RESUMEN
BACKGROUND AND AIMS: Numerous endoscopic assist devices exist, yet data surrounding their comparative efficacy is lacking. We conducted a systematic review with network meta-analysis to determine the comparative efficacy of endoscopic assist devices on colonic adenoma detection. METHODS: A systematic search was performed using multiple electronic databases through July 2020, to identify all randomized controlled trials and dual-arm observational studies compared with either other endoscopic assist devices and/or standard colonoscopy. The primary outcome was adenoma detection rate (ADR). Secondary outcomes included polyp detection rate (PDR), serrated adenoma detection rate (SADR), right-sided adenoma detection rate (RADR), and proximal adenoma detection rate (PADR). RESULTS: Fifty-seven studies (31,051 patients) met inclusion criteria and were analyzed. Network meta-analysis identified an enhanced ADR among (clear) cap [odds ratio (OR): 2.69, 95% confidence interval (CI): 1.45-4.99], endocuff, (OR: 4.95, 95% CI: 3.15-7.78), and endoring (OR: 3.68, 95% CI: 1.47-9.20)-with no significant difference amongst any particular device. Similar findings for PDR were also seen. Enhanced SADR was identified for endocuff (OR: 9.43) and endoring (OR: 4.06) compared with standard colonoscopy. Enhanced RADR (OR: 5.36) and PADR (OR: 3.78) were only identified for endocuff. Endocuff comparatively demonstrated the greatest ADR, PDR, and SADR, but this was not significant when compared with the other assist devices. Subgroup analysis of randomized controlled trials identified enhanced PDR and ADR for both cap and endocuff. CONCLUSIONS: Endoscopic assist devices displayed increased ADR and PDR as compared with standard colonoscopy and thus should be widely adopted. A nonsignificant trend was seen toward higher efficacy for the endocuff device.
Asunto(s)
Adenoma , Neoplasias del Colon , Pólipos del Colon , Pólipos , Adenoma/diagnóstico , Neoplasias del Colon/diagnóstico , Colonoscopía , Humanos , Metaanálisis en Red , Oportunidad RelativaRESUMEN
BACKGROUND & AIMS: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. METHODS: We performed a retrospective, international multicenter cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. RESULTS: In our cohort, median age was 49 (40-56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19-29). Survival was 88% (87-89) at 30 days, 77% (76-78) at 90 days, and 72% (72-74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47-0.74; p <0.001). Steroids only improved survival in patients with MELD scores between 21 (HR 0.61; 0.39-0.95; p = 0.027) and 51 (HR 0.72; 0.52-0.99; p = 0.041). The maximum effect of corticosteroid treatment (21-30% survival benefit) was observed with MELD scores between 25 (HR 0.58; 0.42-0.77; p <0.001) and 39 (HR 0.57; 0.41-0.79; p <0.001). No corticosteroid benefit was seen in patients with MELD >51. The type of corticosteroids used (prednisone, prednisolone, or methylprednisolone) was not associated with survival benefit (p = 0.247). CONCLUSION: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. LAY SUMMARY: Alcohol-associated hepatitis is a condition where the liver is severely inflamed as a result of excess alcohol use. It is associated with high mortality and it is not clear whether the most commonly used treatments (corticosteroids) are effective, particularly in patients with very severe liver disease. In this worldwide study, the use of corticosteroids was associated with increased 30-day, but not 90- or 180-day, survival. The maximal benefit was observed in patients with an MELD score (a marker of severity of liver disease; higher scores signify worse disease) between 25-39. However, this benefit was lost in patients with the most severe liver disease (MELD score higher than 51).
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Hepatitis/tratamiento farmacológico , Esteroides/administración & dosificación , Factores de Tiempo , Adulto , Consumo de Bebidas Alcohólicas/tratamiento farmacológico , Consumo de Bebidas Alcohólicas/fisiopatología , Estudios de Cohortes , Femenino , Hepatitis/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Esteroides/uso terapéuticoRESUMEN
BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is an idiopathic, cholestatic liver disease with a diverse range of clinical manifestations. Inter-regional data on PSC are variable, but its global geoepidemiology has not been well-studied. We aimed to examine the worldwide incidence, prevalence and features of PSC and PSC-inflammatory bowel disease (PSC-IBD). METHODS: A systematic search of multiple databases was conducted to identify all original, full-text studies until December 2020 with data regarding the incidence rate (IR) and/or prevalence of PSC. Outcomes were PSC IR, prevalence, features and IBD concurrence. Additionally, a meta-analysis of PSC IR was performed. The study was registered in PROSPERO (CRD42021224550). RESULTS: Of the 1003 studies identified, 17 studies spanning three continents were included. PSC IR was 0.60 per 100 000 person-years (PY) (95% confidence interval: 0.37-0.88 per 100 000 PY). In pooled subgroup analysis for studies conducted in Europe and North America, PSC IR was 0.62 and 0.53 per 100 000 PY, respectively. PSC prevalence ranged 0-31.7 per 100 000 persons, with notable inter-regional differences. Mean age at PSC diagnosis was bimodally distributed, with relative peaks at 15 and 35 years. Mean concurrence of IBD with PSC was 50%, with 76% having ulcerative colitis, 17% Crohn's disease and 8% indeterminate/unspecified IBD. CONCLUSION: While considerable heterogeneity exists in the geoepidemiology of PSC, overall, the classical dogmata of male predilection, bimodal distribution of mean age and high PSC-IBD concurrence appear to hold true. Despite a seemingly stable IR over time, further studies are needed to better understand the geoepidemiology of PSC.
Asunto(s)
Colangitis Esclerosante , Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Colangitis Esclerosante/epidemiología , Colitis Ulcerosa/epidemiología , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/epidemiología , Masculino , PrevalenciaRESUMEN
BACKGROUND AND STUDY AIMS: The utility of water-aided techniques (WT): water exchange (WE) and water immersion (WI) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate. Serrated polyps owing to their location and appearance have a high miss rate. The authors performed a systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method to determine if there was any impact on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate. METHODS: The following databases were queried for this systematic review: Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences. The authors only included randomized controlled trials (RCTs). The primary outcome was SPDR and secondary outcomes were sessile serrated polyp detection rate and cecal intubation rate. Risk ratios (RRs) were calculated for each outcome. A P-value <0.05 was considered to be statistically significant. RESULTS: A total of 4 RCTs (5 arms) with 5306 patients (2571 in the GA group and 2735 in the WT group) were included. The SPDR was significantly increased for the WT group compared with GA (6.1% vs. 3.8%; RR, 1.63; 95% confidence interval, 1.24-2.13; P<0.001; I2=22.7%). A subgroup analysis for WE technique also demonstrated improved SPDR compared with the GA method (4.9% vs. 3.2%; RR, 1.57; 95% confidence interval, 1.15-2.14; P=0.004; I2=6.1%). CONCLUSIONS: WT, particularly, the WE method results in improved SPDR. This technique should be encouraged in a clinical setting to detect these polyps to prevent interval colorectal cancer.
Asunto(s)
Adenoma , Pólipos del Colon , Neoplasias Colorrectales , Adenoma/diagnóstico , Ciego , Pólipos del Colon/diagnóstico , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Humanos , AguaRESUMEN
Blastomycosis is a fungal infection caused primarily by Blastomyces dermatitis. The fungus is endemic to the Ohio, Mississippi, and St. Lawrence River areas of the United States. Organ transplant recipients are at risk of blastomycosis due to pharmacologic immunosuppression. Over a 20-year period, 30 cases of blastomycosis post-solid organ transplantation were identified at our center. The cumulative incidence of blastomycosis among SOT recipients was 0.99%. There was a male predominance (70% male) and a median age of 59 at the time of diagnosis. Regarding transplant type, 23 patients received kidney transplants, 4 received liver transplants, 2 received pancreas transplants and 1 received a heart transplant. Median time to blastomycosis identification post-transplant was 67.8 months (range: 1-188 months). Amphotericin B was used as initiation therapy in most cases, followed by itraconazole, voriconazole, or in select cases fluconazole or posaconazole maintenance therapy. Regarding comorbid conditions, 87% of patients had diabetes, 50% had congestive heart failure, and 20% had chronic pulmonary disease. Nine patients (30%) developed blastomycosis-related acute respiratory distress syndrome, 33% of these died with a median time to death of 22 days (range 20 days to 2 months); these were the only deaths attributable to blastomycosis.
Asunto(s)
Blastomicosis , Trasplante de Órganos , Antifúngicos/uso terapéutico , Blastomicosis/tratamiento farmacológico , Blastomicosis/epidemiología , Femenino , Humanos , Masculino , Trasplante de Órganos/efectos adversos , Estudios Retrospectivos , Estados Unidos , Wisconsin/epidemiologíaRESUMEN
BACKGROUND: Owning to colorectal cancer's (CRC) high mortality, multiple societies developed screening guidelines. AIMS: We aimed to assess the overall quality of CRC screening guidelines. METHODS: A systematic search was performed to review CRC screening guidelines for conflicts of interest (COI), recommendation quality and strength, external document review, use of patient representative, and recommendation age-as per Institute of Medicine (IOM) standards. In addition, recommendations were compared between guidelines/societies. Statistical analysis was conducted using R. RESULTS: Twelve manuscripts were included in final analysis. Not all guidelines reported on COI, provided a grading method, underwent external review, or included patient representation. 14.5%, 34.2%, and 51.3% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 27.8%, 54.6%, and 17.5% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence and strong recommendations did not significantly differ across societies, nor were significant associations between publication year and evidence quality seen (P = 0.4). CONCLUSIONS: While the majority of the CRC guidelines contain aspects of the standards set forth by the IOM, there is an overall lack of adherence. As over 85% of recommendations are based on low-moderate quality evidence, further studies on CRC screening are warranted to improve the overall quality of evidence.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/normas , Medicina Basada en la Evidencia/normas , Guías de Práctica Clínica como Asunto/normas , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Data regarding hospitalization outcomes in patients with inflammatory bowel disease (IBD) with respect to hospital teaching status are largely unknown. AIMS: We aimed to investigate the impact of hospital teaching status on IBD hospitalization outcomes. METHODS: In this retrospective analysis, we queried the 2016 and 2017 National Inpatient Sample (NIS) databases using the International Classification of Diseases 10th revision (ICD-10) coding system. All adult patients with a principal diagnosis of IBD were included. We stratified the IBD group into ulcerative colitis (UC), Crohn's disease (CD), and complicated IBD. Our primary outcome was mortality. Statistical analysis was performed using STATA, version 16.0. RESULTS: Of the 189,950 adult patients with IBD, the majority were admitted to teaching hospitals (70.9%). There was no significant difference in mortality based upon hospital teaching status (aOR 1.18, p = 0.48); however, these patients had an increased mean length of stay (adjusted coefficient: 0.82, p < 0.01), charges (adjusted coefficient: $8732, p < 0.01), and costs ($2871, p < 0.01). On subgroup analysis, patients with UC admitted to teaching hospitals had a significantly increased in-hospital mortality (aOR 2.11, p < 0.05), while those admitted with CD did not (aOR 0.80, p = 0.4). Among patients with complicated IBD, 73.17% were admitted to teaching hospitals, and no significant difference in in-hospital mortality was seen (aOR 1.06, p = 0.8). CONCLUSION: While outcome differences are likely related to multiple unaccounted factors, greater efforts should be placed to cost-effectively manage patients with IBD at teaching institutions. Future studies are warranted to fully comprehend these variations.
Asunto(s)
Hospitales de Enseñanza , Enfermedades Inflamatorias del Intestino/terapia , Adulto , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Masculino , Persona de Mediana Edad , Mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Resultado del Tratamiento , Estados UnidosRESUMEN
Alkylphosphocholine (APC) analogs are a novel class of broad-spectrum tumor-targeting agents that can be used for both diagnosis and treatment of cancer. The potential for clinical translation for APC analogs will strongly depend on their pharmacokinetic (PK) profiles. The aim of this work was to understand how the chemical structures of various APC analogs impact binding and PK. To achieve this aim, we performed in silico docking analysis, in vitro and in vivo partitioning experiments, and in vivo PK studies. Our results have identified 7 potential high-affinity binding sites of these compounds on human serum albumin (HSA) and suggest that the size of the functional group directly influences the albumin binding, partitioning, and PK. Namely, the bulkier the functional groups, the weaker the agent binds to albumin, the more the agent partitions onto lipoproteins, and the less time the agent spends in circulation. The results of these experiments provide novel molecular insights into the binding, partitioning, and PK of this class of compounds and similar molecules as well as suggest pharmacological strategies to alter their PK profiles. Importantly, our methodology may provide a way to design better drugs by better characterizing the PK profile for lead compound optimization.
Asunto(s)
Antineoplásicos/farmacocinética , Diseño de Fármacos , Simulación del Acoplamiento Molecular , Fosforilcolina/farmacocinética , Albúmina Sérica Humana/metabolismo , Animales , Antineoplásicos/química , Humanos , Lipoproteínas/metabolismo , Ratones , Ratones Desnudos , Modelos Biológicos , Neoplasias/sangre , Neoplasias/tratamiento farmacológico , Fosforilcolina/análogos & derivados , Fosforilcolina/químicaRESUMEN
BACKGROUND Erdheim-Chester disease (ECD) is a rare neoplasm of histiocytes that is characterized by prominent involvement of the long bones. Approximately 1500 cases have been reported since the disease was first described in 1930. The imaging appearance of ECD can be highly variable given the numerous systems it can affect. In this case report we discuss a patient whose ECD was occult on multiple imaging modalities. CASE REPORT We report the case of a 60-year-old woman who presented with sub-acute left knee and calf pain that led to an MRI. She was found to have innumerable marrow-replacing lesions in the axial and appendicular skeleton visualized on the initial MRI, as well as on an ¹8F-FDG PET/CT scan. The patient did not have extraosseous abnormal uptake on the PET/CT. Subsequently, a lesion from the left iliac bone was histologically confirmed as ECD on the basis of positive staining for CD68 and CD163 and negative staining for CD1a. Osseous lesions in ECD have a distinct imaging appearance and are typically detected by radiography and bone scintigraphy, among other modalities; however, the lesions in this case were unexpectedly absent from those studies. CONCLUSIONS If there is a high degree of suspicion for ECD, 18F-FDG PET/CT and/or MRI may be necessary for adequate visualization of bone lesions, given that those lesions can have an infiltrative nature that may be difficult to image with other anatomic imaging modalities. Use of 18F-FDG PET/CT and/or MRI may also lead to adequate guidance of confirmatory biopsy.
Asunto(s)
Enfermedad de Erdheim-Chester , Tomografía Computarizada por Tomografía de Emisión de Positrones , Femenino , Humanos , Persona de Mediana Edad , Fluorodesoxiglucosa F18 , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Enfermedad de Erdheim-Chester/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
Middle meningeal artery embolization has become an important option in the management of subdural hemorrhages with multiple prospective studies demonstrating efficacy and randomized controlled trial data on the way. Access to the middle meningeal artery is usually achieved via the external carotid artery to the internal maxillary artery, then the middle meningeal artery. We report a case where a patient with symptomatic left-sided chronic subdural hemorrhage also had an external carotid artery occlusion. Direct puncture of the superficial temporal artery allowed retrograde access to the internal maxillary artery and thus the middle meningeal artery. Successful embolization of the vessel with 1:9 nBCA was performed with near total resorption of the subdural collection by 1 month postprocedure.
RESUMEN
PURPOSE: To develop and evaluate a deep convolutional neural network (DCNN) model for the classification of acute and chronic lung nodules from nontuberculous mycobacterial-lung disease (NTM-LD) on computed tomography (CT). MATERIALS AND METHODS: We collected a data set of 650 nodules (316 acute and 334 chronic) from the CT scans of 110 patients with NTM-LD. The data set was divided into training, validation, and test sets in a ratio of 4:1:1. Bounding boxes were used to crop the 2D CT images down to the area of interest. A DCNN model was built using 11 convolutional layers and trained on these images. The performance of the model was evaluated on the hold-out test set and compared with that of 3 radiologists who independently reviewed the images. RESULTS: The DCNN model achieved an area under the receiver operating characteristic curve of 0.806 for differentiating acute and chronic NTM-LD nodules, corresponding to sensitivity, specificity, and accuracy of 76%, 68%, and 72%, respectively. The performance of the model was comparable to that of the 3 radiologists, who had area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy of 0.693 to 0.771, 61% to 82%, 59% to 73%, and 60% to 73%, respectively. CONCLUSIONS: This study demonstrated the feasibility of using a DCNN model for the classification of the activity of NTM-LD nodules on chest CT. The model performance was comparable to that of radiologists. This approach can potentially and efficiently improve the diagnosis and management of NTM-LD.
Asunto(s)
Aprendizaje Profundo , Neoplasias Pulmonares , Neumonía , Humanos , Redes Neurales de la Computación , Tomografía Computarizada por Rayos X/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Estudios Retrospectivos , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
INTRODUCTION: Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date. METHODS: We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA. RESULTS: Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt. CONCLUSION: Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.
RESUMEN
BACKGROUND: Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn's disease (CD) remains limited. AIM: To systematically review the global variation in the rates of surgery in CD. METHODS: A comprehensive search analysis was performed using multiple electronic databases from inception through July 1, 2020, to identify all full text, randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with CD. Outcomes included continent based demographic data, CD surgery rates over time, as well as the geoepidemiologic variation in CD surgery rates. Statistical analyses were conducted using R. RESULTS: Twenty-three studies spanning four continents were included. The median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America, Europe, Asia, and Oceania were 30% (range: 1.7%-62.0%), 40% (range: 0.6%-74.0%), 17% (range: 16.0%-43.0%), and 38% respectively. No clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America (R 2 = 0.035) and Europe (R 2 = 0.100). A moderate, negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time (R 2 = 0.520) in Asia. CONCLUSION: There appears to be significant inter-continental variation regarding surgery rates in CD. Homogenous evidence-based guidelines accounting for the geographic differences in managing patients with CD is prudent. Moreover, as a paucity of data on surgery rates in CD exists outside the North American and European continents, future studies, particularly in less studied locales, are warranted.
RESUMEN
BACKGROUND: The increasing complexity and sophistication of neurovascular implants and other therapeutic devices depend on access and delivery systems. Advancements in access technologies are required to improve minimally invasive endovascular procedures. Steerable catheters have been available in other disciplines, however, their implementation in neurovascular interventions has been a barrier previously due to issues with miniaturization and vascular caliber/complexity. METHODS: A retrospective review of the neurovascular stroke database was conducted in accordance with local IRB to identify patients that received neurointerventional endovascular procedures using a novel first iteration 0.021'' microcatheter with controlled articulating tip flexion. Indications, management, demographics, comorbidities, and clinical and technical outcomes were recorded and analyzed. Primary operator feedback on the novel catheter was collected and reviewed. RESULTS: Ten consecutive patients receiving treatment that involved a novel steerable 0.021'' microcatheter were identified and analyzed. No complications were reported. Novel useful features of the catheter were reported on a case-by-case basis. CONCLUSIONS: Initial clinical experience with the controlled articulation that permits flexion at the tip of the microcatheter demonstrated it to be safe. Access to difficult proximal origin curves, and distal clinoidal/ophthalmic segment anatomy may be improved due to the high torque transmission, and acute angulation of this microcatheter. Further experience with the delivery of therapeutic devices will be necessary to better understand the potential role that the present catheter may play in modern neurointerventional procedures.
RESUMEN
Background and study aims Data regarding endoscopic findings and symptom correlation in patients with gastroesophageal reflux disease (GERD) symptoms are largely limited to single-center experiences. We performed a nationwide study to examine the association between patient-reported GERD symptoms and clinically relevant endoscopic findings. Patients and methods Using the National Endoscopic Database, we retrospectively identified all esophagogastroduodenoscopies (EGDs) performed for GERD symptoms from 2000 to 2014.âPatients were categorized into three symptom groups: 1) typical reflux only (R); 2) airway only (A); and 3) both R and A (Râ+âA). Outcomes were the point prevalence of endoscopic findings in relation to patient-reported GERD symptom groups. Statistical analyses were performed using R. Results A total of 167,459 EGDs were included: 96.8â% for R symptoms, 1.4â% for A symptoms, and 1.8â% for Râ+âA symptoms. Of the patients, 13.4â% had reflux esophagitis (RE), 9.0â% Barrett's esophagus (BE), and 45.4â% hiatal hernia (HH). The Râ+âA group had a significantly higher point prevalence of RE (21.6â% vs. 13.3â% and 12â%; P â<â0.005) and HH (56.9â% vs. 45.3â% and 38.3â%; P â<â0.005) compared to the R or A groups, respectively. The R group had a significantly higher point prevalence of BE compared to the A or Râ+âA groups, respectively (9.1â% vs. 6.1â% and 6.1â%, P â<â0.005). Conclusions On a national level, patients experiencing Râ+âA GERD symptoms appear more likely to have RE and HH, while those with only R symptoms appear more likely to have BE. These real-world data may help guide how providers and institutions approach acid-suppression therapy, set thresholds for recommending EGD, and develop management algorithms.
RESUMEN
BACKGROUND: Reactive gastropathy (RG) is an adaptive response to assaults of the gastric mucosa. Demographic information regarding RG as well as the coincidence of RG and gastrointestinal cancer are poorly characterized entities. OBJECTIVE: Herein, we aim to investigate relationships of RG to both modifiable and nonmodifiable risk factors, as well as conduct a stratified analysis by race in an ethnically diverse, urban population. METHODS: In this retrospective study, we queried an urban hospital inpatient pathology database searching for patients with surgical gastric biopsies positive for RG between March 25, 2015, and March 25, 2016. Of the 728 patients with a final diagnosis of RG, 292 were selected based on strict inclusion and exclusion criteria. We explored risk factors and conducted a stratified analysis for associations based on patient demographics. RESULTS: In this urban minority population, nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication associated with RG (Fig. 1), as well as the most common cause of RG, followed by chronic bile reflux. In addition, significant differences in demographics and gastropathic characteristics associated with RG, stratified by ethnicity, were found (Fig. 2). Notably, Hispanics, African Americans, and Caucasians had the highest rate of concomitant RG and diabetes, hypertension, and tobacco/alcohol use, respectively. CONCLUSION: Our study indicated that NSAID usage is the most common cause of RG, followed by bile reflux-mediated mucosal injury, in an ethnically diverse urban US-based population. Of note, few patients had intestinal metaplasia, suggesting it to be a slow or negligent sequela of RG.
RESUMEN
BACKGROUND AND AIMS: Quality metrics were established to develop standards to help assess quality of care, yet variation in inflammatory bowel disease (IBD) clinical practice exists. We performed a systematic review to assess the overall quality of evidence cited in formulating IBD quality metrics. METHODS: A systematic search was performed on PubMed, MEDLINE, and EMBASE. All major national and international IBD societies were included. Quality metrics were assessed for evidence quality and categorized as category A (guideline based), category B (primarily retrospective and observational studies) or category C (expert opinion). Quality metrics were examined for the type of metric, the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the metric. Statistical analysis was conducted in R. RESULTS: A total of 143 distinct, and an aggregate total of 217 quality metrics were included and analyzed. 68%, 3.2%, and 28.6% of IBD quality metrics were based on low, moderate, and high quality of evidence, respectively. The proportion of high quality evidence across societies was significantly different (P <0.01). Five organizations included patients in quality metric development, three reported external review, not all reported measurable outcomes or stated the presence of a COI. Finally, 43% of quality metrics were published more than 5 years ago. CONCLUSIONS: Quality metrics are important to standardize practice. As more than two-thirds of the quality metrics in IBD are based on low quality evidence, further studies are needed to improve the overall quality of evidence supporting the development of quality measures.
RESUMEN
Primary sclerosing cholangitis (PSC) is a chronic, progressive, hepatobiliary disease characterized by inflammation and fibrosis of the intra- and extra-hepatic bile ducts. Its natural history is one that generally progresses towards cirrhosis, liver failure, cholangiocarcinoma, and ultimately disease-related death, with a median liver transplantation-free survival time of approximately 15-20 years. However, despite its lethal nature, PSC remains a heterogenous disease with significant variability in outcomes amongst different regions of the world. There are also many regions where the outcomes of PSC have not been studied, limiting the overall understanding of this disease worldwide. In this review, we present the geoepidemiologic variations in outcomes of PSC, with a focus on survival pre- and post-liver transplantation as well as the concurrence of inflammatory bowel disease and hepatobiliary neoplasia.