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Association between small intestinal bacterial overgrowth and deep vein thrombosis

gastroenterology Report 2016年第4期4卷 299-303,I0002页

作者： Andre Fialho Andrea Fialho Aldo Schenone Prashanthi Thota Arthur McCullough Bo Shen Department of Internal Medicine The Cleveland Clinic FoundationClevelandOHUSA Department of gastroenterology and Hepatology The Cleveland Clinic FoundationClevelandOHUSA

Objective:Small intestinal bacterial overgrowth(SIBO)has been associated with several *** association between SIBO and deep vein thrombosis(DVT)has not been *** study was aimed to investigate the frequency and risk factors for the development of DVT in patients tested for ***:All 321 eligible patients were included from the Cleveland clinic Gastrointestinal Motility Lab databank from January 2008 to January *** who were evaluated with glucose hydrogen/methane breath test as well as Doppler ultrasonography for suspected DVT were *** with catheter-related DVT were *** primary outcomes were the frequency and risk factors(including SIBO)for DVT in this patient ***:Of the 321-case cohort,144 patients(44.9%)tested positive for SIBO,and 53(16.5%)had ultrasonographic findings of *** evaluation before the evaluation of DVT occurred in 201 patients(median time from the breath test to ultrasonography:27 months;interquartile range[IQR]:11.0–45.0 months),and SIBO evaluation after evaluation for DVT occurred in 120 patients(median time from ultrasonography to the breath test:30 months;IQR:11.8–54.3 months).In the univariate analysis,DVT was associated with family history of thromboembolic events(35.8%vs 16.0%,P=0.001),chronic kidney diseases(CKD;26.4%vs 13.4%,P=0.019)and the presence of SIBO(69.8%vs 39.9%,P50.001).In themultivariate analysis,family history of thromboembolic events(odds ratio[OR]:3.39;95%confidence interval[CI]:1.67–6.87;P50.001),CKD(OR:2.23;95%CI:1.04–4.74;P=0.037),and the presence of SIBO(OR:3.27;95% CI:1.70–6.32;P50.001)remained independently associated with ***:SIBO was found to be associated with *** nature of this association warrants further investigation.

关键词： small intestine bacterial overgrowth deep vein thrombosis risk factors

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Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step

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World Journal of gastroenterology 2024年第6期30卷 516-522页

作者： Peter Liptak Martin Duricek Peter Banovcin clinic of Internal Medicine-gastroenterology University Hospital in MartinJessenius Faculty of Medicine in MartinComenius UniversityMartin 03601Slovakia

The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of gastroenterology 2023;29:*** original research presents a new scoring system for fecal *** incontinence is a chronic disease with a severe impact on the quality of life of the *** social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further misman-agement or non-existent management of the *** important fact is that patients are often unable to describe their condition when not asked precisely defined *** problem is partially resolved by scoring *** scoring systems are commonly used;however,each of them has their *** example,the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence ***,there has long been a call for a more precise scoring *** correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy *** editorial describes fecal incontinence,its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.

关键词： Incontinence Fecal Scoring system Questionary Quality of life

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Biological therapy for ulcerative colitis

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gastroenterology Report 2015年第2期3卷 103-109页

作者： Zubin Arora Bo Shen Department of Internal Medicine the Cleveland Clinic FoundationClevelandOHUSA Department of gastroenterology and Hepatology the Cleveland Clinic FoundationClevelandOHUSA

Ulcerative colitis(UC)is a major form of inflammatory bowel disease(IBD)*** understanding of the pathogenesis of UC has led to the development of novel therapeutic agents that target specific mediators of the inflammatory cascade.A number of biological agents have been approved by the *** and Drug Administration(FDA)for the treatment of UC and several more are currently in various phases of drug *** commonly used agents include TNFa antagonists(***,adalimumab,and golimumab)and anti-integrin agents(vedolizumab).These biological agents have profoundly influenced the management of UC patients,especially those with refractory *** paper reviews the currently available knowledge and evidence for the use of various biological agents in the treatment of UC.

关键词： ulcerative colitis biological therapy TNFαantagonists anti-integrin agents

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Diagnosis andmanagement of floppy pouch complex

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gastroenterology Report 2018年第4期6卷 246-256,I0001页

作者： Freeha Khan Tracy L.Hull Bo Shen gastroenterology and Hepatology Center for Inflammatory Bowel DiseaseCleveland ClinicClevelandOH 44195USA

Restorative proctocolectomy with ileal pouch–anal anastomosis has become the surgical treatment of choice for patients with refractory ulcerative colitis,colitis-associated dysplasia or familial adenomatous *** are various pouch disorders and associated *** pouch complex is defined as the presence of pouch prolapse,afferent limb syndrome,enterocele,redundant loop and folding pouch on pouchoscopy,gastrografin pouchogramor *** clinical presentation includes dyschezia,bloating,abdominal pain,straining or the sense of incomplete *** disorder has its own unique endoscopic,radiographic and manometry findings.A range of therapeutic options are available for the management of the various causes of a pouch.

关键词： Floppy pouch complex ileal pouch prolapse afferent limb syndrome efferent limb syndrome ulcerative colitis

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Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome

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World Journal of gastroenterology 2013年第35期19卷 5787-5797页

作者： Nicola de Bortoli Irene Martinucci Massimo Bellini Edoardo Savarino Vincenzo Savarino Corrado Blandizzi Santino Marchi Division of gastroenterology University of Pisa Division of gastroenterology University of Padua Division of gastroenterology University of Genoa Division of Pharmacology and Chemotherapy University of Pisa

Several studies indicate a significant degree of overlap between irritable bowel syndrome(IBS)and gastroesophageal reflux disease(GERD).Likewise,both functional heartburn(FH)and IBS are functional digestive disorders that may occur in the same ***,data establishing a solid link between FH and IBS are lacking,mainly because the clinical definition of FH has undergone substantial changes over the *** available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and *** particular,several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH(as defined by the RomeⅢcriteria)from GERD via pathophysiological *** of these critical issues,there is preliminary evidence supporting a significantdegree of FH-IBS *** underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications,particularly to distinguish FH from *** distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of *** present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.

关键词： Functional gastrointestinal disorders Gastroesophageal reflux disease/Gastro-oesophageal reflux disease Irritable bowel syndrome Acidity(esophageal) Hypersensitivity

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Long-term esophageal and respiratory outcomes in children with esophageal atresia and tracheoesophageal fistula

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gastroenterology Report 2016年第4期4卷 310-314,I0002页

作者： Richard H.Cartabuke Rocio Lopez Prashanthi N.Thota Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Biostatistics Cleveland ClinicClevelandOHUSA Department of gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA

Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond *** aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF through evaluation of clinical symptoms,diagnostic testing and therapeutic intervention at a tertiary care ***:Patients with congenital EA/TEF evaluated from 2011 to 2014 were *** characteristics,type and mode of repair of EA/TEF,clinical symptoms,radiographic,endoscopic,bronchoscopic and medication use data were ***:A total of 43 patients were *** median age of this predominantly Caucasian population was 8 years(interquartile range:3,20).Twenty(62.5%)had type C(EA with distal TEF)***-one(48.8%)patients had heartburn,19(44.1%)had acid regurgitation,and 31(72.1%)had dysphagia to *** swallow in 26 patients revealed strictures in 17(65.4%),dysmotility in 20(76.9%)and recurrent fistulas in four patients(15.4%).Thirty patients underwent upper endoscopy,of which 21(70.0%)had a stricture,and six(20.0%)had recurrent fistula requiring surgical ***(18.6%)patients underwent *** evaluation showed cough and choking in 31(72.1%)patients and dyspnea and wheezing in 32(53.4%)*** respiratory infections were reported in 19(44.2%).*** findings included tracheomalacia in 86.7% and restrictive lung disease in 54.5%of ***:There is a high burden of residual esophageal and pulmonary pathology in patients with EA/*** follow-up is required to monitor both the clinical symptoms and treatment responses.

关键词： esophageal atresia tracheoesophageal fistula gastroesophageal reflux disease(GERD) esophageal dysmotility aspiration pneumonia

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Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

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gastroenterology Report 2016年第3期4卷 210-215,I0002页

作者： Zubin Arora Xianrui Wu Udayakumar Navaneethan Bo Shen Department of Internal Medicine The Cleveland Clinic FoundationClevelandOHUSA Department of gastroenterology and Hepatology The Cleveland Clinic FoundationCleveland OHUSA

Objective:Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis(PMVT)and its impact on the outcomes of inflammatory bowel diseases(IBD).Methods:All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record(study group;n=20).Patients were matched for age,sex,and IBD phenotype with control IBD patients who had no PMVT,with a ratio of 1:3(control group;n=60).Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two ***:Of the 20 patients in the Study group,6(30%)had UC,14(70%)had CD and 11(55%)were *** multivariable analysis,inpatient status(odds ratio[OR]6.88;95%confidence interval[CI]1.88-25.12)and baseline corticosteroid use(OR 4.39;95%CI 1.27-15.19)were found to be independent risk factors for the development of *** one-year follow-up,PMVT patients were more likely to have an adverse outcome of IBD,including subsequent emergency room visit(26.3%vs.1.7%;P=0.003),hospitalization for medical management(60.0%vs.20.0%;P=0.001)or IBD-related surgery(65.0%vs.26.7%;P=0.003)than the non-PMVT *** multivariable analysis,PMVT(OR 5.19;95%CI 1.07-25.28)and inpatient status(OR 8.92;95%CI 1.33-59.84)were found to be independent risk factors for poor outcome,whereas baseline immunomodulator use(OR 0.07;95%CI 0.01-0.51)was found to be a protective ***:IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of *** presence of PMVT was associated with poor clinical outcomes in IBD.

关键词： inflammatory bowel diseases portal vein thrombosis outcomes risk factors

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Healthcare utilization and costs associated with cholangiocarcinoma

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gastroenterology Report 2017年第3期5卷 213-218,I0002页

作者： Vaibhav Wadhwa Yash Jobanputra Prashanthi N.Thota KVNarayanan Menon Mansour A.Parsi Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOhio Department of gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicOhio

Background and *** is a rare but devastating malignancy associated with a poor prognosis and a high mortality *** the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United *** aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the *** utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge *** temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for *** was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in *** in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).*** was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and ***,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.

关键词： cholangiocarcinoma inpatient admissions hospital charges in-hospital mortality epidemiology

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The presence of primary sclerosing cholangitis in patients with ileal pouch anal-anastomosis is associated with an additional risk for vitamin D deficiency

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gastroenterology Report 2016年第4期4卷 320-324,I0003页

作者： Andre Fialho Andrea Fialho Gursimran Kochhar Bo Shen Department of Internal Medicine Cleveland Clinic FoundationClevelandOHUSA Department of gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA

Objective:Vitamin D deficiency is common in patients with ileal pouch-anal anastomosis(IPAA)for ulcerative colitis(UC).Whether vitamin D levels are further lowered in patients with concomitant IPAA and primary sclerosing cholangitis(PSC)is not *** aim of this study was to evaluate the presence of PSC as a risk factor for vitamin D deficiency in patients with UC and ***:In this case control study,74 patients with concurrent IPAA and PSC were included in the study group,and 79 patients with IPAA,but without PSC,served as ***-four variables were *** analysis and multivariate analysis with stepwise logistic regression were ***:A total 153 eligible patients were included,with 74(48.4%)in the study group and 79(51.6%)in the control *** D level in the study group was 18.961.4 ng/dL compared with 30.361.7 ng/d in the control group(P=0.011).Vitamin D deficiency(≤20 ng/dL)was present in 65(42.5%)*** occurred in 49(75.4%)of the 65 patients with vitamin D *** the multivariate analysis,only the presence of PSC(odds ratio[OR]:7.56;95% confidence interval[CI]:2.39–24.08;P=0.001)and vitamin D supplementation(OR:2.58;95% CI:1.57–9.19;P=0.018)remained associated with vitamin D ***:The presence of PSC was found to be an independent risk factor for vitamin D deficiency in UC patients with *** patients should be routinely screened and closely monitored for vitamin D deficiency.

关键词： inflammatory bowel disease primary sclerosing cholangitis ileal pouch-anal anastomosis vitamin D deficiency

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Liver transplantation for nonalcoholic fatty liver disease:New challenges and new opportunities

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World Journal of gastroenterology 2014年第18期20卷 5320-5330页

作者： Mina Shaker Adam Tabbaa Mazen Albeldawi Naim Alkhouri Department of gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicOH 44195United States

Nonalcoholic fatty liver disease(NAFLD)is becoming rapidly one of the most common indications for orthotopic liver transplantation in the *** of graft steatosis is a significant problem during the posttransplant course,which may happen as a recurrence of pre-existing disease or de novo *** are different risk factors that might play a role in development of graft steatosis including post-transplant metabolic syndrome,immune-suppressive medications,genetics and *** are few studies that assessed the effects of NAFLD on graft and patient survival;most of them were limited by the duration of follow up or by the number of *** this review article we will try to shed light on post-liver transplantation NAFLD,significance of the disease,how it develops,risk factors,clinical course and treatment options.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Liver cirrhosis Liver transplantation Metabolic syndrome

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