Antiplatelet therapy associated with lower prevalence of advanced liver fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis.

Despite the growing disease burden of non-alcoholic fatty liver disease (NAFLD), approved medical treatments to improve or prevent liver fibrosis are effective only in a small number of patients. Recent studies have found the new use of antiplatelet agents for antifibrotic benefits in NAFLD, but human studies are still limited. The goal of this meta-analysis was to combine the findings of existing relevant studies to investigate the effects of antiplatelet therapy in reducing or preventing advanced liver fibrosis in patients with NAFLD. We conducted a systematic literature search in PubMed, EMBASE, and Web of Science databases from inception to January 2021 to identify all original studies that investigated the use of antiplatelet agents in patients with NAFLD. We used the National Institutes of Health's quality assessment tool for observational cohort and cross-sectional studies to assess study quality and risk of bias. The primary outcome was the prevalence of advanced liver fibrosis stage 3-4. Data from each study was combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled odds ratio (OR) and 95% confidence intervals (CIs). Of the 2,498 studies identified, 4 studies involving 2,593 patients with NAFLD were included in this study (949 antiplatelet agent users and 1,644 non-antiplatelet agent users). The use of aspirin and/or P2Y12 receptor inhibitors was associated with a lower pooled OR of advanced liver fibrosis in patients with NAFLD (pooled OR = 0.66; 95% CI: 0.53-0.81, I2 = 0.0%; p < 0.001). This study focuses on the outcome of advanced liver fibrosis in patients with NAFLD. Our study is limited by the small number of studies that were included. Preliminary evidence from this meta-analysis suggests a protective association between antiplatelet therapy and the prevalence of advanced liver fibrosis in patients with NAFLD. Our findings support future research into repositioning an antiplatelet agent as a novel NAFLD treatment.

Impact of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Renal Function in Chronic Kidney Disease Patients Undergoing Coronary Angiography.

BACKGROUND: Cardiac catheterizations and coronary angiography are minimally invasive methods for studying the heart and the coronary arteries, using iodinated radiocontrast agents which can cause acute kidney injury (AKI). Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) are widely used due to their well-established benefit in coronary artery disease and renal protection in diabetes mellitus. Renin-angiotensin-aldosterone system inhibitors can induce AKI in some patients. METHOD: This study analyzed the effect of radiocontrast media used for coronary angiography on renal function in patients with chronic kidney disease (CKD) stages 2-5 who also took ACE inhibitors/ARB medications. Information was collected from the electronic medical records of 116 cases to determine changes in serum creatinine following angiography.  Result: The average age of patients was 65.2 ± 12.3 years. There were 89 men (76.7%) and 27 women (23.3%). Six patients had documented ACE inhibitor discontinuation, and one patient had documented ARB discontinuation prior to their procedures. Based on the criteria of an increase in serum creatinine (SCr) by ≥0.3 mg/dl within 48 hours, 19 cases (16.4%) had AKI. Based on the criteria of increasing in SCr to ≥ 1.5 times baseline, AKI developed in 2 cases (1.7%) on day 1, 4 cases (3.5%) on day 2, and 7 cases (6.0%) on day 3 after coronary angiography. CONCLUSION: This study suggests that the continuation of ACE inhibitors/ARB does not appear to have any important effect or association with changes in renal function, within one-month post angiography in patients with CKD stages 2-5.

Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis.

BACKGROUND AND AIM: Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta-analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E). METHODS: The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS: Six randomized controlled trials were included in the meta-analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20-21.20) and propofol (15.58; 95% Cl: 3.27-27.89) in the E-C group compared with the C-E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E-C group than in the C-E group with pooled MD of 0.64 points (95% Cl: 0.09-1.20) and 0.47 (95% Cl: 0.05-0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups. CONCLUSION: The present study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence.

Usefulness of the ReShape intragastric balloon for obesity.

Intragastric balloon (IGB) is approved for weight reduction in obesity patients who have a body mass index (BMI) of 30 to 40 kg/m2. The effectiveness of IGB in various degrees of obesity is not well established. We aimed to study the effect and safety of IGB in different groups of obese patients. A retrospective study was performed. All patients who underwent placement of the ReShape™ gastric balloon and completed a 6-month follow-up were included. There were 35 gastric balloons in 34 patients who had a baseline body weight of 106.5 ± 23.5 kg and a BMI of 37.1 ± 5.5 kg/m2. After IGB removal, total body weight was reduced 6.8 ± 7.3% (P < 0.001) and the BMI reduction was 2.7 ± 2.9 kg/m2 (P < 0.001). Subgroup analysis showed that patients with BMI >40 kg/m2 also had significant reduction of total body weight and BMI. The diastolic blood pressure was reduced by 4.7 ± 12.3 mm Hg (P = 0.03) after balloon removal. The most common complication was nausea in 22.9%. One patient had balloon migration leading to small bowel obstruction. One patient had a bleeding gastric ulcer. In summary, IGBs are an effective method to assist in weight loss in patients with various degrees of obesity, even with a BMI >40 kg/m2, with minor adverse effects.

Gastrointestinal Polyps and Hemorrhage as a Presentation of Primary Systemic Light Chain Amyloidosis.

Light-chain amyloidosis is caused by deposition of immunoglobulin light chains within multiple organs, including the gastrointestinal (GI) tract. Gastrointestinal hemorrhage is a less frequent presentation. Endoscopic findings are nonspecific, and bleeding mucosal polyps are rare. We report a 59-year-old Hispanic woman with a history of gastric polyps who presented with recurrent GI hemorrhage from mucosal polyps. She had periorbital purpura and macroglossia. Biopsy of the gastric polyp confirmed amyloid deposition. Bonemarrow biopsy revealed plasma cell myeloma. She was treated with endoscopic intervention and arterial embolization to control the bleeding, and with chemotherapy for multiple myeloma.

Meta-analysis comparing the effects of statins on the risk of Clostridium difficile diarrhea.

A literature search was performed through May 2017. Studies that compared the risk of developing Clostridium difficile infection (CDI) and/or the clinical outcomes of CDI in patients who received statin treatment versus those who did not receive statins were included. Ten observational studies with 37,109 patients were included. Compared to no treatment, statins reduced the risk of CDI development (odds ratio [OR] = 0.66, 95% confidence interval [CI], 0.44-0.99). However, among patients who developed CDI, the use of statins did not significantly reduce recurrent CDI risk (OR = 0.69, 95% CI, 0.28-1.71) or 30-day mortality (OR = 0.77, 95% CI, 0.51-1.14). In conclusion, our study demonstrates a significant association between statin use and a reduced risk of CDI development. However, the findings of our study suggest no significant associations between statin use and improvement in clinical outcomes of CDI. These findings might impact the clinical management and primary prevention of CDI.