Cirrhosis and Portal Hypertension Worsen Bowel Preparation for Screening Colonoscopy.

BACKGROUND: Colonoscopy is a diagnostic and therapeutic procedure that reduces colorectal cancer incidence and mortality but requires adequate bowel cleansing for high-quality examination. Past studies have suggested cirrhosis as a risk factor for worse bowel preparation. METHODS: We carried out a match-controlled retrospective study evaluating patients with and without cirrhosis who underwent outpatient screening colonoscopies to assess the effect of cirrhosis and portal hypertension complications on preparation quality and endoscopic measures. We also did a subgroup analysis excluding patients with obesity. RESULTS: We examined 1464 patients with cirrhosis and matched controls. Cirrhotic patients had lower mean Boston Bowel Preparation Scale (BBPS) scores and slower cecal intubation times. We found a single point increase in the Model for End-stage Liver Disease (MELD) score, as well as ascites, hepatic encephalopathy, and variceal hemorrhage were all associated with a longer cecal intubation time. Subgroup analysis excluding patients with obesity again found a significantly lower BBPS score and longer cecal intubation time while also finding a 24% drop in polyp detection. CONCLUSIONS: Patients with cirrhosis have worse BBPS scores and longer cecal intubation times. Nonobese cirrhotic patients additionally have a lower polyp detection rate. Portal hypertension complications were associated with worsened preparation quality and longer cecal intubation times. Each incremental increase in MELD score lengthened cecal intubation time. These findings support a more aggressive bowel preparation strategy for patients with cirrhosis, especially patients with severe disease or portal hypertension complications.

Takotsubo syndrome after receiving the COVID-19 vaccine.

The coronavirus disease (COVID)-19 pandemic has affected millions worldwide with prevention efforts culminating in the development of a vaccine. An mRNA vaccine, developed by Moderna (Cambridge, MA, USA), mounts an immunologic response leading to antibody neutralization. Commonly reported vaccine side effects include myalgia, fever, and chills, with low reported rates of cardiovascular events. This case demonstrates the development of takotsubo syndrome (TTS) after administration of the COVID-19 vaccine. A 73-year-old woman with recently diagnosed myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) presented with typical chest pain starting less than a day after receiving the Moderna vaccine. She had troponin elevations and new ST-segment abnormalities. Transthoracic echocardiogram (TTE) findings were consistent with mid-ventricular TTS. Treatment included diuretics, beta-blockers, and angiotensin receptor blockers. Prior to discharge, repeat imaging showed improvement in systolic function. This case presents a post-menopausal woman with a recent diagnosis of MINOCA who developed TTS shortly after receiving the COVID-19 vaccine. Risk factors including sex, age, MINOCA, anxiety about the vaccine, and possibly the vaccine itself may have all contributed to the TTS presentation. TTS may occur after COVID-19 vaccination, and appreciation of this potential rare association is important for evaluating vaccine safety and optimizing patient outcomes. .