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Gastroenterology

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By Jeff Bank Internal Medicine R2 at the University of Utah
https://www.readbyqxmd.com/read/28274107/pathophysiology-and-management-of-alcoholic-liver-disease-update-2016
#1
REVIEW
Felix Stickel, Christian Datz, Jochen Hampe, Ramon Bataller
Alcoholic liver disease (ALD) is a leading cause of cirrhosis, liver cancer, and acute and chronic liver failure and as such causes significant morbidity and mortality. While alcohol consumption is slightly decreasing in several European countries, it is rising in others and remains high in many countries around the world. The pathophysiology of ALD is still incompletely understood but relates largely to the direct toxic effects of alcohol and its main intermediate, acetaldehyde. Recently, novel putative mechanisms have been identified in systematic scans covering the entire human genome and raise new hypotheses on previously unknown pathways...
March 15, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28270681/editorial-not-all-nodules-are-created-equal-a-personalized-approach-to-indeterminate-2%C3%A2-cm-nodules-identified-on-hcc-surveillance
#2
Binu V John, Korosh Khalili
Indeterminate small (<2 cm) nodules are often discovered in cirrhotics who undergo contrast enhanced imaging for further characterization of lesions detected on ultrasound surveillance for hepatocellular carcinoma (HCC). These are either arterially enhancing (without venous washout or capsule) or are non-enhancing (with washout). Differentials include small HCCs (14-23%), atypical arterio-portal shunts, regenerative, and dysplastic nodules. A risk score that combines imaging features (arterial enhancement and nodule size) with clinical (age, prior h/o HCC) and laboratory features (albumin, AFP, hepatitis B 'e' antigen) appear to be superior to radiological features alone in the risk stratification of these nodules...
March 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28274850/direct-acting-antiviral-therapy-restores-immune-tolerance-to-patients-with-hepatitis-c-virus-induced-cryoglobulinemia-vasculitis
#3
Cloé Comarmond, Marlène Garrido, Stanislas Pol, Anne-Claire Desbois, Myrto Costopoulos, Magali Le Garff-Tavernier, Si Nafa Si Ahmed, Laurent Alric, Hélène Fontaine, Bertrand Bellier, Anna Maciejewski, Michelle Rosenzwajg, David Klatzmann, Lucile Musset, Thierry Poynard, Patrice Cacoub, David Saadoun
BACKGROUND & AIMS: Interferon-free direct-acting antiviral (DAA) therapies are effective in patients with hepatitis C virus-induced cryoglobulinemia vasculitis (HCV-CV). We analyzed blood samples from patients with HCV-CV before and after DAA therapy to determine mechanisms of these drugs and their effects on cellular immunity. METHODS: We performed a prospective study of 27 consecutive patients with HCV-CV (median age 59 years) treated with DAA therapy (21 patients received sofosbuvir plus ribavirin for 24 weeks, 4 patients received sofosbuvir plus daclatasvir for 12 weeks, and 2 patients received sofosbuvir plus simeprevir for 12 weeks) in Paris, France...
March 5, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28266591/early-aggressive-hydration-hastens-clinical-improvement-in-mild-acute-pancreatitis
#4
James L Buxbaum, Michael Quezada, Ben Da, Niraj Jani, Christianne Lane, Didi Mwengela, Thomas Kelley, Paul Jhun, Kiran Dhanireddy, Loren Laine
OBJECTIVES: Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis. METHODS: Sixty patients with acute pancreatitis without systemic inflammatory response syndrome (SIRS) or organ failure were randomized within 4 h of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs...
March 7, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28257716/the-risks-and-benefits-of-long-term-use-of-proton-pump-inhibitors-expert-review-and-best-practice-advice-from-the-american-gastroenterological-association
#5
REVIEW
Daniel E Freedberg, Lawrence S Kim, Yu-Xiao Yang
BACKGROUND & AIMS: The purpose of this review is to evaluate the risks associated with long-term use of proton pump inhibitors (PPIs), focusing on long-term use of PPIs for three common indications: gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and non-steroidal anti-inflammatory drug (NSAID) bleeding prophylaxis. METHODS: The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed, EMbase, and the Cochrane library (through July 2016)...
March 2017: Gastroenterology
https://www.readbyqxmd.com/read/28244496/a-comparison-of-the-rate-of-gastrointestinal-bleeding-in-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-or-warfarin
#6
David J Cangemi, Timothy Krill, Rick Weideman, Daisha J Cipher, Stuart J Spechler, Linda A Feagins
OBJECTIVES: Early reports suggested that the risk of gastrointestinal bleeding (GIB) was higher for patients on non-vitamin K antagonist oral anticoagulants (NOACs) than for those on warfarin. We compared the incidence of GIB in our patients on NOACs with those on warfarin. METHODS: We used our VA pharmacy database to identify patients taking NOACs (dabigatran, rivaroxaban, and apixaban) or warfarin between January 2011 and June 2015, and used the VistA system to identify those who were hospitalized for GIB...
February 28, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28244499/the-annual-risk-of-esophageal-adenocarcinoma-does-not-decrease-over-time-in-patients-with-barrett-s-esophagus
#7
Theresa Nguyen, Aaron P Thrift, Xiaoying Yu, Zhigang Duan, Hashem B El-Serag
OBJECTIVES: Endoscopic surveillance is recommended for patients with Barrett's esophagus (BE). However, it remains unclear if all BE patients benefit from long-term surveillance. We investigated the risk of esophageal adenocarcinoma (EAC) in BE patients in relation to number of successive endoscopies, years of follow-up, and calendar year. METHODS: We conducted a retrospective cohort study of male veterans with newly diagnosed BE during 2004-2009 with follow-up until 30 September 2011...
February 28, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28244498/active-surveillance-beyond-5-years-is-required-for-presumed-branch-duct-intraductal-papillary-mucinous-neoplasms-undergoing-non-operative-management
#8
Stefano Crippa, Raffaele Pezzilli, Massimiliano Bissolati, Gabriele Capurso, Luigi Romano, Maria Paola Brunori, Lucia Calculli, Domenico Tamburrino, Alessandra Piccioli, Giacomo Ruffo, Gianfranco Delle Fave, Massimo Falconi
OBJECTIVES: To evaluate the results of active surveillance beyond 5 years in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WF) and high-risk stigmata (HRS) undergoing non-operative management. METHODS: Patients with a minimum follow-up of 5 years who underwent surveillance with at least yearly magnetic resonance imaging were included. New onset of and predictors of WF/HRS during follow-up as well as long-term survival were analyzed...
February 28, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28219690/factors-associated-with-shorter-colonoscopy-surveillance-intervals-for-patients-with-low-risk-colorectal-adenomas-and-effects-on-outcome
#9
Joseph C Anderson, John A Baron, Dennis J Ahnen, Elizabeth L Barry, Roberd M Bostick, Carol A Burke, Robert S Bresalier, Timothy R Church, Bernard F Cole, Marcia Cruz-Correa, Adam S Kim, Leila A Mott, Robert S Sandler, Douglas J Robertson
BACKGROUND & AIMS: Endoscopists do not routinely follow guidelines to survey individuals with low-risk adenomas (LRAs, 1-2 small tubular adenomas, less than 1 cm) every 5-10 years for colorectal cancer (CRC)-many endoscopists recommend shorter surveillance intervals for these individuals. We aimed to identify reasons that endoscopists recommend shorter surveillance intervals for some individuals with LRAs and determine whether timing affects outcomes at follow-up examinations. METHODS: We collected data from 1560 individuals (45-75 years old) who participated in a prospective chemoprevention trial (of vitamin D and calcium) from 2004 through 2008...
February 17, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28195178/recurrence-of-barrett-s-esophagus-is-rare-following-endoscopic-eradication-therapy-coupled-with-effective-reflux-control
#10
Srinadh Komanduri, Peter J Kahrilas, Kumar Krishnan, Tim McGorisk, Kiran Bidari, David Grande, Laurie Keefer, John Pandolfino
OBJECTIVES: Recent data suggest that effective control of gastroesophageal reflux improves outcomes associated with endoscopic eradication therapy (EET) for Barrett's esophagus (BE). However, the impact of reflux control on preventing recurrent intestinal metaplasia and/or dysplasia is unclear. The aims of the study were: (a) to determine the effectiveness and durability of EET under a structured reflux management protocol and (b) to determine the impact of optimizing anti-reflux therapy on achieving complete eradication of intestinal metaplasia (CE-IM)...
February 14, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28195180/successful-resolution-of-recurrent-clostridium-difficile-infection-using-freeze-dried-encapsulated-fecal-microbiota-pragmatic-cohort-study
#11
Christopher Staley, Matthew J Hamilton, Byron P Vaughn, Carolyn T Graiziger, Krista M Newman, Amanda J Kabage, Michael J Sadowsky, Alexander Khoruts
OBJECTIVES: Fecal microbiota transplantation (FMT) is increasingly being used for treatment of recurrent Clostridium difficile infection (R-CDI) that cannot be cured with antibiotics alone. In addition, FMT is being investigated for a variety of indications where restoration or restructuring of the gut microbial community is hypothesized to be beneficial. We sought to develop a stable, freeze-dried encapsulated preparation of standardized fecal microbiota that can be used for FMT with ease and convenience in clinical practice and research...
February 14, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28130846/aasld-guidelines-for-the-treatment-of-hepatocellular-carcinoma
#12
Julie Heimbach, Laura M Kulik, Richard Finn, Claude B Sirlin, Michael Abecassis, Lewis R Roberts, Andrew Zhu, M Hassan Murad, Jorge Marrero
No abstract text is available yet for this article.
January 28, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28071659/acg-clinical-guideline-treatment-of-helicobacter-pylori-infection
#13
William D Chey, Grigorios I Leontiadis, Colin W Howden, Steven F Moss
Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28094313/comparison-of-symptoms-healthcare-utilization-and-treatment-in-diagnosed-and-undiagnosed-individuals-with-diarrhea-predominant-irritable-bowel-syndrome
#14
Gregory S Sayuk, Ray Wolf, Lin Chang
OBJECTIVES: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms including abdominal pain and altered bowel function. Up to 75% of individuals with IBS may be undiagnosed. The aim of this study was to characterize symptoms, healthcare utilization, and treatments in populations with both diagnosed and undiagnosed IBS. METHODS: An online survey was conducted to compare gastrointestinal (GI) symptoms, healthcare visits, well-being, symptom management, and treatment satisfaction in individuals with and without medically diagnosed IBS (Rome III criteria)...
January 17, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28088461/changes-in-the-prevalence-of-hepatitis-c-virus-infection-nonalcoholic-steatohepatitis-and-alcoholic-liver-disease-among-patients-with-cirrhosis-or-liver-failure-on-the-waitlist-for-liver-transplantation
#15
David Goldberg, Ivo C Ditah, Kia Saeian, Mona Lalehzari, Andrew Aronsohn, Emmanuel C Gorospe, Michael Charlton
BACKGROUND & AIMS: Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV) infection, there has been an increase in the incidence of nonalcoholic fatty liver disease. Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States...
January 11, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28069350/prevalence-risk-factors-and-outcomes-of-irritable-bowel-syndrome-after-infectious-enteritis-a-systematic-review-and-meta-analysis
#16
Fabiane Klem, Akhilesh Wadhwa, Larry Prokop, Wendy Sundt, Gianrico Farrugia, Michael Camilleri, Siddharth Singh, Madhusudan Grover
BACKGROUND & AIMS: Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis. METHODS: We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors...
January 6, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28053053/acute-on-chronic-liver-failure-an-update
#17
REVIEW
Ruben Hernaez, Elsa Solà, Richard Moreau, Pere Ginès
Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%-50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF...
March 2017: Gut
https://www.readbyqxmd.com/read/28043907/gastrointestinal-safety-of-direct-oral-anticoagulants-a-large-population-based-study
#18
Neena S Abraham, Peter A Noseworthy, Xiaoxi Yao, Lindsey R Sangaralingham, Nilay D Shah
BACKGROUND & AIMS: Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS: We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with nonvalve atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/27942871/evidence-based-clinical-practice-guidelines-for-cholelithiasis-2016
#19
REVIEW
Susumu Tazuma, Michiaki Unno, Yoshinori Igarashi, Kazuo Inui, Kazuhisa Uchiyama, Masahiro Kai, Toshio Tsuyuguchi, Hiroyuki Maguchi, Toshiyuki Mori, Koji Yamaguchi, Shomei Ryozawa, Yuji Nimura, Naotaka Fujita, Keiichi Kubota, Junichi Shoda, Masami Tabata, Tetsuya Mine, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012...
March 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/27974040/the-human-intestinal-microbiome-in-health-and-disease
#20
REVIEW
Susan V Lynch, Oluf Pedersen
No abstract text is available yet for this article.
December 15, 2016: New England Journal of Medicine
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