Swetha Sattanathan, K. Devadas, Shanid Ahmed, A. Hareendran, Arun Prabhakaran, Nidhin Raveendran
Background and Aims. Endoscopic variceal ligation (EVL) of esophageal varices alters the portal pressure. We observed the changes in 2D-shear wave elastography (2D-SWE) measurements of spleen and liver following EVL and tried to identify the predictors for rebleeding and mortality at 6 months. Methods. A prospective observational study of 202 patients who underwent EVL for bleeding esophageal varices was done. 2D-SWE measurements of liver stiffness (LS) and spleen stiffness (SS) and spleen volume (SV) were measured half an hour before, 1 hour, 2 weeks, and 6 weeks after EVL. All were followed up for 6 months for rebleeding and all-cause mortality. Results. 83 patients were in child C (41%). Difference in SV, SS, and LS at 2 and 6 weeks from baseline was noted as Delta 2 (2nd week post-EVL - pre-EVL SV, LS, and SS) and Delta 3 (6th week post EVL - pre - EVL SV, LS and SS), respectively. Mean Delta 2 VOL and Delta 3 VOL were lower in the bleeding and mortality groups. Delta 2 SS, Delta 3 SS, Delta 2 LS, and Delta 3 LS were higher in the rebleeding and mortality groups. These changes were statistically significant. AUROC in predicting rebleeding was the highest for Delta 2 VOL (0.773) and Delta 3 LS (0.764) amongst the USG parameters that performed better than MELD score (0.677). AUROC in predicting mortality was the highest for Delta 3 VOL and Delta 2 VOL-0.873 and 0.842, respectively, and higher than MELD’s (0.641). Statistically significant variables in binary logistic regression analysis for rebleeding were Delta 3 LS and Delta 3 SS and none for mortality. Conclusion. LS, SS, and SV change after EVL. Changes in liver and spleen stiffness at 6 weeks from baseline had good diagnostic accuracy for predicting rebleeding at 6 months.
{"title":"Spleen Stiffness Measured by 2D-Shear Wave Elastography and Rebleeding Risk in Cirrhotic Patients Undergoing Endoscopic Variceal Ligation for Variceal Bleeding","authors":"Swetha Sattanathan, K. Devadas, Shanid Ahmed, A. Hareendran, Arun Prabhakaran, Nidhin Raveendran","doi":"10.1155/2023/4912991","DOIUrl":"https://doi.org/10.1155/2023/4912991","url":null,"abstract":"Background and Aims. Endoscopic variceal ligation (EVL) of esophageal varices alters the portal pressure. We observed the changes in 2D-shear wave elastography (2D-SWE) measurements of spleen and liver following EVL and tried to identify the predictors for rebleeding and mortality at 6 months. Methods. A prospective observational study of 202 patients who underwent EVL for bleeding esophageal varices was done. 2D-SWE measurements of liver stiffness (LS) and spleen stiffness (SS) and spleen volume (SV) were measured half an hour before, 1 hour, 2 weeks, and 6 weeks after EVL. All were followed up for 6 months for rebleeding and all-cause mortality. Results. 83 patients were in child C (41%). Difference in SV, SS, and LS at 2 and 6 weeks from baseline was noted as Delta 2 (2nd week post-EVL - pre-EVL SV, LS, and SS) and Delta 3 (6th week post EVL - pre - EVL SV, LS and SS), respectively. Mean Delta 2 VOL and Delta 3 VOL were lower in the bleeding and mortality groups. Delta 2 SS, Delta 3 SS, Delta 2 LS, and Delta 3 LS were higher in the rebleeding and mortality groups. These changes were statistically significant. AUROC in predicting rebleeding was the highest for Delta 2 VOL (0.773) and Delta 3 LS (0.764) amongst the USG parameters that performed better than MELD score (0.677). AUROC in predicting mortality was the highest for Delta 3 VOL and Delta 2 VOL-0.873 and 0.842, respectively, and higher than MELD’s (0.641). Statistically significant variables in binary logistic regression analysis for rebleeding were Delta 3 LS and Delta 3 SS and none for mortality. Conclusion. LS, SS, and SV change after EVL. Changes in liver and spleen stiffness at 6 weeks from baseline had good diagnostic accuracy for predicting rebleeding at 6 months.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78221445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Nwaezeigwe, J. O’Grady, Lorraine M. Nolan, Julie O’Neill, Aidan Kaar, Lucy Quinlivan, M. Buckley
Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford score ≤ 2 . A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% ( N = 103 ) of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.
{"title":"Upper Gastrointestinal Tract Video Capsule as an Alternative to Oesophago-Gastro-Duodenoscopy in Clinical Practice","authors":"M. Nwaezeigwe, J. O’Grady, Lorraine M. Nolan, Julie O’Neill, Aidan Kaar, Lucy Quinlivan, M. Buckley","doi":"10.1155/2022/4652730","DOIUrl":"https://doi.org/10.1155/2022/4652730","url":null,"abstract":"Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford \u0000 \u0000 score\u0000 ≤\u0000 2\u0000 \u0000 . A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% (\u0000 \u0000 N\u0000 =\u0000 103\u0000 \u0000 ) of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88907158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryo Sugio, Yoshiyuki Sawai, K. Fukuda, T. Igura, S. Kogita, Masahiro Ichihi, Y. Seki, Norihiko Fujita, M. Oshita, Y. Imai
Background. Liver and spleen stiffness measured by shear-wave elastography have been demonstrated to correlate well with liver fibrosis and hepatic venous pressure gradient, respectively. Aim. To investigate the long-term effect of direct-acting antivirals (DAA) on liver and splenic stiffness in patients with chronic hepatitis C. Methods. We conducted a single-centre prospective observational study including 129 chronic hepatitis C patients who achieved a sustained virological response (SVR) with DAA treatment. Liver and spleen stiffness were measured by point shear-wave elastography at pretreatment, end of treatment (EOT), and 48 and 96 weeks after EOT (SVR48 and SVR96, respectively). Results. Liver stiffness measurements (LSM) continued to decline to SVR96, whereas there was no change in spleen stiffness measurements (SSM). Stratified analysis at the SSM 3.2 m/s, which was estimated as the cut-off value of clinically significant portal hypertension, showed that SSM did not change in the low SSM group (SSM <3.2 m/s, n =81), whereas in the high SSM group (SSM ≥3.2 m/s, n =48), the SSM decreased significantly between pretreatment and EOT but did not change thereafter. Moreover, multivariate analysis of risk factors for the SSM remaining in the range of SSM ≥3.2 m/s at SVR96 in the high SSM group revealed that LSM ≥1.93 m/s was a significant factor (p =0.019). Conclusion. These results suggest that DAA treatment of chronic hepatitis C patients may improve liver fibrosis in the long term and some patients with advanced liver fibrosis may not expect an improvement of portal hypertension even if an SVR is achieved.
背景。剪切波弹性成像测量的肝脏和脾脏刚度分别与肝纤维化和肝静脉压力梯度有很好的相关性。的目标。探讨直接抗病毒药物(DAA)对慢性丙型肝炎患者肝、脾僵硬度的长期影响。我们进行了一项单中心前瞻性观察性研究，纳入了129例经DAA治疗获得持续病毒学应答(SVR)的慢性丙型肝炎患者。在治疗前、治疗结束(EOT)和EOT后48周和96周(分别为SVR48和SVR96)，用点剪切波弹性成像测量肝脏和脾脏刚度。结果。肝脏硬度测量值(LSM)继续下降至SVR96，而脾脏硬度测量值(SSM)没有变化。在SSM 3.2 m/s的分层分析中，SSM在低SSM组(SSM <3.2 m/s, n =81)没有变化，而在高SSM组(SSM≥3.2 m/s, n =48)， SSM在预处理和EOT之间显著降低，但之后没有变化。SSM被估计为临床显著门脉高压的临界值。此外，对SSM高组SSM在SVR96时SSM≥3.2 m/s范围内的危险因素进行多因素分析显示，LSM≥1.93 m/s是一个显著因素(p =0.019)。结论。这些结果表明，慢性丙型肝炎患者的DAA治疗可以长期改善肝纤维化，即使达到SVR，一些晚期肝纤维化患者可能也不会期望门脉高压的改善。
{"title":"Changes in Liver and Splenic Stiffness after Direct-Acting Antiviral Therapy in Chronic Hepatitis C: A Single-Centre, Prospective, Observational Study","authors":"Ryo Sugio, Yoshiyuki Sawai, K. Fukuda, T. Igura, S. Kogita, Masahiro Ichihi, Y. Seki, Norihiko Fujita, M. Oshita, Y. Imai","doi":"10.1155/2022/1374410","DOIUrl":"https://doi.org/10.1155/2022/1374410","url":null,"abstract":"Background. Liver and spleen stiffness measured by shear-wave elastography have been demonstrated to correlate well with liver fibrosis and hepatic venous pressure gradient, respectively. Aim. To investigate the long-term effect of direct-acting antivirals (DAA) on liver and splenic stiffness in patients with chronic hepatitis C. Methods. We conducted a single-centre prospective observational study including 129 chronic hepatitis C patients who achieved a sustained virological response (SVR) with DAA treatment. Liver and spleen stiffness were measured by point shear-wave elastography at pretreatment, end of treatment (EOT), and 48 and 96 weeks after EOT (SVR48 and SVR96, respectively). Results. Liver stiffness measurements (LSM) continued to decline to SVR96, whereas there was no change in spleen stiffness measurements (SSM). Stratified analysis at the SSM 3.2 m/s, which was estimated as the cut-off value of clinically significant portal hypertension, showed that SSM did not change in the low SSM group (SSM <3.2 m/s, n =81), whereas in the high SSM group (SSM ≥3.2 m/s, n =48), the SSM decreased significantly between pretreatment and EOT but did not change thereafter. Moreover, multivariate analysis of risk factors for the SSM remaining in the range of SSM ≥3.2 m/s at SVR96 in the high SSM group revealed that LSM ≥1.93 m/s was a significant factor (p =0.019). Conclusion. These results suggest that DAA treatment of chronic hepatitis C patients may improve liver fibrosis in the long term and some patients with advanced liver fibrosis may not expect an improvement of portal hypertension even if an SVR is achieved.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76357795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Herbal medicines including teas and plant extracts have been in use for thousands of years. There are reports of the use of herbal preparations in Egypt, China, India, and Samaria. Many patients consider “natural” herbal teas to be completely free of unwanted side effects. Many herbal products, however, have biological activities that can result in severe hepatic cell toxicity or interact with other herbal products or prescription medications. Their use is increased dramatically. The most common herbal teas and nonmineral natural products are used as self-medication, principally for health improvement. However, these products are potentially dangerous to some individuals. Monitoring for liver injury is an important aspect of drug and herbal safety assessment. When present, herbal-induced liver injury (HILI) may limit the use or result in the discontinuation of these agents. HILI can exhibit with a wide spectrum of clinical and laboratory manifestations, ranging from asymptomatic elevations in aminotransferases to acute liver failure. Most cases of HILI resolve within several weeks after herbal remedy discontinuation. However, some cases can persist as low-level aminotransferase elevations. Our review aims to (1) describe the possible significant discrepancies between the ingredients listed on the label and the actual contents of the preparation; (2) evaluate teas containing multiple plants or herbs which may be adulterated by more toxic herbs, heavy metals, microbials, pharmaceuticals, and medicines; (3) describe pathophysiologic events in herbal tea-induced hepatotoxicity; and (4) discuss the key elements required for attributing the consumption of tea to the induction of liver injury. The widespread use of mixed heterogeneous remedies and the lack of randomized trials are an obstacle to providing safe use of plant-derived teas.
{"title":"Green Tea Consumption Is Increasing but There Are Significant Hepatic Side Effects","authors":"S. Malnick, Y. Maor, M. Neuman","doi":"10.1155/2022/2307486","DOIUrl":"https://doi.org/10.1155/2022/2307486","url":null,"abstract":"Herbal medicines including teas and plant extracts have been in use for thousands of years. There are reports of the use of herbal preparations in Egypt, China, India, and Samaria. Many patients consider “natural” herbal teas to be completely free of unwanted side effects. Many herbal products, however, have biological activities that can result in severe hepatic cell toxicity or interact with other herbal products or prescription medications. Their use is increased dramatically. The most common herbal teas and nonmineral natural products are used as self-medication, principally for health improvement. However, these products are potentially dangerous to some individuals. Monitoring for liver injury is an important aspect of drug and herbal safety assessment. When present, herbal-induced liver injury (HILI) may limit the use or result in the discontinuation of these agents. HILI can exhibit with a wide spectrum of clinical and laboratory manifestations, ranging from asymptomatic elevations in aminotransferases to acute liver failure. Most cases of HILI resolve within several weeks after herbal remedy discontinuation. However, some cases can persist as low-level aminotransferase elevations. Our review aims to (1) describe the possible significant discrepancies between the ingredients listed on the label and the actual contents of the preparation; (2) evaluate teas containing multiple plants or herbs which may be adulterated by more toxic herbs, heavy metals, microbials, pharmaceuticals, and medicines; (3) describe pathophysiologic events in herbal tea-induced hepatotoxicity; and (4) discuss the key elements required for attributing the consumption of tea to the induction of liver injury. The widespread use of mixed heterogeneous remedies and the lack of randomized trials are an obstacle to providing safe use of plant-derived teas.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80685254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kashif Mohd Siddiqui, S. Attri, Massimo Orlando, F. Lelli, Valeria Maida, Dominique Damais-Thabut
Background. Hepatic encephalopathy (HE) is a frequent and debilitating complication of liver disease. Treatments include lactulose and rifaximin-α. The objective of this literature review and meta-analysis was to assess the overall cost-effectiveness of rifaximin-α in HE treatment. Methods. Electronic database searches were conducted in November 2020 to identify cost-effectiveness studies comparing rifaximin-α with other interventions in HE, published in English. Incremental net benefit (INB) was calculated for each study using difference in effectiveness, difference in costs, and the willingness-to-pay threshold, or gross domestic product per capita for each country, and 95% confidence intervals (CI) were constructed. Costs were standardised to 2019 US$. An intervention was considered cost-effective if the INB was positive. Meta-analysis was used to pool calculated INB across studies, using a fixed-effects model if there was no heterogeneity or a random-effects model. Results. Eleven studies were included in the meta-analysis. For rifaximin-α plus lactulose in the second-line setting, the pooled INB was estimated at $20,156 (95% CI: $13,593-$29,887) versus lactulose monotherapy. For rifaximin-α monotherapy in the first-line setting, the pooled INB was $4834 (95% CI: $1601-$14,596) versus lactulose monotherapy. Due to lack of available data, meta-analyses were not possible for rifaximin-α added to lactulose therapy versus lactulose monotherapy in the first-line setting or for rifaximin-α as salvage therapy in the second-line setting. Conclusions. Rifaximin-α as an add-on treatment to lactulose in the second-line setting or as monotherapy in the first-line setting would be a cost-effective treatment for HE compared with lactulose monotherapy.
{"title":"Cost-Effectiveness of Rifaximin-α versus Lactulose for the Treatment of Recurrent Episodes of Overt Hepatic Encephalopathy: A Meta-Analysis","authors":"Kashif Mohd Siddiqui, S. Attri, Massimo Orlando, F. Lelli, Valeria Maida, Dominique Damais-Thabut","doi":"10.1155/2022/1298703","DOIUrl":"https://doi.org/10.1155/2022/1298703","url":null,"abstract":"Background. Hepatic encephalopathy (HE) is a frequent and debilitating complication of liver disease. Treatments include lactulose and rifaximin-α. The objective of this literature review and meta-analysis was to assess the overall cost-effectiveness of rifaximin-α in HE treatment. Methods. Electronic database searches were conducted in November 2020 to identify cost-effectiveness studies comparing rifaximin-α with other interventions in HE, published in English. Incremental net benefit (INB) was calculated for each study using difference in effectiveness, difference in costs, and the willingness-to-pay threshold, or gross domestic product per capita for each country, and 95% confidence intervals (CI) were constructed. Costs were standardised to 2019 US$. An intervention was considered cost-effective if the INB was positive. Meta-analysis was used to pool calculated INB across studies, using a fixed-effects model if there was no heterogeneity or a random-effects model. Results. Eleven studies were included in the meta-analysis. For rifaximin-α plus lactulose in the second-line setting, the pooled INB was estimated at $20,156 (95% CI: $13,593-$29,887) versus lactulose monotherapy. For rifaximin-α monotherapy in the first-line setting, the pooled INB was $4834 (95% CI: $1601-$14,596) versus lactulose monotherapy. Due to lack of available data, meta-analyses were not possible for rifaximin-α added to lactulose therapy versus lactulose monotherapy in the first-line setting or for rifaximin-α as salvage therapy in the second-line setting. Conclusions. Rifaximin-α as an add-on treatment to lactulose in the second-line setting or as monotherapy in the first-line setting would be a cost-effective treatment for HE compared with lactulose monotherapy.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77516217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sumiko Shiba, Takuro Masunaga, Y. Tamamura, M. Matsuura, T. Nishikimi
Objective. The Japanese guideline for the treatment of chronic constipation recommends that nonpharmacological treatment be applied. However, only a small proportion of patients with constipation seek medical care, and even when they do visit a hospital for constipation in Japan, most are only prescribed medication. This is because the effectiveness of exercise therapy for constipation is still unclear. The purpose of this study was to evaluate the prevalence of constipation in Japanese subjects and the relationship between constipation and exercise. Methods. We conducted a questionnaire survey over a period of four months to determine the prevalence of chronic constipation in nonexercise and exercise groups, as well as the effectiveness of exercise on chronic constipation. Subjective constipation was defined by the constipation scoring system. Multiple regression analysis was performed on risk factors for high constipation scoring system scores, and factors related to constipation symptoms were extracted. Result. We analysed responses regarding 556 participants ranging in mean age 35.6 ± 17.2 years. The constipation scoring system score was significantly higher in the nonexercise group than in the exercise group. Independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Conclusion. The result showed that independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Thus, the present study demonstrated that exercise affects constipation symptom.
{"title":"The Relationship between the Severity of Constipation and Exercise Status in the Japanese Population according to Questionnaire Survey","authors":"Sumiko Shiba, Takuro Masunaga, Y. Tamamura, M. Matsuura, T. Nishikimi","doi":"10.1155/2022/2378353","DOIUrl":"https://doi.org/10.1155/2022/2378353","url":null,"abstract":"Objective. The Japanese guideline for the treatment of chronic constipation recommends that nonpharmacological treatment be applied. However, only a small proportion of patients with constipation seek medical care, and even when they do visit a hospital for constipation in Japan, most are only prescribed medication. This is because the effectiveness of exercise therapy for constipation is still unclear. The purpose of this study was to evaluate the prevalence of constipation in Japanese subjects and the relationship between constipation and exercise. Methods. We conducted a questionnaire survey over a period of four months to determine the prevalence of chronic constipation in nonexercise and exercise groups, as well as the effectiveness of exercise on chronic constipation. Subjective constipation was defined by the constipation scoring system. Multiple regression analysis was performed on risk factors for high constipation scoring system scores, and factors related to constipation symptoms were extracted. Result. We analysed responses regarding 556 participants ranging in mean age \u0000 \u0000 35.6\u0000 ±\u0000 17.2\u0000 \u0000 years. The constipation scoring system score was significantly higher in the nonexercise group than in the exercise group. Independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Conclusion. The result showed that independent predictors for the constipation scoring system score were sex, implementation of exercise, and presence of disease under treatment. Thus, the present study demonstrated that exercise affects constipation symptom.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87502394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Soe, Kyaw Ko Ko Aung, Min Ag Shan, Pann Ei San, Khaing Kyaw Lin, Si Phyo Thu
Background. COVID-19 is rapidly spreading as a global pandemic disease that affects mortality, morbidity, and economic recession worldwide including Myanmar. This study is aimed at investigating the prevalence and temporal nature of gastrointestinal and hepatic manifestations as well as their association with composite clinical endpoints in patients with COVID-19. Method. This was a retrospective hospital-based cohort study conducted on confirmed COVID-19 patients who were admitted to two designated COVID-19 hospitals: DSLH and No. (22/100) MH, Yangon, Myanmar, from June 1, 2021, to August 31, 2021. Data related to patients’ demographics, clinical characteristics, and clinical outcomes were abstracted manually through individual hospital records. Results. Out of the 241 patients recruited, 68 (28.2%) of the patients had GI symptoms. Ageusia/hypogeusia and diarrhea are the most common symptoms at 41.3% and 28.3%, respectively. Abnormal liver chemistries at admission are found in 52.7% of total patients. Mortality is 12.9% (31/241). Patients with abnormal liver chemistry are older ( p < 0.001 ), unvaccinated or incompletely vaccinated ( p = 0.04 ), associated comorbidities ( p = 0.019 ), leukocytosis ( p < 0.001 ), lymphopenia ( p = 0.033 ), hypoalbuminemia ( p < 0.001 ), higher INR ( p < 0.001 ), and longer HDU stay ( p < 0.001 ) and higher mortality ( p < 0.001 ). Conclusion. COVID-19-infected patients with abnormal liver chemistry are found to have worse clinical outcomes, although no significant association is found in patients with digestive symptoms. More attention should be given to this group of patients in the next coming wave.
{"title":"Outcome of COVID-19 Patients Presented with Gastrointestinal and Hepatic Manifestations","authors":"A. Soe, Kyaw Ko Ko Aung, Min Ag Shan, Pann Ei San, Khaing Kyaw Lin, Si Phyo Thu","doi":"10.1155/2022/3615619","DOIUrl":"https://doi.org/10.1155/2022/3615619","url":null,"abstract":"Background. COVID-19 is rapidly spreading as a global pandemic disease that affects mortality, morbidity, and economic recession worldwide including Myanmar. This study is aimed at investigating the prevalence and temporal nature of gastrointestinal and hepatic manifestations as well as their association with composite clinical endpoints in patients with COVID-19. Method. This was a retrospective hospital-based cohort study conducted on confirmed COVID-19 patients who were admitted to two designated COVID-19 hospitals: DSLH and No. (22/100) MH, Yangon, Myanmar, from June 1, 2021, to August 31, 2021. Data related to patients’ demographics, clinical characteristics, and clinical outcomes were abstracted manually through individual hospital records. Results. Out of the 241 patients recruited, 68 (28.2%) of the patients had GI symptoms. Ageusia/hypogeusia and diarrhea are the most common symptoms at 41.3% and 28.3%, respectively. Abnormal liver chemistries at admission are found in 52.7% of total patients. Mortality is 12.9% (31/241). Patients with abnormal liver chemistry are older (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ), unvaccinated or incompletely vaccinated (\u0000 \u0000 p\u0000 =\u0000 0.04\u0000 \u0000 ), associated comorbidities (\u0000 \u0000 p\u0000 =\u0000 0.019\u0000 \u0000 ), leukocytosis (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ), lymphopenia (\u0000 \u0000 p\u0000 =\u0000 0.033\u0000 \u0000 ), hypoalbuminemia (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ), higher INR (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ), and longer HDU stay (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) and higher mortality (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). Conclusion. COVID-19-infected patients with abnormal liver chemistry are found to have worse clinical outcomes, although no significant association is found in patients with digestive symptoms. More attention should be given to this group of patients in the next coming wave.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83833857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anat Hershko-Moshe, Yaako’v Hasin, A. Nevo-Shor, O. Etzion, Y. Ilan
Irritable bowel syndrome (IBS) is a common functional disorder. The syndrome’s multifactorial pathophysiology makes it challenging to design effective therapies. The present paper reviews several therapeutic approaches to treating IBS, highlighting the challenges of losing response over time to therapies. Here, we present the relevance of chronobiology in biological systems focusing on the potential of chronotherapy for IBS. Artificial intelligence- (AI-) based approaches have been developed over the last few years to improve the diagnosis, therapeutic approaches, and monitoring of patients with various diseases. We discuss the use of first-generation AI platforms and their limitations in clinical practice and present the establishment of a second-generation system designed to overcome obstacles in managing these patients. The system identifies costly patients and those who do not respond to therapies and may benefit from algorithm-based therapies. We present a patient-tailored approach for improving the response to therapy in IBS using an AI-based algorithm. This system provides a tool for a patient-tailored monitoring system. The second-generation AI system can provide a comprehensive tool for improving the diagnosis and therapy and monitoring of patients with IBS.
{"title":"Improving the Treatment Response of Patients with Irritable Bowel Syndrome: Implementing a Second-Generation Artificial Intelligence System for Overcoming Resistance","authors":"Anat Hershko-Moshe, Yaako’v Hasin, A. Nevo-Shor, O. Etzion, Y. Ilan","doi":"10.1155/2022/1192547","DOIUrl":"https://doi.org/10.1155/2022/1192547","url":null,"abstract":"Irritable bowel syndrome (IBS) is a common functional disorder. The syndrome’s multifactorial pathophysiology makes it challenging to design effective therapies. The present paper reviews several therapeutic approaches to treating IBS, highlighting the challenges of losing response over time to therapies. Here, we present the relevance of chronobiology in biological systems focusing on the potential of chronotherapy for IBS. Artificial intelligence- (AI-) based approaches have been developed over the last few years to improve the diagnosis, therapeutic approaches, and monitoring of patients with various diseases. We discuss the use of first-generation AI platforms and their limitations in clinical practice and present the establishment of a second-generation system designed to overcome obstacles in managing these patients. The system identifies costly patients and those who do not respond to therapies and may benefit from algorithm-based therapies. We present a patient-tailored approach for improving the response to therapy in IBS using an AI-based algorithm. This system provides a tool for a patient-tailored monitoring system. The second-generation AI system can provide a comprehensive tool for improving the diagnosis and therapy and monitoring of patients with IBS.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82431711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Ramírez de Arellano, Nicholas Norton, D. Enkusson, L. Oldsberg, Y. Thomson, M. Lilja, A. Aksan
Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.
{"title":"Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices","authors":"Antonio Ramírez de Arellano, Nicholas Norton, D. Enkusson, L. Oldsberg, Y. Thomson, M. Lilja, A. Aksan","doi":"10.1155/2022/9991311","DOIUrl":"https://doi.org/10.1155/2022/9991311","url":null,"abstract":"Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86568717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Sudhakar, B. Keersmaekers, Rita Stiers, E. De Dycker, P. Geens, A. Paps, Tessy Lambrechts, J. Wellens, J. Sabino, M. Ferrante, S. Vermeire, B. Verstockt
Background. Complementary and alternative medicines (CAMs) are used by patients with chronic disorders, such as inflammatory bowel disease (IBD), with a desire to manage their disease. Methods. Patients visiting an IBD outpatient clinic and infusion unit in a tertiary referral center were surveyed through an anonymized Dutch version of the international questionnaire to measure the use of CAMs. Results. Of the 467 IBD patients who responded to the survey, 41.8% ( n = 195 ) reported the use of CAMs. Gender ( p = 0.03 , higher in females), educational qualification ( p = 0.02 , higher in more educated patients), and number of prior IBD medical treatments ( p = 0.05 , higher in patients having received more than one therapy) were significantly associated with CAM usage. Overall, there was no significant difference in CAM-usage between UC (45.3%) and CD (38.2%) patients. Over two-thirds of patients reported using CAMs to alleviate IBD-related symptoms. The most prevalent reason for CAM-usage was to minimize stress and symptoms. The top five nonsupplemental CAMs used by IBD patients included probiotics, curcumin, yoghurt, homeopathy, and yoga. Among CAMs with a minimum of 25 users, yoga (93.5%), cannabis (87.5%), and mindfulness (84.6%) had high self-reported efficacy indices. Fifty-six percent of the patients who affirmed the economic worthiness of CAMs expressed their interest to consult with their gastroenterologist about CAM-conventional therapy interactions. Conclusion. CAM usage in IBD patients is highly prevalent, and consultation of the patients with the gastroenterologist about the use of CAMs is warranted. Since CAMs can interact with conventional therapies, a debate could help optimizing CAM use, eventually resulting in better disease management.
{"title":"Profiling the Use of Complementary Alternative Medicines among Inflammatory Bowel Disease Patients: Results from a Single Center Survey","authors":"P. Sudhakar, B. Keersmaekers, Rita Stiers, E. De Dycker, P. Geens, A. Paps, Tessy Lambrechts, J. Wellens, J. Sabino, M. Ferrante, S. Vermeire, B. Verstockt","doi":"10.1155/2022/9919542","DOIUrl":"https://doi.org/10.1155/2022/9919542","url":null,"abstract":"Background. Complementary and alternative medicines (CAMs) are used by patients with chronic disorders, such as inflammatory bowel disease (IBD), with a desire to manage their disease. Methods. Patients visiting an IBD outpatient clinic and infusion unit in a tertiary referral center were surveyed through an anonymized Dutch version of the international questionnaire to measure the use of CAMs. Results. Of the 467 IBD patients who responded to the survey, 41.8% (\u0000 \u0000 n\u0000 =\u0000 195\u0000 \u0000 ) reported the use of CAMs. Gender (\u0000 \u0000 p\u0000 =\u0000 0.03\u0000 \u0000 , higher in females), educational qualification (\u0000 \u0000 p\u0000 =\u0000 0.02\u0000 \u0000 , higher in more educated patients), and number of prior IBD medical treatments (\u0000 \u0000 p\u0000 =\u0000 0.05\u0000 \u0000 , higher in patients having received more than one therapy) were significantly associated with CAM usage. Overall, there was no significant difference in CAM-usage between UC (45.3%) and CD (38.2%) patients. Over two-thirds of patients reported using CAMs to alleviate IBD-related symptoms. The most prevalent reason for CAM-usage was to minimize stress and symptoms. The top five nonsupplemental CAMs used by IBD patients included probiotics, curcumin, yoghurt, homeopathy, and yoga. Among CAMs with a minimum of 25 users, yoga (93.5%), cannabis (87.5%), and mindfulness (84.6%) had high self-reported efficacy indices. Fifty-six percent of the patients who affirmed the economic worthiness of CAMs expressed their interest to consult with their gastroenterologist about CAM-conventional therapy interactions. Conclusion. CAM usage in IBD patients is highly prevalent, and consultation of the patients with the gastroenterologist about the use of CAMs is warranted. Since CAMs can interact with conventional therapies, a debate could help optimizing CAM use, eventually resulting in better disease management.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"123 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77572880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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