Angesom Kibreab

Hypercalcemic pancreatitis a rare presentation of sarcoidosis: A case report

Rationale: The usual presentation of sarcoidosis is hilar adenopathy, pulmonary reticular opacities, skin, joint, or eye lesions. Pancreatic involvement is unusual and hypercalcemic pancreatitis as initial manifestation is very rare. Patient concerns: We present a case that presented with 1-day history of vomiting, diffuse abdominal pain, and altered mental status. Diagnoses: Initial investigations showed highly elevated calcium levels, acute pancreatitis, and kidney failure. Possible causes entertained were malignancy, hyperparathyroidism, hypervitaminosis D, and granulomatous diseases. Full work-up including a hilar lymph node biopsy revealed noncaseating granuloma. After excluding other diseases capable of producing a similar picture, a diagnosis of sarcoidosis was made. Interventions and outcomes: The patient was started on aggressive intravenous fluid hydration and intravenous calcitonin, after which her altered mental status resolved and both kidney function and hypercalcemia improved. The patient was discharged on oral prednisone and serum calcium level normalized with progressive improvement of kidney function at follow-up. Lessons: The current case highlights the need for a high index of suspicion for this condition in patients who present with acute pancreatitis, as steroids are the treatment of choice. Thus, prompt recognition of this entity is of therapeutic significance

Body Mass Index and Intensive Care Unit Outcomes in African American Patients

PURPOSE We sought to determine whether body mass index (BMI) is associated with worse intensive care unit (ICU) outcomes among Black patients. METHODS Patients admitted to the medical ICU during 2012 were categorized into six BMI groups based on the World Health Organization criteria. ICU mortality, ICU and hospital length of stay (LOS), need for and duration of mechanical ventilation and organ failure rate were assessed. RESULTS A total of 605 patients with mean age 58.9 ± 16.0 years were studied. Compared with those with normal BMI, obese patients had significant higher rates of hypertension, diabetes mellitus and obstructive sleep apnea diagnoses (P<.001 for all). A total of 100 (16.5%) patients died during their ICU stay. Obesity was not associated with increased odds of ICU mortality (OR=.58; 95% CI, .16-2.20). Moreover, improved survival was observed for class II obese patients (OR, .031; 95% CI, .001-.863). There were no differences in the need for and duration of mechanical ventilation between the BMI groups. However, ICU and hospital LOS were significantly longer in patients with obesity. CONCLUSION Obesity was not associated with increased ICU mortality; however, obesity was associated with increased comorbid illness and with significant longer ICU and hospital length of stay.

Beverage intake preference and bowel preparation laxative taste preference for colonoscopy.

AIM To examine whether non-alcoholic beverage intake preferences can guide polyethylene glycol (PEG)-based bowel laxative preparation selection for patients. METHODS We conducted eight public taste test sessions using commercially procured (A) unflavored PEG, (B) citrus flavored PEG and (C) PEG with ascorbate (Moviprep). We collected characteristics of volunteers including their beverage intake preferences. The volunteers tasted the laxatives in randomly assigned orders and ranked the laxatives as 1(st), 2(nd), and 3(rd) based on their taste preferences. Our primary outcome is the number of 1(st) place rankings for each preparation. RESULTS A total of 777 volunteers completed the study. Unflavored PEG was ranked as 1(st) by 70 (9.0%), flavored PEG by 534 (68.7%) and PEG with ascorbate by 173 (22.3%) volunteers. Demographic, lifestyle characteristics and beverage intake patterns for coffee, tea, and carbonated drinks did not predict PEG-based laxative preference. CONCLUSION Beverage intake pattern was not a useful guide for PEG-based laxative preference. It is important to develop more tolerable and affordable bowel preparation laxatives for colonoscopy. Also, patients should taste their PEG solution with and without flavoring before flavoring the entire gallon as this may give them more opportunity to pick a pattern that may be more tolerable.

413 Comparison of In-Hospital Mortality of Conservative Versus Surgical Management of Peptic Ulcer Perforation in US Hospitals. Is Conservative Management Deadly?

dences of serious TEAEs were 8.6%, 8.3% and 14.2%, and of TEAEs leading to study drug discontinuation were 7.6%, 4.1% and 12.7%. Serum gastrin increased at Week 4 in all treatment groups, followed by a moderate increase until Week 52. Pepsinogen I and II increased at Week 4 in all treatment groups, then remained at a stable level until Week 52. There were no clinically significant changes in laboratory tests and vital signs preand posttreatment for any treatment group. Recurrence rates of peptic ulcer for L15, V10 and V20 groups, respectively, were 7.0%, 3.8%, and 5.4% at Week 52, and 7.5%, 3.8%, and 5.9% at Week 76 and Week 104. Conclusion: The long-term safety profile of V10 and V20 was similar to that of L15 with no safety issues identified. VPZ 10 mg and 20 mg were highly effective for prevention of peptic ulcer recurrence during NSAID therapy and this effect was maintained during long-term use.

Mo1068 Colorectal Cancer Disparities Between Blacks and Hispanics: Healthcare Utilization Versus Biological Differences

Background: Despite comparable rates of putative risk factors for colorectal cancer including poor access and lower screening uptake, Hispanic Americans have reduced burden of colorectal cancer when compared to Blacks. It is unknown if better healthcare utilization (when access is available) or biological differences are playing a major role in this disparity within minority groups. Aim: To compare the adherence to scheduled out-patient colonoscopy (healthcare utilization) and the findings of neoplasia (biological differences) during colonoscopy performed among compliant patients by race-ethnicity (Blacks versus Hispanics). Method: A total of 2,126 (88.2%) non-Hispanic Black and 284 Hispanic (11.8%) adult patients were scheduled for out-patient colonoscopy from September 2009 to August 2010 in our endoscopy suite at Howard University Hospital, a minority serving tertiary institution in Washington DC. We reviewed their records and abstracted the data in standard fashion. We compared Blacks to Hispanics in their rates of attendance to the scheduled colonoscopy, the quality of colonoscopy performed and the detection of neoplasia. We used logistic regression models to calculate odds ratio (OR) and 95% confidence interval (CI) and adjusted for age, sex, marital status and health insurance. Results: Blacks were slightly older (mean age 56.5 years versus 52.7 years, P<0.001) and were less likely to be married (23% versus 32%, P = 0.001), but there was no difference by sex (P = 0.64). A lower percentage of Blacks were compliant with their procedures (76.9% versus 82%, OR = 0.76; 95%CI: 0.541.06). There was no difference in cecal intubation rate (97.5% versus 97.4%, P = 0.93) and finding of good bowel preparation (73% versus 71.5%, P = 0.13). Blacks were more likely to have polyps (50.8% versus 33.2%, OR = 2.10; 95%CI: 1.54-2.88) and adenoma (26.3% versus 18.8%, OR = 1.53; 95%CI: 1.05-2.23). These differences were mainly from diagnostic procedures (Table). Nine (0.57%) Blacks and one (0.44%) Hispanic had colorectal cancer diagnosed (P = 0.8). Conclusion: Although Blacks were borderline less likely to attend their scheduled colonoscopy, they were significantly more likely to have colorectal neoplasia. This suggests that biological differences may be playing more of a role in the increased burden of CRC among Blacks as compared to Hispanics. Comparison of prevalence of adenoma among blacks and Hispanics by indication of colonoscopy

S1291 Prevalence of Hepatitis and Its Etiologic Changes Over Time in African Americans in a University Teaching Hospital

BACKGRAUND: African Americans (AAs) and Hispanic Americans have a greater risk of developing liver disease than white. In this study we analyzed the prevalence of hepatitis, stage of fibrosis, and cirrhosis from liver biopsy findings of AAs with hepatitis and determined if there are etiologic, or demographic changes over a period of five decades. METHODS: Liver biopsy data, were collected from pathology and medical records at Howard University Hospital from 1959 to 2008. Analysis of the data was done for demographic characteristics, chronicity, stage of fibrosis, and possible etiologies. Continuous variables were described with mean values (SD), and frequency table was used for categorical variables. Students ttest and Chi-square were applied to test the difference of continuous and categorical variables among study groups, respectively. RESULTS: A total of 781 cases of hepatitis were available for analysis. The age range was 15-84 yrs old with mean (SD) of 45.7 (14.6). Males were 428 (55%), and females were 355 (45%). About 50% of the cases were in the middle age group (40-60 years old). Out of the total hepatitis cases, 746 (95%) were chronic liver disease (CLD), of which 107 (14 %) were cirrhosis. About 477 (64%) of the CLD had identifiable etiologic causes. These were viral 287 (60%), inflammatory 42 (9%), fatty changes 20 (4%), alcohol 17 (4%), metabolic 13 (3%) and cholestatic 9 (2%).. Of total CLD (639 cases), excluding cirrhosis, 182 (29%) had fibrosis at different stages. One hundred forty (77%), were in stages 1-2 and 42 (23%) were in stages 3-4. There was no difference between viral and non viral etiology as a cause of fibrosis (P=0.7), or mean age of distribution for the fibrosis (P=0.4). HCV has 156/639 (42%) fibrosis rate. In addition, a significant increase in the total prevalence of chronic hepatitis 295(46.2%) in the years from 2000-2008 was observed compared to the previous decades (P<0.001). There was no difference with regard to sex (P=0.4) or viral etiology (P=0.1) in the prevalence rate of CLD in the last five decades when we compare one decade to the other. The prevalence of cirrhosis in our data was 14 %, with a mean age of 46.6 (SD=14.6). The mean age of the total hepatitis cases was significantly older, 50.8 (SD 9.0) in the year 2000-2008 data (P=<0.001) compared to the prior four decades. CONCLUSION: Our data showed CLD is more in males and is increased significantly (p<0.001) in recent eight years. Further investigation is needed to determine whether this increase is due to improved and better diagnostic techniques, vs. a real increase in incidence of chronic liver disease and cirrhosis.

M1038 Neoplastic Changes in Colonic Mucosa Following Polypectomy, Does Follow Up Make Sense?

Background and Aim: African Americans (AA) are at higher risk for colorectal cancers than general population and the neoplastic changes could be detected if followed properly. The aim of this study was to evaluate the incidence of colon cancer in patients who have previously undergone polypectomy. Method: In a retrospective study, 4793 documented symptomatic (GI bleeding, abdominal pain, weight loss) patients aged 40-90 years with no personal or family history of familial adenomatous polyposis and inflammatory bowel disease who underwent colonoscopy were identified from pathology, surgery and colonoscopy centers of Howard University Hospital over a period of 49 years (1959-2007). Demographic characteristics and histological findings were recorded. The frequency of pathological subtypes (tubular, villous, and tubular-villus and adenomatous polyps) of colorectal polyps was determined. Logistic regression was used to assess the independent risk factor of malignancy in patients with a prior diagnosis of adenoma. Results: Among 4793 patients with colon adenoma (without cancer) diagnosed from 1959-2007. There were 1619 (34%) patients with only right sided adenomas, 2951 (62%) were left sided and 220 (4%) were had adenoma on both sides of colon. Among the adenoma cases 52% (n=74) were 64 years or younger. Half (n=48) of the patients developed cancer before 1999. During the study period colon cancer occurred in 3% of cases previously diagnosed with adenoma. Adjusting for effect of sex and age, tubular adenoma (OR:2.5, 95%CI:1.6-4.1) and right colon location (OR:5.7,95% CI:3.9-8.5) were risk factor for neoplastic changes in cases with adenoma. The median (IQR) duration between diagnosis of adenoma and subsequent colon cancer was 9 (4-15) years. Conclusion: Despite adenoma diagnosis and removal, neoplastic changes is a fairly prevalent outcome in African-American with colorectal adenoma. High risk groups includes right sided and multiple adenoma. Compliance with full colonoscopy after polypectomy will reduce the risk of neoplastic progression in this group.

M1033 Colorectal Neoplasia in Young African Americans, Could Race Be a Risk Factor? a 40 Years Experience in An Inner City Teaching Hospital

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer, and survival in African Americans (AAs) is worse than Caucasians. Some studies suggest that the incidence of CRC is higher in AA patients below the age of 50 when compared to Caucasians. This study aims to confirm the higher prevalence of CRC in an AA population within the age groups of 40-49, and its implications to the screening guidelines. METHOD: In a retrospective study demographic data, indication and outcome of colonoscopy, and biopsy data were collected at Howard University Hospital over a period of 38 years (1970-2007). All of the study patients were (AA), and cases were classified either symptomatic average risk, 692 (91%); or high risk (family history, IBD), 69 (9%). Distribution of variables were studied by mean (standard deviation) or number (%) . RESULTS: A total of 8851 patients who had colonoscopy were analyzed. Female comprise 56%, and the mean (SD) for age was 60.3 (14.9). Out of the total, 965 (11%) were in the age group of 40-49, of which 409 (42%) had adenoma, and 45 (4.8%) had CRC. The location of 86% of the 409 adenomas were obtained. Two-hundred six (59%) adenomas were on the left side, and 144 (41%) were right sided. The histology of the adenomas included, 264 tubular adenomas (64.5%), 83 hyperplastic lesions (0.3%), 44 villous adenomas (10.8%), and 18 other histology (4.4%). When patients from age 40-44 (378) were compared for the prevalence of adenoma and CRC to those age 45-49 (587), the 40-44 age group had 148 (39.2%) adenomas and 18 (4.8%) CRC, vs. the 45-49 age group had 349 (59.4%) adenomas and 28.1(4.8%) CRC. Twenty four (68.5%) cancers were on the left side, and 11(31.5%) were right sided. Females had higher CRC rates 27 (61%), compared to males 18(39%). CONCLUSION: Our data showed a very high burden of colorectal adenoma and CRC in young AAs (<45). CRC rate of (4.8%) was seen for both the age group of 40-44, and 45-49, which indicates cancer in AAs may starts at younger age than predicted (<45). The American College of Gastroenterology recommends to start screening of AAs at age of 45, but this may not cover many high risk people who are younger than 45. Further study is needed on AAs to confirm these findings.