Shikha Mangla

Risk Factors for Inadequate Colonoscopy Bowel Preparations in African Americans and Whites at an Urban Medical Center

Objectives Poor bowel preparation leads to inadequate examinations and shorter surveillance intervals for colorectal cancer screening. Previous studies regarding risk factors for inadequate preparation have not included large numbers of African Americans. Our aim was to determine the prevalence of inadequate bowel preparation on initial and follow-up colonoscopy in a large, racially diverse patient population. Methods Colonoscopies performed during a 1-year period were analyzed retrospectively. Factors including age, sex, race, and start time were recorded. Patient ZIP codes were linked to census data to estimate education and income. For examinations with inadequate bowel preparations, we collected data on recommendations and the preparation quality of follow-up procedures. Results We included 3741 patients (40.2% African American). Of these, 66.9% had adequate bowel preparation and 33.1% had inadequate bowel preparation. African Americans had the highest prevalence of inadequate preparations at 43.0%. African American race was a predictor of inadequate bowel preparation, despite controlling for education and income. Age, male sex, and procedure taking place after 12 PM also were risk factors for inadequate preparation. Receipt of specific preparation instructions on the endoscopy report did not affect preparation quality on follow-up examination. Our study found a high rate (33.1%) of inadequate bowel preparations, and African American race was found to be an independent risk factor for inadequate preparation. We validated previously reported risk factors including age, male sex, and later procedure time. Finally, we noted high rates of inadequate preparation on follow-up examinations. Conclusions Improving the quality of colonoscopy bowel preparation is important for colorectal cancer prevention, especially in high-risk populations such as African Americans.

Mo1843 Mast Cell Densities on Esophageal Mucosal Biopsies Were Higher in Eosinophilic Esophagitis Versus Proton Pump Inhibitor-Responsive Esophageal Eosinophilia in Adults

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition which causes esophageal remodeling and stricture formation over time. Aim: To explore the natural course of symptoms, endoscopic findings to include stricture development, and histology in EoE patients. Methods: EoE adult patients (age > 18 years) were prospectively enrolled from databases of two medical centers (Walter Reed and Mayo Clinic Jacksonville). All EoE patients were diagnosed per recent consensus guidelines. All patients completed index and follow-up symptom surveys. Endoscopic features (rings, furrows, plaques, strictures) and histology from index and follow-up endoscopies were recorded. Disease behavior was classified as inflammatory if endoscopic findings demonstrated furrows or white plaques and classified as fibrostenotic if endoscopic findings included rings or strictures. Results: 165 EoE patients were identified, mean age 42 ± 14 years; 88.5% Caucasian and 70% male. Median (range) duration of symptoms prior to EoE diagnosis was 66 months (0.1-425). Median follow-up time was 19.2 months (0.9-120). At index, the majority (124/165, 75%) presented with fibrostenotic EoE and 25% (41/165) presented with inflammatory disease. Patients who presented with a stricture had a significantly longer duration of symptoms prior to diagnosis (130 vs 86 months, p=0.011). Patients with fibrostenotic features had more food allergies than those with inflammatory disease (23.4% vs. 4.9%, p=0.010); otherwise, other allergic conditions were similar. At index endoscopy, significantly more patients with fibrostenotic disease had dense proximal eosinophilia (>15 eos/hpf) than patients with inflammatory disease (81.1% vs. 64.3%, p=0.015), but were similar in degree of distal eosinophilia (86.4% vs. 85.3%, p=0.415). Over time, disease behavior remained unchanged in the majority (87.3%, 144/165) of patients. Of the 41 patients presenting with inflammatory disease, 21 patients (51%) developed fibrostenotic features with 15 of these developing a stricture at follow-up endoscopy. Patients who developed fibrostenosis had more dense eosinophilia on biopsies (proximal 68.4% vs. 20.0%, p=0.015; distal 68.2% vs. 36.8%, p=0.049) than those who maintained inflammatory features. The majority of patients (68%) reported improved symptoms over time regardless of their disease behavior. Conclusions: The majority of patients with EoE present with or develop fibrostenotic disease. Duration of symptoms was significantly greater in patients presenting with stricture. Dense proximal esophageal eosinophilia is associated with the presence of fibrostenosic disease and higher levels of eosinophilia may predict transformation from inflammatory to fibrostenotic disease.

Tu1215 Weight Regain After Roux-en-Y Gastric Bypass Is Associated With Abnormal Non-Acid Reflux and Symptom-Association on 24-Hour pH-Impedance Monitoring

Background:Obesity has been associated with increased risk and severity of gastroesophageal reflux disease. Prior studies have shown that Roux-en-Y gastric bypass (RYGB) is effective for weight loss and can decrease reflux symptoms and esophagitis among obese patients. The mechanisms by which RYGB reduces reflux are not completely known. Post-RYGB patients may also develop reflux symptoms as a late complication of surgery. Weight regain (WR) has been shown to occur in 20% post-RYGB on long-term follow-up. No prior study has demonstrated the association between post-RYGB reflux symptoms and WR. Objective evaluation and understanding of post-RYGB reflux symptoms may also allow more effective, targeted therapy for these patients. Aim: To objectively evaluate reflux symptoms among post-RYGB patients using 24-hour multichannel intraluminal impedance and pH (MII-pH) study and investigate their association with WR. Methods: This was a retrospective cohort

Su2076 Weight Regain After Roux-en-Y Gastric Bypass Surgery Is Associated With Dysphagia Symptoms but Not Manometric Findings

Background: It has been suggested that a diet low in fermentable short chain carbohydrates, FODMAPs (Fermentable Oligo-Di-Monosaccharides and Polyols) can reduce gastrointestinal symptoms in patients with irritable bowel syndrome (IBS) (Gibson & Shepherd Am J Gastroenterol 2012). However, the intake of FODMAPs in IBS patients compared to the general population has not been studied. Aim: To measure the intake of FODMAPs in patients with IBS in comparison with the general population, and to determine the major sources of FODMAPs in the diet of IBS patients. Method: We included 115 patients with IBS according to the Rome III criteria (39.1±13.0 (mean± SD) years; 88 females) referred to our outpatient clinic. They completed a 4-days food registration record, which was compared with 115 age-and gender matched control subjects from a nation-wide dietary survey. A database including content of fructose, fructan, lactose, galacto-oligosaccharides (GOS) and polyols in 1700 food items was developed specifically for this study to determine the intake of FODMAPs. Results:The IBS patients had significantly lower intake of FODMAPs than the control group from the general population (30.91±14.3 vs.34.56±12.67 g/day; p,0.05). The intake of lactose was lower in IBS patients compared to controls (10.47±8.22) vs.13.70±8.29 g/day; p, 0.001), while polyol intake was significantly higher in the IBS group (1.70±1.87 vs.1.25±1.64 g/day; p,0.05). However, there were no statistically significant differences regarding the intake of fructose (14.18±7.63 vs.15.28±6.93 g/day; p=0.24) fructan (3.91±1.73 vs.3.78±1.67g/day; p=0.55) or GOS (0.63±0.61vs. 0.53±0.56 g/day; p=0.16) between IBS patients and control subjects. The major food sources with naturally occurring fructan and contributing to the intake of fructan in both groups were onion, garlic, wheat and rye. Fruit drinks/-juices and apples were the main contributors to the fructose intake. The richest sources of polyols in the IBS group were pears and sugar-free sweets and in the controls pears, apples and sugar-free sweets. Legumes and wheat-products were the major contributors to intake of GOS in both groups. IBS patients ate less dairy products and replaced 15% of lactose containing products with lactose-free, soy or oat products. The patients ingested half the amount of fruit drinks in comparison to the control group, and their intake of wheat containing food items was also lower than for the control group. Intake of legumes and onions were equal in both groups except for garlic that was more frequently consumed in the IBS group. Conclusion: Intake of FODMAPs seems to be lower in IBS patients than in the general population, and this was mainly explained by a reduction of the intake of lactose containing food items. Further studies assessing the role of intake of FODMAPs for symptoms in IBS patients are needed.

S1150 Predictors of Inadequate Bowel Preparation in a Diverse Population Undergoing Colonoscopy

The stage profile was strongly skewed to early stage (48% Dukes A, 30% Dukes B). 17/33 (52%) were located in the sigmoid colon, 7 (21%) in the rectum and 3 (9%) close to the cecum. The average age at diagnosis was 64 years (range 52-80), while 70% of the cancers were in males. There was a significant shift towards earlier stage CRC in FIT-detected CRC versus SACR-reported and gFOBT-detected CRC (Table 1, Stage A versus Stages B-D, onetailed χ2. FIT versus SACR p=0.003; FIT versus gFOBT p=0.001). Conclusions. FIT detect proportionally more early stage CRC relative to gFOBT. Downstaging due to FIT-based screening is likely to result in improved cure and 5-year survival rates relative to gFOBTbased screening. Table 1. Stage profile of CRC determined through different means