was analyzedwith Kaplan-Meier analysis and log-rank test. P<0.05 was considered significant.Results: After induction therapy, 31 patients responded and 24 reached clinical remission.At baseline, HBi was 11 (6.5-17.5), partial Mayo score 8.5 (7.5-9), FC 2060 (1495-5507)μg/g and CRP 13 (6.5-35.5) mg/L. Following induction therapy, indices, FC and CRPdeclined from baseline levels (p<0.01). In the group of responders, FC level was 210 (70-358) μg/g compared with non-responders 1425 (304-2171) μg/g. The CRP levels in thesame groups were 2 (1-4) mg/L and 5.5 (3.5-27.5) mg/L. In the group that reached clinicalremission, FC and CRP levels were 207 (75-354) μg/g and 2 (1-3.5) mg/L, respectively.Clinical responders were followed 24 weeks further to predict incidents (dosage increase,shortening of infusion interval, surgery) based on FC levels. The ROC analysis optimal cut-off point was 221 μg/g (sensitivity 90%, specificity 71%, probability ratio 3.15). The areaunder the curve was 0.88. Using the level 221 μg/g as cut-off, an FC level exceeding 221μg/g after induction therapy was studied in cinjunction with an incident within 24 weeksafter induction (p<0.01). In those with FC <221 μg/g, one out of 16 patients (6%) had anincident within 24 weeks after induction therapy, among those with FC >221 μg/g thatnumber was 9 out of 15 (60%) within the same time period. Clinical activity correlatedwith FC (Spearman r=0.62, p<0.001) as well as with CRP (Spearman r=0.60, p<0.001).Conclusion: Clinical indices correlate well with FC andCRP levels during infliximab inductiontherapy week 0, 2 and 6. Furthermore, an FC level >221 μg/g after the induction periodis associated with a disease incident within the following 24 weeks. The indices, FC andCRP levels decreased significantly from baseline levels among patients responding to inflixi-mab treatment.

Mo1101

Pulse-Irrigation Enhanced Evacuation and MoviPrep® With AdjunctiveNeostigmine and Glycopyrrolate Improve Bowel Preparation for ColonoscopyAfter Spinal Cord InjuryRobert E. Williams, Miroslav Radulovic, William Bauman, Amer Malik, Milan Glumicic,Ann M. Spungen, Marinella D. Galea, Alan S. Rosman, Spencer Shaw, Kristel K. Hunt,Ravi R. Vinnakota, Mark A. Korsten

Background: Bowel preparation is a challenge in patients with spinal cord injury (SCI). Incomparison to able-bodied patients, per-oral lavage results in suboptimal bowel cleansingin patients with SCI, reducing the efficacy of screening colonoscopy. Per-rectal cleansingtechniques, such as pulse-irrigation enhanced evacuation (PIEE, PIE Medical International,Inc.), or adjunctive prokinetic agents, given with a per-oral lavage, such as MoviPrep®,may be alternatives to standard care. Aim: Colon preps were evaluated in inpatients withparaplegia and tetraplegia. The 3 preparations were: PIEE, MoviPrep® (MOVI), or MoviP-rep® + neostigmine and glycopyrrolate (MOVI+NG). Methods: Subjects received a liquiddiet after breakfast on the day preceding colonoscopy. Subjects who received PIEE consumed300 mL magnesium citrate at 6:00PM the evening before their procedure. At 9:00AM onthe day of the procedure, subjects received PIEE while lying on their left and then rightside using 4.0 L of warm tap water in each position, and, if necessary, changing positionsuntil the rectal effluent was clear. Serum electrolytes were collected prior to and after PIEE.Subjects receiving MOVI consumed 1.0 L of MoviPrep® solution and 500 mL tap water at6:00PM the evening prior to colonoscopy and again at 6:00AM the day of the procedure.Subjects who received MOVI+NG received 2.0 mg neostigmine and 0.4 mg glycopyrrolate(IV) at 9:00AM the day of the procedure. Beginning at midnight on the day of theircolonoscopy, all subjects were provided with NPO orders, with the exception of bloodpressure medication with small sips of water. The Ottawa scale (0-14) is a semi-quantitativetool used to assess the quality of bowel preparation, with lower scores indicating increasedvisibility of the colon wall during colonoscopy. Subjects: Five males with paraplegia (age65±13 years; duration of injury; 35±10 years; level of injury, T5-12) and 7 males withtetraplegia (age 61±13 years; duration of injury; 14±5 years; level of injury, C4-7) wererecruited for study. Results: Data are expressed as mean ± SD. There was no significantdifference in Ottawa scores among the preparations in the group with paraplegia. In thegroup with tetraplegia, Ottawa scores were significantly lower in the PIEE and MOVI+NGgroups compared to the MOVI group (0.7±0.5, 0.5±0.7 vs. 3.5±0.7 points, respectively;P<0.01). There was no clinically significant change in serum electrolytes after PIEE. Conclu-sion: In patients with tetraplegia, PIEE andMOVI+NG aremore efficacious bowel preparations

S-557 AGA Abstracts

than is MOVI alone. The addition of prokinetic agents to per-oral lavage in persons withSCI improves bowel preparation quality. Thus, use of such agents, in addition to PIEE,should be evaluated as alternatives to more traditional bowel care in SCI and, conceivably,should improve cancer and polyp detection rates.

Mo1102

Validation of a Modified Glasgow Blatchford Score (GBS) for Prediction of theNecessity of Urgent Endoscopic ProcedureMasayasu Horibe, Mitsuhito Sasaki, Takuya Yokota, Shin Namiki, Yuuki Ogura, SukenobuShiba

Background Among many scoring systems for calculating the risk with upper-gastrointestinalhemorrhage, the Glasgow Blatchford Score (GBS) is relatively simple as it does not incorporateendoscopic findings but simple laboratory tests and clinical features. Although previousstudies proved that the score could produce reasonable prediction, we aimed to validate amodified GBS in order to predict the necessity of urgent endoscopic procedure. It is importantto determine the need for urgent endoscopy, because the number of local endoscopists islimited. Urgent endoscopy and hospital admission of the patients who present with upper-gastrointestinal hemorrhage could be appropriately reduced if the outcomes are predictedearly in the outpatient department. Method At Tama Medical Center, Tokyo, Japan, 135consecutive patients with upper- gastrointestinal hemorrhage from January 2008 to December2009 were enrolled. All of the patients underwent urgent endoscopy within 24 hours. Wecalculated the GBS, the ratio of blood urea nitrogen to serum creatinine (BUN/CRE), estimatedglomerular filtration rate(eGFR), and recorded history of taking proton pump inhibitor(PPI)s, non-steroidal anti-inflammatory drug (NSAID)s and anti-platelet drugs. The endos-copic findings and the alcohol drinking history were also recorded. Main outcome measureswere endoscopic procedure which contained prophylactic treatment to potential bleedingpoints. The multiple logistic regression was used, and we createdmodified GBS. OurmodifiedGBS is created by (1) substituting BUN/CRE for BUN, and (2) adding the history of takingPPIs as a marker which we subtract three points if the patient takes PPIs. Results The medianage of the 135 patients was 66 years. The all-cause in-hospital mortality was 2.9%. All thepatients underwent urgent endoscopy. Endoscopic intervention was performed in 51% ofthe patients. There was re-bleeding in 8.1%, blood transfusion in 62% and surgery in 0%The GBS mean for non endoscopic procedure patients was 11.0±3.9 and for endoscopicprocedure patients was 13.3±3.4(p<0.05),and odds ratio was 1.20 [95%CI(1.09-1.33)] Thearea under receiver-operating characteristics (ROC) curve for the GBS was 0.712 with bestcut-off at 9. Patients with GBS>9 had greater endoscopic procedure(31%vs56%,p<0.05) Thearea under ROC curve for our modified GBS was 0.764 with best cut-off at 6. Patients withGBS>6 hadmore endoscopic procedure(0%vs54.6%,p<0.001) For patients with our modifiedGBS≦5, there was no endoscopic procedure in all-cause Conclusions: Our modified GBS>6could be superior to GBS>9 in predicting endoscopic procedure for upper-gastrointestinalhemorrhage. It produced better discrimination between low-risk and high-risk patients.The necessity of urgent endoscopic procedure with Glasgow Blatchford Score (GBS)

The necessity of urgent endoscopic procedure with our modified Glasgow Blatchford Score(m-GBS)

Mo1103

Timely Endoscopy Depends on Quality of Early Resuscitation and Pre-Endoscopic Care in Nonvariceal Upper GI HemorrhageFalguny Bhavan, Sara Echelmeyer, Elie Chahla, Nabeel Koro, Juan Li, Charlene M.Prather, Fasiha Kanwal

Background Early endoscopy (within 24 hours) improves outcomes in patients with nonvar-iceal upper gastrointestinal hemorrhage (NVUGIH). However, despite advances in endoscopicmanagement, mortality remains high; inadequate early resuscitation is likely an importantcontributor. There is little systematic information about the extent to which standard resus-citation care processes are delivered during routine pre-endoscopic clinical care. Moreover,the link between these processes and receipt of early endoscopy is unclear. We sought toevaluate the quality of pre-endoscopic care that patients with NVUGIH receive and itsassociation with receipt of early endoscopy. Methods We conducted a retrospective reviewof patients who were admitted with NVUGIH to a University-based VA medical center from2000-2008. Using a standardized data abstraction tool, we assessed quality of pre-endoscopiccare received by patients as measured by five explicit Delphi panel-derived quality indicators(QIs) in NVUGIH [table]. We defined the aggregate quality of pre-endoscopic care as thepercentage of QIs satisfied by those who were eligible. We divided the sample in half onthe basis of aggregate score (<median, >median) and measured the unadjusted relationshipbetween quality of pre-endoscopic care and receipt of early EGD. We then performedmultivariate regression analysis adjusting for demographics (age, gender), severity of bleeding(defined as clinical presentation and Rockall score), location (inpatient vs. outpatient), andtime and day of presentation to isolate the effect of quality care on early EGD. Results Therewere 418 patients (mean age=65±10,SD; Charlson index=3.1±3,SD; severe bleeding=46%).The individual QI scores varied from 7% for early risk stratification to 88% for completebloodwork at initial presentation. On average, patients received 44% of the indicated careprocesses. Although 89% of patients underwent EGD during index hospitalization, only

AG

AA

bst

ract

s