The AIMS65 score is superior to the GBRS for predicting in-hospital mortality and hospital length of stay for patients with UGIH. The AIMS65 score and GBRS are similar in predicting 30-day mortality, rebleeding, and a composite endpoint.

BackgroundTumor necrosis factor alpha (TNFα) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFα medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI.MethodsWe conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications.ResultsWe included 107 and 89 patients with IBD and RA, respectively. We found that a higher proportion of IBD patients had indeterminate QFT-GIT result compared to RA patients. Furthermore, we found that the majority of patients with indeterminate results were tested during an acute flare of IBD (88%) and while taking corticosteroids. Of all patients receiving ≥20 mg equivalent prednisone dose (n=32), 63% resulted in indeterminate QFT-GIT, compared to only 6% indeterminate testing in patients receiving <20 mg of equivalent prednisone dose (n=164, P<0.001). There was no correlation between indeterminate results and age, gender, disease duration, or distribution, or smoking status within each population.ConclusionWe observed that high-dose corticosteroids may affect QFT-GIT outcomes leading to a high proportion of indeterminate results. We propose that IBD patients should be tested prior to initiation of corticosteroids to avoid equivocal results and prevent potential delays in initiation of anti-TNF medications.

Non-hematemesis gastrointestinal bleeding patients undergo multiple non-diagnostic tests and have longer times to diagnosis and then compared those with hematemesis. The high yield of video capsule endoscopy in the non-hematemesis group suggests a role for this device in this context and warrants further investigation.

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INTRODUCTION: Industry-funded trials of microbiota-based therapeutics for treatment of Clostridioides difficile are ongoing, however due to strict enrollment criteria, not all patients are eligible. Furthermore, given the widespread availability of fecal microbiota transplantation (FMT) and overwhelming evidence supporting its efficacy, patients may refuse enrollment in trials with a placebo-arm. METHODS: This is a retrospective study performed at four tertiary referral centers for FMT. The electronic medical record at each was reviewed to capture patients referred for recurrent CDI over a 6- month time period. FMT eligibility was determined based on current CDI treatment guidelines.3 Inclusion and exclusion criteria for a clinical trial of an oral microbiota-based therapeutic were applied to determine eligibility, based on current enrolling trials at these centers. RESULTS: Of 199 patients referred for a diagnosis of recurrent CDI, 130 (65%) were deemed to be eligible for FMT based on the number and severity of episodes. Of the patients in whom FMT was determined to be an appropriate option, 94 (72%) met inclusion criteria for an RCT of a microbiota-based therapeutic drug, however 62 (66%) of those meeting inclusion criteria had one or more exclusion criteria (Table 1) precluding participation and 16 (17%) were eligible but refused to enroll. Only 16 (12%) of FMT-eligible patients were enrolled in the drug trial. Conventional FMT using stool-bank donor material was performed in 96 patients (74%) of those deemed eligible to undergo the procedure (Figure 1). Most patients (79%) met a single exclusion criterion, 14.5% met two criteria and 6.5% met three criteria. The most common reason for study exclusion was immunocompromise (17; 27%). Other common exclusions were inflammatory bowel disease (13; 21%), having already received more than 21 days of vancomycin (11; 18%) and diarrhea-predominant irritable bowel syndrome (10; 16%). CONCLUSION: Less than half of patients deemed eligible for FMT based on clinical history of recurrent CDI met eligibility criteria for a clinical trial of an encapsulated microbiota product. A smaller but relevant proportion of eligible patients refused to participate. Restrictions on stool banks would have detrimental effects on patient access to FMT. Furthermore, these results demonstrate that a relevant number of patients affected by recurrent CDI are currently being excluded from industry-funded trials.

We evaluated serial FMT by retention enema in patients with severe or severe/complicated CDI unresponsive to at least 48 hours of standard antibiotic therapy. Of the 15 patients included, despite initial improvement in most patients, only 5 patients sustained cure at 30 days and serious adverse events occurred in 4 patients.

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