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Kaye AD, Garcia AJ, Hall OM, Jeha GM, Cramer KD, Granier AL, Kallurkar A, Cornett EM, Urman RD. Update on the pharmacogenomics of pain management. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:125-143. [PMID: 31308726 PMCID: PMC6613192 DOI: 10.2147/pgpm.s179152] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/09/2019] [Indexed: 12/30/2022]
Abstract
Pharmacogenomics is the study of genetic variants that impact drug effects through changes in a drug’s pharmacokinetics and pharmacodynamics. Pharmacogenomics is being integrated into clinical pain management practice because variants in individual genes can be predictive of how a patient may respond to a drug treatment. Pain is subjective and is considered challenging to treat. Furthermore, pain patients do not respond to treatments in the same way, which makes it hard to issue a consistent treatment regimen for all pain conditions. Pharmacogenomics would bring consistency to the subjective nature of pain and could revolutionize the field of pain management by providing personalized medical care tailored to each patient based on their gene variants. Additionally, pharmacogenomics offers a solution to the opioid crisis by identifying potentially opioid-vulnerable patients who could be recommended a nonopioid treatment for their pain condition. The integration of pharmacogenomics into clinical practice creates better and safer healthcare practices for patients. In this article, we provide a comprehensive history of pharmacogenomics and pain management, and focus on up to date information on the pharmacogenomics of pain management, describing genes involved in pain, genes that may reduce or guard against pain and discuss specific pain management drugs and their genetic correlations.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, New Orleans, LA, USA
| | - Andrew Jesse Garcia
- Department of Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - O Morgan Hall
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - George M Jeha
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Kelsey D Cramer
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Amanda L Granier
- Department of Anesthesiology, LSU Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Anusha Kallurkar
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Imaging, endoscopy, and pathologic findings of primary gastritis cystica polyposa: description of a rare entity in a small case series. Abdom Radiol (NY) 2016; 41:2095-2101. [PMID: 27377898 DOI: 10.1007/s00261-016-0821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to describe a small case series of primary gastritis cystica polyposa (GCP) and explore its imaging features, endoscopic findings, and pathological manifestations. METHODS In this institutional review board-approved, HIPAA-compliant, retrospective study, an electronic pathology database in our hospital was searched for all cases of GCP from July 2008 to December 2015, yielding five cases with both radiological and endoscopic examination. The characteristics of imaging and gastroscopy were explored, and the pathological basis was analyzed. RESULTS All five cases of GCP occurred in a previously unoperated stomach, which underwent unenhanced CT and enhanced CT, and one of which underwent unenhanced MRI and enhanced MRI as well. Gastroscopy or gastroscopic ultrasound was performed on all five patients. Four submucosal cystic lesions were displayed, including three with low-attenuation liquid, and one with high-attenuation liquid on CT. Another lesion showed soft tissue mass attenuation protruding into the gastric cavity. The surface mucosal layers of all five lesions were smooth and obviously enhanced, with unenhanced cystic component inside. Four submucosal lesions were confirmed by gastroscopy. Gastroscopic ultrasound indicated anechoic area in the center of the lesion. A large mass-like lesion had protruded into the gastric cavity, and gastroscopic ultrasound indicated dispersed anechoic areas in the lesion. All Histopathological analyses indicated mild or moderate epithelial dysplasia, and cystic dilation of the gastric glands in the submucosal layers and lamina propria, surrounded by the infiltration of inflammatory cells. CONCLUSION Primary GCP has relatively particular endoscopy features, which can be accurately diagnosed by gastroscopy when the lesion is small. But endoscopy has its limitations in the diagnosis and differentiation for some large lesions. In contrast to gastroscopy and gastroscopic ultrasound, CT or MRI provides more information about both the gastric wall and the extragastric extent of the disease, which is more helpful for differential diagnosis and surgical planning of GCP before operation.
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Huang TC, Tu TC, Huang SH, Lee CL, Wu CH. Gastritis cystica polyposa in an unoperated stomach. ADVANCES IN DIGESTIVE MEDICINE 2014. [DOI: 10.1016/j.aidm.2013.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Machicado J, Shroff J, Quesada A, Jelinek K, Spinn MP, Scott LD, Thosani N. Gastritis cystica profunda: Endoscopic ultrasound findings and review of the literature. Endosc Ultrasound 2014; 3:131-4. [PMID: 24955343 PMCID: PMC4064161 DOI: 10.4103/2303-9027.131041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 10/22/2013] [Indexed: 12/11/2022] Open
Abstract
Gastritis cystica profunda (GCP) is a rare pseudotumor of the stomach characterized by benign growths of deep gastric glands through the muscularis mucosae into the submucosa. We review a case of GCP in a 61-year-old patient with GCP, with emphasis on endoscopic ultrasound findings and present review of the current literature.
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Affiliation(s)
- Jorge Machicado
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Texas, USA
| | - Jennifer Shroff
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Texas, USA
| | - Andres Quesada
- Department of Pathology, The University of Texas Health Science Center at Houston, Texas, USA
| | - Katherine Jelinek
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Texas, USA
| | - Mathew P Spinn
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Texas, USA
| | - Larry D Scott
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Texas, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Texas, USA ; Division of Gastroenterology, Stanford University, Stanford, California, USA
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Kalra VB, Gilbert JW, Mitchell KA, Salem RR, Israel GM. AIRP best cases in radiologic-pathologic correlation: gastritis cystica polyposa. Radiographics 2013; 33:109-14. [PMID: 23322831 DOI: 10.1148/rg.331115178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Vivek B Kalra
- Department of Diagnostic Radiology, Yale University, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Park HJ, Cho IR, Kim YH, Lee SK. [Image of the month. Gastritis cystica polyposa treated with endoscopic submucosal dissection]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 60:128-31. [PMID: 23094277 DOI: 10.4166/kjg.2012.60.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hye Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Department of Pathophysiology1, Yonsei University College of Medicine, Seoul, Korea
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Sitarz R, Maciejewski R, Polkowski WP, Offerhaus GJA. Gastroenterostoma after Billroth antrectomy as a premalignant condition. World J Gastroenterol 2012; 18:3201-6. [PMID: 22783043 PMCID: PMC3391756 DOI: 10.3748/wjg.v18.i25.3201] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/02/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
Gastric stump carcinoma (GSC) following remote gastric surgery is widely recognized as a separate entity within the group of various types of gastric cancer. Gastrectomy is a well established risk factor for the development of GSC at a long time after the initial surgery. Both exo- as well as endogenous factors appear to be involved in the etiopathogenesis of GSC, such as achlorhydria, hypergastrinemia and biliary reflux, Epstein-Barr virus and Helicobacter pylori infection, atrophic gastritis, and also some polymorphisms in interleukin-1β and maybe cyclo-oxygenase-2. This review summarizes the literature of GSC, with special reference to reliable early diagnostics. In particular, dysplasia can be considered as a dependable morphological marker. Therefore, close endoscopic surveillance with multiple biopsies of the gastroenterostomy is recommended. Screening starting at 15 years after the initial ulcer surgery can detect tumors at a curable stage. This approach can be of special interest in Eastern European countries, where surgery for benign gastroduodenal ulcers has remained a practice for a much longer time than in Western Europe, and therefore GSC is found with higher frequency.
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Lee J, Park CM, Kim KA, Lee CH, Choi JW, Shin BK, Lee SJ, Choi D, Jang KT. Cystic lesions of the gastrointestinal tract: multimodality imaging with pathologic correlations. Korean J Radiol 2010; 11:457-68. [PMID: 20592930 PMCID: PMC2893317 DOI: 10.3348/kjr.2010.11.4.457] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/24/2010] [Indexed: 02/07/2023] Open
Abstract
The cystic lesions of the gastrointestinal (GI) tract demonstrate the various pathologic findings. Some lesions may present a diagnostic challenge because of non-specific imaging features; however, other lesions are easily diagnosed using characteristic radiologic features and anatomic locations. Cystic masses from the GI tract can be divided into several categories: congenital lesions, neoplastic lesions (cystic neoplasms, cystic degeneration of solid neoplasms), and other miscellaneous lesions. In this pictorial review, we describe the pathologic findings of various cystic lesions of the GI tract as well as the radiologic features of GI cystic lesions from several imaging modalities including a barium study, transabdominal ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.
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Affiliation(s)
- Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.
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Oh JY, Nam KJ, Choi JC, Cho JH, Yoon SK, Choi SS, Kwon HJ, Yoon JH, Kim SJ. Benign submucosal lesions of the stomach and duodenum: Imaging characteristics with endoscopic and pathologic correlation. Eur J Radiol 2008; 67:112-24. [PMID: 17720347 DOI: 10.1016/j.ejrad.2007.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/08/2007] [Accepted: 06/29/2007] [Indexed: 01/07/2023]
Abstract
Benign submucosal lesions of the stomach and duodenum are occasionally encountered during endoscopy. But endoscopy has its limitations in the diagnosis and differentiation of these lesions, because submucosal lesions are often difficult to visualize at endoscopy due to minimal change of the overlying mucosa. Furthermore, endoscopic biopsy may not always yield adequate tissue for diagnosis due to the submucosal location of the lesions. For this reason, the role of radiologic imaging is important in the diagnosis of submucosal lesions of the stomach and duodenum. Recent advances in computed tomography (CT) and sonographic technology are helpful in narrowing the differential diagnosis of gastroduodenal submucosal lesions. In contrast to endoscopy and barium studies, CT or ultrasonography (US) provides information about both the gastric wall and the extragastric extent of the disease. Arterial phase contrast enhanced CT enables us to discriminate a mass of submucosal from that of a mucosal origin in the differential diagnosis of gastric or duodenal lesions. Although endoscopic sonography has been considered the better modality in the diagnosis of gastroduodenal submucosal lesions, transabdominal sonography can still be an alternative method to endoscopic sonography in assessing of the origin and character of the submucosal lesions. Some gastroduodenal submucosal lesions have similar radiologic findings that make differentiation difficult. But despite overlaps in radiologic findings, some lesions have characteristic radiologic features that may suggest a specific diagnosis. Knowledge of the differential diagnosis of benign submucosal lesions in the stomach and duodenum may promote correct diagnosis and appropriate treatment.
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Affiliation(s)
- Jong Young Oh
- Department of Diagnostic Radiology, Dong-A University College of Medicine, Busan, Republic of Korea.
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Kurland J, DuBois S, Behling C, Savides T. Severe upper-GI bleed caused by gastritis cystica profunda. Gastrointest Endosc 2006; 63:716-7. [PMID: 16564886 DOI: 10.1016/j.gie.2005.11.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2005] [Accepted: 11/15/2005] [Indexed: 01/14/2023]
Affiliation(s)
- Jayde Kurland
- Division of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
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Hirasaki S, Tanimizu M, Tsubouchi E, Nasu J, Masumoto T. Gastritis cystica polyposa concomitant with gastric inflammatory fibroid polyp occurring in an unoperated stomach. Intern Med 2005; 44:46-9. [PMID: 15704662 DOI: 10.2169/internalmedicine.44.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The endoscopic examination of a 61-year-old male patient revealed a protruding lesion in the greater curvature of the lower third area of the stomach. The lesion, 17 mm in size, was resected completely with endoscopic submucosal dissection using an insulated-tip diathermic knife (IT-ESD). Histological examination of the protruding lesion revealed proliferation of fibroblasts and infiltration of inflammatory cells in the mucosa and submucosa, and it was diagnosed as an inflammatory fibroid polyp (IFP). Gastritis cystica polyposa (GCP) was presented adjacent to the IFP. This may be the first report of GCP concomitant with gastric IFP occurring in an unoperated stomach.
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Affiliation(s)
- Shoji Hirasaki
- Department of Endoscopy, Shikoku Cancer Center, Matsuyama
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Shudo R, Horita K, Takahashi K, Saito T, Waku K, Aoyanagi Y. A case of gastritis cystica polyposa showing a characteristic endoscopic ultrasonogram. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2000.00009.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | | | | | | | - Katsuaki Waku
- Surgery, Shizunai Municipal Hospital, Shizunai, Hokkaido, Japan
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Park JS, Myung SJ, Jung HY, Yang SK, Hong WS, Kim JH, Kang GH, Ha HK, Min YI. Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach. Gastrointest Endosc 2001; 54:101-3. [PMID: 11427856 DOI: 10.1067/mge.2001.114412] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J S Park
- Departments of Internal Medicine, Diagnostic Pathology, Radiology, and the University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Valenzuela M, Martín-Ruiz JL, Alvarez-Cienfuegos E, Caballero AM, Gallego F, Carmona I, Rodríguez-Téllez M. Colitis cystica profunda: imaging diagnosis and conservative treatment: report of two cases. Dis Colon Rectum 1996; 39:587-90. [PMID: 8620815 DOI: 10.1007/bf02058718] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Rectally localized colitis cystica profunda can simulate mucosecretory carcinoma. PURPOSE AND METHODS Because endoscopic examination and barium enema do not clarify the diagnosis, other diagnostic imaging methods such as transrectal ultrasonography, computerized tomography, or magnetic resonance imaging are needed. RESULTS Transrectal ultrasonography identifies multiple cysts in the rectal submucosa, with areas of echorefringent fibrosis between cysts, and confirms the absence of lymph node involvement or invasion of the muscular layer. Findings with computerized tomography and magnetic resonance imaging have not previously been described for colitis cystica profunda. With computerized tomography, the lesion appears as a noninfiltrating entity in the submucosa, with loss of perirectal layers of fatty tissue and thickening of the levator ani muscle. With nuclear magnetic imaging, nodulations produce intense signals that increase in T2, illustrating the mucoprotein content of the cysts. The presence in surgical biopsy material of large, whole cysts confirms the diagnosis. CONCLUSION Reeducation of bowel habits aimed at avoiding straining and a high-fiber diet together with bulk laxatives can lead to complete remission of lesions in 6 to 18 months.
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Affiliation(s)
- M Valenzuela
- Department of Medicine, School of Medicine, University of Granada, Spain
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