Background & Aims Primary sclerosing cholangitis (PSC) is an idiopathic, cholestatic liver disease with a diverse range of clinical manifestations. Inter‐regional data on PSC are variable, but its global geoepidemiology has not been well‐studied. We aimed to examine the worldwide incidence, prevalence and features of PSC and PSC‐inflammatory bowel disease (PSC‐IBD). Methods A systematic search of multiple databases was conducted to identify all original, full‐text studies until December 2020 with data regarding the incidence rate (IR) and/or prevalence of PSC. Outcomes were PSC IR, prevalence, features and IBD concurrence. Additionally, a meta‐analysis of PSC IR was performed. The study was registered in PROSPERO (CRD42021224550). Results Of the 1003 studies identified, 17 studies spanning three continents were included. PSC IR was 0.60 per 100 000 person‐years (PY) (95% confidence interval: 0.37‐0.88 per 100 000 PY). In pooled subgroup analysis for studies conducted in Europe and North America, PSC IR was 0.62 and 0.53 per 100 000 PY, respectively. PSC prevalence ranged 0‐31.7 per 100 000 persons, with notable inter‐regional differences. Mean age at PSC diagnosis was bimodally distributed, with relative peaks at 15 and 35 years. Mean concurrence of IBD with PSC was 50%, with 76% having ulcerative colitis, 17% Crohn's disease and 8% indeterminate/unspecified IBD. Conclusion While considerable heterogeneity exists in the geoepidemiology of PSC, overall, the classical dogmata of male predilection, bimodal distribution of mean age and high PSC‐IBD concurrence appear to hold true. Despite a seemingly stable IR over time, further studies are needed to better understand the geoepidemiology of PSC.

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Background and Aims Quality metrics were established to develop standards to help assess quality of care, yet variation in inflammatory bowel disease [IBD] clinical practice exists. We performed a systematic review to assess the overall quality of evidence cited in formulating IBD quality metrics. Methods A systematic search was performed on PubMed, MEDLINE, and EMBASE. All major national and international IBD societies were included. Quality metrics were assessed for evidence quality and categorised as category A [guideline based], category B [primarily retrospective and observational studies], or category C [expert opinion]. Quality metrics were examined for the type of metric, and the quality, measurability, review, existing conflicts of interest [COI], and patient participation of the metric. Statistical analysis was conducted in R. Results A total of 143 distinct, and an aggregate total of 217 quality metrics were included and analysed; 68%, 3.2%, and 28.6% of IBD quality metrics were based on low, moderate, and high quality of evidence, respectively. The proportion of high-quality evidence across societies was significantly different [p <0.01]. Five organisations included patients in quality metric development, three reported external review, not all reported measurable outcomes or stated the presence of a COI. Finally, 43% of quality metrics were published more than 5 years ago. Conclusions Quality metrics are important to standardise practice. As more than two-thirds of the quality metrics in IBD are based on low-quality evidence, further studies are needed to improve the overall quality of evidence supporting the development of quality measures.

Leptospirosis often takes clinicians by surprise when presenting in urban locations with unusual manifestations. This delays diagnosis and treatment which increases mortality rate. Our case illustrates the importance of taking into account the socioeconomic backgrounds, environmental exposures, and clinical presentations of patients to create a good differential diagnosis.

Background Sex is thought to play a significant role in predicting outcomes in numerous diseases. The role sex plays in acute pancreatitis (AP) remains limited. We sought to determine if sex is associated with hospitalization outcomes in this population, using a large national database. Methods This was a retrospective study of adult patients with AP utilizing the 2016 and 2017 National Inpatient Sample via ICD‐10 codes. The clinical courses of females were compared to that of males. The primary outcome was all‐cause inpatient mortality. Secondary outcomes, including healthcare utilization, were assessed. Statistical analyses were performed using STATA, version 16.1. Results Of the 553 480 adult patients hospitalized with AP; 25.3% had AP secondary to alcohol (61.4% male, 38.6% female) and 17.44% secondary to gallstones (48.6% male, 51.4% female). Females were significantly older than males (52.81 years vs 50.97 years, P < .01). Females had a significantly lower likelihood of mortality (aOR: 0.69), shock (aOR: 0.64), sepsis (aOR: 0.70), acute kidney injury (aOR 0.66), intensive care unit admission (aOR 0.53), and pancreatic drainage (aOR 0.61) as compared to males (all with P < .01). There was no significant difference between females and males with regards to mean length of stay and hospitalization charges and costs. Conclusions In this large cohort of patients admitted for AP, despite being significantly older, we found that females had significantly improved clinical outcomes, including lower mortality, compared to males. Further prospective studies are needed to accurately understand these differences to guide clinical practice.

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Background & Aims Rates of obesity are rising in patients with inflammatory bowel disease. (IBD). We conducted a United States population-based study to determine the effects of obesity on outcomes in hospitalized patients with IBD. Methods We searched the Nationwide Readmissions Database from 2016-2017 to identify all adult patients hospitalized for IBD using ICD-10 codes. We compared obese (BMI ≥30) vs. non-obese (BMI &lt;30) patients with IBD to evaluate the independent effects of obesity on readmission, mortality, and other hospital outcomes. Multivariate regression and propensity matching were performed. Results We identified 143,190 patients with IBD, of whom 9.1% were obese. Obesity was independently associated with higher all-cause readmission at 30- (18% vs 13% [aOR 1.16, p=0.005]) and 90-days (29% vs 21% [aOR 1.27, p&lt;0.0001]), as compared to non-obese patients, with similar findings upon a propensity matched sensitivity analysis. Obese and non-obese patients had similar risks of mortality on index admission (0.24% vs 0.31%, p=0.18), and readmission (1.5% vs 1.8% p=0.3). Obese patients had longer (5.3 vs 4.9 days) and more expensive ($12,195 vs $11,154) hospitalizations on index admission. Obesity did not affect the risk of intestinal surgery or bowel obstruction. Compared to index admissions, readmissions were characterized by increased mortality (6-fold), healthcare use, and bowel obstruction (3-fold) (all p&lt;0.0001). Conclusions Obesity in IBD appears to be associated with increased early readmission, characterized by a higher burden, despite the introduction of weight-based therapeutics. Prevention of obesity should be a focus in the treatment of IBD to decrease readmission and healthcare burden.