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1.
Dis Mon ; 66(11): 100986, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32312558

RESUMEN

Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.


Asunto(s)
Drenaje/métodos , Endosonografía/métodos , Seudoquiste Pancreático/terapia , Pancreatitis Aguda Necrotizante/terapia , Aneurisma/etiología , Ascitis/etiología , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Tratamiento Conservador , Líquido Quístico/citología , Líquido Quístico/metabolismo , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Nutrición Enteral , Infecciones/etiología , Obstrucción Intestinal/etiología , Ictericia Obstructiva/etiología , Imagen por Resonancia Magnética , Fístula Pancreática/etiología , Seudoquiste Pancreático/complicaciones , Seudoquiste Pancreático/diagnóstico , Seudoquiste Pancreático/fisiopatología , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/fisiopatología , Vena Porta , Rotura Espontánea/etiología , Vena Esplénica , Stents , Tomografía Computarizada por Rayos X , Ultrasonografía , Trombosis de la Vena/etiología
2.
World J Gastrointest Pharmacol Ther ; 10(1): 1-21, 2019 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-30697445

RESUMEN

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

3.
World J Gastrointest Pharmacol Ther ; 9(6): 47-54, 2018 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-30568842

RESUMEN

Management of acute cholecystitis includes initial stabilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography (ERCP). Although, these conservative measures are effective, they can cause significant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel method of gallbladder drainage first described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneous cholecystostomy and trans-papillary gallbladder drainage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.

4.
J Clin Gastroenterol ; 50(4): 307-12, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26084006

RESUMEN

BACKGROUND & AIMS: Celiac disease (CD) affects approximately 1% of the population and negatively affects aspects of life including physical and social function. The relationship between socioeconomic (SE) factors, symptom severity, and perceived burden of living with CD is not well understood. The objective of this study was to assess the relationships between income, symptoms, and perceived burden of CD. METHODS: In this survey study conducted at a tertiary care center, 773 patients 18 years of age or more with biopsy confirmed CD were eligible to participate. Patients completed a survey with information on SE data, the validated Celiac Symptom Index (CSI), and visual analog scales (VAS) assessing overall health, CD-related health, difficulty in following a gluten-free diet (GFD), and importance of following a GFD. RESULTS: Three hundred forty one patients completed the survey. Higher income predicted better overall health, better CD related health, and fewer symptoms. In the logistic regression model, low income was associated with greater CD symptoms (odds ratio=6.04, P=0.002). Other factors associated with greater symptoms were younger age, poor overall health state, and more physician visits. Factors associated with increased burden of CD included hospitalizations, more symptoms, poor overall health state, and burden of following a GFD. CONCLUSIONS: Patients with lower incomes have worse CD-related health and greater symptoms. Those with low income had 6 times the odds of greater symptoms compared with those with high income. Our data suggest that income is associated with perceived overall health, CD-related health, and CD symptoms.


Asunto(s)
Enfermedad Celíaca/epidemiología , Factores Socioeconómicos , Adulto , Biopsia , Boston/epidemiología , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/psicología , Distribución de Chi-Cuadrado , Costo de Enfermedad , Dieta Sin Gluten , Femenino , Estado de Salud , Encuestas Epidemiológicas , Humanos , Renta , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Cooperación del Paciente , Calidad de Vida , Factores de Riesgo , Índice de Severidad de la Enfermedad
5.
Am J Gastroenterol ; 110(8): 1216-22, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26150087

RESUMEN

OBJECTIVES: Guidelines recommend routine screening of liver function tests (LFTs) in patients diagnosed with celiac disease (CD). However, little is known about the prevalence of liver disorders in CD outside of Europe. Our aims were to estimate the prevalence of LFT abnormalities in CD and to evaluate the effect of a gluten-free diet (GFD) on LFTs. METHODS: Adult patients with biopsy-proven CD were identified from a prospectively maintained database and matched with healthy controls. LFT levels for women and men were defined as abnormal based on the Third National Health and Nutrition Examination Survey (NHANES III) criteria. Data on demographics, coexisting liver diseases, and laboratory work-ups including aspartate transaminase (AST) and alanine transaminase (ALT) values at the time of diagnosis and on a GFD were recorded. Subsequently, data from this cohort were compared with data from 7,789 individuals participating in the National Health and Nutrition Examination Survey, 2009-2010. Univariate logistic regression, Wilcoxon signed-ranks, Student's t-test, χ(2), and Fischer's exact test were used for statistical analysis. RESULTS: In 463 CD patients with ALT or AST levels at the time of CD diagnosis, 40.6% had elevated LFTs compared with 24.2% of treated CD patients (P<0.001) and 16.6% of matched controls (P<0.001). Similarly, 36.7% of CD patients on the NHANES database had abnormal ALT values compared with 19.3% of non-celiac patients (P=0.03). Approximately, 78.6% of CD patients with elevated LFTs at diagnosis normalized LFTs on a GFD after a mean duration of 1.5±1.5 years. CONCLUSIONS: Forty percent of individuals will have elevated LFTs at CD diagnosis; however, the majority will normalize with standard CD therapy. LFTs should be checked in all patients with CD and coexisting liver disorder should be considered in patients whose LFTs have not improved within a year on a GFD.


Asunto(s)
Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/enzimología , Dieta Sin Gluten , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Estudios Retrospectivos , Estados Unidos
6.
Dig Dis ; 33(2): 175-182, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25925920

RESUMEN

BACKGROUND: Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically susceptible individuals. CD-related enteropathy leads to multiple nutritional deficiencies involving macro- and micronutrients. Currently, medical nutrition therapy consisting of the gluten-free diet (GFD) is the only accepted treatment for CD. KEY MESSAGES: The GFD is the cornerstone of treatment for CD. Prior published studies have concluded that maintenance of the GFD results in improvement of the majority of nutritional deficiencies. In the past, counseling for CD focused mainly on the elimination of gluten in the diet. However, the GFD is not without its inadequacies; compliance to the GFD may result in certain deficiencies such as fiber, B vitamins, iron, and trace minerals. Paucity of fortified gluten-free foods may be responsible for certain deficiencies which develop on the GFD. Weight gain and obesity have been added to the list of nutritional consequences while on the GFD and have been partially attributed to hypercaloric content of commercially available gluten-free foods. Follow-up of patients diagnosed with CD after starting the GFD has been reported to be irregular and, hence, less than ideal. CONCLUSIONS: Monitoring of the nutritional status using blood tests and use of appropriate gluten-free supplementation are integral components in the management of CD. The ideal GFD should be nutrient-dense with naturally gluten-free foods, balanced with macro- and micronutrients, reasonably priced, and easily accessible. Rotation of the pseudo-cereals provides a good source of complex carbohydrates, protein, fiber, fatty acids, vitamins and minerals. Fortification/enrichment of commonly consumed gluten-free commercial grain products should be encouraged. Dietitians specializing in CD play a critical role in the education and maintenance of the GFD for patients with CD.


Asunto(s)
Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Fibras de la Dieta , Alimentos , Humanos , Fenómenos Fisiológicos de la Nutrición , Aumento de Peso
7.
Anaerobe ; 34: 59-73, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25930686

RESUMEN

Clostridium difficile infection (CDI) is increasingly prevalent, dangerous and challenging to prevent and manage. Despite intense national and international attention the incidence of primary and of recurrent CDI (PCDI and RCDI, respectively) have risen rapidly throughout the past decade. Of major concern is the increase in cases of RCDI resulting in substantial morbidity, morality and economic burden. RCDI management remains challenging as there is no uniformly effective therapy, no firm consensus on optimal treatment, and reliable data regarding RCDI-specific treatment options is scant. Novel therapeutic strategies are critically needed to rapidly, accurately, and effectively identify and treat patients with, or at-risk for, RCDI. In this review we consider the factors implicated in the epidemiology, pathogenesis and clinical presentation of RCDI, evaluate current management options for RCDI and explore novel and emerging therapies.


Asunto(s)
Portador Sano/epidemiología , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/patología , Portador Sano/microbiología , Portador Sano/terapia , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/terapia , Humanos , Incidencia , Recurrencia , Factores de Riesgo
8.
Gastroenterol Rep (Oxf) ; 3(1): 3-11, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25326000

RESUMEN

Celiac disease is an autoimmune enteropathy caused by gluten in genetically predisposed individuals. In celiac disease, adaptive and innate immune activation results in intestinal damage and a wide range of clinical manifestations. In the past, celiac disease was thought to result in signs and symptoms solely related to the gastrointestinal tract. Now, more than half of the adult population presents with extra-intestinal manifestations that can also be expected to improve on a gluten-free diet. For this reason, it is recommended that physicians have a low threshold of suspicion for celiac disease. Current knowledge of the immune pathogenesis of this autoimmune disease has served as a catalyst for the development of novel diagnostic tools and therapeutics. Over the years, highly sensitive and specific serological assays, in addition to genetic markers, have been found to target specific steps in the cascade pathway of celiac disease. Also the advent of the gluten challenge has enabled experts to design diagnostic algorithms and monitor clinical responses in clinical trials. The gluten challenge has provided substantial benefit in the advance of novel therapeutics as an adjuvant treatment to the gluten free diet. Generally, a strict gluten-free diet is highly burdensome to patients and can be limited in its efficacy. Alternative therapies-including gluten modification, modulation of intestinal permeability and immune response-could be central to the future treatment of celiac disease.

9.
Am J Gastroenterol ; 109(9): 1304-11, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24980880

RESUMEN

OBJECTIVES: The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of CD, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares with other medical treatments, and there are limited data on the socioeconomic factors influencing treatment adherence. In this study, we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence. METHODS: Survey was mailed to participants with CD, gastroesophageal reflux disease (GERD), irritable bowel syndrome, inflammatory bowel disease, hypertension (HTN), diabetes mellitus (DM), congestive heart failure, and end-stage renal disease (ESRD) on dialysis. Surveys included demographic information and visual analog scales measuring treatment burden, importance of treatment, disease-specific health status, and overall health status. RESULTS: We collected surveys from 341 celiac and 368 non-celiac participants. Celiac participants reported high treatment burden, greater than participants with GERD or HTN and comparable to ESRD. Conversely, patients with CD reported the highest health state of all groups. Factors associated with high treatment burden in CD included poor adherence, concern regarding food cost, eating outside the home, higher income, lack of college education, and time limitations in preparing food. Poor adherence in CD was associated with increased symptoms, income, and low perceived importance of treatment. CONCLUSIONS: Participants with CD have high treatment burden but also excellent overall health status in comparison with other chronic medical conditions. The significant burden of dietary therapy for CD argues for the need for safe adjuvant treatment, as well as interventions designed to lower the perceived burden of the GFD.


Asunto(s)
Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/psicología , Costo de Enfermedad , Dieta Sin Gluten/psicología , Estado de Salud , Percepción , Anciano , Enfermedad Celíaca/economía , Culinaria , Diabetes Mellitus/psicología , Diabetes Mellitus/terapia , Dieta Sin Gluten/economía , Escolaridad , Alimentos/economía , Reflujo Gastroesofágico/psicología , Reflujo Gastroesofágico/terapia , Encuestas Epidemiológicas , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión/psicología , Hipertensión/terapia , Renta , Enfermedades Inflamatorias del Intestino/psicología , Enfermedades Inflamatorias del Intestino/terapia , Síndrome del Colon Irritable/psicología , Síndrome del Colon Irritable/terapia , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Cooperación del Paciente , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto Joven
10.
Nat Rev Gastroenterol Hepatol ; 11(4): 204-5, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24566879

RESUMEN

Epidemiology studies have shown an ~1% prevalence of coeliac disease in Europe, North America, the Middle East and South America, but the prevalence in the Asia­Pacific region remains relatively unknown. Now, Makharia et al. have proposed much needed recommendations to help tackle the problem of coeliac disease in this region.


Asunto(s)
Enfermedad Celíaca/epidemiología , Gastroenterología/organización & administración , Sociedades Médicas/organización & administración , Humanos
11.
Expert Rev Gastroenterol Hepatol ; 8(2): 123-9, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24417260

RESUMEN

Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals and represents a major health issue. The immune mediated response results in villous atrophy of the small intestine with subsequent malabsorption. The classic mode of presentation is that of a malabsorption syndrome resulting in deficiencies of macro and micronutrients. The gluten-free diet is the only treatment currently available for this disorder. The aim of this special report is to elucidate and explain the various nutritional deficiencies seen in newly diagnosed patients with celiac disease and while on the gluten-free diet. Though initiation of the gluten-free diet results in improvement of symptoms and most deficiencies, certain nutritional limitations are associated with the gluten-free diet.


Asunto(s)
Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/metabolismo , Dieta Sin Gluten , Estado Nutricional , Anemia Ferropénica/etiología , Anemia Ferropénica/metabolismo , Dieta Sin Gluten/efectos adversos , Deficiencia de Ácido Fólico/etiología , Deficiencia de Ácido Fólico/metabolismo , Humanos , Resultado del Tratamiento , Deficiencia de Vitamina B 12/etiología , Deficiencia de Vitamina B 12/metabolismo , Deficiencia de Vitamina D/etiología , Deficiencia de Vitamina D/metabolismo
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