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Rasheed W, Dweik A, Dharmarpandi G, Anees M, Aljobory O, Al-Hilli Y. Association between smoking status and inpatient outcomes of acute cholangitis in the United States: a propensity matched analysis. Ann Gastroenterol 2023; 36:573-579. [PMID: 37664229 PMCID: PMC10433258 DOI: 10.20524/aog.2023.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Acute cholangitis (AC) is an infection of the biliary tract superimposed on stasis. This study aimed to investigate the effects of smoking on inpatient outcomes of AC. Methods We identified primary AC hospitalizations using the National Inpatient Sample database (2017-2020). Using a 1:1 matching method, we created a matched comparison cohort of AC patients who were non-smokers, based on demographics, hospital characteristics and comorbidities. Results We matched 3960 smoker patients with 3960 non-smoker patients within the AC population. Non-smokers were older than smokers (70 vs. 59 years, P<0.001). Smokers had a stronger association with bile duct calculi (74.37% vs. 69.29%, P<0.001) and other bile duct disorders (clots, parasites, extrinsic compression and other rare disorders) (6.82% vs. 5.05%, P=0.011). No significant difference in inpatient mortality, median length of stay (LOS), or median inpatient cost (MIC) was found between the matched cohorts (P>0.05). However, smoking was associated with higher odds of complications, including sepsis without shock (0.88% vs. 0.51%, P=0.042), sepsis with shock (1.26% vs. 0.51%, P<0.001), biliary pancreatitis (6.57% vs. 4.42%, P<0.001) and myocardial infarction (6.19% vs. 3.54%, P<0.001), as well as a greater need for inpatient endoscopic retrograde cholangiopancreatography (ERCP) (72.85% vs. 63.76%, P<0.001) and early ERCP (50.76% vs. 42.32%, P<0.001) compared to non-smokers. Conclusions This study found no difference in mortality, LOS, or MIC in acute cholangitis-related hospitalizations associated with smoking. However, smoking was associated with a higher risk of complications and a greater need for ERCP and early ERCP.
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Affiliation(s)
- Waqas Rasheed
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
| | - Anass Dweik
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
| | - Gnanashree Dharmarpandi
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
| | - Muhammad Anees
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
| | - Ola Aljobory
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
| | - Yasir Al-Hilli
- Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo, Texas, USA
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Gao Q, Bi P, Mi Q, Guan Y, Jiang J, Li X, Yang B. Effect of nicotine on cholesterol gallstone formation in C57BL/6J mice fed on a lithogenic diet. Exp Ther Med 2023; 25:84. [PMID: 36684657 PMCID: PMC9849855 DOI: 10.3892/etm.2023.11783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 01/04/2023] Open
Abstract
Gallstones are diseases of the biliary system caused by cholesterol supersaturation and/or deficiency in bile salts in bile. Early studies have shown that symptomatic gallstones are primarily a disease of non-smokers, raising the possibility that nicotine can prevent gallstone formation. The present study investigated the effect of nicotine on the formation of cholesterol gallstone in C57BL/6J mice. C57BL/6J mice (eight-weeks-old) were fed a normal or lithogenic diet (basic feed 82.45%, fat 15.8%, cholesterol 1.25% and sodium cholate 0.5%) and divided into five groups: normal diet (ND); ND + high dose nicotine (H); lithogenic diet (LD); LD + low dose nicotine (L) and LD + nicotine (H). They were treated with or without nicotine injection for 10 weeks. Nicotine treatment did not change the rate of cholesterol gallstone formation. There was no difference in TNFα, IL-1β and IL-6 among the five groups. The LD group showed the highest cholesterol levels and there was significant suppression of the total cholesterol, low-density lipoprotein-cholesterol and total bile acid levels in the serum of the nicotine-treated mice. Quantitative PCR showed nicotine altered few bile acid metabolism-related genes expression in liver tissue and significantly altered cholesterol-metabolism genes in gallbladder tissue. Hematoxylin and eosin staining and western blotting showed that protein levels of farnesoid X receptor (FXR) and megalin in the gallbladder increased in the lithogenic-diet mice, which was significantly suppressed in the nicotine-treated mice. In vitro studies using gallbladder epithelial cells showed that chenodeoxycholic acids increased megalin expression, which could be attenuated by nicotine. Nicotine could regulate bile acid metabolism via the FXR-megalin/cubilin pathways, which potentially contribute to cholesterol nucleation and subsequent gallstone formation.
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Affiliation(s)
- Qian Gao
- Yunnan Key Laboratory of Tobacco Chemistry, R&D Center of China Tobacco Yunnan Industrial Co. Ltd., Kunming, Yunnan 650106, P.R. China
| | - Pinduan Bi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Qili Mi
- Yunnan Key Laboratory of Tobacco Chemistry, R&D Center of China Tobacco Yunnan Industrial Co. Ltd., Kunming, Yunnan 650106, P.R. China
| | - Ying Guan
- Yunnan Key Laboratory of Tobacco Chemistry, R&D Center of China Tobacco Yunnan Industrial Co. Ltd., Kunming, Yunnan 650106, P.R. China
| | - Jiarui Jiang
- Yunnan Key Laboratory of Tobacco Chemistry, R&D Center of China Tobacco Yunnan Industrial Co. Ltd., Kunming, Yunnan 650106, P.R. China
| | - Xuemei Li
- Yunnan Key Laboratory of Tobacco Chemistry, R&D Center of China Tobacco Yunnan Industrial Co. Ltd., Kunming, Yunnan 650106, P.R. China
| | - Bin Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China,Correspondence to: Dr Bin Yang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, Yunnan 650032, P.R. China
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Patel AM, Yeola M, Mahakalkar C. Demographic and Risk Factor Profile in Patients of Gallstone Disease in Central India. Cureus 2022; 14:e24993. [PMID: 35719762 PMCID: PMC9190443 DOI: 10.7759/cureus.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Gallbladder stones are more common in some regions of the world than others. Gallstones that are asymptomatic might be discovered as an afterthought during a regular ultrasound scan for another abdominal ailment. The changing incidence in India is mostly due to westernization and the availability of ultrasonography in both urban and rural areas, as well as increased affordability owing to changes in the socio-economic structure and the budget of investigations. This study aims to know the prevalence of gallstone disease as well as the risk factors that contribute to its development in central India. Method A single-center, cross-sectional observational study was conducted. Seventy-two radiologically diagnosed cases of gallstone disease irrespective of age, gender, and comorbid condition were included in the study. Result Seventy-two cases of gallstone were included in the research. The highest age-specific incidence of gallstone was in the fifth and sixth decades with the maximum incidence in the sixth decade. Females had a higher incidence of gallstone formation. The pain was the earliest symptom but we found that 41.67% patients had asymptomatic gallstones. A family history of gallstone disease is found positive in 69.44% of the patients who also had an increased risk of gallstone. 22.22% patient were only diabetic, 6.95% were only hypertensive and 20.83% were both diabetic + hypertensive. Comorbidity has a high prevalence of gallstone disease. Obesity has a significant link to gallstone disease, with BMI being one of the most important indicators of obesity. Conclusion The prevalence of asymptomatic gallstones is relatively high in central India. We strongly recommend ultrasonography as a screening modality in patients with older age group, female gender, high cholesterol level, family history of gallstones, sickle cell disease, increased BMI and co-morbidities like diabetes or hypertension for early detection of gallstones formation.
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Affiliation(s)
- Aditya M Patel
- Department of General Surgery, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Meenakshi Yeola
- Department of General Surgery, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND
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Papadopoulos V, Filippou D, Mimidis K. Smoking habits and gallbladder disease: a systematic review and meta-analysis study. Hippokratia 2020; 24:147-156. [PMID: 35023890 PMCID: PMC8747579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND It has been claimed that smoking is linked with an increased risk for gallbladder disease (GBD); however, related issues need further consolidation and clarification. The present systematic review and meta-analysis aimed to further investigate the potent correlation between GBD and smoking. METHODS We conducted a comprehensive literature review to identify every study published from January 1989 to December 2019, reporting risk estimates regarding GBD and smoking. The random-effect, generic inverse variance method, according to description by DerSimonian and Laird, was used to compute pooled estimates. We used the Newcastle-Ottawa quality assessment scale to appraise the included studies' quality. RESULTS Thirty published case-control, cross-sectional, and cohort studies including 4,623,435 individuals met the eligibility criteria and were considered for data synthesis. Compared to the non-smokers, ever smokers had 1.25 times higher odds of developing GBD [95 % confidence interval (CI): 1.09-1.44]; however, increased heterogeneity was observed (I2 =96 %, 95 % CI: 62-100 %, p <0.001). Publication bias was non-significant (Eggers' regression p =0.072). The main sources of heterogeneity, as detected by meta-regression analyzing study characteristics, biases and confounders, were non-adjustment for family history (p =0.007) and alcohol (p =0.020), respectively. Subgroup analysis indicated a comparable risk for GBD as far as current, former and ever smokers are concerned (p =0.520). Quantitative analysis suggested a dose-effect for current smoking and GBD (p =0.010). CONCLUSIONS Non-smokers were demonstrated to be at a lower risk of presenting GBD when compared with ever smokers; all relevant risk estimates necessitate adjustment for family history and alcohol intake. HIPPOKRATIA 2020, 24(4): 147-156.
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Affiliation(s)
- V Papadopoulos
- Department of Internal Medicine, Xanthi General Hospital, Xanthi
| | - D Filippou
- Laboratory of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens
| | - K Mimidis
- First Department of Internal Medicine, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis Greece
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Kim HS, Cho SK, Kim CS, Park JS. Big data and analysis of risk factors for gallbladder disease in the young generation of Korea. PLoS One 2019; 14:e0211480. [PMID: 30794560 PMCID: PMC6386282 DOI: 10.1371/journal.pone.0211480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/PURPOSE Few studies have examined the risk factors for gallbladder (GB) disease in young adults. This study aimed to evaluate risk factors for GB disease in young adults based on big data in Korea. METHODS All participants underwent routine checkup at the Korea Medical Institute from June 2014 to May 2015. After excluding 677 individuals with missing information in records, 724,114 individuals (435,635 men, 288,479 women) were finally included. The definition of abnormal GB finding included stones, sludge, polyps, and adenomyomatosis detected using ultrasonography. All statistical analyses were performed using SAS software version 9.2. RESULTS Overall, 27,130 (17.5%) individuals were diagnosed as having abnormal GB finding in the young age group (N = 154,463, aged 20-39 years). In men, significant differences in low-density lipoprotein (LDL) and cholesterol levels were observed between the abnormal GB finding group and normal GB group (p < 0.05). In women, a significant difference in smoking history was noted between the abnormal GB finding group and normal GB group (p < 0.05). The prevalence rate of GB stones was 1.9% (27,979/154,463) in the young age group. High body mass index (BMI), large thigh circumference, and low high-density lipoprotein (HDL) level in women and low HDL level in men were independent risk factors for the presence of GB stones (p < 0.05). CONCLUSION In this study, obesity-related factors (BMI, waist size, thigh circumference, and cholesterol, LDL, and HDL levels) correlated with GB disease in the young generation of Korea.
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Affiliation(s)
- Hyung Sun Kim
- Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Seong Kyung Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Soo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
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Spangenberg B, van Rensburg JJ. Fatty meal sonography comparing coconut oil and chocolate bar with full-fat yoghurt as cholecystagogues for gallbladder ejection fractions. SA J Radiol 2018; 22:1312. [PMID: 31754497 PMCID: PMC6837805 DOI: 10.4102/sajr.v22i1.1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background The authors compared the effectiveness of a chocolate bar and full-fat yoghurt combination to coconut oil in determining the gallbladder ejection fraction (GBEF). The clinical motive was functional gallbladder disorder (FGD) which has the clinical picture of symptomatic gallstones but without gallstones. Functional gallbladder disorder has a decreased GBEF of less than 35%. Gallbladder ejection fraction can be calculated by ultrasound, using cholecystokinin (CCK) as a stimulant for gallbladder contraction. Cholecystokinin is not available in South Africa, and the researchers compared a 60 g Snickers chocolate bar with 200 g full-fat yoghurt, against the theoretically superior coconut oil. Objectives To determine the efficacy of coconut oil versus chocolate bar and 200 g full-fat yoghurt combination in performing sonographic GBEFs. Method This was a randomised clinical experiment, before and after crossover trial. The three experimental components of the study included 15 g coconut oil, 20 g coconut oil and a standard fatty meal consisting of 60 g Snickers bar and 200 g full-fat yoghurt. Results The GBEF for the chocolate bar and yoghurt combination was the highest (62.84%). The GBEF for 20 g of coconut oil was 23.47% and for 15 g of coconut oil was 5.11%. There was a statistically significant difference between the chocolate and yoghurt combination and the 20 g coconut oil, as well as the chocolate yoghurt combination and the 15 g coconut oil, both with a p-value of < 0.0001. No statistically significant difference was found between the 20 g and 15 g coconut oil. Conclusions The 60 g Snickers chocolate bar and 200 g full-fat yoghurt combination was superior to the coconut oil. The authors advocate using the chocolate and yoghurt fatty meal oral stimulant to determine GBEF.
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Affiliation(s)
- Benjamin Spangenberg
- Department of Radiology, University of the Free State, South Africa
- Department of Clinical Imaging Sciences, Universitas Hospital, South Africa
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Shabanzadeh DM, Novovic S. Alcohol, smoking and benign hepato-biliary disease. Best Pract Res Clin Gastroenterol 2017; 31:519-527. [PMID: 29195671 DOI: 10.1016/j.bpg.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 01/31/2023]
Abstract
Gallstone disease and pancreatitis are the most frequent benign hepato-biliary causes of hospital admissions. Gallstone disease is prevalent, but symptomatic disease develops only in about one out of five carriers. Alcohol intake seems to protect gallstone formation in cohort studies possibly through effects on bile cholesterol metabolism, the enterohepatic circulation, and gallbladder function. The impact of smoking on gallstone formation seems minor. Both alcohol intake and smoking do not alter the clinical course of gallstone disease carriers. Cholecystectomy is the preferred treatment for symptomatic gallstone disease. Studies about the impact of alcohol and smoking on the post-cholecystectomy state are few and future studies should be performed. Pancreatitis is associated with both excessive alcohol intake and smoking in observational studies. Interpretation of associations with pancreatitis is hampered by an incomplete understanding of underlying mechanisms and by the co-existence of excessive alcohol intake and smoking. Smoking cessation and alcohol abstinence is recommended in the treatment of pancreatitis, but higher-level evidence is needed.
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Affiliation(s)
- Daniel Mønsted Shabanzadeh
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, Denmark.
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
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Hu ASY, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery - A systematic literature review of 30 studies. Am J Surg 2017; 214:920-930. [PMID: 28739121 DOI: 10.1016/j.amjsurg.2017.07.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The study aims to evaluate the methodological quality of publications relating to predicting the need of conversion from laparoscopic to open cholecystectomy and to describe identified prognostic factors. METHOD Only English full-text articles with their own unique observations from more than 300 patients were included. Only data using multivariate analysis of risk factors were selected. Quality assessment criteria stratifying the risk of bias were constructed and applied. RESULTS The methodological quality of the studies were mostly heterogeneous. Most studies performed well in half of the quality criteria and considered similar risk factors, such as male gender and old age, as significant. Several studies developed prediction models for risk of conversion. Independent risk factors appeared to have additive effects. CONCLUSION A detailed critical review of studies of prediction models and risk stratification for conversion from laparoscopic to open cholecystectomy is presented. One study is identified of high quality with a potential to be used in clinical practice, and external validation of this model is recommended.
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Affiliation(s)
- Alan Shiun Yew Hu
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
| | - R Menon
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
| | - R Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia; Research and Development Unit, Primary Health Care and Dental Care, Narhalsan, Southern Älvsborg County, Region Västra Götaland, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - A de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
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Sanal B, Korkmaz M, Zeren S, Can F, Elmali F, Bayhan Z. Does gallbladder angle affect gallstone formation? Pan Afr Med J 2016; 24:165. [PMID: 27795762 PMCID: PMC5072821 DOI: 10.11604/pamj.2016.24.165.7768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/21/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Morphology of gallbladder varies considerably from person to person. We believe that one of the morphological variations of gallbladder is the "gallbladder angle". Gallbladder varies also in "angle", which, to the best of our knowledge, has never been investigated before. The purpose of this study was to investigate the impact of gallbladder angle on gallstone formation. METHODS in this study, 1075 abdominal computed tomography (CT) images were retrospectively examined. Patients with completely normal gallbladders were selected. Among these patients, those with both abdominal ultrasound and blood tests were identified in the hospital records and included in the study. Based on the findings of the ultrasound scans, patients were divided into two groups as patients with gallstones and patients without gallstones. Following the measurement of gallbladder angles on the CT images, the groups were statistically evaluated. RESULTS The gallbladder angle was smaller in patients with gallstones (49 ± 21 degrees and 53 ± 19 degrees) and the gallbladder with larger angle was 1.015 (1/0.985) times lower the risk of gallstone formation. However, these were not statistically significant (p>0,05). CONCLUSION A more vertically positioned gallbladder does not affect gallstone formation. However, a smaller gallbladder angle may facilitate gallstone formation in patients with the risk factors. Gallstones perhaps more easily and earlier develop in gallbladders with a smaller angle.
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Affiliation(s)
- Bekir Sanal
- Department of Radiology, Dumlupinar University Faculty of Medicine, 43100, Kutahya, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Dumlupinar University Faculty of Medicine, 43100, Kutahya, Turkey
| | - Sezgin Zeren
- Department of General Surgery, Dumlupinar University Faculty of Medicine, 43100, Kutahya, Turkey
| | - Fatma Can
- Department of Radiology, Dumlupinar University Faculty of Medicine, 43100, Kutahya, Turkey
| | - Ferhan Elmali
- Department of Biostatistics and Bioinformatics, Erciyes University Faculty of Medicine, 38100, Kayseri, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Dumlupinar University Faculty of Medicine, 43100, Kutahya, Turkey
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Dietrich CF, Braden B. Sonographic assessments of gastrointestinal and biliary functions. Best Pract Res Clin Gastroenterol 2009; 23:353-67. [PMID: 19505664 DOI: 10.1016/j.bpg.2009.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound has been established as a routine work-up imaging method in abdominal diseases. It assesses the morphology of intra-abdominal organs and depicts the normal and pathological anatomy of the gastrointestinal tract as well as of the biliopancreatic system. Ultrasound is the method of choice for visualisation of motion sequences since it is, in contrast to other imaging methods, a real-time method. The non-invasiveness and the repeatability of the method are important advantages when performing investigations of functional processes. Therefore, ultrasound is most suited for functional studies. Up to now, functional ultrasound and its potential have been undervalued. Functional ultrasound provides a widely available method to increase our understanding of functional processes and motility. The authors review the options of functional ultrasound and discuss its practical relevance.
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