Background Non-alcoholic fatty liver disease (NAFLD) is an emerging extraintestinal manifestation (EIM) of Crohn’s disease (CD). We aimed to investigate the prevalence and comorbid predictors of NAFLD in patients with CD. Methods We conducted a nationwide retrospective cohort study to determine the prevalence, characteristics, comorbidities, and hospitalization outcomes associated with NAFLD in patients with CD. Comparison between groups was performed by Mann-Whitney test for continuous variables and Chi-square test for categorical variables. We performed a binary logistic regression analysis for predictors of NAFLD among patients with CD. Results We extracted 215,049 index hospital discharges with CD; 2.4% had NAFLD. CD patients, with NAFLD, had increased length of stay (4 days; interquartile range (IQR): 2 - 6 vs. 3; IQR: 2 - 6, P < 0.01), and increased median total charges ($32,305.5; IQR: $18,600 - $61,599 vs. $30,782; IQR: $16,847 - $58,667, P < 0.01), compared to CD patients without NAFLD. Non-alcoholic steatohepatitis (NASH) was found to be independently associated with increased mortality (odds ratio (OR): 1.7; 95% confidence interval (CI): 1.1 - 2.6, P = 0.03) and a higher odd for all-cause 30-day non-elective readmission (OR: 1.6: 95% CI: 1.3 - 1.9, P < 0.001). Factors independently associated with NAFLD in patients with CD included portal hypertension (OR: 5.347; 95% CI: 4.604 - 6.211, P < 0.001), vitamin A deficiency (OR: 9.89; 95% CI: 4.49 - 21.76, P < 0.001) and vitamin B12 deficiency (OR: 1.56; 95% CI: 1.098 - 2.209, P = 0.013). Conclusions NAFLD is associated with worse hospitalization outcomes in patients with CD. Study findings suggest the need for early identification and effective management of NAFLD predictors to reduce complications.

Background There are few studies to evaluate the association between iron deficiency anemia (IDA) and Crohn’s disease (CD). We examined this association in a USA-based cohort of patients with CD. Methods We queried the Nationwide Readmission Databases 2018 using the International Classification of Disease, 10th Revision, and Clinical Modification (ICD-10-CM) codes to identify all adult patients admitted with a diagnosis of CD. Primary outcomes were the prevalence of IDA among patients with CD. Secondary outcomes included inpatient mortality, the length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Multivariate regression analysis was performed to study the impact of IDA on inpatient mortality and non-elective readmissions. Results Of the 72,076 patients discharged from an index hospitalization for CD, 8.1% had IDA. CD patients with IDA had increased length of stays in days (4, interquartile range (IQR): 2 - 6 vs. 3, IQR: 2 - 5; P < 0.001), increased median total charges ($35,160, IQR: $19,786 - $64,126 vs. $31,299, IQR: $17,226 - $59,561; P < 0.001), and were more common to require blood transfusion during hospitalization (13.6% vs. 3.4%, P < 0.001) compared to CD patients without IDA, respectively. IDA was independently associated with increased odds of all-cause 30-day non-elective readmission (odds ratio (OR): 1.254, 95% confidence interval (CI): 1.154 - 1.363, P < 0.001) and increased odds of all-cause 90-day non-elective readmission (OR: 1.396, 95% CI: 1.302 - 1.498, P < 0.001). Conclusions In a large nationwide cohort of patients hospitalized for CD, we observed a significant burden of IDA. Additionally, we found a significant association between IDA and worse hospitalization outcomes.

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INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is a spectrum that ranges from hepatic steatosis to Non-alcoholic steatohepatitis (NASH). NASH can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. (Chao CY et al. World J Gastroenterol). Both NAFLD and Crohn’s disease are associated with increased gut permeability. (Miele L et al Hepatology, Pearson AD et al. Br Med J). Current evidence has shown fatty liver disease to be the most common explanation for abnormal liver tests in patients with IBD. (Gisbert JP et al. Inflamm Bowel Dis). A practical approach may be pursued in identifying patients with IBD at risk for having NAFLD and subsequently identifying patients at an increased risk of morbidity and mortality. METHODS We collected data from the publicly available Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Databases (NRD) 2016, 2017, and 2018. We identified and analyzed the burden of NAFLD amongst individuals discharged with a diagnosis of CD or one of its complications (Figure 1). We studied the characteristics, co-morbidities, and hospitalization outcomes of CD patients with NAFLD. A subgroup analysis was performed for those with NASH. Patients who died in index hospitalization or were discharged in Dec. were excluded from the 30-day readmission analysis. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. We performed a binary logistic regression analysis for predictors of NAFLD among patients with CD. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA). RESULTS We analyzed 215,049 index hospital discharges with Crohn’s disease or one of its complications. 2.4% had NAFLD. Hypertension, diabetes, Dyslipidemia, Obesity, and metabolic syndrome are the five most recognized risk factors for NAFLD in the general population. 35.9% of CD patients with NAFLD had none of those risk factors (Table 1). 0.42 % of CD patients had a diagnosis of NASH. Subgroup analysis for CD patients with NASH showed increased mortality, increased length of stay, and a higher rate of 30-day readmission among CD patients with NASH (Table 2). Predictors of NAFLD in patients with CD are illustrated in Table 3. The chi-square test results indicate that our regression model is a significant improvement in fit relative to an intercept-only model (χ2 = 1593.171, p&lt;.001). CONCLUSION The presence of NAFLD in patients with CD is associated with metabolic syndrome components and CD-specific risk factors. The development of NASH is associated with increased morbidity and mortality in patients with CD. Further studies are needed to investigate the pathogenesis of NAFLD in CD patients.

BACKGROUND Chron's disease is an inflammatory disorder that can involve any part of GI tract but most commonly involves the small intestine. Many of the patients with Cohn’s disease end up requiring surgery, and the 10-year risk of requiring surgery is estimated to be around 50%. The most common type of surgery in patients with Crohn’s disease is ileocecal resection. More than 40,000 ileostomies are formed annually in the United States. Up to 15% of patients who receive ileostomy experience a de novo or community-onset AKI within 90 days. Oral rehydration with iso-osmolar fluids is the mainstay of outpatient management. Both hypotonic fluids, and hypertonic fluids can cause a net flow of fluid into the bowel lumen increasing the ostomy output. We aimed to study the risk of AKI within 30 days in CD patients after an ileostomy procedure. METHODS We collected data from the Healthcare Cost and Utilization Project- (HCUP) Nationwide Readmission Database- 2016- 2018. CD patients were identified and those who received an ileostomy procedure were identified using ICD-10 and PCS-10 codes respectively. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and the Chi-Square test for Categorical variables. RESULTS We identified 214,622 index hospitalizations with CD, 3,789 of whom received an ileostomy procedure. Of those who received ileostomy, 2.1% were readmitted within 30 days for a primary diagnosis of AKI while 2.9% had 30-day readmission with a secondary diagnosis of AKI. CD patients admitted for AKI after ileostomy had a median length of stay of 14 days (IQR: 8-24). CD patients who received ileostomy had a higher rate of 30-day admission for AKI (2.1% vs. 0.3%, P &lt;0.001) and a higher rate of 30-day readmission with a secondary diagnosis of AKI (2.9% vs. 1.5%, P &lt;0.001) compared to CD patients who didn’t receive ileostomy during the index hospitalization. CD patients who received an ileostomy procedure and were readmitted for AKI within 30 days had an average cost of hospitalization of $140,544 (IQR: $85,072 - $242,059). CD patients admitted for AKI within 30 days after an ileostomy were older (59, IQR: 48-69 vs. 47, IQR: 33-61, P &lt;0.001) compared to those who didn’t have a 30day readmission for AKI respectively. CONCLUSION In a nationwide cohort of patients hospitalized with Crohn’s disease, patients who received ileostomy had a significant risk of AKI within 30-days. The development of AKI was associated with significant morbidity, hospital readmission, and elevated costs of hospitalization. Further studies are needed to investigate novel measures to decrease the risk of AKI in this patient population.

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Following propensity matching, there were no differences in baseline characteristics between patients who underwent ESG with a gastroenterologist or bariatric surgeon. There was no difference in AE in ESG performed by either specialty (p .0.05). ESG performed by bariatric surgeons led to a higher rate of reoperations within 30 days (p50.025). ESG performed by gastroenterologists led to more ER visits but did not lead to a higher rate of readmissions or reinterventions. LOS was shorter in ESG performed by gastroenterologists, whereas procedure time was longer. Conclusion: ESG is safely performed by both gastroenterologists and bariatric surgeons. Patients who underwent ESG with a gastroenterologist visited the ER more often, while bariatric surgeons were more likely to re-operate on patients within 30d-perhaps highlighting variations in technique or postprocedural management. Both specialties should continue collaborating to expand access while standardizing procedural technique and competency requirements (Table ).[1081] Figure 1. Sample locations: 1) The elevator tab, 2) instrument channel distal opening, 3) composite duodenoscope tip, and 4) the instrument channel. Samples 1-3 were collected with flocked swabs. The 4th was collected by flushing 25 mL of neutralizing buffer through the instrument channel, then scrubbing the channel with a brush, followed by another 25mL flush. The 50mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Duodenoscope serial numbers were recorded and one duodenoscope grew VRE in Phase 1 and Phase 2.

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