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Mesenteric Infarction With Cerebral Thrombotic Relapses and Pulmonary Embolism Two and Four Months After COVID-19. 新冠肺炎后2个月和4个月肠系膜梗死伴脑血栓性复发和肺栓塞。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1525
Henrique Jose Pereira de Godoy, Guilherme Marum Olmedo, Jose Maria Pereira de Godoy, Paulo Cesar Espada

The aim of the present study was to report different sites of thrombotic events during and after coronavirus disease 2019 (COVID-19) in a 49-year-old patient who had acute mesenteric infarction in acute phase, stroke 2 months after and pulmonary thromboembolism 4 months after infection by COVID-19. The obese, previously healthy patient experienced myalgia and headache with subfebrile peaks and was tested positive for COVID-19 with a fast polymerase chain reaction (PCR) assay. Ten days after the onset of symptoms, the patient was submitted to exploratory laparotomy, which revealed 20 cm of small intestine loop with signs of suffering and thickening of the wall approximately 120 cm from the ileocecal valve. Two months after the event, angiotomography was performed, revealing effacement of the sulci in the right parietal region and hypersignal of the right middle cerebral artery with stop in M1. Two months later (4 months after the mesenteric infarction), chest angiotomography revealed signs of acute pulmonary thromboembolism, with no typical image of pulmonary infarction. Despite all these complications in the postoperative period, the patient survived.

本研究的目的是报告一名49岁的冠状病毒病2019 (COVID-19)患者在急性期急性肠系膜梗死、2个月后卒中和4个月后肺血栓栓塞的不同部位血栓形成事件。这名肥胖、先前健康的患者出现了肌痛和头痛,伴有低体温高峰,并通过快速聚合酶链反应(PCR)试验检测出COVID-19阳性。出现症状10天后,患者行剖腹探查,发现距回盲瓣约120厘米处有20厘米的小肠袢,有痛苦和肠壁增厚的迹象。事件发生2个月后,行血管断层扫描,显示右侧顶叶沟消失,右侧大脑中动脉高信号,M1停止。2个月后(肠系膜梗死后4个月),胸部血管造影显示急性肺血栓栓塞征象,未见典型的肺梗死征象。尽管术后出现了这些并发症,患者还是存活了下来。
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引用次数: 0
Trends of Upper Gastrointestinal Bleeding Mortality in the United States Before and During the COVID-19 Era: Estimates From the Centers for Disease Control WONDER Database. 新冠肺炎时代前后美国上消化道出血死亡率趋势:来自疾病控制中心WONDER数据库的估计。
IF 1.5 Pub Date : 2023-06-01 Epub Date: 2023-06-11 DOI: 10.14740/gr1626
Nooraldin Merza, Ahmed Taher Masoud, Zohaib Ahmed, Dushyant Singh Dahiya, Ali Nawras, Abdallah Kobeissy

Background: There have been reports of increased upper gastrointestinal bleeding (UGIB) in patients with coronavirus disease 2019 (COVID-19). Still, only a few studies have examined the mortality rate associated with UGIB in the United States before and during COVID-19. Hereby, we explored the trends of UGIB mortality in the United States before and during COVID-19. The study's objective was to investigate whether the COVID-19 pandemic significantly impacted UGIB mortality rates in the USA.

Methods: The decedents with UGIB were included. Age-standardized mortality rates were estimated with the indirect method using the 2000 US Census as the standard population. We utilized the deidentified data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Linear regression analysis was performed to determine 2021 projected mortality rates based on trends between 2012 and 2019 to quantify the association of the pandemic with UGIB-related deaths.

Results: The mortality rate increased from 3.3 per 100,000 to 4.3 per 100,000 among the population between 2012 and 2021. There was a significant increase in the overall mortality rate between each year and the following year from 2012 to 2019, ranging from 0.1 to 0.2 per 100,000, while the rise in the overall mortality rate between each year and 2021 ranges from 0.4 to 0.9 per 100,000.

Conclusions: Our results showed that the mortality rate increased among the population between 2012and 2021, suggesting a possible influence of COVID-19 infection on the incidence and mortality of UGIB.

背景:有报道称2019冠状病毒病(新冠肺炎)患者上消化道出血(UGIB)增加。尽管如此,只有少数研究检查了新冠肺炎之前和期间美国与UGIB相关的死亡率。在此,我们探讨了新冠肺炎之前和期间美国UGIB死亡率的趋势。该研究的目的是调查新冠肺炎大流行是否显著影响了美国的UGIB死亡率。方法:包括患有UGIB的死者。年龄标准化死亡率是以2000年美国人口普查为标准人群,采用间接法估算的。我们使用了来自疾病控制和预防中心流行病研究广域在线数据(CDC WONDER)数据库的未识别数据。根据2012年至2019年的趋势,进行了线性回归分析,以确定2021年的预计死亡率,从而量化疫情与UGIB相关死亡的关联。结果:2012年至2021年间,人口死亡率从每100000人3.3人上升到每100000人4.3人。从2012年到2019年,每年和次年的总死亡率都有显著上升,从0.1到0.2‰,而从每年到2021年,总死亡率的上升幅度从0.4到0.9‰,提示新冠肺炎感染可能对UGIB的发病率和死亡率产生影响。
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引用次数: 0
Intestinal Parasitic Infections in 2023. 2023年的肠道寄生虫感染。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1622
Monjur Ahmed

Intestinal parasites include intestinal protozoa and intestinal helminths. Intestinal parasitic infections (IPIs) pose a global health problem affecting over one billion people worldwide. Although these infections are predominantly seen in the developing world, they are frequently seen in the developed countries, particularly in immunocompromised patients. Patients' clinical presentations generally include diarrhea, dysentery, abdominal pain, nausea, vomiting, nutritional deficiency, iron deficiency anemia, anal and perianal itching, and rarely intestinal obstruction. The intestinal parasites have similarities in their mode of transmission and life cycle. The stool test is the primary way of diagnosing IPIs. Treatment is given with various anti-parasitic agents. However, appropriate preventive measures are essential for successfully controlling the IPIs.

肠道寄生虫包括肠道原生动物和肠道蠕虫。肠道寄生虫感染是一个全球性的健康问题,影响到全世界超过10亿人。虽然这些感染主要发生在发展中国家,但也经常发生在发达国家,特别是免疫功能低下的患者。患者临床表现一般为腹泻、痢疾、腹痛、恶心、呕吐、营养缺乏、缺铁性贫血、肛门及肛周瘙痒,少见肠梗阻。肠道寄生虫在传播方式和生命周期上有相似之处。大便检查是诊断ipi的主要方法。使用各种抗寄生虫剂进行治疗。然而,适当的预防措施对于成功控制ipi至关重要。
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引用次数: 0
Independent Predictors and Causes of Thirty-Day Gastrointestinal Readmissions Following COVID-19-Related Hospitalizations: Analysis of the National Readmission Database. covid -19相关住院后30天胃肠道再入院的独立预测因素和原因:对国家再入院数据库的分析
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1623
Robert Kwei-Nsoro, Bashar Attar, Hafeez Shaka, Pius Ojemolon, Muhammad Sana, Abdul Tawab Shaka, Naveen Baskaran, Philip Kanemo, Mohankumar Doraiswamy

Background: The coronavirus disease 2019 (COVID-19) pandemic led to significant mortality and morbidity in the United States. The burden of COVID-19 was not limited to the respiratory tract alone but had significant extrapulmonary manifestations. We decided to examine the causes, predictors, and outcomes of gastrointestinal (GI)-related causes of 30-day readmission following index COVID-19 hospitalization.

Methods: We used the National Readmission Database (NRD) from 2020 to identify hospitalizations among adults with principal diagnosis of COVID-19. We identified GI-related hospitalizations within 30 days of index admission after excluding elective and traumatic admissions. We identified the top causes of GI-related readmission, and the outcomes of these hospitalizations. We used a multivariate Cox regression analysis to identify the independent predictors of readmission.

Results: Among 1,024,492 index hospitalizations with a primary diagnosis of COVID-19 in the 2020 NRD database, 644,903 were included in the 30-day readmission study. Of these 3,276 (0.5%) were readmitted in 30 days due to primary GI causes. The top five causes of readmissions we identified in this study were GI bleeding, intestinal obstruction, acute diverticulitis, acute pancreatitis, and acute cholecystitis. Multivariate Cox regression analysis done adjusting for confounders showed that renal failure, alcohol abuse, and peptic ulcer disease were associated with increased odds of 30-day readmission from GI-related causes.

Conclusions: GI manifestations of COVID-19 are not uncommon and remain an important cause of readmission. Targeted interventions addressing the modifiable predictors of readmission identified will be beneficial in reducing the burden on already limited healthcare resources.

背景:2019冠状病毒病(COVID-19)大流行在美国导致了显著的死亡率和发病率。COVID-19的负担不仅限于呼吸道,而且具有明显的肺外表现。我们决定研究指数COVID-19住院后30天再入院的胃肠道(GI)相关原因、预测因素和结果。方法:我们使用2020年以来的国家再入院数据库(NRD)来确定以COVID-19为主要诊断的成人住院情况。在排除选择性和创伤性住院后,我们确定了指数入院后30天内与gi相关的住院。我们确定了gi相关再入院的主要原因,以及这些住院治疗的结果。我们使用多变量Cox回归分析来确定再入院的独立预测因素。结果:在2020年NRD数据库中以初步诊断为COVID-19的1,024,492例指数住院患者中,有644,903例纳入了30天再入院研究。其中3,276例(0.5%)因原发性胃肠道原因在30天内再次入院。我们在这项研究中确定的再入院的前五大原因是胃肠道出血、肠梗阻、急性憩室炎、急性胰腺炎和急性胆囊炎。校正混杂因素的多因素Cox回归分析显示,肾功能衰竭、酒精滥用和消化性溃疡疾病与胃肠道相关原因导致的30天再入院几率增加相关。结论:COVID-19的胃肠道表现并不罕见,仍然是再入院的重要原因。针对确定的再入院可修改预测因素的有针对性的干预措施将有助于减轻本已有限的医疗资源的负担。
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引用次数: 2
Takotsubo Cardiomyopathy Associated With Acute Pancreatitis. Takotsubo心肌病与急性胰腺炎。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1633
Samyak Dhruv, Shravya Ginnaram, Arhum Shah, Don C Rockey

Takotsubo cardiomyopathy is classically associated with emotional stress in middle-aged women. In clinical practice, physical stressors are a more common cause of Takotsubo cardiomyopathy. Here, we present two patients who had acute pancreatitis as a physical stressor that caused Takotsubo cardiomyopathy, and an additional 13 cases identified in the literature. An important clinical feature of these cases is that because metabolic derangements are often encountered, close attention to electrolyte repletion with cardiac monitoring is indicated.

Takotsubo心肌病通常与中年妇女的情绪压力有关。在临床实践中,物理压力源是Takotsubo心肌病更常见的原因。在这里,我们报告了两例急性胰腺炎作为物理应激源导致Takotsubo心肌病的患者,以及文献中确定的另外13例病例。这些病例的一个重要的临床特征是,由于经常遇到代谢紊乱,需要密切关注心脏监测的电解质补充。
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引用次数: 0
Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy. 经口内窥镜下肌切开术后贲门失弛缓症患者的临床结局及并发症。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1617
Dushyant Singh Dahiya, Fnu Nivedita, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Manesh Kumar Gangwani, Muhammad Aziz, Hassam Ali, Chin-I Cheng, Madhusudhan R Sanaka, Mohammad Al-Haddad, Neil R Sharma

Background: Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US).

Methods: The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted.

Results: From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients.

Conclusion: The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.

背景:经口内窥镜下肌切开术(POEM)是一种快速兴起的治疗贲门失弛缓症的微创手术。POEM后当日排放安全可行;然而,有些病人可能需要住院治疗。我们的目的是确定在美国(US) POEM后需要住院治疗的失弛缓症患者的特征和结果。方法:采用美国国家住院患者样本对2016年至2019年POEM后入院的所有成年贲门失弛缓症患者进行鉴定。强调住院特点和临床结果。结果:2016年至2019年,我们发现1885例失弛缓症患者经POEM后入院。POEM后住院总人数从2016年的380人增加到2019年的490人。平均年龄从2016年的54.2岁增加到2019年的59.3岁。大多数与诗歌相关的住院患者为65 - 79岁年龄组(31.8%)、女性(50.4%)和白人(68.4%)。大多数(56.2%)研究人群的Charlson合并症指数为0。东北医院区与诗歌相关的住院人数最多。大多数患者(88.3%)最终出院回家。没有住院病人死亡。平均住院时间从2016年的4天减少到2019年的3.2天,而平均总医疗费用从2016年的52,057美元增加到2019年的65,109美元。食管穿孔是最常见的并发症,占1.3%。结论:POEM术后贲门失弛缓症患者住院人数增加。没有住院病人死亡率,这表明该手术具有良好的安全性。
{"title":"Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy.","authors":"Dushyant Singh Dahiya,&nbsp;Fnu Nivedita,&nbsp;Abhilash Perisetti,&nbsp;Hemant Goyal,&nbsp;Sumant Inamdar,&nbsp;Manesh Kumar Gangwani,&nbsp;Muhammad Aziz,&nbsp;Hassam Ali,&nbsp;Chin-I Cheng,&nbsp;Madhusudhan R Sanaka,&nbsp;Mohammad Al-Haddad,&nbsp;Neil R Sharma","doi":"10.14740/gr1617","DOIUrl":"https://doi.org/10.14740/gr1617","url":null,"abstract":"<p><strong>Background: </strong>Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US).</p><p><strong>Methods: </strong>The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted.</p><p><strong>Results: </strong>From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients.</p><p><strong>Conclusion: </strong>The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/3e/gr-16-141.PMC10284641.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9703669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pharmacological and Endoscopic Interventions for Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. 药物和内镜干预预防内镜后逆行胆管胰腺炎。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1620
Emmanuel Palomera-Tejeda, Mihir Prakash Shah, Bashar M Attar, Hassam Shah, Bharosa Sharma, Roberto Oleas, Vikram Kotwal, Seema Gandhi, Hemant Raj Mutneja

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) represents the most common serious complication after endoscopic retrograde cholangiopancreatography (ERCP). Rectal non-steroidal anti-inflammatory drugs (NSAIDs) and pancreatic duct stenting (PDS) are the prophylactic interventions with more evidence and efficacy; however, PEP still represents a significant source of morbidity, mortality, and economic burden. Chronic statin use has been proposed as a prophylactic method that could be cheap and relatively safe. However, the evidence is conflicting. We aimed to evaluate the impact of endoscopic and pharmacological interventions including chronic statin and aspirin use, on the development of PEP.

Methods: A retrospective cohort study evaluated consecutive patients undergoing ERCP at John H. Stroger, Jr. Hospital of Cook County in Chicago from January 2015 to March 2018. Univariate and multivariate analyses were performed using logistic regression.

Results: A total of 681 ERCPs were included in the study. Twelve (1.76%) developed PEP. Univariate, multivariate, and subgroup analyses did not show any association between chronic statin or aspirin use and PEP. PDS and rectal indomethacin were protective in patients undergoing pancreatic duct injection. Pancreatic duct injection, female sex, and younger age were associated with a higher risk. History of papillotomy was associated with lower risk only in the univariate analysis (all P values < 0.05).

Conclusion: Chronic use of statins and aspirin appears to add no additional benefit to prevent ERCP pancreatitis. Rectal NSAIDs, and PDS after appropriate patient selection continue to be the main prophylactic measures. The lower incidence at our center compared with the reported data can be explained by the high rates of rectal indomethacin and PDS, the use of noninvasive diagnostic modalities for patient selection, and the expertise of the endoscopists.

背景:内镜逆行胰胆管造影后胰腺炎(PEP)是内镜逆行胰胆管造影(ERCP)后最常见的严重并发症。直肠非甾体类抗炎药(NSAIDs)和胰管支架置入术(PDS)是证据更充分、疗效更好的预防干预措施;然而,PEP仍然是发病率、死亡率和经济负担的重要来源。长期使用他汀类药物被认为是一种既便宜又相对安全的预防方法。然而,证据是相互矛盾的。我们的目的是评估内镜和药物干预的影响,包括慢性他汀类药物和阿司匹林的使用,对PEP的发展。方法:一项回顾性队列研究评估了2015年1月至2018年3月在芝加哥库克县约翰·h·斯特罗格小医院接受ERCP的连续患者。采用logistic回归进行单因素和多因素分析。结果:共纳入681例ercp。12例(1.76%)发生PEP。单因素、多因素和亚组分析均未显示慢性他汀类药物或阿司匹林使用与PEP之间有任何关联。PDS和直肠吲哚美辛对胰管注射患者有保护作用。胰管注射、女性和年轻年龄与较高的风险相关。只有在单因素分析中,乳头切除史与较低的风险相关(P值均< 0.05)。结论:长期使用他汀类药物和阿司匹林似乎对预防ERCP胰腺炎没有额外的好处。直肠非甾体抗炎药和适当患者选择后的PDS仍然是主要的预防措施。与报道的数据相比,我们中心的发病率较低,这可以解释为直肠吲哚美辛和PDS的高发率,使用无创诊断方式进行患者选择,以及内窥镜医师的专业知识。
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引用次数: 0
Retraction Notice to "Association of Smoking and E-Cigarette in Chronic Liver Disease: An NHANES Study". 对“吸烟和电子烟与慢性肝病的关系:一项NHANES研究”的撤回通知。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1490r

[This retracts the article DOI: 10.14740/gr1490.].

[本文撤回文章DOI: 10.14740/gr1490.]。
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引用次数: 0
Trends in Hospitalizations of Esophageal Varices From 2011 to 2018: A United States Nationwide Study. 2011年至2018年食道静脉曲张住院趋势:一项美国全国性研究
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1627
Abdelwahap Elghezewi, Mohamad Hammad, Mohammed El-Dallal, Mujtaba Mohamed, Ahmed Sherif, Wesam Frandah

Background: Prevalence of gastroesophageal varices is around 50% of patients with cirrhosis. In compensated cirrhosis they are present in 30-40%. Progression from small to large varices occurs at rate of 10-12% annually. That percentage increases significantly in decompensated liver cirrhosis with gastroesophageal varices found in 85% of patients. Variceal hemorrhage occurs at a rate around 10-15% per year. The outcome of variceal hemorrhage depends on the severity of liver disease, size of varices, and presence of stigmata of recent bleeding (red whale sign). Six-week mortality of variceal hemorrhage ranges between 15% and 25%. Without treatment, variceal hemorrhage tends to recur in 60% of patients within 1 - 2 years. The aim of the study was to assess demographics of esophageal varices with and without bleeding, geographic distribution, comorbidities, outcomes, main payers, and cost of hospitalizations.

Methods: The National Inpatient Sample (NIS) database from year 2011 to 2018 was used. Patients who had a primary diagnosis of esophageal varices with or without bleeding were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes (456.0 for esophageal varices with bleeding, and 456.1 for esophageal varices without bleeding), and International Classification of Diseases, 10th Revision (ICD-10) codes (I85.01 for esophageal varices with bleeding, and I85.00 for esophageal varices without bleeding) in the first two discharge diagnoses. The propensity score to calculate the inverse probability treatment weighting (IPTW) to adjust between the differences of the compared groups was implemented. Two groups were compared in terms of their hospitalization outcomes, including LOS, hospital charges, hospital mortality, and disposition.

Results: A total of 322,761 patients were admitted with esophageal varices between 2011 and 2018, with 236,802 (73.6%) had bleeding esophageal varices and 85,959 (26.4%) had nonbleeding esophageal varices. The majority of the patients from both groups were white (66%), covered with Medicare (38% in the esophageal varices with bleeding vs. 41% in the nonbleeding group). There was a steady increase of patients admitted with nonbleeding esophageal varices. Most common comorbidities were liver diseases, alcohol abuse, uncomplicated hypertension and depression in both groups. There were no significant changes in OLS over the years in both groups, but there was a significant increase in hospital charges, especially in the patients with bleeding esophageal varices starting in 2015, and no change in mortality throughout the years. Regarding hospital disposition, there was a notable decline in rehab discharge in the bleeding esophageal varices group.

Conclusions: Esophageal varices with and without bleeding have been steadily increasing since the beginning of this century. This may result in a substantial imp

背景:胃食管静脉曲张在肝硬化患者中的患病率约为50%。代偿性肝硬化中有30-40%存在。从小静脉曲张到大静脉曲张的进展速度为每年10-12%。在85%的失代偿性肝硬化伴胃食管静脉曲张患者中,这一比例显著增加。静脉曲张出血的发生率约为每年10-15%。静脉曲张出血的结果取决于肝脏疾病的严重程度、静脉曲张的大小和近期出血的红斑(红鲸征)。静脉曲张出血的6周死亡率在15%到25%之间。如果不进行治疗,60%的患者会在1 - 2年内静脉曲张出血复发。本研究的目的是评估伴有和不伴有出血的食管静脉曲张的人口统计学特征、地理分布、合并症、结局、主要支付者和住院费用。方法:使用2011 - 2018年国家住院患者样本(NIS)数据库。初步诊断为食管静脉曲张伴出血或不伴出血的患者,在前两项出院诊断中采用国际疾病分类第九版(ICD-9)代码(有出血的食管静脉曲张456.0,无出血的食管静脉曲张456.1)和国际疾病分类第十版(ICD-10)代码(有出血的食管静脉曲张I85.01,无出血的食管静脉曲张I85.00)进行鉴定。采用倾向评分法计算逆概率处理权重(IPTW),以调整比较组间的差异。比较两组患者的住院结果,包括LOS、住院费用、住院死亡率和处置情况。结果:2011年至2018年期间,共有322,761例食管静脉曲张患者入院,其中236,802例(73.6%)为食管静脉曲张出血,85,959例(26.4%)为非出血性食管静脉曲张。两组的大多数患者都是白人(66%),有医疗保险(食管静脉曲张出血组38%,非出血组41%)。非出血性食管静脉曲张入院的患者稳步增加。两组中最常见的合并症是肝脏疾病、酗酒、无并发症的高血压和抑郁症。两组的OLS历年无明显变化,但住院费用显著增加,尤其是2015年开始出现食管静脉曲张出血的患者,死亡率历年无变化。在住院处理方面,出血性食管静脉曲张组的康复出院率明显下降。结论:自本世纪初以来,伴出血和不伴出血的食管静脉曲张一直在稳步增加。由于急性静脉曲张出血,这可能会对增加医疗保健费用和利用率产生重大影响。死亡、转到城市医院和转到探访护理协助的几率保持不变。
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引用次数: 0
Does Liver Resection Remain a Viable Option in Patients With Pyogenic Liver Abscess? A Single-Center Experience. 肝切除术是否仍是化脓性肝脓肿患者的可行选择?单中心体验。
IF 1.5 Pub Date : 2023-06-01 DOI: 10.14740/gr1611
Aiman Obed, Mohammad Abuassi, Saqr Alsakarneh, Fouad Jaber, Mahmoud Fakhri, Fadi Abufares, Abdalla Bashir, Mahmood Syam, Anwar Jarrad, Ody Abdelhadi, Hassan Ghoz

Pyogenic liver abscesses (PLAs) are relatively rare but often fatal if left untreated. Antibiotic therapy combined with percutaneous procedures has replaced surgery as the cornerstone of treatment. However, open surgical drainage or liver resection may be a last resort. This study aimed to review our experience in treating PLA, with a focus on the conditions requiring partial liver resection as the last viable curative option. Medical records of patients with PLA admitted to Jordan Hospital between October 2014 through October 2020 were retrospectively reviewed. Medical and demographic data of all 43 patients admitted to our facility with a diagnosis of PLA were extracted. We reviewed these patients and extracted the cases that required surgical intervention. Four (three males and one female) of the 43 patients with PLA required surgical intervention. The underlying causes of liver abscesses were as follows: one traumatic due to shrapnel injury from an explosion, one following chemoembolization for hepatocellular carcinoma, and two patients with no apparent etiology. All patients were diagnosed with a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Two patients had negative cultures. All patients received broad-spectrum antibiotics, and all underwent CT- or ultrasound-guided percutaneous drainage or aspiration. All four patients required partial hepatic resection due to treatment failure or inaccessible percutaneous procedures with clinical improvement. Although antimicrobial and interventional therapy remains the primary treatment option in PLA, the surgical option with open surgical drainage or partial liver resection remains viable and curative in selected patients.

化脓性肝脓肿(PLAs)相对罕见,但如果不及时治疗往往是致命的。抗生素治疗结合经皮手术已经取代手术成为治疗的基石。然而,开放手术引流或肝切除可能是最后的手段。本研究旨在回顾我们治疗PLA的经验,重点是需要部分肝切除作为最后可行的治疗选择的情况。回顾性分析了2014年10月至2020年10月约旦医院收治的解放军患者的医疗记录。我们提取了所有43例诊断为PLA的住院患者的医学和人口统计资料。我们回顾了这些患者并提取了需要手术干预的病例。43例PLA患者中有4例(3男1女)需要手术干预。肝脓肿的潜在原因如下:1例由爆炸弹片造成的创伤,1例因肝细胞癌进行化疗栓塞,2例病因不明。所有患者均通过腹部和骨盆的计算机断层扫描(CT)和静脉造影剂进行诊断。2例患者培养阴性。所有患者均接受广谱抗生素治疗,并接受CT或超声引导下的经皮引流或抽吸。所有4例患者均因治疗失败或无法经皮手术而行部分肝切除术,但临床情况有所改善。尽管抗菌药物和介入治疗仍然是PLA的主要治疗选择,但在某些患者中,开放性手术引流或部分肝切除的手术选择仍然是可行的和可治愈的。
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Gastroenterology Research
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