Inflammatory Bowel Diseases Restrictive Eating Behaviors Inflammation Symptoms MalnutritionBACKGROUND & AIMS: Inflammatory bowel disease (IBD) patients alter their dietary behaviors to reduce diseaserelated symptoms, avoid feared food triggers, and control inflammation. This study aimed to estimate the prevalence of avoidant/restrictive food intake disorder (ARFID), evaluate risk factors, and examine the association with risk of malnutrition in patients with IBD. METHODS:This cross-sectional study recruited adult patients with IBD from an ambulatory clinic. ARFID risk was measured using the Nine-Item ARFID Screen. Nutritional risk was measured with the Patient Generated-Subjective Global Assessment. Logistic regression models were used to evaluate the association between clinical characteristics and a positive ARFID risk screen. Patient demographics, disease characteristics, and medical history were abstracted from medical records. RESULTS:Of the 161 participants (Crohn's disease, 45.3%; ulcerative colitis, 51.6%; IBD-unclassified, 3.1%), 28 (17%) had a positive ARFID risk score ( ‡24). Most participants (92%) reported avoiding 1 or more foods while having active symptoms, and 74% continued to avoid 1 or more foods even in the absence of symptoms. Active symptoms (odds ratio, 5.35; 95% confidence interval, 1.91-15.01) and inflammation (odds ratio, 3.31; 95% confidence interval, 1.06-10.29) were significantly associated with positive ARFID risk. Patients with a positive ARFID risk screen were significantly more likely to be at risk for malnutrition (60.7% vs 15.8%; P < .01).
Background: Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups. Methods: 981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center.
C lostridium difficile infection (CDI) is the leading cause of nosocomial infectious diarrhea in developed countries. 1 The composition of human gut microbiome is associated with the development of CDI. This theory is bolstered by the increase in CDI risk after antibiotic exposure and the success of fecal microbiota transplant in treating refractory CDI. 2 Use of non-digestible oligosaccharides (eg, lactulose, oligofructose) as prebiotics may be a safe and effective approach to restoring or strengthening colonization resistance against CDI by selectively promoting the growth of a host's indigenous microbiota. 3,4 Lactulose has been shown to alter the colonic microenvironment in ways that inhibit C difficile growth. 3 We sought to determine whether lactulose use was associated with a decreased risk of CDI. MethodsWe conducted a matched nested case-control study among end-stage liver disease (ESLD) patients admitted to an academic health system between 2005 and 2013. Patients were identified by the presence of ESLD on discharge diagnosis codes. 5 Admissions were excluded if the patient was hospitalized for less than 24 hours, had incomplete medical records, had undergone prior liver transplantation, or had a history of CDI.Cases were identified by incident diagnosis of CDI during admission on the basis of stool toxin or polymerase chain reaction testing for toxigenic genes. For each case, controls were selected by using incidence density sampling matching on age, sex, admission date, and duration of hospital stay. The exposure of interest was at least 10 g/day of lactulose for more than 48 hours.Conditional logistic regression was used to calculate the odds ratio (OR) for CDI risk associated with lactulose use. We examined the following potential confounders: Model for End Stage Liver Disease score, intensive care unit stay, race, type of hepatic decompensation, use of rifaximin, metronidazole, or other antibiotics grouped by class. Variables were included in the multivariate model if their inclusion changed the crude OR for CDI risk by more than 5%. ResultsThe study included 112 eligible cases matched with 928 controls. The 2 groups differed in history of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and use of rifaximin, metronidazole, and cephalosporins ( Table 1).The prevalence of lactulose use was significantly lower among cases than controls (crude OR, 0.48; 95% confidence interval [CI], 0.31-0.74; P < .001). A diagnosis of HE as well as exposure to rifaximin, metronidazole, and cephalosporins significantly changed the crude OR by >5%. HE was automatically excluded from the regression model because it was highly correlated with rifaximin use. The adjusted OR accounting for these variables was 0.60 (95% CI, 0.37-0.97; P ¼ .04).In secondary analyses, the effect estimates were unchanged when excluding patients who received rifaximin (adjusted OR, 0.52; 95% CI, 0.31-0.89; P ¼ .02) or had SBP (OR, 0.60; 95% CI, 0.36-1.01; P ¼ .053). There was no difference in the frequency of CDI testing be...
Background and study aims Most patients with upper gastrointestinal bleeding (UGIB) are hospitalized. Risk-stratifying UGIB with scoring tools may decrease avoidable admissions, thereby reducing the cost of care. We sought to describe how frequently low-risk UGIB patients present to urban emergency departments (ED) and the proportion who are admitted to examine how incorporating risk scores into decision support might diminish healthcare utilization in this population. Patients and methods This is a retrospective cohort study of ED patients presenting from 2009 – 2013 to three urban hospitals that do not use electronic UGIB decision support. We used ED disposition diagnosis codes (ICD-9) to identify patients followed by manual chart review for verification and additional data collection. Patients with a Glasgow Blatchford Score (GBS) of 0 were classified as low risk. We also surveyed ED physicians at these hospitals to assess their beliefs about UGIB decision support. Results Over the study period, 66 patients (13.2 per year) presented to the ED with low-risk UGIB. Of these, 10 patients (15.2 %) were admitted and none required endoscopic hemostasis. Most survey respondents (55.6 %, n = 20) were aware of UGIB risk scores but a minority (19.4 %, n = 7) used one. Conclusions Low-risk UGIB patients infrequently present to the ED and only a minority are admitted. Despite advocacy to incorporate decision support into routine clinical care, ED physicians independently identified low risk patients. There is insufficient evidence to suggest the magnitude of this problem is large enough to warrant implementation of decision support for low risk UGIB.
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