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SUMMARY BackgroundScant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours.

Objective: Prostate specific antigen (PSA) screening for prostate cancer screening is not uniformly recommended by national organizations or primary care physicians (PCPs). Given this lack of consensus, we sought to identify patterns in physician knowledge of and attitudes towards PSA screening and to determine how these patterns along with patient and provider demographics influence PSA screening practices.Methods: A self-administered questionnaire, which assessed provider's knowledge of prostate cancer, confidence in his/her knowledge, and PSA screening practices, was mailed to PCPs at an academic medical center. Frequencies of responses were summarized and 3 outcome variables (knowledge, confidence, and propensity to screen) were derived. Association of covariates with the outcome variables was determined using multivariable logistic regression.Results: Eight-two (30.4%) physicians completed the survey; 98% identified African-American race as a prostate cancer risk factor, 42% identified digital rectal exam and PSA as the accepted screening method, and 59% underestimated the likelihood of prostate cancer in a man with a PSA level Ͼ 4 ng/ml; 19% were confident in their knowledge of prostate cancer; 86% screened fewer than 60% of their male patients over 50. A knowledge score above the median was not associated with a higher propensity to screen (r ϭ 0.06, P ϭ 0.61). Confidence in one's knowledge was correlated with ordering PSA testing (r ϭ 0.33, P Ͻ 0.01). Physician (e.g., ethnicity) and patient (e.g., request for PSA testing) related factors, as well as practice guidelines, particularly those of the US Preventative Services Task Force, influenced providers' decision to offer PSA screening.Conclusions: Respondents correctly identified prostate cancer risk factors but were less knowledgeable about prostate cancer screening tests and overall prostate cancer risk. Most respondents were not confident in their knowledge and did not screen men over 50. Multiple patient-and provider-specific factors influence the decision to offer or not offer PSA screening.

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Leukocyte trafficking to the gastrointestinal tract is recognized to play a role in the pathogenesis of inflammatory bowel disease (IBD). Integrins are expressed on immune cells and interact with cell adhesion molecules (CAM) to mediate leukocyte trafficking. Blockade of the gut-tropic integrin α4β7 and its subunits has been exploited as a therapeutic target in IBD. Natalizumab (anti-α4) is approved for moderate to severe Crohn’s disease (CD), but its use is limited due to potential risk of progressive multifocal leukoencephalopathy. Vedolizumab (anti-α4β7) is approved for the treatment of ulcerative colitis (UC) and CD. It is the most widely used anti-integrin therapy in IBD and has been shown to be effective in both induction and maintenance therapy, with a favorable safety profile. Several models incorporating clinical, genetic, immune, gut microbial, and vitamin D markers to predict response to vedolizumab in IBD have been developed. Etrolizumab (anti-β7) blocks leukocyte trafficking via α4β7 and cell adhesion via αEβ7 integrins. Large phase 3 clinical trials evaluating efficacy of etrolizumab in the induction and maintenance of patients with IBD are underway. Other investigational anti-integrin therapies include abrilumab (anti-α4β7 IgG2), PN-943 (orally administered and gut-restricted α4β7 antagonist peptide), AJM300 (orally active small molecule inhibitor of α4), and ontamalimab (anti-MAdCAM-1 IgG).

Total abdominal colectomy is currently the most common initial operation for patients with ulcerative colitis, and an ileoanal pouch is more frequently constructed at a subsequent hospitalization. These trends coincide with the initiation of biologic treatments and may imply that patients are acutely ill at the time of initial operation. Alternately, there may be surgeon-perceived bias of increased surgical risk or a shift in care to specialized surgeons for pouch construction.

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Abstract Background Data on the incidence of inflammatory bowel disease (IBD) by age group are available in countries outside of the United States or localized populations within the United States. We aimed to estimate the incidence rates (IRs) of IBD by age group using a US multiregional data set. Methods We used the Optum Research Database to identify incident IBD patients with a disease-free interval of 1.5 years between 2005 and 2015. Overall and age-specific IRs were calculated for 4 different age groups: pediatric (0–17 years), young adult (18–25 years), adult (26–59 years), elderly (>60 years). Time trends of incidence were evaluated in each age group. Perianal phenotype (in Crohn’s disease [CD]) was also compared. Results The mean IR for the cohort (n = 60,247) from 2005 to 2015 was 37.5/100,000. The IR was highest in adult and elderly cohorts (36.4 and 36.7/100,000 respectively). In the adult and elderly groups, the IR for UC was higher than that for CD, whereas the opposite was true in the pediatric and young adult groups. The IR increased over the 10-year study period for all age groups (time trends P < 0.001). The elderly group had less perianal disease than the adult group (20.8 vs 22.3%, respectively; P < 0.05). Conclusions In one of the most comprehensive evaluations of the incidence of IBD in the United States, we found an incidence rate similar to those of other national populations. We also confirmed differences of specific IBD phenotypes based on age groups, with lower rates of perianal disease in the elderly.