Mo1270 Foodborne Disease-a Significant Burden to Thailand's Universal Health Care System

of DICA. DICA score validation was carried out by estimating the correlation betweenthe calculated index and Erythro-Sedimentation Rate (ESR) and C-Reactive Protein (CRP)expression. Correlation between the calculated index and the symptoms experienced bypatients at the time of colonoscopy was assessed too. Finally, 50 videos of DD patients notinvolved in the development of DICA were reassessed in order to investigate the predictiverole of DICA on the outcome of the disease. Results: A total of 960 ratings were performedby endoscopists involved. Overall agreement in using DICA was 0.847 (95% CI 0.812 to0.893). It was 0.878 (95% CI 0.832 to 0.895) for DICA 1, 0.765 (95% CI 0.735 to 0.786)for DICA 2, and 0.891 (95% CI 0.845 to 0.7923) for DICA 3. Intra-observer agreementkappa was 0.91 (95% CI 0.886 to 0.947). A significant correlation was found between DICAscore and both ESR (p=0.0001) and CRP values (p=0.0001), as well as between medianpain score and DICA score (p=0.0001). With respect to the 50 patients retrospectivelyreassessed, recurrence or occurrence of disease complications were recorded in 29 (58%)patients: 10 (34.5%) were classified as DICA 1 and 19 (65.5%) as DICA 2 (p=0.036).Conclusions: Diverticular Inflammation and Complication Assessment (DICA) score is asimple, reproducible, validated, and easy-to-use endoscopic scoring system for diverticulardisease of the colon.

Mo1269

Long-Term Outcome After Conservative and Endoscopic Treatment of ColonicDiverticular BleedingAkira Mizuki, Masayuki Tatemichi, Atsushi Nakazawa, Nobuhiro Tsukada, HiroshiNagata, Takanori Kanai

Purpose: This study was designed to compare the long-term outcome of patients treatedwith conservative (no endoscopic treatment because the site of bleeding was not identified)versus endoscopic treatment (clipping and/or HSE injection) for colonic diverticular bleeding(CDB) Material and Methods: Between September 2000 and December 2010, 123 CDBpatients were registered and treated in Saiseikai Central Hospital. The diagnosis of CBD wasbased on the criteria described by Jensen (N Engl J Med 2000;342:78-82). Recurrent bleedingwas diagnosed similarly. Endoscopic injection therapy was based on Jensen's technique: 1-or 2-ml aliquots of epinephrine were injected in four quadrants of the bleeding diverticulum.In tracking the patients, questionnaires were sent in order to obtain information on CDBrecurrence. Outcomes were compared based on initial therapy (conservative vs. endoscopic)using Kaplan-Meier's method. Furthermore, Cox proportional hazards model was performedto identify potent risk factors for recurrence of CDB using information on use of NSAIDand anti-coagulant, medical histories of diabetes mellitus, hypertension, heart disease, andchronic kidney disease. Results: Eighty eight patients with CDB answered the questionnaires,and their median (intraquarter range) follow-up periods were 42.7 (61.8) months. Twenty-four (38.7%) of 62 conservatively treated patients and 16 (61.5 %) of 26 endoscopicallytreated patients had a recurrence of CDB during follow-up. Treatment groups did notdiffer in age, gender, and other patients characteristics. Table 1 summarizes the patients'characteristics. Kaplan-Meier's analysis indicated significantly (p<0.05) more rapid recurrencein the cases with endoscopic treatment, compared to the cases with non endoscopic treatment.(mean recurrence period=55.3 months (95%CI: 30.8-79.9) vs. 99.9 months (95%CI:80.7-119.1) (Fig. 1). Cox-analysis did not identify any significant variables. Conclusion: Endo-scopic treatment of CBD is not effective in preventing an eventual relapse of CDB.Table1. Patients Characteristics

CBD: Colonic Divertcular Bleeding ACD: Acute Colonic Diverticulitis NS: Not Significant

S-603 AGA Abstracts

Mo1270

Foodborne Disease-a Significant Burden to Thailand's Universal Health CareSystemSombat Treeprasertsuk, Kamthorn Phaosawasdi, Kaewjai Thepsuthammarat, BubphaKitsahawong, Aroon Chirawatkul

Aims On January 4, 2011, President Barack Obama signed The Food Safety Act in law.However CDC still estimates that there are 128,000 hospitalizations and 3,000 deaths peryear in U.S.A. In Thailand the Universal Health Care Act was passed in 2002. We used datafrom The National Admission Data in 2010 to study the burden of foodborne disease anddiarrhea in Thailand. Methods: We used the inpatient medical expense from the 2010Nationwide Hospital Admission Data , the National Health Security Office (NHSO), Thailandwhich included the diagnosis of digestive diseases and intestinal infectious diseases codingby the ICD-10 (Infectious diarrhea: ICD10 A00-A09 and K00-K93). The included patients'age were 19 years old or over. Their baseline characteristics and clinical outcomes offoodborne disease and diarrhea were analyzed according to their health insurance categoriesincluding Universal Coverage, Social Security Fund and Government Welfare MedicalExpense Results: Of 4,863,935 admissions in the year 2010, 747,709 of them (15.4%) werethe diagnosis of digestive diseases and intestinal infectious diseases which included 506,449and 241,260admissions, respectively. One-thirds of the diagnosis of digestive diseases andintestinal infectious diseases (214,722 admissions; 29%) were foodborne disease and diarrhea,with a mean age of 53.7 years old. About two-thirds (59%) were between 18-60 years old,while the male to female ratio was 1:1.7, About 63% of patients were diagnosed and receivedtreatments at the primary care hospitals. Their baseline characteristics and comorbiditieswere classified into 3 groups according to their health insurance (Table 1). The majority ofpatients (72%) were in the group of Universal Coverage while 15 % of patients were in theSocial Security Fund group. The remaining of 13% of patients was in the GovernmentWelfare Medical Expense group. For clinical outcomes of acute diarrhea, 1048 patients(0.5% of admission) died. Complications occurring during hospitalization were septicemia(n=4675; 2.2%), on mechanical ventilation (n=1249; 0.6%) and renal failure requiringhemodialysis (n=294; 0.14%). The underlying of HIV infection was 1.4%. The mean durationof the length of stay was 2.5 days. Conclusions: The burden of foodborne disease anddiarrhea is a major problem in Thailand and accounting for 29% of the digestive diseasesand intestinal infectious diseases with the mortality rate of 0.5% in the 2010 NationwideHospital Admission Data. Education of the public about the sanitary and preparation andcooking of food to prevent infections may be the most economic solution to decrease theburden of food-borne diseases in Thailand.The baseline characteristics and the comorbidities of 214,722 admissions with foodbornedisease and diarrhea which classified into 3 groups according to their health insurance fromthe 2010 Nationwide Hospital Admission Data of ThailandThe baseline characteristics and the comorbidities of 214,722 admissions with foodbornedisease and diarrhea from the 2010 Nationwide Hospital Admission Data of Thailand

Mo1271

Characterizing Olmesartan-Induced Enteropathy Risk Factors, Severity, andSymptom Resolution, a Follow-Up to the 2012 Case SeriesAmanda K. Cartee, Ashley Nadeau, Alberto Rubio-Tapia, Margot Herman, Joseph A.Murray

Background: Olmesartan-induced enteropathy (OIE) is a newly described entity in whichpatients taking olmesartan, an angiotensin II receptor blocker (ARB), develop profounddiarrhea, nausea, vomiting, and weight loss. Some patients required hospitalization and totalparenteral nutrition. Duodenal biopsies of all patients showed villous duodenal atrophy.Symptoms resolve with drug withdrawal. In this study, we aim to systematically build uponthe prior study. Patients and Methods: Patients included in the study had contact with theMayo Clinic in Rochester, Minnesota, gastrointestinal symptoms, and histological evidenceof villous atrophy while on olmesartan with subsequent resolution with olmesartan with-drawal, and agreement to participate. Three patients with similar symptoms but on differentARBs were excluded and described separately. Thirty-five patients with OIE were surveyedand medical charts reviewed for demographic information, olmesartan use history, symptoms,alternate diagnoses, interventions, recovery, and HLA-DQ2 status to describe OIE symptomsand its multi-organ nature, identify risk factors, and describe symptom resolution. Results:All patients (21 female, mean age 67.9 years) had taken olmesartan of varying doses, rangingfrom 5 mg to 40 mg, for at least one year. Patients most commonly reported diarrhea anda mean weight loss of 22.1 kg. One patient had a positive tissue transglutaminase (tTG),and 71.4% of patients were HLA-DQ2 positive. Vitamin and mineral deficiencies, hospitaliza-tion, acute renal failure, and total parenteral nutrition were common complications. Gastritisand colitis occurred in 29% of the group, and duration of olmesartan use positively correlatedwith development of colitis. Most patients (62.8%) noted symptom resolution in less thanone month following olmesartan withdrawal. However, no factors were predictive of OIEdevelopment, severity, or resolution. Four of the patients in the group likely have celiacdisease, and all of these patients had evidence of gastritis. Three patients, each taking adifferent ARB, had symptoms similar to patients with OIE. Key features of OIE are displayedin Table 1. Conclusions: These findings underscore the significance of the effects on other

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