Newly Diagnosed Patients with Inflammatory Bowel Disease: The Relationship Between Perceived Psychological Support, Health-Related Quality of Life, and Disease Activity.

Background: Newly diagnosed patients with inflammatory bowel disease (IBD) encounter many physical, mental, and social uncertainties. In other chronic diseases, patients having access to disease-specific information and psychological support adhere better to medical regimens. Currently, there is a paucity of data on how newly diagnosed patients with IBD interact with their medical providers. Methods: Patients diagnosed with IBD within 5 years completed a series of questionnaires related to heath-related quality of life (HRQoL), disease activity, health education resources, medical provider relationship, and psychological support. Results: A total of 89 patients were included in the study. IBD activity correlated with disease-specific quality of life (r=-0.69, p<0.0001). Patient satisfaction with gastroenterologist interaction correlated with HRQoL (r=0.33, p=0.04) and disease activity for Crohn's disease (CD) patients (Harvey Bradshaw Index, r=-0.52, p<0.001). Eleven percent of recently diagnosed patients reported receiving educational or psychological support as part of their treatment program, whereas 42% of patients believed that they would benefit from having these types of support incorporated in their treatment protocol. Discussion: In patients with newly diagnosed CD, the patients' perceived relationship with their medical provider was closely related to both HRQoL and disease activity. More attention to education, support, and the doctor-patient relationship at diagnosis could result in better patient outcomes.

Antibiotic therapy in acute gastroenteritis: a single-center retrospective cohort study.

BACKGROUND: Acute gastroenteritis (AGE) is a common reason for emergency department visits and hospitalizations. The role of antibiotics in AGE is unclear, as the current literature shows only a minor impact on the duration of symptoms and the overall clinical course. Our goal was to assess whether antibiotic therapy in patients with AGE affects the length of hospital stay (LOS). METHODS: In a retrospective study, we evaluated 479 patients admitted to the hospital with a diagnosis of AGE. The study compared the 219 patients (46%) treated with antibiotics to the remainder treated with supportive therapy. The diagnosis of AGE was made either clinically or based on imaging findings. The primary outcome of this study was to compare the LOS in days between both groups. RESULTS: Patients treated with antibiotics had a similar LOS to those treated with supportive therapy (2.62 vs. 2.66 days, P=0.77). Patients with presumed sepsis had a higher likelihood of receiving antibiotics compared to those without presumed sepsis (risk ratio 1.49, 62.5% vs. 41.95%; P<0.001). In this subgroup, patients who received antibiotics had a slightly shorter LOS than those who received only supportive therapy, but the difference was not statistically significant (2.09 vs. 2.54 days, P=0.69). CONCLUSION: We found no difference in the LOS for hospitalized patients with AGE treated with antibiotics when compared to supportive therapy. This calls into question the role of antibiotics in the management of AGE.

Endoscopic band ligation versus endoscopic hemoclip placement for Dieulafoy's lesion: a meta-analysis.

Dieulafoy lesions (DL) are abnormally large arterial lesions that fail to decrease in size as they emerge from the submucosa to the mucosal surface. Endoscopic treatment has become the mainstay of therapy for actively bleeding DL lesions. In this meta-analysis, we aim to assess the efficacy of both techniques in achieving primary hemostasis of actively bleeding DL lesions and their rates of rebleeding. Our search included the Pubmed, Scopus and CINAHL electronic databases. The initial search yielded 440 articles and after appropriate review by 2 individual reviewers, 5 studies met inclusion criteria. Review manager version 5.3 was used for statistical analysis. There were 75 patients treated with EBL and 87 patients treated with EHC. The success rate of primary hemostasis of EBL for bleeding DL lesions was 0.96 [95% confidence interval (CI): 0.88-0.99]. The success rate of primary hemostasis of EHC for bleeding DL lesions was 0.91 (95% CI: 0.83-0.96). The recurrence of bleeding for patients treated with EBL was 0.06 (95% CI: 0.02-0.15). The recurrence of bleeding for patients treated with EHC was 0.17 (95% CI: 0.10-0.28). There was no statistical significance in primary hemostasis or rebleeding in patients treated with EBL or EHC. There was no significant heterogeneity between studies included in the analysis. Endoscopic band ligation and endoscopic hemoclip placement are efficacious procedures for the treatment of NVUGIB secondary to DL with similar rates of primary hemostasis and rebleeding.

Cardiac amyloidosis: pathogenesis, clinical context, diagnosis and management options.

Amyloidosis covers a group of disorders that can manifest in virtually any organ system in the body and is thought to be secondary to misfolding of extracellular proteins with subsequent deposition in tissues. The precursor protein that is produced in excess defines the specific amyloid type. This requires histopathological confirmation using Congo-red dye with its characteristic demonstration of green birefringence under cross-polarized light. There are three main types of amyloidosis associated with cardiac involvement: light-chain (AL), familial or senile (ATTR), and secondary (AA) amyloidosis. The frequency of cardiac involvement and prognosis varies among each type. Amyloid cardiomyopathy commonly manifests as heart failure and the presenting features are usually dyspnoea, oedema, angina, pre-syncope and syncope. The diagnosis of cardiac amyloidosis is very hard and can easily be misdiagnosed. Although the imaging studies (such as echocardiography and cardiovascular magnetic resonance) may guide the diagnosis, tissue biopsy is needed for confirmation. Management of cardiac amyloidosis initially is to treat the underlying heart failure. Pacemaker implantation is usually required in patients with any conduction abnormalities. Transplantation is the next step with worsening heart failure. However, the aim of any treatment in amyloidosis, irrespective of type, is to prevent further deposition of amyloid while managing concurrent symptoms. In this manuscript, we will discuss the pathogenesis of cardiac amyloidosis, diagnostic methods and management options.

A Fixed Stricture on Routine Cross-sectional Imaging Predicts Disease-Related Complications and Adverse Outcomes in Patients with Crohn's Disease.

BACKGROUND: Patients with Crohn's disease (CD) typically undergo multiple cross-sectional imaging exams including computed tomography and magnetic resonance enterography during the course of their disease. The aim was to identify imaging findings that predict future disease-related poor outcomes. METHODS: This was a retrospective, case control study at a single tertiary center. Cases were CD patients diagnosed with complications (bowel obstruction, perforation, internal fistula, or abscess); controls were CD patients without complications. Two radiologists blinded to clinical outcomes, independently scored cross-sectional imaging examinations obtained before the complication. RESULTS: One hundred eight patients (67 F; 41 M) with CD (51 cases; 57 controls) were included. For the cases, 21 had internal fistulae, 15 had bowel obstructions, 13 had abdominal abscesses, and 2 developed bowel perforations. Patients with complications were more likely to have a fixed small bowel stricture on cross-sectional imaging (P = 0.01). A patient with a stricture and upstream dilatation was 3.4 times more likely to develop a complication in the next 2 years. When present in the setting of hypervascularity and/or evidence of active inflammation, the risk increased further to 15-fold. Cases were more likely to be active smokers (29% versus 12%, P = 0.033). Cases had more evidence of inflammation based on higher Harvey Bradshaw Index values and inflammatory biomarkers and lower hemoglobin values. CONCLUSIONS: Information from radiologic studies, especially the presence of fixed strictures, can predict future CD complications. These findings, along with smoking and ongoing inflammation, should alert the clinician to the possibility of future complications.

Coronary artery disease in patients with body mass index ≥30 kg/m(2): a retrospective chart analysis.

OBJECTIVE: In this study, we evaluated obesity as a single risk factor for coronary artery disease (CAD), along with the synergistic effect of obesity and other risk factors. METHODS: A retrospective study of 7,567 patients admitted to hospital for chest pain from 2005 to 2014 and underwent cardiac catheterization. Patients were divided into two groups: obese and normal with body mass index (BMI) calculated as ≥30 kg/m(2) and <25, respectively. We assessed the modifiable and non-modifiable risk factors in obese patients and the degree of CAD. RESULTS: Of the 7,567 patients who underwent cardiac catheterization, 414 (5.5%) had a BMI ≥30. Of 414 obese patients, 332 (80%) had evidence of CAD. Obese patients displayed evidence of CAD at the age of 57 versus 63.3 in non-obese patients (p<0.001). Of the 332 patients with CAD and obesity, 55.4% had obstructive CAD versus 44.6% with non-obstructive CAD. In obese patients with CAD, male gender and history of smoking were major risk factors for development of obstructive CAD (p=0.001 and 0.01, respectively) while dyslipidemia was a major risk factor for non-obstructive CAD (p=0.01). Additionally, obese patients with more than one risk factor developed obstructive CAD compared to non-obstructive CAD (p=0.003). CONCLUSION: Having a BMI ≥30 appears to be a risk factor for early development of CAD. Severity of CAD in obese patients is depicted on non-modifiable and modifiable risk factors such as the male gender and smoking or greater than one risk factor, respectively.