding, Gastrointestinal Neoplasms, and NonInfectious Enterocolitis: A Population-based Study from 2005 to 2014 Amelia C. Chao, Jacky S. Chan, Vincent C. Cheung, Sophia S. Wong, Whitney Tang, Justin C. Wu, Francis K. Chan, Henry L. Chan, Joseph Sung, Siew C. Ng Background & Aims: Gastrointestinal (GI) diseases account for approximately 8 million deaths per year worldwide and it is the third commonest disease for hospitalization in Hong Kong. This study aimed to investigate change in hospital burden and in-hospital mortality of GI diseases over one decade. Methods: A population-based, observational study of over 100,000 discharges each year with a principal diagnosis of GI diseases defined by the ICD9-CM coding, from 2005 to 2014. Data were extracted from database managed by the Hong Kong Hospital Authority managing 42 public hospitals serving a population of over seven million. Trends for age-standardized incidence of hospitalization and inpatient mortality were measured and analyzed by Poisson regression. Results: From 2005 to 2014, the incidence of hospitalization per 100,000 population for all GI diseases increased from 5,041 to 5,698 (Rate ratio, RR: 1.005; 95% CI: 1.005 to 1.006; p = 5.27 x 10-40). Among all GI diseases, GI neoplasms and non-infectious enterocolitis showed the most significant rise in incidence of hospitalization per 100,000, from 1,383 to 1,620 (RR: 1.014; 95% CI: 1.013 to 1.016; p = 1.20 x 10-78) and 426 to 643 (RR: 1.058; 95% CI: 1.055 to 1.061; p = 0.00), respectively. Peptic ulcer disease showed the most significant reduction from 399 to 234 per 100,000 (RR: 0.945; 95% CI: 0.941 to 0.948; p = 2.05 x 10-224); this reduction was most marked for peptic ulcer disease-related haemorrhage (RR: 0.894; 95% CI: 0.889 to 0.899; p = 3.47 x 10-297). In-hospital mortality rate for all GI diseases reduced from 6.56% to 4.36% over 10 years (RR: 0.956; 95% CI: 0.953 to 0.959; p = 5.94 x 10-171). GI neoplasms and non-infectious enterocolitis showed a marked reduction in in-hospital mortality from 13.5% to 8.1% (RR: 0.943; 95% CI: 0.940 to 0.947; p = 1.45 x 10-215) and 2.5% to 1.8% (RR: 0.962; 95% CI: 0.942 to 0.982; p = 2.40 x 10-04), respectively. The in-hospital mortality for both peptic ulcer disease, and peptic ulcer disease-related haemorrhage remained unchanged over the past 10 years (p = 0.02 and p = 1.84 x 10-02, respectively). Conclusion: There is an increasing hospitalization burden for GI diseases, especially GI neoplasms and non-infectious enterocolitis over the past decade. Significant reductions in in-hospital mortality for GI diseases were observed over the past 10 years, especially for GI neoplasms and non-infectious enterocolitis. These data provide new insight into emerging GI diseases and implications for hospital burden and need of resource re-allocation.
Tu1086 Split-Dose Versus Same-Day Bowel Preparations for Colonoscopy: A MetaAnalysis Charles Ménard, Alan N. Barkun, Myriam Martel, Sophie Restellini, Omar Kherad Background: A variety of bowel preparation types and administration schedules are available. Contemporary regimens include polyethylene glycol (PEG), sodium phosphate (NaP), picosulfate (PICO) and oral sulfate solution (OSS). Aims: To compare efficacy, willingness to repeat the preparation, polyps and adenoma detection rates and side effects of split-dose versus same-day preparations amongst all contemporary regimens and subgroups comparing PEG high-dose (‡ 3L) and PEG low-dose (<3L). Methods: Systematic searches were completed querying MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge from January 1980 to September 2015. All fully published randomized controlled trials with colon preparation for colonoscopy were included. Populations including pediatric, sole inpatients or sole IBD patients were excluded. The primary outcome measure was the efficacy of colon cleansing (excellent or good). Secondary outcomes included willingness to repeat, polyp and adenoma detection rate and side effects. A meta-analysis was conducted with results reported as odd-ratios (OR) with 95% confidence intervals. Heterogeneity and publication bias were assessed and quantified. Results: From an initial 2580 citation, 11 trials fulfilled the inclusion criteria (n=1820 ITT). Same-day administration does not provide a significant benefit in bowel cleansing efficacy in comparison to split-dose regimens, regardless of preparation type, volume or use of adjuvants (OR=1,19 (0.81; 1.75)). When performing sensitivity analysis, the exclusion of Cesaro et al. revealed a significant benefit in the efficacy of split-dose administration (OR=1.47 (1.13; 1.91)). Willingness to repeat does not differ between the 2 groups (RC=0.87 (0.38; 2.01)). Split-dose administration causes significantly more cramp, abdominal pain or bloating (OR=1.50 (1.10; 2.05)). Polyp or adenoma detection rates are not different between the 2 administration regimens. 5 studies were included (n= 982 ITT) in subgroup analysis of PEG split high-dose versus PEG same-day low-dose. There is no significant difference between the 2 regimens (OR=1.07 (0.64; 1.78)). Only one study (125 patients) permitted the comparison of PEG split low-dose versus PEG same-day lowdose and showed no difference in efficacy (OR=0.91 (0.34; 2.47)). Conclusion: There is no significant difference in efficacy between same-day and split-dose administration of bowel preparations. However, there is great variability in type and administration schedule of adjuvants in available same-day preparations arms, which may have an effect on the generalizability of the present results. Further studies should focus on a more rigorous comparison of the different administration schedules.
Tu1087 Gastric Acid Suppression and Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis Raseen Tariq, Siddharth Singh, Darrell Pardi, Sahil Khanna Background: Gastric acid suppression has been associated with an increased risk of primary Clostridium difficile infection (CDI), whereas studies evaluating the risk of recurrent CDI in patients on acid suppression medications show conflicting results. We performed a systematic review and meta-analysis to study the association between gastric acid suppression medications and the risk of recurrent CDI. Methods: A systematic search of Medline, Embase, and Web of Science was performed up to September 2015. Studies assessing the association between gastric acid suppression exposure and recurrent CDI were included. Summary Odds ratio estimates with 95% confidence intervals (CIs) were calculated with the randomeffects model using Review Manager version 5.3 (Cochran Inc). Results: Sixteen studies (15 observational and 1 post-hoc analysis of a randomized controlled trial) with 1,550 (19.5%) recurrent CDI cases in 7,947 patients with CDI were included. The rate of recurrent CDI in patients on acid suppression was 20.8%, compared to 18% in patients without acid suppression. Meta-analysis did not show an increased risk of recurrent CDI in patients on acid suppression medications (OR 1.27, 95% Cl 0.97-1.67, p= 0.08). There was significant heterogeneity among the studies with an I2 of 72%. Sensitivity analyses based on definition of recurrent CDI revealed no difference in the risk of recurrent CDI in studies defining recurrence within 90 days from initial episode (OR 1.45, 95% Cl 1.03 - 2.05, p= 0.04) compared to studies defining recurrent CDI as that occurring in less than 60 days, which is the accepted definition for recurrent CDI, (OR 1.06, 95% Cl 0.62 - 1.82, p= 0.83), as the confidence intervals of the two groups overlap. Subgroup analyses based on study type showed no difference in the risk of recurrent CDI in both case control and cohort studies (OR 1.34, 95% Cl 0.81- 2.24, p= 0.26 for case-control studies and OR 1.28, 95% CI 0.93 -1.77, p= 0.13) for cohort studies. Conclusion: Meta-analyses of existing studies suggest that concomitant use of gastric acid suppression medications is not associated with an increased risk of recurrent CDI. Sensitivity analyses based on definition of recurrent CDI (within 60 days versus 90 days) revealed a numerically significant result for 90 days but not statistically different from standard recurrence of definition 60 days.
AGA Abstracts
Tu1089 Admissions for Acute Pancreatitis But Not Inflammatory Bowel Disease Follow a Seasonal Pattern and Are More Common in Summer Maneesh Dave, Rajika Tandon, Kathan Mehta Introduction: Acute pancreatitis (AP) and inflammatory bowel diseases (IBD) are common reasons for gastrointestinal hospitalizations. Some studies have suggested a seasonal variation in hospitalizations for these diseases; however, other studies have found no such association. Aims & Methods: Our aim was to determine the seasonal variation in admission rates and outcomes for hospitalizations for AP and IBD and identify any associated factors. We performed an ecological study with time series analysis using data from the United States (US) Nationwide in-patient sample (NIS) for the years 1998 to 2010. Patients hospitalized with primary discharge diagnoses of AP and IBD in US using ICD9 CM codes were identified. We examined temporal trends in monthly admission rates and mortality for AP and IBD over a 13 year period using spectral analysis. We explored for potential reasons for seasonality in admission rates by compiling climate data (mean monthly temperature[MMT], total snowfall, and total precipitation) from National Climatic Data Center of each US zip code and monthly alcohol sales data from Alcohol and Tobacco Tax and Trade Bureau. The association between weather indices and monthly admissions was assessed by Poisson regression and Pearson's correlation. Results: There were 643,441 (weighted N = 3,158,128) hospitalizations for AP (males =50.8%) and 228,982 (weighted N = 1,130,248) for IBD (males=43.9%) from 1998 to 2010. The admission rate for AP showed marked seasonality every year with progressively decreasing hospitalizations during winter with lowest rates in January (571 admissions/day) and progressively increasing hospitalizations during summer
S-838
assessing the risk of CRC in patients with chronic liver diseases. The primary outcome was the risk of CRC. Only studies that reported standardized incidence ratio (SIR) were included for analysis. Results: Fifteen studies, including 36,628 patients that reported the incidence of CRC in liver diseases were identified. Among the 4 studies that included hepatitis and cirrhotic patients due to alcoholic liver disease, viral hepatitis, primary biliary cirrhosis, or autoimmune hepatitis, the pooled SIR was 2.06 (95% confidence interval (CI) = 1.46-2.90). Moderate heterogeneity was seen ( I2 = 49.18), and meta-regression showed that older age was associated with a higher risk of CRC. Two studies reported an increased risk of CRC in primary sclerosing cholangitis (SIR 7.09, 95% CI = 2.27-22.15). Among the 9 studies that included post-transplant patients, the pooled SIR was 2.02 (95% CI = 1.37-2.97). Moderate heterogeneity was seen ( I2 = 57.83), and meta-regression showed a correlation between the proportion of autoimmune related liver diseases and the risk of CRC. Conclusion: In the present systematic review and meta-analysis, patients with chronic liver diseases, regardless of the cause or history of transplant, had an increased risk of CRC, which warrants more intensive surveillance in this population.
Tu1088 An Epidemiological Study on Incidence of Hospitalization and In-hospital Mortality of Peptic Ulcer Bleeding, Gastrointestinal Neoplasms, and NonInfectious Enterocolitis: A Population-based Study from 2005 to 2014 Amelia C. Chao, Jacky S. Chan, Vincent C. Cheung, Sophia S. Wong, Whitney Tang, Justin C. Wu, Francis K. Chan, Henry L. Chan, Joseph Sung, Siew C. Ng Background & Aims: Gastrointestinal (GI) diseases account for approximately 8 million deaths per year worldwide and it is the third commonest disease for hospitalization in Hong Kong. This study aimed to investigate change in hospital burden and in-hospital mortality of GI diseases over one decade. Methods: A population-based, observational study of over 100,000 discharges each year with a principal diagnosis of GI diseases defined by the ICD9-CM coding, from 2005 to 2014. Data were extracted from database managed by the Hong Kong Hospital Authority managing 42 public hospitals serving a population of over seven million. Trends for age-standardized incidence of hospitalization and inpatient mortality were measured and analyzed by Poisson regression. Results: From 2005 to 2014, the incidence of hospitalization per 100,000 population for all GI diseases increased from 5,041 to 5,698 (Rate ratio, RR: 1.005; 95% CI: 1.005 to 1.006; p = 5.27 x 10-40). Among all GI diseases, GI neoplasms and non-infectious enterocolitis showed the most significant rise in incidence of hospitalization per 100,000, from 1,383 to 1,620 (RR: 1.014; 95% CI: 1.013 to 1.016; p = 1.20 x 10-78) and 426 to 643 (RR: 1.058; 95% CI: 1.055 to 1.061; p = 0.00), respectively. Peptic ulcer disease showed the most significant reduction from 399 to 234 per 100,000 (RR: 0.945; 95% CI: 0.941 to 0.948; p = 2.05 x 10-224); this reduction was most marked for peptic ulcer disease-related haemorrhage (RR: 0.894; 95% CI: 0.889 to 0.899; p = 3.47 x 10-297). In-hospital mortality rate for all GI diseases reduced from 6.56% to 4.36% over 10 years (RR: 0.956; 95% CI: 0.953 to 0.959; p = 5.94 x 10-171). GI neoplasms and non-infectious enterocolitis showed a marked reduction in in-hospital mortality from 13.5% to 8.1% (RR: 0.943; 95% CI: 0.940 to 0.947; p = 1.45 x 10-215) and 2.5% to 1.8% (RR: 0.962; 95% CI: 0.942 to 0.982; p = 2.40 x 10-04), respectively. The in-hospital mortality for both peptic ulcer disease, and peptic ulcer disease-related haemorrhage remained unchanged over the past 10 years (p = 0.02 and p = 1.84 x 10-02, respectively). Conclusion: There is an increasing hospitalization burden for GI diseases, especially GI neoplasms and non-infectious enterocolitis over the past decade. Significant reductions in in-hospital mortality for GI diseases were observed over the past 10 years, especially for GI neoplasms and non-infectious enterocolitis. These data provide new insight into emerging GI diseases and implications for hospital burden and need of resource re-allocation.
Tu1086 Split-Dose Versus Same-Day Bowel Preparations for Colonoscopy: A MetaAnalysis Charles Ménard, Alan N. Barkun, Myriam Martel, Sophie Restellini, Omar Kherad Background: A variety of bowel preparation types and administration schedules are available. Contemporary regimens include polyethylene glycol (PEG), sodium phosphate (NaP), picosulfate (PICO) and oral sulfate solution (OSS). Aims: To compare efficacy, willingness to repeat the preparation, polyps and adenoma detection rates and side effects of split-dose versus same-day preparations amongst all contemporary regimens and subgroups comparing PEG high-dose (‡ 3L) and PEG low-dose (<3L). Methods: Systematic searches were completed querying MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge from January 1980 to September 2015. All fully published randomized controlled trials with colon preparation for colonoscopy were included. Populations including pediatric, sole inpatients or sole IBD patients were excluded. The primary outcome measure was the efficacy of colon cleansing (excellent or good). Secondary outcomes included willingness to repeat, polyp and adenoma detection rate and side effects. A meta-analysis was conducted with results reported as odd-ratios (OR) with 95% confidence intervals. Heterogeneity and publication bias were assessed and quantified. Results: From an initial 2580 citation, 11 trials fulfilled the inclusion criteria (n=1820 ITT). Same-day administration does not provide a significant benefit in bowel cleansing efficacy in comparison to split-dose regimens, regardless of preparation type, volume or use of adjuvants (OR=1,19 (0.81; 1.75)). When performing sensitivity analysis, the exclusion of Cesaro et al. revealed a significant benefit in the efficacy of split-dose administration (OR=1.47 (1.13; 1.91)). Willingness to repeat does not differ between the 2 groups (RC=0.87 (0.38; 2.01)). Split-dose administration causes significantly more cramp, abdominal pain or bloating (OR=1.50 (1.10; 2.05)). Polyp or adenoma detection rates are not different between the 2 administration regimens. 5 studies were included (n= 982 ITT) in subgroup analysis of PEG split high-dose versus PEG same-day low-dose. There is no significant difference between the 2 regimens (OR=1.07 (0.64; 1.78)). Only one study (125 patients) permitted the comparison of PEG split low-dose versus PEG same-day lowdose and showed no difference in efficacy (OR=0.91 (0.34; 2.47)). Conclusion: There is no significant difference in efficacy between same-day and split-dose administration of bowel preparations. However, there is great variability in type and administration schedule of adjuvants in available same-day preparations arms, which may have an effect on the generalizability of the present results. Further studies should focus on a more rigorous comparison of the different administration schedules.
Tu1087 Gastric Acid Suppression and Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis Raseen Tariq, Siddharth Singh, Darrell Pardi, Sahil Khanna Background: Gastric acid suppression has been associated with an increased risk of primary Clostridium difficile infection (CDI), whereas studies evaluating the risk of recurrent CDI in patients on acid suppression medications show conflicting results. We performed a systematic review and meta-analysis to study the association between gastric acid suppression medications and the risk of recurrent CDI. Methods: A systematic search of Medline, Embase, and Web of Science was performed up to September 2015. Studies assessing the association between gastric acid suppression exposure and recurrent CDI were included. Summary Odds ratio estimates with 95% confidence intervals (CIs) were calculated with the randomeffects model using Review Manager version 5.3 (Cochran Inc). Results: Sixteen studies (15 observational and 1 post-hoc analysis of a randomized controlled trial) with 1,550 (19.5%) recurrent CDI cases in 7,947 patients with CDI were included. The rate of recurrent CDI in patients on acid suppression was 20.8%, compared to 18% in patients without acid suppression. Meta-analysis did not show an increased risk of recurrent CDI in patients on acid suppression medications (OR 1.27, 95% Cl 0.97-1.67, p= 0.08). There was significant heterogeneity among the studies with an I2 of 72%. Sensitivity analyses based on definition of recurrent CDI revealed no difference in the risk of recurrent CDI in studies defining recurrence within 90 days from initial episode (OR 1.45, 95% Cl 1.03 - 2.05, p= 0.04) compared to studies defining recurrent CDI as that occurring in less than 60 days, which is the accepted definition for recurrent CDI, (OR 1.06, 95% Cl 0.62 - 1.82, p= 0.83), as the confidence intervals of the two groups overlap. Subgroup analyses based on study type showed no difference in the risk of recurrent CDI in both case control and cohort studies (OR 1.34, 95% Cl 0.81- 2.24, p= 0.26 for case-control studies and OR 1.28, 95% CI 0.93 -1.77, p= 0.13) for cohort studies. Conclusion: Meta-analyses of existing studies suggest that concomitant use of gastric acid suppression medications is not associated with an increased risk of recurrent CDI. Sensitivity analyses based on definition of recurrent CDI (within 60 days versus 90 days) revealed a numerically significant result for 90 days but not statistically different from standard recurrence of definition 60 days.
AGA Abstracts
Tu1089 Admissions for Acute Pancreatitis But Not Inflammatory Bowel Disease Follow a Seasonal Pattern and Are More Common in Summer Maneesh Dave, Rajika Tandon, Kathan Mehta Introduction: Acute pancreatitis (AP) and inflammatory bowel diseases (IBD) are common reasons for gastrointestinal hospitalizations. Some studies have suggested a seasonal variation in hospitalizations for these diseases; however, other studies have found no such association. Aims & Methods: Our aim was to determine the seasonal variation in admission rates and outcomes for hospitalizations for AP and IBD and identify any associated factors. We performed an ecological study with time series analysis using data from the United States (US) Nationwide in-patient sample (NIS) for the years 1998 to 2010. Patients hospitalized with primary discharge diagnoses of AP and IBD in US using ICD9 CM codes were identified. We examined temporal trends in monthly admission rates and mortality for AP and IBD over a 13 year period using spectral analysis. We explored for potential reasons for seasonality in admission rates by compiling climate data (mean monthly temperature[MMT], total snowfall, and total precipitation) from National Climatic Data Center of each US zip code and monthly alcohol sales data from Alcohol and Tobacco Tax and Trade Bureau. The association between weather indices and monthly admissions was assessed by Poisson regression and Pearson's correlation. Results: There were 643,441 (weighted N = 3,158,128) hospitalizations for AP (males =50.8%) and 228,982 (weighted N = 1,130,248) for IBD (males=43.9%) from 1998 to 2010. The admission rate for AP showed marked seasonality every year with progressively decreasing hospitalizations during winter with lowest rates in January (571 admissions/day) and progressively increasing hospitalizations during summer
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