Search

Objective: The aim of this study is to determine the interrater agreement in a clinical practice environment for the most commonly used magnetic resonance enterography (MRE) features of Crohn’s disease (CD). Methods: CD patients with MRE’s before and after treatment were retrospectively identified using search queries over a 7-year period (May 2017–September 2017). MRE features of CD comprising components of multiple CD scoring indices were scored by radiologists in the same segment of bowel. Agreement for nominal categorical and continuous variables was assessed using a κ and interclass correlation coefficients, respectively. Results: 80 scans comprised the study population. Moderate interrater agreement was seen in both the pre- and post-treatment MRE’s for presence of diffusion restriction (к = 0.43, 0.48; pre- and post-treatment), stricturing disease (к = 0.51, 0.52), overall degree of severity (к = 0.49, 0.59). Substantial agreement was seen in pre- and post-treatment scans for length of involvement (interclass correlation coefficient = 0.67, 0.61). The presence of mucosal ulceration had no agreement (к = −0.07, –0.042). Conclusion: Many MRE features of active CD comprising the major CD scoring indices are reproducible when interpreted by non-CD focused abdominal radiologists. However, the presence of mucosal ulcerations had no agreement and may need more investigation before including this feature as a driver in therapeutic decision making. Advances in knowledge: Demonstrates the unreliability of mucosal ulceration by non-CD focused abdominal radiologists, targeting a potential area for future education. Key Points The majority of MRE findings incorporated in to many CD scoring indices have fair to moderate inter-rater agreement even when read by non-MRE expert radiologists. Substantial agreement was seen in the length of involved bowel, but this feature is only incorporated in to one of the CD scoring indices. Presence of mucosal ulcerations had no interrater agreement in our study—a feature which is heavily weighted by several CD scoring indices. Research should be focused bridging those features which have poor interrater agreement.

BACKGROUND: Few studies have examined the metabolic consequences of short bowel syndrome (SBS) and its effects on body composition in adults. We hypothesized that body composition of SBS patients is altered compared to a normal age, race, and sex-matched population, regardless of parenteral nutrition (PN) dependence. AIM: To compare the body composition of adult patients with SBS to age, sex and race matched healthy controls. METHODS: Twenty patients with SBS underwent body composition analysis using the GE Lunar iDXA scanner. Patients were age, sex and race matched to controls from the National Health and Nutrition Examination Survey (1999–2004). Mean differences in body mass index, fat free mass, fat mass, percent body fat, visceral adipose tissue mass and volume, and bone mineral density were measured. Statistical analysis was performed using SAS 9.4 software. RESULTS: Fifty-five percent of subjects had a history of PN use and 30% were current PN users. Mean percent body fat for SBS patients was 35.1% compared to 30.9% for healthy controls (p=0.043). Fat free mass was reduced in SBS (p=0.007). Patients with reduced bone mass had a trend towards significantly more years of PN exposure compared to those with normal bone mass (p=0.0.094), and a trend towards older age (p=0.075). CONCLUSIONS: SBS is associated with increased percent body fat and reduced fat free mass, suggesting that improved dietary and therapeutic interventions are needed to restore normal metabolic indices and avoid risk for metabolic syndrome in SBS patients.

Background Inflammatory bowel disease (IBD) is a chronic luminal disease with genetic and environmental factors affecting phenotype. This study evaluated the relationship between CHRNA5, a nicotinic receptor subunit gene, and smoking in predicting IBD-related surgery as well as the relationship between CHRNA5 and nicotine dependence. Methods Participants completed a smoking questionnaire and were genotyped for CHRNA5 rs16969968. Demographic and clinical data were obtained from medical records. Wilcoxon, ANOVA, Chi square, and Fisher's exact tests were used for comparisons. Logistic regression was used to evaluate the effect of clinical and genetic predictors on surgery, stratified by disease subtype given paradoxical effects of smoking. Kaplan-Meier curves were used to examine the effect of smoking and genotype on time to surgery. (Significance: P AG > GG; P = 0.08]). Smoking and genotype were not independently associated with surgery in UC or CD. However, interaction between rs16969968 and smoking in predicting surgery was observed for both UC (OR = 2.72; P = 0.05) and CD (OR = 2.88; P = 0.1). CHRNA5 genotype, but not smoking, predicted time to surgery in patients with UC (P = 0.007) but not in patients with CD. The interaction between smoking and genotype was not significantly associated with time to surgery in UC or CD. Conclusions The CHRNA5 rs16969968 A variant interacts with smoking to influence IBD-related surgery. 10.1093/ibd/izx094_video1izx094.video15775248538001.

Sa1452 Predictive Validity of the Boston Bowel Preparation Score Within a Hospital Network Comprised of Various Practice Settings Evelyn O. Marquez*, Adeeti J. Chiplunker, Graham A. Colditz, Rebecca Lobb, Jean S. Wang Washington University, St Louis, MO Background: The Boston Bowel Preparation Scale (BBPS) allows for the grading of individual colonic segments (right, transverse, and left colon) to represent colonic visualization. We sought to predict the validity of the BBPS for adenoma detection within a hospital network comprised of various practice settings. Methods: A retrospective review was completed on all outpatient colonoscopies performed from May 2013 to April 2014 in six hospitals including those serving an academic tertiary referral practice, rural setting, inner-city underserved population, and suburban settings. Only colonoscopies that reached the cecum and had complete BBPS scoring were included. Endoscopy and pathology records were reviewed to determine the presence of adenomas. Using the BBPS, we defined adequate colonoscopies as those with scores in each of the three segments of 2 or greater. Inadequate colonoscopies were defined as those with at least 1 segment with a score of 1 or less. Results: A total of 5147 out of 5168 outpatient colonoscopies (57% female, mean age 58 years) met inclusion criteria. There were 23 colonoscopies that had a total BBPS score of 0; 11 had BBPS of 1; 14 had BBPS of 2; 138 had BBPS of 3; 108 had a BBPS of 4; 263 had a BBPS of 5; 1394 had a BBPS of 6; 799 had a BBPS of 7; 1037 had a BBPS of 8; 1373 had a BBPS of 9. Based on BBPS scores given to colonic segments, there were 4464 patients (86%) with adequate bowel preparation (scores in each of the three segments were 2 or greater) and 683 patients (13%) that had inadequate bowel preparation (at least one segment with a score of 1 or less). Adequate bowel preparation based on BBPS had a significantly higher adenoma detection rate (ADR) compared to inadequate bowel preparation with an ORZ1.19 (1.01-1.42), pZ0.04; ADR of 38.2% vs. 34.1%.We then tested various thresholds of total BBPS score. Using a cutoff of total BBPS score of 5, we found that BBPS scoresR5 were associated with significantly higher ADR compared to BBPS scores! 5 with an ORZ1.41 (1.091.82), pZ0.008; ADR of 38.1% vs. 30.4%. In contrast, when using a cutoff of total BBPS score of 6, we found BBPS scores R 6 did not have significantly different ADR compared to BBPS scores! 6 with an ORZ1.17 (0.97-1.41), pZ0.09. Conclusions: A higher BBPS score was associated with a higher ADR. Segment scores all R2 and a cut-off for total BBPS R5 predicted adenoma detection. Adequate bowel preparation throughout the colon based on BBPS (scores in each of the three segments were 2 or greater) had a significantly higher ADR compared to inadequate bowel preparation based on BBPS (at least 1 segment with a score of 1 or less). Total BBPS scores R5 were associated with a significantly higher ADR compared to total BBPS scores! 5.