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  • Kupec, Justin T.  (4)
  • 2015-2019  (4)
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  • 2015-2019  (4)
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  • 1
    Online Resource
    Online Resource
    168 Fecal Microbiota Transplant in Graft-versus-Host Disease of the Intestines: A Comprehensive Pooled Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-10), p. S102-S102
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S102-S102
    Abstract: Graft versus host disease (GVHD) of the intestines is a feared complication after hematopoietic stem cell transplantation (HSCT), and carries high morbidity and mortality. Recently fecal microbiota transplant (FMT) has been explored as a treatment modality for intestinal GVHD. The aim of our study was to pool data from individual feasibility studies to explore the efficacy and safety of FMT for gut GVHD. METHODS: A systematic search was performed for studies in PubMed, Embase, Cochrane database and ClinicalTrials.gov. All studies that reported data on FMT in patients who had previously undergone HSCT were included. Two independent authors conducted the systematic search. Pooled analysis was conducted for safety and efficacy of FMT in HSCT patients. RESULTS: A total of 15 studies comprising a total of 99 patients reported FMT outcomes after HSCT. Indication of FMT was restoration of microbiome in 41, Clostridium difficile infection in 21, and intestinal GVHD in 37 patients. All studies were single center pilot trials. Five studies with 37 patients reported efficacy outcomes for intestinal GVHD. A total of 57 FMTs were performed. All patients had previously failed at least one immunosuppressant regimen. All patients were either steroid resistant or steroid dependent. Overall complete response rate of 62.1% was observed (23 patients). Three additional patients partially responded to FMT. Positive response was accompanied by a decrease in stool volumes and frequency in all patients; reduction in use of anti-motility agents, and cessation of total parenteral nutrition was observed in all responders. All studies reported successful tapering of immunosuppressant and steroid dosage. FMT was generally well tolerated. No treatment-related mortality was reported. Minor adverse events included abdominal pain, nausea, mucosal tears, and minor aspiration without sequelae. Serious adverse events included bleeding in one patient, and grade 3 abdominal pain in one patient (resolved within 24 hours of capsule ingestion). Infections were reported in three patients after FMT (two with bacteremia), but could not be attributed to FMT with certainty. CONCLUSION: FMT is a promising modality for management of intestinal GVHD and carries low morbidity. It appears to be safe and acceptable as a salvage therapy for intestinal GVHD based on the current limited data. The need to withhold antibiotics to allow persistent engraftment may prove challenging in this severely immunocompromised population.
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000590204.27112.60
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    511 High Risk of Ionizing Radiation Exposure Among Patients With Irritable Bowel in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-10), p. S297-S298
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S297-S298
    Abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder. While ionizing radiation exposure, and its associated cancer risk, is well-studied in other GI disorders, there is a paucity of data in the IBS population. METHODS: After IRB approval, a retrospective cohort study at a tertiary care referral center was conducted. Radiologic studies performed between Jan 2008-Dec 2017 on patients diagnosed with IBS were retrospectively evaluated. Data from patients whose primary care physician and gastroenterologist were in our healthcare system were included. Analyses was performed by chi square and Mann Kendall trend test and multivariable logistic regression was applied to assess independent associations. Percentage of participants receiving more than a cumulative dosage of 50 mSv (consensus threshold for high cancer risk) in the study period was calculated RESULTS: The mean age of participants was 40.83 years (SD: 12.12 years). 35.24% participants had a smoking history. A vast majority of participants were female (77.53%) and 55.95% of participants had a co-morbid psychiatric diagnosis. Most participants (85.46%) were on pain medications in the outpatient setting. 16 patients (7%) did not undergo any radiological study during the study period. 56 patients (24.67%) received greater than 50 mSv of cumulative effective radiation dosage during the 10-year study period. Mean yearly effective radiation dosage was 3.75 mSv per year (SD: 5.67). Mean cumulative effective radiation dosage during the study period was 37.45 mSv. A mean dosage of 27.87 mSv was attributable to studies involving the abdomen. Participants received a mean dosage of 17.59 mSv before and 19.86 mSv after the definitive diagnosis by the digestive disease clinic. Female gender, comorbid depression and anxiety, and diarrhea predominant IBS phenotype was significantly associated with an increased risk of radiation exposure ( P 〈 0.05). Mann Kendall trend test did not reveal any change in average ionizing radiation exposure in patients during the study period ( P 〉 0.05). CONCLUSION: Previous limited data from Europe hinted at a low risk of radiation exposure in IBS but we finds that, contrary to popular belief, a significant proportion of IBS patients are exposed to high levels of ionizing radiation, which potentially poses a significant cancer risk. Nationwide cohort studies are needed to assess this risk and quality improvement initiatives are needed to decrease radiation exposure in this relatively young population.
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000591576.44054.e4
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    Location Call Number Limitation Availability
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    Online Resource
  • 3
    Online Resource
    Online Resource
    588 Skipping the Drip: Intravenous Bolus Proton Pump Inhibitor Therapy Produces Similar Outcomes to Continuous Infusions With Less Healthcare Resource Utilization
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-10), p. S340-S340
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S340-S340
    Abstract: Continuous proton pump inhibitor (PPI) infusions remain the most commonly employed therapeutic strategy for administration of PPIs in upper gastrointestinal (GI) bleeding. Recent data has pointed towards non-inferiority of intravenous (IV) bolus regimens, but real-world data is lacking. Cost effectiveness and resource utilization data is also unavailable and projections made by estimation have shown low potential for cost savings. METHODS: A retrospective cohort study to evaluate the impact of a shift in institutional practice from PPI infusions to bolus was conducted. As part of a quality improvement initiative, an electronic medical record-based order set was employed; this involved an IV PPI twice daily for 72 hours subsequently defaulting to an oral regimen. After obtaining institutional review board (IRB) approval, patients admitted with upper GI bleeding at our institution from January 2017 to December 2018 were identified with relevant ICD 10 codes. All patients with peptic ulcer disease as the cause of bleeding were included and divided into two groups on the basis of PPI administration strategy. Clinical and resource utilization outcomes were compared between the two groups. Univariate and multivariable analyses were performed to assess independent associations. RESULTS: Of the 368 patients included the mean age was 62.68 years (SD: 5.3 years) and 170 (46.1%) were male. On univariate analysis, age, gender, smoking status, use of anticoagulants, and PPI administration strategy were not associated with inpatient mortality, readmissions, re-bleeding at 3, 7 and 30 days, need for endoscopic hemostatic therapy and need for re-intervention or surgery (all P values 〉 0.05). Multivariable logistic regression revealed that smoking (OR 2.12 95% CI 1.13- 3.70), anticoagulation use (OR: 2.27 95% CI 1.17- 4.62) and age (OR: 1.03, 95% CI 1.01-1.04) were significantly associated with in-hospital packed red blood cell transfusions. Bolus PPI use was associated with less pharmacy cost of drug calculated per patient, earlier de-escalation to oral PPI, and shorter hospital stay ( P 〈 0.05). CONCLUSION: Our real world, tertiary care experience ascertains non-inferiority of IV bolus PPI regimen compared to continuous infusion for acid suppression therapy in managing upper GI bleeds. The use of simpler bolus regimens can result in a decrease in healthcare resource utilization. A practice shift to such a regimen can therefore serve as a good quality improvement initiative in health care settings.
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000591884.27021.01
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    Location Call Number Limitation Availability
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    Online Resource
  • 4
    Online Resource
    Online Resource
    461 Obstructive Sleep Apnea Is Associated With an Increased Risk of Barrett's Esophagus
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-10), p. S269-S269
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S269-S269
    Abstract: Current guidelines suggest screening at-risk groups of patients for Barrett's esophagus (BE), a precursor to esophageal cancer. Although BE and obstructive sleep apnea (OSA) have common risk factors, including elevated body mass index (BMI) and gastroesophageal reflux disease (GERD), the relationship between these two conditions has not been well established. METHODS: Retrospectively, all patients who had undergone a polysomnography and esophagogastroduodenoscopy (EGD) at West Virginia University Hospital from 2013 to 2018 were identified and divided into groups based on the presence or absence of OSA. Clinical course and procedure reports were reviewed to identify relevant variables. RESULTS: 1091 patients met inclusion criteria. 60.9% were female, and mean age of participants was 53.5 years. Univariate analysis revealed that male gender, age, diagnosis of OSA, severity of OSA, and a clinical diagnosis of GERD were associated with Barrett's esophagus ( P values 〈 0.05). Multiple logistic regression incorporating age, sex, clinical diagnosis of GERD, smoking history, BMI, Helicobacter pylori status, and presence of hiatal hernia was utilized. Patients with OSA had an increased risk of Barrett's esophagus when compared with those without OSA [ P 〈 0.001, Odds Ratio 3.26 (1.72-6.85)]. The risk increased with increasing severity of OSA, categorized in apnea-hyponea index increments of 10. In a separate multivariable regression model where OSA was graded in AHI increments of 10, an increased risk for Barrett's esophagus with every 10 point increase in AHI was found (OR 1.10, 95% CI: 1.02 – 1.19). BMI, evaluated in increments of 5, was not associated with BE. The association of OSA with BE remained unchanged in a separate model incorporating a binary variable with BMI of greater than 30 used as a surrogate for central adiposity. CONCLUSION: OSA is associated with Barrett's esophagus, a relationship that is independent of other known risk factors. Additionally, this risk increases with increasing severity of OSA. Future efforts should determine if patients with severe OSA need to be screened for Barrett's esophagus due to its potential for causing esophageal cancer.
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000591376.08262.b2
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    Location Call Number Limitation Availability
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    Online Resource
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