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Seog WJ, Dhruv S, Atodaria KP, Polavarapu A. An Extremely Rare Case of Rectal Signet Ring Cell Carcinoma. Gastroenterology Res 2022; 15:106-111. [PMID: 35572475 PMCID: PMC9076154 DOI: 10.14740/gr1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/08/2022] [Indexed: 11/11/2022] Open
Abstract
Signet ring cell carcinoma of the rectum is a rare variant of colorectal cancer. When found, it is often diagnosed in late stages and has poor prognosis. This case depicts a patient with a history of Crohn’s disease who presented to the hospital for perirectal abscesses. During the evaluation of both the abscesses and Crohn’s disease, he was found to have stage IV adenocarcinoma with signet ring cell features. The patient was started on chemotherapy before surgical resection was considered, however, showed little response. The patient’s family eventually pursued hospice care with comfort measures only. Colorectal signet ring cell carcinoma is rare but has poor prognosis as it is diagnosed generally at late and advanced stages. There is a need for more research in earlier detection of these rare cancers.
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Affiliation(s)
- Woo Jin Seog
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - Samyak Dhruv
- MedStar St. Mary’s Hospital, Leonardtown, MD, USA
- Corresponding Author: Samyak Dhruv, MedStar St. Mary’s Hospital, Leonardtown, MD, USA.
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Dhruv S, Anwar S, Polavarapu A, Yousaf F, Mukherjee I. Recurrent aseptic liver abscesses in a patient with Crohn's disease: True infection or a Crohn's flare? Arab J Gastroenterol 2021; 23:58-60. [PMID: 34838482 DOI: 10.1016/j.ajg.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/02/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
A liver abscess is identified as a rare extraintestinal manifestation of Crohn's disease, with an incidence of approximately 150 in 100,000 patients with this condition. In many of these patients, infectious causes are identified, and the patient's condition is often noted to improve with antibiotics. An aseptic abscess (AA) is an increasingly recognized entity, especially in patients with inflammatory bowel disease, where repetitive evaluations to identify the infectious cause are futile. The average age of diagnosis for an AA is 29 years. The most common site is the spleen, followed by the lymph nodes and then the liver. In this study, we present a unique case of extensive aseptic liver abscesses extending into the pleural cavity in a young patient with Crohn's disease.
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Affiliation(s)
- Samyak Dhruv
- Staten Island University Hospital, Internal Medicine, NY, USA
| | | | | | - Fahad Yousaf
- Staten Island University Hospital, Internal Medicine, NY, USA
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Madala S, Polavarapu A, Gurala D, Gumaste V. Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy. Case Rep Gastroenterol 2021; 15:513-518. [PMID: 34616249 PMCID: PMC8454251 DOI: 10.1159/000516569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022] Open
Abstract
We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.
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Affiliation(s)
- Samragnyi Madala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Abhishek Polavarapu
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
| | - Dhineshreddy Gurala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Vivek Gumaste
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
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Gurala D, Polavarapu A, Philipose J, Amarnath S, Avula A, Idiculla PS, Demissie S, Gumaste V. Esophageal Food Impaction: A Retrospective Chart Review. Gastroenterology Res 2021; 14:173-178. [PMID: 34267832 PMCID: PMC8256903 DOI: 10.14740/gr1387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Esophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology, with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. Patients presenting with food impaction often have underlying esophageal pathology. We evaluated the possible risk factors for EFI in our study. Methods We performed a retrospective chart review of 455 patients at Staten Island University Hospital (SIUH) that presented with symptoms of food impaction from 1999 to 2017. We analyzed relevant clinical data such as age, risk factors, type of food bolus, location, administration of glucagon, endoscopic technique and complications. Results Overall, 174 patients had endoscopically confirmed EFI. The majority were males 102/174 (58.6%). Esophageal pathological findings included esophagitis in 58/174 (33.3%), strictures in 43/174 (24.7%), hiatal hernias in 29/174 (16.6%) and Schatzki’s rings in 15/174 (8.6%). Thirty-two out of 174 (18.3%) had normal endoscopic findings. Diabetes mellitus (DM) was reported in 20/174 (11.4%) patients. The type of food impacted was mostly meat in 73/174 (41.9%) cases. The location of EFI was mainly in the lower one-third of the esophagus in 94/174 (54%). The endoscopic push technique was used in 95/174 (54.5%) patients and the pull technique in 83/174 (47.7%) cases. The endoscopic therapeutic intervention was successful as a first attempt in 165/175 (94.8%) patients. Complications were reported in only 5/174 (2.8%), and these mostly comprised of perforations and tears. Glucagon was given to 74/174 (42.5%) patients. The median door-to-scope time (time of presentation at the emergency department to endoscopic intervention) was 7 h (range 1.5 - 24 h) in patients who had received glucagon as opposed to 7 h (range 1 - 24 h) in patients who did not receive it. Conclusion EFI is more common in males. Esophageal strictures and hiatal hernias were the most common pathologies found in endoscopy. Esophagitis was evident in 33.3% of patients, but if it was the cause or consequence of EFI is not clearly understood. DM was associated with food impaction in only 11.4% of patients, but more studies are needed to determine if DM has a stronger association with EFI. The door-to-scope time was shorter in patients who had received glucagon. Endoscopy is a safe and effective therapeutic intervention for EFI, and complications reported were minimal.
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Affiliation(s)
- Dhineshreddy Gurala
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Abhishek Polavarapu
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Jobin Philipose
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Shivantha Amarnath
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Akshay Avula
- Department of Pulmonary and Critical Care, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Pretty Sara Idiculla
- Department of Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, India
| | - Seleshi Demissie
- Biostatistics Unit, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Vivek Gumaste
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
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Abstract
Ectopic pancreas (EP) is defined as the presence of pancreatic tissue outside the pancreas with no anatomical connection to the pancreas. It is also known as pancreatic heterotopia, accessory pancreas, aberrant pancreas, or pancreatic rest. The first case of EP was described in 1727 when pancreatic tissue was identified in the ileal diverticulum. Abdominal pain and lower gastrointestinal bleeding are the most common symptoms. On histopathological examination, EP can be classified into four subtypes. Once identified and diagnosed, the treatment is surgical resection and the post-operative course is asymptomatic in most cases. We describe a rare case of EP, which was discovered on the CT scan of the abdomen as a jejunal mass and successfully treated with surgical resection. We have also described the possible role of chromogranin A for diagnosing EP cases and for post-operative follow-up.
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Affiliation(s)
- Samyak Dhruv
- Internal Medicine, Northwell Health, New York, USA
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Rafay Khan Niazi M, Dhruv S, Polavarapu A, Toprak M, Mukherjee I. Solid Pseudopapillary Neoplasm of the Uncinate Process of the Pancreas: A Case Report and Review of the Literature. Cureus 2021; 13:e15125. [PMID: 34159027 PMCID: PMC8213380 DOI: 10.7759/cureus.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare pancreatic neoplasm that accounts for 1-3% of all pancreatic tumors. SPNs are most commonly found in females in their third and fourth decades of life. Even though the majority of the tumors are benign, malignant tumors have also been reported. Given its rare occurrence, it remains a clinical dilemma in gastroenterology, oncology, and pathology. It is critical to diagnose it early and differentiate it from other similar pancreatic tumors or cysts to ensure favorable patient outcomes. Advanced imaging techniques, characteristic histologic findings, and immunohistochemical analysis can help in diagnosing solid pseudopapillary tumors. Early diagnosis and surgical resection can result in a cure in most cases, and tumor recurrence is extremely rare. In this report, we present a case of a 40-year-old female patient who presented to the emergency room and was diagnosed with SPN of the pancreas.
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Affiliation(s)
| | - Samyak Dhruv
- Internal Medicine, Northwell Health, New York, USA
| | - Abhishek Polavarapu
- Gastroenterology, Staten Island University Hospital
- Northwell Health, Staten Island, USA
| | - Mesut Toprak
- Pathology and Laboratory Medicine, Staten Island University Hospital
- Northwell Health, Staten Island, USA
| | - Indraneil Mukherjee
- Surgery, Staten Island University Hospital
- Northwell Health, Staten Island, USA
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Dhruv S, Anwar S, Polavarapu A, Liliane D. Gastric Carcinoid: The Invisible Tumor! Cureus 2021; 13:e13556. [PMID: 33791175 PMCID: PMC8004355 DOI: 10.7759/cureus.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuroendocrine tumor (NET) of the stomach or gastric carcinoid (GC) is a rare tumor derived from enterochromaffin-like (ECL) cells of the stomach and is more common in women after the fifth decade of life. The incidence of GC has been recently trending up. While most GC are visible lesions upon direct visualization on endoscopy, one-fourth of these tumors are intramucosal and not readily identified on upper endoscopy. Thus, a complete gastric map with biopsies of antrum, body, and fundus is required to confirm the presence of carcinoid growth. Herein we report a rare case of GC which was identified on a random gastric biopsy specimen.
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Affiliation(s)
- Samyak Dhruv
- Internal Medicine, Northwell Health, New York, USA
| | | | | | - Deeb Liliane
- Gatsroenterology, Northwell Health, New York, USA
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Dhruv S, Anwar S, Polavarapu A, Kashi M, Andrawes S. Sister Mary Joseph's Nodule: Where Umbilicus Holds the Truth! Cureus 2021; 13:e13091. [PMID: 33728114 PMCID: PMC7934108 DOI: 10.7759/cureus.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An umbilical metastasis from an internal visceral malignancy is defined as Sister Mary Joseph's nodule (SMJN), and, although a rare finding, it is a very poor prognostic indicator. We describe an interesting case of metastatic colon cancer with SMJN, emphasizing the significance of this classic finding. A 64-year-old female with a history of stage IV colon cancer with palliative right hemicolectomy and left hepatectomy presented to the hospital with nausea and abdominal discomfort. A computed tomography (CT) scan of the abdomen was performed, which showed small bowel obstruction secondary to metastatic tumor mass compressing the duodenum. She refused to undergo any chemotherapy or endoscopic intervention and was eventually discharged on hospice care. During the hospital stay an umbilical ulcerative lesion was also noted, which was violaceous, measuring 4.5 x 4 cm in size, firm in consistency with irregular borders, and tender to touch. Therefore, further history was obtained from the patient about it. Several months ago, she had developed localized swelling around the umbilicus, which gradually enlarged and ulcerated later. She eventually underwent the biopsy of that umbilical lesion, which confirmed it as SMJN with metastasis from the colonic primary. However, the patient refrained from the surgical intervention of the umbilical lesion. SMJN presents as a palpable periumbilical metastatic mass with diameter usually not exceeding 5 cm in size. It can be variable in color from violaceous to reddish brown. Once discovered, such lesions should be worked up with biopsy and imaging studies such as CT scan of the abdomen, as the nodule may be indicative of underlying malignancy or cancer recurrence. Its presence indicates a poor prognosis, with average survival time after diagnosis of SMJN of 10 months.
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Affiliation(s)
- Samyak Dhruv
- Internal Medicine, Northwell Health, New York, USA
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Dhruv S, Polavarapu A, Gumaste V. Fidaxomicin Use for Clostridium Difficile Infection Probably Decreases the Effect of Coumadin® in Elderly. Cureus 2020; 12:e11915. [PMID: 33425501 PMCID: PMC7785468 DOI: 10.7759/cureus.11915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Madala S, MacDougall K, Polavarapu A, Gurala D, Gumaste V, Morvillo G. An Emphasis on Screening to Detect Liver Cirrhosis and Hepatocellular Carcinoma in Patients Having Undergone the Fontan Procedure in Early Childhood. Case Rep Gastroenterol 2020; 14:615-623. [PMID: 33362449 DOI: 10.1159/000510332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
The Fontan procedure is a surgical procedure for patients with single-ventricle anatomy that results in the flow of systemic venous blood to the lungs without passing through a ventricle. Before the 1970s, most children with single-ventricle anatomy failed to survive into adulthood. With the introduction of the Fontan procedure, and its many modifications, the survival rate of these patients improved exponentially. With patients surviving longer, complications from this procedure are being documented for the first time. Cardiovascular complications are expected early on and are well studied. More serious are the non-cardiovascular complications in patients who survive into adulthood. The biggest entity is Fontan-associated liver disease (FALD) which needs thorough monitoring to screen for hepatocellular carcinoma (HCC). FALD includes chronic passive congestion, liver cirrhosis, and HCC. Once cirrhosis develops, monitoring with annual liver function tests, AFP, and abdominal ultrasonography need to occur to screen for HCC. Patients may need to be evaluated for combined heart-liver transplantation. Strict guidelines need to be developed for monitoring and surveillance of these patients to prevent late-stage complications. Herein, we report a unique case of FALD in a young female presenting two decades after the procedure with variceal bleeding.
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Affiliation(s)
- Samragnyi Madala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Kira MacDougall
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Abhishek Polavarapu
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
| | - Dinesh Gurala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Vivek Gumaste
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
| | - Gerard Morvillo
- Department of Pathology, Staten Island University Hospital, New York, New York, USA
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Kandlakunta H, Gurala D, Philipose J, Polavarapu A, Abergel JR. A Case of Wernicke's Encephalopathy in a Pregnant Woman With a History of Sleeve Gastrectomy. Cureus 2020; 12:e9970. [PMID: 32983673 PMCID: PMC7510545 DOI: 10.7759/cureus.9970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Wernicke’s encephalopathy (WE) is a neurological complication of thiamine deficiency characterized by a triad of acute confusion, ataxia, and ophthalmoplegia. Even though it is most common in chronic alcoholism, an increase in prevalence has been reported recently due to the increased popularity of bariatric surgeries. WE is a known neurological complication after gastric bypass surgery but rarely reported after sleeve gastrectomy. We present a unique case of WE in pregnant women four months after sleeve gastrectomy.
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Affiliation(s)
- Harika Kandlakunta
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Dhineshreddy Gurala
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Jobin Philipose
- Gastroenterology and Hepatology, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Abhishek Polavarapu
- Gastroenterology and Hepatology, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Jeffrey R Abergel
- Gastroenterology and Hepatology, Northwell Health-Staten Island University Hospital, Staten Island, USA
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Acharya S, Mukherjee I, Anwar S, Lan G, Polavarapu A. Haemobilia Secondary to Spontaneous Cystic Artery-Gallbladder Fistula: A Unique Gastrointestinal Anomaly. Cureus 2020; 12:e9457. [PMID: 32874789 PMCID: PMC7455374 DOI: 10.7759/cureus.9457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spontaneous cystic artery-gallbladder fistula is an extremely rare condition described in the medical literature. We have found two articles in the literature describing fistula formation between the cystic artery and gall bladder. In this report, we present a unique case of a cystic artery-gall bladder fistula that resulted in massive gastrointestinal bleeding through cystic artery erosion and was adequately managed with coil embolization.
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Affiliation(s)
- Sudeep Acharya
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Indraneil Mukherjee
- Surgery, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Shamsuddin Anwar
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Gloria Lan
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Abhishek Polavarapu
- Gastroenterology, Northwell Health-Staten Island University Hospital, Staten Island, USA
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Haddad FG, El Imad T, Nassani N, Kwok R, Al Moussawi H, Polavarapu A, Ahmed M, El Douaihy Y, Deeb L. In-hospital acute upper gastrointestinal bleeding: What is the scope of the problem? World J Gastrointest Endosc 2019; 11:561-572. [PMID: 31839875 PMCID: PMC6885731 DOI: 10.4253/wjge.v11.i12.561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/29/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%. Despite recent newer innovations and advancements in endoscopic techniques and available medications, the mortality rate associated with AUGIB remained persistently elevated.
AIM To explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.
METHODS This is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically. Patients were divided in two groups: Group 1 comprised patients who developed AUGIB during their hospital stay; group 2 consisted of patients who initially presented with AUGIB as their main complaint. Patient characteristics, time to endoscopy, endoscopy findings and interventions, and clinical outcomes were collected and compared between groups.
RESULTS A total of 336 patients were included. Group 1 consisted of 139 patients and group 2 of 196 patients. Mortality was significantly higher in the 1st group compared to the 2nd (20% vs 3.1%, P ≤ 0.05). Increased length of stay (LOS) was noted in the 1st group (13 vs 6, P ≤ 0.05). LOS post-endoscopy, vasopressor use, number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1. Inpatients were more likely to be on corticosteroids, antiplatelets and anticoagulants. Conversely, the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.
CONCLUSION In-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy. Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.
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Affiliation(s)
- Fady G Haddad
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Talal El Imad
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Najib Nassani
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Raymond Kwok
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Hassan Al Moussawi
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Abhishek Polavarapu
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Moiz Ahmed
- Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, Elmhurst, NY 11373, United States
| | - Youssef El Douaihy
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Liliane Deeb
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
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Haddad FG, Zaidan J, Polavarapu A, Khan H, Khan A, Mudduluru BM, Saabiye J, Lukanovic S, Demissie S, Mulrooney S, Khalil A. An insight into Clostridium difficile infection: a single-center retrospective case-control study. Z Gastroenterol 2019; 57:1183-1195. [PMID: 31610581 DOI: 10.1055/a-0997-6829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) has become a worldwide health problem in view of its significant incidence and medical and economic impact on the health system. Prior studies have been undergone about risk factors and disease characteristics. We wanted to study the characteristics, prognostic factors associated with CDI at our institute, as well as a new prognostic factor. METHODS Our study aimed at describing the risk factors, patient characteristics, and outcomes associated with healthcare facility-acquired CDI (HCFA-CDI) and community-acquired CDI (CA-CDI). We intended to identify the factors associated with worse outcomes. We evaluated the characteristics associated with CDI over 3 years. We also evaluated a simple neutrophil-lymphocyte ratio (NLR) and its predictive value for worse outcomes. RESULTS Six hundred patients were enrolled (333 in a control group; 171 in the HCFA-CDI group and 96 in the CA-CDI group). NLR > 5 predicted increased mortality and intensive care unit transfer in all CDI if done as early as day 2 after CDI diagnosis. In HCFA-CDI, NLR > 5 predicted a higher ICU transfer if done as early as day 1 post-diagnosis and with increased mortality as early as day 2 post-diagnosis. In CA-CDI, NLR > 5 predicted a higher mortality and ICU transfer if done at least 4 days after diagnosis. Moreover, every 10-unit increase in NLR was associated with a significant increase in mortality and ICU transfer in patients with CDI. CONCLUSION A timely use of NLR can be used as a mean to predict worse outcomes, namely ICU transfer and mortality, in patients with CDI.
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Affiliation(s)
- Fady G Haddad
- Department of Gastroenterology and Hepatology, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Julie Zaidan
- Department of Internal Medicine, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Abhishek Polavarapu
- Department of Gastroenterology and Hepatology, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Hafiz Khan
- Department of Gastroenterology and Hepatology, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Asif Khan
- Department of Internal Medicine, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Bindu Madhavi Mudduluru
- Department of Internal Medicine, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Joseph Saabiye
- Department of Internal Medicine, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Slobodanka Lukanovic
- Department of Biostatistics, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Seleshi Demissie
- Department of Infectious Diseases, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Stephen Mulrooney
- Department of Gastroenterology and Hepatology, Northwell Health/Staten Island University Hospital, Staten Island, New York
| | - Ambreen Khalil
- Medical Student at the University of the Caribbean, Saint Maarten
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