Objectives Smoking is a known risk factor for developing chronic pancreatitis and accelerates disease progression. Smoking cessation remains an important treatment recommendation, but little is known about its effects. This study evaluated smoking cessation in this population and its impact on quality of life. Methods 27 smokers with chronic pancreatitis participated in a smoking cessation program incorporating the QuitWorks program and individual counseling. Their smoking cessation rates were compared with a control population (n=200) consisting of in-patients without chronic pancreatitis who smoked. Smokers were also compared with non-smokers (n=25) with chronic pancreatitis in terms of quality of life indicators. Results 0/27 patients had quit smoking at 6 months, 1/27 at 12 months, and 0/27 patients at 18 months. There was a 19% quit rate in the control population at the 6-month period. Smokers had a worse quality of life, higher rates of depression and anxiety, and worse coping skills than non-smokers. Conclusions Smoking cessation in the chronic pancreatitis population is extremely challenging, as shown by our 0% quit rate after 18 months. Given that smokers with chronic pancreatitis also experience a worse quality of life, it becomes even more important to stress the importance of smoking cessation in these patients.

Aim To investigate the epidemiology and risk factors of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD). Methods This is a retrospective study of patients diagnosed with IBD. 1006 charts were screened and 654 patients met the inclusion criteria. Patients were divided into 2 cohorts based on the presence of prior diagnosis of CDI. Statistical analysis with Pearson's chi-squared and two-sample t-test was performed. Results The incidence of CDI among IBD patients was 6.7%. There was equal prevalence of CDI among Crohn's disease (CD) (n = 21, 49%) and ulcerative colitis (UC) (n = 22, 51%). IBD patients acquired CDI at a mean age of 42.7 years, with 56% of infections acquired in the community and only 28% associated with healthcare. Only 30% of IBD patients with CDI had prior antibiotic use, and 16% had prior steroid use. IBD patients were significantly more likely to require biologic therapy (57% versus 37%, p < 0.01) and have extraintestinal manifestations of IBD (43% versus 28%, p < 0.02). Conclusions IBD patients are more susceptible to CDI at a younger age and often lack traditional risk factors. IBD patients with at least one CDI were more likely to require biologic therapy and had greater rates of extraintestinal manifestations.

BackgroundThe suspected blood indicator (SBI) function in the RAPID Reader v8.3 program was designed to quickly identify the presence of blood in video capsule endoscopy. While previous retrospective studies have shown that the SBI function was accurate in detecting the presence of active bleeding in the small bowel, its specificity and sensitivity were poor.MethodsAn initial retrospective review (phase 1) compared 115 patients with active gastrointestinal bleeding seen on video capsule endoscopy (VCE) to 115 patients with no active bleeding seen on VCE to produce a highly accurate algorithm. A prospective study (phase 2) was then performed by applying the algorithm to 100 consecutive patients who received VCE for the following indications: obscure bleeding, iron deficiency anemia, melena, and hematochezia.ResultsThe initial retrospective review found that eight contiguous SBI markers had a specificity of 100% in identifying active gastrointestinal bleeding regardless of the total number of SBI markers, while two or more contiguous SBI markers had a sensitivity of 96.5%. Using a cutoff of eight contiguous SBI markers, the prospective arm found that there was a 100% sensitivity and specificity in detecting active gastrointestinal bleeding (P < 0.001).ConclusionsThe SBI function can greatly facilitate the identification of active gastrointestinal bleeding on VCE by using eight contiguous SBI markers as a cutoff for active bleeding.

INTRODUCTION: Different ethnic/racial groups may have unique incidences of colorectal cancer with some groups being at higher risk than others. Our study aims to look at outcomes of multitarget stool DNA testing in different racial groups. METHODS: There were 19400 patients who had multitarget stool DNA tests ordered. Baseline demographic traits were recorded. Of these, 1413 positive stool DNA tests followed by documented subsequent colonoscopy. A total of 12 patients with unknown racial group/ethnicity, unknown indication and findings of other carcinoma other than adenocarcinoma were excluded from analysis. Only the index lesion was recorded. Advanced adenoma was defined as an adenoma that is larger than 10 mm or had high risk features such as villous transformation or high grade dysplasia. Nonadvanced adenoma was defined as an adenoma that is smaller than 10 mm and had no high risk features. Racial/ethnic groups were divided into white/Caucasian and non-white. Statistical analysis with Chi-square was done to compare the proportions. A P-value < 0.05 was considered statistically significant. RESULTS: Of the patients who had multitarget stool DNA tests ordered, 206 (1.06%) were of Hispanic origin, 53 (0.27%) American Indian or Alaskan Native, 242 (1.25%) Asian, 1131 (5.83%) African American/Black, 1 (0.01%) Native Hawaiian, 5 (0.03%) Other Pacific Islander, 17416 (89.77%) Caucasian/White and 346 (1.78%) of unknown/unreported backgrounds. A total of 1401 patients were analyzed. For the white/Caucasian cohort, 1353 (75.54%) had subsequent colonoscopy compared to 97 (75.19%) of the non-white group (P = 0.93). Adenocarcinoma cases were 22 (1.68%) in white patients versus 2 (2.17%) in the nonwhite group (P = 0.67), advanced adenomas were 401 (30.68%) versus 30 (32.61%) (P = 0.70), nonadvanced adenoma was 388 (29.69%) versus 26 (28.26%) (P = 0.77), and no adenoma was 496 (37.95%) versus 34 (36.96%) (P = 0.85), respectively. CONCLUSION: From our study, there is no difference in colonoscopy findings from positive multitarget stool DNA tests between racial groups nor is there a difference in adherence to follow-up colonoscopy. Our study is limited by the number of patients within minority groups.

INTRODUCTION: Due to the increased risk of gastrointestinal bleeding (obscure and overt), antiplatelet/anticoagulant agents may increase the chances of a positive stool DNA test, leading in an increased false positive rate. To date, there have been no published studies to evaluate if anticoagulants/anti-platelet agents can affect the results of the stool DNA test. METHODS: A retrospective chart review of 1413 patients who had a positive stool DNA followed by documented colonoscopy was performed. Two patients were excluded because of finding of “other carcinoma.” Attention was given to the patient's medication list at the time of the test. All patients on clopidogrel or other antiplatelet agents, warfarin, direct thrombin inhibitors were included in the analysis and patients on aspirin were excluded. Patients who met the inclusion criteria were divided in 2 groups. Group one (1) included patients who were not exposed to antiplatelet/anticoagulant therapy while group two (2) included patients who were exposed to at least 1 antiplatelet/anticoagulant therapy. Only the index lesion was recorded. Advanced adenoma was defined as an adenoma that is larger than 10 mm or had high risk features such as villous transformation or high grade dysplasia. Non-advanced adenoma was defined as an adenoma that is smaller than 10 mm and had no high-risk features. Statistical analysis with Chi- square and Fisher exact was done to compare the proportions. A P-value < 0.05 was considered to be statistically significant. RESULTS: Out of the 1411 patients included in the study, 1221 (86.53%) patients were not exposed to antiplatelet/anticoagulant agents while 190 (13.47%) were exposed to at least one antiplatelet/anticoagulant agent. Colonoscopy findings between group 1 and group 2 were compared. “Adenocarcinoma” was found in 1.64% vs. 2.11% respectively (P = 0.55). “Advanced adenoma” was found in 23.01% vs. 27.89% respectively (P = 0.14). “Non-advanced adenoma” was found in 28.67% vs. 34.74% respectively (P = 0.09). Finally, no adenomas were found in 39.39% vs. 28.95% respectively (P = 0.006), which was statistically significant. CONCLUSION: Previously published studies noted higher prevalence of colorectal neoplasms in patients with coronary artery disease. In our study, patients who are exposed to antiplatelet/anticoagulant therapy were found to have about 10% more cancerous/precancerous lesions on colonoscopy which could be due to higher cardiovascular comorbidities in patients on this therapy.