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Clinical and Experimental Gastroenterology

Zohair Ahmed, Umair Ahmed, Saqib Walayat, Jinma Ren, Daniel K Martin, Harsha Moole, Sean Koppe, Sherri Yong, Sonu Dhillon
Background and aims: Many patients with liver disease come to medical attention once they have advanced cirrhosis or acute decompensation. Most often, patients are screened for liver disease via liver function tests (LFTs). There is very limited published data evaluating laboratory values with biopsy-proven stages of hepatic fibrosis. We set out to evaluate whether any correlation exists between routine LFTs and stages of hepatic fibrosis. Methods: A large retrospective observational study on 771 liver biopsies was conducted for evaluating the stage of fibrosis with AST, ALT, INR, BUN, creatinine, platelets, alkaline phosphatase, bilirubin, and albumin...
2018: Clinical and Experimental Gastroenterology
Aliya Ishaq, Muhammad Jamshaid Husain Khan, Turab Pishori, Rufina Soomro, Shadab Khan
Objectives: This study aimed to determine the change in anatomical location of appendix in full-term pregnancy. Study design: This was a descriptive cross-sectional study. Place and duration of study: Liaquat National University Hospital, Karachi, Pakistan, Department of General Surgery, January 01 to July 31, 2010. Patients and methods: Full-term pregnant women undergoing caesarean section were enrolled. The anatomical position of the appendix was noted by visual inspection with reference to the transtubercular plane (TTP)...
2018: Clinical and Experimental Gastroenterology
Kevin M Izquierdo, Ece Unal, John H Marks
Over the past 30 years, colorectal surgery has evolved to include minimally invasive surgical techniques. Minimally invasive surgery is associated with reduced postoperative pain, reduced wound complications, earlier return of bowel function, and possibly shorter length of hospital stay. These benefits have been attributed to a reduction in operative trauma compared to open surgery. The need to extract the specimen in colorectal operations through a "mini-laparotomy" can negate many of the advantages of minimally invasive surgery...
2018: Clinical and Experimental Gastroenterology
Emilie Aubry, Natalie Friedli, Philipp Schuetz, Zeno Stanga
Aging is linked to physiological and pathophysiological changes. In this context, elderly patients often are frail, which strongly correlates with negative health outcomes and disability. Elderly patients are often malnourished, which again is an independent risk factor for both frailty and adverse clinical outcomes. Malnutrition and resulting frailty can be prevented by adequate nutritional interventions. Yet, use of nutritional therapy can also have negative consequences, including a potentially life-threatening metabolic alteration called refeeding syndrome (RFS) in high-risk patients...
2018: Clinical and Experimental Gastroenterology
Matthew Fasullo, Yasir Al-Azzawi, Joan Kheder, Jeffrey Abergel, Wahid Wassef
Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the "step-up approach," which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution...
2018: Clinical and Experimental Gastroenterology
Gregorio Peron, Stefano Dall'Acqua, Vincenzo Sorrenti, Maria Carrara, Stefano Fortinguerra, Giulia Zorzi, Alessandro Buriani
Background: Lactose malabsorption is normally evaluated by measuring exhaled H2 produced by intestinal flora, from unabsorbed lactose. However, differing microbiome composition can lead to the production of CH4 instead of H2 ; hence, some authors challenge the H2 method sensitivity and favor the evaluation of both intestinal gases. Aim: To compare different approaches to usage of a lactose breath test for lactose malabsorption diagnosis, after medical evaluation of gastrointestinal symptoms...
2018: Clinical and Experimental Gastroenterology
Jennie T Grainger, Yasuko Maeda, Suzanne C Donnelly, Carolynne J Vaizey
Intestinal failure (IF) is a condition characterized by the inability to maintain a state of adequate nutrition, or fluid and electrolyte balance due to an anatomical or a physiological disorder of the gastrointestinal system. IF can be an extremely debilitating condition, significantly affecting the quality of life of those affected. The surgical management of patients with acute and chronic IF requires a specialist team who has the expertise in terms of technical challenges and decision-making. A dedicated IF unit will have the expertise in patient selection for surgery, investigative workup and planning, operative risk assessment with relevant anesthetic expertise, and a multidisciplinary team with support such as nutritional expertise and interventional radiology...
2018: Clinical and Experimental Gastroenterology
Deenaz Zaidi, Hien Q Huynh, Matthew W Carroll, Shairaz Baksh, Eytan Wine
Purpose: A significant feature of pediatric inflammatory bowel diseases (IBD), which include Crohn disease (CD), and ulcerative colitis (UC), is failure to suppress inflammation. The inability to regulate inflammation renders a major challenge toward establishing effective treatments in IBD. Nuclear factor kappa-light-chain-enhancer of activated B-cells-induced inflammation is inhibited by A20 through interactions with TAX1BP1 (Tax1-binding protein 1) and A20-binding inhibitor of NF-κβ activation (ABIN)-1 (A20 binding and inhibitor of NF-κβ) and upon phosphorylation by inhibitor of nuclear factor kappa-β kinase subunit beta (IKKβ), which stabilizes it...
2018: Clinical and Experimental Gastroenterology
David G Levitt, Michael D Levitt
Increased blood ammonia (NH3 ) is an important causative factor in hepatic encephalopathy, and clinical treatment of hepatic encephalopathy is focused on lowering NH3 . Ammonia is a central element in intraorgan nitrogen (N) transport, and modeling the factors that determine blood-NH3 concentration is complicated by the need to account for a variety of reactions carried out in multiple organs. This review presents a detailed quantitative analysis of the major factors determining blood-NH3 homeostasis - the N metabolism of urea, NH3 , and amino acids by the liver, gastrointestinal system, muscle, kidney, and brain - with the ultimate goal of creating a model that allows for prediction of blood-NH3 concentration...
2018: Clinical and Experimental Gastroenterology
Manish P Shrestha, Mark Borgstrom, Eugene Abraham Trowers
Background and aims: Initial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB. Patients and methods: We performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014...
2018: Clinical and Experimental Gastroenterology
Jonathan Philip Segal, Faisal Abbasi, Cynthia Kanagasundaram, Ailsa Hart
Introduction: The Internet has become an increasingly popular resource for medical information. Fecal microbiota transplantation (FMT) has changed the treatment of Clostridium difficile with cure rates of 81% following one infusion of FMT, further studies have since validated these findings. The Medicines and Health care Products Regulatory Agency has classified FMT as a medicine and hence should be only utilized in strict clinical settings. Methods: We searched Facebook, Twitter, Google, and YouTube using the words "Faecal Microbiota Transplantation" and "FMT"...
2018: Clinical and Experimental Gastroenterology
Frank L Lanza, Agron Collaku, Dongzhou J Liu
Background: While gastrointestinal (GI) effects of standard ibuprofen and N-acetyl-p-aminophenol (APAP) have been reported, upper GI injury following treatment with fast-dissolving (FD) formulations of these analgesics has not been investigated. We evaluated upper GI effects of over-the-counter doses of 2 FD ibuprofen products and 1 FD-APAP product. Methods: In a randomized, placebo-controlled, endoscopist-blinded, 4-way crossover study, 28 healthy subjects received FD ibuprofen 2×200 mg liquid capsules 3 times daily (TID), ibuprofen 2×200 mg tablets TID, FD-APAP 2×500 mg tablets 4 times daily (QID), and placebo 2×500 mg tablets QID for 7 days...
2018: Clinical and Experimental Gastroenterology
Jan Kubovy, Tom D Boswell, Guy Vautier, Malcolm M Arnold
Endoscopic variceal ligation (EVL) is an important treatment modality in managing complications of portal hypertension. Since its advent 30 years ago, the procedural complications have decreased significantly, especially when compared with variceal sclerotherapy. With the current widespread use of EVL, rare complications are now becoming increasingly recognized. We present a case of complete esophageal obstruction, its management, and clinical course. Our literature review identified only eight reported cases...
2018: Clinical and Experimental Gastroenterology
Yoshiharu Uno
Purpose: Variations in the caliber of human large intestinal tract causes changes in pressure and the velocity of its contents, depending on flow volume, gravity, and density, which are all variables of Bernoulli's principle. Therefore, it was hypothesized that constipation and diarrhea can occur due to changes in the colonic transit time (CTT), according to Bernoulli's principle. In addition, it was hypothesized that high amplitude peristaltic contractions (HAPC), which are considered to be involved in defecation in healthy subjects, occur because of cecum pressure based on Bernoulli's principle...
2018: Clinical and Experimental Gastroenterology
Alassan Kouamé Mahassadi, Justine Laure Konang Nguieguia, Henriette Ya Kissi, Anthony Afum-Adjei Awuah, Aboubacar Demba Bangoura, Stanislas Adjeka Doffou, Alain Koffi Attia
Background: Systemic inflammatory response syndrome (SIRS) and model for end-stage liver disease (MELD) predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis. Aim: This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization. Patients and methods: In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70...
2018: Clinical and Experimental Gastroenterology
Colin J Ireland, Andrea L Gordon, Sarah K Thompson, David I Watson, David C Whiteman, Richard L Reed, Adrian Esterman
Background: Esophageal adenocarcinoma is a disease that has a high mortality rate, the only known precursor being Barrett's esophagus (BE). While screening for BE is not cost-effective at the population level, targeted screening might be beneficial. We have developed a risk prediction model to identify people with BE, and here we present the external validation of this model. Materials and methods: A cohort study was undertaken to validate a risk prediction model for BE...
2018: Clinical and Experimental Gastroenterology
Joseph Mermelstein, Alanna Chait Mermelstein, Maxwell M Chait
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure...
2018: Clinical and Experimental Gastroenterology
Christopher B Nahm, Saxon J Connor, Jaswinder S Samra, Anubhav Mittal
Postoperative pancreatic fistula (POPF) remains the major cause of morbidity after pancreatic resection, affecting up to 41% of cases. With the recent development of a consensus definition of POPF, there has been a large number of reports examining various risk factors, prediction models, and mitigation strategies for this costly complication. Despite these strategies, the rates of POPF have not significantly diminished. Here, we review the literature and evidence regarding both traditional and emerging concepts in POPF prediction, prevention, and management...
2018: Clinical and Experimental Gastroenterology
Bhumit Patel, Vipul D Yagnik
Background/aims: As increasing numbers of Crohn's disease (CD) cases are being recognized in India, so the differential diagnosis of CD and gastrointestinal tuberculosis (GITB) is becoming increasingly important. If patients are misdiagnosed with GITB, toxicity may result from unnecessary anti-TB therapy and treatment of the primary disease (ie, CD) gets delayed. We therefore aimed to assess the accuracy of various parameters that can be used to predict GITB diagnosis at index evaluation...
2018: Clinical and Experimental Gastroenterology
Norikazu Watanabe, Masataka Suzuki, Yoshitake Yamaguchi, Yukari Egashira
It is well known that dietary fiber helps to relieve and prevent constipation, and there are a number of scientific papers, including systematic reviews and meta-analyses on the effects of naturally derived dietary fiber on bowel movements. In recent years, there has been an increase in the manufacture of dietary fiber ingredients obtained from food raw materials, and these are now commonly available in the market. Resistant maltodextrin (RMD), a soluble dietary fiber, is manufactured from starch, and industrially produced soluble dietary fiber is used worldwide...
2018: Clinical and Experimental Gastroenterology
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