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Angiodysplasias (AGD) are common sites of bleeding in the gastrointestinal (GI) tract after Continuous Flow Left Ventricular Assist Device (CF-LVAD) implantation. We sought to investigate whether AGDs are formed as a result of LVAD physiology or preexist as a consequence of heart failure. Thirty-six subjects with HF reduced EF (HFrEF) underwent video capsule endoscopy (VCE) to assess for the presence of AGD. Fifty-three subjects without HF who underwent VCE for a nonbleeding indication formed a control group. The prevalence of AGD was significantly higher in the HFrEF compared to the non-HF controls (50% vs 13%, p = 0.0002). This association persisted after controlling for age and comorbidities. Within the HFrEF cohort, higher Ang2, NT-proBNP and BUN were associated with the presence of AGD. AGD in the GI tract are associated with HFrEF. This is the first description of a new pathology associated with HFrEF and adds to our understanding of CF LVAD associated GI bleeding.

Background The IBD-Disability Index (IBD-DI) is a quantitative measure of disease impact on physical activity and social participation, with higher sores indicating greater disability. Prior studies have been cross-sectional, but few studies have longitudinally measured disability with IBD treatment. Methods Patients with Crohn’s disease (CD) and ulcerative colitis (UC) starting a new biologic or small molecule therapy were surveyed using the IBD-DI at induction, and 2- and 6-months. Surveys also included the Harvey Bradshaw Index (HBI), Simple Clinical Colitis Activity Index (SCCAI), partial Mayo score (pMayo), depression index (PHQ-9), quality of life index [Short IBD Questionnaire (SIBDQ)], and illness perception scale [Brief Illness Perception Questionnaire (BIPQ)]. Clinical data included endoscopic scores, biomarkers (ESR, CRP, calprotectin), comorbidities, and IBD history. Therapy response was defined as a reduction in HBI, pMayo, SCCAI ≥3 or total HBI ≤ 4, pMayo < 2, SCCAI ≤2 at survey 3. Results 111 patients (65 males and 46 females) completed survey 1, 79 completed survey 2, and 63 completed survey 3. There were no significant differences in baseline demographic, disease activity, or psychosocial scores between participants who completed only survey 1, and those who completed all 3 surveys. The median age was 31 years, 58% had CD, 42% had UC, and 32% were non-white (Table 1). At induction, the median IBD-DI score was 34.0 out of 100. IBD-DI scores did not correlate with age, race, sex, comorbidities, IBD-type, or surgery, but there was a weak correlation with prior biologic use, specifically anti-TNF therapy (Table 1). There was a moderate correlation between clinical disease activity scales and the IBD-DI [HBI, pMayo, and SCCAI (r=0.63, r= 0.56, r=0.55; p Conclusion Disability is not commonly measured in clinical studies, but it plays a large role in patients’ overall wellbeing. In this longitudinal cohort, there was a strong correlation between IBD-DI, clinical disease activity, depression, and quality of life indices. Among therapy responders, there was a significant improvement in IBD-DI from a moderate to mild degree of disability. These findings further clarify the relationship between disability, disease activity, and therapeutic response in IBD.

INTRODUCTION: Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives. METHODS: A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis. RESULTS: Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored. DISCUSSION: Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction.

Background:Patients with Inflammatory Bowel Disease (IBD) are at heightened risk of infection, and are often under vaccinated. At our institution, IBD patients may follow up with one of three gastroenterology (GI) providers: IBD specialists, GI Fellows and General GI providers. Aims: Our primary objective was to identify whether the type of GI provider had an effect on rates of vaccinations for IBD patients. The seven vaccines studied were listed in the American College of Gastroenterology’s 2017 Guidelines on Preventative Care in IBD, and include Influenza, Tetanus/Diphtheria/Pertussis, Hepatitis A (HAV), Hepatitis B (HBV), Pneumococcus (PCV13 and PPSV23), Meningococcus, and Human Papillomavirus (HPV).Methods:Retrospective case control study of IBD patients, looking at vaccination rates for each of the seven vaccinations listed above, and type of GI provider followed. Other data collected included patient demographics, IBD type, treatment regimen and insurance.Results:Of 338 IBD patients, 65 (19.2%) followed up with a GI fellow, 110 (32.5%) with a general GI provider, and 163 (48.2%) with an IBD specialist. HBV was the only vaccine with a significant difference in vaccination rate by type of provider. Bivariate analysis showed that patients who followed with IBD specialists and GI fellows were more likely to be vaccinated for HBV than patients who followed up with general GI provider (OR = 2.55, p = .003 and OR = 2.73, p = .007 respectively).Conclusion Type of GI provider only impacted rates of vaccination for HBV among IBD patients in this study, with IBD specialists and GI fellows outperforming general GI providers.

Current guidelines for surveillance of colonic neoplasia are based on data from predominantly white populations, yet whether these recommendations are applicable to blacks is unknown.To define the prevalence of advanced colorectal neoplasia (ACN) among whites and blacks undergoing surveillance colonoscopy.This was a retrospective, cross-sectional analysis of asymptomatic, average-risk non-Hispanic white (N = 246) and non-Hispanic black (N = 203) patients with colorectal neoplasia who underwent baseline screening colonoscopy between January 1, 2000, and December 31, 2007, and a surveillance colonoscopy before December 31, 2010, at an academic safety-net hospital. The main outcome measure was the prevalence of ACN, defined as a tubular adenoma or sessile serrated adenoma (SSA) ≥ 10 mm, any adenoma with villous histology or high-grade dysplasia, any serrated lesion with dysplasia, or invasive cancer at surveillance.During a median follow-up of 4.3 years, the overall prevalence of ACN at surveillance was similar among blacks and whites (11.3 vs. 9.8 %; P = 0.59) with an odds ratio of 1.18 (95 % CI 0.65-2.16) [corrected]. Blacks and whites with non-advanced neoplasia had similar rates of ACN at the 1-3, 4-5, and5 year follow-up intervals. Blacks with ACN or multiplicity at baseline had higher rates of ACN at the 1- to 3-year interval compared with whites, but the difference was non-significant (26.7 vs. 12.5 %; P = 0.32). No interval cancers were observed for either group.The overall prevalence of ACN was similar between non-Hispanic blacks and non-Hispanic whites undergoing surveillance in a safety-net healthcare setting suggesting that current surveillance guidelines are appropriate for both blacks and whites.

Strongyloides stercoralis hyperinfection in an immunocompromised host has a high mortality rate but may initially present with non-specific pulmonary and gastrointestinal symptoms. Donor-derived S. stercoralis by kidney transplantation is an uncommon diagnosis and difficult to prove. We report two renal allograft recipients on different immunosuppressive maintenance regimens that developed strongyloidiasis after transplantation from the same donor. Recipient 1 presented with a small bowel obstruction. Larvae were demonstrated on a duodenal biopsy and isolated from gastric, pulmonary, and stool samples. Serologic testing for S. stercoralis was negative at a referral laboratory but positive at the Centers for Disease Control. The patient's hospital course was complicated by a hyperinfection syndrome requiring subcutaneous ivermectin due to malabsorption. Recipient 1 survived but the allograft failed. Recipient 2 had larvae detected in stool samples after complaints of diarrhea and was treated. On retrospective testing for S. stercoralis, pre-transplant serum collected from the donor and Recipient 1 was positive and negative, respectively. Donor-derived strongyloidiasis by renal transplantation is a preventable disease that may be affected by the immunosuppressive maintenance regimen. Subcutaneous ivermectin is an option in the setting of malabsorption. Finally, routine screening for S. stercoralis infection in donors from endemic areas may prevent future complications.

Granulocyte-macrophage colony stimulating factor (GM-CSF) activity has been linked to pro-inflammatory effects in autoimmune syndromes, such as rheumatoid arthritis. Thus GM-CSF mimetics with antagonist activity might play a therapeutic role in these diseases. The human GM-CSF core structure consists of a four alpha-helix bundle, and GM-CSF activity is controlled by its binding to a two-subunit receptor. A number of residues located on the B and C helices of GM-CSF are postulated to interact with the alpha chain of the GM-CSF receptor (GM-CSFR). Several approaches have been successfully utilized to develop peptide mimetics of this site, including peptides from the native sequence, a peptide derived from a recombinant antibody (rAb) light chain which mimicked GM-CSF receptor binding activity, and structurally guided de novo design. Analysis of the rAb light chain had suggested mimicry of GM-CSF with residues mostly contributed by the CDR I region. Key residues involved in CDR I peptide/GM-CSFR binding were identified by truncation and alteration of individual residues, while the structural elements required to antagonize the biological action of GM-CSF were separately tested in binding and inhibitory activity assays of multiple cyclic analogues. A peptide designed to retain the loop conformation of the CDR I region of the rAb light chain competed with GM-CSF for both antibody and receptor binding, but the role of specific residues in antibody versus receptor binding differed markedly. These studies suggest that structural analysis of peptide mimetics can reveal differences in receptor and antibody binding, perhaps including key interactions that impact binding kinetics. Peptide mimetics of other four-helix bundle cytokines are reviewed, including helical and reverse turn mimetics of helical structures. Use of peptide mimetics coupled with structural and kinetic analysis provides a powerful approach to identifying important receptor-ligand interactions, which implications for rational design of novel therapeutics.

Endoscopic surveillance is an important method to identify colorectal neoplasia in patients with inflammatory bowel disease. Advances in endoscopic techniques using pancolonic chromoendoscopy have improved the detection of dysplasia compared to white-light endoscopy, which has the potential to decrease the risk of colorectal cancer. Currently, pancolonic chromoendoscopy is readily available for use, and in the future, it will likely become the standard of care for endoscopic surveillance. Pancolonic chromoendoscopy followed by confocal laser endomicroscopy may further increase the yield on surveillance endoscopy, although confocal laser endomicroscopy is not readily available outside of a limited number of institutions. Other endoscopic tools such as narrow band imaging have not been shown to be beneficial over white-light endoscopy. Emerging tools such as stool DNA testing show promise as an adjunct to colonoscopy but are still in the early stages of development. For management, patients with well-demarcated circumscribed dysplastic lesions should be resected endoscopically, followed by a continued endoscopic surveillance program. Patients with lesions that cannot be resected completely or that have features suggestive of invasive carcinoma on either endoscopy or histology should undergo colectomy. Patients with flat high-grade dysplasia should undergo colectomy. Patients with flat low-grade dysplasia should have a discussion about the risks and benefits of undergoing colectomy versus continuing in an endoscopic surveillance program. If they opt for surveillance, these patients should have more frequent follow-up surveillance examinations (every 3 to 6 months) with pancolonic chromoendoscopy.