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Introducing Dr. Smith, Dr. Wang, and Emily
Christina C. Huang & Fumiko Chino
doi : 10.1007/s10620-021-07139-3
Volume 67, issue 4, April 2022
Monday, Monday—I Can’t See Clearly Now: How to Improve Bowel Preparation
James M. Richter & Darrick K. Li
Covid-19 and Patients with IBD: Who Is at Highest Risk for Severe Complications?
Sara Horst
Is the APEX Score the Pinnacle of Predictive Scoring Systems of Disease Flare in Crohn’s Patients with Documented Mucosal Healing?
Georgios I. Tsiaoussis & Eirini Christaki
Deconstructing Obstructive Defecation Syndrome with Adaptive Biofeedback
H. HeinrichÂ
Clinical Research Training During Gastroenterology Fellowship
Saad Saffo & Tamar Taddei
Pathophysiology of Dysphagia in Eosinophilic Esophagitis: Causes, Consequences, and Management
Edward Young & Hamish Philpott
Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?
S. Vaccari, M. Minghetti, A. Lauro, M. I. Bellini, A. Ussia, S. Khouzam, I. R. Marino, M. Cervellera, V. D’Andrea & V. Tonini
doi : 10.1007/s10620-022-07450-7
Biliary lithiasis is common worldwide, affecting almost 20% of the general population, though few experience symptoms. The frequency of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be 10–33%, depending on patients' age. Unlike gallbladder lithiasis, the medical and surgical treatment of common bile duct stones is uncertain, having changed over the last few years. The prior gold standard treatment for cholelithiasis and choledocholithiasis was open cholecystectomy with bile duct clearance, choledochotomy, and/or surgical sphincterotomy. In the last 10–15 years, new treatment approaches to the complex pathology of choledocholithiasis have emerged with the advent of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic surgery, and advanced diagnostic procedures. Although ERCP followed by laparoscopic cholecystectomy is the preferred mode of management, a single-step strategy (laparo-endoscopic rendezvous) has gained acceptance due to lesser morbidity and a lower risk of iatrogenic damage. Given the above, a tailored approach relying on careful evaluation of the disease is necessary in order to minimize complication risks and overall costs. Yet, the debate remains open, with no consensus on the superiority of laparo-endoscopic rendezvous to more conventional approaches.
Pharmacological Interventions for the Prevention and Treatment of Immune Checkpoint Inhibitor-Associated Enterocolitis: A Systematic Review
Christopher Ma, John K. MacDonald, Tran M. Nguyen, Niels Vande Casteele, Bryan Linggi, Pavine Lefevre, Yinghong Wang, Brian G. Feagan & Vipul Jairath
doi : 10.1007/s10620-021-06948-w
Patients treated with immune checkpoint inhibitors (ICIs) may develop ICI-associated enterocolitis, for which there is no approved treatment.
Acute Diverticulitis in Young Patients: A Review of the Changing Epidemiology and Etiology
Greg A. Turner, Michael J. O’Grady, Rachel V. Purcell & Frank A. Frizelle
doi : 10.1007/s10620-021-06956-w
Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years, especially in patients under 50 years old. Historically, acute diverticulitis in younger patients was felt to represent a separate entity, being more virulent and associated with a higher rate of recurrence. Accordingly, young patients were often managed differently to older counterparts. Our understanding of the natural history of this condition has evolved, and current clinical practice guidelines suggest age should not alter management. The purpose of this review is to evaluate the changing epidemiology of acute diverticulitis, consider potential explanations for the observed increased incidence in younger patients, as well as review the natural history of acute diverticulitis in the younger population.
Immune Inhibitory Properties and Therapeutic Prospects of Transforming Growth Factor-Beta and Interleukin 10 in Autoimmune Hepatitis
Albert J. CzajaÂ
doi : 10.1007/s10620-021-06968-6
Transforming growth factor-beta and interleukin 10 have diverse immune inhibitory properties that have restored homeostatic defense mechanisms in experimental models of autoimmune disease. The goals of this review are to describe the actions of each cytokine, review their investigational use in animal models and patients, and indicate their prospects as interventions in autoimmune hepatitis. English abstracts were identified in PubMed by multiple search terms. Full-length articles were selected for review, and secondary and tertiary bibliographies were developed. Transforming growth factor-beta expands the natural and inducible populations of regulatory T cells, limits the proliferation of natural killer cells, suppresses the activation of naïve CD8+ T cells, decreases the production of interferon-gamma, and stimulates fibrotic repair. Interleukin 10 selectively inhibits the CD28 co-stimulatory signal for antigen recognition and impairs antigen-specific activation of uncommitted CD4+ and CD8+ T cells. It also inhibits maturation of dendritic cells, suppresses Th17 cells, supports regulatory T cells, and limits production of diverse pro-inflammatory cytokines. Contradictory immune stimulatory effects have been associated with each cytokine and may relate to the dose and accompanying cytokine milieu. Experimental findings have not translated into successful early clinical trials. The recombinant preparation of each agent in low dosage has been safe in human studies. In conclusion, transforming growth factor-beta and interleukin 10 have powerful immune inhibitory actions of potential therapeutic value in autoimmune hepatitis. The keys to their therapeutic application will be to match their predominant non-redundant function with the pivotal pathogenic mechanism or cytokine deficiency and to avoid contradictory immune stimulatory actions.
Imaging of Bowel Lymphoma: A Pictorial Review
Pawan Kumar, Anuradha Singh, Ashwin Deshmukh & S. H. Chandrashekhara
doi : 10.1007/s10620-021-06979-3
Intestinal lymphoma, although rare, is the second most common extra-nodal site of lymphoma, following stomach. It is usually secondary to systemic involvement and is predominantly of non-Hodgkin’s subtype. In addition to the risk factors for lymphomas occurring elsewhere, certain risk factors are specific for intestinal lymphoma. These include enteropathies such as celiac disease and inflammatory bowel disease. Imaging is the cornerstone in the management of intestinal lymphoma. Contrast-enhanced computed tomography or positron emission tomography–computed tomography are the preferred modalities for diagnosis, staging, monitoring response to treatment, and for follow-up evaluation. Bowel lymphomas can have various morphological patterns on imaging; however, certain characteristic features, if present, may prove invaluable in its diagnosis. Hence, it is imperative to be acquainted with the myriad of imaging findings in bowel lymphoma and its complications which may not only help in vivo distinction from other commoner bowel lesions but alter the management accordingly.
High-Pressure Tactics: Jackhammer Esophagus—Diagnosing Is Easier than Treating
Pamela Milito, Stefano Siboni & Luigi Bonavina
doi : 10.1007/s10620-021-07279-6
Diagnosis of esophageal disorders is well ahead of available treatment options. With HRM, for example, one can identify numerous conditions and their variants, which may lose meaning if the clinical and therapeutic implications of these subclassifications are limited. We report an exemplary case of a patient with hiatal hernia complaining of reflux, dysphagia, and chest pain refractory to medical treatment. Jackhammer esophagus was diagnosed and a hybrid approach consisting of POEM and concomitant crural repair and Dor fundoplication is proposed.
Serving Up a Mediterranean Remission in Severe Ulcerative Colitis
Gila Sasson, Caitlin Hosmer Kirby, Matthew J. Hamilton & Rachel W. Winter
Analysis of Speaker Introduction Formality by Gender at the American College of Gastroenterology 2020 Annual Scientific Meeting
Lauren D. Feld, Erin R. Cleveland, Loren G. Rabinowitz, Vijaya L. Rao, Daniel Bushyhead, Thomas Couri & Rachel B. Issaka
doi : 10.1007/s10620-021-07136-6
Gender-based differences in the use of professional titles during speaker introductions have been described in other medical specialties.
Baseline Predictors of Discontinuation of Prescription Drug Therapy for IBS-C: Cohort Analysis at an Integrated Healthcare System
Eric D. Shah, Darren M. Brenner & Vincent L. Chen
doi : 10.1007/s10620-021-06963-x
Effective prescription drug treatment of constipation-predominant irritable bowel syndrome (IBS-C) requires patients to remain on daily therapy, yet predictive factors to optimize treatment selection are unknown.
Cost-Effectiveness of Empirical Bismuth-Based Quadruple Therapy and Tailored Therapy After Clarithromycin Resistance Tests for Helicobacter pylori Eradication
Young Woon Chang, Ga Young Shin, Jung-Wook Kim, Jin-Chang Moon, Eun Jee Chang, Chi Hyuk Oh & Jae-Young Jang
doi : 10.1007/s10620-021-06938-y
The eradication rate of clarithromycin-based standard triple therapy (STT) for Helicobacter pylori infection has decreased due to clarithromycin resistance (CR). We evaluated the cost-effectiveness of tailored therapy according to CR test results, and compared the results of STT with those of empirical bismuth quadruple therapy (BQT).
Effect of the Weekend on Bowel Preparation Quality in Outpatient Colonoscopies
Jeffrey Rebhun, Wilfredo Pagani, Yinglin Xia & Asim Shuja
doi : 10.1007/s10620-021-07037-8
Inadequate bowel preparation has been associated with a higher likelihood of missing adenomatous polyps. Colonoscopies immediately following a weekend may be prone to inadequate bowel preparation. This study aims to evaluate if day of the week is a predictor of bowel preparation adequacy, while assessing other patient and procedural variables and their effect on the Boston Bowel Preparation Scale (BBPS).
IgA Deficiency Is Not Systematically Ruled Out in Patients Undergoing Celiac Disease Testing
Ezequiel Nazario, Juan Lasa, Amalia Schill, Belen Duarte, Diego Berardi, Silvina Paz, Alexis Muryan & Ignacio Zubiaurre
doi : 10.1007/s10620-021-06939-x
Guidelines for celiac disease (CD) testing recommend total serum IgA determination alongside anti-transglutaminase IgA antibodies. It is not well known if lack of serum IgA determination is a common finding in clinical practice.
Treating the Hardest to Treat: Reframing the Hospital Admission as an Opportunity to Initiate Hepatitis C Treatment
Elizabeth Le, Grace Chee, Miki Kwan & Ramsey Cheung
doi : 10.1007/s10620-021-06941-3
Chronic hepatitis C (CHC) is traditionally treated in the outpatient setting. Despite the excellent tolerability, shortened treatment duration, and high cure rates of newer direct-acting antivirals (DAAs), many vulnerable patients remain untreated due to issues with linkage to care.
Functional Analysis of the Transcriptional Regulator IκB-ζ in Intestinal Homeostasis
Tomoki Sasaki, Hiroyuki Nagashima, Atsushi Okuma, Takeshi Yamauchi, Kenshi Yamasaki, Setsuya Aiba, Takanori So, Naoto Ishii, Yuji Owada, Takashi MaruY
doi : 10.1007/s10620-021-06958-8
The Toll-like receptor signaling pathway contributes to the regulation of intestinal homeostasis through interactions with commensal bacteria. Although the transcriptional regulator IκB-ζ can be induced by Toll-like receptor signaling, its role in intestinal homeostasis is still unclear.
Pseudouridylate Synthase 7 Promotes Cell Proliferation and Invasion in Colon Cancer Through Activating PI3K/AKT/mTOR Signaling Pathway
Jiming Du, Aimin Gong, Xuefeng Zhao & Guixin Wang
doi : 10.1007/s10620-021-06936-0
Colorectal cancer is commonly malignant tumor. Herein, we demonstrate that pseudouridylate synthase 7 (PUS7) is closely related to colon cancer. But the biological role of PUS7 in colon cancer is not known.
Presence of Comorbidities Associated with Severe Coronavirus Infection in Patients with Inflammatory Bowel Disease
Rajen Parekh, Xian Zhang, Ryan C. Ungaro, Erica J. Brenner, Manasi Agrawal, Jean-Frederic Colombel & Michael D. Kappelman
doi : 10.1007/s10620-021-07104-0
Comorbidities increase the risk of coronavirus disease 2019 (COVID-19) hospitalization and mortality. As many comorbidities are common in patients with inflammatory bowel diseases (IBD), we sought to investigate the effects of comorbidities in these patients on infection severity.
Apex Score: Predicting Flares in Small-Bowel Crohn’s Disease After Mucosal Healing
V?tor Macedo Silva, Marta Freitas, Pedro Boal Carvalho, Francisca Dias de Castro, Tiago C?rdia Gonçalves, Bruno Rosa, Maria Jo?o Moreira & José Cotter
doi : 10.1007/s10620-021-07148-2
Optimal strategies for using small-bowel capsule endoscopy (SBCE) in established small-bowel Crohn’s disease (CD) remain uncertain. Mucosal healing (MH) has emerged as a valuable predictor of a flare-free disease. We aimed to evaluate the occurrence of disease flare on patients with small-bowel CD and MH, as well as to create a score identifying patients in higher risk for this outcome.
Thiopurine Monotherapy Is Effective in Maintenance of Mild-Moderate Inflammatory Bowel Disease
Grant E. Barber, Steven Hendler, Monica Choe, Kian Keyashian, Sarah Lechner, Berkeley N. Limketkai & David Limsui
doi : 10.1007/s10620-021-06947-x
Crohn's disease (CD) and ulcerative colitis (UC) are complex, inflammatory bowel diseases (IBD) with debilitating complications. While severe IBD typically requires biologic agents, the optimal therapy for mild-moderate IBD is less clear.
Usefulness of Fluoroscopy for Endoscopic Balloon Dilation of Crohn’s Disease-Related Strictures
Hyun Seok Lee, Michael V. Chiorean, Elisa Boden, James Lord, Shayan Irani, Richard Kozarek, Michael Larsen & Andrew Ross
doi : 10.1007/s10620-021-06935-1
Fluoroscopy is often used for endoscopic balloon dilation (EBD) of Crohn’s disease (CD)-related strictures. However, its benefit remains unclear.
Association Between Portal Vein Thrombosis and Pouchitis in Patients with Ulcerative Colitis
Aslam Syed, Talal Seoud, Neil M. Carleton, Shyam Thakkar, Ravi P. Kiran & Bo Shen
doi : 10.1007/s10620-021-06969-5
Pouchitis is the most common long-term complication in patients requiring colectomy ileal pouch-anal anastomosis with medically refractory ulcerative colitis or colitis-associated neoplasia. A previous small case series suggests associated between portal vein thrombosis (PVT) and ischemic pouchitis.
Baseline Histological Findings Do Not Predict the Risk of Subsequent Extension in Patients with Limited Ulcerative Colitis
Yansheng Hao, Clara Yzet, Russell B. McBride, Aryeh Stock, Elisa Tiratterra, Antonietta D’Errico, Andrea Belluzzi, Eleonora Scaioli, Paolo Gionchetti,
doi : 10.1007/s10620-021-06970-y
Among patients with limited ulcerative colitis (UC), 30% ultimately extend to pancolitis and are at increased risk of adverse clinical outcomes. Risk of endoscopic extension has been found to correlate with clinical features such as early age of onset.
Efficacy of a Modified Training Program of Adaptive Biofeedback Therapy for Dyssynergic Defecation in Patients with Chronic Constipation
Yuemei Xu, Xiaoping Li, Feizhen Xia, Feng Xu & Jiande D. Z. Chen
doi : 10.1007/s10620-021-07094-z
Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. However, conventional biofeedback training has limitations.
Patients with Early-Onset Colorectal Cancer Have an Increased Risk of Second Primary Malignancy
Amelie Tiritilli & Cynthia Ko
doi : 10.1007/s10620-021-06971-x
While overall colorectal cancer (CRC) rates in the USA are declining, the incidence of early-onset CRC (eoCRC) under age 50 is increasing. The aim of this study was to examine the risk of a second primary malignancy (SPM) in individuals with eoCRC, and how this risk compares to those with late-onset CRC (loCRC).
History of Diverticulitis and Risk of Incident Cardiovascular Disease in Men: A Cohort Study
Idy Tam, Po-Hong Liu, Wenjie Ma, Yin Cao, Manol Jovani, Kana Wu, Eric B. Rimm, Lisa L. Strate, Edward L. Giovannucci & Andrew T. Chan
doi : 10.1007/s10620-021-06949-9
Diverticulitis and cardiovascular disease (CVD) are two highly prevalent disorders sharing common risk factors which are hypothesized to have an inflammatory basis.
Digital Cholangioscopic Interpretation: When North Meets the South
Michel Kahaleh, Isaac Raijman, Monica Gaidhane, Amy Tyberg, Amrita Sethi, Adam Slivka, Douglas G. Adler, Divyesh Sejpal, Haroon Shahid, Avik Sarkar, F
doi : 10.1007/s10620-021-06961-z
Digital single�operator cholangioscopy (DSOC) (SpyGlass DS™, Boston Scientific, MA, USA) allows for high�definition imaging of the biliary tree. The superior visualization has led to the development of two different sets of criteria to evaluate and classify indeterminate biliary strictures: the Monaco criteria and the criteria in Carlos Robles–Medranda’s publication (CRM). Our objective was to assess the interrater agreement (IA) of DSOC interpretation for indeterminate biliary strictures using the two newly published criteria.
Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Nonagenarians: A Systematic Review and Meta-Analysis
Umair Iqbal, Hafsa Anwar, Muhammad Ali Khan, Simcha Weissman, Shivangi T. Kothari, Truptesh H. Kothari, Bradley D. Confer & Harshit S. Khara
doi : 10.1007/s10620-021-06950-2
Recent advances in modern medicine have translated into increase in life expectancy in the USA and with that, a rise in the demand for invasive procedures in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for managing various benign and malignant pancreatobiliary conditions and can be associated with various adverse events.
Morphologic Severity of Acute Pancreatitis on Imaging Is Independently Associated with Opioid Dose Requirements in Hospitalized Patients
Aditya Ashok, Mahya Faghih, Javad R. Azadi, Nasim Parsa, Christopher Fan, Furqan Bhullar, Francisco G. Gonzalez, Niloofar Y. Jalaly, Tina Boortalary,
doi : 10.1007/s10620-021-06944-0
Prior studies have evaluated clinical characteristics associated with opioid dose requirements in hospitalized patients with acute pancreatitis (AP) but did not incorporate morphologic findings on CT imaging.
Prediction of Outcome in Acute Pancreatitis by the qSOFA and the New ERAP Score
Sebastian Rasch, Eva-Maria Pichlmeier, Veit Phillip, Ulrich Mayr, Roland M. Schmid, Wolfgang Huber & Tobias Lahmer
doi : 10.1007/s10620-021-06945-z
Early identification of patients with acute severe pancreatitis is important for prompt and adequate treatment. Existing scores for pancreatitis are often laborious or require serial patient evaluation, whereas the qSOFA score, that was established to predict outcome in patients with suspected infection, is simple to perform.
Progression of Nonalcoholic Fatty Liver Disease-Associated Fibrosis in a Large Cohort of Patients with Type 2 Diabetes
Nabil Noureddin, Mazen Noureddin, Amandeep Singh & Naim Alkhouri
doi : 10.1007/s10620-021-06955-x
Nonalcoholic fatty liver disease (NAFLD) can progress to advanced fibrosis, especially in patients with type 2 diabetes. Small studies have shown that fibrosis can also regress.
Visceral Adipose Tissue and Non-alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes
Sohrab Nobarani, Fariba Alaei-Shahmiri, Rokhsareh Aghili, Mojtaba Malek, Hossein Poustchi, Maryam Lahouti & Mohammad E. Khamseh
doi : 10.1007/s10620-021-06953-z
To explore the association of visceral adipose tissue (VAT) area and non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).
Race Adjustment in eGFR Equations Does Not Improve Estimation of Acute Kidney Injury Events in Patients with Cirrhosis
Nadim Mahmud, Sumeet K. Asrani, Peter P. Reese, David E. Kaplan, Tamar H. Taddei, Mitra K. Nadim & Marina Serper
doi : 10.1007/s10620-021-06943-1
Accuracy of glomerular filtration rate estimating (eGFR) equations has significant implications in cirrhosis, potentially guiding simultaneous liver kidney allocation and drug dosing. Most equations adjust for Black race, partially accounted for by reported differences in muscle mass by race. Patients with cirrhosis, however, are prone to sarcopenia which may mitigate such differences. We evaluated the association between baseline eGFR and incident acute kidney injury (AKI) in patients with cirrhosis with and without race adjustment.
Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma
Saad Saffo, Chengwei Peng, Ronald Salem, Tamar Taddei & Anil Nagar
doi : 10.1007/s10620-021-06967-7
Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related deaths in the USA. Although management strategies have evolved, there are continued controversies about the use of neoadjuvant chemotherapy (NAC) and pretreatment biliary drainage (PBD) in patients with resectable and potentially resectable disease.
Limy Bile Syndrome Causing Obstructive Jaundice: A Case Series and Review of the Literature
Christopher Nguyen, Michelle Baliss, Obada Tayyem & Sreeram Parupudi
Risk of Infections with Anti-TNF Agents in Patients with Crohn’s Disease After Elective Surgery
Cong Dai & Yu-hong Huang
Regarding “Annoyed with Hemorrhoids? Risks of the Emborrhoid Technique�
Tommaso LupattelliÂ
Correction to: Comparative Effectiveness of Commercial Bowel Preparations in Ambulatory Patients Presenting for Screening or Surveillance Colonoscopy
Shashank Sarvepalli, Ari Garber, Carol A. Burke, Niyati Gupta, Mounir Ibrahim, John McMichael, Gareth Morris-Stif, Amit Bhatt, John Vargo, Maged Rizk
Correction to: A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study
Elyse R. Thakur, Jordan Shapiro, Johanna Chan, Mark A. Lumley, Jeffrey A. Cully, Andrea Bradford & Hashem B. El-Serag
