Babajide, Oyedotun

Objectives: Diabetes mellitus and chronic pancreatitis are established risk factors for pancreatic ductal adenocarcinoma (PDAC). The co-occurrence of exocrine and endocrine pancreatic dysfunction may increase the risk of progression to PDAC and could play a role in early detection. We sought to explore this hypothesis by comparing PDAC risk among patients with diabetes mellitus (DM) and low fecal elastase (FE) in a real-world cohort of patients. Materials and Methods: A retrospective cohort study was conducted using the TriNetX research network including adults with continuous follow-up from 2016 to 2023. The cohort was stratified into 4 groups based on the presence or absence of DM, and normal FE (>200 µg/g) or low FE (<200 µg/g). The 4 groups included: (1) low FE and DM, (2) low FE without DM, (3) normal FE and DM, (4) normal FE without DM. Propensity score matching was performed to balance covariates including age, sex, race, comorbidities to allow for a 6-way comparison of PDAC risk between groups. Time-to-event analyses were conducted with Kaplan-Meier curves and Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for the primary outcome of PDAC incidence. Results: Of the study cohort, 29,207 had fecal elastase levels. Low FE (<200 µg/g) was observed in 33% (n = 9585) of these patients. After 6-way comparisons, we observed a higher PDAC risk among individuals with both DM and low FE compared with other groups. The highest PDAC risk was observed in patients with both a low FE (<200 µg/g) and DM compared with those with a normal FE and without a history of DM (HR: 3.68; 95% CI, 2.07–6.53; P < 0.001). Sensitivity analysis using a stricter fecal elastase cutoff of <100 µg/g showed a similar finding, with the highest hazard ratio for PDAC among patients with both DM and very low FE levels (HR: 3.07, 95% CI, 1.37–6.91; P = 0.004). Conclusions: The coexistence of low fecal elastase and DM amplifies the risk of pancreatic ductal adenocarcinoma in our cohort of patients. These results suggest that fecal elastase values may be used to enrich the diabetic population for future PDAC risk stratification, though more studies are needed to validate these findings.

Objectives The aim of this study was to study the prevalence of exocrine pancreas insufficiency (EPI) at a population level and the subsequent risk of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods Using TriNetX (a database of over 79 million US residents), we included patients ≥18 years with EPI (identified via ICD-10 codes) and continuous follow-up from 2016–2022. Patients with prior pancreas resection and PDAC before an EPI diagnosis were excluded. The primary outcome was EPI prevalence. Secondary outcomes included imaging utilization, PDAC risk, and pancreatic enzyme replacement therapy (PERT) utilization. We performed 1:1 propensity score matching (PSM) of patients with EPI versus patients without an EPI diagnosis. Results The population prevalence of EPI was 0.8% (n = 24,080) with a mean age of 55.6 years. After PSM, PDAC risk among patients with EPI was twice as high compared with patients without EPI (aHR, 1.97; 95% CI, 1.66–2.36). This risk persisted even after excluding patients with a history of acute or chronic pancreatitis (adjusted odds ratio, 4.25; 95% CI, 2.99–6.04). Only 58% (n = 13, 390) of patients with EPI received PERT. No difference was observed in PDAC risk between patients with EPI on PERT and those not on PERT (aHR, 1.10; 95% CI, 0.95–1.26; P = 0.17). Conclusions Despite a low prevalence, patients with EPI may have a higher risk of PDAC, and majority with EPI were not on PERT. PERT did not impact incident PDAC risk after an EPI diagnosis.

Abstract Background There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied. Aims We aimed to investigate the impact of hospital patient racial diversity on GI outcomes Methods Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset. Results Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges. Conclusions Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes. Funding Agencies None

BACKGROUND: The impact of English proficiency on gastrointestinal bleeding (GIB) outcomes remains unclear. In this analysis, we compare inpatient GIB outcomes between patients with English as their primary language (EPL) and those with a primary language other than English (PLOE). METHODS: Using the 2019 State Inpatient Databases for New Jersey, Maryland, and Michigan, we created an analysis cohort of GIB hospitalizations using International Classification of Diseases, 10th Revision codes. Patients were stratified by primary language (EPL vs PLOE) and type of bleeding (variceal upper GI bleeding [VUGIB], nonvariceal upper GI bleeding [NVUGIB], and lower GI bleeding (LGIB)]. Regression analyses were used to compare mortality, 30-day readmissions, and length of stay. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. P < 0.05 was considered statistically significant. RESULTS: In the cohort, 5.5%–10% of the patients spoke a primary language other than English. Endoscopy utilization was lower among patients with PLOE vs EPL for NVUGIB (17.2% vs 21.2%, P < 0.001) and LGIB (26.3% vs 29.2%, P = 0.027). Patients with PLOE had higher odds of dying of VUGIB (aOR 1.45, 95% CI 1.16–2.48) and LGIB (aOR 1.71, 95% CI 1.22–2.12). Patients with PLOE were also more likely to be readmitted after NVUGIB (aOR 1.75, 95% CI 1.64–1.81). However, after controlling for the percentage of patients with PLOE discharged from each hospital, the disparities in mortality and readmissions were no longer detected. DISCUSSION: Disparities exist in GIB outcomes among patients with PLOE, but these gaps narrow at hospitals with higher percentages of patients with PLOE. Cultural and linguistic competence may improve outcomes in this vulnerable group.

AbstractBackground and AimThe impact of the Coronavirus disease‐2019 (COVID‐19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years.MethodsUsing the National Inpatient Sample (2018–2020), we explored year‐to‐year and 2020 month‐to‐month trends in hospitalizations, length of stay, and inpatient mortality for liver‐related complications including cirrhosis, alcohol‐associated liver disease (ALD) and alcoholic hepatitis using regression modeling. We reported relative change (RC) in the study period.ResultsDecompensated cirrhosis hospitalizations decreased in 2020 compared with 2019 (RC: −2.7%, P < 0.001) while all‐cause mortality increased by 15.5% (P < 0.001). Hospitalizations for ALD increased compared with pre‐pandemic years (RC: 9.2%, P < 0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, P = 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID‐19 was higher among patients with decompensated cirrhosis (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] [1.53–1.94]), Native Americans (OR 1.76, 95% CI [1.53–2.02]), and patients from lower socioeconomic groups.ConclusionsCirrhosis hospitalizations decreased in 2020 compared with pre‐pandemic years but were associated with higher all‐cause mortality rates particularly in the peak months of the COVID‐19 pandemic. In‐hospital COVID‐19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.