1
|
Huerta CT, Ribieras AJ, Kodia K, Yeh DD, Kerman D, Byers P. Small Intestinal Perforation Secondary to Necrotizing Enteritis-An Under-Recognized Complication of Crohn's Disease. Am Surg 2022:31348211054521. [PMID: 35023785 DOI: 10.1177/00031348211054521] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Small bowel perforation is an uncommon but severe event in the natural history of Crohn's disease with fewer than 100 cases reported. We review Crohn's disease cases with necrotizing enteritis and share a case of a 26-year-old female who presented with a recurrent episode of small intestinal perforation. A PubMed literature review of case reports and series was conducted using keywords and combinations of "Crohn's disease," "small intestine perforation," "small bowel perforation," "free perforation," "regional enteritis," and "necrotizing enteritis." Data extracted included demographic data, pre- or postoperative steroid administration, medical or surgical management, and case fatality. Nineteen reports from 1935 to 2021 qualified for inclusion. There were 43 patients: 20 males and 23 females with a mean age of 36 ± 15 years old. 75 total perforations were described: 56 ileal (74.6%), 15 jejunal (20.0%), 2 cecal (2.7%), and 1 small intestine non-specified (2.7%). 38 of 43 patients were managed surgically by primary repair (11), ostomy creation (21), or an anastomosis (11). Of 11 case fatalities, medical management alone was associated with higher mortality (5/5; 100% mortality) compared to those treated surgically (6/38; 15.8% mortality; P < .001). Patient sex, disease history, acute abdomen, and pre- or postoperative steroid use did not significantly correlate with mortality. Jejunal perforation was significantly (P = .028) associated with event mortality while ileal was not (P = .45). Although uncommon, necrotizing enteritis should be considered in Crohn's patients who present with small intestinal perforation. These cases often require urgent surgical intervention and may progress to fulminant sepsis and fatality if not adequately treated.
Collapse
Affiliation(s)
| | - Antoine J Ribieras
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - Karishma Kodia
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - D Dante Yeh
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - David Kerman
- University of Miami Department of Gastroenterology, Miami, FL, USA
| | - Patricia Byers
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| |
Collapse
|
2
|
Damas OM, Raffa G, Estes D, Mills G, Kerman D, Palacio A, Schwartz SJ, Deshpande AR, Abreu MT. Ethnicity Influences Risk of Inflammatory Bowel Disease (IBD)-Associated Colon Cancer: A Cross-sectional Analysis of Dysplasia Prevalence and Risk Factors in Hispanics and Non-Hispanic Whites With IBD. Crohn's & Colitis 360 2021; 3:otab016. [PMID: 35309712 PMCID: PMC8924904 DOI: 10.1093/crocol/otab016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is an emerging disease in Hispanics. In this study, we examine the prevalence of IBD-related colon dysplasia (IBD-dys) in Hispanics versus non-Hispanic whites (NHWs) and compare differences in established clinical and environmental risk factors.
Methods
We performed a cross-sectional analysis on adult Hispanics and NHWs with IBD who met criteria for colorectal cancer surveillance and were followed at our center between 2008 and 2018. Clinical variables and IBD phenotype were recorded. Lifestyle IBD-dys risk factors were examined, including smoking and lack of physical activity. Using multivariable regression, we compared the prevalence of IBD-dys in Hispanics versus NHW, using relevant covariates. Receiver operating characteristic and area under the curve were performed to find the best fitting model.
Results
A total of 445 IBD patients were included (148 Hispanics and 297 NHWs). IBD phenotype was similar between groups, except that Hispanics had shorter disease duration, a lower frequency of Crohn’s disease-related complications, and lower reported use of steroids. Frequency of surveillance colonoscopies was similar between Hispanics and NHW. There were no differences in median body mass index between Hispanics and NHW [26.5 (IQR 6.0) vs 25.0 (IQR 6.0), P = 0.40]. Hispanics were less likely than NHW to consume alcohol but smoking history was similar between groups. Three out of 148 Hispanic patients had IBD-dys (2.02%) compared to 29 out of 297 NHWs (9.76%). Adjusting for disease duration, primary sclerosing cholangitis, family history of colon cancer, and smoking, Hispanics had a lower prevalence of IBD-dys compared to NHW [ORadjusted = 0.207 (95% CI 0.046–0.938), P = 0.008].
Conclusions
Hispanics with IBD undergoing surveillance had a lower prevalence of IBD-dys than their NHW counterparts, despite similar risk factors. Future studies should examine dietary and microbial factors that may explain differences in risk.
Collapse
Affiliation(s)
- Oriana M Damas
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gabriella Raffa
- Internal Medicine, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Derek Estes
- Internal Medicine, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Grechen Mills
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Kerman
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ana Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Seth J Schwartz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amar R Deshpande
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria T Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
3
|
Kelly CR, Yen EF, Grinspan AM, Kahn SA, Atreja A, Lewis JD, Moore TA, Rubin DT, Kim AM, Serra S, Nersesova Y, Fredell L, Hunsicker D, McDonald D, Knight R, Allegretti JR, Pekow J, Absah I, Hsu R, Vincent J, Khanna S, Tangen L, Crawford CV, Mattar MC, Chen LA, Fischer M, Arsenescu RI, Feuerstadt P, Goldstein J, Kerman D, Ehrlich AC, Wu GD, Laine L. Fecal Microbiota Transplantation Is Highly Effective in Real-World Practice: Initial Results From the FMT National Registry. Gastroenterology 2021; 160:183-192.e3. [PMID: 33011173 PMCID: PMC8034505 DOI: 10.1053/j.gastro.2020.09.038] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Fecal microbiota transplantation (FMT) is used commonly for treatment of Clostridioides difficile infections (CDIs), although prospective safety data are limited and real-world FMT practice and outcomes are not well described. The FMT National Registry was designed to assess FMT methods and both safety and effectiveness outcomes from North American FMT providers. METHODS Patients undergoing FMT in clinical practices across North America were eligible. Participating investigators enter de-identified data into an online platform, including FMT protocol, baseline patient characteristics, CDI cure and recurrence, and short and long-term safety outcomes. RESULTS Of the first 259 participants enrolled at 20 sites, 222 had completed short-term follow-up at 1 month and 123 had follow-up to 6 months; 171 (66%) were female. All FMTs were done for CDI and 249 (96%) used an unknown donor (eg, stool bank). One-month cure occurred in 200 patients (90%); of these, 197 (98%) received only 1 FMT. Among 112 patients with initial cure who were followed to 6 months, 4 (4%) had CDI recurrence. Severe symptoms reported within 1-month of FMT included diarrhea (n = 5 [2%]) and abdominal pain (n = 4 [2%]); 3 patients (1%) had hospitalizations possibly related to FMT. At 6 months, new diagnoses of irritable bowel syndrome were made in 2 patients (1%) and inflammatory bowel disease in 2 patients (1%). CONCLUSIONS This prospective real-world study demonstrated high effectiveness of FMT for CDI with a good safety profile. Assessment of new conditions at long-term follow-up is planned as this registry grows and will be important for determining the full safety profile of FMT.
Collapse
Affiliation(s)
- Colleen R. Kelly
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eugene F. Yen
- Division of Gastroenterology, NorthShore University HealthSystem, Evanston, Illinois
| | - Ari M. Grinspan
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stacy A. Kahn
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Ashish Atreja
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James D. Lewis
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David T. Rubin
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois
| | - Alison M. Kim
- American Gastroenterological Association, Bethesda, Maryland
| | - Sonya Serra
- American Gastroenterological Association, Bethesda, Maryland
| | | | - Lydia Fredell
- American Gastroenterological Association, Bethesda, Maryland
| | | | - Daniel McDonald
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California,Center for Microbiome Innovation, University of California San Diego, La Jolla, California,Department of Computer Science and Engineering, University of California San Diego, La Jolla, California,Department of Bioengineering, University of California San Diego, La Jolla, California
| | | | - Joel Pekow
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois
| | - Imad Absah
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ronald Hsu
- Sutter Health, Sutter Institute for Medical Research and Division of Gastroenterology, School of Medicine, University of California, Davis, California
| | - Jennifer Vincent
- Division of Gastroenterology, Baylor Scott and White Research Institute, Temple, Texas
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Lyn Tangen
- Carle Foundation Hospital, Urbana, Illinois
| | - Carl V. Crawford
- Division of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Mark C. Mattar
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Lea Ann Chen
- Division of Gastroenterology and Hepatology, New York University Grossman School of Medicine, New York, New York
| | - Monika Fischer
- Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Razvan I. Arsenescu
- Atlantic Inflammatory Bowel Disease Center of Excellence, Atlantic Digestive Health Institute, Morristown, New Jersey
| | | | | | - David Kerman
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida
| | - Adam C. Ehrlich
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gary D. Wu
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| |
Collapse
|
4
|
Sussman M, Sendzischew-Shane MA, Bolanos J, Deshpande AR, Kerman D, Allespach H. Assurance for Endurance? Introducing a Novel Ergonomics Curriculum to Reduce Pain and Enhance Physical Well-Being Among GI Fellows. Dig Dis Sci 2020; 65:2756-2758. [PMID: 32548812 DOI: 10.1007/s10620-020-06406-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Musculoskeletal pain and injuries (MSKPI) are common among gastroenterologists (GI) and GI fellows. Common areas of pain include the back, neck, hands/fingers, shoulders, and elbows. Although the prevalence of career-related pain and injuries among GIs is high, few endoscopists receive training in how to prevent MSKPI. We developed an ergonomics curriculum for our GI fellows that consisted of two modules that were led by physical therapists. Twelve out of 15 GI fellows, and one out of two hepatology fellows, participated in Module 1. Prior to the first module, 77% of participants reported pain in one or more body parts. Of those who reported pain, 100% of the fellows stated that this pain occurred during procedures, and 50% indicated this pain was performance-limiting. After completing Module 1, 100% of fellows reported that this was a valuable topic and 100% of the participants felt that this information would both help them feel and perform better. All fellows stated they had an immediate decrease in physical discomfort after engaging in the exercises that were included in Module 1. Eight fellows participated in Module 2. At the end of this module, 100% of fellows reported that this ergonomics training would likely help them to "physically perform better during procedures" and 100% of fellows indicated a reduction of physical discomfort (pain, aching) immediately after completing these exercises. Preliminary data indicated that this novel curriculum was perceived as valuable by GI fellows and that practicing these exercises reduced pain, particularly in the neck and the lower back.
Collapse
Affiliation(s)
- M Sussman
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - M A Sendzischew-Shane
- Department of Medicine, Division of Gastroeneterology, University of Miami Miller School of Medicine, Miami, USA
| | - J Bolanos
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, USA
| | - A R Deshpande
- Department of Medicine, Division of Gastroeneterology, University of Miami Miller School of Medicine, Miami, USA
| | - D Kerman
- Department of Medicine, Division of Gastroeneterology, University of Miami Miller School of Medicine, Miami, USA
| | - H Allespach
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA. .,Department of Medicine, Division of Gastroeneterology, University of Miami Miller School of Medicine, Miami, USA.
| |
Collapse
|
5
|
Han S, Obuch JC, Keswani RN, Hall M, Patel SG, Menard-Katcher P, Simon V, Ezekwe E, Aagaard E, Ahmad A, Alghamdi S, Austin K, Brimhall B, Broy C, Carlin L, Cooley M, Di Palma JA, Duloy AM, Early DS, Ellert S, Gaumnitz EA, Goyal J, Kathpalia P, Day L, El-Nachef N, Kerman D, Lee RH, Lunsford T, Mittal M, Morigeau K, Pietrak S, Piper M, Shah AS, Shapiro AB, Shergill A, Sonnier W, Sorrell C, Vignesh S, Wani S. Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial. Gastrointest Endosc 2020; 91:882-893.e4. [PMID: 31715173 DOI: 10.1016/j.gie.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy. METHODS In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills. RESULTS In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (-.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P = .03) but not in overall technical skills (intervention, -.26 [SD, 1.4]; control, 1.76 [SD, .7]; P = .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, -.7 [SD, 1.3]; control, .7 [SD, 1.3]; P = .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, -.1 [SD, 1.5]; P = .77). CONCLUSIONS Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.).
Collapse
Affiliation(s)
- Samuel Han
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Joshua C Obuch
- Division of Gastroenterology, Geisenger Medical Center, Danville, Pennsylvania, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matt Hall
- Children's Hospital Association, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Paul Menard-Katcher
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eze Ezekwe
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eva Aagaard
- Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Asyia Ahmad
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saad Alghamdi
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kerri Austin
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Bryan Brimhall
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Broy
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Linda Carlin
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Matthew Cooley
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Jack A Di Palma
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Anna M Duloy
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Swan Ellert
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Eric A Gaumnitz
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Jatinder Goyal
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Priya Kathpalia
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Lukejohn Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Najwa El-Nachef
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - David Kerman
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Robert H Lee
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Tisha Lunsford
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mohit Mittal
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Kirsten Morigeau
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Stanley Pietrak
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Piper
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Anand S Shah
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alan B Shapiro
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Amandeep Shergill
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - William Sonnier
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Cari Sorrell
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| |
Collapse
|
6
|
Damas OM, Estes D, Avalos D, Quintero MA, Morillo D, Caraballo F, Lopez J, Deshpande AR, Kerman D, McCauley JL, Palacio A, Abreu MT, Schwartz SJ. Hispanics Coming to the US Adopt US Cultural Behaviors and Eat Less Healthy: Implications for Development of Inflammatory Bowel Disease. Dig Dis Sci 2018; 63:3058-3066. [PMID: 29982988 PMCID: PMC6182439 DOI: 10.1007/s10620-018-5185-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/26/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The incidence of inflammatory bowel disease (IBD) among US Hispanics is rising. Adoption of an American diet and/or US acculturation may help explain this rise. AIMS To measure changes in diet occurring with immigration to the USA in IBD patients and controls, and to compare US acculturation between Hispanics with versus without IBD. Last, we examine the current diet of Hispanics with IBD compared to the diet of Hispanic controls. METHODS This was a cross-sectional study of Hispanic immigrants with and without IBD. Participants were recruited from a university-based GI clinic. All participants completed an abbreviated version of the Stephenson Multi-Group Acculturation Scale and a 24-h diet recall (the ASA-24). Diet quality was calculated using the Healthy Eating Index (HEI-2010). RESULTS We included 58 participants: 29 controls and 29 IBD patients. Most participants were Cuban or Colombian. Most participants, particularly those with IBD, reported changing their diet after immigration (72% of IBD and 57% of controls). IBD participants and controls scored similarly on US and Hispanic acculturation measures. IBD patients and controls scored equally poorly on the HEI-2010, although they differed on specific measures of poor intake. IBD patients reported a higher intake of refined grains and lower consumption of fruits, whereas controls reported higher intake of empty calories (derived from fat and alcohol). CONCLUSION The majority of Hispanics change their diet upon immigration to the USA and eat poorly irrespective of the presence of IBD. Future studies should examine gene-diet interactions to better understand underlying causes of IBD in Hispanics.
Collapse
Affiliation(s)
- Oriana M. Damas
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Derek Estes
- 0000 0004 1936 8606grid.26790.3aDepartment of Internal Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Danny Avalos
- grid.449768.0Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Maria A. Quintero
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Diana Morillo
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Francia Caraballo
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Johanna Lopez
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Amar R. Deshpande
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - David Kerman
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Jacob L. McCauley
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, USA
| | - Ana Palacio
- 0000 0004 1936 8606grid.26790.3aDivision of Computational Medicine, Department of Public Health, University of Miami Miller School of Medicine, Miami, USA
| | - Maria T. Abreu
- 0000 0004 1936 8606grid.26790.3aDivision of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Seth J. Schwartz
- 0000 0004 1936 8606grid.26790.3aDepartment of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
7
|
Kerman D, Barkin JS. Acid suppression not the only culprit of community-acquired pneumonia. Arch Intern Med 2008; 168:1118-1119. [PMID: 18504343 DOI: 10.1001/archinte.168.10.1118-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
8
|
Kerman RH, Susskind B, Kerman D, Lam M, Gerolami K, Williams J, Kalish R, Campbell M, Katz S, Van Buren CT, Frazier H, Radovancevic B, Fife S, Kahan B. Comparison of PRA-STAT, sHLA-EIA, and anti-human globulin-panel reactive antibody to identify alloreactivity in pretransplantation sera of heart transplant recipients: correlation to rejection and posttransplantation coronary artery disease. J Heart Lung Transplant 1998; 17:789-94. [PMID: 9730428] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Screening pretransplantation recipient sera for percent panel reactive antibodies (%PRA) by an anti-human globulin (AHG) assay may identify recipients who are at risk for graft rejection or development of posttransplantation coronary artery disease. However, the pretransplantation AHG-%PRA does not always correlate with the occurrence of graft rejection or coronary artery disease. METHODS We compared the predictive capacity of the AHG-%PRA with that of an enzyme-linked immunoassay (EIA)-based PRA assay that identifies immunoglobulin G bound to soluble human leukocyte antigen (sHLA) class I molecules from pooled platelets of 240 random donors (sHLA-EIA), and that of an EIA-based assay that detects immunoglobulin G anti-HLA class I antibodies bound to sHLA derived from individual HLA-typed cell cultures (PRA-STAT). The pretransplantation sera from 130 cardiac allograft recipients were comparatively tested and results evaluated. RESULTS Although AHG-%PRA- and sHLA-EIA-determined PRA results were comparable, neither assay discriminated potential recipients at risk for rejection or coronary artery disease. However, cardiac allograft recipients with pretransplantation PRA-STAT sera > 10% were at risk for (1) graft rejection (77% vs 56%, p < .05); (2) more rejections/recipient (1.9 vs 1.0, p < .02); (3) graft rejection within 30 days (92% vs 38%, p < .001); or (4) development of coronary artery disease (48% vs 23%, p < .05) than recipients with pretransplantation PRA-STAT sera < 10%. CONCLUSIONS PRA-STAT analysis of pretransplantation sera from potential cardiac allograft recipients may be more clinically informative about HLA alloimmunity and a better predictor of adverse clinical events than either AHG-%PRA- or sHLA-EIA-determined PRA.
Collapse
Affiliation(s)
- R H Kerman
- Department of Surgery, The University of Texas Medical School, Houston 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kerman R, Susskind B, Kerman D, Lam M, Kalish R, Gerolami K, Katz S, Frazier OH, Radovancevic B, Van Buren CT, Kahan BD. PRA-STAT identifies high-risk, alloimune recipients. Hum Immunol 1996. [DOI: 10.1016/0198-8859(96)85413-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|