receptor antagonist(32.1%). Sucralfate was used in 11.2% but there was nouse of either an aluminium based antacid or a bile binding resin. 2.2% ofpatient population had bile diversion surgery with reported good outcome.The post–gastrectomy pH prior to medication in PUD patients(n�14) was5.5�–1.0 and for gastric cancer(n�7) was 6.1 �–1.2. there was no statis-tical difference (p�0.9).Conclusion: Bile gastritis is a commonly diagnosed post–gastrectomydisorder. Appropriate management has not been well established. Acidreducing medications add to the cost of therapy without controlling symp-toms. Studies should be directed to developing well defined diagnosticcriteria and effective management.

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MORTALITY AND FOLLOW–UP COLONOSCOPY FORCOLORECTAL CANCERDeborah A. Fisher, M.D., Amy Jeffreys, M.Stat., Steven C. Grambow,Ph.D. and Dawn Provenzale, M.D.*. Gastroenterology, DukeUniversity Medical Center, Durham, NC; Biostatistics andBioinformatics, Duke University Medical Center, Durham, NC andInstitute for Clinical and Epidemiological Research, Durham VAMedical Center, Durham, NC.

Purpose: To compare the mortality of patients with colorectal cancer whoreceived colonoscopic follow–up to patients who did not (adjusting for age,race, comorbidity, radiation therapy and chemotherapy).Methods: National VA databases were linked to identify the study cohortand gather follow–up data for a 5–year period. Inclusion required a newdiagnosis of colorectal cancer in 1995–1996. Exclusion criteria were in-flammatory bowel disease, metastatic disease at diagnosis or death withinone year. The primary outcome was 5–year survival rate. The log–rank testand a Cox proportional hazard model were used to examine the associationbetween follow–up colonoscopy and 5–year survival rate.Results: The 3546 patients had a mean age of 68, were 98% male, 81%white and had a 66.8% 5–year survival. The survival of the follow–upcolonoscopy group was higher than the no follow–up group by the log–rank test (p�0.0001). In the adjusted analysis, the risk of death wasdecreased by 43% in the group who had at least one follow–up colonos-copy compared with patients who had no follow–up colonoscopies (riskratio (RR) 0.57 95% confidence interval (CI) 0.51–0.64). The RR (95% CI)for the other significant predictors of 5–year survival were 1.13 (1.10–1.17)for each 5 years in age, 1.35 (1.18–1.56) for 1 major comorbidity and 1.90(1.65–2.20) for 2 major comorbidities each compared to none, 1.32 (1.15–1.50) for chemotherapy and 1.88 (1.62–2.19) for radiation therapy. Raceand site of cancer were not significant predictors of survival. The meannumber of outpatient visits for both groups was equivalent at 123.Conclusions: 1) As expected, increasing age and comorbidities wereassociated with increased mortality. 2) Radiation and chemotherapy werealso associated with an increased risk of death suggesting that they weremarkers of disease stage. 3)Utilization was the same among groups sug-gesting that the reduced risk of death was associated with colonoscopy andnot more intensive follow–up in the group receiving colonoscopy. 4)Thisstudy strongly supports a mortality benefit for endoscopic follow–up ofnon–metastatic colorectal cancer.

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A MULTIDISCIPLINARY TEAM APPROACH SHORTENS PEGTUBE PLACEMENT TIMESpencer J. Jenkins, M.D., Ayaz J. Chaudhary, M.D., Carol Pardue, R.N.and Robert R. Schade, M.D., FACG*. Gastroenterology/Hepatology,Medical College of Georgia, Augusta, GA and Gastroenterology/Hepatology, VA Medical Center, Augusta, GA.

Purpose: This study was designed to improve quality of care, and todecrease length of hospital stay and hospital costs in patients referred forPEG feeding tube placement in a teaching institution.Methods: While monitoring the Ischemic Stroke Clinical Pathway wenoted that some patients were waiting more than 48 hours following

consultation before they obtained PEG feeding tube placement. This con-tributed to delays in skilled nursing facility placement and insurancedenials. To improve care, we reviewed charts of 25 patients: a 42% sampleof all PEG feeding tubes placed during a 6–month interval. We determinedthat the average time from PEG feeding tube consultation to PEG tubeplacement was 4.5 days. In 32% of cases there were documented barriersto placement such as antiplatelet therapy, infection, oral mass, or respira-tory distress. Excluding these patients from consideration, the average PEGtube placement time was 3.3 days from the day of consultation. A multi-disciplinary committee was organized to review this information and makerecommendations for process improvement. A plan was made to designateone physician as the point of contact for all PEG referrals in order tostreamline the fragmented consultation process. Also, guidelines weredeveloped to assist with the PEG feeding tube consultation process whichincluded indications and contraindications and the appropriate regulation ofantiplatelet and anticoagulant drug therapy.Results: Three months after instituting these changes we reconvened andreviewed the PEG feeding tube data on all 18 PEG tubes placed in theinterim. There was an overall decrease of 2 days time (4.5 to 2.5 days)between consultation and feeding tube placement. When the data wereanalyzed eliminating those with documented barriers to feeding tube place-ment, the PEG tube placement time decreased from 3.3 to 1.8 days allowingfor earlier nursing home placement and potential decreased length of staywith a projected cost savings of as much as $180,000 per year.Conclusions: With this multidisciplinary team approach, we should con-tinue to improve on the time delay from initial consultation to successfulPEG feeding tube placement while providing this service to appropriatelyselected patients and decreasing overall hospital costs and length of stay.

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LACK OF SEASONAL VARIATION FOR INTESTINALISCHEMIAJyotsna Talapaneni, M.D., Micheal Lief, M.D., Wang C. Lam, M.D. andLawrence J. Brandt, M.D., M.A.C.G.*. Gastroenterology, MontefioreMedical Center, Bronx, NY.

Purpose: Intestinal ischemia has been shown in anecdotal reports and adeath certificate–based survey to have a seasonal variation. However, thereis no study evaluating this occurrence with regard to the type of intestinalischemic disease. In this study, we attempt to validate this observation anddetermine if it is true for colon ischemia (CI), acute mesenteric ischemia(AMI) or both disorders.Methods: Colonoscopy reports and hospital charts coded for acute intes-tinal vasculopathy (ICD9 code 557.0) from 1/91–12/01 at MontefioreMedical Center were reviewed retrospectively. Patients were selected ifthey had endoscopic, radiologic or pathologic evidence that correlated withtheir clinical presentation of intestinal ischemia. Subcategories of AMI, e.g.embolus, thrombosis, non–occlusive mesenteric ischemia (NOMI), wereevaluated separately. Patients were excluded if the ischemic injury resultedfrom intestinal obstruction. The month of diagnosis was noted and trendsevaluated for seasonal variation (figure 1).

Results: Over this 5–year interval, 342 patients fulfilled selection criteria:310 patients with CI and 32 with AMI. A female to male ratio of 1.8 and1.6 was observed in the CI and AMI groups, respectively. The means usedto confirm the diagnoses are shown in table 1.

S237AJG – September, Suppl., 2002 Abstracts