Clinical and Experimental Gastroenterology最新文献

{"title":"Enterolith Causing Small Bowel Obstruction: Report of a Case and Review of Literature.","authors":"Oshin Sharma,&nbsp;Dhiraj Mallik,&nbsp;Sukrati Ranjan,&nbsp;Poonam Sherwani,&nbsp;Navin Kumar,&nbsp;Somprakas Basu","doi":"10.2147/CEG.S369640","DOIUrl":"https://doi.org/10.2147/CEG.S369640","url":null,"abstract":"<p><p>Enterolithiasis, also known as gastro-intestinal concretions, is an uncommon medical disorder that arises from intestinal stasis. Enteroliths are commonly caused by tuberculosis-related constriction and arise from intestinal diverticula. Small bowel obstruction caused by an enterolith is extremely uncommon and might be difficult to diagnose. The mortality rate of uncomplicated enterolithiasis is relatively low, but it rises to 3% in patients who have background comorbid illness, have significant bowel obstruction, and are diagnosed late. We present a rare case of an uncomplicated partial intestinal obstruction caused by an enterolith in an elderly male patient with small bowel diverticular disease who was treated nonoperatively and did not develop further symptoms in the six-month follow-up and discuss the difficulty in diagnosis and its management.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"101-104"},"PeriodicalIF":2.4,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/13/ceg-15-101.PMC9292452.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40525011","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":"Experience of Telemedicine in Gastroenterology Out-Patient Practice During the COVID-19 Pandemic: Experiences from a Tertiary-Care Hospital in a Developing Country.","authors":"Anjiya Shaikh,&nbsp;Maria Khan,&nbsp;Faisal Waseem Ismail","doi":"10.2147/CEG.S361381","DOIUrl":"https://doi.org/10.2147/CEG.S361381","url":null,"abstract":"<p><strong>Objective: </strong>Telemedicine is being widely implemented in the COVID-19 pandemic to avoid infection risk. However, its effectiveness has not been evaluated, especially in developing countries, where it is invaluable for healthcare access. This study assesses physicians' and patients' perspectives of the usefulness and challenges of telemedicine in the gastroenterology department to identify its pitfalls.</p><p><strong>Methods: </strong>A cross-sectional telephonic survey was conducted on patients presenting to the gastroenterology department at a tertiary care hospital in Pakistan. An online survey was sent to physicians in the department.</p><p><strong>Results: </strong>A total of 160 patients participated, with a mean age 49.8 years, and 42.8% (n=68) males. There were 23.8% (n=38) initial visits and 76.3% (n=122) follow-ups. More than 85% of patients agreed telemedicine saved cost and time, 46.5% (n=74) said it improved healthcare access, and 76.3% (n=122) wanted to use it again. More than 80% were satisfied with the physician-patient interaction. Of the 7 physicians who participated, most felt telemedicine was inadequately facilitated, but felt comfortable with technology. Most felt it did not negatively affect healthcare, but thought it was complex for patients and that lack of physical interaction is a limitation. Nearly half were in favor of continuing its use after the pandemic.</p><p><strong>Conclusion: </strong>Telemedicine is an effective alternative to in-person visits. Patients find it convenient, with adequate interaction. Physicians have reservations that need addressal, such as poor administration. Most patients and half of physicians are welcome to using telemedicine in the post-COVID era.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"91-99"},"PeriodicalIF":2.4,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/b2/ceg-15-91.PMC9211076.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40394184","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":"Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda.","authors":"Charles Newton Odongo,&nbsp;Carlos Cabrera Dreque,&nbsp;David Mutiibwa,&nbsp;Felix Bongomin,&nbsp;Felix Oyania,&nbsp;Mvuyo Maqhawe Sikhondze,&nbsp;Moses Acan,&nbsp;Raymond Atwine,&nbsp;Fred Kirya,&nbsp;Martin Situma","doi":"10.2147/CEG.S356977","DOIUrl":"https://doi.org/10.2147/CEG.S356977","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.</p><p><strong>Methods: </strong>Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files.</p><p><strong>Results: </strong>A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%).</p><p><strong>Conclusion: </strong>Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"79-90"},"PeriodicalIF":2.4,"publicationDate":"2022-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/b2/ceg-15-79.PMC9199528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40041574","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":"Combined Pharmacological and Endoscopic Treatment for Worsening Gastroesophageal Varices in Patients with Cirrhosis","authors":"V. Pepe, P. Angeli, M. Di Pascoli","doi":"10.2147/CEG.S355392","DOIUrl":"https://doi.org/10.2147/CEG.S355392","url":null,"abstract":"Background At the present time, in patients with liver cirrhosis and gastroesophageal varices, primary prophylaxis of variceal bleeding made with combination therapy with non-selective β-blockers (NSBBs) and endoscopic band ligation (EBL) is not recommended. The aim of this study was to evaluate if patients with worsening varices while on NSBBs regimen benefit, in terms of bleeding and survival, from adding treatment with EBL. Methods Patients with cirrhosis and endoscopic finding of gastroesophageal varices with high risk feature (increased variceal size and/or development of red signs) during primary prophylaxis with NSBBs, followed at the Unit of Internal Medicine and Hepatology, University and General Hospital of Padova, Italy, from 2012 to 2019, were retrospectively evaluated. When an increased bleeding risk of the varices was confirmed, patients maintained the pharmacological therapy alone or underwent also EBL. The primary endpoint of the study was the rate of variceal bleeding, the secondary endpoint was mortality at 30 months. Results Compared to patients treated only with NSBBs (n=56), in patients treated also with EBL (n=45), the 30‐month probability of variceal bleeding (29.1% vs 5.1%; P =0.036) was significantly reduced, while the probability of survival was similar (59.6% vs 65.7%; P=0.61). On multivariate analysis, treatment with EBL was found to be a weak protective factor for mortality (HR 0.47, P=0.044). Conclusion In patients with liver cirrhosis, when varices show endoscopic feature of increased haemorrhagic risk, adding EBL to NSBBs is effective in reducing the probability of first bleeding.","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 1","pages":"59 - 65"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44145119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in <i>Helicobacter pylori</i> Treatment from Discovery to Nowadays: A High-Level Analysis of PubMed Publications.","authors":"Eyal Klang,&nbsp;Shelly Soffer,&nbsp;Yiftach Barash,&nbsp;Eyal Shachar,&nbsp;Adi Lahat","doi":"10.2147/CEG.S342048","DOIUrl":"https://doi.org/10.2147/CEG.S342048","url":null,"abstract":"<p><strong>Background: </strong>Since the discovery of <i>Helicobacter pylori</i> (<i>H. pylori</i>) 40 years ago, treatment options have changed dramatically adjacent to new drugs development and the emergence of multi-drug resistance. In this study, we aimed to assess published literature on treatment regimens for <i>H. pylori</i> in the past four decades, with regards to specific drug resistance and geographic distribution.</p><p><strong>Methods: </strong>We have queried PubMed for all available <i>H. pylori</i>-related entries published during 1987-2020. For each entry, we retrieved the title, abstract, and keywords. Two gastrointestinal specialists decided in consensus on a list of terms to classify entries. The terms specify types of treatment and different types of regimens. Annual trends of publications were plotted for different treatment types and sub-analyses.</p><p><strong>Results: </strong>Overall, 47,170 <i>H. pylori</i>-related entries were published between 1987 and 2020. Medication treatment showed the highest number of total publications 6183/47,170 (13.1%), followed by antibiotics 5493/47,170 (11.6%), and probiotic which was substantially lower (0.7%). For treatment regimens type, triple therapy had the highest number of publications 2400/47,170 (5.1%) followed by sequential therapy 342/47,170 (0.7%), and bismuth quadruple therapy 115/47,170 (0.2%). Analysis by antibiotic resistance showed that clarithromycin treatment had the highest number of publications 3537/47,170 (7.5%). Since 2013, there is a steep upward slope (5.1±0.7 publications/year, p < 0.001) for publications originating from China.</p><p><strong>Conclusion: </strong>Our findings reflect the changes of the commonly prescribed regimens along the years, following the occurrence and the rise of <i>H. pylori</i> antibiotic resistance. In recent years, there is a steep rise in publications in countries with policies of screening and eradication for gastric cancer prevention, which is currently not applied in Western countries. A text-mining analysis of <i>H. pylori</i> publications contributes to the understanding of treatment options and development trends worldwide.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"51-58"},"PeriodicalIF":2.4,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/25/ceg-15-51.PMC8939865.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40323945","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":"Alkaline Phosphatase Pathophysiology with Emphasis on the Seldom-Discussed Role of Defective Elimination in Unexplained Elevations of Serum ALP - A Case Report and Literature Review.","authors":"Michael D Levitt,&nbsp;Sophie M Hapak,&nbsp;David G Levitt","doi":"10.2147/CEG.S345531","DOIUrl":"https://doi.org/10.2147/CEG.S345531","url":null,"abstract":"<p><p>While serum alkaline phosphatase activity has become a routine clinical measurement, we have found that physicians' knowledge of the pathophysiology of this enzyme is almost solely limited to the concept that an elevated serum alkaline phosphatase suggests disease of liver or bone. For example, physicians at all levels of training had no understanding of such basic physiological information as the function of alkaline phosphatase in the liver or how this enzyme is eliminated from the serum. Based on a patient with an enormously elevated alkaline phosphatase, this report provides a review of existing clinically relevant information concerning the pathophysiology of alkaline phosphatase with emphasis on the mechanisms involved in the homeostasis of this enzyme. A novel aspect of this paper is the discussion of the previously neglected concept that defective enzyme elimination could play a major role in the pathogenesis of serum alkaline phosphatase elevations.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"41-49"},"PeriodicalIF":2.4,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/63/ceg-15-41.PMC8934114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40310524","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":"A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas.","authors":"Pankaj Garg,&nbsp;Vipul D Yagnik,&nbsp;Sushil Dawka,&nbsp;Baljit Kaur,&nbsp;Geetha R Menon","doi":"10.2147/CEG.S343254","DOIUrl":"https://doi.org/10.2147/CEG.S343254","url":null,"abstract":"<p><strong>Background: </strong>Anal fistulas cause great uncertainty and anxiety in patients and surgeons alike. This is largely because of the inability to accurately confirm postoperative fistula healing, especially long-term healing. There is no scoring system available that can objectively assess cryptoglandular anal fistulas for postoperative healing and can also accurately predict long-term healing.</p><p><strong>Methods: </strong>Several parameters that could indicate anal fistula healing were assessed. Out of these, six parameters (four MRI-based and two clinical) were finalized, and a weighted score was given to each parameter. A novel scoring system (NSS) was developed. A minimum possible score (zero) indicated complete healing whereas the maximum weighted score (n = 20) indicated confirmed non-healing. Scoring was done with postoperative MRI (at least 3 months post-surgery), then compared with the actual healing status, and subsequently correlated with the final long-term clinical outcome.</p><p><strong>Results: </strong>The NSS was validated in 183 operated cryptoglandular fistula-in-ano patients over a 3-year period in whom 283 MRIs (preoperative plus postoperative) were performed. The postoperative follow-up was 12-48 months (median-30 months). The NSS was found to have a very high positive predictive value (98.2%) and moderately high negative predictive value (83.7%) for long-term fistula healing. Additionally, its sensitivity and specificity in predicting healing were 93.9% and 94.7%, respectively.</p><p><strong>Conclusion: </strong>Thus, this new scoring system is highly accurate and would be a useful tool for surgeons and radiologists managing anal fistulas. By objectivizing the assessment of postoperative healing, it can both ease and streamline management. Moreover, reliable prediction of recurrence-free long-term healing will greatly allay the apprehensions associated with this dreaded disease.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"27-40"},"PeriodicalIF":2.4,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/e6/ceg-15-27.PMC8860728.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39670343","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":"Mucosal Gene Transcript Signatures in Treatment Naïve Inflammatory Bowel Disease: A Comparative Analysis of Disease to Symptomatic and Healthy Controls in the European IBD-Character Cohort.","authors":"Simen Svendsen Vatn,&nbsp;Jonas Christoffer Lindstrøm,&nbsp;Aina E F Moen,&nbsp;Stephan Brackmann,&nbsp;Tone M Tannæs,&nbsp;Christine Olbjørn,&nbsp;Daniel Bergemalm,&nbsp;Åsa V Keita,&nbsp;Fernando Gomollon,&nbsp;Trond Espen Detlie,&nbsp;Torben Lüders,&nbsp;Rahul Kalla,&nbsp;Alex Adams,&nbsp;Jack Satsangi,&nbsp;Jørgen Jahnsen,&nbsp;Morten H Vatn,&nbsp;Jonas Halfvarson,&nbsp;Petr Ricanek,&nbsp;Hilde Nilsen","doi":"10.2147/CEG.S343468","DOIUrl":"https://doi.org/10.2147/CEG.S343468","url":null,"abstract":"<p><strong>Background: </strong>Studies of the mucosal transcriptomic landscape have given new insight into the pathogenesis of inflammatory bowel disease (IBD). Recently, the predictive biomarker potential of gene expression signatures has been explored. To further investigate the mucosal gene expression in IBD, we recruited a cohort of treatment naïve patients and compared them to both symptomatic and healthy controls.</p><p><strong>Methods: </strong>Altogether, 323 subjects were included: Crohn's disease (N = 75), ulcerative colitis (N = 87) and IBD unclassified (N = 3). Additionally, there were two control groups: symptomatic controls (N = 131) and healthy controls (N = 27). Mucosal biopsies were collected during ileocolonoscopy and gene expression in inflamed and non-inflamed mucosa was explored. Gene expression profiling was performed using Agilent G3 Human Gene Expression 860K v3 One-Color microarray. We recorded information about treatment escalation to anti-TNF agents or surgery, and anti-TNF response, to explore predictive opportunities of the mucosal transcriptome.</p><p><strong>Results: </strong>Gene expression profiles in symptomatic controls in whom IBD had been excluded resembled that of IBD patients and diverged from that of healthy controls. In non-inflamed Crohn's disease and ulcerative colitis, gene set enrichment analysis revealed dysregulation of pathways involved in basic cellular biological processes. Mitochondria-associated pathways were dysregulated both in non-inflamed and inflamed Crohn's disease and ulcerative colitis (>2.6 normalized enrichment scores <-1.8). Gene expression signatures of Crohn's disease and ulcerative colitis did not predict time for treatment escalation (p = 0.175). No significant association was found between gene expression signatures and anti-TNF response.</p><p><strong>Conclusion: </strong>Non-inflamed samples are probably superior to inflamed samples when exploring gene expression signatures in IBD and might reveal underlying mechanisms central for disease initiation. The gene expression signatures of the control groups were related to if they were symptomatic or not, which may have important implications for future study designs.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"5-25"},"PeriodicalIF":2.4,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/54/ceg-15-5.PMC8848803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39648006","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":"Non-Invasive Risk Stratification in NAFLD/NASH Patients for Screening EGD.","authors":"John Romano,&nbsp;Thaer Abdelfattah,&nbsp;Paul P Manka,&nbsp;Michael Fuchs,&nbsp;Wing-Kin Syn","doi":"10.2147/CEG.S339850","DOIUrl":"https://doi.org/10.2147/CEG.S339850","url":null,"abstract":"1Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA; 2Division of Gastroenterology and Hepatology, Central Virginia VA Health Care System, Richmond, VA, USA; 3Department of Internal Medicine, University Hospital, Knappschaftskrankenhaus, RuhrUniversity Bochum, Bochum, Germany; 4Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA; 5Section of Gastroenterology, Ralph H Johnson VAMC, Charleston, SC, USA; 6Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Universidad del Pa S Vasco/Euskal Herriko Univertsitatea (UPV/EHU), Leioa, Spain Portal hypertension is a major complication of cirrhosis, as it predisposes patients to manifestations of hepatic decompensation, including the development of esophageal variceal bleeding, hepatic encephalopathy, and ascites. Esophageal varices are present in approximately 50% of patients with cirrhosis. The mortality during a variceal bleeding event is high, with estimates ranging from 15% to 20%, being largely dependent upon whether patients have received the standard of care with endoscopic band ligation, vasoactive drugs, and antibiotics. The hepatic venous pressure gradient (HVPG) is considered the gold standard in ascertaining the presence of portal hypertension (PH). Clinically significant portal hypertension (CSPH), which is associated with the development of the aforementioned manifestations of decompensation, has been defined as an HVPG greater than or equal to 10 mmHg. After a diagnosis of cirrhosis, current guidelines recommend screening for esophageal varices with esophagogastroduodenoscopy (EGD). This procedure is carried out to identify patients who are at risk for variceal hemorrhage and would benefit from starting prophylactic therapy with beta blockade. This procedure carries risks, which include any type of respiratory or cardiac suppression from anesthesia, infection, bleeding, and perforation. In addition, a significant majority of patients with varices who are indeed at high risk for bleeding do not have any symptoms from the varices themselves, making EGD a non-ideal screening test. Previous studies suggest that non-invasive blood-based markers are useful to identify patients with liver damage (fibrosis or cirrhosis) and may identify those who will develop complications such as liver cancer. Examples of these markers include the Fibrosis-4 Index (FIB-4), which is a non-invasive estimate of liver scarring in HCV and HBV patients; the NAFLD (Non-Alcoholic Fatty Liver Disease) Fibrosis Score (NFS), which is used to estimate the amount of scarring in the liver based on several laboratory tests; the BARD score, based upon BMI, AST/ALT ratio, and the presence or absence of diabetes; and the AST to Platelet Ratio Index (APRI). We evaluated whether these non-invasive markers and/or any other clinical parameters may be used to identify patients with liver cirrhosis who","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"1-3"},"PeriodicalIF":2.4,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/93/ceg-15-1.PMC8759994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39833530","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":"Decreased Rate of Presentation, but Worsened Racial-Ethnic Disparity in Acute Gastrointestinal Bleeding During Coronavirus 2019 Shutdown: A Retrospective Cohort Study.","authors":"Sumana Reddy,&nbsp;Beyla Patel,&nbsp;Luke Baldelli,&nbsp;Rajiv T Majithia,&nbsp;Michael K Dougherty","doi":"10.2147/CEG.S348574","DOIUrl":"https://doi.org/10.2147/CEG.S348574","url":null,"abstract":"<p><strong>Purpose: </strong>In spring 2020, Coronavirus Disease 2019 (COVID-19) \"stay-at-home\" orders may have led to later, more acute disease presentations of emergent conditions such as gastrointestinal bleeding (GIB). In this retrospective cohort study, we compared incidence and severity of GIB during the strictest COVID shutdown to pre-COVID periods.</p><p><strong>Patients and methods: </strong>We compared weekly counts of emergency department (ED) visits for GIB between March 27 and May 7, 2020 (COVID period) and pre-COVID periods in 2019 and 2020 in a US statewide network of hospitals. We compared the severity of GIB presentations using incident rate ratios (IRR) of \"severe\" GIB (requiring ≥4 units of blood, endoscopic therapy, interventional radiology or surgical procedure), intensive care (ICU) admission and shock. We also looked for effect modification of demographic covariates on associations between year and GIB outcomes.</p><p><strong>Results: </strong>Fewer patients presented to ED for GIB during COVID than during the same dates in 2019 (534 versus 904; IRR 0.59, 95% CI 0.53-0.66). A greater proportion of COVID-period ED visits required inpatient admission (73.6% vs 67.8%, p = 0.02) and had severe GIB (19.3% vs 14.9%, p = 0.03). Proportion of patients requiring transfusion (p < 0.001), with shock (p < 0.01), or with critical hemoglobin (p = 0.003) or lactate (p = 0.02) were worse during COVID. Non-white patients experienced disproportionately worse outcomes during COVID than in 2019, with greater absolute counts of shock (65 vs 62, p = 0.01 for interaction) or ICU admission (40 vs 35, p = 0.01 for interaction).</p><p><strong>Conclusion: </strong>Fewer acute GIB presented during the pandemic period compared to the year prior. The severity of pandemic presentations was greater, driven by disproportionately worse outcomes in minorities.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 ","pages":"67-77"},"PeriodicalIF":2.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/28/ceg-15-67.PMC9112516.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169705","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}