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Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

World Journal of Hepatology 2024年第1期16卷 17-32页

作者： Yash R Shah Hassam Ali Angad Tiwari David Guevara-Lazo Natalia Nombera-Aznaran bhanu siva mohan pinnam Manesh Kumar Gangwani Harishankar Gopakumar Amir H Sohail SriLakshmiDevi Kanumilli Ernesto Calderon-Martinez Geetha Krishnamoorthy Nimish Thakral Dushyant Singh Dahiya Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology and Hepatology University of Illinois College of Medicine at PeoriaPeoriaIL 61605United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Digestive Diseases and Nutrition University of KentuckyLexingtonKY 40536United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(HE)by leveraging beneficial bacterial displacement to restore a balanced gut *** prevalence of HE varies with liver disease severity and *** pathogenesis involves ammonia toxicity,gut-brain communication disruption,and *** aims to restore gut microbiota balance,addressing these ***'s efficacy has been explored in various conditions,including *** suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate *** has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver *** include improved liver function,cognitive function,and the slowing of disease ***,larger,controlled studies are needed to validate its effectiveness in these *** have shown cognitive improvements through FMT,with potential benefits in cirrhotic ***,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of *** evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor *** large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and *** FMT holds potential for HE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

关键词： Hepatic encephalopathy Fecal microbiota transplant Cognitive impairment Liver cirrhosis Chronic liver disease

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Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 148-156页

作者： Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida bhanu siva mohan pinnam Manesh Kumar Gangwani Hassam Ali Sahib Singh Yash R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma Shyam Thakkar Department of Internal Medicine University of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Division of Gastroenterology and Hepatology University of MissouriColumbiaMO 65212United States Department of Rheumatology Medical College of GeorgiaAugusta UniversityNorth AugustaGA 30912United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Interventional Oncology&Surgical Endoscopy GI Oncology Tumor Site TeamParkview Cancer InstituteParkview HealthFort WayneIN 46845United States Section of Gastroenterology&Hepatology West Virginia University School of MedicineMorgantownWV 26505United States

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic *** and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related *** To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning *** This is a cohort study using the 2018-2020 National Readmission *** aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical *** Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and *** primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to *** used univariate and multivariate regression models for *** A total of 9448 patients were admitted for any indications of *** and non-frail patients were 3445(36.46%)and 6003(63.53%)*** for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared

关键词： Endoscopic retrograde cholangiopancreatography Nonagenarians Frailty Mortality Healthcare burden

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Remimazolam for sedation in gastrointestinal endoscopy:A comprehensive review

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 385-395页

作者： Dushyant Singh Dahiya Ganesh Kumar Syeda Parsa Manesh Kumar Gangwani Hassam Ali Amir Humza Sohail Saqr Alsakarneh Umar Hayat Sheza Malik Yash R Shah bhanu siva mohan pinnam Sahib Singh Islam Mohamed Adishwar Rao Saurabh Chandan Mohammad Al-Haddad Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityMO 66160United States Department of Internal Medicine Chandka Medical CollegeSindh 77280Pakistan Department of Gastroenterology and Hepatology University of Arkansas For Medical SciencesLittle RockAR 72205United States Division of Gastroenterology Hepatology and NutritionEast Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Department of Internal Medicine Geisinger Wyoming Valley Medical CenterWilkes BarrePA 18711United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Sinai hospitalBaltimoreMD 21215United States Department of Hepatology University of MissouriColumbiaMO 65211United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States

Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient ***,benzodiazepines and opioids continue to be widely ***,in recent years,Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal(GI)*** is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural *** has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase,volume of distribution,total body clearance,and negligible drug-drug *** also has satisfactory efficacy and has achieved high rates of successful sedation in GI ***,studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol,which is currently a gold standard for procedural sedation in most parts of the ***,the use of Propofol is associated with hemodynamic instability and respiratory *** contrast,Remimazolam has lower incidence of these adverse effects intra-procedurally and hence,may provide a safer alternative to Propofol in procedural *** this comprehensive narrative review,highlight the pharmacologic characteristics,efficacy,and safety of Remimazolam for procedural *** also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.

关键词： Remimazolam Endoscopy Sedation Outcomes Efficacy Safety Pharmacokinetics

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Liver transplant in primary sclerosing cholangitis:Current trends and future directions

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世界肝病学杂志:英文版(电子版) 2023年第8期15卷 939-953页

作者： Yash R Shah Natalia Nombera-Aznaran David Guevara-Lazo Ernesto Calderon-Martinez Angad Tiwari SriLakshmiDevi Kanumilli Purva Shah bhanu siva mohan pinnam Hassam Ali Dushyant Singh Dahiya Department of Internal Medicine Trinity Health OaklandPontiacMI 48341United States Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Postgraduate Education Harvard Medical SchoolBostonMA 02115United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Primary sclerosing cholangitis(PSC)is a chronic and progressive immunemediated cholangiopathy causing biliary tree inflammation and scarring,leading to liver cirrhosis and end-stage liver *** of PSC is challenging due to its nonspecific symptoms and overlap with other liver *** the rising incidence of PSC,there is no proven medical therapy that can alter the natural history of the *** liver transplantation(LT)is the most effective approach for managing advanced liver disease caused by PSC,post-transplantation recurrence of PSC remains a ***,ongoing research aims to develop better therapies for PSC,and continued efforts are necessary to improve outcomes for patients with *** article provides an overview of PSC’s pathogenesis,clinical presentation,and management options,including LT trends and future *** also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with ***,the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is *** research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

关键词： Primary sclerosing cholangitis Liver transplantation Management Psychosocial outcomes Pathogenesis

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Acute pancreatitis in liver transplant hospitalizations:Identifying national trends,clinical outcomes and healthcare burden in the United States

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World Journal of Hepatology 2023年第6期15卷 797-812页

作者： Dushyant Singh Dahiya Vinay Jahagirdar Saurabh Chandan Manesh Kumar Gangwani Nooraldin Merza Hassam Ali Smit Deliwala Muhammad Aziz Daryl Ramai bhanu siva mohan pinnam Jay Bapaye Chin-I Cheng Sumant Inamdar Neil R Sharma Mohammad Al-Haddad Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48601United States Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64110United States Division of Gastroenterology and Hepatology CHI Creighton University Medical CenterOmahaNE 68131United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Internal Medicine East Carolina UniversityGreenvilleNC 27858United States Division of Digestive Diseases Emory University School of MedicineAtlantaGA 30322United States Division of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology The University of Utah School of MedicineSalt Lake CityUT 84112United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Statistics Actuarial and Data ScienceCentral Michigan UniversityMt.PleasantMI 48859United States Division of Gastroenterology and Hepatology University of Arkansas for Medical SciencesLittle RockAR 72205United States Interventional Oncology and Surgical Endoscopy Programs Parkview Cancer InstituteFort WayneIN 46845United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States

BACKGROUND Acute pancreatitis(AP)in liver transplant(LT)recipients may lead to poor clinical outcomes and development of severe *** We aimed to assess national trends,clinical outcomes,and the healthcare burden of LT hospitalizations with AP in the United States(US).METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)LT hospitalizations with AP in the US from 2007–***-LT AP hospitalizations served as controls for comparative *** trends of hospitalization characteristics,clinical outcomes,complications,and healthcare burden for LT hospitalizations with AP were *** characteristics,clinical outcomes,complications,and healthcare burden were also compared between the LT and non-LT ***,predictors of inpatient mortality for LT hospitalizations with AP were *** P values≤0.05 were considered statistically *** The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in *** was a rising trend of Hispanic(16.5%in 2007 to 21.1%in 2018,P-trend=0.0009)and Asian(4.3%in 2007 to 7.4%in 2019,p-trend=0.0002)LT hospitalizations with AP,while a decline was noted for Blacks(11%in 2007 to 8.3%in 2019,P-trend=0.0004).Furthermore,LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index(CCI)score≥3 increased from 41.64%in 2007 to 62.30%in 2019(P-trend<0.0001).We did not find statistically significant trends in inpatient mortality,mean length of stay(LOS),and mean total healthcare charge(THC)for LT hospitalizations with AP despite rising trends of complications such as sepsis,acute kidney failure(AKF),acute respiratory failure(ARF),abdominal abscesses,portal vein thrombosis(PVT),and venous thromboembolism(VTE).Between 2007–2019,6863 LT hospitalizations with AP were compared to 5649980 non-LT AP *** hospitalizations with AP were slightly older(53.5 vs 52.6 years,P=0.017)and

关键词： Liver transplantation Pancreatitis Mortality Cost Length of stay

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