Gastroenterology, Hepatology & Digestive Disorders最新文献

{"title":"Assessment of Suboptimal Bowel Preparation is Highly Variable among Physicians in The Same Practice and Not Associated with Their Adenoma Detection Rates","authors":"Susan M. Lou, Allison J. Levy, A. Shaukat, M. Kuskowski, S. Sultan, M. Levitt, A. Malhotra","doi":"10.33425/2639-9334.1049","DOIUrl":"https://doi.org/10.33425/2639-9334.1049","url":null,"abstract":"Introduction: Suboptimal colonic preparation adversely impacts the adenoma detection rate (ADR) and increases healthcare costs. Though a low threshold for categorizing the preparation as inadequate increases repeat colonoscopies, such fastidiousness could result in a higher quality colonoscopy. Our objectives were: 1) To examine the variability among colonoscopists in their bowel prep ratings and 2) To assess the correlation between suboptimal prep rate (SPR) and ADR. Methods: We conducted a retrospective analysis of all outpatient colonoscopies performed from 2013-2015 at the Minneapolis Veterans Affairs Medical Center. Data were coded by indication for colonoscopy and bowel prep grading (Aronchick Scale). Suboptimal bowel prep was defined as the sum of fair and poor prep grades. Suboptimal prep rates (SPR) per year were calculated for each endoscopist. A random sample of 50 screening colonoscopies/year with adequate prep was used to calculate each endoscopist’s ADR Results: There were 7125 colonoscopies performed by 10 endoscopists during the study period. Results showed large variability of SPR amongst endoscopists, ranging from 5% to 38% (p<0.001, chi-square). Logistic mixed model regression revealed that SPR (for each provider) was not a significant predictor of adenoma detection (OR=1.012 [95% CI: 0. 99-1. 03]; p=0.29). Discussion: The study demonstrates consistent major differences between individual endoscopists regarding the frequency of grading colonic preps as suboptimal. Based on ADR, strict interpretation of the adequacy of the prep did not translate into a more effective colonoscopy. Thus, training about what constitutes an adequate prep could reduce unnecessary repeat colonoscopies.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133264008","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":"Severe Transaminitis and Iron Deposition Induced by Anorexia Nervosa","authors":"Wilson Lee, Raymond E. Kim","doi":"10.33425/2639-9334.1048","DOIUrl":"https://doi.org/10.33425/2639-9334.1048","url":null,"abstract":"Introduction: Anorexia nervosa is associated with a vast amount of general medical complications caused by severe weight loss and malnutrition. Common complications from affected organ systems lead to many physiologic disturbances and multi-organ complications, but rarely severe transaminitis or iron deposition. We discuss a case report of severe transaminitis and iron deposition in a patient with anorexia nervosa. Case: 31 year old male presents to the ED with a history of altered mental status and found to have severe transaminitis. Introduction of nutrition lead to a quick downtrend in liver transaminases with eventual normalization. Additionally, iron deposition as seen in the liver of our patient. Discussion: Severely elevated transaminitis has been a rare complication of anorexia nervosa. Starvation induced autophagy has been a proposed mechanism. There has been one case report of hepatic iron deposition in a patient with anorexia nervosa. Iron deposition has been seen in starved mice livers with gluconeogenesis and alteration in iron homeostasis possibly playing a role.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133565712","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":"Glutamine as A Therapeutic Strategy in Inflammatory Bowel Diseases: A Systematic Review","authors":"Carlos Murilo Schanuel, E. N. Dias, A. P. Ferreira, K. Bertges, L. C. Bertges","doi":"10.33425/2639-9334.1033","DOIUrl":"https://doi.org/10.33425/2639-9334.1033","url":null,"abstract":"Introduction: Glutamine is a non-essential L-α-amino acid – a polar compound due to the presence of amide groups. It is involved in maintaining the intestinal mucosal barrier, acting on gene expression, cell proliferation, differentiation, apoptosis, oxidative action, and regulation of the immune system. Due to its importance to the endothelium, glutamine has been the subject of studies for the protection and preservation of the intestinal mucosa against atrophy, which is caused by inflammatory bowel disease. Objective: To verify the efficacy of glutamine in inflammatory bowel disease based on a systematic review. Methods: The most relevant studies in the MedLine databases were reviewed by including randomized controlled trials only. The search strategy used the following keyword combinations: “glutamine”; “inflammatory bowel disease”. To identify study designs, the following terms were used: “randomized controlled trial”, “humans”. Results: The scope of this review included six articles with controversies regarding the efficacy of glutamine in the treatment of inflammatory bowel disease. Each study used different dosages, methods of administration and duration of administration. Conclusion: According to the results, we concluded that glutamine supplementation in inflammatory bowel diseases does not cause patients any harm. Additionally, both intestinal permeability and modulation of immune and inflammatory response were improved, thus confirming the efficacy of glutamine in inflammatory bowel disease. Although these strategies are very promising and appear to be useful in some contexts, further clinical studies are needed to firmly establish the relevance of glutamine supplementation in inflammatory bowel disease. Thus, further research is needed to determine the optimal dosage, duration, route and method of administration for better use of this amino acid by the enterocytes and for maintaining homeostasis.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131643290","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":"Analgesic Safety of Periodic Intravenous Infusion of Acetaminophen After Hepatectomy: A Propensity Score Matching Analysis","authors":"M. Katayama, S. Koizumi, Shinjiro Kobayashi, K. Ashikawa, Kohei Segami, Atsuhito Tsuchihashi, Y. Ogura, T. Otsubo","doi":"10.33425/2639-9334.1038","DOIUrl":"https://doi.org/10.33425/2639-9334.1038","url":null,"abstract":"Background and Aim: Acetaminophen is an often-used analgesic for management of postoperative pain; it is not associated with hypomotility of the gastrointestinal tract or postoperative nausea and vomiting. It may, however, negatively affect liver function. Thus, acetaminophen is rarely used after hepatectomy and there are few studies pertaining to the analgesic safety of such use. We investigated the analgesic safety of periodic intravenous infusion of acetaminophen following hepatectomy. Patients and Methods: The study included 92 patients who had undergone hepatectomy without biliary reconstruction at St. Marianna University Hospital between January 2014 and November 2018. These patients were identified from among a larger group of patients, and propensity score matching allowed for the creation of two study groups: 46 patients who had undergone periodic intravenous infusion of acetaminophen for postoperative pain management (Group A), and 46 control patients who had undergone bolus injections of the non-steroidal antiinflammatory drug upon request (Group C). The two groups were then compared retrospectively in terms of clinical characteristics; operative variables; details regarding postoperative analgesia; concentrations of serum liver enzymes (total bilirubin [TBL], aminotransaminases aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP] and gamma-glutamyl transpeptidase [γGTP]) determined preoperatively, on postoperative days (PODs) 1, 3 and 7, and between PODs 14 and 28; and in-hospital outcomes and complications. Results: Patients’ clinical characteristics and operative variables did not differ between the two groups. Of the liver enzymes, only the serum γGTP concentrations observed on POD 7 and POD 14 differed significantly (p=0.003 and p=0.017, respectively). No patient suffered CTCAE Grade ≥ 3 hepatic failure, and there was no mortality. Conclusion: Results of our study indicate that periodic intravenous infusion of acetaminophen after hepatectomy is a safe means of managing patients’ postoperative pain.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130803937","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":"Validation of Hepatoma Arterial Embolization Prognostic (HAP) Score in Egyptian Patients with Hepatocellular Carcinoma","authors":"M. Kohla, Gasser El Azab, A. Gomaa, Mohamed Abbasy, M. Abozeid, Asmaa Abdelhaie, M. Abdelgawad","doi":"10.33425/2639-9334.1032","DOIUrl":"https://doi.org/10.33425/2639-9334.1032","url":null,"abstract":"Background: Hepatoma Arterial Embolization prognostic (HAP) score has recently emerged as an overall survival predictor for hepatocellular carcinoma (HCC) patients after treatment with transarterial chemoembolisation (TACE). It depends on serum bilirubin, albumin, alpha-fetoprotein (AFP) and tumor size. We evaluated the utility and validity of HAP score in a cohort of Egyptian patients with HCC who underwent TACE. Methods: Our study included 416 Egyptian patients with HCC who underwent TACE at National Liver institute, Menoufia University, Egypt from January 2013 to May 2015. Child-Turcotte-Pugh (CTP), BCLC Staging as well as HAP score were calculated. Overall survival was assessed with a minimum follow up period of 12 months. Results: Patients were mainly males (83.7 %) with a mean age of 58 ± 8.1 years, 267 (64.9%) patients had Child A cirrhosis, 143 (34.7%) had Child B cirrhosis and only one (0.2%) patient had Child C cirrhosis. Ten patients (2.4%) were in BCLC stage 0, 63 patients (15.1%) were in BCLC stage A, 335 patients (80.5%) were in BCLB stage B, 7 patients (1.7%) were in BCLC stage C and only one patient (0.2%) was in BCLC stage D. Fifty-one patients (12.3%) had a HAP score of 0, 129 (31%) had a score of 1, 164 (39.4%) had a HAP score of 2 and 72 (17.3%) had a HAP score of >2. Patients with HAP 0, HAP 1, HAP 2 and HAP >2 had a median survival of 53, 23, 22, 14 months respectively, showing a significantly shorter survival with more advanced score. Survival probability was 37.2%, 26.1%, 9.2% and 7.3% for patients with HAP score 0, 1, 2 and >2 respectively, with a P value 0.001. Conclusion: HAP score is useful in survival prediction after TACE in HCC patients and can be used for proper patient selection to improve outcome after TACE.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122449588","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":"The Co-existence of Celiac Disease and Neurofibromatosis Type 1 in an African-American Child","authors":"R. Mones, Kalpana Singh, I. Fennoy","doi":"10.33425/2639-9334.1035","DOIUrl":"https://doi.org/10.33425/2639-9334.1035","url":null,"abstract":"A 7-year-old African-American (AA) boy with Neurofibromatosis type l (NF l) was seen in the pediatric endocrine clinic for developing breast buds. It was noted that his growth had been decelerating for the previous several years. Investigations for his growth failure included serologic screening for CD. This was abnormal and biopsies of the duodenum were consistent with CD. This is the first pediatric case of the association of NF l and CD reported in a pediatric patient. Both diseases may cause growth failure. Furthermore, the incidence of CD in AA is very uncommon as compared to Caucasians. CD should be considered in AA with symptoms of CD.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134116024","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":"Seroprevalence of Hepatitis B Virus in Pregnant Women in Pointe-Noire","authors":"P. AhouiApendiC, A. ItouaNgaporoN, A. MongoOnkouo, Agounda Bm, F. MimiesseMonamouJ, Nziengue M'vouala Jb, R. Ngami, M. GalessamiMouakosso, D. Gassaye, Atipo Ibara Bi","doi":"10.33425/2639-9334.1037","DOIUrl":"https://doi.org/10.33425/2639-9334.1037","url":null,"abstract":"Objective: To characterize the epidemiological profile of HBV infection in women pregnant in Pointe-Noire. Patients and Methods: This was a descriptive cross-sectional study conducted in Pointe-Noire over a 6-month period. The study concerned pregnant women received in antenatal care in some hospitals in the city. Screening for HBsAg was performed using two tests, namely the HbsAg immunochromatographic test and the fourth generation ELISA. The socio-demographic factors of the study population as well as the risk factors for transmission of the virus were studied. Results: During the study, 150 pregnant women were enrolled. The average age was 27.22 +/6.10 years old. The most represented age group was 25 to 35 years old. The majority of women were common-law, had a college-level education, were unemployed and consulted from the second trimester of pregnancy. Scarification was the most important risk factor in 52% of cases. Immunization coverage was low, around 3.33%. The frequency of HBsAg was 2.67%. Infection predominated in scarified women, women in middle school, and women in common-law unions. However, no significant difference was found between this biological marker and the study variables.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115566588","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":"Genotypes of The Hepatitis B Virus in Congo-Brazzaville","authors":"A. Clausina, Angala Andzi Jenny Carmela, Mongo Onkouo Arnaud, Itoua Ngaporo Ngala Akoa, M. Florent, N. Stéphane, N. Marlyse, Adoua Céline Sandra, D. Gassaye, Atipo Ibara Blaise Irénée, Ibara Jean Rosaire","doi":"10.33425/2639-9334.1036","DOIUrl":"https://doi.org/10.33425/2639-9334.1036","url":null,"abstract":"Introduction: The hepatitis B virus (HBV) is characterized by significant genotypic heterogeneity. Circulating genotypes in Congo are not all known. The purpose of this work is to establish a national genotypic mapping of HBV. Patients and Methods: Descriptive, cross-sectional study carried out in the blood transfusion centers and integrated health centers of the Congo departments, from 1 January 2010 to 31 December 2016. Asymptomatic, blood donor or consulting patients formed the study population. The search for HBsAg was carried out by rapid tests, supplemented by a discriminatory screening test by the ELISA technique ; then detection of the HBV viral DNA by nested PCR on the HBPol region of the PreS1 / PreS2 / HBsAg domains of the S gene, using the HBPr1 / HBPr135 and HBPr2 / HBPr3 primer pairs and determination of the genotypes by sequencing from PCR product. Results: A total of 3017 patients with mean age of 39 +/16 years were included, including 1576 men and 1440 women. Of these, 379 (12.5%) were positive for HBsAg. Of these 379 samples submitted to the molecular study, 321 (84%) were positive for HBV viral DNA. The genotypes found were genotype E (n = 207, 54.6%), A (n = 88, 23.2%), D (n = 4, 1%), B (n = 1, 0.3). %), B / C (n = 1, 0.3%) and C (n = 1, 0.3%). In 19 cases (5%) the genotype could not be determined. The identified subgenotypes were A3 and A6 for genotype A and D7 for genotype D. The distribution of genotypes was almost homogeneous across all departments. Genotype D was only identified in one department, as were genotypes B and C in only one other department. Conclusion: Genotypes E and A are the most common in our country. The presence of genotypes D, B and C is probably related to population migrations. Subgenotypes A3, A6 and D7 were the only ones identified in our work.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128190642","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":"Acute Liver Failure Precipitated by Diffuse Liver Infiltration of Metastatic Breast Cancer: A Case Report","authors":"M. Hallal, Hiba Achour, M. Mansour","doi":"10.33425/2639-9334.1026","DOIUrl":"https://doi.org/10.33425/2639-9334.1026","url":null,"abstract":"","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116438881","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":"Effectiveness of Azathioprine in Maintaining Remission in Crohn's Disease: A Systematic Review","authors":"Marcella Correa da Silva Coelho, A. Botelho, P. Bruno, Monique Fernandino Dias, L. C. Bertges, E. Bertges, A. P. Ferreira","doi":"10.33425/2639-9334.1030","DOIUrl":"https://doi.org/10.33425/2639-9334.1030","url":null,"abstract":"Objective: To use a systematized review to determine the effectiveness of azathioprine in maintaining remission in Crohn's disease. Method: This study is a systematic review of the literature based on a bibliographic survey having the US National Library of Medicine (PubMed) data collection as the investigative source. The survey was delimited between January 2018 and May 2018 with the following descriptive terms: \"Azathioprine\" AND \"Crohn's disease\". The inclusion criteria were as follows: original articles, experimental models in humans, published either in English or Portuguese. All studies that did not meet the inclusion criteria and those that did not address the scope of this research were excluded. The information was selected according to its relevance and separated into themes that would allow a more didactic interpretation of the results. Results: A total of forty studies were evaluated, of which 28 were excluded and 12 were made part of this review. Azathioprine has been effective in the sustained remission of the disease in most cases, especially in moderate to severe patients. A total of 378 patients were assessed. Conclusion: Azathioprine has shown to be an effective therapy, indicated for the maintenance of remission in refractory (corticosteroid-dependent) and recurrent cases of moderate to severe patients. The patient and the disease should be stratified and treated individually. Treatment of Crohn's disease is complex, and in many cases patients cannot return to their normal daily activities.","PeriodicalId":211573,"journal":{"name":"Gastroenterology, Hepatology & Digestive Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134260841","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}