1
|
Ghazanfar H, Javed N, Balar B. The Role of Timely Angiography in Elderly Patients Presenting With Lower Gastrointestinal Bleeding. Cureus 2023; 15:e47701. [PMID: 38021564 PMCID: PMC10674099 DOI: 10.7759/cureus.47701] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Lower gastrointestinal bleeding (LGIB) is associated with significant morbidity and mortality in the elderly population. Timely diagnosis and establishing the etiology of the LGIB can guide appropriate treatment and management. Our patient is a 91-year-old female who presented to the ER with the complaint of several episodes of hematochezia that started four hours before her presentation. The patient underwent an urgent CT angiography showing active bleeding in the proximal ascending colon. She underwent a super-selective arteriogram followed by embolization of the ascending colon arterial culprit bleeding territory using two coils. Her clinical condition improved, and she had no further episodes of hematochezia. Her case highlights the importance of timely diagnosis of the underlying etiology of a patient presenting with LGIB.
Collapse
Affiliation(s)
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Bhavna Balar
- Gastroenterology, BronxCare Health System, Bronx, USA
| |
Collapse
|
2
|
Alemam A, Shin D, Balar B. Gastric Bezoar: Cause of Weight Loss in a Patient With Previous Bariatric Surgery. Cureus 2021; 13:e20139. [PMID: 35003973 PMCID: PMC8723780 DOI: 10.7759/cureus.20139] [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: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Gastric bezoar is a concretion of undigested material found in the stomach and is classified by its composition. Patients may remain asymptomatic or present with a variety of gastrointestinal symptoms. Upper gastrointestinal endoscopy is required to establish the diagnosis. Treatment options include chemical dissolution, endoscopic removal, or surgical removal. Here, we present a rare case of gastric bezoar in a patient with a remote history of bariatric surgery presenting with acute weight loss.
Collapse
|
3
|
Shehi E, Fortuzi K, Ghazanfar H, Mehershahi S, Balar B. Apixaban Causing Hepatic Cystic Bleeding: A Rare but a Life-Threatening Complication. Case Rep Gastroenterol 2021; 15:904-909. [PMID: 34720842 PMCID: PMC8543326 DOI: 10.1159/000519276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/11/2023] Open
Abstract
Cystic lesions of the liver are a heterogeneous group of disorders with varied etiology, prevalence, and clinical manifestations. Fibropolycystic liver disease encompasses a spectrum of related liver and biliary tract lesions caused by abnormal embryologic development of the ductal plates. These disorders include congenital hepatic fibrosis, biliary hamartomas, polycystic liver disease (PCLD), choledochal cysts, and Carolis disease. PCLD is arbitrarily defined as a liver that contains >20 cysts. Most liver cysts are incidentally found on imaging studies, and the majority of the patients with liver cysts are asymptomatic. Rarely, complications such as compression, infection, and bleeding within the cyst can occur. Under the effect of the increased pressure, the epithelial lining of the cyst undergoes necrosis and sloughing, causing injury of the fragile blood vessels, leading to intracystic bleeding. The bleeding within or from the cyst can be precipitated by anticoagulation. We present a patient with PCLD who developed intracystic bleeding after he was started on apixaban for the prevention of thromboembolism.
Collapse
Affiliation(s)
- Elona Shehi
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Ked Fortuzi
- Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Haider Ghazanfar
- Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Shehriyar Mehershahi
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| | - Bhavna Balar
- Division of Gastroenterology, Department of Medicine, Bronxcare Health System, Affiliated with Icahn School of Medicine at Mt. Sinai, Bronx, New York, USA
| |
Collapse
|
4
|
Shaikh DH, Alemam A, von Ende J, Ghazanfar H, Dev A, Balar B. Ansa Pancreatica, an Uncommon Cause of Acute, Recurrent Pancreatitis. Case Rep Gastroenterol 2021; 15:587-593. [PMID: 34616260 PMCID: PMC8454227 DOI: 10.1159/000516686] [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: 02/23/2021] [Accepted: 04/16/2021] [Indexed: 11/08/2022] Open
Abstract
The pancreatic duct is vulnerable to developmental anomalies which may produce variations in its course and/or its configuration. Ansa pancreatica is the least common anatomic variant. It is characterized by the formation of an “S-shaped loop” from the main pancreatic duct to the minor papilla. Ansa pancreatica has been implicated as a cause of recurrent acute pancreatitis. We review existing literature on pancreatitis secondary to the ansa deformity and present a case of recurrent acute pancreatitis in a patient who was ultimately found to have the ansa deformity on endoscopic ultrasound.
Collapse
Affiliation(s)
- Danial H Shaikh
- Division of Gastroenterology, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA.,Department of Medicine, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA
| | - Ahmed Alemam
- Division of Gastroenterology, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA.,Department of Medicine, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA
| | - Jennifer von Ende
- School of Medicine, American University of the Caribbean, Cupecoy, Saint Martin
| | - Haider Ghazanfar
- Division of Gastroenterology, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA
| | - Anil Dev
- Division of Gastroenterology, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA.,Department of Medicine, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA
| | - Bhavna Balar
- Division of Gastroenterology, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA.,Department of Medicine, BronxCare Health System, Icahn School of Medicine, Bronx, New York, USA
| |
Collapse
|
5
|
Baiomi A, Abbas H, Niazi M, Remotti H, Daniel M, Balar B. Colonic Ganglioneuroma: A Rare Lesion With Extremely Different Presentations and Outcomes in Two Patients. Gastroenterology Res 2021; 14:194-198. [PMID: 34267836 PMCID: PMC8256904 DOI: 10.14740/gr1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
Ganglioneuroma (GN) of the gastrointestinal tract is an extremely rare neuroectodermal tumor. Patients with ganglioneuromas have different presentations depending on the location, extent and size of the lesion. We present two cases of ganglioneuromas that had different clinical presentations and outcomes.
Collapse
Affiliation(s)
- Ahmed Baiomi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Hafsa Abbas
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Masooma Niazi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Pathology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Helen Remotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Myrta Daniel
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
| |
Collapse
|
6
|
Makker J, Shaikh D, Patel H, Hanumanthu S, Sun H, Zaidi B, Ravi M, Balar B. Characteristics of Patients with Post-Colonoscopy Unplanned Hospital Visit: A Retrospective Single-Center Observational Study. Clin Exp Gastroenterol 2021; 14:19-25. [PMID: 33500647 PMCID: PMC7826066 DOI: 10.2147/ceg.s285573] [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: 10/08/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Colonoscopy, although a low-risk procedure, is not without associated adverse events. The rates of major adverse events such as perforation and bleeding after a colonoscopy are well reported. The rates of minor incidents following a colonoscopy, however, are less well examined. Recently the Centers for Medicare and Medicaid Services (CMS) started public reporting on the quality of outpatient endoscopy facilities by using a measure of risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. Aim We intended to record and present the characteristics of our patient population who had an unplanned hospital visit within 7 days after undergoing colonoscopy in an outpatient setting. Methods This is a retrospective single-center observational study. During the study period of July 2018 to December 2019, we reviewed charts of all patients who returned to the emergency room within a week of undergoing an outpatient colonoscopy. Patient demographics, clinical data and details of colonoscopy were collected and analyzed. Results Of the 5344 outpatient colonoscopies performed, our post-colonoscopy emergency room visit rate was 1.05% (n=56). The mean age of the participants was 58 years and 55% were male; 32% of our patients reported gastrointestinal symptoms such as abdominal pain or gastrointestinal bleeding. Patients with gastrointestinal symptoms had a higher rate of polypectomies performed (36.4% vs 11.8%, P = 0.04) and reported higher illicit drug use (31.9% vs 5.9%, P = 0.02) compared with those with non-gastrointestinal complaints. After colonoscopy, 41% of the patients reported reasons for emergency room visits that were entirely unrelated to the procedure. Conclusion Our study highlights that unplanned visits within 7 days of colonoscopy are not necessarily related to the procedure, and those that are, tend to be due to unavoidable patient factors. Hence the CMS measure may not be an accurate determinant of the quality of procedure or facility care delivered.
Collapse
Affiliation(s)
- Jasbir Makker
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Danial Shaikh
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Harish Patel
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Siddarth Hanumanthu
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Haozhe Sun
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Bushra Zaidi
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Madhavi Ravi
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.,Division of Gastroenterology, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA
| |
Collapse
|
7
|
Patel H, Balar B, Irigela M, Vootla V, Chandrala C, Hashmi H, Abdulsamad M, Makker J. Risk Factors for Liver Cirrhosis-Related Readmissions in the Largest Ethnic Minority in United States. Gastroenterology Res 2020; 13:11-18. [PMID: 32095168 PMCID: PMC7011917 DOI: 10.14740/gr1227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background There are very limited data available on 30-day readmissions for ethnic minority patients with cirrhosis. The aim of the study was to identify the risk factors for 30-day readmission in ethnic minority patients admitted for cirrhosis. Methods We did a retrospective review of 1,373 electronic medical records of patients with cirrhosis admitted from 2009 to 2011. Several parameters including alcohol use history, discharge location and cirrhosis severity scores - model for end-stage liver disease (MELD) score and Child-Pugh-Turcotte (CPT) at first admission were assessed. Statistical analysis was done using Chi-square test and t-test for categorical and continuous variables, respectively. Results There were 79 patients in the readmission group (63% male, 54% Hispanics and 22% African Americans) and 104 in the no readmission group (62% male, 58% Hispanics and 24% African Americans). History of alcohol use within a month prior to admission (55% vs. 33%, P = 0.002), platelet count at discharge (89,000 vs. 124,000, P = 0.003), and discharge with more than seven medications per day (7.3 vs. 5.2, P = 0.005) were identified as risk factors for readmissions by multivariate analysis. Conclusion Platelet count, active alcohol use and more than seven medications at discharge are predictors of readmission. These parameters can guide future interventions to reduce readmission rate and health care costs related to cirrhosis readmissions.
Collapse
Affiliation(s)
- Harish Patel
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Maheswara Irigela
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Vamshidhar Vootla
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Chaitanya Chandrala
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Hafiz Hashmi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Molham Abdulsamad
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| |
Collapse
|
8
|
Patel H, Makker J, Vakde T, Shaikh D, Badipatla K, Dunne J, Mantri N, Nayudu SK, Glandt M, Balar B, Chilimuri S. Nonsteroidal Anti-Inflammatory Drugs Impact on the Outcomes of Hospitalized Patients with Clostridium difficile Infection. Clin Exp Gastroenterol 2019; 12:449-456. [PMID: 31849510 PMCID: PMC6911331 DOI: 10.2147/ceg.s223886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/19/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Mouse model experiments have demonstrated an increased Clostridium difficile infection (CDI) severity with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) use. We aim to evaluate the impact of NSAIDs in humans after a diagnosis of CDI on primary outcomes defined as I) all-cause mortality and II) toxic mega-colon attributable to CDI. Patients and methods All hospitalized patients with a diagnosis of CDI were divided into two groups; those with NSAIDs administered up to 10 days after onset of CDI versus no NSAIDs use. The primary outcomes were analyzed between the groups, while controlling for severity of CDI. A logistic regression analysis was performed to identify the predictors of worse outcomes. Results NSAIDs were administered in 14% (n=80) of the 568 hospitalized visits for an average of 2.5 days after the CDI diagnosis. All-cause mortality was high in patients who did not receive NSAIDs as compared to those who did receive NSAIDs (16.6% vs 12.5%, p 0.354). Patients who were prescribed NSAIDs were more likely to have toxic mega-colon as compared to those who were not prescribed NSAIDs (2.5% vs 0.6%, p 0.094). Results were not statistically significant, even after controlling for CDI severity. Logistic regression analysis did not identify NSAIDs administration as a significant factor for all-cause mortality in CDI patients. Conclusion This retrospective study results, contrary to mouse model, did not show association between NSAID use and CDI related mortality and toxic mega-colon. Shorter duration of NSAIDs use, younger people in study group, and timely CDI treatment may have resulted in contrasting results.
Collapse
Affiliation(s)
- Harish Patel
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Jasbir Makker
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Trupti Vakde
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Danial Shaikh
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Kanthi Badipatla
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - James Dunne
- Support Service and Operation, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Nikhitha Mantri
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Suresh Kumar Nayudu
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Mariela Glandt
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Bhavna Balar
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Sridhar Chilimuri
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.,Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| |
Collapse
|
9
|
Kumar K, Patel H, Tariq H, Balar B, Makker J. A juvenile polyp on colonoscopy, is it premalignant? Clin Case Rep 2019; 7:2605-2606. [PMID: 31893117 PMCID: PMC6935639 DOI: 10.1002/ccr3.2561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022] Open
Abstract
Solitary juvenile polyp is a nonneoplastic condition but needs to be differentiated from a premalignant condition juvenile polyposis syndrome.
Collapse
Affiliation(s)
- Kishore Kumar
- Department of MedicineBronxcare Health SystemBronxNew York
- Division of GastroenterologyBronxcare Health SystemBronxNew York
| | - Harish Patel
- Department of MedicineBronxcare Health SystemBronxNew York
- Division of GastroenterologyBronxcare Health SystemBronxNew York
| | - Hassan Tariq
- Department of MedicineBronxcare Health SystemBronxNew York
- Division of GastroenterologyBronxcare Health SystemBronxNew York
| | - Bhavna Balar
- Department of MedicineBronxcare Health SystemBronxNew York
- Division of GastroenterologyBronxcare Health SystemBronxNew York
| | - Jasbir Makker
- Department of MedicineBronxcare Health SystemBronxNew York
- Division of GastroenterologyBronxcare Health SystemBronxNew York
| |
Collapse
|
10
|
Abstract
There is an increasing incidence of diverticulosis and diverticulitis in the younger populations; and its occurrence in very young individual is concerning. Here we report a rare and interesting case of a 20-year-old man who presented with 3-day history of epigastric abdominal pain associated with diarrhea and nausea. His abdominal examination revealed mild tenderness in the right lower abdominal quadrant. Computed tomography (CT) scan of abdomen with intravenous contrast revealed scattered diverticula throughout the colon with focal thickening, pericolonic infiltrative changes suggestive of acute diverticulitis in the distal ascending colon. He was treated with intravenous hydration and antibiotics and discharged when his clinical status improved. He underwent colonoscopy 1 month later which showed pan diverticulosis. This case illustrates the importance of considering acute diverticulitis in the differential diagnosis of right lower quadrant pain when evaluating a young patient.
Collapse
Affiliation(s)
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| |
Collapse
|
11
|
Tariq H, Kamal MU, Sapkota B, ElShikh F, Pirzada UA, Pullela N, Azam S, Zhang A, Baiomi A, Abbas H, Makker J, Balar B, Ihimoyan A, Daniel M, Dev A. Evaluation of the combined effect of factors influencing bowel preparation and adenoma detection rates in patients undergoing colonoscopy. BMJ Open Gastroenterol 2019; 6:e000254. [PMID: 30740233 PMCID: PMC6347943 DOI: 10.1136/bmjgast-2018-000254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/12/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Background Colonoscopy is a commonly used modality for screening and surveillance of colorectal cancer (CRC). Therefore, it is essential to have adequate bowel preparation (prep) for the procedure which depends on type of bowel regimens, diet before colonoscopy and timing of the procedure. Aims The purpose of this study is to analyse the effect of multiple factors on adenoma detection rate (ADR) and prep quality of colonoscopy. This is the also the first study determining outcomes based on various combinations of diet, timing of the procedure and bowel prep regimens. Methods This is a retrospective single-centre observational study. Data about diet before procedure, bowel prepprep regimen and timing of the procedure was collected for patients coming for screening colonoscopy. Results Patients with split prep had higher good prep rates (73.8% vs 56.2%) and higher ADRs (34.2 % vs 29.9%) as compared with non-split prep. The good prep quality (65.8% vs 62.1%) and ADRs (31.9% vs 31.5%) were comparable in patients who received clear liquid diet as compared with low residue diet. The good results of bowel prep were obtained with split prep with either clear liquids or low residue diet irrespective of the timing of procedure. The poor prep was noticed in patients who underwent procedure in afternoon, with a low restrictive diet and non-split bowel regimen. Conclusions The current study adds to our knowledge about the combined effect of multiple variables affecting the bowel prep quality and ADR. It is imperative to opt for the best combination required for colonoscopy, as this will influence the effectiveness of colonoscopies regarding timely cancer detection and prevention.
Collapse
Affiliation(s)
- Hassan Tariq
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Muhammad Umar Kamal
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Binita Sapkota
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Fady ElShikh
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Usman Ali Pirzada
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Nanda Pullela
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Sara Azam
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Aiyi Zhang
- Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Hafsa Abbas
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Ariyo Ihimoyan
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Myrta Daniel
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| | - Anil Dev
- Department of Medicine, BronxCare Health System, New York City, New York, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Health System, New York City, New York, USA
| |
Collapse
|
12
|
Ahmed R, Kumar K, Makker J, Niazi M, Balar B. Recurrent Mantle Cell Lymphoma Presenting as Gastrointestinal Bleeding. Case Rep Gastroenterol 2018; 12:379-384. [PMID: 30186088 PMCID: PMC6120417 DOI: 10.1159/000488193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/03/2018] [Accepted: 02/28/2018] [Indexed: 12/23/2022] Open
Abstract
Mantle cell lymphoma is a rare and aggressive subtype of B-cell non-Hodgkin lymphomas. Mantle cell lymphoma frequently involves extranodal sites, and gastrointestinal tract is involved microscopically and macroscopically in more than 80$ of cases. We present two cases of recurrent mantle cell lymphoma presenting with lower and upper gastrointestinal bleeding, respectively. A 58-year-old woman with a history of recurrent mantle cell lymphoma treated with chemotherapy and stem cell transplantation presented with left-sided abdominal pain and hematochezia. Colonoscopy showed a mass-like lesion in the ascending colon, polyps in the ascending colon, and splenic flexure. A 68-year-old man with a history of mantle cell lymphoma treated with chemotherapy presented with epigastric pain and melena. Esophagogastroduodenoscopy showed a large polypoidal ulcerated mass with oozing in the duodenal bulb. Biopsies in both patients were suggestive of mantle cell lymphoma. Patients with mantle cell lymphoma could be asymptomatic or may present with abdominal pain, obstruction, diarrhea, or gastrointestinal bleeding. In patients presenting with gastrointestinal symptoms, endoscopy must be pursued and biopsies must be taken for any suspicious lesions as well as normal mucosa to exclude mantle cell lymphoma as an etiology for the lesion or symptoms. Even though there are no standard guidelines for endoscopic screening of gastrointestinal tract in asymptomatic patients, one should be aware of involvement of gastrointestinal tract in the early course of disease or recurrent disease. Although mantle cell lymphoma is initially responsive to chemotherapy, it eventually becomes refractory with a median survival of 3–5 years.
Collapse
Affiliation(s)
- Rafeeq Ahmed
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, New York, USA
| | - Kishore Kumar
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, New York, USA
| | - Jasbir Makker
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, New York, USA
| | - Masooma Niazi
- Department of Pathology, BronxCare Hospital Center, Bronx, New York, USA
| | - Bhavna Balar
- Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, New York, USA
| |
Collapse
|
13
|
Abbas N, Makker J, Abbas H, Balar B. Perioperative Care of Patients With Liver Cirrhosis: A Review. Health Serv Insights 2017; 10:1178632917691270. [PMID: 28469455 PMCID: PMC5398291 DOI: 10.1177/1178632917691270] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022] Open
Abstract
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients. Perioperative management of patients with cirrhosis warrants special attention to nutritional status, fluid and electrolyte balance, control of ascites, excluding preexisting infections, correction of coagulopathy and thrombocytopenia, and avoidance of nephrotoxic and hepatotoxic medications. Transjugular intrahepatic portosystemic shunt may improve the CTP class, and semielective surgeries may be feasible. Emergency surgery, whenever possible, should be avoided.
Collapse
Affiliation(s)
- Naeem Abbas
- Divisions of Gastroenterology and Hepatology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Naeem Abbas, Divisions of Gastroenterology and Hepatology, Department of Medicine, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave, Suite 10C, Bronx, NY 10457, USA.
| | - Jasbir Makker
- Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Hafsa Abbas
- Department of Internal Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Bhavna Balar
- Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
14
|
Abdulsamad M, Abbas N, Patel H, Balar B, Khaja M. Immunoglobulin A Lambda Multiple Myeloma in a Patient with HIV: An Unusual Cause of Massive Ascites. Case Rep Gastroenterol 2017; 11:201-206. [PMID: 28512393 PMCID: PMC5422736 DOI: 10.1159/000468516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma (MM) is a neoplastic proliferation of plasma cells with overproduction of monoclonal immunoglobulins and infiltration into the bone and other organs. Ascites can develop in patients with lymphoproliferative and solid malignancies involving the peritoneum. However, ascites is unusual in MM and rarely the initial presenting sign or symptom. The development of ascites can be due to peritoneal infiltration or secondary to hepatic involvement, heart failure, or kidney failure. Ascites in MM reflects a more aggressive stage, and the reported prognosis is poor, with a median survival of 1-2 months. Here we present a rare case of immunoglobulin A lambda MM presenting with massive myelomatous ascites.
Collapse
Affiliation(s)
- Molham Abdulsamad
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | | | | | | | | |
Collapse
|
15
|
Vootla V, Ahmed R, Niazi M, Balar B, Nayudu S. Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid. Case Rep Gastroenterol 2016; 10:600-604. [PMID: 27920648 PMCID: PMC5121549 DOI: 10.1159/000450677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/18/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] Open
Abstract
Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass) and a low-grade neuroendocrine neoplasm (carcinoid of rectum). The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa.
Collapse
Affiliation(s)
- Vamshidhar Vootla
- Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| | - Rafeeq Ahmed
- Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| | - Masooma Niazi
- Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| | - Bhavna Balar
- Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| | - Suresh Nayudu
- Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| |
Collapse
|
16
|
Abdulsamad M, Abbas N, Balar B. An Unusual Case of Rectal and Ileal Carcinoid Tumors. Case Rep Gastroenterol 2016; 10:793-799. [PMID: 28203126 PMCID: PMC5260606 DOI: 10.1159/000454708] [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: 10/04/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Carcinoid tumor is the most common neuroendocrine tumor affecting the gastrointestinal tract. The coexistence of multifocal carcinoid lesions is a well-established phenomenon. Although intubation of the terminal ileum is not routinely attempted during colonoscopy, it can occasionally reveal the presence of some incidental findings. We present a patient with known rectal carcinoid, who was found to have another carcinoid lesion in the terminal ileum during surveillance colonoscopy. The patient underwent right hemicolectomy, and no chemotherapy was required as the patient was found to have stage 1 carcinoid tumor.
Collapse
Affiliation(s)
- Molham Abdulsamad
- Department of Medicine, Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Naeem Abbas
- Department of Medicine, Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Bhavna Balar
- Department of Medicine, Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, NY, USA
| |
Collapse
|
17
|
Patel H, Gaduputi V, Sakam S, Kumar K, Chime C, Balar B. Serotonin reuptake inhibitors and post-gastrostomy bleeding: reevaluating the link. Ther Clin Risk Manag 2015; 11:1283-9. [PMID: 26346885 PMCID: PMC4556253 DOI: 10.2147/tcrm.s87044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction Serotonin reuptake inhibitors (SRIs) are one of the most commonly prescribed classes of medications with a relatively safe side-effect profile. However, SRIs are being increasingly reported to be associated with bleeding complications in patients undergoing invasive procedures resulting from inhibition of serotonin reuptake by platelets and impaired platelet aggregation. The aim of our study was to determine whether there is an increased risk of post-percutaneous endoscopic gastrostomy (PEG) bleeding in patients exposed to SRIs after controlling for other mediations known to increase the risk of bleeding and major comorbidities. Methods This was a single-center cohort study that included who underwent PEG tube placement by standard pull-guidewire technique from July 2006 to June 2014. Patients were categorized into groups based on the medications (SRIs, aspirin, non-steroidal anti-inflammatory drugs, and anticoagulants) administered during the index hospitalization. The incidence of post-PEG bleeding was noted in two distinct post-procedure periods: within 48 hours, and between 48 hours and 14 days. Results A total of 637 PEG tube placements were done on 570 patients during the study period. There were 107 patients (18.8%) with major bleeding within 48 hours of PEG and 79 patients (13.9%) with major bleeding between 48 hours and 14 days. There was no significant increase in the post-PEG bleeding in patients taking a combination of an SRI along with aspirin or non-steroidal anti-inflammatory drugs. Patients on subcutaneous heparin for prophylaxis against thromboembolic events were more likely to have oozing at the PEG site requiring blood transfusion. Conclusion We did not notice an increase in post-PEG bleeding in patients on SRIs. However, in view of the limitation that our study is retrospective and that there are no known significant side effects of withdrawal of SRIs for a short duration, withholding SRIs could be a safe clinical option in patients undergoing PEG tube placement.
Collapse
Affiliation(s)
- Harish Patel
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Vinaya Gaduputi
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Sailaja Sakam
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Kishore Kumar
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Chukwunonso Chime
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Bhavna Balar
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| |
Collapse
|
18
|
Makker J, Sakam S, Arety P, Niazi M, Balar B. Rectal blue nevus: Case report of a rare entity and literature review. Pathol Res Pract 2015; 211:625-7. [DOI: 10.1016/j.prp.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
|
19
|
Makker J, Balar B, Niazi M, Daniel M. Strongyloidiasis: A case with acute pancreatitis and a literature review. World J Gastroenterol 2015; 21:3367-3375. [PMID: 25805946 PMCID: PMC4363769 DOI: 10.3748/wjg.v21.i11.3367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/24/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
Strongyloides stercoralis, a soil transmitted helminth infection, affects millions with varying prevalence worldwide. A large number of affected hosts are asymptomatic. Symptoms pertaining to pulmonary and gastrointestinal involvement may be present. Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection. Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection. Diagnostic modalities comprise stool examination, serology and molecular testing. Stool tests are inexpensive but are limited by low sensitivity, whereas serologic and molecular tests are more precise but at the expense of higher cost. Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious. We present a rare case of acute pancreatitis secondary to Strongyloides. High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.
Collapse
|
20
|
Gaduputi V, Chandrala C, Abbas N, Tariq H, Chilimuri S, Balar B. Prognostic significance of hypokalemia in hepatic encephalopathy. Hepatogastroenterology 2014; 61:1170-1174. [PMID: 25436277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate whether hypokalemia prognosticates outcomes in hepatic encephalopathy. We also examined other potential prognostic variables such as serum pH, systemic vascular resistance (SVR) and serum ammonia levels. METHODOLOGY Patients with cirrhosis who were admitted for overt hepatic encephalopathy were included in the study and divided into two groups: Group-I consisted of patients with serum Potassium level < 4.0 mEq/L and Group-II consisted of patients with serum Potassium level > 4.0 mEq/L. We collected the baseline demographic data for both the groups including age, gender, ethnicity and calculated the Model for End Stage Liver Disease scores for both the groups at the time of admission. We analyzed the correlation between serum potassium levels and outcome variables including 30- day mortality rate, length of Intensive Care Unit (ICU)/ hospital stay, mechanical ventilation rate and 30-day readmission rate. RESULTS A total of 447 patients with diagnosis of cirrhosis were admitted to the hospital with overt hepatic encephalopathy between January 2008 and December 2012. 157 patients with low Potassium level (< 4.0 mEq/L) were included in Group-I while 290 patients with normal Potassium level (> 4.0 mEq/L) and were included in Group-II. Total length of stay in the hospital (P Value= 0.0001) and ICU length of stay (P Value= 0.0003) were significantly longer among the patients with serum potassium level of <4mEq/L. CONCLUSIONS We observed statistically significant correlation between serum potassium level and length of stay in hospital and ICU.
Collapse
|
21
|
Widjaja D, Bhandari M, Loveday-Laghi V, Glandt M, Balar B. Withdrawal time in excellent or very poor bowel preparation qualities. World J Gastrointest Endosc 2014; 6:186-192. [PMID: 24891931 PMCID: PMC4024491 DOI: 10.4253/wjge.v6.i5.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/07/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate association(s) between withdrawal time and polyp detection in various bowel preparation qualities.
METHODS: Retrospective cohort analysis of screening colonoscopies performed between January 2005 and June 2011 for patients with average risk of colorectal cancer. Exclusion criteria included patients with a personal history of adenomatous polyps or colon cancer, prior colonic resection, significant family history of colorectal cancer, screening colonoscopy after other abnormal screening tests such as flexible sigmoidoscopy or barium enema, and screening colonoscopies during in-patient care. All procedures were performed or directly supervised by gastroenterologists. Main measurements were number of colonic segments with polyps and total number of colonic polyps.
RESULTS: Multivariate analysis of 8331 colonoscopies showed longer withdrawal time was associated with more colonic segments with polyps in good (adjusted OR = 1.16; 95%CI: 1.13-1.19), fair (OR = 1.13; 95%CI: 1.10-1.17), and poor (OR = 1.18; 95%CI: 1.11-1.26) bowel preparation qualities. A higher number of total polyps was associated with longer withdrawal time in good (OR = 1.15; 95%CI: 1.13-1.18), fair (OR = 1.13; 95%CI: 1.10-1.16), and poor (OR = 1.20; 95%CI: 1.13-1.29) bowel preparation qualities. Longer withdrawal time was not associated with more colonic segments with polyps or greater number of colonic polyps in bowel preparations with excellent (OR = 1.07, 95%CI: 0.99-1.26; OR = 1.11, 95%CI: 0.99-1.24, respectively) and very poor (OR = 1.02, 95%CI: 0.99-1.12; OR = 1.05, 95%CI: 0.99-1.10, respectively) qualities.
CONCLUSION: Longer withdrawal time is not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality.
Collapse
|
22
|
Nayudu SK, Balar B. Colorectal cancer screening in human immunodeficiency virus population: Are they at average risk? World J Gastrointest Oncol 2012; 4:259-64. [PMID: 23443303 PMCID: PMC3581851 DOI: 10.4251/wjgo.v4.i12.259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate if human immunodeficiency virus (HIV) population is getting adequate screening for colon cancer in the highly active anti-retroviral treatment (HAART) era with improved longevity, and the prevalence of polyps and adenomas in this population, when compared with the general population.
METHODS: We conducted retrospective chart review of average-risk HIV population for colon cancer attending our infectious disease clinic. Individuals who underwent diagnostic colonoscopy were excluded. We extracted various demographic, HIV disease-specific and colonoscopy data including histo-pathological reports in the last 10 years. Total population was divided into a study group, who underwent screening colonoscopy and a control group who did not. We analyzed data using standard statistical methods and software.
RESULTS: We found that 25% of average-risk HIV-infected population was screened for colon cancer using colonoscopy. There was no difference in gender and ethnic distribution between the groups. We found wider distribution of age (50-84 years with mean 56 years) in the control group when compared to (50-73 years with mean 58 years) the study group. However, there were 89% of subjects with well-controlled HIV disease measured by HIV RNA copies of < 75 in the study group when compared with 70% in the control group (P < 0.0001). We noticed polyp detection rate of 55% and adenoma detection rate of 32% in HIV population.
CONCLUSION: It is unclear whether HIV or HAART medications play a role in increased prevalence of adenomas. We suggest that when estimating the risk for colonic neoplasms, HIV population should be considered as a high-risk group and screened accordingly.
Collapse
Affiliation(s)
- Suresh Kumar Nayudu
- Suresh Kumar Nayudu, Bhavna Balar, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10457, United States
| | | |
Collapse
|
23
|
Ihimoyan A, Chelimilla H, Balar B. An inflammatory fibroid polyp in the hepatic flexure of the colon treated with argon plasma coagulation, endoscopic clipping and polypectomy. Case Rep Gastroenterol 2012; 6:63-8. [PMID: 22423241 PMCID: PMC3304079 DOI: 10.1159/000336401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/19/2022] Open
Abstract
Inflammatory fibroid polyp (IFP) is a rare benign polypoid lesion of the gastrointestinal tract. Most IFPs occur in the stomach and colonic occurrence is very rare. Histologically IFP is characterized by a mixture of numerous small vessels, fibroblasts and edematous connective tissue associated with marked inflammatory infiltration by eosinophils. We present a rare case of a pedunculated IFP in the hepatic flexure of the colon treated successfully with a combination of argon plasma coagulation, endoclipping and polypectomy. A 74-year-old asymptomatic female underwent a screening colonoscopy in our hospital. A 12-mm pedunculated polyp was found at the hepatic flexure of the colon. After saline injection, we attempted to remove the polyp with a hot snare. However the polyp stalk was extremely difficult to resect despite several attempts with the hot snare. We placed an endoclip at the base of the stalk and then applied argon plasma coagulation at 1.0 l/min and 40 W. After these measures we were able to resect the stalk and the polyp was retrieved. Histologically the polyp was located in the submucosa of the gastrointestinal tract. Proliferation of spindle cells and infiltration of inflammatory cells such as plasma cells and eosinophils were observed. The spindle cells were positive for CD34 and S100 but negative for c-kit and muscle markers. These findings are consistent with a histopathological diagnosis of IFP.
Collapse
Affiliation(s)
- Ariyo Ihimoyan
- Division of Gastroenterology, Bronx-Lebanon Hospital, Bronx, N.Y., USA
| | | | | |
Collapse
|
24
|
Nayudu SK, Kumbum K, Balar B, Niazi M, Chilimuri S. Small Duct Primary Sclerosing Cholangitis in Association With Hepatitis C Virus Infection: A Case Report. Gastroenterology Res 2011; 4:39-41. [PMID: 27957013 PMCID: PMC5139801 DOI: 10.4021/gr282w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Accepted: 01/24/2011] [Indexed: 12/13/2022] Open
Abstract
Small duct primary sclerosing cholangitis (PSC) is characterized by cholestatic liver function tests, histological evidence of PSC but absence of classic cholangiographic findings. Large duct or classic PSC in association with hepatitis C virus (HCV) infection has rarely been reported. However to the best of our knowledge small duct PSC in association with HCV infection has not been reported. We report this case of small duct PSC in a patient with HCV infection. HCV infection in our patient was successfully treated with ribavirin and peg interferon alfa-2a, as evidenced by undetectable HCV ribonucleic acid levels. However, the patient had persistently elevated liver function tests suggestive of cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed normal architecture of bile ducts. Hence patient underwent liver biopsy and its histopahological findings were suggestive of PSC. He had colonoscopy along with biopsy and inflammatory bowel disease (IBD) was ruled out.
Collapse
Affiliation(s)
- Suresh Kumar Nayudu
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kavitha Kumbum
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bhavna Balar
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA
| | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sridhar Chilimuri
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA; Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated to Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
25
|
Patel P, Widjaja D, Blum S, Glandt M, Akella J, Chilimuri S, Balar B. Significance of bowel wall thickening on computed tomography scan: higher risk of pathology among African Americans compared to Hispanics. J Natl Med Assoc 2009; 101:345-8. [PMID: 19397225 DOI: 10.1016/s0027-9684(15)30882-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The aims of our study were to examine the role of colonoscopy as further workup for bowel wall thickening reported on computed tomography (CT) scans and to investigate whether there were significant differences in pathology found among the racial groups in our study population. METHODS This is a retrospective study from March 2005 and January 2007 of all patients who have undergone colonoscopy for bowel wall thickening found on CT scans of the abdomen. RESULTS Of 94 patients with bowel wall thickening on CT scans, 7 (8%) had adenocarcinoma, 5 (5%) had large adenomas, 3 (3%) had infectious colitis, 2 (2%) ischemic colitis, 1 (1%) had inflammatory bowel disease, and 1 (1%) had a benign stricture. Bowel wall thickening on CT scan predicted clinical pathology in 34% of African Americans, as compared to 14% of Hispanics. Patients with significant pathology were more likely to have anemia and lower albumin levels. CONCLUSION Patients with bowel wall thickening found on CT scans should be referred for colonoscopy, given that significant pathology is found in 20% of the cases. African Americans were 2.5 times more likely to have clinically significant pathology as compared to Hispanics.
Collapse
|
26
|
Abstract
We present a 71-year-old man with mucosa-associated lymphoid tissue (MALT) lymphoma of the colon presenting with massive gastrointestinal hemorrhage. At laparotomy two areas of irregular mucosa were noted in the ascending colon and cecum. Pathology revealed MALT lymphoma. MALT lymphoma of the colon is rare and the presentation as well as outcome of our case makes him unique.
Collapse
Affiliation(s)
- Kalyan Kanneganti
- Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, N.Y., USA
| | | |
Collapse
|
27
|
Gupta V, Balar B, Gbadehan E, Orleans LK, Ozick LA. A rare association of primary biliary cirrhosis with antiphospholipid [corrected] antibody syndrome. Dig Dis Sci 2007; 52:3530-1. [PMID: 17415651 DOI: 10.1007/s10620-006-9356-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 03/25/2006] [Indexed: 12/09/2022]
|