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Gastroenterology Report

Shailendra Singh, Monica Chowdhry, Shifa Umar, Mohammad Bilal, Kofi Clarke
Background and aims: With expanding available treatment options and evolving understanding of the risks and benefits of medical therapies for inflammatory bowel disease (IBD), there is the possibility of significant variations in treatment and outcomes. Little is known about the variation in treatment between IBD specialists and other gastroenterology (GI) physicians. Evaluating possible variations is an important first step to help address standardized care and optimize treatment. We studied the differences in use of biologics and immunomodulators in the management of IBD patients at a tertiary care hospital between IBD-trained physicians and other gastroenterologists...
February 2018: Gastroenterology Report
Wenjie Ma, Yongqiong Tan, Anuj Shrestha, Fuyu Li, Rongxing Zhou, Junke Wang, Haijie Hu, Qin Yang
Objective: To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst (CC). Methods: The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively. Among them, 171 underwent Roux-en-Y hepatico-jejunostomy with complete resection (PBD 0-cm group) and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left (PBD 1-cm group)...
February 2018: Gastroenterology Report
Jayanta Paul, Raj Vigna Venugopal, Lorance Peter, Shihaz Hussain, Kula Naresh Kumar Shetty, Mohit P Shetti
Background and aims: Non-alcoholic fatty liver disease (NAFLD) is remarkably increasing in developing countries like India, in parallel with the increasing incidence of obesity. Lifestyle modification is a recommended treatment for NAFLD. In most of the previous studies, improvement after lifestyle modification was assessed by liver fibrosis through liver biopsy, but we cannot do a serial liver biopsy in every NAFLD patient. Liver fibrosis can also be assessed by fibroscan non-invasively in NAFLD...
February 2018: Gastroenterology Report
Abhinav Koul, Anand C Baxi, Ruilian Shang, Xianmei Meng, Lianyong Li, Steven A Keilin, Field F Willingham, Qiang Cai
Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has become the preferred method to diagnose pancreatic masses due to its minimally invasive approach and diagnostic accuracy. Many studies have shown that rapid on-site evaluation (ROSE) improves diagnostic yield by 10-30%; however, more recent studies have demonstrated effective diagnostic accuracy rates without ROSE. Our study aims to examine whether the current standard of performing ROSE after each FNA pass adds diagnostic value during EUS-guided FNA of pancreatic masses...
February 2018: Gastroenterology Report
Tingbin Xie, Tenghui Zhang, Chao Ding, Xujie Dai, Yi Li, Zhen Guo, Yao Wei, Jianfeng Gong, Weiming Zhu, Jieshou Li
Background: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Mayo Endoscopic Score (MES) were developed as an objective method of the endoscopic severity in ulcerative colitis (UC); however, it was still unclear whether UCEIS vs MES could guide the need for colectomy in acute severe colitis (ASC). Methods: Consecutive ASC patients between January 2012 and May 2016 were retrospectively evaluated. Demographic data, previous therapy, clinical observations, laboratory parameters, medical therapy and endoscopic assessments were documented...
February 2018: Gastroenterology Report
Guosheng Wu, Ruy J Cruz
Background and aims: A co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx). Methods: Between May 2000 and May 2010, 212 adult patients undergoing LITx ( n  =76) and LETx ( n  =136) were included...
February 2018: Gastroenterology Report
Roy J Hopkins, Robert B Wilson
Clostridium difficile is a gram-positive, spore-forming, obligate anaerobic bacillus that was originally isolated from the stool of a healthy neonate in 1935. In high-income countries, C. difficile is the most common cause of infectious diarrhoea in hospitalized patients. The incidence of C. difficile infection in the USA has increased markedly since 2000, with hospitalizations for C. difficile infections in non-pregnant adults doubling between 2000 and 2010. Between 20% and 35% of patients with C. difficile infection will fail initial antibiotic treatment and, of these, 40-60% will have a second recurrence...
February 2018: Gastroenterology Report
Hirsh D Trivedi, Elliot B Tapper
Cirrhosis is associated with debilitating complications that significantly impact on a patient's physical function and reduce quality of life. Owing to highly prevalent sarcopenia, malnutrition and hepatic encephalopathy, functional impairment or frailty is a common complication of cirrhosis. Frailty in turn increases the patient's risk of hospitalization, accidental falls and fractures, and death. The management of frailty and its associated adverse effects is imperative in improving the overall prognosis of patients with advanced liver disease...
February 2018: Gastroenterology Report
Shaomin Zou, Lekun Fang, Mong-Hong Lee
Gastrointestinal microbiome, containing at least 100 trillion bacteria, resides in the mucosal surface of human intestine. Recent studies show that perturbations in the microbiota may influence physiology and link to a number of diseases, including colon tumorigenesis. Colorectal cancer (CRC), the third most common cancer, is the disease resulting from multi-genes and multi-factors, but the mechanistic details between gut microenvironment and CRC remain poorly characterized. Thanks to new technologies such as metagenome sequencing, progress in large-scale analysis of the genetic and metabolic profile of gut microbial has been possible, which has facilitated studies about microbiota composition, taxonomic alterations and host interactions...
February 2018: Gastroenterology Report
Xuanhui Liu, Xianrui Wu, Chi Zhou, Tuo Hu, Jia Ke, Yufeng Chen, Xiaosheng He, Xiaobin Zheng, Xiaowen He, Jiancong Hu, Min Zhi, Xiang Gao, Pinjin Hu, Xiaojian Wu, Ping Lan
Objective: The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intra-abdominal septic complications (IASCs) after primary anastomosis for patients with Crohn's disease (CD). Methods: All CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled. The association of preoperative hypoalbuminemia (<30 g/L) with the risk for IASCs were assessed using both univariate and multivariate analyses...
November 2017: Gastroenterology Report
Kanthi Rekha Badipatla, Preeti Jadhav, Sushma Vaddigiri, Bharat Bajantri, Amandeep Singh, Chaitanya Chandrala, Vijay S Are, Suresh Kumar Nayudu
Background: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes mellitus requiring aggressive medical management. We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding (AGIB) and acute upper AGIB (AUGIB) in patients with DKA. Methods: We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015. We collected demographic, clinical, laboratory, endoscopy and hospitalization details using an electronic medical-record database...
November 2017: Gastroenterology Report
Xiwen Ye, Xianze Xiong, Nansheng Cheng, Jiong Lu, Yixin Lin
Background: In paragonimiasis, the lungs and pleural cavity are the major target organs, and the central nervous system can also be affected. The liver is an organ in which ectopic paragonimiasis rarely occurs. Because the symptoms and examinations in hepatic paragonimiasis (HP) are not typical, the disease is often misdiagnosed in the clinic. Methods: From February 2008 to March 2015, our department accepted 32 patients who presented with a liver mass upon ultrasound and computed tomography imaging and in whom the source of the mass could not be identified upon numerous further diagnostic tests...
November 2017: Gastroenterology Report
Xulong Sun, Pengzhou Li, Xiangwu Yang, Weizheng Li, Xianjie Qiu, Shaihong Zhu
Obesity has become a major global health problem, epitomized by excess accumulation of body fat resulting from an imbalance between energy intake and expenditure. The treatments for obesity range from modified nutrition and additional physical activity, to drugs or surgery. But the curative effect of each method seems to vary between individuals. With progress in the genetics and epigenetics of obesity, personalization of the clinical management of obesity may be at our doorstep. This review presents an overview of our current understanding of the genetics and epigenetics of obesity and how these findings influence responses to treatments...
November 2017: Gastroenterology Report
Guosheng Wu
Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region. Ex vivo surgery followed by intestinal autotransplantation (IATx) is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances. This review aims to assess potential surgical indications, operative techniques and clinical outcomes after IATx...
November 2017: Gastroenterology Report
Peilin Zhang, Lawrence M Minardi, J Todd Kuenstner, Rusty Kruzelock
We have cultured Mycobacteria avium subspecies hominissuis (MAH) from the blood of a patient with Crohn's disease. The patient is a 21 year-old-female with a diagnosis of Crohn's disease for two years. She had been treated with corticosteroids and Humira for six months. A blood specimen was cultured in a specialized medium, and there was visible bacterial growth present in the liquid culture medium after eight weeks. PCR analysis of the bacterial growth and subsequent direct sequencing of the PCR amplicon confirmed the presence of MAH...
November 2017: Gastroenterology Report
Federico P Quirante, Lisandro M Montorfano, Federico Serrot, Mary E Billington, Giovanna Da Silva, Emanuele Lo Menzo, Samuel Szomstein, Raul J Rosenthal
Right lower quadrant pain is a symptom with an exceptionally broad differential diagnosis. Intussusception of the appendix is a very uncommon condition with many manifestations. Additionally, the pathologic finding of ectopic presence of a mixture of at least two mullerian-derived tissue components is rare. This report presents the case of a 49-year-old woman who presented twice with acute right lower abdominal pain. Diagnosis of appendiceal inversion was made surgically. Pathologic examination of the specimen identified extensive endometriosis, endosalpingiosis and endocervicosis of the colon wall...
November 2017: Gastroenterology Report
Custon T Nyabanga, Geeta Kulkarni, Bo Shen
Hyperbaric oxygen therapy (HBOT) has been shown to be efficacious in treating various conditions, including perianal Crohn's disease. Here we present a case of a 59-year-old male with a history of ulcerative colitis, who underwent a total proctocolectomy and two-stage J-pouch construction. He later developed chronic antibiotic-refractory pouchitis with endoscopic features of ischemia. At the completion of HOBT-a total of 20 sessions of 100% oxygen at 2.5-3.0 atmospheres absolute for 60-90 minutes per session-a repeat pouchoscopy showed marked improvement of endoscopic mucosal inflammation...
November 2017: Gastroenterology Report
Min Chen, Erick M Remer, Xiuli Liu, Rocio Lopez, Bo Shen
Background and aims: The differential diagnosis between Crohn's disease (CD) and ischemic colitis (ISC) is important as their clinical management is different. ISC can easily be misdiagnosed as CD, especially in elderly populations. The distinctive radiographic features of the two disease entities have not been investigated. The aim of this study is to assess the utility of computed tomographic enterography (CTE) in the differential diagnosis between CD and ISC. Methods: Patients with confirmed CD and ISC were identified through an electronic medical record search of the Cleveland Clinic Foundation...
August 2017: Gastroenterology Report
Victoria Ekstrom, Rajneesh Kumar, Yi Zhao, Mei Ling Yee, Cynthia Sung, Dorothy Toh, Poh Yen Loh, Jessica Tan, Eng Kiong Teo, Wan Cheng Chow
Background and aim: Conventional hepatitis C treatment using pegylated interferon (PEG-IFN) and ribavirin is associated with significant side effects. IL28B polymorphism can predict response to treatment, with CC genotype having a better response. ITPA gene deficiency protects against clinically significant anaemia induced by treatment. The purpose of this study was to determine IL28B polymorphism and ITPA variation among hepatitis C genotype 1 patients who have undergone therapy with PEG-IFN and ribavirin and their association with sustained viral response (SVR)...
August 2017: Gastroenterology Report
Nan Lan, Jean Ashburn, Bo Shen
Background: Clostridium difficile infection (CDI) in patients with ileal pouch-anal anastomosis (IPAA) has been increasingly recognized. The aim of this study was to evaluate the outcome of fecal microbiota transplantation (FMT) in patients with pouch and CDI. Methods: All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved, prospectively maintained Registry of Pouch Disorders. The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses...
August 2017: Gastroenterology Report
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