Infectious proctitis: when to suspect it is not inflammatory bowel disease.
Dig D…

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Continuous peritoneal drainage of large-volume ascites.
Dig Dis Sci. 2011 Sep;56(…

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Deep vein thrombosis and pulmonary embolism in hospitalized patients with cirrhosis: a nationwide analysis.
Dig Dis Sci. 2011 Jul;56(7):2152-9
Authors: Ali M, Ananthakrishnan AN, McGinley EL, Saeian K
Abstract
…

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Adherence and Adequacy of Therapy for Esophageal Varices Prophylaxis.
Dig Dis Sci. 2011 May 26;
Authors: Maddur H, Naik S, Siddiqui AA, Rockey DC
AIMS: Esophageal varices (EVs) are prevalent among cirrhotics and their …

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The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists.
Dig Dis Sci. 2011 Mar 18;
Authors: Perumalswami PV, Schiano TD
BACKGROUND: Cirrhosis and chronic liver di…

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Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes.

Dig Dis Sci. 2010 Jun;55(6):1658-66

Authors: Dorn SD, Shah ND, Berg BP, Naessens JM

OBJECTIVE: To determine whether outcomes for patients admitted with UGIH differ depending on weekend versus weekday admission, and whether any such differences are mediated by discrepancies in the use and timing of endoscopy. METHODS: This was a cross-sectional comparison of mortality, resource use, and the utilization and timing of esophagogastroduodenoscopy (EGD) among patients admitted with upper gastrointestinal hemorrhage (UGIH) on weekends to those admitted on a weekday. Hospitals in 31 states from the Nationwide Inpatient Sample between 1998 and 2003 were included. This resulted in 75,636 patients admitted during the week and 23,339 admitted on a weekend with UGIH. Multivariable analyses were conducted to evaluate the effect of weekend admission on UGIH outcomes. RESULTS: Compared to patients admitted on a weekday, for those admitted on a weekend: in-hospital mortality was higher (unadjusted mortality 3.76 vs. 3.33%; P = 0.003; adjusted HR = 1.09, 95% CI = 1.00-1.18); adjusted length of stay was 1.7% longer (P = 0.0098); and adjusted in-hospital charges were 3.3% higher (P = 0.0038). Although these patients were less likely to undergo endoscopy (adjusted OR = 0.94; P = 0.004) and waited longer for this procedure (adjusted HR = 0.87; P < 0.001), these discrepancies did not fully explain their inferior outcomes. CONCLUSIONS: Weekend admission for UGIH is associated with an increased risk of death, slightly longer lengths of stay, and marginally higher in-patient charges. Discrepancies in the use and timing of endoscopy do not account for these differences.

PMID: 19672711 [PubMed - indexed for MEDLINE]

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Efficacy and safety of lubiprostone in patients with chronic constipation.

Dig Dis Sci. 2010 Apr;55(4):1090-7

Authors: Barish CF, Drossman D, Johanson JF, Ueno R

AIMS: The aim of this study is to assess the efficacy and safety of lubiprostone in adults with chronic constipation. METHODS: This multicenter, parallel-group trial enrolled 237 patients with chronic constipation and randomized them to 4 weeks of double-blind treatment with oral lubiprostone 24 mcg or placebo twice daily. The primary efficacy endpoint was the number of spontaneous bowel movements (SBMs) after 1 week of treatment. Secondary evaluations included SBMs at weeks 2, 3, and 4; percentage of patients with a SBM within 24 h of first study dose; stool consistency; degree of straining; constipation severity; abdominal bloating and discomfort; global treatment effectiveness; and safety assessments. RESULTS: Lubiprostone-treated patients experienced greater mean numbers of SBMs at week 1 compared with placebo (5.89 versus 3.99, P = 0.0001), with significantly greater percentages having SBMs within 24 h of the first dose (61.3% versus 31.4%, P < 0.0001). At each assessment, SBM frequency and percentages of full responders (> or =4 SBM per week) were significantly greater among lubiprostone-treated patients compared with placebo (P < or = 0.0171). Lubiprostone-treated patients reported significant improvements in stool consistency, straining, and constipation severity at all weeks, and in abdominal bloating at week 1. Patient assessments of treatment effectiveness were significantly greater with lubiprostone compared with placebo at all weeks (P < 0.0004). Gastrointestinal-related disorders were the most common adverse events in both treatment groups. CONCLUSIONS: In patients with chronic constipation, lubiprostone produced a bowel movement in the majority of individuals within 24 h of initial dosing, with sustained improvement in frequency as well as other constipation symptoms over 4 weeks of treatment.

PMID: 20012484 [PubMed - indexed for MEDLINE]

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Fecal incontinence in an inpatient population: a not uncommon finding.

Dig Dis Sci. 2009 Oct;54(10):2215-9

Authors: Hughes BT, Chepyala P, Hendon S, Crowell MD, Olden KW

The prevalence of fecal incontinence (FI) in hospitalized patients was determined, as well as the frequency with which physicians query about FI. Using a standardized questionnaire, subjects admitted to general medicine services at three university hospitals were questioned about FI. Investigators also reviewed the subjects’ charts to determine if presence or absence of FI was documented. One hundred ninety-nine patients were enrolled, and 46% (92/199) reported ongoing FI. Advanced age, looser stools, symptoms of fecal urgency, urinary incontinence, and history of forceps delivery were found to be potential predictors of FI. Only 6% (6/92) with FI had documentation of FI in the medical chart and only 3% (6/199) of the entire sample were queried about FI. Fecal incontinence is an extremely common condition in hospitalized patients. Physician history-taking is severely deficient in this area. Methods to improve FI detection in the hospitalized patient population need to be developed.

PMID: 19058001 [PubMed - indexed for MEDLINE]

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The effectiveness of the treatment of octreotide on chylous ascites after liver cirrhosis.

Dig Dis Sci. 2009 Aug;54(8):1783-8

Authors: Zhou DX, Zhou HB, Wang Q, Zou SS, Wang H, Hu HP

Octreotide is a crucial drug used for treating patients with chylous ascites; however, there have been few reports related to octreotide that are being used in cirrhotic patients. Thus, this thesis is designed to determine the effects of octreotide on patients with chylous ascites after liver cirrhosis. Eight patients were diagnosed with chylous ascites, on the basis of laboratory findings on ascites samples, between January 2003 and May 2008. Octreotide was given to the six patients, while the remaining two were treated as a control. All patients had persistent peritoneal drainage with the quantity and quality of the drainage fluid observed once every other day. All the necessary care was individually given to the patients during the therapy. All patients properly received combined therapy including a low-fat and low-sodium diet, and diuretic and peritoneal drainage. The volume of the peritoneal drainage was reduced to zero in one of the six patients who received octreotide therapy, while the other five had the drainage volumes decreased from 2,000 to 50 ml with a clear appearance and negative qualitative analysis of chyle. For those two patients who did not receive octreotide therapy, the conditions of peritoneal drainage seldom changed both from the qualitative and quantitative aspects. In conclusion, Octreotide, along with combined therapy, can rapidly relieve portal hypertension and reduce triglyceride levels in ascites. It appears to be an effective therapy available for the treatment of chylous ascites caused by liver cirrhosis.

PMID: 19051030 [PubMed - indexed for MEDLINE]

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Hospitalization for achalasia in the United States 1997-2006.

Dig Dis Sci. 2009 Aug;54(8):1680-5

Authors: Sonnenberg A

BACKGROUND AND AIMS: The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) was used to study the demographic characteristics of achalasia patients. METHODS: HCUP data from 1997 to 2006 were stratified by categories pertaining to patient demographics, such as age, sex, race, income, residence in metropolitan area, and region of the United States, as well as categories pertaining to hospital characteristics, such teaching status, location, and bed size. The distributions of inpatients among different categories were compared between achalasia and all other diagnoses, using odds ratios and their 95% confidence intervals for comparison. RESULTS: The annual hospitalization rates of achalasia revealed a clear-cut age-dependent rise between the youngest age group less than 18 years old (0.25/100,000) and the oldest age group over 85 years old (37.35/100,000). Between 1997 and 2007, the rates of hospitalization remained largely unchanged for all age groups alike. Achalasia was equally distributed among men and women and among various ethnic groups. Compared with other diagnoses, achalasia was more frequent among hospitalized patients from zip codes associated with a higher average income (1.26, 1.23-1.29), living in metropolitan areas (1.12, 1.09-1.15), and living in the northeast region of the United States (1.27, 1.25-1.30). Achalasia patients were mostly seen in large hospitals (1.22, 1.19-1.26), teaching hospitals (1.73, 1.70-1.76), and hospitals located in metropolitan areas (1.15, 1.14-1.15). CONCLUSIONS: With exception of its striking age-dependence, the epidemiology of achalasia does not reveal any clues about its yet unsolved etiology.

PMID: 19517232 [PubMed - indexed for MEDLINE]

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Palliation of malignant obstructive jaundice.

Dig Dis Sci. 2009 Jun;54(6):1184-98

Authors: Garcea G, Ong SL, Dennison AR, Berry DP, Maddern GJ

Peri-ampullary and hepatic malignancies will frequently present with obstructive jaundice. For unresectable tumors, effective and lasting decompression of the biliary tree is essential to improve quality of life and survival. An overview of present treatment modalities for palliation of obstructive jaundice is provided, including a systematic review of the English literature regarding the optimum choice of palliation.

PMID: 18770035 [PubMed - indexed for MEDLINE]

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Is oral L-acyl-carnitine an effective therapy for hepatic encephalopathy? Review of the literature.

Dig Dis Sci. 2008 Sep;53(9):2330-3

Authors: Shores NJ, Keeffe EB

Hepatic encephalopathy (HE) is a significant cause of morbidity and mortality in patients with advanced chronic liver disease. Current therapies are associated with inconvenient side-effects, high cost, and incomplete efficacy. The quanternary ammonium compound L-acyl-carnitine has been suggested as a potent, low-cost, and safe alternative therapy for patients with cirrhosis and HE. A systematic review of the literature assessing the use of carnitine in the treatment of HE identified three high-quality human trials for review. Analysis of the selected carnitine trials compared to currently accepted therapies suggests that L-acyl-carnitine is promising as a safe and effective treatment for HE, and further trials of this drug are warranted.

PMID: 18270833 [PubMed - indexed for MEDLINE]

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A meta-analysis on the efficacy of probiotics for maintenance of remission and prevention of clinical and endoscopic relapse in Crohn’s disease.

Dig Dis Sci. 2008 Sep;53(9):2524-31

Authors: Rahimi R, Nikfar S, Rahimi F, Elahi B, Derakhshani S, Vafaie M, Abdollahi M

OBJECTIVE: To evaluate whether probiotics maintain remission in patients with Crohn’s disease (CD). DESIGN: A meta-analysis of controlled clinical trials. METHODS: PUBMED and Cochrane Central Register of Controlled Trials were searched for clinical trial studies investigated the efficacy of probiotics for the maintenance of remission in Crohn’s disease. Clinical relapse and endoscopic relapse were the key outcomes of interest. Data were searched within the time period of 1966 through May 2007. RESULT: Eight randomized placebo-controlled clinical trials met our criteria and were included in the analysis. Seven determined clinical relapse and three evaluated endoscopic relapse among patients with CD received probiotics for maintenance of remission. Pooling of seven trials for the outcome of clinical relapse yielded an odds ratio of 0.92 (95% confidence interval of 0.52-1.62, P = 0.8853), a nonsignificant odds ratio. The odds ratio for three studies for the outcome of endoscopic relapse was 0.97 (95% confidence interval of 0.54-1.78, P = 0.93), a nonsignificant odds ratio. CONCLUSION: This meta-analysis fails to demonstrate the efficacy of probiotics in maintaining remission and preventing clinical and endoscopic recurrence in CD. It is suggested to use probiotic preparations containing a mixture of lactobacillus with E. coli or Saccharomyces.

PMID: 18270836 [PubMed - indexed for MEDLINE]

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Primary prevention of adverse gastroduodenal effects from short-term use of non-steroidal anti-inflammatory drugs by omeprazole 20 mg in healthy subjects: a randomized, double-blind, placebo-controlled study.

Dig Dis Sci. 2008 Aug;53(8):2059-65

Authors: Desai JC, Sanyal SM, Goo T, Benson AA, Bodian CA, Miller KM, Cohen LB, Aisenberg J

The effectiveness of low-dose omeprazole as primary prevention of gastrointestinal adverse events due to episodic use of non-selective NSAIDs was evaluated. Healthy adults aged 50-75 who did not take chronic NSAIDs were randomized to a 6.5-day treatment of naproxen 500 mg twice daily plus omeprazole 20 mg daily or naproxen 500 mg twice daily plus placebo. Seventy subjects were enrolled (mean age 58.6 years, proportion >60 = 41.4%). Subjects receiving naproxen plus omeprazole developed fewer gastroduodenal ulcers compared to subjects receiving naproxen plus placebo (11.8% vs. 46.9%, P = 0.002). Likewise, naproxen plus omeprazole was associated with a decreased risk of ulceration and/or >5 erosions (38.2% vs. 81.3%, P < or = 0.001), and a smaller change in dyspepsia score. Considering their relatively low cost, ready availability, and favorable safety profile, low-dose PPI co-prescription in healthy adults requiring short-term therapy with non-selective NSAIDs may be reasonable.

PMID: 18224442 [PubMed - indexed for MEDLINE]

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Inpatient admissions for drug-induced liver injury: results from a single center.

Dig Dis Sci. 2008 Jul;53(7):1977-82

Authors: Carey EJ, Vargas HE, Douglas DD, Balan V, Byrne TJ, Harrison ME, Rakela J

Objective To review all cases of drug-induced liver injury (DILI) requiring hospitalization at a single tertiary care center. Methods Patient records were identified by ICD-9 codes for inpatient visits from November 1998 through March 2006. Results Of a total 83,265 hospital admissions during the study period, 40 were for DILI (0.048%). Thirteen patients had non-acetaminophen DILI (NA-DILI); 27 had acetaminophen-related DILI (A-DILI). In the NA-DILI group, mean age was 59 +/- 17.9 years and liver injury was classified as hepatocellular (7), cholestatic (5), or mixed (1). A variety of medications were implicated with antimicrobials being the most common class. Resolution occurred in seven, two died of complications related to hepatotoxicity, one underwent liver transplantation, and the outcome was undetermined in three who were lost to follow-up. In the A-DILI group, mean age was 35 +/- 11.0 years. Eighteen involved intentional overdose of acetaminophen; nine were associated with chronic use. The pattern of injury was hepatocellular in all. Resolution occurred in 4 patients, death in 8, and improvement in 15. Conclusions DILI is a rare cause of inpatient admission but is associated with significant mortality. Spontaneous resolution occurs in most patients but return to normal liver function may take months. Antimicrobial agents account for the largest proportion of NA-DILI.

PMID: 18392678 [PubMed - indexed for MEDLINE]

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