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BACKGROUND: Virtual reality (VR) is an advanced technology that transports users into a virtual world. It has been proven to be effective in pain management via distraction and alteration of pain perception. However, the impact of VR on treating perioperative pain is inconclusive. This systematic review aimed to evaluate the effect of VR on perioperative pain after a gastrointestinal (GI) procedure or surgery. METHODS: A systematic review of randomized controlled trials was conducted from inception to January 31, 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The updated Cochrane risk of bias (RoB 2) assessment tool was used to evaluate the risk of bias. RESULTS: Of 724 articles screened, 8 studies with 678 participants were included in the systematic review. Four studies evaluated the effect of VR on perioperative pain during GI procedure (eg, colonoscopy) focused on its use after GI surgeries (eg, abdominal surgeries). Some studies reported a reduction in pain scores after the procedure; however, the findings of pain difference in before or during vs after the procedure in the VR vs control groups were mixed. CONCLUSION: VR is a promising tool to control perioperative pain after a GI procedure or surgery. Differences in study protocols, pain assessment scales, and pain therapy used were limitations in performing a comprehensive meta-analysis. Further studies are needed to better evaluate the effects of VR on perioperative pain compared with standard of care.
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BACKGROUND AND AIMS: Video capsule endoscopy (VCE) is valuable for assessing conditions like gastrointestinal bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are prescribed for diabetes and weight loss, with their pharmacologic effects including delaying gastric emptying. This study investigates the impact of GLP-1 RA usage on VCE outcomes in patients with diabetes. METHODS: This retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1 RA, matched 1:1 ratio with controls based on demographics and diabetes related factors, who are not on GLP-RA. The primary outcome is gastric transit time in VCE studies, with secondary outcome being incomplete small bowel evaluation and the small bowel transit time. RESULTS: In the 68 GLP-1 RA patient cohort, five (7%) experienced VCE failure to pass through the stomach, while all controls passed successfully (p=0.06). GLP-1 RA patients had longer gastric transit time (99.3 ± 134.2 minutes) compared to controls (25.3 ± 31.6 minutes, p <0.001). Multivariate analysis revealed GLP-1 RA usage was associated with increased gastric transit time by 74.5 minutes (CI: 33.8-115.2, p <0.001) compared to controls, after adjusting on relevant factors. Sixteen GLP-1 RA patients (23.5%) experienced incomplete passage of the VCE through the small intestine, a significantly higher rate compared to three patients in the control group (4.4%) (p<0.01). CONCLUSIONS: GLP-1 RA usage is associated with prolonged gastric transit time and a higher rate of incomplete small bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.
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Nintedanib is a medication that has been increasingly used for treatment of idiopathic and progressive pulmonary fibrosis. In this case series, we describe 3 patients with colitis symptoms associated with nintedanib use. Nintedanib discontinuation resulted in symptomatic resolution in all patients. Budesonide decreased symptoms in 1 patient. Clinicians should be vigilant in taking a thorough medication history and include nintedanib as a cause for gastrointestinal symptoms including colitis.
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Purpose: To compare the risks of adverse outcomes, including mortality, gastrointestinal bleeding, and venous thromboembolism, between COVID-19 patients with inflammatory bowel disease (IBD) and those without IBD. Methods: We analyzed data from the National Inpatient Sample between January and December 2020. The study included adult patients with Crohn's disease (CD) and ulcerative colitis (UC) who contracted COVID-19. Inpatient outcomes were compared between the IBD and non-IBD COVID-19 cohorts. Results: Out of 1,050,045 COVID-19 hospitalizations, 0.28% had CD (2954 patients) and 0.26% had UC (2794 patients). After adjusting for confounding factors, UC patients had a significantly higher risk of deep vein thrombosis compared to non-IBD patients, with an adjusted odds ratio (aOR) of 2.55 (P < 0.001). However, CD patients did not show a significant association with deep vein thrombosis (aOR 1.29, P = 0.329). There were no significant associations between IBD patients (both UC and CD) and pulmonary embolism, nonvariceal gastrointestinal bleeding, or in-hospital mortality. UC patients had a longer average hospital stay (8.25 days) compared to non-IBD patients (adjusted mean difference 0.89, P = 0.007). Healthcare resource utilization was similar among the three groups. Conclusion: Our national study on COVID-19 hospitalizations indicates that patients with IBD have comparable rates of gastrointestinal bleeding, pulmonary embolism, and mortality as those without IBD. However, patients with UC hospitalized with COVID-19 have a higher risk of deep vein thrombosis than COVID-19 patients hospitalized without UC. Further research is needed to better understand the relationship between COVID-19 and IBD.