Gastroenterology Commons^™

Prothrombin Complex Concentrates Or Recombinant Factor Viia Are More Effective Than Fresh-Frozen Plasma At Lowering Inr In Patients With Liver Disease, Abel J. Ignatius

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Kwon JO, MacLaren R. Comparison of fresh-frozen plasma, four-factor prothrombin complex concentrates, and recombinant factor VIIa to facilitate procedures in critically ill patients with coagulopathy from liver disease: a retrospective cohort study. Pharmacotherapy. 2016;36(10):1047-1054. doi: 10.1002/phar.1827

Lafora Disease Masquerading As Hepatic Dysfunction, Faisal Inayat, Waqas Ullah, Hanan T. Lodhi, Zarak H. Khan, Ghulam Ilyas, Nouman Safdar Ali, Hafez Mohammad A. Abdullah

Abington Hospital Papers

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of ...

The Transfusion Threshold For Upper Gastrointestinal Bleeding Is A Hemoglobin Of 7.0 G/Dl Or Less, Matthew J. Ouellette , D.O., Katherine S. Lee , M.D., Daniel P. Noack, Aaron Simpson , M.D., Rana K. Zaban , D.O., Chelsea Gonzalez , D.O., Racha El-Ladki , D.O.

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C. Transfusion strategies for acute upper gastrointestinal bleeding. New Eng J Med. 2013;368(1):11-21. doi: 10.1056/NEJMoa1211801

Early Oral Refeeding In Acute Pancreatitis Reduces Length Of Hospital Stay, Sylvie B. Polsky

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Lariño-Noia J, Lindkvist B, Iglesias-García J, Seijo-Ríos S, Iglesias-Canle J, Domínguez-Muñoz J. Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: A randomized open-label trial. Pancreatology. 2014;14(3):167-173. doi: 10.1016/j.pan.2014.02.008.

Sex-Specific Associations Of Infants’ Gut Microbiome With Arsenic Exposure In A Us Population, Anne G. Hoen, Juliette C. Madan, Zhigang Li, Modupe Coker, Sara N. Lundgren, Hilary G. Morrison, Thomas J. Palys, Brian P. Jackson, Mitchell L. Sogin, Kathryn L. Cottingham, Margaret R. Karagas

Open Dartmouth: Faculty Open Access Articles

Arsenic is a ubiquitous environmental toxicant with antimicrobial properties that can be found in food and drinking water. The influence of arsenic exposure on the composition of the human microbiome in US populations remains unknown, particularly during the vulnerable infant period. We investigated the relationship between arsenic exposure and gut microbiome composition in 204 infants prospectively followed as part of the New Hampshire Birth Cohort Study. Infant urine was analyzed for total arsenic concentration using inductively coupled plasma mass spectrometry. Stool microbiome composition was determined using sequencing of the bacterial 16S rRNA gene. Infant urinary arsenic related to gut microbiome ...

Assessment Of Malnutrition In Patients With Liver Cirrhosis Using Protein Calorie Malnutrition (Pcm) Score Verses Bio-Electrical Impedance Analysis (Bia), Om Parkash, Wasim Jafri, S. M. Munir, Romaina Iqbal

Section of Gastroenterology

Objective: Malnutrition is a common problem in patients with liver cirrhosis and tools for nutritional assessment are under debate. We conducted this study to assess prevalence of malnutrition in cirrhotic patients using PCM score and BIA. Additionally we compared BIA to PCM score for detecting malnutrition in this patient population.

Results: This was a cross sectional study conducted in two tertiary care hospitals of Karachi Pakistan on adults with liver cirrhosis. Malnutrition was assessed by PCM score using anthropometric measurements and biological specimens and (ii) Body cell mass was assessed using BIA. Malnutrition as estimated by the PCM score was ...

Bowel Preparation Quality Scales For Colonoscopy., David Kastenberg, Gerald Bertiger, Stuart Brogadir

Division of Gastroenterology and Hepatology Faculty Papers

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred ...

High-Volume Hemofiltration Is Not Preferred For Hypertriglyceridemia-Induced Pancreatitis, Ian N. Monk

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: A prospective randomized controlled trial. J Clin Gastroenterol. 2016;50(9):772-778. doi: 10.1097/MCG.0000000000000552.

Cardiac Mri T2* In Liver Transplant Candidates: Application And Performance Of A Novel Imaging Technique To Identify Patients At Risk For Poor Posttransplant Cardiac Outcomes., Sara M Lewin, Kimberly Kallianos, M Ilan Nevah, Susan Zhao, Oren K Fix, Gabriel C Brooks, Teresa De Marco, Atif N Qasim, Karen G Ordovas, Neil Mehta

All Publications

Background: In end-stage liver disease, alterations in iron metabolism can lead to iron overload and development of iron overload cardiomyopathy. In liver transplant candidates, evaluation for cardiac iron overload and dysfunction can help to identify candidates at increased risk for peritransplant morbidity and mortality, though recommendations for pretransplant evaluation of cardiac iron overload are not standardized. Cardiac Magnetic Resonance Imaging T2* (CMRI-T2*) is a validated method to quantify cardiac iron deposition, with normal T2* value of 20 ms or greater. In this study, we sought to identify the incidence and predictors of iron overload by CMRI-T2* and to evaluate the ...

Comparing Efficacy Of Lumen-Apposing Stents To Plastic Stents In The Endoscopic Management Of Mature Peripancreatic Fluid Collections: A Single-Center Experience, Matthew J. Fasullo, Yasir Al-Azzawai, Joan Kheder, Jeffrey Abergel, Wahid Y. Wassef

Open Access Articles

Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the "step-up approach," which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution.

Methods: A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients ...

Unique Surgical Approach To A Twisted Ileal-Anal Pouch, Hannah Buettner, Maria X. Kiely, Mengdi Yao, James Yoo, Lilian Chen

Open Access Articles

Total proctocolectomy with ileal pouch-anal anastomosis can restore gastrointestinal continuity in patients requiring colectomy for ulcerative colitis, however, it can be associated with high morbidity. Reoperation for pouch-related complications is technically challenging and often leads to deterioration of pouch function or need for permanent stoma. We report a case of acute on chronic small bowel obstruction secondary to a 360-degree twist in the small bowel introduced during creation of the ileal-anal pouch. Our novel approach at repair has not been reported in past literature which included resection and re-anastomosis of the small bowel proximal to the pouch allowing for pouch ...

A Bibliometric Analysis Of The Top 100 Cited Articles On Hepatic Magnetic Resonance Imaging., Waqas Ullah, Hafez Mohammad A. Abdullah, Ejaz Ahmad, Mamoon Ur Rashid, Muhammad Bashir, Asad Ur Rahman, Asrar Ahmad, Abu Hurairah

Abington Hospital Papers

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the ...

Synchronous Gastric And Duodenal Metastases From Head And Neck Squamous Cell Carcinoma: A Unique Presentation Of Upper Gastrointestinal Bleeding., Nicholas P. Tarangelo, Charles Andrew Kistler, Zachary Daitch, Wei Jiang, Daniel M. Quirk

Department of Medicine Faculty Papers

Metastatic disease to the stomach or duodenum is an infrequent diagnosis, and head and neck squamous cell carcinoma (HNSCC) is one of the least common primary malignancies that lead to gastric or duodenal metastases. We report the case of a 65-year-old man with human immunodeficiency virus infection and previously diagnosed HNSCC who presented with melena. The patient had a percutaneous endoscopic gastrostomy tube placed 3 months prior to his presentation. Laboratory testing was significant for normocytic anemia and a digital rectal examination was positive for melena. Esophagogastroduodenoscopy revealed numerous cratered nodules with contact bleeding in the stomach as well as ...

Ahsg Rs4918 Polymorphism Poses A Weak Predisposition To Insulin Resistance During Pregnancy, Aisha Tariq, Aleezay Asghar, Faiza Alam, Syeda Sadia Fatima

Medical College Documents

Objective: To identify the association between Fetuin-A levels and genetic polymorphism with gestational diabetes mellitus among pregnant women visiting a tertiary care centre.

Methods: This cross-sectional case-control study was conducted at Aga Khan University Hospital, Karachi, from December 2015 to September 2016, and comprised pregnant women in their second trimester. Those with gestational diabetes mellitus were considered the cases while the rest acted as controls. The enzyme-linked immunosorbent assay was used to quantify Fetuin-A levels while genotyping for alpha-2-Heremans-Schmidglycoprotein rs4918 was performed using restriction fragment length polymorphism technique. Blood samples were collected and serum and deoxyribonucleic acid were extracted and ...

A Randomized Trial Of Obeticholic Acid Monotherapy In Patients With Primary Biliary Cholangitis., Kris V Kowdley, Velimir Luketic, Roger Chapman, Gideon M Hirschfield, Raoul Poupon, Christoph Schramm, Catherine Vincent, Christian Rust, Albert Parés, Andrew Mason, Hanns-Ulrich Marschall, David Shapiro, Luciano Adorini, Cathi Sciacca, Tessa Beecher-Jones, Olaf Böhm, Richard Pencek, David Jones

All Publications

Obeticholic acid (OCA), a potent farnesoid X receptor agonist, was studied as monotherapy in an international, randomized, double-blind, placebo-controlled phase 2 study in patients with primary biliary cholangitis who were then followed for up to 6 years. The goals of the study were to assess the benefit of OCA in the absence of ursodeoxycholic acid, which is relevant for patients who are intolerant of ursodeoxycholic acid and at higher risk of disease progression. Patients were randomized and dosed with placebo (n = 23), OCA 10 mg (n = 20), or OCA 50 mg (n = 16) given as monotherapy once daily for 3 ...

A Randomized, Placebo-Controlled Trial Of Cenicriviroc For Treatment Of Nonalcoholic Steatohepatitis With Fibrosis., Scott L Friedman, Vlad Ratziu, Stephen A Harrison, Manal F Abdelmalek, Guruprasad P Aithal, Juan Caballeria, Sven Francque, Geoffrey Farrell, Kris V Kowdley, Antonio Craxi, Krzysztof Simon, Laurent Fischer, Liza Melchor-Khan, Jeffrey Vest, Brian L Wiens, Pamela Vig, Star Seyedkazemi, Zachary Goodman, Vincent Wai-Sun Wong, Rohit Loomba, Frank Tacke, Arun Sanyal, Eric Lefebvre

All Publications

The aim of this study was to evaluate cenicriviroc (CVC), a dual antagonist of CC chemokine receptor types 2 and 5, for treatment of nonalcoholic steatohepatitis (NASH) with liver fibrosis (LF). A randomized, double-blind, multinational phase 2b study enrolled subjects with NASH, a nonalcoholic fatty liver disease activity score (NAS) ≥4, and LF (stages 1-3, NASH Clinical Research Network) at 81 clinical sites. Subjects (N = 289) were randomly assigned CVC 150 mg or placebo. Primary outcome was ≥2-point improvement in NAS and no worsening of fibrosis at year 1. Key secondary outcomes were: resolution of steatohepatitis (SH) and no ...

The Non-Healing Lleocecal Ulcer., Kyle Kreitman Do, Patrick Hickey Do, Paola Blanco Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Approach To The Diagnostic Workup And Management Of Small Bowel Lesions At A Tertiary Care Center (Poster), David Stein, Jonathan Green, Christopher R. Schlieve, Ann K. Friedrich, Kevin P. Baratta, David H. Ma, May Min, Krunal Patel, David R. Cave, Demetrius E. M. Litwin, Mitchell A. Cahan

Senior Scholars Program

Background: Primary small bowel lesions (SBLs) are rare entities that are difficult to characterize with modern endoscopic and radiographic techniques. This makes their diagnosis and management a significant challenge. Further, SBLs vary widely in pathology and gastrointestinal tract location. Therefore, it is important to review prior SBL cases to understand what factors were most beneficial in directing diagnostic approaches and subsequent treatments for these patients.

Purpose: To evaluate diagnostic modalities used and management practices of patients with SBLs at an advanced endoscopic referral center.

Methods: We analyzed patients undergoing surgical management for SBL from 2005-2015 at a single tertiary care ...

Periostin And Mesothelin: Potential Predictors Of Malignant Progression In Intrahepatic Cholangiocarcinoma, Pranoti Mandrekar, Vincenzo Cardinale

Open Access Articles

Cholangiocarcinoma (CCA), a heterogeneous group of malignancy arising at any level of the biliary tree based on their anatomical location, is classified into intrahepatic (iCCA), perihilar, and distal subtypes. iCCA, which arises distally to the second‐order bile ducts, is a highly heterogeneous and aggressive malignancy with overall poor prognosis. The rate of iCCA is increasing rapidly, particularly in Western countries; however, its precise etiology and pathogenesis remain elusive.1 While surgical resection is the first line of treatment, liver transplantation is the potential curative treatment for unresectable tumors in patients with iCCA, and posttransplantation 5‐year survival rates are ...

The Morbidity And Mortality Of Laparoscopic Appendectomy In Patients With Cirrhosis, Yasir Al-Azzawai, Yasir Al-Abboodi, Matthew J. Fasullo, Tarek Najuib

Open Access Articles

Introduction: The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy.

Methods: We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control ...