Awad, Mohannad

Breyer, Benjamin

Day, Lukejohn

Hassid, Benjamin

Sewell, Justin L

Gastroenterology

English

eScholarship - University of California

UCSFUC San Francisco Previously Published WorksTitleSu1004 Using Search Engine Query Data to Explore Epidemiology of Common Gastrointestinal SymptomsPermalinkhttps://escholarship.org/uc/item/29s9k8n8JournalGastroenterology, 150(4)ISSN0016-5085AuthorsHassid, BenjaminBreyer, BenjaminAwad, Mohannadet al.Publication Date2016-04-01DOI10.1016/s0016-5085(16)31532-3 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaSu1002Cutaneous Vasculitis in a Patient With Crohn's Disease Treated WithAdalimumabAlex C. Faria, Alan C. Moss, Alexandre W. Souza, Giovanni Viana, Danilo Odashiro,Didia B. CuryBackground: Anti-TNF therapies have been rarely associated with cutaneous vasculitis.Herein we describe a case of cutaneous vasculitis in a patient receiving adalimumab therapy.Case presentation: A 28- year- old woman with a history of Crohn's disease refractory toconventional therapy started treatment with adalimumab in 2012. She had no prior historyof cutaneous manifestations. After 24 months of adalimumab therapy, she reported raisedlesions on her legs (Figure 1). She denied any accompanying as joint pain or constitutionalsymptoms. Laboratory tests, including CRP, ESR, blood counts, urinalysis, and complement,were normal. ANA, anti-ENA, RF, cANCA, pANCA, anti-phospholipid and cryoglobulinswere negative. A skin biopsy described leukocytoclastic vasculitis in the post-capillary ven-ules. This finding was strongly suggestive of cutaneous drug-induced vasculitis (Figure 2).Five days after the onset of vasculitis, the adalimumab was withdrawn and the patient startedon high dose prednisolone (60mg/day). However, only moderate response was observed,so colchicine was added at 0.5mg TID. The cutaneous lesions then resolved within 3 daysof colchicine therapy, allowing steroid tapering. Conclusion: This case report illustratescutaneous vasculitis as a potential association with anti-TNF therapy. In addition to stoppingthe suspected drug, colchicine may be helpful in patients refractory to high-dose glucocorti-coids.Su1004Using Search Engine Query Data to Explore Epidemiology of CommonGastrointestinal SymptomsBenjamin Hassid, Benjamin Breyer, Mohannad Awad, Justin L. Sewell, Lukejohn DayBackground Internet search activities are an increasingly used tool in medical research, andsearch data has been recognized as a promising source of medical information by the Instituteof Medicine. One particularly fruitful source of information has been Google Trends, a freeS-441 AGA Abstractspublically accessible portal for analyzing trends in the Google search engine. This resourcehas been used to understand the epidemiology of multiple disease states, including communi-cable and non-communicable diseases. To date, no studies have examined Google searchdata in relation to common gastrointestinal (GI) symptoms. Our aims were to comparechanges to search volume for common GI symptoms to clinical data sets. Methods: UsingGoogle Trends, we recorded relative changes to search volume for searches related todysphagia, vomiting, and diarrhea in the United States between January 2008 and January2011. At the same time, we queried the National Inpatient Sample (NIS) during that sametime period and identified cases with ICD-9-CM codes related to these symptoms as theprimary diagnosis for the same time period. We also queried the National Hospital Ambula-tory Medical Care Survey (NHAMCS) and identified cases associated with these same symp-toms as the primary reason for visit for the same period. We calculated Pearson correlationcoefficients to assess correlation between changes to Google search volume and changes tonumber of cases in the NIS and NHAMCS datasets during this timeframe. Results: Changesto Google search volume for all three symptoms correlated significantly with NIS output(dysphagia- r = 0.5, P= 0.002; diarrhea- r = 0.79, P <0.001; vomiting- r = 0.76, P <0.001).Both Google and NIS data showed that the prevalence of all three symptoms rose duringthe time period studied (2008-2010). On the other hand, the NHAMCS data trends duringthis time period did not correlate significantly with either the NIS or the Google data forany of the three symptoms studied. Conclusion: Changes to the population burden ofchronic GI symptoms may be easily tracked by monitoring changes to Google search enginequery volume over time, which correlated well with a large inpatient clinical dataset forthree common GI symptoms. During the time frame examined, the burden of dysphagia,diarrhea, and vomiting appeared to rise. The outpatient dataset that we examined did notcorrelate with either of the other datasets, likely related to its relatively small sample size.Its ease of makes search engine query data a powerful tool in furthering our understandingof the population burden of common symptoms, and since some who experience illness donot seek medical attention, data of this type may shed light on dimensions of disease thatexist outside of a standard medical context.Su1005Intestinal Ultrasound Accurately Assesses Disease Activity in InflammatoryBowel Disease When Compared to Faecal CalprotectinNeel Heerasing, Anil Asthana, Miles Sparrow, Simon Jakobovits, Peter R. Gibson, AntonyFriedmanIntroduction Current guidelines recommend a treat to target approach in the managementof patients with inflammatory bowel disease (IBD) utilising objective measures of diseaseactivity. Faecal calprotectin is a non-invasive biomarker which has been shown to be asurrogate marker for mucosal healing. However, calprotectin has significant limitationsincluding a lack of information regarding disease location, inter-patient variability andmoderate rates of both false negative and positive results. Intestinal ultrasound (IUS) is anon-invasive imaging modality which has the ability to provide information on both diseaseactivity and location. There is a paucity of data comparing the accuracy of IUS to calprotectinresults. Aim To assess the accuracy of IUS compared to calprotectin levels in evaluatingdisease activity in IBD. Methods A prospective IUS database for all imaging is maintainedat the Alfred Hospital. All patients with an IUS and faecal calprotectin performed within 7days of each other in 2014 were enrolled. C-reactive protein (CRP) values were also analysedwith a CRP <3mg/L considered normal. IUS was performed by one of two IBD gastroenterolo-gists with expertise in IUS. Statistical analyses were undertaken to assess the accuracy ofIUS using different thresholds for calprotectin including 30µg/g, 50µg/g, 100µg/g and 250µg/g. Results The database included 139 patients (47% females) with the majority havingCrohn's disease (86%). Forty-eight IUS patients had matched faecal calprotectin levels.Sensitivities, specificities, positive (PPV) and negative predictive values (NPV) are shown inTable 1. For each threshold, IUS had very high negative predictive values. Conversely, IUShad a high positive predictive value only when calprotectin levels exceeded 250µg/g. 107patients undergoing an IUS had a matched CRP measured with 7 days of the scan. 45patients had an elevated CRP. The sensitivity and specificity of CRP with positive IUSfindings were 65% and 68% respectively. The PPV and NPV of CRP were 49% and 80%respectively. 35 patients had both matched calprotectin and CRP and in this group, allpatients (n=6) with calprotectin <30 and CRP <3 had negative IUS findings. The sensitivityand specificity of calprotectin & CRP with positive IUS findings were 73% and 85% respec-tively with the corresponding PPV and NPV being 79% and 81%. Conclusion This studydemonstrates the accuracy of IUS in assessing disease activity when compared to faecalcalprotectin. IUS has the additional benefits of being able to provide information regardingdisease location and complications such as strictures and fistulae. This also study also showsthat CRP is an inferior biomarker to both calprotectin and IUS. The combination of IUSand faecal calprotectin are ideal non-invasive tools to monitor disease activity in IBD as areplacement for colonoscopy.1- Accuracy of intestinal ultrasoundAGAAbstracts

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