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  • Early Covered Self-Expandable Metal Stent Placement Is Effective for Massive Post-endoscopic Sphincterotomy Bleeding
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-16
    Tadahisa Inoue, Mayu Ibusuki, Rena Kitano, Yuji Kobayashi, Tomohiko Ohashi, Yukiomi Nakade, Yoshio Sumida, Kiyoaki Ito, Masashi Yoneda

    Abstract Background Placement of covered self-expandable metallic stent (CSEMS) for post-endoscopic sphincterotomy (ES) bleeding achieves excellent hemostasis results. Although CSEMS placement is typically performed after failure of conventional endoscopic combination therapy, its excellent outcomes may justify earlier placement. Aims We aimed to examine the efficacy of “early” CSEMS placement for massive post-ES bleeding. Methods The medical records of 2750 patients who underwent ES between 2005 and 2019 were reviewed retrospectively, and 61 patients who developed massive post-ES bleeding were enrolled. These patients were divided into those who underwent early CSEMS placement (E-CSEMS group) and those who underwent conventional endoscopic combination therapy (Conventional group). The outcomes of hemostasis procedures were compared between the groups. Results The primary success rates of endoscopic hemostasis were 100% (21/21) and 98% (39/40) in the E-CSEMS group and Conventional group, respectively, without significant differences (P = 1.000). However, in the E-CSEMS group, re-bleeding was significantly less frequent (5% vs. 31%; P = 0.023), the median hemostasis procedure time was significantly shorter (14 min vs. 26 min; P < 0.001), and transfusion after initial hemostasis treatment was less commonly required (10% vs. 38%; P = 0.034). Multivariate analyses showed that hemodialysis was associated with a significantly higher re-bleeding rate (P = 0.029), while CSEMS placement was associated with a significantly lower re-bleeding rate (P = 0.039). Conclusions Early CSEMS placement may be effective for improving the clinical outcomes of massive post-ES bleeding by decreasing re-bleeding and the extent of bleeding.

    更新日期:2020-01-16
  • iASPP-Mediated ROS Inhibition Drives 5-Fu Resistance Dependent on Nrf2 Antioxidative Signaling Pathway in Gastric Adenocarcinoma
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-14
    Lu Wen, Shengli Yang, Pindong Li, Renwang Chen, Qiushuang Wang, Bashir Kaspo, Heng Fan, Jianli Hu

    Abstract Aims Inhibitor for the apoptosis-stimulating protein of p53 (iASPP) has been reported to be correlated with 5-fluorouracil (5-Fu) resistance in renal cell carcinoma. Here, we uncover mechanisms of iASPP-Nrf2-ROS regulation of 5-Fu resistance which are important for the development of alternative treatment strategies for gastric adenocarcinoma treatment. Methods We analyzed iASPP and Nrf2 through TCGA RNA-seq data, UALCAN analysis, and cBioPortal datasets. Intracellular ROS generation was determined by 2′,7′-dichloro-fluorescin diacetate staining. Transwell was used to evaluate the invasion. The expression of iASPP, Nrf2, HO-1, and GSTP1 was tested using western blot. Results We found that iASPP KD led to an apparent 5-Fu-induced ROS accumulation in MGC803 and SCG790 cells. Accompanied by iASPP KD, Nrf2 was markedly decreased. iASPP-induced ROS inhibition relies on Nrf2, and due to both knocked down iASPP and Nrf2, the level of ROS did not show an obvious difference with Nrf2 KD solely. Similarly, iASPP KD failed to enhance the Nrf2 KD-mediated ROS accumulation after 5-Fu treatment, suggesting that iASPP-induced antioxidative effects related to 5-Fu resistance are partially dependent on Nrf2. Also, the combination of iASPP KD and Nrf2 KD did not show any synergistic effect on apoptosis after 5-Fu treatment in MGC803 and SCG790 cells. Further studies revealed that iASPP KD or Nrf2 KD could decrease the expression of HO-1 and GSTP1. Conclusions Our data highlight that iASPP plays a crucial role in the inhibition of 5-Fu-induced apoptosis resistance by removing ROS accumulation in gastric adenocarcinoma, and that the removal of ROS induced by iASPP is Nrf2 signaling dependent.

    更新日期:2020-01-15
  • Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-14
    Sascha van Boemmel-Wegmann, Vincent Lo Re, Haesuk Park

    Despite the high efficacy and safety associated with direct-acting antivirals (DAAs), access to HCV treatment has been frequently restricted because of the high DAA drug costs.

    更新日期:2020-01-15
  • Measuring the Quality of Palliative Care for Patients with End-Stage Liver Disease
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-11
    Arpan Patel, Steven Asch, Anna Liza Antonio, Fasiha Kanwal, Karl Lorenz, Deborah Riopelle, Anna Dickey, Jennifer Larkin, Martin Lee, Anne Walling

    Abstract Background/Aims We examined the quality of palliative care received by patients with decompensated cirrhosis using an explicit set of palliative care quality indicators (QIs) for patients with end-stage liver disease (PC-ESLD). Methods We identified patients newly diagnosed with decompensated cirrhosis at a single veterans health center and followed up them for 2 years or until death. We piloted measurement of PC-ESLD QIs in all patients confirmed to have ESLD using a chart abstraction tool. Results Out of 167 patients identified using at least one sampling strategy, 62 were confirmed to meet ESLD criteria with chart abstraction. Ninety-eight percent of veterans in the cohort were male, mean age at diagnosis was 61 years, and 74% were White. The overall QI pass rate was 68% (64% for information care planning QIs and 76% for supportive care QIs). Patients receiving specialty palliative care consultation were more likely to receive information care planning QIs (67% vs. 37%, p = 0.02). The best performing sampling strategy had a sensitivity of 62% and specificity of 60%. Conclusion Measuring the quality of palliative care for patients with ESLD is feasible in the veteran population. Our single-center data suggest that the quality of palliative care is inadequate in the veteran population with ESLD, though patients offered specialty palliative care consultation and those affected by homelessness, drug, and alcohol abuse may receive better care. Our combination of ICD-9 codes can be used to identify a cohort of patients with ESLD, though better sensitivity and specificity may be needed.

    更新日期:2020-01-13
  • Polyp Detection Rate Correlates Strongly with Adenoma Detection Rate in Trainee Endoscopists
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-11
    Sandy Ng, Aditya K. Sreenivasan, Jillian Pecoriello, Peter S. Liang

    Abstract Background The adenoma detection rate (ADR) is a widely accepted quality benchmark for screening colonoscopy but can be burdensome to calculate. Previous studies have shown good correlation between polyp detection rate (PDR) and ADR, but this has not been validated in trainees. Additionally, the correlation between PDR and detection rates for sessile serrated polyps (SSPDR) and advanced neoplasia (ANDR) is not well studied. Aims We investigated the relationship between PDR and ADR, SSPDR, and ANDR in trainees. Methods We examined 1600 outpatient colonoscopies performed by 24 trainees at a VA hospital from 2014 to 2017. Variables collected included patient demographics, year of fellowship, colonoscopy indication, and endoscopic and histologic findings. We calculated the overall ratios of PDR to ADR, SSPDR, and ANDR to assess the correlation between measured and calculated ADR, SSPDR, and ANDR, which is equivalent to the correlation between PDR and measured ADR, SSPDR, and ANDR. Results The overall PDR, ADR, SSPDR, and ANDR were 72%, 52%, 2%, and 14%. PDR (48%) was highest in the left colon, while ADR (32%) and ANDR (7%) were highest in the right colon (p < 0.001 for all). The overall ADR/PDR, SSPDR/PDR, and ANDR/PDR ratios were 0.73, 0.03, and 0.20. Correlation between PDR and ADR was highly positive overall (r = 0.87, p < 0.0001) and stronger in the right (r = 0.91) and transverse (r = 0.94) colon than the left colon (r = 0.80). Correlation between PDR and overall SSPDR and ANDR were not statistically significant. Conclusions PDR can serve as a surrogate measure of ADR to monitor colonoscopy quality in gastroenterology fellowship.

    更新日期:2020-01-13
  • Mutational Mosaics of Cell-Free DNA from Pancreatic Cyst Fluids
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-10
    Agnieszka Paziewska, Marcin Polkowski, Krzysztof Goryca, Jakub Karczmarski, Anna Wiechowska-Kozlowska, Michalina Dabrowska, Michal Mikula, Jerzy Ostrowski

    Abstract Background Pancreatic cyst fluids (PCFs) enriched in tumor-derived DNA are a potential source of new biomarkers. The study aimed to analyze germinal variants and mutational profiles of cell-free (cf)DNA shed into the cavity of pancreatic cysts. Methods The study cohort consisted of 71 patients who underwent endoscopic ultrasound fine-needle aspiration of PCF. Five malignant cysts, 19 intraductal papillary mucinous neoplasms (IPMNs), 11 mucinous cystic neoplasms (MCNs), eight serous cystic neoplasms (SCNs), and 28 pseudocysts were identified. The sequencing of 409 genes included in Comprehensive Cancer Panel was performed using Ion Proton System. The mutation rate of the KRAS and GNAS canonical loci was additionally determined using digital PCR. Results The number of mutations detected with NGS varied from 0 to 22 per gene, and genes with the most mutations were: TP53, KRAS, PIK3CA, GNAS, ADGRA2, and APC. The frequencies of the majority of mutations did not differ between non-malignant cystic neoplasms and pseudocysts. NGS detected KRAS mutations in malignant cysts (60%), IPMNs (32%), MCNs (64%), SCNs (13%), and pseudocysts (14%), with GNAS mutations in 20%, 26%, 27%, 13%, and 21% of samples, respectively. Digital PCR-based testing increased KRAS (68%) and GNAS (52%) mutations detection level in IPMNs, but not other cyst types. Conclusions We demonstrate relatively high rates of somatic mutations of cancer-related genes, including KRAS and GNAS, in cfDNA isolated from PCFs irrespectively of the pancreatic cyst type. Further studies on molecular mechanisms of pancreatic cysts malignant transformation in relation to their mutational profiles are required.

    更新日期:2020-01-11
  • Pyoderma Gangrenosum in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-10
    Vanessa States, Stephen O’Brien, Jayesh P. Rai, Henry L. Roberts, Mason Paas, Kayla Feagins, Evangeline J. Pierce, Richard N. Baumgartner, Susan Galandiuk

    Pyoderma gangrenosum (PG) is an uncommon but severe extra-intestinal manifestation (EIM) of inflammatory bowel disease (IBD). The incidence and risk factors for PG are disputed.

    更新日期:2020-01-11
  • Sex Differences in Authorship of Major Gastroenterology Society Guidelines and Technical Reviews
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-09
    Daniel Bushyhead, Lisa L. Strate

    To analyze the proportion of gastroenterology society guidelines and technical reviews with female authors.

    更新日期:2020-01-09
  • Recent Developments in Drugs for GI Endoscopy Sedation
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-08
    Basavana Goudra, Gowri Gouda, Preet Mohinder

    Providing sedation for patients undergoing gastrointestinal (GI) endoscopy continues to be a debated topic in both anesthesia and gastroenterology circles. Sedation approaches are widely varied across the globe. While propofol administration is embraced by more endoscopists and patients, its administration evolves controversy. Whereas trained nurses and gastroenterologists are allowed to administer propofol for GI endoscopy sedation in Europe and Asia, it is the sole privilege of anesthesia providers in the USA. However, the costs of anesthesia providers are significant and threaten to derail the screening colonoscopy practice. Efforts were made by both drug and device manufacturers to find alternatives. Fospropofol was one such effort that did not live up to the expectations due to respiratory depressant properties that were similar to propofol. Use of a new tool to administer propofol in the form of Sedasys® was the next experiment that tried to find alternative to anesthesia providers. The device did not succeed due to inadequate sedation. The latest effort is remimazolam, a new benzodiazepine that has quicker recovery profile. In the interim, many drug combinations such as propofol–dexmedetomidine and propofol–ketamine are improving the safety without compromising the quality of sedation. This review attempts to discuss the new drug innovations and drug combinations of existing sedatives for the benefit of readers.

    更新日期:2020-01-09
  • Increased Risk of Progression to Gastric Adenocarcinoma in Patients with Non-dysplastic Gastric Intestinal Metaplasia Versus a Control Population
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-08
    Rohit Dhingra, Nikola S. Natov, Yazan Daaboul, Moises Guelrud, Abraham Cherukara, Pu Fang Hung, Mark J. Sterling

    Abstract Aim In previous studies, the 5-year progression rate of gastric intestinal metaplasia to gastric adenocarcinoma has varied substantially. We investigated the incidence rate of dysplasia and gastric adenocarcinoma and the rate of progression among a cohort of patients with non-dysplastic gastric intestinal metaplasia. Methods This is a single-center, single-cohort retrospective study. Patients who had undergone an EGD with biopsies from 01/01/1993 to 12/31/2013 were included. The primary outcome of interest was the composite of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma. Time to progression and risk factor subgroup analyses were performed. Results A total of 1628 subjects were screened, of whom 358 met the inclusion criteria. A total of 21 first-time events were recorded. The annual incidence rate of low-grade dysplasia was 2.1 (95% CI 1.3–3.5) cases per 1000 person-years, 0.5 (95% 0.2–1.3) per 1000 person-years for high-grade dysplasia, and 0.8 (95% CI 0.3–1.6) cases per 1000 person-years for gastric adenocarcinoma. The historical control group had an annual adenocarcinoma incidence rate of 0.07 per 1000 person-years. The event rate in Asians was also noted to be significantly higher between years 0–8 as compared with patients of non-Asian race, and extensive intestinal metaplasia was an independent risk factor (HR = 4.06 (95% CI 1.45–11.34), p = 0.007). Conclusions Patients with non-dysplastic gastric intestinal metaplasia may progress to dysplasia and gastric adenocarcinoma. The incidence rate of gastric adenocarcinoma is higher than that of the historical control population (0.07 per 1000 person-years). The presence of extensive intestinal metaplasia was a risk factor for progression of disease. Triennial EGD may be warranted in patients with non-dysplastic gastric intestinal metaplasia.

    更新日期:2020-01-08
  • Mucosal Th17 Cells Are Increased in Pediatric Functional Dyspepsia Associated with Chronic Gastritis
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-08
    Meenal Singh, Vivekanand Singh, Jennifer V. Schurman, Craig A. Friesen

    Chronic gastritis is a common histologic finding in children with functional dyspepsia (FD). While Th17 cells have been implicated in other forms of gastritis, they have not been evaluated in chronic gastritis.

    更新日期:2020-01-08
  • Characteristics of Drug-Induced Liver Injury in Northeast China: Disease Spectrum and Drug Types
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-06
    Chong Zhang, Yuyu Wu, Suyu Yuan, Xiaoguang Dou, Qiuju Sheng, Jingyan Wang, Wenyue Tian, Lan Yao, Yang Ding

    Abstract Background The aim of this study was to determine the disease spectrum and drug types causing drug-induced liver injury (DILI) in northeast China, so that the affected population can be reminded of the need to increase their post-medication monitoring. Methods A total of 470 DILI patients hospitalized at Shengjing Hospital between 2013 and 2016 were involved in this retrospective study. Results There were significant differences in the disease spectrum of the different age groups (P < 0.001) and genders (P = 0.009). Drugs used to treat osteopathies, dermatitis and infections, as well as health care supplements, each accounted for > 10% of all drugs that caused DILI. The percentage of DILIs related to Chinese herbal medicines (CHMs) gradually increased with patient age (P = 0.002). The percentage of males taking health supplements or CHMs was significantly lower compared with females. Total bilirubin (β = 0.01, OR = 1.01, P < 0.001) and INR (β = 0.74, OR = 2.11, P < 0.001) were found to be independent predictors of liver damage. Conclusions The main type of drug that causes DILI in northeast China is a CHM. There are differences in the disease spectrum found in DILI patients of different ages and gender. Making appropriate changes in the drug-taking habits of high-risk groups and the drugs used to treat high-risk underlying diseases, as well as increasing patient monitoring, may help to reduce the incidence of DILIs.

    更新日期:2020-01-06
  • Predictors of Outcomes in Endoscopies for Foreign Body Ingestion: A Cross-Sectional Study
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-06
    Jason Saltiel, Rebecca Molinsky, Benjamin Lebwohl

    As foreign body ingestion/food impaction is one of the less common indications for upper endoscopy in adults, few studies have investigated outcomes. We aimed to determine the distribution of ingested items warranting endoscopy and to identify factors associated with successful endoscopic retrieval.

    更新日期:2020-01-06
  • Severity of Ascites Is Associated with Increased Mortality in Patients with Cirrhosis Secondary to Biliary Atresia
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-06
    Renata R. Guedes, Carlos O. Kieling, Jorge L. dos Santos, Carolina da Rocha, Fernando Schwengber, Marina R. Adami, Marcio F. Chedid, Sandra M. G. Vieira

    Abstract Background Very few prior studies have investigated the presence of ascites as a prognostic factor in children with cirrhosis. To the best of our knowledge, there are no prior studies evaluating the relationship between severity of ascites and patient survival in children with biliary atresia and cirrhosis. Aims To evaluate the association between severity of ascites and survival of children with cirrhosis and biliary atresia. Methods All children with cirrhosis secondary to biliary atresia evaluated at our institution from 2000 to 2014 were included in this study. Patients were classified into four groups: NA = no ascites; A1 = grade 1 ascites; A2 = grade 2 ascites; and A3 = grade 3 ascites. The primary endpoint of the study was mortality within the first year after patient inclusion. Ninety-day mortality was also evaluated. Prognostic factors related to both endpoints also were studied. Results One-year patient survival for NA was 97.1%, versus 80.8% for A1, versus 52% for A2, versus 13.6 for A3 (p < 0.001). The presence of ascites increased mortality by 17 times. In the multivariate analysis, clinically detectable ascites (HR 3.14, 95% CI 1.14–8.60, p = 0.026), lower sodium (HR 1.15, 95% CI 1.04–1.27, p = 0.006), higher bilirubin (HR 1.06, 95% CI 1.00–1.12, p = 0.023), and higher PELD score (HR 1.05, 95% CI 1.02–1.08, p = 0.001) were all associated with decreased survival. Lower serum sodium (HR 1.20, 95% CI 1.09–1.32, p < 0.001) and higher PELD score (HR 1.03, 95% CI 1.001–1.063, p = 0.043) were associated with increased 90-day mortality. Conclusions Clinically detectable ascites is associated with decreased 1-year survival of children with biliary atresia. These patients should be treated with caution and prioritized for liver transplantation.

    更新日期:2020-01-06
  • Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-06
    Danse Bi, David A. Katzka, Crystal J. Lavey, Debra M. Geno, Karthik Ravi

    Indefinite proton pump inhibitor (PPI) therapy and endoscopic evaluation for Barrett’s esophagus is recommended for erosive esophagitis (EE). However, the clinical course of EE remains undefined.

    更新日期:2020-01-06
  • Correction to: Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Patrick McCabe, Artin Galoosian, Robert J. Wong

    The original version of the article unfortunately contained an error in Figure 3. X-axis of Figures 3(a-d) should be ‘Time in months’. Corrected version of Figure 3 is given.

    更新日期:2020-01-04
  • Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Kishan Patel, Somashekar G. Krishna, Kyle Porter, Peter P. Stanich, Khalid Mumtaz, Darwin L. Conwell, Steven K. Clinton, Hisham Hussan

    Abstract Background and Aims Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database. Methods We retrospectively queried the 2010–2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses. Results The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings. Conclusions Analysis of national data demonstrates an increasing trend of MO patients’ admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.

    更新日期:2020-01-04
  • Genetic Evaluation of Children with Idiopathic Recurrent Acute Pancreatitis
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Zaheer Nabi, Rupjyoti Talukdar, Ravikanth Venkata, Mohsin Aslam, Upender Shava, D. Nageshwar Reddy

    Abstract Objectives Several genetic risk factors have been identified in adults with idiopathic acute recurrent pancreatitis (IARP). However, the literature regarding the genetics of IARP is sparse in children. In this study, we aimed to analyze the genetic risk factors in children with IARP. Methods All children (< 18 years) with ARP from January 2015 to May 2018 were prospectively enrolled in the study. Children with a known cause of ARP like obstructive, toxic/metabolic, and autoimmune were excluded from the final analysis. Children with IARP underwent genetic testing for mutations/polymorphisms in genes known to predispose to pancreatitis including cationic trypsinogen protease serine 1 (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator gene (CFTR), chymotrypsin C (CTRC), claudin-2 (CLDN2) and cathepsin B (CTSB). Results A total of 239 children (116 boys, 10.3 ± 3.7 years) were enrolled during the study period. Of these, 204 (85.35%) children were identified as IARP. The mean age of symptom onset and the number of pancreatitis episodes were 8.3 ± 3.7 years and 3.3 ± 1.8, respectively. A family history of pancreatitis was noted in 4.6% children. Mutations/polymorphisms in at least 1 gene were identified in 89.5% (129/144) children including SPINK1 in 41.9%, PRSS1 (rs10273639) in 58.2%, CTRC in 25.6%, CTSB in 54.9%, CLDN2 in 72.9%, and CFTR in 2.3%. There was no significant incidence of genetic mutations/polymorphisms in IARP with or without pancreas divisum (95.7 vs 88.4%; p = 0.467). Conclusions Genetic alterations are present in the majority of the children with IARP. The incidence of genetic mutations is similar in children with or without pancreas divisum.

    更新日期:2020-01-04
  • Post-Liver Transplantation Anemia and Its Correlation with Mortality and Graft Failure
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Tamar Berger, Iddo Reisler, Tzippy Shochat, Pia Raanani, Eviatar Nesher, Eytan Mor, Anat Gafter-Gvili, Amir Shlomai

    In adults, post-liver transplantation anemia (PLTA) is common, but its characteristics and long-term influence on major outcomes have yet to be elucidated.

    更新日期:2020-01-04
  • Astragaloside IV Synergizes with Ferulic Acid to Alleviate Hepatic Fibrosis in Bile Duct-Ligated Cirrhotic Rats
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Xue-Mei Zhao, Jing Zhang, Yi-Ni Liang, Ying-Cai Niu

    Due to the multi-factorial etiology of hepatic fibrosis, multi-target therapeutics based on combinatory drugs is known to be a promising strategy for the disease.

    更新日期:2020-01-04
  • Non-cirrhotic Extra-Hepatic Porto-Systemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Massimiliano Allegritti, Benedetta Enrico, Emanuela Basile, Lara de Vito, Antonino Morabito, Roberto Cirocchi, Michela Giustozzi, Giovanni Passalacqua

    Abstract Introduction Encephalopathy secondary to hyperammonemia due to Congenital Extra-hepatic Porto-systemic shunt (CEPS) in the absence of liver cirrhosis is an exceptionally unusual condition. We describe the case of a 54-year-old woman admitted to the Emergency Department complaining of recurrent episodes of confusion and worsening cognitive impairment. At admission, the patient displayed slowing cognitive-motor skills with marked static ataxia and impaired gait. Hyperammonemia was detected in the serum. An abdominal computed tomography (CT) excluded portal hypertension and liver cirrhosis, detecting a congenital extra-hepatic porto-systemic shunt which is a highly unusual vascular malformation. The patient was treated by interventional radiologists with a successful endovascular closure. Areas Covered We have performed a review of the last three decades of the literature, starting from the introduction of CT scanning in common clinical practice. Eighteen studies (case reports) described 29 patients with encephalopathy secondary to hyperammonemia due to CEPS in the absence of liver cirrhosis: They underwent treatment similar to our case report of CEPS. Expert Commentary Encephalopathy secondary to hyperammonemia in the absence of hepatic dysfunction is an important diagnostic dilemma to many clinicians. An interventional radiologic approach is currently preferred.

    更新日期:2020-01-04
  • HoxC6 Functions as an Oncogene and Isoform HoxC6-2 May Play the Primary Role in Gastric Carcinogenesis
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Jinping Lin, Jiamin He, Xingkang He, Lan Wang, Meng Xue, Wei Zhuo, Jianmin Si, Kan Wang, Shujie Chen

    Based on previous researches of HoxC6, this study aims to investigate the expression levels of isoforms HoxC6-1 and HoxC6-2 and to explore their roles in gastric carcinogenesis as well as the possible molecular mechanism.

    更新日期:2020-01-04
  • Effects of Connexin 32-Mediated Lung Inflammation Resolution During Liver Ischemia Reperfusion
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-03
    Zheng Zhang, Weifeng Yao, Dongdong Yuan, Fei Huang, Yue Liu, Gangjian Luo, Ziqing Hei

    Hepatic ischemia reperfusion (HIR) leads to a lung inflammatory response and subsequent pulmonary barrier dysfunction. The gap junction communication protein connexin 32 (Cx32), which is widely expressed in the lungs, participates in intercellular signaling. This study determined whether the communication protein Cx32 could affect pulmonary inflammation caused by HIR.

    更新日期:2020-01-04
  • Acute-on-Chronic Liver Failure in Budd–Chiari Syndrome: Profile and Predictors of Outcome
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Shalimar, Sanchit Sharma, Shivanand R. Gamanagatti, Ashish Chauhan, Sudheer Kumar Vuyyuru, Anshuman Elhence, Gyanranjan Rout, Anoop Saraya, Deepak Gunjan, Baibaswata Nayak, Ramesh Kumar, Subrat Kumar Acharya

    There is a paucity of data on the clinical presentations and outcome of Budd–Chiari syndrome (BCS) patients presenting as acute-on-chronic liver failure (BCS-ACLF). We aimed to describe the profile and outcomes of endovascular interventions in patients with BCS-ACLF.

    更新日期:2020-01-04
  • Risk Prediction Models for Barrett’s Esophagus Discriminate Well and Are Generalizable in an External Validation Study
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Colin J. Ireland, Aaron P. Thrift, Adrian Esterman

    Abstract Background Barrett’s esophagus is the precursor to the highly lethal esophageal adenocarcinoma. Risk prediction models have been developed to assist in its detection, potentially improving early identification and treatment of esophageal adenocarcinoma. Six models have been developed. Aims To externally validate three models (Rubenstein, Thrift, and Baldwin-Hunter models) and compare them to a fourth risk prediction model (Ireland model) for Barrett’s esophagus. Methods Data from 120 Barrett’s cases and 235 population controls were available to externally validate the three models. Discriminatory ability of these models was assessed by the area under the receiver operating characteristic curve. Calibration was assessed with the calibration slope, Hosmer–Lemeshow test, and Lowess smoother calibration plot. Following external validation, diagnostic accuracy of the three models was compared to that of the Ireland model. Results On external validation, the Rubenstein model had an area under the receiver operating characteristic curve of 0.71 and was well calibrated (Hosmer–Lemeshow test, p = 0.67). Likewise, the Thrift and Baldwin-Hunter models had similar discrimination (0.71 and 0.70, respectively) and were also well calibrated (p = 0.69 and p = 0.28). Our previous external validation of the Ireland model provided an area under the receiver operating characteristic curve of 0.83 and was well calibrated (p = 0.14). The Ireland model demonstrated a statistically significantly greater area under the receiver operating characteristic curve than the Rubenstein (p = 0.02), Thrift (p = 0.001), and Baldwin-Hunter (p = 0.002) models. Conclusion We externally validated the Rubenstein, Thrift, and Baldwin-Hunter risk prediction models and compared them to the Ireland model. The Ireland model demonstrated improved accuracy, albeit with slightly poorer calibration.

    更新日期:2020-01-04
  • Disturbed Gastrointestinal Contractility in a Polycystic Ovary Syndrome Rat Model
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Kai-Lee Wang, Shih-Min Hsia, Paulus S. Wang, Po-Han Lin

    Polycystic ovary syndrome (PCOS), a common hormonal disorder in women, affects 4–18% of women of reproductive age worldwide. A higher prevalence of irritable bowel syndrome was found in women with PCOS. However, the effects and mechanism of PCOS on stomach and colon contractility remain unclear.

    更新日期:2020-01-04
  • Evaluation of Local Recurrence of Pancreatic Cancer by KRAS Mutation Analysis Using Washes from Endoscopic Ultrasound-Guided Fine-Needle Aspiration
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Kazuyuki Matsumoto, Hironari Kato, Kazuhiro Nouso, Soichiro Ako, Hideaki Kinugasa, Shigeru Horiguchi, Yosuke Saragai, Saimon Takada, Shuntaro Yabe, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada

    Abstract Background and Aims The sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing the recurrence of pancreatic cancer is usually low because of difficulties in obtaining adequate samples for pathological examinations. We evaluated the efficacy of highly sensitive KRAS mutation analysis using EUS-FNA washes to detect cancer recurrence. Methods Nineteen consecutive patients with suspected pancreatic cancer recurrence after surgical resection were enrolled. All underwent EUS-FNA, and samples were obtained for pathological examination. After the first session, the inside of the FNA needle was washed with saline for DNA extraction. KRAS mutations were examined using digital droplet PCR (dPCR). Results The median needle puncture number used to obtain adequate pathological samples was two (range 1–6). In ten patients pathologically diagnosed with malignant pancreatic cancer, nine patients tested positive for a KRAS mutation. All patients who were not diagnosed with a malignant pancreatic cancer tested negative for a KRAS mutation. About half of surgically resected primary cancers (9/19) showed double KRAS mutations (G12V and G12D); however, all but one wash sample showed a single KRAS mutation, G12D. After including one patient who showed a malignant recurrence during follow-up, the sensitivities of a pathological diagnosis and KRAS analysis to detect recurrence were 90.9% and 81.8%, respectively. Conclusions KRAS mutation analysis of needle wash samples using dPCR is a new methodology for the diagnosis of the local recurrence of pancreatic cancer. The diagnostic ability of dPCR with a one-time needle wash sample was comparable to a pathological diagnosis with multiple samplings.

    更新日期:2020-01-04
  • Gender Differences in Hepatology Medical Literature
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Nathalie A. Pena Polanco, Bridgette B. McNally, Cynthia Levy, Elizabeth J. Carey, Juvelyn Palomique, Tram T. Tran

    Studies suggest that gender differences in academic medicine exist. Men frequently have better measures of performance such as number of publications, number of citations, remuneration, and funding.

    更新日期:2020-01-04
  • Circular RNA_LARP4 Sponges miR-1323 and Hampers Progression of Esophageal Squamous Cell Carcinoma Through Modulating PTEN/PI3K/AKT Pathway
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Zhiming Chen, Ninghua Yao, Hongmei Gu, Yao Song, Zhihui Ye, Li Li, Pengpeng Lu, Qi Shao

    Abstract Background Emerged as important regulators in cancer progression, circular RNAs have been tested to participate in diverse biological processes. Former studies have suggested that circular RNA_LARP4 (circLARP4) exerts indispensable function on the development of different cancers such as gastric cancer and ovarian cancer. Nonetheless, the specific role of circLARP4 has not been discovered in ESCC. Aims The aim of this study is to explore the biological function and regulatory mechanism of circLARP4 in ESCC. Methods CircLARP4, miR-1323, and PTEN expression levels were quantified by RT-qPCR. CCK-8, EdU, caspase-3 activity, wound healing, transwell, and western blot assays were chosen to assess ESCC cell growth. Luciferase reporter, RIP, and RNA pull-down assays were performed to examine the interaction between miR-1323 and circLARP4 (or PTEN). Results CircLARP4 expression was observably downregulated in ESCC cell lines, and overexpressed circLARP4 restrained cell proliferation and migration whereas boosted cell apoptosis in ESCC. Molecular mechanism experiments revealed that circLARP4 could act as a sponge for miR-1323 and negatively modulated miR-1323 expression in ESCC. Interestingly, the repression of miR-1323 was correlated with inhibitive cell proliferation, migration, and promotive apoptosis. Besides, miR-1323 bound with PTEN, and PTEN expression was negatively regulated by miR-1323 whereas positively regulated by circLARP4 in ESCC. Moreover, rescue assays testified that miR-1323 overexpression or PTEN deficiency could countervail the function of circLARP4 overexpression on ESCC progression. More importantly, circLARP4 played an inhibitory role in PI3K/AKT pathway. Conclusions CircLARP4 sponges miR-1323 and hampers tumorigenesis of ESCC through modulating PTEN/PI3K/AKT pathway.

    更新日期:2020-01-04
  • Safety of Recombinant Zoster Vaccine in Patients with Inflammatory Bowel Disease
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-02
    Venkata R. Satyam, Pei-Hsuan Li, Jason Reich, Taha Qazi, Ansu Noronha, Sharmeel K. Wasan, Francis A. Farraye

    Abstract Background Patients with inflammatory bowel disease (IBD) are at increased risk of developing herpes zoster. In October 2017, the FDA approved a two-dose adjuvanted, recombinant herpes zoster vaccine (RZV). There is a theoretical concern that vaccine adjuvants may cause flares in patients with immune-mediated diseases. We aimed to assess the rates of IBD flare and adverse reactions after administration of RZV in a cohort of patients with IBD. Methods We conducted a prospective observational study of patients with IBD who received RZV between February 2018 and July 2019 at a tertiary IBD referral center. IBD activity scores were collected from patients during office visit or phone call after vaccination. The primary outcome was rate of IBD flare, defined as an increase in IBD activity, resulting in escalation of medical therapy, following vaccination. The secondary outcomes were rates of local and systemic adverse reactions after vaccination. Results We identified 67 patients (28 with ulcerative colitis and 39 with Crohn’s disease) who received at least one dose of RZV. The two-dose vaccine series was completed by 55 patients (82%). Median duration of follow-up after vaccination was 207 days. One case of IBD flare was identified. No cases of herpes zoster were identified. Local and systemic adverse reactions were reported in 74.6% and 56.7% of patients, respectively. Conclusions In this cohort of 67 patients, a low rate of IBD flare (1.5%) was observed after RZV administration. Rates of local and systemic adverse reactions were comparable to those seen in the RZV clinical trials.

    更新日期:2020-01-04
  • LncRNA ANCR Promotes Invasion and Migration of Gastric Cancer by Regulating FoxO1 Expression to Inhibit Macrophage M1 Polarization
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2020-01-01
    Chunying Xie, Yanyan Guo, Siyuan Lou

    Long non-coding RNAs (LncRNAs) are closely related to the occurrence of cancer, but its mechanism in gastric cancer (GC) is still largely unclear.

    更新日期:2020-01-04
  • Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A "Scoping" Literature Review.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Kemmian D Johnson,Abhilash Perisetti,Benjamin Tharian,Ragesh Thandassery,Priya Jamidar,Hemant Goyal,Sumant Inamdar

    Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perforation. The risks of these complications vary depending on several factors, such as patient selection, endoscopist's skills, and the difficulties involved during the procedure. This review discusses post-ERCP complications and management strategies with new and evolving concepts.

    更新日期:2019-11-01
  • Correction to: Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Zaid Bilgrami,Ameer Abutaleb,Kenechukwu Chudy-Onwugaje,Patricia Langenberg,Miguel Regueiro,David A Schwartz,J Kathleen Tracy,Leyla Ghazi,Seema A Patil,Sandra M Quezada,Katharine M Russman,Charlene C Quinn,Guruprasad Jambaulikar,Dawn B Beaulieu,Sara Horst,Raymond K Cross

    This manuscript is a secondary analysis of a large multicenter randomized controlled trial. The primary study is Cross RK et al., A Randomized Controlled Trial of TELEmedicine for patients with Inflammatory Bowel Disease (TELE-IBD). Am J Gastroenterol, 2019 Mar.

    更新日期:2019-11-01
  • Involvement of EP2 and EP4 Receptors in Eosinophilic Esophagitis: A Pilot Study.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2019-04-17
    Franziska Durchschein,Andreas Eherer,Magdalena Grill,Eva M Sturm,Veronika Pommer,Cord Langner,Christoph Högenauer,Rudolf Schicho

    BACKGROUND The prostaglandin D2 receptor DP2 has been implicated in eosinophil infiltration and the development of eosinophilic esophagitis (EoE). AIMS AND METHODS In this study, we investigated an involvement of PGE2 (EP1-EP4) and PGD2 (DP1) receptors in EoE by measuring their expression in peripheral blood eosinophils and esophageal mucosal biopsies of EoE patients and by performing migration and adhesion assays with eosinophils from healthy donors. RESULTS Expression of EP2 and EP4, but not EP1 and EP3, was decreased in blood eosinophils of patients with EoE vs. control subjects. Adhesion of eosinophils to esophageal epithelial cells was decreased by EP2 receptor agonist butaprost and EP4 agonist ONO-AE1-329, whereas DP1 agonist BW245C increased adhesion. In chemotaxis assays with supernatant from human esophageal epithelial cells, only ONO-AE1-329 but not butaprost or BW245C inhibited the migration of eosinophils. Expression of EP and DP receptors in epithelial cells and eosinophils was detected in sections of esophageal biopsies from EoE patients by immunohistochemistry. qPCR of biopsies from EoE patients revealed that gene expression of EP4 and DP1 was the highest among PGE2 and PGD2 receptors. Esophageal epithelial cells in culture showed high gene expression for EP2 and EP4. Activation of EP2 and EP4 receptors decreased barrier integrity of esophageal epithelial cells in impedance assays. CONCLUSIONS Activation of EP2 and EP4 receptors may inhibit eosinophil recruitment to the esophageal mucosa. However, their activation could negatively affect esophageal barrier integrity suggesting that eosinophilic rather than epithelial EP2 and EP4 have a protective role in EoE.

    更新日期:2019-11-01
  • Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2019-01-04
    Zaid Bilgrami,Ameer Abutaleb,Kenechukwu Chudy-Onwugaje,Patricia Langenberg,Miguel Regueiro,David A Schwartz,J Kathleen Tracy,Leyla Ghazi,Seema A Patil,Sandra M Quezada,Katharine M Russman,Charlene C Quinn,Guruprasad Jambaulikar,Dawn B Beaulieu,Sara Horst,Raymond K Cross

    INTRODUCTION Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. METHODS We assessed change in patient activation and general self-efficacy from baseline to 12 months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). RESULTS Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). CONCLUSIONS Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.

    更新日期:2019-11-01
  • Impairment of Nrf2- and Nitrergic-Mediated Gastrointestinal Motility in an MPTP Mouse Model of Parkinson's Disease.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2019-06-13
    C Sampath,R Kalpana,T Ansah,C Charlton,A Hale,K M Channon,S Srinivasan,P R Gangula

    BACKGROUND Gastrointestinal (GI) motility dysfunction is the most common non-motor symptom of Parkinson's disease (PD). Studies have indicated that GI motility functions are impaired before the onset of PD. AIMS To investigate the underlying mechanism of PD-induced GI dysmotility in MPTP (1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine)-induced animal model. METHODS C57BL/6 mice were administered with or without a selective dopamine neurotoxin, MPTP, to induce parkinsonian symptoms. In addition to in vivo studies, in vitro experiments were also conducted in colon specimens using l-methyl-4-phenylpyridinium (MPP+), a metabolic product of MPTP. Gastric emptying, colon motility, nitrergic relaxation, and western blot experiments were performed as reported. RESULTS MPTP-induced PD mice showed decreased expression of nuclear factor erythroid 2-related factor (Nrf2) and its target phase II genes in gastric and colon neuromuscular tissues. Decreased levels of tetrahydrobiopterin (BH4, a critical cofactor for nNOS dimerization) associated with uncoupling of nNOS in gastric and colon tissues exposed to MPTP. Impaired enteric nitrergic system led to delayed gastric emptying and slower colonic motility compared to the control mice. In vitro results in colon specimens confirm that activation of Nrf2 restored MPP+-induced suppression of alpha-synuclein, tyrosine hydroxylase (TH), Nrf2, and heme oxygenase-1. In vitro exposure to L-NAME [N(w)-nitro-L-arginine methyl ester], a NOS synthase inhibitor, reduced protein expression of TH in colon tissue homogenates. CONCLUSIONS Loss of Nrf2/BH4/nNOS expression in PD impairs antioxidant gene expression, which deregulates NO synthesis, thereby contributing to the development of GI dysmotility and constipation. Nitric oxide appears to be important to maintain dopamine synthesis in the colon.

    更新日期:2019-11-01
  • Ustekinumab Is Effective for the Treatment of Chronic Antibiotic-Refractory Pouchitis.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2019-06-13
    Jacob E Ollech,David T Rubin,Laura Glick,Roni Weisshof,Katia El Jurdi,Amanda Israel,Noa Krugliak Cleveland,Neil Hyman,Atsushi Sakuraba,Joel Pekow,Russell D Cohen,Sushila R Dalal

    BACKGROUND Chronic antibiotic-refractory pouchitis (CARP) occurs in up to 15% of patients with ulcerative colitis (UC) following proctocolectomy with ileal pouch-anal anastomosis (IPAA). AIM To investigate the effectiveness of ustekinumab in the treatment of CARP. METHODS This was a retrospective single-center study of UC patients with an IPAA, who subsequently developed CARP and received ustekinumab with standard Crohn's disease (CD) dosing between 2016 and 2018. Patients with CD of the pouch were excluded. Demographic, clinical, and endoscopic data were collected. Outcomes included a change in the endoscopic subscore of the Pouchitis Disease Activity Index (PDAI), change in the ulcerated surface area, clinical response, and the number of bowel movements per 24 h. RESULTS Twenty-four patients with CARP were included for analysis. Median follow-up time was 12.9 months (IQR 7.9-16). Twelve patients (50%) had a clinical response with the median number of bowel movements within 24 h decreasing from 8 (IQR, 5-12) to 6 (IQR, 5-8) P = 0.002. Thirteen patients had pouchoscopies available post-ustekinumab treatment. In these patients, the median endoscopic subscore of the PDAI decreased from 5 (IQR, 3-6) to 4 (IQR, 2-5), P = 0.016. Likewise, among these thirteen patients, nine (69%) had an ulcerated surface area > 10% before ustekinumab treatment; after treatment with ustekinumab, only four patients (31%) still had an ulcerated surface area of > 10%. CONCLUSIONS This is the largest study of ustekinumab treatment for patients with chronic antibiotic-refractory pouchitis. We found that ustekinumab therapy led to the improvement in clinical and endoscopic endpoints.

    更新日期:2019-11-01
  • Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2018-10-13
    Mandana Khalili,Robert J Wong

    更新日期:2019-11-01
  • Patient and Caregiver Attitudes and Practices of Exercise in Candidates Listed for Liver Transplantation.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2018-09-05
    David M Chascsa,Jennifer C Lai,Michael A Dunn,Aldo J Montano-Loza,Matthew R Kappus,Srinivasan Dasarathy,Elizabeth J Carey

    BACKGROUND Impaired physical capacity increases peri-liver transplant complications. Patient perceptions regarding exercise prior to transplantation are not known. AIMS This study aimed to assess patient and caregiver activity levels, perceptions of willingness to exercise, and of provider advice. METHODS Consecutive patients listed for liver transplant and caregivers presenting for routine outpatient visits were evaluated over a 3-month interval. Anonymous surveys adapted to patients and caregivers addressed the importance and safety of exercise, type and duration of exercise performed, barriers, willingness to wear a monitoring device, and perceived provider recommendations. Responses were logged on a Likert scale from 1 to 5. RESULTS Three hundred and sixty-eight responses were received. Most participants perceived exercise as important. Patients exercised three times per week for 30 min. Eighty percent endorsed walking (median response: 2-agree; IQR 1-2). Most did not jog, swim, cycle, or strength train. Fatigue, reported by 70%, was the major barrier (2, IQR 1-3). Over 90% of caregivers endorsed exercise as important (1-strongly agree, IQR 1-2) and encouraged exercise (median response 2, IQR 1-2). Over 60% of patients (median response 2, IQR 1-3) and caregivers (median response 2, IQR 2-3) felt providers encouraged exercise. CONCLUSIONS Patients and caregivers are willing to exercise to optimize physical fitness prior to liver transplantation.

    更新日期:2019-11-01
  • A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett's Esophagus.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2018-09-05
    Jorge D Machicado,Samuel Han,Rena H Yadlapati,Violette C Simon,Bashar J Qumseya,Shahnaz Sultan,Vladimir M Kushnir,Sri Komanduri,Amit Rastogi,V Raman Muthusamy,Rehan Haidry,Krish Ragunath,Rajvinder Singh,Hazem T Hammad,Nicholas J Shaheen,Sachin Wani

    BACKGROUND Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett's esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance. METHODS An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS3D). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables. RESULTS The survey response rate was 84% (61/73)-41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS3D. Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10-29%) and highest for VLE (30%, IQR 20-50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001). CONCLUSION These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2018-08-06
    Ashley N Tran,Rishabh Sachdev,Zachary P Fricker,Michael Leber,Toni Zahorian,Bhavesh Shah,David P Nunes,Michelle T Long

    BACKGROUND Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP). AIMS To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP). METHODS A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates. RESULTS SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18-31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type. CONCLUSIONS HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Patients over Age 75 Are at Increased Risk of Emergency Department Visit and Hospitalization Following Colonoscopy.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Laurie B Grossberg,Konstantinos Papamichael,Daniel A Leffler,Mandeep S Sawhney,Joseph D Feuerstein

    BACKGROUND The age to stop screening or surveillance colonoscopy is not well established, and unplanned hospital use after colonoscopy in the elderly is not well understood. AIMS To evaluate unplanned emergency department (ED) visits and hospitalization in patients over 75 within 7 days of outpatient colonoscopy. METHODS In this retrospective, single-center, cohort study, we reviewed outpatient screening or surveillance colonoscopies in patients ≥ 50 in a tertiary care academic medical center or affiliated facility between January 2008 and September 2013. Colonoscopies were divided by age based on USPSTF recommendations. The rate of ED visits and hospitalizations per colonoscopy for each age-group was determined. Predictors of ED visit and hospitalization were assessed through univariate and multivariate logistic regressions, and mortality following colonoscopy was evaluated using Kaplan-Meier analysis. RESULTS A total of 30,409 colonoscopies were performed in 27,173 patients (51% male) by 40 endoscopists. ED visits occurred after 188 colonoscopies (0.62%). Age over 75 years was independently associated with ED visit (OR 1.58, 95% CI 1.05-2.37, p = 0.027) and hospitalization (OR 3.7, 95% CI 2.03-6.73, p < 0.001) within 7 days of colonoscopy. Higher number of medication classes, recent ED visit, polypectomy, and endoscopic mucosal resection were also independent variables associated with ED utilization after procedure. The mortality rate at the end of the follow-up (median 4.4; IQR 2.7-6 years) was 1.9, 8.6, and 15.8% for the age-groups 50-75, 76-85, and > 85 years, respectively. CONCLUSION Patients over age 75 are 1.6 times as likely to use the ED and 3.7 times as likely to be hospitalized after colonoscopy. Further prospective studies are needed to assess the risk/benefit of nondiagnostic colonoscopy in geriatric patients.

    更新日期:2019-11-01
  • A miRNA-Based Blood and Mucosal Approach for Detecting and Monitoring Celiac Disease.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Karla A Bascuñán,Francisco Pérez-Bravo,Gabriella Gaudioso,Valentina Vaira,Leda Roncoroni,Luca Elli,Erika Monguzzi,Magdalena Araya

    BACKGROUND The role of microRNAs (miRNAs) in celiac disease (CD) is unclear. AIMS We evaluated inflammation-related miRNA-146a, miRNA-155, miRNA-21, and miRNA-125b expression in peripheral blood and intestinal mucosa of CD adults. METHODS Thirty patients with CD were included: patients with active CD on a gluten-containing diet (CD-active, n = 10), patients on a gluten-free diet (for at least 1 year), and patients with negative blood antibodies (CD-inactivePE, n = 10). In addition, ten healthy volunteers formed the comparison/control group. MiRNA expression was measured in duodenal biopsies from patients (CD-inactiveMU, n = 10) after in vitro exposure to PT gliadin and 33-mer peptide. MiRNAs expression was measured in plasma and in peripheral blood mononuclear cells (PBMCs) and monocytes, before and after in vitro exposure to native gliadin (gliadinN). RESULTS Expression levels of miRNA-146a, miRNA-155, and miRNA-21 in PBMCs, miRNA-155 in monocytes and miRNA-155, miRNA-21, and miRNA-125b in plasma were elevated in both groups of celiac patients. After in vitro exposure with gliadinN, miRNA-146a and miRNA-155 expression markedly increased in PBMCs and monocytes, while miRNA-155 and miRNA-21 increased in the CD-active group. MiRNAs expression in intestinal mucosa did not change. MiRNA-146a and miRNA-155 expression showed high sensitivity and specificity for the presence of CD, irrespective of the current dietary treatment. CONCLUSIONS Selected inflammation-related miRNAs expression is elevated in the peripheral blood of celiac. This suggests their participation in the immune processes underlying the pathology. Their similar response in active and inactive CD suggests that they should be further evaluated, as potential diagnostic biomarkers for CD.

    更新日期:2019-11-01
  • Intestinal Epithelial Deletion of Sphk1 Prevents Colitis-Associated Cancer Development by Inhibition of Epithelial STAT3 Activation.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Seung Bin Park,Byung-Il Choi,Beom Jae Lee,Nam Joo Kim,Yoon A Jeong,Moon Kyung Joo,Hyo Jung Kim,Jong-Jae Park,Jae Seon Kim,Yoon-Seok Noh,Hyun Joo Lee

    BACKGROUND AND AIMS Colitis-associated cancer (CAC) is one of the most serious complications in patients with inflammatory bowel disease. Sphingosine kinase 1 (Sphk1) is a key enzyme in the sphingolipid pathway and has oncogene potential for inducing both initiation and progression of tumors. The aim of this work is to characterize the role of epithelial Sphk1 in mouse colitis and CAC models. METHODS We investigated the roles of Sphk1 in CAC by conditional deletion of Sphk1 in intestinal epithelial cells (IECs). RESULTS CAC was induced in both Sphk1ΔIEC/ApcMin/+ and Sphk1IEC/ApcMin/+ mice by administration of 2% dextran sodium sulfate (DSS) for 7 days. Genetic deletion of Sphk1 significantly reduced the number and size of tumors in ApcMin/+ mice. Histologic grade was more severe in Sphk1ΔIEC/ApcMin/+ mice compared with Sphk1IEC/ApcMin/+ mice (invasive carcinoma, 71% versus 13%, p < 0.05). Deletion of Sphk1 decreased mucosal proliferation and inhibited STAT3 activation and genetic expression of cyclin D1 and cMyc in tumor cells. Conditional deletion of Sphk1 using CRISPR-Cas9 in HCT 116 cells inhibited interleukin (IL)-6-mediated STAT3 activation. CONCLUSIONS Epithelial conditional deletion of Sphk1 inhibits CAC in ApcMin/+-DSS models in mice by inhibiting STAT3 activation and its target signaling pathways.

    更新日期:2019-11-01
  • Upper Gastrointestinal Disease Influences the Occurrence of Inflammatory Bowel Disease.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Amnon Sonnenberg,Kevin O Turner,Robert M Genta

    BACKGROUND AND AIMS Compromise of the gastric acid barrier may facilitate bacterial invasion of the lower intestinal tract and influence the occurrence of inflammatory bowel disease (IBD). Our study tested the associations between histopathologic changes in the upper and lower gastrointestinal tract in patients undergoing bidirectional endoscopy. METHODS The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the entire USA. A case-control study among 302,061 patients, of whom 13,943 harbored IBD, evaluated whether the occurrence of Crohn's disease or ulcerative colitis was influenced by the presence of various upper gastrointestinal diagnoses associated with lowered gastric acid output. The influence of individual risk factors on the occurrence of colonic disease was expressed as odds ratios with their 95% confidence intervals. RESULTS The odds ratio for Crohn's disease being associated with gastric H. pylori was 0.30 (0.24-0.37), with intestinal metaplasia 0.30 (0.24-0.39), with fundic gland polyps 0.42 (0.35-0.50), with gastric hyperplastic polyps 0.35 (0.23-0.51), with Barrett's metaplasia 0.19 (0.14-0.24), and with reflux esophagitis 0.46 (0.42-0.51). The odds ratio for ulcerative colitis being associated with gastric H. pylori was 0.58 (0.50-0.67), with intestinal metaplasia 0.39 (0.32-0.47), with fundic gland polyps 0.61 (0.53-0.71), with gastric hyperplastic polyps 0.64 (0.49-0.84), with Barrett's metaplasia 0.50 (0.43-0.59), and with reflux esophagitis 0.77 (0.71-0.84). CONCLUSIONS A diminished gastric acid barrier function, as evidenced by various upper gastrointestinal diseases associated with lowered gastric acid output, may exert a protective influence against the development of inflammatory bowel disease.

    更新日期:2019-11-01
  • Sequential Versus Combined Heart-Liver Transplantation in the USA.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Yoshikazu Yamaguchi,Candice Burrier,Catherine Roth,Dmitry Tumin,Eliza W Beal,Kenneth Washburn,Don Hayes,Joseph D Tobias

    INTRODUCTION Combined heart-liver transplantation (CHLT) has resulted in acceptable survival rates compared to orthotopic liver transplantation (OLT) alone and orthotopic heart transplantation alone. Using the US transplant registry, we compared outcomes following sequential and combined HLT. METHODS We conducted a retrospective cohort study. De-identified data were obtained from the United Network Organ Sharing Registry. The primary outcome was patient survival from the date of OLT. Secondary outcomes included liver allograft survival and heart allograft survival. RESULTS The study cohort included 301 CHLT recipients and six sequential heart-liver transplantation (SHLT) recipients. Patient survival after CHLT was 88% at 1 year, 84% at 3 years, and 82% at 5 years compared to 83%, 67%, and 50% in the SHLT group (p = 0.010). Liver allograft survival at 1, 3, and 5 years was 88%,83% and 82%, respectively, in the CHLT group compared to 83% and 67%, and 50%, respectively, in the SHLT group (p = 0.009). After OLT, heart allograft survival at 1, 3, and 5 years was 86%, 79%, and 74% in the CHLT group, respectively, compared to 83%, 67%, and 50% in the SHLT group (p = 0.037). CONCLUSIONS Despite the limited size of the SHLT cohort, we found that CHLT was superior to SHLT in survival rate and graft survival. The better outcomes noted in CHLT may relate to immunoprotection provided by liver transplantation from the same donor.

    更新日期:2019-11-01
  • Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Robert D Pesek,Craig C Reed,Margaret H Collins,Amanda B Muir,Patricia C Fulkerson,Calies Menard-Katcher,Gary W Falk,Jonathan Kuhl,Adam Z Magier,Faria N Ahmed,Maureen Demarshall,Ankur Gupta,Jonathan Gross,Tokunbo Ashorobi,Christina L Carpenter,Jeffrey P Krischer,Nirmala Gonsalves,Ikuo Hirano,Jonathan M Spergel,Sandeep K Gupta,Glenn T Furuta,Marc E Rothenberg,Evan S Dellon,

    BACKGROUND Little is known about the endoscopic and histologic findings of non-esophageal eosinophilic gastrointestinal diseases (EGID). AIM To characterize the presenting endoscopic and histologic findings in patients with eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) at diagnosis and 6 months after initiating the treatment. METHODS We conducted a retrospective cohort study at 6 US centers associated with the Consortium of Eosinophilic Gastrointestinal Researchers. Data abstracted included demographics, endoscopic findings, tissue eosinophil counts, and associated histologic findings at diagnosis and, when available, after initial treatment. RESULTS Of 373 subjects (317 children and 56 adults), 142 had EG, 123 EGE, and 108 EC. Normal endoscopic appearance was the most common finding across all EGIDs (62% of subjects). Baseline tissue eosinophil counts were quantified in 105 (74%) EG, 36 (29%) EGE, and 80 (74%) EC subjects. The mean peak gastric eosinophil count across all sites was 87 eos/hpf for EG and 78 eos/hpf for EGE. The mean peak colonic eosinophil count for EC subjects was 76 eos/hpf (range 10-500). Of the 29% of subjects with post-treatment follow-up, most had an improvement in clinical, endoscopic, and histologic findings regardless of treatment utilized. Reductions in tissue eosinophilia correlated with improvements in clinical symptoms as well as endoscopic and histologic findings. CONCLUSIONS In this large cohort, normal appearance was the most common endoscopic finding, emphasizing the importance of biopsy, regardless of endoscopic appearance. Decreased tissue eosinophilia was associated with improvement in symptoms, endoscopic, and histologic findings, showing that disease activity is reversible.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Bacterial Infection in Patients with Cirrhosis: Don't Get Bugged to Death.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Mary D Cannon,Paul Martin,Andres F Carrion

    Bacterial infection remains a leading cause of mortality and morbidity for patients with cirrhosis, with hospitalization, alterations in the intestinal microbiota, and therapeutic drugs all implicated in its development. Bacterial infections also remain the most common precipitant of acute-on-chronic liver failure, with infection occurring as a direct consequence of the progression of this syndrome. Furthermore, recent epidemiological analyses have demonstrated that infections due to multidrug-resistant bacteria are occurring with increasing frequency in patients with cirrhosis. Despite significant advances in the understanding of the pathophysiological processes triggered by an infection in patients with cirrhosis, a demonstrable survival benefit for the sickest patients who require ICU admission has not yet occurred. Early diagnosis of infection and appropriate antimicrobial treatment is essential to ensuring optimal outcomes for these patients. This review provides an evidence-based analysis of both the current strategies for prevention and the recommended management of common bacterial infections in patients with cirrhosis.

    更新日期:2019-11-01
  • Correction to: Vedolizumab Concentrations Are Associated with Long-Term Endoscopic Remission in Patients with Inflammatory Bowel Diseases.
    Digest. Dis. Sci. (IF 2.937) Pub Date : 2019-10-24
    Andres J Yarur,Alexandra Bruss,Snehal Naik,Poonam Beniwal-Patel,Caroline Fox,Anjali Jain,Brandon Berens,Amir Patel,Ryan Ungaro,Bayda Bahur,Marla Dubinsky,Daniel J Stein

    The original version of the article unfortunately contained a couple of errors. In 'methods' section, in 'Outcomes' subsection, the sentence 'Endoscopic remission was defined as an SESCD ≤ 2 in patients with CD and an EMS ≤ 2 in UC patients while off corticosteroids.'

    更新日期:2019-11-01
  • Different Hepatitis C Virus Infection Statuses Show a Significant Risk of Developing Type 2 Diabetes Mellitus: A Network Meta-Analysis.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Ying Chen,Hanzhen Ji,Jianguo Shao,Yulong Jia,Qi Bao,Jianan Zhu,Lei Zhang,Yi Shen

    BACKGROUND The role of hepatitis C virus (HCV) infection statuses in the development of type 2 diabetes mellitus (T2DM) has not been completely understood. AIM To evaluate the prevalence of T2DM in patients with different HCV infection statuses. METHODS We conducted a systematic study on T2DM risk in five types of individuals with different HCV infection statuses: non-HCV controls, HCV-cleared patients, chronic HCV patients without cirrhosis, patients with HCV cirrhosis and patients with decompensated HCV cirrhosis. Studies published from 2010 to 2019 were selected. Both pairwise and network meta-analyses were employed to compare the T2DM risk among patients with different HCV infection statuses. RESULTS The pairwise meta-analysis showed that non-HCV (OR = 0.60, 95% CI [0.47-0.78]) had a lower risk of T2DM compared with CHC, while cirrhosis had a significant higher risk (OR = 1.90, 95% CI [1.60-2.26]). Network meta-analysis further demonstrated patients with HCV infection were at a significantly higher risk of T2DM than those without HCV infection or with HCV clearance, while decompensated cirrhosis had a significant higher T2DM risk than non-HCV (OR = 3.84, 95% CI [2.01-7.34]), patients with HCV clearance (OR = 3.17, 95% CI [1.49-6.73]), and CHC patients (OR = 2.21, 95% CI [1.24-3.94]). CONCLUSIONS HCV infection is a significant risk factor for developing T2DM. CHC, cirrhosis, and decompensated cirrhosis contribute to an increasingly greater risk of T2DM, but HCV clearance spontaneously or through clinical treatment may immediately reduce the risk of the onset and development of T2DM.

    更新日期:2019-11-01
  • Opioid Analgesics Do Not Improve Abdominal Pain or Quality of Life in Crohn's Disease.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    M D Coates,N Seth,K Clarke,H Abdul-Baki,N Mahoney,V Walter,M D Regueiro,C Ramos-Rivers,I E Koutroubakis,K Bielefeldt,D G Binion

    BACKGROUND Abdominal pain and opioid analgesic use are common in Crohn's disease (CD). AIMS We sought to identify factors associated with abdominal pain in CD and evaluate the impact of opioid analgesics on pain and quality-of-life scores in this setting. METHODS We performed a longitudinal cohort study using a prospective, consented IBD natural history registry from a single academic center between 2009 and 2013. Consecutive CD patients were followed for at least 1 year after an index visit. Data were abstracted regarding pain experience (from validated surveys), inflammatory activity (using endoscopic/histologic findings), laboratory studies, coexistent psychiatric disorders, medical therapy, opioid analgesic, and tobacco use. RESULTS Of 542 CD patients (56.6% women), 232 (42.8%) described abdominal pain. Individuals with pain were more likely to undergo surgery and were more frequently prescribed analgesics and/or antidepressants/anxiolytics. Elevated ESR (OR 1.79; 95%CI 1.11-2.87), coexistent anxiety/depression (OR 1.87; 95%CI 1.13-3.09), smoking (OR 2.08; 95%CI 1.27-3.40), and opioid use (OR 2.46; 95%CI 1.33-4.57) were independently associated with abdominal pain. Eighty patients (14.8%) were prescribed opioids, while 31 began taking them at or after the index visit. Patients started on opioids demonstrated no improvement in abdominal pain or quality-of-life scores on follow-up compared to patients not taking opioids. CONCLUSIONS Abdominal pain is common in CD and is associated with significant opioid analgesic utilization and increased incidence of anxiety/depression, smoking, and elevated inflammatory markers. Importantly, opioid use in CD was not associated with improvement in pain or quality-of-life scores. These findings reinforce the limitations of currently available analgesics in IBD and support exploration of alternative therapies.

    更新日期:2019-11-01
  • Marijuana Use in Patients with Symptoms of Gastroparesis: Prevalence, Patient Characteristics, and Perceived Benefit.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Henry P Parkman,Emily P Sharkey,Linda A Nguyen,Katherine P Yates,Thomas L Abell,William L Hasler,William Snape,John Clarke,Ron Schey,Kenneth L Koch,Braden Kuo,Richard W McCallum,Irene Sarosiek,Madhusudan Grover,Gianrico Farrugia,James Tonascia,Pankaj J Pasricha,

    BACKGROUND Marijuana may be used by some patients with gastroparesis (Gp) for its potential antiemetic, orexigenic, and pain-relieving effects. AIMS The aim of this study was to describe the use of marijuana by patients for symptoms of Gp, assessing prevalence of use, patient characteristics, and patients' perceived benefit on their symptoms of Gp. METHODS Patients with symptoms of Gp underwent history and physical examination, gastric emptying scintigraphy, and questionnaires assessing symptoms. Patients were asked about the current use of medications and alternative medications including marijuana. RESULTS Fifty-nine of 506 (11.7%) patients with symptoms of Gp reported current marijuana use, being similar among patients with delayed and normal gastric emptying and similar in idiopathic and diabetic patients. Patients using marijuana were younger, more often current tobacco smokers, less likely to be a college graduate, married or have income > $50,000. Patients using marijuana had higher nausea/vomiting subscore (2.7 vs 2.1; p = 0.002), higher upper abdominal pain subscore (3.5 vs 2.9; p = 0.003), more likely to be using promethazine (37 vs 25%; p = 0.05) and dronabinol (17 vs 3%; p < 0.0001). Of patients using marijuana, 51% had been using it for more than 2 years, 47% were using this once or more per day, and 81% of marijuana users rated their benefit from marijuana as better or much better. CONCLUSIONS A subset of patients (12%) with symptoms of Gp use marijuana. Patients with severe nausea and abdominal pain were more likely to use marijuana and perceive it to be beneficial for their symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01696747.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Breath Test Gas Patterns in Inflammatory Bowel Disease with Concomitant Irritable Bowel Syndrome-Like Symptoms: A Controlled Large-Scale Database Linkage Analysis.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Phillip Gu,Devin Patel,Krutika Lakhoo,Jeffrey Ko,Xiaochen Liu,Bianca Chang,Dana Pan,Greg Lentz,Matthew Sonesen,Renier Estiandan,Eugenia Lin,Mark Pimentel,Ali Rezaie

    INTRODUCTION Breath testing (BT) has gained interest for diagnosing small intestinal bacterial overgrowth (SIBO) in IBD patients with irritable bowel syndrome (IBS) overlap. We aim to characterize the rate of SIBO and BT gas patterns in IBD patients with IBS-like symptoms compared to non-IBD patients. METHODS A database of 14,847 consecutive lactulose BTs was developed from patients with IBS-like symptoms between November 2005 and October 2013. BTs were classified as normal, H2 predominant, CH4 predominant, and flatline based on criteria established from the literature. BT data linkage with electronic health records and chart review identified IBD patients along with disease phenotype, location, severity, and antibiotic response. Poisson loglinear model evaluated differences in gas patterns between the two groups. RESULTS After excluding patients with repeat breath tests, we identified 486 IBD and 10,505 non-IBD patients with at least one BT. Positive BT was present in 57% (n = 264) of IBD patients. Crohn's disease (odds ratio (OR) 0.21, [95% confidence interval (CI) 0.11-0.38]) and ulcerative colitis (OR 0.39, [95% CI 0.22-0.70]) patients were less likely to produce excess CH4. IBD patients were more likely to have flatline BT (OR 1.82, [95% CI 1.20-2.77]). In IBD patients with SIBO, 57% improved symptomatically with antibiotics. CONCLUSION In a cohort of IBD patients with IBS-like symptoms, a high rate of patients had positive BT and symptomatic improvement with antibiotics. In IBD, methanogenesis is suppressed and flatline BT is more frequent, suggesting excess hydrogenotrophic bacteria. These findings suggest methanogenic and hydrogenotrophic microorganisms as potential targets for microbiome-driven biomarkers and therapies.

    更新日期:2019-11-01
  • Corticosteroid Treatment at Diagnosis: An Analysis of Relapses, Disease Extension, and Colectomy Rate in Ulcerative Colitis.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Lorenzo Bertani,Giorgia Bodini,Maria Gloria Mumolo,Nicola de Bortoli,Linda Ceccarelli,Leonardo Frazzoni,Gherardo Tapete,Eleonora Albano,Maria Corina Plaz Torres,Massimo Bellini,Edoardo Savarino,Vincenzo Savarino,Santino Marchi,Francesco Costa

    BACKGROUND Ulcerative colitis is a chronic relapsing disease usually treated with mesalamine. The need of steroid therapy at diagnosis is generally considered as a poor prognostic factor. AIMS The aim of our study was to assess whether patients treated with corticosteroids at diagnosis have more clinical relapses, disease progression, or an increased risk of colectomy during a 5-year follow-up. METHODS We retrospectively evaluated patients who had received diagnosis of ulcerative colitis with a 5-year follow-up. Relapse was defined as a worsening of symptoms requiring an increase in medical treatment. Progression of disease was defined as a proximal extension of mucosal involvement, comparing the colonoscopy performed 5 years after diagnosis with the first one. The need of corticosteroid treatment at diagnosis was correlated to number of relapses, disease progression, and colectomy rate. RESULTS We included 230 patients, 116 of them (50%) treated with steroids at diagnosis. Multivariate analysis demonstrated that there is a strong correlation between corticosteroid use and number of relapses (p < 0.01), as well as with disease progression (p < 0.05). Seventeen patients (7.4%) underwent colectomy, but the correlation with steroids was not statistically significant. CONCLUSIONS These data provide evidence that the need of corticosteroids at diagnosis is associated with a worse clinical outcome.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Use of Accelerated Induction Strategy of Infliximab for Ulcerative Colitis in Hospitalized Patients at a Tertiary Care Center.
    Digest. Dis. Sci. (IF 2.937) Pub Date : null
    Shail M Govani,Jeffrey A Berinstein,Akbar K Waljee,Ryan W Stidham,Peter D R Higgins,Karin M Hardiman

    BACKGROUND Infliximab can prevent colectomy in patients hospitalized with acute severe ulcerative colitis (ASUC). In cases of ASUC, fecal losses of infliximab may lead to low drug levels and reduced efficacy. AIM To determine 90-day colectomy risk and postoperative complications in patients receiving single-dose and accelerated induction of infliximab for ASUC. METHODS We conducted a retrospective review of patients hospitalized with ASUC requiring infliximab therapy between 2013 and 2017 at the University of Michigan. Patients were excluded if they had an enteric infection, received an anti-TNF previously, or received cyclosporine during the same admission. The primary outcome was colectomy within 90 days of admission. Patients receiving single-dose induction infliximab were compared to those receiving accelerated rescue induction with two doses of infliximab prior to day 14. Administration of accelerated induction was guided by a protocol, suggesting administering a second dose of infliximab to those with only a partial response in CRP 3 days after the initial dose. Postoperative outcomes including 30-day readmission rates and complications were compared using descriptive statistics. RESULTS From 2013 to 2017, 66 patients with ASUC met our criteria. Thirty-three received accelerated induction (50.0%). The colectomy rate in the accelerated induction group was 30.3% versus 24.2% in the single-dose induction group (p = 0.58). There was no detected difference in postoperative outcomes between the accelerated and single-dose rescue induction. CONCLUSIONS In this retrospective review, 69.7% of those failing to respond to single-dose infliximab were able to avoid colectomy with an accelerated rescue induction strategy without worsening postoperative outcomes. Larger studies of accelerated dosing infliximab are needed.

    更新日期:2019-11-01
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