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Armando Tripodi, Massimo Primignani, Pier M Mannucci, Stephen H Caldwell
The state of clinical art of the coagulopathy of cirrhosis changed considerably over the last decade. Until 2005, cirrhosis was considered as the epitome of the hemorrhagic coagulopathies and the abnormal hemostasis tests associated with the disease were corrected with infusion of fresh frozen plasma or platelets to minimize the risk of bleeding. Since that time, a great deal of work has been done and there is now a change of paradigm. The prothrombin time once considered as an isolated measure of bleeding risk was rejected, and cirrhosis shifted from a purely hemorrhagic construct to a mixed and thrombosis-prone paradigm...
February 2017: American Journal of Gastroenterology
Guadalupe Garcia-Tsao, Juan G Abraldes, Annalisa Berzigotti, Jaime Bosch
No abstract text is available yet for this article.
January 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Bernd Löwe, Ansgar Lohse, Viola Andresen, Eik Vettorazzi, Matthias Rose, Wiebke Broicher
OBJECTIVES: It remains controversial whether psychosocial burden is an independent predictor of irritable bowel syndrome (IBS) or occurs concurrently as an epiphenomenon. Here we prospectively examine the individual contribution of psychosocial risk factors, demographic factors, somatic symptoms, and gastrointestinal infection within a non-clinical, IBS-free population before infection occurred. METHODS: A prospective community-based cohort study including a consecutive sample of healthy participants with an elevated risk of developing gastrointestinal infection during long-distance travel was conducted...
September 2016: American Journal of Gastroenterology
Rahul S Nanchal, Shahryar Ahmad
Infectious complications are common occurrences in end-stage liver disease (ESLD). Frequent infections precipitate decompensation of liver disease leading to acute or chronic liver failure, organ dysfunction, de-listing from transplant, and major morbidity and mortality. The spectrum of microorganisms has shifted with the emergence of multidrug-resistant strains, which has major implications for both therapy and prophylaxis. Cirrhosis is often associated with an underlying noninfectious systemic inflammatory state that makes diagnosis of infections particularly challenging...
July 2016: Critical Care Clinics
Kevin R Regner, Kai Singbartl
Acute kidney injury (AKI) occurs frequently in patients with liver disease and increases morbidity and mortality. Hepatorenal syndrome is a common cause of AKI in patients with decompensated cirrhosis and is due to alterations in systemic and renal hemodynamics. Serum creatinine-based estimation of kidney function is a key component of the Model for End-stage Liver Disease score in liver transplant candidates. Continuous renal replacement therapy is used in critically ill patients with liver failure and AKI...
July 2016: Critical Care Clinics
Steven M Hollenberg, Brett Waldman
In the cirrhotic liver, distortion of the normal liver architecture is caused by structural and vascular changes. Portal hypertension is often associated with a hyperdynamic circulatory syndrome in which cardiac output and heart rate are increased and systemic vascular resistance is decreased. The release of several vasoactive substances is the primary factor involved in the reduction of mesenteric arterial resistance, resulting in sodium and water retention with eventual formation of ascites. Management of these patients with acute cardiac dysfunction often requires invasive hemodynamic monitoring in an intensive care unit setting to tailor decisions regarding use of fluids and vasopressors...
July 2016: Critical Care Clinics
Prem A Kandiah, Gagan Kumar
Hepatic encephalopathy occurs ubiquitously in all causes of advanced liver failure, however, its implications on mortality diverge and vary depending upon acuity and severity of liver failure. This associated mortality has decreased in subsets of liver failure over the last 20 years. Aside from liver transplantation, this improvement is not attributable to a single intervention but likely to a combination of practical advances in critical care management. Misconceptions surrounding many facets of hepatic encephalopathy exists due to heterogeneity in presentation, pathophysiology and outcome...
July 2016: Critical Care Clinics
Andrew M Moon, Jason A Dominitz, George N Ioannou, Elliott Lowy, Lauren A Beste
BACKGROUND & AIMS: Prophylactic antibiotics are recommended for all patients with cirrhosis hospitalized for upper gastrointestinal bleeding (UGIB). We evaluated the association between use of antibiotics, outcomes of re-admissions, and mortality in these patients. METHODS: We performed a retrospective study of 6451 patients with cirrhosis (mean age, 60.6 y) in the Veterans Affairs health care system hospitalized for UGIB from January 1, 2005, through December 31, 2013 (8655 hospitalizations)...
November 2016: Clinical Gastroenterology and Hepatology
Ankie Reumkens, Eveline J A Rondagh, C Minke Bakker, Bjorn Winkens, Ad A M Masclee, Silvia Sanduleanu
OBJECTIVES: Many studies around the world addressed the post-colonoscopy complications, but their pooled prevalence and time trends are unknown. We performed a systematic review and meta-analysis of population-based studies to examine the pooled prevalence of post-colonoscopy complications ("perforation", "bleeding", and "mortality"), stratified by colonoscopy indication. Temporal variability in the complication rate was assessed. METHODS: We queried Pubmed, Embase, and the Cochrane library for population-based studies examining post-colonoscopy complications (within 30 days), performed from 2001 to 2015 and published by 1 December 2015...
August 2016: American Journal of Gastroenterology
Tim Wyant, Eric Fedyk, Brihad Abhyankar
Vedolizumab is a novel therapeutic monoclonal antibody recently approved for the treatment of moderately to severely active ulcerative colitis and Crohn's disease in adults who have failed at least one conventional therapy. An integrin antagonist, vedolizumab binds to the α4β7 integrin which is expressed specifically by a subset of gastrointestinal-homing T lymphocytes. The binding of α4β7 integrin to mucosal addressin cell adhesion molecule-1 expressed on the surface of mucosal endothelial cells is a crucial component of the gut-selective homing mechanism for lymphocytes...
December 2016: Journal of Crohn's & Colitis
Hiroshi Fukui, Hidetsugu Saito, Yoshiyuki Ueno, Hirofumi Uto, Katsutoshi Obara, Isao Sakaida, Akitaka Shibuya, Masataka Seike, Sumiko Nagoshi, Makoto Segawa, Hirohito Tsubouchi, Hisataka Moriwaki, Akinobu Kato, Etsuko Hashimoto, Kojiro Michitaka, Toshikazu Murawaki, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions 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. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system...
July 2016: Journal of Gastroenterology
Andrew Y Wang, Daniel S Strand, Vanessa M Shami
Over the past 2 decades, it increasingly has been recognized that endoscopic retrograde cholangiopancreatography (ERCP) is the most predictable provocateur of acute pancreatitis, with an incidence of more than 15% in high-risk patients. For this reason, there has been considerable interest in the effect of periprocedural drug administration as well as different ERCP techniques on both the incidence and severity of post-ERCP pancreatitis. Although many agents and techniques have shown promise in small clinical studies, the majority of these have failed to yield consistent benefit in larger randomized patient groups...
November 2016: Clinical Gastroenterology and Hepatology
Nicole Mf van Gerven, Ynto S de Boer, Chris Jj Mulder, Carin Mj van Nieuwkerk, Gerd Bouma
To provide an update of the latest trends in epidemiology, clinical course, diagnostics, complications and treatment of auto immune hepatitis (AIH). A search of the MEDLINE database was performed using the search terms: "auto immune hepatitis", "clinical presentation", "symptoms", "signs", "diagnosis", "auto antibodies", "laboratory values", "serology", "histopathology", "histology", "genetics", "HLA genes", "non-HLA genes", "environment", "epidemiology", "prevalence", "incidence", "demographics", "complications", "HCC", "PBC", "PSC", "corticosteroid", "therapy", "treatment", "alternative treatment"...
May 21, 2016: World Journal of Gastroenterology: WJG
Caroline C Jadlowiec, Timucin Taner
Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and accounts for a large proportion of wait list mortality. While living donation has successfully increased the total number of liver transplants done in Asian countries, the total number of such transplants has been stagnant in the western hemisphere. As such, there has been a significant effort over the past decade to increase the existing deceased donor pool...
May 14, 2016: World Journal of Gastroenterology: WJG
Jeffrey F Barletta, Jeffrey J Bruno, Mitchell S Buckley, Deborah J Cook
OBJECTIVES: Stress ulcer prophylaxis is commonly administered to critically ill patients for the prevention of clinically important stress-related mucosal bleeding from the upper gastrointestinal tract. Despite widespread incorporation of stress ulcer prophylaxis into practice around the world, questions are emerging about its indications and impact. This clinically focused article will review current controversies related to stress ulcer prophylaxis for critically ill adult patients, including bleeding frequency, risk factors, comparative efficacy, adverse effect profile, and overall cost-effectiveness of the available stress ulcer prophylaxis regimens...
July 2016: Critical Care Medicine
Nancy Fu, Titus Wong
Clostridium difficile infection (CDI) is now the leading cause of nosocomial infection. There has been an upsurge of CDI in patients with inflammatory bowel disease (IBD). IBD patients with CDI have increased morbidity and mortality. The establishment, proliferation, and recurrence of CDI in IBD patients form a complex interplay of microbial, environmental, and host-susceptibility factors. Different risk factors have been found predisposing IBD patients to CDI. Vancomycin performs better than metronidazole in treating IBD patients with CDI...
June 2016: Current Infectious Disease Reports
Jennifer Avegno, Matthew Carlisle
Right upper quadrant (RUQ) pain is among the most common complaints in the emergency department. The differential diagnosis is broad and includes gastrointestinal (GI) and non-GI causes for pain. Evaluation of patients requires a combination of history, physical examination, laboratory testing, and diagnostic imaging. This article details the anatomy and physiology of the right upper abdomen and approach to the history and physical examination of the most common diseases encountered in the emergency department...
May 2016: Emergency Medicine Clinics of North America
Patrick Robinson, John C Perkins
Epigastric pain is an extremely common complaint in the emergency department and has an associated broad differential diagnosis. In the differential it is important to consider cardiac causes that may be mistaken for gastrointestinal disorders as well as various serious intra-abdominal causes. This article highlights the limitations in laboratory testing and guides providers through the appropriate considerations for advanced imaging. Special attention is focused on acute pancreatitis, esophageal emergencies, and peptic ulcer disease/gastritis and their associated complications...
May 2016: Emergency Medicine Clinics of North America
Dania Schumann, Dennis Anheyer, Romy Lauche, Gustav Dobos, Jost Langhorst, Holger Cramer
BACKGROUND & AIMS: This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS. METHODS: MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS...
December 2016: Clinical Gastroenterology and Hepatology
Mark S Riddle, Herbert L DuPont, Bradley A Connor
Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings...
May 2016: American Journal of Gastroenterology
2016-07-15 03:01:28
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