Clinical and Experimental Gastroenterology最新文献

{"title":"Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience.","authors":"Salih Samo,&nbsp;Falak Hamo,&nbsp;Anand S Jain,&nbsp;Rushikesh H Shah,&nbsp;Vaishali Patel,&nbsp;Lucie F Calderon,&nbsp;Mengdan Xie,&nbsp;Parit Mekaroonkamol,&nbsp;Steven A Keilin,&nbsp;Qiang Cai","doi":"10.2147/CEG.S297338","DOIUrl":"https://doi.org/10.2147/CEG.S297338","url":null,"abstract":"<p><strong>Purpose: </strong>Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.</p><p><strong>Patients and methods: </strong>A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.</p><p><strong>Results: </strong>There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, <i>p</i>=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, <i>p</i>=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, <i>p</i>=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, <i>p</i>=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, <i>p</i>=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, <i>p</i>=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, <i>p</i>=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, <i>p</i>=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, <i>p</i>=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, <i>p</i>=0.0017). There was no intervention or ICU admission required pertinent to the procedure.</p><p><strong>Conclusion: </strong>Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"173-179"},"PeriodicalIF":2.4,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/7a/ceg-14-173.PMC8290189.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39214518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances in the Management of Severe Gastrointestinal Dysmotility.","authors":"Dipesh H Vasant, Simon Lal","doi":"10.2147/CEG.S249877","DOIUrl":"10.2147/CEG.S249877","url":null,"abstract":"<p><p>Severe gastrointestinal motility disorders with small bowel involvement continue to pose a major clinical challenge to clinicians, particularly because of the limitations of diagnostic tests and the lack of efficacious treatment options. In this article, we review current understanding and the utility of diagnostic modalities and therapeutic approaches, and describe how their limitations may potentially exacerbate prolonged suffering with debilitating symptoms, diagnostic delays, the risk of iatrogenic harm and increased healthcare utilisation in this group of patients. Moreover, observations from intestinal failure units worldwide suggest that this problem could be set to increase in the future, with reported trends of increasing numbers of patients presenting with nutritional consequences. Unfortunately, until recently, there has been a lack of consensus recommendations and guidance to support clinicians with their management approach. The aim of this narrative review is to summarise recent developments in this field following publication of an international census of experts, and subsequent clinical guidelines, which have emphasized the importance of holistic, multidisciplinary care. This is particularly important in achieving good clinical outcomes and ensuring the appropriate use of artificial nutritional support, in order to prevent iatrogenic harm. We discuss how these recent developments may impact clinical practice by supporting the development of specialised clinical services to deliver optimal care, and highlight areas where further research is needed.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"163-172"},"PeriodicalIF":2.4,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/35/ceg-14-163.PMC8121621.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38996178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiation Between Malignant and Benign Endoscopic Images of Gastric Ulcers Using Deep Learning.","authors":"Eyal Klang,&nbsp;Yiftach Barash,&nbsp;Asaf Levartovsky,&nbsp;Noam Barkin Lederer,&nbsp;Adi Lahat","doi":"10.2147/CEG.S292857","DOIUrl":"https://doi.org/10.2147/CEG.S292857","url":null,"abstract":"<p><strong>Background and aim: </strong>Endoscopic differentiation between malignant and benign gastric ulcers (GU) affects further evaluation and prognosis. The aim of our study was to evaluate a deep learning algorithm for discrimination between benign and malignant GU in a database of endoscopic ulcer images.</p><p><strong>Methods: </strong>We retrospectively collected consecutive upper gastrointestinal endoscopy images of GU performed between 2011 and 2019 at the Sheba Medical Center. All ulcers had a corresponding histopathology result of either benign peptic ulcer or gastric adenocarcinoma. A convolutional neural network (CNN) was trained to classify the images into either benign or malignant. Endoscopies from 2011 to 2017 were used for training (2011-2015) and validation (2016-2017). Hyper-parameters, image augmentation and pre-training on Google images obtained images were evaluated on the validation data. Held-out data from 2018 to 2019 was used for testing the final model.</p><p><strong>Results: </strong>Overall, the Sheba dataset included 1978 GU images; 1894 images from benign GU and 84 images of malignant ulcers. The final CNN model showed an AUC 0.91 (95% CI 0.85-0.96) for detecting malignant ulcers. For cut-off probability 0.5, the network showed a sensitivity of 92% and specificity of 75% for malignant ulcers.</p><p><strong>Conclusion: </strong>Our study displays the applicability of a CNN model for automated evaluation of gastric ulcers images for malignant potential. Following further research, the algorithm may improve accuracy of differentiating benign from malignant ulcers during endoscopies and assist in patients' stratification, allowing accelerated patients management and individualized approach towards surveillance endoscopy.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"155-162"},"PeriodicalIF":2.4,"publicationDate":"2021-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/3a/ceg-14-155.PMC8107004.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38976155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Intraoperative Fluorescent Imaging Using Indocyanine Green for Cholangiography During Cholecystectomy and Hepatectomy.","authors":"Hideki Shibata,&nbsp;Takeshi Aoki,&nbsp;Tomotake Koizumi,&nbsp;Tomokazu Kusano,&nbsp;Tatsuya Yamazaki,&nbsp;Kazuhiko Saito,&nbsp;Takahito Hirai,&nbsp;Kodai Tomioka,&nbsp;Yusuke Wada,&nbsp;Tomoki Hakozaki,&nbsp;Yoshihiko Tashiro,&nbsp;Koji Nogaki,&nbsp;Kosuke Yamada,&nbsp;Kazuhiro Matsuda,&nbsp;Akira Fujimori,&nbsp;Yuta Enami,&nbsp;Masahiko Murakami","doi":"10.2147/CEG.S275985","DOIUrl":"https://doi.org/10.2147/CEG.S275985","url":null,"abstract":"<p><strong>Purpose: </strong>Bile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries.</p><p><strong>Patients and methods: </strong>We examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively.</p><p><strong>Results: </strong>There were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50-197) minutes, and estimated blood loss was 43.2 (0-400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3-9) days, and no postoperative complications (Clavien-Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely.</p><p><strong>Conclusion: </strong>ICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"145-154"},"PeriodicalIF":2.4,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/c8/ceg-14-145.PMC8096340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38958142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' Experiences and Challenges in Living with Inflammatory Bowel Disease: A Qualitative Approach.","authors":"Jelena Popov, Yasamin Farbod, Usha Chauhan, Mona Kalantar, Lee Hill, David Armstrong, Smita Halder, John K Marshall, Paul Moayyedi, Sharon Kaasalainen","doi":"10.2147/CEG.S303688","DOIUrl":"10.2147/CEG.S303688","url":null,"abstract":"<p><strong>Purpose: </strong>Inflammatory bowel disease (IBD) significantly impacts patients' quality of life and imposes a considerable psychological, social, and financial burden. While the relationship between disease activity and quality of life is well established, the subjective challenges of living with IBD are more difficult to assess, and suggestions for improving patient experiences are lacking. The aim of this paper was to explore the various challenges patients encounter in living with IBD and to propose suggestions for overcoming them.</p><p><strong>Patients and methods: </strong>This study utilized a qualitative descriptive design with thematic content analysis. Patients were recruited from the Gastroenterology Clinic at McMaster University Medical Centre from December 2014 to April 2015. Data were collected over the course of 5 focus group interviews using a semi-structured interview guide.</p><p><strong>Results: </strong>Seventeen patients aged 25 to 77 years old (mean age 43 years, SD 17 years) were interviewed. Fifteen patients were diagnosed with Crohn's disease and 2 patients were diagnosed with ulcerative colitis. Findings were categorized into 18 subthemes which were grouped into 4 broader themes: awareness factor, psychosocial impacts, financial burden, and quality of care.</p><p><strong>Conclusion: </strong>IBD is associated with complex personal challenges across various demographics. Identifying and meeting the unique needs of individual patients may be achieved through improving communication between patients and their healthcare providers. Family-based education approaches, individualized psychotherapy with therapists familiar with IBD, awareness initiatives addressed to important stakeholders, and patient involvement in community support groups may improve overall IBD care.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"123-131"},"PeriodicalIF":2.4,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/07/ceg-14-123.PMC8088978.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38886230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroparesis Symptoms Associated with Intestinal Hypomotility: An Explorative Study Using Wireless Motility Capsule.","authors":"Mattis Bekkelund,&nbsp;Dag A Sangnes,&nbsp;Eirik Søfteland,&nbsp;Lars Aabakken,&nbsp;Martin Biermann,&nbsp;Elisabeth K Steinsvik,&nbsp;Trygve Hausken,&nbsp;Georg Dimcevski,&nbsp;Jan Gunnar Hatlebakk","doi":"10.2147/CEG.S304854","DOIUrl":"https://doi.org/10.2147/CEG.S304854","url":null,"abstract":"<p><strong>Objective: </strong>Gastric emptying measurements are mandatory in gastroparesis diagnostics, but the association between delayed emptying and symptoms is questionable. It is imperative to find biomarkers better correlated to symptom generation. Hence, we examined the association between symptom severity and gastrointestinal motility measured by wireless motility capsule.</p><p><strong>Patients and methods: </strong>In this prospective single-centre study, patients with gastroparesis symptoms were simultaneously investigated with gastric emptying scintigraphy and wireless motility capsule, measuring regional transit times and contractility parameters. Symptom severity was assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM), including the Gastroparesis Cardinal Symptom Index (GCSI).</p><p><strong>Results: </strong>We included 107 patients (70% women). In the whole patient group, nausea correlated with the gastric (<i>r_s</i> = -0.31, <i>p</i> = 0.007), small bowel (<i>r_s</i> = -0.41, <i>p</i> < 0.001) and colonic (<i>r_s</i> = -0.33, <i>p</i> = 0.012) motility indices. In patients with idiopathic etiology, nausea correlated with small bowel motility index (<i>r_s</i> = -0.81, <i>p</i> < 0.001) and mean stomach pressure (<i>r_s</i> = -0.64, <i>p</i> = 0.013). We also found negative correlations between total GCSI score and maximum pressure of the small bowel (<i>r_s</i> = -0.77, <i>p</i> < 0.001) and colon (<i>r_s</i> = -0.74, <i>p</i> = 0.002). In diabetes patients, total PAGI-SYM score correlated with colonic motility index (<i>r_s</i> = -0.34, <i>p</i> = 0.012), and mean pressure of the colon correlated with upper abdominal pain (<i>r_s</i> = -0.37, <i>p</i> = 0.007). We found no association between symptoms, gastric emptying nor any other transit times.</p><p><strong>Conclusion: </strong>In patients with gastroparesis symptoms, we found that symptom severity was associated with intestinal hypomotility. Based on these results, gastroparesis diagnostics should also include an evaluation of the small bowel and colon.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"133-144"},"PeriodicalIF":2.4,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/63/ceg-14-133.PMC8088984.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38886231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taking the Next Steps in Endoscopic Visual Assessment of Barrett's Esophagus: A Pilot Study.","authors":"Roxana Chis,&nbsp;Simon Hew,&nbsp;Wilma Hopman,&nbsp;Lawrence Hookey,&nbsp;Robert Bechara","doi":"10.2147/CEG.S293477","DOIUrl":"https://doi.org/10.2147/CEG.S293477","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with Barrett's esophagus (BE) undergo surveillance endoscopies to assess for pre-cancerous changes. We developed a simple endoscopic classification method for predicting non-dysplastic BE (NDBE), low-grade dysplasia (LGD)/indefinite for dysplasia (ID) and high-grade dysplasia (HGD)/early esophageal adenocarcinoma (EAC).</p><p><strong>Patients and methods: </strong>Twenty-two patients with BE underwent endoscopy using the PENTAX Medical MagniView gastroscope and OPTIVISTA processor. Sixty-six video-still images were analyzed to characterize the microsurface, microvasculature and the presence of a demarcation line. Class A was characterized by regular microvascular and microsurface patterns and absence of a demarcation line, class B by changes in the microvascular and/or microsurface patterns compared to the background mucosa with presence of a demarcation line, and class C by irregular microvascular and/or irregular microsurface patterns with presence of a demarcation line.</p><p><strong>Results: </strong>Of the class A images, 97.9% were NDBE. For class B, 69.2% were LGD/ID and 30.8% NDBE. One hundred percent of the class C samples were HGD/EAC. The sensitivity of our classification system was 93.8%, specificity 92%, positive predictive value 78.9%, negative predictive value 97.9% and an accuracy 92.4%.</p><p><strong>Conclusion: </strong>In this study, we developed a simple classification system for the prediction of NDBE, LGD/ID and HGD/EAC. Its real-time clinical applicability will be validated prospectively.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"113-122"},"PeriodicalIF":2.4,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/62/ceg-14-113.PMC8075180.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38926979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh.","authors":"Neil Hawkes, Umakant Dave, Mesbah Rahman, Dafydd Richards, Mahmud Hasan, A H M Rowshon, Faruque Ahmed, M Masudur Rahman, M G Kibria, Phedra Dodds, Bethan Hawkes, Stuart Goddard, Imdadur Rahman, Peter Neville, Mark Feeney, Gareth Jenkins, Keith Lloyd, Krish Ragunath, Cathryn Edwards, Simon D Taylor-Robinson","doi":"10.2147/CEG.S297667","DOIUrl":"10.2147/CEG.S297667","url":null,"abstract":"<p><p>The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"103-111"},"PeriodicalIF":2.4,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25550701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Demographic Profile of Inflammatory Bowel Disease Patients in a Reference Center of São Paulo, Brazil.","authors":"Tarcia Nogueira Ferreira Gomes,&nbsp;Fabio Silva de Azevedo,&nbsp;Marjorie Argollo,&nbsp;Sender Jankiel Miszputen,&nbsp;Orlando Ambrogini","doi":"10.2147/CEG.S288688","DOIUrl":"https://doi.org/10.2147/CEG.S288688","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries.</p><p><strong>Purpose: </strong>To report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo.</p><p><strong>Patients and methods: </strong>We conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017.</p><p><strong>Results: </strong>Of 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5-38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up.</p><p><strong>Conclusion: </strong>Despite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"91-102"},"PeriodicalIF":2.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/fb/ceg-14-91.PMC7982433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25526282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions.","authors":"Tom Holvoet, Triana Lobaton, Pieter Hindryckx","doi":"10.2147/CEG.S197719","DOIUrl":"10.2147/CEG.S197719","url":null,"abstract":"<p><p>Acute severe colitis is a severe complication of ulcerative colitis, affecting approximately 20% of patients. For physicians, it remains a challenging condition to treat. Current treatment algorithms have diminished the mortality associated with acute severe ulcerative colitis (ASUC), but colectomy rates remain high (approximately 30%) despite advances in therapy. Colectomy in ASUC is particularly associated with important postoperative complications and morbidity. In this review, reasons for the inability to improve care and avoid evolution to colectomy for ASUC are explored and solutions that might lead to a better management of the disease are investigated.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"71-81"},"PeriodicalIF":2.5,"publicationDate":"2021-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/8f/ceg-14-71.PMC7955027.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25495737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}