Background/Objectives: Micronutrient deficiencies are common in inflammatory bowel disease (IBD) and contribute to anemia, impaired wound healing, neurologic injury, and adverse disease outcomes. Major societies, including ESPEN, ACG, and ECCO, recommend nutritional and micronutrient assessment in patients with IBD, yet few studies describe how comprehensively these recommendations are applied during hospitalization. This study aimed to characterize inpatient testing practices for vitamins B1, B6, B12, and zinc in hospitalized IBD patients, quantify deficiency frequency among those tested, and identify gaps between guideline-recommended and actual micronutrient assessment. Methods: A retrospective chart review was performed on adults with Crohn’s disease (CD) or ulcerative colitis (UC) hospitalized for an IBD flare at a tertiary care center. Demographics, comorbidities, and deficiency-associated clinical features were recorded. Yield was defined as the proportion of tested patients meeting institutional deficiency thresholds. Yield for each non-B12 micronutrient was compared with B12 as an internal benchmark. Results: Among 356 patients (285 CD, 71 UC), inpatient micronutrient testing was markedly imbalanced: B12 was tested in 97.2%, whereas B6, B1, and zinc were tested in only 34.8%, 30.6%, and 18.8%, respectively. Among those tested, deficiencies were common: B6 40.3%, zinc 32.8%, B1 22.9%, and B12 9.0%. Each non-B12 micronutrient yielded deficiency significantly more often per test than B12 (all p < 0.001), a testing-yield mismatch interpreted cautiously given selective testing of non-B12 nutrients. Deficiency frequencies did not differ significantly between CD and UC. Clinical contexts included tachycardia and edema (B1); elevated inflammatory markers and thromboembolism history (B6); anemia and neuropathy (B12); and diarrhea and hypoalbuminemia (zinc). Conclusions: Inpatient micronutrient assessment in IBD is heavily skewed toward B12, with B1, B6, and zinc under-tested despite a substantially higher yield of identified deficiency per test. This testing-yield mismatch represents a measurable implementation gap between guideline-recommended comprehensive assessment and actual inpatient practice; whether systematic panel-based assessment improves clinical outcomes warrants prospective evaluation.

INTRODUCTION:Crohn's disease and ulcerative colitis are characterized by chronic inflammation of the gastrointestinal tract. Mucosal healing (MH) is a therapeutic goal in patients with inflammatory bowel disease (IBD). Current data suggest that Black patients may experience worse clinical outcomes than White patients with IBD. This study assessed MH between Black and White patients with IBD. METHODS:Retrospective analysis was performed on Black and White adults with IBD who were hospitalized for an active flare. The presence of MH was assessed at 6-18 months after hospitalization. IBD treatments received before and during hospitalization, within 6 months, and 6-18 months after discharge were recorded. C-reactive protein (CRP) levels were collected at hospitalization and 6-18 months after discharge; the difference was reported as delta CRP. RESULTS:One hundred nine patients were followed up after hospitalization. Of those 88 (80.7%) were White patients, and 21 (19.3%) were Black patients. White and Black patients received similar proportions of IBD treatment before ( P = 0.2) and during ( P = 0.6) hospitalization, within 6 months ( P = 0.1), and 6-18 months ( P = 0.1) after discharge. Black patients achieved numerically higher rates of MH (15/21 = 71.4% vs 53/88 = 60.2%, P = 0.3) and delta CRP ( P = 0.2) than White patients, however, not statistically significant. DISCUSSION:In patients admitted to the hospital with an IBD flare with similar treatment and care, there was a trend toward higher rates of MH in Black patients compared with White patients. These data suggest that MH is likely not the only factor that is associated with Black patients experiencing worse clinical outcomes when compared with White patients.

Background Micronutrient deficiencies associated with malnutrition in patients with inflammatory bowel disease (IBD) can lead to complications including anemia, coagulopathy, poor wound healing, and colorectal cancer. This study aimed to investigate micronutrient deficiencies (copper, vitamins A, B9, E, and K) in IBD patients and highlight associated symptoms to aid in the recognition of micronutrient deficiencies. Methods A retrospective electronic chart review was performed on adults diagnosed with Crohn’s disease or ulcerative colitis hospitalized at a tertiary care center for IBD flare between January 2013 and June 2017. Patients with serum or whole blood micronutrient levels were included. Pregnant and incarcerated patients were excluded. Results A total of 611 IBD patients (440 Crohn’s disease, 171 ulcerative colitis) met the inclusion criteria. Micronutrients were assessed in a subset of IBD patients (copper: 12.3%, A: 10.1%, B9 : 95.9%, E: 10.3%, and K: 4.6%). Overall, 10.1% of patients had micronutrient deficiencies. The proportion of patients with copper, A, B9, E, and K deficiencies were 25.4, 53.3, 1.9, 23.7, and 29.4% for Crohn’s disease and 50, 52.9, 1.2, 43.8, and 18.2% for ulcerative colitis, respectively. The most common symptoms or historical features associated with micronutrient deficiency were anemia (copper, B9), muscle weakness (copper, E) thrombocytopenia, fatigue (copper, B9), diarrhea (B9), dry skin, hyperkeratosis, pruritus, significant weight loss, elevated C-reactive protein (A), bleeding, and osteoporosis (K). Conclusion Micronutrient deficiencies are common in IBD patients, yet they are not routinely assessed. Copper, vitamins A, E, and K deficiencies are particularly underrecognized. Associated historical features should raise suspicion and prompt assessment and treatment.

repository and electronic chart review. This study was approved by the institutional review board. Results: A total of 760 unique patients were analyzed of which 519 (348 CD, 160 UC, 11 indeterminate) met inclusion criteria. The cohort consisted of the characteristics outlined in Table 1. Of these 519 patient records, 118 (22.7%) had both XCI and colonoscopy during hospitalization, 178 (34.3%) had XCI and 72 (13.9%) had colonoscopy. One hundred and seventeen patients (102 CD, 14 UC, 1 indeterminate) had follow-up at 18-months. The follow-up cohort consisted of the characteristics outlined in Table 1.Of these, 22 (18.8%) had both XCI and colonoscopy, 67 (57.2%) had XCI and 26 (22.2%) had colonoscopy. Mucosal healing was achieved in 70/117 (59.8%) patients. In CD, 61/102 (59.8%) achieved mucosal healing and in UC, 9/14 (64.3%) achieved mucosal healing. Conclusion: Mucosal healing was achieved in over half of patients within 18-months of initiation or adjustment of IBD therapy. Mucosal healing was achieved in similar proportions of CD and UC patients at 18-months.

Introduction: C-reactive protein (CRP) and albumin are two hepatic proteins that have been used to assess inflammation and nutritional status, respectively. The CRP to albumin ratio has been used for prognostication in patients with solid tumors and provides a more consistent marker for mortality in septic patients. The aim of this study was to compare the CRP/albumin ratio versus CRP alone in correlation with active inflammation in IBD. Additionally, we stratified this analysis by inflammation severity. Methods: Retrospective analysis of adults with an ICD-9/10 code diagnosis of IBD during hospitalization for IBD flare symptoms at a tertiary care center between January 1st 2013 to June 1st 2017. Active inflammation was defined by chronic active histologic changes seen on targeted ileal or colonic biopsies or by inflammation seen in terminal ileum or colon on XCI or colonoscopy. Data including the patients’ XCI and colonoscopy reports were extracted from the institution’s integrated electronic data repository and electronic chart review. This study was approved by the institutional review board. To determine the relationship of the CRP/albumin ratio versus CRP alone with active inflammation, Spearman’s correlation analysis was used. The Z-statistic was used to compare the areas under the receiver operating curve (AUC). Results: A total of 760 unique patients were analyzed of which 519 (348 CD, 160 UC, 11 mixed) met inclusion criteria. Two hundred and twenty five were found to have active inflammation with 42.2% having albumin and 35.4% having CRP on hospital admission. The cohort consisted of the characteristics outlined in Table 1. CRP/Albumin ratio had significant correlation to active inflammation (r=0.14, p< 0.0329). ROC analysis (Figure 1a) showed increasing AUC with no inflammation, mild, moderate and severe disease activity (0.482, 0.580, 0.615 and 0.659, respectively). CRP also had significant correlation with disease activity (r=0.14, p< 0.0285). ROC analysis (Figure 1b) showed increasing AUC with no inflammation, mild, moderate and severe disease activity (0.494, 0.590, 0.611 and 0.655, respectively). Conclusion: CRP and albumin are inexpensive biomarkers that can be used as a prognostication tools for active inflammation. Both CRP/Albumin ratio and CRP level alone correlate with active inflammation. The CRP/Albumin ratio suggests a stronger correlation with moderate and severe disease activity in IBD while CRP level alone has a stronger correlation with mild disease activity.Table 1.: a. Outcome: Medication Adherence. Medication Adherence, Patient Activation and Associated Patient CharacteristicsFigure 1.: Flowdiagram of exclusion and inclusion of cases.

Introduction: Crohn’s disease (CD) and Ulcerative Colitis (UC), the two major forms of inflammatory bowel disease (IBD), are characterized by chronic inflammation of the gastrointestinal tract. Mucosal healing is a key therapeutic goal in patients with IBD, as it has been associated with reduced risk of relapse, decreased hospital admission rates, and lower rates of major abdominal surgery. The aim of this study was to assess the proportion of patients that achieved mucosal healing within 18 months of initiation or adjustment of IBD therapy. Methods: Retrospective analysis of adults with an ICD-9/10 code diagnosis of IBD during hospitalization for IBD flare symptoms at a tertiary care center between January 1st 2013 to June 1st 2017. Patients who did not receive treatment for the IBD flare were excluded. Mucosal healing was defined as absence of ulcerations or erosions seen on colonoscopy or cross-sectional imaging (XCI). Patients were followed-up within 18-months of initiation or adjustment of IBD therapy. Data including the patients’ XCI and colonoscopy reports was extracted from the institution’s integrated electronic data repository and electronic chart review. This study was approved by the institutional review board. Results: A total of 760 unique patients were analyzed of which 519 (348 CD, 160 UC, 11 indeterminate) met inclusion criteria. The cohort consisted of the characteristics outlined in Table 1. Of these 519 patient records, 118 (22.7%) had both XCI and colonoscopy during hospitalization, 178 (34.3%) had XCI and 72 (13.9%) had colonoscopy. One hundred and seventeen patients (102 CD, 14 UC, 1 indeterminate) had follow-up at 18-months. The follow-up cohort consisted of the characteristics outlined in Table 1.Of these, 22 (18.8%) had both XCI and colonoscopy, 67 (57.2%) had XCI and 26 (22.2%) had colonoscopy. Mucosal healing was achieved in 70/117 (59.8%) patients. In CD, 61/102 (59.8%) achieved mucosal healing and in UC, 9/14 (64.3%) achieved mucosal healing. Conclusion: Mucosal healing was achieved in over half of patients within 18-months of initiation or adjustment of IBD therapy. Mucosal healing was achieved in similar proportions of CD and UC patients at 18-months.Table 1.: Patient characteristics associated with loneliness and social isolation

tistical significance was set at P # 0.05. Results: Forty-four patients were analyzed. The majority were male (55%), white (52%), and not Hispanic or Latino (91%). Mean age was 56614 years. Mean body mass index was 27.5866.59 kg/ m2. Most patients were nonsmokers (52%) or former smokers (41%). The most common indication for MMF was renal transplant (45%) with other common indications including non-liver non-renal transplant (25%) or liver transplant (23%). Median MMF dose was 1000 mg total daily. See Table for symptoms and signs upon presentation. Mean heart rate was 81614 beats per minute and mean hemoglobin was 9.762.5 g/dL. Eleven patients underwent EGD only, 17 underwent colonoscopy or flexible sigmoidoscopy only, and 16 patients underwent both upper and lower endoscopies. MMF was discontinued in 57%, reduced in 20%, and unchanged in 23%. Sixty-one percent met criteria for severe disease and 81% met criteria for poor prognosis. Friability on endoscopy was associated with severe disease (P 5 0.02); erosions/ulcerations trended towards significance (P 5 0.09). Nausea and erythema on endoscopy were associated with poor prognosis (P 5 0.05 and P , 0.01, respectively); MES trended towards significance (P 5 0.07). Conclusion: In this cohort of patients with MMF GI toxicity, friability was associated with severe disease and nausea and erythema were associated with poor prognosis.

Gluten is a common dietary component with a complex protein structure. It forms incomplete products of digestion, which have the potential to mount an immune response in genetically predisposed individuals, resulting in celiac disease. It also has been linked with nonceliac gluten sensitivity and irritable bowel syndrome due to wheat allergy. A gluten-free diet is an effective treatment of these conditions; however, it can lead to micronutrient and mineral deficiencies and a macronutrient imbalance with higher sugar and lipid intake. Recent popularity has led to greater availability, but increasing cost, of commercially available gluten-free products.

Background: Few studies have evaluated whether a personal and family history questionnaire (PFHQ) administered at the initial patient encounter improves the provider's ability to appropriately risk stratify patients for colorectal cancer (CRC) screening. The objective of this study was to determine if a PFHQ completed by the patient prior to the initial encounter improved the provider's ability to extract pertinent information relating to CRC risk.Methods: This was a prospective intervention study conducted in the adult outpatient gastroenterology clinic at Penn State Hershey Medical Center. A PFHQ was created based on expert opinion and current screening guidelines. 199 patients evaluated as new encounters between February 2009 and June 2009 completed the questionnaire. We also retrospectively evaluated 186 randomly chosen charts of new patient encounters that had not utilized a questionnaire. A point system was created to score all charts in both the retrospective (without the questionnaire) group as well as the prospective group (with the questionnaire) based on quantity and quality of information documented in the consultation reports relating to CRC risk. Results between the two groups were compared using Wilcoxon Rank Sum test.Results: Both patient and family history scores were significantly lower in the prospective study group that completed the questionnaire (p=0.05, p<0.01, respectively) when compared to the group that did not utilize a questionnaire. Composite scores (personal & family history) were significantly lower in the study group that completed the questionnaire (p=0.01).Conclusion: Our study demonstrated that clinician-led history taking was superior to a questionnaire in obtaining quality history that can be used to appropriately risk stratify patients for CRC screening.

Osteopetrosis is a genetic disorder of bone remodeling caused by osteoclast dysfunction. Clinical features include short stature, frequent fractures, and recurrent infections. Abnormal bone obliterates the marrow cavity, resulting pancytopenia and extramedullary hematopoiesis in the liver and spleen. The splenomegaly can lead to left-sided portal hypertension. We report the second case of osteopetrosis-induced portal hypertension and the first case of upper gastrointestinal bleeding in a 52-year-old woman with osteopetrosis.

Introduction: Capsule endoscopy (CE) has emerged as a newer modality in the evaluation of inflammatory bowel disease (IBD). There is little existing data comparing CE to traditional diagnostic methods with regard to presence of IBD, location and severity of disease. Our study is a retrospective review which examines the clinical and diagnostic utility of CE in our IBD population. Methods: We conducted an IRB approved retrospective cohort study of 210 adult IBD patients at the Crohn’s and colitis center of NJ. Compiled data of patients who underwent CE included indication for study, study findings, capsule transit times, quality of preparation, capsule retention rates, diagnosis reached, and extent of disease. Baseline patient characteristics, inflammatory markers, radiologic, and endoscopic findings prior to CE were recorded to correlate with CE findings. Rate of change of diagnosis or reclassification of IBD subtype was also ascertained. Finally, impact of CE on changes in surgical or medical management was also recorded. Results: Our results show that CE was able to detect active disease in 37.5% (12/32) of patients with normal C-reactive protein (CRP) levels. In patients with Crohn’s Disease (CD), CE was able to detect active small bowel disease in 63% (22/35) of patients with normal small bowel follow through (SBFT) and 24% (9/37) of patients with normal ileum on colonoscopy. Moreover, CE led to change in medical management of 50% (48/96) of CD patients. Of these, 50% involved addition or change of a biologic agent. In ulcerative colitis (UC) patients with refractory pain and diarrhea despite medical therapy, 6/44 patients were reclassified as CD, with 4 of them having change in medical management. Of 10 patients with a prior diagnosis of indeterminate colitis (IC), 3 were reclassified as UC while another 3 were reclassified as having CD. Conclusion: Our study highlights important applications for CE in IBD. First, CE is more sensitive than inflammatory markers such as CRP in determining disease activity. As far as diagnostic potential, CE appears to be superior to small bowel follow through (SBFT) and endoscopic terminal ileum intubation in evaluating for small bowel CD. Earlier diagnosis with appropriate intervention of active small bowel disease may prevent disease progression and complications such as strictures. In both our UC patients with refractory symptoms as well as our IC population, CE was useful in reclassifying patients into different IBD subtypes. Finally, the use of CE led to changes in medical management in a significant number of our CD patients, further supporting its importance among the diagnostic tests available for evaluation of IBD.

Patients with inflammatory bowel disease (IBD) often question their doctors about diet. The objectives of this article are to provide clinicians with existing dietary advice by presenting the dietary information proposed by medical societies in the form of clinical practice guidelines as it relates to IBD; listing dietary guidelines from patient-centered IBD-related organizations; and creating a new 'global practice guideline' that attempts to consolidate the existing information regarding diet and IBD. The dietary suggestions derived from sources found in this article include nutritional deficiency screening, avoiding foods that worsen symptoms, eating smaller meals at more frequent intervals, drinking adequate fluids, avoiding caffeine and alcohol, taking vitamin/mineral supplementation, eliminating dairy if lactose intolerant, limiting excess fat, reducing carbohydrates and reducing high-fiber foods during flares. Mixed advice exists regarding probiotics. Enteral nutrition is recommended for Crohn's disease patients in Japan, which differs from practices in the USA.