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Fish oil-based lipid emulsion:current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease

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Gastroenterology Report 2015年第2期3卷 110-114页

作者： Shishira Bharadwaj tushar gohel Omer J.Deen Robert DeChicco Abdullah Shatnawei Center for Human Nutrition Department of Gastroenterology/HepatologyThe Cleveland Clinic FoundationClevelandOHUSA

Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain *** nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal *** PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with ***,prolonged PN is associated with short-term and long-term *** nutrition-associated liver disease(PNALD)is one of the long-termcomplications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these *** affects 30–60%of the adult population on long-term ***,PNALD is one of the indications for isolated liver or combined liver and intestinal *** is no consensus on how to manage PNALD,but fish oil-based lipid emulsion(FOBLE)has been suggested to play an important role both in its prevention and *** is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid *** have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term *** prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.

关键词： intestinal failure parenteral nutrition parenteral nutrition-associated liver disease fish oil-based lipid emulsion

Cutis laxa presenting as recurrent ileus

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Gastroenterology Report 2016年第1期4卷 77-79,I0003页

作者： Shishira Bharadwaj Prakash Shrestha tushar D.gohel Maninder Singh Department of Gastroenterology/Hepatology The Cleveland Clinic FoundationClevelandOHUSA Department of Internal Medicine Guthrie/Robert Packer HospitalSayrePAUSA

Cutis laxa(CL)is a rare connective tissue disorder characterized by phenotypic appearance of loose and redundant *** can be congenital or *** forms include autosomal dominant,autosomal recessive and X-linked *** from cutaneous abnormalities,CL can present with visceral *** this article,we report a case of CL presenting as recurrent ileus.

关键词： Cutis Laxa Gastro-intestinal Symptoms Ileus

Malnutrition:laboratory markers vs nutritional assessment

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Gastroenterology Report 2016年第4期4卷 272-280,I0001页

作者： Shishira Bharadwaj Shaiva Ginoya Parul Tandon tushar D.gohel John Guirguis Hiren Vallabh Andrea Jevenn Ibrahim Hanouneh Department of Gastroenterology/Hepatology McMaster UniversityHamiltonOntarioCanada Department of Gastroenterology/Hepatology Cleveland ClinicClevelandOHUSA

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcarerelated ***,a major dilemma exists due to lack of a unified definition for the ***,there are no standard methods for screening and diagnosing patients with malnutrition,leading to confusion and varying practices among physicians across the *** role of inflammation as a risk factor for malnutrition has also been recently ***,serum proteins such as albumin and prealbumin(PAB)have been widely used by physicians to determine patient nutritional ***,recent focus has been on an appropriate nutrition-focused physical examination(NFPE)for diagnosing *** current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical *** studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively ***,a thorough NFPE has an unprecedented role in diagnosing malnutrition.

关键词： malnutrition physical examination serum markers

Current status of intestinal and multivisceral transplantation

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Gastroenterology Report 2017年第1期5卷 20-28,I0001页

作者： Shishira Bharadwaj Parul Tandon tushar D.gohel Jill Brown Ezra Steiger Donald F.Kirby Ajai Khanna Kareem Abu-Elmagd Center for Gut Rehabilitation and Transplantation the Cleveland Clinic FoundationClevelandOHUSA

Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitation attempts at intestinal adaptation have *** the past two decades,however,outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut *** has become possible through relentless efforts in the standardization of surgical techniques,advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient *** types of intestinal transplants include isolated small bowel transplant,liver-small bowel transplant,multivisceral transplant and modified multivisceral *** guidelines restrict intestinal transplantation to patients who have had significant complications from PN including liver failure and repeated *** an experimental stage to the currently established therapeutic modality for patients with advanced IF,outcome improvements have also been possible due to the introduction of tacrolimus in the early *** have shown that intestinal transplant is cost-effective within 1–3 years of graft survival compared with *** survival and quality of life as well as resumption of an oral diet should enable intestinal transplantation to be an important option for patients with IF in addition to continued *** research should focus on detecting biomarkers of early rejection,enhanced immunosuppression protocols,improved postoperative care and early referral to transplant centers.

关键词： intestinal transplant multivisceral transplant parenteral nutrition intestinal failure gut rehabilitation

Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates

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Gastroenterology Report 2016年第2期4卷 148-153,I0003页

作者： Tarun Rai Udayakumar Navaneethan tushar gohel Amareshwar Podugu Prashanthi N.Thota Ravi P.Kiran Rocio Lopez Madhusudhan R.Sanaka Digestive Disease Institute The Cleveland ClinicClevelandOHUSA

Background and aim:Adequate bowel preparation is important for safe and effective *** indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADR)of at least 25%in average-risk men and 15%in average-risk women aged over *** aim was to investigate the impact of bowel preparation on ADR and colonoscopy completion ***:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December *** main outcome measurements were ADR and colonoscopy completion rates to the ***:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor *** completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;P<0.001),and significantly lower than the QI of 95%(P<0.001).ADR in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼*** the groups had ADR above the QI(25%for men and 15%for women)with evidence of significantly higher ADR in the women with excellent or good preparation and in men with excellent,good or fair *** multivariate analysis,male gender was significantly associated with increased ADR(P<0.001),while the quality of bowel preparation did not influence ***:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good ***,there was no difference in ADR between the different grades of preparation.

关键词： bowel preparation adenoma detection rate colonoscopy completion rate quality indicators

Higher prevalence of colon polyps in patients with Barrett’s esophagus:a case-control study

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Gastroenterology Report 2014年第4期2卷 281-287页

作者： Arthi Kumaravel Prashanthi N.Thota Hyun-Ju Lee tushar gohel Mehulkumar K.Kanadiya Rocio Lopez Madhusudhan R.Sanaka Center of Excellence for Barrett’s Esophagus Department of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA Department of Biostatistics Cleveland ClinicClevelandOhioUSA

Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk *** studies have shown variable prevalence of colon polyps in patients with *** aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without ***:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December *** control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time *** criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis *** demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy ***:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control *** age at index colonoscopy was 618 years and 75%of patients were *** index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the *** multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during ***:Patients with BE had higher prevalence and incidence of colon *** has important clinical implications for screening and surveillance in BE patients.

关键词： Barrett’s esophagus colon polyps cancer prevention