Gastroenterology Research最新文献

{"title":"Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program.","authors":"Julio Zuniga Cisneros,&nbsp;Carlos Tunon,&nbsp;Enrique Adames,&nbsp;Carolina Garcia,&nbsp;Rene Rivera,&nbsp;Eyleen Gonzalez,&nbsp;Jan Cubilla,&nbsp;Luis Lambrano","doi":"10.14740/gr1599","DOIUrl":"10.14740/gr1599","url":null,"abstract":"<p><strong>Background: </strong>The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated.</p><p><strong>Methods: </strong>We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps.</p><p><strong>Results: </strong>A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007).</p><p><strong>Conclusion: </strong>In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"96-104"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/70/gr-16-096.PMC10181342.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829172","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":"Transjugular Intrahepatic Portosystemic Shunt With or Without Gastroesophageal Variceal Embolization for the Prevention of Variceal Rebleeding: A Systematic Review and Meta-Analysis.","authors":"Fouad Jaber,&nbsp;Azizullah Beran,&nbsp;Saqr Alsakarneh,&nbsp;Khalid Ahmed,&nbsp;Mohamed Abdallah,&nbsp;Khaled Elfert,&nbsp;Mohammad Almeqdadi,&nbsp;Mohammed Jaber,&nbsp;Wael T Mohamed,&nbsp;Mohamd Ahmed,&nbsp;Laith Al Momani,&nbsp;Laith Numan,&nbsp;Thomas Bierman,&nbsp;John H Helzberg,&nbsp;Hassan Ghoz,&nbsp;Wendell K Clarkston","doi":"10.14740/gr1618","DOIUrl":"https://doi.org/10.14740/gr1618","url":null,"abstract":"<p><strong>Background: </strong>The role of variceal embolization (VE) during transjugular intrahepatic portosystemic shunt (TIPS) creation for preventing gastroesophageal variceal rebleeding remains controversial. Therefore, we performed a meta-analysis to compare the incidence of variceal rebleeding, shunt dysfunction, encephalopathy, and death between patients treated with TIPS alone and those treated with TIPS in combination with VE.</p><p><strong>Methods: </strong>We performed a literature search using PubMed, EMBASE, Scopus, and Cochrane databases for all studies comparing the incidence of complications between TIPS alone and TIPS with VE. The primary outcome was variceal rebleeding. Secondary outcomes include shunt dysfunction, encephalopathy, and death. Subgroup analysis was performed based on the type of stent (covered vs. bare metal). The random-effects model was used to calculate the relative risk (RR) with the corresponding 95% confidence intervals (CIs) of outcome. A P value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Eleven studies with a total of 1,075 patients were included (597: TIPS alone and 478: TIPS plus VE). Compared to the TIPS alone, the TIPS with VE had a significantly lower incidence of variceal rebleeding (RR: 0.59, 95% CI: 0.43 - 0.81, P = 0.001). Subgroup analysis revealed similar results in covered stents (RR: 0.56, 95% CI: 0.36 - 0.86, P = 0.008) but there was no significant difference between the two groups in the subgroup analysis of bare stents and combined stents. There was no significant difference in the risk of encephalopathy (RR: 0.84, 95% CI: 0.66 - 1.06, P = 0.13), shunt dysfunction (RR: 0.88, 95% CI: 0.64 - 1.19, P = 0.40), and death (RR: 0.87, 95% CI: 0.65 - 1.17, P = 0.34). There were similarly no differences in these secondary outcomes between groups when stratified according to type of stent.</p><p><strong>Conclusions: </strong>Adding VE to TIPS reduced the incidence of variceal rebleeding in patients with cirrhosis. However, the benefit was observed with covered stents only. Further large-scale randomized controlled trials are warranted to validate our findings.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"68-78"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/42/gr-16-068.PMC10181335.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829176","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":"Esophageal Ulcer After Intravitreal Ranibizumab Injection in a Patient With Age-Related Macular Degeneration.","authors":"Xin Qing Li,&nbsp;Ke Wei Zhu,&nbsp;Jun Lai,&nbsp;Jian Wu,&nbsp;Xiao Fang Guo","doi":"10.14740/gr1603","DOIUrl":"https://doi.org/10.14740/gr1603","url":null,"abstract":"<p><p>Ranibizumab is a monoclonal antibody fragment targeted against vascular endothelial growth factor (VEGF) A isoform (VEGF-A). This study aimed to report a case of esophageal ulcer that developed soon after intravitreal ranibizumab injection in a patient with age-related macular degeneration (AMD). A 53-year-old male patient diagnosed with AMD received ranibizumab through intravitreal injection in the left eye. Mild dysphagia occurred 3 days after receiving intravitreal ranibizumab injection for the second time. The dysphagia exacerbated remarkably and was accompanied by hemoptysis 1 day after receiving ranibizumab for the third time. Severe dysphagia accompanied by intense retrosternal pain and pant emerged after injecting ranibizumab for the fourth time. An esophageal ulcer was observed through ultrasound gastroscopy, covered with fibrinous tissue, and surrounded by flushing and congestive mucosae. The patient received proton pump inhibitor (PPI) therapy combined with traditional Chinese medicine (TCM) after discontinuation of ranibizumab. The dysphagia and retrosternal pain were gradually relieved after treatment. Afterwards, the esophageal ulcer has not relapsed since permanent discontinuation of ranibizumab. To our best knowledge, this was the first case of esophageal ulcer related to intravitreal ranibizumab injection. Our study indicated that VEGF-A played a potential role in the development of esophageal ulceration.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"118-124"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/e7/gr-16-118.PMC10181341.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829180","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":"Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis.","authors":"Zohaib Ahmed,&nbsp;Umair Iqbal,&nbsp;Muhammad Aziz,&nbsp;Syeda Faiza Arif,&nbsp;Joyce Badal,&nbsp;Umer Farooq,&nbsp;Wade Lee-Smith,&nbsp;Manesh Kumar Gangwani,&nbsp;Faisal Kamal,&nbsp;Abdallah Kobeissy,&nbsp;Asif Mahmood,&nbsp;Ali Nawras,&nbsp;Harshit S Khara,&nbsp;Bradley D Confer,&nbsp;Douglas G Adler","doi":"10.14740/gr1593","DOIUrl":"https://doi.org/10.14740/gr1593","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes.</p><p><strong>Methods: </strong>Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software.</p><p><strong>Results: </strong>The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I² = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG.</p><p><strong>Conclusion: </strong>PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"79-91"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/1c/gr-16-079.PMC10181338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829174","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":"Quality of Capsule Endoscopy Reporting in Patients Referred for Double Balloon Enteroscopy.","authors":"Joshua Lee,&nbsp;Jonathan Reichstein,&nbsp;Iris Vance,&nbsp;Daniel Wild","doi":"10.14740/gr1596","DOIUrl":"https://doi.org/10.14740/gr1596","url":null,"abstract":"<p><strong>Background: </strong>Abnormal video capsule endoscopy (VCE) findings often require intervention with double balloon enteroscopy (DBE). Accurate VCE reporting is important for procedural planning. In 2017 the American Gastroenterological Association (AGA) published a guideline that included recommended elements for VCE reporting. The aim of this study was to examine adherence to the AGA reporting guidelines for VCE.</p><p><strong>Methods: </strong>The medical records of all patients who underwent DBE at a tertiary academic center between February 1, 2018, and July 1, 2019, were retrospectively reviewed to identify the VCE report that prompted DBE. Data were collected on the presence of each reporting element recommended by the AGA. Differences in reporting between academic and private practices were compared.</p><p><strong>Results: </strong>A total of 129 VCE reports were reviewed (84 private practice and 45 academic practice). Reports consistently included indication, date, endoscopist, findings, diagnosis, and management recommendations. Timing of anatomic landmarks and abnormalities were included in only 87.6% of reports and preparation quality in only 26.2%. Reports from private practice groups were significantly more likely to include the type of capsule (P < 0.001). VCE reports from academic centers were more likely to include adverse outcomes (P < 0.001), pertinent negatives (P = 0.0015), extent of exam (P = 0.009), previous investigations (P = 0.045), medications (P < 0.001), and document communication to patient/referring physician (P = 0.001).</p><p><strong>Conclusions: </strong>Most VCE reports in both private and academic settings included the important elements recommended by the AGA; however only 87% listed the times of landmarks and abnormal findings, which are crucial in determining the type and direction of approach for subsequent interventions. It is unclear whether the quality of VCE reporting influences the outcome of subsequent DBE.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"92-95"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/93/gr-16-092.PMC10181337.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829178","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":"Incidence and Cross-Continents Differences in Endoscopic Retrograde Cholangiopancreatography Outcomes Among Patients With Cirrhosis: A Systematic Review and Meta-Analysis.","authors":"Saqr Alsakarneh,&nbsp;Fouad Jaber,&nbsp;Khalid Ahmed,&nbsp;Fares Ghanem,&nbsp;Wael T Mohammad,&nbsp;Mohamed K Ahmed,&nbsp;Mohamad Khaled Almujarkesh,&nbsp;Thomas Bierman,&nbsp;John Campbell,&nbsp;Yazan Abboud,&nbsp;Muhammad Shah Miran,&nbsp;John H Helzberg,&nbsp;Hassan M Ghoz","doi":"10.14740/gr1610","DOIUrl":"https://doi.org/10.14740/gr1610","url":null,"abstract":"Background There are conflicting data on the frequency and variability of endoscopic retrograde cholangiopancreatography (ERCP) outcomes in patients with cirrhosis. Our aim was to systematically review the literature on the incidence of post-ERCP adverse events in cirrhotic patients and to examine the differences across continents. Methods We searched PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases to identify studies reporting adverse events after ERCP in patients with cirrhosis from conception to September 30, 2022. The random effects model was used to calculate odds ratios (ORs), mean differences (MDs), and confidence intervals (CIs). A P value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Cochrane Q-statistic (I2). Results Twenty-one studies that included 2,576 cirrhotic patients and 3,729 individual ERCPs were analyzed. The pooled overall rate of adverse events after ERCP in patients with cirrhosis was 16.98% (95% CI: 13.06-21.29%, P < 0.001, I2 = 86.55%). ERCPs performed in Asia had the highest ERCP adverse events with an overall complication rate of 19.90%, while the lowest overall adverse events were in North America at 13.04%. The pooled post-ERCP bleeding, pancreatitis, cholangitis and perforation were 5.10% (95% CI: 3.33-7.19%, P < 0.001, I2 = 76.79%), 3.21% (95% CI: 2.20-5.36%, P = 0.03, I2 = 42.25%), 3.02% (95% CI: 1.19-5.52%, P < 0.001, I2 = 87.11%), and 0.12% (95% CI: 0.00 - 0.45, P = 0.26, I2 = 15.76%), respectively. The pooled post-ERCP mortality rate was 0.22% (95% CI: 0.00-0.85%, P = 0.01, I2 = 51.86%). Conclusions This meta-analysis shows that the overall complication rates after ERCP, bleeding, pancreatitis, and cholangitis are high in patients with cirrhosis. Because cirrhotic patients are more likely to have post-ERCP complications, with significant cross-continent variations, the risks and benefits of ERCP in this patient population should be carefully considered.","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"105-117"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/65/gr-16-105.PMC10181340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829175","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 Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease.","authors":"Dushyant Singh Dahiya,&nbsp;Sohaib Mandoorah,&nbsp;Manesh Kumar Gangwani,&nbsp;Hassam Ali,&nbsp;Nooraldin Merza,&nbsp;Muhammad Aziz,&nbsp;Amandeep Singh,&nbsp;Abhilash Perisetti,&nbsp;Rajat Garg,&nbsp;Chin-I Cheng,&nbsp;Priyata Dutta,&nbsp;Sumant Inamdar,&nbsp;Madhusudhan R Sanaka,&nbsp;Mohammad Al-Haddad","doi":"10.14740/gr1605","DOIUrl":"https://doi.org/10.14740/gr1605","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA).</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified.</p><p><strong>Results: </strong>Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD.</p><p><strong>Conclusions: </strong>PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"17-24"},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/af/gr-16-017.PMC9990529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9140335","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 Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis.","authors":"Shahid Habib,&nbsp;Traci Murakami,&nbsp;Varun Takyar,&nbsp;Krunal Patel,&nbsp;Cristian Dominguez,&nbsp;Yongcheng Zhan,&nbsp;Omid Mehrpour,&nbsp;Chiu-Hsieh Hsu","doi":"10.14740/gr1556","DOIUrl":"https://doi.org/10.14740/gr1556","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Alcoholic hepatitis (AH) is characterized by acute symptomatic hepatitis associated with heavy alcohol use. This study was designed to assess the impact of metabolic syndrome on high-risk patients with AH with discriminant function (DF) score ≥ 32 and its effect on mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the hospital database for ICD-9 diagnosis codes of acute AH, alcoholic liver cirrhosis, and alcoholic liver damage. The entire cohort was categorized into two groups: AH and AH with metabolic syndrome. The effect of metabolic syndrome on mortality was evaluated. Also, an exploratory analysis was used to create a novel risk measure score to assess mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A large proportion (75.5%) of the patients identified in the database who had been treated as AH had other etiologies and did not meet the American College of Gastroenterology (ACG)-defined diagnosis of acute AH, thus had been misdiagnosed as AH. Such patients were excluded from analysis. The mean body mass index (BMI), hemoglobin (Hb), hematocrit (HCT), and alcoholic liver disease/non-alcoholic fatty liver disease index (ANI) were significantly different between two groups (P &lt; 0.05). The results of a univariate Cox regression model showed that age, BMI, white blood cells (WBCs), creatinine (Cr), international normalized ratio (INR), prothrombin time (PT), albumin levels, albumin &lt; 3.5, total bilirubin, Na, Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), MELD ≥ 21, MELD ≥ 18, DF score, and DF ≥ 32 had a significant effect on mortality. Patients with a MELD greater than 21 had a hazard ratio (HR) (95% confidence interval (CI) of 5.81 (2.74 - 12.30) (P &lt; 0.001). The adjusted Cox regression model results showed that age, Hb, Cr, INR, Na, MELD score, DF score, and metabolic syndrome were independently associated with high patient mortality. However, the increase in BMI and mean corpuscular volume (MCV) and sodium significantly reduced the risk of death. We found that a model including age, MELD ≥ 21, and albumin &lt; 3.5 was the best model in identifying patient mortality. Our study showed that patients admitted with a diagnosis of alcoholic liver disease with metabolic syndrome had an increased mortality risk compared to patients without metabolic syndrome, in high-risk patients with DF ≥ 32 and MELD ≥ 21. A bivariate correlation analysis revealed that patients with AH with metabolic syndrome were more likely to have infection (43%) compared to AH (26%) with correlation coefficient of 0.176 (P = 0.03, CI: 0.018 - 1.0).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In clinical practice, the diagnosis of AH is inaccurately applied. Metabolic syndrome significantly increases the mortality risk in high-risk AH. It signifies that the presence of features of metabolic syndrome modifies the behavior of AH in acute settings, warranting different therapeutic strategies. We propose that in defining AH, patients overlappi","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"25-36"},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/e0/gr-16-025.PMC9990531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437750","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":"Cytomegalovirus Infection Is Associated With Adverse Outcomes Among Hospitalized Pediatric Patients With Inflammatory Bowel Disease.","authors":"Aravind Thavamani,&nbsp;Krishna Kishore Umapathi,&nbsp;Thomas J Sferra,&nbsp;Senthilkumar Sankararaman","doi":"10.14740/gr1588","DOIUrl":"https://doi.org/10.14740/gr1588","url":null,"abstract":"<p><strong>Background: </strong>Adults with inflammatory bowel disease (IBD) are at increased risk of developing cytomegalovirus (CMV) colitis, which is associated with adverse outcomes. Similar studies in pediatric IBD patients are lacking.</p><p><strong>Methods: </strong>We analyzed non-overlapping years of National Inpatient Sample (NIS) and Kids Inpatient Database (KID) between 2003 and 2016. We included all patients < 21 years with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). Patients with coexisting CMV infection during that admission were compared with patients without CMV infection for outcome measures such as in-hospital mortality, disease severity, and healthcare resource utilization.</p><p><strong>Results: </strong>We analyzed a total of 254,839 IBD-related hospitalizations. The overall prevalence rate of CMV infection was 0.3% with an overall increasing prevalence trend, P < 0.001. Approximately two-thirds of patients with CMV infection had UC, which was associated with almost 3.6 times increased risk of CMV infection (confidence interval (CI): 3.11 to 4.31, P < 0.001). IBD patients with CMV had more comorbid conditions. CMV infection was significantly associated with increased odds of in-hospital mortality (odds ratio (OR): 3.58; CI: 1.85 to 6.93, P < 0.001) and severe IBD (OR: 3.31; CI: 2.54 to 4.32, P < 0.001). CMV-related IBD hospitalizations had increased length of stay by 9 days while incurring almost $65,000 higher hospitalization charges, P < 0.001.</p><p><strong>Conclusions: </strong>The prevalence of CMV infection is increasing in pediatric IBD patients. CMV infections significantly corelated with increased risk of mortality and severity of IBD leading to prolonged hospital stay and higher hospitalization charges. Further prospective studies are needed to better understand the factors leading to this increasing CMV infection.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/a1/gr-16-001.PMC9990534.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437751","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":"Endoscopic Ultrasound Predicts Risk of Occult Intra-Abdominal Metastases in Localized Gastric Cancer: A Validation Study.","authors":"Fares Ayoub,&nbsp;Christopher G Chapman,&nbsp;Heather Chen,&nbsp;Namrata Setia,&nbsp;Kevin Roggin,&nbsp;Uzma D Siddiqui","doi":"10.14740/gr1589","DOIUrl":"https://doi.org/10.14740/gr1589","url":null,"abstract":"<p><strong>Background: </strong>In gastric cancer (GC) patients without imaging evidence of distant metastasis, diagnostic staging laparoscopy (DSL) is recommended to detect radiographically occult peritoneal metastasis (M1). DSL carries a risk for morbidity and its cost-effectiveness is unclear. Use of endoscopic ultrasound (EUS) to improve patient selection for DSL has been proposed but not validated. We aimed to validate an EUS-based risk classification system predicting risk for M1 disease.</p><p><strong>Methods: </strong>We retrospectively identified all GC patients without positron emission tomography (PET)/computed tomography (CT) evidence of distant metastasis who underwent staging EUS followed by DSL between 2010 and 2020. T1-2, N0 disease was EUS \"low-risk\"; T3-4 and/or N+ disease was \"high-risk\".</p><p><strong>Results: </strong>A total of 68 patients met inclusion criteria. DSL identified radiographically occult M1 disease in 17 patients (25%). Most patients had EUS T3 tumors (n = 59, 87%) and 48 (71%) patients were node-positive (N+). Five (7%) patients were classified EUS \"low-risk\" and 63 (93%) were classified \"high-risk\". Of 63 \"high-risk\" patients, 17 (27%) had M1 disease. The ability of \"low-risk\" EUS to predict M0 disease at laparoscopy was 100% and DSL would have been avoided in five patients (7%). This stratification algorithm showed a sensitivity of 100% (95% confidence interval (CI): 80.5-100%) and a specificity of 9.8% (95% CI: 3.3-21.4%).</p><p><strong>Conclusions: </strong>Use of an EUS-based risk classification system in GC patients without imaging evidence of metastasis helps identify a subset of patients at low-risk for laparoscopic M1 disease who may avoid DSL and proceed directly to neoadjuvant chemotherapy or resection with curative intent. Larger, prospective studies are needed to validate these findings.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"9-16"},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/04/gr-16-009.PMC9990533.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437754","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}