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By Jeff Bank Internal Medicine R2 at the University of Utah
Laura Targownik
Proton pump inhibitors (PPIs) are among the most widely used class of drugs prescribed over the long term in all of clinical medicine with 8-10% of ambulatory adults have been prescribed a PPI in the past 30 days. However, numerous studies have raised doubts about the long term safety of PPI use. The purpose of this review is threefold: (i) To provide an overview of the current evidence demonstrating associations between PPI use and adverse health outcomes and the likelihood of the associations being causal (Why?); (ii) To be able to identify long-term PPI users in whom the intensity of PPI therapy could be reduced or in whom PPIs could be eliminated outright (Who?); and (iii) To provide strategies on how to reduce or stop chronic PPI therapy while maintaining symptom control and reducing the risk for symptom or upper GI disease recurrence (How?)...
March 20, 2018: American Journal of Gastroenterology
Christopher V Almario, Brennan M R Spiegel
No abstract text is available yet for this article.
April 2018: Clinical Gastroenterology and Hepatology
Seth Crockett, Yngve Falck-Ytter, Sachin Wani, Timothy B Gardner
No abstract text is available yet for this article.
March 2018: Gastroenterology
Brian E Lacy, Henry P Parkman, Michael Camilleri
Nausea is an uneasy feeling in the stomach while vomiting refers to the forceful expulsion of gastric contents. Chronic nausea and vomiting represent a diverse array of disorders defined by 4 weeks or more of symptoms. Chronic nausea and vomiting result from a variety of pathophysiological processes, involving gastrointestinal and non-gastrointestinal causes. The prevalence of chronic nausea and vomiting is unclear, although the epidemiology of specific conditions, such as gastroparesis and cyclic vomiting syndrome, is better understood...
March 15, 2018: American Journal of Gastroenterology
James Buxbaum, Michael Quezada, Bradford Chong, Nikhil Gupta, Chung Yao Yu, Christianne Lane, Ben Da, Kenneth Leung, Ira Shulman, Stephen Pandol, Bechien Wu
OBJECTIVES: The Pancreatitis Activity Scoring System (PASS) has been derived by an international group of experts via a modified Delphi process. Our aim was to perform an external validation study to assess for concordance of the PASS score with high face validity clinical outcomes and determine specific meaningful thresholds to assist in application of this scoring system in a large prospectively ascertained cohort. METHODS: We analyzed data from a prospective cohort study of consecutive patients admitted to the Los Angeles County Hospital between March 2015 and March 2017...
March 15, 2018: American Journal of Gastroenterology
Elliot B Tapper, Neehar D Parikh, Akbar K Waljee, Michael Volk, Noelle E Carlozzi, Anna S-F Lok
OBJECTIVES: Minimal hepatic encephalopathy (HE) is common, characterized by deficits in reaction time and executive function, and strongly associated with disability and mortality. Point-of-care diagnostics performed without specialized skills or equipment are now available, albeit with limited data regarding their generalizability. METHODS: We systematically reviewed MEDLINE, EMBASE, Cochrane Library, and Scopus for diagnostic studies of MHE using broad search terms including HE and minimal, covert, or the names of published diagnostic modalities...
March 13, 2018: American Journal of Gastroenterology
Johann Hammer
OBJECTIVES: The diagnosis of functional dyspepsia (FD) is challenging due to the lack of reliable biological markers to support the diagnosis. We assessed the relevance of a previously validated simple test for chemical hypersensitivity in the setting of a gastrointestinal outpatient department. METHODS: A total of 224 outpatients who were referred for evaluation of gastrointestinal symptoms in the absence of alarm symptoms swallowed a capsule containing 0.75 mg capsaicin...
March 13, 2018: American Journal of Gastroenterology
L Clifford McDonald, Dale N Gerding, Stuart Johnson, Johan S Bakken, Karen C Carroll, Susan E Coffin, Erik R Dubberke, Kevin W Garey, Carolyn V Gould, Ciaran Kelly, Vivian Loo, Julia Shaklee Sammons, Thomas J Sandora, Mark H Wilcox
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis...
February 15, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Grace H Elta, Brintha K Enestvedt, Bryan G Sauer, Anne Marie Lennon
Pancreatic cysts are very common with the majority incidentally identified. There are several types of pancreatic cysts; some types can contain cancer or have malignant potential, whereas others are benign. However, even the types of cysts with malignant potential rarely progress to cancer. At the present time, the only viable treatment for pancreatic cysts is surgical excision, which is associated with a high morbidity and occasional mortality. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of high-quality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance...
February 27, 2018: American Journal of Gastroenterology
Abhishek Agnihotri, Amy Xie, Christopher Bartalos, Vladimir Kushnir, Sameer Islam, Ebtesam Islam, Mark Lamet, Ari Lamet, Ramin Farboudmanesch, Bergein F Overholt, Johnny Altawil, Dayna S Early, Michael Bennett, Abigail Lowe, Daniel K Mullady, Christine Sade Adeyeri, Mohamad El Zein, Priya Mishra, Lea Fayad, Margo Dunlap, Andreas Oberbach, Lawrence J Cheskin, Anthony N Kalloo, Mouen A Khashab, Vivek Kumbhari
BACKGROUND & AIMS: Reshape Duo is a saline-filled dual, integrated intra-gastric balloon (IGB) approved by the Food and Drug Administration for weight loss in patients with obesity. In a prospective, randomized trial, obese patients who received the balloon had significantly greater percent excess weight loss (%EWL) compared patients treated with diet and exercise alone. However, there are limited data on the real-world efficacy of the Reshape balloon. METHODS: We performed a retrospective study of data collected from 2 academic centers and 5 private practices in which all patients paid for the IGB and follow-up visits out of pocket...
February 23, 2018: Clinical Gastroenterology and Hepatology
Parambir S Dulai, Jay C Buckey, Laura E Raffals, Jason M Swoger, Paul L Claus, Kevin O'Toole, Judy A Ptak, Michael W Gleeson, Christella E Widjaja, John T Chang, Jeffery M Adler, Nihal Patel, Laurie A Skinner, Shawn P Haren, Kimberly Goldby-Reffner, Kimberly D Thompson, Corey A Siegel
BACKGROUND: Hyperbaric oxygen therapy (HBOT) markedly increases tissue oxygen delivery. Case series suggest it may have a potential therapeutic benefit in ulcerative colitis (UC). We investigated the therapeutic potential of HBOT as an adjunct to steroids for UC flares requiring hospitalization. METHODS: The study was terminated early due to poor recruitment with 18 of the planned 70 patients enrolled. UC patients hospitalized for moderate-severe flares (Mayo score ≥6, endoscopic sub-score ≥2) were block randomized to steroids + daily HBOT (n = 10) or steroids + daily sham hyperbaric air (n = 8)...
February 16, 2018: American Journal of Gastroenterology
Avinash K Nehra, Jeffrey A Alexander, Conor G Loftus, Vandana Nehra
First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache...
February 2018: Mayo Clinic Proceedings
Judith Staub, Ali Siddiqui, Linda Jo Taylor, David Loren, Tom Kowalski, Douglas G Adler
BACKGROUND AND AIMS: ERCP (endoscopic retrograde cholangiopancreatography) performed through previously placed enteral stents is an uncommon procedure without a significant amount of supporting literature, and with a wide reported range of technical success. The purpose of this study was to evaluate and better define the technical feasibility and safety of performing ERCP through enteral stents in patients with combined malignant biliary and gastric outlet obstruction (GOO). METHODS: We conducted a multicenter, retrospective study on 71 patients with combined gastric outlet and biliary obstruction who underwent ERCP through a previously placed enteral stent at 2 tertiary care centers...
February 6, 2018: Gastrointestinal Endoscopy
Fernando Calmet, Paul Martin
No abstract text is available yet for this article.
February 7, 2018: Clinical Gastroenterology and Hepatology
Guilherme Piovezani Ramos, Moritz Binder, Paul Hampel, Manuel Bonfim Braga Neto, Dharma Sunjaya, Badr Al Bawardy, Barham K Abu Dayyeh, Navtej S Buttar, David H Bruining, Nayantara Coelho-Prabhu, Mark V Larson, Louis M Wong Kee Song, Elizabeth Rajan
BACKGROUND AND AIMS: Gastrointestinal bleeding (GIB) in the setting of thrombocytopenia raises concerns about endoscopic procedure risk. We aimed to assess the safety and outcomes of endoscopy for overt GIB in the setting of severe thrombocytopenia in liver cirrhosis (LC) and non-liver cirrhosis (NLC). METHODS: Retrospective study on inpatients who underwent endoscopy within 24-hours of presentation for overt GIB with a platelet count (PC) of 20 to <50 x 103/mL...
February 1, 2018: Gastrointestinal Endoscopy
Loren Laine, Stig B Laursen, Liam Zakko, Harry R Dalton, Jing H Ngu, Michael Schultz, Adrian J Stanley
OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes...
January 30, 2018: American Journal of Gastroenterology
Eric D Shah, Hyungjin Myra Kim, Philip Schoenfeld
OBJECTIVES: Linaclotide and plecanatide are guanylate cyclase-C (GCC) agonists for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Our objective is to evaluate the efficacy and tolerability of GCC agonists based on data from multiple randomized controlled trials (RCTs). METHODS: We searched PubMED, EMBASE, Cochrane databases,, major conference abstracts, Food and Drug Administration (FDA) websites, and United States Securities and Exchange Commission filings of drug sponsors to identify RCTs of CIC or IBS-C patients...
January 30, 2018: American Journal of Gastroenterology
Peter L Lu, Miguel Saps
No abstract text is available yet for this article.
January 29, 2018: Clinical Gastroenterology and Hepatology
James D Lewis, Frank I Scott, Colleen M Brensinger, Jason A Roy, Mark T Osterman, Ronac Mamtani, Meenakshi Bewtra, Lang Chen, Huifeng Yun, Fenglong Xie, Jeffrey R Curtis
OBJECTIVES: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that compromise quality of life and may increase mortality. This study compared the mortality risk with prolonged corticosteroid use vs. antitumor necrosis factor-α (anti-TNF) drugs in IBD. METHODS: A retrospective cohort study was conducted among Medicaid and Medicare beneficiaries from 2001 to 2013 with IBD prescribed either >3,000 mg of prednisone or equivalent within a 12-month period or new initiation of anti-TNF therapy, each treated as time-updating exposures...
January 16, 2018: American Journal of Gastroenterology
Alain M Schoepfer, Audrey Simko, Christian Bussmann, Ekaterina Safroneeva, Marcel Zwahlen, Thomas Greuter, Luc Biedermann, Stephan Vavricka, Sébastien Godat, Antoine Reinhard, Catherine Saner, Hugo Maye, Christine Sempoux, Christophe Brunel, Carine Blanchard, Dagmar Simon, Hans-Uwe Simon, Alex Straumann
OBJECTIVES: For technical reasons, the histologic characterization of eosinophilic esophagitis (EoE)-specific alterations is almost exclusively based on those found in the esophageal epithelium, whereas little is known about subepithelial abnormalities. In this study, we aimed to systematically assess the nature of subepithelial histologic alterations, and analyze their relationship with epithelial histologic findings, endoscopic features, and symptoms. METHODS: Adult patients with established EoE diagnosis were prospectively included during a yearly follow-up visit...
January 16, 2018: American Journal of Gastroenterology
2018-01-22 17:41:40
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