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Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment

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World Journal of Gastroenterology 2018年第35期24卷 4014-4020页

作者： Clayton M Spiceland nilesh lodhia Division of Gastroenterology and Hepatology Medical University of South Carolina Division of Gastroenterology and Hepatology University of North Carolina

Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dys-plasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.

关键词： Endoscopy Inflammatory bowel disease Crohn’s disease Ulcerative colitis Colonoscopy Capsule endoscopy Dysplasia detection Stricture dilation Fistula management

Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

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World Journal of Gastroenterology 2009年第12期15卷 1459-1464页

作者： nilesh lodhia Michael Kader Thalia Mayes Parvez Mantry Benedict Maliakkal Department of Medicine Division of Gastroenterology and HepatologyUniversity of Rochester School of Medicine and DentistryBox 646 601Elmwood AvenueRochesterNY 14642United States

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.

关键词：肝硬化患者造影剂肾病风险因素住院治疗慢性肾功能不全肌酐清除危险因素多变量分析

Hepatic portal venous gas due to cryptosporidiosis in a patient with acquired immunodefi ciency syndrome

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World Journal of Hepatology 2010年第11期2卷 406-409页

作者： nilesh lodhia Atif Ali Joel Bessoff School of Medicine University of Tennessee

Although the presence of hepatic portal venous gas (HPVG) on computed tomography (CT) is typically an ominous finding, HPVG may sometimes be less catastrophic. The clinical significance of HPVG is variable, and it depends primarily on the underlying pathol ogy. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who was found to have HPVG on CT as a presumed result of gastrointestinal cryp tosporidiosis, an association that, to our knowledge, has not been reported. This case illustrates another cause of HPVG that should be considered in patients with AIDS.

关键词： Hepatic portal venous gas Cryptosporidiosis Acquired immunodef iciency syndrome

Predisposing factors for positive D-Xylose breath test for evaluation of small intestinal bacterial overgrowth:A retrospective study of 932 patients

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World Journal of Gastroenterology 2015年第15期21卷 4574-4582页

作者： Richard A Schatz Qing Zhang nilesh lodhia Jonathan Shuster Phillip P Toskes Baharak Moshiree Department of Medicine Medical University of South Carolina Department of Gastroenterology University of Florida Gainesville Department of Gastroenterology Medical University of South Carolina Charleston Department of Health Outcomes and Policy University of Florida Gainesville Department of Gastroenterology University of Miami

AIM: To investigate, in the largest cohort to date, patient characteristics and associated risk factors for developing small intestinal bacterial overgrowth(SIBO) using the D-Xylose breath test(XBT).METHODS: We performed a retrospective crosssectional study to analyze patient characteristics who underwent the XBT for evaluation of SIBO. Diagnostic testing with the XBT was performed based on a clinical suspicion for SIBO in patients with symptoms of bloating, abdominal pain, abdominal distension, weight loss, diarrhea, and/or constipation. Consecutive electronicmedical records of 932 patients who completed the XBT at the University of Florida between 2005 and 2009 were reviewed. A two-way Analysis of Variance(ANOVA) was used to test for several associations including age, gender, and body mass index(BMI) with a +XBT. A two-way ANOVA was also performed to control for the differences and interaction with age and between genders. A similar analysis was repeated for BMI. Associations between medical conditions and prior surgical histories were conducted using the Mantel-Haenszel method for 2 by 2 contingency tables, stratified for gender. Reported odds ratio estimates reflect the odds of the prevalence of a condition within the +XBT group to that of the-XBT group. P values of less than 0.05(two-sided) were considered statistically significant.RESULTS: In the 932 consecutive eligible subjects studied, 513 had a positive XBT. A positive association was found between female gender and a positive XBT(P = 0.0025), and females with a positive test were, on average, greater than 5 years older than those with a negative test(P = 0.024). The mean BMI of positive XBT subjects was normal(24.5) and significantly lower than the subjects with a negative XBT(29.5)(P = 0.0050). A positive XBT was associated with gastroesophageal reflux disease(GERD)(OR = 1.35; 95%CI: 1.02-1.80, P = 0.04), peptic ulcer disease(PUD)(OR = 2.61; 95%CI: 1.48-4.59, P < 0.01), gastroparesis(GP)(OR = 2.04; 95%CI: 1.21-3.41, P < 0.01) and steroid use(OR = 1.3

关键词： Intestine Small Irritable bowel syndrome Xylose Breath tests Proton pump inhibitors Gastroparesis Bacteria