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Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

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World Journal of Gastroenterology 2009年第9期15卷 1099-1104页

作者： Supot Pongprasobchai Sireethorn Nimitvilai Jaroon Chasawat Sathaporn manatsathit Division of Gastroenterology Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand

AIM:To identify clinical parameters,and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the ***:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defi ned from the receiver operating curve and prospectively validated in another set of patients with ***:Among 261 patients with UGIB,47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4,95% CI 8.3-60.4,P < 0.001),red vomitus (OR 4.6,95% CI 1.8-11.9,P = 0.02),and red nasogastric (NG) aspirate (OR 3.3,95% CI 1.3-8.3,P = 0.011). The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate),when 1 and 0 are used for the presence and absence of each factor,respectively. Using a cutoff≥ 3.1,the sensitivity,specificity,accuracy,positive predictive value (PPV),and negative predictive value (NPV) in predicting variceal bleeding were 85%,81%,82%,50%,and 96%,respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%,***:The UGIB Etiology Score,composed of 3 parameters,using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

关键词：非静脉曲张破裂出血上消化道出血病因预测因子评分 Logistic回归分析受试者工作曲线核型多角体病毒临床参数

Cholestatic liver diseases:An era of emerging therapies

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World Journal of Clinical Cases 2019年第13期7卷 1571-1581页

作者： Hrishikesh Samant Wuttiporn manatsathit David Dies Hosein Shokouh-Amiri Gazi Zibari Moheb Boktor Jonathan Steve Alexander Division of Gastroenterology and Hepatology Department of medicine LSU health Shreveport LA 71103 United States John C McDonald Transplant Center Willis Knighton Medical Center Shreveport LA 71103 United States Division of Gastroenterology and Hepatology University of Nebraska Omaha NE 68194 United States Department of Molecular and Cellular Physiology Louisiana State University School of Medicine Shreveport LA 71103 United States

Recently the field of cholestasis has expanded enormously reflecting an improved understanding of the molecular mechanisms underlying bile secretion and its perturbation in chronic cholestatic disease. Novel anti-cholestatic therapeutic options have been developed for patients not favorably responding to ursodeoxycholic acid (UDCA), the current standard treatment for cholestatic liver disease. Important novel treatment targets now also include nuclear receptors involved in bile acid (BA) homoeostasis like farnesoid X receptor and G proteincoupled receptors e.g., the G-protein-coupled BA receptor “transmembrane G coupled receptor 5”. Fibroblast growth factor-19 and enterohepatic BA transporters also deserve attention as additional drug targets as does the potential treatment agent norUDCA. In this review, we discuss recent and future promising therapeutic agents and their potential molecular mechanisms in cholestatic liver disorders.

关键词： Bile acids Drug therapy Cholestatic liver disease Nuclear receptor agonists

Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma

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World Journal of Gastrointestinal Endoscopy 2014年第10期6卷 506-509页

作者： Pornchai Leelasinjaroen Wuttiporn manatsathit Richard Berri Mohammed Barawi Frank G Gress Department of Medicine St.John Hospital and Medical CenterDetroitMI 48236United States Department of Surgery St.John Hospital and Medical CenterDetroitMI 48236United States Division of Gastroenterology Department of MedicineSt.John Hospital and Medical CenterDetroit MI 48236United States Division of Digestive Diseases Columbia University Medical CenterNew YorkNY 10032United States

Although insulinomas are rare, they are the most com-mon pancreatic neuroendocrine tumor, with an inci-dence of four cases per million population. Insulinomas are generally benign indolent intrapancreatic tumors. Surgical resection remains the main option for treat-ment. However, up to 67% of a pancreatic head insu-linomas are nonpalpable, thus surgical resection of the nonplapable insulinoma in this area could become prob-lematic resulting in prolonged surgical time, increased risk of pancreatic duct injury and need for pancreati-coduodenectomy. Endoscopic ultrasound-guided fine- needle tattooing(EUS-FNT), has been shown to have a crucial role for localization of pancreatic body and tail lesions, facilitating laparoscopic distal pancreatectomyand helping surgeons identify the location of the tumor. EUS-FNT might have a role for preoperative localiza-tion of pancreatic head insulinomas which are likely to be nonpalpable. We report a case of preoperative EUS-FNT for localization of a nonplapable pancreatic head insulinoma. This report demonstrates that EUS-FNT of pancreatic head insulinomas may facilitate surgical resection, reduce operative time and decrease surgical complications.

关键词： Insulinoma Endosonography Endoscopic ultrasound-guided fine-needle tattooing Pancreas Neuroendocrine tumors

Yield,etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

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World Journal of Gastrointestinal Endoscopy 2013年第3期5卷 122-127页

作者： Supot Pongprasobchai Songla Chitsaeng Tawesak Tanwandee Sathaporn manatsathit Udom Kachintorn Division of Gastroenterology Department of Internal MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand

AIM:To investigate the yield,etiologies and impact of capsule endoscopy(CE) in Thai patients with obscure gastrointestinal bleeding(OGIB).METHODS:The present study is a retrospective cohort *** patients with OGIB who underwent CE in Siriraj Hospital,Bangkok,Thailand during 2005-2009 were included in the *** the patients' medical records and results of the CE videos were *** findings were classified as significant,suspicious/equivocal and *** of the lesions were located to duodenum,jejunum,jejunoileum,ileum and diffuse lesions by the localization device of the *** of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood ***' outcomes(rebleeding,persistent bleeding,anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the ***:Overall,there were 103 patients with OGIB included in the *** age of the patients was 64 ± 16 years(range 9-88 years) and 57 patients(55%) were *** of OGIB were overt in 80(78%) and occult in 23 patients(22%).The median time interval of CE after onset of OGIB was 10 d(range 1-180 d).The median time of follow-up was 19 mo(range 1-54 mo).Capsules reached caecum in 77 patients(74%) and capsule retention was found in 1 patient(1%).The diagnostic yield of CE revealed significant lesions in 37 patients(36%),suspicious/equivocal lesions in 15 patients(15%) and 51 patients(49%) had negative CE *** the significant lesions,the bleeding etiologies were small bowel ulcers in 44%,angiodysplasia in 27%,small bowel tumor in 13%,miscellaneous in 8% and active bleeding without identifiable causes in 8%.Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs(48%,P = 0.034),while patients with small bowel tumors were more commonly female(86%,P = 0.043) compared to the ot

关键词： Angiodysplasia Etiology Gastrointestinal Bleeding Obscure Capsule Endoscopy Outcome Small bowel ulcer Wireless