We performed a comprehensive epidemiologic analysis of privately insured, non-elderly adults and children with AP and CP in the United States. Changes in gallstone formation, smoking, and alcohol consumption, along with advances in pancreatitis management, may be responsible for the stabilization and even decrease in the incidences of AP and CP.

Objective To determine the impact of the TEACH text message intervention as a pragmatic approach for patient engagement among adolescents with celiac disease (CD) as measured by gluten-free diet (GFD) adherence, patient activation, and quality of life (QOL). Study design Randomized controlled trial with patient recruitment at a pediatric, university-based hospital and through social media; 61 participants ages 12–24 with CD diagnosed at least one year were enrolled. The TEACH intervention cohort received 45 unique text messages over a 3 month study period while the control group received standard of care treatment. Primary outcome measures included objective markers of GFD adherence included serum Tissue Transglutaminase (TTG) IgA and Deamidated Gliadin Peptide (DGP) IgA levels. Secondary patient-reported outcomes collected via online survey included the Celiac Dietary Adherence Test (CDAT), NIH PROMIS Global Short Form measure of QOL, Celiac Symptom Index (CSI), and Patient Activation Measure (PAM). All measures were assessed at enrollment and after the three month study period. Statistical analysis performed using the two-tailed paired student t-test. Results Among the TEACH intervention group, there was significant improvement comparing enrollment scores with three month follow-up scores in patient activation (PAM score 63.1 vs 72.5, P=0.01) and QOL (NIH PROMIS Global Mental Health 50.8 vs 53.3, P=0.01 and NIH PROMIS Global Physical Health 50.8 vs 57.7, P=0.03). There was no statistically significant difference in patient-reported or objectively measured GFD adherence. Conclusions TEACH is an effective intervention among patients with CD to improve patient activation and QOL, even among a cohort with GFD adherence at baseline. Trial Registration ClinicalTrials.gov: NCT02458898

Background & Aims The level of fecal calprotectin (FC) can predict the onset of inflammatory bowel disease (IBD) with high accuracy and precision. We evaluated the cost-effectiveness of using measurements of FC to identify adults and children who require endoscopic confirmation of IBD. METHODS We constructed a decision analytic tree to compare the cost-effectiveness of measuring FC before endoscopy examination with that of direct endoscopic evaluation alone. A second decision analytic tree was constructed to evaluate the cost-effectiveness of FC cut-off levels of 100 µg/g vs 50 µg/g (typically used to screen for intestinal inflammation). The primary outcome measure was the incremental cost required to avoid 1 false-negative result using FC level to diagnose new-onset IBD. RESULTS In adults, FC screening saved $417/patient but delayed diagnosis for 2.2/32 patients with IBD, among 100 screened patients. In children, FC screening saved $300/patient but delayed diagnosis for 4.8/61 patients with IBD, among 100 screened patients. If endoscopic biopsy analysis remained the standard for diagnosis, direct endoscopic evaluation would cost an additional $18,955 in adults and $6250 in children to avoid 1 false negative result from FC screening. Sensitivity analyses showed that cost effectiveness of FC screening varied with the sensitivity of the test and the pre-test probability of IBD in adults and children. Pre-test probabilities for IBD of ≤75% in adults and ≤65% in children made FC screening cost-effective, but cost ineffective if the probabilities were ≥85% and ≥78% in adults and children, respectively. Compared to the FC cut-off level of 100 µg/g, the cut-off level of 50 µg/g cost an additional $55 and $43 for adults and children, respectively, but yielded 2.4 and 6.1 additional accurate diagnoses of IBD per 100 screened adults and children. CONCLUSIONS Screening adults and children to measure fecal levels of calprotectin is effective and cost-effective in identifying those with IBD on a per-case basis when the pretest probability is ≤75% for adults and ≤65% for children. The utility of the test is greater for adults than children. Increasing the FC cut-off level to ≥50 µg/g increases diagnostic accuracy without substantially increasing total cost.

A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.