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Cahyadi O, Dhir V, Leeds J, de-Madaria E, Tehami N. The DESTIN trial: to step up or not? Lancet Gastroenterol Hepatol 2024; 9:289. [PMID: 38460533 DOI: 10.1016/s2468-1253(24)00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Oscar Cahyadi
- Department of Gastroenterology, St. Josef-Hospital, Ruhr-University Bochum, Bochum D-44791, Germany.
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
| | - John Leeds
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK; Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Enrique de-Madaria
- Department of Gastroenterology, Dr Balmis General University Hospital and Department of Clinical Medicine, Miguel Herna´ndez University, Alicante, Spain; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Nadeem Tehami
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Lee PJ, Culp S, Kamal A, Paragomi P, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzales J, Stevens T, Barbu S, Nawaz H, Gutierrez S, Zarnescu N, Capurso G, Easler J, Triantafyllou K, Ocampo C, de-Madaria E, Wu B, Hart PA, Akshintala VS, Singh VK, Bischof J, Buxbaum J, Pelaez M, Papachristou GI. Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis. Am J Gastroenterol 2023; 118:2258-2266. [PMID: 37428139 DOI: 10.14309/ajg.0000000000002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Recent pilot trials in acute pancreatitis (AP) found that lactated ringers (LR) usage may result in decreased risk of moderately severe/severe AP compared with normal saline, but their small sample sizes limit statistical power. We investigated whether LR usage is associated with improved outcomes in AP in an international multicenter prospective study. METHODS Patients directly admitted with the diagnosis of AP were prospectively enrolled at 22 international sites between 2015 and 2018. Demographics, fluid administration, and AP severity data were collected in a standardized prospective manner to examine the association between LR and AP severity outcomes. Mixed-effects logistic regression analysis was performed to determine the direction and magnitude of the relationship between the type of fluid administered during the first 24 hours and the development of moderately severe/severe AP. RESULTS Data from 999 patients were analyzed (mean age 51 years, female 52%, moderately severe/severe AP 24%). Usage of LR during the first 24 hours was associated with reduced odds of moderately severe/severe AP (adjusted odds ratio 0.52; P = 0.014) compared with normal saline after adjusting for region of enrollment, etiology, body mass index, and fluid volume and accounting for the variation across centers. Similar results were observed in sensitivity analyses eliminating the effects of admission organ failure, etiology, and excessive total fluid volume. DISCUSSION LR administration in the first 24 hours of hospitalization was associated with improved AP severity. A large-scale randomized clinical trial is needed to confirm these findings.
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Affiliation(s)
- Peter J Lee
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA
| | - Stacey Culp
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA
| | - Ayesha Kamal
- Division of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Pedram Paragomi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | | | - Aiste Gulla
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jose Gonzales
- Universidad Autónoma de Nueva León, Monterrey, Mexico
| | - Tyler Stevens
- Division of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sorin Barbu
- University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania
| | - Haq Nawaz
- Eastern Maine Medical Center, Bangor, Maine, USA
| | - Silvia Gutierrez
- Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina
| | | | - Gabriele Capurso
- San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Jeff Easler
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Carlos Ocampo
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Enrique de-Madaria
- Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
| | - Bechien Wu
- Kaiser Permanente, Oakland, California, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA
| | - Venkata S Akshintala
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jason Bischof
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA
| | - James Buxbaum
- University of Southern California, Los Angeles, California, USA
| | - Mario Pelaez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA
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3
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Freedman S, de-Madaria E, Bruckert E, Löhr M, Rebours V, Jandhyala R. Observed consensus on research priorities for the hypertriglyceridemia patient registry. Curr Med Res Opin 2023; 39:1629-1635. [PMID: 37428680 DOI: 10.1080/03007995.2023.2235153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Priority setting in health research has been described as essential due to disparities within and between countries and populations. Commercial benefits to the pharmaceutical industry may increase the generation and use of regulatory Real-World Evidence which has recently been reported in the literature. Research must be steered by valuable priorities. This study's objective is to identify key gaps in the knowledge of triglyceride-induced acute pancreatitis by generating a list of potential research priorities for a Hypertriglyceridemia Patient Registry. METHOD The Jandhyala Method was used to observe the consensus of expert opinion from ten specialist clinicians in the treatment of triglyceride-induced acute pancreatitis across the US and EU. RESULTS Ten participants completed the consensus round of the Jandhyala method and generated 38 unique items which they all agreed with. The items were included in the generation of research priorities for a hypertriglyceridemia patient registry and presented a novel application of the Jandhyala method for the development of research questions, in aid of the validation of a core dataset. CONCLUSION The TG-IAP core dataset and research priorities combined can develop a globally harmonized framework where TG-IAP patients can be observed simultaneously using the same set of indicators. This will increase knowledge of the disease and facilitate higher-quality research by addressing issues related to incomplete data sets in observational studies. Furthermore, validation of new tools will be enabled, and diagnosis and monitoring will be improved as well as the detection of changes in disease severity and subsequent disease progression, improving the management of patients with TG-IAP overall. This will inform personalized patient management plans and improve patient outcomes along with their quality of life.
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Affiliation(s)
- Steve Freedman
- The Pancreas Center, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital; Department of Clinical Medicine, Miguel Hernández University, Isabial, Spain
| | - Eric Bruckert
- Endocrinology and prevention of cardiovascular disease department in Pitié-Salpêtrière Hospital, Paris, France
| | - Matthias Löhr
- Pancreas Cancer Research Lab, Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France
| | - Ravi Jandhyala
- Medialis Ltd, England, UK
- Centre for Pharmaceutical Medicine Research, King's College University, London, UK
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Freedman S, de-Madaria E, Bruckert E, Löhr M, Rebours V, Jandhyala R. A protocol for an international, multicenter, prospective, non-interventional observational registry for patients with hypertriglyceridemia. Curr Med Res Opin 2023; 39:1663-1670. [PMID: 37665595 DOI: 10.1080/03007995.2023.2255129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND In the study on triglyceride-induced pancreatitis (TG-IAP), a core clinical dataset using the Jandhyala method was developed to collect the minimum amount of information for each patient presenting with TG-IAP globally. This approach offered a unified framework for observing multiple populations of TG-IAP patients using the same set of indicators, resulting in a considerably larger and uniform real-world population. It was understood that when this core dataset is implemented in a patient registry it could address the issue of missing data in observational studies and produce higher-quality research. In this paper, the protocol used to design and implement a patient registry for this core dataset to generate real-world evidence from multiple sites is described. METHOD The study is designed as an international, multicenter, non-interventional, observational registry that will enroll adult patients with hypertriglyceridemia to collect natural history data on the treatment, progression, and long-term outcomes of hypertriglyceridemia-induced acute pancreatitis. Patients with both hypertriglyceridemia and pancreatitis will be invited to participate in the registry at participating hospitals and centers worldwide. DISCUSSION Data from this registry, and others like it, is intended for healthcare providers to optimize clinical decision-making through an enhanced understanding of the variability, progression, and natural history of hypertriglyceridemia as well as the burden of disease. CONCLUSION Global epidemiological data on hypertriglyceridemia and its role in acute pancreatitis is limited. Using real-world evidence, this registry, along with others like it, may help healthcare providers understand the variability, progression, natural history, and burden of the disease, and improve the diagnosis and management of HTG and TG-IAP.
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Affiliation(s)
- Steve Freedman
- The Pancreas Center, Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts, USA
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Department of Clinical Medicine, Miguel Hernández University; ISABIAL, Alicante, Spain
| | - Eric Bruckert
- Endocrinology and Prevention of Cardiovascular Disease Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Matthias Löhr
- Pancreas Cancer Research Lab, Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France
| | - Ravi Jandhyala
- Medialis Ltd, Milton Keynes, UK
- Centre for Pharmaceutical Medicine Research, King's College University, London, UK
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Martinez-Moreno B, López-Roldán G, Martínez-Sempere J, de-Madaria E, Jover R, Aparicio JR. Long-term results after EUS gallbladder drainage in high-surgical-risk patients with acute cholecystitis: A 3-year follow-up registry. Endosc Int Open 2023; 11:E1063-E1068. [PMID: 37954111 PMCID: PMC10637859 DOI: 10.1055/a-2180-9817] [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: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the favorite drainage option for high surgical-risk patients with acute cholecystitis. However, data on long-term outcomes regarding efficacy and security over 1 year are scarce. Patients and methods We performed a retrospective review of a prospectively maintained database to analyze the 3-year long-term outcomes of EUS-GBD with lumen apposing metal stents (LAMS) in high-surgical-risk patients with acute cholecystitis. Results Fifty patients with acute cholecystitis who underwent EUS-GBD with LAMS and 3-year follow-up or until death were included in this study. No endoscopic revisions were scheduled unless an adverse event (AE) or suspected LAMS dysfunction occurred. AEs occurred in 18%, 20%, and 26% of patients in the first, second, and third years, respectively. Thirteen patients developed at least one AE, and six presented with a second AE during follow-up. Recurrence of cholecystitis occurred in two patients (4%). Seven stent migrations (14%) occurred but all were asymptomatic. Symptomatic LAMS-related AEs (LAMS-RAEs) (37.5%) were related to gastric location of the stent compared with duodenal location (66.7% vs. 12.5%, P = 0.03). No stent-related bleeding or stent-related mortality was observed. Conclusions EUS-GBD with LAMS without scheduled removal is an effective and safe long-term treatment in high-surgical-risk patients with acute cholecystitis. Late LAMS-RAEs tend to be more asymptomatic over time. Symptomatic LAMS-RAEs are associated with gastric location, and overall, AEs tend to recur.
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Affiliation(s)
| | | | | | - Enrique de-Madaria
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - José Ramón Aparicio
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
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Oyón D, Marra-López C, Bolado F, López-López S, Ibáñez-Beroiz B, Canaval-Zuleta HJ, García-Rayado G, Rivera-Irigoin R, Grau-García FJ, Boadas J, Millastre-Bocos J, Martínez-Ares D, de-Madaria E. Determinants and impact of splanchnic vein thrombosis in acute pancreatitis. Dig Liver Dis 2023; 55:1480-1486. [PMID: 37210302 DOI: 10.1016/j.dld.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Splanchnic vein thrombosis (SVT) is a well-recognised though little-studied complication in acute pancreatitis (AP). SVT risk factors, its clinical consequences and the role of anticoagulation (AC) therapy is scarce. AIMS To evaluate the incidence and natural history of SVT in AP. METHODS Post hoc analysis of a prospective multicentre cohort study involving 23 hospitals in Spain. AP complications were identified by computer tomography, and patients with SVT were re-evaluated after two years. RESULTS A total of 1655 patients with AP were included. The overall incidence of SVT was 3.6%. SVT was significantly associated with male gender, younger age and alcoholic aetiology. Every local complication increased SVT incidence, and this risk rose gradually with larger extension and infection of necrosis. These patients had a longer hospital stay and underwent a greater number of invasive treatments, regardless of AP severity. Forty-six patients with SVT were followed up. SVT resolution rate was 54.5% in the AC group and 30.8% in the non-AC group with lower thrombotic complications in the SVT resolution group (83.3% vs 22.7%; p<0.001). No AC-related adverse events occurred. CONCLUSION This study identifies the risk factors and negative clinical impact of SVT in AP. Our results justify future trials to demonstrate the role of AC in this clinical scenario.
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Affiliation(s)
- Daniel Oyón
- Department of Gastroenterology, University Hospital of Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain.
| | - Carlos Marra-López
- Department of Gastroenterology, Hospital Costa del Sol, Marbella; Hospital Vithas Málaga. Málaga. Spain
| | - Federico Bolado
- Department of Gastroenterology, University Hospital of Navarre, Health Research Institute of Navarra IdiSNA, Pamplona, Spain
| | - Soraya López-López
- Department of Gastroenterology, University Hospital of Navarre, Pamplona, Spain
| | - Berta Ibáñez-Beroiz
- Navarrabiomed-HUN-UPNA, Research Network for Health Services and Chronic Diseases (REDISSEC); Research Network for Chronic Diseases, Primary Care and Health Promotion (RICAPPS), Health Research Institute of Navarra IdiSNA, Pamplona, Spain
| | | | - Guillermo García-Rayado
- Department of Gastroenterology, University Clinic Hospital, Aragón Health Research Institute, Zaragoza, Spain
| | | | | | - Jaume Boadas
- Department of Gastroenterology, Consorci Sanitari Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - David Martínez-Ares
- Department of Gastroenterology, Hospital QuironSalud A Coruña, A Coruña, Spain
| | - Enrique de-Madaria
- Department of Gastroenterology, Dr. Balmis General University Hospital, Department of Clinical Medicine, Miguel Hernández University, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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de-Madaria E, Buxbaum JL. Advances in the management of acute pancreatitis. Nat Rev Gastroenterol Hepatol 2023; 20:691-692. [PMID: 37344583 DOI: 10.1038/s41575-023-00808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Enrique de-Madaria
- Department of Gastroenterology, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain.
| | - James L Buxbaum
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
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8
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de-Madaria E. Chasing WATERFALLs - The Journey from Question to Answer. NEJM Evid 2023; 2:EVIDctcs2200291. [PMID: 38320165 DOI: 10.1056/evidctcs2200291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
WATERFALL Trial from Question to AnswerThis clinical trial case study discusses the process that led to the WATERFALL trial - from a question asked by a gastroenterology trainee more than two decades ago about fluid management in acute pancreatitis to the completed clinical trial published in the New England Journal of Medicine that may change clinical practice.
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Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
- Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain
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9
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Guilabert L, de-Madaria E. Web Exclusive. Annals for Hospitalists Inpatient Notes - Fluid Resuscitation for Noncritically Ill Patients With Acute Pancreatitis. Ann Intern Med 2023; 176:eM230792. [PMID: 37186927 DOI: 10.7326/m23-0792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Lucía Guilabert
- Department of Gastroenterology, Dr. Balmis General University Hospital-ISABIAL, Alicante, Spain (L.G.)
| | - Enrique de-Madaria
- Department of Gastroenterology, Dr. Balmis General University Hospital-ISABIAL, Alicante; Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain (E.de-M.)
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Lee PJ, Lahooti A, Culp S, Boutsicaris A, Holovach P, Wozniak K, Lahooti I, Paragomi P, Hinton A, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzalez JA, Singh V, Bogado MF, Stevens T, Babu ST, Nawaz H, Gutierrez SC, Zarnescu N, Capurso G, Easler J, Triantafyllou K, Peláez Luna M, Thakkar S, Ocampo C, de-Madaria E, Cote GA, Wu BU, Hart PA, Krishna SG, Lara L, Han S, Papachristou GI. Obesity and alcoholic etiology as risk factors for multisystem organ failure in acute pancreatitis: Multinational study. United European Gastroenterol J 2023; 11:383-391. [PMID: 37096304 PMCID: PMC10165322 DOI: 10.1002/ueg2.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Multisystem organ failure (MSOF) is the most important determinant of mortality in acute pancreatitis (AP). Obesity and alcoholic etiology have been examined as potential risk factors for MSOF, but prior studies have not adequately elucidated their independent effects on the risk of MSOF. OBJECTIVE We aimed to determine the adjusted effects of body mass index (BMI) and alcoholic etiology on the risk of MSOF in subjects with AP. METHODS A prospective observational study of 22 centers from 10 countries was conducted. Patients admitted to an APPRENTICE consortium center with AP between August 2015 and January 2018 were enrolled. Multivariable logistic regression was used to estimate the adjusted effects of BMI, etiology, and other relevant covariates on the risk of MSOF. Models were stratified by sex. RESULTS Among 1544 AP subjects, there was a sex-dependent association between BMI and the risk of MSOF. Increasing BMI was associated with increased odds of MSOF in males (OR 1.10, 95% confidence interval [CI] 1.04-1.15) but not in females (OR 0.98, 95% CI 0.90-1.1). Male subjects with AP, whose BMIs were 30-34 and >35 kg/m2 , had odds ratios of 3.78 (95% CI 1.62-8.83) and 3.44 (95% CI 1.08-9.99), respectively. In females, neither higher grades of obesity nor increasing age increased the risk of MSOF. Alcoholic etiology was independently associated with increased odds of MSOF compared with non-alcohol etiologies (OR 4.17, 95% CI 2.16-8.05). CONCLUSION Patients with alcoholic etiology and obese men (but not women) are at substantially increased risk of MSOF in AP.
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Affiliation(s)
- Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ali Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Stacey Culp
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew Boutsicaris
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Phillip Holovach
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kayla Wozniak
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ila Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Pedram Paragomi
- University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | | | | | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Vikesh Singh
- Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, Maryland, USA
| | | | | | - Sorin Traian Babu
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Haq Nawaz
- Northern Light Eastern Maine Medical Center, Bangor, Maine, USA
| | | | - Narcis Zarnescu
- Department of Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Gabriele Capurso
- Department of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Jeffrey Easler
- Division of Gastroenterology, Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mario Peláez Luna
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad-Autónoma de Mexico, Mexico City, Mexico
| | - Shyam Thakkar
- Division of Gastroenterology, West Virginia University, Morgantown, West Virginia, USA
| | - Carlos Ocampo
- Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Enrique de-Madaria
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - Gregory A Cote
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luis Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Archibugi L, Ciarfaglia G, Cárdenas-Jaén K, Poropat G, Korpela T, Maisonneuve P, Aparicio JR, Casellas JA, Arcidiacono PG, Mariani A, Stimac D, Hauser G, Udd M, Kylänpää L, Rainio M, Di Giulio E, Vanella G, Lohr JM, Valente R, Arnelo U, Fagerstrom N, De Pretis N, Gabbrielli A, Brozzi L, Capurso G, de-Madaria E. Machine learning for the prediction of post-ERCP pancreatitis risk: A proof-of-concept study. Dig Liver Dis 2023; 55:387-393. [PMID: 36344369 DOI: 10.1016/j.dld.2022.10.005] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Predicting Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) risk can be determinant in reducing its incidence and managing patients appropriately, however studies conducted thus far have identified single-risk factors with standard statistical approaches and limited accuracy. AIM To build and evaluate performances of machine learning (ML) models to predict PEP probability and identify relevant features. METHODS A proof-of-concept study was performed on ML application on an international, multicenter, prospective cohort of ERCP patients. Data were split in training and test set, models used were gradient boosting (GB) and logistic regression (LR). A 10-split random cross-validation (CV) was applied on the training set to optimize parameters to obtain the best mean Area Under Curve (AUC). The model was re-trained on the whole training set with the best parameters and applied on test set. Shapley-Additive-exPlanation (SHAP) approach was applied to break down the model and clarify features impact. RESULTS One thousand one hundred and fifty patients were included, 6.1% developed PEP. GB model outperformed LR with AUC in CV of 0.7 vs 0.585 (p-value=0.012). GB AUC in test was 0.671. Most relevant features for PEP prediction were: bilirubin, age, body mass index, procedure time, previous sphincterotomy, alcohol units/day, cannulation attempts, gender, gallstones, use of Ringer's solution and periprocedural NSAIDs. CONCLUSION In PEP prediction, GB significantly outperformed LR model and identified new clinical features relevant for the risk, most being pre-procedural.
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Affiliation(s)
- Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.
| | - Gianmarco Ciarfaglia
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Goran Poropat
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Taija Korpela
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Patrick Maisonneuve
- Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - José R Aparicio
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Juan Antonio Casellas
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Davor Stimac
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Goran Hauser
- University Hospital of Rijeka, Department of Gastroenterology, Rijeka, Croatia
| | - Marianne Udd
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Leena Kylänpää
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Mia Rainio
- Helsinki University Hospital and University of Helsinki, Gastroenterological Surgery, Abdominal Center, Helsinki, Finland
| | - Emilio Di Giulio
- Department of Gastroenterology, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy; Department of Gastroenterology, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Johannes Matthias Lohr
- HPD Disease Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Roberto Valente
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA
| | - Urban Arnelo
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Nicolò De Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Lorenzo Brozzi
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Bouça-Machado T, Bouwense SAW, Brand M, Demir IE, Frøkjær JB, Garg P, Hegyi P, Löhr JM, de-Madaria E, Olesen SS, Pandanaboyana S, Pedersen JB, Rebours V, Sheel A, Singh V, Smith M, Windsor JA, Yadav D, Drewes AM. Position statement on the definition, incidence, diagnosis and outcome of acute on chronic pancreatitis. Pancreatology 2023; 23:143-150. [PMID: 36746714 DOI: 10.1016/j.pan.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute on chronic pancreatitis (ACP) is a relatively common condition, but there are significant gaps in our knowledge on the definition, incidence, diagnosis, treatment and prognosis. METHODS A systematic review that followed PICO (Population; Intervention; Comparator; Outcome) recommendation for quantitative questions and PICo (Population, Phenomenon of Interest, Context) for qualitative research was done to answer 10 of the most relevant questions about ACP. Quality of evidence was judged by the GRADE criteria (Grades of Recommendation, Assessment, Development and Evaluation). The manuscript was sent for review to 12 international experts from various disciplines and continents using a Delphi process. RESULTS The quality of evidence, for most statements, was low to very low, which means that the recommendations in general are only conditional. Despite that, it was possible to reach strong levels of agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached. Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes may be less than 3 times the upper limit of normal and cross-sectional imaging is considered more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality risk than acute pancreatitis. CONCLUSIONS Although the evidence base is poor, this position statement provides a foundation from which to advance management of ACP.
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Affiliation(s)
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Martin Brand
- Department of Surgery, University of Pretoria, Pretoria, South Africa
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary. Centre for Translational Medicine, Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - J-Matthias Löhr
- Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Søren Schou Olesen
- Mech-Sense & Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jan Bech Pedersen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Vinciane Rebours
- Pancreatology Department and Digestive Oncology, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France
| | - Andrea Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Vikesh Singh
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Martin Smith
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, Gauteng, South Africa
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Asbjørn Mohr Drewes
- Mech-Sense & Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
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13
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Al-Leswas D, Baxter N, Lim WB, Robertson F, Ratnayake B, Samanta J, Capurso G, de-Madaria E, Drewes AM, Windsor J, Pandanaboyana S. The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis. HPB (Oxford) 2023; 25:162-171. [PMID: 36593161 DOI: 10.1016/j.hpb.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP. METHODS The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis. RESULTS A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively. CONCLUSION EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.
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Affiliation(s)
- Dhya Al-Leswas
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Nesta Baxter
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Wei B Lim
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Francis Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital; Department of Clinical Medicine, Miguel Hernández University; ISABIAL, Alicante, Spain
| | - Asbjørn M Drewes
- Department of Gastroenterology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - John Windsor
- HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand; Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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Abstract
OBJECTIVE The objective of this study is to generate a core clinical dataset (CD) containing the minimum acceptable amount of information that should be collected for each patient presenting with triglyceride-induced acute pancreatitis within global treatment centres or sites. METHOD The Jandhyala Method, including systematic literature review and SMART interviews, was used to observe expert opinion from ten leaders in the treatment of triglyceride-induced acute pancreatitis (TG-IAP) across the US and EU. RESULTS Using the PRISMA Literature Review Protocol, data were extracted from 123 of the 6718 identified studies. A total of 243 items were identified from the data extracted from these studies and, combined with the unique items coded from the Awareness Round (1) survey, formed the Consensus Round (2) survey. One hundred and ninety-five of the 243 items (80%) met the consensus threshold and were included for appraisal in the SMART interview phase. A total of 109 items were agreed to form part of the current clinical diagnostic and monitoring procedure by all experts once the weights across all the stakeholder disciplines were balanced to eliminate bias. These items were further condensed to form the core dataset, comprising a total of 87 items. CONCLUSION Once validated and adopted, the TG-IAP CD will improve the overall management of patients with TG-IAP by speeding up diagnosis and detecting changes in disease severity and subsequent disease progression, informing personalized patient management plans, and improving patient outcomes.
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Affiliation(s)
- Steve Freedman
- The Pancreas Center, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Vikesh K Singh
- Division of Gastroenterology, Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Eric Bruckert
- Endocrinology and Prevention of Cardiovascular Disease Department in Pitié-Salpêtrière Hospital, Paris, France
| | - Matthias Löhr
- Department of Clinical Science, Intervention and Technology (CLINTEC), Pancreas Cancer Research Lab, Karolinska Institutet, Stockholm, Sweden
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France
| | | | - Ravi Jandhyala
- Medialis Ltd., England, UK
- Centre for Pharmaceutical Medicine Research, King's College London, London, UK
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15
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Oncina-Cánovas A, González-Palacios S, Notario-Barandiaran L, Torres-Collado L, Signes-Pastor A, de-Madaria E, Santibañez M, García-de la Hera M, Vioque J. Adherence to Pro-Vegetarian Food Patterns and Risk of Oesophagus, Stomach, and Pancreas Cancers: A Multi Case-Control Study (The PANESOES Study). Nutrients 2022; 14:nu14245288. [PMID: 36558447 PMCID: PMC9787989 DOI: 10.3390/nu14245288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed to evaluate the association between three previously defined pro-vegetarian (PVG) food patterns and the cancers of the oesophagus, stomach, and pancreas in a multi case-control study. We analyzed data from a multi-case hospital-based study carried out in two Mediterranean provinces in Spain. A total of 1233 participants were included in the analyses: 778 incident cancer cases, histologically confirmed (199 oesophagus, 414 stomach, and 165 pancreas) and 455 controls. A dietary assessment was performed using a validated food frequency questionnaire (FFQ). Three PVG food patterns (general, healthful, and unhealthful) were estimated using 12 food groups for the general PVG (gPVG), scoring positive plant-based foods and negative animal-based foods, and 18 food groups, for the healthful (hPVG) and unhealthful (uPVG) food patterns. Multinomial logistic regression was used to estimate relative risk ratios (RRR) and confidence intervals (95% CI) for quintiles of adherence to PVG patterns and as a continuous variable. The RRR (95% CI) for the highest vs. the lowest quintile of gPVG were, RRR = 0.37 (0.32, 0.42) for the oesophagus, RRR = 0.34 (0.27, 0.43) for the stomach, and RRR = 0.43 (0.35, 0.52) for pancreas cancer. For the hPVG, the RRR were RRR = 0.72 (0.58, 0.90) for the oesophagus, RRR = 0.42 (0.34, 0.52) for the stomach, and RRR = 0.74 (0.59, 0.92) for pancreas cancer. The uPVG was associated with a higher risk of stomach cancer RRR = 1.76 (1.42, 2.18). Higher adherence to gPVG and hPVG food patterns is associated with a lower risk of oesophageal, stomach, and pancreas cancers, while a higher adherence to a uPVG food pattern is associated with a higher risk of stomach cancer.
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Affiliation(s)
- Alejandro Oncina-Cánovas
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Sandra González-Palacios
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Leyre Notario-Barandiaran
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Laura Torres-Collado
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Antonio Signes-Pastor
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Enrique de-Madaria
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
| | - Miguel Santibañez
- Grupo de Investigación de Salud Global, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, 39011 Santander, Spain
| | - Manuela García-de la Hera
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Jesús Vioque
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
- Unidad de Epidemiología de la Nutrición, Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-965-919-517
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Buxbaum JL, Bolado F, de-Madaria E. Aggressive or Moderate Fluids in Acute Pancreatitis. Reply. N Engl J Med 2022; 387:2199-2200. [PMID: 36477046 DOI: 10.1056/nejmc2213440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Capurso G, de-Madaria E. Procalcitonin-guided reduction of antibiotic use in acute pancreatitis. Lancet Gastroenterol Hepatol 2022; 7:896-897. [PMID: 35863359 DOI: 10.1016/s2468-1253(22)00231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan 20132, Italy.
| | - Enrique de-Madaria
- Gastroenterology Department, Dr Balmis General University Hospital, Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain; Alicante Institute for Health and Biomedical Research, Alicante, Spain
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18
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Mínguez A, Ladrón P, Martínez S, Del Val A, Nos P, de-Madaria E. Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis. Gastroenterología y Hepatología 2022; 46:297-304. [PMID: 36243251 DOI: 10.1016/j.gastrohep.2022.10.006] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Choledocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP. METHODS This retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013-2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC. RESULTS Patients underwent MRCP (n=145, 71.1), MRCP and ERCP (n=44, 21.56%), EUS and ERCP (n=1, 0.49%), or ERCP (n=14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p<0.001; OR=27; 95% CI: 5.8-185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72h (p=0.008; OR=3.4; 95% CI: 1.5-8.9); and biliary sludge in the gallbladder (p=0.008; OR=0.03; 95% CI: 0.001-0.3). CONCLUSIONS The predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results. CONCLUSIONS The predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice.
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de-Madaria E, Buxbaum JL, Maisonneuve P, García García de Paredes A, Zapater P, Guilabert L, Vaillo-Rocamora A, Rodríguez-Gandía MÁ, Donate-Ortega J, Lozada-Hernández EE, Collazo Moreno AJR, Lira-Aguilar A, Llovet LP, Mehta R, Tandel R, Navarro P, Sánchez-Pardo AM, Sánchez-Marin C, Cobreros M, Fernández-Cabrera I, Casals-Seoane F, Casas Deza D, Lauret-Braña E, Martí-Marqués E, Camacho-Montaño LM, Ubieto V, Ganuza M, Bolado F. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med 2022; 387:989-1000. [PMID: 36103415 DOI: 10.1056/nejmoa2202884] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited. METHODS At 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer's solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient's clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients. RESULTS A total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P = 0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P = 0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group. CONCLUSIONS In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. (Funded by Instituto de Salud Carlos III and others; WATERFALL ClinicalTrials.gov number, NCT04381169.).
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Affiliation(s)
- Enrique de-Madaria
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - James L Buxbaum
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Patrick Maisonneuve
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Ana García García de Paredes
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Pedro Zapater
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Lucía Guilabert
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alicia Vaillo-Rocamora
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Miguel Á Rodríguez-Gandía
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Jesús Donate-Ortega
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Edgard E Lozada-Hernández
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alan J R Collazo Moreno
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Alba Lira-Aguilar
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Laura P Llovet
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Rajiv Mehta
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Raj Tandel
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Pablo Navarro
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Ana M Sánchez-Pardo
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Claudia Sánchez-Marin
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Marina Cobreros
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Idaira Fernández-Cabrera
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Fernando Casals-Seoane
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Diego Casas Deza
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Eugenia Lauret-Braña
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Eva Martí-Marqués
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Laura M Camacho-Montaño
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Verónica Ubieto
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Mikel Ganuza
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
| | - Federico Bolado
- From the Departments of Gastroenterology (E.M., L.G., A.V.-R.) and Clinical Pharmacology (P.Z.), Dr. Balmis General University Hospital, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, the Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche (E.M.), the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá (A.G.G.P., M.Á.R.-G., J.D.-O.), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (P.Z., F.C.-S.), and the Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (F.C.-S.), Madrid, the Gastroenterology and Digestive Endoscopy Unit, Corporació Sanitària Parc Taulí, Sabadell (A.L.-A., L.P.L.), the Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia (P.N., A.M.S.-P.), the Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander (C.S.-M., M.C.), the Department of Gastroenterology, Hospital Dr. Negrín, Las Palmas (I.F.-C.), the Department of Gastroenterology, Miguel Servet University Hospital and Health Research Institute of Aragón, Zaragoza (D.C.D.), the Department of Gastroenterology, Central de Asturias University Hospital, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo (E.L.-B.), the Department of Gastroenterology, Lucus Augusti University Hospital, Lugo (E.M.-M.), the Department of Gastroenterology, Puerta del Mar University Hospital, Cadiz (L.M.C.-M.), and the Department of Gastroenterology, University Hospital of Navarre, Pamplona (V.U., M.G., F.B.) - all in Spain; the Division of Gastroenterology, University of Southern California, Los Angeles (J.L.B.); the Division of Epidemiology and Biostatistics, IRCSS European Institute of Oncology, Milan (P.M.); the General Surgery Unit, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Leon, Mexico (E.E.L.-H., A.J.R.C.M.); and the Department of Gastroenterology, Surat Institute of Digestive Sciences Hospital and Research Center, Surat, India (R.M., R.T.)
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Kui B, Pintér J, Molontay R, Nagy M, Farkas N, Gede N, Vincze Á, Bajor J, Gódi S, Czimmer J, Szabó I, Illés A, Sarlós P, Hágendorn R, Pár G, Papp M, Vitális Z, Kovács G, Fehér E, Földi I, Izbéki F, Gajdán L, Fejes R, Németh BC, Török I, Farkas H, Mickevicius A, Sallinen V, Galeev S, Ramírez-Maldonado E, Párniczky A, Erőss B, Hegyi PJ, Márta K, Váncsa S, Sutton R, Szatmary P, Latawiec D, Halloran C, de-Madaria E, Pando E, Alberti P, Gómez-Jurado MJ, Tantau A, Szentesi A, Hegyi P. EASY-APP: An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis. Clin Transl Med 2022; 12:e842. [PMID: 35653504 PMCID: PMC9162438 DOI: 10.1002/ctm2.842] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/17/2022] Open
Abstract
Background Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity; therefore, the early therapeutic window is often missed. Methods The early achievable severity index (EASY) is a multicentre, multinational, prospective and observational study (ISRCTN10525246). The predictions were made using machine learning models. We used the scikit‐learn, xgboost and catboost Python packages for modelling. We evaluated our models using fourfold cross‐validation, and the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and accuracy metrics were calculated on the union of the test sets of the cross‐validation. The most critical factors and their contribution to the prediction were identified using a modern tool of explainable artificial intelligence called SHapley Additive exPlanations (SHAP). Results The prediction model was based on an international cohort of 1184 patients and a validation cohort of 3543 patients. The best performing model was an XGBoost classifier with an average AUC score of 0.81 ± 0.033 and an accuracy of 89.1%, and the model improved with experience. The six most influential features were the respiratory rate, body temperature, abdominal muscular reflex, gender, age and glucose level. Using the XGBoost machine learning algorithm for prediction, the SHAP values for the explanation and the bootstrapping method to estimate confidence, we developed a free and easy‐to‐use web application in the Streamlit Python‐based framework (http://easy‐app.org/). Conclusions The EASY prediction score is a practical tool for identifying patients at high risk for severe AP within hours of hospital admission. The web application is available for clinicians and contributes to the improvement of the model.
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Affiliation(s)
- Balázs Kui
- Department of Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - József Pintér
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Roland Molontay
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary.,MTA-BME Stochastics Research Group, Budapest, Hungary
| | - Marcell Nagy
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Szilárd Gódi
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - József Czimmer
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Imre Szabó
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Anita Illés
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Roland Hágendorn
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Mária Papp
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Vitális
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Kovács
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Fehér
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Földi
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - László Gajdán
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Roland Fejes
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Balázs Csaba Németh
- Department of Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Imola Török
- County Emergency Clinical Hospital of Târgu Mures-Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology 'George Emil Palade', Targu Mures, Romania
| | - Hunor Farkas
- County Emergency Clinical Hospital of Târgu Mures-Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology 'George Emil Palade', Targu Mures, Romania
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | | | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Márta
- Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Robert Sutton
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Peter Szatmary
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Diane Latawiec
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Chris Halloran
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Elizabeth Pando
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Piero Alberti
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria José Gómez-Jurado
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alina Tantau
- The 4th Medical Clinic, Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Romania
| | - Andrea Szentesi
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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21
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Paragomi P, Hinton A, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzalez JA, Singh VK, Bogado MF, Stevens T, Barbu ST, Nawaz H, Gutierrez SC, Zarnescu N, Archibugi L, Easler JJ, Triantafyllou K, Peláez-Luna M, Thakkar S, Ocampo C, de-Madaria E, Cote GA, Lee PJ, Krishna S, Lara LF, Han S, Wu BU, Papachristou GI. The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International Study. Clin Gastroenterol Hepatol 2022; 20:1334-1342.e4. [PMID: 34543736 PMCID: PMC9060638 DOI: 10.1016/j.cgh.2021.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/17/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aims of this study were to: (1) assess the performance of the Pancreatitis Activity Scoring System (PASS) in a large intercontinental cohort of patients with acute pancreatitis (AP); and (2) investigate whether a modified PASS (mPASS) yields a similar predictive accuracy and produces distinct early trajectories between severity subgroups. METHODS Data was prospectively collected through the Acute Pancreatitis Patient Registry to Examine Novel Therapies In Clinical Experience (APPRENTICE) consortium (2015-2018) involving 22 centers from 4 continents. AP severity was categorized per the revised Atlanta classification. PASS trajectories were compared between the three severity groups using the generalized estimating equations model. Four mPASS models were generated by modifying the morphine equivalent dose (MED), and their trajectories were compared. RESULTS A total of 1393 subjects were enrolled (median age, 49 years; 51% males). The study cohort included 950 mild (68.2%), 315 (22.6%) moderately severe, and 128 (9.2%) severe AP. Mild cases had the lowest PASS at each study time point (all P < .001). A subset of patients with outlier admission PASS values was identified. In the outlier group, 70% of the PASS variation was attributed to the MED, and 66% of these patients were from the United States centers. Among the 4 modified models, the mPASS-1 (excluding MED from PASS) demonstrated high performance in predicting severe AP with an area under the receiver operating characteristic curve of 0.88 (vs area under the receiver operating characteristic of 0.83 in conventional PASS) and produced distinct trajectories with distinct slopes between severity subgroups (all P < .001). CONCLUSION We propose a modified model by removing the MED component, which is easier to calculate, predicts accurately severe AP, and maintains significantly distinct early trajectories.
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Affiliation(s)
- Pedram Paragomi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;,University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Ioannis Pothoulakis
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;,MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania;,Georgetown University Hospital, Washington DC
| | | | - Vikesh K. Singh
- Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MA
| | | | | | - Sorin T. Barbu
- University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj-Napoca, Romania
| | - Haq Nawaz
- Eastern Maine Medical Center, Bangor, Maine
| | | | | | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy;,Digestive and Liver Disease Unit, Sant’Andrea Hospital, Rome, Italy
| | | | | | - Mario Peláez-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
| | - Shyam Thakkar
- Division of Gastroenterology, West Virginia University, Morgantown, West Virginia
| | - Carlos Ocampo
- Hospital General de Argudos “Dr. Cosme Argerich,” Buenos Aires, Argentina
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Gregory A. Cote
- Medical University of South Carolina, Charleston, South Carolina
| | - Peter J. Lee
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Somashekar Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Luis F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | | | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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22
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de-Madaria E, Mira JJ, Carrillo I, Afif W, Ang D, Antelo M, Bollipo S, Castells A, Chahal P, Heinrich H, Law JK, van Leerdam ME, Lens S, Pannala R, Park SH, Rabiee A, Savarino EV, Singh VK, Vargo J, Charabaty A, Drenth JPH. The present and future of gastroenterology and hepatology: an international SWOT analysis (the GASTROSWOT project). Lancet Gastroenterol Hepatol 2022; 7:485-494. [PMID: 35247318 DOI: 10.1016/s2468-1253(21)00442-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/23/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
GASTROSWOT is a strategic analysis of the current and projected states of the different subspecialties in gastroenterology that aims to provide guidance for research, clinical, and financial planning in gastroenterology. We executed a consensus-based international strengths, weaknesses, opportunities, and threats (SWOT) analysis. Four general coordinators, six field coordinators, and 12 experts participated in the study. SWOTs were provided for the following fields: neurogastroenterology, functional gastrointestinal disorders, and upper gastrointestinal diseases; inflammatory bowel disease; pancreatology and biliary diseases; endoscopy; gastrointestinal oncology; and hepatology. The GASTROSWOT analysis highlights the following in the current state of the field of gastroenterology: the incidence and complexity of several gastrointestinal diseases, including malignancies, are increasing; the COVID-19 pandemic has affected patient care on several levels; and with the advent of technical innovations in gastroenterology, a well trained workforce and strategic planning are required to optimise health-care utilisation. The analysis calls attention to the following in the future of gastroenterology: artificial intelligence and the use of big data will speed up discovery and smarter health-care provision in the field; the growth and diversification of gastroenterological specialties will improve specialised care for patients, but could promote fragmentation of care and health system inefficiencies; and furthermore, thoughtful planning is needed to reach an effective balance between the need for subspecialists and the value of general gastroenterology services.
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Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - José J Mira
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Irene Carrillo
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Marina Antelo
- Oncology Section, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Antoni Castells
- Gastroenterology Department, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain; Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Henriette Heinrich
- Stadtspital Waid und Triemli Abteilung für Gastroenterologie, University of Zurich, Zurich, Switzerland
| | | | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sabela Lens
- Liver Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - San Hyoung Park
- Department of Gastroenterology, and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Atoosa Rabiee
- Division of Gastroenterology and Hepatology, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Edoardo V Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aline Charabaty
- Division of Gastroenterology, Sibley Memorial Hospital, Johns Hopkins University, Washington, DC, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
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23
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Seleq S, Khan R, Gimpaya N, Vargas JI, Amin S, Bilal M, Bollipo S, Charabaty A, de-Madaria E, Hashim A, Kral J, Pawlak KM, Sandhu DS, Lui RN, Sanchez-Luna S, Siau K, Mosko J, Grover S. A32 DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859122 DOI: 10.1093/jcag/gwab049.031] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings.
Aims
To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability.
Methods
An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1).
Results
Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability.
Conclusions
We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.
Funding Agencies
None
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Affiliation(s)
- S Seleq
- St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- St Michael’s Hospital, Toronto, ON, Canada
| | - J I Vargas
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - S Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, Miami, FL
| | - M Bilal
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Boston, MA
| | - S Bollipo
- Gastroenterology Department, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia, Newcastle, New South Wales, Australia
| | - A Charabaty
- Division of Gastroenterology, Johns Hopkins-Sibley Memorial Hospital, Washington, DC, Washington, DC
| | - E de-Madaria
- Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain, Alicante, Spain
| | - A Hashim
- Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - J Kral
- Institution for Clinical and Experimental Medicine, Prague, Czech Republic, Prague, Czechia
| | - K M Pawlak
- Hospital of the Ministry of Interior and Administration, Szczecin, Poland, Szczecin, Poland
| | - D S Sandhu
- Division of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, Cleveland, OH
| | - R N Lui
- Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, China
| | - S Sanchez-Luna
- Division of Gastroenterology and Hepatology, The University of New Mexico, Albuquerque, NM
| | - K Siau
- Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, Birmingham, United Kingdom
| | - J Mosko
- St Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St Michael’s Hospital, Toronto, ON, Canada
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24
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Ocskay K, Juhász MF, Farkas N, Zádori N, Szakó L, Szakács Z, Szentesi A, Erőss B, Miklós E, Zemplényi A, Birkás B, Csathó Á, Hartung I, Nagy T, Czopf L, Izbéki F, Gajdán L, Papp M, Czakó L, Illés D, Marino MV, Mirabella A, Małecka-Panas E, Zatorski H, Susak Y, Opalchuk K, Capurso G, Apadula L, Gheorghe C, Saizu IA, Petersen OH, de-Madaria E, Rosendahl J, Párniczky A, Hegyi P. Recurrent acute pancreatitis prevention by the elimination of alcohol and ciga rette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study. BMJ Open 2022; 12:e050821. [PMID: 34983758 PMCID: PMC8728419 DOI: 10.1136/bmjopen-2021-050821] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/OBJECTIVES Acute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to investigate whether a combined patient education and cessation programme for smoking and alcohol prevents ARP. METHODS AND ANALYSIS The REAPPEAR study consists of an international multicentre randomised controlled trial (REAPPEAR-T) testing the efficacy of a cessation programme on alcohol and smoking and a prospective cohort study (REAPPEAR-C) assessing the effects of change in alcohol consumption and smoking (irrespective of intervention). Daily smoker patients hospitalised with alcohol-induced acute pancreatitis (AP) will be enrolled. All patients will receive a standard intervention priorly to encourage alcohol and smoking cessation. Participants will be subjected to laboratory testing, measurement of blood pressure and body mass index and will provide blood, hair and urine samples for later biomarker analysis. Addiction, motivation to change, socioeconomic status and quality of life will be evaluated with questionnaires. In the trial, patients will be randomised either to the cessation programme with 3-monthly visits or to the control group with annual visits. Participants of the cessation programme will receive a brief intervention at every visit with direct feedback on their alcohol consumption based on laboratory results. The primary endpoint will be the composite of 2-year all-cause recurrence rate of AP and/or 2-year all-cause mortality. The cost-effectiveness of the cessation programme will be evaluated. An estimated 182 participants will be enrolled per group to the REAPPEAR-T with further enrolment to the cohort. ETHICS AND DISSEMINATION The study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (40394-10/2020/EÜIG), all local ethical approvals are in place. Results will be disseminated at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04647097.
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Affiliation(s)
- Klementina Ocskay
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Medical School, Institute of Bioanalysis, University of Pécs, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Emőke Miklós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Antal Zemplényi
- Faculty of Pharmacy, Division of Pharmacoeconomics, University of Pécs, Pécs, Hungary
- Center for Health Technology Assessment, University of Pécs, Pécs, Hungary
| | - Béla Birkás
- Medical School, Institute of Behavioural Sciences, University of Pécs, Pécs, Hungary
| | - Árpád Csathó
- Medical School, Institute of Behavioural Sciences, University of Pécs, Pécs, Hungary
| | - István Hartung
- Medical School, Institute of Behavioural Sciences, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Medical School, Department of Laboratory Medicine, University of Pécs, Pécs, Hungary
| | - László Czopf
- Medical School, First Department of Medicine, Division of Cardiology and Angiology, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- First Department of Internal Medicine, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - László Gajdán
- First Department of Internal Medicine, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | - László Czakó
- Faculty of Medicine, First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Illés
- Faculty of Medicine, First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Marco V Marino
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Antonello Mirabella
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Hubert Zatorski
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Yaroslav Susak
- Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Kristina Opalchuk
- Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Gabriele Capurso
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Laura Apadula
- Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Cristian Gheorghe
- Clinical Institute Fundeni, Bucuresti, Romania
- Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Ionut Adrian Saizu
- Clinical Institute Fundeni, Bucuresti, Romania
- Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | | | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle, Germany
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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25
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Zhou S, Buitrago C, Foong A, Lee V, Dawit L, Hiramoto B, Chang P, Schilperoort H, Lee A, de-Madaria E, Buxbaum J. Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer's versus Normal Saline for acute pancreatitis. Pancreatology 2021; 21:1405-1410. [PMID: 34332907 DOI: 10.1016/j.pan.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/22/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. METHODS In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. RESULTS We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25-0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13-0.81) and local complications (OR 0.42; 95 % CI 0.2-0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. CONCLUSION Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.
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Affiliation(s)
- Selena Zhou
- Division of Gastroenterology, University of Southern California, USA
| | - Carlos Buitrago
- Division of Gastroenterology, University of Southern California, USA
| | - Andrew Foong
- Division of Gastroenterology, University of Southern California, USA
| | - Vivian Lee
- Division of Gastroenterology, University of Southern California, USA
| | - Lillian Dawit
- Division of Gastroenterology, University of Southern California, USA
| | - Brent Hiramoto
- Division of Gastroenterology, University of Southern California, USA
| | - Patrick Chang
- Division of Gastroenterology, University of Southern California, USA
| | | | - Alice Lee
- Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - James Buxbaum
- Division of Gastroenterology, University of Southern California, USA.
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26
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Machicado JD, Mounzer R, Paragomi P, Pothoulakis I, Hart PA, Conwell DL, de-Madaria E, Greer P, Yadav D, Whitcomb DC, Lee PJ, Hinton A, Papachristou GI. Rectal Indomethacin Does Not Mitigate the Systemic Inflammatory Response Syndrome in Acute Pancreatitis: A Randomized Trial. Clin Transl Gastroenterol 2021; 12:e00415. [PMID: 34704970 PMCID: PMC8553238 DOI: 10.14309/ctg.0000000000000415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Experimental data suggest that nonsteroidal antiinflammatory drugs may prevent disease severity and mortality in acute pancreatitis (AP). The aim of this study was to compare the efficacy of rectal indomethacin vs placebo in reducing the systemic inflammatory response syndrome (SIRS) score in a high-risk AP population for clinical progression. METHODS We conducted a single-center, quadruple-blinded, randomized, placebo-controlled trial. Eligible criteria were subjects with AP and SIRS within 72 hours of presentation and those without organ failure. Subjects were allocated in a 1:1 ratio to indomethacin or placebo using simple randomization. Both interventions were administered rectally every 8 hours for 6 doses and compared using both intention-to-treat and per-protocol analyses. RESULTS A total of 42 subjects (mean age 52 years, 55% men) were randomized to indomethacin (n = 18) or placebo (n = 24). There was no significant difference between the indomethacin and placebo groups in the change of SIRS score, proportion of subjects with SIRS, and distribution of SIRS scores at 24, 48, and 72 hours from randomization. There were no significant differences in the change of C-reactive protein levels at 48 hours or clinical outcomes between both treatment groups. Indomethacin was as safe as placebo, with 2 adverse events occurring in the placebo and none in the indomethacin arm. DISCUSSION Rectal indomethacin can be safely administered over 48 hours; however, it is not superior to placebo in reducing the SIRS or clinical progression in a high-risk population with AP (ClinicalTrials.gov: NCT02692391).
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Affiliation(s)
- Jorge D. Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA;
| | - Rawad Mounzer
- Interventional Endoscopy Associates, Scottsdale, Arizona, USA;
| | - Pedram Paragomi
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Ioannis Pothoulakis
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain;
| | - Phil Greer
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - David C. Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;
| | - Peter J. Lee
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, the Ohio State University, Columbus, Ohio, USA.
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
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Carrascal M, Areny-Balagueró A, de-Madaria E, Cárdenas-Jaén K, García-Rayado G, Rivera R, Martin Mateos RM, Pascual-Moreno I, Gironella M, Abian J, Closa D. Inflammatory capacity of exosomes released in the early stages of acute pancreatitis predicts the severity of the disease. J Pathol 2021; 256:83-92. [PMID: 34599510 DOI: 10.1002/path.5811] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023]
Abstract
As acute pancreatitis progresses to the severe form, a life-threatening systemic inflammation is triggered. Although the mechanisms involved in this process are not yet well understood, it has been proposed that circulating exosomes may be involved in the progression of inflammation from the pancreas to distant organs. Here, the inflammatory capacity and protein profile of plasma exosomes obtained during the first 24 h of hospitalization of patients diagnosed with acute pancreatitis were characterized and compared with the final severity of the disease. We found that the final severity of the disease strongly correlates with the inflammatory capacity of exosomes in the early stages of acute pancreatitis. Exosomes isolated from patients with mild pancreatitis had no effect on macrophages, while exosomes isolated from patients with severe pancreatitis triggered NFκB activation, TNFα and IL1β expression, and free radical generation. To delve deeper into the mechanism involved, we performed a proteomic analysis of the different exosomes that allowed us to identify different groups of proteins whose concentration was also correlated with the clinical classification of pancreatitis. In particular, an increase in the amount of S100A8 and S100A9 carried by exosomes of severe pancreatitis suggests that the mechanism of action of exosomes is mediated by the effect of these proteins on NADPH oxidase. This enzyme is activated by S100A8/S100A9, thus generating free radicals and promoting an inflammatory response. Along these lines, we observed that inhibition of this enzyme abolished all the pro-inflammatory effects of exosomes from severe pancreatitis. All this suggests that the systemic effects, and therefore the final severity of acute pancreatitis, are determined by the content of circulating exosomes generated in the early hours of the process. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Montserrat Carrascal
- Biological and Environmental Proteomics, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Areny-Balagueró
- Department of Experimental Pathology, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Guillermo García-Rayado
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Robin Rivera
- Gastroenterology Department, Hospital Costa del Sol. Marbella, Málaga, Spain
| | - Rosa María Martin Mateos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Isabel Pascual-Moreno
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Instituto de Investigación Sanitaria de Valencia (INCLIVA), Valencia, Spain
| | - Meritxell Gironella
- Gastrointestinal and Pancreatic Oncology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquin Abian
- Biological and Environmental Proteomics, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Closa
- Department of Experimental Pathology, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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28
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Capurso G, Gaujoux S, de-Madaria E. Editorial: Hot Topics in Pancreatology From Europe-2020. Front Med (Lausanne) 2021; 8:724457. [PMID: 34568380 PMCID: PMC8456042 DOI: 10.3389/fmed.2021.724457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Sebastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France.,Université de Paris, Paris, France
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
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29
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Twohig PA, de-Madaria E, Thakkar S, Dulai P, Gardner TB, Kochhar G, Sandhu DS. Quantifying the Risk of Drug-Induced Pancreatitis With Angiotensin-Converting Enzyme Inhibitors and Statins Using a Large Electronic Medical Record Database. Pancreas 2021; 50:1212-1217. [PMID: 34714286 DOI: 10.1097/mpa.0000000000001895] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Quantify the risk of drug-induced pancreatitis (DIP) from angiotensin-converting enzyme inhibitors (ACEis) and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). METHODS Retrospective cohort analysis using IBM Explorys (1999-2019), a pooled, deidentified clinical database of more than 63 million patients across the United States. Odds ratios were calculated to determine the risk of DIP from ACEi, statins, and both medications together. χ2 testing assessed the relationship between age, sex, ethnicity, insurance status, and mortality among patients with DIP from ACEi, statins, or both combined. RESULTS Acute pancreatitis (AP) was found in 280,740 patients. Odds ratios for ACEi, statins, and both combined were 6.12, 4.97, and 5.72, respectively. Thirty-eight percent of all-cause AP occurs in adults older than 65 years. Acute pancreatitis from ACEi and statins occurs in 49% and 56% of patients older than 65 years, respectively. Men and patients older than 65 years are at higher risk of DIP from ACEi and statins. Patients on Medicaid are at higher risk of DIP from statins, and Asian patients are at highest risk of DIP from ACEi. CONCLUSIONS We found that ACEi and statins increase the odds of DIP. Although ACEis and statins are critical medications for many patients, clinicians should consider using alternatives in patients with AP of unclear etiology.
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Affiliation(s)
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University, Morgantown, WV
| | - Parambir Dulai
- Department of Gastroenterology, University of California San Diego, San Diego, CA
| | - Timothy B Gardner
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Gursimran Kochhar
- Department of Gastroenterology & Hepatology, Allegheny Health Network, Pittsburgh, PA
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30
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de-Madaria E. Bile volatile organic compounds, smelling trouble. Endoscopy 2021; 53:737-738. [PMID: 34167162 DOI: 10.1055/a-1312-6330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain.,Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain
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31
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Cárdenas-Jaén K, Archibugi L, Poropat G, Korpela T, Maisonneuve P, Aparicio JR, Udd M, Stimac D, Arcidiacono PG, De Pretis N, Valente R, Di Giulio E, Casellas JA, Kylänpää L, Hauser G, Mariani A, Gabbrielli A, Löhr M, Vanella G, Rainio M, Brozzi L, Arnelo U, Fagerström N, Capurso G, de-Madaria E. Chronic use of statins and acetylsalicylic acid and incidence of post-endoscopic retrograde cholangiopancreatography acute pancreatitis: A multicenter, prospective, cohort study. Dig Endosc 2021; 33:639-647. [PMID: 32713065 DOI: 10.1111/den.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis (PEP) is a frequent complication of this endoscopic procedure. Chronic statin intake has been linked to lower incidence and severity of acute pancreatitis (AP). Periprocedural rectal administration of non-steroidal anti-inflammatory drugs is protective against PEP, but the role of chronic acetylsalicylic acid (ASA) treatment is unclear. We aimed to investigate whether statins and chronic ASA intake are associated with lower risk of PEP. METHODS An international, multicenter, prospective cohort study. Consecutive patients undergoing ERCP in seven European centers were included. Patients were followed-up to detect those with PEP. Multivariate analysis by means of binary logistic regression was performed, and adjusted odds ratios (aORs) were calculated. RESULTS A total of 1150 patients were included, and 70 (6.1%) patients developed PEP. Among statins users, 8.1% developed PEP vs. 5.4% among non-users (P = 0.09). Multivariate analysis showed no association between statin use and PEP incidence (aOR 1.68 (95% CI 0.94-2.99, P = 0.08)). Statin use had no effect on severity of PEP, being mild in 92.0% of statin users vs. 82.2% in non-statin users (P = 0.31). Chronic ASA use was not associated with PEP either (aOR 1.02 (95% CI 0.49-2.13), P = 0.96). Abuse of alcohol and previous endoscopic biliary sphincterotomy were protective factors against PEP, while >1 pancreatic guidewire passage, normal bilirubin values, and duration of the procedure >20 minutes, were risk factors. CONCLUSIONS The use of statins or ASA is not associated with a lower risk or a milder course of PEP.
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Affiliation(s)
- Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Goran Poropat
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Taija Korpela
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Jose R Aparicio
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Marianne Udd
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Davor Stimac
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Paolo G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Niccolò De Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Roberto Valente
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Di Giulio
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Juan A Casellas
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Leena Kylänpää
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Goran Hauser
- Department of Gastroenterology, Faculty of Medicine, Clinical Hospital Center of Rijeka, University of Rijeka, Rijeka, Croatia
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Gabbrielli
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Matthias Löhr
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Vanella
- Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Mia Rainio
- Gastroenterological Surgery, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lorenzo Brozzi
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Urban Arnelo
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy.,Digestive and Liver Disease Unit, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Machicado JD, Gougol A, Tan X, Gao X, Paragomi P, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzalez JA, Singh VK, Ferreira M, Stevens T, Barbu ST, Nawaz H, Gutierrez SC, Zarnescu NO, Capurso G, Easler JJ, Triantafyllou K, Pelaez-Luna M, Thakkar S, Ocampo C, de-Madaria E, Cote GA, Wu BU, Conwell DL, Hart PA, Tang G, Papachristou GI. Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected. United European Gastroenterol J 2021; 9:139-149. [PMID: 33871926 PMCID: PMC8259236 DOI: 10.1002/ueg2.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. OBJECTIVE We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. METHODS We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. RESULTS 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality. CONCLUSION In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.
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Affiliation(s)
| | - Amir Gougol
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Xiaoqing Tan
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaotian Gao
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pedram Paragomi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Georgetown University Hospital, Washington DC, USA
| | | | - Vikesh K Singh
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | | | - Sorin T Barbu
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Haq Nawaz
- Eastern Maine Medical Center, Bangor, Maine, USA
| | | | - Narcis O Zarnescu
- "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital, Bucharest, Romania
| | - Gabriele Capurso
- San Raffaele Scientific Institute (IRCCS), Vita Salute San Raffaele University, Milan, Italy.,Andrea Hospital, Rome, Italy
| | - Jeffrey J Easler
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mario Pelaez-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
| | - Shyam Thakkar
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Carlos Ocampo
- Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Gregory A Cote
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Darwin L Conwell
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Phil A Hart
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gong Tang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios I Papachristou
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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de-Madaria E, Siau K, Cárdenas-Jaén K. Increased Amylase and Lipase in Patients With COVID-19 Pneumonia: Don't Blame the Pancreas Just Yet! Gastroenterology 2021; 160:1871. [PMID: 32330475 PMCID: PMC7194902 DOI: 10.1053/j.gastro.2020.04.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Keith Siau
- Liver Unit, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Karina Cárdenas-Jaén
- Pancreatic Unit, Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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34
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Zhen J, Stefanolo JP, Temprano MDLP, Seiler CL, Caminero A, de-Madaria E, Huguet MM, Santiago V, Niveloni SI, Smecuol EG, Dominguez LU, Trucco E, Lopez V, Olano C, Mansueto P, Carroccio A, Green PH, Duerksen D, Day AS, Tye-Din JA, Bai JC, Ciacci C, Verdú EF, Lebwohl B, Pinto-Sanchez MI. Risk perception and knowledge of COVID-19 in patients with celiac disease. World J Gastroenterol 2021; 27:1213-1225. [PMID: 33828395 PMCID: PMC8006100 DOI: 10.3748/wjg.v27.i12.1213] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We recently demonstrated that the odds of contracting coronavirus disease 2019 (COVID-19) in patients with celiac disease (CeD) is similar to that of the general population. However, how patients with CeD perceive their COVID-19 risk may differ from their actual risk.
AIM To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their perception.
METHODS We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac conditions, respiratory conditions, and diabetes. Data was presented as adjusted odds ratios (aORs)
RESULTS A total of 10737 participants with CeD completed the survey. From them, 6019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD (56.1% vs 26.7%, P < 0.0001). Consequently, 34.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations were less likely to perceive an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, P < 0.0001). Older age (aOR: 0.99; 95%CI: 0.99 to 0.99, P < 0.001), male sex (aOR: 0.84; 95%CI: 0.76 to 0.93, P = 0.001), and strict adherence to a GFD (aOR: 0.89; 95%CI: 0.82 to 0.96, P = 0.007) were associated with a lower perception of COVID-19 risk and the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.38; 95%CI: 1.22 to 1.54, P < 0.001).
CONCLUSION Overall, high levels of risk perceptions, such as those found in patients with CeD, may increase an individual’s pandemic-related stress and contribute to negative mental health consequences. Therefore, it is encouraged that public health officials maintain consistent communication with the public and healthcare providers with the celiac community. Future studies specifically evaluating mental health in CeD could help determine the consequences of increased risk perceptions in this population.
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Affiliation(s)
- Jamie Zhen
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Juan Pablo Stefanolo
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - María de la Paz Temprano
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Caroline L Seiler
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Alberto Caminero
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
| | - Enrique de-Madaria
- Department of Pancreatic Unit, Hospital General Universitario de Alicante, Alicante 03010, Spain
| | - Miguel Montoro Huguet
- Department of Medicine, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza 50009, Spain
- Department of Medicine, Hospital Universitario San Jorge. Huesca, Zaragoza 50004, Spain
| | - Vivas Santiago
- Department of Gastroenterology, Univ Hosp Leon, Gastroenterol Unit, Altos de Nava S-N, Leon 24071, Spain
| | - Sonia Isabel Niveloni
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Edgardo Gustavo Smecuol
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Luis Uzcanga Dominguez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF 14080, Mexico
| | - Elena Trucco
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Virginia Lopez
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Carolina Olano
- Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
| | - Pasquale Mansueto
- Department of Internal Medicine, PROMISE Department, University of Palermo, Palermo 90127, Italy
| | - Antonio Carroccio
- Department of Internal Medicine, V. Cervello Hospital, PROMISE Department, University of Palermo, Palermo 90127, Italy
| | - Peter H Green
- Celiac Disease Center, Columbia University Medical Center, Columbia Univ, Celiac Dis Ctr, Div Digest and Liver Dis, New York, NY 10032, United States
| | - Donald Duerksen
- Department of Medicine, St Boniface Gen Hosp, University of Manitoba, Winnipeg R2H 2A6, Canada
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch 8041, New Zealand
| | - Jason A Tye-Din
- Department of Gastroenterology, Royal Melbourne Hospital, Immunology Division, Walter and Eliza Hall Institute, Melbourne 3052, Australia
| | - Julio César Bai
- Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentry, Scuola Medica Salernitana, University of Salerno, Celiac Center at the University Hospital San Giovanni di Dio e Ruggi di Aragona, Salerno 84131, Italy
| | - Elena F Verdú
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton L8S4K1, ON, Canada
| | - Benjamin Lebwohl
- The Celiac Disease Center, Columbia University, New York, NY 10032, United States
| | - M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton L8S4K1, ON, Canada
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Pothoulakis I, Nawaz H, Paragomi P, Jeong K, Talukdar R, Kochhar R, Goenka MK, Gulla A, Singh VK, Gonzalez JA, Ferreira M, Barbu ST, Stevens T, Gutierrez SC, Zarnescu NO, Capurso G, Easler J, Triantafyllou K, Pelaez-Luna M, Thakkar S, Ocampo C, de-Madaria E, Wu BU, Cote GA, Abebe K, Tang G, Lahooti A, Phillips AE, Papachristou GI. Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study. United European Gastroenterol J 2021; 9:54-62. [PMID: 32883182 PMCID: PMC8259260 DOI: 10.1177/2050640620957243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01–2.69) were independent risk factors for oral feeding intolerance. Conclusion Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.
Current knowledge on this subject
Oral feeding intolerance is a relatively common complication of acute pancreatitis. Oral feeding intolerance results in longer hospitalization and frequent readmissions.
What is new in this study
The incidence of oral feeding intolerance is similar irrespective of the timing of the initial feeding attempt. Oral feeding intolerance is independently associated with systemic inflammatory response syndrome at 48 h and nonbiliary etiology.
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Affiliation(s)
- Ioannis Pothoulakis
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Haq Nawaz
- Department of Gastroenterology, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Pedram Paragomi
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kwonho Jeong
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rupjyoti Talukdar
- Department of Gastroenterology, Asian Gastroenterology Institute, Hyderabad, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aiste Gulla
- Department of Gastroenterology, Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Vikesh K Singh
- Department of Gastroenterology, John Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Jose A Gonzalez
- Department of Gastroenterology, Universidad Autonoma de Nueva León, Monterrey, Mexico
| | - Miguel Ferreira
- Department of Gastroenterology, Hospital Nacional de Itaguá, Itagua, Paraguay
| | - Sorin T Barbu
- Department of Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Tyler Stevens
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Silvia C Gutierrez
- Department of Gastroenterology, Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina
| | - Narcis O Zarnescu
- Department of Gastroenterology, University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Jeffrey Easler
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mario Pelaez-Luna
- Department of Gastroenterology, Instituto Nacional de Ciencias Módicas y Nutrición Salvador Zubirán-Universidad Autonoma d Mexico, Mexico City, Mexico
| | - Shyam Thakkar
- Department of Gastroenterology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Carlos Ocampo
- Department of Surgery, Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Bechien U Wu
- Department of Gastroenterology, Kaiser Permanente, Pasadena, California, USA
| | - Gregory A Cote
- Department of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kaleab Abebe
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gong Tang
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ali Lahooti
- Department of Gastroenterology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anna E Phillips
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios I Papachristou
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Gastroenterology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Cárdenas-Jaén K, Vaillo-Rocamora A, Gracia Á, Garg PK, Zapater P, Papachristou GI, Singh VK, Wu BU, de-Madaria E. Simvastatin in the Prevention of Recurrent Pancreatitis: Design and Rationale of a Multicenter Triple-Blind Randomized Controlled Trial, the SIMBA Trial. Front Med (Lausanne) 2021; 7:494. [PMID: 33644082 PMCID: PMC7902790 DOI: 10.3389/fmed.2020.00494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: One in every four patients with a first episode of non-gallstone-related acute pancreatitis (AP) develops recurrent disease. Recurrent episodes of AP or acute flares of chronic pancreatitis (CP) are associated with decreased quality of life and progression of the disease. Besides removing the etiology of pancreatitis (which sometimes is not possible), there are no effective measures to prevent recurrence. Meta-analyses of randomized controlled trials, as well as epidemiological and cohort studies, suggest that statins may be protective against the development of index AP. Methods: The SIMBA study is a triple-blind randomized placebo-controlled, parallel-group multicenter trial. Patients with recurrent AP or with acute flares of CP (at least two episodes in the last 12 months) will be randomized to receive simvastatin 40 mg daily or placebo. During a 3-year study period, 144 patients (72 per arm of treatment) from 26 centers will be enrolled. The patients will receive the study treatment for 1 year. The primary aim is to compare the recurrence of AP or acute flares in CP. Secondary endpoints include the incidence of new-onset diabetes mellitus, new-onset exocrine pancreatic insufficiency (EPI), new-onset imaging signs of CP, frequency of all-cause hospital admissions, severity of AP, adherence to treatment, and frequency of adverse events. Discussion: The SIMBA trial will ascertain whether simvastatin, a safe, widely used and inexpensive drug, can change the natural course of recurrent pancreatitis. Trial Registration: ClinicalTrials.gov Identifier: NCT04021498.
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Affiliation(s)
- Karina Cárdenas-Jaén
- Pancreatic Unit, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Alicia Vaillo-Rocamora
- Pancreatic Unit, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ángel Gracia
- Pharmacy Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pramoud K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pedro Zapater
- Department of Clinical Pharmacology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Bechien U Wu
- Center for Pancreatic Care, Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - Enrique de-Madaria
- Pancreatic Unit, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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37
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Zhen J, Stefanolo JP, Temprano MDLP, Tedesco S, Seiler C, Caminero AF, de-Madaria E, Huguet MM, Vivas S, Niveloni SI, Bercik P, Smecuol E, Uscanga L, Trucco E, Lopez V, Olano C, Mansueto P, Carroccio A, Green PHR, Day A, Tye-Din J, Bai JC, Ciacci C, Verdu EF, Lebwohl B, Pinto-Sanchez MI. The Risk of Contracting COVID-19 Is Not Increased in Patients With Celiac Disease. Clin Gastroenterol Hepatol 2021; 19:391-393. [PMID: 33059041 PMCID: PMC7548761 DOI: 10.1016/j.cgh.2020.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
The World Health Organization declared coronavirus disease-2019 (COVID-19) a global pandemic in March 2020. Since then, there are more than 34 million cases of COVID-19 leading to more than 1 million deaths worldwide. Numerous studies suggest that celiac disease (CeD), a chronic immune-mediated gastrointestinal condition triggered by gluten, is associated with an increased risk of respiratory infections.1-3 However, how it relates to the risk of COVID-19 is unknown. To address this gap, we conducted a cross-sectional study to evaluate whether patients with self-reported CeD are at an increased risk of contracting COVID-19.
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Affiliation(s)
- Jamie Zhen
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Sebastian Tedesco
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Caroline Seiler
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Alberto Fernandez Caminero
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Miguel Montoro Huguet
- Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Hospital Universitario San Jorge, Huesca, Spain
| | | | | | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Luis Uscanga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Trucco
- Universidad de la Republica, Montevideo, Uruguay
| | | | | | | | | | | | - Andrew Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Jason Tye-Din
- Walter and Eliza Hall Institute and University of Melbourne, Melbourne, Australia
| | | | | | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Maria Ines Pinto-Sanchez
- Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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de-Madaria E, Sánchez-Marin C, Carrillo I, Vege SS, Chooklin S, Bilyak A, Mejuto R, Mauriz V, Hegyi P, Márta K, Kamal A, Lauret-Braña E, Barbu ST, Nunes V, Ruiz-Rebollo ML, García-Rayado G, Lozada-Hernandez EE, Pereira J, Negoi I, Espina S, Hollenbach M, Litvin A, Bolado-Concejo F, Vargas RD, Pascual-Moreno I, Singh VK, Mira JJ. Design and validation of a patient-reported outcome measure scale in acute pancreatitis: the PAN-PROMISE study. Gut 2021; 70:139-147. [PMID: 32245906 DOI: 10.1136/gutjnl-2020-320729] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient. DESIGN A PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale. RESULTS PAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test-retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale. CONCLUSION The PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up. TRIAL REGISTRATION NUMBER NCT03650062.
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Affiliation(s)
- Enrique de-Madaria
- Pancreatic Unit, Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Claudia Sánchez-Marin
- Pancreatic Unit, Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Irene Carrillo
- Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Serge Chooklin
- Department of Surgery, Lviv Regional Clinical Hospital, Lviv, Ukraine
| | - Andriy Bilyak
- Department of Surgery, Lviv Regional Clinical Hospital, Lviv, Ukraine
| | - Rafael Mejuto
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Violeta Mauriz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Peter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Ayesha Kamal
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eugenia Lauret-Braña
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sorin T Barbu
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vitor Nunes
- Department of Surgery, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - M Lourdes Ruiz-Rebollo
- Department of Gastroenterology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Guillermo García-Rayado
- Department of Gastroenterology, Lozano Blesa University Clinic Hospital, Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Jorge Pereira
- General Surgery Department 1, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Ionut Negoi
- Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Espina
- Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marcus Hollenbach
- Medical Department II (Gastroenterology, Hepatology, Infectious Diseases, Pulmonology), University of Leipzig Medical Center, Leipzig, Germany
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russian Federation
| | | | - Rómulo D Vargas
- Gastroenterology Department, Hospital Universitario San Ignacio/Universidad Javeriana, Bogota, Colombia
| | - Isabel Pascual-Moreno
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, Spain
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - José J Mira
- Department of Health Psychology, Universidad Miguel Hernández, Elche, Spain.,Hospital Provincial-Pla Health Center, Alicante-Sant Joan Health District, Alicante, Spain
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Abstract
Case reports and retrospective cohort studies have reported an association between acute pancreatitis and COVID-19. As SARS-CoV-2 (the causative agent of COVID-19) receptors are expressed in the pancreas and endothelial damage can occur, this association is plausible. However, this hypothesis has many biases and needs further investigation.
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Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain. .,Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain.
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
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40
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de la Iglesia D, Avci B, Kiriukova M, Panic N, Bozhychko M, Sandru V, de-Madaria E, Capurso G. Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis. United European Gastroenterol J 2020; 8:1115-1125. [PMID: 32631175 PMCID: PMC7724551 DOI: 10.1177/2050640620938987] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic cancer is the fourth leading cause of cancer mortality. Most patients are diagnosed with advanced pancreatic cancer, either at locally advanced or metastatic stages, and have a high rate of malnutrition and weight loss which are associated with poor outcomes. Pancreatic exocrine insufficiency is one of the causes of malnutrition and weight loss in these patients. The prevalence and clinical consequences of pancreatic exocrine insufficiency in advanced pancreatic cancer are poorly investigated with heterogeneous results. We sought to determine the prevalence and clinical consequences of pancreatic exocrine insufficiency and the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer by systematic review and meta-analysis. METHODS Scopus, Medline, and Embase were searched for cohort studies or randomised clinical trials reporting pancreatic exocrine insufficiency and/or the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer. We considered pancreatic exocrine insufficiency as an abnormal result on direct and/or indirect pancreatic exocrine function tests. Pancreatic enzyme replacement therapy was evaluated by its effect on survival and quality of life in patients with advanced pancreatic cancer. RESULTS A total of 11 studies were included; seven studies reported the prevalence of pancreatic exocrine insufficiency and seven the effect of pancreatic enzyme replacement therapy in advanced pancreatic cancer. The pooled prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer was 72% (95% confidence interval: 55-86%), being significantly higher when tumours were located in the pancreatic head (relative risk = 3.36, 1.07-10.54; p = 0.04) six studies investigated the impact of pancreatic enzyme replacement therapy on survival/quality of life. Pancreatic enzyme replacement therapy was associated with 3.8 months (95% confidence interval: 1.37-6.19) survival benefit. Patients receiving pancreatic enzyme replacement therapy had a trend towards a better quality of life.Conclusions The prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer is substantial and its treatment can improve the outcomes of these patients.
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Affiliation(s)
- Daniel de la Iglesia
- Department of Gastroenterology, University Hospital of Santiago
de Compostela, Santiago de Compostela, Spain
| | - Bartu Avci
- Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Mariia Kiriukova
- Department of Upper Gastrointestinal, Pancreatic, and Biliary
Diseases, Moscow Clinical Scientific Center, Moscow, Russia
| | - Nikola Panic
- Digestive Endoscopy Department, University Clinic ‘Dr Dragisa
Misovic-Dedinje’, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade,
Serbia
| | - Maryana Bozhychko
- Gastroenterology Department, Alicante University General
Hospital, Alicante, Spain
| | - Vasile Sandru
- Gastroenterology and Interventional Endoscopy Department,
Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General
Hospital, Alicante, Spain
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS
San Raffaele Scientific Institute, Milan, Italy
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Khan R, Tandon P, Scaffidi MA, Bishay K, Pawlak KM, Kral J, Amin S, Bilal M, Lui RN, Sandhu DS, Hashim A, Bollipo S, Charabaty A, de-Madaria E, Rodríguez-Parra AF, Sánchez-Luna SA, Żorniak M, Siau K, Walsh CM, Grover SC. COVID-19 and Canadian Gastroenterology Trainees. J Can Assoc Gastroenterol 2020; 4:156-162. [PMID: 34056533 PMCID: PMC7665532 DOI: 10.1093/jcag/gwaa034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted endoscopy services and education worldwide. This study aimed to characterize the impact of COVID-19 on gastroenterology trainees in Canada. Methods An analysis of Canadian respondents from the international EndoTrain survey, open from April 11 to May 2 2020 and distributed by program directors, trainees, and national and international gastroenterology societies’ representatives, was completed. The survey included questions on monthly endoscopy volume, personal protective equipment availability, trainee well-being and educational resources. The primary outcome was change in procedural volume during the COVID-19 pandemic. Secondary outcomes included trainee’s professional and personal concerns, anxiety and burnout. Results Thirty-four Canadian trainees completed the survey. Per month, participants completed a median of 30 esophagogastroduodenoscopies (interquartile range 16 to 50) prior to the pandemic compared to 2 (0 to 10) during the pandemic, 20 (8 to 30) compared to 2 (0 to 5) colonoscopies and 3 (1 to 10) compared to 0 (0 to 3) upper gastrointestinal bleeding procedures. There was a significant decrease in procedural volumes between the pre-COVID-19 and COVID-19 time periods for all procedures (P < 0.001). Thirty (88%) trainees were concerned about personal COVID-19 exposure, 32 (94%) were concerned about achieving and/or maintaining clinical competence and 24 (71%) were concerned about prolongation of training time due to the pandemic. Twenty-six (79%) respondents experienced some degree of anxiety, and 10 (31%) experienced some degree of burnout. Conclusion The COVID-19 pandemic has substantially impacted gastroenterology trainees in Canada. As the pandemic eases, it important for gastrointestinal programs to adapt to maximize resident learning, maintain effective clinical care and ensure development of endoscopic competence.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Parul Tandon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kirles Bishay
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katarzyna M Pawlak
- Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Jan Kral
- Institution for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Dalbir S Sandhu
- Division of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Almoutaz Hashim
- Department of Medicine at The University Of Jeddah, Jeddah, Saudi Arabia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aline Charabaty
- Division of Gastroenterology, Johns Hopkins-Sibley Memorial Hospital, Washington, DC
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Andrés F Rodríguez-Parra
- General Hospital Dr. Manuel Gea González, National Autonomous University of Mexico, Mexico City, Mexico
| | - Sergio A Sánchez-Luna
- Division of Gastroenterology and Hepatology, The University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Michał Żorniak
- Department of Gastroenterology, Medical University of Silesia, Katowice, Poland
| | - Keith Siau
- Medical and Dental Sciences, University of Birmingham, Birmingham.,Institute of Translational Medicine, University Hospitals Birmingham, Birmingham
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Kiriukova M, de la Iglesia Garcia D, Panic N, Bozhychko M, Avci B, Maisonneuve P, de-Madaria E, Capurso G, Sandru V. Pancreatic Cancer Malnutrition and Pancreatic Exocrine Insufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer. Front Med (Lausanne) 2020; 7:495. [PMID: 33015088 PMCID: PMC7509408 DOI: 10.3389/fmed.2020.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 11/07/2019] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Malnutrition and cachexia are common in patients with advanced pancreatic ductal adenocarcinoma (PDAC) and have a significant influence on the tolerance and response to treatments. If timely identified, malnourished PDAC patients could be treated to increase their capacity to complete the planned treatments and, therefore, possibly, improve their efficacy. Aims: The aim of this study is to assess the impact of nutritional status, pancreatic exocrine insufficiency (PEI), and other clinical factors on patient outcomes in patients with advanced PDAC. Methods: PAncreatic Cancer MAlnutrition and Pancreatic Exocrine INsufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer (PAC-MAIN) is an international multicenter prospective observational cohort study. The nutritional status will be determined by means of Mini-Nutritional Assessment score and laboratory blood tests. PEI will be defined by reduced fecal elastase levels. Main outcome: adherence to planned chemotherapy in the first 12 weeks following the diagnosis, according to patients' baseline nutritional status and quantified and reported as “percent of standard chemotherapy dose delivered.” Secondary outcomes: rate of chemotherapy-related toxicity, progression-free survival, survival at 6 months, overall survival, quality of life, and the number of hospitalizations. Analysis: chemotherapy dosing over the first 12 weeks of therapy (i.e., percent of chemotherapy received in the first 12 weeks, as defined above) will be compared between well-nourished and malnourished patients. Sample size: based on an expected percentage of chemotherapy delivered of 70% in well-nourished patients, with a type I error of 0.05 and a type II error of 0.20, a sample size of 93 patients per group will be required in case of a percentage difference of chemotherapy delivered of 20% between well-nourished and malnourished patients, 163 patients per group in case of a difference of 15% between the groups, and 356 patients per group in case of a 10% difference. Centers from Russia, Romania, Turkey, Spain, Serbia, and Italy will participate in the study upon Local Ethics Committee approval. Discussion: PAC-MAIN will provide insights into the role of malnutrition and PEI in the outcomes of PDAC. The study protocol was registered at clinicaltrials.gov as NCT04112836.
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Affiliation(s)
- Mariia Kiriukova
- Department of Upper Gastrointestinal, Pancreatic, and Biliary Diseases, Moscow Clinical Scientific Center, Moscow, Russia
| | - Daniel de la Iglesia Garcia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nikola Panic
- Digestive Endoscopy Department, University Clinic "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maryana Bozhychko
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Bartu Avci
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Patrick Maisonneuve
- Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vasile Sandru
- Gastroenterology and Interventional Endoscopy Department, Clinical Emergency Hospital Bucharest, Bucharest, Romania
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Pawlak KM, Kral J, Khan R, Amin S, Bilal M, Lui RN, Sandhu DS, Hashim A, Bollipo S, Charabaty A, de-Madaria E, Rodríguez-Parra AF, Sánchez-Luna SA, Żorniak M, Walsh CM, Grover SC, Siau K. Impact of COVID-19 on endoscopy trainees: an international survey. Gastrointest Endosc 2020; 92:925-935. [PMID: 32535193 PMCID: PMC7287420 DOI: 10.1016/j.gie.2020.06.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Although coronavirus disease 2019 (COVID-19) has affected endoscopy services globally, the impact on trainees has not been evaluated. We aimed to assess the impact of COVID-19 on procedural volumes and on the emotional well-being of endoscopy trainees worldwide. METHODS An international survey was disseminated over a 3-week period in April 2020. The primary outcome was the percentage reduction in monthly procedure volume before and during COVID-19. Secondary outcomes included potential variation of COVID-19 impact between different continents and rates and predictors of anxiety and burnout among trainees. RESULTS Across 770 trainees from 63 countries, 93.8% reported a reduction in endoscopy case volume. The median percentage reduction in total procedures was 99% (interquartile range, 85%-100%), which varied internationally (P < .001) and was greatest for colonoscopy procedures. Restrictions in case volume and trainee activity were common barriers. A total of 71.9% were concerned that the COVID-19 pandemic could prolonged training. Anxiety was reported in 52.4% of respondents and burnout in 18.8%. Anxiety was independently associated with female gender (odds ratio [OR], 2.15; P < .001), adequacy of personal protective equipment (OR, 1.75; P = .005), lack of institutional support for emotional health (OR, 1.67; P = .008), and concerns regarding prolongation of training (OR, 1.60; P = .013). Modifying existing national guidelines to support adequate endoscopy training during the pandemic was supported by 68.9%. CONCLUSIONS The COVID-19 pandemic has led to restrictions in endoscopic volumes and endoscopy training, with high rates of anxiety and burnout among endoscopy trainees worldwide. Targeted measures by training programs to address these key issues are warranted to improve trainee well-being and support trainee education.
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Affiliation(s)
- Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Jan Kral
- Hepatogastroenterology Department, Institution for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Dalbir S Sandhu
- Case Western Reserve University, Division of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Steven Bollipo
- Gastroenterology & Endoscopy, John Hunter Hospital, Newcastle, Australia; University of Newcastle, Australia
| | - Aline Charabaty
- Division of Gastroenterology, Johns Hopkins School of Medicine, Johns Hopkins-Sibley Memorial Hospital, Washington DC, USA
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Andrés F Rodríguez-Parra
- General Hospital Dr. Manuel Gea González, National Autonomous University of Mexico, Mexico City, Mexico
| | - Sergio A Sánchez-Luna
- Division of Gastroenterology and Hepatology, The University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Michał Żorniak
- Department of Gastroenterology, Medical University of Silesia, Katowice, Poland and Department of Medicine II, Ludwig-Maximillian's Univeristy, Munich, Germany
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Keith Siau
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham, Birmingham, UK
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Bolado F, Buxbaum JL, Vaillo-Rocamora A, Cárdenas-Jaén K, Maisonneuve P, de-Madaria E. Early Weight-Based Aggressive vs. Non-Aggressive Goal-Directed Fluid Resuscitation in the Early Phase of Acute Pancreatitis: An Open-Label Multicenter Randomized Controlled Trial (The WATERFALL Trial), Design, and Rationale. Front Med (Lausanne) 2020; 7:440. [PMID: 32984361 PMCID: PMC7492535 DOI: 10.3389/fmed.2020.00440] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Treatment options are limited for acute pancreatitis (AP). Early aggressive fluid resuscitation (AFR) has been widely considered beneficial because of theoretical improvement in end-organ perfusion, including the pancreas and gut, with pancreatic necrosis and bacterial translocation as consequences of ischemia. There is scarce direct evidence for its association to improved outcomes. Furthermore, it has been described that AFR may be associated with poor outcomes in severe AP. WATERFALL is an investigator-initiated international multicenter open-label randomized controlled trial comparing AFR vs. moderate fluid resuscitation (MFR) in AP. The main outcome variable will be the incidence of moderate to severe AP (a clinically relevant outcome that has been validated). Aggressive fluid resuscitation will consist in lactated Ringer solution (LR) 20-mL/kg bolus (administered over 2 h) followed by LR 3 mL/kg per hour. Patients randomized to MFR will receive an LR bolus 10 mL/kg in case of hypovolemia or no bolus in patients with normal volemia, followed by LR 1.5 mL/kg per hour. The patients will be assessed at 3 (±1), 12 (±4), 24 (±4), 48 (±4), and 72 (±4) h from recruitment, and fluid resuscitation will be adjusted to the patient's clinical and analytical status according to a protocol. Based on a prospective multicenter study, the incidence of moderate to severe AP is 35%. Sample sizes of 372 patients per group (overall 744) achieve 80% power to detect a difference in the incidence of moderate to severe AP of 10%, at a significance level (α) of 0.05 using a two-sided z-test, assuming a 10% dropout rate. These results assume that three sequential tests are made using the O'Brien-Fleming spending function to determine the test boundaries.
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Affiliation(s)
- Federico Bolado
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Alicia Vaillo-Rocamora
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO-Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Martínez-Moneo E, Cárdenas-Jaén K, Fernández-Laso AB, Millastre-Bocos J, Torralba-Gallego A, Martín-Arriero S, Alfaro-Almajano E, García-Rayado G, de-Madaria E. Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreatology 2020; 20:801-805. [PMID: 32448748 DOI: 10.1016/j.pan.2020.05.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Statin consumption seems to lower the incidence of acute pancreatitis. We aimed to investigate the relationship between the use of statins and the incidence of PEP. METHODS multicenter (4 Spanish tertiary-level public hospitals) retrospective cohort study. Adult patients undergoing an ERCP were included in the study. We excluded patients with chronic pancreatitis, with ongoing acute pancreatitis and those who developed other complications after ERCP. Patients were classified into 2 groups: those under statin treatment (group S) and controls (group C). A multivariate analysis was performed (binary logistic regression) including age, center, female gender, previous pancreatitis, suspected sphincter of Oddi dysfunction, difficult cannulation (>10 min), >1 pancreatic guidewire passages, pancreatic injection, pancreatic stenting and presence of choledocholitiasis. RESULTS seven hundred and two patients were included, median age 74 (62-82 years), 330 (47%) females, 223 (32%) in group S. Thirty-five (5%) patients developed PEP, 6 (3%) in group S and 29 (6%) in group C. Statin use was not associated with a lower frequency of PEP in univariate analysis, OR 0.429 (95% confidence interval 0.176-1.05, p = 0.06) or in multivariate analysis, adjusted OR 0.5 (0.19-1.32), p = 0.16. Statin use had no effect on severity of PEP, being mild in 50% vs 78.6% in non-statin users, p = 0.306. CONCLUSIONS the chronic use of statins was not associated with a decreased risk of PEP or a milder course of disease in our sample of patients.
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Affiliation(s)
- Emma Martínez-Moneo
- Gastroenterology Department, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Judith Millastre-Bocos
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | | | | | - Enrique Alfaro-Almajano
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | - Guillermo García-Rayado
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
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Löhr JM, Beuers U, Vujasinovic M, Alvaro D, Frøkjær JB, Buttgereit F, Capurso G, Culver EL, de-Madaria E, Della-Torre E, Detlefsen S, Dominguez-Muñoz E, Czubkowski P, Ewald N, Frulloni L, Gubergrits N, Duman DG, Hackert T, Iglesias-Garcia J, Kartalis N, Laghi A, Lammert F, Lindgren F, Okhlobystin A, Oracz G, Parniczky A, Mucelli RMP, Rebours V, Rosendahl J, Schleinitz N, Schneider A, van Bommel EF, Verbeke CS, Vullierme MP, Witt H. European Guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations. United European Gastroenterol J 2020; 8:637-666. [PMID: 32552502 DOI: 10.1177/2050640620934911] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6-0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2-4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added.
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Affiliation(s)
- J-Matthias Löhr
- Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden and Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Miroslav Vujasinovic
- Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden and Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Gabriele Capurso
- PancreatoBiliary Endoscopy and EUS Division Pancreas Translational and Clinical Research Center IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emma L Culver
- Translational Gastroenterology Unit, John Radcliffe Hospital and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Emanuel Della-Torre
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Disease (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sönke Detlefsen
- Department of Pathology, Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
| | - Enrique Dominguez-Muñoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Nils Ewald
- Institute of Endocrinology, Diabetology and Metabolism, Johannes Wesling University hospital, Minden, Germany and Justus Liebig University Giessen, Giessen, Germany
| | - Luca Frulloni
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
| | - Natalya Gubergrits
- Department of Internal Medicine, Donetsk National Medical University, Lyman, Ukraine
| | - Deniz Guney Duman
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nikolaos Kartalis
- Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Fredrik Lindgren
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | | | - Grzegorz Oracz
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Andrea Parniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Heim Pál National Insitute of Pediatrics, Budapest, Hungary
| | | | - Vinciane Rebours
- Pancreatology Department, Beaujon Hospital, Clichy, Université de Paris, France
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle, Germany
| | - Nicolas Schleinitz
- Département de Médicine Interne Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Alexander Schneider
- Department of Gastroenterology and Hepatology, Klinikum Bad Hersfeld, Bad Hersfeld, Germany
| | - Eric Fh van Bommel
- Department of Internal Medicine, Dutch National Center of Expertise Retroperitoneal Fibrosis, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | | | | | - Heiko Witt
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Paediatric Nutritional Medicine, Technische Universität München, Freising, Germany
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- See list at the end of this article
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Hegyi P, Párniczky A, Lerch MM, Sheel ARG, Rebours V, Forsmark CE, Del Chiaro M, Rosendahl J, de-Madaria E, Szücs Á, Takaori K, Yadav D, Gheorghe C, Rakonczay Z, Molero X, Inui K, Masamune A, Fernandez-Del Castillo C, Shimosegawa T, Neoptolemos JP, Whitcomb DC, Sahin-Tóth M. International Consensus Guidelines for Risk Factors in Chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20:579-585. [PMID: 32376198 DOI: 10.1016/j.pan.2020.03.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 12/20/2019] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic pancreatitis (CP) is a complex inflammatory disease with remarkably impaired quality of life and permanent damage of the pancreas. This paper is part of the international consensus guidelines on CP and presents the consensus on factors elevating the risk for CP. METHODS An international working group with 20 experts on CP from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 14 statements generated from evidence on four questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available per statement. To determine the level of agreement, the working group voted on the 14 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS Strong consensus and agreement were obtained for the following statements: Alcohol, smoking, and certain genetic alterations are risk factors for CP. Past history, family history, onset of symptoms, and life-style factors including alcohol intake and smoking history should be determined. Alcohol consumption dose-dependently elevates the risk of CP up to 4-fold. Ever smokers, even smoking less than a pack of cigarettes per day, have an increased risk for CP, as compared to never smokers. CONCLUSIONS Both genetic and environmental factors can markedly elevate the risk for CP. Therefore, health-promoting lifestyle education and in certain cases genetic counselling should be employed to reduce the incidence of CP.
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Affiliation(s)
- Péter Hegyi
- Institute for Translational Medicine & Department of Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary; MTA-SZTE Momentum Translational Gastroenterology Research Group, Faculty of Medicine, University of Szeged, Szeged, Hungary; First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Andrea Párniczky
- Institute for Translational Medicine & Department of Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Markus M Lerch
- Department of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andrea R G Sheel
- Department of Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Vinciane Rebours
- Pancreatology Unit, Beaujon Hospital, APHP, Paris, Université de Paris, Paris-Diderot, France
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery - University of Colorado Anschutz Medical Campus, Denver, USA
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle, Germany
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ákos Szücs
- First Department of Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cristian Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Zoltán Rakonczay
- Department of Pathophysiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Xavier Molero
- Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron - Institut de Recerca, Autonomous University of Barcelona, CIBEREHD, Barcelona, Spain
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Tooru Shimosegawa
- Department of Gastroenterology, South Miyagi Medical Center, Ohgawara, Miyagi, Japan
| | - John P Neoptolemos
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Miklós Sahin-Tóth
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
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Ausania F, Senra Del Río P, Borin A, Guzmán Suárez S, Rivera Irigoin R, Fort Martorell E, Concepción-Martín M, Del Val Antoñana A, Ferrández A, Grau García FJ, Ruiz Rebollo ML, Andreu EB, de-Madaria E. Factors associated with mortality in patients with infected pancreatic necrosis: the "surgery effect". Updates Surg 2020; 72:1097-1103. [PMID: 32306274 DOI: 10.1007/s13304-020-00764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/10/2020] [Indexed: 11/26/2022]
Abstract
Severe acute pancreatitis complicated by infection is associated with high mortality. Invasive treatment is indicated in the presence of infected (suspected) pancreatic and/or peripancreatic necrosis (IPN) in the absence of response to intensive medical support. Step-up approach (SUA) has been demonstrated to lower complication rate compared to upfront open surgery. However, this approach has not been associated with lower mortality, and no factors have been studied that could help to identify the high risk patients. In this study, we aimed to analyse those factors associated with mortality following the invasive treatment of IPN, focusing on the role of surgical necrosectomy. A retrospective and observational study based on a multicentre prospective database was conducted. The database was coordinated by the Hospital General Universitario de Alicante, Spain and the Spanish Association of Pancreatology. Demographics, clinical data, and laboratory and imaging findings were collected. Atlanta 2012 criteria were considered to classify acute necrotizing pancreatitis and for the definition of IPN. Step-up approach was used in all centres with the intention of avoiding surgery whenever possible. Surgical necrosectomy was performed by open approach. From January 2013 to October 2014, a total of 1655 patients with the diagnosis of acute pancreatitis were included in our database. 1081 were recruited for the final analysis. Out of them, 205 (19%) were classified into acute necrotizing pancreatitis. 77 (8.3%) patients underwent invasive treatment of INP and were included in our study. Overall mortality was 29.9%. Upfront endoscopic or percutaneous drainage was performed in 60 (77.9%) patients and mortality was 26.6%. Out of 60, 22 (36.6%) patients subsequently received rescue surgery; mortality in rescue surgery group was 18.3%. Upfront surgery was carried out in 17 (22.1%) patients; mortality in this group was 41%. At univariate analysis, surgical necrosectomy, extrapancreatic infection, immunosuppression and de-novo haemodialysis were associated with mortality. At multivariate analysis, only surgical necrosectomy was significantly associated with mortality (p = 0.002 OR 3.89). Surgical approach for IPN is associated with high mortality rate. However, these data should be interpreted with caution, since we are not able to assess whether this occurs due to the need of surgery as the only resort when the other approaches are not feasible or fail.
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Affiliation(s)
| | | | - Alex Borin
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
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García-Rayado G, Varela-Moreiras G, Lanas Á, Ferrández Á, Balza-Lareu N, Cervera JI, Bodenlle-Bello MP, Argüelles-Arias AM, Latorre P, Udaondo-Cascante MA, Soria-de-la-Cruz MJ, Lariño-Noia J, García-Figueiras R, Gil-García-Ollauri C, Ituarte-Uriarte R, Rosales-Alexander CL, Soriano J, Rodríguez-Peláez M, Mesa-Álvarez A, Oblitas E, Menso MM, Bertoletti F, Rodríguez-Prada JI, Guzmán-Suárez S, Closa D, de-Madaria E. Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain. Front Med (Lausanne) 2020; 7:126. [PMID: 32328495 PMCID: PMC7160296 DOI: 10.3389/fmed.2020.00126] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background/Objective: Evidence from basic and clinical studies suggests that unsaturated fatty acids (UFAs) might be relevant mediators of the development of complications in acute pancreatitis (AP). Objective: The aim of this study was to analyze outcomes in patients with AP from regions in Spain with different patterns of dietary fat intake. Materials and Methods: A retrospective analysis was performed with data from 1,655 patients with AP from a Spanish prospective cohort study and regional nutritional data from a Spanish cross-sectional study. Nutritional data considered in the study concern the total lipid consumption, detailing total saturated fatty acids, UFAs and monounsaturated fatty acids (MUFAs) consumption derived from regional data and not from the patient prospective cohort. Two multivariable analysis models were used: (1) a model with the Charlson comorbidity index, sex, alcoholic etiology, and recurrent AP; (2) a model that included these variables plus obesity. Results: In multivariable analysis, patients from regions with high UFA intake had a significantly increased frequency of local complications, persistent organ failure (POF), mortality, and moderate-to-severe disease in the model without obesity and a higher frequency of POF in the model with obesity. Patients from regions with high MUFA intake had significantly more local complications and moderate-to-severe disease; this significance remained for moderate-to-severe disease when obesity was added to the model. Conclusions: Differences in dietary fat patterns could be associated with different outcomes in AP, and dietary fat patterns may be a pre-morbid factor that determines the severity of AP. UFAs, and particulary MUFAs, may influence the pathogenesis of the severity of AP.
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Affiliation(s)
- Guillermo García-Rayado
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | | | - Ángel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | - Ángel Ferrández
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | | | - Juan I Cervera
- Department of Radiology, Hospital Clínico Universitario, Valencia, Spain
| | | | | | - Patricia Latorre
- Department of Gastroenterology, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | | | - José Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto García-Figueiras
- Department of Radiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Jordi Soriano
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - María Rodríguez-Peláez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Elida Oblitas
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María M Menso
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Bertoletti
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Daniel Closa
- Department of Experimental Pathology, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC-IDIBAPS), Barcelona, Spain
| | - Enrique de-Madaria
- Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
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Pothoulakis I, Paragomi P, Archibugi L, Tuft M, Talukdar R, Kochhar R, Goenka MK, Gulla A, Singh VK, Gonzalez JA, Ferreira M, Barbu ST, Stevens T, Nawaz H, Gutierrez SC, Zarnescu NO, Easler J, Triantafyllou K, Pelaez-Luna M, Thakkar S, Ocampo C, de-Madaria E, Wu BU, Cote GA, Tang G, Papachristou GI, Capurso G. Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium). Pancreatology 2020; 20:325-330. [PMID: 32107193 DOI: 10.1016/j.pan.2020.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 10/20/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are not well-established. OBJECTIVE To evaluate the clinical characteristics of HTG-AP in an international, multicenter prospective cohort. METHODS Data collection was conducted prospectively through APPRENTICE between 2015 and 2018. HTG-AP was defined as serum TG levels >500 mg/dl in the absence of other common etiologies of AP. Three multivariate logistic regression models were performed to assess whether HTG-AP is associated with SIRS positive status, ICU admission and/or moderately-severe/severe AP. RESULTS 1,478 patients were included in the study; 69 subjects (4.7%) were diagnosed with HTG-AP. HTG-AP patients were more likely to be younger (mean 40 vs 50 years; p < 0.001), male (67% vs 52%; p = 0.018), and with a higher BMI (mean 30.4 vs 27.5 kg/m2; p = 0.0002). HTG-AP subjects reported more frequent active alcohol use (71% vs 49%; p < 0.001), and diabetes mellitus (59% vs 15%; p < 0.001). None of the above risk factors/variables was found to be independently associated with SIRS positive status, ICU admission, or severity in the multivariate logistic regression models. These results were similar when including only the 785 subjects with TG levels measured within 48 h from admission. CONCLUSION HTG-AP was found to be the 4th most common etiology of AP. HTG-AP patients had distinct baseline characteristics, but their clinical outcomes were similar compared to other etiologies of AP.
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Affiliation(s)
- Ioannis Pothoulakis
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Pedram Paragomi
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant Andrea Hospital, Rome, Italy
| | - Marie Tuft
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aiste Gulla
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | | | - Sorin T Barbu
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | | | - Haq Nawaz
- Eastern Maine Medical Center, Maine, Bangor, USA
| | | | | | - Jeffrey Easler
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Mario Pelaez-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
| | | | - Carlos Ocampo
- Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Enrique de-Madaria
- Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain
| | | | - Gregory A Cote
- Medical University of South Carolina, Charleston, SC, USA
| | - Gong Tang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Georgios I Papachristou
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant Andrea Hospital, Rome, Italy
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