Background/Aims Computed Tomography (CT) is a useful tool in Crohn’s disease (CD) to assess disease activity and exclude complications. Excessive radiation has been associated with increased risk of malignancy. We aimed to identify automatable algorithms with a high negative predictive value (NPV) of a significant CT finding in patients with CD presenting to the emergency department. Methods We conducted a retrospective review of a tertiary center’s medical records to identify adults with a diagnosis of CD who presented from 2000–2011. Logistic regression was used to model (1) complications [perforation, abscess or other serious finding] and (2) inflammation. Results There were 1095 visits for 613 individuals with a CT scan within 24 hours of arrival. The average number of CTs was 1.8 with a range of 1–31. Complications occurred in 16.8% of CTs. Inflammation was found in 54.5% of CTs while any new/worse finding was found in 67.2%. Using 10-fold cross validation to evaluate our models, the area under the receiver operating characteristic curve for the complications model is 0.80 (95%CI: 0.74–0.86) and the inflammation model is 0.71 (95%CI: 0.68–0.74). Scanning only patients with model-predicted complications would reduce scans by 43.0%, with a miss rate of 0.8% (4/491). Conclusions Patients presenting to the emergency department with CD undergo CT scanning frequently but have no significant findings in 32.8% and complications in only 17%. Models with high NPVs were identified and could aid physicians in the decision to avoid CT scans in patients with low likelihood of a positive scan. Studies are needed to validate these models beyond a single center.

Among US gastroenterologists, OTC medications now dominate primary therapy of GERD and CC. Despite feeling that name brand and store brand PPIs and laxatives are equally effective, the majority of gastroenterologists recommend brand name medicines and underestimate the cost savings associated with store brands. In this age of accountable care, greater efforts to help physicians and patients to better utilize their health-care dollars is warranted.

Irritable bowel syndrome with constipation and chronic functional constipation are common digestive disorders that negatively impact quality of life and account for billions of dollars in health care costs. Related to the heterogeneity of pathogenesis that underlie these disorders and the failure of symptoms to reliably predict underlying pathophysiology, traditional therapies provide relief to only a subset of affected individuals. The evidence surrounding new and emerging pharmacologic treatments, which include both luminally and systemically acting drugs, is discussed here. These include agents such as lubiprostone, bile acid modulations, guanylate cyclase-C receptor agonists, serotonin receptor modulators and herbal therapies.

BACKGROUND & AIMS It is a challenge to predict how patients with small bowel Crohn’s disease (CD) will respond to intensified medical therapy. We aimed to identify factors that predicted surgery within 2 years of hospitalization for CD, to guide medical vs surgical management decisions. METHODS We performed a retrospective review of adults hospitalized for small bowel CD from 2004 through 2012 at a single academic referral center. Subjects underwent abdominal computed tomography or magnetic resonance imaging within 3 weeks of hospitalization. Imaging characteristics of small bowel dilation, bowel wall thickness, and disease activity were assessed by a single, blinded radiologist. Multivariate analysis by Cox proportional hazard regression techniques were used to generate a prediction model of intestinal resection within 2 years. RESULTS A total of 221 subjects met selection criteria, with 32.6% undergoing surgery within 2 years of index admission. Bivariate analysis showed high-dose steroid use (>40 mg), ongoing treatment with anti-tumor necrosis factor agents at admission, platelet count, platelet:albumin ratio, small bowel dilation (≥35 mm), and bowel wall thickness to predict surgery (P≤.01). Multivariate modeling demonstrated small bowel dilation greater than 35 mm (hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.73–4.94) and a platelet:albumin ratio ≥125 (HR, 2.13; 95% CI, 1.15–3.95) to predict surgery. Treatment with anti-tumor necrosis factor agents at admission conferred a non-significant increased trend for risk of surgery (HR, 1.61; 95% CI, 0.994–2.65). CONCLUSIONS Small bowel dilation greater than 35 mm and high platelet:albumin ratios are independent and synergistic risk factors for future surgery in patients with structuring small bowel CD. Platelet:albumin ratios may capture the relationship between acute inflammation and cumulative damage and serve as markers of intestines that cannot be salvaged with medical therapy.

Irritable bowel syndrome with constipation and chronic functional constipation are common digestive disorders that negatively impact quality of life and account for billions of dollars in health care costs. Related to the heterogeneity of pathogenesis that underlie these disorders and the failure of symptoms to reliably predict underlying pathophysiology, traditional therapies provide relief to only a subset of affected individuals. The evidence surrounding new and emerging pharmacologic treatments, which include both luminally and systemically acting drugs, is discussed here. These include agents such as lubiprostone, bile acid modulations, guanylate cyclase-C receptor agonists, serotonin receptor modulators and herbal therapies.