Background Esophageal inlet patch (IP) with heterotopic gastric mucosa is an incidental finding on esophagogastroduodenoscopy (EGD). Although IP is thought to be embryologic in nature, IP has been associated with Barrett’s esophagus (BE). Aims The aim of this study was to compare prevalence, symptoms, demographic factors, and esophageal testing in patients with IP and BE. Methods We retrospectively analyzed endoscopic findings of EGDs, high-resolution esophageal manometry and esophageal pH impedance studies from January 2010 to January 2021 at a single academic medical center. Patients were grouped by presence or absence of IP and BE. Results Of 27,498 patients evaluated, 1.3% had endoscopic evidence of IP and 4.9% had BE. Of 362 patients with IP, 17.1% had BE; of 1356 patients with BE, 4.6% had IP. Both IP and BE patients presented primarily with heartburn and/or regurgitation. Patients with BE and/or IP were older and had higher BMI than those without ( p < 0.001). Mean lower esophageal sphincter pressure was lower and mean acid exposure time (AET) was higher in patients with IP and/or BE than those without ( p < 0.05). Conclusions Our study reports an IP prevalence of 1.3%, with 17.1% patients having concomitant BE; and a BE prevalence of 4.9%, with 4.6% also having IP. Patients with IP alone presented with similar symptoms to patients with concomitant BE. Esophageal function testing showed that patients with either IP or BE had decreased LES pressures and increased esophageal AET. During endoscopy, patients found to have one of these findings should be carefully examined for the other.

Introduction: Management of symptomatic mature pancreatic fluid collections (PFCs) such as pancreatic pseudocysts or walled-off necrosis now involve the use of lumen-apposing metal stents (LAMS) under endoscopic ultrasound (EUS) guidance. LAMS appear to be superior compared to traditional plastic stents however require close follow up. Numerous studies have shown a benefit of LAMS for short-term (e.g., 4-week) outcomes. However, there is a lack of data evaluating longer term outcomes. Our aim was to investigate 90-day readmission rates after LAMS placement over an 8-year period. Methods: We identified all patients ≥ 18 years who underwent deployment of a LAMS from 01/01/2014 to 06/01/2021 at our urban, safety net hospital. We subsequently collected demographic data, cyst characteristics, and stent information. Follow-up upper endoscopies and imaging were examined to determine stent removal date and assess for complications. Hospital admission rates 90 days before and after stent placement were collected. Admissions were stratified into gastrointestinal (GI)-related or other. Results: We identified 27 patients who underwent LAMS for drainage of mature PFCs. Of these, 18 were simple pancreatic pseudocysts (PP), 6 walled-off necrosis (WON), and 3 mixed collections. Mean age was 52.1 ± 11.0 years, 66.7% male, 66.7 % non-white, and 59.3% reported alcohol use. The average collection was 6.6 ± 2.0 cm. Stents were removed in 81.5% of patients at a median of 37.5 days. 7.4% were lost to follow up, and 22.2% of patients had stent complications during follow-up: 2 bleeding, 2 stent migration, and 2 stent occlusions. Patients on average had 1.00 ± 0.20 hospital admissions in the 90 days prior to stent placement vs 0.48 ± 0.17 admissions 90 days after placement (mean difference 0.52 ± 0.17, p< 0.05). Of these patients, 64.7% of pre-stent hospitalizations were due to GI complaints vs 22.2% of post-stent hospitalizations (p< 0.05). Neither cyst size nor time to stent removal were significantly related to complications. Conclusion: LAMS for the management of mature pancreatic fluid collections were effective at reducing 90-day readmission rates especially in the setting of GI-related complaints. Although there was a delay in LAMS removal with a median of 38 days, it did not appear to translate into higher complication rates. Perhaps an extended use of LAMS beyond 4 weeks may prove to be safe and efficacious, however larger studies are required.

Introduction: Esophageal gastric heterotopia or Inlet Patch (IP) is thought to be embryologic in nature. Barrett’s Esophagus (BE) results from reflux. Though IP has been associated with BE in several studies, their relationship is not well defined. The aim of this study is to investigate the potential HREM, EpHI, and risk factor relationships between IP and BE. Methods: All endoscopic, HREM and EpHI data for patients age ≥ 18 years who had EGD from January 2010 to December 2020 at a single high-volume motility center were reviewed. Patients were grouped by presence or absence of IP and/or BE on EGD. Age, sex, BMI, race, alcohol and tobacco use were recorded. ANOVA and t-test were used to calculate differences in HREM and EpHI testing. A multivariate regression model was constructed to identify independent variables associated with presence of IP and BE. Results: Of 27,598 unique eligible patients who underwent EGD during the study period, 1,294 (4.7%) had endoscopic evidence of BE; 362 (1.3%) had IP, of whom 62 (17.1%) had both IP and BE (p< 0.001). Patients with BE alone, IP alone, and both BE and IP were older and had higher BMI than those without either finding (p< 0.001). HREM was normal in 50% of patients with BE alone, 54% of patients with IP alone, 52% of patients with IP and BE (p< 0.05). Mean lower esophageal sphincter (LES) residual pressure was lower in patients with BE and/or IP when compared to those without either (p< 0.05). EpHI testing was normal in 12% of patients with BE, 32% of patients with IP, 15% of patients with both IP and BE (p< 0.05). Mean acid exposure time (AET) was higher in patients with BE and/or IP than those without (p< 0.001) (Table). On multivariate regression analysis, patients with only BE, only IP, and both IP and BE were all independently associated with increasing age and BMI, male sex, Caucasian race, Hispanic ethnicity, and current smoking (Table). Conclusion: In our upper endoscopy database, BE was seen in 4.7%, IP in 1.3%, with 17% of IP patients also having BE. Patients with BE alone, IP alone, and both IP and BE were found to be older, have higher BMI, lower LES residual pressure, and higher AET when compared to those without either endoscopic finding. Factors such as male sex, BMI, Caucasian race, active smoking status were independently associated with BE alone, IP alone, and IP and BE findings. Endoscopic testing and risk factor analysis in individuals with these risk factors should be performed with careful esophageal inspection for both BE and IP.Figure 1.: Differences in Mean High Resolution Esophageal Manometry (HREM) and Esophageal pH-Impedance (EpHI) Testing Characteristics in Patients With and Without Barrett’s Esophagus (BE) and Inlet Patch (IP) [BLUE: Patients without BE or IP; ORANGE: Patients with BE Only; GRAY: Patients with IP Only; YELLOW: Patients with Both BE and IP] Table 1. - Multivariate Regression of Risk Factors for Barrett’s Esophagus-Only Patients vs Those With Only Inlet Patch vs Those with BE and IP Factors Patients with only Barrett’s Esophagus Patients with only Inlet Patch Patients with Both Inlet Patch and Barrett’s Esophagus OR 95% CI p-Value OR 95% CI p-Value OR 95% CI p-Value Age 1.02 1.02-1.03 < 0.001 1.04 1.04-1.05 < 0.001 1.05 1.05-1.06 < 0.001 BMI 1.20 1.20-1.21 < 0.001 1.02 1.01-1.02 < 0.001 1.11 1.09-1.11 < 0.001 Sex Female Ref - - - - - - - - Male 2.22 1.96-2.51 < 0.001 1.47 1.16-1.85 < 0.001 1.30 1.29-1.31 < 0.001 Race African American Ref - - - - - - - - Hispanic 1.17 1.01- 1.37 < 0.001 1.65 1.19 -2.29 < 0.001 1.12 1.11-1.14 < 0.001 Caucasian 1.87 1.64- 2.15 < 0.001 2.51 1.86- 3.39 < 0.001 1.68 1.67-1.70 < 0.001 Asian 0.66 0.40- 1.09 0.11 0.33 0.22-0.45 0.17 0.89 0.75-0.92 0.54 Smoking Status Non-Smoking Ref - - - - - - - - Current Smoker 1.02 1.02-1.03 < 0.001 1.12 1.11-1.13 < 0.001 1.08 1.07-1.10 < 0.001 Alcohol Status Non-Alcohol Drinker Ref - - - - - - - - Current Alcohol Drinker 0.46 0.28-0.76 < 0.001 0.83 0.65-1.05 0.12 0.82 0.88-1.05 0.55

Introduction: Although non-modi fi able factors such as age, sex, and race have been associated with increased risk of developing colon cancer, there are limited studies investigating modi fi able factors. Some studieshaveshown fi berandcalciumtobeprotective,whileprocessedmeatsandalcoholtoberiskfactors.Thedata,however,remainscontroversial.Theaimsofthisstudyareto1)re-evaluatetheepidemiology of colon cancer and 2) explore the nutritional status of those with early colon cancer diagnosis. Methods: The National Health and Nutrition Examination Survey (NHANES) is a survey designed to assess the health and nutritional status of adults and children across the United States (US). Nutritional information wascollected viaa 24-hour diet recall, and thosewith reliable recallwere demographic andnutritional who self-reported The sample size was appropriately weighted strati ed years age analysis. Results: There were 5,767,593 self-reported cases of colon cancer in the US from 2007-2016 with reliable nutritional recall. Demographic data strati fi ed by cohort is outlined in Table along with caloric and dietary intake. The average age of colon cancer diagnosis was 56.5 6 15.3 years of which 19.4% were diagnosed early (age , 45). Univariate analysis showed those with early diagnosis had higher calorie (p , 0.001), fi ber (p , 0.001), calcium (p , 0.001), ca ff eine (p , 0.001), and alcohol consumption (p , 0.001) than those diagnosed over 45. After controlling for BMI, race, sex, education, and income using logistic regression, we found that patients with higher caloric intake ( $ 2000 kcal) were more likely to be diagnosed with early onset colon cancer (OR: 3.81, 95% CI: 3.79-3.82). Conclusion: There were on average 576,759 reported cases of colon cancer per year in the US of which approximately 1/5 th were diagnosed before 45. Females, non-Hispanic whites, and higher education/ income were associated with early colon cancer diagnosis possibly due to earlier screening. Contrary to other studies, higher fi ber and calcium intake did not appear to be protective. However, those with early diagnosis did have higher alcohol intake. Our data suggests those with high caloric intake, a modi fi able risk factor, increases the odds of developing early cancer by over threefold, perhaps due to chronic underlying in fl ammation. angiotensin-converting enzyme 2 (ACE2) and cellular serine proteases (TMPRSS2) in enterocytes, which cause altered intestinal permeability. The purpose of this study was to determine the incidence of diarrhea as it relates to COVID-19 infection and to determine if having concomitant diarrhea had a signi fi cant impact on disease course. Methods: A retrospective chart review of 164,730 patients in a hospital system who were older than 18 years of age and had a positive SARS-CoV-2 test from March 2020 to February 2022 was completed. Diarrhea was determined using ICD code or patient ’ s symptoms. Patients with confounding variables such as IBD, IBS, Celiac, Clostridium di ffi cile, and pancreatic insu ffi ciency were excluded. Demographic

To characterize outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19) who present with gastrointestinal (GI) symptoms. Clinical outcomes in patients with COVID-19 associated with GI symptoms have been inconsistent in the literature. The study design is a retrospective analysis of patients, age 18 years or older, admitted to the hospital after testing positive for COVID-19. Clinical outcomes included intensive care unit requirements, rates of discharges to home, rates of discharges to outside facilities, and mortality. Seven hundred fifty patients met the inclusion criteria. Three hundred seventy three (49.7%) patients presented with at least one GI symptom and 377 (50.3%) patients presented with solely non-GI symptoms. Patients who presented with at least one GI symptom had significantly lower ICU requirements (17.4% vs 20.2%), higher rates of discharges home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and decreased mortality (6.4% vs 9.8%) compared with patients with non-GI symptoms. However, patients who presented with solely GI symptoms had significantly higher ICU requirements (23.8% vs 17.0%), lower rates of discharges home (52.4% vs 78.7%), higher rates of discharges to facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared with those with mixed GI and non-GI symptoms. Although patients with COVID-19 requiring hospitalization with GI symptoms did better than those without GI symptoms, those with isolated GI symptoms without extra-GI symptoms had worse clinical outcomes. COVID-19 should be considered in patients who present with new onset or worsening diarrhea, nausea, vomiting, and abdominal pain even without pulmonary symptoms.

Introduction: While opioids can be effective management for analgesia, GI side effects can limit tolerability. Chronic opioid use (OU) is associated with opioid-induced constipation (OIC) through slowing of GI transit. Studies have noted possible associations between OU and dyssynergic defecation (DD). The aim of this study was to identify chronic OU amongst patients who underwent anorectal manometry (ARM) testing to determine dose or exposure related effects on anorectal function. Methods: We conducted a retrospective study of patients who had ARM from January 2015 to October 2021. OU was determined by pre-procedure questionnaire and medical record review. OU was considered at least one month of use at time of ARM and was standardized based on morphine milliequivalents (MMEs). Results: Demographics are summarized in Table. Of 773 patients undergoing ARM, 12.7% had chronic OU. OU was associated with having DD; Type 1 DD being most common (p< 0.001). Chronic OU patients were older than patients without OU (p< 0.001). ARM in chronic OU patients was performed more often for constipation, constipation and fecal incontinence, and constipation and diarrhea when compared to patients without OU (p=0.04). Chronic OU patients were more likely to have abnormal balloon expulsion time (BET) defined as > 60 seconds (p< 0.001). Within OU, patients were divided into low and high dose of opiates for likelihood of DD findings on ARM (Figure). The lowest group dosing that reached significance defined low OU as 0-10 MME and high OU as ≥10 MME (p=0.005). Of the 34 low dose patients, 67.6% had DD; of the 64 high dose patients, 95.3% had DD (p=0.004). High dose OU was associated with fewer normal ARM tests and more Type I-III DD (p=0.005). Of the chronic OU, high dose patients were more likely to have abnormal defecation index (DI) defined as < 1.4 compared to low dose patients (p=0.006). Conclusion: Our data suggests a correlation between OU and ARM indications as well as OU and DD. We also found that 10 MME was the opioid dose threshold above which there is a greater association with anorectal dysfunction. Chronic OU patients suffered from constipation, were older, and had greater abnormal BET than those without OU, suggesting exposure-dependent association with OU. DI was abnormal at high dose OU compared to low dose OU, suggesting dose-dependent association with OU. Our study suggests that OIC can be associated with DD in addition to the known delayed colonic transit.Figure 1.: Presence of Dyssynergic Defecation in Low Dose Opioid Use and High Dose Opioid Use Groups (Blue: Normal ARM, Orange: Dyssynergic Defecation on ARM) [p=0.004] Table 1. - Distributions and Variables for Non-Opioid Users and Opioid Users in Patients undergoing Anorectal Manometry Non-Opioid(n=675) All Opioid(n=98) p-Value Low Dose (0-10 MME) Opioid(n= 34) High Dose ( > 10 MME) Opioid(n=64) p-Value Gender Male 142 (20%) 24 (24%) 0.43 7 (20.6%) 17 (26.6%) 0.62 Female 533 (80%) 74 (66%) 27 (79.4%) 47 (73.4%) Age (mean) y 48.7 + 16.0 56.0 + 16.9 < 0.001 55.9 + 17.0 56.0 + 17.0 0.98 ARM Indication Constipation 511 (75.6%) 78 (79.6%) 0.04 24 (70.6%) 54 (84.4%) 0.14 Fecal Incontinence 120 (17.8%) 13 (13.3%) 8 (23.6%) 5 (7.8%) Constipation and Fecal incontinence 23 (3.5%) 5 (5.1%) 1 (2.9%) 4 (6.2%) Fecal Urgency 8 (1.2%) 0 - - Incomplete Defecation 2 (0.3%) 0 - - Diarrhea 10 (1.5%) 0 - - Constipation and Diarrhea 1 (0.1%) 2 (2%) 1 (2.9%) 1 (1.6%) ARM Result Normal 281 (41.6%) 14 (14.3%) < 0.001 11 (32.4%) 3 (4.7%) 0.005 Type I DD 174 (25.8%) 43 (34.9%) 10 (29.4%) 33 (51.6%) Type II DD 33 (4.9%) 9 (9.2%) 2 (5.9%) 7 (10.9%) Type III DD 116 (17.2%) 18 (18.4%) 6 (17.6%) 12 (18.8%) Type IV DD 71 (10.5%) 14 (14.3%) 5 (14.7%) 9 (14.1%) Defecation Index Abnormal (< 1.4) 502 (74.3%) 80 (81.6%) 0.13 21 (61.8%) 59 (92.2%) 0.006 Normal ( >1.4) 174 (25.7%) 18 (18.4%) 13 (38.2%) 5 (7.8%) Balloon Expulsion Time Abnormal ( >60sec) 238 (35.3%) 64 (65.3%) < 0.001 21 (61.8%) 43 (67.2%) 0.65 Normal (< 60 sec) 436 (64.7%) 34 (34.7%) 13 (38.2%) 21 (32.8%) Sensory Threshold Low 155 (22.9%) 26 (26.5%) 0.50 11 (32.4%) 15 (23.4%) 0.33 Normal 339 (50.1%) 43 (43.9%) 16 (47.1%) 27 (42.2%) High 182 (26.9%) 29 (29.6%) 7 (20.6%) 22 (34.4%) Mean sphincter pressure (resting) mmHg 64.60 + 23.6 63.50 + 25.3 0.66 58.6 + 25.3 66.1 + 25.2 0.16 Max sphincter pressure (squeeze) mmHg 157.5 + 68.0 147.0 + 62.9 0.15 138.6 + 64.9 151.5 + 61.8 0.33

Rishabh Khatri: NO financial relationship with a commercial interest | Jay Patel: NO financial relationship with a commercial interest | Jun Song: NO financial relationship with a commercial interest | Zachary Jurkowski: NO financial relationship with a commercial interest | Neil Nadpara: NO financial relationship with a commercial interest | Tiffany Lambrou: NO financial relationship with a commercial interest | Marlana Radcliffe: NO financial relationship with a commercial interest | Kamal Baig: NO financial relationship with a commercial interest | Woo Jung Lee: YES financial relationship with a commercial interest;Olympus:Consulting | Saraswathi Cappelle: NO financial relationship with a commercial interest | Stephen Heller: YES financial relationship with a commercial interest;Olympus:Consulting | Frank Friedenberg: NO financial relationship with a commercial interest

Introduction: Gastrointestinal (GI) cases of rumination syndrome (RS) are not well described in COVID-19. RS is defined as postprandial regurgitation of swallowed food without retching for 3 months, with symptom onset ≥ 6 months prior. We report a patient with COVID-19 who was diagnosed with RS as a result of his disease. Case Description/Methods: A 19-year-old male with history of Ehlers-Danlos, postural orthostatic tachycardia syndrome, adrenal insufficiency, transferred from an outside hospital for persistent vomiting. He described regurgitation of swallowed food without retching, abdominal bloating, constipation, early satiety and weight loss. Prior to endoscopic procedures, a nasopharyngeal swab was obtained and was positive for SARS-CoV-2. He was discharged to self-quarantine and prescribed anti-reflux, anti-emetic, and laxative medications. He returned with persistent symptoms and 10 pound weight loss in 4 weeks. Gastric emptying study showed no abnormalities [2 hour study 40% of the radiolabeled meal remained in the stomach (normal < 60%); 4 hour, 6% of the meal in the stomach (normal < 10%)]. Barium swallow revealed no reflux in the esophagus. Esophageal pH-impedance study showed no abnormalities [0.4% of time with pH < 4 (normal < 4.5%)]. He was felt to have RS and was instructed to perform postprandial diaphragmatic breathing exercises. Though bloating, constipation, and early satiety improved, he still endorsed postprandial regurgitation 6 weeks later. High resolution esophageal manometry testing at this time showed no abnormalities per Chicago Classification and adequate peristalsis with normal relaxation of the lower esophageal sphincter with median integrated residual pressure of 13.5 mmHg (normal < 15 mmHg) and 92% of swallows with complete bolus clearance (normal > 80%). He was instructed to continue abdominal breathing exercises and prescribed a serotonin selective reuptake inhibitor, escitalopram. 12 weeks later, he reported resolution of postprandial regurgitation and associated symptoms. Due to the continuity of postprandial regurgitation, despite anti-reflux meditations, no observable abnormalities on diagnostic studies, RS was diagnosed according to the Rome IV criteria, as a sequelae of COVID-19. Discussion: This patient presents with RS, possibly as a GI sequelae from his COVID-19 viral infection. This case illustrates the importance of recognizing COVID-19 as a possible etiology in patients who develop new onset functional disorders, including RS, as illustrated by this case report.

Introduction: Gastrointestinal (GI) cases of functional dyspepsia (FD) are not well documented in patients with COVID-19. FD is characterized by early satiety, abdominal fullness, pain and burning, without structural or functional pathology for 3 months with onset ≥ 6 months prior by the Rome IV criteria. We report a patient with COVID-19 who developed FD as a result of her viral disease. Case Description/Methods: A 57-year-old-female with a history of well controlled Celiac disease and Vitamin D deficiency presented to the emergency department (ED) after recently testing positive for COVID-19 less than 3 weeks prior via nasopharyngeal swab. Upon arrival, she described symptoms of nausea, vomiting, non-bloody diarrhea, early satiety, abdominal pain, fullness, and burning after meals, and weight. She weighed 63.1 kg compared to her normal weight of 67.6 kg. She was discharged from the ED with instructions to self-quarantine and prescribed anti-reflux medications. 4 weeks later, she followed with our institution via Telemedicine visit for her persistent symptoms endorsing increased frequency (multiple times a week) of early satiety, abdominal pain, burning, and severe nausea after eating, and increased fatigue and weight loss. She underwent esophagogastroduodenoscopy (EGD) and gastric emptying study (GES) to evaluate her symptoms. No structural or histologic abnormalities were found via EGD and mucosal biopsies. GES was normal [2 hour study 53% of the radiolabeled meal remained in the stomach (normal less than 60%); at 4 hours there was 2% of the meal in the stomach (normal less than 10%)]. Her weight at this time was 61.7 kg. Upon follow up 4 weeks later, her symptoms persisted. She was prescribed a proton pump inhibitor at this time. Upon follow up 2 weeks later, her symptoms persisted. With no observable structural pathology on EGD, defect on GES, and negative H. pylori testing, FD was diagnosed according to the Rome IV criteria, as a presumed sequelae of COVID-19. She was prescribed the tricyclic antidepressant, amitriptyline, with improvement in her symptoms at follow up visit 6 weeks later. Discussion: This patient had persistent dyspeptic symptoms after her initial COVID-19 infection, which presented primarily with GI symptoms. This case illustrates the development of FD after a COVID-19 illness, post-COVID-19 FD. She was treated conventionally for FD, and improved. Thus, COVID-19 may be a possible etiology in patients who have the onset of FD symptoms without other contributing causes.

Introduction: Management of biliary leaks can involve nonsurgical interventions as part of the standard of care in hemodynamically stable patients. Studies indicate that endoscopic retrograde cholangiopancreatography (ERCP) is a beneficial nonsurgical procedure, as it reduces time to resolution of bile leak in iatrogenic injury and blunt hepatic trauma. Less research supports the role of ERCP in penetrating liver injuries, though studies suggest a benefit for these patients as well. Our aim was to examine patients with penetrating liver trauma who underwent ERCP to analyze if this was associated with clinical improvement, as manifested by decreased drain output. Methods: We conducted a retrospective study of patients with suspected bile leaks following penetrating liver injury from gunshot wounds. Our primary variable was relevant surgical drain output as determined by location. Other data collected included biliary stent size/location, degree of liver injury, and liver function tests (LFTs). Comparisons were assessed for 7 days pre and post ERCP with Wilcoxon Signed Rank tests. Results: We identified 10 male patients with suspected bile leaks following gunshot wounds who underwent ERCP with sphincterotomy and stenting of the biliary tree following surgery. For all, biliary injury was suspected due to bilious output from relevant surgical drains or bilothorax on chest tube drainage in one case. Mean combined drain output pre-ERCP was 112.03 mL/day and post-ERCP it was 63.97 mL/day. The difference was statistically significant (P=0.005). By day 7 post ERCP, 8 patients had at least a 25% reduction in output and 4 patients had at least a 50% reduction. 7 patients had sufficient LFT data for analysis. Post-ERCP mean total bilirubin levels decreased, while mean levels of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase increased. Differences were not statistically significant, however. Conclusion: Our results show that ERCP correlates with decreased biliary drain output in the immediate post intervention period. The lack of significance with LFT trend analysis suggests that following relevant drain output may be a more useful prognostic factor than following post-ERCP LFTs in this patient population. Future directions include analyzing differences in ERCP interventions (i.e. stent size or location of stent placement), timing of ERCP, and comparison with surgery-only outcomes.

Introduction: Coronavirus Disease 2019 (COVID-19) can present with a variety of symptoms. We investigated outcomes in patients with COVID-19 presenting with gastrointestinal (GI) symptoms. Methods: We retrospectively analyzed inpatients age >18 years with COVID-19 from March 2020 to June 2020 in our urban, academic, safety-net hospital. Patients were stratified based on whether they presented with only GI (Only-GI), only non-GI (Non-GI), or a combination (Mixed-Sxs) of symptoms. GI symptoms included abdominal pain, diarrhea, nausea, and vomiting. Non-GI symptoms included generalized (anorexia, fatigue, fever), pulmonary (cough, dyspnea), and head & neck (anosmia, dysgeusia) symptoms. Results: Of 750 patients admitted during the study period, 373 (49.7%) had GI symptoms: 106 patients with abdominal pain, 219 with diarrhea, 196 with nausea, and 123 with vomiting. 21 (2.8%), 377 (50.3%), and 352 (46.9%) patients were in the Only-GI, Non-GI, and Mixed-Sxs cohorts, respectively, with mortality rates of 19.0%, 9.8%, and 5.7% (P = 0.006). Comparing patients with GI symptoms, the Only-GI cohort had higher intensive care unit (ICU) requirements (23.8% vs 17.0%), lower rates of discharges to home (52.4% vs 78.7%), higher rates of discharges to other facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared to the Mixed-Sxs cohort (P = 0.02, Table 1). Univariate logistic regression analysis found higher mortality rates in the Only-GI group compared to the Mixed-Sxs group (OR: 3.9, 95% CI: 1.1-11.8, P = 0.02). Comparing patients with any GI symptoms (Only-GI and Mixed-Sxs cohorts) and no GI symptoms (Non-GI), those with GI symptoms had lower ICU requirements (17.4% vs 20.2%), higher rates of discharges to home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and lower mortality rates (6.4% vs 9.8%) [P = 0.02, Table 1]. Mortality associated with multi-organ dysfunction was higher in patients with GI symptoms (41.7% vs 5.4%) and respiratory failure was higher in patients without GI symptoms (70.3% vs 45.8%) [P = 0.02]. Conclusion: Half of our patients hospitalized for COVID-19 presented with GI symptoms. Patients who presented with only GI symptoms comprised a small minority (2.8%); however, these patients had worse outcomes compared to those who presented with concomitant GI and non-GI symptoms. These patients also had the higher ICU requirements (23.8%) and mortality rates (19.0%) than those with mixed symptoms (17.0%, 5.7%) and Non-GI symptoms (20.2%, 9.8%).Table 1.: Patient outcomes comparing those with GI symptoms and mixed symptoms as well as those with any GI symptoms and no GI symptoms.

Introduction: Barrett’s Esophagus (BE) is a premalignant condition by which metastatic columnar mucosa replaces the normal stratified squamous mucosa in the distal esophagus. Most cases occur in older white males with a long-standing history of acid reflux. Our aim was to conduct a cross-sectional study examining trends in demographics and medications use of BE patients in the US from 2005-2016. Methods: The CDC’s National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 code 530.85 (BE), we identified patients with BE for the period 2005-2016. For these patients, we identified patients with GERD (ICD-9 530.81 or 530.11) and used visit codes to identify presenting symptoms and drug codes to evaluate PPI and H2 blocker use. Weighting of encounters using SPSS were performed to provide population estimates. Results: There were 6,803,008 unique outpatient visits for BE. Mean age was 61.2 ± 14.7y, 57.9% male, and 95.6% non-Hispanic white. Mean age in males was 58.7±14.5y vs females 64.8 ± 14.3y (p< 0.01). Median BMI was 25.8, 16.6% of patients were obese, and 14.8% had current tobacco use. Overall, 69.6% of visits were to a gastroenterologist (GI), 26.9% to a primary care provider (PCP), and 3.5% to surgery. Mean time spent per visit was 21.8± 11.2m. Among presenting complaints for the visit, 7.4% had abdominal pain, 5.6% had dysphagia, 2.8% with heartburn, and most had no GI complaints. 34.6% of patients had concomitant GERD. Most patients were on PPI therapy (69.4%): 23.4% on esomeprazole, 23.3% omeprazole, 14.1% pantoprazole, and 8.8% lansoprazole. 29.5% were no PPI or H2 blocker, 5.6% were on H2 blocker in addition to PPI, and 5.6 % were on aspirin. PPI use has significantly decreased from 86.3% in 2005-2008 to 62.7% in 2009-2012 to 62.1% in 2013-2016 (p< 0.01). Conclusion: Our nationwide results reaffirm that BE predominantly affects older, obese, white, males. Over one-third of BE patients had GERD, which is 3 times higher than the general population supporting the association. Most BE patients were asymptomatic during their office visit and were primarily seen by a GI specialist. Current guidelines recommend indefinite PPI use for patients with BE; our study showed that though most were on PPI, one-third of patients are not at their office visits when predominantly asymptomatic and PPI use has decreased over time. Continued vigilance in treating patients with BE is needed.

Introduction: Esophageal inlet patch (IP) are ectopic location of gastric mucosa in the proximal esophagus, identified on esophagogastroduodenoscopy (EGD) procedures as pink, round or ovular patches in the proximal esophagus. The prevalence of IP and its possible association to Barrett’s Esophagus (BE) has been suggested. We investigated patients with IP who presented for endoscopic procedures at our institution. Methods: We retrospectively analyzed EGD reports for patients age ≥ 18 years who had EGD completed from January 2010 to December 2020 at our institution. Patients were separated on whether IP and BE was present on EGD. Patient demographic data including age, gender, BMI, race (white, Hispanic, African-American, or other), ethnicity (Hispanic or non-Hispanic), alcohol (current or never) and tobacco (current, prior, or never) use were recorded on patients with evidence of IP in EGD. Results: Of 25,010 unique patients who underwent EGD during the study period, 362 (1.4%) had inlet patch findings. Of these IP patients, 62 of the 362 patients (17.1%) had endoscopic evidence of Barrett’s Esophagus in comparison to 1243 (4.9%) of the 25,010 patients in this study period (p< 0.001). Additionally, in patients without IP who had BE, were older than patients without BE (p < 0.001) as well had statistical significance between gender, with high contribution from males (p < 0.001). Overall, of the 362 IP patients, 182 (50.5%) were males, mean age 51.5 ± 15.6 years, and BMI 28.9 ± 6.9 kg/m2. Racial distribution entailed 96 (26.4%) Hispanic, 182 (50%) white, 69 (19.6%) African-American with 100 (27.5%) patients identified as ethnically Hispanic. Additionally, 210 (57.9%) IP patients endorsed current alcohol use. Comparing IP patients with BE to IP patients without BE, the mean age of patients was higher in patients with BE and IP, compared to BE alone (P=0.044). There was significant correlation between gender, with male contributing more than female (p < 0.001), race (0.002), and alcohol use (0.043), but not BMI (0.939), ethnicity (0.198) and tobacco use (0.836) in patients with IP. Conclusion: IP was detected in 1.4% of upper endoscopies at our institution with higher prevalence in patients with BE (4.9%). Furthermore patients with BE and IP, were found to be older age, male gender, white race, and had decreased consumption of alcohol compared to BE alone. Whereas, BMI, ethnicity, and tobacco use were not. Identification of IP on EGD should lead to careful evaluation of the esophagus for BE.Table 1.: Prevalence and Demographic Data of Patients who Underwent EGD between 2010-2020: Barrett's Esophagus and Inlet Patch.