Gastroenterology Commons^™

The Evolution Of Device-Assisted Enteroscopy: From Sonde Enteroscopy To Motorized Spiral Enteroscopy, Freddy Nehme, Hermant Goyal, Abhilash Perisetti Md, Ben Tharian, Neil Sharma Md, Tony C. Tham, Rajiv Chhabra

PCI Publications and Projects

THIS ARTICLE IS PART OF THE RESEARCH TOPIC: Recent Updates in Advanced Gastrointestinal Endoscopy

The introduction of capsule endoscopy in 2001 opened the last “black box” of the gastrointestinal tract enabling complete visualization of the small bowel. Since then, numerous new developments in the field of deep enteroscopy have emerged expanding the diagnostic and therapeutic armamentarium against small bowel diseases. The ability to achieve total enteroscopy and visualize the entire small bowel remains the holy grail in enteroscopy. Our journey in the small bowel started historically with sonde type enteroscopy and ropeway enteroscopy. Currently, double-balloon enteroscopy, single-balloon enteroscopy, and spiral …

Impact Of Compensated Cirrhosis On Survival In Patients With Acute-On-Chronic Liver Failure, Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K. Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Saeed Hamid, Amna Subhan Butt

Section of Gastroenterology

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were …

Health And Economic Benefits Of Achieving Hepatitis C Virus Elimination In Pakistan: A Modelling Study And Economic Analysis, Aaron G. Lim, Nick Scott, Josephine G. Walker, Saeed Hamid, Margaret Hellard, Peter Vickerman

Section of Gastroenterology

Background: Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.
Methods and findings: We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare …

Management Of Gastrointestinal Bleeding During Covid-19: Less Is More!, Hemant Goyal, Sonali Sachdeva, Abhilash Perisetti Md, Rupinder Mann, Saurabh Chandan, Sumant Inamdar, Benjamin Tharian

Other Specialties

No abstract provided.

Direct-Acting Oral Anticoagulants Versus Warfarin In Relation To Risk Of Gastrointestinal Bleeding: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials., Mark M Aloysius, Abhilash Perisetti Md, Hemant Goyal, Umesha Boregowda, Mladen Jecmenica, Mahesh Cheryala, Anurag Bajaj, Bojana Milekic, Milos Babic, Pardeep Bansal, Greg H Enders

Other Specialties

Background: Direct-acting oral anticoagulants (DOACs) are increasingly used, with studies showing a lower risk of gastrointestinal bleeding (GIB), but overall data for GIB risk remains debatable. The objective was to assess non-fatal and fatal GIB risk in patients on DOACs compared with warfarin from randomized clinical trials (RCTs).

Methods: RCTs comparing warfarin and DOACs for various indications (atrial fibrillation, thromboembolism, insertion of mechanical heart valves) were included. The primary endpoint was any GIB event. Other clinical events, such as fatal GIB, and effects of age (≤60 years or older), time in therapeutic range for warfarin, and choice of individual DOACs …

Hepatitis E: Genotypes, Strategies To Prevent And Manage, And The Existing Knowledge Gaps, Lubna Kamani, Zahra Ali Padhani, Jai K. Das

Section of Gastroenterology

Hepatitis E virus (HEV) is considered an emergent source of viral hepatitis worldwide, with an increasing burden of jaundice, liver failure, extrahepatic illnesses, and deaths in developed countries. With the scarcity of data from efficient animal models, there are still open-ended questions about designing new models to study pathogenesis, types, virology, and evolution of these viruses. With an emphasis on available data and updates, there is still enough information to understand the HEV life cycle, pathogen interaction with the host, and the valuation of the role of vaccine and new anti-HEV therapies. However, the World Health Organization (WHO) and the …

Malnutrition And Liver Disease In A Developing Country, Asra Tus Saleha Siddiqui, Om Parkash, Syeda Amrah Hashmi

Section of Gastroenterology

Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients …

Urinary Bile Acid Indices As Prognostic Biomarkers For The Complications Of Liver Diseases, Wenkuan Li

Theses & Dissertations

Hepatobilary diseases cause the accumulation of toxic bile acids (BA) in the liver, blood, and other tissues, which may lead to an unfavorable prognosis. In this study, we compared the urinary BA profile in 257 patients with hepatobilary diseases during a 7-year follow-up period. We investigated the use of the urinary BA profile to develop logistic regression models to predict the prognosis of hepatobiliary diseases in terms of developing disease-related complications, especially for ascites. The urinary BA profile was characterized by calculating BA indices, which quantify the composition, metabolism, hydrophilicity, and toxicity of the BA profile. All patients had high …

Avoidant Restrictive Food Intake Disorder Prevalent Among Patients With Inflammatory Bowel Disease, Emily Yelencich, Emily Truong, Adrianne M. Widaman, Giselle Pignotti, Liu Yang, Yejoo Jeon, Andrew T. Weber, Rishabh Shah, Janelle Smith, Jenny S. Sauk, Berkeley N. Limketkai

Faculty Research, Scholarly, and Creative Activity

Background & Aims
Inflammatory bowel disease (IBD) patients alter their dietary behaviors to reduce disease-related symptoms, avoid feared food triggers, and control inflammation. This study aimed to estimate the prevalence of avoidant/restrictive food intake disorder (ARFID), evaluate risk factors, and examine the association with risk of malnutrition in patients with IBD.
Methods
This cross-sectional study recruited adult patients with IBD from an ambulatory clinic. ARFID risk was measured using the Nine-Item ARFID Screen. Nutritional risk was measured with the Patient Generated-Subjective Global Assessment. Logistic regression models were used to evaluate the association between clinical characteristics and a positive ARFID risk …

Short Versus Standard Esophageal Myotomy In Achalasia Patients: A Systematic Review And Meta-Analysis Of Comparative Studies., Saurabh Chandan, Antonio Facciorusso, Shahab R Khan, Daryl Ramai, Babu P Mohan, Mohammad Bilal, Banreet Dhindsa, Lena L Kassab, Hemant Goyal, Abhilash Perisetti Md, Ishfaq Bhat, Shailender Singh, Stephanie Mcdonough, Douglas G Adler

Other Specialties

Background and study aims Despite the clinical efficacy of peroral endoscopic myotomy (POEM), postoperative symptomatic gastroesophageal reflux disease (GERD) remains a major concern. While it is known that length of the gastric myotomy affects postoperative GERD, the clinical relevance of variation in esophageal myotomy length is not well known. We performed a systematic review and meta-analysis of studies comparing outcomes of short versus standard myotomy length in patients with achalasia. Patients and methods We searched multiple databases from inception through November 2020 to identify studies that reported on outcomes of achalasia patients who underwent short compared with standard esophageal myotomy. …

Impact Of Coronavirus Disease 2019 On Prevention And Elimination Strategies For Hepatitis B And Hepatitis C, Syed Tabish Rehman, Hareem Rehman, Shahab Abid

Section of Pulmonary & Critical Care

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality since its first case was discovered in December 2019. Since then, multiple countries have witnessed a healthcare system collapse due to the overwhelming demand for COVID-19 care. Drastic measures have been taken globally in order to curb the spread of the virus. However, those measures have led to the disruption of other aspects of healthcare, increasing the burden due to other medical conditions. We have also stepped back in achieving the ambitious goal set in place by World Health Organization to eliminate viral hepatitis as a public …

Interventional Treatment With The Transjugular Intrahepatic Portosystemic Shunt (Tips) Procedure May Offer A Preferable Alternative To Systemic Anticoagulation In Patients With Cirrhosis And Portal Vein Thrombosis, Molly N. Pantelic

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Wang Z, Jiang MS, Zhang HL, et al. Is post-tips anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology. 2016;279(3):943-951. https://doi.org/10.1148/radiol.2015150369

for a patient with cryptogenic cirrhosis, gastroesophageal varices, pancreatic cancer, and portal vein thrombosis.

Development And Evaluation Of An Online, Patient-Driven, Family Outreach Intervention To Facilitate Sharing Of Genetic Risk Information In Families With Lynch Syndrome, Pande Mala Mph, Phd, Peterson K. Susan Phd, Mph, Lynch M. Patrick Jd, Md

Gastroenterology, Hepatology & Nutrition Journal Articles

Departments of Gastroenterology Research, Behavioral Science, and Gastroenterology, Hepatology, and Nutrition

This article has been accepted for publication in the Journal of Medical Genetics, 2021 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/jmedgenet-2020-107615

Domestic Currency As A Foreign Body, Nikhil Reddy, Long Vu, Sangeeta Agrawal

Medical Student Research Symposium Abstracts and Posters

Foreign body ingestion is most commonly described in children, however this event can occur in adults as well. In Western countries, the most common cause of esophageal foreign bodies in adults is meat, while coins represent the most common object found in children. Symptoms of foreign body ingestion include sensation of a foreign body, chest pain, dysphagia, and vomiting. In 80% of cases, the foreign body is passed naturally. However, complications of retained esophageal foreign bodies can be life-threatening; therefore, emergent esophagogastroduodenoscopy (EGD) within 2-6 hours is recommended for ingestions of sharp objects, batteries, or those causing complete esophageal obstruction. …

Presence And Implications Of Sarcopenia In Non-Alcoholic Steatohepatitis., Gregory Habig, Christa Smaltz, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

Sarcopenia, defined as the loss of muscle strength, mass, and functionality, confers a poor prognosis in the setting of cirrhosis. Given its clinical significance, a better understanding of the underlying mechanisms leading to cirrhosis, sarcopenia, and their co-occurrence may improve these patients' outcomes. Non-alcoholic steatohepatitis (NASH) shares many of the same etiologies as sarcopenia, including insulin resistance, chronic inflammation, and ectopic adipocyte deposition, which are hallmarks of metabolic syndrome (MS). NASH thus serves as a prime candidate for further exploration into the underlying pathophysiology and relationship between these three conditions. In this review, we discuss the natural history of NASH …

Successful Distancing: Telemedicine In Gastroenterology And Hepatology During The Covid-19 Pandemic., Abhilash Perisetti M.B.B.S, M.D., Hemant Goyal

Other Specialties

Telemedicine involves delivering healthcare and preventative care services to patients without the need for in-person encounters. Traditionally, telemedicine has been used for acute events (e.g., stroke, used to relay essential information to the emergency department) and chronic disease management (e.g., diabetes and chronic kidney disease management). Though the utilization of telemedicine in gastroenterology and hepatology has been modest at best, especially for inflammatory bowel diseases and chronic liver disease management, since the onset of coronavirus disease 2019 (COVID-19) pandemic, utilization of telemedicine in gastroenterology increased by 4000% in the first two weeks, equivalent to the last six years of growth …

Elevated Liver Enzymes Portends A Higher Rate Of Complications And Death In Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Emily E. Currier, Mohamed Dabaja Do, Syed-Mohammed Jafri Md

Medical Student Research Symposium

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, has infected millions worldwide since its discovery in December 2019, but little is still known about the disease process. Preliminary research in China notes liver function test (LFTs) abnormalities are common in COVID-19 patients, suggesting decreased hepatic function, and that abnormalities in LFTs are related to complicated disease course and negative outcomes. However, there has been limited large-scale data assessing COVID-19’s association with liver dysfunction and negative outcomes.

Aim: The significance of this research is to investigate how COVID-19 affects the liver function and disease course in patients infected with …

A Younger Demographic Defines Hepatitis C Patient Profiles In The Recent Direct-Acting Antiviral Era, Ria Minawala, Paul H. Naylor Phd, Murray N. Ehrinpreis Md, Milton G. Mutchnik Md

Medical Student Research Symposium

A Younger Demographic Defines Hepatitis C Patient Profiles in the Recent Direct-Acting Antiviral Era

Authors: Minawala, Ria1; Naylor, Paul H.2; Ehrinpreis, Murray N.2; Mutchnick, Milton G.2

Institutions: 1. Wayne State University School of Medicine, Detroit, MI, United States. 2. Wayne State University School of Medicine, Division of Gastroenterology, Detroit, MI, United States.

Background:

Highly effective and safe direct-acting antivirals (DAAs) against hepatitis C virus (HCV) combined with U.S. Preventive Services Task Force recommendation to screen for HCV in individuals born between 1945 and 1965 (age cohort; 54-79 years of age in 2019) was expected to reduce the number of actively …

Updates On The Diagnosis And Management Of Hepatocellular Carcinoma, Aimun Raees, Muhammad Kamran, Hasan Özkan, Wasim Jafri

Section of Gastroenterology

Introduction: Globally, the incidence, as well as mortality, related to hepatocellular carcinoma (HCC) is on the rise, owing to relatively few curative options. Underlying cirrhosis is the most common etiology leading to HCC, but risk factors of cirrhosis show great regional variability. Over the years, there has been a steady development in the diagnostic and therapeutic modalities of HCC, including the availability of a wide range of systemic chemotherapeutic agents. We aim to review the recent advancements in the diagnostic and therapeutic strategies for HCC.
Methodology: The literature search was done using databases PubMed, Cochrane, and Science Direct, and the …