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Cohen DL, Bermont A, Richter V, Avivi E, Mari A, Shirin H. Technical Success in Performing Esophageal High-Resolution Manometry in Patients with an Epiphrenic Diverticulum. Dysphagia 2024; 39:282-288. [PMID: 37542551 DOI: 10.1007/s00455-023-10610-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
High-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders, yet it can be poorly tolerated and technically challenging. Epiphrenic diverticula (ED) are located in the distal esophagus and are associated with underlying motility disorders. ED patients (2008-2022) were retrospectively compared to achalasia patients (2008-2022) and all other patients (2021-2022) who underwent HRM at a single center. Complete success was defined as at least 7 interpretable swallows including measurements throughout the esophagus into the stomach. HRM studies involving children, previously treated achalasia, and sedation or endoscopic-assistance were excluded. 20 ED patients (mean age 66; 60% female) were compared to 76 achalasia patients and 199 controls. HRM was completely successful in 70.0% of ED patients, 85.5% of achalasia (p = 0.106 vs ED), and 91.0% of controls (p = 0.004 vs ED). Most failures in the ED and achalasia groups were due to inability to traverse the esophagogastric junction (EGJ), while patient intolerance was the main reason in controls. Half of the ED group had motility disorders (25% achalasia, 15% hypercontractile esophagus, 10% absent contractility). Large diverticulum size was inversely associated with technical success compared to small diverticulum size (40% vs 100%, p = 0.013), while the presence of a motility disorder did not significantly affect success (60% vs 88.9%, p = 0.303). In conclusion, ED is a predictor of unsuccessful HRM. This appears to be mainly related to an inability to traverse the EGJ due to the size of the diverticulum. Consideration should be given to alternative means of evaluating motility, such as endoscopy-assisted HRM, given the high likelihood of failure with traditional HRM.
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Affiliation(s)
- Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel.
| | - Anton Bermont
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel
| | - Vered Richter
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Avivi
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel
| | - Amir Mari
- Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth, Israel
- Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Haim Shirin
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Savarino EV, Salvador R, Ghisa M, Mari A, Forattini F, Costantini A, De Giorgio R, Zaninotto G. Research gap in esophageal achalasia: a narrative review. Dis Esophagus 2024:doae024. [PMID: 38525929 DOI: 10.1093/dote/doae024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
In recent years, new translational evidence, diagnostic techniques, and innovative therapies have shed new light on esophageal achalasia and revamped the attention on this relatively rare motility disorder. This narrative review aims to highlight the most recent progress and the areas where further research is needed. The four senior authors identified five topics commonly discussed in achalasia management: i.e. pathogenesis, role of functional lumen imaging probe in the diagnostic flow chart of achalasia, how to define the outcome of achalasia treatments, how to manage persistent chest pain after the treatment, and if achalasia patients' may benefit from a regular follow-up. We searched the bibliographic databases to identify systematic reviews, meta-analyses, randomized control trials, and original research articles in English up to December 2023. We provide a summary with the most recent findings in each of the five topics and the critical points where to address future research, such as the immune-genetic patterns of achalasia that might explain the transition among the different phenotypes, the need for a validated clinical definition of treatment success, the use of neuromodulators to manage chest pain, and the need for identifying achalasia patients at risk for cancer and who may benefit of long-term follow-up. Although undoubtedly, progress has been made on the definition and management of achalasia, unmet needs remain. Debated aspects range from mechanistic insights, symptoms, objective measure relationships, and accurate clinical responses to therapeutic interventions. Translational research is eagerly awaited to answer these unresolved questions.
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Affiliation(s)
- Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Renato Salvador
- Chirurgia Generale 1, Azienda Ospedale Università of Padua, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Matteo Ghisa
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Amir Mari
- Gastroenterology Unit, Nazareth Hospital EMMS, The Azrieli Faculty of Medicine, Bar-Ilan University, Tel Aviv, Israel
| | - Francesca Forattini
- Chirurgia Generale 1, Azienda Ospedale Università of Padua, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Andrea Costantini
- Chirurgia Generale 1, Azienda Ospedale Università of Padua, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Baker FA, Savarino E, Ahmad HS, Zeina AR, Abboud W, Khoury T, Natour RT, Kopelman Y, Mari A. Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis. Dysphagia 2024:10.1007/s00455-023-10642-6. [PMID: 38285232 DOI: 10.1007/s00455-023-10642-6] [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] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH's frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett's esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Helal Said Ahmad
- Department of Gastroenterology, Azrieli Faculty of Medicine, Nazareth EMMS Hospital, Bar Ilan University, Safed, Israel
| | - Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Wisam Abboud
- Department of Surgery, Nazareth Hospital, EMMS, Nazareth, Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar-Ilan University, Nahariya, Safed, Israel
| | - Randa Taher Natour
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel.
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Azrieli Faculty of Medicine, Nazareth EMMS Hospital, Bar Ilan University, Safed, Israel
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Abu Baker F, Kopelman Y, Taher R, Abu Much S, Green I, Mari A, Davidov Y, Ben-Ari Z, Israel A. Hepatitis B virus infection and risk of colorectal cancer: a large, population-based cohort study from Israel. Minerva Med 2024:S0026-4806.23.08964-4. [PMID: 38197570 DOI: 10.23736/s0026-4806.23.08964-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Recent population-based studies have suggested a possible link between hepatitis B (HBV) infection and extra-hepatic malignancies. We aimed to evaluate the association between HBV and colorectal cancer (CRC) using a large, population-based cohort study utilizing data from a large health maintenance organization (HMO). METHODS The study included patients with non-cirrhotic HBV based on relevant ICD-9-CM codes and supportive serology identified from the HMO's database. Age-, sex-, ethnicity-, and BMI-matched non-HBV patients in a 1:10 ratio were included in the control group. We assessed the overall diagnosis rate of CRC and hepatocellular carcinoma (HCC) during the study period and calculated the diagnosis rate of CRC in each age category (≤50, 51-70, and ≥70) in both groups. RESULTS A total of 3430 HBV patients and 34,300 controls were included in the study. The mean age, sex, BMI, and ethnic composition were similar, and the rates of family history of CRC did not differ between both groups. The overall follow-up period was 134±16 months. The diagnosis rate of HCC (1.6% vs. 0.1%; P<0.0001) was significantly higher in the HBV patients. However, the proportion of CRC was comparable for both groups (0.6% vs. 0.8%, P=0.404), which was evident in all age subgroups. CONCLUSIONS Our findings suggest that HBV infection is associated with an increased risk of HCC diagnosis but is not linked to an elevated risk of CRC. These findings may inform future clinical practice and research regarding the relationship between HBV and extrahepatic malignancies.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Randa Taher
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel -
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Saif Abu Much
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ilan Green
- Leumit Healthcare Service, Tel Aviv, Israel
| | - Amir Mari
- Department of Gastroenterology and Hepatology, EMMS Hospital, Nazareth, Israel
| | - Yana Davidov
- Center for Liver Diseases, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Ziv Ben-Ari
- Center for Liver Diseases, Tel HaShomer Hospital, Ramat Gan, Israel
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Mahamid R, Said Ahmad H, Azzam N, Omari A, Abu Baker F, Mari A. The yield of solid swallows in high resolution esophageal manometry among patients with dysphagia and gastro-esophageal reflux symptoms. Minerva Gastroenterol (Torino) 2023; 69:511-516. [PMID: 35388665 DOI: 10.23736/s2724-5985.22.03180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Swallowing disorders are frequently reported esophageal symptoms and represent a common cause for referrals to gastroenterology consultations. Esophageal high-resolution manometry (HRM) is considered the gold standard modality for the evaluation of esophageal peristalsis and esophageal sphincter. The standard protocol of HRM includes water swallows only, that may not assess appropriately esophageal function and symptoms. Hence, we investigated the diagnostic yield of combining solid food swallows (SFS) to standard HRM. METHODS We conducted a retrospective study at the Unit of Gastroenterology of EMMS Nazareth Hospital, Israel. Patients who underwent manometry mainly due to dysphagia or reflux symptoms between November 2019 and November 2020 were enrolled. All patients underwent routine HRM and completed ten 5 mL water swallows and 5 bread swallows. Analysis and reports were done by an expert gastroenterologist, based on the Chicago Classification version 3. RESULTS Overall, 99 patients (45.5% men, mean age 52.1±16 years) who underwent HRM were included. The addition of solid swallows to the test changed manometry results in 43 patients (43.4%) (P<0.005). Furthermore, SFS improved the contractility in 26/42 cases of ineffective and/or absent motility (61%) (P<0.005). Finally, SFS aggravated symptoms in 44 patients (44.6% more aggravation than in liquid only) (P<0.005). CONCLUSIONS Combining SFS to HRM can improve the diagnostic yield of the study. Adding solid swallows is of special value in cases of ineffective esophageal motility but induces a high rate of symptoms aggravation.
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Affiliation(s)
- Rawan Mahamid
- Pediatrics Department, Haeemk Hospital, Afula, Israel
| | - Helal Said Ahmad
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Narjes Azzam
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Ali Omari
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel -
| | - Amir Mari
- Unit of Gastroenterology and Endoscopy, Gastroenterology and Hepatology Institute, The Nazareth Hospital, EMMS, Nazareth, Israel
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6
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Yaccob A, Mari A. Colonoscopy in the young: Rethinking the yield. J Investig Med 2023; 71:795-796. [PMID: 37776212 DOI: 10.1177/10815589231201521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Afif Yaccob
- Center for Liver Diseases, Rambam Healthcare Campus, Rappaport Faculty of Medicine, Haifa, Israel
| | - Amir Mari
- Gastroenterology Unit, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
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Carmel M, Cohen DL, Hijazi B, Azzam N, Khoury T, Pagliaro M, Pesce M, Mari A. Chicago Classification Version 4.0 Improves Stratification of Ineffective Esophageal Motility Patients into Clinically Meaningful Subtypes: A Two-Center International Study. Dysphagia 2023:10.1007/s00455-023-10628-4. [PMID: 37934251 DOI: 10.1007/s00455-023-10628-4] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
The 4th iteration of the Chicago Classification (CC v4.0) for esophageal motility disorders offers more restrictive criteria for the diagnosis of Ineffective Esophageal Motility (IEM) compared to version 3.0 (CC v3.0). In light of the updated criteria for IEM, we aimed to characterize and compare the patients who retained their IEM diagnosis to those who were reclassified as normal motility, and to evaluate the clinical impact of the newly introduced CC v4.0. We performed a retrospective case-control study. We included all individuals who underwent a high-resolution manometry (HRM) between 2020 and 2021 at two centers. Consecutive studies reported as IEM according to the CC v3.0 were reanalyzed according to the CC v4.0. We compared demographics, clinical, manometry, and pH-monitoring parameters. Out of 452 manometry studies, 154 (34%) met criteria for IEM as per the CC v3.0 (CC v3.0 IEM group). Of those, 39 (25%) studies were reclassified as normal studies according to the CC v4.0 (CC v4.0 normal group), while the remaining 115 studies (25% of the overall cohort) retained an IEM diagnosis (CC v4.0 IEM group). The CC v4.0 normal group had more recovered contractions during solid swallows (p = 0.01), less ineffective swallows (p = 0.04), and lower acid exposure time (p = 0.02) compared to the CC4.0 IEM group. Under CC v4.0 criteria, fewer patients are diagnosed with IEM. Those diagnosed with IEM had worse esophageal function and higher acid burden. Though further studies are needed to confirm these findings, our results indicate that CC v4.0 criteria restrict the IEM diagnosis to a more clinically meaningful population.
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Affiliation(s)
- Moshe Carmel
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel.
- Gastroenterology Department, Nazareth EMMS Hospital, Nazareth, Israel.
| | - Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Basem Hijazi
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - Narges Azzam
- Gastroenterology Department, Nazareth EMMS Hospital, Nazareth, Israel
| | - Tawfik Khoury
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Gastroenterology Department, Nazareth EMMS Hospital, Nazareth, Israel
| | - Marta Pagliaro
- Department of Clinical Medicine and Surgery, University of Naples "Federico II" Naples, 80131, Naples, Italy
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, University of Naples "Federico II" Naples, 80131, Naples, Italy
| | - Amir Mari
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Gastroenterology Department, Nazareth EMMS Hospital, Nazareth, Israel
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Mari A, Emmanuel A. Dilated gut conditions: diagnosis and management. Clin Med (Lond) 2023; 23:558-560. [PMID: 38065609 DOI: 10.7861/clinmed.2023-ga2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Dilatation of the gut occurs in response to either mechanical obstruction or aperistalsis. The hallmark features are symptoms of bowel obstruction with vomiting, constipation, abdominal pain and distension. This review will primarily deal with the non-mechanical causes of gut dilatation, both intestinal and colonic, and differentiate between acute and chronic presentations.
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Affiliation(s)
- Amir Mari
- Israel Institute of Technology, Hadera, Israel and Nazareth Hospital EMMS, Nazareth, Israel
| | - Anton Emmanuel
- University College London, and consultant gastroenterologist, National Hospital for Neurology and Neurosurgery (Queen Square), London, UK
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Abu Baker F, Nicola D, Mari A, Zeina AR, Beshara A, Natour RT, Kopelman Y. Screening and Colonoscopy Quality Measures: Ethnic Disparities and Impact on Patients' Outcome. Int J Clin Pract 2023; 2023:8881715. [PMID: 37936891 PMCID: PMC10627719 DOI: 10.1155/2023/8881715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/19/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023] Open
Abstract
Background Recent reports have confirmed the improving trends in colorectal cancer (CRC) incidence and outcomes. Still, disparities in incidence and mortality in CRC continue to persist between major ethnic groups despite the provision of widespread screening and improved care. We aimed to outline, from an endoscopic point of view, ethnic disparities in major endoscopic measures concerned with CRC screening and detection and track their impact on patients' outcomes. Methods We reviewed electronic reports of patients referred for colonoscopy procedures over 20 years. We compared demographic, clinical, and endoscopic findings between major ethnic population groups in Israel. In addition, trends of screening utilization, bowel preparation, and polyp detection rates were tracked, and the incidence of CRC diagnosis was followed. Results A total of 51307 patients had undergone colonoscopies, of whom 16% were Arabs, and 84% were Jewish. The procedures performed for CRC screening throughout the study period were significantly lower in Arabs (5% vs. 13.1%; P < 0.0001). In parallel, for most of the follow-up period, the Arab patients had higher rates of inadequate bowel preparation (overall: 19.9% vs. 12%; P < 0.001) and a lower polyp detection rate (16.7% vs. 22.5%; P < 0.0001). Expectedly, the incidence of CRC has steadily decreased in the Jewish group, while an adverse pattern of increasing incidence was documented in the Arab patient during the follow-up period. Conclusion Characterized by lower screening utilization and poor bowel preparation, the incidence of CRC development in Arab patients is increasing, while improving trends of CRC were observed in their Jewish counterparts.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Dorin Nicola
- Department of Internal Medicine, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Affiliated with the Faculty of Medicine, Bar Illan University, Safed, Israel
| | - Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Amani Beshara
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Randa Taher Natour
- Department of Internal Medicine, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
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Mari A, Na'amnih W, Ghantous L, Ahmad HS, Khoury T, Muhsen K. Quality of life and severity of symptoms among patients with various degrees of reflux esophagitis: a prospective study. Sci Rep 2023; 13:13970. [PMID: 37634042 PMCID: PMC10460377 DOI: 10.1038/s41598-023-41332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/24/2023] [Indexed: 08/28/2023] Open
Abstract
Gastro-esophageal reflux disease (GERD) can cause erosive esophagitis (EE) and compromise the quality of life (QoL). We examined differences in symptom severity and QoL according to EE severity grade. A follow-up study was conducted among GERD patients at the Nazareth Hospital in Israel. Patients underwent a baseline gastroscopy in 2014-2020 during which the EE grade was determined using the Los Angeles classification. Follow-up telephone interviews were conducted during 2019-2020 with a mean time interval of 18.9 months (SD = 14.9) after the baseline gastroscopy to assess GERD symptoms using the Reflux disease questionnaire (RDQ) and QoL using the GERD QoL questionnaire. The patients were interviewed in their native language (Arabic or Hebrew). Overall, 149 (66.4% males) patients were included; 50 had EE grades C/D and 99 had grades A/B. The mean age at baseline and follow-up was 44.6 years (SD = 15.1) and 46.2 years (SD = 14.9), respectively. Cronbach's alpha was 0.928 and 0.855 for the RDQ and QoL questionnaires, respectively. Patients with EE C/D grades had more severe symptoms than patients with EE A/B grades (P = 0.05), especially in regurgitation scores (P = 0.03). Females had more severe symptoms (overall) than males (adjusted OR = 2.34; 95% CI 1.12-4.90). Patients with the more severe esophagitis EE C/D group (adjusted OR = 1.98; 95% CI 0.93-4.24) and those who used PPIs treatment (adjusted OR = 2.19; 95% CI 0.95-5.01) reported more severe GERD symptoms. The number of schooling years was significantly associated with better QoL score (beta coefficient 1.33, P = 0.005) but not EE grade or GERD symptoms. Follow-up endoscopy conducted among 22 patients with EE grades C/D showed that 13 (59.1%) of these patients had normal endoscopic findings, 6 patients (27.3%) had a grade A EE, 1 patient (4.5%) had grade B, and 2 (9.1%) remained with grade C EE. The Arabic and Hebrew versions of the RDQ and QoL questionnaires were highly reliable. GERD symptoms severity was more profound among patients with more severe esophagitis. No significant association between EE grade and QoL; this negative result might be due to the improvement in esophagitis endoscopic findings among patients with C/D grade.
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Affiliation(s)
- Amir Mari
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel.
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Loay Ghantous
- Internal Medicine Department, Azrieli Faculty of Medicine, Nazareth Hospital, Bar Ilan University, Nazareth, Israel
| | - Helal Said Ahmad
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel
| | - Tawfik Khoury
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ahmad HS, Cohen SA, Khoury T, Tome R, Zeibak H, Abboud W, Mari A. Gas Embolism After a Patient's Ninth ERCP Procedure. ACG Case Rep J 2023; 10:e01124. [PMID: 37575487 PMCID: PMC10419710 DOI: 10.14309/crj.0000000000001124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Gas embolism is a rare and potentially fatal complication of endoscopic retrograde cholangiopancreatography (ERCP). We present a 66-year-old man who developed gas embolism after undergoing therapeutic ERCP for cholangitis. Some risk factors of gas embolism in this patient included stones in the common bile duct with cholangitis and a history of multiple ERCP procedures. Early diagnosis and rapid treatment of this potentially fatal complication resulted in our patient's full recovery.
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Affiliation(s)
- Helal Said Ahmad
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
| | - Sari Anne Cohen
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tawfik Khoury
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
| | - Riad Tome
- Department of Anesthesiology, Nazareth Hospital EMMS, Nazareth, Israel
| | - Haitam Zeibak
- Department of Anesthesiology, Nazareth Hospital EMMS, Nazareth, Israel
| | - Wisam Abboud
- Department of General Surgery, Nazareth Hospital EMMS, Nazareth, Israel
- Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Mari
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
- Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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Cohen DL, Mari A, Bermont A, Yovel DZ, Richter V, Shirin H. Ethnic Differences in Anorectal Manometry Findings in Patients With Fecal Incontinence: Results From a Multiethnic Cohort According to the London Classification. J Neurogastroenterol Motil 2023; 29:370-377. [PMID: 37417264 PMCID: PMC10334202 DOI: 10.5056/jnm21233] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/19/2022] [Accepted: 02/20/2023] [Indexed: 07/08/2023] Open
Abstract
Background/Aims Clinical rates of fecal incontinence (FI) are known to vary based on race and ethnicity. It is unclear if anorectal manometry (ARM) findings in patients with FI differ based on ethnicity. Methods High-resolution ARM studies performed between 2014-2021 due to FI at 2 hospitals with multiethnic populations were retrospectively reviewed. Results Four hundred and seventy-nine subjects were included--87 (18.2%) Arab Israelis, 76 (15.9%) immigrants from the former Soviet Union, and 316 (66.0%) Jewish Israelis. Median age was 67 years old (76.0% women: 90.4% were parous). The Arab Israeli group had higher rates of smoking, diabetes, and obesity. Over 95% of ARM's were abnormal per the London classification including 23% with "combined anal hypotension and hypocontractility," 36% with "anal normotension with anal hypocontractility," 67% with "dyssynergia," and 65% with either "rectal hyposensation" or "borderline rectal hyposensation." On univariate analyses, significant differences between the ethnic groups were noted in the rates of "anal hypotension with normal contractility," "combined anal hypotension with anal hypocontractility," and "dyssynergia." In multivariate logistic regression analyses controlling for age, gender, parity, smoking, diabetes, and obesity, the Arab Israeli group remained several times more likely to have "combined anal hypotension and hypocontractibility" compared to the other groups. Conclusions Ethnicity impacts ARM findings in patients with FI. The reason for this is unclear and future studies on ethnically diverse populations evaluating the clinical relevance of these findings are warranted.
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Affiliation(s)
- Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth Hospital EMMS, Nazareth, Israel
| | - Anton Bermont
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Dana Zelnik Yovel
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Vered Richter
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Haim Shirin
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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Arnon-Sheleg E, Farraj M, Michael S, Mari A, Khoury T, Sbeit W. Modified Hepatobiliary Scintigraphy for the Diagnosis of Bile Reflux in One-Anastomosis Gastric Bypass Surgery: a Prospective Multicenter Study. Obes Surg 2023; 33:1997-2004. [PMID: 37184825 DOI: 10.1007/s11695-023-06632-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE One-anastomosis gastric bypass (OAGB) is a relatively simple surgical procedure for those afflicted with severe obesity. Studies reported symptomatic biliary reflux gastritis and esophagitis as predominant complications. Hepatobiliary scintigraphy (HIDA) is the least invasive test for the diagnosis of bile reflux, with good sensitivity, patient tolerability, and reproducibility. The aim of this study was to define an optimized HIDA scintigraphy protocol for demonstrating bile reflux in post-OAGB patients. MATERIAL AND METHODS We conducted a prospective multicenter study. Patients after OAGB with dyspeptic complaints were included. All patients underwent HIDA scan with a dedicated protocol for demonstrating bile reflux; prevalence and severity were reported. RESULTS Nineteen patients were included, 18 females and one male, with mean age of 41.8 years and mean time of 22.4 months from operation to the scan. Bile reflux into the gastric pouch was documented in 11 patients (53%). Reflux to the stomach pouch was severe in three patients (27%), moderate in two patients (18%), and mild in six patients (55%). Bile reflux into the esophagus was documented in four patients (21%), severe reflux in one patient (25%), and mild in the other three (75%). A correlation was found between complaints of vomiting, heartburn and regurgitation, and findings of esophagitis on gastroscopy in patients with vs. without reflux. CONCLUSIONS The tailored HIDA scan protocol detected bile reflux in more than half of the post-OAGB patients included in the study, with a high diagnostic sensitivity.
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Affiliation(s)
- Elite Arnon-Sheleg
- Nuclear Medicine Department, Galilee Medical Center, 2210001, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Moaad Farraj
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Surgery, The Baruch Padeh Medical Center, 1528001, Tiberias, Israel
| | - Samar Michael
- Radiology Department, Galilee Medical Center, 2210001, Nahariya, Israel
| | - Amir Mari
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Gastroenterology Department, Nazareth Hospital, 16100, Nazareth, Israel
| | - Tawfik Khoury
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- Department of Gastroenterology, Galilee Medical Center, 2210001, Nahariya, Israel.
| | - Wisam Sbeit
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Gastroenterology, Galilee Medical Center, 2210001, Nahariya, Israel
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Mari A, Marabotto E, Ribolsi M, Zingone F, Barberio B, Savarino V, Savarino EV. Encouraging appropriate use of proton pump inhibitors: existing initiatives and proposals for the future. Expert Rev Clin Pharmacol 2023; 16:913-923. [PMID: 37632213 DOI: 10.1080/17512433.2023.2252327] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) have revolutionized the management of acid-related disorders, representing today the mainstay treatment of these conditions. However, despite their large range of indications and usefulness, the remarkable expansion of their use in the last two decades cannot be explained by the increasing prevalence of acid-related diseases only. An inappropriate prescription for clinical conditions in which the pathogenetic role of acid has not been documented has been described, with the natural consequence of increasing the costs and the potential risk of iatrogenic harm due to adverse events and complications recently emerged. AREAS COVERED In this review, we summarize current indications of PPIs administration, potential adverse events associated with their chronic utilization, and misuse of PPIs. Moreover, we describe existing and possible initiatives for improving the use of PPIs, and some proposals for the future. EXPERT OPINION PPI deprescribing is the preferred and most effective approach to reduce the use of PPIs, rather than adopting sharp discontinuation, probably due to fewer withdrawal symptoms. Nonetheless, large knowledge gaps still exist in clinical practice regarding the optimal approach of PPI deprescribing in various clinical scenarios. Further prospective well-designed international studies are eagerly warranted to improve our perspectives on controlling global PPI inappropriate use.
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Affiliation(s)
- Amir Mari
- Gastroenterology Unit, Nazareth EMMS Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine, Bar Ilan University, Nazareth, Israel
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Rome, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, ItalyI
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Brigida Barberio
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, ItalyI
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, ItalyI
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Maetzel H, Rutkowski W, Panic N, Mari A, Hedström A, Kulinski P, Stål P, Petersson S, Brismar TB, Löhr JM, Vujasinovic M. Non-alcoholic fatty pancreas disease and pancreatic exocrine insufficiency: pilot study and systematic review. Scand J Gastroenterol 2023; 58:1030-1037. [PMID: 37088949 DOI: 10.1080/00365521.2023.2200452] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2-46% among patients without known pancreatic diseases. An association between NAFPD and non-alcoholic fatty liver disease (NAFLD) has been proposed, as well as an association between NAFPD and pancreatic exocrine insufficiency (PEI). PATIENTS AND METHODS Patients with histologically confirmed NAFLD were included in the study. The control group consisted of individuals included in a surveillance screening program. Magnetic resonance imaging (MRI) of the pancreas was performed in all patients and fat measurement was made using 2-point Dixon imaging. Fecal elastase-1 (FE-1) was performed to evaluate pancreatic exocrine function. Additionally, a 13C-mixed triglyceride breath test (13 C-MTG-BT) was performed in patients with FE-1 < 200 μg/g. RESULTS Imaging signs of NAFPD were present in 17 (71%) patients; 11 (85%) from the NAFLD group and 6 (55%) from the control group. FE-1 < 200 μg/g was found in six (25%) patients (four in the NAFLD group and two in the control group); however, none of them had clinical symptoms of PEI. Therefore, in five out of six patients with low FE-1, a 13C-MTG-BT was performed, showing normal results (>20.9%) in all tested patients. Furthermore, the serum nutritional panel was normal in all patients with low FE-1. A systematic review identified five studies relevant to the topic. CONCLUSION NAFPD was found in 85% of patients with NAFLD and in 55% of control patients. We did not diagnose PEI in either group. A literature review showed PEI in 9-56% of patients with NAFPD.
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Affiliation(s)
- Hartwig Maetzel
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Wiktor Rutkowski
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Nikola Panic
- Digestive Endoscopy Unit, University Clinic "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Amir Mari
- Gastroenterology Institute, The Nazareth Hospital EMMS, Nazareth, Israel
- The Azreili Faculty of Medicine, Bar-Ilan University, Israel
| | - Aleksandra Hedström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paula Kulinski
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Per Stål
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Petersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - J Matthias Löhr
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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Abu Baker F, Ben Ari Z, Green I, Israel A, Kopelman Y, Abu Mouch S, Davidov Y, Khoury T, Mari A. The impact of ethnicity on chronic hepatitis B infection course and outcome: big data analysis from Israel. Ethn Health 2023; 28:458-467. [PMID: 35179096 DOI: 10.1080/13557858.2022.2040957] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The effect of ethnicity on chronic hepatitis B virus (CHB) infection's course and outcome has attracted little research. We aimed to compare different aspects of ethnic disparities in CHB patients, including prevalence, phenotypes, management, and outcome between two major ethnic groups in Israel. DESIGN We conducted a large retrospective cohort study utilizing the Leumit-Health-Service database. Electronic reports of almost 700,000 members from different ethnicities and districts throughout Israel from 2000 to 2019 were reviewed. Patients' ethnicity was categorized based on the classification of the Israeli Central Bureau of Statistics into two main groups, Arabs and Jews. CHB diagnosis was based on ICD-9-CM codes and supportive serology results. Prevalence, clinical backgrounds, disease course, and patients' outcomes were compared between both groups. RESULTS The prevalence of CHB in the Arab minority group was almost twice and a half-higher when compared to their Jewish counterparts (4.3% vs. 1.8%), but they had a lower rate of referral for HBsAg testing (7% vs. 7.9%). The Arab CHB patients were significantly younger at the time of diagnosis (37.6± 13.5 vs. 45.3± 15; P < 0.001). Male predominance was noted in both groups. The Arab patients had a higher rate of active hepatitis (HBeAg-positive and/or negative hepatitis) phase (36.4% vs. 29.8%; P = 0.01), as well as a significantly higher rate of HBeAg seroconversion (45.2% vs. 35.4%; P = 0.033). Nucleos/tide analogue treatment figures were similar, with most patients in both groups receiving a high barrier to resistance treatment. Patients' outcome was similar in both groups as the rate of hepatocellular carcinoma, cirrhosis, and advanced fibrosis (after stratification analysis) were comparable between both groups. CONCLUSION Marked by a prominently higher prevalence of HBV infection, patients in the Arab ethnic group had a lower rate of referral for HBsAg testing but received comparable management and had a similar outcome compared to their Jewish counterparts.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ziv Ben Ari
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Green
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Areil Israel
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Saif Abu Mouch
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Yana Davidov
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Shillong, Meghalaya, India
- Faculty of Medicine, Bar-Illan University, Safed, Israel
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Cohen DL, Avivi E, Bermont A, Shibli F, Azzam N, Hijazi B, Baker FA, Richter V, Shirin H, Mari A. Correlation between Lower Esophageal Sphincter Metrics on High-Resolution Manometry and the Clinical Presentation of Patients with Newly Diagnosed Achalasia. Diagnostics (Basel) 2023; 13:diagnostics13061136. [PMID: 36980444 PMCID: PMC10047697 DOI: 10.3390/diagnostics13061136] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/05/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background: Achalasia is characterized by aperistalsis with poor relaxation of the lower esophageal sphincter (LES). We aimed to systematically assess whether LES metrics on high-resolution manometry (HRM) correlate with the symptomatic or endoscopic presentation of patients with achalasia. Methods: A retrospective study was performed at two tertiary medical centers. All cases of newly diagnosed, untreated achalasia were reviewed for demographics, symptoms, and endoscopic findings. These were correlated with HRM metrics, including LES basal pressure (LESP), integrated relaxation pressure (IRP), percent LES relaxation, and esophagogastric junction (EGJ) morphology. Results: 108 achalasia patients were included; 56 (51.9%) were men, with a mean overall age of 55.6 ± 17.9 years old. Achalasia subtypes included 23.1% with Type I, 65.7% Type II, and 11.1% Type III. Mean LESP was 40.9 ± 13.7 mmHg, IRP 26.8 ± 11.5 mmHg, with 36% ± 20% LES relaxation. On univariate analyses, a higher IRP was associated with age < 50 (p = 0.028), female sex (p = 0.030), Arab ethnicity (p < 0.001), weight loss (p = 0.016), a tortuous esophagus (p = 0.036), and resistance at the EGJ (p = 0.033). However, on multivariate regression analyses, only ethnicity remained significantly associated with IRP. No unique variables were associated with either LESP or percent LES relaxation. Achalasia subtype and Eckardt score were not associated with any LES metrics. Non-Type 1 EGJ morphology was associated with a lower LESP. Conclusions: LES metrics on HRM do not appear to correlate with the clinical or endoscopic presentation of patients with untreated achalasia.
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Affiliation(s)
- Daniel L. Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
| | - Eyal Avivi
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
| | - Anton Bermont
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
| | - Fahmi Shibli
- Gastroenterology and Hepatology Institute, HaEmek Medical Center, Afula 1834111, Israel
| | - Narges Azzam
- Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth 16100, Israel
| | - Basem Hijazi
- Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Fadi Abu Baker
- Gastroenterology and Hepatology Institute, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Vered Richter
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
| | - Haim Shirin
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Mari
- Gastroenterology and Endoscopy Unit, Nazareth EMMS Hospital, Nazareth 16100, Israel
- Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
- Correspondence:
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Mari A, Giudici S, Tellini R, Lambertini L, Di Maida F, Amparore D, Antonelli A, Bacchiani M, Porpiglia F, Schiavina R, Brunocilla E, Capitanio U, Da Pozzo L, Fiori C, Gontero P, Longo N, Montorsi F, Simeone C, Serni S, Siracusano S, Ficarra V, Minervini A. Laparoscopic versus robot-assisted partial nephrectomy for cT1 renal tumors in obese patients: Analysis of perioperative and follow-up functional outcomes (the RECORd2 project). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Tuderti G, Mastroianni R, Mari A, Saidian A, Narasimhan R, Anceschi U, Brassetti A, Ferriero M, Bove A, Misuraca L, Costantini M, Guaglianone S, Autorino R, Derweesh I, Minervini A, Gallucci M, Simone G. Assessing the trade-off between safety and effectiveness of off-clamp robotic partial nephrectomy in patients with high RENAL score: A propensity score-matched comparison of perioperative and functional outcomes in a multicenter analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lambertini L, Di Maida F, Grosso A, Cadenar A, Nardoni S, Gallo M, Valastro F, Mari A, Minervini A. Florence Robotic Intracorporeal Neobladder (FloRIN) stentless configuration strategy, preliminary outcomes and step-by-step technique. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Campi R, Pecoraro A, Roussel E, Amparore D, Mari A, Grosso A, Checcucci E, Montorsi F, Larcher A, Van Poppel H, Porpiglia F, Capitanio U, Minervini A, Albersen M, Serni S. Refining the indication for adjuvant pembrolizumab in patients with clear cell renal cell carcinoma at high risk of recurrence using a risk-adapted approach: A contemporary multicentre study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Vittori G, Bacchiani M, Grosso A, Raspollini M, Giovannozzi N, Righi L, Di Maida F, Agostini S, De Nisco F, Minervini A, Mari A. Multiparametric-MRI computer aid diagnosis for prostate cancer: A pathological validation of the WATSON ELEMENTARY ® system after robotic radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Prata F, Iannuzzi A, Ragusa A, Anceschi U, Flammia R, Tufano A, Bravi C, Brassetti A, Tuderti G, Minervini A, Mari A, Capitanio U, Montorsi F, Autorino R, Veccia A, Fiori C, Porpiglia F, Eun D, Lee J, Deerwesh I, Sundaram C, Steward J, Mottrie A, Leonardo C, Simone G. Analysis of CKD progression for purely Off-Clamp and On-Clamp robotic partial nephrectomy for high nephrometry renal masses: Results of a multicentric series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Rosazza M, Soria F, Moschini M, Del Giudice F, Pichler R, Hurle R, Mancon S, Carrion Monsalve D, Krajewski W, Mari A, Mazzoli S, Livoti S, Dutto D, De Bellis M, Ola L, Pisano F, Fiameni C, Lillaz B, Gontero P. Clinical validation of the EAU2021 intermediate risk NMIBC definition and implications for adjuvant treatment: A multicenter YAU Urothelial Collaboration. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Amparore D, Piramide F, Piana A, Checcucci E, Basile G, Larcher A, Gallioli A, Territo A, Gaya J, Piazza P, Puliatti S, Grosso A, Mari A, Campi R, Serni S, Capitanio U, Montorsi F, Mottrie A, Fiori C, Minervini A, Breda A, Porpiglia F. 3D virtual models improve the accuracy of nephrometric scores in predicting surgical complexity during robotic partial nephrectomy: Results of a collaborative ERUS validation study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Flammia R, Tufano A, Tuderti G, Mastroianni R, Anceschi U, Misuraca L, Bove A, Brassetti A, Ferriero M, Amparone D, Porpiglia F, Mari A, Grasso A, Minervini A, Derweesh I, Autorino R, Larcher A, Capitanio U, Eun D, Bologna E, Leonardo C, Gallucci M, Simone G. Unveil the interplay between baseline renal function, warm ischemia time and tumor complexity when assessing renal functional outcomes of on- vs. off-clamp robot-assisted partial nephrectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Pichler R, Diem G, D` Andrea D, Pradere B, Soria F, Mari A, Laukhtina E, Krajewski W, Teoh J, Del Giudice F, Mertens L, Moschini M, Posch W. Immune responses against SARS-CoV-2 wildtype in unvaccinated patients with high-risk NMIBC undergoing intravesical BCG therapy. Eur Urol 2023. [PMCID: PMC9912110 DOI: 10.1016/s0302-2838(23)00470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Amparore D, Pira F, Piana A, Checcucci E, Basile G, Larcher A, Gallioli A, Territo A, Gaya J, Piazza P, Puliatti S, Grosso A, Mari A, Campi R, Serni S, Capitanio U, Montorsi F, Mottrie A, Fiori C, Minervini A, Breda A, Porpiglia F. Functional outcomes prediction after robotic partial nephrectomy using PADUA score assessed with 3D virtual models: Preliminary results of a collaborative ERUS study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Antonelli A, Cindolo L, Sandri M, Veccia A, Annino F, Bertagna F, Di Maida F, Celia A, D’Orta C, De Concilio B, Furlan M, Giommoni V, Ingrosso M, Mari A, Nucciotti R, Olianti C, Porreca A, Primiceri G, Schips L, Sessa F, Bove P, Simeone C, Minervini A. The role of warm ischemia time on functional outcomes after robotic partial nephrectomy: Data from the clock randomized trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Brassetti A, Mari A, Saidian A, Derweesh I, Anceschi U, Bove A, Costantini M, Ferriero M, Guaglianone S, Mastroianni R, Misuraca L, Tuderti G, Minervini A, Gallucci M, Simone G. Outcomes of on-clamp vs. off-clamp robot-assisted partial nephrectomy for large highly complex renal tumors: A multicenter study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Grossmann N, Soria F, Juvet T, Potretzka A, Djaladat H, Kikuchi E, Mari A, Khene Z, Fujita K, Raman J, Breda A, Sfakianos J, Pfail J, Laukhtina E, Rajwa P, Pallauf M, Cacciamani G, Poyet C, Van Doeveren T, Boormans J, Antonelli A, Jamil M, Ploussard G, Shariat S, Pradere B. Comparing oncological and perioperative outcomes of open versus laparoscopic versus robotic radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A multicenter, multinational, propensity score-matched analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sbeit W, Abukaes H, Said Ahmad H, Sbeit M, Kalisky I, Katz L, Mari A, Khoury T. The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study. Scand J Gastroenterol 2023; 58:83-87. [PMID: 35930433 DOI: 10.1080/00365521.2022.2106150] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstone disease is common worldwide and can lead to severe complications, including cholangitis; thus, it is important to identify modifiable risk factors for cholangitis. Proton pump inhibitors (PPIs) are commonly prescribed to treat gastroenterological disorders. We aimed to explore whether PPI use is associated with an increased risk of acute cholangitis in patients with gallstone disease. METHODS This retrospective multicenter study included all patients arriving to the hospital over a 10-year period with various presentations of choledocholithiasis. We compared active PPI use in two groups: those with cholangitis (group A) vs. without cholangitis (group B). RESULTS Overall, 811 patients were included, 161 in group A and 650 in group B. The average age ± standard deviation (SD) in groups A and B was 74.5 ± 20.6 vs. 61.6 ± 20.9 years, respectively. PPI use in group A was higher vs. group B (42.9% vs. 29.1%, p = 0.001). On univariate analysis, male gender (OR 1.47, 95% confidence interval (CI) 1.04-2.08), age (OR 1.04, 95% CI 1.03-1.05), ischemic heart disease (IHD) (OR 1.68, 95% CI 1.07-2.64), hyperlipidemia (OR 1.59, 95% CI 1.11-2.29), hypertension (OR 1.81, 95% CI 1.28-2.57) and PPI use (OR 1.83, 95% CI 1.28-2.61), all were associated with acute cholangitis. On multivariate analysis, only PPI use kept its association after adjustment for age (OR 1.64, 95% CI 1.2-3.7). CONCLUSIONS Active PPI use was associated with a higher rate of cholangitis among patients with choledocholithiasis. We advocate considering this risk before prescribing PPIs to patients with gallstones. TRIAL REGISTRATION NUMBER NHR-0263-20 received on 14/01/2021 date 'retrospectively registered'.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Hani Abukaes
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Helal Said Ahmad
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Moeen Sbeit
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Itai Kalisky
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Lior Katz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Amir Mari
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Khoury ST, Mari A. The possible association between neurodegenerative/demyelinating neurological disorders in achalasia patients. Transl Neurosci 2022; 13:514-515. [PMID: 36660005 PMCID: PMC9816455 DOI: 10.1515/tnsci-2022-0269] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
The precise pathogenesis of achalasia is still unclear. Neurodegenerative and/or demyelinating disorders (NDD) appear to share some common pathophysiological pathways described in achalasia such as inflammation, autoimmune, mitochondrial dysfunction, and neurodegeneration. Jerie et al. have published on the October issue a prospective study assessing the prevalence of several NDD in achalasia patients. In this commentary, we shed some light on the possible link between achalasia and NDD as well as comment on the study by Jerie et al.
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Affiliation(s)
- Salim T. Khoury
- Department of Neurology, The Nazareth Hospital EMMS, Ramat Gan, Israel, Nazareth, Israel,The Azreili Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Mari
- The Azreili Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel,Gastroenterology Institute, The Nazareth Hospital EMMS, Nazareth, Israel
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Naftali T, Richter V, Mari A, Khoury T, Shirin H, Broide E. Do inflammatory bowel disease patient preferences from treatment outcomes differ by ethnicity and gender? A cross-sectional observational study. World J Clin Cases 2022; 10:12899-12908. [PMID: 36569023 PMCID: PMC9782943 DOI: 10.12998/wjcc.v10.i35.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/08/2022] [Revised: 05/05/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) patients’ expectations of treatment outcomes may differ by ethnicity.
AIM To investigate treatment preferences of Jewish and Arabs patients.
METHODS This prospective survey ranked outcomes treatment preferences among Arab IBD patients, based on the 10 IBD-disk items compared to historical data of Jews. An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients. Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals. Answers were compared to the answers of a historical group of Jewish patients.
RESULTS IBD-disk items of 121 Arabs were compared to 240 Jewish patients. The Jewish patients included more females, [151 (62.9%) vs 52 (43.3%); P < 0.001], higher education level (P = 0.02), more urban residence [188 (78.3%) vs 54 (45.4%); P < 0.001], less unemployment [52 (21.7%) vs 41 (33.9%); P = 0.012], higher income level (P < 0.001), and more in a partnership [162 (67.8%) vs 55 (45.4%); P < 0.001]. Expectations regarding disease symptoms: abdominal pain, energy, and regular defecation ranked highest for both groups. Arabs gave significantly lower rankings (range 4.29–6.69) than Jewish patients (range 6.25–9.03) regarding all items, except for body image. Compared to Arab women, Jewish women attached higher priority to abdominal pain, energy, education/work, sleep, and joint pain. Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity (OR 4.77; 95%CI 2.36–9.61, P < 0.001) and disease activity. The more active the disease, the greater the odds ratio for higher ranking of the questionnaire items (1-2 attacks per year: OR 2.13; 95%CI 1.02–4.45, P = 0.043; and primarily active disease: OR 5.29; 95%CI 2.30–12.18, P < 0.001). Factors inversely associated with higher patient preference were male gender (OR 0.5; 95%CI 0.271-0.935, P = 0.030), UC (OR 0.444; 95%CI 0.241–0.819, P = 0.009), and above average income level (OR 0.267; 95%CI: 0.124–0.577, P = 0.001).
CONCLUSION The highest priority for treatment outcomes was symptom relief. Patients preferences were impacted by ethnicity, gender, and socio-economic disparity. Understanding patients' priorities may improve communication and enable a personalized approach.
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Affiliation(s)
- Timna Naftali
- Institute of Gastroenterology, Meir Medical Center, Kfar-saba 4428164, Israel
| | - Vered Richter
- Department of Gastroenterology, Shamir Medical Center, Zerifin 70300, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth Hospital, Nazareth 16100, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Nazareth Hospital, Nazareth 16100, Israel
| | - Haim Shirin
- Shamir (Assaf Harofeh) Medical Center, Affiliated to Sackler School of Medicine, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Tel Aviv University, Zerifin 70300, Israel
| | - Efrat Broide
- Pediatric Gastroenterology Unit, Asaf Harofeh Medical Center, Zrifin 70300, Israel
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Abstract
Diarrhea represents a common manifestation of several gastrointestinal diseases. Infectious agents are the most common causes of diarrhea in developing countries, where the inadequate sanitation and hygiene are prevalent. In these countries, the scarcity of preventive measures as well as the limited health resources cause a substantial increase in incidence, morbidity and mortality due to infectious diseases, including diarrhea. Currently, with the availability of rapid and inexpensive air transportation millions of people travel for tourism, work and immigration from developing countries to industrialized countries and vice versa. This leads to a high number of imported pathogens such as parasites causing infectious diarrhea. Importantly, while most cases of parasitic diarrhea are short, mild and self-limited, other cases may be associated with chronic diarrhea and serious morbidity and mortality. The aim of the current review was to provide an update, from a clinician's point of view, of the main parasites causing diarrhea, with a focus on their diagnosis and management in the clinical setting.
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Affiliation(s)
- Anna Mauriello
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Amir Mari
- Unit of Gastroenterology, Nazareth Hospital, The Azrieli Faculty of Medicine, Bar Ilan University, Nazareth, Israel
| | - William Nseir
- Department of Internal Medicine A, Baruch Padeh Medical Center, The Azrieli Faculty of Medicine, Bar Ilan University, Nazareth, Israel
| | - Giorgio M Saracco
- Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette Hospital, Turin, Italy
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Abu Baker F, Mari A, Zeina AR, Erew M, Taher R, Davidov Y, Suki M, Kopelman Y. Clinical and endoscopic predictors of gastric precancerous conditions: a large population case control study. Minerva Gastroenterol (Torino) 2022; 68:400-406. [PMID: 36507828 DOI: 10.23736/s2724-5985.21.03007-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are well defined intermediate precancerous conditions (PCCs) in the gastric cancer cascade. The diagnosis of PCCs may be suspected based on endoscopic findings but is established by histology. Estimates of the global prevalence of PCCs vary widely but simple clinical or endoscopic predictors of their diagnosis are ill defined. We aimed to evaluate the prevalence of gastric PCCs in our practice and to identify predictors for its diagnosis. METHODS We analyzed electronic reports of patients referred for gastroscopy procedures over a 5-year period and included those for whom gastric biopsies were performed. We investigated demographic, clinical, and endoscopic findings to identify possible association with histologic detection of gastric PCCs and performed multivariate analysis to identify predictors of its diagnosis. RESULTS A total of 4930 patients with full endoscopic and histologic data were included for the final analysis. Of these, 806 (16.3%) patients had a histologic diagnosis of gastric PCCs. Demographic and clinical variables including male sex (51.4% vs. 45.7%; P=0.003), age over 60 (69.8% vs. 45.2%; P<0.001), and anemia indication for gastroscopy (17.6% vs. 14.8%; P=0.04) were significantly associated with gastric PCCs diagnosis. Likewise, endoscopic findings of Barret's esophagus (2.6% vs. 1.3%; P=0.006), atrophic gastritis according to endoscopist's judgment (12.9% vs. 3.5%; P<0.01) and corpus predominant gastritis (22.5% vs. 14.7%; P=0.02) were significantly associated with gastric PCCs. In multivariate analysis, age>60 (please explain all acronyms HR 2.51, 95% CI 2.12-2.96), male sex (HR 1.235, 95% CI 1.05-1.44), corpus predominant (HR 1.284, 95% CI 1.04-1.57), and atrophic gastritis (HR 4, 95% CI 3.07-5.21) were independent predictors for PCCs diagnosis. CONCLUSIONS Not uncommonly encountered in our practice, a judicious performance of gastric biopsies to detect gastric PCCs should be adopted especially in older, male patients with endoscopic findings of corpus predominant and/or gastric atrophy.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital Affiliated with the Faculty of Medicine, Bar Illan University, Bar Illan, Israel -
| | - Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
| | - Malik Erew
- Department of Internal Medicine, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
| | - Randa Taher
- Department of Internal Medicine, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
| | - Yana Davidov
- Department of Gastroenterology and Hepatology, Sheba Medical Center Affiliated to the Sackler Faculty of Medicine of Tel Aviv, Ramat Gan, Israel
| | - Mohamad Suki
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel
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Zeina AR, Kopelman Y, Mari A, Ahmad HS, Artul S, Khalaila AS, Taher R, Villannueva FZ, Safadi R, Abu Mouch S, Abu Baker F. Pulmonary embolism risk in hospitalized patients with nonalcoholic fatty liver disease: A case-control study. Medicine (Baltimore) 2022; 101:e31710. [PMID: 36397431 PMCID: PMC9666162 DOI: 10.1097/md.0000000000031710] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abundant research has associated nonalcoholic fatty liver disease (NAFLD) with atherosclerosis, but very few reports have evaluated the association between NAFLD and venous thromboembolism. We aimed to investigate the association between NAFLD and pulmonary embolism (PE) in hospitalized patients. In this retrospective case-control study, we included consecutive patients from 2 university-affiliated hospitals who were referred for CT pulmonary angiograms for a suspected PE. Patients with a history of excessive alcohol consumption, chronic liver diseases or cirrhosis were excluded. The imaging studies of the entire cohort were reviewed by 2 expert radiologists who confirmed the diagnosis of PE and examined the liver to detect and grade hepatic steatosis. Accordingly, patients were categorized into NAFLD patients and non-NAFLD controls. Patient demographics, medical history, hospitalization details as well as patients' outcomes were documented. Multivariate analysis was performed to identify predictors for developing PE and hazard ratios with corresponding 95% confidence intervals were estimated. A total of 377 patients (101 with NAFLD and 276 controls) were included. NAFLD patients had significantly higher BMI values (33.16 ± 6.78 vs 26.81 ± 5.6; P < .001) and prevalence of diabetes (41 (40%) vs 85 (30.8%); P = .03). The prevalence of PE was significantly higher in the NAFLD group (80 (79.2%) vs 147 (53.3%), P < .001). In a multivariate analysis, older age, recent surgery or trauma, active malignancy, smoking, and NAFLD (HR ratio = 4.339, P < .0001 and 95% CI = 2.196-8.572) were independently associated with PE development. Patients with NAFLD were associated with an increased risk of developing PE independent of other classical risk factors for PE.
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Affiliation(s)
- Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Nazareth, Israel
| | - Helal Said Ahmad
- Department of Gastroenterology, Nazareth EMMS Hospital, Nazareth, Israel
| | - Suheil Artul
- Department of Radiology, Nazareth EMMS Hospital, Nazareth, Israel
| | | | - Randa Taher
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Rabea Safadi
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Saif Abu Mouch
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
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D’Andrea D, Shariat S, Soria F, Di Trapani E, Mertens L, Van Rhijn B, Dinney C, Black P, Spiess P, Carrion D, Pradere B, Pichler R, Filippot R, Mari A, Moschini M. Stage dependent survival in patients treated with NAC and RC: Implications for patient selection and adjuvant therapy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lambertini L, Di Maida F, Grosso A, Cadenar A, Nardoni S, Giudici S, Valastro F, Vannuccini S, Capezzuoli T, Fambrini M, Petraglia F, Mari A, Minervini A. Urinary tract endometriosis: how to predict and prevent recurrence after primary surgical excision. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gandaglia G, Mazzone E, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval J, Rakauskas A, Sessa F, van den Bergh R, Rahota R, Soeterik T, Roumiguiè M, Afferi L, Zhuang J, Guo H, Mattei A, Gontero P, Cucchiara V, Stabile A, Fossati N, Montorsi F, Briganti A. Outcomes of prostate cancer patients with seminal vesicle invasion at multiparametric MRI managed with radical prostatectomy. Do all patients really need for a multi-modal approach? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Marchioni M, Porreca A, Di Nicola M, Lucarelli G, Dorin V, Soria F, Terracciano D, Mistretta F, Buonerba C, Cantiello F, Cantiello F, Mari A, Minervini A, Veccia A, Musi G, Hurle R, Busetto G, Del Giudice F, Chung B, Berardinelli F, Perdonà S, Del Prete P, Mirone V, Borghesi M, Porreca A, Bove P, Autorino R, Crisan N, Battaglia M, Ditonno P, Russo G, Muto M, Damiano R, Porpiglia F, de Cobelli O, Schips L, Ferro M. Progression-free survival as surrogate endpoint in high-risk non-muscle invasive bladder cancer studies: results from a machine learning-based analysis of a large multi-institutional database. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Crocerossa F, Carbonara U, Veccia A, Rosiello G, Tellini R, Mari A, Mastroianni R, Ferro M, De Cobelli O, Cacciamani G, Minervini A, Simone G, Cantiello F, Damiano R, Autorino R. Preoperative predictors of postoperative complications after robot-assisted and laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tafuri A, Marchioni M, Cerrato C, Mari A, Tellini R, Odorizzi K, Veccia A, Amparore D, Shakir A, Carbonara U, Trovato F, Catellani M, Janello L, Bianchi L, Novara G, Dal Moro F, Schiavina R, De Lorenzis E, Parma P, Cimino S, de Cobelli O, Maiorino F, Bove P, Crocerossa F, Cantiello F, D’andrea D, Di Cosmo F, Porpiglia F, Ditonno P, Montanari E, Soria F, Gontero P, Liguori G, Trombetta C, Mantica G, Borghesi M, Terrone C, Del Giudice F, Sciarra A, Galosi A, Moschini M, Shariat S, Di Nicola M, Minervini A, Ferro M, Cerruto M, Schips L, Pagliarulo V, Antonelli A. Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (radical nephroureterectomy outcomes (RANEO) research consortium). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01230-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Quarta L, Stabile A, Mazzone E, Gandaglia G, Longoni M, Ploussard G, Rahota R, Valerio M, Campi R, Mari A, Mattei A, Marra G, Beauval J, Roumiguiè M, Afferi L, Moschini M, Gontero P, van den Bergh R, Zhuang J, Tuo H, Fossati N, Montorsi F, Briganti A. The prognostic value of the number of positive targeted cores in men with positive multiparametric magnetic resonance imaging of the prostate. results from a large, multi-institutional series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lambertini L, Di Maida F, Grosso A, Cadenar A, Nardoni S, Gallo M, Mari A, Tuccio A, Vittori G, Minervini A. Florence Robotic Intracorporeal Neobladder (FloRIN) stentless configuration strategy, preliminary outcomes and step-by-step technique. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Anceschi U, Di Maida F, Flammia R, Bigazzi B, Grosso A, Spicchiale CF, Mari A, Brassetti A, Ferriero M, Tuderti G, Mastroianni R, Bove A, Misuraca L, Guaglianone S, Agrò EF, De Nunzio C, Pastore A, Fuschi A, Mattioli M, Minervini A, Simone G. Robotic intracorporeal padua ileal neobladder vs florin pouch: head to head comparison of mid-term urodynamic and functional profiles at two high-volume centers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mari A, Sbeit W, Khoury T. Bloating, Diarrhoea and Maldigestion in Patients with Metabolic Syndrome: Are Fatty Pancreas and Pancreatic Exocrine Insufficiency the Missing Pieces of the Puzzle? J Clin Med 2022; 11:jcm11195720. [PMID: 36233587 PMCID: PMC9573420 DOI: 10.3390/jcm11195720] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic exocrine insufficiency (PEI) is a disorder causing symptoms such as maldigestion, malnutrition, diarrhoea, bloating, vitamin deficiency and weight loss [...]
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Affiliation(s)
- Amir Mari
- Gastroenterology Department, Nazareth Hospital, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Wisam Sbeit
- Gastroenterology Department, Galilee Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Tawfik Khoury
- Gastroenterology Department, Galilee Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
- Correspondence: ; Tel.: +972-509870611
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Folman A, Said-Ahmad H, Mari A, Saadi T, Veitsman E, Yaccob A. Severe autoimmune hepatitis following recovery from COVID-19: a novel mode of liver injury triggered by SARS-COV-2? Minerva Gastroenterol (Torino) 2022; 68:334-336. [PMID: 35001607 DOI: 10.23736/s2724-5985.21.03115-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Adam Folman
- Department of Internal Medicine E, Rambam Healthcare Campus, Haifa, Israel
| | - Helal Said-Ahmad
- Gastroenterology and Hepatology Institute, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - Amir Mari
- Gastroenterology and Hepatology Institute, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel -
| | - Tarek Saadi
- Center for Liver Disease, Rambam Healthcare Campus, Rappaprt Faculty of Medicine, Haifa, Israel
| | - Ella Veitsman
- Center for Liver Disease, Rambam Healthcare Campus, Rappaprt Faculty of Medicine, Haifa, Israel
| | - Afif Yaccob
- Center for Liver Disease, Rambam Healthcare Campus, Rappaprt Faculty of Medicine, Haifa, Israel
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Affiliation(s)
- Salim T Khoury
- Department of Neurology, the Nazareth Hospital EMMS, Nazareth, Israel
| | - Amir Mari
- The Azreili Faculty of Medicine, Bar-Ilan University, Tel Aviv, Israel - .,Gastroenterology Institute, the Nazareth Hospital EMMS, Nazareth, Israel
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Soria F, Pradere B, Hurle R, D'Andrea D, Albisinni S, Diamand R, Laukhtina E, Di Trapani E, Aziz A, Krajewski W, Teoh J, Mari A, Moschini M, Chiancone F, Autorino R, Porreca A, Marchioni M, Liguori G, Lucarelli G, Busetto G, Foschi N, Antonelli A, Bove P, Russo G, Crisan N, Borghesi M, Boeri L, Veccia A, Greco F, Longo N, De Cobelli O, Shariat S, Gontero P, Ferro M. Radical Nephroureterectomy Tetrafecta: A Proposal Reporting Surgical Strategy Quality at Surgery. EUR UROL SUPPL 2022; 42:1-8. [PMID: 35911084 PMCID: PMC9334825 DOI: 10.1016/j.euros.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Standardized methods for reporting surgical quality have been described for all the major urological procedures apart from radical nephroureterectomy (RNU). Objective To propose a tetrafecta criterion for assessing the quality of RNU based on a consensus panel within the Young Association of Urology (YAU) Urothelial Group, and to test the impact of this tetrafecta in a multicenter, large contemporary cohort of patients treated with RNU for upper tract urothelial carcinoma (UTUC). Design, setting, and participants This was a retrospective analysis of 1765 patients with UTUC treated between 2000 and 2021. Outcome measurements and statistical analysis We interviewed the YAU Urothelial Group to propose and score a list of items to be included in the “RNU-fecta.” A ranking was generated for the criteria with the highest sum score. These criteria were applied to a large multicenter cohort of patients. Kaplan-Meier curves were built to evaluate differences in overall survival (OS) rates between groups, and a multivariable logistic regression model was used to find the predictors of achieving the RNU tetrafecta. Results and limitations The criteria with the highest score included three surgical items such as negative soft tissue surgical margins, bladder cuff excision, lymph node dissection according to guideline recommendations, and one oncological item defined by the absence of any recurrence in ≤12 mo. These items formed the RNU tetrafecta. Within a median follow-up of 30 mo, 52.6% of patients achieved the RNU tetrafecta. The 5-yr OS rates were significantly higher for patients achieving tetrafecta than for their counterparts (76% vs 51%). Younger age, lower body mass index, and robotic approach were found to be independent predictors of tetrafecta achievement. Conversely, a higher Eastern Cooperative Oncology Group score, higher clinical stage, and bladder cancer history were inversely associated with tetrafecta. Conclusions Herein, we present a “tetrafecta” composite endpoint that may serve as a potential tool to assess the overall quality of the RNU procedure. Pending external validation, this tool could allow a comparison between surgical series and may be useful for assessing the learning curve of the procedure as well as for evaluating the impact of new technologies in the field. Patient summary In this study, a tetrafecta criterion was developed for assessing the surgical quality of radical nephroureterectomy in patients with upper tract urothelial carcinoma. Patients who achieved tetrafecta had higher 5-yr overall survival rates than those who did not.
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