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Journal of Clinical Gastroenterology

David I Fudman, Konstantinos Papamichael, Lilach Roemi, Varun Rao, Kenneth R Falchuk, Daniel A Leffler, Joseph D Feuerstein
BACKGROUND AND AIMS: Informed consent is a vital preprocedural step for endoscopy but there are substantial variations in its delivery. We therefore sought to assess a multifaceted intervention to improve the consent process. METHODS: Gastroenterologists at a tertiary center were educated on the recommended components of informed consent. Following this, 3 cohorts of patients undergoing colonoscopy were surveyed before and after consent. In one cohort, the effect of optimized verbal consent alone was assessed...
July 11, 2018: Journal of Clinical Gastroenterology
Livia Archibugi, Marianna Signoretti, Gabriele Capurso
Many risk factors for pancreatic cancer are related with microbiome alteration. In the past few years, the human microbiome and its relation with the immune system have been linked with carcinogenesis of different organs distant from the gut, including the pancreas. Patterns of oral microbiome associated with periodontitis are associated with an increased risk of pancreatic cancer, possibly because of the increased systemic inflammatory response, or to the capacity of some specific bacteria to alter the host immune response, making it more favorable to cancer cells...
July 11, 2018: Journal of Clinical Gastroenterology
Hyo-Joon Yang, Dong Il Park, Soo-Kyung Park, Sunyong Kim, Taeheon Lee, Yunho Jung, Chang Soo Eun, Dong Soo Han
GOALS: The goal of this study was to evaluate the noninferiority of colonoscopic enema to additional oral preparation in salvage bowel cleansing for inadequate preparation for a morning colonoscopy. BACKGROUND: Colonoscopic enema, administering additional cathartics into the right colon through the colonoscope accessory channel, is suggested to rescue poor bowel preparation for a colonoscopy but lacking comparative study. STUDY: In this prospective, randomized, actively-controlled, parallel group, noninferiority trial, consecutive outpatients and health checkup recipients aged from 19 to 70 years with inappropriate bowel preparation during an elective colonoscopy were enrolled to receive either a colonoscopic enema of 1 L polyethylene glycol (PEG) (enema group) or additional oral intake of 2 L PEG (oral group)...
July 11, 2018: Journal of Clinical Gastroenterology
Neehar D Parikh, Yu-Hui Chang, Elliot B Tapper, Amit K Mathur
INTRODUCTION: The population of patients with cirrhosis is growing and shifting toward a more elderly demographic and thus are at risk of developing orthopedic complications. There is lack of data on safety of orthopedic procedures in this population. METHODS: We performed an analysis of the Nationwide Inpatient Sample from 2005 to 2011 for patients undergoing hip arthroplasty, knee arthroplasty, and spinal laminectomy/fusion, stratified by presence of cirrhosis...
July 11, 2018: Journal of Clinical Gastroenterology
James S Leathers, Domingo Balderramo, John Prieto, Fernando Diehl, Esteban Gonzalez-Ballerga, Melina R Ferreiro, Enrique Carrera, Fernando Barreyro, Javier Diaz-Ferrer, Dupinder Singh, Angelo Z Mattos, Flair Carrilho, Jose D Debes
GOALS: We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America. BACKGROUND: Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America. STUDY: We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017...
June 26, 2018: Journal of Clinical Gastroenterology
Thomas R McCarty, Tarun Rustagi
BACKGROUND AND AIMS: Although argon plasma coagulation (APC) is the current standard endoscopic treatment for gastric antral vascular ectasia (GAVE), radiofrequency ablation (RFA) has emerged as an attractive alternative. The aim of this study was to perform a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of RFA and APC in the treatment of GAVE. MATERIALS AND METHODS: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases along with major gastroenterology annual meetings were performed through March 2017...
June 26, 2018: Journal of Clinical Gastroenterology
Nam Hee Kim, Yoon Suk Jung, Jung Ho Park, Dong Il Park, Chong Il Sohn
GOALS: We aimed to ascertain whether waist circumference (WC) is associated with risk of colorectal neoplasia (CRN), independent of body mass index (BMI). BACKGROUND: Although several studies have reported the association between abdominal obesity, measured by WC, and CRN, it remains unclear whether their association is biased by BMI. STUDY: A cross-sectional study was performed on 154,552 asymptomatic examinees who underwent colonoscopy for a health check-up...
June 22, 2018: Journal of Clinical Gastroenterology
Denise Strijbos, Daniel Keszthelyi, Roel M M Bogie, Lennard P L Gilissen, Martin Lacko, Janneke G J Hoeijmakers, Christiaan van der Leij, Rogier de Ridder, Michiel W de Haan, Ad A M Masclee
BACKGROUND: The optimal technique for long-term enteral feeding has not yet been established. Both percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are widely used. Aim was to extensively review outcomes of PEG and PRG. MATERIALS AND METHODS: A systematic review using Medline, Embase, and Cochrane was performed, using standardized tools for assessing bias. Main outcomes were infectious and tube-related complications, procedure related and 30-day mortality...
June 19, 2018: Journal of Clinical Gastroenterology
Anu Haaramo, Heikki Alapulli, Liisa Aine, Jetta Tuokkola, Ulla Saarnisto, Risto P Roine, Anne Pitkäranta, Kaija-Leena Kolho
BACKGROUND: Up to 50% of pediatric patients with Crohn's disease (CD) report oral manifestations, but less is known about their oral health when they become adults. GOALS: Our aim was to provide detailed descriptions of the presence of oral and otorhinolaryngological manifestations in patients with pediatric onset CD once they reached adulthood, to look for predisposing factors and to compare the findings to matched controls. STUDY: Adult patients diagnosed with CD in childhood at the Children's Hospital, University of Helsinki, Finland, after 2000 were invited for a follow-up appointment in 2016 and 24 were examined by a dentist and otorhinolaryngologist...
June 16, 2018: Journal of Clinical Gastroenterology
Elizabeth Aby, Jennifer Phan, Emily Truong, Jonathan Grotts, Sammy Saab
BACKGROUND: Nonalcoholic steatohepatitis (NASH) is a common cause of liver disease which can progress to cirrhosis and hepatocellular carcinoma (HCC). American Association for the Study of Liver Diseases (AASLD) guidelines recommend abdominal ultrasound, with or without serum alpha-fetoprotein, every 6 months for HCC surveillance in cirrhotic patients. GOALS: Describe HCC surveillance rates in NASH cirrhosis compared with hepatitis C (HCV) cirrhosis and the impact of surveillance on tumor size, treatment, and mortality...
June 16, 2018: Journal of Clinical Gastroenterology
Barbara Wlodarczyk, Anita Gasiorowska, Ewa Malecka-Panas
New-onset diabetes mellitus (DM) is one of the first symptoms of pancreatic adenocarcinoma (PDAC). The frequency of endocrine disorders is estimated between 40% and 80% in patients with pancreatic cancer. DM is a risk factor for cancer development but it may also be a consequence of the tumor growth. Data confirming the existence of a relationship between long standing type 2 DM and an increased risk of PDAC comes from numerous clinical studies. Insulin resistance phenomenon and hyperinsulinemia may result in the increased proliferation of pancreatic islets which in turn may cause a predisposition to cancer development...
June 16, 2018: Journal of Clinical Gastroenterology
Calvin Q Pan, Benjamin C Tiongson, Ke-Qin Hu, Steven-Huy B Han, Myron Tong, Danny Chu, James Park, Tai Ping Lee, Kalyan Ram Bhamidimarri, Xiaoli Ma, Pei Ying Xiao, Smruti R Mohanty, Dan Wang
BACKGROUND: Limited data exist with regard to treatment outcomes in Asian Americans with chronic hepatitis C (CHC). We evaluated sofosbuvir (SOF)-based regimens in a national cohort of Asian Americans. METHODS: Eligible Asian Americans patients with CHC who had posttreatment follow-up of 24 weeks for SOF -based therapies from December 2013 to June 2017 were enrolled from 11 sites across the United States. The primary endpoint was sustained virologic response (SVR) rates at posttreatment weeks 12 and 24...
June 16, 2018: Journal of Clinical Gastroenterology
Muhammad Ali Khan, Zubair Khan, Claudio R Tombazzi, Chiranjeevi Gadiparthi, Wade Lee, C Mel Wilcox
BACKGROUND: Endoscopic retrograde cholangiography and endoscopic sphincterotomy (ES) with subsequent cholecystectomy is the standard of care for the management of patients with choledocholithiasis. There is conflicting evidence in terms of mortality reduction, prevention of complications specifically biliary pancreatitis and cholangitis with the use of early cholecystectomy particularly in high-risk surgical and elderly patients. AIMS: We conducted this systematic review and meta-analysis of randomized controlled trials to compare the early cholecystectomy versus wait and watch strategy after ES...
June 16, 2018: Journal of Clinical Gastroenterology
Chu Kion Yao, James Fung, Natural Hoi Sing Chu, Victoria Ping Yi Tan
Liver cirrhosis is associated with significant nutritional risks that often result in serious hepatic complications and poor survival rates. Diet is an important but underutilized aspect in the treatment modality of cirrhosis. Therefore, the aims of this review are to ascertain nutritional risks associated with its pathophysiology and to summarize existing evidence that support dietary recommendations for managing this patient population. Alterations in substrate utilization for energy production is a main feature of liver cirrhosis, resulting in increased catabolism of protein stores and a predisposition toward protein-energy malnutrition, even in the early stages of the disease...
June 16, 2018: Journal of Clinical Gastroenterology
Jennifer Phan, Vivian Ng, Alan Sheinbaum, Sam French, Gina Choi, Mohamed El Kabany, Francisco Durazo, Sammy Saab, Myron Tong, Ronald Busuttil, Steven-Huy Han
BACKGROUND: Hepatocellular carcinoma (HCC) accounts for 90% of primary hepatic malignancies. With the exception of chronic hepatitis B (CHB), other etiologies of chronic liver disease require progression to cirrhosis before HCC development. Case reports have described HCC in noncirrhotic patients with hepatitis C (HCV) and nonalcoholic fatty liver disease. GOAL: The aim of this study was to determine the prevalence of patients without cirrhosis and CHB who developed HCC among a large cohort of HCC patients and to identify independent variables that are associated with no cirrhosis among patients with HCC...
June 16, 2018: Journal of Clinical Gastroenterology
Gianenrico Rizzatti, Gianluca Ianiro, Antonio Gasbarrini
Recently new insights on gut microbiota have revolutionized many concepts of the modern medicine. The alteration of microbiota, which is called dysbiosis, has been associated with an expanding list of diseases and conditions. The development of next-generation sequencing techniques allowed comprehensive analysis of gut microbiota composition without the limitations of classic culture methods. Furthermore, introduction of functional techniques such as metabolomics and proteomics allowed for integrated analysis thus obtaining more robust insights on microbiota functions in health and disease...
June 16, 2018: Journal of Clinical Gastroenterology
Ting Ji, Xueliang Li, Xiangcheng Zhang, Liangliang Hui, Futai Shang, Xingxing Zhu, Lili Guo, Yiming Xu
BACKGROUND: Computed tomography-measured visceral adipose tissue (VAT) and the distribution of VAT are highly correlated with the severity and prognosis of acute pancreatitis (AP). To date, all available data are from the overall AP patient population; no subgroup analysis has been conducted to evaluate patients with moderately severe AP or patients with hyperlipidemia acute pancreatitis (HLAP) as independent populations. Currently, studies on the relationship between VAT and HLAP are lacking...
June 16, 2018: Journal of Clinical Gastroenterology
Ann E Almazar, Joseph Y Chang, Joseph J Larson, Elizabeth J Atkinson, G Richard Locke, Nicholas J Talley, Yuri A Saito
GOALS: To evaluate agreement of MCM6-13910 with self-report of dairy sensitivity (DS) and lactose hydrogen methane breath test (LHMBT) results in subjects with irritable bowel syndrome (IBS). BACKGROUND: IBS is a functional gastrointestinal disorder with symptoms including abdominal pain, variable bowel habits, and bloating. Adult patients with lactose malabsorption may present with similar symptoms. Patients with lactose malabsorption have a lactase nonpersistent (LNP) phenotype...
June 16, 2018: Journal of Clinical Gastroenterology
Jie Chen, Jian Hua Wan, Dang Yan Wu, Wen Qing Shu, Liang Xia, Nong Hua Lu
BACKGROUND: It is generally accepted that precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of pancreatitis. However, patients with difficult biliary access may be different. We implemented a meta-analysis to explore the effects of early and delayed precut sphincterotomy on post-ERCP pancreatitis in patients with difficult biliary access. METHODS: We searched studies in PubMed, EMBASE, and the Cochrane Central Register of Randomized Controlled Trials for meeting requirement in which precut sphincterotomy was compared with persistent standard cannulation during ERCP...
June 16, 2018: Journal of Clinical Gastroenterology
Prashant Singh, Ananya Arora, Tor A Strand, Daniel A Leffler, Markku Mäki, Ciaran P Kelly, Vineet Ahuja, Govind K Makharia
GOALS: To perform a systematic review and meta-analysis to estimate the overall diagnostic accuracy of point of care tests (POCTs) for diagnosing celiac disease (CD). BACKGROUND: Recently, POCTs for CD have been developed and are commercially available. Studies have reported significant variability in their sensitivity (70% to 100%) and specificity (85% to 100%). STUDY: We searched MEDLINE, EMBASE databases, and the Cochrane library through June 2017...
June 16, 2018: Journal of Clinical Gastroenterology
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