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SAGE Open Medicine 2024This study examined the relationship between gastrointestinal disease and post-traumatic stress disorder in U.S. military Veterans. Based on literature and clinical...
BACKGROUND
This study examined the relationship between gastrointestinal disease and post-traumatic stress disorder in U.S. military Veterans. Based on literature and clinical practice data sources from the U.S. Veterans Administration, gastrointestinal disease and post-traumatic stress disorder were hypothesized to be positively correlated in Veterans.
OBJECTIVES
This study aimed to determine the frequency with which gastrointestinal disease and post-traumatic stress disorder are diagnosed comorbidities, a diagnosis of gastrointestinal disease accompanies a diagnosis of post-traumatic stress disorder, and a diagnosis of post-traumatic stress disorder accompanies a diagnosis of a gastrointestinal disease.
METHODS
The methodology was a retrospective, correlational design using data collected from the U.S. Department of Veterans Affairs patient database.
RESULTS
The results were that post-traumatic stress disorder is bi-directionally correlated with the gastrointestinal diseases of gastroesophageal reflux disease, peptic ulcer disease, functional dyspepsia, Crohn's disease, diverticular disease, irritable bowel syndrome, and the symptoms of constipation and nausea/vomiting within Veterans who served during wartime periods. The study also found that post-traumatic stress disorder is not correlated with ulcerative colitis in Veterans.
CONCLUSIONS
The conclusions are that clinicians who see a presentation of post-traumatic stress disorder should be screening for gastrointestinal disease, while primary care and gastroenterology providers treating gastrointestinal disease should be screening for a history of trauma, as improved diagnosis rates may lead to improved treatment.
PubMed: 38911441
DOI: 10.1177/20503121241260000 -
SAGE Open Medical Case Reports 2024Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen...
Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen but can rarely extend into the mediastinum. Atypical symptoms such as dyspnea, dysphagia, coughing, vomiting, abdominal or chest pain, and hemoptysis are usually the notable complaints. CT scan, MRI, and endoscopic ultrasound are valuable diagnostic modalities. Drainage and surgical removal of the pseudocyst are the treatment options. Herein, we outline the case of a young female with episodic chest and epigastric discomfort, dysphagia, and weight loss. Previously, she was incorrectly diagnosed with gastroesophageal reflux disease and peptic ulcer. A mediastinal pseudocyst secondary to chronic pancreatitis was found to be the cause. The patient underwent surgical removal of the pseudocyst and a pancreaticojejunostomy. Significant improvement was noticed at follow-up. This article highlights the possibility of such unusual conditions and the importance of a proper assessment while treating patients with epigastric pain.
PubMed: 38911178
DOI: 10.1177/2050313X241262139 -
Cureus May 2024Gastrointestinal (GI) disorders, including gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), gastritis/peptic ulcer disease (PUD), and celiac... (Review)
Review
Gastrointestinal (GI) disorders, including gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), gastritis/peptic ulcer disease (PUD), and celiac disease, significantly impact global health and economic stability. This review synthesizes current literature to elucidate the pathophysiology, clinical manifestations, diagnostic challenges, and management strategies of these prevalent conditions. Through a biopsychosocial lens, we examine the role of the gut microbiome in disease modulation and explore innovative therapeutic advancements, including microbiome-targeting interventions. The review highlights the necessity of a multidisciplinary approach to patient care, integrating medical treatment with dietary, psychological, and lifestyle modifications. By addressing these disorders holistically, the article aims to foster a deeper understanding of their biopsychosocial impacts and encourage more effective, patient-centered treatment paradigms. The findings underscore the imperative for continued research and interdisciplinary collaboration to enhance patient outcomes and reduce healthcare burdens associated with GI disorders.
PubMed: 38910693
DOI: 10.7759/cureus.60962 -
Therapie May 2024Evaluate the misuse of proton pump inhibitors (PPIs) in geriatric long-term care (LTC) patients and improve caregiving by de-prescribing non-relevant PPIs in this...
BACKGROUND
Evaluate the misuse of proton pump inhibitors (PPIs) in geriatric long-term care (LTC) patients and improve caregiving by de-prescribing non-relevant PPIs in this population.
AIM
This study was conducted in the long-term care department of the geriatric hospital Pierre-Garraud in Lyon. All patients receiving PPI for more than 8 weeks were included. A reassessment form was filled to evaluate the treatment benefit/risk ratio during a collegial consultation between the patient's referring physicians and pharmacists. During these consultations, the following possible decisions were taken: continuation, dose adjustment or gradual discontinuation of treatment. Patients' monitoring were performed one month and three months after discontinuation to detect any relapses and causes.
RESULTS
Among the 113 patients included, 97 patients had their treatment re-evaluated by collegial consultation. Forty-four (45.4%) patients were treated in accordance with recommendations. For 24 of them, the indication was symptomatic recurrent gastroesophageal reflux disease. The treatment of more than half of the re-evaluated patients (54.6%) was gradually stopped. After the 3-month follow-up post-discontinuation, excluding patients who died during this period, 80.9% of the discontinuations were well-tolerated and only nine were resumed (19.1%).
CONCLUSION
This study allowed a re-evaluation of PPI treatments in a high-risk population and offered a decision support tool focused on the benefit/risk balance of PPIs; 55% of treatments were considered irrelevant and could be stopped with 80% of good tolerance.
PubMed: 38908995
DOI: 10.1016/j.therap.2024.05.002 -
Internal and Emergency Medicine Jun 2024Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well...
Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well studied. We aimed to evaluate the relationship between PPI use and asthma exacerbation using a large administrative claims database in Japan. We conducted a self-controlled case series using the JMDC Claims Database (JMDC, Inc., Tokyo, Japan). The cases included adult patients with asthma who were prescribed PPI and experienced at least one outcome event between January 2015 and December 2019. The primary outcome was the composite outcome of hospital admissions and unscheduled outpatient clinic visits due to asthma exacerbation. We also conducted stratified analyses based on PPI generation, the presence of gastroesophageal reflux disease (GERD), asthma severity, and the number of allergic comorbidities. A total of 7379 eligible patients were included in the study. PPI prescription was associated with a decrease in the composite outcomes (incidence rate ratio, 0.90; 95% confidence interval, 0.87-0.93). However, PPI prescriptions did not affect the outcomes of hospital admissions (incidence rate ratio, 1.34; 95% confidence interval, 0.86-2.10). Stratified analyses based on PPI generation, the presence of GERD, asthma severity (except for severe asthma), and the number of allergic comorbidities yielded consistent results. PPI use was associated with a moderate decrease in asthma exacerbation, regardless of the patient profile. However, this effect was not as strong as the prevention of hospital admissions, and outcome events were not prevented in patients with severe asthma.
PubMed: 38904742
DOI: 10.1007/s11739-024-03687-4 -
Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model.BMC Health Services Research Jun 2024Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's...
BACKGROUND & AIM
Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics.
METHODS
An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention.
RESULTS
91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021).
CONCLUSION
Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.
Topics: Humans; Smoking Cessation; Male; Female; Point-of-Care Systems; Gastroenterology; Middle Aged; Adult; Surveys and Questionnaires; Electronic Health Records; Practice Patterns, Physicians'; Tobacco Use Disorder
PubMed: 38902682
DOI: 10.1186/s12913-024-11092-y -
BMC Gastroenterology Jun 2024In Chinese healthcare settings, drug selection decisions are predominantly influenced by the Pharmacy & Therapeutics Committee (PTC). This study evaluates two recently...
BACKGROUND
In Chinese healthcare settings, drug selection decisions are predominantly influenced by the Pharmacy & Therapeutics Committee (PTC). This study evaluates two recently introduced potassium-competitive acid blockers, vonoprazan (VPZ) and tegoprazan (TPZ), utilizing the Evidence and Value: Impact on DEcisionMaking (EVIDEM) framework.
METHODS
The study employed the 10th edition of EVIDEM, which includes a core model with five domains and 13 criteria. Two independent expert panels were involved: the PTC expert panel, tasked with assigning weights using a 5-point scale, defining scoring indicators, examining the evidence matrix, scoring, and decision-making; and the evidence matrix expert panel, responsible for conducting a systematic literature review, creating the evidence matrix, and evaluating the value contributions of VPZ and TPZ.
RESULTS
The analysis estimated the value contributions of VPZ and TPZ to be 0.59 and 0.54, respectively. The domain of 'economic consequences of intervention' showed the most significant variation in value contribution between the two drugs, followed by 'comparative outcomes of intervention' and 'type of benefit of intervention'.
CONCLUSION
Employing the EVIDEM framework, VPZ's value contribution was found to be marginally superior to that of TPZ. The EVIDEM framework demonstrates potential for broader application in Chinese medical institutions.
Topics: Sulfonamides; Pyrroles; Humans; Proton Pump Inhibitors; China; Gastroesophageal Reflux; Decision Support Techniques; Cost-Benefit Analysis
PubMed: 38902604
DOI: 10.1186/s12876-024-03297-6 -
Surgical Endoscopy Jun 2024Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This...
BACKGROUND
Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This study aims to evaluate recent trends in the utilization of bariatric procedures, associated complications, and conversions using an administrative claims database in the United States.
METHODS
We included adults who had bariatric procedures from 2000 to 2020 with continuous enrollment for at least 6 months in the MarketScan Commercial Claims and Encounters database. Index bariatric procedures and subsequent revisions or conversions were identified using CPT codes. Baseline comorbidities and postoperative complications were identified with ICD-9-CM and ICD-10 codes. Cumulative incidences of complications were estimated at 30-days, 6-months, and 1-year and compared with stabilized inverse probability of treatment weighted Kaplan-Meier analysis.
RESULTS
We identified 349,411 bariatric procedures and 5521 conversions or revisions. The sampled SG volume appeared to begin declining in 2018 while Roux-en-Y gastric bypass (RYGB) remained steady. Compared to RYGB, SG was associated with lower 1-year incidence [aHR, (95% CIs)] for 30-days readmission [0.65, (0.64-0.68)], dehydration [0.75, (0.73-0.78)], nausea or vomiting [0.70, (0.69-0.72)], dysphagia [0.55, (0.53-0.57)], and gastrointestinal hemorrhage [0.43, (0.40-0.46)]. Compared to RYGB, SG was associated with higher 1-year incidence [aHR, (95% CIs)] of esophagogastroduodenoscopy [1.13, (1.11-1.15)], heartburn [1.38, (1.28-1.49)], gastritis [4.28, (4.14-4.44)], portal vein thrombosis [3.93, (2.82-5.48)], and hernias of all types [1.36, (1.34-1.39)]. There were more conversions from SG to RYGB than re-sleeving procedures. SG had a significantly lower 1-year incidence of other non-revisional surgical interventions when compared to RYGB.
CONCLUSIONS
The overall volume of bariatric procedures within the claims database appeared to be declining over the last 10 years. The decreasing proportion of SG and the increasing proportion of RYGB suggest the specific complications of SG may be driving this trend. Clearly, RYGB should remain an important tool in the bariatric surgeon's armamentarium.
PubMed: 38902405
DOI: 10.1007/s00464-024-10985-7 -
Journal of Gastrointestinal Surgery :... Jun 2024To study esophageal acid exposure, esophageal motility, and endoscopic findings before and after Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB BACKGROUND:... (Review)
Review
Significant and Distinct Impacts of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Acid Exposure, Esophageal Motility and Endoscopic Findings: A Systematic Review and Meta-analysis.
OBJECTIVE
To study esophageal acid exposure, esophageal motility, and endoscopic findings before and after Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB BACKGROUND: The lack of standardized objective assessment of esophageal physiology and anatomy contributes to the controversies regarding the impact of SG and RYGB on gastroesophageal reflux disease.
METHODS
We conducted a systematic review and meta-analysis of studies reporting at least one objective measure of esophageal physiology and/or EGD, at baseline and after SG or RYGB. The changes in pH-test, manometry, and EGD parameters were summarized.
RESULTS
Acid exposure time (AET) and DeMeester Score (DMS) significantly increased after SG: Mean Difference (MD) 2.1 (95%CI 0.3 to 3.9) and 8.6 (95%CI 2 to 15.2), respectively. After RYGB, both AET and DMS significantly decreased: MD -4.2 (95%CI -6.1 to -2.3) and - 16.6 (95%CI -25.4 to -7.8). Lower esophageal sphincter resting pressure and length significantly decreased following SG: MD - 2.8 (95%CI - 4.6 to - 1.1) and - 0.1 (95%CI - 0.2 to - 0.02), respectively. There were no significant changes in esophageal manometry after RYGB. The Relative Risk of erosive esophagitis after SG was 2.3 (95%CI 1.5 to 3.5), while after RYGB it was 0.4 (95%CI 0.2 - 0.8). The prevalence of Barrett's Esophagus changed from 0% to 3.6% after SG, and from 2.7% to 1.4% after RYGB.
CONCLUSIONS
SG resulted in worsening of all objective parameters, while RYGB showed improvement in AET, DMS, and EGD findings. Determining the risk factors associated with those outcomes could aid in surgical choice.
PubMed: 38901554
DOI: 10.1016/j.gassur.2024.06.014 -
Biomedical Physics & Engineering Express Jun 2024Presently, close to two million patients globally succumb to gastrointestinal reflux diseases (GERD). Video endoscopy represents cutting-edge technology in medical...
Presently, close to two million patients globally succumb to gastrointestinal reflux diseases (GERD). Video endoscopy represents cutting-edge technology in medical imaging, facilitating the diagnosis of various gastrointestinal ailments including stomach ulcers, bleeding, and polyps. However, the abundance of images produced by medical video endoscopy necessitates significant time for doctors to analyze them thoroughly, posing a challenge for manual diagnosis. This challenge has spurred research into computer-aided techniques aimed at diagnosing the plethora of generated images swiftly and accurately. The novelty of the proposed methodology lies in the development of a system tailored for the diagnosis of gastrointestinal diseases. The proposed work used an object detection method called Yolov5 for identifying abnormal region of interest and Deep LabV3+ for segmentation of abnormal regions in GERD. Further, the features are extracted from the segmented image and given as an input to the seven different machine learning classifiers and custom deep neural network model for multi-stage classification of GERD. The DeepLabV3+ attains an excellent segmentation accuracy of 95.2% and an F1 score of 93.3%. The custom dense neural network obtained a classification accuracy of 90.5%. Among the seven different machine learning classifiers, support vector machine (SVM) outperformed with classification accuracy of 87% compared to all other class outperformed combination of object detection, deep learning-based segmentation and machine learning classification enables the timely identification and surveillance of problems associated with GERD for healthcare providers.
Topics: Humans; Gastroesophageal Reflux; Machine Learning; Support Vector Machine; Neural Networks, Computer; Algorithms; Image Processing, Computer-Assisted; Image Interpretation, Computer-Assisted; Deep Learning; Automation
PubMed: 38901416
DOI: 10.1088/2057-1976/ad5a14